Gagging and coughing are dead give always for heart worms. I have had 3 dogs with heart worms that I cured of heart worms in a short time but it is very risky to do and if a vet does it can cost a lot
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Ivomec straight? Ive seen it work on a buddys dog
FYI a safe alternative is DME 1 tbsp minimum per day, it kills them by abrasion, only seen it tried once but it did work and the dog defiantly had heart worms, he used real high dose of it though on wet food etc...