The 2AM Consult

An abnormal CBC or a belly full of fluid can leave you with a lot of questions—and sometimes the best place to start is a slide.

In this episode of 2 AM Consult, Dr. Deer is joined by Dr. Nicole Weinstein, a board-certified veterinary clinical pathologist and founder of Birdbrain.vet, to talk about practical clinical pathology for general practice and emergency clinicians. Together, they walk through how to approach effusions and blood smears, and how the patient’s history and presentation can help put those findings into context.

Dr. Weinstein shares tips for preparing and evaluating effusion slides, recognizing inflammatory cells and bacteria, and interpreting those tricky mesothelial cells. They also discuss blood smear “deal breakers,” including anemias that can mimic IMHA, confirming a low platelet count, estimating white blood cells, and recognizing when an in-house analyzer result deserves a closer look.

Whether you love looking at slides or feel a little intimidated by your microscope, this episode is packed with practical ways to build confidence and make the most of the information in front of you.

In this episode, we discuss:

• Approaching effusions based on the patient, fluid appearance, and cytology
• Slide preparation and microscope tips
• Recognizing inflammation and looking for bacteria
• Chylous effusions and reactive mesothelial cells
• Blood smear findings in anemia and potential mimics of IMHA
• Platelet clumping, platelet estimates, and thrombocytopenia
• Estimating white blood cells and understanding the limitations of in-house analyzers
• Ways to practice and improve your blood smear skills

Resources from Dr. Weinstein:

• https://birdbrain.vet/ — clinical pathology education and resources
• Free resource for 2 AM Consult listeners
• Focus Vet Path — Dr. Weinstein’s diagnostic laboratory

When a cat starts peeing outside the litter box, it's easy to assume it's "just behavior." But the reality is much more complicated.

This week on 2 AM Consult, I'm joined by residency-trained veterinary behavior clinician Dr. Megan Petroff to discuss feline lower urinary tract disease (FLUTD), feline idiopathic cystitis (FIC), and why successful treatment often requires looking beyond the bladder.

In this episode, we cover:
• How to distinguish spraying from inappropriate urination
• The role of pain, osteoarthritis, and stress in FLUTD cases
• Environmental modifications that can dramatically reduce FIC flare-ups
• Litter box setup mistakes veterinarians and owners commonly overlook
• When prescription urinary diets, supplements, and medications are appropriate
• The growing role of veterinary behavior in managing recurrent urinary cases
• Practical tips to help owners increase water intake and successfully medicate cats

Whether you work in ER, general practice, or feline medicine, this episode is packed with practical pearls that can help you approach these frustrating cases more effectively—and potentially prevent future recurrences.

Whether it's a hit-by-car with an open fracture, a toy breed that jumped off the couch, or a cat with a mysterious hindlimb lameness, orthopedic emergencies can feel intimidating. In this episode of 2 A.M. Consult, Dr. Deer sits down with Dr. Rob Clark to break down the practical side of fracture management and referral.

Together they discuss how to approach orthopedic trauma without missing life-threatening injuries, grading and managing open fractures, splinting techniques that actually help (and common mistakes that don't), when fractures require urgent surgical referral, and how to recognize injuries that are easy to overlook—including Salter-Harris fractures, capital physeal fractures in cats, and pelvic injuries. Dr. Clark also shares tips for taking radiographs that are more useful for surgeons, interpreting soft tissue swelling, and why sometimes no splint is better than a bad one.

Whether you work in emergency medicine or general practice, this episode is packed with practical orthopedic pearls that will help you stabilize patients, improve referrals, and feel more confident the next time a fracture walks—or gets carried—through your doors.

Whether you've never seen a pet pig before or you occasionally find one trotting through your ER doors, this episode is packed with practical pearls to help you feel more confident when they do. Dr. Jessie Ziegler, board-certified large animal internist and clinical instructor at Midwestern University, joins us to break down the unique challenges of emergency and general practice care for pet pigs—from safe handling and sedation to diagnosing GI emergencies, interpreting diagnostics, and managing anesthesia and post-operative care.

We also dive into common emergencies like gastric impactions, foreign body obstructions, dog bite wounds, fractures, obesity-related arthritis, and salt toxicity, along with species-specific considerations for pain control, antibiotics, food animal drug regulations, and client communication. If pigs aren't part of your daily caseload, this episode will give you practical, evidence-based tips you can use the next time one shows up at 2 a.m.

Recurrent yeast infections are frustrating for veterinarians, uncomfortable for patients, and increasingly difficult to manage. But when a Malassezia infection doesn't respond to appropriate treatment, is it truly resistance—or is something else being missed?

In this episode of 2 AM Consult, emergency veterinarian Dr. Courtney Deer sits down with board-certified veterinary dermatologist Dr. Millie Rosales to discuss the growing concern of antifungal-resistant yeast infections in dogs. They explore how to recognize treatment failure, why recurrent otitis and dermatitis almost always have an underlying cause, and the practical steps every veterinarian can take to improve outcomes before reaching for another medication.

