Monday, August 31, 2015

“The BNP is high – just give Lasix!”


This isn't rocket science, right? If your hypoxic patient has a high BNP and a wet CXR, then you give then a diuretic, and admit them. Done, next patient!

Some POCUS skeptics would argue, however, that using echo in CHF doesn't really affect diagnosis or management.
Of course, many of these same clinicians unironically carry a modern version of the sacred hollow stick around their necks...

Something Doc Cottle always carries: Lit cigarette.
Something Doc Cottle never carries:  Stethoscope.
So, can focused echo help us change our acute management?  

TL;DR - Yes.
TL; Will Read - Yes!

The Case:

An elderly male with a history of systolic & diastolic CHF is brought in by EMS. He describes an acute onset of dyspnea and wheezing 1 hour prior. Worse with lying down and exertion. Denies recent leg swelling or weight gain, and denies fevers, chills, or sputum. 
 
His systolic BP is > 200 mm Hg. No JVD, but prominent wheezing diffusely.


Before the CXR, ECG, or labs can be obtained, a focused ultrasound is performed.


A flat, collapsing IVC, but…

… numerous B-lines in the bilateral anterior apices, while …

… the EF appears to be only moderately decreased (chronic, per the last echo in the record).

So how does clinical care change based on the ultrasound?


The patient probably doesn’t have volume overload, given the markedly flat IVC. Indeed, he may actually be hyPOvolemic.

The dramatic “hive” of B-lines in the anterior apices, however, suggests that he nonetheless has quite a bit of water in his lungs.***
Plenty of research has shown that the number of B-lines is proportional to increases in pulmonary wedge pressure, to increases in extravascular lung water, and even increases in BNP


So, despite the flat IVC, he most likely has acute decompensated heart failure, due to diastolic heart failure (Scott Weingart has referred to this as SCAPE).

He isn’t volume overloaded, just volume maldistributed!
 

(*** Yes, a number of other etiologies can produce B-lines/acute interstitial syndrome. But:
  • Bilateral B-lines suggest against pneumonia;
  • Acute development weigh against pulmonary fibrosis or pneumonitis; and 
  • Absence of another severe disease did not support ARDS.)

Treatment


Since the echo suggests that high systemic vascular resistance is the problem, and not sheer volume overload, he is given 3 nitroglycerin tabs under the tongue (yes, 3 tabs at once).

His wheezing stops almost instantly, like someone had flicked a switch. The pro-BNP eventually came back at a kagillion, but his chest x-ray (obtained long after the nitro was given) looks benign.  This complicates the dialogue with the admitting team.

 
“Hey, I don’t have to stay the night, do I?”


49 comments:

  1. it can help a lot for the medicine student!!!http://www.afu.ac.ae/en/vision/

    ReplyDelete
    Replies
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  2. it can help a lot for the medicine student!!!http://www.afu.ac.ae/en/vision/

    ReplyDelete
  3. I am bold enough among many others to state that there is now a potent cure to this sickness but many are unaware of it. I discovered that I was infected with the virus 3 months ago, after a medical check-up. My doctor told me and I was shocked, confused and felt like my world has crumbled. I was dying slowly due to the announcement of my medical practitioner but he assured me that I could leave a normal life if I took my medications (as there was no medically known cure to Herpes). I went from churches to churches but soon found that my case needed urgent attention as I was growing lean due to fear of dying anytime soon. In a bid to look for a lasting solution to my predicament, I sought for solutions from the herbal world. I went online and searched for every powerful trado-medical practitioner that I could severe, cos I heard that the African Herbs had a cure to the Herpes syndrome. It was after a little time searching the web that I came across one Dr Itua(A powerful African Herbal Doctor), who offered to help me at a monetary fee. I had to comply as this was my final bus-stop to receiving a perfect healing. My last resolve was to take my life by myself, should this plan fail. At last it worked out well. He gave me some steps to follow and I meticulously carried out all his instructions. Last month, to be precise, I went back to the hospital to conduct another test and to my amazement, the results showed that negative,Dr Itua Can As Well Cure The Following Desease…Cancer,Hiv,Herpes, Hepatitis B,Liver Inflammatory,Diabetis,Fribroid, Dercum,Get Your Ex Back, You can free yourself of this Herpes virus by consulting this great African Herbal Doctor via this e-mail: drituaherbalcenter@gmail.com or call and whatsapp him on +2348149277967 He will help you and his herb medication is sure. he has the cure on all disease .You can talk to me on INSTAGRAM..tashamoore219....

