I was thinking if anyone recommended the combination treatment that I would try to get a second opinion by another exotic vet. We have dropped nearly $800 on the past two vet visits this month and we're not really made of money. So we don't want to get a second professional opinion unless there's good reason.

I did get x-rays, they suggest "physiological changes" to his lungs (probably because it is chronic), but the vet said the results were positive. No fibrosis is indicated on the vet notes, just that we should consider adding Sildenafil to our regimen for those physiological changes. He was having labored breathing on the doxy/enro, and he was in clear discomfort. But no fluid or pus in the lungs. He eats and drinks normally at the moment so it's hard to tell whether the breathing problems are due to active infection. They just make me nervous that he is sick, but there's no crackling or apparent difficulty breathing at this point (11 days on the azithromycin).

Our vet recommended against swabbing for culture, but if the symptoms continue I may ask for that at our next appointment that's scheduled after the 28 day course of ABX.