Monday, 23 March 2020

COVID-19, people with learning disabilities, and NICE Guideline 159 on critical care

Excuse me for this extremely hastily written blogpost - hope some people will find it useful.

NICE (the National Institute for Health and Clinical Excellence) has just produced a rapid guideline for health professionals on what to do about critical care for people with the COVID-19 coronavirus. Among other things, NICE write clinical guidelines that everyone in health services in England are supposed to follow, so a guideline on this is a big deal. Its basic premise is that there will be a shortage of critical care (intensive care) services in the face of the number of people with COVID-19 who would ordinarily use them, so the guideline is to help health professionals make decisions about who to admit to critical care or not. Horrible, horrible decisions for a health professional to have to make - although these decisions are having to be made due to a shortage of sufficient services and health professionals.

The guideline NG 159 is relatively short and is available here, and in this post I want to quickly outline some potential implications for people with learning disabilities if they get COVID-19 and need to go to hospital (of course, many people, even if they get COVID-19, won;t need hospital treatment and will recover).

The starting point of the guideline is that "On admission to hospital, assess all adults for frailty, irrespective of age and COVID-19 status. Consider comorbidities and underlying health conditions".

'Frailty' is an idea that has typically grown around older people generally and people with dementia specifically, where the purpose is to try and predict who will be more likely to experience things like hospitalisation and rapid deterioration in their health from a set of 'markers', although there is apparently little consensus between measures or markers of 'frailty'.

It is not clear to me (even if people coming to hospital with COVID-19 will be mainly older people) why frailty is the essential thing to assess people for - there are fundamental ethical issues here which others are much better placed than me to comment on.

In this more limited post, there is really no evidence that any frailty measure is applicable to adults across the age range, including people with learning disabilities. [And there no mention in the guideline on children - while the assumption may be that few children with COVID-19 will potentially need critical care the potential health impact on children with learning disabilities and multiple health conditions is not yet clear. Hospitals need to be ready and prepared for this eventuality].

And the consequences of the blanket application of a frailty measure in these circumstances for people with learning disabilities worry me greatly.

First, the scale that NICE says should be used is the Clinical Frailty Scale, developed for people with dementia, that has 9 levels (see below). This Scale strongly assumes that there is a progressive course of dementia, combining (in quite subjective ways) judgements of physical fitness, cognitive functioning, the kind of support people need, and physical health problems into these levels.






































This is, to say the least, profoundly unhelpful when applied to any group of disabled people with long-term impairments and particularly unhelpful when applied to people with learning disabilities who by definition have some issues with learning certain types of things. For example, on this scale I think anyone with profound and multiple learning disabilities would at best be rated 7 (Severely Frail) on this scale. And perhaps pretty much any adult with learning disabilities who has jumped the eligibility hurdle for long-term adult social care support (around 150,000 people in England alone) - and maybe all children with severe or profound multiple learning difficulties with an EHCP (around 40,000 children in England) - would be rated at best as 5 (Mildly Frail)?

In these guidelines, what you score on this scale (being rated by health professionals not routinely working with people with learning disabilities, working in conditions of extreme pressure, when we know that mainstream hospitals are not routinely reasonably adjusted to provide equally effective healthcare for people with learning disabilities) really, really matters.

Section 2 of the guideline (Admission to critical care) is where the main work of the guideline is done. After completed and recording the Clinical Frailty Scale score, the health professional should "Discuss the risks, benefits and possible likely outcomes of the different treatment options with patients, families and carers using decision support tools (where available) so that they can make informed decisions about their treatment wherever possible)." Questions:
1) As far as I can see, none of the materials linked to are designed for use with people with learning disabilities, and there are no references to making reasonable adjustments to this process.
2) Given people's circumstances it is possible that a person with learning disabilities may be admitted to hospital without a member of their family allowed to be with them, and paid carers may be filling in and not know the person well.
3) Capacity is not even mentioned here.
4) The person is likely to be greatly distressed at this point.

Then, the critical care team will discuss whether to admit the person to critical care or not if...
"where the CFS score suggests the person is less frail (for example the score is less than 5) [the for example is doing a lot of work here], they are likely to benefit from critical care organ support and they want critical treatment, or..."
"the CFS score suggests the person is more frail (for example the score is 5 or more), there is uncertainty regarding the likely benefit of critical care organ support, and critical care advice is needed to help the decision about treatment".

People with learning disabilities are unlikely to come out of these discussions with the critical care team well, given the CFS predisposes people to be rated as being frail and the greater likelihood of people being acquiescent to suggestions put to them by health professionals in a position of authority at a time of great stress.

