Good evening, everybody, and welcome to tonight's webinar. My name is Bruce Stevenson, and I have the honour and privilege of chairing this evening's webinar. Before I get started, I'd just like to say a huge big thank you to Volition Veterinary, for their sponsorship of this evening's webinar.
If it wasn't for this generous sponsorship, we would not easily be able to bring you these webinars. Little bit of housekeeping for those of you that haven't been with us before. If you have a question for our speaker, please just move your mouse over the screen.
A little control bar will pop up. It's usually a black bar at the bottom. There's a Q&A box there.
Just click on that, type your questions in, and they will come through to me and we will hold them over to the end, and then we will get through as many of those as what we can. Please remember that we are recording the webinar. So if there is something that you miss or you want to look at again, it'll be up on the webinar vet website in the next day or so.
And then you can go back and you can rewind and fast forward and stop it and look at anything that you'd want to. It is my great privilege tonight to introduce Doctor Sue Ettinger. She is an experienced veterinary cancer specialist, international speaker, and educator, known for making oncology practical, approachable, and impactful.
Sue is passionate about early cancer detection, raising cancer awareness, and helping pets with cancer to live longer and live well. Sue is regularly featured at top veterinary conferences and in the veterinary media. She's a strong communication professional with a doctorate in veterinary medicine from Cornell University and a strong media presence as well as content creator, key opinion leader, and a writer.
Sue, welcome to the webinar, vet, and it's over to you. Thank you so much and thank you everyone for joining. I know there's multiple time zones.
So here in New York, it's the middle of the day. And I know in Europe, you've already finished your workday. So we're at, whenever you and wherever you are joining me from, thank you so much.
I'm always passionate and excited to be talking about early cancer. Detection. It's been one of my missions.
I started a lumps and bumps programme probably about 10+ years ago. So when I learned about the new Q test, I got really excited because this is something that allows us to detect internal cancers. So let's unpack it.
Let's break it down, and let's get going. But again, OK, so let, you know, let's kind of, I always like to start 30,000 ft, take a step back and think about how are we detecting cancer today. And, you know, the hard part with the word cancer is when it's a loaded word, you know, it's very emotional for pet owners, and for people in general, and it's this huge term, right?
And we could be talking about slowly developing cancers like a superficial, you know, skin subcutaneous. Soft tissue sarcoma. And then there are some that can be developed really quickly, like lymphoma and hemangiosarcoma, which we're gonna focus on a lot on today.
And a lot of the problems, you know, think about lymphomas, half of the patients are clinically well when they come in and all they have is big lymph nodes. So they're really not showing clinical signs or symptoms that the owners can pick up on to try to get ahead of that diagnosis. And not all symptoms.
Clinical signs are the same. Again, thinking about, even within a cancer, even within Hemangio, there's gonna be a range, even within lymphoma. So, it's really hard, you know, there are the published top 10, you know, signs of cancer, but again, it can be hard to capture all these cancers.
And a lot of the times, you know, and we're the same, like, do you rush to the, you know, the veterinarian when a, a pet, you know, your own pet, they give out your own pets. You rush to the vet every time they vomit or they're a little bit lethargic or tired, or limping. So sometimes we wait symptoms out.
And, you know, we don't want to be alarmists and have people run to the vet when, you know, there's just one thing going on. So again, it's really, really hard balance. And often we see, our canine patients when the, the symptoms have worsened, and sometimes the history can be really long.
Over, you know, that you guys have probably all heard these stats. It's estimated that over 50% of dogs, over the age of 10 will develop cancer. 1 in 4, you know, over their life.
But then once we're over the age of 10, it's half our dogs. It's an epidemic and approximately 6 million. New cancer, diagnoses are made each year.
And when we think about these cancer diagnosis, hemangio angiosarcoma, and lymphoma make up almost a third of the cases that are diagnosed. And why that's important when we talk about the new Cvet cancer tests, those are the top cancers that it can detect. And when they look at, you know, the cases that we as veterinarians are treating, lymphoma and hemangio are about half the cases that veterinarians are, are, are seeing in practise.
As I mentioned, you know, we're often diagnosing cancer late and it's costly, right? Think about how do we diagnose cancer. So it's typically, you know, we maybe we start with chest radiographs, some sort of abdominal imaging, whether it's ultrasounds, there's aspirants, there's biopsies, sometimes CT scans, we need advanced diagnostics, so it can be very expensive and we're often, you know, it can be late.
And again we have these asymptomatic pets, and then we also have ones that have clinical signs, but, you know, they were in appotent, so the owners, you know, fed them human food and they got better and so they're often waiting it out. So again, it's a really big, you know, group of pets with a really wide range of symptoms. So what we're talking about today or tonight, depending on where you are, is the value of screening, right?
And so we have healthy cells as dogs, cats, and people, and then they can, you know, be damaged by radiation, damaged by things in the environment, or our cells can just make a mistake when they're dividing and will have abnormal cells. But not all of these cancer cells are gonna go on and become cancerous. There are, you know, some of them will hopefully be detected by the immune system.
Or there'll be apoptosis, but there are some cells that are gonna continue to progress along this this progression and we have pre-invasive cancer, invasive cancer, and then the worst is metastatic cancer, right? So those are the dogs that you take chest radiographs, and there's just multiple diffuse nodules throughout the lungs. So typically we diagnose cancer when it's either invasive or metastatic, and what we're trying to do with the new Quvet cancer.
Cancer test at any time we're talking about screening is we have these healthy pets that are asymptomatic, and we're trying to find their cancer, you know, shifting it over to the left at the pre-invasive stage. So that's really what the goal is. And that is what the new vet cancer test is.
And so, when we think about screening, it has to be simple. You know, it can't be super complicated. It has to be accessible, meaning that you can do it in your practise.
With a lab near you or in-house. I'm gonna talk about those options. It needs to be affordable and like I said, really easy to use.
And the new Quvet cancer test checks all those things. And it's one of the things that I get so excited about it because some of the other screening tests that we think about, even chest radiographs and ultrasound, they're expensive and not every practise can do an ultrasound, whether they, it's the equipment or someone to interpret that diagnostic. So, what, you know, the goal of this is why, why, why do we care?
And I think it's pretty obvious, right? But early detection leads to early intervention. And it doesn't mean that pet owners are going to treat, but it gives them the space, and the calmness to be able to make a decision about the, the diagnosis as opposed to the ruptured hemoabdomen where, you know, they're trying to decide what to do for hemanduous sarcoma.
So again, we're really trying to just give the owners more time to think about it and make Decisions and really decide what they want to do. And like I said, give them the space for that spectrum of care. You know, not everyone chooses to treat lymphoma with a multi-agent chemotherapy protocol, and that's OK.
