Internal Medicine

Veterinary Internal Medicine is a specialty field which addresses a broad scope of complex health problems in dogs and cats. Diseases treated by an internist include autoimmune disorders, infectious diseases, or problems involving the gastrointestinal tract, liver, kidneys, pancreas, respiratory tract and other organ systems. In many cases, patients have more than one problem concurrently. The goal of the internal medicine service is to provide comprehensive care for pets, and to maximize quality of life for our patients and owners.

Your pet's visit to an internist will begin with a thorough review of his or her history and pre-existing medical problems. A physical exam and review of completed diagnostic tests will generate a working problem list and a diagnostic or treatment plan. Minimally invasive diagnostic tests are utilized whenever possible. Labwork is crucial in many internal medicine evaluations to help determine the functionality of various organs and systems (ex: the endocrine system) and to look for signs of inflammation or infection. Because diseases can progress, some tests may be repeated over time.

Depending on the individual needs of the patient, additional testing may include radiographs (x-rays), abdominal ultrasound, respiratory tract sampling (bronchoscopy or endotracheal wash), bone marrow sampling or joint taps. In addition, we are able to offer high quality minimally-invasive endoscopic exams including gastroduodenoscopy, colonoscopy, cystoscopy, rhinoscopy and bronchoscopy. Some tests require general anesthesia, and an overnight hospitalization may be recommended to prepare the patient for his or her procedure.

Finally, you will have the opportunity to discuss various treatment strategies, taking into consideration your pet's lifestyle, his or her quality of life, and your goals.

Internal medicine cases often require ongoing monitoring and follow-up tests. This care may be given by our internist, or by your veterinarian with assistance as needed by our internal medicine service. Our goal is to be available to you and your veterinarian for questions or concerns.

Why see an Internist?

Many of the medical conditions treated by veterinarians in general practice are considered internal medicine problems. When disease has progressed despite treatment, or there are multiple medical problems present, a consultation with a veterinary internist may be recommended. An internist is a board certified specialist who has completed a one-year internship followed by a three-year residency in Internal Medicine following undergraduate and veterinary school training. This additional training gives internists experience managing complicated cases with up-to-date medical expertise and equipment. In addition, internists have published in their field, passed rigorous examinations over a two year period, and participated in the education of veterinary students and practitioners.

Specialty practitioners work in an environment which allows thorough examination of each patient, and collaboration between specialties to provide progressive care. We emphasize communication and education, so that you can be an active participant in your pet's care and decision-making.

Who is the Internist?

Amanda Wagner received her DVM with honors from North Carolina State University's College of Veterinary Medicine in 2002. She then completed a rigorous one-year internship in small animal medicine and surgery at Tufts University in North Grafton, Massachusetts. While her husband, veterinary surgeon Toby Eshelman, completed his training, she worked in private practice as an ER vet and then a general practice veterinarian. In 2007, she moved to Madison to begin her Internal Medicine residency at the University of Wisconsin's School of Veterinary Medicine. During residency, she developed a particular interest in feline medicine, gastroenterology, autoimmune disease and infectious disease. She also gained experience performing endoscopy (including gastroduodenoscopy, colonoscopy, rhinoscopy, and bronchoscopy), abdominal ultrasound, bone marrow aspiration, and respiratory sampling.

Amanda's husband, Toby Eshelman, is also a veterinarian and the practicing surgeon at VES. They share their home and crowded sofa with 2 cats, Calvin and Dee Dee, and 2 dogs, Frannie and Zooey. Amanda plays acoustic guitar and hopes to learn how to play the cello in the next few years. She enjoys cooking, traveling around the world, and slowing her husband down on bike rides. It is widely suspected that she is the world's worst snowboarder. She is originally from Ohio and is pleased to be back in the Midwest.

Why choose VES?

Whatever the diagnosis is, our internist will take into account your pet's prognosis and your goals, as well as practicalities such as your lifestyle and work commitments to provide an individualized and logical protocol for the management of your pet's condition. Our goals are to improve the quality of life of our patients as soon as possible, such that you and your pet can get back to a normal routine.

• You will be seen by the same board certified internist and experienced technicians at each visit, ensuring continuity of care and a familiar face for you and your pet.
• We believe in cooperative management with our referring veterinarians, so you won't have to come to us for all treatments or rechecks.
• We work in a small, cooperative environment with collaboration between our emergency, surgery and oncology services to provide progressive care.
• While we hope you don't need to call them, you can rest assured that advice and treatment is available around the clock from our experienced emergency doctors, available 24 hours a day, 7 days per week.

INTERNAL MEDICINE SERVICES

ENDOSCOPY and ULTRASOUND

Endoscopy and ultrasonography are minimally-invasive diagnostic procedures commonly used to evaluate the abdominal organs or the respiratory tract (bronchoscopy). These tools can be used to establish a diagnosis, or monitor a medical condition. In addition, organ biopsies can be performed, which may help avoid a more invasive surgical procedure.

The information obtained from ultrasonography is complementary to radiographs, blood and urine testing (i.e. the "minimum database"); it often helps to determine the next diagnostic or therapeutic step in a patient's care. Endoscopy is often the best way to evaluate the inside of the gastrointestinal tract or respiratory tract. While general anesthesia is required during endoscopy, this diagnostic procedure is much less invasive than traditional surgery. The benefits of endoscopy may include shortened anesthetic time, less physiologic stress and discomfort, quicker recovery time, and fewer serious complications.