Then, if you get through that, health professionals should "Take into account the impact of underlying pathologies, comorbidities and severity of acute illness on the likelihood of critical care treatment achieving the desired outcome".

How will a health professional make this accounting? Well, if they're going on government guidance on social distancing for COVID-19 they will notice that people with learning disabilities are already listed as a 'chronic neurological condition' and therefore part of a group "who are at increased risk of severe illness from coronavirus (COVID-19)" and therefore should be "particularly stringent in following social distancing measures". Does this then mean that all people with learning disabilities by definition have an "underlying pathology"? And it is the case that various groups of people with learning disabilities are more likely to have relevant health conditions such as respiratory health problems, heart problems and diabetes. Will this tilt health professionals away from thinking that critical care treatment is likely to achieve the desired outcome for people with learning disabilities?

Assuming that this means you won't get critical care, what happens to you? The next step according to the guideline is to "Support non-critical healthcare professionals to discuss treatment plans with patients who would not benefit from critical care treatment or who do not wish to be admitted to critical care." Note that from an irrelevant assessment of frailty and an assessment of potential risk factors we are now at the point of apparent certainty about "patients who would not benefit from critical care treatment." And as I mentioned earlier, will people with learning disabilities be assertive enough in this situation to demand critical care for themselves?

Health professionals should also "Sensitively discuss a possible 'do not attempt cardiopulmonary resuscitation' decision (with all adults with capacity) and CFS score suggestive of increased frailty (for example of 5 or more)." There is no mention of what should happen with people without capacity, or of reasonably adjusted ways to discuss these issues with people.

Finally in Section 2, health professionals should "ensure that when treatment outside critical care is the agreed course of action, patients receive optimal care within the ward". What 'optimal care' consists of is not specified.

There is more to the guideline that I won't go into here, but the general direction of travel that stacks the deck against people with learning disabilities is reinforced and replicated throughout. This guideline is not fit for purpose for people with learning disabilities.


UPDATE: NICE have issued the following 'clarification' about this guideline.


This is welcome - it will be important to know what (if anything) the CFS will be replaced with. It is also vital to understand what NICE plans for other groups of disabled people (and in fact, anyone who isn't an older person). Most of my questions in the blogpost about how the guideline will operate in practice, and their implications for how people with learning disabilities are treated (or not) remain.




168 comments:

  1. Thank you for this thoughtful blog Chris- you articulate with characteristic precision, a concern that vexes many.
    My thoughts on this-
    1. The Clinical Frailty Scale and other similar tools are meant to offer some measure of frailty in an individual in comparison to a non-frail or at least less-frail baseline. That is why it was intended for use in the over 65s with (acquired) medical conditions- typically dementia.
    2. With the unprecedented crisis of COVID 19, one has to acknowledge the need for some sort of triaging toll which has some semblance of validation and hence the Clinical Frailty Score, a tool that was intended to identify frailty in the over-65s is now recommended for all age groups.
    3. If one interprets the definitions of the 1-9 score categories in a concrete way, the vast majority of people with a learning disability will get rated as 5 or above because of the significant deficits in adaptive functioning that they have.
    4. But these scores are not meant to be allocated in that concrete way. From the time that the electronic frailty index was introduced into the GP contract a couple of years ago, it has been stressed that it is not a clinical diagnostic tool and that clinical judgment has to be a part of its use.
    (Reference: https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/efi/#what-numbers-of-people-living-with-frailty-do-we-expect-to-be-diagnosed
    5. Hence a person with mild or moderate learning disability who may have some adaptive function deficits, but has no acquired active medical conditions may well in your clinical judgment be rated as a 2 or 3 rather than 5 or 6. The same could apply for people with more severe degrees of learning disability too. The situation becomes complicated if there are serious and limiting additional physical illnesses which co-exist with the learning disability and in those cases, you may well end up with a higher frailty score. Some guidance on that would be welcome.
    6. In all this, one has to stress the importance of clinical judgment, being part of the scoring process so that people with learning disability are not just automatically scored as 5 or above.
    7. It is worth remembering that when the electronic frailty index was introduced, the numbers of people with severe frailty expected to be identified nationally was 291,170 (3% of the over 65s). https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/efi/#what-numbers-of-people-living-with-frailty-do-we-expect-to-be-diagnosed It is clear that just categorizing everyone with a learning disability into that category was never the intention and clinicians using their judgment can still make sure that remains the case.

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  77. Hi it's laa! 9 months ago my doctor told me I was diagnosed with HSV2. I was heart broken, However that same month i found a Dr. who helped me to cured the virus with natural herbal treatment permanently. thanks to Dr. omohan for his natural herbal treatment that eliminated this virus out in my body forever. his contact information for any incurable virus via; dromohanherbalmedicine@gmail.com or whatsapp him or call him through his phone number +2348164816038.    

