Post-Exertional Malaise (PEM/PESE): Clinical Attributes, Part 2 of 7

This video series is intended to review the clinical presentation, scientific underpinnings, and treatment approach for patients with post-exertional malaise (PEM)/post-exertional symptom exacerbation (PESE).
For an abbreviated version highlighting the clinical pearls, please watch videos 1, 2, and 7. Videos 3-6 offer a deeper dive into the scientific and evidence-based pathophysiology of PEM/PESE.
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Post-exertional malaise (PEM)/post-exertional symptom exacerbation (PESE) is an altered physiological state and pathognomonic finding unique to ME/CFS that is now being recognized in those with post-acute sequelae of COVID-19 (PASC), also known as Long COVID.
It is critical that healthcare professionals recognize PEM/PESE and support the patient in avoiding a push-crash-cycle which can exacerbate disease processes and contribute to worsened long-term functional prognoses.
In video two of this seven-part series Brayden Yellman, MD, and Lucinda Bateman, MD, review a cross-sectional study conducted by Dr. Lily Chu, et.al, outlining triggers, time to onset, symptoms and duration of PEM episodes. The phenomenon of variable intensity and frequency triggers for PEM has often been likened to an analogy of debt. Dr. Yellman concludes the video detailing how individuals with PEM/PESE can easily slip into this "energy debt" or "crash cycle," which demands ample and adequate rest and physiologic supports in an effort to return to baseline.
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This video was made possible by the OMF-funded Medical Education Resource Center (MERC) at BHC, our generous donors, and viewers like you.
Video citations:
Chu L, Valencia IJ, Garvert DW, Montoya JG. Deconstructing post-exertional malaise in myalgic encephalomyelitis/ chronic fatigue syndrome: A patient-centered, cross-sectional survey. PLoS One. 2018;13(6):e0197811. Published 2018 Jun 1. doi:10.1371/journal.pone.0197811

[@christinayesenofski2622]

The way that my friend and I describe it (both with ME/CFS) is a double-whammy or single-whammy PEM episode. A double-whammy is when immediately following the activity you feel PEM, you're so sick, with exacerbation of symptoms, you may sleep it off, then the second wave of PEM hits 24-48 hours later, same feeling. It's two waves. A single-whammy is just that traditional PEM that hits 24-48 hours later.

[@kristastrong]

Love the debt analogy! Unfortunately I find myself spending $1.50 a day, every day, only to have it catch up to me later. When will I ever learn?! 😆

[@brentparks8524]

Yep, making so much sense. I keep trying to figure things out and then here come videos that explain what I am dealing with. I keep expecting some sort of normalcy with PEM and there isn't. I guess that's...... normal. 🤦‍♂️

[@MECFSDiagnosticBiomarkers]

I would say that after you pay back the 9.00 in PEM debt what happens is your 1$ a day envelope gets cut to 50 cents and never goes back again.

[@katrinmurnain9197]

So very true i have had M.E/CFS for 25 years now , and experience all of these ... i have been bedbound for over 11 years now , thank you for posting this as we just do not get validation for the hell we are living through it feel's like we are just ghost's... from Kat in Australia ... p.s yes my pic is now 15 years old i keep it up there as a memory of who i once was .

[@barbh1]

Watching this series I'm sitting here nodding my head for most of the symptoms. Thank goodness it's finally recognized by science. I do not suffer from the orthostatic symptoms, but definitely the post exertional malaise.

[@Ninjamom4]

Spot on !

[@sandrinestamm3163]

Merci pour les commentaires en Français 😍

[@KidCity1985]

Me, rolling along

[@jeffreycliff922]

There is no good reason why this video is youtube standard license instead of creative commons. Go switch the license to creative commons in the advanced video settings menu