painted_ponies Posted February 19, 2008 Report Share Posted February 19, 2008 This Friday will be a month since Scot's HW treatment with immiticide. The vet told me to give him an Interceptor at home, and not to worry about adverse reactions. I know, he doesn't practice law and I don't practice veterinary medicine. But of course I had to google. The American Heartworm Society recommends observation of dogs with circulating microfilariae for eight hours after administration of milbemycin oxime in case of adverse reactions. I've also found some papers in the literature, albeit a couple of years old, that suggest reactions can be severe. However, Interceptor's website says reactions are unlikely to occur and are generally mild. The vet says he'll be happy to keep him all day on Friday if I'd like, although he doesn't believe there's any danger. If there's truly no need to leave Scot at the vet all day I'd rather not, since it will involve taking (even more) time off work to drop him off/pick him up. But if there is a possibility that something could go wrong, I'd rather be safe than sorry. What would y'all do? Should I: 1. believe what the vet tells me, since the letters after my name don't spell DVM; 2. leave Scot at the vet and say nothing about my research; or 3. leave Scot at the vet and share my research with my vet? Quote Link to comment Share on other sites More sharing options...
juliepoudrier Posted February 19, 2008 Report Share Posted February 19, 2008 How about plan D? Wait till Saturday morning (assuming your vet's open on Saturday), give him the preventive, and see what happens. If there is a reaction, you'll be there to see it and can rush him to the vet. J. Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 19, 2008 Author Report Share Posted February 19, 2008 How about plan D? Wait till Saturday morning (assuming your vet's open on Saturday), give him the preventive, and see what happens. If there is a reaction, you'll be there to see it and can rush him to the vet. J. I'm tempted to do that. I hesitate because my vet's only open on Saturdays from 8:00 am till around noon or one pm. Since one of the things the dog reacts to is the death of the microfilariae, I'm worried it could take longer than that for a reaction to develop. One paper I read recommended observation for 12 hours after giving the preventative; the American HW Society recommends eight hours. Once my vet closes I'm stuck with the emergency clinic at Myrtle Beach, which is an hour and a half away and wants you to sign a second mortgage on your farm before they'll see your dog. Quote Link to comment Share on other sites More sharing options...
Kenbo Posted February 19, 2008 Report Share Posted February 19, 2008 #2 or the Saturday thing Quote Link to comment Share on other sites More sharing options...
Kenbo Posted February 19, 2008 Report Share Posted February 19, 2008 What about late friday night or early Saturday, 2 or 3 AM then you could go when the Vet opens first thing if needed? Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 19, 2008 Author Report Share Posted February 19, 2008 What about late friday night or early Saturday, 2 or 3 AM then you could go when the Vet opens first thing if needed? I thought about doing that too. But I don't know how quickly the reaction might occur. If it happened within an hour or two, I'd be stuck with no vet close by. My vet actually lives in Camden, several hours away, and operates this clinic in the boonies where I live four and a half days a week. So there's no chance of getting to him outside of office hours. Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 21, 2008 Author Report Share Posted February 21, 2008 OK, having taken a deep breath or two, I've decided to be brave and give Scot his first Interceptor about 6:30 or so Saturday morning. I figure it'll take at least an hour for a reaction (doG forbid) to develop, and by 7:30 there's someone at my vet's office. They close at twelve, but surely a reaction would develop, if it were going to, within five and a half hours? If anyone knows why this might be a bad idea, please let me know. Y'all keep your fingers crossed for us. Quote Link to comment Share on other sites More sharing options...
aljones Posted February 21, 2008 Report Share Posted February 21, 2008 Fingers crossed here! FWIW, I gave both Johnson & Spirit their first monthly doses at home with no incidents...I did make sure it was a day I could be home to watch them, but all went well. I hope the same for you and Scot tomorrow! Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 21, 2008 Author Report Share Posted February 21, 2008 Fingers crossed here! FWIW, I gave both Johnson & Spirit their first monthly doses at home with no incidents...I did make sure it was a day I could be home to watch them, but all went well. I hope the same for you and Scot tomorrow! Thanks, Angie, it makes me feel better to hear of someone else whose vet just had them give the preventative at home. Everyone else I've talked to said their vet had them bring the dog in for the day. Quote Link to comment Share on other sites More sharing options...
