Saturday 27 April 2013

The biopsychosocial model of disease

The biopsychosocial model of disease existed in my notes... an excuse to get out the colouring crayons and draw a diagram, but ultimately another collection of facts that needed to be digested then regurgitated in the summer exams, something to be fitted in around learning about the important stuff - the science.
But the biopsychosocial model has come alive for me recently, now I realise what an impact the later two components, psychological and social, can have on patients.


In the 1977 paper in Science, George Engel introduced the biopsychosocial model:
"The dominant model of disease today is biomedical, and it leaves no room within it's framework for the social, psychological and behavioural dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching and a design for action in the real world of health care."

Following some conversations on Twitter recently and from my own experience at medical school and now as a patient, I wanted to explore my thoughts on this model.



Twitter, in the wonderful way it does, recently introduced me to the Disabled Medic blog, which among many other great posts, has also explored the biopsychosocial model, and I would recommend a read. 

The biopsychosocial model shows the influence that emotions and social circumstances have on physical health, which is important. But while conversations about the model focus on the way it can be used by healthcare professionals (very important!), it needs emphasising that the model can provide a framework for patients to look at/after themselves. The model highlights the psychological and social causes of disease, but more optimistically, it can show that there are a range of treatments for disease, from the medical to the social and psychological. A diagnosis of a long-term health conditions is often simultaneous with loss of control. There are limitations to the success of medications, treatments and surgeries. And in receiving these, we are relatively passive as patients, no matter how engaged we are. The biopsychosocial model looks at our biological, psychological and social needs, and how these factors influence our overall health. Establishing that these factors affect our health is only the first step. As patients, when psychological and social factors are brought in to the equation, it becomes clear that we ourselves have some power to help ourselves. By framing our health in this more holistic way, as patients we are not as powerless as suggested by the medical model. Through self-management we can make positive changes to our own psychological and social situations, which can in turn benefit our physical biological health.

To return to the traditional ground of the model - healthcare professionals....
One strength of the model is that it places psychology side beside its (generally considered) more superior counter-part, biology. I hope that by seeing the biopsychosocial model in action, physicians can appreciate the detrimental psychological impact of a diagnosis, and the assumption of "it is all in the mind" can fall by the way side. By integrating all three elements, the model shows that neither is independent of the others, so it can't be all in the mind, because other factors, biological or social, will be involved to some degree.

For me personally, the biopsychosocial model makes me look at what a 'life' is. One of the attractions of medicine is saving lives. Without getting too deeply into philosophy or ethics, I just want to explore for a second what saving a life really means for me, as a patient. I still believe that A&E staff heroically save lives. But I have come to realise that a life is more than a swiggly line on a heart rate monitor. My counsellor has been just as heroic in saving my life, through addressing my emotions. My life is now something I can live, rather than endure. With saving lives being a key (and honourable) motivation among medical staff, it is important that we can allow them to save lives as often as possible, and in many different ways. It may not always be through emergency treatment in resuscitation, but if we embrace the biopsychosical model, they can save lives in many more ways.

When there is a limit to the effectiveness of the biological approaches to an ill person, and they can't be returned to the land of the healthy, medical science becomes unstuck. Within the biopsychosocial model, the issue of doctors not being able to do anything is slightly less. As I mentioned in my post about making the transition from medical student to patient, I went to medical school because I wanted to make people better. But I was only being taught one way to make people better - drugs and surgery. If we really embraces the biopsychosocial model, doctors could make a difference, even if their standard tools of drugs aren't available because they could turn to psychological and social support. This isn't to say that all clinicians have to be counsellors or social workers - far from it. But an awareness and appreciation of their contribution to the management of a patient is important, as well as an understanding of the basic principles and skills such as motivational interviewing.

In 2013, I don't think I can talk about social in this context without mentioning social media. It was not was Engel originally meant in 1977, but social media has become a vital social tool for patients to manage their health. Ignoring anxieties and postural problems associated with sitting at a screen seeing everyone else's photo-shopped lives, it is undeniable that social media is a big and good resource that can empower patients to take responsibility and manage their own health. To see the best examples in action, take a look at Michael Seres and his blog, Being a Patient Isn't Easy to see a whole new meaning to the social in biopsychosocial!

I am still very grateful for the biological expertise of my medical team. Don't get me wrong - it's a good place to start and I wouldn't be here writing this post today if it wasn't for the biological support. But with chronic illness, when you are past the dramatic relapses, the biological isn't enough.... 
The biology has allowed me to live, but its the psychological and social support I have received that has allowed me to live.


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230 comments:

  1. Brilliant piece of writing as always

    ReplyDelete
    Replies
    1. Thank you!
      Made easier with such good social (media) examples to include! :)

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  2. Anya
    Powerful and true.
    The model you describe and live brings us closer to our nature - we are complex and our energy and vitality, our well being depends on the relationship between body mind and heart (and I would add spirit) In our work on releasing compassion we focus primarily on the power of self compassion as we ask people to think about a question:-

    what do you think and feel about the way you care for yourself?

    and we encourage the listener not to interrupt. This simple question can be very painful as many of us do not care well for ourselves and it is only in the stillness that we encounter our wounded selves.

    I struggle myself with the vigilance needed to take care of myself - I have discovered a simple writing practice (I call it here i am) - i light a candle twice a day, follow my breath and then write for 5 minutes about whatever arises 'in the now' - this means i am never more than a few hours from myself which somehow keeps me safe and in tune with what self compassion and care is for me.