But again, we're just try to give them more, more time, more space, and really less emotional toll, not only on owners, but veterinarians as well. Because I'm sure you guys have had those cases where the owners are so shocked and sometimes, you know, as they're going through the stages of grief and trying to figure Everything out. There's a lot of backlash onto us, the veterinary professionals.
The other reason that early intervention, you know, so we thought about how it can affect the client and the pet owner is early detection in many cancers leads to more positive outcomes. And it makes sense, right? We're trying to find it before it's non-metastatic to lymph nodes and distant metastasis, and that's Staging is often prognostic for many cancers.
Like I mentioned, for cancer screening, it needs to be easy to do, it needs to be affordable, and it needs to be accurate. You don't want to do a test where you're 50% of the cases are false positives and that you're like freaking owners out and then they're doing additional diagnostics. So again, we really want that accuracy.
As I mentioned, the new Quevec cancer test is accessible, affordable, and easy to use, and we're gonna break that down, so you can, you know, see how you can be doing it in your practise. What it does, it detects elevated levels of cell-free DNA in our cancer patients, the nucleosomes, and we're gonna break that down. And the other thing is when we think about cancer, Because it can be very emotional.
I often liken to, you know, and they say people, it's the same thing. You're dropping a bomb on people. Often they're not suspecting, you know, that their dog has lymphoma and without treatment has 4 to 6 weeks.
The other thing is, and, you know, I get excited about, you know, finding cancer early, cause I know it can lead to more positive outcomes and the things that we talked about, but it really can heighten anxiety. And so, you know, if they have a long wait for that, or they're coming in for cancer screening, owners can be really anxious. Like I mentioned, we wanna be able to emotionally and financially prepare our pet owners for the different potential outcomes of the cancers.
And we also, if we are gonna start, you know, implementing this test into our practise, we need everyone on the staff to know about it, and we need the owners to understand what the test is testing for. It doesn't test for all cancers, and, you know, so again, we wanna understand what the test can do and what the test cannot do and be able to relay that to the pet owners and our staff so we all have reasonable expectations. All right.
So how does the test work? And I mentioned nucleosomes, and I know I'm a New Yorker and sometimes I talk fast and I get really excited. We have a lot of information to share.
But you're like, nucleosomes. What is that? And I'll be honest, if I learned about it in vet school many moons ago, I did not remember it.
But it's, it's pretty simple. So let's unpack it. So they, when we think about our, you know, what's inside all of our cells, we have our chromatin, we have our Chromosomes, which is all our genetic material.
And if we, you know, that's all wrapped up, it's very condensed, so we can fit all the genetic information into our cells. But the nucleosome is these pieces of it's fragments of the DNA wrapped around these histones, which are these proteins. And so when, as we'll talk about when there's cell damage, these nucleosomes, again, fragments of DNA wrapped around these proteins are released into the bloodstream.
So, as I mentioned, when there's some sort of high cell turnover, and that can be cancer, sepsis, and other things like that, diseases like cancer, you're gonna have an increased level of nucleosomes into the bloodstream. There are some, you know, they're very low levels because, you know, normal dogs, cats, and people will have cell damage. But what they've done is they've looked at normal healthy dogs and Their nucleosome levels are very low, but it's elevated in certain conditions that we'll talk about.
So why do we care about these nucleosomes? Well, these can be measured with antibodies. So this is a pretty simple ELISA test that can detect these elevated nucleosomes.
And that's exactly what the new cuvet cancer does. It, elevate it detects these circulating nucleosomes using antibodies that are in the bloodstream. And you know, just kind of, you know, before I go into the clinical evidence, it's pretty amazing, you know, for years I've been an oncologist for quite a while.
It's like, is there a blood test that detect detects cancer? And there isn't, you know, there hasn't been, but now there is, and it is pretty exciting when I think about it. So what is the evidence behind it?
So, in the studies, they looked it over. 600 dogs, 662 dogs to be exact, 134 healthy dogs, and 528 dogs with cancer. In the, in this study, the initial cancers that were looked at were lymphoma, hemangiosarcoma, osteo, soft tissue sarcomas, malignant melanoma, mast cell tumours, and histiocytic sarcoma.
What did they see when they looked at these dogs? So, with 97% specificity, so a very low false positive. Remember, I don't want to be doing a test where I'm freaking out half of the owners.
So we want a very low false positive. It was when they looked at all the cancers, it detected 50% of them. But when they looked at the systemic cancers, it, the sensitivity was much higher.
It was 76%. Which one of those cancers was it? Lymphoma, the sensitivity was 77%.
It detected 82%. Percent of hemangiosarcoma, and this is across all stages, and 54% of hisocytic sarcoma. So when you're talking about this owner, about this, when you're talking about this test to owners, it's really good to be able to say, these are the most likely cancers.
It doesn't mean it doesn't detect other cancers. There have been scenarios where it's detect anal sac adenocarcinoma or even one case, it was a GI adenocarcinoma. So, you don't want to say it only picks up these, but these are the most likely cancers that it can detect.
So, You know, when we think about this, we want to have additional data on it for the various carcinomas and other cancers. So let's kind of break this down a little bit more. So, if we're starting left to right with lymphoma, as I mentioned, 77%, hemangiosarcoma, the sensitivity was 82%.
Hisiocytic sarcoma was 54%, but interestingly, when they separated out the bone, . Form versus the visceral form, it was much more, sensitive for the visceral form. So 62%.
And that makes sense, right? Because I'm telling you that it's more likely to pick up the systemic cancers. 43% for melanomas, mast cell tumours, you can see, across all of them, about 20%, and the grade 12, and 3.
So again, it can detect it, but it's not the top cancer that I'm. You know, explaining to owners that the new cue is likely to detect. About a third of the sensitivity was about 35% for sorry, for osteosarcoma and about 30% for soft tissue sarcomas as well.
So again, it tends to be the systemic cancers that the sensitivity is much higher, but there will be other cancers that it, you know, will, it could potentially detect. So let's kind of Break that down with the top two cancers. Let's unpack lymphoma and hemangiosarcoma.
So again, this is the initial studies, so you can see stage 1, that's dog with one solitary lymph node. Stage 2 is multiple lymph nodes on the same side of the diaphragm. Stage 3 is typically what we're seeing in practise, right?
Where they have a generalised lymphatomegaly, stage 4 is liver and spleen, and stage 5 is, . Blood, bone marrow involvement or extranodal involvement. So you can see, the different sensitivities, but across all stages, even the stage 1 and the stage 2, they only had, 7 dogs with stage 2, but you can see that it was able to pick up the lymphomas stage 1, stage 2.
In the initial group of dogs that they looked at, you can see the sensitivity for B cell lymphoma was . Quite high at 95% and lower for the T cell. When they went back and looked at the records for those dogs, a lot of them were the indolent, slowly developing T cell lymphomas.
