My archives might be a little outdated especially the older blogs.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 28, 2009

Mother's Day Give-Away

Permission to Mother makes a great Mother's Day Gift and I'd like to give a copy to someone who wants to give it as a gift. I will pick a winner based on your comment. Leave a comment on blogspot.

Very simply, I would like to know for who and why you would like to win a copy to gift to someone.

I will pick a winner Friday evening. I can mail an autographed copy to you or the winner in the USA.

Sunday, April 26, 2009

The Twilight Saga

Anticipating the teenage years of my handsome sons is a stressor.
I've been warned about the phone ringing and hours on myspace.
I've been warned about too much runescape, xbox, and World of War.

It use to be all you had to worry about was
birth control
and pregnancy.
Now there's STD's

and HIV.

Then there's tobacco

driving under the influence

and hurting someone while under the influence.

Now thanks to Twilight Saga
I'm aware of sneaky vampire girls.
But it's too late.

He's been bitten....
It's not what I had in mind for his future and our family.

Saturday, April 25, 2009

Can U find out.....?

This morning Scott completed Level 3 in his Barton Reading & Spelling Program, which is an Orton-Gillingham Influenced Simultaneously Multisensory Explicit and Systematic Phonics Program. I feel like I've conquered the world getting through this level together. Only seven more levels to go. I suppose by then he'll be reading the name of this curriculum.

We have worked nearly everyday. He has learned strategies to decode(read) and spell many one syllable words. Lessons included Blends. "Blend" is an example of a word with consonant blends at the beginning and end. When to use a double consonant at the end of the word like "kiss."
When to use "c" vs. "k" at the beginning of a word. When to use "ch" vs. "tch" at the end of a word. When to use "k" vs. "ck" at the end of a word. When the vowel makes a short sound and when it makes an unusual sound as in the units: all, ang, ing, ong, ung, ank, ink, onk, unk, oll, old, olt, ild, ind, and ost. He learned 36 sight words and how to form and break apart contractions. Whew! We've had our days... Contractions are challenging, but so are words that have an "n" following a short vowel.

The order of the teaching is much different than any other reading phonics programs and it so hard to find any outside reading for him. The style of the lessons take advantage of his strengths. For example, he builds the new words in three dimensions from tiles and he learns the why for every spelling rule. It is strongly encouraged that he does not read outside books at this point that are not vocabulary controlled, so it doesn't interfere with his progress by reverting to guessing and cover-ups.

He learned all this just in time. In one of his classes he intercepted a note a girl past to his friend. He could read the note!! Can U find out if he likes me? You'll have to get the rest of the details from Scott himself. The upcoming Bar Mitzvah he's attending should be "a lot" of fun.

Next up in Level 4 is reading words with more than one syllable and much more.

Oh, btw, do you like his new haircut?

Friday, April 24, 2009

Friday Updates

  • No closing yet.

  • I still have dandelion greens left. Juicing them with carrots and apples wasn't bad. I must leave the celery out of the juice and it does taste ok. John even likes it.

  • John cooked steak tonight. Scott didn't touch it because I planned a healthy dinner and John didn't clear his plans with me. Scott sticks up for my meals (most of the time). Scott's in the photo with a castle he made out of the Math-U-See manipulatives. He got his long hair cut off this week.

  • Scott has been listening to Harry Potter on CD. That gives me a break from reading out loud. Our library has the whole series on tape. He's up to The Goblet of Fire.

  • William is reading the Twilight Series. He is almost done with the 4th book. Now do I have to worry about him dating a teen age vampiress and choosing to become one himself.

  • I've got a few books of my own I'm flipping through. I'd really like to read them all cover-to-cover (and share more thoughts about them). Unconditional Parenting by Alfie Kohn, Square Foot Gardening by Mel Bartholomew, Making More Milk by Diana West IBCLC and Lisa Mascaro MA IBCLC.

  • On Sunday I am the designated "volunteer mother" at Temple during class hours. My main job is to bring drinks a 10am snack for 60 kids and then whatever else they need me for that morning. I got some honest kids juice pouches (No HFCS) and a case of bananas. Don't even ask me what parents usually bring; It's disgusting what parents bring for a Sunday morning snack. I'll probably be remembered.

