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News and Opinions about MS, Health & Disability

Opinions are divided over suitability of stem cell transplants as treatment for progressive MS

panorama Hallamshire%20web%20ready ms-trust-logo          From left: BBC programme Panorama, Royal Hallamshire Hospital; and Multiple Sclerosis Trust.

Great interest was stirred up, quite predictably, by Panorama programme Can you stop my Multiple Sclerosis? broadcast on January 20. That followed four patients with relapsing remitting MS as they underwent Autologous Haematopoietic Stem Cell Transplantation (AHCST or HCST) therapy at the Royal Hallamshire Hospital, in Yorkshire, UK. See my earlier blog post Can Multiple Sclerosis be stopped? Maybe some can at http://50shadesofsun.com/?p=1347 for more details.

Afterwards, some asked whether the stem cell treatment would also work for people with primary or secondary progressive MS.

Opinions seem divided. The people behind the treatment featured on BBC’s Panorama say: “Unfortunately the trials performed to date show that AHSCT does not work as well in primary and secondary progressive multiple sclerosis. In view of this data, at Sheffield Teaching Hospitals NHS Trust we are only treating people with relapsing remitting multiple sclerosis.”

However, writing on The MS Trust’s Facebook page, Gwen Higgs gave a different answer to that question. She wrote: “HSCT absolutely works for progressive MS! I had successful HSCT for my PPMS eighteen months ago.” Then Gwen added these links: https://www.facebook.com/groups/hsctppms/?ref=bookmarks and https://www.facebook.com/groups/ukhsct/?ref=bookmarks

On its website, the Multiple Sclerosis Trust was a little more cautious, saying that AHSCT could work for those with the progressive variants of the illness and published a blog by Jane of its Information Team. In that, she looks at some of the research so far, what’s possible now and where we might expect to see further progress in the future.

Answering the question ‘does AHSCT work for progressive MS?’, Jane says: “Sometimes it does, although it seems to work well only if your MS has a mix of progression with inflammatory activity.” Read more here: https://www.mstrust.org.uk/news/views-and-comments/could-stem-cell-therapy-work-progressive-ms

Looks like it is another case of ‘wait and see’!

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Words: ‘Leche’, in Spain, can mean more than ‘milk’

leche

As Lisa and I continue to settle into our new way of life in Spain, it is interesting to see not only the correct use of words but also their place in modern usage. Milk is a good, and hopefully humorous, example of what I mean.

Milk is a wonderful product that can be prepared in different ways, used by itself or in so many foods and drinks and a word that is able to be used in other contexts.

First of all, let’s take a look at what milk is called in just a few different languages. In French, it is Lait; in Welsh, Llefrith; and in Spanish, Leche.

Now, taking the liquid product alone, it can be homogenised, evaporated, condensed, sterilised and even ultra-heat treated (UHT). Also it can be full milk, semi-skimmed or skimmed.

And that is without its many other uses to produce cream, cheese, yoghurts and so on. Pretty useful stuff.

Milk is also a surprisingly versatile word in the Spanish language. In English, we can talk about the milk of human kindness, you can milk something for all it is worth and say that it’s no good crying over spilled milk – but that’s about it. Not so in Spanish as it is spoken in Spain. I say ‘in Spain’ as it is necessary to distinguish it from Spanish spoken in other countries where slang and idioms may differ.

In Spain, Leche (pronounced lech-ay) can be used in so many different ways as to be almost mind boggling. A wide range of emotions can be expressed through just that one word. I found the following fictional conversation on the internet1 the other day, It uses slang and illustrates my point so perfectly that it felt right to include it here. English translations follow each Spanish phrase:

El jugador de fútbol corría a toda leche cuando uno de sus oponentes le dio una leche en la pierna.

(The soccer player was running at full speed when one of his opponents hit him on his leg.)

Ay la leche, gritó el jugador al caerse al suelo.

(“Damn it”, cried the player as he fell to the floor.)

Un espectador en el estadio comentó a su amigo, ¡Qué mala leche! Ese futbolista es la leche, y si está herido no va a poder jugar en la final, ¡Me cago en la leche!

(A spectator in the stadium turned to his friend, “That was out of order! He’s the best, and if he’s injured he’s not going to be able to play in the final. Bloody hell!)

Su amigo le respondió, “no te pongas de mala leche, tio. No me parece tan serio. Se levantará y seguirá jugando. Lo verás.”

