Internal Medicine

David Burgener, DVM, DACVIM

Special interest – cardiovascular disease, gastroenterology, endoscopic procedures

Board-certified in Small Animal Internal Medicine, American College of Veterinary Internal Medicine

Las Vegas Veterinary Specialty Center, 2006 – present

Las Vegas internal medicine consulting practice, 1990 – present

Small Animal Internal Medicine Specialty Practice, Phoenix AZ, 1988 – 2001

Assistant Professor of Small Animal Medicine, Michigan State University, 1987 – 1988

Residency in Internal Medicine and Oncology, Michigan State University, 1984 – 1987

Internship, Angell Memorial Animal Hospital, Boston, MA, 1981 – 1982

Colorado State University, DVM, 1981

University of Arizona


Nicole Smee, DVM, MS, DACVIM

Special interest – urinary tract disorders. In addition to receiving numerous awards and honors while at Kansas State University, Dr. Smee has published many research papers and taught numerous veterinary courses and lectures.

Las Vegas Veterinary Specialty Center, 2014 to present

Midwest Veterinary Imaging Associates Consultant, 2012 to 2014

VCA Mission, Small Animal Internist and Internship/Externship Coordinator, 2012 to 2013

Kansas State University, Small Animal Internal Medicine Residency and Masters in Clinical Sciences, 2009 to 2012

Veterinary Specialty Center of Lynwood, WA, Small Animal Intern, 2008 to 2009

Kansas State University, Doctor of Veterinary Medicine, 2004 to 2008

Board-certified in Small Animal Internal Medicine, American College of Veterinary Internal Medicine

Diplomate of the ACVIM, Specialty of Small Animal Internal Medicine


About Our Practice

Our board certified specialists and residency trained doctors in Internal Medicine evaluate, diagnose, and treat many types of internal conditions, often dealing with organ systems related to the upper and lower gastrointestinal tract, endocrine system, liver and respiratory systems, and kidneys and urinary tract.

Our specialists are well equipped to diagnose and manage complicated medical conditions, especially serious and chronic conditions, including:

  • Acute or Chronic Renal Failure
  • Addison’s Disease
  • Bronchitis, chronic cough
  • Diabetes
  • Cushing’s Disease
  • Immune Mediated Hemolytic Anemia
  • Infectious Diseases
  • Inflammatory Bowel Disease
  • Liver Disease
  • Nasal disease
  • Pancreatitis
  • Protein Losing Enteropathy
  • Stones
  • Urinary tract Infections

Part of our rigorous training program includes three years of specialty training in performing advanced diagnostics. With this additional experience, our internal medicine specialists are also skilled in ultrasound, endoscopy and minimally invasive procedures. Not only does this give us the skills to perform testing, but also the experience and education to interpret and manage these chronic medical conditions.

 About Our Service

With board certified and residency trained doctors in Internal Medicine, as well as access to other specialties within LVVSC, we provide a unique service to our clients.  We may see your pet for a specific advanced diagnostic test that we provide or referral may be recommended for difficult to diagnose or manage medical conditions.  We work closely with your general practitioner to evaluate your pet as a whole.  This includes review of all previous records and diagnostics as part of your consultation.

At our facility we house state of the art diagnostic equipment, including digital radiography, ultrasound, endoscopy, laparoscopy, CT and MRI.

Some of the advance diagnostic services we offer include:

*Endoscopy

–Respiratory tract including the trachea and nasal cavity

–Gastrointestinal endoscopy including upper and lower GI tract

–Urinary tract

*Interventional procedures

–Renal bypass (in cooperation with surgery)

–Tracheal stenting

–Urethral stenting

*Laparoscopy

–Liver biopsy

–Kidney biopsy

–GI biopsy

*Minimally invasive bladder stone removal

*Ultrasound

This appointment will be different than other appointments you have experienced in the past.  We will be looking through the entire history for your pet as well as performing a complete physical examination.  Most patients are here for a few hours for the initial consultation.  To be prepared for your appointment, please ensure all medical records are forwarded to our facility from all referring practices.  If there were radiographs taken, we will review these as well and they may be emailed to internalmedicine@lvvsc.com and records can be faxed to (702) 262-7000.  We have a detailed questionnaire that we have you fill out as part of your appointment, including detailed information on any medications, supplements, diets and treats your pet is currently receiving. We recommend that you arrive 15 minutes prior to allow for paperwork.  If an ultrasound is recommended by your primary care doctor, this may be performed in the appointment time prior to speaking with the doctor or we may ask for you to drop your pet off to allow for time to perform additional testing.

Appointments

Appointments are required.  Patients are seen on a referral basis, Monday through Thursday.  If a more urgent appointment is needed, please speak with someone in the Internal Medicine Department for scheduling.

Please call us with any questions or to schedule your consultation at 702-871-1152

What to expect from your Internal Medicine appointment:

Internal Medicine doctors have undergone additional training beyond veterinary school to be able to help with the diagnosis and management of some of the most complex medical cases. They specialize in deciding what diagnostic tests will be most useful in further characterizing an unknown problem, but they also help in figuring out what medications and monitoring are necessary for chronic illnesses.

