Managing Post-Exertional Malaise (PEM): What can help?

Thank you all for sharing your experiences! I appreciate your support and advice. I had been pacing myself fairly well since I had the crash that prompted me to reach out to this community, but I am back in another (albeit milder) crash that started yesterday. I think this time it was triggered by driving - I was in the car for about 2 hours driving back/forth to appointments. I really find driving to be very exhausting because it’s just constant focus.

It’s really frustrating to accept that this is my life now, and really scary to not know how long it will last. Up until yesterday, I was feeling pretty good. Pacing myself for sure, but also functioning fairly well within those constraints. I had even convinced myself that I was improving and would be back to normal soon. The crash this week has made me realize that I am not out of the woods, that I am still vulnerable, and it scares me.

driving is a big deal for me. I haven't driven more than 1 1/2 hours since November 2020. We don't realize how much 'brain work' is involved. If I am going to do something taxing I plan nothing the day before and after. Normally I cross out 2 days a week for recovery; no appointments, errands, detailed/complicated brain work. It's what I need to be able to function the other 5 days a week. If I don't feel well I cancel my plans for the day.
It's a yo-yo life and taken 3.5 years to find my balance and where my boundaries are. There are far less things I really HAVE to do than I thought-sometimes I WANT so much to do something that it feels like a need, but it really isn't. Prioritizing, pacing and pivoting are my key words. Your balance is not the same as anyone else's. The longest I have gone without a crash is 4 weeks-I just keep forgetting to manage myself and revert to pre-covid expectations.
PT, OT, Speech made a big difference in figuring out how to do things differently.

At the risk of being redundant, I crashed after doing a 20 minute walk video. This was my first, and I need help. What do you do all day while recovering?
My crash is a feeling of weakness, deeper fatigue. I am able to do the same things but I just feel like moving slower. Any suggestions would be so appreciated.

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

This may sound strange, but a lot of covid weakness is caused by a low amount of oxygen getting through the arteries / blood vessels that are shrunk tight because of low amount of nitric oxide. You should have foods with nitrates that the body uses to make nitric oxide to allow the arteries to open up.
They say the best way to increase nitric oxide is to have dark greens. The darker the better. When we chew the greens, the good bacteria in our mouth creates the nitric oxide. (Remember, no mouthwash or toothpaste with fluoride that could knock out the good bacteria.)
I try for a type of curly Italian kale, like dinosaur or Lucinato / Tuscan that looks tough but is tender. ( Other choices are arugula or spinach. ) I rinse the kale well and than pull it off the stems and cut it up with kitchen shears.
Beets are a great source of nitrate and you could put some on the greens.
Blueberries are good and could also be added to the salad or have by themselves.
Watermelon is a good source.
If you could find unsweetened cocoa and add honey. I put it in decaf coffee, but you could add or use milk or almond milk instead.
Nuts and celery are a good source, so a nut butter on celery sticks would be good.
Also include some orange slices for vitamin C which is an antioxidant that helps with nitric oxide production.

Think of your body as a battery that only has so much charge in one day. Gauge your daily schedule accordingly. Easy for me to say and not easy to do - another way of describing pacing. Don't forget that mental and physical activities drain your battery, too.

For muscle cramps / spasms I use potassium and magnesium.

"Potassium is a nutrient that helps facilitate muscle contractions. It is a neuromuscular transmitter that provides communication between muscles and nerves. This communication breaks down when potassium levels are low, and muscles can “get stuck” in a contracted position that we feel as spasms or cramps. Historically, potassium has been associated with bananas. However, they are not the best nutrient source, providing just nine percent of your daily recommended intake. Instead, consider one of the following five foods listed below to help with muscle cramps:

Sweet potatoes
Melon
Cooked Spinach
Nuts
Beans"
https://www.wdhospital.org/wdh/services-and-specialties/orthopedic-care/blog/nutrition-tips-to-prevent-cramps#:~:text=Potassium%20is%20a%20nutrient%20that,feel%20as%20spasms%20or%20cramps.
I use "No Salt" for seasoning which is 100% potassium. It is in most groceries, made in Germany. There is also "light salt" that is 50-50 sodium / potassium.
I also take magnesium taurate daily. With those two, I have eliminated the cramps. Hope it can help you.

I can’t let myself get excited—the excitement for me can cause PEM just as easily as too much physical effort.