Heartworm treatment

[connie]

Oh goody, I get to learn about heartworm treatment now! Cancer and ehrlichiosis weren't interesting enough, I guess. Crap, I am SO UPSET about this!

Rowley tested positive for heartworm on his annual exam, as you might have seen on FB. His vet was as stunned and upset as I was. I have not given chemical preventives since 2001, and have never had a positive result on a dog until now -- and that's a lot of dogs, more than a dozen.

I'm inclined to give my dogs the preventive now, and will for at least this year while I think things over. I'm not sure that natural methods are effective, anymore, against the virulence of pests in this climate-changed environment.

I also hope like hell that none of my other dogs test positive; they will have their tests next week. Fingers crossed. Also, fuck fuck fuckety fuck. I keep saying that ...

Rowley goes in on Monday for a chest x-ray to see how his lungs look, and to start on doxycycline for a month as the first step in the treatment. He has to stop agility (twice weekly classes for the last 8 years, that'll be hard on us) for the summer, until he gets a negative result on the recheck test, which is done 90 days after the treatment ends. He is also supposed to be on leash exercise only, and I'm grappling with that. The nature preserve is what keeps us sane. He could be on a long line out there, I suppose ... I dunno, I have to read more about HW treatment and what times are most dangerous in terms of the die-off.

The 'slow kill' method of treatment consists of letting the worms mature and die: we're not doing that. We're doing a month of doxy and preventive to kill the wolbachia bacteria and the immature worms. Then he'll have three shots of Immiticide and at that time, reduced activity is super important.

Still reading up on this. Fuck fuck fuckety fuck.

http://www.mypetsdoctor.com/slow-kill-a ... -treatment
http://www.mypetsdoctor.com/dog-and-cat ... rm-disease

[JudyL]

I'm so sorry about this and that Row will be going through the treatment. We all know he couldn't be in better hands as you treat this. I would want to get rid of the infestation sooner than later too, but don't know enough about slow kill vs more aggressive treatment.

[Trademarkbark]

Do you know what type of test they used? (In house or outside lab?). I’d probably want an outside lab retest just to be safe before treatment. Years ago, we did have one patient test positive on a Snap test but negative when tested at a lab. Just a thought ...

[Riddick]

I’m so sorry Connie. I’ve seen way too many cases of heartworm in this area come into our clinic. Most are adopted from down South and brought up here, but many have lived here for their lives and then all of a sudden come up with heartworm. I think our climate is changing too much and bugs are more resilient. I moved to Lockport March 1st and for the first time in my life one of MY dogs got FLEAS! I know fleas are nowhere near as bad as heartworm, but my reaction was just about the same as yours. MY DOG!? FLEAS!! So that meant my house and my carpeting and my furniture, omg I was so pissed.

But anyway, it was the end of February, super cold, still snowing intermittently and fleas were alive. I saw heartworm in December at my clinic last year. The bugs are surviving in colder temperatures. And for some reason heartworm is rampant in this area. I don’t mess with heartworm. My dogs have been on heartguard and vectra all their lives. Apollo lived to 16 and he was on chemical preventative since he was 8 weeks old.

We had a Border Collie come in with heartworm and she had it so bad she had to be on strict crate rest, and honestly, that’s about all she wanted to do. She was tired, and she didn’t even try to do much of anything. She pulled through just fine, but it was hard on her and she was mopey through her whole treatment.

[connie]

Do you know what type of test they used? (In house or outside lab?). I’d probably want an outside lab retest just to be safe before treatment. Years ago, we did have one patient test positive on a Snap test but negative when tested at a lab. Just a thought ...

Definitely want to be sure before any treatment is undertaken, I have been reading up on that.
https://www.heska.com/documents/soloste ... 721D5F16D0


1. If positive heartworm antigen results are obtained using an antigen test kit, check the animal’s blood for D. immitis microfilariae.
• Presence of Dirofilaria immitis microfilariae and a positive heartworm antigen test confirm the presence of D. immitis adult worms.
2. If no D. immitis microfilariae are detected, repeat with a test utilizing a different antigen detection method.

