Treatment (Day 15)

The sore arm from yesterday turned into an incredibly painful arm overnight. The feeling is similar to a dead arm. It seems that the sodium stibogluconate (and saline) was leaking into the tissue around the vein when I was feeling the pain on injection yesterday. It's clearly worked its way up the arm through the tissue giving me the dead arm today. Hoping it will subside soon. Not wanting to take any painkillers as I want to know that the cause of the pain is disappearing rather than just the pain itself.

Fifteenth dose this morning was fine (in right arm just above that painful cannula) but the cannula has been removed to let my right arm recover. So without a cannula today.

I am grateful that the side effects are no worse than the occasional bout of tiredness or headache--discounting leaking of the drug. I just hope that the wounds start healing in the next few weeks. The larger one looks like it has been for the last month or two anyway but that is not related to this hospital stay. Cutaneous leishmaniasis lesions do heal naturally. The reason for this systemic treatment is to prevent any further effects of leishmaniasis, i.e., more lesions or moving onto mucocutaneous or visceral forms.

Treatment (Days 9-14)

No major changes. The side-effect of being tired/having a headache all the time seems to have slightly subsided but then I am sleeping until about 1pm every day after getting the sodium stibogluconate at about 9am. A different consultant (mine is in Cape Town at an AIDS/HIV conference) seemed to agree that the wounds were flaring up and not just infected today which is a good sign.

Today was the first time the phlebotoxicity of the sodium stibogluconate has been a major problem. You may remember me saying that that was the reason for the slow injection of it. A new cannula was put in my forearm a couple of days ago. First dose was fine. Yesterday's stung a bit, even the saline flush. Today's saline flush was incredibly painful and we had to move the cannula further up to the elbow. Fine there. Clearly that vein was slightly thinner or maybe the dose was given slightly quickly that first day. Right arm still quite sore.


Been up and down last few days. Down because not being fully with it all the time means that I can't read/learn/watch stuff that I would do otherwise. Up with the visitors I had over the weekend and having gone out into town this afternoon/evening.

Enjoyed a collection of Jeremy Clarkson's Sunday Times columns which a friend lent me. Didn't so much enjoy Lance Armstrong's It's Not About the Bike about his life and specifically his cancer. It's very difficult to like him through his arrogance. Only a hundred pages in and he does say that the cancer changed him so maybe he's trying to show how just much and will become more likeable later on. I imagine, and hope, so.

Picked up Jeremy Bowen's War Stories from the library today which is great. Nice follow-up to Jon Snow's Shooting History which was the second book I read in here after the Dawkins one, which was good but not as good as Ancestor's Tale.

I know you're not reading this to find out what books and films I like but I will give a mention to the excellent Dead Poets Society starring Robin Williams as an inspiring teacher encouraging his students to seize the day, something I'm trying my best to do in here!

Treatment (Days 6-8)

Wounds are flaring up as can be seen. Feels different to just a secondary Staph. infection so hopefully means that leishmania is present and this treatment is worthwhile.

Had my eighth dose today and feel as though I have a permanent hangover. The side-effects are kicking in then!

600 Words on Leishmaniasis and My Experiences

An article written for a medical student friend about the disease.

AS TROPICAL DISEASES go, a concise description of leishmaniasis has the ability to make you sit up and listen. The incredibly rare, potentially fatal, flesh-eating disease sounds like every gap year parent’s worst nightmare. Unheard of in Britain bar the small handful of soldiers and travellers who succumb to it every year, leishmaniasis does its worst damage, however, to the world’s poorest people.

Unable to get their hands on the expensive, under-researched drugs necessary to treat it, the majority of the twelve million people who suffer will have no choice but to sit back and watch as the protozoan eats away lesions on the site of the sandfly bite which, if left untreated, will spread. In some cases, the disease will spread to the throat (mucocutaneous leishmaniasis) or the internal organs (visceral) possibly leading to fatality.

