About MSAA

As a national nonprofit organization, the Multiple Sclerosis Association of America is a leading resource for the entire MS community, improving lives today through vital services and support. MSAA provides free programs and services, such as: a toll-free Helpline; award-winning publications including a magazine, The Motivator; website featuring educational videos and research updates; S.E.A.R.C.H.™ program to assist the MS community with learning about different treatment choices; a mobile phone app, My MS Manager™; a resource database, My MS Resource Locator; equipment distribution ranging from grab bars to wheelchairs; cooling accessories for heat-sensitive individuals; educational events and activities; MRI funding and insurance advocacy; and more. For additional information, please visit http://www.mymsaa.org or call (800) 532-7667.

Show Your Support on this National Day of Service

Monday, January 16th is observed as a national holiday in honor of a great leader and activist, Dr. Martin Luther King Jr. In addition to being a federal holiday, Martin Luther King Jr. Day is recognized as a national day of service, empowering citizens to give back to their communities and help bring change in a nation so profoundly influenced by the courageous acts of Dr. King.

This day of service encourages our nation to have a “day on, not a day off” and support causes they feel a connection to. This is why MSAA encourages everyone to take part and offer a helping hand to those within the MS community.

There are many ways to give back and help improve lives in the MS community. Here are a few suggestions to help you get started:

  1. Donate your time by creating a fundraising event to benefit MSAA. This could be anything from a bake sale to a bowling tournament!
  2. Participate in Swim for MS – get creative and make your own unique swim challenge!
  3. Make a purchase from a company that supports charitable causes.
  4. Make a monetary contribution.
  5. Love using social media? Become a member of our Street Squad and help spread the word about MSAA!
  6. Perform a random act of kindness for someone in your community.

The hectic holiday season can certainly bring on a lot of stress. Allow this day of service to help you reflect on what you’re grateful for, and how you’d like to assist your community more in the New Year. We thank you for your continued dedication to our mission and hope you enjoy your volunteer work, whatever it may be!

We would love to hear how you are spending your Monday. Let us know what activities and service you are participating in either on our blog or on our Facebook page.

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MS Clinical Trials Made Easy with MSAA and Antidote

MSAA is pleased to announce that through a partnership with Antidote, a digital health company, we are now offering a clinical trial search tool on our website that will make learning about and connecting with MS clinical trials easier than ever.

While we remain dedicated to improving lives in the MS community through vital services and support, MSAA recognizes the value of having access to clinical trial information, providing important answers to researchers. This is why we encourage you to try Antidote’s clinical trial search tool.

Although some may be familiar with the purpose of clinical trials, others may not know or understand the benefits of these studies. Clinical trials are scientific studies that test the safety and effectiveness of new treatments for diseases, including MS. They often use patient participants; are conducted by universities, MS clinics, and neurologists; and must follow FDA-approved protocol so that all treatment is provided and all data is collected uniformly. No drug can be approved by the FDA until there is clinical trial proof of their safety and effectiveness.

The major advances in the treatment of MS in the last 15-20 years have only been because of data provided through clinical trials, which is why these studies remain so significant for MS research.

You can start searching for clinical trials for you or your loved one right now on our website. Click here to begin.

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New Year’s Resolutions, Taking Stock & Creating a Personal Health Reference Manual

By Stacie Prada

I used to think it was more important to just do things than to track them, but now I see the value in writing them down and acknowledging how far I’ve come over time. When the calendar year ratchets up and I think of myself as another year older, it’s a natural time to reflect and make goals. I like to review what I’ve accomplished, endured, thwarted and nurtured. When I’m feeling like I have a lot I still want to do, knowing how far I’ve come is a reality check for my expectations.

I aim for full life wellness, and I categorize my areas of wellness as health, home, relationships, finances, creativity and adventure.  At all times, I try to have at least one goal for each area. I like to incorporate small activities in my life that move me toward achieving my goals, and I like doing one or two large projects at a time that leap me forward on a goal.  Depending on my levels of energy and obligations, I’ll do a little or a lot on the larger projects. I try to establish and maintain balance in my life without sacrificing or ignoring another aspect of my life. My overarching goal is to keep working toward something while appreciating who, where and what I am now.

My 2017 Resolution: Take stock.

