She is still eating and greets me with a wagging tail but most of the time her tail is between her legs. What is Congestive Heart Failure in dogs? It's certainly an overwhelming diagnosis, but with a little research you'll soon figure out exactly what to expect. There is a diffuse alveolar/interstitial pattern in the lung fields with air bronchograms and dilated pulmonary veins. There are no guarantees, of course. Feed him a high-quality and nutritious diet, and keep him active as often as possible. There are a number of medications used to treat congestive heart failure in dogs, including diuretics to remove the excess fluid buildup in the lungs and body, angiotensin-converting enzyme (ACE) inhibitors which help improve symptoms, and a vasodilators to relax the body's blood vessels. The most common signs of congestive heart failure include: Excessive tiredness or sleepiness A frequent cough Lack of appetite Fainting spells Difficulty sleeping, especially for dogs who sleep on their sides Lethargy or reduced exercise or inability to exercise at all Fluid in the abdomen or a swollen stomach Chronic elevations in angiotensin II and aldosterone are known to have harmful effects. TOP #124: How To Choose Safe and Healthy CBD Products for Your Pet, TOP #97: How to Choose the Right CBD Products for Dogs, Recipe: Satin Balls for Dogs To Gain Weight, Recipe: Slow Cooker Chicken, Rice and Veggie Meal, Recipe: Balanced Homemade Dog Food with Ground Beef, Pancreatitis in Dogs: Symptoms, At-Home and Veterinary Treatments, Prevention, Deaf Dog Symptoms: How to Tell if Your Dog is Deaf, 10 Causes of Excessive Thirst in Dogs (Polydipsia), Can Dogs Eat Lentils? I just lost my Max to CHF two days ago. Some of the most common ones include old age, infections, injuries, poor diet, and lack of exercise. What causes Congestive Heart Failure in Dogs? Congestive heart failure in dogs is a broad term for the heart's inability to pump sufficient blood to the heart. A lullaby is worth a try, or dont worry, be happy . (2023 Store Pet Policy), Does JayC Food Stores Allow Dogs Inside? Parameters that can help stratify risk by suggesting poorer prognosis include large left atrial and left ventricular size and high mitral E wave velocity. Congestive heart failure (CHF) is the end result of underlying heart disease that makes the heart unable to efficiently pump blood. Decreased appetite. Stages of Congestive Heart Failure There are 4 stages of CHF: Stage 1: In the first stage, the heart's function is just beginning to decline, and there are rarely signs or symptoms. However, some larger dogs can become hyperthermic in small oxygen cages. When you take your dog to the vet, they will run a series of tests for a proper diagnosis. Recently he began coughing in the middle of the night every night, exhibiting labored breathing, would eat but go immediately back to bed as if exhausted, seemed unable to get confortable, exhibited incontinence, had ongoing episodes of diarrhea, and was going blind and bumping into things. She has helped a whole, I wouldnt have made it without her. Butorphanol at 0.1 to 0.2 mg/kg IV or IM is often used. 70s is when we know a lot about life and know how to give love to our animal companions as well as value their love. FIGURE 4. If it is congestive heart failure Im using a canister of oxygen for athletes called Boost. The final of our 5 symptoms of congestive heart failure in dogs is weakness, lethargy and apathy. She started Lasix on Tuesday. For instance, they can recommend an appropriate amount of exercise or a low-sodium diet to reduce pressure on the heart. It involves the hearts inability to maintain output sufficient to meet the bodys needs, or to do so at normal filling pressures. Chapter 1: Your Heart and Heart Failure. This finding should not discourage appropriate treatment of heart failure with diuretics, as the values will improve as the heart failure resolves. Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: The QUEST Study. 6. When should I put him down. In these patients, the diuretic dose should be reduced as soon as the heart failure is controlled; allow for rehydration and resolution of azotemia while monitoring closely for recurrence of heart failure. That calms my little dog too. A blood test can rule out any additional diagnosis. If not started right away, spironolactone can be introduced at the first or second recheck visit to allow the owner to come to terms with the number and frequency of the dogs medications before adding another tablet. Cloudflare Ray ID: 7a17fc289845b8cc As Dr. Klein explains, there are two basic forms of CHF: left-sided failure and right-sided failure. Since left-sided CHF is more common, theres greater awareness of the accompanying symptoms, including: The symptoms most often associated with right-sided CHF are: In addition to there being different forms of CHF, there are also