Dogs, cats, and other pets who develop lung diseases such as pneumonia, asthma, kennel cough, bronchitis, and so on can benefit from a nebulizer delivering saline, albuterol, antibiotics, or other drugs. A nebulizer is a machine that aerosolizes medicine into a fine mist; it’s like spraying medicine. A face mask is held over the pet’s muzzle (most pets can learn to accept the face mask) so that medication is inhaled deep into the respiratory tract.
 
The esophagus lies above the trachea and is protected by the epiglottis. Pneumonia may result from infections caused by kennel cough, viruses and bacteria. Pets with megaesophagus are prone to developing aspiration pneumonia because they tend to regurgitate food and fluids into the back of the throat and then aspirate the material into the lungs.

A nebulizer can be purchased from human medical supply stores, online, or from eBay. There are several good nebulizer brands, such as Pulmo-Aide, Omron, Devilbiss, etc. Make sure that you obtain the compressor (the machine), tubing, and the medication cup. The tubing, T-piece (a t-shaped tube that attaches the machine to the pet and to an exit) and medicine cup are called a nebulizer kit.

A vaporizer is not the same as a nebulizer. A vaporizer is typically used for sinus or upper respiratory issues rather than lung issues. Vaporized droplets are too big to get as deeply into the lungs the way nebulized particles

You can purchase an appropriately sized mask from a veterinarian, or make one yourself.

Using a Nebulizer

1. b. Put a little canned dog/cat food, baby food, cream cheese or peanut butter inside of the mask and allow the pet to lick it. This can also distract a pet while the treatment is proceeding.
2. After 5 to 10 minutes, you’ll see and hear that the medicine is running out.
3. Shake the cup downward a few times to make sure all the medicine has come through.
4. Take apart the plastic parts of the nebulizer and wash all the parts.

Cleaning the Nebulizer

Bacteria and viruses can live and reproduce in a nebulizer that is not routinely cleaned.

After each use, swish each piece in warm running water. At the end of the day, after you use it the last time, scrub each piece with warm soapy water. Rinse each piece under warm running water. Let each piece air-dry on a clean dish towel or paper towel. When the pieces are completely dry, put the nebulizer back together. If not using for a period of time, store it in a clean, dry bag.

Twice each week, or after the treatment is completed, mix a half cup of white vinegar with 1.5 cups of tap water. Soak each piece in this mixture for one hour. Rinse each piece under warm running water. Let each piece air-dry on a clean dish towel or a paper towel. When the pieces are completely dry, reassemble the nebulizer.

What do I do if I have Cleaned my Nebulizer and the Tubing is still Wet?

The easy way to dry the tubing is to attach it to the compressor. Then switch on the machine, and let it run for a minute or two. The blowing air will dry out the tubing. Use a paper towel or clean hand towel to dry the other parts.

What Medications can be Given with a Nebulizer?

A variety of drugs can be given using a nebulizer: bronchodilators like albuterol (open up the bronchioles allowing debris to more easily be removed from the lungs), steroids, water-soluble antibiotics, saline, N-acetylcysteine, etc. Albuterol opens up the bronchioles, making it easier to breath and allowing antibiotics to get deeper within the lungs. As albuterol can increase the heart rate, it should be used with caution in dogs with heart disease. Do not exceed three treatments per day unless advised by your veterinarian. The dose of albuterol may need to be adjusted based on the size of the dog. Following the albuterol, use the nebulizer with 2–3 cc of sterile saline. Some pets have side effects from albuterol although that is rare. Sometimes side effects are seen, such as nervousness, a rapid heart rate or excessive panting, and they will disappear within an hour or so. If this happens, report it to your veterinarian for a possible adjustment of dosage or change in frequency of treatments.

If your veterinarian has not previously written a prescription for albuterol, for which there is no veterinary version, here is an example of how to write it.

Albuterol 0.083% 2.5 cc vials × 25
sig: using a nebulizer, administer q8–24hr as directed

Albuterol comes in a box of 25 vials, each containing 2.5 cc.

1. Your veterinarian will prescribe the dose of albuterol for your pet.
2. Nebulize the computed dose of albuterol; if it is 1 cc or less, mix it with 1 cc of saline solution.
3. Nebulize an additional 2–3 cc. of saline after the albuterol treatment is completed.

Warning: Albuterol should not be administered to pets by people who have heart or lung disorders. Ask your physician if it is safe for you to be exposed to the albuterol mist given off during nebulization.  

Saline decreases the thickness of mucus and helps moisturize the bronchioles, which helps the pet cough up debris blocking the lungs. Saline solution can be obtained from your veterinarian, or nebulizer saline can be obtained online.

