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