My archives might be a little outdated especially the older blogs.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, January 22, 2011

Simple, Healthy, Tasty

I won a blog give-away! I didn't consciously enter the contest either, so how cool is that? I won Tammy Nelson's e-book, Simply Scheduled: 2011, A Year of Healthy, Simply, Tasty, Meals Planned for You.

I've been a big fan of Tam's Blog Simple, Healthy, Tasty for 3 or more years now. I found her blog through Green Smoothie Girl as we were both incorporating green smoothies into our diets. Tam was way ahead of me on this. Tam has a recipe blog, which I fell in love with, and started printing many of her recipes right away and trying new things.

Tam has a way of healthifying favorite recipes. Since, at the time, I didn't know how to cook (or prepare food in general), I learned her way, first. Little did I even realize her recipes were vegan (no meat or dairy). I just saw healthy, hearty meals full of taste. I told my sister, " I am finally using the spices in my cupboards!"

Her blog also has a lable for natural living/lifestyle, Many of my readers would find interesting.

I highly recommend Tam's recipes for those who are wanting to eat healthier and find more variety to feed their families healthier. The recipes are on her blog. Go to her blog and become a follower or fan.

What I like about her e-book? She takes me to the next step-organization.
1. She has a shopping list and an ingredient list for each month.
2. She has meal planning for an entire year!

As a fan of hers, for years my pantry is stocked like hers, but I have never been able to put together a monthly shopping list or plan menus. I'm not sure I am going to get organized for a whole year, but I have tried many recipes on her blog over time, I am enjoying looking at the menus and making sure I didn't miss anything appealing that I should have not missed. I will plan out some of the meals I missed and start some planning that way.

My kids have enjoyed her Orange Julius Smoothie, and Mac and Cheese.  The No-fuss potato soup and salad ideas are favorites of mine. I like her this and that section. My kids would put the Mac and Cheese on the menu for a year.

She emphasizes the importance of salads and smoothies. You know I like that; the two main-stays of a healthy diet. She has the kind of recipes that will get the family excited to gather to create together and to eat together.

Her e-books is unique in that it puts it all together to assist planning.

Thank you Tam for sending me your e-book!

Thursday, January 20, 2011

Time Passes

What happened to my blog?

It  use to be all about mothering and breastfeeding. My sister once said for years all I did was talk about breastfeeding. Everyone said that is all I ever talked about. :)

Breastfeeding babies.
Tandem.
Pregnancy.
Mothering.
Weight loss (or the lack of).
Breastfeeding and work.
Breastfeeding and writing.
Breastfeeding friendly clothes.
Breastfeeding and slings
Breastfeeding and society.
Breastfeeding in the news.

Now it seems all I can write about is testosterone related things.
Teen boys, educating teen boys, their bar mitzvah, weapons, karate, the dog is a boy, my own bench pressing and recently remodeling. There is nothing feminine on my blog.

I have to make an effort to think about what I want to say about breastfeeding and anything "girlie." :)

There is a point of telling you this.

One of those points is that seems that when the baby is small and dependent on breastfeeding that the time will never ever pass. It seems like breastfeeding has taken over your life.

But life does move on. We go on to other priorities within our family. Enjoy this special time with your baby, or toddler, or perhaps even your nursing preschooler. It does pass quickly. (Even when a preschooler/schooler continues to come to your breast, in this phase, the breastfeeding may not be the dominant focus of your life, it's just something that is a part of your life.)

My blog documents how innocently and subtly that happens. I am glad to be in the place I am now, still I will miss those baby days and the GOOD excuse to be amongst motherly companionship.

Friday, January 7, 2011

Confrontation and Communication

I changed some one's life this week. Not to brag, but it's not always so easy to have an affect.

This is a mid 50 year old woman with multiple medical problems. She came in 11 months ago for needing refills. Did some labs at the time, but didn't really follow through on other parts of my recommendations. Not everyone has to do everything I say, but in this case she was not doing so well. Non-compliance is not an option when what your doing doesn't work.

She came in this week with a rash, needing her refills, labs, referrals, and other new, but embarrassing, symptoms. She specifies to me exactly how she wants her refills. She has her insurance formulary tier book and will only take the tier-one. She wants 90 days supplies with refills.... that's where I stopped in my tracks. I already thought she was asking for way too much in one visit. Now if I give her a years worth of medication, she has no motivation to come in again. In my mind I anticipated that I'd see her in a year when prescriptions ran out, needed referrals updated, and none of her real issues resolved. This is the kind of practice I am trying to stay away from. Being the refill doctor serves no purpose.

So I explained to her that I would give her, her refills, but she must do her labs and follow-up accordingly. She said she didn't come in because of the co-pay. She says it's only $10.00 but it still holds her back.

I was quite direct. "I am not here to prescribe medications only. I don't want to be your drug doctor. I do want to help you."

She replied, "She could respect that." I actually expected her to be argumentative and find another doctor. Instead she started tearing and further said that I made her feel like I care about her and she hasn't had anyone care before. She readily agreed that she would follow through with her labs and come back in when I need her to.

She remained very apologetic the rest of her visit which was not necessary. The rest of our appointment went well and I found her quite receptive and pleasant after my confrontation.

