Kinderheim's Kandi-Ana Angel, CGC, OFA ("Kandi") was originally diagnosed with perianal fistulas in late October 1993. She wasn't quite three years of age. I had noticed a small "sore" a few months before but I had no idea what it was and did nothing about it, figuring it would heal by itself. I bred her in September, and a short time later, it became apparent that although palpation indicated she was in whelp, she had either suffered a false pregnancy or had lost her litter. However, I still harbored hopes that she had a couple of pups hidden somewhere. It was during this period of time that I took her in to have her anal glands expressed, again, and she was diagnosed with the perianal fistulas.
Kandi is from good lines, her father being a conformation champion and her mother, though an unknown, from working lines out of a well-known police K-9 academy in the midwest. This breeding produced a lovely specimen of the breed, bright and beautiful, though not the "type" that would win in the conformation ring.
As soon as Kandi was diagnosed, I called Helen "Scootie" Sherlock and she made several suggestions, and gave me a phone number to call at Michigan State University ("MSU") where, at the time, research was being done on perianal fistulas. She followed this with the request that I keep her posted on all I learned. I asked our veterinarian, Mike Gentry, D.V.M., Sheabel Animal Medical Center, to call MSU, figuring he knew the right questions to ask and that he would get more informative answers than I would receive as a near hysterical dog owner since most of these facilities only work from veterinarian referrals. We proceeded with the treatment MSU recommended, with the understanding that it was experimental and only 37 percent of the dogs respond to the treatment. The treatment consisted of administering Prednisone, 1 mg per pound of weight per day for four weeks (My GOD Mike, that'll KILL her!), then cut the dosage in half for four weeks, and then halved again, until a maintenance level was determined. I understood that the Prednisone would most likely not cure the fistulas. Hopefully, it would help maintain them. I also understood that the treatment would require a maintenance level of Prednisone for life. Kandi's fistulas DID respond to the Prednisone, in my estimation, falling in the second one-third group mentioned above. The fistulas did stabilize, the inflammation cleared, and they did not get any worse. However, I was never able to get the Prednisone down to a level that I felt was acceptable. When the level of Prednisone became too low, the fistulas would begin festering again and I would increase the dosage. Supplemental treatment included cleaning the area daily with Betadine an supplementing her diet with Vitamin E.
During the first five months of this treatment, Kandi and I visited Dr. Gentry every week, and then cut our visits back to every two weeks. In part, these checkups were because I was keeping such a close watch for any change in her condition. I also felt insecure and needed the confirmation that what I thought I was seeing was correct and that I was doing all I could to help her. I had no one to talk with who had experienced this disease.
If any of you have ever had a dog on Prednisone for any length of time, you will understand when I say it adds a whole new meaning to living life with German Shepherd Dog. These normally intelligent creatures turn into certifiable fruitcakes. The brain disengages--and reconnects directly to their stomach, and life for them becomes one continuous quest--how to obtain food (and water). Any food. Their food, your food, whatever can be snitched from the counter, which on one occasion included a whole meatloaf, fresh from the oven and cooling on the stove. Food on a fork between the plate and your mouth is not necessarily safe. The command "Leave It!" becomes two words they seemingly have never heard before. I'm sure this problem is not as difficult to deal with if the dog is an outdoor/kennel dog.
During this period of time, I called MSU myself and talked with the doctor doing the research. Needless to say, I was full of questions. What did I do wrong? Did I feed her the wrong kind of food? What could I have done to prevent the fistulas? What else can I do to help now that she has them? I was told that I had done nothing wrong, there was nothing I could have done to prevent the fistulas, and I should feed her a good, hypo-allergenic food. I was already doing this at the time and the brand name was pronounced "excellent."
By April, 1994, I knew that this problem would never be solved to a point, if indeed she even survived, where I felt I could try breeding her again and decided to have her spayed. Shortly after this surgery, Kandi began experiencing other health problems due to her suppressed immune system. Both Dr. Gentry and I felt this went directly back to the Prednisone. None of the problems were very serious but a lot more difficult to deal with because of the suppressed immune system and they took 2-3 times longer to get under control than would otherwise be normal. This became a drain on both of us, emotionally, not to mention financially. The problems included a staph infection on her chin and a few months later, puppy mange. We continued to fight the staph infection on her chin off and on through the summer of 1995, and, again, Dr. Gentry and I both felt it went back to the Prednisone Kandi was on for so long. We did eventually get the health problems cleared up and have had no recurrences.
