Updates in Pet Cancer Care: An Interview with Vet Oncologist Craig Clifford

Vet Life Reimagined brings guest, veterinary oncologist, Dr. Craig Clifford.

About the guest:
Dr. Craig Clifford graduated from Mississippi State University College of Veterinary Medicine and received an MS degree in Animal Science/Virology from the University of Delaware. In 2003, he became a diplomate of the American College of Veterinary Internal Medicine (Oncology). He is a medical oncologist and director of Clinical Studies at Blue Pearl Malvern in Pennsylvania.

He is active in clinical research within a referral setting and serves as an advisory board member with both industry and non-profit foundations. He is a renowned oncologist who has authored/co-authored over 70 papers and book chapters. He is a frequent lecturer at major veterinary meetings in the USA and abroad. Dr. Clifford is a member of many committees, task forces, and medical exam review boards.

In this episode, we discuss
- how to implement clinical trials in any veterinary practice & the benefits
- exciting updates in veterinary oncology: diagnostics & treatments
- the reward of mentoring others in veterinary medicine

Resources:
🏥 Dr. Clifford's hospital, Blue Pearl Malvern
📚 Dr. Clifford's book, The Boy Who Wanted to Be a Veterinarian: Conor's Journey
📹 Episode on YouTube

Transcript

Megan Sprinkle: [00:00:00] Welcome to Vet Life Reimagined. I'm your host, Dr. Megan Sprinkle, and today we have an amazing veterinarian, medical oncologist, Dr. Craig Clifford. As always, we will get into Dr. Clifford's career path, but I want to highlight his amazing mentorship and leadership skills. He had an entire oncology practice, Follow him to another state as he became a partial owner in a specialty practice in Pennsylvania where he still is now.

Megan Sprinkle: He is active in clinical research within a private referral setting, and we talk about how you can also participate in clinical research even in a general practice. He has authored or co authored over 70 papers and book chapters. He sits on many committees and boards. He is a frequent lecturer at major veterinary meetings in the 

Megan Sprinkle: U.S. and Canada. And abroad, and he loves taking his family along with him. He has a big heart for helping others in veterinary medicine succeed, including watching his veterinary technicians find thriving career paths. Too much to packed into an intro. So let's get to the conversation with Dr. Craig Clifford.

Megan Sprinkle: when did you [00:01:00] know you wanted to get into veterinary medicine? 

Craig Clifford: Yeah, first of all, really appreciate the opportunity to be here.

Craig Clifford: I think for me, like many, it was very young, my father was a CPA and both my brothers ended up being attorneys and somehow I ended up becoming a veterinarian and I knew very early on I had you know, a massive, pull for animals. Just like most of us in the field did. we didn't have any pets growing up until I was able to pester my parents enough to show I could help take care until probably I was about eight or so.

Craig Clifford: , I was able to, negotiate would be the best way to say it. the idea of getting our, first family dog. so unlike others, many people who grew up on a farm or grew up with pets from day one. I didn't have it until a little later, but clearly I knew right away that. Working with animals in some capacity was where I wanted to be.

Megan Sprinkle: And then as you were getting closer into college and looking at veterinary schools, how is that journey for you? 

Craig Clifford: [00:02:00] Yeah, mine was tough as you may or may not know, literally it took me four times to get in the vet school. So where I went to college was a small liberal arts college in Pennsylvania called Muhlenberg and mainly they spit out MDs.

Craig Clifford: So when I had said I wanted to be a vet, they were like, wow, well, you know, it's really hard to get in the vet school. You need to go to grad school. So I didn't even apply right away. I just jumped right into, grad school. During grad school, I had applied a few times and it wasn't literally until my fourth time that I was able to get in.

Craig Clifford: To me, though, grad school was wonderful because, you know, unlike college, where we all know, traditionally in college, we sit in a class and they give us the information, we furiously write everything down, then try to memorize and regurgitate it back for the test, graduate school was very much a lot of self learning.

Craig Clifford: Yes, we did have courses, but most of it was self learning, your experiments, you set up mostly yourself with guidance from your mentors. So. Being that a lot of it was self taught, that, to me, was something that I 

[00:03:00] seemed to excel at, or at least it was eye opening for me. And when I started looking at veterinary schools, I really tried to narrow it down to the schools I thought that could accentuate that.

Craig Clifford: One of them was looking down in the South at Mississippi State, which had problem based learning. And for those not familiar, problem based learning, instead of learning by courses, we actually learn by cases. So the thought process is you're designed to be, hopefully, a better clinical thinker, because from day one, you're looking at radiographs, you're learning about drugs, you know, you may have a case that's a hit by car.

Craig Clifford: So you learn about bone healing, you learn about surgery, and you look at radiographs at that time period. So it's actually really interesting that we were able to do all of that right away, and that was really, really beneficial for me. I think it's really good to know the different types of learning styles while we don't have tons of veterinary schools.

Craig Clifford: And some people may just be happy to get into one. If you do have some options or you want to look around, each school is a little bit 

[00:04:00] different in the structure that they have, you know, location, all sorts of things that you can consider when trying to look at that school. 

Megan Sprinkle: And so, because you had. Such a great persistent, start into the veterinary industry. I think you're a very good person to also give a lot of maybe pieces of wisdom for people who are trying to get into veterinary medicine. or maybe in vet school?

Craig Clifford: the biggest thing for me was don't give up at all. if it's your dream and this is what you want, this is what you do. So I picked myself up from, you know, I lived at the time in, Delaware, which is where I went to graduate school and I went down a year early to Mississippi state, , and I worked at the USDA as a research scientist for a year and, you know, it was certainly a culture shock, coming from the Northeast to down there, but, you know, it was what I had to do to get in.

