Veterinary Medicine Specialists

Internal Medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases. The types of diseases seen by internal medicine are wide and varied and include diseases of different organ systems for example: kidneys (nephrology), liver (hepatology), lungs (pulmonology), blood system (haematology), central nervous system (neurology) and immune-system (immunology) as well as diseases that may affected multiple body systems at the same time, such as infectious disease or cancer.

Many animals don’t present with signs obviously relating to a specific body system or disease like vomiting, diarrhoea, coughing, excessive drinking, malaise, weight loss/weight gain, anaemia and fever. Sometimes, if a case is found to have a non-medical disease, and, for example, needs surgery or cancer treatment, they can easily be referred to another service within Perth Veterinary Specialists for ongoing treatment.

Positions available:

1. Rotating internship in Internal Medicine, Emergency and Medical Oncology, 1 year fixed term position, commencing  each January.

The intern positions are offered each year and open to all veterinarians. Students expecting to graduate at the completion of the calendar year are encouraged to apply. Applications close in September each year.

2. Small Animal Medicine Residency

Our Medicine department is offering a Residency to start early 2017. The ideal applicant will have already shown interest in Specialising in Internal Medicine and MUST have completed an Internship, or Membership to the Australian New Zealand College of Veterinary Scientists, or both. Perth Veterinary Specialists is a multi-department hospital including Internal Medicine, Oncology, Surgery, Dermatology and Radiology, (with registered Specialists in each of these departments) plus with full after hours’ emergency and critical care. You would be supervised by an Australian-qualified specialist with support from a European trained Registrar, and expected to follow a path to sitting Fellowship of the Australian New Zealand College of Veterinary Scientists in Small Animal Medicine in 2021-2022. You would be supported by an intern and 3 nurses. Equipment at your disposal includes new Olympus endoscopes with Narrow Band Imaging on an Evis Exera II platform, plus onsite CT, MRI, and heaps of other gear. With 1500m2 of space and supportive team-players to work with, PVS is a great place to enjoy your work. Applications will close 30 September 2016. Queries concerning the position and applications (including a cover letter and CV) should be sent to: Dr Ken Wyatt BSc BVMS FANZCVS, kwyatt@perthvetspecialists.com.au Perth Veterinary Specialists 305 Selby Street North Osborne Park Western Australia 6017 www.perthvetspecialists.com.au  

What is Internal Medicine?

Internal Medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or complicated diseases. The types of diseases seen by internal medicine are wide and varied and include diseases of different organ systems for example: kidneys (nephrology), liver (hepatology), lungs (pulmonology), blood system (haematology), central nervous system (neurology) and immune-system (immunology) as well as diseases that may affected multiple body systems at the same time, such as infectious disease or cancer.

Many animals show signs like vomiting, diarrhoea, coughing, excessive drinking, malaise, weight loss/weight gain, anaemia and fever that don’t obviously relate to a specific body system or disease. Sometimes, if a case is found to have a non-medical disease, and, for example, needs surgery or cancer treatment, it may be transferred to another service within Perth Veterinary Specialists for ongoing treatment.

Thoracocentesis

Thoracocentesis is essential for the diagnosis and management of animals with pleural effusions (fluid surrounding the lungs). Chest drain placement is used commonly in the management of conditions such as pyothorax (pus around the lungs).

Treatment of fungal nasal disease

Fungal disease of the nasal cavity, often due to Aspergillus and Cryptococcus species, is common in WA. Diagnosis is often aided by rhinoscopy (see endoscopy section above) and treatment of Aspergillosis requires applying anti-fungal medication directly to the nasal cavity and frontal sinuses.

Bone Marrow Sampling

Why is bone marrow collected and examined?
The bone marrow produces many of the cells found in blood, including red blood cells, white blood cells and platelets. If abnormalities with any of these components are detected during blood sampling, examination of the bone marrow may be required to investigate the problem.

