Sunday, August 7, 2011

Internal medicine: writing and presenting

Many people get into medicine and don't know how to properly write a note or how to present a patient to an attending physician.  This includes medical students and those studying to become physician assistants and nurse practitioners.  Granted, most do learn through trial, error, and guidance from preceptors.  But I thought I would help my readers out with a quick "how to" on the topic.

The first time you see a patient, you should perform a full history and physical.  If you keep the steps of your first, and fullest note in mind, then you will not forget anything:

  • The History of Present Illness (HPI): the full story about what brought the patient into the hospital
  • Past Medical History: a list of the patient's medical conditions
  • Medications: what medications the patient takes, including anything over the counter, vitamins, and supplements
  • Allergies: and what happens when exposed to the allergens
  • Past Surgical History: the patient's past surgeries and an approximate year in which they took place
  • Family History: any medical conditions which run in the family, with focus primarily on the patient's parents and siblings 
  • Social History: sometimes the most difficult part to ascertain, it should always include the patient's past or current use of tobacco, alcohol, or illicit drugs; sexual history, employment, etc., also fall under this category
  • Vital signs
  • Physical exam
  • Test results
  • Clinical assessment: a brief sentence summarizing the patient's presentation and reason for admission
  • Assessments: differential diagnosis, as well as any other conditions which need treatment
  • Plans: treatment for all assessed conditions, including any tests to help eliminate differentials
When presenting the patient for the first time, do it in the same order as your history and physical.  Be sure to report vitals in your presentation even if they all fall within normal limits.  When presenting the physical, you may condense it to only the positives.  When presenting test results, always mention such numbers as hemoglobin, creatinine, etc., as well as any values which fall out of normal range.  For any radiological tests summarize the radiologist's findings. 

Not all physicians expect a lengthy presentation.  For instance- some physicians will want a condensed version: what brought the patient in along with any pertinent information all summarized into a sentence; followed then with an assessment and plan.  Similarly not all will want the exact history and physical I have laid out in this post.  All will expect an understanding of what you write and present.  If you lack knowledge on a certain topic read up on it.

The importance of the history and physical has come into question by some, but research does not agree with such opinions.

ResearchBlogging.org

Pryor DB, Shaw L, McCants CB, Lee KL, Mark DB, Harrell FE Jr, Muhlbaier LH, & Califf RM (1993). Value of the history and physical in identifying patients at increased risk for coronary artery disease. Annals of internal medicine, 118 (2), 81-90 PMID: 8416322

Viner S, Szalai JP, & Hoffstein V (1991). Are history and physical examination a good screening test for sleep apnea? Annals of internal medicine, 115 (5), 356-9 PMID: 1863025

36 comments:

  1. This was a great article that really was really helpful to me and I really cant wait to learn more from your valuable experience. This was really very interesting to me. Thanks.


    Laith Salma

    ReplyDelete
  2. Interesting perspective! And we, the patients, should be involved and take responsibility in our lifestyle choices and health care.

    mitral valve regurgitation

    ReplyDelete
  3. I really appreciate your point of view when it comes to examining the patient. And I do agree with jade89 that patient should also cooperate in discussing their previous health issues to the doctor to avoid misdiagnosis.

    internal medicine

    ReplyDelete
  4. Hello everyone am BRIAN WALKER,
    From USA , i am here to give my testimony about a spell caster called DR IFADE, I was heartbroken because i had very small penis, not big 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 IFADE and decided to email him on his email i saw on the internet,(ifadesolutionspell31@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 Kate, 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 IFADE. i urge you now to contact DR IFADE
    for help on his email via (ifadesolutionspell31@gmail.com or call and whatsapp him on his mobile +2349060120490.

    DR IFADE SPECIALIZE IN ALL OF THIS SO I URGE YOU WITHOUT DELAY TO CONTACT HIM FOR HELP ;
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    HIV
    ALS
    HERPES
    CANCER
    Best regard
    BRIAN WALKER.

    ReplyDelete
  5. Hello everyone am BRIAN WALKER,
    From USA , i am here to give my testimony about a spell caster called DR IFADE, I was heartbroken because i had very small penis, not big 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 IFADE and decided to email him on his email i saw on the internet,(ifadesolutionspell31@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 Kate, 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 IFADE. i urge you now to contact DR IFADE
    for help on his email via (ifadesolutionspell31@gmail.com or call and whatsapp him on his mobile +2349060120490.

    DR IFADE SPECIALIZE IN ALL OF THIS SO I URGE YOU WITHOUT DELAY TO CONTACT HIM FOR HELP ;
    Permanent penis enlargement
    Thick penis
    Bigger penis head
    Effective erections
    HIV
    ALS
    HERPES
    CANCER
    Best regard
    BRIAN WALKER.