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  81. Good evening to you all I want to write a shortly message to the world how doctor ehiaguna help with his great herbal medicine to cured me from this horrible virus HSV 1 and 2 I get his email from someone name Olivia mason how she was also cured by doctor ehiaguna I never believe there was cure until I meet her testimony, I contacted doctor ehiaguna I don’t believe there was cure well I am so happy to write this testimony to the world, this man immediately when I sent him email and this man response within 20 minus and give me the necessary process and the herbal was sent to within 4 day I took it according to the instruction so with 2 week I was completely cured and I get my test done I was confirm negative I am so happy if you want to get his contact you can message him with this email drehiaguna@gmail.com or you can also WhatsApp him +2348073908953 he can fix this.HIV.HEPATITIS.ANTHRAX.HPV.CANCER.ALSAND ALSO SOLVE YOUR RELATIONSHIP PROBLEM

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  84. Hi it's laa! 9 months ago my doctor told me I was diagnosed with HSV2. I was heart broken, However that same month i found a Dr. who helped me to cured the virus with natural herbal treatment permanently. thanks to Dr. omohan for his natural herbal treatment that eliminated this virus out in my body forever. his contact information for any incurable virus via; dromohanherbalmedicine@gmail.com or whatsapp him or call him through his phone number +2348164816038.    

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  86. Good news this is to everyone out there with different health challenges, as I know there are still a lot of people suffering from different health issues and are therefore looking for solutions. I bring you Good news. There is a man called Dr ehiaguna a herbal practitioner who helped cure me from HSV (2), i had suffered from this diseases for the past 5 years and i have spent so much money trying to survive from it. I got my healing by taking the herbal medicine Dr ehiaguna sent to me to drink for about 14 days . 3 days after completion of the dosage, I went for a medical checkup and I was tested free from HSV. all thanks to God for leading me to Dr ehiaguna who was able to cure me completely from this deadly diseases, I’m sharing this so that other people can know of this great healer called Dr ehiaguna because I got to know him through elizabeth who he cured from HIV. I was made to understand that he can cure several other deadly diseases and infections. Don’t die in ignorance or silent and don’t let that illness take your life. Contact Dr ehiaguna through his emaildrehiaguna@gmail.com You can also whatsapp/call him on:+2348073908953 .He cure all forms of disease {1}HIV/AIDS {2}DIABETES {3}EPILEPSY {4} BLOOD CANCER {5} HPV {6} BRAIN TUMOR {7} HEPATITIS {8}COPD{9} SICKLE AND ANAEMIA.etc Be kind enough to share as you received.  

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    Replies
    1. Good news this is to everyone out there with different health challenges, as I know there are still a lot of people suffering from different health issues and are therefore looking for solutions. I bring you Good news. There is a man called Dr ehiaguna a herbal practitioner who helped cure me from HSV (2), i had suffered from this diseases for the past 5 years and i have spent so much money trying to survive from it. I got my healing by taking the herbal medicine Dr ehiaguna sent to me to drink for about 14 days . 3 days after completion of the dosage, I went for a medical checkup and I was tested free from HSV. all thanks to God for leading me to Dr ehiaguna who was able to cure me completely from this deadly diseases, I’m sharing this so that other people can know of this great healer called Dr ehiaguna because I got to know him through elizabeth who he cured from HIV. I was made to understand that he can cure several other deadly diseases and infections. Don’t die in ignorance or silent and don’t let that illness take your life. Contact Dr ehiaguna through his email  drehiaguna@gmail.com You can also whatsapp/call him on:+2348073908953 . Visit his website  https://effectiveherbalcurehome.blogspot.com/   He cure all forms of disease {1}HIV/AIDS {2}DIABETES {3}EPILEPSY {4} BLOOD CANCER {5} HPV {6} BRAIN TUMOR {7} HEPATITIS {8}COPD{9} SICKLE AND ANAEMIA.etc Be kind enough to share as you received.  