So either they use the blood sample they have, or they take a new one, and test for microfilarae. If they are present, the positive is confirmed, and we start treatment. If there are no microfilarae, we may have tripped a false positive on the antigen test, and we test again with a different test.

In my best world, the vet comes into the exam room next Monday and says 'we didn't see any microfilarae, this might be a false positive, we need to run another test to see what comes up.'

So yeah, the positive has to be confirmed, that's step one. Thanks for mentioning that, I had just hit that info in my reading!

[Trademarkbark]

I always remember the odd cases from when I was a tech.

Crossing fingers it’s false positive!

[connie]

Lyssa, I know, I was saying something similar to Alex's breeder today. She thinks that heartworm is so prevalent that pretty soon, every mosquito will be a carrier. I can't say she's wrong. She lives in TN, so for her heartworm is a year-round threat, but it's not something I thought was any significant risk in my area. The HW+ dogs I saw in rescue either came in from rural areas or had been seriously neglected, or both. But lots of things are changing ... remember when ticks were something that were only in 'wooded areas' and if an Illinois resident was taking their dog to Wisconsin, they might find ticks, but never HERE! Yeah, that's long past ...

My other dogs will all be on preventive this year, I'll decide later if I change my protocol permanently. I'm not ruling it out, that's for sure. And then I worry about the pests developing resistance to the preventives -- !!

[Riddick]

I KNOW! These stupid ticks are everywhere now. I had a dog come in that lives in downtown Naperville and he had a huge tick right in the middle of his head! From sniffing normal bushes in the middle of downtown Naperville! Insanity!

And I do believe the bugs are becoming resistant to the preventative too. Vectra is considered one of the best flea/tick preventatives on the market. So good that I usually give it every 45 days instead of every 30. Remus got fleas on day 35.

In the last few years we’ve had about 8 heartworm positive dogs. We use a outside lab to test for heartworm, we don’t use a Snap test. If the regular test comes back positive, then we do another test that I can’t remember the name of, but it tests for the immature worms in the blood. If they are there then we do a chest x-ray, and then a month of doxy, and then the Immiticide. So it sounds like you’re on the right track for everything. If he’s in the very early stages of the disease then you probably won’t have to be sooo strict with keeping him calm and quiet. We had a Scottie/Chi who we caught it very early and he did his doxy and his injections and he was IMPOSSIBLE to keep quiet. Like the owner had to sedate the dog after his injections to keep him quiet, and he was still fine.

[connie]

Yes, my vet was talking about how Frontline is pretty much useless now, it's so ineffective. The company still claims it works, he said, but the number of dogs who are found to have fleas and ticks while using Frontline is just crazy. I have ordered an essential oil blend for tick repellent this year, a friend says she has good success with it and she lives in WI.
https://www.amazon.com/gp/product/B007A ... UTF8&psc=1

Mother Nature's revenge: it won't be pretty.

[Amanda]

That is so crazy and such a bummer. I’m crossing fingers for false positive results today!!

[maxs_mommy]

I saw this on facebook and it sucks. I'm sorry you and Row are going through this. I think you're right with the pests becoming more resililliant. We had fleas last year on both the boys and they were a b*tch to get rid of. I've been doing interceptor on a 45 day schedule for years during the mosquito season but hate the combo drugs. I won't do them. Even my vet carries seresto collars for fleas now. It's crazy

[connie]

Well, it wasn't a false positive, but it is a Stage 1 infestation, so that's better than -- I dunno, better than a poke in the eye with a sharp stick? Alex tested negative; Dee and Beau test today. Rowley starts doxycycline (holy crap, $145 for a month's worth) today, with probiotics. I understand his treatment plan and it's not quite so terrifying now. The fact that it's not a heavy infestation (he had no microfilarae on the test, indicating immature adult worms and not a thriving community of the little fuckers) means that the die-off shouldn't be life-threatening for him, and leash walks and non-strenuous activities will be okay.

