Heartworm?!!?!?

[Personal Champ]

My parents' dog was just diagnosed with heartworm. This is a dog they just got, their last new one was diagnosed with kidney failure. Luck is not great at this moment.

Anyway, dog is not symptomatic. I don't have details on the test results, ie high positive, etc. But the dog is not coughing, great attitude, energy, appetite.

They were quoted as treatment costing $500. Any thoughts? Experiences? Cheaper alternatives? They want to take care of her for sure, but $500 will really strap them.

TIA!

[Bluey]

Could you have them check with the nearest veterinary school?
Sometimes they do those heartworm treatments free if you let them use the dog to teach students.

The whole process can be serious for the dog, but if not treated, the dog probably won't do well at all soon.:no:

[Personal Champ]

I can look into Cornell, but I am not sure if I will have luck there.

I was doing research on the net and found a few treatment protocols: 1 injection of Immiticide once a month for 3 months, 2 injections 24 hours apart, or just using Heartgard.

Vet said they do the 3 month thing but if the dog is low level and asymptomatic I was wondering if we could do the 2 shot route as it seems to be cheaper and safe in low infection cases....

[Blu]

Ugh. Heartworm. Its pretty rampant down here in GA.

$500 is a very reasonable estimate IMO. I would wait until xrays are done to stage the treatment before figuring it out. Honestly, if they are going to someone you trust I would allow them to figure out the protocol and let them do their job (not sayin you're getting in the way by being an informed customer, just saying hopefully they have a protocol down that they trust and know works well for them. There are different protocols and a lot of times what works best is what that particular DVM is comfortable with.)

One thing that *IS* recommended by the American Heartworm Society is to start them on Heartgard during treatment because the Immiticide only gets part of the life cycle and leaves a "hole" in the treatment so to speak.

Considering that Immiticides old nickname was "Immediacide" for its immediate and deadly side effects when it was used in higher doses for short periods of time, I would go the extended route.

One of the main problems with heartworm treatment is not necessarily the heartworm die off, but the symbiotic bacteria that dies when the heartworm dies. This bacteria releases toxins that can cause systemic effects.

IME I have seen an asymptomatic, big, energetic dog drop dead after getting off his leash and running across the yard. Owners presented him for necropsy and he had horrendous heartworms.

Not trying to scare you, but its nothing to mess around with. If done properly, heartworm treatment is safe and effective, but not something you should try to cut corners with.

Here's a link to the AHS http://www.heartwormsociety.org/ there should be some very valuable information on there.

Good luck and keep us posted! I hope my post was helpful and clear enough. And I hope I didn't scare you.

[Personal Champ]

Thanks Blu. You didn't scare me!!

I have been looking around more. Dog is stage 1. I was reading of how they recommend using doxycycline to kill the bacteria that is released from the die off of worms, reducing side effects. Doxy is recommended for the fast (injection) and slow (Heartgard, etc.) kills of heartworm now, from what I've read.

Vet said that she knows several who have opted for the slow kill because of the injection's side effects. She recommends the 3 month protocol rather than the 24 hour one.

Just hoping for more expertiese and experiences here.

[Huntertwo]

$500 sounds very reasonable. When I was working for a Vet way back in the early 80's, that was the charge back then.

They first have to make sure the dog is healthy enough to handle to rigors of the medication that is used. Back then it was quite toxic.
So a slew of prior testing was required. X-Rays, blood work.

[Calamber]

I just lost a dog who was asymptomatic, heartworm positive, xrays taken and heart was only slightly enlarged on right ventricle. No sign of compromised venus cava. He was given the Immiticide, I put him down 3 days later from intractable pain after he screamed for 3 nights and 2 solid days, I could not console him and could not give him enough painkiller, we did not sleep during that time. I am crying as I write this since it only happened a month ago.

He was a sweetheart of a cocker spanieal and one of the love's of my life. I am having a hard time forgiving myself for not giving him Heartguard which I did not do because he was so sensitive to everything (he had hydrocephalus and was not expected to live beyone five months). He contracted it in this area which is rampant with heartworm in 2 out of 3 mosquitoes as I have since learned. We recently moved to the area and I should have known.

