Testing 1, 2, Guess We Don't Need 3

About the heartworm testing 
That link talks about doing a yearly test for dogs:
1. Who have been on the heartworm pills
2. Who have not been on heartworm pills at all before putting them on the pills
3. Who are switching between types of pills (say going from Heartgard to Interceptor or vice versa)

This is some important information - puppies can start on the pills younger than 7 months of course:

Puppies under seven months of age can be started on heartworm preventives without first being tested. This is because it can take up to six and one half months after being bitten by infected mosquitoes before the dog will test positive. The puppy should be tested four to seven months after starting heartworm preventive to detect any infection acquired during the first few months of life. Consult with your veterinarian to determine the right testing schedule for your pet.

This rescue re-tests dogs in foster at the six month point after their first heartworm test.

This is how we discovered that Mila was heartworm positive. Using the SNAP test (tests for antigens if you want to google) it can detect as few as one or two adult female worms, and in general, infections that are at least 7 or 8 months old. When Mila first came in and was tested in December her infection was not yet able to be detected.

Oh, SNAP!

Her doctor checked it twice just in case. Both were positive. That's when we started working on some things.

This blog has been a little slow in terms of her treatment because it took quiet a while to get her to that quieter point, as detailed before. It is nice to have a quiet heartworm positive foster, and a little more nerve-wracking to have one with pizazz and moxy!

As we've said, that's because as the worms die off  they can clog the blood vessles in the lungs and create clots. If the dog is moving, barking, etc, that faster blood rate, higher blood pressure that comes with that activity can cause an embolism: a blood clot in the lung. You do not want this! More here: http://dogaware.com/articles/wdjheartwormtreatment.html#immiticide

So we needed to practice pottying on the leash. Mila is good at that BUT we discovered that she prefers the long line to a shorter leash, so she can at least have a little privacy.

Do you mind?

Bad short leash - too close for comfort

This was in the winter, playing with a friend

Mila likes her orange biothane long line for safe potties

Next on Big Dogs, Big Heartworm: Summary of important HW info, then, Mila starts her treatment.

Heartworm Life Cycle

Boy, this is a lot of blah blah blah to us, but let's try to break it down a little. We have a feeling this will be a short post! But it really is important information to understand those 5 larva stages (larva? larval? larvas?). 

Taking again from the Heartworm Society, and trying to put it in a way we can all understand better - and this starts with the dog who is already Heartworm positive and works its way around:

1. Adult female heartworms release their young, called microfilariae, into an animal's bloodstream. So baby worms are the microfilariae.

2. Mosquitoes bite the heartworm positive dog and become infected with microfilariae (baby worms) when they take in that blood.

3. During the next 10 to 14 days, the baby worms mature to the infective larval stage within the mosquito.

4. Then, that infected mosquito bites another dog, cat or other susceptible animal, and the infective larvae enter through the bite wound.

5. It then takes a little over 6 months for the infective larvae to mature into adult worms.

In dogs, the worms may live for up to 7 years.  The number of worms infecting a dog can be very high, with the number of worms in dogs ranging from one to approximately 250. We should post another gross picture here. Warning - Gross Heartworm Picture Below!

Heartworms in the heart of a dog

Can't stop - here is another!

Heartworms in the Pulmonary Artery of a dog

Sorry.

So:
L1 - Microfillariae aka baby worms
L2 and L3 - Develop in the mosquito over approximately 2-3 weeks time (faster in hotter weather)
L3 - Capable of infecting a new dog, once safely inside the new host, the L3 will spend the next week or two developing into an L4 within the host's skin.
L4 - Will live in the skin for 3 months or so until it develops to the L5 stage and is ready to enter the host's circulatory system.
L5 - Actually a young adult, migrates to the heart and out into the pulmonary arteries (if there is room) where it will mate, approximately 5 to 7 months after first entering the new host.

