msconnection issue 1 2009

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Walk MS 2009Pages 4-7

Pa. license platesPage 9

Focusing beyond MS Pages 10-11

2009 Issue 1 Greater Delaware Valley Chapter

New Web site4-15

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Join the grassroots movement that’s raising awareness, funds and spirits for 11,000 local people living with multiple sclerosis: Walk MS 2009.This Sunday morning stroll is our most accessible, family-friendly event, with friends and neighbors gathering together to celebrate successes large and small.

Each walker, team captain and volunteer who participates in Walk MS is a vital partner in providing services and programs to benefi t 11,000 local people living with MS.

14,000 walkers.16 sites.1 community creating a world free of MS.

JOIN THE MOVEMENT: nationalMSsociety.org/pae2

President’s MessageGiven the current economic downturn, it should come as no surprise that people are turning to our chapter for assistance in record numbers, stretching our resources dangerously thin.

Just fi ve months into the current fi scal year, we are over budget on our funds to provide emergency grants for utilities,

rent and food; home care aid; and physical therapy. Furthermore, we have already been forced to close our incontinence supplies program for the year.

Without the continued and expanded support of people who care about the fi ght against MS, those living with the disease in our local communities could lose access to vital therapies and home care services that allow them to maintain their independence.

We need to pull together, and Walk MS is the opportunity to do just that. No event better exemplifi es the power of community than Walk MS.

Even if you can’t participate as a walker, there are many ways to support this exciting event this spring. Sign up as a volunteer, register as a “virtual walker” and raise funds online or “Talk MS” by recruiting your friends and family to get involved on your behalf.

Finally, if you or someone you know needs assistance to overcome the challenges of living with MS, please contact us at 1-800-FIGHT-MS. The Society has been here to help for more than 50 years—and we will be here as long as multiple sclerosis remains a disease with no known cause or cure.

Sincerely,

John H. Scott

John H. ScottChapter President

National Multiple Sclerosis SocietyGreater Delaware Valley Chapter1-800-548-46111 Reed Street, #200Philadelphia, PA 19147

ChairmanJeff A. Petty

Vice ChairmenLarry KaneDaniel S. Ojserkis, Esq.

Chapter PresidentJohn H. Scott

MS stops people from moving. The National MS Society exists to make sure it doesn’t. We do this through our home offi ce and 50-state network of chapters by funding more MS research, providing more services to people with MS, offering more professional education and furthering more advocacy efforts than any other MS organization in the world. The Society is dedicated to achieving a world free of MS. Join the movement at nationalMSsociety.org.

The National MS Society does not endorse products, services or manufacturers and assumes no liability for the use or contents of any product or service mentioned. Information provided by the Society is based upon professional advice, published information and expert opinion, and does not constitute therapeutic recommendations or prescriptions. We recommend that all questions and information be discussed with a personal physician.

©2009 National Multiple Sclerosis Society, Greater Delaware Valley Chapter

MSConnection welcomes letters to the editor. Send letters to [email protected] or the address above. Include your name and a phone number or e-mail address where we can reach you, if necessary. Please note: we may edit your letter for length and content.

Vice President, CommunicationsKevin Moffi tt

MSConnection EditorAnne Krishnan

TOLL FREE NUMBER 1 800 548 4611 3

NEW LINK BETWEEN MS AND VITAMIN D

For the fi rst time, researchers have found evidence of a direct interaction between vitamin D and a common genetic variant that increases the risk of developing multiple sclerosis.

The researchers found that

proteins activated by vitamin D in the body bind to a particular DNA sequence lying next to the gene, in effect switching it on. The authors believe that vitamin D defi ciency may lead to lowered expression of this gene. This may alter immune processes that ultimately trigger the immune attack on brain and spinal cord tissues in MS.

There are trials in progress that may clarify the potential value and possible risks of vitamin D supplementation in MS.

MS RELAPSES MORE FREQUENT IN KIDS

People diagnosed with MS before age 18 have three times the relapse rate as people diagnosed as adults, according to a recent study.

Coupled with previous reports

suggesting that the disease progresses more slowly in patients diagnosed in childhood, the results may suggest that the nervous systems of younger people with MS have a greater ability to form new connections, less neurodegeneration and potentially more repair capabilities.

MRI MAY FORECAST MS DIAGNOSIS, PROGRESSION

MRI brain scans may be able to detect signs of multiple sclerosis long before symptoms of the disease appear, researchers report.

Researchers in California followed 44 people with abnormal brain scans and found that in less than six years, 30 percent had developed MS symptoms. They said further research is needed before doctors begin treating people with these pre-MS abnormalities.

Other researchers reported that advanced MRI scans can predict the chronic effects of optic nerve infl ammation among people living with MS. Researchers are currently working to expand the approach to assess MS attacks in the brain and spinal cord.

MICE SUCCESSFULLY VACCINATED AGAINST MS-LIKE DISEASE

German researchers have succeeded in vaccinating mice with specially treated immune

cells that prevent them from developing encephalitis, a disease similar to multiple sclerosis in humans.

The scientists placed the nervous system protein that is the target of the harmful immune reaction in MS on the surface of the cells, then treated them with a chemotherapy agent that suppresses immune defense. The immune cells become accustomed to the protein and did not attack it later, even without the inhibitor.

NEW CLUES ABOUT EPSTEIN-BARR

A new discovery by Australian researchers adds new information to the connection between the Epstein-Barr virus and MS and may be a key fi nding in the hunt for the disease’s cause.

About 90% of adults have EBV (mononucleosis), a lifelong infection, but most have immune systems that keep its levels under control. Scientists have found the immune systems of people with MS are less effective at killing off EBV-infected cells.

The fi ndings add weight to theories that EBV plays a role in triggering MS. More importantly, the new study raises hope that the vaccines and antiviral drugs that are being developed against EBV could help reduce the number of people who develop MS or slow the disease’s progress.

IN B

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In this economic crisis, your involvement is more important than ever. We need you to join the movement on April 26 or May 3 by leading a team, walking, volunteering or donating at one of 16 sites throughout the region.

What’s more, we need you to carry the movement into your neighborhood, workplace and community organizations to get even more people involved in creating a world free of MS at Walk MS 2009.

We’ll also have advocacy tables set up at each site to show you how easy it is to become an MS activist.

Join the movement today by visiting walk4MS.org or calling 1-800-883-WALK.

