Message 2197
Date: Sat Jan 5, 2002 10: 19 am
Subject: Proheart 6
I have been one of the slow ones to convert to the new heartworm preventative. You know the old adage, "not the first, but not the last to change". Saw a dog this last week with what I suspect is an Injection Reaction Alopecia. Received vaccinations and proheart injections from another veterinarian. Can't say which may have caused the problem.
My questions to those in the group using a lot of proheart:
1. How pleased are you with the efficacy of proheart?
2. Seen any increase in intestinal parasites over the monthly products?
3. Have you had any reactions or problems with the drug?
4. Are you getting better client compliance?
Thanks, -LL-
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Message 2198
Date: Sat Jan 5, 2002 10: 30 am
Subject: Re: [texasvets] Proheart 6
I had a big allergic reaction to ProHeart on Thursday. . . . 10 month old spayed female black lab weighing 71 lbs. . . . . Came in for suture removal and heartworm prevention. . . . I talked her into proheart. . . . . 5 minutes after giving the 1. 6 cc injection as she was walking out the door the dog stumbled and almost fell over. . . . .
It was brought back to the room and also showed drooling, listlessness and pale mm. . . . In the 10 minutes that it took for me to contact Fort Dodge for instructions this dog returned to normal bouncing lab but the gums were still pale and it was still drooling. . . .
Fort Dodge says this was an allergic reaction to the starch in the carrier vehicle. . . . . an anaphylactic reaction. . . . . Recomended Steroids and Diphenhydramine. . . they said it happens in 2 of 100, 000 dogs. . . . . Needless to say this client will be using Heartgard for her other dog. . . . .
Scary for me. . . . . Just wanted to give everyone a heads up. . . . . apparently "pain at the injection site" is NOT THE ONLY possible side effect. . . . Hmmm would have liked to know that. . . . .
-MM-
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Message 2199
Date: Sat Jan 5, 2002 10: 30 am
Subject: Re: [texasvets] Proheart 6
Probably with the exception of #3, it is too early to tell. I had one large dog react to ProHeart-6. The dog became ataxic, disoriented, and drooled within 10 minutes of injection. Treated symptomatically---walked out of clinic. Called manafacture and reported. They have had several occurances and it is supposed to be stated in the new flier whenever it becomes available.
-JW-
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Message 2200
Date: Sat Jan 5, 2002 10: 46 am
Subject: Re: [texasvets] Proheart 6
I agree with Jim. We are just know sending out cards for the 6 month follow up injections.
I have not personally seen any reaction so far, but I have yet to give it to 100, 000 dogs! : ) - KWB-
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Message 2201
Date: Sat Jan 5, 2002 6: 07 pm
Subject: Re: [texasvets] Proheart 6
We have had no reactions yet. We have used 25 bottles and have not seen any GI parasite problems yet. We just sent our first reminders. Most clients just starting preventative are choosing it. This is with a 10-15$ markup over 6 months of interceptor. About half are switching when they come in for annuals.
-CB-
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Message 2202
Date: Sat Jan 5, 2002 6: 26 pm
Subject: Re: [texasvets] Proheart 6
1. I can't speak personally for the efficacy of Proheart 6 yet, as I have not yet tested animals we've used it on. We began using it in July, 2001, when it came out.
Results from Australia indicate the drug's efficacy is excellent. A recent literature abstract I read on VIN on a controlled study with Proheart showed 100% efficacy in preventing Dirofilaria infection. It is FDA licensed so I'm assuming it will do what it is licensed to do.
2. I have not seen any increase in intestinal parasites, but have not done fecals on these dogs yet.
3. I have seen no reactions of any kind. I have used the drug in all sizes from less than 10 lbs. to 180 lbs. Rarely does a day go by that we do not give one or more injections of Proheart 6.
4. I find clients love the product. For most people, it sells itself. They love the fact that they don't have to do anything or keep up with anything. We send reminders at 6 months when it is due. I like it because it is a service that I can provide. It is not for sale in feed stores or over the internet, either.
-RL-
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Message 2203
Date: Sat Jan 5, 2002 7: 14 pm
Subject: Re: [texasvets] Proheart 6
<< Most clients just starting preventative are choosing it.
