Myasthenia Gravis (MG)

Myasthenia Gravis (MG) is a progressive autoimmune disease that produces severe muscular weakness.  MG is characterized by periods of exacerbation (flare-ups) and remission.  Muscle weakness tends to improve with rest and will worsen with increased activity.  MG is caused by antibodies floating within the body that interfere with the transmission of a substance called acetylcholine at the neuromuscular junctions.

Risk factors associated with myasthenia gravis include other autoimmune conditions such as:

• Rheumatoid arthritis
• Scleroderma
• Systemic lupus erythematosus (SLE)

Conditions and situations including infection, stress, emotional upset, fatigue, pregnancy, and increases in body temperature (fever, sunbathing, hot tubs) all may easily trigger a flare-up of myasthenia gravis.  Signs and symptoms of MG may include the following:

• Progressive muscle weakness
• Double vision
• Drooping eyelids may also occur (either 1 or both eyes)
• Difficulty chewing and swallowing
• Respiratory dysfunction
• Difficulty managing secretions and a decrease in the effort put forth to breathe
• Bowel and bladder dysfunction
• Possibility of incontinence
• Poor posture
• Fatigue with exertion

Diagnosis of MG occurs in a couple different ways.  Following are procedures your medical provider may recommend that you should be aware of:

• Tensilon Testing
• A baseline assessment will be completed of the cranial muscle strength
• Edrophonium (Tensilon) is administered.
• Tensilon is a type of medication given that inhibits the breakdown of acetylcholine, making it available for use at the neuromuscular junction.  The test is positive if there is improvement in muscle strength that lasts approximately 5 minutes.
• Electromyography
• This exam will show the neuromuscular transmission characteristics of MG.
• If MG is present, there will be an apparent decrease in the amplitude of the muscles over a series of consecutive muscle contractions.

Total Home Health will provide you with the best client-centered care in the comforts of your own home.  We will implement several non-pharmacological options in order to promote your comfort and safety, while doing our best to prevent flare-ups of MG.  Non-pharmacological interventions we may try could include:

• Provide continued assessment of your respiratory efforts to maintain a patent airway and a comfortable breathing pattern, while keeping oxygen on hand if needed.
• Allowing for several periods of rest throughout the day, and during your daily activities.
• Provide you with small, frequent, high-calorie meals that are scheduled around the times when your medication is peaking so that both your caloric intake and your medications are able to exert the best effects.
• Ensure that you maintain an upright position when eating to prevent aspiration and/or choking.
• Provide continued assessment of your eyes and apply any eye ointment that may help to completely close the eyes if you have drooping eyelid(s).
• Provide you with a medical identification wristband or necklace at all times in case of an emergency.

As far as medical interventions to combat MG, medications referred to as anticholinesterase inhibitors are used as the first line of defense.  The responsibility of Total Home Health professionals then will be to ensure that you are taking your medication as prescribed and at the specified time, which is generally four times a day and the same time each day.  While taking your medication our professionals will monitor you for periods of weakness and if some are more prevalent than others, we will discuss changing the administration times with both you and your medical provider.  The type of medication that is best for you will be decided by your medical provider depending upon your overall health condition and well-being.

Another intervention to help with your MG is called plasmapheresis, which is an invasive procedure that lasts anywhere from approximately 2 to 5 hours that removes circulating antibodies from your plasma.  This process is usually completed several times over a period of days and may continue on a regular basis for some individuals with MG.  The entirety of the procedure will be explained thoroughly, along with risk and benefits by your medical provider.  Surgery may also be recommended to remove your thymus gland if the severity of your MG has reached a high enough level to compromise your health and how well you function.

Total Home Health has a program that will fit all your needs related to MG.  Our professionals understand this condition in its entirety, and we will be your advocate day in and day out.  Enroll with us today so we can make sure you’re living your life the best you can, while avoiding flare-ups of MG and maintaining your level of functional independence!