Since my surgery, I've been having a major flare of MG....I wake up in the morning with garbly, mushy, thick speech (similar to the Godfather--but worse...I should be an impersonator lol)...My speech is like this as soon as I start talking. It does get worse the longer I talk, but the idea that the weakness/semi-paralysis can only occur after repeated use seems incorrect to me....Whenever my MG's bad, it's bad from the get-go...Also, my tongue is constantly fat and pale looking when I'm weak...When I have a plasma exchange, or mestinon decides to work, my tongue goes back to being very red and 'thin.' Weird!