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  Topic Review (Newest First)
04-22-2014 11:24 PM
lefetz Thank you!!! I am so worried about my boy. I just hate that he has to go thru this. We have a vet visit tomorrow and I will know more than. I really appreciate all your replies.
04-22-2014 07:44 AM
JeanKBBMMMAAN The Heartworm Society is looking at the slow kill method as a possible reason for resistance. If a dog is medically cleared, I think the only way to approach the treatment is to follow their recommendations.
> Support for doxycycline and macrocyclic lactone administration prior to adulticide therapy. The AHS heartworm treatment protocol for dogs includes administration of a macrocyclic lactone preventive coupled with doxycycline to suppress embryogenesis of heartworms, weaken adult heartworms and decrease post-treatment complication rates. This regime begins 60 days before the first of three administrations of melarsomine. Any treatment method utilizing only marcrocyclic lactones as a slow-kill adulticide is not recommended.
CAPC recommends treating infected dogs with adulticide promptly, as soon as medically practical. Delaying treatment while maintaining dogs on preventives may contribute to selection for resistance, allows pathology to progress, and, when treatment is delayed for several months, could lead to more infected dogs remaining untreated if practical concerns interfere with completing an extended treatment protocol. No experimental studies confirm that delaying treatment while maintaining dogs on preventives improves clearance of worms with subsequent adulticide treatment.
Adulticidal therapy using long-term macrocyclic lactone administration - the “slow kill” method - is not recommended especially in light of resistance. It has been demonstrated that repeated macrocyclic lactone administration over a period of time to infected dogs increases the proportion of circulating microfilariae that possess resistance markers (i.e., application of long-term drug pressure will select for survival of drug-resistant microfilariae).
  • Depending on the macrocyclic lactone used, as many as 20% of dogs infected with heartworms will continue to have circulating microfilariae for at least a year or longer when receiving monthly preventative.
  • The “slow-kill” method should be avoided. If it is the only medically acceptable option, microfilariae should be eliminated prior to exposure to preventive doses of macrocyclic lactones.
  • Topical moxidectin/imidacloprid is label approved in dogs for removal of microfliariae when used monthly.
Canine Heartworm | CAPC Vet

---> Agree that you need to have the caval syndrome completely ruled out. You need an experienced vet to stage him. With that many worms...I'd be really concerned and want make sure it's not that. Big Dogs, Big Heartworm: Caval Syndrome Surgical Treatment Ultrasound, x-rays, blood work, urinalysis, etc. plus from that DVM360 article/AHS recs:

> Antigen plus microfilaria testing recommended. Antigen testing is considered the most sensitive diagnostic method when screening an asymptomatic dog or seeking verification of a suspected heartworm infection. But a study conducted on shelter dogs found a 7.1 percent false negative rate due to the formation of antigen-antibody complexes. The AHS now recommends that microfilaria testing be done in tandem with antigen testing to determine if this life stage of heartworms is present; previously the guidelines suggested that microfilaria testing “may be done.” This practice will help in the identification of these heartworm-infected dogs that have negative antigen test results yet may have circulating microfilariae.
Big Dogs, Big Heartworm: Heartworm Disease in Dogs: a Festival of Links links

I started this blog when my foster was one of 7 or so dogs that we had at one time who were HW+, over half local, in an area not supposed to be a HW concentrated one. She was 9 but didn't have that many adult worms: Big Dogs, Big Heartworm: June 2011 I wrote it so that I could chunk the vast information available into more understandable pieces.

I would really want more information on what was going on in there for sure, and do the doxy as Magwart said, in the mean time.
04-22-2014 12:03 AM
Originally Posted by lefetz View Post
I need as much info as I can get!!! My Foster dog has a very bad case of heartworms and we are getting ready to start treatment. He is 8 to 10 yrs old and I have put enough weight on him to get him ready for treatment but have no idea what to expect. Pretty sure he has had them most of his life as I was told he has hundreds of them. We are going with the slow kill method because of his age and health. Any and all info would be greatly appreciated , ...this guy so deserves a second chance in life. thanks!!!!
HW is very serious, but it's also routine for those of us doing rescue work in the Deep South. Nearly every foster I've had since moving here has been HW+. Even the old ones. They're all still alive. (**knock on wood**) We've been very lucky.

With HW+ dogs, you don't want to let them run too much. The harder the heart pumps, the worse the HW disease gets. Low key lifestyle, and easygoing play and walks are the right approach.

Is the dog symptomatic (coughing, exercise intolerance, etc.)? Have they taken x-rays to rule out Caval Syndrome (the final, terminal stage of HW disease)? If the symptoms are bad, a little prednisone may help (it comes with side effects, but in bad cases of HW, the side effects may be worth the benefit) - your vet can help you think about whether it's needed.

In rescue in Gulf Coast region, we are seeing dogs clear HW in 6-12 months using a monthly dose of Advantage Multi and one 30-day cycle of Doxycycline (by contrast, the Heartgard/ivermectin-based preventatives were taking closer to 2 years to clear the worms). From my lay perspective, it really seems like there's something different about how Advantage Multi works on juvenile worms and weakens the adults. I can't tell you how or why, but lots of people who do dog rescue in the Deep South talk about it.

For the Doxycycline, my understanding is that they should stay on it for a full 30 days. It's usually a high dose, but it is an important part of the treatment. I've had several dogs who were symptomatic, with a distinctive cough that is from the HW, who became asymptomatic after the Doxy. It seems to really help them feel better. Most dogs tolerate it well. There may be some tummy upset the first few days, but they seem to settle in and do just fine with it.

Our vet has us start Advantage Multi on HW+ dogs as soon as they come into foster care. We also start the Doxy right away, giving it with their AM and PM meals.

If you are thinking about doing "fast kill" treatment, most vets want them on preventative for 3 months before doing it (sometime in those 3 months, they also want the 30 days of Doxy completed). I've taken two personal dogs through "fast kill" with immiticide. I would be reluctant to start it during warm weather (my understanding is that cold weather makes the treatment easier on them and less risky). The injections are very, very painful -- some dogs suffer a lot with them. The crate rest that follows is worse. 1-2 months of crate rest is very, very tough on the dog, but very necessary after the injections. I have not lost a dog to this treatment, but I know of other rescues who have had dogs not make it through.

With a senior dog, they don't have much time left anyway, so I would be reluctant to put them through that kind of intensive restriction. I think you are right to be thinking about slow-kill options, as long as he's otherwise in good health and the disease hasn't progressed to the point that his life is in danger if the worms aren't immediately removed. Doing a full health work up might be important to make this decision (x-rays, blood work, etc.), given the age and suspected worm load.

Feel free to PM as you are going through it, if you have any questions.
04-21-2014 04:29 PM
Courtney Poor buddy - thank you for fostering him and taking care of his health. He's in for a long road to recovery. You know Jean has posted some excellent information in the past about heartworm treatments. Perhaps send her a PM - not sure if she will see your post. Good luck to you this boy.
04-21-2014 04:25 PM

I need as much info as I can get!!! My Foster dog has a very bad case of heartworms and we are getting ready to start treatment. He is 8 to 10 yrs old and I have put enough weight on him to get him ready for treatment but have no idea what to expect. Pretty sure he has had them most of his life as I was told he has hundreds of them. We are going with the slow kill method because of his age and health. Any and all info would be greatly appreciated , ...this guy so deserves a second chance in life. thanks!!!!

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