    I wonder if you have seen the vision of the amazing people behind FutureHealth in Brighton?

    Here I am, writing to you!

    Thank you

    Andy

    ReplyDelete
  3. I think this is a wonderful, thoughtful and interesting post - and brings up many ideas for me around how we utilise the illness trajectory to ensure that we give people the best "life-saving" care possible (and enable them to save their own lives, too) at the right times. You are so right that life is not about only surviving, but about being able to live, and this really struck me:"with chronic illness, when you are past the dramatic relapses, the biological isn't enough" - to close the loop, if the social and the psychological aren't also looked after, the relapses come around again all too soon... the biological is impacted on by the social and psychological and each three inter-relate and are interdependent.

    Really integrating a biopsychosocial model into healthcare offers a more holistic way to interpret what "health" is and what "illness" is, but also offers a clearer way to think about working together - social care, psychologists, IAPT, primary care and secondary care, in a way that honours the need to fit care to the person's life and their experiences of illness at the specific instance in time and also over time - you can plan to engage with self-management activities (and learn meditation techniques or pick up social activities) when your tablets are sorted and you're on a more even part of your trajectory, and when you're really unwell, you can use your positivity, and your social connections to give you the strength to pull through and endure - whilst you receive the medical care needed. They inter-relate and can thus improve the outcomes of interventions of each kind by providing resources for the person to help them engage and live through any problems they have.

    Thanks for a wonderful post

    Cheryl

    ReplyDelete
    Replies
    1. Thank you! Your comment was really interesting to read!

      Delete
  4. hi is there any way I could reference this for a uni assignment?

    ReplyDelete
    Replies
    1. Hi, I'm delighted to hear it is useful for your uni assignment! There are various ways you can reference blogs in the way you would normally reference academic articles - try this > https://www.citethisforme.com/cite/blog
      Good luck with your assignment!
      Anya

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  5. Can I use the above figure for teaching purpose. You will be fully acknowledged. Thank you.

    ReplyDelete
  6. Of course, as long as you credit my blog and provide a link,
    Many thanks, and hope the teaching goes well.

    ReplyDelete
  7. Hi Anya,
    In the 21st Century 'biopsychosocial' is imho no longer sufficient to account for - understand disease, recovery, well-being, research, public engagement, self-care, interdisciplinary and integrated care (I could go on).

    A model is needed which includes the POLITICAL care (knowledge) domain and Hodges' health careeer model is open, free, easy to understand and yet is quite powerful.

    The blog below includes diverse examples of how the model can be applied plus related content. There is also a bibliography. I am studying the model at Lancaster University in Technology Enhanced Learning another blog theme:

    http://hodges-model.blogspot.co.uk/

    Kind regards to all,
    Peter Jones
    @h2cm

    ReplyDelete
  8. Hi Anya,
    In the 21st Century 'biopsychosocial' is imho no longer sufficient to account for - understand disease, recovery, well-being, research, public engagement, self-care, interdisciplinary and integrated care (I could go on).

    A model is needed which includes the POLITICAL care (knowledge) domain and Hodges' health careeer model is open, free, easy to understand and yet is quite powerful.

    The blog below includes diverse examples of how the model can be applied plus related content. There is also a bibliography. I am studying the model at Lancaster University in Technology Enhanced Learning another blog theme:

    http://hodges-model.blogspot.co.uk/

    Kind regards to all,
    Peter Jones
    @h2cm

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  46. It was during my research on HIV/Herpes that I stumbled upon the Hiv/Herpes information; information which is quite easy to find when doing a search for STD on google. I was into conspiracy at the time thought of HIV/Herpes Cured' being a conspiracy was something Ignorance though,I found pretty interesting about herbal medicine. I asked questions about the Herbal cure's on official HIV/Herpes websites and I was banned for doing so by moderators who told me that I was parroting Hiv/Herpes propaganda. This reinforced my belief that there is a cure for Hiv/Herpes Then i found a lady from germany name Achima Abelard Dr Itua Cure her Hiv so I send him a mail about my situation then talk more about it and send me his herbal medicine I drank for two weeks.And today I'm Cured no Hiv/Herpes in my life,I searched for Hiv/Herpes groups to attempt to make contact with people in order to learn more about Hiv/Herpes Herbal Cure's I believed at this time that you with the same disease this information is helpful to you and I wanted to do the best I could to spread this information in the hopes of helping other people.That Dr Itua Herbal Medicine makes me believes there is a hope for people suffering from,Parkinson's,Alzheimer’s disease,Bechet’s disease,Crohn’s disease
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    Syndrome Fibrodysplasia Ossificans ProgresSclerosis,Seizures,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpe ,Copd,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.
    Dementia.,Hiv_ Aids,Herpes,Inflammatory bowel disease ,Copd,Diabetes,Hepatitis,I read about him online how he cure Tasha and Tara,Conley,Mckinney and many more suffring from all kind of disease so i contacted him . He's a herbal doctor with a unique heart of God, Contact Emal..info@drituaherbalcenter.com / drituaherbalcenter@gmail.com Phone or whatsapp..+2348149277967.

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  49. My husband was diagnosed with MND ALS (amyotrophic lateral sclerosis) when he was 69 years old 6 years ago. The Rilutek (riluzole) did very little to help him. The medical team did even less. His decline was rapid and devastating. The psychological support from the medical center was non-existent and if it were not for totalcureherbsfoundation .c om and the sensitive cure of their herbal formula he would have been not been alive today,there was significant improvement in the first 4 weeks of usage that gave us hope that he will be alive,His doctor put him on riluzole, letting us know there was no cure until we gave try on total cure herbal supplement that cure him totally from this disease after 15 weeks of his usage. There is nothing positive about cure ALS condition except for their herbal treatment .

