My archives might be a little outdated especially the older blogs.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

Saturday, February 28, 2009

Thanks Allana!

Thanks for posting some awesome, original, and honest thoughts over at amazon!

Ideas for my Organic Produce

This is what I am doing or thinking about doing with my Organic produce from this week. I didn't make this last last time when I picked up the produce and I realize how helpful the list is to me to plan and organize and make sure nothing goes to waste.

We got:
broccoli - sauted to mix with quinoa, raw on salad

red leaf lettuce - salad

eggplant -I'd really like to try to bread and fry them to go with the tomatoes. That would be a nice treat. I'd like this mozzarella to go with it. Or maybe I can make these Meatless meatballs. More eggplant info here. Looks like I need more than my share of eggplant....

dandelion greens - these might be full of good nutrition, but the only way I can think to get them down is small amounts in a green smoothie with lots of ripe bananas and strawberries(which I pick at deckerfarms).

curly parsley - I can't use all that we got immediately, so I trimmed the stems and am drying them. I'll toss a little into my meals. If I make the eggplant, I can mix some parsley in with the bread crumb seasoning.

colossal garlic - many things!

carrots - juiced, soup, raw and salads

russet potato- these were great baked. I have potatoes from my last special order and made this No fuss potato soup.

roma tomato- salads, marinated with cucumber

tangelo- juiced

lemon- this is my recipe for lemonade for the boys. I love that they will drink freshly squeezed lemonade or limeade-- no sugar, no additives. In fact they are so used to freshly squeezed, they are starting to notice how store bought is not so tasty. For myself, I prefer a slice of lemon in the water.

granny smith apple- made this raw apple crisp. I reduced the amount of the nuts (since I didn't have enough cashews and replaced it with oat groats.) I like getting in the raw oatmeal.

banana- I made banana bread. All my boys like this.

cucumber- salads

red pepper- John and Scott will eat this in small amounts on salads. Not me. Maybe I'll make this stuff pepper recipe for the boys. Don't tell them its vegan.

Fruit Share:
blueberry -snacks, garnished the boys french toast.
golden pineapple- I have a pineapple slicer. I like to cut it up a chill and eat it as a snack or toss a piece in my smoothie.
honey tangerine -juiced. I am so glad to be able to offer my kids a variety of fresh juice.

apples- I split a case with Lori to snack on and juice.

Thursday, February 26, 2009

Competition for Zac Efron...

Tuesday, February 24, 2009

Black Stripes and Blue Belt Promotion Exam

(My boys are sitting at the left together. )

Monday, February 23, 2009

3D Thinking, Concluding the "D" Word

I explained to Scott that he is a 3 Dimensional thinker. So the first question he asks is why everyone else can only think in 2 dimensions.

Here are some of the things that cinched my conclusion.

First I had to listen to a three hour intense lecture by Susan Barton to be convinced. She went into greater detail about classic warning signs. Much greater than the detail I found summarized elsewhere.

She started with these three facts.

1) Family history is very important. We have family history. I knew my biologic father could not read, but we had always thought it was because he was the oldest of ten and had to go to work at a very early age and never had an opportunity. After a reunion with his sister after all these years this summer, she told me he had dyslexia (just didn't know back then what it was). This sparked my curiosity just a little bit...

2. Dyslexia is very common. 1 in 5 have it. Some may be very mild and may go unrecognized. She said dyslexia is so common that if you suspect dyslexia it probably is. She described the symptoms of mild dyslexia.

3. Dyslexics don't learn foreign languages. (Hmm... what about the Hebrew?)

She went on to list a bunch of criteria for dyslexia and said if you have three of these, you have dyslexia. Family history was the first match. Can't spell is the second. Dysgraphia (bad handwriting) is the third. He is the son of two physicians?? Give us some slack here. But what made the poor handwriting believable now is the specific detail in which she described it. Their thumb crosses the mid line of the pen; the pen is controlled with gross motor skills not fine motor and thus they can't keep the letters on a straight line. Sounds like Scott.

Then she went on to describe the "dimensional" qualities. Dyslexics have to have a reason for everything to understand it. This is the reason they ask a lot of questions. "Seeing it, touching it" and "asking why" are three dimensional quality. Examples of second degree learning is rote memorization like the alphabet, phone numbers and addresses, paper and pencil, days of the week and month, spelling of last name, multiplication tables, knowing right from left (and not having a dominant side), and remembering the sequence to tie their shoes (or their karate uniform!). This made sense to me why Scott is so bright in some areas and why he can't ever remember the things that seem so simple to my 2 dimensional brain.

