My archives might be a little outdated especially the older blogs.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

Readers enjoy your feedback and Reviews (82!) on amazon. Kindle Version Available!

Please Join me on Facebook at Punger Family Medicine.

Tuesday, April 29, 2008

Follow up on my ALCAT blood test

It's been 9 months since I took my food sensitivity test and made significant changes in my diet. I had my blood drawn this morning because I'd like to retest for all the foods (and also for the new foods I eat, but wasn't tested on before) and hopefully I will see less inflammation. I am real curious about the results. I feel better, but I'd like to see it in print, too. I'd like to see if elimination can cure sensitivities. If I don't need to emphasize total elimination for sugar I'd like to know. If there is something else I should put more focus on, I'd like to know that also.

I also am checking my Lipids and HgA1C. I have never had a cholesterol problem. I checked it 9 months ago also, but I am thinking with my diet, my cholesterol would even be better. Without cane sugar in my diet and eating low glycemic foods, you would think my HgA1C would be zero.

Over the past months, I have eliminated cane sugar, msg, carob, codfish, coffee, cranberry, lobster, garlic, clam, codfish, goat's milk, salmon, olive, cocoa, sulfites, colored dyes, saccharine, aspartame, flouride, almond, celery and a few other things. I have reintroduced some of this after the appropriate time.

My test suggested I should do shorter elimination for baker's yeast, brewer's yeast, banana, cow's milk, crab, peanuts, pear, tuna. But I didn't. I cut back on some of this, but I can't say I eliminated it for 2 months straight. Still, I think I should show less inflammation. Hopefully not more!

I have not eaten out. Maybe less than 3-4 times. I prepare almost all my own foods or scrutinize the recipes of who is doing the cooking. I read all labels before putting it in my mouth. I have not had grocery store isle bread, candy, ice cream. I use a bread machine and make honey bread. I get most of my flour from a friend who grinds it from the grain. I use fresh herbs, my cuisine art ice cream maker (to make frozen yogurt), use fresh produce. I make lots of shakes.

I tested safe for soy and whey and added tofu and whey protein to my diet. This resulted in less poultry. I never did eat red meat.

I reduced my dairy by not drinking cow's milk and get sugar-free soy and rice milk instead. I replaced butter with oils on my safe list whenever possible.

Do I miss sweets like Breyer's Mint Chocolate ice cream and Devil Dogs? Actually not really. I feel good being in control. I like the taste of real food. I am looking forward to knowing what the next step to improving my diet will be. I will know in just a few days. :) :)

More info about alcat.

Sunday, April 27, 2008

List of Door Prizes at LLL Spring Sling Fling (and event Reminder)

A chance to win a copy of Permission to Mother....

Next Saturday, May 3, 2008 is

List of Door Prizes at LLL Spring Sling Fling!

A complete Ergo carrier set, an organic blanket set, 2 pouches, a Peanut Shell, Permission to Mother, swaddle blanket and more....

La Leche League of the Treasure Coast presenting their first ever annual
Spring Sling Fling
everyone invited

Presenting the latest in baby wearing fashions
How-to tutorials
Wraps, slings, pouches, structured carriers & simple pieces of cloth

Erika - wraps
Regena - ring slings
Megan -pouch styles
Andrea - Mei Tei
Simple Pieces of cloth - Lisa
Food Table - Lisa, Sophy
Lauren as our fashion show introducer
Tammy O double carriers

Local author and physician Denise Punger MD FAAFP IBCLC
Will be signing copies of her newly released book,

Saturday, May 3, 2008
Fort Pierce branch Library 101 Melody Lane, downtown, Fort Pierce!
Open at 12 noon!

10$ suggested donation
Please bring a healthy snack to share
RSVP recommended
772 464 4597 772 475 8560

Wednesday, April 23, 2008

Passover Meal Plan (and birth)

Matzo Cereal
Matzo and Jam
Matzo Ball Soup

Matzo Cereal
Left Over Soup
Matzo Brie (Scrambled eggs with broken Matzo)

Matzo Cereal
Left over Brie (disgusting)
Matzo Ball and Meatball stew

Matzo Cereal
Leftover stew
Stuff Cabbage (for a change)

OK, I never heard of matzo cereal, really fruit and eggs most days
Left over cabbage
Not sure what's for dinner.