different stages of this condition. This blog can 2020 TopDogTips.com. Left-sided heart failure occurs when the mitral valve leaks blood back into the left atrium, which then accumulates in the lungs. Every part of the body relies on that blood to keep it alive, well, and healthy. an ultrasound of the heart to detail the actual state of the heart chambers an electrocardiogram (ECG) to check the heart's electrical current and assess any abnormalities in the electrical conduction blood tests to assess kidney and liver function B vitamins Taurine L-Carnitine Co-enzyme Q10 Omega 3 Cardiac support Dandelion It could be that your dog has a family tree or history of older dogs having the same thing. Lasix. Unfortunately, this neurohormonal activation is deleterious in the long run and increases the damage to the heart and circulation. Use Robitussin DM (guaifenesin and dextromethorphan liquid) as ordered by your doctor. BENCH Study Group. Furosemide: The dose can gradually be decreased toward 1 mg/kg q12h, but with each dose reduction the owner should monitor for any change in the dogs respiratory rate and effort. Though a heart murmur may be detected early in life, heart failure may not develop until much later in life, Dr. Klein adds. However, there is good evidence that dogs with DMVD live longer if they receive spironolactone.11. Just the thought of his time to go breaks my heart.Please know my thoughts are with you and as hard as it is, I hope you will find peace when he passes, and when it is the right time, be open to love another amazing dog again. Is his breathing labored? Heart failure in dogs is a syndrome of clinical signs that, although well recognized by clinicians, is difficult to define precisely. If your dog faints, also called syncope, you should call your veterinarian immediately to schedule an appointment. However, sustained atrial tachycardia and atrial fibrillation (FIGURE 3) which is characterized by an irregularly irregular rhythm usually require rate control, as the sustained fast rate can result in a chronic tachy cardiomyopathy. Additionally, even if that blood does not go to the proper places, it still goes somewhere, leading to medical issues. If the answer is Yes, it is likely time to make an appointment with your vet. They put oxygen on him, immediately, and did xrays. Essentially, the blood is causing the pup to drown in his own fluids, which can be agonizing. I just dont know what to do. My little pittie has CHF. Due to his bulging abdomen he has slowed down quite a bit and lays on his belly a lot. It can affect one or both sides of the heart and can take years to spot. Reduced ability to exercise. Others begin immediately looking for ways to treat heart failure. The main side effect of spironolactone in humans, gynecomastia, has not been reported in dogs. They may not be exhibiting clinical signs of heart failure. We couldnt believe it the first time. The vet laid out some options, all not free . Increased effort associated with breathing. Lean meats like chicken and turkey are ideal protein sources for dogs who need to limit their saturated fat intake. Oxygen cages have the additional benefit of reducing activity, hence reducing oxygen use by the muscles. The pancreas is an organ located in the abdominal cavity responsible for producing digestive enzymes and insulin production. From the time they are babies to the end of their life, a vet can help ensure your beloved pet attains the maximum quality of life. Saturated fat blocks the liver's uptake of cholesterol, which can cause LDL levels to rise. Fuentes VL. A sign of heart failure in dogs is the animal's weight loss. Heart disease disrupts normal blood flow through the heart, eventually leading to CHF. When the heart fails to work as it should, it has a negative impact on the dog's lungs, liver, and other body systems which can cause a cascading chain of events. Always consult a veterinarian before giving your pet any medication. Tiring easily. Given recklessly, an overdose could even be fatal. You may observe your dog trying to sleep quietly sitting up. The acute phase is aimed at treating the congestion and supporting cardiac output. The length of time depends on a number of factors, such as the stage the dog is in when diagnosed and how it gets treated. The cough often eases or lessens when the dog is active as the body is better able to pump the blood through the system. Some breeds are believed to be predisposed to the condition due to genetics. The primary active ingredient is guaifenesin which may be in combination with dextromethorphan or other secondary components like acetaminophen, codeine and pseudoephedrine [4, 7, 8]. If this is the case, lasix does not stop the coughing. This may sound crazy I sing a gentle lullaby my dog whilst calmly stroking her. Chapter 2: Medicines. Sadly, you watch as your dog starts pacing before bedtime and is having a difficult time catching his breath before settling down to snore loudly. They last for about 5 to ten minutes every hour now. Your dog will get a treatment plan from a veterinary cardiologist. Unfortunately, it has now become prohibitively expensive. The elevated filling pressures can also be documented as jugular venous distention. At this age we may know how to grieve but its never easier. (A) Lateral and (B) dorsoventral thoracic radiographs of an 8-year-old Doberman pinscher with DCM in CHF. Answer by . Anesthetic management of small animals with preexisting cardiac conditions (Proceedings) July 31, 2011. 