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It is interesting that the RCP advice on feeding difficulties does not mention any such conditions beyond 'functional problems' which the text relates to EDS (rather bizarrely). My wife had a psychiatric condition in which she falsely believed that she had bowel obstruction and would inevitably...

I get the strong impression that there is a pressure group based in the UK that wants to say that to get TPN and maybe PEG you should have a non-functioning gut and that this revolves around the idea of 'functional' problems. It may be quite recent. It may be that the most useful specific...

Actually they don't and it isn't in UK hospitals in this century. A member of my family who had a stroke had to listen all night to nurses ten feet away laughing about their relationships without any concern about patients being present. Things were very different forty years ago.

Yes, I see your point now. And it is very important - the need is to get across to those who think they know the answers the fact that the intolerability and the types of sensations that mediate it is not occurring in a normal way, even if something rather like it does occur normally non...

I don't follow the question quite. What I am saying is that health professionals need to face up to the intolerability being undeniable and impossible to overcome, just as a man with a septic knee cannot walk. If the discussion gets sidetracked into whether the mechanism is blockage or faulty...

Thanks @Trish People here with experience are chipping in at appropriate points and that is helping me to get a broader idea. I may put together some questions before I edit my article.

Whether or not it is OK to refer to FMD is a matter for debate. But the concept is reasonably well defined around certain specific clinical presentations - non-epileptic seizures and rhythmic movements such as tremors and choreoathetosis (slower rhythmic movements of whole limbs usually). These...

I am beginning to get a clearer picture of just how badly people with ME/CFS will fall between all the stools laid out in the RCP guidance. The guidance rightly indicates that both enteral and parenteral support can always be justified if failure of nutrition is life-threatening, but it also...

I think there may be confusion with FMD - functional movement disorders - which is more or less what they seem to be talking about. The problem came when that gotblurred out into FND. All a complete mess.

Another thought is that gastroparesis may just be part of the signaling response. It isn't some extra problem. We probably all have gastroparesis when we have 'gastric flu'. Each person's problem may be a bit different but we know that the way the autonomic system responds during eating is very...

The trouble is @Deanne NZ , that I suspect rather than seed doubts this sort of paper merely confirms beliefs that ME/CFS is a concept based on half-baked ideas of physiology from a group of physios that patients lap up but don't hold water. Even the GPS are aware of this debate. They know there...

I agree. I don't see PEM as a physiological concept. It is about a temporal pattern of symptoms. I doubt Ramsay's observation of fatiguability has much to do with CPET studies although it may have even the motivation for doing them.

The neuroimaging discussion just indicates that the authors do not know how to assess pathological findings in this sort of context. With populations of unknown and unstandardisable heterogeneity you cannot conclude anything.

It looks from that study that there some changes but nothing major. If you stop using your hands the skin gets thinner by more than that I suspect but it isn't a problem, just a normal regression. I am not sure what the sepsis argument is about though.

Yes but FND treatment very likely doesn't work for FND. So it is not a discriminatory test.

I appreciate your efforts Andy. There is something about the way this one ca.e up on the link that looked worrying. I shut it so didn't discover much more. I read one or two other forums - mostly academic neuro stuff - and I got caught recently by opening a link someone had posted that ended up...

So he is a trainee who has been asked by a commercial outfiit, that trawls for peoples names to SPAM, to write a review - or just wants to appear to have lots of papers. We don't need to pollute our forum with drivel like this to be honest. Likely nobody will read it and if they do I am not sure...

There are weigh-beds. It is hard to believe that anyone was taking the problem seriously.

That looks like a SCAM site verging on malware. I would ask people to be careful about posting links unless it is a paper in a real journal. I have recently had big problems cleaning stuff off my computer with sites like this.

It's all on message but where is this mysterious "pathophysiology"? The case for this not being FND isn't to do with physical evidence. I am not sure that claiming so does more than dent the credibility of the authors and the case. It disappoints me that everything is couched in this polarized...