This is very difficult question! I can only guess we will probably never know the answer to this. I can't imagine any way in which the physiological v. the placebo effect of any drug can be adequately qualified. How do I know for sure when I am having a placebo effect? How can anyone know unless they get inside my body and do some kind of imaginary physiological testing that proves one way or anther what it is or is not?

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• If the disorder also produces positive neurophysiological tests then yes, how can you tell which is which?

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As I understand (and I may be wrong because I'm not qualified in these things), the main positive neurophysiological sign for weakness of a psychosomatic nature is something called Hoover's sign. This is when the physician asks the patient to lift a leg, which may appear weak. However, when the physician then asks the patient to lift the opposite leg he cups the heel of the other foot to see if pressure is exerted downwards, thereby revealing the weakness as inconsistent.

Whether or not this feature may appear in MG or other diseases I do not know.

But I do not this is one of the main diagnostic signs for psychosomatic,as opposed to other forms of weakness.

This is one of the things I find puzzling about my diagnosis. I have never been able to lift my leg when asked. On first attempt my leg does not rise from the bed, I immediately begin to grip the bed/walls with my arms and body to try to exert pressure from other parts to try and lift the leg. I am guessing I wouldn't be doing that if I were able to lift the leg by merely exerting pressure downwards with the opposite heel. In fact, I don't recall a physician ever cupping my opposite heel in that way.

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• In general is it really possible to inhabit the profile of a disease, itīs symptoms and progression so precisely without prior knowledge of its mechanisms and not actually have the disease?

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I think this is also a complex question, because it is a lot to do with how we perceive our symptoms. Let me give you an example. I thought for a long time I had some kind of postural hypotension. I can't stand up very long and doing so causes me to faint. Equally, I have to keep my feet raised at all times otherwise I get palpitations. But then I began to wonder whether the same set of symptoms, from a different angle, could be explained by muscle weakness. Standing up the muscles get gradually weaker and give way. Sitting with you feet not raised takes more muscle action than sitting with them raised. Does this get me any further to classifying what it is? No. But it makes me realize that how I think about my disease has an impact on how I understand the underlying process.

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• I wonder if those with somatization/functional type disorders resembling MG are actually being treated correctly for them -
  Or is that asking too much when we already know that those with just physical MG symptoms can have a hard enough time
  finding a good neuro these days!!!!!

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From what I read I see a lot of people given functional treatment simply don't respond or see an improvement. I think it's about 50/50. I dare say there are many patients who are suffering from a repressed psychological problem that manifests itself physically and that can be managed through CBT, graded exercise and therapy.

My question is, as somebody who has already completed courses in CBT, and who maintains a good lifestyle through diet and exercise, and who has ALWAYS been very open in talking about thoughts and experiences to the extent that nothing is left buried, who has a strong network of friends and family who are supportive without being overbearing or threatening their sense of independence -- when the patient is doing all this, and is STILL getting progressively weaker, I wonder what they will offer?!? I'm looking forward to finding out on the 15th.


[/QUOTE]Wishing everyone a wonderful day [/QUOTE]
And you too Anacrusis. Thanking you for your inquiring mind and thought-provoking questions in helping me to understand this disease.


Wild_cat