Dear Donna,   I don't know where you live but my husband was diagnosed with PPMS in June 2005 - he probably had the disease between 10-12 years.  It started with unsteady gait and problems lifting his left leg.  After visiting three doctors in NY, we were lucky enough to find Dr. Saud Sadiq at the International Multiple Sclerosis Management Practice in NYC. My husband has received intrathecal (given in the spine) methotrexate - my husband says it is painless.  He was also given a drug called 4-AP for fatigue and last year a long acting form - Rifampen XR.  It has made a very big difference in his fatigue level.  He works full time as an operating engineer (heating and air conditioning) and although he continues to have problems with his gait and he walks with a limp, he does not seem to be progressing much.  I would like to think that the methotrexate is helping.  Dr. Sadiq has two associates who are equally competent and empathetic.  His number is 212-265-8070. Even if you are not in the New York area, maybe they can steer you in the right direction.  I hope that you get some answers to this frustrating and unpredictable disease.  Good luck and I hope this was helpful.   Paula S.