Types and causes of ataxia in adult dogs and puppies. Veterinary care center "Elitevet" Ataxia in dogs, which breeds are susceptible

Neurological disorders in pets are also a “headache”. In all cases, such phenomena indicate serious functional disorders in their body, but the problem is that the cat or dog cannot tell the owner about the reasons for what is happening. Many of these pathologies are combined under the term “ataxia.” In dogs, similar signs develop (as a rule) with damage to the nervous system.

What is ataxia anyway? This is not a separate disease. This is a spectrum of symptoms: sudden loss of coordination, balance, trembling, the animal may fall for no reason. There are three types of ataxia - vestibular, sensitive (proprioceptive), cerebellar ataxia (in dogs it is the most severe). Each type has its own specific clinical manifestations and causes.

Sensitive ataxia develops in cases where the Gaulle and Burdach bundles are affected, and also, as is believed, the spinal cord. A typical sign is a sharp deterioration in walking, and the dog constantly looks at his feet while moving. If the lesions of the cords are serious, the dog is completely unable to sit and stand.

The vestibular apparatus helps the animal maintain balance and position in space. If it is affected, ataxia of the same name develops. The dog cannot hold its head up normally, it constantly tilts when walking, is very unstable, and sometimes spins in one place. “Uncoordinated” eye movements, constant drowsiness, and numbness are very characteristic.

Important! Sensitive and vestibular ataxia do not affect behavioral aspects in any way. Simply put, the dog’s behavior (up to certain limits) remains normal, with no signs of “mental” abnormalities. This helps to differentiate these pathologies from dangerous infectious diseases.

For now, we will discuss cerebellar ataxia, since this pathology is the most severe and is less responsive to treatment attempts than others.

The cerebellum is the area of ​​the brain that controls coordination and movement. When this area is damaged, it leads to loss of coordination, balance, and loss of motor control. In some cases, this also leads to a violation of spatial orientation; the sick animal does not recognize the place and owners.

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Damage to the cerebellum can be caused by a brain tumor or infection, but it is usually caused by birth defects that cause normal neurons to die (hereditary cerebellar ataxia). Such diseases are inherited through a recessive gene. This means that for pathology to manifest itself, it must be present in both parents. Therefore, hereditary cerebellar ataxia is still quite rare, since conscientious breeders struggle with inherited diseases, and such dogs are not allowed to breed.

Symptoms

Symptoms of cerebellar ataxia progress over several years or months (which is less common). As a rule, up to two years the clinical picture does not develop at all. The most common symptoms of ataxia in dogs are:

  • Trembling, nervousness, the pet may be inadequate.
  • When walking, she behaves extremely strangely and unusually. For example, he takes incredibly long steps, freezing after each of them for a second and a half.
  • Loss of coordination (first symptoms).
  • Panic attacks. The animal is confused, excited, trying to hide somewhere.
  • From time to time the dog falls while walking.
  • Progressive weakness.
  • Sometimes the dog begins to quickly rotate its head, and erratic, circular movements of the eyeballs are also observed.

The clinical picture also includes:

  • Constant head tilt.
  • Hearing impairment.
  • Lethargy.
  • Sharp.
  • Other changes in behavior.

Diagnostics and therapeutic techniques

If you suspect your pet is suffering from cerebellar ataxia, contact your veterinarian immediately. The fact is that today there is not a single specific analysis or diagnostic method that would make it possible to unambiguously identify cerebellar ataxia (or another type) in a dog. The diagnosis is made based on the combination of the clinical picture, a complete examination and a whole range of tests.

Be sure to take a urine test. MRI is very useful, but not every city has the opportunity to do it. So sometimes they limit themselves to simple radiography. Other tests may be ordered depending on what your veterinarian finds during initial testing.

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Treatment for ataxia in dogs will depend on the cause. If an infection or tumor is found, powerful broad-spectrum antibiotics are administered or surgery is used accordingly. However, there is no cure for ataxia caused by a congenital or hereditary defect. In these cases, supportive treatment is the only way out, and it is aimed at maintaining the animal’s normal standard of living.

As a rule, with such therapy, sedatives and sedatives are prescribed. They relieve the animal's panic state. To treat movement disorders, more specific medications are used, which should only be prescribed by a veterinarian. Under no circumstances “stuff” the animal with them yourself, as you can only make things worse.

