Internal Medicine

Care that goes deep

Get Help With the Challenging Questions

Pets that are referred to an Internal Medicine Specialist often have diseases that are difficult to diagnose, are multifaceted in nature, and involve several organ systems.
Internal medicine specialists are trained to treat the most serious diseases and health problems that affect pets. Our specialists are experienced with finding a diagnosis in challenging cases and have an arsenal of specialized diagnostic tools and methods available. They are capable of managing patients that have multiple disorders or diseases that do not respond well to standard protocols. Reaching a diagnosis and caring for a sick pet can be scary, frustrating and confusing. Our Internal Medicine Specialists are dedicated to allaying fears and helping clients to make sense of their pet’s options and ongoing care.

Internal Medicine Specialty FAQs

What is a board-certified veterinary internal medicine specialist?

A board-certified veterinary internal medicine specialist, commonly called an internist, is a veterinarian who focuses on diagnosing and treating the body’s internal systems. In addition to completing undergraduate training and four years of veterinary school, a board-certified veterinary internist is similar to his/her human-medicine counterpart in that he/she has completed an internship and residency in the specialized field of internal medicine (an additional 3-5 years training). In addition to this extensive training, a board-certified veterinary internist must pass two rigorous examinations to achieve board certification from the American College of Veterinary Internal Medicine.

Why should I seek the care of a board-certified internist?

Your veterinarian may refer you to an internist if a diagnosis is proving elusive or therapy is not proving effective; due to his or her expertise in internal medicine, the internist may be able to obtain a diagnosis or adjust treatment plans to get your animal back to health.

In some cases, when the diagnosis is known, an internist may confirm the diagnosis and treatment, providing peace of mind.

For what conditions might my family veterinarian refer my pet to an internist?

  • Anemia or other bleeding disorders
  • Chronic vomiting or diarrhea
  • Complicated pancreatic disease
  • Coughing & other breathing problems
  • Endocrine disease (adrenal tumors, complicated diabetes, thyroid disorders)
  • Infectious disease
  • Kidney or bladder disease
  • Liver inflammation
  • Unexplained weight loss

What is endoscopy?

Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope, an instrument that allows the examination of the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ. An internist specializes in using an endoscope to visualize the inside of the nose, the gastrointestinal tract (esophagus, stomach, and intestines), the trachea and bronchus (breathing tubes), and the urethra and bladder.

An endoscope sometimes can be used to retrieve foreign objects from the stomach, thereby avoiding an invasive surgery.

Internal Medicine Initial Appointment FAQs

How do I make an internal medicine appointment?

Boundary Bay Veterinary Specialty Hospital strongly encourages animal owners to obtain a referral from their regular veterinarian whenever possible. This ensures the proper transfer of medical information, is beneficial to the animal and the specialty veterinarian, and will help your companion receive the appropriate care.

Once your veterinarian has sent a referral, we will contact you to set up an appointment. If you have not heard from us within 24 hours of your veterinarian sending a referral, please contact a client care representative at 604-514-8383.

If you need guidance, are unable to obtain a referral, or do not have a veterinarian, please contact a Boundary Bay Veterinary Specialty Hospital client service representative at 604-514-8383.

When are internal medicine appointments available?

Initial Internal Medicine appointments are available on Mondays and Wednesdays.  Please contact the internal medicine service at 604-514-8383 if you have questions about an internal medicine appointment.

In case of an emergency: Should your pet become more ill or require immediate intervention before your appointment, please contact our hospital and we can see you on an emergency basis through the emergency service.


What is the cost of an internal medicine appointment?

The initial consult fee is $300.00 plus tax. Once your pet has been examined and you have had a discussion with the Internal Medicine Specialist regarding diagnostic and treatment options, you will be presented with an itemized treatment plan for the options presented to you. You may accept or decline any option.

What should I bring to my initial internal medicine appointment?

Please bring your pet and any current medications. Your family veterinarian should have provided records prior to your visit. However, it is a good idea to bring an extra copy of your pet’s records just in case. Please bring any x-rays/radiographs that have been performed. It is acceptable for your family veterinarian to send digital x-rays/radiographs prior to your visit.

How long is the appointment?

The initial consult may last up to 1 ½ hours. Diagnostic procedures, treatments and surgeries may sometimes be performed on the same day as your initial appointment or may sometimes be scheduled for a different day.  If your pet will be undergoing a procedure, you will be leaving your pet with us for several hours or for the day. We are open 24-hours per day, so animals may be picked up in the evening if necessary.

Recheck appointments may last up to an hour (or more if any procedures are required).  Some recheck appointments are done as drop-off appointments. Your pet will need to be dropped off before 8:30am and will be picked up in the evening.

Does my pet need to be fasted for internal medicine appointments?

