Professional Documents
Culture Documents
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CONTENTS
What is Heartworm
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................................................................ 5
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............................................................. 14
Heartworm Treatment
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Testing ......................................................................................... 47
Conventional Treatment ............................................................. 50
Alternative Treatment ................................................................. 54
Natural Treatment ...................................................................... 58
Closing Comments
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What is Heartworm
First, let's make sure we all understand that heartworm infestation can be
extremely serious, and that infected dogs and cats that go untreated may die.
Even treatment of infestation can be very uncomfortable (sometimes
requiring surgery in advanced cases) and can be very detrimental to a pet's
health otherwise pets may die from complications during treatment. On
the other hand, prevention measures may be just as detrimental to an animal's
health in the short term and/or the long term, so it's important that one knows
enough to make the best choices in their own circumstances.
Heartworm infection is caused by a filarial organism, Dirofilaria immitis. At
least 70 species of mosquitoes can serve as intermediate hosts, of which the
most common vectors are Aedes, Anopheles, and Culex. Heartworm
infections are possible in dogs, cats, wolves, coyotes, foxes, and some other
animals, such as ferrets, raccoons, sea lions, and even humans. It is called a
"heartworm" because the parasite, in the final reproductive stage of its life
cycle, resides most often in the heart of its host where it can live for many
years, potentially eventually killing its host. Heartworm disease in cats is
thought to be less frequent than in dogs, however due to restricted pulmonary
vascular capacity and subsequent pathology, cats are more likely to die as a
result of heartworm infection.
Adding to the problem is a parasite called Wolbachia that lives symbiotically
inside heartworms. Wolbachia is a rickettsial organism, similar to those that
cause tick disease. Studies indicate that though Wolbachia are not known to
cause mammalian disease, this parasite may contribute to the adverse effects
of both heartworm infection and heartworm treatment, including
inflammation, embolism and allergic reaction.
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Upon reaching the heart, the young adults continue to grow. Up to now there
has been no evidence of disease in the dog. It is only after adult worms mate
and start to discharge tiny motile microfilariae that circulate in the blood that
disease becomes apparent. Microfilariae usually appear in the blood about
200 days after infection.
Visible signs of heartworm disease may not appear until a full year after
being bitten by infected mosquitoes. In fact, the disease may be well
advanced before the dog shows any symptoms. Dogs with typical heartworm
disease fatigue easily, cough, and appear rough and not thriving. Blood and
worms from ruptured vessels may be coughed up. Blockage of major blood
vessels can cause the animal to collapse suddenly and die within a few days.
Dogs with 50-100 mature worms exhibit moderate to severe heartworm
disease. Dogs with 10-25 worms that receive little exercise may never show
signs of heartworm disease, and one may not be able to find microfilariae in
the blood. Heartworm infection without detectable microfilaremia is called
occult dirofilariasis.
Although any dog, indoor or outdoor, is capable of being infected, most
infections are diagnosed in medium to large-sized, 3 to 8 year old dogs.
However, in all dogs generally, the healthier a dog's immune system is, the
lower the number of larvae that reach maturity. In a 1991-1996 disease
testing study of live-captured wolves in Wisconsin, heartworm infection was
found to be very rare (rarer by far than Canine Parvovirus, Infectious Canine
Hepatitis, Canine Distemper Virus, Lyme Disease, and Blastomycosis which
were also tested for). Though there is no scientific study of domestic dog
infections relative to immune system health, I believe the same rarity would
be found in dogs that were not immunocompromised that is, dogs fed a
species appropriate diet and not vaccinated, medicated, subjected to
environmental hazards, or otherwise diseased. A risk that is very difficult to
overcome, however, is immune system problems introduced inadvertently by
the hand-of-man that is through our selective breeding of dogs.
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Let's back up a minute and also consider that the female mosquito, when
biting the initial infected host, consumes more than its weight and will not
feed again for three to four days. Let's also consider that most female
mosquitoes can survive up to a month (or longer in captivity) but most
probably do not live longer than one to three weeks in nature. Their chances
of survival depend on temperature and humidity, not being eaten themselves,
and also their ability to successfully obtain a blood meal while avoiding host
defenses.
