# Perianal fistula treatments



## RebelGSD

I was wondering about the success rate and the cost of the treatment of PF with cyclosporine. How long is a round of treatment and what is the typical cost? How long do the remissions tend to be? What were the side effects?

What special care or medication was needed parallel to the cyclosporine? 

What natural alternatives were you successful with?

What food worked best?

Thank you for any input or experiences you had!


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## JakodaCD OA

the best place to get your answers is to join the pf email list
perianal-fistulas

I have been there twice with gsd's. First had glands removed, second dog went the cyclo route.

Some dogs can tolerate cyclo, some cannot, both of mine got pf's resulting from blown anal glands.

Definately check out the site I listed and join the email group, there is no 'one' answer for your questions and their is a wealth of knowledge on the email list


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## LisaT

RebelGSD said:


> I was wondering about the success rate and the cost of the treatment of PF with cyclosporine. How long is a round of treatment and what is the typical cost? How long do the remissions tend to be? What were the side effects?
> 
> What special care or medication was needed parallel to the cyclosporine?
> 
> What natural alternatives were you successful with?
> 
> What food worked best?
> 
> Thank you for any input or experiences you had!



The cyclosporine treatment, according to Max's Derm, is needed oin about 50% of her PF cases. Some dogs reach remission, some don't. Side effects are minimized by most that use the drug, but they can be significant, and some dogs cannot tolerate the drug. Max could not tolerate it at all.

Single protein, single carb source food is recommended. Something different than what they are currently on, if you can swing that.

I closed Max's PF with a serious antibiotic regimen and alternative methods - lots of different immune modulating supplements, and also homeopathy. Max's PF has been closed for 7 weeks now. I need to update his thread. He has a thread started here (you could probably search here for fistula), but I continued it over on the other board. I need to update his thread, oops! Some links below.



Perianal Fistulas - GermanShepherdHome.net
perianal fistulas - scared for skye - GermanShepherdHome.net
Perinal Fistula - GermanShepherdHome.net


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## RebelGSD

Thank you for all the info!


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## LisaT

Feel free to bounce ideas here if you want to - it's a terrible disease, and all too common in GSDs, and also seen in some other breeds.


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## chocolat

I am fascinated by finding this subject here. I never knew this was a problem in dogs. This is MY problem. I have had 4 surgeries for it and none were successful. I have simply learned to live with the problem
Some of the pictures at the links you sent showed, open weeping wounds. I dont have that issue. My fistula closes, fills and then drains, if it doesnt drain it becomes itchy and painful

I was reading about the desitin. are shepherd folks using that simply because of the weepy sores the dogs have?..ie drying the sores up?

very fascinating and maybe someday your dogs will give folks like me hope for a cure.


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## redsox10

So sorry your dealing with this. My last GSD had a terrible time. I do think I waited to long to start cyclosporine, If you decide to use the cyclo. the best price can be found at Walgreens. Pets can be put on the savers club card. 

MAke sure your GSD is on a high enough dose. The vet can do a blood test to check the levels. 

There is a yahoo group that was very helpful. PF-L : PF-L

Good luck. I hope your dog is better soon.


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## LisaT

chocolat said:


> ..... fistula closes, fills and then drains, if it doesnt drain it becomes itchy and painful
> 
> I was reading about the desitin. are shepherd folks using that simply because of the weepy sores the dogs have?..ie drying the sores up?...


The desitin is partly to help heal externally, since zinc is known to help wound healing. I also make sure that my boy is on internal zinc. 

One person on the colon cancer board had a doc that put him on an ace inhibitor to help increase blood flow through the body - claimed it healed his fistula right up. A nitric oxide bodybuilder supplement might do the same thing, since they are high in arginine.


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## abby

I had great success using cyclo and nizoral combo took about 6mths with remissions in between then combined with changing from a hypoallergenic kibble to raw diet. We did have a small op done to remove a small pocket just as a precaution and fingers crossed that was the end of it. He has been clear for over 3 years now so i wish you the best of luck.


