Heartworm, flea, and tick preventative:
Whether to use heartworm, flea and tick preventative on an ME dog:
Remember, each dog is an individual and may have reactions to ANY drug. We have to weigh the risks of fleas, ticks, heartworm, etc. versus the risks of the preventatives.

Central Nervous System Modulators (work on the nervous system of fleas or ticks, NOT dogs): The primary products in this category are fipronil(Frontline® , Frontline Plus®,Top Spot®) and imidacloprid (Advantage®) and Selamectin (Revolution®). Frontline® and Advantage®
work on the flea’s (adult and larvae stages) central nervous system, but in slightly different manners. Fipronil affects the movement of chloride ions across sensitive nerve cells…essentially paralyzing these nerves. Imidacloprid interferes with the functionality of specific neurotransmitter receptors. By thus interfering with the signals between nerve cells and the essential functions they perform, the effect of either product is death of the adult flea. Frontline Plus® also contains an insect growth regular (IGR)…to prevent development of eggs into adult fleas. The chemicals used in these products are selectively toxic to fleas…not to animals. Revolution®, affects selected chloride ion movement across nerve and muscle cells of invertebrates, resulting in paralysis. It is applied similarly to the other two products but is absorbed systemically and is parasiticidal to a variety of internal and external parasites in this way (round worms and hook worms (cats only), mites; it is also inhibitory to the development of heartworm larvae to adults) in addition to killing adult fleas. Unlike plain Frontline®,or Advantage®, the product also inhibits development of the flea egg into adult fleas.

Veterinarians suggestions for use of flea/tick/heartworm treatment:
IMPORTANT: This information is to inform only and must be discussed with your veterinarian.

“Our vet warned me against usage of certain Tick & flee products for a dog with Myasthenia Gravis. The products included the Pulvex range such as “pour-on” and most dips all containing an organophosphate called permethrin.(it appears to be the active ingredient in most flee & tick products)”
“The vet also discouraged the use of preventic flee collar however I cannot see why as the active ingredient is Amitraz for which I cannot find a link with MG (does anybody know a reason why the vet would have discouraged it’s use?) He did suggest using “Frontline plus” which uses fipronil and methoprene. According to Wikipedia “Fipronil is a broad spectrum insecticide that disrupts the insect central nervous system by blocking the passage of chloride ions through the GABA receptor and glutamate-gated chloride channels (GluCl), components of the central nervous system.” This sounds very much like the action of permethrin!”
“Diazinon should probably NOT be used with dogs having MG, as Diazinon kills insects by inhibiting _acetylcholinesterase_ (http://en.wikipedia.org/wiki/Acetylcholinesterase) , an _enzyme_ (http://en.wikipedia.org/wiki/Enzyme) necessary for proper _nervous system_ (http://en.wikipedia.org/wiki/Nervous_system) function. Diazinon has a low persistence in soil. The half-life is 2 to 6 weeks. The symptoms associated with diazinon poisoning in humans include weakness, headaches, tightness in the chest, blurred vision, nonreactive pinpoint pupils, excessive salivation, sweating, nausea, vomiting, diarrhea, abdominal cramps, and slurred speech. So, bottom line, if your dog has, or might have MG, diazinon should NOT be used outside.”

Insecticides:
Insecticides to stay away from:
–   Carbamates (Carbaryl, Methomyl and Propoxur)
–   Organophosphates (Chlorpyrofos, Coumaphos, Cythioate, Diazinon,
–   Dichlorvos, Dioxathion, Malathion)

Myasthenic weakness has been reported with 18 different antibiotics relative to Myasthenia Gravis (MG) such as:
–   Neomycin
–   Panamycin
–   Streptomycin
–   Certain Tetracyclines.

Drugs with P O T E N T I A L L Y adverse effects on neuromuscular transmission:
Note: There are several antibiotics listed that have the POTENTIAL for causing a problem. However, most specialists have used them in these patients with no untoward effects.
–   Penicillamine
–   ß adrenergic antagonists
–   Propranolol
–   Actazolamide
–   Aminoglycosides
–   Metoprolol
–   Phenothiazine
–   Gentamicin
–   Atenolol
–   Magnesium
–   Amikacin
–   Timolol
–   Methoxyflurane
–   Ampicillin
–   Calcium channel blockers
–   Phenytoin
–   Ciprofloxacin
–   Diltiazem
–   Tropicamide
–   Erythromycin
–   Verapamil
–   Interferon
–   Imipenem
–   Nifedipine
–   Disomer of carnitine
–   Pyrantel pamoate
–   Amlodipine
–   Diatrozoate meglumine
–   Neuromuscular blocking drugs
–   Antiarrhythmic medications
–   Succinylcholine
–   Procainamide
–   Atracurium
–   Quinidine

Treatment of house and yard:
Treating the House:
Vacuum the floors thoroughly in the corners, along the wall edges, under the furniture and other low traffic areas. Flea larvae survive best in low light low traffic areas. Vacuum the floors, carpets and furniture frequently using a vacuum with good suction and discard the bag after each time. Flea eggs and pupae can survive and hatch in a vacuum bag. Discard or frequently wash your pet’s bedding. Steam clean the carpets possible, which will slow down flea development and allow flea larvae to dry up. Regularly wash your pets bedding and rugs that they lay on. Use KNOCK KNOCK OUT Premise Spray to treat the carpet after everything has been cleaned.