SUNDAY, APRIL 26NEW SITE! East Goshen Twp.Park, East Goshen, Pa. (5K run)

West End Fairgrounds, Gilbert, Pa.

NEW SITE! Coca-Cola Park (Home of the IronPigs) Lehigh Valley, Pa.

Elmwood Park Zoo, Norristown, Pa.

Lenape Park, Sellersville, Pa.

Moorestown High School, Moorestown, N.J.

Washington Lake Park, Washington Twp., N.J.

SUNDAY, MAY 3North Penn High School, Lansdale, Pa.

Ridley Creek State Park, Media, Pa.

Tyler State Park, Newtown, Pa.

Philadelphia Museum of Art, Philadelphia, Pa. (5K and 10K run)

Gring’s Mill Recreation Area, Reading, Pa.

Valley Forge Area, Valley Forge, Pa.

Ocean City Board Walk, Ocean City, N.J.

Parvin State Park, Vineland, N.J.

Eastern High School, Voorhees/Gibbsboro, N.J.

Volunteer to create a world free of MSThe success of our events depends on the dedication of thousands of volunteers. Join the movement in 2009 by volunteering at one of our fundraising events:

> Walk MS, April 26 and May 3

> Bike MS: PA Dutch Ride, July 18 and 19

> Bike MS: City to Shore Ride, October 3 and 4

> Challenge Walk MS, October 17-18

WALK MS 2009CONTINUED FROM PAGE 1

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Learn more about volunteer opportunities at nationalMSsociety.org/pae or call Kathie Cronk at 1-800-548-4611.


Philadelphia mom tackles disease through Walk MSHeather Burkart can’t take away her teen daughter’s multiple sclerosis, but she can help work toward a cure by raising money through Walk MS.

So Burkart got involved in a big way in 2008, forming a team that raised $48,988 in its fi rst year to become the event’s top fundraiser.

Walk MS helps Burkart turn any negativity into positive energy when it comes to 16-year-old Jessica’s MS, she said.

“It’s still hard to accept the diagnosis but Walk MS helped me focus on the positive, and it still does,” she said. “It’s my therapy.”

Burkart recruited more than 100 friends and family members to fundraise and walk with her J-Walkers team at the Philadelphia Art Museum site. She made things easy and fun on Walk day, renting buses so walkers wouldn’t have to drive, supplying coffee and doughnuts and handing out handmade spirit shakers.

“It was hard to believe that everyone was there in support of my daughter,” she said. “It was very emotional and very uplifting at the same time.”

As she promotes Walk MS, Burkart also is an evangelist for the Society, its mission and its services. She tells supporters that when Jessica was diagnosed, the Society offered to help fund a trip to Stony Brook University Medical Center in New York for a second opinion.

“If we had needed it, it would have been a godsend,” she said. “It’s important for people to know the Society is real and they are looking to help people with MS.”

In addition to individual fundraising, the team raised money last year with a dinner, auction and 50/50 at a local restaurant.

This year, Burkart wants to recruit 30 more walkers and beat last year’s fundraising total. She’s also looking for a bigger venue that will let her accommodate more supporters at the dinner and will be more proactive recruiting local businesses with personal visits.

Jessica doesn’t quite understand her mom’s “obsession” yet, Burkart said. “One part of her is kind of embarrassed that this has become a big thing. The other part of her does realize the support she has, and I think that helps.”

The J-Walkers at Walk MS: Philadelphia 2008


We need to create a buzz around Walk MS 2009. Not only is the event one of our most important fundraisers, it’s the easiest way to join the movement to create a world free of MS.

Do you have an idea that would get more people to take part in Walk MS? Some ideas that have already been submitted include:

> a YouTube video contest that honors the most creative 30-second Walk MS commercial

> inviting the Philadelphia Phillies to a Walk MS site

> having a team carrying Walk MS signs crash a live TV news weather report

According to the Word of Mouth Marketing Association, there are many different types of word of mouth marketing:

> Buzz Marketing: Using high-profi le personalities to talk about the event

> Viral Marketing: Creating entertaining messages passed along by e-mail

> Community Marketing: Forming or supporting niche communities that are likely to share interest in the event

> Grassroots Marketing: Organizing and motivating volunteers to engage in personal or local outreach

> Evangelist Marketing: Cultivating evangelists, advocates or volunteers who can spread the word

> Product Seeding: Placing the right product into the right hands at the right time, providing information or samples to infl uential individuals

> Infl uencer Marketing: Identifying key communities and opinion leaders who are likely to talk about the event and have the ability to infl uence the opinions of others

> Conversation Creation: Interesting or fun advertising, e-mails, catch phrases, entertainment or promotions designed to start word of mouth activity

> Brand Blogging: Creating blogs and participating in the blogosphere, sharing information of value that the blog community may talk about

The bottom line is to get people talking about us. Do you have an idea that will start conversations or, better yet, motivate people to get involved in Walk MS? If so, you could win a $100 credit at the National MS Society store, which sells hats, T-shirts and everything else you need to show that you are part of the movement.

Just e-mail your ideas to [email protected] with “word of mouth” in the subject line. Be sure to include your name and a phone number where we can contact you.

GET THE WORD OUT:Walk MS Word of Mouth Contest

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Not planning to Walk MS? Then Talk MS!With 16 sites offering accessible routes across the Greater Delaware Valley, Walk MS is an event that welcomes people of all abilities as participants or volunteers. However, we know that everyone affected by MS isn’t able to get involved.

So we are pleased to introduce Talk MS. Talk MS means personally asking fi ve or more people to take strides toward a world free of MS. We need everyone who can’t take

part in Walk MS to encourage their family members, friends or co-workers to join the event. You can do it in person, over the phone, electronically or by mail; all that matters is that you Talk MS.

After you Talk MS, send the names of all the people you asked to get involved in Walk MS to [email protected]. The person with the most registrations will win an L.L.Bean gift certifi cate worth $100!

Make your mark by helping make Walk MS 2009 a success. Talk MS.

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Bike MS: PA Dutch Ride is a journey unlike any other, with challenging terrain, one-of-a-kind landscapes and people you won’t soon forget.

Starting in the rolling hills of Montgomery Country, just an hour’s drive northwest of Center City Philadelphia, this cycling event of a lifetime takes you into the scenic Amish farmlands of Chester and Lancaster counties. The unique route gives the event a unique spirit – a sense of community perfectly captured by the Saturday night fi nish line party at Millersville University.