How are you dosing growing dogs, if they are just starting their preventative. I was under the impression that they needed to be at a steady or near steady weight to start.
-jw-
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Message 2204
Date: Sat Jan 5, 2002 7: 56 pm
Subject: Re: [texasvets] Proheart 6
JW: the package insert says NOT to increase the dose anticipating weight increases in growing dogs, and not to give to dogs under 6 months of age. I think if I were presented with a dog that was going to double his weight in the next 6 months, I might use Interceptor instead.
Due to the gradual nature of most dogs' weight gain and the fact that the Proheart 6 will be repeated in 6 months (think reachback) though, I doubt that such animals would become infected. My experience with the drug so far has been very good. Happy New Year.
-RL-
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Message 2206
Date: Sat Jan 5, 2002 8: 35 pm
Subject: Re: [texasvets] Proheart 6
I believe in educate-educate-educate and let the owner give an informed consent decision. I like the proheart injection for the owners who forget or don't want to do the monthly thing. I have not had any reactions as yet, but I would expect to see more "allergic" type reactions at a repeat dose, and I am just now seeing dogs back for round two.
I have had a few clients decide to do heartworm prevention for the first time with the shot because it was so simple. Everyone else on Interceptor or Heartgard knows they are giving up some routine monthly intestinal parasite control if they choose the shot, so some do and some don't.
I still heartworm test annually on oral meds because I have seen positives that were given the meds faithfully every month - probably they were vomiting the meds pre-efficacy as we confirmed in one case.
I am not heartworm testing the ones who get the shot right on schedule every 6 months because I can't justify this in my own mind, but if they are very late on a shot I will probably test the next year.
From everything I have seen-heard-"think I know", if the med is in the
body it should be as near 100% effective as is biologically possible. Some
owners like it, some don't want it. Overall, however, I think it has been
a positive addition to my clinic.
-PLB-
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Message 2215
Date: Sun Jan 6, 2002 9: 08 pm
Subject: Re: [texasvets] Proheart 6
In a message dated 1/5/02 7: 57: 32 PM Central Standard Time, [email protected] writes:
Jim: the package insert says NOT to increase the dose anticipating weight increases in growing dogs, and not to give to dogs under 6 months of age.
Hmmm, I wonder why it says this when it is suppossedly being used in Austrailia at 3 X our dose and repeated once a year.
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Message 2215
Date: Sun Jan 6, 2002 11: 41 pm
Subject: ProHeart6 Reactions
Here is an interesting piece of information I found online. ProHeart is in the class of drugs with Milbemycin and Ivermec. Here's what it what was stated about them.
"Macrocyclic lactones (Avermectins) Mode of action: modulates chloride ion channel activity in nervous system of nematodes and arthropods, binds to receptors that increase chloride ion permeability, inhibits electrical activity of nerve cells in nematodes and muscle cells of arthropods causing paralysis and death. In mammals, these receptors are only in the central nervous system, usually avermectins do not cross the blood-brain barrier Causes adverse effects to fish, avoid runoff into water "
Interesting that the central nervous system is the only place that the
receptors affected by the drug reside. Aren't the reactions mentioned central
nervous system symptoms ? ? ? Also, somewhere I saw a reference
that stated that 25X the dose of Interceptor was the level where Collie's
got toxic with CNS signs. Granted that 25X is a great level of safety but
what if there are certain animals with lower thresholds of sensitivity
to drugs that could effect their systems ? ? ? Still 8 out of
100, 000 is pretty low to worry about it. Maybe the breed dispostion
is more important. . . .
-TD-
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Message 2218
Date: Sun Jan 6, 2002 9: 47 pm
Subject: Re: [texasvets] Proheart 6
John, my understanding is that they are using a different adjuvant or something, and they have had some reactions. Don't know where I heard that. I asked about giving a 15 week old puppy that will be 50-60 lbs by 6-8 months and 80-90 # adult wt the dose for the 80-90# dog, but no one would talk from the company.
-jw
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Message 2243
Date: Wed Jan 9, 2002 11: 38 am
Subject: Re: [texasvets] Proheart 6
I believe if you read the guarantee policy from Fort Dodge the dog must have a negative test prior to the first injection, the same time as the second injection 6 mo later and then tested annually in order to be covered.
