Heartworm treatment?

I’m getting my new foster today and hopefully she’s a keeper. HW+ and treatment will start after she settles in. Even though I know it’s done all the time, I’m worried. The rescue I’m working with has been great but they aren’t saying much beyond “wait to see what the vet recommends”. I don’t have that much patience! There are 3 kids that seriously want to bond with her and so do I.

What should I expect? I’ve heard her “stall rest” could be anywhere from 2-8 weeks, depending on the vet’s method of treatment.

What is the norm? Tips for keeping her entertained?

If I remember correctly it was no activity for 6 weeks when we went through it. I think the thing to keep in mind so you aren’t surprised is how much pain they may be in after the shot. My poor dog cried all the way home after his second shot. I was not expecting it because the first shot didn’t cause that so it broke my heart. He got through it fine but its not a ton of fun.

It depends. What is the age and breed of this dog? Is she carrying a pretty heavy load of worms or is she just testing a light positive? What treatment is your vet using? Immiticide isn’t available right now to US vet’s. Did he/she have some saved for this dog?

My senior fosters and ones with heavy worm loads that have had heartworm treatment were treated like china dolls and kenneled or allowed to rest quietly on a dog bed in the house. Even potty time was restricted with a leash so there would be no sudden chases after squirrels or crazy romps with the HW- dogs. I’ve had a couple younger dogs with very low counts and they were allowed to live pretty normally except for getting left out of long, strenuous walks.

`She’s a Basset/Terrier mix but looks like a mini Pit Bull with a long back. :lol: Approx 2 years old and 25 pounds. So far she’s been extremely quiet and laid back so I’m less worried about keeping her calm.

The shelter was supposed to treat her before the rescue picked her up but their vet couldn’t get the meds for a few months. I’m not sure what her worm load is but I guess we’ll be starting over with a new vet here. Should be next week.

I’d read about the pain and I’m going to feel really bad about that. :frowning: She’s such a nice little dog!

Be careful - I thought Immiticide manufacturing had been stopped indefinitely. Therefore, the only treatment available in many areas is Ivermectin and Doxy :frowning:

If she’s heavily infested, you may be surprised about how ‘quiet’ she is when the treatment’s over!

Be prepared for her feeling awful, that’s the big thing. But mostly do what the vet recommends as it’ll depend on her individual case how she reacts. Molly collapsed at one point, but she had a heavy heartworm load and also had to be spayed with a litter before the treatment began.

depends on the dog

The rescue with which I volunteer has treated many heartworm positive dogs and I foster most during their treatment.

I think it totally depends on the dog. Some get treated and seem to really struggle those first couple weeks. I remember my first heartworm dog and how concerned I was when he started coughing up yellow yuck and snorting it out his nose. He was ten years old though and had a pretty good case of heartworm. I have others who never bat an eye, show no discomfort, and get through the treatment without missing a step.

Our vet suggests that if the dog is being treated with 2 rounds of immiticide, the dog is on crate rest and leash walks for the first month. The second month the dog can get back to normal with some management. After eight weeks, the dog can do anything it wants.

Rumor is that vets are starting to get some Immiticide again. We have a dog being treated today. Last month none was available and the dog we started treatment on had to go the heartguard/doxy route.

I would not worry a bit about fostering a heartworm positive dog. You’ll be fine.

[QUOTE=HydroPHILE;5891958]
Be careful - I thought Immiticide manufacturing had been stopped indefinitely. Therefore, the only treatment available in many areas is Ivermectin and Doxy :([/QUOTE]

Yep, our clinic hasn’t been able to treat for a bit now and we have no clue when the drug will be available again. So unless your vet has a stock pile or has some still around because they don’t treat that often you won’t actually be able to do the immiticide treatments.

[QUOTE=CarolinaGirl;5893427]
Yep, our clinic hasn’t been able to treat for a bit now and we have no clue when the drug will be available again. So unless your vet has a stock pile or has some still around because they don’t treat that often you won’t actually be able to do the immiticide treatments.[/QUOTE]

That’s a good thing. Immiticide can have horrendous side effects. If it were my dog, I would go with the slow kill, use doxy first for a month.