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  50. , WOW WHO WILL EVE BELIEVE THAT I WILL BE THIS HAPPY TODAY, AFTER MANY YEARS OF PAIN LIVING WITH HIV VIRUS. MY NAME IS STEPHEN LIVE IN UNITED KINGDOM. IT ALL HAPPEN FEW YEARS BACK WHEN I DISCOVERED THAT MY SYSTEM IS NO LONGER FUNCTIONING WELL, SO I DECIDED TO GO FOR MEDICAL CHECKUP ALL TO DISCOVERED THAT I HAVE BEEN LIVING WITH HIV POSITIVE VIRUS AND I NEVER NOTICE IT FOR A VERY LONG TIME. AT THIS PARTICULAR POINT OF TIME I WANTED TO GIVE UP MY LIFE, BUT WHEN I WENT THROUGH THE INTERNET TO READ MORE ABOUT HIV VIRUS, I FOUND OUT THAT THIS VIRUS IS DISGUSTING BOTH INTERNAL AND EXTERNAL. GOD SO HAVE IT THAT I HARD ABOUT THIS SIMPLE WONDERFUL AND GOD SENT HERBAL DR CALLED DR AKHIGBE THE SAME DAY I WANTED TO GIVE UP EVERYTHING BECAUSE I FEEL LIFE WAS NO LONGER IMPORTANT TO ME, MANY THINGS HAPPENED BUT TO CUT THE STORY SHORT, I AM HIV NEGATIVE NOW, AND EVER SINCE I WAS CURED THERE IS NO OUTBREAK EVERYTHING HAS GONE BACK TO NORMAL AND I BELIEVE AM THE HAPPIEST PERSON ON EARTH TODAY. DR AKHIGBE NEVER ASK ME TO TESTIFY FOR HIM, I DECIDED TO DO THIS MY WAY SO THAT AS MANY THAT WILL BELIEVE AND CONTACT HIM WILL BE FREE FROM THIS DEADLY DISEASE. THIS VIRUS IS SPREADING EVERYDAY SO LET PUT OUR HANDS TOGETHER TO SAVE LIFE. BUT I KNOW MANY ARE YET TO DISCOVERED THAT THEY ARE LIVING WITH THIS VIRUS. I BELIEVE THIS IS THE MOST CRITICAL VIRUS, YOU CAN LIVE WITH IT FOR MANY YEARS AND YOU WILL NEVER NOTICE IT. WELL AM SO HAPPY TODAY ESPECIALLY WHEN MY LOST LOVE IS BACK AND WE ARE GETTING MARRIED SOON. SO MY DEAR LADIES AND GENTLEMEN LET PUT OUR HANDS TOGETHER TO SAVE AS MANY WE CAN BY SHARING THIS TESTIMONY SO THAT THOSE THAT DONT HAVE THE OPPORTUNITY TO CURE THEIR DISEASE WILL BE CURED AND BE HAPPY FOREVER, SO YOU CAN CONTACT HIM THROUGH HIS EMAIL ADDRESS, WHATSAPP NUMBER AND WEBSITE AS FOLLOWED. drrealakhigbe@gmail.com +2348142454860. http:drrealakhigbe.weebly.com

    HE CAN ALSO CURE THE FOLLOWING AND AM A LIVING TESTIMONY TO IT.
    DIABETES
    HIV
    PREGNANCY PROBLEM
    HERPES
    ALS
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    CONTACT HIM TODAY AND YOUR LIFE WILL NEVER REMAIN THE SAME AGAIN, AM PROUD OF YOU DR AKHIGBE

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  51. Hello my dear viewers,I want the world to celebrate with me on this numerous testimony, i never believe i could ever get rid of this horrible disease until one fateful day,my story and appreciation goes to Dr.Akuza the powerful great doctor that help me to cure my HIV/AIDS disease from my life,he is truly a truthful man with high herbs power's he uses on saving people's life, just a few days back i came in contact with Dr.Akuza emails which many individuals have testify so much about of his kind work, so i decided and contacted him quickly because the disease was almost at the last minute of taking my life, i have tried all remedies from several physicians from hospitals but none could help me apart from Dr.Akuza who finally cure my HIV/AIDS disease, i was amazed and overwhelmed when the doctor confirmed me negative in the same hospital i have been before,i wish to anyone that is sick today and want healing to please contact this doctor on his Email akuzasolutionhome@gmail.com so if you have any problem HIV, HERPES, CANCER, ALS,HEPATITIS B, DIABETIC, call or whatsapp him on +2349035850834

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  60. I am here to testify how great man called DR EDES helped me out with herbs and roots which he prepared for me in use of curing herpes. I took his product (cure) for (14) days before I was totally cure out of it, and i promised him that i will testify my healing to the whole world about how he cured me which I am very happy I am doing now. Dr Edes also cure all kinds of diseases , HEPATITIS, CANCER, DIABETICS , FRIBLOD,ALL KINDS OF SPELL CAST ,and so much more. you can contact on his whatsapp on +2348151937428 or email him via dredeshome@gmail.com.
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  61. I am here to testify how great man called DR EDES helped me out with herbs and roots which he prepared for me in use of curing herpes. I took his product (cure) for (14) days before I was totally cure out of it, and i promised him that i will testify my healing to the whole world about how he cured me which I am very happy I am doing now. Dr Edes also cure all kinds of diseases , HEPATITIS, CANCER, DIABETICS , FRIBLOD,ALL KINDS OF SPELL CAST ,and so much more. you can contact on his whatsapp on +2348151937428 or email him via dredeshome@gmail.com.
    He can also cure following virus
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    visit his website on; www.edesherbalhome.webs.com

