Four types of Fatigue - May 12th CFS/ME Awareness

Four types of Fatigue
May 12th CFS/ME Awareness

With a name like Chronic Fatigue Syndrome you would think that there would be a deep understanding of the different biological underpinnings leading to fatigue in the illness. However, there is very little discussion of the different types of fatigue, what causes them or how they can be approached or remedied. In fact many of the fatigue terms that are used to describe ME/CFS are borrowed language from other illnesses. This presents problems when patients are talking to doctors about what is going on with the fatigue states they are experiencing. First patients don’t have a clear picture of what’s going on with their bodies so it’s difficult to explain to the doctors and doctors don’t have a clear picture of what’s going on so they don’t understand what patients are trying to say. This has perpetuated mythology and poor research into the illness.

Here I’ve outlined the four main types of fatigue that most of us deal with. There are other types of fatigue caused by other conditions that feed into the illness as well. Feel free to add comments, repost or start a dialogue about these fatigue states. By expanding and defining our illness we can help change the way we talk to each other and to professionals and so shape the future of the illness.


What it is:
PEM or Post-exertional malaise also known as Post-exercise malaise is a general overall body and brain fatigue that happens after you do something, such as taking a shower, eating, washing dishes or other daily activity. This term has been borrowed from other illnesses such as cardiac patients, cancer patients and people who are hard core physical trainers. The term is used to talk about fatigue after exercise that may be related to dehydration or a lack of electrolytes due to poor metabolism as well as fatigue from deconditioning and surgeries.

In general PEM is a type of energy deficit fatigue. The body is called on to continue performing but is unable to produce the necessary energy to do so. All ME patients understand this type of fatigue as the fatigue that requires rest after activity and we deal with it every day all day.

Who gets it:
Google PEM and you will find it applied to many chronic conditions. In a normal healthy person PEM might happen after heavy exercise but usually only as the result of dehydration or depletion of electrolytes. PEM is also seen in recovering cardiac patients, cancer patients, severely obese and deconditioned patients those who are recovering from intense surgery’s or long term chronic illness. It’s a term that is understood in the medical community to mean different things based on the individual patient and receive different advice based on the patient’s situation.

What you can tell your doctor:
How to talk about this type of daily ongoing fatigue with your doctor is a real challenge. The most important thing is to discuss one type of fatigue at a time if you can. Most general practitioners are not set up to deal with separating out the differences and the medical profession is not ready to deal with multi-systemic illness at all.
It would help if ME patients had an understanding of what exactly is stopping the body from producing energy in a natural normal flow. The possibilities range from insulin problems to vitamin deficiency to Meytholation block to cortisol insufficiency. Making sure your doctor checks each area from thyroid problems to full vitamin panels is important. Let your doctor know that you require rest after each activity and keep a diary of activities and rest periods. This shows that you are trying to live your life; it’s your body that’s not cooperating.

What can be done about it:
If you get lucky your doctor will find a thing or two that can be adjusted. Low vitamin D levels or problems with thyroid hormones. While this won’t fix the overall problem it can help at least a small amount and every little bit helps.

For the most part PEM is handled with “pacing”. Separating daily activities into sedentary (listening to music), light (brushing your teeth), moderate (driving or shopping) and heavy (lawn mowing and biking).

Next figure out how much of each of these you can do on a daily basis’s without experiencing PENE (which is covered next). Many of the Extreme cases of ME never get past resting. Sever cases may be able to handle sedentary to light activities with long rest times in between. Moderate cases may be able to deal with sedentary and light activities with a moderate item incorporated once per day or every other day. Mild cases can usually handle day to day living as long as they rest aggressively in between every activity and avoid heavy activities.

Finally, aggressively limiting activities and pacing through out the day can help the body conserve enough energy to help in the healing process. Over time this can add up to higher levels of functioning. It’s impossible to do this perfectly, life will hand you difficult situations. What happens when you work outside of your “energy envelope” is discussed next.


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