Lakota Update: Injections are done & the recovery process can begin

On Friday, Lakota had her third and final Melarsomine injection.  I picked her up at 4 pm and she was miserable.  When we got home, she threw up and wouldn't eat.  She moaned most of the night.  I've never had a dog who moaned at all, but since we got Lakota she has moaned when she is tired or laying down after a good run.  It was really sad during the night because she seemed to be moaning in pain.  She didn't want her back or rump touched, so it was obvious it hurt at the injection sites from both Thursday and Friday's injections.

On Saturday, she didn't want to eat her breakfast but seemed a little better.  I decided that it was ok to leave her alone for a couple of hours to go to the gym.  When I got home, I found she had diarrhea all over the family room.  Ugh.  Not fun to clean up.  She had diarrhea outside one more time, and then seemed much more like her self.  Much perkier and generally more happy.  I think she just had a stomach ache and felt better.

Sunday was much better.  She ate both breakfast and dinner, and although she was sleepy, she was definitely much better.  Today she actually took a toy out of her toy basket to play.  The vet said we have 6-8 more weeks of exercise restriction, but I think she is more used to it now.  I really miss walking her (and Bandit) each evening, but I also know in just a couple of months, we will be able to do that again.  Her good health is certainly worth all of the misery of treatment and recovery.

I will update when there are any changes.

Lakota looking out the window on her favorite couch  5/17/15

For now,

Lakota's Mom

Lakota had her second Melarsomine Injection Today

Thursday May 14, 2015

Lakota had her 2nd Melarsomine injection today.  Unlike last time, she is really sick.  She threw up all over our rug when she got home, and is ailing.  She is sluggish, can't move around well, is breathing very heavy, and looks generally miserable.  Her eyes are glassy, and you can tell she is in pain.  She won't eat.  I feel so badly that she is so miserable.  We have to drop her off in the morning for her 3rd injection.  I am worried she will be horribly sick all weekend.

I am planning on staying home with her all weekend, just rubbing her belly and trying to make her comfortable.  My son will be home on Monday, so he can keep an eye on her.  It's been a rough day, so I will keep this short and update after the 3rd injection tomorrow.

Until next time,

Lakota's Mom

Lakota after 2nd injection 5/14/15

Total cost for treatment is now at $820.00

2/15/15 $208
2/22/15 $175
4/15/15 $176
4/15/15 $85 for Heartguard
5/14/15 $176

Lakota Heartworm Treatment Update Week 2 Post Injection

Wednesday will be 2 weeks since Lakota's first Melarsomine injection.  She doing ok.  She spits up or vomits every day, and has lost her appetite.  I have to add treats and rice to her food to get her to eat, but it doesn't always work.  She is not coughing or gagging like I have heard will happen, but she is also not quite herself.  She still has hyper moments, like when I was walking her in our backyard, and our other dog, Bandit, saw something and took off running.  She tried with all her might to run with him.  She squirmed to get out of her collar, but then looked at me and sat down.  I was shocked that I didn't have to tell her no.  I don't know if she realized she wasn't up to running, or she figured there was no fighting me against the leash, but I am glad she stopped and sat down.

I feel so badly for Lakota.  She is so bored.  I try to change the rooms we stay in throughout the day (if I am home), and sit outside with her on the back patio so she has some outside time.  It is getting really hot out, so this is mostly done at night.  Bandit isn't exactly thrilled to be locked in rooms, either.  They are both used to having the run of the house all day.  They can't look out the front door or sleep on their favorite couch.  I know it is temporary, but I can't help feel badly.  My husband and I take a walk each night, and really miss having the dogs with us.  Neighbors know our dogs, and are always asking why they aren't walking with us.  I then have to explain the whole heartworm explanation, and find most people have no idea that treatment includes strict exercise restriction.   Maybe I should just refer them to this blog!

