Vet School 101 Feline heartworms: The hows and whys of prevention

Cats who live where mosquitoes do, whether they live indoors or out, should [ideally] receive heartworm preventatives. That’s the premise of this post and I hope you’ll all take it to heart.

While it’s true that cats are not the ideal host for heartworms (Dirofilaria immitis), they can become infected by heartworm carrying mosquitoes, nonetheless (as can humans, though usually only immunosuppressed ones). This is a relatively new finding. In fact, it’s not something we discussed in vet school while I was there fifteen years ago.

Though we always knew it was possible, we hadn’t yet understood the disease process for cats, nor were we aware of the significant incidence of hearworm disease among them. Now we know that feline heartworm infection causes sudden death, vomiting, asthma and other chronic lung diseases in cats. And there is no treatment for the disease...only symptomatic treatment for the signs they may manifest.

Before ten or so years ago, many cats previously considered straighforward cardiac deaths, sudden acute respiratory distress patients, gastrointestinal disease suspects or feline asthma sufferers had to be recharacterized as potential heartworm cases. We began testing all cats with these signs (if we got there in time) and noted a high incidence.

How high?

Though it’s hard to say, some studies report as high as 20% exposure and 10% infection rates in heartworm endemic areas. Though the general practitioners among us reject this high an incidence, it’s clear our cats have a need for protection. Especially when the disease, once it does strike, can be deadly.

But not always.

A recent study out of Italy found that 34 of 43 heartworm infected cats cleared the disease within 49 months. The others, usually the older ones, died within this four-year period. This is good news, better than previously expected. Survival is not only possible. It seems likely. But it’s still pretty scary. Especially since 23 of the 34 who cleared the infection showed signs of illness. And we still don’t know how to make them feel better––not always.

But we do know how to prevent the disease. We have lots of experience with dogs, after all.

All it takes is a monthly oral or topical dose. I use Pfizer’s Revolution with tremendous success and, thus far, nary a side effect. One Pfizer insider even boasted of the product’s ability to prevent heartworm infection when applied every three months––though I didn’t take his word for it. I still recommend it monthly.

While I’m far more insistent about using preventatives in chronically exposed outdoor kitties, a recent rash of heartworm exposure-positive indoor-only patients has redoubled my efforts to bring feline heartworm awareness to cats both indoors and out.

It’s also a good idea to take this news outside of the South Florida and Eastern Texas, heartworm-rich enclaves. That’s because cats in “Heartworm Central” states seem to be faring better in their heartworm incidence relative to cats in parasite-easy areas (usually in northern latitudes). These latter cats are proving ill-protected and susceptible, just as these areas’ dogs are.

Here's the incidence as of 2005 (note that more north central regions as far north as Canada are seeing more cases than they did even four years ago):

It’s the out-of-sight-out-of-mindedness that creates these non-prevention circumstances. That, along with the non-year-roundedness of the need for prevention and the newness of feline heartworm awareness. That’s my take, anyway. Some insect watchers even postulate that climate change is responsible for the impressive incidence of heartworm disease in cats as well as dogs dogs in places previously considered low heartworm risk areas.

Furthermore, it's been my experience that the presence of pesky fleas has cut down on the risk of heartworms. That's probably because so many flea meds carry heartworm preventatives, too. For example, I can easily recommend Revolution or Advantage-multi for cats who have fleas and know that the heartworm prevention power is there as well. It’s easier to get my clients to accept prevention if it’s built in to a product they’re willing to use, anyway.

But what about your indoor kitties? Though I can understand why you might not want to apply a poison to your lower-risk cats, my experience with the heartworm positive indoor-only variety means that all cats in mosquito-prone zones are at risk.

Is it worth the risk of applying monthly meds? In the absence of harder evidence not yet available, we can only guess. But mine leans in favor of prevention. What else would you expect a veterinarian to say?

July 2nd, 2009

Add Comment64 Comments

I knew cats could get heartworm, but I didn't realize that knowledge thereof was so recent.

Any suggestions for feral untouchables in terms of heartworm prevention? I have a couple I can slip Revolution onto every few months (glad to hear what the Pfizer rep said, thanks!) but also a couple I rarely even see, definitely can't touch. I worry about deworming these guys, too.

