Full Transcript

Dr. Venable: Welcome to the Veterinary Cancer Pioneers podcast, the show where we delve into groundbreaking work of veterinary professionals who are dedicated to advancing the field of veterinary oncology. I'm your host, Dr. Rachel Venable, and I'm thrilled to embark on this journey with you. 

Hello and welcome to the Veterinary Cancer Pioneer podcast. I'm your host, Dr. Rachel Venable, and I am so excited today. to introduce our guest, Dr. MJ Hamilton, who started the first mobile oncology practice. And when I say mobile, I mean, the whole clinic is in his truck and he actually patented the design. So very interesting, very exciting. And to give some more background on Dr. Hamilton, he's worked in veterinary medicine his entire life, starting at the age of 14. After completing his undergraduate degree in psychology, which I think is pretty interesting, he stayed at Colorado State to complete his doctorate in veterinary medicine. Then he spent two years in general practice in Las Vegas and then started an oncology residency at Michigan State University. He's now a board certified veterinary oncologist and has been commissioned to start multiple oncology departments in the Northeast, participate in clinical trials. and is asked to lecture frequently. He also opened Private Veterinary Specialties and has been providing oncology care in New Jersey since 2011. He now runs Private Veterinary Oncology Consulting, which is helping other veterinary oncologists to start and run their own mobile oncology service. PVOC provides licensing agreements to oncologists across the country, allowing them to utilize his proven methods and patent and design to start their own successful practice. On top of that, he's also founded Veterinary Oncology Partners, which provides online consulting services directly to the primary care veterinarians to guide them through all aspects of cancer diagnosis and treatment. And Dr. Hamilton enjoys the bettering the lives of oncology patients and working with their owners to ensure the best quality of life possible. 

Well, Dr. Hamilton, thank you so much for being here. And that's quite an impressive list. You're quite the entrepreneur. There's a lot on there. 

Dr. Hamilton:  Thanks, I think I just have a busy mind. It kind of leads me to new things all the time. 

Dr. Venable: It must be exciting in your head. Is that how you ended up in psychology? Just trying to…

Dr. Hamilton: Yeah, well, psychology, I mean, as we all know, applying to vet school, you need a plan B because it's so hard to get a plan B. into a veterinary school. So I always like psychology. And so that's kind of where that came from. And it's actually served me surprisingly well. In undergrad, you're obviously not qualified to be doing therapy or anything like that. But it's really great because it introduces you to all the principles of psychology, in particular, learning and behavior, which tends to be quite helpful with our clients and patients. 

Dr. Venable: Oh, I would agree. You know, I didn't didn't do much psychology. I found that I've gotten into it more as I've gotten older, that I really enjoy psychology. And it is, especially with our clients, right? I feel like the more you can learn about communication and grief, 'cause it's this whole other package of trying to communicate. So I can imagine that psychology has certainly helped you along the way. 

Dr. Hamilton: It has, and as times during the day,  you know how hectic things get or emotionally charged. You have to kind of step back and go, okay, what is actually happening right now? Well, let's not get into the suck into the vortex of emotion. Let's actually get to the root of what is actually happening. So it serves me well. 

Dr. Venable: Yeah, no, and it's a good point to kind of get back to, okay, what is actually happening, right? When things are so emotionally charged, which we can see with our clients. And, you know, to touch on your mobile, 'cause this is really interesting to me because you're not just driving to clinics or driving to pet owners homes and you know collecting blood or giving pills. You actually have a full service in your truck and you're actually USP 800 compliant is my understanding.

Dr. Hamilton: Yeah so I designed the first mobile department in the world as far as I'm aware of and it's full service. So we have all our blemish machines, our hood, dawning room, treatment area, chemo area. So all that's all separated. But as far as I know, I'm the first. 

Dr. Venable: That's impressive how you got that in a truck. 'Cause I know plenty of clinics that don't quite have it down yet, the USP 800. So, but what got you into mobile? Like what made you, instead of just going to maybe another practice, what made you decide that you wanted to do mobile practice?

