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I had the same problems, however when I got up to 10 Plasmapheresis 2 to 3 days apart. I was good for 8 months without any Pyridostigmine. I just finished second round of Vyvgart which is great. Be proactive and have your doctor prescribe it immediately. A few months ago I was in crisis, checked myself in hospital in Chicago, was fed via tube for 4 days. After Vyvgart I dropped the Pyridostigmine (Mestinon). My neurologist told me to take it only if I need it. It was affective only for an hour anyway. Now I am taking only 10 mg of Prednisone and nothing else. I lost weight, tough to regain it back. Some neurologists and more proactive than other. Also it may depend what city you live in and the doctors experience. Interesting that people on this forum seek recommendation but do not mention where they live. I am only 72 years old so any inner neurological trigger starts the MG facial, throat, tongue and lips malfunctions. Hope this info helps.