    ReplyDelete
  6. Good day everyone,i am Lisa Robbin from california
    I want everyone to join me to thank God for using DR.KEN to bring my husband back to me.
    Life without my husband was a real mess for me and my children I am so happy to get my Ex husband back through the help of Great DR.KEN the spell caster . My greatest surprise was that 48 hours after the Doctor casted the spell for me, my husband who has abandoned me for years suddenly called me unexpectedly and started begging for my forgiveness.
    Am so happy that we have become one happy family again through the help of Great DR.KEN. Dr Noble is a very wonderful and powerful spell caster, you can contact him if you need his assistant because i know he can also help you. contact him through his email: greatdrkenspelltemple@gmail.com call him or Whatsapp on +2348104557346 and share your testimonies also.

    ReplyDelete
  7. Good day everyone,i am Lisa Robbin from california
    I want everyone to join me to thank God for using DR.KEN to bring my husband back to me.
    Life without my husband was a real mess for me and my children I am so happy to get my Ex husband back through the help of Great DR.KEN the spell caster . My greatest surprise was that 48 hours after the Doctor casted the spell for me, my husband who has abandoned me for years suddenly called me unexpectedly and started begging for my forgiveness.
    Am so happy that we have become one happy family again through the help of Great DR.KEN. Dr Noble is a very wonderful and powerful spell caster, you can contact him if you need his assistant because i know he can also help you. contact him through his email: greatdrkenspelltemple@gmail.com call him or Whatsapp on +2348104557346 and share your testimonies also.


    Good day everyone,i am Lisa Robbin from california
    I want everyone to join me to thank God for using DR.KEN to bring my husband back to me.
    Life without my husband was a real mess for me and my children I am so happy to get my Ex husband back through the help of Great DR.KEN the spell caster . My greatest surprise was that 48 hours after the Doctor casted the spell for me, my husband who has abandoned me for years suddenly called me unexpectedly and started begging for my forgiveness.
    Am so happy that we have become one happy family again through the help of Great DR.KEN. Dr Noble is a very wonderful and powerful spell caster, you can contact him if you need his assistant because i know he can also help you. contact him through his email: greatdrkenspelltemple@gmail.com call him or Whatsapp on +2348104557346 and share your testimonies also.

    ReplyDelete
  8. Hello everyone i Am williams pater and i am from USA i am here to give my testimony about an herbal doctor called Dr,olu I was heartbroken because i had very small penis,not nice 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 could not offer me the help i searched for. i saw some few comments on the internet about this specialist called Dr,OLU and decided to email him on his email i saw on the internet,(drolusolutionhome@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 product for Penis Enlargement, Within three weeks of me use it, i began to feel the enlargement, " and now it just 4 weeks of using his products my penis is about 8 inches longer, and i had to settle thing out with my ex girlfriend , i was surprised when she said that she is satisfied with my performance in bed and i now have a large penis.thanks to DR OLU for is herbal product. you can also reach him with emsil drolusolutionhome@gmail.com though is..number WHATASPP him today on this number [ +2348140654426 ]

    ReplyDelete
    Replies
    1. My name is Benita Willson from GERMANY, I want to quickly tell the world that there is a real spell caster that is powerful and genuine, His name is Dr Ken He helped me recently to reunite my relationship with my husband who left me, When i contacted Dr Ken he cast a love spell for me and my husband who said he doesn't have anything to do with me again called me and started begging me. he is back now with so much love and care. today i am glad to let you all know that this spell caster have the powers to bring lovers back. because i am now happy with my husband. To anyone who is reading this article and needs any help, Dr Ken can help...You can contact him Via this email greatdrkenspelltemple@gmail.com or via WhatsApp with this number +2348104557346


      My name is Benita Willson from GERMANY, I want to quickly tell the world that there is a real spell caster that is powerful and genuine, His name is Dr Ken He helped me recently to reunite my relationship with my husband who left me, When i contacted Dr Ken he cast a love spell for me and my husband who said he doesn't have anything to do with me again called me and started begging me. he is back now with so much love and care. today i am glad to let you all know that this spell caster have the powers to bring lovers back. because i am now happy with my husband. To anyone who is reading this article and needs any help, Dr Ken can help...You can contact him Via this email greatdrkenspelltemple@gmail.com or via WhatsApp with this number +2348104557346

      Delete
    2. 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. He also specializes in the following things
      Herpes virus
      Cancer
      Hsv
      Chronic venous disease
      and others

