Recommendations For Flea, Tick, And Heartworm Prevention.....2015 Update

The last time I specifically wrote about my personal recommendations in parasite prevention was several years ago.  In fact, it was about four years ago!  A few things have changed since then, so I thought it would be a good time to update what I recommend to clients.  While I stand by every one of my recommendations, realize that they are my opinions and I know vets who might disagree.

Heartworm Prevention

Personally, I really love ProHeart.  This is an injectable heartworm prevention for dogs that lasts for six months with a single shot.  From what I understand, outside of the US it is frequently used at a higher dose and lasts for a full year.  I wish we had that here!  I love this prevention because you only have to worry about it twice a year.  It's so easy for people to forget a monthly pill, and this keeps that from happening.  Veterinarians can include this in their preventative care reminders, easily contacting clients when another dose is due.  This is the preventative I give to my own dogs. 

If ProHeart wasn't available I would use Trifexis.  I think this is a very safe product, despite the unwarranted media and internet hype about it.  I like the fact that it covers heartworms, fleas, hookworms, roundworms, and whipworms.  It's the only product on the market to do all of that (Sentinel doesn't count....it prevents flea eggs from hatching but doesn't actually kill adult fleas...and it has the same heartworm preventative found in Trifexis!).

There are a plethora of monthly pills similar to Heartgard.  Iverhart, Tri-Heart, and several others use the exact same combination of ivermectin and pyrantel to protect against heartworms, roundworms, and hookworms.  All of them are equally effective, only differing in cost and brand name.  There is nothing wrong with any of them, and they are still an important staple of heartworm prevention.

I'm not huge fan of Advantage Multi and Revolution because they are topical and therefore have the potential to be less effective with frequent bathing.  But for people who don't bathe their dogs more than 1-2 times per month they can still work well.  I just think that there are better options.  However, for cats I love both!  Revolution is my choice for my cats but I think that Advantage Multi works just as well.  These are the best options for heartworm prevention in cats because you don't have to give a pill orally.  These two products are also great for ferrets, who do get heartworm disease, though neither are officially approved for this species.

The bottom line is that no matter which product you chose, please use an approved heartworm preventative year-round in all dogs, cats and ferrets!  This is a completely preventable disease so there is no reason why any pet should ever have to suffer from it.

Flea & Tick Prevention

There are many more choices in this category, and it can get very overwhelming.  Do a search on my blog for "fleas" and you will get lots of details that I've written over the years on proper flea control.  This time I'm focusing on specific products.  But PLEASE read some of my other posts, as no product will be 100% effective, and there are many, many things that can lead to a persistent flea problem even if the product is working well.

As I mentioned above, I'm a big fan of Trifexis.  In my case since I'm using ProHeart for heartworms, I use other products to control fleas and ticks.  I really like Comfortis, which is the same flea control ingredient found in Trifexis.  Dermatology specialists tend to like this product for dogs allergic to fleas since it kills so fast and so thoroughly.  The only downside to Comfortis is that it doesn't do anything for ticks (neither does Trifexis).  If your dog really doesn't go near places with ticks, this is an excellent choice.  If you worry about ticks as well, I'd recommend something else.

My favorite topical products are Advantage (fleas only), K9 Advantix (fleas and ticks), and Vectra 3D (fleas and ticks.....sold under the brand name FirstShield Trio in the Banfield Pet Hospital chain, but is the same product).  Currently I'm using Vectra on my dogs, but I think that the Bayer products work as well and am happy to recommend them to clients.  Advantage has been shown to be safe in most small animals, so it can actually be used on rabbits, ferrets, and guinea pigs (though this is "off-label" and not officially approved for these species).  The products combined with heartworm prevention (Advantage Multi and Revolution) are just as effective against fleas as the non-heartworm equivalents.