  • David does not attend Sunday class and he is looking forward to being picked up by Mary for the morning. I told Mary she can take him to church. Ironic isn't it, that there is no accommodation for David at the Temple while I volunteer? So he's going to church instead? Before I rant too much, Mary is probably going to treat and spoil him, and not take him to church after all.

  • What's David reading? That's a good question. Is he going to be a natural reader? You'd think by 5 1/2 a natural reader would be showing some definite signs of naturally learning. Hmmm... I've been thinking about this and learning what to look for so he doesn't fall behind.
  • The boys have some celebrations to look forward to in May. Awards night at Temple. A Friend's Bar Mitzvah on another weekend; They are really looking forward to dressing up for this. I have to get them shirts and shoes. Finally they will have a belt test in karate at the end of the month.

Monday, April 20, 2009

How late is too late to re-lactate?

I have previously wrote an unfortunate post, an example of a mother who brought in her 2 month old for me to fix the latch and milk supply. I have seen a few of these types of dyads, since, where I know right from the start (often before I enter the exam room), I am wasting my time; I know the baby will never latch and I am doubtful the milk supply will increase. Sometimes I can even tell from attitudes and what is said via the phone, non-verbal clues, and what's written on the new patient forms. Some just want the correct information to see if it's possible. I try never to give up on anyone.

This past week, I saw a 2 month old who needed help latching and who's mother's supply had dwindled. Mostly he was being fed formula by bottle. While I couldn't promise a fully latching breastfed baby, I thought I could significantly help her milk supply by reinforcing positive attachment parenting skills, her nutrition, and herbal and prescription galactogogues. I thought her baby might latch when the milk supply increased.

So what's so different about this mother with a 2 month old and the previous mother?

For one thing the babies behaviors are different. In the optimistic situation, the baby is rooting and turning towards the breast and showing signs of being very frustrated at not being able to latch. The mother, likewise, was also frustrated that the baby wouldn't latch. In the other circumstance the baby had no clue what a breast was for and totally disinterested.

In the hopeful situation, the mother interactions with the baby was totally different and probably most likely accounted for the difference in the baby's behavior. Mom was responsive to the baby, she was emotionally sensitive to the time loss in breastfeeding and the birth plans that went awry. She took her shirt and bra off to feed. In other words, she was comfortable with skin-to-skin. She was mostly practicing attachment parenting all along and feeling the loss of not being able to provide for her baby. She didn't have an argument and a pity story in retort to my every suggestion. She came in open minded for information. She did not expect me to wave a magic wand. She expected to make the effort herself after receiving individualized guidance. I also really liked her interaction with the baby when I peeked in to the waiting room. I would have not guessed what her reasons for coming in were.

On to another point. A LLL Leader referred her to me. This mom had never been to a LLL meeting. The information LLL meetings provides about mothering through breastfeeding is so important, especially when breastfeeding is NOT working. I can provide medical guidance, but the mother-to-mother support comes from LLL. She had tentative, hesitant plans to attend her local meeting that I inquired about. I've been to enough LLL meetings to anticipate how awkward it would be to go in and bottle feed and didn't want this to deter her.

So I said, "I imagine it will be really hard to sit through a LLL meeting and feed your baby with a bottle."

She had also anticipated this and told me how she planned to excuse herself for the baby's nap, the bathroom or whatever when it came time to bottle feed.

I feel so strongly that mothers need the information provided at LLL and I feel they will glean so much just by observing the interactions between other mothers and babies that she needs to be upfront with why she is there and STAY. I prepared her for what to expect. There is always introductions first and she just needs to come right out and say that until her milk supply comes in she needs to feed her baby with supplements and a bottle. Honesty, I anticipated, should get the support she needs.

I can't pin-point an exact age where its too late to make the effort to breastfeed. I am always ready to give a mother with an open-mind the correct and individualized information, but there must be internal motivation.

