Hello, it's Anthony Chadwick from Webinar vet welcoming you to another episode of Vet Chat. Really pleased today to be speaking to Sam Neetballa, who is the CEO of Cryo Concepts, a company that develops and manufactures and sells cryosurgical and cryotherapeutic products licenced in the UK by MWK. Great to meet you, Sam.
Thank you, Anthony. It's good to be on the programme. And it's great here we were, we were chatting before.
Serial entrepreneurship, obviously a history in Chemistry first. So tell us a little bit about maybe your history and then we can talk more specifically about cryosurgery. Right.
So yes, I, I actually have a master's degree in clinical chemistry and a PhD in chemistry. Spent most of my time working in, medicine, specifically in medical devices. Some of the time, working on in vitro diagnostics, so a lot of, test development for infectious disease, drugs of abuse.
Examples being, HIV, tuberculosis, tumour markers, and, and really along the way had also been exposed to, the earliest of products in the 19. 90s, yes, I'm that old, working in cryosurgery and in those days, these were the first products that were portable products and moved away from the use of liquid nitrogen. So I've been Working in that field for a long time over the counter, so, you know, within the UK you'll see products made by Scholl's or Cryotag, which is another product that you'll see in Boots, and more recently had become interested in veterinary.
And, and maybe we can, you know, tell me which direction you'd like to go from here. Yeah, I mean, I suppose it's really interesting just going back onto your history with the HIV testing the tuberculosis testing. We're all now experts at testing.
We all know what PCR and what lateral flow tests are with the big With the big COVID pandemic that we're hopefully getting towards the end of, but all of this technology has been so useful in in also helping us to control and see what's going on with the pandemic, hasn't it? Oh, yeah, if you think about it, in my days, which were, you know, 10 years. Ago or so, working on these rapid tests, those were the first ones that really went from just telling whether you're pregnant or not to something much more serious because again we don't die from pregnancy, but we do die from many of these diseases.
And in the earliest days of HIV, which is a lot of my background, you know, we didn't even know what it was. And so those were really the pioneering days of people, figuring out first how to do it in laboratories and then later, the challenge was to do it at point of care or point of meeting because of the people living on the streets, lifestyles and that that's how we interceded. And stop the spread of HIV.
So it was really a, a different time entirely and, and, you know, in my life, that was where we were really trying to solve a big problem that impacted a lot of people. And interesting with HIV that it took Many years to really get to the bottom of the genetic footprint of it, you know, it's and so on, whereas I suppose what it showed all the developments that we've had, you know, being able to map the human genome, how quickly we were able to work out, you know, what was going on, what the virus was that was involved with coronavirus and how we could then go on to create a vaccine in a year has been. You know, little short of a miracle, hasn't it really?
Oh yeah, yeah, the people who are behind that just invested everything to solve the problems, especially around COVID and did a phenomenal job. It's, it's going to be with us now forever, but we, we've taken it from just like we did with HIV from where it was a death sentence or a near death sentence to something that is much more manageable. Yeah, no, well, listen, let's, let's talk about cryo.
I remember . As a young boy getting one of those terrible things on your foot called a verruca and going into the hospital to be cryoed and then of course I remember also like you, I would still say young. Coming from the 90s, doing cryosurgery in the veterinary practise that I worked in.
And then it seemed to almost die a bit of a death. It almost went out of fashion, but it's great to see, you know, the new tools coming back in very much portable, miniaturised as a lot of things are going now. Tell us a little bit about why do you think historically cryo has sort of been a bit up and down in its popularity?
Yeah, well, here's, I mean my synopsis is that when I, when I Looked at the use of cryosurgery and again, most of my experience up until the last years has been with the human side. You know, when we, when we're treated in our physician office or maybe something over the counter, it generally works and it's a very sort of mild treatment I would say compared to what we do in veterinary medicine. And I, some years back, I just kind of asked the question, why isn't it done in veterinary medicine more routinely?
And so I began to do the, the literature search and really what you said is true. If you go back to the 1970s and For maybe 20 years you saw it a lot in the UK. There was a veterinarian, Doctor Lane, who seemed to lead a lot of the publications and said this is how you do it, this is how it works, here's what you should expect, and it seemed to really fit a need in a lot of the practises and we'll talk about that in a couple of minutes.
But I think the issue was they were primarily using liquid nitrogen and liquid nitrogen is somewhat problematic to source because you can't store it in a container, it evaporates. So you have to periodically pay for somebody to come refill the tank, so to speak, or the, the vessel. And unless you're using it all the time, it really becomes more of a pain than a benefit to the practise.
Plus, if you spill it, it really runs the risk of, of, you know, suffocating those that are in the room because it evacuates the oxygen. So I think Although it worked, the problem was really the convenience of the materials that had to be used or a lack of convenience, and so it sort of faded away and, and, and as you know, in the veterinary practise, you know, time is precious, so you, you kind of weigh what are the options and cryosurgery just became, I think kind of painful to . To perform.
