Tuesday, May 6, 2014
Jenni and I went to iCAMP.That stands for University of Miami's Intergrative and Complimentary Academic Medicine Programs. This conference provided a lot of cutting edge information about approaching disease prevention and treatment from a functional perspective: What you eat, getting rid of yeast and infection, supplements, endocrine balance, avoiding chemicals, coping with stress, getting enough sleep, methylation.
We are fired up with new ideas for you.
Posted by Denise Punger MD IBCLC at 10:00 PM
Wednesday, December 25, 2013
|Ariana and David|
They were delicious; the kids (and Denise and I) dug right in, Please note anyone can enjoy these cookies, They are not just for lactation, but the inspiration for these cookies were to use ingredients that support milk production like oatmeal and brewer's yeast. None of us in my house are lactating.
She brought me the mix in both the oatmeal chocolate and the oatmeal raisin. Both were just as good as the the prepared Milk Makers Cookies. You can use coconut oil and egg substitutes to keep them GFDF, but we added butter and eggs to our mix. We got 19 large cookies out of the mix. They were very simple to make. A non-baker could make these. Even Denise.
The mix and the prepared cookies are available at Denise's office during office hours.
We had a few cookies left over. The mix bag has a ziplock seal. We can store the cookies right in the bag the mix came in.
Punger Family Medicine on Facebook.
Posted by Denise Punger MD IBCLC at 11:03 PM
Friday, January 18, 2013
Based on the current direction of my practice, I have updated my practice description:
Denise Punger MD IBCLC is a family physician who has very specialized interests and skills. Although she continues to do 'regular' family medicine: school physicals, routine checks, and treat common infections, new patients come to her because of her unique gift and love for breastfeeding medicine, minimally-invasive well-baby care, appreciation for birth plans, attachment-parenting philosophy, and selective vaccination schedules. She has been evaluating newborns with tongue-tie and preforming office frenotomies for over 15 years to preserve the nursing relationship. She supports prevention through nutrition, respects food sensitivities, and understands how hormone balance influence mood and overall well-being in the adult. She's been prescribing bio-identicals over 8 years. She is the author of Permission to Mother and she has a strong online presence and welcomes contact from patients and potential patients through the social media and the website. Patients travel, e-mail, and call for consults from all over.
Posted by Denise Punger MD IBCLC at 10:00 PM
Wednesday, October 3, 2012
I've been working long hours talking to the corporate lawyer, accountant, banker, advisors (both formal and informal) to branch out on my own.... Punger Family Medicine LLC.
Tonight I accidentally ran into the group of Independent Physicians Association. Like the door was waiting for me to walk in!
I came home and my husband asked, "Wouldn't it be nice to not have to worry about any of that administrative stuff and just sell the practice to HCA or Wellcare (or MM or Peds Assoc.. etc...)?"
It would NOT be nice. That's not who I want to be. I do not want to be told what I can and can not do.
I want to be the doctor who comes home to this (this was all yesterday) without restriction to practice what I believe:
"I love love LOVE our new pediatrician!!! She is an hour away, but Dr Punger is SOOOO worth the drive!!! We had an awesome visit with her this morning with well-visits for all 4 kids. Maggie has already gained 13 ounces! WOOO HOOOO!!!"
"Just picked up, "Permission to Mother" by Dr. Denise Punger at the library! I just read the first page....I still have forcep marks on my cheeks. Can't wait to read more!"
This is the doctor I want to be! Thank you for choosing my practice.
(It makes all the professional advisory meetings worth it!)
Posted by Denise Punger MD IBCLC at 8:26 AM
Tuesday, September 18, 2012
We have a new look at the office. When you walk in, "Yes, you are in the right place!" (Thank you, Denise Dinocola for taking this great photo and a few others. Check out more of her photography.) Some are my snapshots (They are easy to identify).
Posted by Denise Punger MD IBCLC at 9:13 PM
Thursday, August 23, 2012
Alicia J. Hill is my guest blogger today! I am posting the speech she presented for WBW at W.I.C in Martin County. I met her when she accompanied her step-sister to my office for a consult.
Breastfeeding for me has been an amazing journey that has brought me a closer relationship to my daughter and my fiancé. I was extremely determined to breastfeed early on in my pregnancy and I researched everything I could find on the subject. I prepared myself for the worse, just in case. I found that in the beginning it was so easy and natural. It was always convenient and ready; I thought, gee this is a piece of cake. My first real ruff patch was when she was about 7 months old; she had 2 teeth. She wanted to use her new found tools on me and I was in agony. I reached out and found as many people as I could to talk with on the subject. I even found the “secret unofficial La Leche page” on facebook, a resource I still use daily. Everyone said, give it a few days, this too shall pass – and it did. We are now at 18 months. She’s only nursing at this point for her nap and bedtime (and the middle of the night nursing she seems determined to sneak in). We are trying to wean and not having much luck so next year I might have more information on my adventure with that.
