I just "graduated" from a GET/CBT therapy at the Mayo Clinic. Ask me anything!

[erin]

This is gonna sound silly, but how were you able to get somewhere at 8 am? For 3 weeks? Is this possible with me? I consider my self moderate nowadays. I could not be on the spot at 8am. even when I was mild.

 

[barbc56]

Excuse my foggy brain but it seems some parts of this program are contradictory. I stated some of these in a previous post.

How can I find out about this program. Is it on the Mayo site? Do you have something such as a pamphlet?

I am really interested in their goals as well as their treatment plans and how they advertise this service. I will also look but it will have to be later.

Did the program have an objective way of showing patients' progress.

Excuse me if these have been asked and answered.

@Quemist would you recommend this program to others. Parts of it?

Thanks.

 

[PennyIA]

Did the program have an objective way of showing patients' progress.

I don't know if it changed since 2006, but at that time they did only subjective measurements.

 

[Quemist]

I'm glad @Quemist you are doing well now, please don't push yourself too hard, getting to way you are now is a huge improvement. My question would be, if you progressed Well from not standing to quite long aerobic exercise yourself in 2 months do you think you would have continued to improve if you hadn't gone into a clinic and do you feel they got you to a higher level than you'd get yourself in a few weeks?

That's a really good question. I actually think that the physical therapist I was seeing was just as efficient. I also wish I would have stuck with that rather than moving forward with the mayo clinic.

 

[Quemist]

Thanks for discussing this in a balanced way @Quemist

This seems bizarre as a combination. How could a treatment programme be appropriate for all these patients?
.

This really bothered me, too. I thought it was strange that we were all lumped together... making me think it was more brainwashing.

Thanks for discussing this in a balanced way @Quemist

Obviously we can't go to the doctor every day we feel ill, but it feels like dangerous advice not to go back about recurring symptoms. Sometimes you have to mention a symptom several times before it gets taken seriously and doctors do forget details. For example I had symptoms that my doctor said if consistent he'd be thinking cancer. In my case it wasn't consistent but imagine if I'd not gone back precisely because it was consistent!

The advice to ignore symptoms goes against what I learnt in Social Cognition lectures. Being told *not* to dwell on something makes you dwell on it much more. Making patients feel they shouldn't cry/feel down about being ill is especially worrying given the suicide incidence in ME. It seems healthier to foster an environment where you accept living with chronic illness is damn hard and it is ok to face this and talk about difficult feelings.


I used to be able to block out symptoms. I don't think this was a good plan though. Also it isn't necessarily a choice. I'm too ill now for this to be an option. In between I had a bedbound relapse. I think over doing it was involved, but so was a virus, so hard to pinpoint.

Yeah, it really bothered me that they said no doctors. Also, Mayo didn't do an infectious disease workup, which I thought was poor judgement. Also, they didnt' do any brain scans, which i thought was very strange. I want to get these things done but I'm not even sure if it'll help me.

I also was told to not see psychologists, accupuncturists, chiropractors, physical therapists, etc. I thought this also was strange. They did tell me when I entered the program to come down off my depression and anxiety medication. I was exhibiting some pretty severe depressive symtpoms and at dismissal they said "to be clear, we didnt' tell you to to stop taking this medication." I think that's partly true; my GP at home told me to stop taking the meds, a psychiatrist told me to keep taking the meds, and when I arrived at Mayo they said "sometimes people take these medications and think they help but its only psychological and the medicine isn't doing anything." Sucks to be them, my metrics went from moderate to severe on symptoms, fatigue, depression, etc in the three weeks so they'll have to have that data point in their study.

 

[Quemist]

I don't know if it changed since 2006, but at that time they did only subjective measurements.

This is still true.

 

[Quemist]

I have one other question I had forgotten earlier and a comment.
With ME many people have the experience of classic ME symptoms and also sadly have symptoms of other AI or other illnesses eg celiac, IBD, Sjogren's, Mast Cell Activation, Rheumatoid arthritis, MS, Psoriasis,
did you experience any of these concominent to your ME?

I actually was admitted for presumed MS/POTS. Tingling/numbness is one of my biggest symptoms.

As a scientist I'm surprised that you responded that you didn't think the criteria mattered for diagnosis.
For ME patients it's pretty much the International consensus criteria or the Canadian consensus criteria that accurately portray ME. The Holmes and Fukuda definitions (of 1990's US) capture less classical ME and more fatigue of unknown origin.

