Tuesday, January 8, 2019

Syövän hoito Suomessa: hyvää vai huonoa? Osa 1: ruusut ja risut



Tilastojen mukaan syöpäpotilaiden selviytyminen Suomessa on huippuluokkaa. Parantamisen varaa on hoidon käynnistymisen nopeudessa, potilas-lääkärisuhteen pysyvyydessä, uusien lääkkeiden käyttöönotossa ja kliinisten tutkimusten saatavuudessa. 

Lyhyt vastaus otsikon kysymykseen vaikuttaisi olevan: ”hyvää”. Viitteeksi sopii vaikka Lancet lehdessä alkuvuodesta 2018 julkaistu CONCORD-3 tutkimus, jossa vertailtiin viiden vuoden elossaoloa 18 eri syöpätyypissä 71 maassa (Allemani et al). Suomi on ollut tässä tutkimuksessa kahdeksan parhaan maan joukossa jo viidentoista vuoden ajan. 

Kansallisesti tärkein referenssi on Suomen Syöpärekisteri, jonka mukaan viiden vuoden elossaolo on parantunut lähes kaikissa syövissä vuosien ja vuosikymmenten mittaan. Vaikka syöpätapauksia todetaan koko ajan enemmän, ja syöpäkuolemien absoluuttinen määräkin on kasvussa väestön ikääntyessä, ikävakioitu kuolleisuus on laskussa.  

Suomessa hyvää on myös se, että syövän hoito ei riipu potilaan omasta varallisuudesta. Vaikka vapaaehtoiset sairasvakuutukset ovat lisääntymässä, ja syöpää hoidetaan myös yksityisesti, valtaosa potilaista saa hoitonsa verovaroin.

Mistä hyvät tulokset johtuvat?

Asiaa tarkemmin miettimättä ensimmäinen ajatus voisi olla, että potilaiden hyvä selviytyminen voisi johtua hyvästä hoidosta. CONCORD-3 tutkimuksessa ei kuitenkaan huomioitu hoitoa. Myöskään Suomen Syöpärekisteri ei arvioi hoitojen vaikutuksia. Viime vuosien immunoterapian läpimurtoja lukuun ottamatta, levinneen syövän hoidossa ei ole ollut kovinkaan monia parantavia menetelmiä. Hoitojen kehitys on yleensä nähty tautivapaan tai kokonaiselinajan pidentymisenä, ja yleensä kyse on ollut keskimäärin viikoista tai kuukausista. Tämä huomioiden vaikuttaa epätodennäköiseltä, että hoidot yksinään selittäisivät selvästi parantuneen ikävakioidun elossaolon. 

Yksinkertaistaen levinnyttä syöpää sairastavan potilaan elämän voi piirtää aikajanalle, joka alkaa potilaan syntymästä. Tässä teoreettisessa mallissa seuraava merkintä on syöpädiagnoosi, ja lopulta viimeinen merkintä on usein syöpäkuolema. Diagnoosin ja kuoleman välissä on yleensä erilaisia hoitoja. Mainitut CONCORD-3 tutkimus ja Syöpärekisterin tilastot mittaavat kuitenkin vain elossaoloa diagnoosista viisi vuotta eteenpäin, eivät syöpään kuolleisuutta, taikka hoitojen vaikutuksia. Samalla väestön keskimääräinen elinikä on pidentynyt, mikä jo yksinäänkin pidentäisi absoluuttista aikaa diagnoosin ja kuoleman välillä, vaikka diagnoosin suhteellinen sijainti aikajanalla ei muuttuisi. 

Suurin vaikutus ikävakioituun kuolleisuuteen syntyisi, jos diagnoosia voisi siirtää aikajanalla vasemmalle, eikä tämä edellyttäisi mitään kehitystä hoidoissa. Toki diagnoosin aikaistuessa parantavan hoidon mahdollisuuskin lisääntyy, sillä useampi tapaus löytyy paikallisena. Diagnoosin aikaistuminen parantaa viisivuotisennustetta kahdella tavalla. Isompi osa potilaista pystytään parantamaan, ja aiempaa isompi osa on elossa tautinsa kanssa viiden vuoden tullessa täyteen.

Aikaisempi diagnoosi

Todennäköisin syy viisivuotiselossaolon pidentymiseen onkin diagnoosin aikaistuminen. Kaikki maat joissa on hyvät viisivuotiselossaololukemat, ovat vauraita maita joissa diagnostiikan taso ja saatavuus ovat erinomaisia: USA; Kanada, Australia, Uusi Seelanti, Suomi, Islanti, Norja, Ruotsi. 

Syöpädiagnostiikan perusvälineitä on tietokonetomografia. Vuonna 2016 eniten näitä tutkimuksia tehneiden 26 maan joukossa oli USA, Kanada, Australia, Islanti ja Suomi (statista.com). Eniten magneettikuvauksia käyttävän 20 maan joukosta löytyy USA, Suomi, Islanti, Australia, Uusi Seelanti, Kanada (statista.com). 

Yleisimmät syövät ovat eturauhassyöpä ja rintasyöpä. Nämä ovat myös syöpätyyppejä joissa ennuste on parantunut nopeasti diagnoosin aikaistumisen vuoksi, eikä viisivuotiselossaolo siten anna juuri mitään käsitystä parantuneiden potilaiden osuudesta. On esitetty että mammografia, PSA seulonta ja tunnustelu löytävät joukon syöpiä, joita ei tarvitsisi välttämättä ollenkaan hoitaa, sillä niiden kasvu on niin hidasta etteivät ne muodosta terveysriskiä potilaan elossaolon aikana (Hemminki A 2016). Potilaat ehtivät siis kuolla johonkin muuhun ennen kuin syövästä muodostuu heille ongelmaa. 

