February 15, 1197

With no warning whatsoever Teddy's right anal gland sac ruptured out leaving a big gaping hole next to his rectal opening. I immediately called my Vet and he told me to apply very warm soaks to the area, then clean the hole with hydrogen peroxide and then smear the area with Panalog ointment. The warm soaks would draw out anything left in the sac opening, the peroxide would kill bacteria and the Panalog would promote healing. We also put Teddy on 480 mg of Sulfatrim twice a day.

February 25th

Took Teddy in for his eqstim shot (an immune system boost). Vet said the blown anal gland sac area is looking OK and will take a long time to heal, as it has to heal from the inside out. Left side doesn't appear to be impacted. Nothing came out when expressed.

March 17

Teddy received his eqstim shot. Vet switched Teddy from sulfatrim to 960 mg of Tribrissen twice a day as the area is still looking a bit infected.

March 28th

Teddy given his eqstim shot. Everything seems to be healing nicely where the sac blew out.

March 31st

Came home to find Teddy's left side of anal area all swollen to the size of a quarter and very red. Vet recommended we cold pack it to see if we could get the swelling down. Put Teddy on 3 baby aspirin 3 times daily.

April 7th

Took Teddy in for a recheck of the anal gland sacs and his eqstim shot.

April 21st

Took Teddy in for a recheck and his eqstim shot. Things are really healing slowly. We decided to hold off on the eqstim shots until the anal area healed better.

April 23rd

Lance was seen dragging his butt and he had a lump on his left thigh.

April 24th

Took Lance to the Vet. Lump was just a cyst. Vet unable to express anything from his anal gland sacs. We have to watch him.

May 8th

Lance is licking and biting at his butt. I don't like this!! Vet agrees to remove Lance's anal gland sacs in the hopes of preventing any blow outs or perianal fistulas from developing.

May 14th

Teddy had an accident on the floor. This is not at all like him.

May 15th

Lance went into surgery and his anal gland sacs were removed.

May 19th

Teddy appears to have a bladder infection. He is having accidents in the house. Put him on 2-500mg of ampicillin twice daily.

May 24th

Lance's sutures were removed.

June 6th

Vet and I agree Teddy isn't healing so we will have to clean the area and suture it shut. Arrange the surgery for Monday.

June 9th

In the beginning we thought Teddy might have Perianal Fistulas but decided he didn't after his anal gland sacs blew out. Well it turns out he does have PFs. He had surgery this morning to do a primary closure on the 2 blown anal gland sac areas and when we got him on the table and under we found he did indeed have the dreaded PFs.

Surgery included tracking the fistulas and removing all the bad tissue, closing the empty spaces left where sacs once were and then pulling the skin over the entire openings leaving Teddy's anal opening roughly 1/3^rd the size it was.

Our hopes are that the stitches hold and that no damage was done to the rectum wall or spincter muscles. One of his arteries was slightly nicked without any of us knowing until 2 hours after I got him home. He suddenly began to hemorrhage and bleed profusely. I had to rush Teddy back to the Vet. When we arrived Teddy had to be put under again and the incision on the right side was opened. Blood spurted out...we had found the problem. After sewing the artery off and re-closing the incision we decided to check the other side and make sure that side was doing ok...which it was.

 So with poor Teddy trying to awaken again and being weak from the loss of blood we left for me to get to my class. Teddy slept in the van through my class and then I got him home. My students completely understood when I showed up all bloody and we had a shorter class than normal. 

June 10th

Teddy is doing better and the really good news at this point is that he had a tiny bowel movement last night and this morning. He is also hungry.

June 13th

Teddy was not having a good time of it. We had to give him suppositories and then an enema plus stool softeners / laxatives (regular over the counter for people). Finally, after no bowl movement for 2 days he had one this morning and he has been catching up for lost time ever since (has had about 6-8 throughout the day).

I noticed he has a huge lump on the underside of his tail on his left. It is about the size of golf ball. Will have to call the Vet first thing in the morning and get him in.

Later that day - Teddy's incision on the left side pulled open. Put in an emergency call to the Vet.

