PSC & myasthenia gravis

[Guest guest]

I saw a neurologist today who said that I have the clasic symptoms of

Myasthenia Gravis and that he is 90% sure that my test results will

come back confirming the diagnosis. He wants me to go ahead and begin

taking medications to treat the disorder; however, he admittedly did

not know much about PSC. The medication that best treats MG is

Mestin, which is a Cholinergic medication and therefor increase

gastric motility and the potential for nausa and vomitting. When I

saw my new Hepatologist last month he said that my colon biopsy

indicated that I have colitis, not UC though. I have always taken

anticholinergic medication to help with teh abdominal pain, blotting

and diareha so taking a medication that is basically the opposite

concerns me. I will call the Hepatologist on Tuesday, I am out of

town on Monday, to see if this is a medication that I can safely take

or if there is another medication that he recommends but I was

wondering if any of you have MG and if so how you are treated. Also

if anyone has taken similar medication or has any input it would be

appriciated.

Thanks

Dawn

[Guest guest]

Hi Dawn;

I'd be a bit concerned that your symptoms of " Myasthenia Gravis " may

have been caused by the " anticholinergic medication " that you have

already been taking:

__________________________

http://www.emedicine.com/emerg/TOPIC325.HTM

Cholinergic crisis

One of the confusing factors in treating patients with MG is that

insufficient medication (ie, myasthenic crisis) and excessive

medication (ie, cholinergic crisis) can present in similar ways.

Cholinergic crisis results from an excess of cholinesterase

inhibitors (ie, neostigmine, pyridostigmine, physostigmine) and

resembles organophosphate poisoning. In this case, excessive ACh

stimulation of striated muscle at nicotinic junctions produces

flaccid muscle paralysis that is clinically indistinguishable from

weakness due to MG.

__________________________

http://www.patient.co.uk/showdoc/40000807/

Myasthenic versus cholinergic crisis

It can be extremely difficult to distinguish between worsening of

Myasthenia or excessive anticholinergic medication when a patient

with known myasthenia gravis presents with rapidly increasing

muscular weakness, with or without respiratory difficulty.

Features suggestive of a cholinergic crisis (too much medication)

include muscle fasciculation, pallor, sweating, hypersalivation and

small pupils. If in doubt perform an edrophonium test. Improvement

suggests too little medication i.e. myasthenic crisis but aggravation

suggests too much medication. Be prepared to stop all medication,

ventilate and possibly arrange a plasmapheresis. This test should

only be performed with the necessary skills and equipment ready for

intubation and ventilation.

__________________________

Physostigmine (Mestinon) is an acetylcholinesterase inhibitor:

http://www.jaoa.org/cgi/reprint/104/9/377

What anticholinergic medication(s) have you been taking?

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

>

> I saw a neurologist today who said that I have the clasic symptoms

of

> Myasthenia Gravis and that he is 90% sure that my test results will

> come back confirming the diagnosis. He wants me to go ahead and

begin

> taking medications to treat the disorder; however, he admittedly

did

> not know much about PSC. The medication that best treats MG is

> Mestin, which is a Cholinergic medication and therefor increase

> gastric motility and the potential for nausa and vomitting. When I

> saw my new Hepatologist last month he said that my colon biopsy

> indicated that I have colitis, not UC though. I have always taken

> anticholinergic medication to help with teh abdominal pain,

blotting

> and diareha so taking a medication that is basically the opposite

> concerns me. I will call the Hepatologist on Tuesday, I am out of

> town on Monday, to see if this is a medication that I can safely

take

> or if there is another medication that he recommends but I was

> wondering if any of you have MG and if so how you are treated.

Also

> if anyone has taken similar medication or has any input it would be

> appriciated.

>

> Thanks

> Dawn

>

[Guest guest]

Hi Dawn;

I'd be a bit concerned that your symptoms of " Myasthenia Gravis " may

have been caused by the " anticholinergic medication " that you have

already been taking:

__________________________

http://www.emedicine.com/emerg/TOPIC325.HTM

Cholinergic crisis

One of the confusing factors in treating patients with MG is that

insufficient medication (ie, myasthenic crisis) and excessive

medication (ie, cholinergic crisis) can present in similar ways.

Cholinergic crisis results from an excess of cholinesterase

inhibitors (ie, neostigmine, pyridostigmine, physostigmine) and

resembles organophosphate poisoning. In this case, excessive ACh

stimulation of striated muscle at nicotinic junctions produces

flaccid muscle paralysis that is clinically indistinguishable from

weakness due to MG.