Syöpärekisterin tilastojen mukaan uusien eturauhasyöpien määrä on kuusinkertaistunut 3 vuosikymmenen aikana. Rintasyöpätapausten määrä on kolminkertaistunut samalla ajanjaksolla. Viisivuotiselossaolo on samalla noussut (eli ikävakioitu kuolleisuus on laskenut), vaikka syöpäkuolemien absoluuttinen määrä on lisääntynyt. Tämä kertoo selvästi siitä, että potilaat elävät pidempään diagnoosista. Kliinikoille on ilmiselvää, että yli viisi vuotta tautinsa kanssa eläviä rinta-ja eturauhassyöpäpotilaita on koko ajan kasvava määrä. Nämä kaksi syöpätyyppiä vastaavat 30 prosentista (5162 eturauhassyöpää ja 4961 rintasyöpää yhteensä 34 122 syövästä vuonna 2016) uusista syöpätapauksista Suomessa, joten ne yksinäänkin riittäisivät selittämään aikaistuneen diagnoosin aiheuttaman ”pidentyneen elinajan”.

Mammografioiden ja eturauhastutkimusten saatavuus on hyvä kehittyneissä maissa kuten Suomessa. Kolmas seikka joka siirtää diagnoosia ”vasemmalle” edellä mainitulla aikajanalla, on valveutuneisuus syövän suhteen. CONCORD-3 tutkimuksen top-8 maalle on yhteistä vähäinen häveliäisyys ja matala kynnys hoitoon hakeutumisessa. Erilaiset kampanjat ja julkisuuden henkilöiden avautuminen syövistään vähentävät stigmatisoitumista ja lisäävät ihmisten valveutuneisuutta pattien suhteen.
On mahdotonta erottaa toisistaan hoitojen, diagnostiikan ja valveutuneisuuden vaikutuksia kuolleisuuteen. Johtuen Syöpärekisterin ja CONCORD-3 tutkimuksen tavasta tilastoida kuolleisuutta (ikävakioitu viisivuotiskuolleisuus), emme tiedä onko parantuneiden osuus todellisuudessa muuttunut ja jos niin miten, vai onko kyse vain diagnoosin aikaistumisesta. 

Kuitenkin, jos tarkastellaan Euroopan sisäisiä lukuja, näyttäisi siltä, että pohjoisessa kuolleisuus on vähäisempää suhteessa tietokonetomografiatutkimuksiin, ja mitä etelämmäs mennään, sitä enemmän tutkimuksia tehdään suhteessa kuolleisuuden vähentymiseen. Tämä viittaisi valveutuneisuuden ja häveliäisyyden puutteen merkitykseen aikaisessa diagnostiikassa.

Parantamisen varaa

Numeroiden valossa syövän hoito tai ainakin viisivuotisselviytyminen näyttäisi olevan hyvässä jamassa Suomessa. Kuitenkin aika ajoin esitetään vastakkaisiakin näkökulmia (viitelistan HS artikkelit). Moitteen kohteena ovat mm hoitojonojen pituus, vaihtuvat lääkärit, kliinisten tutkimusten vähyys ja liian harvat kontaktit hoitavaan lääkäriin. 

Tilastoistakin löytyy tukea sille, että kaikki ei ole kunnossa. Kansallisessa selvityksessä todettiin että hoitoon pääsyssä ja hoitotuloksissa on alueellisia eroja (terve.fi, THL, Syöpärekisteri). TYKS:n analyysissa hoitoon pääsyssä oli viiveitä (Lääkärilehti/tyossa).  

Suomi on Euroopan hitaimpia maita uusien lääkkeiden käyttöönotossa (Mediuutiset, IQVIA). Koska tilastot kertovat menneisyydestä ja parantavat hoidot kuten immunoterapia ovat tulleet levinneisiin syöpiin vasta viime vuosina, ei käyttöönoton hitaus vielä näy kuolleisuustilastoissa. Asia voitaneen todeta vuosikymmenen kuluessa. Lääkkeiden hintalautakunta HiLa ja Terveydenhuollon palveluvalikoimaneuvosto PALKO ovat pahamaineisia hitautensa vuoksi (Lääkärilehti/ajassa). Byrokraatti voi esittää, että vaikka lääketieteellinen näyttö tehosta on jo olemassa, on tarpeellista arvioida tarkasti uusien hoitomuotojen kustannusvaikuttavuus, ja veronmaksaja lienee samaa mieltä. Levinnyttä syöpää sairastavalla potilaalla ei välttämättä ole aikaa odottaa. 

Anonyymi veronmaksaja, joka ei itse sairasta syöpää eikä sitä läheisilläkään ole, voi olla tyytyväinen HiLa:n ja PALKO:n toimintanopeuteen, sillä jokainen vetkuteltu vuosi vähentää lääkemenoja ja lyhentää aikaa siihen, kun geneerisiä hintakilpailijoita tulee tarjolle. Lääkekulujen kannalta kaikkein halvinta olisi antaa syöpäpotilaille vain kipulääkettä tai tarjota eutanasiaa. Kustannuksista lisää blogin osassa 2.

Potilaiden perspektiivistä selvimmät puutteet ovat jonotusajoissa ja lääkäreiden vaihtuvuudessa. On selvää, että edellä mainittu tekijä huonontaa syövän hoitotuloksia, sen lisäksi että se aiheuttaa huomattavaa psykologista haittaa. Koska syöpäsolut jakaantuvat koko ajan, on vaikea nähdä tilannetta jossa odottelusta  olisi hyötyä. Asiaa on tutkittu: odottelun haitallisuudesta on näyttöä, erityisesti jos keskitytään tutkimuksiin joissa potilasmäärä on tarpeeksi suuri, väärien negatiivisten poissulkemiseksi (Hemminki A 2016). 

Lääkäreiden vaihtuvuus aiheuttaa ymmärrettävästi turhautumista potilaalle, mutta ei välttämättä huononna hoitoa kovinkaan paljon, sillä lääkärit kommunikoivat keskenään yllättävän taitavasti sairaskertomuksen välityksellä.  