Craig Clifford: So, I spent a year as a research associate at the USDA working with, bird viruses, to be honest, at the time period. So very, very different. [00:05:00] Part of that was during my grad school as well, so it was somewhat of a natural progression. But it was allowed me to get residency and hopefully make it easier for me to get into med school.

Craig Clifford: And I did everything I possibly could to try to improve my scores or to improve how I looked. during that time frame as well. So certainly I would say for anyone it's not unobtainable. fortunately, as you mentioned, there are more veterinary schools coming up, a lot more now that has its pluses and minuses.

Craig Clifford: We need to make sure they have proper accreditation clearly. But there are a lot more of them. So certainly, the number wise is better in our favor than it was before, but for me it was a good fit, you know, even though it was a culture shock initially being down there. one aspect that was very beneficial was everything closed at 10 PM.

Craig Clifford: So there was no late night party. You went to bed and then you got up and I was able to study right away. So, even though it was a very different atmosphere for me in that aspect, it was very conducive for learning. Less temptations. 

Megan Sprinkle: [00:06:00] Yes, so I went to Auburn for vet school It's very much a college town.

Megan Sprinkle: And I was such a studyaholic, I, you know, I was just school, school, church, grocery store, and study. 

Craig Clifford: Same thing here. That's exactly what I did. 

Megan Sprinkle: Yeah, pretty much. So, well, speaking of, the time going through veterinary school, Did you have an idea of what you wanted to do as a veterinarian? And did that change throughout vet school?

Craig Clifford: Yeah, interestingly enough, I knew I wanted to go into oncology in college. even back then there were, we could see in science, there were leaps and bounds being made within the realm of oncology. And a lot of my research was virus research in grad school and immunology. So oncology is a really a natural fit for that to move forward.

Craig Clifford: And, um, I think that was incredibly beneficial for me in that aspect. But yeah, I knew I wanted oncology early on. There was never any wavering. I think maybe the only slight wavering I had, Mississippi state, since we didn't have a lot of the same 

[00:07:00] specialists that you had at Auburn, we had during our third year, we would go out and do externships.

Craig Clifford: Like I actually did neuro, although I'm many years ahead of you. I did neuro at actually at Auburn, which was kind of fun 'cause at that point you had Simpson and Sorjonen, who were amazing. But I did my, cardiology at Illinois with Dave Sisson, who was this incredible cardiologist and absolutely loved my time there with him.

Craig Clifford: I just couldn't operate the damn probe quick enough. So, to me it was like, you know, that had a fleeting glimpse that maybe I could do cardiology. And then it was, ah, this probe is too much. So, I'm going to stick with oncology. But that was probably the only time period I had a slight change. 

Megan Sprinkle: Yeah, I think mentorship and the people we're around can also influence a lot as well.

Megan Sprinkle: And so it is really interesting that you knew pretty early on that oncology was gonna be your direction, and you stuck with it. I know you mentioned that you were interested in some of the advances that you were seeing in the field of oncology. Was there something else also that kind of attracted you to it as well?

[00:08:00] Craig Clifford: Yeah, two things. both personal. One was I lost my dog to Hemangiosarcoma, the year I graduated college. And at that point, you know, we all know hemangiosarcoma is a devastating disease, but we have treatments for it now. It's not truly just a death sentence. Back then, it was, you know, it was a small clinic we brought him into and they were like, there's nothing we can do.

Craig Clifford: You need to put him to sleep. And I had to make this, uh, quick second decision that I have regretted for a very long period of time. So I think that was part of it, losing my own best friend, because that was my first dog. And we all know the first dog is the one that often sticks with you for a long time, because you grow up with them.

Craig Clifford: the second was while I was in, Mississippi, the year before I got in. I lost my father to colon cancer. So that was, you know, another hard hit from the cancer side for me. And I think certainly furthered that this was something that I wanted to do and to put myself into. Wow. I'm sorry to hear that.

Megan Sprinkle: That's a lot. And it sounds fairly 

[00:09:00] close together within a few years too. 

Craig Clifford: Yeah, they were. And especially being away at the time, because I couldn't just come home to spend more time with him when we knew it was, You know, getting close because in order to have residency, you have to have X number of days that you're there working.

Craig Clifford: And if I had taken off a month or two to be able to be with him, I wouldn't have been able to keep the residency. So, it was a, hard call, very emotional time period, but you know, I think I made the right decision and, it all worked out for the better. 

Megan Sprinkle: Yeah. Oh my goodness. you talked about residency. So you officially become an oncologist and what do you do after that? Because I, I still remember and it's been a good number of years since I was in my residency, but I still remember that transition of the thoughts about, okay, It's time for the real world. What am I going to do? So what was your thought process through this and making that next step?

Craig Clifford: Yeah. I mean, I, I had a different kind of view in that, you know, a lot of people are like, 

[00:10:00] well, I know I want to do academia or I'm a hundred percent. I know I want to do referral practice. I wanted a hybrid in that during my residency, I published a good deal. I had the opportunity to go lecture. I got to be involved in clinical trials and I absolutely loved that aspect of it.

Craig Clifford: My mentor, Karen Sermon, was wonderful in fostering that, of the additional things you can do as an oncologist. And when I was going to leave to go to Red Bank Veterinary Hospital, which at the time when I finished my residency in 2003, it was the largest privately owned hospital. The one thing I wanted to do was create a hybrid.

Craig Clifford: So, I wanted to be, yes, I'm in referral clinic, but I want to be able to do the cool things that you can do in academia. And I was very lucky. It took me some time to be able to convince the owner at the time that clinical trials were worthwhile. But once we started them up, we found that it actually was a revenue builder and then they were very much behind it.

