Breezing (relatively speaking) Through Nightmare of ACL Repair
My majestically athletic, exuberant Weimaraner Maisie made it all the way to age six before she tore her ACL ligament in May. I had been living in absolute dread of it tearing for months before it happened. I was doing everything I could to protect her sore knee — weekly acupuncture, bi-monthly chiropractic adjustments, TRP-Tri-COX joint supplement, Platinum Performance supplement, cold laser, and ElleVet Sciences CBD oil.
But she was an unstoppable force of nature when she revved her engines and — as an expression of pure joy at being alive and pleasure in the power and speed of her own body — she would take off in big, looping figure-of-eight circles at 25 miles an hour. She used her favorite humans as the center point of the circle, just barely grazing your leg as she whizzed past and changed direction to the next circle. (By the way, Healthy Paws pet insurance paid 90% of nearly every single one of those treatment modalities, including the MRI of her spine which was done early and x-rays of her leg. We’re talking close to $9,000 before her ACl even tore). [PLEASE get pet insurance for your pets, I beg you once again.]
Inevitably, her knee defied my efforts and two months ago, as I was gardening, she took off on her high-speed circles and her knee gave way. Suddenly, she had only three usable legs.
I was horrified by the prospect of the ACL surgical repair, which i have been through with more dogs than I care to count. The bone is cut, a lot of metal hardware is screwed into it, and the dog has a swollen leg too painful to step on for weeks and weeks, needing support just to stand and go out and relieve himself. With almost total house arrest for two months, except for bathroom breaks, eventually the leg heals and the dog is left with an “okay” knee joint after a total of 4 months recuperation. In 50% of cases, the dog’s other ACL tears, but I’ve always wondered if it was because of the additional stress and strain on it of supporting all the weigh for so many months?
However, happiest of happy news: we had a different and much, much better outcome this time. Maisie began putting weight on that leg within 10 days, “toe-touching.” Within two weeks she was carefully walking on it. I had to visit Dr. Bo Bergman at West Mountain Vet Hospital because part of the incision wasn’t healing, and he was really surprised she was putting any weight on the leg at all. On an extendable leash I walked her increasing amounts each day because she could, and wanted to — which is not common practice, as vets usually insist on pretty much crating/caging the patient for nearly the full 8 weeks post-surgery. I decided to let common sense by my guide and let her tell me how much she could comfortably do, while keeping her muscles strong.
At four weeks post-surgery I stopped the pain medication she had also been getting. She kept on walking and trotting on the leash and was not lame or limping at all. I believe this remarkable recovery had to be due to the ElleVet CBD oil. What else was different from the other five ACL surgeries I’ve lived through with previous dogs? The surgery has not changed in decades — although each year I have kept interviewing Dr. Rob Hart at the Animal Medical Center in New York City HERE, and HERE, hoping there would be a less invasive and easier-to-recover-from repair of the ACL, but it hasn’t happened.
I am giving credit for Maisie’s brilliant recovery to the large dose of CBD oil from ElleVet Sciences she’s gotten at both meals from the moment she tore the knee. I’d had her on the maintenance dose of a few drops per meal when her knee was just sore, but I learned from ElleVet Sciences (which is a sponsor of DOG TALK) that there was a new clinical trial studying pain management post-ACL surgery in dogs. I learned what that dose was and immediately put Maisie on it. My vet, who has just begun trying that CBD oil on patients, said they hoped Maisie would be their “poster dog” to convince themselves — not just owners — of how useful it could be to their senior arthritic or post-surgical dogs. At the 8-week post-op x-ray visit yesterday, my vet, Linda Morris at West Mountain Animal Hospital, was amazed at how much Maisie was using all four of her legs. “So she’s The Dog you can use as proof that CBD works!” I said.
I sure don’t wish this problem on any dog, but ACL tears are so common that I really hope if it happens to you that you will ask your vet to get you this CBD oil made and measured just for pets.
We’ll be off and running before long now!
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ElleVet Sciences is a sponsor on Radio Pet Lady Network, by our invitation.
The Benefits Of CBD Oil For Dogs
The good news is that it can help with many of your dog’s health issues from allergies to cancer. The bad news is that the CBD industry for pets is still unregulated. That means the majority of pet owners might be getting ripped off.
So today I want to talk about all the good things CBD oil can do for your dogs. Then I’ll show you how to find the best product for your dog and talk about how to give it.
What Does CBD Oil Do For Dogs?
There’s a messenger system in your dog’s body called the endocannabinoid system. It helps regulate sleep, appetite, pain, the immune system and more. CBD impacts the activity of the messengers in this system and stimulates the nervous, digestive and immune systems, as well as the brain. And it can do this because the endocannabinoids in CBD are very similar to the ones found in your dog’s body.
That’s why the benefits of CBD can be deep and significant. And why CBD oil is the fastest-growing healthy plant in the world!
6 Ways CBD Oil Can Help Your Dog
Let’s take a look at common conditions where CBD can help dogs. And after I’ll talk about which CBD oil you should buy and general dosing information.
1. Dogs With Joint Problems
If your dog has joint pain, your vet might prescribe NSAIDs or other pain meds like Gabapentin. But NSAIDs can cause deterioration in joints and soft tissues … and they can damage your dog’s liver. Gabapentin can also cause kidney damage. Plus, it’s not all that effective.
CBD is a natural anti-inflammatory that doesn’t carry the same risk of side effects as drugs. It works by binding to CB1 receptors in the brain. These receptors stimulate the immune system to reduce inflammation. CB1 receptors also change the way the brain responds to pain.