PA Dutch is fully supported with catered rest stops, bike support and gear transportation, and there are route options for everyone, from 50 to 200 miles.

Register now at MScycling.org or by calling 1-800-445-BIKE.

GET READY FOR THE RIDE OF YOUR LIFEJuly 18 & 19, 2009

PA DutchRide 2009


Thanks to an outpouring of local support, Patty Aron, a Philadelphia woman living with MS, can leave her home for the fi rst time in more than seven weeks.

Aron’s 15-year-old wheelchair lift broke on December 6. The company that installed it had gone out of business, and her research showed it would cost $8,500 to replace.

So Aron turned to the Greater Delaware

Valley Chapter and applied for a grant to help repair the lift. Chapter staff members were mobilizing community resources to pay for the repair in January when CBS3 aired a story about her plight and the diffi cult circumstances facing people living with MS and other disabilities.

Within hours, four individuals had contacted the Society offering their services for free. Ray Muller of Firehouse Electric was the fi rst to call.

A frequent volunteer deejay at chapter fundraising events, Muller saw the story on the news and said something didn’t seem right – particularly the $8,500 price tag cited by

the reporter. He called the chapter and was put in touch with Aron.

He stopped by Aron’s house and within a few hours had fi xed the lift. The cost: three hours of his time and about $100 for parts, both of which he is donating to Aron.

“I try to help when I can,” said Muller, whose wife has MS. “My wife can still get out and walk around, but this lady can’t. There’s always somebody worse off than you, when you think about it.”

The Society thanks Muller for his generous response, as well as David Stanley, John J. Dewees from Ground/Up Construction and Thomas J. Keiper, who also volunteered.

Muller encourages others to continue to donate their services to people living with MS. The need is greater than ever. In these diffi cult fi nancial times, the chapter is receiving a record number of requests for fi nancial assistance.

If you can help someone with MS or you need help paying for equipment repairs or emergency expenses, please contact Malika Abd Al-Hakeem at 1-800-548-4611.

You also can download a grant application from our Web site at nationalMSsociety.org/pae. Click on the “Programs & Services” link on the left, then on “Services” and “Financial Assistance.”

Watch the CBS report by visiting tinyurl.com/cbs3aron.

Society volunteer helps woman regain independence

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CBS3 broadcast Aron’s story, with great results


HIDDEN SYMPTOMS OF MSSpeech and Swallowing April 2Good Shepherd Rehabilitation Hospital Allentown, Pa.

HIDDEN SYMPTOMS OF MSVision May 6Crowne Plaza Philadelphia Main Line Philadelphia, Pa.

TO REPAIR AND PROTECT May 13St. Luke’s Hospital Education Center Bethlehem, Pa.

PROGRESSIVE MSFeaturing: Dr. Donald Barone, Monday, June 1Doubletree Guest SuitesMount Laurel, N.J.

PROGRESSIVE MSFeaturing: Dr. David Jones, Tuesday, June 9Lehigh Valley HospitalAllentown, Pa. 18105

PROGRESSIVE MSFeaturing: Dr. Thomas Leist, Monday, June 15The Desmond Great Valley HotelMalvern, Pa.

*Subject to change

UPCOMING PROGRAMS*

For more information or to register for most programs, visit nationalMSsociety.org/pae. (Click on Programs & Services,” then “Chapter Calendars” on the left.)

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Pennsylvania drivers now can show their support for the 11,000 local people living with MS by purchasing a National MS Society license plate.

To purchase a plate, visit nationalMSsociety.org/pae and click on the “Programs & Services” box in the middle of the page to download an application or learn more. Send it, along with a check for $50 made out to the National MS Society, to:

National MS SocietyAttention: Specialty License Plates1 Reed St., #200Philadelphia, PA 19147

The Greater Delaware Valley Chapter will receive $30 from the sale of each license plate. Please allow 8-10 weeks for processing and delivery.

PLEASE NOTE: You may not have both a Pennsylvania disability plate and a National MS Society plate; if you order one of these new plates, you will invalidate your disability plate.

New Jersey’s specialty license plate program is under review; we will begin the license plate process in the Garden State as soon as possible.

Drive MS awareness with a Society license plate


When Estizer Smith’s fi rst major photography show

opened in January, the Easton woman’s MS deserved some of the credit.

After all, if Smith had not been diagnosed with multiple sclerosis 15 years ago, she would have continued in her

vocation as a high school science teacher, blissful and ignorant of the life-changing effects the disease can bring.

“I absolutely loved teaching science – it was my life,” she said. “There was no way I would ever have done anything else.”

Instead, MS made it increasingly diffi cult for Smith to teach, starting her on a road that ultimately took her to Alabama four times as a documentary photographer and home to the Lehigh Valley for a new career as an artist.

Her work, “Back to Lowndes County,” documents the violent area where her parents worked during the heart of the civil rights movement in the 1960s. The exhibition includes more than two dozen images taken by Smith, as well as interviews with African-

Americans who lived through the civil rights movement and several black and white photographs taken by her father in the 1960s that record what life was like for impoverished African-Americans in the segregated South.

Smith wasn’t looking for another career when she started studying photography.

“I was just looking for something to fi ll that void in my life,” she said.

She took yoga and cooking classes, but nothing sparked. Then she picked up a camera.

Digital photography was technically challenging for someone who knew nothing about computers, but it also was a creative outlet.

Photographer focuses beyond MSBY ANNE KRISHNAN

Estizer Smith

“Bloody Lowndes”

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Today, she combines her passions, teaching photography classes to at-risk kids in the Lehigh Valley. She also has opened her own studio; learn more at estizersmithphotography.com.

“I think photography is a tool that can be very useful in healing and in coping and in expressing,” she said. “It’s art. That’s meaningful.”

“Back to Lowndes County” began when Smith’s mother died in 2007. A grieving Smith was compelled to return to Alabama to document the places her father had photographed four decades earlier.

“These photographs grabbed my soul,” she said. “In going back to fi nd the people in them, I was going back to fi nd my parents.”

Smith met people who had known her parents and could show her around the area, and she began taking pictures. She had to be careful on her trips to the South to keep hydrated, stay out of the heat of the day and get plenty of rest.

“I’m doing really well, but I do have to manage fatigue,” she said. “I have a tendency to overextend myself, to plan to do more than I can, and then become very frustrated when I come up short.”

She also tries not to compare herself with other photographers who aren’t living with MS.

