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Myasthenia Gravis

Rehabing after surgery when one has MG

08/10/2009

Question:

My 72 yo mom who was dx with MG at 16yo, (on mestinon since then), recently had a triple bypass followed by surgery to correct a "leaking graft" 24 hrs later. She had to be reintubated 3 times because of difficulty weaning of the vent. and after 1 1/2 to 2 weeks was trached. The trach was removed in the rehab. hospital, but she has been there for almost 2 weeks with very little improvement. She is SOB and so week she can barely transfer from bed to chair, with assist. I`m not sure what else, if anything, we should be looking for. She is on her usual dose of mestinon - 30mg/day. Other PMH = HTN, hypothyroid, NIDDM ( X 3 years), gastric ulcers, High cholesterol/trig.

Could this failure to rehab. be connected to her MG?

Thank You

Answer:

First, you need to establish what is happening with her to make her so weak. Myasthenic flare with crisis is very possible a cause for inability to wean off the vent and to be this weak. But there can be other things that happen in the hospital. Critical illness neuropathy and myopathy, Guillain-Barre syndrome, diaphragmatic paralysis with severe deconditioning because of a prolonged hospitalization, etc. I would suggest having a neurologist evaluate her, especially one who works with neuromuscular diseases primarily. They can determine what pattern of weakness she has and what co-localizing features have occurred, and then can direct the investigation of what is causing the weakness, whether it is MG or another process. As a side note, Mestinon 30 mg once per day is a very low dose and would suggest that her myasthenia was probably well controlled before surgery. If her myasthenia has flared, she will need a neuromuscular doctor to help in her management. I hope this helps.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati