Oh my, the dangers of the internet and a LITTLE information.....sigh

Agadore, my standard poodle, had several stressful reactions to Interceptor..for several days after treatment, he would pant heavily, be inactive, and the look in his eyes screamed stress.   My vet poo poo'd my reaction, until I brought him in and she got to actually SEE it.  We switched to Heartguard  and no problems since.

On to the claim that heartworm meds are "preventative".   Nope..they are pesticides we put in our animals that kill the worms at different stages...pardon me I can't spell the stages...  and they have a reachback effect, so they don't have to be administered EVERY 30 days...   I'm not going into it.anyone who is curious should discuss this with their vet and do research and make their OWN decision...but I digress..

Beaner, my pitbull, has heartmworms.  A very light load.   It isn't just OMG he has heartworms!  He has a light load that he has lived with for about 2 years now.  Still takes heartworm meds to stop it from getting worse.  Has been anesthetised several times and all has been well.  Thank GOD my vet is learned and works WITH ME....we aren't doing the "put 'em in a cage, shoot 'em up with deadly chemicals, and hope for the best" treatment.  We did courses of an antibiotic thought to kill some parasite that the worm needs to live, and now he is on the monthly pill....  

Now to the EVERY 30 DAYS YEAR ROUND...again do your own research and talk to your vet.  But the conditions that have to exist for the cycle of heartworm to LIVE in the mosquito and then be passed to the dog....  in southen illinois there is no need to give pesticides year round..

Now to the testing-  my vet tests yearly. But it's because I get a 6 month supply and it lasts a year....they would test if I went back for a refill at 6 months, but I don't...  and Agadore is 6 and is heartworm negative.  

I don't mind the cost of the test...I just mind that so many vets are driven by the dollar instead of what is best for my pet.  Right now, I am getting phone calls from my vet cause I ignored the emails and postcards that are telling me Agadore is overdue for his YEARLY vaccinations.   Agadore is DONE with vaccs except for rabies.   He's had enough to last two lifetimes...and there are numerous vet teaching colleges that agree .... 

Back to the question "how careful need we be?"   I think a yearly test is easily justified.  Monthly dosing no.   I wish vets would instead insist that their clients become educated and informed, and then ASSIST them in making such important decisions regarding the health of their pet.

agadoremama October 23rd, 2009 10:56:04 AM

Or, you know, if you have MDR1 normal/normal dogs, you can just buy a bottle of cattle ivomec and, if you are a stickler, some dilutant and drop your costs from several hundred dollars per year, per dog to about twelve cents.

Requires some simple math and measuring skills.

The drug companies want to keep the gravy rolling in and support the huge marketing budgets for a product that costs pennies to produce.  Vets profit from the visit and the lab test, as well as the markup on the chewy pill.  Benefit to the consumer?  The patient?

But like my recent financial hosing at the emergency clinic, the math on this has made me opt out of the marketing juggernaut entirely.

That $15 bottle of ivermectin has lasted a very long time, and will still be mostly full when it expires and I replace it, having provided a drop of prevention per month about three hundred times.  Even the owner of one dog sees a huge savings from opting out of the convenience packaging and Rx system.  Those of us with multiple dogs and a rotating cast of fosters -- there's an awful lot of other stuff I can think of that I can spend $360 on every year.

H. Houlahan October 23rd, 2009 11:23:26 AM

I've always been a huge fan of Heartguard Plus.  The newbie vet is now pushing Sentinel.  So I've ended up with 3 on Heartguard and 1 on Sentinal.  Biggest problem with that is that it's my emotionally needed older Lab that's on the Sentinal and, of course, she feels cheated because she's not getting the GOOD monthly treat.  May sound petty to vets but really creates an issue in my house.  After 3 decades of this type of nonsense becoming more and more of an issue with vets, I'd decided a couple of weeks ago that, when my current supply runs low, I'm off to the feed store and I'll do the math.  The vet and the manufacturers can do without my money altogether on this one.

The stray I've taken in is heartworm positive and already on Heartguard Plus.  I've been doing quite a bit of research on this of late.  I fully understand the damage of using ivermectin and letting them die off naturally while the ivermectin kills the babies.  That's well documented.  However, she's a "crazy bouncy Lab" so keeping her calm for 60+ days = nightmare.  As a rescued stray, she gets ballistic bouncy when I come back from the store (2 hour trip) and she's been confined to a room (which I've opted for because it's less traumatic than the enormous kennel which she thinks is some form of punishment).  The alternative is Imiticide treatment with the 60 days confinement and upping the chances of death for the bouncy types.  In addition to that, I can't find anything, ANYTHING, on the long term effects of Imiticide.  I know from the last one I had treated a couple of decades ago (albeit with a different drug) that the treatment ages them.  So, it seems more of a trade off.

These are pesticides, not drugs, not preventatives.  I am getting tired of the increasing number of "gatekeepers" and their desire to expand their roll and demands; think I'm going to start using the term "troll" instead of "gatekeeper".

Frankly, I'd like some Doxy for the stray but that is a drug so I'd have to pay the troll!  And we're reducing costs in this economy.  I hear the doorbell, must be the Houston SPCA wanting to tell me they want my critters since I don't provide the bestest care dictated by the veterinarians :)

PJBoosinger October 23rd, 2009 12:07:06 PM

Interesting post.

We went through heartworm treatment with a southern stray foster last year, it seemed painful and frustrating for the dog, luckily his load was light at 9 months later he tested HW negative.

Since I live in the north east (PA, actually) I don't give my dogs monthly heartworm preventative, rather we blood test them twice a year and use natural repellants. I just don't trust these drugs.

