Cala, I'm so sorry... I totally empathize with your situation. I seem to have this experience every time I see my neuro as well, and I always leave in tears and wanting to just give up. Every day seems like a week while I'm trying to just hold on until my next appt, hopeful that my dr might be able to something to lessen my suffering and improve my quality of life (even just a tiny bit), so when they drop the ball, or simply shrug their shoulders or throw a new RX at you that makes absolutely no sense, it's more than just frustrating! I too have had a worsening of my condition and many new and alarming symptoms. I'm also on Mestinon. I finally had to call this morning and demand to be seen, as my emails stating that I suddenly am unable to walk on my own, and am having breathing and swallowiing issues didn't seem important enough to warrant a reply by my neuro for the past two weeks. BTW, I was originally given Propranolol by my neuro (a POTS specialist), which made my fatigue 100xs worse. Another dysautonomia specialist switched me to Fludro and Adderall, and it totally helped me for many months (especially with the blood pooling in my legs), but now I'm having adrenaline surges and palpitations again, and stopped taking both (on my own, since my dr never returned my calls or emails), as they certainly would have killed me to continue. I hope things get better for you!