I think it’s helpful to take stock.  To think about what made me happy in the past, what I love about the present, and what I would like my life to be soon or someday. Committing those thoughts and ambitions to paper or a digital file allows me to look back over time to see if I still want the same things in life now that I thought I wanted in the past.

I’m taking stock figuratively and literally. I’m pouring through all of my personal belongings, my finances, my routines and my data. I’m compiling the things I’ve learned over the years since I don’t always remember something when I encounter it again. This will focus my attention on what I have, what I could adapt to use differently, what I still want, and what I’d like to upgrade for the perfect fit.

My Personal Health Reference Manual

A big project I’d like to accomplish this year is compiling all of my health information for things I’ve experienced, tried and currently use. I aim to create and maintain a binder for all the ways I keep my health in check. It will include all the successful and unsuccessful treatments.

The idea for this project came to me after my hip started hurting. I know that my hip can hurt when I jog longer distances, and I could tell that I’d overdone it. I believe the cause is foot drop that slightly affects my gait when I jog and triggers a misalignment in my hips to compensate.  In the past, I’d curbed my distances to deal with it. Sadly, it took hurting my hip twice in a month and six weeks of recovery time before it occurred to me I’d dealt with this before!  I remembered that I had physical therapy exercises from seven years ago that helped heal my hip from the same problem.  My hope is that using these exercises will not only allow me to heal my hip faster but prevent future injury and allow me to work back up to longer distances again.

This experience made me realize I need a personalized easy-reference health manual to manage my health with less stress. MS affects each person differently, and it requires constant adaptation to live successfully with MS. I want to reduce the amount of time spent enduring something and wracking my brain figuring out what will work for me in order to hasten effective treatment. An up to date personalized health reference manual will help.

The information I want to compile will include the following:

Conditions, Symptoms, and Injuries

  1. Indicators, triggers and causes
  2. Preventative measures including lifestyle choices, nutrition and activities
  3. Treatments including prescriptions, exercises, and natural remedies
    – Pros
    – Cons
    – When it’s effective
    – When it’s not effective
    – Why I choose this (or don’t)
  4. Experiences with this issue – what’s worked or failed
  5. Theories for why my body reacts a certain way – correlations proven and disproven

Sources of information I’ll use to compile this reference manual include:

  • Tracking calendars of health data and disease-modifying drugs
  • Notes I’ve taken at health appointments
  • Physical therapy treatments and exercises
  • My memory
  • My friends’ memories – often they recall things for me that I’ve forgotten
  • Books and internet resources that can trigger my memory for things I’ve tried but didn’t write down
  • Medical records from doctors

I’ve included a couple of examples at the end of this post that I’ve put together so far. It’s tailored to my health and experiences, so yours will look different. It’s also a work in progress, so I’ll keep adding and editing it as time passes and I change.

I wish I was low maintenance. Sadly, as I’ve aged I’m getting to be higher and higher maintenance. I joke that at least I’m doing the maintenance and not pushing that responsibility onto other people!

That said, if I do ever need help with my health, this will be a great tool for anyone helping me.  They’ll know what I’ve already tried, what works, and what hasn’t worked. I won’t need to start from scratch with each new provider.

This is organizing my health from my information and experiences. It frees me from relying on information from the web each time I confront an issue. Sometimes the information can just be too much, and what will help me gets lost in the mass of opinions and recommendations. This is organizing around me and benefiting from the decades of experience I have being me.

Examples of pages from my Personal Health Reference Manual:

Condition: Vertigo and dizziness with nausea

  1. Indicators, triggers and causes: crystals in ear out of place
  2. Preventative measures: none
  3. Treatments: Epley Maneuver to put crystals in ear back in place
    Pros: Non-invasive, I can do it at home, and no side effects. Immediate results.
    Cons: none
    When it’s effective: When dizziness is caused by ear crystals out of place.
    When it’s not effective: If dizziness is caused by something else.
    Why I choose this for now: It’s an easy fix.
  4. Experiences with this issue, what’s worked or failed. I experienced dizziness and nausea for a week before seeing my neurologist. He did the Epley maneuver to me on one side and it didn’t do anything. He did it again on the other side, and immediately my vertigo vanished! He taught me how to do the Epley maneuver at home, and I have used it a couple times over the years since. When I need a refresher, I’ve found a Youtube video to remind me.
  5. Theories for why my body reacts a certain way, correlations proven and disproven: It’s common.