I was trying my best to be a good patient. I was with my family and every time I asked doctors a question about treatment or tried to suggest something, it started a fight about how I'm too pushy or agressive. So, I started to try to not research my symptoms too much after that.

 

[Quemist]

@Quemist Am on my phone and it's not letting me quote but many pages back you stated that the treatment plan was the same regardless if the patient was in the program for a limb amputation or for POTS.

This is very illogical to me at best and very dangerous/harmful at worst. Can you explain Mayo's philosophy on why different diagnoses would not have individualized treatment plans?

They pushed central sensitization as a main theory really, really hard. They said that most diseases will inherently cause some kind of abnormal response in the brain and therefore lead to more symptoms.

 

[Quemist]

I can help with answering some of the premise ... since I'm betting at this point @Quemist might fell a bit attacked by now. Let's face it, many of us have agreed to therapies we haven't necessarily understood nor wanted simply to try it. I don't know about you, but there are lots and lots and lots of things I've tried just because if it could help even slightly, I would take any improvement I can find.
.

Not feeling attacked Just exhausted! I knew this was going to be a controversial thread. Just wanted to at least share my story and provide some answers for anyone who might be referred to the PRC clinic.

 

[Quemist]

They also had an arm towards reducing pain management medications for chronic pain. (from the study showing it isn't as effective). When I went, they only asked people to stop taking pain killers. (it sounds like they might be expanding it).

Benzos are now just equally as bad in their eyes.

CBT was tied a bit towards you know we've done everything medically possible, now you just need to get on with living life and having something to look forward to, because now you are as healthy as you will ever get.

GET was tied towards increasing your activity levels and while it was all within the vicinity of don't over do things, take things slower than you think you can... it then also says... do more the next day. (smirk)

ALL THAT SAID? I would NEVER, EVER, EVER recommend someone go to Mayo for ME/CFS.

NOT EVER.

I think the general consensus in this group is founded in reality. I think the treatment at Mayo is all about just 'putting' everyone they can't 'fix' into a box and handing them tools so they don't keep pestering us is at play.

When I went, it was part of a study and I was told I would be contacted six times for follow up to see how well I keep improving. I crashed before the first follow up and told them so. I haven't been contacted since.

I'm pretty sure that (like PACE trial seemed to handle some of the patients) that the result is that I will just be considered as someone who 'didn't complete' INSTEAD of showing up as an Adverse Event... because of course, they still believe a little bit of moderate activity cannot do any harm - so the fact that I'm not in the study is unrelated to the fact that the continued attempt to keep increasing my activity level led to a crash.

SO, yes, everything everyone is pointing out as a flaw to their service? Yep, Yep.

That's what bothered me the MOST. Every day I looked around and thought "seriously, this is where they put people that they're tired of dealing with." It was summer camp for borderline hypochondriacs.

I also would not recommend Mayo for CFS/ME. My family is like "oh, well if Mayo can't figure out what's wrong with you...." and kind of leaves it at that. The program did basically give me permission to exclude them from my life. So now I get to say "well, Mayo said it was unhealthy for me to have a relationship with people who are dubious of my symtoms and diagnoses"
I'm looking into Vanderbilt next.

 

[Quemist]

This is gonna sound silly, but how were you able to get somewhere at 8 am? For 3 weeks? Is this possible with me? I consider my self moderate nowadays. I could not be on the spot at 8am. even when I was mild.

Oh, I was late every single day. Some days rolled in around 9am. Surprisingly, they didnt' ask me to leave.
That was another thing that bothered me- some people that they decided weren't going to finish well were asked to leave. I thought that was one way of cherry picking their data.

 

[Quemist]

can you explain more about the "metrix" showing the therapy wasn't working for you, yet is seems like it did work for you. I am very glad you are feeling better

There was a questionnaire that they had me take. I came in in a good mood and low pain. When they had met take it three weeks later, my mood and symptoms were wrecked. I also didn't do any better on my physical fitness tests. Occupational therapy was not improved whatsoever.
Again, I cant help but think that theyre somehow cherry picking their data. I wouldn't be surprised if they find some way to exclude my data from the study.

 

[Undisclosed]

I am hugely bothered and annoyed by the Mayo Clinic if they are offering this to people with ME/CFS. Sorry for the long post.

People who attend this Mayo group are there for 'pain rehabilitation'

'Rehabilitation' = the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.

