Wednesday, April 15, 2015

Dr. Martin Lerner's Treatment Protocol for ME/CFS

Dr. Martin Lerner has been a long-time proponent of antiviral therapies for treating ME/CFS. His background as an infectious disease specialist naturally led him to explore antimicrobials because he believes that microbial infections lie at the heart of ME/CFS symptomatology. He has authored numerous papers on antiviral treatments for ME/CFS, and has treated patients for decades.

Below is his guide to treating patients with ME/CFS using antimicrobial agents. He also includes the roster of tests he uses for diagnosis, and a section on patient care.

Dr. Lerner makes the disclaimer that his guide has not been peer-reviewed, but that does not make it any less valid. The guide is a summary of decades of clinical experience and, as such, stands on its own.

You can read the original document here:

http://www.treatmentcenterforcfs.com/documents/MECFSTreatmentResourceGuideforPractitioners.pdf

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DISCLAIMER: The information contained in this document is meant for informational purposes only. The management of ME/CFS in any given patient must be approached on an individual basis using an Infectious Diseases’ specialist’s best judgment. This document is a culmination of over 20 years of ME/CFS practice and peer reviewed articles. This document is not a peer reviewed publication.

ME/CFS Treatment Resource Guide for Practitioners

By A. Martin Lerner, M.D., M.A.C.P.

Beaumont Health System Treatment Center for Chronic Fatigue Syndrome


Diagnostic Methodology

Initial patient visit:

Complete history, physical examination, chest X-ray, electrocardiogram, complete blood count, urinalysis, serum aspartate and aminotransferases (AST, ALT), glucose, thyroid stimulating hormone, sodium, potassium, uric acid, alkaline phosphatase and creatinine measurements performed.

ME/CFS analysis:

Energy Index Point Score® assessing physical functional capacity in activities of daily life documenting limitations. The EIPS® system defines the severity of patient fatigue, 0-10, through measurement of real-life situations including one’s ability to sit, stand, be out of bed, work, perform housework, socialize, exercise. The EIPS® level is determined through discussion between the physician and patient. A change in EIPS® level of one is a significant change in health and lifestyle for the patient, as ME/CFS symptoms decrease when the EIPS® increases.

Cardiac testing:

–24-hour Holter monitor - symptoms recorded (syncope, chest pain, palpitations, muscle aches)
–Standard 12-lead resting electrocardiogram – if original ECG abnormal
–Rest/stress myocardial perfusion study – if original ECG abnormal
–Multigated (radionuclide) MUGA rest/stress ventriculographic examination – if original ECG abnormal
–Monitor Blood Pressure (laying, sitting, standing)
–Monitor Heart Rate (laying, sitting, standing)


Viral testing for EBV, HCMV, HHV6:

–EBV serum IgM viral capsid antibodies (VCA) - Diasorin, Inc., Stillwater, MN
–EBV early antigen diffuse (EA) - Diasorin, Inc., Stillwater, MN
–ELISA HCMV(V) IgG and IgM serum antibodies to viral capsid, strain 169 HCMV - Diasorin, Inc., Stillwater, MN
–HHV6 IgM and IgG serum - Lab Corp, Dublin, OH

Co-infection testing:

–Western blot and ELISA to Borrelia burgdorferi (IgM and IgG) - Lab Corp, Dublin, OH
–IgM and IgG of Babesia microti - Lab Corp, Dublin, OH
–IgM and IgG of Anaplasma phagocytophila - Lab Corp, Dublin, OH
–IgM and IgG of Mycoplasma pneumoniae - Lab Corp, Dublin, OH
–Anti-streptolysin O (ASO) titer ≥400 units - Lab Corp, Dublin, OH

Note Lyme and Lyme co-infections can be elusive. Lyme disease can present clinically as ME/CFS. A significant portion of Lyme disease cases have negative Lyme serologic tests. We prefer Lab Corp for Lyme testing and use all 4 tests. The antigens used are those used by the CDC. An appropriate rural exposure, a tick bite, a bull’s eye rash, can all add to the likelihood of Lyme disease. Due to the need for both clinical and diagnostic evaluation in Lyme disease, it is recommended to consider an Equivocal (not negative or positive) lab result, as positive and begin Lyme treatment.

Follow-up:

–Every 4-6 weeks - Complete blood counts, sodium, potassium, AST, ALT, alkaline phosphatase, creatinine and urinalysis.