Dr. Hamilton: So it's kind of an evolution. So when I got back to the East Coast, the practice that I grew up in as a kid contacted me. And at first it was just, hey, you're back on the East Coast, let's have dinner and reconnect that kind of a thing. And then they're like, well, you should come here and do oncology. And I was like, what are you talking about? Now, I just got out of the ivory tower. Like how could I possibly do oncology not in the ivory tower? And they were wouldn't take no friends, like just comp, just stop by on Tuesday afternoon and just, let's see how it goes. And so I got there and there was cases they're waiting for me and they had bottles of chemo in the fridge, no closed system, no nothing, just they said, "Okay, do it." And it was very, they threw me into a bootstrap situation. I was like, "No, this isn't exactly ideal." But there was a huge need. And so at their practice, you know, I was seeing... I would only be there for probably part of an afternoon and I would see anywhere from 8 to 12 patients, which is really hardy for an afternoon and a general practice. And I was like, you know what, there is definitely a need here. You know, the owners like being at their general practice, their vet is still in the building. So they have comfort there. They've been here for probably 10 years on average and they get these especially care too. And so I said, you know, I like this, but we need some safety and we need some... some checks and balances and processes and procedures, things that we all set in place for all of our oncology patients. So I said, how can I do this? What am I missing? And what do I need? And so I looked at that. And then I also looked at where I was working full time and especially clinic I said, well, what do I have here? What don't I have there?  And what is my, you know, goal? And I realized that even in the specialty practice setting, like, I had very little accommodations, very little space. Oncology seemed to always be an afterthought for a lot of practices. So the hood, the chemo safe areas, your staffing, like it always, again, afterthought for even specialty practices. And so I said, okay, well, if I want to do this, how much room do I physically need and what do I need? And I realized I didn't need much, you know, and then you kind of put it all together piece by piece. And you, as you go through that, and then you pair it with what USP wants you to have for safety. It was like, okay, I can easily do this in the mobile setting you just got to really work on the design and so I work with an upfitter and their engineers to get everything done. I said, you know, I need my hood here, you have to make sure the sink is a certain distance away from it and you have to have negative pressure here and walls here and so you just went through it line by line and said how do we make this space work. And so we did it. And so that was kind of the evolution. And it took me about two years to get up and running 'cause I was working a lot of back and forth on the design. And so I still did the general practice stuff and I still did my specialty stuff. And then once it was ready to go live, I kind of jumped in. But anyway, that's the long story of kind of where it came from. 

Dr. Venable:  And that's exciting that you were really thinking about that and trying something new. I love it when people, you know, there's something that it doesn't exist and they're like, All right, well, I want to do this, so how can I do it? You know? And that's great that you found people. And because I wouldn't have thought of how to put that in a truck, I would just assume that's not possible. So that's really, really cool. 

What what challenges have you noticed with doing because are you only mobile now or do you still have a brick and mortar specialty hospital?

Dr. Hamilton: So I'm only mobile. So my clinic serves as a hub for the local areas. So I have clinics that I go to and then wherever I'm at clinics around there send into me there. So, but I'm a hundred percent mobile right now, but we do utilize the clinics we're at the brick and mortar aspect of it. So just to kind of get into it, the client experience is the same. So they still are in their waiting room. They're still here. see me in the exam room, they still check out at reception. It's just when I need to do something cancer related, I go out to the mobile department versus being in the building because they obviously don't have what I need. 

Dr. Venable: So what kind of challenges have you noticed with that? 

Dr. Hamilton: So the challenges were huge when I got started. The same things that brick and mortar have when you're fresh and just opening the doors as well as stuff on top of that. So power, making sure I had good power backup. So a lot of these, anything mobile, whether it's an RV or a mobile practice, you're usually on generator power. So figuring out how to never have loss of power due to generator issues. That was it. Scheduling, making sure that I could see the patients and have enough time for every patient before my next location. That was a big challenge. challenge. And just trying to figure out all the day-to-day stuff how to do it. Internet, where do you get internet? You're on wheels. So when someone says you need a hardwire internet for your blood machines, how does that happen? Because you aren't hardwired, you're on wheels. So trying to figure out workarounds for stuff like that. So a lot of little things, but it was certainly stressful for the first year or so.

Dr. Venable:  How many clinics do you typically go to? 

