I am going to try to answer some of your questions about SPMS by explaining a little of my history and hope that will help you understand some things. My MS presented in the mid 90’s but it took several years before I was diagnosed with RRMS. I suffered for years with symptoms and no treatment. I developed a drop foot and weakness on my left side. I had cramps and spasms and was treated with steroids for my vision problems. Fatigue kept me from doing things I used to love and eventually got as bad as narcolepsy, and I retired with medical disability. I got some relief with treatments as they became available and then at my last doctor’s visit, I was told I had SPMS. He said that at my age, I am 63, the medications were harder on me than the MS and took me off all treatment. I was angry, especially when he said that I was already using a cane and had a walker and scooter so I should be able to manage. At this point I weighed 255 pounds. The first thing I did was go on a Keto diet. I had tried lots of diets before but this time it worked. I found out that one of the benefits is that it reduces inflammation and can actually reduce some pain and stiffness. The next thing I did was join a Pilates studio. I limped in the first day and with a lot of patience, eventually improved my overall strength and even balance so that I was able to put away the cane. I even started supplementing Pilates with some other strength training at a fitness gym. But I got overconfident when I bought an e-bike. I still have MS and hadn’t ridden in a bike for about 50 years. I broke my collarbone and had several stitches in my head. My friends laugh and what they call a “stupid man stunt”. I have lost about 75 pounds and am much healthier and feel better. Even before SPMS, I had given up on myself, believing that I was handicapped and couldn’t do things that I used to love. Before I retired from the Navy, I ran consistently. I did 5K and 10K runs and even a half marathon. MS took that away because you can’t run with a drop foot and no balance. I thought I couldn’t exercise at all because my body would heat up and give out in as little as five minutes. Pilates is very slow moving, non-aerobic and, works on balance. It was invented by a man who was bedridden due to a leg in traction. I still fight walking with the drop foot and weakness on my left side. I have digestive and bladder issues along with male problems. I still take a nap nearly every day and don’t drive at night. The one thing consistent about MS is that it effects everyone differently. I know not everyone’s symptoms will allow them to do what I did. The first step is believing you can have some control in your life. I used to read lots of literature about eating for MS but thought it was too hard. Just giving up white flour and sugar requires some dedication but not a whole lot of reading menus or keeping track of macronutrients. Exercise is the same. A little more movement each time can make a difference. Overall, I prefer SPMS to RRMS. It is more predictable, without the surprises of exacerbations. I feel like this means fewer mental ups and downs. There are several things I do which help me cope and stay positive. I make very small goals for each day. I try to think about something positive in my life before I even get out of bed. You need to spend time doing things that make you happy. For me that is spending time with my family and trying do work in my yard even though that is limited by my abilities and the excessive heat in Texas. In the last couple of years, we were able to go on vacation and enjoy myself. I find it helps to keep a journal of my symptoms, changes in how I am feeling and even things like the weather that day. It is especially important for talking to the doctor, so you don’t forget everything that has happened since your last visit since that is always their first question. Anything you do today that you didn’t do yesterday is progress towards a better life and you deserve that. I have been a Buddy for Shift MS for a few years now and hope that my musings help people to deal with their own challenges. Feel free to read some of my prior postings or contact me again. My prayers for you