The 12th Invest in ME Research Conference June, 2017, Part 2
MEMum presents the second article in a series of three about the recent 12th Invest In ME International Conference (IIMEC12) in London.
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Is PEM a crash? Is a crash PEM? Semantically distinct? Or distinct phenomena?

Discussion in 'Post-Exertional Malaise, Fatigue, and Crashes' started by leokitten, Aug 2, 2018.

  1. leokitten

    leokitten Senior Member

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    My question really is about the semantics of 'crash' and 'PEM'. I guess I used to use both these words somewhat interchangeably and wanted to ask PRers what they think.

    In my experience with ME, PEM, or a worsening of symptoms, happens after mental or physical overexertion. When I have too many periods overexertion over a short enough length of time without sufficient rest (or a continually long overexertion) then the PEM continues to build until I have a crash. Rarely too I've had crashes that seem to have come out of nowhere and didn't appear to be preceded by PEM.

    So these words are distinct but related phenomena to me. What do you think? :nerd:
     
    Last edited: Aug 2, 2018
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  2. Wishful

    Wishful Senior Member

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    One problem is that there isn't one clear, concise definition of PEM. I get PEM 24 hrs after activity that strains muscles unusually. I also get PEM-like symptoms within a few hours of certain cognitive activities, such as driving or socializing, and the symptoms and magnitudes are somewhat different from the ones from physically-induced PEM. So, two different types of PEM, or is one of them not actually PEM?

    For me, I prefer to refer to my consistent physically-induced symptoms as PEM, and the cognitive ones as PEM-like. I'd use the word 'crash' for a serious and lengthy increase in symptoms that doesn't fit into the other categories.
     
  3. lnester7

    lnester7 Seven

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    Great question here is my definition
    PEM= exarcebation of symptoms ( could be energy affected also but not necessarily) so muscle pain, sleep worst, fluish... temporary, body saying stop.

    Crash= I hit a wall and my energy base is lower than my normal. Even if symptoms Recide, the energy level has not gone to my normal base.
     
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  4. ljimbo423

    ljimbo423 Senior Member

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    I agree. I have PEM that always hits me 2 days after too much physical exertion and always lasts 24 hours and is mostly just an increase in fatigue with a mild headache.

    I also have crashes or flares, where I feel just like I have a cold or the flu, which are much worse than PEM. These flares now last about 2 days and can happen almost anytime.

    My flares, not PEM, use to last 7-10 days. Slowly they have gone from 7-10 days, to 5-7, then 4-5 and now only last 2. So I seem to be moving in the right direction!:)

    I can't help but wonder if the PEM is caused by mitochondrial dysfunction in the body and the flu-like flares I get are caused by the microglia in the brain being activated by the immune system or by mitochondrial dysfunction.

    The flu-like flares suggest to me that the brain is being affected. Just as if I had a real flu.
     
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  5. leokitten

    leokitten Senior Member

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    ++ to that theory, that this disease is immune and cellular energy dysfunction each feeding back on the other... which came first, chicken or egg, I don't know! ;)
     
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  6. Wishful

    Wishful Senior Member

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    I haven't been able to find a clear verification in scientific papers, but I think many of the flu-like symptoms are due to excess kynurenines, particularly quinolinic acid. That's made in the brain (doesn't cross the BBB easily) by activated microglial cells. My guess is that the immune system triggers this, and mitochondrial dysfunction is part of the feedback loop, but maybe the mito dysfunction makes the immune system more sensitive...

    Do chickens get ME/CFS? :)
     
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  7. Learner1

    Learner1 Forum Support Assistant

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  8. Wishful

    Wishful Senior Member

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    If it was oxidative stress, antioxidants should reduce symptoms. Instead, they seem to make my symptoms worse. I tried NAC, which should boost glutathione, but it had no noticeable effects.
     
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