My archives might be a little outdated especially the older blogs. My links above are all new and current.

I have only positive things to say about Permission to Mother, an autobiographical account of a thoughtful mother and clinician who courageously writes from her heart, soul, brain, and personal experience; who is open to change in her views and opinions and is not guided by the safety of rules of any group or the status quo; she is guided by love and openness to the experiences life brings her and her family. Her process benefits her and those around her and those who read her words. And to add to that, the writing style and story telling ability here make it a very enjoyable read speckled with both the humor and seriousness of life. ~Laura Keegan RN FNP, author of Breastfeeding with Comfort and Joy

I enjoy reading your feedback and Reviews (81!) on amazon. Kindle Version Available!

Please Join me on Facebook at Punger Family Medicine.

Thursday, December 26, 2013

Lavender, Orange and Peppermint Essential Oils... and Beyond....

Carrie Thompson, Guest Blogger
Denise introduced me to essential oils last year. We started adding peppermint and orange to our water. We liked the flavor. We also knew the oils added a lot of antioxidants. Everything was good.

Then... I got a hold of lavender.  I dabbed a little on my neck and chest. I noticed how calming it was. I had heard stories that lavender essential oils was calming at births... not just for the mother, but everyone calmed down. I had heard that lavender was good to rub on babies feet to relax them. I decided to try the lavender on my "older" babies feet. We all noticed soothing effects, even on the teens. One mother told me her 4 year old loved the lavender so much, he looked forward to his massage and winding down before bedtime, and fighting sleep decreased. She said that now the bedtime routine was much more enjoyable.

Then I got curious if essential oils could help headaches. I learned that dabbing peppermint oil on the temples can help. A friend gave my a sample of doTerra Peppermint Essential Oil. I loved the aroma. I liked it even better than my first peppermint oil from another company. I held both bottles up to Denise when she arrived to see if she preferred one over another. She knew what I was doing as she immediately said she had made this observation on her own. She said she was enjoying the peppermint more now because it didn't overwhelm her Chocolate Bliss smoothie. She was so inspired she has been enjoying the lavender essential oil in a diffuser at home and at the office.

My favorites include lemon essential oil in my water and a blend of essential oils called Slim & Sassy in my water. I am in school and I wanted to become an doTerra Independent Product Consultant (IPC) to get the discount and opportunity for free products. Since, my up-line has shared with me a book called Modern Essentials and I am learning even more about the benefits of essential oils. As a full-time student I don't have much time to meet quotas and other requirements doTerra does not require a minimum sales amount, thus, there is no pressure and I can learn about essential oils and share at my own pace. This experience has been so much fun empowering myself with home remedies.

What really is cool is that Denise signed up to be an IPC. Together we are both learning, improving health and having fun. It's neat that she can reinforce the benefits from a medical side and help me use less medication. I know that a lot of women also ask if essential oils are safe with pregnancy and breastfeeding. Overall, yes in small quantities if your not sure -- each drop is powerful--  they improve your sense of well-being. I have already noticed that many of her patients are using them, but I am not a doctor and this is my guest post. I am going to encourage you to ask Denise when you have your consult. I am certain that she would help you find what's best for you. She may have testers in her office and if you happen to visit me in NY, I have samples too.
(Click to Enlarge)

We both have direct links if you want to check it out. The links also offer opportunity for your discount by membership or as a consultant.

www.mydoTerra.com/blissfulawakenings

www.mydoTerra.com/permissiontomother

~Carrie Thompson
Punger Family Medicine


Wednesday, December 25, 2013

Cookies for the Elves (Not just for Lactation)

Ariana and David
Hi, I am Carrie Thompson, I am Denise's sister, AKA Dr. Punger.  This is my first in a series of guest posts on her Permission to Mother blog. Denise and her boys came to visit me in NY and she brought some fun things from the office that I am going to write about. One of them is the Lactation Cookie Mix. It's the first time we've made cookies together. The kids loved it. We used the Milk Makers gluten-free/dairy-free mix.

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.

~Carrie Thompson
Punger Family Medicine on Facebook.