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  62. My husband was diagnosed with MND ALS (amyotrophic lateral sclerosis) when he was 69 years old 6 years ago. The Rilutek (riluzole) did very little to help him. The medical team did even less. His decline was rapid and devastating. The psychological support from the medical center was non-existent and if it were not for totalcureherbsfoundation com and the sensitive cure of their herbal formula he would have been not been alive today,there was significant improvement in the first 4 weeks of usage that gave us hope that he will be alive,His doctor put him on riluzole, letting us know there was no cure until we gave try on total cure herbal supplement that cure him totally form this disease after 15 weeks of his usage.
    There is nothing positive about cure ALS condition except for their herbal treatment .

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  65. I am very much happy to share to every viewers that is reading this,I want to inform the whole public of how I got help for my herpes, I wanted this since 6 months ago, I have also taken treatment from some doctor,few weeks back I came on the net to see if I will be able to get any information as to cure my herpes, on my search I saw various testimony of people who was helped by a great man called Dr Akhigbe and without any hesitation, I contacted him, I wrote to him and and he guided me, I asked him for solutions and he started the remedies for me and indeed 3 weeks after I started using the medicine, I was completely happy as it worked for me.I went to the hospital for check up and indeed I was declared negative from my disease, and I also waited again for two weeks and went back to another hospital for check up to be fully sure and to my great surprise I was still declared negative, and I decided to share this great opportunity to those people out there fighting this sickness, You can contact him now for your medicine to cure your diseases, contact his Email; drrealakhigbe@gmail.com or Whatsapp +2348142454860. website. hpps:drrealakhigbe.weebly.com

    Dr Akhigbe also cure diseases like..
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    Heart Disease
    Diabetes
    Kidney Disease
    Lupus
    Epilepsy
    Stroke
    Eczema
    Eating Disorder
    Back Pain. etc
    contact him for your solution.

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  66. I almost gave up on ever getting cured of HIV VIURS because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for HIV when i came across a post about Dr OSAGIE, in the net from a lady called Angela i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally fee from #HIV V`IURS i want to say a very big thank you to DR OSAGIE for what he has done in my life. feel free to leave him a message on email his email: (drosagiesolutiontemple@gmail.com OR
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    He can still be able to help you with this herbs medicine:
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    DIABETES CURE
    EPILESY CURE
    HPV CURE
    LUPUS CURE
    HEPATITIS CURE
    CANCER CURE
    thank you my great dr .,,

    ReplyDelete
  67. Here is a great herbal doctor who cured me of Hepatitis B. his name is Dr. Imoloa. I suffered Hepatitis B for 11 years, I was very weak with pains all over my body my stomach was swollen and I could hardly eat. And one day my brother came with a herbal medicine from doctor Imoloa and asked me to drink and I drank hence there was no hope, and behold after 2 week of taking the medicine, I started feeling relief, my swollen stomach started shrinking down and the pains was gone. I became normal after the completion of the medication, I went to the hospital and I was tested negative which means I’m cured. He can also cure the following diseases with his herbal medicine...lupus, hay fever, measles, dry cough, diabetics hepatitis A.B.C, mouth ulcer, mouth cancer, bile salt disease, fol ate deficinecy, diarrhoea, liver/kidney inflammatory, eye cancer, skin cancer disease, malaria, chronic kidney disease, high blood pressure, food poisoning, parkinson disease, bowel cancer, bone cancer, brain tumours, asthma, arthritis, epilepsy, cystic fibrosis, lyme disease, muscle aches, cholera, fatigue, muscle aches, shortness of breath, alzhemer's disease, acute myeloid leukaemia, acute pancreatitis, chronic inflammatory joint disease, inflammatory bowel disease, Addison's disease back acne, breast cancer, allergic bronchitis, Celia disease, bulimia, congenital heart disease, cirrhosis, fetal alcohol spectrum, constipation, fungal nail infection, fabromyalgia, (love spell) and many more. he is a great herbalist man. Contact him on email; drimolaherbalmademedicine@gmail.com. You can also reach him on whatssap- +2347081986098.

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  68. Am so happy, i never believe i will be this happy again in life, I was working as an air-hoster ( crabby crew ) for 5 years but last year i loose my job because of this deadly disease called HIV and Herpes(herpes and cold sore outbreaks), I never felt sick or have any symptom, till all workers were ask to bring their doctor report, that was how i got tested and i found out that am HIV and Herpes positive that make me loose my job, because it was consider as an STD and is incurable disease, i was so depress was thinking of committing suicide, till i explain to a friend of mine, who always said to me a problem share is a problem solved, that was how she directed me to this Doctor Called Dr Aziba , that was how i contacted him and i get medication from him and i got cured for real, I just went back to my work and they also carry out the test to be real sure and i was negative. Please contact Dr Aziba if you are HIV And Herpes or any kind of disease you got infected with do contact the Herbal Doctor via his Email ( priestazibasolutioncenter@gmail.com) or call or via Whatsap[+248100368288]
    doctor is a life saver.

