/// QUARTERLY BEAT / OCTOBER 2021
QUARTERLY BEAT / OCTOBER 2021 ///
SPONSORED ARTICLE
BUTTERNUT SQUASH CROCK POT SOUP
Management of Cats with Adult Heartworm Infections
Recipe Submitted by Katie Engel
A PERFECT FALL FAVORITE
MARISA AMES , DVM, DACVIM (CARDIOLOGY) Associate Professor of Cardiology | UC Davis School of Veterinary Medicine
Cats with adult heartworm infection present a unique challenge for veterinarians. Cats are both susceptible to heartworms and more resistant to adult worm infections than dogs, typically harboring six adult heartworms or fewer when they are infected. Infections with just one or two worms are considered common in cats and one-third of these infections are single-sex. The catch is that even one or two adult worms in a cat can constitute a serious, and even life-threatening, situation. There is limited prevalence data on heartworm infection in cats. While canine patients are routinely screened for heartworm infection via antigen tests during annual veterinary visits, cats tend to be tested only when the cat is symptomatic and heartworm infection is suspected. Of 157 feline practitioners who completed a 2020 survey conducted by the American Association of Feline Practitioners (AAFP) on behalf of the American Heartworm Society, 85 percent indicated they believe feline heartworm is underdiagnosed. Antigen tests also have the limitation of only detecting live adult female infections and dying male and female worms, which means that immature and male-only infections can be missed. Nevertheless, a positive result on a heartworm antigen test is a definitive indication that a cat has an adult infection. With this question answered, however, another quickly takes its place: given that melarsomine use is contraindicated in cats, how should an adult heartworm infection be treated? While no official guidelines definitively answer this question, there are steps practitioners can take to support these patients. • Ensure the cat is on a heartworm preventive. While heartworm preventives cannot be expected to kill adult heartworms, they can prevent new heartworm infections from developing. Macrocyclic lactones are generally safe to administer to cats with adult heartworm infection. As noted above, a cat typically has a low adult worm burden and does not have circulating microfilaria, thanks to an immune system that almost always destroys them. This
largely eliminates the concern that a hypersensitivity reaction could develop as a result of microfilaria death.
Client compliance in administering heartworm preventives is paramount, so veterinarians should be sure to recommend a preventive the client is comfortable giving. Multiple options are available, including topical and oral products that are given monthly or bi- monthly. A bonus to administering feline heartworm preventives is that they can eliminate or manage other parasites besides heartworms. Depending on the product, preventives may be effective against intestinal parasites, such as roundworms and hookworms, and external parasites, such as fleas and mites. Meanwhile, preventives containing ivermectin and moxidectin are slowly adulticidal in dogs and this is likely also true for cats. • Eliminate Wolbachia to weaken the adult worms. Heartworm treatment protocols in dogs include the administration of doxycycline for 4 weeks to kill the Wolbachia bacteria that contribute to the inflammatory reaction associated with heartworm infection. The same principle applies in cats; by killing the Wolbachia, heartworms are weakened at all life stages and are possibly rendered less antigenic to the host. The downside to administering doxycycline to cats is the association of this antibiotic with gastrointestinal side effects. Reducing the dose to 5 mg/kg BID or 10 mg/kg SID may help reduce nausea, vomiting and inappetence, while administering doxycycline in a liquid formulation may minimize the risk of esophageal injury. • Consider steroid therapy and other medications to manage clinical signs. If the cat is demonstrating signs such as cough, the cat should be treated for presumed heartworm associated respiratory disease (HARD). HARD essentially is treated like feline asthma, using oral ± inhaled steroids. Inhaled albuterol can be dispensed for
INGREDIENTS • 1 butternut squash, seeded and chopped (leave skin on) • 1 head cauliflower, roughly chopped • 4 carrots, peeled and chopped • 4 stalks of celery, chopped • ½ onion, chopped • 4 cups vegetable stock • ½ teaspoon salt • 1½ teaspoons ground ginger • 2 teaspoons dried rosemary • 1 can (15 oz.) coconut milk • sour cream/plain yogurt, if desired • paprika, if desired
DIRECTIONS 1. Add squash, cauliflower, carrots, celery, and onion to slow cooker. 2. Add vegetable stock. Add water so that crock pot is about ⅔ full of liquid. Add salt, ginger, and rosemary. 3. Cook on LOW for 8-10 hours. 4. Add can of coconut milk. Blend with immersion blender or carefully blend by batch in a blender. 5. Serve with swirl of sour cream or plain yogurt and dash of paprika.
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