AJAX
Our Dog's Fight Against Perianal Fistulas
A Continuing Story
AJAX VON EBBA
We lived in one home for a couple of decades, then sold too quickly so ended up in an apartment, then moved eighty miles north because our daughter (a professor in Japan) decided to marry there and we knew we couldn't handle the international wedding unless we were there. Ajax had a rough time in the first place, was fine in our house in B'ham, but due to professional reasons we moved 1/2 way back to Seattle thinking that would be the answer to all of our problems. Instead, it was one nightmare after another, so we ended up moving back to the same area (9-97) where we had lived for decades. We do hope that it's our last move.
Ajax was slightly over one year when he experienced his first move. He seemed happy, vital, fun and no health problems until he was four years. Then he began to manifest intestinal problems that were diagnosed as colitis - only serious bout was one in '97. The explanation was nerves due to boarding ( he was kenneled approximately every three to four months for three days). I bought it. We had been here approximately 7 months when we had an emergency in Japan and had to leave immediately. It was the first time that I had not gone through a "prep" time with Ajax. He was dropped off at the vet/kennel that day and was there for almost three weeks - the longest ever for him. He showed up with diarrhea and soft stools. The vet assumed that it was nerves; it was not. It was the first development of a PF. Of course I didn't know for at least six weeks what was going on.
He was diagnosed locally - the same vet hospital we'd gone to for 20 years. They warned us that their experience was limited at best. There was a surgeon in Seattle who recently had dealt with a dog with PFs, but because that's also a distance for us, we opted to take Ajax to Washington State University, Veterinary Teaching Hospital (one of the best in the country), in Pullman on the other side of the state. We had the opposite experience that you did. WSU has been like a dream and our local vet like a spoiled child who didn't like the idea of giving up control.
The local vet tried the iodine (called chemical infusion) in late June. It almost killed Ajax. WSU stepped in and put Ajax on Cyclosporin. It just so happened that Ajax' soft tissue specialist knows the researchers who did the study and wrote the paper on cyclosporin. Ajax was put on Clavamox (after his culture showed that he had a resistant secondary bacterial infection that was serious) along with the cyclosporin. The rule was that he had to show no PFs for six weeks before going off the cyclosporin and clavamox. Ajax was at WSU in July and then in August and unless something came up he was to stop the meds Sept 3rd.
Unfortunately from June on, Ajax was showing blood in soupy or very soft stools. It did not go away and at that time I had him on a diet that I considered excellent (a mix of ten veggies, plus cheese, venison/rice and lamb/rice, plus a variety of vitamins and minerals). I kept telling myself that once the PFs were healed that it would stop. It didn't.
In late Sept, after he was off his meds, he showed up with an anal sac infection. He was put on antibiotics while a culture was done, but the bacteria was resistant to those antibiotics, so he was put back on clavamox, a first generation antibiotic. By the time we got to WSU (October 5th), the anal sacs were still infected and also impacted, even with the antibiotics. They were surgically removed; happily there was no sign of PFs developing. During that time the soft team specialists brought in the head of internal medicine that organized another team to evaluate his intestinal problems. He had extensive scoping done to determine whether or not he had cancer or to what extent the colitis had damaged his intestinal area. They found three places that were significant, but wanted to "wait and see" how Ajax did following his surgery.
Ajax had incontinence for almost a week (not bad), but his major problem was soupy stools and blood. After realizing that this could not be from the surgery, I e-mailed Dr. Seguin who immediately consulted with the internal group. They were very concerned. Ajax was put and continues to be on the following:
1) A new food called Pinnacle (chicken and potato) that he is now completely on, as of today (it took ten days to switch him over). 2) 2T of Metamucil (1T in a.m. with food, 1T in p.m. with food) 3) 1000 mg of Sulfasaline at 6:00 a.m., 2:00 p.m., 10:00 p.m. (total of 3000 mg) with food and a lot of water. 4) All of his water is purified (we use Brita), including drinking water and anything added to his food. 5) 1 1/2T Lipiderm, 2000 mg sodium ascorbic, 830 IU Vit E.
That's it! He is not allowed any other food at all, only his dog food - no biscuits, no veggies, no treats, no nothing.
He was losing weight at a pretty fast clip, but now with him eating four times a day, plus "crunchies" (his dog food dry) he not only stopped losing weight, he is gradually gaining. :)
There has been no blood in his stools for three days (that is unbelievable for Ajax) and we are crossing our fingers that this will continue.
His stools are softly formed - that too is new and has been going on for two days.
I don't really know where the cart and horse are in Ajax' situation. Did he already have a propensity to IBD that was exasperated when he took the cyclosporin? Are the PFs related to the intestinal disorder? How do anal sacs play into it? There are two studies going on now to determine some of this or at least to "discuss" correlation. Personally I believe that all these are contributors, but play different roles. Certainly the lowered immune level can create an environment, but I am learning, after much discussion and research, that measuring the immune system accurately, is close to impossible. I tried and had a bunch of tests run on Ajax, but the bottom line (mostly analyzed at Michigan State) was that there really isn't a definitive measure due to the variables that have to be considered. :(
It's possible that Ajax is in the beginning stages of a new PF. It is too early for me to tell, but I am examining him periodically during the day, washing him and waiting. There are a couple of irregularities, so I took a photo of his behind which I will forward to the vets at WSU (if the developers won't have me arrested!!!!! :)).
The bleeding, the pain and the deterioration caused by the IBD is such a nightmare and so difficult to correct. It drains everyone. Oh! I also used Rimadyl occasionally for Ajax.
The vets that I am working with (locally and at the university) are very specific about treating him. I am to use water only with an unusual exception of cutting a Vit E capsule and applying that oil on his rectal area.
At first I balked, but fortunately their "treatment" or non-treatment if you will, is working. So, all of my home remedies (and I have a bunch of them), from additional nutrients to external applications are on hold. I guess I cannot complain since Ajax has improved and hopefully this more recent concern about the beginning of a PF will not materialize into anything at all.
I know that all vets have their own theories and philosophies regarding treatment. The two teams at Washington State and the local group were all reluctant - no, I'd say extremely reluctant - to put Ajax on Prednisone. Although there was evidence that prednisone could be effective toward treating the IBD, the side effects to the organs was too risky so they chose an alternative.
Would I use cyclosporin again? Absolutely. Would I use cyclosporin in order to maintain the recommended levels in the blood that were first considered necessary? Absolutely not! Luckily WSU, rather Ajax' lead vet, was in regular contact with the researchers. When Ajax began to have an adverse reaction, they were contacted and stopped his cyclosporin immediately. He was then slowly put back on, but only reached 1/3 of his previous dosage. He was monitored and the lower dose was more successful than the higher dose. Of course Ajax had the advantage of the researchers' knowledge and advice, but I do believe that given properly, cyclosporin can be an effective drug without the horrific side effects. They were also adamant about including a first generation antibiotic to parallel the cyclosporin treatment.
Oh! Ajax also did his share of vomiting, but I doubt if it was at the same level that Anka endured.
Marty :) and Ajax :-]
For a detailed look at the email diary on Ajax read below.
The following are Marty's emails DJ kept as a Journal
(Marty serves as a great example of how much we love our dogs.)
