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April 10, 2014

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Sandy Youngblood

Our 5 yr old German shep mix was diagnosed in late Aug/Sept with heartworms. My husband said he forgot their prevention for 3-4 months. Fritz took heartguard for a month along with a month of doxycycline and then had the first immiticide injection. In all this time he's never displayed any symptoms.We're approaching the time for the final round of immiticide and I'm considering switching to the soft kill method at this point. I believe he was minimally infected and the money and the restricted exercise are making me think we may be able to get by - since he's already had the one shot.
Do you have any opinion on that?
I've been searching for anyone else who may have done this but I can't find a thing.
I would so appreciate your comments on this.

Doc

Hello, Sandy,

A single injection of Immiticide kills the weakest worms. Statistically, this is believed to be about 50% of them, primarily male worms, very young worms, or very old worms.

Two injections kills in the high ninety-percent (from 94 to 100%) of the worms.

The reason that we give the single injection is to give the dog the opportunity to deal with a smaller number of dead worms at a time.

You kill a few, they clog up the smaller arteries, and the white blood cells take several weeks to clean them out.

Once they have been taken care of, you come back and kill the rest, and the dog recuperates from that over the next five weeks.

You could (and we used to do so routinely) just give the two injections to start with. If there are lots of worms, this is much harder for the dog to deal with.

Also, with three total injections (the program that is considered standard now) versus two, it pushes you more toward 100% worm kill.

With the single injection that your dog has received, it is very likely that there are some worms remaining that you could remove with the two injections.

It is possible that there were only a few and they are all gone. It is also possible that there were only a few, and NONE of them died with a single injection.

"Slow kill" means that your dog is a time bomb for years until the worms die at an unpredictable time. With the standard treatment, you know the time frame, and can restrict the dog's activity, and keep it under close observation. You've narrowed the window to weeks instead of years.

Conrad Galvez

my three yr old female lab tested positive for heartworm so they gave tri heart plus a pill she would take once a month but the whole tratment runs around 1800.00 dollars and we dont know if it would cure the problem or work a little for her lifetime so they prescribed also minocyline to start i have the prescription but dont know if i should start and maybe get lucky with just taking those two meds and cross my fingers i cant believe this is happening

Doc

Hello, Conrad,

You don't say if your dog has been taking preventive medicine regularly, and has just tested positive anyway (perhaps a missed dose, or just less than 100% effectiveness, even with no missed doses).

Minocycline (like doxycycline) inhibits a micro-organism called Wohlbachia that benefits the heartworm. Knocking that organism down makes the heartworms smaller and weaker, easier to kill and dissolve. You take it for a month, and the effects last for several months.

It is a preliminary to killing the worms with the Immiticide injections. There are several other posts on the blog about the heartworm treatment procedure.

The oral stuff is preventive medicine to keep the dog from getting any more heartworms than it already has. If (and this is by no means certain) long term use of the preventive actually did kill the worms, it is a process that would take years.

Without knowing your dog's situation, examining the dog, possibly taking chest X-rays, I really cannot give you specific advice on your best course.

It is obvious that you have questions about the recommended treatment plan. Ask the veterinarian who examined your dog and recommended the treatment. Tell them you need more explanation. That's their job, and I'll bet that they will be glad to talk with you.

Georgia

I am looking at a 1-1/2-year-old Chorkie at a shelter that has been treated for heartworms.

This is what they said of the treatment:
"He was treated to get rid of the baby heartworms and to start killing the adults. The Heartguard monthly preventative in his case will do double duty of preventing new ones and wearing down the existing ones. This treatment is much easier on the dogs that the full treatment which takes 2 -3 months and requires keeping the dog very calm and still."

The only standard of care I can find is that the dog receives 1 shot (which I think is what the Chorkie has gotten) and then 30 days later, a shot, wait 24 hours, then another shot.

The shelter is saying one shot and just use Heartguard to get rid of the rest. Is that new information that I just am not finding on the internet?

I'm very nervous about that approach. I would do the Heartguard regardless, so that's not a problem. It just seems like he is getting 1/3 of the treatment and then giving the Heartguard with the hope that it does the job.

Would you get this Chorkie under these circumstances?

Doc

Hello, Georgia,

I would presume that the shelter folks are believers in the "slow kill" method. This is somewhere between waiting for the worms to die of old age and actually having them die a little sooner than that with the Heartgard.

At 18 months of age, I would guess that the dog has very few worms. Keeping him on Heartgard should certainly be done.

My bias would be to go ahead and do the remaining injections on schedule.

Such a young dog would probably do fine.

You would really need to have the dog examined by your veterinarian and follow his/her recommendations.

