What was your name?

We’ve all been there: the receptionist at an hotel, the telephone enquiry, the customer services representative who barely looks up and says “and what was your name?”  Why should my name have a past?  I haven’t changed it: I’m not a part of a police witness programme or a pop musician travelling incognito.  I know they mean “What name is the booking / purchase under” or similar but why can’t they say “What is your name?”  “Please” would be a nice addition, but I suppose that is too many syllables.   It grates like the announcements in the local airport, which invite us to “await in the departure lounge”; await what, exactly?  Don’t they know the difference between wait and await?  Silly question.  I wonder if these truncations are borne from tweeting and texting, assuming the random casting off of words isn’t important, that we’ll all understand.

The last time I was asked “What was your name” I said “it was, and still is, Andrew Gold”.  There was only the slightest twitch of a mascara’d  eyebrow to show that she was thinking “pedantic old twat” but she said, “Room 401.  Take the lift to the fourth floor and turn right.  Have a nice stay with us”.  What she meant was “and I hope the lift gets stuck.” Maybe she had a point.

Lyme Disease – a personal overview

NB This blog is not finished and represents my personal view.  If it interests you, keep any eye out for additions.

I want to say, right at the start, that any negative comments I make about diagnosis and treatment do not, in the main, apply to me:  I owe my relatively improved health to my excellent GP and his Infectious Disease specialist colleague at my local hospital – when I was living in the Highlands of Scotland.

The second thing I want to say is that there is a lot of bad science, even misinformation, out there.  There are charlatans too.  I am not an expert, I am a victim.  If you have an interest in Lyme Disease, I recommend you look at one of the well-known specialist charities, like Lyme Disease Action.  If you are in the UK, or Europe, the Deutsche Borreliose-Gesellschaft guidelines are worth reading.  See them here

INTRODUCTION

I was diagnosed with Lyme Borreliosis (a.k.a. Lyme Disease, LB or LD) in July 2011.  When I started this, in April 2013, I was not fully recovered and still under treatment. At the time of this update (May 2016) I am no longer under treatment and substantially recovered, but I do not know if I am cured.

LD is a bacterial infection transmitted (mostly) by the bite of an infected tick.  I say ‘mostly’ because, like many features of LD, there is uncertainty (if not full blown disagreement) about whether the Borrelia pathogen can be transmitted in other ways (more on this later).  About the only thing on which there is consensus around the world is that, if diagnosed early enough, LD is curable by a course of antibiotics and that, if not diagnosed early, it can invade the brain and central nervous system leading to permanent disability and, possibly, premature death.  There is disagreement about how early is early enough: it can develop very quickly into a multi-systemic illness that can be hard to treat, never mind cure.  It can mimic many other recognized diseases, like Parkinson’s, Alzheimer’s and Multiple Sclerosis to name only 3.  If you are familiar with the effects of these diseases you will have some inkling of how devastatingly life-changing LD can be.

DIAGNOSIS – First Room in the Hall of Mirrors

Clearly then the really critical thing, for a good outcome, is getting an early diagnosis.  Welcome to the first room in the Hall of Mirrors: for many LD victims, getting a diagnosis of any kind is a challenge.  First of all, assuming the mode of transmission WAS an infected tick, you may not know you were bitten. I had a ‘fastened on’ tick in March 2011 (too early in the year according to ‘the rules’). I became noticeably unwell, with very odd symptoms, in early May 2011.  The symptoms were so bizarre that I began a daily diary.  As a direct result of this evidence, and my general awareness of the potential for Lyme Disease where I lived, I was able to persuade my GP to carry out tests and I was diagnosed in July 2011.  Without that diary I may never have been tested at all, even in Scotland, but recording such detail is a double-edged sword: one doctor thought I was neurotic to be keeping a diary.  In hindsight (while my memory still worked!) I recalled a ‘flu-like’ spring cold – another symptom of early Lyme but, being a “mucus trooper”, had shrugged it off at the time.