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  88. My herpes is cured and it’s miracle healing. Thanks to Dr.Apala who cure my Genital Herpes I was depressed when doctor told me that I have been diagnosed with Herpes disease… I thought about my Family, I know my Family will face a serious problem when I’m gone, I lost hope and I wept all day, but one day I was searching the internet I found Dr.Apala contact number called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I’m cured by Dr.Apala medicine, I’m very thankful to Dr.Apala and very happy with my hubby and family.or you can also reach him through email:dr.apalaherbalhome@gmail.com or Whats App number+2348114047176
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  107. My herpes is cured and it’s miracle healing. Thanks to Dr.Apala who cure my Genital Herpes I was depressed when doctor told me that I have been diagnosed with Herpes disease… I thought about my Family, I know my Family will face a serious problem when I’m gone, I lost hope and I wept all day, but one day I was searching the internet I found Dr.Apala contact number called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I’m cured by Dr.Apala medicine, I’m very thankful to Dr.Apala and very happy with my hubby and family.or you can also reach him through email:dr.apalaherbalhome@gmail.com or Whats App number+2348114047176
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  110. My herpes is cured and it’s miracle healing. Thanks to Dr.Apala who cure my Genital Herpes I was depressed when doctor told me that I have been diagnosed with Herpes disease… I thought about my Family, I know my Family will face a serious problem when I’m gone, I lost hope and I wept all day, but one day I was searching the internet I found Dr.Apala contact number called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I’m cured by Dr.Apala medicine, I’m very thankful to Dr.Apala and very happy with my hubby and family.or you can also reach him through email:dr.apalaherbalhome@gmail.com or Whats App number+2348114047176
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  111. Hello viewers, I'm here to shear my testimony on how Dr.Balogun cured my herpes virus/hpv with his herbal medicine.I do not have much to say but with all my life i will for ever be grateful to him and God Almighty for using Dr.Balogun to reach me when i thought it was all over, today i am happy with my life again after the medical doctor have confirmed my HERPES SIMPLEX VIRUS / HPV of 3 years is gone,i have never in my life believed that HERPES SIMPLEX VIRUS could be cured by herbal medicine. so i want to use this means to reach other persons who have this disease by testifying the power of  Dr.Balogun that all hope is not lost yet, try and contact him by any means for any kind of disease. Thanks once again Dr.Balogun for your marvelous work may God continue to bless you. You can also reach him today via email: balogun.herbalsolutioncenter@gmail.com  call or WhatsApp him on +2349064881054,.  

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  112. My herpes is cured and it’s miracle healing. Thanks to Dr.Apala who cure my Genital Herpes I was depressed when doctor told me that I have been diagnosed with Herpes disease… I thought about my Family, I know my Family will face a serious problem when I’m gone, I lost hope and I wept all day, but one day I was searching the internet I found Dr.Apala contact number called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I’m cured by Dr.Apala medicine, I’m very thankful to Dr.Apala and very happy with my hubby and family.or you can also reach him through email:dr.apalaherbalhome@gmail.com or Whats App number+2348114047176
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  117. I have be dealing with herpes for the past 5 years until i got review online about Dr.Iyayi people testifies how they got cured with his herbal medicine. And i order the treatment, after taking it for 14 to 16 days i totally got cured with Dr Iyayi herbal Medicine. I'm recommending you diagnosed with herpes should get this Herbal Medicine and be cured because his herbal medicine is guaranteed and safe and there is no side effect as well. contact his email; doctoriyayiherbalhome.org@gmail.com and you can as well whatsapp or call him via +2348162352979. I want you to know that Dr Iyayi also cures all kids of infections and viruses, including HIV.

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  118. I have be dealing with herpes for the past 5 years until i got review online about Dr.Iyayi people testifies how they got cured with his herbal medicine. And i order the treatment, after taking it for 14 to 16 days i totally got cured with Dr Iyayi herbal Medicine. I'm recommending you diagnosed with herpes should get this Herbal Medicine and be cured because his herbal medicine is guaranteed and safe and there is no side effect as well. contact his email; doctoriyayiherbalhome.org@gmail.com and you can as well whatsapp or call him via +2348162352979. I want you to know that Dr Iyayi also cures all kids of infections and viruses, including HIV.

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  119. DON'T BELIEVE THERE IS A CURE FOR HERPES? Well here is my testimony about a doctor who helped me when I was infected with HERPES on September 22, 2014, I went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution so that my body can be okay. One day I was online and i saw the testimony of Mrs Amy Kendral speaking on how a man called Dr Razor helped her Eradicate the Herpes Simplex Infection that was eating her up every day, I Immediately emailed the Herbal Doctor Razor with the Details provided by This Woman on how to reach Him and I explained everything to him. Dr Razor told me all the things I needed to do and also gave me instructions to take a wish I followed properly. Before I knew what was happening after 18 days of taking the medication I started having changes in my body, so i told the herbalist of the development in my health and he asked me to go for a medical check up, the Doctors There were Amazed that Herpes have a Permanent and complete cure. Visit Doctor Razor's Website : https://drrazorherbalhome.wixsite.com/drrazorherbalhome . You can Reach him on his Email via drrazorherbalhome@gmail.com . WhatsApp/Call him on +2349065420442. I made sure the Virus wasn't laying dormant in my nerve cells because I have heard of a situation like that. Before deciding to write this testimony so that many who are Battling with different kinds of Challenges Can also get cured.