Conrad Galvez

ya going back like i was sayin about my three yr lab she was not on any type of prevenitive med like heartgard or others out there so i am going to talk to the vet and c if there is any other meds she can take to at least live a long life she is not showin no symptoms yet but im crossin my fingers and ill proably have to pay that 1800 dollars in payments my brown lab just loves to play all the time i cant believe she will die off well ill c when i talk to the vet in a couple days when shes come back to work Thanks

Conrad Galvez

forgot to mention my Lab is on Tri Heart Plus monthly tablet for heartworm since this Dec 2014 when she went in for anual checkup and they told me she tested positive for heartworm so wee stayed with that but i went to a different vet for second opinon and c if she would test positive with them yup she did i was hopin she would be negative but i lost and besides that minocycline she took for a month well that ended Feb 1 2015 but my pup is lookin good u wouldnt think she would have this problem

Doc

Hello, Conrad,
If she didn't take any preventive medicine three years, I'm not too surprised she acquired the heartworms.

I don't know how bad the mosquitoes are where you live, but in my part of the country, even one year without medication would result in heartworm infection.

Stay on your Triheart so that you don't get any more worms than you already have, as then you might have to do the big-buck treatment all over again.

jane

We had our 89lb rescue lab treated for heart worms 6 mo ago. He was determined to be stage 1 with a sonogram. The vet said since he was stage 1 he would only need 2 back to back injections. she then put him on heart guard and he has been on it faithfully every month. we just went back for his re test and he still tested positive. Not sure what to do at this point. Any suggestions would be appreciated. The vet suggests re treat with 2 more injections or continue to use the heart guard and re test sgain in 6 mo. Worried and disappointed.

Doc

Hello, Jane,

If he was treated 6 months ago, that would be in October.

Mosquito exposure has its peak months in July and August. The preventive medications "reach back" to kill whatever was put in by mosquitoes in the past 5 to 6 weeks (six weeks maximum).

Therefore, if you started on Heartgard on the first of October, you had no coverage for May, June, July and the first half of August.

The baby heartworms that entered the body in June would not have been susceptible to the Immiticide until December (six months after the mosquito bites).

So, your October treatment killed the adult worms present at that time, but not the developing worms that didn't reach maturity until December, January, February and March.

In other words, last summer's exposure has now matured and you have adult worms present again.

If you just stay on Heartgard, you shouldn't get any more than you have right now. Those will, however, take years to die.

Continuing on the Heartgard, and doing another 2-injection treatment should get you clear and enable you to stay that way.

Your dog is unlikely to experience much difficulty with this next round of treatment, but the person best equipped to advise you is the doctor seeing your dog.

Contact your veterinarian and share your concerns and questions with him/her.

Nikki Wilson

Our dog was just diagnosed with heartworm about a month ago. She was showing no symptoms at all! We took her in to get her tested because we had heard you could put them on a heartworm preventive that would obviously prevent heartworm infection but also help prevent against tape worms (which she kept getting). We live in Moab, UT where there is no reported cases of heartworm this year and only eleven last year. We did get Kimber from a shelter in Durango, CO when she was only two months old and we have no clue where she came from before there. She just turned three the first of June. She is extremely active, we go on a run everyday and she has twenty acres to enjoy with our other two dogs. We were not expecting for her heartworm test to come back positive. We had the first test done with our regular vet and were not impressed with the lack of knowledge and sympathy of the disease. We choose to go to another vet in town and had two more tests done. She tested negative for the microfilarie and positive for the adult heartworms or as they called it the "antigen" test. The vet said it was possible that there was only a female worm burden or the worms may have been sterile. This I never really understood, but I was some what relieved that they were not reproducing! We started Kimber on heartguard and Doxycycline. She was on the Doxy for two weeks before the Immiticide treatment. After the first shot Kimber was lethargic for about three days.They of course said this was normal especially since they sedated her as well. We finished out the doxy and currently have her on a steroid. She still shows no signs of being infected, no coughing or gagging. She did stop eating regularly and would not eat her dry dog food. I started making her homemade dog food and she got her appetite back pretty quick. So she is drinking, eating and eliminating normally. She has now been going through the treatment for two weeks. She is extremely mad at us for keeping her restricted and would run and play if we let her. She is definitely affected by all the pills we have been giving her and i'm sure the immiticide is not helping either. My heart breaks every time she begs to go outside or when she sees the other dogs running and playing. We have twenty acres for her to enjoy and she is not used to being completely confined.
I guess I am having some second thoughts about putting her through this treatment. Do you see this a lot where dogs have no symptoms and no side effects from the treatment? Can the worms be killed with the first immiticide injection? We are wanting to test her after the first injection just to see if she comes back negative. The whole process is extremely exhausting for my husband and I as well as our fur baby! I am just looking for a little more information on dogs with no symptoms. I am finding a lot of information based on dogs with a large worm burden and really no information on dogs with very small worm burdens. Any advice or information you can give me would be greatly appreciated!
Thank you!
Nikki Wilson

Doc

Hello, Nikki,

I understand your feelings. The good thing is that you should have a good long-term outcome with this.

