Carbón beats heartworm: treatment and recovery journal

[Emily_Babbelhund]

I'm not surprised you are confused, scared and frustrated.

Is there any way you can get on the phone with someone from AHS so you can talk it over, rather that trying to find an article or study that replicates your situation and environment? That would be my first post of call, try to get someone who actually KNOWS about this stuff.

I think that's a good idea, but I don't know if the AHS is the right port of call. The drugs available in the US are very different. They do have an email address, so I could try to send an inquiry, just to see what happens.

But seriously, this is like Leish all over again. Everyone has a different treatment and different protocol and thinks everyone else's treatment and protocol is bonkers. It's so confusing.

I think I would allow some free running but no crazy play.

Sadly, I think that's where we're at. It's one of the reasons I'm almost more in favour of the traditional treatment. The idea of not letting this exuberant happy boy do his thing for over a year. It just makes me so sad.

 

[HAH]

I'm not surprised you are confused, scared and frustrated.

Is there any way you can get on the phone with someone from AHS so you can talk it over, rather that trying to find an article or study that replicates your situation and environment? That would be my first post of call, try to get someone who actually KNOWS about this stuff.

Exactly this, I’ve been googling for European experts so you can get a different perspective but it seems AHS have most of the pros in this area. A friendly expert will be able to give you a solid line on what are known knowns and known unknowns, at least something to key into for decisions.

 

[Joy]

It's a very difficult decision. I think I'd want to be sure he does actually have heartworm before undergoing treatment. I also think that restricting exercise so much for a whole year could affect his quality of life so greatly that I might decide to take the risks associated with exercise - but I do understand what an impossible choice it seems.

 

[HAH]

Sorry @Emily_Babbelhund, I’m a bit slow so didn’t see your reply. I’ll keep looking into the Europe side as I entirely see you want someone with knowledge of the treatment options & regs you’re actually dealing with, plus it does seem the AHS have some strong policy lines that may not be shared across the board...

 

[Emily_Babbelhund]

A friendly expert will be able to give you a solid line on what are known knowns and known unknowns, at least something to key into for decisions.

plus it does seem the AHS have some strong policy lines that may not be shared across the board...

Yes, they seem like a great resource but as it seems you've noticed now, their official line is no slow kill, end of story. But they define slow kill much differently than my vet, that's what makes it such a minefield! I still will ask...you just never know and I don't want to nix an idea without trying it.

I think I'd want to be sure he does actually have heartworm before undergoing treatment.

I agree, that's why I insisted on the test again today, even if the vet said it wasn't really necessary.

I also think that restricting exercise so much for a whole year could affect his quality of life so greatly that I might decide to take the risks associated with exercise - but I do understand what an impossible choice it seems.

That's exactly the position I'm in. He's such a happy, free boy and to take that away for so long seems cruel. Brogan was on restricted activity for a year following his two TPLOs and while he was a happy boy, it was very hard and long lasting in many ways. So I know that road and I also was very committed to it with Brogan as I knew it was necessary. In this situation I'm not sure who/what to believe.

I'm just glad I didn't kill poor little Paul, my foster Bodeguero last year. That dog went full tilt within days of his injections as that's what I was told to do. Didn't hurt him in the slightest, but now that I know more, I feel very very lucky that things ended up just fine for him.

 

[HAH]

Sorry if you’ve already come across the ESDA but they’ve got some good guideline docs on canine heart worm:
GUIDELINES AND TUTORIALS - ESDA One of their committee members is based in Germany, Roland Schaper. Apparently he’s the Manager of Global Veterinary Scientific Affairs at Bayer, but he’s written a few papers on this area. It might be worth dropping him a line with questions, at the least he might give you a contact to talk to?
roland.schaper@bayer.com

 

[Jacqui-S]

Not able to offer you any help, Emily, just wanted to say that your frustration and worry is clear, and totally understandable.
You rely on your vet to give you the best advice, not having to research it all yourself, and such huge decisions on your shoulders.Take your time and try not to be overwhelmed and panic.
I am a believer in quality of life over quantity. I understand how you feel about the restricted exercise.
Sending hugs

 

[kateincornwall]

Ditto to what Jac has said . I am so sad for you, in this damned if you do and damned if you don't scenario . My advice is pathetic really, but I don't know enough to offer sound advice , just gather as much information as you can , information being key but I`m sure you will already be doing this , so just hugs xxxxxxx

 

[snowbunny]

@Emily_Babbelhund - how about asking on the Living With Leish page? I think there are a couple of vets on there who are probably experienced with heart worm if they're from Spain.

 

[Beanwood]

This is difficult...and probably a bit of uncharted water for your vet. It is also very difficult to extrapolate clinical trial data and apply to the real world, especially when the trials need a longer time frame to demonstrate the desired primary outcomes.

