Off topic...Let us please take a moment to mourn Dr. Khuly's 1.5 year-old MacBook whose life was cut short by a fatal hard drive crash last Saturday night. Forgive her the lack of a Sunday post, which was the result of all her recent files having expired with it...as well as her having to run around like a headless chicken to scrape up the funds to purchase a new one. And they say vet care is expensive...sigh...

Dr. Patty Khuly January 26th, 2009 10:25:22 AM

AW  And your Macbook took a dive on 25th anniversary of the Macintosh, too!  I'm sorry about that--I had a similar thing with my beloved iMac, and now I have an external drive :P

Back to fleas---I do not see nearly as many, since I am up north, and often when I do, I just find the dirt and no live insects.  I keep my tone light and explain that a lot of pets are allergic to fleas and you only need one bite from one flea to be itchy--you don't need to be crawling with fleas...and then I can generally get my indoor cat owners (which are legion in our practice) to try some Frontline or Advantage, and maybe a dose of Capstar to get rolling.  I'm in a foo-foo sort of area, so a lot of folks are so grossed out with the idea of parasites, the Capstar tends to be a no brainer.

I recently had a client who claimed that her dog came home from a dental procedure with fleas--she's never had an issue before, etc...how do you handle those.  I'm sure you hear that one.  I actually do suspect we DID have a cat who was overloaded in that same day though...I never suggest to client that they absoultely could not pick up fleas here, and we do review how we handle such things in the future.

drsteggy January 26th, 2009 11:10:50 AM

I'm so sorry about your laptop and your files! That's awful. 

Re. the post: I've been this caretaker! It wasn't quite the same scenario, since my cat's problem was a hotspot. The vet didn't say that he had found fleas or flea dirt; he just suggested that the reaction may have been to a fleabite. I still don't think that any of my cats had fleas at the time. But I do remember that when I said that I was pretty sure it wasn't fleas, my vet's reaction had something of a "yeah well sure okay in that case then" to it (though he did suggest a lot of other things that it could be). I didn't know that people regularly denied the presence of fleas to their vets; I'm amused.

Though I have had the awkward "my animal doesn't have fleas" conversation with other people before. Is there a difference between a flea here or there on an outside animal, and an outright INFESTATION, that people often won't recognize the former? Or are we only seeing 1 out of 20 bloodsuckers anyway, and it's always a big deal? (Even apart from quality of life issues, just one flea seems like a big deal to me since I learned that they can carry disease, ugh!)

Sarah January 26th, 2009 11:16:17 AM

I took my elderly, 11 pound rescue to the vet with hotspots and he spent 20 minutes combing through her long hair. Yes, I use Frontline regularly, bathe my dogs at least monthly, groom twice weekly -after about 10 minutes I asked what he was looking for -fleas of course. I was mildly offended. He didn't find any fleas or signs of flea dirt,  but was willing to keep combing until the cows came home! Um, sometimes we ARE sure the pet doesn't have fleas.

But I am just as sure there are a lot of dogs (and cats!) whose owners are totally clueless.

drsteggy - gotta love that Capstar! We have used it in rescue for years. I don't have fleas in my house - and I want to keep it that way!

robinsdogs January 26th, 2009 11:23:03 AM

Sorry to hear about your laptop Dr. K... As a technician checking in appointments before the doctor would arrive, one tactic that I successfully used was to ask about other pets in the household. If I could, I would have the owner bring the other pet in or flea comb the pet "without the problem" or the one that "never itched". Almost invariably I could find live fleas on the other pet. Now...to be honest, I didn't come up with that myself. Before I joined this wonderful industry I had multiple cats, one of which (my older Siamese, Tawn Lea) had bare patches on the backs of her legs. When we went to our local veterinarian, we took our Himy (Gar) along for the ride (and maybe vaccines). One swipe of the flea comb through Gar's long blue hair was all it took to see that fleas were the culprit!! Great post!

Tomcat January 26th, 2009 11:26:23 AM

Interestingly, in the bird world we often hope for something simple like fleas - the reason we're looking in the first place is that the bird is plucking. If it's not something simple and external like fleas, it could be something internal and potentially fatal, or something psychological and extremely difficult to solve.

zandperl January 26th, 2009 11:38:22 AM

I had the experience where I swore my dog DIDN'T have fleas, till the vet tech found one. :facepalm:

I apologized for being an idiot and bought more flea stuff.