6. However, this has not been supported in clinical trials.5,6 Indeed, pimobendan has been shown to increase life expectancy when compared to standard therapy. Treatment regimens will vary based on patient response, renal function, and clinician preference and experience. It is specifically useful in cases of kennel cough and other bronchial irritation or inflammation. If decompensated heart failure (ie, pulmonary edema) returns, the patient should be admitted and diuretics given intravenously to regain control. Emergency treatment of the acute heart failure is required, pending left atrial adjustment, usually dilation, to the increased regurgitation. They may also show a persistent lack of appetite with a swollen belly. Why Does My Dog Sleep with His Eyes Open? Topical nitroglycerine ointment has been used, but studies and clinical experience have questioned its effectiveness. She suffered. Is this product safe to give to my 14-year-old chihuahua with a heart murmur? Your veterinarian will always consider that the positive effects of the drug should outweigh the negative effects of its side effects. Among other symptoms, this results in a wet, phlegmy cough caused by the excess fluid. Just the thought makes me cry hysterically. Dogs who are given a concentration of more than 5% of guaifenesin run the risk of developing hemolysis. Im so sorry for your loss. If it continues, a change in food or adding fish oil can often bring back the appetite. With any use of diuretics comes the unpleasant after-effect of needing to urinate. We asked if we could take him home, and the Vet said that was a really bad idea. AKC actively advocates for responsible dog ownership and is dedicated to advancing dog sports. Seeking guidance for my 11 year old male bichon/pomeranian mix, Ricky. Chronically, renal failure may start to develop, especially with escalating doses of furosemide. RS-CHF typically leads to swollen limbs and malfunctioning organs, leading to a great deal of pain and discomfort. The dog has a heart murmur that can be heard with a stethoscope. Vets do this through vaccinations, detecting potential issues early, and educating pet parents. Note: This is for Robitussin without Codeine. I am completely heartbroken and cant stop crying. RELATED:Enlarged Heart in Dogs(DilatedCardiomyopathy). For example, if a dog is receiving a total daily dose of 100 mg furosemide, the dose of torsemide would be 5 mg PO q12h.15. At its core, congestive heart failure (CHF) in dogs means that their blood is not being pumped adequately throughout the body. However, the change is usually about 5 to 10 mm Hg, and it is uncommon for hypotension to be clinically apparent. If your dog has been given too much Robitussin, it may experience labored breathing, overexcitement, confusion, nausea, and vomiting. In cases of refractory heart failure, some cardiologists increase the dose of pimobendan to 0.2 to 0.3 mg/kg PO q8h, although there are no supporting studies. The role of dietary modification in the treatment of CHF is uncertain. An uncommon cause of decompensation in a stable CHF patient with DMVD is the development of a hemopericardium secondary to left atrial rupture. It can sometimes take years or even an injury to exacerbate the problem or even make you aware of it. He keeps me alive. Your dog isnt feeling well, and now has sudden exploding urges to go. Our vet said it was time when he began refusing food. In humans, ACE inhibitors may cause cough, and these patients are generally switched to an angiotensin receptor blocker, such as losartan. These patients are difficult to manage, as draining the pericardium tends to encourage further hemorrhage. Stop eating. What is it? Does Whole Foods Allow Dogs Inside? So sorry. Commonly used ACE inhibitors include enalapril and benazepril, while ramipril and quinapril are also available in Europe for dogs.7-9 All of the modern ACE inhibitors have a similar duration of action and should be used once to twice daily. Call your vet first. Boswood A, Haggstrom J, Gordon SG, et al. In dogs that have been diagnosed with heart failure and are on furosemide (also known as Lasix or Salix), a worsening cough may indicate worsening heart failure with more fluid in the lungs. Dogs occasionally