Thankfully, I live in the UK and though it took five Manchester GPs four months to realise that the stagnant, unhealing lesions were not down to an infected hair follicle, I am lucky to have access to Infectious Diseases departments able to administer the sodium stibogluconate necessary to combat the disease. This highly toxic, eighty year old drug, which can riddle the patient with side-effects, is the best available as research money simply will not go towards treating a disease that infects people without wealth.

My own experience began with a lump near my groin and a dark patch on my lower back. Worried primarily about the lump, I saw a GP who told me that it was a swollen lymph node and nothing to worry about. The dark patch would disappear. A week later I was in A&E. The dark patch had clearly become infected and was now described as a crater. For the next four months, the lesion was dressed three times a week, initially with Aquacel which had no effect—the lesion quickly grew to 7cmx5cm which it has remained ever since—and then later with Mepilex Ag, a soft pad embedded with the antibacterial properties of silver. This cleaned up the Staph. aureus infection that had been making the lesion so painful and from then on, I would barely notice it.

It was not until a second lesion appeared that I had to persuade GPs that I needed to be referred to a specialist. A dermatologist excitedly but tentatively diagnosed it as leishmaniasis and referred me to Infectious Diseases. In the weeks in between consultations I learnt a huge amount about the disease. My consultant was keen to reassure me though unable to mollify some of my worries as the exact strain was, and still is, unknown.

As the treatment is so severe, doctors were not keen to give the twenty one daily doses of sodium stibogluconate by intra-venous injection without confirmation of the strain, or indeed the presence of leishmania. Biopsies were duly taken. A ten-week wait ensued which included the work of scientists in Manchester and London and then the country’s top histopathologist. When he came back with a null result, all other avenues closed and so the decision was made to begin the treatment, without a shred of lab evidence that it would help, and assuming that I had the most severe cutaneous form Leishmania viannia.

I’m now a week into the treatment and the lesions have begun to flare up, confirming that leishmania is present. Though it has been an agonising nine months, I realise that I am one of the luckier people to suffer from the disease and so would like to raise awareness of it, if only so that no one else has to be told for months on end that they have an infected hair follicle which will soon heal.

Treatment (Days 1-5)

Today was my fifth day of treatment for leishmaniasis. The treatment is a slow, daily intravenous injection of sodium stibogluconate (Pentosam). Slow and diluted with saline due to its toxicity and the painful sensation that trails up the vein during injection and also due to the risk of thrombosis of the vein.

Thankfully I've not yet suffered any of the many possible side effects except being a little more tired than usual but that could just be because I'm in bed a lot and feeling lazy as everything is done for me.

Saying that, I've been out and about every day since Thursday (day two) even including a pint of Strongbow on Friday which the pharmacist and nurses reluctantly allowed me to have. I'm lucky to be on an Infectious Diseases ward though feel a bit of fraud in being here in that I'm up and about all the time and feeling otherwise as good as normal when the people around me have AIDS, malaria, swine flu and tuberculosis. The reason is that sodium stibogluconate apparently isn't licensed to be given anywhere other than this unit.

Only one of the nurses who has administered the drug has done so before. A few years ago she treated a soldier with the disease and said that he didn't have any side effects for the entire three weeks which is promising.

Had a few doctors and medicine students come visit wanting to see the wounds and have a chat. Keeps me busy and is interesting chatting to some of them too. Other than that have been brushing up on my spanish and reading the papers more than anything. Did pop to the library on Friday and picked up Richard Dawkins' Blind Watchmaker. I forgot (after reading Ancestor's Tale a few years ago) how good a science writer he is, even if people have little respect for God Delusion.



