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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 23811
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My dog 105 pound Mix sheaperd, he has constipation which is

Customer Question

My dog 105 pound Mix sheaperd
JA: I'll do all I can to help. What seems to be the problem with your dog?
Customer: he has constipation which is related to what has been diagnosed as anal fissures....
JA: What is the dog's name and age?
Customer: Patrick 4 years old
JA: Is there anything else important you think the Veterinarian should know about Patrick?
Customer: He has been on Atopica for 2 months now for the anal fissures but doesn't seem to be getting better
JA: OK. Got it. I'm sending you to a secure page on JustAnswer so you can place the $5 fully-refundable deposit now. While you're filling out that form, I'll tell the Veterinarian about your situation and then connect you two.
Submitted: 3 months ago.
Category: Dog Veterinary
Customer: replied 3 months ago.
Anyone working on this?
Expert:  Dr. Michael Salkin replied 3 months ago.

I'm sorry to hear of this with Patrick. Perianal fistulas can be a challenge to manage. Immunosuppressive drugs remain the treatment of choice. It's important that his cyclosporin (Atopica) be maintained at blood levels of 400-600 ng/mL until all lesions resolve. 90% of affected dogs will respond successfully when that's the case. If he's truly refractory to cyclosporin, however, azathioprine may be effective - particularly in patients with mild disease.

To address his constipation he needs to be administered a stool softener such as lactulose which will minimize pain during defecation and prevent constipation in dogs with poorly controlled disease. Please note, too, that excision of lesions may be required in dogs with incomplete responses to immunosuppressive treatment. Laser ablation of lesions, cryotherapy, and en bloc resection have been reported with variable success rates. Please respond with further questions or concerns if you wish.

Customer: replied 3 months ago.
Can it be something other than fistulas? Impacted anal glands?
Customer: replied 3 months ago.
Expert:  Dr. Michael Salkin replied 3 months ago.

Fistulas are readily apparent in tissues surrounding the anus. They're often painful, ulcerated, and oftentimes with deep, draining tracts adjacent to the anus. Anal sacculectomy might be performed during surgical excision of fistulas but anal sac disease is not necessarily present in dogs suffering from perianal fistulas. I regret that the photo is too blurry to be diagnostic. Please try again.

Customer: replied 3 months ago.
Customer: replied 3 months ago.
Thank you... Since this is an autoimmune type of disease... Could changing diet help? Allergic response to something in food?
Expert:  Dr. Michael Salkin replied 3 months ago.

Thank you. Perianal fistulas.

Perhaps. Dietary modification is recommended in conjunction with immunosuppressive therapy. Novel antigen or, preferably, hydrolyzed protein diets should be used due to the suspected association between perianal fistulae and food hypersensitivity or allergy. This is best addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Patrick's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from his vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra (a hydrolyzed protein diet is my preference because it avoids the possibility of my patient being intolerant to even a novel protein). A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.

High fiber/bulking diets should be avoided; highly digestible (i.e., "low residue") foods that result in softer, smaller stool minimize pain during defecation in dgs with uncontrolled disease. Please speak to Patrick's vet about feeding a presumptive hypoallergenic diet that is also low residue. Such a diet may need to be formulated by a veterinary specialist nutritionist. Please continue our conversation if you wish.

Customer: replied 3 months ago.
Thank you. Good for now. Will continue as vet prescribed on atopica and try altering diet. Vet hasn't tested level of cyclosporine in blood. One last thing to feed medicine I wrap in cheese which seems to be the only thing that works... Cheese might also trigger allergic response (diary protein)... Better way?
Customer: replied 3 months ago.
Peanut butter doesn't seem to work...
Expert:  Dr. Michael Salkin replied 3 months ago.

It might but the most common offending food allergens are beef, chicken, corn, wheat, eggs, rice, and soy. Your vet might carry hypoallergenic treats that'll work.

You're welcome. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

Customer: replied 3 months ago.
Thank you again. Very helpful.
Expert:  Dr. Michael Salkin replied 3 months ago.

It's my pleasure.

Expert:  Dr. Michael Salkin replied 3 months ago.

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin

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