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I am sorry to hear you are worried about Toby. I am a veterinarian and will do my best to help.
I suspect the bloating is due to the low protein levels. When the albumin gets as low as his albumin is, then fluid leaks out of the blood vessels and into the abdomen, and sometimes into the chest, which can affect the breathing.
So the thing to do is figure out why the albumin is low. It can be from the liver not making enough albumin, or it can be that enough albumin is being made but is being lost as quickly as it is made. Albumin can be lost in the urine, so doing a urinalysis and checking for excess protein in the urine should be done.
Albumin can also be lost in the intestines, a condition called "protein losing enteropathy". These dogs have diarrhea, and that may be Toby's problem. Since the ultrasound shows thickening of the intestinal wall, that is probably what is happening: the intestine walls are leaking protein into the stool, the protein levels in his body drop, and that causes the bloating.
A biopsy of his intestines might tell you why the intestine walls are thickened. This could be due to intestinal lymphoma, or some inflammatory process.
Did the cortisone help at all? Some dogs with protein losing enteropathy do improve with steroids. Some improve with diet manipulation, and MCT oil.
If he were mine, I would consider trying to get a definite diagnosis, but that probably means an intestinal biopsy.
Let me know what else I can answer or help with. Rebecca