“I look at other people and get frustrated because it seems they can do so much,” she said.

But Smith is one of the students her photography teacher, Ryan Hulvat, is most proud of. He had no idea that she had MS for the fi rst year or two they worked together, but her photos impressed him from the start.

“People who keep on doing, I have a lot of admiration for,” he said. “I think she’s amazing.

“We all have our own challenges, but she doesn’t defi ne her life on the challenges she has. She rises above.”

“We all have our own challenges, but she

doesn’t defi ne her life on the challenges she has.

She rises above.”

“My Black Nationalist”

“House 013” taken by Smith’s father, Louis Anderson


Studies show that many people living with MS spend time online. If you’re fi nding that your regular keyboard’s keys are too small for you to hit or read accurately, BigKeys might be the answer.

The BigKeys LX keyboard offers one-inch keys with half-inch tall lettering. In addition to standard black and white versions, the manufacturer also makes a high-contrast keyboard with black letters on a yellow background.

The keyboard retails for $159; for more information, visit bigkeys.com.

GADGET CORNER: BigKeys


The care managers at the Inglis Foundation knew 2008 had been a diffi cult year for Troy Casey, one of their clients who was recently diagnosed with MS and faced a number of other hurdles.

So they decided to bring Casey and his family some holiday cheer by treating him to a $215 shopping spree.

They pooled their money and used a grant to purchase additional gift cards. Then in December, Casey and his cousin met the care managers at Wal-Mart to shop for Christmas gifts for his son and daughter. Inglis’ care management services for Casey were funded by the Greater Delaware Valley Chapter.

Casey bought books, educational games and dolls for his children with the unexpected windfall.

“When I gave it to them, I felt really good,” he said. “It came in the nick of time, because I didn’t know how I’d get the money to give them a good Christmas.”

Many thanks to the staff of the Inglis Foundation for their generosity!

Inglis makes holidays bright for local man with MS

Troy Casey checks out after Inglis shopping spree

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SERVICES

Consider a typical week for Karen Mariner.

She leads a lobbying trip to the New Jersey legislature. Writes grants to fund new services that will help ease the challenges of life with MS. Discusses MS-related issues on National Public Radio. And stands up to health insurance companies on behalf of local families living with MS.

As vice president of services and activism for the Greater Delaware Valley Chapter, Mariner’s days and weeks include a broad range of responsibilities.

She oversees and directs all of the services that the chapter provides, promotes research at the chapter’s clinical partners, maintains relationships with the local MS Centers, oversees legislative issues in Pennsylvania and New Jersey and supports people when they have health insurance diffi culties.

She does it all with enthusiasm and passion for her role as an advocate for people with MS.

“I don’t like social injustice on a micro or macro level,” she said. “I get very heated when somebody is being mistreated or marginalized.”

A Philadelphia native, Mariner received a bachelor’s degree in women’s studies from Temple University and a master’s degree in social services from Bryn Mawr College.

She originally planned to become an adolescent therapist. Then in graduate school, she got to know someone with MS through her role as a Democratic

committeewoman. When she saw a job posting at the National MS Society in 2001, she thought it was a good fi t.

“What interested me about the position at the beginning was the complexity of the disease,” Mariner said. “From an intellectual standpoint, MS is an intriguing disease because of the level of information generated about it every minute.”

Today, she continues to be motivated by the ever-changing landscape of MS research, as well as by the people she now knows who are living with the disease. She recently advanced her training and the care she provides for chapter clients by receiving a certifi cation in MS information and referral services.

“I learn something new every single day,” she said. “I think I know something about the disease, then I fi nd out I’ve just scratched the surface.”

SERVICES, ACTIVISM VP WEARS MANY HATS

Karen Mariner, MSS, MSCIR, Vice President, Services & Activism


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You asked, we deliveredWe conducted a survey to fi nd out what you wanted to see on our new site, and we took your comments to heart.

Many of you told us you’d like to see daily living tips and reviews of devices and local facilities on the Web. We decided to create a new section called “What works for you?” on our new site. It combines daily living tips and reviews from other people living with MS with a short form to share your own helpful tips or ask questions.

Many people also asked to see bigger text on the new site. We are pleased to let you know that you now have three choices of font sizes. Picking the size that’s right for you is as easy as clicking a button. Best of all, your choice will apply to the content on every page within the site, so you’ll only have to do it once.

Chock-full of content Surf our page and you will notice there is something new around every turn. In addition to expanding our resources about programs and services and volunteering, we have added a section for health insurance concerns and a completely new advocacy section to name a few.

One of the most important additions to our site is the Health Insurance Initiative Project. There, you will fi nd information about appeals to insurance and Medicare, prescription drug assistance

resources, how to get Social Security Disability Insurance and more. Plus, if you need help with anything dealing with health insurance, you can fi ll out a quick form and our staff will assist you.

Another addition is the completely revamped advocacy section. Our chapter combined forces with nearby chapters in Pennsylvania and New Jersey to make one advocacy site for all Pennsylvania chapters and one site for all New Jersey chapters. We’ve added news, action alerts and plenty of ways for you to get involved.

Our site also offers not one calendar, but three. In addition to the programs calendar, which lists our educational workshops and social events, we also have compiled new calendars for wellness classes and self-help group meetings to help you stay mentally and physically well. You can fi nd the calendars under the “Programs & Services” tab on the left side of the new site.

Navigation simplifi edNavigating our site is easier than ever with our new sidebar navigation menus. When you click on a menu on the left, it expands to show you more details on the content you’re interested in, while the other menus remain collapsed, keeping a clean and easy-to-read navigation bar at all times.

Finding relevant news articles is also easier than ever. You can now search all of this chapter’s news articles by keywords and/or by date range.

Take a tour of our new Web siteIn February, we launched our completely re-designed chapter Web site. With new features, new content and our all-new design, you may not recognize us! Read on for a taste of what you can expect.


STILL ACCEPTING SUGGESTIONS

There’s still time to have your voice heard. If you’d like to share your opinions about our new site or suggest something you’d like to

see, please send an e-mail to [email protected] or call

215-271-1500.

Home page

Three choices of text sizes

New calendars list wellness programs and self-help groups

Share tips and questions at What Works for You?

Health insurance information at your fi ngertips


Horizon Blue Cross Blue Shield: Thanks to the efforts of MS activists across New Jersey and the leadership of Sen. Jeff Van Drew, D-Cape May, Horizon announced in January that it has reached a contract agreement with Children’s Hospital of Philadelphia. CHOP will continue to be an in-network provider for Horizon members.

