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.