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Veterinary Practice News August 2010 Letters To The Editor

Posted: 8/10/2010 11:08 AM


Veterinary Practice News August 2010 Letters to the EditorVeterinary Practice News August 2010 Letters to the EditorVeterinary Practice News August 2010 Letters to the EditorVeterinary Practice News August 2010 Letters to the EditorlettersVeterinary Practice News August 2010 Letters to the Editor

Embrace Pain Control


I would like to applaud—and echo—Complementary Medicine columnist Narda Robinson’s article “Toward a Standard of Care for Pain” [June 2010].

Dr. Robinson speaks elegantly and accurately of the ethical imperatives to maximize comfort in human and veterinary patients, and I strongly support the five new “rights” articulated by the National Pain Foundation.

It’s worthwhile to emphasize that parallel to the ethical considerations are the very real, demonstrable medical and clinical ones. The consequences of undermanaged pain are well-established—a cascade of physiologic negative feedback loops that contributes to patient morbidity, slowed recovery, diminished function and death.

This is true of both acute pain (surgical, traumatic) and chronic pain (osteoarthritis, neoplasia, others). In fact, under-recognized and undermanaged pain and its consequences can be a prime criterion for humane euthanasia.

Fortunately, pain management represents one of those rare convergences of being exceptionally good for the patient, satisfying to the owner, rewarding for the doctors and staff, and healthy for the practice.

Articles and programs such as Dr. Robinson’s, and organizations such as the International Veterinary Academy of Pain Management, are helping to change the culture of our profession toward one that does not merely accept pain management as a norm but embraces it with a passion. 

Mark E. Epstein, DVM,
Dipl. ABVP, Dipl. AAPM
President, International Veterinary Academy of Pain Management

Not a Quick Fix


I am not certain that attending a one-day seminar can adequately prepare someone to handle anything but the most basic animal behaviors [“Behavior Expertise Can Generate Revenue,” Web Exclusive].

If veterinarians send their staff to a one-time seminar, they may be disappointed. Depending on the methods taught, this could be the first step for those who want to offer ongoing quality behavior education to their clients.

Veterinary technicians interested in learning more about applying behavior modification during their daily interactions with pets in the clinic setting should consider joining the Society of Veterinary Behavior Technicians. The organization allows technicians to share information and train with each other.  

Linda M Campbell, RVT, CPDT
Director of behavior/training,
Humane Society of Missouri

Lowdown on High Tech


As a small-animal veterinarian for 10 years, I occasionally find myself defending our great profession from the stigma of discount vaccine clinics and low-cost spay/neuter clinics.

A news report in the May 2010 issue [“Worth the Wait”] took the wind out of my sails. Dr. Francisco DiPolo offers Skype “virtual exams” for the busy client? This opens up myriad questions, all of which I won’t ask except for this one: How does one palpate, auscultate or do an otoscopic virtual exam?

Turning a profit shouldn’t be the only motivation for veterinarians. One should consider the integrity and image of our profession before promoting subpar practices for client convenience.

Andrew Frishman, DVM
Somers, N.Y.

Why Fleas Persist


Dr. Rob Feola described his observations after using Frontline Plus on his own pets and expressed his conclusion that Frontline Plus was less effective than in the past [“Resistance Is Real,” Letter to the Editor, June 2010].

Dr. Feola is not alone in his perception of efficacy failures of premium flea products, and several of his comments are characteristic of this situation. He acknowledged that he has “regular visits” by raccoons and opossums, both of which are known to be excellent hosts of Ctenocephalides felis, the cat flea. I would venture to guess that he may also have regular visits from feral cats, because many veterinarians tell us that they are seeing more and more feral cats in their neighborhoods. These flea-infested animals can be the source of hundreds to thousands of cat flea eggs each day1,2 leading to “flea nurseries” in people’s yards, neighborhoods and parks.

I can personally relate to Dr. Feola’s observations. Last summer I observed situations in a Merial-sponsored in-home study involving Frontline Plus, conducted by Dr. Michael Dryden and his Kansas State University Flea Team. During the study, fleas persisted on pets in a few homes despite two consecutive monthly treatments of all household pets with Frontline Plus. In one memorable case, the family dog was found to be covered with fleas every time the students came to perform flea counts.