Do not use saline solution intended for contact lenses.

Antibiotics such as gentocin or amikacin, which are intravenous antibiotics, can be mixed with saline. These drugs can be hard on the kidneys, so ideally it is best to monitor kidney function with blood and urine tests. These antibiotics are more kidney friendly when given with a nebulizer than when given intravenously.

Preventing Aspiration Pneumonia

Nebulizer treatments with either saline and/or albuterol can help prevent recurrence of aspiration pneumonia in pets with megaesophagus, pneumonia or bronchitis, and may be helpful in managing laryngeal paralysis by helping to clear aspirated debris from the lungs. Ask your veterinarian if your pet should have a preventive treatment daily, every other day or twice weekly.

Being carnivores, domestic, feral, and wild cats that hunt for food get adequate amounts of taurine from their diet.  However, some commercial cat foods at that time contained insufficient amounts of taurine causing dilated cardiomyopathy and other health issues.  This discovery resulted in pet food companies adding more taurine to their manufactured foods. Subsequently, taurine-associated dilated cardiomyopathy in cats has all but disappeared.  It is occasionally diagnosed when cat owners feed unbalanced diets (e.g., boiled poultry or vegetarian diets).

A few years later, certain breeds of dogs were found to also have dilated cardiomyopathy in association with taurine deficiency.  This was unexpected because dogs, unlike cats, can synthesize taurine from other sulfur-containing amino acids in their food.  Investigators suspected that these breeds were unable to synthesize taurine in amounts needed to replace losses. Taurine is typically efficiently recycled in the small intestine, but various dietary factors can affect this process. When supplemented with high doses of taurine, these dogs resolved their cardiomyopathy in many cases.

Since that time, specific categories of diets have been sporadically linked to heart disease.  One group of Newfoundlands that were fed a commercial lamb-and-rice diet developed taurine deficiency and reversible cardiomyopathy.  Other dogs have also been found to have a taurine deficiency when fed similar lamb-and-rice diets.  Occasionally, dogs fed vegan or vegetarian diets have been taurine deficient and suffer heart disease.

Most recently, Golden Retrievers have been identified as having a taurine-deficiency associated cardiomyopathy. 

Is diet-associated cardiomyopathy caused by taurine deficiency?

The evidence suggests that the recent “outbreak” of cardiomyopathy in dogs is likely not primarily related to taurine deficiency.  Blood assays of taurine in many affected dogs show normal taurine concentrations.  The observations suggesting this condition is related to taurine deficiency originate from populations where several of the affected dogs were Golden Retrievers (who are a special case, as described above).  It is hypothesized by some that being taurine deficient makes these dogs more susceptible to whatever is causing the diet-associated cardiomyopathy. Because of concerns from some veterinary researchers about the methods used to assess taurine status in the studied populations with few or no Golden Retrievers, we cannot completely rule out the role of taurine deficiency at this time in all breeds. Time will tell.

If it’s not taurine, what is the cause?

We don’t know.  The only common link that investigators have observed is “grain-free” diets that use lentils and other legumes (peas) as the “base ingredient.” There are many theories, but no definitive answers explaining how these diets cause cardiomyopathy. There is also a lack of reporting and consistent data collection on diet-related heart issues in pets. Cardiomyopathy is most likely caused by a combination of genetics, other medical conditions, and diet.

Are all “limited ingredient” or “grain free” diets at fault?

Some dogs are prescribed diets to diagnose and treat allergies (skin or gastrointestinal diseases).  Such diets might include a limited number of uncommon ingredients, such as salmon, kangaroo, potatoes, peas, etc.  At this point, no therapeutic diets, manufactured by the major pet food manufacturers (Hills, Purina, Royal Canin), have been associated with cases of diet-associated cardiomyopathy.

There is no medical or nutritional indication for “grain free” although some veterinary therapeutic diets recommended to diagnose and treat allergies are also grain free. They are chosen because the ingredients happen to be novel for the specific patient, but they are not used because they lack grains per se. Grain free is simply a marketing category and there is no specific benefit. 

In recent years, canine diets containing pulses, which are the dried seeds of foods like chickpeas, lentils, beans, and dry peas, have been linked to diet-associated cardiomyopathy versus just the presence or absence of grains (corn, rice, and wheat).

What should I do if my dog eats a grain-free legume-based or other implicated diet?

First, check the ingredient label.  If peas or lentils are the main ingredient (or main carbohydrate source), consider changing to a diet that contains grains.