Craig Clifford: And we were doing a large number of trials. 25 percent of our caseload at that point was [00:11:00] actually clinical trials. So to be able to do that, to be able to be involved in publications, to be lecturing to my peers, , it was wonderful. It was truly the ability to have it all. That was a lot of work.

Craig Clifford: Don't get me wrong. Not a lot of free nights and things like that, because I threw everything I had into it. But, to me, when you're in practice, you know, you can only as an oncologist, I can only see so many lymphomas before I want to poke my eye out. , I've seen one, you've seen them all to some extent, but to be able to do something different, work on a new drug or a new diagnostic that doesn't even have a name yet, X four, five, one, it's called, you know, and eventually it becomes a trade name.

Craig Clifford: However, and you're like, yeah, I used it, you know, beforehand. So that was a great aspect and we were able to work with animal clinical investigation, which is a large contract research organization that mainly did the time oncology. So we're able to work with them. We had connections with many universities where, per chance, they may not have had the same caseload that we can see in private practice. So many of them started

[00:12:00] Craig Clifford:  reaching out to the larger referral clinics to help with the caseload for studies. And I was just very blessed that All of the researchers who I worked with in the university were very welcoming, did not look down on a person in private practice. they were very excited about the idea of being able to collaborate and it all worked out incredibly well.

Craig Clifford: And, you know, I couldn't be happier. I did that for about 11 years and then had the opportunity to buy into a hospital. one of our previous cardiologists, his name was Dennis Burkett, had shown up one day to myself and our radiation oncologist and said, here's what I'm thinking. You're interested. And, something that I wouldn't have had the opportunity at Red Bank to be able to do so moved the whole family to Pennsylvania and took my entire oncology team with me.

Craig Clifford: So, everyone came together, which was fun. And we set up a hospital called Hope Veterinary Specialist and brought it up for 10, 11 years. And then we ended up, our primary owner was 70 something at the time. And so. We had built it up so big that there was no 

[00:13:00] Craig Clifford: way to stay within the doctors within the practice. So we ended up selling to the Mars network, and then we ended up joining Blue Pearl. So, it led to many different things. And I was able to continue doing the research all throughout, which was wonderful because, you know, a lot of that is what really drives me and keeps me up to date and keeps me happy.

Megan Sprinkle: It definitely sounds like it. And I just want to acknowledge the ability to, convince your entire oncology team to come with you, that takes very good loving leadership that people want to do that cause moving is not easy, not easy. but I just want to acknowledge that that's, that speaks volumes to me when I hear that.

Megan Sprinkle: But, you know, going back, you talked about. Commencing the hospital to allow you to do this hybrid model where you could do clinical trials. And to me, this sounds like something that a lot of veterinarians could do, whether they're general practice or different specialties. 

[00:14:00] If that's something that they're really interested in to diversify their private practice experience and be on the forefront of some of these medications or maybe even pet foods.

Megan Sprinkle: you mentioned that they really got convinced when they realized this was actually a revenue generator So can you help people think about some of the ways to maybe convince the hospital things to think about? When you're trying to do a private practice and then implement clinical trials within it 

Craig Clifford: Yeah, interesting enough last year at AVMA, that's what they had me come out and speak on how to do clinical trials within, primary care, not just specialty myself, but in primary care.

Craig Clifford: And there are many opportunities that are out there. You know, many of the companies now are for that. are looking for that only because sometimes it's more challenging for them working with academia only because of legality issues and the academic institution may want part of the company or something else back. So it's easier for them to reach out to some of the 

[00:15:00] Craig Clifford: referral clinics or primary care. And really a lot of it is, is speaking with them to show the potential benefit. part of it is the way I viewed it was that it allowed us to distinguish ourselves from at least going from the oncology front from other oncologists in our area because we were doing something that was at least perceived by owners as being higher.

Craig Clifford: So essentially a higher learning or at least their implication of us was that we weren't just traditional clinicians. We were actually something more. So to me, part of it is pure marketing. It actually allows you to distinguish yourself from the other groups around you, whether it's referral or whether it's primary care.

Craig Clifford: So you're viewed as an academic edge or an academic type site. And that is viewed differently by owners. the number of owners that actually look up our names and see our publications and what we've done and choose us because of that was incredible. So a lot of that can certainly help now. It's not simple to do. You know, you have to have the management on board because 

[00:16:00] Craig Clifford: it does take more time. But oftentimes many of these are also fully funded studies. So the beauty I found in that was just so many owners who had no financial means, they would have put their pet to sleep, were able to enroll in the trial and it benefited them.

Craig Clifford: And I have found those types of owners are the ones who are, so welcoming and so thankful for it. You know, we even had a couple of dogs that were able to jump from trial to trial and the owner then was able to obtain their finances. They weren't in a good plane in the beginning, but now they were, so they could undergo.

Craig Clifford: standard of care therapy after that. So, I think that there are, multiple aspects, certainly benefit to the clinician benefit to the hospital, but also a huge benefit to the patients as well. 

Megan Sprinkle: Yeah. I think I see this as beneficial for the veterinary professionals, but also for the pet owners, whether it's maybe some financial support undergoing a clinical trial.

Craig Clifford: Yeah. 

Megan Sprinkle: Or, having more options for pet owners in treatment. I [00:17:00] like what you said, it's like people looked up the papers that you have published and man, we are in a society today where pet owners definitely do their research and they love, they love to find out information. So that makes complete sense to me that people would look that up and find that very impressive.

Megan Sprinkle: And not only to have Oh, a wider range of potentially options for treatment for their pet, cancer too, is really unique because I think we're still learning. I think we're in a really exciting time for oncology in veterinary medicine. And so having a wider range of options, is huge for pet owners.