Any reaction from the Immiticide should be long-gone now.

You are restricting the exercise so that the dead worms don't create more of a problem in the smaller pulmonary arteries before they are dissolved.

The antigen test is for a protein from the female heartworm reproductive tract. If there are fewer than 4 female worms, it is possible to get a false negative test.

Thus, testing a few weeks after a single Immiticide injection may not mean a whole lot.

My bias would be to go ahead and complete the treatment with the second round of two injections. I believe this is what is in the dog's best interests in the long run.

Rae flontek

I adopted an adorable chihuahua from a rescue. She had been in 3 different puppy mills, then when she could not have more puppies she was given up as bait for dog fighting. They left her in the woods to die after she had been attacked, but was luckily found by a girl and given to the rescue.
She was treated a year ago for heartworm, but now tests positive again. The vet who treated her said sometimes they can test false positive up to 18 months after treatment and suggests I leave treatment for now. My vet wants to treat her now. I hate to put her through more trauma unless really necessary. What is your advice. She has no symptoms.

Doc

Hello, Rae,
I would suspect that the dog had been exposed to heartworm through the mosquitoes in the months before the heartworm treatment. It would be six months after that exposure before the worms would develop to a stage that could detected or be susceptible to the Immiticide treatment.

While you could see some holdover heartworm protein in the blood causing a false positive test for several months, I don't think it likely that is the case at 18 months.

She probably doesn't have many worms, but when she is in good health and doing well, my bias would be to treat her to remove those.

Certainly you should keep giving her preventive medicine each month.

The veterinarian who is actually seeing your dog is the best person to advise you. I can only give general information and opinion.

lynn

my 14 year old American Bulldog was just diagnosed with heartworms. The vet put him on Heartgard and doxycycline 430 days. When does the heart guard start killing the baby larva.also he still a very active dog. We usually walk about 1 mile a day.... my vet did not seem concerned about this amount of exercise. What do you think?

Doc

Hello, Lynn,

What do I think? I think the doctor actually seeing your dog is your best source of information.

That being said, the doxycycline is probably doing more to clear the microfilariae (baby heartworms) than the Heartgard. The Heartgard works overnight and is then gone from the body, so it's already done whatever it's going to do.

The doxycycline will usually sterilize the females (temporarily), as well as weakening them and shrinking their physical size.

If the dog had a negative test last year, and has been taking preventive medicine, he would have very few heartworms, so they are unlikely to cause a problem with mild to moderate exercise.

Ashley

I rescued a Chow Chow/Spitz mix in April from a rescue that had received him from a kill shelter. The rescue did not have a lot of information for me on his past history but they guessed his age was about two years old. He was tested for heartworms for in May when I took him for a check up, he tested negative. He was on a preventative that the rescue gave us called valuheart (a generic brand from a town and country store) that I continued after we rescued him and on Nov 11 he tested positive on what they called "snap" test but the blood work came back negative. So they did another round of testing, taking more blood and doing an extensive test which came back positive. He is on an antibiotic and his first round of heartgard (he has a six month supply). Next week we go in for the first injection but I am having second thoughts because I feel like the first round of testing should have shown a positive on both blood work and the "snap" test. He has no symptoms, he plays, he runs, his appetite is regular, he drinks water regularly, and he has no cough/gag (unless he gets excited and pulls too hard on his leash). I just want some advice on what to do. It concerns me to pump my dog with chemicals for what seems like a couple of worms.

Doc

Hello, Ashley,

I get what you are saying about not wanting to do an unnecessary treatment.

Here's the thing: the tests are not quantitative. They are pretty much yes or no. You can have a dog that has MANY adult heartworms, and yet tests consistently negative for the baby heartworms in the blood. I have done post-mortem exams on several such dogs.

If there are fewer than four females, the test for heartworm protein in the blood (the snap test and others like it) can give a false negative. It tells you absolutely nothing about the number of males, and positive is just positive - it doesn't tell you how many females are present.

When I am concerned about numbers of worms, I am looking at the dog's mosquito exposure history. Where was he living during the summer? Was he inside or outside? How many mosquito seasons?

A chest X-ray won't quantify the number of worms, but it will show if there is already any heart damage, or damage to the pulmonary arteries (lung arteries where the heartworms live).

A young, athletic dog will experience some damage to his arteries even with just a few worms present, as the blood flow of vigorous activity whips them around inside the vessel.

As far as "pumping him with chemicals", the month of antibiotics is the biggest part of that. The Immiticide isn't much drug. Other than some soreness at the injection site, it is unlikely to bother the dog at all. It takes the worms several days to die.