This comes after months of discussions and threats between offi cials at Horizon, CHOP and the Hospital of the University of Pennsylvania. At press time, it appeared that Horizon would reach an agreement with Penn, as well.

While this issue doesn’t involve legislation, it is a clear example of grassroots activism bringing important issues to public attention. Many thanks to those who shared their stories and made this issue real for leaders in New Jersey.

Personal assistance services (PASP): The Society continues to successfully push for a restructuring of the personal assistance services program, which provides personal care assistants to people working or volunteering with MS.

The new structure puts clients in control of the way they spend the money allotted to their personal care. In addition, they can spend any money left over at the end of the month on durable medical equipment.

At press time, MS advocates expected assembly members to vote on the restructuring during N.J. Lobby Day on March 5. Following the vote, we’ll need New Jersey residents to encourage their senators to support the bill, as well.

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Visit MSactiveNJ.org for regular updates on the Horizon issue, personal assistance services program and other important issues affecting people living with MS in New Jersey.

Help Wanted: N.J. Government Relations Committee

We’re continuing to build the N.J. Government Relations Committee, and we’re seeking new, diverse members, especially a Republican MS activist and a staffer in a South Jersey legislator’s offi ce.

If you want to get involved, contact Karen Mariner at 1-800-548-4611 or [email protected].


The state of Pennsylvania recently updated its laws to further extend protections for dogs, yet vulnerable adults who are subjected to abuse and neglect are still unprotected.

Pennsylvania is one of only six states without protective services in place for adults ages 19-59 with physical or cognitive disabilities. These are adults who are forced to live in unsafe and unsanitary conditions, held captive by loved ones or their caregivers. They have no way of seeking help. Relocating them to a safe environment is not always possible because they often live with, and are dependent on, their abusers.

Adult protective service legislation is working in other states. In Oregon, a Portland couple was recently arrested for subjecting a couple in their care to three years of fi nancial, psychological and physical abuse, including strangulation, assaults and dog bites. In Ohio, a woman was recently charged with abusing her 22-year-old daughter who is not able to walk or talk. In Pennsylvania, we know people are suffering at the hands of family members and care providers. We just don’t know how many.

Health-care workers often seek assistance from the National MS Society when they

believe their patients’ caregivers are taking advantage of them or not caring for them properly. Without a law protecting these vulnerable adults, there’s not much we can do.

The only chance these individuals have is to create adult protective services. Advocates with the National MS Society have been working with lawmakers to put such a system in place through House Bill 361 and Senate Bill 1049. A message needs to be sent to legislators that protecting dogs is important and necessary, but protecting human life is more important.

Now is the time to step up for vulnerable adults. Tell your legislator to help make adult protective services legislation a reality. If you are interested in becoming an MS advocate to help enact an adult protective services system, please contact me at 717-586-8505 or by e-mail at [email protected].

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Visit MSactivePA.org for regular updates on the adult protective services bills and other important issues affecting people living with MS in Pennsylvania.

Advocate now for Pa. adult protective servicesBY JENNIFER STRAYER, PENNSYLVANIASTATEWIDE PUBLIC POLICY MANAGER


Do you have a personal connection to MS?

In my years of being a dentist, mayor, freeholder

and assemblyman, I’ve known all kinds of people who have been struck by this disease and seen how diffi cult it can be. I’ve seen other elected offi cials who have been struck with MS, and I saw how it presented so many different challenges in their lives – whether they could continue to work in the same job, continue to function in the family unit as they always did. I can see how devastating and diffi cult something can be when it just strikes you. That’s our responsibility as leaders – to advocate for people who sometimes don’t have the voice that they need.

What are your legislative interests?

What I like to do most is to really to push forward and hopefully get enacted initiatives that truly make regular people’s lives better day to day, such as consumer issues and health issues.

I love animals, and I’ve been doing a lot of animal-cruelty legislation. I love veterans and just got a bill passed that’s going to be signed into law … that would enable bona fi de veterans groups to claim unclaimed veterans’

remains after one year to be buried in a veterans’ cemetery with honor.

What are your top priorities?

My No. 1 issue is advocacy: fi ghting for people and the issues that they have. One we’ve been going through most recently is with Horizon Blue Cross Blue Shield of New Jersey. Even though it’s not legislation, it’s trying to advocate and fi ght for people most in need. It’s more than dollars and cents – it’s about human beings and their lives.

I’ve had people with MS come to me and say, “Please try to help with this.” I think that’s what being a senator or legislator is about. It’s trying to fi ght for the people because sometimes their voice unfortunately is not heard.

How have you been involved with MS-related issues?

In addition to the Horizon issue, I’ve fought for individual constituents who needed treatment, needed coverage. With insurance companies, sometimes they’re excluded and not treated with care and sympathy. I’m fi ghting for them and being supportive of legislation as well. For folks who are really stricken with it, I’m helping with those handicapped issues, as well.

MEET YOUR LEGISLATORSen. Jeff Van DrewDistrict 1, New Jersey


What’s the best way for constituents to work with you?

All ways are good. E-mail is wonderful, letters are good, phone calls are good. It’s how we fi nd out about issues. With the Horizon issue, certainly the medical society came to us, but the fi rst folks we heard from were people being impacted by it.

I was speaking with someone with MS the other day who said for a long period of time, doctors didn’t know what was wrong with her. Finally, it was at Penn that they were able

to pinpoint it and help her. She is much better now than she was when she was at full thrust, all because of medical treatment she received. You talk about the times when you directly impact people’s lives, and this is one of them.

What don’t people know about you?

I’m a workaholic. I work too much. I’m also a little weird – I enjoy working out. I exercise seven days a week; it’s what keeps me sane. I love animals, particularly German shepherds. Right now, I have a 14-month-old pup and a 4-year-old.

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Amendment restoring ADA protections passed MS activists and others in the disability rights movement changed the course of history when they helped to push the ADA Amendments Act through Congress. President Bush signed the legislation in September 2008.

The act became effective January 1, 2009, bringing millions of people back under the protection of the Americans with Disabilities Act of 1990 (ADA).

How the ADA was erodedAs originally written, the ADA was designed to ensure that all people with disabilities could receive reasonable accommodations in the workplace. But over time, court rulings narrowed the defi nition of “disability” to exclude those who could “control their symptoms.” This included people with MS responding well to their disease-modifying drug.