Matzo, the flat cracker is symbolic for fleeing out of Egypt before the bread had time to rise. My Passover rituals aren't that strict. I eat a little Matzo. I am going to avoid baking and eating bread, but my husband will eat as he pleases and the bread police doesn't enforce the bread fast.

I had a special treat this Passover. My friend and local midwife, Alanna, who many of you know invited my family over for her family's traditional seder. Actually her husband invited us and I bet he had regrets when he realized this meant me and my kids and my dietary restrictions. I was kind-of nervous about it myself. I haven't been eating away from home much. I don't take my kids to eat at other people's houses for a formal meal, let alone a seder! The only recent Passover seders I've been to were at the local Temple and in Atlanta at the Community Center and kids are expected to be quiet and still. Honestly, out of frustration, I stopped making attendance a Passover seder a high priority.

Alanna follows MUCH stricter traditions and rituals than I. I feel so honored that she shared these with me. She was sensitive to my dietary needs and informed me of her recipes ingredients and there were so many choices of food to eat. My kids were well behaved. They kept their kippah's on for a change. William read the four questions from the Haggadah when it was his turn. He reads out loud well. Much of their Jewish learning outside the home is centered around schoooool.

This seder created a a fun memory for them outside of our usual confines. In an assimilated culture I am so happy they (and me) observed some beautiful traditions. My boys got along well with her oldest son. My boys continue to talk about playing with her son again.

Being with a midwife on Passover reminds me of the Exodus midwives. If it were not for the Hebrew midwives disregarding Pharaoh's creed to kill the newborn boys, the Jewish population wouldn't have multiplied. Nothing much has changed in the thousands of years; culture negatively affects birth and midwives today still need Godly strength to bring women the births they want.

There is a figurative translation of leaving Egypt that I love. That is thinking of "slavery" as our mental limitation and freeing ourselves from our own personal bondage. This applies to many aspects of day-to-day life and includes the way we plan to give birth. Are you held in bondage by your beliefs about birth?

Tuesday, April 22, 2008

VBAC article in the TCPALM today

Today there was an article in our local paper on VBAC. I posted the following response in the comment section. It was very hard limiting my comments to 3000 characters.

When I was in residency (1995) VBAC wasn't a big deal. We checked prior birth records to make sure the incision on the uterus was horizontal and moved forward. We scheduled repeat C’s for prior vertical uterine incisions which were fortunately rare.

As the article states ACOG’s new policy in 2004, resulted in nationally hospitals tightening their criteria for who can have VBACs. Many of my friends who had a recent cesarean and were told that a future vaginal birth was no big deal were now being told by the same MD that they could not birth naturally. A woman whose goal is to succeed at VBAC has to overcome a lot of external mental conditioning that she would not have had to deal with a year ago IF she can find a provider. Likewise, women in my training years having a VBAC did not have to overcome such emotional adversity.

ACOG is the governing body for obstetricians and GYNECOLOGISTS. ACOG needs to be concerned with women of all ages and phases including acute and chronic surgical gynecology.

There is another expert who is dedicated to ONLY pregnancy. That is the midwife. Midwives have different accountability organizations, different perspectives, and do not supervise the care of women with serious illnesses distracting her specialty of birth. They often have only a few women under their care at one time.

Furthermore when I was in residency, I was not exposed to midwives and their skills. I did not know what a midwife was. I was only exposed to the high risk, interventioned births that filled our maternity wards. My training was not well-rounded. As a physician-to-be my training limited me to the medical birth. My Family Medicine Department did not share many of the views the OB department held and introduced me to some controversy surrounding birth practices.

