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In This Issue: Editor's Note. The President's Message MACRT Elections Announcement Update on the Medicare project Proper Foot Care for the Visually Impaired Diabetic Helpful Tips for Teaching Independent Living Skills Outwit the Invador Keeping Your Food Safe The Charlyn Allen Award From the editor's Kitchen Rehab Rainbow   Editor's Note BY:Zeze Miller Summertime is supposed to be a time to play, have fun, act silly, and take vacations. Summer is the season for swimming, camping, going to the movies, lying on the beach to catch some rays, visiting the local library, and oh, most importantly, it is the time for baseball, hotdogs, and apple pie! For those of us in Missouri we haven't been able to really get out and enjoy the warm temperatures much because the Midwest has been deluged with rain since early April. While we are more fortunate here than the folks in Iowa and elsewhere we are still fighting the doldrums of long summer days indoors. My hope for this issue then, is to help pick up our spirits and provide a ray of sunshine to our otherwise cloudy days! There's an endless array of possible activities to do during the summer. I'm sure you will find something that interests you and is entertaining. Have fun and happy vacationing! The deadline for the fall edition of the MACRT newsletter is Friday, October 17, 2008. If you have suggestions or ideas, please contact Zeze Miller at zeze.o.miller@dss.mo.gov or call me at 573-751-8903. Thank you in advance for your contribution. You can have your newsletter e-mailed which will cut down on the cost of postage and paper.  If you are interested in a newsletter via e-mail please contact Sue Dalton or Lucille Dolan at transvis@mc.net. Back To Top The President's Message  Latisha Houston, CVRT  I hope you all are enjoying your summer! This is our favorite time of the year.  Not only is it baseball season, but it is also the time of year to throw out the first pitch for our annual MACRT/ASERT Conference.  Let's go VRT's!  I hope to see you all there in Alabama.  You wouldn't want to miss this fabulous event. Smile and the world is smiling with you. Back To Top MACRT Elections   The following information provides a general description of the roles and responsibilities of MACRT officers and Board members.  Elections for all positions will be held at the 2008 conference in Birmingham.  It is a two-year term with spring meetings held in a geographically central location and fall meetings held at the site of the annual conference.  Whenever possible, MACRT supplements travel expenses but some personal expense may be incurred.  We hope that you will consider running for a position.  President presides over meetings of the MACRT Board and over the annual business meeting of the organization appoints chairs to committees not otherwise provided for in the Bylaws and Constitution Vice President Assume the duties and responsibilities of the President in the absence of the President. Secretary records minutes at all Board and business meetings Treasurer maintains all financial records of the organization Board member at large together with the officers, serve as the governing body of the organization If you are interested in nominating someone or in running yourself, please contact Jennifer Ottowitz, chair of the Nominations committee at jottowitz@badgerassoc.org no later than August 15.  During the conference, nominations will be accepted from the floor but we ask that you check with anyone you wish to nominate to verify their willingness and commitment to serve.  Nominees from the floor must be present at the conference. Back To Top Announcement Research Opportunity The Rehabilitation Research and Training Center on Blindness and Low Vision at Mississippi State University invites you to participate in a focus group on the transition experiences of students who are blind or visually impaired. Where:       At the 2008 MACRT/ASERT Conference in Birmingham, AL When:        Currently scheduled to occur at 5:45 p.m on the eve of the conference. The exact room is still to be announced. The Rehabilitation Research and Training Center on Blindness and Low Vision at Mississippi State University would like for you to participate in a focus group with other rehabilitation service providers concerning transition experiences of students, and transition services available through your agency. In addition, we would like to explore other issues that might impact the transition experience of students leaving post-secondary education and moving to employment options. Further, the research team would like to explore your collaborative relationships with other educational institutions and vocational rehabilitation services. Extensive notes and audio recordings will be taken during the focus groups. This information will be used to develop a picture of the overall experiences of students in post secondary education, and the impact of those experiences on employment outcomes. When combined with focus group reports from other professional groups the research team will use this information to assist in developing promising practices, and a model transition program for students with blindness and visual impairments. This research is funded by the National Institute on Disability