Hi and welcome, Chromatic. Interesting name.

MG is what is considered a "head and down" disease. It often starts with facial symptoms such as ptosis (toe-sis), a.k.a. droopy eyelids, and neck weakness. Guess what neck weakness causes? Pain. If your neck muscles are weak, good luck holding up your head well. This muscle weakness can also lead to a odd headache. An x-ray or MRI can't "see" that muscle weakness. Only a clinical exam by a neurologist can!

Brain fog/cognitive function, or dysfunction, are still fairly general terms. Do you get more unable to focus or "think" after you do things? MG is all about muscle weakness upon exertion. So the more you do, the weaker you get and the more "brain fog" you can get. So if you have periods of being more alert and then do something and are worse, it could be MG.

For anything visual, you need to be seeing a neuro-ophthalmologist. Do not go to a "regular" optometrist. N-O's have the tools to see if you have double vision, if it is fatigable and what the possible causes are. Do your eyelids, eyebrows or any other facial features "droop?" Have you taken any photos of your face, like first thing in the morning after a refreshing night's sleep and then again later in the day? That can be very revealing.

Muscle weakness can be caused by many things but it is indeed neurologists who are the specialists who evaluate that. Rheumatologists deal with "itis" or inflammatory diseases such as lupus. Were the RA Factor and Ankylosing Spondylitis tests positive or negative? Actually, there is not one specific test for AS. There is the HLA B27 blood test but that doesn't mean someone will get the disease. It's more of a clinical diagnosis.

MG is a clinical diagnosis, backed up with tests. It is so easy to have the Acetylcholine Receptor antibody tests done. They only do binding and modulating tests now and they should do both. They used to do blocking, and some still do, but they found it not to be diagnostically useful.

I hope I have addressed your basic concerns. You need to see a neurologist. I don't know any in your area. It might be a good idea to see a neuro-ophthalmologist first. And here's a heads up . . . neuros don't like patients who "think they know what is wrong with them." Very arrogant bunch of doctors, in my opinion. So it's good to stay very simple with them, like "My muscles feel weak" and wait for them to ask the questions.

If you are very weak or short of breath (are you?), then you need to seek out help in an ER. MG can be life threatening, especially when a person is undiagnosed and not on any meds. In case you do have MG, you need to seek that help out. There are meds that can make MG worse too. Are you on any medications for other conditions?

MG is not simple but it's fairly easy to diagnose if you get a good neurologist. I hope you will and get some answers.

Annie