Animals suffering from cerebellar ataxia must be kept at home. In the room where the dog will be most of the time, there should be no sharp corners, foreign objects or furniture, as the pet’s condition will inevitably (alas) worsen. In this case, the dog will inevitably start to bump into furniture and corners, which can lead to an even worsening of the process, and you shouldn’t forget about the likelihood of “simple” injuries.

Some pets with congenital or hereditary ataxia live with this pathology all their lives, and it does not particularly bother them (the body adapts to this condition to some extent). Alas, in other cases, the constant progression of the disease can cause euthanasia, since it is difficult for a dog to live in a vegetable state. If the dog cannot even stand up, or falls every step, there is nothing immoral in euthanasia.

Causes of other types of ataxia

They may be different. As you remember, vestibular and sensory ataxia develop against the background of damage to the vestibular apparatus, or nerve cords. The first reason that comes to mind in these cases is oncology. If the tumor damages these important organs, many unpleasant symptoms will develop, which we have already discussed above.

Sometimes it happens that we are unable to help our sick pets. One of the incurable diseases in dogs is ataxia, translated from Greek as “disorder.” This is a motor disorder, which is manifested by a violation of the coordination and consistency of the animal’s movements. Symptoms of the disease first become noticeable when the dog is 3 to 5 years old.

The essence of the disease

Rarely, the disorder appears between one and a half to three years of age or after the age of five. Initially, owners note an episodic loss of balance in their pet when changing body position. As the disease progresses, the symptoms increase: the dog’s gait becomes unsteady, “drunk,” it does not seem to notice obstacles, and may fall when turning or making sudden movements.

How it arises and is transmitted

Ataxia in dogs can be inherited, and only if both parents of the puppy are either carriers of the damaged gene or are already sick. The disorder can also occur due to a number of diseases that damage:

  • cerebellum;
  • vestibular apparatus;
  • a system of nerve fibers that conduct impulses from the brain or spinal cord to the motor organ.

The following dog breeds are more susceptible to ataxia than others:

  • bobtail;
  • Scottish Terrier;
  • amstaff;
  • Scottish Setter;
  • cocker;
  • Mountain Dog;
  • Australian Kelpie;
  • border collie.

Breeders who breed these breeds perform a genetic test on their pets to identify carriers of the gene even before clinical signs of the disease appear. Such dogs are excluded from breeding, which avoids the spread of the defect.

Types of disease

Regardless of the type of disorder, the symptoms of ataxia are manifested by an awkward gait, the inability to overcome an obstacle or climb stairs, trembling, and increased tone of the paws. The gait becomes similar to a rooster's step - with the forelimbs raised high. There is a constant tilt to one side, dizziness due to sudden and frequent shaking of the head. Nystagmus is periodically observed - a short pendulum movement of the eyes from side to side.

As the disease progresses, the animal loses weight due to difficulty feeding.

In clinical practice, there are three types of ataxia:

  • cerebellar;
  • sensitive;
  • vestibular.

The cerebellum is a part of the brain that is responsible for the position of the body in space, coordination of movements and balance in various external conditions. With cerebellar ataxia in dogs, there are no structural changes in this organ. Its biochemical composition changes due to the loss of some Purkinje cells. These cells are a kind of dispatchers, transmitters of information into the cerebellum, to or from the white matter, to the outer layer.

Cerebellar ataxia in dogs has two types - static and dynamic. In the first case, it is difficult for the animal to stay in a motionless position. The dog has difficulty standing on widely spaced paws. Trying to maintain balance, he may fall on his side or forward. With dynamic cerebellar ataxia, discoordination manifests itself during movement, especially when turning.

Sensitive ataxia is less common. It can be differentiated from other types by increased symptoms when closing the eyes. In this case, the dog’s perception of its body in space – proprioception – is disrupted.

Depending on the area of ​​damage to the nerve impulse pathways, only the pelvic limbs or all four legs may be affected.

Vestibular ataxia occurs when the labyrinth, which perceives changes in the head and body in space, as well as the direction of movement, is damaged. The dog seems to be on an inclined surface. The animal tries in vain to maintain balance. With this type of disorder, the dog's body is tilted to one side, movements are slow and cautious. Deterioration and loss of hearing, drowsiness, and numbness are observed. The pet moves in circles, which causes dizziness and vomiting.

