It's great that he's seeing a doctor with experience in both ALS and MG.

Here's what I know about Mestinon doses. Yes, 60 mg. at a time is the typical starting dose. Mestinon has a really short half-life. About four hours after you take it, it's already working only half as well. That's why when people go to their doctors and say that the Mestinon works well, but only for the first couple of hours after they take it, the doctor will increase the frequency instead of increasing the dose. If 60mg was too high a dose for your fiance, I don't know if that would mean he'd feel stronger after it wore off a bit or not.

I know this is emotionally extremely hard, both for your fiance who is strong-willed, and for you who have to struggle to get him to go to a doctor. Being undiagnosed, with scary symptoms, is emotionally brutal. You feel like if you just knew what was going on, you could be strong and face it, but how can you face it if you don't know what you're facing? I hope you get answers soon.

Abby