One of the best side effects of breastfeeding has been that it has made her such a healthy child, she’s had only 1 ear infection and 1 cold. Breastfeeding has also helped ease the pain of teething, the agony of shots, the bruises of crawling and the bumps and scrapes of learning to walk. As soon as she was upset in anyway by one of these things we would immediately nurse and all the worries and cares of these things immediately seemed to slip away.
There are so many other benefits too but I don’t have time to list them all. I want to tell you about my step-sister, not to scare you but to inform you. Her journey has not been so easy and she wanted me to tell you about it so that if you know someone like her or you start down her path, you seek help immediately and not wait. She is an intensely private person, so much that I didn’t even know she decided to breastfeed. I felt bad we hadn’t really discussed it but I kinda threw out there that if she did breastfeed and needed anything please don’t hesitate to call. When her son was a MONTH old I finally heard from her. She had been having pain with her latch from the very beginning. In the hospital they did not have a big education program about breastfeeding nor did they have knowledgeable staff. They basically told her to work on her latch and gave her a nipple shield and sent her home. She was extremely determined to breastfeed her son despite the pain (and there was a lot of pain for her) and despite the fact that she wasn’t really getting much help.
By the time she called me she was missing skin on one nipple and she had open sores on the other. She didn’t want me to make the 1 hour drive to her home so I was trying to help her over the phone with different hold positions and correct latch technique. 24 hours later, I was so frustrated with not seeing her; I could hear the pain in her voice that I drove to her home despite her nagging that she was ok. When I got there I took a look at her first. I noticed she had started to develop mastitis on one side and I told her she really needed to seek medical assistance. I couldn’t get a good look at her latch due to the pain level she was in. Stubborn as she was she said she would wait until the end of the week when he was scheduled for his circumcision. As luck would have it, she developed a fever that night. She of course sought medical attention at that point. They gave her antibiotics and told her that the pain should go away with that and she should see improvement.
She did not. At this point I got her in touch with an LLL leader in St. Lucie County. This leader encouraged her (as had I) to either attend a meeting to check her latch or to seek professional help. She made an appointment with Dr. Punger. Dr. Punger determined that she was doing everything correctly but that the baby was not only tongue tied but lip-tied, something that could have been determined much earlier for her had she sought help in the beginning, before the sores, before the mastitis, and certainly before she had to go through so much agony. They did a simple procedure for him and his latch was almost instantly improved. She healed very quickly after that and is now enjoying breastfeeding her son. There are occasions of lingering pain but she calls it more of an aggravation now than actual pain.
Bottom line is this, no one wants to see you succeed at breastfeeding more than the people in this very room. PLEASE, if you, or someone you know, are having any pain, discomfort, or simply need some advice – YOU NEED TO ASK. We are all here for that very reason but we do not always know you need help. Don’t go it alone. We have all sought the advice and help of others that have gone before us in this journey. They say it takes a village to raise a child and I firmly believe that. We encourage you to find what resource works best for you and USE IT. Whether you be intensely private or very outgoing, there is something or someone out there for all you. Breastfeeding will be an adventure but remember, you are giving your child the best start in life possible and we are very proud of you for making that decision in your life.
Posted by Denise Punger MD IBCLC at 8:25 PM
Tuesday, August 21, 2012
Breastfeeding support can come from a variety of different disciplines (volunteer, allied health, medical) and within a discipline the services vary; I may not provide the same services another breastfeeding medicine practice does.
We all work as a team providing different kinds of support.
These are reasons why one would come to me:
You (and/or baby) need an assessment quickly.
Baby won't latch (even if other breastfeeding support have watched a full latch).
Mother is in persistent pain (breast, nipple, perineum, incision, other).
Baby is exclusively bottle feeding, using a shield, or finger feeding; and mother desires to breastfeed.
Another health care provider told you to stop breastfeeding because X, Y, and Z reasons (or told you to supplement). There is usually a way to make it work.
For your breastfeeding evaluation, you or your baby need labs, cultures, x-rays, or medical prescriptions.