Now for the d-b confusion. I've never noticed that. I have noticed other confusions and the fact that she pinned all of them in her lecture really sealed this.

leaving off the suffix

The reason they confuse the words, I learned is that they do see them correctly, but the can't sound them out (called phonemic awareness, dyslexics lack the instinct to learn this like other native English speakers without very specific instruction) and they just memorize shapes of words and look for the context. They can fool us up to about a second grade level, if that much.


I learned that when they make a mistake like trip for journey they usually aren't even looking at the page. It's too much work for them. BINGO, that is Scott--looking around the room as he is "reading." He's just trying to catch the context. And I thought he wasn't paying attention.

On the other hand, if I am reading to him and he doesn't know a word. He would stop me and ask me for a meaning of a word. He has done this as long as I can remember even as a preschooler. He has a huge vocabulary. If my reading gets sloppy, he can tell me to re-read or speak more clearly.

Now the fact that the Hebrew teacher says he is doing well in her class held me back me from thinking he's a 3D learner because learning a foreign language is 2D. Scott carefully sounds out his Hebrew words. I have observed this and his teacher independently concluded that he has this ability to sound out the words that the other students lack (sounds like he understands Hebrew Phonemes!). I want to think about this more now that I've listened to all the dyslexia video and see if I can figure out what skill Scott has pulled off.

I noticed in Karate tonight when he was fighting, the instructor kept encouraging him to use his right hand to punch. Scott was thinking about this. My 2D brain always just thought that's how coach got them to vary their kicks and punches. But I got it now! Coach noticed some right/left confusion and when I asked coach about this after class, coach told me his son, a a 3rd degree blackbelt (who is also the other coach for this class has dyslexia). That didn't surprise me seeing how talented this young man is in teaching karate to the children.

Where to go from here? Scott is going to learn to read in 3D. For a while we will give up the pencil and two dimensional paper and the alphabet. Using the BartonReading program we are going to use colored tiles, emphasize body language especially enunciation, and our ears to discriminate sound and syllables (this will be torture for a 2D mother). ScienceGeek has posted about this program on her blog. She has been very resourceful to me. I appreciate all the other notes and suggestions and will check them out.

Despite Scott having a huge vocabulary, "dyslexia" is not in his vocabulary right now, but his gift of "3 Dimensional thinking" is how he understands his reading differences. He is darn excited about learning all the whys and the quirks of English and Spelling and not having to memorize it anymore. He doesn't understand why the rest of us just keep on memorizing English the hard way.

When you get a 3D thinker past their reading difficulties they have some amazing potential. Remember Scott wants to be an inventor? Einstein and Edison were 3 D thinkers.

The "D" Word continued...

We are a reading and writing family. We have a library of books. We go to the library. We have many reading and alphabet curricula, toys, and manipulative's around our house. Reading English may be hard to learn if your not native and exposed to it. But I don't think reading is that hard for the average person who is emerged in reading.

I am one to believe that children learn at their own pace. We all have strengths. We are all challenged in some areas. "Screening tests" for dyslexia are very vague. I am finding that between my beliefs about the pace of education and vague clues of dyslexia screening (and lack of readily available correct information) it makes it hard to sort out where true concern should begin.

I am learning that with dyslexia the older child in a family is often delayed in diagnosis because there is no sibling for comparison. Scott's the second. He is ten now. Let me lay out the foundation for "the" comparison in my house.

William learned to read with a tutor (2-3 x/week for 4 moths) when he was eight years old. I found it very difficult to teach him to read. William's handwriting is still a mess. (I'll talk more about this in an upcoming post.) Once he learned to read, he otherwise took off. He reads a lot of the kinds of things I won't read: scary, war, games, violence, and emerging adolescent. He enjoys writing as long as it's on a keyboard. I've noticed he is detailed oriented when he reads like his father who likes to read contracts.

Scott not reading or writing early came as no surprise. So what finally is making me super suspicious? I'll save that for later this week...

Saturday, February 21, 2009

The "D" Word

When I read to Scott he is so curious, he asks 3 questions for every sentence I read to him. It makes for good discussion and language arts. Sometimes I can't answer his profound questions. He has so much insight and wants to know why? why? why? for everything. For example, some great insight is with the Little House books, he asks, "This story can't be all true because she was 8 years old. How does she remember it all when she wrote it later?" I have to explain that either Ma or Pa kept a journal (or letters), or they spent a lot of time telling stories over and over (because there was no xbox) and she remembered."

Scott wants to be an inventor some day. He wants to invent new electronic games. He says I wouldn't understand them. He wants to keep a journal of his ideas because he says, "By the time he finishes high school and algebra 4, he wants to remember the ideas he has now."

Scott is really good at strategy games like mancala and othello.