      Delete
  9. Behold I was in a very bad shape when I lost my boyfriend. We were supposed to get married and everything got cancelled which was my fault. He broke up with me because he was a good guy who I treated wrong and didn’t appreciate.
    Subsequently I became so depressed and ashamed of myself, I realized he was my life coach and all, I cannot live without him. I searched and found Dr. Wakina just like others did, “Doctor please help me out, bring him back to me since he already got a new girlfriend. Not only do I have a broken heart but I have a broken soul too. I don’t know if he wants to show off or take a revenge from me. Make me everything he desires.” The result was presented to me as asked. The man I carelessly lost was brought back. I’m sharing this post to the public because Dr.Wakina via his email……. dr.wakinalovetemple@gmail.com wiped my secret tears and made us whole again. I’m now filled with tears of joy. All my mistakes have been forgiven and forgotten.

    ReplyDelete
  10. Hello everyone, my name is ALFREED SIANG i am here to say a big thank you to my doctor DR OLU who helped me enlarge my penis.i have never had a happy relationship in my life because of my inability to perform well due to my small penis, due to frustration,i went online in search of solution to ending my predicament and than i came across testimony on how DR OLU has helped them, so i contacted him and he promised to help me with penis enlargement,i doubted at first but i gave him a trial and he sent me the product which i used according to his prescription and in less than a week,i saw changes in my penis and it grow to the size i wanted and since then,i am now a happy man and no lady complains again about my penis.if you also need the services of my doctor,you can also contact him on his email..drolusolutionhome@gmail.com or his whataspp is +2348140654426

    ReplyDelete
  11. Readers,be careful here nobody can help you here or even suggest how you can get your ex or love back,most testimonies of most spell casters here must be ignored.because most of them are scam i mean real scam which i was a victim and i got ripped of thousands of dollars because i was so anxious to get my lover back after she left me for over 2 years and 7 months with my 6 years old daughter,i have applied to more than 4 different spell casters here and all to no avail they all ask for same thing send your name your ex,address,picture phone number etc which i did over and over again and most of them were from west Africa until i saw a post about GREAT DR KEN and i decided to give him my last trial.he ask me for 4 things which are my real name,my ex and my ex mother name and some little amount of money to get some items and said my ex will come back in 3days, i have paid over $3500 on spell casting and nothing have work for me after 3days i was thinking about how much i have lost so far so i said let me give him a try so i called him again and send my real name,my ex and my ex mother name and the money for items he requested for because i swear it was my last try so i was waiting as he told me to wait till the next 3 days and i could not sleep those night because i really love my wife and want her back at 9pm the third day i saw my wife online on facebook and she said hi at first i was shocked because she never talked with me for the past 2years and 7 month now i did not reply again she said are you there? i quickly reply yes and she said can we see tomorrow i said yes and she went off-line i was confused i try to chat her up again but she was no more online i could not sleep that night as i was wondering what she is going to say, by 7.am the next morning she gave me a miss call i decided not to call back as i was still in shock again she called and i pick she said can we see after work today i said yes so she ended the call immediately i got off work he called me and we met and all she deed was to beg me to take her and our daughter back.I had no choice than to take her back because i love her so much and now we are back again i called THE GREAT DR KEN that same day to thank him for what he has done infact i still call him and thank him as my life was not complete without my wife please be careful here i have been scammed thousands of dollars if you want a true love spell then contact GREAT DR KEN on his email address greatdrkenspelltemple@gmail.com or whatsapp him via his phone number +2348104557346.

    ReplyDelete
  12. Readers,be careful here nobody can help you here or even suggest how you can get your ex or love back,most testimonies of most spell casters here must be ignored.because most of them are scam i mean real scam which i was a victim and i got ripped of thousands of dollars because i was so anxious to get my lover back after she left me for over 2 years and 7 months with my 6 years old daughter,i have applied to more than 4 different spell casters here and all to no avail they all ask for same thing send your name your ex,address,picture phone number etc which i did over and over again and most of them were from west Africa until i saw a post about GREAT DR KEN and i decided to give him my last trial.he ask me for 4 things which are my real name,my ex and my ex mother name and some little amount of money to get some items and said my ex will come back in 3days, i have paid over $3500 on spell casting and nothing have work for me after 3days i was thinking about how much i have lost so far so i said let me give him a try so i called him again and send my real name,my ex and my ex mother name and the money for items he requested for because i swear it was my last try so i was waiting as he told me to wait till the next 3 days and i could not sleep those night because i really love my wife and want her back at 9pm the third day i saw my wife online on facebook and she said hi at first i was shocked because she never talked with me for the past 2years and 7 month now i did not reply again she said are you there? i quickly reply yes and she said can we see tomorrow i said yes and she went off-line i was confused i try to chat her up again but she was no more online i could not sleep that night as i was wondering what she is going to say, by 7.am the next morning she gave me a miss call i decided not to call back as i was still in shock again she called and i pick she said can we see after work today i said yes so she ended the call immediately i got off work he called me and we met and all she deed was to beg me to take her and our daughter back.I had no choice than to take her back because i love her so much and now we are back again i called THE GREAT DR KEN that same day to thank him for what he has done infact i still call him and thank him as my life was not complete without my wife please be careful here i have been scammed thousands of dollars if you want a true love spell then contact GREAT DR KEN on his email address greatdrkenspelltemple@gmail.com or whatsapp him via his phone number +2348104557346.

