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It is a pity that they have not recruited some haematologists. The main objection to the story is that the lumps in the pictures cannot have been there in the patients because they would have been centrifuged out. Whether or not you call them clots is probably less important. It intrigues me...

I continue to be very confused by what is going on in individual cases. It is uncomfortable to refer to details online but I am not sure how else to get things clearer. I wonder if the real issue is the refusal to set up PEG, if TPN is already in place and home TPN is not an option. But TPN can...

There are two problems with the NICE guideline. One is that it does not intend to cover service provision, just treatment modalities. The other is that it caved in and di make some recommendations for service provision that aren't very good. Charles Shepherd wanted consultant led clinics. That...

Ah, but was he a Barts man? Did he train at Barts?

Not so sure after listening to my old music teacher who survived a Japanese death pit with a smashed femur. I suspect Japanese soldiers were a bit like Bart's men. Peter Denton White was almost but not quite a Barts man, being at QMC. It was said that; You can always tell a Barts man. But you...

Clearly muscle isn't exposed to light but yes we have detailed studies of muscle changes for 48 hrs after exercise. The UCL muscle unit did biopsies after exercise. But there is a very stereotyped resolution time frame. PEM doesn't do that I am told. And of course on 2 day CPET normal people do...

I have no doubt that fatigue after car travel is due to continuous muscle contractions - if the trip is long enough I specifically have neck ache and the neck muscles are going to be working the hardest unless you have an aeroplane pillow. But that is something quite other than the sleepiness...

Nobody is going to fund 'we intend to make a whole load of measurements and hope someone else can figure out what it means. More seriously, the design of the sensors is going to need careful thought in relation to what is going to be analysed.

I think it may have to come from completely objective evidence from actimetry. Not just measures of periods of exertion but measures of subsequent reduction in activity. You might say that this would never show anything - but that is what Sarah Tyson has said, probably because it doesn't suit...

That part yes, but the analysis of the data would require both detailed clinical insight and high level mathematical method knowledge.

I think Fluge and Bella have tried to make a start on this. But you need investigators who understand the point of the exercise. I often wonder if anyone not a member of S4ME has that understanding. We are beginning to see young scientists who want to get to grips with ME/CFS but as for...

From reading the threads I would say it was no where near as stereotyped as that. And what is 'a certain threshold'? Is it defined in a circular fashion as that which gives PEM? In my article I make it clear that something about the time course of worsening is what makes ME/CFS a concept that...

Why, set up an exemplar clinical unit of course!

Traditionally it was the norm. We all know the centre names: Brompton, Queen Square, Rheumatic Diseases at Bath, Birmingham Accident Unit, Royal National Orthopaedic. Almost all trainees in a specialty wanting to become consultants worked for a year or more in these exemplar units. Then in the...

I was thinking of that when I wrote that! A surprising number of people volunteer for 2 dy CPET studies it seems. But the studies never seem to test for what symptoms people have after day 1. If I had bad PEM I would say no thinks to day 2. But I wouldn't recommend that approach anyway. The...

I was specifically referring to the idea that anaerobic thresholds are crucial. I don't think we have any evidence for that. More generally a reduction in output on CPET on day 2 is interesting but we don't have good reason to think it is what makes people feel worse.

I haven't heard that other than from on for two members. Sleep and lying flat course make a face puffy from a combination of gravity and immobility.

Yup. We use UV to study vascular activation this way. The skin goes red after a few hours, like sunburn.

Are we sure this is not sleepiness. Sleepiness with car vibration is surely something lots of people are familiar with. Both I and my wife fall asleep in a vibrating car but not in a train. The sleepiness is irresistible but nothing to do with tiredness. And of course some people feel sick with...

This is the nub.