Condition: Fatigue

  1. Indicators, triggers and causes:
    – When numbness intensifies or spreads from the usual areas
    – Spring and Fall when the seasons change
    – Less daylight in winter
    – More obligations than usual after work or on weekends
    – Workdays that involve constant personal interaction without breaks
    – Relationship stress
    – Big events – both happy and sad!
    – Long periods of added stress
  2. Preventative measures: Track fatigue level daily and adjust activities and treatments based on fatigue level.
  3. Treatments:
    1. Coffee/caffeine:
      Pros: It lessens light or moderate fatigue effectively and temporarily, it tastes good, it’s accessible, I don’t need a prescription, fewer side effects than other methods
      Cons: It can adversely affect sleep and intestinal health. Dosage can only go up to a certain level before getting jittery and anxious. I felt better physically (except for fatigue) when I went without coffee for a month.
      When it’s effective: For minimal to moderate fatigue.
      When it’s not effective: When fatigue is extreme.
      Why I choose this for now: I like it and it fits within my lifestyle. While I need to work in an office setting, it’s helped me maintain.
      Experience: Green tea inflames my throat. Caffeine tablets were harsh on my stomach. I may as well drink coffee and enjoy it.
    2. Rest:
      Pros: It’s helpful
      Cons: It’s isolating, it can conflict with life obligations.
      When it’s effective: At least some rest daily, but more intensive rest needed when fatigue is heavy or extreme.
    3. Modafinil (Provigil):
      Pros: It’s effective
      Cons: It requires a prescription, and my insurance doesn’t cover it. Out of pocket cost was $120 for six pills in 2012. (Could check on this periodically to see if it’s changed.)
      When it’s effective: It can help me get through periods of time when I’m not able to limit my obligations to get more rest. It’s a good temporary option if I can get an Rx.
    4. Exercise:
      Pros: Moderate exercise helps reduce fatigue. It’s good for weight management. It helps keep me mobile and able to experience lots of activities.
      Cons: Hard to always gauge how much exercise is enough and how much is too much. Too much extreme exercise over months can tax my body and lead to more fatigue.
      When it’s effective: When I’m not injured or severely fatigued.
    5. Organization & Prioritization:
      Pros: It lessens stress and frees up mental and physical capacity for reducing stress.
      Cons: It takes a lot of thought and practice to create organization methods.
      When it’s effective: Pretty much always.
    6. Blue light
      Pros: Non-invasive
      Cons: Daily time investment required, and the results aren’t immediate. Hard to gauge if it’s helping or not. It was an expensive investment without any assurance it would help.
      When it’s effective: Fall and winter when the days are short where I live.
    7. Limit activities
      Pros: Helps free up time for rest and sleep.
      Cons: It can get depressing and make me feel like I’m being punished.
      When it’s effective: When I’m still able to do things that satisfy me emotionally.
  4. Experiences with this issue, what’s worked or failed. I used a blue light in 2010 through 2012. I think it helped, and I should pull it out and try it again this winter. I don’t need it in the summer and I forgot I had it. Exercise, rest, coffee, and good nutrition work for daily maintenance. Modafinil works well when I need to keep going for a week or so beyond what my body would prefer. Rest is required to recover from overdoing it.
  5. Theories for why my body reacts a certain way, correlations proven and disproven: Fatigue is the #1 symptom common for people with MS. With so much damaged nerve insulation (myelin), it takes more energy to do common tasks than for someone with healthy myelin. My neurologist explained that the energy it takes a healthy person to walk a mile may be an equivalent of a mile and a half or two miles for someone with MS.

*Stacie Prada was diagnosed with RRMS in 2008 at the age of 38.  Her blog, “Keep Doing What You’re Doing” is a compilation of inspiration, exploration, and practical tips for living with Multiple Sclerosis while living a full, productive, and healthy life with a positive perspective. It includes musings on things that help her adapt, cope and rejoice in this adventure on earth. Please visit her at http://stacieprada.blogspot.com/

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Polar Plunge 2017

On January 1st, we had the honor of attending and being the beneficiary of the 2017 Atlantic City Polar Bear Plunge, hosted by the Atlantic City Polar Bear Club. It was a beautiful, sunny day and hundreds of participants arrived at the Jersey Shore on Sunday morning, eager to plunge into the icy waters to support MSAA and ring in the new year!