    ReplyDelete
  13. Unfortunately there are a lot of AIDS/Herpes denials on Herbal cures still out there. I did research on them after I was tested HIV/Herpes positive I was so worried am I going to die soon. I continue my search again on herbal remedy for Std, then I found lots of testimony on how Dr Itua Herbal Medicine Cured HIV/Aids, Herpes Virus,Copd, Hepatitis, Diabetes, On websites sharing their testimonies, which made much more sense to me. All the authors pronounce Dr Itua As a man with Good Heart, I pick interest in their testimonies and I contact him about my situation then he gave me procedure how it works, I proceed after one week he courier his Herbal Medicine to me and instruct me on how to drink it for two weeks to cure. I receive His Herbal Medicine so I drank it for two weeks as I was told then after 2 days I go for a test I found out I was cured from HIV/Aids & Herpes Virus, I pay homage to him 2 months ago to his country to celebrate with him on his African festival which he told me it usually happens every year. I know there are lots of (HIV)/Aids&Herpes Virus denials of Herbal Remedy movement the same few doctors and they represent a very small faction of the community. I could have died because I refused Natural Herbs Cures for so long, but luckily, by the grace of God I am alive to tell my story. Contact Info...Whatsapp Number...+2348149277967,Email...drituaherbalcenter@gmail.com/My Instagram Username...avat5634 Just in case you need someone to talk with.

    ReplyDelete
    Replies
    1. 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. He also specializes in the following things
      Herpes virus
      Cancer
      Hsv
      Chronic venous disease
      and others




      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. He also specializes in the following things
      Herpes virus
      Cancer
      Hsv
      Chronic venous disease
      and others

      Delete
  14. My name is Benita Willson from GERMANY, I want to quickly tell the world that there is a real spell caster that is powerful and genuine, His name is Dr Ken He helped me recently to reunite my relationship with my husband who left me, When i contacted Dr Ken he cast a love spell for me and my husband who said he doesn't have anything to do with me again called me and started begging me. he is back now with so much love and care. today i am glad to let you all know that this spell caster have the powers to bring lovers back. because i am now happy with my husband. To anyone who is reading this article and needs any help, Dr Ken can help...You can contact him Via this email greatdrkenspelltemple@gmail.com or via WhatsApp with this number +2348104557346


    My name is Benita Willson from GERMANY, I want to quickly tell the world that there is a real spell caster that is powerful and genuine, His name is Dr Ken He helped me recently to reunite my relationship with my husband who left me, When i contacted Dr Ken he cast a love spell for me and my husband who said he doesn't have anything to do with me again called me and started begging me. he is back now with so much love and care. today i am glad to let you all know that this spell caster have the powers to bring lovers back. because i am now happy with my husband. To anyone who is reading this article and needs any help, Dr Ken can help...You can contact him Via this email greatdrkenspelltemple@gmail.com or via WhatsApp with this number +2348104557346

    ReplyDelete
  15. Hello everyone i Am williams pater and i am from USA i am here to give my testimony about an herbal doctor called Dr,olu I was heartbroken because i had very small penis,not nice 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 could not offer me the help i searched for. i saw some few comments on the internet about this specialist called Dr,OLU and decided to email him on his email i saw on the internet,(drolusolutionhome@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 product for Penis Enlargement, Within three weeks of me use it, i began to feel the enlargement, " and now it just 4 weeks of using his products my penis is about 8 inches longer, and i had to settle thing out with my ex girlfriend , i was surprised when she said that she is satisfied with my performance in bed and i now have a large penis.thanks to DR OLU for is herbal product. you can also reach him with emsil drolusolutionhome@gmail.com though is..number WHATASPP him today on this number [ +2348140654426 ]