    ReplyDelete
  120. DON'T BELIEVE THERE IS A CURE FOR HERPES? Well here is my testimony about a doctor who helped me when I was infected with HERPES on September 22, 2014, I went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution so that my body can be okay. One day I was online and i saw the testimony of Mrs Amy Kendral speaking on how a man called Dr Razor helped her Eradicate the Herpes Simplex Infection that was eating her up every day, I Immediately emailed the Herbal Doctor Razor with the Details provided by This Woman on how to reach Him and I explained everything to him. Dr Razor told me all the things I needed to do and also gave me instructions to take a wish I followed properly. Before I knew what was happening after 18 days of taking the medication I started having changes in my body, so i told the herbalist of the development in my health and he asked me to go for a medical check up, the Doctors There were Amazed that Herpes have a Permanent and complete cure. Visit Doctor Razor's Website : https://drrazorherbalhome.wixsite.com/drrazorherbalhome . You can Reach him on his Email via drrazorherbalhome@gmail.com . WhatsApp/Call him on +2349065420442. I made sure the Virus wasn't laying dormant in my nerve cells because I have heard of a situation like that. Before deciding to write this testimony so that many who are Battling with different kinds of Challenges Can also get cured.

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  121. Hello everyone, I’m so happy because I am free from (HERPES) I have been suffering from HERPES since the past three years now, and I have passed through many different processes in getting cured from herpes but nothing was working out. A friend of mine introduced me to a man called Dr.Balogun who sent me a herbal medicine which he prepared for me and told me to use the herbal medicine for 21 days which i did, and my life get transformed and everything is fine and okay with me. Till now I have been going for check up and it is now going to four months and I am still negative.Thanks once again Dr.Balogun may God bless your good works. so contact him today via email balogun.herbalsolutioncenter@gmail.com you can also call or WhatsApp him on +2349064881054.

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  122. Hello! I'm very excited to inform everyone that I'm completely cured from my HSV 1&2 recently. I have used Oregano oil, Coconut oil, Acyclovir, Valacyclovir, Famciclovir, and some other products and it's really help during my outbreaks but I totally got cured! from my HSV with a strong and active herbal medicine ordered from a powerful herbalist and it completely fought the virus from my nervous system and I was tested negative after 14 days of using the herbal medicine. I'm here to let y'all know that herpes virus has a complete cure, I got rid of mine with the help of Dr Balogun and his herbal exploit. Contact him via email: balogun.herbalsolutioncenter@gmail.com call or whatsApp him on  +2349064881054.   

    ReplyDelete
  123. My herpes is cured and it’s miracle healing. Thanks to Dr.Apala who cure my Genital Herpes I was depressed when doctor told me that I have been diagnosed with Herpes disease… I thought about my Family, I know my Family will face a serious problem when I’m gone, I lost hope and I wept all day, but one day I was searching the internet I found Dr.Apala contact number called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I’m cured by Dr.Apala medicine, I’m very thankful to Dr.Apala and very happy with my hubby and family.or you can also reach him through email:dr.apalaherbalhome@gmail.com or Whats App number+2348114047176
    He can also cure so many sickness
    {1}HIV And AIDS
    {2}Diabetes
    {3}Epilepsy
    {4}Blood Cancer
    {5}HPV
    {7}ALS
    {8}Hepatitis
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    ReplyDelete
  124. Hello! I'm very excited to inform everyone that I'm completely cured from my HSV 1&2 recently. I have used Oregano oil, Coconut oil, Acyclovir, Valacyclovir, Famciclovir, and some other products and it's really help during my outbreaks but I totally got cured! from my HSV with a strong and active herbal medicine ordered from a powerful herbalist and it completely fought the virus from my nervous system and I was tested negative after 14 days of using the herbal medicine. I'm here to let y'all know that herpes virus has a complete cure, I got rid of mine with the help of Dr Balogun and his herbal exploit. Contact him via email: balogun.herbalsolutioncenter@gmail.com call or whatsApp him on  +2349064881054.   

