Choline on the Brain? A Guide to Choline in Chronic Fatigue Syndrome
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PEM Timing

Discussion in 'Post-Exertional Malaise, Fatigue, and Crashes' started by cman89, Jun 30, 2015.

  1. cman89

    cman89 Senior Member

    Hayden, Idaho
    For those of you that suffer from excessive PEM, at what point after exertion does it usually come on? And is the actual exertion effect rather benign? As in the adrenalin/etc allows you to avoid pain but then it comes screeching back after?
  2. Valentijn

    Valentijn Senior Member

    My PEM hits approximately 24 hours later. Exertion used to feel a bit good in my muscles, and still can feel nice in some ways, such as better sleep. But my immediate exertion intolerance got worse as me ME got worse and PEM threshold got lower. Now I tend to feel pretty crappy when in the process doing too much or standing too long as well - muscle pain or twitching, tachycardia, low pulse pressure, etc. Though the typical PEM symptoms still don't hit until much later.
  3. SOC

    SOC Senior Member

    My PEM hits 3-4 days later. I feel find until then... not that I'm extremely overdoing. I couldn't say what would happen if I ran a marathon. ;) But for 'normal' overdoing -- moving house, walking through large airports -- I do fine in the moment, although I'm not as strong as I used to be. I might get a bit out of breath or a little tired, but I don't get PEM symptoms.

    If my OI is not under good control, however, I can have immediate OI symptoms from overdoing and/or being upright too long. Unlike PEM symptoms, my OI symptoms from overdoing can be alleviated by rest within about 24 hrs.

    So for me and my daughter at least, there appears to be two parts: exercise intolerance from OI (when it's not under good control) which happens immediately and is relieved by rest within 24 hrs, and PEM (which has different symptoms) and shows up days later and lasts much, much longer.

    I would not say it's an adrenaline situation that keeps me going during overdoing. For me, it appears to be a simple matter of whatever the phenomenon is (cytokines? inflammation? metabolic dysfunction?), it takes a few days to build up to the point where the symptoms are noticeable. The symptoms then increase for another 3 days or so and then fade very gradually over 2-8 weeks.
    Last edited: Jun 30, 2015
  4. Mary

    Mary Forum Support Assistant

    Southern California
    @cman89 - it hits me about 24 hours later. Actually, my muscles generally start to ache some 6 to 8 hours after exertion (which might be something like doing grocery shopping and then spending 1/2 an hour at the library). But the full-blown exhaustion doesn't hit until roughly 24 hours afterwards.

    I've learned I have to stop doing things before I get tired to avoid PEM, actually my activity window is about 3-1/2 hours of light activity to avoid PEM. If I exceed that, even if I do nothing but rest the rest of the day, I will crash.

    Though my crashes are not as bad as they used to be due to several factors, including BCAAs and glutamine, maybe DMG. It used to take me 3 to 4 days of complete non-activity to recover (though I always get sick when I crash, and that takes longer to recover from), and now I'm recovering within about 24 hours, which is pretty amazing. But my activity threshold to avoid crashing has not increased.
  5. Mij

    Mij Senior Member

    I'm not sure what you mean by excessive. I would say PEM starts between 12-16 hrs. I don't experience pain with it though, more muscle fatigue/weakness.
  6. minkeygirl

    minkeygirl But I Look So Good.

    Left Coast
    Mine hits bad the 2nd day after I do something and lasts 4-7 days.
  7. lnester7

    lnester7 Seven

    Depending on the type of PEM. If I raise groceries and try to move them from car to the house and carry more than my share of bags, is immediate. When I over do could be from right there to 24 hours later to weeks when it is accumulative overdoing.
  8. cman89

    cman89 Senior Member

    Hayden, Idaho
    I mean excessive as more than a healthy person would experience after exercise
  9. Aurator

    Aurator Senior Member

    PEM for me always seems to start 36-48 hours after the exertion. Particularly in the early days this made it really difficult to manage activity so as not to crash, because I would compound the damage already done on one day by trying to do too much on the next as well before PEM had had time to properly set in. Of course when it did it did so in an even more emphatic way than if I'd overdone things on one day only.

    PEM and its delayed onset is one of the most remarkable things for me about this illness. Before I became ill I was a committed amateur athlete and if I had competed in a hard race one day or done some particularly heavy training, it would always be the next day (not 36-48 hrs later) when I would feel the worst effects of the activity, with muscle aches and a predictable sensation of (usually) mild fatigue. Since coming down with the viral infection that accompanied the start of my present illness, my body's reaction to exertion is completely different, both in terms of quality and in terms of the time scale on which it operates. It suggests very strongly to me that a different physiological mechanism is at work from the one that operates after exertion when a person is in a normal healthy state.
    SOC likes this.
  10. satori


    Mine starts approximately 48-72 hours after exertion. It used to be 24 hours. I feel good for the time in between just as I used to after working out (exertion). It is the most frustrating thing about this affliction to me. Having been an athlete previously, my PEM seems exactly like overtraining syndrome. Since that phenomenon has been known for decades, you would think there would be some kind of fix by now.
  11. mango

    mango Senior Member

    what healthy people experience after exercise is not PEM, it's usually DOMS. two very very different things...
    SOC, voner and Valentijn like this.
  12. soxfan

    soxfan Senior Member

    North Carolina
    I get PEM mostly from mental over stimulation and it can actually start coming on during the activity. Especially if I am shopping or in a social situation I will feel the energy slipping from my body. By the time I get home it is immediate bed for me...

    I will have to lay in a quiet and dark room for hours while my overstimulated body makes me feel horrendously bad inside...

    I am not sure this is considered PEM since it happens to me immediately..

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