As can be seen, the main wound is slowly healing. The second, newer one, is the same as ever. Since Robert Darbishire stopped dressing them, I've been fairly good doing them and only when I've faltered has the second, smaller, wound become slightly infected. Inadine was used again by the nurses here the other day but today replaced that with the silver (Mepilex Ag) that has been so good since Christmas. Very impressed that neither Glastonbury or Barcelona caused any problems. Slightly worried that customs didn't pick up on the hundreds of pounds worth of silver in my hand luggage (the dressings), nor the scissors to cut it, deodorant, shower gel or toothpaste.

The cannula was initially placed in the back of my left hand which was okay but nowhere near as comfortable as the one placed today further up my arm. There is also much less pain on the injection of the sodium stibogluconate further up the arm. Rather than taking the fifteen minutes it has the previous four days, today only took about five minutes. It's certainly not a serious pain for which I'd like to take any further medication; it's just slightly unpleasant and, the first time, worrying not knowing how I'd react. Anaphylaxis and chest pains during injection are to be looked out for.


One potential side effect of sodium stibogluconate is that it can increase the QT interval measured by an ECG. Have been fascinated learning about the P, Q, R, S and T waves that denote different points in the heart's beating. Takes me back to A-level Biology. Learning about the disease itself over the last few months was stressful initially but later very interesting too. http://www.nhlbi.nih.gov/health/dci/Diseases/hhw/hhw_electrical.html

The guy in charge of the Guardian's response column is the same one that is leading my work experience there next month. He responded to the two letters below along the lines of "you raise some interesting points". It's been a bit long since the interview and he is slightly overrun with content at the moment (but space may become available) so no chance for a direct response, however, I may wish to speak with the paper's Health Editor when I get there. Will do.

Talking of Fogle, his 'On Thin Ice' is on BBC2 tonight at 9.05pm. It is the episode about the disease apparently. I imagine he will be on even thinner ice when I've seen what he has to say.

Follow-Up to Guardian

Hi ______,

This morning I spoke with the Guardian's Letters Editor __________
who refused to publish my letter regarding Ben Fogle's leishmaniasis
as there was little space for letters about "skin infections".

I'd like to highlight that the letter was not about a skin infection,
rather an indictment of how one man's ego and desire for publicity
coupled with adulating journalism can lead to very dangerous
misconceptions being spread, in this case about a terrible disease.

By overplaying the dangers of the disease, the article will have
scared many people away from travel and the massive (though clichéd)
broadening of horizons that it brings. Not once was it mentioned how
incredibly rare leishmaniasis is in Britons, or that generally, even
if caught, it is relatively little to worry about.

Neither was it mentioned that Fogle is most likely the luckiest person
to have the disease. He has been treated relatively quickly and
efficiently. He was of course unlucky in his relapse. However, there
are twelve million people in the world who are currently suffering
from the disease who have little chance of correct diagnosis and even
less chance of adequate treatment, due solely to geographic and
economic factors, neither of which afflict Fogle.

Rather than raising awareness, the article has done nothing but
further muddy the already dirty waters of neglected diseases.

Clearly the facts surrounding the disease have been misinterpreted. I
would like the opportunity to redress the balance by writing a few
hundred words about the disease and the dangers suffered by those it
effects, and if space allows, the more general points of the safety
aspects and of course virtues of travel abroad. It would be good if
this could appear within the Guardian's G2. It will not be an attack
on Ben Fogle or the Guardian as maybe my previous email implied and
will still portray the fact that the disease and its treatment are
incredibly severe.

...

Regards,

Girish
http://www.justgiving.com/jammastergirish-msf

Response to Guardian Interview with Ben Fogle

"The doctor told me, 'Unfortunately, the worst news is - ' and I thought: what? It can't get any worse! He said it's a variety called vianna, which is the worst strain of leishmaniasis. It affects the face. It will go straight to the nose and the lips, and he basically said it leads to facial mutilation. Those were the words he used. Then he described the treatment, which is hideous, and showed me a bottle of the poison, with a skull and crossbones on it."

