Aa
Strange Ear Issue - Shih Tzu
I don't really know where to begin because I don't know where this all started. My 2-year-old Shih Tzu has always had skin issues since she's been a baby. I have had to bathe her with a certain shampoo and conditioner her entire life and if I don't, she has serious itch attacks and nobody sleeps. FYI - she is near my side 24/7. The only time she goes outside is when she's with me on her leash and we're taking a walk. She's ridiculously pampered.
About 2-3 months ago, she punctured her cornea in her right eye and had to have eye surgery (this could be relevant). She had an E collar for over a month and I was not allowed to bathe her facial area at all (maybe the lack of bathing caused this?). As part of her recovery, she was on Prednisone which, as an added bonus, completely stopped her itching during the time she was taking it.
Anyway, I noticed about a week ago that she was getting itchy again and gave her a bath with her shampoo. I looked in her ears and they seemed a little more pink than normal so I pulled out her ear hairs. Afterward, I cleaned them with a special solution given to me by a vet. Within a day or two, her ears became quite red and swollen. I was thinking, "Oh great. We just paid $3,500.00 for eye surgery and now we get to go pay another $200 for an ear infection. I decided to give it a day or so to see if it was just from the hair plucking.
Within a day, her ears were still red and swollen and it almost looked as if there were some... thin blisters on her ear skin. I began giving her Benadryl at night. This stopped the itching altogether and within a day or two, the blisters and swelling went away, and her ears were just a little more pink than normal. I was feeling better because it seemed like things were going in the right direction and we were out of the woods so to speak. I kept up with the Benadryl just at night. Things seemed to be going great.
Today, I took a look at her ears again. The swelling was still down, the color a bit more pink than normal and it appeared as though the blisters (though gone) had almost lifted her top layer of skin from the insides of her ears. The skin texture was rough and when I gently rubbed it with my finger, huge flakes (not much smaller than my pinky nail) peeled off of her ear. Mind you, this was on both the inside of the leather ear flap as well as the inside of her ear - in both ears.
So, today, I gently removed the flakes from her ears thinking that I was helping by keeping her ears free of debris. I didn't scratch or anything, just picked up the flakes between my fingers (sorry to be gross but when it's your baby, it doesn't seem gross when you're helping them). A few hours later, I looked at her ears and they were bright red again. Not swollen, but pretty red. She's also been gently rubbing them with her paws since I messed with them. Not a digging, obsessive scratch or anything - just a soft rub. I think I should have just left her ears alone.
I am completely baffled. If it were an actual infection, I would think that Benadryl wouldn't be helping. To me, the fact that the Benadryl helps with the itching, etc. means that it's probably an allergy issue rather than an infection. Also, since the swelling and dark color subsided, I can't help but think that we're heading in the right direction toward healing. But what's up with this flaking? What is going on? Like I said, we just spent $3,500.00 on eye surgery. I love my little baby - however, she has been a vet bill a month since we've had her. She came to us (2 years ago) from a bad breeder. She had Giardia, ear mites, ticks, an ear infection, etc. After getting her spayed (while also fixing an umbilical hernia) her surgery site became infected... etc, etc, etc! Seriously, this has been the million dollar dog already and I'm just hesitant to take her in. Every time we see a vet, they want to do 40 different tests at $60 a pop. Let's face it - we're in a bad economy and vets, just like everyone are hurting. Tests bring in money... money that I don't have to give unless it is absolutely necessary! I am a responsible pet owner, but who can afford this??
Any advice or help would really be appreciated. Thank you so much!
About 2-3 months ago, she punctured her cornea in her right eye and had to have eye surgery (this could be relevant). She had an E collar for over a month and I was not allowed to bathe her facial area at all (maybe the lack of bathing caused this?). As part of her recovery, she was on Prednisone which, as an added bonus, completely stopped her itching during the time she was taking it.
Anyway, I noticed about a week ago that she was getting itchy again and gave her a bath with her shampoo. I looked in her ears and they seemed a little more pink than normal so I pulled out her ear hairs. Afterward, I cleaned them with a special solution given to me by a vet. Within a day or two, her ears became quite red and swollen. I was thinking, "Oh great. We just paid $3,500.00 for eye surgery and now we get to go pay another $200 for an ear infection. I decided to give it a day or so to see if it was just from the hair plucking.
