You can have as many points as you wish!

Here is the Osserman Classification of Myasthenia Gravis.

http://emedicine.medscape.com/article/1171206-overview

The Myasthenia Gravis Foundation of America Clinical Classification divides MG into 5 main classes and several subclasses[3] :

Class I: Any ocular muscle weakness; may have weakness of eye closure; all other muscle strength is normal.

Class II: Mild weakness affecting other than ocular muscles; may also have ocular muscle weakness of any severity.

Class IIa: Predominantly affecting limb, axial muscles, or both; may also have lesser involvement of oropharyngeal muscles.

Class IIb: Predominantly affecting oropharyngeal, respiratory muscles, or both; may also have lesser or equal involvement of limb, axial muscles, or both.

Class III: Moderate weakness affecting other than ocular muscles; may also have ocular muscle weakness of any severity.

Class IIIa: Predominantly affecting limb, axial muscles, or both; may also have lesser involvement of oropharyngeal muscles.

Class IIIb: Predominantly affecting oropharyngeal, respiratory muscles, or both; may also have lesser or equal involvement of limb, axial muscles, or both.

Class IV: Severe weakness affecting other than ocular muscles; may also have ocular muscle weakness of any severity.

Class IVa: Predominantly affecting limb, axial muscles, or both; may also have lesser involvement of oropharyngeal muscles.

Class IVb: Predominantly affecting oropharyngeal, respiratory muscles, or both; may also have lesser or equal involvement of limb, axial muscles, or both; use of a feeding tube without intubation.

Class V: Defined by the need for intubation, with or without mechanical ventilation, except when used during routine postoperative management.

As you can see, there are subclasses within the II - IV classes above! So which subclass are you? This is used as an overall classification of how your MG is doing, not any particular muscle group or muscle strength.

When a doctor evaluates a patient for their level of muscle strength, they often list it as 3/5, for example. That is not the same "list of 5" as the above one. When I had my MG crisis, I was a 2/5. 5/5 is the best you can be, 1/5 the worst. They "rate" each muscle area (i.e., legs) or give an overall listing. When I had my crisis, I couldn't open my eyes, lift my limbs, or breathe well. To the dismay of my doctors, my speaking muscles had been spared.

The problem with this algorithm is that MG fluctuates. A MG patient can be a 1/5 in the morning and, if they're out in the heat doing things, they can progress to a 4/5 by afternoon. It all depends on how they are overall (stable or not), and many other factors such as what drugs they're on or what other conditions they have. And if you use your arms a lot, for example, they might be 2/5 while your legs are 4/5.

No, I didn't miss the stupid part where you drove to the hospital! 911 is always best in those potentially life threatening situations. What . . . are you of Norwegian ancestry (as I am)? I should temper that by saying that I've been known to drive myself in when I probably shouldn't have, too.

You should know that a drop in adrenal function can affect the heart. Your history is exactly why I was so adamant about you going to the ER! I'm sorry you've had 3 heart attacks. I hope you won't have another.

But that brings up another point. When MG gets worse, the heart beats harder to get us oxygen. The pulse will go up. When the heart can't get enough oxygen to the body, the oxygen saturation goes down. It might be a good idea for you to buy an oximeter, so that you can monitor how you're doing. Also, a pulmonologist can assess your O2 overnight (at home) to see if any apnea (from MG or not) is being hard on your heart, too.

Kudos to your primary doctor!!! How cool is that? I LOVE when doctors want to learn more. It shows a real dedication to the craft of doctoring.

While on Pred, you should take calcium and vitamin D (at the same time). Or do you already? Also, krill, flax, fish or any other omega is a good idea to take daily, too, especially with stomach issues. Omegas keep the gel coating of the stomach healthy and can help prevent bleed issues. Pred is an anti-prostaglandin, which is why good prostaglandins (omegas) are good to take.

I highly suggest a physical therapist. They can help you get any knots out of your back muscles, so some ultrasonic massage, and give you other tips to keep it as good as possible. Now that I know what to do, I can deal with it at home. I grind into those damn knots as soon as possible. With pain, it's always best to deal with it right away. A long-handled, electric massager is great to have around!

Do you have migraines on a regular basis?

As far as the to-be-expected grieving process after getting a disease goes, allow yourself to feel whatever "stage" of grief you're feeling. I don't think I will ever reach the "acceptance" stage because MG is our constant companion.

What can help to get through living with MG is to set yourself up for success in all aspects of your life. You already got a new place, which is great. You have good docs. You're smart, curious, and are asking good questions. You can go to www.myasthenia.org to get more info or just bug us.

You can reevaluate your environment to see if there are things you can do there (childproof it so that you don't trip, etc.). Sit when you can (i.e., shower while sitting). Cool off right away if you are hot. Know that socializing is probably the most draining activity you can do (uses a lot of muscle groups at once). See a psychologist if necessary to vent (really helps). And so many other things.

Whatever you do, don't pooh-pooh any new symptoms, like doctors tend to do. And don't assume they're MG-related.

Okay, that's a lot more than what you asked for. I hope all of that helps. What else can we all tell you about MG?



Annie