Healing the Heart:
Shelter and Rescue Protocol for Heartworm-Positive Dogs
Marie Calabrasa, a widow in her early 70’s, saw Keni the hound’s photo on a local Pennsylvania rescue group’s website. His sweet face and floppy ears almost completely won her over, except for one thing. Rescued from an overcrowded shelter in North Carolina, Keni had been overlooked by potential adopters because he was heartworm positive.
“I’ll be honest—I was concerned because I thought he had a health issue. I’m on a fixed income and was worried about the cost of treatment,” said Marie. After careful thought, she decided to adopt him and took him for his continued treatments, paying for it out of her own pocket. “The rescue did not have the funds to treat him,” she said.
This is not an uncommon scenario that plays out with dogs that are rescued from an area of the country with a high stray animal population where heartworm disease is prevalent1. Sheldon Rubin, 2007-2010 president of the American Heartworm Society, says that “Heartworm disease has not only spread throughout the United States, but it’s also now found in areas where veterinarians used to say ‘Oh, we don’t have heartworm disease’ -- areas like Oregon, California, Arizona, and the desert, where irrigation and building are allowing mosquitoes to survive.”1
Heartworm Disease Prevention
Daily decisions must be made about the best allocation of resources for prevention and treatment of disease, spaying/neutering, and behavioral rehabilitation. Heartworm disease is among the most complex infectious diseases to detect, treat, and prevent. For that reason, it presents a special challenge to animal shelters.2
Challenges in the Shelter Setting
According to Martha Smith-Blackmore, DVM, research assistant professor at Cummings School of Veterinary Medicine at Tufts University, and author of “Managing Heartworm Disease in Shelter Animals” published by the American Heartworm Society (AHS), animal shelters face significant challenges in preventing, diagnosing, and treating many forms of infectious disease due to limited financial and organizational resources. In shelter animals, risk for heartworm infection is thought to be higher than in privately owned pets because stray and surrendered shelter animals are less likely to receive prior veterinary care.5
According to compliance data provided by Vetstreet in 2016, 64.31% of dogs do not receive any heartworm disease preventive medication.3,5 “Considering how difficult achieving compliance with veterinary recommendations is among the best clients, it is easy to understand how a surrendered animal is unlikely to have received good or consistent preventive veterinary care3”, stated Dr. Smith-Blackmore.
In 2014, The Association of Shelter Veterinarians (ASV) and the American Heartworm Society joined forces to discuss the prevention, treatment, and management of heartworm disease in animal shelters. In January 2015, the Heartworm Disease Resource Task Force was formed to formally address this issue.
Heartworm Disease Diagnosis2,4
Although funds may not be available for heartworm disease diagnostics in all shelters, an ideal goal is to perform a heartworm antigen and microfilaria test in all dogs at intake, as recommended by the American Heartworm Society in their current guidelines.
Shelters that evaluate dogs for heartworms should communicate to adopters that immediate, and annual testing is critical to detect infection and initiate treatment, if needed. Additionally, shelters should reinforce the importance of giving pets preventative medications as a safeguard, so heartworm disease does not become an issue.
Heartworm Disease Treatment2,5
The American Heartworm Society’s protocol is considered the gold standard for elimination of heartworms from dogs, based on current knowledge. This protocol for dogs entails a pre-treatment phase, which includes administration of doxycycline, and monthly heartworm preventive agents for 2 months before beginning a 3-injection treatment with an adulticide. Some shelters can implement this protocol while dogs are under their care or in foster homes, while others must leave treatment to adopting owners and their veterinarians to implement.
Use of Other Protocols4
If the shelter does not use, or recommend, the AHS’ recommended protocol for treatment, adopters need to be informed about the risks and responsibilities associated with the selected treatment method, including the following:
“Slow kill” treatment is less effective than the adulticide treatment recommended by the AHS and may not eliminate all the worms—even after 18 months or more of treatment.
During the lengthy waiting period, the worms in the dog’s body will continue to damage the heart,lungs,and pulmonary vasculature.
Strict exercise restriction is needed for the entire time that the animal harbors worms.
Risk for selection of resistant heartworm populations is increased.
Not all shelters share the same level of expertise in heartworm treatment or client education. In the shelter setting, the decision to use a treatment protocol other than the AHS protocol can be a deliberate “war zone” approach to treating heartworm disease—in human medicine, treatment options in war zones or developing countries do not always reflect the best recommendation available but are better than no option.
