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4.   KNOW YOUR COPING STYLE & BE KIND TO YOURSELF

Many people who experience a series of losses have a coping style they can draw on.

Lindsey developed a way of anticipating a loss and the solution to it. When a depression would warn her that some loss was occurring, she'd "take steps to make some changes in the environment or recognize what was going on. I'd face it head on and say, is there some aid that's available, something that I can buy or look into to take care of it?"

That approach, of anticipating what she'll need next - a cane, a scooter, a different schedule - helps her accept the loss and adjust her life.

Hopkins recognizes when her emotions are becoming too difficult to manage. "Whenever I would get to a point where I would come up with a new emotion, a new fear, a new frustration, a new helpless feeling, something that I had not experienced before, eventually I would go into some type of counseling." Besides a problem-solving coping style, it also helps to have some self-nurturing techniques.

Social worker Coker asks people to make lists of things they enjoy doing or that make them happy. You should make the list at a time when you feel good and things are going well.

Then when you start to feel discouraged or overwhelmed by loss, get your list out and do one of the things on it to make yourself feel better.

"There's a tendency when you're feeling down to not do anything and that just makes it worse," Coker says.

"If you take some sort of action, it gets you out of just sitting there and thinking about all that you don't have. To stay isolated and think about what you don't have anymore just feeds into depression and gets you deeper down and makes it harder to take action."

A feel-good action can be as simple as "opening up all of the windows on a nice day and letting the breeze blow through. Going to get a manicure, seeing a movie, or going to a park and just being around nature." Other nurturing actions might include writing your feelings in a journal, listening to music, swimming, playing with pets or doing creative artwork.

Another approach is to keep a gratitude journal and record at least one thing you can be grateful for each day, Coker suggests.

"Maybe it was getting to watch the sunset. It forces people to think about the things that they do have in their life, rather than what they don't have. There's something very real about focusing on simplicity and surrounding yourself with beauty."

Self-nurturing when you're coping with loss "could get you out of feeling sorry for yourself. It could get you focusing on the things that you do have, the positives. No one is going to nurture you like you can nurture yourself."

5.   GET WHATEVER HELP YOU NEED

Counseling or support groups help some people cope with loss. Sometimes, getting the right medical care or orthopedic equipment makes a difference.

About six years ago, Wade Kiner of Mitchell, S.D., lost a job for economic reasons. Shortly after that, his walking seriously deteriorated because of Becker muscular dystrophy. He fought using a wheelchair as long as possible, and, when he began using the chair, he felt he'd lost a great deal.

"You're afraid that it will make you more of a shut-in, harder to get out and about," Kiner says. "I spent so much time at home before we actually got the motorized chair, I would be kind of stuck at home. I didn't have any way to get anywhere without some help."

Though staying home provided a needed rest from a fatiguing job, it created financial problems for Kiner's family.

"That was a haul there. You really didn't even feel employable. 'I'm in this wheelchair, what can I do?' I wasn't trained to do anything. It was pretty low right in there."

In 1998, the Kiners were able to get a van with a wheelchair lift and a power wheelchair. "That kind of brought me back to life. That's kind of got me up and mobile and able to work again.

"Once I had the chair, I was just cruising around, going out to the kids' ball games in the summer. It improved our life immensely," he says, adding that it improved his spirits, too.

Coker advises those coping with loss to avoid isolation. Though some time spent in quiet reflection may help you gather your strength, this period should be temporary.

"Sometimes when people try to isolate themselves and deal with it on their own, they don't get information. And that sometimes limits your options," Coker says.

"Depression can also set in. Sometimes that's very hard to get out of if you don't have anybody who can kind of work with you and teach you new ways to cope. It just builds on itself if you refuse to go out there and seek help."

Several people in this article have experienced levels of depression triggered by loss that called for medication. In most cases, a temporary round of antidepressants helped them regain the energy and will to keep going.

But beware of "self-medicating" with excess amounts of alcohol, food, television, Internet cruising or other forms of escape.

6.   NOTICE YOUR GAINS & POSITIVE CHANGES

If you lose an activity, sometimes you can replace it with another that gives you many of the same benefits. In his early 20s, Kiner had to give up bowling, which also meant getting out of touch with some longtime friends. But Kiner, now 37, took up throwing darts, and found "it kind of kept me with the crowd I was in or at least some of them."

