My archives might be a little outdated especially the older blogs.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

Saturday, January 31, 2009

Old Pump, New Life

I used my medela pump* to express milk for William and Scott while I was at work. I started expressing milk before I returned to work about 12 weeks post partum and continued to use the pump at work for the first year to replenish my supply, keep me comfortable, and nourish my babies while I was at work. I did not use the pump for David, my third baby, because I kept him with me. Yet all this time (its been ten years since I've used it), I've found it hard to get rid of. What if? What if I needed it again for something?

Well, I finally found a new life for my pump. A worthy destiny for a 12 year old medela Pump n Style.

I've donated it to a Pumper. The "Pumpers" is an affectionate term for all the mothers who have come together to pump milk for another mom who needs the milk. One of the Pumpers is using my pump. As much as I would love to donate my own milk, I am not in a mindset right now to concentrate on that effort to take herbs, medication, or take the time out to pump and wash pump parts and store and transport... I am happy that through my pump, I am able to enable another woman to do all this. She says the pumping is going well. Wow, my pump lasted all these years!


Actually it warms my heart to see how a group of woman have informally come together to donate milk. The burden doesn't fall all on one person. I like the team approach and the commitment! I like the sense of community. I like a happy mom and baby. (I also like a mom who takes a beautiful photo and gives me consent to use the photos.)


Let me take this opportunity to list out possible solutions for low milk supply depending on the circumstances:
Lifestyle counseling including skin-to-skin, babywearing, co-sleeping, co-bathing.

Correct latch and position.

Community Support including La Leche League (or other similar support group) meeting attendance and membership.

Prescribing herbs or medications for low milk supply. Indiviualizing the plan and monitor.

Optimal nutrition counseling and Vitamins.

Placenta capsules.

Planning for an optimal birth experience and medication free birth.

Lab testing for thyroid, other hormones and general medical. Consult and collaborate with breastfeeding specialists in other disciplines (IBCLCs, pharmacists, other physicians).

Breastfeeding books for mom to help chill, reinforce the correct information, keep a positive-mind set, and problem solve. Some current favorites and well-rounded group of books all offering somethig different that I recommend--
Permission to Mother, Breastfeeding with Comfort and Joy, Ultimate Guide to Breastfeeding, Making More Milk, Breastfeeding: A Priceless Gift.

Teach a mom how to supplement at the breast with lactaid* (pictured) or other
supplemental nursing system. Help them to decide which system and approach is best.

Teach a mom how to use the correct breastpump* if it is indicated. Hospital grade double electric pumps (the kind you rent) are the only pumps that are indicated for low milk supply. I really like for the mom to spend time with the baby and not the pump, if she doesn't need to pump. So the pump is my last resort.


*(Writing this, made me realize, I have all these supplies available in the office, but my twofloridadocs website doesn't show it.)

Thursday, January 29, 2009

Fan Club

My sister has honored me and started a fan club for my book. Check it out here.

Thanks Carrie!

Monday, January 26, 2009

Mama K's Book Review!

Thanks Mama K for posting a book review on your new blog! I am glad you enjoyed my book.

Saturday, January 24, 2009

I am a Guest Blogger at Adoption Connect Today

Learn more about adoptive breastfeeding and see more photos by visiting my guest post at adoption connect.

Friday, January 23, 2009

Night Nursing and Teeth

Question: I am nursing my 2 year old on demand- she nurses to sleep every night. We just went to the dentist and she suggested that I try to wean her from night nursing or at the very least wipe out her mouth when she falls asleep. Her teeth looked great no problems... I don't plan on weaning her but I am worried about her teeth... any insight on extended nursing and teeth? Thanks! Luanne

I am answering with an excerpt from Permission to Mother:

LLL recommends going within six months of the first teeth erupting. This preventive care hopefully lays the foundation for our dental health for the rest of our lives. The recommendation applies for all babies regardless of feeding method. I emphasize that breastfed babies are not exempt from meticulous dental hygiene. In my breastfeeding-skewed practice, I find more dental disease* in breastfed toddlers than I see ear infections ( I don't see much ear infections).

One of my moms, who survived multiple breastfeeding challenges to this point, was now upset after her 15 month old daughter’s visit to the dentist. Because her toddler had tooth decay, the pediatric dentist said she must stop breastfeeding at night. After all her struggle, she did not want to stop when she was finally enjoying the breastfeeding relationship.

I shared my sons’ dental history.

