The Big Squeeze: Let’s Talk About Anal Glands

I love dogs and (almost) all things dog, but one thing I did not want to become an expert on is anal glands.  I think most any dog owner is vaguely aware of anal glands.   If your dog is licking their hind end more than usual, or scooting their butt all over your freshly cleaned floor, or smelling like a 10 day dead fish marinated in liquid poop…the culprit is probably their anal glands.

If you have not heard of anal glands (lucky you!), they are at the rear end of the dog.  The smelly end.  They are two little kidney bean sized glands seated just inside of the rectum, at “5 and 7 o’clock around the anus.”  The normal order of things is that these little glands fill up with foul smelling fluid and they then empty themselves out when your dog poops, leaving behind a nice reek for other dogs to sniff.  Except, sometimes they don’t empty themselves.  Sometimes things go terribly wrong.   That’s where the butt-rubbing on your carpet comes in.

IMG_5189

Why, dear God, why?!
The stools need to be firm enough to squeeze those glands into emptying themselves.  Firm poop, you want your dog to have it!  If the dog’s diet is too low in fiber, they can suffer chronically from too-full anal glands.  If the dog goes through a bout of diarrhea for any reason, it can leave the glands full and uncomfortable.  Dogs with chronic tummy upset and the resulting soft stools are also at risk.  Obese dogs or dogs who are not exercised frequently can also be prone to poor rear end muscle tone and that can result in the glands not emptying properly.  Some dog’s glands are simply situated “deeper” and “lower” than they should be, and this unfortunately means that when the stool passes out of the dog’s rectum – the full pressure of the bowel movement is not pressing on the glands and they are left with fluid inside.

What can be done?
Prevention!  The dog’s poop needs to be firmer.  This can mean a total diet change, either to a different kibble formula or even to a raw food diet.  It can mean supplementing the existing diet with more fiber.  Pumpkin is touted as the go to diet additive to introduce more fiber into the dog’s diet.   Always use pure pumpkin, never pumpkin pie filling.  Diggin’ Your Dog makes an easy to use pumpkin fiber supplement.  My dog and I are extremely happy with a powdered fiber supplement called Glandex.  The most important thing to remember is that every dog is different, and while it can be frustrating to find the right solution to keep your dog’s anal glands happy, it is worth the trial and error.

When your dog is scooting, licking/chewing and cannot get those glands empty…someone has to manually empty them.   This means a trip to the veterinarian’s office where the staff can express your dog’s glands, and teach you how to do so at home if you so choose.   Some groomers express the anal glands.  If you do learn how to express your dog’s glands, remember to be patient, use plenty of praise and treats (especially peanut butter or squeeze cheese that takes focus to consume.)  Have a gentle assistant help you to restrain your dog and feed him treats while you do the expression.
However! If it ain’t broke, don’t fix it!  Expressing a dog’s glands if they are not showing symptoms of discomfort/fullness is extremely unnecessary.  If your dog’s anal glands are working as they should be, just leave them do their job be happy about that.  Manual emptying of the glands can cause tissue trauma and swelling and there is no reason to do so unless it is truly necessary.
This will not be considered a how-to on how to express a dog’s anal glands!   I highly recommend getting an experienced veterinarian, technician or skilled groomer to show you how to express your dog’s anal glands if it is necessary.  The glands can be expressed externally or internally.  External expression is exactly what it sounds like: pressure is placed on either side of anus until the fluid expresses (if the glands are very full you can actually feel them).   It is less invasive, but in my experience, less effective – external expression does not always completely empty the glands.  Internal expression is also exactly what it sounds like: straight to the source!  Finger inside of the dog’s rectum while the thumb places opposing pressure on the gland externally with slight pressure applied until the gland expresses the fluid.

I don’t have to tell you: Manual expression is not fun for man or beast.   Most dogs are not likely to take the finger probing without a struggle.   When the fluid expresses it often shoots straight out of the rear end and it is best to stay out of the way! (TU’s Katie’s wise words: Make sure your mouth is closed when you express anal glands!)  It takes some practice to learn to express a dog’s glands, and it helps if you can grow four extra hands.