Liz P Posted February 21, 2008 Report Share Posted February 21, 2008 Why don't you just avoid the worry and use Heartguard? Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 21, 2008 Author Report Share Posted February 21, 2008 Why don't you just avoid the worry and use Heartguard? *sighs* 'Cause I screwed up. A year or so ago, when I first started using him, my little vet was so proud of himself for knowing about ivermectin sensitivity in collies that I didn't have the heart (no pun intended) to try and convince him it was ok for border collies. I didn't think it was any big deal at the time, and of course he sent Scot home with a six month supply of Interceptor included in the price of the treatment. I'm afraid it'd be kind of late in the day to try and re-educate my vet at this point. Quote Link to comment Share on other sites More sharing options...
Liz P Posted February 21, 2008 Report Share Posted February 21, 2008 When the safety of your pet is at risk it's time for some educatin'. Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 21, 2008 Author Report Share Posted February 21, 2008 When the safety of your pet is at risk it's time for some educatin'. Ah. After further educating myself, I think I see why my vet wants to do the Interceptor. From the Am. HW Society's veterinary page: The macrocyclic lactones are the safest and most effective microfilaricidal drugs to become available to date. All are effective at the prescribed prophylactic doses. . . . Of the products formulated for dogs, milbemycin oxime is the most potent microfilaricide at its label dose and produces the most rapid rate of clearance. . . . 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 such as lethargy, inappetence, salivation, retching, defecation, pale mucous membranes and tachycardia. If reactions occur, most are transient and the signs usually are too innocuous to be appreciated. Occasionally, however, a dog with microfilaremia as low as 5000 mf/ml develops acute circulatory collapse. emphasis added The manufacturer's instructions on Heartguard said it was not effective as a microfilaricide at the prophylactic dose. I was suprised to read this, since particularly after Katrina and Rita so many rescues were treating HW cases by just putting them on monthly Heartguard. Anyway, I guess that's why most vets have the dog in the office for the microfilaricidal part of HW treatment - they're using ivermectin at a higher dosage. I feel better now, thanks everyone. Just as a warning, Faith's getting spayed the 29th. Y'all think I'm neurotic now. Quote Link to comment Share on other sites More sharing options...
Liz P Posted February 21, 2008 Report Share Posted February 21, 2008 One more quick reply before I get back to studying... If you give HG for a year it does not kill the microfilaria but it does stop them from developing into adults and reproducing. They will die off on their own using this treatment protocol. Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 21, 2008 Author Report Share Posted February 21, 2008 One more quick reply before I get back to studying... If you give HG for a year it does not kill the microfilaria but it does stop them from developing into adults and reproducing. They will die off on their own using this treatment protocol. Gotcha. Makes sense. Now go study! Quote Link to comment Share on other sites More sharing options...
Dixie_Girl Posted February 21, 2008 Report Share Posted February 21, 2008 Sally, I hope all goes well with Scot. But, why isn't the vet testing him? Holly was suppose to go in yesterday for her filter test. We have an appt. for Mon. When the filter test comes back neg, there is no danger in giving the oral preventive. I guess I am confused as it seems Scot's regime has been different than Holly's! Good luck, keep us posted! Will be thinking of you and Faith next week! Hoping all goes well! Holly can't get in to get spayed till March 11~they are booked that far ahead with spays! Yay! For a county like Laurens, that is great news that so many people are spaying! Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 21, 2008 Author Report Share Posted February 21, 2008 Sally, I hope all goes well with Scot. But, why isn't the vet testing him? Holly was suppose to go in yesterday for her filter test. We have an appt. for Mon. When the filter test comes back neg, there is no danger in giving the oral preventive. I guess I am confused as it seems Scot's regime has been different than Holly's! Good luck, keep us posted! The filter test is to determine whether or not there are circulating microfilariae. As I remember, Holly tested negative for HW at the shelter but positive at your vet's. Sometimes that happens if the shelter uses a filter test - which only tells if there are HW larvae in the blood - and the vet uses an antigen test, which tells if there are adult HWs present. I've read that can happen sometimes, for example, in dogs that have only one sex of adult HW present - no babies to circulate and get trapped in the filter. So I bet your vet wants to see if Holly has circulating microfilariae and if so how heavy an infestation she has before deciding how best to deal with them. Since I'm using Interceptor at the regular montly dose, there's not much point in doing a filter test. If he has circulating microfilariae, the Interceptor will kill them. If he doesn't, he still needs to be on a regular monthly dose of Interceptor. It might make me feel a little more confident about the possiblity of a reaction if a filter test showed a low concentration of microfilariae, but dogs with low concentrations can still have a reaction. Anyway, I'm going to be staring a hole in the poor dog for about eight hours on Saturday so I can whisk him to the vet at the first sign if necessary. Thanks for the good wishes. I was surprised my vet was booked two weeks ahead for spays in Marion Co. A good sign indeed. Quote Link to comment Share on other sites More sharing options...
