Non-FD but has heartworms * update* and another

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Jill and Remi

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Just got a new cat today. Well she has been on our porch the past 4 days so we took her to the vet to get examined and make sure we could bring her in without her passing anything to the rest of the crew. Everything was clean except she tested positive for heartworms. I was shocked and of course am saddened by this. I know it is rare in cats and dangerous for the cat when the worms die. Was given some prednisone for if and when she starts to show any symptoms of the worms dying. Anyone have experience? Great outcomes? I am hoping for the best, she is so sweet and is only about 2. Her new name is Chloe.
 
Re: Non-FD but has heartworms

What type of test was used? There is the antibody test that measure if the cat is producing antibodies and trying to "kill" the heartworms. Then there is the antigen test that measure antigen produced by female heartworms. I do not remember which.
- The antigen test can give a false negative If the right gender HW is not present. It works OK in dogs since they usually have a lot of HWs. However, cats have very few. If the cat is positive for an antigen test there is a very good possibility that the cat has active HWs.
- Cats tend to successfully fight off HWs and kill them. However, the antibodies produced by the cat remain in the bloodstream and can result in a false positive.
- What type of test was performed?
- Are there any symptoms of HW infection? X-rays?
For more info see:
http://www.heartwormsociety.org/pet-own ... tworm.html
 
Re: Non-FD but has heartworms

Thanks, Larry. Looking over the invoice it says IDEXX SNAP FeLV Ag/ FIVAb/ HW Ab Test. Then it says Heartworm antigen positive. No symptoms, thank goodness. Vet said we could do x-rays but that would just show what was going on in the lungs and he said when he listened her lungs sounded clear. He does think there are live heartworms, and did say what you did, about how cats will only have a few- like 3 or so. He said it can be deadly to the cat when the heartworms die because their bodies just do not know how to deal with it. But also, not every cat even shows effects when the worms die. Said to keep an eye on her breathing.
 
Re: Non-FD but has heartworms

If and when it becomes necessary to intervene (moderate symptoms), it is possible to remove some of the worms surgically.
This, of course, is pretty expensive and if you wait too long, the cat's condition may not allow it.
 
Re: Non-FD but has heartworms

Hi Jill

I'd put money on the cat having been exposed to heartworm and still having antibodies, rather than actually being infected. Outside cats get bitten by mosquitoes just like people and dogs do, and unlike dogs they very aggressively and successfully fight off most heartworm infections. Some don't, and will end up with adult heartworms in the heart. You can send out an antigen test which will tell you if there is an adult female worm in the heart. If you have the means and a nearby, board-certified cardiologist, you can have an echocardiogram done. Cats have small hearts relative to the size of adult heartworms, so you can often see the worms on echo. This is all to find out if your cat has heartworm for your own peace of mind--there's no real treatment for it.

You're not giving the pred now, right? I'm not sure why it was prescribed. There's no reason to, and your cat has no symptoms of HW disease. Chest x-rays would show if there is lung damage typical for animals with heartworm, but again since there are no symptoms, there's nothing to treat anyway. FWIW, cats who die acutely from adult HW infection do so rather quickly -- they experience massive anaphylactic shock and are gone in a matter of moments.

This can be a false positive test as well. If you are not in a HW endemic area, the chances of that go up.

Personally, I would not be too upset if a stray cat I found tested positive for heartworm antibody. It indicates exposure to heartworm, and >90% of cats exposed to HW will beat it (i.e., prevent formation of adult worms). All of those cats will go around testing positive for some time. I'd do an antigen test and an echo if I could. If you can't, then know that it's possible but unlikely that your new kitty will suffer sudden death (sorry, no less-blunt way to say that) but don't dwell on it since it's very likely that the HW infection is far behind her now.

Congrats on the new kitty :) and major kudos to your family for taking in a homeless animal.
 
