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By Anita Chatigny, PhD, as told to Hallie Levine
If you have a diagnosis of myasthenia gravis (MG), studies show that you have a higher risk of developing depression. This isn’t surprising. MG is a disease that causes symptoms such as muscle weakness, eyelid droop, and difficulty swallowing and breathing. All of these changes affect your ability to do day-to-day activities and to live life as you want to.
But there’s plenty you can do to protect your mental health. Here’s what I advise my patients:
If you have MG, and are in a battle against your symptoms, those symptoms will always win. It’s more productive to create a partnership with your symptoms: Learn what triggers them and what helps relieve them. Most of the people I see with MG complain of disabling fatigue, for example. They can’t fight back against this fatigue, but they can learn how to best manage its rise and fall throughout each day.
The best way to explain this is to use the example of a personal checking account. Just like you need to put money in it a couple times a month so your account doesn’t become overdrawn, you have to do the same thing when it comes to your energy and MG. When you wake up each morning, you have a certain amount of energy, depending on how you slept the night before, your nutritional status, and any recent symptom flares. You need to learn how much energy you can use before you become overextended. Just like you can quickly blow through money in your checking account, you can use up energy, leaving you fatigued the rest of the day.
I tell my patients that there are little things they can do every day to conserve energy: for example, using assistive devices like carts to help them with household chores like setting the table, so they don’t have to make eight trips from the kitchen to the dining room. If you make these small adjustments every day, you’ll have more energy reserves. The result? You’ll feel less fatigued, and you’ll be in a better mood. It also is very powerful because it puts you back into control: you’re the manager of your own energy supply, rather than a victim of fatigue.
It also helps to readjust your mindset. So many times, people assume that an aggravation of their symptoms means their MG is worsening, and they panic. That’s not necessarily the case. If a person without MG runs a marathon, they’ll be exhausted, even if they don’t have any other underlying health issues and they’ll need days, sometimes even weeks, to recover. It’s the exact same concept with MG. If you’re feeling fatigued, or your muscle weakness seems particularly pronounced, you may have just overdone it. Your body is telling you it’s time to take a step back. Listen to it.
Sometimes, people with MG may feel guilty about their disease and are worried that they are creating hardships for their family. If they need to excuse themselves from an activity because they’re wiped out, they may fear that they’ve let their loved ones down. This can cause stress and anxiety, but it shouldn’t. While it’s true that everyone who loves a person with MG is affected by their illness, they also understand that while it’s hard on them, it’s even harder for the person with the condition.
I encourage my patients with MG to advocate for themselves with friends and family members. Loved ones are well-intentioned, but their words of encouragement can be interpreted as words of judgment or criticism. Or they may jump in and try to do everything for the person who wants to do things themselves.
Everyone affected by MG is their own unique individual, and thus they’ll respond to mental health treatments and therapies differently. Some people do well with basic stress-reduction techniques like deep breathing and meditation, some thrive with a few sessions of cognitive behavioral therapy, and some have more significant issues of depression and anxiety that may require prescription medications.
There’s no blanket recommendation that will work for everyone. I tell people that I have a 3-day rule. If you feel down for a day or two, that’s fine: It can happen to anyone, even people without MG. But if it persists past 3 days, let your primary care provider or MG treatment provider know. That’s when you’ll need to seek out more support.
One of the scariest aspects of an MG diagnosis may be the feeling that you’re entering into unknown territory. MG is so rare that if you’re new to the disease, you can feel very alone. Support groups can help, but if you begin to look at personal blogs or go on social media forums, MG may begin to seem as insurmountable as Mount Everest.
Instead, I advise people to break down the multiple challenges they face with MG into chunks. Put blinders on, if you will, and focus on just one issue at a time with laser-sharp precision. The first hurdle to tackle is figuring out how to get the right treatment. Once that’s done, you can move on to other challenges, such as meeting the demands of work, or carving out time to take care of yourself. Otherwise, it’s like trying to scale Everest without any climbing gear. But if you have the right tools, and focus on one chunk of mountain at a time, you’ll be able to meet the demands of MG eye to eye.