So, which kind of makes sense. They're not, you know, turning over as quickly. You know, I have used it for dogs with T cell lymphoma, the high grade ones.
I would expect it to pick that up as well, but obviously, we need more data. Again, with 97% specificity, so low false positive, it was able to detect 77% of the hemangio of the lymphomas across all stages. Already thinking about the next slide.
So let's unpack our stage one. So again, we don't typically see the stage one heangiosarcoma, but it was able to detect that 16. 7% of the time.
We have our stage 2, 76%, and then stage 3, which are our dogs with metastatic disease. So across all stages, it was able to detect it. Again, 97% specificity, 82% 2% sensitivity for hemangiosarcoma across all stages.
So when to screen, you know, what is the right time, you know, is, is, is young too young? Is there an age that's ideal? And so when you think about it, we want to be doing this as part of our senior wellness exam.
So, as I mentioned, nucleosome levels are are low and normal in healthy dogs. So you wanna be doing this for dogs. When they're coming in.
You don't want to be doing it when they're coming in for vomiting or other, you know, other symptoms. This is something that you're incorporating into your annual or semi-annual, I would recommend semi-annual senior wellness exams. So they're coming in, you're probably pulling blood work anyway.
So for those dogs, I think about 7 and older. If you have, I'll come back to some, Variations of ages as we go through. Then if you have your high risk cancer breeds, and our next slide, I'm gonna show you some of those breeds.
I'm gonna start doing that earlier. I'm gonna start doing that at age 4. I have colleagues, other veterinarians, who, I have one who breeds, golden, and she's lost, you know, sadly too many goldens to to cancer, you know, specifically hemangio as well.
And so she'll start screening them around age 2 or, you know, age 3. And so, again, if you have a high-risk breed, I would start at at least age 4. You could always get a baseline, you know, at 2 or 3.
And again, I already mentioned. It's like this is something they're coming in, you're probably pulling blood work anyway, you know, depending on where you're in the world, maybe you're doing, you know, your, your CBC chem, your UA, a T4, maybe checking checking for heartworm or Lyme or other things like that. You can easily run the new cue.
I recommend screening twice a year, and even during my residency, I was always interested in this, and I really thought that, you know, dogs, you know, middle aged and older should be coming in for screening at, you know, every 6 months. And when I explain that to owners, I remind them how quickly dogs age, and that'd be like you and me going to the doctor every couple of years. So again, you know, for the these ages that we recommend twice a year is what I would recommend.
So, recommended for all dogs over age 7 and younger dogs, these are the high-risk breeds. And this is not an all-inclusive list, and depending on where you are in the world, you may say, you know, in our area, we tend to see a lot of that. And this is based on a compilation of different studies and things like that.
I have a Labrador, she's actually sleeping on her. Dog cushion right there. And, she just turned 8 last, last month.
And since I've learned about this test and, you know, first started, discussing it with, the team at Volition, we've been running them on her. And thankfully, all of them have been normal. But again, you know, I, and the other thing that I was Gonna say, you know, knowing that larger dogs, larger breed dogs age more quickly, even if they're not a pure breed and you just have a dog that you're like, Hi, I think there's some great Dane in this or something like that because they age more quickly.
Even if they're a mixed breed dog, large breed, I would probably shift that, but, you know, earlier than 7 just because they do age more quickly. I told you it has to be easy to do and accessible, and it is. So for this, you just need to submit some blood, so 2 to 5 mL, you know, depending on where you're getting your sec your blood from.
I'm an oncologist, so we tend to use the jugular vein when pulling blood and save the peripheral for chemotherapy. You're gonna take that blood and you're gonna put it into a purple top. So EDTA tube and you're gonna just rotate it back and forth 10 times to get everything mixed.
Then you're gonna spin that purple top and I know. I know that like, we don't typically think of spitting purple tops. We, you know, we, we do our serum separators, but what we're trying to do here is separate out the plasma.
You're going to remove that plasma and put it in a non-additive tube, being careful not to disturb the buffy coat. And then you can either run it in-house, which is what we're doing at my practise on the Element Ilus, which is available from Antech, which is Anteesca, or you're gonna put it in the fridge and it's gonna go out to the many labs that I'm gonna show you that. It is available around the world.
I think at last count it is available in over 20 countries. If you're submitting it to the lab, you're gonna get the results back in 1 to 3 days. Once you, pop it in the element I plus, if you're running it in-house, you get the results back in 6 minutes, which is pretty cool.
So this is my, the little baby that I'm very excited. I think I've had it for about a year and a half. So this was available from HESA and HSA has been acquired by Antech.
I think this also runs cortisol and thyroid. Some other things as well. Like I mentioned, you, can get the results back in 6 minutes after you spin the blood for 10 minutes.
So it's really nice. You don't have to refrigerate. If you're having a crazy day and you can't, you know, get the sample, you're gonna separate out the plasma and you can put the sample in the fridge and then run it a little bit later if you're having one of those days.
And the nice thing about that, and one of the examples that I'm gonna show you is I get the results back, owners are in the waiting room and I can talk to them in person about the results. The majority of time, it's gonna be. Normal as you're screening it.
But when you do have one, and we're gonna talk about what to do, it's so much nicer when they're there. They're in person, you're not doing it through email or phone calls or trying to catch them, you know, as they're dropping their kids off and things like that. So I really like when you're able to, you know, do that in-house.
But if you're in a place where it's not available, again, you can get it, to the lab and you're gonna get those results back. And before I had the Element I plus, I was submitting it to a HSA diagnostic lab. And I would usually get the results back at the end of the next business day.
So what do the results look like? So there's 3 categories that you're gonna see the results fall in. There's low risk, which is what we're always hoping for, right?
Ms. Penelope. Then there's high risk, and we're gonna talk about what to do with that.
And then there's the caution zone. It's the yellow zone. I like to call it the grey zone.
It's mildly elevated, and we're gonna break these down on what to do with each of these categories. So like I said, green is what we're hoping for. Green is what the majority of your cases.
You're probably screening are going to get. And so what do you do if it's green? Tell the owners this is a moment to celebrate.
This is great of the cancers that it can likely pick up. It's, you know, we are at low risk that that dog has that cancer, and we're gonna maintain our wellness checks. We're gonna educate the owners about the signs of cancer, and when they should bring them in, and then we're gonna retest at their next appointment, hopefully in 6 months, maybe in a year.
And like I said, most of the time when you do this screening test, I just had a case, the one that I'm gonna share with you that I shared in my Instagram stories, and one of my colleagues was like, oh, you know, most of the time I'm doing it, it's normal, you know, he's like, not that I was happy that your pet, your patient had a high one. He's like, but it's nice to see. And so, Like I said, it's a, it's a chance to celebrate, you know, with the owners because none of us want to have to break bad news with them.
