Have you ever stopped by the pet care aisle at your local store and looked at all the options our clients have for flea and tick prevention? That does not even include all the prescription-based or heartworm prevention-added medications out there.
It can be a lot to take in and sort through for our clients—not to mention, you and me. How does your office work through this? Even more importantly, how do you, as a service provider, work through this with your clients?
What about those clients with multiple pets? Do you choose products based on the individual patient’s needs or do you choose a blanket coverage per the family?
What products do you keep on the shelves at your office? Do you ever prescribe medications you don’t keep in-house? Whether you have ever really thought about it or not, there are a lot of decisions that should be worked through for something as “simple” as flea and tick prevention.
There is no cost-effective way to keep every flea and tick product on your shelf, ready for a client to choose it. As I work through my year-end inventory in my veterinary office, that becomes more apparent every year.
I do believe you should have several options based on the many different lifestyles our patients may lead. Not every product, but enough selection for you to take care of most situations that will present themselves.
Living in the center of the United States, I have yet to find a product that covers every base effectively. My patients cover the entire spectrum, from the pet living in an apartment complex and might never touch “real grass,” to the working ranch dog encountering every parasite you have ever imagined. I try to keep oral and topical flea and tick preventatives, and versions of combination heartworm/flea/tick preventatives. I have found this covers most of my patients.
In the uncommon time I do not have the specific preventative a patient may need, there are several ways to address this. You can script it out to an online pharmacy for the client to purchase, have the client pick it up OTC, or establish your own online pharmacy through a clinic website.
Evaluating patient needs
Depending on where you live and work, your patients may have different parasite concerns and needs.
If you practice in a large metropolis and your patients may never encounter a tick in its life, you are going to have much easier time than someone practicing on the urban/rural line.
I like to evaluate each patient for their own specific needs. In most cases, all patients in a specific family can use the same regiment, but not always. So, how do you work through aiding a client, picking the correct product for a patient? Here is how I do it.
1) Lifestyle. I start out by evaluating the owner and pet’s lifestyle. Do they go to the park together or a lake? Is it a sporting or working dog? Do they go on walks or runs with their pet? Maybe the pet never leaves their yard, or barely even the house. Does the latter even need a flea or tick preventative?
The answer is yes, they do. Just because they might not venture out very far does not mean they are at zero risk. Are they at less risk than the pet that visits the dog park every day? Yes, but never at zero risk.
The neighbor’s wandering cats could very easily “sprinkle” fleas, flea larva or eggs in that pet’s yard; the next thing you know, the pet that “never goes anywhere” has fleas.
Sadly, I really enjoy it when a pet owner comes in with a pet that can be diagnosed with flea bite hypersensitivity from across the lobby and then tells me there is no way their sweet baby could get a flea. Very few things bring me the joy of finding a few fleas on that pet.
There is not a good reason to not have a pet on a flea and or flea and tick preventative anymore. There could be areas where year-round prevention is not 100 percent necessary, but I truly do not know where that would be, or when you could honestly tell a client when it is safe to stop during the year or when they should begin. Where I live, we see year-round fleas and ticks. It is safer to just not stop.
With the ever-increasing number of tick diseases, I believe if there is any chance the pet may pick up a tick, the safest bet is to have that pet covered with a preventative.
If pets frequent the park, or the lake, go on runs or enjoy runs through the woods, they need a tick preventative. End of story. Recommend it, document it. If clients decline after your recommendation, you have done your job and now it is on them.
2) Concurrent issues. We have established every pet needs a fleas and tick preventative, but not all of them may work the same from pet to pet. After evaluating a client/pet’s lifestyle, my next step is to evaluate the pet’s overall health and skin type.
Does the pet have a normal, shiny, healthy coat with no health concerns? If so, pretty much anything is going to work. If there are some health concerns, you may still have some work to do.
What issues are there? Dry skin? Atopy? Flea bite hypersensitivity? There are several skin issues that will give me pause when it comes to recommending a topical preventative. If I encounter literally any disease process that led to abnormal skin health, I recommend an oral preventative. It is just the safest bet. I will not have to worry about whether the preventative is going to give full body coverage with an oral route of administration.
I explain to the owner to follow the manufacturer’s recommendations on administration (usually with a full meal), make sure the product is fully ingested and that is it.
3) Cats. Everything I have written about so far is the same for felines as it is in for my canine patients. Much more frequently, I am dealing with “mostly indoor” cats, and flea preventives are the number one concern. However, if that cat lives in a house with a dog that has a high chance of harboring ticks, then the cat needs a tick preventative.
Skin issues will affect my recommendations of preventatives, as well. I also encounter some households where there may be a cat that “gets” to spend time outside while the others are inside only.
I believe if you have one “inside-outside” pet, then I consider them all that way. That one pet brings the external risks inside and will eventually “share the love.”
It is always better to be safe and recommend prevention. Giving an oral medication is never fun to a feline patient, but I want my recommendations to be effective.
Variety, plus some
There are two main types of flea and tick preventatives: topical and oral (I count collars as a topical). It seems like there is a new product every other week. Most of the time they are just recycled medications with different carrier molecules or binding agents. If you are unfamiliar with the new brand, look at the ingredients, you probably know them.
As I stated earlier, if the patient has a normal coat and no concurrent diseases, pretty much everything seems to work.
Oral flea and tick preventatives have become more and more mainstream the last few years. I have become more and more of an advocate of them. These preventatives work well for the majority of my patients and have a much quicker and more efficient depopulation for both fleas and ticks on the pet.
One issue to consider with choosing between topicals, collars, and oral preventatives is ticks are much harder to eliminate than fleas. Fleas are moving about much more than ticks. This is important because as a parasite moves around the host, they encounter the medication within the preventative product.
When utilizing a topical or properly placed collar (more on that later), that medication will be carried by the oils on the skin, transferred to the parasite’s shell, and effectively killing it.
Here is the problem with ticks: they find a spot and attach to the host. Ticks could possibly not receive a fatal dose of the medication via their limited movement, which could lead to many things, including, but not limited to, transmitting tick-borne illnesses.
Oral medications—when properly dosed and ingested by the patient—utilizes the blood stream, effectively poisoning the food source of both fleas and ticks. This has become my preferred method when not contraindicated for my patients.
If you do have clients who prefer the collar variety of flea and tick prevention, take the time to make sure these are applied properly. Generally, these need to be tight enough for proper “wicking” of the medication to the pet’s skin. More times than not, these products are applied far too loose for this to occur. As I tell my clients, “If it’s flopping, it’s not working!”
I will not get into the politics of the many different brands of oral and topical flea and tick or flea/tick and heartworm preventatives. I have used nearly, if not all of them, and have had very few bad experiences. I will guarantee you this though: none of them work if the client does not give them or does not give them properly. I have yet to find a preventative that works effectively from inside the cabinet and still in the package.
Strongly recommend monthly preventatives be given as instructed by the manufacturer. “Read the room” and make sure you are recommending a preventative your client can give their pet.
If the pet will not take a pill from your elderly client, do not send them with an oral variety. You are setting everyone up for failure. Establishing the relationship properly with your client and patients will help you make good decisions and aid in proper recommendations.
Cade M. Wilson, DVM, is a practicing veterinarian and a three-doctor mixed-animal practice owner in Ardmore, Okla. He has been practicing small animal medicine for the last 18 years and been a practice owner for the last 15 years.