Permission to Mother

Tongue- Tie Tale

2012-01-21T09:55:00.000-05:00

True Story:
this was this week
Mother's nipples hurt during latch of newborn and ended up pointy like a lipstick.
Nurses told mother that the baby looked tongue-tied. They recommended checking with the IBCLC. ((Yay, for the nurses!))

IBCLC confirmed the tongue-tie. Referred her to me. ((Right-on!))
PEDIATRICIAN even confirmed it was tongue-tie!! He referred to ENT!
ENT AGREED!!

ENT scheduled baby to have frenotomy relaeased in out-patient center. :(
Mom's nipples still hurt.
Out-patient surgery center notified parents that they don't take newborns. Either they can re-schedule at 6 months or go to the operating room.

Waiting won't help breastfeeding TODAY.
Anesthesia is not necessary.

Mom came to me. Determined to breastfeed.
She explained all this to me. Showed me the baby's tongue and her lipstick shaped nipple after latching.

A very simple snip in the office released the frenulum.
The baby went to breast.
No pain.
No lipstick shape to the nipple.
Everyone Lived Happily Ever After.
The end.

Milk Sharing (My Statement)

2012-01-12T21:53:00.002-05:00

Addendum1/22/12 : I have been sent updated links and comments in response to this post. My post is outdated. Until I can update, read through the comments. As I have found out there ARE guidelines from LLL. Not too many people are aware that leaders can discuss the pros and cons of milk-sharing when it is brought up. Per the guidelines it is very appropriate for a leader to refer to a health care professional for a discussion of medical pros/cons of informal milk sharing. That is where I would come in. I want to evaluate why the mother can not meet the needs of her baby (low supply or medication exposure or other reason), can it be corrected and if not discuss the options of what to supplement with (donated milk, home-made formula, commercial formula, cow's milk, goat's milk, or vegan mylks with and how to supplement it (bottle vs supplemental system, etc..). Human Milk 4 Human Babies is a commerce free site on facebook to offer your extra milk or seek potential donors. Look for the global network and your regional group.

From my attendance at the recent conferences it is apparent that even some of the breastfeeding doctors can be adamantly opposed to milk sharing. La Leche League does not support informal milk sharing either.

It would be very reasonable to support milk sharing amongst friends who have known blood tests and are obviously healthy.

If the mother is feeding milk to their own baby, and recipient knows both the donor mother and the baby, it sounds responsible for a breastfeeding group to support informal milk sharing. Then go on to clarify if you must that if you don't know the mother and the baby that carries risks of the unknown.

There is VERY little that makes milk bad. I'd be afraid of the risks of formula and increased illness.

If you don't know the donor you can get to know them.

The only reason I once heard for La Leche League not supporting the use of donor milk was desiring credibility to new-comers and the public.

There is much more awareness now on the benefits of milk-sharing, it is time to update policy and make a huge positive impact.

I could also accept if a new policy stated that both mothers and both babies be monitored for good health through out the donation period. The donor mother's prenatal labs with HIV should suffice (HIV is a topic for another post). A donor baby who is healthy and growing, labs are not necessary. We just want to see that the baby won't be compromised if mother shares milk. The recipient mother should have an evaluation on why she can't produce enough milk and optimize her own production.

Doctors get blamed for making decisions based on pharmaceutical and financial interest. I have wondered if the hold out for breastfeeding groups to accept donor milk has something to do with collaboration and survival of milk banks. I don't know if this is fact, so don't quote me. It's just a thought.

Pasteurized milk serve a special community: the preemie babies and research. It is not easy to get pasteurized milk out to the communities healthy babies.

I will take this one step furthur. I have been a Raw food advocate. The same principle applies to breastmilk. While pasteurized breastmilk is much better than formula. Minimally processed breastmilk has the LIVE enzymes. I also support the use of minimizing the handling of fresh milk.

If anyone has milk to share at this time, I can probably find a home for it.

Finally,

I do not support buying milk from Craig's List and Social Media.

Miami Physician's Breastfeeding Summit

2012-01-08T20:52:00.001-05:00

Like a geek, I sat in the front row of this physician's meeting on breastfeeding in Miami. I wanted to make sure I heard EVERYTHING. I didn't even know about this conference til about a week ago.

I get patients from Miami and when I heard about the meeting, I felt like I should now what is going on there.

Who's at the table:

Grisel Garcia MD from Miami

Joan Meek MD from Orlando

Julie Kelogg MD from Jacksonville

Liz Westwater from Baby Friendly

Lourdes Forester MD from Miami

Alberto Dominguez-Bali MD from Miami

So Miami has 14 hospitals and 12 are working towards Baby Friendly! Part of becoming Baby Friendly is that your physicians must have 3 hours of formal training in breastfeeding. Attending this meeting was physicians and other staff trying to meet this requirement. How do you get a physician at a meeting on a Saturday morning, on breastfeeding. FREE CME, FREE breakfast and lunch, and a mug.... the good view of the harbor was a bonus. It got me there!

This was not a lecture to the choir!

Joint Commission a group that hospital quality control has a campaign directed towards mothers to "Speak Up".

That's how the meeting started-- by showing the brochure. What does it mean when your mother speaks up and asks for skin-to-skin. ((It never entered my mind that a physician might not know what skin-to-skin was.)) This was a good non-threatening starting place to reach the participants. Dr. Bali showed a video of attachment after birth and the phases in detail. He emphasized touch, touch, touch... and he was quite passionate about it. He said, if the mother couldn't do skin-to-skin immediately, partner or grandma should.

He said we forgot something very basic-- WE ARE MAMMALS! No other species survives without breastfeeding.

We talked about removing warmers from the delivery room

Talked about how damaging suctioning is because it cause aversions, stresses baby, changes the flora.

We talked about how WE interfere with breastfeeding. We ((doctors)) and our policies interfere.

But the good news is how a little education and a little encouragement form the physician GOES a long way.

The speakers told the other doctors to tell their patients:

"As your doctor, "I want you to know I support your breastfeeding."

A point was made that if you tell mothers this, you should remove the formula display from your waiting room which undermines a mother's confidence in herself and you.

In the hospital, anticpate the baby will be up all night. The hospitals are implementing a no procedure, restful period from 1-3 o'clock in the afternoon. We talked about how society prepares mother that everything will go back to normal. We need to support mother better.

It was noted that in one area no one came to the breastfeeding support group, but they changed the name and many came to massage class (and they spoke about breastfeeding).

When the hospital got an estimate to purchase formula, the formula company inflated the estimate. There was several reasons that actual usage didn't meet the estimated purchase cost. For example- staff passed out extra formula because it was free. As time went on and they used less formula, they purchased less.

We talked about delaying procedures, growth curve, reflux, hepatitis, glucose, jaundice, starting solids.

The participants got to ask Questions at the end. I thought this three hours was excellent for Physician Breastfeeding 101.

The AAP is coming out with a new breastfeeding statement this year emphasizing the physicians role in management.

At the end Liz from Baby Friendly encouraged the doctors and said that surveys use to come back with negative about the doctors being the barrier, but in more recent years, the surveys come back as the doctors being the one who moved it forward!

I see mothers from Miami for tongue-tie (frenotomy was not discussed) and alternative vaccine schedules (discussed briefly, if any of the speakers supported an alternative schedule I didn't here it). Also, most of my Miami consults have had out-of-hospital births. This meeting should have a positive impact on what is going on in the hospital! A good start has lasting effects!!

What's New Here at Permission to Mother

2012-01-05T20:08:00.000-05:00

Over the New Year's Weekend in my blog reader, I noticed a lot of blog authors reposting their favorite blog post of the year. It made me realize how long it has been since I have added anything here. My kids don't like me taking their photos and they like more privacy. I get that. Although I do plan to update about their homeschooling and other activities very relevant, I am not using this so much to update family and friends. I will use it for birth, breastfeeding, and homeschooling mostly.

I've been actively following a facebook group for the La Leche League of the Treasure Coast. We have over 200 enthusiastic mothers standing up for their breastfeeding and asking tons of questions to make good choices. I love seeing so many involved mothers in one place!

I've been to two breastfeeding conferences this fall. I am planning to attend a morning conference in Miami geared towards baby-friendly and physicians this weekend.

I've been going to some local LLL meetings and events. I have an events tab up above on my blog. I like meeting you and seeing your babies out of the office, so hope to see you there!

In my office we have moved from paper charts to EMR (electronic medical records). This continues to be a big transition.

I frequently get e-mail like this:

I received your name from a local IBCLC after being horrified by my current ped's advice. After taking a look at your website, I really hope you can make room for my baby and I in your practice. Here is our situation...

We exclusively breastfeed, cloth diaper, and babywear, and I consider myself very knowledgeable in all 3 areas. Breastfeeding is extremely important to us and I plan on doing baby led weaning.

Now at 6 months, she hasn't gained anything since 4 months. We question vaccines. We'd like to have an opinion from someone else on vaccines, weight gain, etc...

PLEASE be our new doctor!!!

I carefully keep tabs of the amount of active patients in my practice. I leave space each week to offer appointments to those moms who share the same beliefs as I. I hope to fill ALL those spaces with moms and babies who need well visits or consults.

Another question I get asked:


We don't go to the doctors much, but it would be nice to establish with a doctor just in case something comes up. Can my family come to you without getting caught up with vaccine schedules and other demands.



I am very flexible. I know there are many families who take good care of themselves. I know that they don't get sick much and have remedies they use before calling a doctor. That is the goal! You take care of yourself. I only make recommendations and/or support you your choices. As long as we have good communication and what kind of situations you may need medical care, I find this flexibility works. 




So despite the blog being quiet, I've have not been.   One more thing... I don't know why I have problems with fonts and laying out photos. It doesn't make it fun to blog. When the fonts and spacing  are no longer easy to deal with. I can easily kill a lot of time figuring out what is wrong with the spacing, but I am going to hit publish now...Sigh.

Administrative Q about Network Blogs

2011-11-28T22:01:00.000-05:00

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.

Gut Integrity- NEC

2011-11-08T21:36:00.001-05:00

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.

Vitamin D in Florida

2011-11-07T16:57:00.001-05:00

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

Learning from Moms: Babies with Down's Syndrome

2011-11-06T18:45:00.000-05:00

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.

Vitamin D update

2011-09-30T21:30:00.000-04:00

I have tested 7 lactating mothers who have babies between 6 weeks and one year.

So far all the mothers have sub-optimal Vitamin D levels.

All live here in the Treasure Coast (or are close). (This is South Florida, in case you don't know). All are involved in La Leche League and educated on this controversy about giving Vit D supplements to babies.

I do not have any fully breastfed babies tested yet.... Veins to small, don't want to put a healthy baby through that, and other reasons, it's not getting done.

I have one supplemented baby who tested adequate who also takes Vitamin D.

I have been testing a lot of adults who are not lactating. Many come back low.

I am not making any scientific or clinical conclusion yet. I think we all need an Rx to go to the beach this weekend!

Adoption Protocol for Breastfeeding

2011-09-03T11:21:00.000-04:00

I have recently had a cluster of consults for induced lactation for adopting a newborn. I want to lay out some thoughts.
I follow the protocols from asklenore.com
Here is a link to the regular protocol.

There is no typical "adoption."
Everyone's situation is so uniquely different.

Not all women are adopting because they are infertile. Some want to expand their family both biologically and through adoption.

I often asked the adopting parents to consider how they feel about approaching the healthy birthing mom to express some colostrum or provide breastmilk. One of the most recent mothers found out about induced lactation because the birthing mother told about induced lactation. Some birthing moms are even willing to let the baby latch and suckle. This would be the best for the baby. Some people raise concern that the birthing mom will experience strong attachment and change her mind. I don't know if this concern is founded.

