Fleas!

          I have been a pet owner all my life.  I was born into the care of a Border collie mix named Blue, a crazy Siamese cat and a Cockateil named Eli that sang Yankee Doodle dandy to your big toe if you took your socks off.  They were my siblings and they were followed by many more four legged family members in the years to come.  I wouldn’t have had it any other way and the bond we shared is very likely the reason that I am in the field I am today.

          When I was a kid, fleas were a fact of life.  If you had pets, you had fleas.  Some of my less fortunate friends did not grow up with pets, hence the horror their parents experienced when they occasionally came home from a sleepover with a sleeping bag crawling with little black hitchhikers.

          My parents certainly tried to get rid of them, my mom kept a pretty tidy house back then.  She vacuumed, sprayed, flea bathed and steam cleaned, but no matter how much we battled them, those little bastards only retreated further into the thick, green, shag carpet.  A month or so later they’d rear their ugly little heads and we’d start all over again…

          The only thing that ever made a dent in our population of freeloading houseguests was when professional exterminators were called in.  I remember that day.  The dogs and cats were sent to a kennel for two whole days and my sister and I were sent off to Grandmas.  We even had to move the fish bowl lest the nasty chemicals give us all cancer.  We didn’t see another flea in that house for years!  But was it worth it? 

Years later, while glancing through one of my mom’s Good Housekeeping magazines, I spotted an advertisement for a promising new flea treatment made by the trustworthy people at Bayer- the makers of Aspirin.  It just so happened that we were having a flea problem in our new house so off to the vet we went!  WOW!  Two applications and NO MORE FLEAS!  Amazing!

          Now, as a veterinary professional, I love being able to hand out such an effective treatment to pet owners.  It never fails: someone walks through the door, scratching just a little too much with just a hint of shame on their face, approaches the counter, and confesses… “We’ve got fleas…”  Then they glance over their shoulder just a little to see if there is anyone in the lobby listening and judging.  “No big deal!” I always say,  “We’ve all been there.”  Then I start in on the “flea talk”.  It’s a lot of information to hand out all at once, and there are so many choices for treatment now that it can get a little confusing.  Thus this blog entry J

          To understand flea control, you first need to understand a little about their lifecycle.  Adult fleas live, feed, and reproduce primarily on the pet.  They feed on the blood of the host animal, (which could be a human), then they lay eggs which roll off the pet into the environment (bedding, carpets, floor crevices and dirt).  In the environment, the eggs hatch and grow into larvae, the larvae then morph into pupae which hatch into adult fleas.  The average life cycle of the flea is approximately 6 weeks depending on environmental conditions.  If conditions are favourable (fleas prefer warm, moist conditions, ie: Vancouver Weather) the life cycle can be as short as 2 weeks.  A little known fact about fleas?  While in the pupae stage they can actually remain in their cocoon for over 12 MONTHS!!  When conditions are cold or dry fleas can decide not to hatch and remain in a kind of “suspended animation” for over a year!  This allows them to survive all kinds of unseasonable weather and re-emerge when you are least suspecting it. 

(Go to http://www.pet-informed-veterinary-advice-online.com/flea-lifecycle.html for a diagram of the flea's life cycle)

How do you know if your pet has fleas? 

1.       You can actually see them crawling on your pet or hopping through your carpet like Heidi through the alpine meadow.  (This visual is especially accurate if you have the aforementioned green shag carpet) 

2.       Your pet is scratching and chewing frantically, sometimes to the point that they are losing hair and causing skin sores. 

3.       YOU are itchy and finding “mosquito bites” in the middle of February. 

4.       Flea dirt.   Fleas eat and therefore they poop.  Flea poop looks like little black specks of dirt.  If you brush some off your pet onto a white paper towel and drip water on it, it will turn red because flea poop is digested blood!

5.       Your vet saw any of items 1-4 and told you.  Just take our word for it okay? (Oh and there’s no need to expose yourself to show us your bites, we’ll take you at your word.)

          So, what do you do if you have fleas?  First off, don’t be embarrassed.  It happens to every pet owner, and it doesn’t mean that your house is dirty.  Don’t blame it on the neighbors, or your kids’ friends, or God.  Get to your vet clinic and ask for help.  We have some amazing, safe and effective products.

