Pancreatitis 101
Below is information to help caregivers to understand
what pancreatitis is and what seems to work best as far as treating this
condition. Hopefully this will provide some information to discuss with your vet
to confirm a diagnosis. Even more so, it is hoped that this information will
give you some steps to take to try to avoid pancreatitis altogether.
Dr. Hodgkins states in her book that cats with FD typically have at least
low-grade pancreatitis as well. As a result, when a cat comes along that is not
achieving expected results with insulin, initial thoughts should turn to the
likelihood of pancreatitis. It is very common, far more than has been believed
in the past. According to Idexx Labs, pancreatitis is suspected to be one of the
main causes of poor control in FD cats. To date, studies have only been
completed at autopsy, so there is relatively no data available at this time to
determine what percentage of living FD kitties have pancreatitis as well.
A CBC (complete blood count) cannot conclusively confirm pancreatitis, nor can
it be conclusively confirmed by ultrasound, or by a physical exam. If the
results of the CBC show elevated cholesterol and liver values in a cat, and/or
an ultrasound shows inflammation or “spots” in the area, and/or a physical exam
indicates some swelling or tenderness in the abdomen, it is a wise decision to
ask for a pancreatitis test. Most low carb, wet fed cats will have a somewhat
elevated cholesterol level, and most vets, knowing the cat is all wet fed, are
not usually concerned by elevated cholesterol levels in cats due to the higher
fat content in food. That said, very high cholesterol levels can lead to
pancreatitis and sometimes lead to other issues such as gallstones.
If your cat is not responding to insulin, even when increasing doses, the test
for pancreatitis would be a worthwhile spend to confirm or deny diagnosis.
The only reliable test available at this time to measure serum feline pancreatic
lipase immuno-reactivity level is the
Spec fPL1 test by Idexx.
The test normally costs under $50.00 depending where you live. There are a
number of informative links on the page side bar.
Because this test is relatively new,
and because this disease is not yet well understood by most vets (who still
believe that CBC, US and/or physical exam are sufficient for a diagnosis), if
your cat isn’t responding to insulin as expected, liver and/or cholesterol
levels are high end normal or above, and pancreatitis is remotely suspected,
standing firm with your vet may be called for to get the test if you want a
conclusive diagnosis.
What is Pancreatitis?
The pancreas secretes digestive enzymes into the small intestine through a tube
called the pancreatic duct. These enzymes help our cats digest fats, proteins
and carbs in food. The pancreas also releases insulin and glucagon into the
blood – these hormones help the body use the glucose it takes from food for
energy. Typically, digestive enzymes don’t become active until they land in the
small intestine when digestion of food starts. But, when these enzymes become
active inside the pancreas or at the duct area, they can start to “digest” the
pancreas/duct, causing inflammation and even permanent damage.
There are two main forms of pancreatitis - Acute pancreatitis and Chronic
pancreatitis.
The low level form of pancreatitis Dr. H refers to in her book is typically of
the chronic kind. It hides itself well, lurking below the surface, doing its
damage undetected. Chronic pancreatitis is no less dangerous than Acute
pancreatitis if left untreated over the long term. It is generally believed that
chronic pancreatitis does not ever resolve. Recent studies indicate that
supplementation of taurine and sylmarin aid in the regeneration of both the
liver and the pancreas. With long-term supplementation, pancreatitis usually can
be well managed depending on the severity and how quickly it is caught.
Because cats hide pain so well, the signs that our cats aren’t feeling well are
usually so subtle they are missed by even the most attentive of owners.
Something as subtle as your cat repeatedly seeking out cool places to rest their
tummies could be a clue that chronic pancreatitis is brewing in the background,
as pancreatitis can cause abdominal pain. In humans, the pain is described as
being “similar” to extreme heartburn, sometimes coming and going. The pain may
get worse when eating or drinking, and can become consistent and disabling. In
certain cases, abdominal pain actually goes away as the disease progresses,
likely because the pancreas stops making digestive enzymes. Other common signs
of pancreatitis are vomiting, nausea, weight loss (even if eating habits are
normal), fatty stools, and lethargy.
Acute pancreatitis - as its name portrays, the “attack” (and it is always an
attack) is acute – coming on very suddenly and severely. A cat that was “fine”
at lunch, eating – playing – alert…could become a limp-anorexic-unresponsive
kitty by dinnertime. In the event of an acute pancreatitis attack, it is
imperative to respond immediately to the crisis. Aggressive insulin treatment if
needed, syringe feeding (or insertion of a feeding tube), subcutaneous fluid
administration, and pain management are called for right away. An acute
pancreatitis attack can take anywhere from one to two weeks (or longer) to
resolve to the point where a cat is able to eat on its own. If immediate action
is not taken, acute pancreatitis attacks can be fatal.
Both forms of pancreatitis can cause serious complications for our cats…. some
more severe than others. Malabsorption of food, internal bleeding, damage to
tissue, infection, cysts, fluid accumulation, enzymes and toxins entering the
bloodstream, damage to the heart, lungs, kidneys, and/or other organs may occur
if left untreated. It is suspected that pancreatitis in cats may also cause FD.
Diabetes develops because insulin-producing cells (the islet cells) of the
pancreas become damaged.
For more information, here is a link to Idexx’s
Roundtable on Pancreatitis.
What causes pancreatitis?
In humans, pancreatitis is caused by alcohol abuse, the pancreatic duct becoming
blocked or narrowed; high levels of calcium, high levels of blood fats,
autoimmune conditions, and some drugs to mention a few causes. It can also be
idiopathic (unknown cause), or hereditary. Other than alcohol abuse, it makes
sense that any of the things that cause pancreatitis in humans can cause it in
our feline friends.