Megan Sprinkle: And like you said, those pet owners are probably extra grateful. And so they're willing to do whatever the trial needs them to do because they know that they're very lucky to have this opportunity. 

Craig Clifford: Agreed. Even if it's them driving three hours one way, they're willing to do it. And the other benefit, which I neglected to mention really is coming from essentially our own nurses. For them to be able to be part of it, because this expands their role 

[00:18:00] they get to be involved in these new things. And that comes forward to them as well. Because I remember when my nurses would go to some of the, um. meetings and they'd hear about recent advancements and they're like, none of this was an advancement.

Craig Clifford: We did this as part of a trial four years ago. So, they would come back and it made them feel that, you know, they were above the other nurses because they worked on this. And a lot of the trials that we do, we make sure that there's a financial incentive paid to the nurses as well, because we all know they do not receive their adequate share of compensation as they should.

Craig Clifford: That's one of the big downsides in veterinary medicine. So many of the trials that we partake in, we try to make sure that there's a way, it can be shuttled back to the nurses as well so that they have a benefit. I think I can say it. my head oncology nurse, who's a VTS is actually leaving our service.

Craig Clifford: She's actually joining a contract research organization. And because of all of the experience that she got with clinical trials, she loved it so much. He's actually going to move on and be a 

[00:19:00] moderator for one of the big companies. So although I'm very sad that she's leaving, I'm actually thrilled because had we not done that and had that opportunity, she wouldn't be where she was able to go.

Craig Clifford: So to me, that's really cool. And you know, although I'm sad that she's going, I'm so happy for her because this expanded for her what she could do outside of the traditional role of a veterinary nurse. 

Megan Sprinkle: I loved that aspect as well because there's a lot of conversations going on about career options for veterinary technicians or, the ability to have career pathing for veterinary technicians.

Megan Sprinkle: That isn't necessarily just management. Some people may love management. Other people may not so much. And so there are other opportunities to explore different things that you can do in veterinary medicine. And I think this is a great opportunity for a clinic, like you said, another benefit, because it does bring in new opportunities for everybody within the hospital. And 

[00:20:00] Megan Sprinkle: if that's something that they just really love and excel in, then yeah, that they may have an opportunity after that, which, I believe that if you allow these types of opportunities for your people, even if they leave you to go explore that opportunity, they're going to be an advocate.

Megan Sprinkle: They're going to say great things about the hospital, and that's what you want. It really helps with retention of your associates, bringing in the best talent that you want that fits Your environment. So, I just see all great things about, 

Craig Clifford: I couldn't be happier for my nurse. And, you know, she's going to be a rock star out there. And what would really be interesting is we'll probably end up doing a trial where she ends up being our moderator. So, you know, she'll be able to tell me all the things I do wrong with each study and she gets to essentially be my boss for the study now. So that'll be fun as well. 

Megan Sprinkle: Yeah. to stay ahead of the new things that are coming in, in the veterinary industry. That's really exciting to feel like you're in the know. And again, you know, the options 

[00:21:00] for potential clients, you can even share that, maybe you even become a speaker about it because you're on the forefront.

Megan Sprinkle: So again, really cool opportunities for veterinarians and veterinary technicians alike. I think in this, option like you said, it's, it's a lot of work. So explore it, figure out if it makes sense for you and your hospital, but definitely a really unique, idea Now we talked about, Being able to try out these new drugs, ahead of a lot of people and you don't have to say I'm sure you can't disclose anything that's like very, very new right now.

Megan Sprinkle: But like I said, I mean, this. To me feels like a really exciting time for oncology. We have everything from Diagnostics where we're able to detect things earlier than we used to be which Was really hard as veterinarians because a lot of times by the time we got the patient we're able to diagnose the cancer It was so progressed, right?

Megan Sprinkle: That there wasn't a whole lot that we felt like we could do [00:22:00] other than to maybe make the pet comfortable. But I mean, we're in a totally different time now. at least I definitely think we're moving in that direction. we'll be able to diagnose things a little bit earlier and maybe be able to Set up a better plan for long term for these pets.

Megan Sprinkle: So along with diagnostics and treatments, what are some things that you're most excited about in this specialty? 

Craig Clifford: to go back to your, your diagnostic part? for any veterinarian who's listening, how many times have you had an owner say, “Isn't there a blood test for cancer”, you know, be millionaire, the number of time periods we've been asked that.

Craig Clifford: And now we actually have companies that are out there that have blood tests that can help detect cancer to truly catch it early. and it's using the same technology that they do in physician based medicine. So it's not a dog or cat version of the machine is literally the same type of thing. So I think that's incredibly, exciting.

Craig Clifford: And I think that what's really beautiful is that's going to affect the primary care doctor. So these early [00:23:00] cancer screening tests that are coming out are not really for me, the specialist, but more for them to be able to offer. And you can imagine in certain breeds where we know there's a high predilection, they can make these tests part of their senior wellness checkups.

Craig Clifford: So, you know, there's multiple ways that these can be put in because there's no doubt that a large number, a large swath of owners would be very excited for that. the other big area is certainly immunotherapy. You know, it was a hot topic early on, and now it's come back again, and we actually now have medications or drugs that are out that are monoclonal antibodies.

Craig Clifford: this is currently clinical trial is ongoing for it, but it's public knowledge that Merck has what's called a PD-1 or a checkpoint inhibitor and probably the easiest way to describe it is, you know, when we get an infection, our immune system cells will put things on their surface that say we're at war.

Craig Clifford: So the immune system knows, and when we're no longer at war, it puts epitopes on its surface that tells the immune 

[00:24:00] system to calm down. Cancer has learned to use those types of ones on its surface that tell the immune system to calm down. If we can block those, now the immune system may go after it, because cancer often makes abnormal proteins.

