Brief Answer:
Myasthenia IS a possibility but you really need an examination for that DX

Detailed Answer:
Good morning kind person (I don't know whether you are a Sir or Madame) but I'm sorry you're feeling all of this which has caused you to have to quit your job and as a result lose your health insurance coverage.

Let's start with that problem and question first regarding going about getting medical consultations performed. If you have no health care coverage of any sort have you considered seeking out services such as the FREE CLINIC or your local COUNTY HOSPITAL where programs are usually available for folks with no insurance where they can be rated and then, based on sliding scales of payment and ability to pay if they are working vs. not working, etc. they would be able to access medical services.

The other option is to file for State Aid which is usually a long drawn out process but you could call up the local Social Security Services office where you live and ask how to go about the process of being evaluated for a State Medical card. In Ohio, the wait is approximately 9-12 months. But certainly with the type of medical condition you're describing it sounds at least somewhat likely that you would be accepted for some form of assistance in that regard.

If you are planning on just paying straight away for services of both medical consultation as well as paying for ancillary testing or diagnostics in order to really diagnose you properly then, that's very difficult for me to estimate. I can only say that if you make some phone calls to local neurologists who have private practices and ask what a cash visit would cost you will start to accumulate information. You could then, call some group Neurology practices (and there are many of those) to see how their fees compare to the private individual neurologists in your area. They may have the ability to enroll you in payment plans or offer discounted services that a private individual neurologist cannot afford to do.

Finally, no doctor will be able to give you specifics on lab testing or other diagnostics in terms of cost since doctors don't really delve into those sorts of pricing until they actually own or are invested in those types of businesses. Not very doctors do their own laboratory testing anymore due to regulations and other hassles so everything is sent out. Once you've seen a doctor for your condition and they decide on the battery of tests you'll require then, with that information you can call different labs including those at the hospitals or in diagnostic labs around town and get their prices. Many places will offer discounts if they know you are underinsured or without a job and paying cash so it's worth calling around.

Now, let's talk for just a moment about your medical condition. Although your symptoms are consistent with a myasthenic process there are also a number of other things that this could be and which need to be ruled out and I'm sure you've read about them such as thyroid and adrenal problems, nutritional deficiencies (B12, D, folate) when it comes to memory and speech/language issues. If you say brain scans have been done and tests, etc. then, obviously some of these bases have been covered but it also depends on WHICH kind of scans have been done and what exactly did the readings or results from the labs done show?

Fatigue and weakness of a myasthenic type often presents in an ocular form which first is NOTED and felt by the patient as eyelid droopiness. I noticed that you really didn't mention that at all. Primary presentation of GENERALIZED myasthenia compared to OCULAR is very unusual and this is why a good thorough metabolic review needs to be do as well as physical and NEUROLOGICAL examination should be done. As it turns out the general symptoms fatigue and muscle weakness as an initial and/or overwhelming/primary complaint is only diagnosed through laboratory analysis <5% of the time. That's a very telling number....especially if you need to be frugal with your financial resources! Most symptoms of the symptoms of fatigue and generalized muscle weakness end up being seated in lifestyle, medication side effects, or psychological issues related to stress, anxiety, Post traumatic Stress Disorder (PTSD), and just simply being overwhelmed with day to day situations and circumstances.

Therefore, the physical examination and history as to how this all evolved will be teased out in the hands of a good doctor. There are simple and very sensitive bedside tests that can be done bedside or in the office in patients suspected of myasthenia gravis such as the 2 minute UPWARD GAZE HOLD test. This essentially looks to measure the muscle strength and competency of some of the smallest muscles in the body (the eyelids) but asking the patient to look upward and hold the position with eyeballs straining up without moving the head about. In myasthenic patients (especially those with OCULAR forms of the disorder) after 2 minutes of that exercise there will be noticeable and even MEASURABLE changes in the aperture opening of the lids.

And there are other similar sorts of neurological tests that can be performed. The trick though is get a great history from the patient in order to discern what is considered one of the hallmarks of MG which is a story of FLUCTUATING WEAKNESS where a person feels GREAT in the morning upon awakening....ready to CONQUER the day but then, they get to work and after a few hours they need a POWER NAP of 20-30 min. (which is impossible on the job) so they can recharge which will then, take them a few more hours down the line....then, BAM...again, OVERWHELMING fatigue and weakness which could translate into slurred speech, slowed thought processing, etc. Then, another power nap of about 30-60 min. before once again feeling recharged and great before getting home and waving the WHITE FLAG! That's the day of the typical myasthenic.

If you rather feel a sensation of just ridiculous tiredness, weakness, and fatigue from the moment you get up in the morning and that just gets worse and worse as the day goes on no matter how much you try to pace yourself, rest, or take breaks and if your work just suffers terribly because of it and you just can't get yourself to snap out of it no matter.....then, MG is not likely the best diagnosis to explain that scenario. Something called EXCESSIVE DAYTIME SLEEPINESS or EDS may be responsible for those symptoms and that could require a sleep study, etc.

If I've provided useful or helpful information to your questions could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information on your condition and your progress in searching for medical assistance given your situation. Please drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turn out.

You can always reach me at www.bit.ly/drdariushsaghafi for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

Cheers and hope you are feeling better soon.


This query required 52 minutes of professional time to research, assimilate, and file a response.

