Understanding Post-Exertional Malaise - Dr. Brayden Yellman

We are pleased to introduce a four-part series focusing on post-exertional malaise created by Patient-Led Research Collaborative and #MEAction. Each video is an interview with an expert in the field and is conducted by Chimére L. Sweeney*, a Long COVID author, speaker, filmmaker, and writer. We will be sharing a new video each Monday in September and they will be tagged #MedEdMonday.

Our first episode focuses on understanding post-exertional malaise and features an excellent presentation with Dr. Brayden Yellman** from Bateman Horne Center with a follow-up question from Chimére L. Sweeney. Dr Yellman is a board-certified physician in internal medicine and rheumatology at Bateman Horne Center and also serves on the Scientific and Medical Board for #MEAction. This presentation focuses on the importance of pacing and PEM (post-exertional malaise). Pacing is a crucial intervention for ME and Long COVID.

PEM is a flare of symptoms and/or the appearance of new symptoms after exertion, often presenting 24 hours after the triggering event. Physical activity, cognitive overexertion and sensory overload can all trigger PEM. Post-exertional malaise is a unique symptom, incongruent with experiences of fatigue after overexertion in healthy individuals. It is not the same as being more tired than normal after activity.

Resources referred to at the end of the video can be found here:

Other resources:

*Since 2020, Chimére L. Sweeney has championed the inclusion of Black women with Long COVID into conversations and opportunities that support their unique storytelling, as vehicles to share their management of their condition(s) along with treatment, and invite them as authentic stakeholders in advocacy and research.

**Dr. Yellman completed a BS in biology at Washington University in St. Louis, Missouri, and a Doctor of Medicine at University of Texas in Houston. He completed a residency at Exempla Saint Joseph in Denver, CO, and a fellowship in rheumatology at the University of Pennsylvania in Philadelphia. Dr. Yellman joined BHC in January 2019. Prior to BHC, Dr. Yellman practiced at Intermountain Healthcare diagnosing and managing complex health issues and illnesses in an outpatient clinic and consulting with network providers. He developed and implemented a patient referral triage system to expeditiously identify particularly ill patients and provide them with rapid access, with a focus on the underserved population suffering prolonged waiting periods. Dr. Yellman helped create a curriculum to educate primary care providers in recognizing, diagnosing, and managing rheumatological diseases.

#pwME #MECFS #MyalgicEncephalomyelitis #LongCovid #PEM #MedEd

Video description: Dr. Yellman (white man with short dark hair wearing a tie and sweater) appears on camera and then it switches to slides. At the end it briefly show Dr. Yellman again then Chimére L. Sweeney (a Black woman with short hair wearing glasses and a blue sweater) appears on screen to ask a question. Transcript available via YouTube. Captions are added by us.

[julesincambs]

Dr Brayden Yellman sounds like the type of doctor, all of us people with M.E/CFS/LongCovid need.

[USALibertarian]

FINALLY a doctor who actually appears to understand.

[kendallmagnussen]

THIS IS SO IMPORTANT!!! I have had ME/CFS for 18 years and still have not figured out how to properly pace myself. Over the last ten years I have gotten noticeably worse every year, and can do less and less before PEM kicks in. My functional baseline is so much lower than it ever was. It is quite a psychological conundrum as often, in the moment, it doesn't feel like I am pushing, but then the hits start to come a day and then especially 48 hours later. Please, if you have these illnesses, consider my experience a cautionary tale. I don't know if I will ever be able to take walks again because when I could, I went too far - and that is true for pretty much every activity of life at this point. I don't know why I keep hurting myself in this way. I think I just don't want to accept that I am so limited, but that is not helping.🥺

[ixchelkali]

In nearly 25 years of living with myalgic encephalomyelitis, this is the best presentation on PEM I've ever seen (including what I've written myself). Thank you for this. I hope that other doctors can be persuaded to educate themselves by watching it, so they can provide better care to their ME/cfs and Long Covid patients.

[JodieHowell-oj]

This is a brilliant presentation on PEM. People really don’t get it AT ALL. When they see you at a social event looking totally “healthy” one week they can’t wrap their brains around why you can’t join again the following week. It’s because I’m now in a crash bedridden and feel like I’m dying. I’ve gone from mild to severe to moderate. It’s really all so unpredictable. I am the one who has a few good days or weeks and then gets blindsided by a debilitating crash. I was bedridden for 2 months once. I can’t seem to get it through people’s heads that even though I look normal I cannot attend that dinner or social gathering. I have used the house fire analogy myself! This truly is an evil disease.

[EndersWorlds]

This is by far the best presentation on Post Exertional Malaise I've ever seen! Is there any way this exact video could be disseminated to medical personnel or other's working in the front line of ME services?? I know it's available here but they would have to look for it. I immediately wanted everyone who's ever had anything to do with my care to see this video. Because people REALLY don't et it!

