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The treatment that my uncle recommended besides just killing the larva, was to give him one heartworm pill for the first month and then two for the second month in order to kill off the larva and weaken the other adult worms. We would then have to bring him in to the clinic, where they would give in arsenic injections (I think) somewhere near his spine. I think that my grandfather said that he would have to then stay at the vet for a few days and then come back in three months to do the injections again.
The problem is, is that my uncle figures that Rusty has probably had the heartworms for a while and that they might be going into his liver. They are already in his heart and lungs, and he wheezes/ coughs when he runs around too hard.
My uncle is mainly worried that since Rusty's nutrition is very questionable and where exactly the heartworms have taken over, he doesn't know if Rusty would even survive the treatment or not. He said that he only usually recommends it for dogs younger than 7, since they are usually strong enough to handle it.
Those are the only two options I believe that he gave my grandparents. My grandparents didn't want for Rusty to have to have the injections since they would be so hard on him. My uncle said that he personally would just manage the larva and let him live as long as he can with the rest of the heartworms.