Dr. Hamilton: So right now I have five clinics I go to per week and they're standing order. So I'm at the same clinic the same day every week. So there's no guesswork. Clients always know where they can find me. And so it's pretty reliable for there. And they like that. They can say, okay, you're always gonna be here on a Monday. If I need you on a Monday, that's where I go. They're obviously able to reach me all week long. So they don't have to just stick with one place. They can call us at all times, see us wherever they want. So the clients have plenty of flexibility. 

Dr. Venable:  So I heard some of the challenges and can kind of imagine, you know, just to make yourself more mobile. What are some of the positives? What makes you keep doing mobile? What do you like about it? 

Dr. Hamilton: So I like being able to work with the primary veterinarians and their owners in that setting on the front lines. So I think a lot of us as specialists really lose touch with what it's like to be a primary veterinarian. Some of the challenges, everything comes in undiagnosed and you have to just figure out every condition known to man versus us as specialists. A lot of times they're wrapped up with a bow and just sent to us when they're ready for treatment. So seeing them and working with them on the front lines, you know, they'll walk out of a room and go, oh my god, this dog CBC is nuts. What do you think? I'm like, okay, well, that's, it has acute leukemia right now, and so I'm glad I'm in the building because it needs to see me right now. I've had that happen before. Or they'll be taking some rides and say, hey, can you pop in and look at these, give me your opinion. So I really like working with colleagues that way and seeing what they go through and also helping them do their work ups faster. So some cases for us as specialists are very easy and just need a couple of steps, whereas to them it's not as clear. And so it's great to say, okay, consider XYZ and it gets the patient worked up faster and really helps everybody. It helps everybody get to the point quicker. So I like that. 

And the owners, I like the comfort level that they have that they are used to a lot of them, not all of them, but a lot of them are used to seeing me in a clinic where they're used to seeing their vet. And so they take comfort in that. And just having something familiar when you're in such an emotionally charged situation goes a long way. It really does. 

Dr. Venable:  Yeah, I've noticed even with my tele-consulting, like a lot of the pet owners, they're just so comfortable at their vet's office that, you know, regardless of what they end up deciding to do, they just, you can tell they're just much more relaxed knowing that, okay, I hear somewhere familiar and my vet's good with all of this, you know, even if the vet's not right there on the call at that moment, you know, they just seem more comfortable. So yeah, I would, I would totally agree. There's just something about that familiarity, right, versus when you go to a specialty hospital and it's so new and different. 

And how do you think the general practice, how do you think they like your services or what's been kind of the feedback and things you've gotten from them? 

Dr. Hamilton: As far as I can tell, they love it. You know, I'm predictable and so they always know that I'm gonna be there in certain days and so they'll keep cases from me. So they'll have a stack of records and say, "Hey, can we go through a couple of biopsies together?" So they like that predictability to know that they've got, they can phone a friend or whatever that'll be there to help them out with stuff. And the fact that we can offer expended services and they're set to do that. So they like that it's kind of a value add for owners. And they're not having to lose touch with cases. So when I'm there, I literally walking through treatment, I'm like, hey, Fluffy is doing great in remission. And it's just a fast update versus them waiting for a fax or an email from a referral hospital, they get to see me walking in the hall with their patient and hear that everything's fine. So just having that connection still, they're not losing touch with patients. So that's really helpful. 

Dr. Venable: Yeah, no, I could see where they would really like that. 'Cause it's kind of like the pet owner. A lot of times these vets have quite a relationship with some of these people. Like you said, they've been seeing them for 10 years on average. I can't imagine that, I mean, in specialty, that's a lot. 

Dr. Hamilton: So it's stuff like, hey, that's my favorite patient or one of my favorite owners. And you're like, yep, we're doing great and they see they're in good hands and they're in good hands. it's going well. So it's live in front of them versus sending them out the door and kind of hoping that it goes well. 

Dr. Venable: I'm sure that it's also nice for them because they know you. So they know, like you said, it's one of my favorite clients and so they know more of what to expect and how all that process is gonna go. So that's really cool. And what would you say, I find oncologists, a lot of people love practice, but there's definitely people and I feel like maybe just veterinary medicine in general or where people are wanting maybe something a little bit different. They don't want to totally practice, but they're wanting something different. 