Breaking the treatment process down into these various stages gives the dog's body the least amount of stress in dealing with the dead worms clogging his arteries. The doxycycline (or minocycline, another antibiotic) weakens the worms, and makes them physically smaller. They die more easily, and they don't clog up as much artery. The single injection kills the weaker worms, so all the dead worms don't hit him at the same time. When those have been dissolved over the next few weeks, the two injections kill the rest. Again, not so many dead worms to deal with at one time.

Do stay on the Heartgard throughout the process.

Ashley

A chest xray was done but the vet didn't seem concerned about what she saw.
I've had him since April, he lives mostly inside while I am at work, he gets to be outside in the afternoons but not more than 1.5 hours (that was until he was diagnosed). We do live in Central Texas but I didn't think his exposure was severe (this summer of 2015). I don't know much about his life prior to us but the rescue had a negative and I had a negative in May when he was on preventative.
I'm wondering if I do the antibiotic, and one immiticide treatment if that will kill off what worms are affecting him.

Doc

Hello, Ashley,

You really need to do the complete protocol. A single injection will almost certainly leave worms present. We used to just give them two injections, no antibiotics, no single injection preliminary. Lots more complications that way. Three injections gives the best chance of 100% kill.

That being said, there are some dogs where you cannot clear every worm. My personal opinion on these patients is to just keep giving preventive medicine, rather than repeating the whole rigamarole.

Treating as thoroughly as possible makes sense for your dog. He is young and strong, and has a long life ahead of him. It would take years for those worms to die on their own, and you wouldn't be restricting his activity when it happened.

This is better.

Connie Wheeler

We have had our dog since he was 10 months old along with 3 others. We have them on Heartguard every month. He is now 3 and in June he tested positive for heartworms. He was treated with back to back injections over two days. Confined for 6 weeks and today we had him retested for his 6 month check up. Sadly he tested positive again for baby heartworms. Our vet was unsure how she wanted to move forward but decided to give him some immiticide liquid form and retest in 2 months and continue to give him Heartguard which we have done every month since getting him. Do you think this will work or do you think we will have to do the injections again? Thanks

Doc

Hello, Connie,

Did he test positive for adult heartworm antigen (the protein from the female worms that you would see on the little tests that look like a pregnancy test)?

Ordinarily, one would expect the monthly Heartgard to have killed the circulating microfilariae (the microscopic baby heartworms), but it may not have.

You might have removed the adults, but not ever really killed their circulating babies.

I suspect the oral liquid your dog was given was a high dose of Ivermectin (the active ingredient in Heartgard). Immiticide is only available as an injection.

To clear the bloodstream of baby heartworms, we often use this form of the drug, and the dose of ivermectin is about 400 times the dose that would be in the monthly Heartgard.

I would certainly continue to give him the Heartgard while you are waiting for the retest.

The two injections of Immiticide, 24 hour apart, will clear most of the adult worms, but some can survive. Using the 3-dose protocol (one dose, followed one month later by two doses) has a higher percentage of kill in the research studies.

It is possible that some of the adults survived, but it would be a small number. It is also possible that you have some new infection because your dog doesn't do well with the Heartgard. Some dogs just don't get the protection they need; apparently they don't absorb the drug as well as other dogs or something (we're not entirely sure what the problem is exactly).

When we have patients who have repeated infections after being cleared, we have had the best luck with switching them to Advantage Multi as their new preventive after treatment.

If the baby heartworms are gone on the retest, and the antigen test is negative, then great. If they are still there after the big dose of ivermectin, then you probably have a live mommy and daddy adult in there. You might get a negative antigen test, even so, as with fewer than four adult female worms, we can get false negative antigen tests.

Every case is different, and your best source of information is the doctor seeing your dog. I really cannot recommend whether you should re-treat the dog, or just continue with preventive, or switch to a different preventive. Without seeing your dog and knowing the case, I just cannot make a recommendation.

Leah Crotsley

I was at the vet today with my dog. Three years in a row her heart worm test came back pos. then they run it again and it's fine. Has anybody else had this happen. She takes heartguard on the 28th every month. I have never missed a dose since I got her 6 years ago. She was 9 weeks old when I got her.

Doc

Hello, Leah,

If they are running an antigen test for the adult heartworm protein in the blood, very low levels of antigen can give false negatives. So, if you have fewer than 4 adult female worms, you can get a positive test on some occasions, and a negative test on others. After three years, it is also possible that the worms finally died.

Sending a blood sample to an outside reference laboratory is the way to double check this. They have more sensitive testing methods.

Anne

We have a young rescue pug going through treatment right now. He has had the 3 shot protocol. He tested + for baby heartworms prior to the treatment. We just got his results back from his post treatment and the baby heartworms and it was - . Can we read anything into this? Does this mean there is a good chance the overall treatment was successful? He won't be tested for adult heartworms until Nov.