While there are risks associated with embolism, largely due to inflammation caused by a number of factors, my thoughts are this is highly unlikely, but this risk has to be mentioned.

The reason I think the risk of embolism and/or damage (organs) is low is two-fold. Firstly, the co-comittent use of steroids, plus the pre-treatment with Doxy. Both of these treatments in the protocol are designed and have been shown to be effective in reducing inflammation. Secondly, the doxy will render the adult worms sterile, we know, through the ultrasound, that the worms were undetectable, so the chances of an increasing wormload are non-existent, and we know it's the adult worms that cause the progressive damage.

So where does this leave us with exercise?

Now, these are just my thoughts. Carbon is currently healthy, asymptomatic to any heartworm effects.

It is likely his adult worm count is low.

So I would exercise gently, keeping an eye on heart rate. Focus on tricks, twists, middle.. scentwork treats on walks.etc when out and about. Keep high explosive exercise to a minimum if possible. Monitor breathing, gum colour, appetite and keep a daily journal so any physical changes can be picked up early. Keeping Carbon in good physical and mental condition is probably better for him than cooped up and stressed in a crate.

 

[Aitch]

I think, for me, it would all come down to quality of life. The scan did show he has a healthy heart? Or am I wrong? If his heart is healthy then I can't see how short runs can do anything bad. In fact a run will only make a healthy heart stronger can't it? Ignore me if I'm missing something here.
I'm so sorry you are having to go through all this with poor little Carbon. He is so lucky to have you.
I'm betting that everyone on here wishes they could advize you properly.

 

[Lisa]

So sorry you have all this worry and frustration. Agree with the others that if you can get expert opinions that would help. Also agree towards allowing some exercise rather than 100% restriction.
At the end of the day it all seems like such a guessing game, which is crazy to me. Hope you can find a way forward without too much continuing stress.

 

[Xena Dog Princess]

Oh Emily, this is rough (what an under-exaggeration). My totally uneducated opinion would be to a) try to confirm the presence of the worm, b) keep doing the slow kill treatment like you're doing, and c) let him have his off leash time but keep it controlled - calm dogs only or just walk him when no other dogs are around.

I hope you manage to speak to some experts asap.

 

[Emily_Babbelhund]

The scan did show he has a healthy heart? Or am I wrong? If his heart is healthy then I can't see how short runs can do anything bad. In fact a run will only make a healthy heart stronger can't it?

Sorry, I realised I didn't explain anywhere what the big deal about exercise is. I'll let the experts do it for me:

But your dog’s normal physical activities must be restricted as soon as the diagnosis is confirmed, because physical exertion increases the rate at which the heartworms cause damage in the heart and lungs. (source: American Heartworm Society)

When adult heartworms die, pieces of the decomposing worm bodies can block blood vessels in the lungs, causing potentially fatal pulmonary emboli. If exercise or excitement cause the treated dog’s heart rate to rise, pieces of decomposing worms can be forced into the tiny blood vessels of the lungs, causing further complications. The more pronounced the clinical signs of heartworm disease are, the more restricted any activity or excitement need to be. (source: http://veterinaryteam.dvm360.com/dog-box-battle-boredom-with-comfortable-quiet-time)

So the good news, as @Beanwood put it so well, is that he doesn't have a high adult worm count in his heart that could be seen on the ultrasound. He does have adult worms SOMEWHERE though, or he wouldn't test positive. So they could be in his lungs or hiding out in other creepy places (how's that for scientific language?).

His odds of immediate death from an embolism are lower because of his supposed lower worm count, but they still exist. And completely opposite to a normal heart, a heart worm positive heart actually gets worse with increased exercise. That's why it's been noted that couch potato dogs do better with the treatment than their working dog cousins.

Then you get into the 'slow kill' vs 'standard' treatment protocols. Some - mainly rescue groups from what I've seen - argue that slow kill means you don't need exercise restriction because you don't get the sudden massive die off that you get with the standard treatment. But when I look at the reason for WHY exercise is restricted ("When adult heartworms die, pieces of the decomposing worm bodies can block blood vessels in the lungs, causing potentially fatal pulmonary emboli."), doesn't that exist if even one adult worm dies? In that sense, does how it dies - slow or normal - even matter?

Anyway, there's a short (I know - hah, hah) explanation behind my paranoid obsession on Carbon's exercise levels!

 

[Emily_Babbelhund]

This is difficult...and probably a bit of uncharted water for your vet. It is also very difficult to extrapolate clinical trial data and apply to the real world, especially when the trials need a longer time frame to demonstrate the desired primary outcomes.