And sometimes, things go extra terribly wrong.
My dog Molly is a poster child for bad anal glands.   She came to me as a very young shelter puppy, a stray on the streets of a big city.  She always had a difficult tummy.   We tried a lot of different foods and she still had chronically soft stools as a pup, often diarrhea.  She often licked her hind end and was able to relieve her full glands this way.  She was rather tidy and efficient about it even if she was smelly - we called it “busting a gland.”  We have visited the vet or groomers countless times for manual expressions.  The vet tried to teach me how to express them myself one time and it was a miserable failure.  I DIY just about every aspect of dog care and grooming, but anal gland expression was the one thing I said “No!” to.

Molly is the perfect storm.   She continues to be very prone to stomach upset and gets soft stools rather easily from dietary changes or too many treats and she also has very deep set, recessed anal glands.  She is a challenge to manually express, even for the experienced.  It is amazing that we went 6 years without a major issue.

A few months ago my husband chose to share three chicken skins with Molly.   (Sigh.)  She had a few days of diarrhea followed by soft stools and then she was busy “bustin’ a gland” like nobody’s business.  Then she started….leaking.   Gland fluid on my couch covers, blankets, bathrobe, floor, crate padding.  On my pillow.  One night I woke up and my pajama pants had a big smelly wet spot on them from where Molly had her butt cozied up to me.   Yuck!   This was excessive, but it just felt like another chapter of Molly being kind of gross and having butt trouble.   I took her to the vet and had her glands expressed and was dismayed that the very next day she continued leaking.  This went on for about two weeks before Molly woke me up at 3am with her licking and when I turned on the light, her tail and hind end were covered in blood.   Whoah.

Back to the vet office and this time we made an appointment to see the vet rather than to just have her glands expressed.   The vet on duty that night told me he had never expressed more difficult glands on a dog, and he told me that Molly’s right anal gland was badly infected.  And let me just tell you, an infected anal gland is a pain in the butt, literally.  There is a lot of bacteria in the area, the dog is licking at it and irritating the tissue even further.  If an infection progresses without treatment, the gland can actually abscess and rupture externally.   Ouch.

The treatment for Molly’s infected anal gland began with several courses of different oral antibiotics and warm compresses to the anus.  I soaked a washcloth with hot water, wrung it out and placed it right underneath Molly’s tail and applied gentle pressure for 5-10 minutes each evening.  We visited the vet weekly for manual anal gland expression to evaluate Molly’s progress.   I groaned every time I saw blood fly out onto the exam table – that meant the infection was not going away.  When the first two rounds of (different) oral drugs did not work, we moved on to direct “infusions”.   Infusing the anal gland involves using a small catheter to access the anal gland’s emptying duct and packing the gland full of antibiotics directly.  The rectum has to be pulled out slightly in order for the vet or tech to be able to access this duct – not very fun for the dog at all.  Molly’s infection took two rounds of infusions before the fluid that was expressed was a mixture of blood and regular fluid.   It was the first sign of improvement!  Another infusion, and the next week, all regular fluid.  It took nearly two months to resolve.  I did not think it would ever resolve.

For the first month after the infection cleared up, I was instructed to express the glands weekly.  By now I had gotten over my shyness of doing Molly’s gland expressions myself.  I wanted to be able to keep an close eye on that gland fluid to be certain that the infection was not returning.  Weekly expressions are definitely not necessary anymore – if I notice Molly “bustin’ a gland” I take her into the bathroom and express her glands for her now.  And if she is not fussing at her hind end, we leave well enough alone.   Less manipulation to the tissue back there is best.

If infections or abscesses become a recurrent issue, it is possible to surgically remove the anal glands.  This was very much a Last Resort decision as far as I was concerned.  The anal glands are uncomfortably close to the nerves that control the anal sphincter.  In other words…if there is a complication your dog could become unable to control their bowel movements.  I am hopeful that Molly and I will never have to face that sort of decision, and that her anal glands stay happy and empty for many years to come!