And you, if correct me if I'm wrong here, you can actually help oncologists with your design and things so that they could do this on their own. What do you find that would be a reason people would prefer mobile over clinical practice?

Dr. Hamilton: Well, it allows them to have their own business if they want. And when you have your own business, you call the shots when it comes to scheduling, pricing, staffing, inventory, all that stuff. And so it empowers them to do it their way. And I think a lot of us are perfectionists inside and we all have opinions about how things could be better or we could do it our way. And when you work for somebody, else, you know, your input is taken to some extent, but not always. And depending on how big the organization as you work for it may fall in deaf ears, or they may actually consider you. Whereas when you're in your own practice, it's always your way. So it's I find that, you know, that's something that people see value in. So I don't know, I think owning your own practice just empowers you to have the life that you want to have. 

Dr. Venable: Oh, it's true. You know, I've noticed even, you know, since I've started my own company, it is, it's kind of, you get more of that flexibility. And what would you say, you know, because I can only imagine what kind of finance and loans and things you'd be committing to if you're trying to buy your own brick and mortar. How would you compare that to the mobile because your truck's pretty, I mean, it's pretty advanced. It's not just a van. Yeah.

Dr. Hamilton: Yeah, they are custom builds. This is not a retrofit. This is not someone else's prior RV. This is complete custom build, start to finish, brand new. Compared to brick and mortar, it's drastically less. I mean, drastically less. So you're in the hundreds of thousands of dollars mark versus brick and mortar. You're almost always in the millions. And so it's drastically less. Even so, if you've never owned your business and taking loans out. out for six figures, it's still scary. I mean, when I got started, I was terrified. I was like, the first to do this. So I'm like, is this going to work? Am I going to make money? Can I pay my staff? Can I pay my loans? So all of that was just this giant cloud of anxiety over me trying to figure out if it worked. And then I quickly learned that it works great. There's still stress involved, but it works great. And so the figures are the number one. are much more palatable once you get to know them.

And so that's part of what I offer to people is I show them that, you know, how does it work? Why do the numbers work? And how is this going to be okay? 

Dr. Venable: A little bit of that counseling, I'm sure I would need that. I totally can understand, yes. And that would be nice having someone to mentor you along. And when you do have that, you know, it, is it your brand or can they call it whatever they want? Like if I open one with you, can I call it whatever I want or is it your brand? 

Dr. Hamilton:  No, no, it's their brand. So everybody that works with me, they have their own business. So the way that my company works, Private Veterinary Oncology Consulting, is we walk people through how to start a mobile practice and they have a licensing agreement. with us to use my patented design. But in the end, they can do whatever the heck they want. So they can staff how the way they want, supplies, schedule, all that stuff. We just walk them through it for the initial steps from starting your LLC all the way through your first year of practice to get all the things done. Because when you start a new practice, it is huge as far as what you have to get done. And there's no guide, so no one tells you. And so that's kind of what we help get them through is let them know all the steps, how to do the steps in the right order to save themselves some heartache, so that they can be successful. But it's all their business, their brand, they set their own pricing, you know, in the end, they call the shots, we just get them launched, if you will. 

Dr. Venable: So as far as mobile, is this something you can do in all 50 states? You know, the states all have different practice acts and things. But as far as mobile, I mean, you're you're seeing the client. So I would assume you can do it anywhere. But since you're USP 800 compliant, I'm sure you've read all the regulations. So have you noticed, is there any geographical issue with doing this?


Dr. Hamilton: Not that I'm aware of. I haven't looked into every state, to be honest. There's some straight states that are stricter than others that they'll have state aws above and beyond what we're used to hearing. But I am not aware of anywhere you couldn't do it, as far as I know. 

Dr. Venable: Yeah, I would think if you're USP 800, that's got to be pretty close, if not all the states, you know, and you're seeing the actual pets. So I think that would help with a lot of the practice acts and things. 

Dr. Hamilton: Yeah, we have a client -patient relationship with all the owners. I mean, we're looking at them in the eye, face to face, just like we would be in a specialty practice and they're signing chemo consent, just like they do to keep a specialty practice. So it's essentially the same thing. It's just we bring all the safety with us in a mobile fashion, but it's all of our services the same. We can do, I can do everything now that I always could. I can run research trials. I can give all the drugs I used to give. So I don't feel at all, inhibited by being mobile at all. 

