Feline parasite control: Cat-friendly practices and products (Sponsored by Bayer HealthCare)

In this roundtable and accompanying video interviews, experts in veterinary behavior, infectious disease, and feline practice discuss ways to improve preventive care of feline patients, including a discussion of the importance of effective parasite control and the use of flea and tick collars for cats. The participants discuss how they educate clients about the importance of annual visits and preventive care programs. They also share tips for decreasing cat stress during these visits and describe tools, practices, and products that they consider cat friendly (i.e., atraumatic or easy to apply) and that may help owners implement new therapies at home, including the use of collars.

Dr. Joe Hostetler (Moderator): Today's roundtable discussion will focus on the feline patient and the challenge and opportunities that cats and their owners present when providing veterinary care. The recent Bayer Veterinary Care Usage Study III: Feline Findings found that fewer than 50% of all cats receive routine annual wellness examinations. The study pointed out the four primary reasons that cats aren't receiving routine veterinary care:

• Lack of pet owner knowledge about appropriate veterinary care of cats

• Resistance and reluctance of cats to get into carriers and the use of carriers and travel in general

• The stress that both the cat and owner experience and associate with veterinary visits

• Lack of pet owner understanding of the benefit and value of regular veterinary visits to increase the quality and longevity of life for cats versus the economic cost of those visits.

Clearly, veterinarians have an opportunity to increase the number of feline visits and their practice revenue by addressing these issues.

In your practice experience, what do you find works best in communicating with cat owners about the necessity for and the benefits of routine feline veterinary examinations?

Dr. Wayne Hunthausen: What is useful in relaying value once the pet owner is in the door is getting the owner involved in the examination process. As you go through the examination, explain what you're doing and what you're looking for. Make it obvious that there are things that we can see during an examination that the owner can't see at home.

Dr. Susan Little: I agree, and that's why I narrate every step of the exam. Owners often don't know what we're doing in an exam. We know what we're doing and why, but they don't. In addition, changing the owner's perception of why an examination is important can be useful. For example, I don't like the term annual wellness examination. A cat owner thinks, “My pet looks well. Why do I need to come in to the veterinary clinic to have you confirm that for me?” I think our terminology should focus on preventive care. That's got value, and we can hang some hooks on that - whether it's parasite control, vaccinations, obesity, or behavior problems.

Dr. Debra Horwitz: I think you also have to make the owners partners in their pet's care. They assume certain things indicate wellness when perhaps they don't. For example, if their cat doesn't groom itself they may think he's just a messy cat. But this could be a sign of illness or anxiety, and they're not aware of that. Cats are mysterious and some people want a cat because, while it's loving, the interaction and the need for care appear to be less. However, we need to emphasize that the need for care may actually be greater than for a dog because cats are so covert in so many things that illness may be missed. Educating owners would help them to be a partner in patient care. Together, we are going to help guide this cat through a long, healthy life.

Dr. Michael Lappin: I think we can capitalize on the fact that clients seem to know more about dogs needing care. When it comes to cats' preventive health needs, cats are not that different from dogs, and we need to communicate to the owners that we also need to identify health issues early in cats.

Dr. Little: It speaks to cats' subtle signs of illness, doesn't it? Somebody once told me that a healthy cat asleep on a windowsill looks a lot like a really sick cat asleep on a windowsill. They just don't look much different to pet owners. A lot of behavior changes can also be medically driven and owners may not be aware of that.

Dr. Horwitz: One thing that can really upset a cat owner is changes in their cat's litter box habits, yet owners usually don't realize that this can occur for a medical reason. They are often unaware that the jump from two wet spots in the litter box to five wet spots can be a big deal and signal a medical problem.

Dr. Little: Cat owners actually may not know their cats as well as they should or as well as they think they do.

“We're going where?!”

Strategies for reducing the stress of visiting the clinic

Dr. Hostetler: What steps have you taken to help reduce the stress that owners and cats experience before, during, and after the clinic visit for those preventive care examinations?

Dr. Horwitz: One of the first things I tell clients is, “Don't ever put your cat carrier away.” The cat carrier should be like a piece of furniture. If you don't like the way it looks, decorate it, do something else, but it should always be out. Cats are suspicious of novel things, so the carrier should be left out and the owner should put something inside that the cat likes (e.g. food, catnip, something soft to nap on). 

