In case you haven’t noticed, hemp CBD products have taken over the world and can apparently be used to either treat or cure just about everything. It’s hard to go pretty much anywhere without seeing some sign or advertisement touting the amazing wonders of CBD products. In the pet world, CBD oil and treats are being marketed as a tool to treat arthritis, anxiety, GI issues, and even cancer management. You can get it in oil or treat form from a bazillion online vendors, pet stores, and even some veterinary professionals. If this wonder product is so great, why is there so much controversy surrounding it? I am not a CBD hater. I see the potential applications and am hopeful that it will stand the test of time and scrutiny. My issue is that this widely purchased product seems to have skipped all of the rigorous testing and inspection and has gone straight to the consumers.
Let’s Start At The Beginning
What is CBD anyway? CBD is short for cannabidiol which comes from the cannabis plant, Cannabis sativa. It is the non-psychoactive part of the plant with the THC (the part that makes you high) removed to a very low or undetectable level. It was first discovered in the 1940s by Roger Adams at the University of Illinois when he separated CBD from hemp and studied its properties. The Cannabis sativa plant has several varieties that vary in levels of THC, CBD, and fiber content. The variety more commonly known as marajuana has a high THC content with a lower CBD concentration. The variety known as industrial hemp is high in fiber, low in THC levels (0.3% or lower) and higher in CBD levels.
Is The Sale And Distribution Of CBD Legal?
In 2014 President Obama signed the Agricultural Act of 2014 allowing for study and farming of industrial hemp in limited amounts. An additional act in 2015 allowed for larger farming opportunities and took hemp off of the controlled substance list as long as the THC content was less than 0.3%. This distinction is important and yet confusing as far as the federal government is concerned.
Industrial hemp is not a controlled substance according to the DEA but CBD is a different story. As far as the federal government is concerned, CBD grown from a hemp plant with THC levels of less than 0.3% is NOT a controlled substance. CBD derived from a marijuana plant with higher levels of THC IS a Class I controlled substance. This is just at the federal level, however. States have their own laws concerning CBD sales and distribution. Oral CBD products are still a gray area as far as legal sale and use is concerned. The state of Delaware allows for the legal use of marijuana with a medical card from a physician. CBD products in Delaware fall into two categories: oil with a CBD concentration of 15% or higher fall into the marijuana category and need a medical card, oil with a concentration of 7% CBD and 0.3% THC are unregulated and can be purchased by anyone. Currently, there is one FDA approved CBD based human medication, Epidiolex, which is used to manage seizures.
An Exploding Market For The Pet Industry
In 2016, the first CBD oil marketed for dogs was launched. Sales of CBD related pet products has increased from $8 million in 2017 to $32 million in 2018 to and expected to rise to $1.16 billion annually by 2022. This is huge revenue for a product that is just now starting to have any scientific data evaluating dosing and effect on specific disease processes in dogs and cats.
One of the many fears in the veterinary community is that consumers will reach for the all powerful CBD products first and consider a doctor’s evaluation and recommendations for a pet’s illness last. Another stumbling block between consumers and veterinary professionals is the lack of comfort that many doctors have even considering CBD applications with clients. One study showed that only 45% of the veterinarians participating in the study were comfortable talking about CBD topics with clients. Also the veterinarians that were more likely to discuss using CBD products in pets practiced in states that already had legalized recreational marijuana use. Pet owners are frustrated that they are not able to get the guidance from their veterinarians that they need. The bottom line is that the veterinary field needs to be open and informed about CBD products and how owners are using them. We need to educate ourselves so that we can then better educate our clients on when and how to use CBD products in our pets.
So What’s The Big Deal?
Quality Control Issues
The lack of regulation for CBD products is problematic for a variety of reasons. There is the obvious one of not really knowing if the product that is purchased actually has the amount of CBD listed on the package. Could be a little in there, could be a lot, maybe the amount listed on the package is just a ballpark estimate. Who knows? No third party source is checking and verifying package labeling.
And to be clear, CBD is derived from parts of a hemp plant, but not all hemp sold on the market has CBD in it. The hemp seed and hemp seed oil has only trace amounts of CBD in it and is cheaper to produce. Unless you know all of the industry names of hemp that assume to have CBD in it, you may be purchasing a hemp based product that actually contains little to no CBD. Buyer beware!
Understanding The Label Of CBD Products Can Be Problematic.
