heartworm

How herbal therapies were used to successfully treat heartworm disease in a dog that didn’t respond to macrocyclic lactones and melarsenoxide.

ABSTRACT

A case of heartworm (Dirofiliria immitis) disease in a dog resistant to macrocyclic lactones and melarsenoxide was successfully treated in 3.5 months with several herbal products. The herbs targeted not only the nematode but also the Wolbachia organism, while concurrently supporting the cardiovascular and pulmonary systems. In such cases, the individual’s constitution and unique responses to disease regression determine the specific botanical medicines required.

INTRODUCTION

Veterinarians rely on macrocyclic lactones (MLs) to protect their patients from heartworm disease (HWD) caused by Dirofilaria immitis, and on melarsenoxide for its treatment. Evidence from recent research has shown that sub-populations of heartworm have developed resistance to MLs and melarsenoxide.1 2 In at least one study, every ML compound currently marketed in every form of administration (oral, topical, and parenteral) has been shown to lack 100% efficacy,3 and the incidence of resistance to these drugs is growing.4

In the face of increasing drug resistance, effective alternative therapies must be explored for both preventing and treating HWD. The official guidelines for the treatment of heartworm disease outlined by the American Heartworm Society state: “No ‘natural’ or herbal therapies have been shown to be safe and effective prevention or treatment for heartworm disease.”3 Personal communications with other veterinarians, along with personal practice, have shown this to be incorrect. Successful clinical experience of herbal heartworm prevention does exist.5 There are also cases of successful treatment of heartworm-positive dogs using herbs, although none of these cases has been previously published.

heartwormBotanical medicines have historically been used to kill offending parasites, and also have a general physiologically-supportive influence on the cardiovascular system during treatment, which can result in a more satisfactory treatment and recovery from this type of parasitic infestation. This generalized physiological effect differs from a pharmaceutical drug’s specific one cell receptor-type effect. In cases of heartworm, botanicals are used to“soothe” blood flow, remove obstructions to blood flow (heartworms), and eliminate blood stagnation.

Wolbachia bacteria are obligate mutualistic endosymbionts in nematodes. Veterinary scientists have recently discovered both phylogenetic and biochemical evidence for the obligate symbiosis of D. immitis and the bacteria Wolbachia pipientis. This apparent mutualistic dependency has also offered a novel approach to devitalizing the nematode through the use of antibacterial and anti-rickettsia botanicals that can eliminate the Wolbachia organisms.6 7

The Wolbachia activation of innate inflammation drives inflammatory adverse events in response to chemotherapy with either diethylcarbamazine (DEC) or ivermectin, making the need for alternative treatments more imperative.8

CASE REPORT

A seven-year-old castrated male 45-pound Pit Bull cross presented for a wellness exam on June 1, 2014 with the chief complaints of anxiety, rapid breathing and an occasional cough. In the spring of 2013, the dog had been found to be heartworm (HW) positive while in a Kentucky Pit Bull rescue organization. The medical records stated that he was treated in compliance with the American Heartworm Society’s(AHS) official protocol, using doxycycline and a macrocyclic lactone prior to a three-dose regimen of melarsomine (one injection of 2.5 mg/kg body weight followed one month later by two injections of the same dose 24 hours apart).

Immediately after treatment, the dog was sent to New York to another adoption group and given a ML-based heartworm preventative. In December of 2013, he was found to be HW positive again, and was retreated with doxycycline and a macrocyclic lactone prior to the three-dose regimen of melarsomine.3 No drug doses were cited on his adoption papers; it was only noted that his treatment followed the standard protocol of the AHS. He was adopted by his new owner in May of 2014.

heartwormOn presentation, the dog’s tongue color was purple, with deep red edges and congested sublingual veins. The lung sounds were very harsh, the heart rate was rapid, and the pulse was taut and slippery with a severe choppy quality. He exhibited pain on acupuncture points Bl 14, 15, 18 and 20.

The Western medical diagnosis was HW (Dirofiliria immitis)disease based on a positive test result with antigen testing via a Witness: Canine Heartworm Antigen Test (Zoetis).a The Chinese Medical diagnosis was Blood stagnation, pathogenic phlegm, and channel obstruction with secondary Blood Heat with Shen disturbance.

Given the dog’s history of two recent unsuccessful heartworm treatments, the owner requested an alternative approach.

The initial prescription consisted of four herbal products:

  1. Empirical Lung and Heart, administered at a dose of 1 tsp q 12 hr PO

2. Black Walnut, (Juglans nigra), a company formulated 1:5 tincture bat 5 drops q 12 hr PO

3. A combination tincture formulated by the author consisting of 15% 1:5 tincture of Andrographis (Andrographispaniculata)c and 15% 1:5 Sweet Annie (Artemisia annua)c in 70% Blood’s Mansion, Xue FuZhu Yu Tang.c The dosage was 40 drops q 12 hr PO.