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  72. you need help to reunite with your ex lover or you are finding it difficult to keep a serious relationship or you are battling with any kind of infection/diseases. your problems will be over if you contact this great spiritual doctor. He cure diseases and reunite exs within a short period of time. contact him today via: ogbidihomeofsolution1@gmail.com or whatsapp/call him on: +2348052523829.

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  73. I got diagnosed with HIV, i have be dealing with this mess for the past 6yrs. On till i got review online about natural cure people testifies how they got cured with natural treatment. And i order the treatment, after taking it for two weeks i totally got cured with herbal treatment. I'm recommending you diagnosis with HIV should get this treatment via; DrAkhere66@gmail.com or whatsapp +38972751056

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  77. Hello everybody,

    I don't just know the reason why some people is finding it difficult to believe that there is a cure for herpes, I have been suffering from herpes since last three years with my boyfriend but today I am happy that am cure from it with the herbal medicine of  PRIEST WISDOM  the great healer, I was browsing the internet searching for help when I came across a testimony shared by someone on how  PRIEST WISDOM   cure his herpes I was so much in need of getting his treatment but after all PRIEST WISDOM brought a smile to my face with his herbal medicine. I am so much happy today that we have someone like this great healer out there, so my people out there kindly contact this great healer on his email address: Supernaturalspell1@gmail.com  please sir keep your good work cause there are people out there who is in need of your healing medicine.once more contact him now: Supernaturalspell1@gmail.com  you can call him or whatsApp his number   +2348124644470 

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  80. For years, I have read and seen the advertisements in the mass media about all of the penis enhancement pills and thought that they were all scams or gimmicks. All of the medical sites that I have visited stated that none of the herbal supplements would ever help increase the size of a penis. I got very depressed when I read this, because unfortunately I was not naturally blessed with a penis that was big enough to arouse my sexual partner or past partners. I am a man that is past my sexual primetime and my sexual performance has a lot to be desired. I decided to try Doctoc Akhigbe herbal medicine after all the reading and researching that I have done.I saw a testimony " Joe" about doctror Akhigbe Herbal Medicine Since there is a Money Back Guarantee, I give him a trial what did I have to lose? I couldn't believe the results I was seeing after drinking the Natural  Herbal Medicine  and Herbal Soap to be rubign my penis! he sent to me through DHL courier delivery service . Within about 2 weeks I had a noticeable increase in the girth of my penis. Then after a coupleof aditional week it started to grow in length and I was amazed and very excited.before I finish the drink and the soap my penis had grown an additional two inches. I've had a considerable improvement with my sex life and these pills are certainly worth every penny I spent on them! I want to thank Dr Akhigbe for the time and effort they have spent on helping people in my situation.I know many are out there who are suffering this problem and they need help, email him.    drrealakhigbe@gmail.com.    He also cure other diseases like: Painful or Irregular Menstruation. HIV/Aids. Breast Enlargement. Diabetics. Vaginal Infections. Vaginal Discharge. Itching Of the Private Part. Breast Infection. Discharge from Breast. Breast Pain & Itching. Lower Abdominal Pain. No Periods or Periods Suddenly Stop. Women Sexual Problems. High Blood Pressure Chronic Disease. Pain during Sex inside the Pelvis. Pain during Urination. Pelvic Inflammatory Disease, (PID). Dripping Of Sperm from the Vagina As Well As for Low sperm count. Parkinson disease. Lupus.  Cancer.  Tuberculosis.  Zero sperm count.  Asthma.  Quick Ejaculation. Gallstone,  Premature Ejaculation. Herpes. Joint Pain. Stroke. Weak Erection.  Erysipelas, Thyroid, Discharge from Penis. HPV.  Hepatitis A and B. STD. Staphylococcus + Gonorrhea + Syphilis. Heart Disease.  Pile-Hemorrhoid.rheumatism, thyroid, Autism, Penis enlargement,  Waist & Back Pain.  Male Infertility and Female Infertility. For your cure email him now:   drrealakhigbe@gmail.com    or Contact his numbe:  +2349010754824.

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  86. hello everyone my Mother was diagnosed with ALS November 2018, since the prognosis she has lost the ability to speak, struggles to chew and swallow, her arm strength is minimal on her best days and she’s loosing control of her balance and neck muscles. She has began to decline not only in health but mentally as well as she has given up the fight it seems, i couldn't just watch my mom dying so i decided to go into the internet for a possible solution and luckily i saw a Facebook post singing the praises of a herbal formula from Dr James that someone with ALS used and got cured and quickly contacted the email (jamesherbalformula @ gmail. com) and order for the formula and since i started using the formula my mom have recovered greatly. am so happy and thanks James for reviving my mom. you can contact him for the ALS herbal formula via his above email and also add him on hangout or through his whatsapp +2348102574680 Best Regards