Topics covered include:
• Why recurrent ear infections are usually a symptom—not the primary disease
• When to suspect antifungal resistance versus poor compliance or uncontrolled inflammation
• The importance of ear cytology in every otitis case
• Managing inflammation to improve patient comfort and treatment success
• Practical approaches to recurrent otitis in ER and general practice
• Ear cleaners, long-acting medications, and selecting appropriate antifungal therapy
• When it's time to refer a patient to a veterinary dermatologist
• Why better surveillance of resistant yeast infections may be needed

Whether you work in emergency medicine or general practice, this episode is packed with practical dermatology pearls you can apply to your next itchy patient.

Whether you're working an overnight ER shift or seeing neurologic cases in general practice, neurology can feel intimidating—but it doesn't have to be. In this episode of 2 A.M. Consult, Dr. Deer is joined by board-certified veterinary neurologist Dr. James Cellini to break down some of the most common neurologic emergencies into practical, immediately applicable clinical pearls.

Together, they discuss the approach to seizure patients, choosing anticonvulsants, managing cluster seizures, assessing deep pain in IVDD patients, and why deep pain—not withdrawal reflexes—is one of the most important prognostic indicators. They also cover vestibular disease, differentiating central versus peripheral lesions, when time can be your best diagnostic tool, and how to approach referral conversations with pet owners.

Rather than focusing on complex neuroanatomy, this episode is packed with practical decision-making tips, common misconceptions, and real-world advice that emergency and general practice veterinarians can apply on their very next shift.

In this episode you'll learn:
• The first neurologic exam finding to assess in a comatose patient
• Practical seizure management pearls and rescue medication protocols
• How to differentiate withdrawal reflexes from true deep pain perception
• Medical management versus surgical considerations for IVDD
• How to localize vestibular disease and when to suspect central disease
• Tips for discussing neurologic referrals and prognosis with clients

If you've ever found yourself staring at a seizuring patient, a rolling vestibular dog, or a suddenly paraplegic Dachshund at 2 a.m. wondering what to do next, this episode is for you.

Episode Description

Seizures are one of the most common neurologic emergencies encountered in general practice and the ER—but they're also one of the most misunderstood. In this episode of 2 A.M. Consult, Dr. Deer is joined by board-certified veterinary neurologist Dr. Ryan Gibson to break down a practical, evidence-based approach to seizure patients.

Together they discuss how to distinguish seizures from other collapse events, the diagnostic workup for first-time seizures, when MRI and CSF analysis are (and aren't) indicated, and how to build confidence diagnosing idiopathic epilepsy. They also cover when to start anti-seizure medications, choosing between phenobarbital, levetiracetam, zonisamide, and potassium bromide, monitoring recommendations, rescue medications for cluster seizures, and what current evidence says about supplements, diets, and CBD.

Whether you're a GP veterinarian, emergency clinician, or veterinary student, this episode is packed with practical clinical pearls you can apply to your very next seizure case.

Can a patient lose vision in just a few hours? With glaucoma, the answer is yes.

In this episode of The 2 AM Consult, Dr. Deer sits down with board-certified veterinary ophthalmologist Dr. Alex Sigmund (The Vet Eye Guy) to discuss one of the most time-sensitive ophthalmic emergencies encountered in general practice and the ER.

Together they cover:

• What glaucoma actually is—and why it's a true emergency
• Primary vs. secondary glaucoma
• Breed predispositions and clinical signs
• Tonometry tips and common diagnostic mistakes
• Emergency treatment protocols, including when to use dorzolamide, latanoprost, mannitol, and aqueocentesis
• Pain management and long-term monitoring
• When to refer to ophthalmology
• Surgical options and when enucleation is the best choice

Whether you're a GP veterinarian, ER clinician, intern, or student, this episode is packed with practical, evidence-based pearls you can apply the very next time a painful red eye walks through the door.

Guest: Dr. Alex Sigmund, DVM, DACVO
Board-Certified Veterinary Ophthalmologist | Co-founder of The Veterinary Eye Team | @TheVetEyeGuy

CHAPTERS

00:00 Introduction to Dr. Sigmund and Episode Overview

00:36 What is Glaucoma in Veterinary Medicine?

01:30 Causes of Glaucoma: Primary and Secondary

02:32 Breed Predispositions and Screening Methods

04:13 Clinical Signs of Glaucoma in Pets

07:04 Diagnostic Approach and Criteria for Glaucoma

13:59 Medical Management and Emergency Protocols

19:59 Surgical and End-Stage Treatment Options

44:33 Key Takeaways and Final Advice from Dr. Sigmund

Welcome to the 2AM Consult Podcast! On this podcast I interview experts in the veterinary field about topics they wish they could share far and wide. You'll learn about diseases, procedures and so much more from those closest to the material.

Launching August 4th, new episodes every other Tuesday!