Every day for five weeks, Fogle received the poison on a drip - a form of chemotherapy so powerful that some patients don't walk again for two years. Every night he would vomit. By week two his body was aching and he was in agony, and by week three he had pneumonia. Yet the doctors cleared him to go, and five days after completing the treatment Fogle set off for the south pole. -- The Guardian's G2 (15th June 2009)

Dear Sir/Madam,

As a fellow sufferer of leishmaniasis, I am becoming increasingly angered by the scaremongering and downright lies that Ben Fogle is spreading about the disease in his attempt at public sympathy and therefore book sales.

I am referring to the paragraph beginning with the quote, "The doctor told me...," and the one that follows it in today's (15th June 2009) G2.

Viannia does not directly affect the face. In five per cent of cases, it can lead to the mucocutaneous form, which does affect the face. Yes, "L. braziliensis [a viannia form] is the most important cause [of mucocutaneous leishmaniasis]," (Oxford Handbook of Tropical Medicine, Eddleston, et al). However, "we estimate that less than 5% of patients who develop a L. v. braziliensis primary skin lesion develop mucosal disease," (Infectious Diseases, Gorbach, et al).

The pentavalent antimonial treatment that I am assuming Ben had is a form of chemotherapy but then so is taking antibiotics. Use of the word "chemotherapy" without definition by the media is dangerously misleading.

"Some patients don't walk again for two years," says Ben about the long-term effects of his treatment. I have not found any evidence of this and neither did my consultant feel the need to mention this to me before my own treatment.

Leishmaniasis is an incredibly complex disease of the third-world. It kills many people unnecessarily in the Middle East, South America and Asia. The treatment is eighty years old, exceedingly toxic and very expensive. As leishmaniasis is a disease that affects the poor, there is no money in looking for new treatments.

I find it incomprehensible that Ben Fogle uses his platform as a celebrity to do nothing but whine about his own (relatively lavish) experiences in this latest wave of interviews, rather than focus on the twelve million people around the world who share his symptoms yet have no chance of treatment or even proper diagnosis.

Regards,

Girish Gupta, Manchester
http://www.justgiving.com/jammastergirish-msf

Press: MEN

Appeared in Tuesday's Manchester Evening News.

Press: Maidenhead Advertiser & Slough Express

Appeared in Thursday's Maidenhead Advertiser (top) and Friday's Slough Express (bottom).

Formal Request For Mitigating Circumstances for 2009 Exams

Hi,

A few months ago I was tentatively diagnosed with a rare flesh-eating
tropical disease called leishmaniasis. It became apparent to me
mid-November (2008) when a wound began opening up on my back which has
had to be redressed every two days since then. I was repeatedly told
by doctors that it was most likely an infected hair follicle and so
they were not keen to refer me to a dermatologist. Mid-February a
second wound appeared and this made me force them to refer me. The
dermatologist suspected leishmaniasis and gave me a biopsy to confirm
the strain and urgently referred me to an Infectious Diseases expert
who I am now under the care of (Dr _____________ at North
Manchester General). Results of that biopsy came through
"inconclusive" over three weeks later. A further biopsy was taken by
the Infectious Diseases department at North Manchester General which
another three weeks later came back with the same result. Another
sample was then sent to the country's top histopathologist Professor
___________ based at St Thomas' in London. This came back a
fortnight ago with the same inconclusive result.

As the strain (or even the disease) cannot be confirmed in the lab, I
will most likely be forced to opt for an incredibly harsh three-week
IV treatment which the consultant refused to give me a few weeks ago
when I wanted things sorted. This was due to its very severe
side-effects. However, now that he has no other avenues to explore, I
am being offered it. I will most likely take it sometime over the
summer with my fingers crossed. I do have a meeting with Dr
__________ on May 27th in which we will discuss the options.

The situation has been incredibly stressful, not just in visiting
either the walk-in centre, surgery, dressing clinic or various
hospitals every couple of days but primarily in learning about the
disease, spending time when attempting to learn physics reading
infectious and tropical disease textbooks.