CBD also binds to CB2 receptors found in the nervous and immune systems. When this happens, the body may produce more cannabinoids naturally. This helps reduce inflammation even more and reduce the pain associated with it.
In fact, researchers at Cornell University found that dogs taking CBD for arthritis were more active and showed a decrease in pain.
Some of the common people buy CBD Oil for dogs as an anti-inflammatory for joint problems include:
- Hip and elbow dysplasia
- Sprains and strains
- Torn ligaments (CCL)
2. Dogs With Cancer
Sadly, 50% of adult dogs will get cancer. Cancer is a massive health challenge for dogs, especially if they undergo chemotherapy or radiation.
Cancer researchers are always looking for new ways to treat cancer and release the pain and nausea that can go with it. And CBD has been extensively researched as a cancer-fighting substance.
A study in mice showed that CBD slowed the growth of mammary cancer cells. And in 2018, researchers found that CBD increased survival time in mice with pancreatic cancer. Other animal studies show CBD oil has cancer-fighting abilities and can slow the growth of tumors.
In another study, cancer cells became more sensitive to treatment with CBD. That means CBD can increase the effectiveness of conventional cancer treatments.
CBD also kills cancer cells by blocking their ability to produce energy. And it can stimulate the immune system to produce killer cells that cause death in cancer cells.
Researchers also found that CBD blocks a cannabinoid receptor called GPR55. This is important because GPR55 increased the growth rate of cancer cells in mice.
CBD oil can also help with nausea associated with many cancer treatments. And studies have shown CBD can significantly reduce cancer-related pain.
3. Dogs With Seizures And Epilepsy
It’s estimated that about 5% of dogs suffer from seizures. They can be terrifying for both dogs and their humans … and they can cause anxiety.
Most vets treat epilepsy and seizures with antiepileptic drugs. Common options are phenobarbital or potassium bromide. But these drugs are extremely harmful to your dog’s liver and other organs. And even if the drugs don’t cause unmanageable side effects, they don’t always work …
So researchers at Colorado State University got excited when they studied CBD as a treatment for epilspsy in dogs. A whopping 89% of dogs that received the CBD had a reduction in seizures.
In human trials, CBD even worked in patients with drug-resistant epilepsy. In one study, 7 out of 8 patients saw a marked improvement within 4 to 5 months.
CBD reduces the frequency and severity of seizures because of how it interacts with the endocannabinoid system. It’s believed that abnormal electric charges of the neurons in the nervous system cause seizures. But CBD can bind to receptors in the brain … researchers speculate this can improve the functioning of the nervous system.
4. Dogs With Anxiety
Anxiety is a common reason dog owners turn to CBD. Anxiety can appear in different forms, including:
- Noise phobia
- Separation anxiety
Of course, there are anti-anxiety drugs available … but CBD is being studied for anxiety because it doesn’t carry dangerous side effects.
Most human users of CBD take it for pain, anxiety and depression. Over a third of these users report that CBD worked “very well by itself.” CBD has even helped manage anxiety and insomnia in children with post-traumatic stress disorder (PTSD). And animal studies show its antidepressant effects aren’t just for people.
CBD can work quickly given directly by mouth when your dog gets stressed. It usually only takes 5 to 20 minutes to work. But CBD appears to be most beneficial for anxiety when given over a period of time. So if your dog is prone to stress, a daily dose might work best.
A 2012 study looked at stress in rats exposed to cats. The rats given repeated doses of CBD had less anxiety than those given a single dose.
Researchers aren’t certain how CBD relieves stress and anxiety, but it’s thought that it can help regulate serotonin. Serotonin is a hormone that regulates mood, social behavior, digestion, sleep and appetite.=
5. Dogs In Pain
Probably the most promising research on CBD is that done on pain. From nerve pain to arthritis, it works well … without the harmful side effects of pain medications.
CBD binds to both CB1 and CB2 receptors in the brain and nervous system and this helps change the way your dog’s brain perceives pain. Plus, CBD can help manage the other symptoms that accompany pain, such as sleeplessness and nausea.
CBD can also help manage acute pain from injuries.
6. Dogs With Allergies
Allergies are on the rise in dogs. And they’re difficult to treat … so, sadly, allergies are a common reason dogs are euthanized. Skin conditions in general are one of the most frequent reasons for vet visits.
The endocannabinoid system is also found in the skin … and that’s good news for dogs with allergies. It means CBD can help relieve dry and itchy skin. And it can promote the growth of new healthy skin cells.
You can give CBD internally for allergies, or use it externally for hot spots or interdigital cysts.
Now that you know a bit more about WHY you would give your dog CBD oil to your dog, let’s about HOW to choose a good quality product.
How To Choose The Best CBD Oil For Your Dog
CBD (Cannabidiol) is a naturally found substance in cannabis and hemp. Both deliver amazing health benefits … but there are differences.
Cannabis (marijuana) contains a relatively large amount of THC (tetrahydrocannabinol). THC is what causes the psychoactive activities of cannabis. It’s why marijuana can give a “high” or “buzz.”
CBD oil made from hemp contains much lower amounts of THC. To sell hemp legally, it must contain less than 0.3% THC. So while your dog can still enjoy the calmness and reduction in anxiety that CBD provides, he won’t get high. And that’s important … because you might enjoy the high, but your dog definitely doesn’t!
Your dog will also get the same pain-relieving and immune-supporting benefits from hemp CBD.
But not all hemp CBD products are the same …
1. Look For A Full Or Broad Spectrum Hemp
Check the label of your CBD product to make sure it’s full spectrum or broad spectrum.