Amount of active CBD per serving ,
Supplement Fact Panel, including other ingredients,
Manufacturer or distributor name,
Type of CBD used (Full spectrum, broad spectrum, or isolate)
Batch or date code
Most CBD products for pets are labeled for the total amount of CBD expected per bottle of oil or bag of treats. The recommended dosing by the manufacturer is then listed as the number of drops to administer or treats to give based on a pet’s weight range. With this packaging it is not clearly stated how many mg/kg you are giving per dose in a way that the average consumer can understand.
Who Determined How Much Was Enough For Pets?
What I want to know is who determined what dose to give and how often to give it if there were not any trials or studies completed before 2018 to evaluate this for specific diseases? Recent studies have suggested a dose of 2 mg/kg twice daily for arthritis symptoms and 2.5 mg/kg twice daily for seizure reduction. That’s a great start but it is difficult for most consumers to take this information further and apply it to the CBD pet products as they are currently labeled.
Can you give too much? What happens to the body when you give too much? What are the symptoms of too much? What are the long term effects of CBD use at any dose? Some pet owners have been putting the value of CBD products in the same category as FDA tested and monitored prescription medications without the proper testing to determine how much and how often is appropriate.
Are All CBD Products Absorbed The Same?
There was a study done in 1988 that compared the bioavailability of CBD delivered IV and orally. In this study the CBD doses that were given IV were absorbed right away, readily detectable in the blood, and had a terminal half life of 9 hours. Oral CBD given as a powder loaded into gelatin capsules had much different results. Half of the dogs given the oral CBD never had any detectable levels of CBD present at all. The other half of dogs given the oral dose had only 13-19% of the CBD bioavailable. A recent study done at Cornell used a proprietary brand of CBD delivered with olive oil. Their findings showed acceptable absorption with a terminal half life of 4-5 hours. Cornell hypothesized that the poor absorption in the 1988 study may be due to first pass effect (the liver readily metabolizes the product before it is able to reach blood levels) or that the delivery method of CBD effects absorption. This is important information that we don’t have full understanding of yet. Is that $70 bottle of CBD oil or bag of treats even being absorbed by your pet? Should it be given with food? Should it be a specific type of food (fatty?)? There are CBD powders available on the market today. Are we wasting our time even considering the powder forms or do they just need to be given a certain way?
How Safe Is CBD For Our Pets?
At this point we can say with certainty that CBD is metabolized in the liver. There is some research out there that suggests CBD may improve liver function in certain cases by reducing scar tissue from disease processes such as cirrhosis. In contrast, in both human and dog studies, elevated liver specific enzymes were reported in several of the participants. In fact, a recent study done on mice using high doses of CBD, equivalent to the max dose of prescription medication Epidiolex, concluded that “ CBD differentially regulated more than 50 genes, many of which were linked to oxidative stress responses, lipid metabolism pathways and drug metabolizing enzymes. In conclusion, CBD exhibited clear signs of hepatotoxicity, possibly of a cholestatic nature.” So far, we are seeing some elevations in liver specific enzymes ALT and AlkPhos in animal trials using commercially available CBD products but not in every case. The general thought is that we really need to evaluate long term usage effects on the body to determine the significance of these early findings. We also need to determine if there are specific groups of dogs that should not be taking CBD at all.
What about cats? Cats seem to be from a different planet when it comes to processing some medications. A study published in 2019 had results indicating that cats may absorb or process CBD differently than dogs: showing lower serum concentrations and adverse effects of excessive licking and head-shaking during oil administration.
Fun fact: hemp plants have long been used to cleanse the soil of heavy metals and other contaminants. They are what we call phytoremediators. Where the hemp plant is grown and the type of chemicals used during the growing process are very important to the long term safety of the resulting CBD product. Cheaper hemp imported from overseas may contain unhealthy levels of mercury, lead, and arsenic as well as unwanted chemicals such as pesticides. These hemp plants are planted as cover crops to pull toxins out of the soil and then they exported for the ever growing CBD industry. One survey of 240 of the top selling human CBD lines found heavy metal contamination in over 70% of the products tested. Ideally, any hemp being processed for consumption should be grown organically and be tested for contaminants every step of the process.
Does CBD Affect Other Medications?
The short answer is yes. Since CBD is processed in the liver, it may compete with medications being taken that are also metabolized by the liver thus increasing their blood levels. In the veterinary world, many of the patients who are being given the CBD oils/treats are either arthritic or epileptic. The medications that most likely have been prescribed by a veterinarian for these ailing pets include NSAIDs and Phenobarbitol. These drugs are cleared by the liver just like CBD. What can we see when these prescription medications are combined with CBD? We can see the potential for unwanted side effects and a stressed liver.