    ReplyDelete
    Replies
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  4. Thanks to this great herbal doctor who cured my friend of HIV/aids, his name is Dr. Iyabiye. My friend suffered HIV for so long that she lost her job and became stranded financially because of HIV antiretroviral drugs she buys every time. Until 2 months ago when I heard about this doctor and I did contacted him to help my friend, he administered his medication on her and she was confirmed cured and free at the hospital after the treatment. I came here to inform the general public and to safe people from this life threatening & killing disease. Contact: iyabiyehealinghome@gmail.com (+2348072229413 / +2348158577300)

    ReplyDelete
  5. my husband and I have been married for about 7 yrs now. We were happily married with two kids, a boy and a girl. 3 months ago, I started to notice some strange behavior from him and a few weeks later I found out that my husband is seeing someone. He started coming home late from work, he hardly care about me or the kids anymore, Sometimes he goes out and doesn't even come back home for about 2-3 days. I did all I could to rectify this problem but all to no avail. I became very worried and needed help. As I was browsing through the Internet one day, I came across a website that suggested that Dr jeffrey can help solve marital problems, restore broken relationships and so on. So, I felt I should give him a try. I contacted him and he did a spell for me. Two days later, my husband came to me and apologized for the wrongs he did and promise never to do it again. Ever since then, everything has returned back to normal. I and my family are living together happily again.. All thanks to Dr jeffrey . If you need a spell caster that can cast a spell that truly works, I suggest you contact him. He will not disappoint you. This is his E-mail:
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    ReplyDelete
    Replies
    1. Do anyone still doubt natural herbs? I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. I wonder why people still spend their money on injections and drugs each time they are sick. Natural herbs can cure all kinds of illness including herpes, diabetes, asthma, HIV, HSV1&2, hepatitis, HPV etc. I've seen it with my own eyes. I was cured from Herpes and HPV and my aunt and her husband were cured from Hiv too by DR. Chukwu madu herbs. He uses natural herbs to cure different kind of virus. Dr. CHUKWU,prove to the world that natural herbs can cure all illness and he cured countless people using herbs. I know is hard to believe but am a living testimony. I was diagnose of Herpes and HPV in 2016 and i believe there is cure even when the doctors said there is no cure yet. I strongly believe in herbs and i came across a comment on a blog written by Lisa Pierre, saying she was cured from HERPES by Dr. CHUKWU MADU and i contacted his herbal hom on the email that was provided on the comment and order one for myself and he send it to me through UPS and gave me instructions on how to use it and after i finish taken it i went for checkup and the result shows am Herpes and HPV NEGATIVE. The doctor said that the virus is completely gone from my body. There is no harm trying herbs it work perfectly and it has no effect. You can contact Dr. CHUKWU MADU to get yours.. His email is dr.chukwumaduherbalhome@gmail.com.
      WhatsApp +2347030936239.

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

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

    ReplyDelete
  8. I Can't still believe that i got cured from Genital Herpes through herbal treatment from Dr Aizonofe herb who I met through the internet, I actually couldn't believe it at first because it sounded impossible to me knowing how far I have gone just to get rid of it. Dr Aizonofe herb send me his medicine which I took as instructed and here I am living a happy life once again, a big thanks to Dr Aizonofe herb, I am sure there are many herbal doctors out there but Dr Aizonofe herb did it for me, contact him draizonofeherb@gmail.com , also call or whatsApp him on +2348136785562