I have been doing some research about heartworm prevalence.  Lakota was a stray puppy picked up at the age of about 7 months in Floyd County, Georgia.  This is where she had to have been infected, given the date we adopted her, the amount of time it took for the heartworm test to become positive, and the fact that we never missed a dose of heartworm preventative.  The prevalence of heartworms in that county is very high, at 1 in every 28 dogs.  In Orange County, FL where we live, the prevalence is 1 in every 79 dogs.  We moved here from Rockland County, NY.  The prevalence of heartworms there is 1 in 242 dogs.  The United States as a whole averages 1 in 73 dogs infected with heartworms, with the highest rates in the southeast.  What is most interesting about the maps is that every state has heartworms, and every state has varying degrees of infection (as color coded on the maps).  It is interesting to see the differences in prevalence around the country.  To check out where you live, click the link below:

http://www.capcvet.org/parasite-prevalence-maps

Lakota's 2nd and 3rd injection dates have changed to Thursday May 14 and Friday May 15, 2015.  I will update whenever there is any change with Lakota.  For now, she is resting comfortably in her bed.

4/27/15

Until next time, 

Lakota's Mom

Three days post-injection and doing really well

It has now been 3 days since Lakota' first Melarsomine injection.  She is doing surprisingly well.  The biggest challenge is keeping her still.  She wants to run outside with Bandit, chase lizards, and be normal.  Unfortunately, this is not an option.  We walk her in our fenced-in back yard on a short leash just long enough to go to the bathroom.  I feel like she is a shackled prisoner.  She is extremely bored.  I have been giving her a Kong with peanut butter in it and occasional dental bones.  I don't want her to get an upset stomach, so I need to limit these food-based toys.  I can't give her other toys she likes because she runs around with them.  So for now, she will have to be a bored puppy.  She does gag from time-to-time, and has spit up a couple of times, and I am guessing that will get worse once the heartworms start dying off.  Overall, I am very pleased with how she is doing.  I will update when there are any changes.

One more thing.  Total costs so far are now at $644:

For now,
Lakota's Mom

Lakota playing with her Kong 4/18/15

Lakota has her first Melarsomine injection

Wednesday April 15, 2015

Today, Lakota had her first Melarsomine injection.  We were warned that this would likely make her very weak and tired, and will also begin her extreme exercise restriction.  My husband dropped Lakota off at the vet at 8:00 am this morning, and I picked her up at 4:00 pm.  To my shock, when the vet brought her to me, she was happy, hyper, and wagging her tail.  It is going to be really hard to keep her calm and quiet.  I walked her to the car and before I could scoop her up, she jumped right in.  I was worried I wouldn't be able to pick her up.  I guess I don't have to worry anymore.

Driving home, she was her normal car-loving self, looking out the window, excited, and enjoying the ride.  Thank goodness I had her in her doggie seatbelt, or she would have been jumping around the car.  When we got home, I let her jump out of the car, but walked her on a short leash for just a minute so she could go to the bathroom.  As soon as we got into the house, she greeted our other dog, Bandit, like she wanted to play.  I should note that Bandit does not like to be alone, so he was very happy to see her.  My daughter had come home earlier and told me Bandit was whining and going crazy when she came home because he was so lonely.

Now that we have been home for a couple of hours, I am noticing that Lakota is definitely feeling the effects of the injection.  She is very restless, and keeps re-positioning herself.  She has always been a "moaner," but she is moaning a lot more than usual, making me think she is uncomfortable and possibly in pain.  The vet gave her pain medication earlier, (Carprofen) and her next dose is not until tomorrow morning.  She is starting to get tired, and is sleeping on the couch.  She also needed assistance in getting up onto the couch.  I am guessing that the injection site is starting to feel sore.  Three weeks ago, I cut my finger and needed a tetanus shot.  It didn't hurt at all until the next day, when my arm was very sore at the injection site.  I am guessing that Lakota's injection site (deep in the muscle of her lower back), is starting to get sore just like an injection we would have.

