[losul]

I just discovered Tuesday evening that our dog Turbo has heartworm infection. It came as a huge shock, as i thought I was being meticulous with his care and his diet. Almost as bad, I am probably to blame for it, and I am sickened and upset by this. I was using
Heartguard+ chewables. I was trying to minimize his toxin exposure, so I didn’t give year round, just for the approximately 7 months mosquito season, and every 35 days instead of 30. Also, because Turbo is 34 pounds and I had the box for 26-50lbs, I was only giving him 2/3 of the chew. Lastly I was keeping the HG in the refrigerator, and now I found out that HG isn’t supposed to be refrigerated and they can’t guarantee the efficacy when refrigerated. I just called them and reported the case to them, telling them all the truth about the situation.

I don’t want to write our life story, sorry about the lengthy post, I’m just trying to get all the info out, so I can hopefully get some good advice to help me make the best decisions. Turbo is approximately 32 months old, 34 pounds, a boston terrier mix, we think maybe mixed with staffordshire or pit, but almost certainly mixed with some kind of bully type. We adopted him from our County’s Animal control about 1.5 years ago. He spent somewhere around 1/2 of the first 14 months of his life in 2 different sessions at the County shelter, and evidently 1 session at a City shelter. It was the first dog we have had in about 7 years, after having had many previously, for most of my life. We were out of the loop on most things dog, so I got very studied up on it, wanting to do things as right as possible, before we even started looking for another dog. I knew the type ( boston terrier or mix) I wanted and knew that I would put him on a raw diet before we even got him, and so be it, within 3 or 4 weeks we had him on about a 60% raw, 40% commercial diet, with no problems ever, except some gas for awhile.

Turbo is very handsome, charming, and playful, but can be rude, stubborn, very assertive, sometimes defiant. We love him the way he is, he’s always been a joy, and no real problems at all, except some assertion/agression (not fearful aggression) towards certain dogs, usually only the largest dogs or bully types. He’s completely different (quirks) than any other dog we’ve ever had, but for us, he’s really a perfect fit, and is always well behaved in the house.

We’ve been in search of a great dog Vet since we got Turbo. Tuesday’s visit was the 4th different vet. I had set up an appointment ahead of time for his upcoming rabies shot, and to test the waters with a new (and hopefully permanent) vet. In the meantime Turbo had a really strange and scary issue that happened Saturday evening and lasting into Sunday. An hour or so after he had his Saturday evening meal, and totally not typical, he began “hiding” in a corner of the house, or he would go to either the basement door or the back door. We take him through the basement into the garage when we go in the car. He goes out the back door into our yard. He also started very visibly trembling, looking very sheepish, and scared. He would not take a treat at all, so totally untypical of him. Once outside, he did not want to come back in at all, wanting to lay on a chair on the deck instead, even though it was quite cold and he doesn’t like cold for long. We’d make him come back in only to do the same again. Sitting in the corner at the end of the hall or at the basement door or the back door. He acted like he just wanted to be out of the house and maybe even away from us, seemed afraid of me for no reason, and the trembling hard, very scary. So not typical, Turbo has NEVER been fearful of anything that I know of, but he just did NOT want to be in the house at all. I eventually took him for a short car ride, and he seemed to have perked up some. So we got back into the house just a little bit reluctantly. He then took a treat fairly eagerly, but after taking a second one, he suddenly just dropped it and ran away to the corner again. The trembling and strange behavior again too. We nearly took him to the emergency clinic. It later subsided though, and eventually he went to bed right beside me, where I watched him the rest of the night. He seemed to sleep well. Next day, just a little more of the same scary stuff, and then he ate his typical raw morning meal. Soon after eating he started acting better throughout the day (Sunday). He never vomited nor had diarrhea nor showed any obvious pain through the whole ordeal.

Baffled, I spent most of Sunday researching the trembling symptoms. Nothing seemed really to fit at all, but I was concerned about problems like kidney/liver. I contemplated all sorts of things such as Lyme or tickborne illness ( he had a tick on his ear that I didn’t catch right away, it was November and we had already had several hard freezes. The tick left a pea sized nodule that lasted about two months. Friday evening he chewed on a cow hoove awhile until I took it away from him, because he had broken off a rather large sharp shard. Saturday morning he had his typical raw meal, but his evening meal was not quite as typical. Usually he gets 2/3 cup kibble matched with 1/3 of a can food, or 3/4 cup kibble and an egg, or sardines. This time I gave him less than 1/2 cup kibble + about 4 ounces of canned salmon + 1 egg cooked in coco oil, and i added about 1/2 t of nutritional yeast. i think I’ve added a very small amount of yeast to his raw mix before, but not completely sure. So thoughts of a bad reaction to the yeast also came into play, along with thoughts of too much fat at once. Even the thought of a ghost in the house came up.

Monday morning I called the vets office an\d told them I thought we needed to put the rabies shot on hold, and instead get him checked and do some blood work to get to the bottom of this. Tues evening: I explained everything to the techs and the vet as best I could, even that I home prepped over 1/2 of his diet. He asked me what I was feeding him and I told him him briefly, just didn’t come out and say”raw”, but I think he knew it. He didn’t ask if raw and seemed satisfied with what I was feeding and supplementing. This
vet spent alot of time with us, well over an hour, didn’t admonish for anything, wasn’t arrogant in the least, didn’t “push” anything , and so far I think I like him O.K. He examined Turbo and was pleased with his apparent health. So he didn’t push any lab work at all. I still elected to go with an outside lab wellness blood work, along with an in house tick borne illness and heartworm check.

I was floored when they came back and said he was both pos on the antigen and microfiliae HW tests. He was negative on the tickborne. He explained the clinic’s HW protocol; 1) monthly HW preventative for 2 months prior to treatment, and continuing throughout treatment and beyond. 2)Doxycycline. for 2 weeks prior to treatment.3) first immiticide treatment (injection); dexamethasone injection, tramadol injection. Hospital overnight, strict confinement until returning for next treatment.4) doxycycline again for 2 weeks prior to immiticide treatment. 5) 2nd immiticide treatment. ( 2 injections 24 hours apart), dexamethasone and tramadol injections given daily with each treatment. Hospitalized for 3 days and 2 nights. strict confinement at home 30 days 6) Heartworm check 6 months afdter last immiticide injection to confirm elimination of heartworms.

He also explained the clinic’s preferred HW preventative – Advantage multi – a topical application, (imidacloprid for fleas which Turbo does not have + moxidectin, the HW preventative, which is supposedly absorbed through the skin). I didn’t even realize they had a topical for HW. I told him I would rather not use an insecticide for fleas that he didn’t need. He said alternatives (such as heartguard) could be used but may not be as effective, in his opinion. I then mentioned that I recalled hearing about a “slow kill” method. He seemed a little stunned, and said that that method was actually more dangerous, wasn’t as reliable and it could take much longer if it even worked. I again expressed my concern about all the toxins, especially the arsenic/immiticide.

He didn’t think the trembling episode was HW related at all, although he didn’t offer any real explanation for it. Also he thought it would be fine for him to go ahead and get the rabies vaccination, or I could wait for the outside lab’s bloodwork results in a day or 2. I told him we would definitely wait.
—–

Here’s where I need advice;

Do you think I should get another HW test from another vet along with a second opinion?

Should I consider a slow kill method vs the clinic’s protocol?

Should I use heartguard or another ivermection based HWP vs the advantage multi, moxidectin based? Is their any other moxidectin based without other insecticides included? Is there another one more effective than the others? Are there any other HWP’s using some different drug altogether?

Should I continue to put on hold the rabies vaccination? if I put off more than a few more days, then he will be past due again, will probably only be able to get the 1 yr vs the 3 yr, and would have to be re-vaccinated again in a year.

Does anyone have anyone input about what could cause the trembling episode?

Any other opinions/advice?

