Kane's Heartworm Journey
I’ve been tossing a blog post around the old noodle titled “Fork,” but this one felt more important, so I’m going to write it first.
As has been documented, I am an obsessive pet parent. As has also been documented, Sean and I recently adopted a heartworm-positive dog. This whole thing has thrown me for a bit of a loop, and I spend my days googling every. single. thing. During my last googling session, I came across another dog parent’s blog post that helped me so much, so I’ve decided I’m going to do the same thing.
If you don’t care to read a detailed account of our heartworm experience (because why would you unless you were going through it too?), you can skip this one and look forward (or not) to my blog post about forks soon :)
Unfortunately, we are not yet out of the woods, so this will continue to be updated until I can one day post the happiest update: “KANE TESTED NEGATIVE TODAY! THIS JOURNEY IS OVER!”
In the meantime…
Some context: We adopted Kane on December 13th, 2020. The shelter we adopted him from had already administered Immiticide injections on December 8th and 9th. He had also already started Doxycycline and Prednisone by the time we adopted him. He was given Tramadol by the shelter, but none was sent home with us, so I do not have any firsthand experience with it. We were told to continue his medication and keep him as calm as possible until told otherwise by our veterinarian.
Here’s a pic of him for reference (and because – look at that face!). He is just under 50 pounds and received the below dosage.
Prednisone: He received 10mg of Prednisone every 12 hours from December 9th-15th, then every 24 hours December 16th-22nd, and then every 48 hours until we ran out. (I believe we ran out on NYE.)
Doxycycline: He received 2 100mg tablets every 12 hours from December 5th to January 5th.
Week 1: December 13-19 (4-10 days post melarsomine injection)
Keeping Kane calm during this first week was really easy. We thought that was because he was just a super chill pup, but it turns out it was because he was feeling like total crap from his treatment.
“The shelter said he’s high energy. He isn’t high energy!” We were total dumbos.
Because he is, in fact, high energy, the shelter recommended we crate him when we aren’t home monitoring him, at least during the six-week recovery period. I am anti-crate for a few reasons, but I thought I could handle it if I knew it was temporary and could potentially save his life.
Turns out I couldn’t.
The first time I left him home alone, I did a test trip to Publix. I was gone about 20 minutes, and I’m pretty sure my blood pressure was through the roof the whole time because I was so eager to get home and let him out.
I cried like a baby the night before we had to return to work because I didn’t want to crate him, so Sean installed a dog gate so that we could just keep him restrained to a hallway instead. I still don’t like locking him in there when we’re away, but at least he can walk around, drink water, eat food, etc. We also leave a puzzle ball in there for him to work on while we’re gone, along with his two favorite toys.
Obviously, I’m not a vet, so you need to do whatever you and your doctor decide is the right thing for your dog.
On December 17th, I completely panicked because he started to gasp for air (turns out it was a reverse sneeze) and pant heavily. As the night went on, his breathing became quicker and shallower, and he started to cry.
At the first sign of breathing difficulty, I called our local emergency vet, and they handed me off to the next one because their wait time was too long and, “it sounds like he needs immediate attention.” The next one handed me off to the next one, and so on, until I was connected to one about 45 minutes from our house.
A complete angel answered the phone and told me that as long as he was alert and his gums/tongue were pink, he’s fine. I called her throughout the night as things changed, and when he started crying, she recommended we go ahead and bring him in.
Turns out, he was experiencing some pretty major pain from the injections. (From what I was told, this is pretty normal one week post-treatment, so the timing made sense.) I was actually gently scolded for bringing him in because the stress he experienced from the visit was counterproductive to the whole keep-him-calm protocol. Even so, they were incredibly kind and helpful, and ultimately, I was glad I brought him in because everything turned out fine, and I felt better knowing his vitals had been checked.
The rest of the week was pretty uneventful, with the exception of poor Kane dealing with me constantly pulling on his face so I could check the color of his gums.
Week 2: December 20-26 (11-17 days post melarsomine injection)
Kane had his first wellness checkup with our regular veterinarian on December 22nd. By then, he had started to show his high-energy side and was becoming a lot more difficult to keep calm. (A good sign that he was feeling better!) At first, I was bummed we couldn’t get an appointment sooner, but I think it worked out for the best because at this point, we knew him a little better and knew what was normal/what wasn’t.
Everything checked out great, and we were given a prescription for Trazodone to keep him calm throughout his recovery time. His doctor was a little concerned that the shelter had gone with a two-injection method rather than the American Heartworm Association recommended protocol of three injections, but she said this was likely due to budget/timing constraints that shelters are under.
We scheduled a follow-up appointment for January 19th (six weeks post-injection) to administer a microfilariae test. If that came back negative, we were cleared to start slowly reintroducing exercise into Kane’s routine. Weeks six to eight would be the transition time, and then after eight weeks, he was good to get back to his normal, happy, bouncy self. At the six-month mark in June, we could retest him for adult worms.
Trazodone has been a life saver for us because Kane is definitely OVER the exercise restriction at this point. The first time we gave him a full pill, it knocked him out, so we took him down to a half pill. After one day, we realized he needed the full dose because he was bouncing off the walls, so we took him back up to one full pill every 12 hours. It works out perfectly because it keeps him calm but no longer knocks him out.
Weeks 3-6: December 27-January 16 (18-45 days post melarsomine injection)
Weeks three through six were pretty uneventful. (With Kane on exercise restriction, there isn’t much to do!) At this point, we’ve pretty much settled into a routine, and we know how to keep Kane calm. We are looking forward to next week when we can *hopefully* start taking him on walks and letting him run around the yard.
