Creams for Menopause Treatment: A New Side Effect That May Place Your Pet At Risk?

It has been a “bucket list” week away from the clinic that I spent in London, England!  Highlights included The Royal Mews (Queen’s carriage collection), the Chelsea Flower Show, Blenheim Palace, Wisely Gardens, Kew Gardens, and the Churchill War Room. Of course, being a food lover, in the food category, items such as fish & chips for lunch, a raisin brioche from a French bakery, and High Tea in The Diamond Jubilee Tea Salon at Fortnum & Mason were highlights. I have to say surprises included pay toilets and toilet paper discarded in separate trash cans (not the toilet). The weather was perfect and visual memories were priceless.  

The dogs came in all sizes and were everywhere! I enjoyed seeing the dog walkers on the street in the south Kensington neighborhood where I stayed.

  The Labrador Retrievers that I saw appeared to be smaller, and the Spaniels larger than the American version. 

The Chelsea Flower show was amazingly beautiful: the super bowl of plant displays. 

Prince Harry had his own garden in the judging competition among 14 others for his favorite charity.  

Although no seeds or plants could be shipped to the USA, I learned a lot of new color combinations, and hopefully I can research local suppliers. In addition to the garden displays, lots of products such as body lotions were available for purchase from suppliers such as the Royal Horticultural Society. 

What does this have to do with pet care? For all topical creams, pet owners should ask is there any risk to pets that lick/ingest the product or consume the tube.

Human labeled lotions do not mention the risk of oral ingestion by pets. For example, Desitin Diaper Rash ointment is very toxic to pets since it contains zinc, and once ingested it leads to destruction of red blood cells and kidney failure. A new concern recently reported is pet exposure to human ESTROGEN-containing, topical creams (hormonal replacement therapy) to counter menopause side effects in women. 

WHAT ARE SOME OF THE SIGNS SEEN IN PETS WITH EXPOSURE TO LICKING THE ARMS OF OWNERS ON HORMONAL REPLACEMENT TOPICAL CREAMS?

Most commonly is hair loss without itching on the thighs, flanks, and neck. The side effects are dose per pound dependent, and it seems to be more of a risk in small dogs sitting on the laps or in close proximity to owners prescribed estrogen containing topical medications.

HOW IS HAIR LOSS DUE TO EXPOSURE TO HUMAN HORMONAL TOPICAL CREAM DOCUMENTED?

Besides the history of exposure, blood levels of estrogen (estradiol) are performed on the pet. IN SOME CASES a skin biopsy is performed along with testing for other hormonal conditions such as a low thyroid or an adrenal (steroid secreting) tumor. 

WHAT SUGGESTION SHOULD BE GIVEN TO OWNERS ON TOPICAL HORMONAL THERAPY?

Apply the cream in an area the dog cannot lick and dispose of the application gloves safely so a dog cannot retrieve or lick the gloves. If gloves are not worn for application, a small amount of the hormone can remain in the owner’s hands and be transferred to pets while petting. In addition, some pets seem to show signs by simply cuddling (aerosol exposure)  with owners over long periods of time, so be alert to that possibility. There is some risk of transfer on bedding or clothing as well. In summation, stop the exposure!

BESIDES THE HAIR LOSS, WHAT RISKS ARE TO THE PET?

Concerns include suppression of the bone marrow’s production of red blood cells (irreversible anemia), enlarged vulva, and signs of coming into heat (bloody vaginal discharge), and breast tumors that grow in the presence of estrogen.

 Veterinary Quiz

What do you think this kitty ingested? 

Answer: Sewing needle!

Betsy T. Sigmon DVM, ABVP Diplomate Canine and Feline Practice

Hospital Director, Creature Comforts Animal Hospital

Below are some additional trip highlights.

Degenerative Myelopathy

                                                       

On my day off, I often volunteer in the community. One service project, Pan Lutheran Ministries, has some apartments near Big Wake Hospital to provide free, short term housing.

I was asked to help clean up an apartment for a family with a member in the hospital. I was expecting a sparsely furnished apartment. As I knocked on the door, it was actually very well furnished, and the occupant seemed very surprised by an offer to clean and bring in cleaning supplies. Unfortunately, I I didn't realize I was actually  starting to clean the apartment of an actual renter across the hall from the Pan Lutheran Ministries apartment. I was thinking one thing and it turns out I needed to be in an entirely different place. 

Similarly, many older pet owners observing dragging of rear feet or nails think they are coming in for an examination for arthritis. Ultimately the workup up often leads to an entirely different direction and diagnosis.