Jen October 23rd, 2009 12:14:07 PM

I guess a yearly HW test isn't that big a deal...but I do think that the stuff should be available OTC. I've read in so many places that the "monthly dose" really lasts more than a month, and I'm pretty faithful in my dosing, AND my vet certainly sees me more than once in the course of a year, so he doesn't need an excuse to drag me and my pups in...It reminds me of an OB-GYN that I had and left who insisted on exams every 6 months just to get a renewal of my BC Rx. It was ridiculous.

Someone who hasn't seen their vet in over a year is not doing their pet a favor. It's YOUR heart that will be broken when your best friend suddenly starts behaving oddly, and when you do bring him in, there's nothing left to be done. Just like with us, catching things early can make a big difference.

Susan October 23rd, 2009 12:55:34 PM

I found the opposite of agadoremama, a noticeable reaction to Heartguard , but less to nothing with Interceptor.

But more importantly, how many clinics have gone to the Snap 3-4 test? I'm always surprised to hear of pets tested for hw, but not Lyme--which has gotten pretty widespread.

I'm still amazed over the various "Lepto" scares published or instilled into clients, yet have not read or heard about a single "outbreak" in NH in all the years I've been here.

Considering that Lyme is prevalent and Lepto is apparently not, it is bewildering to find emphasis askew. After all, both are serious diseases to humans , as well as Triple E and West Nile.

Lepto? another scam perhaps?

Barbara A./NH October 23rd, 2009 01:01:37 PM

Troll...ow. I completely understand your feelings, PJ, but I'm not sure that's fair. I agree that especially the younger set of Veterinarians tend to be a bit inflexible and dictatorial, which I find insulting, too. I know a lot about the care my dogs need. I switched vets recently for complex reasons, and only after sitting down with the new prospect and making sure he was someone who understood that I made the decisions about my dogs' care, and that if my input was ignored, he'd have one less client. I listen to him, and he listens to me, so far, so good.

Susan October 23rd, 2009 01:03:56 PM

One of my online friends just posted yesterday about losing a dog to lepto. She said it was quick but not pretty. I've been told by more than one source that the new vaccine addresses quite a few more strains than the old one, and since my dogs wade in a local stream fairly often, I've opted to get the vaccine. Neither reacted badly, and both are breeds with a propensity towards vaccine reactions. Just an FYI. Oh -- and in both cases I raised the issue, not my vet.

Barbara October 23rd, 2009 01:09:26 PM

How did that last post get signed Barbara? So sorry!

Susan October 23rd, 2009 01:10:41 PM

". . .rather we blood test them twice a year and use natural repellants. I just don't trust these drugs."

Jen:

I am with you!!!  Go holistic, the nature's way!!!  Lemon grass oil, , eucalyptus, vinegar, and so many other natural ingredients are the MOST EFFECTIVE prevantative alternatives to killer drugs.

www.alabamavetboardwatch.110MB.com

PS.  I got a rabies vaccination waiver letter from my vet!!  Enough is enough!!!

Fotini October 23rd, 2009 01:20:50 PM

Troll might be too strong a term but I was thinking "Three Billy Goats Gruff" troll rather than "Grendel ogre/troll".  I recently realized my "go to" rational vet celebrated 35 years in practice 2 months ago so I probably won't have a choice but to find someone new in the not distant future.  I absolutely refuse to deal with the inflexible, dictatorial human doctors and I'll be hanged if I'll put up with that from someone I'm paying the full fee to when what they're inflexible and dictatorial over is also irrational and based in arrogant control rather than science.  I do without health care altogether now as a result and I'd rather not do that with my pets but there comes a point, a line in the sand, and I'm starting to draw mine.

PJBoosinger October 23rd, 2009 01:40:18 PM

Blog readers: Why is it that every recommendation from your veterinarian is a maniacal, unsubstantiated sales pitch to gouge you for more money?

Aga, et al: It's great you think you learned everything there is to know on a public website in 1 hour, whereas it took your vet 4 years, 80hrs per week, busting his/her butt in professional school and he/she is still clueless, right?  BTW, based on your history, you're mistreating your pet(s) - you should have another chat with your vet, and this time pay attention to his/her recommendations, not the treatment that you end up with after declining those recs.  You're probably the type who gets stuff from the local 'feed store' anyway.

fedup October 23rd, 2009 01:45:31 PM

fedup, THANKS!  Off to look up feed stores now :)

PJB http://pjboosinger.viviti.com/ October 23rd, 2009 01:55:43 PM

Regarding the Northeast, I live in southern New England (RI), and heartworm is not an uncommon occurrence in unprotected dogs around here. I have a relative whose dog wound up getting infected during a poorly-timed (mid summer) Heartgard lapse, and though he survived the treatment, it was pretty brutal. Working in kennels, I encountered a number of positive animals. Heartworm may not be as prevalent here as it is in, say, the deep south... but it is definitely still an issue.

Despite the fact that we're pretty far north, I'd be afraid to risk going without in this area. Our house is dogless at the moment (as a student, my schedule and living arrangement aren't conducive to dog ownership right now), but I feel like the benefits outweigh the possible risks... and when the time comes, we'll opt for the preventative.

Every clinic I've encountered in our area uses the 4dx snap test. Lyme is a *major* issue, (everyone in my family- canine and human alike- has had it numerous times, except for me... evidently ticks are not fond of me) and we see a fair amount of ehrlichia and anaplasma as well. I know a lot of people who use preventative year-round try to opt out of the heartworm test, but personally, I intend to make a point of doing it yearly to check for the tick-borne stuff, if nothing else.

3 Fabulous Felines October 23rd, 2009 02:01:25 PM

Susan, Would love to know what state/location and how the diagnosis was confirmed to be Lepto?