Dr. Venable: How do you like being mobile with the vet versus going directly to the pet owner's house? Have you thought of that or have you experienced going directly to their house?


Dr. Hamilton: Yeah, both. So when I first got started, I did do a little bit of owner direct at their house. I don't like it. So for safety reasons and for patient care reasons, I do not go to people's houses anymore. I'll do some horses that way. So there's some horses around that need melanoma vaccine or are on lymphoma protocols. Even then, I'm not thrilled about it, but I'll do the horses because they physically can't hold them back and forth every week. But for small animals, I don't go to people's houses. And the reason being is safety. So I've had, we all had in practice patients that have decompensated while they're there. So I've had dogs going to tamponade right in front of me in the exam room, or had other issues where I needed to make sure I had a full service facility that I was at. So I only do it in association with a host location. I don't go to people's houses at all. And I'm very happy about that. It was a decision I made early on. I only did a couple of house calls and I quickly realized like I wanted, I wanted back up, I wanted to be with other vets in case I needed something. 

Dr. Venable: So that makes sense. And it is interesting because I feel like the traditional mobile setup is to go to people's homes. And then to pivot a little bit, you also have a company that kind of directly with the vet. Now tell me a little bit about this. How is this different than your mobile? Like why would you start this?

Dr. Hamilton: So this is telehealth. So Veterinary Oncology Partners works with primary veterinarians to bring cancer care to underserved areas. So as you know, there's areas of the country that don't have oncologist period or specialty period. So we're trying to fill that need because we're trying to fill that need because we're trying to fill that need because we're trying to fill that need still so many dedicated owners out there that need help with their pets, as well as great veterinarians that need help to help those pets in the underserved areas. So we're trying to fill that gap. So we founded this company about almost two years ago now, myself and my partners. So they are internal medicine specialists and a pharmacist to try to fill that void. And so it's a, telehealth company that works with those vets to get them through their oncology cases. And we're actually different in that we will mail and ship IV chemotherapy in close system transfer devices. So as you know with USP, they really want you drawing things up in a proper hood that's vented and we can't expect vets in underserved areas to have a hood and have an oncology department in the wings. So we do all that for them. And then we walk them through patient management and safe chemotherapy administration step by step. So that's what this company does and kind of how we do it.

Dr. Venable: Yeah, so you're right, that would bypass a lot of the USP800 as far as the infrastructure, you know, then you just need more of the PPE and, you know, you said instructing just how to safely do this. How are you shipping IV? I mean, I'm assuming do you have have the dosing how are you guys setting that up because that seems like that logistically could be a challenge. 

Dr. Hamilton: It has been a huge challenge so we've been working on all the back and forth logistics for quite a while before we even went live and we're actually just finishing our beta phase now. So we ship them all their PPE it's kind of like a bark box if you will, so they have a bag full of all their PPE for two people so every single dose they get fresh PPE for that case. As far as the dosing goes, they will send us all the information on the patient and we will calculate the dose. And then we ship it. We have a certain timeline we have to work in as far as drugs being stable. And so it's obviously shipped on ice/chilled with temperature control regulating strips to make sure there is no compromise to the drug during transport. And then... then before they actually give it, they have to also send us their CBC that day and a patient assessment to make sure the patient's ready for it. So there's a lot of hand holding with it, but the logistics have been huge. They've been really huge, but we want to do it because we want everybody to be safe. We want the staff to be safe and the patients to be safe. And so we had to, again, sit down and go through all this stuff that we worry about every day and say, how do we make this work? And what's our checks and balances for it? So, yeah, we got to go in and we're doing it. 

Dr. Venable: And how's that being received so far by the general vets? 

Dr. Hamilton: It's going well. We're on purpose, keeping it a bit slow at the moment. So we're not doing a big push. We've kind of handpicked a bunch of beta sites around the country for either vets that we know or vets that are really ambitious. And we're working with them and we're going through the cases one by one, trying to make sure they all go smoothly. So it's been well received. I just did one like half hour before I started this interview. And they were texting back how happy the referring that was and how smooth it was. So it's an exciting venture. We really want to help people out that needed. it. Of course, we still want people to see an oncologist who actually can. So owners that are in a state that's within a locality close enough to oncologists that still is our recommendation. We're just trying to help those that can't do that. 