Within a day, her ears were still red and swollen and it almost looked as if there were some... thin blisters on her ear skin. I began giving her Benadryl at night. This stopped the itching altogether and within a day or two, the blisters and swelling went away, and her ears were just a little more pink than normal. I was feeling better because it seemed like things were going in the right direction and we were out of the woods so to speak. I kept up with the Benadryl just at night. Things seemed to be going great.
Today, I took a look at her ears again. The swelling was still down, the color a bit more pink than normal and it appeared as though the blisters (though gone) had almost lifted her top layer of skin from the insides of her ears. The skin texture was rough and when I gently rubbed it with my finger, huge flakes (not much smaller than my pinky nail) peeled off of her ear. Mind you, this was on both the inside of the leather ear flap as well as the inside of her ear - in both ears.
So, today, I gently removed the flakes from her ears thinking that I was helping by keeping her ears free of debris. I didn't scratch or anything, just picked up the flakes between my fingers (sorry to be gross but when it's your baby, it doesn't seem gross when you're helping them). A few hours later, I looked at her ears and they were bright red again. Not swollen, but pretty red. She's also been gently rubbing them with her paws since I messed with them. Not a digging, obsessive scratch or anything - just a soft rub. I think I should have just left her ears alone.
I am completely baffled. If it were an actual infection, I would think that Benadryl wouldn't be helping. To me, the fact that the Benadryl helps with the itching, etc. means that it's probably an allergy issue rather than an infection. Also, since the swelling and dark color subsided, I can't help but think that we're heading in the right direction toward healing. But what's up with this flaking? What is going on? Like I said, we just spent $3,500.00 on eye surgery. I love my little baby - however, she has been a vet bill a month since we've had her. She came to us (2 years ago) from a bad breeder. She had Giardia, ear mites, ticks, an ear infection, etc. After getting her spayed (while also fixing an umbilical hernia) her surgery site became infected... etc, etc, etc! Seriously, this has been the million dollar dog already and I'm just hesitant to take her in. Every time we see a vet, they want to do 40 different tests at $60 a pop. Let's face it - we're in a bad economy and vets, just like everyone are hurting. Tests bring in money... money that I don't have to give unless it is absolutely necessary! I am a responsible pet owner, but who can afford this??
Any advice or help would really be appreciated. Thank you so much!
Ashley, Something else: Don't be surprised if you see detox symptoms in your girl......This is natural & a good thing! You may notice worse ear symptoms, diarrhea, mucus in stool, casing or coating on the stool, itchier skin, peeling skin or dandruff.....Do not be alarmed....Again, hang in there, it's only the body getting rid of the old toxins and enjoying the new found health!
Please, let me know if you have any questions or concerns.....Keep us updated on her progress.....If you follow the above post, you'll have a new dog in a month, I promise........Karla
P.S. When/if you get the shampoo, I want you to bathe her once a week for 2 weeks...If she's better, wait 2 weeks and bathe again.....Then once a month or less......The instructions for the ear ointment are on the bottle...It's an all natural product & cannot be overused! Bye
Please, let me know if you have any questions or concerns.....Keep us updated on her progress.....If you follow the above post, you'll have a new dog in a month, I promise........Karla
P.S. When/if you get the shampoo, I want you to bathe her once a week for 2 weeks...If she's better, wait 2 weeks and bathe again.....Then once a month or less......The instructions for the ear ointment are on the bottle...It's an all natural product & cannot be overused! Bye
Hi Ashley......The Natural Balance is a very good food...I don't think you have to feed any of their limited ingredient/hypoallergenic diets, but you DO want to stay with their GRAIN-Free foods.....
Now, your girl is going to give you trouble with these good foods......She's use to junk food!!! This would be like offering a child a cupcake or a plate of veggies...Of course they want the cupcake! Same thing goes for your dog & she's going to be stubborn! Here's what to do:
Personally, I'd get a couple of CANS of Natural Balance Food (Any flavor)......Not only does she need the moisture in her diet (For Life), but also more tasty.....Do Not Free feed...Offer her 1/4 Cup of dry with a few teaspoons of Wet mixed in.....Set it down for 20 Minutes.....If she doesn't eat it, take it back up and try again in the evening.....NO dog will starve them selves!!!! This might take 2-3 days and your going to Panic, but hang in there......
