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Monday, September 1, 2014
Weight loss (exericse and diet) for MG pts
My sister has Musk Ab positive myasthenia gravis. They tried to reduce her prednisone which caused myasthenic crisis. The prednisone has caused her already obese state to become worse. She now weighs 400 pounds. She has turned diabetic now as well. She must lose weight but it is a struggle. Where do I go to find information on a comprehensive wt loss program (including diet and exercise) for obese, diabetic, myasthenia gravis patients? I specifically want to know if myasthenia is effected by caloric intake? Or will a diabetic, low fat diet be okay? How can one build an effective exercise program that will help lose weight while not triggering a crisis? Does she need hemodynamic monitoring during exercise or just be followed via physician on a regular basis?
Tough question. Weight loss is best achieved with a mixture of diet and cardiovascular exercise. Diet is probably easier to work with than exercise. Consider requesting a consult from a dietician or nutritionist, who can help you come up with a sensible diet that slowly decreases caloric intake while being mindful of nutritional needs so she does not get sick. This requires big lifestyle changes and does not happen overnight.
Cardiovascular exercise is harder to accomplish as a myasthenic. The first issue is the muscle issue. Fatigue is a huge issue for myasthenics so they are often experience significant difficulty reaching a level of sustained exercise that helps burn calories. Slow, gradual increased exercise (a graded exercise program, for example, walking 4 minutes a day 4x/week, then walking 6 minutes a day 4x/week, etc). This allows the body to reasonably try to acclimate to increased exercise demand. This also implies that her myasthenia is well-controlled and her shortness of breath issues are well-controlled.
The second issue is the weight. Because of her weight, she has different stresses on her heart wall than a normal person. I would recommend a cardiac screen before beginning any exercise program. A good program for exercise might be the same kind of exercise that patients receive after coronary artery bypass ("open heart") surgery, called cardiovascular rehab. This is a program usually run by nurses and physical therapists connected to cardiology centers. They do hemodynamic monitoring with these patients, and that might be the safest. But they will probably need education about the myasthenia so they understand that she will be a difficult case.
She should have regular follow-up with her physicians, both primary care and neurology, during this time. Good luck with this.
Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati