Any new thoughts on an old problem?

Re: Any new thoughts on an old problem?

grumpyoldman — Sat, 01 Mar 2014 23:07:12 GMT

1 remove the anal glands

2 Pred as well at 2mg/kg

3, intra lesional Sandimmune weekly

4. Are people still thinking the underlying problem is IBD on the outside ? potato and lamb diet

5.Cryo never worked , it just rearranged the tracts

6. wondered about manuka honey a few times

7. trib 80s seem to work better than more expensive fluroqinolones do not know why ?

8. New puppy for christmas !

Re: Any new thoughts on an old problem?

Shams Mir — Sat, 01 Mar 2014 20:26:43 GMT

To all contributors thus far: many thanks for your responses and valuable advice.

Shams

Re: Any new thoughts on an old problem?

John Flynn — Sat, 01 Mar 2014 16:49:42 GMT

[quote user="robloxley"]Nizoral is discontinued; I'm unaware of any other oral ketoconazole[/quote]

Don't know if there's an appropriate cost-effective alternative?

Clarithromycin? Is already on abs, so why not use one that might block up the p450?

Re: Any new thoughts on an old problem?

Rob Loxley — Sat, 01 Mar 2014 16:20:00 GMT

[quote user="John Flynn"]using ketoconazol[/quote]

Nizoral is discontinued; I'm unaware of any other oral ketoconazole

Re: Any new thoughts on an old problem?

John Flynn — Sat, 01 Mar 2014 13:01:50 GMT

Long-term prospective evaluation of topically applied 0.1% tacrolimus ointment for treatment of perianal sinuses in dogs

Bryden J. Stanley, DVM, MVetSc, DACVS; Joe G. Hauptman, DVM, MS, DACVS

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824. (Stanley, Hauptman)

Address correspondence to Dr. Stanley.

Objective—To evaluate effectiveness of a combination of topically applied tacrolimus, orally administered prednisone, and a novel-protein diet for treatment of perianal sinuses in dogs and to monitor clinical progress and owner management of the condition for 2 years.

Design—Noncontrolled clinical trial.

Animals—19 dogs with perianal sinuses.

Procedures—Perianal sinuses were diagnosed during physical examination, and dogs were placed on a 16-week treatment protocol consisting of topically applied 0.1% tacrolimus ointment, orally administered prednisone (tapering dose), and a novel-protein diet. Metronidazole was orally administered for the first 2 weeks. Anal sacculectomy was recommended whenever anal sacs were involved. Dogs were evaluated every month for the first 4 months and then every 6 to 12 weeks for 2 years.

Results—Perianal sinuses resolved completely in 15 of 19 dogs during the 16 weeks. In the remaining 4 dogs, the lesions markedly improved but failed to completely resolve. Three of these had anal sac involvement, and the owner of 1 dog had complied poorly with treatment instructions. During the 2 years following treatment, all dogs were maintained on intermittently applied tacrolimus ointment, 4 dogs also received prednisone every other day, and 11 dogs remained on the novel-protein diet. At the conclusion of the study, 13 of the 15 dogs that survived to that point were free of perianal disease.

Conclusions and Clinical Relevance—The described protocol was effective and economical for resolving perianal sinuses. Dogs maintained on intermittent medications were unlikely to redevelop lesions. When the anal sacs were involved, anal sacculectomy appeared to improve the outcome.

Abstract

Journal of the American Veterinary Medical Association

August 15, 2009, Vol. 235, No. 4, Pages 397-404

Re: Any new thoughts on an old problem?

John Flynn — Sat, 01 Mar 2014 12:45:43 GMT

don'y know if it works well or not, but using ketoconazole to mess with cytochrome p450 enzymes and reduce ciclosporin metabolism is sometimes talked of as a more wallet-friendly version of increasing ciclosporin tissue levels than upping the dose.

Re: Any new thoughts on an old problem?

Anthony Todd — Sat, 01 Mar 2014 12:42:44 GMT

I used to make sure the A/Gs were not infected [often were] and pack them with the discontinued Panolog.

Some used to remove them too as I recall.

Wouldn't suggest this as a cure though but it helped.

Soft stools were supposed to contribute, and short docking done, [conformation extremes] but a bit severe for most owners and vets.

Sorry not new, but always seemed to improve them and, these days, the old tricks are often forgotten.

Re: Any new thoughts on an old problem?

Rory Bell — Sat, 01 Mar 2014 12:21:40 GMT

Hi Shams

As Hannah said, upping the dose of ciclosporin to 5 to 7.5mg/kg daily would be an initial first step. I think Hannah also neatly sums up why this is considered a medical, rather than a surgical condition. If there is no improvement over a two week period, then measuring circulating concentrations to ciclosporin to ensure you have dosed adequately might be worthwhile considering, and if ciclosporin is ineffective, then as Chris said, topical tacrolimus would be the next logical step

cheers

Re: Any new thoughts on an old problem?

Christopher Saul — Sat, 01 Mar 2014 12:13:08 GMT

Hi Shams

I'm not a dermatologist so not really my main area but one option I reckon is topical tacrolimus ('pro topic') - has a similar mechanism of action to cyclospirone. Might be worth a look

Re: Any new thoughts on an old problem?

Hannah Wynne Richards — Sat, 01 Mar 2014 12:08:29 GMT

I have seen them operated on - Barbara Weaver at Bristol used to do them (in the dim and distant past) Bloody surgery, and took ages, and risk of nerve damage. Cambridge used to use cryo-surgery, which caused a stinking mess.

No easy answers, but it might be worth trying long-term, as opposed to pulse antibiotics, after culturing. Also going by BSAVA small animal formulary, the dose of cyclosporin for peri-anal fistulae is 5 mgs/kg every 12/24 hours. Unless side effects to cyclosporin, I'd up the dose

Wynne