My doctor actually gave me a schedule to follow initially & told me to tweak my mestinon as needed,as my symptoms required. He did the same thing when he switched me to neostigmine. As a matter of fact, he called me this week to see what my dosage of neostigmine was so he could call in my refill. I like the fact that he recognizes that I know my body & can tweak the dosage so long as I know the acceptable range. Lessening the brreathing issues played a big role in my new dose, so I can relate to your "heavy chest" comment. Good luck with the new neuro!!