RAMBO RIP
- Tuesday, January 14 2014 @ 10:40 pm UTC
- Contributed by: erik
- Views: 2,286
RAMBO RIP
UPDATE: WE DID NOT HAVE A CATEGORY FOR THIS SITUATION AND I AM SORRY I HAD TO PUT IT UNDER 'SUCCESS' TO GET IT OFF ADOPTIONS, BECAUSE IT SURELY IS NOT A SUCCESS OF ANY KIND. We were advised today by the Vet who is treating Rambo that his condition is not one that he can EVER recover from and combined with some other issues we found, we have given the OK to humanely euthanize him. Rambo, you were a great dog, a loving pet and we are truly sorry we had to contribute to making this decision, but it is truly in your best interests. Rambo was turned into the shelter from a family who was unwilling to treat his medical condition. He was with his family for his lifetime and now at 5 years of age he was regarded as a burden and given up. Rambo deserves better and we are looking for a family willing to help this great dog to have a long and productive family life.
The medical story is detailed below. It isn't a pretty story but it is also not a death sentence... so please read it over. The lay description is an issue with his anus, and it is quite painful to the dog unless kept under control with diet and antibiotics, both of which are readily available but both of which have some cost. The condition is life long but not life threatening.
Rambo is a super sweet and calm black 5 year old GSD. He is HW Negative, housebroken, fully trained, kid, people and dog friendly and just as sweet a dog as you will ever find. When we decided to put this dog on the site and into our rescue we had to consider his treatment and if we could find a family willing to help him. We are sure that he is worth saving and that he will make some family a fabulous pet. He is otherwise healthy and active, but unless treated, he will be in pain and not have a reasonable quality of life. He is also required to have grain free food, which is what we feed all of our dogs. He has been neutered, he is also chipped and has all of his shots. Rambo was in a home with kids and he is affectionate and sweet to everyone he meets, even though he is in some pain and discomfort. We think he is a real trooper who deserves a chance at a long life.
If you think that you can open your heart to this sensational dog, please call us asap to meet him.
Home » Perianal Fistulae
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THE PET HEALTH LIBRARY
By Wendy C. Brooks, DVM, DipABVP
Educational Director, http://VeterinaryPartner.com
Print this article Email this article
Perianal Fistulae
(also called perineal fistulae, anorectal abscesses, perianal fissures, perianal sinuses, and pararectal fistulae)
Most people are not in the habit of inspecting the area under their dog’s tail unless the dog seems to be doing something that indicates a problem. A dog will lick under the tail, scoot the rear end on the ground, or seem to be in pain when sitting or raising the tail. When the tail is lifted and the anus inspected, a dog with perianal fistulae will show deep open crevices and some oozing pus all around the anal sphincter. Odor may be noted, and the dog might be straining to defecate. This condition waxes and wanes but ultimately over time is progressive, ulcerating the surface of the anus and its surroundings.
What Causes this Condition?
At this time, no one knows but recent information suggests an immune-mediated basis. There seems to be some genetic basis as the German shepherd dog seems predisposed to this condition, though this phenomenon may be more about conformation than about a specific genetic factor for the disease. Relative to other breeds, the German shepherd dog has an increased number of apocrine sweat glands, the type of sweat glands that produce stinky oily sweat (as opposed to watery sweat) in the anal area relative to other breeds. The average age of onset is 5 years and approximately twice as many males are affected as females. The anal glands may or may not be involved in the fistulation.
Photo by Mary Buck
Approximately 80% of affected dogs are German shepherd dogs.
What Else Could it Be?
A biopsy is necessary to confirm the diagnosis as the following conditions can appear similar to perianal fistulae:
Squamous cell carcinoma of the anus (cancer)
Hyperplastic anus (common in older unneutered male dogs)
Perianal adenoma (benign tumor also common in older unneutered male dogs)
Anal sac rupture
Treatment
After the diagnosis is confirmed, there are several aspects to therapy. It will take 2 to 5 months to get the lesions under control, and maintenance therapy will likely be needed for the remainder of the animal’s life.
