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Services

At Bath Veterinary Referrals we specialise in cats and dogs

Services Provided

If we can't find a diagnosis or treat a case in house we have an extensive network of colleagues who specialise in different areas to us who can help.

For more information on the services we provide, see below.

  • Internal Medicine
  • Soft Tissue Surgery
  • Orthopaedic Surgery
  • Neurology
  • Ophthalmology
  • Oncology
  • Laparoscopic Procedures
  • CT
  • MRI

Internal Medicine

The internal medicine team are experienced in all aspects of feline and canine medicine. We work closely alongside our surgical team and are also actively involved in the diagnostic imaging of our own cases. We are also involved in the investigation and treatment of oncological and neurological cases. We have a dedicated team of referral nurses assisting us and looking after the inpatients. We also have a separate peaceful, large and modern cattery which is ICC (International Cat Care) accredited in a different location of the building to the kennels to reduce stress in our feline patients.

The internal medicine services we provide include

  • Feline and canine infectious diseases
  • Endocrine conditions such as diabetes mellitus, hypoadrenocortism, hyperadrenocortism
  • Hepatic, pancreatic and adrenal diseases
  • Haematological conditions such as coagulopathies, thrombocytopaenia, anaemia, transfusion of blood products
  • Immune mediated diseases
  • Respiratory diseases
  • Gastrointestinal conditions
  • Urinary tract disease
  • Oncology
  • Fever of unknown cause

 

We have a wide range of diagnostics available to help investigate these cases including:

  • In- house blood analysis (haematology, biochemistry, coagulation, blood gas analysis, Angiostrongylus testing)
  • Same day blood, urinalysis and cytology results from our external laboratory and 1-2 day histopathology results in urgent cases
  • Endoscopy including bronchoscopy and bronchoalveolar lavages (BAL), upper and lower gastrointestinal endoscopy and biopsies, rhinoscopy and cystoscopy
  • Ultrasound including doppler flow and ultrasound guided trucut biopsies
  • CT/CT angiography/CT urethrography
  • MRI
  • Radiography
  • Arthrocentesis
  • CSF collection
  • Bone marrow aspirates and biopsies

 

Meet our Vets

    

Dr Federica Manna                         Dr Lisa Gardbaum                  Dr Andrew Jagoe

Soft Tissue Surgery

The soft tissue referral team at Bath Vet Referrals consists of Samantha Lane (Advanced Practitioner in Small Animal Surgery) and Barbara Karolczak who are supported by Edward Corfield.

Sam and Barbara accept referrals of a wide range of cases and work closely with our internal medical team, orthopaedic and ophthalmic surgeons. The team is supported by our knowledgeable and dedicated nurses and our first opinion night team, providing hospitalised patients with the best care 24 hours a day.

Bath Vet Referrals’ facilities include a state-of-the-art theatre, dedicated to soft tissue surgery, along with extensive diagnostic equipment, comprising ultrasonography, endoscopy, digital radiography, on-site CT scanner and MRI scanner. Our facilities ensure that all referred cases benefit from a thorough work-up of a variety of conditions.

Sam and Barbara also offer an email advice service (including radiographic interpretation) and telephone advice to referring practices. Bath Vet Referrals also offers out-of-hours referral service for existing and new cases.

 

Our soft tissue surgery includes:

EAR, NOSE AND THROAT:

  • Brachycephalic obstructive airway syndrome (BOAS)
  • Total canal ablation and lateral bulla osteotomy
  • Ventral bulla osteotomy
  • Laryngeal paralysis tieback
  • Nasal discharge investigation
  • Salivary mucocoeles
  • Stick injuries

 

 

THORACIC:

  • Thoracotomy
  • Thoracoscopy
  • Lung lobectomy
  • Ruptured diaphragm/Peritoneopericardial diaphragmatic hernia
  • Chest wall tunours
  • Pericardial strip

 

ABDOMINAL:

  • A range of gastrointestinal surgery from laparoscopic spays to management of peritonitis
  • Cholecystectomy
  • Perineal surgery
  • Urogenital surgery including urinary incontinence investigations/treatment and urinary obstruction cases
  • Splenectomy
  • Prostatic investigations and surgery
  • Liver biopsy and lobectomy