Osa 2 julkaistaan 14.1.2019

Akseli Hemminki
Syöpätautien professori, syöpätautien ja sädehoidon erikoislääkäri

Viitteet ja linkit

Hemminki A. Kuoleman Laakso. Voiko syöpää hoitaa kokeellisilla menetelmillä? Nomerta, Turku. Ilmestynyt englanniksi 2015 ja suomeksi 28.4.2016. http://www.nomerta.net/kirjat.php


http://syoparekisteri.fi/

https://www.hs.fi/mielipide/art-2000005774501.html (Luulin, että Suomi on syövänhoidon huippumaa – sitten sairastuin)

https://www.hs.fi/kotimaa/art-2000005778035.html. (Kukaan tai mikään ei sinua pelasta, sanottiin syöpään sairastuneelle Emmi Leppäselle – Maailmalla käytetyt syöpälääkkeet tulevat Suomeen usein vasta vuosien viiveellä)

https://www.hs.fi/kotimaa/art-2000005390017.html (Syövän hoitotulokset ovat huippua, mutta vain harva uskoo, että kaikki saavat yhtä hyvää hoitoa – päättäjät ovat optimistisempia kuin kansalaiset)


https://www.laakarilehti.fi/ajassa/ajankohtaista/syopalaake-tutkimuksiin-paasy-vaikeutui-pohjoismaissa/

https://www.laakarilehti.fi/tyossa/raportit-ja-kaytannot/syopapotilaiden-hoitoonpaasyn-pullonkaulat/

statista.com

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    ReplyDelete
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    am here to share with you my life experience on how a great man called Dr gbojie saved me and my marriage.I have been Married & Barren for for 5 years i had no child. i have never been pregnant i was a subject of laughter from my Friends & neighbors, i almost lost my marriage because of this issue.i was so confused that i did not know what to do until i came across this great Dr online and i contacted him at once i was scared weather it was going to work because i never believed things like this before, so i decided to give it a try and i did all what Dr gbojie asked of me and today to my greatest surprise i took in the first time and i gave birth to a bouncing baby boy and now my marriage that was about crashing before is now restored. my husband now love and want me better, Am so happy for everything that have been happening in my life since i met this Dr gbojie .I want to tell all the women/men out there who have a similar situation like mine,that the world is not over YET they should dry up their tears and contact this great man and their problem will be gone or are you also having other problems you can also contact gbojiespiritualtemple@gmail.com His spells is for a better life OR call his number +2349066410185
    website : http://gbojiespiritualtemple.website2.me
    blog : https://brokenmindmend.blogspot.com











































































    LOVE SPELL FOR BROKEN RELATIONSHIP AND MARRIAGE WHATSAPP +2349066410185
    am here to share with you my life experience on how a great man called Dr gbojie saved me and my marriage.I have been Married & Barren for for 5 years i had no child. i have never been pregnant i was a subject of laughter from my Friends & neighbors, i almost lost my marriage because of this issue.i was so confused that i did not know what to do until i came across this great Dr online and i contacted him at once i was scared weather it was going to work because i never believed things like this before, so i decided to give it a try and i did all what Dr gbojie asked of me and today to my greatest surprise i took in the first time and i gave birth to a bouncing baby boy and now my marriage that was about crashing before is now restored. my husband now love and want me better, Am so happy for everything that have been happening in my life since i met this Dr gbojie .I want to tell all the women/men out there who have a similar situation like mine,that the world is not over YET they should dry up their tears and contact this great man and their problem will be gone or are you also having other problems you can also contact gbojiespiritualtemple@gmail.com His spells is for a better life OR call his number +2349066410185
    website : http://gbojiespiritualtemple.website2.me
    blog : https://brokenmindmend.blogspot.com

    ReplyDelete
  5. Get Your Wife Back, Perfect Urgent Love Spell. Am Alexis scorpio from FL Usa All Thanks To Dr happy Who Brought Back The Love Of My Life. my girlfriend cheated on me and asked for a breakup. I don't believe at first i try to get back with her but all she told me was she’s with someone else. that she is no longer interested in marrying me at that point i was heart broken coz i love my girlfriend so much that i could not let go off her all of a sudden she left me, i really love her and never can imagine my life without her. not until i came across a powerful real spell caster Dr happy who promise me 24hours urgent love spell to get back with my girlfriend, good twenty-four {24} hours. hmm-mm, it was a good night time at 11:pm within the days that Dr happy told me that my girlfriend will be back, at first i heard the bell rings getting close to my door i heard someone saying honey!!!, it sound familiar i opened the door and i saw my girlfriend standing and weeping in front of me. i was not surprised because its all i have been praying for her to come back home. Guess what 2 weeks after she noticed her system and her body temperature was changed and i took her to clinic for check up and the doctor told me that there is life in her which means she was pregnant i really wants to use this opportunity to thanks Dr happy so much and the love page that directed me to Dr happy if you have any problem getting your ex back, or predicament that is worse or exactly like this you have been into, contact Dr happy on happylovespell2@gmail.com Whatsapp/cal +2348133873774
    visit his website...happylovespell2.webnode.com/
    about his love spell Blogs site.http://happylovespel.blogspot.com.ng/

    ReplyDelete
  6. I am here to say thanks you to Dr Lucky my wife was
    was have herps diseases over 4 months and I went
    to the hospital for medication thinking that it was a
    little sickness but hearing from the doctor I was
    afraid that am going to loose my wife because the
    doctor said there was no cure but I should try and
    contact a herbal doctor I have it a try and contacted
    Dr Lucky I did all necessary things and got my
    medicine through dhl services I gave it to my wife
    behold in a week time the symptoms was gone and
    after two good weeks my wife was free from hero's
    diseases brother and sisters out there who don't
    believe in herbal medicine stop deceiving your self
    and contact Dr Lucky on this email
    ( drLuckyherbalcure@gmail.com ) or message him
    on WhatsApp on
    this same +2348154637647 he is here to help
    spread this good new please and God in heaven
    will bless you amen,
    him can also cure
    {1}HIV And AIDS
    {2} HPV
    {3}Diabetes
    {4} Hepatitis
    {5} Vitiligo
    {6} Blood Cancer etc.