He was only nine years old and in otherwise decent health, needed a dental since he had chronic plaque buildup as he would not chew bones or anything hard enough to clean his teeth and had lost some weight, I took him to the vet to have that done and his hw status was discovered. I wish to God that I had just given him the long range treatment of Heartguard. Vet thought that he did not have that much time and told me to consider the fast kill.

The worms only live two years in the heart and Heartguard will kill all of the larva in the bloodstream. Go for the long term treatment or investigate the natural methods.

RIP Hector my sweet boy, I am so sorry.

[Personal Champ]

Oh Calamber, I am so sorry for your loss. If you don't mind, what natural methods are you referring to??

Our vet was very up front with us regarding the side effects of the injections, but we know that Heartguard or Interceptor won't get the adult worms... cost is a concern although not the deciding factor, we are just stuck on what to do.

I will tell you this, though - my dog will be staying on Interceptor year round instead of April-November after reading what I've read.

[Blu]

Just an FYI- do NOT give interceptor to a HW positive dog!! This will cause too fast of a die off and is very likely to put a HW + dog into shock.

Calamber- I'm so sorry to hear of your loss. Don't kick yourself too hard, its not like you did not do monthly HWP because you were too cheap, too lazy or didn't care. There is nothing you can do about it now, and you gave him a much longer life than was anticipated.

Personal Champ- sounds like you are on the right path and getting good information on HW disease. Good luck again!

[dalpal]

I'm sure that someone will blast me for this....BUT,

My first foster (three years ago) came to me HW positive. Never showed any outward signs. My small animal vet quoted me 750.00 for the "fast method"....the "fast method" horrified me. Dog could not come out of a crate except to go to the bathroom for two months, and it could kill the dog.

When my equine chiro vet was out at the barn...I asked him if there was any other option and he told me just to start giving her heartguard plus..it would take a very long time, but was safe.

I opted for the heartguard plus route and have never regretted it. I decided that even if she didn't live as many years due to the slow kill method, at least she would be happy/healthy during her prime.

That was three years ago and she is just as vibrant today as she was the day that I got her....she has never shown any signs of heartworms, other than a positive test.

I do not regret my decision.....I am a firm believer that the KISS method is the only method for my animals.

[Horsegal984]

Just a note to add to what Blu has said, all very god advice. I too have used to the slow kill method(Heartgard) with one of my fosters, as we know he was infected before 5 months of age, and he had already been on Heartgard for 6 months at the time of testing positive, so we just continued with that. It worked well for him, and it took about 3 years for him to come up negative.

If you decide to do the slow kill method have your vet do some digging into the use of Doxycyline, as the newest research(last 6 months or so) shows that the bacteria that we are killing with doxy is actually bad for the worms, and seems to be causing them to die a little faster. So in theory not giving doxy might help your dog to be negative faster. He would have to be monitored very closely for any adverse effects though.

And as far as the budget goes, for now start Heardgard, for the slow kill. If they want to do the Immiticide treatment they can, as long as the dog is on Heartgard he won't get 'more positive' so to speak. However the longer the worms are in the heart the more damage that is done, so if they can save up for the treatment over the next 6 months or so to do the 3 injection protocol it might be in his best interests in the long run. We wanted to do that with my foster, but the man that adopted him couldn't afford to(he adopted him before his pos test) and there was no way we would keep him quiet enough, he was a year old Cattle Dog!

[dacasodivine]

I'm another that treated with slow way. I used ivermectin, which is the main ingredient in heartguard. My dog was coughing and had lost weight. She lived several more years and was pts due to cancer.

[Personal Champ]

Everyone, thanks for the info.

I really think that Heartgard Plus is where we are going to go. Blu, why can't we use Interceptor in place of the Heartgard? Is it stronger? The research I've been seeing said that you can use Heartgard or another approved preventative..... We can do Heartgard, no problem. I did see the stuff about the doxy and would definitely like to do a month of that in conjunction with the Heartgard.

Hopefully time is on our side as she is not exhibiting any symptoms yet.

Keep the info coming!

[dalpal]

Everyone, thanks for the info.

I really think that Heartgard Plus is where we are going to go. Blu, why can't we use Interceptor in place of the Heartgard? Is it stronger? The research I've been seeing said that you can use Heartgard or another approved preventative..... We can do Heartgard, no problem. I did see the stuff about the doxy and would definitely like to do a month of that in conjunction with the Heartgard.

Hopefully time is on our side as she is not exhibiting any symptoms yet.

