New Zealand: ANZMES

Youtube video

Episode 3 Know ME - Diagnosis of ME/CFS
Know M.E. the podcast where guest speakers talk about pressing issues surrounding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post COVID Conditions. Join researchers, clinicians, and patient advocates as we take a deep dive into the most recent, evidence-based information, so that you too can know M.E.

In today's episode: ANZMES president Fiona Charlton speaks with RNZCGP Fellow Dr. Sarah Dalziel and Dr. Rosamund Vallings, on diagnosis of ME/CFS.

00:00
Introduction
00:24
Episode Introduction
00:34
Speaker Introduction
1:52
How might a patient describe their experience to their GP?
3:49
What are the next steps for a GP, what questions should they ask?
7:07
What tests should they order?
9:00
How important is it to find the root cause and treat that?
11:00
How many consults are needed to reach a diagnosis?
14:13
What criteria is recommended for a diagnosis for ME/CFS?
15:57
What else is important for a patient-centred approach?
16:59
Is it helpful for GPs to provide written information to patients?
19:00
Is it helpful to provide a summary of the GP/patient discussion?
19:36
What is your advice for tackling the many symptoms of ME/CFS?
22:54
Collaborating with patients to assess symptom order of priority.
24:20
Style of treatment the patient prefers.
25:18
Collaboration with other modalities.
25:47
What advice would you provide a GP to feel confident in making a diagnosis?
29:11
Conclusion.

A full transcript of today's episode can be found here: https://docs.google.com/document/d/1P...

 
ANZMES releases two new resources to guide assessment and management of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome and long COVID.
ANZMES (the national advisory for ME/CFS and a RNZCGP registered provider of continuing education) has released two short reference guides for primary care. These resources offer a snapshot of the key aspects of diagnosis, assessment, symptom management, comorbidities, and care and support planning.
https://anzmes.org.nz/anzmes-release-resources-for-primary-care/
 
In today's episode: ANZMES president Fiona Charlton speaks with RNZCGP Fellow Dr. Sarah Dalziel and Dr. Rosamund Vallings, on diagnosis of ME/CFS.00:00 Introduction
00:24 Episode Introduction
00:34 Speaker Introduction
1:52 How might a patient describe their experience to their GP?
3:49 What are the next steps for a GP, what questions should they ask?
7:07...

I just watched the first 7 minutes of this and thought it was awful.

Dr Vallings misdescribed ME fatigue as tiredness, and PEM as feeling more exhausted than normal after activity,
Yeah, well I think, you know, many, many patients present with fatigue, there's no doubt about that in many, many diseases the characteristic post exertional malaise that we're talking about today may not be what they present with it may be as a result of some direct questioning. But they may well be for example a sports person who says, you know, they can no longer play their sport as freely and easily because they feel this total exhaustion afterwards from which they don't really recover in a hurry.

It's a very sluggish slow return to normality, which they haven't had that problem before.

So people with post-exertional malaise certainly don't recover quickly from their fatigue that they would in a normal way, but this doesn't necessarily mean that they, all going to present with post-extertional malaise, they will usually be presenting with the fact that I'm just terribly tired and it's a direct questioning that may uncover the post exertional malaise being the type of tiredness.

Dr Dalziel described OI as feeling worse after being upright all day.
The other, 2 other symptoms that are kind of, really important to talk about.
Would be orthostatic symptoms. So that's not just dizziness on standing up.
That’s generally the worsening of symptoms with upright posture. And so some people say, well, look, if I just stand up all day or at the end of the day, I just, yeah, everything's worse.

Both descriptions massively underplay the seriousness both in terms of symptom severity and loss of function in of PEM and OI.
I hope the rest of the video is better. I can't face watching any more. No way would I recommend this.

Quotes taken from the transcript linked in Sly Saint's post.
 
The podcast/vodcast where guest speakers talk about pressing issues surrounding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post COVID Conditions. Join researchers, clinicians, and patient advocates as we take a deep dive into the most recent, evidence-based information, so that you too can know M.E. Health professionals can earn CME credits whilst they listen by signing up here: https://anzmes.org.nz/what-is-me/medical-professionals/
https://www.youtube.com/playlist?list=PLlV7biMCtpYDdldX5H94-cJrEIUAsgzU1

Oh dear. I thought the first episodes were a bit meh but that on balance they would do more good than bad. I so, so, soooo wanted this CME series to be at least ok-ish but unfortunately it got worse. The latest episodes are an almighty muddle of some good bits, a lot of very confusing parts and some seriously unhelpful statements.