    ReplyDelete
  7. i want to inform the public how i was cured of HERPES Simplex Virus by a
    Doctor called Dr.DADA. i visited different hospital but they gave me list
    of drugs like Famvir, Zovirax, and Valtrex which is very expensive to treat
    the symptoms and never cured me. I was browsing through the Internet
    searching for remedy on HERPES and i saw comment of people talking about
    how Doctor DADA cured them. I Was scared because i never believed in the
    Internet but i was convince to give him a try because i was having no hope
    of been cured of HERPES so i decided to contact him on his email, i
    searched his email on net and i saw a lot of people testifying about his
    goodness. when i contacted him he gave me hope and send a Herbal medicine
    to me that i took and it seriously worked for me, am a free person now
    without problem, my HERPES result came out negative. You can contact him on
    his Email: (drdadaspellhome7@gmail.com) OR (drdadaspellhome@hotmail.com) whatsappl him +2348158568638 and get all
    your problem solved.
    1)Sickness of any kind
    2)Help to CURE Hepatitis B, HIV/AIDs CANCER and BIPOLAR
    3)Divorce, Breakup problem and To Re-unit
    4)Pregnancy problem
    5)Financial problem and Job promotion
    6)To get a good and rich life partner
    7)To Lose your wath
    8)to enlargement of pennis .......

    ReplyDelete
  8. I want to share a testimony of how Dr.Osemuhau herbal mixture cream saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I can't make love to my wife and my penis was just too small a full grown man like me having 4 inches penis and to worsen it i don't last in sex i cant even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr.Osemuhau herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 8 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. can contact him drosemuhau@gmail.com {) or call or what-apps him through +2348168714427

    ReplyDelete
  9. Traditional Herbs that I used to cure my Genital herpes
    Most fake doctors online will claim to have total cure for the virus and they will end up scamming you, I was once a victim of that because I was desperate in getting rid of the diseases and the outbreaks, I was referred to a traditional Herbal doctor whose name was Ahmed Usman a traditional Herbs roots specialist who has lots of experience on Herbal roots through a health blogger page  with lot of series of his patient testimony that were cured from different diseases  with the doctor email attached to the testimony, I contacted him with the email I found on the testimony and after much deliberation and few questions, he prepared the Herbal medicine which he sent to me through DHL service and with his prescription for 21 days the outbreaks that I have were cured and after concluding the Herbal Medicine I went for another Herpes test with my result Negative with no trace of the virus in my blood. Doctor Ahmed Usman is real and his treatment is very affordable and safe for all, you can reach him on his official email; drahmedusman5104@gmail.com  or Call/Watsapp +2348064460510 he said he has herbal Cure for Breast Cancer, HIV, Fibroid and diabetes.

    ReplyDelete
  10. Hello everyone this is serious and real i want to tell the whole world about how DR DADA HERBAL MIXTURE product helped me enlarge my penis size ..i have trying since 25 years of age to enlarge my penis but none rendered me the help i want, i have used vaccines,penis pump,surgery,online creams from USA CAMBODIA,AUSTRALIA and many more but none of them enlarge my penis i was really frustrated and tired of living because my penis was too small ,imagine a cute and handsome 40 years old man like me having 3.5 inches and to make it worse i was having erectile dysfunction which was so annoying to me,my girlfriends have left me because of my small penis ....to GOD be the glory as i was searching for help on a Facebook page i saw one Mr Peter  from TEXAS testifying of how DR DADA HERBAL MIXTURE product enlarge his penis and healed his grand mom PROSTRATE CANCER .so i quickly  message him on his email drdadaspellhome7@gmail.com and he replied me and gave me comforting words and told me all i need to do and i was surprise when i got his product and he sent it to me through united parcel service (UPS) and i got it 4 days later and used the product just as he told me and its just 9 days of using his herbal mixture my penis is now 10 inches long and 8.0 flaccidity am so happy to feel like a man in the bedroom at last, so if you need penis enlargement,breast enlargement,weak erection,erectile dysfunction cure and many sexual relation cure do not hesitate to email him now drdadaspellhome7@gmail.com or drdadaspellhome@hotmail.com  you can also whatsapp him on +2348158568638 thanks

    ReplyDelete
  11. WITH THE HELP OF  DR PERFECT ENLARGEMENT CREAM MY PENIS GROW  FROM 3 INCHES TO 9 INCHES YOU CAN ON EMAIL AT SOLUTIONTOALLPROBLEMS1@GMAIL.COM

    Hello everyone I have to give my testimony about a herbal doctor called Dr Perfect. I was heartbroken because I had a very small penis not good enough to satisfy a woman, I have been in so many relationships but they were cut off because of my situation, I have used so many products prescribed by the doctor but none could render me the help I was looking for, so I decided to search online for solution and I saw a lot of comments about this specialist called Dr Perfect on how he helped people with small penis, cancer and others so I decided to give his herbal product a try, I messaged him on WhatsApp and replied me back, he gave me some comforting words we talked on how i can receive the product and he sent me his herbal product for penis enlargement, within 1 week of using it I began to feel the enlargement of my penis, now it just two weeks of me using his products my penis is about 9 inches longer, and I settle things with my girlfriend I was surprised when she said that she is satisfied with my performance in bed and am happy that i have a big penis now all thanks to Dr Perfect feel free to contact Dr Perfect at solutiontoallproblems1@gmail.com or WhatsApp him +1(256)251-3614 and get your enlargement cream 

    ReplyDelete
  12. WITH THE HELP OF  DR PERFECT ENLARGEMENT CREAM MY PENIS GROW  FROM 3 INCHES TO 9 INCHES YOU CAN ON EMAIL AT SOLUTIONTOALLPROBLEMS1@GMAIL.COM