    ReplyDelete
  9. I am bold enough among many others to state that there is now a potent cure to this sickness but many are unaware of it. I discovered that I was infected with the virus 3 months ago, after a medical check-up. My doctor told me and I was shocked, confused and felt like my world has crumbled. I was dying slowly due to the announcement of my medical practitioner but he assured me that I could leave a normal life if I took my medications (as there was no medically known cure to Herpes). I went from churches to churches but soon found that my case needed urgent attention as I was growing lean due to fear of dying anytime soon. In a bid to look for a lasting solution to my predicament, I sought for solutions from the herbal world. I went online and searched for every powerful trado-medical practitioner that I could severe, cos I heard that the African Herbs had a cure to the Herpes syndrome. It was after a little time searching the web that I came across one Dr Afrid (A powerful African Herbal Doctor), who offered to help me at a monetary fee. I had to comply as this was my final bus-stop to receiving a perfect healing. My last resolve was to take my life by myself, should this plan fail. At last it worked out well. He gave me some steps to follow and I meticulously carried out all his instructions. Last month, to be precise, I went back to the hospital to conduct another test and to my amazement, the results showed that negative,Dr Afrid Can As Well Cure The Following Disease…Cancer,Hiv,Herpes, Hepatitis B,Liver Inflammatory,Diabetics,Fribroid, Dercum,fibromyalgia,Get Your Ex Back,Als,SYPHILLIS,Genetic disease, Parkinson's disease.Fibrodysplasia Ossificans Progressiva.You can free yourself of this Herpes virus by consulting this great African Herbal Doctor via this e-mail:  drafridherbalhome@gmail.com or call and whatsapp him on +2349057260738 He will help you and his herb medication is sure. he has the cure on all disease...

    ReplyDelete
  10. 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

    ReplyDelete

  11. Its a miracle that I am alive today. I encounter HERPES SIMPLEX VIRUS (HSV1/2) for good four (4) years, six (6) months and twelve (12) day with my calculations, before 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

    ReplyDelete
  12. So happy right now.Words are not enough to thank you Dr.Chukwu madu herbal home, for healing me of the deadly disease that have been disturbing me for 9 years now, I have promise to share testimony about you if you are really able to cure me of my HSV2 which you really cured. I am here to tell the whole world that there are real powerful herbal doctor who can cure any disease because i am a living testimony to your work. You have wiped away the shame on my face and brought Joy back to my life that i have wish for over 9 years now. I was reading a testimony in a forum of a lady who said you cured her from the deadly Herpes Simplex virus, and i never believed not until i gave you a try and you really cured me. You are really a God sent to people and i will continue to spread the good thing you are doing to other people in the world who might also be having same problem cause i know you will also be of help. Anyone who is suffering from any kinds of disease should contact this great herbal Man called Dr.Chukwu madu on his email[ dr.chukwumaduherbalhome@gmail.com] . or call his mobile number or whatsapp him  +2347030936239,
    and get your problem solved. 

    ReplyDelete
  13. Do anyone still doubt natural herbs? I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. I wonder why people still spend their money on injections and drugs each time they are sick. Natural herbs can cure all kinds of illness including herpes, diabetes, asthma, HIV, HSV1&2, hepatitis, HPV etc. I've seen it with my own eyes. I was cured from Herpes and HPV and my aunt and her husband were cured from Hiv too by DR. Chukwu madu herbs. He uses natural herbs to cure different kind of virus. Dr. CHUKWU,prove to the world that natural herbs can cure all illness and he cured countless people using herbs. I know is hard to believe but am a living testimony. I was diagnose of Herpes and HPV in 2016 and i believe there is cure even when the doctors said there is no cure yet. I strongly believe in herbs and i came across a comment on a blog written by Lisa Pierre, saying she was cured from HERPES by Dr. CHUKWU MADU and i contacted his herbal hom on the email that was provided on the comment and order one for myself and he send it to me through UPS and gave me instructions on how to use it and after i finish taken it i went for checkup and the result shows am Herpes and HPV NEGATIVE. The doctor said that the virus is completely gone from my body. There is no harm trying herbs it work perfectly and it has no effect. You can contact Dr. CHUKWU MADU to get yours.. His email is dr.chukwumaduherbalhome@gmail.com.
    WhatsApp +2347030936239.

