Advise by veterinarian Dec 21, 2011 - treatment by a vetarinarian !!! :

About Aspirin
It works as vascular enhancer (vasodilator) and helps the body to oxigenate better, diminushing muscular pain (as happens in tick fever) and improving the regeneration of tissues.
You can do the aspirin for the hole 21 days of doxicyclin and then for 10 more days
For heartworm, first aspirin 5 to 10 mg/kg once daily for 2 weeks.
Premedication Start with:
* Asperin
5 to 10 mg/kg once daily for 2 weeks
* Enalapril 20mg once a day for the heart

Between and after the treatments vitamine B complex

* Asperin 1x a day (work out the dosage with your veterinarian)
5 to 10 mg/kg once daily for .. weeks ?
* Enalapril 20mgr both continue after the treatment for 2 weeks
* Chimar = anti inflammatory every 12 hours for 20 days - you can start on the day after the treatment
* Doxicicline for a month -
Doxicicline has a double effect: the blood parasites (ricketsia and erlichia) and a bacteria named wolbachia that is associated to heartworm
100mgr per 10kg body weight a day in total
* in case the dogs gets Alopurinol do not stop it

Food - drink - walks
* No food for at least 12 hours before the injection. - drink allowed 
* Food and drink only 6 to 8  hours
after awakening.
* He / she can go out to pee but NO WALKS....... Immediately home!!!

Medetomidine is a sedative, not painkiller. 
* He / she should be the quietest possible, and if he / she has a little bit of disconfort he wont move so much.
* Only use it if the animal has severe pain, like problems walking the next days after the injections.
* If you see he / she needs it and want to give him a painkiller, you can use carprofen or meloxicam.

Immiticide (melarsomine) 2.5mg/kg IM twice, 24 hours apart, via deep lumbar injection (L3 to L5 advisable). The animal should be sedated for this, because is very painfull.

The injection is done in the muscle, deeply. If you imagine a pork chop, that has a bone that does an L (that is the spinal bone) and the round piece of meat attached to it (that would be the lumbar muscle).
The injection is given in the middle of the meat.
The dosage is 2,5mg per Kg. ( example dog was 22.6 Kg, the dosage would be 56,5mg one day and the same the next day, 24hrs after . . . )

* I usually recommend the association of a enzimatic anti-inflamatory like CHIMAR 2x a day for the next 4 weeks, to help reabsorve the dead adult worms. * Microfilaricid treatment is done 4 to 6 weeks after melarsomine, with ivermectine in the dosage of 50 to 200mcg/kg in the morning, and the animal has to be in close observation during the day (sometimes hospitalization is necessary), because of the high risk of pulmonary emboly.
* He can not have exercice of any kind for 2 days."
90 days after the procedure, re-test and if its negative, start prevention of heartworm


* . * . *

About the bloodtests :
"The blood test only tells us if there are adults, it does not specifies if they are female or male, but we always assume there are both. . .
The amount of parasites can only be assessed by ecocardiography or x-ray, and never an exact number. In my practice I dont do those tests because the animal has no symptoms that justify spending so much money. . .
There could be the need of surgical procedure to remove the adult worms from the heart, but usualy the amount of parasites do justify that need is so high that the animal would have other symptoms: Severe heart murmur, intolerance to exercice, faints, blue (cianotic) mucosas, ascitis, etc. . . .
All the information I received so far regarding Stronghold is that it kills only larvae, not adults. . . .
It can be used instead of ivermectin, but its so much expensive. . . .

* . * . *

(scroll down for types of treatment by several veterinarians)

The heartworm is transmitted by mosquitoes.

The heartworm is a long thin worm that gradually but in the end literally clogs the heart as if it is stuffed with spaghetti. Untreated it is always fatal. In danger areas it is only a matter of time before a dog will be infected unless it is protected by a heartworm preventive. There are many excellent products on the market that you can purchase from your vet, including some that have dual or multi-preventive qualities. You can give your dog a pill once a month and not only prevent heartworms, but also flea infestations, hookworms, roundworms and whipworms.. You can even buy a monthly topical heartworm application that will protect your dog against ear mites, flea infestations, mange and ticks. The vast majority of stray dogs have heartworm disease. Despite the fact that heartworm disease is curable for economical reasons detection forms a death sentence even at private shelters. The disease is a huge burden for rescue groups as shelters call them, hoping they can save the dog. And most of the dogs they are called upon to help by individuals who have found lost or stray dogs, have the disease. If a dog is fairly young and otherwise healthy, and the disease is not too far advanced, it is now possible to completely cure it. In recent years the treatment has been refined and most dogs who undergo it recover completely. The test for heartworm requires only one drop of blood and a rapid analysis and is free of charge in many vet practices.

How can you help?

First, if you are interested in adopting a dog that has been treated for heartworm disease, but worried about the long term effects on its health, please know that these dogs can live normal healthy lives following treatment. We suggest that you consult your own vet to confirm this. Then don't be afraid to lose your heart to one of these dogs. Second, if you are financially able, we ask you to donate the (documented) cost of the dogs complete veterinary treatment as your adoption fee. Many people are willing to independently foster the stray they have found.

Please be a responsible owner and keep any dogs you have on a heartworm preventive. It really takes so little to keep your dog safe from this deadly disease.

Medication as a possibility if heartworm in blood:

First vet:

Start with medicine for heart (Enalapril 20mg once a day) give it 2 to 3 months.
and the pill to thin the blood and widen the bloodvvessels, about 10 days before you start the treatment.
Between and after the treatments vitamine B complex

Please work it all out with your veterinarian !

Watch how the dog reacts on it - prevent a shock

READ this web site please

By experienced vet (we experienced this treatment for our dog and it worked out fine)

Start with:
* Asperin 100mgr - 1 to 3 weeks
* Enalapril 20mg once a day for the heart -
* both continue after the treatment for 2 weeks
* Between and after the treatments vitamine B complex

Regarding Heartworm procedures, it is as follows:
- Aspirin 100mgr 1 to 3 weeks before adulticide treatment, during and up to 3 weeks after treatment, in the dosage of 5 to 7 mg per Kilo.
No food/drink the day before after 22.00 hours because the dog gets a sedative before these painful injections are given, very slowly
in the lumbar muscle
- The adulticide treatment is by using Immiticide (melarsomine), in the dosage of 1 ml / 10 kg , given twice, 24 hours apart.
Next day start :
once a day Asperin 100mgr - Enalapril 20mgr
twice a day Chimar = anti inflammatory (every 12 hours) you can start on the day after the treatment

The secondary effects of this injections can be:
- 1 or 2 days after injection, anorexia
- 7 to 20 days after injection, respiratory symptoms, like depression, anorexia, cough, tachypnea. These secondary effects are due to the death of adults in the pulmonary system and only appear if the infestation of heartworms is very high.
If it occurs, we need to medicate the animal with antibiotic to prevent pneumonia and corticoids as anti-inflammatory agent and modulator of the immune system.

The microfilaricide treatment, for the babies, is given 4 to 6 weeks after the adulticide, and it’s ivermectine in the dosage of 50 mcg per kilo.
3 to 4 weeks after the microfilaricide treatment, we test again to see if its negative already. If its not, we repeat the ivermectine treatment, in the same dosage.
3 to 4 weeks again, and repeat the test. If its negative, then we can start the prevention with oral form.

If the test is positive 12 weeks after the adulticide treatment, at the time of the second test, then we need to assume that the adulticide treatment was insufficient in one dosage and we need to repeat the entire protocol again.