Craig Clifford: Because our immune system, when we're born, is really taught two things. The first thing it's taught is never attack self, that's an autoimmune disease, IMHA, ITP, Crohn's disease. Second thing it's taught is kill anything that's not self, so a virus, a bacteria, or a parasite. The problem with cancer is that even though it looks abnormal, it comes from self.

Craig Clifford: And sometimes cancer will produce what are called oncoproteins. They're bizarre proteins the immune system will go after. But by putting these other things on their surface, the immune system calms down and leaves it alone. With these monoclonal antibodies that can bind to it and block it. Now the immune system sees these oncoproteins and goes after it.

Craig Clifford: On the physician based side, for heavily pre treated cancers, they were seeing, you know, 30, 40 percent 

[00:25:00] response rates that were long and durable. This was the stuff that came out maybe five, seven years ago on the people side, where you heard people that were part of these trials were told, nothing we can do, go home to die.

Craig Clifford: They're still alive seven years later, cancer free. So it works on a small percentage, but in the ones that it does work, it's an amazing response. So we finally have these out now, and they're what I call histology agnostic or cancer agnostic. Theoretically, they could work against many different types, which is important, because if you have a drug that only works against cancer A, then you're going to And you have all these other cancers that are prevalent and just as important, you know, it has a minor scope of activity.

Craig Clifford: If you have something that's cancer agnostic, well, now this could be used against a wide variety. So we're really excited about having those and they're just the first step. So we are really getting there. 

Megan Sprinkle: Yeah, and you read my mind. I was about to ask, which cancer does this seem to be most, successful for? So it sounds like it may have multi uses.

Craig Clifford: Yeah, currently the label is [00:26:00] for mast cell and melanoma. Okay. But, what's interesting is biologics go through the USDA, drugs go through the FDA. So this has to go through the USDA, but once it gets its full licensure, which is what they call it in the USDA, then you could theoretically use it off label.

Craig Clifford: And that's where we're going to see it proliferate against a wide variety. So, yeah, we're very excited. It's only a couple of years away from that. 

Megan Sprinkle: Oh, wow. And going back to, things that we can do in the general practice, cause I think that's another opportunity for discussion. This came up in the, past veterinary innovation summit, oncology was a big focus and. The neat thing about this conference is that everybody is in the room. We had the general practitioners, we had the oncologists, we had the people from the industries that are making all of these wonderful things, and everybody was there talking.

Megan Sprinkle: And it came up about opportunities for general practitioners to be more involved in the, not only diagnostic, but also the Part of it, but also in [00:27:00] the treatment and not that we're trying to take business away from oncologists. I think we have plenty of business so that there's still options that general practitioners can do and not only is this a revenue generator opportunity for them, but it empowers them again to give more options to pet owners.

Megan Sprinkle: And I'm pretty sure you've talked on this topic as well. So what are your thoughts around what the general practitioner can do? 

Craig Clifford: Yeah, no, that's a wonderful point. And, you know, I passed probably four or five years, maybe four years ago, I kind of really changed how I was doing my lectures.

Craig Clifford: I used to get up there as a specialist and say, here's the things I can do. So send me your cases. And then it really dawned on me, like, what are they leaving with? you know, where have I really helped them other than understanding a certain disease process or certain type of therapy. So really I've changed how I lecture now really to be primary care centric and everything I try to go over is really what they can do in their clinic. you know, I have an entire lecture on diagnostics they can do in their clinic,

[00:28:00] Craig Clifford: an entire lecture on therapeutics they can do in their clinic, because you're right, oncology should not be the scary thing that, oops, it's cancer. I'm going to send it to the specialist. It doesn't need to be that, and as we know, if you don't live in one of the major cities, you may not have an oncologist for, you know, several hours and that's not feasible.

Craig Clifford: So we've really changed, at least in our area, how we do things and that we really like for a lot of the cancers, the primary care to do a lot of the staging, whether that's x rays, whether that's blood work, whether that's specialized testing, like for our lymphomas, we like them to do the phenotyping to see if it's B or T.

Craig Clifford: That's going to affect prognosis, and it makes my talk with the owner more streamlined. So it actually helps me by having that information. And for us, it also changes how we treat them. We don't use the same protocol for B or T for dogs anymore. So if the primary care can do these things beforehand, it actually benefits me, and it benefits the owner because they have a much more, instead of, hey, it could be this, could be that, and they're left with, what did he mean? It's, here's what

[00:29:00] Craig Clifford: we're doing. You know, we know that this is the path that we're moving forward. So I would say that primary care should not be afraid to do any of the staging. And I think if there are oncologists out there who don't want the staging done by the primary care, they feel they should be the one doing it.

Craig Clifford: Then I would worry that may not be the best oncologist for them, because I would worry that it would come across, or the perception is it's more financially driven. I mean, there's enough cases out there for us. So the more things that I can have done and in regards to the treatment, same thing with lymphoma, we have certain treatments done at the primary care.

Craig Clifford: If it's an oral cytoxan week, I have them go there. If it is a blood work week, I have them go there because you know, the way I look at it is the primary care should be an integral part of the team, me, the owner, the pet and the primary care because oftentimes they're far distance from me and say, there's something small pops up and we just need someone to lay hands on the pet.

Craig Clifford: If I've been a black hole and everything's been with me and all they have are my notes, [00:30:00] which are probably not that great, but they have just my notes, you know, that, that's a big ask of them. If they've been seeing the case intermittently, then it's much easier. Plus they've been with the pet oftentimes since it was a puppy or a kitten.