    ReplyDelete

  14. Hello Am From The UK , I want to write a little testimony about the good work of doctor Oyagu who cured me from Hsv 1 and 2 for just 2 weeks with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc Oyagu email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through email address oyaguherbalhome@gmail. com or text him on what's app, phone number +2348101755322 Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from suffering.

    ReplyDelete
  15. Am Laura Mildred by name, i was diagnosed with Herpes 4 years ago i lived in pain with the knowledge that i wasn't going to ever be well again i contacted so many herbal doctors on this issue and wasted a large sum of money but my condition never got better i was determined to get my life back so one day i saw Mr. Morrison Hansen post on how Dr. Emu saved him from Herpes with herbal medicine i contacted Dr. Emu on his Email: Emutemple@gmail.com we spoke on the issue i told him all that i went through and he told me not to worry that everything will be fine again so he prepared the medicine and send it to me and told me how to use it, after 14 days of usage I went to see the doctor for test,then the result was negative, am the happiest woman on earth now thanks to Dr. Emu God bless you. Email him at: Emutemple@gmail.com Whats-app or Call him: +2347012841542 

    ReplyDelete
  16. I’m here to testify about what Dr Samuel did for me. I have been suffering from (GENITAL HERPES VIRUS) disease for the past 4 years and had constant pain and inching, especially in my private part. During the first year, I had faith in God that i would be cured someday.This disease started circulating all over my body and I have been taking treatment from my doctor, few weeks ago I came across a testimony of Rose Smith on the internet testifying about a Man called Dr Samuel on how he cured her from 7 years HSV 2. And she also gave the email address of this man, advise anybody to contact him for help on any kind of diseases that he would be of help, so I emailed him telling him about my (HSV 2) he told me not to worry that I was going to be cured!! Well, I never doubted him I have faith he can cure me too,, Dr Samuel prepared and sent me Healing Oil, Soap, roots and herbs which I took. In the first one week, I started experiencing changes all over me, after four weeks of using his Roots/ Herbs, Oil and Soap, I was totally cured. no more inching , pain on me anymore as Dr Samuel assured me. After some time I went to my doctor to do another test behold the result came out negative. So friends my advise is if you have such disease or know anyone who suffers from it or any other disease like HPV, HBV, HIV, ALS, HBP, CANCER etc. you can contact Dr.samuel for help via dr.samuel 245@gmail.com or whatsapp +2348166600171

    ReplyDelete
  17. I feel very happy to share my great and wonderful testimony with everyone on this site..: I was married for 4 years to my husband and all of a sudden another woman came into the picture he started hating me and he was abusive.but i still loved him with all my heart and wanted him at all cost.... He filed for divorce and my whole life was turning apart and i didn't know what to do, he moved out of the house and abandoned me and the kids... my very close friend told me about trying spiritual means to get my husband back and introduced me to a spell caster so i decided to try it. although i didn't believe in all those things then when he did the special prayers and spell, after 2 days, my husband came back and was pleading that he had realized his mistakes I just couldn't believe it, anyway we are back together now and we are happy in case anyone needs help here is his email address; Account
    doctorirekenagba@gmail.com His spells is for a better life OR call his number
    +2347059630655 or contact him on WHATSAPP

    ReplyDelete
  18. I feel very happy to share my great and wonderful testimony with everyone on this site..: I was married for 4 years to my husband and all of a sudden another woman came into the picture he started hating me and he was abusive.but i still loved him with all my heart and wanted him at all cost.... He filed for divorce and my whole life was turning apart and i didn't know what to do, he moved out of the house and abandoned me and the kids... my very close friend told me about trying spiritual means to get my husband back and introduced me to a spell caster so i decided to try it. although i didn't believe in all those things then when he did the special prayers and spell, after 2 days, my husband came back and was pleading that he had realized his mistakes I just couldn't believe it, anyway we are back together now and we are happy in case anyone needs help here is his email address; Account
    doctorirekenagba@gmail.com His spells is for a better life OR call his number
    +2347059630655 or contact him on WHATSAPP

