6 yr old intact male recently diagnosed with perianal fistulas...

[Elisabeth]

So, this last week my 6 yr old shepherd was diagnosed with perianal fistulas. I noticed blood when picking up his poo and was shocked to discover 2 sores next to his anus. Luckily there is a vet school with a teaching hospital here so was able to get him in right away and have him examined by a primary care vet as well as their dermatology department.

They put him on 100 mg of cyclosporine twice a day and will be rechecked in 3 & 6 weeks t and if things are getting better the dose can be tapered down and perhaps switched to cyclosporin with ketoconazole, and then maintained with a topical tacrolimus. I chose to go with the single med of cyclosporine to start off with even though it's more expensive because of the side effects of the two being upset stomach etc and would rather let him get used to one medication since he has had issues with loose stools before. Luckily there was no infection and he's not looking too bad according to the vet.

I have been cleansing the area with adult wet wipes after every time he goes to the bathroom, I did use a pet antiseptic cleanser and triple antibiotic ointment when first discovered the problem but since it looks clean figured I'd switch to something not as harsh on his skin. I am applying a&d ointment or desitin as well.

I was wondering what experiences people have had with treatment. He was miserable the last few days so I got benadryl and am giving it twice a day, he seems to be much more comfortable and I can leave the e collar off which is good because it makes him very sad looking. The on call vet said 50-100 mg twice a day as needed until the cyclosporin begins to help would be fine as well as a&d ointment or triple antibiotic ointment. He didn't know about using the desitin. I'm also uncertain about the desitin and whether it is a lot better than a&d or if it could make him sick. I've seen some people highly recommend it but the other night he vomited a white pasty substance, I don't know if it was a result of possibly licking at the desitin or if it was the medication, I tried to give it without food since they said it's absorbed better but has a higher rate of side effects than if given with food. I've gone back to giving it with meals just in case and only put the desitin on when he's going to have the e collar on for a while. Suggestions? I want whatever will make him the most comfortable as well as promote healing.

I am also switching him to natural balance venison and sweet potato, I had him on natural balance before but don't think he's had this kind and I see they recommend a new protein source. He most recently was on a more traditional food that had more ingredients etc. He has had issues with loose stools before and saw the vet this year because of it but they didn't know the cause and tests were all normal so they gave him an anti diarrheal until it settled down. It seems like the last year he gets this every few months and I've been giving him imodium as needed. There hasn't seemed to be a trigger for it so I assumed that my fiance had given him table scraps and that triggered it. Now that I see there might be a connection with bowel problems and perianal fistulas so maybe that was actually when he started having symptoms. I usually give him a treat ball and puzzle before I leave for work with grain free treats as well as a Kong with the Kong brand paste in it, his favorite is the cream cheese but he also has chicken etc. I don't want to take that away from him because it keeps him occupied while we're gone and don't know if the small amount of treats and Kong paste will detract from the benefit of the new food.

He is also intact, I've been arguing to get him fixed for years but my fiance seems to take the idea personally even though I told him that since he has a retained testicle he needs to have it out to prevent cancer. The vet he just saw gave me some information about cryptorchidism in dogs and I think I might be able to talk him into getting him neutered
now. Is it beneficial for purposes of the fistulas if he was fixed? I would wait until the disease is under control before doing anything. He doesn't have many of the intact male behavioral issues otherwise I might have been able to talk my fiance into getting it done earlier.

[LisaT]

I don't know if the retained testicle is related in any way...in general, I don't think neuter status is related at all to these things.

Sounds like you have done your homework. You probably then have found the yahoo PF-L list. There is more info here: Perianal Fistulas - GermanShepherdHome.net

My boy did terrible on the standard protocol, and had a very bad reaction to cyclo, he required combination antibiotics to heal his fistula. The key point will be whether the fistula gets better or worse on the meds, you'll know fairly quickly.

I did use Desitin, later switched to the version by Burt's Bees, and often rotated that with Preparation H, I also rotated between other alternative topicals I put into the fistula, depending on the healing stage. He spent *a lot* of time in boxers to keep him from bothering with that area back there.

[LisaT]

Jakoda will be by later, she had very good luck with cyclo.

[JeanKBBMMMAAN]

I know it's more common in intact males - do not know why, I was just kind of ticked because I have a female with what I just call "the boils" because it's a weird furunculosis which...seems like a cousin to PF (in my mind). But it seems to go intact males, males, females in order of occurrence from what I could tell, GSDs being #1 by a landslide in breed representation of the disease.

[LisaT]

I don't think we've seen a pattern on the list, other than predominantly GSDs of course. If it's pure autoimmune and responds to immuno suppressants, then it's genetic for almost sure.

There's some BS anti-speuter stuff out there that says it's more common in neutered males. The proof and the studies aren't there to confirm such a statement, don't believe it for a minute. I don't know enough about the causes of undescnded testicles to have an idea of whether that's related.

[gagsd]

Desitin mixed with viscous lidocaine ($4 at Walmart with a prescription) works well for my girl for pain.

Nothing has helped her with clearing them up.

[MountainGSDs]

I have a male that has been weaned down to 100mg cyclosporine and 200mg ketoconazole just Monday, Wednesday and Friday and he is 100% symptom free and all bloodwork is perfect including liver and kidney function. Tried single source protein and other hocus pocus none made a difference. I deal with the University of Pennsylvania. It's been at least 3 1/2 years now. Walgreen prescription plan is the cheapest around here. Other areas may be different.

[gagsd]

Roadrunner Pharmacy (online) had excellent prices when I was purchasing cyclosporin.

[LisaT]

Originally Posted by gagsd

Nothing has helped her with clearing them up.

That sucks, I'm sorry

I had to use a combination of 3 antibiotics, diet changes, homeopathy, and probably a few other things. I know there are some on tehd PF list that just manage them. Terrible awful disease

[arycrest]

This is a link to my favorite PF site BUT I don't know how up-to-date it is ... the latest date I found in the Memorial section was 2004 unless dogs aren't dying from it any longer???
perianal-fistulas

As a side note, I never heard of the intact vs neutered connection to PF's in males, but I would definitely have that retained testicle removed even if you don't get him fully neutered.