Everyone knows fleas suck. But is your vet doing everything he or she can to inform you of the dangers of parasitic infections to your pets and other household inhabitants? Maybe. Maybe not.
Though diseases spread by fleas are relatively uncommon in the US’s people population, they’re out there. The spread of Yersinia pestis, the bacterium that causes Plague happens via fleas that jump from rodents and often onto pets before infecting humans. Cat scratch fever, another bacterial infection, can also be transmitted through the bite of a flea.
Then there’s the possibility of allergic reactions and tapeworms. Though flea bite reactions are usually self-limiting and merely itchy, some humans’ immune systems respond with painful boils. Tapeworms––believe it or not––can spread to humans via fleas should you ingest one (though I recommend you not try this at home). Luckily, these are NOT the tapeworms that’ll eat all your ingested nutrients and result in dramatic weight loss. But you WILL be sharing a dewormer with your pets if you get them.
Next up, the dreaded tick. Everyone knows about Lyme disease and Rocky Mountain spotted fever. ‘Nuff said, right?
These are all insidious diseases no one needs to suffer. Not if basic prevention regimens are adhered to. Not when the most powerful anti-parasitic tools in human history come in a box––usually without a prescription. But is veterinary medicine doing enough to observe its oath to minister to public health? Arguably, the answer is a resounding “NO!”
In light of the shift in veterinary medicine to the care of individuals over populations (consider the rise in radiation therapy and the backlash against rabies vaccines, think on the widespread use of antibiotics in poultry and the pending legislation against it), some public health officials worry that veterinary medicine is ignoring some of the most basic tenets with respect to protecting humans from zoonotic diseases (these are diseases that spread from animals to humans). At least when it comes to companion animal medicine.
Given the state of parasitic affairs, some contend, veterinarians have to work harder to protect the public by protecting their patients. Climate change, the increasing mobility of pets, closer pet-keeping standards (pets in bed, for example) and human encroachment into wildlife-friendly zones are increasing our risk of zoonotic disease infected flea and tick exposure.
It’s possible that a perfect storm is brewing in the world of pet parasites some CDC officials fear. And veterinarians are on the front lines of flea and tick prevention. Not only is prevention best for people and pets, they say, it’s also in our best financial interest to tackle fleas and ticks with more aggressive tactics.
Not only does this include the sale of products hand over fist, it also includes testing for the diseases these critters can carry. To that end, I’m lobbying hard to amend my hospital’s bloodwork protocol. Ehrlichia and Lyme testing should come with all my basic annual panels, I say. Same as for heartworm. After all, I see more ehrlichiosis than I do heartworm these days.
Granted, 80% to 90% of my canine patients get regular heartworm preventatives, compared to only about 30% to 40% for the flea and tick stuff. But then, the risks of flea and tick prevention are greater than their benefits in some cases. (Not that everyone agrees with me.) That’s why I tend to reserve these products for treatment rather than prevention and prefer to focus more on disease screening by way of protecting public health.
So you tell me: Am I NOT doing enough for public health when I side with individual pet health over what MAY be best for humankind at large? Am I denying the public the duties required by my oath in so doing? Here’s your chance to have your say...
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My cat had her first asthma attack a little over a week ago and has had acute symptoms since. X-rays, ekg, oxygen, injections, inhalers - the works. The vet ran a blood panel and it came back positive for heartworms, now the probable cause to her asthma. This is a 10-yr-old indoor-only cat in the Northeast. I never expected heartworms; didn't even realize that cats were susceptible. Since the diagnosis, I am now treating my other cats with heartworm prevention. So my experience is that I wish I had known that this was a threat. I wish feline heartworm preventative treatment had been recommended to me by my vet. (And I wish my cat wasn't suffering...)
Lauraj August 8th, 2009 12:29:31 PM
LauraJ: We're all guilty to some extent of failing to recommend heartworm preventatives for indoor cats. Outdoors? For all. But even then, sometimes I feel like a cheap salesman when I "push" products based on the fear of disease. I think lots of veterinarians feel this way. Sometimes we just don't believe it's worth all the pushback we often get when we present the topic with the detail it deserves. :-( Hearing your story sure does change that perception for me. Thanks for the reminder.
Dr. Patty Khuly August 8th, 2009 12:46:29 PM
"sometimes I feel like a cheap salesman when I "push" products"
Therein lies the principal problem in your profession - the mixed prescription and dispensing rights. If you were prescribing (& recommending OTC products) and the customer was purchasing elsewhere, this would be moot. I wouldn't suspect my vet of being a pill pusher, & you wouldn't feel the sleaze of sales.
