Perianal Fistulas (previous thread older) Looking for updated information - Page 1

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.

@Mindhunt, SO sorry to hear this horrible and complicated story, my heart goes out to you. My small experience of nursing a dog with AF would go nowhere towards even beginning to help - all I can say is that I found the frequent bathing to be extremely helpful in managing the condition, and that this was at a time when we used human-grade Cyclosporin to treat bouts in this young neutered male, with initial success, but that by the fourth bout began to seem less effective in keeping symptoms at bay. He was eventually euthanised, not because of the AF (although if he had lived with it longer we might have had to go there) but because he developed a tumour in his shoulder. I think basically he probably had a weaker auto-immune system than his siblings, although none of the 4 in that litter made 'old bones'.

Perianal fistulas are nasty and you need to find a vet who knows how to treat them properly. Here's a useful summary:

https://www.merckvetmanual.com/digestive-system/diseases-of-the-rectum-and-anus/perianal-fistula

"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.

I had a female, show lines with SchH tltles. At four she developed the fistulas. We treated with Cyclosporine. Very expensive but it worked and they never came back. If possible, find a vet who is very familiar with GSDs, it will make a difference. Neutering or spaying has zero to do with it and you vet recommending it simply shows he or she does not know what they are talking about and a good reason to find another vet.
Good luck.

Mindhunt, I have a 6 year old GSD bitch that was diagnosed with perianal fistulas last year. She was treated with Atopica (cyclosporine) 50 mg twice daily and Ketoconazole 200 mg 2 tablets once daily. She did throw up due to the Ketoconazole a couple of times. I too clipped the hair from around the anus and kept it washed. She responded well to the medication and the fistulas did heal. It was a full 4 months of medication. The vet never mentioned spaying as part of the treatment. Meds were expensive through the vet so I got a prescription and ordered through AlliVet. It's been 6 months since she completed the regimen and the fistulas have not returned.

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. 

Like many diseases, Emoryg, AF can have greater effect on some dogs than others, and some individual dogs may tolerate some symptoms others will not. If the dog your colleague handled only had one fistula / hole, and apart from the late-on time when it became infected, it did not give much pain / soreness, then that dog got away lightly, by comparison to some. Our boy had multiple holes opened up, each time the problem came back it got more spread and therefore more complicated. The treatment you describe does sound as though it was Cyclosporin. Whereas one course of this seems to have fixed Gertrude's dog (and it does sometimes, I've heard of other cases where it only happened once), it did not achieve this for our dog. Reckon Mindhunt needs to know both scenarios are possible.

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.         

I talked to a friend at club today who had a rescue with this problem. They treated with Silvadene and kept the area clean, changed diet and they did not continue to be a problem. I think she also said the dog had immune deficiency issues also. Everything I've read about doing surgery on these says its a bad idea and never works. Really hoping treatment works for your dog, that sounds like a horrific thing to deal with.

I’m very sorry to read that your dog is suffering from perinanal fistulas. My mother’s dog is also undergoing treatment for fistulas. He is not neutered, and doesn’t need to be neutered for best practice treatment. He is 90 lbs., and gets 200 mg daily of Atopica (brand name cyclosporine) plus 200 mg daily of ketoconazole. Costco has the best prices for these pet meds. The vet has prescribed this regimen for 3 months to heal and clear up the fistulas. They are healing, slowly. The goal is to reduce the meds to 3 times a week, then perhaps 2 times a week for maintenance and to prevent the fistulas from recurring. Fistulas are a symptom of an autoimmune disorder. The cyclosporine is helping to dampen an overactive immune system that is turning on the dog’s body. Her dog has had no negative side effects from taking these meds.

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.