This means your dog’s CBD oil contains not just CBD, but other important cannabinoids that occur naturally in full-spectrum hemp. This includes CBC (Cannabichromene) and CBG (Cannabigerol).
Researchers have looked at CBC for its …
- Cancer-fighting activities
- Ability to block pain and inflammation
- Positive effect on brain cells
CBG is also studied for its medicinal use. It can decrease inflammation in the digestive tract and it can protect nerve cells and the eyes. It also supports healthy bladder function and fights cancer cells.
A full-spectrum CBD oil will also contain terpenes such as limonene, alpha-pinene, and beta-pinene. These are also naturally occurring medicinal substances found in all hemp.
Together, cannabinoids and terpenes create the entourage effect. This happens when compounds in hemp oil work synergistically to boost the medicinal properties of hemp oil.
CBD extracted with CO2 (I’ll talk about this in a moment) pulverizes the terpenes. This will make them hard to detect in testing and they won’t show up on the Certificate Of Analysis …
… but they’ll still be there and will contribute to the CBD oil’s medicinal effects.
CBD extracted with solvents will better preserve the terpenes. So you will find them noted on the Certificate Of Analysis.
But I don’t recommend solvent extracted products, which leads me to my next point …
2. Make Sure Your Dog’s CBD Uses CO2 Extraction
There are two common ways to extract the CBD oil from the hemp plant:
As you’ve probably guessed, CO2 extraction uses carbon dioxide to extract oil from the plant. Using a high-pressure chamber, CO2 puts pressure on the hemp. This breaks down the hemp and releases the oil.
This method of extraction creates oils with a higher concentration of CBD. That means your dog will get more from his supplement. Of course, that also makes the product more expensive … but it’s better than the alternative.
The cheapest way to extract oil from the hemp plant is with solvents, such as …
- Petroleum products
But residue from these solvents will be in the product and they can be toxic to your dog.
Some CBD extraction uses natural solvents, such as ethanol or olive oil. This is much safer for your dog but these oils can destroy the hemp plant’s waxes and the resulting oil isn’t as beneficial.
3. Look For A Certificate Of Analysis
If your dog’s CBD oil doesn’t have a certificate of analysis (COA), run away!
A certificate of analysis is a document that shows the amount and type of cannabinoids in the CBD product. And it usually comes from a third-party laboratory,
COAs protect your dog from poor quality products and the manufacturer should have one for each batch of hemp. If there isn’t a COA on the company’s website, you’ll want to ask for one before you buy any CBD oil.
When looking at the COA, there are 5 important things to look for.
CBD Is The Same As Advertised
This is more common than you would think … in fact, we were once tricked by this!
What you might see is something like “500 mg CBD” on the product label. But don’t take the label at face value! Make sure the COA says the same amount as the label does.
Some lab tests express the CBD content in mg/g. So to calculate the amount of CBD, you need to know how many grams are in the bottle of CBD.
For example, let’s say the COA shows 16.9 mg/g CBD. To calculate how much CBD is in the product, multiply the number of mg/g by the number of grams the bottle weighs. (A typical 1-ounce dropper bottle of CBD will weigh 30 grams.) This will give you the total mg of CBD in the bottle. In this example, it’s 507 mg (16.9 mg/g x 30 gram bottle).
CBD Is Really Full Spectrum
Again, never take the label at face value! Some CBD is from isolate, which means it won’t have other important cannabinoids and terpenes.
Remember the entourage effect? You won’t get this extra boost with CBD isolate. So how do you find out if your dog’s CBD is from isolate? The COA will show that the product only contains CBD and no other cannabinoids. Stay away from these products.
There’s Not Too Much (Or Too Little) THC
If your dog’s CBD contains more than 0.03% THC, it’s probably marijuana and not hemp. It’s not legal and your dog won’t enjoy the psychoactive effects.
You also want to avoid products with zero THC. If there’s none, then your dog’s CBD is from isolate … and the health benefits will be fewer.
A Third-Party Did The Tests
Once again, never take the manufacturer’s word that the product is high quality. Make sure the product was properly tested by a third party lab. Unfortunately, the CBD industry isn’t regulated, which leaves you vulnerable to poor products.
There’s No Contaminants
You need to know where and how the hemp that’s used to make the CBD oil is grown. This plays a huge role in those test results you see in the COA.
Always look for an organic product to reduce any environmental toxin risks. You want to know that the soil and water it’s grown in is as clean as possible. That’s because hemp plants are really good sponges and can absorb contaminants as they grow. And it’s why heavy metal toxicity can be a concern when looking at CBD oils.
So be sure that you check the COA for any contaminants such as pesticides, heavy metals and solvent residues.
Cost Shouldn’t Be A Priority
It can be hard to compare products and some people give up and look at costs only …
… but this is not the best approach!
You want a high-quality and safe product for your dog. Extracting CBD from hemp requires a lot of plant material as well as careful monitoring.
If the product you’re considering has a price that’s significantly lower than the competition, there’s probably a reason for that …
But the most expensive doesn’t mean it’s the best CBD oil for dogs …
Instead, consider what we’ve reviewed …
- How was the CBD oil extracted? (CO2 is best.)
- Is the CBD concentration different than advertised? (CBD on COA should match the bottle.)
- Is it full-spectrum? (The product should have other cannabinoids, not just CBD.)
- Is the THC content worrisome? (THC should be less than 0.3% but higher than 0%.)
- Is it organic? (Hemp is a sponge for contaminants.)
- Was it third party tested? (If you can’t find a COA online, ask the manufacturer for one.)
These variables are what you need to look for when determining the quality of a product. The cost is never a sure sign of a product’s quality.
