Dr. Anderson,

Thank you very much for the information. I actually visited the AHS website on Sunday so I was aware of most of it, but it never hurts to be reminded.

I’m certain you’re aware that the protocol you included is predicated on a dog showing signs of pulmonary distress. This is mentioned in the first milestone notes, but what about dogs like Delilah who show no symptoms? Lilly was as asymptomatic as a dog could get, and you only cage-rested her for 30 days. I remember that because I was the guy schlepping back and forth on Metro busses every few days to visit his dog and counting the days.

Why was 30 days sufficient for Lilly (circa 2002) but not for Delilah? Priscilla’s description said the “pre-medication” period was to build up the dog’s immune system, and I believe she was referring to mostly the doxycycline. It appears that we started Lilly at day 60 of the protocol without any problem. My concern about Delilah is based on her physiology being the opposite of Lilly’s. Lilly was a furry little tank. To call Delilah underweight is putting it mildly. Of course I realize I have the advantage of having seen her twice (once before the spaying) while you haven’t yet examined her. Once you get to, I think you’ll understand why I’m concerned about giving her any more cage-rest than absolutely necessary. Yes, we can improve her nutrition, but her body isn’t going to do much with better nutrients without some stimulation. I’m not worried the melarsomine will kill her, but she was already weak before being spayed. The melarsomine and 60 days of inactivity might leave her unable to do anything for some time.

Yes, the HHS deal for heartworm treatment seems great until you consider the specifics of my situation. I’ll have to board Delilah somewhere since she can’t stay in my house with Hot Rod. Moreover, who’s going to administer the daily meds? Not my “caregivers,” I guarantee. Gone are the days when caregivers became members of my household. Now they’re just clock-watchers. And, can you imagine what a pet taxi might charge for taking Delilah down to HHS daily? That, with the boarding, might dwarf the estimate you quoted.

Just some thoughts.


From: Marsha Anderson []
Sent: Wednesday, July 8, 2015 10:03
To: Scott Royall
Cc: Marsha Anderson
Subject: Delilah

I will try to compose and have the verification letter ready to fax tomorrow when I am at PMCK as they have a fax machine and I only do email. Plus I am swamped with work right now and have been working over 12-hour days this week. I have not done a heartworm treatment in many years so I pulled up the recommendations from the American Heartworm Society’s website. I recommend you go to their site and review the information. This is the protocol we would be following. When you look at the protocol it involves actually 120 days of exercise restriction. Initially she needs to be examined and her heartworm test confirmed with an occult and microfilaria test. I don’t know when she got spayed as I have no medical records but I am assuming recently. I agree with the shelter that we should not even think about starting treatment until she has had a month’s recovery from the spay and is in better shape. I was told that she has not had any Immiticide injections yet, that they usually did a month of "premedication" before they started the Immiticide protocol. I am not sure what they mean by "premedication", as I have never heard that term before associated with heartworm treatment and Ms. Lopez did not know exactly. I am attaching the protocol and example of charges. As you can see the treatment at a private facility is extremely expensive. Ms. Lopez told me they would do initial bloodwork and all three injections for $125.00. That is a bargain. We can’t even buy just the drug for that. As far as the exercise restriction, she would do much better in a quiet home environment than in a kennel with constant activity and loud barking dogs all day. Exercise restriction involves keeping her in the house and letting out to go to the bathroom only, then back in the house. I would think you could pay someone to take her over there for the injections – there is a service called Pet Taxi and of course many petsitters in Houston that do that sort of thing. As I said in an earlier email the off label use of the monthly preventatives is NOT the recommended protocol and is reserved only for those patients who are not candidates for the Immiticide treatment or who begin to have complications during it. My verification letter, as they call it will reflect these recommendations. Again you can read all about this on the Society’s website. Waiting until she is in pulmonary distress as you mentioned to do the treatment is not an option because at that point it is much more dangerous and problematic. -Marsha


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