BTW, since this is such a serious "human concern", I would think it would be reported to the local/state proper authority and the CDC.

Barbara A./NH October 23rd, 2009 02:05:05 PM

All: I'm sorry about the feed store jab at the end of my reply.  I didn't intend to get nasty.

The post started out with the intention of being constructive.  If you decline recommendations, most vets will try to 'do something' - but you must know that cheaper treatment option you walk out the door with is rarely the 'same' as the original recommendation - and typically does NOT meet the Minimum Standard of Care - bartering your pet's health does not typically benefit the patient...

fedup October 23rd, 2009 02:06:39 PM

Regarding the issue of "natural" products vs. "killer drugs", I think it's important to remember that just because something happens to be natural doesn't necessarily mean that it's harmless. (Cyanide is totally natural, but giving it to your dog? Bad idea!) Likewise, just because something happens to be a regulated product of the pharmaceutical industry doesn't necessarily mean that it's intrinsically any more dangerous... or that it isn't natural.

Just my two cents.  :)

3 Fabulous Felines October 23rd, 2009 02:32:50 PM

There are items on my car that I can easily do myself and yet I don't.  I have my local dealership do them.  You wonder why, now don't  you?  Well, see, if I have them do a 20 or 30 dollar procedure, I am considered a regular.  What's that get you?

What it gets  me is superior service at a price less than others are paying.  In short, they cut me a break.

So let me apply this way of thinking to this subject.  Now my vet has to make a living.  I never saw "Veternarian" on the list of occupations that will make you a Trump or Rockefeller.  So even if it cost me a little more, I'll go ahead and get the pills off of them.  As I previously stated, my vet treated our little Rescue dog right in the lobby because they didn't have room in the back.  I doubt if "first time" or "rare" visitors get such treatment.

As far as the test goes, well, it falls to liability as well as anything.  If there is a chance, minimal as it may be, that giving a heartworm treatment to a dog with heartworm may be harmful or fatal, then they have to test.  I guess the best fix is not to let it lapse.

EAB October 23rd, 2009 02:37:55 PM

"If there is a chance, minimal as it may be, that giving a heartworm treatment to a dog with heartworm may be harmful or fatal, then they have to test."  Over the years, I've had a number of heartworm tests because I missed doses by a few days and, having had one turn up positive even though I'd been religious about her doses, I've been overly paranoid about it.  Stuff happens, they can be positive even if the test says negative, even if they're given pesticides in the right dose and precisely on schedule.  If we're going to talk about that level of "minimal" chances, it would argue for a monthly visit and test before every dose and I have no doubt there's some vet out there somewhere telling owners just that, the same way there are still OB/GYNs demanding 6 month invasions of women's crotches (yep, I left one for that too, he also had his own in house pharmacy and wouldn't right scripts) even though I fell into the 3 year exam protocol.  In reality, 2 weeks late probably isn't a problem as long as it isn't habitually late.  I'm perfectly comfortable that my dogs are more than protected when my 75 pound dogs get a dose good up to a 100 pound dog and so long as it's a pesticide that is reasonably safe for those who are heartworm positive (and some of the pesticides are not).  I am somewhat annoyed at the inaccuracy of using these pesticides with such broad weight ranges.  I'd be very uncomfortable giving a 55 pound dog this dose but that's what they'll likely be given these days rather than 2 pills (a 25-50 and an under 25 [which should actually be cut in half, IMO]).

MY mechanic is buried in work; he's a great mechanic.  Loves to give me the part number and I get a discount for not pestering him with silly little stuff I can do myself.  I'm still a regular, just a rational, reasonable regular.  With 4 dogs, if I'm extraordinarily lucky, they'll only need their annuals which I'd like them to have even if they don't get shots every year AND I've always gotten their Heartguard in a year at a time supply.  THAT alone should be sufficient for me to be considered a "regular".  BTW, for those who have read Three Billy Goats Gruff of late, it contains several morals.  My favorite is "the greedy get gored".

fedup, No problem for me.  I actually appreciate the impetus.  Turns out I have at least 18 feed stores within 25 miles of home.  Now I have a list so I can make the rounds and see who's got what and where the pro farmers hang out.  Long past time to get back to my own roots, being more self sufficient, not wasting so much of my time and money trotting in and out of the vet's office; too bad I didn't do that when my Shiba was bitten, would have save me some money and her a great deal of pain and trauma.

PJB http://pjboosinger.viviti.com/ October 23rd, 2009 03:22:02 PM

Barbara --

Not Susan, but we nearly lost a young healthy dog to Lepto this summer.  Western Pennsylvania.  Not pleasant, and not cheap to save her, either.

I haven't vaccinated for lepto for years -- on the explicit advice of my vet, because it is not very common regionally.

But apparently, dogs who spend their leisure time hunting mice in a hayfield have an elevated risk of exposure.  Yah duh!

Now we vaccinate -- with the newer stand-alone vaccine that protects from four strains, not the "L" tacked onto a 7-way puppy shot.

H. Houlahan October 23rd, 2009 03:40:10 PM

I use the cattle ivomec for my 8 dogs.  Have used it for years.  I live in the Northeast but give it year round and I rarely HW test.  When I do HW test (if I am shipping/selling an adult dog) they have always been negative.

I was wondering Dr. K what your opinion was on the "Old Country Vet"  http://www.oldcountryvet.com/

Holly October 23rd, 2009 03:58:41 PM

We I live in Northern California dogs do get heartworm, mostly dogs that live out doors all the time.  I do give my dogs Heartgard, every six weeks since I have been told by a vet that it works for that period of time and only the end of April through the beginning of October.  Since it is NOT a preventative but a pesticide, no reason to give it ahead of time or after it is too cold for mesquitos.