–Every 3 months – Serum assays for EBV VCA IgM, EBV EA, HCMV(V) IgM and IgG, HHV6 IgM and IgG and all co-infections which are positive originally


EIPS® - A Functional Capacity Measurement Tool For Chronic Fatigue Syndrome (CFS) Patients

To Physicians Caring for Patients with CFS

The Energy Index Point Score (EIPS) chart provides the severity of patient fatigue. A change in EIPS level of one is a large significant change. The EIPS level is determined by agreement of physician and patient with the EIPS chart easily available for viewing at out-patient visits. As the EIPS level increases, CFS symptoms lessen and disappear.

How to use the EIPS system in four easy steps:

1) Post the EIPS chart in examining room
2) Ask patient to evaluate their level of activity based upon the prior two weeks
3) Question the patient’s EIPS evaluation
4) Record and track the EIPS level. Report every 6-12 weeks.*



* The EIPS is not assessed if the patient has an intercurrent infection (respiratory, gastroenteral, ...). At the same visit the following 4 symptoms are regularly categorized: 1) chest pain 2) palpitations 3) muscle aches 4) lightheadedness - noting whether absent or present. If present, when (beginning or end of day, how frequent), where, severity, etc. All of these factors are included in the EIPS assessment.


Antiviral Treatment of EBV

General Information

A diagnosis of Epstein-Barr virus(EBV) infection is made with a positive EBV EA antibody diffuse and/or a positive VCA IgM antibody.

Treatment

Valacyclovir (Valtrex) is remarkably effective and safe. The one concern is that valacyclovir is excreted by the glomerulus and secreted by the tubules and can cause acyclovir stones and obstructive uropathy. This will not occur if the patient drinks at least six 8-ounce glasses of water daily. Occasionally diarrhea may be caused by the valacyclovir. If the patient weighs 70 kg, the dosage is 1 gram four times daily, ideally every six hours; however safe to take four hours after the last dosage (it is not necessary to awake in the middle of the night for a dose). It is important that the patient take four doses for treatment. A higher dose of Valtrex may be necessary with patients who weigh more than 175 pounds and this must be done carefully. A patient who weighs more than 175 pounds may require 1.5 grams of Valtrex, valacyclovir four times daily. Please note valacyclovir is now available in generic form. While I have not had experience with all distributors of generic forms yet, I have had patients move to the generic form of valacyclovir by Teva and Mylan with no issue.

Famvir at the same dosage can be substituted and although there is not the strong evidence that we have for valacyclovir, it likely is equally effective. One does not have the worries concerning renal calculi with Famvir and it has also been extraordinarily safe. It does not cause diarrhea.

An initial worsening of symptoms with normal laboratory at a two-week special visit with worsening symptoms is a Jarisch Herxheimer reaction and predicts a good response. Initial benefit is usually not noted for the first six weeks’ of therapy and then occurs thereafter. A minimum period of therapy is one year. Usually benefit is not apparent until after 3.5 months of therapy.

We have not seen thrombocytopenia with Valtrex, valacyclovir. However, an elevated mean corpuscular volume is seen. This is not a toxicity, and does not require one to stop medicines.

Antiviral Treatment of HCMV & HHV6

General Information

A diagnosis of cytomegalovirus(CMV) infection is made with an elevated CMV IgG titer. The IgM titer for CMV is inaccurate and insensitive. The higher the CMV IgG titer, the greater the viral load. Human herpes virus 6 infection is made with an elevated titer at least twice normal. The diagnosis of EBV, CMV, or HHV6 ME/CFS meets the Canadian consensus and Fukuda CFS criteria.

Treatment

The usual treatment for either/both is valganciclovir (Valcyte) one 450-mg capsule daily for three days, followed by two 450-mg capsules in the morning daily. Liver function tests are studied very carefully. If there is any abnormality, one alters the dosage. Given the patient’s ability to safely tolerate two 450-mg capsules, dosing can be increased to two, 450-mg capsules in the morning and a one additional 450-mg capsule twelve hours later. Liver function tests, again, must be studied carefully and frequently.

Both valacyclovir and valganciclovir are absorbed with a 20% increment if there is food in the stomach. The most common side effect of valganciclovir is hepatotoxicity. If this occurs, the drug is stopped, the dosage is decreased, and is again restarted. When monitoring reveals AST and ALT are normal, the monitoring can continue every four to six weeks, but more frequent with hepatotoxicity. The rule is no valganciclovir at all if there is any abnormality in liver function.

