My archives might be a little outdated especially the older blogs.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

Friday, February 26, 2010

Second part of GSG Foreword

You can read that here...

Thursday, February 25, 2010

Get Started With Better Nutrition

When I heard Robyn, Green Smoothie Girl, was expanding her 12 step green smoothie e-book to a whole course, I was offered the honor of writing a foreword to her complete program. I recommend this program to anyone who is wanting better nutrition for themselves and their family. Here is what I contributed. I have tried recipes from virtually all her videos and been through the steps in the e-book many time. I am not one to get into fad or brand name crash diets. The sensible way she incorporates good eating habits is possible for almost anyone who is motivated. I started her program two years ago and utilize most of her steps. I find her approach very accommodating: financial, allergy, medical, religious, and taste preferences (and even people with dentures (yes, you can get your raw greens in a smoothie) !). In some cases, I have gone beyond her steps, like having all raw days, but her generally philosophy is increasing the amount of plant-based food in your diet from wherever you are at with small steps. I just feel so good I want to keep doing more. I hope you take a peak at my foreword and enjoy Robyn's information.

Tuesday, February 23, 2010

@ Men's Wearhouse

We are getting ready for Uncle Ed's Wedding... We are packing and going to a MM event tonight at traditions ( I was conveniently dressed to go to the wear house), a birthday party tomorrow and I arranged to move in two weeks.

Monday, February 22, 2010

Remodel Update and Moving in Update

I've kept a private day-by-day blog, mostly photos, at for my family and I am ready to invite readers. As long as I recognize you, I'd love to have you visit that blog. If I don't know you and you are interested in remodel (or just nosey) let me know and identify yourself. In any case I am pretty certain I'll be posting room-by-room before and after on this, PTM, blog because I can't help but keep staring at the contrast. I am blown away looking back on my photo journey at how many wonderful updates we have made and how out dated it was before.

What was I thinking when we bought it.... check here (a backyard resembling a national park, maybe...). :)

John and I are really looking forward to having our friends over for Summer Cabin Fever fun. We've been living in a boring little hovel for the last few years and never, never invite anyone over.

I know that many of my readers know Alanna and she has delivered many of your babies. But I realize that not all of you realize her husband, Steve, has been our builder. Our families had done things together before and not needing a General Contractor, I never really realized what one does. We had a few "lay contractors/handymen" come over to the house initially and most of them told us what a lovely house we had and why would we want to change anything. I shoo'd them out, fast.

Bernadette has always told me G-d has perfect timing for birth. One day, John had a long to-do list for me after office hours. Go to Jetsons, go to kitchen remodel (meet their contractor), go do this and go do that. Let's get on and move in. No sooner did I leave John to start my honey-do list, I got a call from my friend Trish that she was in labor. I rarely go to birth and I was intent to follow through on my promise to go to her birth. John was going to love this. Instead of getting stuff done and moving forward, I was going to hang out while someone he doesn't even really know has a baby(that's something how he sees it anyway).

The birth turned out to be much more productive (from John's perspective) than I would have ever imagined. It was perfect Timing! I love empowered woman giving birth, but besides that, Trish and her husband just finished remodeling and sent me home with tile and granite samples and some direction. Not what John wanted me to accomplish, but non-the-less got me thinking. Trish and her husband are far more handy around the house with painting and tiling, they even added a tiled shower to the bathroom. John and I have had our noses in medical books all our lives and barely can use a drill (and every attempt at a home project is a total disaster). But interestingly while there, this is when Alanna had a chance to explain to me about her husband's business, Rubin Custom Homes. I had seen the gorgeous house they lived in. John and I wondered how everyone else manages to find a perfect home on a re-sale but us. We spent a long time looking for that perfect home. Little did I know they remodeled their home. We loved their home. Knowing his previous work and style, we had no doubt that night we had found our builder. Now, John and I have a perfect custom home that we are getting ready to settle in. We are so much going to enjoy this summer living in that house.

If you haven't seen or can't remember what this room in the picture was like before the remodel, you can click here. (It's so ugly, I don't feel like reposting it here.)

I am pretty excited that the final touches are happening this week as I begin to move in my stuff.

