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My dog has heartworms. Now what?

Presentation about how veterinarians may address one practitioner's approach to heartworm disease in clinical practice.

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My dog has heartworms. Now what?

  1. 1. Now What?By Jacquelyn H. Burns, DVMCopyright © Jacquelyn H. Burns
  2. 2. 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.
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. Staging in the HeartwormDisease Blood Chemistry Profile CBC Urinalysis Chest X-Ray For some, an E.K.G.
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. Three TreatmentApproaches  Routine Treatment with Immiticide  “Soft Kill”  Delayed Treatment
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. The American HeartwormSocietyOfficiallyrecommends treatment with Immiticide rather than Soft Kill
  17. 17. 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
  18. 18. 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.
  19. 19. 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
  20. 20. Heartworm PreventativeIs recommended once-a- month, 12 months a year for dogs in our areaIf your other dogs are not on heartworm preventative, we need to test them and get them on it!!!
  21. 21. 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
  22. 22. 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
  23. 23. My dog has heartworms, nowwhat? Slide Show Courtesy of:  Jacquelyn Holmes Burns, DVM  Holmes Veterinary Hospital 100 Church Street Laurens, SC 29360 (864) 984-2365 www.holmesvethospital.com Copyright © Jacquelyn H. Burns, DVM 2011 Information presented in this slide show is for client education is not intended to be used as a substitute for your veterinarian’s clinical judgment and treatment recommendations.