Hello, it's Anthony Chadwick from the webinar Vet welcoming you to another episode of Vet Chat this time around our miniseries around what is a a massive problem, but also so much progress has been made and that's around veterinary oncology. Very fortunate today, it's always great to hear from the other side of the pond. We've got Rachel Venableable with us, who is the proprietor at Pet Cancer Care Consulting.

We're gonna be talking about that. In a bit is also board certified in oncology. Rachel, it's great to have you on the podcast.

Thank you so much. I I'm so excited to be here. Great, and perhaps, Rachel, just for people who aren't familiar with you, certainly on this side of the pond, perhaps you can just give us a little bit of an introduction.

When did you first of all decide to be a vet? It's always a. Interesting one to to know.

You know, I'm one of those. I was actually older. I was in high school, you know, a lot of people you hear ever since they were little kids, they've known and I grew up on a farm, so I'd always been around animals, I'm from the, the centre part of the US.

I'm from Missouri. And so I knew I wanted to work with animals, but originally I actually thought zoo animals. So when I was in high school, I did a job shadow at a zoo.

And that's where I realised the zookeeper. So basically the people cleaning up after the animals had, you know, higher education, had difficult college degrees, and I was like, well, I want to do more than clean up after animals, and so then I really started thinking about the vet cause the zoo vet got to do a lot and so then I went back to my hometown area and started hanging out with vets and just fell in love with it then. Fantastic, and then obviously you went to Missouri for your first degree for the veterinary degree, and then I moved around doing internships and residencies, so perhaps just tell us where you've where you've been doing those.

Yeah, so I went to a vet school at the University of Missouri, like you said, that's where I'm from. A lot of times in the states, you kind of go to the, the state school where you live. And then my internship was at the University of Georgia, and then residency was at Colorado State.

So it was fun to kind of move around the country because Georgia is very different than Colorado, which is different than Missouri. And also you get to see how people practise medicine differently and different diseases, you know, the stuff we saw down in Georgia, I did not see in Colorado. You know, Georgia, everything has fleas and ticks and heartworms.

I, I don't know if you guys get some of that stuff out there, but, you know, Georgia was like, if you missed one month of your heart guard, the dog was positive. They always had heartworm versus Colorado. I remember one time.

We found a tick and it was even one of the faculty, and they freaked out cause they'd never seen one. They didn't want to touch it, you know, so it's just very different. Yeah, I mean, it's such a massive country, isn't it?

And I, I'm, I'm sort of with you in that I went to my very local vet school, which is in Liverpool where I'm from, but then obviously went off to do dermatology and I remember . Listening to Michael Dryden, who's Mr. Flea of course in Florida, and you know, going to somebody's house, one of the vet's houses, and there was a plaque outside the door and it said this is the house that the fleas built on so much flea treatment.

And then I remember I think speaking to Rod Rosicuuck who was based at Colorado State University, and he said we basically don't see fleas in Colorado because it's so high up, so yeah, it's . It's fascinating and then obviously Georgia, you're starting to get into the south and more almost subtropical diseases that are becoming more and more important, spreading with, with climate change and things as well, aren't they? Yes, yeah.

And then now I'm in Arizona, which we have our own, we've got valley fever, which when I was in vet school, I remember learning about different fungal disease. Missouri has a lot of fungal disease because it's very humid and the rivers and things. But I remember valley fever or coccidomycosis, you know, it was always one big test question, you know, like the Nali, that's our big certifying test.

There would always be one on there and it was kind of this, you'll never see this in practise, but it's a good test question. And now that I'm in Arizona, everything has valley fever. Like it's wild, it's, you know, a dog has coughing, it's valley fever.

They have seizures, it's valley fever. Like it's just, it's wild. And how do we, obviously going a tiny bit off off oncology for a second, but how do you treat that, and it's interesting, it's.

Very much with all diseases, you know, cancer can often be on that differential, but treating and diagnosing for cancer is, is the first thing, isn't it? So presumably as an oncologist. You see a lot of things that you have to first of all make the diagnosis, is it or isn't it?

