Help with ideas to approach to persistent anal gland infection

RE: Help with ideas to approach to persistent anal gland infection

SL Liakouras — Wed, 04 Aug 2021 06:14:44 GMT

That explains it, I’m a surgeon at heart! I’ve done 1 maybe 2 flushes but never with Osurnia (in the States we use panalog) and always work to resolve d+. But yeah, if they have chronic issues I advise to whack them out.

RE: Help with ideas to approach to persistent anal gland infection

Clive Lloyd — Tue, 03 Aug 2021 20:33:37 GMT

Thank you for the advice Anthony. Unfortunately, I gave up using i/v catheters for packing anal glands some time ago due to the very thing you mention - they bend/ kink far too easily - hence the Spreull's needle. The other laternative is a lachrymal cannula - either plastic or metal.In times gone by another option was either a Tetra Delta or Leo Yellow intramammary tube - they go down the canal easily and most dogs will allow it to be done conscious. However if you are going to go the whole hog and flush the sacs first I would always recommend sedation. Cats rarely seem to suffer such infections and I would agree that an i/v catheter is the only way to do it in cats.

RE: Help with ideas to approach to persistent anal gland infection

Anthony Todd — Tue, 03 Aug 2021 13:15:14 GMT

It would be helpful if all of you still at the rear end of practice [geddit?] kept a record of rear-end-probs [REPs].

After 6 months or so we/you all should have some sort of database rather than "views and opinions" so you all can profit in the future.

i've given mine and can't help any more.

PS I never ever changed the diet in these cases.

RE: Help with ideas to approach to persistent anal gland infection

mike jessop — Tue, 03 Aug 2021 09:06:29 GMT

Still lurking! Interesting thread and confirms my belief that the profession just loves fiddling with dogs bottoms. I have up emptying glands in anger 15-20 years prior to stopping clinical practice.

Back to first principles and the glands empty by good faecal function. The trigger here has been poor faecal function. Correct the stool and the glands should heal. I found Hills RD to be the best gland regulator.

This is a poodle so I would also factor in Atopic perianal pruritus. Are ears and feet behaving?

Sorry to steer away from meds and surgery!

RE: Help with ideas to approach to persistent anal gland infection

Iain Richards — Tue, 03 Aug 2021 07:12:14 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29941/help-with-ideas-to-approach-to-persistent-anal-gland-infection/231692#231692"]

Hi Iain, do you think anal glands are ever "infected" or do they, just, like faeces, contain bacteria. Certainly if they were atopic it explains why Croids work...

i must say some of the content was pretty liquid and looked like pus?

don't think i can remember a case with dermatitis as well??

[/quote]

YOu certainly do get infected ones - I've even hd a dog die wehn one ruptured internally, appalling peritonitis. But these are usually unilateral.

I suspect most people are attuned to just emptying the sacs - clients and owners alike - that no one has really questioned if they are the problem or not. mike jessop seems to be on the list still - I stopped routinely emptying glands basd on his comments on the SPVS list. It just amde better sense that the real problem was atopy/perianal irritiation

RE: Help with ideas to approach to persistent anal gland infection

Anthony Todd — Mon, 02 Aug 2021 22:37:30 GMT

Spreull's needle

Clive et al, please try a venocath [or similar] next time. Actually not many/any dogs would need less than a 20G Can't remember cats??

You will be gob-smacked at the ease that the flexible!!! tapered!!! tip enters the duct [as opposed to the "knob" "] and it's length is easier too.

And it bends if needed.

RE: Help with ideas to approach to persistent anal gland infection

Clive Lloyd — Mon, 02 Aug 2021 21:02:20 GMT

In my experience persistent anal sac infections do not respond very well to oral antibiotics(provides temporary relief at best). If there is frank pus (green or bloody) then I would advise that the sacs are flushed and packed under sedation. By all means do C+S but I find flushing with 10mls saline through a Spreull's needle, followed by 5mls metronidazole solution (use normal injectable) and then pack with Otomax ear drops until sacs overflow works very well. Check up in 7 days (they will be fine by then) and then a further 4 weeks. I would not advocate weekly manual emptying as patients soon get wise to this and grow to resent it. Increase dietary fibre intake long term. if they relapse within 4 weeks then surgical removal is indicated. Some dogs with relapse again in the longer term and repeat flushing and packing is reasonable if the interval between episodes is months/ years. Do look out for underlying atopy as part of the problem. God gave dogs anal sacs for a reason and it wasn't to give vets something to do - anal sac disease is a real problem for some dogs and needs careful discussion with the owner.

RE: Help with ideas to approach to persistent anal gland infection

Anthony Todd — Mon, 02 Aug 2021 19:28:26 GMT

Fair doos, thanks

RE: Help with ideas to approach to persistent anal gland infection

Clive Ansell — Mon, 02 Aug 2021 17:56:20 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29941/help-with-ideas-to-approach-to-persistent-anal-gland-infection/231692#231692"]do you think anal glands are ever "infected"[/quote]

yes. I have seen infected anal glands, both in the form of abscessation and recurrent anal gland problems where something is cultured via a C&S swab. Whether these are primary pathologies, or secondary, to atopy, impaction etc, I don't know? my feeling is that they are. Proof as been in the pudding, as they have resolved with antibiotic therapy.

RE: Help with ideas to approach to persistent anal gland infection

Anthony Todd — Mon, 02 Aug 2021 15:32:36 GMT

Hi Iain, do you think anal glands are ever "infected" or do they, just, like faeces, contain bacteria. Certainly if they were atopic it explains why Croids work...

i must say some of the content was pretty liquid and looked like pus?

don't think i can remember a case with dermatitis as well??