So you, you leave it behind for many years and we could fast forward to today, and in today's world, you, you know, the veterinarian is still under pressure for time, but now with cryosurgery, some of the changes, we spent about 2 years, working with, you know, general practitioners, not the dermatologists, but the general practitioners who are seeing lumps and bumps and lesions every day. But what they would typically do, and I'll, I'll speak to it here in the US, is they would wait for a dental, while the animal was under sedation, they would then, you know, cut or use electrocautery to burn out the lesion. But of course the problem there is it takes extra time, takes extra money then for the client.
And so nobody was really happy. So in many cases, what I found is the, the, the general practitioners would sort of avoid treating these things because it was more of a pain and danger of infection that it was worth, you know, the time and effort that I had to go into it. Now that's really fascinating and I, you know, I remember very well the, the liquid nitrogen man would come and and pour some liquid nitrogen into the canister and you had to use it from there.
What, what is the the gas that's now used in, in these treatments? So we use either nitrous oxide, which is the coldest portable gas at -89 degrees C, or we use a refrigerant called R410A, and that is, that depending on how you apply it will be anywhere from 52 to -74. And there's, there were a number of articles in the literature that actually use canine models where they studied at what temperature is it lethal to cells.
And as long as it was below -50 degrees C, I'm sorry, I have to keep saying C or F because I where I live. So C, you got 100% cell death and We know that as long as we're at that temperature or below, we're going to get an effective freeze. And so now you have the ability of bringing in materials that are adequately cold and going after the idea of how do we deliver them and beautifully, beautifully packaged, you know, much more convenient, as you say, than the old fashioned way where you had to make sure you had the liquid nitrogen in and it would only last for so long before it.
Dissipated, I suppose you know you you've explained it really well. It's that sort of client with a wart where do you bring it in just for the wart or do you bring it in and do a dental at the same time, whereas if you don't need to anaesthetize and it's in an easy place to to treat, cryosurgery was, it really came into its own for those small warts or skin tags and things, didn't it? Yeah, well, so think about it for a moment, and, and, and again, this was supported many years ago.
If I freeze something freeze the lesion adequately, what I do is immediately numb the local nerves. So I, especially in older patients, I don't have to use the anaesthetic and many times we, somebody might use a local, but I would say more often than not, they're not using anything because within a few seconds of applying the cold, I basically anaesthetize the local area and now I could freeze as many times as I want and the patient never even notices it. So, it really is a very convenient way to do this versus, using a scalpel or electrocautery where you must, you know, anaesthetize at least locally and of course, you're creating a wound.
Anthony, the one thing I want to point out that's different, and this was the aha moment for us when we were looking for the difference between human cryosurgery and veterinary cryosurgery, is that when you really look at the physiology of the skin and the way it's composed for, say, companion animals, you can be super aggressive with treating a companion animal, and their lesion. And never create an open wound because of the way they react. So you will get a scab that forms, but never will it go to a blister.
And that is the benefit compared to the alternatives which are going to create a wound. When you do, when you use cryosurgery, now the patient can go home, they, that area was numb, so they don't. Pick at it, lick it, scratch it, and then let it just go through the healing process, which, you know, we've surveyed our veterinarians and that's usually 2 to 4 weeks.
The scab falls off. There's pink healthy skin underneath, and now you've taken care of what used to be just kind of a pain to do and turned it into a new source of service for the practise. You know, and as you've said, I think the situation is similar in America as here, you know, we as vets and nurses are very busy.
We've just gone through a painful pandemic. We've had to change the way that we work. Many people have bought pets during the pandemic as well, so practise is very, very busy.
Once you need to anaesthetize an animal, it takes a lot of time. If it's an older animal, there's a risk involved in doing that. So there are A lot of advantages for smaller lesions, very sick animals that, you know, you don't want to put through an anaesthetic cry really fits in in that area, doesn't it?
Yes, absolutely. Now, we never, because of the temperature and the risk, we never Propose it be used for something like mast cell tumours. These are really focusing on those benign lumps and bumps and tags, maybe eyelid, tumours, mybomium, anal glands, those are, those are primarily the uses of the technology that we would say are successful, with the materials, the gases, and the deliveries that have been put together.
Do you find though with performing surgery around the eyelid, it's a very sensitive area. So do you do the vets often sedate animals in that situation so that they, you know, don't have the animal moving around as much? No, usually a nurse or technician who can hold the animal is adequate.
We, we will, pull down on the eyelid and then use a tongue depressor or something just to protect the, the eye from any ice or something that may come off during the treatment. But usually the something around the eye is like a 5 2nd treatment, so it's very quick and you might do that a couple times at 5 seconds. But no, it's, it's it's surprisingly well tolerated, especially by older patients.