———–

Update: The vet called with the bloodwork results. Everything looked “perfectly normal” he especially stressed the liver and kidney values, the blood cell and platelet counts and values, thyroid, and some other things I don’t recall now, I don’t have a copy yet. What a big relief on that much. I had some more questions to ask, such as should he have X-rays, ultrasound, etc. He could, but didn’t think neccesary nor did he advise it. I asked about the microfilariae count, he said a fair amount? Somewhere I had read about the 3 classes of HW infections. I asked what “class” his condition would be, he replied definitely class 1, which I saw described somewhere (going by memory)as asymptomatic to mild, no radiologic signs, nor signs of anemia. He still encouraged going ahead with the rabies vacination, and strongly urged getting started on the advantage multi soon. But he seemed much more amenable now to a slow kill method, maybe along with doxycycline, before I even asked again, even seemed to kind of go along with it, though he still didn’t recomend it, he still recomended their protocol. He also expressed concern that these worms may be resistant to ivermectin, and it could take a very long time to kill them using it. So he again really encouraged using their Advantage multi. I guess this multi is a new thing.

——-

Any advice/opinions would be very much appreciated, as I’m feeling lost and very worried over this. I think my questions still remain the same after getting the blood work results.

[pugmomsandy]

I can tell you my fosters get back to back immiticide injections, maybe 2 days at the vet and then to me for 30 days of crate rest.

[losul]

Thnx Sandy, they get just the 1 (double) immiticide treatment? Are those fosters symptomatic, coughing, underweight, tire easily or anything like that? and do they take doxycycline and preventatives before/after also?

[losul]

I just found this about advantage multi. So maybe it is a good/safer product? Also compares some of the others.

“Advantage Multi

Moxidectin is a remarkable substance that is both safe and effective as a heartworm prevention. Advantage Multi is a topical solution for application to the pet’s skin once a month.

It is the only heartworm prevention that may be given to heartworm positive dogs.
It is the only heartworm prevention that is effective against all strains of heartworms identified.
It is the only heartworm preventative that kills early L5 or young adult heartworms.
Advantage Multi is a combined product of Moxidectin which prevents heartworms and controls intestinal worms (hookworms, roundworms and whipworms) combined with imidacloprid which kills adult fleas. I recommend Advantage Multi as the best Heartworm Prevention Available today. It has a broader range of effectiveness against the life stages of heartworms and is also effective against more species of intestinal parasites as well. It is safer than other products in the same category and can be given to puppies at 7 weeks of age and to heartworm positive animals. There is a new concern that heartworms are developing resistance to heartworm preventions. See this article that compares Advantage Multi to all the other common heartworm preventions.”

Heartworm Prevention Dogs

Also found info on heartworms, treatments, etc. here;

http://www.heartwormsociety.org/pdf/2014-AHS-Canine-Guidelines.pdf

[losul]

Now I’m really confused. I thought the slow kill method was done without using immiticide at all, just the ivermectin or? and doxycycline. According to this site, it seems the slow kill method is what my vet was originally reccomending and still is, the 1 immiticide treatment followed one month later by a double (2 day) immiticide treatment, and includes alll the other drugs also? I guess what Sandy describes (1 two day treatment) is a faster kill method then?

http://heartwormtreatment-fordogs.com/slow-kill-heartworm-treatment-for-dogs/

I think it was Dave’s Hounds who awhile back was using some other kind of slow kill method on his rescue dog?

But now I find this describing a slow kill method as what I had thought it was ivermectin, or ivermectin + doxycycline to sterilize the female worms. This site doesn’t recommend that at all, the same as my vet really doesn’t.

http://vetmedicine.about.com/od/diseasesandconditions/a/CW-HeartwormSlowKillversusImmiticide.htm

[aimee]

Hi losul,

First I’m so sorry for what you and your dog are going through. I myself have nightmares that I get that dreaded call in which I’m told my dog has heartworms. I know that giving less of the pill and less frequently than recommended is likely playing heavily on your mind. In actuality we don’t know what role that played as sometimes dogs on full prevention protocols come up positive too.

I’m sure this is scarey. I’ll try an answer your questions to the best of my ability.

Do you need a second opinion? If you want to look further, have a different type of test done vs a different vet who may be using the same brand test. There can be false positives on a heartworm test, but they are rare.

The fact that they saw microfilaria kinda clinches the diagnosis. There are other microfilaria that can be seen in blood, Dipetalonema comes to mind and a parasitologist can likely identify them for you. The sample may need to be sent to a university vet school. But really the chance you have both a false positive and a different type of microfilaria seems unlikely …I think you would be grasping at straws …

Should you consider slow kill? I’ll give you my opinion for what it is worth, I wouldn’t. I can’t put my hand on it at this moment. Will look for it if you want but as I remember in dogs treated with slow kill considerable ongoing lung damage occurred UNLESS the dogs were on complete exercise restriction for the entire duration. Your dog is young, I’m guessing active, and would be difficult to keep continually crated for nearly a year plus(?) of his life. There also is some speculation that slow kill may be contributing to resistance. Unless your dog is clear of microfilaria during a slow kill treatment ( meaning your dog has microfilaria because of your dosing and not strain) your dog will be infecting others with a resistant strain and spreading resistance.

Should you use moxidectin? So far as I know of only one study that compared efficacy head to head and moxidectin was more effective when given as a single dose. Time will tell if that holds: one study one strain. The moxidectin treated dogs didn’t develop heartworm with only one dose post exposure whereas dogs given 1 dose ivermectin or milbemycin did develop worms. Dogs given 3 monthly doses of milbemycin post exposure were also clear. As I recall this test was done with a strain thought to have resistance.

Moxidectin is also the drug in Pro Heart injections. Is a continuous yet decreasing amount of moxidectin as effective as monthly peak doses? I don’t have any answers for you, I think though it has failed whereas the monthly topical has not due to higher blood concentrations with monthly pulse doses.

I’ve noted on Trifexis (milbemycin) commercials it states to give for 3 months post exposure whereas Sentinal Spectum (milbemycin) has upped that to 6 monthly doses post exposure. For now my dogs get milbemycin, same day each month year round. If I lived in heartworm land… southern states where resistance is being seen I’d choose moxidectin. Likely if my vet was saying moxidectin topical I’d go with it trusting that he/she understands the local strains. I don’t mess around with heartworm prevention.

The preventatives I can think of are ivermectin ( heartgard and others), selamectin( Revolution) milbemycin( sentinal, trifexis,) moxidectin( advantage multi, proheart) diethylcarbamazine (daily still available???)

Should you vaccinate? This is beyond my ability to answer. I think your vet is the best person to answer this one.

Trembling/ fearful…. two things come to mind: pain and fear unrelated to pain. Fears can be to unusual scents, sounds (electrical equipment, ultrasonic, rodents etc ) Pain… any lip licking swallowing drooling that might help you pinpoint it?
.
Again I’m so sorry you are going through this…your vet is the best one to help you through this. The American Heartworm Society guidelines are written as they are for a reason…. If it was me I’d make use of them: 3 injections and doxy. Best of luck

[losul]

Just want to add, the money and effort to keep him restricted is not really a consideration, I just want to do what is best for Turbo.

The more I read, the more see that my vet’s original recomended protocol may be the best for him at this point?

Is the immiticide treatment in itself very damaging as a poison?

What a horrible situation.

Edit: Aimee, I posted the above before I saw you reply, I was really hoping you would be one to reply, THNX. I’m going to read it now

• This reply was modified 10 years, 10 months ago by losul.

[aimee]

Hi again… While I was answering the first set of questions I see you found more: )

The “slow kill” typically refers to not using immiticide and using preventative (ivermectin) with doxy and dosed more frequently

Initially immiticde was recommended as a 2 injection series for dogs without heavy worm burdens and 3 injections for dogs with heavy burdens. It is now recommended that all dogs undergo 3 injections; safer and more effective. It is a staged kill, not as many dead worms hit the lungs at the same time. Shelters typically don’t do this. They opt for 2 because of cost and time constraints. It is “faster” in the sense that it is a one month instead of 2 month treatment but it is riskier.

[losul]

Aimee. Thnx so much for your replies in detail.

What i am reading this morning is confirming much of what you are telling me.

The vet wants him on the Advantage multi for 2 months first before the 1st immiticide treatment. I already have a tube, just not applied yet. I’m going to call him with a few more questions this morning.

