Taking pyridostigmine

After 2 yrs of stroke like symptoms, blurry vision, low o2, intolerance to heat, trouble chewing and swallowing...I have a diagnosis of seronegative MG. A wrong dx of lung fibrosis and ILD led to a second opinion, on the advice of my rheumatologist treating me for lupus. My low o2 is not a lung issue and I do not have fibrosis or ILD....great news! My new pulmonologist suggested we check heart...heart was great! She then suggested perhaps neuromuscular disease like mg. Conveyed I had been tested 2 yrs ago and was negative, she ran a MuSK test which was negative too. She then mentioned seronegative mg and referred to a neurologist which took 4 months to get in "quickly"...I just had my appt on Jan. 15, 2025. I did the 2 min ice test and had a WOW improvement! Finally a dx, and med along with SFemg to be scheduled...(may29).

I started on pyridostigmine 30mg 3 times a day 4 days ago. First and second day the nausea and diarrhea were horrible but yesterday and today nothing really. But what I have noticed is I get almost 2hr block of time after my first dose ( 9am) in which I can do things but after that block of time, I'm exhausted and must sit. My next 2 doses, I get hardly any boost. Will that improve? Today at lunch I could hardly chew and almost choked several times. For supper I just drank a Premier protein drink, as my entire face feels so sluggish. I love the 2 hr of relief and I think today I just pushed too hard...but it's been so long to have that. Tonight my words are slurred and I feel I have stepped backwards.

I read they can do steroids but I have taken so much of those with my lupus my bone scan shows osteopenia. Do you think it's reasonable to call to see if we can up the pyridostigmine? I know 4 days is not much time.
I have went from active to sitting in my chair trying to lift my coffee to my mouth...the second night of being on meds, I finally was able to take care of my showering all by myself.