Critical Care Veterinarian

04/08/2025

📸 SPOT THE MISTAKE: Active Learning Edition! 🧠🔍

Let’s play another round of “Spot the Mistake,” an educational exercise designed to sharpen your critical thinking and engage your brain, not just your memory.

👇 Here’s the scenario:
A 10-week-old kitten is presented after being found limping near a construction site. On exam, she’s BAR and non–weight bearing on her right thoracic limb, which is painful and abnormally positioned.

Dr. Pardo orders a lateral radiograph and gives buprenorphine (0.02 mg/kg) for pain and butorphanol (0.2 mg/kg) for sedation. The radiograph shows a mid-diaphyseal radial-ulnar fracture with an elbow luxation.

Dr. Pardo places a forelimb splint up to the elbow, prescribes meloxicam, and sends the kitten home. The plan is to recheck in 2 weeks to assess healing.

Here’s the radiograph. Something isn’t right. Maybe more than one thing. Can you spot it?

🧠 Why we’re doing this:
This is active learning in action. Instead of passively consuming facts, you’re:
• Engaging with real-world trauma management
• Thinking critically about orthopedic decision-making
• Practicing safer analgesia planning
• Recognizing red flags in case triage and discharge

👉 Your task:
Drop your observations below! What would you change? What’s missing? What safety considerations stand out?

Let’s keep this supportive and constructive. Learning works best when we teach each other with kindness.

29/07/2025

Allergic Reactions in Dogs: Why Benadryl Isn’t Always the Hero We Think It Is

You spot the hives. Maybe a swollen muzzle. The dog’s itchy, panting, and uncomfortable. Classic allergic reaction, right?

Most of us reach for diphenhydramine (Benadryl) without hesitation 🙋🏻‍♀️… but!!! a good derm friend .j_animal_dermatolgist taught me some important stuff recently!

🧪 Diphenhydramine has poor and inconsistent ORAL bioavailability in dogs.
Studies show it undergoes significant first-pass metabolism, meaning a big chunk of it gets broken down in the liver before it ever hits systemic circulation. That’s likely why it often doesn’t work as well when given orally, especially during acute flare-ups.

💊 Enter cetirizine (Zyrtec)
A second-generation antihistamine with:
• Better oral bioavailability
• Less sedation
• A longer half-life (once-daily dosing!)

⚠️ Clinical pearls:
• Cetirizine ≠ hydroxyzine. Don’t confuse the two.
• It’s still not magic, if a patient has respiratory compromise, hypotension, or vomiting → they need the ER, and treatment for anaphylactic SHOCK
• Always dose appropriately. Typical canine dose: 1 mg/kg once daily (max 10 mg).

💉 BUT…injectable diphenhydramine HCl is a different story.

It bypasses the liver, avoids that first-pass effect, and reaches therapeutic levels much faster. That’s why it can be effective during acute hypersensitivity reactions, especially when paired with other treatments like corticosteroids, fluids, or even epinephrine in more severe cases.

⚠️ But remember:
👉 If a dog is vomiting, has GI signs, or is unstable → oral meds are out. Go parenteral.
👉 If there’s tongue swelling, respiratory signs, or cardiovascular collapse → this is anaphylaxis, and antihistamines alone won’t cut it. You need epinephrine, oxygen, fluids, and fast action.

📚 ER takeaway:
• Oral Benadryl = meh
• Injectable Benadryl = helpful
• Cetirizine = better oral outpatient option

19/07/2025

Advocacy comes with a cost. And one of the most frustrating patterns we see, especially when people try to speak up or push for change, is being told that their tone, their message, or their voice is “unprofessional.”

Recently, I was told that my platform is “too political,” “too personal,” and “disgusting” because I dared to speak about justice, equity, and real lived experiences.

Here’s the truth:

🟡 Advocacy is not always comfortable.
🟡 Identity and lived experience are not distractions from professionalism, they’re part of what shapes it.
🟡 Disagreement is not the issue. Entitlement is.

We’ve lost the art of respectful disagreement in vet med (and honestly, in this country). We don’t have to agree on everything, but we do have to stay in dialogue.

Disagreeing means “I see it differently.” Entitlement says “change your content to fit what I want.”

Let’s be real: if you’re consuming free content from someone who is pouring time, energy, and expertise into educating others, it is not only ungrateful, it’s absurd! to demand they deliver it in a way that makes you more comfortable. This is a personal page, not a public service built to cater to your worldview.

