260 Evergreen Ave

Huntington Station NY 11746

(631) 367-7387

www.advancedcareforpets.com

Liver Disease in Pets

Conventional Veterinary Perspective

The liver is the main filtering system for the body since all blood supply travels through it to be detoxified. The liver performs many critical functions including:

• metabolism of fats, protein and carbohydrates
• filtering harmful substances from the blood (e.g. toxins and/or medications)
• storage of vitamins and minerals
• production of bile which aids in digestion and absorption of nutrients
• glycogen storage (involved in blood sugar regulation)
• synthesis of important proteins such as albumin and clotting factors
• red blood cell maintenance, in conjunction with the spleen

A pet may have NO outward symptoms that the liver is overburdened. It may only be discovered in a laboratory test and/or a physical exam by your veterinarian. During the physical examination, your veterinarian will look for signs of liver disease such as a distended abdomen due to enlargement of the liver, bruising under the skin, fever (due to secondary infection or inflammation), pain when pressure is applied to the abdomen or yellowish discoloration of the ears, gums and hairless areas of the skin. Anemia might be observed by checking the mucous membranes for a normal pink color.

The veterinarian will also look for symptoms such as:

1) Loss of energy
2) Digestive problems, diarrhea and/or constipation
3) Light tan or grey stools
4) Darker urine color (can be orange)
5) Changes in behavior such as pacing, circling or even seizures
6) Excess water drinking and urination

Since pets may have no symptoms however, diagnostic laboratory tests will provide the most valuable source of information. For example, a young pet may have a congenital condition such as microvascular dysplasia or a liver shunt and the symptoms may not be apparent until the pet is one or years old. A blood test may be the only way to know. There are certain blood values, for example, that if abnormal, may signify liver disease. These can include:

• Alanine Aminotransferase (ALT) – An enzyme that becomes elevated with liver disease.
• Alkaline Phosphatase (ALKP) – An enzyme produced by the biliary tract (liver) can be elevated in liver and non-liver related diseases. High levels can indicate bone disease, liver disease or bile flow blockage.
• Gamma Glutamyltransferase (GGT) – An enzyme produced in many tissues as well as the liver. Like alkaline phosphatase, it may be elevated in the serum of patients with bile duct diseases. Elevations in GGT, especially along with elevations in alkaline phosphatase, can indicate impaired bile flow
• Total Billirubin (TBIL) – A component of bile, bilirubin is secreted by the liver into the intestinal tract. Bilirubin is a byproduct of the breakdown of hemoglobin. Hemoglobin is found within red blood cells and carries oxygen to the tissues. When red blood cells die, hemoglobin is broken down by the liver as bilirubin. Elevated bilirubin levels can be caused by excessive numbers of red blood cells breaking down or when the liver is diseased and unable to clear the bilirubin from the blood. Also if there is an obstruction in the bile duct, the flow of bilirubin into the intestine is impaired and this can also cause elevation of bilribuin in the blood.
• Albumin (ALB) – Produced by the liver, albumin is a plasma protein that helps control osmotic pressure in the tissues. When albumin is low, fluids can leak resulting in a swollen abdomen. Low levels of albumin can indicate chronic liver or kidney disease, or parasitic infections such as hookworm. High levels indicate dehydration and loss of protein.

A urine analysis and XRAYS can provide valuable information as well. If signs and symptoms appear that a pet’s liver is not functioning optimally, additional tests are warranted to determine the underlying cause. A bile acid test, ultrasound and/or liver biopsy may be needed to determine the reasons behind your pet’s poor liver function. Your veterinarian will recommend medications, diet changes and potential surgical procedures upon determining the cause of your pet’s liver disease.

Holistic Alternatives for Liver Disease

In many ways, your pet’s liver is analogous to the oil filter in a car. You need to keep it clean or the “blood” (e.g oil in the car) gets dirty. When the liver’s job becomes overextended, the body cannot filter out as much as it should and toxins are released into the bloodstream. These toxins can cause harm to other tissues which in holistic medicine, is thought to be the root of disease. Since the liver is an integral component of so many critical bodily functions, it is easy to see a domino effect that can occur when the liver becomes overloaded. For instance, when a person drinks too much alcohol, the liver can’t keep up with the necessary “cleaning action” to process out the toxins, and people often develop other health conditions, such as increased levels of fat in the blood (triglycerides). Similarly, if the liver becomes overloaded following years of poor diet, medications and exposure to toxins, your pet’s liver can become overburdened as well.