Sunday, April 19, 2009

100% Raw Vegan Nutrition Today

I once decided if John and the boys went out of town without me, what I would. I've contemplated that I would take that opportunity to do a 100% Raw Vegan diet for at least one of those days.

Well, he spontaneously headed out with David and a buddy this morning and W & S were occupied for a few hours outside the house this morning. Without the constant responsibility of being a short order cook, I figured today was as good as any day to make this "Raw day." Not to mention, that before I realized it, Lori gave me her two shares worth of Dandelion Greens last Thursday. I've got a lot of greens that need to be used up.

When I juice (not the citrus juicer) I usually make it more fruity with apples and pears. The other day I made "plant blood" as Kristen calls it: bok chow, celery, apple... something like that. I drank 12 ounces of it. The taste was like a shot of wheat grass, only this was not just a shot. It was a lot.

Today I had this:

2 1/2 cups of plant blood with some of those dandelion* leaves, 2 apples, cucumber and celery. The taste was gagging.

4 cups of smoothie with strawberries, banana, dates, lacuma powder, lemon peel.

A BIG handful of organic raw sunflower seeds. (If I was calorie counting this would have blown it.)

Teriyaki Almonds (per GSG youtube recipe).

Cut up raw veggies, cucumber, carrots, daikon radish, yellow squash

Carob nibs. These are great for some Raw desserts, but it's another taste you have to get used too.

Marinated Asparagus on a large bed of Arugula. This was really good!


Freshly Squeezed orange juice.

I swam for 40 minutes this morning without kids, and Scott and I cycled a few miles this evening.

So how do I feel after a day without cooked food? A little hungry but "my blood feels Clean." My mind feels clear and sharp. My diet is fairly meticulous, but I can still feel a difference as far as being detoxified goes. None of this was really the kind of food you sit around and enjoy with friends and family. I idealize this kind of eating. But it doesn't really make it conducive to being around people at meal time in the long term.

I've got a Raw vibrant oatmeal** breakfast planned for the morning using my own sprouted almond milk. If I have time to make a smoothie I'll be good for the workday. Whether I want it or not, I have a ton of dandelion and I might as well do something with it tomorrow. I really didn't plan to do all this, but it looks like I'll be keeping my blood clean for a few more hours.

I am at a plateau as far as weightloss goes. I've plateaued for a year, so I'd like to do something that's healthy that gets me passed this. I am not always vegetarian (but very, very close) and have been trying many vegan and Raw recipes.

* The highlighted veggies are from our co-op.

**From A Celebration of Wellness by James Levin MD and Natalie Cederquist

Friday, April 17, 2009

A Wonderful Place to Raise Boys

I wrote about our house hunting experiences a few weeks ago. I think we've narrowed it down.
I've never had a backyard.
And now I will a little one. :)
(When we close.)These first two photos are from the listing.
William is pointing to one of many "baby" mangoes on this tree that are waiting for closing day to ripen. You can see he is as excited as I am to have a fruit tree on the property.

There is plenty of room to do our own stuff outside.

I love this bonus room. We looked at this house several years ago. This room was part of the huge garage. John and I both thought that part of the garage needed to be converted. At that time it didn't have a pool either. The sellers did a good job adding what we thought the house needed.

Now, I am standing in the bonus room and William is waving to me from the kitchen. This little window will ease my job as a short order cook. I can take requests while they are playing and just pass it through the window. Hmmm... I wonder if dirty dishes will get returned this way or if I'll have to come around to collect them.

Another part of the garage was converted into a bedroom

that will make a great school room.
This should be a great house for maturing boys
Appreciating the outdoors.

Saturday, April 11, 2009

Sharing our Seder

The boys really got a chance to show me how much they learned in Hebrew School. I wouldn't have been able to pull this Seder off without their help. I asked them what the most important thing about Passover was and their answer was the wine. When I asked them for a more significant meaning, I got various factual replies about freeing the Jews from slavery. The spiritual answer I was looking for is that Passover reminds us about freedom. We should not allow ourselves to be slaves to our fears and personal limitation.