I know this is a hot contested topic, but I adopted a HW positive (low to med) older girl a few years ago and we opted for the slow-kill method. She was so medically fragile, it wasn’t worth the chance of killing her. We did Doxy (and I repeated it just for good measure last feb) and she came up negative not two weeks ago :slight_smile: I would not have done it any other way.

And ditto about the immiticide, my roommate’s clinic has been out of it for months.

[QUOTE=danceronice;5892061]
If she’s heavily infested, you may be surprised about how ‘quiet’ she is when the treatment’s over! [/QUOTE]

She’s energy conserving Basset quiet, not sickly as far as I can tell. No coughing or lethargy but she did pant indoors at first, which concerned me. I think it was just anxiety and change of temperature from the shelter because she’s fine now.

The rescue is looking into whether the shelter had her X-rayed but they didn’t plan on doing it themselves. I requested a set so I know what we’re dealing with. Chances are, with her age and the fact she has no clinical symptoms this isn’t a heavy worm load and she’s already had a few doses of Heartgard. I’m really torn about which way to go!

Fast kill would get the complications over sooner but she’s basically two months in for slow kill at this point. What are the risks in 6 months, one year or five if I don’t zap the heartworms now? Can she have fairly normal activity on slow kill? Normal activity for us is going lots of places and taking long walks but no marathon running. Getting excited to see the kids come home from school or chasing a squirrel out of the yard is about as much commotion as I tolerate. :lol:

Found out from my vet that Immiticide is shipping out in small quantities inthe US now.

I’d heard that though the Immiticide is once again shipping, it’s in such small quantities that the manufacturer is asking vets to utilize it on their most heavily loaded HW+ dogs. I could be wrong…

We’ve decided to go the slow kill route on any HW+ dogs that come into the shelter at this point in time. We try to keep them relatively quiet (we have a pit mix that right now is heavy HW+ and it’s SO difficult to keep her quiet), but with the slow kill method, it’s going to take quite a bit of time before a negative will occur.

Immiticide is on indefinite backorder so treating her may be a moot point right now.

Strict exercise restriction after treatment is more than vital. We just had a cut little dog in the ECC recently that finally died due to post heartworm treatment complications. It all started with him getting out one day and playing in the back yard. Not anything violent, just some playing. Short version of long story–dead about 10 days later. And I know why since I did the necropsy.

Admittedly I do just do ECC work so I see the complicaitons. But rest is vital!!!

Here is the latest recommendations:

URGENT • URGENT • URGENT • URGENT • URGENT • URGENT • URGENT
The American Heartworm Society:
Guidance for Heartworm Disease Management
During the Adulticide Unavailability
Background
August 9, 2011: The American Heartworm Society became aware of a pending product unavailability of the only available heartworm adulticide product, IMMITICIDE®, for an undetermined duration.
Because there are no other approved products available for killing adult heartworms, the American Heartworm Society Board and Scientific Committee has developed and approved the following management plan for heartworm positive dogs during this period of adulticide unavailability. While the unavailability persists, heartworm-positive dogs should be managed to achieve three primary goals:
• Reduce potential pathology from the infection.
• Maintain the health of the dog until it can be appropriately treated.
• Prevent additional heartworm infection of the dog.
These goals may be achieved by strict adherence to the following:
• Limit the activity level of the dog to reduce pathology.1,2
• Carefully place the non-protected dog on heartworm prevention.3,4,5,6,7
• Administer doxycycline to reduce pathology and infective potential of heartworms.8
The Management Plan: Heartworm-Positive Dogs and Dogs Not Completing a Full Course of Adulticidal Therapy