The trembling thing, I can not imagine at all, what he would have been fearful of, even though at the time he even acted fearful of me. He’s just not a fearful dog. Very bold if anything. He didn’t do lip licking, swallowing or drooling. It just totally baffles me.

Thnx again Aimee.

• This reply was modified 10 years, 10 months ago by losul. Reason: changed reply to replies

[aimee]

I respect immiticide.. I can’t lie the drug scares me a bit. It is painful and is injected deep into the back muscles. When injected into legs it causes lameness. Rarely it has caused sterile abscesses and if it leaks and migrates and gets to the spinal cord very very rare cases of paralysis have been reported. I’ve heard of dogs having “allergic” ie anaphylactic reactions again very rare. As far as organ toxicity …it is a lot safer than what used to be used. Still knowing all that it is what I’d choose for my own dog if ever faced with a heartworm positive dog.

P.S. Means a lot to me that you hoped I would be one of the ones to reply.

[Cyndi]

I don’t have any advice to offer, I’ll leave that to the experienced people on here. I just wanted to say I will keep you and Turbo in my thoughts and prayers and pray for a speedy recovery. I am so sorry you & Turbo have to go thru this. 🙁

[weezerweeks]

I have been through the heartworm treatment with my yorkie so I know what ur going through. The second injection Bailey had made him paralyzed in his back but my vet gave him some kind of narcotic and he was okay. The hardest part for me was the confinement for 30 days. Every time we went out had to put him on leash where he couldn’t exert much energy but we made it and u will too. I will be thinking about and praying for u and Turbo!

[losul]

Cyndi, it’s not matter that no advice offered, what you have offered is very helpful and means alot to me thnx. Weezer, it helps much to have support from someone who has been there, and your prayers also means very much to me. Thnx

[Dori]

I also don’t have any advice, I’ve never gone through anything like what you’re going through. I just wanted to say that I read your post late last night and have not been able to get you and Turbo and your situation out of my mind. If you don’t mind, I said a prayer for you both last night and will continue to do so. I’ve been following your posts for quite a while and also your advice. The issue of heart worm prevention (should we, shouldn’t we) has always been a tough one some of us do, some don’t, some try to go by the weather which in the last few years is impossible to guess. Do we give it all year long all just when the weather brings mosquitos? We all do our very best to take care of our dogs which is what you were and are doing. Best of luck to you and Turbo. I’m hoping Shawna will come on line and give you her thoughts. PLEASE keep us updated as our hearts go out to you. Dori

[losul]

Dori, i would never mind anyone’s prayers and thoughts. I very much welcome them. Thank you very much.

Turbo is inside over 90% of the time, but is free to go out whenever he wants. I have about 2 acres of our property covered with a radio/underground fence. Ordinarily mosquito’s are a really big problem right here in my localized area, and property. the last two warm seasons and summers though we had extreme drought, except in the Spring of last year, and mosquitos were not even all that noticeable the last couple of years, compared to years past The back of the adjoining property to us, was evidently used to keep livestock or horses at some time in the past, but since we’ve been here, the area is completely overgrown with woods and brush. There are large areas of low lying shallow pools, ponds, wallowing ponds or whatever back there, where water sits and stagnates during a wet season. Really it’s a big swampy area during rains or a wet season. In years past, as soon as dusk or even before dusk would start, we couldn’t even stand to be working in our garden. I’ve always wanted to do something about it, but the property owner was very much a recluse, and enstranged to us. She has since passed away several months ago, and nit certain who owns the property now (relatives). We couldn’t use any kind of mosquito dunks in it, because of close vicinity to the creek at the back of property and the creek often overflows into that area. I’m going to have to look into getting a backhoe, and either cut a drainage trench from the pools to the creek or try to fill in the areas with dirt.

I too am VERY much hoping for Shawna’s input soon. I will keep updated when I can. Thnx Dori.

• This reply was modified 10 years, 9 months ago by losul.

[Dori]

With everything you’ve got going I think it is truly very kind of you to take a moment and respond to my post. When I woke this morning the first thing on my mind was you and Turbo and I immediately gave all three of my dogs Sentinel. It seems like you may have an impossible situation on your hands with the neighbors property and the mosquitos. Though I live now in Georgia (Atlanta) and the winter was so cold I didn’t give the dogs any Sentinel all winter, in lieu of what’s happened to Turbo I will be keeping my girls on Sentinel year round. It’s always so darn difficult trying to figure out what’s too toxic and do the benefits over ride the toxins. I’ll be keeping you in my prayers and keeping an eye on your posts.

[Dori]

I think someone mentioned at some point that Shawna doesn’t usually post on the forums. Have you tried sending her a post on the general site? If not, please do. She like some of the others had an encyclopedic brain. She’s amazing and I hope she’s got some info to keep some of your fears at bay though it sounds as though you’ve already gotten some good advice with some of the posts above. Also a lot of warm heartfelt prayers going your way from the community here.

[pugmomsandy]

The pugs get one immiticide shot on one day and another on the following day. Then they spend maybe 2 days more at the vet. None have been lame. A few have a “welp/welt?” but sometimes the non heartworm ones get that from the other vaccinations they got. The pugs I’ve had post heartworm treatment have been fat to almost emaciated, young and old, post URI or other ailment and they all received a full round of vacc’s as well. Half will be symptomatic afterwards – they have a cough/gag and that’s all for a few days to maybe 2 weeks. I’ve only had 4 out of 228 pugs die from probable pulmonary embolism. One was necropsied and he had a very bad case of worms. He was full of 12-18 inch worms, so he was severe. Some of the vets that do half-way slow-kill give doxy for a month prior to immiticide and then another month of doxy and then the second immiticide and that’s it. The rescue won’t do the non-immiticide slow kill. Takes too long and people are afraid to adopt a dog with heartworm.

[InkedMarie]

I have no answers but just want to say I’m thinking of you.

[losul]

Dori, I saw that Cyndi was very kind to post a message/request to Shawna on the off topic message board on my behalf. Shawna is indeed amazing. Thnx Cyndi, and thnx again Dori.

Sandy thank you so much for the feedback, very helpful. 228 pugs wow, that’s such an amazing and honorable feat to rescue/foster that many dogs. Right now I am leaning towards the entire protocol with the immiticide, and the advantage multi immediately, doxy, etc. as my vet first desribed. The immiticide would happen beginning 2 months from now. I want these damned things out of him ASAP, but as safely and reliably as possible also. I am now awaiting a return call from him.

InkedMarie, thank you very much for your thoughts also, it means alot to me.

[Shawna]

Hi Losul,

SOOOO sorry to hear about Turbo’s issues :(…

Here is what Dr. Becker says about heartworm treatment (and no, what your vet recommended is not the slow kill method).
“As it turns out, low-dose ivermectin therapy in dogs with no sensitivity to the drug, in combination with the antibiotic doxycycline, can be an extremely effective, inexpensive option for treating heartworm infection.

The cost was about 50-75 percent cheaper than Immiticide and all four cases of infection cleared beautifully.

The only time I’ll consider using Immiticide in the future (once it becomes available), is when I have an ivermectin-sensitive patient.” http://healthypets.mercola.com/sites/healthypets/archive/2011/11/22/cheaper-safer-therapy-for-heartworm.aspx

Dave’s Hounds has been using the slow kill treatment with his older, adopted Hound Dog and things, last reported, seem to be going well. Might be worth talking with him!!!!

Mary Straus at Dog Aware website has some fantastic information on heartworm and the slow kill method. Doxy basically makes the worms sterile which prevents the existing ones from reproducing. Since your vet says stage 1 there assumably aren’t an overload of them. Steralizing the ones that are there would be a good idea. Doxy also makes it so Turbo can’t infect any other dogs. Doxy also kills the bacteria that hitches a ride w/ the heartworm. It is thought that the bacteria, called wolbachia, die off is what causes a lot of the dangers with the fast kill method. As well as clogging due to mass die off of the worms. You can pulse the doxy and ivermectin for a few months and then do the immiticide or you can stay on the doxy/ivermectin long term from my understanding.

