ࡱ> xzw7 -bjbjUU Lg7|7|~'FlTJ^^^^zlJ(QO;O;O;PPPPPPP$R UPO;o5O;O;O;P?gP???O;P?O;P?6?FzNMhSP UvJ^<lOSPTP0(QO|Us= USP?JJSimplified Diabetes Meal Planning Includes More Than Potatoes in Idaho Helena M. Rizor, RD, CDE, Kathleen Thomas, RD,CDE, Julie Harker, RD, Marisue Smith, RD, CDE On a daily basis in our practice, we meet people with hectic lives and suboptimal math skills who feel overwhelmed with the reality of day-to-day diabetes management. A frequent patient complaint is that portion control is too complicated and time consuming. Traditional carbohydrate (CHO) counting requires the ability of the user to compute grams of carbohydrate, frequently for larger or smaller servings than those listed on the food label or in the CHO counting list. For optimal accuracy, portion size should be estimated closely or the food should be measured/weighed. Many individuals find measuring servings and computing grams of CHO daunting and frustrating. Initially, many patients follow their meal plans closely. Those who know how to count CHO benefit from guidelines to use for better visual estimations of portions. Our challenge as dietitians is to make healthful meals a workable reality for each patient with diabetes, even those who are unable to implement CHO counting. In our experience, the Idaho Plate Method and other methods of simplified portion estimation can yield excellent results. SIMPLIFYING PORTION CONTROL Most patients, whether on intensive insulin therapy or diet and exercise alone, benefit from learning at an individualized pace. If needed, the dietitian can train the patient on one or more of the following steps in the same session. Step 1. Identify High Carbohydrate Foods Teaching tools that can help patients identify and categorize carbohydrate based foods are the Food Guide Pyramid, especially The First Step in diabetes Meal Planning (1); The Idaho Plate Method (2-4 and 8); or a one-page list of carbohydrate-containing foods (Figure 1). These tools enable patients to quickly and visually identify the food groups that contain CHO. In this article we will discuss the last two. Step 2. Generalize Portion sizes While it is true that exact gram calculations of CHO matched to the right dose of insulin yield the tightest glycemic control, some patients are better able to implement new information if it is streamlined. One challenge of using the exchange lists is the variety of portion sizes of foods, even within the same group (eg, c. pasta, 1/3 c. rice, 1/4 c. grape juice, and c. cereal). The following simplifications have been helpful. These servings provide roughly 15 grams CHO and can be used interchangeably (also see Figure 1). One piece (eg, one slice bread, or one small apple) One half (eg, hamburger buns, English muffins, large banana, or grapefruit) One half-cup or one quarter plate (mashed potatoes, juice, or cut up fresh fruit) One cup of milk Step 3. Use a Visual Comparison