Date: Thurs, 25 Jun 1998
I learned 6-23-98 that my 6-yr., male GSD has perianal fistulas. My vet said that Ajax was at the beginning stages of it, but I felt rather stupid having three former GSDs and didn't know a thing about it. I took Ajax in because he seemed determined to have very soft stools that began to show with slight red blood on one side. He had been kenneled for three weeks (first time he had been away from me for that long a period) and began showing loose or worse stools; but they were inconsistent. By the time I returned from Japan, we (the vets and I) believed that his condition would correct itself. We all assumed it was a similar condition that he had manifested over a year before that we thought was caused by stress. When he didn't get better, a vet (at the same clinic who was new) prescribed a mild antibiotic that did a band aid approach and Ajax got slightly better. Several weeks later I had to kennel him again for four days and Ajax, this time, had consistently soft but not runny stools. Since I always "pick up" after he has had a bowel movement, I had a good idea what he was eliminating.
His diet was variable, including many cooked vegetables such as broccoli, potatoes, squash, peas, cauliflower, some rice, slim amounts of chicken or turkey, plus his dog food which I mix: venison meal and rice (Nature's Recipe) and lamb meal and rice (Natural Choice), plus Lipiderm (Omega 3 fatty acids).
I began mixing non fat shredded cheese in his diet hoping that that would help firm his stools, but they continued to be consistently very soft or formless but not runny. That was when I began checking his behind and at first thought that he had a blood blister, small, on one side of his rectum. I began washing him with a solution of dial soap and using Neosporin, but I really didn't have any idea what I was doing.
When nothing improved I took him to my vet (it's a clinic of six vets; they know me well as I've been going to them for twenty years). My Vet at first thought that it was a bacterial infection similar to what he had had before, but when he examined him closer, he discovered a fistula 3.3cm. At this point he prescribed antibiotics for the intestinal infection, Metronidazole, 500mg 2x daily; Cephalexin 500mg, 2x daily for the anal infection, and is waiting for results of the culture.
My vet told me that he had not seen a perianal fistula in ten years and that he had to believe that there were some updated treatments that he was not up on. He suggested doing a cauterization once we got the bacterial infection controlled, told me to stop giving him everything except his dog food and Lipiderm (Ajax' stools are already solid and formed after 48 hours) and wait for the culture. He said that he wanted to be aggressive in his treatment, hoping that he might be able to correct at the beginning stages of the condition. Van said that otherwise it could develop into a terrible, agonizing condition.
My questions to you are:
Do you know of any specialists in the Pacific Northwest (I live in the Seattle area)?
If not, how would I go about getting the best treatment for him? I know that the longer I wait the more serious this will become.
I would truly appreciate any and all info you can give me. Ajax is the light of my life. I don't want to lose him, but I also don't want him to suffer and go through the agonizing pain that I am now learning about that perianal fistula serves.
The vet said that it was a rare condition usually idiosyncric to GSDs and that he had not seen the disease in 10years.
Date sent: Sat, 27 Jun 1998
DJ's ResponseHi
I forwarded your email to Carolyn Lavengood (one of the founders of the Perianal Fistula Support Group. She may know of someone in your area you could contact.
Suggestions in the meantime include;
Rubbing pure Vitamin E oil on the PF site
Sitz baths
Betadine wash to kill bacteria in the area
Oral Vitamin E (build up to 800 IUs)
Vitamin C (build up to 500 mgs)
Carolyn will have more info for you and a lot of the necessary information is found in her article on the PF homepage in her letter.
Date sent: Sat, 27 Jun 1998
Thanks for the info and forwarding my email to Carolyn.
If it's pure Vit E oil am I correct in assuming this would be capsule form? Is this used as an external healer along with the 800 IUs (eventually) taken internally?
I gave Ajax sodium ascorbic (C) until last November when I gradually reduced to zero (he was 5 1/2 yrs in Nov). Ajax began on the C as a pup, was gradually increased to 2000 (1000mg, 2x daily), at four years reduced to 1000mg, (500, 2x daily) and then from 5yrs to 5 1/2 reduced to none. The recommendation was to use the sodium ascorbic rather than ascorbic acid because it was easier on the animal's digestive system and his breeder believed that C could resist any tendencies, if there were some, of dysplasia to occur. It will not be a problem to return to 500 mg as I still have some here.
I still give Ajax, Lipiderm, a fatty acid supplement that has the Omega 3 and 6 fatty acids, plus Vit A, E and zinc. The E is minimal (in his daily dose of 2T, he only gets 60 IUs) so I'll simply supplement. Do you know how quickly I should increase the dosage?
Sitz baths????? Yikes! He'll probably do it, but it may be a challenge. Maybe I'll get a kiddie pool. Is there anything that I should put in the water or is the water the primary focus?
Betadine wash? I called my pharmacist and he said that they vary in potency. I have been using an anti bacterial dial soap solution three to four times a day, so according to the pharmacist I'm on the right track with the Betadine being a bit stronger. Do I rub the Vit E oil on him after each wash?
My vet suggested using Huggies baby wipes for sensitive skin (they have oat extract etc) when we are out and about and I don't have the luxury of slopping about with the solutions.
Ajax is six years old on June 30th. Prior to this situation, he has only been ill once. There is nothing on either side to indicate that this condition is via genes. My theory is far fetched but I think it has to do with a nervous, explosive intestinal track that was not treated aggressively enough when needed and I was too ignorant and did not have enough information about the GSDs rectal area and the down side to counter anything that was happening. Shame on me. Hindsight so 20/20 doesn't do my fourth and great Ajax a darn bit of good. This is such a serious disease there needs to be a way to educate owners about PF so that they are aware and might be able to do something.
Date sent: Sat, 4 Jul 1998
I feel as if I've been on a marathon and trying to be as quick a study as needed to make some very serious decisions involving Ajax. Between the office, my daughter and my 18 mo. old granddaughter arriving here tomorrow from Japan and living here until she finds a position statewide (she was a professor over there), plus Ajax, I feel as if I don't have quite enough oxygen!
I've spent the majority of last week on the web, on the phone, reading information and materials; or with Ajax at the vet, playing, hugging, sleeping, cleaning, feeding, grooming and talking to him. He was definitely at the top of my priority list. Much to consider and although I'm trying to be a quick study, sometimes not quick enough.
I did decide to let my local vet do a chemical infusion (iodine). He had done them before and I thought what's the harm. In retrospect, it was a mistake that could have cost Ajax his life. I will not go down that road again. I knew that the iodine is toxic, so one of two things probably occurred. Either Ajax is sensitive/allergic to the iodine (which could be possible because the only time he licks himself is after I put the Betadine on him), or the vet (who hadn't treated PFs in ten years) didn't inject it properly and it got into his system (as he was injecting - I was there holding Ajax - he exclaimed that it was alot longer than 3.3 cm as he had previously measured and that there had to be a big hole because all of the fluid went in so easily. Aagh!!
Whatever the reason, Ajax was as close as I hope he'll ever come to giving up. It's strange because I watched one of my GSDs die from a reaction to some anesthetic when he had his teeth cleaned at 11 yrs. A bunch of years ago a friend had a vet hospital locally (he's moved since) and I used to help him out. He did lg/sm animals, but was uncomfortable around big dogs that had been hurt. So he'd call me and have me come down. My only point in this extra chapter is that I've seen many dogs die which is the unfortunate part of care giving. When Ajax began reacting, I knew and can't remember when I have been so afraid. At that point there was nothing to do except wait and see if Ajax could rally. He did after fourteen hours and after 48 hours was back to his crazy, happy self. Instead of passing clumps of blood and mucus both clear and bloody, he's producing color constant, formed yet soft with minute hints of blood. Can dogs be tested for that (I know that it's poisonous/toxic) or is the more logical explanation that the vet messed up? Whatever the reason, no more of those for Ajax!!!!!!