Doc

Hello, Anne,

It is not uncommon to test negative for the baby heartworms if you have been taking preventive medicine along with the treatment. It doesn't tell us a whole lot at this point. I think your odds of success are very great, though.

maryellen

My 6 year old westie had a positive heartworm snap test 1 year ago. They sent the blood out for a second test and it came back negative. One year later, she now tested positive on the snap and also on the test they sent out. Subsequently they tested for babies and found none. Yesterday I took her for an ultrasound and the doc saw no heartworms. Her oxygen levels were low after exercise (88-89)for several tests so the ultrasound vet recommended still treating her for heartworms. She has no symptoms but mysteriously her bark has changed over the last two months with no explanation. Neither vet thinks this is related but my friend thinks she should be check for laragyl paralisis. Im baffeled by this and don't know what to do. Shes on her 5th day of doxy and Im afraid to do the treatment anyway (of coarse)I have not seen any mention of the ultrasound results. I thought this was a good way to either confirm or negate the diagnosis. I now this is a lot to digest but I'm not sure where to turn.

Doc

Hello, Maryellen,

With very small worm burdens, the tests can give false negative results, even at the reference laboratories. I suspect there were a very small number of worms last year, and the same this year.

The ultrasound may reveal the presence of heartworms, but can easily miss them in small numbers.

With such a small number of worms, the odds of her having complications with the treatment are very low, roughly on a par with having the same problems if left untreated. I think you have more potential for gain than loss.

I cannot speak to the barking issue, though partial laryngeal paralysis is possible. My grandmother developed paralysis of one side of the larynx and was speaking in a whisper for the last two years of her life.

A C-T scan or MRI might show something putting pressure on the nerve supply (if that is actually what is going on).

I cannot imagine how the heartworms situation could relate to the barking situation.

maryellen

thank you for your quick response. Could you please clarify the comments 1) roughly on par with the problems if left untreated and 2)I think you have more potential for gain than loss. Since I want to be 100% positive before I treat her are there any other tests I can do? Do you think it might be a good idea to wait a month or two and then have the blood work retested? Thanks in advance.

Doc

1. I think that both are unlikely to cause problems, but both could.

2. Getting rid of the worms is a plus that lasts the life of your dog. Chances of having complications with the treatment are remote, given your circumstances. Possible, but remote.

3. I don't think that there are any other tests that will give you more information than you now have.

4. I doubt there will be any change in the bloodwork that would be helpful. You have an extremely small worm burden, so you can get false negative tests. If it turns up positive again, it's the same. If it turns up negative next time, you can't really trust it, based on past results.

Jessica

Hello,
I rescued a puppy from the south who was brought up to Wisconsin. The rescue records show she was on a heart worm preventative and when I got her home I started her on heart guard every month. At her one year check up she tested positive for microfilaria and heartwom. The rescue paid for her treatment (antibiotics, the two injections over two day) During this time she took a monthly preventative still (a different one because she is a hearing breed) We just finished our 30 days of crate rest, but I felt she was still not doing well in the heat and tiring easily after short walks. My vet finally agreed to do a blood test to put my mind at ease, even though she said it would tell us if she was really negative yet. My dog is still microfilaria positive. My vet had me double check the dosage of the preventative, which should work for a dog up to 55lbs and my dog is only 34 lbs. she said she has never seen this before, and my dog should be negative because she took a preventative two days before the test. Any thoughts on what is going on or how to proceed?

Lisa

We just adopted an approx. 10 mo old dog from a shelter last week. Took her to our vet for exam. Gave blood sample & that test came back positive for adult heartworms. Had us give another blood sample to do another test to check for babies (same lab as first test) That test came back negative so they took more blood & sent it to another lab to verify. This test came back negative for both adults & babies?? We live in an area with hardly any cases of heartworm so concerned our vet may not have a lot of experience with heartworms. Vet is supposed to call us on Mon. After she consults with someone. Should we be worried? Does our puppy have heartworms or not? Also puppy is on panacur c for guardia. Could this be affecting the heartworm test? She wasnt on panacur for the first two, but had been on it for two days when the 3rd test was done.

Doc

Hello, Jessica,

My recommendation would be to continue the monthly preventive year-round and re-test 4 months after the two injections.

One dose of preventive frequently does not clear the microfilariae, even if there are no fertile adults left to produce new ones.

It is also possible that you didn't have a complete kill, but my advice is the same at this point.

Continue regular monthly preventive medicine and re-test.

Doc

Hello, Lisa,

The Panacur won't affect the heartworm test. Really small worm burdens can give inconsistent results, false negatives, then positives, then false again.

I would follow your veterinarian's recommendations. My advice (bearing in mind that I have not seen the dog or test results) would be to continue monthly preventive and re-test in six months.

