My archives might be a little outdated especially the older blogs.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

Monday, November 30, 2009

Thanksgiving Weekend

My holiday weekend was productive and restful with my family.
We started by going to my mother's house for Thanksgiving. We always get a good meal there. It's a lot easier to drive to Orlando than to make dinner. :)
I didn't get stuck with too much cleaning either because I took Scott to my Grandmother's assisted living with the Max during clean up.

My grandmother hasn't been able to ambulate (walk a round) since she has broke her hip over a year ago. She is only up for quick short visits in between the card games she enjoys. She's 94!

Scott wants to get Max certified as a therapy dog which means he can (officially) bring him to nursing homes, classrooms and other places that request this service.

Scott got a prerequisite out of the way for therapy dog certification this weekend. Max was evaluated For the AKC's award, Good Canine Citizen this weekend and passed. To pass Max had to walk on a loose lead, sit, lay, stay, be handled by strangers and stay with the evaluator without Scott for a few minutes. She also pushed some carts by Max to see how he responded. Scott is Max's handler. He's go the knack! I am just the driver.

My mother also started a 4x6 square foot garden. I am hoping to do the same. I've been taking a bunch of notes on how to begin. She also helped me pick out paint colors for my new house. One day I WILL LIVE THERE! Seems like that time will never come!
The boys went to Dekker farms. We picked strawberries. The boys enjoyed the new goats there. And they like Laurens farm and horses and dog also. She's got a garden going, too. Everyone is making a vegetable garden look real easy....
My boys also had a karate promotion exam this past week. William and Scott will test for Black Belts in February. Dates to be announced (either the 13th or 20th). They have had over three years of training in this class, but also had a year and a half in Georgia in TKD.
We've accomplished alot this weekend. It was nice to not be on such a tight weekday schedule!

Saturday, November 28, 2009

Vampires vs. Werewolves

I promised my kids last weekend if they could hold out on opening weekend, I'd go see New Moon with them this weekend. On the way in to the theatre the kids were playing and asking me if I was on the vampires team or the werewolves team. (I'm now such a dog person, I picked werewolves.) I was also trying to remember the last time I went to a movie theatre.... I couldn't remember being in a theatre since being back in Florida.... the last movie I could remember was Cold Mountain while I lived in Georgia. I had 2 month old David nursing through the show, and I remember bawling when the baby was exposed and abandoned in the cold night. I did go to private showings of Business of Being Born and Orgasmic Birth since than.

So, my kids thought it was really special that I went to the movie with them! John takes them all the time. I don't care for the loud speakers, the junk food, and I especially hate being packed in like sardines in a theatre. The theatre fortunately wasn't packed. And the rows were pleasantly elevated. Also, I often don't "get" movies. There is usually way to much drama for me.

William read all four books in the sequence. Scott listened to the audio version and I enjoyed listening to most of series with him as my time allowed. Enough to get the drift. David has the Twilight DVD. I don't get to sit through movies much at home either. I only caught little bits and pieces of it. Am I the only one who hasn't watched Twilight (but listened to the audio)?

So what did I think of the movie? I liked the werewolves. Jake's facial features and coloring are similar to the Peruvian features of John and his brothers and cousins and even William, in my opinion. Yep, I like the werewolves. That's my favorite part. Blush. I liked and even laughed at the dog jokes.

If I had not "read" the book, I don't think I would of understood the movie. I don't think like "Hollywood." Listening to the audio I thought how powerful the prologue was that Bella dreamed she was her grandmother. I would have never realized that was her if I only watched the movie? So right from the start I found myself recalling the book rather than watching the movie. I thought the movie story, moved a little slow, but each scene was quick and bounced around and if I didn't know the story I would have not kept up. I talk with my boys a lot about movies vs. book. I enjoy getting to have those discussions.

I am glad I listened to the audio. I actually thought it was a great story for both my boys to read. I thought the character, plot, and dialogue were very descriptive and imaginative. Like William told me then, "You know everything she is thinking." I like how the books described facial expressions and body language and the meaning of eye color and how it relates to mood and plot. I missed that in the movie. Hollywood mostly concentrated on lips flirting and brushing up with one another. :)
There is good lessons in the book about mortality, aging, and value of life. This series is excellent teen reading, especially because teens think they are invincible. I like how much detail the book gave to the history and background of the vampires and wolves. I like how the Cullens were human friendly and wolves persued evil vampires. Nice balance.

Our movie audience was interactive. For example, they "whewed" and "whistled" when Jacob took off his shirt. (For the record and unfortunately my Peruvians don't share his ripped physique.) The audience "awed" when Edward gave Bella the condition in which he would change her. William goes to a lot of movies and never sat in an interactive audience. He was very impressed. (He obviously hasn't gone to see Rocky Horror in the theatre!)

When I told John that I thought his brothers look like the werewolves, he tried teasing me and telling me they were part wolves.

And one more kind of related story. John ran in to my first obstetrician a few days ago. My birth was traumatic, but he was a good guy. John announced at dinner he saw Dr. Collins.