I learned from another mom, that her adopted child nursed better than her biologic children! This mom is planning a twins adoption now and starting the protocol again.

Some moms don't mess with herbs or prescriptions and just put the baby to breast with a supplemental nursing system. They may have had not enough time or just don't want the medication. Even if you used the protocol, it is still a good idea, to be familiar with this option to meet the babies full nutrient needs in case your supply isn't fully in. Medela makes a supplemental nursing system and lact-aid.com. ( I do have the supplies of both systems in stock, if you like to look at them.)

What to supplement a newborn with if you can't bring in your own full supply?
Birthing mom's milk, donated milk, make your own formula, commercially prepared formula.

Most moms don't know the ways to get breastmilk.
1)Once involved in a local breastfeeding support group many woman find other local moms with extra stored. 2)Facebook has a group with Human Milk for Human Babies (this is Florida, you can search for your region) where those in need can find those with donations. 3)There are pasteurized milk banks (expensive and not enough of them, mostly serving the needs of a hospitalized preemies, special situations, and research), and 4)For-profit milk banks (I do't know enough about these). I am biased towards the first two choices.

Get yourself a sling or babywrap to promote bonding and milk production. It's a great idea to attend a LLL meeting and have the support of an IBCLC lined up.

If you have a medical condition or concern, I may also be able to help you with approaches that won't interrupt breastfeeding.

Feedback From a Midwife

2011-08-27T14:27:00.002-04:00

"Your book is the most borrowed book in my library."

I know women in my area enjoy Permission to Mother because they get to know my practice and family better and read stories about mothers they recognize, but that I appreciated her feedback knowing that it has been a good resource in her area, too.

"I live in a very conservative area and these women were sometimes surprised at first by the book's candid approach (as well as mine) but I've enjoyed the various "reviews" when they return the book:

"Sure does make you think"

"It helped me to laugh about everything instead of being as worried,"

and

"It's about time someone said it like it really is."

Julia Swart, LM, CPM

Southwest Idaho

Dr. Punger's Informal Vitamin D Study on Breastfed Babies, Toddlers, and Children

2011-08-09T20:45:00.001-04:00

"The American Academy of Pediatrics is recommending 400IU of Vitamin D to breastfed babies starting soon after birth. Breastfeeding is the ideal form of infant feeding, but supplementation with Vitamin D, starting soon after birth, is recommended because breastfed infants generally do not obtain adequate Vitamin D from other sources. Pediatricians should encourage parents of infants who are either breastfed or consuming less than 1 liter (just under 1 quart, or 33.8 ounces) of infant formula per day to give their infants an oral Vitamin D supplement to meet the current AAP recommendation."

Vitamin D is a hot topic. It's a potent anti inflammatory and antioxidant. Up to this point, I have not routinely recommended Vitamin D supplementation of the exclusively breastfed baby living in South Florida. I would prefer that babies consume only breastmilk to protect the optimal development of a healthy sealed gut and natural flora. I have been making recommendations to get indirect sunlight in the morning and late afternoon.

Are we giving our babies, toddlers, and children enough sunlight?

With the enthusiasm and interest of a diverse group of mothers I would like to check Vitamin D levels in mother and baby (toddler and children).

Your participation is voluntary. I can give you a the script to get you and your breastfed child's levels checked. Results will be kept anonymous, but will be made available to other mothers via Internet and possibly formal research. I will ask each participant to fill out a brief questionnaire regarding ethnic background, diet (vegan, vegetarian, wholefoods, junk food) and
supplements.

The lab test will be at your lab and you will responsible for for any portion not covered by insurance. I will provide you with the best diagnosis codes and results of your test.

I am looking for self-motivated, volunteers(mothers and breastfed baby), enthusiastic about furthering our understanding about Vitamin D deficiency in South Florida.

References
AAP
Sunlight
Kelly Mom

Starting Thursday AM, if you have contacted me to participate, you can pick up your script for lab work.
You may contact me here to express interest: email Use Vitamin D as your subject.
I will confirmed that your lab requisition is ready before picking it up from my office.

An example of how I may share anonymous results on my blog would be:

1. 2 month old Latin male exclusively breastfed -- suboptimal levels.

World breastfeeding Week Schedule

2011-07-29T20:59:00.000-04:00

This schedule of WIC/LLL events are awesome. I wish I could be at everything, like a weeks vacation. Looks like so much fun! I didn't realize that WIC was having so many activities. Facebook is a great way to reach out (there is an event page for each activity) and I hope their is lots of attendance at all the events.

Tuesday, August 2nd, at WIC office on Avenue C from 11 am to 1 pm Babywearing Fashion Show.

Wednesday, August 3rd, at WIC office 531 Lake Whitney Place, SLW. 11 am Permission to Mother. Dr. Punger will answer your breastfeeding questions.
Wednesday, August 3rd, at WIC Office 531 Lake Whitney Pl, SLW 2:30 - 3 and 3 - 3:30 Yoga classes by Jenn Cohen.

Thursday, August 4th, at WIC office 531 Lake Whitney Pl, SLW 11:30 - 12 and 12 - 12:30 Yoga classes by Jenn Cohen

Friday, August 5th, at WIC office 531 Lake Whitney PL, SLW 11 am to 1 pm Babywearing Fashion Show.

culminating in the www.LATCHonPALOOZA.org extravaganza on Saturday morning
....and the following week be sure to hit Panera Bread in Vero, 2nd wed of the month La Leche League meeting, where you can meet our newest Leader!!!

What's your favorite nursing bra?

2011-07-25T21:55:00.001-04:00

I wore playtex for many years (do they still make bras?). After I found medela, I realized my playtex bras fell apart quickly and gave them up. I tried bravado, but found they lacked the support I need (13 years ago, things might have changed). I have one from motherwear... this was before I had medela and I was feeling huge. It was the best support ever for heavy pp breast. Once my first son was born, I wear a bra 24/7. I am not comfortable without one, ever. I still wear my medela sleep bra around the house and at night. The tanks didn't come out till after my third. After a few months pp I was comfortable in a tank without a bra. If I wear my tanks now to exercise, I put a sports bra underneath. I wear them around the house without a separate bra. The first time I bought nursing bras, I thought to myself, "Do I really need this? I'll only need it a short time!" haha-14 years of maternity and nursing bras...that's a short time... my size has changed through the years with pregnancy and weight management issues. I've had quite a collection. Makeshift- sports bras were not comfortable to me. I have never worn a target, k-mart, or off brand bra... I need support. The latch on playtex I could release and put back with one hand. Medela can be released with one hand, but I need two hands to put it back.

Now for what I don't like... I never wore one, but it must be popular. I see it a lot. Not sure what it's called and if more than one company makes it... but I don't like when the cup is thick and "molded." What I observe is that it is hard to pull it truly out of the way so that the breast position is not distorted. Your breast should be in the natural position when the flaps are moved out of the way. If you can't get your cup out of the way, either get it out of the way, or consider another style. Newborns need your breast and nipple to be in natural position and no fabric in the way of learning to latch.

Disclaimer: I currently sell Medela bras in my office. When I run out of inventory I am not stocking up again. It's too much to keep up with all the different styles, colors, and sizes. I don't have space for the inventory. I am not paid for this review.

Can Nursing Twins be Done?

2011-07-21T18:27:00.001-04:00

I know nursing twins is hard and time consuming. Tandem nursing took up my focus for years (a bit different because one is old enough to benefit from solids and distraction from another caregiver). My breastfeeding advice to a woman expecting twins, if they want to breastfeed exclusively is to not plan to do anything else for the first 6 months after babies are born except hold babies. With a singleton, I got that advice; that was probably the best advice I got.

Of course, that's not always real life. We all have other elements of our life to consider particularly earning money and paying bills and the educational requirements to be employed. I had to let go of optional things for one baby. Deciding on your breastfeeding goals and if it is realistic (and what other things to put on hold) would be something only the mom (or parents) can decide. I am glad to support you with where you are at.

On the positive side of things, some mothers don't need the full 6 months to get in the groove and find themselves incorporating the babies into life more easier or sooner than expected.

I just appreciate knowing what your goal is, so I can be most helpful.

Liquids, greens, and high quality grains, vitamins or high quality supplements are beneficial to establishing your milk supply as well as mastering the art of babywearing twins. Have several carriers.

I didn't say it would be easy. Planning ahead for donated milk, galactologues, and shields probably a waste of time. I have mixed feelings about pacifiers. I have a hard time recommending pacifiers at least til supply and breastfeeding is established in any circumstance. Probably better to hold the babies than to worry about the results of pumping.

I do believe it's possible to build a supply of milk for your babies. To deliver it to your babies exclusively at the breast is a HUGE commitment. I won't lie about that. I commend the mothers of twins who can provide their milk for their babies.

I hear it's hard to find good twin breastfeeding information. Any words of wisdom anyone care to share?

How late is too late to become a nursing baby?

2011-07-18T00:00:00.004-04:00

Here is another beautiful comment left by Daryllyn. I wanted to make sure everone has a chance to see it. A part of my feels that feeding at the breast is a lifestyle choice. I have not been that successful getting babies past 4 months old to latch on, but there is always exceptions. Thank you for sharing this story with me.

noelani has left a new comment on your post "How late is too late to re-lactate?":

When my fourth adopted child was placed with me, she was 6 1/2 half months old. I was still nursing my 2YO and really wanted to nurse her. She had spent most of her life in the hospital and had issues with both her physical and emotional health. I was told that a baby over 4 months could probably not be taught to nurse, but I tried, anyway. At first, things did not go well at all. I applied everything else I knew about attachment parenting and made a great deal of progress with her. For months, I tried to be happy with that, but I couldn't do it. Finally, I decided to consider every aspect of her experience of bottle feeding and then tried to make small changes toward breastfeeding. The day before her first birthday, she became a nursing baby!

Since then, I have been in touch with other adoptive moms who wanted to get older babies started breastfeeding and needed encouragement. Some of their children have been well beyond infancy when they began breastfeeding. The results have been tremendous, especially with children who have experienced a great deal of trauma and/or deprivation in their early lives.

I would encourage any mother who has an interest in re-lactating to go ahead. It may take a lot of patience and creativity, but it can be done!

Adoptive Nursing: Advance Preperation is Helpful but not Necessary

2011-07-17T19:02:00.000-04:00

I was happy to get this comment to a post buried way down in my archives... I want to make sure you all get to see it. Thank you Daryllyn for sharing!!!

I was very happy to come across this site today! I have breastfed my six adopted babies, born between 1983 and 1995, using the Lact-Aid. Domperidone, which is the only drug that is safe and effective for use in induced lactation, was either not around or not available to me. I never knew very far in advance of the babies' arrival; sometimes less than 24 hours. I just started nursing on demand with the Lact-Aid when they got home. In a short time, I was producing drops of milk and that slowly increased as we went along. I needed to supplement until they were taking other foods, but they got a significant amount of milk from me. My last four children nursed until they self-weaned, at an average of a little over two years old.

I want everyone to know that, although advanced preparation can be helpful, any mom who wants to can start nursing with the Lact-Aid, whether she's had a chance to prepare in advance, or not.

I like the fact that this site focuses on nurturing. In recent years, the option of inducing a milk supply in advance with medications and breast pumps has had an unfortunate side-effect in that some adoptive moms focus so much on pumping milk that they never get nurturing at the breast established. I think they, and their babies, miss out on the best part!