Dr. Hunthausen: We recommend pheromones, which can help keep cats calm for the trip to the veterinary clinic. When a cat owner makes an appointment, the receptionist should say, “If you might have or have had problems getting your cat in a carrier, go to our website for an article on what type of carrier your cat would be most comfortable with, how to get your cat acclimated to it, and other things that make it helpful to get your cat in.”

Dr. Little: It's all about pre-visit planning, so we spend a lot of time on that. Our reception staff are trained to be proactive and ask clients before the clinic visit, “Do you need help?” or “Have you had a problem getting Fluffy in the carrier before? Is there something we can help you with?” We also post a lot of helpful materials on our website, blog, and Facebook page.

Dr. Hunthausen: Using social media is really important for veterinarians. Social media is a great way to regularly remind people about the importance of bringing their pets in for routine examinations.

Dr. Horwitz: Apps for mobile devices that help assess cat health and behavior are available. Veterinarians should be proactive and, if they are so inclined, help develop apps. We need to move the bar so that owners know what to look for.

Dr. Little: We're going to be behind the times if we don't keep up with new technologies, new tools, new ways of communicating.

Dr. Horwitz: Of course pre-visit planning doesn't reach owners who aren't thinking of coming. Having a discussion with someone who's already made an appointment makes it better for him or her. But it can be difficult to move the bar on those 50% who don't come in for a veterinary visit.

    In the clinic, I think having separate cat rooms and separate entrances can help minimize stress. It's also helpful to provide elevated places for the cats in their carriers, so they're not on the floor.

Dr. Hunthausen: Towels are helpful to gently handle the cat instead of scruffing it.

Dr. Little: Towels are also good for covering carriers so the cat doesn't feel so exposed. We also provide loaner carriers in case an owner comes in with a cat in his or her arms.

Dr. Horwitz: We use pheromones, as Dr. Hunthausen mentioned. The pheromone we use most often in practice is Feliway® (Ceva). It is a synthetic feline facial pheromone and helps the cat feel more relaxed and more comfortable. It comes as a spray, a diffuser, and wipes. The wipes are effective in our practice to use on tables and carriers. Not every cat is pheromone-responsive, but many of them are.

Dr. Little: We also have owners treat the carrier before they even bring the cat in the clinic.

Dr. Hunthausen: Even several days before they get the cat in the carrier, it is helpful so the cat is becoming calm for several days before it goes in the carrier and comes to the clinic.

Dr. Horwitz: Our pets live in a world that's rich with smell, and we don't capitalize on that enough. Surrounding cats in the veterinary clinic with smells that are cat friendly helps calm them, and pheromones contribute to that effort.

Don't underestimate the importance of cat-friendly products in your toolkit

Dr. Hostetler: So those things help with stress and prepare a cat and owner for the clinic visit. How about for cats that require antimicrobials, parasiticides, or other medications? Are there some medications or vehicles you prefer over others? 

Dr. Horwitz: We talk a lot about preconditioning, specifically if it is for a medication that the cat doesn't need right away. We teach owners to call the cat and feed it a treat at the same time every day for a number of days. Cats are very suspicious so we make handling a fun thing. We use things like Nutri-Cal® (Tomlyn) or anchovy paste, something the cat really likes.

Dr. Little: That's something veterinarians don't think about often enough. Not every medication needs to be started today. Maybe you could take a day or two to precondition the cat.

Dr. Hostetler: Is there anything that would be a little more cat friendly than a pill?

Dr. Lappin: On the subject of pills, we know that cats can have an issue with taking pills because of their poor secondary esophageal peristalsis. There have been many studies that have shown that pills or capsules can lodge in the esophagus at the level of the carina and may still be there more than five minutes after administration. If medication is given in the form of a treat, coated with butter or a vitamin supplement like Nutri-Cal, or followed by 2 ml of liquid, the pill or capsules are in the stomach within a minute or two.1 

Dr. Hunthausen: Overall with medicating cats, the less interaction, the better, whether it's something oral or something topical. For example, delivering medication in food or in a transdermal carrier is better than forcing a pill down a cat's throat. For cats that are very averse to handling, a flea and tick collar that lasts for several months might be more readily accepted than monthly topical treatments. It's very easy to bruise the owner's relationship with a cat by forcing it to accept something it doesn't like. 

Dr. Horwitz: Unless you precondition them to accept interaction as something that's worthwhile. I would also like to see cat-friendly medications that are formulated. I think it's a great idea to compound the medication so the cat will eat it, but we don't know if it's actually bioavailable to the cat. There are some transdermal medications that do work and are useful for treating cats. 