Because people may refer things across to you as oncology, but actually you then discover that it isn't, and I always talk about these reactive lymph nodes compared with, Neoplastic lymph nodes, it can be quite a a difficult diagnosis to see is that lymphocyte reactive or neoplastic, isn't it? Yes, and I, I feel like for a lot of vets, the diagnosis, that's because they're the front line, right? They're the ones that they come into.

Normally we, it's pretty well honed down or, you know, when it comes to see me, we've already kind of ruled out a lot of things and so I think for vets, something to keep in mind, especially any lump or bump, you know, really. And the needle and syringe is your best friend, right? I mean, if you can aspirate it, just do it, you know, I mean, sure, there's some things that it's just gonna come back blood or fat, and maybe that's what it is, right?

Maybe it's a lipoma or something, but I think so often cause even valley fever, going back to that can present as multiple lumps on a dog. But if you aspirate those, it's all this inflammation, it looks very odd compared to like if it was a mass cell tumour, you see those beautiful round cells and You know, I also always tell people, stay in at least one slide in the clinic because then you know, one, does this look like a lot of inflammation? You know, did I get a good sample?

Like, you don't need to sit there and scroll through and diagnose it for people. Like, that's why you send it to the lab. Have the professional tease through, you know, the slide, but I think for the vet, just make sure you got a good sample because if you are only seeing blood and fat, well, maybe that's what it is, but also you can tell the owner, you know, you can say, look, I'm not staining all these, but from what I'm seeing, it just looks like blood and fat, so that maybe what it comes back as, especially if you're worried, like it's something really hard, like you think it could be a sarcoma or, you know, you don't believe it's a fatty tumour.

Then you can tell the owner, you know, maybe we should jump to biopsy or if you do send in the slides and they come back blood and fat, I find the owners aren't angry because they were already kind of prepped for that, right? So I think it's so important to just sample, check it in-house, and then communicate with the owner. I must admit, funnily enough in Liverpool we don't see coccidomycosis, but I remember there were all these funny fungal diseases in Mullakirk and Scott that of course we just don't see in the UK but often presented as lumps and bumps and.

I agree, I think my most profitable tool that I had in the practise was my microscope. And actually doing cytology as a clinician, taking that sample, staining it with diff quick, mast cell tumor's very easy, I think for most people to do. But, but it, it helps you get better cos of course if you send it away.

And it comes back as something completely different than what you thought, at least you're learning through that, if you like, failure. But failures are often the best way to learn, aren't they, where you say, oh, I think it's a mast cell tumour and it ends up being something, you know, different or weird and wonderful. So I, I must admit I really enjoyed, doing cytology when I was doing more dermatology, cos I think it's .

It's a skill that we can learn and it's very quick, isn't it? We get an idea, is it a fatty lump? It's probably nothing to be too worried about, but, you know, the dog's insured or you're worried about it, let's get a second opinion from somebody who is doing this all day every day.

Exactly, exactly. It's so cheap, but you can charge, right? I mean, it's another thing.

I think sometimes vets, I, I don't know about in the UK, but I feel like in the US we're not always good about charging for some of those things because it seems so second nature, but it's like, no, the owners are OK to pay for that because it's telling them so much, you know, it can tell them, does it look concerning or not. That that's what they're, that's why they came to see you. Yeah, I know, you know, as I said, I think the microscope was a big profit centre for me.

Get a good microscope. Be able to go to those lower powers particularly or higher power, should I say for, for bacteria and fungus and so on, but it it's I think I found it, you know, very satisfying cos it does give you that immediacy of potential diagnosis doesn't it? And to take it completely off topic, there's nothing better than finding a scabies mate.

Do you, do you have those in Arizona? We do, but I'll be honest, I, that's one of those where I would just start itching, like I don't even know what to do if I would be like the faculty member that freaked out the all the tech. If I saw this scabies, I'd be like, oh.