Friendly reminder of rule #1 for any effective communication and teaching: take account of where your audience is at, what they know and don't know (or think they know but have wrong), and how they're likely to interpret your words and how they're likely to integrate that interpretation into their prior knowledge and beliefs

Unfortunately I got carried away when ANZMES first announced this CME series and gave the link to my practice nurse. I just hope she threw it away or quickly gave up listening

Sorry to be so harsh, but I'm very disappointed
 
That video (which I agree is really awful in places) makes me very concerned about who they will have evaluating the research proposals. Does anyone know?I suspect the panel will involve Dr Vallings - she's the doctor who recommends singing in the shower in order to tone up the vagal nerve... I'm not quite sure if she is still the Medical Advisor to ANZMES, but for sure ANZMES think she is an expert on ME/CFS. Unfortunately, a career spent providing medical services to people with ME/CFS does not necessarily equate to having expertise on ME/CFS.

I did email Fiona Charlton (President of ANZMES) a while back to see if I might be able to help with anything, including evaluating the research proposals, and inviting her to spend some time on Science for ME. I didn't even get a 'thanks, but no thanks'. Nothing.

The video on You Tube allows viewers to say they disliked it, but I don't think numbers of 'thumbs down' are being displayed. Still, they say the feedback is shared with the creator of the video, so it's one way for them to hear us.
 
Last edited:
Oh dear. I thought the first episodes were a bit meh but that on balance they would do more good than bad. I so, so, soooo wanted this CME series to be at least ok-ish but unfortunately it got worse. The latest episodes are an almighty muddle of some good bits, a lot of very confusing parts and some seriously unhelpful statements.

4a, midway through. Neuroplasticity. FFS.

ETA: 4, Ros Vallings slide at 11:00. Point #1 "Attention to mental wellbeing: music, meditation, yoga"

<Head-explode emoji>
 
Point #1 "Attention to mental wellbeing: music, meditation, yoga"
Indeed. And this is being suggested to doctors as appropriate things to focus on with their ME/CFS patients. There's a serious disconnect there. Music, meditation and yoga sounds like a pleasant holiday.

For people only mildly affected, attention to well-being is much more likely to be negotiating a drastic reduction in work hours and securing other sources of income; convincing your partner and family that you haven't taken leave of your senses; working out how to still be a parent from your bed, becoming reliant on help to parent or coming to terms with not being a parent for now; and so much more. Even for me at the milder end of the scale, a yoga session had me in bed for most of the next couple of days. At the severe end of the scale, suggesting listening to music for mental well-being might be a cruel joke.

Yes, I know you've heard all of that before. But so should have Dr Vallings. There's just no excuse. She's earned her living from being a doctor to hundreds of patients and she's received funding for years from ANZMES to speak to patients and doctors, to inform them about managing ME/CFS.
 
I haven't watched any more of this than in my earlier post when I said this:
Dr Vallings misdescribed ME fatigue as tiredness, and PEM as feeling more exhausted than normal after activity,
Judging from what others are saying, it sounds to me like Dr Vallings has been conflating with ME/CFS things like burnout, idiopathic chronic fatigue, mild depression and general exhaustion from trying to do too much. Only if most of your patients don't actually have ME/CFS can you get away with advising adding things like yoga, and talking about PEM as increased fatigue and recommending mind games.

I don't think she's alone among so called ME experts on this. The BPS people's descriptions of ME/CFS often sound more like burnout to me, or just general overtiredness. They frequently describe PEM as PEF, and seem to really mean it, spelling it out as things like feeling more tired and achey the next day after exercise. No wonder they think it's something you can push through. Things like sleep hygiene, being allowed to cut back before gradually adding back activities etc may be fine in those cases, but are disastrous for most pwME.
 
ANZMES video/podcast series: Episode 5 Know ME - Lived and Professional Experience of ME and long COVID with Dr Asad Khan

00:00:00 Introduction
00:00:25 Disclaimer
00:00:47 Episode Introduction
00:01:09 Welcome
00:01:26 Tell us about yourself
00:13:40 Strategies for symptom management
00:16:52 Re-infection
00:22:02 Contributing to society
00:22:36 Micro-clots in long COVID
00:30:05 NICE guidelines
00:33:23 When did you know your were transitioning from long COVID to ME?
00:38:48 Prevention
00:40:38 long COVID Kids
00:47:32 Respiratory medicine for long COVID / disordered breathing
00:51:47 Dysautonomia / Vagus Nerve
00:55:06 Sleep hygiene tips for ME and long COVID
01:00:00 Severe ME advice for hospital setting
01:04:09 What do you want health professionals to know about these conditions?
 
