I would like to comment that those of us who think/thought we have mild MG, because we haven't had a crisis yet, may have no idea about how much the disease is interfering in our lives. It sounds like you are progressing in your illness and Mestinon may not be enough, and something more may be necessary to treat the actual disease process. I don't know what your problem is with taking larger doses, I had horrid stomache ache to start with, but now up to 60 every 4 hours. But one thing I found was that chewing and not swallowing not only got into the system quicker, but bypassed the stomach ache. So if I have to take 60 without food now I take the first 30 under the tongue and the other 30 with water. (After a number of months, I could finally take 60 with food which prolongs the maximum blood level and enabled me to spread out the Mestinon to every four hours.) nc