And again, recommend that biannual exam and that to make sure that they're in the low risk category. And again, use this as an opportunity to bond with the owners, teach them about early cancer detection, lumps and bumps, and all the different things that we worry about. What we don't want is high risk, right?
Because that means they're at high risk for cancer and that we're more suspicious. And that's, like I said, that increased risk of cancer. So what do we do with that?
Like I said, take a pause. Did I miss anything in this case? You know, one time I had it, I was like, I'm gonna go back and feel this dog's lymph nodes again.
Maybe, you know, I missed something out. I'm gonna, did I, did I forget to do, a rectal exam, you know, just And then go back in their history, you know, did anyone, you know, and do they know of any of their litter mates or, you know, someone from their line has had cancer. Like I said, go back, feel that belly again.
It may be normal, but like I said, it's a good opportunity, especially if you, especially if you did the element I plus and you got the new cue back while the pet's still there, and it's elevated, you can go back and the case that, you know, I told you about, or I'm gonna tell you about Charlie exactly what we did. And then you, you know, maybe you're submitting blood work, but when you get the blood work back, is there anything that can kind of clue you in with what's going on? Is this dog anaemic or anything like that?
Or maybe there's an infection or something else that's causing, you know, nucleosomes to be released. But again, just trying to figure out what's going on, especially if you as a clinician as well, were not expecting that elevated high risk. And then what do you do?
Further workup. You've probably run blood work already, but if not, and you'll see from some of the cases, which I think are gonna be the most helpful, consider radiographs, ultrasound, and other imaging as well. The other thing is you can always reach out to the team at Volition.
Their email is here, their phone number is here as well. There are veterinarians on, staff that can also help you on a case by case basis if you're having one of these challenging cases. So, what do we say to the owners?
This is a screening test. I'm gonna say this again. This is a screening test.
This is not a diagnostic. And so, you wanna tell the owners that there's a high risk of cancers. These are the most common cancers.
And then, you know, some owners are gonna wanna work them up right away if they can, if you can, during your day, you know, right then. And some owners just might need to pause. Maybe they're even gonna wanna recheck.
Before they come back, even if it's very high. But again, this is a screening test. I really would, you know, be crushed if I ever find out that a pet was euthanized over a high new cu.
But again, you know, just really emphasising that this is a screening test. Just the way if you do a mammogram and there's a bump there, it's not a diagnosis, you know, you need to go on and do additional diagnostics to confirm whether there's breast cancer. So it does not equal cancer diagnosis.
It tells us there's something going on internally. There is some sort of these high level of circulating nucleosomes cause normal healthy dogs, they should be low. The other thing is make sure the sample is processed, that, you know, when they, when you were separating out the plasma, you didn't, you know, mess up the buffy coat or go into the red blood cells or things like that.
But then you're gonna consider a diagnostic workup. The owners are, it's too much for them. Repeat it, repeat it in 2 to 4 weeks, and monitor the trends.
That would be another option as well. And then there's the caution zone, the grey zone, the yellow zone, and this is where it's mildly elevated, and so again, you just want to make sure it was handled correctly, you know, if you Did submit it to the lab? Did it get to the fridge?
Like I said, you want to spin it for 10 minutes within an hour of collection. Maybe it sat out. So again, just make sure, you know, just like you would with, you know, a low glucose and a, and a pet that, you know, you weren't expecting.
And maybe it was that no one, you know, spun the tier top to separate out the serum. What do we do in that situation? OK, the sample was handled correctly.
So then we're going to recheck before you go into a big workup. If it's in the grey zone, recommend rechecking that. Usually about 2 to 4 weeks, and that is when you want to do a 4 hour fast just because we wanna make sure there are no nucleo zones released from the GI tract.
You do not need to fast them on a regular basis when you're running the new queue. It's only if they're in the new queue and you're monitoring it for trends. And I've had a case like that and I think Randy is coming back next week for that.
If it remains at the increased level, then you're gonna shift over to recommending a diagnostic workup. And we're gonna, again, go through some cases. If it returns to low normal, yay, then you can go back to your regularly scheduled programming and you can recheck that pet in 6 months.
All right, let's do some case studies because I think that's always, the, the best way to learn about it. We're gonna start with Belle, 5 year old female spay golden retriever. I'm an oncologist, I'm a breedist.
I'm already worried. About cancer in her. But that's not why she went to see her primary care veterinarian.
This was not a case of mine. So she's going to the vet annual wellness exam. And what you'll see is a theme in a lot of these cases that are coming in, you know, part of their annual or semi-annual wellness exam is the physical exams are pretty boring.
She had a, a soft murmur, really soft. She's doing well at home. They just got a puppy.
She was a little bit tired, but, you know, she was playing with a puppy a lot. So they didn't really didn't, they just attributed it to that. Like I said, her exam is normal.
Her TPR was normal. Her blood work is pretty normal. So, in this reference lab, her platelet count was a little bit low.
Her a phosph was a little bit elevated, but really nothing that you would get worried about. Unfortunately, you can see her new Q was elevated. So, greater than 60, on most reference.
Labs is considered elevated. Hers was 187. So again, we're, we're highly suspicious that she has cancer, based on what I've told you so far.
But again, we want to confirm that with, with additional diagnostics and review the history and repeat, you know, make sure we didn't miss anything on exam. So what do we do next with her? Ona agrees to further diagnostics, so we're gonna do an abdominal ultrasound and thoracic radiographs.
On her chest, radiographs, there was a cranium mediasinal mass and her on her ultrasound, her spleen was read out as enlarged, so spinomegaly with a moth eaten modelled appearance. Both were aspirated in this case, and unfortunately came back with high grade lymphoma. And there are some lymphoma cases where the peripheral lymph nodes are normal and it's just visceral and internal.
And when we think about the two most important prognostic factors for lymphoma, the first is B versus T, right? Phenotype. So we don't know that yet for her.
Based on the craniumatasinal mass, I'm suspicious that this is T cell, but the second most important prognostic factor for lymphoma is substage A versus B. Are they well at time of diagnosis? And Belle was, and the owners did go on, and elected to do chemotherapy.
And as I mentioned, you know, the cytology that you see over. On the bottom right was consistent with high grade lymphoma. Now, I'm gonna tell you a couple of cases that were mine, and, we have Benji, and then we also have Boomer.
So let's start with Benjamin, because he was the, the case that I saw. And so this is a little bit different. This is, he's not coming to me for screening.
When I first met him, he was a 9 year old male castrated Labrador that had already been diagnosed with, splenicamangiosarcoma. Their primary care vet had actually done the Onco canine, which is a screening test that is no longer available. It also detected hemangio.