What sorts of problems justify a bone marrow evaluation?
The most common reason for examining the bone marrow is a shortage of a particular cellular element in the blood. Examining the bone marrow can help determine the cause and may help to predict what the outcome might be.

Bone marrow evaluation may also be done to look for certain types of cancer. Some cancers arise in the bone marrow and others may spread to there. Examination of the bone marrow gives a better understanding of the cancer.

Which bone is the marrow collected from?
Although many bones contain marrow, samples are routinely collected from the front leg, just below the shoulder. Other sites where the sample is commonly collected from include the hip bone and the top of the thigh bone.

How is the sample collected?
At the start of the procedure, pets are deeply sedated so that they will remain calm and still during the procedure. This sedative includes pain killers which will provide comfort and ensure no pain is felt during or after the procedure. A small area of hair is clipped away from the skin and this area is surgically prepared, meaning it is cleansed and disinfected. Local anaesthetic is placed under the skin to desensitise the area. A small nick is made in the skin with a sterile scalpel blade and a needle is inserted to take a sample of bone marrow. This small skin opening is then closed with tissue glue which will fall off by itself once the wound has healed.

The sample, called a bone marrow aspirate, is spread on a glass slide, dried, stained with special dyes and examined under the microscope.

What is involved in marrow evaluation?
Marrow evaluation is complex and requires specialist interpretation. Information gained includes how active the marrow is, what cells are present and in what proportion, the presence of abnormal cells and any other details that may explain the abnormalities noted in the patient.

Endoscopy

Endoscopy is a minimally invasive diagnostic procedure that is used to assess the interior surfaces of an organ. The endoscope can be a rigid or flexible tube which provides an image of the desired organ, but more importantly also enables biopsies to be taken or the removal of foreign objects.
Unlike in human medicine our feline and canine friends require general anaesthesia for this procedure. Endoscopy, however, is considered safe as complications from the procedure are uncommon.
At Perth Veterinary Specialists we are equipped to perform endoscopy and endoscopic procedures in the following areas:

  • Upper and lower gastrointestinal endoscopy and biopsy
  • Oesophageal foreign body removal- small foreign objects in the stomach may also sometimes be removed by endoscopy but some require surgical removal.
  • Dilation of oesophageal strictures
  • Percutaneous endoscopic gastrotomy (PEG) tube placement- to allow feeding in patients with oesophageal disease
  • Bronchoscopy (examination of the airways) and bronchoalveolar lavage (sampling cells from the airways)
  • Rhinoscopy (examination of the nasal cavity and nasopharynx) and biopsy of nasal tissue

Medical Assessment of Complex Cases

We will happily accept referrals for investigations of all medical problems, no matter how complicated they are. The following are examples of the types of cases we love to be able to help with:

  1. Endocrine cases- for example uncontrolled diabetes mellitus, suspected Cushing’s disease, electrolyte abnormalities and investigations of polydipsia (increased thirst).
  2. Pyrexia (fever) of unknown origin
  3. Neurological cases for example animals presenting with seizures, vestibular signs or neck pain
  4. Respiratory disease including investigations of coughing, respiratory distress, pleural effusions
  5. Nasal disease- cats and dogs with sneezing, nasal discharge and/ or epistaxis (nasal bleeding)
  6. Liver disease- investigations of jaundice and the management of animals with portosystemic shunts
  7. Cardiology cases- including investigations of heart murmurs and treatment of heart failure or arrhythmias.
  8. Urogenital disease such as incontinence and recurrent urinary tract infections.

For Pet Owners

At Veterinary Medicine Specialists we are equipped with the knowledge and expertise to perform the ‘detective’ work required to establish a diagnosis for your pet which results in the ability to treat your pet as effectively as possible.

In order to have an appointment with any of the specialists at Perth Veterinary Specialists, you must be referred by your own vet. They are in the best position to determine if your pet needs referral and to which speciality. The referral procedure is simple, and generally only requires a phone call for an appointment and a referral form from your vet.