Galadriel July 2nd, 2009 11:40:26 AM

Thanks for yet another educational post. I live in Northeast Texas (Dallas/ Fort Worth) and had never realized quite how bad this area is compared to other parts of the country - your map illustrates quite nicely. When I first got a kitty, my vet at the time said indoor cats don't need heartworm preventative. When we moved back to this area recently, our new vet made a strong case for it. He even gave the very sad example of his own (indoor only) pet kitty who died of heartworms. Needless to say, he convinced me that it's not a frivolous preventative measure for our indoor-only kitties.

Posey July 2nd, 2009 11:42:36 AM

This may be a stupid question but have you seen any difference in how commonly heartworm is seen in shorthair vs longhair cats? And in fact are there any studies regarding how fur length, type and thickness may affect heartworm susceptibility in dogs? I ask because with long thick hair it might be more difficult for a mosquito to reach the skin. Even though there are areas on every animal where skin is exposed, some dogs have significantly more or less than others. Would you happen to know of any correlation? I'm curious because I own very short haired dogs on whom i can see mosquito bites, and a cat with short but thick hair and a cat with long hair where it can take effort to find the skin (good, healthy, thick non matted coat). Okay not significant effort for me but i would imagine for a mosquito it might be.

Tatyana July 2nd, 2009 11:51:40 AM

I live on Vancouver Island which is just north of Washington State. If I project northwards from the map it seems as if all my kitties could be in danger of contracting heartworm. What tests are available? Should owners have all their cats treated routinely?

My daughter lost her 11 year-old Persian cat suddenly on Sunday. He was asthmatic, but not severely so. No heart problems had been picked up on a recent checkup. My daughter had an inconclusive necropsy. Now I wonder if heartworm could have been present.

Jean July 2nd, 2009 12:14:39 PM

Fifteen years ago, my regular vet was a house-call vet who also did pathology at Angell in Boston. She was encouraging protection for cats who went outdoors because they were seeing, at that time, no cats who had died of heartworm, but a lot of cats who had died of other causes, who when they did a necropsy, proved to be heartworm-infected. Because they weren't seeing cats dying from the hearworm, and most of the infected cats had been cats with access to the outdoors, they were reluctant to push heartworm protection for indoor cats who seemed to be at lower risk.

But that was at the major tertiary care facility in a six-state region, and I'm not surprised it wasn't a big deal at vet schools then. OTOH, it was in MA, which is a moderate-risk area. My two cats are strictly indoors, and both getting on in years, and I don't want to add another medication to their lives at this point. But I suspect that if I get another, younger cat, with the direction climate change is going in, I'll just go with the heartworm protection from the beginning. The heartworm risk is not going to go down.

Lis July 2nd, 2009 12:29:18 PM

Tatyana: There are no stupid questions. But, no, there's so far been no work on which cats are more at risk (none I've seen or heard of), save for lifestyle and geographic concerns.

Jean: The basic screening test is for heartworm antibody. It's a yea/nay test that indicates exposure. As a follow-up to these positives, I'll test for the antigen (which indicates the presence of the actual worm protein in the circulation). If it's negative, I'll flag that cat for serial heartworm testing every few months.

The test for babies, as we often do for dogs, is not helpful, as the babies (larval forms) don't tend to make it into the circulation.

But there's more information on this in the link I provided above (within the text). It's actually a very complete article from the Heartworm Society.

Dr. Patty Khuly July 2nd, 2009 12:36:51 PM

I couldn't get past the idea of applying a topical treatment on my cats. Our cats don't go outside and we don't have dogs that do, so I hope the possibility of getting fleas is less. Our vet uses Bayer Advantage Multi for topical although will order the other I believe. One cat reacted like I hit him and ran away after it was applied. Next day he turned his head around just far enough to get to the spot (it was obvious it was still bothering him 24 hours later) and vomited. He has IBD so I decided I didn't want to go that route. Cat #2 did OK with it, but it's hard to believe that the same sized vial my 15 and 17 lb cats are supposed to get is also for my 10 lb cat - it drips all over him. Cat #3 did OK last year with it but when I restarted in April he managed to get it on his paw and vomited.