Jessica (and Charlie)’s Guide to Addison’s Disease

Guest blogger Jessica Troup shares her experience with her dog’s Addison’s Disease.

It was a typical Wednesday afternoon: come home from work, walk the dogs and then head to my horse barn across town. Except this time was different, Charlie, my 3 year old yorkie-poodle mix, was not himself.

YOLO Charlie

Now let me explain Charlie. Charlie is the epitome of everything terrier. He has a zest for life that can only be matched by a bingeing Ozzy Osbourne snorting a line of fire ants off the pavement (apparently a true story), mixed with the Man vs Food guy at an all you can eat BBQ joint, but with a dash of just enough swagger that you find him cuddling with you when you need it most.

So I was naturally alarmed to find that he hadn’t eaten his breakfast, he was slow moving to exit his kennel, and then it happened…diarrhea everywhere. Vomit every few steps. Not good. I ran through my mental log of things this could be, suspecting perhaps leptospirosis or a similar infection. I checked his gums, but he happens to have those frustrating blackish colored gums which makes color checking difficult.  Still, his capillary refill looked normal, but it was hard to tell with his color. I grabbed the thermometer and checked his temp, expecting him to possibly be running a fever. Wrong. It was low, it was 98.2…..we needed to go to the vet right now.

Our regular vet said they could squeeze him in at the end of the day, but that if he needed hospitalization we’d have to go to the emergency vet. I got on the highway and started driving. I wrapped Charlie in my fleece jacket and turned on the heated seat for him. I began to get the feeling I was wasting my time driving all the way across town to the regular vet, when the animal ER was much closer. I turned the car around and was at the ER in minutes, breaking a few speed limits in between.

When we arrived at Carytown Animal Hospital, I realized Charlie had some pretty vague symptoms with the only glaring thing being his low temperature. While I filled out paperwork, they took him back and immediately ran bloodwork and put him on fluids. They said the results from all the testing they ran would take a few hours and that I should maybe go and come back. Since this vet is in an area where you can walk to various stores and restaurants, I went for a walk. It was the longest 2 hours of my life. I made my way back to the vet, and that’s when they gave me news I didn’t want to hear.

“Everything is negative except for his kidney values. He is going into kidney failure. Has he gotten into anything he wasn’t supposed to eat?”

“…..no” Tears began to fill my eyes.  Charlie hasn’t gotten into anything. We don’t even allow foods like raisins in the house.

“So there are two possibilities. He may have acute renal failure, in which case there is not much we can do at this point. Or he may have Addison’s Disease. Of the two, Addison’s Disease is what you want as a diagnosis. It’s very treatable once we can get a diagnosis…..” Her words became inaudible to me. I started crying and couldn’t stop.

Addison’s Disease…..that’s what JFK had…..the only thing that came immediately to mind, but I remembered studying about it in school. Basically, the adrenal glands are responsible for making cortisol (needed for many hormones produced in the body but most notably, adrenaline), and the hormones that control the basics of kidney function, all gone. It is considered an autoimmune disease, which means his body attacks the adrenal glands, and is known to be carried in the poodle line among other breeds.

Apparently it would take a few days to get a confirmation on his Addison’s disease but she went ahead and ran one of two tests used to diagnose. The first test checks their current cortisol levels. And the second test is done where there is a baseline cortisol level taken, then the adrenal glands are stimulated to give a response to release cortisol, and the final cortisol result is measured (this is called the ACTH Stim test). Normal dogs have a huge increase in cortisol in the ACTH Stim test, and A-Dogs have small to zero response.

Charlie was going to have to be hospitalized over several days. It would take time to stabilize him and then to perform the ACTH stim test. His initial cortisol levels were basically zero, so it was promising that he may have Addison’s disease. But again, the vet continued to tell me, many dogs can have low cortisol but be completely normal.  She cautioned me not to get my hopes up. The next few days of waiting for the call were agonizing.

image1

The vet techs at the Carytown Animal Hospital were sweet enough to send me these pictures of Charlie while I was at work.

“His ACTH results are positive for Addison’s Disease” the vet’s voice said optimistically.

