Tbreak as one with MG and Crohns disease I am very familiar with digestive issues. While this may not be the issue, the clue is that it happens after you eat. It sounds like you are getting some bloating which of course can make breathing with your diaphragm a bit harder.

If this does correspond to a time afer you eat, I would focus on what you eat. The simplest of dietary offenders is gluten, or the stuff that makes up breads, pastas, baked goods ets, anything with flour. If you can try having an evening meal with no or very little carbohydrates in it. Try having a meal with just some simple meats and veggies which will have no gluten in them for a couple of nights. If the problem goes away it may be a dietary intolerance. Also do not have any beer, try to have just a juice, wine or some other drink that it not based on beer or a wheat priduct.

I have been dealing with dietary issues for a lot of years and what you describe is quite familiar and due to at least for me anything with wheat flour in it. Its worth a try and you may very well feel better.

I hope you feel better soon....

Take care

Joe

You should play around with your mestinon times and dosages even perhaps. Talk to your doctor for peace of mind. Timing of medication can be a big difference. It was for me in my struggles. I would choke if I didn't time it right. For example, with Mestinon, try eating your dinner a little over an hour (maybe 1.5 hrs) AFTER you take mestinon and see if it helps. The reason it clears up around 9PM maybe because that is when the mestinon is reaching its full effect on you, especially after you have taken food in.

As a general guideline, Mestinon can last for 4-6 hrs and won't hit it peak until 2hrs in.

I don't know if this applies, I have noticed since I was diagnosed, I need to eat things that are fairly easy to digest, or I feel as though I've overeaten. Hope you feel better, and please keep us updated on this mystery.

I too suffer from digestive issues. Similar to Joe - this is at least partially attributed to MG (** I need to look into Crohns disease.)

My digestive issue has been diagnosed as slow motility of the GI tract. One of the symptoms of slow-motility: is a general inflammation of the GI tract, which gets aggravated after eating.
Resulting - in a ''full feeling'' - even when you have eaten very little.
This general-inflammation can also affect breathing, and the diaghram, which is adjacent to the GI tract.

With me, milk-products can often cause this bloating and discomfort. (** I also have to try a glutein-free diet.)
I have learned that the OTC Enzyme Lactaid - helps reduce this reaction to milk products, that are in my new OTC protein drink, called Pure Protein 35 Gram Protein.
My old doctor-prescribed protein drink, Jevity 1.2? It was soy-based and did not cause anywhere near as much bloating. I no longer qualify for the doctor-prescribed Jevity, and I have been unable to find an OTC soy-based protein drink/protein supplement - that my GI-tract can tolerate.

It's my belief that all this bloating and abdominal distress - is due to MG, attacking the vagus-nerve. The vagus-nerve carries signals from your brain, to many of your organs - including the stomach. If MG attacks the Acetylcholine-Receptors, all along the vagus-nerve? Well one of the results can be bloating, and a general-inflammation of the GI-tract. Anything - that disturbs the stomach - will have an effect on the rest of the GI-tract.

Here are a couple links, giving a description of the function of the vagus-nerve.
http://emedicine.medscape.com/article/1875813-overview
http://en.wikipedia.org/wiki/Vagus_nerve

I don't often rely on info - from Wikipedia. In this case, however? The Wiki link contains basically the same info, as the Medscape link - only the Wiki link is more readable, for non-professionals. (Not much, but a little.)

In both links, you will see listed all the organs, to which the vagus-nerve is connected. ** Note in particular, that another name for the vagus-nerve - is the ''pneumo-gastric nerve''.

OTC Prilosec - also helps to reduce the general-inflammation of my GI-tract. I see my Neuro next week, and will be asking for a prescription for Omeprazole, the prescription-strength version of Prilosec.
- Ross

I will apologize in advance for the length of this response. It's a doozy though.

Similar to Joe, I have dealt with digestive issues for many years so this is very familiar. Having said that, it could be a number of things so lets not tie it down to one possibility here. Mestinon has been known to cause bloating and indigestion. Gluten intolerance is a good guess too but there is also the possibility that it could be a gallbladder issue. If you had pizza, the fatty content could set off an attack which also causes bloating and pain.

The things that you should consider are as follows;
1. Does it happen at every meal or just at dinner time.
2. How long after you take your mestinon does it happen?
3. If you ate nothing, would you still get this attack?
4. If you eat a low fat meal, does this still occur?
5. If you eat a low or gluten free meal, does this still occur?
6. What kind of beverages are you having with your meal (soda?)?
7. Have you chewed gum or sucked on candies throughout the day?
8. Did you drink anything during the day that you used a straw with?
9. Did you experience any shortness of breath earlier in the day?
10. How much activity or exercise did you do during the earlier part of the day?