The duration of valganciclovir and therapy for CMV and/or HHV6 is aimed at one year to start with no improvement expected for the first four to six months. It is a general rule that the shorter the duration of ME/CFS, and the earlier appropriate therapy is started, the earlier recovery will occur. Recovery is a continuing, gradual process.

We have not seen thrombocytopenia with Valcyte, valganciclovir. An elevated mean corpuscular volume is seen. This is not a toxicity to stop medicines.

Antibiotic Treatment of Co-infections

Background

If the diagnosis of ME/CFS is made by the accepted criteria and there is no coinfection, one begins antiviral therapy promptly. However, if there is coinfection with a diagnosis of Lyme disease, Babesiosis, Ehrlichiosis, Mycoplasma pneumoniae, or adult rheumatic fever, these conditions are addressed first. After these conditions are addressed, ME/CFS is treated with antiviral therapy. Should one or more of these co-infections occur mid- antiviral treatment, do not stop but treat in parallel.

Treatment of Lyme Disease

The protocol for Lyme disease, serologically positive or epidemiologically positive and serologically negative, that I use is a six-week’s course of intravenous therapy. Ceftriaxone is preferred. If there is a history of allergy to penicillins and it is not an immediate allergy, I routinely refer the patient to an allergist for cephalosporin testing. Under ordinary circumstances if this is negative, ceftriaxone is given; depending on the size of the individual 1-1.5 grams intravenously every 12 hours. The patient is seen weekly. They are asked not to travel further than 45 minutes from this office, because a PICC lines has been placed and infection of the PICC line site or side effects to the cephalosporin can occur; particularly biliary dyskinesia or abnormal liver function tests with ceftriaxone. Cefotaxime may be substituted for ceftriaxone in the case of biliary dyskinesia. If there is biliary dyskinesia, Unasyn, or ertapenem may be used. If diagnosis of Lyme occurs after antiviral treatment has commenced, and patient shows liver sensitivities with Valcyte dosing, Unasyn is recommended. Unasyn is given 2 grams IV piggyback every 12 hours. Ertapenem is given 2 grams IV piggyback every 24 hours. The same dosage of cefotaxime (as ceftriaxone) of 1-1.5 grams is used, but the administration of cefotaxime IV is every 8 hours, rather than every 12 hours, for ceftriaxone. Cefotaxime has no hepatotoxicity. Cefotaxime is excreted by the kidneys.

The goal of Lyme therapy, of course, is a well patient, but particularly a negative serology. Oral suppressive therapy is continued for at least three months or until the Lyme serology is negative. Typical medicines used for Lyme suppression after the original six weeks are amoxicillin; in a 70-kg individual 750 mg before every meal and at bedtime. Doxycycline 100-150 mg twice daily after meals and with a full glass of water may be given in the place of amoxicillin for suppression.

Treatment of Mycoplasma Pneumonia

We use LabCorp less than 300 as a normal level. The patient is not considered to have persistent Mycoplasma pneumoniae infection unless the initial titer is 600 or more. Mycoplasma pneumoniae is treated intravenously with doxycycline 150 mg IV piggyback for six weeks followed by oral suppression with doxycycline 100-150 mg twice daily or moxifloxacin 400 mg once daily for three months. The goal of this therapy is a serum level which is less than twice the normal. The duration of time again is six weeks intravenously plus a minimum of three months oral suppression.

Treatment of Adult Rheumatic Fever

The diagnosis of adult rheumatic fever is made with an ASO titer of over 400. Echocardiograms are done in all patients with ME/CFS originally and any changes in the mitral valve, either thickening or mitral valve prolapse are additional supports for the diagnosis of adult rheumatic fever. A patient who meets the criteria for ME/CFS with an ASO titer of 400 or more is considered to have adult rheumatic fever and treated accordingly.

Chest pain, joint pain, rash, life-altering fatigue are all common to ME/CFS and adult rheumatic fever. Patients are diagnosed with adult rheumatic fever with the following criteria:

(1) EIPS <5

(2) Diffuse, multi-joint pain

(3) Antistreptolysin O titer ≥ 400 (critical to diagnosis)

(4) Abnormal 24 hour Holter monitor with tachycardia and oscillating T-wave flattening, with or without T-wave inversions

(5) A thickened mitral valve at echocardiogram.