A few hours later I received a social networking friend request.

As my teens would say... Score.

Taking care of herself may have not been a priority when she walked in to my office, but I had no doubt that by the time she left her focus shifted.

Tuesday, January 4, 2011

Scott's Career Inventory

I am sharing the report Scott wrote after taken a career interest inventory in keyboarding.  My days are filled with helping my teens write essays. Remember Scott is dyslexic and he has come along way. Sometimes I help him more than other times, but this one is almost all him. I really like the opportunity to save the boys work on the blog, particularly when it is relevent to my blog topics. I also like the blog feature to create a book out of my blog post. It would be cool for Scott if I take the best of his work and turn it into a book!

My career results are interesting. I probably got the best income jobs on the test, but I did not like them. It said that I should go in to something medical like Radiation Oncology. I am interested in having a leadership career or a creative career, but not a medical career. It’s just not my thing. So I picked veterinarian, animal trainer, game designer, and police officer. I did not like my results, so most of my careers that I picked were searched on the test. I cannot see myself being a vet or a game designer. They were just the only jobs that I liked enough. I had to put in at least five jobs so I could move on.


There were two jobs that I actually liked: animal trainer and police officer. I can see myself being one of them. Actually I only put police officer as a job because it was the closest one they had to military, but I might be a police officer too. As far as being an animal trainer that comes naturally to me I have already trained my own dog to be a canine good citizen and therapy dog. An animal training career is easy to me. I think of it as a hobby not a career.


I also want to be an inventor but that was not an option on the test. If I had to give this test feedback, I would not give good feedback. I would say that it consumes too much time. It does not give specific feedback on what kind of person you are. It only gave a basic list of jobs. This test is not a very good one and who ever does it should now that it does not always give the best results. It said that I was practical, outgoing, and influential. Practical is just the opposite of me. I am analytical. My parents are doctors and my Dad got accepted to a Radiology Oncology Fellowship. He was impressed that this inventory selected that for me.


Scott Coquelet
Student, FLVS Keyboarding

Scott's Fitness Video

This is Scott's final project for his fitness class. Part of his assignment was to share his project.
He should appear on Doctor's TV!

Text Version
A hereditary disease is something you are born with. It’s not something you get later on. A true hereditary disease can’t be turned around. For example dyslexia or Down’s syndrome can’t be reversed, but things like heart disease, Type 1 Diabetes, and cancer can be. These supposedly hereditary diseases can be turned around and be prevented. How you ask? You can get rid of them nasty fake hereditary diseases. Thousands of people have done this with great success. Don’t live your whole life thinking that eventually you will get a disease that your parents had. If you get something as an adult, it’s not because you inherited it, it’s because you ate or did the same bad habit as everyone else in your family. All you have to do is eat fruits and vegetables, exercise daily, and don’t drugs, smoke or alcohol. If you do not want to get addicted to drugs, don’t try it. The healthy food is better than you think. There’s a lot of healthy recipes and I am drinking a healthy sugar free chocolate smoothie. You have control. You are what you eat.

Tongue-Tie Discussion on Doctors TV

I was glad to have it called to my attention that Tongue-Tie was discussed on Doctors TV by Dr. Jim Sears. I don't watch much TV and it's the first time I heard of the show, but I do know Drs. Sears (the father and 2 sons, all authors of many parenting books), and I knew it would be a great resource for trying to self-recognize if their baby has tongue-tie, making the decision to find a physician who will do the simple procedure, and seeing what all is involved.

Most new parents have no idea what tongue-tie is. It was my mother that was watching the show and told me about it. She said, if it wasn't for me, she wouldn't have known what it was, but because she knew I took care of breastfeeding problems and tight frenulums, it made her pay attention.

It is very intimidating to a new parent to think about "someone" making a little snip under their baby's tongue. All to often, it's the Pediatrician who tells the parent that nothing needs to be done when a parent thinks their baby may be tongue-tie. The mother goes on continuing to not be able to breastfeed. Her baby may not latch. It may be a painful latch, or it may be poor milk transfer with a failure to gain  weight. Without the Pediatrician to concur, I find parents are reluctant to pursue treatment. I find that if a Pediatrician confirms the concerns, the parents will often follow through. Far too many Pediatricians blow off tongue- tie issues, and new vulnerable parents don't know to keep questioning. That's why I am so glad this topic was covered on TV programing. I find the more (main stream) information parents have on tongue-tie and frenotomy empowers them to trust their instincts and follow through finding resources.

Dr. Sears video is here.

I take care of frenulums for breastfeeding problems. The earlier the better, but I have no age limit. I do it right in the office, parents can be present and in constant contact with their baby. After the quick procedure, if the baby is hungry, I like the baby to go to breast or at least have some skin-to-skin time while I answer questions and make some recommendations for success.

If you have sore nipples from the first latch like the baby is biting or gnawing, a tight frenulum should be evaluated for. If there is poor milk transfer with weight loss, jaundice, or decreased urine or stooling, consider checking for tongue-tie. If your IBCLC, midwife, or postpartum nurse nurse tells you they think your baby has tongue-tie, especially if you live in my area, they are usually right-on as I have been working with them for over 12 years and many of our breastfeeding supportive have been around long before me.

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