I think now with all the good ectopparasiticides we've got, of course they're becoming rarer and rarer, but no that's great. So yeah, let's talk a little bit more about diagnosis. Obviously you are seeing cases sometimes with a presumptive diagnosis and it may not be cancer, new graduate coming out into Arizona doesn't know the state that well, sees a dog with loads of lumps and bumps, probably doesn't first of all think about valley fever.

But what are tips for, for vets, you know, all over the world, how do you go about diagnosing, what are the sort of tips and what are the, the things that can trip you up? I would say the first thing is to listen to the pet owner. I think often we kind of have our own agenda or we're in a rush, and, but they really can tell you a lot.

If they don't think their pet's doing well, we do really need to lean into that because they would know, right? They, they're with them all the time. So I think if they're telling you things like, hey, I just noticed this new lump, don't, don't just brush it off, right?

Like, pay attention. Or if they're saying, you know, they're really just not eating as well, or they're not getting around. So I, I do think it's important first of all, to really listen to what they're telling you.

And then on exams, especially lumps and bumps, you know, usually we'll say, you know, anything that's been there for more than a month, it's greater than 1 centimetre, firm, you know, those are things you at least want to put a needle in. I mean, yes, it could still be fatty, it could still be a cyst or something, but especially if the owner is bringing it to your attention. They want to know what it is and so it's so simple just to aspirate it.

And even sometimes lumps that feel soft, they don't even feel hard. You know, mast cell tumours are that great hider, right? They can look like anything.

And I've definitely seen these soft, ill-defined, you would have thought it was fat, but there's actually a mast cell tumour in there. So, you know, again, if the owner is like, I feel like this goes up and down in size, that should be a huge red flag in your mind that, oh, this could be a mast cell tumour. .

The other thing that I always like the dermatologists do, that I find a lot of general vets don't necessarily do this is the punch biopsy, you know, cause I, I get a lot from you guys, you know, cutaneous lymphoma, usually is it. And I find most of them, when I'm reading through the history, you know, they've had this history where they didn't respond to antibiotics or allergy meds, you know. They just had red skin or maybe they had sores, but sometimes it's just this diffuse redness, hair loss, and I feel like dermatologists, you guys just will do like a local, a little punch biopsy and you're done.

Like you don't make a big deal about it, you know, it's not like we don't have to put this dog under anaesthesia and schedule him for this whole big procedure like we can do this quick and we can get an answer. Can I share a little pet hate with you as a vet when a vet actually. Has a feel of a lump and says.

No, I don't think that's cancer. I mean that is like a superpower if somebody can just feel a lump and know if it is cancer or it isn't. I mean, do you have that superpower or do you still think cytology is that important?

I do think cytology is important. I do think there are some lumps, so like sebaceous adenomas, you know, poodles get those, they have a classic appearance on the outside, you know, so I do think there are some lumps where you kind of like, OK, I, I know what this is. But for the most part, you know, I've seen these weird pedunculated masses that turned out to be mast cell tumours or I've seen things in the the file where it says they thought it was an inclusion cyst that ruptured and it turned out to be a mast cell tumour, actually a really aggressive one.

So I've seen that a few times. So while it's tempting, like you say, to just feel it and be like, oh, that's nothing to move on. To me again, you're not really listening to the pet owner if they're, if they're bringing it to your attention, right?

If they're, if they're worried, then just take the time and again charge, make sure you're covering for your time. But, you know, evaluate that mass. It's, it's very quick.

And cause I, I've definitely had pet owners come to me where they're like, I had been telling my vet about this lump for months, and they just kept telling me it was nothing and then all of a sudden, you know, it really grew and now it's a real problem. So, I think too often we get busy and we just think like, oh, that's probably nothing and move on with other things. But again, that's that whole listen to the pet owner.

If they want to, if they're worried, we should at least check it out. I, I tend to as, as a person, you know, and as a vet, often think if I went to the doctor's with a lump and the doctor had a little feel of it and said, oh well it doesn't feel like anything, don't worry about it. You know, as a vet who knows a bit about clinical, I would not be happy with that.

