Craig A Clifford, DVM, MS, DACVIM (Oncology) talks about Laverdia-CA1, as well as indolent lymphoma in this interview with dvm360

About the novel drug for canine lymphoma

Earlier this winter, Craig A Clifford, DVM, MS, DACVIM (Oncology), sat down with 

 to talk about his lecture on canine lymphoma, presented at the Fetch dvm360 conference in Long Beach, California. In this interview, Clifford focuses on the new drug for treating lymphoma in dogs: Laverdia-CA1. He talks about how the drug is given, its efficacy against T cell lymphoma, and why it is a game-changer for the primary care physician. Clifford also discusses what indolent lymphoma is and what to do after an indolent lymphoma diagnosis. 

Below is a partial transcript. It has been lightly edited for clarity.

Craig A Clifford, DVM, MS, DACVIM (Oncology): 

So we're going to be discussing with “Canine Lymphoma” a couple of things. One, going back to what I had said previously, the idea of immunophenotyping and why it's important, and why that should be done by the primary care but most of the lecture is going to focus on the new novel drug called Laverdia-CA1, and this is an oral anticancer drug. It's not on the same level as what we call chemotherapy, where I think of chemotherapy as like a shotgun. When chemotherapy enters the body, it kills all cells that are growing. Now, cancer generally grows faster than most cells, so that's [what] it preferentially kills, but clearly other cells that grow, such as hair, such as immune system cells, and GI tract cells can be affected by it and that's why we see those adverse events.

[Laverdia-CA1] is a much more targeted drug, and the data suggests that this drug will work for dogs with lymphoma. The beauty of it, it is an oral medication, so if we were tasked with, you and I, the idea of creating the perfect drug for a primary care doctor, the first thing we'd want is something that's going to be oral—so we're not having to give injections, place catheters—and something that's convenient. This is given twice a week, with 3 days off in between: that's incredibly convenient.

We also want something that doesn't have a lot of side effects, and the side effect profile is very favorable. Based upon the studies that have been done, no dogs have been taken off the study due to severity of adverse events, so it means that it's a safe drug. The final thing we want is it's got to work, and clearly this drug does. We know for the average dog, it may hold the disease for about 3 months or so. So it's not meant to be a silver bullet, a cure-all for lymphoma. More likely in the future, oncologists will be combining it with other agents in other types of protocols, but to me, knowing that 80% of lymphomas are left untreated, this gives the primary care a game changer—something else that they can utilize, other than just prednisone.

Videos

I’ve noticed an uptick in no-shows for procedures. How can we get clients to arrive on time for surgeries?

Surgical and dental services account for 10.9% of hospital revenue.

 No-show clients are a serious headache, risking lost revenue and putting extra stress on teams. Missing procedures also has consequences on patients’ health. Try these 8 strategies:

Never tell clients they can “drop off” pets on the morning of procedures. Pet owners may assume they can hand you the leash or cat carrier and go. You also risk random arrivals with everyone showing up at once or at the end of check-in time.

Schedule admission appointments every 10 to 15 minutes such as 8 AM, 8:10 AM, etc. Prioritize check-ins based on the length of procedures:

 Long procedures of 60 or more minutes such as orthopedic surgeries, C-sections, and abdominal exploratory surgeries.

 Medium procedures of 45 to 59 minutes such as spays on large dogs, ear resection, and enucleation.

 Short procedures of 44 or fewer minutes such as feline spay/neuter, small tumor removal, and dewclaw removal.

Set expectations when scheduling procedures. Say, “<Pet name>’s admission appointment begins at <time, date>. For 10 to 15 minutes, you will meet with a technician who will answer your questions and confirm how to reach you on the day of the procedure. We will text/email you reminders as the date nears, including presurgical instructions and an anesthetic consent form to review and return in advance.”

“Begins” communicates “Be here, be ready”—not down the street at Starbucks…unless you’re getting lattes for the entire staff. Let clients know that important instructions and medical forms are part of the confirmation process.

