Pulmonary function testing in patients with liver cirrhosis (Review)
Study Compares Heartworm Disease Treatments
An extended release injectable moxidectin protocol (MOX) has shown promise in a recent study as an alternative heartworm treatment for dogs. Investigators found the MOX is equally effective to a 3-dose melarsomine protocol (AHS-3) recommended by the American Heartworm Society for clearing heartworm infections in dogs.1
Photo: Natasa/Adobe Stock
The MOX protocol consisted of 0.5mg/kg moxidectin by subcutaneous injection on Day 0 and Day 180, plus doxycycline, 10mg/kg twice a day on days 0 to 30; prednisone, 0.5mg/kg twice a day on days 0 to 7, once a day on days 8 to 14 and once every 48 hours on days 15 to 30. The AHS-3 protocol was comprised of melarsomine 2.5mg on days 60, 90 and 91; plus doxycycline and prednisone regiment with monthly heartworm prevention suggested by the American Heartworm Society.1
Lead investigator Ta-Li Lu, DVM, DAiCVIM (Cardiology), a practitioner and superintendent at Chuan Animal Hospital in Taipei, Taiwan, noted that although there is a "really good protocol from AHS" for treating heartworm disease, there are sometimes issues that cause the treatment to become unavailable such as lack of stock. "I do think we need a second option. Right now, moxidectinplus doxycycline is a promising one," he said in a dvm360 interview at the 2025 American College of Veterinary Internal Medicine Forum in Louisville, Kentucky.
According to the FDA, heartworm infection is a serious parasitic condition that causes lung disease, heart failure and other organ damage in canine and feline pets as well as other animals. Spread through bites from host mosquitoes, the heartworm (Dirofilaria immitis) matures, mates and produces offspring while living inside a dog or other animal.2
Heartworm disease in the US is most common along the gulf and Atlantic coasts, as far north as New Jersey, as well as the Mississippi River and its tributaries. However, all 50 states have reported heartworm infections.2
The study in Taiwan enrolled 24 client-owned dogs that were heartworm antigen-positive. These canines were randomized into 2 groups comprised of 12 dogs each. They received heartworm antigen/microfilaria tests, blood work, thoracic radiographs, ECG and echocardiography on days 0 and 90, and monthly after Day 90.1
Treatments were considered effective when dogs tested negative for heartworm antigen. In each of the 2 study groups, 11 dogs achieved antigen-negativity within 360 days of treatment.1 "The time they turn to negative is similar within 2 groups," Lu emphasized.
During the study, one dog died after receiving 3 injections, according to Lu. However, the cause of death is unknown.
The investigators would continue to recommend the AHS-3 protocol, Lu said, but the MOX protocol could be an effective alternative choice. Additionally, clients may find the MOX protocol beneficial in other ways.
"The benefit is [MOX] makes their life easier," Lu said. "So for the new protocol, they only got 1 injection and 1 month of dosing cycling, and that's all basically, and then a 6-month recheck and, if it's still possible, 1 injection more. Then it's gone. So they don't have to take a lot of medicine…I think the injection moxidectin is more tolerable too. We don't see any severe side effect after the injection."
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A Dog Trainer Had No Symptoms. An X-ray Found A Terminal Disease - Yahoo
When Christopher Kennedy went to have an X-ray before a routine surgery, he thought he would be in and out. Then a technician spotted scarring in his lungs.
Kennedy, 68 at the time, had never noticed any warning signs. He was a retired Air Force technician who exercised regularly and spent his time landscaping his backyard and training Bernese Mountain dogs to be hospital therapy animals.
After several tests, a pulmonologist gave him an alarming diagnosis: Idiopathic pulmonary fibrosis, or IPF. It's a type of lung disease with no known cause where scar tissue grows in the lungs and prevents oxygen from reaching the bloodstream, according to Dr. Panagis Galiatsatos, a medical spokesperson for the American Lung Association and pulmonologist at Johns Hopkins, who was not involved in Kennedy's care. The condition is progressive with a "high mortality rate," Galiatsatos said.