If there are symptoms of sinus disease, a CT of the sinuses is done to make certain there is no obstructive sinusitis which may need sinus surgery.

Patients are treated with intravenous Unasyn 3grams IV piggyback every 12 hours for 4-6 weeks, followed by 2.4 million units IM (1.2 million units each hip every 30 days) until ASO titer is ≤200.

Patient Management

Patient Visits and Testing

Check-ups with labwork should occur every 6 weeks in-person.

Diet and Exercise

A healthy, well balanced diet is a must. Minimize sugar intake. Minimize caffeine intake. Absolutely no alcohol allowed, as it may be a cardiac toxin for ME/CFS patients.

No physical exertion or exercise until above a 7 Energy Index Point Score. Stretching regularly is recommended. Once the EIPS is 7, modest exercise can and should begin. The ultimate test is - Are you tired the next day after exercise? If you are, then the exercise that you have done is too much. Start out very slow. Just a few minutes, allowing for breaks and recovery time.

Lifestyle

10-12+ hours of sleep per day and daily naps until the EIPS is at least a 6. Avoid germs (think airplanes, libraries, churches). Stretch daily, minimize exertion, seek assistance with housework/chores/errands. Keep feet elevated, promote a network for assistance and ask for help. 

Daily energy envelope management is a must. Do not push until a crash. This is not productive. As much as possible, do not allow yourself to get overly tired. Healing is a slow process.

Publication Resources


•Dworkin, H.J., Lawrie, C., Bohdiewicz, P., and Lerner, A.M.: Abnormal Left Ventricular Myocardial Dynamics in Eleven Patients With TheChronic Fatigue Syndrome. Clinical Nuclear Medicine 19:675-677, 1994

•Lerner, A.M., Zervos, M., Dworkin, H., Chang, C.H., Fitzgerald, J.T., Goldstein, J., Lawrie-Hoppen, C., Franklin, B., Korotkin, S., Brodsky, M., Walsh, D., O’Neill, W.: New Cardiomyopathy: Pilot Study ofIntravenous Ganciclovir in a Subset of the Chronic Fatigue Syndrome. Infectious Diseases in Clinical Practice 6:110-117, 1997

•Lerner, A.M., Zervos, M., Dworkin, M., Chang, C.H., O’Neill, W.: A Unified Theory of the Cause of Chronic Fatigue Syndrome. Infectious Disease in Clinical Practice 6:239-243, 1997

•Lerner, A.M., Goldstein, J., Chang, C., Zervos, M., Fitzgerald, J., Dworkin, H., Lawrie-Hoppen, C., Korotkin, S., Brodsky, M., O’Neill, W.: Cardiac Involvement in Patients with Chronic Fatigue Syndrome asDocumented with Holter and Biopsy Data in Birmingham, Michigan, 1991-1993. Infectious Diseases in Clinical Practice 6:327-333, 1997



•Lerner, A.M., Beqaj, S.H., Deeter, R.G., Dworkin, H.J., Zervos, M., Chang, C.H., Fitzgerald, J.T., Goldstein, J., and ONeil, W. Asix-month trial of valacyclovir in the Epstein-Barr virus subset of chronicfatigue syndrome improvement in left ventricular function. Drugs of Today 38 8:249-561, 2002

•Carruthers BM, Jain AK, DeMeirleir KL, Peterson DL, Klimas NG, Lerner AM, Bested AC, Flor-Henry P, Joshi P, Powles AC, Sherkey JA, van de Sande, MI. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical WorkingCase Definition, Diagnostic and Treatment Protocols. Journal of Chronic Fatigue Syndrome 11 1:7-115, 2003

•Lerner AM, Beqaj SH, Deeter RG, Fitzgerald JT: IgM SerumAntibodies to Epstein-Barr Virus are Uniquely Present in a Subset of Patientswith the Chronic Fatigue Syndrome. In Vivo 18:101-106, 2004

• LernerAM, Dworkin HJ, Sayyed T, Chang CH, Fitzgerald JT, Beqaj S, Deeter RG, Goldstein J, Gottipolu P, O'Neill W: Prevalence of AbnormalCardiac Wall Motion in the Cardiomyopathy Associated with IncompleteMultiplication of Epstein-Barr Virus and/or Cytomegalovirus in Patients withChronic Fatigue Syndrome. In Vivo 18:417-424, 2004


