b"patients with RAW was similar. However, thisare commonly encountered in people with same study showed that patients with PIRAMS but are sometimes tricky to link to a progressed to needing a cane to walk fasterspecic cause. It is essential to recognize that than patients with RAW.not all neurologic symptoms are from either This description of RAW and PIRA seemsRAW or PIRA. These other symptoms can straightforward. Still, it is often difficult tohave a combination of causes and can be distinguish between RAW, PIRA, and otherexacerbated by different conditions. Therefore, symptoms related to MS and unrelated to MS.careful evaluation by an MS patients healthcare Decreased concentration, foggy cognition,providerisimportanttounderstandthe walking difficulties, bladder problems, andsymptoms and strategize a way to try to bowel problems are just a few symptoms thatalleviate them. RRAAWWvveerrssuussPPIIRRAAR PIRA (Progression independentRAAWW((RReellaappsseeaassssoocciiaatted w of relapse activity) worsening)Trigger: Clinical relapse No clinical relapse or MRI activity Timing: Sudden worsening during a relapse Gradual worsening over time Recovery: Partial or no recovery after relapse No obvious recovery because no acute relapse Cause: Inammation and damage Likely neurodegenerationor smoldering inammation Treatment: DMTs can reduce frequency Less responsive to DMTs and severity of relapses and minimize RAW What my MS diagnosis has taught me: Lynn Schwartz: Perseverance, adapting, nding my new self and taking more time to do something. Ellen Skogsberg: How to live with intention. Barbara Titus: My diagnosis taught me that it was time to eat healthier and exercise. I have MS, but MS doesn't have me. Ken Nashif: Diagnosed in 1996 with RRMS and then with SPMS in 2019. Initial diagnosis led me to quit smoking (25-year chain smoker), quit drinking, and start naturopathic care. Since I couldnt tolerate the DMTs that the neurologist put me on I made my mind up to live the best life I could. Most important lesson I learned is you can have everything you want.15 msfocusmagazine.org"