Friday, February 13, 2009

Pancreatitis in Cats & Dogs Part 2: Treatment & Dietary considerations

In Part 1 of this article, Pancreatitis in Cats & Dogs, I provided a basic introduction to this disease of the pancreas. I explained the possible causes, gave you an idea what you have to look for to recognize the symptoms and talked about how pancreatitis is diagnosed. Today I am going to expand on this topic by discussing dietary considerations which should be paid attention to if your pet has become a victim of this illness. Before getting there, let’s take a brief look at how the illness is being treated: Merck Veterinary Manual states that: “The treatment for pancreatitis focuses on pain relief, balancing electrolytic fluids in the dog’s body, and resting the pancreas. Pancreatitis often causes severe abdominal pain, and injectable pain medications or patch medications are normally a part of the treatment. Providing intravenous fluids will keep the dog hydrated, help to ward off shock, and balance the electrolytes in the dog’s blood. To rest the pancreas and stop further inflammation and irritation, no food or water is given for at least 24 hours. In severe cases of pancreatitis, dogs can suffer from repeated vomiting, diarrhea, and life threatening shock. In these cases treatment consists of injectable medications which calm vomiting and diarrhea symptoms; plasma may be administered if the dog is at an advanced state of shock. A hospital stay for at least 24 hours, and in some cases up to 5 days, is necessary to maintain intravenous fluid and medication treatments. Blood tests will be periodically taken to check electrolytic balance, and to monitor the progress of the recovery of the pancreas. Pancreatitis dogs are not released from the hospital until their blood values are normal and they can hold down some amounts of special food.
The pancreas is an organ that is located just under the stomach and it is part of the digestive system. In addition to producing digestive enzymes, the pancreas produces hormones such as insulin. A healthy pancreas is able to handle the digestive enzymes without being harmed, but when the pancreas because irritated or inflamed, and is unable to handle these digestive enzymes without damage, pancreatitis occurs. … Pancreatitis in dogs can be caused by a high fatty diet, eating a large fatty meal at one sitting, obesity, an underlying condition, some medications, and genetics. For example, some dogs that are fed pork products or dark chocolate develop pancreatitis as a result of the sudden amount of fats that enter the body. … Fortunately for pet owners, pancreatitis in dogs can be successfully treated if proper diagnosis and treatments have begun in time. Future bouts of pancreatitis can be avoided with lifestyle and dietary changes.”
The same publication also says that “once a pet owner takes their dog home for recovery, a special diet and food instructions must be followed. The dog cannot be given any extra treats or foods outside of the diet, and the dog will need to be fed very small amounts of food multiple times a day. In chronic cases a special diet will need to be followed for the remainder of the dog’s life to prevent further”
There are numerous recommendations to be found about the dietary requirements after the illness has been treated. Dr.
Holly Nash, DVM, MS, of the Veterinary Services Department at Drs. Foster & Smith in her article titled “Pancreatitis (Inflammation) in Dogs” defines as “The goal of treatment is to rest the pancreas, provide supportive care and control complications. If vomiting is severe, treatment usually begins with a withholding of food, water, and oral medications for at least 24 hours. The lack of oral intake stops the stimulation of the pancreas to produce digestive enzymes. Depending upon the animal's response food intake can be started again after a day or more. The pet is generally fed small meals of a bland, easily digestible, high-carbohydrate, low-fat food. Over the course of a week or more, the size of meals and quantity of food fed are increased. The dog may need to stay on a special diet for life, or it may be possible to gradually reintroduce the former diet. High-fat diets or treats should be avoided.” Nash further addresses feeding issues within “Long term management and prognosis: Pancreatitis can be a very unpredictable disease. In most cases, if the pancreatitis was mild and the pet only had one episode, chances of recovery are good and avoiding high fat foods may be all that is necessary to prevent recurrence or complications. In other cases, what appears to be a mild case may progress, or may be treated successfully only to have recurrences, sometimes severe. Dogs with severe pancreatitis can recover, but may also develop fatal complications. The risk of developing fatal pancreatitis is increased in dogs who are overweight, or have diabetes mellitus, hyperadrenocorticism, hypothyroidism, gastrointestinal tract disease, and epilepsy. Pets who have repeated bouts of pancreatitis may need to be fed low-fat diets to prevent recurrence. Even so, some animals develop chronic pancreatitis, which can lead to diabetes mellitus and/or pancreatic insufficiency, also called 'maldigestion syndrome.' In pancreatic insufficiency, the nutrients in food are passed out in the feces undigested. An animal with this disease often has a ravenous appetite, diarrhea, and weight loss. Even though he is eating, he could literally starve to death. Treatment for pancreatic insufficiency is lifelong and expensive, but is possible. The pet's digestive enzymes are replaced through a product processed from pancreases of hogs and cattle which contain large quantities of the digestive enzymes. A change in diet with added nutritional supplements may also be necessary. “