Rehabilitation Research of the U.S. Department of Education. If you are interested in participating or would like more information, contact BJ LeJeune at 662-325-2694 or email at bjlejeune@colled.msstate.edu. This is a great opportunity to participate in important research that may impact best practices for transition services. Your involvement is greatly appreciated. B. J. LeJeune, CRC, CVRT Director of Deafblind Programs RRTC on Blindness and Low Vision Mississippi State University bjlejeune@colled.msstate.edu 662-325-2001 Back To Top Update on the Medicare project By Nancy Paskin, CVRT Trying to bring you an update of the Medicare Low Vision Project has proven to be more difficult than I first thought. I was only able to find one recent piece of literature in the February 2008 issue of JVIB, entitled "Speaker's Corner".  The article merely represents the opinion of the authors and thus remains open to dialog with others. All the other resources I located were over one year old, and were dated between 2006 and 2007, hence they did not seem to be worthy of being called updates. Talking with individuals about the project was also less than rewarding as most were not enthusiastic about the current state of affairs. However, the project continues in the four states: Washington, New Hampshire, North Carolina and Kansas; and two cities Atlanta and New York City (NYC) where it is running, and will continue until March 31, 2011. The Medicare Low Vision Demonstration Project was initiated in April 2006 at the six sites listed above. In all cases, except for the state of New Hampshire, services were to be provided on-site in rehabilitation facilities or in low vision clinics. In New Hampshire, all work was to be done in the community, as that is how that state's services are provided. People who met the criteria for service were to be limited to a total of nine hours of rehabilitation services. Services were to be provided by ACVREP certified vision rehabilitation specialists. Occupational, physical, and speech therapists could also provide services, as they have long been recognized as providers by Medicare. All services were to be billed in 15 minute increments using specific codes predetermined for the project. The supervising physicians were to do the billing, though occupational therapists could bill independently for services if they worked in private practice. Unfortunately; reimbursement for certified low vision therapists, certified orientation and mobility specialists, and certified vision rehabilitation therapists is at a rate that is approximately half or less than half of the reimbursement given to occupational therapists already. In 2007, the Centers for Medicare and Medicaid Services (CMS) made a few changes to the project which were intended to ease some concerns. These changes increased the number of service hours from nine to twelve, and provided services to additional zip codes and counties in Atlanta and NYC. Since the project had started slowly it was hoped these changes would increase the number of consumers being served. Since I was unable to find any current information, I can only hope that at least one presentation or poster session at the upcoming AER Conference in Chicago will address the Medicare Low Vision Demonstration Project and give an update as to how the six sites are proceeding with services.  We can then share this information with our members in a future issue. While the inclusion of service providers in the project was not based on licensure, one piece of good news to share is that the ongoing efforts in the state of New York to establish licensing for vision rehabilitation service providers came a step closer in June 2008. Specifically, at 6:01 pm on June 16, 2008, the New York State Senate passed S.5308-A - Licensure for Vision Rehab Professionals. The vote for passage was 62-0. This is a major accomplishment in the nearly 10 year effort to license Orientation and Mobility Specialists, Vision Rehabilitation Therapists (formerly known as rehabilitation teachers), and Low Vision Therapists. Passage of the bill must still happen in the New York State Assembly and plans are being made to carry it forward to a vote there in the next session. As concerned rehabilitation teachers and vision rehabilitation therapists, we need to continue to support these efforts in any way we can. We need to be certified and continue to promote certification of our profession through ACVREP, congratulate those who make positive strides, and recognize those who are participating in the project to make Medicare a reality for vision rehabilitation.   References: ACVREP newsletters, http://www.acvrep.org/  AFB, http://www.afb.org/ Low Vision Rehabilitation Network, http://www.lowvisionproject.org/ VisionServe Alliance, http://www.agenciesfortheblind.org/ Back To Top Proper Foot Care for the Visually Impaired Diabetic   By: April Seiffert, RT, RN, MSW, BSN  It comes as no surprise that a multitude of challenges face the visually impaired diabetic. Ideally a client with diabetic-related issues would be referred to a diabetic educator or endocrinologist. The question is do these professionals really teach all the skills necessary for a blind or low vision client to manage their diabetes? As a rehabilitation teacher, social worker, and registered nurse I can say from experience that many clients do not receive all the education necessary for primary prevention of wounds. Rather, they seek and receive care only after its too late and tertiary management of wounds is the only option left to them. If your client has some usable vision they can learn to use a magnifier or magnifying mirror for proper foot care. The use of a magnifier will enable the client to better inspect their feet for skin integrity and healthy skin coloration, which indicates proper pedal blood flow.  