Not until I had my own birth in a local TC hospital, did I realize how influential birth is to a women's well-being. Many of the complications I witnessed in my residency training were iatrogenic (caused by our medical interventions). My next birth at the hospital was with a doula that protected my birth plan. My third birth was a footling breech born safely in my own bed with a midwife. My obstetrician father-in-law thought I was crazy, but the breech presentation caught me be surprise and I later learned breeches are delivered vaginally around the world.

Now I am in a unique practice setting focused on wellness. Many of my babies are born at home. It is such a pleasure to serve these healthy families. I have no doubt that the circumstances surrounding one's birth influence one’s immediate health and long-term health. While bonding with your baby is possible and health of mother and baby can be maximized after a difficult birth scenario, all other supports and conditions must be optimized. Inform yourself about natural pregnancy and seek a second opinion from your independent midwife.

Denise Punger MD FAAFP IBCLC

Monday, April 21, 2008

No Replacement for Breastmilk

At each new mother/baby consult, I almost always remember to tell the mom who wants to continue breastfeeding to call me if she has any medical people tell her she can't continue to breastfeed. It's just some anticipation because you never know what unexpected test, dental work, surgery, medication, etc.. one might need and mothers are told over-and-over that they must or should wean. I hate when my patients come back and weaned without getting all the facts.

So... I have a mother of a nine-month old come in. Breastfeeding is going well and she wants to wean. She's nursed this one longer than her first child. I see this quite a bit. I patiently work through the issues. Most of these moms come around. They've been influenced by previous experience and culture and have a new perspective after getting their concerns expressed.

She brings her back in for the 12 month check-up. I ask mom if her daughter is getting any breastmilk.

"I had surgery and I had to wean."

[Inside, I feel like exploding.] "What kind of surgery did you have?"


"Why did you have to wean."

"They told me I couldn't get anesthetics and breastfeed."

[Very patiently] "What do they think they give mothers who have cesareans?"

"Oh-I didn't think of that."

"Why, didn't you call me and ask if that was necessary?"

"I didn't think of that."

"Well, you said you wanted to wean, so I guess it wouldn't of mattered."

"Oh, but after we talked to you, we were doing well with breastfeeding. The surgery came up all of a sudden and happened so fast. She's adjusted well."

Eventhough, I can't change it, she needs to understand the significance. "I feel like I failed you. I usually tell moms to call me if anyone tells you to cease breastfeeding."

I'm not sure she got it, yet.

We start talking about the baby's diet. She is dairy sensitive. Mom also asks me what formula to use. She won't drink soy either.

I could cry for all that is lost here all because a flippant comment by an otolaryngologist (and anesthesiologist) who knew nothing about what he was advising and didn't even think to tell her to ask the baby's physician! I point out to the mother that all is not really well.

She did feed this baby longer than the first, but there is no replacement for breastfeeding.

Sunday, April 20, 2008

Slime Lab

Is it a solid or a liquid?
David wanted nothing to do with this.
Reading labels--Scott making sure there is no sugar in it. ;)
Not so sure about this.
OK! It's fun!
16 0unces of cornstarch and 1 1/2 cups of water per kid
and you got some

Thursday, April 17, 2008

I Love My Share of Organic Produce

I love bringing home my share of produce from our organic co-op on Thursdays. I want to eat everything tonight while it looks so fresh. When Andrea started the first co-op a few years ago, I was very hesitant to join. I thought it would all go bad before I could use it. I lurked on her yahoogroups for a while. She shared tips on storage and everyone shared serving suggestions. When she needed a sub, Lisa graciously picked up my 1/2 share for me because I couldn't get to Andrea's place. Anything that could be eaten raw that day was. Initially most of the rest went bad. I wasn't cooking then. I didn't know how. My mind was so focused on the practice, I unfortunately ate whatever John picked up. And all the while I craved home cooked food. I knew I didn't feel good, but my kitchen skills were pathetic.

When a hostess formed a groups closer to home, I jumped on the chance and got a full share and a fruit share. This hostess also was making bread and grinding grain. I got that stuff from her, too. I also purchased eggs through the co-op then. This is when I got more involved in my own kitchen. I missed it when her group dismantled.

