Internal Medicine

Internal Medicine

The specialty of small animal internal medicine service is centered around personalized, compassionate approach to diagnose, treat, and manage common illnesses, complex medical conditions, and long-term chronic illnesses affecting major body systems like the liver, kidneys, gastrointestinal tract, pancreas, lungs and upper airways, endocrine glands, immune system, blood and bone marrow and those systems affected by infectious diseases.

We take a close look at how all the systems in the body work together as a whole, because a problem in one area could cause complications in another, and how these can be prevented or minimized. The focus of our work revolves around providing you with all the options and coming up with a comprehensive treatment plan to help your pet have a better life.

Very often this includes using specialized laboratory testing, advanced diagnostic modalities like imaging (x-rays, abdominal ultrasound, CT scan, or fluoroscopy), procedures where a camera is used to look inside the body or organs (endoscopy), and/or getting samples from mass or within the body (aspiration, biopsy, or bone marrow etc.) where appropriate.

These state-of-the-art diagnostic tools and tests are done to diagnose your pet’s disease/problems and individually tailored to meet your pet’s needs. This may include the services of other specialists like surgeons, radiologists, dermatologists, cardiologist, neurologist,
oncologists, nutritionists, ophthalmologists, and criticalists to name a few, as some of these diseases may be advanced or uncommon where a simple solution might not exist.

Board certified veterinary internal medicine specialists receive an additional 4 years of specialized training (internship and residency) to be able to with your pets advanced care are certified by the American College of Veterinary Internal Medicine

To better understand why you are seeing a small animal internist, please see the following link.

Internal Medicine appointments are made only on a referral basis, meaning that an examination here has been advised by your pet’s regular veterinarian, or the emergency veterinarian. Please have your veterinarian contact us via our online portal website ( with the referral information. After the referral is made, we will contact you to schedule your appointment. The Internal Medicine service cannot provide advice to clients over the phone for patients we have never seen for legal reasons, and it is often difficult to judge the correct approach to a situation without the opportunity to gather a complete history and directly examine
the patient. Currently the Internal Medicine service at Pulse Emergency and Veterinary

Specialists is available from 8:00am to 6:00pm Tuesday through Friday, and for consults through the emergency service, if necessary, after hours if deemed appropriate by the emergency service.

Our Team

Tools and Technology

The Internal Medicine service at Pulse Veterinary Specialists & Emergency currently can provide the following services for dogs and cats

This procedure involves using a syringe to collect synovial fluid from a joint capsule looking for infection or inflammation.

Lower airway endoscopy/ Bronchoscopy – a flexible camera (bronchoscope) is used to look inside air ways (trachea and the bronchi) and collect samples for cytology and culture.

This is how a normal trachea looks during bronchoscopy. The exam allows us to look for evidence of tracheal collapse. 

This is how the bronchi look on the bronchoscopy. Samples of the mucous (yellow) would be collected for a pathologist to look at and also for a culture to identify micro-organisms that could be causing disease.

Esophagoscopy / Gastroscopy / Duodenoscopy or upper gastrointestinal endoscopy: Endoscopic examination of the upper digestive tract includes an evaluation of the esophagus, stomach and duodenum. These procedures are done to visualize the lining of the tract and collect biopsy samples without the need for surgery.

Sometimes, we use an endoscope to remove foreign objects, such as pennies, tennis balls, etc. from the stomach.

Upper gastrointestinal endoscopy is also used in conjunction with fluoroscopy for balloon dilatation of esophageal strictures, or polyp removals etc. We also do offer capsule endoscopy as an option in larger dogs and those who cannot undergo general anesthesia. 

Colonoscopy or lower gastrointestinal endoscopy: A flexible endoscope is used to examine the lining of the colon and rectum and sometimes the terminal part of the small intestine the ileum in pets with frank blood in the stool, or issues with defecation. 

Lower gastro-intestinal endoscopy in a dog showing the ileo-cecal junction which is the connection between the small and large intestines. 