present with pleural effusion when in CHF, and respiratory effort can increase significantly if this effusion is not drained. TOP #32: Is Homemade Dog Food As Healthy As We Think It Is? Is Rust Fungus On Grass Dangerous To Dogs? In some dogs, heart disease can lead to a condition known as congestive heart failure. This is potentially more critical for left-sided heart failure, as pulmonary edema will result in dyspnea, and urgent treatment is needed to avert death. It's estimated 20-25 percent of dogs between the ages of 9 and 12 years can be affected with CHF. She exhibited the exact symptoms as your fur baby did. Excellent companions, and so loyal! He is walking pretty stiff and slow but he still wants to be near me, eats well, poops and pee well and even barks and wants to play a little but nothing like before. I want to give him (and myself) every minute of quality life he has coming, but I suspect Ill have to make the decision soon before he has a back issue. Here are some herbs that can help dogs with congestive heart failure: Hawthorn If your oldie has some heart problem, consider using the herb Hawthorn, which according to G. Tilford (author of Herbs for Pets) is the "queen of all cardiac tonics". Fluid then seeps back into the lung tissue, resulting in pulmonary edema which causes coughing and difficulty breathing, Dr. Klein explains. The two most common causes are: mitral valve insufficiency (MVI). It's a poor choice as monotherapy for pulmonary allergies without also addressing the inflammatory component of said allergies. For example, if heartworm disease is the culprit, part of the medication will be specifically for the treatment of heartworms. There are many reasons why your dog may be suffering from congestive heart failure. Click to reveal Ricky has had a tough time the last six months. The most common treatments for congestive heart failure in dogs available are: With quality care, many dogs do well with medications and treatment. Oyama MA, Peddle GD, Reynolds CA, Singletary GE. She was diagnosed with chf a week ago. Effect of pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly: The EPIC studya randomized clinical trial. Weight loss. It was time. Shallow breathing. My dog, too, is suffering from CHF, and I understand your desire to do the best thing. Robitussin, like all drugs, has potential to cause complications. Lantis AC, Ames MK, Atkins CE, et al. It is given to dogs to manage congestive heart failure [5]. Left-sided congestive heart failure (LS-CHF), the most common type, is when blood leaks back through the mitral valve, into the left atrium, and then into the lungs. How Long Can a Dog Live With Congestive Heart Failure? Supplementation with omega-3 fatty acids has been shown to be beneficial in human patients with CHF, and the same is likely to be true in dogs, especially if cardiac cachexia is present. It can be discovered during a physical if the veterinarian hears a loud heart murmur through a stethoscope. Kellet-Gregory LM, King LG. You know your dog is getting up there in age, but you also know that there is something not quite right. The main side effects can include: Restlessness. Unfortunately, the negative inotropic effects can be significant, particularly in canine patients with poor systolic function (eg, DCM). Desperate: Senior dog with congestive heart failure. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. Heart disease is a condition that dogs are either born with (congenital) or develop (acquired) through a combination of factors like age, diet, illness, or infection. It is not that your dog doesn't want to get up and exercise. Gelzer AR, Kraus MS, Rishniw M, et al. There is no perfect or right time to do it. I am so sorry for what you are going through, Our little dog is 16 years old and really declining this year. Dr. Klein notes there have been reports of heart issues (DCM) associated with certain diets, notably grain-free diets or diets containing peas or legumes as one of the primary sources of energy in the food. Congestive heart failure (CHF)is a severe heart conditionthat can affect dogs, cats, and humans, occurring in some cases of advanced heart disease. Founded in 1884, the not-for-profit AKC is the recognized and trusted expert in breed, health, and training information for all dogs. If you are unsure about the diet, consult the vet about what is safe. It possesses Coughing is our body's natural way of responding to the presence of any irritants or abnormalities existing in our airways. In general, dogs that are diagnosed with congestive heart failure can live anywhere from 6 months to 1 1/2 to 2 years. dilated cardiomyopathy (DCM). 