Dr. Hostetler: There are also products on the market such as Veraflox® (pradofloxacin; Bayer), which cats take very well, and we do have the pharmacokinetic data available for that.

*CAUTION: Federal law restricts Veraflox® (pradofloxacin) to use by or on the order of a licensed veterinarian. WARNINGS: For use in cats only. PRECAUTIONS: The safety of pradofloxacin in cats younger than 12 weeks of age has not been evaluated. Click this link to see the Veraflox® Brief Summary.

Dr. Little: It's really important to explore alternative ways of getting medications into cats. What Dr. Lappin brought up (the pill hangup) is an underestimated issue. In human medicine, there's a long list of medications that cause esophageal discomfort or erosions and irritations. In cats, we know of a handful of drugs that do that, and I'm sure there are more. Owners often report that it went well for the first day or two, but now can't get them to take the medicine. Don't you wonder if that's what could be going on?

Dr. Lappin: Thankfully, I don't think there are many medications irritating enough to cause the 270 degrees of inflammation thought to be required to lead to a stricture. But, imagine how weird it feels to the cat to have a pill hung up in their throat.

Dr. Little: We teach owners never to dry-pill any medication because I just assume they all could be uncomfortable. So they all receive a treat or food afterward and that also helps with conditioning the cat to take the pill.

Dr. Hostetler: How do you address parasite prevention and control and factor that into your client conversations and recommendations for their pets?

Dr. Little: We talk about the myth of the indoor cat. I practice in a big city and a lot of my patients never go outside, but there are many ways that indoor cats can be exposed that owners are not aware of - whether it's mosquitoes, creepy crawlies, a dog that lives in the same house, or other pets in an apartment building. 

Dr. Horwitz: Owners have the mistaken idea that because their cat doesn't go outside that it cannot get fleas or ticks. If they also have a dog, we must remember to tell them it's not true. Cats are so clean that you wouldn't necessarily know if they had had external parasites on them. We must have these discussions with clients so that they understand normal cat grooming habits and how grooming might skew the visualization of external parasites on the cat.

Dr. Lappin: We've known since 1970 that roundworms can be transmitted by flies. “Have you ever seen a fly in your house, Mrs. Smith?” As for mosquitoes, they follow CO2. “Have you ever seen a mosquito in your house, Mrs. Smith?” Cockroaches can also carry larvated roundworm eggs. We need to shift the owners' thinking to understand that all of these transport hosts can get into the house, regardless of where they live.

   The owner's activities come into play too. If you hike, like I do during the summer, you'll occasionally bring back ticks.

Dr. Little: We also focus on the ease of prevention versus the challenge of some treatments. It's much easier to prevent a problem in the first place.

Dr. Lappin: It is good to have on your clinic reminder cards and other communications that clients should remember to bring a fecal sample in so that the pet can be evaluated for parasite control issues.

Education is key to effective infectious disease control

Dr. Hostetler: What specific tips do you have for relaying to clients the importance of protecting their cats from fleas and ticks and educating them on the infectious agents those parasites can transmit?

Dr. Lappin: It is a bit of a double-edged sword because we want to use the importance of parasite prevention to emphasize coming in for preventive care, but we don't want to frighten owners. I think it's very important to mention to them that fleas aren't just itchy and gross but that they also can transmit infectious diseases; however, we need to do this responsibly and in a way that doesn't scare them away from owning a cat. There is also the concern with tick-borne diseases like cytauxzoonosis, which can have a very high mortality rate in non-treated cats. 

Dr. Little: Most owners are not even aware of the diseases that fleas and ticks transmit.

Dr. Horwitz: There is the misperception that because cats are so clean, and owners might have never seen fleas, that there is no need to worry about flea control or infectious diseases.

Dr. Little: An important part of our job is to raise awareness to help protect susceptible, immunocompromised individuals in homes as part of our One Health initiative. So we need to think of not just the client who's in the exam room, but also who needs to be protected at home.

Dr. Horwitz: We need to ask about the family composition - for example, are there small children or immunocompromised individuals in the house? Bringing the whole family in, making them a partner in the wellness of the cat is going to impact the quality of life of the cat.

Dr. Lappin: I support the American Association of Feline Practitioners (AAFP) and Companion Animal Parasite Council (CAPC) because the more we have national or international groups suggesting these things, the better. Information from these organizations and their websites can help with client education to show them that these are national and international parasite control guidelines, not just individual clinic policy. And CAPC says it very clearly - it's all pets, it's all the time, no matter where you live. The CAPC website also has U.S. infectious disease prevalence maps for dogs and cats. 