It is a good idea to help your pet’s liver function by using holistic care BEFORE liver disease sets in. For example, if your pet is taking pain medications such as Rimadyl or Deramaxx, these medications can negatively impact your pet’s liver. However, if you use liver detoxification supplements you can minimize the potential impact of these medications. The liver is one of the few organs in the body that can regenerate new healthy tissue so it is not uncommon to see patients with compromised liver functions show significant improvements with our holistic protocols.

Certain foods can help to naturally detoxify the liver. Green vegetables contain not only valuable vitamins and minerals but they also contain natural cleansers and antioxidants that help to purify the blood and the liver. Giving your pet green vegetables such as green beans, squash or asparagus, along with some carrots can provide fresh enzymes and extra nutrition. Omega 3 fatty acids found in Amazing Omegas can be very helpful too. In general, pets with liver conditions need a diet low in animal fat, high in Omega 3s, reduced protein and high in fiber. Prescription diets are available but a homemade, balanced diet specifically for liver conditions is best. The homemade diet would need to take into account your pet’s overall health status and blood test results or it could result in additional problems. For example, cooked fish is often helpful for pets with liver disease but not if the kidney values are elevated as well. Telephone consultations are available at Care by phone if you would like to develop a homemade diet for your pet.

It is never too late to give your pet increased vitality and energy by adding a liver support supplement and extra nutrition to their diet.  Many pet owners notice their pets have extra energy after just a few days. And, reducing animal fats (e.g. never give pets chicken skin or fat off meat for example), increasing Omega 3 fatty acids found in fish and flax seed oil and extra vegetables can all help to support your pet’s liver and longevity.

Click here for more information

Anyone who has ever pulled out a credit card at the emergency clinic for something that wasn’t an emergency comes away wishing for a better knowledge of what constitutes an urgent situation — and what doesn’t. But as big an “ouch” as a nonemergency can be to the budget, it’s a lot better than the opposite situation: an emergency that goes untreated until it’s too late for your pet.

But how can you tell? The signs of a healthy pet are pretty apparent to an observant pet owner: bright, clear eyes with no sign of discharge; clean ears, free of buildup or smell; a mouth not overpowered by its odor, with pink gums free of infection; a nose that appears moist, with no discharge; a shiny coat, with unblemished skin below that snaps back easily when pulled away from the shoulders. A healthy attitude, a healthy appetite and normal thirst are part of the package, too, without signs of intestinal upset. No lameness, no swelling. No heavy panting.

Anything to the contrary is reason for concern. But is it an emergency?

The first way to start finding out is with a thermometer. Pet thermometers are available at pet-supply stores or you can use one designed for humans. Just be sure to put the latter in a special place so there are no mix-ups.

To take your pet’s temperature, put a little water-based lubricant on the tip of the thermometer and insert it in the animal’s fanny. After a minute or so, remove and check the temperature. Normal is between 100 and 102.5 for dogs and cats; anything below 99 or above 103 is worth checking with a veterinarian, day or night.

Some other trouble indicators include seizure, fainting or collapse, as well as any suspected poisoning, including antifreeze, rodent or snail bait, or human medication. Snake or spider bites, too, demand immediate attention. Cats in particular can be fatally sensitive to insecticides (such as flea-control medications that are safe for dogs), petroleum-based products or medications such as Tylenol.

Sometimes situations that might not seem urgent really are, even such as mild eye injuries or allergic reactions — swelling around the face or hives. A single incident of vomiting or diarrhea is probably nothing, but anything more than two or three times within an hour or so could indicate a serious problem. Other signs of possible serious conditions are breathing problems, chronic coughing, or difficulties urinating or defecating, especially in cats.

Animals can sometimes seem fine after accidents, such as being hit by a car, exposed to extreme heat or cold, or being cut or bitten. Beware! Your pet may have internal problems that may be lethal if not attended to quickly.

There are also situations that may not be life-threatening but are certainly painful enough to warrant immediate veterinary attention. Some of the signs of an animal in pain include panting, labored breathing, lethargy or restlessness, loss of appetite, aggression, hiding or crying out. While it may be possible to wait until your regular veterinarian is available, put yourself in your pet’s place. Don’t let your pet suffer!

Make best use of this column by saving it in your phone book and writing the phone number of your regular veterinarian and the phone number and directions to the nearest emergency clinic on it, so all the information is ready when you need it. And always remember: When in doubt, call a veterinarian.