Thank you for such a well-written and thought out reply, Kate. As usual, you are my scientific to normal language translator.

Firstly, the co-comittent use of steroids, plus the pre-treatment with Doxy. Both of these treatments in the protocol are designed and have been shown to be effective in reducing inflammation. Secondly, the doxy will render the adult worms sterile, we know, through the ultrasound, that the worms were undetectable, so the chances of an increasing wormload are non-existent, and we know it's the adult worms that cause the progressive damage.

Don't know if it's important to mention, but as of yesterday, the vet has decided to do only one eight day treatment of Prednisone (steriods), 4 days prior and 4 days after his next topical Advantage treatment.

Also the standard treatment with melarsomine injections calls for 1 to 2 months pre-treatment with doxy, but the slow kill is intermittent doxy and once monthly Advantage. The doxy makes the adults sterile over time and the Advantage slowly, over 10-13 months, kills the existing adults.

What worries me is that the existing adults are damaging his lungs or making their way into his heart over the next year. Bursts of exercise - i.e. zoomies - could increase damage to heart and lungs while the worms are still alive and then once they are dead, increase chances of an embolism.

I agree with you that the chances are low, but it's hard not to worry.

Also he has increased inflammation - we've already seen that in his prior blood work - that was attributed to Leish. Now I'm starting to wonder if it's actually from the heart worm. Are there different kinds of inflammation caused by different diseases? Does the Leish inflammation complicate heart worm treatment? It's so confusing.

Monitor breathing, gum colour, appetite and keep a daily journal so any physical changes can be picked up early.

Argh, I should never google things like "Pulmonary embolism death in dogs". It looks like there isn't any progression to monitor. If he gets an embolism, he's dead in minutes or he gets treated with oxygen and the prognosis is poor as blood thinners apparently don't work well in dogs.

Zoomies just went from the happiest thing on earth to something terrifying.

Excuse me for venting, but right now I hate hate hate the Spanish perreras that either kill the dogs right away or just leave them outdoors in cages with no protection from Leish, heart worm and all the other nasties. I know why they do it and I know there are good people fighting against it, but I'm just so angry.

I'll get over myself and get on with it, I'm just having a moment.

 

[Emily_Babbelhund]

Sorry, should probably also say I'm not reacting well to the pulmonary embolism thing because while the reason was different, Brogan died suddenly and this is bringing out some old demons in me. Brogan died of hemagiosarcoma, the upshot was that I went out for an afternoon walk with a 'healthy' dog (he was asymptomatic and undiagnosed) and came home 2.5 hours later with any empty leash.

As there is no cure for hemangiosarcoma, I was always grateful that I didn't know about the tumour as I don't know how I would have dealt with that over our heads, just waiting to him to suddenly die.

I'm not saying Carbon is in the same situation - his prognosis is very good - simply that the whole pulmonary embolism thing is completely doing my head in maybe more than it should.

I'll just keep repeating: I'll get over it.

 

[Cath]

Oh Emily I am so sorry for you both, but chin up I know you both can make it

 

[Stacia]

Have only just seen this, you must be in a state of shock, so difficult for you. I managed to stop my Lab's zooms, so maybe you could stop Carbon's. He could have lead walks and some free running, but I can see you would be a nervous wreck waiting for the worst to happen, but I feel you have to make a decision, grit your teeth and give Carbon the best life he can have.

 

[Emily_Babbelhund]

Apologies for all the drama today and a big heartfelt thank you as always for the support. I've calmed down, though I imagine my panic and paranoia will go in waves as I learn more.

One good thing having cancer taught me is that my brain simply can't deal with the threat of death on a constant basis. Eventually it switches off and says, "Next!" no matter how dire things are. Not that Carbon is facing death - there I am being dramatic again! - but simply that you weigh all the possibilities and eventually just get on with it.

Case in point, today I thought, "OK, I'm going to give him interesting on lead walks in the morning when he's more likely to zoom, then quiet evening walks off lead when he's usually more mellow". Our evening walk through the snow was a lot of sniffing, a bit of fairly calm snow snuffling...then we we get to a bend in the path, with Carbon just slightly ahead of me. He lifts his head, looks and before I could even get the whistle to my mouth, tears off around the bend. He'd seen a friendly dog, I'd lost control and it was game on.

What can you do?

But you know, he did come back to me - albeit belatedly - he had a very positive interaction with the dog AND he didn't keel over from a pulmonary embolism.

I'm just going to have to learn from each situation, manage what I can and go forward. Oh, and work just a LITTLE bit more on the old recall.

 

[Aitch]

Do you have a long line Emily? He'd still get all the freedom to sniff but wouldn't be able to run off.
He is such a bouncy, happy boy though isn't he?