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How to manage physical and daily activities with fatigue and post-exertional malaise (PEM)

Thu, 24 Jul 2025 18:45:31 GMT

If you're living with fatigue and post-exertional malaise (PEM), managing daily life can feel like walking a tightrope. One moment you’re doing okay, and the next—after what seems like a minor activity—you’re hit with overwhelming exhaustion, brain fog, and symptoms that can linger for days or even weeks.

You’re not lazy. You’re not failing. In fact, many people with PEM were once highly active—working full-time, parenting, exercising—before their condition changed their capacity to function. It’s not a matter of motivation or willpower. It’s about physiology.

At ReStory, we understand how real and frustrating PEM is. That’s why we take a compassionate, science-backed approach to help you manage it. Here’s how to begin.

What Is PEM, Really?

Post-exertional malaise is a delayed and prolonged worsening of symptoms after physical or mental exertion. Unlike typical fatigue, PEM doesn’t improve with a nap or good night’s sleep—and the symptoms are often disproportionate to the activity that triggered them.

PEM can affect multiple body systems at once. You might notice:

Intense fatigue
Brain fog
Worsened pain
Flare-ups of neurological or flu-like symptoms
Poor temperature regulation
Dizziness or weakness

This response isn’t just “in your head.” It’s a dysregulation in how your body processes exertion, and it demands a new way of approaching activity.

Step One: Learn (and Respect) Your “Wall”

PEM happens when your body’s energy system is pushed beyond its current capacity—what we call “your wall.” Everyone’s wall is different, and it can shift over time. Your job is to learn where your wall is right now and to respect it.

Start by identifying what triggers your PEM:

Physical activity (even light housework or self-care)
Cognitive effort (reading, screen time, decision-making)
Social interaction (conversations, texting, meetings)
Emotional stress (positive or negative)
Sensory input (light, sound, motion)
Standing or upright posture (orthostatic stress)
Environmental factors (heat, cold, chemicals, fragrances)

Tracking these triggers gives you valuable insight for daily pacing—and crucial data to share with your healthcare providers.

Step Two: Use the 4 P’s

Once you understand your limits, the goal is to reduce unnecessary exertion while still living meaningfully. The “4 P’s” can help you do that:

Pace: Break up activities, schedule intentional rest, and avoid back-to-back tasks.
Prioritize: Decide what must be done today. Let go of what isn’t essential—or ask for help.
Position: Choose body positions that conserve energy. Sitting with back support, elevating your legs, or lying down can drastically reduce energy output.
Plan: If you know you’ll have an activity (like an appointment or social event), build in rest before and after to soften the impact and support recovery.

Step Three: Respond Early and Kindly

Even with the best planning, PEM can still happen. When it does, it’s important to respond quickly and gently.

Immediate recovery tips:

Stop all activity and rest in a quiet, dark space
Hydrate with water and electrolytes
Minimize sensory input (noise, light, movement)

Long-term prevention strategies:

Build extra rest into your schedule after any planned exertion (even physical therapy!)
Learn to recognize early signs of PEM, like rising fatigue or irritability, and adjust your day before symptoms escalate

This early response can mean the difference between a short flare and a long, debilitating crash.

You Don’t Have to Figure This Out Alone

At ReStory, we specialize in helping people navigate PEM with compassion and evidence-based strategies. Whether you’re managing Long COVID, chronic fatigue, or another complex health condition, we’re here to help you move forward—without overdoing it.

Schedule a free consult today to gain personalized strategies for managing PEM and making daily life more manageable.

Hoppers M, Yellman B, Bateman L, et al. Clinical Care Guide: Managing ME/CFS, Long COVID, and Infection-Associated Chronic Conditions (IACC’s). Bateman Horne Center, 2025: 13-17.

How to Enjoy and Sustain Physical Activity After Bariatric Surgery

Thu, 24 Jul 2025 18:29:11 GMT

Using the E.A.S.Y. Framework to Build Confidence and Momentum

When recovering from bariatric surgery, movement can become one of the most powerful tools in your wellness journey—but only if it feels achievable, supportive, and aligned with your life.

That’s why Dr. Thobaben created the E.A.S.Y. framework: a simple, thoughtful way to reintroduce physical activity in a way that honors your body and your goals.

E.A.S.Y. stands for Enjoyable, Accountable, Sustainable, and Say Yes—four interdependent pillars that help you build lasting, meaningful movement habits.

E is for Enjoyable

The best kind of physical activity is the kind you want to return to. But for many people, especially those recovering from surgery, the idea of “enjoyable” movement can feel far away or unrealistic. That’s okay. The first step is to get curious about what feels good —and explore movement on your terms.

Consider:

Do you prefer being outdoors, indoors, or a bit of both?
Would you enjoy moving with a friend or family member—or do you prefer solo time?
Does a structured class feel supportive, or would you rather set your own pace?
Are there types of movement you’ve enjoyed in the past—walking, dancing, swimming, lifting?