Please do not feed your pet after midnight the night before your appointment; it is ok to give your pet water up until the appointment. Please call for instructions if your pet is diabetic, younger than 4 months, or less than 4kg (10 pounds).

What should I expect during my initial internal medicine appointment?

When you arrive for your appointment, please check in with Reception. The receptionist will advise the internal medicine service that you have arrived.

An internal medicine assistant or technician will bring you into an exam room with your pet, complete a history form, and perform a check of your pet’s vital signs (such as heart rate, temperature, etc). The internist will then review the information and examine your pet. Once this is complete, the internist will go over the diagnosis (or any further testing that may be required to reach a diagnosis) and treatment options. Depending on your animal’s condition, diagnostic testing or treatments may include:

  • Advanced laboratory testing of various tissue and blood samples;
  • Diagnostic imaging – ultrasound, radiography (x-rays), CT scans, MRIs;
  • Biopsies of masses, internal organs, or bone marrow;
  • Endoscopy – bronchoscopy (lungs), cystoscopy (bladder & urethra); colonoscopy (colon & small bowel), gastroduodenoscopy (stomach & upper intestines), rhinoscopy (nasal cavity), laparoscopy (minimally invasive surgery for biopsies of internal organs);
  • Feeding tube placement;
  • Nutritional consults.

Each option will be thoroughly explained so that you can make an informed choice for your pet.

A treatment plan will be prepared for you based on your pet’s specific needs. A treatment estimate will be explained and authorized by you prior to diagnostics or treatment.

We are often able to perform diagnostic procedures and treatments on the same day as your initial appointment, in which case you may be leaving your pet with us for several hours or for the day. We are open 24-hours per day, so animals may be picked up in the evening if necessary.

Internal Medicine General Service and Communication FAQs

Hours of Operation

  • Members of the IM service are in the hospital from Monday to Thursday from 9am – 5:00pm. The IM service is not in the hospital Friday-Sunday or on statutory holidays.
  • On days when the service is in the hospital, the IM team will endeavour to answer all your emails and phone calls. Please note that your questions and emails may be answered by any one of a number of people on the team (including veterinary technicians, assistants, or client service representatives) depending on the question. Rest assured that if it is not the IM specialist responding, the team members are responding at the direction of the Internal Medicine Specialist.
  • If at any point you have a concern about your pet’s health during one of these communications, please inform the team member of the decline in health status and provide as much information as you can.

In case of an Emergency

Should you need emergency care prior to your scheduled appointment or anytime after your appointment, the Boundary Bay Veterinary Specialty Hospital emergency service is open and fully staffed with veterinarians 24/7 to handle any emergency. You may call or bring your pet into the hospital at any time.

Fee Schedule*

Type of Exam
Initial Consult Up to 1 hour appointment in person (or by phone as necessitated by Covid) with the Internal Medicine specialist
**Recheck appointment Complex Up to 30 minute in person or by phone for recheck by Internal Medicine specialist and/or for repeat diagnostic imaging
**Recheck appointment Simple Up to 15 minute in person or by phone for recheck and/or recheck laboratory diagnostics performed
**Technician Recheck (Vitals recheck, PCV check)

*All charges are at the discretion of the Internal Medicine specialist at the time of the appointment and will depend on the status of the patient at the time of examination.

**Recheck appointments are additional visits within 6 months of the previous appointment. If you are calling for a recheck appointment and we have not seen your pet in the last 6 months or your concerns are due to a new problem, you will be required to pay for an initial consult.

Results and Follow-up

  • The initial relaying of results and follow-up questions will be handled by the veterinary technician or, in complex cases, by the Internal Medicine specialist.
  • If multiple follow-up calls are requested by you to go over diagnostic and treatment options, a recheck charge may be assessed.

Medication Refills

  • The number of medication refills allowed will be shown on your prescription.
    • Please make sure to call the IM service at least 3 working days prior to your last refill running out.
    • Compounded medications take longer to refill, and you should contact the IM service at least 1 week prior to the prescription running out.
    • Controlled drugs may also take longer to refill. Contact the IM service at least 1 week prior to the prescription running out.
      • Please note written controlled drug prescriptions are only valid for 5 days; they must be picked up from BBVSH and filled at a pharmacy right away.
  • Medication refill requests will be accepted only during IM working hours: Monday to Thursday 9:00am-5:00pm excluding holidays.
    • Refills outside of these hours will be granted for a supply only sufficient to last until IM is next in the building.
  • Additional blood tests may be needed in order to refill medications.  If you have no allotted refills, please call to make a recheck appointment or to discuss.

Communication with Your Primary Care Veterinarian

BBVSH works closely with your primary care veterinarian to ensure your pet receives the medical attention and care they need.

