That hits the spot!

 While on vacation with a friend in the North Carolina mountains this past weekend, I noticed that one of her Golden Retrievers had a bald, shaved area on its right flank. When I asked her, “Did he have a recent hot spot treatment?" she said, "Yes." 

Summer is definitely on its way, as skin and ear problems often present themselves this time of year. Prevention is the best medicine, so let’s chat about this common skin problem of dogs (and occasionally cats).

What is a “hot spot”?

A "hot spot" is a wet, weepy overgrowth of the surface bacteria on the skin. As the bacteria overtakes normal skin defenses, a pet begins chewing or biting on the area in response to the itching and discomfort. Often pus, pain, and foul odor develop quickly as the irritated, debris exposed area crusts over the surrounding skin and hair. Hot spots are most commonly found in pets with a dense coat such as Labrador Retrievers, Golden Retrievers, Newfoundlands, Bernese Mountain Dogs, German Shepherds, and Cocker Spaniels. Hot spots go by many names such as pyotraumatic dermatitis, superficial pyoderma, and acute moist eczema. Whichever term is assigned, they are all ways to recognize one of the most common problems of dense coated pets during the spring, summer and even fall months.  

How are they caused?

There are multiple causes of hot spots. Insect bites, fleas, pain, allergies, a damp coat (swimming, post bath, leaving out in the rain), skin folds, an especially dense coat that retains moisture, a contact allergy, irritating collars, ear & anal sac infections,  and anything that encourages a pet to scratch or chew their skin, thus leading to surface skin trauma.

That's a lot of causes, Dr. Betsy! So my question is, do they take a long time to develop? I took my dogs to a local lake to swim then left them for an hour at home, and found what I think is a "hot spot" the size of a tangerine upon my return! Is that possible? 

Yes, it's definitely possible! Once the skin is irritated, pets can obsessively chew and bite an irritated area quite rapidly. It is estimated that at least 30% of these pets had an underlying skin condition that allowed the sore to develop so quickly. It is important to check your pet's skin frequently to hopefully notice skin conditions early before hot spots begin.

Dr. Betsy, I heard that sometimes hot spots turn into Staph infections. Ewwww! What is the concern to pet owners with a a pet that has a surface “Staph bacterial infection?" 

There is only a low risk of infection to pet owners as people get a different strain typically. People get "Staph aureus" and pets get "Staph pseudoimtermedius."

What are the most common treatments prescribed for hot spots?

Initially, the best treatment begins with clipping the area (which sometimes requires sedation). The key is to set up a one to two inch barrier around the sore to keep the infection from spreading further.  A cytological exam may be performed as well to help determine the type of infection causing the hot spot and to rule out mange or other fungal infections. Then, a technician will begin washing the area with anti-bacterial soap followed by applying a topical antibiotic-steroid spray or cream. Depending on the extent of the infection & inflammation, an oral antibiotic and steroid/anti-histamine may be prescribed.  Sometimes an E-collar or "cone of shame" may be needed to keep a pet from self-traumatizing the area further.

What are some basic "first-aid" treatments for hot spots if you're in the mountains and unable to get to a veterinarian right away?

Try to keep your pet from further traumatizing the area. With a disposable razor, try to remove the hair near the wound as much as possible and then create a shaved barrier of at least 1 inch around the lesion. Cleanse the area with cool water and a topical antiseptic shampoo, then rinse, pat dry, and apply a triple antibiotic ointment. Sometimes a warm compress of a black tea bag can temporarily help alleviate discomfort in 5 to 10 minute intervals once or twice a day.  In addition, try to cut itching by administering Benadryl at 1mg per pound of weight twice a day. Do not use products containing zinc oxide (such as Desitin or diaper cream) as it is toxic to pets when consumed even in moderate quantities.

Should monthly flea and tick control be continued year round?

Absolutely. It can help prevent hot spots triggered by fleas and ticks. 

How can I put together an Emergency Kit to help cover such emergencies when away from home?