June 14th

Took Teddy to the vet and the vet re-stitched the area that was opening. Things with Teddy are still crazy and frustrating. I have been cleaning the surgical area with hydrogen peroxide as the Vet requested and all was fine when I left last night. I got home and in my bare feet stepped on a sticky wet spot on the carpet. Mike looked at the lump that Teddy had on the underside of his tail and noted that there was a scab-like spot on the lump and the lump appeared smaller. What he didn't see was the gaping open area where Teddy's stitches on the left of the anal opening had been ripped open. For reasons I can't explain I decided to have a look myself and saw the huge opening. I was shocked. The left side was completely open and the right side was just beginning to open. I got on the phone to my Vet and made arrangements to bring Teddy in the next morning.

June 15th

We had to put him under again and re-sew the left side and secure the right side. The good news: The left side has granulated nicely and the edge of the skin was trying to heal to itself instead of to where the skin was sewed together. The way Teddy would strain to go to the bathroom it is a pretty safe bet this played a major role in his stitches pulling apart. Now we pray these new stitches hold for the next 7 days.

Teddy is in an Elizabethan collar, which had to be modified (extended in depth) to keep him from licking the incisions or pulling his stitches. So he resides in our living room with 2 baby gates set up like barn doors complete with a drop bar. It keeps him in and the others dogs out.

The Vet put him on 2 Amoxicillin 500mg capsules twice daily.

I spray his butt after every bowel movement with the hydrogen peroxide. He is on his normal diet of Iams and Eukanuba mixed (I have fed this food to my dogs for years with no problems and I have a dwarf surviving on Eukanuba as well).

June 16th

New open holes are appearing on Teddy's left of anal opening. Are these new fistulas?

June 17th

Teddy has openings now just below his stitches and they are oozing what I swear is the gunk his anal gland sacs would be filled with. Is this possible? He hurts so damn much he whimpers. My house smells like an extremely unclean whelping box. YUCK!! I feel so tired. I am cleaning his poor sore butt 5-6 times a day. I am spraying it with the peroxide on a stream setting in a spray bottle (holds 12 ounces) to shoot the poop off his butt and out of the openings without hurting the stitches themselves. Holding his tail up seems to hurt him and pulls on the stitches so I have to have him lie on his side in a more relaxed position and his tail is more relaxed as well. Thank heavens I taught my dogs the "Down" and "Over" commands! Next I apply panalog ointment directly over sutures. Teddy gets tears running down his muzzle he hurts so badly. He won't sit either.

June 18th

Teddy's surgical area is extremely red and swollen. Actually looks like raw hamburger. He cries tears when I have to clean him and yet he gives me no fight. How much more can he take? He hurts so badly he refuses to sit.

June 19th

Things for Teddy have grown much worse. His butt now looks like someone shot him full of holes and the surgical area looks so bad its like it has been ripped wide open. He whimpers a little as I spray his butt. We decided we can't make him suffer any longer and Vet says there is nothing more he can do. The decision was made to take Teddy into the Vet's on Saturday and the way it looks he won't be coming home. Meanwhile I am trying to make his as comfortable as I can and there is so much heat coming from his butt that I am applying ice packs every 1/2 hour for 5 minutes. I stopped using the peroxide.

He has been so wonderful through this whole ordeal but when I look into his eyes they are glazed with pain. He tries to be happy for me. I can't do this to him any more. I can't stand to see him in so much pain and as much as I love him I want to do what is best for him. This is breaking my heart.

June 20th

I am doing my best to make Teddy as comfortable as possible. It is hell and I can't stop crying. I am taking the garden hose and spraying him after he has a bowel movement. Tomorrow morning at 11 am we take Teddy in and it looks like he will be put to sleep. I have taken pictures but it kills me to think this is how I will remember him. Am letting him have whatever he wants to eat.

That evening: I swear the area looks less red. The heat is hardly noticeable. He actually sat for the first time in 2 days.

June 21st

Got up (didn't sleep) and took the dogs outside to go potty. Went to spray off Teddy's butt and I couldn't believe my eyes. The area looks like it is scabbing. Is he healing? I need a second opinion. Yup! Looks like it is not only healing but the redness is barely there. Like a ton of bricks it hits me! I had been causing third degree burns to his entire surgical area. I call the vet and ask him if this is possible. YES!! By stopping the peroxide I stopped burning him and through keeping the area cool and washing with Betadine I allowed the area a chance to begin healing. Only 45 minutes before he was to be put to sleep. WAY TOO CLOSE!!