Darillyn Starr
noelani54@hotmail.com

Latchonpalooza

2011-07-15T22:07:00.004-04:00

Latchonpalooza


Treasure Coast
	Saturday morning, August 6th, 2011 Charles E Ray Park 5626 N.W. Manville Drive Port St Lucie, FL Please register by 10am Latch On 10:30-10:31 The first 100 moms to register will receive a free goodie bag with samples from our sponsors.
La Leche League of the Treasure Coast is partnering with the Big Latch On to celebrate world breastfeeding week, on August 6th from 10:00-11:00 AM at Charles E Ray Park in Port St Lucie. On August 6, 2011 at locations around the world groups of mothers will simulataneously nurse their children at 10:30 AM local time to promote breastfeeding and to celebrate world breastfeeding week. Please register early, the first 100 moms will get a free goodie bag filled with samples from our sponsors. The event will include free raffles, playground for the toddlers, informational tables from organizations including La Leche League, and others. Follow us on Facebook Latchonpalooza in the Treasure Coast for more information on the exciting event!

Treasure Coast

Saturday morning,

August 6th, 2011

Charles E Ray Park
5626 N.W. Manville Drive Port St Lucie, FL

Please register by 10am

Latch On 10:30-10:31

The first 100 moms to register will receive a free goodie bag with samples from our sponsors.

La Leche League of the Treasure Coast is partnering with the Big Latch On to celebrate
world breastfeeding week, on August 6th from 10:00-11:00 AM at Charles E Ray
Park in Port St Lucie.

On August 6, 2011 at locations around the world groups of mothers will
simulataneously nurse their children at 10:30 AM local time to promote
breastfeeding and to celebrate world breastfeeding week.

Please register early, the first 100 moms will get a free goodie bag filled
with samples from our sponsors.
The event will include free raffles, playground for the toddlers,
informational tables from organizations including La Leche League, and others.

Follow us on Facebook Latchonpalooza in the Treasure Coast for more
information on the exciting event!

Some Vaccine Books I've Read

2011-06-22T22:49:00.000-04:00

In case you don't get around to reading all these books, I have. These in the photo are in my library.

The left side is more pro-vaccine choice.

The right side is more for the complete schedule.

A long time ago, I read making an Informed Vaccine Decision: A Parent's Guide to Childhood Shots by Mayer Einstein MD and How to Raise a Healthy Child in Spite of Your Doctor By the Robert Mendelsohn MD. Both of these books would be far to the left opposing vaccination and actually coming right out and saying "Don't Vaccinate".

Whether or not we agree on vaccinations, I know the issues. I'd rather you concentrate on learning about empowering birth and breastfeeding if you don't have time to read everything. I can help you make a good choice.

I've often wondered if pediatricians or other doctors visit my blog with an open mind or if the critical type follows me. All are welcome. Please come back.

Compulsory Vaccination: Monetary vs. Altruistic

2011-06-11T21:21:00.001-04:00

Many assume physician practices make a lot of money off vaccines. Maybe there is a lot of profit for some doctors. I am naive as to how they are making the vaccine profit (that makes them so stubborn). I know the manufacturer gets the product sale, but I am not sure what drives the Pediatrician to be so insistent on the full vaccine schedule. Capitalism motivates and perhaps that's why it is so hard to find doctors who are flexible with vaccine choice. Or is it really the fixed-firm altruistic belief that the complete schedule saves lives. ( I realize I am really putting myself out there....)

I'd like to consider the financial incentive:

Medicaid distributes vaccines to participating pediatricians (I think), but I am not a part of that program. I don't know much about it. Is there incentive for the provider to push?

The physician gets to bill for the office visit, but that's the office visit and not the immunization. Would some visits be lost if there would be no vaccination administered. Sure, there would be. But that's the families choice and I am not responsible if they don't choose to see me (It should be clear if you are missing appointments without mutual agreement, I am not repsonsible for after hours care.). In my practice situation, many still come in for the recommended visits for questions, concerns, education, breastfeeding, nutrition without the pressure to vaccinate and the reassurance in having my emergency availability. The visits equal out. At least for me it does not make a case.

I have never been given (or even offered) a bonus or any kind of incentive for vaccination children. If I've been indirectly offered a bonus for vaccinating adults, I am oblivious to it and focused on what I am (not) doing. I am not eating their free-lunch either. I'd rather have my smoothie.

I am not saying these incentives are or aren't out there. I am just not sure.

Perhaps it's in the volume. Maybe in bigger, multi-physician practices the financial incentive is in the quantity. I am just relatively small volume seeing patients of all ages in the mix. "Vaccine-volume" doesn't work to my benefit. We don't have one nurse dedicated to vaccines all day.

Health Insurance reimburses for administration. They do not reimburse for these items regarding vaccines.

Inventory
Storage
Refrigeration (including keeping cool during storms)
Needles & Syringes
Staffing & Training
Extra time needed for chart-work
Production of Forms for the Chart
Education of Families
Expired Products (if anything expires, its a complete wash-out)
Our purchase (and reproduction) and distribution of School Forms
Follow-up phone calls regarding side-effects and complaints. (Fortunately, I don't get many of these calls).

Quite honestly from an overhead standpoint it would be just as well if you did not vaccinate at all and I can simply document DECLINE VACCINATION on the office visit note.

I like to disclose this. Because it's not what you'd expect.

Perhaps, without significant financial incentive to my small practice, it is easier to be opened-minded to accept patients in my practice who do not fully vaccinate because it's a monetarily neutral decision. Let me just say, maybe I'd even come out ahead in overhead if I did less immunization (My nurses might like it too.). Really, it would be very hard to truly analyze this. I am just glad I am able to offer flexibility and feel good about it.

Giving-up Pump Sales and Rentals

2011-06-09T11:42:00.001-04:00

When I started my Breastfeeding Practice 7 years ago, I mistakenly thought, I had to provide pumps for sales and rentals to be successful. I thought I could not have a breastfeeding practice without pumps. I loaded up with the two leading brands and rentals.

I am totally wrong. I hardly sell or rent a pump.

What does this mean?

When I sell my last Medela Pump (which happens to be cheaper than Targets price) I am not going to stock up on pumps anymore.
When my contract for hospital grade rental pumps expires I am sending my rental pumps back.

Now, if I am wrong and I truly need to provide pump sales and rentals, PLEASE, someone let me know what information I haven't considered.

I will continue to provide replacement parts for Medela. I have some parts for the Ameda style pump, but overall Ameda and other promising new pump brands don't seem to be in too much demand in my area.

You'd think pump companies would have special interest in "latching" on to me and bribing me to support them. Truth is, I hardly get any support, emails, or calls from pump companies.

The mothers who come to me who legitimately need a pump, seem to have them before coming to me. Someone in the area is doing well with pumps sales/rentals. Target? the Hospitals? the Medical Supply? They are doing so well at selling pumps, I don't need to.

Mothers who come to me, often still have problems. Or they wouldn't have come to me. Could it be

THAT THE PUMP DIDN'T SOLVE THE PROBLEM? Yes, the pump didn't solve the problem. I try to correct the problem, I tell the mom to put the pump away, and just nurse the baby.

No pump. NO PUMP. I can't sell a single pump. I want the baby to nurse.

It is possible to have an out-patient breastfeeding practice and not be the supplier of pumps.

Mothers of preemies, the hospital will certainly supply you with the highest quality rental pump.

Working mothers (or those pumping for other reasons), Target will still be there for your pump purchase.

Others with medical problems (sore nipples, fussy babies, under or oversupply), be leery of what you are purchasing. If you need lactation support, get the right information.

To summarize, some lucky person will get my last Medela pump. If anyone needs a rental pump, I will have till the end of the year. After that I officially retire from pump sales and rentals and concentrate on preserving breastfeeding. I will continue to carry replacement parts and kits.

From up to 2 hours Away

2011-06-07T22:30:00.005-04:00

I am getting more and more babies from Miami to Palm Bay (both 2 hours away in either direction) coming to the office. This is a typical question I get asked.

How does well-child care work with your patients living so far away? This is my first baby so I'm just learning what the normal doctor schedule is once the baby comes.

At first I had no particular thoughts on this and no "plan" for long distance. "You all" were coming to me and telling me it's worth the drive. I am just letting you know what seems to be working.

I like to meet with mom (and dad) before the baby is born if possible. I prefer you to opt-in to my email program.

I like to see both the mom and baby together feeding at first visit after the birth. Nearly 100% of the time this is very beneficial because new parents have many questions pertinent to both the mother and baby. I like to see the baby breastfeed and reassure you that feeding is normal.

The baby's schedule is approx (amended 8/20/11) :
1 week -2 weeks (or sooner)
4 weeks-2 months
4 months
6 months
9 months
1 year.

I offer heelstick testing of the newborn (PKU). I don't routinely do any other blood work. I individualize the need for Iron, CBC, Lead. I rarely find the levels necessary. Those levels are requirements to maintain WIC benefits and not a part of well-child care. Less is more.

I find that breastfed, stay-at-home babies don't get sick as often as we are conditioned to think kids do, so I don't think that moms are making the long drive too often with acutely sick kids. I try to avoid that. Many times I have called in something to hold you over until you can safely drive to the office. If it turns out you have a chronically fussy baby or very sick-one, the arrangement with me may not work.

For many parents, they prefer my style of well-child visits (and will go to the urgent care locally if it is that bad that one time). Obviously for injuries and emergencies it is appropriate to go urgent care or ER no matter who or where your pediatrician is.

I find when I get to know families, walk-in clinic visits for fever and illness are less frequent. I can usually manage an illness with close communication. I try to empower families to need less visits overall. I have utilized flexible services like phone consult and email services to accomodate different needs of different families.

I have a Question for you. I have listed out 8 times in the first year, I like to see the baby. Who's interviewed traditional pediatricians? How many visits do they require? (on 8/20/11) I amended the above post to 6-7 well-child visits the first year.

Emerging David

2011-06-06T15:09:00.000-04:00

I haven't posted an update on David's speech therapy and reading since Nov 6. Wow does time pass!
David is an emerging reader finally at 7 1/2 (practically 8). After a long break from structured lessons, we got started again in Level 3 of Barton.

I took a break because one thing after another kept me busy and I couldn't focus myself on teaching him. He didn't seem ready. He kept fighting me everytime. I decided it wasn't worth the attempt.

Neither of his brothers read ANYTHING at 7 so I decided not to be so hard on ourselves and relax.

David has coninued to go to speech therapy nearly twice a week. He has made enourmous progress since I started taking him in October. I am not sure how much longer he'll need. His speech is pretty clear, but I still feel their is benefits to be gained. He really likes Libby his therapist. She's found lots of ways to reward him with motor activities, puzzles, and games. He has benefitted in more than on way from speech therapy.

MOTOR ACTIVITES

that is a key phrase for David.

He is good at everything I give him to do:

skateboarding

surfing

hoola hoop

jump rope

scooter

bikes

diving

swimming

tree climbing

and of course karate (black belt by the end of the year if all goes well)

It gives me plenty of opportunity to tell him how good he is at everything he does.

Finally he has asked me to do reading leassons. He eagerly went through the first lessons (blends at the end) in level 3. I see that he will eagerly get through the next few lessons which is familiar material from his speech therapy work.

I made a few modifications with handwriting and the dictation of phrases and sentences. I wrote it out and asked him to read my handwriting and copy it. I just don't think he is quite ready this lesson to write a dictated sentence.

He's atteneded some Science camp this summer and is loving a building set called Snap Circuits and built a radio at with what he learned at camp.

We have Medela Nursing Bras

2011-05-18T14:31:00.002-04:00

Did you know I have Medela Nursing Bras in stock. Here is my inventory of sizes and colors. We can provide a comfortable room for you to try them on and can help you with size. I generally find that Medela soft cup bras run full. Like if you are an F or G, a DD would work for you, if you are a D, a C would work likley work for you. These styles are durable and functional, but may not as sexy as some of them out there. :) I am not a certified fitting specialist, but I am pretty good. One of my staff used to be certified.