Capstar (nitenpyram)- This is an oral tablet. It acts very quickly, taking only about 15 minutes to kill all the adult fleas on your pet.  The problem with this drug is that it only lasts about 48 hours.  Capstar is meant to be used in conjunction with another product for long term flea control.

Program  (lufenuron) – This is an oral tablet for dogs and an oral liquid for cats.  This is flea birth control.  It inhibits flea reproduction and lasts for one month.  Given monthly it is a safe and effective way to prevent a flea infestation in your home.  This product is probably not the best one to use if there is an active flea infestation.  It does however work very well with Capstar.  For Cats this product is also available in an injection that lasts 6 months.

*Sentinel  (Lufenuron/Milbemycin) Oral tablet.  This is an oral tablet like Program, but with an added ingredient that deworms your pet monthly as well..  In areas affected by heartworm, this product is a lifesaver!  Once again, if there are a lot of adult fleas, this product should be used in conjunction with Capstar for more immediate relief.  This product is not available for cats.

Advantage (imidicloprid) This product is applied topically to the skin over the shoulders.  It spreads out in the oily layer of skin and lasts for a month.  When fleas come into contact with a treated pets skin their nervous system is affected and they are unable to bite and feed and they quickly die.  This is an excellent choice for pets that have an allergy to flea bites.  This product will leave a crusty residue for a couple of days and does have a bit of an odour for a few hours after it is applied.  Dogs that get bathed frequently with shampoo may need to have this product applied more often than once a month.

*Advantage Multi (imidicloprid/moxidectin) This is a topical product,  the same as Advantage, except that it contains a de-wormer and heartworm prevention.  This product will leave a crusty residue for a couple of days and does have a bit of an odour for a few hours after it is applied.  Dogs that get bathed frequently with shampoo may need to have this product applied more often than once a month.

Advantix (imidicloprid/pyrethrin)  This product is Advantage with an added ingredient that repels ticks.  It is applied topically to the skin over the shoulders.  This is an excellent choice for people that live/hike in areas with a lot of ticks.  This product is for DOGS ONLY and should be used with caution in households where the cats and dogs share close quarters.  This product will leave a crusty residue for a couple of days and does have a bit of an odour for a few hours after it is applied.  Dogs that get bathed frequently with shampoo may need to have this product applied more often than once a month.

*Revolution (selemectin) This product is applied topically to the skin over the shoulders and is absorbed into the bloodstream.  Fleas ingest it when they feed.  It lasts for a month and kills adult fleas quickly.  This product dries quickly and has less odour than Advantage.  Because it is absorbed into the bloodstream, this products efficacy is not affected by bathing.

*Comfortis (Spinosad) This product is an oral tablet that kills adult fleas very quickly (within 15 minutes) and lasts for one month.  The drug remains in the bloodstream and thus the product is waterproof and not affected by bathing.

*Trifexis (Spinosad/mylbemycin) This product is the same as Comfortis but has an added de-wormer and heartworm prevention.  The drug remains in the bloodstream and thus the product is waterproof and not affected by bathing.

          Most of the above products are available from Sechelt Animal Hospital.  The products with * next to them are prescription products and require an up-to-date (within the past year) Wellness Exam with a veterinarian before they can be purchased.  If you are unsure which product is best suited for your situation, please contact one of our Client Service Team members.  They are well versed in parasite control and would be happy to assist!

          Finally, don’t forget to do a thorough clean-up of your pets environment once you have treated your pet.  Wash all bedding (including yours- you know they sleep on your pillows when you’re not home right?) in hot soapy water.  Vacuum carpets and crevices well and make sure to throw the bag away or empty the canister into an outside garbage bin.  In extreme cases you may need to use a premise spray to treat your home but in my experience, if you use one or two of the above products there is no need to spray.

~By: Meghan Graves

  

Pet Loss and Grief

                One of the hardest parts of my job is having quality of life discussions with owners, and euthanasias.  It’s difficult for all of the obvious reasons, like the sadness and the grief experienced by both myself and the owners, but it’s also difficult for me, personally, because I handle my emotions differently than most (or so I’ve been told).  I have a hard time relating to people on an emotional level, and I’m extremely uncomfortable with people being in my personal space.   So, when I’m confronted with a mourning client who is looking to me to make them feel better, I feel at a loss, and very out of my element.  I marvel at how my co-workers seem to instinctively know exactly what to say and what to do in these scenarios, and have often wondered why I seem to be unable to do so.  I’ve been told that it will come with time, seeing as I’m only 2 years into my career as a technician, but it’s still frustrating to know that when I see someone on one of the hardest days of their lives, the only things I can think of are clichéd condolences that always seem insincere simply because we’ve heard them all too often.