Friday, January 18, 2013

Practice Description

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.

 ~~~~~~~~~~

I haven't been blogging much (or at all). I do have some topics I would like to write about that take up more space than facebook. So, I may be back.... It seems I can't keep up with the changes on the blog and it is hard for readers to leave blog comments. I am active on my personal facebook profile and my business profile (Punger Family Medicine). I have a "Permission to Mother" facebook page, also. They all kind of overlap. I post at Instagram. I have a Pinterest Account; one day I will start pinning. Thank you for your continued interest in following me.


Wednesday, October 3, 2012

This is the doctor I want to be!!!

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...)?"

NOOOOOOOOOOOOOOOOOOOOOOOOOOO!

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!"  


"I wanted to thank you so much for fixing our little tongue issue! I came into your office after a harrying visit to a pediatric surgeon and a husband with a million questions.  You didn’t back down and you helped us get things on track. Caden is now over 15LBS and 25” fully aware and I think a very pleasant little man. Thank you for helping us get the job done."




This is the doctor I want to be! Thank you for choosing my practice.



(It makes all the professional advisory meetings worth it!)

Tuesday, September 18, 2012

Yes, You are in the right place!

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).

This is the sign you see when you walk in. I truly believe in trusting your instincts.


I thought David, my son, was going to stay all day and play. He was fascinated with old fashioned games.
David thought the playground built by Crystal and Amber was for 8 years and under. (He just turned 9.) TTT and HS is for "my age."

If you want to know why the room was updated, Here is something to help you remember the old seating.
The ugly fountains are gone. Hopefully more great changes to come!!!! Thanks to everyone who had ideas and moved these ideas forward.

Thursday, August 23, 2012

Toddler Breastfeeding & Frenotomy and Upper-tie Release (Two Success Stories)

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 fiancĂ©. 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.

Tuesday, August 21, 2012

A Suprisingly Long List of Why One Would Come in to See Me!


 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.

Pre-conception planning
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

Thursday, August 2, 2012

Breastfeeding and Hysterectomy

I helped Kim with some early breastfeeding problems with 2 babies. She is very committed to breastfeed as long as possible. I am familiar with her medical situation through the years leading up to the most recent surgery.

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:


I approve Kim and L to breastfeed as soon as Kim feels up to it. In the event that her daughter is not present, Kim’s breasts need to be pumped so she does not risk getting mastitis which would complicate her surgical recovery. (Also, her milk supply would likely be compromised after a week of not nursing.) I have spoke to Kim about positioning her daughter as not to interfere with the wound and to make sure her partner, assistant, or hospital IBCLC is present to get her positioned to the side. At L’s age this should not be difficult. Eighteen-month-olds are accommodating.
Being allowed to breastfeed L as soon as Kim is comfortable is the best thing that can happen to ease her overall well-being and benefit her recovery.


With all the concerns of major surgery, the desire to breastfeed is still innately strong. The day after surgery Kim posted this photo to my facebook wall. There weren't any big dialogue with the photo. (They probably didn't need my letter either.) The picture was 1000 word. It made my day! It brought me to tears knowing that she got to meet her little one's needs. She later told me that as soon as her daughter latched, she Kim was able to fall asleep.

I don't know too many new mom's who need hysteretomies. This surgery inspired mom to form a new support group on facebook: 
 
http://www.facebook.com/groups/hysterectomymommies/

This blog post is my perspective and you can read more on the facebook group from Kim's perspective and many of the other real problems recovery presents.

Another photo to show how to position an 18 month old as to not interfere with the incision.

Wednesday, August 1, 2012

World Breastfeeding Week/ Back to Bed

Natacha and son at LLL parenting Conference
For World Breastfeeding Week I thought I'd ramble on this blog. I'll try for most days. I want to cover the topic of bedsharing while I ramble on.

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.


Thursday, May 24, 2012

TIME - You know the one....

Photo of woman with breast-feeding child


Yes of course, I agreed, offensive and controversial.... I went on to tell them my passion is to help mothers succeed at breastfeeding and it really wasn't a big deal to see a mom nurture her kid, but many people think it is. My son who is embarrassed by every thing I say, didn't think twice about any of this.So, I haven't read the article, yet. I've only seen the cover.




 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
In the course of my daily work, it is not so unusual for me to see children breastfeeding. It's not really a thing that phases me.

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
I love seeing anything that supports the upper durations of breastfeeding.
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.










Non-Specific Hormone Problems

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.