It's easy for a healthcare professional to inspect socks for drainage or bleeding, but if your client doesn't have access to these services the following strategies may help them identify these potentially harmful conditions. To test for foot drainage the client may remove a sock they have been wearing and touch it to their forearm or elbow to determine if there is moisture. The client may determine if there is an unhealthy odor by simply smelling the sock or stocking. If the client can use a magnifier, it can be used to examine the sock for visual confirmation of moisture or bleeding. Another strategy that may be used is to apply a dark colored piece of paper to the foot which will allow the client to visually observe whether the skin is flaking. If flakes are observed the client should apply aloe based lotion to the feet after showering, being careful not to apply the lotion to the areas between the toes which can retain too much moisture. A client who is totally blind may use a cotton ball in place of the dark colored paper. They should lightly run the cotton ball against their lower legs, feet, and toes. If the cotton ball catches or leaves fragments, it's an indication that moisturizer is needed. Edema is another concern worth noting because it can lead to skin break down which indicates poor blood flow to the extremities. An easy way to check for pedal or lower limb edema is by pressing a thumb on the lower calf and then feeling for an indention. One way to prevent edema is to avoid socks with tight elastic bands or those that are constricting. Cotton socks are preferred. The best time to try on shoes is later in the evening as this is when feet are the most swollen. Doing so will leave room in the shoe to accommodate the swelling, thus making the client more comfortable. The best practice for your client is to always have a professional inspect their feet and have a podiatrist cut and trim their toenails, however if they would prefer to perform these tasks independently the tips listed below might be helpful. These tips and informational clues are in no way the only means of conducting a thorough inspection of the diabetic foot; rather they serve as a starting point at which to educate your clients. Keep in mind there is more than one way in which to achieve goals, and listening to your client is an important first step! 1. The client must never walk barefooted. 2. They must not wear any shoes with open toes, soles or heels. They should wear shoes or slippers with firm soles; especially outside their house, in their yard, a swimming pool, or at the beach. 3. Shoes that fit snugly, but not too tight should be worn. One half inch between the big toe and the shoe is recommended. The toe-box should be round and high to allow space for toe deformities. The upper portion of the shoe should be soft and flexible. The lining should be smooth and free of ridges, wrinkles and seams. 4. Shoes should be rotated every day and kept in good condition. 5. Shoes need to be broken in gradually and worn for only a few hours at a time to prevent blisters and sore spots. Clients need to examine their feet regularly for red areas which can indicate too much pressure from the shoes. 6. Shoes must be checked daily for sharp edges and foreign objects. 7. Clients should not soak their feet. This causes too much moisture between the toes and can lead to Athlete's foot. 8. Feet should be dried carefully and gently. Pat them dry with a soft towel and DO NOT RUB! The client should remember to thoroughly dry the areas in between their toes. 9. Moisturizing cream should be used in small amounts and massaged into feet twice a day. It should not be applied between toes. 10. Loose pieces of skin should be removed by a health care professional. 11. Socks must be changed daily and discarded when worn out. They should be inspected regularly for signs of drainage from an open sore that may not be readily apparent. 12. Toenails must be kept trimmed. Keep in mind this is best performed by a podiatrist. 13. Clients must not attempt to trim their own corns or calluses. 14. Commercial corn or wart remedies are not recommended. These contain harmful acids that are very dangerous to diabetics. 15. Extreme temperatures should be avoided. If the client complains of cold feet advise them to wear warm boots. The client should never use hot water bottles or heating pads. 16.  The client should test the temperature of water with their elbow or any unaffected limb and they should only use luke-warm water.  If the client has extreme neuropathy issues it is strongly recommended that they purchase a temperature or scald- protect nozzle for their shower. 17. A client may need a friend, family member or healthcare professional to check for capillary refill and weakened or decreased pedal pulses on a regular basis.  