Helpful parasite prevention websites for veterinarians and clients

The Companion Animal Parasite Council (CAPC) maintains two websites, one for veterinarians and one for pet owners.

CAPCvet.org contains user-friendly, searchable, up-to-date information for veterinarians. The website states, “The mission of the CAPC is to foster animal and human health, while preserving the human-animal bond, by generating and disseminating credible, accurate, and timely information for the diagnosis, treatment, prevention, and control of parasitic infections.” To that end, CAPCvet.org contains numerous parasite prevalence maps, expert articles, and CAPC's recommendations and guidelines for parasite protection for cats and dogs.

CAPC's petsandparasites.org contains similar information, but it is written for pet owners. It provides content to help them easily understand the threats parasites pose to their pets and families. Veterinarians can familiarize clients with this site during a clinic visit. 

Dr. Horwitz: Many veterinarians may not know about these maps. But if they are more aware of the disease prevalence in their area, then they're going to initiate that conversation about parasite control.

Dr. Lappin: We definitely need to educate veterinarians, which is what we're trying to do at the CAPCvet.org website. The petsandparasites.org site is written more for the layperson. Veterinarians' social media and reach-out messages to pet owners should relay that parasites are important and provide links for more information before the visit. Once clients are in the exam room, if they give pushback about not needing flea control for their cat, you can bring up the CAPC site on the exam room computer to validate your recommendations quickly.

Dr. Horwitz: These sites are informational; they're non-commercial. These are wonderful tools veterinarians have right at their fingertips. Veterinarians can display them on an iPad, tablet, or computer right in their exam room. When talking to a client, you can just click on a link and that helps initiate a conversation. People want information, and they look to the veterinarian to get it.

Dr. Hostetler: CAPC has also unveiled a Parasite Map app for use in the exam room.

Ease of use is critical for compliance

Dr. Hostetler: When considering products for flea and tick control, what are the disadvantages and advantages that come into play as you make a decision about what to recommend to a client?

Dr. Hunthausen: Ease of application is really important. If the pet owner can't get the medicine into the pet or onto the pet, you've lost right there. The pet's environment and the owner's activities are important considerations. The cost of the medication influences what we recommend or when we recommend preventives.

Dr. Little: Today I have more owners asking about safety than I used to. I get more questions about things they perceive as a chemical being applied to their pet. We've made sure that our staff members are well versed in talking to owners about safety studies. Fewer owners voice concerns about efficacy.

Dr. Hunthausen: And the questions are about safety not only for the pet, but safety for the children in the home, for other adults.

Dr. Horwitz: Or even for in-contact animals. The ease of application is a big concern for cat owners because they don't like their cats to be mad at them or avoid them because they're administering something that they know is good for the pet's health but is adversely affecting the bond. So it's that balance of making sure that we've provided them with the right tools to administer the product in an easy way. A lot of products are easy for veterinarians to administer, because we've pilled or treated lots of cats. But it's not right to make that assumption that it's easy for the pet owner to do because it's so easy for us.

Dr. Little: Owners need a demonstration about how to use topical products. So we'll put the first dose on the cat in the exam room.

Dr. Lappin: Even when we demonstrate and educate, and then a month elapses and the owner thinks, “So, now it's the next month. How did they do this again?”

Dr. Hostetler: As for compliance with feline patients, you've mentioned less interaction is important, as are ease of administration, duration of efficacy, and safety. Are there any other concerns that relate to compliance, and how are you addressing compliance? What are your recommendations to your clients that relate to tick and flea control?

Dr. Hunthausen: It just keeps coming back to ease of use. That's important not only to make sure the pet gets the medication it needs, but also to maintain the relationship the owners have with the pet. For the owner, there's nothing worse than to walk into a room and have the cat look up and walk away because it doesn't like what the owner has been doing to it. You don't want treatments to damage the owner's relationship with the cat.

Dr. Little: Owners are very sensitive about that relationship with the cat, and they are quite easily put off if they feel that that relationship has been damaged in any way.

Dr. Hostetler: So with all that in mind - the bond to the cat, efficacy, safety, ease of administration - what products do you recommend for flea and tick control for cats?

Dr. Little: What you pick is going to depend on what parasites are prevalent in your region and what your patients' needs are. For cats, even though the topicals have really revolutionized things, there is a big gap because few topical products are efficacious against ticks on cats.

Dr. Hostetler: Are collars in that mix as it relates to topicals?

