"Mom! What do you think about this awful scarf? Mom... are you even listening to me?"

We were at a local charity shop, aiming to find a costume for my daughter to wear in her school performance as Mrs. Darbus in the high school musical. I tried to listen, I tried to pay attention, but I felt distant, disconnected, and utterly exhausted.

Over the past 48 hours, I've been in and out of the workplace, attending meetings that require focus, and generally fulfilling the duties of a mom/wife. I wasn't keeping up (more on that later), and I was about to pay the price.

At teatime, I couldn't hold a conversation in bed, wracked with pain, desperately trying to fall asleep but unable to relax into a comfortable slumber.

I crashed.

I crashed due to post-exertional malaise, and the hell lasted for 36 hours.

What is Post-Exertional Malaise (PEM)?

Post-exertional malaise (PEM) is a worsening of symptoms even with mild physical or mental exertion, typically worsening 12-48 hours after activity and lasting for days or weeks.

PEM is also known by other names such as post-exertional symptom exacerbation (PESE) or post-exertional neuroimmune exhaustion (PENE).

PEM is one of the diagnostic criteria for myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), a name that is more misleading than informative. It goes beyond ongoing persistent fatigue. The Institute of Medicine recently convened an expert committee to release a report titled "Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness." The committee recommended the use of the following diagnostic criteria.

For diagnosis, patients must have the following three symptoms.

  1. A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities, lasting for more than 6 months and accompanied by fatigue.
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