•Lerner, Beqaj, Deeter, Fitzgerald. Valacyclovir treatmentin Epstein-Barr virus subset chronic fatigue syndrome: thirty-six monthsfollow-up. In Vivo 21(5): 707-713, 2007


•Lerner AM, Beqaj SH, Fitzgerald JT, Gill K, Gill C, Edington J: Subset-directed antiviral treatment of 142 herpesvirus patientswith chronic fatigue syndrome. Virus Adaptation and Treatment 2010:2 47-57

•Lerner AM, Beqaj SH, Gill K, Edington J, Fitzgerald JT, Deeter RG: An Update on the management of glandular fever (infectiousmononucleosis) and its sequelae caused by Epstein-Barr virus (HHV-4): new andemerging treatment strategies. Virus Adaptation and Treatment 2010:2 135-145


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Patent Information

•A US patent (CFS LLC and The Ohio State University) is underway to be filed, February 2012, describing serum antibody to molecular markers EBV EA(D), EBV dUTPase and EBV DNA polymerase for diagnoses of EBV subset ME/CFS.

•CFS LLC has a US patent application pending entitled Methods for Diagnosis and Treatment of Chronic Fatigue Syndrome. Inventor Lerner, Albert Martin. Agents Barry, Thomas F. et al: Venable LLP, P.O. Box 3485 Washington, DC 20043-9998 (US). This patent differentiates Group A and Group B CFS.

Further information concerning patents owned by CFS LLC can be found in US Pat Nos 5,872,123; 6,258,818; 6,399,622; 6,537,997 and 6,894,056.

© 1998 - 2008 Dr. A. Martin Lerner CFS Treatment Center ; Last revised: February 2011
EIPS® and Energy Index Point Score ® are trademarks of the Dr. A. Martin Lerner CFS Treatment Center. All rights reserved. This document may be copied for use by physicians and patients, but may not be modified, sold, or distributed promotionally in any form without express written permission.

For more information visit: treatmentcenterforcfs.com

18 comments:

  1. This is all very well and good, except "Chronic Fatigue Syndrome" was started on the basis of 19 patients located by Dr Paul Cheney who could not possibly have the "Chronic Epstein Barr Virus Syndrome", as we were entirely EBV negative.

    To move CFS back into the CEBV realm, one would have to prove that all of us have EBV which went undetected.

    ReplyDelete
    Replies
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  2. On what basis are you that the 19 patients could not have had EBV?

    ReplyDelete
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  12. I want to express myself to the world and tell them about the great thing that Dr.Ogudugu whose contact details are +2348142250751, greatogudugu@gmail.com or http://greatdrogudugusolutiontemple.webs.com/, Dr.Ogudugu was the great man that brought back my lover to me within the period of 48hours and the amazing thing was that Dr.Ogudugu never asked me for anything in return i only paid for the items he used in casting the spell and that was all. As i am writing now my lover is still with me treating me with care and showing me so much love thanks to Dr.Ogudugu. My name is Ana and i am from Los Angeles in USA.

    ReplyDelete
  13. Hello i am Adam Jose,i am from Houston,Texas.And am out here to spread this good news to the entire world on how i got my WIFE back.I was going crazy when my WIFE left me for another MAN last two months after one years of marriage,so i was confuse and even thinking of committing suicide.So one day i was just browsing through INTERNET and i met a friend that introduce me to Dr. Egodi the great messenger to the oracle that he serve,I narrated my problem to Dr Egodi about how my husband left me.He only said to me that i have come to the right place were i will be getting my heart desire without any side effect.He told me what i need to do,After it was done,In the next 2 days,My WIFE called me on the phone and was saying sorry for living me before now and also in the next one week after my WIFE called me to be pleading for forgiveness,I was called in the school where i work that am free that i should resume with work,I am so happy and overwhelmed that i have to tell this to the entire world on how Dr.Egodi help me grant my heart desire. If you need any kind of help contact Dr.Egodi at the following email address. [Drkennethraymond@outlook.com and get all your problem solve. No problem is too big for him to solve. Contact him direct on: [
    drraymondspellcaster@gmail.com