So if we sort of think the way that we would think if it was us rather than the the dog or cat, it's a much more empathetic way of looking and as you said, if somebody's, I mean, obviously sometimes lumps and bumps are discovered by the vet at the clinical examination rather than the, the client feeling it. But if the client has come in. Just saying, oh it's a lump, it's probably benign, you know, this is cytology is, is so useful to help, but if in doubt, you know, it's a, it's a removal or as you say, .

Punch biopsies are really useful, I suppose the, the kind of exception is if you take something, a lump away and you haven't taken it away in clean margins, you can make things worse rather than better, can't you? So then that's the kind of exception where we have to be a bit more careful, don't we? And that's where I think aspirating.

Like if you've already poked that lump and you know, like, you know, oh, this looks like a fatty tumour, or, you know, I keep saying mast cell tumours because I feel like that's what people see the most. Because if you know it's a mast cell tumour, then when you go in to do surgery, you're gonna be prepared that, OK, I can't just shell this out, right? And so I think that really helps with that surgery that comes back incomplete, and then it's like, oh, what do I do now?

I have to tell the owner this, you know, so if you do just a little planning upfront, one, the owner is now expecting it, so they, they know it's a cancerous tumour, and they're expecting a bigger incision. Sometimes people People freak out about that, you know, the incision looks so big. So if you explain to them up front, and some of this, it doesn't need to be a long conversation.

I mean, you can just say this in a few sentences, but it's enough to prepare them. So mentally, when they see their dog, they're like, oh yeah, there's that scar they talked about. Yeah, exactly, yeah.

How are you feeling about that, we were very busy during the pandemic doing webinars and and conferences and of course it was at that time that Stelfonte was released. We helped to launch the product for VA . Seems a really cool product and it's always one I like to use as an example of why we really should be protecting our rainforests because potentially there are so many great medicines in there that we haven't yet discovered.

Is, is steelfonter a a product you like and and use in your practise? Yes, I, I like Stephonta. I think it's like most things.

I think it's knowing, you know, the appropriate use for it. You know, I, I'm not one that's gonna tell you, oh, everything gets Stephonta and just inject every mast cell tumour. I, I don't think that's appropriate.

I think surgery is still best, you know, if you can cut it and get it off, that's still ideal. But there, you know, we've all seen those mast cell tumours, especially on the limbs. That's usually where it's the hardest, where it's like, gosh.

I don't even think we can debulk this, you know, and so you're actually looking at removing, you know, multiple toes or the whole limb sometimes if it's higher up. And so I think it's a really great option when surgery is not a good option, or even sometimes on the head, you know, it makes me a little more nervous on the head, but people have had pretty good success and I, I always show owners pictures. I, I'll pull up the Vervac or the Steelfonta.

They actually have separate websites. But I'll pull up and show them pictures because, you know, a lot of people, they'll kind of grimace, but they're like, oh, OK, I can handle that versus, you know, like my father-in-law would pass out, you know, like there's some people that can't handle blood and wounds. So you just gotta make sure you got the right tumour and the right owner.

Yeah, well, I, I always think, you know, I do study, veterinary websites as well sometimes and vets, of course, like to show the vets in scrubs doing a, a, you know, a quite sort of aggressive piece of surgery, whereas I think most people just want to see pictures of fluffy dogs and cats, don't they really? They don't want to see the blood in the guts. Exactly, yes.

But listen, perhaps if we could talk a little bit about pet cancer care consulting, cos of course, and I don't know the stats and you possibly will know better than me, but there must be so many cases of cancer that never ever go to the referral that, you know, they're dealt with in-house or or they're not dealt with, you know, they're they're they're dealt incorrectly with. So I think there is a real place for advice, isn't there, for, for first opinion practitioners to be able to speak to people like yourself and and to get advice. So I'm presuming that pet cancer care consulting is very much peer to peer rather than you speaking to, to clients directly, or, or can you explain how the service works and perhaps a little bit of the history?

Yeah, thank you. So, yeah, pet cancer care consulting, which I know it's such a mouthful, but you know what it is, right? Like webinar vet, you know what that is, you know, I'm not a big fan of the nebulous names that you don't know what it is.