(His friend responded, “don’t get into a bad mood, man. It doesn’t look that serious. He’ll get up and continue playing. You’ll see.”)

Y una leche”, dijó el espectador abatido.

(“No way”, said the spectator, dejected.)

In that short passage, we can see the word leche being used to express so many different things; it goes to prove that a little milk does go a long way.

 

1 https://www.babbel.com/en/magazine/favorite-spanish-words

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Why me? Maybe I have my answer

IMG_0796_cropped  ms montage

Most people being forced to live with an illness such as multiple sclerosis are bound to ask in those blackest of moments ‘why me?’ Despite my positive outlook on life, I certainly did a few years ago when I had several falls in one day.

I can still recall that awful day when, having taken yet another tumble, I swore out loud about ‘this ******* MS’ and, in pure frustration, hammered the floor with my good hand as I cried out ‘why me?’

Ok, so those dark emotional days are well behind me now, I have grown used to living with my MS. Looking back is something I do with pleasure, remembering the good times and my successes while forgetting the rest. Looking forward is full of anticipation and hope, while the present is for living every moment to the fullest that can be managed.

Now, the question ‘why me?’ is no longer asked. MS is an uninvited guest that is not going away. But I am still interested in how it got in. In other words, what caused it in me.

No single cause of MS has yet been identified but various sources reveal that scientists believe that the likelihood of contracting the illness is linked to four factors. These are: Immunologic, Genetic, Environmental and Infections.

Immunologic; It is well established that in MS the immune system malfunctions and attacks the central nervous system. Researchers know that the myelin sheath is directly affected, but they don’t know what triggers the immune system to attack the myelin.

Genetic: Several genes are believed to play a role in MS. The chance of developing MS is slightly higher if a close relative, such as a parent or sibling, has the disease. According to the Multiple Sclerosis Foundation (MSF), if one parent has MS, the risk of their children getting the disease is estimated to be between two and five percent. Scientists believe that some people are born with a genetic susceptibility to react to certain, but as yet unknown, environmental agents. Maybe an autoimmune response is triggered when they encounter these agents.

Environmental: It is now well-known that MS is more predominant in countries that are further away from the equator and this has indicated that a lack of vitamin D may play a role. Vitamin D does benefit the function of the immune system. People who live near the equator are exposed to more sunlight. The more sunlight that skin receives, the more the body naturally produces the vitamin.

Infections: Researchers are considering the possibility that viruses and bacteria may cause MS. Viruses are known to cause inflammation and a breakdown of myelin (called demyelination). Therefore, it’s possible that a virus could trigger MS. Several viruses and bacteria are being investigated to determine if they’re involved. These include: measles, human herpes virus-6 and Epstein-Barr virus that causes glandular fever.

Ok, so how does all that affect me? I have no idea about the immunology but there was no-one in my family with MS, so a genetic cause can be discounted.

Of course, environmental factors could well play a part as from birth until my 63rd birthday I lived in the UK, first in the south-east and, for the last 23 years, further north in North Wales. The lack of sunlight in the UK, especially the further north you go, comes as no surprise, but University of Oxford researchers used NASA satellite data to quantify the decreasing levels of UV (ultraviolet) rays from the sun as you move north. Less UV means less vitamin D produced in the body. There are also concerns that worries about skin cancer mean people can cover up too much. New official advice stresses the need to strike a balance between healthy sun exposure and skin cancer risks.

I have already said, in a previous blog post http://50shadesofsun.com/?m=201508&paged=2, the poor British weather with almost constant grey skies, rain and strong winds – plus my desire to increase my vitamin D level – was the prime reason behind our move to Spain.

Finally, and for me the most telling factor, is infection. Of the infection listed as possible causes of MS, one was the Epstein-Barr virus that causes glandular fever and this I had in or about 1974. That year I was approaching my 22nd birthday.

When I was finally diagnosed with MS, 27 years later, the consultant neurologist told me that he had gone back through my medical records and found evidence of MS as far back as my mid-20s.

Hmm, glandular fever at 21, almost 22, and evidence of MS mid-20s. A clinical link may not be scientifically proven but, if you were me, would you need any further proof? I most certainly don’t!

 

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What’s in a name? Counterfeit cheats in Cheetham

Counterfeit goods seized in Cheetham Hill. Picture: Manchester Evening News.

Counterfeit goods seized in Cheetham Hill. Picture: Manchester Evening News.