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## Sheepdog

I currently use 1-cyclosporine gel cap 100MG and 1-ketoconazole 200MG every other day. Walgreens prefered plan 45 bucks a month. Haveing great results for some time now. Food changes had no effect for us. We also use desitine(generic) and even Lanacain spray occasionally.


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## RebelGSD

Thank you everybody. $45 a month is reasonable, a long as it is not hundreds. I am reading the literature. I will try some chinese herbs that come highly recommended.


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## LisaT

If they are the herbs that Patti once mentioned, Max has done great on one of them, the Long Dan Xie Gan - just picked up a new jar today. We never tried the other one.


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## MyGully

*perianal fistula*

My GSD has been suffering from perianal fistula's for more than 3 years now. If I knew then what I know now about them I would have put him down. He is suffering every day and I pay $145 for 2 weeks of treatment with cyclosporine.
He is a lovely dog, smartest dog I have ever known. He is my companion, I have disabilities and he often helps me with day to day life.

PF's are so cruel. I have a constant regime with him now. If I do not keep this up I will have what I call a blow out- where the fistula will heal on the outside, become like a boil and will burst and bleed. It will bleed for quite some time- looks like someone was murdered. This has happened twice.

When I brought him to the vet she told me just to go home, nothing they could do. He was on antibiotics for 3-4 weeks with his Atopica.
I feed him Eukanuba for German Shepard's. He can not eat anything else except Arrowroot (a type of shortbread cookie), baked chicken or baked lamb treats. If I give him a bone he will suffer with it- he can not pass it without straining terribly.

I take him into the shower with me to wash him each morning. I wash him with a medicated shampoo, Maleseb. It took me a long time to find out this shampoo was probably the best. It has anti bacterial and antifungal properties. It is most important not to excessively wet the hair around and on the tail because this condition make them more prone to fungal infection. Because they have dense coats they have a very hard time drying off. Using the hand held shower has helped matters very much.

Another problem is biting because of the fear of pain. At first I didn't know that the pain was not always acute. I would try to hold him still and then attempt to wash him. This is not necessary. By the way, he would try very hard to bite us. I would have to muzzle him and then hold him down- not good.

After talking to my skin specialist vet I realised it was like any other problem with dog training. ignore bad behaviour and praise the good behaviour. I rewarded him with a cookie every time he held still even for a second. Slowly but surely I was able to shampoo his bottom with out any fear from his biting at all. 
I was so ready to put him down several times even though I loved him so much. This is a cruel horrible disease, please someone out there find a cure.


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## LisaT

MyGully, you gotta get him off the Eukanuba, even if you are just feeding a meat and calcium diet, with a few added supplements. Single protein diet is a must, and preferably a protein that the dog hasn't had alot of exposure to.

Are you using the Protopic topical creme (tacrolimus)? You can also use diaper creme that is high in zinc. You don't list where you are, if you are in the US and near a Walgreen's, you can get generic cyclosporine by putting your dog on an individual pharmacy plan (about $35 a year), and then the cylco, 100mg capsules, are $78 for 30 of them. I think on the PF list someone may have found them cheaper at a Costco once, though that wasn't the case here.


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## Bargonaut

*Beware of side-effects*

Just a caution from our experience with Cyclosporin+prednisone as a treatment for perianal fistula. Although we found the drugs to aid in the healing of the wound, we did experience many re-occurrences of the fistula during treatment. In addition, Cyclosporin is a powerful immuno-suppressant which made our shepherd highly susceptible to infection. As a result, after many months on Cyclosporin he contracted pneumonia and was rushed to the vet-hospital, where he spent nearly a week on oxygen and IV-antibiotics. Many weeks and thousands of $$ later, he was finally in shape to return home. During that time we suspended all PF medication, and simply fed a single-protein food as treatment for the fistula. After nearly a year without another fistula episode, I am convinced he did not need the drugs at all.

Not all PFs will heal without medication or surgery, but please switch your German Shepherd to a high-quality food with limited ingredients (we use duck+potato) as part of your dog's treatment. You too may find that this condition is a reaction to the byproducts in commercial dog food.