Janice in GA January 26th, 2009 11:48:04 AM

DrSteggy: I do what you do in the case and owner swears the fleas came from our place. It's always possible, right? And Capstar is so cheap and safe (for one dose, anyway). It's definitely one case where "the client is always right" holds, whether it's true or not.

Dr. Patty Khuly January 26th, 2009 11:57:28 AM

I'm so sorry for you loss!  Mac just doesn't make them like the old System 6 Mac SE any more. :)

I'm in a Houston condo and just left a nearly 3 year stint on the condo board.  No, no way, nobody has fleas.  The COMPLES has fleas but they didn't come from anyone's dogs or cats or homes!  Yeah, sure, uh huh, OK, WHATEVER.  It took a few months of ranting (not blaiming just repeatedly pointing out this is HOUSTON and the nasty little bugger fleas thrive here year round; they just ARE and have to be dealt wtih communally for everyone's sake) but everyone is less defensive now and more willing to deal with it.  The complex sprays the grounds quarterly.  I put out an email post to the community periodically that starts with: "You have pets?  You have fleas.  You have carpet?  You have fleas.  You don't have pets or carpet but live in a condo here?  You probably have fleas because we have 40+ dogs around here and an untold number of cats and other pets and those buggers will hitch a ride in on YOU."  I go on to cover cleaning in the corners, bombing, spraying, spot ons, oral meds, and am downright pushing Capstar (which I personally think should be declared the miracle drug of the last decade).  I'm even up to recommending citrus plants for those resistant to chemical destruction (which I'm not a fan of either but will resort to when dealing with fleas or roaches).  When I moved into the condo, it was INFESTED with fleas from prior pets.  My poor dogs had never seen one at the Missouri farm.  It took almost a year to thoroughly erradicate them (or as close to that as is possible in Houston because I'm under no delusions that there's a couple of them sneaking past me every single day around here).

Could you do worms tomorrow?     :)

PJBoosinger January 26th, 2009 12:36:13 PM

I like the ones who, when I find fleas or flea dirt on their pet, they exclaim "He must have gotten them from your waiting room, I don't have fleas at my house"

Hobson January 26th, 2009 12:58:42 PM

OK so that's true on the flea feces. If your pet's got flea "dirt" he definitely didn't get them overnight.

Dr. Patty Khuly January 26th, 2009 01:11:13 PM

^*^ That's a lightbulb going off.  I'm reading Vets talking about Capstar???!!!  Neither my current or former Vet had Capstar in their anti-flea arsenals when I sought their advice!  I found it on the internet and neither of them could even tell me if they thought it was safe when I asked in 2006 and 2008.  I thought it must be brand new but just found out it's been around since early 2001.  I really do GOTTA find a new Vet before annual exams in June!!!  That bites.  I like one of them and thought I could trust him quite a bit.  He was my Vet for years the last time I lived in Houston but, after 35 years in practice, he may be stuck in his ways or just not keeping up any more.

PJBoosinger January 26th, 2009 01:13:37 PM

oh Dr Patty, invest in the extended warranty for your new MacBook.  Laptops are fragile things.

It's a sure guarantee that if you pay for the warranty, your laptop will be fine until the month after the warranty expires in 3 years.

What is this Capstar of which you speak??  We don't have a big problem with fleas in my northern plains state... but the bunnies and ground squirrels are apparently great hosts, and my dogs are picking them up even though I use Frontline (the fleas are few and mostly dying but still I'd rather not have them). I've been spreading diatomaceous earth around the bunny and squirrel holes.

EmilyS January 26th, 2009 01:36:55 PM

Capstar is an oral flea killer that lasts 24 hours. It starts working within minutes and has been a great help for our most flea-allergic pets or pets who pick up fleas only when they go to the puppy park, etc.