Dr. Little: The veterinary profession has traditionally steered owners away from collars. Now that we have Seresto® (Bayer), we're going to have to change our thinking. It'll be a real turnaround, because Seresto® is a breakthrough product that lasts 8 months. 

Dr. Horwitz: I think owners will need to be educated about how to use collars correctly and how long to leave them on. If owners use the product improperly and it doesn't work, the fact that they used it improperly doesn't factor into their opinion about the product.

Dr. Lappin: At Colorado State University, we've been strongly aligned with topicals ever since they became available for cats. Now with a product like Seresto®, it addresses some of the compliance issues.

Dr. Horwitz: Owners don't like the fact that collars can create hair loss and hair breakage. So that when they remove the collar, it's still there. There's still that change.

Dr. Little: Even if it's just cosmetic.

Dr. Lappin: The other concern people have with collars is that they may get hung up on things.

Dr. Little: We can't underestimate that there is a risk that needs to be addressed.

Dr. Hostetler: The Seresto® cat collar actually has two safety release mechanisms. If you look closely at the collar, there's an area that, should a small amount of force be applied, the collar is going to snap. This is designed to snap at about 80 newtons, the equivalent of a handshake. The ratchet mechanism for securing the collar also will give way at about that same force.

Dr. Horwitz: Have you had cats do it?

Dr. Hostetler: Yes. There is a phone number on the back of the package for the owner to call to talk to Bayer representatives. Over the past year and a half, however, it has been a nonissue.

Dr. Horwitz: In your research, how many cats have taken the collars off? Do you know?

Dr. Hostetler: It's been a very miniscule percentage. The ultimate test is in the market. The collar has been available in Europe a year prior to launching here in the U.S., so there is another year's worth of real-world experience with it. Loss of collars, cats getting caught in trees or on fences, has been a nonissue. It's not something we took lightly, but we found it was not a problem.

Dr. Lappin: In one study we completed, even cats in multi-cat households did not spontaneously remove their collars. (We did have one cat that got the Seresto® collar entrapped on his lower mandible twice, and so he was removed from the study.) We also compared Seresto® collars to a placebo collar in that study and, overall, there were no greater side effects with either collar. In contrast, group-housed research cats will occasionally succeed in removing collars from their “friends,” usually by chewing them.

Dr. Little: Some cats are chewers and some aren't.

Benefits of 8-month flea and tick protection

Dr. Hostetler: Do you have other thoughts about Seresto® versus any other products as far as it relates to flea and tick prevention and specifically the repellency, efficacy, convenience, and ease of administration?

Dr. Hunthausen: The repellency of the Seresto® collar is a nice quality because if you can prevent these little critters from feeding, that can be a step in avoiding transmission of some of these more serious diseases.

Dr. Lappin: One of the things that we downplayed in cats to this point was tick-borne infection. Along with cytauxzoonosis, we know there are other tick-borne illnesses in cats, such infections with Anaplasma and Ehrlichia species. When you look at vector distribution, these infections cover the majority of the U.S. Therefore, as we learn more about tick-borne diseases in cats, we should be thinking not just about fleas, but also about protection against ticks. Compliance is important. The 8-month flea and tick protection of Seresto® makes it a real game changer.

Dr. Hostetler:It's a big paradigm shift for us.

Dr. Little: It's important to know what the history is that has pushed veterinarians away from flea collars. Those are exactly the things that we need to address. Seresto® is just a different delivery system, but it's still a topical. 

Dr. Lappin: One of the things that surprised our group was that it's not that powdery type collar.  

Dr. Little: Yes, that's a good point.

Dr. Horwitz: In the past, the powdery texture and the smell have been big owner complaints with other types of collars for cats that dispensed a product topically.

(See sidebars: Features of the Seresto® collar and How the Seresto® collar works.) 

Features of the Seresto collar

• Seresto® delivers the performance you expect from a topical treatment in an easy-to-use collar against fleas and ticks for 8 months.

• The active ingredients, imidacloprid and flumethrin, are provided in a non-greasy, odorless, and convenient collar.

• Bayer's Polymer Matrix is designed to slowly and continuously release the active ingredients over 8 months.

• The Seresto® cat collar features a release mechanism (with predetermined breaking point). In the unlikely event of a cat becoming trapped, the cat's own strength is sufficient to allow for quick release.*

*Data on file.

How the Seresto collar works

• The unique Bayer Polymer Matrix of the Seresto® collar (Figure 1) allows a sustained release of the active ingredients, imidacloprid and flumethrin, for continuous flea and tick prevention that lasts 8 months.