-B

Owner of "Shadow," a 9 year-old male GSD (neutered)


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## micheleroyalty

My 9 year old GSD had a bad episode of perianal fistulas 2 years ago. I learned to clean her twice a day with soap foloowed by clean up with baby wipes, then application of Desitin in the affected area. After seeking veterinary diagnosis, we started her on cyclosporin with ketoconazole. She cleared up in 6 months. I also changed her diet to a salmon potato diet, as recommended. she was sysptom free for 1.5 years and just last night started bleeding, with all the other symptoms. I know this is an immune systom disease, so surgery is not likely to be effective. I will repeat the regimen I used last year. Fortunately, I am a pharmacist, so I understand the drugs and why they work.


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## LisaT

You're right Bargonaut, not all dogs need those meds to heal the fistula. Our Derm said about 50% of her fistula dogs need cyclosporine. My dog's fistula was actually worse on the immune suppressants.


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## Xenith GSD

*perianal fistula*

Our GSD 8 yr old female has been diagnosed with PF . She has been on anitbiotics and anti inflammatory for 2 wks now and she still has not healed. The vet is going to read up on plan of treatment and will get back to us in a couple of days. 

Is anyone familiar with this illness and what type of treatment is most successful ? The vet told us that the PF is secondary and that something else is causing her problem. 

We are hoping that this can be taken care of without putting our girl thru too much. Thanks for any help and knowledge that you may have.


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## LisaT

A food change almost always helps.


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## Magwart

LisaT said:


> A food change almost always helps.


My vet thinks PAFs have a strong correlation to food allergies. His theory is that the chronic inflammation in the rectum from the food allergy sets the stage for the PAFs forming. (Tip: If you look at your dog's rectum and it's red, you've likely got a food allergy.)

When our young one started experiencing lots of issues with butt licking, anal glands needing to be expressed, and eventually a polyp needing surgery, the vet thought the dog very likely was be headed for a life of PAFs. We had the "I'm worried about your dog" conversation. He thought all those early problems were the warning bell. 

His advice was to get ahead of the suspected food allergy aggressively, to get the inflammation down. With the inflammation down, things in the rectum have a chance to heal.

He was right. We were able to turn it around. We did three 10-week trials of LID kibbles. None worked. We were about to go to a hydrolyzed protein RX kibble, but before doing that we first started feeding The Honest Kitchen's Preference-Base Mix (which mixes with any protein you choose). As long as we feed that and beef--and only beef-- we're now doing fine. Kibble was the problem. THK is an expensive way of feeding, and a bit of work, but it's cheaper than all the vet visits. 

In the transition phase, I also gave daily bovine colostrum with a probiotic. I also used a supplement called Glandex for a while, which turns out to have some but not all of the ingredients in Carmen's Sunday Sundae. Were I to do it again, I'd use Carmen's product as it has some "extras" that would be good. My dog now has a whitish-pink perfect bum, instead of an angry red one, as he did for so long.

Again, I'm talking as someone whose dogs didn't yet have PAFs, but had all the precursors to believe he was headed for them. Once your dog has them, I don't know. I'd be tempted to try aggressive use of diet and supplements to see if taking down the inflammation gets the dog off heavy meds and avoids surgery. It is one of those things where the food and supps won't hurt....and might help the GI tract heal.

ETA: We chose beef because none of the kibbles this dog had been on had beef in them. It was novel. If we'd been feeding a beef kibble with these issues, I'd have been looking at rabbit, venison, lamb, turkey, etc. It all depends on what you're dog has been exposed to.


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## Splendid

Xenith GSD said:


> Our GSD 8 yr old female has been diagnosed with PF . She has been on anitbiotics and anti inflammatory for 2 wks now and she still has not healed. The vet is going to read up on plan of treatment and will get back to us in a couple of days.
> 
> Is anyone familiar with this illness and what type of treatment is most successful ? The vet told us that the PF is secondary and that something else is causing her problem.
> 
> We are hoping that this can be taken care of without putting our girl thru too much. Thanks for any help and knowledge that you may have.