-KM-
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Message 2268
Date: Tue Feb 12, 2002 2: 27 pm
Subject: subsequent ProHeart injections
We want to tie the follow up ProHeart injections to an additional fee for additional services. How are you handling the follow up injections?
-JW
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Message 2877
Date: Tue Feb 12, 2002 6: 58 pm
Subject: Re: [texasvets] subsequent ProHeart injections
I'm just beginning to see patients back for their second injection. About half just need their next injection but the other half are needing other services. For those getting only the injection, I am charging just for the injection.
-MB-
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Message 2879
Date: Tue Feb 12, 2002 7: 16 pm
Subject: Re: [texasvets] subsequent ProHeart injections
We are sending a reminder when the next ProHeart 6 injection is due.
When the client comes in, we give the injection. We also discuss
the pet with the client, check it over and take care of any other
issues needed. Is this what you mean, J? -RL-
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Message 2883
Date: Tue Feb 12, 2002 11: 19 pm
Subject: Re: [texasvets] subsequent ProHeart injections
In a message dated 02/12/2002 7: 16: 59 PM Central Standard Time, R@com writes:
<< We also discuss the pet with the client, check it over and take care of any other issues needed. Is this what you mean, J?
Actually yes, in a way. The question arose to me by the Ft. Dodge rep. that if I did not have ProHeart-6 what could/would I do to initiate a 6 month visit, if anything. My answer was that I would like to train a staff to utilize the 6 month visit for additional "needed" services on that visit.
Otherwise what we have is the same as if the client just came in to buy another 6 month package of Heartguard or Interceptor. So, is the injection visit just charged for the injection or is there "value-added" services we can do with the subsequent ProHeart-6 injection?
For me, I would like to see a brief exam fee, a glaucoma check using the "Ton-A-Pen"(? ), and a profile for liver, kidney, and glucose. Also, with the new Heska "Micro-albumin" table top test, I would do that too, since this would give us our earliest indication of future early renal disease.
I am trying to determine how to build this, market it to the client (early), train the staff to see it's value, and to find something for the <5 year old dog too. For < 5 year old dogs I considered an exam/fecal and Panacur for 3-5 days regardless of the fecal exam results.
I already tell clients that a fecal lets me see what might be there today, but a negative fecal does not tell me that the dog "has no" intestinal worms. The fecal helps indicate if we do or do not have a positive today whether it be protozoal or nematodes.
Most clients that I talk with that have new puppies and kittens are told that I prefer to deworm on each visit, even if the fecal float and direct are negative since we know that the parasites can be present and not shedding, or are just missed, and that few, if any, are willing to run 3-5 day serial fecal exams.
Soooo, I said all that to ask "what are most/many doing? Are you adding something to the injection---such as a brief o. v. , or brief o. v. and value added services or are you just giving the injection and letting it go?
For years some have been giving the 6 month Parvo injection, which IMHO (be that as it may be) is WRONG, WRONG. If there is a benefit to any vaccine given each 6 months it should be Kennel Cough, since it is the poorest at holding a titer.
Folks have used the Parvo & Corona--(a vaccine looking for a disease) to get the client in the door. Now we have a truly legal reason for them to come back, how do we utilize that to the pet's and the pet owner's health benefit?
How is that for being wordy? -JW-
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Message 2889
Date: Wed Feb 13, 2002 7: 50 am
Subject: Re: [texasvets] Ivermectin as an adulticide
In a message dated 2/8/02 1: 45: 54 PM Central Standard Time, d@com writes:
Subj: RE: [texasvets] Ivermectin as an adulticide Date: 2/8/02 1: 45: 54 PM Central Standard Time
>>>> I have always wondered how the experimental model that was used in the McCall study presented at the Heartworm Symposium 2001 will compare to "real world" heartworm infections. I guess time will tell.
I have put many heartworm positive dogs on Heartguard Plus, and have not yet seen a single one convert from positive to negative. I know the data in the McCall study looks good, but I'm not convinced that ivermectin works as well as an adulticide in naturally acquired infections. Hopefully, someone will do a study on naturally infected dogs some day.
