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Daniel Nelson, MD
Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience:  Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
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I have very low blood pressure (in the region of 55/39)

Customer Question

I have mild MG but my doctor won''t put me on medication for it because I have very low blood pressure (in the region of 55/39) and I don''t sleep more than two hours a night. Is there anything I can take to alleviate the MG without causing myself other problems?
Submitted: 8 years ago.
Category: Health
Expert:  Daniel Nelson, MD replied 8 years ago.

Greetings,Customer Thank you for submitting your question(s) to in the category of HEALTH. My name isXXXXX I am a licensed physician, trained throughout Internship, Residency/Fellowship at the Mayo Clinic in Rochester, MN in the specialties of Internal Medicine and Critical Care.

When you mention that your physicians won't place you on MG medications, are you speaking of all possible medications or just the Acetylcholine Esterase Inhibitors (AChEi)? Have they considered other modalities of treatment with immune modulation agents like prednisone, azathioprine, cyclosporine, and mycophenolate mofetil. Sometimes, other agents such as a monthly pulse cyclophosphamide and tacrolimus may be considered.

Have you been presented with IVIG (intravenous immune globulin) or plasmapheresis as options? What about having a thymectomy? (This thymectomy approach is controversial, not terribly well studied, and can take years to see benefits if at all).

I will get back to you once I know a little more information requested herein. Thank you for asking us here at

Customer: replied 8 years ago.
I must admit that I got a little lost with all the medecines that were mentioned. I do remember that azathioprine and mycophenalate mofetil were ones mentioned as not options. I was told that a thymectomy would be of no use as I seem to be in the small percentage of people who don't have MG because of a thymus problem.
Expert:  Daniel Nelson, MD replied 8 years ago.
Customer you may still be a good candidate for low dose prednisone therapy (a steroid), plasmapheresis, and IVIG (the intravenous immune globulin I mentioned before). Is your doctor a specialist in MG or a general practitioner?
Customer: replied 8 years ago.
Reply to XXXXX XXXXX, MD's Post: He is my GP but is also a specialist in MG. However, I think he knows too much of my medical history to be strictly objective. I think he is erring too much on the side of caution.
Expert:  Daniel Nelson, MD replied 8 years ago.


Aside from the acetylcholine esterase inhibitors, other immune modulating medications, plasmapheresis, and IVIG (I agree, thymectomy is not an ideal solution), this is about the extent of our treatment repertoire.

I am sure you have already been there online, but the Myasthenia Gravis Foundation, UK website offers a great number of resources and outlets of information:

I hope this information is helpful. I strongly encourage you to have another conversation with your specialist on options available, arming yourself with some of the information amassed and perhaps attempting to get to the bottom of the low blood pressures, which is a whole new issue altogether.

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