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Discussion Starter #1
Pimg was just diagnosed with perianal fistulas and I've read that it's important to switch the dog to a single source protein different from what they are currently eating.


  1. Does 'single source protein' simply mean only fish, or only chicken, or only one protein source (rather than a blend like TOTW's 'duck & chicken' Wild Wetlands)?
  2. What about the fact that protein is often added to pet foods from vegetable sources like peas? Does this affect the single source protein?
  3. Or does 'single source protein' really refer to feeding raw in some way, shape, or form?
Pimg is currently eating TOTW Pacific Stream but since the medication is so expensive, and since apparently it's important to change the diet, I think I'm going to try out (Costco) Nature’s Domain Grain Free Salmon Meal and Sweet Potato hoping to save a bit of money while we figure this thing out.
 

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Im almost positive single source means ONLY fish, ONLY chicken, ETC. Just one protein in the food, not a blend of different proteins. Your other questions...I am not sure. I dont think it requires you to feed raw, but vegetables...hm. Did you ask your vet? Sorry to hear about Pimg!

Pimg was just diagnosed with perianal fistulas and I've read that it's important to switch the dog to a single source protein different from what they are currently eating.


  1. Does 'single source protein' simply mean only fish, or only chicken, or only one protein source (rather than a blend like TOTW's 'duck & chicken' Wild Wetlands)?
  2. What about the fact that protein is often added to pet foods from vegetable sources like peas? Does this affect the single source protein?
  3. Or does 'single source protein' really refer to feeding raw in some way, shape, or form?
Pimg is currently eating TOTW Pacific Stream but since the medication is so expensive, and since apparently it's important to change the diet, I think I'm going to try out (Costco) Nature’s Domain Grain Free Salmon Meal and Sweet Potato hoping to save a bit of money while we figure this thing out.
 

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Discussion Starter #3
I did not have the questions/knowledge needed when initially diagnosed at the vet's office.
 

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Ah gotcha, well based on some quick research I just did....it says for perianal fistulas you wanna put the dog on a protein it hasnt tried before (for example fish, venison, rabbit etc) and one carb (potatoes for example) I cant find anything about the vegetables with protein, or any other smaller source of protein in the kibble affecting that, but maybe try a limited ingredient diet.
 

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What you will have to do to truly get a one protein source food is go to prescription diets-royal canin, hills, purina, Iams-or do a home cooked diet. Even foods labeled as such OTC are not truly free from other protein sources because they are made in the same dog food plant as the other brands' foods and therefore contaminated.
 

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Willy, gsdlover is correct, a 'different' protein source, however, FIsh is one that alot of the pf people recommend..So honestly I couldn't say whether I would change pimg's diet or not..

I know I told you with mine I did not change the diet, but then again, mine were not 'true' PF disease.

I'm not sure I asked you, or if I did, I forget,,did Pimg have any anal gland issues? or did the vet say anything about her glands when you brought her in for the pf's?
 

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Discussion Starter #7
Pimg's been on TOTW Pacific Stream for a while now. She does really well on it, and I'm not so thrilled about having to change it (especially since she doesn't tolerate change well). I decided to pick up the Nature's Domain Turkey & Sweet Potato (grain free) from Costco after work and will fade that in. I wavered on the Salmon vs Turkey formula, but what's the point of changing if I don't change protein? (Other than cost savings.) I'm really tempted to go to Fromm 4 Star Duck & Potato. Same basic nutrition as ND and TOTW, but with Fromm quality. If money were no issue...


Diane- no, the vet said nothing about any anal gland infection, and she did express them. Seems like she would have noticed an infection and mentioned it.
 

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but did she 'need' them expressed? I guess that was what I meant...has she had anal gland issues? like needing them expressed alot?

I swear , and my vet agrees, to much expressing of glands can exsasperate (sp) the problem...the gland issue I mean.

My first one, I went to a quack, this was way back, so PF's wasn't really mentioned much, he kept expressing Jake's glands which finally made the gland un viable, it basically turned into a hard walnut:( When the surgeon removed them, he said, the gland was non functioning, and by continually expressing just made the whole thing flair up more..just something to ponder.

Are you seeing any change with the atopica??
 

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Discussion Starter #9
I've only ever gotten it done one other time in her 7.5 years, and I wasn't there for it. I think she had a week long bout with diarrhea or something, and the vet decided to express them for some reason. I don't really remember, and I no longer go to that vet.

Anyway, I would say that she might have needed them expressed. The vet asked me if she had an odor about her, and I didn't think she really did until I smelled the room when she was expressing them. She did kind of have that smell a lot. So she might have needed them done.

A change with the atopica... well, I don't really know. It's hard to answer you see because Pimg didn't SEEM to be in a lot of pain. I took her in because she was constantly licking her butt and had licked it raw. (Sure, I guess that's a sign of pain.) But this wasn't a "don't even think about lifting my tail up it hurts so bad" kind of pain. The vet said that she had only one fistula, and it was quite small at that; she missed it at first inspection.

Pimg is still attempting to lick just as much- though I'm not letting her and (sadly) putting the cone of shame on her when I leave for work. She still has kind of labored defecation. So I'm not sure I've seen a whole lot of change yet. But she's only been on it for two days. Her raw butt area does seem slightly better with the Otomax ointment.

How soon should I expect results with the Atopica?
 

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I don't have first hand experience with using it for PFs but I know in skin allergies it takes 4-6 weeks just for comparison. I know some people use tacrolimus with good results. Ketoconazole can sometimes be combined with atopica to lower the dose (aka make cheaper) too.
 

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I agree with ugavet..I saw results after about the first month and a half..