I decided to go beyond the Seattle area and began talking to researchers and vets nationwide. One researcher from Cornell gave me a long list of references (I think that she thought I was a vet), but I haven't figured out how to tap into them unless I can get access to a veterinary library. It is interesting and would be even more intriguing if I weren't so emotionally involved. There are a lot of studies out there, a lot of information to integrate. Shame on the AKC and the GDS organizations for not communicating this possibility. Information and education are keys to this - not that there are any magical answers, but the more information and research, the better able the vet community is in dealing with it along with informed owners. Think how many problems could have been prevented?
I am now working with a group of veterinarians at Washington State University. One (who seems to be a master at smoothing feathers) is working with me and my local vet who doesn't like the idea that his "expertise" is being questioned. He's a defensive guy, made some weird comments putting down the importance of doing the thyroid test and why go to MI because most of their test results aren't relevant anyway. In most instances he is outstanding, but frankly I don't think that he has enough recent information on PFs, making him defensive. Anyway, like it or not, WSU is at the head of the class for Ajax, with my local vet doing the mechanical things that he gets directives to do.
Ajax, as of Friday, started on Cyclosporin. The vets at WSU recommend four to six weeks, then follow with surgery. Did your dogs have a fistula gram? Anyway, I am taking Ajax over to WSU (it's on the other side of the state, about 350 miles away) next Wednesday. The Vet said I probably didn't need to because they won't operate yet, but I want him to evaluate Ajax's condition as it is now, so that he has his own summary to refer to.
Ajax is on the following:
800 IUs E
2000 mg sodium ascorbic
B 100 complex
multi/child's chewable [Bugs Bunny]
body guard (an amino acid, elemental sulfur supplement)
A mix of two dog foods: Natural Choice/lamb and rice, Nature's recipe/venison and rice and shredded cheese (either reduced or non-fat). He is fed twice daily.
2 T Lipiderm (Omega 3, 6, 9 oils including linolenic acid, plus A, E and zinc.
His meds are:
Cyclosporin, 2X daily, total 400 mg
Clavamox (amoxicillin trihydrate/clavulanate potassium), 2X daily, total 1250mg [this is for his secondary infection after the culture came back, there are only two anti-biotics that aren't resistant. Ajax is on the best of the two.
Metronidazole, 2X daily, total 2000 mg ) he's almost done; it won't be refilled.
His "bottom" treatments are:
Huggies when we're out and about or I'm in a hurry.
Wash with a diluted solution of liquid Dial, dry, put a light coat of Betadine and blot dry, then put Vit E oil on. I am still using the pill 2X daily because I only have a Vit E solution instead of the pure Vit E oil in a bottle. I do this at least twice a day.
As far as his sitz baths are concerned, well, so far I'm not doing well, I picked up a couple of those plastic kiddie pools? Well he loves them, just as he does any water, but he's either pawing at the water or trying to splash or he's taking the hose in his mouth and dragging it all over. It's great fun - we used to do it, but stopped and it's fun to get back into it. He loves the tub but is much more interested in trying to dig at the drain than to sit???? You've got to be kidding! Fortunately I have a little time to get him to do this, because at this point his bottom is not too bad. He never licks himself (unless the Betadine is left on), but has been like that since he was a pup.
Oh! The vets at WSU commented that they think there might be a combination of allergies, immune deficiency / thyroid that causes this. Is that what your vets surmised? Just wondering. I have my own theories, but they aren't necessarily compatible with the above.
Date sent: Sat, 4 Jul 1998
Carolyn wrote:
Hi
ROFL at the sitz baths escapades. With a lot of dogs, it is impossible. Just thought it would be soothing, especially following surgery. With Kandi, I used the tub, always had a little people food in hand like a sandwich, and she would do a beautiful sit while waiting for me to share tiny tidbits with her. Needless to say, I ate slowly and occasionally give her a little bite. When the food was gone, she was ready to get out.
I'm very sorry to hear of Ajax reaction to the iodine treatment. Perhaps it would be best to discontinue the Betadine also and go with hydrogen peroxide. Just a thought since he's obviously sensitive to the iodine. Glad he survived it and is recovering.
I don't really blame the AKC and the GSDCA too much. Though perianal fistulas are a nasty disease, especially for those of us to have to deal with it, it in over all picture, it's a minor and fairly rare problem as compared to some of the diseases like hip dysplasia and Degenerative Myelopathy.
The biggest problem with treating PFs is that the true cause is unknown. I tend to agree with Washington State vets, at least in part, because so many of the dogs who develop PFs have other symptoms of autoimmune deficiencies, including allergies, and in a large percentage of those who have a thyroid screening done, the T3/T4 numbers are very low or in the low/normal range.
However, I do believe that some of the cases may be bacterial in nature. I do know that with immunologists, who treat humans with similar diseases, bacteria are the suspected cause. I had one lady contact me who had two Border Collies come down with PFs within a couple of weeks of each other, shortly after they had both gone swimming in contaminated water. The disease was easily treated and the dogs are fine. In that case, I definitely suspect bacteria.
Date sent: Sat, 25 Jul 1998
Sure you can use Ajax's story. I have another chapter that makes his prognosis very good. I took him into the local vet today for a troph test and a check. The vet was very excited because he thinks that the fistula's have decreased substantially in size, to the point where they may be almost healed. As long as he's on the cyclosporin he needs to be on a first generation antibiotic, so I opted to keep him on Clavamox for one more ten day run and then if he continues to be better, put him on a less expensive antibiotic until he's off the cyclosporin. He'll be on all medications until I get him back to WSU, probably the first part of August, but the daily amount of his cyclosporin may change depending upon the levels in his blood. Good news, huh!!??
I checked your web site to see your dogs. Nice looking! :) The background of your first page reminded my daughter of Ajax. If I ever have the time I will get some snaps off to you.
I tried to have five dogs and one cat at one time, but it was a little much and not planned as you did. We had three shepherds (all males), an Irish setter (male), a coyote/shepherd (female), plus a little thing that looked like an Oreo cookie that my daughter brought home and two foster dogs who we cared for for five years while the owners got their act together. They too were male (Stan and Ollie). One looked like a very big black lab, the other looked like the old golden retriever champions with the slightly darker coat and he was beautiful. They were actually brothers and each had some mastiff in them, which accounted for their size. Better you than me. One or two is about my speed.
By the way, Ajax was originally intended for Schutzhund. I knew the breeder who at the time was a puritan re the German lines. Anyway, the pick of the litter was Ajax, who he kept for himself. He had already started his training and puppy shows (Mystique is Ajax's 1/2 sister - the one who Jimmy handled all over the country and was expected to win Westminster two years running - now retired) when one of his testicles rubberbanded and they couldn't pull it down. So he was automatically DQ'd from Schutzhund competition. Bob called, I was looking at some German blood GSDs in Oklahoma, Georgia (where Mystique is from) and Wisconsin; I bought Ajax the next day and he was just under four months. He's the best dog I've ever had. One of his sisters is in rescue work in Oregon, his only brother is a K9, and another sister is a drug dog. I don't know about the others, but I'm sure that they're all doing well, as the temperament and intelligence are extraordinarily good.
