Mixed results

I saw a really interesting case today (exhausting, but interesting).

Geriatric dog, recent anesthesia event, chronic vomiting (since the anesthesia event), unable to keep food down. History of eating people food, including bones.

Physical exam: dehydrated dog, painful abdomen, just plain looks sick

My differentials: Pancreatitis, GI foreign body, some sort of organ dysfunction (kidneys/liver/etc.), possibly neoplasia (cancer) or Addison's disease

My recommendations: Abdominal radiographs and bloodwork

Let me put this as diplomatically as I can. The client was an a-hole uncooperative and wanted to argue every single line item with me (despite having enough funding to pay for a week's worth of hospitalization at a gold-plated teaching hospital).

1 hour later, I finally get agreement for radiographs. I look at them and my suspicion of pancreatitis increases (the cranial left abdomen had poor serosal detail and there appeared to be widening of the gastro-duodeneal junction).

30 minutes and a LOT of effort later, I get agreement to run a (< $60) snap cPL test (a blood test that can help to confirm my suspicion of pancreatitis). It is positive.

I then spend another 30 or 45 minutes going around and around with the client about treatment. They very reluctantly agree to my plan Z and go out the door still grumpy.

On the one hand, I’m happy that my suspicions were correct and I actually found an answer! On the other hand, the client interaction left a lot to be desired. I’m not-so-secretly hoping that they don’t come back for a recheck.