Did you happen to see a news story on the internet yesterday about an area of the UK that has been labelled the ‘knock-off’ capital of the country in a new Government report?

It certainly brought a smile to my face, not because of the efforts to close down the thriving industry in counterfeit goods but because of the name of the place: Cheetham Hill, in Greater Manchester.

Can you think of anywhere more appropriate to locate your criminal counterfeit goods business than in a place called Cheetham? After all isn’t that the aim of the trade in fakes; the idea being to cheat ‘em.

Apparently, the trade in counterfeit brands is continuing to flourish there despite a series of high-profile raids which have seen fake goods worth millions seized by the authorities, according to the Government’s Intellectual Property Office.

Now it is asking for additional funding to help Greater Manchester Police tackle what it describes as ‘widespread criminality’ in Cheetham Hill.

A series of raids was organised before Christmas when police and trading standards officers teamed up to strike at 14 shops. Those raids were a success, as goods worth £1.5 million were seized. That’s really only the small tip of a massive iceberg, however.

In 2014, a million cigarettes and 70 kilos of tobacco, all falsely purporting to be genuine brands with an estimated value of more than £5m, were seized. While, in 2013, £1m worth of fake designer clothes, handbags and footwear were confiscated. Anyone fancying a drink was in for a surprise back in 2010 when counterfeit vodka worth £250,000 was seized.

Customer demand for fake designer goods remains high, with ‘Louis Vuitton’ satchels available for £15, ‘Beats’ headphones at £5 and ‘Nike’ shirts at £20. All these are sold well below the prices charged for the genuine articles.

The report says: It is indicative of the entrenched criminal culture of the area that the trade in counterfeit goods has continued despite regular enforcement action and high-volume seizures.

“Cheetham Hill occupies a focal point in the UK market for counterfeit goods. In addition to the significant retail trade occurring directly from premises in the area, there is also information suggesting that local wholesale operations supply counterfeit goods to online and in-person traders across the UK.”

The production, distribution, and sale of counterfeit goods has always had close links to serious organised crime, a fact often not considered by the everyday bargain-hunter or cash-strapped consumers.

The counterfeiters of Cheetham Hill are no different; they have links to serious organised crime, drug dealing and violence, says the report, but adds that the fakers are so ‘embedded’ that agencies like the police, trading standards, the brand-owners and Government departments ‘could not successfully tackle the problem’ on their own.

It’s a serious matter but the fact that the town at the centre of this cheating crimewave is called Cheetham is just too funny for words.

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Can Multiple Sclerosis be stopped? Maybe SOME can

Prof Basil Sharrack (left) and Prof John Snowden have a clinical partnership of neurology and haematology.

Prof Basil Sharrack (left) and Prof John Snowden have a clinical partnership of neurology and haematology.

Last night on the UK’s BBC television, its leading documentary programme Panorama aired an episode entitled Can you stop my Multiple Sclerosis?

It followed four people with relapsing remitting MS as they were given bone marrow transplants that are more usually reserved for cancer patients. I say ‘transplant ‘ but the stem cells are taken from the individual patient, so there is no risk of rejection.

The treatment – known as an autologous haematopoietic stem cell transplant (HSCT) – aims to destroy the faulty immune system using chemotherapy. It is then rebuilt with stem cells harvested from the patient’s own blood. These cells are at such an early stage they’ve not developed the flaws that trigger MS.

Now, as my MS is not the relapsing remitting type, this treatment would not be right for me but, as I watched the programme, it was a delight to see some real progress being made treatment and remarkable improvement in the lives of those for whom it is suitable.  If a similar treatment could help me, would I take it? Once it had been proved to be safe, yes of course – wouldn’t you?

The treatment is being pioneered in the UK by two consultants at Yorkshire’s Royal Hallamshire Hospital where 20 patients have been treated so far. Neurologist Prof Basil Sharrack said: “To have a treatment which can potentially reverse disability is really a major achievement.”

Prof John Snowden, consultant haematologist, said: “The immune system is being reset or rebooted back to a time point before it caused MS. It’s clear we have made a big impact on patients’ lives, which is gratifying.”

The treatment involves intensive chemotherapy, so patients are warned that there are side-effects such as nausea and hair loss.

Prof Richard Burt, of Northwestern University, Chicago, carried out the first HSCT for MS in 1995. He said: “There has been resistance to this in the pharma and academic world. This is not a technology you can patent and we have achieved this without industry backing.”

