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Health Care Manager (or the Assistant Director or Director in his or her absence), <br />who may order additional tests such as radiographs or laboratory work if needed. <br />Dogs with no or mild clinical symptoms of heartworm disease may be scheduled for <br />spay/neuter surgery as long as they are cleared by the veterinarian and approved <br />by the Veterinary Health Care Manager. <br /> <br />Patients are be grouped by symptoms into one of the following groups: <br /> <br />Mild symptoms or Class 1: <br /> Asymptomatic or mild cough <br /> <br />Moderate symptoms of Class 2: <br /> Cough, exercise intolerance, abnormal lung sounds <br /> <br />Severe symptoms or Class 3: <br />Cough, exercise intolerance, dyspnea, abnormal heart and lung <br />sounds, syncopy, ascites, hepatomegaly <br /> <br />Very severe symptoms or Class 4: <br />Caval syndrome: sudden onset of severe lethargy and weakness <br />accompanied by hemoglobinemia and hemoglobinuria <br /> <br />Generally, only dogs that fall into Class 1 and 2 would be treated for heartworms at <br />OCAS. <br /> <br />2) Treatment – pre-adulticide <br />After the patient is identified as heartworm positive and passed the behavioral and <br />medical evaluations, the Veterinary Health Care Technicians administer a dose of <br />heartworm preventative and, if the patient also is microfilariae positive, they also <br />administer a glucocorticosteroid to reduce risk of anaphylaxis (Dexamethasone at <br />1mg per 25lbs). Heartworm prevention is continued every 30 days ongoing. <br />Exercise restriction is initiated. The Veterinary Health Care Technicians begin the <br />patient on a 28 day course of Doxycycline at 10mg/kg BID. There is a rest period of <br />up to 4 weeks after the Doxycycline therapy. During this time the exercise <br />restriction is continued. <br /> <br />3) Treatment – adulticide <br />Patients that are identified as Class 1 (mild symptoms) are treated using a 2 <br />injection protocol of melarsomide: Melarsomide injection #1 and #2 are <br />administered 24 hours apart at 2.5mg/kg deep IM in the middle of the lumbar <br />musculature in the 3rd through 5th lumbar region on alternating sides by a <br />veterinarian. The Veterinary Health Care Technicians pre-medicate patients using a <br />pain medication and sedative and administer a NSAID pain medication on each day <br />of the injection and for at least 3 days afterwards. If post-injection treatment with <br />Prednisone is indicated, it will be initiated by the veterinarian. The patient needs to