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Jim, sorry to hear about your wife 🙁 I do believe her manifestation of symptoms is common. Symptoms spiraled for me the first 6 months until accurately diagnosed and stabilized on prednisone. Did doctors prescribe any immunosuppressant drugs or corticosteroids? Mestinon/pyridostigmine does not delay/prevent the progression of myasthenia gravis, it is a transient band-aid that lasts only few minutes/hours. In regards to regaining strength during the day, the only thing that helps for me is to take a good nap after being awake for few hours, and doing some neck and upper-back strengthening exercise only when I am feeling strong. I would not recommend doing any exercises when she is feeling weak as it can only worsen her symptoms.