Side Effects Of CBD Oil For Dogs
The American Holistic Veterinary Medical Association surveyed dog owners. They wanted to see what, if any, side effects they noticed. And the great news is that there weren’t any major effects reported.
The most consistent side effects noticed were:
- Sedation 19%
- Overactive appetite 5%
- Lack of energy 4%
- Panic reactions 2.7%
- Dry mouth/excessive drinking 2.3%
- Nausea 1.7%
- Vomiting 1.7%
- Increased seizures 0.69%
- Impaired mental functioning 0.68%
This means the most likely side effect you may see is that your dog gets sleepy. And that isn’t a bad thing. Especially if your dog suffers from seizures, anxiety, or has any pain, and you’d like to give CBD oil a try …
… but some CBD oils will have other additives and may not be safe.
Caution With CBD Oil Additives
You want to be sure there are no chemical additives or preservatives in the product you buy. These will cancel out the health benefits, even if the hemp is grown organically.
Also be aware of companies who have added essential oils (EOs) to their CBD oil. Even though they’re “natural,” EOs can affect animals profoundly.
If your holistic vet has recommended using a CBD oil with an EO, then follow her dosing recommendations. She’ll know what’s best for your dog’s unique health needs.
Some will recommend using CBD with frankincense as it’s good for tumor reduction in cancer patients. But always check with your holistic vet or herbalist first.
Dogs Taking Other Medications Or Supplements
If your dog is taking any other medications or supplements you will want to check with your holistic vet as well. CBD oil has many health benefits but it can change how your dog metabolizes some medications or supplements.
Researchers have looked at how CBD oil changes metabolism in humans. It can be similar to grapefruit, which causes significant reactions. So if your dog is taking any of the following medications you’ll need to ask your vet about dose changes:
- Allergy medications
- Liver or kidney medications
- Heart medications
- Anxiety medications
Hopefully, your holistic vet has helped you find alternatives to the medications above. But even then … CBD can affect herbs and natural supplements.
This doesn’t mean you can’t give your CBD oil if he uses other supplements or medications. You may just need to make adjustments. CBD changes the metabolism of other things but sometimes for the better! Meaning you can use less of another product or skip on the medications altogether.
And less is often more.
CBD Oil Dosage For Dogs
Each bottle of CBD has a specific concentration expressed in milligrams (mg). Most dogs are okay with the taste, so you can just put it on your dog’s food.
Dr Robert Silver recommends giving your dog 0.05 to 0.25 mg/pound of body weight, twice daily. He also suggests starting with a lower dose and working your way up. If 0.05 mg/pound is enough, stay at that dose. There’s no need to increase unless the lower dose stops working. If that happens, increase the dose to 0.125 mg/pound, twice daily and only continue to increase if your dog needs it.
For anxiety or health prevention, you’ll usually find that the lower doses work well. But if your dog is dealing with pain or immune issues, you’ll probably need a larger amount.
DNM RECOMMENDS: Four Leaf Rover’s Full Spectrum CBD Oil is 100% USDA organic, with a wide range of healthy cannabinoids. Buy CBD oil for dogs now >>
CBD oil for dogs is a natural, safe remedy that can help your dogs with pain, anxiety, caner, seizures and more.
McAllister SD, Christian RT, Horowitz MP, Garcia A, Desprez PY. Cannabidiol as a novel inhibitor of Id-1 gene expression in aggressive breast cancer cells. Mol Cancer Ther. 2007 Nov;6(11):2921-7.
Corroon J, Phillips JA. A cross-sectional study of cannabidiol users. Cannabis and Cannabinoid Research. 2018;3(1).
Aviello G, Romano B, Borrelli F, Capasso R, Gallo L, Piscitelli F, Di Marzo V, Izzo AA. Chemopreventive effect of the non-psychotropic phytocannabinoid cannabidiol on experimental colon cancer. J Mol Med (Berl). 2012 Aug;90(8):925-34.
Getting real with CBD- a veterinary surgeon’s perspective
It was about the third week into Bastion’s recovery from his TPLO surgery, and he was already having a rough time. Bastion was a gregarious yellow Labrador who had injured his stifle about 25 days earlier. Fortunately, his family elected to have the stifle surgically reconstructed. Initially, he was recovering well from surgery, but one day in particular, he returned to the hospital because he’d had a brief setback. He was limping far more severely than would be normally expected at that stage of recovery.
Related: Get our guide to CBD
The osteotomy from his surgery had not yet completely healed, and he was still in the middle of his prescribed five weeks of strict exercise restriction. His family was trying their best, but Bastion wasn’t having it. He was too active at home, and his humans were growing frustrated. They’d received anti-anxiety medications but weren’t giving them. Instead, his family had decided to give him CBD oil at home. When I asked why, the client responded, “I found CBD oil at the local farmers’ market, and I figured it would work just as well.”
Like Bastion, an increasing number of pets are receiving cannabidiol (CBD) supplements. The popularity of CBD continues to rise, and many clients are incorporating it into the medication protocol for their pets, either as an adjunct or an alternative treatment option. Perhaps the initial interest in the benefits of CBD can be traced back to 1998, or possibly earlier, when scientists at the National Institutes of Health discovered that CBD could protect cells from oxidative stress.
