I can perform abdominal, cervical (thyroid and parathyroid) and thoracic (non-cardiac) ultrasound, thoracocentesis, abdominocentesis, fine needle aspirates and cystocentesis. With ultrasounds, I will review the medical record as long as they are provided to me before the ultrasound and give basic medical recommendations to complement the ultrasound findings. The report and images will be given to you prior to my leaving on a reusable USB key. There is an area to upload medical records on the request page.

I am also available for internal medicine consultations. This can be done in conjunction with an ultrasound or can be a standalone request. I do not have to be at your practice to perform an internal medicine consult. You can request them through my website. Please provide a complete medical record including clinical notes and test results. I also ask the clients to fill out the appropriate questionnaire to get a complete history. If there are tests pending at the time of the request, I will wait for those results before completing the consult.

Internal medicine consults and rechecks will be completed within 48-72 hours of receiving all the necessary information (medical records, test results, ultrasound results if one is requested, and the client internal medicine questionnaire).

If you have a challenging case that is stable but needs considerable attention, I can help manage these cases on an ongoing basis. I will do an initial internal medicine consult and also provide interpretation of any tests I recommend in that consult. I can continue to help you manage the patient long-term with recheck exams (one visit to you = one HammerVet recheck fee).

I do not consult directly with clients since I do not have a valid veterinary-client-patient relationship. I understand that sometimes clients have additional questions or concerns that can be helpful for me to answer directly. If these situation arise, I am happy to schedule a call with them after the consult is completed and you have discussed my findings with them. I do not maintain ongoing primary communication with clients or maintain direct contact with clients about their pets. I am unable to meet with clients at the time of the ultrasound due to time constraints and unpredictability in my schedule.

If I have performed internal medicine consult and recommend a procedure you are not comfortable with, I can perform the procedure at your practice. This would include but is not limited to bone marrow aspirates, arthrocentesis, feeding tube placements, ultrasound-guided biopsies, etc.

Ultrasound:

· For AM visits, fast patient after midnight the night before. For PM visits, a small meal at 6am or before is fine. Water is always OK. If you have a patient with special medical needs where fasting is unsafe, advise them appropriately or contact me with questions.

· Consider whether or not patients would benefit from a ‘chill’ protocol using gabapentin and/or trazadone. Even the sweetest patient doesn’t always sit still for ultrasound exams. Ask owners if additional sedation is permissible, if needed. Place a sedation protocol in the record that can be administered by the staff. I do not prescribe sedation.

· Discuss aspirates with clients if you think they will be needed. Have a CBC with normal platelet count less than a month old.

· Plan on having patients ready for the exam when I arrive (shaving is always helpful!). I will need a staff member to restrain and a quiet dark space to perform the scans. I will call and confirm the appointments in the morning and give an approximate arrival time. I will call again when I am on my way to your practice.

· Add-ons are usually easy to accommodate but please let me know in advance.

Internal medicine consults:

· The majority of internal medicine consults and rechecks are done remotely.

· I will need a complete medical record and all test results – if possible, wait until all results are in before submitting.

· Direct clients to fill out an internal medicine questionnaire which provides me with a detailed history and saves time for the practice in gathering this information.

· Keep in mind that in most cases, I will not have a valid VCPR relationship so my role will mostly be as a consultant. I am happy to talk to clients when the need arises but cannot manage cases primarily.

I am available for abdominal ultrasounds Monday-Thursday. There is occasional availability outside these hours. Please contact me. I also visit some area referral hospitals and can see outpatient ultrasounds there. Please inquire as to where I will be next. I cannot do internal medicine consults at these outside locations.

Internal medicine consults and rechecks can be requested anytime and a complete report will be delivered within 2-3 days after receiving a COMPLETE medical record, all pending tests and the completed internal medicine questionnaire from the client.

Click here for the referral form for all my services.

I will contact you promptly to schedule if I am not already scheduled to visit your practice.

Click here for consult/recheck request.

I also ask that your client fill out the internal medicine questionnaire. Click here for the link or direct your client to my web site's "Client Forms" page and fill out the Internal Medicine New Consult questionnaire. There is also a shorter recheck questionnaire that is very useful for the purpose of history and identifying any ongoing concerns by the client.

Payment for ultrasounds is expected at the time of the practice visit by the practice. I do not accept payments directly from clients. Internal medicine requests that are done remotely are invoiced directly to the practice and payment can be made through electronic fund transfer (ACH) or check. Any alternative payment arrangements must be made with me prior to the examination/consultation. For updated pricing, please contact me.