The way it sounds it that it might just be heart worm. The only symptoms I know are trouble breathing and coughing, which it sounds like he's experiencing. I have no experience with heartworms though, so all I can do is wish Almalfi the best. Poor little guy has been through so much.
I do know they have medicines for heartworm, but it's a tricky thing and they need to be administered under strict supervision because if you kill the worms off to quickly, it could be even more detrimental to Almalfi's health.
Tubby
Spring 1986 - Dec. 11, 2004
RIP Big Boy
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Peanut
Fall 1988 - Jan. 24, 2007
RIP Snotty Girl
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Robin
Fall 1997 - Oct. 6, 2012
RIP Sweet Monkeyhead Girl
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