My first son has no dental problems. My second son who is eight years old now
had staining on his front baby teeth. The stains were there when they grew in. The
family dentist reassured me that they were just superficial and that his teeth were
solid without decay. When he was about three, he could sit still long enough for the
stains to be filed out. Neither of my two older boys had any major dental work.
Subsequently there was no reason to discuss night nursing and our family dentist
never told me to wean.

It is my third son with all the dental problems. His teeth grew in looking bad. At first I didn’t think much of it because they looked like the stains his older brother had on his front teeth. But his stains got bigger and the tips of his teeth disintegrated. Of all my sons, he was the latest to start solids and he never had a bottle (because he was with me at work). He was actually the one who was more likely to sleep through the night (or perhaps I just slept right through the nursing). I suppose I was in a sort of denial that his front teeth needed work, “Not my breastfed baby!”

His teeth looked really bad by the time he had them repaired. He was one- and-a-half. Fortunately, there is a minimally invasive pediatric dentist in town with five sons of his own who feels that breastfeeding is important to a toddler’s well-being. He will treat the decay and respect your right to continue breastfeeding. My son was sedated and caps were placed on his four upper front teeth. The dentist encourages good brushing, xylitol supplements (wipes or chewables), and nutrition (less sugar) as a part of the treatment program. Flouride treatment is individualized.

Our local La Leche League network helped me understand that breastfeeding through the night is entirely normal behavior for a toddler. If you stop breastfeeding at night, what beverage can you give that is healthier? Don’t necessarily expect any baby to sleep through the night at this age. They are not neurologically programmed for that. In fact, nursing at night is one of the best things for neurological and brain development. Formula and heavy foods may disrupt this built-in, sleep-hunger-wake feed cycle. If it’s important to you that your breastfed baby sleeps through the night, and he does, count yourself lucky.

If you have a toddler without dental problems you may get away with going to any dentist you want because breastfeeding won’t be an issue. If you have a breastfeeding toddler with caries, it becomes much more crucial to go to a breastfeeding-friendly dentist.

*Since, I wrote this two years ago, I have not seen much dental disease. David's dentist and I closely collaborate and many of my patients do get in to the dentist between the babies 1st and 2nd birthday. I'd like to think that the dental decay I see has decreased as we have worked together to provide preventative education.

Thursday, January 22, 2009

My Organic Produce, Wow!

I never took a photo of all my produce. Well, it looks yummy to me. It looks like a lot. It is a lot. The bulk of it will be gone in a week or less and I'll need to get more fruit. The bok choy (got ideas?) and lettuce will probably last the longest... and some of the garlic.

We got:
baby bok choy
broccoli crowns*
rainbow chard -most of this will end up in smoothies. If its bitter a quarter lemon rind will take the bitterness out.
green leaf lettuce
cucumber -one of them got devoured with fresh dill and salt
grape tomato - salads and snacking, or a side to a meal
celery - last time this was great sliced and with ground peanuts. Will go good with hummus ( I use dry beans, I may even sprout them x2-3 days).
2 colossal garlic- missing from picture - will go in everything
kiwi *
bosc pear
navel orange - boys devoured upon arrival
fuji apple*
ruby grapefruit
green pepper - I usual don't take this, but John said he liked green peppers and onions sauteed. He's going to be eating a lot of this. Maybe he'll add pepper to salad or dip in hummus.
yukon gold potato- sliced and baked and used them all today, I didn't really want to share them, either(maybe why my weight loss is at a plateau??). I should ask Gerrie about getting a whole case next time.


Fruit share:
blueberry
tommy atkins mango
strawberries - one basket GONE!

Unfortunately not all this is local (someone asked). But I do like going to the local growers at the farmer's market for more.

Someone else asked how I get John to eat all this good stuff. Well... he likes green peppers and mangoes...

* What I don't snack on whole, I have a few recipes from Kristen's Raw I want to try (cranberry dressing, chocolate applesauce, and flying dragon broccoli ). I've got all the ingredients for these, so I should have some fun in the next few days making some real tasty and healthy stuff.

I made this apple crisp that the boys liked! ( I can't get that link to work.)

Saturday, January 17, 2009

Difficulty Concieving

Question from Tricia and Nick :
Denise-I have insomnia tonight so I was looking over your blog. I think I originally happened on to it from the 12 step blog from GSG. My husband and I have been trying to get pregnant for the last 15 months now. I was looking for anything on your blog that talked about conception or lack thereof. I was relieved somewhat to find out that if we do end up adopting that I could have a way to breastfeed, thus it would feel like my very own child. I don't really want to do fertility treatments, I'm not into meds so much. I don't know at what point we should just adopt and stop waiting. We are 25 and my husband has good work at the moment. What advice can you give me?

