My archives might be a little outdated especially the older blogs.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 28, 2011

Administrative Q about Network Blogs

I set up Network Blogs with my old facebook account that got hacked using my active email address. To make  a new facebook profile I had to make a new email address. Network Blogs didn't get hacked. Since then I have 70 followers on network blogs (THANK YOU for your interest). Network Blogs no longer recognizes me as author with a new address. Do any of you know how I can claim this blog on Network Blogs. If you leave a comment on facebook I will see it (I think). I would like to have this blog fully functioning and update-able.

Tuesday, November 8, 2011

Gut Integrity- NEC

Gut integrity -- nothing in the gut except breastmilk for 6 months. The thought amazes me. The life LONG benefits of optimizing sealing your baby's gut with nothing but breastmilk so the intestinal lining seals and matures.  Sealing your gut would promote natural flora and keep proteins from being absorbed that shouldn't get absorbed by the gut. In turning possibly causing digestive problems and inflammation.

I am not sure many of our full-term healthy babies get nothing BUT BREASTMILK for this long. There is too many tempting tastes, religious customs, grandma's treats, tylenol for vaccines and fevers, Vitamins, and early use and misused formula given. I don't know that a drop of something that is absorbed in the mouth ruins gut integrity, but you get the idea.

I believe in gut integrity. I trust that if we keep doing research we will one day have all the Science to back it this up- NOTHING BUT BREASTMILK.

Neonatologist at the conference don't agree on what to supplement the NICU micropremie with. I say UNPASTURIZED mother's own milk is best without supplement if it's available. Someone else's premie milk is second best. Third best is donated milk from the bank regardless of age. I actually like the idea of unpasteurized milk even if it's screened donor, but it is assumed that all milk from a donor will be pasteurized. I am bothered by the thought that the live enzymes needed to seal and protect the gut are going to be killed... but better than formula. Formula offers know immunity.

The current practice in most places is using a cow protein based fortifier. Adding fortifier to milk is better than the worst option (just formula).  There is some research being done on human milk fortifier. This is an all human product being added to mother's milk. But why add it? just give breast milk. In general, the studies  show the more breastmilk / the less fortifer the less NEC (necrotizing enterocolitis- the problem that keeps neonatologist up at night in the NICU). This is a serious bowel ischemia. Think about it. Nothing belongs in the gut but mother's breastmilk. Of course these little premies should still be protected by the placenta in the womb, but why put cow's milk protein or anything but mother's milk in the premies intestines? Just to fatten them up quicker and make them "look good."

Despite all the time and energy on  research being done on fortifier use in the premie, it is going to take me a lot of convincing that any fortifier is necessary.

Monday, November 7, 2011

Vitamin D in Florida

I "absorbed" everything I could about Vit D at the conference, met the authors, and bought the book with all the research
I really want to show that we don't all need to supplement our baby in Florida, however, almost everyone, all ages, I test is sub-optimal.  I hope to get it set up soon that I can do Vitamin D testing by fingerstick. That way I can check more babies.

The current recommendation is that we begin to supplement our babies with 400 iu shortly after birth.
If  you are going to choose not to give your baby a Vit D supplement. This is what you can do yourself. With my current clinical experience I believe this would be effective.

Get Sunshine, both mom and baby
Take 4000 iu while pregnant
Take 6400 iu during lactation. This is the amount it takes to get 400 iu into the breastmilk daily. 
Take surf lessons. :)

For darker skinned women in Florida this is especially important. Perhaps over time and with increase awareness we can redefine what is best for all women and babies and minimize supplement exposure.

I have not seen Ricket's. Vitamin D is a powerful antioxidant and anti-inflammatory. If you want to boost your immunity Vit D is important.

I also believe in gut integrity. I want nothing in the babies gut but breastmilk. I want the gut to seal off and mature with several months of exclusive breastfeeding whenever possible.  The "seal" has benefits long beyond the duration of breastfeeding. I really hope to reconcile the need for D and maintaining gut integrity.

With awareness preconception and during pregnancy, I hope we can keep our D levels up.


New Insights Into Vitamin D: During Pregnancy, lactation & Early Infancy
Wagner, Taylor, Hollis

Sunday, November 6, 2011

Learning from Moms: Babies with Down's Syndrome

I have just got back from The Academy of Breastfeeding Medicine Conference. It was in Miami and I was there 2 1/2 days for 22 continuing education hours. With lots of thoughts, I'll probably frequently blogging over the next few days about breastfeeding.

I was very touched by a Platform Presentation on Down's Syndrome presented by Barbara Phillips MD. Mother's of who breastfed babies were surveyed.  Here is some of their responses that I had jotted down during the presentation:

"Never considered that DS would even have affect."
"I didn't know that low tone, meant I couldn't breastfeed, I just breastfed."
"The diagnosis of DS made me even more determined to breastfeed because I knew he was at a disadvantage in so many other way. I wanted to give him this benefit."
"Slowing down to nurse, was beneficial  to me in that it made me slow down."

Do you feel touched? I thought moms of babies with DS would be discouraged like everyone else from breasrfeeding. I am sure many are.

The title of this presentation was Learning from the Moms. It was shown with support these mom can do quite well breastfeeding.

I love the title. I learn from moms all the time. I enjoy being on our local LLL facebook page because there is so much to learn. I know I was at a big physician meeting and I learned a lot. I know what the Academy wants us to know from around the world, but the experts are right here local-- the voice of the collective moms. No matter how much I post, I learn more from you.

Not all sessions were emotionally/maternally moving. Some were quite political and academic, but I realized how important being around  breastfeeding moms is for new moms. It's more than just receiving and exchanging information and support, but there must be something about being around other lactating moms that helps your instincts and milk flow, miss your baby, want to cuddle and hold your baby. I know mothers past lactation have said the get a sensation years after they wean... seems to be the same idea.

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