Slow-Kill Heartworm Protocol

[Tx2]

Hi, Everyone!!! I'm Niki's mom ...

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Niki owes her life to Molly who championed her cause and to Jill at Ewenity who brought her into the state of Florida where I live. I offered to foster Niki because we had lost our Border Collie, Silk, 5 months prior ...

http://www.youtube.com/watch?v=RtZsGjbkDjs

The foster thing didn't last long. My husband and I ended up adopting her. I don't think either Molly or Jill was surprised. (grin)

Like a lot of dogs that come into rescue, Niki had some health issues. Among other things, she was heartworm positive. After quite a bit of research, we decided to use the Slow Kill protocol to treat Niki's heartworms ...

http://www.2ndchance.info/heartworm-ivermectinstudy.pdf

Eight months of treatment later, Niki went back to the vet for a heartworm test and is, I'm happy to report, HEARTWORM NEGATIVE!!! The cost of treatment was roughly $75 plus the cost of an office visit and a heartworm test.

The first vet I took Niki to was something less than motivated to help me with the Slow Kill protocol. He wanted full blood work to see that the liver and kidneys were operating the way they were supposed to. He wanted X-rays. Niki is so freaked out about hands and being handled by strangers that we would have had to anesthetize her. Right out of the starting gate, before treatment, it would have been $400 to $500.

Jill asked me to talk with another vet that she had been talking to, a wonderful lady that has worked with other rescue organizations in town. I printed out the protocol above and asked her how she felt about it. She told me that she had one other dog that was following the protocol and that it was a "VERY safe protocol," no x-rays and blood work required. All that was required was a quick checkup so that Niki was a patient of record, and she sold me the Heartgard. Even though Niki is/was 32 pounds, I asked her to sell me the Heartgard Brown since I was going to have to give her Heartgard every week for 32 weeks and wanted to carefully divide the Heartgard chews into smaller doses appropriate for her size.

I called Merial and asked whether I could buy Heartgard Brown and divide it into 3 equal doses if the dog weighed 32 pounds (almost perfectly 1/3 the body weight that Heartgard Brown protects). They told me that doing so was considered an off label use of the product. I asked whether the product was homogenous (uniform in composition). They told me it was, but that they could not give me permission to use the product in that way. Since it was information I was looking for and not permission, I decided to proceed with my plan.

I have a very precise scale that measures to an accuracy of 0.01 grams ...

http://purebulk.com/0-01-gram-precision-scales-c-410

As an example, one of the Heartgard chews might weigh 7.50 grams. I would carefully divide it into 3 equal servings of 2.50 grams each. A year's supply of Heartgard Brown provided me with 36 individual treatments. The Slow Kill protocol was 32 weeks. Your cost might vary, but 1-800petmeds sells a year's supply of Heartgard Brown for $91.98. And I think there is a mail-in rebate which brings the cost down.

The other part of the protocol is pulsed (meaning some weeks on, some weeks off) Doxycycline to kill the Wolbachia. Doxycycline is not expensive even if you have to purchase it. Luckily, Doxycycline is on Publix's list of FREE medications ...

http://www.publix.com/pharmacy/Free-Medications.do

I made a calendar and shaded the days that Niki need Doxycycline and crossed off every day to make sure I didn't miss a dose. Niki got her Heartgard every Sunday morning, and to make sure I never forgot, I put a recurring appointment (reminder) into MS Outlook. Flea medication (Comfortis) was given to Niki once a month on Wednesday at the vet's recommendation. The idea there is to give the flea medication as far away from the Heartgard as possible.

The reason I'm sharing this protocol is I know how strapped for cash a lot of the rescue organizations are, and I would hate to see some of you not take a dog because you couldn't afford the treatment. Less than $100 to treat a heartworm positive dog is well within most rescue organizations' budget. The most important thing is to follow the protocol with PRECISION.

The pluses for me were the fact that Niki didn't need to get a series of 3 painful, intramuscular shots to the lumbar spine. Paralysis is a rare side effect, but a known one, nonetheless. I didn't have to crate her for a month or more. For the full eight months I exercised her lightly. We took a lot of walks, threw a few balls, played tug of war. But it wasn't necessary to crate her.