A study published last year involving MS patients in Chicago, USA, showed significant reductions in neurological disability and, for some, the improvements persisted for at least four years – although there was no comparative control group. The outcome of a more detailed international trial – which will report in a couple of years – could determine whether the stem cell transplant becomes a standard NHS treatment for many MS patients.

A note of caution was later voiced by Dr Emma Gray, head of clinical trials at UK’s MS Society. She said: “Ongoing research suggests stem cell treatments such as HSCT could offer hope and it’s clear that in the cases highlighted by Panorama they’ve had a life-changing impact.

“However, trials have found that while HSCT may be able to stabilise or improve disability in some people with MS it may not be effective for all types of the condition.”

Dr Gray said people should be aware it was an “aggressive treatment that comes with significant risks”, but called for more research into HSCT so there could be greater understanding of its safety and long term effectiveness.

 

 

 

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Fun facts to entertain you

Just for a bit of fun, here are a few facts about me that you probably don’t already know or don’t even want to! Well, you probably know a few but not all of them.

1.       My third forename is Hunter, my mother’s maiden name.

2.       I was the only one of my parent’s family to be born outside the English county of Sussex; I was born in what was then Kent. My birthplace is now in the London Borough of Bromley.

3.       I am the youngest of three siblings. My sister is seven years older than me and lives in Devon, England. My brother, who was 11 years older than me, died in April 1990 at the age of 48.

4.       My earliest childhood memory is of being wheeled in my pram and left outside while mum went into a shop. Not something recommended these days.

5.       Although never sporting at school, I played both cricket and hockey (on grass, not ice) for local clubs.

6.       I qualified as a football (soccer) referee while still at high school and immediately started refereeing matches between adult teams. Often I was the youngest person on the pitch.

7.       I was once fired three weeks after I resigned! All a bit silly, I had already given four weeks’ notice but one week before my planned departure I was fired for refusing to work one evening because I was going to a formal dinner dance with the guy who would soon be my new boss. When he heard about it, he told me I could start my new job a week earlier than planned. Not bad – as my new job paid almost double the old one.

8.       Corgis, to be exact Pembroke Welsh Corgis, played a major role in my formative years. Most Saturdays were spent at dog shows. My mum started breeding and showing corgis when I was six or seven and she later became an international judge. She also was a judge at Cruft’s.

9.       Up to the age of 11, I attended a private fee-paying school but from then until I left, aged almost 18, I went to a regular state-funded high school.

10.   Two bones in my right ankle were broken in an accident while riding my bicycle in 1968. Six weeks in plaster from toes to knee, walking with crutches. Still remember it. Another time, I broke a finger on my right hand playing the supposedly non-contact game of basketball in the school gym. I still recall being told to walk to the local hospital by myself.

11.   I fell in love with politics at the age of 10 and at 14 joined the youth section of a political party even though its minimum age was 15. I didn’t lie, they just bent their own rules. In the years since I have voted for various parties as my views and circumstances have changed. Now that I live in Spain, I am allowed to vote in parliamentary elections in the UK and local elections in Spain.

12.   Hobbies? Not really had the time for those although I have been involved in the running of various not-for-profit community and charitable organisations. These days, most of my ‘hobby time’ is dedicated to preparing and publishing this blog.

13.   Although brought up and later confirmed as a member of the congregation of the Church of England, I have since changed my faith. While recognising that all faiths and deities are equally valid, I am now a Pagan and follow the Wiccan religion.

14.   It is no secret that I have a disability caused by Multiple Sclerosis. This is one of a few illnesses and conditions that affect me but my life is full and enjoyable. Apart from difficulty with walking, standing and using my left side generally, I feel well and like to do everything that I can.

15.   I follow the fortunes of quite a mixed bag of sports teams: Football (soccer) – Fulham and Spain; Rugby Union – Ospreys and Wales; Cricket – Sussex and England; Formula One – Anyone who can beat Mercedes; Baseball – NY Mets.

16.   There are two distinct musical loves in my life: Country and the Sixties.

17.   Holidays are rarely better than those taken aboard a cruise ship. You get to take part in shore excursions every time you dock and enjoy dining and entertainment on board. You visit different towns, even countries but only unpack once as the ship is a floating hotel – and much more.

18.   Following 63 years of living in the UK, I have now moved to Spain with my adorable New York City-born wife, Lisa. We arrived in Spain on November 15, 2015, and now live in our own two-bedroomed single-storey property in a small community in an agricultural area with a real Spanish village nearby. The nearest town is Cuevas del Almanzora which is only about 10 minutes away by car, while the Mediterranean coast is a drive of about 15 minutes.