My feelings were mixed. While yes, I had prayed for this diagnosis over kidney failure, I had no idea what to expect for living with an A-dog.

Charlie was released on day 4 with a bill for $3,000 (thank God for care credit). While the prognosis was good, he would have to be on medication for the rest of his life. He would have to take prednisone every day, and a shot of percorten once a month to replace all of the mineral regulating hormones for his kidneys. But the good news was that A-dogs have the same life expectancy as regular dogs and never (as long as they are well controlled) die of their complications of Addison’s.

It was termed that Charlie had been in a “Addisonian Crisis”.  His adrenal glands had reached the point that they were no longer functioning, and kidney and cortisol control and function ceased. All at once. Unfortunately, this is how so many Addisonian dogs are diagnosed. It is known as the “great pretender” because its’ symptoms mimic so many other disorders that it may be too late before the thought to test for addisons comes to mind for a vet. Luckily, our ER vet had seen this before, and she followed her instincts.

image2Here’s where the real work began. I had to bring him back to eating and drinking regularly, and figure out the dosing of both medications that worked for him specifically. Each dog varies in what dosages of each of these medications they need to do best. Overdo the prednisone, and you’ve got a ravenous, agitated pup who’s urinating everywhere. Don’t give enough, and you’ve got a lethargic, listless pup who may not want to eat.

I discovered that since he received so many fluids at the vet, he probably wasn’t feeling thirsty, but it was imperative to get him to drink. He also wasn’t hungry. The vet sent me home with cans of something so vile I could never feed it to him, so I decided to find something I could live with feeding him. Being the “dog foodie” that I am, I found an amazing brand of canned food that was bland enough for his tired tummy to digest, but with an ingredient panel I could trust, and sourcing I could trust. I landed on “Dave’s Chicken and Rice” canned food. I took small amounts and diluted it in water. I was feeding him about 4-5 small meals a day for the first two weeks he was home. Some were more watery than others to make sure he was getting adequate water intake. This was crucial for many reasons, but restoring kidney function was the most important. I kept him on this food for about two months.  His stomach had been through hell.

I was basically considered the “poo police” by my husband. I was the one to walk Charlie at all times to go potty and I monitored for signs of improvement. It was about two weeks before I saw the first solid poo, but I sure did celebrate the first time I saw it. It meant he was on the way to recovery, and that he might be ok.

The percorten presented its own challenges.  You strive for a certain sodium to potassium ratio in their bloodwork based on what dosage of percorten you give. You want it as close to what is called homeostasis (what is normal for the body) as possible. But this becomes an art form, and checking it enough in the beginning comes with a price tag. But I promise it is all worth it. It takes time, as some doses may cause different ratios, never quite balancing out, but eventually you hit your stride with it, and don’t have to check the electrolyte panel so often.

After a while, Charlie returned to being his normal self. He went back to eating his regular food with his usual enthusiasm and also drinking at normal intervals. But there were several things about living with an A-dog that I did have to make sure I changed permanently.

 

Living with an A-Dog

IMG_1170

One thing you will learn when living with an A-dog is that you will end up knowing more about Addison’s disease than the vet will. It’s just natural. The vets spend maybe a chapter out of their entire schooling on this disease, as it is so rare, and end up relying on specialists to know more about it. Similar to human medicine except the specialists in the dog world are far more expensive (unless you have pet insurance), and are few and far between. So you must educate yourself to the point of nauseum, and be proud of it. I joined a facebook group comprised of owners of A-dogs, and vets that own A-dogs. The name of this group is “Addison’s disease in dogs” and they were immensely helpful.

Through personal contacts, I know a vet in Chicago who has an A-dog and is a board certified internist. We did several phone consults with my own vet for a basic understanding of his medication and where he needed to go from his initial diagnosis. This vet set the tone for how Charlie was to be cared for, and the more I became a self-proclaimed expert on the topic, the more my local vet trusted my judgment on medication adjustments.