But, so it's a service I started a couple of years ago to exactly that increase access to care because there's so many people with pets and we know cancer is a huge problem. You know, it's, it's estimated about 50% over the age of 10, you know, have cancer or will get cancer and And, and the other thing, oncologists, there's not that many of us, depending on where you look, there's something like 450 to maybe 500 registered oncologists in the US and Canada. And so, and that just means registered, that doesn't mean they're still practising.

You know, so, and then on top of that, most of us are located in major metropolitan areas, which, you know, because that's where you would need to get that client base. But there's so many people that don't live near those areas. And so it's a service I've started to really help.

I, I love working with vets, trying to help them even practise a higher standard or just offer more options to their pet owners because what I do is I talk with the vet. But I'll actually talk with the pet owner too. So that's where I'm I'm kind of a hybrid from some of the other services, where I'll do a live video chat, with the pet owner, but it's also with the vet.

And I, the vet is very important. One, because sometimes things do change on exam. So I have them do a quick exam, or sometimes, you know, you read through the records and something may sound one way and then you see the pet and you're like, oh, wait, that's not what I was actually expecting.

And so I, I like having the vet and then also tell medicine laws wise, the vet needs to be there in most states. So it, it's a nice way because I feel like especially cancer, people just have so many questions, you know, and it's a lot to put on, like you said, the primary. At the first line, you know, they're just trying to see everything and trying to help people, and it can be impossible to know everything about everything.

And when it comes to cancer, it's usually loaded with tonnes of emotions and people already have other thoughts and experiences. And so I feel like that, especially that initial consult, is really to just step-wise, go through what's going on, you know, what testing if we need to do any more, or, you know, what you would do for monitoring and then treatment and big picture. And I feel like a lot of people, whether they decide to do anything or not, they feel so much more empowered after having that conversation because now they know what to expect.

And I think having an oncologist do that, one, it, it takes that burden off the vet cause like, you know, like I said, you can't know everything. I mean, God forbid somebody come to me with an ear infection. Like, I don't know what to do.

Go, go see your vet, right? Like I can't, you know, so I understand, especially cancer is not every vet's forte. And the other thing I found after doing this is pet owners are so much more comfortable when they're at their vet's office.

I think because they've already been going there, they have a rapport, they, they know everybody. It's not all this newness versus going to a new specialty clinic. It's all new that, you know, there's just that extra level of stress.

And so I, I do find they love being with their vet. And they also love when their vet can do that for them, where they don't have to drive maybe several hours or, you know, for some people it's just going somewhere new, you know, I feel like distance, it very much depends on the person. Some people will be like, oh, that's 20 minutes outside of my bubble.

I won't do it, versus other people are like 2 hours, you know, and so everyone has a little bit different perspective on that. I think it's a really, really nice model because obviously there's been all sorts of telemedicine models come out, you know, post pandemic. One of the things I like to pick up on in this way, with you having the much closer relationship with the first opinion vets.

It's a real opportunity for educating and learning for the first opinion vets as well because it it's nice if, if they're picking up the more common things and then they're not ringing you about those, your referral vets are then. Actually sending you the more taxing and interesting cases, you have to think about it a bit more, which makes it more satisfying and, and more of a stretch for you, doesn't it? Yes, and that is very true, you know, some of the, the, the tumours where, you know, I see on my schedule and I'm like, this doesn't even need an oncologist, you know, now sometimes that's pet owner driven because they just heard cancer, so they want to see an oncologist, but But I do, I think, I think having the vet know what the different options are and there's, there's so many more pill options, you know, I, I don't know about the UK, but in the US, you know, you, you have to have a lot more special equipment for IVs, you know, we're worried a lot more about handling these days than we were, you know, like back when I started a while back.

So I think that's a nice thing for vets cause a lot of them don't even know those pill options exist, and a lot of times pet owners, they would prefer pills if it's a good option, you know, so it's kind of going over what all the options are and and what to expect with them. And it's interesting cos America certainly for CPD is very regulated compared to the UK and yet in the UK. We have the, the cascade system which stops us using certain medicines, whereas in America I believe there's quite a lot of opportunity to be using some of these monoclonals that are coming out as human medicines, but are having some success with with animal tumours as well.

