Feline Pancreatitis – Treatment

The main goal of treatment in pancreatitis is simple: to quiet down inflammation in the pancreas.  This involves removing the cause (if known), treating the side effects caused by the release of pancreatic enzymes and providing supportive care.  Since most cats with pancreatitis have severe nausea and vomiting, I place them on intravenous fluids to maintain their hydration.  I also give them anti-nausea medication.  My favorite is a drug called maropitant  (Cerenia is the tradename) that is injected once per day.  

Pancreatitis is an extremely painful disease.  Therefore, medications to control pain are a cornerstone of therapy.  Cats often sit with their legs tucked up under them in what my friend calls a “meatloaf” position with their heads hung low in front.  When the pain gets really bad, they close their eyes and drool.  After a dose of a pain relieving medication such as buprenorphine, they slowing relax and stretch out.   
 
While a high fat diet is a predisposing factor for developing pancreatitis in dogs, this does not seem to be the same for cats.  In my experience, cats with inflammatory bowel disease seem to be at much greater risk for pancreatitis.  If a cat has a history of IBD, I sometimes add steroids to their treatment as well as antacids and B-12. 
 
Once they can eat again, I switch them to a low antigenic diet because of the association of pancreatitis with IBD.  I usually start with a novel protein i.e., a protein source they have not eaten before, with moderate levels of fiber then monitor the response.  The most important thing to remember is that each cat responds in its own way.  In my experience, there is no diet that is perfect for every cat with pancreatitis or IBD.  Watch your cat closely for signs of recurrence.          

Feline Pancreatitis – Diagnosis

Since the most common signs of pancreatitis in the cat are nonspecific; lethargy and anorexia, diagnosis can be challenging.  The gold standard is a surgical biopsy of the pancreas and evaluation by a veterinary pathologist.  During surgery, the pancreas is swollen and often an angry pinkish-orange color.  The downside of a surgical biopsy is that it requires subjecting an ill patient to anesthesia and surgery.  The biopsy will also cause more inflammation where it is performed.    

Fortunately, a non-invasive test became available called feline pancreatic lipase immunoreactivity (fPLI).  In a normal cat, small amounts of lipase are found in the bloodstream.  The levels jump with pancreatitis.  If the results are in the questionable range, I usually follow-up with an abdominal ultrasound.  Either way, the cost, risk to the patient and turn around time are much reduced when compared to a surgical biopsy.

It is extremely important to diagnose pancreatitis as early in the course of the disease as possible.  Left untreated, a chronic smoldering pancreatitis may destroy the pancreas leading to pancreatic insufficiency or diabetes mellitus.  If your cat is ill, bring them to your veterinarian for evaluation right away.  Waiting may cause permanent damage.   

Book Signing at Common Good Books

The book signing at Garrison Keillor’s bookstore, Common Good Books, was a great deal of fun!  Thanks to everyone who came to learn about the book and the first year of my veterinary clinic in Minnesota.  It was wonderful and fitting  that so many dogs and such varied breeds would participate in the celebration.  Thanks as well to the terrific booksellers at Common Good Books: Claudette, Jean, Martin and Sue.  Your Minnesota hospitality was genuine and very much appreciated.   Here is a picture from the event.  If you are in St. Paul, be sure to visit Common Good Books in the Cathedral Hill area, just downstairs from Nina’s.  I left autographed copies of the book at the store.                                                              

                                                                   

On Wednesday, we will continue discussing pancreatitis in cats. 

Flyball Is Great Fun For Dogs And People

If you are looking for a fun activity for you and your dog, give flyball a try.  In this timed sport, two teams of four dogs and their handlers compete against each other in a best of three heat format.  Each dog takes their turn running over hurdles to grab a tennisball from a box and then run back over the hurdles again to the finish line.   The hurdle height is set for the smallest dog on the team which leads to some interesting strategies.  

The dogs seem to love this sport.  They bark and prance when they enter the ring.  I had one patient, a Sheltie, who started to run in place the minute she saw the jumps.  Her owners developed a special harness with a handle on top that allowed them to carry her without being scratched.  I nicknamed her the flyball maniac!   

Before starting this activity, consult with your veterinarian to make sure your dog if physically fit for flyball.   

Feline Pancreatitis – Causes

Pancreatitis in cats may be caused by several factors.  Here are some to consider: 

1)  Inflammatory Bowel Disease – It is thought that bacteria migrate into the pancreas, triggering an infection which leads to inflammation.
2)  Trauma – When I interned at the Animal Medical Center in New York City, I saw several cats develop pancreatitis after falling out of their high-rise apartment windows.  Now I see it develop occasionally after cats are hit by a car.
3)  Toxin exposure, especially organophosphates used in the garden as insecticides. 
4)  Other reported causes that I have yet to observe – Feline distemper, toxoplasmosis and drug induced although this seems to occur more frequently in dogs on azathioprine.  

The really frustrating thing about pancreatitis is that I often never find a definitive cause.  I personally think it is most often related to diet, especially the long-term use of high carbohydrate, grain based diets.  Hopefully research will provide answers soon.       

Feline Pancreatitis – Clinical Signs

The pancreas is a pink/tan lacy organ that has two big jobs.  First, it secretes insulin to control blood sugar levels.  Second, it produces enzymes that flow into the intestines to digest food.  In a normal pancreas, these powerful enzymes are stored in special compartments and then secreted into the pancreatic duct when needed.  If the pancreas becomes inflamed, the normal architecture is disrupted, allowing enzymes to leak out of their storage compartments into the actual tissue of the pancreas.  They digest the pancreas and cause even more inflammation which causes more leakage and inflammation.  Eventually, pancreatitis occurs which translated means inflammation of the pancreas.  If left untreated, the inflammation may “kill” the entire organ leaving the cat unable to digest its food (pancreatic insufficiency) or regulate its blood sugar (diabetes mellitus).

Unfortunately, pancreatitis is a common problem in cats.  Dogs and humans with pancreatitis suffer nausea, vomiting and abdominal pain.  In cats, the signs are much more vague, often just anorexia and/or lethargy.  By the time people realize the cat is ill, significant pancreatic damage may have already occurred.

To catch this disease early, I recommend feeding a precise, measured amount of food twice per day and then monitoring your cat’s consumption.  If consumption decreases and the cat starts sleeping more, seek veterinary care immediately.  

P.S.  In a nod to a friend and Catholic monk who has devoted his scientific career to diabetes research, I should mention that Fr. Cyprian Weaver, O.S.B., Ph.D., Ph.D., refers to the pancreas as the “Sacred Organ”.     

Do You Agree With Breed Specific Legislation?

Since I’ve got jet lag from the trip to Asia, I decided to ask for your opinion on breed specific legislation.  While walking in a park along the South China Sea, my husband noticed this sign posted prominently.  Singapore requires certain breeds of dogs to wear muzzles when in public places.  Although I appreciate the intent behind the law, to protect humans and other animals from attack, I have mixed emotions about breed specific legislation.  What do you think?  Are these breeds so unpredictable that all members should be muzzled by law or should the decision be made on an individual basis?  In other words, are there dangerous breeds or dangerous owners?  Please let me know what you think.  I should add that I thoroughly enjoyed the visit to Singapore.  Regardless of your view on this issue of muzzling dogs, I suggest you visit the country if given the chance.  It is clean and beautiful!