Useful tools for estimating portion sizes are the dinner plate and the hands (see Figure 2). Since they are readily available at meal times anyway, their use is convenient. The patient learns to use hand and plate servings especially well if there is an opportunity during the training session to try estimating actual foods. Food models also work. Using a Plate (The Idaho Plate Method) A group of registered dietitians in Idaho have adapted a Swedish meal planning approach known as the Plate Model (5,6) to fit American nutrition recommendations for people with diabetes (7,8). The Idaho Plate Method Meal Planning Guide, available in both English and Spanish versions (the Spanish version features English translation), illustrates the Idaho Plate Method approach to meal planning and shows sample meals using graphics and color photos. The Spanish version contains photos of Mexican meals. The Idaho Plate Method Meal Planning Guides illustrate how to keep a more consistent level of carbohydrate at each meal, increase antioxidant nutrients and fiber, and lower intake of fat (9). Patients who are unable or unwilling to measure food and count fat or CHO grams have benefited from this simple approach. It is easy to use because the dinner plate becomes the measuring instrument. By using the same amount of CHO each meal, insulin dosing is also simplified. While the nutrition guide is especially useful for patients who are not ready to dose insulin for varied CHO intake, it can be used for newly diagnosed patients as a springboard to more advanced learning. The steps discussed in this article can assist in this process. The Idaho Plate Method is also useful for estimating varying amounts of CHO on a plate. On a nine-inch plate, patients can use their utensils to shape soft, CHO-rich foods (i.e. noodles), into a -inch deep layer. Each quarter of the plate provides about cup, or 15 grams of CHO (Figure 3). Likewise, a 1 layer of CHO-rich food on a quarter of a plate would contain about 1 cup, or 30 g CHO. Using the hand Another convenient way to estimate servings is by using the hand. One such approach, Hand Jive has been described in the literature (10); we have been using a similar approach. Because hands come in many different sizes, we have found it useful to individualize reference points on each persons hand, especially if the patient is matching short-acting insulin to CHO. Ask every patient to determine a cup and a 1cup serving size on their own hand by using water displacement (Figure 4). Comparing the hand to food models can also work. Part of a flat hand (usually the fingers or the palm) can be used to estimate a cup serving size of rice, mashed potatoes, noodles or cut up fruit. The entire flat hand can be used to estimate a 1-cup serving of the same foods. The fist lends itself as a gauge for baked potatoes, whole fruit, and large dinner rolls. Many baked potato the size of a womans