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Chris,
First off, it sounds like you have a wonderful ophthalmologist. That was a good catch.
My particular issues with MG haven’t been ocular, but I have a close friend who does. When she has flair-ups, her neurologist tends to put her on a moderate prednisone protocol which tapers off after a couple weeks. That and tweaking the Mestinon for awhile seems to really help her.
Interestingly, a similar approach has worked for me — and I have what I guess is called generalized MG. While RV camping a couple summers ago at 7200 elevation, I began to experience extreme muscle fatigue and mildly labored breathing, especially when I lay down to sleep (weird). We got off the mountain the next day and things got a bit better. I also went and had any heart issues ruled out.
I had experienced that same kind of muscle weakness before from the MG, but not the breathing issues. When the heart and blood tests came back showing no issues, my neurologist put me on a 3 week protocol of prednisone. The results were almost immediate. I’m now on 1 10mg pill of prednisone per day, along with 2 Mestinon every 4-5 hours, and I’ve been doing pretty well. We even took the same trip this past summer and there were no issues.
It will be interesting to see what the summer brings for you (I don’t know if you live in a hot climate). Some find that their MG does tend to flare up in the heat of the day. Just be aware that you may need to pace yourself.
Best of luck to you —