Craig Clifford: So I want them to continue that relationship with them. And I think it just fosters a better collaborative. approach with the primary care. I'd rather have them with me than to be fighting back and forth with it. I think nobody gains anything with that. 

Megan Sprinkle: it empowers everybody a little bit more probably helps the pet owner feel good to that. Okay, all of the doctors seem aligned. Everybody in sync to help my pet. another question that I have for you when it comes to dealing with oncology cases, this is definitely a rotation. I still remember in vet school was my oncology rotation. All the oncologists were amazing, but, There is some sadness to it because we're not at the puppy stage where we're towards usually the end of life.

Megan Sprinkle: so [00:31:00] they can be hard conversations to have with the pet owner. But what really surprised me when I was going through the rotation was that. Man, the relationships you build with the pet owners, because again, they usually are really dedicated and they really appreciate everything that you're doing, that there is something really special about that.

Megan Sprinkle: And I think this kind of goes along with continuing to be involved as a general practitioner with these cases is, you know, there's something special about that relationship that you have with the pet and the pet owner going through this time So that was something I realized from working in oncology, but I'm curious for you.

Megan Sprinkle: is there something also that's At the heart of kind of why you can get up and do another lymphoma case or another case. 

Craig Clifford: I think it's a great question. I love having that interaction with the owner. You know, one of the things that, I didn't have during my early training in veterinary school was, you know, you would follow the instructor in and [00:32:00] they would talk with the client, but oncology, you're right, is very different. So for me, when I get in there, I sit on the floor. And usually the dog or the cat comes over to me and sits right next to me.

Craig Clifford: And right away, I think that makes the pet feel at ease. And clearly the owner's at ease because they're like, my dog's sitting next to him, not me. You know? So I think that that makes them feel very at ease because you're right. A lot of them come with perceptions of chemo, et cetera, that we have to try to counteract.

Craig Clifford: So the idea of dragging the pet there, who's not happy on a weekly basis seems like a lot, like what am I doing? But when they see that the pet is interacting well and seems very happy, I think it's a very different story. And the biggest thing I think I learned was, and I think this happens to a lot of people when they first come out, whether it's just going into primary care or going into specialty, you know, we learn a lot and we think that when we get out there, we need to show the owner all the big words we know.

Craig Clifford: so we throw out all of these huge words and half the time they have no idea what we're talking about. So to me, we've actually done them a [00:33:00] disservice by trying to show them how much we know. And the way I try to view it is regardless the person could be an MD, they could be a plumber, they could work in a garage, doesn't matter.

Craig Clifford: I try to frame it as a story in a way that regardless of what their scientific background is, it's in terms that they can understand. And they can follow the story and then when they leave, they're like, wow, that's better than I got from my MD, because I had six minutes with them when I went in for my yearly exam and you talked to me for an entire 35 minutes regarding everything and then you wrote it all down.

Craig Clifford: I think that's one thing I think people don't realize when they first come out. And I, I was the same way, you know, I use those big words cause I thought I was super smart and I had to show them I was super smart, but really in the end, that doesn't benefit them. They need to understand what's going on because if they leave confused, You've done them a disservice.

Craig Clifford: So, you know, really, that's how I've been for almost 20 years now is, is trying to really turn any 

[00:34:00] cancer into a story and then how their pet pertains to that story and how we can then move forward. 

Megan Sprinkle: think that's wonderful. And even when. Talking to another veterinary professional or a veterinary student that can also be very helpful And it also helps us understand how to communicate it, to someone who may not be as well versed you are probably the most wonderful teacher and you are actually able to teach classes as well. At Delaware.

Craig Clifford: Yeah, so once a year, so Delaware is where I did my grad degree and, one of my, closest friends is, one of the top professors there. His name is Mark Parcells and every year Mark does a career class. So every year I go down in May and I talk to the, juniors or seniors at the time about getting into veterinary school.

Craig Clifford: You know, what are some things to think about? What are the pros and cons of it? Talking about internship, talking about finances, talking about moving, are you going to go to somewhere like you and I, you know, that was very much culturally very different than we were used to.

Craig Clifford: So just [00:35:00] trying to go through all of those things and help them understand it better. it's a lot of fun, although as I do it more and more, they look like babies to me. I feel so old when I'm up there because I'm like, they look 10, you know? 

Megan Sprinkle: Yes. although I have to be careful, I still look pretty young for my age. So they may make me go into class and think I'm late, no, it is, it's very fun to speak to you. undergrad students. I myself got invited down to the University of Florida to speak to a pre vet group, and they're just so excited and curious, and they just soak in everything you say, and it feels very rewarding.

Megan Sprinkle: But it's also a great opportunity to go ahead and make sure that they stay curious and stay open and know they have possibilities. And, to not give up if things sound hard, you know, really understand what they want to do. I'm sure you're talking about all sorts of different things in veterinary medicine you can do.

Megan Sprinkle: But another thing that I'm starting to also realize is with, even [00:36:00] within veterinary oncology, there's a lot of different, specialties within oncology. like one is focus on the radiology aspect of things, 

Craig Clifford: radiation therapy and surgical oncology, uh, So basically there's multiple paths that you could potentially take the surgical aspect.

Craig Clifford: Usually they go do a surgery residency and then they go on and do a fellowship afterwards. radiation oncology is its own subset. It's actually under ACVR, not ACVIM like you and I are under. So it is, it is a bit odd that it's a bit dispersed. So the surgical oncologists are under ACVS, radiation oncologists under ACVR, medical oncologists under ACVIM.

Craig Clifford: But that's a very cool thing. And I've been very blessed because at Red Bank we had interns and, interns want to go on and do residencies. And I was able to help 18 of them move on to, You know, different ones that are now under my, my family tree. So even though I didn't, train people in academia, I was able to train them in private practice.