Thanks again for the info on the 3% Cyclosporin. The exterior area is healing quite well. The vet said to keep using cold compress, cool water and the kiddie pool that he will lie down in for three or four minutes at a time.
Date: Mon, 03 Aug 1998
Well it's never over until it's over. The vets thought, and I hoped, that Ajax was out of the woods. They saw no sign of a fistula and his rectum was reasonably healed except for a small (9am to 11am) area that looked like a dark scab diminished in size. Ajax's levels of the cyclosporin had gone from 139 to 514 with the increase in the medication from 400 mg daily to 600 mg daily. They did the thyroid test that came back normal and did a total chemical scan that showed his blood counts normal, cholesterol a tad high and liver enzymes normal. The same day that I got the results from the chemical scan, Ajax showed up with fresh blood in his stool - quite a bit and I had flashes of what went on in June. I called the vet who thought perhaps that it was a fluke, that his intestinal track is easily reactive. He suggested that I wait until Monday or Tuesday to see if it would correct itself. (It didn't) and if anything got worse. Soooooooooo, Ajax will go in for a rectal early tomorrow morning. The poor dog. I feel so sorry for him. I wish I could endure it for him - at least I could tell someone how I felt and what was going on with me.
Did any of your dogs or have you heard of anyone going through the bloody stool symptom as the premier for a fistulas? I think that might be what's going on. I don't want him to have a new fistula, but if not that, then what? Ajax is such a good guy dog. It just doesn't seem fair that the good guys get nailed!!!!!
Date sent: Thurs, 13 Aug 1998
DJ's ResponseHi
Yes, Thank you. I received the mailed information.
So, if what the experts think is happening is true then I wonder how they would explain Lance's situation? We had removed his anal gland sacs in May and he still developed PFs by October (5 months after surgery) and had to undergo surgical removal of the PFs the first of December that same year. Interesting case to say the least since the PFs came back in under a month. Been fighting them ever since.
Now in Trisha's case (she is Lance's sister) her anal gland sacs blew out and she began the same exact route Teddy (uncle to Trisha & Lance) had taken the year before so we immediately began her on Optimmune and we beat the PFs from ever really getting a hold.
Teddy's case proves their theory more correctly. His anal gland sacs blew out and he developed PFs. As soon as we performed the surgery to remove the PFs we were on the road to recovery and remain so. (Sigh!)
Liz just removed Nemo's anal gland sacs in the hopes of preventing further butt problems (not 100% diagnosed as PFs). Nemo is a brother to Lance and Trisha.
Teddy's sister, Tawnee, also developed PFs about the same time Teddy and Lance did (June of '97). She still has her anal gland sacs intact.
So you can see why I have a big interest on what the experts are finding and claiming.
Feel free to tell the Vet about the above cases, as I would be interested in hearing what they have to say.
Date sent: Thurs, 12 Aug 1998
I don't totally understand the premise that the researchers are working on. When I drive across state next Monday so that WSU can examine Ajax, I'll ask them for more details. The gist of it is that the researchers, who did the study and wrote their findings on the effectiveness of using cyclosporin, are now in the process of studying the correlation between fistula's and anal sacs/glands. According to the vet at WSU, they are coming toward the end of their study and found some strong evidence that the anal glands are at least a complication that can lead to fistulas.
When through with the research, The vet from WSU is quite certain that the researchers will recommend that anal glands/sacs be removed to control the return of fistulas. I'm not certain of my information so will ask more when I get to Pullman and ask the Vet to forward the written study once done. I hope that they go into it in even more detail because it may be a compound issue with anal glands, bacteria, release of oils etc etc. It should be very interesting. Did your dogs ever have colon or intestinal problems? I'll let you know after my trip.
Well, time for a little more work before some sleep. I won't be leaving until Aug 17th (next Monday), but like you, I am really curious to find out how the connection plays out.
Date: Sun, 09 Aug 1998
DJ's Response
Hi
I am looking through my notes and questionnaires to see how many noted anal sac problems. Are the Vets at WSU saying they feel the anal sacs are a contributing cause of PFs? What about the dogs that showed no anal gland sac problems prior to the onstart of PFs making their presence known? Was it possible that the sac problem was over-looked? Or not pronounced enough? Interesting theory though since all 5 dogs in my 3 generations that had anal gland sac problems showed signs of PF onstart and 3 of the 5 dogs developed full-blown Perianal Fistulas.
I'll be compiling your emails into a journal about Ajax this week and adding his story to the webpage. I already have Rommel's and Sweetie's up so with Kandi's and Lance's surgery that makes for informative reading for anyone needing to learn more about PFs in dogs. Thanks so much for your contribution.
Date: Thurs, 06 Aug 1998
I am beginning to realize that this is a saga that never ends. Now that I've reached that conclusion, it's much easier for me to plow through all of the "stuff" that happens.
The French vet called me last night (from WSU). He talked to the researchers who did the paper on the cyclosporin and are finishing up on another study that connects the anal sacs to PFs. Their info seems to be reasonably conclusive that animals that have PFs are much more successful in controlling and /or closing PFs if the anal sacs are removed. I know that there is a chance that the nerves can be damaged and either the dog may have a contracted rectal opening or one that does not have much or any control. He also said that if only one side is damaged that sometimes the healthy side would compensate for the other side. I think that I already told you that WSU pulled Ajax off of the cyclosporin for 24 hours. Ajax was put back on a low dose late last night - it was supposed to be 300 mg daily but since I couldn't cut the jell capsule in half (they come in 100 mg's) they dropped it even further, to 200 mg a day. I'll pick up the lower dosage tomorrow and then he'll be on 300 mg daily.
The time period to keep PF dogs on the cyclosporin is 6 weeks or 2 weeks after all is healed.
The vets also seem to think that although there is no history of bleeding, Ajax seems to be contradicting most of the symptoms and problems that PF dogs seem to show, and that it may be closely related to his propensity for intestinal problems. Who knows? Probably no one!
Ajax is really red on his behind, so I am watching him closely to see where that leads. WSU has scheduled him to come over Monday the 17th and his status at that juncture will determine whether he has surgery or not. There is one thing for certain. For Ajax, higher doses of the cyclosporin make him apathetic, depressed, exhausted and gassy. Because he has not been a "gassy" dog, it was pretty funny to watch him continually whirl his head around looking at his butt with such a funny, "What is that?" expression with his eyebrows all wrinkled up.
Thanks to both of you for your help and support. I truly feel for all of those out there who are unable to connect with others who have or are going through a similar experience. It could be very lonely and very difficult.
Oh! I am having some trouble with my vet being cooperative with WSU. I've been going to the same group for twenty years, but for some reason my vet is not eager to work along side the vets at WSU. It really surprised me and wondered if anyone has had that hurdle? As far as I'm concerned, all I want is to get the best information and care I can for Ajax. Ego's should not be an issue, only Ajax' health.
Mon, 7 Sept. 1998
Hi Everyone,
This may seem like a very elementary question, but how do I know when a PF is forming? I think that I should know this, but I really don't. By the time I noticed Ajax' butt the first time, the fistula was going strong and what I looked at was a "blood type blister" from 9 to 11 (on the clock). The vet knew what was going on, not me. Now that Ajax is off all of his medication, I'm checking him periodically during the day (poor dog).