It’s better to make a trip you needn’t have than to miss the one you should have made.

Our services include physical examinations, routine and preventive healthcare, vaccinations, diagnostic laboratory testing, health certificates, microchipping, as well as gentle and compassionate home euthanasia.

Beyond the basics, there are many common problems in veterinary medicine that can be diagnosed and treated at home. Examples include: itching and scratching; problems with the eyes, ears or skin; mild to moderate arthritis; minor wounds and lacerations.

During a house call, we may need to collect samples from your pet for outside laboratory testing. Common tests include Complete Blood Count & Blood Chemistry Panels, Heartworm Testing, Feline Viral Testing, Urinalysis, Fecal Examination, Bacterial and Fungal Cultures.

No matter how much we’d like it; there are just some things that can’t be done in the home. For conditions that require anesthesia, dentistry, surgery or x–rays, we can transport your pet to our veterinary clinic for the extra care they may need.

Why choose a mobile service?

Mobile service is very convenient for those who have limited transportation (for families with young children or those with disabilities) or time (we can see your pets while you are at work). It is also easier for those pets that are too stressed traveling to a conventional veterinary hospital and a great convenience for owners with multiple pets. Your pets will receive caring, high quality, personalized care.

If you are interested in a house call for your dog or cat, or if you have any questions, please call us at (631) 367–7387

Appointments will be scheduled for a window of time (i.e. 9:00–9:30am) due to traffic conditions in our area. We will call if running a little late or early. To save time, please have your pets ready to be examined before the scheduled appointment time (sometimes cats seem to sense what is going to happen and will disappear).

Please give a minimum of 24 hours notice if you need to cancel or reschedule your appointment. Otherwise we reserve the right to charge for time reserved.

Payment: We require payment at time of services and accept cash, checks, and most major credit cards.

Things to bring with you:

Benadryl : very effective in combating allergic attacks and insect stings.

A Flashlight : for nighttime walks.

Your Veterinarians phone number : in case you need medical advise while you are out of town.

Things to do before you leave:

Ask your Veterinarian about medications and treatments if your pet suffers from motion sickness.

Verify all vaccinations are current and keep those records (which are required by the airlines) with you.

For more information go to www.advancedcareforpets.com

Pets need occassional baths to clean up odors and good dental hygiene can do wonders too. But, for the most part, pets should feel and smell nice. You should be able to hold them, hug them and love them without feeling like you are going to pass out from the smell. Peculiar pet odors are generally a sign that something is “off” and as your pet’s best advocate, it is important for you to find out the source of the odor as it can be a sign of disease. Pet odors are not just cosmetic–they are warning signs alerting you of a potential problem. Here are just a few odors to watch out for:

Bad Breath—Pets need dental cleanings just like we do. If you have recently had your pet’s teeth cleaned and there is still a bad odor, then your pet’s bad breath needs to be addressed. Bad breath can be a sign of an underlying health condition such as acid stomach, poor digestion, dental or gum infection or kidney disease. It is not just a cosmetic issue—it can be a very real sign that you shouldn’t ignore. If you have an older pet, get a blood test and urine analysis. Poor digestion from food is also a very likely culprit. Pets with bad breath often have other problems such as poor coat quality, scratching and itching and allergies. Be sure you are using a hypoallergenic pet food.

Smelly Skin and Coat—Allergies—both environmental and digestive, contribute to skin problems. Both yeast and bacterial infections can cause an odor. Pet owners often get discouraged because their pet will have an odor even after giving them a bath. It is a misnomer to conclude “my pet just smells” or that it is somehow related to your pet’s breed. The odor is a sign of imbalance and possibly infection.

Many times pets have an odor from allergies which can also leave a white powdery or greasy film on your hand when you touch your pet. Common food allergens include grains such as wheat, oats, gluten and corn. Too many carbohydrates such as rice and potatoes, when given to a young pet, can contribute to yeast overgrowth. Some meat proteins such as chicken and poultry can be big allergens too. In addition to food allergies, pets can have environmental allergies too.

At the first sign of a skin odor, please take your pet to the veterinarian to determine the cause. Your pet could have an infection, parasites or an underlying endocrine disorder. Change your pet’s diet to address the problem. Use supplements to prevent reoccurences and to give your pet a healthy skin and coat.
Stinky Ears—If you smell near your pet’s ears and there is a strong odor, take your pet for a checkup right away. During the hot summer months, pets are prone to ear infections. Many ear infections are due to yeast overgrowth. Using dry kibble is often a contributing factor, especially if it contains the grains mentioned above or is high in carbohydrates. Dry pet food, while convenient for you, can greatly contribute to yeast overgrowth. Pets need fresh foods such as green vegetables, meat and Omega 3s to optimize health. Omega fatty acids can dramatically reduce ear infections, especially if you make the diet changes as well.