Diagnosis and treatment

There are no specific tests or diagnostic methods to detect ataxia. The diagnosis is made after a series of examinations and the exclusion of other, less serious diseases with similar symptoms. The most informative will be a magnetic resonance or computed tomography scan. In the absence of the necessary equipment, they are limited to radiography.

In the case of hereditary ataxia, a DNA test is performed for diagnostic purposes. A complete genetic treatment for a disease of this nature has not been developed. Over time, a sick dog becomes practically incapacitated. The veterinarian prescribes maintenance therapy to alleviate the condition and maintain normal living conditions for the pet. Most often this is symptomatic therapy in the form of sedatives, sedatives and vitamins.

It is important to create the most comfortable living conditions for a sick dog, because it will no longer be able to cope without the participation and care of its owner. It is better to provide your pet with a separate room without traumatic objects, sharp corners and interior items.

If the disease arose for another reason, then treatment of ataxia in dogs is aimed primarily at eliminating it.

The animal body is able to partially compensate for existing disorders. When one part of the brain is damaged, another area of ​​the brain takes over a share of its functions. In addition, dogs are taught to control the strength, speed and range of movements using their visual abilities. In this regard, manifestations of the disorder are noticeable only when the animal is tired or excited.

These body abilities can not only prolong the dog’s life, but also make it close to normal, despite the disorder.

Causes

In addition to the hereditary factor, the disease may have other underlying causes.

For cerebellar ataxia:

  • neoplasms or cysts in the cerebellum;
  • intoxication;
  • autoimmune diseases.

For vestibular ataxia:

  • otitis media of an infectious or fungal nature;
  • neoplasms of the middle ear;
  • injuries in the temporal region;
  • hypokalemia;
  • stroke. For sensitive ataxia:

For sensitive ataxia:

  • tumors;
  • injuries;
  • pathologies of spinal development;
  • acute vascular and compression disorders;
  • infections.

If a tumor is detected, further treatment includes, first of all, surgery.

For infectious diseases, antibiotics and anti-inflammatory drugs are prescribed.

Intoxication occurs not only due to poisoning by certain poisons, but also due to infection of the dog with worms that release toxins into the animal’s blood. In this case, treatment is carried out with anthelmintic drugs. Folk remedies will no longer help in such serious cases.

For cerebral lesions, nootropics, vasodilators, B vitamins, and nicotinic acid are prescribed to improve cerebral circulation.

Ataxia may result from an autoimmune disease. A healthy immune system identifies and destroys pathogens. But if there is a malfunction in the mechanism of its action, the tissues of the body’s own, including nerves, become the target of immune cells. Then a lack of coordination of movements develops.

If ataxia occurs as a result of trauma, the brain or spinal cord, spine, or nerve impulse pathways may be affected. One of the types of disorder occurs - cerebellar, vestibular or sensitive type. Appropriate treatment is carried out after examination, establishing the cause and making an accurate diagnosis.

Ataxia in puppies

Although most cases of congenital ataxia develop in dogs during adulthood, there are occasional abnormalities that are noticeable from birth. Problems with the musculoskeletal system and coordination problems are clearly expressed.

The puppies try to move their paws, but cannot walk. There is a shaking of the head and twitching of the eyes. Otherwise, babies develop normally - they are active, inquisitive, and have a good appetite. But such dogs will never be able to move.

To avoid acquiring a carrier or a sick puppy, you must first take into account the breed's genetic predisposition to ataxia. Secondly, it is better to purchase a small pet from a trusted nursery with a good reputation. A responsible breeder will not allow a sick dog to breed, and if there is concern, he will conduct a DNA test on individuals intended for mating.

Ataxia in dogs is a disease that gives the animal virtually no chance if the owner does not notice alarming symptoms in time and does not seek help from a veterinarian. The disease is associated with dysfunction of the cerebellum, the main part of the brain. With severe ataxia, the dog loses the ability to coordinate its movements and maintain balance. This disease can be congenital, genetic, or acquired. Today we will talk about the causes of ataxia in dogs, its symptoms and treatment.

Ataxia in dogs: symptoms and treatment

Dogs that, for some reason, have developed ataxia, that is, the cerebellum functions with disturbances or does not perform its function at all, lose the ability to move in space. You need to understand that the muscle strength and performance of the limbs do not disappear, but the animal simply cannot use its paws.