I am not against testing.  I just paid $80 for a titer test on my year and a half year old Dachshund rather than another vaccination. I just like to keep the balance between promoting health and promoting illness as even as I can.

Eliza October 23rd, 2009 04:11:46 PM

I am a Veterinarian with a Companion animal Practice in the Southeast.

Although there is no established statute in my state nor Veterinary Medical Board ruling which stipulates that the 1 year term is the basis for a current Veterinaryian-Client-Patient status this period seems to be a generally accepted concensus amongst the colleagues I think highly off.

In order for our practice to consider a pet a 'current patient' we require, as a minimum, an annual physical exam with our practice for 'healthy' patients from 1-8 years of age. For older patients in our 'Senior' group we require the annual exam and strongly recommend a q six month follow-up.

There are numerous medical reasons why we feel the annual exam (and semi-annual exam for seniors) - not to mention more frequent progress exams for patients with medical conditions - is in the best interest of your pets.

We also require annual Heartworm testing - using the Idexx 3DX - prior to prescribing either as dispensing or writting prescriptions to be filled elsewhere, (As a side note, we don't use the 4DX as we have had very few documented cases of Anaplasmosis in my state and 'add ons' looking for marginal occurrence conditions quickly add up on clients bills with little to no improvment in patient care.)

The reasoning behind this is fairly simplistic - I find a fair number of these patients come up antibody positive to Lyme or E.Canis - which tells me they need to do a better job on tick control and we need to keep those exposure results in consideration in the event the pet develops possible associated symptoms. We also require it to detect Subclinical Heartworm disease because when we detect heartworm positive patients before they develop heartmurmurs, heart failure, anemia etc etc... we have more options in how to treat it.

I also require annual heartworm testing because of other factors -

(1) Many clients are not compliant with administering their medications on a monthly basis. Yes, we have mosquitoes about 10+ montsh of a year. Yes the HWP may have a longer reachback effect than just 4 weeks - but we don't accurately know how long that is... I normally tell clients nto to sweat it too much if they miss by 2 weeks... but longer than that who knows?

(2) Some patients aren't compliant - they either won't take the pill, hold it in their mouth or vomit it up later. I have had a patient which tested positive despite the owner being adament they gave it monthly... she found a cluster of about a dozen pills behind her couch were only her poodle could go.

(3) I'm sure noone would be surprised to find out that manufatcuring and storage erros occur to pet medications just like in human pharmacies - Heck Virbac just finish a major recall on Iverhart Plus / Iverhart Max this last month due to these issues

Now as far as it being a financial racquet - Yes, it is true most veterinarians make money on product sales. I can't speak to or defend the Practices which use gigantic mark-ups which put their prices at 3 times that of the major online retailers. - I carry both Heartgard Plus (in small quantities) and Iverhart Max for dogs, and primarily Revolution for cats. My mark-up on these products is substantially lower than what I see around me - our HWP prices are basically set to those of Pet Meds Express on a quarterly basis - some weeks PME drops theirs and some weeks the increase them - but I don't check them every day.  What this translates to is a 'profit' of, on average, about 10-15 dollars on a years supply... Occassionally we have clients that find HWP online at some obscure site I haven;t heard of... for prices which are BELOW what I pay for the product.... I try to be competetive with the majority of the market...but can't beat below my cost.

However, we have a simple prescription policy in our practice - if your and your pet are a current client / patient and you have met our practice policies regarding testing for Heartworms (or other appropriate medications), we are more than happy to either dispense medications from our hospital or to write a prescirption for it to be filled elsewhere....

Why? Well besides the fact that it's a requirement in our state - state stautes and Veterinary Medical Board stipulation - it's just good customer service.... and because of the manner we do our practice pricing in total.... our products aren't a huge PROFIT source for us.... they generate a fair amount of Gross Revenue... but because they COST me quite a fair bit when compaired to the amount of profit they generate I don't draw alot of profit from them....

Last year 20% of our Gross Revenue came from Product sales...but only about 5% of our total profit came from them....Frankly, it's almost not worth it to carry these things in our practice if we had to put up with alot of grief from our clients regarding our 'prices' or our prescription policies.

Fortunately, our clientel appears to be satisfied that we are trying to be both fair and honest with them and their pets with respect to healthcare recommendations and pricing... We occassionaly get price concerns regarding our services, but I can't tell you the last time someone really complained about our product pricing... because when they do...our staff tells them you know, we are more than happy to provide you with a writtens cript if you want to shop around on yoru own to find a better deal.... I'd estimate we write prescriptions about 10-15% of the time... and frequently, once the client has shopped around they still come back to us to purchase them....

Now, can you use Liquid Ivomec as a form of Heartworm Prevention - sure you, as the client and the owner of the pet can - but many of you may not be aware of another simple fact - While Veterinarians are covered in many cases by a concept known as Off-Label pharmaceutical use... where we can recommend or prescribe the use of pharmaceutical products for a condition or in a manner for which they haven't been officially licensed via the FDA - so it's a drug approved for one use, but we want to use it in another unapproved manner - this generally only applies when (1) There isn't a different product already label for this particular condition or (2) Where there are known risks with the aproved product such that the use of that product would be considered mroe hazardous than the use of the off label product...

Liquid Ivermectin in the big bottle doesn't qualify for Veterinarians as an approved off label use for the prevention of Heatrworms - because while it is the same base pharmaceutical product as what is in Heartgard - it is not in an FDA approved formulation for this use in dogs as a Heartworm Prevention. And since there are approved formulations - Heartgard Plus, Iverhart, Trihart - available for the exactlt same drug... well it would be considered unethical (and thus unprofessional as seen in the eyes of the VMB) for me to recommend the use of liquid Ivermectin as a form of Heartworm Prevention because it wouldn't fall under 'off label prescribing'...