Press Release – ANZMES Awards Academics 25K Grants to Boost ME Research
The 2023 Grant recipients are:

Principal investigator: Dr. Nicholas Bowden, Research Fellow, Department of Women’s and Children’s Health, University of Otago
...
The study will investigate the health, labour market, and social service use of people with ME, in NZ, through a population study.
...

Principal investigator: Dr. Lynette Hodges, Senior Lecturer School of Sport, Exercise and Nutrition, Massey University, Registered Clinical Exercise Physiologist
...
The study will investigate activity and energy management and the hallmark symptom post-exertional malaise (PEM), in people with ME through an observational study that assesses exertion during normal daily activities of living, such as doing dishes or laundry.
https://anzmes.org.nz/press-release-anzmes-awards-academics-25k-grants-to-boost-me-research/

These look like good projects if done well. I can't recall having come across Dr Bowden before. Dr Hodges has done repeat-CPET studies in the past.

Disappointingly there weren't any scholarship applications (4 available for $5,000 each for postgraduate research projects). I wonder what would be a good way to promote these next year?
 
Dr Bowden
His profile
I am a quantitative social scientist specialising in using linked whole-of-population data.

Currently I lead three separate projects. The first examines health and non-health outcomes for autistic children and young people and their parents to better understand the impacts of autism. The aim is to establish a nationwide early screening programme to facilitate more timely diagnoses, and an early support programme for autistic children and their whānau.

The second project explores associations between the physical environment that young people grow up in and subsequent mental health outcomes. The third project examines educational outcomes for young people with type 1 diabetes.

More generally, my research explores the intersection between health and non-health outcomes using population level data and I’m involved in a number of ongoing projects in this space.
https://www.otago.ac.nz/healthsciences/expertise/profile?id=3102
 
Press Release – ANZMES Awards Academics 25K Grants to Boost ME Research

https://anzmes.org.nz/press-release-anzmes-awards-academics-25k-grants-to-boost-me-
It will be interesting to see how this progresses each year. I have a concern that the maximum value of an award, NZ$25,000 (€13,834/ST£11,928/US$14,769) may be too small for a lot of biomedical research and a lot of it may go to non-biomedical, questionnaires, etc. research (these can have a value of course).

It’s unclear to me on a quick skim what will be measured in the Hodges’ research: will it be like the Physios for ME pilot study which used interesting biomedical measurements?
 
From last year but don't think this has been posted?
National Advisory on ME releases Best Practice Guidance with clinician and researcher support.

December 4, 2023 by anzmes01

The Aotearoa/New Zealand National Advisory on ME (ANZMES) has released best practice guidance for the diagnosis and management of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome. There is a call for national guidelines to be developed in consultation with ANZMES, to ensure only the latest evidence-based research and data is adopted and used by the health profession. New Zealand-based and international reputable ME/CFS and long COVID researchers and clinicians have signed their names in support of this newly released guidance. The document has been sent to the relevant health associations, medical bodies, and medical schools. The document can be seen below:
https://anzmes.org.nz/national-advi...idance-with-clinician-and-researcher-support/
 
press release for World ME Day
[...]Associate Professor Mona Jeffreys at Te Herenga Waka / Victoria University of Wellington says “The COVID-19 pandemic has resulted in large numbers of patients with long COVID, many of whom meet diagnostic criteria for ME. “ME is a debilitating condition, which cannot be treated, but with compassion and evidence-based care, the symptoms and their impact can be lessened.

“I call on all health professionals treating someone with ME to understand that this is a neurological, not psychological, illness. “Encouraging your patient to exercise is likely to worsen their fatigue and post-exertional malaise. “Suggesting treatments such as graded exercise therapy and cognitive behavioural therapy is outdated and is not evidence-based. “Investigating symptoms of POTS, that can respond to treatment, is important.

“The best thing you can do is to familiarise yourself with the Best Practice Guidelines, and treat patients accordingly.” The National Advisory on ME released easy to follow best practice in December 2023[...]
https://anzmes.org.nz/category/news/
 
From an email

ANZMES Special General Meeting & AGM on 2 November 2024

Special General Meeting part refers to
SGM notice said:
The motion put to the ANZMES membership:

It is proposed that ASSOCIATED NEW ZEALAND MYALGIC ENCEPHALOMYELITIS SOCIETY INC will transition to a charitable trust board.