Lisa

Thanks Doc! Third blood test came back negative from outside lab. Dr. Had one more blood sample drawn & sent to same lab as first test (which was the one that came back positive for adults) and it came back negitive so Dr. said absolutly no adult heartworms but like you she said to start on heartguard & test again in 6 mo. So grateful she is heartworm free. Fingers crossed she will stay that way. Thanks again for your advise.

Kathleen McLeod

My currently 5 year old rescue Chihuahua tested positive for heartworm when I adopted her 18 months ago. She had no.symptoms. An echocardiogram showed such a high burden that the vet and cardiologist advised the 3 injection melarsomine protocol after only 30 days of Advantage Multi and one round of doxycycline. (She continues on monthly Advantage Multi, no lapses.) It was explained that she might still test positive after treatment because all microfilarae might not be dead when treatment commenced. Six months later she was negative for microfilarae but antigen positive. An echocardiogram showed greatly reduced burden of adult worms but still a substantial number. Melarsomine protocol was repeated. Six months after second protocol, she is still antigen positive, microfilarae negative. Vet has few ideas--maybe melarsomine resistance? Long time to clear antigen? He will get a Knotts test performed to see if microfilarae might be there previously undetected. Have you seen any cases like this? She has never had any symptoms and seems in excellent health. Is she in danger from adult worms that are likely sterile but may take a long time to die?

Doc

Hello, Kathleen,

Some dogs will never totally clear all the worms, so says the expert from the American Heartworm Society (not me). If the echo does not show a significant worm burden, I would be tending to just stay on preventive medicine, rather than a third, 3-dose Immiticide regimen.

Some day the worms still present will die of old age, and they may move and cause a problem, but you will probably be okay.

Just my feeling on the matter. Since I haven't seen your dog or the imaging, I'd say it's best to rely on the advice of your veterinarian who has.

Michelle Daniel

I adopted another dog last Feb.(2016). The rescue group had her tested for HW in Dec.'15 by doing a smear test as well and it was negative, then when I adopted her in Feb'16 she was tested again and it was negative. I have had her on Heartgard every month, religiously. I just took her in ( a month early too) to get her annual testing and vaccines updated. She tested positive. How can this be? She was negative in two prior testings and now 11 months later she is positive even while never missing a dose of preventative. I am sick about this. We adopt all our dogs. One a shelter treated with the slow kill method and we have had her 12 years and she is great. The other we did the aggressive, which is just so scary. We are getting her retested at another vet today to make sure, but how could this happen?

Michelle Daniel

And now an update from my question this morning. We took her to our old Vet that is some distance from our home. They ran a smear test in their office and it was negative. WHAT IS HAPPENING? Who is right? What do we do now. One vet is saying positive, one says negative.

Doc

Hello, Michelle,

If a dog has a very small worm burden, you can get conflicting results. If there are fewer than four adult female worms, you can get a false negative antigen test. The antigen is a protein from the female heartworm's reproductive tract. Male worms are not detected on this test at all.

I'm not sure what you mean by a "smear test". When we look for the microfilariae (microscopic baby heartworms), you can sometimes see those in a drop of blood if there are lot of them. If there aren't many, they can be missed without a concentrating exam, like the modified Knott's test. This takes 1.0 cc of blood and puts any microfilariae in the whole sample into one drop, so you are less likely to miss them.

Unless you have both males and females, there won't be any babies in the blood.

Many dogs taking heartworm preventive will show no babies in the blood, even if there are adults of both sexes present.

I have had patients where we sent the results to a teaching hospital reference laboratory and the results were still equivocal, and they recommended a retest in six months.

A likely explanation is that the dog just has a very small number of worms present, possibly they've been present all along and the first test was the false negative.

At any rate, you don't have very many worms present.

I cannot make recommendations for a pet I haven't seen. However, it is likely that simply continuing this dog on preventive will work out okay, based on what you have told me.

Michelle Daniel

Thank you for the clarification. We are just so confused as to what to do. My old vet said the test they did today (a re-test in their office) was the antigen test? Looked for the babies and the females and both were negative. The Vet that did it last weekend sent the blood off to an outside facility and they are the ones that said she is positive. They want to start her on Doxycycline for 30 days and then the 3 Immiticide injections. I asked about just keeping her on preventative and she lectured me on the damages the adult worms are doing to her heart and lungs and they never do the slow kill. I asked if she was a strong positive and she said that was like saying someone was a little pregnant. I am so confused. My original vet of over 25 years has used the term 'strong positive' himself. Yet this (very young) Vet acted like that was idiotic and not a thing. I just do not want to subject her to this very aggressive poison if she truly doesn't need it. Is there something else we can do to see 100% if she has worms? Should I request from my Vet that showed negative if they can send out a sample to a lab? Thank you for all your help.