So, what's on our Seder plate? You know about the parsley, Charoset, and horseradish. My cookbook suggested grapes and olives to replace the lamb shank with a scriptural reference. That red thing is an egg with silly putty in it. I just wanted something fun!


Charoset - From the Jewish Vegetarian Year Cookbook
Stuffed Kishke (knish) - From the Jewish Vegetarian Year Cookbook
Both of these were EASY. 4 out 5 in my house liked it. That's a good rating! Both make good left overs. It's the first time I made either and they both turned out well. I will be looking at the other recipes in this book.
Matzoh Ball Soup in Vegetable Broth.
Boiled Chicken - my husband and William insist, so I boiled it seperately and added it to theirs after.
Passover Kugel - from the Vegan Heart Doctor's Blog

This was plenty of food for us. We were very informal. I am usually to unorganized to do stuff like this. The Vegetarian Cookbook helped for my last minute planning (which began this morning) because The ingredients were things I mostly keep in the house. Made it easy!

Scott read the four questions in Hebrew. I can't even do that! He is so excited to be able to do that for us.
After they ate, they searched for the Afikomen. They searched high and low. David and Scott found it. The Seder doesn't end until the children find the hidden piece of matzo in return for a prize. The prize was Silly Puddy for each and some chocolate.

Last of all is a photo of the knish. Photographing food I prepare really isn't my thing, but I thought this recipe came out really cool. I hope you enjoyed learning about Passover through our eyes.

Friday, April 10, 2009

Produce Pick-up Day

One of the things I like about being in the produce co-op is the camaraderie and exchange of ideas. When we pick up our produce sometimes I hang out and socialize. Its the few rare minutes every other week I get to just relax and chat. Lately it seems I don't have time to linger or relax at all. I am between running the boys to drum lessons and karate. I want to... I have to... finish the boy's (especially Scott's tedious tutoring) lesson plans for the day before I head out to pick up my stuff. Of course I am eager to get home and make a meal out of all the new goodies. I wish I could hang out all day.....

Gerrie gets the photo credit and this photo links to our yahoogroup where we exchange more ideas. Our produce shares are in bags around the room and we get to individualize our share by picking about 5 items on the shelf and window or trading for something we can't use. Isn't Gerrie's daughter adorable?

We got:
green beans- 1) chop and add to salads 2) side dish
collards- all be going into smoothies
carrots- 1) salads 2) split pea soup 3) munching
green leaf lettuce - I got tons of lettuce and eating a large salad daily
russet potatoes - good for baking.
zucchini - Some version of these crisps
grape tomatoes - salads
red jumbo onions - salads and lots of other things
fresh mint - 1) this raw mint dessert 2) and a version of this Fattoush Salad 3) Add mint(press with spoon to release juices), lemon and lime to ice water for a refreshing drink
eggplant - My husband love this-- I thinly sliced the eggplant. Seasoned with EVOO, s &p, sauteed lightly. Then I put it in the oven with a layer of tomato sliced, mozzarella and fresh basil until cheese melted
red peppers- I don't care much for these. I did eagerly make Kristen's Hemp Dressing and I chopped the rest up adding a piece or two to salads. Hmmm, still not that crazy aout them.
blood oranges - these juice and mix well with the juiced grapefruits for a colorful and refreshing treat.
ruby grapefruit
bananas - snacks and smoothies
braeburn apple - snacks and smoothies

Fruit Share: strawberries, temple oranges and golden pineapple (snacks and smoothies).

Sunday, April 5, 2009

Horse Day

Lauren invited us to ride her pony today. The boys really liked being up there.
I rode, too. They got to groom the pony and round him up, but they liked riding better.
Scott helped saddle him up and put on the bridle. We all appreciate Lauren's
hospitality and generosity.

Saturday, April 4, 2009

Tentative Bar Mitzvah Plans??

Another, long winded post by me. It assumes that you've been following my blog closely. :) It also assumes you like reading my tedious thoughts.