Sen. Tom Harkin, D-Iowa, the chief sponsor of the ADA Amendments Act, described the situation: “The more successful a person is at coping with a disability, the more likely the court will fi nd that they are no longer disabled and therefore no longer covered under the ADA.”

The new act reverses four Supreme Court decisions that had eroded ADA coverage for people with MS and other conditions, including diabetes and epilepsy, that are controlled by medication, are episodic and/or do not always severely restrict major life activities.

New protectionsStarting this January, courts may not consider “mitigating measures” such as prescription drugs, hearing aids or artifi cial limbs. The new law says “an impairment that is episodic or in remission is a disability if it would substantially limit a major life activity when active.”

To learn more about this historic bill and the protections it provides, visit adabill.com.


Deductions, exclusions and credits that may apply to you

Taxes pay for many things we all need. But that doesn’t mean any of us should pay a penny more than the law requires.

IRS Publication 907, Tax Highlights for Persons with Disabilities has important details for you or your tax preparer. Download it at irs.gov, or order a copy by calling 1-800-829-3676.

Gross Income: Supplemental Security Income (SSI) and certain veterans (VA) disability benefi ts are excluded from your gross income. However, Social Security Administration payments may be taxed, and income from disability insurance that was paid for by your employer (or former employer) is taxable. See IRS publication 525.

Impairment-Related Work Expenses: If a physical or mental disability limits your ability to function as an employee, you may be able to deduct work expenses related to that impairment. Examples: wages for an on-the-job personal care attendant or the cost of a text-to-speech computer program. See IRS publication 907 for details.

Medical Deductibles: You may deduct your medical and dental expenses for the year to the extent that they exceed 7½% of your adjusted gross income, with a few exceptions. You may count the cost

of home improvements or equipment to alleviate your physical or mental condition as medical expenses. Examples include installation of ramps or air conditioning, the amounts paid to purchase, train and maintain a service animal and more. See IRS publication 502.

Dependent Care Credit: If you pay someone to care for a dependent person so that you can work or look for work, you may claim a credit for those expenses. The dependent can be your spouse or another adult who lives with you, even if that person has some income, as long as he/she is physically or mentally unable to be left alone. See IRS publication 503.

The Earned Income Credit (EIC): You may be due a cash payment if you worked in 2008 for a low annual wage – up to $12,590 for a single person with no dependents and up to $39,783 for a married couple, fi ling jointly, who have more than one dependent child. To get the check, you have to apply. See Publication 596.

Credit for the Elderly and Disabled: Low-income individuals with taxable disability income may qualify for a tax credit. See Publication 524.

Start planning now. Get free help from the IRS at 1-800-829-1040. Call early, not on April 14!

Smart tax prep for people with MSBY MARTHA KING

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Ray Colliton had walked in all seven Challenge Walk MS events held by the Greater Delaware Valley Chapter, but he

was getting frustrated.

Each year, he had new fundraising ideas, but he always hit a ceiling around $2,500 to $3,000.

Then last fall, as he sat at the event’s emotional candlelight ceremony, he came up with a new strategy. He stood to speak to his fellow walkers – something he never does – and challenged them each to recruit another participant for the 2009 event.

“The easiest way to fundraise for the Society is to get more people to participate in the walk,” he said. “I’m only one person with a certain number of contacts. But if I recruit 10 people and they each raise $1,500, that’s $15,000 we wouldn’t have had before.”

He has taken his own challenge to heart, recruiting 10 additional walkers for the event, planned this year for October 17 and 18 in the Brandywine Valley and historic Philadelphia.

These walkers also will be able to continue with the event when Colliton’s MS makes it too diffi cult for him to do the walk himself, he said.

“I’m passing this on and leaving a legacy for people who will do this, even if I can’t,” he said.

People walk for a number of reasons, many of them emotional, he said.

But as a researcher at an institution that receives Society funding, Colliton recognizes the bottom-line impact of the chapter’s fundraising events.

“Once the weekend ends, research is all about the money,” he said. “Progress totally depends on how much money there is and how much support you can put behind it.”

REGISTER for Challenge Walk MS 2009 today and multiply your impact by inviting a friend to join you. Visit walk4MS.org or call 1-800-883-WALK.

WALKER DRIVES RECRUITMENT WITH “YOU+1 CHALLENGE”

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Ray Colliton (left) celebrates at Challenge Walk 2007

Challenge 2009


Getting help to go mobileBY SUSAN FERRIER

Shortly after my diagnosis in 1995, I remember reading the statistic that 50% of all people diagnosed with multiple sclerosis would require some sort of mobility assistance within the fi rst 15 years after diagnosis. I’m not sure what the criteria for reaching that fi gure were or how accurate the numbers were, but it stuck with me.

At that time, I knew two people with the disease. One I had known since childhood, and he had been severely disabled for a long time. The other was a woman I was working with who walked with a cane. I didn’t know why she used a cane until I began talking about what I was going through.

She seemed happy enough and was living a productive life despite the assistance of a walking stick. Her quality of life was encouraging, but I still didn’t want to be in that 50%.

I did well for many years. I had periodic relapses, but I always regained all the abilities I had prior to the episode. Then in 2004, I had a relapse that left me with uncontrolled tremors. They were exhausting, and the fatigue hampered my balance and coordination.

It was at this time my doctor fi rst suggested using a cane. I wanted no part of it. He explained that the cane would help me conserve energy. Still, I was 38 years old and was not about to use a cane. A year earlier, I was an endurance athlete, now I needed a cane?

So I dug my heels in and continued to struggle. Within a year, along came another relapse. This one left me with muscle spasms. Now I had tremors that were mostly controlled by medication and muscle spasms that were out of control. My muscles were being taxed constantly. Day-to-day tasks were diffi cult.

At this point, I did something my husband had been asking me to do for a long time -- I asked for a handicapped placard for my vehicle. My doctor obliged, but again he suggested a cane. This time I let him write the script. I wasn’t sure I would follow through, but I was at least willing to consider it.

Around the same time, I noticed while pushing a grocery cart around the store that having that extra support did seem to help conserve my energy. Finally, I reluctantly decided to go look at canes.

I drove myself to the local medical supply store. I could feel myself getting angrier and sadder, as if I were getting old before my time. I hadn’t yet hit 40 years old and I needed a cane.

I had always said if I ever got to this point, I would have to get a cane that made a statement. It would have to suit my personality.