So, from the time the female mosquito bites the initial infected host, around
three weeks at a minimum must pass before infectious stage larvae can be
deposited on the skin of another animal. Thus most female mosquitoes will
have only one opportunity to potentially infect another animal, and then only
if they have bitten an infected host early on and survive at least three weeks
afterwards in optimal conditions.
If one is in a seasonal mosquito area, it should also be apparent that the threat
of an infectious mosquito bite in almost the first month of conducive
temperatures is virtually nil (unless an infectious mosquito is shipped to your
immediate local from the gulf coast :-).
The idea that mosquitos might linger around inside say your house might be a
concern at the end of a mosquito season for a month or two at the most, but
after that they will be dead, and if they have managed to propagate, the new
mosquitos will not achieve an infectious state unless there is also a host
animal present. In seasonal mosquito areas there is no real justification for
year around chemoprophylaxis other than profit, or to treat a heartworm
positive dog.
In subtropical and tropical zones there are some longer lived mosquitos, and
usually a greater host pool, so augment this information with local
conditions. Some adult mosquitos can hibernate over cold months, and
though there is evidence that viruses in such may not be killed, I can find no
evidence that heartworm microfilariae can survive such.
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There is a simple home-made mosquito control you can employ in moderate sized
areas such as around dog runs. Fill one or more 5 gal. containers about 2/3 full of
water and add about an ounce of household dish soap and a few squirts of WD40. Cover the containers with chicken wire to keep birds and small mammals out,
and place them where pets can't get into them or knock them over. If youd like,
decorate the buckets to blend in with your landscape :-)
When a mosquito lands on the water it will get stuck, because the WD-40 in the
water acts to break up the surface tension, impeding the mosquito from flying
away. If a mosquito lays any eggs the dish soap will kill any larvae that do happen
to hatch from the eggs.
Periodically check the buckets and refill them as needed. Youll be surprised how
many mosquitoes youll catch this way.
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There are, of course, more elusive factors that bear on incidence. For
example, Louisiana has a high incidence of heartworm and after Katrina
many of the dogs there were relocated throughout the country, potentially
providing hosts for increased distribution. Then there is global warming and
the effect it will have on mosquito populations.
The most elusive factor of all is that all the applicable statistics are strongly
influenced by voluntary reports in a commercial environment that is, not an
altogether scientific or altruistic environment :-) While heartworm cases are
readily reported, adverse effects to the drugs aren't as often reported and/or
maintained by the drug companies, especially if they are not immediate and
incontrovertible. In my research I have come across numerous statements by
vets that say that probably less than ten percent of drug reactions are
reported, and some state a lower number.
Whatever percent of incidence you arrive at should only be viewed as a
general potential probability of infection, as a specific pet's circumstances
strongly influence the probability of infection, just as they do the probability
of adverse effects.
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Heartworm Prevention
There are two initial primary actions applicable to heartworm prevention,
followed by a choice of steps aimed at prevention.
First, one should clarify in their own mind, and consider the implications of,
environmental factors in general and a dog's state of health in particular. As
to environmental factors, considering where the dog has spent any time in the
last year, what are the chances of heartworm infection? If the dog has spent
the last year in the Arctic or Antarctica, and will continue to reside there,
there is no chance of infection, but if the dog has been in any relatively
warmer local, or will be traveling to such, where there are mosquito
populations for a month or more, there certainly is a chance of infection. As
to a dog's state of health, just how healthy is it, and are there any potential
immunological issues? A dog's true state of health is not necessarily
apparent. If a dog seems healthy consider whether it has had the benefits
of a species appropriate diet (see diet note below) for most of its life, has a
history of few or no vaccines and medications, has spent most of its life in a
positive emotional environment, has had sufficient exercise and rest, and has
had sufficient exposure to build its immune system. Then consider
immediate environmental factors such as potential exposure to toxic
chemicals, like those used in the house or garden or on the lawn.
Detrimental chemicals might also be found in a dog's drinking water,
especially if the water is from a treated municipal source.
Also, keep in mind that man's selective breeding has contributed to health
problems in domestic dogs. Various breeds are more susceptible to adverse
effects issues such as autoimmune problems, hypo-thyroidism, lymphoma
sarcoma, seizure disorders, heart problems, and skin allergies.