Dr. Venable: Right. There's a lot of dead zones. You know, I mean, there's only so many oncologists and when you start looking, there's actually multiple states that don't even have oncologists. So, yeah, this is a really neat idea because you are keeping people safer. You know, so often when that's even before certainly before USP 800, sometimes the I think we probably all have stories of people telling us how they pull up chemotherapy or how they were administering it and it was just a bit frightening.

Dr. Hamilton: It is and even today, like people are relaxed, even the specialty setting, you know, we've seen here of all kinds of stuff that's probably not the best that there could be done better. But all the safety is built in. Like it or not, you're getting your PPE fresh every time. So you may want to reuse that gown, but you're not because we're giving you a new one every single time and new gloves and your chemo spill kit and your mat and all that stuff. So we work hard to make sure they have everything and to think of every little thing. 

Dr. Venable: Yeah, it sounds like you guys, I've been really detailed. How do you communicate back and forth? Is this an email, phone call? How are you guys doing that so far?

Dr. Hamilton: So every site that chooses to use our services is onboarded and they have a login to our website and they'll submit recheck requests, their first consult requests and it's standard information name, address, phone number, putting attachments on with your CBC or recent cytology. And we go through it just like you would in specialty practice, you know, you dig for it, the record, summarize what's happening and come up with a plan. So that's how the first consults go. And then for rechecks, meaning a chemotherapy treatment, they will submit that day. So the patient will come in, they'll draw their CBC, they'll do their exam, they'll submit that to us. And we have to turn that around within two hours. So essentially, these vets are doing some drop off appointments. And within that two hours, we have to prove that it's safe to give this patient. that's responding as you would expect for the disease and the protocol that they're on and we send them that back in writing so that they've got a document to say hey it's okay to do it. We're also available by phone so if they want us to talk to them about the case or just pick our brain we're still available for that. So we're accessible both ways but most of it tends to be online through documents.


Dr. Venable: Very cool I think it's great. trying to leverage technology, right? And seeing how can we do things better than we used to before, but then also sounds like you're very good about thinking about what are the issues and how to try to work through that in the detail. And, you know, I kind of wondering, 'cause obviously you're thinking of, okay, how can we do things better, but what are some issues kind of going along that? 

What are some, is there any interesting research or technology that you're seeing coming out, certainly in veterinary oncology, but just maybe just in general with vet med, anything that you're excited about? 

Dr. Hamilton: Well, I'm still, I still continue to be very excited about the genomic stuff for our profession. You know, doing tumor profiles and looking to see if there's any potential use for targeted drugs. I'm still very excited about that. I know we've had it for a couple of years, but it takes a lot of time, while for it to take traction. And in my day to day, I try to use as much of that as I can for owners. So I find that exciting and all of our data is still coming. You know, it's new. We don't have it all figured out yet, but I love the possibilities that it might have for us. So I find that exciting still.

Dr. Venable:  I just like to learn how other people are using it. Do you use targeted therapies? Are you combining that with IV? Do you like the more single agent? How do you use that in your practice? 

Dr. Hamilton: I use it in addition to what I would consider standard of care. So say you have a Hemangiosarcoma when you're putting it on Adria. I'll run the profile also, and then if we have a potential targeted drug, I'll layer that in addition to what they're on. I almost never use it instead of what I would presume is standard of care. And I tell owners why. I just, I don't want to give their pet less. I'm hoping to give their pet more. It doesn't always work out that way, but that's the hope of all this. So that's how I use it. But I, that does not help the data though, I will say that. Because with the more drugs you have in concomitant meds, it really messes up everybody's data. But I, I answer to the patient, the pet, not to the, the studies. So on a day-to-day basis in clinical practice, that's how I do it. But I think for study purposes, you can't do it that way. 

Dr. Venable: Right, that's true. Studies, that's the problem with some of our studies, right? And when you're giving it together, have you noticed any more side effects or maybe any more positive outcomes? I know sometimes there's so much bias that gets thrown into that.