Tonight was an interesting night at Temple. William's class was responsible for leading the Service. William had a couple of solos at the Bima where he read English and Hebrew. He has come along way from when I first brought him to this temple when he was 7 and only a pre-reader who couldn't sit still. The ladies in the congregation including the rising prez, came up to me to tell me how beautiful his reading is. They all want to know if I will give him a Bar Mitzvah.

In the meantime I am sitting with Scott and David who were quiet. I am thinking, after 5 years of attendance can all this be coming together?

Then all of a sudden David is all done. He got up and yelled like an obnoxious animal. I am totally embarrassed. I pretty much have my fist down his throat to get him outside without another verbal outburst. He gets even louder outside. The prez comes out to check on us. David called her a not-so-very-nice name. She misunderstood and replies, "I am not Ethel, I am S." Not knowing she's hard-of-hearing, I thought she handled him well. He called her that not-so-nice-name again. She heard him correctly this time and asked me if he has tourettes. Sigh. I have never had a proud mother moment at this Temple. I called John to see if he can pick up David. I go back in feeling humiliated. (I am feeling like a coward and I am definitely not feeling like Permission to Mother.)

William and Scott both made friends this year. Both friends were there tonight. We accomplished making arrangements for both boy's friends to come over.

It seems that everyone is curious about my plans for Bar Mitzvah for William. They wouldn't let it go. William did so well, I could tell they would be disappointed if I didn't follow through with all the time invested into his education.

Confession time. My plans seem to be leaning towards having a a private Cantor give my older boys private lessons this upcoming school year and have a double ceremony outside the Temple. Practically speaking, I don't have the time to be at the Temple 5 times a week for 6 months and then do it in a year and a half all over for Scott. I am so stressed out now about getting them there two times a week, sometimes three. When the Cantor told me that she could get both boys ready and have a combined ceremony, it was a major relief to me that there is a feasible way for me to do this.

Back to the curiosity about William's Bar Mitzvah ceremony. I decide to do some comparison shopping :). I asked the prez-to-be, if they ever have a double BM? Yes, she says.

Since William is ready now, I'd rather have Scott go early next year rather than William wait two years. I ask do they ever give a BM at 12 (the age Scott will be next summer)? She said, it happens all the time, but not at this Temple. The Rabbi won't do that. I decided just to fess up then and tell her (and William's friend's mother, who happen to nominate herself for the Board last week) that it is a concern of mine about how I would manage the boys BM training, but with my busy schedule, I don't think I can manage the Temple's Bar Mitzvah training schedule. Then on top of the training schedule, to be stressed out if David can't sit still or who can stay home and watch him. I told them I don't like dividing my kids up leaving David at home. Shabbat is suppose to be about families not division, especially family Shabbat. The prez actually volunteered to bring William to his Rabbi classes so he wouldn't miss out! I am really appreciative that both new Board members were glad to see that I had looked into plans to follow through that would work for me. They probably assumed all along, I wouldn't have any BM for the boys. They see how presured I am all the time. They are probably relieved I am pursuing something.

I am grateful for for the education William and Scott have received at the Temple and I don't take lightly my choice to pull them out of Hebrew School next year. I just don't see how I can fulfill the BM requirements at the Temple, especially now all the extra time I am putting into Scott's very, very, very, very explicit reading program. I want to continue to keep my nutrition a priority and I can't do that if I am in the Temple every night (and its not helpful that they serve terribly unhealthy food). I also keep trying to up my fitness and there always is something bigger and bigger in the way. Oh, yeah, John's house hunting, too. That's demanding.

Private Bar Mitzvah training offers so many possibilities. Besides the boys lessons being time-efficient. They can have their lessons during the day when I am at work. My evenings and every weekends would not be tied down. I will only have one "teacher," the Cantor, to check in with. Right now they have two teachers each, subs, and a principal and VP, I report to. The Cantor finds my sons very interesting. She does not have any teaching disabilities! She says deep thinkers are a joy to work with. Imagine what it would do to Scott's confidence to be a Bar Mitzvah a year ahead! I just love the idea that he'd be ahead in one subject and trained by someone who lets deep thinkers explore. No more word search puzzles. No more down time for him in a classroom. Actually, by the time he became a Bar Mitzvah, he'd be caught up in all his subjects including reading and he'd can move on to bigger things! He's even going to be a Black Belt in that season also.

