Metro Paws Animal Hosptial, LLC - Heartworm Treatment Contract
STEP 1 – Pre-treatment evaluation
 The purpose of the pre-evaluation is to try and identify the high-risk patient so
that TREATMENT PLANS CAN BE MODIFIED TO REDUCE RISK. There is
a chance we will elect not to treat your dog until any problems can be corrected.
 All pre-existing medical conditions should be addressed prior to undergoing
immiticide therapy. Treatment of such conditions may not have been included in
your original financial estimate.
A) Physical Exam (Cost $55)
The death of adult heartworms during treatment can be a severe insult to the dog's lungs,
worsening an existing medical condition. Advanced pulmonary vascular disease, allergic
pneumonitis, or congestive heart failure may require a delay in heartworm treatment until
these problems can be corrected.
B) Chest X-ray (Cost $129.15)
A chest x-ray will be taken to assess the severity of the damage caused by the heartworms
to the heart and lungs. Radiographs may indicate that heartworms have caused high blood
pressure in the lungs (pulmonary hypertension). If radiographs show changes to the lungs
or heart, your pet may be placed on steroids after treatment to reduce the risks caused by
dead heartworms passing into the lungs.
C) Heartworm testing
 The heartworm test will be sent out to an outside lab (IDEXX) for confirmation.
($37)
 A Difil test for the immature microfilaria (baby heartworms) may be performed.
Cost is $36.75.
D) Complete Bloodwork (Cost $97.20) (GMP46 without T4)
 CBC - Changes in the CBC may indicate a pre-existing medical condition, which
may require attention before heartworm treatment. A low platelet count will
increase the risk to your dog. We may prescribe an antibiotic and/or steroids to be
administered for 2-3 weeks immediately prior to treatment.
 Chemistry panel – This panel assesses overall organ function - in particular, the
liver and kidneys. Both of these organ systems are utilized in the processing of
the anti-parasitic drug and can be affected by a high worm burden.
 Thyroid panel (special cases) – Cost: $34.65
TOTAL COST OF PRETREATMENT EVALUATION
 Physical Exam
$55
 Chest xrays
$129.15
 Heartworm Test
$37
 Difil – microfilaria check
$36.75
 Bloodwork Panel
$97.20
TOTAL
$355.10
METRO PAWS ANIMAL HOSPTIAL, L.L.C.
Jennifer Lavender, DVM
Kathryn Sarpong, DVM
1910 Skillman St – Dallas, Tx – 75206 – (214) 887-1400
STEP TWO – HEARTWORM TREATMENT
Doxycycline
Wolbachia is a bacterial organism that resides inside heartworms and is thought to
possibly play a major role in the inflamation associated with heartworm disease. For this
reason we treat all dogs with doxycycline for two weeks following heartworm treatment
if not treated prior to immicide therapy.
The most commonly reported side effects of oral doxycycline therapy in dogs and cats
are nausea and vomiting. To alleviate these effects, the drug could be given with food
without clinically significant reductions in drug absorption.
Immiticide – Elimination of the Adult Heartworms
24 Hr Dosing Regimen
 Your dog will be hospitalized for 2 days. Confinement is 6 weeks post-treatment.
 Two intramuscular injections of Immiticide are given in the lumbar (back)
muscle. These injections are given 24 hours apart.
 Most dogs may experience muscular soreness at the injection site in the muscles
along the back for 2-3 days.
Split Dosing Regimen
 An injection is given on day 1. 30 days later, your pet undergoes the 24 hour
dosing regimen.
 Confinement starts at day 1 and continues for 6 weeks following the second phase
of treatment.
 This is considered a safer and more effective method of treating heartworms. It
may be required on severely affected dogs. However, if cost and length of
confinement are not of concern – this method is always recommended.
NOTE
Immiticide will kill the adult heartworms. However, there is no guarantee that this
will kill 100% of heartworms. At the 24 hr interval dosing regimen, the label states a
90% kill rate. At the split dosing interval, reported kill rate is 98% for female worms
and 100% for males.
COST OF TREATMENT
Hospitalization
Immiticide (up to 22#)
Immiticide (23-44#)
Immiticide (44-66#)
Immiticide (67-120#)
Oral medications to go home
$78.75
$105
$180
$255
$330
depends upon size of patient and selected meds
METRO PAWS ANIMAL HOSPTIAL, L.L.C.
