AHS: Recommended Management Protocol

ShinBi healthcare schedule:

28 February 2014

28 March 2014

14 March 2014

  • Minor re-check exam ($22.50)
  • Glucose Curve  ($65.79)

28 March 2015

  • Minor re-check exam ($22.50)
  • Glucose Curve  ($65.79)

11 April 2014

  • Minor re-check exam ($22.50)
  • Glucose Curve  ($65.79)

25 April 2014

  • Minor re-check exam ($22.50)
  • Glucose Curve  ($65.79)

28 April 2014

9 May 2014

  • Minor re-check exam ($22.50)
  • Glucose Curve  ($65.79)

23 May 2014

  • Minor re-check exam ($22.50)
  • Glucose Curve  ($65.79)

28 May 2014

29 May

28 August 2014

  • Test for microfilariae–If positive, then treat with microfilaricide and re-test in 4 weeks
  • Establish year-round heartworm prevention

February 2015

  • Antigen test six months after completion

PROJECTED COST FOR DIABETES  (MARCH-AUGUST 2014)

  • Minor re-check exam ($22.50) twice a week for six months  = $270
  • Glucose Curve  ($65.79) twice a week for six months = $789.48
  • Insulin ($42) once a month for six months = $252
  • Insulin Syringe ($33.60) once a month for six months  = $201.60

SUBTOTAL =  $1513.08

PROJECTED COST FOR HEARTWORM TREATMENT

SUBTOTAL = $474.79

TOTAL PROJECTED COST = $1987.87

If you’d like to help Southland Collie Rescue cover the costs of ShinBi’s care, you can:

Donate directly by sending a check to:

  • Southland Collie Rescue 
  • P.O. Box 1596
  • Brea, CA 92822-1596
  • Instruct that the donation is for ShinBi

You can donate through Just Give.

You can donate through the GoFundMe page.

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Treatment: Melarsomine injection

ShinBit is receiving a Melarsomine injection to kill the adult heartworms. So Melarsomine is an adulticide and is the Immiticide referred to in the heartworm treatment report.

Remember the adult worms can live in the heart and pulmonary arteries which is why heartworms get their name. Melarsomine is the only medication currently being used to kill adult heartworms. Because it is injected into the muscles of the back, the injections can be painful.

Doxycycline is also used to kill the Wolbachia organism infection that often accompanies heartworm disease.  This organism is thought to also provide some sort of protection for adult heartworms and may cause inflammation in the lungs of the infected animal after the adult heartworms die.

The dying heartworms can cause obstructions in the blood vessels of the lungs. Exercise can increase the risk of an embolism and serious side effects so ShinBi must be kept quiet and inactive during his heartworm treatment.

Heartworm treatment

Treating for heartworms is not just a simple pill. The treatment must kill the microfilariae and the adults. Remember that a dog can have a heartworm infestation and not test positive. A heartworm infestation will only become apparent if there are adult females present because the standard tests looks for microfilariae (baby or the first larval stage of heartworm parasite development).

Here’s what the Heartworm Society writes about the standard treatment:

Adult Heartworm Therapy (Adulticide Therapy)

There is currently one drug approved by the FDA for use in dogs for the elimination of adult heartworms. This drug is an organic arsenical compound. Dogs receiving this drug therapy will typically have had a thorough pretreatment evaluation of its condition and will then be hospitalized during the administration of the drug.

Melarsomine dihydrochloride (Immiticide®, Merial) has demonstrated a higher level of effectiveness and safety than any other adult heartworm treatment previously available. It is administered by deep intramuscular injection into the lumbar muscles. For complete information on the classification and treatment for heartworm infected dogs using this product, consult your veterinarian.

Post-Adulticide Complications

Prior to treating the adult heartworms, your dog will be put on a 4 week course of doxycycline (or a related antibiotic). This helps reduce the viability of the parasite and decreases the reaction to the dying and decaying heartworms following adulticide treatment.

The primary post-adulticide complication is the development of severe pulmonary thromboembolism. Pulmonary thromboembolism results from the obstruction of blood flow through pulmonary arteries due to the presence of dead heartworms and lesions in the arteries and capillaries of the lungs. If heartworm adulticide treatment is effective, some degree of pulmonary thromboembolism will occur.

When dead worms are numerous and arterial injury is severe, widespread obstruction of arteries can occur. Clinical signs most commonly observed include fever, cough, hemoptysis (blood in the sputum) and potentially sudden death. It is extremely important to not allow exercise in any dog being treated for heartworms. Often dogs with severe infections will also require the administration of anti-inflammatory doses of corticosteroids.

Elimination of Microfilariae

The most effective drugs for this purpose are the macrocyclic lactone (ML) anthelmintics, i.e.,milbemycin oxime, selamectin, moxidectin and ivermectin. These drugs are the active ingredients in commonly used heartworm preventives. Although their usage as microfilaricides has not been approved by the FDA, they are widely used by veterinarians as there are no approved microfilaricidal drugs currently available. It is recommended that microfilariae positive dogs being treated with these macrocyclic lactones be hospitalized for at least eight hours following treatment for observation of possible adverse reactions, including those resulting from rapid death of the microfilariae.

Circulating microfilariae usually can be eliminated within a few weeks by the administration of the ML-type drugs mentioned above. Today however, the most widely used microfilaricidal treatment is to simply administer ML preventives as usual, and the microfilariae will be cleared slowly over a period of about six to nine months.