Reason transition to a charitable trust board:

With the new Incorporated Societies Act 2022 requiring re-registration by April 2026, ANZMES has the unique opportunity to optimise our organisational structure. Currently, as an Incorporated Society, member involvement is required for major decisions, but participation is low, with less than 5% of those affected by ME/CFS in NZ engaged. We propose transitioning to a Charitable Trust model which allows for more agile governance, aligning with our strategic plan to better serve the growing ME/CFS and long COVID community.
SGM notice said:
Transition Plan: If approved, your role will shift from 'members' to 'supporters,' acknowledging your valuable contributions. The transition will unfold as follows, with a focus on open communication:

Voting: Members will vote on this transition via mail or online form and during the SGM/AGM in November.

Trust Deed Development: A pro bono lawyer will develop the Trust Deed to replace our Constitution.

Establishment: The Charitable Trust will be formally established, followed by the recruitment of the Trust Board, and the winding up of the Incorporated Society.
 
This seems worth talking about a bit. ANZMES could choose to be an Incorporated Society, in which case it would continue to be accountable to its members and officers would be elected. It has however chosen to be a Charitable Trust Board. The Trustees choose themselves, and later choose their replacements.

Arguably, the existing people in control of ANZMES have been pretty effective at keeping people with new and different ideas about how to run things out even with the structure where committee members were elected. But a Charitable Trust Board structure would formalise that.

I believe that ANZMES has significant assets following at least one bequest. The new structure means that the existing people in control of ANZMES will retain control of those assets, and there will be even less effective scrutiny of what they do with them.

Multiple Sclerosis New Zealand is an Incorporated Society, not a Charitable Trust Board.

While I think it's worth talking about a bit, I suspect that this change is a done deal. There are few paid up members of ANZMES, and most of them will be in favour of the proposal. I imagine that many of them expect to have a seat at the table of the new Charitable Trust Board.

I'm interested in what others think about this move. Is there scope to do anything about this, and should we?
 
I don't know what to think about this

Clearly the current structure (Incorporated Society) doesn't work very well, on at least two counts

1) there's low engagement from members and the wider ME community, ANZMES say so themselves

2) I also suspect they're hobbled by clumsy processes like everything having to go through committee and so on. That's just me reading between the lines but in the SGM notice they go into some detail about how the new structure would allow them to work more efficiently

So there's definitely cause to consider whether a different structure would be better

A Charitable Trust Board would likely address point 2 to some degree, how much I can't tell as I have no insider knowledge of how ANZMES currently functions

It's unclear to me how the change in structure would affect point 1, or if that even is a goal

What worries me is that it's a general vote on whether to change but unless I misunderstood something the trust deed would only be drawn up after the (yes-) vote so you don't know what you're voting for

Trusts can be easier to run than an inc soc because they can better control who's on the trust board. Having the right people with the right skills and who work well together makes all the difference as does the ability to keep bad faith disruptors out

But this can turn into a major weakness because it also tends to keep constructive disruptors out, the ones who can stop group think while still being team players. And if a trust board goes badly off track there's very little anyone can do about it unless they're grossly ignoring whatever's in the trust deed - currently unknown - and you're prepared to take the matter to court. In less egregious cases there's still a significant risk of trustees not implementing the 'nothing about us without us' ethos

What I'm really disappointed about is that they didn't take the opportunity to review the whole ecosystem of ME organisations in NZ and how ANZMES fits into this to best effect for all concerned. Maybe they did but if so they're not telling
 
While I think it's worth talking about a bit, I suspect that this change is a done deal. There are few paid up members of ANZMES, and most of them will be in favour of the proposal. I imagine that many of them expect to have a seat at the table of the new Charitable Trust Board.

I'm interested in what others think about this move. Is there scope to do anything about this, and should we?
I think a pause on this move to allow for more discussion would be appropriate and any vote should really include a vote on a draft trust deed

But, as you say, most likely a fait accompli. The committee said they'll vote for it and if the past is anything to go by few other people will bother to vote at all (including me unless I can unmuddle my thoughts before the postal vote closes)

I could be wrong but I doubt they'd be able or prepared to delay the vote now they've sent the paperwork out. Perhaps, if a member were to quickly request an additional motion be added, they could still send that out to the wider membership for a vote. I don't know. Failing that the only other way to force a pause would be to somehow campaign to get people to vote no. But then you'd still have to convince the existing/new committee (doesn't look like there's going to be any change) to prepare a draft for a trust deed and then engage in an open discussion on it

In the short term I'd be surprised if a change in organisational structure would change much for the rest of us. In some ways the ANZMES committee is largely operating like a trust board already since the annual elections are mostly a formality

In the long term much depends on how carefully the trust deed is written and on a bit of luck with respect to trustee appointments
 
Back
Top Bottom