Antibiotics
Since these lesions are commonly infected at least at the beginning of treatment, antibiotics are typically prescribed. A topical antibiotic may be helpful for long-term infection control. It is important to realize that antibiotics alone will not control this deeply rooted problem; they merely aid in the control of complicating infections.
Stool softeners
Because of the ulcerations, defecation may be painful. To minimize the straining, stool softeners may be prescribed.
Novel protein diet
Food allergy seems to be a possible cause so using foods that the patient could not possibly be allergic is recommended as an additional therapy. Such diets are typically made from unusual protein sources such as rabbit, duck, kangaroo, fish, or venison. Most veterinary hospitals stock an appropriate food. It is important to note that there is nothing especially hypoallergenic about these unusual proteins; the idea is that the patient has likely never eaten them before. If the patient has never been exposed to these proteins, there should be no possibility of allergy (developing allergy requires multiple exposures to a protein).
Immunosuppressive drugs
Years ago some surgical procedures were used to trim the diseased tissues of the perineal fistulae but immunomodulating drugs have largely supplanted surgery. In particular two medications have emerged: cyclosporine (a pill) and tacrolimus (a topical drug). Many dogs will need both to control their disease at least at first but often eventually the topical product can be used alone.
Cyclosporine was originally developed for organ transplant patients to prevent organ rejection by modulating the immune response without necessarily suppressing it. Medication is given twice daily and improvement should be seen within the first two weeks of use. Cyclosporine is an expensive medication and there is tremendous controversy over whether or not generics are bioequivalent.
Cyclosporine tissue levels can be boosted with the concurrent use of ketoconazole, an antifungal drug. This "trick" can be used to cut the dose of cyclosporine and save money. There is controversy regarding whether blood levels of cyclosporine area helpful in determining dose and what the relationship actually is between tissue levels and blood levels. Because of the long-term use needed to control perianal fistulae, it is best to monitor liver enzymes or liver function tests in the patient; cyclosporine blood tests may or may not be recommended by your doctor.
Tacrolimus is a much stronger immunomodulator than cyclosporine and because it can be applied directly to the fistulae, high tissue levels can be achieved right in the area they are needed. The potential for side effects and expense is also much more favorable than that of cyclosporine but only 50% of dogs experienced resolution with tacrolimus alone after 16 weeks versus 85% with cyclosporine.
Another immunosuppressive protocol involves prednisolone, azathioprine, and metronidazole and is particularly helpful to patients with concomitant inflammatory bowel disease. This protocol is substantially less costly than cyclosporine but 30% of dogs can be expected to fail to respond.
Whatever the immunosuppressive protocol, it is best to re-evaluate the patient every 3 to 5 weeks to see if modifications are necessary. Most of the medications listed above are reviewed in our pharmacy library if more details are desired.
Surgery
Before the advent of cyclosporine, perianal fistulae were treated surgically with mixed results. Currently, surgery is only recommended for patients for whom immunosuppression has failed or where the anal glands are involved. The goal of surgery is to remove the dead tissue, prevent or treat any anal or rectal strictures (narrowed areas caused by scarring), and change the "environment" of the perineal region. Tail amputation may be required; in fact, in one study, tail amputation alone was 80% successful in preventing recurrence of the fistulae.
If the anal glands are involved in the fistulae, they will have to be removed. In milder cases, chemical cauterization of fistulae - which destroys abnormal tissue and allows normal tissue to heal - may be helpful. Cryotherapy, in which a freezing agent is used instead of a chemical one, has been less effective (more scarring, less control over the area treated etc.) Laser therapy, on the other hand, has been 95% successful in preventing recurrence and controlling pain (20% of patients developed fecal incontinence but most of these cases were controlled with diet).
The more extensive the surgery, the more there is potential for complications. Stool softeners are typically needed for a month after surgery and the owner should be comfortable cleaning the anal area. Fecal incontinence, narrowed anus, and inability to control the fistulation are the chief complications with surgery.