Disturbances in the functioning of the cerebellum are characterized by such unpleasant consequences as impaired coordination and balance; therefore, the dog seems to be “dangling” in space, unable to control its own body. Accordingly, pets with ataxia continue to exist, can eat and drink and even move around, but only with the help of the owner.

Types of ataxia in dogs

In addition to the cerebellar, there are other types of ataxic lesions of the dog’s brain:

  • frontal lobes;
  • channels responsible for vision;
  • crown areas;
  • posterior nerve canals;
  • mental;

Table. Variations of ataxia in dogs

The types of ataxia differ only in the location of damage to the nervous system; they do not differ in symptoms or treatment methods.

Why does cerebellar ataxia occur in dogs?

One reason is a gene mutation or heredity, due to which the puppy receives the disease from its parents. The following representatives of the canine world are most susceptible to gene ataxia:

  1. Cocker Spaniels (English).
  2. Old English Sheepdogs.
  3. Staffordshire Terriers.
  4. Kerry Blue Terriers.
  5. Hairless Chinese Crested.
  6. Scottish Terriers.

Responsible owners and breeders of these dogs perform special veterinary tests to determine the animal's ability to pass on the disease by inheritance. If the test is positive, the dogs are not allowed to be bred. But, unfortunately, heredity is not the only reason for the development of ataxia in dogs.

The disease can be triggered by head injuries in a dog, during which the brain is damaged (fall from a height, collision with a car), neuritis and otitis, severe infectious diseases, brain tumors.

Ataxia in dogs: symptoms

In Greek, the word ataxia means “without order.” This description speaks volumes about the symptoms of the disease. With progressive ataxia, the dog looks “drunk”: falls, stumbles, turns its head, crouches when turning. At the same time, moving in a straight line is quite easy for sick dogs, but the pet is not able to climb stairs, walk along a winding corridor, or change the trajectory of movement.

Dogs with ataxia may even bump into large objects, are unable to jump, make a turn, are unable to chase a person or other animal, or play with their relatives. Animals with a damaged cerebellum move with small “goose steps”, and at the same time they can walk too wide, placing their paw much further than necessary.

Some owners confuse the manifestations of ataxia with epilepsy, as animals often shudder, suffer from dizziness, their head shakes, their eyelids and chin tremble. Convulsive jerks and movements usually occur in a situation where the animal is concentrated, for example, eating or trying to plot a route.

Video - Ataxia in dogs

Examination and diagnosis

Despite the characteristic signs of the disease, an accurate diagnosis can only be made in a veterinary clinic. As a rule, there is only one examination method - the animal undergoes magnetic resonance imaging. This procedure is performed under general anesthesia and allows the doctor to make a conclusion about the functioning of all parts of the brain, including the cerebellum.

During the diagnosis, the veterinarian must also exclude or detect other or concomitant diseases that may give similar symptoms or be the root cause of ataxia in the animal.

Treatment of ataxia in dogs

The treatment regimen for ataxia in dogs depends on the cause that caused it. If the cause of ataxia is a tumor compressing the cerebellum or nerve canals, its surgical removal can result in significant improvement, up to complete recovery.

If ataxia is caused by genetics, then it is impossible to cure the brain damage. If the stage of damage is severe, veterinarians consider it humane to euthanize the dog so as not to condemn it to years of unpleasant and painful existence. In cases where ataxia is relatively mild, the animal's quality of life can be improved.

The therapeutic regimen for maintaining an animal with ataxia includes painkillers, medications that relieve nervous tension, antispasmodics, anti-inflammatory drugs, vitamin complexes (in particular, B-group vitamins).

The owner of a dog who has been diagnosed with ataxia must provide the pet with the most comfortable conditions possible: select equipment for walking in which the animal can be well controlled (for example, a harness), secure the room where the dog is. It will never be possible to cure genetic ataxia, and the owner must be prepared for the fact that his pet will be dependent on his attention and patience all his life.

Ataxia in dogs is not always automatically a death sentence. With superficial lesions, the animal only needs emergency measures, and thinking about euthanasia is too hasty. This is confirmed by the long-term life of a significant percentage of dogs surrounded by the necessary care.

