Absolutely not. It’s certainly once it turns chronic that it can really get to you and I’d say once chronic the body has lost its ability to reset itself and it becomes increasing more difficult to get under control. But, no it doesn’t have to always be chronic. Mine was episodic in self contained episodes for more than a decade and although those episodes were extremely bad it would clear between and it was as though they’d never happened. Life went on as normal, no intermittent side effects at all for many years. The acute episodes were bad, very bad, but the pattern was quickly established, I could time the attacks, they’d stop abruptly after 72 hours so just a question of sitting it out and remembering to keep breathing. Chronic MAV is an entirely different ballgame.