Over the eight months I was treating Niki, I watched her general health improve. Her energy levels are not high compared to a lot of border collies, but they've increased from what they were originally. The coughs went away. Niki is now a happy, healthy, heartworm-free dog.

Since we're on the topic of treating for heartworms, I though it might be of interest to some of you to know the adjunctive (supportive) supplements I used. Niki is on a raw diet (raw, green tripe, organ meat, yogurt, raw meaty bones, and a few supps (MSM, alfalfa, kelp, diatomaceous earth)). The supplements I added to support her cardiovascular health/healing are:

* Turmeric paste (powder boiled in water to make it more bioavailable) -- 1/4 rounded teaspoon -- anti-inflammatory herb added to food every day
* Hawthorne berry & flower extract -- 1/4 teaspoon -- heart tonic herb added to drinking water every other day
* Fish oil -- 5 grams -- anti-inflammatory supp added to food every day

I am very, VERY happy with Niki's results. If you read the Slow-Kill protocol carefully, dogs receiving the Heartgard and Doxycycline saw an average reduction in heartworm load of 78.3%. If Niki's test had come back positive, I would have repeated the cycle which starts with 6 weeks of Doxycycline and ends with 6 weeks of Doxycycline. In other words, after the last 6 weeks of Doxy, I would have taken 4 weeks off and picked up at Week 10 of the protocol.

I'll try and keep an eye on this thread, but if anyone needs to get hold of me, Molly has my email address and phone number.

Thank you, all of you for the wonderful work you're doing. Niki and I owe bcrescue.org a huge debt of gratitude.

Terry Lee Gonzalez
Tampa, Florida

[PSmitty]

Wow, thanks for the awesome update! Niki sure did luck out when she landed with you. I love to find out the happily ever afters!

[Tx2]

I was asked a really good question about the Slow-Kill protocol I followed, which I'll paraphrase and respond to here ... for the benefit of all.

There are 2 different protocols that have over a 70% success rate within the first round; the one you chose and one that is 30 days of Doxycycline, followed by Heartgard every 15 days for 6 months. Can you tell me - briefly if you can - why you chose the pulsed Doxycycline? I'm thinking it is easier for the average adopter to wrap their brain around the 30 days/15 days protocol.

I wasn't aware of the other protocol when I started treating Niki for heartworms. When I printed up the abstract and brought it to my vet, she was already familiar with it and gave me an enthusiastic "Thumbs Up," telling me that it was a *VERY* (her emphasis) safe protocol and that she already had one patient following the protocol. I agree that one month of Doxycycline versus pulsed Doxycycline is easier for the average person to get their head around. I ended up making a calendar and setting reminders for myself on my computer so that I wouldn't forget to give Niki her Doxycycline.

The American Heartworm Society recently updated their treatment guidelines, saying "the administration of Doxycycline at 10 mg/kg [approximately 5 mg/lb of your dog's bodyweight] BID [twice a day] for a 4-week period every 3 to 4 months should eliminate most Wolbachia organisms and not allow them to repopulate."

I think the question I was asked above would be a great question to ask of as many vets and/or pharmacists as possible to get their perspectives and insights. It looks like the first round of Doxycline (6 weeks in the protocol I followed) would kill any existing Wolbachia, and the pulsing of the Doxycyline would prevent them from repopulating. What I DON'T believe would be effective is to take the Doxycycline CONTINUOUSLY because bacteria and parasites tend to build up a RESISTANCE to antibiotics. The greatest advantage of pulsing Doxycycline seems to be that the Wolbachia DON'T build up a resistance to the Doxycycline.

So bottom line, it seems that there are 2 or 3 options as it relates to taking Doxycycline ... 1). Pulsed Doxycline as per the protocol I followed; 2). 1 month of Doxycycline; and 3). 1 month of Doxycycline every 3 or 4 months.

