Thread by @fearnley_k

1/ I don’t know which medic needs to hear this, but post-exertional malaise (#PEM) is NOT fatigue.

Short explanatory 🧵

#MedEd #MedTwitter #TeamGP #ME #LongCovid

2/ Patients with #MyalgicEncephalomyelitis and approximately 50% of patients with #LongCovid experience Post-Exertional Malaise (#PEM), also called, Post-Exertional Symptom Exacerbation (#PESE)

3 #PEM or #PESE is a worsening of symptoms after any form - physical, cognitive, emotional - exertion.

#PEM or #PESE is NOT fatigue.

4/ To give example of #PEM, after ‘exerting’ myself to take a shower, I experience worsening ANS dysfunction: I have an elevated resting HR (100bpm), drop my oxygen saturations & experience worsened tinnitus. My body feels poisoned and it starts to SHUT DOWN

5/ Patients with #LongCovid and #ME have to limit how much they ‘exert’ themselves.. but it isn’t fatigue which stops them, it’s the blowback

You can push through fatigue. You cannot push through #PEM.

6/ To call #PESE (aka worsened ANS dysfunction on exertion etc) ‘fatigue’ is misleading,

Fatigue doesn’t cause your nervous system to go haywire or your body to shut down.

7/ When patients with #ME or #LongCovid have to limit their activity, please check the reason - More likely than not, ‘fatigue’ is not the cause.

They are forced to limit themselves in every capacity because when they exert they experience #PEM #PESE.

8/ Terminology matters.

Words like ‘fatigue’ downplay symptom severity, are deliberately misleading, and are not medically accurate.