Now in this Fort Pierce group, I pretty much know what to do with all the produce or know how to store or freeze for later use.

Tonight, I sliced the potatoes and single layer them in my stoneware with grape seed oil and salt and crisp them at 450 degrees. My kids eat these potato chips. They also ate up all the strawberries. They will eat the bananas and citrus. The other veggies might be more challenging to get in my kids.

I sauteed spinach (and onion hat I had) for myself. I often serve it with an omelet or rice. Tonight I kept it simple.

With the tomatoes, (cabbage and lemon from before) I can make a mock stuff cabbage, maybe more accurately called "unstuffed cabbage" (with rice and ground beef). This is an easy sugar-free recipe. If I need to add any more canned tomatoes, its easy to find tomatoes without sugar. If I need to sweeten the sauce agave has worked well before. It might not be Grandma's stuff cabbage, but I can feel good about eating it. At least one son eats this.

With scallions, I was thinking I could make Chinese fried rice. I cook the rice with sesame oil and add Tamari soy sauce for the Chinese flavor. Toss in diced omelet, scallions, pieces of chicken or ground turkey, baby corn, water chestnut. My kids all love Chinese fried rice (I never put scallion in it though...we'll see )Peas would be good too.

I tend to juice the fresh citrus. My sons eat it our of the shell. I like to be neat and drink it. I drink the pulp, so I don't cheat myself out of any fiber.

See... I have learned a lot and have come along way by participating in the organic co-op. When John picks out produce from the places he shops, It just doesn't look that good anymore. I wish I ate like this when I was pregnant!

I am not sure what to do with the Fennel. I put the Mint(?) in the freezer. I also have a bag of Mustard greens a friend gave me from her garden. I sauteed them with onion and they were too bitter for my preference. I need to get some ideas for the Mustard greens I have left over.

Conference Exhibit

I am showing off the posterboard my mom and sister made for me. As you can see they matted many of the reviews from amazon or my from my e-mail so I could display them. I was at the conference for the Florida Lactation Consultant Association so there was a lot of interest in the book and what I do. The IBCLC's enjoyed reading your reviews. I have room on the board to add a few more reviews and photos. I also framed some reviews and laminated a few (laying on the table) and hang them in my office.

I appreciate all who have asked about the interest the book at conference. Overall it's really great. I suppose if I retired from practice and motherhood, I could go on tour full-time to promote the book. Obviously, I am not doing that. The book is limited somewhat as to how much I can do and how efficient I am. Of course, the reviews, links, and word-of-mouth goes along way and is so appreciated!

I find it interesting at how many times I've been asked to give a talk. Like, just because I wrote a book (in my spare time), people now think I want to volunteer to give speeches in my other spare time. I've been asked so many times, I wouldn't have time to do ANYTHING else if I agreed to all. I am only seriously interested in one invite, TBA later.

I do expect being at the conference will help the forward momentum of the books exposure and number of office consults. In time I should be getting more feedback and discussion. Here is another letter I received:

Hi Denise,

I am a pediatrician/IBCLC in Connecticut. I just read your book cover to cover this evening after returning from 3 very rewarding housecalls for nursing moms/babies. Thank you so much for such a great and very personal book!! I am a mother of four. My eldest is 8 years old and my youngest is turning 2 soon. I am feeling such pangs for another newborn. (Essentially I'm having a hard time moving on the the next phase of life!!) I enjoyed your book so much...I think we have a lot in common in our experiences with our babies and our styles of raising our children....although kudos to you for home schooling. I'm not sure I have the strength to do it, or the ability to do it well!! Similar to you, I also delivered a "vaginal breech." She was my first-born, and I had a very enlightened and capable OB who honored my request in a hospital setting (so that the c/s room was readily available!!). I really just wanted to say thank you. I will re-read this book often, and I will suggest it to many moms in my practice!!