Second, if you are reluctant to change the diet, consult your veterinarian about having a cardiac ultrasound (echocardiogram) to see if your dog has evidence of cardiomyopathy.  If your dog is found to be affected, even if it’s showing no clinical signs, change the diet to a grain-based commercial diet. Most nutritionists recommend using the WSAVA guidelines for the selection of commercial diets.  

Third, if you have a dog that is “at risk” for taurine deficiency (American Cocker Spaniel, Golden Retriever, Newfoundland, Dalmatian) and eating an implicated diet, have the blood taurine levels checked. Measure both whole blood and plasma collected at the same time to enable the most accurate interpretation of your dog’s taurine status. If those are low, determine if the dog has cardiomyopathy with a cardiac ultrasound, change the diet, and supplement taurine as directed by your veterinarian.

The more data collected, the more likely researchers will be able to resolve whether taurine deficiency plays a primary or secondary role in causing this diet-associated cardiomyopathy.

Your veterinarian or veterinary cardiologist is the one best able to advise you about the most appropriate course of action for your dog.

What about cats?

A few cat cases have been reported to the FDA, but the numbers are too small to say anything definitive. This appears to be primarily a dog problem. 

(Dogs and cats have a sense of smell at least 1,000 times more accurate than ours and this is their primary means of perceiving the world.)

Anatomy First

The fibers making up the lens come together in the center of the lens, forming a “Y” shape that is sometimes visible when one looks into the eye. These Y-shaped lines are often called the sutures of the lens.

The lens is enclosed in a capsule that, if disrupted, allows the immune system to see the lens proteins for the first time, recognize them as foreign, and attack. The resulting inflammation (a form of uveitis) is painful and can be damaging to the eye. A cataract can result from this inflammation or from any of the numerous other reasons listed below.

A cataract is an opacity in the lens.

A Note on Diabetes Mellitus in Dogs

Cataracts can be congenital (born with it), age-related; of genetic origin (the most common cause); caused by trauma; dietary deficiency (some kitten milk replacement formulas have been implicated); electric shock; or toxins. The patient with a cataract is not able to see through the opacity. If the entire lens is involved, the eye will be blind.

Many things can cause the lens to develop a cataract. One cause is diabetes mellitus. In this condition, the blood sugar soars as does the sugar level of the eye fluids. The fluid of the eye’s anterior chamber is the fluid that normally nurtures the lens but there is only so much glucose that the lens is able to consume. The excess sugar is absorbed by the lens and transformed into sorbitol. Sorbitol within the lens unfortunately draws water into the lens, causing an irreversible cataract in each eye. Cataracts are virtually unavoidable in diabetic dogs no matter how good the insulin regulation is; diabetic cats have alternative sugar metabolism in the eye and do not get cataracts from diabetes.

What Else Could It Be?

Many owners cannot tell which portion of the eye looks cloudy. Cloudiness on the cornea, as caused by other eye diseases, can be mistaken for a cataract by an inexperienced owner. Also, in dogs, the lens will become cloudy with age as more and more fibers are laid down, as described above. Nuclear sclerosis, as described, can mimic the appearance of a cataract, yet the eye with this condition can see and is not diseased. It is a good idea to have your veterinarian examine your pet if you think there is a cataract, as you could be mistaken.

Why is it Bad to Have a Cataract?

The area of the lens involved by the cataract amounts to a spot that the patient cannot see through. If the cataract involves too much of the lens, the animal may be blind in that eye and there could be cataracts in both eyes, which means the pet could be rendered completely blind.

A cataract can luxate, which means that it can slip from the tissue strands that hold it in place. The cataractous lens can thus end up floating around in the eye, where it can cause damage. If it settles to block the eye’s natural fluid drainage, glaucoma (a buildup in eye pressure) can result, leading to pain and permanent blindness. A cataract can also cause glaucoma when it absorbs fluid and swells so as to partially obstruct fluid drainage.

Cataracts can begin to dissolve after they have been there long enough. While this sounds like it could be a good thing, in fact, it is a highly inflammatory process. The deep inflammation in the eye creates a condition called uveitis, which is in itself painful and can lead to glaucoma. If there is any sign of this type of inflammation in the eye, it must be controlled before any cataract surgery.

A small cataract that does not restrict vision is probably not significant. A more complete cataract may warrant treatment. Cataracts have different behavior depending on their origin. If a cataract is a type that can be expected to progress rapidly (such as the hereditary cataracts of young cocker spaniels) it may be beneficial to pursue treatment (i.e. surgical removal) when the cataract is smaller and softer, as surgery will be easier.

What Treatment is Available?

Determining if a Dog is a Candidate for Cataract Removal

Obviously, the patient must be in good general health to undergo surgery; diabetic dogs must be well-regulated before cataract surgery. Also, it should be obvious that for a patient to be a good candidate for surgery, the patient must have a temperament conducive to getting eye drops at home. 