    ReplyDelete
  19. I would like to let all know that the size of your Penis really matters in your relationship or marriage. I got married to my wife about 1 month after we met on a photo studio, we lived happily for the first 3 months of our marriage until i and my wife started having quarrels at home because i couldn't satisfy her on bed with my little penis. Actually my penis was very small, it measured about 4.5 inch long on erection and i am 39 years old. My wife said it was forbidden by the women of this world. My wife started sleeping with other men outside. Sometimes i will return from work without finding my wife at home and whenever i call or ask her where she was, she will always snub at me and sometimes just tell me to go get a larger dick. All this continued for a long time and it hurt me so much that i was at the edge of breaking up on the marriage till when i read about a doctor called DR.OMOHAN. online. I never thought i could smile and be in a happy marriage again if not for the help of DR.OMOHAN. I got the doctors Emails:(dromohanherbalmedicine@gmail.com ) on the internet and i emailed him, and he got back to me with some encouraging words, he got me some herbs cream which i use for just 8 days and i began to feel the enlargement of my penis, and without surgery. This went on for a little period of about 10 days and to my surprise my wife keeps screaming that she love my big dick now. Now my wife no longer cheat on me, and my penis is now about 10.5 inches long on erection and off course very large round. And now my wife uses breasts, hips and bums enlargement. I and my wife are very happy for the help rendered to me by DR.OMOHAN , and i want to say a big thanks to Doctor for the help. You can contact the Doctor now on his Email:( dromohanherbalmedicine@gmail.com ) Am thankful to the doctor for helping me.
    his whataspp number +2348164816038

    DOCTOR OMOHAN 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 SPELLhim to solve
    6 LOW SPERM COUNT SPELL
    get all your problem solve. No problem is too big for him to solve.

    ReplyDelete
  20. I was diagnosed of herpes virus in 2015, I have tried all possible means to get cure but all my effort proved abortive, until a friend of mine introduced me to a herbal doctor called Dr Onokun who prepare herbal medicine to cure all kind of diseases including herpes virus (Hsv), when i contacted this herbal doctor via his email, he sent me herpes virus herbal medicine via courier service, when i received the herbal medicine he gave me step by step instructions on how to apply it, when i applied it as instructed i was totally cured from the virus within 2 weeks of usage. Contact this great herbal doctor today to get your cure.
    Via Email : Dronokunherbalcure@gmail.com

    ReplyDelete
  21. God bless Dr Ebacol for his marvelous work in my life, I was diagnosed of HERPES since 2018 and I was taking my medications, I wasn't satisfied i needed to get the HERPES out of my system,I searched out some possible cure for HERPES i saw a comment about Dr Ebacol, how he cured HERPES,DIABETES,HIV,and CANCER with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine I took the medicine as prescribed by him and 14 days later i was cured from HERPES, Dr Ebacol truly you are great, do you need his help also? Why don’t you contact him through his EMAIL:    drebacolherbalhome1@gmail.com  call or whatsApp him on +2348159042641 

    ReplyDelete
  22. DR OYAGU herbal medicine is a good remedy for herpes simplex virus cure. My name is MIGNON WRIGHT , am from USA,I am here to give my testimony about DR OYAGU who helped me in my life, i want to inform the public how i was cured from (HERPES SIMPLEX VIRUS) by DR OYAGU, i visited different hospital but they gave me list of drugs like Familiar, Zovirax, and Valtrex which is very expensive to treat the symptoms and never cured me. I was browsing through the Internet searching for remedy on HERPES and i saw comment of people talking about how DR OYAGU cured them, when i contacted him he gave me hope and send a Herbal medicine to me that i took and it seriously worked for me, am a free person now without any problem, my HERPES result came out negative, I pray to God to never let me and my family forget you in our life,am now cured permanently, you can also get your self cured my friends if you really need this doctor help, you can reach him now his website https://oyaguspellcaster.wixsite.com/oyaguherbalhome Email: oyaguherbalhome@gmail.com or via whatsapp +2348101755322

