The Times [UK]: We’ve forgotten the vital need to convalesce

[Andy]

It’s binary and there’s little room for nuance. Once we’re back in the workplace we’re expected to perform, snapping back almost overnight from one state to another. The pressures on any business mean that no matter how kind others wish to be, it’s a burden on them when we aren’t up to the normal pressure, and want more time, or later deadlines, or shorter hours.

The term we’re missing that makes sense of all this is convalescence. It’s a concept that’s largely fallen out of use, so most of us neither consider it nor take it seriously, and yet for many conditions this slow restoration is a vital part of recovery.

Sign-up wall at https://www.thetimes.co.uk/article/we-ve-forgotten-the-vital-need-to-convalesce-qlrnzl95d

 

[Barry]

In the forces there is the notion of "light duties". I caught glandular fever in 1971, and was in bed for a week, then off sick for several weeks, then back to work but signed off for light duties several weeks after that. That may have saved me from developing ME later, though there were several periods where I thought the illness was lurking in the background, possibly coming back.

 

[Cinders66]

On Facebook a hospital had a post promoting the continuation of exercise such as jogging, fine, in cold winter weather. However it then went on to say that having a cold was no reason not to carry on jogging in winter unless you had a fever which i thought was pretty controversial, not necessarily too harmful but showed the attitude to “carrying on” with a sickness. The PE teachers at my school always said “if you’re well enough to come to school you’re well enough to do PE”, even if that was playing hockey in the rain at 5 degrees, which I always thought was barmy too.

 

[Wonko]

If you want barmy, we used to play cricket in the snow, not a sprinkling, thigh height. I suspect PE teachers aren't employed for their intelligence or flexibility.

The most fun was either the long jump when the sand was iced solid, or basketball outside in winter in subzero temperatures, nice cold ball meets frozen fingers, amongst the great memories of PE.

 

[Arnie Pye]

The PE teachers at my school always said “if you’re well enough to come to school you’re well enough to do PE”, even if that was playing hockey in the rain at 5 degrees, which I always thought was barmy too.

My emphasis.

When I was at school in Scotland in the 1970s I was expected to play hockey with snow falling and small amounts of snow on the ground. In order to see the ball against the snow it was painted half blue and half red. What we actually wore to play hockey was hockey boots and socks, navy-blue underpants, shirt and jumper. Having legs blue with cold was part of the uniform too. The PE teacher was, naturally, wrapped up in a thick tracksuit, probably had long johns on underneath, and wore a huge puffy anorak with fur-lined hood, gloves and a scarf. I always hated, hated, hated school. The levels of casual cruelty and standard issue bullying from both teachers and pupils made it hell.

 

[Peter T]

It is interesting that various of us in various forums and in threads here have raised the idea, could convalesance prevent acute conditions developing into ME?

I have regularly wondered if I had not pushed myself to get back to work within a few weeks of the onset of my glandular fever could my ME have been avoided?

Presumably if we think that convalesance could prevent an acute infection from becoming ME then surely we are suggesting the infection itself was not sufficient to cause the ME, but also over exertion in the recovery period is necessary.

My personal initial onset experience was acute glandular fever followed by desperate over exertion trying to regain premorbid activity levels. This is consistent with the suggestion my ME was caused by infection plus over exertion. However after a number of years when I had gone half time at work, I experienced what I believed to be a total remission. My subsequent relapse was triggered by a bad dose of flue, but I had by then learned to not to fight it, I took the time and rest needed, but there was no total remission, this second experience of ME was triggered by an acute infection, but there was no over exertion in the 'recovery' from that infection and the condition still progressed.

Do we currently have any objective evidence that relates to this question? Given the idea of convalesance relates primarily to acute conditions, does the existence of gradual onset ME suggest it is irrelevant to our condition. Certainly the variety of initial triggers for ME rules out any simple idea of infection followed by over exertion being the cause.

Also there is the suggestion that though many people attribute the onset of their ME to an acute infection, for many there are other symptoms present prior to or associated with the onset the infection suggesting a model of infection followed by over exertion is not adequate for explaining their ME.

 

[Andy]

Do we currently have any objective evidence that relates to this question?

No, as the research hasn't been done. My suspicion is that it's actually based on experience of PEM, i.e. where over-exertion makes us worse and rest helps us recover, so it's understandable to project that on to the start of our illness.