Even the nymphal stage of the most common tick Ixodes Ricinus (there are several others) can carry infection; the nymphs can be the size of this fullstop (.) but nearly translucent.  You may only see it if it bites you in a visible place, or when it has started to swell with your blood, or after the bite site has begun to get inflamed. Incorrect removal of the tick may result in giving yourself an infection that you might otherwise have avoided (more on this later).  Similar to the organism that causes Syphilis, the effective agent of the Borrelia pathogen is a spirochete, spiral-shaped: it travels in your blood to any part of the body where it, almost literally, ‘drills’ into your tissues.

The annual number of new cases of LD, in the UK, is disputed.  The official statistics exclude anything directly diagnosed by a doctor, that is to say clinically, without a laboratory test.  Of course what is also excluded from the statistics is the unknowable number of cases that go undiagnosed or misdiagnosed.  Even if the informed, but unofficial, estimates of 3000+ UK cases are correct, many doctors will never have seen a case, ever.  What is not disputed is that the rise in cases, year-on-year, is faster than those of HIV/AIDS which has a much higher public profile.  Recently (since 2015) there has been a change in the official perception of LD as an emerging disease, and the challenges to diagnosis and reatment it presents, but opening the minds of, and offering training to, GPs is slow.

It is, therefore, still highly unlikely that any UK doctor will treat for LD following a tick bite without symptoms present.  If you are infected you have <50% chance of developing a signature rash, the so-called ‘bullseye’ Erythema Migrans.  Note the word  ‘migrans‘ – spreading.  If it appears, it may not be at the site of the bite, or it can disappear to reappear somewhere else.  If it appears it might be a few days to several weeks after the infecting bite: you may have forgotten about being bitten, or even having been in a location where you might have been exposed to being bitten.  A rash might be large or small, might not be distinct, there may be several.  However, and this is important, the appearance of an EM rash is, by itself, accepted as clinical evidence of LD and your doctor should prescribe antibiotics right away.  Should.  Unfortunately the experience of many LD sufferers is that GPs, even in areas where LD is recognised as endemic, ignorantly misdiagnose even a classic ‘bullseye’ rash as a skin condition or something else.  “Try this cream and come back in 10 days”.  “Let’s try some steroids (the worst thing you can do for Lyme because it interferes with your immune system)”.  If this doesn’t resolve doctors have been known to treat for psychosomatic disorders (stress).  On the other hand, the rash may resolve, leading to the presumption that the diagnosis of psoriasis, ringworm or eczema, was right and you go on your merry way – as do the borrelia organisms.  I was in the <50% who didn’t get a rash. So your next chance to get a diagnosis is when you start to exhibit other symptoms: kiss goodbye to early diagnosis and welcome to the second room.

SymptomsSecond Room in the Hall of Mirrors

The list of possible symptoms is enormous, and I’m not going to reproduce it all here, but many of them can be associated with other illnesses or diseases.   Muscle weakness, pain and cramp, twitching, Bells Palsy, joint pain/arthritis, severe headaches, vision and hearing disturbance, loss of co-ordination or the ability to walk, extreme fatigue, inability to think (so-called “brain fog”) are just a few.  The many effects on the central nervous system may be fleeting and move about the body, vague and difficult to describe.  You may have one major symptom, or many.  Your doctor may again think you are over anxious or neurotic.  He/she may diligently set off on a number of tests – all of which take precious time and, confusingly, may unearth another, previously unsuspected, condition which comlicates diagnosis and redirects treatment.  Moreover LD is, by nature, a remitting/relapsing disease: you may spontaneously get better, again pre-empting correct treatment.  As a result some victims of LD fight for a diagnosis for YEARS while the disease slowly infiltrates their bodies and becomes ever more difficult to eradicate.

If you are, somehow, tested for LD the blood test(s) may come up negative: the tests are fallible and there is NO test to prove active infection, only a test to show, by presence of antibodies, that you have at some time, been exposed to the infection.  With an equivocal blood test your doctor may adopt a ‘wait and see’ approach.  I have been confirmed twice, by Western Blot blood test, as “weak positive” for LD.  My Lyme-aware GP started treatment immediately we found out but, as bad luck would have it, he was on extended leave when I first got ill, so I was initially seen by 2 locums, one of whom clearly thought I was neurotic (but later apologised).  By the time I started antibiotic treatment crucial months had passed, however this might have been to my advantage as it can take several weeks for the antibodies to appear and a false negative test would have been disastrous.