Abscess of the breast and diagnosis of other dermatological conditions of the breast and infants mouth (wounds, rash, viral& yeast)
Management of chronic breastfeeding issues
Supervision of breastfeeding while another specialist manages other medical problem
Integrated approach to postpartum depression and other psychiatric disorder or hormonal problems
Counseling after traumatic birth
Grieving Lactation Failure
Too many breastfeeding issues
You'd rather not post personal scenarios on networking sights and forums.
You're uncomfortable with Google/forums/phone.
You're in need of a confirmation pregnancy test; you want to discuss pregnancy plan and referral to midwife, OB, doula and resources.
Birth control planning (or not)
Prenatal visit; planning for the actual birth/well child care
Support for unassisted birth
Birth Plan to optimize breastfeeding
Idealistically, scheduling the prenatal appointment and at least the first appointment after birth to get breastfeeding started with the fewest complications possible
Over the counter/herbal remedies not working or endorsement of proper use
You need help sorting out conflicting information from many sources
Mother has history of unsuccessful breastfeeding
Chronic low milk supply in successive babies
Individual counseling on how to supplement (Lact-Aid vs bottle, Haberman or other), what to supplement (formula, home-made formula, donor milk, milks, mylks)
Prior breast surgery
DCF is involved.
You've been discharged from another medical practice.
Mother or baby is in hospital (for any other reason other than routine childbirth and routine newborn care).
2nd opinion on jaundice, allergies, rash, digestive problems, etc.
Tongue-tie and upper tie, corrected in office
Opinion on vaccination (medical exemption)
Needs support from a medical professional
Well child care and care for the whole family
Teething resources :)
Needs research for a preemie, NICU situation, or other unusual and anticipated congenital situation
Needs a medical clearance note "ok to breastfeed" ei, after dental work, surgery, or diagnostic test
Needs a prescription for banked donor milk
Medical clearance to donate your milk to a bank
Slowly but surely building a local network with specialists who respect my input on breastfeeding
Slow weight gain/failure to thrive/developmental delay
Support for extended breastfeeding/bedsharing/co-sleeping lifestyle
Support for vegan, vegetarian, elimination diet, etc
Maternal weight loss supervision
Maternal newly diagnosed medical condition
Just wants to establish just because (I like easy, too)
I empower you to take charge of your health. Thus, down the line less visits are needed to the doctor.
You take pride in supporting mom (and pop) business; in medicine it is no different than any other business.
I'm not owned by the gov't, university, hospital, or medical association and like other local business I support the local economy (sports, recreations, educational, religious, other local health providers).
Chances are good that I have seen your particular problem and more than once.
My certifications and experiences:
I've earned more than 75 formal hours of breastfeeding CME and CERPS in the past year, way beyond my requirements for family medicine.
I have clinically mentored CLC/IBCLC/Midwives/LLL/ ARNP students.
14 years CONTINUOUSLY breastfeeding my own children, nursing through 2 pregnancies, seven years tandem nursing, full-time employment x 2, and self-employment x 1, pumping, donation, extended co-sleeping, babywearing, and experiencing my own children needing sedation for [fortunately] minor surgery.
Fluent in Google, Facebook, blogging, and technology in general; knows what current issues are relevant to moms today.
MD for 20 years
IBCLC for 12 years
Member with LLL, FLCA, ABFM, ILCA for 12 years
Posted by Denise Punger MD IBCLC at 12:17 PM
Thursday, August 2, 2012
I am going to skip the explanation of why she needed a hysterectomy and hernia repair. My focus is preserving breastfeeding (but when I know an alternative for hysterectomy, I like to present it.). Not only did she come to me to discuss her specialists recommendations "should she go through with it." At that same meeting she told me that she was warned that she couldn't breastfeed in the hospital. She expected to be in the hospital for a week. This is very traumatic and insensitive news to a mom breastfeeding an active toddler.
I had an injury once (very, very, very minor in comparison to open abdominal surgery). Before going to the walk-in my biggest fear was that I would not be allowed to breastfeed or being denied pain medication because I was breastfeeding. Although my fear never came to be, it brings up the point of the powerful protective force we have as mothers to be allowed to nurse or babies. Nursing is healing all the way around. Even though I couldn't bear weight on my ankle, it was a relief to know that I could provide everything my baby needed right by bedsharing and by keeping a glass of water for me and a diaper close by.
