by Mindhunt on 07 March 2019 - 15:03
I looked at the older posts about perianal fistulas and was unable to post questions. My 4 year old intact male was experiencing blood in his stool and excessively licking his anus, blood was pooled under him and I could not find anything other than some blood by his anus, no other signs of anything. 1 surgery later and an anal gland cleaned out and packed with antibiotic, he developed symptoms again and not 2 weeks after his first surgery, he went in again. Both anal glands cleaned out and packed with antibiotic and sent home, the left gland was the worst by far. He was diagnosed with perianal fistulas (I have NEVER heard of this) which is apparently very common in GSDs. Recommendation was neutering would greatly decrease the recurrence because the disease seems to feed on testosterone (research says it doesn't matter). A few days later, he was not weighting his left rear leg and just a painful mess, moaning and whining, and clinging like velcro. Verdict from vet was torn ACL so off to the board certified surgeon who performed ACL surgery on my vet's sport dog. My appointment was changed 2 hours before scheduled time because of a mandatory meeting for new phone and computer system, keep in mind I took the day off of work, no personal day pay. I live over an hour away and of course with tourist traffic I was stuck, got there 15 minutes before the meeting, tried calling multiple times and phone disconnected me (they are also a 24 hour emergency vet). Arrived only to be told I have to reschedule, I said no and I need to see someone right now. Told to leave Quint and they would perform surgery in the morning, they had all his records sent over by my vet, then upset because I brought no food or his medication, I said I was not told he would spend the night. Anyway get a call next morning. He was put under and they shaved him for surgery only to find significant fluid buildup in his knee, hock, stifle, and under his pads causing severe pain. He will be placed on cipro and given rimadyl and tramadol for pain. I freaked a bit and told her NO CIPRO he is extremely allergic to cipro and I almost lost him to anaphylaxis. Surgeon said no mention of that was in his notes (yes it was, they found it later, it was in big red letters) and rimadyl makes him vomit. So no surgery, fluid drained and sent off for culture. He stayed an extra night ("don't worry, the overnight charge is very small", it wasn't). I picked him up a couple days later still limping and the bill was over $2,000 for NO SURGERY. Really!?! Now we are at 2 weeks without a return call from the surgeon for results of the culture (despite me leaving numerous messages for her to call me), no one at the specialty surgical vet can tell me what is wrong with my poor limping miserable dog. Meanwhile back at home, his anal glands ruptured a couple days later (vet said they looked good when he was under). I now have two big openings on either side of his anus. My vet said nothing she can do until he is neutered, I pointed out that she said she can't do anything until his anal glands have healed and there is no chance of infection, she said we are in a catch 22, can't do anything either way. So I have researched and put him on a novel protein no grain diet (can't afford balanced raw which was highly recommended by multiple sites), keeping his booty clean and washing carefully after every poo, keeping it dry by clipping all the fur around his anus and under his tail (plush coat), using Preparation H around the openings (NOT in the rupture openings) and anus to help with pain and keep it dry alternating with coating lightly with zinc oxide to dry everything out (again not in the openings), using sterile/clean technique on everything. I have essential oils recommended to help keep it clean and healthy. Doing everything I can because the consensus is euthanizing when it gets too bad (already on the downward side of having to euthanize my two seniors, 14 and 16, for mobility and pain management issues, probably in the next few months and they will go together, all three are very tightly bonded with the 4 year old sleeping next to or in between them). Sorry for the long post but wanted to set the stage.
I am looking for any new information or experiences that anyone had. Thank you in advance.
by Hundmutter on 07 March 2019 - 16:03
by susanandthek9s on 08 March 2019 - 03:03
Perianal fistulas are nasty and you need to find a vet who knows how to treat them properly. Here's a useful summary:
"Cyclosporine has been an effective treatment at a dosage of 5–10 mg/kg, bid for 10–20 wk and then for an additional 4 wk after all fistulae appear to be healed. Concurrent administration of ketoconazole (8 mg/kg/day) allows the dosage (and cost) of cyclosporine therapy to be reduced (1–3.5 mg/kg/day). Prompt treatment is recommended early in the course of the disease to reduce the likelihood of recurrence. However, some dogs are intolerant of ketoconazole. Cyclosporine at a dosage of 5 mg/kg/day can effectively decrease the severity of lesions. In one study, the combination of cyclosporine therapy for 12 wk followed by surgical excision of any remaining draining tracts, along with cryptectomy and anal sacculectomy, successfully resolved disease with minimal recurrence. Topical tacrolimus (0.1% ointment applied once to twice daily) in combination with a tapering course of prednisone (2 mg/kg/day for 2 wk, 1 mg/kg/day for 4 wk, and then 1 mg/kg every 2 days for 10 wk) with metronidazole (10 mg/kg, bid for 2 wk) and a novel-protein diet has also been found to be effective in some dogs. Other aspects of medical management include the use of fecal softeners to reduce dyschezia. Perianal cleansing and antibiotics may reduce inflammation."
I have seen unbelievably horrible perianal fistulas treated successfully with cyclosporine and tacrolimus. Good luck with your poor dog.
by Gertrude Besserwisser on 08 March 2019 - 18:03
by KiokeeGSD on 09 March 2019 - 15:03
by emoryg on 09 March 2019 - 16:03
Not sure is this will any help since your boy is allergic to it, but one of the guys I worked with handled a dog that had this type of fistula. It was quite impressive to look at. I remember sometime early 2000s one our vets told us about a drug that was showing promise on this condition. I don’t recall the name, but I remembered it from the heart transplant patients in the 80’s getting a script to suppress the immune system. I am almost certain it was cyclosporine and there was improvement in the dog. I reached out to the handler but he couldn’t remember the name. Then again, I asked if after he was neutered did he see a difference in the fistula and he said the dog was never neutered. I specifically recall after surgery asking the vet to show me the retained testicle the dog had carried for eight plus years.
FYI The dog lived to be around 14, spending over seven years working the streets, never once missing a day from the fistula. It was never operated on. The handler did say the fistula became badly infected and was a deciding factor on having him euthanized.
by Hundmutter on 09 March 2019 - 16:03
by emoryg on 09 March 2019 - 19:03
HM, I can’t remember how many the dog had. I remember the biggest one was perhaps 2x4cm, perhaps slightly longer. I could have easily pressed my thumb into the opening when the tail was raised up. Having only seen them on people, I was a bit daunted by the size. I’m thinking it developed around 3 years of age. At the time, surgery was not recommended. I tried calling the vet’s office in hopes they kept the medical records, but it was closed. He was also on a topical, but the name slips me as well. I will check back Monday when they open.
by astrovan2487 on 09 March 2019 - 22:03
by Zenit2010 on 10 March 2019 - 01:03
Just to add... my own GSD was on Atopica for almost 5 years because of severe environmental allergies, with no negative side effects.
I hope your dog heals from his fistulas. Please give cyclosporine (Atopica) a try.