I recently had the very great pleasure of being presented with a dog for the purpose of emptying his anal sacs. His owner informed me that he'd brought the dog in several days prior, and a licensed tech had done the sac-emptying, but maybe didn't do a good job because the dog was still scooting. So, I assessed the situation digitally, as one does in these circumstances, and I found that in fact the sacs were empty. "Guess what, TBB? You actually did a great job! These are empty! Now let's see...." I said, as I looked for another cause of scooting in this pup. "Aha. See that little protrusion there, sticking out from the dorsal rim of the anus, where 12 o'clock would be if this were a clock?" I asked the owner. The owner expressed agreement that yes, there was something there. "Well, I'm not 100% sure what that is, but it's only about 2 mm wide, and it's on a less than 1 mm wide stalk, and it's a tiny bit irritated - this could be the issue." I gave them some cream to put on it and explained ultimately we could just remove it if it continued to be a problem.
About an hour or so later, the owner's other half called me. I was instructed to take the call.
Me: Hello, this is Dr VBB, how can I help you?
Mrs. Knowsit: Yes, my dog and my husband were just there. Why didn't you run a fecal?
Me: Oh, you mean on little Fluffypants, with the scooting problem? Well, you didn't send in a fecal sample, and I didn't feel one was indicated for any reason, so I didn't do one.
Mrs. Knowsit: but obviously she has worms, she is scooting.
Me: That doesn't mean she has worms. It could be something else.
Mrs. Knowsit: well, but most likely it's worms. I just don't understand why you didn't do a fecal.
Me: I don't believe she has worms. A fecal was not indicated. She's 12, she's on a monthly dewormer, she's never had clinical signs referable to worms before, and she has a perfectly reasonable cause for scooting in any case.
Mrs. Knowsit: Oh? What's that?
Me: The mass on her anus.
Mrs. Knowsit: The what?
Me: The mass on her anus, it was a little inflamed.
Mrs. Knowsit: (laughing) I've never heard it called that before!
Me: What do you mean? You've never heard a mass called a mass, or you've never heard of a mass being called inflamed? Sorry I don't understand.
Mrs. Knowsit: Wait a minute. A mass? I thought you said she has a mouse on her anus.
Me: No. Your dog does not have a mouse on her anus.
Mrs. Knowsit: OK. But I still think she has worms.
Me: I'm more than happy to run a fecal for you any time. Just drop off a sample at your convenience.
Mrs. Knowsit: Ok, thank you doctor.
The fecal was duly dropped off and was run. GUESS WHAT? It was negative. But how much do you want to bet that this client will tell me she doesn't want to spend whatever my next recommendation was cost because she just "had to" spend "so much money" on a fecal? HMMM? I did try to avoid taking her money for the fecal. Honest.