Medela Seamless Softcup
$40.00 each

Black
36C x2
36D
38C x2

White
36C x2
36D x2
36DD x2
38C
40C

Nude
36 xC
36Dx 2
36DD X2
38C x2

Medela Comfort Nursing Bra for day or night
one each-
White small
Nude large
Nude extra large
$34.00 each

If you would like to know the best time to come in to try one on in privacy, contact us at twofloridadocs.com or call 772-466-8884.

And Even More Inspirational Reviews

2011-04-30T20:56:00.000-04:00

From One Jewish Mama to Another, March 12, 2011

By Liz P-L -
This book is amazing--I wish I read it when I was pregnant so I could have avoided heartache and doubt BEFORE my little one was born. Dr. Punger's journey from doctor to mom and then to her amazing blended life is inspiring. As a Jewish mom that questions conventional wisdom regarding birth and the early years, I especially appreciated Dr. Punger's candidness about her experiences as a young mom and her spirituality. The letter to her boys (included in the book) about their Jewish names is beautiful. There are not many resources out there for Jewish moms that need "Permission to Mother" so this was an extra special message for me. There are not a lot of heroes in this world like Dr. Punger that have the courage to speak the truth of what it means to be a woman and mother from a thoughtful, emotional, physical, and spiritual perspective. I will refer back to this book as I raise my daughter when I need to remember that we indeed have the right to raise our children in ways that align with our core beliefs. I also appreciate her example of blending her career with motherhood and perhaps find that aspect of the book most inspiring.

She was 'lively', April 28, 2011

By Channah
The book was excellent! Once I opened it, I couldn't put it down. I was intrigued as to how this doctor had the nerve to use the services of a doula, at the hospital; and then, go on to have a footling breech birth at home. As I read each chapter, I was convinced that her experiences were for the many women who will read her book, and receive the answers they need. The most inspiring section of this book is, most certainly, the manner in which she prepared to deliver her last child. She so eloquently describes how she focused on the tetragrammaton, the sacred name of God, putting her trust in HIM; and He not only heard her; but, strengthened her to persevere such an obstacle of great proportions and triumph dramatically.

Indeed, she was `lively'. This is the word used in Exodus 1:19 to describe the Hebrew woman who delivered their children without the assistance of a midwife, in order to save them from Pharaoh. Let it be known, however, that I wouldn't of known this had Dr. Punger not interpreted this Scripture in her book, Permission to Mother. It is a MUST READ!

Two More PTM Reviews

2011-04-29T19:49:00.005-04:00

For Older Moms, April 26, 2011
By Connie Allen Pridgen

I can say what a blessing to have met Dr Punger, by accident, as a dr. who believes in all the things I do and doesn't question me. My daughter is 19 and wish I raised her the way Dr Punger has raised and is raising her children and her teaching other moms how to raise theirs...naturally....Another book I would encourage her to write......is transition from mothering to peri-menopause and what happens next....as she is quite useful and knowledgeable in that area as well!!!! Read her book and her blogs, but become a patient, it truly is life changing ask me and my husband and we have only been her patients since Jan.!!

A "MUST-READ" book for all mothers, February 4, 2011
By Jenn Cohen --See Jenn's Blog, The Natural Mama

This book is a "MUST-READ" for all mothers! I have bought several copies for my pregnant friends. This book totally opened my eyes more to natural births, breastfeeding, attached parenting, etc! I enjoyed Dr. Punger's honest and knowledgable accounts of not only her own birthing experiences but also of today's "typical" birthing senerios. She encourages and empowers women to trust their bodies and their instincts as mothers and embrace nature! With so many other "parenting" books out there, this book truly sets it's self apart. I have personally read this book several times, gathering more from it each time. I had planned a homebirth with my son and at 20 months now, he still breastfeeds, co-sleeps and co-bathes with us. He is an extreemly healthy, bright and independent little boy and I thank Dr. Punger for her inspiration and "permission to mother".

More Reviews

2011-04-27T18:42:00.002-04:00

A book every woman should read before having children, April 8, 2011

By Kristeen Oliveira
I really wish I read this book before my daughter was born! It's a raw eye opener on the subject of natural birth, breastfeeding, and bonding with your children. Dr.Punger helped me tremendeously with low milk supply issues with my infant. I owe it to her that I was able to continue breastfeeding my daughter into toddlerhood. I refer all my nursing mommie friends to her and recommend her book to any mother or mother-to-be. Help other customers find the most helpful reviews

This book is an inspiration!, March 23, 2011

By bobbi2782
I recently have received this book from my sister in law. She gave it to me when I became pregnant with my third baby. I always have had trouble breastfeeding and wasn't sure if I would breastfeed with my third, but after reading this book I am inspired to try again! I am also preparing for a natural birth this time around, even at home! Denise has inspired me and I know I can do it now! I can also add that because of her book and blog that I am eating much healthier than I did when I was pregnant with my first two. I would definitely recommend this book to any mother, whether you are pregnant with #1 or #5, or you are just a mom looking for a great book with great information!

Recent Permission to Mother Reviews

2011-04-26T18:04:00.000-04:00

M. Roth "Roth Family" (Hollywood, FL) - See all my reviews
(REAL NAME)

I highly enjoyed reading this book and found it to be a real eye opener. In the five years that I have been mothering, I have come to distrust many doctors. The doctors I have been to do not seem to understand the importance and need for attachment parenting. Epidurals, C-sections, vaccinations, over use of antibiotics, etc. seem to be much more accepted in mainstream America than natural birth, homebirth, extended breastfeeding, babywearing, co-sleeping, tandem nursing, and homeschooling. To find a real MD that not only encourages these naturalistic practices, but came around to adopting all of them personally is beyond refreshing. I loved the brevity of each chapter and found myself finishing the book quickly because I wanted to just read one more chapter and that kept happening over and over. I think the book's overall appeal comes from the fact that Denise Punger is so open and vulnerable, she didn't hide anything about her experiences or opinions. I felt like i really knew this woman after reading the book. I too came to adopt many of these attachment parenting practices on my own, after searching out what I felt was right for me, my children, and family. In a world where there is so much advice and information from doctors encouraging us to detach from our children as young as possible, it is beneficial for women to know that there are other ways to parent. Hopefully more mothers will seek the permission they need to mother by reading this informative book!

Natacha - See all my reviews

This review is perspective from a woman who breaks the stereo type of attached parenting/child led weaning/cloth diapering/all things considered "alternative". To have this book in my personal library has given me much pride as a woman and mother and I plan on
passing it along to my daughters in the hopes that it resonates with them and hopefullly it will empower them as much if not more than it did me. Another word that comes to my heart to describe this book is validating. To have a woman who has had the exposure to the world of all things medical come forward to share her journey on mothering the way she chose is and will be so validating for many women and men who question themselves over criticism from those they respect and trust (esp the opinions in the medical field). Everyone who loves to read knows that some books are so special they crawl in your heart and live their forever well this is one of those books for me. If you need a fresh perspective on parenting and or you need some validation this is def the book for you.

Vaccine Schedule for K Entry in My Office

2011-04-25T22:50:00.000-04:00

Patients often come to me because they have concerns about vaccines. I am selected out by a unique group of parents that understand good nutrition more than most, understand the deleterious affects of preservitives, dyes, HFCS and other toxins in food, have high breastfeeding rates (and bf for the biologic norm), actively involved in their children's education, and are around decreased amounts of second-hand smoke. It may be hard to compare my group of patients to other local pediatrician's practice vaccine outcomes or Pediatrician's in other areas. Many families choose not to immunize in my office, but from those that do this is the most they get in my office.

From 0-2 months
Nothing. I will not give a vaccine before 2 months.

From 2-6 months
Most families will wait till ~6 months to get Hib and/or Pediarix, but I can start now.

From 6-12 months
Pediarix x 3 doses (Can be done at 6, 8, 10 months or 6, 9, 12 months)

Hib x 2 doses. Hib was back ordered for several years. Much of my "vaccinated" practice never got Hib because it wasn't available. (Can be done with Pediarix or opposite months. Most of my "vaccinated" kids get it with Pediarix.

I can provide Pediarix (Heb B, DTaP, polio) and Hib without each other. I can also provide Heb B, DTap, and Polio seperately).

That's it. Up to 5 shots.

From 12 months - 24 months

Pediatricians give Chicken Pox and MMR at 1st birthday. Most of my families who do eventually give these two wait until school entry or more developmental maturity. There is a 4th doese of DTaP due this year. A 3rd Hib can be given this year.

That would be 3 (maybe 4) more shots, if you get these.

Kindergarten Entry
I provide boosters for K. 4 boosters are "required." Polio, MMR, Chicken Pox, DTaP. I do not give these at one visit. I will do 2 and 2, 1 month apart. For Kindergarten entry I get referrals from the school, so I get more requests for these than I do the primary series from families that started with me with new babies.

A No-Hassle Medical Exemption is available from me whether you started shots or not.

Author reflections...

2011-04-22T10:20:00.000-04:00

Tonight I am reflecting on the 4 years PTM has been out and what's new since. I am impressed with the diversity of mothers who have benefited from my work. The variety of reviews should be helpful to you as you could quickly determine if my book would be helpful to you or goes against any deep convictions you have. True, I want to preserve breastfeeding. You could call this a collection of articles on topics of concern to mothers and how they all relate to breastfeeding. I have been pleasantly surprised that even women, who have babies that didn't breastfeed, still find inspiration in my words. I am encouraged that the birth stories I share have given women courage to speak up for and reflect on their birth experience in an empowering way.

The basic needs of new mothers are the same. My personal autobiography of my childbearing years won't change. The way we get information since publication has advanced. Social networking is big. Yahoogroups was how I stay connected prior to printing, but I am quite impressed with the birth and breastfeeding community on blogspot and facebook. I would have loved a blog journal of my last pregnancy. I am most impressed with a facebook group matching up moms in need of milk with moms who have milk, Human Milk 4 Human Babies. There is a lot to be said for human milk donation especially since it's not heat treated. Despite facebook's adversity towards breastfeeding photos, the on-line extended breastfeeding community has reached a new level. Mom's are more openly willing to share their photos. I've been candid, but not to the level you can find on facebook now-a-days. Once, I thought Bernadette and I were like the only ones pouring out birth and breastfeeding updates via yahoogroups and our print magazine, Mother to Mother. It's a pleasure to get on my feed and have you sharing news stories quickly and instantaneously.

Since publishing, there have been birth documentaries to come out; Business of Being Born and Orgasmic Birth. See them both.

My own journey with nutrition has involved and I can support the desire to eat vegan and vegetarian while pregnant and breastfeeding (and I totally understand the cravings may keep you from your ideal goals.) I took my nutrition journal to its own blog.

Weaning is a process. I was still producing milk at the time of publication and nursing the baby. I am no longer producing milk, but he is still lingering. Some babies wean all of a sudden in a day or a week or a month. After 14 ½ years of nursing, the last 1 ½ years have been the weaning years.

Many call me courageous to speak out. What gives me confidence is my experience with vulnerable moms. All my topics were carefully considered before including (and before posting to the blog). As an author, I was hoping the book would help me find the woman that needed me. PTM along with the help from blogs and facebook have definitely helped mothers in need find me. I continue to find that in a highly technical world most mothers appreciate having permission to mother.

Bernadette and I met when I was pregnant with my second son. Traditional educated with a full-time career and completely vulnerable myself, I was totally fascinated with the world of a homebirthing, breastfeeding, homeschooling, doula, mom of 10. She has had tremendous influence on my mothering journey and opening the doors to possibilities of raising my boys in ways that deviated from societal norms. Through the years the internet has helped us stay connected and to allow us to support each other with our common goals. As one of the busiest moms I know, Bernadette's communications are a treat to me.

