Anal gland abscess

Re: Anal gland abscess

Evelyn Barbour-Hill — Sat, 16 Jul 2011 22:19:07 GMT

[quote user="SteveOwen"]

Why does most of the veterinary profession refer to anal sacs as anal glands? A gland is an endocrine organ!

[/quote]

Ha hah, we have had that out in this forum before! I don't know why they do it, but I do know that if you query it you get dismissed as a mere pedant.

Umm, by the way, a gland is not necessarily an endocrine one. There are plenty of exocrine glands. Including the true anal glands.

Re: Anal gland abscess

SteveOwen — Sat, 16 Jul 2011 18:53:23 GMT

Why does most of the veterinary profession refer to anal sacs as anal glands? A gland is an endocrine organ!

Re: Anal gland abscess

mariette asselbergs — Sun, 19 Jun 2011 20:27:47 GMT

David, It is clear that you are very passionate about this thing of using antibiotics based on anecdotal evidence and experience. But I think you are far too harsh in your judgement of the participants of this forum. It is precisely the act of looking for more evidence than your own experience which obviously leads the participants. True, the scientific experiment is the highest quality of evidence, but it is not the only one. Joining up experience and anecdotal clinical cases and their outcomes creates evidence surpassing everybody's individual experience. I think your argument would be taken far more seriously if it was not made in the style of a boy's debating club!" src="http://www.vetsurgeon.org/emoticons/v2/Winking_smiley.gif" />

Re: Anal gland abscess

Niall Taylor — Sat, 18 Jun 2011 22:04:38 GMT

[quote user="David Mills"]'x' thalidomide victims claimed their diseases was from exposure to thalidomide, but until this was investigated they were the same as the levitaters - data only in number and claim[/quote]

IIRC the medical profession stopped using Thalidomide based on case reports only - the investigation came later. Lucky for potential victims the agencies responsible didn't have such a high handed and purist attitude to evidence based medicine as some on this list.

Niall

Re: Anal gland abscess

plantagenet — Sat, 18 Jun 2011 18:29:14 GMT

[quote user="David Mills"]A little more thought, people; one of my only consolations is my hope that a percentage of negative head-in-sand opinion-holders on this forum will soon be heading towards retirement.[/quote]

...and in 20 years someone will same of you, because, like it or not, you do begin to trust your own experience as you get more ..er.. experienced. I'm not necessarily saying that's right or wrong, just seems to be the human condition.

Re: Anal gland abscess

David Mills — Sat, 18 Jun 2011 15:45:45 GMT

The witticisms are truly brilliant, really.

The plural of anecdotes are in one semantic, strictly speaking, data - e.g. if 10 people say they levitated then that is a fact i.e. that they say they levitated, and there were 10 individuals who said this. This is not to say that they actually levitated. This would require a test or experiment whereby you could set up a camera in their rooms and when they next said they levitated you could watch the video back to see if they did or not. 'x' thalidomide victims claimed their diseases was from exposure to thalidomide, but until this was investigated they were the same as the levitaters - data only in number and claim.

The same is true for veterinary medicine, and the thread above. Simply because someone gives antibiotics for anal gland infection/abscess/disorder and the dog gets better is nothing more than an anecdote, regardless of how he arrived at the decision about which antibiotic and if he does this 50 times it is the same as the levitaters in that it is data but only in number and claim. The only way to make this scientific data is to apply an objective or as-near-objective-as-possible test to show some cause and effect relationship was in play rather than just coinicidence - in this case C/S would show which bacteria were present in the largest numbers and to what antibiotic they were sensitive to. IF your chosen antibiotic is effective, then great, you're likely curing the infection. So, Mr Todd, I'm sure you can now see that your argument was a Bad Argument.

(What also needs bearing in mind, however, in the anal gland argument is that many of us will also apply other treatment e.g. lancing, flushing, anti-inflammatories which will improve the disease outcome. It then, from a scientific perspective (if not a therapeutic) becomes even more important that some science is applied to antibiotic choice as improvement from other modalities may mask lack of response.)