Keep the info coming!

Stick with the HG, it is safer.....I use Interceptor on my other dog, but not even willing to risk it with the one who came in HW Positive.

[x]

We had a HW positive dog, and we did the $500 treatment, and our dog has been fine ever since. She was a 6 year old when she got the treatment. (We adopted her, and she was positive). Anyhow, after spending that much $$, I make sure my dogs stay on heartguard year-round!

[grayarabs]

My rescue GSDX was HW positive. We did the slow-kill treatment - this was about seven years ago. She was given "Heartguard" (Ivermectin) - ie the same thing she would be receiving as HW negative. One per month. We gave her Prednisone - low dose - for the first week or so - then tapering off - the Pred on board in case of any problems.
We had no problems at all. Had to wait 18 months to re-test and she was negative and has been ever since - of course on HW meds monthly.
I think the slow-kill method was relatively new at the time - and as doggie and I were waiting in our room for the results - I could hear the vet saying happily to the staff "looks like we are going to have another negative". He was as thrilled as I was.

[Calamber]

I really wish I had posted for people's experiences for my boy. I would most certainly have opted for the slow treatment no matter what the vet said. I have to say that I will never again, no matter what, give Immiticide to any dog. I understand that it works for some but this was such a horrendous amount of pain that this dog was in, I will never chance it again. I did also give him doxycycline for a month because what happens is that as the worms die with the fast kill method, the toxins from the parasite co-host is weakened by the use. Some protocols say to give the doxy for 2 weeks, then some time off, then another two weeks. Others say give for 30 days. The thing is, that the Heartguard from my understanding, also prevents the adult worms from reproducing in the heart, so what you have is what you will have until they live their lifespan of 2 years. Some probably die earlier. We just have not done enough studies, which would entail euthanizing the dogs along the way to study the life cycle and the treatment protocol more closely.

If I were a researcher, I would most certainly want to find something that is not as shocking to the system as Immiticide. Or, would like to develop a way to eliminate the cycle in mosquitoes, or maybe to find a way using electromagnetic waves to kill all mosquitoes. I understand there is a way to do that as insects bodies are tuned to a frequency far different than other life forms (obviously) and we could be using that method to kill insects. That sounds like the best; our best friends would not have to suffer so much and the environment would also not be harmed by the pesticides!

Thank you for the kind words, I am learning a tough life lesson here. I really miss the sweet little guy with his soft blonde hair that I left to cover his overly large head. He was just like a butterfly, never tried to hurt anyone. :(

[Blu]

From the AWS

"Ivermectin
Continuous monthly administration of prophylactic doses of ivermectin, alone or in combination with pyrantel pamoate, is highly effective against late precardiac larvae and young (<7 month="month" post-infection))" adult heartworms. Comparable adulticide capability of the other macrocyclic lactones has not been reported. The adulticide effect of ivermectin generally requires more than a year of continuous monthly administrations and may take more than two years before heartworms are eliminate completely. The older the worms when first exposed to ivermectin, the slower they are to die In the meantime, the infection persists and continues to cause disease. Therefore, long-term continuous administration of ivermectin generally is not a substitute for conventional arsenical adulticide treatment. If arsenical therapy is declined, a lengthy course of prophylactic doses of ivermectin will gradually reduce the number of adult heartworms, but in chronic mature infections this may not be clinically beneficial. Exercise should be restricted in dogs treated with prophylactic doses of ivermectin as the adulticide.
The results of a recent study in which monthly ivermectin was administered to client-owned heartworm infected dogs for two years indicated that this method of killing adult heartworms should not be used in dogs with signs of heartworm disease or very active dogs, and if used in asymptomatic dogs, the dogs should be examined by a veterinarian at least once every four to six months until all of the worms are dead As worsening of radiographic signs may be observed, periodic radiographic evaluations may be useful in monitoring the treatment."

More to come later gotta go to the grocery store with DH.

[dalpal]

I really wish I had posted for people's experiences for my boy. I would most certainly have opted for the slow treatment no matter what the vet said. I have to say that I will never again, no matter what, give Immiticide to any dog. I understand that it works for some but this was such a horrendous amount of pain that this dog was in, I will never chance it again. I did also give him doxycycline for a month because what happens is that as the worms die with the fast kill method, the toxins from the parasite co-host is weakened by the use. Some protocols say to give the doxy for 2 weeks, then some time off, then another two weeks. Others say give for 30 days. The thing is, that the Heartguard from my understanding, also prevents the adult worms from reproducing in the heart, so what you have is what you will have until they live their lifespan of 2 years. Some probably die earlier. We just have not done enough studies, which would entail euthanizing the dogs along the way to study the life cycle and the treatment protocol more closely.




