Different Delays for Different PEM Symptoms?

[Wishful]

I was reading a paper about ME, and it mentioned how different parts of the brain communicate. This brought up the question: do any PWME have noticeably different delays for different symptoms of PEM? For example, does muscle weakness reliably strike 12 hrs after the exertion, and severe brainfog strikes at 20 hrs? I don't recall any such differences, but if a significant number of people do have differential delays, it might affect theories for what's going on. I'm guessing that in-brain communication delays are too short for noticeable differences, but it seems like a worthwhile question.

Another question: is PEM delay from the start of exertion, the end of exertion, or somewhere in between? I didn't pay close enough attention to my PEM to answer that question, but maybe someone else has kept more precise time records.

Do any factors reliably affect the delay? I had different delays for cognitive exertion and physical exertion, but does the delay depend on the magnitude of the exertion? Is the delay different for moving a roomful of heavy furniture than for moving a few books? I didn't experiment adequately with cognitive/emotional exertion, but maybe there's a difference between logical problems and emotional experiences (such as socializing).

 

[L'engle]

For me brain fog PEM strikes while I'm still doing whatever mental work, until it forces me to stop. It then lasts a variable amount of time, somewhat dependent on how much I kept pushing through it. If I keep doing this I get a long stretch of up to weeks where it is hard to do any mental work.

Physical exertion seems to often let me carry through over doing that day and then PEM strikes the next. I've never charted it down to the exact hour.

 

[Rufous McKinney]

For me brain fog PEM strikes while I'm still doing whatever mental work, until it forces me to stop.

similar, here.

I can go down rapidly DURING a phone call, or chat or...mental exertion. A sort of "zombie coma" can strike rapidly.

Physical exertion seems to come with a bit more delay before PEM strikes.

But anything involving concentrating plus "looking" "seeing"...I crash pretty intensely.

 

[Wishful]

My physically-induced PEM had a consistent 24 hr delay, although I'm not sure whether that was from the start, finish or middle of the exertion. Cognitively-induced PEM could strike in less than an hour--during a conversation, as you said--or could take over an hour; much more variable.

 

[Azayliah]

Muscle issues generally take about 2 days to show up, occasionally 1 or 3.

Stomach, fever, and flu symptoms usually hit the next day or the day after that.

Insomnia occurs the same day or the next day.

Brain fog is almost immediate, but is also not a solo symptom. It always aligns to how (physically) fatigued, sleep-deprived, or sick I'm feeling. It does worsen when I do a lot of cognitive processing, but a high mental or emotional load also causes physical fatigue (and PEM if I push too much), so it never seems to be a symptom that occurs in isolation like the others do.

 

[hapl808]

Variable, and nuanced.

I will start getting acid reflux and feeling 'underwater' if I push through a social interaction too long. Then when I stop, I won't know for the next 12-48 hours if I avoided a crash. For awhile the crash was coming in 12-24 hours, but that led me to thinking I avoided the crash several times - only it came 36 hours later or whatever.

Supplements often can delay or slightly lessen crashes, but don't usually help me avoid them. So I'll take Q10, quercetin, BCAA, taurine, ALCAR, allicin, slippery elm, and on and on.

As for physical crashes, it's somewhat similar. Often I will fall asleep immediately after, but I won't get the full poisoned feeling crash until the following day. Since I do less physical things, I have less data on the delay.

 

[Wishful]

Brain fog is almost immediate, but is also not a solo symptom. It always aligns to how (physically) fatigued, sleep-deprived, or sick I'm feeling.

From ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124899/ ):

"The involvement of glia may explain the “coupling” of clinical symptoms in ME/CFS: Mental and muscular fatigue are always occurring concurrently. The more a patient suffers from cognitive or mental disturbance, the less the muscles work. The more centrally fatigued a patient, the slower their gait. Central sensory dysfunction such as hypersensitivity to noise, light or touch goes hand in hand with decreased exercise capacity. Cognitive dysfunction parallels poor peripheral perfusion. Also, as disease severity increases, mental and motor dysfunctions deteriorate in unison, i.e., the less functional a patient is the more pronounced their central AND peripheral disturbances. Conversely, amelioration, temporal improvement or recovery from PEM are similarly in tandem processes. This again may be attributed to a central role of neuroglia that are simultaneously involved in the regulation of CNS functions, the innate immune system, the basic circuits involved in autonomous functioning, and the stress response."