Key word is 'after'

The following is from the Mayo Clinic -- re: the program mentioned in this thread -- https://www.mayoclinic.org/documents/mc1459-02-pdf/doc-20078829

With the support of staff and peers in the program, participants regain strength and stamina, and shift toward a focus on what they can do to regain control over their life again.

People come to Mayo Clinic's Pain Rehabilitation Center with many different types of chronic pain and conditions. Examples include:

• Chronic back pain
• Fibromyalgia
• Nonepileptic spells
• Chronic fatigue
• Headaches, including migraines
• Generalized pain or pain in multiple areas
• Abdominal pain
• Postural orthostatic tachycardia syndrome (POTS)
• Upper or lower body pain, such as pain in the chest wall, jaw, face, pelvis or joints
• Pain after removal of breast tissue from a breast (mastectomy)
• Nerve (neuropathic) pain
• Complex regional pain syndrome

I don't see ME/CFS mentioned here at all or anywhere in the 16 page pdf. What I do see are the words "Chronic Fatigue" which is NOT ME/CFS.

The rehabilitation program is focused on functional restoration. A cognitivebehavioral
model serves as the basis for treatment and incorporates physical
reconditioning, biofeedback and relaxation training, stress management,
chemical health education, activity moderation, and cognitive restructuring to
decrease pain catastrophizing and pain anxiety. Throughout the three-week
program, various types of treatment and therapies are presented to help each
patient achieve individualized goals in returning to an active and fulfilling life.

How does one functionally restore a person with ME. The same way as you functionally restore somebody with AIDS, Cancer, diabetes?

For illness, recovering from it or still ill, coping strategies are a good thing as long as they aren't used as a direct treatment of the illness in question.

I am saying rude words in my head right now --

Pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to ruminate on it more (e.g., "I kept thinking 'this is terrible'"), and/or to feel more helpless about the experience ("I thought it was never going to get better").

I have had mild to severe pain every day since 1997 -- when I say my pain is mild -- it's mild. When I say it's severe -- it's severe. It's not an exaggeration. It's my experience. I own it. I don't feel helpless. What a load of shite pain catastrophizing is. To even suggest to a person in pain they are exaggerating is abusive.

Goals
The primary goal of the Pain Rehabilitation Center is to restore functioning and improve
quality of life for persons suffering with chronic pain. The program emphasizes the
discontinuation of opioids for the treatment of chronic benign pain and the return to a
fulfilling lifestyle.
Other important goals include:
• Return to regular daily activities
• Increase physical strength, stamina and flexibility
• Reduce/eliminate use of pain medications
• Minimize pain behaviors
• Learn stress management techniques
• Return to gainful employment (if applicable)
• Resume leisure and recreational activities
• Improve interpersonal relationships
• Reduce reliance on health-care professionals, with improved ability to
self-manage chronic pain

Pain is only one symptom of ME/CFS.

So if you are a patient with ME/CFS, they are offering to rehabilitate you.

Again,

'Rehabilitation' = the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.

Would a person with cancer, AIDS, leukemia, congestive heart failure etc be offered a program to restore them to health or a normal life via training and psychological therapies.

Naughty words again. Perhaps some CBT for acute anger issues is in order.

When I read the sixteen page PDF that I linked to at the top of the forum -- most of it is exactly what Quemist is saying.

This was a pain rehabilitation program.

See my comments above. Why is a patient diagnosed with ME/CFS being sent to such a program?

I think that deconditioning was PART of it. I am in NO way in recovery, just able to cope a bit better.

There are many books, programs etc that aim to help people 'cope' better with an illness.

I also think that pacing was their number one sell. I think that trying some pacing was very good for my recovery and thinking of things as steps instead of all-or-nothing.

You said that you are "NO way" in recovery (above). But here you are saying trying some pacing was 'very good for your recovery'.

CBT was very helpful. I'm having a lot of grief about losing my career as a scientist and what I might have done to cause this. I feel a lot more solid. They also did a good job of talking about "pain behaviors" and making sure that we are trying to refocus our attention to other things and distract ourselves. I also am having a lot of issues with family support and school/work. This helped with my perception of these three things significantly.

See this is what, in part, CBT is supposed to be about -- helping people who need help coping with health related losses -- job loss, loss of social life etc. It's a slippery slope to start talking to people about 'pain behaviours'. Being in some of level of pain for 20 years, pain has become my norm. I have learned to ignore it when I can, distract myself etc -- All by myself. You can only do that up to a point though. But seriously, who gets to define that your coping strategies or pain behaviours are wrong or naughty. What are good 'pain behaviours'?

