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

1. Now What?
By Jacquelyn H. Burns, DVM
Copyright © Jacquelyn H. Burns

2. Member,
American Heartworm
Society is a current member of the
 Dr. Burns
American Heartworm Society.
Material in this slide presentation reflects
Dr. Burns’ and Holmes Veterinary
Hospital’s philosophy about and
approach to management of heartworm
disease. It may differ somewhat from
the AHS guidelines. It is not intended to
be a substitute for examination and
treatment by your pet’s veterinarian.

3. Don’t panic!
 Our veterinarians and staff have many
years of expertise in treating
heartworms successfully
 We are current on all the latest
treatment techniques
 We approach treatment gradually to
avoid patient (and owner) stress
 98% of our treated patients return to
normal, healthy lives

4. Step 1
 Identify and treat concurrent problems
 Classify the heartworm disease’s
severity
 Set up a safe and effective treatment
plan individualized for each patient
 Ongoing prevention
 Follow up testing

5. Identify and Treat
Other Problems
 For example, if your dog has skin
disease, an injury, heavy intestinal worm
infestation, we want to treat and control
those situations before moving on to the
heartworm disease
 If your dog is underweight (such as a
malnourished stray or rescue), we want
your dog to gain some weight before
treating for heartworms

6. Staging in the Heartworm
Disease
 Blood Chemistry Profile
 CBC
 Urinalysis
 Chest X-Ray
 For some, an E.K.G.

7. Heartworm Disease
Classifications
 Class I
 Mild Disease, no symptoms
 Mild Disease, mild symptoms
 Class II
 Moderate Disease, mild to moderate symptoms
 Class III
 Severe Disease with mild to severe symptoms
 Class IV
 Caval Syndrome

8. What are the symptoms?
 Many dogs have no symptoms at all!
 Coughing
 Shortness of breath
 Labored breathing
 Weight loss
 Poor appetite
 Lethargy
 Getting tired easily with routine exercise
 Syncope
 Swollen, distended abdomen
 Edema of the legs

9. What are the dangers?
 Developing right sided or generalized
congestive heart failure
 Sudden death
 Pulmonary embolism
 Blood clot to the lungs
 Most often fatal
 Caval Syndrome
 Most often fatal

10. Couch Potato!
 Your dog should become a couch potato
until his or her heartworm infection is
cured
 This means not doing things that
increase the heart rate
 Running, jumping, playing ball
 Climbing steps, stairs, hills
 Barking a lot
 Breeding/mating

11. Three Treatment
Approaches
 Routine Treatment with Immiticide
 “Soft Kill”
 Delayed Treatment

12. Regardless of Treatment
Plan
 Alldogs start Heartgard Plus (or
equivalent ivermectin-based
heartworm preventative) at the
time of diagnosis
 Prevents the dog from getting
more heartworms, which
worsen the disease

13. Routine Treatment vs Soft
Kill
 Routine Treatment  “Soft Kill”
=Immiticide Injections  Start on Heartgard Plus
 Start on Heartgard Plus at time of diagnosis
at time of diagnosis  Doxycycline for 6 weeks
 Doxycycline for 2 weeks  Prednisone for a
before and 4 weeks minimum of 6 weeks
after last Immiticide  Exercise restriction until
treatment negative
 Prednisone for 2 weeks  Antigen test every 6
before and 4 weeks months until negative
after last Immiticide
treatment

14. Routine Treatment
 Injections of Immiticide kill the adult
heartworms
 The heartworms turn loose and flow
downstream where they lodge in small blood
vessels in the lungs
 The worms decompose in the lungs and are
broken down by the body
 Sometimes causes cough
 Sometimes causes appetite loss, weight
loss, lethargy
 Rarely can have pulmonary embolism and
death, usually first 3 weeks after Immiticide

15. Soft Kill
 Concedes that your dog is living “okay” with
the heartworms he or she currently has
 Preventative with Heartgard Plus
 Keeps matters from getting worse
 Heartgard Plus and Doxycycline work together
 Weaken the adult worms and shortens their life
expectancy
 They live 6 mo to 18 mo instead of 2 to 5 years
 Prednisone
 Reduces inflammation in lungs
 Retest for heartworms every 6 months
 Most are heartworm negative in 12 months

16. The American Heartworm
Society
Officiallyrecommends
treatment with
Immiticide rather than
Soft Kill

17. So why do people choose the
Soft Kill?
 It’s often easier on the dog, especially
older dogs or dogs with other problems
 No three week period with danger of
embolism after Immiticide injections
 No post-Immiticide
coughing, lethargy, weight loss

18. Delayed Kill?
 Postponing treatment with Immiticide until
cooler weather for stable patients!!!
 Asymptomatic pets
 Pets with mild or no changes on x-rays
 Postponing treatment for other reasons
 Since August 4, 2011, Immiticide, the
drug to treat adult heartworms has been
in very short supply and is released by
Meriel on a case by case basis, reserving
it for the more severely affected dogs.
We can currently get Immiticide if
needed, but that has not always been the
case.

19. Can my dog give heartworms to
my other dogs?
 No—not directly through playing
together, eating together, bunking together
 Other dogs if taking heartworm preventative
are not at risk
 Heartworms are transmitted through mosquito
bites
 A mosquito bites an infected dog, ingesting
heartworm microfilaria
 Microfilaria develops into an infective larva in the
mosquito
 If the mosquito bites a dog that is not on heartworm
preventative, it can transmit the larva in its bite

20. Heartworm Preventative
Is recommended once-a-
month, 12 months a year
for dogs in our area
If your other dogs are not
on heartworm
preventative, we need to
test them and get them on
it!!!

21. What about my cat?
 Cats are sometimes infected with
heartworms, but it is much less common
than in dogs
 Symptoms are more likely to be
 Asthma-like (H.A.R.D.=Heartworm
Associated Respiratory Disease)
 Sudden death

22. Heartworm Prevention in
Cats
 Very easy!
 No pre—preventative blood test needed
 Advantage-Multi, our once-a-month flea
med, takes care of:
 Heartworm prevention
 Flea control
 Hookworms
 Roundworms
 Ear mites

23. My dog has heartworms, now
what? Slide Show Courtesy of:
 Jacquelyn Holmes Burns, DVM
 Holmes Veterinary Hospital
100 Church Street
Laurens, SC 29360
(864) 984-2365
www.holmesvethospital.com
Copyright © Jacquelyn H. Burns, DVM 2011
Information presented in this slide show is for client education
is not intended to be used as a substitute for your veterinarian’s
clinical judgment and treatment recommendations.