Pre-anesthetic lab work can be done with the patient’s regular veterinarian. Some ophthalmologists prefer that patients have their teeth cleaned before surgery to minimize infection sources in the eye.

A complete examination of the eye should be performed. If your veterinarian is not comfortable treating cataracts or does not have the appropriate equipment, your pet may be referred to a veterinary ophthalmologist.

It is impossible to see the retina through a cataract; an electroretinogram test can determine if the eye has a functional retina and can benefit from cataract surgery. Ultrasound of the eye can be used to look for retinal detachments. If the eye has a blinded retina, there is no point in subjecting the patient to surgery. Inflammation in the eye will require treatment before surgery. Sometimes, other eye drops are prescribed for a period before surgery depending on the veterinarian’s preference.

Cataract Removal: Phacoemulsification and Surgical Removal

In either case, the eye must be paralyzed during surgery to prevent eye movement or even blinking at a critical moment. Nerve blocks can be used to paralyze the eye, or specific medications can be used to paralyze the entire patient (in which case a mechanical ventilator is used to breathe for the patient during surgery).  After the lens is removed, an artificial lens is implanted. (Without the prosthesis, the dog’s vision will be approximately 20/800, and objects will appear to be reversed, as in a mirror.)

After surgery, the pet must wear an Elizabethan collar for a good three weeks, and eye drops to reduce inflammation will be needed for several months. A harness may be recommended for walks instead of a collar to reduce pressure on the head and eye from pulling. There will be a schedule of recheck appointments.

Complications

Some degree of uveitis (deep inflammation) is unavoidable. This can cause a pupil constriction reaction that can increase the risk of scarring within the eye. Eye drops to keep the pupil dilated are usually effective in preventing this but not always. Inflammation in the eye will resolve over weeks to months after surgery. The success rate is higher for cataract surgery if there is minimal inflammation in the eye prior to surgery, thus pre-operative anti-inflammatory eye drops are frequently prescribed.

Another complication involves the development of opacities on the remaining lens capsule. In humans, laser surgery is used to remove the lens capsule, but in dogs, the capsule is too thick for this. Some ophthalmologists prefer to remove the capsule as a preventive measure. The portion of the capsule that is involved in this reaction is present in young dogs but not in adult dogs.

Bleeding after surgery can be an enormous complication and can easily be caused by excess barking or activity after surgery. Small bleeds are of little consequence, but a large bleed could ruin vision.

Glaucoma can develop at any time after cataract surgery. This complication is not only blinding but painful as well. The risk of this complication has been decreased by placing a prosthetic lens (a formerly uncommon but now fairly standard procedure) but dogs who start off with hypermature (dissolving) cataracts or have an unusually long surgery time tend to have an increased risk for this complication.

Overall, a 95 percent vision rate is described immediately after cataract surgery with 80 percent having long-term vision success.

Before embarking on the adventure of cataract surgery, be sure to obtain a clear explanation from your veterinarian or ophthalmologist of exactly what the home care will involve.

What if the Cataract Goes Untreated?

A cataract by itself does not necessarily require treatment. If there is no associated inflammation or glaucoma and the only problem is blindness, it is perfectly reasonable to have a blind pet. Blind animals have good life quality and do well though it is important not to move furniture around or leave any hazardous clutter in the home. Some dogs, however, become anxious or even aggressive when they lose their vision. Restoring vision for the pet is weighed against risk and expense and is a decision for each owner to make individually. Many cataracts will progress to a hypermature state where they will begin to dissolve as described and anti-inflammatory eye drops are needed as mentioned. 

Can Eye Drops Dissolve Cataracts?

Products containing N-acetylcarnosine have been marketed to dissolve cataracts and have led to a great deal of false hope. N-acetylcarnosine is an antioxidant eye drop that may have beneficial effects on the eye but they do not include any sort of dissolution of a mature cataract. For smaller cataracts, it may be possible to dilate the pupil so that the pet can see around the cataract but there is some controversy about doing so as these medications have other effects on the eye.

The iris, which is the colored part of the eye, surrounds the pupil and regulates how much light passes through it. Behind the iris and pupil is the lens, a transparent structure that also focuses light onto the retina. The retina converts the light into nerve impulses, which travel to the brain through the optic nerve. The brain interprets these impulses into an image. Abnormalities in these and other structures of the eye may lead to blindness.

Some of the more common causes of blindness in dogs and cats include the following.