    ReplyDelete
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  126. My herpes is cured and it’s miracle healing. Thanks to Dr.Apala who cure my Genital Herpes I was depressed when doctor told me that I have been diagnosed with Herpes disease… I thought about my Family, I know my Family will face a serious problem when I’m gone, I lost hope and I wept all day, but one day I was searching the internet I found Dr.Apala contact number called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I’m cured by Dr.Apala medicine, I’m very thankful to Dr.Apala and very happy with my hubby and family.or you can also reach him through email:dr.apalaherbalhome@gmail.com or Whats App number+2348114047176
    He can also cure so many sickness
    {1}HIV And AIDS
    {2}Diabetes
    {3}Epilepsy
    {4}Blood Cancer
    {5}HPV
    {7}ALS
    {8}Hepatitis
    {9}Low spam count.
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    ReplyDelete
  127. Hello! I'm very excited to inform everyone that I'm completely cured from my HSV 1&2 recently. I have used Oregano oil, Coconut oil, Acyclovir, Valacyclovir, Famciclovir, and some other products and it's really help during my outbreaks but I totally got cured! from my HSV with a strong and active herbal medicine ordered from a powerful herbalist and it completely fought the virus from my nervous system and I was tested negative after 14 days of using the herbal medicine. I'm here to let y'all know that herpes virus has a complete cure, I got rid of mine with the help of Dr Balogun and his herbal exploit. Contact him via email: balogun.herbalsolutioncenter@gmail.com call or whatsApp him on  +2349064881054.   

    ReplyDelete
  128. I can’t believe this. A great testimony that i must share to all HERPES patient in the world, i never believed that their could be a complete cure for HERPES or any cure for HERPES,i saw people’s testimony on blog sites and comment section about Dr.Apala a herbal doctor and the efficiency of his herbal medicine.I had to give him a try because i my self have been suffering from the same virus, and i was not disappointed. It took just few weeks i started using it i started noticing changes. I was cured . You can also contact him on his email:dr.apalaherbalhome@gmail.com or Whats App number+2348114047176
    He can also cure so many sickness
    1. HIV/AIDS
    2. HERPES
    3. CANCER
    4. ALS
    5. HEPATITIS B
    6. DIABETES
    7. HUMAN PAPILOMA VIRUS DISEASE(HPV)
    8. ALZHEIMER
    9. LUPUS (Lupus Vulgaris or Lupus Erythematosus)................

    ReplyDelete
  129. Please share as you read okay you may save a soul today, natural herbs
    are really great, I was cured from HSV by a doctor called DR Okiti from West Africa, now I believe that natural herbs and roots has their own way of working, based on medical report I was told that HSV has no cure even when I saw a post about Dr Okiti how he cured many people with his herbal medicine I doubted it at first but just decided to give it a try because I was so desperately trying to get rid of my problems not knowing it was going to be the end of this deadly virus in my body, please if you have anyone with this same virus or diseases like this contact Dr Okiti via email drokitiherbalhome100@gmail.com or whatsapp +234 705 067 0365. I'm a living testimony of his herbal medicine and don't forget to share as you read okay, please save a soul today.

    ReplyDelete
  130. I’m so happy to testify of the good work of Dr. Balogun I suffered from Herpes virus since 2007 and I had frequent symptoms in my private area, after some time it will go away after using acyclovir drugs, then come back after some months. it was disheartening since i have been diagnosed, but after finding Dr. Balogun and his reviews i was convinced that he will definitely cure me and so i contacted and he told me how to get his medicine and using it for just 14 days and i will go and check up and first i said how can that be possible but i used his herbal medicine after making purchase and truly i used it and went for the test again, and my result came back negative. So I made it a task to share this good testimony on the internet so that those sick can benefit and get cured. What's App or call him on +2349064881054 or reach him on his email via; balogun.herbalsolutioncenter@gmail.com.  

    ReplyDelete
  131. I can’t believe this. A great testimony that i must share to all HERPES patient in the world, i never believed that their could be a complete cure for HERPES or any cure for HERPES,i saw people’s testimony on blog sites and comment section about Dr.Apala a herbal doctor and the efficiency of his herbal medicine.I had to give him a try because i my self have been suffering from the same virus, and i was not disappointed. It took just few weeks i started using it i started noticing changes. I was cured . You can also contact him on his email:dr.apalaherbalhome@gmail.com or Whats App number+2348114047176
    He can also cure so many sickness
    1. HIV/AIDS
    2. HERPES
    3. CANCER
    4. ALS
    5. HEPATITIS B
    6. DIABETES
    7. HUMAN PAPILOMA VIRUS DISEASE(HPV)
    8. ALZHEIMER
    9. LUPUS (Lupus Vulgaris or Lupus Erythematosus)...................