Re: Non-FD but has heartworms

Thanks everyone. This does help. I am not giving the pred now, vet said if she starts to have labored breathing, coughing to give it to her then get her to the vet if there is no improvement. I am pretty sure we have high rates of heartworm down here in the southeast. Vet was insistent it was not a false positive- not that I buy that 100%. I will have to check around to see if there is a board-certified cardiologist in the area. I am betting the closest one will be in Birmingham, AL or Atlanta, GA-both 3 1/2 hourse drive. Not to say I am unwilling to do this, because if I get myself thinking too much I will probably take her to a specialist to be safe-and keep my sanity. What other antigen test could I have run?
The >90% of cats beating it really does lift my spirits. Thanks again!
 
Re: Non-FD but has heartworms

Hi Jill

Ah you're in AL. I didn't notice that. I don't know if the vet school has a cardiologist, but whomever does echos there must see a lot of HW so if you're close, it's worth calling to see if the echocardiographer feels confident in identifying HW in cats.

The test you did is an antibody test. The FeLV/FIV/HW is an antibody test. The antigen test would be a send-out to the lab. If they didn't send blood out, they didn't do the antigen test. It's probably a misprint on your discharge instructions. You can call to ask.

EDITED to add: I would be treating everyone, cats and dogs of course, with HW prevention (Heartgard for cats) from here on out, if you aren't already.
 
Re: Non-FD but has heartworms

Thanks, Jess. They did not send out the blood so I will call tomorrow to see if they have any left that they can send out. Or else, we are going back next week to have another vaccination given and they can draw more blood to send out. My other cats are strictly indoor so should I worry about HW prevention? No fleas or ticks or any of that stuff on them.
I can try to contact Auburn to see about their cardiologist.
 
Re: Non-FD but has heartworms

Hi Jill

Mosquitoes get in the house too :) I even have Dillon on it during the summer months, although we aren't in a big HW area. Ivermectin (the drug in Heartgard) is extremely well-tolerated in cats and it's not prohibitively expensive so why not be as safe as possible? If a cat develops an adult HW infection, there is no real treatment for it. Cats who contract HW can also get respiratory disease (asthma-like symptoms) if the infection progresses to a certain point, even if they don't get adult HW, so why not try to prevent this too. (The link Larry posted has more info on HW-associated resp. disease.)
 
Re: Non-FD but has heartworms

This triple Idexx test included the HW antigen test.
http://www.idexx.com/view/xhtml/en_us/s ... SSOTOKEN=0
"Feline Heartworm Disease (Antigen)
The SNAP Feline Triple Test is a rapid immunoassay for detection of heartworm antigen in feline serum, plasma or anticoagulated whole blood. Heartworm disease is caused by the filarial nematode Dirofilaria immitis, which has worldwide distribution. The insect vector for D. immitis is the mosquito. The detection of heartworm antigen is diagnostic for the adult stage of infection."
Jess & Earl said:
Hi Jill

Ah you're in AL. I didn't notice that. I don't know if the vet school has a cardiologist, but whomever does echos there must see a lot of HW so if you're close, it's worth calling to see if the echocardiographer feels confident in identifying HW in cats.

The test you did is an antibody test. The FeLV/FIV/HW is an antibody test. The antigen test would be a send-out to the lab. If they didn't send blood out, they didn't do the antigen test. It's probably a misprint on your discharge instructions. You can call to ask.

EDITED to add: I would be treating everyone, cats and dogs of course, with HW prevention (Heartgard for cats) from here on out, if you aren't already.
 
Re: Non-FD but has heartworms

Aargh it IS an antigen test. I swear that Idexx used to only have an antibody test for cats. I clearly remember this, because they sent us a sample box and we never used it because AB tests aren't that useful in cats.

