# Running out of options on Perianal Fistula



## jmumaw (Jul 22, 2011)

I do not have a GSD but figured this is a good place to look for help for PF's as I know GSD are most common for them. I have a 5 yr Pitt Mix-Petey. We have been dealing with PF's since he was 2yr. I was basically told by my vet today that she doesn't know what else to do for him. We have tried the cyclosporin with ketaconzale but it makes him terribly sick. We have also tried tacrolimus, cepahelxin. pred., Simplicef, Sulfadiazine( topical), and we have also tried some homeopathic things as well such as Silicea as well as others. Most of this stuff worked at first but then the PFs came back and the same medication that had just worked before didn't work this time. My vet has said that we could have the Cyclosporin turned into a topical but it was quite expensive for a very small amount and she could not be sure it would even work. Right now we are using zinc oxide as I have read many people have had luck with it, so far nothing. I am looking for any suggestions, I am open to anything-meds, homeopathy, surgery (within reason). Please give me some hope that we may be able to continue treating him, he's my only baby.:help:


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## JakodaCD OA (May 14, 2000)

your best bet is to go the PF site, and join their email list, tons of very knowledgeable people that can help guide you.
perianal-fistulas

I have been there done this twice, with two gsd's..The first one I went for surgery, he was around 8 years old, surgery did the trick...the second was around the same age, and did cyclo, which took care of it, (I was prepared to do surgery but decided to try this route)..He had a few relapses, the zinc oxide cleared them up.

Keep in mind, both my dogs, got PF's as a result of infected/blown anal glands. They were not "true" PF's, true pf's are immune system related, and you usually have other issues, ibd, sibo, allergies etc..

IF you go the surgery route, I would find a board certified surgeon who is savvy dealing with PF's..On the link I posted, there should be 'vets' listed by area, that deal wth PF's..

Definately join the PF email list, you will get alot of good information and suggestions


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## LisaT (Feb 7, 2005)

I second everything that Jakoda said. The only problem with the list, is that they can help a lot with the drug protocols, and your boy might not be able to tolerate them. They can help with things that might support him while he is on those drugs though.

If you've been dealing with this, you've probably read all the information about it, but here are some links: Perianal Fistulas - GermanShepherdHome.net

Did the anal glands abcess at any point? 

Have you done a food change during this? What are you feeding?

Has he recently had any bloodwork done?

Does he have a history of any tick diseases? Pits in particular are susceptible to a certain type of tick disease, that can also be passed from Pit to Pit (so doesn't have to be from a tick), and maybe even run in certain lines, and there has been a link between this and perianal fistulas. 

I used a rather unique protocol to close the fistula in my boy. If yours really can't tolerate the standard protocol, it might be a long shot.

Oh, and silica, used homeopathically, at the lower potency, say 30C, it will increase draining from the fistula. After it has opened, you have to go to a higher potency, and use it very carefully. I don't know if you did that. I also used Silica during my boy's protocol.


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## GSDAlphaMom (Jul 20, 2010)

I dealt with this in the mid 90's. We went the surgery route and within a few months it was back. There are more options now but wanted to share surgery may or may not work. I wish you well with it.


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## LisaT (Feb 7, 2005)

GSDAlphaMom said:


> I dealt with this in the mid 90's. We went the surgery route and within a few months it was back. There are more options now but wanted to share surgery may or may not work. I wish you well with it.


Curious, was it a surgery for the fistula, or to remove the anal glands?


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## jmumaw (Jul 22, 2011)

Thanks for the info. I have joined the PF site already.As far as medications he seems to be ok on most things, just not the Atopica. When I used Silica the first time I was AMAZED at how well it worked but ever since then, it doesn't seem to do anything. I can not remember what type of dosage it was that we gave him, we've been through so many things. I feel this started as a result of having his anal glands done at the groomer. He never had a problem for the first 1 1/2 yrs then he went to the groomer and next thing you know we have impacted glands and then the openings started appearing. When we first tried Atopica we changed to IVD Duck and Potato but after vomiting so much with the meds in addition to the food he was eating he lost A LOT of weight. He was skin and bones so I had to change his diet. Now we are on Blue Buffalo, my vet said this was fine. As far as blood work, the only thing he has had done was the initial bloodwork after starting Atopica, nothing since then besides heartworm tests. And tick diseases- he had Lymes about a year ago, he tested a faint positive so a round of doxycycline took care of it. At this time we are looking into specialists. I don't know what type of Dr. I should be looking into though- dermatologists, internalists, or what. We are also looking into places like VA Tech Vet School.