On examination, there may be concurrent stiffness or decrease in range of motion in the joints. However, in many cases when the neurological exam is performed, a decreased perception of the location of the rear feet (proprioception or knuckle test) is noted. One such cause is a degenerative nervous system condition such as Degenerative Myelopathy.

WHAT IS DEGENERATIVE MYELOPATHY?

It is a slow, progressive disease of the nervous system, which involves the spinal cord and a dog’s ability to walk.  This will eventually lead to rear-end paralysis over several months to years. 

ARE THERE SPECIFIC STAGES OF THE DISEASE? AGE?

The condition initially starts as a subtle lack of picking up the feet in one rear foot or the other. Eventually it leads to staggering, uncoordination, weakness, muscle atrophy, and finally, paralysis in both rear limbs. The front legs do not appear to be involved and the condition is not painful. Most dogs with the disease are middle aged or older. 

WHAT IS THE THEORY BEHIND THE STAGES OF THE NEUROLOGICAL SIGNS?

Veterinary scientists believe that similar to the insulation around transmission of phone lines, the spinal cord nerve fibers are insulated by myelin to enhance signaling between the peripheral legs and the brain. In degenerative myelopathy, the signal is interrupted especially in the caudal spinal cord. The cause is reported to be a DNA mutation in a gene called superoxide dismutase 1 (SOD1). It appears similar to the human ALS (Lou Gehrig’s disease).

WHICH BREEDS APPEAR MOST AT RISK?

Here is a partial list of breeds recommended by the OFA to be tested:

American Eskimo Dog
Bernese Mountain Dog
Boxer
Cardigan Welsh Corgi
Chesapeake Bay Retriever
German Shepherd Dog
Golden Retriever
Great Pyrenees
Kerry Blue Terrier
Lancashire Heeler
Pembroke Welsh Corgi
Poodle
Pug
Rhodesian Ridgeback
Shetland Sheepdog
Soft Coated Wheaten Terrier
Wire Fox Terrier   

IS THERE A SPECIFIC TEST TO DIAGNOSE DEGENERATIVE MYELOPATHY IN PATIENTS?

No, it is a disease that exclusion of other diseases such as spinal cord cancers and intervertebral disk disease is required via radiographs, MRI, and spinal fluid analysis to rule out other causes. It can only be conclusively diagnosed with a biopsy of the spinal cord in a deceased dog.

I'VE HEARD THAT THE ORTHOPEDIC FOUNDATION FOR ANIMALS HAS A GENETIC SCREENING CHEEK SWAB (SALIVA) TEST. HOW DOES THAT WORK?

Pet owners can order a test kit ($65) via the website http://www.offa.org/dnatesting/dm.html  

The test helps veterinarians, breeders, and owners determine if a pet carries the trait: no genes (very low risk to get the disease), one gene (low risk), or both genes (at risk of developing the disease and passing the trait on to offspring).

IS THERE A TREATMENT FOR ANIMALS SHOWING SIGNS OF THE DISEASE?

There is no specific treatment found to change the course of the disease. Physical therapy, walking, and swimming are felt to delay the muscle deterioration and weakness.

Betsy Sigmon DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline Practice

Hospital Director, Creature Comforts Animal Hospital

Cary, NC

Dog Bites: Getting Back in the Saddle Again

There is rarely a week that goes by that I do not receive a phone call concerning a dog biting a child, neighbor, or another pet. It is also a normal occurrence during the week, for yours truly, to be scratched or have near misses with bites. So what happens when the veterinarian gets bit? Well, this was the week for me. After 34 years, a dog patient, without warning, went for my face. Lucky for me, it missed my eye. Sadly, it did not miss the upper left side of my face. The front team cancelled the remaining appointments, and I went to the plastic surgeon. Many prolene sutures later, the doctor’s skilled hands brought things together. AND, I, like so many of my patients, have been vaccinated for Rabies. 

Why do I share this with you? Unfortunately, every day this is a risk for any dog owner or individuals that work with animals. This is the reason it is recommended that team members, when possible, hold animals in the office during the examination. Dog bites are 90% of all bite injuries reported. Over 4.5 million dog bites occur each year in the United States, with a minimum of 20% needing physician attention and 30,000 requiring reconstructive /plastic surgery. Note: With 75 million dogs in the United States, the CDC feels large percentages of bites are under reported. Children between the ages of 5 and 9 are more commonly involved. 

WHAT IS THE PROTOCOL AFTER A DOG BITES A PERSON? Once there has been a puncture of the skin, BY NORTH CAROLINA PUBLIC HEALTH LAW and animal control guidelines, a local animal control officer must be contacted within 24 hours if medical attention is sought (physician, emergency room). 