                When I am sad or grieving, I prefer to be by myself; if there are other people around me, for example, if I’m at work and a euthanasia hits me particularly hard (and it happens to everyone that works in the veterinary world), I’d rather they’d just be quiet, pretend I’m not bawling, and leave me alone.   It is due to this personal preference, that I have a really hard time being comforting to others; when your instinct is to leave a grieving person alone and in silence, that often comes off as being cold and un-caring.  Believe me, I DO care and I DO empathize, I’m just not very good at expressing it, and I usually feel awkward when I do try (I probably come across this way to the clients as well); when I say things like “I’m so sorry for your loss”, it feels so scripted and disingenuous to me that I generally elect to say nothing at all.  The worst is when someone wants a hug; I’m not a hugger, but I really want to support people during their time of need, so I have this internal battle between my own personal comfort level, and the desire to help.  What results is usually an incredibly awkward and lame half hug, which (I think) is less helpful than nothing at all.

So, in an effort to better myself and to improve my job skills, I went off to North Vancouver for a 3 day Pet Loss and Grief Companioning Certification course.   The speaker was Coleen  Ellis, and she is the founder of the Pet Angel Memorial Center, which is a pets only funeral home that was the first of its kind in the United States.  When I walked into the room, she immediately greeted me with a firm two-handed handshake, the most intense eye contact I’ve ever had in my entire life, and a fervent “thank you, I appreciate you for being here”.  I felt a little uncomfortable; it’s very disconcerting for someone like me to have a complete stranger get in your space, grab your hand like they’re never going to let go, and stare directly into your eyes.  I think my only response was to look elsewhere (thereby avoiding eye contact), back up a little, and murmur a very quiet “Hi…Thanks…” into my shoulder. 

“Well,” I said to myself, “this is part of why you’re here: to learn how to be more comfortable in situations that involve invasion of personal space.”  So I sat down, and started to listen. 

There were a lot of things that I took away from that course (including hug-avoidance techniques), and I will write about them in separate articles, because there’s just too much to fit into one.  Perhaps the most important thing, was that my job is not to make the client feel better as soon as possible.  We live in a “quick fix” and death-avoidant society that says we should get through the stages of grief in an orderly manner, and as soon as possible; in reality, every person experiences grief differently and the stages of grief are not so clear-cut.  People and pets need time and the ability to mourn however they need to in order to heal.  My job is not to make everything better, but to let them experience their loss in whatever manner is best for them, without judgment and without hurrying them along to happiness and a new pet.   Our instincts are to try to take the suffering away by saying things like “at least you got 15 years with Fido”, “you did all you could for Fluffers”, and “I’m sorry to hear about FruFru, but you know they have lots of puppies at the SPCA that you can get.”  Fido’s family may have gotten 15 good years but they probably wanted 15 more, and I need to respect that sometimes 15 years is not enough, even if that is a good old age for any pet.  Fluffer’s owner did everything under the sun for her cat, but that doesn’t stop her from feeling like there was something else she could have done, and if I say “don’t feel like that because you did everything you could”, I’m actually arguing with her and telling her that what she’s feeling is wrong, and that’s something that Fluffer’s owner doesn’t need to hear.  There may be pets in need of a home at the SPCA (and I am a big advocate for adoptions), but FruFru’s owner needs time to mourn, and it would be disrespectful to suggest that she can just replace her old companion with a new one.  At the end of the day, it doesn’t matter what I think or believe; what matters is what the owner thinks and believes, and it isn’t my place to tell them they should or shouldn’t feel a certain way. 

