For me, there is a kind of back-and-forth to this disease. On the one hand, at least in my case, it is not so debilitating that my functions are impaired. Thus the tendency for work colleagues and friends to assume that I am perfectly fine and have no limits on what I can do. On the other hand, I do have instances of flare-ups where I am evidently not functioning and this can be disruptive (if I am speaking in a lecture or singing in a choral group). I admit to being frustrated at times, particularly with dysphonia and my difficulty speaking (or singing) but I don’t feel like a nuisance. Instead it provides an opportunity to share (with those who don’t know) about the condition I have so they don’t need to feel anxious or upset (have I been drinking? am I about to have a stroke?). Those who know me also know that I cannot do everything that I used to do, and I need to moderate my activities (more napping, less talking!), but I am not incapacitated. I do think there is one characteristic of this disease that is confusing, and can feel like a nuisance both for those of us who have it and for those we interact with, which is that it is so unpredictable: when will flare-ups occur? how serious and prolonged will they be? what is the longer term prognosis? will it get better? will it get worse? This unpredictability, combined with the relative rarity of MG, makes it seem elusive, even unreal. But those of us who have it know its realities all too well, whether the symptoms are life-altering (even life-threatening) or more, well, a nuisance.