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  87. HOW I GOT MY EX HUSBAND BACK WITH THE HELP OF REAL AND EFFECTIVE SPELL FROM DR Osasu My name is Olivia Jayden, I never thought I will smile again, My husband left me with two kids for one year, All effort to bring him back failed I thought I'm not going to see him again not until I met a lady called Jesse who told me about a spell caster called Dr. Osasu , She gave me his email address and mobile number and I contacted him and he assured me that within 48hours my husband will come back to me, In less than 48hours my husband came back started begging for forgiveness saying it is the devils work, so I'm still surprise till now about this miracle,i couldn't conceive but as soon as the spell was cast,i became pregnant and gave birth to my third child,if you need any assistance from him you can contact him via:email: drosasu25@gmail.com Or WhatsApp or call him now:
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  94. What a beautiful and wonderful testimony, sometimes things you don't believe can just happen. My name is Adams Vera, from U.S.A am 28 years old i got married at the age of 24 i have only one child and i was living happily. After three years of my marriage my husband behavior became so strange and i don't really understand what was going on, he packed out of the house to another woman i love him so much that i never dreamed of losing him, i try my possible best to make sure that my husband get back to me but all to no avail i cry and i cry seeking for help because i was heart broken until i coincidentally came across an online spell caster called Dr. Osasu , i contacted him and explained to him what i have been going through in my marriage and he gave me the full assurance that my husband will come back to me and my marriage will be restored, He told me what to do to get my husband back and i did, he said after 3days my husband will come back to me and start begging, it really happen it was so surprising and everything was just like a miracle, ever since my family have been living with so much happiness and our relationship was now very tight because of this great and powerful spell caster.he is a very great and powerful spell caster that can be trusted and there is nothing concerning life issues he cannot solve because i am a living testimony. i know there are so many people out there who are going through similar problems in one way or the other, believe me this is the right spell caster to contact and all your problems will be forgotten. contact Dr. Osasu viaWhatsapp: +2347064365391 Email:Account drosasu25@gmail.com

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  95. What a beautiful and wonderful testimony, sometimes things you don't believe can just happen. My name is Adams Vera, from U.S.A am 28 years old i got married at the age of 24 i have only one child and i was living happily. After three years of my marriage my husband behavior became so strange and i don't really understand what was going on, he packed out of the house to another woman i love him so much that i never dreamed of losing him, i try my possible best to make sure that my husband get back to me but all to no avail i cry and i cry seeking for help because i was heart broken until i coincidentally came across an online spell caster called Dr. Osasu , i contacted him and explained to him what i have been going through in my marriage and he gave me the full assurance that my husband will come back to me and my marriage will be restored, He told me what to do to get my husband back and i did, he said after 3days my husband will come back to me and start begging, it really happen it was so surprising and everything was just like a miracle, ever since my family have been living with so much happiness and our relationship was now very tight because of this great and powerful spell caster.he is a very great and powerful spell caster that can be trusted and there is nothing concerning life issues he cannot solve because i am a living testimony. i know there are so many people out there who are going through similar problems in one way or the other, believe me this is the right spell caster to contact and all your problems will be forgotten. contact Dr. Osasu viaWhatsapp: +2347064365391 Email:Account drosasu25@gmail.com

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  100. Mahira group is launched a new project as given name mahira homes in gurgaon sector 63 which has a new affordable housing project. They have reputed developer in real state for last many years which working under the affordable housing policy 2013 in rera also the working on pmay (pardhanmantri awas yojhna).

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  110.  I'm 59 years old and female. I was diagnosed a couple of years ago with COPD and I was beyond scared! My lung function test indicated 49% capacity. After having had flu a year ago, the shortness of breath, coughing and chest pains continued even after being treated with antibiotics. I've been smoking two packs a day for 36 years. Being born without a sternum caused my ribs to be curled in just one inch away from my spine, resulting to underdeveloped lungs. At age 34 I had surgery and it was fixed. Unfortunately my smoking just caused more damage to my already under developed lungs. The problem was having is that I enjoy smoking and don't want to give up! Have tried twice before and nearly went crazy and don't want to go through that again. I saw the fear in my husband and children's eyes when I told them about my condition then they start to find solution on their own to help my condition.I am an 59 now who was diagnose COPD emphysema which I know was from my years of smoking. I started smoking in school when smoking was socially acceptable. I remember when smoking was permitted in hospitals. It was not known then how dangerous cigarettes were for us, and it seemed everybody smoked but i was able to get rid of my COPD lung condition through the help of total cure herbal foundation my husband bought, totalcureherbsfoundation .c om has the right herbal formula to help you get rid and repair any lung conditions and cure you totally with their natural organic herbs,it class products at affordable prices because how awful it is with this lung dictions . I wish anybody who starts smoking at a young age would realize what will eventually happen to their bodies if they continue that vile habit throughout their life, certainly total cure herbs is the formula to get over Chronic Obstructive Pulmonary Disease

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  111.  I'm 59 years old and female. I was diagnosed a couple of years ago with COPD and I was beyond scared! My lung function test indicated 49% capacity. After having had flu a year ago, the shortness of breath, coughing and chest pains continued even after being treated with antibiotics. I've been smoking two packs a day for 36 years. Being born without a sternum caused my ribs to be curled in just one inch away from my spine, resulting to underdeveloped lungs. At age 34 I had surgery and it was fixed. Unfortunately my smoking just caused more damage to my already under developed lungs. The problem was having is that I enjoy smoking and don't want to give up! Have tried twice before and nearly went crazy and don't want to go through that again. I saw the fear in my husband and children's eyes when I told them about my condition then they start to find solution on their own to help my condition.I am an 59 now who was diagnose COPD emphysema which I know was from my years of smoking. I started smoking in school when smoking was socially acceptable. I remember when smoking was permitted in hospitals. It was not known then how dangerous cigarettes were for us, and it seemed everybody smoked but i was able to get rid of my COPD lung condition through the help of total cure herbal foundation my husband bought, totalcureherbsfoundation .c om has the right herbal formula to help you get rid and repair any lung conditions and cure you totally with their natural organic herbs,it class products at affordable prices because how awful it is with this lung dictions . I wish anybody who starts smoking at a young age would realize what will eventually happen to their bodies if they continue that vile habit throughout their life, certainly total cure herbs is the formula to get over Chronic Obstructive Pulmonary Disease