"Who that?" the boys asked.

"Evan Collins, he delivered William."

You know in the next book, Bella's baby gets delivered by the Vampire doctor. David thought John said Edward Cullen. I love his little perspective on ALL that he's seen and heard.

" YOU mean William was delivered by a vampire?"

Friday, November 27, 2009

I am having a give away

I'd like to give-away one of my books, Permission to Mother. Please leave me a comment, short and sweet, what your favorite topic(s) are that I blog about. In a few days, I will choose a winner and post it. If I have a have a great response I may pick more than one winner.

You can go here to learn more about my book.

Please be sure you leave your comment on blogspot (not facebook, twitter, wellsphere, etc...)

Saturday, November 21, 2009

Types of Office Visits

My sister lives in New York and she just told me how her doctor is swamped with so many sick people that the office has cancelled well visits, so they don't make the well-people sick-people. Maybe we have lots of urgent care and emergency rooms here? Maybe her area is more populated?

I was wanting to summarize my practice in words. After 5 1/2 years most visits fall into one of these groups:

Lactation visits - in this category I include well-baby visits where the focus is breastfeeding and families where lactation continues to be a current priority. Also includes the prenatal visits to plan for breastfeeding and inquire about my well-child care philosophy.

Bio-identicals - this includes treatments for hotflashes, libido, cycle irregularities, hormones, and stabilization of mood. I work in collaboration with a compounding pharmacy.

Medicare replacement - this includes primary care for seniors (mostly) 65 and above who have chosen a medicare replacement. I have straight medicare clientele also.

Primary care for adults beyond reproduction age not yet medicare age.

Urgent Care A part of my daily schedule is set aside for same day appointment requests for skin & rashes, UTI, acute pain, Respiratory illness, and pre-op clearance.

There is a lot of misconception what I do. The distribution of my practice is evenly divided amongst the above areas. When I opened my practice I never heard of bio-identicals and subsequently that's been the fastest growing part of my practice in contrast to other areas that have seemed to plateau. The busiest times in my practice are January, February and the two weeks before public school starts.

My staff schedules patient:

Monday and Tuesday 9-3:40. I'd rather schedule through lunch first than to schedule later afternoon appointments. I stay till finished and that time can vary. On M, T, W evenings my children have heavy schedules out of the house (especially b/c the details of the karate schedule changed) and I often don't get home untill 8:30.

Wednesday 12:30ish -3:40

Friday- varies from all or none depending on the season.

Note: these times aren't office hours. They are the times my staff can schedule for me. Other requests by special arrangement. (Staff clarifies with me on my day-to-day schedule.)

I've done my best to bring honesty and integrity to medicine within my practice (and beyond with my writing). I try to speak boldly on topics allowing families and couples to make personal choices. My focus and interest is on areas where there is little understanding amongst other health care professionals and others in general.

It will be interesting(?) to see how my practice changes over the next years.

Friday, November 20, 2009

Max's Sleepover (AKA Scott's first dog job.)

Max went to visit Lauren's farm with us. He made a friend name Tory.
Tory looks a lot like Scott's Grandma Irma's dog who he use to live with.Max had to have a sleep-over. :)
Really, Scott is watching Tory for the weekend.

When all went to pick Tory up and when we got back we found dog vomit on the floor. David jumped up to see the mess and smashed his chilli and bowl on the floor. It was a little crazy cleaning up and keeping the dogs out of the mess.

Fortunately the rest of the evening was quiet.

Scott and I took them both out for a walk.This is both the dogs sitting quietly in front of the open door patiently waiting for a signal from Scott that it's ok to walk. Scott is truly a boy dog whisperer!
Good Night!

Regular Flu Thoughts

6/7/12 -update. My practice does not recommend routine flu immunization to breastfed babies.

It's not just young families who ask a lot of questions about vaccination, but also a lot of older folks do to. The seniors fall into two categories: would camp out to be the first for a shot or the "no thanks" group.

I feel it's my responsibility to up date my practice with trends in vaccination and preventable disease and I am always open to talk about these topics in the office. I find that those that insist on vaccination probably need it and those that decline are well-informed. I feel like I am pretty in tune with this and can guide families to make the best decision for themselves.

I prefer to optimize my own health with my good nutrition which includes lots of fresh, seasonal, organic, fruits and vegetables. Exercise, good hand washing. I don't weaken my immunity with fast food, tobacco, or alcohol. I do my best to watch my labels closely for caffeine, sugar, and enriched flour. I am fortunate that many in my practice also take personal responsibility for their health.

 The last flu shot I received was 1994 in Georgia. I was the only one in my household that received the vaccination. Mid December, John and William got the flu. They were totally miserable. William's legs were so weak, he wanted to be carried around. Scott was still nursing (at 4) and had mild illness. I wasn't yet pregnant with David. I was unaffected. Prior to that year I worked in Urgent Care for 8 years, I decided year-by-year if I wanted the flu shot depending on circumstances. I probably got it 1/2 the years. I have never noticed a reaction from the shot. Since 1994, I've been in private practice, I have not had much of my patients come in with flu. I opt out because I never felt at risk. My kids haven't had a flu shot and I am not sure about my husband. We get one virus that hits my family about once-a-year. But if I get a cough... it lingers forever...