My arguments were non anti-antibiotic, or doubtful of whether people with the same protocol have been cuing these things for years. My cry was at the entire lack of, and lack of awareness of, scientific rigour in selecting antibiotics beyond 'I've always done it that way', and the general dismissal of the rational use of narrow spectrum antibiotics where possible, or the need for CS in bacterial infections. It is all very well smugly sitting back saying "I've always cured them that way" as Mrs Jones leaves with her poodle heaping praise on you, but you are doing the profession and more importantly the future profession a great harm in this head-in-sand complacency, especially if you are too ignorantly dogmatic to see what you are doing. Antibiotics especially are not harmless drugs to be thrown around and every time they are used they select for resistance which is irreversible, unpredictable, and may not even be in the area you're targetting. I can assure you that if vets don't get their house in order over this then they will be removed - ask yourself where would you be without the fluoroquinolones, cpehalosporins, and amoxiclav? I need hardly tell people that resistance is multiplying - look at the E.coli deaths of recent years, MRSA (now incredibly commonly carried in dogs), VRSA, the CS result from a parrot on this thread, the fact I recently faecal sampled some calves who carried E.coli that was resistant to every antibiotic commonly tested against it.

For the record, I do not prescribe to C/Sing every AG abscess, just a proportion - and this goes for all bacterial infections, or suspected ones. Some need it every time - urine from blocked cats, potentially ears. But what I am passionate about is this ridiculous notion that C/S is a time-wasting, expensive, scientific irrelevance. It may well become almost compulsory for vets in the future if we continue to overprescribe or prescribe wrongly and without forethought.

A little more thought, people; one of my only consolations is my hope that a percentage of negative head-in-sand opinion-holders on this forum will soon be heading towards retirement.

Re: Anal gland abscess

Julian Earl — Sat, 18 Jun 2011 12:51:06 GMT

[quote user="Anthony Todd"]

[quote user="Julian Earl"]The plural of anecdote is indeed not data,[/quote]

Sorry you'll have to justify that.

Certainly scientific journals are full of a series of [lets say ruptured cruciates] with anecdotal descriptions of techniques, ages, breeds, procedures and outcomes which seem to me to be a collection of anecdotes which, when put into a spreadsheet, become data.

If you mean "I heard about a ruptured cruciate and I think it got better when it had an operation" then, sure, a pretty vague anecdote and not data, but with all the accurate information tabulated and a number of cases, surely data?

Or do you mean that data can only come from institutions and only anecdotes from practicioners?

[/quote]

You are directing your retort at the wrong person I fear:

[quote user="David Mills"]

...Of course I'm not advocating not treating whilst CS is happening but your justification is nothing more than anecdote (+ data sheet + misreading a scienitific paper) - and as elsewhere on these forums, the plural of anecdote is not data; wheras I could treat with a wealth of objective CS for the last months-years behind me...

[/quote]

I was responding to the above post. However, strictly speaking, you are correct and I was agreeing with Mr Mills that a lot of variable anecdotes on a single subject do not equate to scientific data, so as a Proud Pedant, I have been hoist by my own petard.

But despite his comments, I think he is wrong that C&S is always required, as was demonstrated by my earlier post.

Edit: also, whilst I agree about the obvious benefits of lancing a ripe abscess, there are many anal gland cellulitises/"abscesses" that are not ready to burst when presented and those have to receive antibiotics; trying to lance through inflamed swollen tissue to find the centre of a developing abscess is Not A Good Thing in my experience.

Re: Anal gland abscess

bob lehner — Sat, 18 Jun 2011 10:50:30 GMT

[quote user="Horcrux"]Absolutely - it is just as simple as that! And concerning costs - do we really always need GA to drain an abscess? Usually I use a local one and sometimes sedation. [/quote]

Very good point - often no need for GA or sedn - I've lanced and flushed innumerable cat bite abscesses without either, provided the patient is relatively co-operative and the abscess is good and 'ripe'.

I'm quite convinced that a very swift stab with a no 11 blade inflicts no more pain or stress than phaffing about with iv injections, keeping the animal in for the day, anaesthetic risk, additional expense etc etc.

Sometimes I think we make too much of a meal out of simple things.

Re: Anal gland abscess

Horcrux — Fri, 17 Jun 2011 21:02:20 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Richard Fox"] However is it also not unreasonable to try and treat conservatively first and then drain/debride surgically (like you would an abcess, stick injury or grass seed) if it fails to respond? Especially as some clients can't afford GA/Sedation, surgery and further AB's and NSAIDS?[/quote]

I don't know if it's unreasonable or not. I just feel it's more reasonable to drain first and then go for heaps of antibiotics if it fails to respond.

The answer to your second point is that it depends on what you charge. Especially as some clients can't afford/won't want to pay for GA and sugery after already forking out for loads of antibiotic and NSAID.

An abscess - or an "abscess" - needs draining. Let's leave it there.

[/quote]

Absolutely - it is just as simple as that! And concerning costs - do we really always need GA to drain an abscess? Usually I use a local one and sometimes sedation.