Treating the Yard:
Use Virbac® Yard Spray once a month in the shady areas of the yard. Apply in the evening and allow to dry overnight before allowing your pets to back into the treated areas. This may be more than anyone wants to know, but…The difficult concept for many pet owners is that the fleas they see on their pets and in their homes came from flea eggs laid 3 to 8 weeks previously. Those initial few fleas came from flea eggs deposited by neighbor’s pets, feral dogs and cats or possibly flea infested wild mammals. Those eggs deposited in the outdoor premises developed through to the adult stage and jumped on their dog or cat or even occasionally the pet owner. Most pet owners never see the first 2 to 3 fleas their pets acquire. What they are reacting to is the second or third generation. Those initial few fleas (trickle infestation), mate within a few hours and females start laying eggs within 24 hours and in a few days are producing up to 40-50 eggs/day. These fleas deposit their eggs into the haircoat of the pet with the eggs then fall out of the haircoat into the premises where they ultimately develop in a few weeks to the adult flea. By the time the pet owner reacts and take their pet(s) to the veterinarian there are already flea eggs, larvae, pupae and emerging fleas in the home and protected outdoor source points. Pet owners need to be educated to these biologic realities so that they understand where the fleas are coming from and why it may take several weeks to get complete flea elimination. The over-riding concept of flea control today is to force fleas to “extinction” in a localized environment (home or yard) by preventing the flea population from reproducing. Currently this may be theoretically accomplished by 1) killing newly acquired fleas with a residual on-animal adulticide before they can initiate reproduction (24 hours) or 2) directly affecting the viability of the eggs (insect growth regulators or other ovicidal compounds).

Here is a common scenario:
“A young couple with a 9 month old baby brings in their 1 yr old mixed breed dog because it has fleas. Physical exam reveals several fleas on the dog and some alopecia over the tail head. The Veterinarian treats the dog with Frontline Plus and sends couple home with a six months supply of the product.
One week later the fleas are still in the home and on the on the dog so they take their dog to another veterinarian. They tell the second veterinarian that they are certain the fleas are resistant to the Frontline and that the other veterinarian had sold them a worthless product. They can not believe that the dog still has fleas and even worse since they stopped letting the dog into the babies room the baby has gotten bitten by fleas. The second veterinarian runs a flea comb through the dog’s hair coat and recovers 10 cat fleas. Due to their size none of the fleas appear to be fully engorged and none of the females appears to be actively reproducing. This veterinarian explains to the owner that none of these fleas has been on the pet more than a few hours and certainly less than 24 hrs, since it takes female cat fleas at least 24 hours to become reproductively active. The Veterinarian further explains that the product (or any product) is not a repellent and does not kill fleas instantly but is intended to kill newly acquired fleas within 24 to 48 hours. Actually it appears the product is working correctly. The pet owner wants to know “Why are there more fleas now than a week ago?” The veterinarian explains that the fleas on the dog and the fleas on the carpet came from fleas eggs laid 3 to 8 weeks ago. The pet owners react by saying “that is not possible because the dog did not have fleas then”. The Veterinarian explains that most of the time (likely >90%) pet owners never see the first 2 to 3 fleas their pets acquire outdoors. The females then begin laying eggs within 24 hours and within a few days are laying 40 to 50 eggs a day. Fleas they are seeing now are actually the next generation. Therefore once you begin treatment you can expect to continue to see some fleas for a few weeks until all immature life stages have developed and fleas have emerged to be killed on the treated pet (Development Window). The pet owners then ask “Why did the fleas get so bad in the bed room?” The veterinarian explains that you removed the pet from the bedroom thinking incorrectly that the fleas were coming directly from the dog. The fleas on your dog do not jump off and on the dog. The fleas on the carpet in the bedroom came from pupae, which came from larvae, which came from20eggs laid 3 to 8 weeks ago. Those are newly emerged unfed fleas that had never been on the dog. Fleas lay their eggs on the dog and then the eggs fall off into the carpet. Places pets spend most of the time are where most eggs and ultimately fleas will be found. The reason it has gotten worse is because the “living flea vacuum”, the treated pet has been taken out of the room and all those emerging fleas are now feeding on the only remaining warm blooded hosts, you and the baby. Simply “let the dog back into the room”. The product did not fail; the failure was simply a lack of client education by the first veterinarian on the flea life cycle and performance attributes of the product.”