    ReplyDelete
  23. Dr Ishiaku herbal medicine is mighty and genuine,I use to use Mellisa oil and Lavender Healing herbs but result were just still the same.But using Doctor Ishiaku herbal medicine cured my herpes final and I have being living for 2 years now No Sores.My herpes is truely gone.Contact him if you interested of his herbal medicine too Dr Ishiaku can as well cure the following....HIV...HERPES,,COPD..FIBROID..ASTHMA..DIABETES..SICKLE CELL...ALS..EPILEPSY,,HEPATTITIS...CANCER...LOVE SPELL ...ishiakuherbalcure@gmail.com Or Whats-app Number On +2348180828544  

    ReplyDelete
  24. Becoming wealthy and living the lifestyle of the rich and famous is the dream of many people. And whilst most people go to work or seek other ethical methods of making money online. The blank ATM withdraws money from any ATM machines and there is no name on it because it is blank just your PIN will be on it, it is not traceable and now I have money for business, shopping and enough money for me and my family to live on. PROGRAMMED blank ATM card that is capable of hacking into any ATM machine,anywhere in the world.
    Contact Person: Prof Alexander Castro
    E-Mail: atmservices44@aol.com
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    whatsapp: +17042750147

    ReplyDelete
  25. Using herbal natural remedy was what got me tested negative to HSV 2 after been diagnosed for years.I have spend so much funds on medications like acyclovir (Zovirax), Famciclovir (Famvir), and Valacyclovir (Valtrex But it was all a waste of time and my symptoms got worse To me It is very bad what Big pharma are doing, why keep making humans suffer greatly just to get profits annually for medications that doesn't work.I'm glad that herbal remedies is gaining so much awareness and many people are getting off medications and activating their entire body system with natural herbal remedies and they are become holistically healed totally. Quickly contact Dr Felix herbal home now email him directly on Dr.felixherbalhome@gmail.com or Whatsapp :+2349068063760

    ReplyDelete

  26. I am here to express my deep and warm gratitude to herbal medicine, which I obtained from Dr. Patrick. Now I am living a healthy life since last 6 months. I am now free of genital herpes virus after the herbal medication I received from him. You can contact him to get your medicine through his email: drpatrickspelltample2001@gmail.com

    ReplyDelete
  27. We have a lot of credit cards available. We are trying to get them out of hand to people.

    You can hack and break into a bank's security ATM Machine without carrying guns or any weapon.How is this possible? First of all we have to learn about the manual hacking of ATM MACHINES and BANKING ACCOUNTS HOW THE ATM MACHINE WORKS. If you have been to the bank you find out that the money in the ATM MACHINE is being filled right inside the house where the machine is built with enough security to hack this machine. We have developed the special blank ATM Card which you can use in any ATM Machine around the world. This card is been programmed and can withdraw 5000 USD daily  in any currency your country make use of. depending the card withdrawal amount you buy. The card will make the security camera malfunction at that particular time until you are done with the transaction you can never be traced. If you are interested in getting the card Contact us now and make more money.  email us now mrbeckhamblankatmcard@gmail.com

    ReplyDelete
  28. Having herpes is not the end of life there is a treatment that can get rid of Genital herpes with traditional herbs from Dr Kham. I was positive to this infection (HERPES) and I lost hope because I was outcast and rejected even by my closet friends. I searched on-line to know an enquirer cure for HERPES and I got a testimony posted by a patient on how she was cured from HSV by Dr. Kham herbal product, So i decided to contact the same herbalist Dr. Kham because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs created by God Almighty! After contacting him, he told me that the cure has to be prepared and he will send it to me via (UPS Delivery service) and unfortunately it got to me after 5 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! it's really like a dream but I am so happy now! That's the reason I decided to also add more comments on Him so that more can be saved just like me! and if you need his help, you can email him on dr.khamcaregiver@gmail.com or whats-app +23478159922297 for more information about his herbal medication visit his website via: https://herbal-dr-kham.jimdosite.com/

