Hello, it's Anthony Chadwick from the webinar vet welcoming you to another of the UK's number one veterinary podcast, Vet Chat. And I'm super thrilled today to have Gillian Dank on the line. Gillian is a veterinary oncologist based over in Israel.
And so thank you for coming on, Gillian, and really looking forward to chatting to you about all things oncology and maybe a couple of other things on the side. Thank you for having me. So Gillian, that, that's right, the Hebrew University based, it's in based in Tel Aviv isn't it, or is it, it's based on a couple of cities, isn't it?
Yeah, so the Hebrew University is close to Tel Aviv. It's in Rehovo, which is a little south of Tel Aviv, and the Hebrew University Veterinary Teaching Hospital is much closer to Tel Aviv in a place called Ron Lezion. And that's where you qualified from as well.
Yes, I went to my veterinary school there, and I actually worked there for 20 years until a year ago when I left, but I spent most of my life at the Hebrew University. That's fantastic. And what I wanted to start, perhaps before we launch completely into oncology is one of the great assets that you have in Israel that one of your colleagues, Ron Ofre, who's done many ophthalmology lectures for, for me, talks about whenever I have him on the phone, he always asks me what the weather is like in the UK cos it's always sunny in Israel, isn't it?
Yes, almost always sunny in Israel. It's one of the wonderful things about Israel. As a kid, I grew up in Vancouver, BC, and I remember every day we woke up that it was grey and rainy, and then we moved to Israel, and every day it's got beautiful blue sky.
And when did you move, what, how old were you when you moved from Vancouver? 1415. But also a beautiful city, but it can be pretty cold, can't it, as well.
Pretty grey, yes. Yeah, yeah. I remember we had our dermatology conference there in 2012 and I walked up Grouse Mountain, saw beavers in Stanley Park, it is a amazing place.
Wow, yeah, I remember those. So lots of sun, and one of my sort of side hustles is I'm, I'm trying to facilitate the veterinary profession to become, more hopeful and more environmentally friendly and sustainable, and I know, we were talking just before the podcast about some of the fantastic stuff that's happening in Israel around solar panels. So perhaps tell us a little bit about what is possible there when government, individuals and business work together.
So one of the amazing things in Israel is the amount of sunshine that we get. And so different people have taken that to different levels, but even if you just walk around my neighbourhood, which is all apartment buildings and some kindergartens, everyone in Israel throughout the summer doesn't use hot water that is electricity heat electrically heated. We have the sun heating the water that we use to shower.
On every building, we have solar panels for heating our own water. And photovoltaics to to make electricity. And one of the most amazing things is when you drive through the desert towards a lot, which is at the most southern part, there used to be in some areas all sorts of fields of vegetables, and now you could just drive and you see fields of of solar fields.
That's what they're called in Hebrews, solar fields. So you just see kilometres and kilometres of solar panels, which is the new way that Israel is trying to get its electricity. And of course that makes it more secure.
We've just unfortunately had the war in Ukraine start and it made the government in the UK realise that it's energy wasn't very secure, so they're now starting to to work on that. But solar is free, it doesn't cost anything, and if it allows us to be more independent of the big energy companies who at the moment are charging exorbitant fees in the UK. Then it absolutely makes sense.
I've just had, solar panels fitted on my, well, I've had solar panels for 14 years, but I had a battery fitted recently and it's been fascinating to see how you can power the house in the evening, using the, the electricity that's been stored during the daytime when we do have a bit of sun. But even on dull days, you know, it's, it's just the ambient light that can, that can help, although obviously the sun is, the sun is better and. I'm hopeful to get 300 practises this year to actually put solar panels on their roofs, you know, to help and to reduce our requirement for gas and, and oil, which is obviously carbon and causes problems as well.
It's amazing. Yeah, I mean, presumably veterinary practises and the university has solar panels as well, do they in Israel? I think it really depends on here it depends on the way the roof is built.
So, so certain roofs, you can do it and some of them it's much more difficult. Anyway, we should get onto our main topic, which of course is oncology, and you've been an oncologist for over 20 years, left the university last year to, to do independent work. Tell us a little bit about what maybe are the big three changes you've seen over that sort of 20 year period.
There's been such an explosion of learning and knowledge, and let's face it, in the end, better outcomes both for humans but also animals who, who get that dreadful diagnosis of cancer. It's not quite the death knell that it used to be, is it? That that is totally true, so.
