Thanks all for the advice: I did sit and talk to the surgeon for almost 2 hours: he is advising a full sternal approach and radical thymectomy as the thing is huge.... and as he put it he doesn't want to have to go back in because he didn't get it all the first time....not good for me, not good for him....

We also discussed drugs as I do not react well to any narcotic (even before dx / knew I had MG)... he warned me upfront I'm probably gonna be in more pain than his usual patient as there are so many options he can't use either because of my reactions or the MG.... IV tylenol and toradol?- haven't heard of either....

I've been relatively stable on 60mg Mestinon q4 (just don't be late with it...) so he and the neuro want to reserve plasmapheresis / IVg as a big gun if I need it after surgery and will put in a line then to do it if needed - and the insurance company can't argue necessity at that point either....

One more complication to add to the mix:- after the surgeon looked over my history he told me "you are very inflammatory/hyper-reactive - i.e. you don't react well to much of anything that isn't you - which includes the vicrol they typically use for stitches - the last stitches i had to get for an ulnar nerve transposition - my body ejected them whole in blistery white bubbles.... not fun.... So he's got to find something as minimally reactive as possible and will be using staples outside......

The other interesting note: he's not going to wire me - because my job requires lifting he prefers to plate the sternum for more stability and feels it heals better... but I forgot to ask if that means I'm going to set of the metal detectors at the airport now