Savannah
 |
Savannah's Profile
Breed: Doberman
Age: 5
Diagnosis: Heartworm |
Heartworm infection from Texas
Savannah moved from Texas to Vermont when she was 3 years old with a history of unintentional head tremors. On her physical exam at CRVC in June, 1998 she had a heart rate of 78, respiration rate = 30, slightly pale mucus membranes, normal vulvar mucosa, healthy skin and coat. Savannah had a normal range of motion of her neck, without pain. She had a mild scoliosis (lateral deviation of the spine) and muscle tension in the right scalenius muscle, but was otherwise in fine shape. Savannah was on phenylpropanolamine, a drug commonly prescribed for urinary incontinence.
We discussed heartworm prevalence in Vermont and how to prevent the infection naturally. Much to our surprise, a routine canine heartworm antigen test was positive. A positive heartworm antigen test indicates the presence of adult heartworms in the circulation. These patients are not treated with preventive medications that kill larvae, but with an arsenic-based medication effective against adult worms.
Further blood tests showed microfilaria (heartworm larvae) on a direct smear and a Knott's test. In addition, a fecal test showed hookworm infection (Ancylostoma) that was treated with an anthelmintic (worming medication).
Due to the risk of heart and lung injury, the decision was made to have Savannah treated at CRVC with intramuscular injections of Melarsomine dihydrochloride ("Immiticide") to kill adult worms. Our job was to limit all the possible adverse effects of this drug.
Prior to treatment with the adulticide (Melarsomine) we took radiographs shown here, of the thorax to identify changes to the pulmonary vessels that would suggest a heavy burden of adult worms. Radiographs revealed a "reverse-D" cardiac silhouette, prominent right atrial appendage, right atrial enlargement, irregular pulmonary arteries, and an interstitial lung pattern.
With the permission of Savannah's caregivers we cautiously initiated treatment for heartworm disease. For heartworm treatment our goals were to:
- Provide a low-stress environment for inpatients being treated for heartworm disease
- an intravenous catheter to maintain hydration, and administer vitamins and antioxidants
- Administer Melarsomine according to the label
- Monitor the patient for potential complications as the adult worms die in the circulation.
Worms No longer a Problem
On an August morning, 1999, Savannah arrived for her treatment with Melarsomine but her temperature was subnormal at 98.9 F. We started Savannah on intravenous fluids with vitamin C, potassium, and B-vitamins to support cardiac function, reduce inflammation, and to help her excrete or detoxify the arsenic-based medication after the worms would have been killed. She also received natural pet foods and nutritional supplements during her hospital stay. Fortunately Savannah did not have signs of heart failure or respiratory distress from heartworm in the pulmonary arteries. Her Melarsomine treatment was continued according to the manufacturer's instructions, without complications. Some minor swelling occured at the injection site as the medication is slightly irritating. Her temperature on re-check three weeks later was normal at 101.3, heart rate = 120. Savannah's subsequent heartworm antigen test in May, 2000 was negative! She remains negative for heartworm antigen in 2001, and her caregivers follow our recommendations for heartworm prevention.
www.crvetcenter.com