If I were a researcher, I would most certainly want to find something that is not as shocking to the system as Immiticide. Or, would like to develop a way to eliminate the cycle in mosquitoes, or maybe to find a way using electromagnetic waves to kill all mosquitoes. I understand there is a way to do that as insects bodies are tuned to a frequency far different than other life forms (obviously) and we could be using that method to kill insects. That sounds like the best; our best friends would not have to suffer so much and the environment would also not be harmed by the pesticides!

Thank you for the kind words, I am learning a tough life lesson here. I really miss the sweet little guy with his soft blonde hair that I left to cover his overly large head. He was just like a butterfly, never tried to hurt anyone. :(

I am so sorry that you went through this...bless your heart.

I had a receptionist get REALLY pissed off at me last year because I declined a HW test.....I said that I would not ever use anything other than HG even if the dog tested positive.....she took this to mean that I didn't have the dog on preventative pills and got very nasty in front of everyone. When I explained to her that yes, I do have them on the pills..she didn't believe me because I buy through my horse vet and not through their practice. She told me that she was "going to have the vet have a talk with me"

When I got in the room, I heard her telling the vet about me/bad owner (the vet actually KNOWS me)...so she came in and suggested the test because it would also test for other things such as lymes....well, I consented/caved in. But I told her the same thing....if it were to be positive, I would not go through the fast kill method.....she said to me.."Oh yes, we will be using that method if he were to test postiive". I said nothing but thought....Oh WE will?? Youre going to be the one forking out the 750.00 and taking care of the dog for two months...don't think so. Of course it came back negative (big shocker there).....but I would never ever use that method on any dog.

[Personal Champ]

Dalpal, if a vet ever did that to me, or let their receptionist do that to me, I would not be utilizing their services in the future. And I worked for a vet. That behavior is inexcusable!!

My parents are having me call the vet tomorrow to discuss treatment. Their dog vet is my horse vet, and I have to set up our spring farm call anyway.

[danceronice]

dalpal--that would be the last time I used that practice.

The $500 sounds very reasonable to me, PC. Molly came from the vet chock-full o' heartworm and had to undergo the intensive therapy, and though there was a scary moment (she collapsed once and we had to take her in on a emergency call) she pulled through and now her only issues with the vet has been when she's been a couple pounds overweight. (She's a beagle and LOVES to eat.) Good luck to your parents and their dog!

[Personal Champ]

Everyone, thanks for the replies - keep the info coming if you have more, hopefully it can help someone else in the future. I will update the thread as we decide on course of treatment, etc.

[lolalola]

I've fostered heartworm postive dogs for a rescue, and $500 was about the going rate.

[dalpal]

Dalpal, if a vet ever did that to me, or let their receptionist do that to me, I would not be utilizing their services in the future. And I worked for a vet. That behavior is inexcusable!!

My parents are having me call the vet tomorrow to discuss treatment. Their dog vet is my horse vet, and I have to set up our spring farm call anyway.

Oh I agree with you......the only reason I have stayed as long as I have is because this vet has such a good repor with my dog who can be very timid and afraid in the vet's office.

[Personal Champ]

Dalpal, I'm glad the vet is good with your dog - at least he/she has a redeeming quality!!

Spoke to the vet today who was on-board with Heartguard. Said that Angel most likely has a low amount of worms b/c her heart and lungs sound great and she acts well.

I will try to remember to update this thread periodically with her progress.

[Calamber]

How is Angel? I hope all is well. Give her a kiss from me and Hector.

[FalseImpression]

Sometimes there are false positives and false negatives.
And $500 is cheap. Here it is a minimum of $1500!
The rescues in Canada who bring in dogs from the South make sure they are tested several times and IF they are confirmed +, that they are treated in the US. It is much much cheaper.