A newer product is the Seresto collar, made by Bayer.  I have not personally used this, but I have been hearing many good things about it.  Several of my clients use it and have been extremely happy.  I've also spoken to some veterinary colleagues who use it and recommend it.  The technology behind Seresto is very unique and is unlike any other flea and tick collar ever made.  Do not think this is just another collar!  In fact, I haven't recommended flea collars at any point during my career (18 years at this writing) until Seresto came around.  It is supposed to last for eight months, which if true is a huge advantage for it.  Do NOT buy other collars!  They are simply not effective and are a waste of money.

Frontline is an old reliable topical product, and since the patent ran out you can find cheaper brands containing the same active ingredient (fipronil).  When it first came out it was a huge benefit in the fight against fleas and ticks.  However, I've seen it fail more than other products over the years, and there is anecdotal evidence that there may be some resistance developing to it.  I don't think it's a bad product overall, and many people are still using fipronil products with good success.  However, because there are much more effective products on the market I don't generally recommend it.

I would never use any other topical products currently on the market!  I just don't think that the Hartz and Sergeants products are effective and I've seen some cases of toxicity with them.  Please stay away from them.  Yes, they're cheaper, but in this case you're going to get what you pay for.  Don't throw your money away on them.

Also stay away from flea shampoos.  Yes, they will kill fleas, but they give you no residual protection.  Within a day of you rinsing off the shampoo any new fleas in the environment will be right back on your pet.  Use a product that lasts at least a month in order to get good flea control.

Capstar is a great product for what it does.  There really isn't anything else that kills fleas as quickly!  Within 30 minutes of giving it the fleas will start falling off!  I've seen it happen in my own clinic.  If you want a rapid flea kill, this is a great choice.  The big downside is that it doesn't last for more than a day.  For spot control, such as if you're bringing a new pet home, I love it.  But you won't get lasting control.

There are a couple of newer products on the market this year, Nexgard and Bravecto.  Honestly I don't know anything about them other than what I've read in journals and veterinary forums.  I have no personal experience with them so I can't attest to their effectiveness.  I'm eager to try out Bravecto, as it controls fleas and ticks for three months, and there is growing anecdotal evidence that it can treat demodex mites with a single tablet.  But for now I'll leave those recommendations to other vets who have actually used them.

Okay, I think that covers most of the current products!  As always, check with your own veterinarian if you have questions about anything I write.

Aids For Reading Pet Food Labels

It seems that pet nutrition is a common topic in the profession nowadays.  Just a couple of weeks ago DVM 360 posted an article on how to read and interpret pet food labels.  Along with the article they posted a couple of great client handouts on the topic.  I can't attach the files on Blogger, but here are direct links to the handouts.  I would encourage everyone to check them out.

The Pet Food Guessing Game  (information on what different words and phrases on a label really mean)

Forget The Packaging, Read The Ingredient List  (definitions of different terms in the ingredients)

Read Carefully....Corn Isn't Bad And Vets Haven't Sold Out

I've blogged a lot about nutrition in pets, especially the big myth that corn is a bad, worthless ingredient.  I still revisit these issues because I've developed a real interest in nutrition and because there is still so much misinformation out there about pet food ingredients.  For those who may not have read my previous posts, I would strongly recommend going back and doing so at the following links:

Nutrition Mythbusting
Nutrition Week #1
Nutrition Week #2
Nutrition Week #3

Veterinary Food Conspiracy?

Today's post was stimulated by a recent email from Kevin.