The other difference between the two protocols is that the protocol I followed with Niki invovled her taking the monthly dose of Heartgard every week versus twice a month. Heartgard is well tolerated (by the dog), even at more than the recommended dose per pound of body weight. It is NOT well tolerated by the heartworms themselves, though, and shortens the heartworms' life expectancy. Remember, too, that if all you do is put your heartworm positive dog on Heartgard and make sure that you NEVER miss a single monthly dose, it should take 2 to 5 years to kill all heartworms. The protocol I followed just shortened the time from 2 to 5 years down to 8 months. Of course, Niki was NOT heavily infested.

There are a couple of complementary adjunctive (supportive) therapies that I feel are most helpful for a heartworm positive dog. First, I'd recommend Hawthorn Berries, a wonderful cardiac TONIC. Herbalists call it an adaptogen, meaning that if something (like blood pressure) is too high, it will lower it. And if something is too low (again, like blood pressure), it will raise it. Check out this article ... http://www.whole-dog-journal.com/issues ... 625-1.html.

I make my own Hawthorn Berry extract. All you need is some 100 proof vodka, some organic, dried Hawthorn Berries (I get mine from Mountain Rose Herbs) and a quart sized Mason jar (or used GLASS jar with top). It's a 5:1 ratio, meaning that for every 100 grams of hawthorn berries, you need 500 mililiters of vodka. If you buy a 1 ounce bottle of extract, the cost is about $15 with some S&H. If you make your own, you can make a quart of extract for about the same price. Shake the jar every day for 4 to 6 weeks. At the end of that time, strain out the berries with a clean handkerchief, squeezing as much extract out of the berries as possible. Store in a cubbard, away from light. Good for 2, 3 or more years.

The other adjunctive therapy I recommend is Lugols iodine. To this day, I add 2 drops to my dog's drinking water. I change the water every day or two. Iodine is anti-viral, anti-parasitic, anti-bacterial, anti-just-about-everything-that-is-single-celled-and-bad-for-us-or-our-dogs ... including microfilariae, Wolbachia, heartworms, etc. Where dogs (and people) can build up a resistance to antibiotics, they CANNOT build up a resistance to iodine. That's because iodine reacts chemically with tyrosine and histidine (both amino acids) in the membranes of single-celled pathogens. Here's a better explanation of how it works ...

Dr. Derry says that iodine is effective “for standard pathogens such as Staphylococcus, but also iodine has the broadest range of action, fewest side effects and no development of bacterial resistance.” There is a world of difference between using an antibiotic – anti-life substance – and a antibiotic, antiviral and antifungal substance like iodine, which is life serving because it is a basic and most necessary nutritional substance.

Iodine kills single celled organisms by combining with the amino acids tyrosine or histidine when they are exposed to the extra-cellular environment. All single cells showing tyrosine on their outer cell membranes are killed instantly by a simple chemical reaction with iodine that denatures proteins. Nature and evolution have given us an important mechanism to control pathogenic life forms and we should use it and trust it to protect us in ways that antibiotics can’t.

Iodine is a ncecessary substance for dogs and humans, both. It helps us fight off colds, flus and viruses. Hikers use it to disinfect the water they drink. It can be use to prevent Montezuma's revenge (traveler's diarrhea). It stablizes heart rhythm. I could go on for HOURS about iodine's health benefits. Lugol's Iodine can be purchased online or at any salt water aquarium store that sells coral. The kind you buy in said salt water aquarium store uses iodine that is more chemically pure than pharmaceutical grade (USP).

Questions? (grin)

[Jfb]

Thank you Terry for posting the treatment you used. I have many questions and would love to call you but do not know how to reach you.

In March of this year we lost our beloved border collie, Freckles to complications caused by medication for a seizure disorder. A few months later we received a call about Mr. Tibbs, an abused and neglected border collie, 18 months old who was severely underweight, afraid of everything and everyone,but otherwise healthy. He was in desperate need of an emergency home and we agreed to drive the five hrs to LA from Fl to pick him up. About 2 weeks later we received his medical records and found out he was heart worm positive, something this rescue group did not share with us before we agreed to take him. We certainly were disappointed since we were not emotionally ready to care for another "sick" dog, but once we picked him up we were committed to do everything we could for him.