Dr. Patty Khuly January 26th, 2009 02:21:59 PM

Our staff takes the same approach you do, Dr. K. I have to admit it's pretty satisfying to pick a flea off a pet whose defensive owner swears up and down there are no fleas...and I'd say we're able to do that in 80% of our skin issue pets. I really don't get why it's even an issue for some clients. Fleas are bugs. Are there bugs in your yard? Do you get bugs in your house? Then why is a flea infestation such an unlikely scenario? And it's so hard sometimes to convince people that they need to treat their environment, too - it only makes sense that if your pet picked up fleas and has been in your home, your home has fleas, even if you can't see them. And it's not the pet that's the problem - they're just the preferred food source. I find it strange that people are ashamed of fleas...it doesn't mean that you don't take care of your pet or that your house is unclean. I live in Oklahoma...everybody has fleas, pretty much year-round (just a few days ago it was in the mid-seventies!). I always make sure to tell clients that every member of our staff, including the docs, have to be vigilant with their flea/tick preventives, too, or we'd have the same problem. Btw, I love Capstar, too...unfortunately the markup at my clinic means we have few clients who are willing to pay that much for something that only lasts 24 hrs. :(

anna January 26th, 2009 02:57:51 PM

There are actually folks like that ? Especially in florida and loke climates? good lord every time i see a pet of mine scratching i look for parasites and have no trouble telling my vet or any bidy who will suggest a remedy.

Jim January 26th, 2009 04:03:18 PM

As "anna" said people (some people) equate fleas with uncleanliness and with fault - I own a doggie daycare and boarding kennel, frequently people come in with fleas I mention it of course and the standard reply is "well they must of got em while here" I say, well If I was a flea I would love to live here so that's possible (even though I know it is unlikely ).  I had a elderly lady tell me that it was impossible that her dog got fleas at her house because her house was spotless - she was soooo offended that I would even imply that her poor housekeeping practices could of  led to Fluffy having a flea ;)  I immediatly apologized and told her that fleas on a dog does not mean dirty house but she was sure that it happended here so I apologized for that too LMAO

sorry for your laptop loss !!!!

LC January 26th, 2009 04:31:47 PM

There is/was a sign at the Clinic that pets that come in for extended stay (surgery/dental, etc) will be treated for fleas if "seen". I was pretty glad to read that and think it is totally appropriate.

It has been some years, but I seem to remember a few flea bites on my legs/ankles...how can anyone "not notice" an indoor festation?

Barbara A. Albright/NH

added a 'family' photo page to my website: http://clik.to/scotty

Pocket's Story from NH January 26th, 2009 08:07:10 PM

We haven't missed a dose of Frontline, nor have we had fleas.. We learned our lesson.. We delayed using Frontline on Socks, as I felt he was too small (3.3 lb at eight weeks), and didn't want to take a chance on compromising his neurological development.. At four months he  had ear mites.. The vet was so kind to pick the 8 yo up to see the mites under the microscope.. At six months, we pulled  four ticks off his face..  After that Socks has it on schedule.. 

I've seen people with flea bites.. it's not a pretty picture...

Now that we're on the subject of insects.. What do you think about maggots for medical treatments?

barri January 26th, 2009 08:12:25 PM

What about the reverse problem. The client that swears up and down their pets scratching HAS to be caused by fleas despite any evidence of them? It's hard to convice someone that their pet could have an allergy to food, environment, a hotspot, staph infection, etc. But they'll go on and on about wanting 'just a flea treatment and that will fix 'em all up doc'. *sigh*

cl January 26th, 2009 08:24:40 PM

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sameh January 26th, 2009 09:22:46 PM

For those of you who love Capstar....heard of Comfortis?? It is a pill that given to dogs(not approved for cats just yet) will start killing fleas very quickly and last for 30 days!! Have you had the experience with it yet Dr. K?? Also for those of you who use Capstar have you given it or did you know you could give it rectally?? It is great for those surgical patients that you find the dirt and/or they are the land sharks that you couldn't get a pill down if you tried. You can give it rectally while asleep although I guess you could also do it awake...but it still works great and you get to keep all your fingers!!

