There was a progressive decline in race times(5-9% slower), beginning in March 2023, which was the earliest indication of dysfunction. As her disease progressed her times slowed more(7-13%). AChR+ JMG was diagnosed October 2023, when she presented with shortness of breath, swallowing difficulties, and the inability to pull herself out of the pool. She started monthly 2g/kg intravenous immunoglobulin (IVIG). A transcervical thymectomy was performed in November 2023 and Rituximab was added in February 2024. In June 2024, 10mg of prednisone was started, which by September resulted in symptom-free status and return to her pre-MG level of swim training. By February 2025, she was swimming personal bests and won all her events and the state level, and was nominated for Oregon Swimmer of the Year. Due to the desire to discontinue prednisone, Zilbrysq was started in July 2025, and she was able to taper completely off steroids. A flare in mid 2025 was first noticed by a slowing of race time to pre-treatment levels.