He is really good with his building sets. Not only does he like to build , he likes to combine pieces to three or more game boards and/or sets to come up with a new 3-dimensional "map" as he calls it. He is very creative. One of my favorites is when he took all the action guys that were as good as new and put them on one side of the fort that he made and than took all the guys with broken arms and missing heads and made a fort for these guys. He called his scene the battle of the good guys vs. mutants(great name for the broken figures).

Scott is sensitive (and emotional) and caring. We aren't an athletic family, but Scott is the first to pick-up healy's, the only one who can hoola hoop. He is flexible and quick in Karate, swimming, and cycling. Always, very agile and able on the playground equipment.

Once again, I asked the Hebrew teacher how Scott is doing. (This is not the "Sunday school teacher.") The Hebrew school teacher said Scott read his Hebrew to the Rabbi this past class and did very well. She says Scott has an ability that the other kids in his class don't have and that is to carefully sound out the words syllable-by-syllable. His teacher says the other kids just memorize.

Scott is well-rounded in that he enjoys stories and movies in many genre. He understands and appreciates them. He is fun to discuss stories and ideas with.

Soooo, it blows me away, it has puzzled me that I can't get him to read English or write on paper.
This past year and a half, I would type into my search engine, "Is it dyslexia?" Any short quizzes and summaries that popped up didn't seal it for me. I've never noticed the d-b confusion everybody thinks dyslexia is. This past week, I've invested a great deal of time digging into the websites beyond the superficial summaries that show up first for a dyslexia search and listening to videos, which provided me with much more useful information. Absorbing all this information (and filtering out the myths) is overwhelming yet productive.

One thing I have learned is that all of Scott's strengths are right brained: curiosity, insight, sensitivity, athletics, 3D creativity. Right brain gifts may be characteristic of dyslexia and the fact that he is so smart in some areas make it even more consistent for dyslexia to be the suspected diagnosis.

The good news is that I found out about reading strategies that will help him. Instead of memorization of letters and sounds, the style of learning will appeal to his 3D thinking and answer all the "why" questions he has about our language that I have not been able to answer for him.

To be continued....

Sunday, February 15, 2009

Breastfeeding with Comfort and Joy (a book review)

A brand new photographic breastfeeding guide has caught my attention.

If you are (or will be) nursing a baby or you are in the position to help a mother nurse a baby, and you have any qualms at all about how to recognize good position and latch, Breastfeeding with Comfort and Joy is for you.

There are already quite a few how-to manuals (with drawings) and videos (which did not solidify it for me, despite my preconception of a video being the gold-standard for this purpose) out there.

Family Nurse Practitioner, photographer, and mother of four, Laura Keegan has done an incredible job combining (mostly) her own professional quality photography with descriptive text to describe how to attain the perfect latch.

The photos are amazing. They tastefully convey the tender intimacy of the breastfeeding relationship while instructively showing the steps to obtain proper position and latch. The photos capture very specific moments in time, for example, all the details of the mother's posture, the baby's position, direction of the nipple in relation to baby's mouth, up close latch photos, and more. There are lots of happy satiated babies (from a few days to a few weeks old) shown after a feed near the breast and all the mothers are breastfeeding with comfort and joy. I noticed the photos of dyads breastfeeding with comfort and joy that didn't necessarily "pair" with the text about clinical concerns, but I liked that because as I read about a clinical problem, the photo reminded me of the emotional rewards of why it's worth it to hang in there.

The photos bring back lots of memories. My favorite is the content twins falling off the breast after a feed on page 113. It reminds me of my early days tandem nursing William and Scott. How I tried to capture that moment of contentment of both boys on film and never was successful at getting that recorded. Laura Keegan is an incredible photographer. These photos are technically correct and printed on high quality pages which emphasize every single positive element in the photographs. It won't take you long to read, but the photos will draw you back in for more information.

Beyond the photos and latch instruction, Laura anticipates common concerns and special situations the new mother may face. Laura and I both agree on one important fact--despite obstacles getting in the way of breastfeeding, the mother's desire and the correct technique is most important. Breastfeeding can be successful despite unfortunate (and sometimes necessary) early interventions and this is why I recommend this book.

If you are a mom or you are a helper and have doubts about your ability with latching skills, you need this book. If you are like me--confident in knowing a good latch by intuition--this book defines each step with words creating an organized approached.

Although many babies have the ability to nurse and extract milk in any position, the step-by-step approached becomes critical when you have a compromised baby such as twins or NICU grads or for some other reason won't latch correctly. Several success stories are included in the book and some can be found here.

Breastfeeding with Comfort and Joy is a self-published book. The best place to order a copy is at . I look forward to hearing back from you if you benefited from it as much as I did.

For my local readers the LLL of the Treasure Coast has this book in the lending library.