So, first know your dog! You should realize that you know the most about
your dog if you take the time to consider the above points. A veterinarian's
opinion of a dog's health provides more insight, but generally (in my
experience) will not get into all these considerations, and/or because of their
education will see diet and potential drug effects if a different light.
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As to diet, I've said it before but it bears repeating, understand that despite
outward appearances the dog [Canis lupus familiaris] is a domesticated wolf,
differing from gray wolves [Canis lupus] by at most 0.2% of mtDNA sequence,
and there is almost no correlation between a dog's breed and the
mitochondrial DNA sequences it carries. In comparison, the gray wolf and
domestic dogs differ from their closest wild relative, the coyote, by about 4%
of mitochondrial DNA sequence. Even analysis of the highly variable
markers in the regular (nuclear) DNA of dogs and wolves shows a
considerable overlap there as well. Jackals and coyotes, though they can
interbreed with dogs and produce fertile offspring, possess quite distinct
groups of mitochondrial DNA sequences which are not found in domestic
dogs. The evidence comes from a 1997 study by Robert Wayne, an
evolutionary biologist at the University of California at Los Angeles, who has
applied the modern tools of genetic fingerprinting to dogs, coyotes, wolves,
and jackals. This study has been scientifically validated numerous times (e.g.
Feldhamer, G.A. 1999. Mammology: Adaptation, Diversity, and Ecology.
McGraw-Hill. pg 472.) since, and its conclusions accepted (even by the
Smithsonian Institute in reclassifying the genus of domestic dogs), despite
what commercial interests and others that anthropomorphize would have you
believe otherwise. Yes, the little toy poodle is a domesticated wolf, and it has
all the same optimal dietary needs as a gray wolf. As determined by scientific
observation and biologists studying gray wolf scats, in nature gray wolves
thrive when they consume diets high in the best quality animal protein and
fat, rich in vitamins and minerals, low in carbohydrates and fibrous
materials, and devoid of plant based protein (e.g. see the Smithsonian
National Zoological Park Gray Wolf Facts, and the Wisconsin Dept. of
Natural Resources Gray Wolf Facts). What has not been observed is wolves
sitting around a campfire preparing their dinner :-))) The only difference in
dietary needs one might note, is that for domestic dogs less quality fat is
needed unless they are serious working dogs.
Commercial pet foods are composed mostly of low quality plant processing byproducts, rendered meat by-products, and a wide variety of chemical additives,
many of which are questionably safe (e.g. cancer-causing agents such as
BHA, BHT, and ethoxyquin). Nutritionally these pet foods are a disaster, with
associated health problems of oral disease and the toxins such cause to be
distributed through a dog's body, kidney and urinary tract diseases, digestive
system problems, hyperthyroidism, and heart disease, to name only the more
common problems.
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Now, if you have given due consideration to these two primary actions, then
you are ready to consider what preventative measures are appropriate in your
circumstances. Herein, preventative measures fall into three general
categories that will be outlined in turn conventional, alternative medicine,
and a natural approach. There are, of course, overlaps, but the idea is simply
to present all possible approaches that might be considered, and
categorization helps in assimilating the information.
Conventional (Chemoprophylaxis) approach to heartworm prevention
There are a seemingly confusing number of chemoprophylactic heartworm
products on the market, but the most commonly used active ingredients in
them are the macrocyclic lactones (ivermectin, milbemycin oxime,
moxidectin and selamectin), together in some cases, to extend their
applicability, with anthelmintic and benzoylurea pesticide agents. These
drugs have high therapeutic/toxicity ratios [drug industry's words], and
possess anthelmintic activity against microfilariae, 3rd and 4th stage larvae,
and in some instances young adult heartworms, and the combined drugs
extend applicability to intestinal worms and fleas. What the drug companies
and many vets don't mention is that the long-term effects of constant use are
unknown (i.e. not scientifically proven), and they have made no genuine
effort to study such.
According to the American Veterinary Medical Association (AVMA) a
minority of animals experience adverse drug reactions, but those that occur
are seen in most breeds. The AVMA went on to say they have found that
65% of all drug reactions reported, and 48% of all reported deaths caused by
drug reactions were from heartworm preventive medicine. [quoted on many
Holistic Veterinary sites, but I was unable to gain access to the source AVMA
report]
The following FDA official data below may provide some perspective.