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Susan Ferrier with her “funky” collapsible cane


It needed to be something funky. No old lady cane was going to do.

In the fi rst store, all I saw were canes of the geriatric variety. As I stood looking at these canes, I could feel myself growing more upset. Adding to my disappointment was the fact that the sales staff seemed unwilling to answer my questions.

Disgusted, I left that store and went to another nearby. My experience was completely different. They were helpful and they had many different styles of canes to choose from.

The saleswoman and I talked a little about what I wanted and how I felt about my need for the apparatus. She suggested a fold-up cane in one of many prints. She told me that if I didn’t feel that I needed my cane but wanted the security of having it close by, I could fold it up and keep it in my handbag.

I loved this idea. As we talked, I became more comfortable with buying a cane. I decided on a folding one with a butterfl y-collage print.

Fortunately, I haven’t needed to use my cane recently, but I am glad I have it available to me. I’m no longer embarrassed by it. I’ve put streamers and bells on it at holidays and special occasions. This, of course, only draws attention to it, but who cares? Without it, I’d be home, not out enjoying myself.

And I must say my crazy cane comes in handy when I’m doing those 30 and 50-mile MS Challenge Walks. I fold it up and put it in my backpack, and away I go.

LETTERS

To the Editor:

I received the most recent copy of MSConnection and I am very sad about the opinions written on page 1 and continued on page 4 [“New President, New Priorities for People Living with MS”].

Mr. O’Neail makes the assumption that President-elect Obama is more dedicated to the MS agenda than President Bush. No one knows that for certain.

I thought Mr. O’Neail’s comment regarding embryonic stem cell research as a “slam dunk” in Obama’s administration was very insensitive. He seems to take the topic of embryonic stem cell lightly and I don’t think it should be referred to so fl ippantly.

Like President Bush, I don’t believe that it is ethical to use embryonic stem cells for MS research. My position does not make me less dedicated to the MS cause than someone else who does support embryonic stem cell research. I also want to help people with chronic diseases (myself and my brother included) but not at the expense of the unborn.

Please thoughtfully consider including other opinions regarding embryonic stem cell research in your publications.

Sincerely,June Rodriguez-Ashmar, Macungie, Pa.

MSConnection welcomes letters to the editor. Send letters to [email protected] or MSConnection, 1 Reed St., #200, Philadelphia, PA 19147. Include your name and a phone number or e-mail address where we can reach you, if necessary. Please note: we may edit your letter for length and content.


People living with MS saw rapid research progress in virtually every fi eld of science and medicine that impacts the understanding and treatment of the disease in 2008.

“Staying nimble and maximizing every opportunity is the only way to keep research moving forward in these diffi cult fi nancial times,” said Dr. John Richert, the Society’s executive vice president of research and clinical programs.

This strategy allowed the Society to invest nearly $47 million to support over 440 new and ongoing MS research projects as part of its international effort to prevent, treat and cure MS.

Signifi cant advances have been made in both clinical and laboratory studies in MS. In addition, more than 130 clinical trials are under way around the world, including more than a dozen fi nal-phase trials of new therapies, including some taken by mouth.

Some key highlights of the last year include:

> University of Rochester researchers funded in part by the National MS Society showed for the fi rst time that implanting immature myelin-making cells into the brains of mice born without the ability to form myelin could restore the insulation on nerve fi bers, as well as neurological function. Myelin is a key target of the immune attack in MS.

> A study of brain tissue obtained from people with MS indicated that, while many areas

of damage showed expected loss of myelin and nerve cells, a few older lesions showed a 72% increase in nerve cells when compared with neighboring brain regions. The fi ndings, by Society-funded investigators at the Cleveland Clinic Foundation, support the possibility that nerve cells in the white matter of the brain can be replaced after they are destroyed by MS.

> Two teams of researchers funded by the National MS Society reported fi ndings on nerve tissue injury and repair that add important information needed to stop MS progression and develop nervous system repair strategies. One team found two enzymes that may serve as markers of progressive MS and nerve fi ber injury, and the other team reported that another enzyme is essential for replenishing myelin-making cells that have been depleted by MS. Both teams hope to identify targets for the development of new therapies for MS.

> Investigators from the University of Queensland, funded by the National MS Society and MS Australia, published results suggesting that a person’s set of immune-related genes may help determine which parts of the brain and spinal cord are attacked by the immune system during the course of their MS, and may explain why individuals with MS experience tissue damage and corresponding symptoms differently.

Learn about promising therapies in late-stage clinical testing in this issue’s Top 5 on the next page.

2008 MS RESEARCH & TREATMENT HIGHLIGHTSSpeeding treatments to people living with MS

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TOP 5 Promising drugs in the MS pipeline

CLADRIBINE: German drugmaker Merck KGaA says its experimental pill cladribine reduced MS relapses by 55% to 58% in a two-year study – the fi rst oral MS medication to complete such a study. The drug also reduced lesion activity when measured by MRI and slowed disease progression, Merck said. The company is on track to submit an application for approval to regulators by the middle of this year, and the drug may be on the market as early as 2010.

Merck also is testing cladribine in combination with interferon therapies in a clinical trial at Thomas Jefferson University and the Hospital of the University of Pennsylvania. Visit MSonward.com to learn more.

DIRUCOTIDE:The experimental drug MBP8298 (dirucotide, BioMS Medical Corp.) has been shown in small-scale clinical trials to safely delay median time to disease progression for fi ve years in progressive MS patients with certain immune response genes. A recent clinical trial in relapsing-remitting MS showed that the drug did not signifi cantly decrease the relapse rate, but it did reduce disease progression. The drug is being studied in secondary-progressive MS in four late-stage clinical trials and has been granted fast-track designation from the U.S. Food and Drug Administration, which could potentially bring it to the market faster.

FAMPRIDINE: Walking speed improved signifi cantly in a clinical trial of 303 people with all types of MS taking Fampridine-SR (MS-F204, Acorda Therapeutics, Inc.), an oral therapy. Among those taking Fampridine-SR who improved in walking speed, there also was a statistically signifi cant improvement in leg strength. Acorda applied to the FDA in February for marketing approval of Fampridine.

FINGOLIMOD: The experimental oral drug FTY720 (fi ngolimod, Novartis) reduced relapses signifi cantly more than Avonex® (interferon beta-1a, Biogen Idec) in a one-year study involving 1,292 people with relapsing-remitting MS. The drug appears to induce immune cells to remain in lymph nodes, where they can do little harm, preventing them from migrating into the brain and spinal cord. Two other large-scale, phase III trials of the drug are ongoing: Novartis expects to submit the drug for FDA for approval by the end of 2009.