Yeah, we've got a bit of free range over here. It, it seems like as long as it's been FDA approved for some species, we can use it. But there is a whole debate over that, like you brought up monoclonals, which is a great topic because, you know, we have all this data on people because, you know, to get it FDA approved, you, it's, it's a lot of work.

But then we're kind of trying to piggyback off that and veterinary, but the problem is we then don't have like the pharmacology data, so we don't really know like what, what is the optimal optimal dose? Are they absorbing it? So there's this whole pretty fiery debate if you actually hear some of the topics.

Yeah, brilliant and. Who knows, we may get a mention of that at Ama in in Texas in in June, which I'm, I'm hoping to get to. And I know you're speaking at it.

What are you going to be speaking about at at AMA this year? So I'm gonna talk about one of my lectures is what oncologists wish the GP knew and did, so really walking through like. You know, cause I think there's always sometimes that disconnect when you're the first line vet of like, well, what, what do they really want?

Do I just punt immediately, you know, do I just send them the case immediately or should I do some stuff, or are they gonna repeat it all? So anyway, really going through what the oncologists would like, right? And just kind of what vets can do.

So that's, that's one of my talks. And then the other one I'm going over different advances, so different tests. And therapies that are out there, but also kind of highlighting some of the issue that there's not a lot of oncologists.

And so to try to, you know, even oncologists to keep up with all this stuff, you know, I go in a little bit about teleconsulting because they've actually started doing that some more in paediatrics. So paediatrics, you know, in, in people with kids, it's very similar to veterinary, right? Your patient can't always talk or really explain what's going on.

And there's been some studies out of California which found that if a specialist got on, especially a video chat with like these rural hospitals where again access is a problem, they really found that it helped lower medical errors and also increase everybody's I can't think of the word now, but essentially happiness, right? The doctor word for happiness, because they were able to help work with the primary physician there in the rural areas in the family. And so they were able to figure out like dermatology was a big one.

They did a study on where they really found that The dermatologist could get in remotely, the diagnosis actually changed, like, I want to say it was like 60% of the time, you know, so it's, it's really helped in those areas where maybe those people can't, you know, go several hours to a specialty hospital. And one of the reasons I set up Webinar that, you know, 14 years ago when nobody knew what a webinar was, was very much by virtualizing it, you, you're saving people's time, you know, I used to at the end of an evening surgery, jump in the car, travel to Manchester or Preston to do an hour of CPD CE as you would call it in America. Have a drink maybe in the bar with some colleagues and then get home at midnight and that one hour of CPD had cost me 5 hours.

You know, similarly, when I did dermatology, yeah, I probably knew a bit more than the average GP but the biggest blessing I had was to have an hour with the clients because you can learn so much more in an hour. And of course if we're struggling with time. If we can save that client from having to spend 3 hours, 2 hours in the car, you know, going to Arizona and then going home from Arizona, you know, 6 hours is a massive amount of time, isn't it, which allows them to do other things, and as we said before, if at the same time, the, the doctor in the community hospital or the vet in the, you know, rural town.

Is learning as well, that's a, that's a beautiful sort of combination, isn't it? That is, yes. Well, it's really fascinating, I think, what you're doing with the service because it's quite unusual in the sense of with a lot of telemedicine, it's either, you know, the, the, the .

The client is speaking to somebody who's never been their vet before and doesn't really know the animal, or it's, you know, vets to their client, but at different hours to make it easier, and then often with the telemedicine, it's, it's vet to referring vets, whereas this is bringing. All three people in plus the dog or cat at the side, and I think it really helps, it's a much more holistic approach than maybe some of the other strategies that we're thinking about. I, yes, I totally agree, and I, I think it's, it's nice cause there's times, like I said, the vet will say something or show me something that like when I was reading the record, like if I had just saw this pet at, you know, my specialty hospital, I would have missed that.