It does suck, and I almost lost it with one FB poster who chose to talk about how she hates to give her dogs chemicals BUT SHE DOES TO AVOID THIS, blah blah blah. My feeling now is: when you take in NINE senior dogs and give them time of great quality to the end of their lives, when you help a dog with cancer live for seven years with that cancer, when you help a dog with ehrlichiosis live four years with that infection -- THEN you can tell me what's wrong with my protocol and how your smug mug is so superior. And that, folks, is why FB is not a nice place: too much passive-aggressive shite.

On Sunday night I went online and applied for Care Credit, and got approved in about ten seconds, with a $4000 limit. Care Credit seems like a good thing, so long as you pay it all off in the 12-month promotional period; no interest is charged if you do that, but if you have a balance at the end of that time, they charge interest from day one. It, like most credit cards, traps people who don't pay off balances. I'll pay off the balance, I just don't want to do it the same month my taxes are due. The total cost of Rowley's vet visits and heartworm treatment will be around $1500. The shots are $773. The rest is labs, x-rays, drugs, etc. I figured it would be about that, so I'm okay there.

I have a question about HW preventive dosing, will make another thread.

BIG thanks to all ODO peeps and family for the support; it really means a lot.

[Sabine]

So glad you have a solid plan and don't have to stress about the financial aspect. Get well quickly, Row!

[Amanda]

Get better soon, dude! Sorry it wasn’t a false positive, but sounds like best case scenario for the situation you’re in... keep us posted! There are a couple of really good Facebook pages/groups for enrichment ideas. Canine enrichment Joy is one and I think the other is just called Canine enrichment.

[maxs_mommy]

Holy cow that's a lot for Doxy! Fwiw, I got 100 mg doxy for max at Costco for about $1 a pill. I've heard lots of different prices for it but searched goodrx for a better price when we did it on the regular.
I'm glad you have a plan and die-off won't be so severe and financing can dull the pain. As to the keyboard warriors, I take it with a grain of salt. It's easy to pontificate for likes.

[JudyL]

Definitely price shop for the doxycycline. ChiChi was on it during the time it was taken off the market a few years ago and the prices went crazy. Human pharmacies may or may not be less expensive. I see 100 mg tablets for $0.69 at Allivet, and either $19 or $24 for a bottle of 50 pills at Valley Vet depending on your comfort level with the generic and the brand. Even at a higher dose than I'm used to thinking of, it seems like you could save a lot by ordering online.

[connie]

He's got to take the 200 mg tabs. Sixty tabs = $145. It is what it is. My vet is excellent about sending me to pharmacies or even online when the price is significantly different, so I didn't check around. Looking now, online, I don't see any lower prices for the 200 mg tabs. He's on a massive dose of the stuff to kill the wolbachia bacteria.

[Sabine]

You might want to consider adding some saccharomyces boulardii to your probiotic regimen, since it's a yeast and not affected by abx. I would still give a potent multi-strain product as well, but the yeast can really make a difference.

[connie]

Thanks, I'll look into that. Right now he gets doxy with each meal, and a probiotic in the middle of the day.

When he has the Immiticide shots, he'll get CoQ10 and Hepaclenz for two months, and some other stuff I am blanking on right now. Roger at Marina's is sending supplements.

ETA: I just ordered some -- Jarrow makes saccharomyces boulardii and that's a brand I like a lot. Thanks again, Sabine.

[Sabine]

You are welcome!

Jarrow or NOW is what I typically use for Dax.

[JudyL]

He's got to take the 200 mg tabs. Sixty tabs = $145. It is what it is. My vet is excellent about sending me to pharmacies or even online when the price is significantly different, so I didn't check around. Looking now, online, I don't see any lower prices for the 200 mg tabs. He's on a massive dose of the stuff to kill the wolbachia bacteria.