LAQUINIMOD: Laquinimod: Treatment with the oral therapy laquinimod (Teva Pharmaceutical Industries) reduced disease activity by 40% in a phase II study of people with relapsing-remitting MS. Laquinimod recently received fast-track status from the FDA. A phase III study of 1,200 people testing laquinimod against Avonex (Biogen Idec) is enrolling at Thomas Jefferson University in Philadelphia. For more information, contact Janet Cipriani at Jefferson at 215-955-9363 or [email protected]

For information about participating in clinical trials for these or other drugs, visit our Web site at nationalMSsociety.org/pae. Click on “Programs & Services” on the left, then “Clinical Trials.”


At fi rst, doctors suspected a heart attack. Once his heart was ruled healthy, medical professionals began to search for other causes. That’s when Chance was told in 2001 that he has MS. Since then, his symptoms have accelerated and he has been forced to apply for short-term disability. While MS has wreaked havoc with his livelihood, it hasn’t stopped his passion for music. In fact, Chance is the fi rst artist to be signed by Groupof12, a new record company started in Los Angeles. Hear his music at JasonChance.com.

What has living with MS taught you?

My wife will catch me laughing at something that happened earlier in the day – it’s hard to explain, but having MS forces you to see the lighter side of things. On a more serious note, it has also taught me not to put myself in harm’s way. I go running every day, but always take the same route, avoiding train tracks or heavy traffi c.

What advice would you give other people living with the disease?

Be a fi ghter. I didn’t know I was a fi ghter until I got MS, and it’s something I deal with every day. For me, fi ghting means taking care of myself:

working out every day, eating right – that means no junk food -- and getting plenty of sleep.

Have any of the treatments helped?

After I was diagnosed I was immediately put on Avonex and then I was part of a Tysabri trial. The injections have done wonders for me as far as stopping progression. However, you do end up with a weakened immune system. Something as simple as a cold can stay with you for months, and that makes life tough.

How did the recording deal come about?

It’s funny. A guy I knew in Princeton 20 years ago called and said “I was thinking about one of your songs the other day. I can’t get it out of my head. I know that was a long time ago, but your stuff is timeless.” I was so surprised – it does mean that if you have faith, your dreams really can come true.

Have symptoms affected your ability to play guitar?

Talk about expecting the unexpected – I can’t extend my arm, so when I play it feels better if I pick with my arm curled in. The weird thing is that I couldn’t do that before I started to have MS symptoms.

Face of MS:Jason Chance, Musician

Living with MS has taught Jason Chance to expect the unexpected. Chance, 53, has been writing and performing music his entire adult life, a passion that was fueled by 9-5 employment in the mortgage industry. His life, however, took an unexpected turn when he experienced numbness in his arm and pain in his chest.

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DRIVING HAND CONTROLS: Complete set. $500 OBO. Call Brenda at 610-488-0710.

BRUNO OUT-RIDER LIFT: For a pick-up truck. Safely lift your scooter or wheelchair to the bed of your truck using a remote control. Asking $1,000 OBO. Call Brenda at 610-488-0710.

JAZZY SELECT: Red, brand-new, barely used motorized scooter. Comfortable & very helpful. Asking $2,500. Call Melissa at 484-477-5551.

LIFT CHAIR: Ceiling-mounted chair helps user move within a room. FREE. Call Celina at 215-820-4884.

LEGEND 3-WHEEL SCOOTER: Silver, barely used, brand-new condition with new batteries. Comes apart in three pieces, includes trunk lift and cover for outdoor storage. Asking $1,500. Call Beth at 610-670-4508.

MAGNECIZER PEDAL EXERCISER 18030: Magnetic resistance, older model, good condition. Portable and lightweight. Display

shows speed, time, distance and calories consumed. FREE. Call Terry at 610-876-4934.

HEAVY DUTY CELEBRITY XL SCOOTER: Great for outdoors, higher ground clearance than smaller models. 4 years old, good condition, runs great. Asking $1,500 OBO. Call Brenda at 610-488-0710.

HOVEROUND POWER CHAIR: 1.5 years old, used twice; includes leg pieces and special premium medical cushion designed for people with MS; accommodates up to 350 lbs. Asking $1,200. Please call Lorrie at 215-437-1650.

ACCESSIBLE HOME IN CHERRY HILL: 5-bedroom, 3.5-bath home offers at-grade entrance, fi rst-fl oor laundry and master bedroom, renovated master bathroom with roll-under countertops and roll-in shower, large doorways. Asking $350,000. Contact Jill Dubin, Realtor with Prudential Fox & Roach Realtors, at 856-428-8000 or [email protected].

Volunteers needed for Poconos eventVolunteer, donate to the Society and take in some NASCAR action at the Pocono Raceway during the fi rst weekend in June.

Ellena Kirschbaum is organizing a group of volunteers to staff the gates at the speedway on Friday, June 5; Saturday, June 6; or Sunday, June 7. After volunteering for an eight-hour shift, participants can watch the races, which culminate with the Pocono 500 NASCAR race on Sunday.

The cost of admission and volunteering is $50 per person on Friday and Saturday and $75 per person on Sunday. The raceway will donate the cost of each ticket to the National MS Society, Greater Delaware Valley Chapter.

To learn more, contact Ellena Kirschbaum at 570-857-0161 or [email protected]. The deadline to sign up is May 1.

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NASCAR action at the Pocono Raceway

Register today at walk4MS.org or by calling 1-800-883-WALK.

SUNDAY, APRIL 26NEW SITE! East Goshen, Pa. Gilbert, Pa.NEW SITE! Lehigh Valley, Pa. Norristown, Pa.Sellersville, Pa.Moorestown, N.J.Washington Twp., N.J.

SUNDAY, MAY 3Lansdale, Pa.Media, Pa.Newtown, Pa.Philadelphia, Pa.Reading, Pa.Valley Forge, Pa.Ocean City, N.J.Vineland, N.J.Voorhees/Gibbsboro, N.J.

GET MOVING walk to create a world free of MS.Walk MS 2009 features two exciting new sites: Coca Cola Stadium (Home of the IronPigs) and East Goshen Township Park.

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msconnection issue 1 2009

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