We've been battling this since last summer. At first we tried prednisone with antibiotics which helped but it came back a few weeks later really aggressively. We tried some diet related things which didn't help at all when we were "out of time" in November, he went on cyclosporin. It is VERY expensive (the first round was $30/day) but we saw results almost immediately. We stopped seeing blood the day he started taking it and within a week the lesions started closing up (which I thought would be impossible). I'm just now getting up the confidence to start experimenting with new diets again to see if he can go off the meds, it at least reduce the dose. Best of luck


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## heron163

My dog was diagnosed with PAF when he went through emergency bloat surgery back in November of 2014. I waited until he was fully recovered before starting treatment. 250 mgs of cyclosporine a day with the activator. Within one week of the start of treatment, the bleeding stopped and the PAF started closing up. It was half the diameter after seven days so looking good so far.

I also changed is food to single source protein (Acana duck/pear formula).

the treatment was initially rough on him - he had some GI distress/loose stools. He seems to be doing better now. I am scheduling a follow up appointment with a dermatologist and will see.

ETA: initial meds = $600/month... Walgrens plan helped.


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## BeachLvr

Single source protein food and cyclosporine modified 100Mg and ketoconazole 200mg every other day. Higher dose in the beginning but quickly worked down to this. Diagnosed in 2008 and still doing great.

True PF is an autoimmune disease so be aware of all the hocus pocus out there. I'm not big on vaccinations once you start the immune-suppressants.


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## BeachLvr

chocolat said:


> I am fascinated by finding this subject here. I never knew this was a problem in dogs. This is MY problem. I have had 4 surgeries for it and none were successful. I have simply learned to live with the problem


I dealt with the University of Pennsylvania at first and they said not a lot of progress because really the numbers in dogs are really small. Doesn't feel like when you are dealing with it but.......
In dogs it is autoimmune disease. The body attacks the anus like MS attacks the myelin sheath and some think degenerative myelopathy in dogs is an autoimmune too.


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## BeachLvr

Splendid said:


> I'm just now getting up the confidence to start experimenting with new diets again to see if he can go off the meds, it at least reduce the dose. Best of luck


If he truly has PF don't stop the meds or you will likely go back to square one and have more scar tissue. Reduce slowly and watch carefully.


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## jerryr

abby said:


> I had great success using cyclo and nizoral combo took about 6mths with remissions in between then combined with changing from a hypoallergenic kibble to raw diet. We did have a small op done to remove a small pocket just as a precaution and fingers crossed that was the end of it. He has been clear for over 3 years now so i wish you the best of luck.


hi, my dog is currently in this same situation and im desperate to find a specialist that will charge a reasonable price to do surgery on him. If anyone can recommend me a specialist in Los Angeles I would greatly appreciate it. Also, can someone recommend me a good hypoallergenic food brand to give to my dog, please, I really dont know which brand to trust. Im really stressing out over my dogs health right now.


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## JakodaCD OA

perianal-fistulas

I encourage you to join this PF email group, check out the page, they have vet referrals for different parts of the country that are PF savvy..You want to find a board certified surgeon who is knowledgeable in this type of surgery.. 

The email group will also give you tips on feeding etc.. Good luck


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## jerryr

my vet prescribed 800mg sulfameth, Betagen spray, and Prednisone 5mg and then prescribed cyclosporine. but cyclo really didnt seem to help much because it looked like it was coming back again. Now my dog's rectum look a descent pinkish color but the anal glands look very much open and red. I'm not sure what else to do. I just recently changed his diet to only beef soup and rice and vegetables (1 day). should I continue to purchase cyclo? Have him go through surgery (does it help)? or put him on other meds?


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## Allie512

My Riley had PF; we tried laser surgery; cycloprorine; diet changes, etc. What worked the best was topical Tacrolimus - I was a member of the Yahoo PF forum / group and that group was the best support a person could have for this disease. Riley became very ill on the cyclo and I was not seeing great results. This however, was back in 1999-2001 - Riley passed due to a stroke, not PF; I would really suggest joining the PF group.
Best wishes


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## jerryr

can you tell me how much the surgery cost? 
and for how long did you use topical Tacrolimus for?


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## Heidigsd

I am no expert on PF's but was reading this article and it states that surgery should only be considered if medical therapy has failed. 