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## LisaT (Feb 7, 2005)

Okay, this is what I would do....

I would do limited ingredient dog food. I do believe that subtle food issues contribute.

I would STRONGLY consider having those glands removed, they may be a constant source that will keep that fistula from healing.

As far as drugs go, I would put him on an aggressive dose of doxycycline and niacinamide. This is often used as an immune suppressant (instead of pred) in some skin diseases. Lyme is almost never erradicated, only kicked back. If a lyme dog is put on steroids, or immune suppressants, it is also supposed to be put on lyme antibiotics. So, if you use the immune suppressants, you should also be using doxy for lyme, to prevent recurrence. However, the doxy alone, without the other drugs, might be enough to help to close the fistula up, with the zinc creme.

My dog is maintained on doxy, and it keeps his fistula away. The Derm has another dog for which this is true, and that dog has a history of lyme. Dermatologists are the specialists that mostly take care of fistulas. Just like any other vet, there are good ones, and not so good ones. I really like the one that I use.

I think you still have some options.


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## GSDAlphaMom (Jul 20, 2010)

LisaT said:


> Curious, was it a surgery for the fistula, or to remove the anal glands?


 
It was to remove the fistula. This was about 1995, they didn't know much about it then (not that they know alot now). He said it was a 50/50 shot of working. It came back with a vengence. I ended up having to put him down as his whole rear end became exposed and there was nothing more they could do for him.


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## LisaT (Feb 7, 2005)

GSDAlphaMom said:


> It was to remove the fistula. This was about 1995, they didn't know much about it then (not that they know alot now). He said it was a 50/50 shot of working. It came back with a vengence. I ended up having to put him down as his whole rear end became exposed and there was nothing more they could do for him.


Oh, I'm so verry sorry!! :hugs:

The only surgery that is recommended now, is the anal gland surgery. But back then, they didn't know as much, and didn't have the same drug protocols. 

What a terrible loss


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## GSDAlphaMom (Jul 20, 2010)

Thanks. He was nine so I had a good nine years with him.

The only thing the vets knew back then, or thought was......it happens mainly in german shepherds and we don't know why. 'We think it has something to do with the tail and maybe not getting enough sunshine in that area!'

It's really a horrible disease, especially back then when they didn't know how to treat it. They never even tried any drugs on him. Only protocol was try surgery with a 50/50 shot.


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## LisaT (Feb 7, 2005)

1995 was a long time ago, in terms of what they knew about fistulas 

So glad that you had those 9 years.


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## jmumaw (Jul 22, 2011)

Thanks Everyone, for the info. My regular Vet is suppose to be referring me to a surgeon this week. Dr. Bradley in Manassas, with Northern VA referral (I believe is the name of the hospital) Any one heard of him?


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## Peleandtwo (Jul 23, 2011)

Our vet successfully treated a periannal fistula in our older shepherd (she was about 10 when she was diagnosed). He put her on a combination of immune-suppressant and antibiotic. Once it was under control, we were able to cut back the doses, but she did stay on the medication. She did not have any more issues with the fistula (she died at 14).


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## NancyJ (Jun 15, 2003)

We had surgery performed in 2004 by Brian Arneson at Heartland Vet Clinic in Harrisonburg VA, in 2005. I drove 6 hours each way to get to him based on a strong referral from the PF-L group and don't regret it one bit.

My dog lived another 4 years with no recurrence and passed away due to hemangiosarcoma. His fistulas were very deep running well into his leg muscles. A risk of surgery is fecal incontinence though which we did not suffer.


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## JakodaCD OA (May 14, 2000)

I was lucky, or should I say Jake was lucky, my first pf dog. He had his surgery in the early 90's..Around the same time, Kay Goolsby had written an article about her experience with her GSD Shadow, for the GSD Review..I wrote her, we have been friends ever since

Jake ended up being referred to board certified surgeon Steven Haymen, Cheshire Vet Clinic..who had done ALOT of PF surgeries..Thank goodness for him They removed the glands and fistula tracts , it was a really radical surgery, basically just went in and SCOOPED the entire area out. It was not a pretty site, but Jake was a model patient..

I have always heeded his words, don't mess with a dogs anal glands (referring to having them expressed) unless you absolutely have to, once you start, it can be the start of a bigger mess than you want to deal with..

He's still practicing altho he's "mobile" now, travels to vet offices around the NE area doing surgeries that vets don't want to tackle..


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## NancyJ (Jun 15, 2003)

Dr Arneson told me for it to work, they have to locate and dissect out all the tracts.