    Hello everyone I have to give my testimony about a herbal doctor called Dr Perfect. I was heartbroken because I had a very small penis not good enough to satisfy a woman, I have been in so many relationships but they were cut off because of my situation, I have used so many products prescribed by the doctor but none could render me the help I was looking for, so I decided to search online for solution and I saw a lot of comments about this specialist called Dr Perfect on how he helped people with small penis, cancer and others so I decided to give his herbal product a try, I messaged him on WhatsApp and replied me back, he gave me some comforting words we talked on how i can receive the product and he sent me his herbal product for penis enlargement, within 1 week of using it I began to feel the enlargement of my penis, now it just two weeks of me using his products my penis is about 9 inches longer, and I settle things with my girlfriend I was surprised when she said that she is satisfied with my performance in bed and am happy that i have a big penis now all thanks to Dr Perfect feel free to contact Dr Perfect at solutiontoallproblems1@gmail.com or WhatsApp him +1(256)251-3614 and get your enlargement cream 

    ReplyDelete
  13. My name is Ryan am from U.S.A. I want to share a testimony of how Dr. DADA  herbal mixture cream saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I can't make love to my wife and my penis was just too small a full grown man like me having 4 inches penis and to worsen it i don't last in sex i cant even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr.DADA herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is inced 8 es and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. You can contact him via {drdadaspellhome7@gmail.com) or call him or what-apps him through +2348158568638 .he also specialize on the following things
    BREAST ENLARGEMENT
    BREAST LIFT & REDUCTION
    PENILE/PENIS ENLARGEMENT
    GENERAL BODY SLIMMING
    HIPS & THIGH REDUCTION
    Thanks for the Enlarging my penis sir, you indeed save my marriage...I am really grateful sir,..,,

    ReplyDelete
  14. Hello everyone this is serious and real i want to tell the whole world about how DR DADA HERBAL MIXTURE product helped me enlarge my penis size ..i have trying since 25 years of age to enlarge my penis but none rendered me the help i want, i have used vaccines,penis pump,surgery,online creams from USA CAMBODIA,AUSTRALIA and many more but none of them enlarge my penis i was really frustrated and tired of living because my penis was too small ,imagine a cute and handsome 40 years old man like me having 3.5 inches and to make it worse i was having erectile dysfunction which was so annoying to me,my girlfriends have left me because of my small penis ....to GOD be the glory as i was searching for help on a Facebook page i saw one Mr Peter  from TEXAS testifying of how DR DADA HERBAL MIXTURE product enlarge his penis and healed his grand mom PROSTRATE CANCER .so i quickly  message him on his email drdadaspellhome7@gmail.com and he replied me and gave me comforting words and told me all i need to do and i was surprise when i got his product and he sent it to me through united parcel service (UPS) and i got it 4 days later and used the product just as he told me and its just 9 days of using his herbal mixture my penis is now 10 inches long and 8.0 flaccidity am so happy to feel like a man in the bedroom at last, so if you need penis enlargement,breast enlargement,weak erection,erectile dysfunction cure and many sexual relation cure do not hesitate to email him now drdadaspellhome7@gmail.com or drdadaspellhome@hotmail.com  you can also whatsapp him on +2348158568638 thanks

    ReplyDelete
  15. HOW DR PERFECT ENLARGEMENT CREAM HELP ME TO ENLARGE MY PENIS YOU CAN ADD HIM UP ON WHATSAPP +1(256) 251 3614

    My name is David Richardson from USA I want to share a testimony of how Dr Perfect herbal mixture cream saved me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing and I was also having weak erection problem. I can't make love to my wife and my penis was just too small, a full grown man like me having 3 inches penis and to worsen it I don't last long in sex I can't even last four minutes it was really a big shame to me. My wife was really tired of me because my sex life was very poor, she never enjoyed sex, I was always thinking and searching for solutions everywhere until when I saw a testimony of how Dr Perfect herbal mixture cream have been helping people regarding their sex life, so I decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 10 inches I couldn't believe my eyes and as I speak now my penis is now 10 inches long and I don't have weak erection anymore. I can make love to my wife longer in bed. And my marriage is now stable my wife is now enjoy me very well in bed. All thanks to Dr Perfect for enlarging my penis he indeed save my marriage. You can contact him at solutiontoallproblems1@gmail.com or you can add him up on WhatsApp +1(256) 251 3614. you can also view my blog http://davidrichardson12356.over-blog.com. He also specializes in the following things
    Herpes virus
    Cancer
    Hsv
    Chronic venous disease
    and others 

    ReplyDelete
  16. I was despondent because i had a very small penis, about 2.5 inches soft and 4 inches hard not nice enough to satisfy a woman, i have been in so many relationship, but cut off because of my situation, i have used so many product which doctors prescribe for me, but none could offer me the help i searched for. i saw some few comments on the INTERNET about this specialist called Dr DADA and decided to contact him on his email: {drdadaspellhome7@gmail.com} so I decided to give his herbal product a try. i emailed him and he got back to me, he gave me some comforting words with his herbal pills for Penis Enlargement, Within 3 week of it, i began to feel the enlargement of my penis, " and now it just 4 weeks of using his products my penis is about 9 inches longer, and i had to settle out with my Ex girlfriend JOY, i was surprised when she said that she is satisfied with my sex and i have got a large penis. Am so happy, thanks to Dr DADA I also learn that Dr DADA also help with Breast Enlargement Hips and Bums Enlargement etc.. If you are in any situation with a little Penis, weak ejaculation, small breast_hips_bums do get to Dr DADA now for help on his email:{drdadaspellhome@hotmail.com} or whatsapp +2348158568638