Gas, Belching and Vomiting—This is something our pets may do on occassion. But frequent rumbly tummies, gas, burping and regurgitation are a sign that something is wrong. Often these signs are due to the food you are feeding. Finding the optimal food depends greatly upon the age and health conditions of your pet. For example, pets that have IBS may do just fine with potatoes while other pets with chronic ear infections do not. If your pet has digestive issues, scheduling a telephone consultation to determine the best diet and supplement program is highly recommended. It is very common for pet owners to report that years of gas and belching were early symptoms that their pet was suffering from inflammatory bowel disease. For example, cats can develop intestinal lymphoma especially if they have been exposed to foods they cannot digest properly for years. It is always a good idea to revisit your pet’s diet with a veterinary professional if you notice any of the above digestive symptoms.

Conventional Veterinary Perspective

Cancer is a disease process in which healthy cells stop functioning properly and abnormal cells begin growing at an out of control rate. Normal cells grow, divide and die in an orderly fashion. Cancer cells grow and divide and instead of dying, outlive normal cells and continue to form new abnormal cells. Some cancer cells can travel to other parts of the body beyond where their development originated and again grow and replace the normal tissue. This process called metastasis occurs as the cancer cells travel through the blood stream or lymph vessels of our bodies.

There are many types of cancer. Cancer can arise in the skin, organs, bone and blood. Some types of cancer are fast growing and other types grow more slowly. Lymphoma is an example of a common form of cancer that we see in dogs and cats.

Common Signs of Cancer In Pets

• Abnormal swellings that persist or continue to grow
• Sores that do not heal
• Weight loss
• Loss of appetite
• Bleeding or discharge from any body opening
• Difficulty breathing, urinating or defecating
• Persistent lameness or stiffness
• Hesitance to exercise or loss of stamina
• Difficulty eating or swallowing

Please note that many of the above signs are also seen in pets with noncancerous conditions. Regardless, these are signs your pet has some type of health condition and a visit to your veterinarian is warranted. Any new lump or growth on your pet should always be checked by the veterinarian. 60% of skin growths on cats are cancerous. Even though dogs have a lower percentage of malignant tumors on their skin, even soft lumps should be aspirated for the presence of unusual cells.

Many times pet owners will notice some of the above signs and bring their pet in for a check-up. Depending upon the timing of bringing their pet in, more or less will be able to be done to help the pet. Initially the veterinarian will recommend some initial laboratory tests such as bloodwork, urine analysis and XRAYS (As a general rule, it is recommended that bloodwork and urine analysis be performed on pets over 6 years annually to maximize the possibility of catching cancer and/or other diseases as early as possible) Most of the time, this will provide some preliminary insight to the veterinarian, but a biopsy is generally required in order to definitively diagnoses the presence of cancer and the type of cancer.

Once diagnosed, there are several avenues a pet owner can explore. If at all possible, it is recommended that you make a visit to a veterinary oncologist, even if you do not wish to pursue chemotherapy or radiation. It is important for you to see an oncologist for a more comprehensive discussion from a specialist and to get a definitive course of action on your options from a conventional veterinary standpoint. Oncologists will have the greatest amount of experience with cancer and will be able to give you an idea about your pet’s prognosis, with or without using various forms of cancer medication. Many times, pets may require removal of a tumor and an oncologist can assist you with this as well.

There are a full range of medical options available for your pet with cancer, and using a combination of both conventional and holistic treatments can most benefit your pet. There are many prescription medications that can help your pet to feel more comfortable and potentially control the rate of growth of the cancer. Remember, quality of life is most important—be sure to watch your pet for signs of extreme discomfort and lethargy. From a holistic standpoint, much can be done to help your pet maintain a higher quality of life (using acupuncture, diet changes, supplements), especially if the diagnoses is made early.