Doc

Hello, Michelle,
I think that generally speaking, you cannot really estimate severity of infection from the results of the test. It's either positive or negative. Except when it's equivocal, looking like neither one definitely. In those cases, we believe there are very small numbers of worms.

The reference labs can usually detect smaller number of worms than the tests we use in our clinics.

You are a little mistaken in calling the Immiticide a "very aggressive poison". The problems with treatment are related to dead worms clogging up the arteries. It is rare to have anything worse than some temporary soreness at the injection site with Immiticide. Lots of dogs don't even have that.
The problem with "slow kill" is that you don't know when the worms are going to die of old age, years from now. It is when they die and move from a big artery downstream to a small one that trouble occurs.

When you are going through the treatment process with Immiticide, you know when that is going to occur, and can restrict the dog's activity to reduce risk of complications.

It won't hurt to re-test, but if your dog has a really low number of worms, the results may continue to go back and forth.

The upside of that is that dogs with really low numbers of worms rarely have any complications with the treatment.

Michelle Daniel

Update: My old Vet ran 4 more antigen tests in house and they all came back negative. They sent off to a lab and had a special heated test done and sure enough, it was positive. There are studies now proving that if a dog that is positive (un-knowingly) and is on preventative, that it can show a False Negative as the drug in the preventative bonds the blood and will not show the true results. The only way is to have the plasma heated and that forces the separation in the blood. So this is what the specialist recommended and so we did it and this is where we are now, she is positive. So we will be starting her on the Immiticide soon.

Doc

Hello, Michelle,

The heating is supposed to break down the complexes of heartworm antigen/antibody, to release free antigen. In other words, the body is trying to get rid of this stuff. Antibodies are protein molecules that bind to something that is "not the body", in this case the protein molecules from the female heartworm's reproductive tract. Once the two are bound together, there's nothing left to react in the antigen tests we run in the clinic.

Heating the sample is supposed to free up antigen (if it's there). If you have to do this to detect the presence of worms, it is very likely that the worm burden is really small.

That's good, as the bottom line here is that fewer worms equals fewer chances for side-effects with the treatment.

Vic Rice

We adopted Sweetie about 2 months ago, she was rescued from a puppy mill (we are trying to help her get over trust issues), she was previously treated for heartworms, we have given her the Heartguard religiously... Anyway, she started coughing the other day, we took her to the vet. He indicated an enlarged heart and blood vessel (signs of HW damage). She tested positive for adult heartworms, but not babies. Her heartworm treatment was 8 months ago. I am leaning toward waiting on retreating as I have read that they will sometime be positive for some time. Especially with her heart damage already noted, I do not want to put her through the treatment if I do not need to.. All advise and comments are welcome!

Doc

Hello, Vic,
The latest reading I've done suggests that adult heartworm protein can persist for up to 7 months after the treatment. What about 8 months? Hard to say.

We know that there are some dogs from whom you can never completely eliminate every single worm.

The tests are not very reliable as far as estimating the quantities of worms present.

The chest X-ray doesn't really tell you whether that damage is new, old, or ongoing. If you had X-rays from before the treatment 8 months ago, it would be helpful to compare the two for changes.

Treating her for heartworms again shouldn't really have any direct effect on her heart. It is the arteries in the lungs that suffer when the worms die and move downstream.

Sometimes a dog in this situation will benefit from a course of corticosteroid therapy if the problem is old damage in the arteries. Relieving inflammation opens up the vessels, and the dog's arteries and lungs function better, and the cough may stop (at least for a time).

Without knowing everything about the dog's history and actually seeing the dog and the X-rays, I really cannot give you specific advice.

Michelle Daniel

We are starting her on Doxycycline now. I was wondering what your thoughts were on doing the Immiticide vs. slow kill ? Since we are looking at the strong possibility that she has minimal worms after needing the heated testing done to get a + result after 4 neg. in-house tests. The rescue I adopted her from suggested to just do the slow kill and stated that is all they have done with their personal dogs and rescues and all their dogs in their program are doing excellent many years later. I have done the Immiticide with my other adopted dog and it was a bit scary as she was so hyper. Now this most recent dog is 1,000x's more hyper & we are concerned about trying to keep her calm. She is young and healthy, and very active. Our oldest dog we adopted at 2 yo and she was slow kill treated by the shelter, she tested neg. after 14 months, and is now almost 14 yo & shows no signs of her age. My vet is suggesting either, that it was our choice but warned of the damage the worms are doing the entire time. We are so confused and just want to get all the information we can. Thanks you for all your help.

Doc

Hello, Michelle,
My personal philosophy is to get them killed with the Immiticide so that I'm not waiting for a reaction to worm death for 3 years. If I know when they are dying, I can monitor the dog, and I can medicate with prednisone to minimize inflammation. Then I'm done with it.