If you don’t like someone’s content, you can scroll. You can unfollow.If you’re curious, ask questions, with humility.

But don’t expect people to edit themselves to fit inside your version of “professionalism.”

This field doesn’t need more silence. It needs courage. It needs boundaries. And it needs more people who can disagree without trying to control the conversation.

You don’t owe anyone access to your story, your platform, or your labor. Especially when they show up with judgment instead of curiosity.

Let’s normalize advocating with clarity, holding boundaries with kindness, and staying open to respectful dialogue even when we don’t agree

18/07/2025

Making a Cat Vomit: The Ultimate Humbling Experience

Trying to induce emesis in a cat is like trying to give a bath to a cloud made of 🔪!

Historically, our only options were:
🔹Injectable dexmedetomidine (sedation, maybe vomit, maybe just judgmental drooling)
🔹Hydromorphone (ehhh… 20–30% success and now your patient is dysphoric and constipated)

But now? There’s a better way. Enter: oral dexmedetomidine (transmucosal)… and yes, it actually works!

Indication:
For emesis in clinically stable feline patients with recent ingestion of:
✅ Non-corrosive toxins (e.g. lilies, rodenticides)
✅ String/ribbon (if not symptomatic)
✅ Drugs (e.g. human meds)

Dose & Route:
• Dexmedetomidine 20 mcg/kg (yes, really)
• Administer transmucosally (buccal/sublingual)
• Onset: Vomiting in 5–15 minutes
• Reversal: Atipamezole IM if needed

Why Oral Dexmedetomidine Works:
Alpha-2 agonist activity in the chemoreceptor trigger zone, it doesn’t need to be absorbed systemically to trigger emesis.

Pros:
✔️ 70–90% success rate (100% for me so far!)
✔️ Non-invasive
✔️ Cheaper and faster than endoscopy/surgery
✔️ Avoids unnecessary sedation

Cons / Caveats:
• Bradycardia, hypotension, heavy sedation
• Avoid in ❤️ compromise or foreign body risk
• Requires close monitoring and reversal on hand

Backed by Research: (my favorite kind)
Studies like Maxwell et al. (JFMS 2024) support safety and efficacy of transmucosal dex for feline emesis.

Disclaimer: No cats were spun in the management of this case

Ready to try this out? Want to share your experience?

17/07/2025

16/07/2025

Let’s play a round of “Spot the Mistake”

This is an educational exercise designed to sharpen your critical thinking and engage your brain, not just your memory.

👇 Here’s the scenario:
It’s a busy day in the ER and Dr. Pardo decides to help the nursing staff by setting up an insulin CRI for a 12 kg Miniature Schnauzer recently hospitalized with DKA. She adds 26.4 units of regular insulin into a 250 ml bag of 0.9% NaCl, inverts it to mix, attaches it to the patient, and starts the CRI at 10 ml/hr based on the sliding scale she printed for the nurses. She informs the nurses of how helpful she’s was before going to see the next case.

Here’s a photo of the setup and the bag.

👉 Your task:
Drop your observations below! What would you change? What’s missing? Did Dr Pardo mess up?

Let’s keep this supportive and constructive, learning works best when we teach each other with kindness. (but be honest, and analyze this case well, what did I miss, what would you do differently, maybe I was perfect? 🤩, don’t worry I can handle it!)

14/07/2025

📚✨ I’m honored to attend the very first VetECCed Conference, the first emergency and critical care conference dedicated to education itself!

Not just what we teach, but HOW we teach.

As veterinarians, we’re constantly learning. But how often do we stop to ask:
👉🏽 Are our learners really absorbing what we’re teaching?
👉🏽 Are we reaching them in a way that sticks, in the chaos of ER, the overworked nurse, the sleep-deprived intern, or the steep climb of ECC board prep?

VetECCed is grounded in the science of education: cognitive load theory, adult learning principles, psychological safety, and measuring teaching outcomes, not just content delivery. It’s about intentional teaching, where we learn to communicate complex, high-stakes medicine in a way that builds confidence, not confusion.

💡 Because knowing something isn’t the same as knowing how to teach it. (I’m sure we we can all relate to having known a brilliant clinician that wasn’t a good teacher)

Whether you’re a mentor, intern director, conference speaker, or just that doctor who always has a student shadowing you, what we say, and HOW we say it, changes lives, it makes an impact, they remember it.

I’m here to grow as a better educator, a more impactful communicator, and a more compassionate teacher. Because knowledge is only power if we know how to share it.