TreatmentThird room in the Hall of Mirrors

With a firm diagnosis of LD you would think your troubles are over.  Indeed many sufferers (some of whom will have begun to doubt their own sanity) express profound relief that they at least know what is wrong.  This relief is likely to be very short-lived, as the next battle will be over getting a treatment that works.  The fact is that the science on Lyme Borreliosis is both developing and mired in controversy.  Until 2016 Public Health England (PHE), and Health Protection Scotland (HPS) based UK treatment guidelines on the American model promoted by their Centre for Disease Control (CDC), and the Infectious Disease Society of America (IDSA).  Although the PHE clearly stated that adherence to the guidance is not mandatory for clinicians they, the General Medical Council (GMC) and the British Medical Association (BMA), behaved as if it were.  This left clinicians who diverged from the guidelines open to disciplinary action, which they naturally avoided.  Unfortunately the CDC/IDSA guidance is founded on the species of ticks, infective pathogens, and potential co-infections, found in America.  The most common of these is Borrelia burgdorferi whereas in the UK and Europe generally you are more likely to be infected by Borrelia afzelii or Borrelia garinii. These agents affect, and may need to be treated and tested for, differently: the American experience is not necessarily relevant but the HPA/HPS continued to base treatment guidelines on those of the CDC/IDSA.  At last PHE is reviewing and revising its guidance, acknowledging the uncertainties of diagnosis and treatment, but it may be a long time before hard-pressed GPs approach LD with a more open mind than hitherto.

To date, then, the first-line response to an early diagnosis, say by erythema migrans rash, is a single course of a tetracycline antibiotic (usually Doxycycline) at 200mg per day for 14 days.  Once this course is completed, some clinicians will not prescribe further courses.  Some will prescribe the same dose for 28 days, as a first course, or as a further course if the first course fails.  Some doctors say that all of this is ineffective for disseminated disease because the blood concentration resulting from these dosages is too low to be bactericidal for LD, and of too short a duration.  Very few doctors will follow the European guidelines, e.g. Deutsche Borrelia Gesselschaft, or those of the International Lyme and Associated Disease Society of America (ILADS) which suggest a more appropriate dose is at least 3 or 400mg/day for one, two, three, or even many more, months.

For so-called “late stage” and strongly neurological LD, the “silver bullet” is suggested to be several weeks of intravenous antibiotics, commonly Ceftriaxone.  As I said before, everything from the particular strain of your infection to your age, general health, and physiology may make one treatment succeed where another fails, and vice-versa, but the authorities persist in following a “one size fits all” approach.

Persistence of Infection – Fourth Room in the Hall of Mirrors

The official position is that once “appropriately” treated (i.e. according to the guidelines) LD will have been cured, and that any persistent symptoms or relapses are either due to something else or re-infection.  For those people who live in tick ‘hotspots’ re-infection is always a possibility and cannot be discounted.  However there is no blood test to show that your symptoms are caused by a new infection only, as before, that you have been infected sometime.  So this is unhelpful in determining persistence.  The “something else” list is long. The main theory is that, though the disease is eliminated by the “appropriate” treatment, there is long-lived, even permanent, damage to the central nervous system or an over sensitive auto-immune response.  If you want to see the experience of one UK individual who has persistent Lyme, you could do a lot worse than follow this link.

If you want to read a brief, learned, exposition of the two sides of the persistence debate, try this link.

The main ways currently used to determine whether you have viable spirochetes in your system is by biopsy, or spinal fluid examination; sequential brain scanning might show continuing scarring implying ongoing disease.  These tests are invasive, expensive and, consequently, rarely done in the UK.  Some promote the use of various microscopy techniques on live blood smears but the UK health system does not support these. Amongst other candidate reasons for persistent symptoms are residual inflammation of nerves and (surprise, surprise), neurotic focus on otherwise ‘normal’ symptoms; etc., etc.  As previously noted, it is also unfortunately true that the presence of other disease in the victim can cloud the issue:  I had confirmed diagnoses of a virus, and a D.V.T, simultaneously with my Lyme diagnosis.