I did still think heartworm preventatitive is important though. We have a lot of mosquitos here. This summer not too bad so far as it's been cold, but last year was awful. So, we use the oral preventative Interceptor. Two cats will eat the chews on their own - although I cut it in half for the smaller cat as I think he swallowed it whole once and didn't seem to feel very good after that. The third cat is very suspicous and won't eat the chews on his own. So, for him, I grind up some and mix in his canned food and pill the rest. None of them have any problems with the Interceptor, outside of the one cat not wanting to eat it on his own.

Although our vet recommends year round prevention, I did stop December - March.

Jenny July 2nd, 2009 12:53:49 PM

Worst case scenario: 20% will be exposed; half those will be infected; 1/5 of those will die within 4 years (and they were older to start with so this is how much of a shortened life?). Doc, how can you possibly be arguing for and promoting caution and prevention for such a small percentage after arguing essentially the opposite yesterday with regard to raw feeding (or do you not know the prevalence of immunocompromise in our population)?

PJBoosinger July 2nd, 2009 01:58:26 PM

PJB, what on Earth are you talking about? Dr. Khuly was not arguing against the feeding of raw food yesterday. Go back and read her closing paragraph again.

Further, I have 4 senior dogs. Each day with them is precious. You can't begin to try to tell me that if they got sick and died a little sooner than otherwise, it would be okay because they were already older. I'm sure every person with a pet cat will tell you the same about their cat. EVERY pet is precious; every pet's health is important. If preventative measures give a pet even 6 months more to live, that's 6 months that we wouldn't otherwise have.

Half of 20% is 10%; 1/5 of that is 2%. 2% of the entire cat population is a pretty darned big number.

Galadriel July 2nd, 2009 02:45:11 PM

Galadriel, she was arguing for dismissing the concerns over a small possibility for disease from feeding raw while here arguing for proactive intervention for a small possibility of disease.

And 2% (although it would be a much larger percentage actually affected) of humans isn't?

PJBoosinger July 2nd, 2009 02:50:39 PM

PJB, she wasn't arguing *anything* yesterday. She was pointing out a study, saying it did have some valid concerns, but that it was a shame such studies "play into the hands of the conservative veterinary establishment"--when it wasn't a study that said "raw feeding is bad," just a study that said "in some instances, people may not want to feed raw."

She didn't say "feed raw." She didn't say "don't feed raw." She didn't dismiss the conclusions of the study, though she did say they apply to a specific group. None of that is remotely relevant to today's post.

Galadriel July 2nd, 2009 03:11:18 PM

Jean: Please speak with your vet for sure, but I too live on VI and we do not currently have any record of heartworm on the island. They apparently have started to see if occassionally in places like Kelowna etc but it has also been recorded that these pets also all travelled into the states. Our general rule for clients is that if they are travelling any further past Vancouver, to use a heartworm preventative like Revolution, Advantage Multi, Profender just to be safe.

Kathy July 2nd, 2009 03:53:00 PM

OK, so here is something I found on safety studies in cats.

linkinghub.elsevier.com/retrieve/pii/S0304401700003071

I still don't feel entirely reassured. Lots of the cats that they infected with hearworm, treated, and then killed still had heartworms when they were necropsied. Granted, less than the control group, but . . .

Do these studies let cats live long enough to tell if a drug is affecting kidneys? Liver?

How can we trust them when they tell us that the bloodwork had no significant changes? (without giving #s)

And I hate that I look this stuff up, because reading about how these studies are done, makes me want to cry. Administered heparain to a cat and then euthanized it by letting it bleed to death. Sheesh. Gives me the creeps.

Stefani July 2nd, 2009 04:12:13 PM

The clinic I worked at ten years ago (Hamilton, Ontario) recommended heartworm preventative (Revolution) for indoor and outdoor kitties alike. However, they also pushed yearly vaccinations, including FIP, Lepto and Lyme. Essentially, if they sold it, they wanted you to buy it. I didn't last long before I quit.

I agree 100% with you last line - what else would you expect a vet to do? I mean, of course, err on the side of caution, not sell everything in their pharmacy. ;O)

However, we err on the side of caution - I believe, anyways - and don't treat any of our pets with flea or heartworm meds. We test the dogs twice a year and have not ever had a positive case. Our area is not a heartworm hotbed, and we take precautions (natural bug repellents, keeping them indoor during peak times, a thick layer of cedar chips covers the yard, etc).

