Sally, I have a question for you. Your the only SPMSer I can think of right now and you always give such great advice. But anyone with SPMS can chime in too. I'll take advice from anyone Im now on year 20 with MS, and am wondering how you know when you've gone from RRMS to SPMS? Ive always recoved completely from my flares, but now Im not. I can no longer walk alone, I have to use a cane or walker, I can no longer walk long distances like thru the grocery store, I have to use a motor cart. Im constantly dizzy, that never goes away. Spasticity is a constant unwanted companion. It use to be the only time I got dizzy was when a flare was coming, now its constant. I have also developed foot drop in my right foot. I could go on, but you get the jist. I asked the neuro if Im now SPMS, and he said no in the same breath as he was trying to push tysabri down my throat. I know neuro's are hesitant to label SPMS/PPMS due to insurance reasons. Im just getting nervous now.