HOW IS THE CARY POLICE DEPARTMENT OR ANIMAL CONTROL INVOLVED?  In the event of a bite at our hospital, the officer comes to take a case report, find out the address of the pet owner, and see if immunization is current. In the event the owner lives in the county, Wake County Animal Control or the sheriff’s office will be referred the case. 

IS THERE MORE CONCERN ABOUT SECONDARY INFECTION OR RABIES? In all cases, there is a risk of secondary bacterial infection and a need for antibiotics is often necessary as the mouths of dogs are dirty (contrary to an old wives tale). Rabies status (current depending on the age and when last administered) can have significant bearing on the case. In my case, the patient was past due by 4 months but had received a rabies immunization as a puppy and one year later. 

WILL THE DOG HAVE TO GO TO AN APPROVE QUARANTINE AREA? That will depend on the animal control officer under guidance of the local health director assigned the case. NCGS 130A-196 requires a 10 day quarantine period with proper restraint, observation, and confinement. The local health director is responsible for designating the place of confinement, which could be a veterinarian’s office, a public or private animal shelter, or even the owner’s property. Regardless of where the animal is confined, the owner is responsible for any costs related to the confinement. An owner who fails to confine the animal as required by the health director will be guilty of a Class 2 misdemeanor.  Questions that may be asked include: Was it a provoked bite or unprovoked (no warning)? Or, is there a history of reported bites by the pet in the past?

 http://epi.publichealth.nc.gov/cd/rabies/control.html

WHY THE 10 DAY QUARANTINE PERIOD IN PREVIOUSLY VACCINATED ANIMALS? This is the time period health officials determine if the animal is at risk for the shedding/passing of Rabies in the saliva. If there are no neurological signs, then the pet is released from quarantine. 

Dr. Betsy Sigmon, Diplomate American Board of Veterinary Practitioners

Creature Comforts Animal Hospital

Cary, NC

Copperhead Snake Bites in Dogs: Is there a doctor in the house?

 As North Carolinians celebrate a glorious spring, there has been an upswing in copperhead snake bites starting last week at Creature Comforts. Although Caylee Lee would have preferred to not be the winner in this lottery, nevertheless,  her ticket was drawn last week. This unfortunate encounter resulted in an overnight stay in the Creature Comforts Hospitality Suite, as well as 24 hours of fluids and supervision. 

What are the signs of a snake bite in your dog?

Most commonly, there will be bruising, pain, and swelling that spreads rapidly, although the puncture site is not always found. Some bleeding at the puncture site is often noted. This is due to the venom of crotalids (Pit Vipers) which contains toxic protein components which leads to tissue damage, shock, and low blood pressure. The crotalid family of snakes includes copperheads, rattlesnakes, and water moccasins (cottonmouths). These snakes have triangular heads, cat-like eyes, and are thick-bodied.  To identify snakes found in North Carolina, two good websites are: http://www.ces.ncsu.edu/gaston/Pests/reptiles/copperhead-1.htm

http://www.livescience.com/43641-copperhead-snake.html

When should a client seek veterinary care?

Immediately! Carrying your pet to the car and remaining calm is important. Do not apply ice, apply compression, make cuts in the skin, or attempt to suck out the puncture sites. 

How are they treated?

Most copperhead bites are dry bites (little to no venom) so anti-venom is rarely used due to both the extreme expense and lack of true need. Typically intravenous fluids, antibiotics, pain control, and anti-shock therapy are employed to combat shock. For patients with facial punctures, monitoring for breathing difficulties due to acute head/neck swelling that may include an emergency tracheotomy is critical for the first 12 hours. In addition, blood work, electrocardiogram, and blood pressure monitoring may be recommended in the estimated 24 hour hospital stay. 

What is the prognosis?

This depends on the size of the snake, the amount of venom injected, the location of the bites, the size/age of the dog, and the time lapsed prior to treatment. The area around a swollen puncture site may become extremely discolored and even slough several days later.  In people it is estimated over 8,000 people are bitten by venomous snakes (45,000 bites of venomous & non-venomous snakes) each year; yet only 12 of these bites are fatal. There are no similar central data figures available for pets. North Carolina leads the nation in crotalid bites as copperheads tend to strike rather than leave when confronted. 

What actions lower the risk of snake bites in their yard?

Keeping debris away from your house, cutting the grass, avoid storing wood against the house, and trimming shrubs are important landscaping tips. When out with your pet this time of year stay on open paths, especially at dusk. Avoid allowing pets to explore under logs, and when they appear super curious about something in the yard back off when possible. 

My thanks to Bella Willoughby and Caylee Lee for the photos.

Betsy Sigmon DVM, Diplomate ABVP Canine & Feline Practice

Creature Comforts Animal Hospital

Cary, NC

Key West at Sunset