You, you kind of see them go do whatever you need to do to me. I'm good, and, and they seem to tolerate this very well. I think it's a really important point you made, Sam, about Knowing what the tumour is, so actually doing cytology on the lump prior to actually freezing it is important because something like a mast cell tumour you can cause more problems if you're not removing it successfully and so on.
Yeah, absolutely. I mean, it's just, this is where the professional veterinarian will make that clinical call. Certain things like a skin tag or You know, an eyelid tumour.
I mean, they're not, they, they'll be differentiated, but in any case that's questionable when cytology is, is called for. Exactly, but again, you know, you have a tumour, it's in an older dog, it's a small lesion, you know, you suspect it, it's OK. Taking that tumour out, maybe to get a definitive diagnosis.
Yeah, you know, maybe be really difficult for the older dog. So there's definitely a space there for, for, for treating and and getting rid of the problem with, with cryo. You were saying you can be quite aggressive with it compared with.
In humans, what's the problem you see in, in humans because obviously you have these products across the counter like the skull products. Can they be misused by the clients? The ones that are over the counter as an example are much warmer.
So they can't, they're, they're not as aggressive as the ones that we would, you know, the products for veterinary cryosurgery. And so with veterinary cryosurgery, you'll freeze for much longer periods of time and there's just a few things that are keys to success. So one that we like to teach, which is a little hint, and again, some of these things.
Whether you use products through MWK or you're using something else, there's a few things that we've learned along the way. If you put an ice cube on whatever it is you want to freeze first and let the moisture and the cold help the patient acclimate, then, then when you apply the cold, it's not as much of a shock. So that's #1.
Number 2 is if you were treating something that's at war and say it's thickened with dead tissue, you should remove that dead tissue because remember freezing only works if there's moisture in the tissue. So, we call it a dremel tool or a file or something to take off the dead tissue, should be done. The third is, you always want to do what's called the freeze thaw cycle.
So you freeze according to the instructions and you'll see when you take off the applicator or cone that it's white, then let it, the thaw phase is pretty simple. Let it thaw till it returns back to flesh colour. When it does, then freeze again, let it thaw, freeze again, and depending on the thickness and location, you might do that 1 to 3 or 4 times.
. Again, you will not create a wound and we've, we've, we've done this in the early days we, we froze a couple adenomas on, I, I think of a few patients and we had someone that we nicknamed Bald Bob. We froze for several minutes. Now, the lesion came off wonderfully and the hair did as well, but then everything grew back within a few months and Bob went on to have a good lesion-free life.
Fantastic. And I just made a note there about free cycles, which you've obviously answered. I think that's the key if you let the free cycle go through, you then can make sure that you don't do it too many times.
And I suppose what's your success rate or the vets that are using the product, we all don't want to freeze too much. So are there cases where people have tried maybe 2 or 3 and then. When they've seen the dog back in a week, they've realised maybe they need to do a little bit more, or or does usually 2 or 3 sort of sort the problem out.
Yeah, usually, OK, so where the this is where the art part of it will come into it. So the bigger it is, the thicker it is. The more aggressive you have to be because you will always get something to come off.
The question is, will you get it to the margin that you want and so something that is large is going to be the most difficult. So I would say if you have a very large lesion, you treat it like going around the slices of a pizza. You, you go around in sections until you get the whole thing covered.
Smaller lesions generally are, are treatable in one session. The larger ones you can get in one session, but I would say as you get practise, you will understand how aggressive to be. It's, as you said, doing more of it, you get better at it, don't you?
Yes, absolutely. Obviously this podcast will be will be heard in in many countries, . How do we get hold of this?
I is this in in obviously in America also in the UK? Are there other places where the the kisses got to? Yes, you know, Europe, Australia, North America.
You can reach out to Cryo Concepts, and we will be glad to direct you to whoever carries the product in the territory you may be. We also have a lot of videos. We also teach various courses.
I, I, as we started out in the beginning, Anthony, we talked about how this was used. A long time ago and what I found is education is really the best vehicle and then once the vet, gets the practise at it now it becomes a tool that they can use routinely and, and the way it's benefited here to a great degree is that, these were often things that the veterinarian was putting off and really what it becomes is a new source of revenue as well for the practise because they can. Pet owners really dislike petting their companion animal and feeling these things at a minimum, not to mention in some cases they just become, you know, partially blocking the eye, etc.
It's uncomfortable. And so it's nice to have a simple tool that doesn't create problems for the vet, but rather a solution for both the vet and the owner. It's been great speaking to you, Sam.
I, you know, I love the tool looking at it now and I'm, I'm glad to see that those cyclical things that happened, cryosurgeries is back in fashion again. Thank you, Anthony. Thanks Sam.