This is especially important if you’re booking procedures weeks in advance. Text and email up to 5 procedure confirmations. Each confirmation serves a purpose.

Include a calendar invite in the first confirmation. Calendar invitations, called .ics files, are saved in a universal calendar format used by several email and calendar programs, including Google Calendar, Microsoft Outlook, and Apple Calendar.

 Calendar invites can lower no-show rates up to 25 percent, especially among working professionals.

Buttons increase click-through rates by 15% over hyperlinks.

 Use buttons for important call-to-action requests such as “confirm” or “Reschedule/cancel.” 

Five days before the procedure, give clients the last chance to reschedule or cancel. With advanced notice, you can easily fill empty slots. Keep a waitlist or call clients with upcoming procedures to see if they want their pets to be seen sooner. If you can’t fill empty surgical slots, the doctor could start afternoon appointments earlier.

3. Perform preanesthetic testing before procedure days.

Let’s say the doctor diagnoses a pet’s dental disease during today’s checkup and discusses the need for treatment. The technician explains services and fees in the treatment plan. The client agrees and books the procedure for next week. Collect samples for the preanesthetic test today.

Doing preanesthetic testing on the day of diagnosis has 3 advantages:

Clients pay for lab tests today and are financially committed to showing up on the day of the procedure.

You may choose whether to do in-house testing or send it to the reference lab.

Increases clients’ perception of value because the dental treatment cost will be lower when they prepay lab work today.

Rolling Hills Veterinary Service in Bethel, Ohio, cut surgery check-in time in half by automatically sending and collecting digital forms by text and email through Otto.

 Forms write back to patient records in its practice information management software, saving administrative time for client service representatives (CSRs).

Because clients have invested 10 minutes of personal time answering patient health questions and authorizing consent, they are more likely to show up for procedures. Your anesthetic consent form will confirm clients’ preferred contact method, give consent, offer additional services such as nail trim and microchip, current medications, the last time the pet was fed, allergies and health concerns, and payment policies. Download an anesthetic consent form at 

https://www.dvm360.com/view/anesthesia-surgery-and-treatment-consent-form

Clients at VCA Sheridan Animal Hospital & Veterinary Specialists of Western New York in Buffalo get an admission process sheet when scheduling. Instructions explain what to do or not do 10 days before the pet’s procedure, the day before, what to bring, and what to expect on procedure day. Download the admission process sheet at 

If pets take medications that must be given with food, veterinarians should set protocols on medication administration and fasting. Include special instructions for patients with diabetes.

Have cancellation, no-show, and late policies that you communicate upfront during the confirmation process. Clients need to know how far in advance procedures must be cancelled or rescheduled, what happens if they no-show, and how you’ll handle late arrivals. When sending procedure confirmations, include hyperlinks and buttons where clients can click to access policies. Include policies on your online booking webpage and new client registration form. Get a free sample of cancellation, no-show, and late policies at 

7. Call clients who haven’t responded 2 days prior.

Expect most clients to confirm digitally and complete online anesthetic consent forms. Abigail Fulton, a CSR and veterinary assistant at Rolling Hills Veterinary Service, says 65% to 75% of clients confirm digitally. She noted that staff can focus more of their time on face-to-face interactions with clients coming into the clinic, rather than speaking on the phone.

If clients don’t confirm or submit forms, call them. Say, “We have reserved a surgical/dental procedure for <pet name> with an admission appointment on <date, time>. We need your confirmation and anesthetic consent form today by <time>. This will help our medical team prepare for your pet’s procedure. I am resending the text/email. If we do not receive confirmation and the consent form by <time> today, this surgical/dental procedure will be released to another patient in need. Please call/text/email us today.”

Requesting deposits for procedures can prevent no-shows—but don’t use the term “deposit.” Check state laws on deposits and partial payments (

). In New Jersey, businesses must visibly post refund policies. If you don’t, you are liable to give clients cash refunds or credits for up to 20 days after purchase.

