For your initial appointment with the Internal Medicine Service, you will be asked to withhold food from your pet after midnight the evening prior to the appointment. Some tests used to assess your pet's health require blood samples obtained only after fasting. Water should always be available. Patients with diabetes should not be fasted. If your pet is a young puppy or kitten, please ask the staff about specific fasting instructions for your pet.

Prior to your appointment, the doctor will review your pet's medical record from your referring veterinarian. After speaking with you and performing a physical examination of your pet, we will discuss our concerns about your pet's illness as well as a diagnostic and therapeutic plan. Diagnostics may be performed during the day of the initial appointment or may be scheduled for a different day. Your doctor will talk to you about a financial estimate for options of diagnostics discussed during the appointment. During and after the appointment (as we get the results of the diagnostics), your doctor will talk to you about the short and long term plan for your pet. Within a few days of the appointment, we will provide you with a written summary about what was discussed at your appointment. After the appointment, once we receive the results of the diagnostics performed, we will send a summary letter to your referring veterinarian as it is very important to keep them informed so that they can continue to be an active member of your pet's medical team.

For your recheck appointments, one of our nurses or assistants will come into the room to discuss how your pet is doing. He or she will ask you questions about your pet as well as ask you about the medications that your pet is receiving. Please be prepared to list the name of each medication, the dose of medication given, and how frequently you give the medication. We will ask about your pet's medications at every appointment to verify that what we think your pet is receiving is truly the medication that he/she is getting. At that time, we will also ask you if you need a refill of any medication so be sure to check the status of your pet's medications prior to the appointment. After you speak with the nurse, he or she will bring your pet into the treatment area to perform the planned diagnostics for the day. These diagnostics may include lab work (performed in the hospital or sent to a referral lab), radiographs (x-rays), or ultrasonography. The nurse will check your pet's vital signs at this time. Often, the doctor will examine your pet while the nurse is performing these diagnostic tests. If you would prefer the doctor to perform the physical examination in the exam room with you present, please let the nurse know. The doctor will come into the exam room to review how your pet is doing and the results of the in-house diagnostic tests once the results are available. A medication and recheck plan will be discussed. We will provide you with a written summary of your pet's appointment and will send a summary letter to your referring veterinarian within a few days of your appointment.

Many of our diabetic patients are monitored using blood glucose (BG) curves. For these appointments, it is very important that you feed and give the insulin following your normal schedule. If you give the food and insulin at a different time than normal, it will change the curve results and may alter your doctor's recommendations. As soon as you have given the insulin, please bring your pet into the hospital. Often, for these appointments, we will put your pet's appointment at the top of our schedule as a “drop-off” to get him or her into the schedule. Please follow your pet's schedule and not this appointment time, when giving food, insulin and coming in to drop off your diabetic pet. We get to know your arrival time based on your schedule and worry less about where your pet has been put in the schedule.

When you arrive at Hope Veterinary Specialists, the nurse or assistant will come up and ask you how your pet is doing. We will always ask you what medications your pet is receiving including insulin, other oral medications, and eye medications. We will ask you the name of the medication, how much you are giving (how many mg) and how frequently you are giving the medication and will also ask if you need refills of these medications. We will also ask about your pet's drinking, urination, hunger and how he/she is doing in general. The nurse will ask you if you have any other concerns that you would like your doctor to address while your pet is at Hope VS for the day. The blood glucose appointments will last all day and the average time needed to be in the hospital is approximately 8 hours. The doctor will call you at the end of the day after we review the information that you provided us, perform a physical examination, and review the blood sugars for the day. During this call, we will ask you any questions we have about how your pet is doing and discuss a plan for your pet.

Patients with Cushing's disease are monitored with a blood test called an ACTH stimulation. Your doctor will use the results of this test as well as what she found on physical examination and how your pet is doing at home to make recommendations for your pet's medications. On the day of the appointment, it is very important that you feed and give medications (trilostane or lysodren) at the same time as usual as any changes to the timing could impact the results of the testing. Typically, ACTH stimulations are performed 4-6 hours after the morning pill for patients on trilostane. The exact timing of the test is less important for patients on lysodren. The nurse or assistant will come and get your pet from you at which time they will verify what medication(s) your pet is receiving, the timing of the medications that morning and how your pet is doing at home. Specifically, we will always ask about his or her eating, drinking, appetite and energy level. The ACTH stimulation takes about 1.5 hours. The blood is sent out to a referral laboratory for analysis. Your doctor will call you with the results of the ACTH stimulation and discuss a plan for your pet the next day your doctor is in the hospital.

Your pet may be admitted to the hospital during your appointment with the Internal Medicine Service or may be admitted to the hospital by the Emergency Service and transferred to the Internal Medicine Service the following morning during rounds. If your pet has been transferred from the Emergency Service to the Internal Medicine Service, his or her cage or location within the hospital does not change. During hospitalization, your doctor will speak to you 1 to 2 times a day to discuss how your pet is doing, the results of diagnostic tests, and the plan for your pet. We ask that you designate one primary contact person with whom we will talk and ask that this primary contact person disseminates the updated information to the other members of your family. You may call in for updates from the nurses and can schedule visits with your pet during his or her hospitalization.

The Internal Medicine Service will care for your pet during the day and create the overall plan for the day. In the evening, the internal medicine specialists update the overnight emergency doctors who oversee care until the internal medicine specialists are back in the hospital in the morning. Over the weekend, while the Internal Medicine Service is not in the hospital, the emergency doctors will take over your pet's care. Prior to transferring the case to the new doctor, we make a short and long term plan for your pet, although this plan may need to be modified based on the changing status of the patient. Each weekend, one of the internal medicine specialists is on-call and is available to speak directly with the emergency team about the internal medicine patients who are in the hospital.

During each conversation that you have with your pet's doctor, she will let you know when your next phone call will be. If your pet's status significantly worsens between phone calls, the primary doctor on the case or the overnight emergency doctor will call you.

Prior to each recheck appointment, please check the medications that you have at home to see if you will need any refills. If your pet needs medication refills between appointments, please give your doctor at least 24 hours while she is in the hospital to process your refill request.