Veterinary Referral Services
This section is for your information about the referral services at Animal Hospital of Rowlett and Diagnostic Center.
We are here to help you provide your patients the diagnostic services that can only add to your medical work up. Clients perceive these referral services as necessary for the care of their pets. The standard of care in small animal medicine is changing dramatically. Veterinarians should never be guilty of not offering the best diagnostic work up to their clients. Our added diagnostic services can provide important medical information, complimenting your medical knowledge.
Echocardiology & Thoracic ultrasound - We provide complete cardiac and thoracic ultrasound services. This includes Doppler interrogation of vascular/valvular problems. A complete written report of the 2-D and m-mode measurements with interpretation is provided to the referring veterinarian. Ultrasound guided pericardiocentesis and lung or mediastinal mass fine needle aspiration is routinely performed.
Abdominal Ultrasound - We provide any abdominal ultrasound service you may require. Adrenal and pancreatic scans are routinely performed. Fine needle aspiration guided by ultrasound of any mass or organ is easily and quickly performed. Stomach and intestinal ultrasound has all but replaced barium swallow and radiographs (motility studies excluded). Intussusceptions are readily detected with ultrasound. GI tract neoplasia is often diagnosed with fine needle aspiration. Porto-systemic shunts can be recognized with ultrasound. We can perform 18 gauge core biopsies if the case dictates the need.
We have used a particular cytopathologist for our interpretation of cytology samples for 7 years. However, we will be happy to send the samples back to you for your pathologist of choice to interpret.
Ocular sonograms - ultrasound is very effective to diagnose detached retinas, luxated lenses, intraocular masses / retrobulbar neoplasia or abscesses.
Clinical indications for you using this diagnostic tool (not totally inclusive):
- Any type of heart disease: Echocardiograms will stage the severity of the heart condition which dictates the needed therapy and establishes a prognosis. True myocardial function in dogs with mitral valvular disease can be obtained with the end systolic volume index. Again, appropriate information will dictate proper therapy! Early diagnosis of dilated cardiomyopathy in Dobermans is essential. Once you suspect it or have noticed 1 VPC (yes even 1)on a ECG, the next step is an echocardiogram. All cats with hyperthyroidism should be screened for hypertrophic myocardial disease. We also include blood pressure measurements with any cardiac or endocrine case. Thoracic ultrasound is important in lung masses, pleural effusions, mediastinal diseases.
- Hepatic disease: This is very important! You can not treat liver disease correctly based upon only enzyme values!!! We recommend that pre and post bile acids be performed and if abnormal values are noted then this certainly dictates the need for hepatic ultrasound and biopsy. Evaluation of the gal bladder and bile ducts along with other abdominal concerns is important in every case! Pancreatitis is the most common cause of obstructive biliary tract disease (increasing total bilirubin levels). In cats the severity of hepatic lipidosis is important to know for appropriately aggressive therapy. The cholangiohepatitis complex of cats can be a frustrating disease to treat if you do not have the specific diagnosis.
- Renal and Bladder disease: Ultrasound and fine needle aspirations of the kidneys are needed to truly diagnose acute renal failure. This will allow a more specific treatment plan. Ruling out concerns like amyloidosis and pyelonephritis is also a benefit of needle aspirates and cultures of urine directly from the renal pelvis. Bladder ultrasound is important in evaluating the lining and neck of bladder for masses or calculi.
- Adrenal disease: Visualization of the adrenals is important when diagnosing hyperadrenocorticism.This is the most specific way to rule out adrenal tumors.
- Pancreas: Ultrasound examination is the most specific and quickest way to diagnose pancreatitis (the TLI has a long turn around time). You cannot diagnose pancreatitis based upon an elevated lipase and/or amylase (they are only suggestive at best). Ultrasound allows the visualization of the pancreatic tissue and surrounding areas - looking for abdominal ascites, pancreatic calcifications and dilated pancreaticoduodenal vein along with the sonographic parenchymal changes of the pancreas. We can also rule out pancreatic cysts and abscesses.
- Spleen: Enlarged spleens are often encountered in geriatric patients. The sonogram allows examination for masses, cysts, enlargement and parenchymal changes. Benign splenic nodular hyperplasia is a common occurrence in small animals and can easily be confused with cancer. Fine needle biopsies are extremely important to rule out neoplasia, septic splenitis and other causes of splenomegaly.
- Gastrointestinal: Many gastric and intestinal masses or tumors can be visualized and have a biopsy taken for appropriate diagnosis. Intusussceptions are readily diagnosed with ultrasound. Evaluation of intestinal lymph nodes is easily done with ultrasound.
- Reproductive Organs: Uterine, ovarian, prostatic and testicular masses and/or enlargement is easily noted. Many times prostatic enlargement needs ultrasound evaluation for biopsy. This helps rule out cysts, abscesses and neoplasia, each having very different treatments and prognosis for recovery.