Clients also may assume they will get money back if you say “deposit.” Use the term “surgical reservation fee” or “prepayment.”

Explain the payment when booking procedures. Say, “We have scheduled <pet name>’s procedure on <date>. Your admission appointment will be at <time>. You will receive a text/email confirmation and an invoice for your surgical reservation fee of $___. Use the link to pay online. This amount will be applied to the procedure. If you need to change the surgery date, notify us at least X days/hours in advance for it to be refund eligible. We will send presurgical instructions and an anesthetic consent as the date nears.” If fees aren’t refund eligible, explain, “This surgical reservation fee is nonrefundable.”

Take payments through your practice app, text-to-pay links, online payments, or swipe cards if booking procedures in-person. Never take credit card numbers over the phone and manually process payments. Card-not-present transactions are usually more expensive than card-present transactions because they have a higher risk of fraud and chargebacks.

 The average rate for card-not-present transaction increases to 2.25% to 2.65%.

When you set clear expectations and provide timely reminders, you’ll resolve your no-show problem.

Need a script for a client conversation? 

Submit your scenario to info@csvets.com for consideration in future columns.

Best known as the “Queen of Scripts,” Wendy Myers knows the right words will lead clients to accept your medical advice, driving patient and practice health. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, conferences, and onsite consulting. Wendy’s experience as a partner in a specialty and emergency hospital helped her understand issues that owners and managers face. Learn how Wendy can train your team at 

2024 Veterinary Industry Benchmark Report. iVET360. Accessed December 2, 2024. 

Calendar Invites. InEvent FAQ. Accessed December 2, 2024. 

https://faq.inevent.com/l/en/in-event-registration/calendar-invites

Dean S. 8 Solutions to Patient No-Shows and Missed Appointments. Keona Health. Accessed December 2, 2024. 

https://www.keonahealth.com/resources/8-solutions-to-patient-no-shows-missed-appointments

How Otto Flow helped Rolling Hills cut time spent on confirmation calls and surgery check-ins in half. Otto. Accessed December 2, 2024. 

https://otto.vet/how-otto-flow-helped-rolling-hills-cut-time-spent-on-confirmation-calls-and-surgery-check-ins-in-half/

Hilst H. Consumer Returns and Refund Laws by State. FindLaw. Accessed December 2, 2024. 

https://www.findlaw.com/consumer/consumer-transactions/customer-returns-and-refund-laws-by-state.html

Rej M. Card present vs card not present transactions. Merchant Cost Consulting. Accessed December 2, 2024. 

https://merchantcostconsulting.com/lower-credit-card-processing-fees/card-present-vs-card-not-present-transactions/

Articles

Scripts for confident client conversations

How Do I Say…? : Reducing surgery no-shows

Common linear foreign bodies include string, yarn, carpet, cloth material, or leashes. Linear foreign bodies present a unique challenge as they can trail down the intestines which will result in intestinal plication and the string material can start to act as a saw on the mesenteric border of the intestines. This can result in perforation, bowel death, and septic peritonitis. Clinical signs can include anorexia, vomiting, lethargy, regurgitation, ptyalism, abdominal pain, dehydration and, as in this case study, the offending foreign object may be protruding from the anus.

Rusty, a 6-year-old orange tabby, found some sparkly string which he decided might be tasty. The owner witnessed him ingest the string 2 days prior to presentation. He had passed a few bits of string in his stools, but on this particular day, he had approximately 4 cm of string protruding from his anus and Rusty became anorexic and painful.

Rusty's radiographs confirming intestinal plication with no free air and normal serosal detail within the abdomen. (Image courtesy of Heather Timmermans)

Physical examination revealed normal vital signs with mild dehydration and palpation of the intestines revealed they were bunched and painful. No string was found in the oral cavity under the tongue.

Abdominal radiographs confirmed intestinal plication with no free air and normal serosal detail within the abdomen. The stomach contained a soft tissue opacity in the pylorus and a heterogenous mix of gas and soft tissue opacity within the fundus.

