1. Creating a need for the VetLyte®
Electrolyte testing and Fluid Therapy
Electrolyte testing and Emergencies
Electrolyte testing and Pre-Anesthetics

2. Why are electrolytes so important ?
They help maintain normal cell activity
They help maintain normal body fluid balance
They are part of the diagnostic puzzle
diagnosis of underlying disease
level of hydration
Monitoring patient care
Most importantly, monitoring the electrolyte balance increases the level of patient care.
Electrolytes are often the missing piece of the puzzle, especially in emergency and treatment situations. (READ SLIDE)

3. Electrolytes In Review
Na = Sodium
associated with water balance
regulated by the kidney
all mammals need salt in their diet in order to maintain proper fluid balances
We will start with Electrolytes – (READ SLIDE)

4. What causes high Sodium Levels?
Increased intake
highly salted diet
Fluid replacement containing sodium
Excessive loss
fluid loss which exceeds sodium loss
vomiting and/or diarrhea
dehydration
evaporation due to heatstroke, panting, hyperventilation
Inadequate intake
water unavailable (anesthetic recovery)
insufficient amounts provided
The following can cause high sodium levels. READ SLIDE

5. Medical conditions that can cause high sodium levels
Increased loss
vomiting and/or diarrhea leading to severe dehydration w/o sodium replacement
end-stage kidney failure
Addison’s disease
diuretic therapy
Diabetes
Over hydration
excessive administration of fluid replacement
administration of Na free or low fluids-types
There are also medical conditions that cause high sodium levels – they are (READ SLIDE)

6. Why Doctors should test for sodium levels
Senior pets on heart medication
Addison’s disease
Fluid therapy
Pre-anesthetics
These are 4 of the most common reasons to test dogs for electrolytes. We will talk about these four reasons to follow

7. Senior pets on heart medication
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?
Here is an example of how you can use action selling to tie back a benefit of the VetLyte with a high yield question
OEQ – means Open Ended Question

8. Furosimide PROOF SOURCE: From the IDEXX Medication Monitoring Chart
Here is an example of how a heart medication can influence electrolyte balances. Furosemide is a diuretic which causes the patient to eliminate excess fluids. When an animal diereses, they can become dehydrated and deplete their electrolytes, such as sodium. That is why it is crucial to include electrolytes as part of pre-anesthetics as well as part of medication monitoring screening.

9. Diagnosing Addison’s Disease
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?
Here is an example of how to use a high-yield question to tie back to the importance of immediate results with the VetLyte

10. Sodium (Potassium) and Addison’s Disease
ELECTROLTYES
Hyponatremia (low sodium)
Hyperkalemia (elevated potassium)
CONFIRMATION TEST:
ACTH test (cortisol readings)
The only test to confirm suspicions of Addison’s is electrolytes. Often, patients are misdiagnosed because doctors do not identify that the patient has low sodium and high potassium levels. The VetLyte allows you to instantly identify whether the dog’s symptoms, which wax and wane (are on again, off again) are because of Addison’s. Also, addisonian dogs must be treated immediately with proper fluid therapy to restore the electrolyte balance.

11. Sodium and Fluid Therapy
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?
Here is an example of using questions to draw out the need for a benefit of the VetLyte with fluid therapy

12. Sodium and Fluid Therapy
As you can see, Saline and Lactated Ringers both contain Sodium and Chloride. You do not want to use these fluid therapies on a patient who has high sodium or potassium levels. You would want to use Dextrose, which contains nothing but a sugar supplement. Running electrolytes before administering fluids is a very cost effective way to insure you are giving a patient proper treatment. It allows the patient to heal faster and feel better during the treatment.
From the VetLyte Sell Sheet

13. Sodium and Pre-Anesthetics
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?

14. Important facts to remember when combating the “my client’s won’t pay” objection!
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.
My client’s wont pay is a world-wide objection. Often we lose a sale, and doctors forgo the best treatment for a patient because they are concerned about the client’s ability to pay. There are two types of pet-owners. The crazy ones like me who spend too much money on my pets because I consider them my children and the ones who only bring their pets to the vet because the situation has forced them to. It is important to remind doctors that they see these two types of clients. Most caring pet owners are willing to pay for something if they are educated about why it is important. As I have stated above, this is especially important when the patient is a senior. The older the pet, the stronger the bond.