Sunday, February 21, 2010

Co-op list and raw food summary for past two weeks

I am doing pretty good on mostly Raw. The unraw stuff I've had in the past two weeks is a baked potato, stove top popped popcorn with salt and nutritional yeast to flavor. Today I made Chickpea Moroccan stew, which was all vegan and a big success in my house.The other day, I totally blew the Raw-thing on pasta and jarred vodka sauce. I couldn't resist the left overs. That's the only white flour and dairy I've had in a month. I won't be too tough on myself. Everything else was Raw Vegan. Once a seemingly healthy, quick meal, seemed like total junk food and a non-nutritious. Ugh, I put it in the microwave, too. Considering that I am packing to move and getting ready to go out of town for a wedding, I am amazed that overall it hasn't been to hard to keep up with raw. I usually have a daily smoothie, but I've been juicing a bit more the past few days. I am pretty happy with how most of my Raw concoctions have turned out. I usually don't share food that I prep -- pot lucks intimidate me-- because I could never cook, but many of the juices, desserts, or salads are coming out pretty good and I am glad to have some people to share with. Ok...sigh, I thought of another cooked quinoa meal I had that had some chicken stock in it, but we ate so much kale chips (it must have neutralized it) and it was so nice to have company. Going sugar-free, I felt like I would never be able to socialize around a plate of food again. But it is so nice to have so many people around me interested in eating better that I am not isolated to eating in my own house. Ok, ok... sigh, I thought of another cooked meal... We went to Chipoltes and I had a salad (with beans and chips). I guess I haven't done so good with Raw this past 2 weeks, lol. My intentions are pretty good. Maybe I should re-assess my goals and stick with it better. Sigh.

From co-op, most of this stuff is getting used up pretty fast on all the salads my family is enjoying:

broccoli crowns- This is John's favorite thing on a salad
romaine lettuce
red russian kale- I wasn't sure if this would be the same as the other kale we get. I made cheesy dehydrator chips and David ate them as the were being prepped. If David liked them, I guess they are good!
white mushrooms
red pepper-- not for me, but Scott and John both like this
jumbo yellow onion-- This is John's non-negotiable thing on a salad. He won't eat the salad if it doesn't have onions.
rutabaga-- any ideas for using this?
sunchoke-- I could use some help with this, too
pink lady apple
meyer lemon-- I usually make lemon aid with 3 lemons, 3/4 cup raw agave and water to fill a quart. This time I added a lime and club water as Leanna suggested (thanks Leanna) and my boys loved the soda. They couldn't believe I MADE SODA!
royal mandarin

Fruit Share:
orlando tangelo -- juicing with the large pink grapefruit one of my employees, Lucy, gave me still dirty from the fields. I love mixing citrus flavors.
kiwi (green)

Saturday, February 20, 2010

First Day as Black Belts

When Scott saw William come out of the bathroom in his new black gee he was amazed, "OMG!You look like Hanshi!" After class, William says that you are treated like royalty from the peewees and the other black belts. We noticed previously, by observing the other black belts, that their instructors respect black belt status very much and you no longer got picked on. William found this to be true. Scott said he felt like he was at the beginning, the bottom of the black belts and only beginning.Black belts sit at the front of the class. And you can see David with his bright shiny new green belt. I think he is excited that he can see William and Scott now. And mutually I think the older boys like being positioned so they can keep an eye on David. The four new black belts with stiff new gees are lined up with their instructor leading class.
Black belts demonstrate the techniques to the rest of the class. For all you who are wondering about rank. In one year William and Scott can earn first degree. Two years after that you get second degree, three more years you get third degree and so on.... Hanshi, the teacher of teachers is a 1oth degree and 200 :) years wise.

Announcement: I can begin moving boxes tomorrow to our new house!

Wednesday, February 17, 2010

Black Belt Promotion!!!!

Disclaimer : I need a new camera.
More than three years of training, a written test, knowing the forms and names of punches and kicks in English in Japanese, and THE big ten person fight, William and Scott now have the privilege of wearing a black belt in Karate. The fight involves 10 students in a row. Here is Scott facing his pending opponents. Nine are sitting and the big one is standing on the right. As a mother it is very emotional watching. John and I were sweating. We felt like we were getting a work out and we were JUST watching! The boys say it was very tiring. Maybe I'll get to share photos of the fight soon. This is just the short story.