I personally prefer Heartgard Plus and do recommend it to anyone who asks. I prefer Heartgard because I have a strong preference for Advantage as opposed to Advanage Multi and of course the two can be used together.

I also suggest to everyone who asks that they get their dog on heartworm preventative, and THEN research the facts about the incidence in their area, their dogs' unique risk factors and confer with their vet as well. Much the same suggestion I make regarding vaccines - get the initial set and you have a year to decide whether you want to continue. I personally do not, but its up to each parent (of a four-legger or a two-legger!) to make their own decisions regarding risk vs. reward.

The important part, in my opinion, is that we know that heartworm is an issue for dogs AND cats, and remain aware of the risk factors and symptoms.

More research is needed.

One last note: I use the term "preventative" here - but in reality "heartworm prevention" actually equals "heartworm treatment". I find the term "preventative" to be awfully misleading... and would prefer not to use it, except for confusion's sake.

Kim July 2nd, 2009 04:13:18 PM

This post got my questions going. What is done when a cat is heartworm positive...same as canine treatment?

Stef, Thanks ---where did they allow bleeding for 'euthanasia'? Not following AVMA OR AWA guidelines?

I know of a "positive" cat near me (didn't ask much) & had mine tested towards the end of her life.

I'm in my usual pickle with the seniors , two having elevated liver enzymes--one doubled from 600 to 1200 I never quit the Frontline, but have the Interceptor & cross my fingers. So far, none have been HW pos. at the end.

And NONE have ever been on HW or flea prev. year-round.

(new vaccine on the market!--my blog)

Oh, PJB: I agree--- 1 out of 150 human children have vaccine-associated events, see blog archive pg. 2

Barbara A. Albright/NH July 2nd, 2009 05:13:43 PM

PJB: You know, I was a bit vague in that post. But Galadriel was right on the money. I think we need to be cautious. But there are, as yet, no studies that outright prove we need to be. Right now its just about common sense and basic hygiene when it comes to service dogs and immunocompromised people. As to cats, we know they die of heartworm disease. We don't have any evidence that they die of Revolution. Hence, my current conclusion.

Dr. Patty Khuly July 2nd, 2009 05:59:47 PM

Barbara: No definitive treatment for cats with heartworm. I should make that clear in the post. We can only treat them symptomatically. They do succumb whenever we try to treat them as we do dogs (with caparsolate or Immiticide).

Dr. Patty Khuly July 2nd, 2009 06:01:25 PM

Barb, re the study: The cats were anesthetized. But still . . . creeps me out.

So, Dr. K, does your reference to cats succumbing when treated for Hworm infection mean that once they have it, its safer not to treat?

Stefani July 2nd, 2009 06:37:47 PM

Oh, PJB: I agree--- 1 out of 150 human childrenhave vaccine-associated events, see blog archive pg. 2

Barbara, where does that statistic come from, and what does it represent?

1 in 150 happens to be the number of children who have symptoms of autism. Repeated studies have failed to produce any evidence that this is the case, and the claimed mechanism--the presence of thimerosol in vaccines--has been absent from most vaccines for years, and the incidence of autism hasn't changed.

Also, "vaccine-related events" is an impressively vague phrase, that could easily encompass muscular soreness for a day or so after the injection, and the people who routinely get mild symptoms of flu when they get the flu vaccine. And, of course, much worse reactions. And much milder ones.

I presume the "Green Our Vaccines" movie linked to on the page you linked to is what you meant us to look at, but I don't currently have a version of quicktime recent enough to watch it, and I'm not inclined to download it at this hour.

Lis July 2nd, 2009 10:20:28 PM

Stefani; you can't (that I know of) use Immiticide in cats....it will kill them for sure. I know of two cats that were diagnosed with heartworms (incidently they were INDOOR cats) and we were not aiming to treat the adult worms per say. As Dr. K indicated you treat symptomaticaly which is a lot of asthmatic type symptoms. You may still lose the cat but you do have a better chance of killing them if you use the immiticide.

I admit I have not looked through the heartworm article but something that I think is worth mentioning in regards to the cat heartworms is the fact that they can have symptoms and problems from early larval stages of the disease - a condition I have often heard referred to as "HARD" -- Heartworm Associated Respiratory Disease. They can die just from the inflammation that the larval stages can cause and often you will not find adult worms in the cats at necropsies. All I can do is offer my client a way to prevent a disease that has high morbibity and can be fatal with no good treatment once they have it. If they want to take a chance that they are not in that 2%........by all rights it is their choice to make and I respect that.

