4/24/2026

DVM Intake Exam Estimated age: 2-3 years based on dentition Microchip noted on Intake? Scanned negative History: Owner surrender Subjective: QAR Observed Behavior - tense, whale eyes, food motivated, allows muzzling, frozen for exam and pancakes for tasks, allows brushing/grooming without issue Is there evidence of suspected cruelty? No Objective: T = P = WNL R = WNL BCS: 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Adult dentition, clean incisors, limited exam due to muzzle PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: Externally WNL, intact male, 2 scrotal testes MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat with tufts of matting CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally WNL Wood's Lamp Exam: Assessment: Underweight Matted fur Intact male Prognosis: Good Plan: Intake tasks + exam Brush with furminator Await sort + behavior assessment Rx: Trazodone 125mg PO BID indefinitely SURGERY: Okay for surgery

4/24/2026

Possible heartworm positive, first HW Ag test showed positive control and test but 2nd test showed positive test line before control which deems test inconclusive. P: 4Dx with microfilaria to IDEXX +/- start HW treatment if indicated

4/25/2026

Microfilaria Present - Dirofilaria immitis Microfilaria Quantity Seen >50/LPF Serology Heartworm Antigen Positive Ehrlichia spp. Negative Lyme (Borrelia burgdorferi) Negative Anaplasma spp. Negative A: Heartworm confirmed positive P: Starting doxycycline 175mg PO BID x4w plan to premed with steroid and administer heartworm prevention at beginning of the day to monitor for anaphylaxis

4/26/2026

Heartworm positive with microfilaria Day 1 Administer appropriate heartworm preventive (e.g. Heartgard or Interceptor) If MF are detected, pre-treat with antihistamine and glucocorticosteroids, if not already on prednisone, to reduce risk of anaphylaxis Observe for at least 8 hours for signs of reaction Dexamethasone- 4 mg/ml (0.07 - 0.15mg/ml) sig: 0.5 ml IM Diphenhydramine- 50 mg/ml (0.5 - 2.0 mg/kg) SIG: 0.3 ml IM Heartgard for 36 lb dog Days 1–28 Administer doxycycline 10 mg/kg BID for 4 weeks Reduces pathology associated with dead heartworms Disrupts heartworm transmission Day 30 Administer appropriate heartworm preventive Apply an EPA-registered canine topical product to repel and kill mosquitoes Days 31-60 A one-month wait period following doxycycline before administering melarsomine is currently recommended as it is hypothesized to allow time for the Wolbachia surface proteins and other metabolites to dissipate before killing the adult worms. It also allows more time for the worms to wither as they become unthrifty after the Wolbachia endosymbionts are eliminated. Day 61 Administer appropriate heartworm preventive Administer first melarsomine injection, 2.5 mg/kg intramuscularly (IM) Prescribe prednisone 0.5 mg/kg BID first week, 0.5 mg/kg SID second week, 0.5 mg/kg EOD for the third and fourth weeks Decrease activity level even further: cage restriction; on leash when using yard Day 90 Administer appropriate heartworm preventive Administer second melarsomine injection, 2.5 mg/kg IM Prescribe prednisone, 0.5 mg/kg BID first week, 0.5 mg/kg SID second week, 0.5 mg/kg EOD for the third and fourth weeks Day 91 Administer third melarsomine injection, 2.5 mg/kg IM Continue exercise restriction for 6 to 8 weeks following last melarsomine injections Day 120 Test for presence of MF If positive treat with a microfilaricide and retest in 4 weeks Continue a year-round heartworm prevention program based on risk assessment described in prevention section Day 365 Antigen test 9 months after last melarsomine injection; screen for MF If still Ag positive, re-treat with doxycycline followed by two doses of melarsomine 24 hours apart/okay for surgery