Of all the areas of medical dispute, perhaps the most contentious is what drugs to use, how often and, especially, for how long.  LD was first named in 1970’s America; after Old Lyme, a town in Connecticut, where a large number of cases of childhood arthritis had appeared.  Although there is evidence that the disease has been around for thousands of years, the infective organism there was isolated by Willy Burgdorfer – hence the most commonly quoted strain is Borrelia burgdorferi.  The American healthcare model is one of private medicine funded, mainly, through insurance: the expensive testing, treatment, and subsequent care of LD is accessible mostly to those with insurance.  Self-evidently the insurance companies have a vested interest in limiting their exposure to, potentially, open-ended care.  Many of the doctors who compose the board of IDSA have direct, or indirect, financial relationships with insurance and drugs companies.  Is it any wonder that the IDSA promotes guidance that has the effect ot supporting the commercial interest?  With a publicly funded healthcare system in the UK, and with very few cases of LD caused by Borrelia burdorferi (which are mostly, if not all, acquired outside the UK) it is hard to understand why the PHE/HPS rigidly promoted adherence to guidelines based almost entirely on the American experience.

Those that maintain the persistence of LD say that the low dose, relatively short, courses of antibiotics actually cause the spirochetes to ‘hide’ under a so-called biofilm, or transform into a cyst in tissue out of the bloodstream, or other location with a poor blood supply and inaccessible to drugs.  Then they re-appear when conditions are favourable to their continued reproduction.  There are physicians who recommend high dose, intravenous, antibiotics for months – perhaps years.  Over-prescription of antibiotics is widely held to be a cause of drug resistant infection in hospital, some of them potentially deadly like C-Difficile, so their caution is understandable.  Given that Doxycycline is prescribed by doctors for skin conditions (as an anti-inflammatory not as an antibiotic), sometimes for years, it is odd that the same doctors will not give long-term courses for a potentially life-threatening illness like LD – as indeed they would for Tuberculosis (TB).  Of course long-term antibiotic therapies may have unpleasant, even dangerous, side effects that need to be monitored and managed.

Other uncertainties

Vectors and Distribution

World-wide there is an assumption that Lyme Disease is predominantly, if not entirely, limited to a band of the northern hemisphere.  Amongst other things this has led to official denial of its existence (and therefore treatment) in Australia where, nevertheless, cases appear!  In the UK there is a presumption that you would have to visit a ‘hot spot’, and then in spring or summer, to be exposed to Lyme Disease.  The key areas are thought to be heathland, where wild deer, ponies, and sheep roam.  Therefore parts of Wales, the New Forest, the hills and dales of Yorkshire and Derbyshire, the Dartmoor and Exmoor national parks and the Highlands of Scotland, are often quoted as the hotspots.  This is a mistake, based on the common perception that deer, and infected deer ticks, are the only vectors of LD.

There are several types of tick in the UK and they are all opportunistic feeders: all they need to survive and reproduce is a warm-blooded host to feed from.  They are able to survive temperatures in excess of 40C and, clearly in Scotland, long periods of sub-zero conditions.  Birds (migratory or otherwise), small mammals like mice, rats, rabbits, hedgehogs etc., all can carry ticks and host the pathogens.  All larger mammals like foxes, badgers, cats, dogs, horses, cattle (of course, deer) can also carry ticks.  It is not much of a leap of imagination to say that foxes, birds, hedgehogs and the like, transiting rural corridors, can bring ticks right into your city garden, your urban farm or allotment, or to a park near you.  There is no research to find out the extent of infection being carried in this way, but LD is widespread in continental Europe so is perfectly feasible for a strain of Borrelia, totally unknown in the UK, to be brought right into your house via a migrating bird and then your pet cat or dog.  Recently a tick borne pathogen previously known only in Japan, Borrelia myamotoi, was isolated in Sweden (Gothenburg University).  There is, at time of writing, a furious dispute in Australia where the state government of New South Wales is denying the existence of Lyme Disease in Australia despite growing evidence to the contrary.  The truth is that you may get a tick borne illness anywhere.