I think it is true when they say that it may be a 1 in a million (0.000001%) but when you are that ONE it is a 100%

J.C. July 2nd, 2009 10:31:48 PM

J.C.: my motto too! Statistics don't seem frightening until you become ONE...

Lis: I don't have quicktime either & I deleted the email I received...my friend's 4 mo. grandson became one of those statistics 8 hours after receipt of multiple vaccines...died.

If I had a cat again, I would probably go for the 'preventative', if an in-outdoor one.

Barb A./NH July 2nd, 2009 11:42:54 PM

I admit that I don't keep my strictly-indoor kitties on heartworm preventive. I live in central Oklahoma, and heartworms are considered endemic in this neck of the woods. The dogs, who spend most of their time outside, are on it consistently, and I emphatically recommend heartworm preventive to all clients with dogs or cats that have outdoor access. The bottom line is that it's not cost-effective for me to treat all five given the very low risk of infection. I feel my money's better spent on routine blood screening, dentals, etc. Of course, that's my personal decision, and those are the kinds of concessions in care you have to make when you commit to owning several pets. If cost weren't a concern (oh, if only), then of course I would...why wouldn't you? As a side note, I was not aware that an in-house test for feline heartworm antibody was available...a little research pointed me towards Heska. Too bad Banfield has agreements with Idexx...the only tests we carry are antigen tests, and those are just about worthless, it would seem. I'm also guilty about not recommending heartworm preventive often enough to owners of strictly-indoor cats...it seems we only seem them for more pressing issues, as a lot of cat owners tend to skimp on preventive care. This post will remind me to do better...for a while, at least. :)

anna July 2nd, 2009 11:57:35 PM

"there are, as yet, no studies that outright prove we need to be. Right now its just about common sense and basic hygiene when it comes to service dogs and immunocompromised people" There are studies aplenty showing the susceptibility of the immunocompromised to opportunistic infections. That there isn't one specifically saying that the opportunistic infection came from raw food (and there are actually plenty of those, they just usually link it to uncooked or undercooked human food) fed to a pet, doesn't mean it isn't coming from that source. To me, common sense would then dictate something more than "basic hygiene" for these individuals and their animals, to err on the side of a bit of additional caution rather than telling those who are at risk to take the same precautions as those who are healthy. Way too many people are harmed because doctors want to wait until they have proof positive or build their own bias into their analysis and then call it "common sense" (which should be objective).

Lis, sure. For centuries people avoided Lepers. Then some folks came along and called that "hysterical over-reaction" but some of those who lived in close contact with them contracted the disease. Leprosy has been around for at least 4,000 years and yet today: "The exact mechanism of transmission of leprosy is unknown... The most widely held belief is that the disease is transmitted by contact between infected persons and healthy persons" (although they point out that those who are immunocompromised are at greater risk) and there is a push to not isolate people with Hanson's disease even if they want to be isolated.

Do children get Autism from vaccines. Hmmm, the vaccines are tested individually then given simultaneously. Countries who give lots of vaccines to children see increases in Autism and other illness at far higher rates than in countries where fewer vaccines are given. Res ipsa loquitur. Sure, regularly and repeatedly provoking the immune system (which is exactly what vaccines do) when we don't really have a firm grasp of how immune systems work or what exactly those vaccines do (other than the intended and tested effect), yep, that's a really good idea; especially while dismissing all possibility of the effects observed and refusing to independently test them. And let's don't forget that the prevailing theory of the cause of Autism for decades was "cold mothering"; by the same scientific community who now dismisses the possibility of a vaccine connection/contribution.

And silicone breast implants have never been "proven" to cause health problems but those companies were willing to right a rather large number of $900,000+ checks to the small percentage who were quite ill or had died. Do you really write checks like that if you think it can't be proven or do you write them in hopes of shutting people up so you can go right on pushing your drug or product? Proving the direct link or contributory link is quite difficult in anything less than an immediate reaction but that doesn't mean it doesn't exist.