“These studies clearly indicate that treatment with a combination of weekly ivermectin and daily doxycycline given intermittently will sterilize the heartworms, prevent the dog from being infectious to other dogs, speed up the death of the worms prior to (or in place of) Immiticide treatment, limit inflammation and damage caused by the worms’ presence, and reduce the chance of serious adverse reaction from Immiticide treatment.” http://dogaware.com/articles/newsheartworm.html

And more on dogaware http://dogaware.com/articles/wdjheartwormtreatment.html

He’s young and strong enough that he could probably handle the immiticide but if the slow kill is just as effective without as many complications…….. At the very least, do a round of doxy and ivermectin BEFORE the immiticide.

I can not believe the vet would recommend a rabies shot knowing that Turbo has heartworm AND wanting to do the immiticide treatment??? That’s just asking for trouble in my opinion. Just my opinion though….

I did not know that heartguard should not be refrigerated? Thanks for mentioning that in your post!

I would also consider giving, or continuing, supportive care such as giving high quality probiotics, anti-inflammatories etc. I would also suggest looking into a product called Canine Cardiac Support by Standard Process. Here’s a brief primer on it but more can be found (or even call the company) http://www.animalrehabstlouis.com/wp-content/uploads/2012/10/cardiac_support.pdf

I have no suggestions or ideas for the trembling… 🙁

I personally would get a second opinion before starting heartworm treatment be it slow or fast kill. I would simply need that piece of mind. I wouldn’t tell the new clinic that he had already been found positive either..

[losul]

Shawna, thnx so much for your info and reply. I just now saw it and will definitely read the links ASAP.

All I can say right now is the vet seems to really be against using ivermectin at all as he thinks they may well have ivermectin resistance, even if I try a true slow kill method. He said it could actually take years with the ivermectin, if it ever even would completely killed them, and the the meantime, damage could occur or continue to occur. I think, but not sure, he was talking about using moxidectin with doxycycline and without immiticide as a slow kill method over the phone and he seemed kind of amenable to, although he still would not really reccomend ithat, it was the full protocol he was reccomending. Did you see what that was in my initial post? He also told me several serious disadvantages to attempting this slow kill that are really worrisome. I have been seeing all kinds of resistance stories now, and even some vets calling the ivermectin slow kill “no kill”.

Geez. I wish I could get my mind together, and type faster also. It took me virtually all day yesterday to write my initial post.

I was really leaning towards another vet’s opinion , and I should have already done it, but this point, it’s late Friday and I’m afraid to continue anymore postponement, i feel very pressed, exhausted, and I’m about to go nuts.

I didn’t think the rabies shot was at all a good idea right now either, and it kind of really bothers me that he is still encouraging going ahead with it.

I don’t think the Heartguard box says anything about temperature on it, I can’t find anything, but on the back at the top right of the foil package it says store at 68 degrees to 77F, excursions between 59 and 86 degress fahrenheit are permitted. I didn’t realize that until the other day, and never even thought about it before the other day. The vet didn’t even know. I don’t have my glasses on me, and hard to read, but I’m pretty sure that is the ranges. When I called Merial, they simply would say that they can’t guarantee efficacy when refrigerated. Maybe they don’t test it for efficacy when kept at lower temps, I don’t know.

I’m still awaiting a call back from the vet, I suspect he won’t call call back until the EOD. I’m going to have to try back again soon.

Thnx again so much Shawna, I’m going to read now your links.

[Shawna]

I just posted this to HDM on the regular site but thought you might not see it..

“The doxy makes the worms sterile so resistance shouldn’t be an issue with any worms picked up from the doxy treated dog. One of the benefits of giving doxy is that it makes the dog no longer infective to other dogs.

From heartwormsociety.org “Microfilariae from dogs treated with doxycycline that were ingested by mosquitoes developed into third-stage larvae that appeared to be normal in appearance and motility, but these larvae were not able to develop into adult worms, thus reducing the risk of selecting for resistant sub-populations.” http://www.heartwormsociety.or…

I see advantages to the fast kill as well as slow kill methods. I personally would use the slow kill with SP Canine Cardiac Support and herbs mentioned in Dr. Goldsteins book for heartworm treatment plus. But I understand Losul’s desire to get the worms out as soon as possible too… And Turbo seems to be a good candidate for the fast kill method when doxy and heatguard (or another form) are used first to lessen the risks of immiticide treatment.

I’d give raw eggs to keep glutathione levels up. Cardiac support by giving an organ supplement or giving organic heart. I like Standard Process because it has anti-inflammatory factors that work specific to the organ being used for as well as “food” for the specific organ. Anti-inflamatories like turmeric. I personally would give small amounts of garlic and use probiotics regularly. etc etc etc Chlorella is an excellent detoxer.

Edit — been a HORRIBLY busy at work last few days.. I’ve missed much of what has been discussed :(..”

Another thing to consider is that although nobody wants to get that diagnosis, it is really not as bad as some try to make it. You caught it early. Even before symptoms appeared. He has every chance of doing well no matter which way you go. After re-reading your post I do see where your vet is recommending doxy and heartworm before the immiticide. That makes me feel more comfortable with his recommendation!!! 🙂

Here’s a link that may not provide new info but hopefully will take a little of the scare out of the diagnosis.. This is naturopathic vet Dr. Jeannie Thomason’s site http://www.thewholedog.org/heartworm.html

PS — I found several folks that had dogs with a minor infection like Turbo’s. One said her dog was free of heartworm nine months after starting the slow kill method. Some of the results you are hearing from could be from immune compromised dogs as well. Turbo is way ahead of the pack in that regards. That is also why I would be less freaked about the fast kill method for him!!! You’re a good puppy parent and Turbo has every chance of having no complications because of it.

I’ve always read to use ivermectin when doing slow kill. I’d do more research before choosing slow kill and anything but ivermectin. A quick google search says this about moxidectin “Ivermectin is the medication most commonly used to kill the microfilaria (larval stage.) There are other medications that will kill them (such as milbemycin) but ivermectin kills more slowly. When too many microfilaria die at once, it can cause shock and collapse for the dog. Thus, ivermectin is preferred because of the slower kill rate. Other products like selamectin and moxidectin do not kill the microfilaria efficiently enough to clear them reliably. Fortunately, ivermectin is available in several monthly heartworm preventive medications. Examples are Heartgard ®, Tri-Heart® and others.” http://vetmedicine.about.com/od/diseasesandconditions/a/CW-HeartwormTreatments.htm

Of course, one comment on vetmedicine site is not enough to base something like this on but do research more before deciding. I’ll try to check it out too.

Did you ask him his reasoning for recommending the rabies vacc at this time? Is it that he is not aware of the problems, disagrees that problems could arise, thinks they are overstated or what? Does your state allow exemptions? Why not put it off?

Here’s data from several people that have actually USED the slow kill method and cleared heartworm. And likely these are dogs that are nowhere near as healthy as Turbo however I don’t know that. Just a guess. http://www.chronofhorse.com/forum/showthread.php?365271-Slow-Kill-Heartworm-treatment

It’s also the method that most rescue use around here. And again I would try to get Dave’s Hounds input. BUT, when it really comes down to it you will do what you think is best for Turbo and EVERYONE here that is truly your friend will support your decision because we all know that you are the one that has to live with that decision not us… We all will support you no matter what your choice. And as stated before, I think Turbo is a good candidate for the immiticide option as he is young, healthy and has the right person in his corner!!!!!!

• This reply was modified 10 years, 9 months ago by Shawna.

[Melissaandcrew]

Hi losul-

So sorry to hear that you and Turbo are going through this-Take two deep breaths and breathe…While you want to make a decision sooner than later, nothing is going to change in the next few days, so consider all your options : )

Its been years since we have had to treat a heartworm positive dog in our rescue, but we have used the Immitricide protocol since it was first released as an option. For us, we have never had any type of reactions or losses.

I prefer the Immitricide as while it has its risks, I want those suckers gone before they can continue to burrow and cause more damage. The only time I would consider slow kill(for me) is if the dog was old, compromised or otherwise ill-and then I would consider it.

