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Doc Sara
Doc Sara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 952
Experience:  I am a dog and cat veterinarian with a lifetime of experience in our family veterinary hospital.
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I have questions about treatment fistula, which began around

Customer Question

I have questions about treatment for perianal fistula, which began around four weeks ago.
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Doc Sara replied 1 year ago.

Good morning - I'm Dr. Sara. I'm a licensed veterinarian who works exclusively with dogs and cats. I'm sorry to hear that Max has developed perianal fistulas. Perianal fistulas are quite a frustrating problem to manage, but it is possible.

We usually start with a course of antibiotics and possibly some prednisone. Since these are open wounds, it's not uncommon for them to become infected - sometimes clearing up the infection does a world of good. Prednisone is a potent anti-inflammatory and in some cases if the fistulas heal well with prednisone, they may not recur for quite some time. Perianal fistulas are a poorly understood inflammatory disease that is still considered "idiopathic" - that is to say that we don't know exactly what causes the inflammation. Unfortunately the majority of dogs with perianal fistulas will need maintenance medication to keep their fistuals under control. The most commonly used medication for this is Atopica (modified cyclosporine). Atopica is given once a day for at least the first month. If the pet is doing well after that i can be tapered to every other day and possibly twice per week, but often it can't be lowered any more than that or the fistulas will recur. Another bit of bad news - Atopica can be expensive in the long run. For most pets, though, it does keep the fistulas under control quite nicely. Sometimes we combine Atopica with a drug called ketoconazole to allow us to lower the dose of Atopica and save some money, but recently the ketoconazole has gone way up in price and it's not quite expensive as well. For smaller lesions, I've had success keeping them controlled with a topical ointment called tacrolimus. This is a local anti-inflammatory that can handle smaller or less active lesions. Prednisone is an option too, but it doesn't always keep the symptoms under control and the side effects are tremendous. In the short term the pet will be excessively thirsty and hungry, but in the long term prednisone administration at the doses needed to control fistulas lead to liver troubles, poor hair coat and hair loss, muscle weakness, pot belly, immunosuppression (making them more prone to get infections of all types), and even diabetes. In some severe cases, we need to perform surgery to "clean up" the rectal area and remove dead tissue in conjunction with medical treatment. Another thing commonly recommended is a switch to a hypoallergenic diet.

Here is a bit more information from the American College of Veterinary Surgeons:

I hope that this helps - please let me know what other questions I can handle for you :)

~Dr. Sara

Customer: replied 1 year ago.
I don't know where to begin.
I must not understand how this service works because when I originally made my inquiry, the site displayed a different veterinarian. I made my decision to use the service based on this person's credentials and experience of forty-three years.
So I am a bit confused as to why I am hearing back from a vet other than the one to whom the message was addressed. Secondly, this service seems to limit characters in a message and there was no way to ask my question and provide the necessary background information within those constraints. So I mentioned what the topic was, but there was no question. My question is more in-depth and technical which is what I thought the purpose of speaking with an expert was. Respectfulluly, everything you stated is on the Web and common knowledge. I blame the service, not you. But I can not rate or pay for the service when I have not received the service. Thank you.
Expert:  Doc Sara replied 1 year ago.

Thanks for your reply - I can help. The site is set up to be a "live chat", so you can enter as much information as you wish into the text box and send it. If you can't include it all in one message, you can send multiple messages. We encourage you to chat with us so that we can cover all of your concerns. We have to know your questions so that we can answer them :) If your requested expert isn't online at the time you ask your question, the site sends an email to the expert, then waits a predetermined amount of time (I'm sorry, I don't know how long - I'm a vet not the tech guru, haha!). If the expert doesn't reply in a certain amount of time, the system alerts the whole expert community to the availability of the question, since the idea of the service is to connect you with an expert to chat and get you your answer ASAP, not keep you waiting around until your expert gets online. I'll forward your question to customer service and they will handle forwarding your message to the expert that you requested.

Thanks and best of luck :)

~Dr. Sara

Customer: replied 1 year ago.
Thank you for your reply.
I had used this service only once before and recall my follow-up messages being overlooked to the point where I had to repeat myself and ask the question repeatedly because they'd only read the first message. Considering this was a medical issue, I wanted to ensure that did not happen again so I could include all pertinent details straight away. Thank you very much for your response. Your explanation was very helpful regarding the way the site works. I wish it had said it to.begin with. I don't mind directing my questions to you if you have any knowledge of alternative treatments for this condition, such as herbs or traditional Chinese Medicine or anything you know of that may not be the standard recommendation, but may help without going the route of heavily taxing the systems of.the body of the animal. Thank you. And please understand that I do not doubt your expertise. I was searching for someone who may have more experience in alternative veterinary medicine. Any suggestions you may have are welcome.
Expert:  Doc Sara replied 1 year ago.

Thanks for being so gracious - I haven't experienced first hand how the site works from your side (yet), so perhaps your feedback would be useful to the tech wizards after we are through!

Unfortunately, as much as I wish I could help, I'm not trained with Chinese herbals or eastern/complementary medicine. I've always wanted to do the appropriate training but it actually takes months away from work, which I can't afford at this point in my career :(

One thing that I do use in my practice quite often, though, that I appear not to have mentioned above is laser therapy. Laser therapy consists of treatments done at your vet's office in a series. Laser light is applied to the area and has potent anti-inflammatory and healing effects. I have seen wounds that I never thought would heal improve tremendously with laser therapy. One of my technicians adopted an aged German Shepherd with perianal fistulas a few years ago and we maintained him for a good long time on twice weekly laser therapy and tacrolimus. Laser therapy typically starts with an induction phase of two to three treatments a week until the lesions are looking significantly improved, and then the treatments are spaced out to the least frequent interval that maintains the disease. The brand of laser we use is the Cutting Edge MLS system. Another very popular one is the LiteCure Companion Therapy Laser. There are many other lasers out there, but those are the two I'm most familiar with.

I would also expect that acupuncture could have beneficial effects on perianal fistulas, but unfortunately that's another discipline on my list that I've not yet had a chance to explore! The International Veterinary Acupuncture Society is one of (if not the) most respected certifying bodies for acupuncture vets. I would check their website to help you find a vet in your area that is trained properly. The Holistic Veterinary Medical Association can also help you find a vet in your area with an interest in holistic and complementary medicine:

I'll opt out of your question so that it shows as available to other experts in case any have herbal/traditional Chinese medicinal training :) You can also continue to reply to me if I can clarify anything that I've touched on here.

~Dr. Sara