I'm tired of medical professionals pooh-poohing the possibilities and not giving adequate cautions. One day, it will be "proven" that this attitude helped significantly increase the number of those with with immunocompromise (as it did in the early days of HIV when doctors were highly reluctant to see it as a transmissible STD). Tell people the possibilites and let THEM choose how much risk they wish to take. How many times must medicine repeat the same mistakes of attitude that biases their critical thinking?

PJBoosinger July 3rd, 2009 03:19:31 AM

Anna: Idexx has a snap combo with FIV/FeLV and Feline Heartwom Antibody. We use it.

Dr. Patty Khuly July 3rd, 2009 08:36:02 AM

PJ, the possibility of a vaccine-autism connection hasn't been "dismissed"; it's been studied, and even before the studies, the claimed mechanism, the use of thimerosal as a preservative, had been deemed a reasonable-enough possibility that it was removed from vaccines.

Other theories of the supposed mechanism came later.

Meanwhile, it remains a fact that standard childhood vaccines are given at the age that autism normally manifests itself--whether or not vaccines are given.

Also, children are now diagnosed who previously would have been treated and handled as "behavior problems." When I was a kid, the diagnosis of "Asperger's Syndrome" (an autism-spectrum disorder, for those who don't follow this stuff) did not exist.

If you want to argue that we should space out vaccines more than we do, and not combine them, I'm on board with that. Heck, it's what I do for my pets, why wouldn't I think we should do it for our kids?

What I'm not buying is vague and manipulative "statistics" with no specificity, are intended to scare and shut down critical questioning, have no apparent source, and don't say anything.

"1 in 150 children"--the exact same statistic as children who are autistic. Coincidence? Who knows? We're not told anything to base a conclusion on. "Vaccine-related events"--what kind of events? What's being counted here?

Lis: I don't have quicktime either & I deleted the email I received...my friend's 4 mo. grandson became one of those statistics 8 hours after receipt of multiple vaccines...died.

Barb, I'm sorry for what happened to your friend's grandson. However, I have to ask: Are you saying that 1 in 150 children experiences a life-threatening reaction to vaccines? No? The fact remains that for the "1 in 150" statistic to mean anything, we need to know what it represents. We can't make any intelligent, humane, caring, responsible decisions on the basis of scare statistics that contain no information.

Because I bet a number of people reading and commenting here, not just me and Barb, are old enough to remember measles, mumps, rubella, chicken pox parties--caring, loving, responsible parents intentionally trying to get their kids sick, because the "standard childhood diseases," while potentially life-threatening even for young children, were much safer to get in early childhood than after the onset of puberty. I myself did my Civic Duty at four years old by giving mumps to my entire nursery school.

These were the choices parents were making before vaccines. I have a friend just a year or two older than me, who got polio as a toddler right before the vaccine became widely available. Her mother got it, too, and because she was devoting all her efforts to caring for her sick daughter, didn't notice the early symptoms and didn't get treatment fast enough herself. She never walked again.

The diseases that vaccines prevent killed, crippled, permanently damaged health, in vast numbers. So, no, it's not enough to cite a content-free statistic like "1 in 150 children experiences a vaccine-related event" and then one or two genuinely tragic cases. We need to know what we're talking about. For real. Because even though children had a better survival rate than adolescents and adults for the "standard childhood diseases," parents still buried far more children in the Good Old Days pre-vaccines, than they do now.

One of the reasons family size has changed so drastically, just in my lifetime, is that parents now take it for granted that every child they have, will survive. That simply wasn't true, prior to vaccines.

If you want to make specific arguments, I'm all ears. As I said above, I am in favor of spacing out vaccines, not giving them together. But I'm not much interested in content-free scare "statistics." You remember what Mark Twain said, I'm sure?

Our cats and dogs don't die of distemper, our dogs don't die of parvo, our kids don't die of measles, mumps, rubella, chicken pox, whooping cough, and scarlet fever, because of vaccines. Rabies is vanishingly rare in our pets because of vaccines.

Over-vaccination is a problem. Giving multiple vaccines together is a problem. But vaccines? No, sorry, vaccines are definitely not the problem.