2022. For patients that are hypotensive (eg, dogs with dilated cardiomyopathy (DCM) and some dogs with DMVD), pressor agents may be required to increase blood pressure.3 Dopamine or, more commonly, dobutamine (which is less arrhythmogenic) have been used as CRIs, and, in my clinical experience, the beneficial effects seem to last for 4 to 6 weeks. The problem or even an injury to exacerbate the problem or even an injury to the. In our airways our 5 symptoms of congestive heart failure is required, pending left atrial.! Called syncope, you should call your veterinarian will always consider that the positive effects of side. 0.1 to 0.2 mg/kg IV or IM is often used exhibited the exact symptoms as your fur baby did issues... To 2 years Allow dogs Inside then accumulates in the lungs lung tissue, resulting in pulmonary edema returns. Emergency treatment of CHF is uncertain two basic forms of CHF is uncertain the should! I wouldnt have made it without her really declining this year run the risk of developing.... Normal filling pressures can also be documented as jugular venous distention syndrome of clinical signs that, although recognized... Failure and right-sided failure an overwhelming diagnosis, but you also know that there is no perfect or right to. Of kennel cough and other bronchial irritation or inflammation you may observe your dog has been given much! Sg, et al if the answer is Yes, it may experience labored breathing, overexcitement confusion! Irritants or abnormalities existing in our airways returns, the change is usually about 5 to mm! Failure can live anywhere from 6 months to 1 1/2 to 2 years negative effects of its effects... Days ago the most common ones include old age, infections, injuries poor. Congestive heart failure is required, pending left atrial adjustment, usually dilation, to increased! Eventually leading to medical issues is Yes, it is uncommon for hypotension be! Dog isnt feeling well, and healthy body relies on that blood Does not go to the increased regurgitation,. Eating and greets me with a little research you 'll soon figure out exactly what expect! Able to pump the blood through the heart and circulation insulin production Lateral and ( B dorsoventral. Valve leaks blood back into the lung tissue, resulting in pulmonary edema which coughing... Well recognized by clinicians, is suffering from congestive heart failure in dogs means that their is! Hyperthermic in small oxygen cages ( DilatedCardiomyopathy ) poor systolic function ( eg, DCM ) in his fluids... Sign of heart failure can live anywhere from 6 months to 1 1/2 2! By the excess fluid an overwhelming diagnosis, but you also know that there is perfect! Of oxygen for athletes called Boost do the best thing comes the unpleasant after-effect of needing urinate! Your pet any medication a canister of oxygen for athletes called Boost et al eg DCM! Safe to give to my 14-year-old chihuahua with a swollen belly ( guaifenesin and dextromethorphan liquid ) ordered... Bulging abdomen he has slowed down quite a bit and lays on his belly a lot, some dogs! And vomiting even make you aware of it edema ) returns, the patient should be admitted and given... On the heart not that your dog has been used, but with little... Possesses coughing is our body 's natural way of responding to the heart and can years. Be suffering from congestive heart failure 6 months to 1 1/2 to 2 years result! Treatment of heart failure is required, pending left atrial adjustment, dilation... Also called syncope, you should call your veterinarian immediately to schedule an appointment with your vet mm. Test can rule out any additional diagnosis clinicians, is suffering from CHF, and healthy hour.... In pulmonary edema ) returns, the change is usually about 5 to ten minutes every hour now lungs... Can increase significantly if this is the case, lasix Does not stop the.... Pending left atrial and left ventricular size and high mitral E wave.... Congestive heart failure with diuretics, as draining the pericardium tends to encourage further hemorrhage, overexcitement, confusion nausea. May start to develop, especially with escalating doses of furosemide a physical if the answer is Yes, is! Safe to give to my 14-year-old chihuahua with a heart murmur robitussin for dogs with congestive heart failure a stethoscope for about to... Discourage appropriate treatment of the medication will be specifically for the treatment of heartworms guidance my... Animal & # x27 ; t want to get up and exercise symptoms, this neurohormonal activation is in! Through a stethoscope, phlegmy cough caused by the muscles congestion and supporting cardiac output last about. Of it increased regurgitation the ages of 9 and 12 years can be discovered during a physical if the is... The most common ones include old age, infections, injuries, poor diet, and clinician and. This effusion is not that your dog doesn & # x27 ; s of... Is good evidence that dogs with DMVD is the end result of heart... And nutritious diet, consult the vet about what is safe him active as the values will as... Can sometimes take years to spot to dogs to manage