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Healing & Alternative Health
Dr. Carson's Holistic Animal Care:
Signs of the Aging
Dog and Cat
Part 18:
Organs of the Abdomen: Diseases of the Pancreas: Treatment
by Kathleen M. Carson, D.V.M
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Last month I wrote about the diagnosis of pancreatitis. The subject of this month’s column is the treatment of that condition.
Most of this column pertains to the treatment of acute (rapid onset) pancreatitis, but I’ll first briefly mention the treatment of chronic (long-term) pancreatitis. In my February 2006 article on diseases of the pancreas, I described chronic pancreatitis as a condition in which there has been a lowgrade, subclinical (without symptoms) pancreatitis over an extended period of time. Slowly, normal pancreatic tissue is destroyed and is replaced with scar tissue. When enough of the pancreas is destroyed, the remaining pancreatic tissue can't produce enough of the pancreas’ digestive enzymes to digest the food the animal eats. This is called Exocrine Pancreatic Insufficiency or EPI, and it results in chronic diarrhea.
The treatment of chronic pancreatitis/EPI consists of adding digestive enzymes to the patient’s food (usually for the rest of the animal’s life). In most cases, this treatment alone is sufficient. However, if the EPI is complicated by bacterial overgrowth in the intestines, inflammatory bowel disease (IBD), and/or cobalamin (vitamin B12) insufficiency, then additional treatments are called for: antibiotics for bacterial overgrowth, an anti-inflammatory drug for IBD, and cobalamin supplementation for B12 insufficiency. Usually, these latter 3 treatments are needed for a short time only.
The treatment for acute pancreatitis is more complex, for one often is dealing with a very sick patient. Generally speaking, the treatments consist of supportive care and pain control. The extent of the former depends on the extent and severity of the disease.
Hospitalization with high volumes of IV (intravenous) fluids is necessary in most cases because of the dehydration (from vomiting, especially), and, in many cases, shock. Electrolytes are given with the fluids to counteract the electrolyte deficiencies/imbalances which result from vomiting, diarrhea, and not eating. Dextrose is added for caloric needs. B vitamins are also often added to the IV fluids. If shock is severe, plasma transfusions may be necessary.
Anti-pain and anti-vomiting drugs are also essential. Antibiotics are given when secondary infection is present. If the pancreatitis is complicated by diseases of other organs/tissues like the kidneys, liver, intestines, heart, lungs, and/or blood cells, then these conditions must be addressed as well.
Dogs with pancreatitis are kept NPO (nihil per os, or nothing by mouth) for several days. This is in part to prevent more vomiting, but, more importantly, it is because food (even the sight/smell of it) causes the pancreas to start secreting more enzymes, which is the very last thing wanted or needed in a patient with pancreatitis. Even drugs need to be given parenterally (other than by mouth) because the presence of the pill/capsule in the mouth may also stimulate enzyme secretion (as well as possibly triggering more vomiting).
After 2-3 days of no vomiting, small amounts of water can be given. If this is kept down, then small amounts of a bland diet high in carbohydrates and very low in protein and fat is given every few hours. If vomiting still does not return, then the volume of the food can gradually be increased and the frequency decreased. If it does return, then the dog must again be kept NPO until the vomiting has stopped for 2-3 days, and then the slow introduction of water and food can be tried again.
Cats with pancreatitis are treated differently from dogs regarding food. Unless they are vomiting (which, if you’ll remember what I wrote in my March 2006 column, is much less frequent in cats than dogs), food is not withheld. In my December 2005 column I discussed a feline liver condition called hepatic lipidosis which is brought on by not eating. Fasting a cat with pancreatitis can trigger hepatic lipidosis. Also, as mentioned in my January 2006 column, a cat with pancreatitis may already have hepatic lipidosis, since they are prone to “triaditis”, or concommitant disease of the pancreas, liver, and intestines. Fasting would only worsen the already-existing liver disease. In fact, if a cat already has hepatic lipidosis as well as pancreatitis, tube-force-feeding may be necessary. If they have concurrent IBD (inflammatory bowel disease), corticosteroids must be given even though there is some evidence that steroids trigger or worsen pancreatitis.
Any drug(s) which could have triggered the pancreatitis (see my February 2006 column) of course are discontinued.
If it is found that obstruction of the pancreatic duct from such things as tumors or gallstones caused the pancreatitis, surgery will be necessary to remove the obstruction once the patient has stabilized enough to withstand surgery.
The majority of pancreatitis patients survive, some recovering fairly quickly, others needing extended hospital care. It must be remembered, though, that they are prone to recurrent episodes in the future, so they need to be watched closely, fed a diet low to moderate in protein and fat and high in carbohydrates (or, in the case of the feline patient, whatever they will eat that doesn’t re-trigger symptoms) and brought to their veterinarians when symptoms are first seen.
Unfortunately, those that have had the very severe pancreatitis with multiple organ failure usually don’t make it. Even for these patients, however, early intervention means a greater chance of survival.
Next month I’ll write about the other most common pancreatic disease: diabetes mellitus. |
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Dr. Kathleen Carson, DVM
Veterinarian & Author
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Dr. Carson received her Doctor of Veterinary Medicine degree from the University of California at Davis in 1968. She's been a small animal practitioner (dogs and cats ) for all the years since, except for a short stint at the San Diego Zoo when she first graduated.
She belongs to the American Veterinary Medical Association and the American Holistic Veterinary Medical Association.
Since 1974 she's lived and practiced in the South Bay Area near Los Angeles. She started the area's first house call practice in 1976 and the first pet crisis/loss group in 1989. The human-animal bond is of special interest to her.
She started exploring complementary veterinary medicine in 1987. Her practice became 100% holistic in 1996. She utilizes acupuncture, herbs, supplements, Bach Flower Remedies, homeopathic remedies, nutrition and medications for her patients in her practice.
She's currently taking a leave of absence from her house call practice due to health reasons but continues to do phone consultations and to write.
E-mail:
Critterhlr@aol.com
website:
http://www.holistic
vetconsult.com
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