The goal is not perfection. It’s reconnecting with what brings you energy and joy.

A is for Accountable

Accountability isn’t about pressure—it’s about having support systems that help you stay connected to your goals, especially on hard days. Even when motivation dips (which it will), a bit of structure can keep you grounded.

Ways to build accountability:

Set simple, realistic goals and track your progress
Check in regularly with a trusted friend, therapist, or coach
Keep your “why” visible—whether it’s mobility, confidence, or long-term health
Celebrate small wins. A short walk counts. So does stretching or dancing in your kitchen.

Remember: all movement counts. Give yourself credit.

S is for Sustainable

Sustainable movement is safe, consistent, and kind to your body. It means you don’t pay for it the next day with pain, fatigue, or burnout.

Here’s how to keep it sustainable:

Start slow when trying something new—steady progress beats fast starts
Support your body with solid nutrition, hydration, and sleep
Ask for help when needed—from a physical therapist, trainer, or coach

Sustainability means you can keep saying “yes” to movement over time—because it works with your life, not against it.

Y is for Say Yes

This is where it all comes together. Saying “yes” to intentional movement—on good days and not-so-good ones— builds confidence and helps momentum grow over time. It doesn’t need to be big or impressive. It just needs to happen.

Each time you say yes, you reinforce that your body is capable of healing, progress, and strength.

Ready to Make Movement E.A.S.Y.?

You don’t have to do it alone. ReStory offers virtual support to help you build a plan that honors your experience and helps you move forward with confidence.

Schedule a free consult today to create your personalized E.A.S.Y. framework and begin your journey to sustainable movement.

How to Ask for (and Get) Person-Centered Care When You Have a Complex Chronic Condition

Thu, 10 Jul 2025 05:02:15 GMT

Living with a complex chronic health condition—whether it's ME/CFS, Long COVID, EDS, POTS, fibromyalgia, or another long-term diagnosis—often means navigating not just symptoms, but systems that weren’t designed with you in mind.

You may have experienced appointments where your story was rushed, misunderstood, or reduced to lab values and symptom checklists. Maybe you've left feeling unheard or even blamed. You’re not alone.

At ReStory , we believe that the way care is delivered matters just as much as what care is delivered. That’s the essence of person-centered care —and yes, you deserve it. Here’s how to advocate for it in medical spaces, even when it's hard.

1. Know What Person-Centered Care Looks Like

Before asking for it, it helps to define it. Person-centered care means:

You are seen as a whole person, not just a diagnosis
Your lived experience is valued as essential clinical information
Your preferences, goals, and values help shape your care plan
Communication is collaborative, not one-way
You are allowed to ask questions, take time, and say "no"

This isn’t a special favor—it’s a basic standard of ethical care. But in complex or high-pressure settings, it often gets lost. Naming it helps.

2. Bring Your Story Into the Room

Complex conditions don’t always fit neatly into a 15-minute appointment box. If you have a nuanced history, summarize key patterns and priorities in writing ahead of time:

A 1-page health history timeline or symptom overview
A list of things that help vs. worsen your condition
Your top 1–2 goals for the visit (e.g., “rule out X,” “update treatment plan,” “ask about referrals”)

This can ease your cognitive load and give your provider a better chance to understand the full picture.

3. Use Grounding Language to Advocate Without Conflict

It’s possible to advocate for yourself without being adversarial . You can name what you need with calm, clear phrases like:

“It’s helpful when I feel included in decisions about my care.”
“What you’re describing makes sense. Can we also explore X based on what I’ve experienced?”
“My body tends to respond differently than expected. I’d love to walk through what’s worked and what hasn’t.”
“Would you be open to co-creating a care plan together?”

Most providers want to help. Giving them a pathway to meet you in partnership can shift the dynamic.

4. Ask These Specific Questions

Sometimes you just need the right question to reframe the conversation. Try asking:

“How do you usually approach care for patients with overlapping conditions like mine?”
“What would a person-centered version of this treatment look like for someone like me?”
“If this doesn’t work, what’s our next step together?”
“How can we measure progress in a way that matches my lived experience?”

These invite collaboration instead of compliance.

5. Know You Can Redirect—or Opt Out

If a provider seems dismissive, rushed, or rigid, you can reset the tone by saying:

“Actually, I’d like to focus on how this is affecting my daily life.”
“That approach hasn’t worked well for me in the past. I’m open to alternatives.”

And if a provider consistently disregards your input or autonomy, it’s okay to leave. Seeking care elsewhere isn’t quitting—it’s reclaiming your right to be treated with respect.

You Are Not Asking for Too Much

Your needs are not too complicated. Your story is not too long. Your voice is not too loud.
You are allowed to ask for care that sees you.

And if you’ve never had that experience before—we want you to know: person-centered care is possible. It may take persistence, but it is worth seeking, and you don’t have to do it alone.

Book a free consult today to speak with Dr. Thobaben and take the next step towards getting the care you deserve.