For treats: Any of the Natural Balance Treats are wonderful....They make bisquit types & meat types.....My favorite is the LAMB Rounds......They're in a blue package.....They're disks/discs of lamb jerky.....About 2 inches round......They're hard & make great chews, but very healthy...She'll like them! My dogs like raw baby carrots & sliced apples......3 of them will eat a banana, but one will spit them out! She's my stubborn one.. ;) They love watermelon & cantaloupe......
Other things you can offer if she's not eating......A small bowl of Unsalted beef or chicken broth, cottage cheese or small bowl of unflavored yogurt.....All yummy & healthy!
She should eat 2 small meals a day.....Table scraps are fine as long as they are NOT fried, No fat, No seasoning......Any baked or broiled meat or veggies & fruit can be added to her bowl whenever you have them......NO Onions!
Now about the products: I'm hoping you can get these online for her:
#1 and most important- The Zymox Otic Eardrops W/Hydrocortisone.....Small bottle is $12.00...There is no better product on the market for ears, I promise...
#2 - An Anti-bacterial/Anti fungal (Yeast) Shampoo- Here's three good ones:
Chlora Seb Antiseptic Shampoo- 12oz..for $15.00
Malaseb Shampoo- 250ml for $20.00
Zymox Medicated Shampoo -12 oz for $12.00
Vet Universal Medicated Shampoo (My Favorite)- 16 oz. for $15.00
These prices are from Entirely Pets.com.....This is where I order from...Here's a coupon code to save 10%...That will help..
Coupon code: (sca10)......I hope you can get these 2 items......
Next: She needs to be on a good probiotic...There are thousands & I don't trust most of them....The easiest for you to find is "PEARLS" Acidophilus....You can get it at Wal-mart, Wal-greens or most pharmacies....
They will be in a blue box in the vitamin section....30 to a box, I believe.....
They are tiny little probiotic pills to fight Yeast from the inside, also.....She will need 1 pill every other day for 60-90 days...If she gets constipated, give 1 every 3 days......This is a must in order to heal her.....
OK, I think I'm done......Let me know what you think.....ANy of those foods listed (On the Best list) will be fine for her.......You also need to rotate foods every now & then for many reasons.....She should not have to eat the same food day in and day out for life.....I wouldn't want to either !!! ;)
Take care, Karla
Now, your girl is going to give you trouble with these good foods......She's use to junk food!!! This would be like offering a child a cupcake or a plate of veggies...Of course they want the cupcake! Same thing goes for your dog & she's going to be stubborn! Here's what to do:
Personally, I'd get a couple of CANS of Natural Balance Food (Any flavor)......Not only does she need the moisture in her diet (For Life), but also more tasty.....Do Not Free feed...Offer her 1/4 Cup of dry with a few teaspoons of Wet mixed in.....Set it down for 20 Minutes.....If she doesn't eat it, take it back up and try again in the evening.....NO dog will starve them selves!!!! This might take 2-3 days and your going to Panic, but hang in there......
For treats: Any of the Natural Balance Treats are wonderful....They make bisquit types & meat types.....My favorite is the LAMB Rounds......They're in a blue package.....They're disks/discs of lamb jerky.....About 2 inches round......They're hard & make great chews, but very healthy...She'll like them! My dogs like raw baby carrots & sliced apples......3 of them will eat a banana, but one will spit them out! She's my stubborn one.. ;) They love watermelon & cantaloupe......
Other things you can offer if she's not eating......A small bowl of Unsalted beef or chicken broth, cottage cheese or small bowl of unflavored yogurt.....All yummy & healthy!
She should eat 2 small meals a day.....Table scraps are fine as long as they are NOT fried, No fat, No seasoning......Any baked or broiled meat or veggies & fruit can be added to her bowl whenever you have them......NO Onions!
Now about the products: I'm hoping you can get these online for her:
#1 and most important- The Zymox Otic Eardrops W/Hydrocortisone.....Small bottle is $12.00...There is no better product on the market for ears, I promise...