-WB->>>>>>
W, If such a study is done, it will probably be done us folks out in the trenches. I have started trying to keep track of some things here in a HW endemic area. To now, my "study" has just being occassionally photocopying a medical record and sticking it in my desk to tally up later. This study is badly flawed becuase it is dependent on clients giving the meds and returning for rechecks when they should, me and the other vet in the practice remembering to copy the record, and many "lost to followup" cases. Recently, I have attempted to do better on my end by copying the record at the start of things, so I can at least call the client and try to get them back in when they should be, so hopefully I will have fewer "lost to follow up" ones.
I do 2 "off lable" things with heartworm treatment which are:
1. Using Heartgard only as an adulticide: These are usually asymptomatic dogs that have only a "low antigen" positive on the SNAP test. So far, I have follow ups on 8 dodgs that I have done this way. 7 of the 8 have converted to antigen negative with a range of 72 monlths to 6 months.
The 72 month dog was one of those who doesn't believe in seeing the vet too often, so these worms may have just died of old age). I threw out the 72 month dog and the average for the other 6 was 13 months. One dog was still positive at 24 months, so the HG continues.
2. Using just 1 injection of Immiticide, starting the dog on Heartgard. I have managed to copy the records on 10 cases. So far, 6 out of 10 have have been antigen negative 6 months from the single injection of Immiticide. The 4 that were still positive recieved another single injedction of Immiticide and the HG was continued. So far, I haven't had to give a 3rd injection. The 4 dogs that required the 2nd injection were all clinically improved after the first injection.
I did get one fatality after the 2nd single injection. This was a 4# chihuahua, that did not receive the HG between the 1st immiticide injection, and the 2nd one 6 months later. My quess is that he picked up additional HW's since he was off prevention in the late summer and early fall.
This dog was not very symptomatic even though he was a high antigen positive on the SNAP test before each of the Immiticide injections. In hind sight, I wish I had of used HG only on that one. And to me, the smaller the dog, the greater the risk in the adulticide treatment. -JS-
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Message 2890
Date: Wed Feb 13, 2002 8: 08 am
Subject: Re: [texasvets] subsequent ProHeart injections
We are charging for the injection only which is priced at only $5 more than what the HG would cost them, but often they need other things while they are there for the injection. Suck it up Pet Med express. : -)
-JS-
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Message 2893
Date: Wed Feb 13, 2002 10: 32 am
Subject: Re: [texasvets] subsequent ProHeart injections
We ran a query and estimated on dogs approx 66% compliance with our 6 month visit. . . We just looked up how many annuals vs how many 6 month visits we did in 2001. rough estimate but probably about right.
I would have guessed 75% -TC-
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Message 2927
Date: Thu Feb 14, 2002 2: 12 pm
Subject: Re: [texasvets] subsequent ProHeart injections
That is exactly correct D. The value to the client is the convenience and the assurance that their pet will not get heartworms as long as they return every six months. The value to us is twofold. The first part is the higher profit margin with the guarantee of seeing each dog every six months. The second part is just as important. We are providing a service and product that can not be obtained from PetMed {or Walmart, etc. , in the future}. In our experience, about 75% of our clients value the " convenience factor" enough to pay 15$ more for the injection. Yes J, by seeing the dog twice yearly we provide other services also. -CB-
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Message 2933
Date: Thu Feb 14, 2002 4: 14 pm
Subject: RE: [texasvets] subsequent ProHeart injections
But the question I keep asking myself is where is the value for the client. <<<<
The value to the client is convenience. This product IS NOT marketed or sold as a dollar savings for the client. It is convenience, giving a medication one time every six months, rather than a tablet monthly.
I thought the original sales pitch was that ProHeart was less expensive than Heartgard, Interceptor or Revolution. <<<<
ProHeart is less expensive for the veterinarian to purchase to sell to his/her clients. There was never a mention at any time of a savings for the client. People are often willing to pay more for convenience, consequently the object here is to charge more for that service.
If you charge for a recheck plus injection fee plus the drug, where is the savings? ? ? ? <<<<
Charging more for convenience in this case with this new, more convenient drug is the object of the game!
I thought the sales pitch was that it is more convenient for the client and more lucrative for us! <<<<
Now, that's the spirit!
-RE-
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