These findings fueled interest in the human medical field and, in large part, that appeal has been transmuted into veterinary medicine. The regard for this molecule has risen to such levels that in many homes, CBD is being used as the sole treatment option for a variety of medical conditions. Veterinarians are becoming more fluent in the fascinating pharmacology regarding the use of this phytocannabinoid. A recent survey indicated that most veterinarians (61.5%) felt comfortable discussing the use of CBD with their colleagues, but only 45.5% felt comfortable discussing this topic with clients.1
Furthermore, veterinarians and clients in states with legalized recreational marijuana were more likely to talk about the use of CBD products to treat canine ailments than those in other states.2 Lastly, CBD was most frequently discussed as a potential treatment for pain management, anxiety, and seizures.1 At first glance, the use of CBD has tangential or limited relevance in the world of veterinary surgery. However, as one takes a closer look at the putative—and proven—benefits, it is clear that we are just scratching the surface of its therapeutic benefits.
Whether you perform surgery within a specialty discipline (oncology, orthopedics, neurology, soft tissue surgery, mixed animal, oral/dental, etc.), or surgery is only a small part of your general practice, every veterinarian endeavors to manage pain aggressively. The first choice for pain relief among many clinicians are the medications that have been more extensively studied, including but not limited to anti-inflammatories, gabapentinoids, opioids, local anesthetics, and other analgesics (acetaminophen, amantadine, Cerenia, etc.). These medications or a combination thereof have been prescribed to treat pain from orthopedic surgery, soft tissue surgery, intestinal surgery, and surgical neuropathic conditions, to name just a few. In the most basic schema, pain is divided into four categories: nociceptive pain (a response to damaged tissue), neuropathic pain (a response to directly-damaged sensory or spinal nerves), centralized pain (the result of pain signals being improperly amplified), and inflammatory pain.1
Cannabinoids may have a role to play in mediating all four of these types of pain states. When tissue is damaged, histamine, serotonin, TNF-alpha, IL-1-beta, IL-6 and Il -17 6 , and interleukin 17 are released.2 Cannabinoids bind to the CB1 receptors and attenuate the pain signal by slowing down the release of those neurotransmitters.3 This process can take place locally or in the central nervous system.3 Cannabinoids have also been shown to inhibit the release of GABA, a well-known neurotransmitter associated with pain.3 Although there is a paucity of clinical research on the use of CBD to treat postoperative pain in the veterinary medical setting, there has been heartening research conducted in humans. Indeed, the National Academies of Sciences, Engineering, and Medicine concluded that there is “substantial evidence that cannabis is an effective treatment for chronic pain in adults.”
Opioids have long been the go-to option or cornerstone of pain management, but the potential for the adverse events associated with the use of opioids in veterinary patients is universally accepted.38 I have seen how distressing it can be for a family to see their pet experiencing any of the unpleasurable side effects of opioids, including urine retention, delayed bowel movements, whining, panting, disorientation, or other manifestations of dysphoria. Those are just some of the challenges that clinicians face when using opioids for chronic pain management. Considering the ongoing consequences of the opioid epidemic, there is a search for pain management solutions that are innovative, prone to less adverse events, and are more effective. As the scientific community begins to evaluate the evidence for use of CBD, it is clear that more research is needed.
Anecdotal reports of CBD’s efficacy as a pain reliever are ubiquitous, but more practitioners are turning to scientific data for evidence of CBD’s efficacy. A study in 2020 evaluating effects of CBD hemp extract on opioid use and quality-of-life indicators in chronic pain patients found that over half of chronic pain patients (53%) reduced or eliminated their opioids within eight weeks after adding CBD-rich hemp extract to their regimens.5 Almost all CBD users (94%) reported quality-of-life improvements.5 A recent study evaluating orally consumed cannabinoids for long-lasting relief of allodynia in a mouse model found that cannabinoids reduced hyperalgesia, and a similar effect was not found with morphine.4 Mouse vocalizations were recorded throughout the experiment, and mice showed a large increase in ultrasonic, broadband clicks after sciatic nerve injury, which was reversed by THC, CBD, and morphine.4 The study demonstrated that cannabinoids provide long-term relief of chronic pain states.4 If research shows that use of cannabinoids in animals—specifically, CBD—can help to decrease the use of opioids for pain management, that would help make more animals comfortable and potentially help to fight the tragic epidemic of human prescription opioid abuse. Further research is needed in a variety of species, specifically, both the canine and feline species.
Both general veterinary practitioners and veterinary surgeons commonly diagnose and treat fractures. No large retrospective study of fracture incidence in dogs in North America has been published since 1994; however, the findings from that year’s study are still informative regarding the frequency of bone injuries. The study demonstrated that approximately 24% of all patients in the population studied over a 10-year period were affected by a disorder of the musculoskeletal system, with fractures contributing the largest proportion (over 29%) of all of the diagnoses of the appendicular skeletal system.7 Although that research is dated, the conclusions from this study, at the very least, indicate that fractures are commonplace in the clinical veterinary setting.7 Fracture repair has gradually become more straightforward due to improvements in technology. Because of these innovations, specialty surgeons and general practitioners who repair fractures have begun to see better surgical outcomes. So whether you primarily stabilize fractures with implants, or if external coaptation of fractures with the intention to refer (or perhaps as the primary means of fixation) is your treatment of choice, all veterinary practitioners aim to help fractured bones heal quickly. Despite these technological improvements, bone healing can be protracted or non-existent with some fractures. There are a variety of options at a veterinarian’s disposal to kick-start the healing process, but perhaps in the near future, CBD may be added to that armamentarium . The effect of CBD in fracture healing has been investigated evaluating bone callus formation in femur fractures in a rat model.8 The findings demonstrated enhanced biomechanical properties of healing fractures in those given CBD compared with a control group.8 This effect was not found in those given only Δ9-THC. Moreover, the bone-forming (osteogenic) effects of CBD were weakened when test subjects were given equal amounts of CBD and Δ9-THC.6 Another in vivo research study indicated that when CBD is incorporated into a surface that promotes bone growth (osteoconductive scaffold) it can stimulate stem cell migration and osteogenic differentiation.9 Further studies are needed to better evaluate the role of CBD in healing and bone metabolism of companion animals so that these findings can be applied in the clinical setting.
