Hi Barbara,
Imuran may take several months (6 or more…) to be effective, thus as others suggested, you need something to help you in the meantime, IVIG or plasmapheresis.
There is also something else, an increase of your Mestinon intake. I presently take 3x60mg/d but 3 weeks ago, during our vacations in Sicily, the first 2 days were rather difficult: the mornings and afternoons visits plus the heat (July temperatures, they said…), so I took 60mg more: 7am-1pm-7pm and 11pm and the fatigue went away! I was even doing better than my wife…!
So talk also to your neuro about inscreasing Mestinon.
Maurice.