15. Cl = Chloride Least important electrolyte Mimics sodium changes
Chloride is the least important electrolyte. The values often mimic sodium and we will not be spending a lot of time on this electrolyte today

16. Potassium Carries the most clinical significance
Regulated by the kidney
Potassium, like sodium, is very important in veterinary medicine. This electrolyte is regulated by the kidney and changes in potassium are often seen when a patient has kidney disease. We will spend some time on this electrolyte

17. High potassium -Hyperkalemia
Potassium containing drugs
potassium chloride
some antibiotics
reduced excretion
urethral obstruction
bladder rupture
Addison’s disease
acute renal failure
ethylene glycol
Addison’s disease is one of the most obvious reasons for elevated potassium levels
First, lets look at high potassium. There are several reasons a patient might be hyperkalemic. The most obvious is Addison’s disease but other conditions are included on this slide as well. They include (read of list)

18. 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
Low potassium, or hypokalemia is much more common than high potassium. There are several reasons for hypokalemia. Sometimes hypokalemia is identified in cats but no underlying cause is discovered. Many times, in this situation, doctors will monitor electrolytes and treat the cat with a potassium supplement. Other reasons are (read list )

19. Potassium significance in the cat
Hypokalemia relatively common
especially in early stage renal disease
Condition/symptoms non- specific
Mimicked by other disorders
many associated with aging
Potassium is very significant it the cat. It is often seen as an early indicator of kidney disease. Signs and symptoms are often vague and non-specific, especially early on which makes diagnosing without tests near impossible. Often, clients do not bring up signs of hypokalemia to the vet because they associate the signs as “old age”.

20. Facts about Hypokalemia
In A study performed by Dr. Irwin 19 out of 67 cats (28%) that were clinically normal were HYPOKALEMIC. Most were diagnosed with pre- dental/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
I will now read many quotes about the importance of screening for potassium levels.

21. Facts about Hypokalemia
Hypokalemia occurs in 30% of cats and 10% of dogs with chronic renal failure.
Pg 98, Small Animal Clinical Diagnosis by Laboratory Methods

22. Facts about Hypokalemia
By adding electrolytes to routine blood panels, we fine- tune 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

23. Facts about Hypokalemia
A JAVMA study found that one in every three cats examined for a variety of illnesses were hypokalemic. Hypokalemia in Cats: 186 cases ( ) Dow, S.W. JAVMA Vol. 194, no. 11, June 1, 1989.
JAVMA – Journal of the American Veterinary Medical Association

24. 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.

25. Potassium and Pre-Anesthetics
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?
Here is an example of questions you can ask to create a need for electrolyte testing for potassium levels.

26. Potassium and senior patients
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?
“ain’t doing right” - means - the cat is not himself, has non specific signs of being sick.

27. Electrolytes are similar to pain management
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.
Pain Management –
Animal feels less pain
Recovers quicker

28. Electrolytes and Pain Management
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?
Here is an example of how to use an open-ended question and a high-yield question to create a need for the VetLyte in relation to pain management

29. Cost justifying the VetLyte®
VetLyte is perceived as expensive!
How do you overcome this objection?
It is easy to ask many questions that get a doctor to say he or she may benefit from having electrolytes but many doctors don’t think they can afford to run the analyzer or they think it costs too much. How can we cost justify the VetLyte.

30. Cost Justifying the VetLyte®
OBJECTION: The VetLyte costs too much to run!
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!
By asking questions like the ones we have covered we have gotten the doctor to agree that there are many areas that he or she would benefit from using the Vetlyte. Now we must identify exactly HOW MANY of these opportunities the doctor has on a regular basis

31. 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?
In order to identify how many opportunities their might be you can ask questions such as the ones listed above. (read off)

32. 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
Here is an example, unfortunately in US DOLLARS – or maybe fortunate considering the dollar is valued so poorly against the EURO, of how cost effective the VetLyte is the more you use it.

33. 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.
Often, a doctor has never really understood how the VetLyte works. Usually, if the doctor would average 2 runs a day – the VetLyte is actually the cheapest electrolyte analyzer available. If you divide the cost of $2.91 by 3 it nets the cost of each result to less than one dollar. This is the cheapest test we offer.

34. I get electrolyte results from the reference lab!
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
READ SLIDE FIRST Let me ask the audience. Has anyone here had a hang over? Most often, this is the result of dehydration. If I took blood from everyone in the room after a night of drinking, besides elevated liver enzymes, I would see electrolyte imbalances. If I sent your blood to the reference lab in the morning, when everyone is hung over results would indicate this. Unfortunately, because I would not get results back from the lab until later in the day the results would no longer be valid. By then everyone would have drank their water, taken aspirin or started drinking again! What is going on in your bodies when the results come in is different than what your bodies looked like earlier in the morning. Let me put it another way – go to next slide.

35. 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
Here is a snap shot from the United States Stock Exchange. The top details how the US stock market was doing before the attacks on the US on September 11th. The next evaluation is after the September 11th attacks. Notice the big difference. In one the stock market was doing great, the economy is strong. After September 11th, the stock market plummeted. If these were electrolyte values and a sick animal and you relied on the first set of values you would think the patient was doing great, in reality the patient is very sick. Electrolyte values change rapidly and need to be monitored routinely. Clients expect a high level of care, technology is now available to offer this, running electrolytes allows for fine tuning diagnosis and treatment and finally, values change quickly. There is a greater significance when results are obtained immediately.

36. In Summary It is important to create the need for electrolytes first.
This can be done using Sodium and Potassium
Senior patients on heart medications
Pre-Anesthetics
Fluid Therapy
High incidence of Hypokalemia in cats
Client satisfaction
Once you create a need, you need to cost justify the VetLyte
How many times would the doctor average using the VetLyte a day?