If that slide was intended to be thought provoking they have succeeded. The more I think about it the more questions I have.
They have non-physical PEM triggers on the slide, which is good. What I don't understand is if they also view non-physical triggers in terms of anaerobic thresholds being passed, e.g. brain cells working so hard that their broken aerobic system can't deal with it (that's if brain cells even have such a system?)? Or do they assume a different mechanism for non-physical triggers but don't go into it because that's not their specialty?
Should the immediate symptoms listed - fatigue, shortness of breath, dizziness, nausea - be considered part of PEM? I agree that there
can be immediate symptoms. I get those if I overexert really badly. However, stopping overexertion before any symptoms appear still leads to PEM down the track. Also, as they say in the video, they're the sort of symptoms everybody gets if they overexert badly, so they're not specific to ME, it's only that us PwME hit that overexertion threshold a lot sooner.
Do they mean PEM symptoms occur in a linear fashion? The slide could give the impression that after the immediate symptoms first you get a certain range of symptoms for 2-4 days and then, if you have more severe PEM, you move into a second set of different symptoms. Even after listening to the video I'm not really clear if that's what they mean? At one point it sounded like it, at another time it sounded like they thought people get either short-term or long-term PEM? Can anyone clarify?
At any rate, neither of the above matches my experience. I get all the symptoms they've listed for both short- and long-term PEM already on day 1. For me the difference between shorter and longer PEM, apart from duration, is in the intensity of the symptoms, not the type. In fact flu-like symptoms, listed under long-term on the slide, for me start to niggle already about 4 hours after overexertion, mild at that point, more like a common cold coming on, but then rev up the next day to full flu-like misery.
So I think they're onto something with their concept of a cascade of stuff happening right from the start but I don't think it's as linear as the slide suggests. My sense is that the first trigger sets off many or all the different symptom pathways, for want of a better term, at the time the trigger occurs, so before even the 'immediate' symptoms show. Initially those symptom pathways are so mildly activated we don't perceive anything but they keep activating more and more (maybe some sort of evil feedback mechanism?) until we can perceive the symptoms, and then they activate even more...
Another slide at 39:25 comparing healthy, ME baseline, ME PEM, and deconditioned is good. I still wonder if certain people who shall remain nameless would try to twist it to say that we're not only deconditioned but extremely deconditioned? They'd have to explain the difference between baseline and PEM: can we really get that much more deconditioned overnight? - but they'd probably just ignore that little problem of logic.