#2 - An Anti-bacterial/Anti fungal (Yeast) Shampoo- Here's three good ones:
Chlora Seb Antiseptic Shampoo- 12oz..for $15.00
Malaseb Shampoo- 250ml for $20.00
Zymox Medicated Shampoo -12 oz for $12.00
Vet Universal Medicated Shampoo (My Favorite)- 16 oz. for $15.00
These prices are from Entirely Pets.com.....This is where I order from...Here's a coupon code to save 10%...That will help..
Coupon code: (sca10)......I hope you can get these 2 items......
Next: She needs to be on a good probiotic...There are thousands & I don't trust most of them....The easiest for you to find is "PEARLS" Acidophilus....You can get it at Wal-mart, Wal-greens or most pharmacies....
They will be in a blue box in the vitamin section....30 to a box, I believe.....
They are tiny little probiotic pills to fight Yeast from the inside, also.....She will need 1 pill every other day for 60-90 days...If she gets constipated, give 1 every 3 days......This is a must in order to heal her.....
OK, I think I'm done......Let me know what you think.....ANy of those foods listed (On the Best list) will be fine for her.......You also need to rotate foods every now & then for many reasons.....She should not have to eat the same food day in and day out for life.....I wouldn't want to either !!! ;)
Take care, Karla
Holy cow I ran to Petco yesterday and picked up some Natural Balance Sweet Potato and Bison. Boy am I glad I picked a good brand!
Karla, you should write a blog on this stuff - I think you'd save so many animals' lives! THANK YOU!
HUGS do you!! :)
Karla, you should write a blog on this stuff - I think you'd save so many animals' lives! THANK YOU!
HUGS do you!! :)
This is from dogfoodscoop.com: There are many resources that rate foods, but they all say basically the same thing......
The worst foods on the market:
Bad Dog Food List
Bad Dog Foods 0 Scoops
Here, you will find our Bad Dog Food List. These commercial dog food brands are, in our opinion, the worst dog foods on the market!
We give them a disgusted 0 Scoops!
Our personal recommendation is that you take a good look at these dog food names and memorize them.
Now! Tuck your tail between your legs and run for the hills!
See here for a glimpse of what really goes on behind the commercial dog food industry.
These dog foods contain the worst dog food ingredients you will find! They are comprised mainly of by-products; carcinogenic flavors and preservatives; cheap, unhealthy fillers, and ... Heaven only knows what else!
In addition, we have no respect for the philosophy of these pet food companies. In our opinion, they are clearly dedicated to their bottom line with a total disregard for the health and well-being of our beloved furry companions.
They are truly a far cry from the best dog foods available!
It is highly unlikely that any of these awful supermarket brands on our list of Bad Dog Foods will be carried or recommended by any respectable, independent dog food store.
Worst Dog Food Rating - Zero Scoops!
0 SCOOPS
THE VERY WORST DOG FOODS ON THE MARKET
Abady Dog Food
Alpo Dog Food
Beneful Dog Food
Bil Jac Dog Food
Diamond Dog Food (Plain, Regular Formula)
Good Life Recipe
Iams Dog Food
Kasco Dog Food
Kibbles 'n Bits Dog Food
Ol' Roy Dog Food
Pedigree Dog Food
Purina Pro Plan Dog Food
Purina One Dog Food
Science Diet Dog Food
Tuffy's Dog Food
---------------------------------------------------------------------------------------------------
Next: Here's a list of the Very best foods on the market:
The Top Recommended Dog Food Brands
Rated 5 Scoops!
Here's our 5 Scoop list of the best dog foods ranked!
We consider these among the best commercial dog food brands on the market.
We found that not only are these the top recommended dog food brands by experts and dog nutritionists -- but they also appear consistently as the best rated dog food brands on various consumer reports on dog food.
So! What do the top recommended dog food brands all have in common? In a nutshell, the following:
All natural, human grade dog food ingredients.
Hormone and antibiotic free dog food ingredients.
No by-products whatsoever.
They offer a high protein dog food choice.
Quality grains and no cheap and nasty fillers.
Void of harmful chemicals, preservatives or additives.
Ready! In alphabetical order, here's our pick of the best rated dog food brands on the market ...