    ReplyDelete

  14. Happiness is all i see now I never thought that I will be cured from HERPES virus again. I have been suffering from a deadly disease (HERPES) for the past 3 years now, I had spent a lot of money going from one places to another, from churches to churches, hospitals have been my home every day residence. Constant checks up have been my hobby not until this faithful day, I was searching through the internet, I saw a testimony on how DR Aba helped someone in curing his HERPES disease, quickly I copied his email which is dr.abaherbalhome@gmail.com just to give him a test I spoke to him, he asked me to do some certain things which I did, he told me that he is going to provide the herbal cure to me, which he did, then he asked me to go for medical checkup after some days after using the herbal cure, behold I was free from the deadly disease, he only asked me to post the testimony through the whole world, faithfully am doing it now, please brothers and sisters, he is great, I owe him in return. if you are having a similar problem just email him on ( dr.abaherbalhome@gmail.com ) or you can whatsApp his mobile number on +2348107155060

    ReplyDelete
  15. Hello everyone! I still don’t know the right words to express my Gratitude to the Great Dr.Ozolua! I want to share this wonderful testimony to the world should in case there is any body in this same situation, i was diagnosed with toilet infection and Hepatitis B virus and i feel pains when i urinatin and discharging yellowish pus, and outbreak. I was given so many health prescription and advice with no improvement, I totally lost hope, until i found many testimonies of Great Dr. Ozolua in online research on google, I was very skeptical about contacting him, but i later did and he opened up
    to me and told me is going to prepare a herbal medication and send it to me true DHL delivery to apply for three weeks, i gave him a try and Thank God now i am cured of these virus, i advice any one that is living with virus should Contact the Great Dr Ozolua today, because it has the cure to any problem Email him on dr.ozolua@yahoo.com or his whatsapp on +2348051421297

    ReplyDelete
  16. I AM HERE TO TESTIFY ON HOW MY HERPES VIRUS WAS CURED BY DR AMAKOR.


    I'm Liubov Nikonets, from Texas USA. I had been in a relationship with a guy and we had unprotected sex for the first time and within a day i got a big bump on the crease of my thigh and vagina. after a few days it began to hurt more and more. I told him to take a picture of it for me, and it looked like open sores, like bugs were biting off my skin or something. So i went to the ER and they said genital herpes. I was soooo depressed. my boyfriend and i cried. he cried for me, but he had no idea he had it too. next day, same thing happens to him. at this point, we think i gave it to him because I was the first one to show the symptoms. The next phase I went through was depression. At this point, all I did was sleep and cry. I felt like my life was over. I knew I could never get married, I felt dirty, and worthless. I was depressed for about two months. I fought thoughts of suicide and it was a hassle to even carry out my daily tasks. So I started to wonder if there would be a remedy to this disease, which led me to going to visiting many hospitals, and nothing good came out from it, until I read a person’s testimony online that said that they were cured with the help of Dr AMAKOR Spell, of this disease that the world deems incurable and tears rolled down my face. That persons testimony sparked a hope in me that led me to contact Dr AMAKOR. So he assured us that we are going to be alright, after meeting up with the necessary requirements, he sent us a parcel and gave us instruction guide on how to use it, which we did, after 7 days of using the medication, the herpes was totally cured. So I and my boyfriend went and got tested for every STD in the book and every single test came back NEGATIVE, we also went back to the hospital, and it was confirmed NEGATIVE. I am posting my testimony to help someone out there suffering from this disease. Do not hesitate to contact Dr AMAKOR via e-mail: dramakorspelltemple@gmail.com or call him on +2347067468416.

    HE ALSO HAS CURE TO THE FOLLOWING DISEASE:
    HPV
    GENITAL HERPES
    TRICHOMONIASIS
    CHLAMYDIA
    HIV
    GONORRHEA
    HBV
    SYPHILIS
    CANCER.

    ReplyDelete
  17. I was checking for solution in the internet then miraculously came Across Dr Miracle, the powerful herbalist that Cure Numerous individuals HSV-1 AND HSV-2 INFECTION,then i contacted his Email: (MIRACLESPELLHOME@YAHOO.COM) I Explained everything to him and prepared a cure that cure my HSV-1 AND HSV-2 Disease totally after receiving his Herbal medicine, So My friends viewers why wait and be suffer when there is someone like Dr Miracle,that can cure any disease HIV/ CANCER/ HEPATITIS B VIRUS, You Can "CONTACT Via : Email : (MIRACLESPELLHOME@YAHOO.COM) You Can Contact Him Today And Get Your Problem Solved Or"Call +2348071398555.." Or You Can Also Contact Him Through His Website http://miraclespellhome.webs.com/,,,,

    ReplyDelete

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