aljones Posted February 23, 2008 Report Share Posted February 23, 2008 Hi, Sally--Just wondering how you and Scot are doing this morning? Hope all is going smoothly and you are enjoying a lovely Saturday without incident! Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 23, 2008 Author Report Share Posted February 23, 2008 Hi, Sally--Just wondering how you and Scot are doing this morning? Hope all is going smoothly and you are enjoying a lovely Saturday without incident! Thanks for asking, Angie. Unfortunately, it's been an eventful day. In the interests of advancing our collective BC Board store of knowledge, here are the symptoms of a reaction to milbemycin oxime: extreme lethargy (as in semi-conscious); labored, rapid breathing; and pale almost white gums. It took about an hour and a half for Scot to react. I gave him an Interceptor at 6:30 this morning, fed him breakfast, he helped me do chores - all was well. So I go in and eat my own breakfast, check on Scot - still fine. Go out to turn out the horses, peek in the back porch at Scot - and find him lying on his side on a hay bale, gasping and retching. Off we fly to the vet's office, and in walks this little guy I've never seen before! My heart sinks, 'cause my regular vet didn't know dogs could react to Interceptor, and now I'm stuck with some intern who no doubt knows even less. The sub vet stares at me while I run through the "31 days past immiticide treatment for heartworm, reacted badly, treated with doxycycline for ten days, had first dose of milbemycin oxime two hours ago" without drawing breath. Then he looks at Scot, who's being propped up by two vet techs to keep him from falling off the table, and drawls, in an accent even thicker than mine, "Is he usually this calm?" Nothing like a Southern sense of humor. Then the vet takes pity on me, and says "Ah've seen this before, an' Ah ain' never lost wun," and gives Scot a horse-sized syringe of dexamethazone intravenously. He tells me they're going to keep Scot a few hours and if he doesn't stabilize within that time I'll need to take him to the emergency clinic. The vet techs start carrying Scot to a crate in the back when suddenly he comes to life and starts whipping his head around looking for me. So I grab a paperback out of the truck, pull up some floor beside his crate, and get comfy. After about an hour, his gums started to pink up again and his breathing got less labored. After about two hours, he was able to sit up and drink a little water. By noon, we were pronounced out of danger and sent home. Right now I have him on the back porch, because when I brought him home Faith was so frantic she nearly strangled him, and wouldn't stop kissing his face long enough for him to get any rest. I'm checking on him every fifteen minutes or so. But you know, no cloud is without its silver lining. The sub vet is also a local farmer who has sheep. We had lots of time to chat this morning, so of course I asked loads of questions since no one, AFAIK, around here has done anything with sheep except give up. He wasn't an intern after all, but the guy who had the practice before my vet bought it out. Now he spends part of the year practicing at a couple of different clinics, and another part of the year travelling around the country doing embryo implantation. So for future reference, if anyone is interested, here's the sub vet's recommended protocol for HW treatment: Simply treat the dog with a prophylactic dose of ivermectin every month and within two years the worms are gone. I asked about damage to the heart over that time. He reminded me that successful parasites don't kill their hosts. He told me that, until forty or fifty years ago, we had no heartworms here. When we first got them, dogs left untreated tended to die relatively quickly - within a few years. But nowadays, he sees eleven and twelve year olds who've never been on preventative and who presumably have been HW+ve since their first year. He says if he has to treat with immiticide, he uses about half the recommended dosage and then uses ivermectin as the microfilaricide. It kills them gradually rather than all at once, like the milbemycin oxime, which lessens the likelihood of an adverse reaction. Well, time to go look in on my patient - who is one lucky dog, I reckon! Quote Link to comment Share on other sites More sharing options...