I remember that Dave (Rommel) mentioned that he believed two small fistulas were developing that were the size of a pin. I've noticed two changes in Ajax that have gradually evolved in the last two/three weeks. Actually ever since his cyclosporin was reduced from 600 mg to 200 mg. and since 9-2-98 to zero 1) His butt has become puffier or more swollen to me; before it was more level/flat. 2) He has two marks, each about the size of a pinhead, one at 7, the other at 5. When I initially took Ajax to WSU, the specialist picked up on them, but after putting him under, said that they were not fistulas. Unfortunately, they've become more noticeable and I am beginning to wonder - is that what a fistula looks like when it starts?
I began using cyclosporin on his butt (cut a pill and rub the fluid on Ajax' butt) (shortly after I heard from Dave about the small fistulas that he was trying to close by rubbing the cyclosporin on Rommel, and was successful). Being such a whiz (ha, ha) how do I detect them? Or, isn't there a way?
I will try to take Ajax into the local vet toward the end of the week, but I'm not sure that he's much better than I am at recognizing PFs when they begin. I think all of you are probably a lot more knowledgeable. Any help would really be appreciated.
I hope that all of you and your "friends" are doing well.
Dave, how is Rommel doing after his surgery?
Carol, the same question for Julio and are your house guests helping or hindering?
Carolyn, Kandi is the star as far as keeping these nasty PFs at bay; give her a special pat and hug for that.
DJ, Lance and you are continually in our prayers - we hope that you find out soon what is causing the bleeding problem so that you can begin to fight it and also hope that it isn't too serious.
I will be grateful for any info/advice.
Ajax sends slurpy licks and I send hugs to you and yours.
Marty :-)
Mon, 7 Sept. 1998
Hi Dave!
Thanks for all of the information. I appreciate it a lot. I have a few questions. When you comment on topical cyclosporin, what does that mean? I am piercing one of Ajax' pills and putting that on him. Since I already purchased and still have the oral (pill) cyclosporin/Sandimmune that's what I'm using. Is that all right? If not, what should I be using?
Did your vet ever put Rommel on antibiotics? Ajax had a fierce infection/bacterial that was in one of the fistulae. It was resistant to all antibiotics excepting Clavamox (after they did a culture) and a sulfur type that causes eye problems. He was put on two other antibiotics initially and then switched to the stronger one once the vet learned that nothing except the first generation Clavamox could counter the bacteria. Did Rommel not have any infection?
What is an anal ring dissection? The Neoral - what is the formula that determines the amount to use? i.e. weight to ml? I used to give shots to animals so I doubt that that would be a problem for me. Is it under the skin or in the muscle? Costs: I was spending around $750.00 per month for the Sandimmune until they "up'd" the dosage to 600 mg daily and then it was almost $1000.00 a month. Later when the researchers suggested reducing it to 200/250mg daily, the costs were reduced to $450.00 although I really don't think that it was doing a whole lot of good. The Clavamox was about $300.00 a month, but when I got it through WSU instead of my vet the cost was reduced by 20%.
Regarding reaction to the Cyclosporin? When the amount of cyclosporin was reduced, his diarrhea stopped and his apathy and depression also stopped. When I look at it from a clinical perspective (I'm a counselor, isn't that funny?) he wasn't told that he would be better, so I don't think that I influenced him enough to cause the change in his physical responses. It's possible, but I don't think I did.
The researchers who did the paper on cyclosporin/fistulae treatment are either closely connected to or are the same group who are doing the study on the correlation between fistulae and anal gland/sacs. I have not e-mailed Dr. Seguin recently, but when I was at WSU the 18/19/20 of August, the researchers had not written the paper. They were getting close to completing the study and had found a connection which is why the team of vets at WSU caring for Ajax were suggesting (but not recommending because the info wasn't in print yet) that Ajax have his anal sacs/glands removed. We finally agreed that he would have it done if Ajax showed up with more fistulae. I fought that one because I am terrified that Ajax will show up with incontinence and it would destroy this regal dog's confidence beyond repair. Sooooooooo, I am the one who is fighting the suggestion.
I just finished reading your update on DJ's web site. I am so glad for you and Rommel and it sounds as if you have a great routine set-up. Also, wanted you to know that I think Rommel is a handsome fella. It's late and I have much work to do tomorrow.
Oh! Is Rommel completely off the cyclosporin now? Do you do sitz baths for Rommel or did you decide that the hand shower and iodine treatment was enough? Is that a Betadine and is that for reducing the chance for infection?
As always, thanks for your information and help. I sent a group e-mail regarding a puffy butt and pin marks that are there, were checked out in July and August, found no PFs connected to them, but seem to be increasing in size and yet are still at the pin head size and do not seem to be open????
There's one more thing to add to that inquiry. For the first time ever, Ajax is balking at me "treating" his behind and will sit down or flip around. He is such a non-complainer and has never been a whiner or baby about all of this, it concerns me. Is it possible that the cyclosporin that I am using is too strong and is creating sensitivity? I am clueless, but his behavior has definitely taken a 180', so something has changed. Any ideas?
Hope all is well with you and your star, Rommel.
Marty (and Ajax)
Mon, Sept. 7 1998
Carolyn's Reply
Hi Marty,
In most cases, the fistulas start on the inside and work outward so by the time you see visible evidence that they are there, they're THERE.
Fistulas do show different symptoms in different dogs before they erupt. I never noticed any puffiness on Kandi, but then, I wasn't checking for them either. I had never heard of them. The first I noticed was the small holes -- and Kandi constantly licking at her rear. At first I didn't think to much about the first one. You know, like a little sore and the scab comes off type of thing. When the second appeared, I knew that wasn't it but thought they would heal.
Kandi gave me quite a scare back in late spring. Her butt got a red irritation look to it and swollen and had little scabs. Talk about panic!! I rushed her to the vet He shaved the area, did an internal palpation and said he couldn't feel anything that felt like fistulas on the inside. We put her on Chephaloxid for about 8 days and everything has been fine since.
So, all I can say is check frequently -- once a day or every two days should suffice and if you notice anything that appears abnormal -- like Ajax paying particular attention to his behind and/or licking, the swelling and in particularly, extra, unneeded, unwanted pinholes, get them checked immediately. The quicker they're found and treated the less damage they can do. I know this isn't a lot of help but with fistulas, you're pretty much running blind until you can actually see them.
Date: Sat, 22 Aug 1998
Hi DJ!
Well my saga this week is computers. First my "Little Engine That Could" computer was wiped out by a well meaning computer person who planned to update it and instead erased everything and couldn't do the update he wanted to do. So, no internet etc, etc. Then my bigger and better (?) computer with all of the neat stuff on it, decided that it wanted a new hard drive! Not really, but the hard drive went defunct and kept freezing, finally to the point that it was permanently frozen and I never knew whether or not I was able to get e-mail's out. I gave up and then learned that the hard drive had to be replaced. Everything on that computer was wiped out also. Oh well, worse things can happen. I'm waiting for that computer to be fixed, but the happy news is that I have my little engine computer back. It's not very fast and has a small screen, but I can use my hotmail. So far my aol account isn't functional any more, so may have to call aol about that.