fist might contain about 30 grams CHO (Figure 2). We have found the palm on most women to be too large to be used as a good estimate of a 3 oz portion of meat. SUMMARY These simplified approaches for controlling CHO intake impact glycemic control to a much greater degree than no attempt at all. They can be beneficial for individuals on diet and exercise alone, as well as for those who use more intensive insulin regimens, for the newly diagnosed, as well as for people who need to get back on track. In many cases, patients are willing to negotiate healthful changes only if they become convinced that it will not be time consuming and complicated. CARBOHYDRATE (CHO) COUNTING (15 g) Breakfast Snack Lunch Snack Dinner Snack CHO: MILK (12 grams CHO) Standard serving size 1 cup 1 cup (8 oz) of skim or 1% milk 1 cup light yogurt (8 oz) 1 cup low-fat buttermilk FRUIT (15 grams CHO) Standard serving size 1 small piece, 1/2, or 1/2 cup cup any fresh, frozen, unsweetened canned fruit 1 small (4 oz) apple, pear, peach, banana (or large), or nectarine 1 cup melon 1 cup berries 15 grapes or raisins 1/2 cup orange, grape fruit, or apple juice 1/3 cup grape, prune, or cranberry juice 1/4 Tbsp dried fruit 12 cherries BREAD / STARCH (15 grams CHO) Standard serving size 1 slice, 1/2 , or 1/2 cup 1 slice light bread 1/2 cup noodles or rice 1 oz any cereal or bread product 1/2 bagel, English muffin, burger bun, or hot dog bun 1/2 c. cooked cereal 1 cup soup (broth type) (~6 oz) 1/2 cup light ice cream or sugar-free pudding 3/4 oz pretzels 3 cups popcorn 6 saltines 6 inch tortilla 1/2 cup potatoes, corn, peas 1/3 cup cooked dried beans, sweet potatoes, or yams 1 cup winter squash NO CHO ( AFFECT HEART AND WEIGHT ( EAT SMALL PORTIONSPROTEIN: Limit to oz per day. Includes lean beef, pork, veal, chicken, fish, cottage cheese, cheeses, eggs, peanut butter FAT: Limit to servings per . 1 Serving = 1 tsp. Margarine, butter, oil, 1Tbsp regular salad dressings. 1 strip bacon, 2 olives, 1/6 avocado Nuts, olives, and avocados are very high in fat and calories, but the fat is heart-healthy.VEGETABLES (5 g CHO) 1 serving = 5 g CHO=1/2 cup cooked or 1 cup raw. Count CHO if you eat more than 3 servings per meal. Examples: Tomatoes, salad greens, spinach, peppers, onions, mushrooms, broccoli, cauliflower, green beans, zucchini, cabbage, carrots, asparagus, beets, celery, Swiss chard, mustard greens, kale, bean sprouts Figure 2. Hand and Fist Sizes  References/Resources Figure 3.      Figure 4. Water Displacement  Resources and References The American Diabetes Association and American Dietetic Association. The First Step in Diabetes Meal Planning. Alexandria, Va and Chicago, Il. 1995. Rizor H, Richards S. All our patients need to know about intensified diabetes management, they learned in fourth grade. The Diabetes Educator. 2000; 26(3):392-404. Rizor H, et al. Practical Nutrition: The Idaho Plate Method. Practical Diabetology. 