Sure it works, sure it can be incredibly cheap.... and for my clients who decide to use it... I don't 'penalize' them for doing so... but I can't recommend it, nor can I give them a dose to give..as that would be tantamount to prescribing it's use.

And, like a few of my colleagues, I do look forward to the future when HWP are available as OTC products.... because, in theory, that should drive the price down for everyone....

As for those of you who don't want to give these products to your pet - that is certainly your choice - Honestly, I don't think most of the holistic products sold to ward off mosquitoes, fleas, ticks etc work on any sort of a reliable or predictable basis... but then again, since your pets aren't my pets... once I've communicated my recommendations and we've discussed pros and cons... then if something happens that's up to you to decide and live with the consequences.... I'd like to think that my 9+ years of college and graduate medical education and 13 years of private practice experience (plus the general concensus of the Veterinary Community at large) probably trumps anecdotal 'evidence' collected from internet blogs and pseudo-science reviews... but hey, every now an dthen an old wives tale turns out to have some truth in it....

Dr. Mac October 23rd, 2009 05:16:29 PM

Dr. Mac,

what a delightfully honest posting. Wish that more vets were more like you. In regards to the ivermectin dosing...I understand...come on people, it's not really even algebra....we can do it and make our math teacher's proud....<LOL>

PJB...feed stores are awesome for the most part...

Dr. K....another scintillating topic...ALWAYS love to read the poster's pros and cons. if nothing else, they are entertaining. But I do think that people should be more aware of what they put into their pets, and just how those items work....since heartworm pills do not exactly prevent heartworms...

LorriM October 23rd, 2009 05:38:06 PM

Yes heartgaurd CAN last up to 45 days but that is taking a risk with your pets health.  I have done many lunch and learns with all the hw prevention reps and they say it can last 45 days but it is recommended every 30 for a reason.  There is no guarantee that it will stay effective that long. 

It also takes 6 months from infection to show up positive on a hw test.  I live in the south and give my 4 dogs heartgaurd all year round!  I'm just not willing to take a chance!  I have seen dogs suffer through hw treatment and I've seen them not know anything happened to them at all but I'd rather pay for prevention that pay for treatment.  Prevention is way cheaper and my dogs just enjoy it more!

stlrsgirl October 23rd, 2009 06:36:43 PM

<<I have done many lunch and learns with all the hw prevention reps and they say it can last 45 days but it is recommended every 30 for a reason.>>

yep..and we ALL know about how honest and alturistic pharmacy reps are....paleeze...

LorriM October 23rd, 2009 06:43:47 PM

LorriM, Ya beat me to it! <G>  I used to love feed stores; been in the City for years now and got out of the habit; they're pretty few and far between in metro areas!

PJBoosinger October 23rd, 2009 07:11:15 PM

hmmm.. I live in the northern high plains, where the climate is cold and dry for 6 months and nary a mosquito can be found.  Is there any reason I should keep my dog on hw preventative 12months/year or for that matter, test them before I start up again?

EmilyS October 23rd, 2009 07:21:39 PM

I am one of the money grubbing, horrible veterinarians who insists on regular heartworm tests and a valid client-veterinarian relationship to sell you heartworm prevention. I will also talk to you until I am blue in the face about putting your new pup or older dog on year round prevention. Want to know why? I practice the South where an outside dog has a 95% or better chance to get heartworms by the time his first birthday rolls around;  a strictly  inside dog still has a 50% lifetime chance of contracting heartworms.

Over the last 24 years I have seen plenty of dogs die from end-stage heartworm disease, from vena cavae syndrome (when a young dog is infected by a large number of mosquitoes at one time and all the developing heartworms try to reach the heart at the same time), and some from fatal reactions to feedstore Ivomec in overdose...

I practice what I preach. My own dog, adopted from a rescue organization immediately after they pulled her from "death row" at the pound, had every parasite known to man, including heartworms. I put her through the 60 day Immitticide treatment, complete with the Doxy for 30 days and after starting heartworm prevention under STRICT supervision. She is now healthy, tests HW-negative every year and is on year - round prevention.

As to the particular preventative to recommend, one size does not fit all. We have seen a handfull of dogs with seizures or vomiting on one, but not another product. A few of the topicals bombed out when not applied directly to the skin and occasionally a dog tests positive in spite of getting prevention every month (unchewed chewables can pass undigested, the dog can throw them up or hide them et.c). Guess what, the manufacturers payed for treatment in every one of the few "breakthrough cases", as long as we could document negative initial tests and uninterrupted purchases of product.

As to how to proceed once a dog tests positive depends on severity of the infection, age of the dog, duration of infection, your vet's best judgement and, to be frank, your  willingness to pay for the Immitticide treatment and ability to keep the dog quiet for 60 days. again, each case is different.

Heartworm disease is incredibly cheap and easy to prevent, difficult and expensive to treat!

DT October 23rd, 2009 09:06:11 PM

Before I knew what was involved in HW treatment, I was very sloppy about HWP. Since becoming involved with a rescue group and finding out the details and risks, I've changed my tune.

However, just today I called my vet's office to ask about a prescription for Sentinel, which his office doesn't carry. My Boston seems to react badly to flea topicals and since Sentinel covers both fleas and HW, and is an oral med, it seem to be a good choice for him.  He doesn't break out in hive or go into anaphylactic shock but he clearly is in significant discomfort, rolling around on the ground and trying to get the substance off him. If I can avoid causing distress, why not?

Barbara, I believe the state was Georgia; this is an online friend and I don't have an exact address.

Susan October 23rd, 2009 09:27:50 PM

DT: are you saying then that chewables must be chewed?