Jill, the antigen test is much more likely to indicate active infection. I would have her blood sent out to the lab for confirmatory testing, if that comes back positive then please let us know. The good news is, cats also can defeat adult heartworm ('self-cure"). A study in 2008 found that 79% of cats self-cured in a few years, with only some of those cats having symptoms (asthma-like symptoms, or vomiting). The bad news is, cats have tiny hearts that can't comfortably accommodate these large worms, and dying lungs can cause shock (if a worm suddenly breaks) or lung damage (as pieces of dead worm go into the lungs). I would put her on preventative (Heartgard, Revolution or Advantage Multi) for sure, and I would do x-rays of the chest to look for lung damage. If they are digital, ask for them to email them to you or to put them on a CD.

Sorry, I thought for sure it was an antibody test.
 
Re: Non-FD but has heartworms

Thanks again! I will get a preventative for all of my girls. And probably do some lung x-rays next week on her when she goes for her follow-up. I hope she can beat it and has no problems. Of course, now I am worried again.
 
Re: Non-FD but has heartworms * update*

So DH just got back from the vet with Chloe and it is not good news. I had them do the x-rays on her lungs even though two vets said they sounded clear. The x-rays showed no clean spots on her lungs and her pulmonary artery is bigger than her rib. My vet is consulting with Dr. Dillon at Auburn(the foremost authority on heartworms) and hopefully we will have a plan of action soon. Vet is supposed to call me on Monday with the next step. I foresee taking her to Auburn to get treatment. I kind of want to go ahead and start her on the prednisone they prescribed but vet said to wait. Vet also said if she remained outdoors and was chased by something for a while she would probably die from this damage to her lungs. She is really the sweetest calico I(and all of the vet staff) have ever met and we have only had her 2 weeks. I really hope she will make it through this.
 
Re: Non-FD but has heartworms * update*

That was amazing and gross. I did not realize how long they were. I am thinking at this point that the best case scenario is that there are no more in her heart and this is the most damage that can be done. I will pray that this is the worst of it and she does not keep sustaining damage form these invasive worms. My heart is hurting for her.
 
Re: Non-FD but has heartworms * update*

The prednisone is to reduce inflammation in the arteries which is caused by the heartworm. Since you now know they're there, I'd consider using it. Reducing the inflammation may allow more blood to flow through.
 
Re: Non-FD but has heartworms * update*

Steroids add to the risk of surgery. Your vet may be asking you to hold off in case surgery is the suggested treatment.
 
Re: Non-FD but has heartworms * update*

Sorry - didn't catch that the vet had said to wait on the pred.
 
Re: Non-FD but has heartworms * update*

Jill and Remi said:
So DH just got back from the vet with Chloe and it is not good news. I had them do the x-rays on her lungs even though two vets said they sounded clear. The x-rays showed no clean spots on her lungs and her pulmonary artery is bigger than her rib.

Oh darn. I was so much happier when I thought it was an antibody test! So she is one of the rare ones to have a real HW infection.

Re: treatment. The treatment of choice for dogs, Immiticide, is extremely toxic to cats to the point that it is rarely even used as a last resort. Dogs can also be treated surgically, as you saw in the video, but this procedure is much more risky in cats. The average-sized dog has a nice big jugular vein into which you can easily place one of the inflexible "grabber" instruments to pull out worms. A better video of this procedure is on the American HW Society (AHS) website. You have to pull the worms out whole, without breaking them, because breaking the worms can result in anaphylaxis. Cats are, of course, very small in comparison to dogs so going through the jugular vein is rarely even attempted. An experienced surgeon + cardiologist + anesthesiology team can try to get them out by opening up the chest and trying to pull them from the heart. This, too, is just as risky as it sounds. Cats are exquisitely sensitive to HW antigen, so if a worm breaks during this procedure, the cat doesn't have a chance.

Personally I would not try surgical extraction for my own cat. Maybe there are vets out there who have had a ton of positive experience with this; the specialist at Auburn would probably know. As is, it is very high risk for a cat who is not having symptoms. I would give Heartgard and await a "self-cure"; pred use is up to the vet, the AHS recommends a single tapering course of pred for cats believed to have adult worms. (The AHS is generally regarded as the last word in HW in the US--they do a lot of research and have conferences, etc.) Some vets are trying out doxycycline, an antibiotic which may weaken the worm and shorten its lifespan. It's commonly used in dogs with HW but not yet in cats; I would consult a specialist about its use. You'd have to get it compounded.