It was also quite expensive, so in the states it was about $500 600 dollars cost to the owner. But that was how they figured out that he had Hemangio. They did a splenectomy, he was treated with 5 doses of doxorubicin.
And then he went back to his primary, this was all done at the primary care vet, and they did an ultrasound and chest radiographs, and they thought that maybe he had peritoneal metastasis. So he was referred to me for about 6 months after his diagnosis, and we, I do a physical and his, was a little bit pale, subjectively, the rest of his physical exam was normal, and the plan was to do a full workup and also run the new cue to see if that would give us information about whether or not this internal mass was metastasis. So he was anaemic, at 24%.
His chemistry panel was normal, his urine and urine protein creatinine ratio. The reason I did the UPC is I was thinking I might end up using Pallaia, which is a CCI inhibitor. If you're in Europe, it's similar to Massive.
Just different companies make it slightly different, but they're both CCI inhibitors. And we ran the new cancer test. I was sending it to HESA at this point.
I didn't have the in-house machine. His radiographs were reviewed by radiologists as normal. Ultrasound, what our, I work with an internist and they're the ones that do the ultrasound.
He didn't think there was anything that there were peritoneal nodules. He didn't see any free fluid, but he saw this hyperchoic. You know, he's like, Sue, come on in.
Never good when the internist wants me to see what he's, you know, doing. And he's like, this is weird. It's like hyperrechoic fat.
He's like, it doesn't look normal, doesn't really look like a mass, and we can we aspirate it? So we try to aspirate that mass. The, we get back the results of the new Q.
It's in the high risk category. And again, so this is telling me that I'm concerned that this is, you know, based on what we know and what I've, you know, explained so far about the new cue that this is likely, you know, related to his hemangiosarcoma. The aspirate came back non-diagnostic, which was frustrating.
But based on this high new Q and the history, you know, we didn't, the owners didn't want to go back in and do biopsies of this, you know, deep retroperital fat looking thing. So, based on the anaemia and the new cue, it was presumed metastasis, and the owners did put him on oral. Cladia, and the plan was to do serial new cues and monitor that.
He actually did fantastic for 2 months. We checked him 2 weeks, 2 weeks, and then 1 month. His anaemia resolved.
He was playful. He's hanging out with Boomer. He's doing great.
But then at his 2-month recheck on Palladia, so again, he was diagnosed in April. We're in December now. The new cue went up.
Again, this is a That's clinically doing great at home, still not anaemic. We repeated his chest X-rays and ultrasound, and they're really similar. So no mats to the lungs and that similar mass, no free fluid on the abdominal ultrasound.
So we decided to continue with Pladia because clinically, he was doing well. I just had this new cue that went up. Still suspicious, but didn't know what else to do with him.
Comes back a week later on emergency, vomiting and lethargy. Now on blood work, he's anaemic and moderate thrombocytopenia. I wanna say it was around 800 to 90.
The owner elected to do a CT scan about a week later, so this is right around the Christmas holidays. And what, I think this is a really important thing. Again, his chest X-rays were normal, and his ultrasound just had that weird retroperitoneal space fat thing.
On his CT two numerous to count nodules in the skin, subcutaneous tissues, body wall muscle, mesentery retroperitoneal space, and skeletal muscle of his pelic glands and para spinal muscle, consistent with Regional subcutaneous, peritoneal, and retroperitoneal fluid, most likely from haemorrhage from bleeding from these metastatic lesions. Remember, we just did chest X-rays and ultrasound on this dog about a week and a half ago. And the reason I say this is so important is I think sometimes we forget, and I do too, that like, oh, the chest X-rays and ultrasound.
That's just imaging that the thoracic cavity and the abdominal, cavity. And there's, you know, the mediastinum, there's the subcutaneous, you know, an intra. Muscular, areas that we don't appreciate with chest X-rays and abdominal ultrasound.
So I think that that's really important when we think about that. I'm not saying do a CT in all these cases, but just realise we may be missing out on these things if we don't do advanced imaging. It's not that, you know, the test is wrong, it's that we just haven't found it with what we've done so far.
Sadly, he was euthanized two weeks later due to progressive anaemia, hypoglobin anaemia, and just poor quality of life. All right, so not a great ending, but you know, it was, you know, for hemangiosarcoma, not, you know, it was about 8 months, so it's kind of typically what we expect, sadly. What about Boomer?
So Boomer is Benji's brother, and he was a 6 year old male castrated Labrador. So now the owners are even more concerned about cancer, right? They just lost their one dog to cancer, so they want to do screening, and They had just done recent blood work, but they asked me if I would see him for a screening.
Comes in doing great physical exam, normal, and the plan was to do chest radiographs, ultrasound, and run the new cue. So we'd get back our diagnostics, happily, chest radiographs and ultrasound were normal. He had a cyst in the left kidney, some age-related kidney changes, and submitted the new cue to the HESA diagnostic lab, which is what I was using at the time.
Yay, came back green, came back in the low risk, and we just talked about, doing imaging biannually. We talked about, you know, you know, the cancers that this can pick up, and they were very excited about that. So next recheck was about 8 or 9 months later, just due to life and scheduling, comes in, has not had recent blood work, so we're gonna do full blood work and imaging on him and is now I'm running the new Q in-house.
They were super excited. Like the, the idea that they didn't have to wait a couple of days for results, fantastic. And happily also came back, so less than 50, which is in the low suspicion, so low risk.
His was less than 15. His chest radiographs, an ultrasound, no evidence of cancer. He did have a new cyst in the kidney and based on the Location, the internist recommended an internal medicine consult, and he now sees one of the internists at my practise.
And then this, is, Busters, so they just got him, he's a little puppy when I met him, I think he was about 9 months old. So just super, super cute, and I'm sure we will be screening Buster at some point soon. All right, so now let's go back to this case is not mine.
This is Otis. He's a 12-year-old male castrated Catahoula mix. He had a history of subcutaneous hemangiosarcoma removed two years ago.
So those tend to have a better prognosis with surgery and chemotherapy, instead of the 6 to 9 months for the splenic ones, depending on what study you look out, about a year and a half. 3 years is the median survival time. He's doing well, coming in for his annual, recheck.
Like I said, doing great. Pretty, you know, what you would expect for a senior patient exam, soft murmurs, some arthritis, a little bit of tartar, but overall doing well at home. And as part of his exam, the owners agreed to the new cue.
Again, pretty boring blood work is gonna be our theme here. You can see the chemistry panel is getting a heartworm, faecal float, all the things that we're doing at an annual or semi-annual exam and everything is coming back nice and boring. However, take a deep pause, you know, take a deep breath.
His new cue came back elevated. It was in the high risk level. So what do we do with that?
So again, we're concerned, and this is a dog with a history of subcutaneous hemangiosarcoma. So what do we want to do in this case? Probably some imaging, right?