A pet Emergency Kit is an excellent idea. Patients of record are eligible to purchase a customized kit from Creature Comforts that takes into consideration the health needs, weight, and age of your animal. Let our staff know if you would like to purchase one. 

Celebrating the Joy Pets bring to our lives!

Dr. Betsy Sigmon, Hospital Director, Creature Comforts Animal Hospital

The below is a picture of Molly  and her favorite kiddo! Molly is owned by Melissa VanHouten.

Choices and Calculated Risks

I’ll admit it – I’m normally a pretty conservative person. You’ll never catch me jumping out of what my husband calls a “perfectly good airplane,” nor will I be bungee jumping off  bridge or rock climb a vertical mountain slope. In fact, before embarking on anything remotely risky,  I pride myself in researching a situation before engaging. 

Of course sometimes, even the best laid plans end up going horribly wrong, and that happened to me in a trip to Costa Rica I’m sure my family will never stop teasing me about. 

You see, in the midst of exploring the absolute gorgeous scenery in Costa Rica, I happened across a picture of two women who appeared to be riding on a “cable car” through the jungle next to an article about canopy tours through the rain forest. My time was limited, but assuming the picture and the article to be the same, I signed up for the adventure. There were no signed releases and no next of kin forms; it must be a harmless adventure, right? 

Upon arrival at the  base of a mountain volcano, I was assigned a harness and instructed to climb on top of the luggage rack of a Land Rover.  “They must be extra cautious by giving us a harness,” I thought. “So far so good.” As we began the 45 degree, roller coaster ride up the mountain, my inner self started questioning what I had gotten myself into. 

When we stopped in front of what can only be described as a clothesline next to a huge, very deep Crevasse. This was nothing like the picture! With a brief instruction of hooking up to the “training course,” I soon realized we were about to engage in 10 very long passes going tree to tree and down the  mountainside valley on a zip line.  Clearly, somewhere along the way I missed the memo concerning informed choice and the warning to not let your gloved hand clamp too hard on the line or you will set yourself up for a 360 degree spin. I learned the hard way! 

It’s oftentimes the same when we’re looking at pet healthcare. There are so many products claiming to do the same thing that we may just pick the one that looks good. Unfortunately, without really understanding it, we don’t make informed choices and learn things the hard way. I see this every year around this time when owners face fleas and ticks. 

So to help you not end up making the wrong choice, I’ll answer some questions you may have about this new season of flea and tick control. 

There seem to be a lot of choices for flea and tick control. How does a pet owner make a choice?

Between Creature Comforts, on-line retailers, and now big box stores there are a lot of choices for generic, brand name, topical, and now even oral treatments. The most common monthly products I dispense at Creature Comforts are Frontline Plus (a topical medication for dogs & cats), Trifexis  (an oral tablet for heartworm, deworming, and flea in dogs only), Comfortis (an oral tablet flea control for cats and dogs), Advantage multi (an oral tablet for flea & heartworm control), and  a new product,  Nexgard (an oral tablet for flea & tick control).

Nexgard? Wait…you mean there is yet another choice? What makes it better?

Nexgard is revolutionary because it is the first product labeled in the USA for oral tick and flea control. Labeling of products across multiples species of ticks is increasingly expensive and challenging for manufacturers, and NexGard is only labeled to control the American Dog Tick. I am speculating that since the American Dog tick (Dermacentor variabilis) is associated with Rocky Mountain spotted fever, Tularemia, tick paralysis, and some forms of Ehrlichiosis, the makers of Nexgard chose this as their first targeted species for the product. (Want to know what a Dog Tick looks like? Go to www.ces.ncsu.edu for a photo id.) Dog Ticks are common in the piedmont area of North Carolina for both pets and people. I suspect the company will be changing to a broader tick control species labeling pending further FDA approval. 

Tick paralysis? Yikes, that sounds serious! What is it?