Seeing all these fleas on a treated dog was disconcerting, but further investigation revealed the source of the problem. Environmental flea traps placed in the house showed, as expected, that the number of fleas emerging indoors was plummeting, ruling out the house as the main source of fleas on the dog. The homeowner acknowledged that one or more raccoons were living in the yard, however, and when the Flea Team investigated sites in the yard that were favorable for flea development they came back with fleas on them! They had found flea development “hot spots” in the yard.

Furthermore, the fleas combed off the dog were small and had no visible blood in them, evidence that they had recently jumped onto the dog. Investigations in the other homes where fleas persisted on pets revealed the root cause in every case, and in no case was product failure at fault.

Dr. Feola also mentioned that when he switched products the problem was solved “within a month.” This is a classic scenario that can be readily explained by flea biology. When all pets in the household are treated with a flea-control product, particularly one that contains an adulticide and an insect growth regulator,3 the supply of new, viable flea eggs in the environment is stopped. But the fleas that we see on our pets can be the tip of the iceberg and indicate that a large biomass of flea eggs, larvae and pupae may be developing right under our feet.
This pre-existing flea biomass will continue to develop after the pets are treated, and the number of fleas seen on the pets can become greater than before the first treatment.4 This is when pet owners typically complain about a product and are given a new product to use. By this time, though, the flea biomass has often become exhausted; the eggs, larvae and pupae in the environment have all completed the development process, and meanwhile no viable flea eggs were shed from the treated pets. Thus, the number of fleas emerging from the environmental infestation plummets, coinciding with the use of the new product, and it appears that the second product worked better than the first.

The interaction of the flea lifecycle with hosts and environmental conditions can be quite complex. Flea development from eggs to emerged, hungry fleas requires environmental conditions that are best met in areas protected from direct light and extremes of temperature and moisture.5 These infestation sites can be prolific producers of adult fleas, but they are also fragile. For instance, a downpour from a thunderstorm, or a sudden heat wave, can kill all larvae that are exposed to the elements.6 Thus, flea populations can blossom and disappear and a few weeks later reappear based on environmental conditions and fresh supplies of flea eggs. It can be very difficult to determine the source of fleas, and in many cases pets and pet owners may be confronted with outdoor and indoor sources.

The bottom line is that when people see fleas on their treated pet, the pet has encountered a site of environmental flea infestation. Importantly, with premium flea products like Frontline Plus, these fleas will be killed. If the dog continues to pick up new fleas, whether from inside the home or outside, the seemingly constant presence of living, crawling fleas on the pet may be misconstrued as product failure.

Michael J. Murray, DVM, MS, Dipl. ACVIM
Technical marketing director for USA Pet Parasiticides,
Merial Ltd.
Duluth, Ga.


  1. Dryden MW, Rust MK. The biology, ecology, and management of the cat flea. Annu Rev Entomol 1997; 42:451-473.
  2. Dryden MW: Host association, on-host longevity and egg production of Ctenocephalides felis felis. Vet Parasitol 1989; 34:117-122.
  3. Young, DR, Jeannin, P, Boeckh, A. Efficacy of fipronil/(S)-methoprene combination spot-on for dogs against shed eggs, emerging and existing adult cat fleas (Ctenocephalides felis, Bouch´e). Veterinary Parasitology 2004; 125:397–407.
  4. Dryden, M. Focus on residual activity: Case study data reveal a clearer flea control picture. Vet. Med. suppl., March 2009.
  5. Silverman J, Reierson DA, Rust MK. Influence of temperature and humidity on survival and development of the cat flea, Ctenocephalides felis (siphonaptera: pulicidae). J Med Entomol 1981; 18:78-83.
  6. Silverman J, Rust MK. Some abiotic factors affecting the survival of the cat flea, Ctenocephalides felis (siphonaptera:pulicidae). Environmental Entomol 1983; 12:490-495.
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