I have yet to have a dog that will chew a chewable. I always have to hide them in cheese or a hot dog.

I used to HAVE to get my rimadyl online because the local vets ONLY stocked the chewables, and my bulldog would spit them out like poison.

Does this mean I should crush the chewables? What a PITA.

Susan October 23rd, 2009 09:32:44 PM

Susan,

I always break the chewables into several pieces to make sure they don't get swallowed whole and tell my clients to do the same.

Years ago my colleagues Dobie passed a whole undigested chewable heartworm pill when he had somewhat loose stool. When she checked with the manufacturer, she was told to make absolutely sure the pill gets chewed, not inhaled in one piece.

DT October 23rd, 2009 09:48:12 PM

PS to Susan,

Just re-read your post, I am not sure about the other chewables' absorption since I was focused on heartworm preventative, especially the large beef-treat type. It would be a good question for the manufacturer.

DT October 23rd, 2009 10:01:25 PM

Well, more reason for me to prefer Heartguard Plus Chewables to Sentinel.  I've always broken up the Heartguard (although no one ever told me to do so) because the dogs go bonkers for them and think they're treats.  The Sentinel may be chewable but the only way I'm getting those down my Lab's throat is the "shove down the throat" method and none of the others show the teeny, tiniest interest when I get the Sentinel out.  Might have something to do with how little beef I feed since it causes problems for my 2 older dogs; still worth the trade off of an evening of itching to get those down easily though!

And the SPCA of Texas lost one today,  That makes it a good (could have been better so not great) day for Texas pet/livestock owners!

PJB http://pjboosinger.viviti.com/ October 23rd, 2009 11:19:24 PM

Although our vet only requires annual testing, they have a requirement to see the dog within 6 months to renew *any* medication.  So somebody wants to pick up another 6 months of hw preventative?  Must pay an exam fee just to be given a box of meds.  That's gouging.

nb October 23rd, 2009 11:23:57 PM

"... and they have a reachback effect, so they don't have to be administered EVERY 30 days... I'm not going into it.anyone who is curious should discuss this with their vet and do research and make their OWN decision...but I digress. Beaner, my pitbull, has heartmworms."

agadoremama, I'm curious...did you acquire Beaner hw positive, or did he acquire them while in your care?

Our clinic's policy is as follows: annual testing required, monthly dosing required, purchase of hw preventive w/in 30 days of neg. test if spotty preventive up to that point...otherwise, your rx expires and you have to have your pet re-tested. It's what the manufacturer requires to guarantee their warranty, so that's what we follow, and in Oklahoma you don't mess around w/trying to time your preventive so you can spare a few months' worth of pills...just not worth it. I know it frustrates clients to have to pay for a retest if they miss more than a month, especially since that test won't show if the pet actually contracted hw during that lapsed period, but because we're very good about informing our clients of this policy (and documenting the conversation in the record), I figure a $35 test is just the price paid for failing to go through the red tape, much as we all hate to do so.  We're more than happy to approve prescriptions from online pharmacies, but we let the clients know that they're on their own when it comes to ensuring product legitimacy, warranty claims, etc., if they choose to go that route. 

I like the idea of OTC hw preventive in theory, but I'm not sure how well it'd work out for pets.  A lot of pet owners still confuse heartworms with intestinal parasites, or think their flea and tick topical automatically does heartworm, too (when in fact they've just been using Frontline OTC).  I'm just not sure the majority of pet owners are familiar enough with heartworms and disease prevention to allow OTC preventive, and I also think something going OTC gives people the impression that what it's intended for can't be that serious to begin with.

anna October 23rd, 2009 11:52:53 PM

Frontline and other flea medicines are OTC, and what do people do? They go to their local 'grocery store' and buy the stuff on the shelves there because, well, it's the same, right?

We would need to make sure that nothing of this nature happens with HWP.

twelvetigers October 24th, 2009 12:26:09 AM

DT: I agree with your stance. Though I may not be so persnickety on the timing of re-testing post monthly filaricide (though I don't know for sure if that's the case). The thing I really want to know is if you believe it's better to allow anyone to just buy it without a script given that seeing a vet adds an additional barrier for many among a certain class of outdoor dog owners. Would it be more highly adopted if it were more freely available? Would the incidence of heartworm disease be lower? Just curious as to your take since you hail from a heavy heartworm area of the country.

Dr. Patty Khuly October 24th, 2009 05:31:59 PM

Ivermectin and pyrantel pamoate are the ingredients in Heartguard Plus.  Neither of those appears to be a controled substance.  (FDA 2004 example says ivermectin is OTC here; and in 2009 same for pyrantel pamoate here.)  In other words, Heartguard Plus IS an OTC product but for those exclusive contracts the vets sign with Merial.  So, basically there's ZERO excuse for not selling them to anyone who walks in and coughs up the price.

Well, heck, I could be wrong.  Somebody cough up the FDA link that says I am :)  Otherwise, let's talk strangleholds.

PJBoosinger October 24th, 2009 10:44:56 PM

Here it is, PJB. This is not one of those "vet-only" products to which you refer. Legally, a prescription is required. But your point is well taken: What's so magical about ivermectin and pyrantel pamoate when used in this specific combination in this species for this indication?

In veterinary school we were taught that the potentially devastating effects of a filaricidal reaction made this parasiticide a "drug" according to the FDA. 

Yes, we can argue that the drug companies enjoy Rx status along with veterinarians. In the former's case, it thwarts competition. In the latter's it drives annual visits.  

For my part, I would never want to risk a bad reaction in my own pets. I would never administer ivermectin or milbemycin without testing them first. Selamectin? Another story. That's why I tend to like Revolution. 