That would be great. And so the owners, you could repeat it, but the owners elected to do chest radiographs and ultrasound. You could refer for a CT.
I would probably start with the least expensive. I have some owners that just want to go straight to a CT because it's more sensitive and that's fine. It requires anaesthesia and it's obviously more expensive, but Unfortunately, he had diffuse metastatic disease on his Freeview radiographs also had a splenic mass as well.
So that was consistent sadly with Manio. So again, you know, this, it's a sad outcome, but it allowed the owners to know what was going on, so they can, you know, go into palliative mode and things like that. All right, so this is the case that I was alluding to.
This is a very recent case with what's happened with the new cue. So this is a dog that originally came in to the hospital that I work at for UVitis and blindness, didn't come see me, which makes sense. I think he went through Otto, and ended up getting worked up, through the ophthalmologist in our IM department internal medicine.
And they confirmed that he had lymphoma. They diagnosed that his opal lymph node, I had felt it was not that big, but just his pools were big, aspirated it and was consistent with intermediate to large cell, B cell, so the better type of lymphoma, based on that lymph node cytology. So we started the top protocol, in September of last year.
He did super fantastic, he's. On Instagram, he's living his best life. Here he is at his chemotherapy graduation with his parents who were just ecstatic that he had graduated.
Then I like to see them back monthly. Came in for his first monthly appointment in February of this year. Pretty boring, lymph nodes felt good.
I like to do blood work after they graduate chemo, just make sure everything's still normal, and recommended the new cue as part of his monitoring and everything came back normal. Comes in a month later. Living his best life.
So now we're in March. So, you know, just under 2 months ago. I wasn't planning on running full blood work because I had just done it.
The owners also work with a holistic veterinarian, so they wanted so full blood work for that vet and also to check a thyroid. So we were gonna do that. I thought it polis and I'm sensitive because that's where his lymphoma was initially.
So I tried to actually aspirate them while his new cu was running. I couldn't get a good sample and I get back as new cue and I, I literally took a double take. It was, it was in the high risk.
It was in the 500s. I was like, wait, what? And I'd already tried to aspirate his lymph nodes.
I done a good physical exam and so, you know, I'm like, oh, I, I'm really concerned that his lymphoma has relapsed. Luckily the owners were in the waiting room. And so I brought them into the exam room and I said I'm suspicious that his cancer or he developed another cancer and recommended doing imaging.
They said, absolutely. So we did thoracic radiographs and they were normal, and we did an ultrasound. The ultrasound, he had a 1 centimetre, so you can see 0.7 by, you know, 1 centimetre nodule in the tail of the spleen.
No splenomegaly, no modelled moth-eaten appearance, nothing that I would say this is a dog with lymphoma. Probably this was not a dog with lymphoma. I would have thought this was like extramedually hematopoiesis or something benign.
But because of that new cue, we aspirated it and lo and behold, we found out that his lymphoma had relapsed. Not what I was expecting. So, pretty impressive to me that this, you know, test could pick up his cancer so early.
There was also some extramodually hematopoiesis, but it did confirm that his lymphoma relapsed, and then the owners elected to restart, his chemotherapy. This is an actual picture of his cytology. I use, images from Zoettas.
Which is great because I get those results back. You know, once they scan the slides, we get the results back from a board certified, clinical pathologist in 2 hours. So, you know, again, just really allowed us.
We decided to restart his chemo next week, kind of because I got a cytology back after they left, but they kind of like had their mind thinking about it and we booked their appointment while they were still there. And then this is another case of mine. This is Polly, when I met her, she was a 15 year old, female spayed, mix.
She had a history of TCC, transitional cell carcinoma in January of 2020. This was, she was not my case at this point. She was seeing another oncologist who had moved out of the area by the time that I met her.
They did an oral chemotherapy drug for a little over a year and a half, And her cancer was confirmed with the breath, which is the breath mutation test, depending on where you are, if that's available. But, and they stopped chemo because they just thought that her quality, she was not tolerating it. She wasn't eating well.
And now she's starting to have some recurrent urinary tract signs. And so they're interested to find, like, put her back on therapy and see what's going on with her. So they make an appointment with me.
We're 2 years out from when her cancer was originally diagnosed. As you can see, she has some tartar, not a big deal. She has a heart murmur.
And I, we talked about starting a different chemotherapy. I said, but let's stage her. Let's make sure that her cancer hasn't metastasized in the two years that, you know, it's been since she's been diagnosed.
Chest radiographs look great. Ultrasound, we do see a bladder mass, no surprise in the trigone, but she also has a splenic mass by a 6x6, . You know, cavitated, hyperchoic, mixed eco ecogenicity mass.
So not something that we're gonna aspirate like Charlie's mass. I, so now I'm like, oh, I have an incidental splenic mass, could be benign, could be malignant. And what do I do?
I was about to give this dog chemotherapy for her recurrent TCC. So, this was actually during COVID. It was during, January of 2022.
I think that was the Omicron one. The owners are in the parking lot, so I call them because we're not bringing owners into the office. Remember that?
And talked about doing the new Quevec cancer test. Why do I want to do a new Quvec cancer test? So I told them it picks, she's feeling well, that it picks up 82% of dogs with hemangiosarcoma.
I'm not gonna condemn her if the score is high, but, you know, it tells me that this It is more likely something malignant. If it's low, it doesn't definitively rule out hemangiosarcoma, but it gives us that comfort of maybe working it up. And this is a 15 year old dog with bladder cancer, and the owners didn't just want to do a splenectomy.
And so we told them to keep her quiet. We didn't want her to, you know, rupture this mass, whether it was benign or malignant, that can happen. But let's just wait for the results.
So, good news. Her result came back in the green level. It came back normal.
This was when we were sending it out to the lab, so it took a couple of days. The editors thought about it and they said, yeah, we are comfortable going to surgery. So she actually had a splenectomy.
This was, when the test was originally available, it was only available through Texas A&M. So here's her score. It was 11, less than 50 is considered normal, super happy.
And now she goes. And gets her spleen out. And here is the path report from ATAC.
They offer the cancer panel and the nice thing about this is you get 2 to 4 pathologists read out the biopsy sample the first time, so I don't need a second opinion on a biopsy sample, which I often do for spleens. And on their first opinion, they read it out as or multiple opinions, multiple pathologists all agreed, . That this was a splenic hematoma arising from a myelolipoma.
So that was a great way and I've had a couple of other cases, incidental splenic masses where I've used that. I wouldn't do it in a hemoabdomen, you know, because that could potentially cause the newQ level to go up. But if you have an incidental splenic mass, it, you know, it's an interesting way to try to collect more information if you have owners that are apprehensive.