I have a few suggestions for difficult conception.

1. Super nutrition for you and hub. Sounds like what you are doing, already. Green Smoothie Girl is a great sight for this. (It makes no sense to me that people go to spend all kinds of bucks at fertility clinics and won't eat descent meals.)

2. Learn more about fertility awareness. There are several good books out. ccli.org is a good place to start. Know when you can conceived.

3. Susun Weed has a book with a short chapter on herbs used for increasing fertility. I don't know anyone who has given me a personal testimony of success or otherwise, but it seems harmless and much less invasive than infertility clinics.

Lauren (Poseygirl) e-mailed me earlier with a comment:

I would love for Tricia to know that if she adopts, the child would be her "very own child" no matter what. Speaking as someone who has bio children already, therefore having "something to compare it to", so to speak, my love for Taj was/is no different, less immediate, or less strong than my love for my bio kids, even before I began breastfeeding.

I do understand it can be different with adopting older children, but I also have been told that the same feelings will come.

Also, if they don't plan to pursue fertility treatments right now, yet want to be parents soon, they should at least start looking into adoption if she is open to it. We have not completely ruled out trying to have another bio child, nor have we ruled out adopting again (or doing both:)) She could at least find out what her options are. Please feel free to send her to my blog if you like.

Friday, January 16, 2009

Homeschool Progress

William finally began 6th grade Florida Virtual School Math. This is the first week and last night he completed the first lesson for the third week. He should progress through this nicely and at a quicker pace than they suggest. Doing the DK math books prior to this was helpful. I work through the advanced assignments with him and he'll get honors credit. He goes to drums every other week. Karate 2-3 times a week (less than a year to black belt), and Hebrew School 2-3 times a week.

Scott had his vision checked by our family optometrist. Scott's vision is perfect. Our eye doctor suggested a program called"Perceptual Visual Tracking Program. " It's a computer based program with exercises to strengthen the ocular muscles. Scott has been doing the recommended 15 minutes of exercise daily in this program. He hasn't been diagnosed with any specific reading disability, but obviously he has one. I received many suggestions via the blog to help him learn to read. I appreciate all of them. I decided to trust our eye doctor first and go with his suggestions. As far as reading improvement. He did read a book to me. He read a "Biscuit" book to me. I know some of you may be thinking that's a preschool book and I should be embarrassed, however, he did not want to read anything to me a few weeks ago. And after Biscuit he read "Danny and the Dinosaur, 3 in 1." Since I don't let what our critiques say negatively influence us, I share this to help the others who may be struggling with the same type of learning problems. Also, I enjoyed him reading to me VERY much. Scott is the brother who listens and comprehends the most when I read aloud. We are half way through Little House on the Prairie now. I read before we go to sleep and the next day we discuss what we read. Scott is also in Hebrew school doing well with reading Hebrew and preparing to be a black belt soon in Karate.

David is only five and would not officially be in Kindergarten till next year. He is learning his letters and numbers. He is proud to show me what he learns. This is such a different experience than with William and Scott who I have to drag it out of. David also is involved in karate. I don't believe its necessary to involve young children to a million scheduled activities so that's it for David.

Wednesday, January 14, 2009

Yeah Jen!


I am so priviliged to be with Jen at her house after the birth of her baby girl this afternoon (another birth I missed) . It is such an honor to see a newborn cuddled up with her mother undisturbed (except for my flash). Jen radiated through her pregnancy and she radiates today.

We saw The Orgasmic Birth movie together and attended a Birthing from Within workshop together. She's done so much more like yoga and hypnobirthing to get ready for this birth and the preparation paid off!


It brought me much happiness to see Dad greet me with a big smile and be at peace with this homebirth.
Photos posted with permission...




Check the top of my blog because I have another baby(!) to post about tonight, too.

Mothering at the Breast (adoptive breastfeeding)

I'm so lucky getting to meet a celebrity baby today. This 3 day old is adopted and will be breastfed. I am so excited. Mom said he took to the lact-aid much better than the hospital nipple, which he was gagging on. You can see her own words on her blog here.


The lact-aid works by holding a reservoir of expressed milk or formula and a little tube brings the liquid to the baby's mouth as he suckles. An easy regimen of a few medications prior to the arrival of the baby helps bring the milk in. The lact-aid provides a supplement while mom's milk supply is building up. A relaxed smile and the eye-to-eye contact between mother and latched baby is unmatched!