Quesinberry finds his life is different, but not his interests and activities.

"I haven't developed any new interests," he says. "I've always loved to read, write, listen to music. I volunteered years before CMT. So nothing has changed that drastically, except that my world is in slow motion. That's the way I look at it. I don't do anything rapidly any more."

You can't "replace" a significant loss - a person, a relationship, a major ability. But you can reconstruct your life so that the loss is no longer center stage. Both Marlatt and Kiner were faced with the loss of their roles as family breadwinners. But the change brought some rewards.

After Marlatt stopped working as a bank branch manager, his wife started a decorating business out of their home. He worked with her, doing mailings, bookkeeping and things he called "menial." But the activity helped him to feel productive.

Having more time for his two daughters also helped him cope with his losses.

"There were times when I was very resentful of my life. 'My God, why me?' type things when you'd get depressed, particularly if you take a fall," he recalls.

"If I was bummed out, suddenly at 3:15 the kids would come home from the school bus and they're all excited and they're jumping around and making a snack and turning on TV and we're talking about what's going to happen on 'General Hospital' or something. There was always some excitement with them in the house." Marlatt also took over more parenting responsibilities, helping get the girls ready for school in the morning and driving them to activities.

His specially built chair in the family room became the center of family life - the place for socializing and eating meals.

Kiner noticed a similar result. "I got to be with my kids when they were smaller. I guess I got to see them grow up."

7.   REALIZE THE PROCESS ISN'T SMOOTH

The popular view of grief as a series of stages - denial, anger, depression, bargaining and acceptance - oversimplifies what is for most people a lifetime of constant adjustment. Stages don't always go in the same order, and new losses may reawaken the pain of old losses. Larger losses produce deeper grief and take longer to recover from.

Marlatt and his family created a good life after he stopped working, adding equipment and adapting their house as his LGMD progressed. Then his wife was found to have cancer, and she died at age 50.

Around the time of her illness, Marlatt was losing his ability to walk. At about age 60, he was faced with increasing disability and loss of the person he'd relied on most for help. During that period, he underwent some depression, but has largely bounced back.

Within a couple of years, he'd sold the family business and the home and moved into a seniors' facility, which has independent apartments as well as assisted living and a nursing home. The new residential arrangement has made for a smoother relationship with his daughters and opened up some new social activities. Marlatt, 66, still has some down moments when he contemplates his losses, past and future. But all in all, he copes by dealing with one change at a time.

Grief can be triggered unexpectedly by anniversaries, holidays and other reminders.

This can happen, Coker notes, when you're put in a different environment on the job or at home. "Or you see a picture of yourself from a certain period of time, or somebody sees you for the first time since you've been diagnosed and their reaction to you sends you back."

When such reminders awaken the sense of loss, call on your best coping and self-nurturing techniques.

8.   USE WHAT YOU'VE LEARNED TO HELP OTHERS

Quesinberry and Lindsey put their losses to constructive use by channeling what they've learned to help others.

Quesinberry is very active in his MDA support group and contributes to keeping the conversation "positive."

"I enjoy making other people feel better about whatever. When you respond positively to everything that's going on, it seems like all of a sudden everyone in the group is coming out with positive things."

For example, when people begin to dwell on the fact that there's no cure for their disease or any way to stop its progression, he'll say, "This requires you to be creative. How can I improve what I'm going through? How can I make it easier for me to accept what I'm going through? Rather than, all is doom.

"The thing I ask is: 'Other than physical problems, are you really any different now than you were before? I know I'm not, and I'm pretty sure you're not either.'"

Lindsey, 75, lives in a retirement community in which many people are dealing with physical disability and loss for the first time. Though she's very fatigued by the end of the day, she gets around on her scooter and participates in many activities.

"I feel like the rest of the world is catching up with me," she remarks. "In other words, I slowed down at an early age physically. And now, living here in this retirement community, I don't feel so unique in my limitations.

"I feel that I've used this to help other people, help them cope with whatever their problems are. I was a co-facilitator for an ALS group of caregivers. Being able to do that sort of thing has helped me realize that I'm not useless.

"I like to think of myself as a role model. There's something to be gained."