Here is some info but there is more.
Heartworm treatment options
Q: Dear Dr. Mike, I am a new dog owner, so I don't currently have a vet picked that I have complete confidence in. My problem in my new dog, which I just got from the local animal shelter, has tested a weak positive for heartworms. He is a 2 year old brittany and shows no symtoms of the disease. After talking to three local clinics, I'm confused as to the most prudent treatment. Please look at the three choices and please let me know the one you feel makes the most sense.
1. Two injections of Immiticide followed by a treatment of ivermectin in 2 weeks, and then placed on Heartguard Plus with a retest in 6months.
2. Two injections of Immiticide followed by a retest in 4 weeks and placed on Heartguard Plus(no follow up of ivermectin recommended) and retested again in 6 months.
3. Put on Heartguard Plus and not treat the adult worms since a weak positive indicates a very minor infestation. The explanation is to prevent any new worms and let the small number of adults die over time.
Being a new dog owner I'm not sure I know which of these is best and I'm asking you for a second opinion of sorts. If this is too trival for your Q and A page, could you please E-mail me your thoughts.
A: Of the options you presented, I like the second one best except that I don't understand the recommendation to retest for heartworms in 4 weeks. Perhaps your vets meant 4 months?
I never really know what the term "weak positive" means. If this is the designation from a CITE Snap Test which has a high and low antigen spot, then I think retesting using a different test would be the best idea. False positive tests do occur. This is particularly important if you live in an area in which heartworms are not a frequent problem. If this means that one microfilaria was seen on a direct or filter examination then I strongly recommend treatment. We have seen a couple of dogs develop significant symptoms of heartworm disease while we kept them on heartworm preventative and waited for heartworms to die. I am just not comfortable taking this approach anymore.
Every vet has different experiences in practice and controversies over things like how to best treat heartworms are frequent. It is a very difficult thing to have to find a new vet in the middle of a problem like this in which conflicting advice is highly likely and you haven't got the advantage of a trusting relationship with a vet.
I wish you the best with this. The good news is that Immiticide really does seem much better than the old heartworm treatment. It is highly likely that you dog will do OK.
Mike Richards, DVM