 

ONCOLOGY:

  • Oncological investigation, staging and surgery
  • Mass removal and wound reconstruction
  • Maxillectomy
  • Mandibulectomy

 

LAPAROSCOPY:

  • Ovariectomy
  • Ovarian remnant syndrome
  • Cryptorchid castration
  • Liver biopsies/bile sampling
  • Laparoscopic assisted gastropexy
  • Laparoscopic assisted gastrointestinal biopsies

 

To refer a case, please click here

 

Meet our Vets

  

Dr Samantha Lane                       Dr Barbara Karolczak                Dr Edward Corfield

Orthopaedic Surgery

The surgical team who perform Orthopaedic surgery include Jon Shippam (RCVS Advanced Practitioner in Small Animal Surgery) and Barbara Karolczak.

Orthopaedics

Orthopaedic cases seen at Bath Veterinary Referrals include lameness investigations and surgical treatments for bone, ligament or tendon injuries and abnormalities. 

A lameness investigation consists of taking a detailed history, observing the patient walking to assess lameness and gait, followed by an in-depth physical examination including palpating for evidence of swelling or muscle wastage, looking for signs of pain, assessing range of motion, joint stability and feeling for crepitation.  Basic neurological tests are performed to assess for delays in conscious proprioception.  In many cases the cause of lameness can be localised to specific areas which allows further investigations such as advanced imaging to help make a diagnosis.  Where a diagnosis has already been made we will perform a thorough assessment to confirm the diagnosis and to rule out any concurrent issues.

The method of advanced imaging we most commonly use for orthopaedic conditions is computed tomography (CT). This uses x-rays to create a three-dimensional image that is especially good for identifying bony lesions. Magnetic resonance imaging (MRI) is also useful in some cases - especially if a lameness is actually caused by a neurological problem such as lumbosacral stenosis. Simple fractures, hip dysplasia and cruciate ligament ruptures are examples of conditions where radiography provides sufficient diagnostic information.

We encourage physiotherapy and hydrotherapy in the treatment and post-operative rehabilitation of orthopaedic cases. Our ACPAT physiotherapist is available to provide treatment for post-operative inpatients as well as follow up appointments for outpatients.

Fractures

Fractures classifications describe whether they are open or closed, simple or comminuted, displaced or non-displaced and articular or non-articular. We offer a range of fixation methods such as using bone plates (including use of Synthes LCP which allows use of locking internal fixation with the benefits of achieving fracture compression), external skeletal fixation (using the Imex SK Linear ESF System), hybrid fixation (using the Imex SK Hybrid ESF System), Ilizarov ring fixators, and for some avulsion fractures using pins and tension band fixation. Each case is classified and carefully assessed to allow us to recommend the most appropriate method of fixation.  Autogenous cancellous bone graft is used to help speed the repair in many cases.

Cruciate ligament ruptures

Cranial cruciate ligament tears or ruptures are most commonly a degenerative process that leads to instability of the stifle (knee) and often causes secondary tearing of the meniscal cartilages. Various methods of treatment are available, but in larger dogs we usually recommend the tibial tuberosity advancement (TTA) procedure using genuine Swiss made Kyon implants. The TTA procedure changes the biomechanics of the stifle to overcome the instability caused by failure of the cranial cruciate ligament. We also offer lateral suture stabilisation which can be used in any size of dog but is best suited to small dogs and cats.

Patellar luxation

Patellar luxation is a common condition that can be asymptomatic through to causing severe mobility issues. The most common presentation is where dogs show intermittent skipping lameness, and often isn’t painful at the time of diagnosis. In the majority of cases the patella (knee cap) luxates because of a malalignment in the hindlimb. Treatment options include compensating for the malalignment by moving the part of the tibia called the tibial tuberosity, or by directly correcting the malalignment by use of a corrective osteotomy which involves straightening the bone (and/or correcting torsion) and using a bone plate to stabilise the bone whilst it heals. Many cases also require deepening of the groove that the patella sits in to improve stability. Studies have shown patellar luxation to have disappointing complication rates including recurrences, but modern techniques including CT alignment measurements can help make a tailored plan for each case which can significantly reduce the complication rates.