I sincerely hope you will take the time to read Permission to Mother from cover to cover. Read it again. You may be surprised that you find a new theme speaks to you the second time reading. Good or bad, I love your feedback. I would love for you to find me on the web.

You can also find me at:

Rawontheriver.blogspot.com

Twofloridadocs.com

Twitter

Facebook: Denise Punger Coquelet, Permission to Mother, Coquelet & Punger

My amazon, Permission to Mother page

Vaccination Observation

2011-04-13T22:23:00.000-04:00

I am approaching 7 years in private practice. I have been in a unique situation where I can support parents choices in regards to vaccination.

The concern about vaccination is not just limited to parents about the childhood schedules, my senior patients also voice concerns. I have been able to support my older patient's decisions to vaccinate or not.

At the end of seven years this is what I have observed in children.

I have not seen consequences of "not vaccination." For example, I have not observed significant illness or tetanus that could have been prevented by vaccination. I have very few hospital admissions amongst my my pediatric patients following my schedule for well-child care (which is often individualized). ( I have lots of one-time consults and naturally don't know what happens to them.)

I have not seen serious consequences of partial/delayed vaccination. For example, I have not seen "fine-today, not fine tomorrow." No one gets vaccinated before 2 months. Most parents tend to delay vaccination in my practice at least 6 months. We are NOT vaccinating sick children, failure to thrive children, or preemies. When parents accept MMR vaccination, it is almost always significantly delayed until social developmental milestones are obtained (or the lack of development noted and plan made.).

The less serious side effects I have seen of an injection is pain on injection. Some babies and children tolerate a shot well. I've seen a few rashes or knots at the site of injection. Sometimes the injection technique has unfortunately not been the best. The side-effects in a partial/delayed schedule seem to be few (I don't recall many parents reporting fever.) or maybe they don't report it to me. A few have changed their minds and discontinued vaccination. I appreciate feedback from families if a negative experience has been noted.

I have not offered full immunization. Most families seeking me out, seek me for supporting their decision and are not interested in Hep A, rotavirus, pediatric influenza or pc. I can not comment or compare positive or negative incidences to routine pediatric practice because I don't follow the full schedule. I don't offer HPV to young girls. All physicians providing vaccination should be open to discussion with their patients.

I have not enrolled in state computer system to record shots. Records are kept in our office at this time.

Getting a medical exemption is not an issue. Starting vaccination and declining further shots in a series is not a problem.

In my elderly population, more or less I am not seeing "consequences" of not vaccination.

Keep in mind I tend to have a healthy population of patients. Breastfeeding rates are high. Families tend to be conscientious of nutrition. Also, families tend to be aware of exposure such as tobacco, false-food products, community exposure. Making good lifestyle choices influences how we respond to infectious illness. In my practice, I observe that families are active in their pregnancy choices and birth plans which in turn has lasting beneficial affect on the baby's health.

Today's epidemics are diabetes, obesity, high cholesterol, hypertension, cancer, and arthritis. These conditions are far better of manged with nutrition and lifestyle.

We are human and "bad" things happen. Still, I feel like I can support families decisions to evaluate what their family is most at risk for and support their decision. I can also intervene if a particular family has apparently made a poor choice for their circumstances. It is my responsibility to inform my practice if community circumstances change that may sway them to change their previous decision.

I am traditionally educated. I was trained that vaccinations are the best advancement ever in medicine. Never did I imagine that I could be so flexible. I came across the debate 12 years ago for the first time when my 12 year old was a baby. I was shocked that a debate even existed and felt resistant to it.

By observing many of the families in my practice, I have come to the conclusion that the children in my practice are overall thriving and healthy. I am practicing the BEST medicine to optimize health and will continue to provide this flexible kind of care supporting families. I feel it is important to get this message out. Many physicians are employed, controlled by large practices and hospitals, or other external or internal regulations and don't have the fortunate situation to observe what I do.

Posterior Tongue-tie

2011-03-05T22:08:00.000-05:00

It's often very satisfying to help a mom with a tongue-tied baby because there is almost INSTANT relief.
If I suspect tongue-tie, I recommend taking care of it as soon as possible, if the mom wants to continue breastfeeding.

This past week a mom came in with her two month old. She had constant nipple pain almost from the first latch. She described her baby as clenching and intense. She has been treated for several rounds with anti-fungals. The baby never showed any symptoms of thrush. Out of desperation, baby was treated, too with anti-fungals. The only thing that consistently relieved nipple pain was to pump and give the nipples a rest from the baby's latch. The focus of treatment was on thrush and keep giving mom more anti fungals. Mom was also doing elimination diets wondering if something in her diet was upsetting the baby making him intense.

What made me suspect tongue-tie?
1. Nothing else helped.
2. I always think of tongue-tie because it's what I do.
3. Yeast doesn't occur at the first or second latch. (However with nipple damage, she could have at some point had an infection.) Also, yeast is hard to treat, but not impossible to treat.
3. The only time she got a break was when the baby wasn't latching.

Okay, so I looked at the baby's mouth. I wasn't that impressed, but there was a posterior frenulum. It wasn't long. It wasn't particularly noticeable. I could see how other professionals not so focused on tongue-tie could easily overlook this. I recommended clipping it because the mom's history was right-on: nipple pain from birth, baby was intense and clenching.

Mom nursed baby right away after frenotomy. As suspected she noticed a decrease in pain, good milk transfer, a satisfied baby, a relaxed snugly baby. And he wasn't very intense anymore.

What do I learn from this. Tongue-tie may be suspected by just listening to what the mother is saying. A baby who is not getting adequate milk transfer, seems to be biting, clenching, and intense is probably a baby that would benefit from a frenotomy. (especially when "everything" else isn't helping.) Obviously, confirm suspicions of tongue-tie by checking the baby.

My approach to tongue-tie may not be very scientific based, but it's one that works for the families that come to me.

I found this relatively new professional group uniting tongue-tie professionals, International Affiliation Tongue Tie Professionals.

Well, How did the Bar Mitzvah go?

2011-02-19T20:56:00.003-05:00

The ceremony was last Saturday. If the weather was as gorgeous last week as it was today, no one would have ever gone home. :) You could have helped us eat all those sandwiches. We are grateful for the kind of Februaries we have here in South Florida.

The boys are full of pride. That's what counts!

This has been very meaningful for Scott. Scott wants David to have a Bar Mitzvah just like his: At home, small and intimate. I take Scott's opinion as a high level of satisfaction.

William has pride too, but in different ways. He's glad he had a party and sleep-over with friends and good food. The meaning for him will sink in over time. Unexpectedly, he went to a Bar Mitzvah today. Now if you asked me, who would have been in synagogue first (after the Bar Mitzvah) from my sons, I would have never picked William. Scott has actually asked to go to a service as a man, but William had the fortunate opportunity to go with his buddy and I think his pride and connection is apparent.

John is happy because we didn't run out of food (runing out of food was the one thing that would have embaressed him) and everything from the party-end went smooth. He felt like we handled the amount of people without a crisis and even thinks that at next party we could handle more. ( A NEXT PARTY... that's really great that he is is so inspired!)
I am happy because I fulfilled my responsibility in rekindling the Jewish spirit in my home, teaching Judaism faithfully to my children, and providing the boys with this opportunity.

Our adult guests said they felt uplifted by the ceremony. In fact, one guest, called me this morning, after a week, to tell me how uplifted she felt all week, she felt inspired to reference the songs and prayers in her Bible. How special she felt to be included in an important event in our sons lives. I got similar feedback nearly everyday from our guests this week.

William said the teens had fun.

So, I am very satisfied with how things went.

I thought I got a break from studying. However David is even so excited that he asked to start studying his Hebrew letters that night on behrmanhouse.com. He has opened up his student center almost every evening.

I was a little worried that after the celebration there would be a let down that there was nothing else to look forward too. Like TV and movies build up Birthdays and Holidays. There was no build up. You don't see Bar Mitzvahs on TV much and the boys had only been to one or two Bar Mitzvahs previously.

In planning we asked the boys what they wanted. They chose the prayers and music. They had input into the food choices. They made the guest list. Not to be sappy, but if we invited you, we really missed you. Really, really missed you.

Almost a "mynion"

We chose to have a small personalized event. I had never planned a party. Ever. Not even little birthday parties. I wanted this to be about the boys and people in their lives and not overwhelm them with crowds and places to be all weekend or what me and John wanted. The just wanted to hang out with friends and have a sleep over. That they got.

Just as a reminder over two years ago, Scott couldn't read English and now he reads Hebrew, too. It is amazing, how far he has come!

David passes out candy to be thrown at W & S by our guests. Symbolic of wishing them a sweet life.

Parents Bar Mitzvah Speech

2011-02-12T11:49:00.003-05:00

Dad remembers when you boys both fit in his pocket. I remember a slightly different version. You didn’t want to leave my arms. [The boys would die if I said BREASTFEEDING.] Amazingly time passes quickly. Although, you have been men in my eyes for some time now, today is symbolic of me letting go and letting you officially become men as you are called to the Torah.

Our guests asked ahead of time if the ceremony is usually at a Temple. Yes, a Bar Mitzvah Ceremony is traditionally held at a Synagogue during regular Saturday service when a boy turns thirteen. With our family being an eclectic spiritual mix, the boy’s learning style, and my need to be unique, we decided to do it this way. Plus we wanted to open our new home to you.

In Judaism, the rule is, is if the mother is Jewish, the children are Jewish. With each passing generation, like many modern Jewish families, my family seemed to be getting away from the traditions that make us Jewish. With so much separation from customs, ironically, my biggest inspiration to rekindle the tradition is from you, my family and friends, who I observed, were faithful to your spirituality. Before we started our formal study of Judaism we actually attended congregation and camps with many of you. I was health-fully jealous that many of you had well-grounded spiritual homes. Although today we represent different denominations, every one, here today has influenced and inspired the boys to reach this mile stone.

With my desire to raise the boys in Judaism and our family’s unique needs, our last year of intense study, we found our Cantor Debbi, whom we are most appreciative for her flexible teaching style and accommodation to our needs. She has been driving to us monthly from S. Florida, calling us weekly, and available by e-mail. Looking back, I hardly remember the reasons we started private study as learning styles and interfaith family hardly matter with her special way.

My original priority in their training was to teach the boys to love Judaism as we rekindled the tradition in our family. When William and Scott were 7, like David, they didn’t know what a Bar Mitzvah is. I actually had not attended many myself. David is excited to plan his own. How our thinking has changed! William, I don’t care if your ”religious” or not. I want you to have a kind heart and a love for humanity. There are many ways to express your goodness. Scott, we love your depth of understanding on complex Torah-based concepts. I am proud of you both for learning your Hebrew and Torah portions. We are proud of you for the example you set through your karate and activity with Max. We are even proud of simple abilities like standing before a mixed audience to speak. Dad and I are proud of the sacrifice of time you have put into your preparation for this special day.

As you now have a foundation to be good men, Dad and I let go of your youth and pray for G-d to work on your heart as men and may He continue to guide you.

Scott's Dear G-d Letter

2011-02-12T11:05:00.001-05:00

Dear G-d,

Thank you for allowing me to become a Bar Mitzvah today. To me becoming a Bar Mitzvah means becoming a man in G-d’s eyes. This day is important to me because I want to become a Man in G-d’s eyes and I am ready to become accountable for my Jewish responsibilities and to make this world a better place through the mitzvah’s I perform.

