Carbón beats heartworm: treatment and recovery journal

[FayRose]

Only just catching up with the latest. This is a nightmare, I'm so sorry. You are a saint with what you are going through, have been through and yet still doing everything possible to help Carbon.

I can only offer a cyber hug and wish SO MUCH that things continue OK and you can manage as you are doing. So much love and care coming from your posts, bless you x

 

[Emily_Babbelhund]

Do you have a long line Emily? He'd still get all the freedom to sniff but wouldn't be able to run off.

I do have a long line - still in the package I bought it in last summer as I hate the things. I'm always afraid I'm going to break a leg - his or mine - from it getting caught on something. But I may have to get over it and try it out.

Though I must say, Carbon manages to do zoomies even on a regular lead. He's figured out just how long the lead is and bounces like a loon all around me. I probably shouldn't, but it makes me laugh every time!

 

[jazzmynn]

Just catching up, and so very sorry to read all of this. I have no advice but wanted to know we’re thinking of you and Carbon.

 

[Natalie]

Oh Emily, this is so horrible for you both. Not that anyone needs this kind of crappy stuff, but you really don't need this kind of crappy stuff.
I admire your perseverance with the research and seeking out the very best advice. I don't really understand anything much about it but think you are doing great.

I had a thought while I was just cooking dinner. Maybe Carbon is the dog for you, and you were destined to look after him in the same way he's starting to assist you.

If you had fostered him to someone in the U.K., I wonder if the heart worm would even have been discovered? Keeping his Leish levels in check is one thing, but further tests for non U.K. parasites (if you know what I mean) sound quite rare, plus the levels of expertise here would probably be even more limited.

Maybe he's still not your forever dog, but right now I think you're his angel sent from heaven ( © @Jen and Stanley ) and he couldn't be with a better person fighting his cause.

Sending hugs xx

 

[Aitch]

I do have a long line - still in the package I bought it in last summer as I hate the things. I'm always afraid I'm going to break a leg - his or mine - from it getting caught on something. But I may have to get over it and try it out.

Though I must say, Carbon manages to do zoomies even on a regular lead. He's figured out just how long the lead is and bounces like a loon all around me. I probably shouldn't, but it makes me laugh every time!

There is an art to them. I expect @snowbunny would be able to explain better but as long as you keep reeling them in as the dog gets closer to you or the line slackens so he can feel that he is on a lead all should be well. It's annoying at first but you will soon get a feel for it.

 

[Oberon]

I just read an article published by the Australian Veterinary Association that said that the American Heartworm Association argues against the use of ‘slow kill’ in an effort to prevent population drug resistance to the macrocyclic lactones (ivermectin, moxydectin) that are used in this approach. In other words, not on the grounds of treatment efficiency.

The article, by Mark Rishniw: Queensland News March 2015 - Heartworm Disease – dilemmas, dramas and dogma - Mark Rishniw | Australian Veterinary Association

The relevant paragraph:

“The American Heartworm Society (AHS) and Companion Animal Parasite Council (CAPC) are advising strongly against the slow-kill protocol. Should I listen to them?

The argument proposed by AHS and CAPC against slow-kill (aka trickle-kill) protocols is that microfilariae produced by the adults in these dogs are exposed to the same sorts of selection pressures as described in the experiment above – that it leads to a selection of microfilariae with a resistant genotype. These microfilariae can then mature in mosquitoes to L3 larvae that are able to withstand preventative macrocyclic lactone administration, leading to adult patent infections in the face of preventative administration (“loss of efficacy”). With sufficient spread of these resistant genotypes through the population, widespread loss-of-efficacy issues arise. HOWEVER, all the studies performed to date have administered preventative doses of ivermectin alone.”


And I noticed also that the American Heartworm Association is sponsored by Zoetis, which is the US distributor for melarsomine.

Also....When there are a number of treatment options, as there are here, it usually means that there is no standout one that is obviously much better than the rest.