Video and Fiberoptic Endoscopy Services
We utilize video-endoscopy in the majority of our referral procedures. This allows us to send COLOR pictures of the procedure back to the referring veterinarian. We can document lesions and problems for your records and for future reference when monitoring progression of disease.
Clinical applications of endoscopy: examples
- EGD (esophagogastroduodenoscopy) - this procedure evaluates the esophagus, stomach and duodenum into the jejunum. We obtain multiple biopsies of the mucosal surfaces. Any dog or cat with chronic vomiting or diarrhea is a potential candidate after the initial blood work, urinalysis and appropriate radiographs. Inflammatory bowel disease is very common in middle and older age patients.
- Colonoscopy - This procedure is often done in combination with EGD for chronic weight loss and soft, mucoid stools. Hematochezia and tenesmus are primary indications for colonoscopy after ruling our parasites (whipworms). Multiple biopsies are always obtained. Colonic polyps, neoplasia and fungal diseases are easily diagnosed with this procedure.
- Bronchoscopy - any chronic bronchitis or chronic coughing patient is a candidate for bronchoscopy. We evaluate the primary and secondary bronchii as far down as possible. We will take brush cytology samples and perform broncho-alveolar lavage (BAL) on almost all cases. This fluid is submitted for cytopathology and culture.
- Rhinoscopy - patients with unilateral or chronic bilateral discharge need further evaluation than just radiographs. We can examine the nasal and pharyngeal areas with the smaller endoscopes. Obtain biopsies when indicated and perform brush cytology . Neoplasia and fungal diseases are likely ruleouts for these patients.
- Cystoscopy - we have the ability to evaluate larger canine patients with flexible endoscopy for examining the urethra and bladder. Ectopic ureters can be ruled out in young animals. Biopsies are obtained of the bladder wall.
- Percutaneous gastrotomy tubes - PEG tubes can be placed in cats and dogs for long term nutritional support. Feline hepatic lipidosis, cancer therapy or any problem with anorexia may benefit from a PEG tube for proper nutritional support.
- Balloon dilitation of esophageal strictures - we have the proper equipment for dilitation of esophageal strictures in cats and dogs. Reflux esophagitis (usually associated with surgery) will cause scarring of the lower esophageal tissue and then 10-14 days later the animal regurgitates food. Surgery is NOT appropriate in these cases. The best response is with multiple balloon dilitation procedures along with metoclopramide, H-2 blocker and prednisolone (for inhibition of scarring after treatment).
CO2 Laser for treatments and surgical use. Laser is very exact and safe way to treat many small animal problems. Lasers are used extensively in human dermatology, surgery, ophthalmology and dentistry.
Laser has the power to incise, excise and ablate. The benefits to the patient are: little or no bleeding, shorter procedures, minimal edema and scarring, reduced need for anesthesia, more comfortable healing course, reduced or eliminated need for sutures, overall increased surgical acceptance and decreased morbidity.
Owners are well aware of laser surgery in the human field. We can offer the same quality and comfort for their pet with laser treatment and surgery.
Examples of CO2 Laser uses in small animal veterinary medicine and surgery:
- Extremely effective in upper respiratory surgery. Soft palate resection performed with no crushing of tissue and no sutures. Next to no post-operative swelling and the patients go home the same day!! Removal of everted saccules is also done quickly and effectively. Most veterinarians would rather have healthy long term patients like English bull dogs, Shar peis, Boston terriers, Chinese pugs, etc., than emergency respiratory cases that are problematic and often die. No more snoring or snorting at home.
- Vaccine induced fibrosarcomas - Laser surgery and chemotherapy - No radiation therapy has been used in these cases. The cost of treatment is much more in line for many owners. When aggressive surgical debridement is utilized, the surgical field is then treated (sterilized) with the laser to kill remaining cancerous cells, then closed routinely. Chemotherapy is utilized along with surgery. This protocol has had excellent results with no recurrences to date. Final analysis of the data will be available later this year.
- Used for squamous cell carcinomas - debulking the ear and nasal neoplasia.
- Dental uses - oral neoplasia and lingual neoplasia. Due to the rapid healing and minimal post-operative swelling the animals recover very quickly.
- Dermatology - any surface skin tumor can easily be excised with mild sedation and or local infiltration of anesthetic. Laser therapy of lick granulomas has been very rewarding, allowing the tissue to heal while eliminating the nerve endings that cause the persistent stimulation to the animal. Multiple skin hemangiomas, papillomas, etc can be removed. Minimal post-op pain and edema compared to other methods is noted, and no sutures are needed in most cases.
- The ability to remove one cell layer at a time is important when removing neoplasia and fibrotic masses. This allows delicate dissection of tissue for saving nerves and blood vessels encountered in infiltrative disease cases.