Arthroscopy and Elbow Dysplasia

Our facilities include high definition video endoscopy facilities that allow us to perform arthroscopy procedures to both assess and treat conditions inside joints. The most common use of arthroscopy is to assess cases of elbow dysplasia, especially if they have fragmentation of the medial coronoid process. In cases of suspected elbow dysplasia we will usually start with CT, and particularly if this shows fragmentation then we may recommend arthroscopic (key hole) removal of the fragment. In some cases with persistent lameness, loss of cartilage in the medial compartment of the elbow but intact cartilage in the lateral compartment we may recommend the PAUL procedure (proximal abducting ulnar osteotomy) which aims to reduce load on the medial compartment.

Humeral intracondylar fissures (HIF) in Spaniel breeds

Sometimes referred to as incomplete ossification of the humeral condyles, this condition is mainly seen in Spaniel breeds and may be a developmental abnormality but evidence shows some cases develop fissures after being previously documented as normal. CT is the most sensitive method of diagnosing this condition. HIF can cause a progressive forelimb lameness, but most seriously can lead to spontaneous elbow fracture (including lateral condylar fractures or T or Y fractures). The lameness and risk of fracture can be resolved in most cases by placement of a transcondylar screw.

Other conditions and treatments at Bath Veterinary Referrals include:

  • Hip luxations
  • Shoulder injuries
  • Meniscal tears
  • Limb deformities
  • Immune mediated polyarthritis
  • Osteochondrosis dissecans (OCD)
  • Stem cell therapy
  • Platelet therapy
  • Hock and carpal injuries including pancarpal and pantarsal arthrodesis

Meet our Vets

 

Jonathan Shippam                        Barbara Karolczak

Neurology

Medical Neurology

The internal medicine team at Bath Vet Referrals consists of Lisa Gardbaum (RCVS Advanced Veterinary Practitioner in Small Animal Medicine) and Andrew Jagoe (RCVS Advanced Veterinary Practitioner in Small Animal Medicine) who are supported by Federica Manna.

Our medical team see a wide variety of neurological cases including:

  • Investigation of seizures
  • Abnormal mentation
  • Facial paralysis
  • Vestibular signs
  • Tremors
  • Ataxia
  • Paresis/paralysis
  • Spinal disease
  • Neck pain
  • Neuromuscular disease
  • Suspected syringomyelia/chiari malformation

In cases of suspected inflammatory brain and spinal diseases, as well as diagnostic imaging of the brain if deemed necessary, we will also carry out lumbar or cisternal cerebrospinal fluid sampling to make a definite diagnosis as well as routine clinico-pathological testing.


We also offer medical treatment/chemotherapy for brain tumours and can organise tertiary referral for radiotherapy or surgery where appropriate.
 
Surgical neurology

Our head surgeon Dr Jon Shippam (RCVS Advanced Practitioner in Small Animal Surgery) is experienced at spinal surgery to treat acute disc disease and, as we have permanent MRI and CT facilities on site, we are often able to diagnose acute disc prolapse and spinal cord compression and carry out spinal surgery immediately post-imaging if indicated.


Surgical treatments offered for acute disc extrusions:  

  • Hemilaminectomy in the thoracolumbar area
  • Ventral slot in the neck region

Our ACPAT physiotherapist provides inpatient treatment post-operatively and includes hydotherapy on an outpatient basis using our water treadmill. 

Lumbosacral disease
Some of the cases we have referred for lameness related signs are diagnosed with lumbosacral disease including foraminal stenosis.  These dogs can show a range of signs from reluctance to jump, pain and neurogenic claudication (lameness caused by nerve compression).  We investigate these cases as part of a lameness investigation, and if suspicious of lumbosacral disease then we may offer MRI of the lumbosacral spine.

To refer a case, click here

Meet our Vets

   

Dr Lisa Gardbaum                         Dr Federica Manna                 Dr Andrew Jagoe

Dr Jonathan Shippam

Ophthalmology

Bath Veterinary Referrals frequently examine and treat eyes with many different problems including lid problems and corneal problems. We also see many problems within the eye such as blindness, retinal problems, uveitis, hyphaema and glaucoma. These problems often have causes beyond the eye,  and our team of medics and surgeons, along with our large variety of diagnostic equipment,  allows us to treat not just the eye problem, but also to often get to the bottom of,  and manage the underlying cause. 