• Uveitis: Uveitis is a painful condition in which the uvea becomes inflamed. The uvea is a blood vessel-rich tissue consisting of the iris, the ciliary body (which produces fluid inside the eye) and the choroid (which nourishes the retina). Causes of uveitis include infections such as feline infectious peritonitis (FIP) and tick-borne ehrlichiosis, tumors, immune-mediated conditions, eye trauma, toxins and eye irritants.
• Cataracts: A cataract is a cloudiness in the lens. The lens is supposed to be transparent to allow light to pass through, but cataracts impair this function. Cataracts may affect only a small part of the lens initially, but progress to affect more of the lens over time. The most common cause of cataracts in cats is uveitis, while genetics and diabetes are the two most common causes in dogs. Other causes include eye trauma, toxins, nutritional deficiencies, radiation, electric shock and age-related degeneration.
  
• Glaucoma: Glaucoma is increased pressure in the eye. In a healthy eye, the volume of fluid that goes in and out of the eye is balanced to maintain a normal eye pressure. In glaucoma, a problem draining that fluid causes the eye pressure to rise, a condition that can quickly and painfully cause loss of sight. Primary glaucoma results from genetics while secondary glaucoma results from conditions such as uveitis, eye tumors and anterior lens luxation (see section on lens luxation). 
• Retinal detachment: The retina is a 10-layered structure that converts light signals into nerve impulses that are sent to the brain for interpretation into an image. When specific layers of the retina separate or detach from one another, the retina can no longer carry out this function properly, resulting in impaired vision. Causes of retinal detachment include genetics, trauma, tumors, infections, immune-mediated conditions, uveitis, eye surgery and high blood pressure. 

• Progressive retinal atrophy (PRA): PRA is an inherited disease that occurs in dogs and more rarely in cats. In pets with PRA, the retina degenerates over time, leading to blindness. In most cases, the pet is initially blind only in low-light conditions, but will eventually become blind in all conditions. Cataracts may also accompany PRA in some dogs.
  
• Sudden acquired retinal degeneration syndrome (SARDS): This syndrome is a disease in dogs in which the retina rapidly and irreversibly deteriorates, leading to blindness within days to months. The cause of SARDS is unknown.
  
• Optic neuritis: Optic neuritis is inflammation of the optic nerve, which carries impulses from the eye to the brain to be interpreted as images. Dogs and cats affected by this condition generally end up with partial or complete blindness. Causes of optic neuritis include such infections as distemper in dogs and cryptococcosis, a systemic fungal infection, in cats. Inflammation, immune-mediated conditions, toxins such as rodenticides, eye trauma and tumors are other potential causes.
  
• Lens luxation: The lens is normally held in position by fine ligaments. If these ligaments fail, then the lens shifts – or luxates – from its normal position. A forward shift can block circulation of the eye’s fluid and quickly lead to painful glaucoma. A backward shift is not as immediately harmful, but secondary glaucoma and retinal detachment can occur. Terrier breeds are predisposed to primary, inherited luxations. Lens luxation may also occur due to cataracts, glaucoma, trauma, tumors, and uveitis.
  
• Corneal diseases such as keratoconjunctivitis sicca, pigmentary keratitis, and pannus will completely scar the cornea if untreated.

If you notice any signs of blindness or changes in your pet’s eyes, take your pet to the veterinarian. Oftentimes, older dogs and cats develop an age-related cloudiness in their eyes that is usually harmless to vision. However, it can look similar to a cataract, so it is still worth getting checked by a veterinarian to make certain it’s harmless.

What is Cannabidiol?

Cannabidiol, or CBD, is another commonly recognized cannabinoid produced by Cannabis sativa. However, unlike THC, CBD is not psychoactive. The United States Congress recently passed a law allowing industrial hemp to be grown. Hemp is a strain of Cannabis sativa that still has CBD but has very little THC. Cannabidiol derived from hemp is not a controlled substance.

Cannabis is a Schedule I substance in the US, which means it has a high chance of abuse (due to the THC, which is the psychoactive substance in marijuana) and has no currently accepted medical use. Nevertheless, research is showing that THC may help many diseases.

Some synthetic versions of THC for humans are approved as drugs and are federally legal, but none are currently approved for pets. However, CBD is approved in humans as a drug, so your veterinarian may be able to prescribe it if considered necessary for treating your pet.

How Cannabinoids Work

One of the many systems working to keep the body healthy is the endocannabinoid system in the brain. This system is made of naturally produced chemical compounds produced by neurons (cells that make up nerves) that are then sent on to direct many other cells.

The endocannabinoid system includes receptors located on different body cells, especially the nervous system. Phytocannabinoids may work at receptors like endocannabinoids.

Scientists are increasingly finding more diseases can be treated by targeting the endocannabinoid system.

