this is indeed possible, as steroids have a direct effect on the muscle, apart from their effect on the immune system. so possibly you are a bit stronger in the first few hours after you take it. you can just try to take the mestinon a few hours later and see if you are any better. also, if you drink coffee in the morning, this too can have an effect on your muscles (in a relatively complex mechanism), which can add to it all.

just give yourself time to get to know how different things affect you, and don't be afraid to experiment with it. after all a lot of what we do (even as physicians) is trial and error.

many neurologists will tell you that when patients take alternate days of steroids they are much better on the day they take them, then on the day they don't. this is most likely due to a direct metabolic effect on the muscle as the immune system doesn't work that way. and you can't have good immunsupression one day and less good on the next.

also, it is not only taking the pred. in the morning vs. the evening. it is taking it early, eg-6-7 AM. I found that to me it made a very big difference if I took them at 6 or at 8. and when I was on relatively high doses I tried to take them no later then 6:30. it may of course be different for someone else. and I also had very severe side effects. the most important being that it had a very negative effect on my muscles. ( which is rare in MG, but does happen).

hope this helps, I know it is a bit confusing, and I hope that your doc. will help in clearing the haze a bit more.

alice