Today we had a follow up at the vet's to discuss a treatment plan in light of the fact that the ultrasound showed no visible adult worms in Carbon's heart nor thickening of the heart wall associated with advanced heart worm.
There was some good news - especially from Carbon's point of view - but frankly it also left me scratching my head. A lot like Leishmaniasis, heart worm seems to be a disease with as many options for cures and opinions as there are vets.
Because of his good ultrasound, the vet wants to use the slow kill off method instead of progressing to the harsher injection of Melarsomine method at the end of a month of doxyclycine.
The slow kill method is not approved protocol in Germany, but is used in 90% of heart worm cases in Hungary. My vet heard of it through her work with rescue organisations, including Hungary. News to me, but heart worm treatment protocol varies widely from country to country where heart worm is present. What is standard in Germany, for example, is very different from what I experienced with Paul in Spain.
Standard in Germany would be topical Advocate spot on and one month of doxycyline followed by two to three injections (I'm assuming Melarsomine but I'm not 100% sure) 30 days apart. Prednisone is given regularly during the injection phase. No or restricted physical activity during and including one month after the last injection.
The slow method is very different. First of all...it's SLOW. As in 38 weeks - or nearly 10 months - slow:
- Stronghold spot on treatment on day one, then Advocate spot on every 28 days. Prednisolon (prednisone) four days before and four days after every monthly spot on treatment.
- Doxycycline for six weeks, then stop for 3 weeks
- Then Doxy for 3 weeks, then stop for 3 weeks
- Then Doxy for 3 weeks, then stop for 3 weeks
- Then Doxy for 3 weeks, then stop for 3 weeks
- Then Doxy for 3 weeks, then stop for 3 weeks
- Doxy for a final six weeks
That's a LOT of antibiotics. However, for the 'fast method' you're injecting an arsenic derivative into the dog's back muscles. That's some seriously scary stuff. One source I read online said something to the effect that, "The treatment could kill the dog, but the heart worm left untreated will definitely kill the dog."
So with that in mind, slow kill method definitely sounds more attractive.
My vet is going to do Carbon's bloods on Monday to see how the doxy is effecting his liver function. I asked if she would still do another test for the heart worm and she said it was too early. However, my thought is that I'd rather do one anyway. She's already taking blood so no extra pain for Carbon and I'd feel better double-checking his positive status.
As it looks like we're in this for the long haul, I will need to look into better/more natural stomach protectors. I'm not sure that continuing to feed him only white fish on a semi-permanent basis meets his nutritional needs in the same way as a wide variety of protein.
@M.F. , I asked my vet about kefir and she confirmed that unfortunately, while he is taking the doxy, he can't have any milk products.
SO NOW TO WRAP UP WITH SOME GOOD NEWS:
Slow kill method big advantage: no physical activity restrictions! As Carbon did not have any adult worms visible on his echocardiogram and the vet decided to follow slow kill, that means Carbon was cleared for free runs as of today.
You can bet he took advantage of that big time pretty much as soon as we cleared the vet's front door!