 

Meet our Vets

Dr Jenny Lambert

Oncology

At Bath Veterinary Referrals, Oncology cases are assessed by both our Internal Medicine and Soft Tissue Surgery teams; each case is individually approached and treatment is tailored to the individual patient.

Diagnosis

We have on-site access to a range of diagnostic tools, which allow prompt investigation, diagnosis and staging before treatment options are discussed with the owner.

Diagnostic facilities available:

  • On-site laboratory and twice daily external laboratory collection (same day results).
  • High quality ultrasound scanner, this allows assessment and ultrasound-guided fine needle aspirates and Tru-cut biopsies to be taken from abnormal areas.
  • On-site Siemens 16-slice CT scanner with the ability to obtain CT-guided biopsies. Full specialist interpretation is available through VetCT.
  • On-site MRI.
  • Digital radiography (X-ray).
  • Video cystoscopy, rhinoscopy, endoscopy and biopsy.
  • Laparoscopic assisted biopsies.
  • Surgical biopsies.


Treatment

Chemotherapy options and prognosis are discussed with owners and tailored to the individual patient.

Frequently performed protocols:

  • CHOP/COP for lymphoma and leukaemia.
  • Adjunctive therapy for mast cell tumours, osteosarcomas, carcinomas.
  • Newer drugs such as tyrosine kinase inhibitors are used in appropriate cases based on identification of tumour markers using immunohistochemistry

Tertiary referral for radiotherapy will be organised in appropriate cases such as brain/nasal neoplasia and certain non-resectable tumours

Our surgeons assess cases that need diagnostic, curative and adjunctive surgical procedures.

Frequently performed surgery:

  • Large mass removal and reconstruction (soft tissue sarcoma, mast cell tumour, other large skin masses).
  • Thoracic surgery and lung lobectomy for primary pulmonary masses.
  • Abdominal oncological surgery (liver lobectomy, splenectomy, intestinal mass resection, nephrectomy for renal masses, bladder wall neoplasia).
  • Lymph node biopsies/removal.
  • Limb amputation in osteosarcoma cases.
  • Advancement and axial pattern flaps following surgery.

If you would like advice on an oncology case, please don’t hesitate to contact us​.

To refer a case, please click here.

Meet our Vets

  

Dr Lisa Gardbaum                          Dr Federica Manna                   Dr Andrew Jagoe

 

  

Dr Samantha Lane                       Dr Barbara Karolczak                Dr Edward Corfield

Laparoscopic Procedures

Our surgical team who perform Laparoscopic procedures include Jon Shippam (RCVS Advanced Practitioner in Small Animal Surgery), Sam Lane (RCVS Advanced Practitioner in Small Animal Surgery), Barbara Karolczak and Edward Corfield.

Minimally Invasive Surgery 

Minimally invasive or 'keyhole' surgery uses specialist instruments and rigid endoscopes (cameras) to perform surgeries through very small incisions in the body wall (e.g. abdomen/thorax). We are able to do some procedures entirely using this technique, in other cases we can use the endoscope to assist with the procedure.

Such techniques have been used in human surgery for many years as they have marked benefits when compared to traditional 'open' surgeries. At Bath Veterinary Referrals we are fortunate to have a state-of-the-art Storz high definition camera system which provides very clear and detailed images, facilitating optimal treatment provision to our patients.

The main benefits of minimally invasive surgery are: 

  • Reduced post-operative pain and discomfort.
  • A quicker return to normal activity.
  • Smaller surgical wounds.
  • Decreased risk of complications and infections.
  • Enhanced magnification afforded by the endoscope enabling greater surgical accuracy.

 We use these techniques in particular for: 

  • Neutering - laparoscopic ovariectomy (spay) and retained (cryptorchid) testicle removal.
  • Laparoscopic ovarian remnant removal.
  • Laparoscopic assisted gastropexy.
  • Laparoscopic liver biopsies and bile aspiration.
  • Laparoscopic pancreatic biopsy.
  • Laparoscopic assisted intestinal biopsies.
  • Laparoscopic assisted cystotomy.
  • Thoracoscopic procedures.