    ReplyDelete
  132. Hello everyone, I’m so happy because I am free from (HERPES) I have been suffering from HERPES since the past three years now, and I have passed through many different processes in getting cured from herpes but nothing was working out. A friend of mine introduced me to a man called Dr.Balogun who sent me a herbal medicine which he prepared for me and told me to use the herbal medicine for 21 days which i did, and my life get transformed and everything is fine and okay with me. Till now I have been going for check up and it is now going to four months and I am still negative.Thanks once again Dr.Balogun may God bless your good works. so contact him today via email balogun.herbalsolutioncenter@gmail.com you can also call or WhatsApp him on +2349064881054.

    ReplyDelete
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  134. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS.I was positive to the Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw testimony about DR Ebhota online on how he cured so many persons from Herpes Disease so i decided to contact the great 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 help 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 FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drebhotasoltion@gmail.com) You can contact him on WhatsApp +2348089535482 He also have the herb to cure difference cure for any sickness (1) HERPES,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) HEPATITIS B,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA..

    ReplyDelete
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  138. _*Before people said there is no cure on herpes virus but today many people have now believe that there is a cure.of herpes virus can be cured through Africans root and harms,and days our great doctors has finally found the cure of herpes virus many have get cured with the help of a great spell caster known as Dr.chala he is the one of the great spell doctor in Africa and he has the cure on this virus last month he share his Haber medicine in some medical hospital and now he is well recognize as one of the best spell caster in Africa, you don’t have to be sad any more or share your tears any more on this virus when the cure have already be found from Chala*_dr.chalaherbalhome@gmail.com or drchala2@gmail.com http://meet.google.com/tks-xree-tsb

    ReplyDelete
  139. It’s obvious some patients with herpes are being enslaved to the antiviral and other supplementary Orthodox medicine just to help suppress the virus and not a cure. I have been with the virus since 2015 until I was introduced by a blogger who also narrated her story online on how she was cured of Genital Herpes after using Dr Sikies Herbal Medicine. This is a year and 2 weeks since I was delivered from genital Herpes. All thanks to God for using this Great herbalist to heal me. I have promised to keep telling good things about Dr Sikies. Please feel free to share Your problems with him and don’t forget to tell him I did refer you to Him. Thanks. Write him on mail Drsikies@gmail.com He deals with Alzheimer virus, Cancer, HIV, Herpes, Genital, warts, ALS, BV, UTI, Virginal infection, Genital, Wart, HPV, Hepatitis A/B, Good luck, HSV, Pregnancy, Ex back.

    here is his website: https://drsikiesherbalcure.weebly.com

    you can reach me via mail: anitalawson515@gmail.com

    ReplyDelete

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  141. i want to  inform the public how i was cured of herpes  Virus by a Doctor
    called Dr ishiaku. 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 ishiaku 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: ishiakuherbalcure@gmail.com or whatsapp him via +2348180828544
     and get all your problem solved.
    1)Sickness of any kind
    2)Help to CURE Hepatitis B, herpes, 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 wrath
    8)to enlargement of penis

    ReplyDelete
  142. I am really happy that i have been cured from (HERPES SIMPLEX VIRUS) with the herbal medicine of Dr OGBENI , i have been suffering from this disease for the past 3 years and 4 mouth without solution until i came across the email of this doctor who have cure so many people with his herbal medicine, i also choose to give him a chance to help me and my husband, he told me what to do and i kindly did it, and he gave us his herbal medicine and direct me on how to use it, i also follow his instructions for use and he ask us to go for a check up after 1 week and 5days which i did, to my greatest surprise our result came out as negative, we are really happy that there is someone like this doctor who is ready to help anytime any day. To all the readers and viewers that is doubting this testimony stop doubting it and contact this doctor if you really have one and see if he will not actually help you. i am not a stupid woman that i will come out to the public and start saying what someone have not done for me and i know that there are some people out there who are really suffering and hurting their family just because of these diseases so you can Email him on dr.ogbeniherbalhome@gmail.com OR
    WHATSAPP him on +2348103170329

    Thank you for your time and be happy again

    https://www.facebook.com/Dr-Ogbeni-100937351577518/

    ReplyDelete
  143. I still don’t know the right words to express my gratitude to this great man Dr. Uromi. After been diagnosed of HERPES SIMPLEX VIRUS in 2months ago, i was given so many health prescription and advice with no improvement, I totally lost hope, until i found testimonies of Great Dr. Uromi online research and on Facebook, Like anybody would be, I was very skeptical about contacting him, but i later did and he opened up to me and told me what was involved and he started the remedies for my health. Thank God, I was cured from herpes by the herbal medication I received from him. I never thought that herpes can be cured, from the bottom of my heart I'm truly grateful,i pray you have long life so you can help many more people on earth with your herbal medical support, You can Email him via email Druromiherbalhome@gmail.com or for easy and fast communication you can also call or add him on whats-app with this mobile number +2349021374574 , one thing i love most about DR Uromi is honestly, and he is very polite with his patience, everything he told me was what he did, and his herbal medicine are very affordable  

