Re: I’m new! 6yr old Rottie/Catahoula mix recently diagnosed and having quite the tim
Jenni, thanks so much for all this additional info! There’s never a need to apologize for a lengthy post — the more you can tell us, the better ;-).
I have to say that all of your concerns sound perfectly reasonable to me. It’s true that Cushing’s is thought to increase a vulnerability to blood clots, but putting an animal who’s recovering from a GI bleed on a blood thinner is definitely a head scratcher for me, too. In our experience here, blood thinners are not routinely prescribed for Cushpups, and I definitely agree with you that it seems like a very odd choice in Eli’s situation. I also understand your questioning of the high blood pressure. I believe I, too, would want to have more than one elevated reading taken during a high-stress situation to confirm the finding before starting on medication. So after encouraging you to rely on a specialist, I’m coming away with some of the same questions as you.
As far as the LDDS vs. the ACTH, it seems to me as though the majority of experienced clinicians actually prefer the LDDS as their leading diagnostic, but with the following caveat. Both tests are vulnerable to “false positives” if a dog is suffering from an illness or physical stress other than Cushing’s. However, the LDDS is more likely to be skewed in this manner than is the ACTH. So if a dog has other known physical ailments, the ACTH may indeed be the more reliable test. The trade-off is that the ACTH is more likely to miss diagnosing Cushing’s (“false negatives”) in a dog who truly suffers from it. So in my own mind, which of the two tests is “better” really depends upon the situation that is specific to each individual dog. Now knowing that Eli was suffering from these other underlying issues, the ACTH might indeed have been a more reliable diagnostic option for him. But given his overall symptom profile, I personally don’t doubt that he truly has Cushing’s.
So what to do now... I agree that it’s far less than ideal to have to speak to a different vet whenever you have questions. In a non-emergency situation, it seems as though you ought to be able to arrange to consistently talk with a single specialist who’s in charge of Eli’s care. If this practice can’t make that happen, then perhaps a different group would be a better option. However, if logistics are such that you’d rather stay with them, I’d encourage you to press them on scheduling a time that you know you’ll be able to speak to the vet you prefer. And then I’d proceed with explicitly asking whether it wasn’t risky to prescribe a blood thinner while Eli was recovering from a GI bleed. And I’d also advocate for a few additional blood pressure readings in less stressful conditions, too. If the answers you get don’t satisfy you, then I’m afraid I’d encourage you to investigate other vet options :-((((. Sheesh!
Marianne
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Word of caution....DO NOT increase the dose until at least 30 days have passed on the 30mg a day dose. Cortisol continues to drop those first 30 days without a dose increase so Dechra says do not increase during that time frame. If the 30 day ACTH still shows elevated cortisol AND the signs are still strong then a dose increase of no more than 25% is the next step. fyi, Eli should have an ACTH at the 2 week mark after starting then again at the 30 day mark after starting....and it is this 30 day mark that will tell if an increase is needed. And btw a 28ug/dl isn't all that high; my own Trinket registered as greater than 50ug/dl and she was misdiagnosed because of her numerous other conditions. 