Craig Clifford: And now many of them work with me again. So [00:37:00] I joke, I couldn't have been that much of a jerk because they did come back and work with me afterwards. that's also very, you know, not only the aspect of being able to train the early people, but to see your people move on. And then also, you know, I have several people that I've helped train that are much better than me now.

Craig Clifford: And that's even more gratifying when you can train someone that you see as better than you. That's awesome. that you're part of their path forward, even if it's a small part, like that's very gratifying. And I've been very blessed to have that. 

Megan Sprinkle: Well, I can definitely tell you love watching people succeed.

Megan Sprinkle: And I also think about not only you're helping an individual succeed, but if they're doing super well, that benefits. The entire veterinary profession. And as we build up, the future of veterinary medicine, which is super exciting we get to still watch it and be a part of it, but there are going to be new people that come and they're going to have other, perspectives and skills and interests that can take us into wonderful new, roads that [00:38:00] will ultimately help the profession and help our patients for sure.

Craig Clifford: Agreed. A hundred percent. 

Megan Sprinkle: Well, again, you are a man of many skills and interest and you have even, written a book that is on Amazon. You were, you seemed really excited when we were talking about it. So do you mind sharing, why you wrote a book and that process? 

Craig Clifford: I've done, like, books for oncology as part of chapters for things like that, or, you know, Ettinger for people to learn from, but this was something very different.

Craig Clifford: I ended up writing a children's book, and, I have two sons, Connor and Kieran, and Conor had a, Spoken when he was younger about wanting to be a veterinarian. So I thought of the idea of creating a children's book about the journey of Conor the boy who wanted to be a veterinarian So I you know did my background and my homework on it and really If I did it, I promise you any of you listening could easily do it probably better than I did amazon, you know, you go to YouTube They have literally YouTube channels on how to write a book amazon has its own publishing.

Craig Clifford: [00:39:00] It helps you with it You Chat, GPT. As we all know, AI is pretty incredible. It has its pluses and minuses, but it was able to help me write it. And then there are UMIs out there that can draw the images for you, and their images are incredible. We've all seen some of the deep fakes people use for jokes, but it gave these incredible images I was able to have with it.

Craig Clifford: And you know, I created this book called The Boy Who Wanted to Be a Veterinarian. And, it was dedicated to my son, Conor. So I was pretty excited about getting it out there. I think my royalties have been an entire $25 in the last year, but it was more just the experience of writing it and just showing that, you know, I could do something different outside the box.

Craig Clifford: And again, I promise you, if I was able to do it. Any of you could do it. it was really a fun thing to go over 

Megan Sprinkle: I love opportunities for additional creative outlets and podcasting is a big one for me.

Megan Sprinkle: Not a lot of people may sit down and find editing fun, but I, get to, you know, especially with the YouTube version, I 

[00:40:00] get to do all these B roll and really get creative with it, and so I think it is good to find those things that allow us to kind of just show ourselves, wow, I did that, that's really cool. And I'm curious, how old is Conor now?

Craig Clifford: Conor's now nine, still wants to be a veterinarian. I haven't dissuaded him of it, but, uh, although, his dog happens to defecate in the house, he has a hard time cleaning it up. without gagging, I'm like, You got to get past that buddy or veterinary school is not going to work out for you because you can't not have that.

Megan Sprinkle: that's kind of how I started is, you know, the kennel kid that cleaned up the same way. 

Craig Clifford: Same way I was. I was the kennel boy for a long time. 

Megan Sprinkle: Yep, yep, exactly. I just see so much wonderful, mentor qualities of you So what is something that is on your mind right now that you would like to share with the veterinary profession? 

Craig Clifford: I mean, I think one, one aspect of the veterinary profession that I really think we need to work on, and it's something that, I've been thinking about, I just haven't been able to get [00:41:00] enough people to help, is the idea of trying to create something for owners.

Craig Clifford: You know, we have CE lectures for veterinarians, but we don't have much for owners. And we all know that a lot of times they come into a room and they brought their Google Sheets. And sometimes that's good, but sometimes the sites they find may not be so good. wouldn't it be wonderful if we could potentially put together something that was done right, basic information for them, and that would help the primary care when the owner comes in, or the specialist if it's going to see a specialist.

Craig Clifford: So that's my next endeavor that I want to work on, is the idea of trying to open up a platform to help owners. I'd want them to look at the videos beforehand.

Craig Clifford: That way, when they come in, they're already armed with very specific questions. And to be honest, you know, it may help streamline my conversation with them because all the basic stuff they've already gotten down and they've had time to take it in because as you know, a lot of [00:42:00] times when they come in the room, they're often a little shell shocked, so it's hard for them to take it in.

Craig Clifford: So two days before the family was able to sit YouTube video, now they've taken time to go through it, to write their questions down. So when they come in. They're already armed with a lot. So I think that there's a lot of benefit to it. And right now, nobody's done it. So, that's one of the things I'm looking at.

Craig Clifford: So you never know if you're interested, let me know. I'd love some help. 

Megan Sprinkle: Absolutely. And, and, you know, going back to what I said, that owners really like to do research beforehand. And so if we can be the ones that give them what's going to be most relevant for them in their appointments, and I don't know how people feel about the word pre work, but that's basically what it is, right?

Megan Sprinkle: You know, you, you do your little pre work and what you would probably normally want to research anyway, we've just given it to you and hopefully in a very digestible way enough where you're getting the basics. And like you said, It's not gonna be completely brand new information when you're in the room with the doctor.