    ReplyDelete
  144. God bless Dr Uromi for his marvelous work in my life, I have been suffering from herpes virus since 2015 and I was taking my medications, and I wasn't really satisfied i needed to get this disease out of my system, I searched about some possible cure for herpes and hsv infections online when i saw some wonderful comments about Dr Uromi, how he cured hsv infections with his herbal medicine, I was relieve a little so I contacted him through the emaiL i got from the testifier, and i told him my problem and asked for solutions, he told he can help cure me completely if only i can trust him to work for me and i said yes i can and immediately he started the remedy for my health, and after which he sent me the medicine through UPS SPEED POST. I took the herbal remedy as directed by him and 14 days later i was cured from my herpes infection, thank you so much sir, so my dear viewers online if you have or know anyone out there suffering from Hsv, Herpes, Cold Sore, Fibroids, Anemia, Hiv etc i urged you to recommend them to Dr Uromi and i assure you he will be of great help. you can reach Dr Uromi on Email:: Druromiherbalhome@gmail.com . You can also add him on WhatsApp +2349021374574    .   

    ReplyDelete
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  147. It’s obvious some patients with herpes are being enslaved to the antiviral and other supplementary Orthodox medicine just to help suppress the virus and not a cure. I have been with the virus since 2015 until I was introduced by a blogger who also narrated her story online on how she was cured of Genital Herpes after using Dr Sikies Herbal Medicine. This is a year and 2 weeks since I was delivered from genital Herpes. All thanks to God for using this Great herbalist to heal me. I have promised to keep telling good things about Dr Sikies. Please feel free to share Your problems with him and don’t forget to tell him I did refer you to Him. Thanks. Write him on mail Drsikies@gmail.com He deals with Alzheimer virus, Cancer, HIV, Herpes, Genital, warts, ALS, BV, UTI, Virginal infection, Genital, Wart, HPV, Hepatitis A/B, Good luck, HSV, Pregnancy, Ex back.

    here is his website: https://drsikiesherbalcure.weebly.com

    you can reach me via mail: anitalawson515@gmail.com

    ReplyDelete

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  154. Hello everyone i want to use this medium to inform the world on how i got cured from Herpes at first when i had symptoms back in 2014 i went for test and it came out positive i lost hope of getting a better relationship or marriage, everything changed when i met Dr Harry i contacted explained everything to him and he said he has the cure so i decided to order it from him, so i actually did after 2 weeks i went for test and i was negative i'm forever grateful to him.he can also cure
    hpv
    epilepsy
    sickle cell anaemia
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    psoriasis
    pityriasis rosea etc.
    email: drharryherbs@gmail.com
    website: https://drharryherbs.weebly.com
    whatsapp: +2347034556861

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  157. what a miracle i never believe there is cure because my doctor tested me HSV 2 positive and she told me there is no cure, i’m very happy today that i’m having a free life without this sickness, i can remember some months ago when i was crying all through the night and day that i can’t get cured from this sickness, i found this herbal man email on internet when i was doing research on cure for HSV 2 i contacted him to found out if i can get help from this sickness, i was so surprise when he told me that he have the herbs cure to it and he sent me the herbal in less down 4 days i was so happy when i get someone giving me hope that he can cured me i took the herbal for just 2 weeks, when i went for test after taking the herbal i found out that i am cured i was so happy and surprise, i want to use this opportunity to inform you that there is cured to HSV 2 you can also contact him for his help as soon as possible so that you can get rid of this sickness once and for all you can reach him through this email: DRAZIEGBE1SPELLHOME@GMAIL. COM or and you can also call or whatapp him now +2349035465208. You can also contact him on any sickness in this he all have the herbal cure to it
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  158. My wife diabetes symptom was diabetic neuropathy. We didn't know she was diabetic until we went to my doctor complaining about constant foot pain. After a multitude of tests for everything from rheumatoid arthritis to muscular dystrophy, an emergency room physician checked her blood sugar.After reviewing a letter written by my doctor, where I read he had prescribed Celebrex for her due to pain of Arthritis which had really messed her neck, back and knees, I found that one of the side effects of Celebrex is Diabetes, my wife was able to effectively cure herbal condition multivitamincare org It is too much for a patient to endure such as they slowly begin to pass away if the right medication is not taken organic herbal treatment.Having a positive mind is a powerful tool .My prayers goes out to diabetes patients and their care givers.

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