__________________________

http://www.patient.co.uk/showdoc/40000807/

Myasthenic versus cholinergic crisis

It can be extremely difficult to distinguish between worsening of

Myasthenia or excessive anticholinergic medication when a patient

with known myasthenia gravis presents with rapidly increasing

muscular weakness, with or without respiratory difficulty.

Features suggestive of a cholinergic crisis (too much medication)

include muscle fasciculation, pallor, sweating, hypersalivation and

small pupils. If in doubt perform an edrophonium test. Improvement

suggests too little medication i.e. myasthenic crisis but aggravation

suggests too much medication. Be prepared to stop all medication,

ventilate and possibly arrange a plasmapheresis. This test should

only be performed with the necessary skills and equipment ready for

intubation and ventilation.

__________________________

Physostigmine (Mestinon) is an acetylcholinesterase inhibitor:

http://www.jaoa.org/cgi/reprint/104/9/377

What anticholinergic medication(s) have you been taking?

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

>

> I saw a neurologist today who said that I have the clasic symptoms

of

> Myasthenia Gravis and that he is 90% sure that my test results will

> come back confirming the diagnosis. He wants me to go ahead and

begin

> taking medications to treat the disorder; however, he admittedly

did

> not know much about PSC. The medication that best treats MG is

> Mestin, which is a Cholinergic medication and therefor increase

> gastric motility and the potential for nausa and vomitting. When I

> saw my new Hepatologist last month he said that my colon biopsy

> indicated that I have colitis, not UC though. I have always taken

> anticholinergic medication to help with teh abdominal pain,

blotting

> and diareha so taking a medication that is basically the opposite

> concerns me. I will call the Hepatologist on Tuesday, I am out of

> town on Monday, to see if this is a medication that I can safely

take

> or if there is another medication that he recommends but I was

> wondering if any of you have MG and if so how you are treated.

Also

> if anyone has taken similar medication or has any input it would be

> appriciated.

>

> Thanks

> Dawn

>

[Guest guest]

Dave,

Thanks, I do not take the anticholinergic medication regularly, maybe

once a month when the cramps get really bad. I have trouble with my

vision when I take them. Because I don't take the medications

frequently the Dr. did not feel that they were related. He ran all

of my meds through a symptom checker of some sort. Could you please

tell me more about what your concerns are?

Thanks

Dawn

> >

> > I saw a neurologist today who said that I have the clasic

symptoms

> of

> > Myasthenia Gravis and that he is 90% sure that my test results

will

> > come back confirming the diagnosis. He wants me to go ahead and

> begin

> > taking medications to treat the disorder; however, he admittedly

> did

> > not know much about PSC. The medication that best treats MG is

> > Mestin, which is a Cholinergic medication and therefor increase

> > gastric motility and the potential for nausa and vomitting. When

I

> > saw my new Hepatologist last month he said that my colon biopsy

> > indicated that I have colitis, not UC though. I have always

taken

> > anticholinergic medication to help with teh abdominal pain,

> blotting

> > and diareha so taking a medication that is basically the opposite

> > concerns me. I will call the Hepatologist on Tuesday, I am out

of

> > town on Monday, to see if this is a medication that I can safely

> take

> > or if there is another medication that he recommends but I was

> > wondering if any of you have MG and if so how you are treated.

> Also

> > if anyone has taken similar medication or has any input it would

be

> > appriciated.

> >

> > Thanks

> > Dawn

> >

>

[Guest guest]

Thanks Dave for clarifying this for me.

Dawn

> > Thanks, I do not take the anticholinergic medication regularly,

maybe

> once a month when the cramps get really bad. I have trouble with

my

> vision when I take them. Because I don't take the medications

> frequently the Dr. did not feel that they were related. He ran

all of

> my meds through a symptom checker of some sort. Could you please

tell

> me more about what your concerns are?

>

[Guest guest]

Thanks Dave for clarifying this for me.

Dawn

> > Thanks, I do not take the anticholinergic medication regularly,

maybe

> once a month when the cramps get really bad. I have trouble with

my

> vision when I take them. Because I don't take the medications

> frequently the Dr. did not feel that they were related. He ran

all of

> my meds through a symptom checker of some sort. Could you please

tell

> me more about what your concerns are?

>