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Looks like a perianal fistula. Researching treatments.

Customer Question
Looks like a perianal...

Looks like a perianal fistula. Researching treatments.

Veterinarian's Assistant: I'll do all I can to help. What is wrong with the dog?

Started with bad diarrhea with blood and pus. Then, I got that under control but now she strains and strains to poop mostly unsuccessfully, although I am giving her pumpkin and pysllium husks to help move things along. Vet ( Not her usual vet, a new one that seems to have taken over the practice.. I am not so sure about her,,) She has been on metrodiazanole and on an antibiotic now. She suggested doubling up on my dog's Apoquel to see if it helps too. I don't think we are getting anywhere much except for improved stools. My Shepherd has been allergic to many food protiens all her life. She is currently eating Royal Canin's hypoallergenic food after many years on Science Diet's ZD which quit working in the last year or so. She has always tolerated pork products, but I am beginning to wonder about that too. She is back to licking her paws and her lips are puffy as well. We have gone through allergy shots and had some relief with Apoquel... until this.

Veterinarian's Assistant: What is the dog's name and age?

Heiko. ( Hee koh) She is a ten year old White German Shepherd. Yep. I know. I have heard it all about Shepherds and White GSD's in particular.

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about Heiko?

She has had two ACL surgeries. She has degenerative arthritis in her spine. Her desposition is as sweet as can be, and she is a real trooper through all this. I am trying to decide if Atopica is the route to go, or whether there is a holistic alternative that might work. She is so immune compromised.

Submitted: 10 months ago.Category: Dog Veterinary
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Answered in 9 hours by:
9/30/2017
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 10 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 35,544
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 10 months ago

I'm sorry that your question wasn't answered in a timely manner. Because perianal fistulae are addressed with long-term immunosuppressive agents, it's essential that they be confirmed before initiating any treatment. Cyclosporine successfully control perianal fistulae in 90% of affected dogs. Concurrent ketoconazole administration permits cyclosporine dose reduction. This stategy permits large reduction in cost of treatment but ketoconazole-associated anorexia or hepatotoxicosis (liver toxicity) may require discontinuation of this drug. Alternatively, topical 0.1% tacrolimus with dietary modification* can be used in dogs with mild to moderate disease or as maintenance therapy following remission. Azathioprine until resolution of all lesions may be effective in some dogs, particularly those with mild disease. Prednisone is effective in ~33% of dogs.

*Novel antigen diets should be used due to the suspected association between perianal fistulae and food hypersensitivity or allergy - an important consideration in Heiko. High-fiber diets should be avoided; highly digestible diets (i.e., "low residue") food that result in softer, smaller stool minimize pain during defecation in dogs with uncontrolled disease.

Please respond with further questions or concerns if you wish.

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Customer reply replied 10 months ago
Thank you. I had a feeling about modifying her diet again, and wondered if the fiber and pumpkin was a good idea now that her diarrhea has cleared. I am going to call the vets office now, and work on a new protocol.
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 10 months ago

You're quite 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.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 10 months ago
Hi,

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

Dr. Michael Salkin
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