A visit to our vet confirmed he was heart worm positive and she explained the "fast kill treatment" she uses which costs $900 if there are no emboli complications requiring emergency care and hospitalization. But the worst part was the required crate rest for approximately 6-8 weeks to try to prevent emboli complications. My immediate response was that Mr. Tibbs was an extreme high energy 18 month old dog who would never tolerate crate rest. He would spend all his time trying to claw his way out of the crate. When I say high energy, I mean really high energy.

Tibbs was put on 30 days of Doxycycline and Ivermectin for three months in prep for the series of three shots of immiticide, the first of which was scheduled for Dec., 2012. I began to research other options that were possible to treat Tibbs without the rapid kill and possible emboli complications in a dog that was going to be very hard if not impossible to keep quiet. In the research I found the treatment plan you used and the other plan that uses weekly Ivermectin dosage. I also found the information on the MDR1 mutant gene that causes toxic reactions in herding dogs to higher than normal preventative doses of ivermectin.

Tibbs is supposedly a purebred border collie and certainly looks like one, but since we have no papers for him, we could not be certain. Less than 5% of border collies have this mutant gene or worse yet, double mutant gene, but 50% or more Australian shepherds have this gene mutation. Since some Aussies look just like border collies we could not be certain Tibbs did not have Aussie blood so we had him tested by cheek swab at the University of Washington genotype testing lab for this mutant gene ($70) If Tibbs had this mutant gene, he could not be treated with the slow kill treatment since he could not tolerate the higher than normal doses of ivermectin, the drug in hartguard and some other heart worm preventative treatments.

Two days ago we got the results that Tibbs does not have the mutant gene and so I am back researching and planning his treatment since now he could be safely treated with the higher monthly dosing of ivermectin. In my research though I read that using the slow kill does not eliminate the need for rest at all times since the worms do eventually die and can still be dislodged with exercise causing emboli and possible death. That is discouraging news since it requires 8-18 months of rest rather than 2 months. I cannot help but think that the slower death rate of the worms would be easier on the dog than killing half of them the first month and the second half the second month. But I cannot find any studies that looked at this specifically.

I was thinking this morning that we would have to go with the immeticide injections until I came across your post. I do not want him to be hospitalized for the shots since he is just coming around to beginning to trust people. I could deal with walking him on a leash at all times and no letting him run free like the wind, something he loves, but I cannot deal with crating him or keeping him confined in a small room all day, everyday.

Tibbs came to us at 34 pounds and was grossly underweight. He is now 54 lbs and healthy looking. He currently has no heartworm symptoms but we have not had any heart or lung studies done to see the damage the adult worms may have caused so far.

Did Publix fill a vet Rx with a dog's name for free. I somehow believed they would only fill a persons Rx for free. I thought the cost our vet charged us for the doxycycline was high but I could not find the bill today to see what the actual cost was. I am wondering if our vet will even write a Rx for me to get the meds at Publix. She in fact does not sell hartguard but uses trifexis and iverhart plus instead. Not sure how this is going to work with her. When I first approached her with the slow kill she spoke about giving Tibbs ivermectin shots weekly or biweekly and I can guess that this will be costly also. I was thinking of using liquid ivermectin and dosing according to his weight rather than using the hartguard brown since I would have to use 4 a month of the brown. There are no vets here that I have found that will give a Rx for hartgard to go online to purchase it cheaper. They all insist on selling it. Ivermectin dilutions suitable for dog dosage can be purchased online or in farm feed stores. This is what I planned on using, but I still need the Rx for the doxycycline. You were lucky finding a vet willing to work with you to keep the cost down. Not so sure I will be that fortunate since treating the dogs and selling the meds is how they make their living. I can understand that, but we are retired and have to live within a budget that requires keeping costs down as much as possible.

Thank you for any help or hints you can give

Joyce

[Tx2]

Joyce, I'll reply to your post here on the forum in the next day or two. I also sent you a PM with my telephone number.

Regards,
Terry Lee Gonzalez