18. An Emory board can be used to file toenails in between podiatry visits rather than clippers.  They should never go to a salon for pedicures by a non-healthcare professional. Back To Top Helpful Tips for Teaching Independent Living Skills By: Zeze Miller How many of your clients have given up on looking good because they have lost their vision? How often have you heard a client say "I can't see to apply makeup?"  In fact, many of us who are blind or visually impaired do wear makeup and wear it well. However, makeup alone does not improve one's appearance. How about a facial? When working with makeup issues with your clients, do facials come up in the discussions? If so, try the following tip that could benefit everyone. For a facial: Don't waste mustard on a hot dog-spread it on your face instead! Use mild yellow brand mustard to soothe and stimulate your skin. But keep away from your eyes and test on a small area first to make sure it doesn't irritate you. Dry up pimples: The only thing worse than being a teen with a zit is being an adult with one. Crush an aspirin and add a little water. Apply the paste to the pimple, wait a few minutes, and then wash it off.  It will reduce the redness and relieve the sting. Problems with scaly elbows? Soften dry, scaly elbows with a lemon juice/baking soda paste. To remove a splinter: If digging around your finger with a needle to get a splinter does not appeal to you because you are unable to see it, use the following easy painless technique.  Cover the wound with tape. After three days, pull off the tape and the splinter will come out with it. Long days wearing down your eyes? You do not have to go to your tools menu to change the fonts on your computer every time you want to make the print bigger, especially if it is just a few sentences or a short paragraph. Just hold down the "Ctrl" key on your key board and turn the mouse wheel, the zoom will change. It will get larger when you roll the mouse wheel away from you, it will get smaller when you move it toward you. How many times have you struggled with a client who was trying to learn Braille and had difficulty with the letters that are similar? Here are some tips that I used with my clients which may be of assistance to yours! The difference between "D" and "F" is, "F" is similar to a lower case print F with the line on the left minus the lower tail, whereas the line on the letter "D" is on the right. "H" and "J". "H" is similar to the lower case H minus the two lower legs. "J" looks like the lower case "J" minus the dot on top. How about the E and I? That was a little trickier. What worked for some of my clients was when they learned that the letter "E" slanted to the right, whereas the "I" slanted to the left. I did not think this little trick was that magical so I discussed this subject with one of our teachers to see if she had another trick up her sleeve. Her answer was the same, regretfully, no magic. Her clients found using the "slant" clue was just as beneficial to them, which substantiated my own findings. Many adults have difficulty feeling the Braille dots because their finger tips have calluses from all the manual work they have done. For some Clients, if they rub hand lotion into their fingertips, it will help their fingers become more sensitive, and they will have better feeling. How about the Library of Congress tape player? Many consumers have difficulty knowing when to rewind and when to fast forward a tape at the end of a book. Two suggestions may work to resolve this problem. One, if the book ends on an odd side, rewind the tape, and if it ends on an even side, then fast forward. Two, if a book ends on a side where the Braille is facing up, rewind, if it is facing down, then fast forward. Do you have a tip you'd like to share? If so, please e-mail me at zeze.o.miller@dss.mo.gov and it will appear in the next issue of this newsletter! Back To Top Outwit the Invador By: Rekha Nanchal, RT The strokes of a stroke on the beautiful canvas of the brain leave a stricken trail behind. A Transient Ischemic Attack (TIA) may leave a faint trail but the heavier strokes leave darker marks. This nefarious invader is a major trespasser. It creates devastation on the left while invading the right side and devastates the right when invading the left side, thus ruining God's perfect work of art! This rogue likes to party and visit with his notorious friends. It is never a casual visit. The scoundrel takes complete control very soon. To prevent such a party never lease out the beautiful building of your body to high blood pressure, high cholesterol, smoking, obesity or inactivity. Besides other complications, a stroke frequently causes partial visual loss and a decline in visual fields. This invader is insensitive to the fact that his victims may be limited in their work and daily environments. What a chivalrous gentleman! He finds pleasure in reducing perfectly healthy people into frail, dependent, incapacitated human beings.  