I would like to thank a few people for helping me get to this place today. I want to thank my mom for her persistence to follow through on her desire to raise me to get a Jewish education. I would like to thank my Cantor Debbi for being available to our family, for her accommodation and flexibility. I would like to thank my Grandma Irma, who sets an example of praying for us all the time, and my Grandma Maxine for taking me to the Jewish stores to get ready. I want thank my dad for writing the BIG check and letting me have the celebration here at the house. I want to thank the rest of my family and friends for being here today and along the way.

I want to make this world a better place. I pray that I am able to go to college and have a good job. I pray to be happy and healthy and one day I want a family of my own. I pray that my actions and model may be an example to others.

I pray for the world. I pray for Israel. I pray that the country has a credible government. I pray for the safety of the people living in Israel. I pray that the Armed Forces come home safe. I pray for no terrorism and for the American economy to get better.

Those are big goals. Through my small actions, my mitzvahs, me and my dog, Max who is now a therapy dog, I want to continue bringing smiles to other people who aren’t as fortunate to have good health.

As a first degree black belt in karate I want to continue setting a good example to the other students, like David, to resolve conflicts without violence and to set an example for them to stay off the street. I want to set an example to them to train and be healthy. Although our karate park clean-up days are a small project, all good deeds start small.

Thank you G-d for allowing me to reach this special day.

Scott Coquelet

William's Dear G-D Letter

2011-02-12T10:45:00.002-05:00

Dear G-D,

Today I become a Bar Mitzvah. A bar mitzvah signifies that I am not a childish boy anymore. I am a man in G-D’s eyes. That mean I am held accountable for being a good man. I am not very religious, but for me, today means that for now on I have to set a good example. Actually I am a good example to the little kids and my peers, but now I am responsible for having the initiative and drive (oh DRIVE, does that mean I can drive a car). It also means less goofing off and just getting my work done. I might sound like a hypocrite, because I get side tracked easy, but it is harder then what I thought to be focused. Religious or not, the world will punish you, if you are not responsible. The Torah can guide us.

My parents are fortunate to have good health, good jobs, and three strong and smart boys, ESPECIALLY me. I thank my parents for their priorities and core values. My mom kind of forced me to study Judaisim, but at least I got to be home-shuled to prepare for this day today.

I THANK my mom who just keeps nagging me to get my work done, even karate and class work when I’d rather be playing. I thank my dad because I am created in his image and I am just like him.

I THANK my Grandma’s who encourage me and says stuff like, “You can do it!”

I THANK Debbi, my Cantor, who drove a long ways to us and always says my worK is “Fabulous!”

I THANK my family and friends who can celebrate with me today.

I pray that I can be a good person and in the meantime, prepare for a good job.

For the world, I hope in a day soon to come that there will be Peace, and no terrorism in Israel. It must be scary living in Israel with bombings and threats so common.

World peace might be hard to come by, but Peace in the world begins with me. Studying Torah is what I can do. In Judaism and as part of my Bar Mitzvah training we do a volunteer activity for repairing the world. In Hebrew “mitzvah” means a good deed in G-d’s eyes. I may have not put in a huge amount of volunteer hours yet, but my Bar Mitzvah project is providing a foundation for on-going life-long contributions. It doesn’t just end today. Really, it just starts today with my own accountability. Mitzvah can be big or small. They all add up. Through my community organizations I do my part to help the world.

1. I volunteered in a haunted garden on Halloween a few times to scare the heck out of people. This lets kids of all ages have a happy and fun time.

2. With Police Athletic league (a group to keep youths from doing crime) and my karate group, I have been to pick up litter off the road and parks. This helps the park look good, helps community spirit, and reduces global warming. It also helps remind me to keep the river out back looking good. IIn karate, we have an annual tournament that raises money for Saint Jude’s Childrens Hospital. I’ve helped supervise the little kids in the community parades.

3. Very important in today’s world, I set an example for the little kids about peaceful conflict resolution through my karate training. We always try to resolve conflict civilly before fighting. PAL’s is affiliated with D.A.R.E. (Drug Awareness Resistant Education). By participating in all these PAL’s activities it makes me a good example about keeping dopey kids off the street.

I pray for my continued ability to do well in my local activities, my scholastic activities and continue learning the wisdom from the Torah.

William Coquelet

Tetzaveh

2011-02-12T10:30:00.001-05:00

William: The Torah is divided into 55 portions. In each Hebrew Calender year if we read a portion of the Torah each week we will have read the complete Torah in one year. Our Torah portion, Tetzaveh, meaning High Priest, is taken from the Book of Exodus, Chapter 27. Exodus is the 2nd book of The Five Books of Moses, and specifically teaches us about the Jews' exodus from Egypt.

Scott: The Torah is very vague in most places and it leaves for our own interpretation, and that's why we think many people are leery of accepting the guidance of the Torah. Our portion is not an exciting part like Creation, or Cain murdering Abel, or the parting of the seas. Tetzaveh is very specific about the details of what a High Priest should wear. This portion gives mundane details about his apron, breast plate, stones to represent the 12 tribes of Israel, the tunic, head piece, and the sash he must wear while preforming the very important mission of lighting the oil lamps in the new Tabernacle. Everyone else is just in regular clothes.

William: What I learned from my Torah portion is how symbolic our clothes may be for specific purposes. For example in karate we wear different patches to denote our school, and gees and different colored belts to denote our rank. Even black belts with different amount of stripes sets an order. When I am in uniform I represent my karate school. I wear my karate gee at karate, I don't wear it at the gym or air soft.

Scott: Likewise my tzitzit, tallit, and kippah are an important uniform for Jewish men. It helps me to be good when I am wearing it. By looking down at these strings and knots it reminds me of G-d and keeps me accountable especially now that I am a man in G-d's eyes. My mom says, when she sees me in a kippah and tzitzit, it reminds her of her responsibility to Judaism, like preparing me to be called to Torah today, so my attire, helps remind her of G-d's presence, the commandments, and G-d's love for us.

William: What do we learn from all this? What does the right clothes for the right purpose have to do with anything else in life? Well, the uniforms, which are clothes designated for a specific purpose, are symbolic for taking what you've got, using it in the right way, for the right reason. G-d does not expect you to be perfect, but you do need to do your best effort with what you got. My brother and I are fortunate to be surrounded by loved ones, have good health, and we have parents that meet our needs. My brother and I are smart enough to know that these are blessings we are given. Now as Bar Mitzvah's we are responsible for what our Torah portion teaches us: to be aware of the spiritual and ethical consequences of our actions.

The Big Day

2011-02-11T12:08:00.002-05:00

Tomorrow is my boys big day! The will become Bar Mitzvahs. I have scheduled some of their speeches and stories to be published on my blog tomorrow along with photos of some of the preparation, so check back...

I have used my facebook page to post updates about things not long enough to post on a blog these past two weeks and feel free to add me. My facebook name is Denise Punger Coquelet.

Fitness Videos: Bench Pressing

2011-02-05T00:02:00.000-05:00

Now it's William's turn to make a video for PE. He takes fitness on-line through virtual school. How come I did all the hard work for this video?? This is MY debut on Youtube. He recorded John and I going through our workout this evening and he discussed safety. His sense of humor is so dry I find it entertaining. I'm sure, he'll get all his points on this assignment. John benched 205. I benched 135. Please don't make fun of me as you see this side of me. :)

E-mail Communication Program

2011-01-23T22:01:00.000-05:00

Concierge--noun: a French caretaker of apartments or a hotel; lives on the premises and oversees people entering and leaving and handles mail and acts as janitor or porter

Concierge care is a concept in medicine where doctors reduce the volume of the practice by offering upscale service for annual fee such as lengthier appointments, same day appointments with provider of choice, e-mail, text, or phone communication directly with physician, shorter waiting times, convenience care (like handling problems that usually require a visit over the phone).

Many years ago my office manager, Dino, said I do concierge care medicine, but had no program set up for it. She worked for other doctors before and thought my patients have greater access to me than anywhere else she's been.

Dino is right. I do or try to do all that on a regular basis with the exception that I can't always guarantee a same day appointment with me, but I try. I can't always guarantee the waiting time, but I try to stay on top of that, too! My patients sure do seem to enjoy the convenience of e-mailing me concerns.

Last Spring, after a few patients suggested and encouraged me to start an email program, I did. I notified only those that had e-mailed me in the past 5-6 months.

Instead of feeling like they are bothering me, now I have defined how I like to be contacted, and by opting in, they know they are not bothering me.

This year, I decided to open my e-mail program up to all patients coming into the practice. I posted the VIP link on my blog and twofloridadocs.com website for references. Everyone coming in for an appointment as of January 2011 will have the opportunity to opt their family in at that time as they update forms.

I am pleasantly encouraged. E-mail access is most useful for those who want to save time:

1- with small children

2- those who travel a lot (and avoid walk-in centers)

3- those who need to contact me over holidays

4- those who totally want to avoid calling the office for appointments or inquiries (though if appropriate a staff member may return your call)

5- those who want to request their appointments, especially for appointments within 24 hours, by emailing me when they are thinking of it

I love my blackberry. My e-mail comes righ to me. So far this is working out well for me. I like being accessible, especially if it's what YOU need from me. I am glad to offer this extra service to you. If you don't want to wait for the next emergency you can let me know now that you want to enroll. I don't want to change a lot around and confuse people (or confuse me by having another place to check), so I am still using my current e-mail address.

Beyond the e-mail program, I am not trying to reduce my practice (it's about the right size) like other "concierge" physicians. I am still gladly accept your referrals. I still try to minimize waiting times and I still do try to handle after hours problems over phone/e-mail with a follow up appointment for all. Obviously, I will always offer exceptional in office care to all patients that opt not to enroll in the additional service.

Feedback and suggestions are always appreciated on how to make communication better.

Simple, Healthy, Tasty

2011-01-22T19:34:00.000-05:00

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!

Time Passes

2011-01-20T12:45:00.000-05:00

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.

Confrontation and Communication

2011-01-07T22:46:00.000-05:00

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.

Scott's Career Inventory

2011-01-04T23:59:00.001-05:00

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

2011-01-04T17:29:00.001-05:00

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

2011-01-04T15:09:00.000-05:00

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.

Week Long Shiva Candle

2010-12-28T23:30:00.000-05:00

One more heavy post about my Grandma Pauline. I wrote this while at my conference a few weeks ago and never published it.

My shiva candle burned for a week. It's my third shiva candle (this is my last of my three maternal grandparents) and I have learned how symbolic the candle is representing the time we need to mourn and reflect. Hoping to watch the candle burn to the end (or at least be there for the flicker to go out), so I can go on to the next phase of mourning, but instead, in this case, reminded me of sitting on grandma's bedside wondering if it would be with her, her last breath. Would I be present for the last flicker to burnout?

Just, like I had to leave hospice to go back to my kids, I had to leave the candle a night early to get to a conference required by Florida to keep our license. We had signed up for it months before knowing we had to be there. Or else. For me it was hard to leave my personal shiva space that I created in my bedroom and go on while the candle continued to burn.

The previous times, I burned a shiva candle, I felt a sense of responsibility of being present to respect the shiva space and for the memory of my grandparents' soul. It was frustrating for me not to be able to be present for Grandma Pauline's candle to go out.

What made me decide to come back to this post tonight is what Scott said to me.

He said in my absence, he was watching the candle burn. He "told" the candle that he promises to tell his children and grandchildren about Grandma Pauline. Then the candle went out and was done burning. He said it was like grandma was telling him that she understood.
With some rituals we wonder why we do it. We just do it. In the end, we find meaning. Sometimes you never find the meaning, but the symbolism and meaning was clearly there this time. If I couldn't be there, I am glad Scott was. It gave me a feeling of resolution. I can only imagine how Blessed Scott is.

Scott's Fitness Essay Continued...