Ataxia is a neurological disorder of a congenital or acquired nature, which is manifested by lack of coordination in the movements of an animal. At the same time, muscle strength is often preserved in the limbs, and any involuntary movements, paresis or excessive spasticity may be absent. The animal's consciousness often does not change.

Causes of the disease

Ataxia is not considered as a separate disease, because it is a symptom complex of one or another lesion of the central nervous system or vestibular apparatus of the dog. Often it is a genetic defect or occurs as a result of specific underlying causes.

Types of ataxia

Depending on the location of the lesion, ataxia exists in three forms: general proprioceptive (sensitive), vestibular and cerebellar ataxia in dogs - the cerebellar form.

Cerebellar

Cerebellar ataxia in dogs can have a sudden onset or a chronic course, be congenital or occur for a number of reasons, progress or remain stable.

As the main coordinator of movements and balance regulator, the cerebellum also controls the animal’s muscle strength and ensures the rhythm and balance of these movements. Because of this, the affected cerebellar hemispheres lead to dynamic ataxia of the limbs, and dysfunction of the cerebellar vermis results in the dog’s inability to maintain body balance and maintain a certain posture (static subtype).


Congenital pathology is caused by autosomal recessive inheritance. The dog receives from each parent 2 defective copies of the mutated gene, affected by ataxia. In this case, the pathology is considered as an isolated disease. The congenital form may not progress throughout the dog’s life.

Acquired cerebellar ataxia in some cases develops as a result of the following pathologies:

  • tumors in the brain;
  • falling from a height;
  • autoimmune diseases (systemic lupus);
  • brain infections and severe inflammation;
  • collision with a car;
  • anomalies in the development of cerebellar structures and the structure of the skull;
  • degenerative processes in cerebellar cells;
  • metronidazole intoxication;
  • acute thiamine deficiency;
  • ischemic infarction in older dogs;
  • helminthic intoxication.

In most cases, characteristic signs of the disease begin to appear after 3 or even 5 years.

Ataxia is manifested by the dog's awkwardness, which is unusual for the owner, and a gait with widely spaced paws, which is initially most noticeable after the animal has woken up and is trying to get up. After a certain time, strange swaying of the body and a clear inability to maintain balance become more and more obvious.


Male dogs begin to lose balance when urinating. The dog moves either too fast with goose steps, or, on the contrary, slow, taking too wide a step. Freezes unpredictably from time to time. When driving in a straight line it goes almost exactly, but gets very lost when turning.

Muscle tremors are present both when the dog tries to maintain a specific position (postural) and when moving (dynamic). There is no threat reflex: the animal does not reflexively close its eyelids when hands or objects approach the eyes, and over time, nystagmus develops - frequent involuntary rotations of the eyes. The pupils of the left and right eyes are of different sizes - anisocoria. Hypertonicity of the forelimbs and occipital muscles manifests itself in paroxysms. The dog often throws its head back.

The progressive form leads to stable weight loss, because it becomes increasingly difficult for the dog to eat. She often hits her face on the food in her bowl. In especially severe cases, the animal ceases to recognize the owner and long-familiar, familiar places. Quite often, owners mistake the clinical manifestations of the disease for a stroke or epilepsy.

Hereditary cerebellar ataxia particularly affects Staffordshire terriers, American and English cocker spaniels, Kerry blue terriers, hairless Chinese crested dogs, Scottish terriers and shepherd dogs.


Sensitive

Sensitive (proprioceptive) ataxia develops in animals in the case of a number of spinal cord pathologies. Often these are damages in the systems of ascending SC fibers that lead to the cerebral cortex, which are responsible for awareness of the position of the body in space. In medicine, these systems are called Gaulle and Burdach bundles. And the second root cause is compression (compression) of the spinal cord due to narrowing of the spinal canal, all kinds of injuries, arterial blockages, cysts, tumors, intervertebral hernias, infections and degenerative processes in the spinal tissues.

The dog's gait suddenly becomes "strange." While walking, the animal often looks down carefully and takes very careful steps, as if it is afraid to step on something. The most basic typical sign of this form of the disease is volar flexion - when moving, the dog does not fully raise its paws, but seems to “drag” its toes along the floor or on the ground.

The animal looks confused and cannot determine the correct direction of movement for a long time. At the same time, the rest of the dog’s behavior is completely adequate. Severe lesions lead to complete inability to move.