Re: Anal gland abscess

Anthony Todd — Fri, 17 Jun 2011 18:37:05 GMT

[quote user="bob lehner"] If the last 100 anal sac abscesses I have treated have responded well, quickly and cost effectively to what ever treatment protocol I have used, then I am likely to stick with it.[/quote]

Bob, don't worry, mate, call it EXPERIENCE BASED MEDICINE, [don't mention "anecdotal"] and you'll be quoted in journals for the next 100 years.

Re: Anal gland abscess

Evelyn Barbour-Hill — Thu, 16 Jun 2011 21:01:08 GMT

I don't know if it's unreasonable or not. I just feel it's more reasonable to drain first and then go for heaps of antibiotics if it fails to respond.

An abscess - or an "abscess" - needs draining. Let's leave it there.

Re: Anal gland abscess

Anthony Todd — Thu, 16 Jun 2011 11:45:20 GMT

[quote user="Wren"]Does this not become Evidence Based Medicine? In which case it's got a name, so is a perfectly acceptable clinical technique[/quote]

So that's where I'm going wrong!

It's not a collection of anecdotes [think Bernard Manning..] it's EVIDENCE BASED MEDICINE!

Credibility and peer respect at last!

I feel so much better!

Re: Anal gland abscess

Wren — Thu, 16 Jun 2011 11:31:13 GMT

[quote user="bob lehner"]

A tad patronising if I may say so. If the last 100 anal sac abscesses I have treated have responded well, quickly and cost effectively to what ever treatment protocol I have used, then I am likely to stick with it.

[/quote]

Does this not become Evidence Based Medicine? In which case it's got a name, so is a perfectly acceptable clinical technique

Re: Anal gland abscess

Bob Russell — Thu, 16 Jun 2011 11:27:23 GMT

Sorry! I may be less scientific than some other vets but with flushing and five days (Co-amoxiclav in my case) my patients (over 25 years worth) have always got better. If I find I am getting problems I will discuss it with my lab and follow their advice. Until that time I am going to continue.

Re: Anal gland abscess

bob lehner — Thu, 16 Jun 2011 11:11:13 GMT

[quote user="David Mills"]he number of responses whose justification relies on "always worked for me" .....is truly, truly, tragic for a supposedly intelligent profession.[/quote]

Those of us who beaver away at the coal-face of veterinary medicine generally base our treatments on what we suspect will work in any particular circumstance, based on our previous experience and knowledge - whilst of course remaining receptive to new ideas and developments.

Re: Anal gland abscess

Anthony Todd — Thu, 16 Jun 2011 10:02:48 GMT

[quote user="Julian Earl"]The plural of anecdote is indeed not data,[/quote]

Sorry you'll have to justify that.

Or do you mean that data can only come from institutions and only anecdotes from practicioners?

Re: Anal gland abscess

Richard Fox — Thu, 16 Jun 2011 08:01:29 GMT

Well then the term abscess is probably wrong.

Edit: I did type a lengthy retort but I removed it as I don't want to prolong this diatribe any further - we will just have to beg to differ!

That said I agree with you Evelyn that when the sac ruptures is releases highy antigenic material (secretions and keratin) which comprises most of the reason why the whole area becomes inflamed and therefore it benefits from drainage to release the antigenic material (bacteria included) like you would explore a stick injury or grass seed lesion? However is it also not unreasonable to try and treat conservatively first and then drain/debride surgically (like you would an abcess, stick injury or grass seed) if it fails to respond? Especially as some clients can't afford GA/Sedation, surgery and further AB's and NSAIDS?

Re: Anal gland abscess

Evelyn Barbour-Hill — Thu, 16 Jun 2011 02:30:26 GMT

[quote user="Richard Fox"]suppurative anal saculitis which IS NOT AND ABSCESS! [/quote]

Indeed it is not. I thought we'd got that clear.

[quote user="Richard Fox"] the anal sac has been devoured by an infection and walled off by fibrous tissue[/quote]

Does that ever happen? I've never known an "infected" anal sac, that had not ruptured, that could not be induced to discharge through its duct (whether it would be a good idea to discharge it that way is another question altogether).

The classic anal sac abscess as so neatly described above by Michael occurs when the wall of the distended, battered sac splits. Yes of course there's cellulitis around it. You're going to tell me that it's not actually an abscess. Hmmmmm, well, OK, but in that case we shouldn't be talking about "anal sac abscess" at all.