What are your teaching or learning struggles?

12/07/2025

🦴💥 Intestinal Bone Impaction

This abdominal radiograph shows dense, mineralized material consistent with bone fragments impacted in the colon, often the result of feeding cooked or raw bones.

❗While bone impactions are commonly viewed as mechanical, the secondary effects can be much more dangerous:

🔬 Mucosal irritation & inflammation
Fragmented or compacted bone abrasively damages the intestinal mucosa, triggering localized colitis, edema, and painful tenesmus. Sharp fragments may embed in the wall, causing focal ulceration.

🦠 Bacterial translocation & systemic inflammation
As mucosal integrity breaks down, gut bacteria may translocate, leading to endotoxemia, systemic inflammatory response syndrome (SIRS), or even sepsis, especially in prolonged cases or debilitated patients.

💉 Hematochezia
Bloody diarrhea is common, typically due to colonic irritation or mucosal ulceration. The bleeding may be mild or profuse depending on the degree of trauma and mucosal sloughing.

💣 Risk of perforation & peritonitis
Though rare, sharp edges or progressive pressure necrosis can lead to intestinal rupture, particularly in the distal colon or re**um. Radiographic signs of free gas, peritoneal effusion, or decompensation warrant urgent surgical intervention.

Don’t underestimate the “constipated bone dog”
Some cases resolve with fluids, osmotic laxatives (PEG CRIs), and enemas, but others require manual deobstipation under anesthesia or colotomy if refractory (very severe cases- no one wants to cut into a colon!). Always assess for pain, sepsis, and signs of obstruction beyond the colon (e.g., ileocecal impaction).

📸 Save this case. Teach your team. And gently remind clients: bones can kill.

08/07/2025

🔬 Ever seen “green granules of death”?

A rare, ominous sign in canine bloodwork—blue-green cytoplasmic inclusions in neutrophils, should make you pause. Fast.

🟢 These inclusions (also seen in monocytes) are associated with acute severe hepatocellular injury, often with fulminant liver failure, sepsis, or multiorgan dysfunction. Think DIC, hypoglycemia, massive ALT/AST spikes, and rapid clinical deterioration. Death often follows within 24–48 hours.

🧪 Believed to be lipofuscin, bile pigments, or degraded organelles, these granules are rare but real. You won’t see them often, but when you do, consider it a red (green?) flag.

👀 Spotting them under the microscope may prompt urgent action:
→ Discuss poor prognosis with the family
→ Prioritize stabilization
→ Rule out underlying causes like leptospirosis, SIRS, or toxins

📸 Don’t forget to document and save a slide. These cases make excellent teaching moments, morbid, but memorable.

This was a 3 year old SF Golden with acute liver injury of unknown origin, negative leptospirosis, positive anaplasma with few hypoechoic splenic and liver nodules, this cytology was from the scant ascites. Unfortunately, despite intensive care she declined and developed ARDS 48 hours into her hospitalization.

🐶 Have you seen green granules before? Drop your case below 👇

05/07/2025

Every summer, we see it: dogs presenting with painful, peeling, sometimes necrotic paw pads after exposure to hot pavement, asphalt, or sand. Surface temperatures can exceed 150°F (65°C) under direct sun, even when ambient temps feel mild.

🩺 Pathophysiology
Digital and metacarpal/metatarsal pads are highly vascularized but poorly insulated. Prolonged contact with hot surfaces can cause:
• Partial or full-thickness epidermal necrosis
• Sloughing of keratinized pad epithelium
• Secondary bacterial infection
• Exposed dermis → severe pain + infection risk

📋 Clinical Signs
• Lameness or reluctance to walk
• Vocalizing with pressure
• Erythema, ulceration, sloughing
• Excessive licking/chewing
• +/- systemic signs (fever, lethargy) in severe cases

🧪 Diagnostics
• Physical exam: assess depth, drainage, secondary infection
• CBC/chem if systemic signs are present
• Culture if purulent or non-healing
• Rule out differential trauma (e.g., chemical burns, frostbite, immune-mediated dermatoses)

Treatment Protocol
🔹 Mild burns (superficial erosions):
– Topical antimicrobials (silver sulfadiazine, mupirocin)
– NSAIDs for pain/inflammation
– E-collar to prevent self-trauma
– Daily bandage changes or open wound care if tolerated

🔹 Moderate to severe (deep ulceration, dermal exposure):
– Systemic analgesia: gabapentin, opioids if needed
– Broad-spectrum antibiotics if infected
– Silver-impregnated dressings or hydrogel
– Soft padded bandaging with non-adherent layers
– Sedation or anxiolytics for bandage tolerance

⛑️ Supportive care
– Strict activity restriction
– Protect from environmental exposure (booties, grassy areas)
– Rechecks every 48–72h initially
– Full re-epithelialization may take 1–3 weeks

🧠 Client Education Tip
Use the “7-second rule”: Instruct owners to place the back of their hand or bare foot on the pavement. If it’s too hot to hold there comfortably for 7 seconds, it’s too hot for paws. Simple, effective, and easy to remember.