It is so inspiring to me to see mothering at the breast!

See more photos here.

Sunday, January 11, 2009

Will My Produce Last a Week?

Probably not.

We got:

green beans- snacking on these delicious beans raw
red chard- using for smoothies. Ripe bananas and a quarter of a lemon rind takes the bitterness out. Unfortunately I'll be done with this tomorrow. I haven't cooked greens in awhile because I need them all in my smoothies.
red leaf lettuce- this has been washed and stored in a seal container for salad. I put a few leaves into the smoothie.
yukon gold potato- steamed mashed "potatas" --my kids don't like when I say it like that
white mushroom-traded with Lauren for her Bananas
leek -not sure yet
roma tomato- lentil soup
alfalfa sprouts- for salads so far
carrots- juiced a few with apples and beets, the left over fiber went into the soup
granny smith apple - put some in smoothies, snacking
navel orange- kids love them, I squeezed some of the juice into my smoothie
banana- snacks, made banana bread
bicolor corn - boiled and savoured
green pepper- traded in for more corn


Fruit Share:
golden pineapple- I have a pineapple slicer and it is peeled and being chilled in the 'fridge for snacks or smoothies.
blueberry- served as an appetizer to my kids
tangelo- the kids will eat these up

It seems we go through this stuff so fast. I'll need to get more produce soon. I still have grape fruit and lemons, but it does go faster than you would think. I'm saving all my lemon rinds to add to the smoothies with bitter greens.

All my boys have lost weight even David. He was about 45 pounds and now he is 40. He wasn't fat to start with, he does look skinny now. I am so glad to have reduced the junk in their diet. The boys still get plenty of it. It is all around us and John isn't really on board with my meals, so he always has something for them I disapprove of.

As time goes on it gets easier and easier to pass on junk, processed food, and things that don't agree with me. Often if its not good for my health, it doesn't seem appealing. Overall I feel great. I find myself carefully monitoring how much produce I have in the house a planning ahead for where I want to go to restock.

Where to find Breastfeeding Help

Where would one go to find a breastfeeding specialist doctor in my area?
I'd start by asking lots of mothers. Keep in mind that while there are more of "us" over time. You would likely have to drive a bit to get to one. Women in my location have to drive to get to other specialist in Orlando and Miami, don't give-up just because there is not one next door. It is worth traveling for the informed consult!

What organizations that you belong to might help with that? (all of these have directories and links in my resource list)

La Leche League has Medical Associates
Academy of Breastfeeding Medicine
Attachment Parenting International (I don't actually belong right now)
International Lactation Association
Florida Lactation Consultant Association


OK, I do have a question. My DIL was told by a lactation professional that she was not making enough milk. (Baby was sleeping a lot and mom was told that that is a sign, along with little weight gain, of not enough nutrition) The lactation consultant checked the baby's latch, said it was fine, and told mom to pump and suggested herbs to help increase her milk. She never got engorged (which she sees as evidence of her inability to produce sufficient milk), but nursed through pain and difficulties for weeks and finally stopped. (That girl is a trooper! most of us would have quit much sooner.)

So: 1) are there or are there not some women who, while fully capable of growing a baby and giving birth well, are unable to make milk for that baby? I have heard both yes and no to this question and want to know the truth with data to back it up.

I think it is very rare that a mother can't make enough milk, although I occasionally have a mother whom I've worked with and still can't. Our cultural influence and prior experience affects breastfeeding (beliefs, motivation, misconceptions, initiation (or lack of) ,lack of support, labor medications, prior breast surgery, or other surgery like gastric bypass and nutrition). But there is still occasional times when all these conditions are optimized and a woman still can't make enough milk like inadequate glandular tissue, thyroid, pituitary disease (but can still be optimized ).

Here, I am considering the mother's side not the babies side which can include prematurity, immaturity, tongue-tie and suck disorders and other cranial facial disorders.

Pregnancy is not required to produce milk. Surrogate and adoptive mom can produce milk with support and proper information.

A mother who can't provide breastmilk can still mother at the breast (lact-aid, SNS) and provide skin-to-skin (co-bath, co-sleep, babywear). Recently one of our La Leche League leaders daughters asked, "What if I can't breastfeed. Will you be mad at me?" You can still provide mothering at the breast and skin-t0-skin. Many mother's who "give-up" breastfeeding, give-up on it all, too. A mother's desire to breastfeed is the most important factor.

