I’ve been advised to swap the mountain bike for a road bike

Why? Makes no sense whatsoever.

Sounds like BS from where I’m sitting (I’m a GP with a bit of an interest in sports medicine). Time for a second opinion. I’d suggest you forget the knee support for now, long term it may make things worse.

What do you want to contact them for?

It does make sense.

I’m very sorry for your, and your children’s loss.

EDIT: this paper might help your cause, and though it’s 11 years old it does highlight the problems you’ve identified about regional variation. There’s a more recent follow up to the original too, which suggests that things are getting better but still aren’t there yet. It might be worth emailing the author of the paper (email at top of page) for any suggestions they might have?

It’s clearly your decision whether or not to sue grantus and that those you mention have failed you is awful. I hate insurers (I fill in the forms and watch them wriggle), the govt is sometimes there but often not when you’d expect it to be, and the banks, well…

My point was only that suing won’t help you achieve the outcome you stated you want – the focus will shift from accepting fault and making changes to defending a negligence claim. To prove a negligence claim you’ve got to prove 1. duty of care (easy), 2. breach of duty of care (not so easy), 3. breach of duty of care led to harm (hard).

Thanks for your reply grantus.

Missing an SCC is obviously not good, but doing so is very rarely going to be fatal. You can miss them and still get away with it- they’ll continue to grow, patients come back, and the cancers don’t do much in the interim as a rule. They are sometimes tricky to diagnose too. “In a dying woman” – that’d make me think of something else, in fact I’d probably ignore what I thought might be a SCC “in a dying woman” as I wouldn’t have thought an SCC would make someone that unwell. I’d be more concerned about picking up stuff like endocarditis in an immunocompromised person.

Missing a malignant melanoma really is a completely different ball game, as SCCs are nowhere near as nasty as MMs. MMs are, as you’re all too aware, horrific things.

I don’t know what the renal consultant was thinking, perhaps that it was an abscess? Who knows. Sticking a needle in a lump is not necessarily a bad thing, not doing anything about it when nothing comes out probably is.

There’s a big move in healthcare to bring in checklists (see Atul Gawande’s book The Checklist Manifesto) and to my mind that’s what you need – for transplant patients at risk, skin cancer education needs to be a point on the list. Education for health professionals? I’m very surprised your partner’s unit didn’t know of the increased risk.

Bwaarp- the subungal melanomas you’ve linked to are a well known banana skin, AFAIK melanomas looking like keratoacanthomas aren’t.

Bwaarp – they certainly can do. Dermatological conditions often look different on ears to how they do elsewhere too. What’s odd is that looks nothing like a melanoma. Perhaps it’s hiding underneath a keratoacanthoma??

Think I’d want to:

– increase awareness of skin cancer risk in transplant patients – medical / nursing staff
– increase awareness of skin cancer risk in transplant patients – renal transplant patients
– screening for renal transplant patients – perhaps, needs research to determine risk / benefit

Given what Grantus has posted on here I think the most unfortunate thing is that his partner wasn’t aware of her increased risk and therefore thought nothing of the skin lesion on her ear until it was too late. When she first presented with it, if the first doctor she saw had done the best thing he could have that would have been a 2 week wait referral to dermatology. I doubt (but we have no way of knowing) this would have made any difference to the final outcome unfortunately. I certainly would be wary of blaming the doctors – they have an educational need by the sounds of it, but I don’t think they were negligent and even if they were I doubt that they caused her death. If grantus wants to achieve change and stop this happening again, which he seems to, I really don’t think suing people and being so critical is the way forward. These drs will be doing much soul searching have no doubt.

A tragic story, I’m very sorry to hear what’s happened Grant.

I’d caution against getting a lawyer involved, especially at this early stage- it won’t help you to achieve what you say you want to.

I’m confused- was it a squamous cell carcinoma or a malignant melanoma? Do you (or does anyone else) know? The course of your partner’s illness (the widespread metastases and her rapid deterioration) make it sound like a malignant melanoma but those pictures look like a SCC, a cancer which wouldn’t normally be expected to be so aggressive.

Off those pictures I’d actually have thought your wife had a keratoacanthoma but her history of renal transplant with a (rapidly?) growing skin lesion would have worried me.

The endocarditis sounds like it might have muddied the waters too?

I recently discovered that Amazon pays no tax in the UK. Do you even want to use them?

I use the book depository now.

Amazon own The Book Depository too do they not? http://www.guardian.co.uk/books/2011/oct/27/amazon-takeover-book-depository-oft

It’s one of these: http://www.thebikefactory.co.uk/productdetails.asp?productid=56993

Problem with cutting a slot in it is that the rubber seal is attached to the crown race.

I did grease it.

Thanks for your replies.

Poor lad!

Risk of hep etc as close to zero as it’s possible to be. Might get infected wound / cellulitis – unlikely though.

Yeah, was going to post and say thanks CHB. Seems popular!

hmmm, so where the f*** is mine! :-)

This book would be a good place to start.

GP here. I’d want to get that sorted today – out of hours GP, walk in clinic or A+E. Might wait until tomorrow but cellulitis can be nasty. Where do you live?

I’d stay given what you’ve said.

But Canadian people can be strange.

In what way? (Interested as considering emigrating).

good luck

:-) Thanks CHB – that underpriced?!

Definitely want to sell as I just don’t use it – daft to buy it really, have spent ages trying to get back into MTB but never really got back into it for various reasons. I only did about 30 miles on it. Have listed it on ebay now with a BIN of £495 (+£15 P+P). Perhaps a bit cheap! Listed as auction too.

Mainly it’s about side effects not cost (I’m a GP).

If you’re talking about the steroid injections people used to get – they work but corticosteroids are nasty long-term. If you’re talking about desensitisation injections then they’re specialist clinic only as occasionally people have severe (even fatal) reactions. The injections are given in the clinic. We’re normally not allowed to refer to those specialist clinics as they’re ‘tertiary referral only’ (though it does vary between regions) – so you have to go see a consultant who then makes sure you’ve tried all the standard treatments and if s/he deems your case severe enough they refer you on. Then the allergy consultant assess you and sees if your case is severe enough. Most people’s hayfever isn’t deemed severe enough.

Most of the time with the NHS – if you need something you get it, even if it’s expensive. If there’s a cheaper alternative that’s just as effective then we try prescribe that to save some money. The obvious exceptions are the higher profile drugs and procedures but they get rationed at a higher level.

Private clinics offer it of course.

I have one I’m just about to sell (18″) that’s done a total of about 30 miles if you’re interested? :-)