1998; 17:42-45. Rizor, H. The Idaho Plate Method. DCE Newsflash, 1996; 17:18-20. Proceedings of the Congress of the International diabetes Federation. New York: Excerpta Medica, 1989; 923-925. Nutrition Subcommittee of the British Diabetic Associations Professional Advisory Committee. Dietary recommendations for people with diabetes: An update for the 1990s. Diabetic Medicine 1992; 9:189-202. The American Diabetes Association. Clinical practice recommendations1999. Diabetes Care 1999; 22 (supplement 1). The American Diabetes Association: Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications. Diabetes Care 2002; 25: 50-60. To order Idaho Plate Method Meal Planning Guides, write to Idaho Plate Method, LLC, P.O Box 441, Rexburg, ID 83440-0441, or see web site at  HYPERLINK "http://www.platemethod.com" http://www.platemethod.com. Baumer EM. Using the Zimbabwe Hand Teaching Method with an urban Austrian population [letter]. Diabetes Spectrum 1999;12:185-186. cup women cup men 1 cup women 1 cup men 1 cup women 1 cup men A 9 Plate as a Tool for Estimating CHO 1/4 plate, 1/2 deep=1/2c.=15 g CHO 1/2 plate, 1/2 deep=1c. =30 g CHO 3/4 plate, 1/2 deep =1 1/2c.= 45g CHO 1 plate, 1/2 inch deep =2c.=60 g CHO Step 1: Dip hand into 2-cup or quart-size measuring cup filled with water. Step 2: Keep lowering your hand until you raise the water by: 1/3 c. (rice, beans, 15 g CHO, 10 g CHO other foods) 1/2 c. (15g CHO) 2/3 c. (20 g CHO) 1 c. (30 g CHO) Step 3: Make a pen mark on your hand at each level. G +,OsAB!!!!!!!!!!!B"F"W#Y#o##ǷǩyqnqqCJ5CJOJQJ jCJOJQJUmHnHu j5OJQJ5CJOJQJ CJOJQJ CJOJQJ5>*OJQJ 5OJQJj5OJQJUmHnHuOJQJ56OJQJ\]^J5OJQJ\^J6OJQJ]^J5CJOJQJ\^J OJQJ^J+GH (   ?  O & F#$d%d&d'dNOPQ$a$~+-,^_gOPs % & F p^p$a$#$d%d&d'dNOPQ%AB #8d & F#$d %d &d 'd N O P Q  & F h^ & F h^ & F ^ ` & F p^p + L !! !=!q!!!!pV$$Ifl      '&(0      4 la $$Ifa$ & F^!!B""X#Y###$$$@fd($$d%d&d'dIfNOPQV$$Ifl      '&(0      4 la`$If^``$If$If ##$$$$$$%!%'%1%2%3%:%;%E%G%K%L%O%P%j%z%%%%%%&&''E'Z'''' ())******μμμԼԼԼεװujU^J jU^J0J5\^J 0J5\5\OJQJ 6]aJ0JaJaJ^JaJCJ$^J OJQJ^J"j5CJU\^JmHnHu 5\^J^JjCJU^JmHnHuCJ^JOJQJ CJOJQJ5CJOJQJ.$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$%%%%%%%%%%%% %!%1%3%;%<%=%>%?%@%@%A%B%C%D%E%H%I%J%K%M%N%O%Q%R%S%T%U%V%W%X%Z%[%\%]%^%_%`%a% a%b%c%d%e%f%g%h%i%j%k%l%m%n%o%y%z%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%`&'l' & Fh^h l'' ((b)%**}+~+++++++++++++++, & F7$8$H$^` & F & F & Fdd[$\$****}++,,,,,,"------ʿʿʿB*CJ^JaJ8ph6>*B*CJ]^JaJ8phB*CJ@^JaJ@phB*CJ^JaJ0ph^J0J^J jU^J,,,,,,=,>,?,@,A,B,j,k,l,m,n,,,,, -"-W- & F7$8$H$ 7$8$H$^ h7$8$H$^h & F7$8$H$^`7$8$H$W-h-z------- h7$8$H$^h 7$8$H$^ & F7$8$H$ &P/ =!"#$%9 0&P/ =!"#$% P0# 0&P/ =!"#$%9 0&P/ =!"#$% P05 0&P/ =!"#$%0@&`!Qu;iF@YІ z<c+xSkG=LIM6$!Qm5U6"K֠ 16͇jŪ@XD$ ZRA+R!Ui|g;|wBB/fpDqGYze-lѡ\"[5%G*V/(G[8DVZ5&"7xxeXj|٫\lXEɆ^]$*D_?ȝpd!Ldox"2BY8t C Cf+~⛍dk G 0(ue< t#NeG!W|gvYpΘbkZ[\#wJ< rϑr>VsM"7s]\9sܗiI<|Sk?[tu kc8OYg%C/>z"K˱*`i_pxw+ه弋 g˙2D.5U%7K3s_l'YX}ld+Ws'p^s?SOX?