So, I wouldn’t rush to the conclusion that your vet hasn’t chosen the best treatment for Carbón.

 

[Granca]

I can’t add anything to all the thoughts above, Emily, but really feel for you. Frustrating doesn’t even begin to describe it. Hang on in there - you’ve already done so much for Carbon, so I’m sure you’ll work through it all. He’s so lucky to have you.

 

[Emily_Babbelhund]

I just read an article published by the Australian Veterinary Association that said that the American Heartworm Association argues against the use of ‘slow kill’ in an effort to prevent population drug resistance to the macrocyclic lactones (ivermectin, moxydectin) that are used in this approach. In other words, not on the grounds of treatment efficiency.

The article, by Mark Rishniw: Queensland News March 2015 - Heartworm Disease – dilemmas, dramas and dogma - Mark Rishniw | Australian Veterinary Association

The relevant paragraph:

“The American Heartworm Society (AHS) and Companion Animal Parasite Council (CAPC) are advising strongly against the slow-kill protocol. Should I listen to them?

The argument proposed by AHS and CAPC against slow-kill (aka trickle-kill) protocols is that microfilariae produced by the adults in these dogs are exposed to the same sorts of selection pressures as described in the experiment above – that it leads to a selection of microfilariae with a resistant genotype. These microfilariae can then mature in mosquitoes to L3 larvae that are able to withstand preventative macrocyclic lactone administration, leading to adult patent infections in the face of preventative administration (“loss of efficacy”). With sufficient spread of these resistant genotypes through the population, widespread loss-of-efficacy issues arise. HOWEVER, all the studies performed to date have administered preventative doses of ivermectin alone.”


And I noticed also that the American Heartworm Association is sponsored by Zoetis, which is the US distributor for melarsomine.

Also....When there are a number of treatment options, as there are here, it usually means that there is no standout one that is obviously much better than the rest.

So, I wouldn’t rush to the conclusion that your vet hasn’t chosen the best treatment for Carbón.

Very interesting, thank you! I'd not found this page yet. Maybe because of my search history, US info seems to come up first and most info is somehow linked to the AHS which seems to be everywhere when it comes to heart worm.

Yesterday I did go down an intriguing rabbit hole about the links of AHS and melarsomine and the US pharmaceutical industry.

Seems as if the FDA only approves melarsomine (that's the 'fast kill' injection protocol). That means that if US vets try any other method including slow kill, they are open to law suits.

For what reason the FDA only approves melarsomine, I'm not qualified to speculate. However, the fact that doxy USED to be practically free as an old generic drug and ivermectin or moxi (Advantage Multi topical) is sold as an affordable monthly treatment (these are the two main drugs in Carbon's slow kill protocol) vs melarsomine costing upwards of $1000 probably tells the story.

Interestingly, when melarsomine's price went up in the US due to 'shortages' and vets started looking for alternatives and using doxy, doxy was also pulled from the market. When it came back it's price also went up, making it MORE expensive than melarsomine. That info was from 2007 or so and apparently it is again available on the US market at comparatively reasonable prices for the generic version. Still, I found this from 2017: "The cost of doxycycline hyclate prescriptions increased 1,854% between 2011 and 2013 in a retrospective analysis of commercial claims data published in the The Journal of Investigative Dermatology."

Not saying at all that the doxy availability and price is due to manipulation by melarsomine manufacturers, just to say that the US pharma situation is nuts. That's my scientific analysis: nuts.

The AHS also apparently actively squashes any scientific papers published supporting moxi/doxy protocols (again, those are the drug combos being used on Carbon).

Sadly the AHS recommendations seem more based on big pharma money than science. Not saying that one protocol is better or worse than the other, simply that because of their melarsomine-only stance, it's very hard to get information on anything but melarsomine protocol.