~Burlington, CT

Monday, April 14, 2008

Motherhood and Exercise

My mother and sister have been attending Zumba (aerobics) classes. They tell me how much fun it is. Since I am unable to show up at a particular time for class, I decided to buy the DVD set and use it with my family (we are enough people to make a class) at home.

Anyways, the DVD arrived before I left for the weekend. I packed it. On Sunday morning, me, my mother and her exercise friend try it out. They have been attending classes, but never had the chance to do the beginner steps in the privacy of home and they really enjoyed the slow pace of learning. I liked it, too. The guide says, "10 days of Zumba, to a lower dress size!" Wow, just 10 days! I am doing this.

Tonight, I am excited to take it out and Zumba with the boys. William sets up the TV & DVD for me ( I never watch TV and I don't know how to use it.) We turn the DVD on. Guess what? David starts crying and throwing a fit. I can't hear the music or directions. So much for THE lower dress size.

Scott spouts out, " I heard you and dad used to be athletes and now you are a little old fat couple in a little old house with so many kids you don't know what to do." He's rolling on the floor laughing at his humor.

I told him how I ONCE belonged to Martin Memorial Wellness center when he was a baby. I told him how I loved the spinning classes. "Guess what happened, Scott?" I put you in the nursery, got warmed up and you would throw a fit and cry. Just like DAVID is. The sitters called me out of class, nearly everytime. I continued to explain that's how athletes turn into fat oldies after kids. He couldn't believe HE did that.

Before kids, I loved weight lifting (believe it or not). One of John's funniest stories. He was spotting me on the incline bench press. I was wearing a bra top (if you can believe that, too). Looking down my top, he says, "The view around here is really nice." I guess he expected me to blush and get up. I told him, "To enjoy the view" and kept on pressing.

Brag alert- I was able to bench press the bar with the big 45 pound dumb bells on both sides-that's 135 pounds. It took me a year to work up to it. Then I met John. Downhill started. Then I had William who cried in the nursery at the gym and then Scott cried in the nursery and by the time David came along, I resigned to walking if I did anything at all.

That's my story on motherhood and exercise....

Thursday, April 10, 2008

Weekend Plans Coming Together

As David nursed this morning, I prepare him by telling him I won't be here Saturday and maybe not Sunday either. He retorts, " I am going with you.."

"No you are not." It's like he knows. He is nursing more to make up for my being gone.

The first time I left William and Scott (4 & 2 years old), was the first time we took recertification boards. We weren't gone that long. I nursed them to sleep. John and I went to the hotel where the exam was and was back late afternoon. We left overnight a year later when they had their teen babysitters stay with them. That was fun for them. David went overnight with John to his Grandma's recently. That was David's choice. He left me. :(

I now have clothes for exhibiting. If I had a nice sling with a baby placed in it. I could wear ANYTHING. It's amazing how a sling dresses up any old clothes. I don't have a baby now so I need clothes to make up for the loss.

Mary is going to take William and Scott to the monthly children's service on Friday. John promises he'll take them on Sunday morning to class.

John plans on junk food all weekend. My only hope for a good meal in them is what their babysitter makes on Friday. If I leave some meat, he doesn't mind preparing seasoned and freshly broiled. That's my highest hope for something nutritious in my absence.

Monday, April 7, 2008

A Packed Week

Basically I do the same thing over and over. I mother, I work, I eat, I sleep, I write about what I do. I hardly go out-of-town. I am in my office during hours and with my kids after hours.

Tomorrow I am heading south for the afternoon for Grandfather's Military Memorial. Seeing cousins that I rarely see. I hardly go to a funeral. Taking my kids since it is outdoors and they can be as involved or uninvolved as desired. I think they'll like the 21 gun salute.

Then I am out of the office Friday afternoon (twice in one week!), to drive to conference, my favorite lactation conference Friday evening and Saturday: attending and exhibiting. I am lucky to have the help of my mother and sister. They put together a display board many of the 5 star reviews posted to amazon and some pertinent blog posts.