J.C. January 26th, 2009 11:38:01 PM

J.C.: er...thanks for the Capstar tip...I think. ;-)

On Comfortis: Yes, it's the once a month pill for dogs only. I use it on one of my dogs (he's very flea allergic and it works great for him). It DOES, however, have side effects that 12% of dogs reportedly experience: GI signs like vomiting, diarrhea and inappetance. It cannot be used for dogs with seizure disorders. But it DOES kill fleas as well as Capstar at a much lower price.

Dr. Patty Khuly January 27th, 2009 09:31:55 AM

Here a re a couple of posts on Comfortis: one and another.

Dr. Patty Khuly January 27th, 2009 09:33:49 AM

For those in denial, I like to tell them what else is living ON or AROUND them.  People are generally in denial of all the microscopic life around them and especially that carpet is literally alive and most of them seem to be determined to stay oblivious and in denial rather than deal with the "ick" factor they perceive.  Barbara, if there's critters in the house, the fleas generally go for them instead of the humans so many don't/refuse to notice; these types absolutely refuse to do the white sock test too!

For EmilyS and anna (please don't shoot me Dr. K). I buy the 57 mg doses and own a pill splitter (yeah, I know, not scored, yada, yada...) which makes it about 85 cents per small cat dose, expensive if used daily but quite reasonable for periodic "boost" in an overall program. http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=10902

Comfortis?  Thanks J.C.  I didn't know about this one.  It looks like it still requires a script and needs monitoring when used along with ivermectin but I'll be keeping an eye on it now.  :)  It's also a chewable so probably has stuff in it at least one of my critters would likely be allergic to. :(

PJBoosinger January 27th, 2009 09:48:22 AM

Dr. K, thanks for the internal links.  I did try using altavista to search but I get a hit for each and every comment to each post so my search brought up 788 hits for three Doolittler articles.  I'm not always up to sifting that many. :)  Pick on that tech person about internal searching please.

PJBoosinger January 27th, 2009 11:10:04 AM

Comfortis and ivermectin in heartworm prevention can be a bad combination for many collie and 'collie-type' breeds (ex. Bearded collies, Aussies, Silken Windhunds), so picking a different flea med (and often a diff HW med) is smarter.

KateH January 28th, 2009 03:55:52 PM

Oops, sorry, Dr. K. I just chimed in before clicking on your links - which the first one explains what I said so much better!

KateH January 28th, 2009 03:57:27 PM

Over the summer I through a period in which 3 of my 4 cats were scratchign excessively. Even though I combed and saw no flea dirt, nor fleas, I did 2 mos of Frontline. They were still scracthing. Vet confirmed she saw no fleas. I don't know what it was. Ironically, now they aren't scratching maniacally, in spite of the insane indoor dry heat (the humidifier is just not doing the trick). I'm the one who is scratching like a fiend.

Stefani January 28th, 2009 04:13:02 PM

I'm probably one of those "my dogs don't have fleas" owners. When I say that at the dogs annual wellness checks, my vet ALWAYS nonchalantly whips out his little comb and starts looking. And looking. And looking. Has never found one, nor flea dirt. I've never had a dog with fleas. Never. And I've lived with my 3 dogs all over the US. From the deep south to Michigan, to California. Never a flea. Why is this? Hard to believe its pure luck, all those dogs, for so many years, in so many states. Equally hard to believe I'd miss seeing the signs. I've entered houses with flea infestations, and I'm acutely allergic to fleas and their bites are unmistakable to me. Why don't my dogs have fleas? (not that I want them...but I'm just asking). My vets NEVER stop saying that I need to have them on flea preventative...but I reply that the day I see one on my dogs, or see flea dirt, I'll be right in. Chris, mom of 2 Dobes and a Great Dane.

chris January 30th, 2009 02:10:49 PM

Flea allergy dermatitis doesn't require an infestation - a couple of bites can set off that horrible itch-scratch cycle. At the other extreme, I've seen an owner request euthansia for her two terriers because she couldn't clear the dogs and the house of fleas and her whole family were being eaten alive, even though she had spent over £150 on pet shop flea products. Two packs of Frontline and an effective spray for the house later, everyone was happy again and the dogs were granted a reprieve. Funnily enough, none of the pet shop products seem to kill fleas, but I've seen quite a few that have just about killed the cat or dog they were applied to.

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