He derives sadistic pleasure by watching people stumble and causes the loss of their ability to perform the simple tasks of daily living. Very often he does not come alone to invade but brings other darker foes with him as well; such as diabetes which may also adversely affect vision. Visual neglect and Homonymous Hemianopsia are two conditions that can be very easily confused. The visual neglect that is caused by a stroke results in the neglect of attention to one side of the body, whereas Hemianopsia is an actual physical loss of the visual field. Visual neglect is spatial inattention due to damage to the brain, and Homonymous Hemianopsia is a loss of half of the visual field when the connections of the visual system to the brain are injured due to stroke. Therefore, in Hemianopsia, problems associated with field loss are noticed, on the other hand visual neglect is a syndrome that causes the client to neglect a part or half of his body; this can lead to functional limitations like combing only half of the hair or shaving only one side of the face. It may also lead to functional blindness in one eye. The functional limitation manifests itself like vision loss but it is actually due to the dysfunction of the brain. Reading becomes a chore for those affected by either condition as the person will miss the beginning or the end of a line depending on which side the loss has occurred. Use of proper optical aids may help. Depending on which side is affected vertical marking or keeping a finger or thumb at the starting or ending point of the line may improve reading skills.  Little does this insensitive invader know that he is not invincible! Medical management and rehabilitation is a strong combat! Rehabilitative services and special devices can help a client cope with vision loss. Orientation and mobility training can further help them with both spatial disorientation and visual loss. Since fine motor functions are affected with gross motor functions, and vision loss is also experienced, quite often non-medical professionals as well as family members attribute the loss of balance to vision loss due to their lack of knowledge of a stroke's effects. Lack of balance may actually be caused by the stroke's effect on the cerebellum which in turn may cause paralysis/weakness in a limb or an entire side of the body. Their gait may become uncoordinated, resulting in an increased tendency to fall and thus the clients are more prone to injury. An assessment of fall risk should be performed on every client who has suffered a stroke and special devices may be provided. Rehabilitation may then improve motor strength and function. People affected by a stroke, may not have insight into their disease process. They may require situation-specific training and constant practice to maintain a learned skill. Skill-learning abilities may be compromised.  A need may exist to keep a person's surroundings absolutely constant to enhance coping. A considerable amount of time is generally required for the person to learn a new skill. A person may need supported employment and situation-specific services with any change in environment.  The inability to perform the activities of daily living may lead to a loss of self -worth and self-esteem and a person may go into a depression. Counseling and work adjustment strategies can help a person overcome these obstacles. If depression occurs it should be treated aggressively, and mental health support services can be provided. The invader may think it is all powerful but the illusion does not remain for long. We have found many a weapon to combat and outwit it. The best way to accomplish this is to take steps to prevent the stroke from occurring. These include: smoking cessation, control of blood pressure, control of blood sugar, lowering of blood cholesterol levels, increasing physical activity and reducing weight. Keep in mind there are some non-modifiable risk factors that cannot be changed, such as genetic predisposition to stroke or other genetic factors. If the invader does strike, there are ways to battle against him.  A combination of medical management and physical therapy, speech language therapy, occupational therapy, and services provided by a rehabilitation agency may help clients regain independence. Back To Top Keeping Your Food Safe By: Joseph LaPrise Do you know that fifteen percent of the food we eat in the United States comes from outside our country? That figure represents approximately $60 billion a year. What is disconcerting is that many of the countries supplying our food do not observe the same food safety standards as the United States. Only a small amount of the food we import is inspected. While we cannot control the safety of the food coming into this country we can take some measures to protect the food in our own home. Let's take a quiz to see if you are keeping your food safe: Q. What do you think the proper temperature should be inside your refrigerator? A. It is suggested you check it on a regular basis. If it is not at least 41 degrees Fahrenheit or lower then your food is not being kept at a safe temperature (Not including frozen foods). Q. How long can prepared food be kept in the refrigerator? A. Seven days is considered the maximum time prepared food should be kept. If you have prepared food that is more than seven days old it should be discarded immediately. Prepared food should be dated so as to remind you when to discard it. Q. What is the proper way to thaw out frozen food? A. There are four acceptable methods of thawing food, any one of which can be used safely: 1) Place frozen food in the refrigerator overnight. 