2010-12-28T16:31:00.002-05:00

I interviewed my mom and dad who are both family doctors. I also interviewed both my grandmas. My mom and mom’s grandma are in the best health. My dad and dad’s mom are getting better. I found that they are concerned about obesity. They all feel like our nutrition and what we ingest affect our health including food, alcohol, and smoking. I also found that they are concerned about cancer. They all stated that the media has a negative influence on our health behaviors. They state that there is a lot of information out there and that they like looking on the internet. My Grandma Maxine, says, “People believe everything they hear.” My dad added that most of what we hear has a negative influence. My mom calls the internet Dr. Google and Dr. Youtube. I even once heard her say that Dr. Facebook is where many of her patients get second opinions. What my mom likes about the internet is finding personal testimonies of what works rather than research. She encourages her patients to look up information with her guidance. My dad likes science based sites like webmd.

My family is fairly health conscious. I learned that we tend to all agree, but we all had a different way of stating it. I didn’t learn that much new information, but this lesson was fun hearing all the different ways they said the same thing. It was fun hearing the same thing I know but in a different perspective for this class. I’d like more lessons like this in fitness class. Everyone was willing to voice their opinion. In fact my family has strong opinions on health information.

My dad was the most interesting because he knows about healthy lifestyle, but his diet is not always the best compared to the rest of my family. In other words, he can do a better job. It sounded like my mom was part of a conspiracy. This is what she said, “Obesity can be prevented by avoiding processed food. Babies should be breastfed, avoiding formula, as much as possible. After weaning and for the rest of your life food should include fresh greens, sprouts, and a wide range and variety of seasonal plant-based food. Animal products including meat, fish, poultry, and dairy should be less than 5 % of the diet. No fast food and no soda, Ever.” When I told her that sounded like conspiracy, she said that the big businesses are a conspiracy and she is only one voice.

I am concerned about obesity and the consequences like diabetes, high cholesterol, sleep apnea, and high blood pressure. I want to be fit and I want to prevent problems by eating raw fruits and vegetables and have a total meat intake of 10% of meat in my diet a day or less. I don’t think you have to be as strict as my mother says. I exercise daily. I like the internet as a resource. Although I use Wikipedia and Youtube, I continue to research on more reputable places and ask my parents. I am lucky that my parents and grandmothers are good role models and I get an early start in life.

My next project is to talk about hereditary diseases in a format to educate with media. My mom questions the hereditary nature of diseases that we often think are genetic. So this should be interesting. I am looking forward to hearing more about why she feels that way. Since the internet is where most people say they find information, she said she would post this essay on her blog. I probably will publish my final project on her blog, too, if it is relevant and I can find the right format to do it.

Fitness Class Interview

2010-12-22T10:58:00.001-05:00

Scott interviewed me for his fitness class today. Lucky for my readers, You get a blog post today! He has a chance to turn in an interesting assignment!

Age: 45
Gender: Female
Job: Family Physician
Date and time of interview: December 23, 2010

What are some major health concerns that you have? Poor nutrition and tobacco abuse.

Are there ways that you know you can prevent these health concerns (or other concerns like obesity)? Obesity can be prevented by avoiding processed food. Babies should be breastfed, avoiding formula ,as much as possible. After weaning and for the rest of your life food should include fresh greens, sprouts, and a wide range and variety of seasonal plant-based food. Animal products including meat, fish, poultry, and dairy should be less than 5 % of the diet. No fast food and no soda, Ever.

If you need to find out more about a specific health issue, what do you do? Please be specific. (Don’t let them say “look on the internet”, because we have already learned that not everything on the Internet is reliable! They should tell you a specific site if they use the Internet as a source.) I listen to my patients to know what the issues are. My favorite nutrition site is greensmoothiegirl.com. I like radicalhealth.com. I like asking Dr. Google and Dr. Youtube too!

What do you think is the biggest health concern facing our country is? The tobacco/ food/meat/dairy/formula lobbyist give money to our government keeping their profitable products in consumers faces. Americans believe the government have their best interests in mind.

What are some things that you do to help monitor your health? Annually check cholesterol, intracellular vitamin levels, food sensitivities, check weight and blood pressure. Monitor and record fitness progress.

How do you monitor your food and water intake now? I drink at least 4 cups of green smoothie daily and two handfuls of green leafy vegetables a day. I add some kind of sprouts and superfood to my daily nutrition. We grow our own greens. I eat something from our own garden daily.

How would you help get the word out about this lifestyle change? I have a preventive medicine family practice. I blog.

How do you think the media influences what concerns we have for our health? The media has a negative influence on what people think they should eat and where to shop. Farmers and grass roots businesses can't compete with the millions of dollars spent trying to fool Americans. Everyone needs to take their own responsibility.

9. How do you stay fit?
I go to the gym and lift weights when the boys are in karate. I am active with the boys kayaking, walking, yard work, and cycling.

10. Why did you start trying to be healthy? I was tired of being fat. I didn't like how processed food tasted anymore. I wanted my kids to be healthier.

Black Belts and Interview Sensations

2010-12-20T22:44:00.001-05:00

Check out all three of my boys in action! They want to take you down!

Give Away Winner

2010-12-18T23:00:00.001-05:00

The First Winner of My Give Away is Andrea Santoro. This is the Permission to Mother book review she posted on amazon. She won a copy of my book.

"I found out about this book after being referred to Dr Punger when my newborn was losing a significant amount of weight. It was evident that I was having supply issues. Lost and without other support, I went to see Dr Punger and she assured me that we could work this out and that I didn't have to throw in the towel. Through Dr Punger's guidance, I was able to double my supply and am still breastfeeding my daughter who just turned 6 months old yesterday!

One of the biggest issues I dealt with was the guilt of not being able to provide all that my daughter needed. I felt that I was neglecting her. After reading Permission to Mother, I realized that I am doing the best that I can and I can bond with her not only by breastfeeding, but in other ways like co-sleeping and co-bathing. I have really enjoyed the special closeness I have with her now that I have given myself permission to mother in the way that feels so right for me/us.

I wish I would've read this book while pregnant because I didn't have the labor I had hoped for. I would've liked to be more in control and have experienced it but instead, I let doctors manipulate me into their convenience and while I am so blessed to have my daughter, I do feel cheated. I'm hoping to have the birthing of my dreams when I have my next child and I know it is possible and I have been encouraged by the experiences in this book.

Thank you Dr Punger!

Get this book if you want to be encouraged to parent the way that you feel works best for your family. You don't have to follow what society says is normal, or what your best friend or even your own parents did. Give yourself permission to mother and be the best mother to your precious baby."

I appreciate this review and the insight and update it provided me about Andrea's situation.
Their was no entries for the second book I had to give away. I may do this again in just a few weeks when we are not all so busy with the holidays. I appreciate any feedback you'd like to give me.

Black Belt Certificates

2010-12-18T16:07:00.000-05:00

After a year of Black Belt Training, you become officially certified. Last night William and Scott and two other very hardworking young men got their new rank. This is what the certificate says:

This Certificate Officially Declares That William and Scott Coquelet has Successfully completed all requirements in accordance with the curriculum of the United States Karate Federation and has been tested in all aspects of the Martial Arts systems of Shorinj-Kempo and Mas Oyama's Kyo Kushin Kai-Kan attaining the rank of Sho Don 1st Degree Black Belt on Dec 17th 2010.
The Grand Master is 10th degree Hanshi Robert Fabrey. Also shown are 5th degrees Shihon Joe and Shihon Rich.

David got a rank promotion, too. He has one black stripe on his brown belt. He fits right in with the Black Belts! He got the GOLD Medal Ribbon around his neck for fighting like a champ.

Our Office Best Sellers

2010-12-16T20:18:00.001-05:00

For convenience my office stocks these popular items in our little store.
The best sellers are:

1. Permission to Mother, autographed by Denise Punger
2. Motherlove Products to support milk supply and breast pain
3. Chocolate Bliss and other whole food, raw supplements to support
weight loss and blood sugar,
(No artificial ingredients, fillers, dyes)
4. My Breastfriend Nursing Pillow
5. Mustela skin care and sunscreen for babies (and adults with sensitive skin)
6. Medela Double Electric Pumps, tubing, flanges, etc...
7. Cloth Diapers and covers: Bumkin, Bummies, cotton, bamboo, All-in-one, fitted, traditional rectangle
8. Lunapads
9. MD Forte Replenish Hydrating Cream (staff favorite)
10. Lact-aid and SNS for low milk supply
11. We have a few beautiful Peonies non-padded ring slings

Medela Lactina Breast Pump Rentals and Supplies

These are all products that I would use for myself or family.

Give Away

2010-12-14T21:45:00.000-05:00

I am going to have a give-away for my readers of my book Permission to Mother. I am going to give away 2 books.

I am giving the first copy to the first new positive review added to my amazon page. I positive review would be 5 stars and share how my book helped you or inspired you.

I am going to give a 2nd copy of my book to a randomly selected person amongst the additional positive reviews added. If you already put a review leave me a comment that you would like to be entered.

Please leave a comment on my blog after you have done this. I will randomly select the 2nd winner after 12 noon on Saturday. Amazon reviews don't always show up right away. I may not be able to announce the winner exactly at 12 noon. Please be patient. Thanks. Good Luck!

The Days After Parting

2010-12-05T08:59:00.002-05:00

This is heavy stuff...

If there was anything about Judaism that ever left the most impression on me was Jewish Death Rituals. Obviously, the death rituals are for the family(survivors) to follow through on. But I do feel like, how we respect the deceased spirits and remains are are of significant spiritual value for survivors and respectful to the parted on getting them to World After.

First all, Grandma bought her plot near her brothers about 20 years ago. Back then I thought what a morbid kind of thing to do. But now:
1. I am glad she made her wishes known (whether by accident or peer pressure or she got a good deal). And now we the survivors didn't have to decide or fight about it.
2. Her plot was $1800 back than rather than $18,000 it would have cost now (or was it 180 and now 1800?).
3. She is in a Jewish cemetery. Her good deal ( I am pretty sure it was a good deal, or a 2 for 1 deal, or she wouldn't have done it.) worked out in her favor so she had a respectful Jewish burial. She is also near her brothers.
4. She was buried quickly, within 40 hours, as it should be. No embalming (don't speed or slow down the process of dust to dust). No make-up and fixings. No public viewing. I agree with Jewish explanation that that a viewing does not help the mourning process in anyway. Not for me anyway. But we all do have different needs.
5. My boys and I arrived to the cemetery right on time. The cemetery brought her all pine, all wood, casket out. Before you could blink, they were lowering it into the 6 foot hole. In Observant Judaism the family is responsible for the actual burial. Never in my life had I given it much thought, but my boys all took the shovels and put the dirt back on over Grandma's casket. Talk about reality check. Acceptance. Physically doing the work ourselves until we were tired. When we couldn't do it any more, we read, Lord is my Sheppard, Mourner's Kaddish, my sisters Eulogy, and a few other short blurbs from the The Comfort Book provided to us. We read what worked for us and had meaning for us. Each of my boys read something. We watched until the last piece of sod was in place like there was no hole just an hour before by the team of workers. I recall being at graveside once for this (but don't ask me who, don't remember, I was a kid along for the ride). I also recall being graveside for a non-Jewish burial and after the memorial, the mourners go elsewhere, to eat and console, and the "dirty" work is done the the burial team. I am glad my Grandmother left this last opportunity to my boys.

I am so glad it worked out that I could be there to represent the family especially because it was important to me. Sometimes you do something that feels right and you don't know why it's right, it just is and you get the blessings later and insight later on. Family is far and spread out. Each one of us had our own roles in the arrangements, prayers, Grandma's life or some how getting her to her resting place, or helping getting each other through this.