Bear in mind that these were obvious immediate incidents voluntarily
submitted, and that there are no studies for, or reporting of, long term effects.
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4499
415
2001
1500
138
Injection
Revolution
(Selamectin):
8695
181
1999
1737
36
Topical
Interceptor
1922
(Milbemycine oxime):
84
1995
214
Oral
Heartguard
2840
(Ivermectin/Pyrantel):
51
1996
355
Oral
Sentinel
(Milbemycine
oxide/luferon):
25
1999
233
Oral
892
*In 2004 the manufacturer reluctantly withdrew this product from the U.S. market, while denying any
problem with its product and smearing the FDA vet that brought the issue to light. The same
manufacturer is currently involved in another flap over a new flea & tick preventative.
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Four years ago HUA alumni, Zeke, was diagnosed with diabetes. We had a terrible
time with the disease. He went completely blind and had to have cataract surgery
to restore his sight. He developed a neurological disease that caused his eye to
sag. Then he developed a different neurological disease that caused him to waste
in his back legs. He, of course, met every challenge with the grace of a dog always an inspiration.
Weve done a lot of research on diabetes since that time and learned that Zeke is
not the typical type of dog who gets this disease. Hes a mixed breed dog, and it
typically strikes certain breeds of purebred dogs. He has not been vaccinated
annually, and it typically strikes dogs whose immune systems are stressed by
annual vaccinations. He eats top quality foods and drinks filtered water, and it
typically strikes dogs who have poor diets. And hes not treated with flea and tick
chemicals which can also stress the immune system. So we asked his vet how it
could be possible that this dog, who has never been sick in his life, got this disease.
Although the vet cant prove it, the probable cause of Zekes diabetes was the
heartworm pill that he got two weeks before the onset of the diabetes. Heartworm
chemicals alter the normal cells so that the body considers them foreign and
attacks them. This can lead to a variety of immune problems from allergies to liver
failure or as in Zekes case, diabetes.
This statement by Zekes vet sent us off to research heartworm preventatives. The
Summary of Adverse Drug Reactions published by the Food and Drug
Administration tracks the numbers of dogs who have reacted to heartworm
preventative treatment and who have died from them. The numbers are pretty
startling. For instance ivermectin which is the ingredient in Heartgard had 681
dogs react and 134 dogs die from 1987 to 2000. These numbers dont even include
dogs like Zeke since the links cant be proven. The story of Sage the Aussie who
died after being treated with Revolution was reported widely on the Internet. The
fact is that the heartworm preventatives are all poisons. They are designed to
kill the worms. Now of course heartworms are an terrible thing. So the question is
whether the treatment is worth the risk.
Your dog cant speak for himself, he relies on you to protect him. His life depends
on you.
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HS II [producer's description]
This product is a combination designed for support to the circulatory system,
containing: hawthorn berries, capsicum and garlic. Hawthorn berries is used
to strengthen and tone the heart, feed the adrenals, cleanse arteries, and has
been known to balance blood pressure. Capsicum has long been used as a
way to boost circulation and cleanse the body. Recent studies have shown
garlic to be of benefit to the digestive, circulatory and immune systems.
Ingredients are stated as:
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Did you know that the pharmaceutical industry, in their never ending quest
for new proprietary products, commonly focuses their search on natural
sources, such as herbals, with empirical evidence of applicability to their
interests. Then they isolate and synthesize components for testing, and add
toxic adjuvants. One might say they take something natural and turn it into
something unnatural, which might, in part, suggest why these drugs have so
many adverse side effects. Even natural compounds that we and our pets did
not evolve to handle in a positive manner, or excesses otherwise, have
adverse effects. Our metabolic physiology, and that of our pets, is much
more complicated and finely tuned than we seem to understand in looking for
a quick-fix or a new profit stream.
The pharmaceutical industry's avoidance of long term studies of adverse
drug effects in humans and especially animals over the years, in stark
contrast to the 25 to 30% of every sales dollar spent on product promotion, is
very unsettling to me. I believe one aspect is that there is so much money
involved that too many turn a blind eye on the issue 30% of worldwide
sales is almost $200 billion with about half disseminated in the U.S.
