Service led by Dr. Eleanor Vance, DACVIM · Diplomate, American College of Veterinary Internal Medicine
The internal medicine service handles the cases that exceed general-practice scope on workup, protocol design, or duration. Chronic GI disease that has not responded to dietary trials. Suspected endocrinopathies that need definitive testing. Hepatic disease where the bloodwork suggests more than fatty change. Renal disease that needs staged management. Immune-mediated disease that requires immunosuppressive protocols.
Eleanor co-founded Field & Stone in 2009 after eight years on the internal medicine service at UC Davis. She reads every abdominal ultrasound personally; her error rate on missed pathology, audited annually, is below 1.5%. Complex imaging cases (suspect adrenal masses, pancreatic lesions, complex hepatic vascular anomalies) get sent to a board-certified veterinary radiologist for second-read confirmation.
Most internal medicine consults are 45 minutes; chronic complex cases are scheduled as 60-minute consults so we have time to actually talk through the workup plan. We do not stack consults back-to-back in 15-minute increments. The conversation is the medicine.
Caseload categories
- Endocrine
- Diabetes (canine and feline), Cushing's, Addison's, hyperthyroidism, hypothyroidism, insulinoma workup.
- Gastrointestinal
- Chronic enteropathy, IBD workup with biopsy, pancreatitis, exocrine pancreatic insufficiency, protein-losing enteropathy.
- Hepatic
- Hepatic insufficiency workup, portosystemic shunt evaluation (medical management; surgical correction by surgery service), copper storage hepatopathy.
- Renal
- CKD staging and management, proteinuric kidney disease, pyelonephritis workup.
- Infectious disease
- Tick-borne disease, fungal disease, leptospirosis, immune-modulated infectious workup.
- Immune-mediated
- IMHA, IMTP, polyarthritis, immunosuppressive protocol design and monitoring.
- Cardiac
- Initial cardiac workup with echo coordination. Complex cardiology referred to a DACVIM (Cardiology) at the LA-area academic referral centers.
Imaging & diagnostics
In-house abdominal ultrasound (GE Logiq E10 with linear and curvilinear probes). In-house CT (Toshiba 16-slice). Full lab panel turnaround under two hours during operating hours. Cytology and bone marrow aspirates read in-house with confirmation through Antech or IDEXX as indicated. Endoscopy and colonoscopy with biopsy capability.
Pricing & estimates
- Internal medicine consult (45 min)
- $385 — includes case review of records sent in advance.
- Abdominal ultrasound (focused)
- $485 — includes a verbal review with the client and a written report to the GP.
- Abdominal CT (with contrast)
- $1,850 — inclusive of anesthesia, contrast, and board-certified radiologist read.
- Endoscopy with biopsies
- $1,650–$2,200 — depending on the procedure (upper GI, lower GI, or both).
"Internal medicine is mostly listening to the data the body has already given you, and then deciding which question to ask next."