That's why I wrote this letter for her to take to the hospital:
Posted by Denise Punger MD IBCLC at 3:54 PM
Wednesday, August 1, 2012
|Natacha and son at LLL parenting Conference|
I am proud of my local community for all the breastfeeding events going on in this area. We have a Latch-on event at the Civic Center this Saturday, Aug 4th at 10. Our facebook LLL group has over 450 members. I expect there will be a good show. I helped sponsor it and was offered a table. I didn't want to commit to a table. I thought if I can make it, I just want to have fun without responsibilities. The latch-on is an event to break the record for how many babies can be breastfeeding at one time. Maybe I am jealous that I don't have a nursling, but I do think it is a little strange that only latched babies count. I'd like for all supporters to count, but it's not such a big deal to me to make a big deal about it.
Once upon a time I couldn't wait till the monthly LLL came. We have so many LLL events (babywearing, ITAV, play groups, birth-ed and more in our community), that one could practically go to a meeting everyday. Most of these Treasure Coast groups have a group on facebook which keeps us in touch 24/7. It is really exciting to see.
By reading the groups myself I learn so much about what concerns mothers. One big concern is bedsharing. I literally mean with the baby in the crook of your arms or on top of you all night (or most of the night.) Some are scared that the baby is too little. I understand that, but your baby will grow. Some are concerned that the baby will be spoiled or never out grow it. You can't spoil a child by providing reassurance and human touch. Does it really matter if your older child wants to cuddle with you at night, be read to, laugh with you in the morning. Don't you want to see that angelic sleeping face? I love when my kids have slept near me. One day recently I wasn't feeling well and stayed in bed and my older child was reading a page turner and brought the dog and book in to be near me. I love watching my older child read and comfort me with his presence and availability. It was like my nurturing came full circle.
For World Breastfeeding Week reconsider your sleeping arrangements and do what is best for your family.
Posted by Denise Punger MD IBCLC at 9:00 PM
Thursday, May 24, 2012
I went to Publix tonight ( a few weeks ago, this sat in draft mode), I thought I'd better get a copy of that TIME issue and weigh in as an early mothering expert. You guys want to know what I think, right? They didn't have the issue. There was a May 14th issue. At check out with my 15 year old, I asked to the cashier and carry-out people, if they knew if there were any more around. They said they never saw it. They thought that the store probably wouldn't put something out like that because it might be offensive. So I haven't read the article. I have only seen the cover.
When I first saw the cover of TIME, I first thought, big deal, it could have been me....A photo of a mother with her kid standing next to her reaching for her breast to breastfeed.
|I could have been on the cover!|
Photo by Bernadette Clark
However, I never did a professional poised photo shoot with my three year old(s). Most of the time, when I fed a boy the same age as the one in the photo, it was in bed, on the couch, in a chair, in PJ's or something cozy ... and I was overweight .... Most often, my hair was wet, in a towel... definitely no make-up. And there was eye-to-eye contact, laughter, happiness and connection. My boys also were often in over sized T's or some other comfy houseclothes, barefoot and suited for cuddle time. Most of the time.
But at times, the boys stood and see if they were big enough to nurse or just because they could. If they could they were happy. By three years old if I pulled out a camera in a propped situation they would have ran. The boy in the TIME newspaper looks a little stressed. His mouth is just there.
Breastfeeding a three year old is about so many different things. It's hard to condense the value of nursing a three year old into one photo or one short news article and condense the years that lead to such a journey.
I want to help mother's overcome the common obstacles society places on them that interfere with breastfeeding.
It's OK to speak up for your birth.
It's OK to hold your baby after birth. No one should rob you of that time.
It's OK to co-sleep.... in the same room... in the same bed... even if you have a dog.
It's OK to hold your baby and Babywear. It's OK to stay at home with your baby (or get out if you prefer.)
It's OK to be the most natural mother you can be if you desire. You are mom enough, you are doing a fantastic job. Traditional Medicine shouldn't make you feel guilty. A cover of TIME shouldn't make you feel guilty either.
Yet, it's nice to see breastfeeding and Dr. Sears get some coverage in TIME.
|Breastfeeding Meeting in PSL|
Nursing a three year old is more common than you think. Even in Port Saint Lucie, Florida.
All the power and honor to the mom who got the opportunity to be on TIME's cover.
As a new mom you only have to take it day-by-day and not worry about nursing your child till he can tell you he wants to join the military. The moms I see on a daily basis are doing an excellent job attending to their children's needs.
My 15 year old finally saw the cover to TIME. He said, "That's not natural." He meant the pose. He knows breastfeeding is natural. He KNOWS.
Since seeing the cover my younger son has found mommy-stuffed-animals for his baby-stuff-animals. Thank you TIME for reminding my 8 year old how his little babies need their mommy's night-nights.
I have a copy now. I'll let you know soon what I think of the article, itself.
