1) Pancreatic Exocrine Replacement Therapy (PERT)
What is PERT?
PERT is a pancreatic enzyme supplement that you can take when your body cannot make enough of the enzyme on its own. It comes in the form of large capsules that you take orally.
Why do I need PERT?
A blockage in the pancreatic duct, or removal of part of the pancreas, can cause a change in the flow and amount of pancreatic juice. Pancreatic juice contains enzymes that help the body to digest and absorb nutrients such as fat, carbohydrate and protein.
If your body cannot produce enough pancreatic juice, you will have difficulty getting nourishment from foods and, eventually, you will lose weight. Studies have shown that taking a pancreatic enzyme like PERT can improve the absorption of nutrients from the digestive system and help prevent weight loss.
Signs that indicate that taking a PERT supplement would be helpful are:
- pale stools (bowel motions) that do not flush away easily;
- loose bowel motions;
- abdominal pain and bloating after eating; and
- good appetite and food intake but with continuing weight loss.
How should I take PERT?
Ideally PERT capsules should be taken before meals but it is not absolutely time critical. It is usual to start taking 1 to 2 capsules with meals and 1 with snacks and, if necessary, this can be increased. Your doctor and dietitian will advise you. If you are more comfortable eating smaller, frequent meals, with for example three snacks a day, it may be necessary to take one capsule before each snack. The capsules can be swallowed whole. If you find this difficult, you can open the capsule and mix the granules with fluid or soft food. Please remember that if you do this, it is important that you take the fluid or food immediately, so that you get the full effect of the granules.
The granules must not be crushed or chewed.
It is important that you try to drink plenty of fluid every day.
You may find that some foods, particularly fatty foods, do not agree with you.
A dietitian will be able to provide advice or supplementary information on managing your diet.
2) Pain Relief
There is absolutely no necessity to be in pain and in many patients discomfort is relatively easily fixed by simple alterations to medication. Occasionally it can be challenging to achieve an adequate balance of pain relief against the sedative effects of major analgesics (opiates) and in these circumstances there are additional interventional treatments that can be very helpful, such as coeliac plexus blocks or surgical neurolysis.
Your doctors, specialist nurses and support team will all work in conjunction with the hospital and community palliative care teams to strive to control any pain issues as they arise. It is really important that patients are honest with their support team regarding symptoms, as unless they know about them, simple solutions can often be missed.
3) Psychological Support
Please see our Counselling & Therapies page and the partnership we have with Cancer Support Scotland
4) Oral Nutritional Supplements
It is difficult to provide universal advice in that every individual has a different experience. In general, it is better to take small snacks frequently rather than attempting to take larger meals at fixed times.
Maintaining an adequate energy balance is important regardless of the type of treatment you are receiving. Ideally this will be through a normal diet, but some patients do experience difficulties due to lack of appetite, feeling full quickly or as a result of side effects of medication. Changes in taste are more common following an episode of jaundice.
In general eating small frequent meals and snacks, focusing on what a patient likes is probably more important than following any specific or healthy diet. Oral nutritional supplements are high calorie concentrated feeds which can supplement sub-optimal intake.