    ReplyDelete

  16. Hello Viewer, my name is Walker Brian i want to thanks DR Akpudeke who use his herbs enlargement cream to make my penis bigger without any side effect because my penis was very small before someone in my working place introduce me to this grate herbal doctor called Dr Akpudeke and i contacted him, and told him that my penis is very small if he can make it bigger and he told me that he his going to help me with the bigger size of pines with his herbs which was send to me through the DHL, after making use of the herbs as it instructed by him and i found out that after one week of making use of the herbs my penis that was very small become the biggest without any side effect but now i am very happy the way it is now, i am now very happy that i can satisfy a lady and if you want to contact this man here his email:drakpudeke@gmail.com
    DOCTOR AKPUDEKE CAN AS WELL HELP THE FOLLOWING PROBLEMS
    1. HIV/AIDS SPELL
    2. HERPES SPELL
    3. CANCER SPELL
    4 IF YOU WANT YOUR EX LOVER BACK SPELL
    5 IF YOU NEED A BABY SPELL him to solve. Contact him now {drakpudeke@gmail.com} from united state
    6 LOW SPERM COUNT SPELL
    get all your problem solve. No problem is too big for God

    ReplyDelete

  17. Hello Viewer, my name is Walker Brian i want to thanks DR Akpudeke who use his herbs enlargement cream to make my penis bigger without any side effect because my penis was very small before someone in my working place introduce me to this grate herbal doctor called Dr Akpudeke and i contacted him, and told him that my penis is very small if he can make it bigger and he told me that he his going to help me with the bigger size of pines with his herbs which was send to me through the DHL, after making use of the herbs as it instructed by him and i found out that after one week of making use of the herbs my penis that was very small become the biggest without any side effect but now i am very happy the way it is now, i am now very happy that i can satisfy a lady and if you want to contact this man here his email:drakpudeke@gmail.com
    DOCTOR AKPUDEKE CAN AS WELL HELP THE FOLLOWING PROBLEMS
    1. HIV/AIDS SPELL
    2. HERPES SPELL
    3. CANCER SPELL
    4 IF YOU WANT YOUR EX LOVER BACK SPELL
    5 IF YOU NEED A BABY SPELL him to solve..Contact him now drakpudeke@gmail.com from united state......
    6 LOW SPERM COUNT SPELL
    get all your problem solve. No problem is too big for God

    ReplyDelete
  18. 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. He also specializes in the following things
    Herpes virus
    Cancer
    Hsv
    Chronic venous disease
    and others

    ReplyDelete
  19. OMG!! This is certainly a shocking and a genuine Testimony..I visited a
    forum here on the internet on the 20TH OF JUNE 2018, And i saw a
    marvelous testimony of this powerful and great Doctor called
    PRIEST AZIBA on the forum..I never believed it, because i never heard
    nor learnt anything about Natural Enlargement Product. Nobody would have been able to influence me about Natural Enlargement Product not until PRIEST AZIBA did it for me and restored my Penis to a Normal size which i was very ok to have(11inch) he ask if i want to increase it further more i told him am ok with this i have now, so i am recommending you all in same or similar depress to contact DR AZIBA via mail: PRIESTAZIBASOLUTIONCENTER@GMAIL.COM and also Contacted him on his whatsApp +2348100368288
    I am really short of expressions, and i don't know how much to convey my appreciation to you PRIEST AZIBA you are a God sent to me and my entire family.. And now i am a joyful man with my family here is DR Email and WhatsApp contact below
    * Email: priestazibasolutioncenter@gmail.com
    Website: [ http://drallenhealingcureworldwide.webs.com ]
    *.WhatsApp:+2348100368288.......



    OMG!! This is certainly a shocking and a genuine Testimony..I visited a
    forum here on the internet on the 20TH OF JUNE 2018, And i saw a
    marvelous testimony of this powerful and great Doctor called
    PRIEST AZIBA on the forum..I never believed it, because i never heard
    nor learnt anything about Natural Enlargement Product. Nobody would have been able to influence me about Natural Enlargement Product not until PRIEST AZIBA did it for me and restored my Penis to a Normal size which i was very ok to have(11inch) he ask if i want to increase it further more i told him am ok with this i have now, so i am recommending you all in same or similar depress to contact DR AZIBA via mail: PRIESTAZIBASOLUTIONCENTER@GMAIL.COM and also Contacted him on his whatsApp +2348100368288
    I am really short of expressions, and i don't know how much to convey my appreciation to you PRIEST AZIBA you are a God sent to me and my entire family.. And now i am a joyful man with my family here is DR Email and WhatsApp contact below
    * Email: priestazibasolutioncenter@gmail.com
    Website: [ http://drallenhealingcureworldwide.webs.com ]
    *.WhatsApp:+2348100368288.......