If you are near Dutchess County, New York (about an hour and a half south of Albany, 1 hour North of NYC), and need breastfeeding help or integrative family care, Laura Keegan, RN, FNP is the one to see.

Thursday, February 12, 2009

Teaching Disabilities

Scott came home from Sunday school and explained what the teacher said, "Just because you have learning disabilities, you still have to do your crossword puzzle."

I told Scott to sit down next to me and tell me everything. He vented all his feelings. Then I suggested that we look at this in different ways.

First, "Is this the teacher that had problems with William last year just because he was homeschooled? Is it the one who often said he needed practice with the scissors, he's a lefty, and the teacher never provided the correct pair for him?"


Second, I clarified, "This is the teacher who wants all the students to take a turn reading passages from the lesson and she skips you?"


I showed him a book Lauren lent me called, The Fluent Reader. On the first page it says that "Round Robin Reading which is often used in the classroom is very detrimental to students." The book's purpose is to bring out the reading potential in your student. It describes damaging habits commonly found in the classroom. It suggests exercises to enhance reading lessons and when round robin might be beneficial. Scott easily understood the teacher had some bad teaching habits.

Next, I said, "Each week she gives the students a crossword puzzle on the lesson's theme. The girls tend to enjoy the puzzle and complete them week after week. The girls have "mastered" the skills needed to do crossword puzzles and they are no longer challenged. The boys, overall, are restless and want something else to do, (and some still need help with the fine motor and thinking skills for crossword puzzles). The boy's time is wasted. They are not learning. Week after week no new skills are learned--boys or girls. Additionally, for the teacher to tell you, you have to do the puzzles without offering any specific help is a bit ridiculous. It's very similar to telling William to improve on his scissor skills without giving him the correct tool to cut." Scott sees this point too.

"Now," I explain to Scott, "What if she asked you instead to make a model of WWII weapons or maps and you explain it all to the class instead of doing the Holocaust crossword puzzle, you'd be excellent at it. I don't even know that stuff. Another student can put the puzzle on the overhead projector and lead the class in how she approaches the puzzle. Wouldn't that be a better way to get everyone interested and learning again."


We decided everyone in the class has strengths and weaknesses and a good teacher would know how to bring the best out in everyone. That is when we decided the teacher has teaching disabilities. Scott clearly understands every student has potential and it's his teacher that's disabled.

"I am Scott C. and I approve this message."

Sick Week

I stayed home from the office Monday AND TUESDAY. I actually got showered and dressed on Tuesday fully planning to go in and than realized the shower and food didn't make me feel better and I went back to sleep for all day. I slept most of the 2 days. I hardly ever get sick (and am well-suited for my type of job because I have good immunity). This bug I have now kind of comes and goes. I am still feeling weak. My left eye burns on and off, my sinus' burn on and off. I am sleeping a lot and not feeling rested. When I wake up in the middle of the night, my head and throat hurt.

I didn't really feel like I'd be very coherent in the past few days if I wrote anything so I refrained.

I felt ok enough to do some lessons with the boys this morning, so now I am going to check out some e-mails and blogs now. :) See what I've left hanging...

Monday, February 9, 2009

First Sick Day

I can't remember when I had to call out sick in the past 10 years. I usually work through anything. Usually I am not this weak and achy. I went to Orlando to do my presentation despite this bug. I took two tylenol and my adreneline must have helped me get through it. I feel good about how the talk went. Once I got home, I was chattering and aching and ready for bed. That's where I stayed mostly for the past 2 days. My bed is calling now. Hopefully a good nights sleep will get me back to high functioning tomorrow. :)

Friday, February 6, 2009

Super Tramp's Viewpoint

Hey Super Tramp,
I responded to your 3 star viewpoint on amazon. I wish you sucess in mothering.

Here is my reply... (scroll down a bit)

Wednesday, February 4, 2009

Orlando Breastfeeding Presentation

-Remember this presentation is this Saturday

When Breastfeeding Seems Impossible

I will present several success stories (ei, women I am really proud of).

At the next Meeting of the Florida Lactation Consultant Association

February 7th at Business meeting at 10:00 PM, lunch at 12, my presentation and discussion at 1:00

Where? Orlando Regional Education Center, details and map

This is 2 hour CERPs awarded.

FLCA meetings are well attended (~40 IBCLC's and counselors ) from around the state and the meetings are always interesting. New attendees are aways welcome.

If you would like to read the current FLCA newsletter I'd be glad to email it to you. Just let me know.

I promise I won't be as nervous as my last talk ; ) . I am looking forward to sharing with the IBCLC's and others exactly what I can do!

Oh, and thanks to my mom for being my assistant at this talk: helping me set up and whatever I might need!

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