I've always been told that corn is bad for cats and as a good daddy I want nothing but the best for my furkids as they are my babies and part of my life. My Vet of Six years nows put one of my boys on Hills Science Diet Prescription for urinary tract issues with struvite crystals in his urine. I've read their label and corn gluten meal is the second ingredient after brewers rice and the protein from chicken is like 5th or 6th on list. I don't feel comfortable with feeding my boys this food but my Vet who I believe has sold out to Hills as.she carries nothing but Hills products says that she's had good results with this food from other clients that she's had on this food. It also states on the bag that it is clinically tested to dissolve struvite stones and crystals. Marketing hype I imagine but if it works my boys will be much better off as I don't have 3 to 4 thousand dollars to throw at a blockage including hospital stays and surgery and such and would likely have to say goodbye to my boy. Would you say that this is a good formula to try being that you've had first hand experience with urinary tract issues with cats and dogs I presume being a Vet and all. If you could take the time to answer my questions I would be most appreciated by my boys as well I myself. I have one other choice of food that my boy likes and its by Royal Canin Urinary so and he liked the samples that this other Vet gave him last week when his regular Vet was all booked up I was referred to this other Vet and this is the food that both the Lady Vet and the guy Vet recommended for him. Don't know if you've had any experience with Royal Canin brand food but Chion liked it and his other brothers like it as well and that's what counts with me.

Let me begin by once again speaking against the issue of corn being bad.  CORN IS NOT BAD.  It is NOT filler, it IS digestible, and both dogs and cats DO get benefit from the protein in it.  Seriously!  Years ago some people started espousing the idea that corn was a horrible ingredient, and that has taken hold in the collective consciousness of the American pet owner.  Some food companies have continued to perpetuate this myth (Blue Buffalo, I'm looking at you!).  It is a complete fallacy and there is no scientific basis to that belief that I can find.  In fact, I can find quite a bit of evidence to the contrary.

Here's some specific data from Small Animal Clinical Nutrition, 5th Edition, Hand et al, 2010. 

Protein Digestibility, Dogs
Beef and bone meal--82.4% (25% crude protein in food)
Chicken and chicken by-product meal--85.1% (33% crude protein in food)
Lamb meal--79.7% (20% crude protein in food)
Poultry by-product meal--80.1% (20% crude protein in food)
Beef, fresh--89.8% (20% crude protein in food)
Corn gluten meal--84.7% if 15% crude protein in food; 87.8% if 20% crude protein in food; 90.3% if 30% crude protein in food

Protein Digestibility, Cats
Fish meal--78%
Meat meal--91%
Chicken and chicken by-product--83-88% (different studies represented)
Chicken meal--86%
Corn gluten meal--70-86% (different studies represented)

You can clearly see that the protein in corn gluten meal is just as digestible as in various meat sources, and even more than some of them.  Corn meal absolutely IS digestible! 

From the same text a table summarizes protein quality of common pet food ingredients (Table 5-17 if you want to find a copy of this book).  Corn gluten meal is listed as "good" quality, the same as beef, lamb, pork, chicken, liver, fish meal, meat and bone meal, and lamb meal.  Corn meal IS good quality protein!

I'm not going to take the time to write down many studies referenced in these tables,  but there are around a dozen of them from multiple scientific journals and covering time periods from the 1980s through the early 2000s.  All of the studies that lead to this data are peer-reviewed and accepted by the scientific community and veterinary nutritionists.  There is NO reason why corn gluten meal should not be used in pet foods or why it should be considered inferior to animal protein sources.  I challenge anyone who thinks that corn gluten is a poor protein choice to present a similar list of scientific studies proving their point of view.  I'm sure that you'll get many opinions, but without true scientific studies and data.

Okay, so now on to the next concern...selling out.

Currently there are four major companies making therapeutic diets for pets in the US:  Hill's Science Diet, Royal Canin, Purina, and Eukanuba/Iams.  All of them have their pros and cons and while I don't think any of them are "bad", I do have personal preferences.  Those preferences are based on experience, and I'm sure that other vets have great experience with foods I don't favor.  The bottom line is that all of these companies put a ton of money into research on the quality and efficacy of their foods, and I have no problems with any of them.  Also, all of the companies have comparable diets for different conditions.  For example, each of these companies makes diets for gastrointestinal disorders, kidney disease, and diabetes.  While the forumulations and methods of treatment will vary somewhat, they all do the same basic thing.