But even Revolution is not OTC. And no filaricidal downside. So why does it get the Rx status? Because it's in a class of meds that does require an Rx. And it keeps competitors from scooping them. It helps justify higher prices. 

In this case, I'm with you. It should be OTC. We do have safer alternatives and we don't use them/know about them/bother to think about this issue––which is a critical one for many pets in many parts of the country––because that's just the way things are. 

That's what this post is about and I don't disagree with you with respect to your assertion of a stranglehold. It's just that veterinarians don't necessarily stop to ponder this subject in much depth because 1) it's the way things have always been and 2) because it happens to be a favorable situation for us. Still, I don't see anything nefarious about that. Not from an individual vet's standpoint. Remember, most of us aren't practice owners. These sales don't dent our paychecks much, if at all. 

Dr. Patty Khuly October 25th, 2009 06:48:35 AM

PJB,

You are correct that one can purchase Ivermectin as an OTC in certain forms (injectable and pour ons) for large animal use.

Pyrantel Pamoate is also availabel as an OTC - I believe for all species.

Yet, Ivermectin in the formulations labeled, licensed and available for use  as a Heartworm Preventative in Dogs (and cats) - sich as Heartgard Plus, Iverhart, Trihart  et al - is defined as a prescirption product.

What this means is if you, or any other person, wanst to walk into a feed store and purchase Ivomec liquid pour on (or injectable) as a large animal product and pyrantel pamoate paste or tabs or Amoxicillin / Penicillin inejctables- and then figure out how to dose your own animal - you may do so - to YOUR OWN ANIMAL. That would be legal, to do to your own animal, as long as what you are doing wouldn't consitute cruelty or abuse... you can choose to do it and it's completely legal... for now.

However, since there are product formulation labeled, licensed and approved for the use as Heatrworm preventions in Dogs - Heartgard, Tirhart, Iverhart - and those Items have been deemed prescription products... this means, that I, as a Veterinarian, must:

(1) abide by the prescription requirement (which by default includes a valid Veterinarian-Client-Patient relationship be in place)

and

(2) prescribe Ivermectin in the approved and available formulation for it's use in Dogs. (Heartgard, Iverhart, Trihart)

Technically, ethically and professionally - due to stipulations and regulations in my veterinary license, pharmacy prescribing and AMDUCA.... I am not permitted to advise someone to use the large animal formulations of Ivermectin as a method of Heartworm Prevention in their dog.... because the stipulations for the use of products in an "Off-Label" manner would not cover liquid Ivermectin - since their is an approved formulation of this product for this species (dog) and treatment condition (heartworm prevention) available on the market....

So while YOU can pick up the LA Liquid Ivomec, calculate YOUR own dose, and give that dose to YOUR dog.....

I, as a licensed veterinarian, cannot advised / recommend or 'prescribe' the use of LA Ivomec to you or my canine patients as a method of Heartworm Prevention...

Do some Veterinarians tell their clients to use Liquid Ivomec and how much to use... absoluetly they do....and while I understand the sentiment behind it... since I am aware of the legal and professional technicalities making this a professional No-No... I choose to follow them. And granted, few Veterinarians are ever actually penalized or receive any type of chastisement for violating these elements of practice but....

While I may not like some of the legal / professional requirements placed on Veterinarians in the practice of medicine - but I follow them - I do not pick and choose which of these requirements to abide by and which ones to violate.... I happen to believe that while I might not like them, and advocate for some to be changed, I will still follow the requirements until such time as they are repealed or changed.

Dr. Mac October 25th, 2009 07:55:29 AM

Thanks Docs, Now I get it.  Thanks for the help.  I hate digging through the FDA website. Dr. K, don't shoot me but isn't that link to plain Heartguard, just ivermectin (without the pyrantel pamoate)?  So, I need to get a really silly law changed.  Hm, I've been up against worse but this one's not that tough if they've targeted just dogs (and cats?), the home pet market, which is what this appears to come down to.  And they started it with the plain ivermectin, not because of the combo?  (That jives up with the rumors I'd heard over the years but I wasn't the least bit sure of the truth of those rumors.)

I don't really have an issue with annual testing for heartworms but my go to vet let it slip that, as long as I'm consistent with the preventatives, it really isn't necessary that often and he's the one who knows I'm downright paranoid about giving HW preventatives ever since he had to treat my first dog for one of those "one sex only" HW infections that caused seizures but didn't show up on those in house tests.  NO, I don't EVER want to go through that again!!!

"Pyrantel Pamoate is also availabel as an OTC"  Yep, I get it at good old Wally Mart :)  And, frankly, given my druthers, I'd dose the ivermectin and pyrantel pamoate separately, one of them 2 weeks after the other.

"I will still follow the requirements until such time as they are repealed or changed."  You'll get zero objection from me on that one although I sure like the pros that are willing to speak out on the absurdities within their own professions :)

PJBoosinger October 25th, 2009 11:23:38 AM

Anna-

Beaner was HW positive when I rescuued him.  He came from a swampy area, was on a chain,starving.  No food, water, or shelter. 

I'm not telling people to do as I do- I'm saying we need to educate ourselves, and talk to our vets, and make the best decisions we can based on our experiences, our information, and our abilities.

I don't make my decisions on HW drugs based on money.  I make it based on the health of my dogs.

agadoresmama October 26th, 2009 01:24:30 AM

Hi,

Part of the reason that Ivermectin is expensive because the pharmaceutical company donates it to WHO to prevent river blindness in Africa.  Your puppy $$ is helping a continent.

http://human-infections.suite101.com/article.cfm/eliminating_river_blindness

Lymie October 26th, 2009 04:50:01 PM

Hi, Dr. Patty,

This discussion may be over by now, (sorry, I was off line for a few days)however, I have mixed feelings whether heartworm prevention should go OTC

- most of us just don't take OTC medications and the conditions they treat (eg. headaches, indigestion, intestinal gas) too seriously. I'm not sure most clients would understand how truly crucial HW Rx is, especially in the South. In addition, this is a parasite with a pretty complex life cycle. Even with all our pamphlets and face to face discussions, it is often difficult for clients to understand why they have to be extremely careful to watch for a reaction when re-starting prevention after a 6 month break or on a positive dog, but not if they just missed the last month.