Co-Infection

Ticks can carry more than one pathogen, potentially infecting you with more than one disease.  The official position in UK is that so-called co-infection is not a problem.  Some LD specialists and patient support groups disagree on this vehemently, saying that one or more of Anaplasma, Babesia, Bartonella or Erlichia may be transmitted along with the Borrelia.  They say that the overlaying of these diseases means symptoms of LD may manifest differently and will need to be treated differently.  Quite how this affects the treatment of the number of UK residents who acquire Lyme while overseas, where co-infections are accepted to be common, I don’t know.

Inter-Human Transmission

There is no research to find out if a tick bite is the only way to catch LD. There are alleged cases of trans-placental infection from mother to unborn child; there are suggestions that other body fluids like breast milk, tears and sexual fluids are capable of transmitting infection.  There is a question mark over other, blood-feeding, biting insects.  There is, as yet, no evidence for any of these. Though definitely blood-borne, the UK Blood Transfusion service does not screen donations for Lyme Disease.

Incidence

Since 2010 it has not been a requirement to notify PHE or HPS about a case of Lyme Disease in the UK.  It’s not even reportable unless it has been diagnosed by a laboratory, or occurs in the armed forces, or is acquired “occupationally”, in which latter case it is a matter for the Health & Safety Executive under RIDDOR.  That means all cases which are diagnosed only on the basis of clinical suspicion, perhaps because of an Erythema migrans rash, simply do not figure in the official statistics.  Other European countries, with smaller populations than the UK, report many times the number of cases: they may have different recording systems.  Obviously our governments do not think it worth prioritising scarce resources, or research, on the basis of a few hundreds of cases but if it were many thousands (as suspected by the leading testing laboratory in the UK), then what?

Tick Removal

Unattached

Ticks, especially the adults, are tough and incredibly hard to get off your skin, even if not attached. Unattached they can be hard even to crush between your fingernails.  This is not recommended as you could infect yourself through your skin, especially if broken, but if you get one off you before it attaches, make sure you kill it DEAD.  If you flush it down the toilet, make sure it has really gone.  Wash your hands.

Attached

Once attached you should proceed with great caution.  It is said that a tick is unlikely to pass an infection to you if it has been attached for less than 24 hours, though there are those who say even 12 hours or less is possible.  Even if <24 hours is true, the key word here is “unlikely”: don’t wait, get it off as soon as possible.

Bizarrely, NHS Highland recently pubished advice which encouraged the application of methylated spirits or alcohol to remove a tick!  This is completely wrong.  Do not, under any circumstances, apply creams, fluids, cigarette ends or anything else to an attached tick.  Anything which stresses or crushes the tick may cause it to regurgitate the contents of its mouth or stomach into you, along with any infection it is carrying.

The easiest way is to use a proprietary tick removal tool – there are several on the market.  A problem here is that the proprietary tools are less good at grasping nymph ticks: they are so small.  Better than nothing, but trickier, use a pair of needle nosed (precision) tweezers, NOT the blade ended type you might use for eyebrow plucking.  You must grasp the tick close to the head NOT by the body and pull gently upwards.  Try not to leave the head attached in your skin as this can also result in infection and, in the worst case, septicaemia.  At all costs avoid crushing the tick.  It may seem ridiculous at the time but, if you get an attached tick off, save it in a secure container (an old film canister would do) and mark the date and geographical location where you were bitten.  You can send the tick to be identified and it may even be tested for infection (though this is unusual).  Even if a tick that bites you is found to be carrying the LD pathogen it does not mean you will have been infected but it should encourage your GP to treat you anyway, even without symptoms and even if you haven’t had a positive blood test,.  If nothing else it will add to the knowledge about spread of infected ticks in the UK.  The PHE website has information on how to do this at

http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Ticks/TickRecordingScheme/

If bitten you should note the date in a calendar or diary, and then watch for early signs of illness.  If it is going to appear, the Erythema migrans rash should be seen within 4 weeks as the infection has a (roughly) 4 week cycle.  If you don’t get a rash but feel like you’ve unaccountably got a mild dose of ‘flu (especially out of season), get odd cramps or twitches, feel excessively fatigued or have trouble concentrating, start a diary and consult a doctor.  Mention the tick bite and ask about Lyme Disease but be prepared to be dismissed – keep your diary going for as long as you are symptomatic.  When I presented my Infectious Diseases consultant with a chart covering 9 months of symptoms and treatment he laughed at my self-description of “mildly obsessive”, but he did agree it was helpful data and added it to my burgeoning file.  Not all doctors would be so open-minded: you need to be cautious about the impression you give to your doctor.

