Got into my chart at the university today as I noted I have online access now and this is the result of my recent pulmonogist visit. Thank heaven for Dr W. The 'pucker' thing that is noted I talked to him about and said that this is because without the mestinon in me I dont have the same control in my mouth muscles. I asked how to get around this. The bad thing is that when the 'doubters' in other departments look at that they make it about me doing it on purpose to change the results.

RESULTS REVIEWED Spirometry today shows a FEV1 of 1.98 L (73% predicted), FVC 2.38 L (68% predicted), and FEV/FVC ratio of 83.
Prior testing in February 2010 showed FEV1 of 2.25 L (81% predicted) and FVC 2.74 L (77% predicted).
Review of the 5 efforts performed today did not show a progressive fall in forced vital capacity with successive efforts.
Peak negative inspiratory force today was -45 cm water. This compared with previous NIF of -50, which increased to -91 post-Mestinon. It should also be noted that her pre-Mestinon NIF was when her cheeks were noted to "pucker," which can falsely increase the measured value. The post-Mestinon NIF was performed without this noted.
IMPRESSION AND RECOMMENDATIONS
Ms. Q. continues to have persistent decline in her functional capacity, with multiple systemic symptoms which are consistent with a neuromuscular process. She is scheduled to see Dr. M. next week for further evaluation of this. I think it might be useful to perform a Tensilon test (or equivalent) in the Pulmonary Function Laboratory (in a blinded fashion) if there continues to be uncertainty about the diagnosis of myasthenia gravis. I also feel she should have a swallowing study to look for objective evidence of neuromuscular dysfunction.

Annie59