Transcript Creating a need for the VetLyte®

Creating a need for the VetLyte®
Electrolyte testing and Fluid Therapy
Electrolyte testing and Emergencies
Electrolyte testing and Pre-Anesthetics
Why are electrolytes so important ?
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They help maintain normal cell
activity
They help maintain normal body
fluid balance
They are part of the diagnostic
puzzle
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diagnosis of underlying
disease
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level of hydration
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Monitoring patient care
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Most importantly,
monitoring the
electrolyte balance
increases the level of
patient care.
Electrolytes In Review
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Na = Sodium
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associated with water balance
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regulated by the kidney
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all mammals need salt in their
diet in order to maintain proper
fluid balances
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
What causes high Sodium Levels?
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Increased intake
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highly salted diet
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Fluid replacement containing sodium
Excessive loss
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fluid loss which exceeds sodium loss
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vomiting and/or diarrhea
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dehydration
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evaporation due to heatstroke, panting, hyperventilation
Inadequate intake
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water unavailable (anesthetic recovery)
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insufficient amounts provided
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Medical conditions that can cause high sodium levels
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Increased loss
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vomiting and/or diarrhea leading to severe dehydration w/o
sodium replacement
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end-stage kidney failure
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Addison’s disease
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diuretic therapy
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Diabetes
Over hydration
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excessive administration of fluid replacement
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administration of Na free or low fluids-types
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Why Doctors should test for sodium
levels
Senior pets on heart medication
 Addison’s disease
 Fluid therapy
 Pre-anesthetics
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Senior pets on heart medication
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Feature:
Monitor Sodium values while dog owner waits
Benefit:
Insures that there are no adverse reactions when a senior pet is
receiving heart medications such as Furosimide. This medication
can cause electrolyte imbalances and dehydration.
OEQ:
What is your current protocol when maintaining a patient on
Furosemide?
High
Yield:
How would the ability to immediately identify adverse reactions to
medications such as this benefit you?
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Furosimide
PROOF SOURCE:
From the IDEXX
Medication
Monitoring Chart
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Diagnosing Addison’s Disease
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Feature:
Diagnose Addison’s Disease
Benefit:
Having the ability to immediately identify if the patient has Addison’s
disease. Because signs and symptoms of Addison’s often wax and
wane, the ability to run a test while the patient is symptomatic is
crucial.
OEQ:
What is your current protocol when confirming if a patient has
Addison’s disease?
High
Yield:
How would the ability to run electrolytes in less than a minute
benefit you and the pet owner in a suspected Addisonian case?
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Sodium (Potassium) and Addison’s
Disease
ELECTROLTYES
•Hyponatremia (low sodium)
•Hyperkalemia (elevated
potassium)
CONFIRMATION TEST:
ACTH test (cortisol readings)
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Sodium and Fluid Therapy
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Feature:
Monitoring Patients on Fluid Therapy
Benefit:
VetLyte offers doctor ability to have immediate electrolyte results
which will allow doctor to choose and monitor patient’s on fluid
therapy. This will allow for faster and better recovery.
OEQ:
What is your current protocol when choosing what types of fluid
therapy you use?
High
Yield:
How would the ability to identify if a patient had an electrolyte
imbalance effect what type of fluid therapy you choose?
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Sodium and Fluid Therapy
From the VetLyte Sell Sheet
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Sodium and Pre-Anesthetics
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Feature:
Check sodium levels before a senior patient on heart medication is
anesthetized for surgery
Benefit:
Reduces risk that patients will not have an adverse reaction to
surgery or anesthesia due to medications/electrolyte imbalances.
Senior patients are already in a high risk category for anesthetic
risk, especially those on medications.
OEQ:
What is your current protocol when preparing a senior pet,
especially on medications such as Furosimide?
High
Yield:
How would the ability to immediately reduce the risk of
complications due to age or medications benefit you or the pet
owner?
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Important facts to remember when
combating the “my client’s won’t pay” objection!
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If a pet owner is willing to spend the money and take the
time to medicate their pet daily, then they most likely will be
willing to spend the extra money to run additional tests
before a surgical/anesthetic event.
Senior pets are an established part of the family, and the
human-animal bond is strongest because the pet has been
part of the family for years. Pet owners want to avoid
added risks because of this bond.
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Cl = Chloride
Least important electrolyte
 Mimics sodium changes
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Potassium
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Carries the most clinical
significance
Regulated by the kidney
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
High potassium -Hyperkalemia
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Potassium containing drugs
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potassium chloride
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some antibiotics
reduced excretion
 urethral obstruction
 bladder rupture
 Addison’s disease
 acute renal failure
 ethylene glycol
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Addison’s disease is
one of the most obvious
reasons for elevated
potassium levels
Low potassium - Hypokalemia
Causes of hypokalemia
 chronic vomiting
 pancreatitis
 intestinal obstruction
 chronic diarrhea
 relief of urethral obstruction
 kidney failure
 long-term administration of K free fluids
 prolonged anorexia
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Potassium significance in the cat
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Hypokalemia relatively
common
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especially in early stage
renal disease
Condition/symptoms nonspecific
Mimicked by other disorders
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many associated with aging
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Facts about Hypokalemia
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In A study performed by Dr. Irwin 19 out of 67
cats (28%) that were clinically normal were
HYPOKALEMIC. Most were diagnosed with predental/pre-surgery lab work. He recognized
this as a probably cause for the short-term
anorexia these cats experienced post
anesthesia/surgery. Electrolytes in Veterinary
Practice, Dr. Irwin
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Facts about Hypokalemia
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Hypokalemia occurs in 30% of cats and 10% of
dogs with chronic renal failure.