Whatever you decide, be certain and take some time to think it through so that you are comfortable and not second guessing yourself.

We are all here for you and will keep both of you in our thoughts and prayers .

Melissa

[theBCnut]

Hi Losul

I just want to point out that since you have only had Turbo for 1.5 years, he could have already had the heartworm infection, but it wasn’t far enough along to be detected before you got him.

I hope everything goes smoothly for Turbo. I don’t know what I would do in your shoes myself. Sorry you are having to go through this.

[losul]

Shawna, I assure you I am going to go over all the information you and all the others have graciously provided, and take everything into consideration. It’s been hectic and I’m an airhead, exhausted yet so wired with all the coffee and tea. So bear with me, if I can’t get back right away. I have some posts to get to on the off topic board also

I will say this much for now, I had another lengthy phone conversation with the vet and he has set my mind at ease on a number of points. Don’t worry about the rabies vaccine fore now, we have some weeks grace, if I’m still concerned he will help me in seeking an exemption.

He still will not advise the ivermectin as a slow kill at all, nada. He is however quite agreeable to trying an advantage multi/doxycycline slower kill without immiticide. The drug companies won’t and don’t exactly tell them this, nor are their actual studies showing this, (should I be repeating this?), but in his own experience and anecdotal evidence from others are that in general, the worms are cleared within 9 to 12 months in this way is what he told me. It takes longer than with the immiticide and is absolutely not without it’s own risks either though. He would not remain infective to others, nor would he be able to be re-infected. Because they have to give the advantage plus at least 2 months prior to immiticide treatment anyway, I would have that much time to decide whether to go through with the immiticide, except that they usually then give the doxy under a different schedule. They said the worst reaction they have personally expierenced to the immiticide is a welt. He told me they have on average about 2 or so HW cases/month. He is pressing for the the Advantage multi, but I don’t think it is just because his clinic sells it, I think he believes in it. He also said I could later change it to something else if need be. It’s not really priced horrible – 6 for $99.99 plus 3 “free.” I already have a “complimentary” tube.

He gave me the name of a supposedly renowned expert in field who is very much a proponent of advantage multi, and I think he said he wrote some papers on it for The American Heartworm Sociey. Dr Byron Blagburn. I haven’t had time to look for anything about this yet, just some general info;

http://www.vetmed.auburn.edu/faculty/pathobiology-faculty/blagburn#.UxEimfldXeU

He also said I could wait until Monday to start the Advant if I was concerned about some possible kind of reaction while their clinic was closed. He said the only reaction they have persomnally seen is some itching after application at the site, that quickly subsides in about 10 or so minutes.

He was not opposed to taking X-rays, and thought if not neccesary it could still be a good ideal, it was just that most people don’t and want to keep expenses to a minimum. They have a professional radiologist look at them, he only comes in once a month, but they could be sent to him (extra charge of course) for faster results.

This vet is not the senior vets ( which are a married couple) at this office, he was a 2000 graduate. But the vet office and their vets came highly recommended to me by several people. He might not have extensive expierience, but so far, I do like him. Very easy to talk to and get along with, seems like a vet that continues to seek an share knowledge and wants to grow that knowledge. Yet I am still thconsidering about that 2nd opinion or at least another HW test elsewhere. I called some and couldn’t get an appointment before mid-week. I found out Vetco – those traveling clinics that usually appear once a week in Petco stores can do a HW test Sunday at Petco, but not exactly crazy about going that route. There wouldn’t be any second opinion there. Yet I might just do it to confirm and it would get done and with results Sunday.

The baffling trembling episodes are still very troubling to me, but no reoccurences.

Melissa, Thanks so much for the support, your input and your expieriences I have calmed some finally now and I am going to take a day to think things over. I’m going to try and shut my eyes soon 🙂

Patty, I think going by the records I showed him, he said the infection likely couldn’t bhave been more than a 1 1/2 years ago, but not sure on I recall correctly. Thank you Patty, I really appreciate the kind words.

[DogFoodie]

Hi Losul,

I just wanted to say again how sorry I am for all that you and Turbo are going through. I can’t imagine being in your shoes. Shawna sounded very encouraging in her earlier post, so I’ll offer all that I can, which are my prayers that Turbo’s treatment goes smoothly and that he makes a full and speedy recovery.

I also want to add that you’ve inspired me to be more consistent and vigilant with my dog’s heartworm prevention. I was bad about keeping track of when I had administered their doses, etc. I decided a short time ago to use natural products for flea prevention this year and had been previously using Trifexis for one dog and HeartGuard for the other. The Trifexis was a bad experience, so I was reluctant to use it, but it was paid for. Although we still have a foot of snow on the ground, with more on the way, I’ve already planned to have them tested the last week of March and talk to my integrative vet about her recommendations for the HW prevention products she feels are best for my dogs.

Thank you for sharing your experience. I’ll eagerly read this thread and especially your updates.

[Shawna]

I know you will be very thorough losul! Turbo is in GREAT hands!!

[losul]

Betsy, Thnx much, all the words and support definitely helped me get through my initial shock and panic stage. I made the mistake of watching that video the other day, Dr. Turner I think, where he surgically removed 86 1 foot long worms from that poor dogs heart, and all I could think was I wanted those friggin things out of Turbo NOW.

I should have been paying more attention to all the talk a few months ago about the HW preventatives. I think it was on the off topic thread and went on for a week or two. I’m going to have to look for that discussion and read it.

I was lame to think I would just casually keep doing what I had been doing and my dog wouldn’t ever get heartworms. As much as I hate it, once Turbo is cleared I will probably have to keep him on preventative year round, on the full dosage, and maybe even checked 2X year, I can’t ever risk this happening again. There are alot of mosquitos here, I’m considered within the Mississippi valley, and part of my property is within a flood plain, actually the majority is now included in the flood plain, since they remapped after the Great Flood. Probably the mosquitos aren’t near so bad in your area.

Shawna, I hope I can manage to make the right decisions going forward. Thnx

About the Dr Byron Blaghorn that my vet mentioned. I found that yes he has an impressive bio, but I wasn’t so impressed by the study he conducted. The study was limited in size, they tested 4 different HWP’s and found that Advantage multi was the only one that had 100% efficacy against 1 certain strain of HW larvae after a single dosage. Apparently that strain has never again been found in the wild, and apparently it was not even the supposed resistant strains found in the Mississippi river delta and valley. The study was paid for by Bayer Pharma and I understand that the Dr. also received a fee from Bayer. Bayer publicized this study ALL over the place, but they didn’t publicize the fact that all 4 HWP’s had 100% efficacy after 3 doses.

I’m not sold on advantage multi. And I don’t like the included flea insecticide. I get so much conflicting information, which do I believe?
I can’t find any info on multi and doxy alone being used in a slow kill method, and not sure on it’s effectiveness at weakening/killing adult worms or it’s actual reliability to clear microfilariae. So much conflicting info. Plus I’m not sold on it’s safety. Is it better to use a drug that accumulates and builds up in the body (moxidectin) or one that does it’s job quickly and leaves the body rather quickly (such as ivermectin)?

• This reply was modified 10 years, 9 months ago by losul.

[Shawna]

Hi losul,

I came across the information posted below while researching for a conversation I was having with HDM.. As I’ve stated before, I do think Turbo is a good candidate for the fast kill method. You are a great dog parent and his immune system is so much better than most dogs in this situation!!! Oh, you should be able to contact your local extension office and find out what type of mosquitos are common for your area. You might then be able to determine which medications best work against those particular strains.

Also, I was really happy to hear your vet was open to options :). And that he was willing to postpone the rabies vacc.. I feel more comfortable about him after learning that.

Slow kill Ivermectin treatments are being used to kill a parasite in humans called onchocerciasis.

“Most widely known for causing “river blindness,” Onchocerca volvulus infection affects an estimated 17.7 million people worldwide in 34 countries in Africa, the Middle East, South America, and Central America. An estimated 500,000 people and 270,000 people experience secondary visual impairment and blindness, respectively [1]…..