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Disturbed nights: a frequent problem with MS

urine night

Oh wonderful, this morning I feel really great because, for once, I have had a decent night’s sleep. The traditional ‘eight hours’ is virtually unknown to me but, last night, I managed nine hours broken by only one interruption in the form of a bathroom break.

In comparison, the previous night, my sleep was broken after the first, second and fourth hours for the same reason and that after ensuring I emptied my bladder before going to bed.

urine urgentProblems with your ‘waterworks’ is one of the things associated with multiple sclerosis and is one that many of us with the illness tend not to talk about because it can be embarrassing to admit to having less control than most people. My own experience, and here I cannot talk for everyone with this condition, is that when I first feel the need to urinate, I need to go NOW. Putting it off for half an hour just isn’t an option.

And, even having just been to the bathroom doesn’t mean I won’t have to go again quickly. On some occasions, it has not been unknown for me to have to make repeat trips every 20 minutes during the daytime but two hours is more usual.

The medical term for a frequent need to get up and go to the bathroom to urinate at night is nocturia.

Most people without nocturia can sleep for six to the magic eight hours without having to urinate. Some researchers believe that one event per night is within normal limits; two or more events per night may be associated with daytime tiredness. Patients with severe nocturia may get up five or six times during the night to go to the bathroom. It is often a symptom of one of many other medical conditions that include multiple sclerosis.

Again, speaking for myself alone, I am not ashamed to admit that for years I have been on medication designed to treat symptoms of overactive bladder, such as frequent or urgent urination, incontinence (urine leakage), and increased night-time urination. It works by reducing muscle spasms of the bladder and urinary tract. It has not eliminated my problem but it most certainly has improved it.

urine signDealing with the daytime issues that remain mean that, when away from home, I need to know the location of the nearest bathroom facilities and be able to get there quickly. Also, to avoid any accidental leakages, in those situations I wear a special pad. I throw away many unused but the old adage ‘better safe than sorry’ comes to mind as, just once in a while, it is necessary.

Getting back to my night-time issues. Waking up when I need to visit the bathroom does not cause any problem but, because standing up makes the need even more urgent, there is sometimes not enough time to get there. To overcome this, I keep a urine bottle by the bed. Again, better safe than sorry.

Anyway, last night was a great night for me so, today I feel wonderfully refreshed and ready to take on the world.

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Really fresh juice from locally grown fruit

orange trees2_edited

Just have to say that we enjoyed a great addition to our breakfast this morning. Peter, one of our neighbours, rang the doorbell yesterday and handed Lisa a carrier bag absolutely bulging with oranges and grapefruits that he had picked from trees nearby.

Having thanked him, we wondered how we could possibly eat them all before they spoiled, especially considering the fact that grapefruit still languishes on my ‘I don’t like’ list of foods. So, thinking it over, I suggested that Lisa make her own freshly squeezed orange and grapefruit juices.

She liked the idea and, this morning, she tried making orange juice for the first time. We don’t have a juicer so, instead, she used our blender – with impressive results. To be honest, we weren’t too sure how it would turn out but we needn’t have worried. It was excellent. We didn’t bother sieving it to remove the odd bits after all, back in the UK we used to buy fresh juice ‘with bits’ from Tesco.

Next time, we will try grapefruit juice. Although I don’t like the fruit itself, I know the juice is a pleasant drink and will have no problems with that.

Sitting here on Saturday with the sun streaming in through the windows, it seems quite a lot warmer than the 14C being recorded at our local weather station but, of course, that is the shade temperature – just as they always give in forecasts. It is always warmer in the sunshine itself.

Talking of weather, I see that, so far at least, those forecasting the UK weather seem to have covered themselves in confusion once again. Over the last few days there have been awful predictions of heavy snow and ‘an arctic blast’ of freezing air set to bring temperature as low as -15C. Granted that this was going to be worse in parts of rural Scotland but even there it has not got that cold. At the moment, the worst I can find is -3C but it will, no doubt drop tonight as it does every night.

Artic winds? It seems that the forecasters got in wrong again but there’s always tomorrow for them to redeem themselves.

Here in southern Spain, we are experiencing our own winter with tonight’s low forecast to drop to just 2C, which will be the coldest that we have known it in the two months we have lived here. Such is life!

