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May 18, 2010

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Marge

Thanks. I've been wondering about this.

Brett

Hello,
I recently adopted a lab named lauren, brought her for her exam and found she has heartworms. she is between 1-2 yrs and seems very healthy and never tires. I have an apt set for next week for and injection, i just wanted an opinion on what her chances of beating this and living a healthy long life are? sorry i do not live in MO i just like your blog so i figured i'd ask.

Doc

Hello, Brett,

I think the odds are greatly in your favor. Most dogs in her situation will do well. Stay in close touch with your veterinarian and let them know if anything doesn't seem just right.

Good luck.

Tammi

Dear doctor, I have a 3 year old Aussie (vet was guessing this, since she was a rescue). She was placed on Iverhart Max by her vet in LA 2 years ago and was on it until we moved to AR where her new vet tested her before giving us a new refill and she tested positive. She recommended Immiticide. We did 2 injections March 27/28. Now, my dog is a "case study" at Merial because she has had so many complications. She came home on a Wed, barely able to move, pitiful whining, in a lot of pain. By Thurs she had bloody diarrhea and vomiting. I don't mean a little blood in her stool/vomit - this was hugely horrible. Off to the emergency room, got her through that. Mid week the next week she had a "reaction" to the dieing worms, her face swelled up, her fever went through the roof, back to the bloody diarrhea. Emergency room, medications, got her through that. Her facial swelling and such went down, but by end of week 2 she looked like a camel. Week 3, spent half of it in the hospital with embolisms (yes, she is cage rested), she was also on steroids, pain medicine and MSDO (spelling?) for the back swelling. Next couple of weeks, the swelling seems to improve, she tapered off the steroids and her back swelled right back up. Back on steroids for a couple weeks, no improvement, tapered back off steroids, and this week, her skin ulcerated and ruptured, tons of crap came out. She has a huge dip in her back where her muscle is gone and we have a gaping hole and huge "empty" space across her whole back. She is very uncomfortable right now - alternately whimpering and resting. No pain meds, but is on Clavamox and I am putting Forasin in/around the wound a few times a day. I guess am looking for someone to tell me that my vet is ok, that my dog is ok and will recover, that I didn't make a huge mistake in this treatment - OR, that I need to get another vet or something else entirely! Everything I read suggests immiticide being where it wasn't supposed to is the cause of this latest "emergency surgery", and the vet confirmed this, saying it was because the dog was too fat (she weighed 53 pounds at the time of the treatment) and the needle didn't get through the fat pad. My husband is sure that the vet should assume some responsibility in all this - but then, my vet wouldn't have charged me $170 for this last procedure if she felt responsible, would she? He also thinks that she is too off-handed about our dog's discomfort, but the vet says that she isn't really in a much pain. It goes without saying that all these complications are exhausting - emotionally and financially. btw - Thank you for your blogging! I have read everything you have posted concerning heartworms and the treatment of it. Great info.

Doc

Hello, Tammi,
Holy cow! What a nightmare. I can understand that you have a lot of questions.
I have had one case similar to this, though not nearly so bad as you describe. The dog did develop a swelling, and it did break open and slough out tissue like a giant spider bite. However, the open wound was never bigger than 2 inches. Also, that dog did not have any other apparent illness in the same time period that one might have thought liked to the Immiticide.
My feeling is that this is what they call an "idiosyncratic reaction", meaning that it is a problem with this medicine and this particular individual (just as some people cannot take an aspirin). I think that is more likely than a failure of technique.
We know that the medicine is irritating to tissue, and a small amount of swelling is common. Most patients are back to normal within 3 days, even if they were intensely painful at first.
I know that this is no consolation to you when your dog is the "one in a million".
Since I am "long distance", I really cannot evaluate the situation or prescribe for your dog.
I do not think it would be inappropriate to request pain medication for her. Even if she "doesn't need it", it shouldn't hurt anything for her to have some Tramadol and see how much difference it makes in her quality of life. Sometimes we don't realize how much pain there is (or isn't) until we do a trial therapy with some pain-relieving medicine.

Good luck in this ordeal.

Tammi

Thank you so much - I can't tell you what a relief it is to hear this. It is hard enough to see her go through all this, without having the added doubt that either we or her vet (we, by proxy) were responsible for any of it! The hole itself isn't huge - only about 1", but the empty space (where air is and I can hear stuff sloshing around) is very large, about 3"x7". She probably won't get pain medicine, but at least I don't feel like an idiot for thinking she SHOULD have it. Again - thanks so much for your reply. :)

Doc

Hello, Tammi,

If there is a really big pocket under the skin, you should ask your veterinarian about placing a drain tube, or making a hole at the bottom of the pocket so that stuff can drain through the bottom. If the only hole is at the top, the pocket can keep getting bigger.

Best wishes.

Tammi

It is a pretty large pocket - I have to turn her over and massage it a few times a day to facilitate draining, and flush it every other day with a betadine solution. If I understand correctly, this thing is supposed to granulate from the back of the pocket forward. The hole is trying to close now, so I clean it a couple times a day with a antibac soap and warm water in an effort to keep it from scabbing over so it can continue to drain. Thank you for the suggestion, and I will TRY to talk to her about the drain tube - I am concerned that the daggum thing will close up on the outside before it heals on the inside, and here we will be, right back at square one. That drain tube sounds like a good option.

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