A vet has to pay to stock food in their practice, and if the food doesn't sell it comes out of their pocket.  A vet simply doesn't have the space or money to stock food from each of these companies.  Some vets may stock two companies, possibly because they prefer one company for treatment of certain disorders but another company for different illnesses.  But it's impossible for a vet to stock all of them and give people the choices.  Therefore most vets chose a single manufacturer to sell.  That doesn't mean that they've "sold out".  They just have to make a practical, realistic decision as a business owner, and they chose a food that they believe is high quality, will treat necessary illnesses, and be cost-effective to them and the client.  Hill's Science Diet was one of the first companies to make therapeutic diets, and they're still the biggest and most well known, so it's not surprising that a vet would chose them over the other brands.

As an aside, I personally prefer the Royal Canin diets for most disorders.  I base that on personal experience with using the foods compared to Hill's, palatability, their high involvement in nutritional research across the world, and their strong ethics, especially regarding research animals.  I do really like Hill's Metabolic diet for weight loss and overall think they have high quality foods.  I just lean more towards Royal Canin as a personal choice but wouldn't at all advocate against Hill's.

Now that I've spent a lot of time on generalities, let me specifically address Kevin's concerns.  I absolutely and strongly believe that Hill's urinary diets do what they say they will do.  Their C/D and S/D are good foods and will do what the vet says they will.  As I said before, I personally prefer Royal Canin Urinary S/O for these conditions, but honestly it's a matter of degrees as opposed to Royal Canin being significantly better.

Kevin, I hope that answers your questions!

Injuries To The Vet

One of the things many people don't realize about being a vet is the very real risk of personal injury. Many of the patients we see every day have the ability and desire to hurt us.  While we take precautions and are good at avoiding most injuries, sometimes it's just going to happen.  

Here are some photos of my arms after a recent tussle with a dog.

These are scratches from the dog's nails, which happened while I was trying to restrain him.  While they aren't fun, these are minor compared to some I've had and will heal quickly.

Over the years I've been bit by dogs, cats, horses, birds, snakes, hamsters, guinea pigs, lizards, ferrets, and just about every kind of animal I've worked with.  Some of the injuries have required me to go to a doctor for treatment and antibiotics.  I know vets who have been mauled by patients, had their back broken by a cow's kick, and other serious incidents.  No matter how careful we are and how well we read body language or chose to use sedation, injuries will happen from time to time.  In fact, the risk of injury is one of the bigger stressors in my job and has been one reason why I've wanted to get out of daily practice.

This ain't an easy job!

Super-Vet!

Lately I've been toying around with different design options for this blog, wanting to change things up a bit.  One of the things I wanted to do was have something related to superheroes, as comic books have always been one of my biggest interests.  I searched for free clipart and even considered purchasing some images.  Then I became reintroduced to a web-based program called HeroMachine.

Years ago I played around with an early version and had fun making different characters.  The latest iteration is a bit more robust than what I previously used and is surprisingly flexible.  My artistic abilities aren't great, and I was able to create an image that was surprisingly good.

So here I am....Super-Vet!

I'm not completely sure what I'll do with it in this blog, but it was a blast to make.

Mega-Geeks Working Together Is Bad

It should come as no surprise that I consider myself a major geek.  I love comic books, sci-fi, fantasy, animation, and most things that would be considered geeky.  If you start me talking on one of those subjects be prepared for a long discourse filled with bits of random and obscure trivia, all presented with great passion.  When I'm with my fellow geeks in my private life we have a lot of fun.  But it can be distracting at work.

 

The practice I work for has several satellite clinics in the area.  I work at and manage one of them, and spend the vast majority of my time there.  Some of my staff are relatively geeky, and we may have discussions about TV shows or movies, but typically it's a brief conversation with them asking me a lot of questions for clarification.  Thankfully we can still go about our day with only minor delays for such things.