Even so, one should not allow their disillusionment with one industry to blind
them to the shortcomings of another. The so-called natural alternatives is
a rapidly growing industry with their eye on greater profits, which entices
many of the same types of business people.
Success, like war and like charity in religion, covers a multitude of sins.
-- Sir Charles Napier
Anyway, you get the idea behind avoiding vaccinations and medications that
stress and weaken the immune system. I'm sure you also understand the
ideas of regular exercise, and a healthy emotional environment relative to a
pet's health. The species appropriate diet aspect, however, is another area
where big industry has brainwashed a majority of pet owners. I wont get into
the inappropriateness of commercial pet foods herein because I have another
lengthy paper entitled The Facts About Pet Diets, but I think a few points
applicable to a species appropriate diet are necessary herein.
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The first point is really understanding what a species appropriate diet is.
Basically, for dogs and cats, it is raw meat, bones, and organs in
approximately a 80% meat, 10% bone, and 10% organ (half of which should
be liver) ratio, fed over time (such as a week). It must be raw because
cooking meat and organs destroys many of the nutrients, and cooked/smoked
bones are dangerous because they are brittle and splinter.
Fortifying/supplementing cooked foods is not nearly as bioavailable as the
natural nutrients, and is a slippery slope. As to plant matter, how many
reports have you heard of wolves attacking a grain field or vegetable garden,
and yet they thrive (except for the predation of, and competition for food
from, mankind). Maybe they just sneak into the garden when we're not
looking :-)))
It is also important that this diet be fed whole (as whole as possible relative to
the size of the recipient) and not pre-ground. This promotes oral health and
prevents periodontal disease which otherwise looses toxins in the blood
stream for yet another burden on the immune system.
Aside from a human squeamishness aspect :-) , unless one has access to
complete wild game prey, or can afford such from a reputable source, there
are a few considerations in trying to mimic such. The meat one can normally
purchase originates from industrial agriculture, and it is not the meat that
wild game is, or even the next best choice of organic grass-fed/free-ranging
livestock.
One of the major problems with industrial agriculture meats is, while they
have a high omega 6 content, they have a much lower omega 3 fatty acid
content. Ideally a dog needs a 4:1 (n-6:n-3) fatty acids ratio in their diet and
closer to 2:1 would be better. Supplementing with wild salmon oil [not from
a mass rendering facility and not molecular distilled] can offset this problem,
but not cod liver oil because then you would be adding too many fat soluble
vitamins as well.
Omega-3, being one of the essential fatty acids, is a significant problem in
human diets as well, where the actual ratio is typically more like an
unhealthy 30:1.
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Industrial agriculture livestock are fed out on high gain feeds and don't get a
lot of exercise which adds a couple issues. The first is a higher proportion of
fat, so you might need to trim away some fat. The second is potentially
lower taurine (a sulfur-containing amino acid important in the metabolism of
fats and a potent neuroprotectant) in some meats, but including enough heart
and/or brains can compensate. Consider heart a meat rather than an organ.
Lastly, the food processing industry is using more and more additives to
packaged meats for longer shelf life and better appearance. Avoid all you
can, especially nitrates, sweeteners, and hydrogenated fats. Industrial
agriculture livestock are also given lots of medications which you can't
completely avoid, and even nowadays GMOs (genetically engineered
organisms) which should be avoided because we really don't know the long
term effects. Avoid farmed fish because they receive more antibiotics per
pound than any other livestock, and even many wild caught fish contain high
levels of contaminates such as mercury, so select carefully and feed sparingly.
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Heartworm Treatment
Here again, after discussing testing, we'll categorize by conventional,
alternative, and natural.
Testing
Whether you just suspect your dog has a heartworm infection because of
symptoms, or an annual/semiannual heartworm test is positive, you should
see your veterinarian for further tests, regardless of whether you might follow
the veterinarian's treatment advice. It is important to understand exactly
what you need to deal with. Diagnosis and treatment for cats will vary.
False-positive and false-negative antigen tests do occur, the former usually
due to technical error, and the latter (if unexpected) occurs most commonly
when infections are light, female worms are still immature, only male worms
are present and/or the test kit (for test kits requiring refrigeration) or sample
has not been warmed to room temperature. If an antigen test contradicts
other clinical evidence, a second antigen test format might be employed.