Holistic Alternatives for Cancer In Pets

By far, the best results we have seen in cancer patients has been when the pet owner was able to catch the cancer early (as a result of regular laboratory testing) AND when a combination of both conventional and holistic medicine is used. While holistic veterinary medicine cannot cure cancer, it can make a tremendous difference. It is unfortunate that many times, people don’t discover the wonders of giving their pets the best nutrition and supplements until their pet has been diagnosed with a serious illness. The best way to help prevent cancer is to start at the beginning of your pet’s life, giving them optimal nutrition, vitamins, Omega 3s and building a sound immune system. But, even if your pet has been recently diagnosed with a life-threatening illness, it is not too late to make important changes that can give you more time. It is analogous to the advertisements you might have heard about lung cancer and that it is never too late to stop smoking!

One misconception that can be misleading for pet owners is that there is not “one” diet or “one” set of nutritional supplements for a pet with cancer. The reason is that cancer can have many forms, arising in different parts of the body which will affect the pet’s nutritional needs differently. All pets do need nutritious whole foods rich in Omega 3s, vegetables and some quality protein (varies depending upon the pet’s condition). Common sense should be the guiding factor in feeding your pet. Be sure to avoid giving your pet anything with artificial colors, sweeteners or preservatives. Never give animal fat such as chicken skin or fat from a piece of steak for example. Avoid foods made from simple carbohydrates such as biscuits, bread or crackers. Use caution with protein–giving your pet endless amounts of protein is not advisable, everything should be in balance as in some cases (e.g. if the pet has a liver condition) too much protein can be harmful. We strongly urge you to seek the advice of a veterinary professional for dietary advice. Telephone consultations are available at advancedcareforpets.com if you would like assistance in developing a home made diet and determining a holistic plan for your pet with cancer.

Listed below are some of the more common forms of cancer in pets. As you can see, cancer can develop in different parts of the body and depending upon where it is found, the pets need for nutritional supplements vary.

Lymphoma – is cancer of the lymphatic tissue. The lymph system is a core part of the body’s immune system. The lymphatic system is an extensive drainage network that defends the body against infections. It is comprised of a network of lymphatic vessels that carry lymph (a clear, watery fluid that contains protein, salts, glucose and other substances) throughout the body. The lymphatic system also serves as a low pressure drainage system that collects interstitial fluid throughout the body and returns it to the bloodstream. The most common sign of lymphoma is a painless enlargement of the lymph nodes.

Mast Cell Tumors – Mast cell tumors are among the most common tumors in dogs and are the most common type of skin cancer found in dogs. The most common location to find mast cell tumors is, by far, the skin, followed by the spleen, liver, and bone marrow. Both normal and cancerous mast cells contain chemicals that can be released into surrounding tissues. When these chemicals (particularly histamine) are released into the normal surrounding body tissues, side effects can include digestive problems (for ex: bleeding ulcers), skin rashes, shortness of breath and other symptoms. Mast cell tumors vary greatly in their size, shape, appearance and texture. The only way to definitely identify them is with a biopsy and pathology report.

Hemangiosarcoma – Most commonly found in the spleen, liver and heart and the prognosis is determined by the location of the disease. The cancer arises from the blood vessels and results in the production of abnormal blood vessels that can be weak and prone to leaking. As the cancer progresses, the cancerous vessels can rupture and results in blood loss. As the spleen is the organ most commonly affected by this type of cancer, rupture can lead to blood loss into the abdomen. This is an emergency situation and can result in weakness and collapse. Many pets with hemangiosarcoma often require a splenectomy.

Squamous Cell Carcinoma – Cancer that occurs in the mouth, underneath the tongue or along the gums of the middle-aged and older cats. Common signs of squamous cell carcinoma in cats includes difficulty eating, interest in food but not wanting to eat, drooling and odor from the mouth.

Osteosarcoma — Osteosarcoma is the most common type of bone tumor in dogs. Osteosarcoma beings in the bone but can spread throughout the bloodstream very early in the course of the disease (metastasis). The most common areas for this cancer to appear are the wrist, shoulder, knee and hip. The first sign of bone cancer is lameness due to pain from the cancer. Swelling often occurs at the tumor site.

Transitional Cell Carcinoma – Tumors usually form at the bladder opening and can cause blockage causing painful urinartion. Pets often strain while trying to urinate. Transitional Cell Carcinoma can be difficult to diagnose because many of the symptoms such as straining to urinate, blood in the urine or frequent urination are often due to a urinary tract infection. This can delay the discovery of the cancer, especially since antibiotics can often result in some improvement of symptoms. Thus, at the time of diagnosis, bladder cancer can be fairly far advanced and have spread to other parts of the body.