  1. Verify any positive antigen test by performing a second antigen test, sourced from a different manufacturer. If a dog is confirmed antigen positive or for dogs already initiated on, but not completed adulticidal therapy (due to product unavailability), a microfilariae test should be performed. In rare cases, the administration of heartworm preventives to microfilaremic dogs can result in shock-type reaction. For this reason professional observation is highly recommended.
    • If microfilariae are detected, the dog should be pretreated with corticosteroids with or without antihistamines9 and then administered a dose of heartworm preventive (macrocyclic lactone).10
    o While all heartworm preventives affect microfilariae, the resulting immunologic reaction of the dog to the microfilariae can vary dramatically.3,4,5,6,7 Therefore dogs should be kept under clinical observation for at least 8 hours following the initial dose of heartworm preventive to allow rapid, appropriate medical treatment should a shock reaction occur.
    o Anti-inflammatory pretreatment: Dexamethasone at 0.25 mg/kg intravenously and diphenhydramine at 2.2 mg/kg intramuscularly, or 1 mg/kg of prednisolone orally 1 hour before and 6 hours after administration of the first dose of preventive.9
    o Elimination of every single microfilaria is not the goal; the health, safety, and maintenance of the patient is the goal.
    o Microfilariae will likely persist following preventive dosing.
    o If the positive dog is already on prevention, continue regular monthly oral or topical dosing or twice yearly injections of preventives.
    • If the dog is negative for microfilariae, a heartworm preventive should be administered.
  2. Dogs should then be maintained continuously on heartworm preventive to limit further infection of the dog until the adulticide product is again available.
  3. Dogs should also receive doxycycline at 10 mg/kg BID for 4 weeks. This dosing should be repeated quarterly until adulticide is available. (Dose may be reduced to 5 mg/kg BID if tolerance issues exist.)
    • Doxycycline has been demonstrated to affect the viability of subsequent heartworm stages.
    • Microfilariae will still be able to infect mosquitoes, but the infective larvae from these mosquitoes will be less capable of infecting another dog.
    • The doxycycline protocol would be 1 month on, 2 months off, 1 month on, 2 months off, etc.
    • The combination of macrocyclic lactone and doxycycline is proven to be more effective than macrocyclic lactones alone. Research studies have demonstrated macrocyclic lactone/doxycycline combinations will:
    o Shorten the life span, but not eliminate the adult worm infection.
    o Lessen the pathology associated with worm death.
    o Disrupt heartworm transmission.
  4. Restrict ALL activity of the dog! Limit ALL exercise!
    • The severity of heartworm disease is directly related to the activity level of the dog.
    • As physical activity increases, pathology associated with adult heartworms increases.
  5. Any dogs that are symptomatic for heartworm infection should be treated medically to relieve signs of respiratory distress. Surgical options should be weighed for dogs exhibiting cardiovascular compromise.
  6. When adulticide product is again available:
    • Adult heartworms will likely persist in the dogs managed under this protocol.
    • Nevertheless, dogs should be retested to revalidate the presence of an adult heartworm infection.
    • If positive, the dog should be appropriately treated for adult heartworms with the approved adulticidal product.
    REMEMBER THE GOALS:
    • Reduce potential pathology from the infection.
    • Maintain the health of the dog until it can be appropriately treated.
    • Prevent additional heartworm infection of the dog.
    For further background information considered in development of this management protocol, refer to the American Heartworm Society’s Current Canine Guidelines under the Veterinary Resources at www.heartwormsociety.org.
    This American Heartworm Society guidance statement is based upon the cumulated knowledge and expertise of the American Heartworm Society’s Board of Directors and AHS Scientific Committee experts, considering the latest information on heartworm disease, disease processes, known drug activity, and impact of these factors on disease management as of August 2011.
    The American Heartworm Society needs your support. Please help us by
    becoming a member so that we can continue to provide information and guidance to
    the profession. Membership applications are available at www.heartwormsociety.org.
    IMMITICIDE® is a registered trademark of Merial Limited, Duluth, GA.
    ©2011, American Heartworm Society. Use with acknowledgment of the American Heartworm Society.
    REFERENCES
  7. Dillon AR, Brawner WR, Hanrahan L. Influence of number of parasites and exercise on the severity of heartworm disease in dogs. In: Soll MD, Knight DH (eds): Proceedings of the Heartworm Symposium ’95. Batavia, IL: American Heartworm Society, 1995, p 113.
  8. Fukami N, Hagio M, Okano S, et al. Influence of exercise on recovery of dogs following heartworm adulticide treatment with melarsomine, Recent Advances in Heartworm Disease: Symposium ‘98. Batavia, IL: American Heartworm Society, 1998, pp 225-227.
  9. Lok JB, Knight DH, LaPaugh DA, Zhang Y. Kinetics of microfilaremia suppression in Dirofilaria immitis-infected dogs during and after a prophylactic regimen of milbemycin oxime. Proceedings of the Heartworm Symposium ‘92. Batavia, IL: American Heartworm Society, 1992, pp 143-149.
  10. Courtney CH, Zeng QY, et al. The effect of chronic administration of milbemycin oxime and ivermectin on microfilaremias in heartworm-infected dogs. Recent Advances in Heartworm Disease: Symposium ‘98. Batavia, IL: American Heartworm Society, 1998, pp 193-199.
  11. Neer TM, Hoskins JD. Clinical experience with ivermectin used as a microfilaricide and for prophylaxis in the dog. Proceedings of the Heartworm Symposium ‘89. Batavia, IL: American Heartworm Society, 1989, pp 95-97.
  12. Blagburn BL, Paul AJ, et al. Safety of moxidectin canine SR (Sustained Release) injectable in ivermectin-sensitive collies and in naturally infected mongrel dogs. Recent Advances in Heartworm Disease: Symposium ‘01. Batavia, IL: American Heartworm Society, 2001, pp 159-163.
  13. Dzimiankski MT, McCall JW, et al. The safety of selamectin in heartworm infected dogs and its effect on adult worms and microfilariae. Recent Advances in Heartworm Disease: Symposium ’01. Batavia, IL: American Heartworm Society, 2001.
  14. McCall JW, Genchi C, Kramer L, et al. Heartworm and Wolbachia: Therapeutic implications
    Vet Parasitol. 2008;158:204-214 (Special issue: Heartworm Revisited - Selected papers presented at the 12th Triennial Heartworm Symposium 2007).
  15. Bowman DD, Atkins CE. Heartworm biology, treatment, and control. Vet Clin North Am: Small Anim Pract. 2009;39(6):1127-1158.
  16. Nelson CT, McCall JW, Rubin SB, et al. Diagnosis, Prevention, and Management of Heartworm (Dirofilaria immitis) Infection in Dogs (2010), accessed on 5 Aug, 2011 @ http://heartwormsociety.org/veterinary-resources/canine-guidelines.html.

