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There is no categorical tiredness vs illness dichotomy. What about pathological tiredness? Depression is not the same as sadness but malignant or pathological sadness expresses sth. So does malignant or pathological fatigue. It's just different from ME PEM And the diagnosis of ME has been such...

Could be both. Engine problems, pilot keeps flying, enginen gets worse (potentially), pilot gets tired/overwrought. Two systems one flight experience.

Thanks for the clarification though I am not sure I have understood and I am surprised that nothing has been found over such a range of systems. Thomas found low o2 uptake in PMNBC's at Newcastle in an ME cohort. I have read one article from Bath (I think) where a disorder of proprioception was...

Maybe a division can be made between PEM with explanations along your lines and other exertion intolerance where such things as muscle probs from aberrant protein, low o2 uptake may be part of the mechanistic picture. As stressors they may contribute What about the question of what is benign...

I think you have a fair point. I was amused by your reference to the antebellum. What word might be better is another matter.

Suppose that was pre-exertional.

In my opinion we need to define "post" - how long after, "exertion/al" remembering that in any illness much normal activity will be an exertion, and "malaise", because in normal usage fibro sufferers, sarcoid sufferers. GWS, Lyme, post Lyme can put a good argument that they get malaise. We must...

Perhaps a category of "post activity malaise" needs to be added for conditions such as sarcoidosis. The experience there for many is beyond PEF and beyond exercise intolerance but thus far has not given 2 day CPET worsening. I think fibro and GWS would fit too and possibly Lyme and post Lyme also.

Has it been confirmed in Long C on a 2nd day CPET or sth?

I am sorry for your experience and I agree that PEM is not appreciated enough whether PEM of ME or post exertional sarcoid phenomena - and neither of course is basic fatigue.

Kitty. JE. This, from a patient, may interest you. "Chronic, multi system here. Full on fatigue from the minute I wake until bed. Any activity, whether it be washing up or taking a shower then requires a sit down. Going out for errands or to the dr means I’ll pay with about a week of extra pain...

This is interesting to me as I carry Pompe's disease (one allele, insufficient GAA enzyme) but should be without overt symptoms. This is a lysosomal condition with, in overt Pompe's, poor breakdown of glycogen in lysosome and compromised autophagy. In carriers glycogen breakdown should remain...

Kitty, Reply above (failed to link , sorry)

Sorry Jonathan I missed your last sentence. That would be at the severe end but may be most common. I don't know the mild/moderate/severe proportions in ME. People with an ME diagnosis do report varying durations of PEM. I certainly know of people with sarcoid who experience days of fatigue...

The length of relapse may vary within ME, so if sarcoid exertion response is too short for PEM so is less lengthy ME! The specific type of worsening may well simply reflect the fact that ME is a specific type (maybe over a spectrum) of disease and sarcoidosis another disease with a pattern of...

I think sarkies do crash but whether the crash is the same as PEM I do not know. Then again I think ME as diagnosed is an umbrella and also with fluctuation, plateauing and in some cases resolution I do not think it likely that there is one paradigm of PEM for all sufferers at all times. I am...

Jonathan Re. sarcoidosis: the key matter is that the fatigue is marked and often markedly beyond what one would normally expect for the degree of apparent disease. Problems with ongoing or repeated exertion parallel the experience of ME sufferers, as in some sufferers do many "oddities" such as...

I don't go along with your "no reason....same" . How would you account for relief of symptoms by stressors mentioned? Don't the testimonies support a role? - maybe raised cortisol suppressing inflammation and/or creating a high, maybe endorphins. There is a lot of support for your points on...

Thanks

I know of similar stories in numerous illnesses. My take is that genes, health status, exposure to toxins, pathogenic organisms may all play a role in various immune related conditions in given individuals and over time may get involved in the life experience, even if irrelevant to cause. To...