From: http://www.ampvetclinic.com/Heartworm.php

Hello, microfilariae

Baby worms cannot mature into adult heartworms without first passing through a mosquito. It seems like there wouldn't be so many heartworm positive dogs (6 in one rescue in a few months as a recent example), doesn't it? Then we read this little ditty from the Drs. Foster and Smith site:

An important part of a complete heartworm prevention program is testing. All dogs should be tested for heartworm infection before starting a preventive program. Testing ensures that your pet is free of adult heartworms, and ready to start or continue on heartworm preventive medication. The American Heartworm Society (AHS) estimates that only 50% of dogs in areas where heartworm occurs are actually on heartworm preventives. Of those prescribed heartworm prevention products, only about 75% receive all of the doses. Since heartworm continues to be a fatal disease and pet owners' compliance with heartworm prevention is less than optimal, the AHS recommends these guidelines for heartworm testing 

Next time - those tests and more Mila. 

Wolbachiwhat? Mila Loves Cream Cheese!

While waiting for her heartworm treatment to start, Mila took a month of Doxycycline.

If doxycycline is incorporated into a heartworm treatment protocol it should be given before administration of melarsomine so the Wolbachia organisms and their metabolites are reduced or absent when the worms die and fragment. Doxycycline administered at 10mg/kg BID for four weeks has been shown to eliminate over 90% of the Wolbachia organisms and the levels remain low for three to four months.

From: http://www.heartwormsociety.org/veterinary-resources/canine-guidelines.html

Mila loved her month of Doxy because that meant she got 2 gobs of cream cheese every day, plus yummy liquid probiotic mid-day to help her gut. We were really careful about separating out the dose and did not use yogurt in case that might upset her stomach.

What are these wolbachia that we speak of?

Wolbachia is a genus of rickettsial organisms (sort of like bacteria but not exactly). They live inside the adult heartworm. These organisms seem to be protective or beneficial to the heartworms and treating the dog with the antibiotic doxycycline, which kills the Wolbachia, seems to sterilize female heartworms (meaning they cannot reproduce). Wolbachia is also thought to be involved in the embolism and shock that results when heartworms die. The role of this organism is still being investigated.

From: http://www.marvistavet.com/html/body_heartworm_treatment.html

But Mila's beloved cream cheese was not taken from her just yet. Mila is one of the youngest nine year old dogs ever. We have taken her to events that would tire a much younger dog and she, much like a Cyborg in a Terminator movie, regenerates on the car ride home. So we are ready to take a nap, and Mila thinks maybe we should do something else, because she loves to interact with her people.

Okay, we've got the dog food, where do we go next?

Unfortunately, this level of activity is not good for a dog undergoing heartworm treatment. From that same link:

After treatment, the patient must be strictly confined for one month following the final treatment.* No walks, no running around. The dog must live the indoor life. The reason for this is that embolism to some degree is inevitable and it is important to minimize embolism-related problems. Exercise increases heart rate and oxygen demand and we need the heart to rest during this recovery period.

* after each treatment

So we need to keep Mila quiet. Even in her bed, Mila can be raucous! So we started experimenting with heartworm treatment safe medications to calm her. Talk to your vet about this as some can be dangerous for the dog during treatment. After much trial and error, we may have found a combination of things that we hope will help her to stay quiet during her treatment:

•  A different crate: Mila was in a GIANT, open wire bed while we were practicing crate rest, so we moved to a GIANT closed crate, like an airline carrier
• A different location: Mila was right in the middle of things at first, she is now in a bedroom (with the AC on) that is quieter
• Over the counter medications and remedies were tried and we moved into prescription medications - and we are still experimenting and working on this
• Animal communicator to explain the situation to Mila (hey, we will try anything to help)

Keeping a dog quiet during heartworm treatment is extremely important and we want Mila to get through this two months well. Thanks for reading!

You Say Mosquito, I Say...Well...Mosquito

Remember that famous heartworm map from the last post on Heartworm in general? With the dark colors areas where you are not going to avoid heartworm no matter what (but can prevent it of course), and then the lighter areas where there is heartworm, but not originally in that area so much? And the whole make it easy, heartworm is brought to you by the letter M, for Mosquito with the giant mosquito picture?