[dalpal]

I really wish I had posted for people's experiences for my boy. I would most certainly have opted for the slow treatment no matter what the vet said. I have to say that I will never again, no matter what, give Immiticide to any dog. I understand that it works for some but this was such a horrendous amount of pain that this dog was in, I will never chance it again. I did also give him doxycycline for a month because what happens is that as the worms die with the fast kill method, the toxins from the parasite co-host is weakened by the use. Some protocols say to give the doxy for 2 weeks, then some time off, then another two weeks. Others say give for 30 days. The thing is, that the Heartguard from my understanding, also prevents the adult worms from reproducing in the heart, so what you have is what you will have until they live their lifespan of 2 years. Some probably die earlier. We just have not done enough studies, which would entail euthanizing the dogs along the way to study the life cycle and the treatment protocol more closely.

If I were a researcher, I would most certainly want to find something that is not as shocking to the system as Immiticide. Or, would like to develop a way to eliminate the cycle in mosquitoes, or maybe to find a way using electromagnetic waves to kill all mosquitoes. I understand there is a way to do that as insects bodies are tuned to a frequency far different than other life forms (obviously) and we could be using that method to kill insects. That sounds like the best; our best friends would not have to suffer so much and the environment would also not be harmed by the pesticides!

Thank you for the kind words, I am learning a tough life lesson here. I really miss the sweet little guy with his soft blonde hair that I left to cover his overly large head. He was just like a butterfly, never tried to hurt anyone. :(


Totally agree......I will tell you that most equine/small animal vets understand this and are much more willing to do the slow kill method than just the small animal clinics. Just had this discussion with my large animal vet two weeks ago (he also runs a small animal practiice) and he had no problem with my philosophy....whereas the small animal practice vet wouldn't hear of it.

[Daydream Believer]

dalpal...that is awful! My small animal vet has kind of beat around the bush with me on Heartworm tests...one day the receptionist just came out and asked me if I'm using Ivermectin myself (they know I have horses) and they were cool when I said yes.

I don't do the heartworm tests annually them either for the same reason. I won't do the fast kill regardless of what the dog has or not...not going there...and after reading Calamber's story, I'm 100% convinced that it the right answer.

I worm my dogs with Ivomec and Propolene Glycol solution...it's safe and effective....and way less expensive than the pills. You do have to be careful with it...like any meds...but with JRT's (who are not Ivermectin sensitive) it works fine.

[TXnGA]

Everyone, thanks for the info.

I really think that Heartgard Plus is where we are going to go. Blu, why can't we use Interceptor in place of the Heartgard? Is it stronger? The research I've been seeing said that you can use Heartgard or another approved preventative..... We can do Heartgard, no problem. I did see the stuff about the doxy and would definitely like to do a month of that in conjunction with the Heartgard.

Hopefully time is on our side as she is not exhibiting any symptoms yet.

Keep the info coming!

DO NOT, I repeat, DO NOT use Interceptor on a HW positive dog. The rate of kill in a HW positive dog will negatively affect the dog, and could result in death. It is the active ingredient in the interceptor (milbimycin). Use HG plus or an ivermectin based product for HW preventative in dogs. Do not use just ivermectin for cattle/ horses b/c overdosing is a chance and not good for dogs- that is why there were all those deaths with collies that were sensitive to ivermectin- they were overdosed by their farmer owners who gave them liquid ivermectin.
I would definitely go to the heartwormsociety page and ck out the new protocols. They do recommend 3 months out starting with an "ivermectin" based product- HG+ - and doing doxy then a 3 dose protocol. But your vet may choose to do that or do their own protocol. You are getting some great info from Blu and Horsegal...


On a side note: the way Heartgard works is by killing the L3 and L4 larval stages of the heartworm, it does nothing for the adults. This is the reason why you give HG the same day every month, to kill off whatever may have been injected by a mossie from the last time you gave your HG. THe way the HG works on a HW positive dog, is it will kill off the L3 and L4 stages before they become adults and reproduce.When you use HG to treat a HW positive dog, it takes 2+ years to completely get the cycle, because you are killing them off every month at the L3 and L4 stages.... sorry, it gets way more scientific and technical- I tried to keep it simple...

You may have a HW positive dog that may test negative because the test your vet may use only test for the female hormone. So if a dog has male HW's, then it won't test- but that also means it can't reproduce. Immiticide is very a painful treatment on the dogs- that is why vets are so adament about HW prevention for dogs/ cats.