"Dr. Punger refers you to the best resources for  your circumstances. She uses the PharmD, Doctor in Pharmacy, (the compounding pharmacist) as her clinical extender which means you are getting expert team approach care. It is not likely she will call your hormones locally if she made a referral that you agreed to. The pharmacist is a part of your medical care team. She relies on him and his team to gather information about hormones and endocrine disorders not so always readily accepted by other MD's and drugstore pharmacists. The PharmD attends continuing education and meetings when she can not. She relies on him to make recommendations about dosage and delivery route (for example, SL, sublinguals are not available locally). The Pharmacist also is available to you for on-going opinions and adjustments in dosage often after hours. That will save you face-to-face visits. At the current time, Dr. Punger prefers to keep up with her primary care skills and she can extend you the specialized hormone balance by keeping the pharmacist on the team. It is rare to find a physician who continues primary care AND extends services to hormones to the extent she does. By using the same pharmacy team, medial errors are reduced, as compared to having different pharmacies and different protocols for her to keep up with. 

She has no disclosures. She does not receive kick-back from the pharmacy. Nor are PharmD's employed by the practice. She simply refers you to the best resource for your circumstances at the time. In the meantime you are not paying high fees for anti-aging or weight loss clinics. Most of the consult is handled by phone call after initial face-to-face appointment with Dr. Punger. The teamwork between the PharmD and the MD is a highly specialized one and patients come from all over seeking this kind of care.

Dr. Punger won't refer you to the Pharmacist if she doesn't think you need that approach. If you simply need straight forward Vit D, or Synthroid, you will be directed to the locally pharmacy from the get-go. She will send you to an ENT, GYN, thyroid specialist right-off if that is what she thinks is best. 

If you don't like the team approach Dr. Punger has with the PharmD you may seek on your own a GYN or endocrinologist (who will likely tell you that what Dr. Punger does doesn't work) and offer you other options. Understandably not all patients will respond to Dr. Punger's treatment and you are free to seek any opinions you want. At that point, you will be under the specialist care and Dr. Punger will no longer be responsible for your hormone balance/weight loss/bleeding etc.... 

Dr. Punger has had good results with her approach and thus she continues to use all the resources available to her."

Thursday, April 19, 2012

Amber Bead Necklaces

Photo by Susie Faughnan
I've learned a lot about Amber Bead Necklaces recently. Like everyone else, I wondered if they really worked when I first was aware of the crunchy moms in my practice putting them on their babies. That was several years ago. Since, I've heard many  moms insist that the teething necklaces decreased the drool and fussiness and improved their baby's quality of sleep. I kept hearing how  it had to be Genuine, Raw, Baltic Amber, Light as possible is the best for teething. Before I placed my second order I reconsidered if it had to be raw and "as light as possible." When you start re-questioning, the moms have said they all get the job done.

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

More About Pre-Folds

I am so excited by how many babies I see in cloth diapers... more are in cloth than in paper.


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

Quick Drying Covers  (Bummis and Bumkins, vecro and snaps, single and double gussets) white and print, boys, and girl!!)   $10 each
(use over bamboozle, prefolds, or use smaller bumkins size as swim diaper)

preemie 6-10 pounds                       5
newborn 9-16                                 2
medium 15-23                                14
large      22-35                               18                           
toddler    over  35 pounds                 7



All-in-Ones (whites and prints) $10 each!!! (you may use all alone)

Bumkins (mostly white, a few prints left)
All-in-One      5 mediums 12-22 pounds
                    6 grande     32-42 pounds


Photo by Christine Lopez
Bamboozle   only 7 left
size 2 (fits 12-35 pounds) $18.00 each, 10% off 5 or more


Swim diapers  $10 each
I have 2 small prints ones, 9-15 pounds 
Bumkins covers in a smaller size could be used as Swim Covers--More in the next post.

  
Cotton liners for extra absorbency to fit inside other diapers. $0.50 each 




Four sizes of pre-folds
1) Preemie (up to 10 pounds) 1.00 each
2) Newborn(up to 15 pounds) 2.00 each
3) Regular (over 15 pounds)   2.50 each
4) Toddler  (over 35 pounds)  3.00 each

A preemie can be fully clothed diapered with 3-4 covers and 20 diapers.  That is $60 or under and a great way to get started. And a baby under 15 pounds can get started for $80 or under. 

Once you get used to cotton, you won't what to go back to scratchy paper.

All the diapers I have has been a big secret, because I've been way to busy. With all the interest in cloth diapers, I don't expect any of this inventory to last long. 

Thursday, March 29, 2012

Activities (Vero and Delray)


♥♥♥
MARK YOUR CALENDARS:


Delray Beach Palms Birth House – April 27th 10:30


Vero Beach – May 17th 10:30 (Dr Max Cohens Chiropractic office3730 7th Terrace Ste 302, Seacoast Bank Building, third floor)



Informal discussion with Dr. Punger on your personal "Permission to Mother" your children through childbirth, breastfeeding, mothering and more. This is free. Appropriate for mother's with babies under two and who are pregnant. Babies and toddlers welcome.

Permission to Mother available after meeting and at the office for $10 for meeting attendees.
                                                                                                     


                                                                 Abby and I look forward to meeting you!  
                                                                             

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