Tick Paralysis is when a dog becomes paralyzed in all 4 legs due to a neurotoxin (poison) released by the American Dog Tick. With the advent of so many tick control products, it is seen less frequently. For patients not on tick control with this disease, recovery is usually complete once the offending tick is removed and no other concurrent sources of illness are noted. 

How does Nexgard work and at what age and weight may it be started? 

The active ingredient, Afoxolaner, is absorbed into the bloodstream of dogs and kills fleas within 24 hours after a flea bites a dog. It can be used in puppies 8 weeks of age or older weighing 4 pounds or more. 

How long after administration do I need to wait to bathe my dog? Are there any concerns about concurrent use with other medications or medical health risks?

Since it is a oral tablet, there is no wait period as swimming and bathing have no effect. It may be given concurrently with many other medications including heartworm preventative. In epileptic pets on anti-seizure medication, I would use caution.  

I’ve used Frontline for years, but there are so many varieties. What is the difference between Frontline Top Spot,  Frontline Plus, and Frontline Tritak?  

 They are similar in that they all contain Fipronil, but each type is a little different. Fipronil applied topically works by collecting in the oils of the skin and hair follicles and is released over time (up to one month). Fiproni works by attacking the flea and tick’s nervous system through the pet. The differences between the different types of Frontline are as follows:

FRONTLINE (also known as FRONTLINE TOP SPOT) is simply fipronil and kills adult fleas and ticks. 

FRONTLINE PLUS is fipronil plus (S)-methoprene. The added ingredient is an insect growth regulator to keep flea larvae from developing into adult fleas. 

FRONTLINE TRITAK is fipronil, (S)-methoprene, and cyphenothrin. The third ingredient kills fleas of all stages (adult, larve, or egg). This means you get instant flea control plus the benefits of long-term flea control. 

I have seen less ticks in the last year, and was wondering what are the possible causes? 

There is a seasonal variation year to year in tick populations due to weather, rain, compliance of pet owners using flea/tick control year round. 

Do rabbits and squirrels contribute to the flea problem for dogs and cats? 

No, they carry an entirely different type of flea. The “cat flea” is carried into the yard most commonly by the raccoons and opossums. 

      

I’ve seen a product called Pet Armor that is MUCH cheaper than Frontline. Is this product line the same as Frontline?
 These are a lot of choices! How do I choose what is right for MY pet?

NO!!! I strongly urge you to avoid this product. While Pet Armor is a generic form of fipronil, it is made in India (the world's largest generic drug manufacturing country.) This means you roll the dice when giving this to your pet. India and the USA do not use the same standards for drug manufacturing, and you run the risk of doing harm to your pet.  Pet Armor also has Pet Armor Pro Advanced which contains permethrin which repels fleads, ticks, and mosquitos. Again, I urge to to avoid these products as the safety and efficacy of the product cannot be determined.

What about Activyl  from Merck?

Activyl^® for Dogs works differently than most topical flea treatments. Using bioactivation technology, the Activyl component,  indoxacarb (licensed from Dupont and most commonly used in the lettuce industry) works only on the flea’s nervous system, not the pet’s.  Activyl^® Tick Plus For Dogs and Puppies has added permethrin for tick protection. Client complaints include the amount of oil in the topical product application.

I read about Vectra 3D from Summit Labs but I have not seen it in pet stores?  

Vectra 3D is available by prescription only, and it is a very effective product against fleas, ticks and mosquito control. That being said, it is not for all pets as it is very strong and I have seen more reactions with it than any other product. 

What are the active ingredients in Vectra 3D?

Vectra 3D contains Dinotefuran to control fleas. It also contains Pyriproxyfena, a photo stable, insect growth regulator to interrupt hatching of eggs, pupae, & larval stages of fleas. For instant control, Vectra 3D contains Permethrin to repel & kill ticks, black flies, deer flies, mosquitoes and cheyletiella mites for 4 weeks. Note: it does not repel or kill demodex or sarcoptes—they burrow down too fast.