I fed both dogs together like I normally do tonight, but Lakota would not eat.  Well, she ate the dog treat I put on top of her food to entice her, but left her regular food.  I might make her some burger or chicken with rice if I can't get her to eat later.

I will update in a day or two as her treatment progresses.  I have a feeling this is the calm before the storm.  For now, I am thankful and relieved that she is doing pretty well.  Hopefully the days to come will be just as positive.

Until next time,
Lakota's Mom

Lakota resting peacefully at home 4/15/15

The date is set for first injection. Update

We have been anxiously awaiting an appointment date for Lakota's first Melarsomine injection.  We finally have a date.  It will be on April 15.  We have to drop her off in the morning, and if all goes well, we will be picking her up that evening.  Someone will need to be home for her for the next few days.  Since it is a Wednesday, my husband and I are planning to each take one day off.  Then we will have Saturday and Sunday with her, as well.  I am really nervous about this, but I know it has to be done.

Lakota has been doing pretty well over the last month.  An occasional cough and being a little less rambunctious are the only signs that she has anything wrong with her.  We cannot walk her, and she only goes outside in our fenced-in back yard for potty breaks.  It is really hard to keep her from running in the back yard, but when she does, I immediately call her into the house.  I feel really badly about it, but the repercussions of running and getting excited certainly outweigh any apprehension from not letting her play.  I have purchased some dental bones and treats to keep her occupied, but I have to be careful because she has a sensitive stomach.  I am not sure the sensitive stomach is from the heartworms, or she is just a dog with a sensitive stomach (like our other dog, Bandit).

Lakota's personality is a little quirky right now, as well.  She is acting very cat-like.  Wanting affection at times, and then being aloof at other times.  Again, I am not sure if this is from the heartworms (and perhaps not feeling well), or it is just Lakota.  We have only had her for a little over a year, so this could just be her personality.  She was definitely more affectionate when we first got her, but she was a puppy then.  I guess we will have to just wait and see in the months following treatment.  Thankfully, she will never turn down a belly rub or hug, but sometimes we have to seek her out, rather than typical dog behavior of wanting lots of attention.

For now, it is a waiting game.  I want it to be over with, but it will be months before this is all done.  I will update as soon as there is any more news.

Lakota's Mom

Heartworm Update - Day 8

I have learned an awful lot about heartworms this week.  I learned that the treatment plan goes by days. Day 1 was last Sunday, the day Lakota was diagnosed.  Today is day 8.  We dropped Lakota off at the vet today for x-rays and more blood work.  It broke my heart to leave her there because she fought the technician who was trying to take her back, running back towards us.  My husband had to walk in the back with them just to get her into the clinic.  The purpose of the tests today was to determine what class (how advanced) Lakota's heartworms are.  The lower the class, the less chance of complications during treatment.  Below is a list of the classes of heartworms from the LSU School of Veterinary Medicine:

http://www1.vetmed.lsu.edu/VTHC/Shared%20Services/Cardiology/Cardiac%20Diseases%20and%20Conditions/Acquired%20Cardiac%20Diseases/item41535.html

Clinical Signs and Stages 

Heartworm disease has four distinct clinical stages and treatment is initiated specifically for the stage diagnosed:    

•    Class 1 heartworm positive animals have a positive antigen test but are generally asymptomatic. They cough rarely and may show slight exercise intolerance. They may have very mild changes evident on thoracic radiographs. Blood work is normal other than a positive heartworm antigen test.

•    Class 2 heartworm positive animals also have a positive antigen test but have clinical signs associated with moderate disease. Clinical signs can be occasional coughing, exercise intolerance and fever. A split 2nd heart sound may be heard on physical examination due to delayed closure of the pulmonic valve compared to the aortic valve due to pulmonary hypertension. Blood work may reveal a mild anemia and urinalysis may show mild to moderate protein loss. Thoracic radiographs may reveal moderate disease such as dilated pulmonary arteries and right heart enlargement.  

