Heartworms are disgusting and awful parasites that affect our beloved pets. Unfortunately, parasites are a part of the animal kingdom, and even though we provide our pets with protection, they can still cause harm. I want to share a story about my dog Sage and his journey through his heartworm treatment. Describe what we did to make it easier, mistakes we found, and why this treatment process is essential. There are many stories online about people’s experiences with heartworms, and it adds an overwhelming fear to the treatment. Even though, in the past, this treatment would have been a death sentence, we can certainly say the new advancements have created a reliable process with a higher survival rate.

How do you get heartworms and what are they?

So, how are heartworms contracted? Was it that dog we played with, or was it that poop he ate, maybe through drinking the water? Nope, it’s from something we all hate. MOSQUITOS! That’s right, just like all awful diseases you hear about in the media, the mosquito holds another disease on its resume. Heartworms, known as Dirofilaria, are long, thin parasitic roundworms that infect various mammals, but most commonly dogs, ferrets, cats, wolves, foxes, raccoons, and, in rare cases, humans [1] [2]. Though, I wouldn’t worry about contracting heartworms since, in 1991, there were only 80 cases ever recorded in the United States [3]. There are three types of heartworms worldwide, and in North America, you can find D. tenuis , found in raccoons (weirdly only in North America), and D. immitis, the species that affects our pets.

Where are they found?

Unfortunately, heartworms are found throughout the world. There are regions where the cold can help decrease the chances of heartworms. However, due to various factors, there is no stopping the spread of heartworms unless you can control the spread of mosquitos. Throughout the United States, the number of cases varies depending on the region. Commonly, the data supports that most cases of heartworms are located in areas with fresh bodies of still water and high concentrations of wildlife or domesticated animals.

Prevention

Fear not, though. There are preventions to help stop the spread of heartworms. Multiple types of preventions available can fit your dog’s needs and should be discussed with your doctor in finding the right option. However, just because you are on preventative doesn’t mean it’s 100% effective. You need to make sure:

Preventatives are taken on time and monthly
The proper dosage is given
Use bug spray or mosquito repellent during peak mosquito season
heartworm checkup every six months

Do I stop prevention during treatment? Taking preventative is vital to killing young worms before they can cause more damage.

More information on the American heartworm society page [5]

Monitoring

As prevention and treatment are essential, you should also get your dog tested for heartworms annually or biannually. Should I bring my dog to get tested more often? Probably not. Detecting if your pet has heartworms will only result in a positive seven months after a pet has been infected. [5] This is why getting tested every six months for the first year when adopting a pet or starting a preventative is recommended. There for it’s best to:

Get your pet tested every year
Test every six months when starting treatment or adopting
Get tested if your pet has any signs or symptoms

No, monitoring is not a treatment for heartworms. But it can increase your pet’s survival rate dramatically when heartworms are caught early.

More information on the American heartworm society page [5]

Treatment

Unfortunately, heartworm treatment differs for every animal and should be confirmed through the American Heartworm Society website [5] and your veterinarian. Here we will discuss the treatment for dogs as of 2023 and the two methods, slow kill and fast kill. Keep in mind that the slow kill method is not recommended but we will discuss it as an option.

Method 1: Slow Kill

The “slow kill” method is an alternative approach to treating heartworm disease in dogs. Still, it’s important to note that it is generally not recommended by the American Heartworm Society and many veterinarians due to various concerns. However, it is essential to discuss this method as there might be some constraints to treating a dog with the quick-kill method. Here is the basic idea of the “slow kill” method:

Concept: The slow kill method aims to gradually kill heartworms over a more extended period, rather than the quicker kill achieved by the standard treatment (which uses melarsomine). During this time, the dog will be limited in exercise and on bed rest (usually with a create). Once a heartworm test has returned negative for heartworms, the dog can exercise again.
Medication Used: This method typically involves administering a monthly heartworm preventive medication, such as those containing ivermectin. These medications are designed to kill heartworm larvae (microfilariae) and prevent new infections, but they also have some effect on adult worms.
Duration: The slow-kill method can take a very long time, often several years, to kill all adult heartworms. During this time, the heartworms continue to live in the dog’s body, potentially causing damage to the heart and lungs.
Limitations and Risks:

- Less Effective: This method is less effective than the standard treatment for killing adult heartworms.
- Health Risks: The prolonged presence of heartworms can lead to ongoing damage to the heart, lungs, and blood vessels.
- Risk of Resistance: Overreliance on this method could lead to drug resistance in heartworm populations.
- Increased Stress: Some dogs can experience increased stress and other health issues due to prolonged bed rest.

Circumstances of Use: Sometimes, the slow kill method is considered when the standard treatment is not an option, such as in cases where the dog has certain health conditions that make the standard treatment too risky or in situations where the standard treatment is not available or affordable.
Monitoring: Regular monitoring by a veterinarian is crucial if this method is used to assess the dog’s health and the effectiveness of the treatment.

