Is Impacted Anal Gland Really That Hard To Diagnose?

I’m extremely unhappy with my vet clinic right now and wanted to get some perspectives, so apology for any lengthiness. I’ll preface this with the fact that I am a horse trainer by trade and dealing with vets and indeed a lot of animal health care is pretty second nature to me. Thus I do not take my cats to the vet unless I’m pretty damn sure something’s wrong with them.
Working late wednesday night I notice cat Aspen is very uncomfortable. After watching for a few minutes I see that he will not sit on his bum. He’s looking around at his butt, skin on his back is twitching, and he’s licking his butt, but he will not put any weight on it. Lying down he’s clearly still uncomfortable and readjusting frequently.
Cat has history of constipation issues and lives on enulose (good god he LOVES the stuff. anyone else have a cat that literally begs for his dose of enulose???) Obviously this is the first thing I want to rule out so we go for the enulose and a few hours later we have poo. Yay.
Work until 2am and he’s in pain whole time. Morning is no better and I fear kidneys . . . but then he pees, no problem or straining. There’s been no change in litterbox habits. He’s eating and drinking normal amount. Out of ideas I call vet and describe symptoms. “He’s pooped and peed, he’s eating and drinking, but he’s in a lot of pain. Do you have any ideas? ” I say. “Well, I’m certainly not the vet but sounds as though it could be an anal gland problem. Go ahead and bring him in.” is the response on the other end, from the desk girl.
Off he goes for a day of observation, 8am-6:30pm. Around 11 I get a call, they can find nothing wrong with him. He look’s fine. I insist there is something wrong with him. We go over symptoms again and she suggests we take xrays to rule out the constipation I know it is not. I agree because hey, they’re the one’s with the degree.
Call comes that xrays are clean. I inquire what else can this possibly be? There is no mention of anal gland problems. I ask what the exam told her and she honestly told me he was squirmy and didn’t want them touching him so she was pretty much going entirely off my observations (which was, steadfastly, that the cat won’t sit down and is in a lot of pain). Well no ****. He squirmed when I examined him, which is why he ended up at the vet as they’re better equipped to handle sick squirming kittens, so you can get a full and thorough exam.
So we decide maybe it’s the kidneys. Let’s run bloodwork and urine, but they want him to stay overnight because he has no urine in his bladder. I ask if he had peed in the litterbox there, why yes, he had. That makes twice today, we’re still thinking kidneys is the problem? Okay, you’re the doctor.
Cut to chase: I leave him there till very end of the day and they get some urine. I show up, take out a line of Care Credit to pay the $480 bill with no questions asked, and Aspen comes home. No more than 2 hours later the gland begins to rupture so that it is finally visible above the fur. 1 hour after that it bursts and blood/puss everywhere.
Of course he goes back today and they get a mouthfull from me. They insist he was “looked at” yesterday, to which I insist that getting “looked at” isn’t why I dragged him to the clinic, an exam was what I wanted. And if you can’t subdue the cat enough to do a thorough exam then get help or tranq him. It would NOT have been that hard to localize where the pain was coming from – an abscess is VERY acute and VERY painful – and that should have instantly given them a clue as to the problem. They tell me anal gland problems are very difficult to diagnose and that they DID do an anal probe (which was the first I heard of that) and found nothing.
I have to believe that cat would have screamed bloody murder from the pain an anal probe would cause. Or if they had bothered to try and express the glands I’m sure that would have clued them in to where the pain was, though it was probably too impacted to express at that point.
And all that aside, given the symptoms – won’t sit down, licking bottom, extreme pain and discomfort BUT still eating, drinking, peeing and pooping, should an anal gland problem not have come to mind? And if that problem is very hard to diagnose, would it not seem such an obvious potential that we wait a day before ordering a panel of bloodwork and xrays and see if the anal gland presented itself?
Would a gland that ruptured at 9pm be that dormant that it is unnoticed 5-6 hours before?
When I researched this clinic (which is a cat only clinic) many of the comments were that it was way pricey. I have no problem paying top dollar for good vet care, which is what I assumed “way pricey” equated too. But for that top dollar I expect diagnostics better than my own. I took him in for preventative, they could do nothing until problem was physically expressed. Today’s bill was $120 for treatment he needed, yesterday’s was $480 for treatment he did not need. All