June 24th

Took Teddy in for the sutures to be removed. The whole area looks 75% improved. Teddy is acting more like his old self with each passing day.

August 21st

Lance put on 2-500mg of ampicillin. He is dragging his butt. Is he getting PFs? Also he's coughing and wheezing.

September 8th

Lance is improved. No more cough or wheeze but he is still licking his butt. It is getting red and has the dreaded odor. He has no anal gland sacs so I fear PFs.

October 22nd

No doubt about it. Lance has PFs. Cleaning the area with Betadine and treating it with Panalog ointment. No peroxide!!

October 28th

Confirmed PFs. 3/4s of the way around the anal opening. His butt looks very swollen and red and the smell is awful. Put him on antibiotics and he has to wear an Elizabethan collar when we can't watch him to keep him from licking.

November 14th

Vet wants to do surgery as soon as we can get the swelling down.

November 20th

Lance is urinating blood. Bladder infection? Put Lance on Clavamox 375 mg twice daily.

December 1st

Lance went in for PF surgery. Everything seems to have gone very well. Same exact surgery as Teddy had.

December 10th

Lance is healing nicely. We are very hopeful that we got all the PFs. Teddy is all healed up and doing great.

December 13th

Lance's sutures were removed. He is doing good.

December 29, 1997

I can't believe my eyes! Lance's PFs have returned!! His butt is all red and swollen again. Damn!

For the next 15 months we will fight Lance's PFs using homeopathic and conventional medical treatment. In December of 1996 (on the Monday before Christmas) Tasha (Teddy's mom) had undergone mammary gland cancer surgery. With both Teddy and Lance having PFs and undergoing their PF surgeries it has wiped out our meager savings. We can't afford to try the Cyclosporin on Lance. The blood spots seen on November 20th return again January 5, 1998 and from there it will become a battle between the blood in his urine and his PFs. On August 31st we will see a growth (tumor?) in Lance's bladder when we do an ultra sound. By September 7th the bloody urine will disappear only to reappear again September 29th.

July 1999 UPDATE!!

As of today Lance's long struggle is finally at an end, at least for now. One of the biggest heartbreaks of learning your dog has been diagnosed with perianal fistulas is realizing that there is no exact known cause and thus no cure for this disease. One's only hope is healing the fistulas and putting the disease into remission. For exactly how long no one can say.

My older male German Shepherd, Teddy, was the first of my dogs to develop PFs. Teddy has been in remission (PF-free) since June 9, 1997 after undergoing surgery to remove the PFs where his anal gland sacs had ruptured.

Here is another PF dog owner's extremely excellent description of seeing their dog's PFs begin: "First symptom we noticed was a swelling and redness. Afterward you could see the skin becoming a greyish color and beginning to get pretty rough looking. Then the holes appeared. You can think of PFs as how a plant grows. You don't see the roots but may notice the soil (skin) disturbed. But until the plant breaks the surface and "blossoms" you won't know for sure what it is. This is why internal treatments are important. The PFs are 'seeded' beneath the skin. You could also think of it as a 'plantor's wort'. If you ever saw one of those and had to get rid of it, you would know that until the 'seeds' or what some call 'the mother' is removed (dead) it just keeps spreading 'children'. The real frustrating part of PFs is the fact that the dogs own system is causing this, not something exterior. And nobody really knows what triggers the body to form these things!"

The surgery itself appeared to be completely successful and we prayed it was the last we'd hear of PFs. This was not to be. On December 28th Lance began to lick his backside again. With absolute dread I lifted his tail and to my horror saw the PFs were back with a vengeance. My heart ached for him. All the pain and suffering earlier was for naught. It was then I fully realized how deadly serious PFs were and that our previous success with Teddy's PF battle would not come with any guarantees either.