    ReplyDelete
  20. my name is Promise dickson Finch am from Texas USA. I want to share a testimony of how Dr. OLU 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 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. OLU. 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 two weeks 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 weak 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 (drolusolutionhome@gmail.com) You can contact him today and get your problem solved.Call +2348140654426 .." or you can also contact him through his what-app +238140654426

    ReplyDelete
  21. 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. He also specializes in the following things
    Herpes virus
    Cancer
    Hsv
    Chronic venous disease
    and others

    ReplyDelete
  22. 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. He also specializes in the following things
    Herpes virus
    Cancer
    Hsv
    Chronic venous disease
    and others

    ReplyDelete
  23. Hello, i just want to pass a brief information to you all here about the cure for HPV / WART VIRUS, i have been sick with this Virus for the past some Years now, i did all i could to be cured , i went to different hospitals but no cure was found so to make it shot, a friend of mine (Alisha) visited me and told me about a herbal Dr called Dr AZIBA who cured her mum from diabetes just some weeks ago and assured me that the herbal Dr is well known and he will send me his medicine and that will be the end of my virus after i must have use it according to his instructions, i had no choice again so i contacted the Dr and explained to him my problems, so he actually sent me the medicine here and which i used according to his instruction and today i am totally cured from HPV/WART, I went for text and ,my home Dr confirmed to me that am texted Negative and that i am strong and healthy, i say a very big thanks to Dr Aziba for his help and i will also write down his contacts so you can apply for your cure or any other disease or virus you may be having popularly like....
    HEPATITIS A,B AND C
    DIABETICS 1/2
    CANCER
    ALS,HPV 1/2
    HIV AIDS
    WART
    BODY REDUCTION AND
    Enlargement
    FIBROID
    CANCER
    PREGNANCY
    Relationship issues etc. all you just have to do is to contact Dr Aziba via
    Email: PRIESTAZIBASOLUTIONCENTER@GMAIL.COM
    WhatsApp: +2348100368288

    ReplyDelete
  24. 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. He also specializes in the following things
    Herpes virus
    Cancer
    Hsv
    Chronic venous disease
    and others

    ReplyDelete
  25. If you should be opting for finest contents like me, just visit this blog site daily because it provides the feature contents, thanks. PARALLEL PROFITS AIDAN BOOTH

    ReplyDelete
  26. Thank you Dr.Ogudugu for the great work you did for me when my lover broke my heart. Dr.Ogudugu was able to bring my lover that left for about 2 months back to me within 48 hours of me contact Dr.Ogudugu. Contact Dr.Ogudugu on greatogudugu@gmail.com or better still you can give Dr.Ogudugu a call onWhatsApp +27663492930 for a better understanding for what i just said about him..

    ReplyDelete
  27. I was diagnose of Chronic Obstructive Pulmonary Disease (COPD) 2 years ago, my family doctor told me there is no cure but it can only be controled. Ever since then i have been running heather scepter looking for a solution to my problem because i was going to lose my Job if i dont get better, until i ran into this online testimony of Mrs Alicia who have been cured of COPD by this herbal clinic in Africa (Astoria Herbal Clinic), i immediately contacted them via their email (azentemple@gmailcom), to God be thy glory i bought this COPD herbal remedy and was cured within 3 weeks of usage, at last this is a break through for all COPD patients contact this herbal clinic via their email ( azentemple@gmailcom) or whasapp +2349038299828 He also have the herb to cure:
    (1) ALS,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) CANCER,
    (6) HERPES.

    ReplyDelete
  28. I was diagnose of Chronic Obstructive Pulmonary Disease (COPD) 2 years ago, my family doctor told me there is no cure but it can only be controled. Ever since then i have been running heather scepter looking for a solution to my problem because i was going to lose my Job if i dont get better, until i ran into this online testimony of Mrs Alicia who have been cured of COPD by this herbal clinic in Africa (Astoria Herbal Clinic), i immediately contacted them via their email (azentemple@gmailcom), to God be thy glory i bought this COPD herbal remedy and was cured within 3 weeks of usage, at last this is a break through for all COPD patients contact this herbal clinic via their email ( azentemple@gmailcom) or whasapp +2349038299828 He also have the herb to cure:
    (1) ALS,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) CANCER,
    (6) HERPES.

