Hi Louise & Maggie, sorry to hear your pup is suffering. I’ll answer the ketamine question first.

There are some specialists using intermittent once weekly/fortnightly injections of ketamine in small dogs and cats, the main problem is once we get up to large dogs the injections can be painful. A vet could also administer a ketamine infusion in hospital over about 30 mins – you might be able to sit and wait. It is a tiny dose compared to what would be used for anaesthetics. There is an oral human medicine which works in a similar way to ketamine, that vets may prescribe to dogs, with which we have quite a lot of experience and one good quality clinical trial. Amantadine capsules are used for certain types of dementia in humans but have also been used for pain – we use it a lot in specialist practice and increasingly general practice vets are discovering it. It is safe to use alongside the other meds your dog is on and may even mean you could come off one of them if it works well. Your vet could get free advice from a specialist (anaesthesia and analgesia) – there are several around the country – I am at Langford Vets http://www.langfordvets.co.uk so they could find me easily enough or find out if their local specialist practice has a pain clinic.

On the topic of CBD oil. Our problem currently is that some limited trials have been done but are not of a high quality. Furthermore, it is an unregulated industry and testing done by an independent body has revealed very low concentrations or no CBD at all contained in some products. CBD oil may alter the way the liver metabolises other drugs so it is quite a game of ‘chance’ dosing CBD alongside all the other drugs your dog is on. It is possible to ‘virtually overdose’ your dog as a result. I feel it is highly likely CBD will turn out to be beneficial for many dogs in future trials. However, in the meantime, I don’t feel it is worth the risk until we have better information about how it alters metabolism.

Regarding getting hold of CBD oil, the government regulatory agency for veterinary medicines has put a ban on marketing of CBD oil intended for animals (for the reasons above – safety and toxicity). Vets may legally stock a human product on their pharmacy shelf but only limited suppliers exist. Again your vet could call me for free advice. I know that the vet wholesaler NVS supplies it but I have no idea about the quality.

I hope this is helpful,
Gwen

Hi again , amantadine does not cause irritation of the stomach but can cause the dog to vomit soon after taking it on the first couple of days as it causes a rush of dopamine to the brain. This can be reduced if the capsule is given with food and usually settles after a couple of days anyway.

Hi, it is difficult for me to make any more recommendation as I’ve not seen your dog myself. One thing might be worth trying is reducing anxiety by using a DAP diffuser (dog appeasing pheromone) or supplementing magnesium (or both). Magnesium can cause an upset stomach but you could try a supplement called stress-less by nupafeed. You can buy it online. Magnesium has a mild sedating effect (often used to help load horses into trailers if they are anxious about travelling) and may also help with chronic pain and this is an emerging area of research.

Hello Louise and Maggie,

I want to start off by saying I am only a nurse, not a veterinarian and I live in the USA. I am a certified veterinary pain practitioner (CVPP) through the International Veterinary Academy of Pain Management.

Now – Amantadine combined with gabapentin can be quite useful. Amantadine is an NMDA antagonist drug like ketamine. Gabapentin and Amantidine are drugs that typically reduce the nerve transmission of pain to the brain hence aid in pain reduction. This may be preferable to the injections of ketamine. Your other choice is to hospitalize Maggie and have her receive a subanesthetic dose of IV ketamine to help disrupt the current cycle of chronic pain. This must be done at the veterinary hospital since it is a continuous IV infusion.

Now for CBD oil, there are several studies published from Dr. Joe Wakshlag at the University of Florida.  Both dogs and cats were provided 2 mg/kg total CBD concentration orally twice daily. In healthy dogs and cats, an oral CBD-rich hemp supplement administered every 12 h was not detrimental based on CBC or biochemistry values. Cats
do appear to absorb or eliminate CBD differently than dogs, showing lower serum concentrations and adverse effects of excessive licking and head-shaking during oil administration.

This paper: Kelly A. Deabold, Wayne S. Schwark, Lisa Wolf and Joseph J. Wakshlag. Single-Dose Pharmacokinetics and Preliminary Safety Assessment with Use of CBD-Rich Hemp Nutraceutical in Healthy Dogs and Cats, Animals 2019, 9, 832; doi:10.3390/ani9100832

So the company I recommend is Ellevet. They are quite reputable. They provide a certificate of analysis on all allotments of their CBD products. I recommend you conract Mr. Stephen Cital (Ellevet’s Director of Education) and ask if there is a branch in the UK.

Stephen Cital RVT, RLAT, SRA, VCC, CVPP, VTS- LAM (Research Anes.)

Academy of Laboratory Veterinary Technicians and Nurses- Executive Director
Veterinary Anesthesia Nerds – Chief Operating Officer
Veterinary Cannabis Academy- Co-Founder
Phone: 916-799-6926
http://www.stephencital.com

Stephen Cital <matacital@gmail.com>

Yes, Stephen and I are quite good friends and he lectures all around the world about CBD and pain.

I hope that you receive some satisfaction about Maggie! I have osteoporosis and osteoarthritis myself. I have kidney disease and am unable to take NSAIDS any longer, thus I take CBD for my OA pain.

Please know that I do not live in the UK, so legally things may be quite different than the USA. However, I am a member of the British Veterinary Nursing Association.

Mary Ellen Goldberg LVT, CVT, SRA, CCRVN, CVPP, VTS-lab animal medicine (Research anesthesia), VTS-physical rehabilitation

Academy of Physical Rehabilitation Veterinary Technicians

Academy of Laboratory Animal Veterinary Technicians and Nurses

Veterinary Medical Technologist

Surgical Research Anesthetist

Certified Canine Rehabilitation Veterinary Nurse

Certified Veterinary Pain Practitioner.

Mary Ellen Goldberg

Hey Rob

CAM has done a number of videos on Facebook and also available on our YouTube channel about CBD. Please check them out as a little alarm bell went off when I read your message.

Currently it is against the Veterinary Medicines Directive to market CBD for pets. So if this is a UK company they are breaking “the law”. There’s been a big Hoi ha about it, and companies can only market it as a food supplement to humans and should not be suggesting health claims in animals… just giving you a heads up as the company may be a little unscrupulous and not playing by the rules! Definitely get a certificate of analysis to check content… but sadly there are no regulations or monitoring whether these are legitimate… tricky times!!! So be careful xx

Regards Hannah,
Director of CAM

Hey Rob

It’s very, very hard to comment on a case when you haven’t seen the dog.

If you think CBD helped and you are running out of options then I’d say use it and that’s what the prescription cascade days too. It’s just making sure it’s a good source.

If you were my case I would be willing to spend as much time with you as needed and look at all options. This may mean a blood sample, full exam, x-rays etc to check if there is anything else going on, and to get an up to date diagnosis. Sometimes if arthritis without other complications.  I’ve really thrown everything I have at a case and advised the owner to sit pretty for 5-7 days and let the acute flare of arthritis pass and we’ve done very well after…

I think a chat with your vet is needed.

Best of luck… thinking of you.
Hannah