Dr. Chad HigginsI had never seen Max before, but as soon as I walked into the exam room I knew he was in big trouble. From the record I saw that Max was a 6-year-old hound dog mix of some type. By glancing at the emaciated dog lying on the table, I could tell that his condition had occurred over many months if not years. Max followed me with his eyes but didnít even attempt to lift his head. Petting his head did illicit a slight tail wag. My rule of thumb is that if there is still a tail wag then there is still hope.I started asking his owner some questions about Max to try to get some ideas on what might be going on. He told me that Max was a completely outdoor dog. He was pretty sure Max had a puppy vaccination, but wasnít certain. I asked if Max had been on heartworm prevention and he told me he had bought worm pills a couple times, but they didnít seem to help. He had noticed Max losing weight over the last few months, but until recently Max had seemed to be eating pretty well. When I asked if Max had been having any diarrhea, he told me he didnít know since he was outside all of the time.My examination of Max revealed slightly pale gums, a high heart rate, fluid-filled intestines, a slight fever, and severe emaciation. On the plus side, he seemed pretty well hydrated and the tail was still wagging during my exam. I discussed some of the possible causes of these signs and recommended starting off with a heartworm test. Max wagged his tail some more while we drew a blood sample for the test. The heartworm test normally takes 10 minutes, but within 4 minutes there was a bright blue color change indicating a heartworm infection.Clinical signs associated with a heartworm infection can include weight loss and a fast heart rate, but there are usually other signs seen that Max wasnít exhibiting. The owner reported there had been no coughing noticed, the lungs sounded clear, and there was no sign of abdominal fluid associated with the right-sided heart failure associated with heartworm disease. I wondered if there was something else going on and wondered about other parasites. I did a rectal exam to attempt to get a stool sample and couldnít believe what I saw when I withdrew my gloved finger. There was a little bit of soft, bloody stool on my finger, but I hardly noticed this clearly abnormal stool. What really got my attention was that my finger was coated with small white worms! It isnít uncommon to see an occasional tapeworm segment round the anal area, or even maggots in a severely sick pet that has been having diarrhea. But these were whipworms! Whipworms can be very hard to find in an infected dog. It only takes a few worms to cause loose, bloody stools. Whipworms shed very few eggs so often on routine annual stool checks they might not even be in the stool sample checked. In dogs with a history of loose, bloody stools with repeated negative stool checks we often will just treat them for whipworms to see if that resolves the problem. Dogs pick up whipworms from ingesting eggs in stool in their environment. Normally they inhabit the large intestine and are never seen. The environment Max has been living in must have been severely infested with eggs for me to have found whipworms with a rectal examination. Whipworm eggs are very hardy and can live through the hot, dry summers and also the long, cold winters. Max was continuously re-infecting himself from either eating stool or even just licking his feet after stepping through the infected environment. The case of Max just reinforces the importance of annual stool examinations by your veterinarian. In addition, it is a reminder of how important it is to keep dogs on heartworm prevention year round. I recommend heartworm preventions that also treat and prevent the variety of intestinal worms that dogs can pick up. Most monthly heartworm preventions are labeled to be effective against roundworms and hookworms. A few are also labeled to prevent and treat whipworms as well. Ask your veterinarian what would be best for your situation.Dr. Chad Higgins has owned Amanda Animal Hospital for the past 15 years. He sees dogs, cats and anything else small and furry.