RE: Help with ideas to approach to persistent anal gland infection

Iain Richards — Mon, 02 Aug 2021 10:54:19 GMT

There are papers to show that colour and consistency are not associated with infection and that all anal sacs have a mixed flora.

Treat the underlying atopy...

RE: Help with ideas to approach to persistent anal gland infection

Anthony Todd — Sun, 01 Aug 2021 12:50:02 GMT

As far as I remember faeces were just normal, constipation or diarrhoea not a feature?? Pain on defaecation may have been mentioned but not often???

RE: Help with ideas to approach to persistent anal gland infection

Yantha Smyth — Sun, 01 Aug 2021 12:06:09 GMT

Thanks everyone for your input.

I was thinking along the same lines as Clive in this particular case as it was a 'first offence' with the anal glands, and in the grand scheme of things not been especially protracted or yet had the time to show itself as a chronic recurrent AG issue. In which case I would be offering surgical removal as an option. But the persistence of the lime green pus, and knowing the dogs diet was jumbled, and that the faeces frequently are soft had me thinking about diet change etc.

I was lucky enough on the day he came for his ACTH stim test, after the test, I was able to flush each gland without sedation, and instil some flamazine (this was open, and nothing else was...). I used the little nozzles that used to come with the canaural drops- still have a small stash- they are great since they are blunt and easy to place and won't kink.

After taking on board all your comments, chatting to the owner, and seeing there does now seem to be progress after the flamazine instillation, we have elected to empty q7-10d, complete the stomorgyl course, and introduce a dietary change- initially just streamlining current diet and adding protein pro-fibre.

RE: Help with ideas to approach to persistent anal gland infection

Anthony Todd — Sat, 31 Jul 2021 11:09:15 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29941/help-with-ideas-to-approach-to-persistent-anal-gland-infection/231651#231651"]I prefer too, although some dogs will allow conscious.[/quote]

Certainly easier with sedation, but venocaths made such a difference!!

Not/never?? accompanied with diarrhoea, IMHE??

PS Venocaths kink easily.....sedation has only advantages!!

PSS I don't think we ever removed A/Gs after a Panolog infusion. There must be similar preps, now that Panolog is no longer available??

RE: Help with ideas to approach to persistent anal gland infection

Clive Ansell — Sat, 31 Jul 2021 10:54:28 GMT

[quote userid="17833" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29941/help-with-ideas-to-approach-to-persistent-anal-gland-infection/231644#231644"]Do you have to sedate to flush? or have you been able to do it consciously?[/quote]

I prefer too, although some dogs will allow conscious.

It is often sore or painful, and I find I can examine and perform lavage easier and better with sedation.

RE: Help with ideas to approach to persistent anal gland infection

Sarah Keir — Sat, 31 Jul 2021 09:59:57 GMT

Flush and pop in an Onsurnia. Could also do cytology but is highly likely to be rods being in poo central. Can sometimes do concious, depends on dogs, they are often terrified of anyone going near their bottom and you need the dog to have a relaxed anal sphincter to catheterise (with an IV cannula minus stylet). Plus longer term need to stop the diarrhoea. These cases can be frustrating and only a crystal ball will tell if you should have gone to surgery sooner or not but most settle down medically (unless you ask a surgeon).

RE: Help with ideas to approach to persistent anal gland infection

SL Liakouras — Sat, 31 Jul 2021 09:12:57 GMT

Do you have to sedate to flush? or have you been able to do it consciously?

RE: Help with ideas to approach to persistent anal gland infection

Clive Ansell — Sat, 31 Jul 2021 07:46:43 GMT

It has not been going on that long with this one. why not try repeated emptying and lavage in the first instance, along with a diet that will firm up and bulk stools. Wouldn't jump in with preds unless inflammed or pruritic, and would use antibiotics unless clearly infected or C&S identifies a pathogen.

Ultimately, surgery if doesn't settle or is recurrent.

RE: Help with ideas to approach to persistent anal gland infection

Emily Rainbow — Fri, 30 Jul 2021 20:05:16 GMT

Diet trial +/- preds or apoquel before considering surgery in my book!

RE: Help with ideas to approach to persistent anal gland infection

Anthony Todd — Thu, 29 Jul 2021 05:12:22 GMT

Yup, that's what most thought, and was the advice at Penn,but we tried Panolog infusion as a last resort with good permanent results, much to everyone's surprise. Mind you it was pointed out that Panolog contains an awful lot of the 'roids.....

I'm just suggesting this as a possible alternative if surgery, for any reason, isn't an option as it can be done without even sedation [usually], may well solve the problem, and avoids GA etc.

RE: Help with ideas to approach to persistent anal gland infection

Evelyn Barbour-Hill — Wed, 28 Jul 2021 23:25:49 GMT

Surgical removal is the answer.

RE: Help with ideas to approach to persistent anal gland infection

Anthony Todd — Wed, 28 Jul 2021 13:08:14 GMT

If nothing else works express, flush with saline [IV cannulas 18-20G are the best to enter gland!] and "import" Panolog from somewhere. Never failed me.

Works in cats too.

RE: Help with ideas to approach to persistent anal gland infection

Bob Russell — Wed, 28 Jul 2021 09:17:29 GMT

Change of diet would be my easy choice, preferably to something very different. Intermittent loose poo seems to be a recipe for disaster. Could try adding bran to keep the owners occupied

Not sure how common true infections are but the really difficult ones come in for flushing and packing with good old Canaural. We don't seem to need to do this often.

Regular emptying every ten days until normal secretion found (or none) probably does most good. Then if it ain't broke don't fix it!

Based on zero science and no controlled studies of course.