Additionally, cannabis has been shown to be a useful addition in treatment plans to improve bone health in laboratory studies. Studies have endeavored to better understand the role of CB2 receptors in maintaining bone health. CB2 receptors in bone cells have been linked to maintaining bone density and stimulating growth and may therefore have a part in reversing the effects of osteoporosis.10 One study evaluating the role of CB2 receptors found that mice whose genes had been altered to remove the CB1 or CB2 receptors developed signs of bone weakness that were far more pronounced than those in the control group.12 Another study in 2009 investigated the relationship between CB2 expression and bone disease in humans. It found that people with dysfunctional CB2 receptors have significantly weaker hand bones.11
Osteoarthritis (OA) affects many dogs, large and small. Most often, OA is the consequence of a developmental orthopedic disease that affects a single joint or a pair of joints and, less often, affects multiple joints. It is axiomatic that ‘Mother Nature likes symmetry,’ thus developmental orthopedic diseases frequently affect both left and right joints. For example, hip dysplasia is reportedly bilateral in >60% of affected dogs,13 and elbow dysplasia is bilateral in approximately 50% of affected dogs.14Osteoarthritis occurs secondary to a myriad of primary orthopedic conditions that affect a variety of joints including: the hip (most common causes of OA in the hip: hip dysplasia, Perthes disease); stifle (patellar luxation, cranial cruciate ligament disease, osteochondritis dissecans [OCD]); elbow (elbow dysplasia, elbow OCD, fragmentation of the medial coronoid process, incomplete ossification of the humeral condyle); shoulder (shoulder OCD, developmental shoulder subluxation); tarsus (OCD of the talus), and carpus (carpal laxity, carpal subluxation secondary to chondrodystrophy); and metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joint degenerative osteoarthritis (digital osteoarthritis).
Cannabinoids were found to treat pain secondary to inflammation in a variety of studies on humans. Some of the most compelling research has shown that cannabis can reduce the inflammation in the joint caused in human patients diagnosed with immune-mediated arthritis.15 One study found that cannabinoids could simultaneously reduce the secretion of cytokines involved in inflammation from one type of TH immune cells, which were being under-produced, while also increasing their numbers to correct their scarcity.15 Furthermore, in a study in 2003, researchers found that plant-based cannabinoids could suppress the expression of interleukin-1beta—one of the most prominent markers for inflammation in patients with rheumatoid arthritis—by as much as 50%.16 And finally, in 2006, transdermal applications of CBD were shown to decrease biomarkers that can contribute to neurogenic inflammation in a sample of arthritic rats.17
A report published in The Journal of PAIN and written by researchers at Baylor College of Medicine revealed the results of a large, double-blinded, placebo-controlled study on the positive effects CBD had in the fight against osteoarthritis.18 The study was designed with two main goals: The first portion of the research studied the effect CBD had on the inflammatory molecules and cells in mice.18 The second portion of the study investigated whether CBD improved the quality of life in dogs diagnosed with osteoarthritis. In lab tests and in mouse models, CBD significantly decreased the production of natural chemicals that promote inflammation, and it increased the natural chemicals that fight inflammation.18 Essentially, they saw a drop in proinflammatory cytokines and an increase in anti-inflammatory cytokines.18 For dogs with osteoarthritis, CBD significantly decreased pain and increased mobility in a dose-dependent fashion. Importantly, a lower dose of liposomal CBD was as effective as the highest dose of non-liposomal CBD, indicating that the effect of CBD was quicker and more powerful when CBD was delivered encapsulated in liposomes than without.18 Blood samples indicated no significant harmful side effects or adverse events over the 4-week analysis period.18 Although this study is very promising, and it supports the safety and therapeutic potential of hemp-derived CBD for relieving arthritic pain in dogs, it is important to consult with your pet’s veterinarian before giving any supplement or medication.
In the veterinary population, use of cannabidiol and other alternative treatments has the potential to obviate the need for other medications and thus spare patients from adverse effects associated with their use. More likely, the use of cannabinoids could be additive or synergistic in a multimodal treatment strategy and could increase quality-of-life issues associated with painful arthritic conditions.
