My archives might be a little outdated especially the older blogs. My links above are all new and current.

I have only positive things to say about Permission to Mother, an autobiographical account of a thoughtful mother and clinician who courageously writes from her heart, soul, brain, and personal experience; who is open to change in her views and opinions and is not guided by the safety of rules of any group or the status quo; she is guided by love and openness to the experiences life brings her and her family. Her process benefits her and those around her and those who read her words. And to add to that, the writing style and story telling ability here make it a very enjoyable read speckled with both the humor and seriousness of life. ~Laura Keegan RN FNP, author of Breastfeeding with Comfort and Joy

I enjoy reading your feedback and Reviews (81!) on amazon. Kindle Version Available!

Please Join me on Facebook at Punger Family Medicine.

Saturday, November 20, 2010

Open Enrollment

You wouldn't necessarily know from reading this blog that I take care of medicare eligible patients (65 years and over). But I do!

At first, I didn't know if I would like treating older patients, but I found out I enjoy providing Medicare patients with the same open-mindedness care as I do my younger patients. I found all the pharmaceuticals protocols a bit excessive and enjoy finding LIFESTYLE approaches to help improve conditions such  as hypertension, cholesterol, diabetes and hot flashes, etc....

Lifestyle = nutrition and exercise.

I am not afraid to individualize treatment and testing schedules and to reduce doses of and possibly discontinue pharmaceuticals with appropriate monitoring. Many seniors have found they are taking better care of themselves, now more than ever (less work, stopped smoking, eat-in more, have time to exercise...) and realize they may not need the medications anymore. They find no one ever suggested a chance to reduce medication. My approach means that my patients accept some responsibility for their health. I only provided guidance. And I am there just in case.

In fact I found what I didn't like about the prospect of older patients was the business of pharmaceuticals. I LOVE that the many diseases of aging aren't really an age process, but one we can control with our own choices.

They aren't genetic either. I hear so much from seniors, "My mother had diabetes (or XXX), so I have it too." You and your family members have XXX because you eat and do similar things.

It is genetic if you are born with it or you acquire the condition early on.
If you are a senior, male or female, and want to take charge of your health, you may be in the right place. If you want to hear a unique approach, you are definitely in the right place. I have an opinion, that differs, on just about everything.

It is open enrollment through the end of the year, if you are medicare eligible in Saint Lucie County (Port Saint Lucie and Fort Pierce). My practice accepts Summit, Wellcare, Freedom, and Humana. (Hopefully Universal by the first of the year-check back or call the office.)

Saturday, November 6, 2010

More on Round 2 Dyslexia (David)

David is progressing in speech well. Its going to take some time to get to goal, but he started profoundly delayed. I see no reason why he won't reach potential. His speech therapy is helping his reading. David is not aware of his deficiency in reading. He never knew he was behind which is good because I don't have to deal with peer pressure and academic competition bringing him down. Since he is by law in first grade, I think now he may actually be at an acceptable grade level in reading and phoneme awareness.  He has learned all the sounds in Level 2 BartonReading (the alphabet, short vowels, CVC words, digraphs, ck, th, sh, ch, wh. ), but is not always co-operative with the writing and work sheets in this level. (Scott liked the worksheets.) I have Handwriting without Tears, but may need a tutor or OT at some point for this. I have patience for only so much teaching remediation.  I take on the reading and may delegate the rest. Honeslty, I also think keyboarding may outdate handwriting.

He likes playing the on-line games by Barton to reinforce spelling, which Scott never did like to play. He also is aware of words all around him and sounds them out. William and Scott were not interested. David is motivated by his success says his therapist. She said that he has a different way of learning, but once he gets it, he gets it. (Or maybe once we figure out how to teach him, he gets it.) David is figuring out words beyond his BartonReading Level on his own. YEAH!  I came home one day and he told me he figured something out. "An "i" after a "a" changes the /a/ to the /ay/ sound (long a). It has been  painful teaching the older boys to read. No one ever figured ANYTHING out! I am relieved for this insight. Using his own logic, I explained to him that "gh' after "i" changes short the short "I" sound to a long "I" sound as in fight and night.

As I was preparing for Scott's next lesson, watching the next set of DVD tutorials. David wanted to watch and sound out Level 8 words. These were too advanced for David. While I had his attention, I decided to put in the tutorials for Level 3 reading and spelling. He liked watching them and happily and correctly sounded out words. He paused the DVD to do the work before Ms. Barton explained it. So he was sounding out blends and digraph blends like french and thrush. Scott learned and did the Barton Levels in the exact order. If I wait for David's handwriting skills to catch up, I see we will really hold  up reading progress now that he is interested in reading. (Imagine soaking up reading.) I am carefully keeping track of what he does, and watching for those teachable moments to progress and fill in what he skipped. He is also looking for CVC books on our shelves that he can "read." It's not easy to find books limited to CVC words, but we've come across a few.

I am grateful for a therapist who is experienced, adaptable (to the moment). I am grateful that I can be present. Although sometimes it is helpful for me to be out of sight, I think David is mostly focused when I am there. By me knowing what they've done, I can reinforce and make sure we are all working synergistically. With his sever delay, I am glad to be able to make progress quickly. I know that going through the school board would be a free service to me (and all homeschoolers), I am so leery of going through the school board and calling attention to our homeschooling choice and learning disabilities. I know lots of excellent teachers (Hi, Lauren, Lisa, Jenny, Loma and more!!), I don't get to pick them for this. I don't think the school would be able to accommodate dyslexia or the pace.  I may be wrong, but I think we are right where we need to be.

One of his many speech problems is his lateralization on the /s/ sound. His therapist brought up to me that the cupping of the tongue in breastfeeding is a conflicting movement to the way "s" needs to be pronounced. So I thought about this. And I see what she means. As I put some thought into it and I noticed latching differently. David's ineffective child latch was more about comfort and not draining the breast. His cupping is, I mean was, he's done--really, REALLY, was not really cupping. I agree cupping in a newborn is totally different than the lateralization to make an "s" sound (I hope I explain this tedious detail correctly). But I think we can all agree that breastfeeding a newborn or extended breastfeeding does not cause speech delay. If we don't agree, we can agree to disagree. Certainly other issues contribute to the speech delay and breastfeeding is beneficial in all other ways. I stand behind breastfeeding. :)

One day, a few weeks ago, I was feeling specially emotionally about David's LD, I really appreciated his therapist saying that he's just been busy learning and absorbing other information. This past week has really shown how fast he can absorb what he is focused on.

Susan Barton, founder of Barton Reading, is going to be talking Monday(Melbourne) and Tuesday (Lake Wales) evening (15th and 16th). I am not sure if we are going, but my boys have expressed an interest in meeting her. If anyone is interested I will send you the invitation.

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