In short, the uses for laser assisted surgery are numerous and expanding every day. We want to share this advancement with our colleagues and help you provide your patients with truly state of the art procedures and technology. Referral cases are treated for the presenting cause and sent back to their veterinarian for follow-up and medications.
Magnetic Resonance Imaging and the Small Animal Practitioner
We want to inform you of an exciting diagnostic tool available to the area veterinarians through the Animal Hospital of Rowlett and Diagnostic Center. In conjunction with Dr. Brian Poteet, ACVR, we have formed a working relationship with an MRI facility, allowing the veterinary community to have access to this state of the art technology.
Your next question might be, "Why do I need to consider MRI for my patients?". Below are listed a few examples of an MRI vs. CT or radiographs. The first thing you need to know is that a computerized tomography(CT) scan is actually a number of radiographs grouped together by a computer to give a more detailed picture. CT scan is the superior technique if your goal is to look at bone or hard tissues. CT will show up soft tissue like a radiograph , BUT the MRI detail of soft tissue is far superior.
The areas where MRI scans are far more valuable are in evaluating the brain, spinal canal or nerve root tumors and disc herniations we see in dogs/cats. Human medicine (and veterinary medicine) also uses MRI to evaluate joints for meniscal damage, ligament damage, tendon strains, etc.(joints are just soft tissue with bones). For the brain MRI is far superior to CT. Lesions that can be identified on MRI images include inflammation, structural abnormalitites, hemorrhage, infarction and neoplasia. CT may show the asymmetry present but not the tumor detail. CT cannot differentiate the tissue fluid differences like MRI can. This becomes very important when you want to differentiate actual tumor plus peritumoral edema in the normal surrounding tissues. A tumor could be made to look much larger on CT or the opposite, much smaller depending upon location, tumor type and fluid accumulation. The MRI is the "best" diagnostic tool for spinal and nerve root tumors. Myelograms show some detail but nothing compares to MRI for spinal disease such as disk herniation and neoplasia. Myelograms cannot diagnose most nerve root tumors since most have not started compressing the cord and may even be outside the spinal canal. On MRI you can see the extent of involvement and do a great job of prognosis. There is a specific contrast agent (gadalinium) that is used for detecting and highlighting neoplasia/inflammatory tissue for MRI evaluation, it is routinely utilized in most scan procedures.
Special anesthesia protocols are used for these procedures. Primarily pre-op with valium and butorphanol then propofol and oxygen(+/- isoflurane). There can be no metal based items in the scanning room! Most scans will take about 30-60 minutes.
MRI interpretation will be performed by Dr. Brian Poteet, ACVR. He is very experienced with MRI interpretation in small animals. The information will be digitized and sent via modem to Dr. Poteet for interpretation, results should be available to you within 12-24 hours.
Diagnostic Uses of MRI in small animal medicine:
- Seizures - to help rule out neoplasia vs. GME or other inflammatory problems . Remember that "epilepsy" is primarily a young animal problem (<5 years). In dogs over 5 years of age, we must rule out other causes of seizures. Very young pets may have hydrocephalous causing seizures or stuporous activity.
- Chronic cervical pain - inflammatory disease of the meninges vs. disc herniation is a primary rule out.
- Upper motor vs. lower motor neuron diseases- neoplasia of spinal canal vs. nerve root tumor vs. disc herniation.
- Lumbosacral instability - especially in the older large breed dogs that you assume to be hip osteoarthritis.
- Trauma - To evaluate intra-cranial hemorrhage or trauma, MRI is extremely helpful.
- Stroke or thromboembolism(brain infarction) - Yes, it does occur in older pets. MRI of the brain will help differentiate these changes.
- Pituitary based tumor - previously controlled Cushing's patient that now has worsening clinical signs with stupor/seizures. We can evaluate these masses and recommend radiation therapy to palliate the clinical signs. (see images below)
- Ocular and orbital diseases - inflammatory vs neoplasia.
- Head and nasal neoplasia - determining the extent of involvement (into or through cribiform plate) will be a direct correlation with prognosis and recommended therapy in nasal neoplasia. Differentiating size and location of brain masses(tumor vs. edematous tissue) will help determine whom may be surgical candidates.
- Neoplasia of soft tissues - fibrosarcoma, etc. MRI with contrast agents gives exquisite detail regarding tumor invasion into surrounding structures.
MRI technology has many uses in all organ systems. Clients who want the best for their pets will not hesitate to authorize MRI scans. Especially, in cases of neoplasia, where the contrast agent lights up the masses and differentiates fluid densities. This is of great benefit for the surgeons as well as prognostic information. We should offer this technology to any clinical situation that would benefit and let the CLIENTS make the monetary call.