Immiticide is coming back to the states. The clinic needs to get on the list to receive the meds.
http://www.veterinarypracticenews.com/vet-breaking-news/2011/09/30/merial-to-import-limited-quantities-of-immiticide-from-europe.aspx

When we pulled a dog that someone had dumped from the streets, she was HW+. Because she was young and didn’t show any additional side effects from infestation, we chose the Immiticide route. Our Vet said, “it is absolutely imperative that she be on kennel rest for 6 weeks…at least. Hand walks only to potty, no play time. Minimal activity. I have seen dogs go through the two day treatment great only to have an owner not adhere to strict kennel rest, and the dog die from a blood clot.”

I think she has some Immiticide reserved because that was part of the rescue taking her on, in conjunction with me doing the after care. I should find out in the next couple days.

Would it be worth it to take her to my vet now for the X-rays and another HW test?

Thanks for all the info!

I took her in to start treatment yesterday. X-rays showed early stages and her bloodwork was just a little off, but within range for being HW+. Vet says two months of limited activity. I think I can get away with confining her to the family room during the day and crating her when the kids are home. Weekends are going to suck.

I may be fostering a dog recovering from back surgery to keep her company.

[QUOTE=CrazyGuineaPigLady;5919851]
I took her in to start treatment yesterday. X-rays showed early stages and her bloodwork was just a little off, but within range for being HW+. Vet says two months of limited activity. I think I can get away with confining her to the family room during the day and crating her when the kids are home. Weekends are going to suck.

I may be fostering a dog recovering from back surgery to keep her company.[/QUOTE]

If she’s going through treatment, she needs to be on kennel rest for the two months. Unless you can ensure that she will lay down and be calm the whole time while in the family room, I’d recommend crating. When we went through HW treatment with the dog we were fostering, the Vet said, “I mean…limited to no activity. I’ve seen dogs successfully go through the first two days only to end up back home, jump on a bed, blood clot dislodges, and they end up passing away.”

She is pretty calm and being contained to the family room is essentially being tied to some part of my body while I watch TV or use the computer, and only when the house is dead quiet.

I realize something could happen at any moment but is the risk of her jumping up on the couch to sleep for a couple hours any worse than the drive home today when she hates long car rides? What if she gets out of the crate anyway and runs like a lunatic because she’s stir crazy after 6 weeks? I’m just thinking that keeping up some semblance of the peace and quiet we’ve had so far might be the happy medium with her.