There are definitely more details if you are interested!

First, mosquitoes. Did you know that this group existed? Yes, the American Mosquito Control Association!

And here is a blog that has some information from that group. Not to be all "the sky is falling!" (um, again) but "mosquito control experts are expecting the summer of 2011 to be the worst mosquito season in decades." According to that blog a couple of things we can do is to get rid of standing water and to not go out an hour before and after dawn and an hour before and after dusk. Of course, that's when it's cooler so that's where using a heartworm product that you get from a veterinary office or reputable online store will come into play.

So what's the more complicated part? Heartworm: Beyond the Mosquito (that would be the movie title if we could make this into a summer blockbuster, probably starting Christoph Waltz as a very bad mosquito).

From this link: http://www.canismajor.com/dog/hartworm.html

Heartworm disease is present on every continent except Antarctica.(1) It occurs where these four factors are found:

1. a susceptible host population (DOGS!)
2. a stable reservoir of the disease (UNTREATED dogs)
3. a stable population of vector species (MOSQUITOES)
4. a climate that supports the parasite’s life cycle (but note that AHS still recommends year round use of medicines such as Interceptor)

Dogs are considered the definitive host (2) for the parasite; even though the disease is not transmitted directly from one dog to another, untreated dogs provide a stable reservoir for the disease.

Note the whole "the disease is not transmitted directly from one dog to another" idea. That just means that a dog doesn't lick another dog and give them heartworm. Or a dog can't get heartworm from eating the poop (yes, some dogs do that - not ours of course) of a heartworm positive dog. And they can't get it from sitting on the toilet seat after a heartworm positive dog either!

This is the easiest explanation I could find and it's from Interceptor. The infected dog is #2 from above. The mosquito is #3. The healthy dog is #1. If they are on a med, the heartworm will not develop into adults. If they are not, the cycle can begin. I am hoping this makes sense, because it's taken a while for us to get it to make sense in our heads too.

When you look at that, and can understand that, you can either stop there, knowing enough, or you can go nitty gritty. This graphic talks about Larval stages:

And we will finish up with that next time we talk about HW disease!

Next post: Back to Mila!

It's about time!

Staging Mila

When we first found out Mila was heartworm positive, it was somewhere between a surprise and expected. Expected because she had been outside, without heartworm pills for 7 months. A surprise because she had tested negative in December. But expected based on what we understand about how heartworm works. Still, just a little surprised and the reason for this blog - trying to help other people and dogs not have to go through something that can be prevented.

Once a dog is found to be heartworm positive, you start to work on keeping them quiet. We knew this was going to be a challenge with her. Mila is nine years old on paper, and her legs may be a little wonky sometimes, but in her mind and in her attitude she is a much younger dog. Mila is spirited and bossy, in a caring way. She is a town crier, announcing things that need to be done. Breakfast, end of quiet time, afternoon potties, all of these things and more, Mila is the app for that, without the need for a fancy phone. She's a SmartDog.

So that was challenge #1, and one that we are still working on leading up to her treatment. That's right, we still haven't figured out how to keep Mila calm. More on that another time!

Little old me?

The next thing you need to do is let your vet stage the disease. There are four stages. Below is a handy chart! If you ever have to deal with a dog with heartworm disease, it's nice to have an idea of the lingo that is used so you can translate doctor speak in your head.

You Can Read More Info From: http://cardiology.vetmed.lsu.edu/Education/AcquiredCardiacDiseases/HeartwormDisease/tabid/448/Default.aspx
So Mila had:

• bloodwork done
• x-rays
• a medical exam  

The good news is that she looks like a Level 1 case.
Other tests that could be done to stage:

• A Knott's test could have been done too to look for microfilaria. The microfilaria are the baby worms. 
• A urinalysis could have also been done to gain more information, but based on what we had, we did not do that. She had a urinalysis done a couple of months before her treatment started.
• Echocardiography

X-ray for staging Mila

Next time - that complicated life cycle thing. Thanks for reading and feel free to ask any questions, make any comments.