Oh, we were most definitely told to push through our symptoms.

Like to see them say that to a cancer patient.

'Cancer Patient' -- I am having severe pain. The chemotherapy is making me throw up, I have severe diarrhea'

'CBT Therapist' -- Just push through your symptoms

'ME patient' -- 'I have severe POTS, severe MCS, muscle weakness, light sensitivity, noise sensitivity, fatigue that is unrelenting.

'CBT Therapist' -- Just push through your symptoms

Even for a person with lower back pain as their only symptom --- being told to push through the symptom is a bit much. Pain is the body warning you that something is wrong. If it is caused by inflammation -- why push through it. How about an anti-inflammatory.

Absolutely no lying down allowed. People who came in with heating pads were "tapered" off of them, everyone was expected to sit. One person hated sitting and had to stand for periods of time and they put them on a "taper" so that they gradually got used to sitting more and more, despite pain or discomfort.

I am sorry but what is the thinking behind this. So you take somebody who has the coping strategy of doing one thing, force them to do something that will cause them pain and discomfort. Why can't a person stand instead of sitting? Why can't a person use a heating pad to help decrease pain.

The tingling and numbness has improved but it does creep back occasionally. They had us do "distraction" techniques, which has helped. The brain fog is the most severe- memory is really failing and word-finding is terrible.

How is that CBT had an effect of decreasing a neurological problem which tingling and numbness is symptom of. Distracting yourself from numbness and tingling does not have any effect on the physiological cause of numbness and tingling itself. I really don't know how a person can cope with distracting themselves from pain, numbness, tingling when they are suffering from severe brain fog, let alone sit and learn how to do it. When I am having severe brain fog, I can't even take in what people around me are saying, I don't remember it five seconds later. I have okay days and I have crappy days when it comes to brain fog. Not too bad today -- just problems concentrating and blocking out any noise.

Try do your best to sit but don't resort to just watching TV. Don't lay in bed all day. Talking about your symptoms is very taboo (actually, being on this message board is technically a pain behavor). Don't go back to the doctor if the symptoms are the same as other bad days. Don't drink too much coffee, don't rub areas that are in pain, do your best to not cry about it. Try not to grimace or hunch over, do your best to exercise good posture.

Sometimes 'sitting around' watching TV isn't something a person with ME can do.

Talking about symptoms is taboo -- Why? Seems like thinking about your symptoms is taboo too. Telling people to ignore pain and not go to the doctor. Everything about this program is actually not treating people as if their symptoms are real or important. It's one thing to help people cope with their losses caused by chronic pain, it's another to tell them to basically ignore it, don't get medical help, don't cry -- don't be a human and don't react your body. Actually, it seems like they are telling a bunch of children to behave themselves.

I know that CBT/GET isn't welcome-- because most approaches reported don't work. They didnt' tell me "think" my way out of it- they gave us some coping strategies. They also REALLY emphasized that we were never going to return to the person we were before we got sick-- but they staunchly said that with good mindset we can attempt to have a good prognosis towards having some semblance of life outside of of our illness. GET for us was extremely below most thresholds. I was seeing a physical therapist before the program that was really wearing me out. The therapy at Mayo was so far below that exertion limit to the point that it was very benign. I certainly am not recovered but I am better and I'm not constantly freaking out about how this ruined my life

CBT is a 'psychological' therapy.

One of the basic things about CBT is that it is your faulty or irrational thoughts that are responsible for maladaptive behaviour and mental health problems. Since when is ME/CFS a maladaptive behaviour or mental health problem. Grieving over loss of job, friends, etc is not a maladaptive behaviour. CBT ignores or dismisses other factors that might be at play -- like genetics. CBT labels 'negative' thoughts as pathological/dysfunctional which isn't always true. Negative thoughts can be very productive and protective. CBT has been shown to be effective for anxiety and depression. It is not a 'treatment' for ME/CFS. Sure it helps with thinking about how to cope with things but you don't need a formal program for that.

The goal was for us to feel more comfortable in our bodies despite living with chronic illness. Most people in the therapy were super type-A (doctors, lawyers, judges, scientists, etc) and being sick has compeltely wrecked them. Their goal was to improve function, regardless of how we felt.