I am not taking my kids or dear John. I've never left breastfeeding David for the night. I won't be there in the morning. It's been over 5 years that I left Scott and William for the night. (Get over it Denise, they are 11, 9, 4. They'll be ok. The older are actually looking foward to a weekend of xbox and junk food and NOOOO nagging). I have a chance to stay two nights. Should I? I am not to worried about leaving John.

All this takes an enormous amount of planning. Who is going to take the kids to Hebrew School this Sunday? They will miss Friday. I declared a pace break from William's on line school. When you go out of town (or do anything different) you suddenly realize you have no clothes for the occasion. We sure get used to the same thing when we are in a rut. I've had to make time for dress shopping. I really don't like shopping that much, believe it or not.

Its been several months since I have eaten food not prepared in my own house. I am trying to think what I am going to eat for the weekend, what I might bring with me and what MIGHT they offer as part of the conference packet.

In all this I do think about /try to get in some exercise.... and I've got a little board review studying in. That's all........

Saturday, April 5, 2008

Check out this Book Review!

This made my day:
Check out this review by Kim Wildner at Fearless Birthing for Permission to Mother!
Also, scroll down further to her post about her recent post about her favorite physicians.

Thursday, April 3, 2008

Links in the comments??

In my post below the commenter made a hyperlink to her site. How do you do that? The only other times I have seen links is in spammy type of comments. The comment is suspect, too. Never heard of her. I'd like to think she really cares about bf. Time will tell.

I know HTML. Perhaps I should try to leave a comment with a link. I actually think I tried before and it didn't work. Probably need to be a hacker-type to do it. My almost-teens probably know how. :)

Regular readers, tell me what you know.

Another morning of Breastfeeding!

....Continuing from yesterday.

I wake up first and then David wakes. He can read my mind. He knows I am thinking about getting out of bed and checking my e-mail.
"Mommy, I want night-nights before you get up."

Whew, I think. Today won't be the day I shrivel up! I gladly nurse my boy. There is all day to check my e-mail. Checking can wait a few minutes.


Along the same lines...

I posted a note about a Tot Shabbat song a few weeks ago with changing verse:

"I got the Shabbat feeling right in my head, right in my head, right in my head...
"I got the Shabbot feeling right in my mouth, right in my mouth, right in my mouth...
"I got the Shabbot feeling right in my ears, right in my ears, right in my ears...

I am vocally challenged so I won't sing the tune for you. David wouldn't sing it correctly at Tot Shabbat. When he got home it stuck in his mind and he has been singing this version:

"I got the Shabbat feeling right in my night-night, right in my night-night, right in my night-night...
(It gives a more meaning to the "in the mouth verse." And he laughs and laughs....)

It makes me happy that my boys can relate breastfeeding to their spiritual development. Most adults can't relate the two. I shared a story on page 137 PTM of when William was four and had similar had similar insight.

Breastfeeding is so much more than breastmilk!

Wednesday, April 2, 2008

Waking up to Breastfeeding

I woke up this morning to my oldest son sleeping in the crack between our full mattress and king mattress, which are both on the floor. My middle is laying across the bottom of the bed twisted in blankets and my youngest side-by-side with me. I am so happy to see his not-so-little mouth start rooting (can you call it rooting when they are four years old?) and turning for me in his half awake daze.

It seems like it was just yesterday, I nursed William for the first time and wondered how I would ever pull-off this thing called "breastfeeding." ( I wondered, if I would ever get to sleep in, now that I have a baby.) Where has all the years gone? My breastfeeding days will be done when this one weans. I have been lactating since William was born. The oldest two boys weaned. My breasts continued to feed the younger brother who was at my breast making me forget the sadness in the cessation of breastfeeding of the older. I am so happy he had a good, strong, lengthy nursing this morning. That means he will probably breastfeed tomorrow morning! I don't want to become an old, nonlactating, dried-up, barren woman. I don't want to "have" a weaning story to tell. I fear its close to that time.

AND, :) I also like the excuse to linger in bed longer because my baby needs his milk.

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