Where is Heartworm? How Do Pets Get It?

It. Is. Everywhere.

This is the famous Heartworm Map. Sometimes people use it to say, "see we don't have heartworm here." But, according to the Heartworm Society, heartworm has been found in all 50 states. As Shaggy might say, "Zoiks."

So what we need to look at is the text around the map on that Heartworm Society website (and this time no graphic photos when you click on that link).

And that text says that it shows areas in red that are particularly endemic based on number of cases reported by vet clinics. They are even nice enough to tell us what endemic means:

endemic

native or indigenous. Originating in that given geographic area.

So we see that the areas in red just have heartworm no matter what. And that other areas have it, but it is not AS native or natural to have it there. But don't think it doesn't happen. Mila is from a light pink area. We have had six dogs test positive this spring/early summer - there are always going to be people who will say that this information is not needed, is reactive and overwrought, and you can read what they have to say as well.

A couple of other points:
If pets don't get tested for heartworm, they don't get reported. It would be quite interesting to see what would happen if all dogs were tested for heartworm. A big national heartworm grant or something!

They call it the Katrina effect of bringing HW+ dogs from the hurricane area and dispersing them throughout the country, bringing the infection with them but we know it's not just Katrina dogs. This is a bigger problem if the people taking dogs from higher heartworm areas to lower heartworm areas don't test and treat. Rescues and shelter adopters that treat help the problem!

Creepy mosquito graphic from www.umaa.org/

So how do dogs get infected with heartworm? Well, it's complicated. But it's not. We can start with the simple answer. Mosquitoes. We can go complicated next time.

Next Time...

Huh?

A Note to Mila's Person

Mila had a person of her very own for over 8 years of her life. We understand that the two were inseparable, and each others treasure. 

Dear Mila's Person,

We have your girl now. We know that if you could, you would still have her with you. She is safe and in a foster home.

But more than that, when we have fosters, we treat them like we hope someone would treat our own dogs if something happened to us. We know that things can happen in our lives that we can't control. We know that happened with you.

And we want you to know that Mila is loved and cherished, and will be whether it is in a foster home or her forever home, by all of us in the BDBH organization.

Right now is a hard time for Mila as she gets ready for her heartworm treatment. Mila is not a quiet, retiring senior. She is a a nine year old go-getter. She is vim and vigor.  We are working to find ways to help her stay calm, which is very important for her treatment.

But no matter what, Mila is loved. That is our promise to her, and to all the others that we can help.

BDBH

Heartworm Pill Reminders

The Heartworm Society is now recommending year round prevention - from their website:

Chemoprophylaxis: AHS recommends year-round administration of chemoprophylactic drugs to prevent heartworm disease, increase compliance and control pathogenic and/or zoonotic parasites.

Our blog isn't here to give medical advice (for sure!) so take a look again at their site, talk to your veterinarian and go from there. There is a graphic picture near that text so warning for that!

Too much to remember!

I have a plastic bag that I put my dogs' heartworm preventatives in. Each time they get one, I write it on the plastic bag. I guess I've been giving a monthly heartworm pill since 1993, so it is an ingrained habit! I forget my own meds, I don't know where my car keys are, and don't ask me any of my computer passwords, but DING, I know it's heartworm pill time.

What if though, you are someone who has those other things under control, but that one pill...can slip your mind? Well, there's an App for that! Yes, we can get e-mail and text reminders for pet medications.

A quick google search came up with these sites - please check them out thoroughly before signing up:

Remind My Pet 
We could not find anything about a cost for this and it looks like you can do reminders for all kinds of medications. Interceptor links to this site.

Merial/Heartgard E-mail Reminder
Free monthly email service

Heartgard Apple App
A free Apple product from Heartgard

Revolution Membership
Sends you email reminders and more

If you use a brand of preventative not named, check their website to see if they will send you a reminder.

Next two blog posts:
A note to Mila's person.
Where is heartworm and how do they get it?

Have a Happy and Safe Fourth of July Everyone 
from BDBH!