According to Dr. Smith-Blackmore, shelter staff should inform adopters when dogs are being treated with a protocol that is less than the gold standard, and instruct them to consider following up with their veterinarians for further treatment. This is a rational approach given the limited time and resources in the shelter setting.2,5
Association of Shelter Veterinarians (ASV) Position Statement on Heartworm Disease Management6,7
The ASV supports the application of the American Heartworm Society guidelines for the prevention, diagnosis, and management of canine and feline heartworms in animal shelters.
Regardless of geographic location, sheltering organizations are urged to maintain all dogs and cats on monthly heartworm preventive medications year-round to protect individual animal health and welfare and limit disease transmission within the community.
The ASV encourages shelters to perform screening tests on all dogs to identify infected dogs and institute therapy to reduce pathology and infective potential. Alternatives to maintenance of infected dogs within the shelter population, such as foster care and transfer to partnering agencies, should be considered when possible.
Organizations choosing to treat and/or adopt out infected dogs should ensure that:
Resources and mission allow for the humane care of exercise restricted dogs with extended lengths of stay
Shelter staff, volunteers, and potential adopters are educated on the importance of adhering to each component of the management protocol
Potential adopters are encouraged to consult with their veterinarian for further guidance.
Shelter and Rescue Heartworm Disease Resources
In 2017, The American Heartworm Society and ASV published new 'best practices' to help stop heartworm transmission via transported dogs.
A Heartworm Disease Management for Animal Shelters Webinar is also available.
ARE YOUR DOGS SUFFERING FROM NOISE AVERSION?
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MAKING INTAKE AND ADOPTION SPECIAL FOR SPECIAL NEEDS PETS
The Task at Hand (or Paw)
While the spring and summer are the busiest and most challenging times of the year for many of us in animal welfare, the good news is that a little planning and preparation now can go a long way to ensuring things run smoothly in the months ahead.
During Kitten Season, raising orphaned kittens on a large scale has long been considered a job better left to small-scale rescue groups, or achieved in small numbers by dedicated foster volunteers.1 The expansion of feline foster programs and, more notably, the establishment of kitten nurseries to address Kitten Season, are changing the situation for the better. Both inside the shelter and in the greater community, and with media exposure, this idea is catching on as a way to bring awareness to the kittens and drives potential adopters to the rescue or shelter.
As an example, The Best Friends Animal Society in New York City’s kitten nursery operates 24 hours a day, seven days a week. The nursery’s team of staff members, volunteers and foster homes provide around-the-clock care for every kitten. Their duties include bottle-feeding every two hours, preparing food, doing laundry, making sure each kitten has a warm blanket, and more. No matter the task, the goal is to provide each kitten with all the newborn support he or she needs. Best Friends kitten nursery also takes in as many kittens as possible from partner shelters to further the goal of no-kill shelters in New York City and its surrounding areas.
Ready for the Busy Spring and Summer Months?
First, estimate how many cats and kittens you are likely to see this year. This important detail forms the foundation of your planning, and lets you accurately estimate which resources—housing, staff members, volunteers, foster homes, vaccinations, medications—you’ll need.2
When estimating how many cats and kittens you may see, you should look at the intake numbers in several ways3:
- Separate strays from owner surrenders, because in most cases they will have different holding periods based upon vaccination status. If that doesn’t apply in your jurisdiction (e.g. there is no holding period for cats) or if you don’t accept strays, don’t worry about this step.
- Separate kittens from adults. A cut-off of 5 months is a general rule per the ASPCA, but your shelter may handle different populations of kittens differently.
- Look at the real number for each month, rather than using annual intake and assuming it is equal across every day of the year.
- It’s always a good idea to look back at several years—particularly if your shelter is seeing a trend of increasing or decreasing intake.
- Place this information into an easy-to-chart program like Excel—it’s easy to organize, and you can use calculations in the spreadsheet.
Next, it’s important to assess your shelter or rescue’s capacity for care and compare available resources to the population of cats in your shelter in order to eliminate any gaps.
Protocols and Procedures4
Age and surrender status of the kittens determine shelter intake protocols and procedures. Below are recommendations to keep in mind:
- Physical examination
- Viral testing (feline leukemia and FIV)
- Treat for internal and external parasites
- If stray, quarantine until available for adoption
- If surrendered and healthy, place for immediate adoption
- If too young for adoption, utilize foster care/foster family
Although Kitten Season may seem like a year-round event, shelter and rescue groups have done an exemplary job trying to stabilize the feral cat population, which in turn impacts the number of kittens that are born this time of year.
What can make a difference in how to manage this time of year is getting the word out within your community that “The season is coming”. By letting people know early that their help is needed, you will have a better chance of recruiting volunteers and a list of foster families eager to help with your kittens.