Things to remember for your appointment:

  • It is wise not to feed your pet on the day of referral as fasting is required before some procedures, such as blood samples and ultrasound. You should however provide free access to water at all times. In certain circumstances it may not be appropriate to starve your pet for such a long period, for example if your pet is young or has a particular condition such as diabetes mellitus. In any case, if you are at all concerned about fasting your pet overnight, please get in touch with us and we will be happy to advise you.
  • Please bring with you any medication your pet is currently receiving.
  • Your vet may ask you to bring with you referral information for us containing your pet’s history and any blood test results or x-rays.

What to expect

Pet’s requiring specialist medicine care often have long histories or a complicated mix of signs, so it is vital that we obtain as much information about your pet from you as possible. So the initial step in the process of investigating your pet is to take a detailed history and then examine your pet thoroughly. After this will discuss with you the possible causes of your pet’s symptoms, the investigations that may be required to diagnose the problem(s) and where appropriate discuss treatment options. This whole process will usually take about an hour. As most internal medicine cases require further tests, we will usually need to admit your pet into the hospital. The duration for which your pet is hospitalised will depend on your pet’s problem. After tests have been performed, your pet may need to go back home to await results, but some pets may need to stay in for additional treatment, according to how unwell they are. You should be aware that at Perth Veterinary Specialists, we have 24 hour continuous care. The hospital never closes.

Whilst your pet is hospitalised we will keep in touch with you on a daily basis to let you know how your pet is getting on. Upon discharge, you will receive a written report which will provide a summary of your pet’s problems, investigations performed and details of any medications required. We will then also contact your own vet to update them your pets visit to us.

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Our Team

Dr Janine Stone|

Dr. Janine Stone BVSc MRCVS ECVIM-CA Eligible Referral Clinician in Internal Medicine

Janine qualified from the University of Liverpool, UK, in 2004 and spent some time working in general small animal practice before pursuing a career in Internal Medicine. She completed her specialist residency training at the University of Glasgow before working for over 3 years at a private small animal hospital and referral centre in Derby, UK. She joined PVS in July 2016 and will be sitting her specialist exams to obtain the European Diploma in Companion Animal Internal Medicine in 2017. Her clinical interests are in gastroenterology and hepatology, and she also enjoys immunology and haematology cases in particular. Janine feels it is extremely important for the animal’s welfare to be a vet’s utmost concern and aims to treat every patient as though they were her own pet. Her husband Mark and 2 ½ year old son join her in Perth and so far they are enjoying everything the city has to offer, especially the beautiful parks and beaches!

Publications:

Duplicated ectopic ureter in a nine-year-old Labrador. Novellas R, Stone J, Pratschke K, Hammond G. J Small Anim Pract. 2013 Jul;54(7):386-9

Thoracic computed tomography findings in dogs naturally infected by Angiostrongylus vasorum. Coia M, Hammond G, Chan D, Drees R, Walker D, Murtagh K, Stone J, Bexfield N, Reeve L, Helm J.  Veterinary Radiology and Ultrasound, in press.

Articles in progress:

The AST:platelet ratio index (APRI) as a marker of canine hepatic fibrosis. Stone J, Lamm C, Parkin T, Bell R

Cranial peripheral neuropathy and vestibular syndrome associated with multiple myeloma in a ten-year old Border Collie. Stone J, Olivera M.

 

Dr Fleur James|BSc BVMS FANZCVS

Dr Fleur James is a Fellow of the Australian and New Zealand College of Veterinary Scientists (ANZCVS) – Small Animal Medicine and registered specialist.  She is also an Australian Veterinary Association and Veterinary Cancer Society member. Fleur adopts a rigorously scientific yet compassionate approach to patient care.  Her particular areas of interest include cardiorespiratory medicine, neurology and oncology, whilst much of her research has been in the area of acute pancreatitis in dogs.  Fleur is Perth born and bred and in her spare time, she tries to enjoy all that WA has to offer with her family, particularly activities that involve the water.