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  117. My name is Donald Boykins, I'm here to appreciate Dr Akhigbe for using his herbal medicine to cure my herpes virus. Is about 3 years and 6 months now I have been living with this virus and it have really really be a serious problem to me, I was so confused cause I have been taking several drugs to be cure but all of my effort was in vain, one morning was browsing through the internet then I saw several testimonies about Dr Akhigbe curing people from herpes virus and Immediately I contacted Dr Akhigbe on his email:  drrealakhigbe@gmail.com. I told him about my troubles and he told me that I must be cured. He gave me instructions and which I rightly followed, so he prepared a herbal medicine and sent it to me which I used for three weeks and I was cured totally everything was like a dream to me and my herpes was permanently gone. Dr Akhigbe God bless you and give you the power and wisdom for more cure, I don't know if there is any one out there suffering for herpes virus or any other of there diseases. DIABETES, CANCER, HIV/AIDS, HERPES, HEPATITIS A&B, HEART DISEASES, CHRONIC DISEASES,  YELLO FEVER, EPILEPSY, LUPUS, STRIKE, SPINAL CORD, ECZEMA, KIDNEY DISEASES, ACME, BACK PAIN,   DENGUE SCHIZOPHRENIA, POLIO,MULTIPLES SCLEROSIS, HIGH BLOOD PRESSURE, VAGINAL  DISCHARGETHYROID, ARTHRITIS, MENINGITIS.etcWhy don't you contact Doctor Akhigbe and be free from your diseases because he is very good and honest herbalist doctor, he is also know as the godfather of herbal root. Contact him now via his email:   drrealakhigbe@gmail.com         or whatsapp   him on     +2349010754824.         website https:drrealakhigbe.weebly.com.   

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  121. four (4) years, six (6) months and twelve (12) day with my calculations, befItsgood  a miracle that I am alive today. I encounter HERPES SIMPLEX VIRUS (HSV1/2) forore I meet the great Dr. Abumere. I am Tina Richard from Fresno California, united state of America and I was affected with herpes virus.Herpes is a viral infection cause by the Herpes simplex virus, marked by painful, watery blister in the skin or mucous membrane or on the genitals. This was what I suffered for good four years. I have visited CVS Pharmacy in Fresno for treatment but no improvement. I meet Dr.Abumere online while I was searching for herpes cure I read a testimony about his work. I give a try that now becomes a testimony in my life. I contacted Dr.Abumere on Email: doctorabumere6@gmail.com or WhatsApp: +2349021975055

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  122. four (4) years, six (6) months and twelve (12) day with my calculations, befItsgood  a miracle that I am alive today. I encounter HERPES SIMPLEX VIRUS (HSV1/2) forore I meet the great Dr. Abumere. I am Tina Richard from Fresno California, united state of America and I was affected with herpes virus.Herpes is a viral infection cause by the Herpes simplex virus, marked by painful, watery blister in the skin or mucous membrane or on the genitals. This was what I suffered for good four years. I have visited CVS Pharmacy in Fresno for treatment but no improvement. I meet Dr.Abumere online while I was searching for herpes cure I read a testimony about his work. I give a try that now becomes a testimony in my life. I contacted Dr.Abumere on Email: doctorabumere6@gmail.com or WhatsApp: +2349021975055

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  125. Good News My People ..I Want To Appreciate Dr OYAKHIRE Herbal Medicine Is A Good Herbal Medicine For( HIV ),I Was Diagnosed With Hiv
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  127. I have been suffering from (HERPES SIMPLEX VIRUS) disease for the past four years and had constant pain, especially in my knees. During the first year, I had faith in God that i would be healed someday. This disease started circulating all over my body and I have been taking treatment from my doctor, few weeks ago I came on search on the internet if I could get any information concerning the prevention of this disease, on my search I saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr VOKE and she gave the email address of this man and advise we should contact him for any sickness that he would be of help, so I wrote to Dr. VOKE telling him about my (HERPES Virus) he told me not to worry that I was going to be cured!! hmm I never believed it,, well after all the procedures and remedy given to me by this man few weeks later I started experiencing changes all over me as the Dr assured me that I have cured, after some time I went to my doctor to confirmed if I have be finally healed behold it was TRUE, So friends my advice is if you have such sickness or any other at all you can email Dr voke on doctorvoke@gmail.com
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  128. I can never appreciate Tokubo enough for helping me because I never thought that i will ever have a normal life again thinking I'll never get out of this hiv virus in my whole life but i was wrong. My story goes thus: I found dr tokubo contact in a post i followed online, I copied the email and contacted him because i read about how he cure a man of hiv and that he have herbal remedy for cancer, yeast infection,HIV, Herpes e.t.c. I told him all he needed to know about my hiv status and he told me to relax and stay calm that he will help me by sending his medicine to me via courier delivery and he did as he promised. I received my healing within 10 days of using his herbal remedy. my lost joy came back alive as there is no more HIV, no symptoms, no fear of transmitting the virus to my love ones. Now I'm in a relationship and my sex life is awesome. All these happened last month ago and I decided to keep silent because I wanted to be sure of the healing. Now I'm saying this because I have undergone series of medical check up and all results came out negative. At first i thought it was just a joke until i tried it out and it worked perfectly well. The doctor never asked me to talk about him but I see it as my little way of showing other people out there need his herbal medicine to be cured. You can reach dr tokubo via his email at: drtokubotemple@gmail.com or you can whatsapp him on: +2349037990322