Scott's form held up great. He demonstrated his endurance and stamina.
(He's been cross training in cardio.)
Later he told me he was so stunned he didn't really know he was
wearing his black belt till he sat down.William fought a similar line-up ( a smaller student was traded out for a big one). Being big and powerful, he treated his opponent like they were bowling balls throwing them out of bounds into the other fighters like he was stiking all the pins with one blow. I must say I am surprised how easy he made it look.David didn't have to fight the big guys, but he sure is excited.
He's 1/2 way to black belt and one in spirit!A bright shiny new green belt!

Now as a black belt you get the honor of sitting up front in class and a new gee. If you are wondering what I am doing this weekend, I'll be transferring patches to black uniforms.

Two other students got promoted to black belt. The two Sensai's got promoted to Shihan (5th degree) and a few other awards and certificates were obtained. This was a very exciting promotion.

We appreciate Mary and Nate coming out for the promotion!

Saturday, February 13, 2010

High and Tight! He let me do it!

Remember I said I wanted him to get his hair buzzed for his blackbelt exam?
This morning when he wouldn't brush it, I told him this was the big day!
Surprisingly, we had a few good laughs at the inbetween cuts.After:
I am certain that after a few compliments,
he won't go back to long.
His face is to handsome to hide.Well the jokes on me. His payback was a trip to Gamestop.
He'll do anything to go to Gamestop.
We had a lot of laughs. This was a good time spent with William.

Thursday, February 11, 2010

Karate Countdown

The black belt testing is next week. The boys have been telling me "basically they are Sempei (prounouced -- semp I) now." In class last night Hanchi lined the rising black belts up in the front with the black belts and sure enough honored them with their earned titles: Sempei Scott and Sempei Will. I am glad they had a preview at being Sempei's (whatever the plural might be???). Already excited, I am glad they got a chance be distinguished and to experience their new roles. Both have gone through times where they wanted to quit. I know last night they were feeling their earned titles and glad they were made to go. David is such a little black belt in spirit. He lines up in front with the peewees and now he can see his brothers right in front of him.

William and Scott went to Roman Martial Arts in Georgia for a year and a half when they were Little Dragons (what I call peewees now). William was a strong beginner student. Scott was 4 and much more difficult. He didn't want to go in. He cried. Master Bradley told me it was okay to drop him off and go (or stay, whatever I wanted). He even through a tantrum and wound up nursing through class one time. He wasn't bashful in the least bit. Scott looks at disruptive peewees now and he really wants to set an example for them. He points out ones to me that he questions if there's hope for maturity and I tell him how he was. He can hardly believe it He has come a long way. He always wants to get there early and gets mad if I am late now. He doesn't want to miss anything. These photos are from one of their first testings as Little Dragons.
I am glad we made the effort to bring them three times a week these past few weeks. I can see how they have improved and strengthened. They had an interesting drill last night. Instead of sparring on their feet they all went on their knees and mostly used punches. Some of those kids are very tall and I like how it sort of neutralized their height differences. The usual sparring is a flag game. That is they tuck flags in the back of the belts and using your kicks and punches you defend your back. Don't let your guard down or someone will grab you'll flag and you'll be out. My boys are so clever at figuring out strategies. David wants Mary (hi Mary) to anchor a flag with a stitch to his belt. Then obvious no one will ever get him "out." :)

Williams hair is long now. I want to give William a military cut, a high and tight, or whatever you call it before his black belt testing. I think he would look good, intimidating, and like a new kid. I really like him with his hair short. We'll see......

Wednesday, February 10, 2010

Well-child Care Appointments-- Are they Necessary?

I am often asked this question:

What is your opinion of well baby visits? I was recently reading "How to raise a healthy child in spite of your doctor" and that guy is totally against them. We decided against immunizations and I've gone twice to the ped and it just seems totally pointless. I know nothing is wrong with my baby so why am I taking him to the doctor?

Capt'n Amazing Wife specifically asked this time. She is out of state and I am going to answer this question in that context.