  • In certain situations, you can choose to have your recheck appointment bloodwork or imaging done with your primary care veterinarian.
    • Please note it is your primary veterinarian’s responsibility to directly relay the results of these tests to you within 24 hours.
    • If your primary care vet cannot directly relay the results of the test to you, we suggest you do all follow up appointments with the internal medicine team.
    • If your primary care veterinarian requests that IM deliver the results to you, there may be a significant delay and you will be assessed a recheck charge.
  • Results performed by your primary care veterinarian should be sent to us for our records. This may take a few days.
    • All results sent to us will be looked at by the Internal Medicine specialist. If the Internal Medicine specialist assesses that changes need to be made to the treatment plan, the IM service will call you to set up a recheck appointment or recheck phone call.

Veterinary Internal Medicine Services

Our Internal Medicine Specialist provides Diagnostic Evaluation and Treatment for the following conditions:

  • Endocrine diseases including diabetes mellitus, Cushing’s disease, Addison’s disease, hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoparathyroidism, hypoglycemia;
  • Gastrointestinal diseases including inflammatory bowel disease, chronic vomiting or diarrhea, esophageal and gastric foreign bodies, and gastrointestinal neoplasia and pancreatitis;
  • Renal and urogenital diseases including acute and chronic kidney disease, urinary incontinence or obstruction, urinary tract infections, and glomerulonephritis;
  • Hepatic and biliary diseases including lipidosis, acute hepatitis/hepatocellular necrosis, cholangiohepatitis, biliary obstruction, hepatic encephalopathy, chronic active hepatitis;
  • Immune-mediated and hematologic diseases such as immune-mediated haemolytic anaemia (IMHA), immune-mediated thrombocytopenia (ITP), Evan’s syndrome and polyarthritis;
  • Infectious diseases including Ehrlichiosis, Lyme disease, feline infectious peritonitis (FIP), fungal infections, and Leptospirosis;
  • Cardiovascular diseases including congestive heart failure, pericardial effusion, hypertension, and pleural effusion;
  • Respiratory diseases including rhinitis, nasopharyngeal polyps, bronchitis, pneumonia, and asthma.
  • Refractory diabetes, blood disorders, infections, digestive tract problems, hormone/endocrine or immune disorders, diseases of the kidney, liver, gallbladder, lungs and urinary or reproductive tracts.
  • Tracheal and urinary tract stenting
  • Feeding tube placements
  • Stricture dilation

Diagnostic and Treatment Procedures offered:

  • Comprehensive physical examinations
  • Advanced laboratory testing of various tissue and blood samples
  • Diagnostic imaging (ultrasound, radiographs, MRI)
  • Endoscopy with high-resolution video
    • Upper GI (Gastroduodenoscopy)
    • Lower GI (Colonoscopy)
    • Nose (Rhinoscopy)
    • Lungs (Bronchoscopy)
    • Bladder (Cystoscopy)
    • Foreign Body Retrieval
  • Biopsies of masses, internal organs
  • Bone marrow aspirates and biopsies
  • Feeding tube placement
    • E-tubes
    • PEG tubes
    • J-PEG tubes
  • Nutritional consults
Need a referral to Boundary Bay Veterinary Specialty Hospital?

Why Choose Us for Veterinary Internal Medicine?

Boundary Bay offers specialty veterinary internal medicine services; serving dog and cat owners throughout Vancouver, Surrey, Langley, Abbotsford, Maple Ridge, Burnaby, North Vancouver, West Vancouver, Chilliwack, the Interior and the Island as well as Bellingham, WA and northern Washington state. We invite you to consider the following reasons to entrust your pet to Boundary Bay’s internal medicine specialist.
Board-certified internist

Dr. Kim Hooi is available full-time for internal medicine referrals and consultations to determine if a referral might be beneficial.

Help with difficult cases

Internists perform advanced diagnostics and therapeutics for patients who are not easily diagnosed, that do not respond to standard treatments or have multiple disorders.

Specialized, minimally-invasive and rapid diagnostics

Our internists utilize endoscopic cameras to look inside your pet and find out what is wrong. Also at their disposal: CT scanner, MRI and C-ARM fluoroscope (enables real-time video images during interventions).

Team-oriented approach

Our internist works closely with other on-site specialists in critical care, surgery, radiology, oncology, cardiology and neurology to provide timely, collaborative, seamless care.

Download our Internal Medicine flyer

Meet Our Veterinary Internists

Dr. Kimberly Hooi


Board-certified Internist

Dr. Claire Johnston

DVM, Internal Medicine

Internal Medicine Specialist

Dr. Geert Paes


Board-certified Internist

Dr. Lydia (Po-ching) Pan


Board-certified Internist

Ask Us a Question

We’ll do everything in our power to help you make an informed decision!