Pg 98, Small Animal Clinical Diagnosis by Laboratory Methods
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Facts about Hypokalemia
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By adding electrolytes to routine blood panels, we finetune diagnostic and treatment capabilities. Knowing
electrolyte values has great significance in diagnosis and
treatment. Because values change quickly,
however, this information is significant only
if it can be obtained immediately. Electrolyte
Values Remain Underdog of Diagnostic Testing, DVM
Newsmagazine, May 1998, Dr. Irwin
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Facts about Hypokalemia
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A JAVMA study found that one in every three cats
examined for a variety of illnesses were hypokalemic.
Hypokalemia in Cats: 186 cases (1984-1987) Dow,
S.W. JAVMA Vol. 194, no. 11, June 1, 1989.
JAVMA – Journal of the American Veterinary Medical
Association
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Facts about Hypokalemia
In the beginning stages of hypokalemia, signs of potassium loss
are very subtle and often are attributed to “old age” or other
diseases. In severe cases of hypokalemia, cats will often exhibit
weight loss, muscle weakness, stiff gait, poor hair coat and
listlessness; however, the majority of potassium depleted cats will
not manifest these signs until the condition becomes acute and
possibly life threatening. Potassium Depletion in Cats: Causes
and consequences, Steven W. Dow, DVM, PhD.
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Potassium and Pre-Anesthetics
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Feature:
Screening patients, especially cats, before surgery/anesthesia
Benefit:
VetLyte offers the doctor the ability to have immediate electrolyte
results, which allows the doctor to identify the number one
abnormality in pre-anesthetics, hypokalemia. This abnormality can
be an early indicator of serious conditions such kidney failure.
Since signs are non-specific and mimic other conditions, this
condition often is misdiagnosed.
OEQ:
What is your current protocol to identify cats which might be in a
high risk category for anesthesia.
High
Yield:
When a patient does not recover from anesthesia as expected, how
does this effect you and your staff? How does it affect the pet
owner?
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Potassium and senior patients
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Feature:
Adding electrolytes to senior testing
Benefit:
Hypokalemia is an early indicator of kidney disease and is
commonly seen in senior cats. It is treatable and cats recover
quickly from this problem with minimal treatment. Since
hypokalemia signs are non specific and often mimic other diseases
and conditions, the VetLyte is essential to rule in/out hypokalemia
as the cause
OEQ:
When a client says their older cat “ain’t doing right,” what conditions
and/or diseases do you consider as a cause of this?
High
Yield:
How would being able to identify the cause of a cat’s non-specific
signs immediately help you and the pet owner?
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Electrolytes are similar to
pain management
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Except for Addison’s disease, electrolytes are a piece of
the diagnostic puzzle used in conjunction with other tests
to aid in a diagnosis. They are not usually a life or death
test, so how do you justify the use with your doctors?
Electrolyte monitoring is like pain management. The
patient would most likely survive without it, but the level of
patient care and time to recover is increased when used.
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Pain Management –
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Animal feels less pain
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Recovers quicker
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Electrolytes and Pain Management
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Feature:
Electrolytes increase patient care
Benefit:
Animals with electrolyte imbalances identified by the VetLyte
receive proper treatment, which includes fluid therapy, supplements
and further testing. All increase the patient’s recovery time and help
them to feel better.
OEQ:
Doctor, do you currently use pain management medications in your
practice? How do they help you and the patient?
High
Yield:
How would the ability to offer that same quality of care in other
areas in your practice benefit you? How about the pet owner?
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Cost justifying the VetLyte®
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VetLyte is perceived as expensive!
How do you overcome this objection?
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Cost Justifying the VetLyte®
OBJECTION: The VetLyte costs too much to run!
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During the sales call you have asked open-ended and high
yield questions that help to identify areas the doctor would
benefit from electrolytes
Now you must identify the opportunities!
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Identifying Opportunities
How many pre-anesthetic opportunities?
 How many fluid therapy opportunities?
 How many medication monitoring
opportunities?
 How many sick patient opportunities?
 How many senior patient opportunities?
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Cost Justifying the VetLyte®
This spread sheet is the US example of cost per test. It takes into
consideration the cost of reagents, electrodes and parts. It bases the cost
analysis on the assumption that the doctor will replace EVERY electrode
yearly. It does not include the cost of instrument
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
Cost Justifying the VetLyte®
This spreadsheet illustrates
that the VetLyte is not
expensive. It is just the
opposite! The more you
use the instrument, the
more cost effective it
becomes.
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
I get electrolyte results from the
reference lab!
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Electrolyte results are as time sensitive as hematology (but
for different reasons)
Electrolytes are affected by:
• Fluids going in the body
• Fluids leaving the body
• Intake of salt and potassium
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
I get electrolyte results from the
reference lab!
•Clients expect a high level of
care
•Technology to provide this
service is available
•Fine tune diagnosis and
treatment
•Values change quickly!
–significance is greater
when obtained immediately
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© 2004 IDEXX Laboratories, Inc., IDEXX Confidential
In Summary
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It is important to create the need for electrolytes first.
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This can be done using Sodium and Potassium
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Senior patients on heart medications
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Pre-Anesthetics
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Fluid Therapy
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High incidence of Hypokalemia in cats
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Client satisfaction
Once you create a need, you need to cost justify the
VetLyte
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How many times would the doctor average using the VetLyte a
day?
© 2004 IDEXX Laboratories, Inc., IDEXX Confidential