Best Dog Foods Ranked 5 Scoops
Acana Dog Food
Addiction Dog Food
Artemis Dog Food
Back to Basics Dog Food
BLUE Dog Food
BLUE Organics
BLUE Wilderness
Eagle Pack Dog Food
Evangers Dog Food
Fromm Dog Food
GO Natural Dog Food
Holistic Blend
Honest Kitchen Dog Food
Horizon Legacy Dog Food
Mulligan Stew
Nature's Variety Instinct Dog Food
Merrick Dog Food
**** Van Patten - Natural Balance Dog Food
Nature's Logic
NOW
ORGANIX (Castor and Pollux)
Orijen Dog Food
Party Animal (Canned Only)
Nature's Variety Prairie
Solid Gold Dog Food
Taste of the Wild Dog Food
Timberwolf Dog Food
Wellness Dog Food
Weruva Dog Food (Canned Dog Food Only)
Wysong Dog Food
ZiwiPeak Dog Food
I'll be back, Ashley.......Karla
The worst foods on the market:
Bad Dog Food List
Bad Dog Foods 0 Scoops
Here, you will find our Bad Dog Food List. These commercial dog food brands are, in our opinion, the worst dog foods on the market!
We give them a disgusted 0 Scoops!
Our personal recommendation is that you take a good look at these dog food names and memorize them.
Now! Tuck your tail between your legs and run for the hills!
See here for a glimpse of what really goes on behind the commercial dog food industry.
These dog foods contain the worst dog food ingredients you will find! They are comprised mainly of by-products; carcinogenic flavors and preservatives; cheap, unhealthy fillers, and ... Heaven only knows what else!
In addition, we have no respect for the philosophy of these pet food companies. In our opinion, they are clearly dedicated to their bottom line with a total disregard for the health and well-being of our beloved furry companions.
They are truly a far cry from the best dog foods available!
It is highly unlikely that any of these awful supermarket brands on our list of Bad Dog Foods will be carried or recommended by any respectable, independent dog food store.
Worst Dog Food Rating - Zero Scoops!
0 SCOOPS
THE VERY WORST DOG FOODS ON THE MARKET
Abady Dog Food
Alpo Dog Food
Beneful Dog Food
Bil Jac Dog Food
Diamond Dog Food (Plain, Regular Formula)
Good Life Recipe
Iams Dog Food
Kasco Dog Food
Kibbles 'n Bits Dog Food
Ol' Roy Dog Food
Pedigree Dog Food
Purina Pro Plan Dog Food
Purina One Dog Food
Science Diet Dog Food
Tuffy's Dog Food
---------------------------------------------------------------------------------------------------
Next: Here's a list of the Very best foods on the market:
The Top Recommended Dog Food Brands
Rated 5 Scoops!
Here's our 5 Scoop list of the best dog foods ranked!
We consider these among the best commercial dog food brands on the market.
We found that not only are these the top recommended dog food brands by experts and dog nutritionists -- but they also appear consistently as the best rated dog food brands on various consumer reports on dog food.
So! What do the top recommended dog food brands all have in common? In a nutshell, the following:
All natural, human grade dog food ingredients.
Hormone and antibiotic free dog food ingredients.
No by-products whatsoever.
They offer a high protein dog food choice.
Quality grains and no cheap and nasty fillers.
Void of harmful chemicals, preservatives or additives.
Ready! In alphabetical order, here's our pick of the best rated dog food brands on the market ...
Best Dog Foods Ranked 5 Scoops
Acana Dog Food
Addiction Dog Food
Artemis Dog Food
Back to Basics Dog Food
BLUE Dog Food
BLUE Organics
BLUE Wilderness
Eagle Pack Dog Food
Evangers Dog Food
Fromm Dog Food
GO Natural Dog Food
Holistic Blend
Honest Kitchen Dog Food
Horizon Legacy Dog Food
Mulligan Stew
Nature's Variety Instinct Dog Food
Merrick Dog Food
**** Van Patten - Natural Balance Dog Food
Nature's Logic
NOW
ORGANIX (Castor and Pollux)
Orijen Dog Food
Party Animal (Canned Only)
Nature's Variety Prairie
Solid Gold Dog Food
Taste of the Wild Dog Food
Timberwolf Dog Food
Wellness Dog Food
Weruva Dog Food (Canned Dog Food Only)
Wysong Dog Food
ZiwiPeak Dog Food
I'll be back, Ashley.......Karla
1 Comments
You might want to take Blue off the list, they have have to pay out $32,000,000 for lying about by products in their food. The very best would be a slow introduction to a raw food diet because it is species appropriate. Check out Dr Karen Becker. Even "good kibble" is highly processed and very hard on the kidneys and liver over time. Bless you for taking the time to help this wonderful, caring woman and her precious dog!