The endocannabinoid system includes receptors located on different body cells, especially the nervous system. Phytocannabinoids may work at receptors like endocannabinoids. A common endocannabinoid, anandamide (AEA), is called the “bliss” endocannabinoid because it helps relieve stress.

THC interacts with cannabinoid receptors like AEA does, causing the same positive psychoactive effects in most people. CBD also interacts with the endocannabinoid system, but not at the same sites that THC works, which is why it does not affect the brain the same way THC does. 

Both THC and CBD can potentially interact with other receptors in the body. Because CBD may have many of the medical benefits of marijuana but does not have psychoactive effects, CBD is emerging as the cannabinoid most used medicinally in animals.

CBD as a Potential Treatment for Some Diseases

Because cannabinoids are mainly present in the brain, diseases involving the nervous system have been the focus of study for positive benefits. Some studies in humans have not found a clinical effect of CBD, but that does not mean that CBD does not work.

CBD appears to help other drugs control pain in humans, especially if it is chronic. Studies have shown that pain associated with osteoarthritis in dogs may be better controlled if CBD is added to drugs such as nonsteroidal anti-inflammatories (e.g., carprofen, robenicoxib, grapiprant, etc.).

Another potential indication for CBD is epilepsy, or seizures, that have not responded sufficiently to other antiseizure medications.

The use of CBD in treating diseases involving the nervous system, such as anxiety and pruritis (itchy skin), needs further research but may be promising. Studies involving cancer are also underway. CBD for treating various cat diseases has not yet been studied. 

CBD as a Supplement  

Animals must receive CBD orally. It is commonly given to pets as a treat, in oil, or as a capsule supplement. In the last decade, many supplements containing CBD have been marketed for use to treat a wide variety of diseases in animals. While CBD may prove to help treat some of these diseases, using these supplements to treat a pet can be a problem for several reasons.

It is important to understand that supplements are not like drugs approved by the Food and Drug Administration (FDA). Approved drugs have undergone a rigorous assessment to ensure that the drug is safe and effective for the disease being treated. The label guarantees the product contains the correct medication in listed amounts, strength, and quality. Any additional ingredients are clearly listed.

Supplements, including those containing CBD, are not held to the FDA standard. There is no guarantee that what is listed on the label is correct.

CBD products can be inconsistently labeled. Hemp oil is not the same as hemp extract, and the amount of CBD in the product can vary.

Labels can list the amount of CBD in ounces, by ml, in the total container, per dose, or per serving. This can make it difficult to ensure you give your pet the correct amount of CBD needed.

Another issue with CBD supplements is that they may contain other compounds added by the manufacturer. The compound might be a drug or, worse, a synthetic cannabinoid. Added synthetic cannabinoids are also Schedule I products and are illegal but hard to identify. This includes metabolites of THC. They are much more likely to be toxic compared to phytocannabinoids.

Yet another concern is how the CBD is “delivered” to your pet. Some manufacturers are trying to increase CBD absorption by changing what it is in. However, CBD may be absorbed differently if mixed in hemp oil, sesame seed oil, or other fats or added to a cookie or biscuit.

A final consideration is to be aware of the cost of CBD in these supplements, which can vary greatly. Higher cost does not equate to a better product.

One of the ways to avoid most of these concerns is to ask your veterinarian to prescribe a CBD that has been approved by the FDA for human use. Because it is approved, your veterinarian is legally allowed to prescribe it.

Is Cannabidiol Safe for Your Pet?

CBD appears very safe in dogs and is not likely to cause behavior changes. Studies have shown that CBD in oil, even at very high doses, does not cause any more side effects than oil alone in dogs or cats.

However, longer-term studies need to be done because there is some suggestion that the liver might be affected. This may be more likely if CBD is combined with other drugs.

Another safety consideration is whether CBD might change how other drugs work in the body. Some drugs inhibit the metabolism (or processing) of other medications, making it possible for other medications to become toxic.

In most cases, studies show that the effects of CBD are seen around two weeks after beginning treatment at the dose recommended by your veterinarian. However, the body often develops a tolerance for drugs used in treating the nervous system.

If tolerance develops, a higher dose may be necessary to control the clinical signs.

You must discuss with your veterinarian any other drug or supplement your pet may be receiving and make sure you know the potential benefits, dosing suggestions, and any cautions to look for when giving CBD to your pet.

The heart muscles contract after they are stimulated by an electrical impulse. A small area of special tissue in the right atrium called the sinoatrial (SA) node starts an electrical impulse (it’s like the heart’s spark plug) that travels out through the atrial muscle, stimulating that muscle, and, simultaneously down special electrical tracts (AV node, Bundle Branches, Purkinje Fibers – the heart’s “wiring”) to the ventricles and ultimately out into the ventricular muscle (see Figure 2 below).