Our surgeons Samantha LaneJon Shippam and Edward Corfield perform these procedures at Bath Vet Referrals.

Meet our Vets

  

Dr Jonathan Shippam                    Dr Samantha Lane                   Dr Barbara Karolczak

 

Dr Edward Corfield

CT

At Rosemary Lodge Veterinary Hospital, we have an on-site Siemens Emotion 16 slice CT scanner. CT (computed tomography) is essentially three dimensional x-ray. It has revolutionised the way in which both human and veterinary medicine is able to assess certain patients. CT and MRI work in very different ways and therefore each has its own strengths and weaknesses. For example, CT can provide excellent detail in bone, creating almost perfect 3D reconstructions of joints, whilst MRI is not a great tool for examination of bones. However, CT does not provide very good detail within the brain or spinal cord tissue, whilst MRI is able to show subtle changes due to inflammation or tumours.

The CT scanner at Bath Veterinary Referrals has allowed us to significantly change and improve how we approach certain cases. This scanner is a "16-slice" scanner allowing us to obtain very detailed pictures for a very short scan time. This means that we can achieve excellent detail in moving organs such as lungs. In fact, once you have seen the detail that we can achieve with CT it is very hard to go back to using x-rays, particularly for lungs and nasal chambers.

CT has many uses, including some of the following common investigations:

  • Any respiratory disease e.g. chronic coughing, difficulty breathing
  • Nasal diseases
  • Orthopaedic diseases including elbow dysplasia and spinal fractures
  • Soft tissue surgery planning to assess how deeply a tumour invades into the surrounding tissues
  • Large dogs with any abdominal disease (CT has been shown to be more accurate than ultrasound to assess abdominal disease in dogs over 25 kg)
  • Trauma cases such as road traffic accidents

 

 

We offer CT scans as either part of a referral investigation, which is often the most useful approach, or they can be performed as an outpatient procedure. In the latter case, the animal will be admitted by one of our nurses and the CT performed during the day. We will either provide you with a disc of images or can arrange an external specialist opinion on the scan. For outpatient scans, we need you to indicate which areas are to be scanned, whether you wish us to arrange a specialist opinion on the images and an indication of the clinical questions to be answered.

Outpatient scans do not include consultations or advice from our own clinicians, although if it becomes apparent that other tests would be useful, we will contact you to discuss this. We have set a range of prices for CT scanning that are very competitive (all include sedation or GA, the technique to be at our discretion, but GA offers distinct advantages in most animals).

MRI

Magnetic resonance imaging (MRI) is an advanced imaging modality which does not use ionising radiation and produces detailed soft tissue images. The other main advanced imaging modality available to veterinary patients is computed tomography (CT). This utilises x-rays and computer technology to form an image. CT images are useful for assessing bone changes, and for imaging of the thorax. CT scans are also generally cheaper than MRI scans. However, MRI is thought to be safer than CT since it does not use ionising radiation. Compared to CT, MRI also has advantages of the ability to image in any plane, better spatial resolution, better tissue contrast and increased sensitivity to disease processes which alter the water content of tissue. Essentially, MRI is looking at the density of hydrogen ions or protons within the body. These ions are most common in water, so MRI is sensitive at picking up changes in the water content of tissues, as may be seen with inflammation or neoplasia.

MRI is now the gold standard imaging modality for a number of disease conditions, both in human and veterinary medicine. It can also be complementary to other imaging modalities such as CT, ultrasonography and radiography.

The major application of MRI in veterinary medicine is in the field of neurology. This is because of the ability of MRI to “see through” bone, and image the soft tissue within. Conventional radiography and ultrasonography are both extremely limited in visualising the central nervous system. However, MRI and to some extent CT are the imaging modalities of choice for this area. Neurology is not the only field to benefit from MRI technology. For example, Ophthalmologists find it important to assess the retrobulbar space. Delineation of soft tissue masses elsewhere in the body can be important for oncologic surgical planning, and there are a number of internal medicine and orthopaedic uses.

 

Meet our Vets

   

Dr Federica Manna                            Dr Lisa Gardbaum

For any further information or advice, please do not hesitate to contact us and speak to one of our staff.