Now for the happier news, however temporary. I took Ajax to WSU for a thorough exam and the vets said no more fistulas and his rectum looked pretty good. :) The interesting part is that even though Ajax looked good, half of the group of specialists still wanted to remove his anal glands/sacs. BUT, we agreed to delay surgery until 1) Ajax shows up with more PFs or 2) his rectal area begins to exhibit swelling, infection etc. He is still on the cyclosporin. The medical community changed the length of time to stay on the cyclosporin to either 8 weeks or 2 weeks after the last fistula is healed. The antibiotics (always first generation) are always given along with the cyclosporin because the cyclo. reduces the immune system so it becomes a protective, preventative procedure. The group of researchers over there did some of their own research regarding Ajax' bloody stools and found out that that is a side effect when taking this medicine (in humans - hm! Do you suppose that someone forgot to tell Ajax that he's a GSD????) They also learned that the level of cyclo. is not important as they once thought.
Ajax dropped from 600 mg or 300 BID to 250 mg or 125 mg BID. His schedule got really messed up when I was traveling and feeding/not feeding him. His medication times got too close and what did he show up with the following day? Yep! You guessed it, bloody stools. Now he's back to a regular schedule and no more bloody stools.Ajax will stop taking the cyclosporin and Clavamox on 9-2-98 and then we wait to see what happens. He is scheduled to go back to WSU the third week in September, but of course if any problems show up earlier, I'll take him over sooner. It will be in September or possibly October that Ajax may show with more PFs, but nobody really knows.
The vets and researchers are very excited about the correlation between the anal sack glands and the PFs, but decided to wait until the study is complete crossing a bridge that may not even be there. I did give them your info that they said they'd hold until they have the researchers info in writing. One said that he didn't think that there are any easy or simple answers, that he thinks that it is extremely complex which is why there aren't any explanations yet. He said that the "recipe" probably contains at least several ingredients before even reaching the threshold of PFs. He's more than likely right, but it would be nice if it was easier.
I don't know how expenses compare for different treatments, i.e. the cyclo/clava. vs. prednisone/surgery. Has anyone done any comparison's? If Ajax doesn't need surgery, his treatment may not be a heck of a lot more. 'Course traveling all over might jump expenses, but it would be interesting.
I checked out the web site and it's great. :) Also reached Carol in northern WI. It sounds as if Julio is recovering nicely with their help. Ajax has reached the point now that when he sees me with a particular posture, he knows that I'm about to check or wash his behind and he now raises his tail. It's really cute.
I hope that everything is going well. You're certainly doing a great job of getting information out. What would all of us do without you? Well we wouldn't, that's all.
Take care,
Marty :) and Ajax :)
Date: Sat, 22 Aug 1998
Hi Carolyn and DJ!
Now that I have my "Little Engine That Could" computer running, I've been trying to catch up on the web site info.
The info about Rommel was very interesting, but what happened and what did Dave decide to do? Did the topical work and is it really 20% and 20% of what?
I am using the Sandimune for Ajax and started on July 2, '98. He started at 400 mg daily (200 BID), but the levels in his blood were too low (137), so he was upped to 600 mg, his levels went up to 514, but he began bleeding. The researchers were contacted and Ajax was pulled off of the Sandimune for 24 hours and then put back on at 200 mg. He was increased once to 250 mg (125 mg BID), but that was it as he began to show some side effects again. Then the researchers were contacted again (that was the time when WSU learned about the correlation in a study being done about the anal sacs/glands) and the researchers doing the cyclosporin study found that the levels were not as critical as they had once thought, so Ajax was kept at 250 and the med would not be increased unless he showed up with a fistula. So far so good. I probably won't know anything until I take him off the Sandimune Sept 2nd and then see if he develops any more fistulas. WSU did not recommend that he switch to the Neoral. I e-mailed Dr. Seguin to find out if there was any reason other than possibly Ajax' intolerance for higher doses and that his fistulas are closed. So far (at least when he was examined by WSU earlier this week) no more have developed. Is the most dangerous time when the dog comes off of the medication (when the fistulas recur)?
My monthly costs of the Sandimune varied depending on the amount that was prescribed for Ajax. He started at $752.15 and then because they increased the dosage the monthly amount went to $1166.22 and is now down to $491.66. No matter how you slice it, it's not cheap. It's worth it if it's effective, but if it is only a theory and we're the practical applicants, more or less, then I think that the concept should be thoroughly scrutinized. As I've already said, I want the best treatment for Ajax, but if this is still in the if/then stages, it's very costly for those of us enabling the process.
Also, the Clavamox isn't cheap either. Ajax is on 625 mg BID. That adds up to $213.56 for one month. I think! It's either that or $320.34 a month. I can't remember whether I get ten days or I get 15 days.
Anyway, wondering if you know what Rommel's status is and if there's a way to connect with Dave?
Carolyn - thanks for the compliment about my furry friend. :) I told Ajax that you called him a handsome lad and he was very happy. I'm not sure whether he was happy that you called him happy or if it was because you called him a lad rather than a dog (because he thinks he's a person) or if it was both. In any case he was excited and bouncing about in his usual happy, crazy self. He did another sitz bath in his pool tonight. He really didn't need it, but wanted to anyway - how could I say no to that?!!!!!!
Date: Sat, 29 Aug 1998
Hi DJ!
I did connect with Dave (thanks for the info) and he sent me what he sent to you and then also sent me an e-mail with some advice.
Ajax is on such a small dose of cyclosporin that I'm not sure it's doing much good. I am watching him like a hawk. Several days ago I thought that he might be getting another, but fortunately no. Ajax is going off his cyclosporin on 9-2-98. He is also supposed to be taken off the Clavamox at the same time, but I'm going to keep him on it for a short while since the cyclosporin impacts their immune system so dramatically.
He's scheduled to go back to WSU the third week in September if nothing happens before. I am crossing my fingers and toes on this one.
What's your feeling about having the anal sacs/glands removed if he doesn't show up with any more fistulas. Ajax' first was apparently small (the anus area), so it's hard for me to know what I might be up against if the area burst more dramatically. I am still waiting for Dr. Seguin to give me more info from the researchers who are doing the study correlating the anal glands and the fistulas. The school just had their major rotation so he is busier than usual and I know he is the only one who has enough clout to be able to connect with them. When it is done, how extensive is the recovery time? Treatment?
As usual, lot's of questions and very few answers.
Date: Sun, 06 Sep 1998
Hi Everyone,
This may seem like a very elementary question, but how do I know when a PF is forming? I think that I should know this, but I really don't.
By the time I noticed Ajax' butt the first time, the fistula was going strong and what I looked at was a "blood type blister" from 9 to 11 (on the clock). The vet knew what was going on, not me.
Now that Ajax is off all of his medication, I'm checking him periodically during the day (poor dog). I remember that Dave (Rommel) mentioned that he believed two small fistulas were developing that were the size of a pin.
I've noticed two changes in Ajax that have gradually evolved in the last two/three weeks. Actually ever since his cyclosporin was reduced from 600 mg to 200 mg. and since 9-2-98 to zero 1) His butt has become puffier or more swollen to me; before it was more level/flat. 2) He has two marks, each about the size of a pinhead, one at 7, the other at 5.
When I initially took Ajax to WSU, the specialist picked up on them, but after putting him under, said that they were not fistulas.