Like I didn't quite catch. In the records or the history. So it is so nice to have us all talking together.

And again, I, I find a pet owner, they also feel more comfortable because they're already comfortable with their vet and then when you bring in somebody new, if their vet is agreeing, then that makes them feel more comfortable too. Exactly. You know, before we finish, obviously it's been great to to hear about that.

You did your masters in new treatments of oncology. We've talked a little bit about the monoclonals, but what is the one treatment that gets you the most excited for the future? I'm excited for the immunotherapy, you know, I, I, they've been looking into this, you know, honestly, century, the, the vaccine, you know, from the tumour itself really came out over 100 years ago.

And what we found is it only works in a very small population of people, you know, cause it's kind of, well, if your immune system didn't recognise the tumour is for the first time. Injecting it again, they don't always recognise it, you know, so that's why that doesn't work. And then in the 70s, there was a lot of work with immunotherapy, but then they had bad side effects, so it kind of went away to the wayside.

But now checkpoint inhibitors, that's something in people that has taken off in the last decade or so, like Keytruda is one that I've seen a lot of commercials for. And in dogs, we just came out with one, it's by Merck called GilvetM. And they studied it with mast cell tumours and melanoma.

So that's kind of where it is at the moment. But I think that could be really interesting because we're not seeing as much side effects. You don't have to have all the special equipment to give it, you know, it's just trying to use another part of the body because I, I think treatment for oncology, especially if it's a more advanced cancer or really aggressive, you're gonna need multiple therapies, you know, unfortunately, it's not just one.

And done with something aggressive. So I think having other approaches to go after the cancer, I really think immunotherapy is gonna be that next tier that hopefully will really help to, to move the needle because we have so many cancers that we really haven't done much with in the last few decades. So it would be nice if we could find something to really help move that survival time needle.

And as you were saying, you know, a lot of tablets coming in, is Gilvetmab a tablet form of chemotherapy? No, it is an infusion. So it is something you have to go to the vet's office.

I want to say you give it over like half an hour or so. So it is an infusion. Unfortunately, it's not pills.

But I do think it'll be interesting to see how that works. And you know, we're still looking for other monoclonal antibodies and things in dogs, and so we'll see, see where the future, you know, they're getting that in people, so hopefully the future in dogs will find and cats. Nobody ever looks in cats, but hopefully at some point we'll get some cat products.

Yeah, brilliant. And is Gilgat now licenced in America or are you still waiting for that? It's conditionally approved.

So it's that middle of the road where essentially the, I, I think it's USDA. So we have USDA and FDA are the two big regulatory bodies when it comes to drugs. And so they're basically saying, OK, look.

Safe enough, you can start trying to sell the product to now get more data. So, you know, it's something where you definitely have to tell clients like, hey, we're still learning about this, but this is what we've seen so far, you know, this is what's been reported and then hopefully, I'm not sure what the timeline is. I would guess, usually it's like 3 to 5 years, something like that, that they would get the full approval.

Like I said, I'm not sure where it is for this drug, but somewhere in there. This is the exciting thing about going to conferences like Ama because I can remember as a dermatologist hearing about Apaquel and cyto Point, which is obviously a monoclonal. And we knew it was coming and then it came and things and so it's something to look forward to in in the treatment of oncology.

So I will look out for Merck's Gilvet map and remember you heard it here first on on vet vet chat. Rachel, it's been absolutely fantastic speaking to you, hoping that maybe we might do a face to face if I get over to to Austin in the in June time, but . Thank you so much for spending time, I know how busy you are, really appreciate it and love the model of the cancer care consulting, as you say, it does exactly what it says on the tin, er, which is always good and just wish you continued success with it.

Oh, thank you so much. It's definitely been my pleasure to be on your show. Fantastic, thank you so much, Rachel.

Thank you everyone for listening. This has been Anthony Chadwick from the webinarets and this is Vet Chat, the number one veterinary podcast in the UK coming into America as well. So it's it's great to have you on and hopefully see you on a podcast or a webinar very soon.

Take care, bye bye.