My 1st Encounter with Myasthenia Crisis

For the past 8 years, my only problem with MG is mainly on double vision and drooping of eye lids. But in Year 2008, condition suddenly get worst, maybe due to work stress other symptoms like weakness of arms start to surface.

In Jan 2008,I had a very bad diarrhoea and vomitting due to a bad gastric flu. After that I start to have swallowing problem and speech also not clear at times. One day in the office, I was badly choke while drinking water and my colleagues sent to Tan Tock Seng Hospital A&E Department.

After the doctor examined me, he said that the problem is due to my muscles weakness at the throat and suggested that I consult my neurologist. So I made a call to SGH to arrange to see my neurologist.

On the 15th day of Chinese New Year was my medical appoinment wth my neurologist. When my neurologist see me, my speech was really bad. He said that I need immediate treatment and warded me to hospital straight away. He said that he will give me a 5 day course of treatment of IVIG (intravenous immune globulin). IVIG is derived from pooled donor blood and contains normal antibodies that will help to temporarily counteract the abnormal antibodies.

Speech Therapist was also called to assess my swallowing. Water and water with thickner added was given to me to swallow. Speech Therapist said that I could only drink water with thickner added and consume porridge as my swallowing muscles are still weak.

During the infusion of the IVIG, I felt very tired and weak. Each day the infusion will take about 6 to 7 hours. After 2nd day of the infusion, my speech start to get clearer. Unfortunately on the 4th day of the infusion, I start to experience chest pain. Due to that, the neurologist decided to stop the treatment and send me home.

My 1st Encounter with Myasthenia Gravis

Somewhere in late 2000, suddenly one day everything I see became double. I thought it was my glasses and went to see an optician. They confirmed that the glasses were of the right degrees and suggested that I consult a doctor.

I went to see my family doctor and he advised me to go to A&E department at the hospital right away. Immediately thereafter, my hubby drove me to SGH (Singapore General Hospital). After much examination and tests, they concluded that there were nothing wrong with my eyes and suspect that it could be due to the nerve system. Hence they scheduled me to consult a Neurologist.

A couple of weeks later, I followed up with my appointment to consult the Neurologist. The Neurologist performed some simple tests on my eyes movement by holding a pen in his hand and moving it in different directions. At each location, he would ask if I see single or double. He also performed some simple tests to test the strength of my arms and limbs.

Thereafter, he scheduled me to do some blood tests, CT scan on the thymus gland and an electrical test (called Singer Fiber Electromygraphy or SFRMG). This electrical test involves inserting a small needle electrode, into the forehead muscle to record the differences in response time between a pair of muscle fibers. After all the result of the tests, the Neurologist concluded that my double vision was due to Myasthenia Gravis. The CT scan also showed enlargement of my thymus gland. At the same time, my blood tests also showed that I was having Thyroidism.

The Neurologist prescribed me with Pyridostigmine Bromide. Pyridostigmine Bromide prevents degradation of acetylcholine in the neuromuscular junction. It is usually given to improve weakness. But there is an side effect of this medication on me, there is always a blotted feeling in my stomach and I always had diarrhoea. I was subsequently prescibed with Propantheline Bromide to overcome this side effect.

What is Myasthenia Gravis???

On 30th October 2009, it was my 3rd hospitalization to treat Myasthenia Gravis (the doctors called it MG in short) within 2 years. I never expected that this chronic sickness could affect my life so much when I was first diagnosd with this sickness in late 2000. This sickness is not common, when I tried to explain it to my family and friends, most of them had problem understanding it. Hence I decided to create this blog to bring awareness to people on this sickness and hope to share my experiences with other MG patients.

Myasthenia Gravis (MG) comes from the Greek and Latin words meaning "grave muscula weakness" and is a chronic, autoimmune, neuromuscular junction disorder. The voluntary musces of the entire body are controlled by nerve impluses that arise in the brain. These nerve impulses travel down the nerves to the place where the nerves met the muscle fibers. There is a space between the nerve ending and muscle fiber and its called the neuromuscular junction. When the nerve impulse arrives at the nerve ending, it releases the neurotransmitter (a chemical called acetylcholine). Acetylcholine travel acrosses the space to the muscle fiber side of the neuromuscular junction where it attached to many receptors. This activates the receptor which generates a muscle contraction.

In autoimmune disorder, the body produces antibodies against its own tissue. In MG patient, the antibodies block, interfere or destroy the receptors and prevent the transmission of nerve impulses to the muscles resulting in easy fatigability and fluctuating muscle weakness.

MG can affect any skeletal muscle in the body. It can affect muscles that control eyelids, eye movements, facial expression, chewing, swallowing, speech, respiration and limbs. Not all abovementioned symtoms are present in every patient or at the same time.

The symtoms is usually gradual but it can be sudden, with rapid deterioration of swallowing, breathing and generalised weakness. This is termed Myasthenic Crisis and it often requires hospitalization and urgent treatment. Infection and sudden withdrawal of treatment are common triggers.

MG affects all ethnic groups and both genders. It is more common in young adult women (under 40 years old) and older men (over 60 years old) but can affect all age groups. It can also occur in the newborn (usually from a myasethenic mother who passes the antibodies to the fetus) and children. In adults, MG is usually not hereditary and it is not contagious.