As for zoonotics & parasites, I'm surprised how little physicians know about parasitic diseases and how unwilling they are to consider & test for parasitic infestation. Pediatric outbreaks of pinworms & lice seem to be the only things on their radar in my part of the continent; but with travel & pets etc, I suspect many people have all kinds of "visitors". The tropical medicine drs seem to be the exception....
hornblower August 8th, 2009 02:15:12 PM
Hornblower definitely has a point about the ethics and public perception toward DVMs who both prescribe medications and then sell those same meds - but I think most pet owners would still prefer the convenenience of not having to go elsewhere. As long as they have the choice - i.e. not getting an argument from the vet if they want to take a script and get it filled elsewhere.
Back to the topic at hand - from the studies I have seen, OTC topical flea/tick remedies have a MUCH greater incidence of causing problems than the prescription products. I'm not sure the EPA study made that clear enough.
Barb August 8th, 2009 02:44:33 PM
"from the studies I have seen, OTC topical flea/tick remedies have a MUCH greater incidence of causing problems than the prescription products. I'm not sure the EPA study made that clear enough."
I agree––anecdotally speaking––but Frontline was on that list, too (though I don't think I've ever seen a severe reaction to any flea and tick product in the veterinary-only category. Furthermore, I see plenty of moderate reactions to Comfortis, though I only recommend it for severe canine flea infestations where the benefit seems greater than the risk.
Dr. Patty Khuly August 8th, 2009 03:14:33 PM
hornbower: Agreed. It's frstrating to me that my profession suffers from an overdose of protectionism when it comes to these products. For me, it offers a discomfiting scenario. But then, I almost always remember to tell my clients they can buy it elsewhere. No skin off my nose and only a teensy slice off my paycheck. I'd rather not earn the income off it if it wasn't a "convenience" sale.
Dr. Patty Khuly August 8th, 2009 03:17:14 PM
Wasn't the Frontline listed on the EPA---the Frontline Plus version? If my clinic carried the older plain version, I would gladly buy it there instead of driving further to the pet & feed supply store or ordering it via catalog.
Barb A./NH August 8th, 2009 03:24:32 PM
Barbara: yes, it was the Frontline Plus. Sorry for the confusion.
Dr. Patty Khuly August 8th, 2009 03:56:20 PM
Just a comment about the Frontline Plus. The only reactions we have seen to it (and they were mild) were in patients whose owners got it at the farm store. Turned out it was counterfeit Frontline Plus from China. So I have my doubts about having Frontline on that list - was it really Frontline that the complainers had? I hope that this aspect is investigated too.
sassy August 8th, 2009 05:26:58 PM
There are some natural ways to cut down on fleas too, which make your position on preventatives a lot easier. Regular vacuuming helps a lot, as does occassional vacuuming with borax powder. Diatomaceous earth is great to sprinkle around outside.
I have one dog who is very allergic to fleas and have started using Sentinel as my heartworm preventative in addition to giving the dogs Capstar if we go somewhere with a lot of fleas. Vacuuming more often has really helped. I live in the South and haven't had a flea problem in quite some time.
Tracy August 8th, 2009 07:56:32 PM
@Barb-
Speaking only for myself, and not Dr. K, of course, I will never again use an OTC flea product.
I once, years ago, applied "bio-spot" to my bulldog. Within minutes she became agitated and couldn't walk straight, weaving, disoriented. I called my vet at the time and he told me to bathe her immediately! I was at work, so I took her to a groomer who gave her an emergency bath. Before long she had substantially improved.
I won't repeat what my vet later said about Bio-spot, but suffice to say that he didn't think the reaction was peculiar to my dog.
Susan August 8th, 2009 08:37:42 PM
I don't think veterinarians can foot the responsibility for controlling tick-borne diseases in humans.
People get tick bites -- and are exposed to disease from them -- when they live active outdoor lifestyles. Pets are a trivial risk factor, and I don't think are a disease vector to humans.
Game commissions and pest-control policy have more to do with it. Whitetail deer and field mice are the vectors.
Search and rescue personnel who conduct ground SAR without a dog are just as likely to get a Lyme tick as are dog handlers. Maybe moreso, since they are not preceeded in their travels by a more tasty and appropriate mammal.
H. Houlahan August 9th, 2009 12:09:36 AM
Today there seems to be a whole crew of people who dismiss personal responsiblity. Every professional is vital in the role they provide for guiding their clients (medical docs for humans and veterinarians for pet owners) to make the right choices and decisions.
Ultimately it is up to the pet owner to step up to the plate.
IMO It is a personal choice matter.
In the past our animals survived flea infestations. Today, we have gotten used to more sophisticated products and methods for eradicating, controlling, and preventing parasite infestations BUT how much risk is their really when the pharmaceudical industry is expanding and recommending drugs for our pets when alternative practices may be much safer and that also can work if applied properly.
