Peter - Have you tried taking something to block the side effects of Mestinon (ie, the cramping), such as glycoppyrollate or hyoscyamine? I take Hyomax-SR .375mg (hyoscyamine) 2 times a day, and have no problems with the Mestinon side effects (including the severe cramping), even if I take the Mestinon on an empty stomach (which I do on a regular basis). I do know some people who have problems even with the glycoppyrollate or hyoscyamine, so it may not work for you. But, it might be worth asking your neurologist / gastroenterologist / anesthesiologist about it.