Sorry Connie, I didn't look back to see that you've already purchased and started Row on the doxycycline. It's too bad that the Rx wasn't written for two 100 mg tablets at a time where you could have purchased 3 whole bottles of the drug at 1/2 the cost. Again, sorry, it's hard to shut off the accounting part of my brain.

[connie]

Dang, I didn't even think of giving 2 100-mg tabs! Now see, that's how upset by this I am -- the compliance part of MY brain was not present!

It's a drop in the bucket, anyway, but I'll remember for any future use of the drug. Beau has a Lyme Quant test out and if it comes back positive, it's doxy for him, so ...

[connie]

It's finally Kill Day. Rowley will be dropped off at our vet clinic this morning, where they will sedate him, prep the injection site, and administer the first of three shots of Immiticide, to kill the adult worms that are living in his heart.

Living in HIS HEART. Say that a few times and you'll have an idea of the absolute horror show it feels like I'm living in now.

He will stay at the clinic for 4-5 hours, just so they can make sure he has no adverse reaction to the shot; then he can come home, and he will have gabapentin for pain and prednisone for inflammation, since the shot is a big deal: administered deep in the lumbar back muscles.

This first shot will typically kill about 85% of the worm population. As the worms die, they break up and get reabsorbed by the body tissue, primarily the lungs. They don't get excreted; they are not in the digestive system. The body will deal with them but they can stick in the lungs and cause pulmonary embolism, which is the reason for the 'rest and no exercise' mandate. I've looked for ways around that and there aren't any.

Rowley doesn't have a crate set up in the house, and to set one up now would stress him more than it would help -- although I can put his travel crate in the dining room and I may, if I think that's a good idea -- but he is going to be on inactive status for the rest of this week, only going out into the yard and only on a leash. After I see how it's going, we will do leash walks around the block several times a day, that will be his activity for a while. He can't engage in strenuous activity that would stress the heart and lungs, because that pulmonary embolism thing is lurking in the background of his life for the next few months.

Truly, this has all been like a nightmare. As freaked out as I am about the shot today, I also wish we could have done it a month ago -- FFS, there are worms living in my dog's heart!

That's where we are today. There is another set of two Immiticide shots that will be given on successive days in mid-June, 30 days from now; the same protocols will be in effect; and then we're done. In October or November he will be given another heartworm test and it has to come back negative. But right now, we are getting through this day. The only good worm is a dead worm.

I won't say that I regret my decision to not use chemical heartworm preventive for the past 17 years, although I probably do; but I absolutely think I bought into false assurances about worst-case scenarios. This reality is far worse than anything I should have conjured but didn't.
https://www.luckydoganimalrescue.org/si ... ve_dog.pdf

[connie]

But at least we've got this. And I'm thankful we do.

rabies exmp.jpg (52.13 KiB) Viewed 2286 times

[SherriA]

Hang in there, Connie. We're all rooting for Rowley and a problem free treatment cycle.

[emmas_mom]

Thinking of you and Rowley today - may it all go smoothly, and successfully, today and in the months ahead.

[connie]

Yay, the first Kill Shot is done! Now my dog has dead worms in his bloodstream, but that's better than live ones! (This whole thing is beyond gross, and worse than any horror movie, to me.)

Of course he handled it like a trouper. He was really tired afterwards, and he had a good night's sleep after he ate his dinner. This morning he's back to normal, just about. Now I have to tell him about the exercise restriction. But we'll get through it -- he's going to go for short walks with Beau, his hench-dog, and Alex and Dee can go for longer walks. This weekend Rowley starts a Tricks class with my Canis Sapiens trainer, there is only one other dog in the class plus the trainer's Lapphund, so it will be a very calm hour of brain games. And it's spring, so we'll just spend plenty of time outside in the yard, with Rowley on a 15' cotton lead so he doesn't go charging around!

Starting his liver and heart support supplements today, and he has a cold laser treatment this afternoon of the injection site.

[SherriA]

Thanks for posting the update, Connie. I couldn't scroll through all of FB looking for it in my feed, so I came here Please do keep us posted on how he's doing!