Blood work revealed a normal complete blood count, mild hyperglycemia at 275 mg/dL (reference range 70-150), and mild hypokalemia at 3.3 mmol/L (reference range 3.7-5.8). The hyperglycemia was attributed to stress and pain and the hypokalemia was attributed to anorexia and gastrointestinal

GI) obstruction. Intravenous fluids were started to rehydrate him prior to surgery.

Rusty was placed in dorsal recumbency, and his abdomen was sterilely prepped. He received 22 mg/kg cefazolin IV perioperatively. A 10 blade was used to make a ventral midline incision from the xyphoid process to just caudal to the umbilicus. The intestines were plicated from the pylorus to the large bowel.

Rusty's stomach exteriorized from the abdomen

The stomach was exteriorized from the abdomen and packed off with sterile moistened lap sponges. A stab incision was made into the stomach and a hemostat was used to exteriorize the wadded string from the pylorus. The string was cut caudal to the wad of string. The intestinal plication was immediately improved. The stomach was closed with 3-0 monoweb in a double inverting pattern. The intestines were gently manipulated into more normal positioning. Evaluation of the mesenteric side of the intestines revealed no evidence of perforation nor necrosis. Gentle traction on the string from the rectum did not result in movement of the linear foreign body so the distal jejunum was isolated outside of the abdomen and packed off with sterile lap sponges. A stab incision was made into the distal jejunum, the string was exteriorized and cut.

The orad portion of the string was able to be gently removed from the jejunal incision. The caudal portion of the string was able to be removed with rectal manipulation caudally. The jejunal incision was closed in a simple interrupted pattern with 3-0 monoweb. The abdomen was closed with 2-0 monoweb in a simple continuous pattern, the subcutaneous tissues were closed with 3-0 monoweb in a simple continuous pattern and then an intradermal pattern. The skin was closed with 3-0 monoweb in a cruciate pattern. Recovery from anesthesia was uneventful.

Rusty was continued on intravenous fluids for the remainder of the day. He received maropitant for nausea and Zorbium topically for pain control. After a couple of days of ileus, which was treated with Mirataz ointment, oral Cerenia, and gentle syringe feeding, his appetite returned to normal. He was back to his normal self by suture removal.

Objects can get caught around the base of the tongue, knot up in the stomach, and become lodged in the pylorus or further down in the gastrointestinal tract 

Case study: Linear foreign body in feline patients

, has been eradicated from the United States, according to an announcement from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) and the Washington State Department of Agriculture (WSDA). The achievement represents the culmination of 5 years of dedicated effort by the APHIS, WSDA, researchers, and the community.

With a long stinger and toxic venom, the northern giant hornet posed a threat to pollinators and the ecosystems that depend on them, as this invasive species could eliminate a honey bee colony in a matter of hours.

 However, this species does not typically attack humans unless provoked. Native to Asia, the northern giant hornet is the largest hornet in the world, with the size of a double-A battery—approximately 2 inches long.

The northern giant hornet was first spotted in the Vancouver Island region of Canada in August 2019.

 Later that same year, it garnered national attention after it was found close to Blaine, Washington.

During the eradication effort, the APHIS used a ground-based radio telemetry tracking system to locate northern giant hornet nests in heavy forests, generally hidden inside alder trees.

 Four northern giant hornet nests were eliminated between 2020 and 2021 by the WSDA and its partners. The project called for a unique approach, specialized tools, and protective suits to guarantee the team’s safety in each eradication, according to the agency.

Photo courtesy of Karla Salp, Washington State Department of Agriculture.

The success in eradicating this species was a collective effort with community involvement: public reports of northern giant hornet sightings led to almost half of the confirmed hornet detections. According to the APHIS, local residents and citizen scientists played a vital role by reporting sightings, monitoring traps, and tracking wasp populations for signs of the hornet.

