Sep
18
2013

The American Heartworm Society (AHS) was founded in 1974 with the mission of leading both the veterinary profession and the public in understanding heartworm disease.

I attended the 2013 Triennial Symposium thinking I knew everything there was to know about the disease. After all, I live in a state where the mosquito is considered the honorary state bird and most clinics endorse year-round prevention. So here I was thinking that this was going to be a ho-hum refresher course from Dr. Stromberg's parasitology class. Au contraire! I should have known better. After all, something with a life cycle as exquisite as Dirofiliaria immitis, which requires different drugs to kill its different life stages, is never going to be a bore.

When I was a student, we didn't understand the endosymbiosis existing between adult heartworms and Wolbachia pipensis. Talk about a complex relationship! It's like LinkedIn on steroids. Parasitologists are now working on how to interfere with that relationship. Apparently, the adult heartworm cannot exist without Wolbachia. The knowledge of this coevolution has allowed several strategies for eliminating one to eliminate the other. Thus enters the controversy of slow kill versus the AHS-recommended treatment for heartworm disease. You thought intubation dentistry was a hot topic? Listen to a bunch of parasitologists, internal medicine specialists, shelter medicine specialists, and general practitioners go through the pros and cons of this. Throw in a cardiologist or two and you have n + 1 opinions where n = the number of people present.

At the end of the conference what is most clear is that new strategies are being developed to interfere with the various life stages and complicated interrelationships of heartworm. We also are going to be able to use different biomarkers and ultrasonographic motion modes to help stage heartworm disease better. Surgery remains the treatment of choice for caval syndrome. All of this is exciting and excellent news and it was great being back in an atmosphere of research at the symposium.

In all of the talks I attended, the abstracts I read, and the posters I perused, I kept coming back to the same conclusion: Heartworm is a totally preventable disease. Yes, we can discuss the topic of loss of efficacy (LOE), but it is extremely infrequent. To this date, only two LOE strains have been identified through DNA mapping. While it is medically cool that you can surgically extract adult worms out of the vessels of pets with caval syndrome, what happened to the conversation discussing prevention? Where do we fail as a medical profession in educating our clients that treatment of heartworm does NOT give you back the healthy pet you had prior to the disease occurring? Once a pet has heartworm disease it causes irreversible damage to the lungs and the heart.

Heartworm treatment is expensive and potentially life threatening. So why aren't we, as general practitioners, explaining the importance of prevention? How do we band together as a profession and come up with that consistent message?

Speak to the staff at your hospital about the repercussions of heartworm disease. Are you all able to have a conversation to encourage prevention given every 30 days? How many of your patients are on year-round protection?

I will leave you with a copy of a record we received and ask that you give it thought. I know we can do better than this. Our patients deserve it.

 

 

Comments (5) -

Dr. Sharon Sprouse
Dr. Sharon SprouseUnited States
9/27/2013 4:52:45 PM #

My practice is in a heart worm area but in San Diego the risk is much less than in the southern states, the Midwest or the east coast.  But the risk is not zero.  The disease is in our coyote populations as proven by our County Veterinarian who did several necropsies on "oddly acting" coyotes.  No they did not have Rabies, they had heart worm!  I myself have seen several cases of heart worm disease, one in my receptionist's dog who has lived in Poway all it's life (Poway is just around the corner from my practice, in San Diego County but 30-40  miles north of downtown).  We treated all cases with doxycycline first and steroids after the injections were given.  Merial is now saying they no longer manufacture the actual get rid of heart worm injectable medication but when I spoke to several vets from heart worm areas such as Texas, Louisiana and so forth they said they had no trouble getting it.  And yes the medication does leave some adult sterile heart worm(s) behind.  They don't usually make larvae as proven by repeated testing in these dogs for migrating larvae.  

We encourage all our clients to have their dogs on preventative all year round.  We have talked about it as a Team and that is what we do. If the client is reluctant to follow our recommendations we always give them a brochure from both the topical and from the oral preventative that we use and we encourage them to speak to our receptionist whose dog had to have treatment.  We will call them back a couple of weeks later to see if they would like to come in for a "tech" exam of running a heartworm test.  And of course, every dog on preventative gets a heartworm test every two years.

So the record you have in your discussion is frightening but it would not take much effort to turn that around to a positive conversation.  All any veterinarian has to do is make up his/her mind to treat heart worm disease seriously, to establish the Team effort and protocol and philosophy and the sales of preventative will take off.  Unfortunately many of the preventative medications are ridiculously expensive and it really frosts me when online pharmacies can sell these for less than I even pay for them but I still stick to my Team philosophy.  You just have to remind the Team members about it every once in a while.

There are lots of vets in the USA...hopefully they will all strive to be the best vet ever in the history of the world. But there are always some who will not.  Are we really doing a bad job promoting preventative medicine here?  Not in my hospital!  We are doing better than that by far!

Wendy Hauser, DVM
Wendy Hauser, DVMUnited States
9/28/2013 8:23:15 AM #

Dear President:
Nice summary of the AHS meeting.  I recently heard an alarming statistic that was presented at the AAVP meeting, concurrent with AVMA.  In one study, 64% of owners in an area considered "endemic" did not have their animals on heartworm prevention!!!  With statistics like that, it is clear we are failing our clients and patients.
Dr. Knutson makes an outstanding call to action-every client deserves to be engaged in a conversation about heartworm disease and its implications, as well as appropriate prevention strategies. Every patient deserves to be protected.

I would further challenge veterinarians to remember, test and educate for  feline heartworm disease.
Wendy Hauser, DVM

Amy Hungerford
Amy HungerfordUnited States
9/29/2013 11:39:46 AM #

A veterinarian gave this "treatment" plan for a patient? Shame on them!! Especially with the scientific evidence that we have available. Perhaps some CE is called for!

Kimberly Smith
Kimberly SmithUnited States
9/30/2013 7:20:43 AM #

In our practice we use a variety of combination products that cover HW, Fleas, Internal parasites, ear mites. Some clients, esp feline owners, would not necessarily use a HW preventative "because their pet only goes outside to potty." But they are using a flea product, So we try to change their perception to that 'Yes HW dz can infect indoor only pets" and for a few dollars more a month, they're not only controlling fleas, but preventing the other diseases as well.

 Dr. Niomi
Dr. NiomiUnited States
10/18/2015 10:16:12 AM #

Interesting that there was no mention of the risks associated with taking heart worm medication... especially in areas where the risk of infection is low...

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