So what to do?
Traditional vet therapies for
pancreatitis include the withholding of food for 24-48 hours. This has been
standard practice when treating small dogs, but this is not the right way to go
for cats. Particularly with cats on insulin, they need their food to keep their
strength up. An all wet diet, low in fiber, and as low in fat as possible is
better indicated to help ease the load on the pancreas.
If your cat is anorexic and syringe feeding is not possible, a feeding tube
(inserted by the vet) is highly recommended. In the TR College of Knowledge,
there is a recipe for the Sick Mix, which is recommended when the need for
syringe feeding arises. Supplements (other than Slippery Elm) can be mixed into
the Sick Mix formula.
Any owner of an FD cat would be well advised to start their cat on a
supplementation program right after FD diagnosis to try to avoid the development
of pancreatitis altogether.
Supplements
As previously mentioned, supplements are proving to have a strong place when it
comes to pancreatitis. The standard rule of thumb for dosage when it comes to
cat is 1/6th (for larger cats) to 1/10th (for smaller cats) of a human dose. It
is always a good idea to start out with a lower than recommended dose and work
your way up to a suitable amount for your cat. Some supplements have a very
strong taste or smell and are not always well accepted at first. In addition, it
is best to start supplementation one supplement at a time. There is no way to
know how your individual cat will accept the individual supplements, or how they
will affect their BG. By taking it slow but steady, if there are any challenges
with any supplement, you will have a much better idea of which one might be
causing any problems for your cat.
Sylmarin is a wonderful liver support, also recommended for FD cats by Dr. H in
her book. Recent studies have shown that sylmarin works to regenerate liver
cells. Sam_E is also excellent support for both liver and pancreas. Denemarin or
Sam-E 100 both contain both Sam-E and Sylmarin. Denosyl is plain Sam-E, while
Milk Thistle Tincture is just sylmarin. There is also plain Sam-E for humans on
the market, but the tablets are usually too large for cats.
Denemarin and Denosyl are both vet products that come as enteric coated tablets
which cannot be broken. They must dissolve in the gut and therefore must be
given on an empty stomach.
Milk thistle – the active ingredient in milk thistle is sylmarin. It comes in
powder and liquid form. The challenge with powder forms is that rice flour and
other carbs not suitable for FD cats are usually added. If possible, liquid milk
thistle (tincture) is a better choice. Look for the highest amounts of sylmarin
extract you can find, and the lowest count of ethanol (alcohol) – ideally under
5%.
Choose only one of the above mentioned supplements - do not use any combination
of them.
Taurine – preliminary recent studies indicate that taurine is also capable of
regenerating cells of the liver, as well as pancreatic cells. This is exciting
news! The maximum dose of taurine is up to 500mg per day.
L-carnitine – this amino acid helps the system break down fats to process them
through the system. Acytel Carnitine or D-carnitine are NOT at all suitable for
cats. You will want to make sure you get the purest form of L-Carnitine you can
find. Nature’s Way has a suitable L-Carnitine product for cats, available
through Vitacost at a very reasonable price. Daily dose 250mg. Here’s a great
article on the benefits of LCarnitine, follow the links to “learn more”…the
sidebars have great info on the use of LCarnitine in cats as well.
In humans, the use of L Carnitine is not recommended for those who have
seizures, are using blood thinners, or have hypothyroidism. Similar caution for
use in cats is recommended.
Agaricus Blazeii mushrooms – available in capsule form, and also available in
liquid form (called Super Bio liquid from Atlas World). Dr. H highly recommends
all FD cats get this supplement. It is an overall immune system support. In
fact, her instructions to me were “give your cat a quarter capsule a day and
take the rest yourself”.
Acidophilus – this probiotic is very helpful when it comes to malabsorption
issues, which are very common for cats with pancreatitis. Daily dose ¼ to ½
capsule a day. Make sure that there are no sugars or FOS in any probiotic you
choose. While the argument is that FOS does not cause resistant BG or other
health issues in humans, experience on forum so far indicates FOS does cause
problems for our cats. Country Life makes a dairy free version with no sugars,
suitable for FD cats.
Slippery Elm Bark Powder – standard dose is 1/8 to ¼ tsp once a day. This
supplement must not be given with any other supplements or medications as it
renders them useless. It is best to give Slippery Elm two hours apart from any
other supplementation/medication.
B-Complex – this supplement is beneficial in times of stress. In the event of an
attack of acute pancreatitis, add this supplement to food when syringe feeding.
Pancreatic enzymes are also useful when dealing with pancreatitis.
Other steps to take….
Adding fluids, either subcutaneous fluids with electrolytes, or adding water or
plain broth (directly to food or by syringe) is helpful. Dehydration is very
common when dealing with pancreatitis, especially the acute form. Home made
chicken broth, cooled with the fat skimmed off is usually better received than
plain water and can be added to food or syringe fed with a baby dropper.
Pepcid AC (must be AC - active ingredient famotadine) is also very helpful when
dealing with a cat with pancreatitis. Ideally given 20-30 minutes before
feeding, the dose is 1/4 tablet twice a day (BID).
For pain management, ¼ of a baby aspirin only can be given for a day or two.
Aspirin can be toxic in cats, so this is definitely not a suitable pain
management therapy on an ongoing basis. PLEASE CONSULT
YOUR VET BEFORE GIVING ASPIRIN TO ANY CAT!
The treatment methods are the same for both Chronic and Acute pancreatitis – and
the supplements are beneficial even if your cat doesn’t have pancreatitis as FD
affects many organs. For further (more in depth) assistance please post on
Talking TR forum.
Updated March 2011