Perianal Fistula: Diseases of the Rectum and Anus: Merck Veterinary Manual

Nikki's PF's are due to anal gland issues and she did have surgery to have them removed, recovery was rough for the first few days  The surgery was done by a board certified surgeon and we paid $2,000


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## Allie512

Try the Yahoo Group, please - it is https://groups.yahoo.com/neo/groups/PF-L/info
The surgery was in 1999 or 2000 and did not work. I do not recall the cost. Riley was a rescue and died in 3/2001 of a stroke - she may have been quite old but I loved her so much. I cannot recall how long or the exact protocol for the tacrolimus but it was working - hopefully there are even better treatments you can learn from the Yahoo group. Will post their exact site later as I have to retrieve my old Yahoo password to do so.


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## Allie512

[email protected]

this will send an email to subscribe to the group - just tell them why you are joining.

Hope all goes well.


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## Fwright101

PF in my German shep
My God there is sooo much confusion and what to feed 
My vet says nooo beef nooo potato 
No chicken
Some say cyclosporine Will help ,others say don't waste your time could bring on worse issue with your dog
Helpppp
What is one supposed to do
I feel so bad for my poor girl


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## Mary Jane

I'm sorry to hear that your girl has PF. I only have experience with my own dog and it may not apply to yours. I really did not want to try such a strong drug as cyclosporine systemically, it has a huge impact on the immune system. Instead, when Mars was diagnosed, we changed his diet to a novel protein and carbohydrate and started an antibiotic and tacrolimus ointment-that's topical cyclosporine. It goes right where it's needed. His PF cleared up within a month, as best I remember. He has had a few pink places since then-when that happens I resume tacrolimus for a while.

Good luck with your girl,
MJ


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## Erinb3040

Hello, I?m a new GSD mama & have learned from my friend working at the vet?s office that 2 other gsd?s from the same breeder I used have had PF now. These dogs are older, mine is just 4mos now, so I?m looking into a PREVENTATIVE lifestyle for my girl. I?ve googled until my eyes bug out & can only find Treatments for PF, nothing preventative. So I?m looking at foods & supplements now to hopefully prevent future PF issues. Being cost-conscious (I have another adult dog at home & 3 kids), I've read somewhere on this site, I think, that Kirkland Signature Nature?s Domain has all the good stuff (novel protein-salmon- & pre-/pro-biotic, grain free) and none of the bad (chicken mainly). Anyone have any thoughts or suggestions? Looking to get my girl on a regime that will hopefully prevent PF since she hasn?t had it.... thank you!


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## JakodaCD OA

I would join the PF email group listed above and ask about preventative measures,,if the pf's are a result of anal gland issues, well isn't much you can do to stop it if it's going to happen..One thing I think contributes to anal gland issues, is to much expressing of glands once you start getting a problem, but that's just my take on it..Dogs glands should really 'never' have to be expressed, it happens on it's own...But again, join the group and ask they are a great resource


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## Magwart

Erinb3040 said:


> Anyone have any thoughts or suggestions? Looking to get my girl on a regime that will hopefully prevent PF since she hasn?t had it.... thank you!


My vet has a theory that inflammation starts the cascade that eventually leads to them. Things that cause inflammation (allergens, esp.) are one preventative worry, as it may start the immune system attacking itself. 

If you want to do something about diet, I would actually think seriously about getting it off kibble, and feed a complete, balanced alternative diet, with whole food sources of fiber and raw bone. High-end kibble is designed to produce small poops -- that's its big selling feature. Small poops decrease the odds of natural anal gland emptying. I really wonder if all the anal gland emptying happening at vet clinics isn't an unintended consequence of owners feeding low-output kibble (as contrasted with diets that include fresh or minimally processed whole fruit/vet foods, soft, digestible raw bones, etc.--which produce the kind of poops more likely to empty glands naturally).


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## Erinb3040

Thank you, Jacoda & Magwart - I appreciate your responses. Im unsure of how to even begin with a raw Whole Foods diet. It?s been on my bucket list  any suggestions for particular website-tutorials?


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