Proceed With Caution And Education
The pet CBD industry is a multi-million dollar powerhouse that is increasing exponentially every year. Consumers are reaching for CBD products as a way to give their pets some relief from a huge list of diseases and conditions. The fact of the matter is that there are more claims for CBD benefits than there is scientific proof. Research is showing that there may be a reasonable application for CBD use in pets with seizures and potentially arthritis pain. Scientific study has also revealed some concerns regarding delivery for bioavailability and general safety that needs further investigation. The legal gray zone that CBD has lived in for the past few years has allowed an industry to explode for consumers while the necessary safety regulations have lagged behind. It’s time for the veterinary community to stop running away from CBD and to start figuring out what role it will play in veterinary care.
Consumer Bottom line: Use CBD products with caution until the safety protocols are developed to protect your pet from doing more harm than good when taking them. Stick to organic CBD and preferably a brand that has withstood the rigors of scientific study.
Veterinary community: We need to educate ourselves about potential CBD applications because this trend is not going anywhere and our clients need our direction. Pet owners are relying on us to help them navigate the wild west CBD industry with sound medical advice based on the facts as we learn them.
We live in a world of amazing medical advances and technology. The combination of advances in veterinary medicine and the willingness of owners to invest in their pet’s health has allowed our companion animals to live longer and happier lives. With this longevity comes certain age related diseases, most notably, cognitive decline that resembles human dementia or Alzheimers in both pathology and progression. This change in mental function called Canine Cognitive Dysfunction (CCD), can begin to effect dogs as they approach senior age and is a progressive disease.
Cognitive Changes Can Vary
CCD can effect any breed with varying symptoms that can begin as early as 5 years old in giant breeds to the teen years in others. Early signs can be subtle changes in behavior or habits that can be easy to miss. Maybe they aren’t as interested in toys like they used be to or aren’t as quick to greet you at the door. As time goes by though, it will become clear that your dog’s mind is changing.
Some of the common symptoms of Canine Cognitive Dysfunction :
Change in sleep cycles– sleeping during the day and up at night, pacing at night, sleeping more over all
Increased Anxiety- common symptoms can be pacing, vocalizing, excessive panting, and trembling,
Decreased Activity- Not interested in things that used to interest them such as playing, less willing to go for walks or play with housemates
Inappropriate Vocalization- barking, whining, howling for not apparent reason
Incontinence- urinating and defecating in the house or inappropriate places (even after just having been outside), not indicating that they need to go out for potty breaks
Increased aggression- bite first mentality,some loose the ability to communicate with other dogs leading to fights or unwanted behavior
Less Social Interactions- becoming withdrawn or isolated even with family members, loss of interest in other housemates, generally less engaged in what is going on around them
Generalized disorientation- getting lost or seeming confused in their own house or yard, getting stuck in corners or under furniture, not able to figure out how to get out of a room or back home during a walk, forgetting to go to the food and water bowls when they are thirsty or hungry, staring at the wall
Make Sure That You Are Not Dealing With Another Health Related Issue
Just as with our human family members, it is hard to watch the decline in our pets. Over time, they begin to lose their independence and require more and more care to meet their daily needs. The good thing about canine cognitive dysfunction is that is a slowly progressing disease. Some pets will demonstrate only one or two symptoms in their lifetime while others could show more. The first thing that any pet owner needs to do if they are worried about CCD is to consider what signs that they are seeing and then consult their veterinarian. Several of the symptoms that we have discussed can also be from other health issues. Sometimes dogs can be crabby and change their behavior because they are in pain from arthritis. If a pet’s vision is declining they may be less willing to participate in the usual activities or navigate a once familiar area. Once we have determined that any other medical need of an aging dog is met, then we can evaluate the best way to manage the remaining symptoms of mental decline (if there are any)
Helpful Management Strategies
Diet Changes. What your pet eats can play a significant role in delaying cognitive changes as they age. Studies have shown the having a diet rich in antioxidants, medium chained triglycerides (MCT), antioxidants and omega 3 fatty acids can help to slow the progression of the disease. Companies such as Hills and Purina make specially formulated “brain” diets rich in these components. If you are interested in a more natural diet then look for one that centers around antioxidants, vitamin B, and omega 3 fatty acids. If you are cooking for your dog, make sure that the antioxidants are dog friendly like blueberries, dark green veggies, and sweet potatoes. For the MCT supplementation, coconut oil has been commonly used if the pet will tolerate it. (Any oil supplement can soften the poop and if you are already dealing with incontinence then that can be a disaster!)
Medication to Slow Progression and Reduce Anxiety.