I am in Family Medicine because I enjoy relationships with my patients and families. Getting to know my patients when they are well goes along way. When an illness or injury comes along, often I am able to accommodate you quicker and provide more individualized care because I know your preferences. This applies especially in the evening hours. I am much more likely to initiate an evening or weekend treatment (or reassurance) until I can see you if I have current records. I have come into my office or practice medicine on the go (whereever I am! ) after hours to help someone out who has taken the time to keep their appointments. Much of my practice emails and texts me (I prefer email, btw, for medical questions.) Someone with a current chart probably will get a fast evening response from me. If you are way overdue for an appointment (or have missed appointments), I am more likely to ask my staff to handle it in the morning. It just depends. After living in the area for over 15 years I have come to know many families who have active "medical" times and fortunately quiet times. I really respect the families who take good care of themselves.

I am happy to give some advice or initiate evening treatment. In fact I tend to think of myself as accessible and can help nip things in the bud before they get worse or lost sleep. I have a few local families ask if they need to keep a well-child schedule or can they come in just when they need something. I've been right upfront and told them if they don't bring a baby for well-care don't expect me to take call for their baby in the evening. It's not fair to me (and my family )to answer questions about a baby who changes so quickly whom I am available for during the day and family chooses not to keep appointments. Fortunately most of those families pretty much understand that and don't take issue with that negotiation. It's kind of like what they are looking for anyway.

I have read that book 11 years ago. The book was out-of-date then and removed from the LLL library. I understand that the author is trying to reform pediatric care. Just be careful because 1/2 the specific issues didn't apply anymore when I read it.

I happen to disagree with him on weights checks. I think they are very important. Sure I can eyeball a baby and see if he is growing. I look at the baby before I look at the weight. Weight questions is one of the most common questions parent have-- about adequate weight gain and poor gain. It is also important for physicians to know what to do with the weight checks and when to worry. And many physicians don't (so I understand his desire for pediatric care reform).
The biggest impact I can make at a well-child visit is preserving the breastfeeding relationship. I didn't do a study, but I am pretty certain my breastfeeding rates are the highest in my area. :)How it irks me when a mom who doesn't believe in well visits finally comes in later for a sick visit and stopped breastfeeding because of some simple-to-resolve problem. I suppose if she really was interested she would have asked. But there is also other issues that come up that parents don't recognize as a breastfeeding issue, but is, For example colic, gas, loose stools may be oversupply, NOT lactose intolerance or reflux. There is also some things not likely to be breastfeeding related. For example, baby acne will pass and is not an allergy to breastmilk. For many families I am the only voice (or the first voice) reminding mothers of their inner strength and reminding them to listen to their heart and their baby and not to others.

As far as the well-child schedule. I imagine my schedule is much more relaxed compared to the AAP's. I have seemed to find what works in my office. 1st week, 2nd week, 4 weeks, 2, 4, 6, 9, 12 months. 15, 18, 24, yearly after that. I am flexible yet. First breastfed baby may require more visits initially. I often reduce the schedule for an experienced mom or one coming a very long distance if all is well. It also depends where the mom is on her journey with all the current issues surrounding well-child care and how her emotional recovery from birth is going. I do a lot of work with healing. All moms with babies under one have an active chart in my practice so I can get to know them too.

All this and we haven't gotten to vaccines yet because not having vaccines is not a reason to keep well-child visits. I answer lots of vaccine questions in the office. ( I do not take vaccine questions via blog.)

As far as my boys go, I worked for the big dominant hospital system when William and Scott were babies. I was programmed to have well-child visits from residency. They kept their appointments because it was easy. It was there. I was showing my babies off to my colleagues at the same time. I often felt like I had to remind the pediatricians that breastfeeding works and for them to prioritize it. I left interesting pamphlets with them hoping to leave an impact. I guess you can say I was hoping to do them a favor. When David was born, I had a likeable and popular pediatrician in Rome, Georgia who previously was a classmate. We kept a few visits for David. Scott had a visit once that year.