• Active ingredients are stored within the collar. They are slowly released on contact with the hair and skin and are then distributed over the body (Figures 2-4).

• The Seresto® collar kills fleas and repels and kills ticks for 8 months. If a tick is repelled or killed, it cannot attach to a cat and transmit organisms that may cause disease.

• Seresto® aids in the control of flea larvae in the cat's immediate surroundings following contact with a cat treated with Seresto®.

• The Seresto® collar is easy to apply, non-greasy, and odorless.

It is a myth that cats won't wear collars

Dr. Hostetler: A 2010 study by Dr. Linda Lord and her colleagues looked at owner perceptions of whether their cats would wear collars.2 In your opinion, what were the primary findings of this study as it relates to cats and collars?

Dr. Little:I love the fact that many owners in that study had a preconceived notion that their cat wouldn't wear the collar and were surprised when the cat did wear the collar for the whole six months of the study. It's one thing for us to say that, but it's another thing to be able to point to some data and say this has been studied, and not in just 20 cats, but in hundreds of cats.  

Dr. Horwitz:The take-home message is that we know that cats will wear collars. It is worth pointing out, however, that their sample was all from veterinary schools, and owners in the general public may be more inclined to think that their cats would not tolerate a collar. About 25% of the veterinary students who took part in the study thought that their cats wouldn't tolerate collars well.

Dr. Little: Our clinic cats all wear collars and ID tags. We try to make sure that any image of a cat that we use in materials or on our website is a cat with a collar and an ID tag. So you've got to walk the walk, if you're going to be recommending collars.

Dr. Hostetler:Dr. Lappin shared his experience and thoughts about Seresto® use on cats. Now that you know a little more about Seresto®, are you considering including it in your options for flea and tick control with cats and why? What would make you consider it?

Dr. Hunthausen: Some of the things that I'm considering in regard to adding it to our practice would be the tick control, especially for some of the pet owners that have cats that are at high risk for exposure and some of the more serious consequences of tick infestation. And then ease of use for some owners. There are some owners who I'm sure would be open to the fact that they only have to apply the product once every 8 months.

Dr. Horwitz: I agree. For ease of compliance, it is a great option for cat and dog owners so that you know your pet has protection for a fairly long period without having to reapply. That is really a useful modality to have available to you.

Dr. Little: I'll echo that. I think the compliance is going to be a big step forward for us with cat owners.

Dr. Lappin: I would add that I was very impressed at how well tolerated the collar had been by our research cats. In the client-owned cat study we just completed, there seemed to be an adjustment period within the first two weeks with either the placebo or Seresto® collar, and then they were fine. Initially they would scratch at the collar and there was some local alopecia and very mild crusting. If we can provide some tips for getting cats used to wearing a collar and they can make it through that first two weeks, then they should be fine.  

Dr. Little: So an acclimation period more or less, and then they stopped.

Dr. Horwitz:You thought the crusting was self-inflicted and not due to the collar itself?

Dr. Lappin: Yes. Licking at the collar site was by far the most common side effect. And then some cats licked other cats' collars if they were in multiple-cat households. Our assessment of the ones that did have crusting, erythema, or any local disease was that it was self-inflicted. We had only one out of 96 total cats that self-traumatized enough that he needed to be treated.

Dr. Little:It may be worth making a follow-up phone call with the owner within a week or two to assess how the cat is doing during that two-week period.

Dr. Horwitz: Also, tell the owners what might happen within the two weeks, because information is knowledge. Two weeks would be a timeframe in which most owners would take the collar off if they see problems. However, if they knew the response was transitory, they might be more likely to continue to use the product.

Dr. Lappin: We saw that cats that wore the Seresto® collars licked more initially, but otherwise acted the same as the cats with the placebo collars. So, coupled with Dr. Lord's study, we know that some cats just don't like collars and it will take time to get them used to it. That's my take-home message.

Dr. Hostetler: I wanted to make sure that we solicit all the tips and suggestions you have related to acclimating a cat to this collar. Are there any tips you want share?

Dr. Lappin: We saw that the cats that have already had a history of wearing collars were more tolerant of Seresto® or the placebo collars than were cats that hadn't worn a collar in the past. So basically you just need to acclimate a cat once. Once they're acclimated to a collar, then having this collar probably won't cause any major issues.

Dr. Little: So it could be important to know if they've worn a collar before.