Anipryl (selegiline) is one drug out there that is thought to reduce or slow down some of the destructive pathology in the brain. Medication that may reduce anxiety or aggression associated with the cognitive changes include fluoxitine, amitriptyline, benzodiazapines, and gabapentin. One daily supplement for anxiety that is promising is Solloquin. There are many stories out there about the use of CBD to manage anxiety in dogs but there are currently no scientific studies to support this claim. So the question is two parts: does CBD help reduce anxiety associated with canine cognitive dysfunction and if so, what would be the dosing ? The answer is that the two studies out there looking at the use of CBD products in dogs have focused on either epilepsy or pain control for arthritis so we don’t know. Also the CBD products are considered nutraceuticals and therefore are not regulated for purity and content. The biggest concern with CBD use, in my opinion, is the potential for serious issues with the quality of the product. My guess is that CBD products will eventually play a role in canine cognitive management in the future after we have worked out some of the existing issues.
Keep Them Active (both mentally and physically). Don’t treat your older dog as if they are old! Keep encouraging those walks and fun times. Make an effort to engage your senior pet with mental games like “find the toy” or offering behaviors like sit/stay/heel/giving paw for treats or rewards. Continue to make them “mind their manners” with commands and expectations if it is still within their comprehension. If your dog is showing some of the signs of CCD but still has the drive to participate in sporting events, keep going but maybe scaled back some or with more supervision in case they get confused. Give your dog a reason to get up and to get going every day. Most importantly, keeping an older dog active and awake during the day may help them hold on to their normal sleep cycle at night.
Stick to a routine. Try to have a routine feeding , walking , and bedtime schedule. Change is hard for these dogs and a source of anxiety so keeping eating, activity, and resting as routine as possible is important.
Modify the Environment. If your dog is getting stuck behind or under furniture and not able to figure how to get out, then limiting unsupervised access to parts of the house may be necessary. Baby gates and/or crating (if they were already used to a crate and accepted it as part of their routine) can keep an unsupervised disoriented pet out of trouble and safe from harm. You may need to block off stairs if your dog is unable to navigate them without the potential of falling. Harnesses and lift systems can be lifesavers if your dog needs a hand going up the stairs, in/out of the car, or even help keeping steady during potty breaks. Belly bands or doggy diapers can be very helpful in allowing a pet to remain with their family in the house and not isolated because of soiling concerns.
The Smoothing Out the Bumpy Road of Cognitive Decline
Aging is an unstoppable process that we are all going through. Some of the changes that come with the aging process are are good, some are not so good. A few of the management strategies that we have discussed are easy enough to implement earlier in life, before any signs of potential canine cognitive dysfunction even show up. Keep your dog active and stimulated while also feeding a nutrient rich diet with omega 3 fatty acids and good stuff like veggies. Easy, right? On a final note, if we can take a moment to assess the needs of our pets as they enter the later stages of their life and combine that with compassion, we certainly can smooth out the bumpy road of cognitive decline.
As a veterinary rehab therapist I have seen my fair share of hind end weakness in older dogs. This loss of function can be from a variety of causes. A thorough exam is a great place to start to rule out issues such as tick diseases, weakness from anemia or endocrine imbalance, and to localize any areas where pain may play a factor. Arthritic joints and orthopedic injury can lead to a pet that doesn’t want to move because of pain and discomfort.
Do We Really Know the Cause of the Weakness?
The hind end weakness that I am referring to is the generalized geriatric hind end weakness that we often see in senior aged dogs. Several of my patients go through a progressive decline in function that is not arthritic in nature but rather a neuromuscular degeneration. We can be quick to call this neurological decline Degenerative Myelopathy (which is a truly terrible disease similar to ALS in people) and set ourselves on a negative course of doom and gloom for the patient. In my rehab career I have seen many dogs with hind end weakness but only a few of them actually had true DM (diagnosed by DNA testing and/or MRI screening). The DM dog’s journey of decline to complete dependency was fairly quick (months) and very heartbreaking because their bodies gave out well before their spirit did. So let’s just agree that dogs can have many other neurological things happening to their body (age related muscle loss, spondylosis, lumbrosacral disease, degenerative disks to name a few) besides DM to bring them to their weakness issues. Why is this distinction important? In short, TIME. Many of these non-DM related causes have a much slower rate of decline and that makes all of the difference when keeping a dog on their feet. Can we manage this hind end weakness, whatever the cause, and give these dogs a good quality of life? Sure we can!
