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I believe my first signs occurred about 3 years ago. I was an avid walker, sometimes as much as 7 miles. I started feeling a tugging on my diaphragm causing me to stoop over and causing breathing problems. This went on for a year and then stopped. Another year passed and it returned but worse. Then my neck got involved, partially due to RA and I was getting more classic symptoms like swallowing and chewing. Finally my MD sent me to a neurologist and my concerns were validated. Mestinon seems to be handling the problem and I try and exercise daily along with oral exercises.