ųd}{ 7xL^-^oimN1+LuM 5/8y%CݥV D\sx#\&HԸ"qY+lo1Ը؅ktZ]$tٴ3O< xL 9“wt{EĬ;}_+Ms“]2>GJ(ɟw['ZH+GЛ$+g\Xsv9#9tK<'1+`"~6X!ZÇiM>㯩7CE}| >*I4"$&jC_C+=C}D{iAQzS&tx!*)G}jSWxz닐n.*)fRaˋ.#:Ok5net͠n0\[z*Q4@]!Jjo2ךڍRns]OWVdw9NكtC8`O>{W [GrL1OO/ګ"u?ȋnv+FS>.^ VlYf+Ik[KJ&& ޕ A >Ug23RFH`t JB_)inV2#ɒAWAjݠD*6٥$ 6ԳsG "ekJ @xU`x]wpp n n3.!i 6}tI:nZhksC[Hu%AITw Jk7@uzeRƸ2͕ntS5bI4%in#娞ԦTRZR ySTYRmkZWy{yޕSJ E3Eg'(Y&PY@JV.QK!N["BBC*ɠ;Z,O%9T,#P_rEm)j2J K2J!DK:Ni7 ל '8V>7;@lVe;&."5A8W\~sِeƋ.r)z=<ʹ\uԽ2^xW\I|}ەtYqe9Iw%{iI~t[[Z:6hN.U=t-kn]p鴛SKǪE}n;N;(%h ZjI˩ -P:>4S6Q7>]H4:TjK)SE#5uZM-T t:)5EHm[)'Q4T.\jf1e^TMvx:k;ܛؠ;Qwj:nJ_]s)R$ u(:Q8޵E }@7t*Spi+@].wi Frjc\}דCOa7LOhrc@n,R4C!j5[k>6`8=tSqF?#Zح~f9 :}F=zmRS|h$JCyA/{Y|(J/"2 ;% jac9 Eg[9DMsZyD qi)b"΢gޢp#q1eiFs6M͗si&^ø):e+7N܃Tnś3$e7s9T!Vc-\P_vrQYåe>\YqhsA)͕$7rd :XtDE $JnEftQSuO4_~>mhMga)2|^ߦB;TEr)j>HwP:J/9/ܗz[PR %2|Ľ^^p\p+W$򄋻Y]cb?b~ | /o/l{N#G*ͣZ4_09M ME?̔ /e P>, =/o)_"R={qIcGԣj ރ7x;ߨEބrC>T棨gＲ*x#9=g/"E^ȯ ij"J1xVY&)&^P@4uA~饹`䔑K-j.{O`-—OɞOio"ߌn7Ppy.vﱟRfMmF\V[gF( E N`Yp}|V~T* 8*6d #G- Q6P  Q5,} &j97 44 f`Ehvt b3+XU& vTp7@p 1blF.csq-[_UmI6޼ʎvpϣ'}:pQzWѝc4M87Y|-^V$-tO;߃JO gEy(nyˬ6fifKs3AO#LO5H]$ ~ڌREfaH 1sS\̓stN"˗0di$L4uWd)eN!4w9^.kVsq3Z{*Oz5njjqS6]SjiMgWx3V_[N48ɜds&L2d))M-Ylr/KLڴ|QO=GuDyK http://www.platemethod.comyK 8http://www.platemethod.com/ i8@8 NormalCJ_HaJmH sH tH @ Heading 1L$$d %d &d 'd @&N O P Q 5CJOJQJaJ@@@ Heading 2$@&56OJQJ\]P@P Heading 4$7$8$@&H$B* CJ$OJQJaJHph3fP@P Heading 5$h@&^h56OJQJ\]^JaJ@@@ Heading 6$ @& CJ$OJQJ<A@< Default Paragraph FontHC@H Body Text Indent ^ OJQJaJ8>@8 Title$a$5CJ OJQJaJ8B@8 Body Text5CJ OJQJ\&X@!& Emphasis6]"W@1" Strong5\.U@A. Hyperlink >*B*ph %0=HqE)!"3 %0=HqEH)P"P]PPPGH  (? O   ,^_gOPs %AB #8d+L =qBXY !!!!!!!!!!!! !!!1!3!;!!?!@!A!B!C!D!E!H!I!J!K!M!N!O!Q!R!S!T!U!V!W!X!Z![!\!]!^!_!`!a!b!c!d!e!f!g!h!i!j!k!l!m!n!o!y!z!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!`"#l## $$b%%&&}'~'''''''''''''''((((((=(>(?(@(A(B(j(k(l(m(n((((( )")W)h)z))))))00000000000 0 00000 0 0 0 0000 0 0 0 0 0 0 0 0 0000_0_0_0_0_0_00 0 0 0000B`0B 0B 0B 0B 0B 0B 0B 0B 0B 0B`0B0B`0B 0B 0B 0B 0B 0B 0B 0 B 0 B 0 B 0 B 0 B 0B 0B@0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0B0BX0B0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!0z!H0BH0BH0BH0B0! 0! 0! 0! 0! 0! 0! 0! 0! 0! 0 !0000000000000800H 000000 000000 00000 00H0000 0 0 0 000@0#*-%%!$$@%a%%l',W-- !"#$&'-&&&)X34/X2$u;iF@YІYP2$,8U rn%QMT@33\(  bB  c $1?"bB  c $1?"bB  c $1?"bB  c $1?"bB  c $1?"bB  c $1?"bB  c $1?"bB   c $1?"\B   S D1".   c AC:\Documents and Settings\Helena\Application Data\Microsoft\Media Catalog\Downloaded Clips\cl66\j0255094.wmf    C AC:\Documents and Settings\Helena\Application Data\Microsoft\Media Catalog\Downloaded Clips\cl4\BD10373_.wmf6      BCDE4F CyJk!4/9^Jn&Cy @    `#"   B CuDELF$u0<yx8W <Xt  @      #" TB  c $DԔTB  c $DԔH  #  H  #  TB @ c $DoTB @ c $DoH  #  H  #  NB  S DNB  S D   C AC:\Documents and Settings\Helena\Application Data\Microsoft\Media Catalog\Downloaded Clips\cl4\BD10373_.wmfTB  c $DjJTB  c $DjJ H  #   NB @ S D N  3   NB   S D ` ! c $ % ` " c $" + Z2 # s *T$Z2 $ s *T#Z2 % s *T"Z2 & s *T(`B ' 0DT*`B ( 0DT!