Is PEM triggered by physical exertion the same as worsening triggered by sensory stimuli, cognitive exertion or emotions? What are the implications?

When I first came to the forums I use to wake up in the mornings hoping no one had quoted any of my posts and even today I still feel a sense of relief when I can post freely and not worry about having to reply to one of my posts being quoted. If I do get quoted, often I can only do a like in response.

 

Purely subjectively, but it feels as if driving with bumps in the road increases neuroinflammatory type responses. I wonder if this could be VanElzakker's hair-trigger microglia. Yesterday I drove 40 km to pick up medication and yesterday evening was headache-y, with noise hypersensitivity developing by late evening. However, I slept OK and am having a quiet mid Spring day, during planned leave from work. (Work for me is half-time, 10 steps down the hallway in my home office.)

Perhaps things like this may appear to be PEM but aren't, or are in some ways distinct, instead related to specific aspects of the overall mechanisms.

I remember when more severe and being driven to hospital my wife had to inch over pedestrian crossing speed bumps. As weak as I was I still lifted myself up from the seat so that the impact didn't propagate up my spine. Even now, many nights reading in bed before sleep with head/pillow against the headboard, I still have to flex my head forward if my wife sits forward and then back against the headboard to avoid the modest jarring of my head. I expect this is what post-concussion might be like. It's such a trivial thing that I absolutely would not even have registered/noticed/cared about before becoming ill.

It's awful to think of very severe people transported to or in hospital being subjected to much worse, with not only often very limited accomodation, but frequently deliberate stimulus challenge.

 

I drive both my car and my wheelchair like that. Lean forward to create a space behind my back and the seat whenever there's a bump coming up, because it's...really unpleasant in a way I can't describe. I'd no idea I was even doing it until somebody pointed it out, it was just automatic.

It's uncomfortable enough to be worth the energy costs of spending most of the time without any back support when I have to wheel on pavements. I limit it to short distances, but every now and again I can't avoid having to go a few hundred metres.

Yep. Even trying to imagine it is overwhelming.

 

Haven't been able to catch up with my reading yet but the topic of this thread felt vaguely familiar. That feeling must have been the last faint memory traces of a 2020 poll on it

https://www.s4me.info/threads/poll-physical-vs-cognitive-pem-same-or-different.16948/

There are probably some useful descriptions in the following old thread, too

https://www.s4me.info/threads/post-...n-including-defining-and-measuring-pem.15783/

 

I am of the motion sickness group. Whilst I’ve not the greatest ENT including ears I’m not sure it is vestibular - I’ve had labyrinthitis to compare and it gives me vertigo where I almost feel like I’m tipping on the bed or at sea.

you see I get motion sick with everything and it’s genetic as another family member also gets it to a similar level. We both find driving less exertion than being a passenger due to it and could never sit in the back. Weirdly I was ok on coaches in the very straight roads in Australia back in the day. Get it with films, and the more jerky the film and bigger the screen the more likely. I got so motion sick snorkelling in a life jacket looking at fish I had to hold on to the instructor to get back to the boat. I was sick then but not always (though I would never eat a load before any journey because of it)

these aspects make me think it’s processing load where the visual vs body movement is different. I’ll get a banging headache and exhaustion which carries on after.

train is interesting because I’m generally better on certain lines and the speed makes a difference. I’ve a faster (and quicker to get there) option to central london which tilts and has narrower carriages (I look in the centre and try and avoid windows but you can’t when it’s that narrow - I can’t read or look down) vs a slower but takes ages and I can’t stand the seats option. There’s an actual point on the track 40% into the journey where I go from managing because it must have not had to tilt yet or the extra speed hadn’t yet turned on to knowing I’ll just about survive that last but before I feel like I’ll pass out. To me it’s like being on a virtual reality roller coaster. I have to lie down with no sensory for hours after. That was obviously when I was more well. The alternative is doubling the journey and in back agony due to seats and injuries so I’m exhausted from that snd can’t read etc but I’m less having too hold the bottom of the seat the whole way so the utter body crumbling and brain flashing lights tinnitus walking stumbling ly with my hands out to find somewhere to lie down isn’t the same. And the after effects are consistent with the quite different experience ie tired in different ways.

 

I've seen the direct transformation in my face in front of the mirror while getting my hair cut at the salon. Fine when I sat down in the chair and completely different 40 minutes later- sunken eyes and face. Being upright, swung around in the chair, and talking with the stylist for almost an hour (one time it was 2 hrs!). I didn't think I would make the 10 minute walk home. I was swaying all over the place on the sidewalk. When I got home I called a friend and called the wrong person 3 times!!

It felt like PEM and like I did gymnastics during my outing, but I recovered after a couple of hours.

 

What do you suggest? I can't think of another word except fascial edema or fascial swelling which isn't what that is.

 

Oh I meant like I'm not sure how much this is a PEM-related symptom or an all the time symptom.

 

And the brainwork of multitasking any combinations of physical & mental effort is another exertion in itself. Eating a meal while talking to someone isn't two kinds of exertion, it's three.

 

I would agree that you can't separate them entirely. But for me, the cognitive exertion recovery is much quicker than the delayed physical overexertion.

 

Yeah for sure this is about the constant need to use muscles to balance out the vibrations and movements, completely different from the droning buzz and minor shaking that a healthy body can get used to. And highlights the key difference between somnolence and fatigue. Those are just different issues here.

When exhausted enough, being in a normal car is closer to being in a rally race, or maybe a roller-coaster. Zero of the normal pleasantness drifting to sleep here. In fact the noise alone is exhausting, if not painful to endure.

 

I expect that it does sound trivial to people who have never experienced it, or maybe had it briefly during a flu or whatever. However, like Chinese Water Torture, experiencing it daily with no expectation of relief, can probably drive some people to suicide. Maybe "Brain Crippling" is a better term?

Adding in other symptoms, such as hypersensitivity or neuropathic pain certainly makes the phenomenon worse, but the fog on its own is quite awful.

 

Yes, I agree. I know all about it. I have experienced the hell of it.