So I did my residency in UC Davis, and the main reason that I chose oncology, was because I really wanted to learn about how to help animals. And at that point in Israel when I came back to Israel after I finished my residency, most people thought, well, if your dog is diagnosed with cancer, let's put it to sleep. They didn't understand that there were other options.
I mean, even the other options that there were when I finished my residency. Those options have, have increased over the last 20 years. We now know that other chemotherapies that weren't even available at that time that everybody uses in practise pretty much daily, like palladia, has only been along around since then.
Tannovia is another drug that is very new and helping dogs live much longer. And I think one of the main areas where, Veterinary oncology has just jumped forward amazingly as radiation therapy, which at the very beginning was kind of point and shoot, and now it's beyond belief how specific they can get, even though I'm not a radiation oncologist, I can appreciate the amazing work that they do and they can really see a tumour and treat it and save all the tumours around, all the tissue around it. So I think it's really amazing how much we've come forward.
You just go to the best places, Gillian. I mean, UC Davis probably at that time was, if not the best, one of the best oncology universities in the world. Who were your lecturers at that time at and your tutors at that time in UC Davis?
I was very, very lucky to go to UC Davis and my mentors were Doctor Bruce Madewell and Doctor Cheryl London. So I was very, very lucky to have the best. Yeah, brilliant.
We had who was still there, so it was brilliant. No, we have quite a few lecturers who lecture from UC Davis as well. So from my, with my dermatology hat on, I love Stephen White, who I'm sure you remember from from those days in UC Davis.
So you, you, you presumably would never come to somewhere like Liverpool or London because there just isn't enough sun, is there? I hate to tell you that all my children want to do is come to the UK because all they want to see is Harry Potter. Yes.
No, brilliant and I'm also fascinated by lymphoma as well, the fact that you know, we used to see it as a kind of diagnosis and now we realise it's much more sort of personalised to the individual animal. Making that difference between a, a tissue that is truly cancerous and one that's just a reactive tissue, how do you, how do you deal with lymphoma in You know, in your clinical practise, how do you stage it and begin to think how you're gonna take it forward and treat it? So, so that's changed too, because when I finished my residency, we were still doing biopsies of lymph nodes, and we were still, we, sometimes we did immunostochemistry, but we really didn't use that information.
And now any lymphoma that comes into me, we'll do immunocytochemistry, because lately we've learned that whether It's a T cell or a B cell really does change the way we're going to treat it. And many papers have shown that if you treat T cells differently and not just with the CO protocol, that they'll live longer if you incorporate more alkalating agents into your protocol. So I think that that's made huge changes in the median survival times of T cell lymphomas, definitely.
And moving forward into Some of the new areas of innovation that we're talking about, both in the, the sort of diagnosis of the tumours as well, one of our words is innovation, and I know you've been starting to work more closely with one of the companies we're also working with an Israeli company called HT Vet. I was lucky enough to meet the two founders at London Vet Show and at VMX in in Florida, Shani and Gideon. Again, some amazing work going on just looking at scanning tumours to really get some idea as to how they might be behaving, you know, with within the animals.
So perhaps tell us a little bit about how you got involved with the company and and what how, how that's developing over time as well. So, while I was still at the university, I got a phone call from Shani Taledano, and she said, I'd really like to meet you. I have this amazing new technology.
It's going to change the way we diagnose tumours in dogs and cats, and I pretty much said, OK, whatever you say, because people call me all the time and say they have all of these wonderful ideas, and as you all know, it doesn't always work out. So I came to meet her and I said, that sounds interesting, but unfortunately, I'm a pessimist. So until I actually see that it works and I have a trial that proves that it actually works, I'm not going to get too thrilled about this.
And so what, HT Vista, the device, do, does, so actually there's an iPad and a handheld device, and that handheld device is put onto tissue, onto a tumour, and then it heats up the tumour for about 10 seconds, and then the tumour cools down. And so this device records the tumour temperature as it's cooling down, as it's heating and as it's cooling down. And based on those results and the thermal camera in there, they can give you a result whether the tumour is benign or whether it requires further diagnostics.
And the information It is based on the tumour characteristics which are very different between different tumour types and between tumour tissue and benign tissue. So it's really very fascinating and it's been very interesting to work with the company over the last couple of years. At the point when I started consulting for the company, there were very few people in the company.