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By Marcia Lorimer, as told to Hallie Levine
I’ve lived with myasthenia gravis for 65 years. I was diagnosed when I was 10. Up until then, I was a very active child who went from playing every sport imaginable to suddenly feeling constantly exhausted. I began to choke on food, slurred my speech, and developed droopy eyes. This was back in the 1950s, so after my family doctor couldn’t find anything wrong, he suggested that I might be seeking attention. At first my parents just thought I could be trying to mimic Marilyn Monroe. It took several months — and one hospitalization — before I got the correct diagnosis.
Back then, there wasn’t much known about MG, and there were very few treatment options. But over 6 decades later, there have been major advances in research and treatment. It’s true that day-to-day management of MG can be unpredictable and sometimes challenging. Yet it hasn’t stopped me from pursuing a fulfilling career as a pediatric nurse practitioner and university professor, as well as raising a family. Here’s advice I give to other people living with MG, to help them live a full life:
Stay up to date on vaccines. For me, one of the biggest triggers of an MG flare is a respiratory infection. COVID-19 is such a looming villain out there for folks with MG, but even a respiratory infection like a bad cold or pneumonia can be a serious threat. I personally have been hospitalized in the past after a bout with the flu. Some shots to make sure you’re up to date on the COVID-19 vaccine (including your booster, if you’re eligible), influenza, pneumococcal, and Tdap (it protects you against pertussis, or whooping cough). Your family doctor will advise you on other vaccines as well.
Get the best medical care you can. They call MG the snowflake disease for a reason: it’s different in each individual, and no two people respond the same way to a treatment. I can’t stress enough how important it is to have a doctor who really understands MG. You can’t just rely on your regular family doctor. My late husband, Bill, was an internal family medicine physician, and he’d get patients with MG who wanted to see him because they knew I had the same disease. But that’s very different from going to a neuromuscular specialist who sees patients with MG every day.
I’ll give you a personal example: about 30 years ago, I had an unexpected terrible flare, and neither I nor my doctor, Donald Sanders at Duke University Medical Center, could quite understand why. Dr. Sanders reviewed my situation with other MG experts, did some research, and decided that even though I’d had my thymus removed as a child to treat my MG, some residual thymus may have remained or grown back to trigger symptoms. I had a second surgical procedure to remove it and got much better.
I might not have gotten the right treatment if I hadn’t had a doctor as knowledgeable about the disease and as committed as Dr. Sanders to getting me the best care. The Myasthenia Gravis Foundation of America (MGFA) has a physician referral list of MG experts so you can find a doctor in your area.
Have a strong support system. This is particularly important during times of big emotional upheaval, such as death or divorce. I had one particularly bad flare, for example, when both my father and sister-in-law died around the same time. What always made these stressful times easier was to have a wonderful husband who was constantly there for me. It’s so difficult to parent as a person with MG because sometimes you can’t participate or go to things that are important, like school functions or sports games, because you’re so exhausted. That’s why having someone who’s willing to step in and fill in for you is crucial.
Attending a support group is a great way to meet others with myasthenia gravis and learn about their experiences. The support groups are run by volunteers who are typically MG patients or family members of patients. MGFA also has patient education materials such as webinars and patient meetings that provide important information about MG, research findings, and various treatment options.
Be open to trying new treatments. Thankfully, with all the medical advances with treating MG, many people should be able to function day to day fairly well. It’s normal to have an occasional off day, but if you frequently feel like you need to crawl back into bed, that’s a sign that your medications need to be adjusted. No treatment works 100%, but you should be able to find something that works every day, all day.
Trust me, I know what it feels like to struggle: When I was first diagnosed, I was so weak I could only eat pureed food and couldn’t even speak. Thankfully, over the years, I’ve found treatments that work.
Try to think positively. It’s important to not give into the gloom and doom and instead look at what’s bright in your life. People who sit around and think clouds form around them to make it rainy every day usually won’t fare as well as others who try to find happiness around them. This will help you cope when the unexpected happens. The day I got married, for example, I woke up with double vision, a symptom I hadn’t had in years. It most likely was brought on from the excitement that surrounded my wedding. It would have been easy to become depressed, but I simply decided to make the best of it and closed my eyes before every photo, to conserve muscle strength. It worked. My eyes may have looked droopy in some of the photos, but I also looked happy, and that’s what matters.
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