The standard treatment for onchocerciasis is ivermectin (150-µ g/kg given orally ever 6 to 12 months). Ivermectin is a highly lipophilic [49], 16-membered macrocyclic lactone from Streptomyces avermitilis [50]. Single-dose ivermectin effectively kills microfilariae by blocking postsynaptic, glutamate-gated chloride ion channels, inhibiting transmission, and paralyzing the nematode. It also appears to enhance immune responses against O. volvulus in the treated host [23].”

They go on to state that because Ivermectin doesn’t control the adult worms the patient has to be treated (in this case every 6 to 12 months) for the life of the adult worms. This is the same with heartworm in dogs other than monthly treatment in dogs versus once to twice a year with human infections. My guess is the life cycle of the O. volvulus is different than heartworms — it discusses life cycle in the article but I didn’t read it.

They very briefly talk about moxidectin for potential use to kill adult worms but as of this writing it’s not used.

“A new approach to therapy targets endosymbiotic Wolbachia bacteria. In 2000, a landmark study first showed [74] that doxycycline cleared Wolbachia bacterial endosymbionts from the endodermis and uteri of adult female worms, leading to unusually extensive worm sterility not seen in other antifilarial treatments.”

They use the “slow kill” method to treat this horrible disease in humans but are looking in to less toxic options for a fast kill (namely moxidectin).”

And we’ve both heard numerous accounts of dogs doing well on the fast kill option. Dogs not in nearly as good of health as Turbo. Trust that whatever your decision you have put your boy in the best position possible to fight this with no lasting after effects…

I wonder if prevention could be cycled in case a resistance is potentially part of the problem? Could you use an Ivermectin product for three months and then the product recommended by your vet for three months. If you decide to give the product only during mosquito season it is important to watch the weather and give the last dose one month AFTER the last possible chance of infection happening and to begin the following season one month after the weather is warm enough for infection to occur. I completely understand if you decide to give year round protection.. 🙂

[Melissaandcrew]

I just wanted to comment on Avantage. I have never used the muti nor would I due to the moxidectin. For me after the proheart issue its a drug I won’t consider. Even without the moxi, i will not use spot on flea and heartworm in one products. My concern here is how can I be sure the vector used to cause the heartworm preventative to be absorbed into the blood stream is not also carrying in the flea meds? I don’t want anything extra in the bloodstream.

I never used Advantage or any other products containg imiclopramide (spelling) either until last year when some of those products were given to me. I figured what the heck and gave them a try for one month. One week aftef using my doxie got spayed and it was the only time I feared losing a dog from the anesthesia. This dog had clear bloodwork prior to and ivs during as a “just in case”…it took her 3 days to eat/drink afterward (and a visit back to the vet in the meantime for more fluids etc) it was tbe longest spay recovery I have ever experienced. Perhaps it was coincidence but it was enough for me to toss it out. It ws d the one that did fleas and ticks only.

[losul]

Shawna thanks much and I’ve been reading the prior links you provided also. I’m positive doxy is going to be a part of whatever treatment we go with. I’m getting that the doxy will cause the female worms to abort and expel their babies (larvae) well before the mama ever dies, and become sterile, the females shrink some, causing a little less congestion? It helps weaken the worms, shortens their life, lessens pathology, and disrupts transmission. When the mamas do die, they should be virtually empty of the larvae that is believed to cause much irritation and reactions in the system when the large worms die? I didn’t word that very well, I know, but does that sound somewhat right?

The slow kill ivermectin/doxy treatment. Does that require extra ivermectin treatments, I think I saw somewhere every 15 days. And also concerning would be repeated rounds of the doxy? too much antibiotic treatment concerns me also.

I read that in order to be antigen detectible that there has to be at least 6 to 9 mature worms and at least 3 of those must be female. But there may be more sensitive tests used currently according to the A.H.S.. I don’t know how many he could have at the upper end. And we know that if the microfilaria test is correct that there are both males and females. We are supposed to be getting another ice/snow storm tonight and through tommorrow, they’re saying the roads are extremely slick already, but if I can get out tommorrow, I’m going to take him to the Vetco clinic (at Petco) for another HW antigen check.

The vet said I could always later change HWP’s, and with only a 30 day gap but I don’t think he meant during treatment. I think it would concern me going from moxidectin to ivermectin. I researched this before, but just going off the top of my head for now. Ivermectin has a short half life, it seems maybe 6 or 8 hours or something like that. It’s rapidly metabolized by the liver, after a day it’s mostly gone, and after a couple of days it’s nearly completely gone.

The way I understand it, the topical moxidectin builds up gradually to levels before tapering off to more constant levels (3 to 4 months.) During that period and supposedly even on the first dose it goes to work on L3, L4, and even immature L5, and supposedly it works well on those, the proponents say better than the others, and with a narrower suceptibility gap. But evidently it isn’t so effective on microfilaria (L1) until it accumulates for some reason. It seems to me that if moxi takes that much time to build up, it would also take a long time to completely leave the system, so I am surmising that it would probably be fairly easy to switch from ivermectin to moxidectin, but maybe not vice versa, because, even after a month of nothing, I think there would still be substantial moxidectin in the system, and then to be adding something else (ivermectin).

AHS guidelines about seasonal preventative usage;
“To be maximally effective, heartworm prophylaxis should be given year-round, but if seasonal treatment is chosen, administration should begin at least one month prior to the anticipated start of heartworm transmission and should continue for at least 3 months after transmission typically ceases. The latter 3-month recommendation emanates from new knowledge regarding resistant strains, which showed that extended treatment after exposure is required to prevent infection. Current data demonstrate that not all compounds and formulations necessitate this extension.” ( they may be referring to
moxidectin here?)

I think Ivermectin will cause a very rapid die-off of L1 microfilaria which is not usually desired in cases where the L1 count is moderate or high, due to risk of severe reaction, so the slower kill off of L1 could be an advantage with moxi. I think I read somewhere that is actually the only one FDA approved as a microfilaricide.

A.H.S. guidelines;
” Topical moxidectin is now FDA-approved for use in heartworm-positive dogs to eliminate microfilariae. No adverse reactions due to high microfilarial counts were observed in the
laboratory or field studies conducted for approval of this label claim.”

also they say this about other combos with doxy may have similar results as the ivermectin/doxy combo. for weakening the adults, but only going by anecdotal reports;

“Select macrocyclic lactones coupled with doxycycline individually suppress embryogenesis
and weaken adult heartworms. As mentioned previously doxycycline reduces Wolbachia levels in all stages of heartworms. Studies have shown that administration of doxycycline in combination with ivermectin provided more rapid adulticidal activity than ivermectin alone as well as more efficiently reducing Wolbachia numbers more effectively than doxycycline alone. Anecdotal reports on other macrocyclic lactones with adulticidal properties suggest similar results but no confirmatory studies have been published.”

“In cases where arsenical therapy is not possible or is contraindicated, the use of a monthly heartworm preventive along with doxycycline at 10 mg/kg BID for a 4-week period might be considered. An antigen test should be performed every 6 months and the dog not considered cleared until two consecutive negative heartworm antigen tests have been obtained. If the dog is still antigen positive after one year, repeat the doxycycline therapy. Exercise should be rigidly restricted for the duration of the treatment process.”

Shawna, Dr. Garner is a big proponent of advantage multi, and he advocates and uses a similar protocol as what my vet is recommending (excepting all the prednisone), and also as the AHS guidelines. You can see my vets protocol in my initial post. I realize now, his was the HW surgery video I watched. I EMailed him with some questions, including one about using advantage multi/doxy in a slow kill, hopefully he will find time to reply. If you get a chance could you take a look. Maybe you can tell me your opinion about using multi/doxy in either the full 3 treatment immiticide plan or the slow kill possibilty using multi/doxy. As of now I’m leaning towards the fast kill, but at the very least I need to decide quickly which monocyclic lactone (moxidectin,ivermectin, or?) to get him on. Then I can decide more from there.

Heartworm Treatment Dogs

Thnx Shawna!