From there it was a downhill battle for Lance. As if the PFs weren't enough he had begun to have blood in his urine in amounts to cause me alarm. Repeatedly we tested the urine looking for clues as to the cause of the blood. The first vet treated him for urinary tract infections. Then tested for bacteria, found two of the worst and treated him with antibiotic injections, which I had to give him twice a day for 3 weeks. The bloody urine continued. We tried antibiotic after antibiotic trying to find the one that would solve the bleeding problem. I took Lance to a second vet who shot die into the bladder with x-rays and did an ultra sound looking for abnormalities to his prostate, bladder. Nothing abnormal was found. This second vet's gut feeling was it was Lance's prostate but the x-rays showed the prostate to be so slightly larger that this didn't fit the profile. The prostate was still within normal range for size. This vet then referred us to a specialist who performed an ultra sound for a whopping $210 fee compared to $35 at the regular vet. The specialist saw what she thought was a possible thickening of the bladder wall (scaring us into believing possible cancer) which turned out to be nothing and left us no closer to the cause.

By now we were desperate to find the cause and stop the bleeding. Lance's PFs were at an all time flare. He was one very sick pup. Then one day the blood urinated was a bright red indicating the source was near the urethra and getting worse. There was hardly any urine at all. Upon being notified the second vet suggested that we go ahead and neuter Lance and see what results, if any, that brought about. His suspicions remained with the prostate being the cause. So it was agreed that Lance would be neutered. I had planned to neuter him anyway because I refused to stud a dog that had a dwarf sister and PFs.

It wasn't until the vet confirmed we had found the cause that we finally let out a sigh of relief. Now to battle Lance's PFs into remission.

I had heard there was a new vet in the area and decided to meet her after she began sending clients to me for behavioral help and training. Upon meeting her I liked her instantly and in the midst of our conversation I told her about my problem with PFs in my dogs. She was currently treating 2 PF dogs. I decided to bring Lance to her and get her input on his condition.

By this time I had been with the PF support group for two years and the PF-L online support group from its beginning on October 25, 1998. Long enough to establish that the treatments of choice to heal PFs were Cyclosporin (which I couldn't afford) and a combination of Prednisone with Sulfasalazine (which met my budget and Lance's needs). I learned that the 2 PF cases (littermate brothers) this vet was treating were on the Pred/Sulfa and showing improvements.

It was agreed that we would try this route with Lance and see what happened. By this time Lance had been battling PFs for nearly 2 years. Upon examination her exclamation of, "Oh my! This is much worse than the other 2 PFs cases I'm treating!" my heart sank.

On February 26, 1999 Lance was put on 50 mgs of Prednisone once a day and 1500 mg of Sulfasalazine twice a day, although the plan of choice is 1000 mg given 3 times a day, which my work schedule wouldn't permit.

Remarkably within a very short two weeks I saw considerable improvements and although Lance was showing side effects from the Prednisone I knew we had to continue with this course of treatment.

Prednisone, a steroid immune system suppressor, given to dogs will cause rapid heart beat, heavy panting, very increased thirst, sometimes ravenous appetite and either give the dog more energy or make the dog sluggish, depending on the individual dog's side effects. Lance's panting was not only heavy, it made reading or hearing a TV difficult if in the same area / room. At least we knew this was a sure sign that the prednisone was working.

After a month of this treatment the PFs were gone and all that remained were small areas of gray where the fistulas had been. On March 29, 1999 Lance was officially declared to be PF-Free at last. He had fought this dreadful disease for nearly two full years. Although guarded we celebrated our victory. Lance had now been on the prednisone/sulfasalazine for four weeks so the prednisone dosage was cut in half to 25 mgs once a day. The sulfasalazine dosage would remain the same for a total of three months after which time he'd be taken off of it but Lance had to be weaned off the prednisone gradually to allow his immune system to begin functioning on its own again.

Lance had won his battle against PFs but the winner of the war still remains unclear.

Lance continues his weaning process off the prednisone. Treatment began with four weeks at 50 mg a day. Then dropping down to four weeks at 25 mg a day. Then dropping down to four weeks at 12.5 mg a day. Then dropping down to four weeks at 12.5 mg given every other day after which he'd be taken off the prednisone entirely. He is entirely off the prednisone as of today July 12, 1999. Now we hold our breath and wait.

The prednisone/sulfasalazine left its marks on Lance. He lost a good deal of the muscle tone in his head due to the prednisone making him look very much older than his five years. The vet assures me that over time he will gain it back and fill out again. His eyes have a very sunken in look from the sulfasalazine attesting to the horrendousness of his battle. We are grateful to have Lance and Teddy still with us and hopefully do our best to keep it that way until we lose them naturally to old age.

 

Copyright 1999 DJ Hensch

Last updated July 12, 1999

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