Honestly I did not have trouble with the approach because my husband suffered for years with pilonidal cysts which were similar in my mind and were completely resolved by surgery....but he has a large nasty scar at the base of his spine from it.


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## MountainGSDs (Jul 25, 2011)

Surgery is a tough route since you're dealing with an autoimmune disease.
Cyclosporine combined with Ketoconozole is the tried and true and once you get results you keep lowering the dose till you hit the minimum necessary.
Wlagreen's drug plan has the best price in most areas.

Vaccinations and boosters need to be kept to a minimum of what is necessary as you don't want to rev up the immune system.

Good luck.


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## JakodaCD OA (May 14, 2000)

providing they are "true" PF's, which are not the case with some as my two...My dogs PF's were the result of infected/blown glands, thus easier to treat in my opinion.

I think it's recommended to give NO vaccines at all, when you are dealing with immune related pf's.


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## avagsd (May 13, 2008)

I am surprised to see repeated mention of surgery for PFs. If the source of the PFs is auto-immune in nature, surgery is almost never recommended. Someone else mentioned this but it is important enough to be repeated. You don't know how far those tracts extend and surgery could be much more extensive than expected. And, of course, you wouldn't be addressing the cause.

To the original poster, you did not mention azathioprine (brand name Imuran). This is an inexpensive immunosuppressant and has been used successfully on some PF dogs in conjunction with metronidazole. My own dog was on this protocol in addition to pred and had good results. She has multiple auto-immune issues. 

Good luck!

Molly


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## LisaT (Feb 7, 2005)

avagsd said:


> I am surprised to see repeated mention of surgery for PFs. If the source of the PFs is auto-immune in nature, surgery is almost never recommended. Someone else mentioned this but it is important enough to be repeated. You don't know how far those tracts extend and surgery could be much more extensive than expected. And, of course, you wouldn't be addressing the cause.


I agree. I think long ago it's been recognized that the ONLY surgery that might be beneficial is anal gland removal, IF the anal glands seem to be a source of problem or infection.

Any other recommended surgery, now, I would run from that vet. Treatment has come a long way. 

I hope that the OP is on the PF list, I haven't checked. They will help with all of this stuff. My concern with the OP, is that this is a history of tick disease. Using immune suppressants without also using appropriate antibiotics, will cause problems for this dog.


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## JakodaCD OA (May 14, 2000)

I also agree, when Dodge developed them maybe 6 -7 years ago, my vet had never had the opportunity to go the cyclo route, as it was costly for most. 

I had no problem trying it, but would have gone the surgery route (since Dodge's was anal glands not immune system related),,had the cyclo not worked.

I was lucky to get the cyclo at cost, so I didn't go bankrupt and it worked..Treatment HAS come a long way, lots of other options to consider vs going into the unknown via surgery


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## NancyJ (Jun 15, 2003)

avagsd said:


> I am surprised to see repeated mention of surgery for PFs. If the source of the PFs is auto-immune in nature, surgery is almost never recommended. Someone else mentioned this but it is important enough to be repeated. You don't know how far those tracts extend and surgery could be much more extensive than expected. And, of course, you wouldn't be addressing the cause.
> 
> To the original poster, you did not mention azathioprine (brand name Imuran). This is an inexpensive immunosuppressant and has been used successfully on some PF dogs in conjunction with metronidazole. My own dog was on this protocol in addition to pred and had good results. She has multiple auto-immune issues.
> 
> ...


I think the surgery is last resort but the bottom line is it is the only thing that worked for us and I gather it worked for others.


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## jmumaw (Jul 22, 2011)

As of right now I'm at a stand still. I am still using the ZincOxide it seems to help a little. I spoke with the Surgeon's office and the surgery is out of my cost range. There are a few homepathic vets down my way that I may contact.


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## MountainGSDs (Jul 25, 2011)

jmumaw said:


> As of right now I'm at a stand still. I am still using the ZincOxide it seems to help a little. I spoke with the Surgeon's office and the surgery is out of my cost range. There are a few homepathic vets down my way that I may contact.


IMHO if your dog has the real deal then you are losing time playing with hoepathic and other questionables.

I have weaned my dog down to a super low dose of the 2 drugs and he is doing super and the cost is about 30 bucks a month now. No side affects for him either. There were in the beginning like barfing but once the dose came way down he doesn't have one single issue.


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## RebelGSD (Mar 20, 2008)

I had a foster with mild PF. She did poorly on Blue Buffalo (I thought it was a good food) and my other dogs also had problems with it. The PF cleared up completely on ProPlan ( go figure) and she is on Orijen now with no recurrence. It may be worth experimenting with the food.