And 2) what are the different kinds of lactation consultant people? There are the lay helpers like La Leche League, which do a lot of good, and there are some professionals and people like you who have letters after their names. What kind of help do these various people offer, and who would you expect to have the best, most helpful information? I want to know to whom I can direct moms when they are having trouble with nursing.

Remind me where you live. You can send me a comment or e-mail and I'll let you know if I know someone. I won't publish a comment with your location. There are many types of professionals who can help breastfeeding, and unfortunately there are many who think they are helping, but are causing harm. For example midwifes, doulas, physicians, nurses (and nurse practitioners), chiros, therapists, dietitians and dentists (and more) are in great positions to help breastfeeding, but its the rare few who take special interest to specialize in lactation. However, I can think of a few who provide exceptional help in all all of those professions. La Leche League leaders are great if the mother needs mother-to-mother support. It's great to refer all mothers to LLL. (Our local group is great. I am not sure that all areas have an active gr oup like we have.) They can often help locate a physician who belongs to LLL medical associates. But medical associates and members of the academy of breastfeeding medicine differ in the level of experience, knowledge, area of expertise and service (clinical, research-based, academic) and may not all be available. Some do primary care w/ breastfeeding and some have limited their practice to just breastfeeding.

In some areas WIC is a good place to ask for a lactation consultant. In some places WIC isn't as helpful.

It all goes back to asking lots of local mothers who the professionals are in an area.

There seems to be a lot of certifications and levels for various lactation providers and many certifying organizations. So many, I am sorry to say, I haven't kept up. I have kept a list of old favorites in my resource list in the navbar.

And 3) where can I go to get training in this myself?) Thanks.

Become a La Leche League leader or at least a paid member for now, so you get on the mailing list for meetings, conferences, journals. Join your state and/or local lactation group or Breastfeeding Task force. Contact the office certifying IBCLC's for reputable information.

Saturday, January 10, 2009

Are Doulas Necessary at Unassisted Births?

Question from Tophat:

I bought your book last month and in it you really promote the use of a doula and said something on the lines where you think everyone should have a doula.

I (Unassisted Childbirth) UCed last March. I did end up calling a friend for emotional support once the labor hit somewhere around 30 hours and it was wearing on me, but had I had a labor shorter than 30 hours, I wouldn't have called her.

Because of that, I'm inclined to not get a doula in the future. If a woman is UCing, what would the advantages of a doula be? I'm interested in your thoughts.

I love your book, though. :)

On a side note: the labor ended up being 44 hours, wonderful healthy pink little girl.

Answer:

Thank you for noticing my emphasis on the benefit of having a birth doula. I know you really read carefully and with interest. This is a great question.

Yep, I pretty much think all birthing woman should have an experienced doula. I am so tired of women being in denial about the amount of effort and focus it takes to get through labor and birth. I am so tired of hearing labors gone badly and observing the emotional scars and separation. Tired of hearing women aren't researching birth. Tired of women thinking that the first birth was easy and the second (or third, etc...) will come easy, too (you never know). Tired of hearing women emphasize unimportant details like nursery themes and token ultrasounds. Tired of hearing the same women complain they can't afford a doula (but they could afford the nursery and ultrasound). Women need to be prepared and arm themselves with all the support possible in this horrendous birth climate we have. I must recognize the value of an experienced doula. I also recognize the value of a student doula or any loving, caring women who serves in this role (which is what you had).

While writing the book, I anticipated getting asked your question by an "UCer." I admit my main concern or intended audience for my statement was the uninformed mother making no decisions for herself. I want to wake that woman up.

OK- So what do I think about unassisted birth (UC) and doulas? First of all, I commend anyone who researches birth like you do, prepares themselves for complications and emergencies and how to handle them independently, and doesn't give in to hostile and anti-intuitive birth practices and wants privacy. If one has done all that research and trusts that they can have a hands-off birth, and has meticulous nutrition, I fully support them. The woman who has done all this preparation may be the exception to my "everyone should have a doula" rule.

Most women haven't done this research and most women don't know their bodies. Just look at our full maternity wards.

BUT, the fact is, you never know how your labor will be and how you will emotional respond to it. Nor do you know how helpful your partner will be if you haven't birthed together before. You did the right thing. You DID prepare and have a "doula" available to you and you called her when you needed her.