Anda Posted February 23, 2008 Report Share Posted February 23, 2008 Oh, that's scarry, Sally! Glad you were aware of the potential side effects and reacted so quickly, had a great vet that knew what he was doing and that Scot is now out of danger and feeling normal again. Give him lots and lots of hugs from me, please! Quote Link to comment Share on other sites More sharing options...
aljones Posted February 23, 2008 Report Share Posted February 23, 2008 Ohmigosh! My heart was just racing as I read through your post, Sally! I am so glad you monitored Scot so carefully and got him to the clinic ASAP. And got an experienced vet who knew what to do and treated him right away. (Although I have to admit I first read "sub vet" not as "substitute veterinarian" but as "lower than the usual vet life form," so that had me really worried! ) I think it's super-sweet that, as soon as he started coming around, Scot was immediately searching for you! What a guy! I also appreciate hearing the sub vet's recommendations for HW treatment. I know that there are a lot of different protocols available right now, and I like to keep on top of the various options because--unfortunately--it is quite likely in this area that I'll come across HW-positive BCs quite a few more times. Thanks again for sharing your dramatic tale and increased knowledge, and I hope Scot and you have a very uneventful rest of the weekend! You've definitely earned it! Quote Link to comment Share on other sites More sharing options...
Liz P Posted February 23, 2008 Report Share Posted February 23, 2008 So glad to hear he is feeling better! Poor kid. Simply treat the dog with a prophylactic dose of ivermectin every month and within two years the worms are gone. I asked about damage to the heart over that time. He reminded me that successful parasites don't kill their hosts. He told me that, until forty or fifty years ago, we had no heartworms here. When we first got them, dogs left untreated tended to die relatively quickly - within a few years. But nowadays, he sees eleven and twelve year olds who've never been on preventative and who presumably have been HW+ve since their first year. He says if he has to treat with immiticide, he uses about half the recommended dosage and then uses ivermectin as the microfilaricide. It kills them gradually rather than all at once, like the milbemycin oxime, which lessens the likelihood of an adverse reaction. Exactly why I was asking why you didn't just give HG instead. Some people want the buggers dead ASAP, but that isn't always the best thing to do. Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 23, 2008 Author Report Share Posted February 23, 2008 So glad to hear he is feeling better! Poor kid.Exactly why I was asking why you didn't just give HG instead. Some people want the buggers dead ASAP, but that isn't always the best thing to do. Thanks. My vet is in the "HWs must be destroyed immediately" camp. I don't know how long he's practiced in this geographical area - it may be where he's from dogs react differently to HW infestation. I think, too, that both of us underestimated the severity of Scot's infestation. He appears to be about Faith's age (fifteen months), except for some discoloration on his molars. So we thought, how heavy an infestation could he have? Judging from Scot's reaction, the vet who saw him today thought he must have had a pretty heavy parasite load. Either Scot's older than we thought, or maybe conditions in south Georgia are different from those here. Anyway, if Scot had a severe infestation, I guess I'm just as glad we went ahead and got rid of the adults with immiticide. But if I had it to do over, I'd certainly go with ivermectin as a microfilaricide. Quote Link to comment Share on other sites More sharing options...
painted_ponies Posted February 24, 2008 Author Report Share Posted February 24, 2008 Just wanted to let everyone know Scot's doing fine today. So fine, in fact, that I decided I could at long last give him a bath. When he first came to my house, he still had his stitches in from his neuter surgery, and then we did HW treatment and I didn't want to upset him unnecessarily. Y'all know how some dogs seem really small once you get them wet? Well, Scot ain't one of 'em. Quote Link to comment Share on other sites More sharing options...
aljones Posted February 24, 2008 Report Share Posted February 24, 2008 Y'all know how some dogs seem really small once you get them wet? Well, Scot ain't one of 'em. Hahahaha! So it's not all fluffy fur, eh? Did he get weighed at the vet's yesterday? I just wonder how he compares, size-wise, with Spirit. Spirit weighed in at 63# on his last vet visit, but I was chastised for letting him get a little too bulky, so we're working to get that down. Of course, my vet also referred to him as a "circus pony" because of his size and markings. Glad to hear that Scot's feeling so much better today. Quote Link to comment Share on other sites More sharing options...
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