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| american hearTworm SocieTy'S hearTworm hoTline because the radiographic appearance of HWD in cats is often minimal, or worse, mimics feline bronchial disease ("asthma"), resulting in misdiagnosis. Therefore, any cat with appropriate clinical signs— cough, wheeze, dyspnea—should have antibody testing performed to rule out HWD or HARD. • A negative antibody tests means that neither HWD or HARD is likely and that bronchial disease is the most probable diagnosis. • A positive antibody test should be followed by (or accompany) an antigen test; a positive result indicates mature HWI. n HARD=heartworm-associatedrespiratorydisease;HW= heartworm;HWD=heartwormdisease;HWI=heartworm infection References 1. Miller Mw, Atkins Ce, stemme K, et al. Prevalence of exposure to Dirofilaria immitis in cats in multiple areas of the united states. in seward rL (ed): recent Advances in Heartworm disease. Proc Annu Heartworm Symp 1998; pp 161-166. 2. dillon Ar, Blagburn BL, tilson dM, et al. immature heartworm infection produces pulmonary parenchymal airway and vascular disease in cats. Annu Heartworm Symp Proc 2007. 3. Atkins Ce, ryan wG. Cvt update: diagnosis and prevention of heartworm disease in cats. Kirk's Current Veterinary Therapy: Small Animal Practice, 13th ed. Philadelphia: wB saunders, 2000, p 782. 4. Atkins Ce, deFrancesco tC, Coats Jr, et al. Heartworm infection in cats: 50 cases (1985–1997). JAVMA 2000; 217(3):355-358. 5. Bayes t, Price r. An essay towards solving a problem in the doctrine of chance. Philosophical Transactions of the Royal Society of London 1763; 53:370-418. 6. Courtney CH, Zeng Q. Comparison of heartworm antigen test kit performance in dogs having low heartworm burdens. Vet Parasitol 2001; 96(4):317-322. 7. Atkins Ce. Comparison of results of three commercial heartworm antigen test kits in dogs with low heartworm burdens. JAVMA 2003; 222(9):1221-1223. 8. Bowman BB, Atkins Ce. Heartworm biology, treatment, and control. Vet Clin North Am Small Anim Pract 2009; 39(6):1127-1158. (GI Intervention continued from page 24) products with increased mixed (soluble and insoluble) fiber are ideal. Soluble fiber (psyllium mucilloid, 1 tsp/10 kg body weight) may be added to a bland diet. Therapeutic Deworming Parasite Identification. If a GI parasite is identified on fecal examination, the appropriate antiparasiticide should be prescribed. In many dogs and cats with acute diarrhea, parasitic infection remains a possibility despite negative test results because: • Testing is not 100% sensitive • Not all parasites shed ova continuously. Antiparasiticide Selection. For these reasons, a good therapeutic strategy to consider is administration of a broad-spectrum dewormer, such as fenbendazole, which is also an excellent choice for treating giardiasis, showing better efficacy and a greater safety margin than metronidazole. If a response to therapeutic deworming is seen, a second course of fenbendazole in 3 months is needed for some parasites, such as whipworms. 54 Today's Veterinary Practice May/June 2013 This article is the last in the first installment of the Heartworm Hotline column. we want to extendoursincerestthankstoDr.Atkinsforsharing his amazing knowledge on this topic with us and to the american heartworm Society for working with us to bring this knowledge to our readers. we look forward to the return of heartworm hotline in future issues. read all the articles published in the column at todaysveterinarypractice.com (search Heartworm Hotline). Clarke Atkins, DVM, Diplomate ACVIM (Internal Medicine & Cardiology), is the Jane Lewis Seaks Distinguished Professor of Companion Animal Medicine at North Carolina State University. He is also a member of the Today's Veterinary Practice Editorial Peer Review Board and American Heartworm Society's Executive Board. Dr. Atkins received the 2004 Norden Award for excellence in teaching. His research involves canine and feline heartworm disease and pharmacologic therapies for cardiac disease. Dr. Atkins received his DVM from University of California–Davis and completed his internship at Angell Memorial Animal Hospital in Boston, Massachusetts. Antidiarrheals Indications. If diarrhea is frequent enough to interfere with the animal's (or sometimes the owner's) ability to rest, causes apparent pain or discomfort, or results in large fluid losses, an opioid may be given to alter intestinal motility. Mechanism of Action. Opioids prolong intestinal transit time, allowing increased fluid absorption and reduction in the frequency of diarrhea. They act by: • Increasing colonic segmentation, fluid absorption, and anal tone • Decreasing propulsive peristaltic contractions and secretion These drugs are particularly effective in patients with large bowel diarrhea (colitis). Specific Drugs. Diphenoxylate or loperamide is very effective in reducing frequency of diarrhea. • Both are available as elixirs, making dosing convenient for small dogs and cats. • Loperamide is more potent and has faster onset and longer duration of action than diphenoxylate. • In dogs, both drugs—at recommended doses—are safe and have few side effects.