As local South Jersey radio station, 100.7 WZXL and Mayor of Atlantic City, Don Guardian began the countdown to the plunge, we felt fortunate to have a large group of supporters spending their New Year’s Day giving back to the MS community. Seeing all the creative plunge-themed costumes and cute animals in decorative outfits was a plus, too!

MSAA would like to extend our thanks to the Atlantic City Polar Bear Club, Resorts Casino Hotel, 100.7 WZXL, and Dab Tech LLC for all of their hard work. Without their dedication, the plunge would not have been possible! We would also like to thank Ventnor No. 7311, Starbucks of Atlantic City and Sam’s Club of Pleasantville for their lovely donations of snacks and coffee for participants. Each organization went above and beyond to ensure everyone had a fun day!

While MSAA staff did not brave the freezing waters on New Year’s Day, we certainly appreciate all of those who did. We hope the chilly water wasn’t too intense, and that you’ll continue to join us next year in Atlantic City. Thank you and Happy New Year!

See more fun pictures of the Atlantic City Polar Bear Plunge on our Facebook page!

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Happy New Year

From all of us here at MSAA, we are thankful for your continued support throughout this past year.

We wish you and your families a safe and happy New Year!

Please note that MSAA offices will be closed on Monday, January 2nd and will reopen on Tuesday, January 3rd.

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Tips to Fight Those Winter Blues

After the excitement of the holidays wind down, the remaining winter months can often seem very long and keep many indoors and away from social activities. To help prevent the winter doldrums, we invite you to check out the following strategies for ideas on how to stay active and engaged in the comfort of your home:

  • Lend your voice. As you may know, MSAA launched its first online MS peer forum this summer titled, My MSAA Community. With more than 1,400 members to date, this safe and supportive community offers tremendous resources and personal insights into managing the day-to-day challenges of MS. Among the most frequently discussed topics include tips on cognition, handling family relationships, symptom management strategies, and much more.
  • Find some happiness. What makes you happy and inspires you? Is it a craft, hobby, or artist expression? Perhaps learning about mindfulness stress reduction, yoga, or aquatic exercise can help improve your physical and emotional outlook on life. MSAA offers an extensive Overall Wellness section on our website at mymsaa.org, providing useful information, resources, informative videos, helpful tip sheets, and more.
  • Take a journey with Christine. Just added to the “Personal Stories” section of MSAA’s Lending Library, Walk of Hope: One Woman’s Journey with Multiple Sclerosis is a book written by Christine Ganger. In this writing, she describes some very raw and personal moments in her life, while also revealing how hope can make the mind and heart overcome the anguish one feels when experiencing similar physical disabilities.
  • Plan your own journey. Now is a perfect time to think warm thoughts and plan ahead for any possible spring or early-summer travels! The Lending Library includes a section on “Accessibility,” and features titles such as: 101 Accessible Vacations, Barrier-Free Travel, and There is Room at the Inn.
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Happy Holidays

From everyone here at MSAA, we wish you and your families a Happy Holiday!

Please note that MSAA will be closed on Friday, December 23rd and Monday, December 26th.  We will be back in the office on Tuesday, December 27th.

Enjoy your holiday!

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The Ponds of Socialization

By Lauren Kovacs

Being with family and relationships are like skating on thin ice. Caution and preparation for these are something we need to do, especially near the stress of the holidays. Using some information can help us skate safely onto the pond of socialization. Having MS requires more of everything.

Like anything, we cannot “wing-it.” We cannot fly by the seat of our pants. The biggest thing to remember is to stay calm. Know your limits. Our speed is slow or “No.”

This is where knowing where the thin spots are will help.  I like to know people’s personalities ahead of time, if I can. Going to family events or parties may take some personality planning. I like to know who respects the limits of my MS. Know your audience, so to speak.

Know the thin spots and stay clear. Know what situations and who is safe. This will reduce stress. Pick events that keep stress and fatigue to a minimum.

Some people you may have to physically stay away from. Other situations or people you may have to emotionally stay away from. MS is tough enough without someone commenting how his or her sister-in-law’s cousin’s friend ate something and is fine.

Attending work related parties is part of PR for my husband’s job. I always use my chair.  It cuts down on fatigue so, I can stay a bit longer.  I am social, but in the evenings I am exhausted and the MS “misbehaves” more. My speech is garbled so, I mostly listen.  Sounding drunk at a work party is not wise. I try and eat before I go too.

