Creating a need for the Vet Lyte Electrolyte

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

Why are electrolytes so important ? l l l They help maintain normal cell activity They help maintain normal body fluid balance They are part of the diagnostic puzzle l 2 diagnosis of underlying disease l level of hydration l Monitoring patient care © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential Most importantly, monitoring the electrolyte balance increases the level of patient care.

Electrolytes In Review l Na = Sodium l associated with water balance l regulated by the kidney l 3 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? l l l 4 Increased intake l highly salted diet l Fluid replacement containing sodium Excessive loss l fluid loss which exceeds sodium loss l vomiting and/or diarrhea l dehydration l evaporation due to heatstroke, panting, hyperventilation Inadequate intake l water unavailable (anesthetic recovery) l insufficient amounts provided © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Medical conditions that can cause high sodium levels l Increased loss l l 5 vomiting and/or diarrhea leading to severe dehydration w/o sodium replacement l end-stage kidney failure l Addison’s disease l diuretic therapy l Diabetes Over hydration l excessive administration of fluid replacement l 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 l Addison’s disease l Fluid therapy l Pre-anesthetics l 6 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Senior pets on heart medication 7 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 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 8 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Diagnosing Addison’s Disease 9 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) 10 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Sodium and Fluid Therapy 11 Feature: Monitoring Patients on Fluid Therapy Benefit: Vet. Lyte 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 Vet. Lyte Sell Sheet 12 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Sodium and Pre-Anesthetics 13 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! l l 14 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 l Mimics sodium changes l 15 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Potassium l l 16 Carries the most clinical significance Regulated by the kidney © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

High potassium -Hyperkalemia l Potassium containing drugs l potassium chloride l some antibiotics reduced excretion l urethral obstruction l bladder rupture l Addison’s disease l acute renal failure l ethylene glycol l 17 © 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 l chronic vomiting l pancreatitis l intestinal obstruction l chronic diarrhea l relief of urethral obstruction l kidney failure l long-term administration of K free fluids l prolonged anorexia 18 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Potassium significance in the cat l Hypokalemia relatively common l l l Condition/symptoms nonspecific Mimicked by other disorders l 19 especially in early stage renal disease many associated with aging © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Facts about Hypokalemia l 20 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 l l 21 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 l 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 22 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Facts about Hypokalemia l l 23 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, Ph. D. 24 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Potassium and Pre-Anesthetics 25 Feature: Screening patients, especially cats, before surgery/anesthesia Benefit: Vet. Lyte 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 26 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 Vet. Lyte 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 l l 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. l 27 Pain Management – l Animal feels less pain l Recovers quicker © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Electrolytes and Pain Management 28 Feature: Electrolytes increase patient care Benefit: Animals with electrolyte imbalances identified by the Vet. Lyte 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 Vet. Lyte® l Vet. Lyte is perceived as expensive! How do you overcome this objection? 29 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Cost Justifying the Vet. Lyte® OBJECTION: The Vet. Lyte costs too much to run! l l 30 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? ü How many fluid therapy opportunities? ü How many medication monitoring opportunities? ü How many sick patient opportunities? ü How many senior patient opportunities? ü 31 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Cost Justifying the Vet. Lyte® 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 32 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

Cost Justifying the Vet. Lyte® This spreadsheet illustrates that the Vet. Lyte is not expensive. It is just the opposite! The more you use the instrument, the more cost effective it becomes. 33 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

I get electrolyte results from the reference lab! l l 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 34 © 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 35 © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential

In Summary l It is important to create the need for electrolytes first. l l This can be done using Sodium and Potassium l Senior patients on heart medications l Pre-Anesthetics l Fluid Therapy l High incidence of Hypokalemia in cats l Client satisfaction Once you create a need, you need to cost justify the Vet. Lyte l 36 How many times would the doctor average using the Vet. Lyte a day? © 2004 IDEXX Laboratories, Inc. , IDEXX Confidential