I have seen Revolution for a long time for flea, tick, and heartworm  control in dogs and cats? Why is it not more widely used? 

 Although very safe, Revolution is an older drug. My major observation is that its efficacy against ticks for dogs has been variable.

What is in the Bayer product, Advantix?

Advantix is a product for dogs older than 7 weeks of age and  repels and kills adult ticks, fleas, and mosquitoes. The ingredients in Advantix include imidacloprid and permethrin. Unfortunately Advantix has been sold in pet stores. This has led to inconsistent indiscriminate use. The result has led to pockets of flea/tick resistance. In addition, the  imidaclopid in Advantix is also often used for pest control in golf course areas. Flea resistance to the ingredient has developed on pets in these areas. 

What about Advantix II? Is that any better?

Advantix II has an added ingredient, pyriproxyfen, which is an insect growth regulator. It helps prevent eggs and mature fleas from developing into adults. But as stated above, pockets of flea/tick resistance to the product have developed. 

(FUN FACT: Did you know for every flea seen, there are 10 eggs, 7 larvae —like maggots!— and 2 pupae.)

These are a lot of choices! How do I choose what is right for MY pet?

It depends on where you live and your pet’s overall health. If I lived on a golf course with pets having flea control issues, I would investigate golf turf management products that share similar compounds. For example,  if the pet was on fipronil (active ingredient in Frontline products)  or imidaclopid ( active ingredient in Advantix) I may suggest pet owners in those communities try a different product. In North Carolina, tick control is important so that rules out Trifexis, straight Activyl, or Comfortis as sole agents.

SO WHAT IS THE SUMMARY HERE? 

IF YOUR CURRENT PRODUCT IS WORKING THERE IS NO NEED TO SWITCH. I HAVE RECOMMENDED FRONTLINE PLUS FOR YEARS. 

IF YOUR PRODUCT IS NOT WORKING OR YOUR PET IS NOT TOLERATING IT, I WOULD RECOMMEND THE FOLLOWING:

A. Nexgard - for dogs only flea and tick control 

B. Vectra3D - for dogs only flea, tick and mosquito control 

C. Activyl - for cat & dog flea control 

D. Activyl Plus- for dogs only  flea and tick control 

E. Comfortis-oral tablet for dogs and cats

What product do I use on my precious dog, Taco Belle?

I switched Taco Belle to Nexgard three months ago. She was the first dog in the practice to be prescribed this product. So far I’ve had no issues of concern and she eats this chewable product readily. It is beef flavored but contains no real beef, so with her “beef intolerance” it has not been an issue. 

How safe are all these products?

Where flea and tick control are concerned, the question is “Are the risks small and the benefits large?”  The answer that real safety studies have produced for Nexgard, Frontline, Activyl, Revolution, and Advantix is, “Yes.”  The chances of an adverse reaction to any of these pesticides on a pet’s skin is very real but very small.  The risks of serious disease in pets from fleas, ticks, mosquitos, and other parasites is very real and quite significant.  In Lyme disease alone, the CDC reports a 4% population prevalence among humans in Virginia with an apparent growth of the problem, and that’s just one disease from one parasite.  A five year study by the Environmental Protection Agency found the incidence of adverse reactions in pets to topical permethrin was 0.00055%.  That study includes any reactions that cats in the same household as the dogs may have had.

So here’s the conclusion.  Do not fall for scare tactics and ploys to grab at your emotions.  Use science and reason.   TREAT ALL PETS, INCLUDING OUTDOOR ONES with  REGULAR, MONTHLY TREATMENT. Even totally indoor pets need to be treated.  Pet owners should be cognizant of the potential for adverse reaction any time they apply any pesticide on their pets. 

  

-Dr. Betsy Sigmon, Hospital Director, Creature Comforts

My thanks to Jennifer Collins that submitted this picture of her precious “Haddie” to be our star. 

I neglected to acknowledge Lily Keyser last week so here is a repeat “spotlight”.