first the district court conflate of the failure to relieve mr johnson symptoms at the time with defendant's failure to treat the underlying cause of those in terms which was cancer because of this conflation the district court erroneous and concluded that mr johnson you are his injury as soon as defendant failed to alleviate mr johnson's symptoms instead of when he was diagnosed with cancer and nd at the very least the district courts have given mr johnston leave to amend because submissions outside the complaint make it in clear that mr johnson does not know or have reason to mr johnson is not suing defendant because of a lack of treatment to alleviate his initial symptoms it claims that he was denied care for the underlying cause of the symptoms of cancer which is a separate and very altogether this is similar to the augustine case  when the failure to provide medical services occur right that's correct the failure to provide any treatment for that underlying condition occurred in two thousand and nine but a cruel inquiry is not the date of the injury necessarily but the date on which the plaintiff knew or had reason to know of the injury well follow up on that it's not as though he complained of a symptom just to follow up and talk and as a question it's not as he complained of the symptoms and was sent away my understanding of the record is he complained of a symptom and he was given some testing and then it was almost immediately transferred but at that if so my st question  indication that there's anything wrong with them from defendant on the basis of of those initial tests right countess i think the answer to my question is yes he got some testing and not treatment and so that's like are you saying so it seems to me to be  that and this as this is for both counsel really i don't know how he's supposed to know they had anything that required treatment or a reason to complain much less reason to sue and if he had sued at that point i don't know what he would have sued for in terms of causation and he had certain symptoms of for he went in yes certain system symptoms after he went in at that point i don't understand how clock starts pursuant to that as every well because he's got some of the same symptoms if he had reason to know it and there are some cases where folks had reason to know that there was a real danger presented by symptoms one of the cases that we've all read it has to do is somebody who had a chronic condition and he wasn't getting what he needed and so issaquah occurred because he had these chronic wildly fluctuating blood sugar levels and whatnot but just getting back to your days i'm not sure is there something i'm missing that would have signaled to him that he needed treatment at that point no and i think that that's the basis of basis of this argument on appeal is that based on the experience that mr johnson had of the time there was no way for him to know that something had been done that he had received constitutionally an adequate treatment at the nih to treatment for the underlying cause of his and so if we can get right to it and you need to distinguish your team needs to distinguish fact intense is nature of the claim and i think we see that most clearly in the question what of plaintiff knew or had reason to know at the time at the time of the injury and when he knew or had reasons you know that he didn't injure correctly concluded that mr johnson's claim is time our nd and the district court did raise this point independently inconsiderate mr johnson has pleaded the deliberate indifference he asserts deals with a failure to treat occurring in summer two thousand everything is tied back to that so the claim in theory would be based on the film or treat the serious medical needs as they existed in two thousand not in or there's some unclear failure to diagnose be receive any treatment testing it is treatments diagnose you start your answer to my question with a yes or no yes your honor testing my understanding of the testing is part of treatment diagnostic in nature is it doesn't remediate any pain that's unclear from the record and that's part of why this will form the basis for a deliberate supposed to know that he had crossed a cancer but then again it is alleged in the complaint and this is that development of prostate cancer later on and again in deliberate indifference contexts you want that causal link perhaps nobody knows whether he has the cancer or not two thousand high because nobody did a treatment right and his claim may be dismissed for that reason because there's a really big difference of being negligence that mal and deliberate indifference but today we're talking about the statute of limitations and when the clock starts running and so just for my vote  concerned about your theory because it seems to me you're advocating a rule that were we to adopt it and i don't see that we have or have them prisoners would be in a position where if they go to you know whatever medical facility is available to them with a and and leave instead their foot still hurts their hand still hurts their head still hurts because somebody hasn't made that pain stop that that they are going to be in a position of being advised by you know the statute of limitations has started to run any courage to file suit and it is not the case that any medical care provider nawas make pain stop so what is your answer to that certainly are my my answer that we're not asking the court to adopt any new based on this court's precedent we believe that the flame crewed in two thousand and nine and that's really because there was a denial of treatment for serious medical needs that are based on the pleaders causally related to the later diagnosed cancer in a way that would suggest that the cancer is really if further deterioration and i believe appellant uses in the d case from another district court judge that and talked about two tracks in our case law for one a claim of prose or you are you advocating that we have two tracks in our case i'm i'm i'm not  believe that the court has two tracks differentiated from what we argued in our brief which is there are simply cases of delayed discussed at there are cases that do not involve to leave discovery and this  case that i do not believe involves delay discover and all be clear as to what the criteria for a serious medical need involves conditions that a reasonable doctor or patient would consider worthy of treatment or calm certainly occurred in this case mr johnson sought treatment other conditions conditions that would interfere with the plane daily activities difficulty urinating in those things certainly would appear to implicate mr johnson's daily activities and then there's chronic or substantial pain and there's and the fact that he would experience what i imagine to be a substantial pain would further to the by this constellation of symptoms are in these truly bracing symptoms as a serious medical need if treatment was not organically just a continuation of the same injury which mr johnson presented in which the defendant allegedly failed to treat and if that's the case on when the time clock started the day that he sought treatment for the conditions you describe your honor it he is conditions some tester order and then what happens and then mr johnson is transferred to another facility and is it fair to say that nothing happens it's not it's not in the records so we are bound by what is in our i record does not answer that question for us i'm just trying to figure out if what point  fact you want the panel to adopt the rule that the moment he goes in for the treatment of the either these conditions the clock starts in that instance or does it start a week wait here when he's wondering for nothing the cruel question turns on when a plaintive knew or should have known that he suffered a constitutional injury that forms the basis of the action and again i think that's generally a highly fact in terms of question when the issue is in dispute as i mentioned incredible to talk to us to ask sort of questions about the point at which they claim did it crew was it that week was it the following week at one point to the light go on in his head and i would say that because of the ambiguity of any of those question existence of some amount of ongoing symptomology has been insufficient to categorically time bar a claim so in a bebo case for and over the course of thirty years between the treatment and the out of the lawsuit rather the plaintiff experienced severe recurrent testicular pain rashes and once in his nose and that wasn't enough to categorically put him on notice and similarly in the great case the abusive therapeutic harm the rather the harm that forms the basis of the complaint that he was just lashing at recent over time this is a case in which the plaintiff did not know on the basis of the lack of medical treatment that he received that he was a denied care for something as serious the pain question and i just want to know that this court has made clear and bebo that pain is objective and that dr categorical conclusions about what he did knew or ought to have known simply based on some knowledge of pain is is insufficient