I get that people can be upset when we cannot get a diagnosis in one visit and when they have spent money that they can ill afford, but lashing out and accusing us of profiteering sticks in my throat. I was in the office on the day this really nice dog came in and although he was not my case I was in the room when most of the phone conversations went on and I know what was said and what was not. Just for reference, because we were such profiteers, we took eleven xrays of this patient and billed the owner for four. We did run an ECG on this patient without calling the owner first, he had a had a fairly major arrhythmia and we wanted to get a handle on it quickly ($45) and my associate called immediately apologized and explained why we had done it. This patient had serious and major changes in one of his long bones. The changes were unusual and quite rare, and rightly the owner was offered the option of having the images reviewed by a Board Certificated Radiologist, which she declined as is her right. Yes we did explain to her that we could do more work-up to get to the bottom of what was going on with her dog. She asked that we call out her prescription of pain relief to an outside pharmacy which we did (without making a prescription charge). When she collected her pet she asked if she could have pain relief from us because she did not want to drive back to the pharmacy to collect it. My colleague explained that she absolutely could, but our drug, licensed for use in dogs was considerably more expensive than the human generic drug she had requested us to prescribe, so it would be much less expensive (if more inconvenient ) to drive to the pharmacy and collect it. I am sorry for this patient that we do not have a definite diagnosis, but everything we did was geared to that end, including the bloods which were looking for a hypercalcemia of malignancy because of the appearence of the radiographs. That's about all I have to say about the visit. No-one tried to make the client feel bad we are always sympathetic and know that money does not grow on trees. As for he last comments. Since we don't stuff tomcats in an old boot and cut off their testicles with an old knife, there is a cost to neutering them, for anesthesia, for pain relief, for preparation and monitoring, for the surgery. Honestly for what we do $200 for a neuter is pretty good. Don't want to do pre anesthetic bloods don't do them. Its a recommendation not an order. We would prefer you do because about 10% of pre anesthetic screens throw up something that we ought to know prior to inducing anesthetic, but it is the owners choice for a neuter not a clinic demand. There are also subsidized neuters available at the SPCA clinic for people who do not have the means to come to a regular hospital.