Where are the rest of the chronically ill people who happen to be average joes eeking out a living? Does chronic illness only wreck type A personalities.

It is clear that you are feeling much better psychologically. I am not sure why you put this thread in the 'General Treatment' forum because it's not any kind of treatment for ME/CFS itself. It's a psychological treatment designed to help people cope. I am not sure why all the posts about the program are a repetition of what is in the 16 page pdf. It's eerie how similar they are.

 

[Mohawk1995]

This really bothered me, too. I thought it was strange that we were all lumped together... making me think it was more brainwashing.

This all sounds like Protocol driven medicine with very limited individualized plans of care. In other words it is driven from Population health models that look at averages of averages. This is NOT Evidence Based Medicine if practiced in this manner. The very definition of EBM is that the research is applied to each patient individually through the filter of the provider's experience.

The problem with applying "Central Sensitization" in a protocol model is that everyone has varying degrees and types of sensitivity of their nerve tissue and nervous system. Many have equated Central Sensitization exclusively with CBT/GET, but in my opinion that is a huge error. In theory, it is simply that the Central Nervous system becomes more sensitive to the stimuli it is receiving and more likely to become reactive to it. In other words: Same Input/Stimuli + Greater Sensitivity = Stronger Autonomic Outflow.

I also think it is dangerous to place all types of "non-responders" in the same program. Although there are commonalities among them, ME/CFS, Fibromyalgia, Chronic Pain, Atypical Migraine and POTS all have different presentations and responses and even variability individually among the same diagnostic groups. Not to mention, placing those who may have more behavioral issues in with these groups really creates issues and confusion.

Do I believe there is a place for CBT and GET with ME/CFS patients....yes. BUT if introduced it needs to be for a specifically identified individual purpose at a dosage that is tolerated and effective in helping that patient gain greater function. Blindly applied or as a Protocol with no variance based on the individual patient and the skill/experience of the provider is very bad medicine. Obviously I have strong opinions on this matter!

Glad you are functioning at a higher level and that this treatment has helped you cope better for sure! As a disclaimer, I am a Physical Therapist and yes I believe an astute PT could have helped you improve without all the baggage.

 

[barbc56]

I don't know if it changed since 2006, but at that time they did only subjective measurements.

Thanks Penny, I misread your post and thought you were in another program.

@Kina
Thank you for this information. It's exactly what I was looking for but didn't have the wherewithal to find it.

 

[Undisclosed]

They pushed central sensitization as a main theory really, really hard. They said that most diseases will inherently cause some kind of abnormal response in the brain and therefore lead to more symptoms.

Central sensitization is not supported by research.

Not feeling attacked Just exhausted! I knew this was going to be a controversial thread. Just wanted to at least share my story and provide some answers for anyone who might be referred to the PRC clinic.

That's what bothered me the MOST. Every day I looked around and thought "seriously, this is where they put people that they're tired of dealing with." It was summer camp for borderline hypochondriacs.

For the first pages of this thread, you went on and on about how the program helped you with coping, how your symptoms were decreased, now you are describing it as a 'summer camp for borderline hypochondriacs'. So why were you referred there?

I also would not recommend Mayo for CFS/ME. My family is like "oh, well if Mayo can't figure out what's wrong with you...." and kind of leaves it at that. The program did basically give me permission to exclude them from my life. So now I get to say "well, Mayo said it was unhealthy for me to have a relationship with people who are dubious of my symtoms and diagnoses"
I'm looking into Vanderbilt next.

Again, you seemed to be saying in the thread that you were happy with them, that they helped you, that your symptoms were being relieved. I don't get your abrupt change.

Oh, I was late every single day. Some days rolled in around 9am. Surprisingly, they didnt' ask me to leave.
That was another thing that bothered me- some people that they decided weren't going to finish well were asked to leave. I thought that was one way of cherry picking their data.

Is this a study or a program. The way I understand it, it is a program to help people to be rehabilitated from chronic pain. What data are they collecting?

There was a questionnaire that they had me take. I came in in a good mood and low pain. When they had met take it three weeks later, my mood and symptoms were wrecked. I also didn't do any better on my physical fitness tests. Occupational therapy was not improved whatsoever.
Again, I cant help but think that theyre somehow cherry picking their data. I wouldn't be surprised if they find some way to exclude my data from the study.