•    Class 3 heartworm positive animals also have a positive antigen test but have clinical signs associated with severe disease. Clinical signs include difficulty breathing without exercise, frequent cough, weight loss, inappetance, lethargy, coughing up blood and abdominal distension due to ascites. Blood work can show a moderate to severe anemia and urinalysis can show severe protein loss. Thoracic radiographs show signs of severe disease with tortuous and dilated pulmonary arteries, enlarged right heart and other pulmonary parenchymal changes such as an interstitial pattern from allergic pneumonitis or pleural effusion secondary to right heart failure. A split 2nd heart sound may be heard on physical examination due to delayed closure of the pulmonic valve compared to the aortic valve due to pulmonary hypertension.  

•    Class 4 A syndrome called Caval Syndrome defines Class 4 heartworm positive dogs. Clinical signs include a very sick patient that can be weak or collapsing due to shock. All clinical signs of a class 3 heartworm dog can be present. In addition, urinalysis will reveal a dark brown urine signifying hemoglobinuria secondary to red blood cell lysis from the shearing forces as blood is forced across the tricuspid valve which is entangled with worms. Thoracic radiographs are similar to class 3 animals. Echocardiogram can reveal the presence of many adult heartworms in the right heart and pulmonary artery. A loud systolic murmur heard best of over the right apex can be present due to tricuspid valve regurgitation. A split 2nd heart sound may be heard on physical examination due to delayed closure of the pulmonic valve compared to the aortic valve due to pulmonary hypertension.  

Based on Lakota's x-rays and blood work, the vet determined she is between class 1 and 2, although she is classifying her as a 2 because her lungs showed inflammation and although her heart looked good, the vessels were inflamed.  I was shocked, once again.  Lakota has not coughed at all this week, and rarely has coughed since the episode a little over a month ago.  She does not have weight loss (she actually gained a little weight), her abdomen is not distended, her heart sounds normal (to the vet), she doesn't have fever, and although I definitely see some lethargy, she seems like a healthy dog.  Ironically, just like our other dog, her liver enzymes were elevated.  I am now going to give both dogs a SAMe milk thistle supplement to see if it brings those enzyme levels down.

The next step is to continue on the antibiotic for 20 more days, and finish up the prednisone (now at every other day for a few more days).  The vet said that if Lakota starts coughing or shows other issues like diarrhea, vomiting or not eating, we will have to continue the prednisone for the next few weeks.  We also have to give her Heartguard on the first of each month, following our normal heartworm prevention schedule.  

On day 60, Lakota will have her first injection of melarsomine, the arsenic based product.  We are slated to do this on or around April 15.  I am actually hoping to schedule this on a Friday (either April 10 or 17), so I can be with her during the entire weekend.  This will be the time when she cannot have any exercise or get too excited.  When I talked to the vet today, she said that if Lakota is not used to being caged, caging her may actually make her more stressed.  If we can keep her calm at home around the house, this would be much better for her.  Someone is home most of the time, so I think this will be feasible.  If we leave the house, I will put her in our guest room, which has her favorite couch and a window that while she can see out, she can't see people or dogs walking by (something which always gets her excited and barking).  I can leave her favorite toys with her, too.

Days 90 and 91 (around May 15) will be the final two Melarsomine injections, followed by complete rest for at least another month.  Around day 120 (June 15), she will have a full assessment of her health, emphasizing how the heart and lungs are faring.  Hopefully she will be doing well enough to resume her walks and build up to our normal hyper puppy again.

One thing I failed to mention in my previous post is how much this is costing us.  I am keeping a running tab, so I will know the final amount we spent.  So far, in 8 days time, we have spent $383.  It will likely cost at least another $700 or more for the 3 injections, medications and follow up exams.  

I will keep updating any time there are changes and treatments.  For now, Lakota is happy to be back home, in her favorite spot under a dining room chair.  

Until next time,

Lakota's Mom