Internal Medicine

Derek D. Nestor, DVM, DACVIM

Derek Nestor, DVM, ACVIM joined Iowa Veterinary Specialties in 2005 as the staff internist. He spent two years in a general practice in West Des Moines following his 1999 graduation from Iowa State University. He then completed a one-year internship at the University of Illinois and a two-year residency at Michigan State University. Dr. Nestor achieved Diplomate status in the Specialty of Internal Medicine in the American College of Veterinary Medicine in 2005 and is currently Des Moines only board certified Internist. Most recently Dr. Nestor comes to IVS from a private referral practice in Milwaukee, Wisconsin.

As Iowa Veterinary Specialties staff internist, Dr. Nestor performs services such as endoscopy, abdominal ultrasonography and echocardiography, bone marrow biopsies, general biopsies, and spinal taps. These services are generally provided on a referral basis through your family veterinarian.

Endoscopy is a broad term used to describe the examination of the inside of the body using an instrument called an endoscope. The endoscope is often used to view and search the gastrointestinal tract as well as airways and examination of organs. Endoscopic procedures are generally performed for two reasons, diagnostic or therapeutic. A diagnostic example would be using the endoscope to take biopsies of various tissues which are then sent to a laboratory for diagnostic evaluation. A therapeutic example is the removal of a foreign object from the stomach or trachea/lungs.

Colonoscopy: An endoscopic procedure through which the colon is examined via the anus.

Gastroduodenoscopy: Examination of the stomach and duodenum through endoscopy.

Bronchoscopy: Visual examination of lungs tissue via the mouth using an endoscope.

Rhinoscopy: Examination of the nasal cavity via the nose or the back of the throat through endoscopy.

Cystoscopy: An endoscopic procedure through which the urethra and bladder are examined.

Chemotherapy is the chemical means of treating an illness. The most common uses of chemotherapy by Dr. Nestor are lymphoma, bladder cancer, and mast cell tumors. The treatment of each patient is unique, but treatment often includes multiple visits involving blood work and chemotherapy.

This chemotherapy process is relatively safe for both owner and pet; however caution by the owner is needed for the first 48 hours after a treatment. Any discharge (urine, feces, and vomit) is considered “contaminated” during this time so owners should protect themselves by wearing gloves while removing these contaminants from the environment. Owners should remove fecal matter from the yard immediately after defecation and any “accidents” inside the home should be wiped and removed immediately from the environment. 

If an accident occurred in the home, the owner should avoid “spraying” a cleanser directly on the site to avoid aerosolation of the contaminant. Instead a cleanser can be poured onto a rag or towel, and then the area can be wiped down once the contaminant has been initially removed. Any contaminated discharge and all items to clean and/or remove should be double bagged and taken to the trash bin immediately.

As previously mentioned, chemotherapy is relatively safe for your pet, but each pet will respond differently. The most commonly seen “side effects” include lethargy (tired, lack of energy), anorexia (lack of appetite), and vomiting. If the owner sees any of these symptoms at any time during their pet’s treatment, you should notify Iowa Veterinary Specialties immediately.

Ultrasonography is another diagnostic tool available at IVS. Ultrasonic waves are directed toward tissues in the body and then reflected back to produce an image or echo. This technique can provide further visual detail to the area of concern, which may not be obtainable via radiographs.  This procedure is non-invasive to your pet, but will require shaving of fur in the area of interest. Ultrasonography can also be used in conjunction with biopsying to ensure precise placement of the biopsy instrument.

Bone marrow biopsies are commonly performed at IVS. As previously mentioned, ultrasonography can be used to assist the biopsy process. Bone marrow aspirates are obtained to test for disorders of the blood such as anemia. The two most common sampling sites for bone marrow biopsies are the hip and the shoulder.

Other general biopsy samples can be taken from all kinds of tissues. The samples are prepared by a pathologist and examined microscopically. Diagnoses ranging from infection to cancer can be made via biopsy.

The last service to be discussed is spinal tapping. This procedure involves placing a needle into the spinal column and withdrawing fluid. There are two regions of the spinal column which are used to harvest spinal fluid. A cisternal puncture is made in the neck region while a lumbar puncture is performed in the lower back. Most of the spinal taps performed by Dr. Nestor are made with a cisternal puncture. Typically, this process diagnoses meningitis or other diseases of the brain.

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