You described them as helping you and aiding in your recovery. I am sorry but I am totally confused. You said your physical symptoms have improved. You seemed pleased. Nothing about this is making sense. Could you clarify your earlier comments compared to later comments. They are not jiving with me.

 

[Snowdrop]

@Quemist

If it's true that you have not really done much research than perhaps you have not seen the recent good research coming out of Stanford. See: http://www.nature.com/news/biologic...onic-fatigue-syndrome-begin-to-emerge-1.21721

http://www.pnas.org/content/113/37/E5472.full

Not from Stanford but also this: http://simmaronresearch.com/2017/03...chronic-fatigue-simmaron-science-contributes/

From a series of blogs hosted by Virology on why the PACE trial data is deeply flawed: http://www.virology.ws/mecfs/

Edit to add:http://stanmed.stanford.edu/2016spring/the-puzzle-solver.html

PS: Hypochondriac could just be another word for someone with an illness Dr's have yet to define/describe or know how to treat. It could be said by many Dr's about people with ME and be very insulting.

 

[Diwi9]

I believe that @Quemist has been incredibly gracious to share her experience and be available for questions. She's just completed a long course that required her to put forth effort and commitment. Will her feelings about the program change in time? My hunch is most likely. She has been under pressure from her family, that was a big reason why she committed to this program. A person wants to feel like their effort and commitment have not been completely futile. And, based on what she has stated, there were some helpful therapeutic coping skills that she learned. Furthermore, whether or not we like the messages she was getting at Mayo, people were giving her attention...something people with ME/CFS do not normally experience. All of this has an impact on one's perspective. Based on everything I've read, Quemist is a very sincere, courageous, and intelligent woman who has been suffering and is looking for answers, just like the rest of us. I would love an update in a few months to see where her perspective is then.

My big skepticism here is that this Mayo program/trial sounds like it is being funded by insurance companies...maybe even the Social Security Administration/Worker's Comp. All they need is a treatment that can be called "evidenced-based" to dump people into so they don't have to provide real benefits. I'm very familiar with evidenced-based therapies and how they are studied/validated. It's crap, as data can be manipulated (think PACE) to get the results you want. This is especially so when one develops their own outcome measures and they are not done independently. I'm particularly shocked by how untreatable conditions have been lumped together in the program.

 

[Alvin2]

@Quemist I am delighted for you that you consider this PACE-like therapy to have been a success. Nevertheless, the thread leaves me feeling quite unsettled over the prospect that severe patients, especially those who "check" virtually every symptom on the lists in the most-stringent criteria (CCC and ICC), may be forced into what sounds to me like torture. I'm left wondering how many have been harmed.

I agree, it took many years before i got the ME/CFS diagnosis, and my only goal was to function, and i had no idea that pushing myself was bad. I have permanently made myself worse, and its not because of self defeating beliefs or any of that nonsense or deconditioning, i had no idea what ME/CFS was and was not in such a mindset yet i harmed myself greatly by doing what this is suggesting.
I am at the point today that if i get much worse i will not be able to care for myself, and unless the mayo clinic can pay for lifetime care i am not stupid enough to try and kill myself as painfully as possible.

I've noticed something like this too.

Many people on PR (including myself) have mentioned that in that short window after we've exerted ourselves too much but before PEM sets in, we can feel hyper and energised. Perhaps by exercising and then pushing through the PEM and exercising again, they can delay the PEM by getting into this hyper state again and again?

When I was undertaking graded exercise, I also found that the exercise itself temporarily improved fatigue and pain. At the time, I put this down to endorphins released by the exercise. This stopped working after a few years.

I've also found that an episode of intense stress can temporarily pull me out of PEM because the adrenalin (or cortisol?) masks the PEM symptoms. This phenomenon is effective enough that I can attend a social function when I've been in a severe crash a few minutes before. Of course, I end up paying for it even more once the adrenalin wears off.

i've noticed this too, sometimes i am so far gone i can function. But i pay for it with a vengeance later.

 

[Mel9]

Kina's post has cleared my head about this thread. It has been really disconcerting to hear Quemist changing her mind from 'Mayo is good' to 'Mayo is bad' in this thread while, In another thread starting with 'Mayo is bad' .

I feel so sorry for you Quemist: it sounds as though you have had a traumatic experience andyou are trying to make some sense of it through typical brain fog. I hope you can recover enough, one day, to go back to the job you love.

However, from experience, you will probably find that if you do get back work, your day will need to be broken up into short periods with good (horizontal ) rests in between.