Finally, the web site Wikipedia has a good overview of Lyme Disease and it can be found at http://en.wikipedia.org/wiki/Lyme_disease

Where’s my magazine?

In March of this year I gave a magazine subscription as a birthday present.  I did it online with the publisher, Archant Life Magazines, who print and circulate a range of glossy ‘lifestyle’ magazines across the UK.  This one is a monthly about Devon and is called ‘Devon Life’.  The issues have repeatedly arrived late, or not at all, the latter event prompting an extension of the subscription.  There have been several ‘phone conversations with subscription staff and, earlier in the year they applied a “Track and Trace” label to our copies which briefly seemed to correct the situation.  Needless to say the October issue, which was released on 26th September, hasn’t arrived.  My wife ‘phoned Archant and was given the clear impression that they thought she was making a fuss about nothing: “We allow 10 days for delivery, but if it isn’t there by 4 October, call back”.  It wasn’t, so I did.  Finally I got to the truth: it is because we are not in Devon.  Apparently the magazines are shipped by a carrier, TNT, who will not ship until they have at least 25 items for the same distribution hub.  However long it takes.  I railed against this, particularly since there is nothing in the subscription process that warns you of these facts.  Although the subscriptions are quoted as including P&P (postage and packing) there isn’t a way of “out of area” subscribers to pay extra for postal delivery.  So we are left with two options: cancel and get a refund or wait indefinitely for a magazine that is out of date if and when it arrives.  “We don’t want to lose a valued customer” seems pretty hollow to us, so I wrote to the MD and got a reasonably quick and positive (if badly written) reply.  Our subscription is being extended for 12 months in compensation.

Update 26 October

Archant promised a direct mailing of the missing issue by first class post.  It arrived 5 days later, having been posted second class.  The original traceable copy, supposedly with TNT, has still not arrived.  The MD of Archant admitted they were having a meeting with TNT as we weren’t the only people to complain.  My wife wrote to him on the 17th to ask about progress, and express her worry that this would happen all over again with the November issue, but he hasn’t bothered to reply.  Great Service, Archant.

Pass the parcel – part 3 “The way home”

14:00 02 OctoberLenovo ring to tell me the laptop has been repaired and is on its way back.  I got a new tracking number at 17:00.

08:00 03 October – tracking number returns no data on the DPD.uk website – I’ll try again later.

16:30 I embark on a lengthy, and ultimately fruitless, attempt to discover where my laptop is: DPD parcels has no record of the tracking number I have been given!  Despite the valiant efforts of Lloyd he suggests I speak to Lenovo.  James, at Lenovo, agrees to send an e-mail to Germany but the repair centre is  closed and he, James, is not at work tomorrow (4th) so he can’t get me an answer before Friday.  He concedes the laptop may  already be with me by then.  Let’s hope so, and that it works.

08:00 4th October.  The use of the tracking number still returns no data, more than 40 hours after it was issued.  I would have expected my parcel to have a unique number that followed it wherever it went, and however it was combined and recombined with other parcels to form larger consignments.  It appears that once an item is into the system it can attract layers of numbers which cloud, rather than clarify, the identity of an item, its destination and ultimate owner.

16:00 .  Lenovo explain that although my laptop/parcel had been given a tracking number two days ago, it was probably sitting on a pallet to make up a full load.  Nice of someone to tell me.  They suggest I check the DPD.de (German) website tomorrow and, once it appears there it should be in UK within 24 hours.

