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For me it’s fatigue, which will bring on not being able to hold my head up, and swallowing and breathing issues. I walk slowly anyway due to severe osteoporosis which helps to conserve strength and get through the day. I usually crash about 2-4pm and take another dose of Pyridostigmine to make it to my 7pm dose. I also do a lot of standing and some stretching exercises while holding onto something, and as many chores sitting as I can. I drink fortified almond milk with collagen protein powder 3x a day and a lot of plant based proteins, vegetables and supplements. It’s hard chewing meats but I try to make the effort each day. So far I’ve been fairly stable on 60mg 3x a day but I’m feeling more tired and weak as I’ve lost 20 lbs on my very small frame in a year. Always seeking another way to fortify my nutrition.