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## LisaT (Feb 7, 2005)

The Derm that treats Max thinks that food is always involved with PFs. With Max, his fish oil capsules were a huge problem, go figure.

Suspect everything.


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## RebelGSD (Mar 20, 2008)

With my foster they disappeared after I switched her to ProPlan. I thought I was doing a good thing feeding the dogs Blue.


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## LisaT (Feb 7, 2005)

RebelGSD said:


> With my foster they disappeared after I switched her to ProPlan. I thought I was doing a good thing feeding the dogs Blue.


Isn't that weird? Like the fish oil capsules, that are *supposed* to help with immune system dysfunction.

Which ProPlan did you use?


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## MountainGSDs (Jul 25, 2011)

There are a lot of things that can help with PF. For some going to a virgin single source protein can help although in time the immune system may fire up again. Some of the topical stuff may give some relief.
The key is to use an experienced vet and get it under control asap to prevent pain and infection and get the fistulas healed before they head into the anal gland and you have a real mess.

Cure, nope, can't cure PF,DM or Pannus in dogs or MS in people. All are auto immune and all we can do is try for a remission.


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## LisaT (Feb 7, 2005)

jmumaw said:


> There are a few homepathic vets down my way that I may contact.


I think that homeopathy would be a good option in your situation. You have a dog that is drug intolerant, and I believe has an underlying pathogen (such as a tick disease) that is complicating this. If you are going to use any antibiotics for this, I would be sure to use one that is effective against lyme disease.

Every dog is different with these PF's, and they will respond differently. So many do very well on the cyclosporine. The immune suppressants made my dog's fistula worse, so you have to find what works best for your dog. 

I hope that you have a vet that is willing to work with you and experiment a little.


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## jmumaw (Jul 22, 2011)

I just feel that homepathy would be easier on his system then the meds are. I have tried many different foods and it really doesn't seem to make a difference. Another thing I thought of was while on vacation one year Petey did alot of swimming in a pool and I noticed the open fistulas started to close. Might try putting up a pool and get him swimming again to see if it helps again. (Bonus is good exercise that is easier on his joints


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## LisaT (Feb 7, 2005)

I used to alternate, using a dropper.....liquid vitamin E (Solaray has a dropper) and the next day I had a mix of aloe gel mixed with potassium iodide. That seemed to work well.

The chlorine in the pool was probably killing off "stuff" and allowing it to heal.

The food, it just takes one ingredient, and you have to get the food right, with the right antibioitic, remedy, whatever else you are using. If one thing is off, then none of it will completely work. It's very frustrating.


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## JakodaCD OA (May 14, 2000)

bringing up the chlorine reminded me, when Jake had the surgery, I was instructed to syringe the area out daily with water and a little bleach...Honestly, I didn't do it, because I thought ee gads bleach?? Burn??? Luckily I just hosed him down a few times a day (summer thank goodness!) and he'd sit his butt in the doggie pool..

so gee maybe chlorine=bleach right?


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## jmumaw (Jul 22, 2011)

It made sense to me, the Chlorine kills off the bacteria and has a drying effect. We shall see the pool is filling up now Its a plus all around since I get to use it to. LisaT it is absolutely frustrating since I have found things that work one month and then months later it won't work. For now I'm liking the Blue Buffalo because others that I've tried either he doesn't like or he gets diarrhea. He loves the Blue Buffalo and using a laxative I can keep his stool at a good consistency as to not irratate the fistula.


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## LisaT (Feb 7, 2005)

If the fistula gets better on the food, that's a good sign. 

I tend to think that a single protein without a bunch of stuff in it might be best. 

I hear you on the variability of things, I went through the same thing, until things kinda fell together. But then, even just sharing some popcorn with him would mean bad news the next couple of days


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## Evah (Dec 28, 2020)

JakodaCD OA said:


> your best bet is to go the PF site, and join their email list, tons of very knowledgeable people that can help guide you.
> perianal-fistulas
> 
> I have been there done this twice, with two gsd's..The first one I went for surgery, he was around 8 years old, surgery did the trick...the second was around the same age, and did cyclo, which took care of it, (I was prepared to do surgery but decided to try this route)..He had a few relapses, the zinc oxide cleared them up.
> ...


Hi. I’m searching for most current perianal fistula information.


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## Fodder (Oct 21, 2007)

Evah said:


> Hi. I’m searching for most current perianal fistula information.


feel free to use the forum search bar and sort by recent. this thread is from 2011.


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