Trouble with hognose RI not responding to antibiotics

[SeaPancake]

Any update on your hognose, @SeaPancake ?

Things are still up in the air, but long story short I'm not sure there's much else I can do for him at this point.

The vet stuck a catheter down his trachea and managed to pull up some of the same white fluid that he had sneezed up and sent it off for both a culture and another MiDOG DNA sequencing test (this is actually the test they had done previously, not a culture). In the meantime while the results were pending she put him on a much more intense course of antibiotics than before which entailed 15 doses of both Ceftiofur (one he's had before) and Amikacin which she said targets the other main group of bacteria that Ceftiofur and Ceftazidime don't cover. Depending on the results of the tests she was either going to keep him on those two antibiotics or switch him to different ones, but by the time the results did come back he was nearly done with the course.

Both tests came back with nothing. The culture grew absolutely nothing at all, and the MiDOG came back with the same negative results that it did the first time around. The vet said that it could possibly be some strange anaerobic bacteria that wouldn't have thrived in the conditions that the culture was grown in. The only thing that she could think to do to try and diagnose this is a lung biopsy. I have concerns about doing that both due to his size and the fact that he's likely already in his upper teens and I really don't want to put him through a surgery like that especially since there's no guarantee of finding answers.

The good news (at least for now) is that the course of antibiotics did make a very significant improvement, although he's still not 100%. The sneezing has almost completely stopped and I haven't seen anymore white stuff. He still does open his mouth occasionally in a way that doesn't seem like a yawn but he's not thrashing around like he did before. He's definitely improved far more than he ever did with the past two tries with antibiotics. It was a very long course and I actually just gave him his last injection a few days ago so at the moment it's just a waiting game to see if he goes downhill again.

All that being said I do wonder about a few more things which I'd love any insight into if anyone has any:
- His one symptom that has never improved even with antibiotics has been his slight clicky breathing when being held. I've seen a few people online say that this might be a permanent issue caused by scarring in the respiratory tract due to long term illness (which he has definitely had)
- If there is indeed scarring, possibly in his lungs, could this be what's keeping him sick/making him constantly susceptible to illness?
- It seems like there's still fluid in his lungs still (even at the very end of the antibiotic course he had a fit of the soundless sneezes followed by a loud one, unfortunately he had his face hidden so I couldn't see if he sneezed anything up), is it possible that the scarring/constant irritation is contributing to the fluid buildup? Could some sort of long-term anti-inflammatory help? He was prescribed one in the past (Meloxicam) but it was only 4 doses so I didn't have time to see if it made a difference
- A few people online mentioned that since snakes can't really sneeze up fluid in their lungs in the same way that we can, that it might take a lot of time for it to get reabsorbed. Is there maybe a small chance that the antibiotics worked but that he's just working out the last of the fluid?
- I've heard that bloodwork might be able to detect antibodies to certain illnesses?
- I've also read a little about X-rays being able to detect scarring and and fluid in the lungs. I definitely want to bring this up to my vet as a possibility in the future. It would at least give a little insight into what might be going on physically and wouldn't be invasive.

I wish I had a better update but that's where we're at right now. He just ate his first meal yesterday since starting the antibiotics nearly 2 months ago (I was advised to not feed him during the course) and he took it very enthusiastically so that's good. Overall he's been much more active and alert, but just still seems to have some fluid in his lungs. I have a feeling that he's going to go back downhill like he has the last two times, and then it'll be time to have another conversation with the vet. In the meantime I'm just doing everything I can to keep his enclosure sterile and his heat at good levels to give him the best chance that I can. In a month or so when he's had a few more meals in him and I've had a chance to see if the sneezing comes back or not I'll post another update. If anyone has any other ideas though I'd love to hear them!