You can expect that when you arrive for your internal medicine appointment, one of our skilled nurses will begin by reviewing your questionnaire with you – this questionnaire will be sent to you prior to your pet’s appointment & we ask that all forms be returned 24 hours before the visit. The nurse will often have additional questions, beyond those on the questionnaire to help us better understand what you’re noticing with your pet. Sometimes these questions will have even come from the doctor assigned to your case. If an ultrasound scan is indicated, the nurse will let you know. Sometimes it’s helpful to complete the ultrasound right away, so that you and the doctor can use the results in your discussion later on.

Next, your pet will be brought to the doctor for an examination. The doctor and the nurse will discuss the information that you provided. If there are additional pieces of information that the doctor needs, the doctor or nurse may reach out again. You can expect that the doctor will have already reviewed available records sent by your primary care veterinarian. It is very important that if there have been multiple clinics involved in your pet’s care, we know about all of them. This helps us track down the pertinent records for review ahead of time, so we can understand exactly which tests have already been performed, what the results were and which medications (and doses) have been tried. This step, review of the records, is an essential part of what we do, allowing us to look for clues and subtle information. If records are not received from your veterinarian(s) ahead of time, the appointment may be rescheduled.

If an ultrasound is indicated, we’ll often perform that step next. After the ultrasound is performed, you will speak with the doctor to review that result and discuss additional testing that may be indicated.

It’s important to know that an ultrasound is one of the most common tests that we do, but it is seldom a stand-alone test. It is often paired with blood analysis, urine analysis or advanced testing (like specialized scans and biopsies). It’s very uncommon for us to be able to provide you a diagnosis based solely on the tests your vet may have already performed (otherwise, they wouldn’t need to send you to us!). If additional testing is indicated, an estimate will be prepared and reviewed with you. We cannot run additional testing without your consent.

While we cannot provide comprehensive cost estimates or legally provide medical advice for pets that we have not yet seen, it may be helpful for you to know some of the costs ahead of time. If your primary veterinarian feels one or more of these tests may be indicated, discuss any cost concerns you may have with them, prior to your referral:

  • Consultation fee: $200
  • Abdominal ultrasound scan: $500
  • Ultrasound guided fine needle aspirate with pathologist’s review: $400 (plus additional cost of blood work if indicated prior)
  • GI endoscopy with biopsies: $3700-$4800
  • CT scan of the head with Rhinoscopy of the nose: $3700-$4800
  • Bronchoscopy and bronchoalveolar lavage of the lungs: $3000-$3700
  • Cystoscopy of the bladder: $2000-$2400
  • Laparoscopic liver biopsies: $2600-$3500
  • CT scan of the whole body: $3000-$3300

*Prices subject to change

Usually, an advanced procedure requiring anesthesia (such as a scope or CT scan) will be scheduled on a subsequent day. If this is the case, the initial consultation visit will focus on being sure we understand your pet’s case and that we feel an advanced diagnostic test requiring anesthesia is both safe and indicated for your pet’s care. Any necessary pre-anesthesia testing will be coordinated at the first visit to ensure your pet is the best anesthetic candidate possible.

Please be aware, our aim is not to repeat tests that have already been performed by your primary care veterinarian. However, sometimes rechecking bloodwork, urine testing or ultrasound scans is necessary in order to understand how the problem may have changed with time, treatments from your vet or both. Additionally, ultrasound is a highly individual skill – different doctors may be able to detect different clues, based on their skill levels and background training. Therefore, even if your pet has previously had an ultrasound performed by a general practice vet, we may advise allowing us to look for ourselves. Generally speaking, screening blood and urinalysis are needed within 30 days before general anesthesia.

The majority of our tests require pet’s to be fasting – this means no food for 12 hours prior to the appointment but free access to water should be allowed for your pet. If your pet is a diabetic receiving insulin, we do not wish the pet to fast. Give normal medications on the morning of the appointment (either on an empty stomach or with the smallest coating of food needed to get the medication into your pet). Recent ingestion of food interferes with our ability to see past the stomach on ultrasound and can cause alterations on bloodwork that could then necessitate rechecking with the pet fasted. Therefore, it saves time and money for you to please fast your pet as instructed for the appointment.

Most appointments last 60-90 minutes, and our aim is to get the most information for you during that time. There may be a need to schedule follow-up visits for monitoring/rechecking the condition or for advanced procedures requiring anesthesia (such as scopes or CT scans). Many laboratory tests (blood, urine and pathology samples) take several days to a few weeks to return to us. When you leave from your appointment, we will let you know when you can expect a call with any pending test results.

Finally, following our consultation and workup, you will be encouraged to return to the care of your primary care veterinarian for long term care and monitoring when we feel it is appropriate. When your pet’s condition is sufficiently controlled, your primary care veterinarian may be able to manage the case at that point. If your pet is cleared to return to the care of their primary veterinarian, we are happy to answer questions for your vet by phone but they will need to review results and recommendations with you. We are not able to discuss test results with you that were performed outside of our direct oversight.

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