Dr. Lappin: Yes, and that was statistically significant in our group. They were less likely to have a side effect if they had a collar history of any type. And most of those were ID collars, not flea and tick collars.

Dr. Horwitz: The owners will also need to be shown how to put on the collar. My experience has been that cats protest more about collars that are too tight. Owners should associate putting on the collar with something positive, like treats. Also, if they notice that the cat is pawing at the collar a lot initially, distract the cat with play. We need to be upfront about telling owners what to expect and what to do.

Dr. Little: I would elaborate on that and say we need to start by training the veterinarian and the team members just as much as pet owners. They likely have misconceptions about collars as well. Having staff members use the collars on their own cats could be valuable too. You make them advocates for your product. The best sales pitch to clients is to have clinic cats wear the collars. There's honestly nothing more powerful than my clinic cat wearing one.

Dr. Hunthausen: Acclimating the cat to the collar starts at ground zero in teaching the cat to tolerate and be comfortable with novel things in its environment and being handled. So if we can introduce the owner to the idea of putting a collar on the cat from a young age, that sets the cat up to be more comfortable with a Seresto® collar later on in life. And then teaching owners of older cats how to acclimate as well, maybe by using a paper collar and treat rewards.

Another thing we might want to recommend, to increase the success rate, would be to trim the cat's nails before applying a collar.

Dr. Lappin: So they're less likely to cause trauma.

Dr. Little: Yes, that's something to train team members to do at the time the collar is dispensed - to include a complimentary nail trim.

Dr. Horwitz: The other thing we want to do is set people up for success. That's what we try to do in our practice. If we're going to institute something, like wearing a new collar, we try to do it when they're going to be home. And tell them what to expect, both the good and bad. I think it's better that way. Nobody likes surprises. Cats don't. People don't.

    I also give owners these tips for introducing collars to cats:

• Don't ambush the cat. “Oh, he's sleeping quietly. I'll grab him and put the collar on.” That'll freak the cat out if they do it that way.

• Always associate the collar with something positive. Put some treats on the floor and put enough treats down so that the cat stays busy eating throughout the process of putting the collar on.

• Start out using a regular identification collar for a short time and, if the cat is bothered by it, distract the cat until it is calm and not paying attention to the collar and then take it off. Repeat the process again with treats or food, and cats will usually acclimate to it. Once the cat is acclimated to a regular collar, then apply the Seresto® collar.

• Distract the cat. If a cat is pawing at the collar a lot initially, owners can distract the cat with play or put it on with food rewards. Over time the cat is likely to wear the collar without a problem.

    If we talk to clients up front about the process, and that it can be done in stages, we can anticipate possible pitfalls and answer questions.  

Dr. Little: Right. So that'll be part of the whole team training thing too, to make sure staff know. Seresto® is going to shift a paradigm, and it's going to need a more critical investment in education to make this work.

Dr. Hostetler:The Bayer Veterinary Care Usage Study revealed that cats are a major opportunity for increases in number of visits and revenue in practice. What are your best recommendations for successful client follow-up, whether it be making sure the clients understand their cat's examination results that day, your health care recommendations until the next visit, and the timing of the next scheduled visit. How do you go about communicating all of that?

Dr. Hunthausen: One thing we talked about earlier is educating the owner during the examination about what's being done and what your findings are. Take-home examination reports are a good idea. It's a lot easier for somebody to read something they have in their hand even though people are more Internet savvy these days. It's very important to ask if the owner has any questions about the exam or treatment options, or if they have any questions in general. And then depending on the situation, a follow-up phone call after the visit is a good idea.

Dr. Little: Maintaining that contact is a big thing. So even some routine follow-up after a preventive care visit would be helpful. I do a lot of email follow-up too, and maybe send them a link to a website we talked about (e.g. petsandparasites.org).

Dr. Lappin: And the other important thing is if it's a type of problem that's going to require a follow-up visit, don't just allow the owner to go out there and make an appointment on their own. Escort them out and say to your receptionist, “Mrs. Smith would like to bring Fuzzy back in a few days. Please make that appointment.”

Dr. Little: Yes, walk them out and make it.

Dr. Lappin:One of the things I've found to be interesting over the years is that owners are fascinated that dogs and cats get some of the same diseases that people do. I think we can capitalize on them recognizing that animals get the same types of diseases, but it happens in a compressed timeline. This is why annual visits are so important so that we can catch things early. It gets back to the preventive maintenance.

Dr. Little: Right. And we need to get better at communicating the value of what we do instead of assuming that people know what we do and what the value is.

