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Management Of Perianal Fistulae / Anal Furunculosis

The Leonberger Club of Gt Britain organised a talk on AF, on the 28^th February 1999 at Cambridge Veterinary College.

The talk was given by Dr Richard White Specialist in Small Animal Surgery, for which 60 people attended the seminar, the majority being German Shepherd owners. It would have been nice if more breeders attended, as this disease is not one that should be swept under the carpet It is heritable, transmissible from parent to offspring. I have written up my notes, which have also been checked by Dr R White to guarantee they are accurate and they read as follows:

Anal Furunculosis (AF) Perianal Fistulae (PAF) is now looked at from a different point of few as regards its underlying cause and its treatment. Whereas in the past an animal with AF would be treated for that condition alone the animal is now treated for a generalised Immune-Mediated syndrome, which is present for the life of the dog.

AF is part of the Immune-Mediated syndrome, and not as previously thought to be caused by poor tail carriage, or bad hygiene management. The lesion's that appear around the anal region at the base of the tail are just the tip of the iceberg and it is important to appreciate that lesions are normally present throughout the lower bowel too. German Shepherds are high on the list of affected breeds, followed by Collies, Labradors, and then some miniature breeds. It is life long disease although the age at presentation varies considerably with some presenting as early as 12 months of age whereas others may not present until late in life. Once diagnosed the dog will need care to control the problem for the rest of its life. Some animals will go into remission but the problem will and can re-appear from time to time during its life. The most common time for symptoms to get worse or re-appear on a dog in remission is during the summer, when owners tend to go on holiday, and put there dogs in boarding kennels. The stress from this event is often enough to trigger signs of lower bowel inflammatory disease (LBID), and it is suggested that should you need to go away, it would be wise to get someone to come and house sit the animal concerned. Other Symptoms of the syndrome include:

* Skin lesion's on the back of paws, legs, and flanks

* Colitis - Lower Bowel Inflammatory disease (LBID)

* Small Bowel Bacterial Overgrowth (in many cases)

* Chronic diarrhoea and Chronic Constipation

* May be Perianal fistulae

It is known to involve the Colon - Lower Bowel and small intestine. Immune related diseases could be related to a dietary condition early in life from beef derived protein. Gluten can also cause some problems in some cases too.

The syndrome in dogs has many similarities to Crohns disease in humans

One of Dr White’s comments was that he believed the breeders with German line bred "German Shepherds" did not think the problems were in German dogs, only in the English? This caused a little humour from the audience, as we all know that "The Germans" never admit to having any problems with their dogs. It was suggested that those that do.... seem to contract the problem(s) on there trip across the channel? Ha Ha

Dr White went on to say that he recently presented a talk in Stuttgart the the German Small Animal Veterinary Society, and after talking with specialists over there and from the USA, he confirmed the problem is not isolated to the UK, as others would like us to believe! The problem is definitely in Germany and in the USA.

Clinical Signs

The lesion's around the anus itself Dr White believes are usually painless?

The signs of the problem are:

1. Licking at Perianal region.

2. Serosanguinous discharge (Thin bloody type of string fluid) with some straining

Colitis - Clinical Signs

* Difficult defaecation

* Frequent or constant straining or constipation then diarrhoea

* Mucus, blood covering motions

* Often painful!

Most symptomatic dogs that have PAF/AF also tend to have had colitis too.

Investigations

It is suggested that when investigating a dog with the syndrome to have the following tests done:

TLI, B12 and Folate studies for small intestinal disease. B12 and Folate studies, say if there are any abnormalities there. (Blood test) Trypsin (TLI) is to rule out pancreas and small bowel disease.

Sometimes, a proctoscopy is performed to look up the rectum and see what is going on. Signs to look for would be red inflammation, or thickening (Colitis)

Treatment

For Small Bowel Bacterial Overgrowth...

Treatment for Small disease

* Oxytetracycline

* Metronidazole

* Low fat diet

For Lower Bowel Inflammatory Disease...

* Sort out diet - Hypo-allergenic

* Prednisolone - 1mg per kg BID (Twice a day)

* Sulphasalazine - 10-20mg / kg BID (Twice a day) (side-effects can be dry-eyes)

USE WITH CARE, ESPECIALLY ON GERMAN SHEPHERDS

Diet

Foods that should NOT BE USED are all Beef derived proteins, and in some cases Gluten. This includes chews, which are normally beef derived, some cereal diets and all diary products.

Suggested Complete Foods

Walthams (prescription), Select Protein, Wafcol Special 21 which is also Gluten free, Wafcol "Corn and Maize", Iams Eukanuba "Mutton & Rice", or "Response Formula", and Chappie Complete Chicken were some of the foods recommended. Not all dogs will respond well to the same food, and you may need to test a couple out before finding the right one for your dog.

Fibre

Some animals require additional fibre, and this can be given in their daily food.

* Isogel

* Fibagel

* All Bran

(All can be brought from a chemist or supermarket, and can be sprinkled over the dog's food dry, and not fed as per the packet)

Immunosuppressive Therapy

Drugs - Prednisolone (steroid anti-inflamatory) and Cyclosporin

Prednisolone is widely available, cheap and reasonably effective. The side effects are increased thirst, appetite, and Cushings disease. This is recommended for short-term use only and should be tapered off after 3-4 weeks when stable on their diet.

Cyclosporin

Cyclosporin is used for immunosuppression in human transplant patients, it stops the body rejecting organs and suppresses the immune system. Dogs put onto Cyclosporin normally get good results and in most cases return to normal with all signs of PAF/AF disappearing. Unfortunately, when the drug is withdrawn, PAF/AF symptoms may return. This is a very expensive drug, and costs at present £2 -3000 for 2 months treatment on a Leonberger size dog. Trials on reducing the dose to 1-2mg / kg twice a day are in progress, this in turn could bring the cost down to a more affordable figure of £300.00 per month.

Side Effects - Vomiting - Diarrhoea - Weight Loss - Hair Growth

Surgical Management

* Cryosurgery ( no longer recommended)

* Tail Amputation (Performed in USA -NOT RECOMMENDED)

* Anal sac removal (as normally abnormal, and full of pus)

* Sinus Excision (Cutting out tunnels of bad areas)

Cryosurgery

Not recommended because:

This technique does not allow control of damage to health tissue and muscles in surrounding areas can be effected. Therefore, causing scaring to an area that needs "minimal scaring".

We then broke for a break, and were served up lovely home-made cakes, and the raffle was drawn where all proceeds went to Leonberger Rescue. Returning after break for a question and answer session, then a walk around the hospital to see the facilities.

I have put this article together from the notes I took during the seminar, I have also included two article’s written by Dr R White, which hopefully clarifies what I have written. My version being a little more in depth.