Dr. Hamilton: So I will kind of stagger things. So, for example, if a dog's on Adria from Hemangiosarcoma, they'll get Adria day one and then say day seven, then I'll let them layer in their first doses of targeted meds. That way I know with pretty good certainty that for the next 14 days, if they're just on targeted drug, if they had side effects, it's most likely targeted drug. And so I kind of stagger them that way to try to figure out where side effects are or not coming from. And then once they put them on, that for their first cycle, then I will do them together. There's a couple of drugs you just cannot do that with. But in general, for most of them, you can layer that way.

Dr. Venable: Have you been doing that for urinary carcinoma? I heard a talk recently, and it was from a lot of academic institutes where they can't because they don't want to compound, so they can't get a hold of these drugs. But then when I talk with you. vets in private practice and things that's what a lot of them are using because they're compounding the drugs. What, have you been using that compounded, sorry, targeted therapies with urinary? And what are you seeing? 

Dr. Hamilton:  Yeah, so I use exclusively compounded 'cause you can't get brand name at the correct dose for these patients in the regular manufactured form. So it's, if you want to get the dose you're looking for, it kind of has to be compounded. Of course, there's pitfalls to that, you know, with the small molecular inhibitors, we've seen it with Palladia a couple of time, you just can't always get a great dose compounded. So if it's possible for me to use a manufactured size, I almost always do. But if it's impossible, you have to go to compounded. So specifically for urinary, I do get it compounded. I know there was some recent controversy that with the sulfate trametinib versus the not. So that is a very real thing We have to really watch the compounded drugs that we're using But I have absolutely used like trametinib with and vinblastine or trametinib with mitoxantrone and it's been very well tolerated.

Dr. Venable: That's exciting. Now. I always like hearing what are other people doing? Especially I think once you leave your residency and you're in private practice I think that's when you also are always like am I doing what everybody's doing in my keeping up So, no, that's great. Thank you for sharing how you've been using these meds. And also, what do you think are maybe some challenges facing? You know, we're talking a lot about the positive and what's new and exciting, but what do you think is maybe something as a practice, as a profession rather, we should maybe be a bit cautious. 

Dr. Hamilton: We don't have all the pharmacokinetics done, you know, the PKPKD data, it's just not done in a lot of these drugs. We're trying and there's some residents out there that are there working. working on a couple of drugs, but we don't have it. And that's a huge criticism. And anytime you go to a meeting, the academics get up in arms because it's not all finished. And we don't know all the stuff, which I agree with, but we also only have so much time to wait. And unless someone's going to do it or at least try, you gotta get the ball rolling somehow. So that's how I view it. And I'm very open with my clients about it. I'm like, Hey, we're not FDA approved to use this drug. This is new. This is not standard of care. So all the disclaimers, but you really have a lot, at least I find there's a lot of owners out there that are so committed and they really do want to be novel or daredevil. You know, they want to push the line a little bit. And as long as it's, they're on board, we'll do it. Thankfully, I've never had any horrible things happen, knock on wood. But we all go through it in a thoughtful way. And I say, I want to try this this because and this is what could go wrong. And are you comfortable with that? Are you not comfortable with that? So it's a meaning of the minds. But so far, it's gone well. But yeah, the criticism over the PKPKD stuff is going to be there until it's all finished. So we have a long way to go with that to satisfy ourselves. And admittedly, some of these drugs may do nothing. They may do absolutely nothing. But you got to start somewhere.

Dr. Venable:  I think that's a good attitude because it is, it's hard at the conferences, right? And the more I'm learning about some of these startup companies and things, it is so expensive, unfortunately, to get a lot of these studies rolling. I think we were so lucky and vet med early on because we just did retrospective because we knew nothing. So you kind of just start anywhere. And I think also back then, because even if you think about. about CHOP, when you talk to some of the people who were involved with some of those original veterinary studies, they just pick the doses at random. And I've never really heard any criticism about, well, why do we treat at this dose? You know, when most, I don't think we've really done much to challenge, can we go up or down or, you know, what? So it is interesting to me, and I think some of it is just because our science, thankfully it's gotten better, but it's, the same time, it's like, yeah, you're trying to find that push and pull between how do we move forward with science and treatment and actually help things and not just stay back and never get anywhere because it's so expensive.