Craig Clifford: Exactly. And these types of things [00:43:00] can always be updated as more information comes out because, you know, the paradigm of how we look at certain things changes over time as we have better diagnostics and better therapy. So it can always just be updated. 

Megan Sprinkle: Absolutely. Well, I think that's a fantastic idea. I hope they say I heard you on Vet Life Reimagined. 

Craig Clifford: I'm looking forward to it. I got to find something else to do. My wife will kill me if I'm just sitting at home. It won't last very long. 

Megan Sprinkle: Oh, well, you brought up your wife. Is she in veterinary medicine at all? 

Craig Clifford:  Yeah, she's an oncologist as well. Although we never speak of it. We never speak of cases when we're home, because if I bring up something she didn't do or go about it a different way, she gets angry. So we stopped talking. So we literally never speak about cases when we're, home.

Megan Sprinkle: That could be a pretty good. Policy. 

Craig Clifford: We work together as well, but we are only together kind of one day that we're on, but it's kind of, nice that we get to work together one day. 

Megan Sprinkle: Absolutely. And I'm very impressed. You have a very large team. So I think again, that speaks [00:44:00] to what you've built and, the environment that people feel very comfortable. And again, there really aren't that many oncologists. So when I hear of a very large number, one location, I'm like, that's saying something that's really cool. So I'm glad you have that set up.

Craig Clifford: Yeah, I've been very blessed with it. And, you know, most of them were my own people. Um, one of them is actually the head of oncology. So I call her my boss, Christine Mullen. So her nickname is, uh, 2. 0. She's the better version of me. So, I actually have her as my boss. So that's a, it's a nice thing.

Megan Sprinkle: Yeah. Like you said, watching people go on their career path and, do really amazing things and be very successful. 

Craig Clifford: That is very rewarding. Without question. That's how we should be. 

Megan Sprinkle: Yeah, exactly. Well, to close, I'd like to ask a final few questions. And is there anything on your bucket list that you would like to do?

Craig Clifford: On my bucket list, I would like to, the one place I haven't really been able to travel to is Asia. So I do definitely want to travel to Asia. Um, I've been blessed to go to Europe, [00:45:00] South America, other places. I haven't gotten a chance to go to Asia yet. And, you know, the beauty of that is I able to put together business and, and pleasure together. So my kids have been able to travel to all of these places. Um, and that's been a lot of fun. I think Connor, the one who's nine. You know, he took his first plane trip to Canada. He was six months old, so he was, he's been in planes since he was very little and he's gotten very used to it.

Craig Clifford: He, secondhand to him. Well, I'm glad to hear that. I hope it went well because that's something my husband and I've talked about. It's like, can we just strap the baby on and go? And he's like, yeah, sure. The only downside I have is that a lot of times when we would travel like that, we would travel first class.

Craig Clifford: because the company would pay for it or however, so he got used to that. And then one time, I think we were going to Florida to visit friends and we're like, it's a two hour trip, let's just go coach. And, you know, we get in the seat and he's like, where's my hot towel? He's like, where's our food, mommy and daddy.

Craig Clifford: And we're like, oh my God, I'm the worst parent ever. He doesn't know how to live in the real [00:46:00] world. But he had gotten so used to only flying first class, so it was a rude awakening to him, but now he understands it better that most of the time you don't get those types of things. 

Megan Sprinkle: That's hilarious. another question I like to ask is, is there a hidden skill or an interest that maybe not a lot of people know about?

Craig Clifford: I'm an avid sports fan. especially for football, big New York Giants fan. I finally got season tickets cause for anyone who knows football, you know, like season tickets, they don't pop up, you got to wait for someone to die or you get very lucky, something happens. You're on a list with Hundreds of thousands of people.

Craig Clifford: And I was able to get it just before we moved to Pennsylvania. So now I have to drive all in its first world problems, but now I have to drive all the way up for it, but no avid, avid giants fans. And I look forward to every Sunday driving up there and just being part of it, whether it's college or anything, you know, when you're at that, it's such a cool feeling because you're with a group.

Craig Clifford: You [00:47:00] don't know any of them. But you all have the same goal. You want your team to win. And it's just a cool feeling of camaraderie being involved in that. 

Megan Sprinkle: Yes. It's like a veterinary conference on steroids. 

Craig Clifford: Yeah. Without question. And alcohol. 

Megan Sprinkle: And probably more alcohol. 

Craig Clifford: A lot more. 

Megan Sprinkle: Oh, fun. And finally, what is something you're most grateful for?

Craig Clifford: I think I'm most grateful for the people that helped me get to where I was. You know, every year I do my best to try to reach out to my mentors through the years, and I thank them because I know I was a very, intense and probably a challenging resident and intern for many of them. And I thank them so much for helping me.

Craig Clifford: My main mentor, Karen Ceremo, I can't say enough of. She was absolutely wonderful, you know, sticking with me through everything. People that I had in veterinary school who helped me to say, look, you need to do a residency. You need to move [00:48:00] forward. Here's how you do it. Kevin Clark, Claire Wigand, among others at Mississippi State, were absolutely wonderful.

Craig Clifford: And I wouldn't be here without them. None of us would be. You know, we need to help each other. I think that's why I've always been such a cheerleader for all of my people to try to push them forward in what they're doing, because I didn't get here by myself. It wasn't just me. Many others helped me get to where I am and I need to play it forward.

Megan Sprinkle: Make sure you check out the show notes for links and resources that we've discussed. And also make sure you're following me, Megan Sprinkle, on LinkedIn to catch information about the May campaign. And subscribing to the podcast on audio and YouTube is a huge help to the podcast and totally free for you.

Megan Sprinkle: I hope you'll continue to be with me on this journey. It's going to be a huge year and I want you to be a part of it. [00:49:00]