Eating is very difficult for me. I can more easily refuse food, if I am not famished too. For me, it makes the gluten gods happy. I can be polite and have one or two bite size hors d’oeuvres. I don’t like to wear food in public so, I stay away from that thin ice.

If you are going to an unfamiliar place, take note of bathroom locations the minute you get there. Wear easy off clothes. When I gotta go, I gotta go now. I find thigh-high tights are easier than regular tights or hose. They are a bit drafty, but it is better than dealing with hose when now means now.

Know your limits. Don’t over party because the recovery time is not worth it. Try to stick to any diet restrictions. I mostly eat gluten free, but I allow a cookie or something. Balance for me is key. With a bit a planning, I can have that delicious gluten filled cupcake and be social. Be mindful of your limits and needs. A straw is a must and I carry an extra one in my purse. Most of all, try to enjoy the season.

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Feeling Connected and Nurtured When I’m Alone on Christmas

By Stacie Prada

Families seem to be expanding and shrinking simultaneously these days. With second and third marriages, births, in-laws and kids by marriage, the number of people I care about and am related to keeps growing. At the same time, divorce, death, living miles away and conflicting schedules reduce the number of people I spend time with in-person during the holidays.

This year I vacationed over Thanksgiving week, and I enjoyed a lot of time with family and friends while having a lot of fun. Now I’m back at home and while I’ll have plenty of parties to attend this month, I anticipate spending Christmas Day alone. Living far away from my closest family members makes it impossible for me to spend all holidays with them. I enjoy spending time with others, and I enjoy my time alone. Still, there’s something about the holidays that is tricky. If I don’t plan ahead, it can be easy to fall prey to self-pity.

In my life, I’ve experienced a couple decades of small family gatherings and another couple decades of large and wonderfully chaotic extended family holiday events. More recently I’ve experienced celebrating holidays solo, and it’s coerced me to think hard about what will allow me to enjoy the day alone. For me, I feel nurtured if I can include some time connecting with people important to me, some time outside reflecting and appreciating all of the good things in my life, and some time indulging with good food and drink.

If I’m going to be alone on a meaningful day, I try to connect with others in one or more of the following ways:

  1. Try to set up a time to Facetime or phone people important to you. If schedules are complicated, email or text a holiday greeting.
  2. Do things to connect with people throughout the month or year, not just on or near the holiday itself.
  3. See if friends will invite you to join them. You can be somewhat subtle by asking what they’re doing. They’ll ask what you’re doing and often invite you to join them, but make sure before asking that it’s someone with whom you would like to spend the day.
  4. Ask a neighbor if they’ll be around. You can get together for an hour for coffee, tea or wine. It doesn’t need to be big, just something to break up the day and include some interpersonal connection.
  5. Volunteer at a local charity. You can help prepare or serve a meal for others. You can also just be a smiling greeter if you’re not able or up to performing tasks. Listen, share, learn and connect.
  6. Tell people that you’ll be alone and would appreciate a phone call. Often people assume I have it all together and will be busy. They’re happy to connect when they know it’ll be appreciated and not a bother.
  7. I’ve never found a relationship that does better from no interaction. Give people a chance, and don’t assume the worst. Appropriately credit responsibility for behavior to the person doing it. Feel good about yourself. Make sure you feel good about your behavior regardless of the actions of others.
  8. Consider people you know that may also be spending the day alone. Make plans to do something together for a portion of the day.
  9. Post something to Facebook. One Thanksgiving I enjoyed watching the sunrise on the beach while drinking my coffee. I took a video of the sunrise and shared it with friends while expressing my gratitude for them in my life.

Some of the ways I’ll nurture myself include the following:

  • Do something special for yourself to commemorate the occasion. Do something indulgent for you, or engage in some activity you love. Sit on the beach, go for a walk, or stop at a coffee shop that’s open. What you love may be totally different than anything I would ever consider.
  • Find a restaurant nearby that’s open, and go alone if you want.  At the very least you’ll talk to people that have to work instead of spending time with their own family.  It’s usually a very friendly time.  Plan ahead since a lot of places are closed on holidays.
  • Visit and leave flowers at someone’s final resting place. Honor the impact that person had on your life.
  • Make and enjoy a meal you love if you enjoy cooking.
  • Decorate, even if it’s just a holiday themed bouquet or plant. Differentiate the day and your surroundings from every other season or day of the year.
  • Get outside. Even a rainy, cloudy day outside can feel better than staying inside or under cover.
  • Think about what you could do so that you’ll feel loved and appreciated even if it’s just you who loves you.
  • Make sure you find a way to enjoy the time instead of just trying to get through it.