Unfortunately, they've become more noticeable and I am beginning to wonder - is that what a fistula looks like when it starts? I began using cyclosporin on his butt (cut a pill and rub the fluid on Ajax's butt) (shortly after I heard from Dave about the small fistulas that he was trying to close by rubbing the cyclosporin on Rommel, and was successful).
Being such a whiz (ha, ha) how do I detect them? Or, isn't there a way?
I will try to take Ajax into the local vet toward the end of the week, but I'm not sure that he's much better than I am at recognizing PFs when they begin. I think all of you are probably a lot more knowledgeable. Any help would really be appreciated.
I hope that all of you and your "friends" are doing well. Dave, how is Rommel doing after his surgery? Carol the same question for Julio and are your house guests helping or hindering? Carolyn, Kandi is the star as far as keeping these nasty PFs at bay; give her a special pat and hug for that. DJ, Lance and you are continually in our prayers - we hope that you find out soon what is causing the bleeding problem so that you can begin to fight it and also hope that it isn't too serious.
Date: Mon, 07 Sep 1998
When you comment on topical cyclosporin, what does that mean? I am piercing one of Ajax' pills and putting that on him. Since I already purchased and still have the oral (pill) cyclosporin/Sandimmune that's what I'm using. Is that all right? If not, what should I be using?
Did your vet ever put Rommel on antibiotics? Ajax had a fierce infection/bacterial that was in one of the fistulae. It was resistant to all antibiotics excepting Clavamox (after they did a culture) and sulfurs type that causes eye problems. He was put on two other antibiotics initially and then switched to the stronger one once the vet learned that nothing except the first generation Clavamox could counter the bacteria. Did Rommel not have any infection?
What is an anal ring dissection?
The Neoral - what is the formula that determines the amount to use? I.e. weight to ml? I used to give shots to animals so I doubt that that would be a problem for me. Is it under the skin or in the muscle?
Costs: I was spending around $750.00 per month for the Sandimune until they upped the dosage to 600 mg daily and then it was almost $1000.00a month. Later when the researchers suggested reducing it to 200/250mg daily, the costs were reduced to $450.00 although I really don't think that it was doing a whole lot of good.
The Clavamox was about $300.00 a month, but when I got it through WSU instead of my vet the cost was reduced by 20%.
Reaction to the Cyclosporin: When the amount of cyclosporin was reduced, his diarrhea stopped and his apathy and depression also stopped. When I look at it from a clinical perspective (I'm a counselor, isn't that funny?) he wasn't told that he would be better, so I don't think that I influenced him enough to cause the change in his physical responses. It's possible, but I don't think I did.
The researchers who did the paper on cyclosporin/fistulae treatment are either closely connected to or are the same group who are doing the study on the correlation between fistulae and anal gland/sacs. I have not e-mailed Dr. Seguin recently, but when I was at WSU the 18/19/20 of August, the researchers had not written the paper. They were getting close to completing the study and had found a connection which is why the team of vets at WSU caring for Ajax were suggesting (but not recommending because the info wasn't in print yet) that Ajax have his anal sacs/glands removed. We finally agreed that he would have it done if Ajax showed up with more fistulae. I fought that one because I am terrified that Ajax will show up with incontinence and it would destroy this regal dog's confidence beyond repair. Sooooooooo, I am the one who is fighting the suggestion.
I just finished reading your update on DJ's web site. I am so glad for you and Rommel and it sounds as if you have a great routine set-up.
Also, wanted you to know that I think Rommel is a handsome fella.
Oh! Are you completely off the cyclosporin now? Do you do sitz baths for Rommel or did you decide that the hand shower and iodine treatment was enough? Is that a Betadine and is that for reducing the chance for infection?
As always, thanks for your information and help. I sent a group e-mail regarding a puffy butt and pin marks that are there, were checked out in July and August, found no PFs connected to them, but seem to be increasing in size and yet are still at the pin head size and do not seem to be open???? There's one more thing to add to that inquiry. For the first time ever, Ajax is balking at me "treating" his behind and will sit down or flip around. He is such a non-complainer and has never been a whiner or baby about all of this, it concerns me. Is it possible that the cyclosporin that I am using is too strong and is creating sensitivity? I am clueless, but his behavior has definitely taken a 180�, so something has changed. Any ideas?
Date: Sun, 27 Sep 1998
Hi Everyone!
I thought about calling, but it was too late.
Ajax is going through something new for me and when I play the hindsight game, there are many things that may or may not be connected to this. He went off the cyclosporin 9-3-98. Until last week he seemed to be all right, then I noticed that his stools seemed darker than usual (although they're already quite dark), about five days ago his behind was very sensitive and he did not like it when I patted him with Kleenex. He was consistent in that behavior. I checked his behind, but couldn't find anything that looked different, although around his rectum it seemed puffier than before and redder. Yesterday he seemed to ooze and I thought that it was a "remnant" from going to the bathroom. It was more liquid than solid and was brown. Today Ajax was very sensitive and I put the pool out for him. He dashed in as if he couldn't wait to lie down (which he did) and seemed relieved and happier. He is also licking which for him is close to unheard of. Tonight he showed with red blood and brown that is not rushing out, but seems to be a very slow ooze. At this point in time his rectum is red and angry and some of the leaking is through the puffy area around the rectum instead of actually coming out of the rectum. I cannot find anything else. Do fistulas begin under the skin and break out through the anal sacs? Could that be what us going on? I have a call in for my local vet who probably won't know any more than I do and have an e-mail in for the WSU vet. Does any of this sound familiar to anyone? Help!!!!!!
Date: Mon, 28 Sep 1998
Hi Everyone!
Thanks to all of you for your quick response. I really appreciate it a lot.
Two vets from WSU called one around midnight last night and the other early this morning. Their advice (like Carolyn's) was getting him in ASAP. I did.
The vet almost missed the problem. He checked for fistulae and couldn't find any, looked at his behind and said that he'd never seen anything like it (the bloody oozing stuff). I asked him if he thought that Ajax' anal sacs needed to be expected, so he went back in to release the oil. Low and behold when he was working on the right gland, he was practically shot out of the room as the gunk came flying out - mostly blood with some oil. The smell was incredible and one of the girls who came in to help clean up ended up loosing her breakfast, while I sat there smiling happily because it was something that at least was fixable. :)
Ajax is on Tetracycline while a culture is done to determine what antibiotic will be the most effective. The vet was reluctant to put him back on Clavamox because after so many months of taking it he was afraid that he might have developed a resistance to it.
Soooooooo, another chapter in the life of Ajax: He is still "weeping", but not as dramatically as before and I'm assuming that with the help of the medication he will eventually stop the bleeding.
I talked to Dr. Seguin (the soft tissue surgeon at WSU) who is the one who is following the research about the correlation of anal sacs/glands to PFs. I have not talked to him in a while so I don't know if any conclusions were reached and if they've started writing the paper. They were definitely leaning toward some connection although I don't know how strong the correlation will be and, as always there are always variables that come into play. Dr. Seguin suggested that Ajax have his anal sacs/glands removed even (though they were healthy) when I was there in August. Hindsight is always so 20/20! I will have it done, but not until he is free from infection.
Ajax has another problem that all the vets believe is unrelated, but they were much more concerned about it than the behind problem. He showed up with black pooh both times that he went potty on Sunday. I didn't think to save them and this morning his pooh was back to normal. All of them were very concerned because of the origin of that kind of bleeding. If it happens again I'm supposed to take him in immediately with the stool.