Some of the questions above (7 to 10) are because any of those things could cause you to ingest air throughout the day and the bloating isn't felt until later in the day. Gallbladder issues are very similar in that it filters toxins from the body but when it isn't functioning properly the toxins turn to air in the digestive system and thereby causing you to bloat. This is often described by patients as feeling like you have to "belch" or let go of a large air bubble.

I don't know what your physical build is but your age tells me that the gallbladder is a possibility. The medical catch phrase for a gallbladder attacks is fair, fat and 40. That basically means that the most common things associated with gallbladder sufferers is fair skin, obesity and 40 yrs of age and above. That doesn't mean that it's a requirement because I was skinny and 28 when I had my gallbladder surgery. I have to admit to the fair skin though. I almost glow in the dark, I'm so white. lol

If you haven't already, I would call your primary doctor and get an appointment. They can do an exam and gather some more details from your day to day experiences and go from there. No matter what they find you will need to share this information with your neuro. If you have to wait a while for an appointment I would follow a very bland diet and with as few carbs as possible. Only lean meats with a vegetable as Joe suggested. Minimize the spices and the especially the salt and any cheeses. Try to avoid veggies that have a high water or fiber content though. (Stick with simple vegetables like carrots, green beans, peas. Avoid the green leafy ones for now like broccoli, cucumbers, peppers, etc.)

I hope that you can figure this out soon. I know how uncomfortable the bloating and shortness of breath can be and I'm sorry that you are dealing with this on top of so much else.

Angie

More on the vagus-nerve.
http://www.md-health.com/Vagus-Nerve.html

Stick with fruits
veggies
and protein
That is what works best for me.
After a couple weeks you introduce new foods such as eggs.
This may save you a lot of work.
A book called the Virgin Diet has helped me so so much. Written by JJ Virgin

Okay, now you guys got me thinking. Thankfully, I keep track of everything I eat. There is always, some sort of gluten or carbs involved in my evening meals. Also milk and I've eaten a little more cheese than usual too. I drink a lot of water throughout the entire day, along with a variety of different juices, and sometimes, a glass of iced tea.
I have talked to my PCP and Neurologists about this. My PCP prescribed protonix (Pantoprazol) but I wanted to clear it through my neuro first and he said I should take it. I just hate to add another drug to the mix.
I will start trying to prolong the Mestinon by an hour also, slowly.
I was blaming it on all the meds, but I think it's in my diet. I got a lot of experimenting to do. You guys got me started in the right direction once again. I'll keep you posted. Happy Thanksgiving.

If I was you I would take out all dairy
That is a real enemy. You can drink almond milk instead.
It is really good.

My sister has autoimmune gastroparesis, and she has the symptoms you describe. The diet she requires is not a healthy one, but fruit and veg make her really sick. Hope you figure it out.

I have to say that a good diet is important regardless of MG. I love my organic milk, and I see zero problems with anything in diets unless you have food allergies, which you can be tested for. If you suspect these issues, get tested. Otherwise just eat healthy. Organic Milk is NOT unhealthy.

Organic foods can make a huge difference. Especially for wheat products etc. We have to keep in mind there is so much modified food out there and our bodies seem to be more hypersensitive now. Wheat was drastically changed via corporate modification the sixties in the US I believe. Stick to organic and wheat seminola, buckwheat etc.

I was diagnosed with gastrophersis which is essentially slow motility that is a product of my neuromuscular disease(s). My GI doctor says that after a certain length of time your stomach should be empty after a meal, and mine does not empty. He said the stomach is in charge of preparing the food for the intestine to absorb nutrients and not to hang on to it for extended periods. When it does stay, it starts fermenting and producing gas that makes you bloated and uncomfortable and it presses on the diaphragm making breathing more worrisome.

Sorry to hear about your issues with this. I can relate, but perhaps not for the same reason. I hope you can figure this out and feel better soon.
You may want to see the gastroenterologist and see if you have delayed gastric emptying. That can cause the feelings you have described.

Hope you feel much better soon!

Carly

It's been two days, and the first thing I eliminated was milk. Had Thanksgiving dinner, turkey, potatoes, gravy, green beans, and some stuffing. No problems and was okay till about 9 pm at night and started feeling full, but not to the point of feeling bloated or hard to breath. It lasted for an hour or so. No milk all day today and felt great all day until around 9 pm, but very minor discomfort. Stuck with baked chicken, a little rice, and some peas. I just had two days of IVIg this week and maybe it is helping a little too, because I was symptom free of everything. This is the first day I have had since July that I can truly say I felt really good. I even went shopping with my wife, and I NEVER go out on black Friday. Even when I wasn't sick. I will still be working on the food issues though.