If my labor was short and easy the first time, I would not have had a doula the 2nd time. I suppose I could also say if my labor was real quick the second time, my doula may not have made it. Perhaps, I could say the same for my 3rd birth. I am certain my 2nd and 3rd labors stayed focused with the doula support I planned for. Wouldn't it be great if we could all have short, easily managed labors?

It makes me wonder, if perhaps you called your friend/doula sooner for the physical support and emotional and spiritual reassurance could it have helped your wear. That's just a rhetorical thought and it may help give another woman perspective and something to consider. I am not really directing it at you. Chances are really great your next labor won't be 2 days.

Personally, as part of the "back-up" plan for UC, it's a great idea to have a support person on-call and call if your intuition tells you too. Discuss ahead of time under what circumstances you will be calling. Discuss if you do call them, do you want physical (touch, massage) support or perhaps just verbal support, or perhaps just to pass cool rags and drinks only. Having a doula supported birth doesn't mean you failed at "medically unassisted childbirth." Having someone available in the doula role can keep your birth clinically hands-off if your labor becomes more difficult than you thought. You can even discuss ahead of time, if they should leave the room after a bit or leave the house if you regain your focus.

I would like to point out that the term "Unassisted Childbirth" is used very lightly and to mean a lot of different things. When I think of unassisted birth, I think of someone who has read, researched, found like-minded support during pregnancy, had no midwifery/obstetrical care during pregnancy and intended to have a totally hands off delivery. No pregnancy ultrasound. Knows their plan to handle (or ignore) GBS, meconium, bleeding, lacerations, etc… Relying on their partner for support.

Is that what others think UC birth means?

I have heard it used in so many other contexts:

  • Precipitous delivery before getting to the hospital (and possibly transferring to hospital)
  • Precipitous delivery before midwife arriving
  • prenatal care and staying home without ever intending to call the provider
  • midwife arriving just after the birth
  • medically unassisted, but with an active involved birth doula
  • medically unassisted, but with or without the partner

One recent woman in my practice planned an unassisted birth, but with "prenatal" visits to me. I've included two women in the book who had unassisted birth. One was a quick labor, unplanned(page 35). The other had left several OB groups who wouldn't agree to VBAC(page 79). By including these women it was one way to give balance to my statement "everyone needs a doula." Obviously I accepted and learned from both births (and encouraged it!). The first example actually had hired a doula, which arrived after the baby delivered. The latter tried to hire a doula. I don't know the details of how it fell through. I also helped support a unassisted home birth after cesarean, that ended up transporting and being a repeat C. Having a doula isn't a guarantee of anything. But this transfer occured on her own terms.

Since the book, I have several readers who have birthed unassisted. I am especially interested in comments and feedback on this topic.

Friday, January 9, 2009

The Score is in...

I've worried and studied for this family medicine board exam for what seems a year.

I've rearranged my life and priorities to make time to study. So many good projects and causes put on the back burner.

I've taken the test twice this year (with the first test's score dissapearing into cyberspace). To put it simply.

I couldn't sleep this week anticipating the score to be released on Dec, 9.

I've felt my heart beating out of my chest checking my portfolio on-line for results last night, this AM just to find the site down as they uploaded the scores.

I've questioned the importance of being Board Certified.

I seemed to have found my own niche and style anyway.

Much of the data is biased towards using and funded by pharmaceuticals and the test and review books reinforce the importance of surveillance and pharmaceuticals AND not how to help people make good lifestyle choices. Did studying for the boards make me a better doctor (no way!!!)? At least I don't see it.

I've questioned the consequences of not being board certified.

Many hospitals require board certification for admitting privileges. I choose not to have these special privileges.

To be on insurance plans, some insurance plans require board certification. It's not that I care about insurance plans needs, per say, but the majority of people won't go to a doctor out-of-network (despite complaining about the one they do see).

I couldn't think of any other consequences besides what it would do to my self esteem of setting a goal and not reaching it.

I've mentally prepared myself that my board certification might lapse. It expired Dec. 31. And what would I do-- give up or take the darn thing next July.

I put that I am board certified on my authors bio.

Why did I do that?

The most important reason for being board certified is that perhaps it may still give me some credibility within my profession. I am still one of them. I can still be of influence (hopefully) and not a stray.......
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I passed!!!!!! I'm certified until 2015.



IBCLC exam in 2010, but next Family Practice Board Exam is in 7-10 years.


Thursday, January 8, 2009

Taking Questions

(This post expired. I am not taking questions at the current time. I am still answering questions that have been asked. Remember to use the search feature above or check in my book.)

