Q: My treating doctor says that I have myasthenia gravis, an autoimmune disease. I have been advised to take Myestin 60 mg (3 tablets/day), Wysolone 5 mg (one tablet/day) and PAN 40 mg (one tab/day). My fingers don't erect completely. I had speaking problems, liquid used to come from nose, pain in legs and nowadays a lot of pain in the back. Most of it seems to have subsided with Myestin. I am tested positive for Tensilon & EPS-RNST. My test report for acetylcholine receptor (AChR) antibodies is due. The problem increases with exertion. I don't wish to take steroids but have heard that they are the only cure. I have PCOD also, for which I have been on contraceptive pills for about 3 years, called Femilon. I have huge chances of putting on weight with the steroidal medicine. I don't want to put on weight due to my profession of a fitness instructor. Is there any alternative to cure my disease?

A:Autoimmune Acquired Myasthenia Gravis is an autoimmune disorder (meaning thereby that some antibodies are produced in the body itself which harms the vital organs; in this case the nerve and muscle junction in the muscles where electrical impulses are carried by nerves to effect muscle contraction). The cardinal symptom is fatigue and weakness in muscles (in your case fingers and muscles of swallowing and speaking). Treatment is 3 pronged: 1. Drugs which give symptomatic relief (by circumventing the deficits at neuromuscular junction). Myestin is one such drug. But will not have any effect on the disease per se. 2. Drugs, which modulate the immune system. First line drug is a steroid. Indeed, it has lot of adverse effects but that depends on dose. You are receiving very marginal dose and therefore the chances of side effects are less. Weight gain can occur and you have to take less salt and do lot of exercises (of course not exhausting yourself). Other immune modulators can be tried if steroids fail or have appreciable side effects or to keep the steroid doses low. But all the alternative drugs also have potential serious adverse effects. 3. Surgery: There is a gland in our body called thymus. It usually becomes small as we grow up. It has been suggested that the auto antibodies, which are found in myaesthenia gravis have a link with thymus tissue. Hence, removing this gland by surgery helps. The need for drugs like myestin and steroids can decrease significantly (or may be obviated at times). CT scan Chest is needed to see if there is any tumorous enlargement of this gland (which sometimes happen in some myesthenics; in this situation surgery is a must). It must be emphasized that benefits of surgery may not become apparent immediately after operation and it may take months or years to derive benefits.