That made me laugh! Rectus (abdominal) muscles don't cause eye issues!

Even athletes can have heart issues. And, if you have MG, apnea is also a possible problem. There was a bodyguard here several years back whose MG made him feel as wobbly as a newborn kitten. How in shape someone is doesn't matter when an illness is involved.

I think that semantics are getting in the way here. Fatigue can mean sleepy. But when neurologists use that word, they mean that muscles are weak. Fatigable muscle weakness is the hallmark of MG.

Normal eye muscles, for example, do not fatigue or become weak. If the cause of vision issues is fatigable weak muscles, then the cause is usually MG/CMS/LEMS. A good neuro-ophthalmologist will find double vision upon a specialized exam (and droopy eyelids/ptosis).

Vision issues that are not due to MG do not involve fatigable muscles. There can be "static" muscle weakness that does not come and go, such as that in multiple sclerosis (secondary to nerve damage).

The next time you have vision issues, take a photo of your face. If you don't have droopy eyelids, then the issue might be from something other than MG.

I had ptosis/droopy eyelids my entire life. I did not get diagnosed with MG until I was 41. No one noticed my eyelid droop, but it was clearly in all my photos.

For MG patients, an overall fatigue is when the entire tank of muscle gas (acetylcholine) is running low. For example, if someone with MG goes for a walk (and their MG is not well-controlled), their legs might be weak right away and throughout the next couple of days. But when someone does physical activity, such as chasing cows, many of the 640 skeletal muscles will be overused and losing acetylcholine. That is what causes an overall fatigue, often to the point of the body needing to sleep (or literally putting us to sleep).

Is that what is happening with you? I have no idea.

You say that you are having vision issues, and yet you also say that you are overall fatigued/worn out. I hope the doctors will think about other possible diseases, such as polymyositis.

Mestinon helps if someone hasn't done too much. At some point, Mestinon might not appear to help. But it does help those with MG, even if results can't be seen.

A thyroid problem or diabetes can cause overall fatigue (and eye issues). Many things can. I just think that some more investigating/thinking might be necessary. I'm sure that you'd like to have proof of what is going on, especially before deciding on taking powerful drugs such as steroids.

Might you have a congenital myasthenic syndrome? That's possible. Does anyone else in your family have these issues?

Do you stay hydrated during an activity? Just wondering.

They could do the MuSK or LRP4 antibodies. And with ocular MG, the AChR antibodies don't necessarily show up right away.

I really hope someone can figure out what is going on. Vision issues are not fun. In the meantime, why don't you ask a primary doctor to check your vitamin B12, vitamin D, thyroid, and do a metabolic panel (if they haven't been done already). That certainly couldn't hurt.

Annie