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Brief Answer:
Myasthenia IS a possibility but you really need an examination for that DX

Detailed Answer:
Good morning kind person (I don't know whether you are a Sir or Madame) but I'm sorry you're feeling all of this which has caused you to have to quit your job and as a result lose your health insurance coverage.

Let's start with that problem and question first regarding going about getting medical consultations performed. If you have no health care coverage of any sort have you considered seeking out services such as the FREE CLINIC or your local COUNTY HOSPITAL where programs are usually available for folks with no insurance where they can be rated and then, based on sliding scales of payment and ability to pay if they are working vs. not working, etc. they would be able to access medical services.

The other option is to file for State Aid which is usually a long drawn out process but you could call up the local Social Security Services office where you live and ask how to go about the process of being evaluated for a State Medical card. In Ohio, the wait is approximately 9-12 months. But certainly with the type of medical condition you're describing it sounds at least somewhat likely that you would be accepted for some form of assistance in that regard.

If you are planning on just paying straight away for services of both medical consultation as well as paying for ancillary testing or diagnostics in order to really diagnose you properly then, that's very difficult for me to estimate. I can only say that if you make some phone calls to local neurologists who have private practices and ask what a cash visit would cost you will start to accumulate information. You could then, call some group Neurology practices (and there are many of those) to see how their fees compare to the private individual neurologists in your area. They may have the ability to enroll you in payment plans or offer discounted services that a private individual neurologist cannot afford to do.

Finally, no doctor will be able to give you specifics on lab testing or other diagnostics in terms of cost since doctors don't really delve into those sorts of pricing until they actually own or are invested in those types of businesses. Not very doctors do their own laboratory testing anymore due to regulations and other hassles so everything is sent out. Once you've seen a doctor for your condition and they decide on the battery of tests you'll require then, with that information you can call different labs including those at the hospitals or in diagnostic labs around town and get their prices. Many places will offer discounts if they know you are underinsured or without a job and paying cash so it's worth calling around.

Now, let's talk for just a moment about your medical condition. Although your symptoms are consistent with a myasthenic process there are also a number of other things that this could be and which need to be ruled out and I'm sure you've read about them such as thyroid and adrenal problems, nutritional deficiencies (B12, D, folate) when it comes to memory and speech/language issues. If you say brain scans have been done and tests, etc. then, obviously some of these bases have been covered but it also depends on WHICH kind of scans have been done and what exactly did the readings or results from the labs done show?

Fatigue and weakness of a myasthenic type often presents in an ocular form which first is NOTED and felt by the patient as eyelid droopiness. I noticed that you really didn't mention that at all. Primary presentation of GENERALIZED myasthenia compared to OCULAR is very unusual and this is why a good thorough metabolic review needs to be do as well as physical and NEUROLOGICAL examination should be done. As it turns out the general symptoms fatigue and muscle weakness as an initial and/or overwhelming/primary complaint is only diagnosed through laboratory analysis <5% of the time. That's a very telling number....especially if you need to be frugal with your financial resources! Most symptoms of the symptoms of fatigue and generalized muscle weakness end up being seated in lifestyle, medication side effects, or psychological issues related to stress, anxiety, Post traumatic Stress Disorder (PTSD), and just simply being overwhelmed with day to day situations and circumstances.

Therefore, the physical examination and history as to how this all evolved will be teased out in the hands of a good doctor. There are simple and very sensitive bedside tests that can be done bedside or in the office in patients suspected of myasthenia gravis such as the 2 minute UPWARD GAZE HOLD test. This essentially looks to measure the muscle strength and competency of some of the smallest muscles in the body (the eyelids) but asking the patient to look upward and hold the position with eyeballs straining up without moving the head about. In myasthenic patients (especially those with OCULAR forms of the disorder) after 2 minutes of that exercise there will be noticeable and even MEASURABLE changes in the aperture opening of the lids.

And there are other similar sorts of neurological tests that can be performed. The trick though is get a great history from the patient in order to discern what is considered one of the hallmarks of MG which is a story of FLUCTUATING WEAKNESS where a person feels GREAT in the morning upon awakening....ready to CONQUER the day but then, they get to work and after a few hours they need a POWER NAP of 20-30 min. (which is impossible on the job) so they can recharge which will then, take them a few more hours down the line....then, BAM...again, OVERWHELMING fatigue and weakness which could translate into slurred speech, slowed thought processing, etc. Then, another power nap of about 30-60 min. before once again feeling recharged and great before getting home and waving the WHITE FLAG! That's the day of the typical myasthenic.

If you rather feel a sensation of just ridiculous tiredness, weakness, and fatigue from the moment you get up in the morning and that just gets worse and worse as the day goes on no matter how much you try to pace yourself, rest, or take breaks and if your work just suffers terribly because of it and you just can't get yourself to snap out of it no matter.....then, MG is not likely the best diagnosis to explain that scenario. Something called EXCESSIVE DAYTIME SLEEPINESS or EDS may be responsible for those symptoms and that could require a sleep study, etc.

If I've provided useful or helpful information to your questions could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information on your condition and your progress in searching for medical assistance given your situation. Please drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turn out.

You can always reach me at www.bit.ly/drdariushsaghafi for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

Cheers and hope you are feeling better soon.


This query required 52 minutes of professional time to research, assimilate, and file a response.

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