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Case 27
 | Heartworm Treatment |
| Marso presents to the Cardiology Service for the second step in
treatment of his heartworm disease. Last month (11/13/99) Marso was
diagnosed with heartworm disease and was given a single IM injection of melarsomine
(100mg). He is also microfilaria positive. |
| The owners report that Marso was lethargic and anorexic during the week
following the injection. He also had intermittent episodes of difficulty
breathing. His attitude subsequently improved; he is now breathing without
apparent difficulty and his appetite is good. He is being kept indoors only,
and the owners are restricting his activity. He has not had any more
bleeding from his mouth, and his defecations are normal. The owners report
that he still occasionally coughs at home, especially after drinking. He has
always done this, and the owners think it is a sequelae of his debarking
surgery. |
| General: BARH, Wt=35.2kg, T=102.7, P=104, R=panting (56bpm with mouth
closed). |
| Integument: Normal |
| EENT: Normal |
| Musculoskeletal: BCS=4/9, no gait abnormalities. |
| Cardiovascular: CRT=1sec, MM pink. No murmurs, when Marso begins to
pant his heart rate dramatically increases to ~180 bpm, no jugular pulses.
Femoral pulses present bilaterally, no deficits. |
| Respiratory: Dog is breathing deeply. |
| Gastrointestinal: Normal |
| Genitourinary: Normal |
| Nervous system: NE. |
| Lymph nodes: WNL. |
| Heartworm disease |
| 12/16/99: Problem #1: Heartworm disease. S/O: Gave first dose of second
stage of adulticide therapy - melarsomine (88mg IM) in the left epaxial
musculature along the L4 vertebra at 13:00H. This dose was lower than the
dose given one month ago because the dog has lost weight. A: Adequate recovery following
first stage of adulticide therapy. We have most likely killed the male worms
at this point; the two injections in the second series will hopefully kill
all the remaining worms. Risks associated with melarsomine treatment include
direct lung toxicity, GI signs (vomiting), and later, pulmonary
thromboembolism secondary to worm dissolution. P: Give second IM injection
of melarsomine tomorrow afternoon. Owner intends to pick Marso up on
Saturday (12/18/99). |
| 12/17/99: Problem #1: Heartworm disease. O: Marso's resting respiratory
rate ranges from 16-64bpm. His heart rate is within normal limits
(80-100bpm), although he does have runs of tachycardia associated with an
increase in his respiratory rate (when he begins panting). His temperature
has remained within normal limits. He continues to be nervous and refuses to
eat. He was given the second dose of melarsomine (88 mg IM) today at 13:00H
within the right epaxial musculature at the level of L3. Approximately one
hour later, he had a bout of diarrhea. A: The diarrhea may be due to his
nervousness, or may be a reaction to
the melarsomine. He is doing well otherwise. P: Continue to monitor vital
signs. |
| 12/18/99: Problem #1: Heartworm disease. No change in Marso's status.
Discharged at 09:30H. |
| We have given Marso his two remaining injections of melarsomine in the
second step of treatment for his heartworm disease. He received one
injection on each side of his back within the muscles. As a result, he may
be sore in this area for the next week or so. |
| As you know, it is very important that Marso be kept indoors and quiet
for the next month. Please do not allow him to rough-house with your other
dog and only take him outside on a leash when he needs to go to the
bathroom. Keeping him in a separate room or in a crate is ideal. Excitement
or exercise can dislodge a large number of dead worms rather than allowing
them to slowly decompose, and could cause serious problems, including death. |
| There is a possibility that Marso will experience some negative effects
from the melarsomine itself and also as the remaining worms in his lungs are
killed. Some of the side effects include difficulty breathing, lack of
appetite, and gastrointestinal signs such as vomiting or diarrhea. |
| If he begins to have difficulty breathing or his respiratory rate at
rest is rapid, please take him to your local veterinarian right away. If
possible, check the rate of his breathing once daily when he is resting; if
it is greater than 40 to 50 breaths per minute, call us or your local
veterinarian. |
| Marso's appetite may also be decreased during the next 7-10 days. If he
begins to vomit or has diarrhea, please contact us or your local
veterinarian. He may cough up a small amount of blood; if he continuously
coughs or coughs up more than just a small amount, again, please contact us
or your local veterinarian. |
| The treatments he has received do not kill the larvae present in his
bloodstream. These are a potential reservoir for infection of mosquitoes,
which can then spread the disease to other dogs. He can be treated with a
heartworm preventative (Interceptor) in one months' time to kill the
circulating larvae. He must be observed at your local veterinarian for the
day when he is given the Interceptor to ensure he does not have a bad
reaction to the dying larvae. You can get Interceptor from your local
veterinarian or from us. Another blood test for presence of microfilariae
(larvae) should be run a month after the Interceptor is given. |
| Either your veterinarian or we can retest Marso in four months to check
for any remaining adult heartworms by performing an antigen test. If he is
still positive for adult heartworms, he may need another series of melarsomine
injections. |
| Thank you for bringing Marso to the VMTH and entrusting his care in us.
He is a beautiful boy and has a sweet disposition. |
Quiz
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