 

[Emily_Babbelhund]

There is an art to them. I expect @snowbunny would be able to explain better but as long as you keep reeling them in as the dog gets closer to you or the line slackens so he can feel that he is on a lead all should be well. It's annoying at first but you will soon get a feel for it.

I have one very unfortunate friend who broke both her finger and her ankle - in two separate incidents - with long lines. So it really makes me look at them with more than a bit of trepidation!

 

[Stacia]

I have never been a lover of long lines, but they can have a place. I have never used one but have friends who have and the best way is not to hold the line, but put several knots at the end of the line which you can tread on to stop the dog. Obviously if the dog is going full pelt I guess you could be tipped over!

 

[M.F.]

How are the bits of worm removed from the blood? And how long does it take? It seems Carbon needs a well-functioning immune system to get rid of those worm bits. What does your vet recommend for boosting his immune system? There’s a relatively new protocol for chemo patients to do regular exercise throughout treatment to keep their immune system in good condition (not to mention their mental health). So, while I understand the mechanics of a pounding heart exacerbating the chance of embolism, exercise in itself is so important for holistic health management.

Oh boy. It’s so hard. My heart goes out to you and Carbón.

 

[snowbunny]

the best way is not to hold the line, but put several knots at the end of the line which you can tread on to stop the dog

This really depends on the dog and the ground. I tried knots with Luna, and it just doesn't work, even on hard ground. She is too strong, the knots just slide under my foot. Also, I'm very reluctant to do anything to cause any jerking on my dogs' bodies, which this method can easily do. I just use it like a schooling line for a horse, reeling it in and out as needed so it stays "connected" to the dog, never dragging, but also without tension. I use an "end" cue to let the dog know they are approaching the end of the line. One important thing is to not "loop" the excess, but to fold it back and forth across the palm of your hand as you gather it in. This means that, if your dog does take off without you being able to manage, the line just unravels, rather than any loops tightening around your hand.

If you use it like this, rather than letting it drag, then your dog will never have the chance to build up enough speed to do any damage to himself or you, because there is no slack. You do have to be very aware of others in your environment, and it takes a lot of concentration at first, but in the end it becomes second nature

 

[Emily_Babbelhund]

Obviously if the dog is going full pelt I guess you could be tipped over!

Yes, my poor friend who had the two accidents: first one was holding the line and she broke a finger, second one was where she didn't hold the line anymore, but let the dog drag it. Dog ran around her, line got tangled = broken foot. I'll give it a go with Carbon, but with a 'slowly slowly' approach.

How are the bits of worm removed from the blood? And how long does it take?

The bits of worm are over time re-absorbed into the body. They are in the blood stream, not the digestive system, so they aren't expelled through bowel elimination like other types of parasitical worms. I've not yet found any info on how long it takes for a single dead worm to be re-absorbed by the dog's system.

What does your vet recommend for boosting his immune system?

She didn't recommend anything, but overall immune strength is why I've ordered a boat load of Impromune which should get to me from Spain next week. It's the gold standard used in Spain for Leish dogs (one study says in fact that it's more effective than Allopurinol without the side effects). I gave my vet the ingredient info and she was quite thrilled with it as an idea for Carbon.

There’s a relatively new protocol for chemo patients to do regular exercise throughout treatment to keep their immune system in good condition (not to mention their mental health).

Yes, I read that when I was doing research for myself before starting chemo. Brogan was happy to help me with that part of my chemo experience.

For Carbon, however, the thing is, the more the blood pumps into his heart, the more effectively the worms can get to his heart and cause damage. That's in addition to the pulmonary embolism risk.

On the other hand, it's a balance as especially with the slow kill, we're talking a year of his life. I could do (and have done with Brogan) full cage rest for pretty long period of times, but that's just not feasible or a good idea for Carbon's mental well-being to do it in this case. Also as @Beanwood pointed out, thanks to the ultrasound we "think" his adult worm count is fairly low, so moderate exercise is probably fine.

It's just the unknowns and getting the balance right that is very tough. The risk is always there that any exercise is doing more harm than good.