Discussing the risks and benefits of any heartworm treatment with a veterinarian is vital. The best approach to heartworm disease is always prevention, which is safer, more effective, and less costly than treating an active infection. Regular use of preventive medications, as prescribed by a veterinarian, remains the most recommended strategy for managing heartworm risk.

Method 2: Fast Kill

The “quick kill” method, known as the standard or conventional treatment, is recommended for treating heartworm disease in dogs. The American Heartworm Society [5] endorses this method and involves the following steps:

Diagnosis: Confirming the presence of heartworms through blood tests.
Staging the Disease: Evaluating the severity of the infection with additional tests such as chest X-rays, a complete blood count, and possibly an echocardiogram. In addition, consider the dog’s other health conditions.
Exercise Restriction: This is crucial both before and during treatment. As the adult worms die, they can cause blockages in the dog’s heart and lungs, which is especially dangerous if the dog is active.
Pretreatment: This might include a course of antibiotics, such as doxycycline, to weaken the heartworms and reduce the risk of complications. Dogs may also receive a heartworm preventive to kill immature worms throughout treatment.
Adulticide Treatment: A drug called melarsomine dihydrochloride is then given through a series of deep intramuscular injections in the dog’s back muscles. The first injection is 30 days after the doxycycline preventative has been completed. Then, two more injections are given 24 hours apart, one month later.
Post-Treatment Care: Continuing strict exercise restrictions for several weeks after the final injections is essential. The dog’s body needs time to absorb and dispose of the dead worms safely. In addition you will be given pain killers for 5 days an possibly prednisone for 30 days.
Follow-up appointments with the veterinarian are crucial to monitor the dog’s recovery. Blood tests are done six months after the completion of treatment to ensure all heartworms have been eradicated.
Continued Prevention: After recovery, ongoing heartworm prevention is vital to prevent re-infection.

The quick-kill method is preferred because it eliminates the adult worms more rapidly, thereby reducing the duration of damage they can cause to the heart and lungs. However, it’s a more aggressive treatment and can have significant risks, especially in advanced cases of heartworm disease. This treatment must be carried out under the guidance and supervision of a qualified veterinarian.

Duration: just because it says its the quick kill method doesn’t mean you can go out tomorrow and play with your dog after getting his shot. I will explain more later, but this is about a 9-month process. Yeah, not fun.

During Treatment

I won’t lie; the treatment process is painful and depressing for your furry friend. There will be moments when your pet is stressed, or you will be frustrated, but you have to remember it’s part of the process. But the key to all of it is relaxation. Though your dog might disagree, it’s important to have your dog relax for 30 days after getting his shots.

Why can't my dog run around?

The reason your dog needs rest is due to the location of the heartworms. Heartworms are located within the heart, which means they are active in the circulatory system. This poses a couple of problems:

They can damage the heart and lungs
Large amounts of damage can be permanent and scaring
Worms can cause blockages

High activity increases the movement of the worms, causing more damage, and when dying, can cause potential blockages. This is why the doctors are so adamant about giving your dog bedrest. Everyone has a different idea of what limited exercise is. My doctor told me, “If they would be panting afterward or have to put a lot of physical effort into it, don’t do it.”

What to stop or limit doing?

Now, there are many things you will have to stop doing, but it depends on your dog and what gets him excited. It could be a toy your dog gets too excited about or having friends over, even having in a particular place when you come home. But here are some things to help get you thinking to help with your dog’s treatment:

Do I keep my dog kenneled 24hrs a day?

This is hard because some dogs do well in kennels, and others don’t. I couldn’t keep Sage in a kennel before Sage got his shots because he would be way too worked up and aggressive. After two months of gradual training, he loves his kennel, mainly because he associates it with where he gets the best treats. Generally, it’s best to keep your dog in a kennel for the majority of the time throughout treatment, but if there are situations you are aware of where your dog gets worked up or needs to get out, yes, take them out. But DON’T think you have to keep them in a kennel 24 hours a day for nine months, you don’t have to, and you shouldn’t have to unless stated by your doctor.

Can I go on long walks or short runs?

Yes, you can go on walks, but short ones spread throughout the day. You might need to for the first two months after their first shot, depending on if you are given steroids for your dog after a shot is given. These steroids will make your dog pee and won’t a lot of water. It does depend on the dog, but with Sage, he would drink as much water as he could and then need to pee 20 minutes later. To reduce possible dehydration and peeing in the house, we limited him to small amounts of water throughout the day and 5 to 10-minute walks four times daily.

What about playing or seeing other dogs?

If you have other dogs in the house like we do, preventing them from wanting to play will be hard. As long as your dog is calm and on a short leash, yes he can see other dogs. If there are moments when they get to rambunctious when toys come out, I recommend isolating them into a smaller room with toys and playing. This way, they have limited room to prevent running but can still lightly play. The key here it to do light play and for a short period.

There are many other factors to consider when keeping your dog limited in excitement and physical activity, but as long as you are focusing on limiting their exercise and keeping activity to a short period of time.

What can I do to make my dogs experience better?