    ReplyDelete
  17. hello everyone here i am Jack Mark a medical doctor from United Kingdom , i want to share a great testimony of how Dr AKIOYA herbal mixture cream saves me from shame and disgrace, my penis size was a big problem to me as the size was really so embarrassing and discouraging, a 39 year old full grown man like me having 4 inches penis and to worsen it i don't last in sex i cant even last two minutes it was really a thing of shame my wife was really tired of me because my sex life was very poor , she never enjoyed sex, i was always thinking and searching for solutions everywhere until last two months when i saw a testimony of how Dr AKIOYA herbal mixture cream have been helping people from the globe,i saw one MR KENNETH BERTNEY testifying of how Dr AKIOYA helped him enlarge his penis size so i decided to give him a try ,i visited his website link https://drakioyaherbalhome.blogspot.com/ we talked and he gave me steps to follow which i did and to my greatest surprise in less than two weeks of taking the herbal mixture cream my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 10.5 inches long and i was amazed when my wife said i satisfy her so well now all thanks to Dr AKIOYA herbal mixture cream,i will forever be grateful To him i also learnt that Dr AKIOYA also have the herbal cure to problems like

    PENIS ENLARGEMENT
    ERECTILE DYSFUNCTION
    DIABETES type 1 and type 2
    HERPES GENITAL WART
    LOW SPERM COUNT
    WEAK ERECTION
    BREAST ENLARGEMENT
    PROSTRATE CANCER
    HIV/AIDS
    SPELL OF ALL KINDS LIKE EX BACK,CANCEL DIVORCE,BREAK UP SPELL ,PREGNANCY SPELL,PROMOTION SPELL,JOB SPELL
    ALS
    HPV 123
    PILE
    ASTHMA
    HEART FAILURE
    PREMATURE EJACULATION
    HEPATITIS A,B,C AND MANY MORE
    so if you you are suffering from any of this problems please do not hesitate to contact him now email drakioya17spellhome@gmail.com website http://drakioyaherbalcenter.home.blog
    https://drakioyaherbalhome.blogspot.com/ you can call him or Whatsapp Dr AKIOYA via whatsapp +2348105257464 thanks

    ReplyDelete

  18. HOW I GOT MY HUSBAND BACK HOME WITH THE HELP OF A REAL AND GENUINE SPELL CASTER DR IKHILE TEXT OR CONTACT VIA WHATSAPP +27789518085

    My name is TAYLOR am from united state, I almost took my life because of my husband who left me and stop picking my calls answering my mails and my messages. He said He do not trust me anymore, I tried to convince and beg him, but he will not believe or answer me until we had a fight and broke up for 6months, after then I realize I can not live without him because of the love I have for him. I tried everything possible to get him back, but non worked for me, some fake spell casters scammed me and went away with my money until I came across this man called Dr Ikhile he helped me cast a spell and behold my husband came back after 48 hours, begging me for forgiveness, I was so surprised that spell caster like Dr Ikhile still exist. If anyone here needs some help, with all sincerity, contact Dr Ikhile today Website:http://solutiontemples.com Email solutiontemple27@gmail.com or Contact him via is whatsapp number +27789518085 indeed you are a priest thank you for making my home a happy home again.i can never stop talking about you sir.
    DR Ikhile is really a great man you can contact in any solution for any kind of problems like
    (1) lottery spell
    (2) ex back
    (3) get pregnant
    (4) cure for any kind of sickness,disease and infection
    And many others contact this great man today and get your Problems solved 100%.

    Website:http://solutiontemples.com
    Email solutiontemple27@gmail.com
    Call & Whatsapp +27789518085

    ReplyDelete
  19. hello everyone i am Blake Carrington from new york a medical doctor i never believed herbal products could solve what my science technology could not solve ,i have been having little penis size since childhood and that really Embarass me alot and up till now that i am 37 years old i still find it difficult to find a permanent solution until my friend from Africa at work place introduce his uncle to me Dr Harry .i contacted him through his email drharrysolution@gmail.com and he replied me and we discussed my situation and told me what i need to do ,i did it and received his herbal medicine  through UPS and i got it within 3/5 days and used his miraculous herbal mixture cream just as he told me ,its just 4 days i started measuring and got 4 inches already and after two weeks i got 11 inches size and 8.0 girth size .i was so happy because no woman will dare reject me now with my big Cock .life is really full of surprises me that was having 2 inches before now having 11 inches big cock size .so if you need any help or cure to any sickness or disease like small penis,low sperm count,premature ejaculation,HIV/AIDS ,herpes ,spells of all kinds etc  you can quickly whatsapp him on +2349036417079 or visit his website https://drharryherbaltempl.wixsite.com/solutiontemple good luck as you reach him 

    ReplyDelete
  20. Herbal Penis Enlargement product is 100% guarantee to Enlarge and get a better ERECTION ,
    the reason why most people are finding it difficult
    to enlarge Penis is because they bedlieve on medical
    report, drugs and medical treatment which is not
    helpful for Penis Enlargement . Natural roots/herbs are the best remedy which can easily Enlarge your Penis permanently
    Contact Dr sebi via Email : drsebicurecenter@gmail.com or via WhatsApp : +2347010538590 for Natural root and herbal remedies put together to help you get Enlarge and Erect healthy.
    Thank you

    ReplyDelete
  21. God bless Dr. maggi for his marvelous work in my life, I was diagnosed of HERPES since 2018 and I was taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched out some possible cure for HERPES i saw a comment about Dr. maggi, how he cured HERPES,DIABETES,HIV,and CANCER with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine I took the medicine as prescribed by him and 14 days later i was cured from HERPES, Dr. maggi truly you are great, do you need his help also? Why don’t you contact him through his EMAIL: drmaggiherbalhome@gmail.com/ +1-917-979-6387.