 

Recently I was asked to help out at one of our sister clinics, and the hospital manager there is just as big of a geek as I am.  When we work together, all bets are off!  My own hospital manager talked to him yesterday and asked if he was working with me today.  His reply was "Well, if you call it work."  He knew how distracted we can get!  When I arrived this morning he was already there, and immediately we began talking.  For the first 20 minutes I was in the clinic, we did nothing but talk about the season finales of The Flash and Arrow, along with the extended trailer for the new Supergirl TV show.  We both had to force outselves to stop talking and get down to the business of seeing patients!

 

I have fun hanging out with him (his name is also Chris) and talking with equal passion about comic book titles, shows, creators, and so on.  He's one of the few people I know who can match me in my knowledge, and even then I can sometimes stump him (today I got him with a random trivia question....who was created as Ultron's wife?  Go ahead and Google it....it's not in the recent movie).  I love having someone with equal knowledge to my own, as we can talk depth and details that I can't with other people.

 

But we get very little done!

 

Chris trained at my own clinic before moving to our sister location permanently.  While he was there I would constantly be distracting him from his work and my hospital manager had to keep telling us to stop talking so he could focus.  I joked with her that maybe I'd see if he could work at our location.  She said "Well, then nothing would get done around here."  I'd have to agree with her!

It would be fun to have someone like this all of the time, and he and I definitely have a "bromance" going on.  But I also think that it's good that I don't have someone to distract me from my patients, and that I can get through my case load efficiently. 

Don't Wear Good Clothes To Veterinary Work

Something I've learned in this profession is to not invest in nice clothing if I'm going to wear it to work.  I was reminded of that this week.

A regular patient of mine had received a nasty laceration about ten days ago, and I had to suture it closed.  He came in for a recheck today and was overall doing well but there was a lot of swelling around the wound.  After feeling it I concluded that it was a simple seroma.  This can happen when there is open space under the skin after an incision or wound.  Serum and a little blood builds up in the "dead space", sometimes resulting in a fluid-filled pocket.  His wound was in his left armpit and therefore had a lot of movement so it didn't surprise me that this had happened.

I had started removing stitches and was looking at the condition of the laceration when suddenly it burst open, spraying me with a copious amount of serum and blood.  This is a big dog so I was on the floor with him standing.  My position put his wound just in front of me, and as the liquid spurted out my legs were the first thing they it.  Before I had a chance to scoot out of the way I had about 20-30cc of fluid covering the insides of my legs.

There isn't much that can be done in situations like this.  I grabbed a towel and some gauze and expressed the remaining amount of the fluid.  The wound had opened up about a half-inch so I left the remaining sutures in place and put some skin staples in to close it again.  I was tempted to put in a drain tube, but we'll see how he does since it did have a chance to drain.

Some vets have learned to keep a pair of scrubs or a change of clothes with them just for situations like this one.  I'm not that smart or wise, and only had the one pair of pants.  I live 35 minutes from work, so there wasn't an easy way for me to run home and change.  Instead I ended up letting it dry and wearing those pants for the rest of the day.

I typically buy my shirts, pants, and shoes at Wal-Mart, Target, and thrift stores like Goodwill.  I just can't imagine paying $30 or more on a pair of nice slacks since I know that in the course of a day I'll get blood, pus, feces, urine, and who knows what else on them.  My shoes are typically inexpensive ones that can be replaced cheaply and easily.  I've also had clothing torn during struggles with pets, again discouraging me from investing in costly shirts or pants.  Many of my colleagues were scrubs during their day because of these very concerns, but I've never found scrubs all that comfortable.  My work-clothes look nice and are professional, but I also consider them somewhat disposable considering the fluids and materials I contact on a daily basis.

If you love nice clothing and want to work in the veterinary profession, have a second set of clothes that you wear to work.  I would hate to see someone who bought a designer-label shirt or blouse for $100 end up getting it covered with urine from a struggling dog.

On the positive side I certainly give my dogs some entertaining scents when I get home from work!