I often wonder who I would go to if I had to take my kids somewhere now. They each have had one peds visit in the last 5+ years at the time when one of them needed clearance before dental work. I understand the pointless part. ( I wonder what physician I would go to if I needed something.) Fortunately the minor things that come up, are the kind of things I have access to supplies and pharmacists knowledge. Prior to this practice I was employed in urgent care and didn't necessarily have access or the well developed skills of well-child care I have now. As you know from reading my blog we do a lot of prevention in my house. Exercise, eat better than most, breastfeed for years and years :), avoid large crowds of sick kids. Our house, car, and property are NO SMOKING ZONES. Smoking is absolutely not tolerated. I know a lot of my readers feel the same way.

Like everything else, keeping well-child visit is a parents decision. Explaining how I see things may help you locate one in your area who may share ideals and you could have a better rapport with. Ideally there would be a physician in your area that you could have a good relationship.

Tuesday, February 9, 2010

Karate Testing and House Time

Black Belt Testing next week!

WED, FEB, 17th at 6:00

My boys asked their Sensai (4th degree black belt) and Hanchi (10th degree) when they get tested so they can watch them get tested. Two of the Sensai have testing sometime soon. You get a first degree one year after black belt, second degree two years after you obtain first degree, third degree, three years after second degree and so on. My boys were reassured by Hanchi that they be invited. David asks Hanchi when he can become a Hanchi. Hanchi is an old wise master of the masters and explained to pee wee David that when he has gray hair he can be a Hanchi. :) Hanchi told the boys that his own testings involve observation of his students. His students are a reflexion of how good he is. Scott told Hanchi that he felt so lucky to have found a 10th degree black belt in PSL to be his teacher. I am so happy to see how karate has benefited the boys.

William and Scott will become black belts. They have passed the written exam. Beyond karate I am excited for how nicely they wrote out their answers and they both did it independent (they wanted nothing to do with each other). David will get a new green belt. I've tried hard to get him to drink his smoothies. "Daaaavid, you have to drink your greeeen smoothie to become a green belt."

Guess what else is next week (on Thursday)? A walk through with our general contractor for the final punch list, then it's moving time....

Saturday, February 6, 2010

The Money Man

I showed my sons the coin building project at Homeschooling Day By Day. David got all in to this and built me not one, but two men made of money!!

Friday, February 5, 2010

Produce day and Upcoming Meal Planning

My fridge was really running low on supplies Wednesday night so I was so glad to be able to pick up on Thursday. Wednesday has been the only night I cooked something. Israeli Brown Rice seasoned well... and popcorn made on the stove with real salt and nutritional yeast to top it. I am feeling really good eating all this raw stuff. I did miss some rice... but the popcorn... I knew if my kids asked me to make it I wouldn't be able to keep my hands off...

On Thursday we got:

Broccoli crowns
Green Kale - I made Kale Chips. I know it sounds like something something only some crazy raw vegan would eat, but WILLIAM ATE THIS. AND SO DID JOHN, DAVID and of course Scott. AND MAX.
Romaine Lettuce
Curly Parsley - Tabbouleh My husband loved this! We had no left overs! But I have another batch of parsley and a plant that is doing well in the yard!
Red Chopper Pepper - Scott likes this sliced fresh!
Colossal Garlic
White Mushroom - I am going to put these in my veggie patties I make this weekend.
Roma Tomato
Kent Mango
Navel Orange
Braeburn Apple
Ruby Grapefruit

Fruit Share:Blueberry, Honey Tangerine, Golden Pineapple (the top will go in the garden).

Once again I am so fortunate to have fresh herbs(chives, orgeno, basil, cilantro, dill, and more parsely), and greens aloe, arugula, and chard from my own garden and my friend's. Every bit will be savored.

To add to the variety, other things I am making in the upcoming days:

Almond butter I am going to soak, to activate, my almonds and put them in my food processor to make almond butter . I suppose another time I'll see if my Blendtec can make this as well. Does anyone know?

I found an oatmeal cookie recipe that calls for almond butter. I realized how much substitution I did. First batch was oat groats (from my friends grinder). The second batch I ran out of groats and put the whole grain in to my Blendtec and it grinded it easily into flour. I used coconut butter butter instead of almond butter and flax oil instead of coconut oil. We (Scott and I) used raisins in place of chips. My Blendtec also grinded the flax, but I mixed the batter in the food processor because I am in a kick to see what my food processor can do. I added the raisins at the end. I have a bunch frozen in my fridge.