4. Finally, the dog was given 10 drops q 12 hr PO of a company-formulated 1:5 tincture of Houttuynia cordata.c

The dog’s owner was advised to give him a diet high in antioxidants and to keep him relatively quiet. She was to watch his respiration and tongue color. At follow-up on June 15, the dog’s owner reported that he was bright and alert with good appetite. His coughing had stopped and he experienced only occasional periods of more rapid breathing.

On June 30, when the owner’s horses got loose, the dog spent four hours running very hard while chasing them. He immediately began breathing faster. On examination on July 1, he was panting very hard, and had a purple tongue. He was exhibiting a greater sense of anxiety. Bronchial sounds were very loud and harsh, with areas in the lung field devoid of air sounds. It was suspected that due to the exertion, he had experienced several pulmonary emboli.

His herbal formula was changed to Stasis Breaker (JT)d for a strong anti-thrombi effect, at a dose of 1 tspq12 hr PO, and 10 drops q 12 hr PO of a company-formulated 1:5 tincture of BloodRoot (Sanguinaria canadensis)c for a presumed hepatization of pulmonary tissue. The Blood Mansion tincture was continued, and Black Walnut was discontinued to slow the die-off of nematodes. A conversation with the owner on July 6 revealed that the dog’s breathing was back to normal.

On examination on August 1, the dog was acting normally, with good appetite and respiration. His tongue color was pink, slightly lavender, and his pulse was slightly taut. On palpation, the acupoint Bl 18 was very painful, which indicated the dog had some residual Liver stagnation. Stasis Breaker was discontinued, and he was started onGe Xie Zhu Yu Tang,da formula for hepatic circulation. He resumed the Black Walnut and Blood Mansion combination. On August 15, conversation with the owner indicated that the dog was acting normally with a pink tongue and easy breathing, and no cough. He seemed much calmer. On September 15, the dog was HW negative on antigen testing via Witness: CanineHeartworm Antigen Test (Zoetis).aHis tongue was pink, his heart rate normal, and his pulse smooth. No abnormal lung sounds were heard, and he was calm.

DISCUSSION

From a Traditional Veterinary Chinese Medicine (TCVM)perspective, the treatment goals for this dog were to soothe the Blood Stagnation, clear Blood Heat, clear pathologic phlegm and open obstructions. Herbs with these effects would need to also protect his cardiovascular system, ensure minimal health risks from “dying worms” due to their anti-thrombi effect, and remove pathologic phlegm, all while exerting an anti-nematode and antibacterial effect (to weaken and kill the heartworm parasites and kill theWolbachiaorganisms). Due to the synergistic relationship between the Wolbachia organisms and Dirofiliriaimmitis, a strong intention was to focus on anti-Wolbachiabotanicals with the thought that the nematodes would “die off” easier with fewer thrombic concerns.

heartwormIn TCVM, the Shen or Spirit resides in the Blood and is housed in the Heart; by soothing the Blood, and clearing Blood heat, a strong anti-anxiety effect would occur.

The leading herbal used in this case was formulated by Paw Healer and called Empirical Lung and Heartb (see Table 1). This formula has been designed to kill nematodes (a product claim through case studies) while soothing Blood flow and removing obstructions (heartworms) and phlegm in the lungs.

The various botanical medicines used in this case have a long history of traditional usage which is reinforced by current “scientific” research. The cardiac, circulatory, and pulmonary supportive effects, as well as the antibacterial and anti-nematode influences of the leading herbal formula, illustrate the power of botanical medicine.

The effectiveness of this formula is revealed when examining the botanical medicines contained within it.

