Make Visible: Complex Chronic Illness Explored

#20 Practical guide to pacing and managing Post Exertional Malaise (PEM) with Dr Melanie Hoppers, Bateman Horne Center

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Aug 14, 2025

In this insightful discussion, Dr. Melanie Hoppers, an internist and pediatrician at the Bateman Horne Center, shares her holistic approach to treating chronic illnesses, especially ME/CFS. Drawing from her experience as a mother and clinician, she discusses effective strategies for managing Post Exertional Malaise (PEM), including heart rate monitoring and daily symptom documentation. The conversation also highlights the role of wearable technology in empowering patients to take control of their health and navigate the complexities of chronic illness.

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ANECDOTE

Daughter's Illness Shaped Her Practice

Melanie's daughter fell ill with ME-CFS in 2015, prompting Melanie to seek specialists and learn pacing.
Personal experience changed her clinical approach and led her to the Bateman Horne Center.

ANECDOTE

Seizures Improved After Treating MCAS

Melanie treated a teen's seizures by addressing suspected MCAS and saw seizures drop dramatically.
This example convinced her to learn more and build clinical guidance for complex cases.

INSIGHT

PEM Is An Energy-Threshold Problem

Post-exertional malaise (PEM) is an impaired recovery after exceeding an individual energy threshold.
PEM can be delayed by days and includes new or worsened symptoms beyond simple fatigue.

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Bateman Horne Center internist and paediatrician, Dr Melanie Hoppers, has always been driven to approach her patients’ treatment with a holistic strategy, combining first line medicines with lifestyle, diet, stress reduction and movement. But in 2015, when her daughter became sick with ME/CFS, it became an even more personal mission to understand, treat and create frameworks to assist people with chronic illness.

Under the guidance of Dr Lucinda Bateman, and drawing on the expertise of her colleagues at the Bateman Horne Center, Dr Hoppers has ploughed her energy into helping patients to understand their conditions and their bodies, employing FDA approved drugs with lifestyle measures to make gains in their health and mitigate crashes.

In this week’s episode Dr Hoppers talks through her primary strategies for pacing and managing post-exertional malaise (PEM) to enable patients to regain some control over their illness. Drawing on her personal experiences with her daughter, along with treating hundreds of people in-person and through telehealth, she shares her ideas and resources that people can use at home – from monitoring your morning heart rate, to documenting symptom flares and activities, this episode is packed full of real life strategies to help understand and monitor your illness, and advocate for yourself with healthcare professionals and family members.

We also discuss the Bateman Horne Center’s Clinical Care Guide offering advice to patients and healthcare professionals in the diagnosis and management of ME/CFS, Long Covid, IACCs and the multiple co-morbidities that make these conditions inherently complex:

Bateman Horne Center Clinical Care Guide

Further BHC Resources for patients and professionals:

Crash Survival Guide: practical strategies to manage PEM and prevent crashes

Brief Educational videos:

NASA Lean Test Instructions

ER and Urgent Care Considerations for ME/CFS

A Mother’s Perspective – Dr Melanie Hoppers advocating for children, and advice for other parents

Make Visible

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@visible.health