Confirmation of Adulticide Efficacy

The goal of adulticide treatment is the elimination of all adult heartworms. However, clinical improvement in dogs treated for heartworm infection is possible without completely eliminating the adult heartworms. Heartworm antigen testing is the most reliable method of confirming the efficacy of adulticide therapy. If all the adult worms have been destroyed or very few survive, heartworm antigen should be undetectable after six months post-adulticide. Dogs that remain antigen positive at that time could be considered a potential candidate for repeat treatment with an adulticide only after a full review of each case. In some cases, an alternative is to not retreat with the arsenical but to continue with a preventive such as ivermectin which will gradually eliminate the remaining worms.

Treatment: Doxycycline

Doxycycline is an antibiotic used for treatment of a variety of problems. ShinBi is being given this medication for his heartworm.  ShinBi was also positive for Anaplasmosis and Doxycycline is also used to treat this–that’s two for one!

According to PetMed.com, here’s what you need to know:

  • Drug Name: Doxycycline
  • Common Name: Vibramycin®, Doxychel®, Doxy Caps®, Bio-tab®, Monodox®, Doryx®, Doxirobe®
  • Drug Type: Broad spectrum antibiotic
  • Used For: Bacterial infections
  • Species: Dogs, Cats
  • Administered: Tablets, Oral liquid
  • How Dispensed: Prescription only
  • FDA Approved: Yes
  • Recommended Online Pharmacy: Get Doxycycline at Pet360.com

General Description

Doxycycline is a broad spectrum antibiotic that is a member of the tetracycline family. It is used to fight bacterial infections in dogs and cats. Doxycycline is used to treat many different bacterial infections including, leptospirosis, toxoplasmosis, mycoplasma, psittacosis, and tick borne diseases including Lyme disease, ehrlichiosis, and Rocky Mountain spotted fever.

How It Works

Doxycycline binds to specific cell parts (ribosomes) of the bacteria and inhibit the protein synthesis, thus not allowing the bacteria to grow and divide. The process of shutting the protein synthesis down is not rapid. For this reason treatments using Doxycycline are generally termed as a long term treatment. It takes some time after the process is shut down until NSAIDs work by reducing the enzyme COX-2. COX-2. these enzymes are involved in the formation of prostaglandins which cause swellingand inflammation. Reduction of these factors reduce the pain and inflammation your pet experiences.

Treatment: Dexamethasone

ShinBi received a Dexamethasone injection.

PetMD.com explains the usage of Dexamethasone:

Dexamethasone is many times more potent than other anti-inflammatory and immunosuppressing drugs including hydrocortisone and prednisone. It is often mixed with other drugs to treat difficult ear, eye, and skin infections. It reaches every system in the body and therefore is used to treat many disorders:

  • Adrenal insufficiency
  • Rheumatoid arthritis
  • Systemic Lupus
  • Allergies
  • Asthma
  • Dermatologic diseases
  • Hematologic disorders
  • Neoplasia (Tumor growth)
  • Nervous system disease
  • Emergency shock
  • General inflammation
  • Inflammatory bowel disease
  • Nephrotic syndrome

Heartworm treatment: Trifexis

ShinBi is being treated with Trifexis.

According to 1800petmeds.com:

Trifexis is a chewable tablet that kills fleas and prevents infestations, protects against heartworms, and treats and controls adult hookworm, roundworm, and whipworm infections.

Benefits:
Begins killing biting fleas within 30 minutes
Kills fleas before they can lay eggs
Prevents heartworm disease
Treats and controls roundworms, hookworms, and whipworms
Artificial beef flavor made from pork liver and hydrolyzed soy
Easy to administer chewable tablet

How it works:
Spinosad, an active ingredient in Trifexis, starts to work within 30 minutes to kill fleas and has been proven to kill 100% of all biting fleas within 4 hours. Trifexis also kills flea eggs before they can mature, which helps to end the flea life cycle. Trifexis prevents heartworm disease by killing microfilariae and larvae from maturing into adult heartworms.

Cautions:
Serious adverse reactions have been reported following concomitant extra-label use of ivermectin with spinosad alone, one of the components of Trifexis chewable tablets. Use with caution in breeding females. The safe use of Trifexis in breeding males has not been evaluated. Use with caution in dogs with pre-existing epilepsy. Puppies less than 14 weeks of age may experience a higher rate of vomiting.

Side Effects:

Average Monthly Rate (%) of Dogs With Adverse Reactions
Adverse Reaction Trifexis Chewable Tablets2 Active Control Tablets2
Vomiting 6.13 3.08
Pruritus (itching) 4.00 4.91
Lethargy 2.63 1.54
Diarrhea 2.25 1.54
Dermatitis 1.47 1.45
Skin Reddening 1.37 1.26
Decreased appetite 1.27 1.35
Pinnal Reddening 1.18 0.87

Heartworm: Positive/Negative

In order to ShinBi to be cleared for transport from South Korea to Los Angeles, he had to be pest-free. ShinBi was tested for heartworms and the test came back negative. The day after ShinBi arrived, Sue Baldwin took him to the veterinarian. That was on a Friday (21 February 2014).

On Monday, Sue Baldwin learned that ShinBi was heartworm positive. How is that possible? The South Korean vet, Dr. Choi used the American Veterinary Association HW protocol and used the IDEXX HW test. HW tests are not 100 percent accurate.

The IDEXX SNAP HW RT test is 81 to 90 percent accurate according to the the Journal of the American Veterinary Medical Association. Other tests have lower accuracy rates such as the Abaxis CHAT (71-82 percent) and Heska Solo Step (71-82). The HW tests  depend upon the presence of mature female hookworms that, having been fertilized, send out offspring, microfilariae,  into the infected animal’s blood.

According to the American Heartworm Society, “A positive test tells us mature female worms are present. And, while false-negative results are uncommon, they can occur if a pet has a “male-only” infection (since the test detects antigen from females), if only one or two worms are present, or if the female worms are immature.”

ShinBi’s treatment for heartworm was started immediately.