One thing to remember is that the more stress or excitement your dog experiences, the more prednisone they need. But you also want to balance that with an overall low dose, as close to physiological dosing as possible, protocol. Sounds difficult? It actually isn’t. You taper down from what the ER vet put the dog on (usually high to compensate for the massive cortisol loss they had during the crisis) and go down to the lowest dose in which your dog remains himself, without feeling listless or low in energy (for himself, obviously dogs vary considerable in energy level). So while a therapeutic dose of prednisone might be 10-20mg for an allergic dog or one needing prednisone therapy, Charlie, a 15lb dog, receives 0.3mg daily. BIG difference, and often a point of contention that you might face with the holistic dog owners and vets out there since they hear the word prednisone and see red. Nothing against them, and I do my part of holistic care in my dogs, but there is a fundamental difference between the physiological need for prednisone (which is synthetic cortisol) and therapeutic doses. Ok, off the soap box.

Managing the “mineralocorticoids”, which are the hormones that control kidney function (specifically sodium and potassium levels), is a bit tricky. There are two ways to go about it. The first, and gold standard, is a monthly injection given either SubQ or intramuscular. You only need to give the injection in the muscle if the dog is about to go into crisis, and as long as he is well maintained and you haven’t forgotten a shot, this shouldn’t ever be necessary. SubQ is given between the shoulder blades, under the skin. There are two protocols for giving percorten, and the first is not the best. It goes by the weight of the dog and that’s it. This is often costly, uses too much percorten, and can cause damage to the kidneys long term. The second protocol is newer and based off of more accurate research and data. It is termed the “low dose protocol.” The dog starts off on a lower dose, but still weight dependant, and then the dose is dropped until the sodium to potassium ratios, run via electrolyte blood checks, is at the ideal range. For an example, Charlie initially was at 1.5cc of percorten monthly, and dropped to 0.23cc, which puts him at ideal ratio.

I know this sounds challenging and expensive, but it isn’t really. Percorten can be purchased from stores like Costco or 1800 petmeds, and one vial is 4mL (cc).  For Charlie, a $200 vial lasts about 14 months.  The good news is that if you are comfortable giving injections at home, then you can have your vet teach you how to give it and you save yourself money and your dog the stress of a vet visit. In fact, as I type this, I just gave Charlie his monthly shot while he was laying on the couch (obviously followed by some really tasty treats).

Another option for those a little more squeamish is to buy the vial and have the vet (or the vet tech) give it monthly. Usually they don’t charge office visits for this sort of thing, so again it is economical.

There is also the option of Florinef tablets. For those in Europe it is the only option, as percorten is not available there. Florinef combines the action of prednisone and percorten in a tablet. It is less ideal as you cannot independently fine tune the prednisone and mineralocorticoid function independently and it is far more costly. For human medicine, it is the chosen drug for maintenance of Addison’s disease, mostly due to convenience of taking a pill over a shot, but percorten is still considered more effective in canines.

So when you boost the prednisone, how do you do it? And how do you get such low doses to begin with? I order prednisone in liquid form from CVS. Make sure to ask for xylitol-free prednisone! Xylitol is a sweetener used to make it more palatable for kids, but is absolutely deadly to dogs. The pharmacist knows the difference and will give you the regular, non-sweetened medication. It can be sweetened with regular sugar if you need to. I always, without question, give Charlie a treat following his squirt of pred in the morning. There are two reasons for this.  Obviously we want Charlie to like getting medicine.  He comes running at 7:30am every morning to the bathroom and waits for his meds. However prednisone can be hard on an empty stomach, so if you aren’t ready to feed breakfast yet, a tasty treat will do the trick (the second reason).

Now on to boosting!  When you know your dog may experience some extra excitement or stress (perhaps for, an agility round or a trip to the groomer), you will need to boost his prednisone.  I boost by 0.1mg at a time. Usually this is more than adequate. For Charlie, I have never had to take him higher than a grand total of 0.5mg total for the day. In most cases, he doesn’t even need a boost. You end up knowing your dog very well, and what his stress triggers are (positive or negative) and compensate for that.