I just finished researching this topic and am posting information related specifically to flea control on my blog Flea Control Secrets, During my research process I have been watching the CAPC--isn't it surprising that the CAPC sponsors include many of the pet pharmaceudical companies--and HOW trustworthy are their statements based on that bias?
Ark Lady August 9th, 2009 11:45:22 AM
Christie interviewed Dr. Steve Hansen of the ASPCA Animal Poison Control Center, and his frustration with flea-control products had to do with pet owners.
In brief: READ THE DIRECTIONS and follow them.
He said most of the adverse reactions were because those directions weren't followed ... especially regarding the use of dog products on cats.
Gina Spadafori August 9th, 2009 12:21:37 PM
Gina: With all due respect to Hansen (and he truly deserves it) I see planty of reactions to products that *appear* to have been applied correctly. These are not otherwise compromised animals in many cases, nor does all of the packaging explain that you should see a veterinarian if your pet isn't 100% healthy (this labeling issue is especially problematc with the permethrin-based shampoos). But the worst reactions are undoubtedly dog product-on-cats. It's a source of frustration for all of us.
Dr. Patty Khuly August 10th, 2009 08:30:29 AM
Have you ever figured out what kind of regimen your goat requires? and mine?
The closest vet that handles goats is several hours away. Can I administer whatever is required myself?
Bob Jones August 10th, 2009 08:54:12 AM
Ark Lady,
Some of the concerns you cite are why I remain perpetually torn particularly on the topic of Sentinal for indoor cats.
I would not hesitate to treat my cats if they had an active flea infestation, as I did not hesitate to treat them when they had ringworm.
But now I am being recommended by my vet to use flea and heartworm preventative on my indoor-only cats.
I live in one of the "middle risk" states, in the mid Atlantic. We aren't one of the high heartworm states, but we do have enough of it in dogs.
And . . .
Once a month or so, I kill a mosquito that has gotten in.
But as cats are resistant hosts, and they must be very rarely bitten even in the summer when I find on mosquito a month in the house -- should I be giving them monthly pesticides?
Something about it doesn't feel right to me.
I'm sure my vet is only recommending what she herself has been convinced to believe. But as the "convincing" is being done by the pharmaceutical sales staff for Sentinel.
Gone are the days when I just trundled off and did what I was told without really thinking about it myself.
stefani August 10th, 2009 10:46:05 AM
Stefani: As long as you've been given an informed choice I think your veterinarian is doing what she's supposed to do. And I'm convinced it's a good thing. I see too much feline exposure to heartworm in indoor cats to fail to recommend the option highly. Nonetheless, I tend to prefer Revolution for this function. Does a better job against fleas and I happen to prefer the safety of selamectin over milbemycin. Both are considered low risk. Ask your vet about the every three month approach for Revolution (the reps cite it as an off-label approach to heartworm prevention).
Dr. Patty Khuly August 10th, 2009 11:22:21 AM
Bob: Sadly, no. I'm doing it all myself since I've recently confirmed that I now know more about goat medicine than my local mixed animal or equine vets. Not bragging. It's just that we have virtually no goats around.
Dr. Patty Khuly August 10th, 2009 11:23:46 AM
Actually, Dr. K, I think it was Revolution she last talked to me about. I mis-remembered. Thanks!
Stefani August 10th, 2009 11:27:28 AM
Given how much more is now known about zoonoses, although I don't think you're violating your oath, I think the vet oath should be amended to better address or at least make point of the potential issues for the client (and I wish Hippocrates were around to rewrite his completely as I know he would). Yes, "client" because that's the humans who own the pets and to whom the much of the vet's duty is owed. Sorry, there really isn't a "doctor/patient" relationship independent of that "client" except when dealing with strays/ferals. However, I have 2 bigger gripes: 1) human docs lack of even truly passing knowledge of zoonotic diseases that patients may be susceptible to from their pets and (the REAL biggie) 2) The utter lack of communication between health care professionals of all stripes. M.D.s and Dentists are still haggling it out. GIVE ME A BREAK. Put those egos in check. Everyone, every profession, has a contribution to make and all the others need to be listening to that contribution. The absolute worst for patients (human and animal) is having to chase down a diagnosis by seeing multiple doctors.
PJBoosinger August 10th, 2009 07:59:37 PM
PJB: And things get even more contentious between generalists and specialists in vet medicine and between the specialists themselves it's even worse in both veterinary and human medicine. Some won't even work on you or your pets if you've already seen their less-than-favorite surgeon, neurologist, cardiologist, etc. Yes, gimme a break.
Dr. Patty Khuly August 11th, 2009 08:46:10 AM
I want to say something snarky and sarcastic about those specialists whom you mention. I've dealt with a few of them. Unfortunately, it's just too depressing to come up with that this morning. Sigh...
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