The treatment I have received from the University of Manchester-owned
Robert Darbishire Practice has done a lot to exacerbate the situation,
as has that from the Walk-In centre at Manchester Royal Infirmary.
Three doctors at Robert Darbishire, and two at MRI Walk-In, were
unable to admit they had no idea and gave advice to 'wait and see' or
'have another blood test'. The first led me to A&E a week later and
the second urged me to force them to refer me. The surgery's recent
policy of refusing to dress my wounds, advising me to go to Moss
Side's Health Centre open for dressings for 45 minutes every day, has
ruined any sense of timetabling that is expected by the University and
my own studies.

Waiting for biopsy results has been excruciating, as was finding out
that the country's top man found nothing ten weeks after the first
tentative diagnosis. Now they're clutching at straws.

I appreciate your help in allowing a couple of extensions over the
year but I now ask you to take the above into account with my exams.

I shall be bringing in evidence of the above to the Physics school
office at some point over the exam period.

Thanks

Girish
http://www.justgiving.com/jammastergirish-msf

Letter from Consultant

Confirmation of last week's news.

Dear Girish,

I apologise for the delay, but we've finally got some further results.

The further samples that went down to the Hospital for Tropical Diseases for PCR assay (looking for DNA) for leishmania have come back as being negative. The biopsies were sent down to Professor ________, the best infectious diseases pathologist in the country, based at St Thomas', and he commented that there was nothing specific that gave us a definite answer, that it could be consistent with ongoing healing leishmaniasis, but he could see no evidence of leishmania itself.

I think it would be good to chat through the options. There are perhaps one or two further blood tests that we can think about doing, looking for alternative causes. I'm not sure there's much use in repeating a further biopsy, as now two biopsies have failed to give us a definite answer.

Though it is not optimal, sometimes in this situation we do treat people for possible leishmania to try and prevent any long term recurrences if this was a possible diagnosis. This won't be an easy decision and I think we need to chat through it.

I've asked my secretary to send you a further appointment with this letter. If it is inconvenient ...

Yours sincerely



Dr _________
Consultant Physician in Infectious Diseases & Tropical Medicine

Great Manchester 10km Run

Massively enjoyed the run. Didn't walk and got less than an hour (54m13s) and £162 raised so far for MSF so I'm happy.


"Since 1988, MSF has treated more than 60,000 patients with leishmaniasis ... but the best of efforts are dwarfed by the limitations of existing treatments and world's lack of interest in this forgotten disease."—MSF

A few weeks ago I was diagnosed with a rare flesh-eating tropical disease called leishmaniasis. Affecting just two Britons a year on average, the disease still kills 80,000 worldwide. The reason for this discrepancy is that leishmaniasis is a disease of the Third World. The Middle East, South America and Asia are where it kills those without medical aid.

It was seen by six NHS doctors before it was realised not just to be a normal skin infection and that's in Britain, with one of the best healthcare systems in the world. In the developing world, the doctors simply don't have the facilities to deal with it. The treatment is eighty years old, expensive and poisonous. As leishmaniasis is a disease that affects the poor, there's no money in looking for new treatments.

I have chosen to donate sponsorship from my 10k run to Médecins Sans Frontières as they are one of the few organisations willing to help in areas where it is rife and prevent just some of the unnecessary deaths that occur.

The second, more grandiose and less personal, reason is that Médecins Sans Frontières is one of the few charities to genuinely have no respect for international borders YET still have the balls to criticise political regimes and bodies that inflict and abet human tragedy.

Please donate generously to this important charity.

Médecins Sans Frontières

Leishmaniasis on Wikipedia
Leishmaniasis on patient.co.uk
Ben Fogle - the other Briton to be suffering
James Orbinski's Imperfect Offering - about the work of Médecins Sans Frontières

http://www.justgiving.com/jammastergirish-msf

Pics

Top picture is of the secondary, smaller wound. The orange surround is a remnant of Inadine, the iodine-containing dressing used occasionally when I feel the early signs of a secondary infection coming on. Lower picture is the main wound which was also dressed in Inadine for a couple of days before the picture was taken.