While the dehydrator is running, I am going to experiment with the drying out apples and bananas. My kids will probably eat any fruit that goes in way before its done.

I'll be juicing the citrus together to mix the flavors and I have lots of great ingrediants for salds and smoothies.

A lot of people tell me that they want their food to taste good and try to justify not improving their habits because of taste. I am using fresh herbs and seasonings generously, and I like how much of this is turning out. The SAD diet can be extremely bland in terms of taste. In fact someone today told me how all their food was unsasifying and I remember feeling exactly the same way about 2 years ago.
(The photo is from an old share when Gerrie asked me to take a photo of the gorgeous spinach.) After seeing Lauren keep her garlic in a wiker basket, I started keeping mine in a little basket my grandmother gave me as a young girl. It's perfect for garlic!

Wednesday, February 3, 2010

Bedwetting Update

After a few days on a .2 mg dose of DDAVP, I noticed that all it did was make less pee at each accident. It was an improvement but not the one I hoped for. I called my consultant pharmacist who suggested increasing the dose to .4 mg then .6 mg if needed. Looks like the .4 mg dose will be successful. After a week David's been dry all night, except for one morning his "little accident" woke him up. He got up and went to the bathroom. He's always slept totally unaffected by a wet bed. Not me though. I have always been on guard for a wet bed with one eye open. He won't let me layer the bed or put on any kind of training pants. I tried to stay awake longer than him to at least layer a fleece blanket beneath him to keep the wetness off the bed. He wouldn't get out of bed if I woke him in the early morning to take him the the bathroom. He's a heavy sleeper. He has never been motivated to do behavioral approaches. So we'll stick with the oral DDAVP for a while limiting fluids in the evening. I have also tried observing if the avoidance of bad foods would help, but I can't always control him. I'm glad we did the ultrasound, so I know we aren't medicating some kind of anatomic problem. I just wished I knew what really caused bed wetting.

Weekend Fun

John is working a lot less these days (since the first of the year) because Medicare replacement is only allowing their hospitalized patients to be cared for by hospitalists. Thus he is not spending as much time in the hospital on weekends and evenings because some one else is doing the work.

With him home this weekend we had a pretty good family weekend. We started off going to the farmer's market. I find it very important to keep fresh produce around if I am to plan my super healthy meals. I love the unpasteurized OJ I can get there. I look for variety so I am not eating the same thing everyday. For something different, I found red navels which have a short season and rhubarb that I sliced for my salad. I haven't had sun dried tomatoes in awhile and I' ve enjoyed adding them to my salads.
After that we went to my boy's friend's TKD Black Belt testing. Already, inspired and eager for their belt they are more inspired and besides themselves now waiting for test day. (Thanks Susanna, for taking a great photo of our boys.)
After that we went to a local fair. You can see they had a bunch of fun on the slides, bungee, and rock wall.
But the real accomplishment this weekend was getting my family dressed for an upcoming wedding. We are excited about John's brother getting married at the end of the month. Uncle Ed gave the boys the option of wearing tuxes and all three were very excited about this opportunity. It was so easy to get them fitted. We were in and out without tears and we go back a few days before the wedding to pick the tuxes up and make sure they fit. John got a suit.

But the real question is, if my boys where tuxes, what am I suppose to wear? I am not one to go pick out prom dresses. I have never worn one. I am not really that crazy about one-time use dresses. But somehow I got some good sales floor help and found a reasonable dress and shoes (Let's not get in to the wide width issue I have.), and that chore is done. I am sure if I hadn't stuck to a Vegan Raw these past 2 weeks and working out every day, this dress shopping thing would have ended empty handed and in tears for me. There, now you know what has motivated me beyond the usual to have a cleansing diet. :)

Two weeks was my goal and I made it, but I feel good and have more ideas for a few more Raw meals.

Scott made this climb look easy. He's ready for the Alps.

Max had fun meeting other Corgis.

David flipped a few times like the girl in the background!

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