Publications:

Bilateral phalangeal fillet technique for metacarpal pad reconstruction in a dog.  Shaw T, James F, Beierer L, Hosgood G. Can Vet J. 2014 Oct;55(10):955-60.

What is your diagnosis? Fleur E James, Jennifer Mills, Giselle Hosgood. Australian Veterinary Practitioner 03/2013; 43(1):376-381.

Immune-mediated myasthenia gravis in a methimazole-treated cat. Bell ET, Mansfield CS, James FE. J Small Anim Pract. 2012 Nov;53(11):661-3.

A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis. Mansfield CS, James FE, Steiner JM, Suchodolski JS, Robertson ID, Hosgood G. J Vet Intern Med. 2011 May-Jun;25(3):419-25

Morphological and molecular characterisation of a mixed Cryptosporidium muris/Cryptosporidium felis infection in a cat. FitzGerald L, Bennett M, Ng J, Nicholls P, James F, Elliot A, Slaven M, Ryan U. Vet Parasitol. 2011 Jan 10;175(1-2):160-4.

Remission of histiocytic ulcerative colitis in Boxer dogs correlates with eradication of invasive intramucosal Escherichia coli. Mansfield CS, James FE, Craven M, Davies DR, O’Hara AJ, Nicholls PK, Dogan B, MacDonough SP, Simpson KW. J Vet Intern Med. 2009 Sep-Oct;23(5):964-9

Clinical remission of idiopathic hypereosinophilic syndrome in a Rottweiler. James FE, Mansfield CS. Aust Vet J. 2009 Aug;87(8):330-3

Pancreatic response in healthy dogs fed diets of various fat compositions. James FE, Mansfield CS, Steiner JM, Williams DA, Robertson ID. Am J Vet Res. 2009 May;70(5):614-8

Development of a clinical severity index for dogs with acute pancreatitis. Mansfield CS, James FE, Robertson ID. J Am Vet Med Assoc. 2008 Sep 15;233(6):936-44.

Ascites due to pre-sinusoidal portal hypertension in dogs: a retrospective analysis of 17 cases.  James FE, Knowles GW, Mansfield CS, Robertson ID. Aust Vet J. 2008 May;86(5):180-6.

Severe haemoptysis associated with seizures in a dog. James FE, Johnson VS, Lenard ZM, Mansfield CS. N Z Vet J. 2008 Apr;56(2):85-8.

Management of acute renal failure in small animal practice. See AM,  JamesFE, Raisis A, Swindells K.  Australian Veterinary Practitioner 01/2007; 37(4):140-140-157.

 

Rotating Veterinarian in Internal Medicine|

Each year, 3 veterinarians are chosen to work with us for 4 months in each of the disciplines of Oncology, Internal Medicine, and Emergency

Dr Sune Smit

Suné graduated from the University of Adelaide. She moved to Perth to further explore her interests in emergency and internal medicine, diagnostic imaging and oncology, with the goal of becoming a specialist in the future. In her spare time, Suné enjoys playing tennis and violin, reading and travelling around the world.

Dr Troy Bunn

Troy graduated from James Cook University in Townsville, Queensland and moved to Perth to pursue further training in small animal internal medicine, oncology, emergency medicine and diagnostic imaging. He loves all aspects of small animal clinical practice and is hoping to specialize in the near future. Outside of work, Troy spends his time caring for sick and injured wildlife and enjoying everything Perth has to offer socially and visually.

Dr Nick Lai

Nicholas graduated from Sydney University in 2015 and moved to Perth to continue building on the foundation his university had laid out for him. His interest areas include small animal internal medicine and neurology. Nicholas spends most of his free time around food, whether that be cooking up a storm in the kitchen or eating his weight in pastries. He tries to sneak in a game of tennis to work off those extra calories wherever he can.