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Same-sex marriages threaten Anglican church split

Shield_of_the_US_Episcopal_Church.svg Anglican_rose.svg    The shield of the Episcopal Church of the USA and, right, the rose of the Anglican Communion.

It’s liberal view on the seemingly still religiously controversial topic of same-sex marriage has landed the US Episcopal Church, the Anglican church in America, in trouble with the fellow members of the Anglican Communion and has resulted in the American church being barred from joining any of the Communion’s decision-making bodies for three years.

This effectively ostracises the US church that, in 2003, was the first within the Communion to ordain an openly-gay bishop and last year passed a resolution to allow its clerics to perform same sex marriages.

A statement from those church leaders taking part in the meeting in Canterbury, UK, said that the US church should “no longer represent us on ecumenical and interfaith bodies, should not be appointed or elected to an internal standing committee and that while participating in the internal bodies of the Anglican Communion, they will not take part in decision making on any issues pertaining to doctrine or polity”.

The Anglican leaders said the Episcopal Church’s approval of gay marriage was “a fundamental departure from the faith and teaching” of the majority of Anglicans.

But one British MP, himself a former curate and youth chaplain, is so disgusted by the decision that he has now ´given up´ on the Anglican church.

Chris Bryant, Labour MP for Rhondda, Wales, took to social media to say: “I’ve finally given up on Anglican church today after its love-empty decision on sexuality. One day it will seem (as) wrong as supporting slavery.”

And speaking to the BBC, he went on to say: “The whole point of the Anglican communion is that we agree in the autonomy of its churches. I think we’ve behaved disgracefully to the American church. This is the established Church of England taking a stance against homosexuality.

“Church leaders should read the Bible – Jesus’s message was not one of hatred and division, but one of peace and understanding.”

So, where do other faiths stand on the issue of same-sex marriages?

A look at this table shows the attitude of most Christian churches and other religions in the USA:

ssm

As you can see, most are in favour of allowing same sex marriages.

Regretfully, Pagans have been omitted from this table but I can tell you that the various faiths that are collected under the Pagan umbrella do not discriminate against the LGBT community. To us, a loving couple is just that, a loving couple, however it is comprised.

The decision of the Anglican Communion to criticise and partially exclude the US Episcopal Church for taking a decision with which it disagrees, but that even the Archbishop of Canterbury agrees it was entitled to make, is little to do with faith but is rather a political move to head off a potentially damaging split in the Anglican church worldwide.

Is that justification enough? I’ll let you decide.

 

 

 

 

 

 

 

 

 

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Restaurant service at your table and with a smile

waiter

Eating out in Spain, seemingly in all establishments from upmarket restaurants to simple bars or coffee shops, is like stepping back in time for me and is a return to normal for Lisa. And the reason for that is really so simple.

Here, when you go out to eat, you are greeted courteously as soon as you arrive and are shown to a table, there you are given a menu, asked if you’d like a drink and then, due time, your order is taken – all with a smile. At the end of your meal, you ask for the bill/check and pay at your table.

Nothing strange there, you might think. Regular restaurant practice, you might think, they are giving regular and expected customer service. Well, of course they are doing just that – as Lisa learned to expect by the service given in the US but, sadly, not by what we both experienced in the UK.

To be fair, there are lots of restaurants in the UK that do offer the same level of table service that I am talking about but there are a number of them, notably outlets of major national chains, that operate differently.

Typical order point in a 'pay now, eat later' restaurant in the UK.

A typical order point in one of the many ‘pay now, eat later’ restaurants in the UK.

There, having been shown to your table, you select your dishes from the menu. So far, so good, but then one person from that table has to go to the bar and place everyone’s order, not forgetting the table number, and pay for it before returning to sit down with drinks and wait for the food to arrive.

Now, I don’t know about you but I much prefer to have my order taken at the table in comfort and not have to go to the order point where you usually have to wait to be served before placing your order – hopefully not forgetting anything – and them stumping up the cash before being served anything.

In our case, because of my disability, Lisa has always had to be the one going to place our order and she really loathes it. It is something she never experienced in the USA.

I have no idea how such an idea came to be put into practice in the UK but it is certainly not good customer service and falls well below the level of service available in quality restaurants, including Indian, Chinese etc.

Whether any such ‘pay now, eat later’ restaurants exist elsewhere in Spain, such as in the main tourist areas or major cities, I really don’t know but they certainly aren’t any in the area in which we live – and long may that continue.

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