Jennifer Lavender, DVM
Kathryn Sarpong, DVM
1910 Skillman St – Dallas, Tx – 75206 – (214) 887-1400
STEP THREE – CONVALESCENCE
Your dog MUST NOT be allowed to play and run around for six weeks after the
completion of heartworm treatment. The dog must be kept indoors and quiet or YOUR
PET MAY HAVE A SEVERE REACTION, including death, to the dead adult
heartworms. In case of cough, fever, or lack of appetite, please call immediately:
Metro Paws Animal Hospital, LLC - (214) 877-1400
After hours – call the E-clinic -
(214) 520-8388
www.eclinic.org
POTENTIAL COMPLICATIONS
 Pulmonary Thromboembolism - When the heartworms die, they are carried by the
blood stream into the lungs. This causes a blood clot in the lungs. Symptoms
would be coughing, fever, or lack of appetite. A platelet count and/or x-rays may
confirm the diagnosis.
Treatment consists of:
Antibiotics to prevent pneumonia
Steroids as an anti-inflammatory
Cough suppressant
Strict confinement for an additional 3 weeks
 Systemic Thromboembolism – Blood clots of any kind have the ability to enter
the bloodstream. If this happens, your pet could suffer a stroke or even die.
Original estimates do not cover complications associated with heartworm treatment. You
may incur additional charges at our hospital and/or an emergency clinic.
METRO PAWS ANIMAL HOSPTIAL, L.L.C.
Jennifer Lavender, DVM
Kathryn Sarpong, DVM
1910 Skillman St – Dallas, Tx – 75206 – (214) 887-1400
STEP FOUR - LARVAE TREATMENT
Currently, no FDA approved drug is marketed for microfilaria removal; however,
ivermectin has been used by veterinarians across the country and is recognized as a
treatment for microfilaria. This also serves as that month's heartworm preventative.
STEP FIVE - RE-EXAMINATION BY DIFIL TEST (6 weeks after treatment)
A negative Difil test indicates that the microfilaria have been removed from the
bloodstream. A positive Difil test indicates that the microfilaria have not all been killed
and re-treatment is necessary with an ivermectin based heartworm preventative.
If the test is negative for microfilaria, it is important to continue your dog on the
preventative.
STEP SIX - RE-EXAMINATION ( Follow Up Tests $37)
An Occult test 6-12 months after treatment confirms the elimination of the adult
heartworms.
STEP SEVEN – CONTINUED HEARTWORM PREVENTION
*After successful heartworm treatment you cannot relax. Dogs must be given monthly
preventative all year long or they may be re-infected with heartworms.
METRO PAWS ANIMAL HOSPTIAL, L.L.C.
Jennifer Lavender, DVM
Kathryn Sarpong, DVM
1910 Skillman St – Dallas, Tx – 75206 – (214) 887-1400
METRO PAWS ANIMAL HOSPTIAL, LLC
HEARTWORM TREATMENT CONTRACT
By signing below, I understand and agree to the following:
All price quotations are approximate. Because treatment must be individualized for each
patient we cannot quote exact prices.
Charges incurred from complications related to heartworm treatment have been included
in any estimates provided.
Heartworm preventative is not included in the treatment; heartworm pills should be
purchased separately and must be started after the difil test comes back negative.
Three Way Split Treatment - An alternative protocol is available. This method involves
administering 1 injection and then coming back with a 2 injection series 30 days later.
This protocol will likely be required if an animal is determined to be greater than stage 1.
However, although more expensive, this method is considered safer and may have a
higher rate of effectiveness. An estimate can be provided for this protocol if requested
for any patient. This protocol is not approved by the FDA and is considered an off label
use of this drug. Confinement will be at least 10 weeks with this regimen.
I have been informed of the risks to my pet, including death, and have received and read
information on heartworm treatment. Declining any of the recommended diagnostics
and/or treatments for my dog may increase their risk of complications, including death.
I have been informed that heartworm treatment does not always get rid of all the
heartworms.
I have been informed that the use of ivermectin as a microfilaricide is not approved by
the FDA and is considered an off- label use of this drug. I have been informed of the risk
of using this drug and consent to its usage.
I understand and agree to follow all post-treatment instructions.
DOG: _______________________________ BREED: _________________________
AGE: _______________________________ WEIGHT: ________________________
CLIENT NAME: ______________________ SIGNATURE: ____________________
STAFF MEMBER/WITNESS: ____________________________________________
METRO PAWS ANIMAL HOSPTIAL, L.L.C.
Jennifer Lavender, DVM
Kathryn Sarpong, DVM
1910 Skillman St – Dallas, Tx – 75206 – (214) 887-1400