Again, not a diagnostic, but it can be a really good screening test. Oops, sorry, it's a double side. All right, so some frequently asked questions before I get to your questions.
Does it tell you what type of cancer that the pet has if their new cu is elevated? Nope. Like I said, it's, it's detecting those nucleosomes or circulating nucleosomes, which is.
Typically associated with the systemic cancers, lymphoma, hemangio, we've, we've gone through that. It can pick up other cancers, mast cell tumours, osteome melanoma, soft tissue, sarcoma. We went through that data.
Like I said, it has picked up other cancers as well, anal sac, . Like a GI adenocarcinomas, you know, and other things like that, but, you know, so if you can't find lymphoma and hemangiosarcoma, it doesn't mean it doesn't have that the test was wrong. It may be a different cancer.
It's hard to show, they have to have a lot of numbers, right? They have to have a lot of cases to be able to statistically show what the sensitivity and specificity are, so that's why, you know, the ones that we know that we've gone through. When should we screen it just as a reminder.
So ideally every wellness exam, annual to semiannual, if it's just, you know, your, average mixed breed dog, you can start at age 7, for some of the high risk breeds or a larger giant even mixed breed dog, I would probably start younger around 4, and again, really recommending this as a biannual, thing. How do we communicate high results to the owners? Remember, this is a screening test.
So only a, you know, you're not, you're not gonna be doing this every time that you run the test, which I think is to give you some comfort, but you are probably eventually gonna have a high one. So what do you say? So you just wanna tell them that this is a high risk for cancer.
And again, I usually use the mammogram example with owners, because I think they understand that like, again, you can have a mass that's a, a lump, you know, something abnormal is seen on a mammogram, and then do additional diagnostics. You are recommended to confirm if there's breast cancer. And again, you can have a normal mammogram and still have breast cancer, and you can have a lump, you know, on it, and, you know, then do additional diagnostics and it turned out not to be cancer.
So again, it's a screening test, and again, we want to do further clinical investigation. If they need a moment to pause, you can repeat that in 2 to 4 weeks. Does the baseline offer any prognostic insights?
And so did it matter that Charlie's was 500? Is that a worse prognosis? No.
And that hasn't been shown, so I don't really worry about the score, but it definitely told me there were high levels of nucleosomes in him, but that doesn't mean that he has a worse prognosis. I recently ran a baseline for a dog and his baseline was 600, and again, he was a large dog with a lot of lymphoma. It it doesn't necessarily mean that he has a worse prognosis.
How can our prices most effectively? So I told you that this is affordable and the, the cost is gonna change a little depending on, you know, what country you're in and what lab you're getting. But, you know, for the highest compliance, like I said, you know, we want this to be affordable.
It is a very affordable test, and hospitals that are running large amounts of the tests and integrated it part of their wealth. So, you know, CBCAM UAT4, newQ. That's really gonna be a great way to price it, and put it into the other wellness exams.
And again, this is a really a volume repeat screening test. And that's why I also think it's really, you know, to get used to running it and talking about it and having your whole team talk about it. Does it differentiate between hemangiosarcoma and hemangioma, or other benign, benign masses, you know, in the spleen.
And so again, we talked about this and I think, Polly is a great example, so. We don't want to run into the dogs with hemo abdomens are likely to be in shock, right? And so that can be causing elevated nucleosomes.
But if there's no evidence of bleeding, so that incidental splenic mass, like in poly or hadty was the other case of mine, then it can help you differentiate between versus benign versus malignant. Again, it's not a diagnosis, but you can raise your index suspicion or you can lower your index of suspicion. Can I run into a sick patient and the, the, the simple Answer is no, it's not recommended.
Because, and when, like, it's that I mentioned that dog that comes in vomiting, you're like, I think they have cancer. That's not the time to use your new cue to help you figure out what's going on. Because that, you know, things like sepsis, hit by car, trauma, things like that, severe, severe autoimmune mediated disease could cause nucleosome levels.
But they have done studies, so, you know, one of the things I was concerned about, what About all the things that we see in our senior senior patients. So atopic dermatitis, otitis externa, low thyroid, arthritis, dental disease, those things will not cause an elevated newQ, which is really important. But again, if you have a sick patient, your new cues, I would not recommend, you know, doing it in that situation.
Where can I find it? So like I said, it's available in about, 2020 countries at this point. And so you can look here to see if you want the element I plus, so, you're gonna get that from Ante and like I said, there's a list of different countries here where it's available, and the different labs that you would want to contact to be able to run it.
For those of you that are in the US or if you use IEX, this is a QR code that will take you to the IDEX and give you more information. And then Ante if you're interested in the element I plus, and again, so that's, you know, you know, spin the blood for 10 minutes, then pop it in there and you get results in, in 6 minutes. So, you know, once you pull the blood, probably gonna take 20 minutes to get the results.
So in summary, sadly, cancer is the leading cause. Of death, and I'm very excited that we have something that can lead to early detection and early screening. So gives early, the opportunity for early intervention if the owners are interested.
And if not, it gives them that information and that, that space and that time to be able to kind of, you know, Get used to the diagnosis, and, you know, not be in such shock. It's accessible, it's affordable, it's easy to use. It's a simple blood test.
It's that, you know, pull some blood, put it in a purple top, spin it, separate out the plasma, and then you can run it. Top cancers that it picks up as we went through 77% of lymphomas and 8. 2% of a mano.
Think about it for all your middle aged and older dogs, 7 years and above, for the high risk cancer breeds, I would recommend at age 4. And again, I know I keep harping on these large and giant breeds, but I have some pretty large mixed breed dogs, and I would recommend starting it earlier in 7, earlier than 7 in them as well. So, we're gonna take some questions.
I'll go back to this slide, but before we do that, I just wanna give you the website, for Volition Veterinary where you can get more information. They have a lot of resources, pamphlets that I, we keep in my room in the exam room that I do so as. Running it, you know, I explained it to them, but I give them a pamphlet so they can read more about it, and they have something in their hands that they can read.
Again, if you're having a challenging question, case and you want to reach out to the team at, Volition, you can email them or you can call them as well. All right, so that's it for me. Fantastic.
That was really, really interesting. Thank you so much. Could I ask you to just pop it back onto that info slide that you had before this one.
Just so that people can get that information, because a lot of the questions that we have are, will be answered, on that site. I have no doubt. So, big thank you to you, Sue, for making it so interesting and being so excited about it.
It really is a fantastic subject and, you have brought it to life. Also, a really big thank you to Volition Veterinary for sponsoring this evening. We do appreciate it.
Before we start with specific questions, I just want to remind folks that we have recorded this webinar. There's a lot of questions that have come in, that you have answered already. And if we don't get round to your question, my advice would be, go back onto the webinar that website tomorrow and go back and go and watch this again.