23/06/2025

I can’t stop thinking about this.

I need to order a passport card… not for travel, but because I need something I can carry to prove my citizenship.

Because I’m Latina. PROUDLY LATINA.

Because of how I look. Because that’s what this country feels like right now.

I’ve spent 5 years doing DEI work, speaking, teaching, building spaces where people can feel seen and be heard. This is not easy work… you face the worst of what humanity can do while trying vehemently to remain hopeful that we can still change the world and make it more equitable and fair. I’m usually pretty resilient in this work… but this week, I’m not ok.

I’m seeing Latinx families ripped apart. Children screaming for their parents being ripped away from them. People being profiled, detained, disappeared. Here. In the USA, land of the “free”. This is happening.

And now there’s war on the horizon, after the U.S. attacked Iran. More fear. More violence.

How do I explain this to my kids? How do I tell them this is the country they’re growing up in? That their mom, a doctor, an immigrant, a citizen, feels the need to carry papers to prove she belongs. How do I watch them sleep and not look up how many miles away from NYC are we in case of an attack? How do I control the rage I feel that my children are now in even hypothetical danger because of our president wants to be a dictator. How can anyone watch these videos and not breakdown is beyond me?

The anger sits in my chest. The heartbreak doesn’t fade.

But here’s the thing: I will never stop fighting. For my children. For your children. For all of us.

And for anyone reading this: if you voted for Trump, it is okay to change your mind now. In fact, it is necessary. None of this is normal. None of this is acceptable.

This is a human rights crisis. And it demands all of us. Speak up. Show up. Vote. Refuse to look away.

Because if our kids are watching, and they are, I want them to see that we stood up. That we never stopped. That we believed in something better, and fought for it with everything we had.

ImOnAListForSure

16/06/2025

🚨Raw, Uncooked, Freeze-Dried, “Natural” — BEWARE THE RISKS!

Lately, I’ve been seeing a huge increase in pets come into the ER in critical condition. Fevers above 105°F, signs of sepsis, and in some cases, confirmed infections that trace back to one common source: RAW DIETS AND TREATS

Whether it’s labeled as “raw,” “freeze-dried,” “unpasteurized,” or “minimally processed,” the risk is the same. These diets can harbor bacteria (like Salmonella, E. coli, Listeria), parasites, and even highly pathogenic avian influenza (bird flu).

These pathogens don’t just make pets sick. They can be zoonotic, meaning they can infect humans too, especially kids, elders, and immunocompromised family members.

This isn’t theoretical. It’s what I’m seeing on the ER floor, from a couple cases a month to several per week now. Why is there an increase and severity of cases?

🚨 Federal food safety protections are getting weaker.

Recent cuts to USDA and FDA funding have led to fewer inspections, slower outbreak detection, and less testing of pet foods. That means contaminated products are more likely to slip through the cracks—especially raw and minimally processed diets.

📣Marketing Tricks That Rebrand “Raw

Pet food companies often avoid the word “raw” entirely, instead using buzzwords like: Freeze-dried, dehydrated, air-dried, uncooked, minimally processed, ancestral, paleo-inspired, whole prey model, natural, clean, human-grade, farm fresh, instinctual feeding, raw-inspired, wilderness blend, wild-fed, etc.

I’ve recently treated a dog that developed pericardial effusion, joint effusion , diarrhea that spent many days in hospital recovering from a custom raw diet from Oregon, I euthanized a neurologic 2 year old cat that we suspect had bird flu that was eating Target’s Kindful freeze-dried treats and we are still waiting on their internal investigation, almost EVERY severe AHDS case I’ve seen lately that is sicker than usual, in septic shock and requering much more intensive treatment, broad spectrum antibiotics, dewormers and longer hospitalizations.

The THEORETICAL, unproven benefits of raw diets do not outweigh the MASSIVE RISKS when they do occur.