Adenocarcinoma – Anal sac adenocarcinomas are tumors arising from the apocrine glands present on either side of the rectum. These tumors can range greatly in size from a very small mass that can be found only after a rectal examination or a large mass protruding from the rectum. While the tumor appears locally, it is quite common for them to metastasize, often to the lymph nodes inbetween the spine and colon. Symptoms vary depending upon the gender of the pet and can include increased thirst, weakness, persistent licking at the site, difficulty defecating, decreased appetite.

Nutritional supplements should address the most critical needs facing the pet which will vary over time. In other words, the supplements that a pet needs at one point in their cancer care most likely will not be the same at a later time. This can be very confusing for pet owners who seek to find a few master remedies that will help to keep their pet comfortable and increase their longevity as much as possible. For example, the most pressing issue at the beginning of cancer therapy may be to help a pet with digestive problems, diarrhea or vomiting and not use any supplements at all specifically for cancer until the pet’s digestive condition stabilizes. Again, we encourage you to seek the advice of a veterinary professional in selecting supplements for your pet as their needs will vary, especially if your pet is undergoing chemotherapy or radiation.

Some key objectives in using nutritional supplementation for cancer are:

1) Supportive care for digestion (many pets with cancer have digestive issues)
2) Supportive care for the organs affected (e.g. liver support supplements if the pet has liver cancer)
3) Immune system support
4) Detoxification to help release toxins
5) Antioxidants to neutralize free radicals (limited use with approval from your veterinarian if undergoing chemotherapy/radiation)

When selecting products specifically for your pet’s cancer, be sure to check whether the products are deemed safe to use during chemotherapy and/or radiation if your pet is undergoing treatment. Good manufacturers will have researched this issue carefully and will advise you.

There is no question that we have seen by far the best results when patients use a combination of both conventional and holistic veterinary medicine when treating their pets with cancer. Regardless of the treatment protocol, a nutritious diet and some carefully selected supplements can only help to strengthen the pet and keep them feeling more comfortable. Research and education are key, as well as working with your veterinarian and other veterinary professionals to ensure that your pet is receiving all of the treatment alternatives possible—both conventional and holistic.
Updates on Cancer Treatments

Cancer is a tough diagnoses to hear and our hearts go out to all of you who may have a pet or family member with cancer. Below are recent updates on cancer treatment as well as our cancer newsletter (previously published).

New Conventional Treatments for Cancer

Melanoma Vaccine–Conventional vaccines (for other common diseases) stimulate an immune response directed against foreign proteins. Tyrosinase, a protein present on canine melanoma cells, is not usually targeted by the dog’s immune system because it also is present on normal canine cells. This vaccine helps the immune system to respond to the cancer cells and may help the survival time of the dog with oral melanoma (after the tumor is surgically removed).

Spay Before 6 Months–Recent research is showing that female dogs, (especially nonspayed dogs) have a much higher likelihood of developing breast cancer than human women. If you get your female dog spayed before 6 months of age, the risk of breast cancer is rare (.05%) vs. after a 2nd heat the risk is dramatically higher–26% (1 in 4 females spayed after 2nd heat). Thus, it is important to spay female dogs before the first heat to reduce this risk.

Small Molecule Kinase Inhibitor (TKI) is a new cancer therapy for mast cell tumors of the skin in dogs. The medication in the US is called Palladia and has been shown to be effective in treating lower grade mast cell tumors in the skin by attacking the tumor cells and cutting off the blood supply to the tumor.

Preventing Heartworm Infection in Dogs

Your options:

Ivermectin-based Products: Heartgard, Heartgard Plus, Iverhart Plus, Iverhart Max, Tri-Heart Plus
Milbemycin-based Products: Interceptor, Sentinel
Selamectin-based Products: Revolution
Moxidectin-based Products: Advantage Multi, Proheart6

Heartworm preventive medications are used to periodically kill larval heartworms that have managed to gain access to the dog’s body. At this point, the products available are intended for monthly use. This means that they kill all the heartworm larvae (stage L3 and L4) that have accumulated in the past month each time they are given. Some products offer the ability to kill older larvae which helps keep the pet protected in case someone is late giving the heartworm preventive medication at some point. There are presently many choices, both topical and oral, plus, while the subject of this page is canine heartworm prevention, all the products discussed have feline formulations.