Vestibular

A sluggish, unsteady gait, staggering and periodic “throwing” to the side, which are accompanied by a tilt of the dog’s head to the left or right, are signs of vestibular ataxia. Along with this, spontaneous strabismus and nystagmus are often observed, regardless of head movements. One-sided or bilateral deafness cannot be ruled out. During an examination at the clinic, specialists may detect facial paralysis and Horner's syndrome - pathological constriction of the pupil and drooping of the upper eyelid.

The vestibular system controls muscles that are directly involved in maintaining head position, eye movements, and overall balance. And all incoming information from the outside is used to appropriately coordinate and regulate the movements performed.

The central structures of the vestibular apparatus are located in the brain, and the peripheral structures are located in the inner and middle ear. Damage to these structures in one area or another causes vestibular ataxia. In particular, these are the following pathologies:

  • congenital vestibular syndrome;
  • hypothyroidism;
  • polyneuropathy;
  • internal and otitis media;
  • fungal infections;
  • tumors in the ear or brain;
  • ototoxic antibiotics;
  • nerve degeneration.


Symptoms

Regardless of the location of the initial lesion, some manifestations of ataxia are common to all three forms:

  • incoordination of movements, which is manifested by staggering, uncertain, careful walking, stumbling, squatting when turning, or rolling onto one side;
  • it is extremely difficult or even impossible for a dog to climb stairs or jump even onto a low surface (for example, onto a sofa);
  • during walks the animal does not show activity towards other dogs;
  • muscle tremors are noticeable at rest or during movement;
  • appetite is significantly reduced;
  • Nystagmus periodically appears: rapid movements of the eyeballs to the sides or up and down.

Each dog has its own quantitative and qualitative symptoms. The intensity of manifestations is always individual. And if one animal has all the symptoms “on the list,” another dog may have only one sign (balance problems), and the diagnosis for both dogs will be the same. In addition, in some cases there is a mixture of symptoms of cerebellar and sensory ataxia, as well as cerebellar and vestibular. This suggests that the animal has a mixed form of the disease.


Signs of ataxia in puppies

Mostly, the pathology affects already mature dogs. But in a situation of congenital pathogenesis, ataxia in a puppy manifests itself quite clearly already at the 4th or 5th week. As a rule, the root cause is hypoplasia (underdevelopment) of the cerebellum.

The puppies shake their heads, rise to their paws with great difficulty, and fall onto their sides after only 2-3 steps. Nystagmus is possible. In all other respects, the behavior of babies is no different from healthy puppies: they are very active, curious and have a good appetite.

Similar symptoms of cerebellar ataxia can be observed in a puppy against the background of infestation with large helminths.

Diagnostics

Based on a number of visual manifestations, detailed complaints from the owner and specific tests, a specialist can easily determine ataxia and its form. But in order to find out the root cause of the pathology, it is necessary to donate blood and undergo an MRI - an extremely informative diagnostic option for suspected ataxia. If the clinic does not have such equipment, use an x-ray.

The symptoms of vestibular ataxia are quite striking. In this case, an additional otoscopy (detailed examination of the ear) is performed, and a CT scan or ultrasound is required if there is no way to undergo an MRI.

There are known cases of hereditary cerebellar ataxia, when the results are normal in all respects, but the animal dies, and the diagnosis is clearly confirmed after an autopsy.

Treatment of ataxia in dogs

The treatment regimen is determined by the root cause of ataxia. The most favorable prognosis is for the vestibular and sensitive forms. In this case, it is enough to eliminate the tumor, inflammation or symptoms of intoxication for the recovery process to begin. Whether recovery is complete or only partial depends on the severity of the original lesion. Some irreversible processes often leave residual neurological signs, which still allow the dog to live more or less fully for several more years.

The cerebellar form is the most severe case. Genetic etiology, unfortunately, cannot be treated. But if the disease does not progress, the dog lives a fairly tolerable life, adapting to its “shortcomings.” At the same time, acute cerebellar ataxia, provoked by an ischemic infarction, often allows the animal to fully recover after timely treatment.

To one degree or another, a dog’s life is made easier by sedatives, multivitamin complexes, antispasmodics, anti-inflammatory drugs, antibiotics and painkillers. Each product and its dosage must be prescribed exclusively by a veterinarian. Any experiments on the part of the owner can result in irreversible consequences.