The time frame of the Cantor's training gives me a little longer break over the summer than the Temple's schedule. I would actually be able to get Scott much further along scholastically with an early Winter Start up in Hebrew as opposed to a Early Fall start-up competing for his academic time. These upcoming months in Scott's reading schedule is very critical to his long term success.

I often don't enjoy myself at the Temple because I am so caught up in getting W & S to their activities and figuring what to do with David, I never get anything out of it myself. I actually don't enjoy the kids services as much as I do the regular service. Maybe I'd have a chance to enjoy the services that I want to attend if I am not having mandatory school attendance requirements.

After talking to these two Board Members tonight, I actually feel better with the self-realization knowing that my time constraint problems are not necessarily the Hebrew Schools internal issues and I should do what works for me. I have a tentative Double Bar Mitzvah date in mind. I will make a final decision after we attend William's friend's Bar Mitzvah Service early May. Our plans will mean more to the boys after they actually attend a fun Bar Mitzvah.

Wednesday, April 1, 2009

House Hunting

We've been looking and looking to purchase a family house for us to live in. Mostly it's my husband's job to look because I don't enjoy looking, negotiating, decorating and most of the processes involved. Not too mention, looking takes away time from all the other important things I need and want to get done.

I am so tired of hearing how now is a time to buy.

It might be if you are looking for a first time home and you like fixing things up. It doesn't seem to be for us.

Some of our personal barriers include:

We have been settled into a routine: getting to office, dropping boys off at activities and other errands. I am wanting to stay close enough so we don't have to disrupt our routine too much.

Houses around here tend to be showcase homes designed for seasonal and retirement living. The most common number of bedrooms to find around here is three and I'd like a house with more spare rooms. The layouts of most houses are awkward and not practical for a family. Showcase houses don't seem right to put my family in. We are hard on a house.

People tell us we need "bedrooms" for boys. We have looked at houses that do have bedrooms but have teeny-tiny driveways. I am thinking, we might get enough bedrooms for the growing boys, but in three years will there be room for their cars? Some neighborhoods, like the one we are in, you can't use the street for parking.

The deed restrictions have advantages both ways. The restrictions may keep things looking nice. One of the biggest things I think about now is the trend towards more composting, square-foot gardening, and having a few citrus trees. Many neighborhoods around here don't allow any of that. With resales being so low and the economy so bad, I am thinking that this restriction should be lifted by homeowners associations to increase interest in the neighborhood. I've never had much luck in the way of gardening (except for some simple herbs)but I have held back a bit from pursuing particular houses because I don't want to permanently limit the option. I am certainly not the only one who doesn't want to be restricted permanently. After a year of composting, I don't want to chance that I can't expand on outdoor living.

I miss having a pool. Being in a pool is good evening quality time activity for my family. I am frustrated our neighborhood doesn't allow evening swimming. I might be more motivated to stay if this need was satisfied. Many a busy day, I can't seem to relax til late evening. How I miss that relaxation time, especiallyin the hot summer. What I like most about the neighborhood I am in is that I feel safe walking and bike riding, even late at night.

My husband has been looking at country club house where many of the doctors live--nice big houses and it's possible to have a descent yard and walk at night. Ug. It is much further West and would not be very convenient to my current routine. In our own neighborhood, the big homes tend to still be three bedroom and not offering a whole lot of reason to move out of the one we are in. We've looked at acreage and not found what would be suitable. We've looked on the water. We have looked at building. I am sure we would kill each other if we had to build from scratch.

We have a very comfortable roof over our heads. I am not complaining at all about that. I am very grateful for the house I've been in and the simplicity as I chose to start up a new practice and not have to worry about much yard and maintenance. If we were moving from out of town we'd just have to pick. With a comfortable roof it adds an element of holding out for a good investment.

There is so little inventory and subsequently not much on deals. My husband has made verbal offers and written contracts. One day I'll be surprised when just the right thing comes through!

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