-even when purchased from the most expensive vet, HW prevention for a big dog costs less than $ 10.- per month. Going OTC would pay for ONE pack of cigarettes or ONE Latte at Starbucks. ( Also, the on-line pharmacies can sometimes sell it for less than we have to pay for it.) Even if you add $ 20-40 for a HW test per year it is hardly cost prohibitive.

Of course there are always well informed owners with large numbers of dogs who truly know what they are doing and are somewhat inconvenienced by the prescription requirement. However, in my neck of the woods they are a small minority.

In short, I'd rather see more of the flea and tick products go OTC rather than heartworm preventative.

DT November 1st, 2009 07:24:48 PM

My dog was just at the vet a couple of months ago for her regular annual shots and check-up.  Nothing was mentioned to me about doing a heartworm test - they only ask if I were using heartworm meds.  I order online.  I just tried to re-order.  The vets office called me and said they could not give the ok for the meds without me brining my dog in - again - for the test.  I feel they (my vet) is putting my dog in jepardy since I am at the mercy of having to get off work, make an appointment.  I do believe it is all about the money - RX and vets. Not to mention that we have created a world where low income and poor people cannot even begin to afford to take care of vet cost and meds.  They do love their pets, feed them, give them good homes.  I think something has gotten a little backwards here about loving and caring for pets.

Kathy November 4th, 2009 10:51:36 AM

The vet just told my friend that the reason her dog tested positive was because she buys her hw Rx from Australia. She claimed that there are storage rules for hw Rx that must be followed or else the product fails to protect.

My question is, is there any truth in this or is this just a vet who's sore that the my friend is avoiding paying her for the product.

MaryJane December 8th, 2009 09:25:31 AM

Mary Jane, I don't know if you'll check back - after about 5 days or so most readers don't look back anymore, but I was deleting spammers and will hazard a comment.

The vet is not exactly wrong - anything with chemicals can degrade under certain conditions, high heat and moisture levels being the most common.  Not all storage facilities, anywhere, are always 100% temperature controlled and have zero issues with moisture.  However, I'd be thinking far more along the lines of...did the product REALLY come from Australia?  Chances are high that it came from another place in Asia where control standards are hit-or-miss at best in terms of production, or are outright counterfit products.  Buying online is a risk because there might be little to no real, active ingredients, AND the storage is even more problematic.

AND, if the meds aren't bought from a vet that your friend actually has a client-patient relationship with, the company won't back up the product.  If it can be shown that the meds were bought from a vet, and given correctly, the company will pay for treatment for heartworms.  That alone, convinces many people, especially in areas with high incidence of heartworms, that buying from the vet is better than trying to be 'a penny wise, and a pound foolish.'

KateH December 10th, 2009 06:53:53 PM

related questions to vets regarding treatment for hw postive dogs. My Lucy is hw postive - very mild case according to the test they did. She is a rescue dog -- 2 years old (she tested negative when they originally rescued her one year ago.) I took her to the vet that rescued her (I moved to St L from Southern IL 4 years ago) -- and she says she's hw positive, and they want to do the treatment (2 shots over 24 hours, then 30 days strict rest.) I called my former vet in So Il (he took care of our pets for 20 years). He said in this case (if she is not showing clinical symptoms and is generally in good health) he would not recommend this. He would suggest continue the Heartguard once a month and let the adult worms die on their own over 18 - 24 months.

I simply can't decide what to do. For everyone who knows a dog that handled this process well, I know someone who had a dog die from the treatment.

Also, Lucy has already BEEN on heartguard for the years since she was rescued. Doesn't that suggest that the adult heartworms will be dead in another 6 mos to a year? And how much damage can they do in that time?

Help!

Donna Werner December 16th, 2009 06:46:37 PM

additional info: Lucy is a german shepherd mix, about 35 pounds.  Fairly active - so I suspect that keeping her quiet for 30 days is going to be a challenge.

Donna Werner December 16th, 2009 06:48:13 PM

Donna I have the same question so I hope someone can answer it. I am seeking to adopt a mature/senior dog and found a retriever/x 8yo who seems great. However the rescue told me he is light HW positive and they have him on monthly Heartguard. I am abit nervous to adopt him in case the adult HW harm his heart while the microfilia are dying off. I have often read that people have had great success doing it this way but I would like to know for sure as I am abit nervous in case he becomes ill and dies from the adult HW as I have had two recent deaths and not ready for another heartbreak :( brit

brit January 3rd, 2010 04:04:27 PM

Brit, I don't know if you (and Donna) will come back to read this, but I wonder what you mean by a HW test that tells if a positive response means it's a 'light' case versus a 'heavy' case.  The HW tests I've set up and read the results for (at 3 different places in 20 years) could not tell the degree of severity - just a positive or negative.  I'm not a vet, and there may be such a test out there, but I'd suggest you ask further questions about how the severity of a positive test result is determined.  I think a lot of the problems with the 'bigger' treatment and any deaths from that are often because of underlying heart issues and/or not being able to keep the dog quiet enough for the month, causing sudden, major shedding which blocks the lungs/heart.

I suggest discussing (both) case(s) further with a vet, in person, so they can explain the situation better.

KateH January 5th, 2010 11:49:18 AM