I'm sorry, I can't answer any questions about the efficacy of the flea and tick preventatives that you mention. I have made the plunge to go all natural there and I live in "bug central" and have no fleas. The raw diet and garlic and diatomaceus earth keep the little buggers at bay.
What it comes down to is that everyone needs to research and decide for themselves what is best for their dog. As an ER tech, I can tell you that heartworm treatment is not pretty, not cheap, not fun for the pet and if you want to talk about rushing a dog's body with drugs...that's a good way to do it.
The reason the Dr's recommend adding the smaller mg tablet in addition to the large mg tablet for LARGE dogs is because of the dosing. Every medication is dosed for a specific mg/kg...you wouldn't take an anti-biotic that is half your recommended dose would you?
I live in AZ...the incidence of heartworm is not very high in most parts but most of the preventatives have a deworming effect for other parasites too. Since my dogs travel to parks and go hiking so often it is a concern to me the types of things they might pick up...and let me tell you, coyote feces must be a delicacy b/c they love to try to sneak it before mom and dad can see.
And John...I wouldn't be too quick to dismiss Veterinary Diets...they are very important to maintaining animals with certain illnesses and dietary requirements.
I had a male cat that was on Royal Canin indoor formula for a very long time, no problems. I then had him on Innova Evo...which then introduced us into the world of crystals...but luckily was caught in time before any urethral obstructions. The cat is now on RC Urinary SO and Cosquin for cats and has had no problems since. Now I do believe the Evo is a great food but I don't think there is any 'best' food and that all others are garbage. It depends on your animal, its physiologic requirements and most importantly its genetic make-up. I have seen a Rottweiler that was 15yrs old that has only been fed canned Alpo all its life... I'm still in shock.
Also what about the flea and tick preventatives that prevent mosquitos? If you use them will that lessen the chances of heartworms? My vet wants monthly treatments of each one. Heartguard only kills larvae already present (correct?)but doesn't stop future problems. Does a heartworm test detect larvae or only adults?
Kind of sounds logical that if they repel mosquitos then they would prevent hw doesn't it. I do know people that swear by Avon Skin So Soft as a flea and mosquito repellent. The stuff seems to work fairly well. At least the dog smells really good.
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