Ivermectin-based Products:
Heartgard®, Heartgard Plus® made by Merial
Iverhart Plus®, Iverhart Max® made by Virbac
Tri-Heart Plus® made by Schering Plough

These monthly medications utilize an extremely low dose of ivermectin that is adequate to kill any L3 and L4 larval stages inhabiting the pet’s skin tissues at the time the medication is given. In other words, infection takes place but is halted every month when the medication is administered.

Other Parasites Covered

Ivermectin at the heartworm preventive dose is not strong enough to kill common intestinal parasites. Because of this fact, the dewormer pyrantel pamoate was added to cover hookworms and roundworms in the original Heartgard product. As other ivermectin-based products have entered the market, these have also added pyrantel pamoate to extend the spectrum of protection.

Whipworms are not covered by any of the ivermectin-containing products at this time, but in order to remain competitive in the market, manufacturers may pay for treatment for whipworm infections acquired while their product is administered. The products containing both ivermectin and pyrantel pamoate are Heartgard Plus®, Iverhart Plus®, and Tri-Heart Plus®. Iverhart Max® includes both pyrantel pamoate and praziquantel so as to cover tapeworms as well.

Breed Sensitivity

There are breed-related sensitivities with ivermectin (i.e. collie-related breeds have some difficulties) though at the low doses used in the prevention of heartworm disease are not a problem for any breed.

For information on these products from their manufacturers visit:
http://heartgard.us.merial.com/home/
www.iverhart.com
www.triheartplus.com

Milbemycin Oxime-based Products
Interceptor® & Sentinel® made by Novartis

This product is also given monthly, also clears microfilariae, acts by killing all L3s and L4s accumulated in the month prior to administration, and will suppress female worm’s ability to reproduce. There are a few important differences to note between this product and the ivermectin-based products, though.

Other Parasites Covered

Milbemycin, however, does not require the addition of other dewormers in order to provide a broad spectrum of parasite control. The milbemycin products control roundworms, hookworms, and whipworms without the addition of a second parasiticide. Milbemycin is also available combined with lufenuron for the control of fleas in the form of Sentinel®. Lufenuron is an oral flea sterilizer that prevents any fleas feeding on the dog from laying viable eggs.

Milbemycin can also be used in the treatment of demodectic mange. A special dosing schedule is needed to accomplish this; heartworm preventive doses are not adequate but milbemycin does offer a convenient treatment option for collie-type breeds.

There are no breed-related sensitivities for milbemycin.

For more information on Interceptor® or Sentinel®, see the Novartis Animal Health heartworm section.

Selamectin-based Products:
Revolution® made by Pfizer

Ivermectin’s entrance onto the anti-parasite warfront represented a culmination in the trend for broader and broader spectrum parasite control. Selamectin is a closely related cousin of ivermectin. It is designed for broad coverage of small animal parasites and will protect dogs not only against heartworm but also against ear mites, sarcoptic mange mites, ticks, and fleas. Cats are protected against heartworm, fleas, ear mites, roundworms, and hookworms. The product is topical, applied monthly and is fully approved for safe use in heartworm infected animals. Selamectin is not as effective at clearing microfilariae as other products and thus is not generally used in the treatment of active heartworm infections.

See more information on Revolution from the manufacturer.

Moxidectin-based Products:
Advantage Multi® made by Bayer
Proheart6® made by Fort Dodge

Moxidectin is another relative of ivermectin. In 2007 it was combined with imidacloprid, the active ingredient in Advantage®, to create a broad spectrum topical for dogs and cats. The product prevents heartworm infection, kills roundworms, hookworms, and whipworms. The imidacloprid will kill the pet’s fleas. As with selamectin, it can be given to heartworm positive dogs and it will decrease the number of circulating microfilariae but it is not a good choice in the treatment of active heartworm disease.

Moxidectin is available in Australia and Europe in a long-acting injectable form that is given once a year for heartworm prevention. A similar product, Proheart6®, was previously available in the U.S. but it was withdrawn from the market due to adverse events. The long-acting products were developed to address the problem of accidental failure to administer the preventive on schedule. Since adverse events have not been problematic in Australia or Europe, it is possible that this mode of heartworm prevention may return to the U.S. as there is the potential to prevent a great deal of heartworm infection. Currently, however, the only moxidectin product available for small animals in the U.S. is Advantage Multi® which is given once a month as a topical.

See more information on Advantage Multi.

