Guest Post: Hormonal Cream Poisoning in Cats and Dogs by Dr Keith Niesenbaum

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Hormonal creams, such as topical estrogen prescribed to relieve some of the symptoms of menopause, can have a devastating effect on dogs or cats (or other 2 legged children) who come in frequent contact with you.

I was talking on Facebook recently with Dr Keith Neisenbaum about hormonal cream poisoning. He mentioned a particular example so, given it's accident month at Embrace, I asked him to guest blog to spread the word about this innocuous but possibly fatal poison.

Dr Neibenbaum writes...

Trouble (not her real name) was a small but spunky Yorkshire Terrier. She became a patient of mine 13 years ago when she was just a pup. Unfortunately, her poor breeding stock left her with a couple congenital problems that we had to deal with in her first year of life. Her knees were never quite right, and she needed a surgery to correct a blood vessel anomaly that shunted blood away from her liver. She did well after that though, and the next 13 years were relatively uneventful healthwise. Of course we are going to overlook her nasty habit of stealing the remote control for the TV and then hiding it so that no one could change the channel (I assume from Animal Planet).

In the spring of 2008 she presented at our office with some vague gastrointestinal signs. She was on some medication for arthritis and had been in a couple of months ago for a complete work up. At the time her blood work was normal and her radiographs showed nothing other than the degenerative joint disease.

It was June 2^nd and Trouble’s Mom said that Trouble just wasn’t acting right. She had been vomiting and her appetite was off. We thought it might be the arthritis medicine so we stopped that, gave her something to settle her stomach, and ran some preliminary blood work in our in house lab. We were surprised to see that her platelet count was low.

Since she was so small, and her owners were so concerned, we admitted her to the hospital and placed her on IV fluids and monitored her. The next day we took some abdominal x rays and saw that here liver looked a little small and that there was some gas in her intestines. The small liver fit with the congenital liver shunt that had been corrected 12 years ago. Her chemistry panel was normal and an ultrasound was performed. No masses were found and no specific reason for her condition could be identified. We became concerned that she had an auto immune disease, one where the body attacks it’s own cells, in this case the platelets.

By June 5^th, her platelets were even lower and the other blood counts (red blood cells and white blood cells) were beginning to drop. This puzzled the team at Crawford Dog and Cat Hospital since we usually see a high white count in auto immune disease. She continued to deteriorate and she was given her first transfusion with a synthetic hemoglobin product on the 6^th, as her anemia was worsening. The condition was starting to look more and more like a bone marrow shutdown than anything else. We carefully questioned the owner and we could not come up with anything in Trouble’s environment that might have been causing the problem.

She was started on injections of Erythropoietin to stimulate her bone marrow to produce red blood cells. On the morning of the 7^th, she was given a second transfusion of the synthetic hemoglobin and a unit of packed red blood cells.

Concerned that her condition was continuing to worsen, we transferred Trouble to a specialty practice with an intensive care unit. They continued to support her and she seemed to be responding to the multiple transfusions. Her count, while still very low, seemed to be beginning to turn for the better. Plans were made to discharge her to her owner’s care. She went home on the 9^th of June. Unfortunately, this trip home was brief, and she took a turn for the worse almost immediately. She passed away on the morning of June 11^th.

We were all very puzzled by the way this case unfolded. Auto immune disease is usually seen in younger dogs. In addition, her laboratory work did not fit that diagnosis. There was no evidence of cancer anywhere in her body. We had planned a bone marrow biopsy, but were concerned that she would not survive the procedure, so we couldn’t really get a handle on what had caused it to shut down.

I went back to the owner and reviewed the history repeatedly and the only thing that we could find was that she had been using a topical estrogen product prescribed by her physician to relieve some of the symptoms of menopause. This was applied to alternate sites on her for arms and on reflection, the dog used to lick her hands and wrists (the latter being one of the application sites).

Estrogen in high doses can be very toxic to the bone marrow. We used to always see it in ferrets, back before they were spayed at an early age. Several hormonal preparations used in dogs up until the 80’s had also been shown to cause bone marrow suppression, sometimes non reversible and fatal in dogs. Apparently the combination of Trouble’s diminutive stature combined with the amount of estrogen left on the skin, sometimes days to hours after, provided a toxic dose of the hormone.

Trouble’s mom contacted the FDA and the company that makes the topical hormone medication, but no one really responded in a satisfactory manner. I guess that as long as it was just a little dog that we were worried about it, would remain under the radar; however, there must have been other problems because this year the medication’s label was changed to include a warning that human infants can absorb this drug by contact with the skin of the person using it.

We have tried to get the word out to our clients about the dangers of this medication to others that they might come in contact with, no matter the species. As we become a society that relies on more more medication, with different delivery systems, we are starting to see a dramatic increase in the number of poisonings’ of pets with their owner’s drugs. Please, read you labels, speak with your physicians, and keep all medications out of the reach of children and pets.

Dr. Keith Niesenbaum graduated from the University of Pensylvania with a VMD degree in 1984. He has been practicing on Long Island Since 1988, and is currently the owner of Crawford Dog and Cat Hospital since 2002 (find them on facebook too). Dr. Niesenbaum uses a therapeutic laser and nutritional supplements to complement traditional medications for the management of chronic degenerative diseases. He also provides regenerative stem cell therapy to treat arthritis in dogs. When he’s not tending to his many four-legged patients, Dr. Niesenbaum can be found out and about training for upcoming triathlon races. He competed in his first Ironman race in 2008 complementing his interest in performance medicine, pain management, and nutrition.