I think my neurologist knew right away it was PPMS as I also suspected. He did not diagnose me with that right away in order to give me the time to try a DMD as insurance companies will not allow them for other than RRMS. After a long time of giving it a try (with no success) he wrote PPMS on my file. My current neurologist talks, is very receptive (my e-mails answered within 12 hours or less) and treats symptoms. He is good, if anything comes up not in his field, notes it and refers me out. His rating by patients on-line gives ghim 5 stars and calls him compassionate. I copy and send him. But all my tests were almost trxt-book MS results and my anecdotal history very PP, not everyone's MS is so clear-cut.