Recent research suggests that CBG (cannabigerol) in combination with CBD (cannabidiol) is neuroprotective. Can it help slow the effects of Degenerative Myelopathy in dogs?

The diagnosis of DM is one we vets hate to hear and hate to give! While Degenerative Myelopathy, analogous to ALS in humans, is not usually a painful condition, it is relentless. DM takes away a dog’s ability to stand and support his weight, starting with the hind legs, and moving cranially. We can provide supportive care, like protective booties for scuffed dorsal paws, harnesses to lift the hind end, and eventually carts. But in the end, loss of mobility means loss of quality of life for both the dog and the caregiver.

As a holistic vet, I have followed Dr. Steve Marsden’s recommendations of treating Degenerative Myelopathy as a spinal inflammatory disorder, which gains a foothold via spinal injury, and spreads from there. A year ago, I began adding a novel CBG/CBD combination tincture to the anti-inflammatory protocol. Recent research on “minor” cannabinoids (other than CBD and THC) suggests that CBG (cannabigerol) in combination with CBD (cannabidiol) combats neuroinflammation, imparting neuro-protective effects.^1,2,3 The promising results give hope that this may be another tool to help slow the neurodegenerative devastation of degenerative myelopathy.

Case study

Zac is an 8-year-old boxer with a history of musculoskeletal issues: spinal spondylosis, hip pain and a possible ACL tear. He began treatment for back pain at a holistic rehabilitation clinic in the fall of 2020, which included laser and underwater treadmill therapy weekly. Acupuncture was not performed because he seemed to object to it. He did not improve as expected, so the veterinarian tested for Degenerative Myelopathy, which was positive. He continued with weekly laser and UWT therapy, gabapentin and supportive supplements. In the summer of 2021, his mobility rapidly deteriorated, until he could no longer support his hind end or generate gait. His owner came to me to investigate further options.

On PE, Zac was strong and well-muscled in the forelimbs and back, but had significant muscle atrophy behind. He could not rise to a standing position or support himself, but when his hind end was supported with a harness, his back legs made some gaiting motions, indicating that some motor function was still present.  He had some discomfort at the thoracolumbar junction, consistent with his concurrent diagnosis of spondylosis.  His tongue was bright pink, and his pulse was somewhat wiry.

My treatment plan was intensive anti-inflammatory therapy along with intensive physical interventions. Once he lost ambulatory function, Zac was not deriving benefit from the UWT— he was not using his hind limb muscles during sessions because he was being completely supported and his limbs advanced manually.   After the initial consultation, he was sent home on the following protocol:

• CBD/CBG formula: 1/4 ml 4:3 CBG Ultra, BID (30/22.5 mg CBD/CBG)
• Xiao Chai Hu Tang, TID
• Curcumin & Boswellia (60 mg/120 mg micellar solubilized SID)
• Vitamin B12: 500 mcg SQ once a week
• Milk thistle and other antioxidant therapies

Zac’s physical interventions became more directed and intensified. His owner, a medical professional, was trained to needle Bladder 19 and GB 34 twice weekly. She acquired an Assisi Loop (PEMF therapy) and used it twice daily. A highly trained canine physiotherapist (a licensed PT with animal certification) worked with Zac weekly, doing physical therapy exercises and nerve pathway focused laser treatments. The owner performed the exercises at home several times daily.

From the owner:

2 weeks: “Zac is doing a little better. Less pain and seems to have more purposeful movement/steps with his back legs.”

4 weeks: “The supplements seem to be helping and Zac has started physical therapy. This is much better than the UWT. I no longer have to give gabapentin daily because the curcumin and boswellia seems to control his pain.”

From the animal PT, 4 weeks after start of treatment:  

I have started basics with Zac: reaching and extending his spine in sternal lying, crawling (which he does now), changing positions side to side, lateral trunk flexion, lots of manual work, and proprioceptive work to all four limbs which are quite sore with significant triggers in the scapulothoracic joints and triceps from compensations. Last week we started work in a seated position with his hind end elevated 4 inches making it easier for him to maintain posture.  I’m lasering his fore limbs, hind limbs (sciatic and femoral nerve pathways), and down bilateral paraspinals in cervical through lumbosacral regions.  

We have been working on getting him to shift himself from one side to the other. He also has been pushing himself up to a seated position at rehab and some more at home, something his owner says he has not done in over a month. Last week his owner also stated that he was doing so well, noting that he has been so playful and happy overall. 

Synergistic treatment

As holistic vets, we often perform simultaneous, synergistic treatments, so it is difficult to say which intervention can be credited for success. In this case, the regime of CBD/CBG and Xiao Chai Hu Tang, with strong anti-inflammatory support (curcumin and boswellia), resulted in steady improvements in his mobility and attitude even before the physical therapy began. Since the skilled PT began, he has regained some of his strength and proprioception in his trunk, which makes daily management easier for his owner.

Can degenerative conditions like DM be reversed? Perhaps not, but the nervous system has many ways to “work around” damage, and with some neuro-protection and anti-inflammation on board to slow down the degenerative process, perhaps manual therapy can help this dog to be more functional.

It is worth noting that we, as veterinarians, have a lot to learn from our Physical Therapist colleagues, who train for 5–7 years to learn their profession. While veterinary medicine has been at the forefront in adopting many novel joint (HA, PRP) treatments, as well as modalities (therapeutic ultrasound, laser, underwater treadmills), some vet practices embarking on “rehab” services are substituting the use of these high-tech modalities for the manual skills (both diagnostic and therapeutic) that a trained physiotherapist can bring to the care. Ideally, “vet rehab” should be performed with the same high standards for manual therapy that we hold for human practice, with patients benefitting from both high tech modalities and highly skilled manual interventions.

Want to hear more about Zac’s journey? Dr. Gellman and PT Whitney Mitchell
will be giving a webinar with videos of Zac’s manual therapy for the NYCAVMA
clinical series on January 31, at 7 PM. Contact Dr. Cynthia Lankenau to register:
cyndvm@gmail.com.

¹Aguareles J, Paraiso-Luna J, Palomares B et al. Oral Administration of the Cannabigerol Derivative VCE-003.2 Promotes Subventricular Zone Neurogenesis and Protects Against Mutant Huntington-Induced Neurodegeneration.  Translational Neurodegenaration  (2019) 8:9.

²di Giacomo V, Chiavaroli A, Recinella L ,et al. Antioxidant and Neuroprotective Effects Induced by Cannabidiol and Cannabigerol in Rat CTX-TNA2 Astrocytes and Isolated Cortexes.  Int J Mol Sci. (2020) 21(10):3575.

³Echeverry C, Prunell G, Narbondo C et al. A Comparative In Vitro Study of the Neuroprotective Effect Induced by Cannabidiol, Cannabigerol and their Respective Acid Forms: Relevance of the 5-HT 1A Receptors.  Neurotox Res. (2020) Sep 4 Online ahead of print.