When the licking drops off, that's a good sign...I would use the desitin it worked WONDERS..not only for licking, but healing the fistula,,put some on a q tip and put it IN and around the fistula..

Mine never really were in "pain" either..I'm sure it is painful, and more irritating than anything unless it's really severe...

Pimg sounds like having just the one, if ya gotta get em, is a "good" thing, vs having a bunch ...She's licky because it's probably ooozy..
 

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Discussion Starter #12
I *KNOW* better than to change Pimg's food. I now have a deep dark brown stain in my living room carpet from a pile of vomit that included only undigested Kirkland kibble from early this morning. At least she vomited this up before bloating like last time I changed her kibble. And lest anyone think I switched to fast, I certainly wouldn't think so at 66% old, 33% new...

Sigh... back to TOTW Fish (which is probably fine anyway)
 

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Discussion Starter #13
If it were the Atopica that made her vomit, I would have expected that much earlier in the day. I fed her at 8:20am, and gave pill at 8:40am. She vomited at 8:20pm. We did just come inside from playing fetch outside in the heat, but she had plenty of water
(which she drank) and plenty of down time to recoup. Man, she is so intolerant to diet change.
 

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Atopica is known for causing stomach upset in the beginning. It works better on an empty stomach but for the first several doses most need it given with a full meal. It can still be that even hours later.
 

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Discussion Starter #15
My point was that she threw up 12 hours after giving the pill. Surely that can't be pill related??
 

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My point was that she threw up 12 hours after giving the pill. Surely that can't be pill related??
Certainly can and probably is.

I have a young dog on cyclosporine/ketoconazole treatment for reoccurring PF. Dog is on a single protein fish based food. Dosed every other day or every 2 days - he will vomit occasionally when given medication. It is not food related and vomiting is associated with administering the medicine. My dog experiences quite a few symptoms with cyclo/keto: extensive hair loss with sped up shed/growth cycles, vomiting, lethargy, diarrhea, mood changes on daily dose that has tapered off as dose lowered. However, it's the only medication that can keep the PF under control and allow him to have comfortable bowel movements so we just have to take the side effects in stride...

Cylcosporine takes a longer period of time to influence a response in the dog and takes awhile to establish standard blood therapeutic levels - one reason why PF dogs are sometimes started off on steroid treatments first combined with Cyclo/Keto as the steroid treatment will result in a quick response with the cyclo taking a longer period of time to enact a change resulting in a two fold approach to quickly bringing the disease under control. I think you should discuss the addition of ketoconazole to your treatment plan as keto allows you to drastically lower the dose of cyclo which will be much more cost effective for you. Cyclo is cleared fairly quickly and efficiently by the liver - through a mechanism not entirely clarified yet, keto allows for slower clearance of cyclo by the liver meaning the cyclo stays around in the blood for longer at a higher therapeutic dose than without concurrent keto administration. Allows you to give a smaller dose of cyclo and save money on treatment. Most/all recent literature cites cyclo/keto treatment as the best option for PF right now.

Good general game plan for a PF dog:
-clip and shave the hair around the perianal area. Let the area breathe so bacteria is not trapped by the hair.
-wipe the dog with a baby wipe after bowel movements. Helps clear the area of local bacteria
-spray the perianal area with Vetericyn and apply Desitin to the fistulas.
-continue with cyclosporine treatment until you start to see complete elimination of the fistulas. Keep the dog on the meds for at least one month after you see complete disappearance of the external PF as the deep tunneling tracts of PF can extend very deeply into the dog's viscera and you want to make sure there is complete reduction of the fistulas.
-Once the PF are under control, find a maintenance dose that works for your dog. I've known dogs that never needed to be on cyclo again after one round of treatment, and there are dogs that need to be on the meds the rest of their lives. Will have to fine tune and see what works.
-regular blood/liver panels to monitor the dog as the medication can cause issues in some dogs
-single protein diet. Avoid changes or numerous sources/additions. Adding bulk and probiotics can be helpful
-I don't vaccinate my PF dog at all.
 

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Discussion Starter #18
Thanks qbchottu. It must be the medication... she's thrown up three times tonight, poor girl. I've retired her to the crate for the night so hopefully the lack of movement allows her stomach to settle. Wow, this sucks so bad. Her PF isn't even that bad!! I decided not to give her the pill tonight. Just doesn't seem right to keep giving her the medication that's causing her to throw up multiple times! Hopefully her stomach has calmed down by the morning, and I can give her a dose then.
 

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willy, yes one of the side effects of the cylco is vomiting and diarhea. She just may not be able to tolerate it:(

I'd check with the vet, see if they recommend an alternative.. I probably would keep her on the same food because even tho you changed it slowly, changing the food and the cyclo could have upset her stomache especially if she is sensitive to food change.

Hope she feels better this morning..Honestly, if ME, and she has only one small fistula, I wouldn't have been so fast to throw her on cyclo, I probably would have gone with a heavy duty antibiotic, the vetericyn which is a good idea and the desitin and gone that route for a couple weeks to see if there was any change.
 

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Discussion Starter #20
Got a callback from the vet; she was not too concerned about the vomiting and said Pimg should even out in a few days. She told me sometimes freezing the pill can help (so I'll try that tonight). After that, she was concerned with Pimg's addison's suggesting that the higher stress of the cone (and Pimg's plenty stressed having the stupid cone on her head) might be contributing- so up the pred a little bit. After that, she suggested an anti-vomiting med. And finally if none of that worked, she suggested ketoconazole. She didn't want to jump right to the ketoconazole because of its affect on the kidneys. She prefers to not use it if possible.
 
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