Intervertebral Disk Disease
As our patients age, discs in their spines undergo degenerative changes. Thus, degeneration of intervertebral discs is inevitable. This process of degeneration is multifactorial, and it involves hypoxia, inflammation, neoinnervation, accelerated catabolism, and reduction in water and glycosaminoglycan content.39 The magnitude and severity of disc degeneration can vary widely between patients. The most common locations of clinically relevant disc disease are the cervical spine, thoracolumbar spine, and lumbosacral spine.40 Although there are various manifestations of disc disease, broad classifications of Hansen Type I and Type II are typically used to describe the condition. In short, disc material may either extrude (acute herniations) or protrude (chronic herniations), both of which compress the spinal cord, which can ultimately cause pain, paresis, paralysis, and other neurological deficits.40 The prevalence of thoracolumbar disc disease in dogs has been estimated at 3.5%.40 Depending on the neurologic examination, diagnosis, severity, prognosis, and other factors, surgery may be recommended to decompress the spinal cord. After surgical decompression, there is a host of challenges that the patient, the family, and the surgeon may have to work through, including a potentially protracted recovery, recurrence of neurological signs, post-surgical pain, spinal instability, urinary disorders, (cystitis, urinary tract infection, urinary retention, micturition disorders), ascending myelomalacia, and others.41 Could CBD play a part in helping to improve those affected by disc disease pre-, intra-, or post-operatively, and what types of spinal disorders could benefit from CBD? A study conducted on the use of CBD in mice with degenerative disc disease showed promise in mitigating the effect of disc damage and wear.19 Instead of being ingested orally, CBD was injected at the site of the disc. Researchers investigated the effects of cannabidiol intradiscal injection using a combination of MRI and histological analyses.19 A puncture was created in the disc, and then CBD was injected into the disc (30, 60 or 120 nmol) shortly after.19 The effects of intradiscal injection of cannabidiol were analyzed within 2 days by MRI.17 Fifteen days later, the group that received cannabidiol 120 nmol was resubmitted to MRI examination and then to histological analyses after the cannabidiol injection.19 They found that cannabidiol significantly decreased the effects of disc injury induced by the needle puncture.19 These results suggest that this compound could be useful in the treatment of intervertebral disc degeneration, perhaps using a novel route of administration. Unfortunately, the exact mechanism for how CBD oil helped alleviate disc damage is still being investigated. The hope is that the neuroprotective properties of cannabidiol can also be found in the study of canine and feline disc disease to ultimately improve functional recovery.
Fortunately, more effort, research, and attention is being paid to treating pain in veterinary medicine.Nociceptive pain is caused by external pressure, cold, heat, or internal trauma, stimulated by the release of compounds like bradykinin, prostaglandins, or leukotrienes.20 Humans may describe this pain as a sharp, aching, or throbbing sensation. In veterinary patients, nociceptive pain may be manifested by limping, sharp movements, lip smacking, panting, vocalization, or, in select cases, no obvious response. The function of nociceptive pain in humans, and presumably in pets, is to alert them that they are injured and hopefully prevent further injury.20
Neuropathic pain, caused by direct damage to sensory or spinal nerves, allows aberrant pain signals to be sent to the brain.21 In veterinary patients, a common example of neuropathic pain that I diagnose commonly is sciatic or radial nerve hyperpathia, but lumbar or cervical foraminal radiculopathies can also be relatively frequent causes of neuropathic pain. Neuropathic pain syndromes are often secondary to intervertebral disc disease, static and dynamic nerve foramen impingement, vertebral instability, recent surgery, trauma, abnormal conformation, abnormal gait, and chronic joint pain.21 A classic example of neuropathic pain in humans is diabetic neuropathy.
Unfortunately, there are some challenges to diagnosing and understanding neuropathic pain in the veterinary setting, particularly in the presence of an otherwise normal orthopedic exam. To be sure, neuropathic pain can be evoked by low- or high-intensity stimuli; it can be spontaneous and not stimulus-dependent; it is maladaptive (maintained in the absence of tissue trauma), and it responds poorly to opiates and anti-inflammatory drugs.21
CBD use has shown promise in the treatment of neuropathic pain. In a 2010 study, researchers looked at a sample of diabetic rats and administered daily doses of Cannabis sativa ranging from 25 to 100 mg/kg [AC6] of body weight.22 After fourteen days, the rats exhibited significant reductions in tingling, heat, and pain in the extremities associated with advanced diabetes.22 Another study, from 2015, compared descriptions of spontaneous pain among sixteen patients with painful diabetic peripheral neuropathy in a randomized, double-blinded setting.23 The study subjects were administered four single-dosing sessions of placebo or cannabis. Significant reduction in pain intensity varied directly with the size of their dose.23
As we begin to understand neuropathic pain in animals more clearly, treatment strategies and pharmaceutical alternatives will more adequately address their pain, possibly including the use of CBD or CBD alternatives. Additional research will hopefully actualize the promise and potential that CBD may have in treating the veterinary population in neuropathic pain.
Exercise restriction is a critical component for successful surgical outcomes in many elective orthopedic surgeries. For example, post dynamic stifle stabilization surgery, I frequently recommend a minimum of five to eight weeks of strict monitoring and exercise restriction. This recommendation can be extremely challenging for families, because many of the animals are inclined to be active, are frequently powerful and athletic, and are young and unaccustomed to confinement. Implant failure or a poor surgical outcome overall can many times be ascribed to the challenges related to activity restriction. Difficulties with this process may lead to protracted recovery or even surgical treatment failure, necessitating a second surgical procedure.
