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Sure, it takes 2 hours. But the point is that if you have two curves one going down and the other nine times as much up and you blur or overlap them by a spread of minutes you never get any time point with a serious down. We know that there major autonomic signaling changes going on during and...

But if you get 9 times as many calories as you have to spend and everything is spread over many minutes there isn't going to be any realistic time point when you are down on energy. The symptom of being down on energy is hunger. That doesn't seem to be something people get immediately after eating.

So i don't see why payback in form of pain and having to lie down isn't comparable to the payback of PEM i.e. ME type exertion intolerance. Some sort of signaling is saying no thanks - later. But also as Trish has said, at the time , if you are pushing things. If the stomach was starved of...

Trouble is, disease physiology isn't simple. 10% of calories may be used to digest and transport and store but you are still 90% up on before the meal. So it isn't a problem of energy depletion. And "effort" or "exertion" are how your brain represents what is being done and achieved in the body...

It involves a sense of exertion, yes, but 'energetic' doesn't otherwise have any useful scientific meaning. It just feels like hard work. I think it is important not to start talking about ATP and mitochondria and energy in a metabolic sense when we have no evidence that is the problem and in a...

Which is gratifying, but where are all the doubters? Where are all the reviews from professionals I know have been asked to do one? Fairly soon I am likely to modify it with what may be rather more contentious text. If I make it contentious enough sea lion Garner might even appear.

Yes, this is a problem that physiotherapists do understand and are very familiar with dealing with. It occurs in people on ITU for long periods. The film clip of J T-B suggests that she had the same problem when trying to stand again. There is likely to be shortening in the whole...

A nice point to include.

I don't think it is even that specific, it just means passing the buck.

Interesting that I cross-posted with Amw66 on this. I thin we can agree that it makes no sense to say that EDS would be associated with a 'functional problem'. 'MCAS' might be less clear since the mast cells might just be 'malfunctioning'. But we don't have any evidence for either of these...

The RCP document on feeding is interesting but as far as I can see says nothing about people with functioning gut needing to be sectioned in order to qualify for enteral or parenteral feeding. In the closest it gets to ME/CFS, which is an example of a 'functional' problem it says that even TPN...

Posts moved from Maeve Boothby O'Neill - articles about her life, death and inquest I have been looking through the RCP document on feeding and thinking of some further things I might say on Qeios. I will post on that later. However, it strikes me that it would be useful to add some things...

And what, pray, does that quarter truth have to do with someone starving to death? Having said that there is too much clashing of narrative why keep doing the same thing?

Sort of something like that, maybe, yes, @Andy, but: I was a physician. I worked in that culture. Talking to patients seemed an obvious thing to do. It seems weird not to. I am just intrigued by my colleagues behaviour. But when you see a patient in clinic everything is focused on the...

Hopefully everyone else would realise that if that was the case it was just bullshit.

I am left wondering what happened to PEG feeding? We are given reasons for not using TPN IV lines - infection. I am not aware of an equivalent risk of septicaemia for PEG. What can the experts here advise on this?

I am pretty certain that 'medicalise' in this context means to give credence to biomedical explanations and management approaches for an illness. That is the only UK medical usage I am aware of in this context.

There are biomedical teams in the UK and Netherlands who really do have the skills and insight to be looking in good places. They are not physicians but if they find something the physicians will take an interest. I know that a lot of patients feel people are not looking but to be honest there...

A fantastic job by @Nightsong. It is all becoming clear that the problem was very much as suspected - not a fault with guidelines but with people putting groundless theories before what was needed. I have had some suggestions about things to add to my Qeios piece, which I can do whenever I...

I am sure that is right. But I think it may be important to note that somewhere Maeve had said something like that she had been told to lie flat all the time for months as the only road to recovery. That concerns me. We need evidence.