Who is the vet on the board?

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I've got a question regarding heart worm and kidney disease in our rescue and was hoping to ask someone a few questions.

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I'm a vet, but the military really didn't prepare me for these questions.

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AubieAlumDVM

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He is off pheasant hunting but I'll text him.

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Fire away OP

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Thanks.

We have a rescue we found on the side of the road exactly one year ago. 6 or so year old, 40 pound beagle, hound mix.

Her owners gave her up and told us she had heart worms. We took her in last week to begin the treatment. Got a call from our vet and said during the pre-op blood work they detected signs of what might be kidney disease (said there was a possibility of bladder or kidney infection instead) so wanted to wait until culture came back before starting HW treatment. Found out today her urine culture was negative for a uti and her SDMA test does indicate that she has kidney disease.

Our vet spoke to a specialist who recommends going through with heart worm treatment. Told us the heart worms could be causing the kidney problems and the values might improve after treatment.

I know HW treatment is tough on a dog. We want her to have a good quality of life and would hate to put her through HW treatment if the kidney disease is going to take her anyway in a short amount of time.

Any experience in this area? What would you do?

Thanks

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I'm no expert, but I thought heart worms were pretty hard to come back from.

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Heart worms that are set in are a rough treatment. Usually takes 3 to 4 weeks and you have to keep them from exercise as much as possible. Some of the dead worms will get in the lungs and they have a tough time breathing and will throw up some of it.

As for the kidney disease, not sure what to tell you on it. At least they found it now. My mother's dog died of liver cancer and it pretty much happened over a course of a few weeks before she died. It is always tough to go through you are taking on a lot for a rescue you just found. I know you want to do the right thing but sometimes it is pretty brutal to go through for you too.

He is talking about a vet ordered heart worm treatment for existing, not a simple prevention. What he is talking about ranges in the 400 to 600 range and takes like 3 treatments over a month and is pretty brutal on the dog. You are killing all the baby heart worms in the dog and trying to kill as many big heart worms as you can.

I would probably do the treatment of it were my own dog. Can you give me any lab values from the pre op blood work (BUN and CREATININE)and sdma?

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but don't put too much on yourself. They don't live that long anyway.

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Maybe not, but we've grown attached to her and our golden has really gotten attached. Also, at this point it's not as much about the money as her quality of life.

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What he is talking about ranges in the 400 to 600 range and takes like 3 treatments over a month and is pretty brutal on the dog.

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Luckily, because she is a rescue we get a little bit of a discount because of the vet we use.

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AubieALUMdvm

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I would probably do the treatment of it were my own dog. Can you give me any lab values from the pre op blood work (BUN and CREATININE)and sdma?

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Thanks. I will ask the vet and post when I have that info.

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FearlessFreep

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Thanks for the advice. Our vet stressed no physical activity. She said even when we take her outside to put her on a leash. She also said can give us a sedative if we need it.

forgot to ask - do you know if there was a bunch of protein in the urine? If so, how much?

My initial answer was yes, I think I'd treat but it could be more complicated than that as you likely already know.

Ideally we'd want to further investigate the cause for the kidney disease. If it were due to some something other than heartworms, say Leptospirosis (entirely possible in a southern stray dog) or kidney cancer, then we'd like to know that. If Lepto, or some other dz, is the reason for the kidney disease and it's causing massive protein loss in the kidneys then that can really shorten the dog's lifespan. I'd also want to know if the blood pressure was really high too. EDIT: I'd also want to have an xray of the chest to see if the heart and the vessels around it were in really bad shape from the heartworms.

If it were my own dog and I couldn't/didn't want to go through the extra diagnostics then I'd want to get the dog on an antibiotic (doxycycline) and heartworm prevention for a month before treating with melarsamine (what actually kills the heartworms). The melarsamine is excreted from the bile ducts/feces so, in theory, it shouldn't affect/exacerbate the kidney disease. I'd have to go into this plan though knowing that the kidney disease could progress despite heartworm treatment and I could be looking at some long term treatment for it long after the hearworm issue is resolved.

If this makes no sense just tell me and I'll reword it - as with most things in medicine it's not an easy, straightforward answer.

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forgot to ask - do you know if there was a bunch of protein in the urine? If so, how much?

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I don't think there was. I believe that's why the vet didn't think it was just a kidney/bladder infection, but actually the beginning of kidney disease.

The vet had me put the dog on doxycycline the month before I took her in for the treatment.

Best I can tell the vet and specialist are thinking treat the heart worms to see if that's the reason kidney levels are off.