Brief Answer:
I cannot see your submitted reports---sorry--check with Tech support?

Detailed Answer:
Good evening.

Thank you for submitting your question and I'm afraid to wherever you sent your notes they are not here with these questions for me to view. However, you certainly can upload them as .pdf documents if you'd like. I don't know the technical aspects of doing that....I'm but a lowly neurologist....however, all you need do is contact the Customer Service people and they can certainly lend a hand if needed.

Well, if you are asking about the workup for "fatigue, lethargy, generalized weakness, lack of stamina, feeling blase, just not centered," or any other number of references that people use to describe feeling NOT QUITE LIKE I USED TO....then, unfortunately, the potential list of problems goes into the exponential stratosphere. However, fortunately, you've narrowed down a few layers for us and given some information which I believe is pertinent.

Whenever I work someone up for symptoms of GENERAL TIREDNESS or NAGGING WEAKNESS then, there are a few things that I need to look at immediately, if not sooner, before going on to more complicated problems. Very akin to plugging the TV into the wall before trying to figure out why it's not turning on.

Medications turn out to be one of the major causes why people in general feel tired or more fatigued than usual. Not only that but physicians are not as sensitive to this statistic and therefore, don't necessarily pay as much attention to medication lists as they should and go on to look for other less common or less likely causes.

Unfortunately, I cannot see your medication list because you have submitted them to some part of this network which doesn't show up here, however, of the medications that you're taking I can tell you that I was unable to find any interactions between your aza/pyrido/niacin that could cause fatigue. The pyridostimine can lead to weakness and fatigue even though it is your primary medication to combat your MG. Those are what we would refer to as paradoxical side effects of the drug. Azathioprine isn't known to directly cause fatigue but it can cause bone marrow suppression which can result in reduction of produced blood cells such as RBC's which would potentially be related to any type of ANEMIA that could also be a cause for your symptoms.

You did not mention anything having to do with recent checks on your thyroid and parathyroid gland status. Assuming there's a history for it- perhaps an expanded thyroid panel can be done or at least a screening for parathyroid dysfunction while looking at serum calcium and ionized calcium.

I understand that you're very active going to the gym 2x/week even after had cardiac ablations, a-fib, and then, implantation of a DBS system.....that's pretty rugged there sailor! I'm a bit athletic myself...hope I'm like you when I "grow up"...but now, consider this...and please do not misinterpret what I'm saying but one very overlooked cause of generalized fatigue is either LACK OF (which it doesn't look like you have) or REDUCED physical activity....and perhaps, one would argue that you certainly don't have reduced physical activity...compared to your peers....but if we really want to take an HONEST INVENTORY of the possible things that you can do that are totally within your control, don't require the use of more medication, or devices, and has been PROVEN to improve feelings of tiredness....it's INCREASING WHATEVER YOUR BASELINE activity is. Remember, the body quickly gets used to whatever it's doing and that becomes the routine....the BASELINE if you will. And if a person does not push the body to go beyond that routine at some point to try and reach a bit higher in terms of stamina, strength, agility, speed....then, the body's functional production will become Plateaued.

I always tell people....EXERCISE is that which you do that is ABOVE AND BEYOND your normal daily routine activities. So, if a person is a construction worker, or a harried housewife and both lift heavy loads and walk long distances daily in order to do their jobs well.....that STILL DOES NOT COUNT as any form of exercise. What those 2 people need to do is a REGIMENTED, CONSISTENT, and CHALLENGING routine of additional physical tasks that cause the heartrate and muscle contractions throughout the body to exceed the norms by a minimum of 20-40%.

In addition, that amount of work needs to be maintained for about 20-30 min.

Having said all that about your physical activity levels I am very cognizant of your condition of MG and how that needs to be taken into serious consideration when you discuss escalating your levels of activity because there is such a thing as OVERDOING it in MG...then, your fatigue levels will increase by orders of magnitude as a consequence and in response to the lack of your muscles to respond to the release of acetylcholine packets into the synaptic cleft which then, results in an overflow of Ach into the muscle which is neither metabolized nor able to cause a response in the muscle....upshot? Cholinergic side effects of weakness and fatigue.

But if you'd like to try and increase your physical activity level just a TAD and see if that can make you kick up the thermostat's set point that would be one way I could see something happening.

Now, when you say you have OCULAR MYASTHENIA that has been stable for 3 years and not "spread to the rest of my body"....I'm not trying to dispute that your MG has been well controlled but if we again are looking for any and all possible explanations to how you're feeling then, we must look at your condition of MG which is autoimmune and as well controlled as it may be in terms of portion of the body affected in a clinical way...we cannot lose sight of the fact, that all the same it is an autoimmune disease that does have the propensity and characteristic of WEAKNESS. Therefore, has your neurologist done a thorough and general survey of your body muscles looking for some deficit that can be quantified using dynamometry, functional load testing, or some other objective means of detecting small differences in muscle strength or stamina, charting that, and then, following it through time to determine if and to what extent the MG may being breaking through to other muscles in the body outside the head?

BTW, I'm an assistant wrestling coach at for the Varsity Men's team at a Division III University, XXXXXXX XXXXXXX University, and at 56 I still actively compete in tournaments against the young bucks....never gone to a Masters Tournament yet....because I won't let my thermostat set point settle. It is more challenging as I get older to maintain the same levels of work and stamina...but the nice thing is I can quantify that ability season to season since we don't really change our routines for guys who are 18-24 years of age which means the level of difficulty and sophistication of training exercises is pretty constant and high....so I know that if I'm working at that level I'll always maintain a high sense of awareness, alertness, and physical stamina. I do not have MG and so that's not a factor but if I did I would look for a way of pacing my energy output throughout the day and still try to maintain the same daily caloric output without highly concentrating it at any given time and then, literally making it impossible for me to move or function until I've totally recovered....PACING....big part of having MG......How about aquatherapy?

That could be something that your doctor could recommend you do as an additional part of your daily routine of 2x/week....perhaps, you could do the aquatherapy/aqua-aerobics on a 3rd day by itself....something not too terribly taxing but enough so that your body knows you want it to work a bit.

If I've satisfactorily addressed your question could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and if you think maybe a 5 star rating could describe our interaction? Again, many thanks for posing your question.

Do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 85 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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