The point I keep banging on about is that an abscess - or an "abscess" - needs drainage, not prolonged antibiotic administration. It may not need any antibiotic at all even if there's cellulitis and pyrexia. Veterinary surgeons were curing abscesses centuries before antibiotics were discovered.

In the hypothetical case that Michael describes above, I'd get that dog in that very same evening, anaesthetise it, stick a blade in the swelling, have a good guddle round (sorry, debride and flush) till I was fairly sure all the serum, pus and anal sac secretion had left it, give it some NSAID and send it home a happier dog, with one to three days' worth of Stomorgyl. It's only in that last clause that there's any scope for criticism.

Re: Anal gland abscess

Julian Earl — Wed, 15 Jun 2011 23:02:11 GMT

[quote user="Richard Fox"]

Evelyn - I think we need to be clear on our terminology here - do we have a tissue abcess i.e. the anal sac has been devoured by an infection and walled off by fibrous tissue (by definition a walled off area of aggregated puss) or a pyogranuloma / cellulitis due to infection / keratin extending into the tissue - or just suppurative anal saculitis which IS NOT AND ABSCESS! Some might think who cares but a thick walled off abscess is more difficult to treat as AB penetration is reduced?

I would be sceptical we are dealing with a true abcess was my train of thought which I probably didn't make clear.

Generally dogs, unlike cats, poorly wall off infection and infrequently get true abscesses in my clinical and pathology (post mortems) experience if we are indeed splitting hairs on whether we have an access or cellulitis

My point was if theres severe anal saculiutis then AB's may not lead to a rapid cure if the sac ruptures? If I am incorrect and you have a chronic abscess then I apologise?

[/quote]

I have long been telling owners that antibiotics do not work for sacculitis; I have seen too many purulent anal glands persist despite metronidazole or pot.amox or cephalosporins or etc., etc. I do not believe that abs penetrate in to the gland well enough when it is a warm, moist area in probably the most contaminated region of skin on the body.

However, the red, painful swollen perineum around an anal gland that may or may not be on the point of rupturing is sacculitis behaving like an abscess until it ruptures subcutaneously with a consequential cellulitis, is it not? Those are highly likely to contain mixed infection with mixed sensitivities and require immediate broad spectrum antibiosis. The plural of anecdote is indeed not data, but sometimes the practical and requisite solution to a problem is to get off a high horse and sort it out pronto.

Re: Anal gland abscess

Anthony Todd — Wed, 15 Jun 2011 22:48:50 GMT

[quote user="David Mills"]the plural of anecdote is not data;[/quote]

I suspect the thalidomide victims might disagree.

A collection of good anecdotes makes data good enough for me.

Re: Anal gland abscess

Richard Fox — Wed, 15 Jun 2011 20:07:38 GMT

I would be sceptical we are dealing with a true abcess was my train of thought which I probably didn't make clear.

My point was if theres severe anal saculiutis then AB's may not lead to a rapid cure if the sac ruptures? If I am incorrect and you have a chronic abscess then I apologise?

Re: Anal gland abscess

David Mills — Wed, 15 Jun 2011 17:56:58 GMT

[quote user="Michael Woodhouse"]

So, dog comes in to your clinic this evening, been licking backside and off colour. T39.5°C. Painful and purple lateral to the anus on right hand side. What are you going to do? Swab tonight, send home on NSAID. Read plate tomorrow night, mixed infection so try to grow the separate bacteria, taking another 24 hours. Once you have a pure culture type it and then put up for another 24 hours as a sensitivity profile? Two or three days have now gone and it's Saturday night, you going to start it on the Synulox now for the coliforms/staphs or will it wait until monday?

Going by most other people here we would have the dog well on the road to recovery by the time you had chosen yours.

[/quote]

Ignorant complacency such as demonstrated above will only lead to disaster. Whereas your use of antibiotics is empirico-anecdotal all of the time, and probably works for you most of the time, it relies on others to ensure it continues to do so. Blindly following amoxiclav data sheets - are you aware how flimsy the evidence required to have soft tissue infections on them? - means you might rarely go wrong. But if you're conscientious, or even just a rational person, and CS say 1 in 5 AG abscesses (or any infection come to that) then any major changes in sensitivity will be picked up.

Of course I'm not advocating not treating whilst CS is happening but your justification is nothing more than anecdote (+ data sheet + misreading a scienitific paper) - and as elsewhere on these forums, the plural of anecdote is not data; wheras I could treat with a wealth of objective CS for the last months-years behind me. If antibiotics are considered necessary (for instance there is justification for lancing and lavaging and cleaning, with anti-inflammatories, and no antibiotics if the dog is systemically well and apyrexic), whether we are talking about guidelines or law, using as narrow a spectrum as possible antibiotic - especially where coliforms or staphs are involved - cannot be argued with.