Another thing that was brought up a lot is that many “pet parents” feel shame for mourning their pet.  If they want to have a funeral or memorial, or if they take longer than a week to get over their loss, many people think they are crazy and over-emotional, because “it was just a dog/cat/fish/gerbil/whatever”.  This is something that I (fortunately) have never experienced, because the people I surround myself with tend to love animals as much as I do and, therefore, understand that the strong bond between people and their pets is not easily broken and discarded.  I was appalled to think that someone might think me “crazy” because I still acknowledge the anniversary of my dog’s death, even though she died a little over 7 years ago.  After all, no one would think twice about acknowledging the anniversary of a human’s death, so why not a pet’s?  So many times I’ve heard owners say that they feel ashamed because they mourned their pet more than a family member that passed away.  This doesn’t make them bad people and it doesn’t mean that they loved that family member any less; it does prove that the bond between people and their pets is unique, and that the relationships are different.  A pet is often closer than your own shadow and when they are gone, when that little (or not so little) soul that followed you everywhere suddenly isn’t there anymore, that sense of loneliness and that feeling that something important is missing, can be overwhelming.  I say again: it doesn’t mean you valued one life over the other, it just means that the relationships and the bonds formed are different, and therefore, they feel different when they are gone.  It should never be a source of shame.

The last thing I’ll mention here was one that really struck me, simply because I had never thought about it this way.  Many people who have lost their pet have expressed frustration that they just want to feel normal again, like they did before the loss.  I never knew how to respond to that, other than with the whole “time heals all wounds” speech, especially because I also sought out that sense of normalcy after the passing of my dog.   Instead, we talked about the “Old Normal” and the “New Normal”.  The “Old Normal” is the way you were before you got your pet.  “Normal” is how you were while you had your pet, and the “New Normal” is what you become after your pet passes away.  Each of these “normals” are accompanied by change, and as we all know, sometimes change is scary, but just as the arrival of your pet changes you, so does it’s departure, and the only way to start to feel better is to acknowledge that you will never be the same you were.  In order to move forward, you need to realize that you will never get back to the “old normal”, acknowledge the impact that your pet had on your life, and realize that the “new normal”, while it might be scary, is actually a positive thing.

This is just a small amount of what we discussed at the course, and I walked out of there feeling more confident about how to handle these types of situations.  I’m never going to be entirely comfortable with physical contact, and my first instinct will always be to remain quiet, but at least now I feel like I have some other options, some other “tricks of the trade”  if you will, and I know that sometimes the best thing I can say is nothing.  I know that no one will ever get over the loss of their pet, but they will get through it.  I know that my job is not to make you feel fine by the time you walk out of the clinic, but to assist in the expression of grief in whatever way I can.  I know that my job is to provide a safe and, above all, non-judgemental environment for the grieving client.  There is always a good-bye hovering in the shadows of our pets, and I hope that if I’m in the room with you when you have to go through it, that you leave the clinic feeling like I am a supportive resource and an asset to you in your grief journey, and not that quiet weirdo who gave you an awkward pat on the hand. 

~By: Lisa Horne

     

Getting drugs at your Vet vs. Retail Pharmacies and Wholesalers

       I hope you are sitting down as you read this article because I have shocking news.  Are you ready?  Ok here it is:

Things are cheaper at retail Pharmacies and Wholesalers.

I’ll give you a minute to process this information…

       Now that I’ve gotten some of the sarcasm out of my system, let us proceed to the point of this article.  Recently, the CBC wrote a piece (and featured it on the news) titled “Pet medicine much cheaper from pharmacies and wholesalers”.  After reading the article, as well as the comments left by other readers, I started feeling frustrated with (what seems to be) the general opinion that the veterinary community is nothing but a bunch of uncompassionate, money-grubbing jerks.  I could write a novel about how wrong this perception is, but for the sake of being concise, I will attempt to confine myself to the issue of the costs of drugs in the vet clinic vs. pharmacies and wholesalers.

Before I get started, there are a few things that I will mention later in the article that I’m just going to define now:

1) Veterinary-Client-Patient Relationship (VCPR)àThis is the foundation of   

effective veterinary medicine and animal care, and is required by law.  A valid VCPR can only exist if the veterinarian knows your pet well enough to be able to diagnose and treat any medical conditions your animal develops; the only way this can happen is if the veterinarian has seen your pet in person, and if the relationship is maintained by regular veterinary visits to monitor your pet’s health.  Your part of the VCPR is allowing your vet to take responsibility for medical judgments about your pet, asking questions to make sure you understand, and following your vet’s instructions.  Your vet’s part of the VCPR is to make those judgments, accept responsibility for your pet’s care, advise you on the benefits and risks of different treatment options, keep a written record of everything he/she does regarding your pet’s health, and help you know how to get emergency care if the need should arise.  If a VCPR is not present, or is not maintained, then it would be illegal and unethical for your vet to either prescribe or recommend treatment without recently examining your pet; a VCPR cannot be established or maintained online, via email, or over the phone.     