  • Trichosanthes fruit (Trichosanthes japonica, T. kirilowii, GuaLou Shi) is traditionally known to clear the Lungs, dissolve phlegm, regulate Qi, expand the chest, dissipate nodules and eliminate pus.9 Our current research supports these traditional actions, showing it has strong controlling abilities in the lung, along with anti-cancer,anti-toxicity,8 and cardioprotective effects.10-12
  • Sparganium (Sparganium stoloniferum) breaks up and dispels blood stasis, activates Qi circulation and relieves pain. Research has validated these traditional uses, illustrating strong antioxidative and anti-cancer effects, especially in the liver.13,14 In addition, it has been recognized to inhibit platelet aggregation and prolongation of thrombin time.15
  • Curcurcuma zedoaria has research supporting its traditional ability to invigorate Blood circulation, break Blood stasis, and activate Qi circulation; physiologically, this herb prolongs the aggregation of platelets and prevents the formation of thrombi. It also has strong antimicrobial, antiplasodial, and antibacterial effects, and shows very strong anti-nematode effects.16-18 Additionally, there are reports of Curcurcuma zedoaria clinically curing individuals with psychiatric disorders with Blood stasis.19 The mental state characterized by severe anxiety in the dog in this case report was considered to be due to Blood stagnation (heartworm disease), and his anxiety resolved with this herbal treatment.
  • Alismatis orientalis regulates water circulation, and resolves dampness from the kidney. This herb has an ability to decrease drug resistance through the inhibition of P-glycoprotein.20
  • Xing Ren (Prunus armeniaca) has been clinically used to arrest cough and relieve wheezing. These actions are supported by research showing strong antibacterial effects and the elimination of bacteria in biofilms.21
  • Crataegi Fructus (Crataegus cuneata, Shan Zha)is a very popular botanical medicine for cardiac support. Traditionally it is said to activate Blood circulation and disperse Blood stagnation, thereby treating cardiovascular disorders and eliminating stagnation with demonstrated cardiotonic, vasodilating, antihypertensive, and antibiotic effects.22,23
  • Tao Ren (Persicae Semen, Prunus persica) is traditionally used for activating Blood circulation and moving Blood stasis while also helping drain pulmonary abscesses. This herb has proven antibacterial and antioxidant effects with strong controlling effects in the chest.24,25
  • Hong Hua (Carthamus tinctorius) is another herb that traditionally activates blood circulation, eliminates Blood Stasis, and opens channels. It is also proven to have strong antibacterial effects.26
  • Di Long (Lumbricus) is an antipyretic, inhibits formation of thrombi and facilitates their dissolution, and opens channels with a protective effect on the internalorgans.27,28Di Long has very powerful antimicrobial effects which are crucial to countering theWolbachiaorganisms.29
  • Chuan Xiong (Ligusticum chuanxiong) is another blood-invigorating and stasis-removing herb that activates Qi and Blood circulation with antiplatelet and anticoagulant effects. It contains activity to increase blood perfusion, and has been shown to have antibacterial effects.30,31
  • Black Walnut (Juglans nigra) has a long traditional use as an effective antihelminthic, antiparasitic herb.32It was used in this case to reinforce the antihelminthic effect of Curcuma with additional thyroid support.33
  • Blood’s Mansion (Xue Fu Zhu Yu Tang)c is a classical Chinese formula that acts as a carrier to the heart, calms anxiety, and that has an effect on removing BloodStagnation. The formula was used in this case as a carrier of the antimicrobial herbs to the chest and heart.

The ability of botanicals to eliminate Wolbachiaorgan-isms34 opens vast potential for them to treat heartworm dis-ease easily and in a safe manner. Two botanicals with evidence of effects againstWolbachiaare Sweet Annie (Artemisiaannua) and Andrographis (Andrographis paniculata)35,36 In addition, Houttuynia cordata has a wide range of actions, including antiviral, antibacterial, antifungal, antimicrobial, anthelmintic, and larvicidal. It has a specific affinity for the chest and lungs and has been found to significantly increase IL-10, the cytokine synthesis inhibitory factor, and anti-inflammatory cytokine. It downregulates the other cytokines and blocks NF-B activity.37

As the dog’s treatment progressed, he experienced a presumed thrombi crisis after a period of severe exertion. This life-threatening episode was diagnosed as Blood Stagnation and treated with Stasis Breaker,d a proprietary formula specifically crafted by Jing Tang herbals for cancer. This formula containsFritillaria (Zhe Bei Mu), Ostrea (Mu Li), Sparaganium (San Leng),Zedoary (Er Zhu), Scutellaria(Ban Zhi Lian), and Oldenlandia (Bai Hua She She Cao). Blood root (Sanguinaria canadensis) is considered specific for pulmonary hepatization.

After the pulmonary thrombi were resolved, a slight hepatic imbalance was detected via sensitivity on acupoint Bl 18. Using the flexibility of botanical medicine, the herbal prescriptions were shifted from Blood Moving herbs in the chest to those that influence primarily the Liver, with Ge Xie Zhu Yu Tang, and this physiologic imbalance was rectified.

CONCLUSION

In 3.5 months, an anxious rescue dog that remained HWpositive after two standard HW treatment regimens was successfully treated with botanical medicines. The HW infection and the anxiety resolved. Botanical medicines have the flexibility to treat complex physiological disease states; in this case, the severe stagnation of Blood within the heart with secondary pulmonary inflammation. Botanicals also have a significant ability to influence various microbial and parasitic organisms.

Due to the single molecular effects of pharmaceutically derived antimicrobials, it is possible for microbes to develop resistance to these treatments. Because of the emergence of macrocyclic lactone and melarsomine resistance in canine HW, the potential for botanical intervention deserves consideration by the veterinary profession.38

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a. Witness: Canine Heartworm Antigen Test (Zoetis, Inc.), Kalamazoo, MI

b. Paw Healer, San Diego, CA; 877-255-388

c. Herbalist and Alchemist, Washington, NJ; 1-800-611-8235

d. Jing Tang Herbs, Reddick, FLeKan Herbal, Santa Cruz, CA; 1-800-543-5233

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