[losul]

Melissa, I too wouldn’t yet consider the proheart as preventative (at least not until it can be proven better), after treatment, and I totally hate that the advantage multi has the flea insecticide with it, I don’t want or need that at all. The vet keeps telling me how it’s only toxic to the fleas nervous system and nothing else, but that’s kind of going in one ear and out the other with me.

I might be using the multi during and several months after Turbos treatment, not entirely sure just yet, but I will have to really think about and study it more as to giving as a future regular preventative.

Thnx for the input!

• This reply was modified 10 years, 9 months ago by losul.

[losul]

All the regional Vetco clinic’s at Petcos in my area have canceled operations today due to hazardous driving conditions, so a 2nd HW antigen testing is out of the picture for today. We are expecting more sleet/ice/snow later today/tonight still. They will be at some of the Petco locations again next Sunday.

The thing to do upon diagnosis of HW is to immediately start (if not already on) a HWP, ivermectin, milbemycin, moxidectin to arrest maturation of some of the larval stages, and possible resulting further damages. The worst thing to do is nothing, and yet it has been almost 5 days now, and I still have done nothing. He hasn’t been on an HWP since Oct 18(heartguard+).

My turmoil has been;

1) the still unexplained trembling episodes last weekend.
2) the shock finding that he is heartworm positive
3) the fear that I wouldn’t be able to get treatment without a current rabies vaccination, it expires tomorrow, the vet was originally pressing to go forward with the vac.
4) I have a brand new vet, which i know/knew little about, wanting to put him on advantage multi (moxidectin) a drug that I knew very little to nothing about, and advising not to use the others, that I knew a little about.
5) The fear that once starting on moxidectin, I wouldn’t be able to change to different one throughout his treatment protocol. I think that may still be the case.
6) The fear that once given moxidectin it would alter any further HW testing results for a second opinion. This was largely unfounded, and especially for the antigen testing. The antigen remains for several months after adult worms clear. The moxidectin would affect the microfilaria testing probably some, but one dose of moxidectin will not likely clear so many of the L1, whereas Ivermectin, or the others would induce a much more rapid and sudden kill of L1.
7) I still don’t know the number of adult worms ( never will), whether more are still maturing, they likely are, and I don’t know if the heartguard lost any, all, or most efficacy by my refrigerating it for the entire season last year., and how much protection if any he had.

I don’t want everyone to think I’m totally Nutzo, (I am, I just don’t want everyone to think that 🙂 I can’t tell how horrible I feel about still not starting some kind of treatment still after five days, knowing the situation may likely be growing worse with each day’s postponement. Unless I find out something different in the interim, and provided my vets office can be open and road conditions are where I can get out (in case of a bad reaction) My intent is to go ahead and apply the advantage multi to my dog tommorrow morning, and then take things from there. I just cannot sit on my hands any longer.

[losul]

The moxidectin component of advantage multi topical, supposedly is rapidly absorbed through the skin within 30 minutes into the subcutaneous fat layer. The flea component supposedly stays within the dermal cells and takes much longer to spread through the dermal tissues, the way I understand. They should have left the flea insecticide completely out of it. As it is, it’s another thing to be concerned about, and that I really know little about.

Evidently the moxidectin component is highly lipophilic, meaning 1. showing a marked attraction to, or solubility in, lipids.
2. having an affinity for oil or fat.

“Actual preventive products may perform differently.
Table 2 summarizes important differences in heartworm
preventives. Properties such as unique pharmacologic
behavior could result in improved efficacy. For example,
moxidectin is a highly lipophilic molecule, resulting in
higher drug concentrations and delayed elimination from
the host. Moxidectin in the Advantage Multi® for Dogs
topical formulation achieved high concentrations in plasma
(15.1 µg/L) and maintained levels at or above about 12 µg/L
for the 30-day treatment period. More importantly, consistent
administration of moxidectin (Advantage Multi® for Dogs) to
dogs for 4 or more months resulted in a continuous presence
(steady-state; approximately 36 µg/L) of moxidectin in
plasma.8 Product properties such as these may prove to be
important for effective heartworm prevention.”

See pages 8-11. See also the tables and chart. Note; this comes from Bayer Pharma’s own website, and by the Dr. Byron Blackburn, who I think has financial bias.. Regardless of any bias, I think the article still has some good information.

http://www.bayerdvm.com/show.aspx/canine-heartworm-disease-blagburn

[losul]

I found this article which mostly describes and talks about MOX use in horses and certain worms, and describes the drugs chemistry, etc. It also mentions many other uses in many different species, including the Onchocerca volvus thing that Shawna was talking about, and the brief, so far, Proheart 6 month thing for heartworm in dogs. Interesting.

Note: the 2 authors of this paper are affilliated with Fort Dodge Animal Health.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751841/

I’m wondering if Wyeth/Fort Dodge owns the rights to Moxidectrin, and maybe only licenses the drug to Bayer (advantage multi) in a topical formulation and with an included insecticide, so that it couldn’t compete directly with their so far, troublesome 6 month injection for HWP in dogs.

[Melissaandcrew]

It has a much lower safety margin than other wormers I can use even for the horses. It just not a product I am willing to risk. IF its only absorbed into the fat layer than how is it supposed to kill the microfilaria that are circulating in the boodstream….food for thought..

[Melissaandcrew]

And ps.. its the higher concentration levels and longer time in the body that concern me. If the dog had a reaction it does not clear the body rapidly like Ivermectin does. That’s one of the reasons I would not use the injection. If I recall, the dogs that were dying from it were doing so after the second injection. This in my mind and opinion means it was not exiting the body quickly enough and building up in the system.

[losul]

Melissa, I don’t have any doubt that it’s (supposedly gradually) released into the bloodstream, where it slowly builds up plasma concentrations. If the vet wanted to use a 6 month injection of this, (and as far as i know it would Never be done on a HW pos dog) I would have already immediately looked elsewhere. Speculation, but I think it would be very hard to formulate a timed release product for prevention that would give a relatively even plasma concentration for an entire 6 month period. There’s also the issue of injecting it properly. I would imagine it would have to be very carefully injected into storage fat, and if not done properly, the potential for really big problems, which I think they proheart6 had. I doubt I would ever trust a 6 month injection of this, not for prevention or otherwise, not ever.

Speculation again, but i would think 1 month topical doses would have a much higher margin of safety. Absorbed through the skin, wouldn’t the drug have to meet the subcutaneous -below skin fat layer before ever reaching the bloodstream or at least without an excessive amount getting in the bloodstream right off the bat? Supposedly it only builds up slowly for the first 3 or 4 months (3 or 4 applications) before the plasma concentrations level off and stop building up even with additional applications. Bayer says this the big advantage. On page 11 on the right, there is a chart that shows supposed plasma concentrations over time.

I don’t even really want to dwell too much about shortcomings of proheart6, I’m not even considering it and I think I know some of it’s problems, but in table 2 on page 10, it says this about it “At the end of the 6-month dosing interval, residual drug concentrations are negligible12”

http://www.bayerdvm.com/show.aspx/canine-heartworm-disease-blagburn

Intuition at first tells me I would rather have a drug that gets in, and more importantly gets out fast. Bayer claims the slow and more continual and evened out plasma concentrations is the big advantage to this vs. a big plasma spike and rapid exit such as ivermectin dosing, and then there is very real risk of anaphylactic shock from using ivermectin in a HW pos dog, because of the very sudden and too rapid die off of microfilaria. I don’t know, I really wish I had more answers and more time. I can’t really argue for this drug, sadly, I just don’t have anywhere near all the answers.

[Shawna]

Hey Losul,

You may have already made your decision on what to do and what product to use but either way I think it is important for you to know the heartworm life cycle.

Microfilaraie circulating in the bloodstream, from my understanding, CAN NOT become adult worms without first going through L1 to L3 changes IN A mosquito. With this in mind, I don’t see how the worm burden can increase during these frigid winter months. Check with your vet to make sure about this but here’s some data.