Dr. Horwitz: Another part of it is understanding that the client comes in with his or her own narrative, which may or may not include all the information we need to successfully care for the cat. Our job is to elaborate on that narrative until we have enough information to properly do our job - diagnose the problem and treat the pet for optimal health and welfare.

Dr. Little: Owner observations are useful, but their conclusions are not always useful.

Dr. Horwitz: So the veterinarian has to be prepared to listen to the client and ask about certain things like litter box use changes, changes in appetite, or changes in the home situation, anything that can also cause a change in the health or behavior of our patient.

Dr. Little: It's an environmental assessment, isn't it?

Dr. Horwitz: It's really important to do the environmental assessment. We also need to discuss what will happen when the owner brings the cat back home to a multi-cat household after its visit to the veterinarian. Reentry, especially with other cats in the home, can be tricky and cause problems.

Dr. Little: Especially if you come home with a new collar on.

Dr. Horwitz: Correct. It's important to have that discussion and to have tools on the clinic website where the owner can go for information.

Dr. Little: Reentry could be a real issue. It's important to know if there are any other cats in the house. We do a household census at each visit, so when the client comes in our staff is trained to check the file and verify which cats are in the house. Then we can get a better sense of what the exposure risks are too.>

Dr. Hostetler: We've discussed a lot of things - managing stress, acclimating to carriers, flea and tick control. What are a couple of statements that convey your recommendations related to the opportunities for flea and tick protection in cats in a compliant cat-friendly way?

Dr. Little: I'll circle back to what I said earlier. I'll talk to the owner about the ease of prevention versus the challenges of some treatments. Many of the things that we worry about in cats are easy to prevent but they can be a real challenge to treat. That can be really helpful for owners to understand.

Dr. Horwitz: With respect to parasite control, owners need to understand that the diseases that are a result of parasite infestation are often hidden for a long time. By the time they become serious enough that they're obvious, the pet can be very sick and owners may mistake that for an age-related change. “He's just slowing down.”

Dr. Lappin:I would say we need to gently reiterate that ectoparasites can negatively affect the health of your pet. We've found that up to 80% of cat fleas have either Rickettsia felis, Bartonella henselae, or hemoplasmas, so they pose a real risk.3-5

Dr. Hunthausen: Owners need to understand that we're not just controlling the “ick” factor or the irritation factor. Controlling those parasites goes beyond that in regard to controlling more serious things that they might not be aware of. If we want to help keep the pets healthy and happy and around for a long time, that's just something we want to pay a lot of attention to.

Dr. Hostetler: Anything else that you want to share with the practitioner relating to cats or a cat-friendly practice?

Dr. Horwitz:Increasing cat visits and improving preventive care will make the cats' lives better and improve their welfare. It's not just about the income for the practice; it is about providing good patient care through all the life stages of the cat so that families can enjoy their relationship for as long as possible. It will help the cats, but it's also great for the veterinary profession as a whole to do that.

Dr. Little: Generally good medicine means good business. One tends to follow the other. The Bayer Veterinary Care Usage Study has shown that pet owners don't always understand the value of preventive care visits and, as a result, cats in particular may not be receiving the care that they need. As our pets live longer and infectious diseases are less geographically isolated, the need for routine care becomes even more important. Veterinarians are in a unique position to have a significant positive impact on human and feline health by educating clients, staff, and colleagues to ensure all aspects of preventive care are being addressed.

References

1. Bennett AD, MacPhail CM, Gibbons DS, et al. A comparative study evaluating the esophageal transit time of eight healthy cats when pilled with FlavoRx pill glide versus pill delivery treats. J Feline Med Surg 2010;12:286-290.

2. Lord LK, Griffin B, Slater MR, et al. Evaluation of collars and microchips for visual and permanent identification of pet cats. J Am Vet Med Assoc 2010;237:387-94.

3. Hawley JR, Shaw SE, Lappin MR. Prevalence of Rickettsia felis DNA in the blood of cats and their fleas in the US. J Fel Med Surg 2007;9:258-262.

4. Lappin MR, Griffin B, Brunt J, et al. Prevalence of Bartonella spp., Mycoplasma spp., Ehrlichia spp., and Anaplasma phagocytophilum DNA in the blood of cats and their fleas in the United States. J Feline Med Surg 2006;8:85-90.

5. Lappin MR, Hawley J. Presence of Bartonella species and Rickettsia species DNA in the blood, oral cavity, skin and claw beds of cats in the United States. Vet Dermatol 2009;20(5-6):509-514.