[Suppention]

Continuing to push, based on doctor’s advice, kept me in PEM. My baseline is so low now.

[gillianharper-ward]

Oh my word, THIS is me, not able to escape a house fire if I needed to 🔥 😮 THANK YOU SO MUCH FOR THIS .I wish everybody would watch it.😢 it should be on TV 📺

[lisaespiritu]

Excellent explanation, you nailed it! As a person living with M.E. for 33+ years, I SO appreciate BHC's resources, support groups & outreach. Thank you 🙌🏻

[bigjoegamer]

This video seems very accurate. Good job.
One of the most important things that keeps me from getting sicker is the freedom to choose what activities I do and to choose what activities I won't do. Being able to rest whenever I want to for as long as I want to is the most important thing for fighting the symptoms of this illness.

[shaktiillumination]

Thank you for providing the right information. There is a whole new wave of long Covid “experts” saying it’s all neural brain retraining and to just exercise through .. and that is wrong! If we could exercise we would be ! Thank you for posting the correct information for the safety and understanding for patients.

[SamSamkha]

Very good video. 10 years+ of ME here and this is complete and really helpful. Sent it to my doctor, my physical therapist and my psychologist 😊 I have personnally learned how to deal with it in a better way. Thank you 🙏

[SBCinNC]

As a patient, I truly appreciate your thoroughness with which you explained PEM. I think I will share this with my primary care provider. Thank you!

[nicolettemandelstam]

Absolutely brilliant! I'm one of those who keep pushing and pushing and pushing. Feels like it's expected of me to "get up, stay up and do things" instead of recover. A shower, conversation, call, sending an email, being around people / noise results in PEM. The result is devastating. The all over pain is excruciating, the cognitive impairment devastating, breathlessness so much worse, headaches on a different level.
Wish all doctors could be this informed, sympathetic and supportive. Thank you for this!!!

[RobinS]

I agree with everyone who has said this is the BEST presentation on PEM that I’ve seen. I’m hoping to get a few friends and family members to watch (and truly ingest) the info — not sure I’ll succeed but we’ll see, because people who aren’t going thru this truly have no clue. Of course, why would they? PEM is so different from the fatigue that people normally experience. Definitely an outstanding presentation here. I wish I had even one doc in my circle with Dr. Y’s expertise, but alas….

[jangeiger]

Thank you for this vert important information, It was so helpful to me. I have been living with CFS/Fibromyalgia and PEM episodes for 7 years. I would push myself to exercise and not pay much attention to my PEM, until it worsened and my quality life was affected. I was told by many doctors to increase my exercise to produce a healthier me. I had been a fitness instructor for 25 years and I believed too that an exercise routine would heal me. I now know how harmful it was/is to me. This video was exactly what I needed to understand that pacing my days will be my new routine.

[TeineUaine]

This is the best video on PEM! (LC since March 2020) When thinking about the battery, I like to think about "all the Apps in the background" that are using energy, too, like digestion, heartbeat, breathing, temperature control, thinking etc.. Just like the notification on the phone that the "Battery is Low" it's good to learn to recognize some signal that the body's battery is not 0% yet, but will be soon if the drain continues at the same rate. Resting and micro-pasting plugs in the charger just in time!

[storiesuntoldunfold]

Thank you for this validating & informative video! A lot of this is what my ME Dr out of Stanford told me. But, I wanted to know HOW to work w this crushing illness.
Be mindful of energy battery / envelope
Never let battery drain completely
Pacing
Pacing
Pacing
Surrender to state of PEM
Embrace radical rest

So, maybe even tracking body battery and using that as tool along WITH our symptom inventory & severity.

Just because you CAN do an activity, does not mean you SHOULD

Modify every single activity to minimize energy use on CELLULAR level!!!

Becoming so deliberate in daily existence that we adopt it as default & stay out of PEM.

Not easy, but so worth it.

Thank you for this tool❤

[ambermartin]

Such a wonderful explanation. Even my loved ones who understand still seem to struggle with "but it's a happy emotion/event." I think that is still a link to the "connection to depression" or thoughts that "stress is only negative" thinking most of us learn.

I also want to add that digesting food takes more energy than people think. If I'm flaring, I can't process certain foods well. When I was mostly housebound, anorexia (not nervousa) was one of my notable symptoms.

[mashr]

Yeah, well doctors didn’t get me diagnosed till I was in the severe stage housebound/bedbound and now I’m worse. I don’t see myself getting better. I only see getting worse because that’s all that’s happening. My baseline is way too low. I can’t even function. It’s like dying every day, but you’re still alive.