At first, Kennedy thought he could "beat" the disease. But as his lung function degraded, he realized that was "baloney." Medications meant to slow the progressive fibrosis weren't working, and he was starting to need oxygen in his daily life. Even walking to the kitchen was leaving him winded. In 2024, Cleveland Clinic pulmonologist Dr. Aman Pande confirmed Kennedy's worst fear: He had less than a year to live.
Christopher Kennedy and his wife on their anniversary in 2021. / Credit: Christopher Kennedy / Cleveland Clinic
"We all wonder, as human beings, how we're going to go," Kennedy said. "And you never know. It's a great mystery. Well, for the first time in my life, I was told 'This is how you're going to go.'"
"You come out one of two ways"
Pande did have one option for Kennedy: They could see if he was eligible for a double-lung transplant. Kennedy, at 74, was older than most patients who undergo the operation, but he was otherwise a promising candidate, Pande said. Lung transplants are usually the final option offered to IPF patients, Pande said, and are usually curative, though a small percentage of patients can see the condition recur.
Kennedy was initially resistant to the idea, because his younger brother had died after the same procedure. But after more convincing from Pande, he agreed to undergo testing to see if he would be eligible. Cleveland Clinic doctors "scoured everything," Kennedy said. Finally, he was approved as a candidate. He was registered on the national transplant list, and waited for a pair of suitable lungs to become available.
As the months passed, Kennedy's lung function continued to degrade. He went from using two liters of oxygen a day to 10. He had a mild case of COVID-19. He lost more than 40 pounds. In October 2024, he was admitted to the hospital.
"Dr. (Jason) Turowski, (a transplant pulmonologist at Cleveland Clinic) said 'OK, we're going to admit you and you come out one of two ways: With a set of lungs, or we're going to carry you out,'" Kennedy recalled.
Bernese Mountain dog Fini visits Christopher Kennedy in the hospital. / Credit: Christopher Kennedy / Cleveland Clinic
"You're reminded every breath matters"
Kennedy spent a month in the hospital. There were two false alarms, where it seemed that a pair of lungs might be available but ultimately were not. The third time was the charm, and on Nov. 15, Kennedy underwent a double-lung transplant.
"It was a relief. I was apprehensive, obviously, and anxious. I can remember going into the operating room," Kennedy said. "I can remember the flurry of activity, all the people that were in there getting me ready for the surgery. Next thing you know, you're in your room."
Just hours after the surgery, Kennedy's lung capacity was already better than it had been in months. He had several setbacks, including a post-surgery infection and a stroke, but his "indomitable spirit" has helped him recover, said pulmonologist Rachel Powers, who has been part of Kennedy's post-transplant care team.
Christopher Kennedy early in his post-transplant recovery. / Credit: Christopher Kennedy / Cleveland Clinic
"I'm very proud of him. He really has kept a very good perspective of his course of recovery," Powers said. "He's kept such a good outlook, and I think that's been really important for some of the things that he's had to overcome after transplant."
For Kennedy, now 75, life is now beginning to feel normal again. Tests show that his lung capacity is at 98%. He is back to spending time with his wife, children and grandkids. He is able to exercise at home and was recently able to take his dog for a walk without losing his breath. He's almost done training the canine, a Bernese Mountain dog named Fini, to be a hospital therapy dog.
Kennedy had believed Fini would be the last therapy dog he trained, and named him after the retirement flights conducted by Air Force members. But in a few weeks, he'll be getting a new puppy. He plans to name her Encore to celebrate his own second chance. Training hospital therapy dogs has become even more meaningful after his own medical journey, he said.
"There's a lot of things that are different in my life. It gives you great perspective and proportion of life, of what's important and what isn't," Kennedy said. "You take every breath for granted, because, you know, why would you not? But as soon as they become compromised, you're reminded every breath matters. It keeps you centered."
Christopher Kennedy in September 2024. / Credit: Christopher Kennedy / Cleveland Clinic
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