And, as I say, I have seen, at least a half dozen questions that you have already answered, that we will probably not get to tonight. And I also know that I'm at, I'm at fault for talking quickly. I try to slow it down, but I think it's great that it is available.
I'm sorry if you have to watch me again, but let's try to hit some of those questions. No, it's a big one that I think we could have predicted before you even started. What about cats?
Oh, I know, I know. I feel like we need to have a slide here cause it, it's probably the question I get all the time. It's either the first or the second question that we get.
So this is an Eliza, it's an antibody test. It's a different, antibody, and newQ has been working on it, and you know, I know like the golden question like, will it be able to find lymphoma, will it be able to determine IBD versus lymphoma, . We don't know yet.
So stay tuned for that, but I'm as anxious as whoever asked that question or the multiple people that did is because I think that would be a great test or even if it could just tell us if a cat's sick, right? Because I think cats are, you know, what do they do? They hide for 3 days, you know, or they're, they're so good at hiding their illness.
So again, I think it could be a really good test, but it's not, it's not available yet. Stay tuned. Stay tuned.
Martin wants to know about the effect of inflammation on the new Q test. Yeah. So, if there's severe inflammation, it can cause nucleosome levels to go up because of that high cell turnover.
So that's really why this test is meant to be part of a healthy wellness exam. And Martin, I had the same question that you did when I first started using this. Well, I'm, you know, we're talking about senior patients.
Most of these dogs have arthritis, lots of them have Dental disease. Some of my patients have really bad dental disease. So those sorts of inflammation will not, cause the, UQ to be elevated.
But if you have a dog that has IMHA, so immune hemolytic anaemia or ITP or some other immune-mediated and it's having a big flare up, yeah, you could get an elevated, new. You from that. So again, if they have an IMHA and it's, you know, it's maintained and they're just coming in for their annual or semi-annual exam, you could do it.
But yeah, trauma, pancreatitis, vomiting, you know, anything like that, is, that's causing inflammation could cause the nucleosome levels to be elevated. So I wouldn't run it then cause I think it's just gonna confuse us. Excellent.
Just, I want to just reiterate what you were saying earlier about the test being available in so many different countries around the world. There's a lot of questions of asking, is it available to me and how much will it cost? I think that is beyond the scope of tonight's webinar because every country will be different.
And my advice to you is either use the, information on the screen that Sue's put up for us, or contact your local lab, and they will be able to give you an answer as to where you are. Is the test and then also obviously what the cost is. So we're not going to go into any of that.
I just because I know that is a really important point for veterinarians. And so I'm in the metro. I'm, can I, can I answer it a little?
Yeah, sure. OK. So I'm in the metro New York area and I'm in a pretty expensive part of the country.
And, the new queue at my practise and I'm at a specialty practise. I do the element I plus, is under $100. And like I said, I feel like we're an expensive practise.
I love where I work. I love the, you know, the quality of care that we can provide, but I think that that's really important. So, and I think, you know, based on what I know, the different labs in the US that's pretty consistent-ish, around $100.
When we were first running it at Texas A&M when, you know, they were just started, it was much more expensive. So the price has actually come down, as, you know, the tech they've with the technology and the more availability and things like that. And it makes Me really happy that, Felician has been able to get that price down.
And again, I think that's gonna make it more available. But, you know, it just, and for reference, and ultrasound, people are gonna fall off their chairs. And my practise is almost $900 now for an internist to do a full ultrasound.
Chest radiographs are $500 to $600. So, it's a lot, you know. So again, I think when you put that into perspective and you're adding that on to blood work, it's pretty reasonable.
Yeah, well, that puts it into perspective. As, as I said, you know, every country will have their own pricing structure, and you need to ask your local lab. But for you guys in New York, if you're doing $900 for a full ultrasound and only $100 for this, it does fit into that box, and we can tick that it is cost-effective.
So that's absolutely fantastic. There's an, a pattern coming through here, and basically, the gist of, of these number of questions is, what are the circumstances that you should not use the new cue? I think you've touched on this, but we've got quite a few questions coming through on that.
Yeah, I think, the sick patient, to be honest, . Cause you know, they could have nucleosomes from whatever the underlying cause of inflammation is going on. So I wouldn't do it as a sick patient.
So you have that dog, you're like, I think they have lymphoma. I think that's not the time to run the newQ. Use your other, you know, diagnostics and your other, you know, clinical exam skills for that patient.
If you have a hemoabdomen and you see a splenic mass, again, we don't know that that hemoabdomen, a lot of those dogs prevent coming in shock and that could cause the nucleosome. So I wouldn't do it in that. So again, really the sick patient, a dog that's having, you know, some sort of flare-up, we talked about like IMHA or things like that.
So really using it as part of their screening, their wellness exam. And I actually run a lot of these. Because, you know, people like, what kind of wellness exams are you doing as an oncologist?
But I feel like mast cell tumour patients, maybe I've treated them with alphanta and they come in every 6 months. And so often, you know, when I'm doing, I'm like, they haven't had blood work at their vet or they have, even if they had blood work, we'll do a new cue with their, their ultrasound and if it's time for chest X-rays, I might be doing that as well. So, yeah, I'm running a lot of new cues.
Fantastic. We are running very short of time, so. There are a lot of comments coming through thanking you and saying how fantastic people enjoyed it.
But the last, sort of, run of questions that I'd like to put to you is about breeds. And it's not the breeds you mentioned to do it in, but rather, are there any breeds where you should stay away from newque? Oh.
Interesting. That's the first time, and that is why I love doing talking and speaking cause sometimes I'll be, oh, I haven't thought of that, and I don't think so, you know, and the other thing is when you think about breeds, right, you know, those are the breeds are at high risk for cancer, and then within that breed, you know, sometimes you have a breed that's actually low risk for cancer, but high risk for TCC like Scotty's or things like that. So, I don't know that I know of a breed that I wouldn't do the new Q in as long as they're healthy, .
Yeah, I, I'm, I'll think on that if I have a better answer than that, but at that point I, I, I don't have that, but again, just, you know, using it in the healthy dogs. Fantastic. Excellent.
Sue, thank you so much for your time tonight. Unfortunately, we have run out of time. But, the a lot of the questions that they're coming through.
Folks, we are recording this. It will be up on the webinar vets website tomorrow. I hope the technical guys don't shoot me.
If not tomorrow, the next day, and, you can then go back and most of the rest of the questions we haven't got to were covered in detail by Sue. So, Sue, thank you very much for your time tonight. Thank you so much.
Have a great day. And thank you once again to our sponsors, Volition Veterinary, to all of you that attended. Thank you so much for your time.
I hope you enjoyed it and learned as much as what I did. And then last but not least, to back my controller in the background for making everything run smoothly. From myself, Bruce Stevenson, it's goodnight.
