Does anyone have any experience with treatment of fistulas?

I have an 8-year old bitch with a history of having an absess in the general area of the right anal sac for close to two months. The local vet has opened and cleansed the area three times and we've treated with Clavamox and metronidazole, with topical care such as hot compresses. This past time we thought the infection was resolved, but within a week of stopping the antibiotics, the infection returned. When the vet cleaned the area this morning, she saw something that suggests the presence of a fistula.

Has anyone had a Lab with this problem? How was it treated, and what was the success (i.e., Did the infection go away? Did the problem recur?)?

Any help would be really really appreciated! This girl’s really been through the wringer with this uncomfortable situation. Thanks!

You need a new vet!

What your dog needs is to have the glands removed. It is an easy surgery and it will take the problem away for good.

Yes, we currently have a girl who developed perianal fistulas (several actually) about 2 years ago. She became very uncomfortable when she had fistulas, crying and pacing until we gave her Tramadol. We treated her with a three month course of Keflex, Metronidazole, and chemotherapy to suppress her immune system. We also placed her on a grain-free fish based kibble. She had a remission of her symptoms for about a year. She had a recurrence, which we treated with a month of metronidazole. She has been symptom free for the past year. She is 12.5 years old.

We understood from the outset that chemotherapy treatment was likely to have temporary success and be expensive. We consider ourselves very lucky because some perianal fistulas result in death. Of course, recurrence still might result in her death, but she is now 12.5 and has two pretty darn good years.

As your vet no doubt has told you, fistulas are not the same as infected anal glands. However, the two often co-exist because of the auto-immune issues involved. Our girl had a bad anal gland infection as well as multiple fistulas. We presume that she also had other fistuals in her abdomen.

Thank you, yes, this whole episode seems to have started with an infected anal gland, but the infection has persisted for about a month after the gland became clear (i.e., when the discharge from gland upon expression completely normal now).

Would you mind telling me which chemo regimen they used, if you still have the records?

Thanks!

I had a rescued dog that developed them. I have heard they use an immunosuppressor (Atopica?) that sometimes works. He was gigantic so we did not try Atopica on him, just far too expensive, but perhaps your situation is different.

We tried a combination of prednisone and antibiotics, but it didn't really help all that much. Topical zinc oxide is reported to help manage them, but he wouldn't leave it alone. There is a European vet who treats them with a combination of doxycycline and imidocarb, and supposedly has permanent resolution in many dogs. He believes they are triggered by tick born diseases. I may still have his email address if you want it. You might have your dog checked for tick diseases just in case she has an active case of them. My dog's fistulas did regress while my vet did a round of this treatment, at one point he had only one small one left, but the regression was not permanent. We eventually put him down, but that was only one of his problems, bad hips, bad stifles, bad elbows, other immune system diseases. Too much to be solvable. I do think he developed the immune system problems as a result of a past tick disease, we don't have much of that here, but he could have come from anywhere.

My understanding is that the longer it goes on the harder it is to treat, so don't wait around.

Have you been here? http://perianal-fistulas.tripod.com/MainIndex.html

EDIT: Actually his email address is in this document. http://www.gsdhelp.info/auto/imidtarello.html At the time it was written he was not using the doxy in combo with imidocarb, but when I emailed him he told me he had added it to his treatment protocol. That was a few years ago, you might want to contact him yourself.

We gave cyclosporin which belongs to a class of drugs that are immunosuppressive agents and are used to prevent rejections during organ transplants and diseases such as Crohn's disease and rheumatoid arthritis. There is a cyclosporin (modified), which is somewhat less expensive, but I believe it is also less effective in treatment of perianal fistulas. Not all dogs can tolerate cyclosporin because it can have serious side-effects. But our dog did well on it. We tapered it slowly over a two month span after treatment with a full dose for a month.

We also used metronidazole which acts not only as an antibiotic but also an anti-inflammatory agent. Perianal fistulas are considered similar to an inflammatory bowel disease.

Keflex was used to treat the infections that seem to go hand in hand with perianal fistulas. We also cleaned her anal area thoroughly twice a day for three months.

And lastly it is important to strictly restrict diet to food that is unlikely to cause inflammation in the gut. We feed her Earthborn Coastal Catch grain free kibble.

We also gave tramadol as needed for pain. Our dog was in a lot of pain for a long time during her initial episode and then again during her recurrence (which we were able to limit to about 3 weeks with quick and aggressive treatment.

Good luck with your dog. I would be happy to talk with you about our dog privately. We have an outstanding vet who stays abreast of all the best treatments, and we trust him (and he trusts us) to try things that may be fairly aggressive treatments. You will need a good vet.

We had a GSD years ago who had many bouts with perianal fistulas... We used many meds,, which worked but they kept coming back... We finally elected to have cryosurgery done at Angell when they were in Springfield, Ma... It was a complete success. He never had another post surgery.