Member,American HeartwormSociety is a current member of the Dr. Burns American Heartworm Society.Material in this slide presentation reflectsDr. Burns’ and Holmes VeterinaryHospital’s philosophy about andapproach to management of heartwormdisease. It may differ somewhat fromthe AHS guidelines. It is not intended tobe a substitute for examination andtreatment by your pet’s veterinarian.
Don’t panic! Our veterinarians and staff have many years of expertise in treating heartworms successfully We are current on all the latest treatment techniques We approach treatment gradually to avoid patient (and owner) stress 98% of our treated patients return to normal, healthy lives
Step 1 Identify and treat concurrent problems Classify the heartworm disease’s severity Set up a safe and effective treatment plan individualized for each patient Ongoing prevention Follow up testing
Identify and TreatOther Problems For example, if your dog has skin disease, an injury, heavy intestinal worm infestation, we want to treat and control those situations before moving on to the heartworm disease If your dog is underweight (such as a malnourished stray or rescue), we want your dog to gain some weight before treating for heartworms
Staging in the HeartwormDisease Blood Chemistry Profile CBC Urinalysis Chest X-Ray For some, an E.K.G.
Heartworm DiseaseClassifications Class I Mild Disease, no symptoms Mild Disease, mild symptoms Class II Moderate Disease, mild to moderate symptoms Class III Severe Disease with mild to severe symptoms Class IV Caval Syndrome
What are the symptoms? Many dogs have no symptoms at all! Coughing Shortness of breath Labored breathing Weight loss Poor appetite Lethargy Getting tired easily with routine exercise Syncope Swollen, distended abdomen Edema of the legs
What are the dangers? Developing right sided or generalized congestive heart failure Sudden death Pulmonary embolism Blood clot to the lungs Most often fatal Caval Syndrome Most often fatal
Couch Potato! Your dog should become a couch potato until his or her heartworm infection is cured This means not doing things that increase the heart rate Running, jumping, playing ball Climbing steps, stairs, hills Barking a lot Breeding/mating
Three TreatmentApproaches Routine Treatment with Immiticide “Soft Kill” Delayed Treatment
Regardless of TreatmentPlan Alldogs start Heartgard Plus (or equivalent ivermectin-based heartworm preventative) at the time of diagnosis Prevents the dog from getting more heartworms, which worsen the disease
Routine Treatment vs SoftKill Routine Treatment “Soft Kill” =Immiticide Injections Start on Heartgard Plus Start on Heartgard Plus at time of diagnosis at time of diagnosis Doxycycline for 6 weeks Doxycycline for 2 weeks Prednisone for a before and 4 weeks minimum of 6 weeks after last Immiticide Exercise restriction until treatment negative Prednisone for 2 weeks Antigen test every 6 before and 4 weeks months until negative after last Immiticide treatment
Routine Treatment Injections of Immiticide kill the adult heartworms The heartworms turn loose and flow downstream where they lodge in small blood vessels in the lungs The worms decompose in the lungs and are broken down by the body Sometimes causes cough Sometimes causes appetite loss, weight loss, lethargy Rarely can have pulmonary embolism and death, usually first 3 weeks after Immiticide
Soft Kill Concedes that your dog is living “okay” with the heartworms he or she currently has Preventative with Heartgard Plus Keeps matters from getting worse Heartgard Plus and Doxycycline work together Weaken the adult worms and shortens their life expectancy They live 6 mo to 18 mo instead of 2 to 5 years Prednisone Reduces inflammation in lungs Retest for heartworms every 6 months Most are heartworm negative in 12 months
The American HeartwormSocietyOfficiallyrecommends treatment with Immiticide rather than Soft Kill
So why do people choose theSoft Kill? It’s often easier on the dog, especially older dogs or dogs with other problems No three week period with danger of embolism after Immiticide injections No post-Immiticide coughing, lethargy, weight loss
Delayed Kill? Postponing treatment with Immiticide until cooler weather for stable patients!!! Asymptomatic pets Pets with mild or no changes on x-rays Postponing treatment for other reasons Since August 4, 2011, Immiticide, the drug to treat adult heartworms has been in very short supply and is released by Meriel on a case by case basis, reserving it for the more severely affected dogs. We can currently get Immiticide if needed, but that has not always been the case.
Can my dog give heartworms tomy other dogs? No—not directly through playing together, eating together, bunking together Other dogs if taking heartworm preventative are not at risk Heartworms are transmitted through mosquito bites A mosquito bites an infected dog, ingesting heartworm microfilaria Microfilaria develops into an infective larva in the mosquito If the mosquito bites a dog that is not on heartworm preventative, it can transmit the larva in its bite
Heartworm PreventativeIs recommended once-a- month, 12 months a year for dogs in our areaIf your other dogs are not on heartworm preventative, we need to test them and get them on it!!!
What about my cat? Cats are sometimes infected with heartworms, but it is much less common than in dogs Symptoms are more likely to be Asthma-like (H.A.R.D.=Heartworm Associated Respiratory Disease) Sudden death
Heartworm Prevention inCats Very easy! No pre—preventative blood test needed Advantage-Multi, our once-a-month flea med, takes care of: Heartworm prevention Flea control Hookworms Roundworms Ear mites