The internal medicine referral team at Bath Vet Referrals consists of Lisa Gardbaum and Giulia Grenga.

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

To refer a case, please click here.

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

Meet our Vets

    Dr Lisa Gardbaum                            Dr Giulia Grenga

The soft tissue referral team at Bath Vet Referrals consists of Samantha Lane, Edward Corfield and Cate Khursandi.

Sam and Edward 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 Edward 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.

If you would like advice on a soft tissue case, please don’t hesitate to contact us​.

Meet our Vets

Dr Samantha Lane                             Dr Edward Corfield                     Dr Cate Khursandi

The Bath Vet Referrals surgical team who perform Orthopaedic surgery include Jon Shippam, Cate Khursandi and Edward Corfield.

Orthopaedics

Orthopaedic cases seen at Bath Vet 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

At Bath Vet Referrals we offer TPLO, TTA, CCWO and lateral suture as treatment options for cranial cruciate ligament (CCL) disease.  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 plateau levelling osteotomy (TPLO) or tibial tuberosity advancement (TTA) procedure (using genuine Synthes and Kyon implants respectively). The TTA and TPLO procedures change 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.  Cranial closing wedge osteotomy of the tibia (CCWO) is another option similar to TPLO that is recommended in selected cases.

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

To refer a case, please click here.

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

Meet our Vets

Dr Jonathan Shippam                    Dr Edward Corfield                  Dr Cate Khursandi

Medical Neurology

The internal medicine team at Bath Vet Referrals consists of Lisa Gardbaum.

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.

To refer a case, click here. 

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

Meet our Vets

Dr Lisa Gardbaum                         

At Bath Vet 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.

To refer a case, please click here.

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

Meet our Vets

Dr Lisa Gardbaum                       Dr Edward Corfield

Dr Samantha Lane                          Dr Cate Khursandi 

The Bath Vet Referrals surgical team who perform Laparoscopic procedures include Jon Shippam, Sam Lane, Edward Corfield and Cate Khursandi.

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 Vet 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.

To refer a case, please click here.

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

Meet our Vets

Dr Jonathan Shippam                    Dr Samantha Lane               Dr Edward Corfield

Dr Cate Khursandi 

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, tumours or disc compression.

Our 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:

• Abdominal disease (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)
• Any respiratory disease e.g. chronic coughing, difficulty breathing
• Disorders of the musculoskeletal including the spine eg spinal fractures and discospondylitis and orthopaedic diseases including elbow dysplasia and growth disorders
• Suspected portosystemic shunt
• Nasal disease
• Retrobulbar/orbital swelling
• Stick injury
• Suspected foreign body
• Vestibular disease, chronic otitis externa/media
• Investigation of renal and urinary disease eg hydronephrosis, dilated ureter, incontinence
• Dental disease (e.g. abscess)
• Metastatic screening/investigation of tumour origin and organ involvement
• Soft tissue surgery planning to assess how deeply a tumour invades into the surrounding tissues
• Trauma cases such as road traffic accidents eg jaw fractures

CT scans are commonly carried out as part of a medical or surgical referral investigation. We also offer outpatient CT scans for stable cases where referral input or additional investigations under the same GA are not deemed necessary.

Click here for more information on outpatient CT or outpatient CT form

Please contact us​ to discuss the suitability of a case for outpatient CT

In addition to a range of diagnostic services, we also offer CT and MRI scans as outpatient services, which are ideal for referring vets who wish to continue management of their own cases. Cases will be admitted and discharged by a referral nurse and do not include a consultation or advice from a referral vet, however if it becomes apparent other tests are needed, we will contact you to discuss. After the CT or MRI is performed, the images are sent for specialist interpretation and a report is sent to the clients registered veterinary practice to be reported back to the client.

Outpatient CT and MRI can be arranged by submitting an outpatient form. It is preferable to contact the team initially to discuss the suitability of cases for outpatient CT and MRI. We can then also recommend any bloods or addition work up to be carried out in advance of the imaging.

This service is not suitable for emergency or unstable cases. 

Outpatient Advanced imaging

Computed tomography (CT)

CT is a diagnostic imaging technique based on x-ray technology. Computer enhancement of the electronically detected image produces much greater tissue definition than conventional radiography. CT is highly sensitive for subtle bone changes. We are able to produce three-dimensional (3D) images after acquisition which may be viewed from any chosen angle. This imaging technique should be considered in dogs and cats with suspected thoracic or abdominal disease where other diagnostic imaging modalities (radiography and ultrasonography) fail to identify the cause and extent of the disease. CT is also used in the determination of the extent of a mass, which is essential for surgical planning.

Indications for CT scan:

• Thoracic and abdominal disease
• Intracranial and extracranial lesions
• Disorders of the musculoskeletal system including the appendicular skeleton and spine
• Investigation of bone (e.g. FCP in elbow dysplasia in dogs) and growth disorders
• Suspected portosystemic shunt
• Nasal disease
• Orbital swelling
• Stick injury
• Head trauma
• Any oncology disease
• Suspected foreign body
• Vestibular disease
• Adrenal masses
• Hydronephrosis
• Middle and inner ear disorders
• Dental disease (e.g. abscess)
• Metastatic screening

Magnetic resonance imaging

Our Veterinary MRI scanner is an Esote Vet MR. The use of MRI is most commonly indicated in conditions that require differentiation between soft tissues, such as in the field of neurology.

MRI scan uses a combination of a magnetic field and radiofrequency (RF) energy to create cross-sectional images of the area under examination. MRI produces highly detailed images of soft tissue in comparison with CT. However, it is less sensitive than CT for subtle bony lesions, such as minor osteolysis, or for areas of calcification. Inflammatory brain disease such as granulomatous meningoencephalitis or necrotising encephalitis will also usually produce highly suggestive MRI changes. Confirmation often relies on CSF analysis and it is advised to perform MRI prior to this in order to identify patients in which a spinal tap may be contraindicated due to increased intracranial pressure.

Indications for MRI:

• Ear diseases likely to extend to the brain
• Horner’s syndrome
• Blindness
• Vestibular syndrome
• Chiari like malformation
• Suspected spinal disease (e.g. disc disease, spondylosis, trauma)
• Orbital swelling & masses
• Suspected inflammatory brain disease (e.g. meningitis)

The majority of our clinicians are involved in outpatient scans.

To refer a case, please click here.

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

Our Vets

Dr Jon Shippam                        Dr Lisa Gardbaum                   Dr Samantha Lane

               Dr Edward Corfield               Dr Federica Manna               Dr Cate Khursandi

               Dr Giulia Grenga               Dr Lucy Andrews Hird