Common pharmaceutical strategies employed to help with exercise restriction include the use of Trazodone and Acepromazine.24However, both of these medications can have variable effects depending on the individual, and in some cases, there are undesirable adverse effects (e.g. excessive sedation and paradoxical excitation with Acepromazine, serotonin syndrome with Trazodone, etc.).24
Could CBD or CBD derivatives enhance calmness and alleviate anxiety in animals? Based on CBD’s proposed mechanism of action in mitigating anxiety, the answer may be encouraging. Higher levels of natural endocannabinoids in the human body are associated with an antidepressant effect.25 Cannabinoid receptors are found throughout the central nervous system and play a key part in maintaining our sense of well-being. They are particularly numerous in cells tasked with manufacturing serotonin where it is needed.25
Cannabidiol may also have an effect on the hippocampus, which is a region of the brain responsible for memory and mood. Glucocorticoids are secreted during stress, which may cause the hippocampus to atrophy.26 That shrinking process plays a role in diminished memory and depressed mood.26 Cannabinoids have shown an ability to counter this process through the phenomenon of hippocampal neurogenesis (regrowth and development in nerve tissue), which can be activated by the expression of cannabinoid type-1 receptors.26 Both natural endocannabinoids and plant-based cannabinoids have both been shown to accelerate this process.26
In another random-controlled trial performed on humans, subjects receiving a 600 mg CBD supplement also reported less subjective anxiety symptoms during public speaking than those who’d taken a placebo.27 CBD also shows activity specific to the limbic system in the brain. A study evaluating that effect on the limbic system found that CBD administration helped to reduce symptoms in people with social anxiety disorder.28 Indeed, the National Academies of Sciences, Engineering, and Medicine specifically referenced CBD’s effects in a statement about anxiety disorders, “…there is evidence that cannabidiol is an effective treatment for the improvement of anxiety symptoms, as assessed by a public speaking test in individuals with social anxiety disorders.”30
A 2019 study in mice simulated to have an anxiety disorder, (Fragile X Syndrome—a neurodevelopmental disorder that affects intellectual, social, and physical development due to a mutation of the FMR1 gene) were shown to have fewer anxiety-related behaviors across tests when given CBD.31 Furthermore, CBD decreased the anxiety response of all mice tested while not affecting their cognitive performance.31
The potential for CBD to be efficacious in treating anxiety in other species will be important to study, but its use as an anxiolytic and sedative is growing in popularity despite the paucity of research specific to this indication. As previously mentioned, anxiety was one of the most common reasons for veterinarians to discuss CBD.1 The most commonly used CBD formulations were oil/extract and edibles1 for the putative benefits of relieving anxiety, among others.1 As CBD research continues to gain steam, more attention will hopefully be directed towards how the full ensemble of cannabinoids, terpenes, and flavonoids seem to complement each other, working through multiple receptors at once, and often enhancing each other’s signals to the body (entourage effect).
When it comes to wounds, all medical professionals are generally united in a common purpose: we want wounds to heal faster. Indeed, products that promote or accelerate wound healing have been of interest to veterinarians and physicians since the advent of wound treatment. Wound healing products and topical agents may target different phases of wound healing, including debridement, wound contraction, epithelialization, and granulation. Many products promote the formation of granulation tissue, while others are more effective after granulation tissue has formed (e.g. hyaluronic acid). For this reason, adapting the topical dressing specific to the stage and progress of wound healing is of utmost importance.
CBD has shown efficacy in the maturation phase of wound healing and some inflammatory skin conditions.33 In a 2019 study of 20 patients with two most frequent skin disorders—psoriasis (5 patients), atopic dermatitis (5), and resulting outcome scars (10)—the subjects were instructed to administer topical CBD-enriched ointment to lesioned skin areas twice daily for three months.33The results showed that topical treatment with CBD-enriched ointment significantly improved the skin parameters and the symptoms associated with the skin condition.33 This study concluded that the topical administration of CBD ointment, without any THC, is a safe, effective, and non-invasive alternative for improving the quality of life in patients with some skin disorders, especially inflammatory ones.33 Another study in 2019 investigated the potential effect of a Cannabis sativa L. ethanolic extract standardized in cannabidiol as anti-inflammatory agent in the skin.34 The study found that the extract inhibited the release of mediators of inflammation involved in wound healing and inflammatory processes occurring in the skin.34 The down-regulation of genes involved in wound healing and skin inflammation was at least in part due to the presence of cannabidiol.34 The findings provided new insights into the potential effect of Cannabis extracts against inflammation-based skin diseases.
Bacterial infiltration can negatively influence wound healing. Another area in which topical cannabis treatments show a great deal of potential is in the treatment of bacteria-related skin disorders. One study from 1976 indicated that isolates of THC and CBD were effective in reducing samples of staphylococci and streptococci, two bacteria associated with acne.35 Another study from 2008 found that the plant-based CBD, CBC, CBG, THC, and CBN were substantially potent against a variety of Staphylococcus aureus strains, which were resistant to the antibiotic methicillin (MRSA).36
However, a recent study perhaps underscores the importance of adjusting topical therapy according to the stage of healing. In 2020, the Australian Veterinary Journal reported a study on horses with wounds that were created in a laboratory setting and then deliberately contaminated. Each wound was assigned to a treatment group that contained 1% cannabidiol in three different manuka honey formulations.37 Treatments were applied topically daily for a total of 42 days. The results indicated that irrespective of the treatment, wounds did not retract as expected in the first seven days after wound creation.37 There was no difference in wound area, daily healing rate, or days to complete healing between treatment groups.37 This study highlights the importance for continued study on the correct time, concentration, and best practices when using CBD to accelerate wound healing.
Though the overall potential for cannabidiol to address specific surgical conditions is encouraging, strong double-blinded, placebo-controlled studies with large sample sizes are lacking. Based on the research that’s available in animal models and among human patients, there are large pockets of convincing research that inspire hope and promise in the use of CBD in veterinary surgery and veterinary medicine writ large. To be sure, the concept of scientific integrative medicine should be considered along with other first-line treatments for veterinary patients. Evidence-based solutions should be prioritized when treating disease, but innovative or novel treatments may have to be considered in patients with neuropathic pain, disc disease, anxiety, or debilitating arthritis. New discoveries in the world of cannabis-based medicine may be just what the doctor ordered for an effervescent Labrador like Bastion.
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Abraham, A.D., Leung, E.J., Brenden, A., Wong, B.A., Rivera, Z.M., Kruse, L.C., et al. (2020) Orally consumed cannabinoids provide long-lasting relief of allodynia in a mouse model of chronic neuropathic pain. 45(7):1105-1114. DOI: 10.1038/s41386-019-0585-3. Epub 2019 Dec 7.
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