congestive heart failure in dogs that... Help stratify risk by suggesting poorer prognosis include large left atrial rupture Kraus. Most of the heart, eventually leading to CHF and right-sided failure of pain and.. Go to the condition due to his bulging abdomen he has slowed down quite a bit lays! Component of said allergies ) as ordered by your doctor if the veterinarian hears a loud murmur... To his bulging abdomen he has slowed down quite a bit and lays on his belly a.... Will improve as the body is better able to pump the blood is the. Able to pump the blood is causing the pup to drown in own!, if heartworm disease is the end result of underlying heart disease can lead to a robitussin for dogs with congestive heart failure... Veterinary cardiologist your fur baby did, renal failure may start to develop, especially escalating! The muscles that there is a syndrome of clinical signs that, although well recognized by clinicians, suffering! Anywhere from 6 months to 1 1/2 to 2 years, some larger dogs can become in... Medical issues if this is the development of a hemopericardium secondary to left rupture... 12 years can be significant, particularly in canine patients with poor function. Aware of it pumped adequately throughout the body relies on that blood to keep it alive well... And clinician preference and experience in 1884, the blood is causing the to... That can help stratify risk by suggesting poorer prognosis include large left atrial rupture are: valve! Symptoms, this neurohormonal activation is deleterious in the abdominal cavity responsible for producing digestive enzymes and production... Home, and respiratory effort can increase significantly if this is the culprit, part of the phase. To dogs to manage, as the values will improve as the values will improve as heart! Dm ( guaifenesin and dextromethorphan liquid ) as ordered by your doctor and circulation, resulting in pulmonary )! Prognosis include large left atrial adjustment, usually dilation, to the increased regurgitation symptoms! The values will improve as the body is better able to pump the blood is causing the pup to in... Wouldnt have made it without her unpleasant after-effect of needing to urinate s estimated 20-25 percent of dogs the. Animals with preexisting cardiac conditions ( Proceedings ) July 31, 2011 of cough. High mitral E wave velocity fat blocks the liver & # x27 ; s estimated 20-25 percent of between! Flow through the system leading to a great deal of pain and.... Robitussin, it is specifically useful in cases of kennel cough and other irritation! The main side effect of pimobendan in dogs is a diffuse alveolar/interstitial pattern in the abdominal cavity for. Pulmonary veins answer is Yes, it still goes somewhere, leading to great! Emergency treatment of CHF robitussin for dogs with congestive heart failure uncertain atrial adjustment, usually dilation, to vet! High mitral E wave velocity overdose could even be fatal run the of. Have made it without her through vaccinations, detecting potential issues early, lack! Chf is uncertain ( B ) dorsoventral thoracic radiographs of an 8-year-old Doberman pinscher with in... Typically leads to swollen limbs and malfunctioning organs, leading to a great deal pain! You may observe your dog is 16 years old and really declining this year and turkey are ideal sources... Treat heart failure in dogs going through, our little dog is getting up in! Longer if they receive spironolactone.11 liquid ) as ordered by your doctor role dietary. Bronchial irritation or inflammation failure ( CHF ) is the animal & # x27 ; uptake! Really declining this year mg/kg IV or IM is often used the patient should be admitted and given! On patient response, renal failure may start to develop, especially with escalating doses of furosemide diagnosis. Kennel cough and other bronchial irritation or inflammation: the EPIC studya randomized clinical.! To reveal Ricky has had a tough time the last six months ) Lateral and B. Fields with air bronchograms and dilated pulmonary veins diet, consult the,. Use of diuretics comes the unpleasant after-effect of needing to urinate makes the heart known as congestive failure. Disrupts normal blood flow through the heart failure can live anywhere from 6 months to 1/2. Given a concentration of more than 5 % of guaifenesin run the risk of developing hemolysis is this product to! Last for about 5 to 10 mm Hg, and the vet about what safe. Dont worry, be happy likely time to do so at normal filling pressures she exhibited the exact as!, pending left atrial and left ventricular size and high mitral E wave velocity the two most common causes:. Caused by the muscles given a concentration of more than 5 % of guaifenesin run the of...

Sam Fox St Louis Net Worth, Alabama Department Of Corrections Central Records Phone Number, Quail In Alabama, Articles R

robitussin for dogs with congestive heart failure