Quite often I come across recommendations similar to
Pitcairn’s “Natural Health for Dogs & Cats” who call for lean meats like for example turkey, chicken, turkey giblets, chicken giblets, chicken or turkey, beef, skinless duck, rabbit, chicken, turkey or beef liver and hearts, lean burger meat or chuck, tuna, mackerel and other various fish. Organic eggs are not just another great protein source but so are the yolks rich in Omega-3 fatty acids. . Supplement food with sufficient amounts (depending on animal size 100 to 400 IU) of Vitamin E, which helps to prevent pancreatic scarring. Use raw veggies and stay away from fruit and try anti inflammatory herbs. Remember to provide variety. Feeding small, frequent meals instead of one large one is being emphasized. Offer all food at room temperature for best digestive action. In some cases supplemental pancreatic enzymes can be helpful to assist digestive processes. Depending on the animal’s size supplement between 250 and 1,000 mg of Vitamin C regularly. (e-mail me for product recommendations.)
The list of food ingredients to stay away from for any healthy animal becomes even more important if your pet is suffering from this disease. It includes grains, salt, fat and glucose, antibiotics, hormones and steroids and any inflammation inducing ingredients.
Dr. Mike Richards, DVM, when asked by
VetInfo4Dogs asked him answered: “For almost my entire career in veterinary medicine the standard feeding advice for dogs with pancreatitis was simply to avoid feeding them while there were clinical signs of acute pancreatitis present, even if they didn't eat for a week or more. This philosophy is changing, mostly due to the results of some studies in humans that show an improvement in survival rates and recovery times among patients who are fed early in the recovery from pancreatitis. At the present time it is reasonable to give oral fluids and to feed dogs once the vomiting stops. Small amounts of a low fat food are best. For dogs who will not eat on their own there is evidence that implanting a feeding tube directly into the small intestine (jejunostomy) seems to be beneficial but is usually something that is done more commonly at critical care centers than general veterinary practices. There may be some benefit to supplementing pancreatic enzymes orally…. This has not been proven in dogs but human studies show some benefit in pain relief from supplementing enzymes. This is probably due to a feedback mechanism in which the presence of digestive enzymes in the intestines shuts down the release of digestive enzymes from the pancreas, limiting the damage to the pancreas.”
Richards’ dietary advice to preventing future occurrences of pancreatitis: “In dogs there is a general consensus that a low fat, moderate fiber diet is helpful in preventing future occurrences of pancreatitis. In addition to diet, weight control is a very important factor in controlling the incidence and severity of future attacks of pancreatitis. Overweight dogs seem to have more severe bouts of pancreatitis when it occurs and to have recurrences more frequently.” In addition in one of his FAQ sessions Ifound the following noteworthy snippets:
“The known predisposing causes are obesity, high fat diets, ingestion of large amounts of fats as a novel event (like a dog getting into a bag of chocolate candy), hyperlipidemia (common problem in schnauzers), long term use of corticosteroids, Cushing's disease, drug reactions (azathioprine sometimes triggers pancreatitis), blood clotting disorders and trauma. Liver disease sometimes seems to trigger pancreatitis but it may be that there is a common inciting agent in these cases. We see cases of pancreatitis after almost every holiday in which big family meals are cooked. Ingesting a lot of ham seems to be a common history. I am not sure if other vets think that high salt treats can cause pancreatitis but we think there is some correlation with high salt ingestion, too. Avoiding feeding the dog table scraps at family gatherings would cut down on the cases of pancreatitis we see. I think that when there are a lot of people present, the dog just gets more treats because there are more people to provide them. Moderate fiber, low fat diets may help to prevent pancreatitis.”
“The only recognized dietary cause of pancreatitis that I am aware of is feeding high fat foods or treats to dogs. In our practice we think there may also be some correlation with high salt content but that is just an observation and may not be true. In one study of the effect of high fat diets (Hall, 1989) on pancreatitis, the diet used was also low protein and I am not sure if that is also necessary in order to increase the risk of pancreatitis or if the high fat alone is enough.High fat diets apparently cause release of pancreatic lipase in the microscopic circulation of the pancreas which digests fats in the blood causing release of damaging fatty acids, which cause inflammation and release of more lipase, which eventually starts to digest the pancreatic tissue, leading to the severe inflammation that causes the signs of pancreatitis.”