This year one of the Medicare Replacement HMO's supplied flu vaccination for their own patients to be administered by my practice. We ordered flu shots to offer other patients who requested them, but could not obtain them. We don't order enough to be a priority to distribute flu shots to. A vast majority of my practice doesn't want the flu shot, so it's not a big deal to me that we don't get them. Two seasons we had enough demand for ordering a few pediatric flu shots, but the interest has decreased and this year and last have not offered pediatric flu shots.

Wednesday, November 18, 2009

Swine Flu Thoughts

I'm weighing in a little late on this topic. Since there is so much hysteria over swine flu, I thought I'd share my experience.

My background is urgent care before going into private practice and for the most part I leave time in my schedule for same day "sick" add-ons. In other words, you would think I am on the front line for treating the flu. According to the media, you would think I would be inundated with swine flu cases. In reality, I have not seen what I can call swine flu. (Is it just my practice?) The only exception is a 6 year old boy with chills and fever last spring (at the beginning of this "epidemic") who was very sick. His flu (regular flu) test was positive. Since it was out of season, we CONCLUDE it was swine flu.

I have seen enough colds, strep, bronchitis. If I have seen swine flu in the office, it's been mild and not something to cause as much hysteria as the media would lead you to believe. Some people have asked for Tamiflu, the antiviral. I am fine prescribing it as long as the patient realizes, I can't confirm the swine flu. I don't mind providing coverage if there is doubt in exposure history.

John said at his hospital there has been a few cases of confirmed swine flu. One case he recalled for me, the patient had underlying problem -- weighing 400 pounds.

At one point John thought he had swine flu. I didn't agree. He tends to think he gets everything that goes around. He wanted to take Tamiflu and wanted one of our boys to take a few doses.

I don't have confirmation test for swine flu. Most small practices can't confirm, so I don't know where all the documented confirmed cases are coming from. Small offices can preform a nasal swab for flu and if it's out of season for flu call it the swine flu.

I can't remember when exactly the swine flu became well known as H1N1. H1N1 sounds so much more clinical. It puts another spin on it. Perhaps when the vaccination was being developed?

Most of you already know my office is not giving H1N1 vaccination. John's practice for the most part is over the age at risk. My younger practice doesn't really demand vaccinations. I thought the few who really wanted it had other opportunities to get it at the Health Dept, Walgreen's, or through employer, at their own discretion. It's an expensive vaccination for a private practice to invest in. Since I feel the vast majority of my clientele did not want it or do not need it, we passed on the opportunity to provide H1N1. I'd rather provide Tamiflu early on if flu like symptoms present for those that want something.

Like everything else I do try to provide individualized care. Perhaps a person travelling to colder climates may have other considerations? I've talked to several pregnant women and have given them "permission" to resist pressure to take H1N1. I suppose the thing that bothers me the most is how fast it was developed and came out. I have written one script to be picked up at a pharmacy for it for a biologist who wanted to analyze it in a lab. Me and my kids did not get the shot. I don't think John took it, but he mentioned the ID nurses had his ready for him.

There is so much media coverage and fear surrounding this. Most of my patients are relieved to hear I am not caught up in it.

Tuesday, November 10, 2009

Questions about Breastfeeding at our House

Q: Do your older boys make fun of your youngest son for continuing to breastfeed.

A: Absolutely not! Extended breastfeeding is the norm for my boys. Although I don't know anyone in real life who admits to breastfeeding a single child as long as mine go, my boys know that many of my friends nursed their friends 3 or 4 years. My older boys also see that breastfeeding is calming for their brother. There is also secondary gains for the older boys; it sometimes works to get their baby brother out of their way. :)

Q: Do you still produce milk?

A: I get mixed and very unreliable answers from David when I ask how much he gets. I can't express a drop. I suspect he isn't getting much if any. Yet, he continues to request to nurse. Several mothers of (young ) toddlers have concluded that it's time to wean because they don't produce milk anymore. I recently thought of an analogy; Kids still want Capri Sun even though not much is in that pouch. There's definitely more to both than just abundant liquid. Nursing meets other needs.

Q: Does David show any signs of weaning completely?

A: One night his really cool teenage babysitter stayed with him overnight when I went out-of-town. David shared that Nate was better than having night-nights.

I see Scott, nurturing his dog in AP style. We often talk about caring for a dog like we are taking care of a baby. That dog is worn out at the end of the day after the boys run him around and take turns playing. Last night Max got right into bed at 9:00. He's always quiet at night. I asked Scott if he liked having a baby that sleeps through the night rather than being real needy. I love Scott's answer:

As long as my dogs happy, it wouldn't matter how he sleeps at night.

Related Posts Widget for Blogs by LinkWithin
There was an error in this gadget