Lis July 3rd, 2009 09:14:15 AM

Great subject. My cat Bear was diagnosed with heartworm disease almost 5 years ago. He was so sick and it took forever and a lot of $$$ to find out what was wrong. He was the only case my vet had seen in over 15 years. I tried to give him the meds to help his breathing but the treatment was worse than the illness at that point. He struggled and then couldn't catch his breath, it was a fight every time, 3 times a day. So I stopped and started thinking about quality of life. He was eating, drinking, purring and seeking my attention still. So I let it go. He's had some really great times and some really bad times. He's coming into a bad time again, wheezing, sneezing a lot, coughing too. So we try to treat the symptoms the best we can and go from there. But he still seeks out my daughter (who is 4 years old) to play with, and will play until I have to separate them, so he can catch his breath. He's approxiimately 14 years old now, so getting up there in age and with his breathing difficulties recently I fear the end is near. We just lost two dogs and not sure how much more my 4 year old can take or understand. It's hard.

Sharon July 3rd, 2009 09:27:53 AM

So sorry, Sharon. I have a couple patients like yours. The cardiologist has managed to improve them better than I could. Both, however, are amenable to nebulization treatments. One even allows himself to receive the inhaler with the mask attachment we like to use if they'll let us. Only time will tell if they can clear the infection by themselves. The best we can do is keep them comfy. And, yes, sometimes that means leaving them alone to fight off their infections in peace. Don't feel guilty about taking this tack. Heartworm is a wily invader we sometimes can't do much about.

Dr. Patty Khuly July 3rd, 2009 09:53:31 AM

Dr. K - thanks for the heads up! I knew Idexx had a product out that combined the FeLV/FIV w/heartworm, but I thought it was hw antigen. Maybe I can do some persuading and get our inventory manager to order it. :)

anna July 3rd, 2009 08:18:40 PM

I'm confused. I couldn't find any other test on their website.

anna July 3rd, 2009 10:23:45 PM

Anna: I'll check into it for you. It's new for us (we usually send it out).

Dr. Patty Khuly July 4th, 2009 07:53:28 AM

I'm a fan of Revolution. I have 7 predominantly indoor cats (they do occasionally go outside for leash walks or in the cat enclosure).

I used to use Frontline and Heartgard for cats but that was a pain. The cats hated the Heartgard and most wouldn't eat it unless I broke it up in teeny pieces and mixed with tuna. Heck with that many kitties my cuticals would bleed before I got all that broke up. Then sometimes one or two wouldn't eat it even in tuna so I'd have to stuff it teeny piece by teeny piece down the cat. I don't miss those days.

After a bout of earmites with my younger ones when I got them I switched to Revolution. Much easier and offers far more preventatives than the other way. Although if we should have a tick situation I'd have to go back to Frontline but so far no ticks.

I've never had a reaction or problem using Revolution and it's been about 3 years now using it.

cl July 5th, 2009 10:45:52 PM

All my cats are indoor, but have outside enclosures so I want to protect them from heartworms and fleas. Would it be dangerous to treat them with Advantage or Frontline in combination with Revolution? In my experience Revolution does not do much of anything for getting rid of fleas despite its claim.

Penn July 6th, 2009 12:48:25 AM

Should we be treating our indoor cats for this? Just wondering as both Niki and Boo Boo have asthma. Would love to know!

Jayne Bersok July 6th, 2009 11:56:13 AM

FWIW, my oldest cat (~14 years) recently started coughing...he's been strictly indoor, w/a few short escapes (short being no more than 10 minutes) his whole life...he just tested hw antigen neg. but antibody pos. Which means he's been exposed (I live in central Oklahoma). There's no good way to determine if his current symptoms are caused by an asthmatic process or by a heartworm infection - a positive antibody test only shows that he's been exposed, not when he was exposed or how far the infection progressed or if he's still even infected (antibodies can persist even after an infection is cleared). His neg. antigen test and clear chest radiographs are encouraging, but hardly conclusive. His next trip in will be for an echocardiogram, which will be more helpful in ruling out a patent infection. So...for all those who read Dr. K's post and wondered whether or not their indoor-only cat should be on heartworm prevention...my kitty is now the poster child. I'm not beating myself up about it - as I posted earlier, not putting the indoor cats on hw preventive was a cost/benefit/odds decision I made...unfortunately with this one, I may have lost. The silver lining? My experience should help me relate to clients the importance of heartworm preventive, even if your pet is low-risk (b/c after all, low-risk does not equal zero risk).

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