[mustangtrailrider]

After adoption a HW + dog that had been treated with "fast" kill method, I would never put another dog thru that. I thought is was cruel and in humane. If I had the hind-site, I would have done the slow kill.

Hind site is 20-20. I would do the slow method if I ever had to again.

My small vet's office knows that I do my own prevention on my big dogs. I have 2 small doxies. They are tested and put on oral prevention. To great a risk due to their size.

[cloudyandcallie]

Do NOT try to treat a dog that has heartworms yourself or use a quick or cheap method. If you have seen the heartworms in the dog's heart in a jar that is in many examing rooms here in GA vet hospitals, you can understand how a quick die off can cause a clogging up in the heart and death.

Dogs that are treated for heartworms now recover and live long and useful lives. Back in olden times they got treatments every summer after they got heartworms, and died about 7 or 8 yrs of age from heart failure. Advances in medical science now allow us to prevent heartworms, and when we adopt a dog with them, to successfully treat the dog and save his life.
Check with a vet school. They are usually a lot cheaper than local vets. Or ask if they have payment programs or reduced costs for a rescued dog.

The mosquito in the south is our worst enemy. Even cats can get heartworms though I've never seen one with them.

[Calamber]

This is a belated answer for a long ago question but as far as the "Natural" treatments, the best protocol that I had seen is listed on a website called Bandit'sbuddies.com, I was concerned as far as treating Hector, that the walnut oil used is also fairly toxic, and he was so sensitive. Anyway, just want to help spare anyone else and their dog the pain.

[FatPalomino]

Blu, why can't we use Interceptor in place of the Heartgard? Is it stronger?

They are 2 totally different meds.
Heartguard is our old friend Ivermectrin.
Interceptor is Millibemycin oxime.

I can't offer any suggestions (knock on wood, haven't run into that problem yet!).

But, if you keep your dog on HG year round, and buy it from your vet, if your dog comes up positive, they will foot the bill for treatment.

Remember HG and such treats any infection from the month PRIOR. So make sure to use it at least a month after the mosquitos are gone- and never a bad idea to use it year round, esp. given our horses and other yummy parasitic hosts on a farm (rabbits, cats, etc).

[pAin't_Misbehavin']

Another person here who let the vet use Interceptor post immiticide treatment on a rescue. Never, never, never again. Dog went into shock and nearly died - would have had I not been standing by and rushed him to a vet for a steroid injection.

I would opt for the slow-kill ivermectin (Heartguard) protocol.

Even on a border collie. Don't let your vet tell you ivermectin can't be used on border collies. There is no documented case of ivermectin sensitivity in border collies. Really, there's not. Some rough (Lassie) collies, but not border collies.

[JanM]

I have lived in New Mexico, Colorado and now Alabama and I have always had my dog on year round HW preventative. When I moved to Colorado in 97 there were many people that didn't think year round or any HW preventative was necessary, and they were wrong. With the up and down temperatures there I sometimes saw mosquitos in midwinter-and got mosquito bites in the winter too. It's easier to remember and keep track of for me that way. I wish there was a less toxic and dangerous method to treat animals with this, but maybe there will be. After reading the stories on here I would definitely go with the slow method, but hopefully I'll never have to worry about it.

Dalpal-I dumped a vet practice in Colorado because of garbage like you experienced, and the 'we know everything and don't question us' stuff too. My dog was on HW preventative year round, went in for her annuals, HW test, but didn't need more HW pills yet so I asked the vet if I could just get the pills for the year in a few months when they were due since the dog was just tested and on it year round, and she said fine. A few months later I call to arrange to get the HW pills, and the receptionist (who was a total fool by the way) said I would have to bring the dog in for another test, I explained what the vet had said and she backed off. When I went in to pick up the pills the receptionist said that because I was risking my dog's life by not retesting (2 or 3 months later) that I had to sign a release saying they weren't responsible for the effects on the dog (the vet was hanging back and listening too). (I only signed and put up with it so my dog wouldn't have to get tested at the next vet office I would be switching to so I could get the HW pills) I told them again what the vet had said, signed and paid and as I was leaving the receptionist said that they would send me a postcard when my dog was due for her next shots, etc. She and vet seemed surprised when I told them that they were fired-I certainly enjoyed that part. By the way, my next vet was much nicer, and considerably cheaper, and more organized-and treated my animals and I like clients not idiots.