Well, what *CAN* I do? (nothing, Mila)

------> Immiticide Unavailable  <--------

Just keeping that Immiticide issue above in front of all of us. We did call to check, and Mila should be set for her next injections, but we will probably have to call again just to satisfy that little OCD tendency. Maybe one more time after that. Wonder if they will let us go over with a little sticker that says Mila and put it on the vials?

So on to the idea of restriction of activity (not even exercise - exercise is out of the question - exercise: heartworm as Frisbee: ligament) after heartworm treatment. Lots of times when things happen with our pets, the big thing happens at the vet office in terms of treatment, but we often forget that our part is also important. Hip surgery - being compliant with the aftercare can prevent serious issues with the implant. We get it. Bloat/GDV - making sure you take care of that stomach with smaller meals as instructed by the vet. We understand.

But for some reason, people think they can do a leeeeeeeetle more than recommended with heartworm treatment aftercare. And maybe they will get away with it. However, if they don't, the result to the dog can be deadly. There is a reason best practices are called best. 

From: http://projectspayneuter.com/petowner/heartworm.htm They even CAPPED IT!

Strict exercise restriction. THIS IS THE MOST IMPORTANT PART OF THE TREATMENT PROCESS.  This is THE ONE thing owners can do to reduce the risk of serious complications.  Dogs who have been treated for heartworm disease should receive the absolute minimum of exercise for up to 4 months from the beginning of treatment.  Ideally, cage rest should be provided.  In very hyperactive dogs, a sedative may need to be used to help achieve this very important goal.  Dogs should be walked on a leash, not turned loose, for toilet duties.

And again here: http://www.petplace.com/dogs/heartworm-disease-in-dogs/page1.aspx

Exercise restriction is so important, because as the drugs are killing the worms in the arteries, the worms can break off and travel to block parts of the blood vessels (pulmonary thromboembolism or PTE). PTE results in obstruction of the blood flow to parts of the lung (pulmonary infarction). Keeping the dog quiet allows the body time to slowly break down and absorb the dying worms.

What are you looking for - how do you know something is wrong? http://www.houstoncollierescue.org/download_info_files/heartworm%20treatment%20aftercare.pdf is a good read. They have a nice disclaimer, and we also say - always call your vet - and talk to your vet about this before and after treatment to be sure that you are all on the same page. None of this is a replacement for the knowledge and expertise of a doctor, and if you can, find a doctor who has done heartworm treatment before.

1.Keep an eye on the gums; they should be pink. If they get very red or white, along with listlessness, call us and take the dog to the vet: the dog may have a secondary infection (red gums) or anemia/shock (white gums) and need quick intervention.
2. Pay close attention to combination of lethargy, increased respiration, restlessness, and coughing; if you note these symptoms after treatment, call us and take the dog to the clinic. She will probably be put on Prednisone and will respond quickly.
3. Watch for vomiting or any bloody discharge combined with listlessness, fever, rapid breathing/heart rate, and pale gums. Although extremely rare, also watch for hindquarter paralysis and urinary incontinence. With the symptoms in (3), which are life‐threatening, the dog goes immediately to the nearest Vet Clinic because the signs point to embolism (worm clot from the die‐off of the parasites during treatment); the doctors will keep her overnight, possibly a couple of days or even a week, put her on IV to hydrate her, sometimes oxygen if she's in distress, and give her cortisone injections to break up the clot.

Another http://www.petplace.com/dogs/heartworm-disease-in-dogs/page4.aspx:

Owners need to be very alert for the signs of PTE: coughing, fast or heavy breathing or fever. If these signs are noted, the dog should be presented for examination as soon as possible. If PTE is identified, it is usually treated with the administration of the anti-inflammatory drug prednisone. Oxygen may need to be administered until the dog is breathing more easily.

Some very mild coughing is to be expected after heartworm treatment. However, if the coughing is occurring frequently during the day, or if the dog coughs up blood, the dog should be examined. Any coughing should be reported to your veterinarian.

We know we've talked about these clots before and we will probably talk about clots again. Repetition is the mother of retention?

A HUGE (CAPS!) note on exercise restriction BEFORE (CAPS AGAIN!) heartworm treatment begins.
You say to yourself, oh, pish tosh, why would that be important? The worms aren't dying. I don't need to worry about the clots they keep talking about. I need to give my dog a month of doxycycline and I'm going to let them enjoy that last month of freedom  before 2-4 months of being quiet. Right?

Wrong! Sad study says that by letting dogs be more active after being diagnosed (and before treatment begins) they get sicker faster! Even if they have less heartworms to begin with.

As expected, the number of worms has an effect on the severity of disease, but of equal, if not greater, importance is the activity level of the dog.

Controlled studies have shown that dogs infected by surgical transplantation with 50 heartworms and exercise-restricted took longer to develop clinical disease and developed less pulmonary vascular resistance than dogs with 14 heartworms that were allowed moderate activity.

Or as they said in the Urgent Alert about the Immiticide Unavailability - see the CAPS - we know what that means:

Restrict ALL activity of the dog! Limit ALL exercise!
• The severity of heartworm disease is directly related to the activity level of the dog.
• As physical activity increases, pathology associated with adult heartworms increases.

So if you have a dog who tests positive for heartworm, you begin limiting activity immediately. At some point we'll talk about slow kill - that's almost 2 years of activity restriction. If you have a foster dog who is waiting to start treatment for whatever reason, restrict activity. Or your dog will get sicker, faster.

Am I at least allowed to shake my head? Potty #1, am.

I'm as still as statue for potty #2, at noon.

Am I done with my treatment yet? Last potty before too dark for potty pics.

And that was Mila's big day!