Flea control 2009: Tips for more effective communication

Dealing with a flea infestation is no different than working up a patient with another medical issue such as vomiting or diarrhea. The presenting complaint of seeing fleas or flea allergic dermatitis is a clinical sign related to an underlying problem. Whether or not a patient has secondary flea allergy dermatitis, we need to ask more questions to find the cause of the problem in order to help our patients.

Communication is the key to success

Most pet owners do not understand flea control or how treatment products work. Veterinary clinics should be the source of flea education for pet owners. It's helpful to train staff members to communicate with clients about flea control and how to apply products, as well as handle complaints regarding product failure. The practice should develop a simple, consistent message. This is a lot of information for busy clients to take in, so veterinarians need to make it as easy as possible.

IN ORDER TO INVESTIGATE FLEA INFESTATION, THE FOLLOWING QUESTIONS SHOULD BE ADDRESSED:

• On which pets are you seeing fleas? How many fleas are you seeing on each pet?

• When are you seeing fleas? After the pet has gone outside? When the pet is on the furniture with you?

• Where (on your property) are you seeing fleas?

Outdoors: Do other animals have access to the yard? Where do you take your pets? How much acreage do you have?

Indoors: In which room(s) are you seeing fleas—the garage, screened porch, vehicle, or a pet carrier?

• Are all the dogs and cats in the home treated? How often are they treated?

• What flea-control product do you use?

• Where was the product purchased? You may not be the only practice that the family uses for all of their pets (i.e., cats, ferrets, etc.).

• Is the product an over-the-counter purchase?

• How are you applying product? A study has shown an average of 40 percent of product is still left in tube.

• Are you shampooing, wetting, or grooming the pet? Does the pet swim?

• Have there been visiting or untreated pets?

• Is there access under the house, deck, porch, or shed? These micro-climates are flea heaven. Advise the client to block them off from pets and untreated animals.

Look like an expert

Simplify client education by using the flea-control communication aids provided by manufacturers.

Helpful handouts are available to educate clients, as are guides for the clinic to work through complaints regarding product failure. For example, Merial® provides a client-focused flea handout called "The blood sucking menace." They also have a "Take Control" chart containing many of the questions listed above. If all else fails, the company's technical support number is at the bottom of the chart to help you get to the bottom of the situation. These aids make our jobs easier and help to provide clients with a consistent message from everyone in the practice.

Explain how fleas get on their pets

When a pet has fleas, they have been in contact with an infestation site, where flea eggs have fallen from an animal. Potential sites of infestation include the home, garage, vehicle, pet carrier, storage shed, yard, neighborhood, dog park, and even doggie day care. Even wood floors are not a barrier, as eggs fit into the cracks and base boards.

Set the proper expectations with the client for the flea product and explain how it works

The fleas clients see on properly treated pets are in the process of being killed, they are not killed immediately. Fleas typically die before they can reproduce, so it is important to point out that an indoor infestation can be eliminated with monthly treatments of all dogs and cats. With regard to the speed of kill, Dr. Michael Dryden says, "with any product we've ever studied at Kansas State University, whether it is topical or systemic, the majority of fleas will consume some quantity of blood before they die." Usually three or more monthly treatments are required to solve this problem. So veterinarians and staff must educate the client not to expect all fleas to be gone after one treatment.

If the source of fleas is outdoors, the infestation may be difficult to eliminate. Clients will still see fleas on their pets. I recommend continuing flea treatment and preventing access under the porch and house, cleaning up yard rubbish, treating protected areas with an insect growth regulator (IGR), etc. Warm, dark, moist areas are the perfect habitat for fleas to reproduce. To encourage regular product application for preventive maintenance, remind clients that fleas are always waiting somewhere to jump on the pet and start a new infestation.

Barriers to success

Pet owner misconceptions about fleas and flea control can be a barrier to helping the patient achieve successful flea control and relief from flea bite allergies.