The electrical impulses cause the heart to contract in a coordinated fashion: the atria contract first, because they get stimulated first. As they contract, they push blood into the ventricles. Then, as the electrical signal reaches the ventricles, they also contract and push blood to either the lungs or the rest of the body. This coordinated electrical activity can be recorded on an electrocardiogram (ECG or EKG). There are several components to the normal ECG, called waves or complexes. They are labeled P, QRS and T. The P waves represent the atrial stimulation, while the QRS waves represent the ventricular stimulation. The T waves represent the re-setting of the ventricular muscles, so that they can be stimulated by the next impulse. The short pause between the P waves and the QRS waves is the time that the impulse is traveling along the wiring system from the atria to the ventricles.

Occasionally, giant and large-breed dogs develop atrial fibrillation without any other heart disease, similar to what we see in humans and horses (let’s face it, some Great Danes are almost as big as horses!). This is termed “lone” or primary atrial fibrillation.  In some cases, this is “lone” atrial fibrillation turns out to be the first indication of dilated cardiomyopathy; in other cases, the arrhythmia exists without underlying heart disease.

How Is Atrial Fibrillation Diagnosed?

Often, the first idea that a pet has atrial fibrillation is when your veterinarian detects an erratic heart rhythm while listening to the heart with a stethoscope. Many veterinarians describe the sound as bongo drums or shoes in a dryer. Your pet’s pulse quality may also be irregular. However, to confirm the diagnosis an electrocardiogram (ECG) needs to be performed (because other arrhythmias can sound like atrial fibrillation. There are specific ECG criteria that must be met prior to making the diagnosis.

At times, a pet with severe heart disease may suddenly become weaker, or have a relapse of heart failure upon development of atrial fibrillation, prompting you to visit your veterinarian. Again, the veterinarian will auscultate the abnormal rhythm and diagnose atrial fibrillation via an ECG examination.

In giant breeds with lone atrial fibrillation, the arrhythmia may be detected on routine examination – often the owners are unaware that any problem exists. Some dogs may develop mild exercise intolerance when they develop atrial fibrillation.

However, in a pet with serious heart disease, atrial fibrillation causes a worsening of clinical signs, and can further damage the heart. Cardiac output, or the amount of blood pumped out of the heart to the rest of the body, is reduced and often congestive heart failure develops or recurs. These pets usually have very fast heart rate (more than 200 beats per min) which, if not controlled, can lead to additional heart muscle damage and dysfunction.

How Is Atrial Fibrillation Treated?

Treatment in people is aimed at re-establishing and maintaining a normal rhythm, because this greatly reduces the risk of strokes. This is usually achieved by delivering a “shock” to the heart (termed electrocardioversion), or by using antiarrhythmic drugs. Recent studies in people suggest that re-establishing a normal rhythm is not essential and medical therapy might suffice if clinical signs are tolerable or absent.

In pets, cardioversion is generally not feasible. Several studies have examined electrocardioversion or chemical cardioversion in dogs with lone atrial fibrillation – none has shown consistent success. Newer studies are being conducted that may ultimately provide a technique that allows a normal rhythm to be established in these pets.

Pets with severe heart disease are generally not candidates for cardioversion. In these pets, a normal rhythm can rarely, if ever, be re-established. Instead, the veterinarian attempts to reduce the high heart rate with antiarrhythmic drugs. By reducing the heart rate (which is often more than 200 beats per minute), the veterinarian allows the heart to pump more efficiently, and prevents some of the damage that the high heart rate can produce. Additionally, the clinical signs associated with the development of atrial fibrillation (that is, congestive heart failure) resolve when the rate is controlled. The drugs that decrease the heart rate need to be given indefinitely to maintain rate control and will generally be added to drugs already being administered. Studies have shown that dogs in which the heart rate is reduced to 120 beats per minute (average over a day) do better than dogs in which the heart rate is not as well controlled. In other words, the closer to “normal” your veterinarian can bring the heart rate, the better the outcome.

People with atrial fibrillation are usually treated with anti-coagulants, such as warfarin, or other similar drugs (commonly, but incorrectly, termed blood thinners), to reduce the incidence of strokes, which can be devastating or fatal. However, dogs with atrial fibrillation do not appear to have increased risk of strokes and are therefore not treated with anti-coagulants. Cats with atrial fibrillation usually have severe heart disease, and are often treated with anti-coagulants whether they have atrial fibrillation or not.

