I will also be doing additional research on the topic.
I talked to the owner of the school/daycare/boarding facility that I use and she said all she requires is rabies, since that is state law. She is more than satisfied with titers for the other stuff. So that's a huge win. She also said that the dogs she sees getting more illnesses are the over vaccinated ones. She believes vaccines dampen their immune system.
I am leaning more and more towards less medication (or "poison" as some call it), but I want to be safe. I checked the heat map someone posted for heartworm incidence and we are in a lower risk region (Iowa). I also checked Lyme, and we are in also in a lower risk region (although I have a friend who's lab died of Lyme disease about a year ago).
It is not at all motivated by cost. I simply want what's best for my dogs. I'm more than willing to pay for any veterinary care they need.
I am considering moving to only doing the rabies vaccine, coupled with biannual exams including blood work, stool exam, heartworm check, and possible titers.
As for flea and tick, I have already moved to using Seresto collars from April to November. I am considering doing the same for heartworm preventative.
I am very open to suggestions