Now there's a huge amount of people. It's just grown overnight. It's unbelievable to see.
And the first study that we did was a pilot study just in 45 dogs when I was at the Hebrew University, and we found amazing results. And based on that, we continued, and, and that was actually published just a couple of months ago in January in Frontiers in Veterinary Medicine, and based on that, we continued to a validation study. Which included many more dogs, over 400 dogs, and we got really great results, so it's very encouraging.
What would you say was the sort of positive predictive value and the negative predictive value, because presumably you go and you do the test and it tells you it's likely benign or malignant and. Presumably in the the study at Frontiers in vet medicine, you've followed that up with an actual removal of the tumour and, and to work out, you know, exactly what it is because obviously the HT Vista is really giving you that differential between benign and malignant, but doesn't tell you the. Tumour type, does it?
Not yet. So, so right now, so it's so the purpose of the of HT Vista is for general practitioners to understand whether they need to continue diagnostics. So the most important number that we need in this is the negative predictive value.
And at this point, the negative predictive value is about 97%, meaning that there may rarely rarely be a tumour that we missed, but 97% of the time. We're gonna know that benign is benign, and that's the, that's the critical factor in a screening test. And if you look throughout the literature at different screening tests, even in people, anything above 90% is pretty amazing.
Well, 97% is amazing, isn't it? Yes, so, so that's, that's the general factor. So, so we want people to use it as a screening test and then to continue diagnostics.
It's very obvious to us that we at this point, even though we are getting better results, we still have many false positives, but we feel much more comfortable having false positives than having false negatives. And when there is a false positive, you do the fine needle aspirin like you would have done anyway, but many of the cases you already sent home. Could the false positives, for example, if I, scanned a a an abscess, which presumably will have some heat in it anyway, is that where you are?
Yeah. More likely to get a false positive. Yes, many cases of inflammation, infection, abscesses, there are certain, epidermal tumours and cysts, epidermal inclusion cysts that have infection and inflammation in there, which you know as a dermatologist.
So those are the ones that we're working on that are false positive and hopefully in time we'll be able to diagnose those as negative. So things like kerato anthomas, for example. Yes.
Yeah. No, that, that's fascinating, and I suppose on the negative, 3%, you know, is a very low number, but can you also have a, a continuum where a tumour when it starts and you know, it's obviously not that malignant, but that actually kind of becomes more malignant and so at some point. If you were testing something and it was negative, is it possible to go back to that same lump, 2 to 3 months later and see a transformation from, What was, you know, potentially benign, but transforming into a malignant tumour as well.
So, so first I'll just answer the first part, the, the, the neg the, the cases that we missed, were all low grade mast cell tumours. And some people would say that in many cases, low-grade mast cell tumours may be more benign and mal than malignant even though we call all mass cell tumours malignant. But, but we do actually have some new of thermal imaging which is specific for mast cell tumours.
So in the future, the chances of missing mast cell tumours will probably decrease significantly. And to the second part of your question, so, so one of the tumours that we have not looked at at all with HTVSA mammary tumours, and the reason that I was against looking at memory. Tumours as an oncologist was because memory tumours are one of the only tumours that have been shown in veterinary medicine that they can transform as in women from benign to malignant, and I didn't want veterinarians to have the rationale and saying, OK, it's benign, now it's OK to wait and see because I know that they can transform and other tumours haven't been shown to transform.
After discussing this with many other oncologists in Europe, because we're just starting to do a lot of collaborations with people all over Europe and the UK, they said that they didn't agree with me because they feel that if we do know that the mammary tumours are benign, that it will change their surgical margins and they'll be able to do a more minimal surgery, but it doesn't mean that they'll leave it there, and I was OK with it. Answer. So now we're going to start a new study just on mammary tumours with all sorts of people from Sweden and Spain, Portugal because in Israel we don't have that many mammary tumours, but we need to go to areas where there are many more mammory tumours.
So that's one of the studies that we're going to start with our multi-central studies in Europe. I presume that that means that you spay your dogs early in their life. Yes, we certainly encourage it.