`B ) 0DT/`B * 0DT&`B + 0DT)fB , 6D1T.`B - 0DT0`B . 0DT'T / c $T T 0 c $TT 1 c $T-T 2 c $T,Z 3 S   1  B S  ? !!"!#!$!%!&!1!3!4!5!6!7!8!9!E!F!K!O!!)'",t5'A,t'-t ',tU'q ,ti'A-t yt hr tlV Wt ")t(/ *t ! t^ td: !t D#t8t(t K t F(tYtY&t?  t6= t!t\ G"Jt StV|tx x t QtAt t ^}t0^!u t/ .%Z t(^ # ^ vt%).B#Gt$D "]t#" t!T(0t*  t.GD#t&:}S#t+c"ct'  t"BGt2 1t1{#t,"t) t-5M#5t3K$5tA B D % & ( X Y [ P\E"G"O#Z#$$ $$&&~'))HuyPrBkxyYlp9"E"G"Z"""##;%M%N%b%Z'p'w'}'~'''''''''( (_(a((( ) )))333333333333333333Pkr   '(JK  $%9;eg+,NO"#qr+Vv v }')HelenaIC:\Documents and Settings\Helena\My Documents\Helena\Diabetes\15g CHO.DOCHelenaaC:\Documents and Settings\Helena\Application Data\Microsoft\Word\AutoRecovery save of 15g CHO.asdHelenaIC:\Documents and Settings\Helena\My Documents\Helena\Diabetes\15g CHO.DOCHelenaIC:\Documents and Settings\Helena\My Documents\Helena\Diabetes\15g CHO.DOCHelenaZC:\Documents and Settings\Helena\My Documents\Helena\Plate Method\Newsletter article 2.DOCHelenaZC:\Documents and Settings\Helena\My Documents\Helena\Plate Method\Newsletter article 2.DOCHelenaZC:\Documents and Settings\Helena\My Documents\Helena\Plate Method\Newsletter article 2.DOCHelenaZC:\Documents and Settings\Helena\My Documents\Helena\Plate Method\Newsletter article 2.DOCHelenagC:\Documents and Settings\Helena\Local Settings\Temporary Internet Files\OLK80\Newsletter article 2.DOCWIN the Rockies4C:\My Documents\Julie\Plate\plate article Helena.doc,  ggj&B0`DSWh_[g* hh^h`OJQJo(h pp^p`OJQJo(h @ @ ^@ `OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh ^`OJQJo(h PP^P`OJQJo(h   ^ `OJQJo(oh ^`OJQJo(^`.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(EF, h_[glFggj&DSWE @0 ^`OJQJo(F`4t@h  ^ `OJQJo(xF @CJ"OJQJo(v                           qXY #)@'8)`@UnknownG:Times New Roman5Symbol3& :ArialO& ?Lucida Sans Unicode5& :Tahoma;Wingdings?5 :Courier New"qh:qF:qF]c E"20'}'2Q"CARBOHYDRATE (CHO) COUNTING (15 g) David RizorWIN the Rockies Oh+'0 0< X d p |#CARBOHYDRATE (CHO) COUNTING (15 g)sARB David Rizoraviavi Normal.dotWIN the Rockies2N Microsoft Word 9.0C@ @2@Pv@Pv  ՜.+,D՜.+,T hp  HomemE' #CARBOHYDRATE (CHO) COUNTING (15 g) Title 8@ _PID_HLINKSA8http://www.platemethod.com/|m mC:\Documents and Settings\Helena\Application Data\Microsoft\Media Catalog\Downloaded Clips\cl66\j0255094.wmfJ3 lC:\Documents and Settings\Helena\Application Data\Microsoft\Media Catalog\Downloaded Clips\cl4\BD10373_.wmfJ3lC:\Documents and Settings\Helena\Application Data\Microsoft\Media Catalog\Downloaded Clips\cl4\BD10373_.wmf  !"#$%&'()*+,-./012356789:;=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefhijklmnpqrstuvyRoot Entry FUv{Data 41Table<UWordDocumentLgSummaryInformation(gDocumentSummaryInformation8oCompObjjObjectPoolUvUv  FMicrosoft Word Document MSWordDocWord.Document.89q