Despite innovations such as cyclosporine, perianal fistulae can be extremely frustrating.
UPDATE: WE DID NOT HAVE A CATEGORY FOR THIS SITUATION AND I AM SORRY I HAD TO PUT IT UNDER 'SUCCESS' TO GET IT OFF ADOPTIONS, BECAUSE IT SURELY IS NOT A SUCCESS OF ANY KIND. We were advised today by the Vet who is treating Rambo that his condition is not one that he can EVER recover from and combined with some other issues we found, we have given the OK to humanely euthanize him. Rambo, you were a great dog, a loving pet and we are truly sorry we had to contribute to making this decision, but it is truly in your best interests. Rambo was turned into the shelter from a family who was unwilling to treat his medical condition. He was with his family for his lifetime and now at 5 years of age he was regarded as a burden and given up. Rambo deserves better and we are looking for a family willing to help this great dog to have a long and productive family life.
The medical story is detailed below. It isn't a pretty story but it is also not a death sentence... so please read it over. The lay description is an issue with his anus, and it is quite painful to the dog unless kept under control with diet and antibiotics, both of which are readily available but both of which have some cost. The condition is life long but not life threatening.
Rambo is a super sweet and calm black 5 year old GSD. He is HW Negative, housebroken, fully trained, kid, people and dog friendly and just as sweet a dog as you will ever find. When we decided to put this dog on the site and into our rescue we had to consider his treatment and if we could find a family willing to help him. We are sure that he is worth saving and that he will make some family a fabulous pet. He is otherwise healthy and active, but unless treated, he will be in pain and not have a reasonable quality of life. He is also required to have grain free food, which is what we feed all of our dogs. He has been neutered, he is also chipped and has all of his shots. Rambo was in a home with kids and he is affectionate and sweet to everyone he meets, even though he is in some pain and discomfort. We think he is a real trooper who deserves a chance at a long life.
If you think that you can open your heart to this sensational dog, please call us asap to meet him.
Home » Perianal Fistulae
Back Top Bookmark this article
Search Now | Advanced Search
THE PET HEALTH LIBRARY
By Wendy C. Brooks, DVM, DipABVP
Educational Director, http://VeterinaryPartner.com
Print this article Email this article
Perianal Fistulae
(also called perineal fistulae, anorectal abscesses, perianal fissures, perianal sinuses, and pararectal fistulae)
Most people are not in the habit of inspecting the area under their dog’s tail unless the dog seems to be doing something that indicates a problem. A dog will lick under the tail, scoot the rear end on the ground, or seem to be in pain when sitting or raising the tail. When the tail is lifted and the anus inspected, a dog with perianal fistulae will show deep open crevices and some oozing pus all around the anal sphincter. Odor may be noted, and the dog might be straining to defecate. This condition waxes and wanes but ultimately over time is progressive, ulcerating the surface of the anus and its surroundings.
What Causes this Condition?
At this time, no one knows but recent information suggests an immune-mediated basis. There seems to be some genetic basis as the German shepherd dog seems predisposed to this condition, though this phenomenon may be more about conformation than about a specific genetic factor for the disease. Relative to other breeds, the German shepherd dog has an increased number of apocrine sweat glands, the type of sweat glands that produce stinky oily sweat (as opposed to watery sweat) in the anal area relative to other breeds. The average age of onset is 5 years and approximately twice as many males are affected as females. The anal glands may or may not be involved in the fistulation.
Photo by Mary Buck
Approximately 80% of affected dogs are German shepherd dogs.
What Else Could it Be?
A biopsy is necessary to confirm the diagnosis as the following conditions can appear similar to perianal fistulae:
Squamous cell carcinoma of the anus (cancer)
Hyperplastic anus (common in older unneutered male dogs)
Perianal adenoma (benign tumor also common in older unneutered male dogs)
Anal sac rupture
Treatment
After the diagnosis is confirmed, there are several aspects to therapy. It will take 2 to 5 months to get the lesions under control, and maintenance therapy will likely be needed for the remainder of the animal’s life.