Many of you ask some really good questions. I'd like to give you an opportunity to ask questions about topics covered on this blog, but have left you hanging. Regular followers or lurkers, I'd like to hear from you. Leave your questions in the comments. I will probably answer them in a future post at the top of the blog. I'd like to know what you want to know more about. In depth questions may require more some time for answers.

There is tons of info on this blog already. Just for your information there is a search box at the top of my blog and all blogspot blogs to help you find what your looking for.

I will welcome all questions and I find that my writing is inspired by your comments, but please remember I can't do personal medical assessments and diagnosis over the blog. Thanks for understanding.

Tuesday, January 6, 2009

Moving

One thing I don't like about Florida is that it is so transient. It seems everyone is moving away. I actually left for 1 1/2 years but I came back (knew I would). It seems that almost everyday someone tells me they are moving. Realizing that you won't be seeing each other in person anymore has a finite quality. It makes you think about the positive influence they may have had on you. So many people are moving away that sometimes someone you don't even see often still leaves you with a bit of sadness when they tell you they are moving. People can touch you and inspire you in so many ways.

Please no one break the news to me that you are moving. I have heard enough and you're not allowed to move.

Monday, January 5, 2009

Too Cool

David thinks he is way too cool because he is wearing his brothers shirt and matching glasses. Look :) at his cute toes and serious face.

Here is some cute things David has been saying.

On serving himself from a full gallon container into a little papercup, "I am older enough to do it all by myself."

David loves washing dishes and spraying the entire kitchen. To keep some control I let him "help me." We were "washing" dishes side-by-side in our double sink, he realizes something, "Mom, this is like playing a two-player [remote control] game."

David on getting his height checked:

"When I stand on my feet, I am 4. But I'm six when I stand on my toes."
More on checking his height:
He is measuring himself with a six inch ruler moving it up his body. "David, what are you doing?" "Mom, I am measuring how old I am getting."
Now David on getting weighed:
"Let's see how told I am getting."
I'm not sure if "told" is his little prenounciation of "old" or if its a combination of "tall" and "old."

I am still wondering if I produce milk:
"David, you know there is medicine to make more milk."
"Are you sick." He asked me this about 10 times before I could ask the next question. The word "medicine" really stuck out to him.

I've thought about taking the medication to increase milk supply just for the experience of taking it and being familiar with it's effects. But I wonder if it would work too well (Like an unexpected choking hazzard!)and I'd ruin a good thing. "David do you like it the way it is or do you want more milk."

"I want TONS of milk."




Sunday, January 4, 2009

Green Smoothie Video

As much as I have talked about Green Smoothies, I realized I never actually put a direct link to the video that started it all for me on my blog. It's not that I forgot to post it, it used to be on the GSG homepage in my blogroll and I like keeping my posts all original content.




I started making green smoothies in my oster blender. Even before I started making smoothies I noticed the oster didn't have much power (I've replaced several even before I started smoothies.). I used the oster for smoothies daily from about April to September when I received my blendtec. Magic bullet type blenders make nice smoothies. With daily and consistent use and as much quantity that I make, I went for the horse power.

I have worked my way up to about 4 cups of smoothie a day. Some days I juice instead (or additionally). It depends on what fruits and greens are available and what my mood is. I haven't juiced much greens, mostly apples and carrots. On the days I am juicing mucho citrus, I make sure I eat a lot of salad to get the greens in.

This is such a different place than I was ate last year. I was struggling with (cane)sugar detox and still wasn't sure what to eat and totally confused about supplements. Learning about daily smoothies has made my breakfast decision easy. I always start my day with smoothies or juice.

On most days I do eat lots of greens and veggies, so I am not really making an extra effort to make a salad now on juicing days. It seems normal to me now to have something uncooked at (preferably before) every meal (fruit, salad, smoothie, juice, marinated veggies, sprouts, or dehydrated treats.)

I still don't use much cane. If I do use it in my house, it is sucanat and in modest quantities and I make careful choices when I am not home.

My husband doesn't think I enjoy my food. He thinks I've limited myself too much. That is far from the truth. I am enjoying my food far more than ever, especially more than I year ago. I love the fresh stuff. I love the variety. I love the herbs and seasonings. I don't take a single supplement pill. (I do take a monthly B12 shot). I enjoy my food now that I understand nutrition. I understand there is a big difference between being a good cook and eating nutritiously. I may never be a good cook, but it is not really a goal of mine. My goal would is to obtain and prepare food healthfully. For someone who doesn't know where to start green smoothies is the best single change.