Rescheduling Summer

Email to The Guardian following acceptance onto their work experience scheme

Hi __________,

I'm sorry but I am forced to reschedule and resubmit the form I sent
you the other day regarding my availability for work experience with
you due to a few months ago being diagnosed with an incredibly rare
flesh-eating tropical disease called leishmaniasis which I picked up
from a sandfly in my time in South America last summer. I have spent
the past six months dealing with the wounds and eventually receiving a
tentative diagnosis and since have been waiting for confirmation of
the strain. Yesterday I received the news that not even the country's
top histopathologist has been able to positively identify it. This
leaves things very much up in the air. My consultant suspects
leishmaniasis, however, as there is no lab evidence, he has been
reluctant to treat me for it as the treatment is very severe. With no
further avenues to explore, however, this treatment is to be the
likely next step. This is obviously worrying on my part as there is
not a shred of (lab) evidence that it will help. I will be discussing
my options with the consultant later this month.

The disease in no way leaves me debilitated except the awkwardness of
a couple of large holes in my back. I am absolutely fine otherwise,
as demonstrated by my interview with you and the fact that I am
participating in a 10k run on Sunday for Médecins Sans Frontières, one
of the few organisations able and willing to help people with this
third-world disease.

The treatment is three weeks on an IV drip with a very nasty
pentavalent antimonial being injected into my bloodstream. For this
reason, I will have to stay in hospital under constant monitoring.
However, after the three weeks (and some recuperation) I will be
absolutely fine. Unfortunately, I am about to begin my third year
university exams and so will not have time to complete the treatment
now. I will most likely be postponing it until July.

I therefore would like to resubmit the form I sent you a couple of
days ago giving my availability for the summer placement. I am sure
you will appreciate that this inconvenience to you has been completely
out of my control and I have informed you as soon as possible.

Thanks for the offer of work experience and apologies for being so difficult!

Girish
http://www.justgiving.com/jammastergirish-msf

Final Result

The country's top histopathologist has found nothing so I'm going to be offered treatment. Bit of a relief but also worrying that the consultant was refusing to give it to me previously when I just wanted it over with and now nothing's changed, it seems there's no other option. Looking up the effects of sodium stibogluconate:

Sodium stibogluconate is exceedingly phlebotoxic. Pancreatitis is a common problem. The drug can be given intramuscularly but is exceedingly painful when given by this route. It can also be given intralesionally when treating cutaneous leishmaniasis (i.e., injected directly into the area of infected skin) and again, this is exceedingly painful and does not give results superior to intravenous administration. Sodium stibogluconate can also cause a reduced appetite, metallic taste in mouth, nausea, vomiting, diarrhoea, headache, tiredness, joint pains, muscle aches, dizziness, and anaphylaxis. -- Wikipedia

Response to Ben Fogle's "life's not so rosy for dogs"

In response to Ben Fogle's Country Diary

Dear Sir/Madam,

As a fellow sufferer of leishmaniasis who has been treated nowhere
near as quickly and efficiently as Ben Fogle, I read his Country Diary
(25th April 2009) with disgust. His assertion that now he is cured,
his readers should now be concerned that "life may not be so rosy for
dogs" is an insult to the two million HUMANS around the world who are
diagnosed with this disease every year, many of whom will die due to
inadequate healthcare, maybe due to research funds being channelled
towards helping dogs.

Incredibly little is known about the disease and treatment is complex
using pentavalent antimonials which are eighty years old. They are
toxic, may cause pancreatitis and anaemia as well as headaches,
abdominal pains, nausea and vomiting. No one is interested in
research as the disease is of the third world and so those suffering
generally have no money.