Antibiotics
Since these lesions are commonly infected at least at the beginning of treatment, antibiotics are typically prescribed. A topical antibiotic may be helpful for long-term infection control. It is important to realize that antibiotics alone will not control this deeply rooted problem; they merely aid in the control of complicating infections.
Stool softeners
Because of the ulcerations, defecation may be painful. To minimize the straining, stool softeners may be prescribed.
Novel protein diet
Food allergy seems to be a possible cause so using foods that the patient could not possibly be allergic is recommended as an additional therapy. Such diets are typically made from unusual protein sources such as rabbit, duck, kangaroo, fish, or venison. Most veterinary hospitals stock an appropriate food. It is important to note that there is nothing especially hypoallergenic about these unusual proteins; the idea is that the patient has likely never eaten them before. If the patient has never been exposed to these proteins, there should be no possibility of allergy (developing allergy requires multiple exposures to a protein).
Immunosuppressive drugs
Years ago some surgical procedures were used to trim the diseased tissues of the perineal fistulae but immunomodulating drugs have largely supplanted surgery. In particular two medications have emerged: cyclosporine (a pill) and tacrolimus (a topical drug). Many dogs will need both to control their disease at least at first but often eventually the topical product can be used alone.
Cyclosporine was originally developed for organ transplant patients to prevent organ rejection by modulating the immune response without necessarily suppressing it. Medication is given twice daily and improvement should be seen within the first two weeks of use. Cyclosporine is an expensive medication and there is tremendous controversy over whether or not generics are bioequivalent.
Cyclosporine tissue levels can be boosted with the concurrent use of ketoconazole, an antifungal drug. This "trick" can be used to cut the dose of cyclosporine and save money. There is controversy regarding whether blood levels of cyclosporine area helpful in determining dose and what the relationship actually is between tissue levels and blood levels. Because of the long-term use needed to control perianal fistulae, it is best to monitor liver enzymes or liver function tests in the patient; cyclosporine blood tests may or may not be recommended by your doctor.
Tacrolimus is a much stronger immunomodulator than cyclosporine and because it can be applied directly to the fistulae, high tissue levels can be achieved right in the area they are needed. The potential for side effects and expense is also much more favorable than that of cyclosporine but only 50% of dogs experienced resolution with tacrolimus alone after 16 weeks versus 85% with cyclosporine.
Another immunosuppressive protocol involves prednisolone, azathioprine, and metronidazole and is particularly helpful to patients with concomitant inflammatory bowel disease. This protocol is substantially less costly than cyclosporine but 30% of dogs can be expected to fail to respond.
Whatever the immunosuppressive protocol, it is best to re-evaluate the patient every 3 to 5 weeks to see if modifications are necessary. Most of the medications listed above are reviewed in our pharmacy library if more details are desired.
Surgery
Before the advent of cyclosporine, perianal fistulae were treated surgically with mixed results. Currently, surgery is only recommended for patients for whom immunosuppression has failed or where the anal glands are involved. The goal of surgery is to remove the dead tissue, prevent or treat any anal or rectal strictures (narrowed areas caused by scarring), and change the "environment" of the perineal region. Tail amputation may be required; in fact, in one study, tail amputation alone was 80% successful in preventing recurrence of the fistulae.
If the anal glands are involved in the fistulae, they will have to be removed. In milder cases, chemical cauterization of fistulae - which destroys abnormal tissue and allows normal tissue to heal - may be helpful. Cryotherapy, in which a freezing agent is used instead of a chemical one, has been less effective (more scarring, less control over the area treated etc.) Laser therapy, on the other hand, has been 95% successful in preventing recurrence and controlling pain (20% of patients developed fecal incontinence but most of these cases were controlled with diet).
The more extensive the surgery, the more there is potential for complications. Stool softeners are typically needed for a month after surgery and the owner should be comfortable cleaning the anal area. Fecal incontinence, narrowed anus, and inability to control the fistulation are the chief complications with surgery.
Despite innovations such as cyclosporine, perianal fistulae can be extremely frustrating.