    ReplyDelete
  29. I'm 15 years old. I was born with HIV my mother passed away because of the HIV infection And I regret why i never met Dr Itua he could have cured my mum for me because as a single mother it was very hard for my mother I came across Dr itua healing words online about how he cure different disease in different races diseases like HIV/Aids Herpes,Parkison,Asthma,Copd,Epilepsy,Shingles,Cold Sore,Infertility, Chronic Fatigues Syndrome,Fibromyalgia, Diabetes Hepatitis even Cancer I was so excited but frighten at same time because I haven't come across such thing article online then I contacted Dr Itua on Mail drituaherbalcenter@gmail.com I also chat with him on what's app +2348149277967 he tells me how it works then I tell him I want to proceed I paid him so swiftly Colorado post office I receive my herbal medicine within 4/5 working days he gave me guild lines to follow and here am I living healthy again can imagine how god use men to manifest his works am I writing in all articles online to spread the god work of Dr Itua Herbal Medicine,He's a Great Man.

    ReplyDelete
  30. After my boyfriend of one year broke up with me, I could barely speak without crying. I felt blindsided and didn't know what to do. I didn't know if I could get him back and the anxiety was unbearable. I needed him back desperately because i loved him so much. So i contacted this great spell caster for help. He helped me cast a return love spell on him and just within 48 hours my boyfriend came back to me crying and begging for my forgiveness. Dr Larry released him to know how much i loved and wanted him. And He also opened his eyes to picture how much love we have share together. As I am writing this testimony right now i am the most happiest woman on earth. I want to recommend this great spell caster to anyone that truly needs an urgent solution to a love break up Email him at assurancesolutionhome@gmail.com or Call/WhatsApp him: +1(424)-261-8520 "I'm so grateful and can say that if you have been broken up with and want to get that person back, Dr Larry is the best! I'll never forget how much he helped me  website http://assurancesolutionhome.wordpress.com  http://assurancesolutionhome.website2.me/




    After my boyfriend of one year broke up with me, I could barely speak without crying. I felt blindsided and didn't know what to do. I didn't know if I could get him back and the anxiety was unbearable. I needed him back desperately because i loved him so much. So i contacted this great spell caster for help. He helped me cast a return love spell on him and just within 48 hours my boyfriend came back to me crying and begging for my forgiveness. Dr Larry released him to know how much i loved and wanted him. And He also opened his eyes to picture how much love we have share together. As I am writing this testimony right now i am the most happiest woman on earth. I want to recommend this great spell caster to anyone that truly needs an urgent solution to a love break up Email him at assurancesolutionhome@gmail.com or Call/WhatsApp him: +1(424)-261-8520 "I'm so grateful and can say that if you have been broken up with and want to get that person back, Dr Larry is the best! I'll never forget how much he helped me  website http://assurancesolutionhome.wordpress.com  http://assurancesolutionhome.website2.me/



    After my boyfriend of one year broke up with me, I could barely speak without crying. I felt blindsided and didn't know what to do. I didn't know if I could get him back and the anxiety was unbearable. I needed him back desperately because i loved him so much. So i contacted this great spell caster for help. He helped me cast a return love spell on him and just within 48 hours my boyfriend came back to me crying and begging for my forgiveness. Dr Larry released him to know how much i loved and wanted him. And He also opened his eyes to picture how much love we have share together. As I am writing this testimony right now i am the most happiest woman on earth. I want to recommend this great spell caster to anyone that truly needs an urgent solution to a love break up Email him at assurancesolutionhome@gmail.com or Call/WhatsApp him: +1(424)-261-8520 "I'm so grateful and can say that if you have been broken up with and want to get that person back, Dr Larry is the best! I'll never forget how much he helped me  website http://assurancesolutionhome.wordpress.com  http://assurancesolutionhome.website2.me/