Posted by Denise Punger MD IBCLC at 9:32 PM
I refer out to compounding pharmacist often. I am willing to try cutting edge approaches to help balance non-specific hormone problems. Some people call it Anti-aging Medicine (or Bio-identicals). I find those titles too limiting to describe the full-spectrum of what I do as I help teens with issues; preconception & lactation; and weight-loss, fatigue, and libido in all ages(both genders).
I should have been an Endocrinologist?
Maybe, but I like being a primary care physician who can work with open-minded specialist. There are like-minded endocrinologist, but they are hard to find.
Patients don't understand the relationship I have with the Pharmacist I consult with and patients often go to my nurses to ask if I will transfer the recommended prescription hormone to a different pharmacy. I wrote out a dialogue for my nurses to share with callers why I won't transfer locally. I decided to share my reasons with you. Pardon me for talking about myself in third person.
Posted by Denise Punger MD IBCLC at 7:04 PM
Thursday, April 19, 2012
|Photo by Susie Faughnan|
From all the feedback I get about the necklaces, I honestly think it doesn't matter raw vs polished, dark vs light.
I hear how adults want a necklace too for carpal tunnel, neck pain, help them sleep better.
I have found out is is very hard to find raw necklace 18 inches and above. Everything I have found in longer lengths is polished. If you have found them let me know. For adults who truly wanted raw, they have screwed two shorter ones together.
At least from this Lithuanian company. There may be "imitators" out there? I say you should get what ever your personal preference is and that's why I got more variety with my second order. I'd love your opinion on this.
Perhaps, the amount of anti-inflammatory activity in the light may be "a little" more than in the dark, but is it significant. Doubtful.
The most popular question I get is; "Can you leave it on at night?" They baby ones are designed for 2 months old and above. They work when your skin warms the amber to reduces inflammation. At night when you are warm seems to me to be the most beneficial time to wear a necklace. Removing for sleep seems to me to be reducing the optimal benefit. I believe disclaimers "not intended for sleep" are legal disclaimers. Yet, you have to what your instincts and comfort level are. Take it off at night if you want, but you may lose some benefit. I know that some moms keep it on the baby's ankle at night. That is a compromise. An ankle doesn't seem to be as warm as the neck and chest and certainly not the same proximity for teething benefits. There is a knot between each bead. It is not a chain that can snap and the beads go everywhere.
They can be cleaned with damp cloth and warm water.
So my husband decided to give it a try and twisted two 12 inch ( dark chips) chains together to make a 24 inch chain. Within 10 minutes like he discovered gold, he said "it works"! Then he went to sleep. :) I was happy.
My office is well stocked and the best bet is to come by during office hours.
Tuesday, April 3, 2012
Since my post I realized how little is known about pre-folds-
Prefolds (the flat rectangle):
Pros: Tried and true, not a fad. They are cost effective and customizable. They easily fold into thirds and a velcro or snap cover (bumkins or bummis are examples of two brands) holds them in place (no pins required). As long as the cover is clean it can be used again. The covers dry quickly. It is easy to fold into thirds. For boys any extra is doubled (6 layers) in the front. For girls the extra length would be folded in the back.
They come in 4 sizes and you never out grow the previous size. The smaller sizes become liners for the bigger sizes or for most of the modern diapers. As a liner it also makes it possible to use the next size up All-in-One by lining it to fit. And as you know they also can be used as burp clothes, car rags, house dusters, forever. They are easy to wash, dry, and store. The first 2 sizes work best for under 10-15 pounds. Five pound babies can be clothed diapered without leaking. This is the best diaper for small babies. The largest size goes for beyond 35 pounds if you have a late bloomer or bed wetter. You can even layer 2 large ones to make them have more coverage ( I know this too well.)
It's a great way to start cloth diapering if you are unsure since it is inexpensive. It is also a great way to inexpensively add a little more fluff to your stash in case you miss a laundry day.
They look great on a clothes line(they do!)
If you are motivated to use Diaper pins, these are the ones you want! I can help you with your pre-folds under covers, but I can't help you with the pins.
Cons: Watch out for imitators that are filled with polyester and not layers of absorbent cotton. Only skill necessary is folding into thirds. The biggest mistake is not moving up to the next size.
Current Inventory and Prices (updated 6/22/12)
|Bumkins, print, double gusset at legs|
Photo by Kim Williams
|Photo by Christine Lopez|
Thursday, March 29, 2012
Abby and I look forward to meeting you!
Posted by Denise Punger MD IBCLC at 1:09 PM