6-year-old Intact Female Queensland Heeler. $10,000 Spent and nobody has an answer. Need some second opinions.

Hello everyone, I have been through one hell of a week. I have spent $10,000 at the specialist vet over the last 7 days and all I am told is this is very odd, and we don't have any answers for you.

Discharge Write-up from 9-18-2024: Thank you for entrusting us with Bailey's care. She was hospitalized for vomiting and elevated liver values. We diagnosed Bailey with severe duodenitis (inflammation of the portion of the small intestines that connects to the stomach) causing an extra-hepatic (outside the liver) biliary obstruction (obstruction of the bile ducts that connect the gall bladder to the small intestines). These types of obstructions can be managed medically (liver protectants, symptomatic care) or surgically (placing a stent in the bile duct). Medical management is typically preferred and is indicated in stable patients. Thankfully, Bailey has been doing fairly in hospital and we have seen improvement of her bilirubin. This is a blood value checked when concerned for a bile obstruction. It is great news that it is decreasing with treatment started! We did perform a recheck focal (mini) ultrasound today, which did show a bit more free fluid in the abdomen but no significant change to the intestines or biliary obstruction. We recommend continuing current therapies as Bailey is doing fairly, but careful monitoring is recommended. We discussed inpatient vs outpatient care and, as Bailey is currently stable, you opt to take her home tonight. We recommend you return tomorrow for exam and bilirubin. Please return in the morning in case additional work-up (eg possible abdominal CT scan) is recommended.

DIAGNOSTICS:

1. Bloodwork- This showed an elevated bilirubin, elevated liver enzymes, and a mildly high white blood cell count.

During Bailey's hospitalization, her bilirubin has improved (but is still high).

1. X rays- Normal.
2. 4DX (screens for some common infections) – Negative.
3. Abdominal ultrasound- This showed inflammation of the stomach and small intestines (specifically, the duodenum) causing a biliary duct obstruction. There were enlarged lymph nodes in that area and mild fluid dilation of the uterus. There is also free fluid in the abdomen.
4. Fluid analysis and cytology (abdominal effusion) – Pending. (UPDATE: Fluid came back a-cellular, vet said it doesn't tell them anything other than they do not believe it is cancer, but the fluid is still there as of 9-23-2024 and they do not know why).

TREATMENTS:

We have Bailey on IV fluids and both Gl and liver support. She is hydrated and stable, though still icteric (jaundiced).

She ate some last night, but has not been interested in food today. We are sending her home with a script for a hydrolyzed protein diet. We will also send home a few cans of this food. If she will not eat it, you may feed another bland diet (eg boiled chicken, steamed white rice) at this time.

Discharge Paperwork from 9-23-2024: Thank you for entrusting us with Bailey's care. She is very sweet and it was a pleasure to work with her.

Bailey's Tbili today remained static compared to the last time we checked it (4.6). We have decided to start steroid therapy today to see if this will help treat the underlying inflammation of the small intestine and stomach. Please continue giving the other medications as previously prescribed. We recommend rechecking her Tbili again in 3-5 days, this can be performed either through our ER department or with your primary veterinarian.

Total Medications:

• Capromorelin (Entyce) 30mg/mL/15mL OralS. QTY: 1.00 btl — Give 1.2 ml by mouth every 24 hours as needed for appetite. Due tomorrow afternoon.
• Omeprazole DR (gen) 10mg Cap. QTY: 14.00 cap — Give 1 capsule by mouth every 24 hours for 14 days. Due tonight.
• Maropitant (Cerenia) 24mg Tab 4pk. QTY: 1.00 pack — Give 1 tab by mouth every 24 hours as needed for anti-nausea and appetite. Due tomorrow morning.
• Mirtazapine (gen) 15mg Tab. QTY: 1.00 tab — Give 1/2- 3/4 tablets) by mouth once daily as needed for appetite stimulant.
• PredniSONE (gen) 10mg Tab. QTY: 30.00 tab — Give 1 tablet by mouth once daily for 2 weeks, then decrease to 1/2 tablet by mouth once daily until otherwise directed by a veterinarian.
• Bailey was given an injection of a steroid today in the hospital. The first dose of the prednisone is due Tuesday morning.
• Steroids may cause increase in thirst, urination, and panting.
• Do not abruptly discontinue. This medication needs to be weaned under a veterinarian's supervision.

I don't know what to do, I have spent so much money trying to figure out what is wrong with my girl and not 1 but 2 vets have no answers for me. They are asking me to do CT scans and Endoscope probs etc. for another $6k-$10k. I cannot afford to keep going, I never expected to pay $10K in the first place, but this I had to do whatever I could to save her. I cannot justify putting myself out $20K and the vet come back to say, "we don't know what it is." If anyone has a second opinion or knows anything about her condition, I would be very grateful. I feel so hopeless right now and really at a loss for words.