Hopefully it's a fluke and won't repeat itself.
I have some work to do. Again thanks for all of the great support and in such a timely manner - couldn't have asked for anything better.
Date: Thursday, 01 Oct 1998
Hi DJ!
Whew! It sounds as if Lance is really having some serious problems again. This is tough and I wish you and Lance the very best. What is with all the bleeding anyway?
Ajax is still bloody, also passing clots and now the WSU vet team thinks that there may be two separate situations going on at the same time. He is on 4,250mg of antibiotics every day, the culture has not come back with a definitive bacterium yet, and only that he does have a potent bad bacterial infection in his right anal sac. I will be leaving either Monday or very early Tuesday for WSU. The soft tissue specialist said that they would set up any time that I could get him there (he doesn't normally see patients on Tuesdays). And make certain that he also brought the head of and a team of internal medicine specialists to be ready and on call so that they are all available when Ajax arrives. The bleeding that Ajax does is twofold - black or sometimes dark green stools and the clots plus red to dark red blood. How do you know whether or not they're peeing blood or is it obvious? Ajax urinates in the woods and in the rough area, so I don't know how to check it out.
When I'm in Pullman I'll be staying in a motel while Ajax is at the hospital. They said to figure at least three to four days. I will not have my computer. Is there a way that I can reach you via phone?
We're thinking about you and praying for Lance and of course for you.
Date: Sun, 4 Oct 1998
Hi everyone!
Well, Ajax and I leave tomorrow for the vet's at Washington State University. He has a few problems running simultaneously, but he seems to be in pretty darn good spirits. His rear is angry red, one side is seeping blood (but not as bad as a few days ago). He is still eliminating blood, usually in the form of small clots, but the color of his stools have gone from black to a medium brown. :) Guess they're going to bring in an internal medicine team to work with the surgical team and I'll call them an hour or so before I arrive, so they'll be ready.
Thanks for everyone's helpful information and support. Your idea about the drive-in and his favorite toys is a good one Dave - Ajax loves Happy Meals at McDonalds. All I need to do is drive near and he starts to salivate and drool, knowing that he's going to get the cheeseburger while I get the french fries and the drink! I'll have to scout around Pullman so after I pick him up I'll know how to get to Ronald McDonald's.
I'm going to try to work out of my motel room since the vet told me that I needed to plan to stay until at least Thursday. If I get crazy and can't concentrate, I may bother you and call.
DJ, I hope that Lance is stabilized and that they're finally able to figure out what's causing his bleeding.
Does he drink a lot of water like Ajax? Well I should say did because Ajax is back to his normal intake as of yesterday. Did the vet put him on antibiotics? The vet put Ajax on Tetracycline (3000 mg), then added Clavamox (1250 mg), then dropped the tetracycline after the culture results came back and it wasn't doing any good. Then he was put on ampicillin (3000 mg). That is sure a lot cheaper than the Clavamox (about 1/10 as much).
Well, have to organize and begin packing. Have a bunch of meetings tomorrow and will take off as soon as my last meeting is over, hopefully by 4:00 p.m.
Hope all is well with the great furry friends and of course with you.
Date: Fri, 16 Oct 1998
Hi DJ!
How is Lance holding up? I am sure that the pressure and stress is affecting all of you. Let's see. Lance gets to be neutered next week? On Tuesday? How are you holding up? Without you, Lance wouldn't even have a chance. He is lucky to have such a strong and devoted owner. I'm sure he knows that well. Please take special care of yourself for Lance and your other furry friends.
I am playing the waiting game with Ajax. I am hoping to hear something about the results of the biopsies, but the vet won't leave me a message or e-mail me as he has in the past when we can't connect. Scary. Ajax is fair. Does a lot of sleeping, is still losing very small amounts of feces and frankly I think that he is getting depressed over it if that's possible. I play with him, give him hi 5's, tell him how great he's doing, but somehow he knows that things are not what they should be.
The vet tried to reach me yesterday, but wouldn't leave a message and said that he talked to Dr. Maley (?) who headed up the internal medicine team who took the biopsies. So, I wait.
One thing that the vet did tell me was that they found two parasites in Ajax. I am apparently very ignorant because I thought that by giving him Interceptor monthly for all of these years (since he was 14 mo.), that parasites wouldn't be a problem (except for tapes which are easily recognizable when I pick up the stool immediately after defecating). Guess not! So now I'm trying to get some information to find out if there is anything that I can give Ajax to prevent this from happening again. When Ajax was a young dog - 6 mo. to 13 mo. he had a problem with roundworms that stayed in his chest cavity and didn't show up when doing stool specimen checks. The only reason I knew was because he'd throw the roundworms up. After three separate periods where we tested with negative results and then he'd show up with round worms by throwing up, the vet did a blood test for heart worms and then put him on the monthly Interceptor with the explicit concept that that would take care of the parasites. Guess not!
Do you remember when I asked you how in the world you even knew that Lance had blood in his urine and you explained what had happened? Well when I was in Pullman (WSU) the vets asked me to get a urine specimen. Yeah right!!!!
At first I thought that they were kidding, but they weren't. So here I am with my tiny little plastic cup running behind him trying to collect little squirts as Ajax "endowed" each bush, tree, rock and hydrant! We turned out to be the entertainers of the day for the restaurant clientele as they watched Ajax' and my dance of futility.
After twenty minutes and Ajax out of juice I think I only had about 1 �" of the gold like urine! The vets took what they could get! :)
It's time to get back to work, but I was thinking about you and hoping that you are doing all right, along with Lance and all of his furry companions.
Date: Sun, 25 Oct 1998
Hi Julie,
I'm sorry I'm so slow in getting something off to you. I started one, but had another urgent situation; by the time I returned from counseling, my message was thrown off of Hotmail.
My name is Marty and Ajax is my furry friend. He too has had a very difficult road and just when I think that we're coming up for air, something else hits us. I am learning that nothing is impossible and that these dogs are special beyond belief. Angels? Perhaps!
I can't remember how far Ajax' web page story is, but he too is not secure when I'm not there. It may be a good idea for you to mention that to the specialist so that if it is possible, you can be there - if not all at least part of the time. It did wonders for Ajax and at one point when they thought that they were going to lose him, WSU called me up there (at 10 p.m.) to walk by him so that he could know my foot steps and smell me (he was in a coma). It worked and a few hours later he was going in the "right" direction. Sometimes the vet needs to know the psyche as well as the physical aspects of the dog.
I do hope that all goes well for Twink tomorrow. It is so difficult and so scary. When I first learned that Ajax had PFs, I didn't even have the poise of where with all to ask, "perianal what?" like Carolyn did. I had to get home before I could call to find out what it was and how to spell it. It is natural to try to back track and figure out what we could have done to prevent it. I'm not sure about others, but I know that I have gone over and over and over what I could have done differently to prevent the disaster that Ajax is in. Unfortunately it does no good. So if you can concentrate on what is happening now and what you can do to help, instead of beating yourself up over the "would ya's and could ya's", it'll be so much more beneficial for both you and Twinkeltoes (by the way, I absolutely love her name).
My family is all praying for you and for Twinkeltoes.
Copyright 1999 DJ Hensch
Last updated May 12, 1999
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