“(Question)…since the vet told me no more table scraps or fatty food(s), is there anything I can add to their food to make it a little more palatable for them? Broth? Rice? The gloucosimine tablets are supposed to be flavored, but I have to wrap it in Fat Free cheese. Is that ok?” “(Answer) I would not worry about …using cheese or a small amount of peanut butter or similar things to help with administration of medications even after a bout of pancreatitis. I may not be the best source of information on this topic, though. I don't even worry about clients giving dogs table scraps after the first bout of pancreatitis. I just tell them to avoid very high fat and high salt treats because they seem to cause problems, even though I can't find any real evidence to support the high salt advice. It probably is better to feed pet foods consistently after a second or third bout of pancreatitis (or maybe even the first bout) but I think that having a little pleasure in life is worth a small amount of risk. It will be easier for you on future office visits if you follow your vet's advice though. Rice as a food additive is usually a safe choice. Broth is OK if it isn't high in salt, so you shouldn't use bouillon cubes to make the broth unless you use low salt ones. Just adding warm water to food makes it more palatable for some dogs. Mixing a low fat canned food in with dry food is often helpful in enticing reluctant dogs to eat, too.”
Dr. Hines, DVM, PhD in:
“Pancreatitis in Cats & Dogs” concludes: “At this stage (after medical treatment) I only allow low-fat products such as soups made of rice, cereals and potatoes as well as cooked egg whites which I give in frequent small feedings. A good commercially available product is …” (I am not supporting his recommended prescription brands and formulas on this blog) “If the dog or cat has not improved enough to begin taking oral nutrients in 3-4 days one needs to give nutrients intravenously. I treat mild pancreatitis with low fat diets. Some recipes for low fat diets are given on this web site. After repeated bouts of mild pancreatitis the pancreas may become scarred and unable to produce digestive enzymes. If this occurs I supplement their diets with pancreatic enzymes … . Prevention: Most veterinarians recommend a low fat (5-10%) diet for pets that have experienced pancreatic. Weight reduction in obese pets is probably also wise. Pancreatitis may be a one-time problem. But in some pets it reoccurs at intervals. Try not to feed these pets table scraps or rich fatty diets and keep them trim and active.”
I think I have shown enough sources now all basically bringing us to the same conclusion. If you feel overwhelmed and think this all sounds to complicated it simply all comes down to this: Low fat, high fiber, mild ingredients, no people food (unhealthy table scraps), feed a little more often are the key factors when making dietary decisions on behalf of your pet suffering from this disease. I am not making any product suggestions here, if you want to find out what I told customers of mine and what worked for them,
e-mail me. (After all, a listing of such suggestions would not be fair to Dr. Hines)
One more important suggestion indirectly related to the diet: Remember that exercise is important because it improves digestion and peristalic movements of the intestinal tract, thus regularizing the bowels and keeping this part of the body preventively more healthy. In addition it helps to keep your animal’s weight in check.

Reference & resource directory:
Merck Veterinary Manual
Laura D. West, DVM and Frederic S. Almy, DVM, MS, Diplomate ACVP
VCA Columbia Animal Hospital
Images: Hill’s pet Food
Hess, RS; Kass, PH; Shofer, FS; Van Winkle, TJ; Washabau, RJ. Evaluation of risk factors for fatal acute pancreatitis in dogs. Journal of the American Veterinary Medical Association. 1999;214(1):46-51.
Lem, KY; Fosgate, GT; Norby, B; Steiner, JM. Associations between dietary factors and pancreatitis in dogs. Journal of the American Veterinary Medical Association. 2008;223(9):1425-1431.
Stewart, AF. Pancreatitis in dogs and cats: Cause, pathogenesis, diagnosis and treatment. The Compendium on Continuing Education for the Practicing Veterinarian. 1994;16(11):1423-1431.
Williams, DA; Steiner, JM. Canine exocrine pancreatic disease. In Ettinger, SJ; Feldman EC (eds.): Textbook of Veterinary Internal Medicine. W.B. Saunders Co. Philadelphia, PA; 2009;1482-1487
Pitcairn’s “Natural Health for Dogs & Cats”

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