Luckily for you and your canine, you can do many things to have him entertained, relax, and reduce pain. Your primary focus is finding something your dog can do while staying in one place or limiting them to one room. I’ll share a list of what we did, but it’s best to build upon these and other ideas and adjust according to what helps your dog. Now, keep in mind Sage is a cattle dog and border collie mix. He requires a lot of exercise and attention, and what worked for us might not be the best for your dog. Therefore, ensure you adjust these ideas to your dog and see if there are thing here that can help you.

Consider the following ideas:

Lick mats: cover with some food or mix it with some medicine, keeping them busy and entertained for a few hours. This worked great for Sage; when he was in pain or pent up with energy, it helped calm him down.
Slow feeders: slowing their feeding can help a lot. Sage was already used to the slow feeder since he eats too fast. We sprayed a little water onto his food to improve this idea and froze it.
Mandatory affection time: keeping your dog in a kennel will make them feel separated and sometimes upset. If there were days when Sage had to stay in the kennel for longer than standard times, I would put on a movie and let him snuggle up on the couch. My doctor suggested it since the affection helps them get comfortable and ease pain. It will be helpful in the first few weeks after getting one of his three shots.
Short, slow walks: Taking your dog for a 10-minute walk at least four times will significantly help throughout the day. While walking, keep your dog on a short leash, and don’t fast-walk. Let them take the time to sniff every bush and leaf. This will keep them stimulated and reduce the number of accidents in the house.
Car Rides: Yes they half to be bed rest, but they aren’t exercising, and sage doesn’t get excited in the car but does enjoy a good car ride.
Chewing bones or treats: Your dog might get bored of the same lick or puzzle mat, so giving bones on rare occasions can help.
Training: We practiced many things with sage that we had been meaning to get to. Yes running is a great way to get energy out, but so is communicating to your dog.
Search: Limiting your dog to a small room to find treats or toys can help get a lot of energy out. However, I recommend limiting this and stopping if your dog gets too excited.

These are just some ideas of what you can do for your dog that might not work for you. Just know that there are things you can do to help. The best thing to do before doing anything is discussing with your doctor. A variety of factors might limit your dog, but asking questions geared to what he can do and what you need to make sure doesn’t happen will help.

What to keep in mind.

Lastly, I want to cover a few points you probably should know going into this. I wasn’t aware of it initially, but luckily, Sage and I had a great doctor who made us aware of the entire process.

Yes, your dog could die from exercise. The restriction isn’t due to running around if they have heartworms. A little excitement is acceptable or just a moment of zoomies until you stop them, so it’s not that dire. But completely ignoring what your doctor says and then going on a run with your dog will do a lot of damage and kill them.
Your dog will be in pain: for the first two weeks after a shot, your dog is going to be in a lot of pain, and painkillers will only help so much. There might be moments when your dog will be panting and/or winning, and it’s because they are in a lot of pain. Help them, give them attention, and it will pass.
Your dog will be bored: They will be very bored unless laziness is part of their routine. Just keep finding some new things to do and keep switching it up.
You might not have to restrict food: Heartworms are parasites, and they will steal nutrition and energy from your dog. We started reducing his food due to the lack of exercise but found he was loosing to much weight. Turns out he needed more food.

Conclusion

As Sage’s story exemplifies, treating heartworms in our beloved pets brings challenges and emotional turmoil. Yet, it is a testament to the resilience of our pets and the advancements in veterinary medicine. As pet owners, our role transcends providing primary care; it demands vigilance, compassion, and informed decision-making.

Heartworm disease, though daunting, is no longer the impossible plight it once was. Thanks to modern treatments and preventative measures, pets like Sage have a fighting chance for a full recovery. It’s a path with patience and perseverance, where every small step forward marks significant progress. Even though the treatment is long and complex, there are things you can do to help your dog along the way.

In conclusion, while heartworm treatment is a demanding process, it is also a journey of hope and healing. It reminds us of the unconditional love and commitment we share with our pets and the remarkable strides we can make when facing challenges with determination and informed care. Let Sage’s story be a guide and an inspiration to all pet owners facing similar battles. With the right approach, a supportive vet, and a heart full of love, we can help our pets emerge healthier and happier from heartworm disease.

[1] https://www.cdc.gov/parasites/dirofilariasis/faqs.html

[2] Malik D, Amaraneni A, Singh S, Roach R. Man’s best friend: How humans can develop Dirofilaria immitis infections. IDCases. 2016 Mar 24;4:43-5. doi: 10.1016/j.idcr.2016.03.003. PMID: 27077028; PMCID: PMC4816904.

[3] Watson J, Wetzel WJ, Burkhalter J. Human disease caused by dog heartworm. J Miss State Med Assoc. 1991 Nov;32(11):399-401. PMID: 1784039.

[4] https://www.avma.org/news/map-shows-heartworm-rates-continue-increase-hot-spots-new-locations#:~:text=The%20states%20with%20the%20highest,%2C%20and%20Arkansas%2C%20said%20Dr.

[5] https://www.heartwormsociety.org/pet-owner-resources/heartworm-basics#:~:text=You%20need%20to%20consult%20your,the%20infection%20can%20be%20diagnosed.