Whereas obviously in countries like Germany, it's still perceived as a bit of a mutilation and therefore it's much less common and therefore you start to see more reproductive problems, don't you? Yes, and, and they also, the, the oncologists that we discussed this with in Sweden, Portugal and Spain said that they see many, many cases of mammary tumours. And once the dog is of a certain age, there is really no point in spaying at the same time as removing the mammary tumours because there's less benefit, isn't there, or would you still always recommend spaying when you are doing sort of mammary tumour removals?
In most of the cases in Israel, we recommend if the anaesthesia is OK, we recommend spaying just to try to prevent pyometer and additional complications in the future. Yeah. Fantastic.
It was really interesting to hear you talking about mast cell tumours, which are, I mean that, it's always a terrible thing to say, but they are a, a fascinating type of tumour, aren't they, as well, the way that they, they respond, even in different species of, of dogs, as you said, some of them mast cell tumour sounds bad, but actually they can be quite a benign tumour in certain dogs, can't they? Yes. What has been your experience with the new Verbach drugs, Deelfontra, is that a drug that you've used much in, in Israel and how have you found that er working?
So, one of the interesting things about veterinarians, over the years is what, what I now see is that if there are certain either diagnostic tools or drugs that you were not taught about when you learn to be a vet and that they are new and innovative, it is very difficult to persuade veterinarians to, to be exposed and to use new diagnostics and new drugs. Over time and so what has happened in Israel is that because Telphanta is such a new drug, it's very hard to convince other people that they should try this. And so we're having some issues now trying to import it into Israel just because there's no, not enough people who want to use it.
But I was one of the only ones who used it in Israel. How well it was in Israel, and I can say that I think that it's, it's an amazing drug and, and that there are certain cases that it can really, really help them, and I wish I could use it more. But again, I think it's an example of education, education, education, and I think the same is it's the same with HT Vista.
If you have a new technology, if you have a new drug and you educate. Any kind of veterinarians, whether they got out of school last week or or 30 years ago, if you educate correctly, then they'll be exposed to new techniques and new diagnostics and and they'll become better veterinarians. But if they don't want to be educated, then it's really difficult.
I think it's, it's interesting cos obviously I set up Webinar vet 13 years ago, very much to make veterinary education, you know, for vets already qualified and nurses much more accessible and affordable and. For me, part of the reason why I kind of brought webinars in was because the bigger companies weren't looking outside, so it's so important that we do look outside and you know, with this particular drug found in a rainforest in Australia, it just shows the importance that we do remain innovative and open, and we actually did the . The sort of webinars for when Stelfonte was released, you know, to the, to the veterinary er community, both to the oncologists and the general practitioners.
And, and the results do seem amazing, but it, as you say, if you don't have a a growth mindset and if you don't have a lifelong learning perspective, then unfortunately these drugs and new technologies do get left behind. So it, it is so important to be open-minded, isn't it? Yeah, it really is, and I think that that as you're doing with webinar that that the education has to continue, it's not enough just to give one lecture on steelonta that you have to continue and and stuff like that, which, which is really critical for people to understand, because I think that the fear of new drugs is, is understandable.
When when Paidia came out and at the beginning they said there's so many side effects and, and everybody was afraid to use it and now everybody uses it. It's just a matter of getting used to things and feeling comfortable with them. Well, I always say it's with anaesthetics, and I understand that because you're anaesthetizing a dog, you obviously want it to come through the anaesthetic.
You use the anaesthetic that you're most familiar with and that you're most comfortable with. But if there is something that comes out that is so much better, you've also got to move with the times. So, you know, halothane was the anaesthetic that I used at the beginning of my career and then isoflurane became a much safer.
Drug both for humans, but also for the, the pets and particularly rabbits. I remember when you had to anaesthetize rabbits with halothane, you always said a quick prayer before you started because there was always a good chance that the the poor rabbit wouldn't make it through. So anything like a a a spay or a castrate you really kind of put off doing, although you thought it was good for the rabbit because you really didn't want to have the stress of the anaesthetic, so it is good to see these new products coming in.
And I suppose that brings us back. You know, I think it's so important to have products like HT Vista because we learn all the time that we use it and I know that . You're going to be in, you're only, you only go to sunny places because ECVIM I believe is in Barcelona this year, and without giving the game away too much cos you might have to hold that in.