    ReplyDelete
  31. MY TESTIMONY ABOUT HOW DR IMOLOA HERBAL CREAM ENLARGE MY PENIS FROM 4 INCHES TO 8 INCHES

    Hello everyone here i want to share a marvelous testimony oh how Dr Imoloa HERBAL MIXTURE CREAM saved me from shame and disgrace .So Many Women Today Cheat On Their Husband All Because Of The Poor Performance Of Their Husband In Bed,I Have Come To Know That Women Love Men Who Last Long In Bed And Also Has That Big Dick That Can Make Them Scream And Also Make Them Rich Their Climax,Women Truly Love Good Sex. I Have Been Passing True Sexual Problems For The Past Six Years Now All Because Of The Size Of My Penis And My Poor Performance In Bed I Caught My Wife With A Man On Our Matrimonial Bed I Was Heart Broken And Confused When I Asked Her Why She Did All What She Did She Told Me I Was Not Good In Bed That I Can Not Satisfy Her That She Needs A Man Who Can Satisfy Her That Was How She Broke Up With Me At That Moment. I Told My Self I Was Never Going To Have Any Thing To Do With Any Woman Again I Started Going To The Club Sleeping Around With Different Girls at a Point I Got Tired Of Living That Kind Of Life Because That Was Never Part Of Me I Was On Line Last Month When I Came Across so many testimonies On   Dr imoloa, How He Made their Sex Life Come Back To Life And That He Had Giving Them The Real Size Of Penis A Man  Suppose To Have I Got Interested And I Contacted Him At Once Luckily For Me He Was Online After About 30 Minutes He Replied Me And Then He Told Me Every Thing I Needed To Do After Every Thing He Sent Me A herbal cream Package True The DHL courier  Service Which I Received The Next three Days And Then I Started Using Them As Instructed By Him After About 2 Weeks I Started Seeing My Penis Got to 8 inches And i Felt So Many Changes Inside Of Me And Today I Am Happily Married With 2 kids And Last Up more than 1 Hour On Bed and can go up to 10 rounds with my wife All Thanks To Dr imoloa For Making Me Feel Like A Man Once Again.note he also have cure for..PENIS ENLARGEMENT, BREAST ENLARGEMENT, DIABETES 1/2,HIV/AIDS,HERPES,CANCER,PREMATURE EJACULATION,WEAK ERECTION,ERECTILE DYSFUNCTION ,LOW SPERM COUNT PREGNANCY HERBAL MEDICINE HIGH BLOOD PRESSURE LOW SPERM COUNT LYME DISEASE many more..  Contact Via drimolaherbalmademedicine@gmail.com or  whatssapp--+2347081986098

    ReplyDelete
  32. Great Dr. imoloa herbal medicine is the perfect cure for the HIV virus, I was diagnosed of HIV for 8 years, and every day I always looking for research to find the perfect way to get rid of this terrible disease because I always know that what we need because our health is on earth . So, on my internet search I saw several testimonies about how Dr. imoloa can cure HIV with powerful herbal medicines. I decided to contact this man, I contacted him for herbal medicines that I received via DHL courier service. And he guided me how. I asked him for a solution to take herbal medicine for two weeks. And then he instructed me to go check what I was doing. Look at me (HIV NEGATIVE). Thank God for Dr. Imoloa for using a powerful herbal remedy to cure me. he also has a cure for diseases such as Parkison's disease, vaginal cancer, epilepsy, anxiety disorders, autoimmune diseases, back pain, sprains, bipolar disorder, brain tumors, malignant, bruxism, bulimia, cervical disc disease, cardiovascular disease, cardiovascular disease, sprains, bipolar disorder, brain tumors, malignant, bruxism, bulimia, cervical disc disease, cardiovascular disease, cardiovascular disease, sprains, bipolar disorder, brain tumors, malignant, bruxism, bulimia, cervical disc disease, cardiovascular disease , chronic respiratory diseases, mental and behavioral disorders, Cystic Fibrosis, Hypertension, Diabetes, asthma, autoimmune mediated arthritis. Chronic kidney disease, arthritis, back pain, impotence, feta alcohol spectrum, Dysthymic Disorders, Eczema, skin cancer, tuberculosis, Chronic Fatigue Syndrome, constipation, inflammatory bowel disease, bone cancer, lung cancer, mouth sores, oral cancer, body pain, fever, hepatitis ABC, syphilis, diarrhea, Huntington's disease, back acne, chronic kidney failure, Addison's disease, Chronic Disease, Crohn's Disease, Cystic Fibrosis, Fibromyalgia, Inflammatory Bowel Disease, Fungal Nail Disease, Paralysis, Celia Disease , Lymphoma, Major Depression, Malignant Melanoma, Mania, Melorheostosis, Meniere's Disease, Mucopolysaccharidosis, Multiple Sclerosis, Muscle Dystrophy, Rheumatoid Arthritis, Alzheimer's Disease email- drimolaherbalmademedicine@gmail.com / or {whatssapp .....+2347081986098}

    ReplyDelete

  33. This is my testimony about the good work of DR.KABAKA who help me.... I'm from Carolina USA. And am sorry for putting this on net but i will have to, by this world best spell caster that brought back my husband who left me out for past 3 years, i eventually met this man on a blog site posting by one of is client for help, i explained everything to him and he told me about a spell caster that he had heard about and he gave me an email address to write to the spell caster to tell him my problems. In just 2 days, my husband was back to me. I just want to say thank you to this truthful and sincere spell caster, sir all you told me have come to pass and thank you sir. Please i want to tell everyone who is looking for any solution to their problem, i advice you to kindly consult this spell caster, he is real,he is powerful and whatever the spell caster tell is what will happen, because all what the spell caster told me came to pass. You can kindly contact him on: his email address is drkabakaspiritualtemple@gmail.com or directly on whats-app +2349015857861

    ReplyDelete