Even when a positive test result is not questioned, quantitative analysis of
antigen results is highly speculative and requires correlation with other
relevant information, such as concentration tests for microfilariae, thoracic
radiography to detect signs of heartworm disease or ultrasonographic
(echocardiography) visualization of worms. Radiography provides the most
objective method of assessing the severity of heartworm cardiopulmonary
disease. Echocardiography can provide definitive evidence of adult
heartworm infection, but is not an efficient method of assessment of cardiac
anatomic and functional consequences, particularly in lightly infected dogs.
Obtaining a second independent diagnosis from another veterinarian is not
unheard of.
If there has been limited potential for exposure, insist that all positive antigen
tests in asymptomatic dogs be rigorously confirmed prior to any adulticide
therapy.
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Recent research has shown that it is also important to treat for Wolbachia, a
parasite that lives symbiotically with the heartworms and may be responsible
for much of the damage that they cause, both from inflammation and from
pulmonary emboli, no matter what other form of treatment you decide on.
Exercise restriction should be enforced from the time of diagnosis through
the complete treatment.
Conventional Treatment
The first step, nowadays, is usually treatment with doxycycline (an antibiotic)
to kill the Wolbachia parasite in heartworms. The purpose is to weaken the
heartworms and make them unable to reproduce, lessen their adverse effects
on the body and reduce the chance of adverse reaction during heartworm
treatment. A current recommendation is to treat with doxycycline for 30 days
prior to beginning adulticide and microfilaricide treatment. However, a
study done in a UK lab showed that intermittent treatment was more effective
in depleting Wolbachia than continuous treatment. Wolbachia will repopulate
over time, so the treatment with doxycycline should be repeated
intermittently during heartworm treatment, depending on the time span of
treatment.
Alternately, for a Class IV diagnosis, surgical extraction of adult heartworms
must be pursued first and promptly, if such a dog can potentially be saved.
Further heartworm infection treatment can't be contemplated until the dog is
stable enough to fit into one of the less severe classes. This may entail
enlisting another veterinarian that has special training in the procedure and
special surgical equipment. Fluid therapy may also be necessary in critically
ill, hypovolemic dogs to restore hemodynamic and renal function.
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Though there is some disagreement, the second step for at least Class I and II
diagnosed dogs is usually killing the microfilaria and migrating worms.
Ivermectin (Heartgard) at prophylactic doses will kill microfilaria, L3, and
L4 larvae, and reduce female worm mass by inhibiting their reproductive
system. Administration of ivermectin at prophylactic doses for greater than
three months should result in reduced antigenic mass, which in turn may
reduce the risk of pulmonary thromboembolism during adulticide treatment.
A veterinarian may recommend a higher ivermectin dosage, or shortening
the administration interval to two weeks, to shorten the time before adulticide
treatment, but such is your call based on how urgently adulticide treatment
needs to begin, considering that it is the adult worms that cause heartworm
disease, but there is a risk of anaphylactic shock in killing off the microfilaria
too fast. Comments by holistic veterinarians I have come across in my
research question whether a higher dose protocol is any more effective.
Macrocyclic lactones, other than ivermectin, might also be recommend, but
others don't have as wide a range of effectiveness, and some substantially
increase the risk of anaphylactic shock.
This second step may be combined with the first step (intermittent treatment
with doxycycline) and may proceed for a term of three to six months. While
most heartworm positive dogs get away with taking ivermectin safely, the
dog might be pretreated with anti-inflammatory medication, and ideally
observed in the hospital for this first day of treatment. However, the
empirical use of aspirin for its antithrombotic effect or to reduce pulmonary
arteritis is not recommended for heartworm-infected dogs. Convincing
evidence of clinical benefit is lacking, and there is some research suggesting
that aspirin may be contraindicated.
The rapid death of large numbers of microfilariae during the early elimination
phase, 4-8 hours following the first dose, can cause systemic side effects and
potentially acute circulatory collapse. Close observation of higher risk dogs
is advised for the first 8-12 hours following administration of microfilaricidal
drugs at doses that produce a rapid reduction in circulating microfilariae.