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  129. MY HIV HEALING TESTIMONY
    My mouth is short of words, i am so so happy because Dr Samuel healed me from HIV ailment which i have been suffering from the past 5years now, i have spent alot when getting drugs from the hospital to keep me healthy, i have tried all means in life to become Hiv negative one day, but there was no answer until i found Dr Samuel from the parish of Africa who provide me some healing spell and herbs that he used to help me, now i am glad telling everyone that i am now HIV Negative, i am very very happy, thank you Dr Samuel for helping me get my life back without any form of crisis, may God bless you Dr Samuel and equip you to the higher grade for healing me. i am so amazed. so i will announced to everyone in this whole world that is HIV positive to please follow my advice and get healed on time, because we all knows that HIV disease is a deadly type,contact Dr Samuel for your HIV healing spell and herbs today at: drsamuelherbalclinic27@gmail.com.... He will always be happy to assist you online and ensure you get healed on time, You can reach him through his email address which is drsamuelherbalclinic27@gmail.com or his WhatsApp line on + 2348168178485 today for your healing spell immediately, thank you sir. His website is https://dr-samuel-herbal-clinic.business.site/


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  130. MY HIV HEALING TESTIMONY
    My mouth is short of words, i am so so happy because Dr Samuel healed me from HIV ailment which i have been suffering from the past 5years now, i have spent alot when getting drugs from the hospital to keep me healthy, i have tried all means in life to become Hiv negative one day, but there was no answer until i found Dr Samuel from the parish of Africa who provide me some healing spell and herbs that he used to help me, now i am glad telling everyone that i am now HIV Negative, i am very very happy, thank you Dr Samuel for helping me get my life back without any form of crisis, may God bless you Dr Samuel and equip you to the higher grade for healing me. i am so amazed. so i will announced to everyone in this whole world that is HIV positive to please follow my advice and get healed on time, because we all knows that HIV disease is a deadly type,contact Dr Samuel for your HIV healing spell and herbs today at: drsamuelherbalclinic27@gmail.com.... He will always be happy to assist you online and ensure you get healed on time, You can reach him through his email address which is drsamuelherbalclinic27@gmail.com or his WhatsApp line on + 2348168178485 today for your healing spell immediately, thank you sir. His website is https://dr-samuel-herbal-clinic.business.site/


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  131. COMPLETELY CURED FROM GENITAL HERPES.
    I want to give all the glory to a herbalist Dr Samuel for changing my life by destroying the yoke of Herpes Simplex Virus from my body system with herbal roots and herbs. I have lived with Herpes Simplex Virus for 5 years now, my condition was so obvious because of the constant Fever & flu like symptoms, Tingling, burning or itching sensation in the area where blisters will appear. I started using antiviral drugs, until i saw on daily news that a herbalist specialize on curing Herpes! everyone on the site were talking about him so i got connected to the herbalist, he assured me he will get rid of the virus within 14 days. I believed and had faith in him for i really needed his help. He sent me a herbal medication through UPS delivery service. I used the medication for two weeks, I was experiencing changes in my body system cause the whole pain, Muscle aches were gone and now i have gotten myself back through herbal means and i advice you do the same by contacting this herbalist on
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  132. 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}

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  135. 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 12 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 Oyagu and his herbal exploit. Contact him via email: oyaguherbalhome@gmail.com call or whatsApp him on +2348101755322.

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  138. I have suffered with herpes since I was young it is only the last few years I got to know so I started to look for a cure I went to several hospitals but to no avail. So I came here online to see if I could find a cure so I came across a page here a man was sharing testimonies about Dr Ohikhobo for his natural herbs cure for herpes so I decided to give it a try it only took two weeks of me taking his herbs and I was completely cured from herpes. contact Dr Ohikhobo today if you want to be cured from herpes or any kind of disease too .
    His Email: drohikhoboherbalcenter@gmail.com
    His Whatssap: +2348103601042
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  139. I have suffered with herpes since I was young it is only the last few years I got to know so I started to look for a cure I went to several hospitals but to no avail. So I came here online to see if I could find a cure so I came across a page here a man was sharing testimonies about Dr Ohikhobo for his natural herbs cure for herpes so I decided to give it a try it only took two weeks of me taking his herbs and I was completely cured from herpes. contact Dr Ohikhobo today if you want to be cured from herpes or any kind of disease too .
    His Email: drohikhoboherbalcenter@gmail.com
    His Whatssap: +2348103601042
    His Blog: https://drohikhoboherbalcenter.blogspot.com/

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  140. I have suffered with herpes since I was young it is only the last few years I got to know so I started to look for a cure I went to several hospitals but to no avail. So I came here online to see if I could find a cure so I came across a page here a man was sharing testimonies about Dr Ohikhobo for his natural herbs cure for herpes so I decided to give it a try it only took two weeks of me taking his herbs and I was completely cured from herpes. contact Dr Ohikhobo today if you want to be cured from herpes or any kind of disease too .
    His Email: drohikhoboherbalcenter@gmail.com
    His Whatssap: +2348103601042
    His Blog: https://drohikhoboherbalcenter.blogspot.com/

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