When Kandi developed a couple of small spots of puppy mange in September of 1994, after being on the Prednisone approximately 10 months, I said "This stuff has got to go!" And go it did! I had, in the meantime, obtained the name of Dr. A. D. Elkins, D.V.M., Indiana Veterinarian Surgical Referral, Inc., in Indianapolis, Indiana, who does work in conjunction with Purdue University and does a lot of fistula surgery. Since I live in Lexington, Kentucky, and Indianapolis is approximately three hours away, I opted to go there rather than MSU, even though they had agreed to perform the surgery. It also helped that I am originally from Indiana with family in the vicinity with whom I could stay. Sisters give unconditional loving support.
The surgery was not guaranteed. Because the fistulas were bad, on a circle of 360 degrees, Kandi had involvement in approximately 270 degrees, it was difficult to treat the perianal fistulas aggressively enough to make sure all diseased tissue was removed and still not damage the sphincter muscle causing incontinence. The possibility of strictures (scar tissue) and stenosis (narrowing of the anus) are other side effects of aggressive surgery which can cause post-surgical problems. We were lucky that the fistulas had not eaten through into the intestinal track. Kandi's surgery consisted of scoping out the diseased tissue and then heat cauterization of the tracts. I brought her home the day following surgery, with a supply of antibiotics, an Elizabethan collar, and with instructions to keep the area clean and continue with the Betadine treatment as I had been doing, as soon as she would allow me to touch the area.
Driving home, I kept thinking about the best ways of cleaning and treating her and thought about sitz baths with epsom salts. Sitz baths are good for people, so why not dogs? It would at least aid me in keeping the area clean until Kandi would allow me to touch it, and might also be soothing, so I called Dr. Elkins' office the next morning. He thought it was "a wonderful idea if you can get her to do it." Not a problem! Something good finally came from owning a German Shepherd who tries to climb in the tub to take a bath with me. I came home on my lunch hour every day for two weeks to check her, let her out to potty as she couldn't get through her doggy door with her E-collar, and give her a sitz bath. She received four sitz baths a day for 5-10 minutes each. And I was able to start with the Betadine the second day after surgery.
I was in Indianapolis in December 1994, three months following surgery, and stopped in to talk with Dr. Elkins and give him a post-surgery update. It was then he told me that if we got past six months without the fistulas recurring, the incidence of recurrence dropped considerably and our chances would be greatly improved that they would not come back. As you can imagine, everything I could cross was crossed. We will reach the three year mark since her surgery in September 1997 without a recurrence and everything is looking great. Kandi will be seven in January 1998 and it is beginning to seem like a bad dream. However, I feel like a cancer patient in remission. That monkey is always sitting on our shoulder.
In April 1995, I had Kandi's anal sacs removed as they were a source of constant irritation and needed to be frequently expressed. They were very large, which apparently contributed to their not draining properly. I opted to have this surgery done more in the line of "preventive medicine" than for any other reason. We didn't need to be constantly expressing glands, having them get infected, or possibly rupturing. Enough already!! And if you've been counting, you are right. Kandi did in fact undergo three surgeries in a 12-month period. , I might also add that she has not suffer any of the post-surgical problems of strictures, stenosis or fecal incontinence which is so common following fistula surgery.
Post surgical treatment: I continue to check the area for any signs of the perianal fistulas returning. (Kandi, Stand! Stay! and with tail in one hand and flashlight in the other, I carefully inspect the anal area -- being careful to NOT stand in front of a window. I see no sense in proving to my neighbors that I'm crazy.) I do keep the hair trimmed around the anus and the under side of her tail that falls over the anal area. At first glance, it is not noticeable and this allows me to keep the area clean, allows better air circulation, and makes it easier to check for any signs of a recurrence. I also continue to treat the area several times a week with Betadine. I will continue doing these things for the rest of her life. It may not help. It can't hurt. I also continue to supplement with Vitamins B-100, C, E, and Fish Oil to help boost her immune system. For a period of time, I also steamed fresh vegetables to add to her regular food using whatever I had on hand but usually including white potatoes, yams, carrots, cauliflower and broccoli, with a generous dash of garlic powder. I also kept the water and added it to her food, not wanting to lose the vitamins.
Has dealing with perianal fistulas been easy? NO! It is time consuming and it does get old. It is a drain, both emotionally and financially. If I had it to do over, would I go through all this again for my lovely German Shepherd Lady? A resounding yes! She is worth it--and the bonding between us is even stronger than before, if that is possible. However, I would make a few changes in her treatment. I would try the Prednisone treatment again to see if the perianal fistulas responded. If they did respond, I would NOT leave her on that medication for nearly so long. As soon as the inflammation was down, I would have the surgery done. I personally feel that the less inflammation at the time of surgery, the better chance the surgery has of being successful--but then, this is only my humble layperson's opinion. If I didn't see a response to the Prednisone treatment within three to four weeks, I would get her off the Prednisone and proceed with the surgery immediately. As time goes by, and Kandi gets older, I would also have to rethink my options if the fistulas should return.