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For acute circulatory collapse, prompt treatment with parenteral fluids and
one or two shock therapy doses of glucocorticosteroids is usually an effective
antidote.
For some with heartworm positive dogs, this second step extended is the
treatment regimen. This is termed the slow kill approach, and takes from
18 months to sometimes over two years. This slow kill approach does
work, and is safer than the fast kill adulticide treatment from the point of
view of drug reactions, but the risk of emboli is the same, or even worse,
since you're stretching it out over a much longer time. An Italian study
presented at the American Heartworm Society Symposium in 2004 followed
actual client owned dogs treated with this approach, and the incidence of
pulmonary changes and other problems was very high - higher than with the
standard "fast kill" protocol. Though there is still not sufficient scientific
evidence to quantitatively assess individual risk, there is the general warning
owners of dogs receiving such therapy should be advised that any
respiratory difficulty should be considered an emergency."
This slow kill approach might be practical for a Class I diagnosis of a dog
that is not overly active, but beyond that it may be increasingly risky.
Adulticide therapy is the administration of Melarsomine Dihydrochloride
(Immiticide made by Merial; an organic arsenical chemotherapeutic agent)
which is highly effective against both sexes of L5 larvae and adult
heartworms. It is administered via deep intramuscular injection into the
epaxial lumbar muscles. This is a painful injection with a painful substance,
and it is common for the patient to experience swelling and considerable
soreness at the injection site for a few days (pain medication may be needed).
The injection site may actually form an abscess that requires warm
compresses, and some dogs develop a permanent firm lump at the site of the
injection. The potential extent of swelling and soreness may be reduced
somewhat by ensuring that the injection is deposited deeply with a needle of
appropriate length and gauge for the size of dog and body condition.
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Adverse reactions may occur after the second/third injection in the series
even if no problems were encountered with previous injections. All patients
should be closely monitored during treatment and for up to 24 hours after the
last injection. Post-treatment mortality due to thromboembolism and/or
progression of the underlying disease may occur in 10 to 20% of the Class 3
patients.
Treatment can be done in two doses or three doses depending on the class of
heartworm infection. The three-injection staged protocol is the treatment of
choice of the American Heartworm Society and several university teaching
hospitals, regardless of the stage of disease, due to the increased safety and
efficacy benefits with a more gradual kill of the adult worms (which is safer
in terms of embolism and shock), and subsequently fewer dogs that require
further treatment with melarsomine.
In the two dose protocol, the dog receives a second injection the next day on
the opposite side of the lower back. In the three dose protocol, the dog
receives a second injection one month after the first, and then a third injection
24 hours after the second. In the three-injection staged protocol the first dose
represents an introductory treatment to kill some of the more sensitive worms
to avoid too many worms dying at once and creating circulatory shock.
During treatment, and for at least one month following the final injection, the
patient must be strictly confined (no exercise) because embolism to some
degree is inevitable and it is important to minimize embolism-related
problems. If coughing, fever, or nose bleeds occur, consider it an emergency
and contact your veterinarian immediately. The most critical time is 7 to 10
days following a melarsomine treatment but they can occur anytime in the
following month. If the dog can not be monitored full-time at a veterinary
hospital, then you should have some help at home throughout the treatment
and one month afterward.
Six months post-adulticide treatment an antigen test is done to determine the
treatment efficacy. At this point a microfilaria test could also be performed
to insure the dog is no longer a potential host. If any microfilaria are still
present ivermectin at prophylactic doses might be given for a period.
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Alternative Treatment
See the initial notes under Alternative medicine approach to heartworm
prevention (page 29).
This is a sampling of what I could find. Some are also used in alternative
heartworm prevention, though the dosage may vary.
HeartWorm Free (aka HWF) [producer's description]
Studies have shown Amber Tech's natural organic formula can help relieve
your dog of heartworms. It can eliminate the heartworms slowly over a
period of time allowing the dog's own immune system to help rid the
heartworm from his or her body. Because it works slowly your dog does not
need to be confined and can continue to play as he or she normally would
(not allowing over exertion such as racing or breeding). It can take 14 to 36
weeks to overcome heartworms. The ingredients are:
During treatment they recommend also putting your dog on another of their
products, Kidney Rejuvenator to help eliminate some of the stress on the
kidneys.