Nikkie Hartmann

Hi there, I just came across your blog and hope you're still monitoring this thread!

Before I adopted him, my dog was treated for heartworm on 4/24 and 4/25 - Ivermectin and Immiticide treatment (1.4 ml IM on 4/24/17) and repeat dose of Immiticide (1.4 ml IM on 4/25). He started monthly heartworm preventative after and has had two doses since. His new vet tested him for adult and microfilariae on 6/11 and both came back positive. He had a follow-up echocardiogram because of a heart murmur showing worms still present in the heart. The vet recommended retreating ASAP. Does this seem appropriate to do just two months after initial treatment? I worry the treatment has not had time to completely kill off all the worms, and his body may still be breaking down those that died. I don't want to overload his system and am inclined to wait the additional 4 months and retest at 6 months as the guidelines recommend. Thanks!

Doc

Hello, Nikkie,

Sorry to be late replying. I always feel that the best doctor to advise you is the one seeing your dog.

Having said that, if you keep the dog on monthly preventive medication, he shouldn't get any additional worm burden while you are waiting to try the re-test in four months.

However, if the worms are interfering with heart function, you might be making a mistake to wait that long.

You might talk with your veterinarian about monitoring him for a few more weeks and repeating the echo.

Anne

Dr,

I'd appreciate your perspective on an alternative approach to treating heartworm in a young otherwise healthy dog.

Aside from cost -- why not remove the adult worms via some sort of cardiac catheterization procedure -- entering through the jugular I presume -- and then use the adulticide on the remaining worms that cannot be fished out. It seems that there would be less risk of worms migrating to bad places if you got the bulk of the worms out before killing them with adulticide.

If this approach is at all feasible, I would want to take my dog (4 yo 50 lb lab/pitbull mix) to a center that does a lot of these procedures so that they had the skill/experience that comes with lots of cases.

Could you suggest such a center? I assume they would be more in the south since there is a greater prevalence of heartworm in the south.

Thank you in advance for your opinion!


Doc

Hello, Anne,
Sorry to be so late replying, but I have been out of town.

What you suggest sounds great, but is not feasible. The worms don't really get into the right side of the heart much until the pulmonary (lung arteries are filled with them, all their branches).

When heartworm retrieval forceps are used as a salvage procedure, they are used primarily to remove worms from the vena cava outside the heart (accessed via the jugular vein), and perhaps into the right atrium. Heartworms are not usually located here, but when they are, the dog gets dramatically ill very quickly with "post caval syndrome". Sometimes you can remove enough worms to get them out of this crisis and then the dog still must undergo the regular treatment procedure to remove the bulk of the worms that are inaccessible to the forceps.

To get into the pulmonary arteries, you would have to maneuver all the way through the heart making numerous turns and trips back and forth. This would be impossible without using dye and a fluoroscope, and would take hours if you did have such equipment.

The procedure you suggest sounds good, but just cannot be done with today's technology.

Alex Christianson

Hi-
I help run a canine rescue and have a question regarding one of our rescues. He was diagnosed with HW in March- received doxi for a month then was given 1 shot on April 26 and then another shot April 28th down south. He arrived up North and we had him retested in June and he was still positive for HW and they want to start the treatment all over again- 1 shot then 30 days later 2nd and next day 3rd. We are concerned about doing another round so close to the last partial round- is that ok to do? Also, isn’t it normal to have a HW+ test 1 month after treatment- isn’t 6months a better indication. Any clarification would be wonderful.
Thank you

Doc

Hello, Alex,

Generally speaking, the protocol is to start on Heartgrad, give 4 weeks of doxycycline,rest four weeks, give one injection of Melarsomine (Immiticide, Diroban), wait one month (during which I give prednisone for inflammation in the arteries as the worms break up and move), then give two injections of melarsomine, 24 hours apart.

Giving the two injections closer than 24 hours is considered to be more toxic, and more than 24 hours apart is considered to be less effective.

Even if all the worms are dead, the adult heartworm protein can persist in circulation for four months.

I would continue on preventive, retest in September. If he is still positive, I would just do the two injections 24 hours apart, not a full 3-shot series.

Marian Burgess

Hello, I live in the UK and have recently adopted and re homed a Romanian rescue dog who has heartworm. In the UK we don't have heartworm so vets know very little about it. My vet is treating my dog but this is her first time of treating any dog with this condition. Would you be happy to confirm that we are going in the right direction for treatment as it doesn't appear to be along your suggestions and recommendation

Doc

Hello, Marian,

While I could compare the treatment being prescribed with what we consider to be standard in the USA, I cannot really speak to the specific treatment of a dog that I have never examined.

I would be happy to help in any way that I can.

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