Proheart6® is an injection given once every six months, obviating the need for the owner to remember to use a monthly product. The moxidectin is contained in “microspheres,” enabling the drug to last a full six months (or in the case of the Australian version of the same product, a larger volume is given and it lasts 12 months). In other countries, Proheart6 rapidly captured 40-50% of the entire heartworm prevention market but in this country, it was voluntarily withdrawn from the market in 2004 after a number of adverse reactions were reported. There has been great deal of controversy regarding these adverse reaction reports, especially since similar reactions have not been reported in the international market using the identical product made in the same manufacturing plant as the U.S. product. In June of 2008, Proheart6® returned to the U.S. market with some restrictions so that true reactions to the product can be tracked and not confused with other diseases or reactions to other medications. The FDA is studying the situation. The current restrictions are up for review in one year.

The restrictions in place are:

• All veterinarians prescribing Proheart6® must receive specific certification.
• Proheart6® may not be used in dogs under age 6 months or over age 7 years.
• A baseline blood panel is required prior to injection to rule out concurrent illness that could be confused with a drug reaction.
• The Proheart6® injection may not be given within 30 days of vaccination (to rule out any confusion between adverse drug reaction and vaccine reaction).
• The dog must be negative for heartworm infection before receiving the injection.
• The owner must sign a consent form prior to injection.
• The owner must receive an information sheet provided by Fort Dodge explaining the product and its use.

Proheart6® is also effective in controlling hookworm infection.

Learn more about Proheart6® made by Fort Dodge Animal Health.

When to Start Giving Heartworm Preventive Each Year?

Obviously the answer to this question is regional. Indeed it may be simplest to just use preventive medications all year round or to see what your regular veterinarian recommends for your area.

There is more to transmission than the simple presence of mosquitoes; it must also be warm enough for a long enough time period to allow the development of microfilariae to infect L3s within the mosquito’s body. A simple formula involves counting the degrees above 57 degrees F reached each day. Each degree is called a heartworm development unit and when 234 heartworm development units have accumulated within a 30-day period, conditions have been reached that will allow the transmission of L3 heartworm to new hosts. A monthly heartworm pill, chewable, or topical must be given at the end of a month in which 234-heartworm development units has accumulated.

When 30 days pass and 234 heartworm development have not accumulated, mosquitoes will be dying from the cold before any microfilariae they carry can develop to the infective stage. Monthly heartworm preventive needs not be given after a month under these conditions.

If all this sounds complicated, it is. In addition, most of us have better things to do besides monitoring average weather temperatures. It may be simpler to use the product all year round or just go by the recommendations of a practicing veterinarian in the region in question.

Let’s not kid ourselves: Things are tight, and people are learning to make do with less. That’s the bad news.

The good news: You don’t have to shortchange your pets to save money. By focusing on prevention, smart buys and sharing, you can slash what you spend on your pets. Some tips:

• Vaccinations are no longer recommended annually for most dogs and cats, but that’s not a good reason to skip your pet’s yearly vet check (twice-yearly for older pets). These “well-pet” examinations can spot little problems before they become expensive ones. Consider pet health insurance as a backup in case of emergency — it can help save your pet’s life when money is the issue.
• Keep your pet fit and trim. A majority of dogs and cats are overweight, and those extra pounds increase the likelihood of serious health problems, such as arthritis, diabetes and cancer. If your pet is overweight, get your veterinarian’s help to reduce weight slowly to avoid the health risks of sudden weight loss, especially in cats.
• Learn to do things yourself – Grooming. Most people can learn to handle basic pet grooming at home, from bathing to nail trims. If nothing else, you can probably stretch out time between professional groomings for high-maintenance pets with some at-home care. Check your library for grooming guides and find breed-specific tips with an Internet search.

  Another do-it-yourself strategy is more about health than grooming: Brush your pet’s teeth — it’ll help prevent liver, kidney and heart disease.

• Minimize risk from accidents. Saving the life of a pet who has been hit by a car or poisoned can cost hundreds or even thousands of dollars — and these tragedies can often be prevented. Keeping cats as indoor-only pets will prevent injuries and protect them from communicable diseases; a sturdy fence and the use of a leash will do the same for dogs.

  Go through your home with an eye toward possible hazards, especially foods, plants and drugs that can be ingested, as well as cleaning supplies, pesticides and herbicides. The ASPCA’s Animal Poison Control Center offers information on all toxic risks to your pet at ASPCA.org/APCC.

Do you have favorite cost-cutting tips? Drop us a line at advancedanimalcarecenter.com and we’ll share them.

(Do you have a pet question? Go to thecaringvet.com.)