This isn't about AG infections per se, but any use of any antibiotic. Anyone remember when we could kill Pseudomonas easily? The number of responses whose justification relies on "always worked for me" and "isn't CS just theoretical?" above is truly, truly, tragic for a supposedly intelligent profession.

Re: Anal gland abscess

Michael Woodhouse — Wed, 15 Jun 2011 16:17:09 GMT

[quote user="David Mills"]For the record, cost price for C/S is around £3-5 when the equipment is bought. Price of 2 synulox.[/quote]

Maybe so in consumable terms, but I'm sure I don't need to tell you that the staff costs and time taken eclipse that. Equally the cost of the infrastructure (incubator, API strips, glassware, stains etc) even if you cultured everything you put on antibiotics I reckon it would double your basic costs.

Just smearing a bit of puss on a blood agar and Maconkey plate with some sensitivity discs tells us next to nothing. We either do a proper job (if we are charging for it, rather than these things we do to satisfy our own curiosity) or nothing, It's why we stopped doing our own milk bacteriology.

Can I suggest looking at the various generics if 2 synulox are costing £5!

[quote user="David Mills"]Stormogyl is a licensed product containing metronidazole. It is not pure metronidazole, which, according to cascade would be usable in its generic form because no licensed veterinary product of pure metronidazole exists, and where clinical grounds (ideally C/S or unique characteristics of the drug) exist to indicate its use even if a licensed product from another class of antibiotic exists.[/quote]

Go back and read the first line of the cascade

If there is no medicine authorised in the UK for a specific condition, the veterinary surgeon responsible for treating the animal(s) may, in order to mitigate unacceptable suffering, treat the animal(s) in accordance with the following sequence:

There [unquestionably] are licensed veterinary medicines for this specific condition that are effective. Unless you have used then first and they have failed there is no justification here for using off label metronidazole.

Going by most other people here we would have the dog well on the road to recovery by the time you had chosen yours.

Re: Anal gland abscess

David Mills — Wed, 15 Jun 2011 14:03:24 GMT

[quote user="Michael Woodhouse"]

Never cultured one so I don't know, but there's a study published where the bacteria matched skin bacteria, therefore gram positive aerobes likely, and so close to the backside that gram negatives have to feature. I can easily justify a broad spectrum antibiotic.

[/quote]

I assume you refer to "Macroscopic, cytological and bacteriological evaluation of anal sac content in normal dogs and in dogs with selected dermatological diseases" by Pappalardo et al.? I quote from the method: "This study aimed to identify only aerobic bacteria": low and behold, that's what they did when they cultured in aerobic conditions. These were from normal dogs, and the anal sac would, emptying into the air, be at least microaerated. In a large deep tissue abscess I would say anaerobes are far more likely to be the primary problem.

[quote user="Michael Woodhouse"]

Cascade again, Stomorgyl specifically licenced for oral infections only AND in combination with spiramycin. Clindacin licensed for treatment of infected wounds, abscesses, oral cavity/dental infections. Clinically, Synulox has been shown to be effective in treating a wide range of diseases of dogs including: Skin disease (including deep and superficial pyoderma); urinary tract infection; respiratory disease involving upper and lower respiratory tract, enteritis, dental infections (e.g. gingivitis), soft tissue infections (e.g. abscesses and anal sacculitis).

[/quote]

Where to start. Stormogyl is a licensed product containing metronidazole. It is not pure metronidazole, which, according to cascade would be usable in its generic form because no licensed veterinary product of pure metronidazole exists, and where clinical grounds (ideally C/S or unique characteristics of the drug) exist to indicate its use even if a licensed product from another class of antibiotic exists. Anal sacculitis is not an abscess - the clue is in the name.

[quote user="Michael Woodhouse"]

Is ANYONE doing routine C&S for any bacterial infection?

[/quote]

And we wonder why antibacterial resistance is on the rise. What happened to rationality?

For the record, cost price for C/S is around £3-5 when the equipment is bought. Price of 2 synulox.

Re: Anal gland abscess

Evelyn Barbour-Hill — Wed, 15 Jun 2011 12:55:32 GMT

[quote user="Richard Fox"]Can I also point out that even if the lesion is infectious then the sac can quite often rupture[/quote]

I don't understand. If there is an abscess then the anal sac has ruptured. No?