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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    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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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

  18. 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
  19. 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
  20. 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

    ReplyDelete
  21. 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   

    ReplyDelete
  22. 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
  23. 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

    ReplyDelete
  24. I got help for my diabetes type 2 from DR.DUDU a herbal doctor from Africa, I wanted this cure since a year and 3 months, i was taken treatment from some doctor, few Months back i came on the net to see if i will be able to get any information for a permanent cure, on my search i saw various testimony of people who was helped by a great man called Dr ODUDU and without any hesitation, i contacted his email: dr.oduduherbalhome@gmail.com , i wrote him and and he guided me, i asked him for solutions and he started the remedies for me and indeed in 3 weeks and few days after i started using the medicine, i was completely happy as it worked for me. You can contact him now for your medicine to cure your diabetes if you sicking for a permanent cure for it, contact his Email; dr.oduduherbalhome@gmail.com his cell phone contact, Call / Whats-app +2348101571054 https://www.facebook.com/DR.ODUDU

    ReplyDelete