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I think perhaps any confusion or concern arises because as a diagnostic symptom (something you have to have in order to get a diagnosis), PEM relates to any exertion response.
What I think Levi and certainly me were wondering is if this symptom can/should be researched as a collective entity or sub-divided perhaps into looking at 'mental' and 'physical' responses/abnormalities.
Does that make more/less/no sense?
I have read many times that you can have PEM immediately after activity whether it is mental or physical. For some reason mental exertion is what wipes me out...as with emotional exertion. If I have a bad morning emotionally I am done for the day.
I am not saying I can go out and run marathons but I don't seem to have the same degree of physical exertion problems that others have..I know some people with CFS are able to work full time where that would be impossible for me. My brain would not be able to handle all that stimulus. I have been sick for 8 years and the mental exertion has always been a huge problem for me. Some days it will take me 2 days to recover from a 5 hour shift at work...I believe that qualifies as PEM...
It definitely keeps me from working even part time. I am able to work 3 days a week tops..and they can't be in a row so I will have time to recover. Any situation where I have to interact is very exhausting for me. When I become mentally drained it does turn to physical exhaustion like my body has been drained of life. I am not even close to having a normal life because of this.
I find that I get both mental and physical PEM from both mental and physical stressors, but they tend to be more tied to the type of stressor. So PEM from mental exertion will have a heavier focus on the cognitive symptoms and feeling wired, probably with eyestrain. It also seems to hit me immediately after the exertion, once I've reached a tipping point, whereas after physical exertion, the main jolt often doesn't hit me until the next day or even the day after that.
Put another way, they go like this:
Mental exertion - can probably keep going for longer than with physical exertion, then will hit a tipping point and suddenly feel wired, brain foggy, probably eyestrain, generally fatigued. Mostly gone by next day, though may feel generally wiped out, and perhaps emotional if it was something emotionally stressful as well.
Physical exertion - shorter activity time, may feel bouncy from emergency energy, will gradually wind down if I stayed within my limits or crash physically if I didn't, main crash will be a day or so later, fatigue and achy muscles in particular, though brain a bit fried as well. Same thing about emotional stress applies here too, I'm more likely to burst into tears the day after overdoing it.
That doesn't sound like PEM which is POST-exertional malaise.
It happens the next day, when you've not been ill for too long - but the longer you've been ill, the longer it takes to appear - and the longer it lasts.
It's not the pains you get while doing things - and if you don't have any trouble with physical activity, it doesn't sound like ME. I haven't a clue what else it might be, though.
PEM is not "unwellness" - it's an exacerbation of all symptoms, a serious downturn in functional capacity.