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Is heartworm treatment painful for dogs?

Heartworm Treatment

Heartworm Treatment: We provide thorough care and treatment of heartworm disease to our patients infected with heartworms. Heartworm treatment is a process carried out through 4-6 months. During heartworm treatment the patient must stay confined while the heartworms are dying off to prevent embolisms and other health risks. We take necessary steps in assuring that your pet is healthy and stable before going through heartworm treatment. Below is the heartworm protocol that we take to provide the best care for your pet and to rid their bodies of this unforgiving parasite.

  • Confirmed Heartworm Test:When your dog comes for their routine heartworm test and tests positive for heartworms, we then send a blood sample to an outside lab to confirm the heartworm status. When the results come back as a true positive, we then take the next steps for beginning treatment.
  • Antibiotics are Prescribed:After the confirmation test comes back positive, we start the patient on a 30 day course of Doxycycline. Doxycycline is an antibiotic that will kill the bacteria (Wolbachia) carried by the heartworms. By killing the Wolbachia, the heartworm has a greater chance of being terminated during the heartworm treatment process.
  • Staging: Anytime before the initial heartworm treatment is done, we have our patients go through a staging process. At this time the patient will have a complete work up with blood work testing, urinalysis, and chest radiographs (x-rays). During the staging process it gives us a better idea of how severe the heartworm disease is and how much damage has been done so far. Staging is an out-patient evaluation, the pet is dropped off in the morning and the owner is notified when staging is complete.
  • Heartworm Prevention:Before beginning heartworm treatment, the patient must have been on 2-3 months of heartworm prevention. Being on heartworm prevention will kill the baby heartworms that the Immiticide will not. Also, the patient must continue on heartworm prevention throughout treatment and after, so further heartworm infection will be prevented.
  • 1st Immiticide Treatment: After the patient has been on 30 days of Doxycycline and 2-3 months of heartworm prevention, we can begin the initial Immiticide treatment. For this process the patient is dropped off in the morning between 7:30a.m. & 8:00a.m. and will stay one night for monitoring. The Immiticide injection is given in the morning and requires 24 hr. monitoring for any side effects. The injection itself is given in the lumbar muscle of the patient, the patient is given pain management for about 3-5 days following treatment. Once the 1st treatment is started, the patient must be on restricted cage rest until for 4 months or otherwise directed by the doctor.
  • 2nd & 3rd Immiticide Treatments: One month following the initial Immiticide treatment, we have the patient come in for their 2nd & 3rd injections. Same as before, the patient is dropped off the morning of their treatment but this time the final two injections are given 24 hrs apart in both the left and right lumbar muscles. The patient is required to stay 2 nights for monitoring and they are given pain management for 3-5 days.
  • 2 Month Recheck: 2 months following the Immiticide treatments, the patient comes in for an evaluation to insure that he/she is okay to return to normal activity.
  • Recheck Heartworm Test: After the Immiticide is administered it takes about 4-6 months for the heartworms to die off. 6 months after the 2nd & 3rd treatments we retest for heartworms to make they were all terminated. Continuous heartworm prevention is highly recommended to insure the patient will test negative. If prevention is not used during or after treatment there is a high possibility of contracting heartworms again and process will start all over.

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Heartworm Testing


Yearly heartworm testing is strongly recommended in all dogs. The blood test can be performed at your veterinarian’s office and will test for the presence of heartworms and other tick-borne diseases such as Lyme’s disease. Once we are sure your dog is free of heartworms a monthly preventative medication will be dispensed. This ensures your dog will remain heartworm-free during the summer and fall months.

What are the symptoms of heartworms in a dog?

Clinical signs vary depending on the type and number of heartworms present in the animal’s body. Clinical signs can include: asymptomatic (no clinical signs), coughing, exercise intolerance, nose bleeds, pot-bellied appearance, difficulty breathing, collapse, shock, and/or death.

How do dogs get heartworm?

Dogs acquire this infection through mosquito bites, as mosquitoes readily pick up larval heartworms from infected dogs and carry them to new dogs.

What are the treatment options for heartworms?

Stabilization of the patient. Some dogs will require exercise restriction prior to treatment. If the dog has heart failure, this will need to be controlled. Some dogs will need anti-inflammatory doses of steroids to control the inflammation that stems from the presence of worms.

Heartworm treatment can last at least a couple of months, thus it is important to prevent the immature worms from developing into adults. Immature worms can be killed by administering monthly heartworm preventive products. The American Heartworm Society recommends one to three months of a preventive prior to treating the adult worms.

The only product currently available for the treatment of adult heartworms is melarsomine dihydrochloride (immiticide). During treatment, the patient receives an intramuscular injection deep in the lower back muscles. This is a painful injection and it is common for the patient to be quite sore at home afterwards. Pain medication may be needed. The site may form an abscess, which requires warm compresses and possibly antibiotics. Approximately 30% of dogs experience some sort of injection site reaction that resolves in one to four weeks. Some dogs develop a permanent firm lump at the injection site.

After the treatment, the patient must be strictly confined for one month following the final treatment, no walks and no running around. The dog must live the indoor life. Exercise increases the heart rate and oxygen demand and we need the heart to last during this recovery period.

Why is recovery and heartworm treatment challenging?

Treatment of heartworm can be quite challenging, as it spans over several months, is very expensive, requires strict exercise restriction and can be life-threatening to the patient. Treatment involves using very harsh arsenic-based drug to kill the adult heartworms. This medication is painful to administer and can lead to injection site reactions in some patients. This killing of the heartworms can also lead to anaphylactic shock in some patients, which in some cases can lead to death. The most critical time period is 7 to 10 days following treatment, but these signs can occur anytime in the following month.

Veterinarian with owner and dog

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