“This success demonstrates what’s possible when agencies and communities unite toward a common goal,” Mark Davidson, deputy administrator for APHIS’ Plant Protection and Quarantine Program—the country’s first line of defense against the introduction and spread of invasive pests—said in a release by the agency.

 “By tackling this threat head-on, we protected not only pollinators and crops but also the industries, communities, and ecosystems that depend on them.”

APHIS in action: Victory over the world’s largest hornet species. 

Animal and Plant Health Inspection Service. Accessed January 6, 2025. 

https://www.aphis.usda.gov/news/agency-announcements/aphis-action-victory-over-worlds-largest-hornet-species

Plant protection today: PPQ invests in technology to keep hornet-hunting employees safe. 

https://www.aphis.usda.gov/news/agency-announcements/plant-protection-today-ppq-invests-technology-keep-hornet-hunting

Animal and Plant Health Inspection Service. October 17, 2024. Accessed January 6, 2025. 

https://www.aphis.usda.gov/plantsplant-healthplant-pests-and-diseases/northern-giant-hornet

Officials announced the eradication of Vespa mandarinia, marking the end of a 5-year battle to protect pollinators from the invasive species

Northern giant hornet eradicated from the United States

As the General Manager of Caring Pathways and a veterinarian who has walked alongside countless families in their pets’ final chapters, I’ve learned that no 2 clients are the same. Each family approaches this profound moment with their own emotions, expectations, and coping mechanisms. Understanding these differences is crucial for providing compassionate and tailored support during such a tender time.

Planners often want to understand every detail of what’s to come. They ask thoughtful questions about the process, logistics, and next steps. These clients find comfort in preparation, and the focus on planning helps them regain some sense of control during an uncontrollable time.

Provide clear explanations of what they might be able to expect with regards to disease progressions or other insightful information surrounding their pet and any unique circumstances.

Offer resources such as quality of life (QOL) scales, daily QOL tracking calendars, or other helpful materials they can review at their own pace.

Ensure that they understand all their options leading up to their pet’s final life stage, including in-home hospice care and in-home euthanasia. Providing recommendations to in-home end-of-life companies that you trust can go a long way in demonstrating to these clients that you have the best interest of both client and patient in mind.

Acknowledge and normalize potential anticipatory grief. It can cause hyper-fixation on details and meticulous following of instructions and, while this can be helpful, it may also feel overwhelming at times for the individual.

Caring Pathways Gina Singleton, DVM creates space for Koa's owner during a Quality of Life Assessment. (Images courtesy of Caring Pathways)

For planners, knowledge is empowering. Anticipating their questions and proactively addressing them fosters trust and reduces their anxiety.

These clients wear their emotions openly, and their love for their pet is palpable in every word and tear. Their grief begins long before the final appointment, and they may need extra reassurance that they’re making the right decision.

Listen with patience and empathy, letting them share their feelings without interruption. Setting aside longer appointment times to give these families the time they need and deserve is a helpful practice.

If your clinic is unable to accommodate longer appointment times to discuss quality of life, consider a referral to a practice that specializes in end-of-life care and that can offer extended QOL discussions via TeleAdvice or in the client’s home.

Reaffirm their decision is out of love and selflessness, and allow space for them to express emotions and offer comforting words to validate their grief.

A compassionate presence is invaluable to emotional hearts, helping them feel seen, heard, and supported during this vulnerable time.

Stoics approach their pet’s end-of-life with a calm, composed demeanor. While they may appear detached, this is often their way of managing overwhelming emotions. Stoics might focus on practicalities and avoid showing visible signs of grief.

Respect their need for composure, and avoid pushing them to share emotions they may not be ready to express.

Focus on practical support, such as compassionately discussing aftercare options or addressing logistical questions.

Gently remind them that your team is there for emotional support if and when they need it. Having resources on hand like a Grief Support Specialist or certified counselor that you can refer them to is another way to show support to these clients who may be ready to open up with a professional down the road.