 

[Emily_Babbelhund]

If you use it like this, rather than letting it drag, then your dog will never have the chance to build up enough speed to do any damage to himself or you, because there is no slack. You do have to be very aware of others in your environment, and it takes a lot of concentration at first, but in the end it becomes second nature

Thanks for the tips, Fiona.

Re: others in your environment, this is one of the main reasons I've had bad experiences with drag lines. My friend (yes, the one of the broken ankle and finger) uses drag lines a lot on new foster dogs which she brings to the weekend hooligan walks. We're talking 10-18 dogs all together in a relatively small space, with 1 or 2 dogs on drag lines. It was a full time job to make sure that the lines didn't tangle around Brogan's legs and injure him, especially in his last couple years.

Then I tried one on my fosters 2 years ago in Spain and that lack of success was down to me. I bought a super long cotton webbing line FOR THE BEACH. D'oh. That sucker weighed about 15 pounds once wet and full of sand.

But last summer I got one of the non-porous nylon types and a shorter version, so that should work better.

 

[MellowYellow]

I'm really sorry about all this Emily, and just wanted to add my support.

 

[Aitch]

I use the lines with adopted dogs for a while and find them really useful. The secret is always to have no slack. Slack is where it gets dangerous. I hope it works out for you and Carbon as it will give him limited freedom and a little less worry for you.

 

[Emily_Babbelhund]

I got the results of Carbon's blood work back today. He's still heartworm positive which is no surprise, but it was worth the cost to me to be doubly sure. The good news was liver function was still perfect after two weeks on doxycycline. So now it's time to buckle down for the duration with literally hundreds of tablets of doxy.

The vet and I sat down to figure out how I can load up with enough doxy to get me through my UK/Ireland travels and back to Germany end June/beginning July (300 tablets as it turns out). She wrote me scripts for the doxy, Advocate spot on and the stomach protector. The prednisone I got in office. Her idea is that I get everything from an online pharmacy as it will be cheaper. I've had a look and it seems quite complicated, so I'll ask the cost at a brick and mortar pharmacy then see if the price difference is worth it.

Outfitting us with four month meds and supplements will be about EUR400 for the supplements and another EUR400 for the prescription meds. That doesn't include Alopurinol for his Leish, just the heart worm stuff. Though Alopurinol is dirt cheap, thank goodness. When I see all these articles online about how people choose 'slow kill' because it's cheaper than the injection protocol, I think that's pretty funny. Slow kill will be about EUR2.000 all told without laboratory costs, which have already hit the EUR400 mark since he was diagnosed less than 3 weeks ago.

Please don't misunderstand, I'm not complaining. I'm very lucky - I can afford it and thanks to Brogan and his $10.000 knees, I'm well immune to the shock of nearly any vet bill. But I am rather intrigued by the funny rep that slow kill has as the 'cheap' alternative.

Anyway, onward and forward as I try to stockpile enough doxy over the next few weeks for our trip. I also completely forgot about his alopurinol, so it will be back to the vet to ask for that script too.

Carbon himself was in fine form at the vet's. We had to wait about an hour in a full waiting room and I was SO proud of him. He went through nearly all the treats in my pocket, but he was good as gold.

 

[snowbunny]

I also completely forgot about his alopurinol, so it will be back to the vet to ask for that script too.

Do you need a prescription for allopurinol in Germany? It's OTC in Spain, as I'm sure you know

 

[Emily_Babbelhund]

Do you need a prescription for allopurinol in Germany? It's OTC in Spain, as I'm sure you know

Yes, you need a script in Germany, but once you have that, the price is about the same as in Spain. I love that it's OTC in Spain...makes it so easy!

 

[Jacqui-S]

PetdrugsOnline are definitely cheaper for the stuff we have used before - mostly Previcox and Bravecto, even factoring in the prescription costs.
These are expensive drugs.
Doxy is cheap as chips here though