Meaning of the word 'malaise' and its use in the term Post-exertional malaise (PEM)

[JemPD]

I can't tell the difference between the flu and PEM.

Me neither John, in fact I have missed flu/infections for a few days on several occasions because the experience, the sensation, is indistinguishable. The only things that prompts me question whether i have an actual fever & take my temperature, is when
a) i get a bad cough
b) the cognitive isnt 'bad enough' in relation to my other symptoms - so i am able to function better cognitively than i would expect with that level of PEM
c)or the lack of fluctuation, so PEM still fluctuates/changes throughout the day, whereas flu/infection symptoms are more constant (excepting use of pain killers etc)

But it takes me at least 48hrs to question it, even then, unless the cough is very bad.

 

[duncan]

Looking at Webster's Medical Dictionary on Fatigue:

1: weariness or exhaustion from labor, exertion, or stress
2: the temporary loss of power to respond induced in a sensory receptor or motor end organ by continued stimulation

So that is not the professional meaning. The professional isn't bothered with 1 - they assume that the patient is likely to recognise it as normal and not consult a doctor about it.

OR they assume the patient is not self-aware enough to tell the difference, or the patient is catastrophizing because they read an article in Psych today.

So fatigue is used to mean weariness or exhaustion (or whatever) out of proportion to normal causes. So rheumatoid and lupus include fatigue as a major symptom.

So do depression and grief and ennui and eating too much turkey and laughing too hard, that is, cause weariness out of proportion.

And if fatigue is meant to be in lieu of exhaustion, I'd suggest changing to exhaustion because degree matters. Degree matters. Intensity matters. Levels matter. Medicine gets that as long as it's something objective and overt and mechanically measurable (although they still even get that wrong).

But it often seems to forget degrees - or is indifferent to them - when it comes to subjective symptoms. They'd generally rather err on the side of understatement, frequently at patients' expense, and call that understatement caution or prudence or whatever.

What ever happened to striving for accuracy in medicine, broadly speaking?

I'm not directing this little rant at you, @Jonathan Edwards. I'm just yelling at the greater medical community.

It is what it is, this artifact of distrust and condescension, and not easy for the medical community to overcome, especially with the friction that would ensue.

 

[AliceLily]

I think an important aspect of PEM is a strange inability to function well.

I have what I would consider "mild PEM" at the moment. I tried to do some undemanding software work and I'm having difficulty completing any of the tasks I set out to do. I run out of patience and get frustrated, make mistakes, and am slow, can't formulate clear ideas. It's difficult to achieve anything when the brain isn't working well.

Physically I'm also not in good shape. Pain levels are up. Being upright is unpleasant due to fatigue. At some point I had a "feet dragging on floor due to not being lifted high enough from the floor" gait which I tend to get while fatigued.

Today's disorganization also extends to food preparation. I just ate whatever was there and neglected preparing proper meals. Then ended up grumpy later because I hadn't eaten enough and healthy enough.

You bring back memories of how it was for me in my early years of ME when I didn't know I had ME.

 

[Sean]

I think we should stop using the term depression as it is currently practiced, being used as a waste basket diagnosis for unexplained physical symptoms (See: https://www.s4me.info/threads/how-o...sed-as-depression-changed-thread-title.22366/ ).

Yes, I don't think 'depression' is particularly well defined and handled either. Nor most other 'mental' conditions.