    ReplyDelete
  29. I’m here to testify about what Dr. Omola did for me. I have been suffering from (GENITAL HERPES VIRUS) disease for the past 3 years and had constant pain and inching, especially in my private part. During the first year, I had faith in God that i would be cured someday.This disease started circulating all over my body and I have been taking treatment from my doctor, few weeks ago I came across a testimony of Mary on the internet testifying about a Man called Dr. Omola on how he cured her from 5 years HSV 2. And she also gave the email address of this man, advise anybody to contact him for help on any kind of diseases that he would be of help, so I emailed him telling him about my (HSV 2) he told me not to worry that I was going to be cured!! Well, I never doubted him I have faith he can cure me too,, Dr. Omola prepared and sent me Healing Oil, Soap, roots and herbs which I took. In the first one week, I started experiencing changes all over me, after four weeks of using his Roots/ Herbs, Oil and Soap, I was totally cured. no more inching , pain on me anymore as Dr. Omola assured me. After some time I went to my doctor to do another test behold the result came out negative. So friends my advise is if you have such disease or know anyone who suffers from it or any other disease like HPV, HBV, HIV, ALS, HBP, CANCER etc. you can contact Dr. Omola for help via dr.omolaherbalhome@gmail.com or whatsapp +2348118116254.

    ReplyDelete
  30. Herbal treatment is 100% guaranteed for Herpes cure, the reason why most people are finding it difficult to cure Herpes is because they believe on medical report, drugs and medical treatment which is not helpful to cure Herpes. Natural roots/herbs are the best remedy which can easily eradicate herpes forever for more information about Herpes cure Pls share this. I was so happy to see that my result showed up negative after taking Dr.Sandy herbal medication for my Herpes contact him via Email    dr.sandyspelltemple@gmail.com     call Whatsapp Number +2349154145362
    FOR FIX THE FOLLOWING PROBLEMS USING POWERFUL SPELLS TO ALL ACROSS THE GLOBE ON:
    1 Cancer herbal medicine
    2 Hiv herbal medicine
    3 Low sperm count
    4 Barrennessi
    5 Hvp herbal medicine
    6 Herpes herbal medicine   7 ADHD CDC cure.. 
    8 Coronavirus cure

    ReplyDelete
  31. I never thought I would be herpes negative again after been diagnosed for 4 years, I have tried everything possible in life from one medical doctor to another, one hospital to another, series of tests, different kinds of medication, I had already lost hope until I meet Great Dr. Riaria online testimonies, a specialist in herbal medication from Africa, I contacted him through his email and number I got from one of the many testifiers, and he prepared herpes herbal medication for me which I took for weeks and now I am completely cured. I have gone to different hospitals for check ups to be totally sure, and all my reports are negative. I want to use this medium to express my gratitude to him for saving my life and curing me from herpes virus, for taking away all my pains and sorrows, I'm indeed grateful and I am so happy I'm now herpes negative. I will continue to tell the good news of your great works to everyone, if you have herpes virus or other disease contact him now via: drriaria@gmail.com or WhatsApp +2349134987375 thank you all and god bless you

    ReplyDelete
  32. IT WORKS EVERYWHERE IN THE WORLD!! JUST LOCATE AN ATM MACHINE!!!
    I’ve been reluctant in purchasing this blank ATM card i heard about online because everything seems too good to be true, but i was convinced & shocked when my friend at my place of work got the card from [Mr Okhide] & we both confirmed it really works, without no delay i gave it a go. Ever since then I’ve been withdrawing $5000 daily from the card & the money .has been in my own account. So glad i gave it a try at last & this card has really changed my life financially without getting caught, its real & truly works though its illegal but made me rich!! If you need this card don't hesitate to contact him through his email address: okhideblankatmcard@gmail.com ..