What is the prognosis for a pet with atrial fibrillation?

Lone atrial fibrillation, like we see in large or giant-breed dogs, is well tolerated, even if we cannot convert it back to a normal sinus rhythm. In dogs with underlying severe heart disease, 50 percent of those with higher heart rates (more than 125 beats per minute) in one study had died from their heart disease within four months. On the other hand, 50 percent of those with lower heart rates (less than 125 beats per minute) lived to at least three years. Whether or not these numbers reflect what will happen with all dogs is hard to say, but we can say that bringing the heart rate close to normal improves survival.

When your pet is stumbling and staggering around, almost as though drunk, the condition is called ataxia. It is an inability to make normal, coordinated, voluntary movements but is not caused by muscle weakness, involuntary spasms, or too little strength to move. Generally speaking, ataxia is a symptom caused by some type of central nervous system problem in which the brain cannot correctly tell the body what to do.

Ataxia affects a pet’s ability to coordinate their head, legs, and body. Perhaps the pet cannot place their foot appropriately while walking, resulting in the pet knuckling their feet and dragging their toes on the ground. Since the pet does not realize where their feet are, they cannot just flip the feet over to walk normally. Dragging knuckles on the ground can damage the tops of their feet. Some pets with ataxia do not knuckle their toes, but their foot placement is exaggerated.

Ataxia needs to be differentiated from lameness or weakness due to musculoskeletal disease or generalized illness.

Three types of ataxia can be seen in dogs and cats, depending on whether the inner ear, brain, and/or spine is involved: 

• Cerebellar (brain)
• Proprioceptive (brain or spine)
• Vestibular (inner ear)

Cerebellar

The cerebellum is the part of the brain that coordinates voluntary movement, allowing your pet to reach toward the water bowl or you to move your arm appropriately when you want to pick something up. Common causes of cerebellar ataxia in pets are congenital defects and inflammatory diseases. Other causes include degenerative neurological diseases, brain tumors, and strokes.  

The pet’s head and torso sway and stagger (see video) and their feet step up high and wide in an exaggerated walk as though they are about to go up steps even though they’re not. They may have head tremors.

Proprioceptive

Proprioception is an awareness of where your body is positioned in space, strengthening coordination. It tells us how much force to use when pushing or pulling. Proprioception is how your pet knows without looking if their tail or foot is up or down, and you know if you are standing up straight or slanted. Proprioceptive ataxia is caused by a problem in the cerebral cortex of the brain or the spine. Common causes include brain tumors, infectious diseases of the brain or spinal cord, traumatic brain injuries, injured disks, and strokes. 

The pet’s unsteady body is seen swaying, knuckling, feet crossing over, and with a wide-based stance. You would see an inability to get the limbs into their normal positions. This form can affect one or more limbs and the torso.

Vestibular

Vestibular ataxia is caused by a problem in the vestibular system in the inner ear or within the balance center in the brain, both of which contribute to balance. The vestibular system helps your pet stay upright when walking forward and lets you walk or run on uneven ground without falling. The vestibular systems signal to the brain to let the eyes and extremities know what they are supposed to do. Here, the ataxia is characterized by leaning and falling to one side or, less commonly, both sides. It affects the head, trunk and limbs. It’s often the easiest form of ataxia to recognize and often is worse if the animal is removed from contact with the ground.

Pets with vestibular ataxia may have a head tilt, walk like they are going in a circle rather than straight ahead, and may have odd back-and-forth eye movements called nystagmus. Drooling, leaning, rolling, and falling are common. Nausea or vomiting may occur as a result of dizziness.

• Mentation (level and quality of consciousness)
• Posture of head, limbs, and body
• Gait (how the pet walks)
• Postural reactions (incoordination)
• Spinal reflexes (normal, diminished, or increased)
• Cranial nerves (e.g., vision, eye movements, facial sensation, etc.)
• Palpation of the spine to look for swelling or atrophy
• Nociception (ability to sense pain)

A neuro exam will suggest the location of the problem but cannot by itself determine which disease your pet has. The history you provide is the most important information in determining which diseases are likely causes of abnormal signs.

Treatment

Treatment depends on what is happening with your pet. Your veterinarian needs to figure out where the problem is located, and which diseases are most likely, to determine which tests and treatments to recommend. Hospitalization with some medication to help the pet’s specific signs, such as vomiting, and some IV fluids may be of most use, especially early in the game. Good nursing both at the clinic and at home can be helpful. 

The prognosis for pets with ataxia depends on where the lesions are located and what the specific disease is that is causing the abnormal signs. Some diseases are benign, and recovery only requires time and supportive care. Other diseases are serious and may be difficult to resolve.