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Punished for Moving - the confounding impact of Post Exertional Malaise

 I used to joke with my admin that I'm allergic to Mondays.  It didn't really feel like a joke, as I felt loaded with shame at the moment.  It was the fourth or fifth Monday in a row in which I cancelled my patient schedule due to feeling unwell. 

This unidentified unwellness, which I didn't know was Long COVID, usually began as a lightheaded slightly out of breath feeling on Saturday.  On Sunday, this would escalate to a severe headache.  I'm not one to have headaches (at least I wasn't before). I'd go into PT mode and self treat, working on trigger points and mobilizing my neck, jaw.  Nothing would help.  I'd take an OTC medicine, which would for a little bit, at least to get to sleep.  On Monday I'd wake up with a pounding head, mild fever, and nausea when I tried to get ready for work or eat breakfast.  

Sometimes I would cancel Monday, rest for a day, and force myself through the rest of the week.  I love being a PT.  I love meeting people, forming therapeutic relationships, and solving pain problems.  But some weeks I had to cancel my full Monday-Friday schedule.  It was heartbreaking.  

"WTF Monday?" I would complain.  "What did I ever do to you?!" 


When I got diagnosed with Long COVID I was introduced to a term I had never quite heard before called Post Exertional Malaise or PEM.  PEM, according to the CDC is the worsening of symptoms following even minor physical or mental exertion, with symptoms typically worsening 12 to 48 hours after activity and lasting for days or even weeks.

That's right.  You get sick when you exercise.  You can also get sick from reading a book. Or going to a party.  Or going shopping.  Or writing a blog -- which is why I will end this post with a "to be continued" in order to pace myself properly through this project.  Stay tuned for Part II, where I'll share what the actual cause of my Monday sickness was. 

If you want to learn more about PEM in the meantime -- check out this video from Long COVID Physio: Note: The Brits call it Post Exertional Symptom Exacerbation. 





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