But lots of interesting stuff that you're seeing now about how hot tumours can be and how that can help with diagnosis. So, although we're just at the moment looking at benign versus malignant, I suppose there's even a possibility of looking at what position a tumour is and what the heat is. That you'll be able to get perhaps a bit closer to some of the potential tumours, which then helps us if we are removing them, how aggressive we are in, in that surgery as well.
Exactly. So, so with the algorithm for HT Vista, with all this huge amount of information that we're getting based on all the diagnosis, and we've checked over 1,000 1000 masses by now, we also have information on what all these masses are, where they are in the body, which tumours are in different places, which is something that hopefully we will publish in the next couple of months. And, and we also have information on baseline.
With a thermal camera. So, so several studies have been performed in veterinary medicine on osteosarcomas, perineal tumours, mast cell tumours, and memory tumours with mixed results on the temperature, the baseline temperature, and those temperatures were were checked by very complex and expensive thermal cameras in specific situations where they had to bring in the dog and have them at a specific temperature beforehand. And what we're looking at is the delta between the temperature at the beginning of the mass versus the the healthy tissue beside it.
So there are no issues if the entire dog is warm or cold because you're measuring the same dog. And so what we've found is that tumours, several tumours may have differences in those baseline temperatures. Which is fascinating, and that's something that we hope to present at the CVIM in Barcelona.
And one of the most obvious differences that we've seen is soft tissue sarcomas, which the soft tissue sarcomas are much warmer than healthy tissue and then benign tissues and other tissues. And also something we can't, we can't prove yet because we don't have enough cases, but we're actually seeing a difference in the delta in grade 1 and grade 3 tumours. So in the future we may even be able to tell the owners and tell the vets that this is a soft tissue sarcoma based on the thermal imaging and the heating and the cool down and whether it's a grade 12, or 3, which would really help us as oncologists and obviously as general practitioners.
I think this is really fascinating and of course it's, you know, it's if you like HD Vista version one, as we do more and more and and look at more tumours, we're gonna learn more and more things about it. And this is very much a machine for the GP then, for the GP to be able to say with a very good degree of confidence, this is almost certainly a negative tumour, whereas a positive result. Would obviously mean further investigation, so for example, the first thing you might do is to do some needle aspirates.
If you pull a load of puss out, then clearly it's a, it's an abscess. But if you do pull cells out, it's then having that confidence, and it was one of the areas I loved doing is needle biopsies or, or cytology, spray the cell with H&E and then be able to see what sort of cells are in there and. This is something that, you know, I felt comfortable with as a dermatologist, but this is also a place where we can now send those samples off.
And again with some of the technology that's coming out, that's gonna help it actually ID the cells er much quicker than perhaps before with the help of AI and things, isn't it? I certainly hope so. And, and as you said, this again, this is for general practitioners at this point, many oncologists are going to get either have or we're going to get these but for collaborations with us on validation studies and memory tumour studies and several other studies we're going to run, we're even gonna start a CAT study very soon.
But, but this is meant at this point for the general practitioner, and the most important thing is to understand the results that you're receiving. So if you receive a negative, it's negative, but if you receive a positive, it means just like you said, to aspirate it. It does not mean to do surgery because we know at this point that it's suspicious.
It's not necessarily a malignant tumour, and we don't want to cause unnecessary surgeries. Yeah, definitely, and I'm so pleased . Gillian, a cat adopted me over the pandemic.
He came to live at our house, so it's, I'm on his staff now. And he usually actually comes and joins us on the podcasts and likes to sit on the computer, but he's, he's outside at the moment. So the fact that you're also working with cats is, is great news as well.
Yeah, we're just starting, we're planning to start that in the next couple of months, so it should be very exciting. Fantastic. Gillian, it's been so great to chat to you both about your career, about solar in in Israel, which I'm fascinated about, but obviously, mainly about the new innovation coming out of Israel with the HC Vista.
It sounds like it's a fascinating machine that we can do more and more with and learn more and more about, so I just encourage you, as you said, with an innovative head to carry on. Developing and and and improving and progressing the machine, so I'm really excited to, to follow the history and maybe let's get you back in a year or so to see See the new work that you and the rest of the team have managed to do over over the next 12 months. Thank you so so much for having me.
So if you think that this is really interesting and you'd like to hear more about HT Vista, you can come visit us at our booth at BVA booth 61. Thanks everyone for listening, this is Anthony Chadwick from the webinar Vets, and this has been Vet Chat. Thanks, bye bye.