Needs and Goals: Let’s Be Realistic
The first place to start is with setting realistic goals. In the case of age related progressive hind end weakness, we will never restore full function in our pets. Rehabilitation therapy will slow the process of weakness and decline but won’t change its course. My rehab goal is to improve quality of life, teach families how to manage a changing pet, and keep my patients on their feet for as long a possible. In the older patient, I usually find that once we begin rehab therapy we are maintaining where they are now in function and may be able to get back some activities such as being able to climb stairs again or getting on the bed without help. If they are currently able to just walk around the block before tiring out, rehab therapy will not get them back to that three mile walk that they used to do a few years ago. Rehab therapy will realistically keep the weakening dog walking that block for as long as possible with the least amount of help and secondary issues. They can still play ball or tussle with their canine buddies, but with some modification to avoid over fatigue and injury.
I like to have my owners identify some things that their dog used to enjoy doing but are not able to do any more. These lost activities can be markers for improvement if they return or goals to achieve with therapy. It is also important to find out what actions an owner needs their pet to be able to do (like get in and out of the car, up and down entry stairs) in order for the owners to feel comfortable taking care of their pet at home. There is a delicate balance between the level of care that a person is able to give and the level of care that a disabled pet actually needs.
Managing Hind End Weakness: The Plan
- Manage any source of pain. While the neurological decline leading to weakness may not be a painful process, there is often secondary pain in some of the joints and muscles because of how a pet is moving or compensating. If they use their front legs to push themselves to their feet or to carry most of their weight, maybe the elbows and surrounding muscles are sore. Often times the muscles of the spine are affected by changes in posture, falling over because of instability, or slipping on some surfaces. Oral medication such as NSAIDs and supplements as well as laser therapy and/or acupuncture are great resources for pain control. Massage or a warm compress on aching muscles can bring relief and comfort as well. Let’s not forget home care devices such as the Assisi Loop for portable pain control.
- KEEP THEM LEAN!! These dogs are having a hard time lifting their body mass and staying on their feet. Carrying excess weight will make the loss of strength and mobility even worse and eventually shorten the amount of time that they have with you.
- Consistent home exercise. Shorter walks twice daily are a great way to keep a dog moving and grooving. Mix it up with changing terrain by walking on grass, pavement, sand, and other surfaces to increase the feedback your pet gets from their feet to their brain. Challenge stability by adding in wide circles or figure 8s to a walk. Encourage pets to step over things like tree branches to lift their feet. Walking on a low unstable surface such as an air mattress can help to strengthen core muscles and promote body awareness for stability. Avoid the long hikes or play activity that may cause over fatigue that takes days to recover from.
- Acupuncture. I like to think that this modality is great for helping what does work to work a little better. Acupuncture will help to strengthen the nerve-muscle connection and is our go-to therapy when there are incontinence issues along with the hind end weakness. With acupuncture there is an increased circulation to problematic areas, nerve and muscle stimulation, and usually a general sense of well being for the patient.
- Formal Rehabilitation Therapy. Adding in aqua therapy and targeted exercises can work to strengthen muscles and build endurance for home exercises and activities. About half of my rehab session with a patient and their people is spent talking. Each session is therapy for the pet and the owner because watching a pet change can be hard. Use your rehab therapist as a valuable resource to help with solutions for home care needs. We are reassessing needs and goals all of the time and having someone to guide the way can reduce anxiety for both the owner and their pet.
- Environmental Changes. Slick, slippery floors are a huge problem with the hind end weakness pets. They can lose their footing and then not be able to get themselves back up without assistance. Placing throw rugs over slippery surfaces will help your dog to navigate at home without falling. Block off stairs if the pet can not go up and down them without some issue such as slipping or falling. Ramps to get in the house or car have their place but you need to find the right size and fit that works for your situation.
- Mobility Aids. There are so many products out there when you look online or in stores that picking one for your needs can be a bit overwhelming. My advice is to look at the reviews, see what worked and did not work for that particular item, and think twice before purchasing anything. I have a box full of items that people bought on their own that ended up not working at all. For the larger dogs, I do have one product that I consistently recommend and that is the Help Em Up harness system. You can use it to help a dog get into the car, up the stairs, get onto their feet, and to stabilize them during other day to day activities. This harness system is not for everyone but seems to be helpful to the majority of my families that use it.
We Are Here For You!
It can be a very difficult thing to watch a beloved furry family member age and decline in mobility, among other things. It is important to remember that this journey of age related change is inevitable, but we can make it a whole lot more comfortable for everyone. There is help out there for you and your pets. You just need to take that first step with your veterinary professional to start your journey of management and support.