Patience and quiet understanding allow stoics to process grief on their own terms, knowing they have a safety net if needed.

Clients experiencing guilt often wrestle with the timing of their decision. They may question whether they’re acting too soon or late, and their words often reflect inner conflict, such as “Am I doing the right thing?” or “How do I know if it’s too early/too late?”

Reassure them that choosing a peaceful end is an act of profound love and kindness.

Share objective insights about their pet’s quality of life to help them feel confident in their decision. Using QOL scales can aid in this process.

Let them know that guilt is a natural emotion and that their love for their pet is evident in their care and thoughtfulness.

A compassionate reminder that they are prioritizing their pet’s comfort can help alleviate their guilt and give them peace of mind.

A grieving owner holds her recently deceased companion's head following an in-home euthanasia

Silent grievers process emotions internally and may not outwardly display grief. They often prioritize their pet’s comfort over their own feelings, appearing stoic even in deeply emotional moments. 

Offer a quiet presence and reassurance without forcing conversation.

Provide opportunities for them to ask questions or share feelings if they choose.

Respect their need for silence, while reminding them of the resources available to support them.

Sometimes, simply sitting with them in compassionate silence can be the greatest gift.

Support-seekers often look to their veterinarian and the care team for emotional guidance and validation. They may rely heavily on your expertise and perspective to navigate this challenging time.

Provide emotional reassurance and share stories of other families who have walked a similar path.

Emphasize that they are not alone and that your team is there for them every step of the way.

Suggest grief resources, self-help books, or support groups if they express a need for it.

For these clients, the bond they share with your team can be a powerful source of comfort and strength.

Every pet parent’s journey is deeply personal, shaped by the unique relationship with their beloved companion. As care providers, it’s the veterinary team's responsibility to meet them where they are, adapting approaches to suit individual needs. Doing so will help them remember the passing of their beloved pet with fondness, as opposed to the alternative, because they felt supported by their professional team.

Caring Pathways holds space for each client’s emotions and decisions, ensuring they feel supported and respected. By offering empathy, understanding, and unwavering care, we can help families navigate this heart-wrenching time with grace and love, knowing they are not alone in their journey.

In the end, the goal is to honor not only the lives of the pets we care for but also the relationships they shared with their families. This is the heart of our mission, and it’s what makes our work so meaningful.

Assistance with guiding clients through end-of-life care with compassion and understanding

Navigating different client types as their pet's journey nears its end 

Good morning and happy Monday dvm360 readers! For those being affected by the winter weather and snow hitting parts of the United States, we hope everyone is staying safe. Throughout the week, we will continue to provide our readers with the latest news in veterinary medicine, so continue to check in throughout the week to see what is going on in the industry!

Here is an inside look at what you can find this week on dvm360.com:

A cow in southern Mexico has recently been discovered to have New World screwworm infection. New World screwworm has been generally eradicated in the United States since 1966, but veterinarians close to the Mexico-United States border are being asked to look for signs of possible infections.

The Washington State Department of Agriculture and the USDA Animal and Plant Health Inspection Service announced that after 5 years, the northern giant hornet has been eradicated from Washington State and the United States.

On this week’s episode of The Vet Blast Podcast presented by dvm360 our host Adam Christman, DVM, MBA, sat down with Joe Owens, DVM, to discuss problem solving, decision making, and communication skills veterinary professionals can use to help with patients, clients, and other professionals. 

Otis, now a 6-year-old pug, was brought to UC Davis veterinary hospital’s emergency room for respiratory and cough issues at 2 months old. After his history showed his littermate had recently died with similar symptoms, veterinarians did a through workup where they discovered he had Hemophilia A.

Because every client and patient is different, when it comes to end-of-life care, the discussion needs to be tailored to each individual patient. Chelsea McGivney, DVM, general manager at Caring Pathways will share some tips on how to navigate the various client times as their pet approaches the end of their life.

Here is a sneak peek of this week’s headlines 