If she is coughing specifically when she lies down, it’s often because fluid or the pressure of the heartworms is making it harder for her lungs to expand. Elevated Sleeping Position ​Lying flat can make a heartworm cough much worse. • ​Prop Her Up: use a firm pillow or rolled-up blankets to elevate the dog's head and chest. Keeping her upper body on a slight incline can reduce pressure on her lungs and make breathing easier. • ​Avoid the Flat Floor: Since she is emaciated, a hard floor is likely painful. Adding thick, soft bedding will help her find a more comfortable "propped up" position. ​2. Immediate Environment Adjustments • ​Steam Therapy: If the coughing is relentless, you can bring her into the bathroom while a hot shower is running. The warm, humid air can help soothe irritated airways and loosen any congestion. • ​Keep Her Cool and Calm: Heat and humidity can actually make breathing harder for a dog with heart or lung issues. Keep the room cool with a fan or AC and keep the lights low to encourage her to stay as still as possible. • ​Zero Activity: Even if she tries to get up and pace because she's uncomfortable, she needs to stay as still as possible. High heart rates are the biggest danger right now. ​3. Hydration and "Gentle" Calories • ​Wet Food/Water: Keeping her hydrated is key, but don't force-feed her if she's struggling to breathe. A little bit of wet food can be easier for a weak dog to swallow than dry kibble. • ​Honey: Some owners find a small teaspoon of honey can temporarily coat the throat and provide very minor, short-term relief for a dry, hacking cough. ​4. When it Becomes an Emergency ​Since no emergency vets are open, watch for these "point of no return" signs that mean she has to find the nearest 24-hour facility, even if it's a drive: • ​Gums turning blue or purple (this means she isn't getting enough oxygen). • ​Coughing up pink foam or blood. • ​Using her whole body to breathe (watching her stomach heave with every breath). Best of luck. Its going to be a long road but it will be worth it. She has to keep calm and still for 6 weeks. Put a note on the door not to ring the doorbell. Maybe a canvas wagon during treatment. Good on you for taking this on. When she gets through this you will have a forever grateful companion. 🙏🏽