2) Run 70 degree potable water over the food to thaw it. 3) Food can be thawed in a microwave if it is to be prepared soon after. 4). Food may be thawed as part of the natural cooking process. Note- Do not thaw food at room temperatures because this can cause a food borne illness if left out too long. Q. At what temperature can prepared food be kept outside the refrigerator? A. Food must be held at 135 degrees or higher to remain safe. Cooked food that drops below this temperature can foster bacterial growth. Q. Is it safe to use a common towel to dry your hands at home when you will be handling food? A. No. Using a common towel can spread bacteria from the towel to your hands which in turn can be transferred to the food you're handling. One-time use paper towels are recommended. While we cannot completely eliminate illness-causing pathogens from our food, following the guidelines mentioned above can greatly decrease their numbers and thereby increase the safety of the food you eat. Back To Top The Charlyn Allen Award Charlyn Allen worked in the field of rehabilitation teaching for the state of Missouri for approximately 35 years.  The last 10 years she was supervisor for the Missouri Bureau for the Blind.  Mrs. Allen was president of MACRT, then MCHT, in the late 1950s, and then assumed a leadership role in all of MACRT's conferences as well as other groups relative to rehabilitation teaching of persons with visual impairment. MACRT named this award in honor of Charlyn Allen, a remarkable woman who happened to be blind, who exemplified dedication and service to the rehabilitation of persons who are blind. This award is presented annually at our Training Conference awards luncheon.  If you know someone who is deserving of this award please email me (zeze.o.miller@dss.mo.gov ) their information along with a few lines as to why they should be nominated. Past Charlyn Allen Award Recipients: 1984 - Alvin Roberts 1985 - Virginia Offutt 1986 - Norman Dalke 1987 - Wayne Zoutendam 1988 - Don McBride 1989 - Paul Miller 1990 - Judy Pool Hansen 1991 - Judy Matsuoka & Pat Smith 1992 - Alice Raftary 1993 - Garry Bowman 1994 - Louise Reynolds 1995 - Lenore Dillon 1996 - Nancy Paskin 1997 - Geraldine Lawhorn 1998 - Lynn Wiggins 1999 - Don Golembiewski 2000 - Louise Yates 2001 - Marcia Gevers 2002 - No award presented 2003 - Judith K. Smith 2004 - Jennifer Ottowitz 2005 - Susan Dalton 2006 - Elaine Kitchel 2007 - Nancy Parkin Bashizi Back To Top From the editor's Kitche  Ziploc Omelet A friend gave me this recipe. I tried it once and I have not worried since about producing the perfect omelet. This works great! This is good when all your family is together. The best part is that no one has to wait for their special omelet because you can cook them all at once! -Put out a variety of ingredients beforehand, these could include: cheeses, ham, onions, green peppers, tomatoes, etc.  -Have guests write their name on a quart-size Ziploc freezer bag with permanent marker. -Crack 2 eggs (large or extra-large) into the bag (not more than 2). -Shake to combine them.  -Each guest may add any ingredient listed above to their bag and shake it all together! -Make sure to remove the air from the bag and zip it up. -Place all the bags into rolling, boiling pot of water for exactly 13 minutes. -You can usually cook 6-8 omelets in a large pot. For more, make another pot of boiling water.  -Open the bags and the omelets will roll out onto a plate easily. Be prepared for everyone to be amazed!  -Nice to serve with fresh fruit, coffee cake, or hash browns or dressed with salsa. -Everyone gets involved in the process and it is a great conversation piece. -Email me with your opinion if you try this FANTASTIC dish! Greek Orzo Seafood Salad Yields 8 servings Ingredients 1-3/4 cups orzo 8 oz. shrimp or scallops or a combination, chopped 1 cup halved snow peas 12 oz. tomatoes, chopped 3 oz. feta cheese, crumbled Dressing Ingredients: 1/4 cup olive oil 1/4 cup freshly squeezed lemon juice 1 tablespoon dried oregano (or 1/3 cup chopped fresh) 2 teaspoons minced garlic 2 teaspoons grated lemon zest 1/4 teaspoon ground black pepper Directions 1. In a large pot of boiling water cook the orzo for 8 to 10 minutes or until tender but firm; rinse under cold water and drain. Put in large serving bowl. 2. In non-stick skillet sprayed with vegetable spray, cook shrimp or scallops over high heat for 2 minutes or until just done at center. Drain any excess liquid. Add to orzo in serving bowl. 3. In a saucepan of boiling water, blanch snow peas for 1 minute, or until tender-crisp; refresh in cold water and drain. Place in serving bowl, along with tomatoes and feta cheese. 4. In small bowl whisk together olive oil, lemon juice, oregano, garlic, lemon zest and pepper; pour over salad and toss well. Chill before serving. Nutritional Information per Serving:  Calories: 226 Protein: 11 g Sodium: 163 mg Cholesterol: 53 mg Fat: 10 g Carbohydrates: 23 g Exchanges: 1 Starch, 1 Vegetable, 1 Very Lean Meat, 1-1/2 Fat Recipe taken from: file:///C:/Documents%20and%20Settings/Owner/Local%20Settings/Temporary%20Internet%20Files/Content.IE5/KWAIMJB7/www.dailydiabeticrecipe.com If you like this recipe, visit them often! Back To Top