Heartworm treatment.

Dr. Marie replied:

Poor Sam has had some tough issues in his life! I'm so sorry to hear that he has heartworm.

Immiticide is definitely the best and safest treatment that we have for heartworm. Did your vet mention if they have Immiticide to use for treatment? There have been issues with shortage of the drug.

With that being said, as you know, there are some risks in using it. One of the concerns is that the dog can get something called a thromboembolic event. This means that the worms, once killed can cause a problem with obstructing blood vessels in the lungs. This risk increases with a higher heart rate. So, we believe that exercise restriction really helps reduce the risk of a thromboembolic event happening.

Did the vet mention what class the heartworm disease is? We grade heartworm on a scale of 1 to 4 depending on how much heart damage the dog has at the time of diagnosis. A thromboembolic event is much more likely if a dog has a class 3 or 4 type of heartworm.

There are other options for Sam's treatment, but they are not ideal. One is something called a "slow kill" method. The point of this method is to give a monthly preventative such as Heartgard that will kill any microfilaria (baby heartworms) that are there. However, if there are currently no microfiliaria in his blood this may not be necessary. (This can happen if all of the worms in the heart are either male or female. If you don't have both a male and a female then they are not going to reproduce.) The problem with the slow kill method though is that it does not kill the adult worms. The idea is to kill larvae to prevent more adults from forming and then just wait till the worms that are already in the heart die.

However, it can take several years for the worms in his heart to die on their own. During this time they will continue to cause problems in the heart and can even lead to heart failure.

It is much better to kill those worms in the heart now than to let them sit there for several years. But, the best way we know to do that is with Immiticide.

I understand your dilemma in having trouble keeping Sam's heart rate down, but this is how I see it: Every year a LOT of dogs are treated for heartworm and how many of them do you think get excited? Almost every dog gets excited...that's what dogs do! They love to be excited about people and their surroundings.

You may need to keep Sam in a crate for 2 months and just take him out on a leash to do his business. In my mind this is a temporary hardship that should buy him many more years of life. I'm not so worried if Sam's heart rate goes up in the cage. It's the combo of high heart rate plus running around like a crazy dog that leads to a thromboembolism.

There are some vets that will prescribe medication, if necessary to help calm him down as well.

I hope this helps and I really hope he does well!

Dr. Marie.


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