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August 25, 2010

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Kellie Olinsky

I have a 12-15 mouth old Bullmastiff that I just rescued with B2-Class 3 heartworm. I do trust my vet. But I was just confussed because I was told to give him interceptor 3 days after the first tx with immiticide it was one dose and then in 35 days the next 2 injections will be given, He is on prednisone.I am suppose to give the interceptor on Fri. 9-17-2010 Just scared because I have always been told that you do not give interceptor to dogs with heartworm.

Doc

Hello, Kellie,

Sorry to be so late with a reply. I was out of town for several days.

The first heartworm preventive medicine was diethylcarbamazine, also known as D.E.C. This preventive had to be given daily. If given to a dog with heartworms, there was about a one in three chance that the dog would die - Russian Roulette with two bullets.

The monthly preventives have carried warnings not to give to dogs unless they are tested negative for heartworms. Now that these drugs have been around for quite a while, we find that the risk is not as high as previously thought.

Selamectin (Revolution) is actually FDA approved as safe to be given to dogs that already have heartworms.

The big boys in heartworm research tell us that ivermectin (Heartgard) is
safe to use in heartworm-infected dogs, and actually recommend it when starting a dog's treatment regimen. Several have told me that they don't think that milbemycin (Interceptor) is as safe.

That being said, I have had numerous patients who were taking Interceptor and got heartworms anyhow (missed dose or whatever) continue taking the medicine through their heartworm treatment with no trouble.

It sounds like your veterinarian has had a similar experience, and isn't worried about it. While the "authorities" recommend a different medicine, the risk with the Interceptor appears to be low. In my own practice, if the dog has not been on a heartworm preventive, we are starting them with Heartgard in cases like this.

If you have misgivings, it is better to discuss them with your veterinarian directly.

Good luck.

Brittany Miser

Hello, I'm in a bit of a pickle. My 9yr old pit bull lola-mae tested positive LAST year for adult heartworms. My vet at the time chose not to proceed with ANY treatment aside from her monthly heart guard and chose not to inform me at all, instead to inform his assistant. A full year later, my new vet strongly disagreed with his conclusion and quickly began treatment just as you have recommended. I was only informed after she reviewed our file this week. My question is how much more "risky" is it now, one full year after positively tested, and I'd like to note that she receives her monthly dose of heart guard all year and I've never missed a treatment. P.s. her proin treatment for urinary incontinence is now failing almost completely due to treatment...

Doc

Hello, Brittany,

Since you have been giving the heartgard regularly, there shouldn't be any more heartworms than there were one year ago. Any increase in risk would probably be minimal.

I assume the dog is taking some kind of corticosteroid like prednisone if you are having incontinence problems. That will get better when you get off the steroid.

Suzy Mongeon

In January I adopted a dog who had recently been treated for heartworm with 2 injections of Immiticide. According to the rescue group, he was asymptomatic and the worms were found during routine tests. I did some reading but apparently not enough, and didn't realize the importance of keeping him quiet during the recovery period. He did go on Doxycycline when my vet noticed a cough reflex in his initial exam, right after he arrived from Tennessee. His vet down there had sent a dose of Ivermectin which I gave a month later. About 2 weeks ago he had a coughing fit which prompted another visit to the vet and a prescription for Baytril. When he failed to improve and actually seemed to go downhill in terms of appetite and energy we went back to the vet. His temperature has gone from 102.1 (previous visit) to 104.7 and his white blood cell count is low. Also he has some abdominal discomfort. He's had x-rays - abdominal (showed a little buckshot!)and chest - bloodwork of course, now is on Cephalexin. We are treating symptoms of an upper respiratory infection, but I'm afraid the real problem is the dissolving worms and my ignorance! Lee is mixed breed and just under 20 pounds. He eats but not with his usual gusto, bowel movements seem okay, drinks water as usual. He just isn't improving and the bills are piling up. I am determined to get him through this! Any advice? Would Prednisone be helpful at this point?

Doc

Hello, Suzy,

The worms are usually pretty well gone by six weeks after the injections. It is certainly possible that the breakup of the worms caused some damage that has predisposed your dog to a respiratory infection. However, it is not likely that there are still worms present.

I understand your concern. Sometimes a low dose of corticosteroid (like prednisone) for a short period of time helps with the inflammation in a respiratory infection.

If antibiotics don't seem to be helping, I do worry about a fungus infection like blastomycosis or histoplasmosis. Regular antibiotics do not work for these. Mira Vista laboratories can do a test for these using a urine specimen.

IF fever is down and he is improving on the antibiotics, I would stay the course. It is unlikely that dissolving worms are still a factor.

It sounds like your veterinarian is being very thorough.

Sallie dim

My dog just tested positive for heartworm along with arthritis and has tested positive for Lyme's and antiplasmosis for years..we brought him in because of joint stiffness as he gets that each summer it seems from perhaps the Lyme's and doxy clears it up but the vet insisted we come in and claims the two tests for h worm were positive and inactive microfilaria were seen in blood.. Started on doxy and gabapentin but worried about prednisone side effects and very worried about the h worm shots...is the prednisone for the arthritis or to help with the dying worms not hurting and clogging his organs and at age 11 do you feel the slow treat ongoing hrehreartguard is a more reasonable option? Of course after the appt and a couple doses of vetformin he's running around looking fine but panting more so I am hopeful we're not getting duped...

Doc

Hello, Sallie,
Doxycycline is an antibiotic that is the drug of choice for tick-borne diseases, like Lyme. It also has some anti-inflammatory effects.

Gabapentin is believed to be helpful with pain associated with nerve inflammation.

I don't know what vetformin is.

Prednisone is a potent anti-inflammatory. It would certainly help relieve arthritis. With heartworm disease, we use it to reduce the swelling in the wall of the arteries where the worms are banging around. This keeps the arteries more open, and lets the blood flow more freely. There is less damage in the lungs, and it is easier for the heart to pump the blood through the lungs.

Prednisone has other effects in the body. It can cause fluid retention in some patients. It can affect carbohydrate metabolism. Too much can suppress the body's defenses. Long term excessive use causes even more problems.

It can be very safe when dosed properly, and very beneficial. It depends on what is going on the the individual dog.

It sounds like you have been working with this doctor for years. I doubt you are being duped. If in doubt, you could take the dog to another doctor for testing.

The doxycycline can cause death of the baby heartworms in the blood, causing a temporary false negative test. However, the antigen test for adult heartworm protein in the blood would not be affected.

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