    ReplyDelete
  33. I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
    liver already present. I started on antiviral medications which
    reduced the viral load initially. After a couple of years the virus
    became resistant. I started on HEPATITIS B Herbal treatment from
    ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
    treatment totally reversed the virus. I did another blood test after
    the 6 months long treatment and tested negative to the virus. Amazing
    treatment! This treatment is a breakthrough for all HBV carriers.

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


    ReplyDelete
  35. I was broken, rejected and almost lost all hope due to my 13 years of HIV infection. Then I read about the doctor Osasu on a blog and wrote to him on Whatsapp Via: +2347064365391 and Email: drosasu25@gmail. com, after hearing my story he sent me herbal remedies that cured me of HIV / AIDS. My doctor is still puzzled by the results of the laboratory investigations because I tested negative 4 times after using the drugs. I lost all shame because I am now free and my husband took me back. I testify that you will be cured of hepatitis, cancer, herpes or diabetes and others if you use his medicines. Don't be a victim, but be victorious, Please share as you read okay, you may save a soul today. Natural herbs are really great.

    ReplyDelete
  36. There is no other way to get the body of herpes virus other than detoxification using natural diet or pure herbs. The health industry is a billion dollars industry - which is why the big pharmaceuticals sued Dr. Sebi the moment he discovered a 1-Week CURE FOR HERPES (Oral and Genital). Most diseases are acquired by what you eat. Even when infected by someone, it thrives because your body is receptive and filled with mucus. No disease can survive in an electric filled body. What you eat will determine how you live, how you behave, and even how it relates to you. Detoxification is the heart of ridding the body of the herpes virus. There is no other way to bring the necessary result. There are three ways to achieve this; Stop putting acidic foods into the body - if possible eat only alkaline diet, Fast daily before eating if possible for a year, Cleanse the body of toxins and acids with Nze Njoku Herbal Formula (Which also increases oxygen to cells). Feed the body with the right nutrients to repair, rebuild, and strengthen it at a cellular level and watch the body heal itself.

    Some may wonder, how long is one expected to maintain such a diet and what herbs can help you achieve all these within few weeks?

    Nze Njoku Herbal Home provides all the
    answers.

    ReplyDelete
  37. powerful herbal healer called Dr. voodoo who use his natural herbs to cure
    my HIV disease I suffered from 5years, but now I am a happy woman and i am
    free from this disease that has been problem to my living, after using Dr.
    voodoo herbal medicine within 1week i was diagnose negative, I will
    recommend Dr. voodoo to everyone reading this article because this herbal
    healer is capable to heal anything below.

    1. Diabetes
    2. HERPES 1/2
    3. CANCER
    4. Lymphoma disease
    5. Conceived a child
    6. Fibroid

    Email Dr voodoo at: voodoospelltemple66@gmail.com add Dr. voodoo on
    whatsApp: +2348140120719

    ReplyDelete
  38. I’d recommend using Dr. Utu Herbal Cure topically for instant pain and itch relief as well as accelerated healing of lesions and permanently stopping oral and genital herpes virus outbreaks. I have tried just about everything from acyclovir suppressive therapy to different natural oils, extracts, and other natural methods, some of which are EXTREMELY painful and exacerbate the problem (i.e. apple cider vinegar!). While vitamin E oil and suppressive therapy worked well for me, when I became pregnant I went back to trying to find a herbal cure. I was using vitamin E oil topically for a while but it was thin and difficult to use and only seemed to prevent further outbreaks rather than getting rid of it. I contacted Dr. Utu Herbal Cure through my friend. To my surprise, I could tell my outbreak was starting to heal within only a few hours! No more itching or pain! Dr. Utu Herbal Cure that I used was liquid herbs in bottles, so it was very easy to use. It simply whiffs, but it works so I don’t care! The best piece of my testimony was that I successfully delivered a herpes-free beautiful daughter without further treatments. Anyone who has tried Dr. Utu Herbal Cure knows just how quickly those treatments can add up. So give it a try! Anyone can reach Dr. Utu through
    drutuherbalcure@gmail.com
    +2349072733661

    ReplyDelete