09:30 5th October.  Checked the DPD.de site.  My parcel was scanned, on pick-up for Kesselsdorf, at 19:29 (18:29 UK BST) last night but still does not show on the tracking system on the UK website 13 hours later.  At least the destination is shown as our postcode.  What is the point of a tracking system that doesn’t update and track internationally?  It’s ludicrous that you have to check the website of the country the parcel is (or may be) in at the time you check.  That’s a question for ‘James’ from Lenovo, who promised to ring me with an update today.

18:30 .  Guess what, no call from James (or anyone else).  The laptop parcel’s location is still where it was 24 hours ago, according to the DPD.de website.  According to the DPD.uk site it still doesn’t exist.  GRR.

07:00 6th October.  According to DPD.de the parcel was scanned into Unna Depot, still in Germany, at 02:34 this morning.  Still doesn’t exist on the UK site.

07:00 7th October. According to DPD.de the parcel hasn’t moved from Unna and it still doesn’t appear on the UK site.

09:00 8th October.  Both DPD.DE and UK show no change.

12:45 . I ‘phoned Lenovo again because I’d had an e-mail from Medion Electronics inviting me to complete a customer satisfaction survey because I had now received my computer back! After apologising that James had not ‘phoned as he promised they told me what I already knew – they have no idea where my parcel is.  Ben promised to call back but “since he would have to contact Germany, it might not be today”.

06:30 9th October.  Hooray!  Suddenly my parcel appears on both websites:  it was allegedly scanned into Oldbury (Hub 3 Birmingham) at 20:42 yesterday.  This is a bit odd since I checked before I went to bed and nothing had changed then.  Still, mustn’t grumble eh?

13:01 .  It has arrived in at my local depot but is not marked ‘Out for Delivery’.  I think this means it missed the afternoon van and will be here tomorrow afternoon.  Let’s hope it works after all this.  I’m still waiting for Ben to call back.  GRR.

09:03 10th October. ‘Out for delivery’

14:00 AAAAARGGHHHH!  It has ‘misrouted’ – been put on the wrong van!! I don’t believe it.  (Actually yes I do).  of course, nobody let me know, so I waited in.  Chris, from DPD customer services in Swansea offers to “upgrade” me to a delivery before 12 tomorrow but, sort of, suggests they cannot track parcels being moved by third parties.  Since AJG in Inverness is acting for them, in primary pick-up and final delivery, I don’t understand his point.  The bottom line is that NONE of this is my fault.  I’ve done everything I’ve been asked to do, even when it was really up to DPD / Lenovo / Medion to do it.  Throughout, nobody has kept me in the loop and nobody has ever called back when they promised to.  I just hope the laptop works – I couldn’t go through all this again.

12:05 11th October Far from being here before 12 noon it is still showing at the depot, where it was returned to at 18:00 last night: not even ‘Out for Delivery’.  I rang DPD again, this time speaking to Tom in Liverpool who ‘phones Swansea and then the depot (Inverness).  Tom tells me they left it off the van for today!  He also says that the Inverness depot can’t deliver to us in the morning, despite Chris saying they would, because of our “remote location” (which all of 45 minutes from the depot).  Talk about being economical with the truth!  He PROMISES it will be here this afternoon.  This is SO infuriating – I was in Inverness this morning and could have collected it.

12:42. Miraculously the parcel is now marked ‘Out for Delivery’ – with the scan timed at 09:36!!  How do they think they can get away with changing their records like this?

16:30 It’s arrived!  Now for the laborious process of updating it with everything that MS and my Security programme has issued in the last 3 weeks.

Conclusion 17 October   Well, my laptop is working as it should.  I bought an item with a warranty and, when the item failed, the warranty was honoured.  The process has clearly been less successful.  It would be better to not give customers a means of tracking the progress of their repair if that system doesn’t work.  The major difficulty arose because MY supplier devolved responsibility for managing the process, and our relationship, to third parties.  This is a major systemic customer services failure :  as Lenovo’s customer I should NOT have been left (and sometimes explicitly encouraged) to progress chase or project manage Lenovo’s suppliers – even if those suppliers are subsidiaries.  I’m closing this blog now with one final comment: DPD promised that someone from their customer service team would call to discuss their failures (which they admitted): they haven’t.  Enough said.