P.S.
I hope all is going well for you. Our move is finally over - it was a complete nightmare but we got through it!
I hope all is going well for you. Our move is finally over - it was a complete nightmare but we got through it!
OH MY WORD!!!
Well, I just came back to report what has been going on.
You were right - it was a yeast infection. I did some research online trying to find the differences in symptoms between bacterial and yeast infections. Of course, the only REAL way to tell for sure is to get tested, but I was feeling desperate. One of the main symptoms in differentiating between yeast and bacteria is if the ears are peeling. Her ears were peeling profusely and there wasn't black wax or smell. I also noticed little yellow crusty things (gross). I made her a vet appointment for Friday (yesterday) but while I was waiting to get in, I decided to try an experiment. A friend of mind (former vet tech) told me that it is safe to use Monistat in a dog's ears because the main ingredient is the same thing that the vet gives for yeast infections. Keep in mind that if I would have tried to treat for a bacterial infection, gave an antibiotic and it was actually a yeast problem, the yeast infection could have gotten worse. It's okay (according to her) to treat for yeast without knowing for sure.
Anyway, I bought Monistat one (name brand). I put it in her ears just where I could see - I didn't shove it down her ear canal or anything. The first night she slept and in the morning, she started scratching again so I figured it wasn't working and I cleaned it out. This was on Thursday. On Friday, I noticed she hadn't been scratching. About 2 hours before her appointment, I looked at her ears and there was NO redness or swelling. The infection was apparently GONE! Here it is on Saturday late afternoon and still no scratching and her ears are back to normal! HOLY COW!
As for what you're telling me about her food - I'm totally freaking out right now. I had NO idea that I was poisoning her. This makes me angry and it's disgusting. I was told that Bil Jac was a decent store brand. Please tell me - what else should I be giving her? Is Innova a good brand? I've heard it is too but apparently I can't trust what I'm hearing. Thank you for telling me this - you're probably saving my dog's life!!!
How do you know all of this? You are a true saint for helping me out!
Well, I just came back to report what has been going on.
You were right - it was a yeast infection. I did some research online trying to find the differences in symptoms between bacterial and yeast infections. Of course, the only REAL way to tell for sure is to get tested, but I was feeling desperate. One of the main symptoms in differentiating between yeast and bacteria is if the ears are peeling. Her ears were peeling profusely and there wasn't black wax or smell. I also noticed little yellow crusty things (gross). I made her a vet appointment for Friday (yesterday) but while I was waiting to get in, I decided to try an experiment. A friend of mind (former vet tech) told me that it is safe to use Monistat in a dog's ears because the main ingredient is the same thing that the vet gives for yeast infections. Keep in mind that if I would have tried to treat for a bacterial infection, gave an antibiotic and it was actually a yeast problem, the yeast infection could have gotten worse. It's okay (according to her) to treat for yeast without knowing for sure.
Anyway, I bought Monistat one (name brand). I put it in her ears just where I could see - I didn't shove it down her ear canal or anything. The first night she slept and in the morning, she started scratching again so I figured it wasn't working and I cleaned it out. This was on Thursday. On Friday, I noticed she hadn't been scratching. About 2 hours before her appointment, I looked at her ears and there was NO redness or swelling. The infection was apparently GONE! Here it is on Saturday late afternoon and still no scratching and her ears are back to normal! HOLY COW!
As for what you're telling me about her food - I'm totally freaking out right now. I had NO idea that I was poisoning her. This makes me angry and it's disgusting. I was told that Bil Jac was a decent store brand. Please tell me - what else should I be giving her? Is Innova a good brand? I've heard it is too but apparently I can't trust what I'm hearing. Thank you for telling me this - you're probably saving my dog's life!!!
How do you know all of this? You are a true saint for helping me out!
Have an Answer?
You are reading content posted in the Dogs Community
Members of our Pet Communities share their Halloween pet photos.
Like to travel but hate to leave your pooch at home? Dr. Carol Osborne talks tips on how (and where!) to take a trip with your pampered pet
Ooh and aah your way through these too-cute photos of MedHelp members' best friends
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