After treatment they recommend keeping the dog on HWF, but at 1/2 the
normal dose once/day for 3 to 4 months. They also note that one might give
a full body detox to help the body eliminate dead worms using Amber
Technology's Internal Gold Detox Kit.
Their qualification is: Although most dogs recover on the 16 - 24 week
course not all dogs will. Severely infested dogs may not recover if the
worms have formed a tight ball within the heart. A good diet, moderate
exercise, and plenty of fresh water may increase your dog's odds of
overcoming heartworm. If your dog is on the HWF longer than 36 weeks,
take a 3 week break, then continue if needed.
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Natural Treatment
If you understand the section A Natural approach to heartworm prevention
(page 40) then you should understand (whether you agree or not) the thinking
that for a dog with a healthy immune system the best treatment may be no
medical treatment.
If a dog has a light infestation and has a very healthy immune system, then it
is possible the dog will be able to fight off heartworm infestations, or at
least tolerate a small number of adult worms. If this approach is taken, then
the state of the heartworm infestation should be closely monitored with more
frequent testing. If the infestation increases, then it might be time to consider
either an alternative or conventional approach.
One should also understand that in not treating a healthy dog that seems to
tolerate a small number of worms, one is allowing one more potential host for
spreading heartworms.
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Closing Comments
Whatever approach one takes to heartworm prevention and treatment, locally
appropriate periodic testing and the overall health of your companion animal
are the keys to prevention, the extent of possible infestation, and the long
term overall success of treatment.
You know (or should) that eating one french fry is as hazardous to our health
as smoking one cigarette, and that soda pop is a nutritional disaster, but we
can exist many years on a diet of mostly french fries and soda pop,
although we will be more susceptible to health problems. Commercial pet
foods, or any non-species-appropriate diet, have a similar effect on our
companion animals.
Similarly, consider all the potential side effects and long term damage of the
medications humans take (even OTCs), and you know there is hokey-pokey
reporting (at least you have a suspicion if you have followed the news, and
know if you have done much research). Then consider that because animals
are supposedly inferior to humans, oversight of drugs is even more of a
sham, and there is considerably more industry chicanery.
I wont even get into all the environmental dangers humans have created, that
can affect us and our companion animals.
Whether to take a conventional, alternative, natural, or some combination
thereof, approach to the heartworm issue is an individual decision that should
be made in the best interests of your companion animal. Here in northern
New England, when most veterinarians began advising year around
chemoprophylaxis (remember that is a misnomer) some years back, I began
to suspect their understanding and/or priorities, and started learning
everything I could about mosquitos, heartworms, chemoprophylaxis and
chemotherapy, alternative approaches, and natural approaches. Along the
way I have become increasingly aware of just how much big business tries to
influence our decisions by sophisticated manipulation of our emotions. It
doesn't matter whether such is for a new TV, car, influenza vaccinations, or
pet food.
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In the hope that reiteration will make the point clearer The heartworm has
been out there forever as far as we know, but we dont read reports of wild
canines, distanced from the hand of man, being wiped out by heartworm, and
yet domestic dogs are increasingly victim to it. Nature didn't intend for
parasites to kill off their hosts, otherwise the parasites would not survive
either. And evidence supporting this line of thinking In a 1991-1996
disease testing study of live-captured wolves in Wisconsin, heartworm
infection was found to be very rare (rarer by far than Canine Parvovirus,
Infectious Canine Hepatitis, Canine Distemper Virus, Lyme Disease, and
Blastomycosis which were also tested for). [Check out Wisconsin on the
heartworm incidence map I've been there and it is a mosquito paradise in
the summer.]
Why are more domestic dogs increasingly more seriously affected by
heartworm?
If you're stumped then you missed some salient points in this paper :-)
Just my personal take, but for what it's worth, my dogs and I take a mostly
natural approach, believing that a [metaphorical] meteor strike is less likely
to do us in than man's tinkering with nature in general and our physiology in
particular. I grew up on a ranch in Wyoming in the 1940s and have come full
circle, learning not to play the game of life with those having loaded dice ;-)
I sincerely hope this paper gave you sufficient insight to be more fruitful in
your own research.
And I hope this finds you and yours "As fit as a butcher's dog"
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