Heartworm Treatment Aftercare
[Foster Homes, please print and save these instructions]
Caveat: The following are guidelines for our Foster Homes caring for our heartworm patients and not intended as medical advice to third parties, as we are not veterinarians but are rescuers following our clinics' guidelines combined with our experience after years of caring for heartworm patients. Though we are happy to share what we have learned with other individuals and rescue groups who log onto this article (feel free to link to this page if you'd like to) and are taking their dogs through the treatment, this article is not a substitute for consultation with veterinarians, closely following their treatment protocol.
Please do not write us for additional advice as that is not within our purview or time constraints, and we wil not respond; instead, contact your clinics with any further concerns and read the web sites linked at the end.
I t is important for people taking care of heartworm patients to understand that heartworm
disease is not a vague microscopic infection as some owners who don't give the pil s mistakenly believe, but is a severe infestation of the heart by worms of from 6-12" in length which load the heart and cut off its ability to function. In severe cases, the worms grow, reproduce, and migrate from the heart to arteries, the lungs, and even other organs in the body. It is a horrific disease that no dog should have to endure and is completely preventable by heartworm pil s, which kil the microfilaria deposited in the blood stream by mosquitoes before they can invade the heart, mature, consume the heart, and kil the dog. Yet because of the ignorance about heartworm disease or even indifference of some dog owners, rescue groups across the nation receive far too many dogs that are heartworm positive. Fortunately, there is a cure, though it is rough on the dogs and their caretakers, and expensive, but most dogs with heartworm disease do survive through the treatment and the loving, knowledgeable care of their concerned caretakers.
From the occult blood test, if a heartworm positive (HW+) dog is a Stage 1 or 2 (mild to moderate heartworm disease, though the assessment is more complicated than this) with no clinical symptoms(slow heartbeat, congested lungs, fever, prior coughing, and listlessness), we do the ful treatment of two injections over 24 hours. A second, milder injection may be done in 4 weeks with re-check, OR oral Ivermectin or pil for microfilaria. If the dog is a Stage 3 - 5 (severe to critical heartworm disease--"loaded" with the heartworms), or has clinical symptoms (is symptomatic), we split the treatment over four weeks -- a 'split
treatment' that is much easier on the dog who is extremely il with the disease. The dog gets one injection; then the standard two injections over 24 hours in 4 weeks; recheck and possible Ivermectin in another week. The injections (cal ed an Immiticide or Adulticide because it kil s adult heartworms) are made in the lumbar region with a long needle; the Immiticide is an arsenic-based compound (though the modern compound has less arsenic than older compounds): it can hurt some dogs, cause pain to spread throughout the lower back muscles, and make the dog feel nauseated. Both symptoms wil usual y ease in a couple of days. Usual y Rymadil is sent home with them for the after pain.
In San Antonio area, because of our climate, waterways, and resultant heavy mosquito infestation--along with the ignorance about heartworm disease and carelessness of far too many owners--one-third of our rescues are HW+. However, most of our HW+ dogs, close to 95%, get through the heartworm treatment without complications, but the fol owing are signs to watch for and aftercare to observe during heartworm treatment.
Some patients are very tired and sleep a lot for two to four days; some have temporary difficulty getting up because of the muscle soreness. Though some dogs do not experience the muscle soreness, it is particularly important not to pick up the dog or put any pressure on the back for 2-4 days after the injections. Even a gentle dog might cry out and snap in pain if that area is touched. You wil know the dog is feeling better when the eyes brighten, tail wags, and the dog resumes interest in the caretaker and home activities, usual y in just a few days. Let the dog sleep in a crate or on a preferred doggy bed or blanket, wherever she is most comfortable, while you watch her and keep her quiet; some dogs think they’re feeling wel and may even want to play, but it is imperative that no heartworm patient exercise during the recovery period. The dog may not run, play, or go for any extended walks during the four-week period. Even after heartworm treatment is successfully completed, the patient should not go for long walks or engage in strenuous play for another month: each patient should be allowed to gradually build his or her strength. Go out in the yard with him to make sure he doesn’t run but just eliminates and comes back in. If he wants to run or chase squirrels in the yard, then take him out on a leash. The most important observations are the fol owing: (1) Keep an eye on the gums; they should be pink. If they get very red or white, along with listlessness, cal 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, cal us and we may need to have the dog seen. She wil probably be put on Prednisone and wil 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 Clinic because the signs point to embolism (worm clot from the die-off of the parasites during treatment); the doctors wil 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. If hindquarter
paralysis, which we have heard happens, but have never seen and seems to be caused by muscular 'grip' or possible embolism pressing on the nerves, the doctors wil treat with injections of corticosteroids and antibiotics. In both of our cases, the paralysis eased within a few days, and the dogs ful y recovered. We wil assist with al decisions for treatments in the clinics and cover the medical expenses.