A-Dogs have compromised immune systems. They do not handle getting infections as well as other dogs. I am one to use many supplements in my dogs regardless, but I find it paramount in Charlie’s diet. Boosting his immune system gives him every fighting chance possible when he is exposed to something. For a normal dog, kennel cough could last a few days, maybe a week.  In Charlie, I’ve seen it last almost a month. Sadly, that can be normal for these guys. When choosing the supplements I use, I research companies, where they source ingredients, and if they are third party tested. If they don’t have data to back up what they say is in their supplement, it isn’t worth my time, or my dog’s. I wanted Charlie on a set of probiotics that had multiple bacterium present, prebiotics, as well as omega-3 fatty acids. I also wanted him on a wellness supplement which was clinically proven to support the immune system, gut, and joints. Here’s what I settled on:

  1. Nordic naturals fish oil for dogs  Must be the pet specific one as cod liver oil for humans may contain too high of vitamin A levels. It is the same quality as the human version, but third party tested for the correct ratios.
  2. Platinum Performance Canine  This one speaks for itself to a certain extent. The clinical research surrounding the immune boosting properties of their proprietary ingredient, “bio sponge” which works in the gut to remove toxins that may cause allergic and immune reactions. It also gives you glucosamine, MSM and chondroitinpe, as well as other essential amino acids and vitamins and minerals for overall wellness.
  3. Nutrivet Probiotics and Digestive enzymes  This product is tasteless and provides a good swath of bacterial cultures as well as digestive enzymes to aid in food digestion.

But there is one more thing.  A-dogs are technically not considered healthy enough to be vaccinated. While vets will vaccinate them, they do not handle the vaccines like normal healthy dogs do. Vaccine reactions are much more common in A-dogs, and their immune systems remain very low following the vaccination.  I made the choice to titer test Charlie for the core vaccines (minus rabies – it’s the law) and opt out of the non core vaccines such as leoptspirosis and lyme. Many people may argue that if he is exposed to these diseases he would be much more sick, or even die, but the reality is that Charlie is a house dog.  He has never been in an environment where his would be exposed to these diseases. Titer testing allows me the autonomy to know what his immune levels actually are for these diseases, and make an informed decision based on the results.  If he is showing strong immunity to them, then we can postpone revaccination for a year and recheck the titers at that time.Stress and excitement levels also have to be closely monitored, as both require cortisol for him to cope. And remember, at times he may need a boost in prednisone.  This means that boarding is basically out of the question for him. We have had success with having him stay in other people’s homes for pet sitting.  However, because he is a small dog (15lbs), he fits very nicely underneath airplane seats. We typically take Charlie everywhere with us. He is a more well travelled dog than most, and his stress and excitement levels remain pretty constant as long as he is with us, which also means less prednisone boosting for him. He handles turbulence like a pro, and I’ve literally caught him snoring while taking off and landing in turbulent winds. I at times envy his naiveté.To date, Charlie has travelled to Washington DC (and had a romp across the Vietman war memorial, which is another story for another day!), Naples, Tampa, Tallahassee, Charlotte, Atlanta, New Orleans, Ft Lauderdale, Orlando, Chicago and the list goes on. The fun thing about taking him places is that TSA agents turn totally mushy when they see his crazy cute terrier face, and I don’t have to go through the X-Ray thing and can instead carry him through the old metal detector like the old days. He is also allowed to walk on leash through the airport (must be in carrier bag to board), so I have taught him how to run on moving side walks, which he thinks makes him super dog! He has also learned to pee exactly on command in an exact location (unfortunately on concrete) when we are in the airports for a quick potty break.

I won’t lie–taking on the challenge of an A-dog has had a huge learning curve, and at first it can be a financial burden. The initial diagnosis is very expensive, as they usually are only discovered when they are in a “crisis”, but once properly diagnosed, they really do live like normal dogs, and can do normal doggie things. Charlie now seems no different than he was before his diagnosis, which means to me he is living his life to the fullest. There are many A-dogs I know of who compete in Agility and obedience as well as dock diving. While Charlie doesn’t compete, he finds that world travelling is more his speed, and he hopes to get many more stickers on his puppy passport.

IMG_4099