One last thing. I'm not sure what your vet would think of this, but it doesn't hurt to ask. If I knew my cat had adult HW in his heart, I would get a script for an Epi-Pen (or a syringe with some epinephrine in it, if the Epi-Pen Jr. is too high for a cat dose). That is not a guarantee that if your cat had anaphylaxis, that you would make it to the ER, but it gives the kitty a chance. People have also tried Dex SP (a steroid) to buy time. Unlike dogs, cats (and humans!) with anaphylaxis often have severe respiratory distress (dogs have other signs, neuro and GI most commonly) and it's key to get them treatment right away. So I'd want to have an epi-pen (or at least dex SP) and directions to the ER at home, ready, and then I'd try not to think more about it. Your little one is unlikely to experience this, as I mentioned already the majority of cats kick the heartworms on their own without incident (though they may have signs of asthma throughout their lives). In the superstitious vet world, though, being prepared almost always means it will never happen :-)

Please keep us posted on your vet's consult with Dr. Dillon. I'm good friends with a cardiologist practicing in Tennessee, but even she hasn't seen many HW cats. I'll pick her brain anyway though.

Take care (and try not to worry! be prepared and then forget about it! you have a great new kitty, that's the main thing!)
Jess
 
Re: Non-FD but has heartworms * update*

I e-mailed my vet's office to ask again about going ahead with the pred since my DH was the one at the vet visit(I knew I would get emotional there) and I am not 100% he asked about it or asked correctly. Vet tech responded and said he spoke with vet and said I could go ahead with the pred. I don't know what else Auburn could do other than they would have more experience than my regular vet and may be able to do the echocardiogram of her heart? I do think the pred is a good starting point. She is not exhibiting any symptoms listed on the AHS site. She has actually even gained .8 lbs since being here. I just hate that my vet said they were the worst x-rays of lungs he has ever seen. He also ran some more bloodwork to check her kidney, heart, and liver values(I believe). Will post more info as I get it.
Will ask about an epi-pen when he calls me Monday.
 
Re: Non-FD but has heartworms * update*

Just another update. Got her lab results and most everything is in the normal range. The exceptions are as follows:
Urea Nitrogen(high) 37 ranges 14-36mg/dL
Triglycerides(high) 172 ranges 26-160mg/dL
WBC(high) 19.8000 ranges 3.5-16.0 10^6/mL
Lymphocytes(high) 49 ranges 20-45%
Absolute Lymphocytes(high) 9702 ranges 1200-8000
Absolute Eosinophils(high) 2178 ranges 0-1000
And finally her Occult Heartworm Antibody(Feline) Negative
I don't really have any idea what a lot of it means. I know a high WBC means her body is fighting something(infection). And that Triglycerides have to do with cholesterol.
Oh, and we had an episode Sunday night where I thought I was going to lose her. She got in a huge fight with Phoebe and after they separated Chloe could not seem to catch her breath- how I imagine someone with asthma would breath during an attack. She did finally settle down and her breathing regulated. I asked vet about epi-pen and he said the pred was the best thing to use during something like that. Thought I would not know how much epinephrine to give during a situation. Vet still has not heard back from Dr. Dillon(heartworm specialist at Auburn) so we are going to finish the course of pred and re x-ray her. Any insights are appreciated.
 
Re: Non-FD but has heartworms * update*

Jill and Remi said:
I know a high WBC means her body is fighting something(infection).

This is a common mistake that people make. A high WBC does not necessarily denote that an infection is present. WBCs also go up with any source of inflammation, as well as with stress.

19K could very well just be a normal stress response.

Also, with regard to TGs and cholesterol...it is very important to consider that the lab values were generated on cats eating crappy high carb dry food....not species-appropriate diet of meat and animal fat. 172 is perfectly fine.
 
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