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My vocal cords are keenly affected by MG. Talking is often difficult. I’m always hoarse to some degree and often need to whisper. Mestinon helps during the first 2 hours after taking it. But should I try to produce any volume, my vocal cords will freeze for a second or two, causing me to choke. My right vocal cord is partially closed all the time and I am conscious of it all the time. My muscles weaken with use; but I have learned how to manage them and have to rest most of the day. I am very lucky in that after getting MG controlled after my initial diagnosis; I had 16 years of minor symptoms before a dramatic return which has disabled me. I subscribe to spoon theory and make sure I don’t over tax myself. That alone can be intrusive. But worrying about vocal cord paralysis is the most intrusive.