2) Compounded MedicationsàThese are pharmaceuticals that have been formulated or reformulated into an different form.  For example, a pill that gets crushed up and mixed with a flavoured suspending agent to turn it into a liquid medication has been compounded.

3)Extra-label/Off-labelàUsing a drug “off-label” means that the drug is properly licensed and manufactured, but not for the ailment or species for which private practitioners intend to use them.

4) Drug Identification Number (DIN)à This is an 8 digit number assigned by Health Canada to a drug prior to it being marketed. It uniquely identifies all drug products sold in a dosage form and is located on the label of prescription and over-the-counter drug products that have been evaluated and authorized for sale in Canada.  It also uniquely identifies the following product characteristics: manufacturer; product name; active ingredient(s); strength(s) of active ingredient(s); pharmaceutical form; route of administration.

          The main point that the CBC article makes is that veterinary drugs and supplies can be purchased for a cheaper price at wholesalers (like Costco) and at retail pharmacies.  Although they very briefly mention a veterinary clinic’s increased overhead and a pharmacy’s/wholesaler’s ability to stock more than a vet clinic would ever need to, they certainly do not go into depth about it.   I would like to attempt to give you the whole picture, not just a fraction.

First of all, I’d like to point out that EVERYTHING is cheaper at a wholesaler; the whole point of a store like Costco is that you can buy in bulk at a cheaper price.  What many people don’t realize is that places like Costco can sell their products for less than what the vet clinic pays just to get the products in stock.  Furthermore, clinics keep very little in stock compared to pharmacies and wholesalers, which increases the cost of shipping.  On top of that, clinics have to make sure to cover their overhead, which is HUGE, and substantially more than in any retail pharmacy or wholesaler.  It includes (but is not limited to) consumable supplies, anesthetic machines, x-ray equipment, lab machines, maintenance for everything, as well as staffing the hospital with qualified personnel.  Contrary to popular belief, this overhead is not covered by exam fees and surgeries; the cost of overhead in most clinics is spread over everything the clinic offers, including pharmaceuticals and prescription fees.  The CBC article fails to mention the price of prescription fees, perhaps because you pay them no matter where you go. 

Another thing you are paying for at a vet clinic is the expertise of the vet and their staff, phone consultations and follow-ups regarding how your pet is doing on the prescribed treatment plan, and help if you are having trouble getting meds into your pet, or if you need clarification on how to do so.  No one at a wholesaler has that kind of training, and pharmacists know next to nothing about treating non-humans; even if your vet has prescribed a human drug for your pet, the pharmacist, unless they are also a trained veterinarian, knows nothing about how the dosing works with animals (because it is often wildly different between humans and other species), nor do they know about how the drug interactions change between species.  If you take any prescription, whether it’s for you or your pet, legally, pharmacists are allowed to change the dose and even the type of drug.  As far as that goes, I’ll say simply this: pharmacists are not trained in veterinary medicine, and even if they were, they have no access to the pet’s medical records so they do not know what is an appropriate treatment plan.  Your vet does.  If you fill your prescriptions at your vet clinic, you know without a doubt that you are getting the appropriate drug and dose for your pet.

While you can certainly get some medications for your pet from the pharmacy, there are some veterinary exclusive drugs that you can only get through your vet.  But that’s just another example of money hungry vets, right? Wrong. 

Let me give you a brief summary of how a drug gets licensed for use (bear with me, it’s a little boring).  All drugs, whether for humans or other species, are governed by the same federal regulatory authority; this means that they must undergo stringent testing to demonstrate safety and efficacy for the specific species and disease that it is meant to treat.  Once it has passed all that testing, it is granted a DIN, and the product then must be manufactured according to the approved practices.  In other words, just because a drug has been approved for use in humans, does not mean it has been sufficiently evaluated for its effects on animals, and vice versa. So why doesn’t the vet just use human drugs because they are cheaper for the owner?  A vet often uses drugs off-label because the veterinary market is small, so sometimes the drug they need isn’t available for animals; however, in doing so, the vet places his/her veterinary license on the line.  If the drug causes an adverse reaction in the pet, then it’s the veterinarian’s fault for using a drug off label. 