Cystoscopy: A rigid camera is used to examine the bladder (cystoscopy) and urethra (urethroscopy) are performed in female dogs with various urinary tract problems, like recurrent infections, tumors, urinary incontinence, or difficulty urinating. This serves as a method of a definitive diagnosis and for collecting biopsy samples. 

Rhinoscopy: An endoscope is used to examine the front and back of the nose for cancer, inflammation, cancers etc. and collect biopsy samples. Sometimes this is used to treat nasal and fungal infections.

  • (in conjunction with the surgical service): A small camera is introduced into the abdomen to look at the abdominal organs and collect biopsies from organs like the liver. Animals have a very small incision and usually go home the same day. This is considered the method of choice for investigating liver disease in dogs and cats.  

Tubes are placed in the esophagus or the stomach, and rarely in the intestines to help with long-term feeding in dogs and cats who cannot or do not eat on their own. Sometimes this needs to be done with endoscopic assistance. 

Samples and biopsies are collected from the bone marrow to help evaluate issues with the red and white blood cells. 

options like urinary stents, managed of subcutaneous ureteral bypass (SUB) devices etc. in conjunction with surgery, radiology, and cardiology services. 

and monitoring for dogs and cats who reside locally and require chemotherapy after virtual consultation with a board-certified oncologist. Currently there is no medical or radiation oncologist on staff at Pulse Veterinary Specialists & Emergency.  


Currently, we do not offer the services primarily pertaining to canine and feline reproduction, nor dermatology (including the ears).

Before getting treatments and procedures, our in-depth consultation gives the opportunity to discuss the diagnosis, recommended procedures and their limitations, expected outcomes, and care needed. This is the time dedicated to answering your questions or addressing any concerns with our team.

Frequently Asked Questions

During your appointment your pet’s medical history will be reviewed and any previously performed laboratory and diagnostic imaging tests will be evaluated.

A complete physical examination will be performed by the Internal Medicine Specialist, and vitals will be collected. Further diagnostic and treatment recommendations will then be discussed along with a detailed cost estimate for any tests, diagnostics or treatments. 

Before getting treatments and procedures, our in-depth consultation gives the opportunity to discuss the diagnosis, recommended procedures and their limitations, expected outcomes, and care needed. This is the time dedicated to answering your questions or addressing any concerns with our team.

Whenever possible, diagnostic procedures will be done on the same day as the as your pet’s initial appointment. These can include x-rays, abdominal ultrasounds, CT scans, fluoroscopic exams, and endoscopic examinations. The duration of these procedures can vary and can be a few hours as they very often do involve sedation or general anesthesia. On average, Internal Medicine evaluations can be time-consuming, so please prepare for a longer visit (typically 2-6 hours). For this reason, we may ask that you leave your pet with us so that we may complete our evaluation and provide you with a detailed treatment plan.

To make the consultation more efficient, please fill out the patient questionnaire at:

Please bring any videos, pictures or medication/ symptom logs or journals that you have with you.

Pets must be fasted prior to the appointment – no food after midnight, your pet may have a drink of water in the morning. (Unless your pet is a diabetic or less than 6 months old, in this case please contact the internal medicine service ahead to find out the recommendations for you). Being fasted does help us proceed with procedures that require sedation or general anesthesia the same day.

Your pet will only be able to go home once they have recovered from the anesthesia or sedation and we are happy with the recovery. Generally, most pets that undergo a procedure, unless there is a complication or a concern, can go home the on same day usually by the end of the day around 5 or 6pm.

Sometimes, procedures that require general anesthesia, special preparations (i.e., enemas for a colonoscopy) or some laboratory diagnosis will be scheduled for a later date or the next day.

If your pet is hospitalized, they will be kept comfortable in a kennel or run with bedding, water and a litter box (for cats). Dogs will be walked outside every 4 to 6 hours where possible. There is always a veterinarian and technicians in the hospital 24/7.

We realize that your time is valuable and will do everything possible to address your situation in a timely fashion, and to fit within your schedule where possible.