So I like what you said to owners. I think that's the truth. We just have to be up front because dogs, there's not nearly as many restrictions on trying different therapies versus people. I think, you know, know, and probably understand, well, you have to sign off and jump through a lot of hoops before you necessarily get those newer drugs that we don't know as much about. Is that kind of how your experience or what your thoughts are?

Dr. Hamilton:  Yeah, very similar. And even my own mentor, you know, she would tell me stories from way back in the day, like the forefathers or grandfathers of oncology, how they would do it. And they're like, here, go give this dog bank. See how it goes. Like, really, it was in the early days, it was very cowboy back then. So we have to always remember that every big step that we take in treatment and work up, there's always criticism and we get through it. And here we are 30 years later and CHOP’s no big deal. But back then it was like, you're gonna do what to a dog? You're gonna put that in the dog and it's, whose idea was that? So you're gonna get that every step of the way when something novel is going on.


Dr. Venable: Very true. very true. And I think it's still always good to learn more about the novel products. And then also thinking, okay, you know, what are we worried about? What are some of the side effects? And just being very upfront and communicate that, which it sounds like you're doing a great job of that. So very excited to hear all the things that you're doing. And you know, also with your mobile oncology things is it's with other oncologists. If someone listening is interested in doing some of the things that you're doing. like that, how can they get a hold of you? 

Dr. Hamilton: So they can easily contact me through any of the websites I'm on. The company that I use to consult with other oncologists is called Private Veterinary Oncology Consulting. So they can find me there. We're also on LinkedIn. And it usually just starts with a conversation. There's a contact us button, of course, but it's really us getting on the phone and kind of talking about what they're looking for, or what their expectations are. and what their goals are for their career. Mobile might be for them or it might not be. So talking through all that's really important before you jump right in.

Dr. Venable: Yeah, that sounds important. You're right. Sometimes like, what are the goals? What are the motivations and making sure that those actually all line up? And before we sign off here, do you have anyone else that you would recommend for this podcast?

Dr. Hamilton: I do. And I was thinking about that today. A different one that you'd expect. So who I thought of for you to interview would be Dr. Sarah Boston. As you know, as a surgical oncologist. And the hook with that is, you know, with this being a podcast about things that are kind of innovative and new is kind of where she's gone as a side projection of her career. So she's now doing a comedy podcast. And I just think that that's that's innovative in itself, you know, the fact that you can have such a successful career and be well trained and say, you know what, we need some balance, but yet also not forget who we are to say, yes, I'm an oncology surgeon, but I need to laugh sometimes. And I'm and allow happiness into my life and have that balance. So I think I'm kind of fascinated by that, stepping outside the box and not being a complete academic or just a clinician and saying, let's be human and laugh a little bit, which is not at all part of oncology. Laughter is not usually part of what we do. But I just, I found that was, it really caught my eye. I heard from her last week and I was like, you know what, I'm actually gonna recommend her because it's a different take on career, different take on life. So there's something to that. 

Dr. Venable: Oh, that's a great one. I hadn't thought about Sarah Boston, but you're right. She Yeah, the comedy podcast. I mean, it's just, yeah, no, that's a great, a great one. Thank you so much for your time. This has been a great chat. It's so nice to hear kind of a different spin on things, right? How can we still be oncologists, but do something different? Because you know, we don't one size is not fit all so that this has just been really great. Thank you so much for being on our show today.

Dr. Hamilton: No problem. Thanks for having me. 

Dr. Venable: And for all the listeners if you would like to reach out to Dr Hamilton, you can certainly find him on Facebook and LinkedIn, but also his website the Veterinary Oncology Partners is veterinaryoncologypartners.com is pretty straightforward. And then his veterinary oncology consultants if you're interested in direct to the veterinarians, that one is called vetoncologyconsulting.com.

Well, that's it for this episode of the Veterinary Cancer Pioneers Podcast. If you enjoyed this episode and gained valuable insight, we would be so grateful if you could mention our podcast to your friends and colleagues. The Veterinary Cancer Pioneers Podcast is presented to you by ImpriMed.