    ReplyDelete
  22. My Name is Dr sebi you can Contact Me via Email drsebicurecenter@gmail.com For Penis Enlargement Product to help you get as long as 8inches Long with good Erection. Contact Me Via Email : drsebicurecenter@gmail.com Via WhatsApp +2347010538590

    ReplyDelete
  23. Herbal Penis Enlargement product is 100% guarantee to Enlarge and get a better ERECTION ,
    the reason why most people are finding it difficult
    to enlarge Penis is because they bedlieve on medical
    report, drugs and medical treatment which is not
    helpful for Penis Enlargement . Natural roots/herbs are the best remedy which can easily Enlarge your Penis permanently
    Contact Dr life via Email : drlifetemple@gmail.com or via WhatsApp : +2347064927420 for Natural root and herbal remedies put together to help you get Enlarge and Erect healthy.
    Thank you

    ReplyDelete
  24. My name is Joel dwin  am from Texas US. I want to share a testimony of how Dr DADA herbal mixture product saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I cant make love to my wife and my penis was just too small, a full grown man like me having 4 inches penis and to worsen it i don't last in sex, i cant even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr.DADA  herbal product have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 8 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. You can contact him via drdadaspellhome7@gmail.com call or whatsapp him +2348158568638

    ReplyDelete
  25. Hello everyone this is a testimony of how a man named Dr Thomas gave me the reason to be happy again.
    I was having small penis and weak erection problem. I can't even make love with my girlfriend for 7 minutes and my penis was just too small a full grown up man like me having 4 inches penis and to worsen it i can't even last more than 3 minutes in bed, it was really a shame to me. I came across Mr Williams  testifying on how Dr Thomas save him from shame too,  so I decided  to give a  try to his products.  So I talk with him he told me that all everything will be alright that my penis will increase after he is true with what he was about to do. At  forst I thought it was a joke but in less than a week after taking some of his products  my penis  increased from 4 inches to 7 inches and I started lasting in bed for 30 minutes.  So i  called him and told him about it he told me that it was just the beginning that I will also last longer than that.
    As I am talking with you now my girlfriend can now enjoy me in bed.
    you can contact him for  more information's. you can contact him on his email : (Doctorthomas73@gmail.com).
    Or you can also contact him on what's app :(+2348152190329).
    He is also specialize on the following:
    1.Body enhancement 
    2.COPD(Chronic obstructive pulmonary disease).
    Thanks for enlarging my penis sir,  I am so grateful.

    ReplyDelete

  26. Herbal Penis Enlargement product is 100% guarantee to Enlarge and get a better ERECTION , the reason why most people are finding it difficult to enlarge Penis is because they bedlieve on medical report, drugs and medical treatment which is not helpful for Penis Enlargement . Natural roots/herbs are the best remedy which can easily Enlarge your Penis permanently Contact Dr DADA via Email : drdadaspellhome7@gmail.com or via WhatsApp : +2348158568638 for Natural root and herbal remedies put together to help you get Enlarge and Erect healthy. Thank you

    ReplyDelete
  27. Hello everyone i am here to share a testimony of how Dr.Thomas herbal mixture cream saved me from  shame i have tryed so many ways everywhere until when i saw a testimony of how Dr.Thomas herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than TEN DAYS of taking the herbs my penis grow to 7 inches i couldn't believe my eyes and as i speak now my penis is now 9 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. you can contact him for more information's.(Doctorthomas73@gmail.com) or call or what-apps him through +2348152190329. he also specialize on the following things 1. CANCER
    2. ALS (Lou Gehrig's disease)
    3. COPD (chronic obstructive pulmonary disease) 
    Thank you sir, you indeed save me. 

    ReplyDelete
  28. HOW DR PERFECT ENLARGEMENT CREAM HELP ME TO ENLARGE MY PENIS YOU CAN ADD HIM UP ON WHATSAPP +1(256) 251 3614

    My name is David Richardson from USA I want to share a testimony of how Dr Perfect herbal mixture cream saved me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing and I was also having weak erection problem. I can't make love to my wife and my penis was just too small, a full grown man like me having 3 inches penis and to worsen it I don't last long in sex I can't even last four minutes it was really a big shame to me. My wife was really tired of me because my sex life was very poor, she never enjoyed sex, I was always thinking and searching for solutions everywhere until when I saw a testimony of how Dr Perfect herbal mixture cream have been helping people regarding their sex life, so I decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 10 inches I couldn't believe my eyes and as I speak now my penis is now 10 inches long and I don't have weak erection anymore. I can make love to my wife longer in bed. And my marriage is now stable my wife is now enjoy me very well in bed. All thanks to Dr Perfect for enlarging my penis he indeed save my marriage. You can contact him at solutiontoallproblems1@gmail.com or you can add him up on WhatsApp +1(256) 251 3614. you can also view my blog http://davidrichardson12356.over-blog.com. He also specializes in the following things
    Herpes virus 
    Cancer
    Hsv
    Chronic venous disease
    and others 

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  29. HOW DR PERFECT ENLARGEMENT CREAM HELP ME TO ENLARGE MY PENIS YOU CAN ADD HIM UP ON WHATSAPP +1(256) 251 3614

    My name is David Richardson from USA I want to share a testimony of how Dr Perfect herbal mixture cream saved me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing and I was also having weak erection problem. I can't make love to my wife and my penis was just too small, a full grown man like me having 3 inches penis and to worsen it I don't last long in sex I can't even last four minutes it was really a big shame to me. My wife was really tired of me because my sex life was very poor, she never enjoyed sex, I was always thinking and searching for solutions everywhere until when I saw a testimony of how Dr Perfect herbal mixture cream have been helping people regarding their sex life, so I decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 10 inches I couldn't believe my eyes and as I speak now my penis is now 10 inches long and I don't have weak erection anymore. I can make love to my wife longer in bed. And my marriage is now stable my wife is now enjoy me very well in bed. All thanks to Dr Perfect for enlarging my penis he indeed save my marriage. You can contact him at solutiontoallproblems1@gmail.com or you can add him up on WhatsApp +1(256) 251 3614. you can also view my blog http://davidrichardson12356.over-blog.com. He also specializes in the following things
    Herpes virus 
    Cancer
    Hsv
    Chronic venous disease
    and others 