Saturday, January 3, 2009

A Dream About My Blog Followers

Since I love my blog so much, I had a dream about my followers last Saturday night! My dream was that I woke up and overnight I had five new followers; up to 37. My dream basically came true! By the time I went to bed on Sunday I DID have 5 more followers, all in one day, after no "follower"activity for a few weeks. I am not sure why this dream was remembered in the morning. Maybe because I thought I was boring you with so many "food" posts, I may have been wondering if all of you left.

I appreciate those who come to the blog and visit. I like communicating via blogspot. I like being understood. Writing gives me a chance to compose my thoughts carefully. I like knowing who is enjoying my blog and so I appreciate my followers very much. I like the social interaction (I could not live in a Little House in the woods). Overall, I enjoy all the variety of feedback from my blog: the comments, my private e-mail from readers, the links back to me on your blogrolls, and the book reviews. I like to go back and look at your blogs also, especially if I didn't know you previously.

Thank you blog readers for your interest in my thoughts and ideas. Thanks for making my dream come true!

Friday, January 2, 2009

Four-year Yahrzeit of My Grandmother

A yahrzeit is the anniversary of one's death (using the Hebrew calender and a time for remembrance. This is the eulogy I wrote and presented at her funeral 4 years ago.


Grandma's Tribute

Adele Deutsch: A Mother to Us All

May, 10, 1925 December 19, 2004
Written and Presented By Denise Punger with David Stuart (in arms)
December 21, 2004

Respectfully, we the children, grandchildren, and great grandchildren, husband, family, and friends of our Mother, Adele Schlein Friedman Deutsch show honor to her on this sad day.

Doctors said she had a sickly heart her whole life. I say she had a strong heart for mothering. She made each one of us feel the most loved. It did not matter if you were her biologic or her step child. Her heart had enough love for us all. Anyone who knows her would know how much she loved each one of us.

As a child in West Babylon, I have fond memories of Grandma Adele: the cole-slaw and chicken Parmesan she made for me, playing with her in the above-ground-pool with cool rap-around-deck, showing us the forest trail behind her house that lead to her sisters house and the candy store, chasing fire flies together, and playing with the leaves that looked like "W's" for West Babylon and opening the nut pods off the oak trees and sticking them to our noses. The girl's bedroom upstairs was like a secret place for all of us girls to gather.

Through the years, I recall Grandma, sharing the details of her daughter's, Joanne, Jackie, and her son David's lives whom were across the country as if they were right there with us. She was a proud mother. I feel like I have celebrated with you your marriages, children, grandchildren, career advancements, and graduations, travels, honors and disappointments. She was always bragging about you.

My most recent adult memories of Grandma Adele include giving me encouragement in my non-Jewish world to make contact with a Rabbi for the first time in my life and honor my son David Stuart's birth right.

And another recent memory is my last visit with her that happened to be on David Stuart's first birthday. She seemed conscience of not having a toy as a gift for him on this day. As it turns out, I was telling her about my older boy's activities in Hebrew school at Temple Beth El Israel and she seemed pleased to hear of their involvement and thoughtfully pulled out a souvenir kippah from her son David's Bar Mitzvah in 1968 at Temple Beth Shalom and asked if we could use it. The name "David" is imprinted inside with date and location. I readily accepted this old and faded silk thing. There is no toy that could match the meaning of this gift; passing down our heritage. David and I will always have this as a loving memory of Grandma Adele as she encouraged me to go with our heart and encouraged my growth in Judaism. She welcomed my e-mail and articles on topics such as the influence Judaism has had on my own mothering style. She specifically complimented me on how well I could express my beliefs (and lack of beliefs). She reminded and comforted me that if I never did a religious thing in my life, I'd still be Jewish.

Ironically, little did I ever imagine that David and I would come up to the bimah and present a tribute to her life in another Temple called Beth Shalom with this ragged kippah and I would be struggling to find the words to tell all of you the significant role she played in my life. In her passing, she is still inspiring me as I reflect on my memories, what really matters, and my rights to observe Jewish mourning rituals in her memory.

May Grandma's loving ways teach us to be just as loving.

Grandma Adele, we all come together as One today, honoring you and ignoring our differences, we all pray for you today in unity. May our prayers lift your soul to the highest spiritual elevation. Please look down on us and protect us and all of our children. I want to continue to make you proud of me. I love you.

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