If your vet does decide to write a prescription for something you can get at the pharmacy, they’ll still charge you a prescription writing fee.  Many people view this "nickel-and-diming" as unfair because they feel like they are paying for the 10 seconds of time that it takes to scribble on a piece of paper.  In actuality, that fee is not for the prescription itself; it’s for the time it takes to read and analyze the file of the pet in question, to decide if that drug is appropriate, to do research into how (or if) that drug will affect any other drugs that your pet is currently on, and to do research into the risks involved in that specific drug for whatever species it’s being used for, not to mention all the follow-up afterwards.  This can take anywhere from 30 minutes to over an hour for complicated cases, and the people in veterinary medicine, just like any other profession, deserve to get paid for that time and effort.

Some drugs are approved for both human and non-human use.  For example, meloxicam (commonly known in my world as Metacam) is a non-steroidal anti-inflammatory that we use for pain control and to bring down fevers.  I don’t pretend to know what it’s used for in human medicine, but I would guess the same thing; however, clinics do not usually write prescriptions for Meloxicam to be filled at the pharmacy.  This is not because we want to squeeze your wallets, it’s because Meloxicam made for humans often does not come in a small enough dose for a dog or a cat.  After all, a pill made for a 60kg person would be an incredible overdose for a 3kg cat.  You can compound a medication to make the dose suitable for a 3kg cat, but compounding changes the form of the drug, thereby bypassing the federal regulations for manufacturing that drug; this means that the potency, efficacy, and stability of the drug is no longer guaranteed, and once again, the vet assumes 100% responsibility.

So ask yourself this: Is saving $100, or even $20, worth risking my pet’s well-being if there is a more expensive but species appropriate drug available?  Is it worth my vet losing their license?  I would say a very emphatic “NO”.

The last point I’ll make regards the very last line of the article, which really burned my bacon.  It’s another topic that I could write a novel on, and it’s one that doesn’t apply exclusively to drug costs, but it’s one that I feel needs to be addressed; it’s also one that I, personally, feel very strongly about.  The article finishes with quotes from one of their interviewees who mentions the “lack of regulation” to make veterinary care more affordable, and then closes off with this gem: “in the meantime, [he] recommends finding a compassionate vet.”  I’m going to write this in big, bold capital letters to make it very clear:

LOW PRICES DO NOT EQUAL COMPASSION

It’s true that the CVMA publishes guidelines about how much to charge, and it’s also true that they are simply guidelines, and individual clinics can charge whatever they deem necessary.  The cold hard truth is that vet clinics are businesses that need to make money in order to function.  I, and my fellow veterinary professionals, do this job because we love it.  The fact that we get to help animals every single day makes our less-than-amazing wages and salaries more acceptable.  Just to make a point: many technicians get paid on par with, or less than, some baristas at Starbucks, and vets graduate with a debt load that is just as large as human doctors, but most get paid less than half of what a human doctor makes; in other words, we are NOT in this for the money.  Many clinics also have funds in place to help people in emergency situations, not to mention the fund-raising that many do for worthy causes like the SPCA; in other words, we ARE compassionate people who will try to help out in any way we can. 

          I do encourage people to do some research (through reliable internet sources, not just random chat-room/blogger/I-have-an-axe-to-grind-webpage information), tour the clinics, and meet the vets so a discussion about standards of care can take place.  That being said, I also beg people to remember that low prices do not equal better care, and that includes prices related to pharmacy costs.

          Ultimately, it is up to you, the owner/pet parent.  If you know your cat requires $150.00 of drugs per month to stave off kidney failure, you have to plan for that.  Pet insurance is an invaluable asset here, as are the PetCard Finance companies.  Many people have set up bank accounts specifically to save for their pet’s care. 

          To sum up: Yes drugs are cheaper at retail pharmacies and wholesalers, but you may not be getting safe, species appropriate drugs, and you don’t get the veterinary expertise and care that your pet deserves.  As an added bonus, by buying your pet’s medications at the vet clinic, you support the clinic and the people who love and care for your pet.       

~By: Lisa Horne