1. Clients do not understand where fleas come from because they don't understand the flea life cycle or what an infestation is (eggs, larvae, pupae). They don't know that every time they see a flea on their pet, it came from a site of infestation (home, yard, park). And they don't know how rapidly fleas can lay eggs and establish an infestation.

2. Clients think that fleas jump from one pet to another. Once fleas jump onto a dog or cat, they live their entire lives on that animal.

3. Clients do not understand that neighborhood pets, and feral and wild animals visit their yards and deposit flea eggs.

4. Clients think that indoor cats don't get fleas. People can bring "hitchhiker" fleas into the home.

5. Owners worry that fleas in their house equal a dirty home.

• This can be an important barrier to communication with the clinic.

• Explain that fleas are a way of life in many areas of the country, and it has nothing to do with cleanliness. In Florida, if a pet is not on flea control the pet will inevitably have an issue with fleas.

6. Clients do not understand how products work.

• They expect to never see fleas on their pets if they are treated.

• They think flea-control products repel fleas.

• They think all fleas are killed in minutes.

7. They do not understand the flea development window.

• It takes three to eight weeks, or longer, for all stages of flea development (eggs through pupae) to be exhausted.

• They expect a flea infestation to resolve within days of beginning treatment.

• They don't understand that they may see more fleas on their pets, even though they have started treatment.

8. Clients think that putting pets outside will help the problem.

• But without the pets to feed on, the fleas may attack the owners.

9. Clients think that treating the yard with insecticides should solve the problem.

• Adult fleas do not live free in the environment. It is the eggs, larvae, and pupae that form the environmental infestation.

• Treating the yard may be helpful, but it is a small part of the solution.

10. Clients think that once a flea problem is solved they can stop treating their pets.

• They don't understand that flea infestations are present in the yard, neighborhood, parks, etc., and their pets will pick up fleas and re-establish infestations in the home.

The flea life cycle and why it is important

Once there is an infestation in the environment (house and yard), it can take several months to stop seeing fleas. The reason behind this is simple flea biology, or the flea-development window. Adult female fleas lay 40 to 50 eggs per day, which fall off the animal into the house, car, and yard. Eggs hatch in one to 10 days to become larvae. The larvae then pupate in five to 11 days. Fleas emerge from the pupa (silk cocoon) in seven to 174 days. Adding up these numbers, even if we have perfect flea control with 100 percent prevention of egg production, it could take a total of 195 days or 6.5 months to complete the life cycle.

The flea life cycle and a blooming flea infestation

In this scenario, the affected area contains a large number of larvae and pupae. The flea population may be ready to explode, even after treatments have been applied to the pets. Because of the development window described above, it will appear that the product is failing since there are so many eggs, larvae, and pupae in the environment that will become adult fleas in the intervening three weeks to six months. These fleas will then get on the pet and be killed by the flea product. So while you and the client may still see fleas on the patient, there is an endgame scenario in place.

The importance of integrated flea control

Integrated flea control is the consistent use of an adulticide with an IGR to eliminate fleas and stop reproduction. This is especially important as the concentration of adulticide wanes and ensures any eggs laid are nonviable. "The concurrent application of an adulticide with an ovicide, such as an IGR, along with appropriate mechanical measures is the optimal approach for killing existing fleas, preventing re-infestation, and inhibiting the development of resistance," says Dr. Dryden.

Solutions to perceived product failure

Experts agree that the resistance suspected as causing the failure of modern flea adulticides has not been documented. It is import to remember the three- to eight-week development window, and that once treatment starts, owners may see fleas for up to eight-plus weeks. During this time, new fleas will continue to jump onto pets from indoor or outdoor infestations. If outside of the pet owner's property, this cannot be controlled.

Also educate the client that fleas are not killed immediately. All fleas on the pet are usually killed in less than 24 hours (before eggs are laid), but some may survive longer. Missing a dose can lead to the production of hundreds to thousands of eggs, which in turn can result in more fleas being seen on the pet and a repeat infestation. With this in mind, it is important to make sure all family pets are being treated and repeat "the flea talk" frequently, even with our best clients.