DEAR DR. GOTT: I have myasthenia gravis and am under good care. These are my symptoms: low energy, shortness-of-breath, shaking, sluggish bowels, cramps in hands and legs, blurring vision some times, and my voice is raspy.
My medications are prednisone, Benicar, baby aspirin, vitamin D all daily and Pyridostigmine four times a day.
I would appreciate any additional information. I’m a 79-year-old male.
DEAR READER: Myasthenia gravis is an autoimmune disorder in which the immune system incorrectly attacks voluntary muscle cells. In your instance, your body produces antibodies that block cells known as neurotransmitters from receiving messages from nerve cells. Oddly, the condition commonly affects younger women and older men. Although any voluntary muscles within the body can be affected, certain ones seem to be involved more frequently, to include those of the eyes, face, throat, limbs, and neck.
You have fairly typical symptoms but other common ones include difficulty maintaining a steady gaze, eyelid drooping, problems swallowing, difficulty climbing stairs or lifting objects, and facial paralysis. Individuals with specific disorders such as hyper/hypothyroidism and pernicious anemia appear more prone to developing myasthenia gravis.
Diagnosis may be accomplished through blood testing that might signify the presence of abnormal antibodies that disrupt those receptor sites where nerve impulses signal muscles to move. An EMG measures electrical activity of the muscles. A nerve conduction study, which can be performed at the same time, provides information about nerve and muscle interaction. An MRI or CT can confirm or rule out a tumor or other abnormality of the thymus gland. And, a specific nerve conduction study can measure the ability of your nerves to send signals to your muscles.
In large part, your treatment may be geared toward lifestyle changes such as avoiding stressful situations and exposure to heat — both of which can worsen your symptoms — wearing an eye patch for your double vision, and scheduling rest periods throughout the day. You’re already on several medications that are known to help with your symptoms. Beyond those, plasmapheresis may be used for weakness involving the muscles you use to breathe. With this technique, plasma (containing antibodies) is removed from your body and replaced with donated, antibody-free plasma or other fluids. This procedure may help reduce symptoms for up to six weeks. An alternative is intravenous immunoglobulin infusion in which a major amount of antibodies are given directly into the bloodstream. A procedure known as thymectomy that removes the thymus, an organ involved in the development of cells of the immune system, may result in permanent remission or in a need for less medication that you may be presently taking. The thymus gland is located at the base of the neck/upper chest beneath your breastbone. In healthy adults, the gland is relatively small; however, in some adults diagnosed with myasthenia gravis, it becomes unusually large. Almost 15% of all people with your condition are known to have tumors on the gland but the good news here is that the tumors are generally non-cancerous in nature.
Long-term stabilization and/or remission are possible; however it may be necessary for you to modify your lifestyle. Plan any activities, whether they may include exercising or simply eating a meal, at times when you feel most up to the task. And, be sure to stay in contact with your physician should any symptoms exacerbate. Good luck.