    ReplyDelete
  30. hello everyone Have you heard of this man, a spell caster and a herbal doctor ? DR HARRY what a great man, black magic really work, well I know this man must be giving a great regards due to what he have done in my life,Am from UK, I travel to Texas  for business I have to spend 2 months over there during to the business I meet this girl what a petty girl well she draw my attentions I was interest on her I decide to speak to her, how I felt for her, and I was having it in mind that I should propose to her, I spend time with this girl, and will were in love very tight, and will had sex together, all I was thinking about is how to introduce her to my parent before I propose to her because I really love her when it was time for me to go back to my country, but due to business my time do not permit me I have to go back fast, but all was already done, and she were to come after 2 weeks  to visit me so that I can introduce her to my parent when I was back my doctor decide to do his duty work and test me and give me some treatment but he found out that I have HIV, it was so surprised to me that she have HIV and she refused to tell me about it, and she allow me to have sex with her without condom, but I feel like crying I decide to behave like a man, all I think about is I will not be about to have children anymore then due to that I was force to look for help, I believe there is no cure in HIV, but I decide to try magic if it can work for me. I search for magic power men then I found a man called DR.HARRY  how it cured HIV within 7 days spell, well I did not conclude immediately because of who I Am I thinks this can work and it cannot also work, I give a try this man go according to the post I see, and his spell work within 3 weeks  I was cured totally, with the little I have i have to send a car to this man because of his good work but only God can tell who this man his, let me stop from here because I know there are many people who need his help that is why I have to write about him, He can cure all kinds sickness or illness and cast any spell likePENIS ENLARGEMENT PREMATURE EJACULATION LOW SPERM COUNT ERECTILE DYSFUNCTION HIV/AIDS HERPES ALS CANCER DIABETES GET YOUR EX LOVER BACK SPELL MONEY SPELL LOTTERY SPELL BREAKING CURSE SPELL PROTECTION FROM WITCH CRAFT SPIRITUAL ATTACK SPELL WIN COURT CASE SPELL  etc email him drharrysolution@gmail.com   visit His website  https://drharryherbaltempl.wixsite.com/solutiontemple or call.....whatsapp +2349036417079

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  31. THE 3 IN 1 PENIS ENLARGEMENT COMBO WhatsApp +2348100368288, 3 IN 1 PENIS COMBO, PENIS ENLARGEMENT, CONTROL EARLY EJACULATION, ELEVATE YOU SEX DRIVE, INTENSIFY YOUR ORGANISM, MAKE MORE ROUNDS, PENIS SIZE UP CREAM, STRONG ERECTION, PENIS OIL AND PILLS It is the leading male enhancement HERBAL MEDICINE providing you the safest, quickest and easiest HERBAL MEDICINE to increase your penis size by 3 to 15 full inches GUARANTEED!!! You can do all that in only 5 minutes per day for 3 to 5 days... My clients are reporting MASSIVE IMPROVEMENTS in their size More length, width and lots of orgasm GUARANTEED. And PENIS POWER HERBAL REMEDY ARE YOU A ONE MINUTE MAN, DOES YOUR LOVER ASK FOR MORE AND YOU CAN’T DO IT. CONTACT DR AZIBA VIA EMAIL :Priestazibasolutioncenter@gmail.com and WhatsApp Him on +2348100368288 website https://naturalherbsmedicine.webs.com/ FACEBOOK PAGE: @DOCTOR AZIBA

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  32. I want to share this wonderful testimony to the Good people all over the world on how I was able to Enlarge my Penis by Dr. zubby. I was living a shameful life from my young age, just last month as I was browsing on the internet about Penis size and Enlargement Products, I saw a testimony of a Man called George , testifying of how he was able to get his penis Enlarged by Dr. zubby and I decided to also Email Dr.zubby for my small penis size and he quickly respond to me and gave me the normal instructions which i did and then he shipped the product to me here in the united state which i received in just 3 working days and today i am very happy because i started seeing positive changes in my penis size in just 7 days of use. Dr zubby herbal product is the best recommended for you and to whom ever suffering from this shame or having any other diseases as well should Contact this great herbal doctor via his Email : dr.zubbysolutionhome@gmail.com and WhatsApp Him on   +2348070673249

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  33. I want you all to help me thank dr irosi for saving my life, i was diagnosed of herpes and at the same time i was 7 months pregnant, i was confused and i didn't know what to do until i meant a friend on the Internet who directed me to dr irosi did not believe it until i contacted the good man who was able to help me out of the situation with his herbs, it only cost me some little amount of money to cure herpes through dr irosi so i will also advice any body that needs help from him should contact him because i know you will also get cured of your disease. Thanks once again dr irosi. Anyone who needs help having the same disease should contact him on his email drirosisolutioncenter@gmail.com or call/whatsapp him via: +2348118829771   

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  34. My name is Clifford John from USA taxes, I want to share a testimony of how Dr_Ogodo1 herbal mixture cream saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I can't make love to my wife and my penis was just too small a full grown man like me having 4 inches penis and to worsen it i don't last in sex i can't even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr_Ogodo1 herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 8 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed.
    * He can also bring back your Ex
    *Love spell
    * Herpes virus diseases
    *Diabetes
    *Aid virus
    *STD/HSV
    *Cancer/typhoid E.t.c you contact him through the mail. Ogodoherbalhomesolution@gmail.com
    You can also WhatsApp him on +2349044680467

    ReplyDelete
  35. Hello, everyone! I'm here to explore blogs and forums about the wonderful and most safe cure for (Herpes Virus). I was positive about the deadly virus called herpes and I lost hope because I was outcast and rejected even by my closest friends. I searched on-line to know an enquirer cure for Herpes and I read someone's testimony on how he was cured from Herpes so I decided to contact the same herbalist because I know that nature has the power to heal everything. I contacted him to know how he can help me and he told me never to worry that he will heal me with the natural herbs from God! After 2 days of contacting him, he told me that the cure has been ready and he sent it to me via DHL and it got to me after 3 days! I used the med as he instructed (MORNING and EVENING) and i was cured! it's really like a dream but I am so happy! That's the reason I decided to also add more comments on Him so that more can be saved just like me! and you can get in touch with him via email chiefdrlucky@gmail.com WhatsApp +2348132777335

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