I find it incomprehensible that Ben Fogle chooses to use his platform
as a celebrity to advertise the cause for helping dogs with the
disease while many people around the world suffer a huge amount more
than he has, yet receive no mention.

Yours faithfully,

Girish Gupta, Manchester

Second Visit to Consultant

Reassuring again, though no real step forward. The first biopsy and second that was taken on 19th March came back negative and consultant would now send over slides to the top histopathologist in the country. Another wait.

Email to Uni Staff

Hi,

The second biopsy results came back yesterday inconclusive again.
Today I saw my consultant at North Manchester. Though reassuring in
what he said and telling me not to worry, it was basically a nice way
of saying, "We don't know." Further tests are being conducted and
other people becoming involved. This will take another three weeks at
least. This means that exams themselves shouldn't be affected (as I
will hold off treatment until they are completed) and I will be able
to sit them as normal so nothing to worry about on that front.

On a personal level, I am reassured by the consultant but obviously
quite frustrated about the time that this is taking and the lack of
certainty. I will find out how to present my case to the University's
Mitigating Circumstances Committee at some point soon, as _________
suggested.

Thanks for your help.

Girish

Email to Uni Staff

Hi,

A few weeks ago I was diagnosed with a rare flesh-eating tropical
disease called Leishmaniasis. It became apparent to me mid-November
when a wound began opening up on my back which has had to be redressed
every two days since then. I was repeatedly told by doctors that it
was most likely an infected hair follicle and so they were not keen to
refer me to a dermatologist. A few weeks ago a second wound appeared
and this made me force them to refer me. The dermatologist suspected
Leishmaniasis and gave me a biopsy to confirm the strain and referred
me to an Infectious Diseases expert who I am now under the care of (Dr
____________ at North Manchester General). Results of that
biopsy came through today "inconclusive". I have been told to come in
Monday morning at 9am for a further biopsy to be taken this time by
the Infectious Diseases department at North Manchester General. This
will hopefully determine the strain of the protozoan and therefore
treatment.


Treatment will either be a 21-day stint on an IV drip or a series of
injections. Either way, it will impinge heavily on my time over
Easter and most likely after it (everything takes longer that it has
to, it seems, with the NHS!), as it has done since mid-November. I do
not yet no how much time it will take up.


I am telling you this because it is now obvious that it's affecting my
work and has done for the majority of the year. Seeing a nurse every
two days (normally taking a couple of hours at Walk-In but quicker
once I started going to a surgery) was bad enough, along with the pain
of the wound itself generally. Over the past few weeks, however,
things have obviously become a bit worse with not only literally more
time taken up travelling to and from hospitals but also with the
stress of learning about the disease and dealing with the NHS's
systems.

I'm not sure exactly what I'm hoping to get out of telling you. My
marks were okay in the exams, maybe could have been higher but I can't
blame that entirely on this. I've had to miss a bit of lab to the
detriment of my experiment and lab partner. I've missed the last
month's worth of Spanish lessons also. I've been forced to miss parts
of _________' lectures on Nuclear Age and had to ask him for a
deadline extension a few weeks ago when first diagnosed.

I know that you give marks for attendance of examples classes. I have
been to most but missed a few unavoidably. I would therefore ask that
I can have some of these marks back. I've also missed a fair few
lectures but am able to get notes from friends so that's a start.

Please let me know if you would like any more information. I'm sure
the doctor at North Manchester General will be able to give me a
letter of some form and if you like, I can get A&E, Walk-In and the
surgery to print off a list of all my visits since mid-November
detailing what was done and said.

Thanks

Girish

Biopsy 2

Taken by registrar at North Manchester General. Much more bloody than my first!

Pic

First Meeting with Consultant

Consultant was very reassuring but didn't really tell me anything I hadn't learnt about the disease in the couple of weeks since it had first been suspected I had it by the dermatologist at Hope Hospital.


Checked it out and concluded saying we'd wait for biopsy results that Hope had taken a few weeks previously.

Pic

Pic