FDA — “Microfilariae cannot become infective larvae without first passing through a mosquito. When the infected mosquito bites another dog, the mosquito spreads the infective larvae to the dog through the bite wound. In the newly infected dog, it takes between six and seven months for the infective larvae to mature into adult heartworms.” http://www.fda.gov/animalveterinary/resourcesforyou/animalhealthliteracy/ucm188470.htm

From what this and others are saying — Turbo has had this infection for at least six or seven months but maybe longer for there to be detectable L1 microfilariae in the blood.

American Heartworm Society — “Microfilariae cannot mature into adult heartworms without first passing through a mosquito.” http://www.heartwormsociety.org/pet-owner-resources/heartworm.html#lifecycle

Trifexis website — “Microfilariae are actually microscopic larvae. They live in the blood of most heartworm-infected dogs. Microfilariae are ingested by a mosquito that feeds on an infected animal, where they molt twice over a period of about 2 weeks and develop into infective larvae…. An infected dog will typically be carrying microfilariae within 6 to 7 months after first being infected by the initial mosquito bite. And the cycle continues.” http://www.trifexis.com/about-parasites/about-heartworms/heartworm-lifecycle.aspx

There hasn’t been enough time for the infection to have been caused by not giving the preventative in November and after — the infection had to have happened before that. Which also means that the heartguard you were using wasn’t working (unless you missed giving – which I doubt). I also thought I read that heartguard should not be divided into multiple doses as the medication is not uniform throughout the product. Someone please correct me if that is incorrect.

If the above mention of splitting is correct, you could have given one dose with medication in it. The very next day Turbo could have been bitten by a mosquito. The next month you could have given the non-medicated portion and then again when splitting the next month non-medicated could have been given. By the time the next dose carrying medication is given the larvae could have developed to L5 stage (young adult) where heartgard (and others) are ineffective. OR, the mosquito’s in your area are ivermectin resistant.

• This reply was modified 10 years, 9 months ago by Shawna.
• This reply was modified 10 years, 9 months ago by Shawna.

[Shawna]

Oops, forgot this..

IF refrigerating the product does cause issues, that could be another reason it failed.

And

Heatguard kills L3 and L4 stage larvae. I’m not sure why one would need to continue giving it up to three months after heartworm season ended. If giving every 30 to 45 days it should kill any L3 and L4 still maturing under the skin??

[Dori]

This is from the Heartgard website as to administration. Shawna, I believe you are correct in that the entire pill must be given. From what I’m reading the site says that you should continue to give Heargard for one (1) month not 3 after heart worm season ends.

ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food.The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole.
Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended.
HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog’s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog’s last exposure to mosquitoes.
When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication.
If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the recommended dosing regimen will minimize the opportunity for the development of adult heartworms.

[Dori]

Hi losul and Shawna, I just spoke with tech support at Merial makers of Heartgard and was told that the ENTIRE dose must be given. You cannot split in half because they can not guarantee it’s efficacy. It is suggested that you not do that. Also, HEARTGARD PLUS (or any Heartgard product) MUST NOT BE REFRIGERATED. It can take a very short exposure to 59 degrees but very short (car ride from vet in cold weather, situations like that) but she stated again NO. DO NOT REFRIGERATE.

I hope this clears up these two questions that I’m sure we’ve all been thinking about.

losul..please keep us posted as to which treatment you decided on and how Turbo does throughout treatment…..And PLEASE keep us posted as to how you are doing and how else we can help. I don’t work outside the home (my husband, my three dogs and my illness is work enough for me in the home) so I can make as many phone calls as you need. Here is my email: [email protected]. Dori

[Shawna]

Hi Dori,

THANK YOU for checking in to that.. I was pretty sure about that but not positive. Now we know for sure!! I also had no idea, until Losul brought it up, about the refrigeration thing. Hopefully they have that printed on the box somewhere. Guessing if it is it is not in bold print… 🙁

I can see your pups better in the forums avatar.. They are just too adorable!!!!

[Dori]

I don’t use Heartgard so I’m not sure weather it says it on the box or not. If it doesn’t, it certainly should as they were so adamant not to refrigerate unless they expect the Vet to tell you but, really, it would be their responsibility. As i said, I don’t use the product so maybe it is on the box in tiny print. I use Sentinel and after Losul’s tragic story with Turbo I will be doing year round treatment. I live in Atlanta and the weather is always a little dicey here in this part of Georgia. Yesterday it reached 76 degrees in the afternoon and today’s high will be 46. I was only treating during the hotter months but now I’m a bit freaked out about putting their health in the hands of my ability to predict the weather or keep track of it moment to moment. From what you said in some earlier post, I think it was you, the treatment for Heartworms seems more toxic and scary if not the same as giving year round Sentinel. My guys are too small (as are yours I believe) to withstand treatment if they actually got heart worms. My biggest is 8 lbs. and healthy, yes, but she was 14 years old last September so she’s not a great candidate for major heart worm infestation or the treatment for even low infestation. I don’t like the idea and of course will worry about giving them the Sentinel year round but I will do that. Actually I gave the a dose the morning after I read Losul’s original post on this Forum. I do give Milk Thistle for seven days after the dose.

[losul]

Thnx Shawna, you bring up very good points. I too would think that all or most of any infectious larvae would have already transformed into adults based upon the latest possible date(s) of infection. But I wonder if some of the migrating larvae take longer to mature than others? I can’t possibly see how Turbo could have been infected after the last heartguard was given, it got cold here early, already had some hard freezes, and I don’t think the temp again even barely hit the 50’s let alone 60 for more than a day or 2 past the date of his last HWP dose. But then I didn’t dream I would ever find a tick on his ear in early November either. Of course If I only knew then what i know now..

I think probably why the A.H.S. advised if giving seasonal to go 3 months past last possible transmission date, and 1 month before, is because of Dr. Blagburn’s studies of possible resistance to HWP’s. If one were to do that, it would be about 9 or 10 months anyway here, almost year round. it’s hard to tell what’s true, these preventatives are big moneymakers for the pharmas, and of course ivermectin has been off patent (generics) for awhile. But for me, after this is cleared, it will be necessary to err on the side of overcaution going forward.

It was explained to me that one reason they want to give the HWP first for a couple of months is because of the gap between what the HWP will kill and and what the adulticide will kill. Evidently some stages are not susceptible to either the adulticide or the HWP. The time is supposed to allow those stages that are in the gap, time to get vulnerable to the adulticide. Otherwise new adults could still move in after the older ones die.

I didn’t miss any doses, it was every 35 days, the actual dose dates are all marked on my calendars but I am trying to find more about the failure. I believe it’s most likely my failure, I can’t blame anything else. I have a case number with Merial, which they told me to have my vet call them with the case I.D. and he could then speak to their vet. All Merial would tell me is that they couldn’t guarantee it’s efficacy if refrigerated. I forget to ask or remind my vet about this the last time I talked to him.

I went ahead and applied the multi this morning after talking to them, about 4 hours ago. No reaction thus far. They assured my that if I change my mind on the HWP used, I could still do that after 30 days. I still intend to try to seek another HW test at least and/or a second opinion. I believe I might go ahead with X-rays, and I wonder why they also didn’t do a urinalysis. The extent, how long, how many, etc. it’s all questions that bear heavy on my mind, although these things may not even be able to really reveal. If I knew it were just a minor infection, it would be easier to bear and decide the course, I don’t know if he had multiple infections throughout last season, if he had minimal or any protection at all, or what.

Thnx Shawna.

• This reply was modified 10 years, 9 months ago by losul.

[losul]

Dori, yes. thank you very much for that. I appreciate.

And after checking yet again, I do see the temp ranges printed right on the back of the box, not just on the interior package.. I can’t believe I missed that, even after looking distinctly for it. OMG.

[losul]

Thnx so much Dori, for the offer I sent my reply to Shawna before I saw your posts.

OMG I feel like such a dummy.

[Dori]

Losul. Please don’t beat yourself up about that. What’s happened has happened and you just need to look forward with optimism. You’ll do what’s best for Turbo and this will all be a distant memory. Take a few deep breaths, relax and be well.

[Shawna]

Missed the data posted regarding heartgard plus and dosing… Thanks also for posting that Dori!!!! Both the call and quote confirms things I was already thinking… 🙂

[Author]

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