Connecting with people important to me takes some initiative. Lots of them have a busy day ahead, so it’s good to plan in advance to make sure my emotional needs met. Overall, I’ll be happy if I remember to genuinely look at the bright side, do something I love, connect with everyone I care about either during the month or on the day, and find a way to be generous.  And if nothing else works, I’ll distract myself and remember tomorrow is another day.

*Stacie Prada was diagnosed with RRMS in 2008 at the age of 38.  Her blog, “Keep Doing What You’re Doing” is a compilation of inspiration, exploration, and practical tips for living with Multiple Sclerosis while living a full, productive, and healthy life with a positive perspective. It includes musings on things that help her adapt, cope and rejoice in this adventure on earth. Please visit her at http://stacieprada.blogspot.com/

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Canceled Plans… Again

canceled-plansBy Penelope Conway

Life was good before multiple sclerosis. I had great friends. We would spend time together on the weekends going out to eat or bowling. In the summer we would plan hiking trips through the mountains and in the winter we would go skiing. When MS became a part of the picture, those nights out and trips dwindled. Eventually I wasn’t even being invited out anymore, they would just go without me. I wanted to scream at the top of my lungs, “I have MS, I didn’t die.”

Amazingly, you discover who your real friends are once MS becomes a part of your life. People will either stand by you and help hold you up when you are at your weakest or they will walk away. If they choose to walk away, let them. You don’t need anyone in your life pulling you down. MS is already doing a pretty good job of that already.

I have days when I find myself dealing with physical symptoms like tremors, pain, weakness, numbness, vision problems, and muscle spasms. Enough to cause me difficulties but not enough to stop me from continuing on in my day. Then there are times when everything become so intense, when the pain and weakness grows so deep, that it bleeds over into every part of my life as it tries to get its grubby little hands on things like my thoughts and emotions.

One thing I have learned over time is that MS is not a disease you can keep to yourself. We try though… don’t we?! I know I do. I try to keep the effects of MS neatly contained in its own little space hoping to shield myself and those around me from its impending destruction, but it seems the more I try to contain it, the more it spills out. It’s kind of like trying to rake the leaves in my yard into a pile on a windy day. What a futile task. No matter how hard I try, they just won’t stay where I put them.

Regardless of what anyone thinks, we need people, especially when living with a chronic illness and even more so at this time of year. It’s a time when the weather is unforgiving, parties don’t cooperate with our MS limitations, and depression has this sneaky little way of creeping into our lives.

It’s amazing the things we have to consider when receiving an invitation. Is the location accessible? Will the wheels on my walker or wheelchair leave wintry slush tracks on someone’s nice carpet? Will my body play nice? Will I be able to manage the crowds and traffic? Will my finances be stretched too thin, above and beyond any past due medical bills? Will fatigue hit hard keeping me from being a part of the fun? Will people understand my decision to go home early or that I had to cancel plans last minute? Will they even invite me in the first place?

Real friends get it, though. I was once told, “You can count your true friends on one hand and sometimes on one finger.” How true is that?

I know it’s not always easy to do, but be determined to fill the days ahead with the warmth of a few close friends. It really does brighten the gloomy winter days. If you can’t get out, invite someone over for a special movie night complete with pizza and popcorn or even Skype with someone you haven’t seen in a while. Sometimes something as simple as a text message back and forth with someone you haven’t heard from in a long time can give you a smile that lasts for days.

From one friend to another: do your best to find joy in the wintry cold mix and always remember just how absolutely, positively, incredibly amazing you are. I sure happen to think so.

*Penelope Conway was diagnosed with Multiple Sclerosis in November 2011. She is the author and founder of Positive Living with MS (positivelivingwithms.com) where she uses humor and her own life experiences with MS to help others navigate this unpredictable journey. She believes that staying positive and holding onto hope is the key to waking up each morning with the strength to get through the day.

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