The above warning signs are the most serious to watch for and are rare in our experience. Most HW+ dogs do go through a certain amount of coughing and/or gagging reflex which could start at any time, but some patients rarely cough at al . The worms are dying and dissolving, being passed through the bloodstream and lungs; the dog has to cough up the resultant phlegm – not the same as real vomiting, which you’d recognize. If coughing starts, cal us; they wil want to listen to his heart and lungs and may want to put the dog on cortisone. The coughing/gagging is alarming for the caretaker; even more so for the dog: pet him if he wants it; talk to him to let him know he’s loved and secure. However, if the coughing/gagging reflex seems heavy and uncontrol able, causing the dog distress, cal the vet and us as he may be starting an embolism. Again, this is rare in our experience, and we do expect some coughing/gagging a few times a day or a few times a week for a couple of weeks; then it gradual y subsides as he improves. However, the veterinarian may prescribe Prednisone for your foster because he hears a 'crackling' in the heart indicative of higher level infestation or fluid build up. Use low fat cream cheese, cottage cheese, or hotdog to ease the Pred. down. If the dog loses his appetite, mix a little Mighty Dog canned food or Veg-Al (mixed vegetables) or turkey/chicken broth in with his kibble until he regains appetite, usual y in a couple of days; be sure he’s drinking water every day. Crate him during the day when you’re gone, keep him quiet and loved when he’s out of the crate: no play or walks for four weeks. Crate the first couple of weeks, though we find often weeks 2 and 3 can be the most ‘gaggy.’ If so, continue to crate him another week.
Even after treatment and health clearance, in rare cases some former heartworm patients can stil test positive for the heartworm antigen for four to six months after treatment, which is why the dog should be re-tested in four months and again six months later while being kept on the monthly preventative. This does not necessarily mean the dog stil has heartworms and must go through the treatment again but that it is taking longer for the antigens to leave his system; however, in rare cases, the treatment may not have kil ed al the worms, and the doctors must make a case-by-case decision about re-treating the dog. Thus we want to monitor every heartworm patient a ful year after the treatment and then yearly after that as for al dogs. Also, in rare cases, a dog that initial y tested HW- when brought into our program may actual y have heartworms because the antigens don't show up in the test for 4-6 months. This is another reason we want our adoptive homes also to re-test. HW+ dogs almost always have some enlargement of the heart, and some damage that can be seen on x-rays (vets can tel from x-rays when a dog has had heartworm disease) that may stil need some healing time for a few more weeks; they also may have a residual cough for a few weeks (or not) depending on the amount of fluid buildup they are stil getting rid of. But, unless the damage was extensive, which we cannot always be sure of (rare in our
experience), the dogs wil be cured and live normal lives from that point on. We have former heartworm patients going strong six years after treatment.
We recommend you read more about heartworm disease and treatment. Go to the American Heartworm Society’s web site atand the Pet Center’s discussion of the disease at also see a Houstonfor more links, and info. Please Note: dog owners reading these pages need to know that most heartworm preventative manufacturers wil not cover the treatment if the pil s are purchased on line and fail, as they have no way of knowing for sure those were actual y their products, where they came from, the conditions they were kept in, etc. It is always best to purchase the pil s from a vet clinic.
Foster homes please cal or e-mail any time you have questions or concerns, and we’l walk/talk you through. Thanks so much for being wil ing to help us help our dogs. Homes for Pets (210) 566-7776
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