Week 7: January 17-23 (officially six weeks post melarsomine injection as of January 20th)
Kane had his microfilariae test on Tuesday, January 19th, and he officially hit the six-week mark on Wednesday, January 20th (Inauguration Day!). Even so, we decided to wait until we got the call from the vet that his test results were negative before we resumed exercise.
Unfortunately, on Thursday, January 21st, we received the news that he had tested positive for microfilariae, which are essentially baby heartworms. There are a few different reasons his test results could have come back positive.
1. His microfilariae test at the shelter back in December yielded a false negative.
Because Kane initially tested negative for microfilariae, he was only treated for adult worms. It’s possible that the microfilariae test yielded a false negative, and the ones we’re seeing now are simply baby heartworms that were never properly dealt with.
There are a few different microfilariae test methods, and some do occasionally result in false negatives. One method involves simply looking at a blood sample under a microscope, and if you don’t see any baby worms swimming around, you assume the dog is negative. This is not the most accurate way to go about testing for obvious reasons, but it could be that this is the method the shelter used because it is the fastest, most affordable option. Our vet’s method, on the other hand, takes a bit longer to get results, but it can detect even just one microfilaria present in the bloodstream.
Our vet is trying to get in touch with the shelter to see which testing method they used so she can get a better read on whether this could be the case or not. This would be best-case scenario because it would mean that all we have to do is put Kane on Advantage Multi for one month to kill off the microfilariae; he’ll retest in February; it’ll likely be negative; voila! We can move on.
Another possibility, on the other hand…
2. The Immiticide injections were ineffective at treating Kane’s heartworm.
If Kane was truly microfilaria-negative back in December, and he isn’t now, that means there are still adult worms present. (Can’t have babies without adults.) In this case, we would have to start over: three melarsomine injections over the course of two+ months and then six-to-eight weeks of exercise restriction.
Obviously, we’re hoping for scenario #1. I feel optimistic, but the fact that Kane only had two melarsomine injections instead of the recommended three-injection protocol does have me a bit concerned that there are still adults present. And while the thought of having to start all over makes me want to pull my hair out, what’s more worrying to me is the damage they could be doing to his heart and lungs in the time it takes for us to sort all this out.
But worrying about it won’t change it, and all we can really do is wait until February to retest and go from there. The good news is that Kane is a wonderful candidate for heartworm treatment because of his age and health, so I’m confident this will be but a blip on his otherwise happy, healthy, long life ahead no matter which of these two scenarios proves to be true.
Week 8: January 24-30
I received some FANTASTIC news on Monday, January 25th. Kane's doctor called and said she managed to get a hold of the shelter. Turns out, with the two-injection protocol, microfilariae can take several months to die off. While this doesn't sound like good news, it explains why Kane is still testing positive six weeks post treatment. They recommended waiting to retest for both adult and baby worms at the six-month mark in June.
So basically, while it's possible Kane has a few worms that survived the treatment, a positive microfilaria test at this point doesn't mean anything. We really have absolutely no way of knowing until June, unless we were to take him to a cardiologist. In the meantime, Kane can resume exercising.
After asking the doctor a million questions, I felt a lot better! She was comfortable moving forward with their suggestion because shelters encounter heartworm very frequently and have a lot of experience treating them. Apparently the two-injection protocol yields a 90% success rate (not quite the 98% rate of the three-injection protocol but still good!), and even in the 10% that aren't successful, they still see most of the worms die off with the first round of treatment.
Long story longer, Kane is officially off exercise restriction, and we're starting to reintroduce activity. I took him on three walks the first day, but plan to cut it down to two for a little bit. The afternoon walk was tough on him, I believe because of the heat. Other than that, he has a ton of energy and is doing well!
He will stay on Trazodone until the eight-week mark, at which point we'll start tapering off.
Another very important update for this week: Kane discovered a love for watermelon.
Weeks 9 & 10: January 31 - February 13
Not much to report. Kane worked up to three walks a day, and he enjoys playing fetch in the backyard. (Although his version of fetch leaves out the whole bring-it-back portion of the game.)
Week 11: February 14-20
Kane hit the eight-week mark on February 17th, so he is officially 100% off Trazodone. We are seeing a much more hyperactive dog as a result, but he seems to be doing pretty well with his exercise!
Week 12: February 21-27
Time to call in reinforcements! Kane barks all day every day at absolutely nothing. I worked from home this week, and it was challenging keeping him quiet for my conference calls. He has also become a bit of a nightmare to walk, as he tries to chase cars, cats, dogs, birds, bikes…you name it, he’ll chase it. We quickly realized his behavioral issues were anxiety/fear based (which is why we didn’t see them before - Trazodone is an anti-anxiety medicine), so we called a professional trainer on Monday to get us on the right track.
She came over Saturday morning and worked with Kane (and us) for an hour, and he’s seriously a new dog. We have a lot of work to do, but it feels good to have a plan and know that we’re well on our way to helping Kane feel more comfortable and confident.
Step one: Switch him from a harness to a gentle leader head collar, and keep walks super short until he gets more comfortable with his surroundings. We are also introducing 20-minute training sessions to his morning routine to help him with basic obedience. Smart boy already knows “watch me,” “sit,” “come,” and “down.” We are working on “leave it,” which will be the phrase we use to stop any unwanted behavior. Definitely feeling like we’re on the right track!
Week ?: June 15, 2021
Wow, I haven’t updated this since February? Also, it appears I got super off track and started talking about non heartworm related things, but whatever.
Kane is a wonderful dog and is doing so well, both with his training and his exercise. He’s up to 1.5 miles a day for his walks! I also just got the fantastic news that our boy is officially heartworm free!!!