About

Dr. Otoni and Dr. Galvao are both board-certified Internal Medicine specialists by the American College of Veterinary Internal Medicine (ACVIM). 

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Our services that are unlikely offered anywhere else, we can combine interventional radiology and interventional endoscopy, internal medicine, nuclear medicine, and more recently extracorporeal therapy. Having expertise in these different areas gives us a unique perspective and ability to offer solutions taking into consideration a variety of different aspects. 

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Why should you come and see us?

There are many reasons, here are some examples:

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Calcium oxalate stones

When dealing with calcium oxalate stones, you want to make sure that you mechanically remove all the calculi. It is equally important to set up an appropriate calcium oxalate prevention plan. Instead of having a surgeon remove the stones and then refer the pet to an internal medicine specialist for a prevention plan, you can get the stones removed via a minimally invasive approach that is more effective than conventional cystotomy as well as have a prevention plan done at the same time. Dr. Galvao has a special interest in calcium disorders. Here, we offer the tools to be aggressive in stone prevention methods when stones are initially removed.  

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Hyperthyroidism

Regarding hyperthyroidism, we have seen cats present for radioactive iodine treatment who did not have hyperthyroidism or, had hyperthyroidism but it was not the cause of the weight loss. In this case, the thyroid scintigraphy (very few places have this capability) confirmed that the patient did not have hyperthyroidism, and we proceeded to work-up the patient for primary gastrointestinal disease. There have also been patients that have had very mild hyperthyroidism, but significant weight loss. Therefore, there was a disparity between the weight loss and the severity of the hyperthyroidism. What was discovered in this case is that the cause of the severe weight loss was due to small cell lymphoma rather than the mild hyperthyroidism. Without having the expertise in internal medicine and the ability to do a thyroid scintigraphy, cats could either receive I-131 therapy without truly having hyperthyroidism, or have I-131 therapy that will not ultimately resolve the patients' main clinical signs. 

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GFR and ureteral obstruction

Our ability to measure individual glomerular filtration rate (GFR) has given us a unique perspective in cats with ureteral obstruction that underwent subcutaneous ureteral bypass (SUB) placement. We measure GFR via nuclear scintigraphy in our patients that have underwent SUB placement. This is important, especially in bilateral ureteral obstruction cases since there are times that one of the kidneys may not have any kidney function left. If they don't have any kidney function left and they become obstructed, there is no need to put significant effort into a demineralization protocol or tube exchange. 

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Intrahepatic portosystemic shunt

Intrahepatic portosystemic shunts require the expertise of someone to manage these patients, which is typically an internal medicine specialist. However, it is also important to have someone with the expertise to correct the shunt. Having the ability to correct and manage these patients concurrently, may be more beneficial than to have someone correct the shunt and have someone else manage these patients medically.

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Chronic kidney disease and hemodialysis

It is beneficial to not only have the expertise to manage patients with chronic kidney disease or acute kidney injury, but also to be able to use extracorporeal therapy as a treatment modality when needed in these patients. Having the knowledge and perspective of both approaches is important when dealing with complex cases. 

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Ureteral obstruction

The same is true when dealing with ureteral obstruction. Being able to use interventional approaches to treat ureteral obstruction is very important. However, it is equally important to have the expertise to medically manage patients that develop ureteral obstruction.

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Tracheal collapse

Dogs with tracheal collapse require both medical treatment as well as interventional treatment like stent placement. Dogs with tracheal stents will continue to require medical treatment for the tracheal collapse even after stent placement. It is ideal to have a person managing these cases that can not only place a stent, but also manage them chronically. 

 

These are just some examples of the importance of having the expertise in multiple areas.  

 

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