[connie]

And for anybody wondering: heartworm treatment runs about $1500 in my area. The SHOTS are $775. The rest of the charges are the bloodwork, tests (antigen and microfilarae and then antigen again), doxycycline, chest x-rays of the lungs, physical exam, Benadryl for pre-injection, and Carprofen for pain afterwards.

There were three heartworm tests, here's that sequence -- I wanted to correct several people on FB who said 'maybe he has microfilarae only' but I didn't.

The annual IDEXX Snap4 test is an antigen test. It screens for adult worms. If a dog throws a positive on that test, you test again (using the same blood sample) for microfilarae.

If the microfilarae test is positive, you've got adult worms that are producing immature worms -- you're far enough into the life cycle of the heartworm to have both. You plan the treatment accordingly: the dog takes Heartgard for at least one month and also takes doxy for a month, then you stage the Immiticide shots.

If the microfilarae test is negative, and Rowley's was, you have to draw more blood and run another antigen test, to be sure that the first antigen positive was not a false positive. They really don't want to give Immiticide shots to a dog that doesn't need them.

Of course, when Rowley had no microfilarae, I was all 'yeah, false positive, we're outta here!' but my vet immediately ran another antigen test and it was positive too. It's not unusual to have positive antigen and negative microfilarae, it just means the worms are adult but not yet reproducing, so a relatively recent infection.

That confirms the heartworm diagnosis and then you do a physical exam to see how the heart sounds, and take film to see how the lungs look. Rowley was excellent on both, so his very good physical condition will help him recover, we think, with no problems.

I requested the rabies waiver because Immiticide, arsenic-based, is a carcinogen; I'm not gonna put that in my dog and then be required to inject him with killed rabies virus, EVER. Let's not stack the deck against him!

Because he is very fit and tolerated the shot so well, he didn't need Pred or Gabapentin afterwards. The Immiticide will clear his body in about 72 hours, so he'll get liver support twice a day for three days; he'll get CoQ10 twice a day for the full two months of treatment. (First shot, 30 days elapse, second shot, another 30 days.)

Four months after the end of the treatment period, he has to pass another antigen test, it has to come back negative. If it doesn't, we test again after 60 days; if that's still not negative, he may need to repeat the treatment. That's not something I'm thinking about right now. In the meantime, he takes Heartgard every 30 days just in case there are any microfilarae from any source; it will prevent any more heartworms from growing to maturity.

Interesting, in a gruesome way.

[connie]

Rowley update: he's doing really well. He has taken this in stride like he takes everything in stride, and I'm so relieved that it's going this well.

I thought a lot about the instructions to rest him and take it easy and I read all the admonitions that a dog post-treatment should do nothing but go out to the yard on a leash to potty and otherwise just lie in a crate all day. I wondered how it would help his condition to do that -- sounds like it would just lead to boredom, loss of muscle tone, and a decline in overall health for this dog. He's always been very active, and he's in outstanding physical condition; he also is a Level One case, not an advanced case, of heartworm. So I decided I would keep his heart-rate from becoming elevated, and I would limit his time spent in any activity, but I wouldn't try to make him impersonate a potted plant.

We do three walks a day, each walk is about 15 - 20 minutes. On leash, of course. The other dogs are with us; Rowley is 9, he is way past finding the company of his housemates on walks a cause for agitation or excitement. After the walks, he has a rest period of about an hour, and he does use it. The rest of the time, he can be out in the yard with me or on the deck; he can't run around, and certainly we're not playing ball, and he stopped agility in early April, so the activity he's getting is not strenuous.

His appetite is quite normal, which is to say excellent; he had a few days of liver support when the Immiticide shot was clearing his body, and he gets CoQ10 twice a day and will until the end of June. He seems content with this routine. We miss the nature preserve, and we miss agility, and we miss the fields by the Ag HS, but we'll get back to all that in 6 weeks or so.

Fingers crossed that his progress continues to be so positive!