Modern culture forces us to go on with life. Before the burial is the time of preparation, after the burial is a Shiva period for a week. Shiva is more strict for household immediate family. I feel like Grandma is immediate family, although, some Rabbi's might tell me I am not obligated. It's her health (lack of mobility and poor hearing) that separated us in later years. Although I am not Observant, I do think it's appropriate to follow my heart. And if I don't want to go to a party or parade this week, I don't belong there. It's not like I am crying, "Grandma, why'd you leave, I don't understand, Come back." I totally accept that she lived a peaceful life til 95. Like the hospice nurse said, her last breath was between her and her creator. But there is a lot for me to process for myself, for my boys, for my family who I am not immediate with and listening to them. Giving them some space to process. Mourning does not mean just begging the dead to come back and crying. It is so much more complicated than that. It is so appropriate to reflect on your memories. Reflect on your life and your own goals. I am totally enjoying hearing what other people have to say about her. I want this Shiva time.

A Shiva candle is symbolic of this time I want to allow myself. (Catholics use a similar candle.) Ideally I wouldn't work, go out to party, show vanity. And heck, I don't really want to. Right now. (I do have to work a little.) I totally get where Jewish mourning rituals come from because it feels right to me. It doesn't end after a week, but that's all I want to deal with right now.

Two "angels" came to visit her in the hospital. I had no idea she had friends at skilled nursing. Two ladies who visited their Dad truly missed my Grandma and left the hospital in tears seeing my Grandma. They told me since their Dad couldn't talk my Grandma would give them updates. And she made them laugh. This is so nice to know.

My family wants to have a memorial at a later date for all the out of town relatives. Without asking for it or us knowing anything about it, her skilled nursing facility is planning a memorial for her on Tuesday. I am so impressed they would do this. I am moved that she is being honored this way. I know she was taken good care of.

So Grandma, You can rest peacefully knowing your "deal" way back did not burden us and your immediate memorial was "included." I know that would make you happy. Many people may not understand why the ritual details are important to me, you may not even understand. We all have different needs, and for different reasons, we both have peace with the final arrangements.

Last Days with Grandma

2010-12-03T19:17:00.003-05:00

I wrote this Wednesday. This is how I remember the last days. All due respect if I forgot details or don't tell them how someone else perceives them.

My Grandmother Pauline took her last breath today.

She lived in Orlando. She is 95. We share the same birthday and she is 50 years older than me. Each birthday I made it a point to go celebrate her birthday with her.

Living 2 hours away and a crazy-hectic schedule, I have often wondered how in the world I would get up there when the time came and if I would even make it.

Wednesday evening she seemed fine to her friends at her dinner table in skilled nursing. Thursday (my first of four days in a row) morning, the nurses called my mother and I, and said she was having trouble breathing and could they transfer her to the ER. The ER doctor called my mother 3 times as we were preparing our Thanksgiving dinner. By the time we sat down to eat, we already knew we would be packing and driving to Orlando. The good food was not really enjoyed and the abundant left-overs was packed straight into coolers. I got a pair of jeans and a few shirts together (and Scott and Max) and we drove. (I left William and David behind.I never leave them overnight, let alone 3 nights.) By the time we got there, Grandma seemed to be better than expected. She seemed to make improvements since the morning. Whew. She was social and enjoyable to converse with. In the morning she still looked good. BUT, doctor started talking PEG tube (feeding her through a permanent line to her stomach) because she was aspirating her stomach contents into her lungs and that is what gave her pneumonia. Doctor said that would keep on happening. This was really emotional seeing her stable, but seeing no potential and each hour bringing different news.

My mom and I researched our options. Hospice care. We knew the PEG wasn't going to happen. She was already confined to a wheel chair for two years since a hip fracture. She had a subtle case of congestive heart failure and probably some renal insufficiency. I couldn't see making her go through heroic and futile tests and procedures. We made some calls and appointments. Ironically by the time we had a plan, Grandma seemed to decline again in just hours. (This was Friday afternoon).

Saturday we took advantage of a coherent period. We put her on the phone with my sister and cousins. She said, I love you Carrie. I love you Jason. I love you Geoff. She named each. I was touched. She mumbled a lot about bingo and cards. She loved bingo and cards, too! She recognized us in the room.

I asked her if she remembered the time she took me on the bus to the beach. Remember the bus driver looked at me and exclaimed. "An Angel! An Angel!" I was only like 21, yeah, I looked good, the only young person the bus driver probably ever saw on public transport in S. Florida (haha), but my Grandmother never forgot his excitement and repeated that story to me many times with a smile. And she smiled this time, too, when I reminded her. She loved to show me off like a proud puppy owner and this bus driver justified her bragging right. When I became a doctor (my grandparents dream), she would take me around and tell her friends, can you believe she is a "doctah" in her strong Brooklyn accent. So embarrassing.

During this coherent period on Saturday morning she talked to us more, but I could see her slipping away and agitated. Sunday was long as we waited for a Hospice bed. I was eager to see her transferred OUT of the hospital and comforted in hospice. Finally she was in hospice at 4:30. She was bathed and we could visit her some more. I didn't think she would talk to me. I thought she was to far away by now and too medicated. But she had one more alert period.

I told her that the time had come for me to go back home. It was so hard to leave. She squeezed my hand and said, "Stay more."
Sigh. Tears.
My Mom, and Scott were all sobbing and emotional.
I told her it was to hard for me to leave her and she might have to leave me first.
I told her it was ok to close her eyes and rest and go. You see she was still breathing hard. Although she said she wasn't in pain, I felt pain.

The hospice nurse gave her medicine to relax her and told us they usually sleep a lot after the hospital because they are drained from all the noise and disturbance. It was good to see her respirations relax and facial muscles relax. It was good for me to see the poking and prodding ceased. When I peaked into the hospice rooms of other residents they all looked peaceful. In the hospital did you ever notice that geriatrics sleep with their mouths open, arms restrained, struggling and often unintended, almost ignored (by hospital staff). Grandma was relaxed now. I feel like at some point then her spirit left us, but the heart would take some time to slow. Like when I toss the ball, I must let go, yet it takes some time for the ball to come to a complete stop.

That was Sunday night. And her heart beat until Wednesday as she slumbered comfortable until her time. My mother and the nurses say she didn't stir. Gasped for the last breath.

I do feel like I was there for her need or was it my need? That doesn't make it easy, though.

Grandma was there for me as a little girl when she was able. My sister already did a great job telling that story here. I too eagerly waited for her to get off the train for her weekend stays on Long Island. I loved waking her up long before she was ready. I loved hearing of her travels to Mexico with her sister, Greece and cross country with her husband. She inspired me to travel. When old enough she toured us through New York City. Later she moved to South Florida. She brought me on several day cruises and the infamous bus ride. When she couldn't live independently anymore she was moved to Orlando by my mother. Most of the 13 years she lived in Orlando, I lived with in driving distance and could pop in for short visits as she tolerated. For the first few years she was mobile and we could bring her to mom's house or out to eat. In the past two years it was short visits as she couldn't tolerate her routine being interfered with. She loved seeing me and the boys. Almost every time she saw me she reminded me I was an angel like the bus driver proved to her. She also always told me I was still adorable like I was still her baby, her first grandchild.

She is my last Grandma to go. She will be remembered and miss.

Pauline Markman-Deutsch-Aghas
October 8, 1915- December 1, 2010
Rest in peace....

Open Enrollment

2010-11-20T20:58:00.000-05:00

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.)

More on Round 2 Dyslexia (David)

2010-11-06T21:37:00.000-04:00

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.

Our Halloween

2010-10-31T22:13:00.000-04:00

I know some people have spiritual convictions about not participating in Halloween, but my dietary convictions :) don't allow me to pass out candy.

Last year we passed out some coins. John said our pumpkin got assaulted by big kids that expected candy and that you must pass out candyor get egged. I think John wanted the candy.

Considering I have a garden, I was hoping to do some decorations that looked like harvest (not goth and grave), but never got around to it.

We live in a quiet neighborhood this year and people coming to the door is not an issue. Because we were so busy on Saturday with community fund raiser activity, my youngest were happy to stay home today. Scott and David took Max to the Humane Society Mutt March Saturday am, Heathcote Haunted gardens in the early evening, and PALS haunted house in the evening. William went to his friends house for Saturday night co-ed party and stayed over all day until trick or treating. (He didn't care about T or T for a few years, but a renewed interest this year with friends.) William is the only one of my sons who dressed up.

One of my sons is not eating any candy this year!!! Can you guess which one? Nor is a single piece of candy is passing my lips. I am not having any sugar cravings today and I know how to make my own dairy- free smoothies and treats.

In the top photo William is in the middle between his friend and his friend's mother. She actually looked really good. His friend was not a vampire, and doesn't like vampires love stories, but to me he was a a very good looking Edward Cullin. Next photo, David is playing a game at Heathcote. I am glad he had so much fun. He is usually forced into being a teenager and doing teenager things, that finally he got to totally enjoy himself. And next photo Scott is loving on a 4 month old Corgi. Obviously, I am blogging for Halloween. :)

Have fun but don't eat too much candy!

Scott's Reading Progress

2010-10-28T21:42:00.001-04:00

It's taken almost a year to help Scott complete Level 7 BartonReading! We have lots to blame: moving and taking time off, remediation and reviewing. At the beginning of October we made it a goal to finish the remaining lessons.Despite the length of time its taken to make progress through this level Scott is a good reader now. In this level, Scott had learned how an "r" following a vowel changes the sound the vowel. He has learned a lot of rules for spelling and reading. So many, don't ask me what they are, I can barely keep them straight. He seems to comprehend the (dis)logic behind our language. As long as their is a reason, he gets it. Level 8, I can't wait to meet you, not!

Here is a post back when we began this reading program.

LLL Enrichment Meeting, Nov 13, 2010

2010-10-28T20:32:00.000-04:00

I am honored that our Treasure Coast LLL has invited me to be the speaker at the November 13, 10 am, Enrichment Meeting in Port Saint Lucie. As my days are filled with activities for older boys now, I don't get out much and don't have the chance to meet you in a casual setting, especially to meet the newest mothers. I sincerely look forward to meeting those of you I have not met before and see how the little ones I know are growing.

I'd like to know what you want me to "speak" about. If you plan on attending would you e-mail your questions or what you would like to know more about. I'd like to stick with Permission to Mother topics: birth and breastfeeding. Not very original subjects, but let me know specifically what you want to know more about. Please don't be shy. I do want you to help me focus on a useful and fun discussion.

One other thing I was wondering since I hardly get out to do this kind of thing-- I am so behind on technology, isn't their a way to record the discussion for Internet access for those who can't attend or for later viewing? Is there anyone who can take charge of this or offer tips on how to do this?

World Culture: Contributions for All (William's Completed Lesson)

2010-10-21T21:07:00.000-04:00

I posted Scott's discussion a few weeks ago because he did such a fantastic job on his own. I helped William with the brainstorming. I knew he would come up with some good stuff with some probing. He surprised himself at how many ways he contributes to society.

Name anything that you are already doing to contribute to society. What is it and how is it a contribution? This can be something simple or something big.

The last two Halloweens I volunteered to scare little kids at the botanical “haunted” gardens. I dressed up as a scary zombie and some parents took pictures of me. I’d do it again this year but I we were too scary for the kids.

I helped my neighbor move furniture.

At the PAL Karate (Police athletic league) we have a yearly Saint Jude’s sparring tournament to raise money and awareness for the children’s hospital.

Name three simple things that you CAN do to help with your family or your community. What are they and how can they help? Refer to the Quest portion of the lesson for ideas.

I have participated in two PAL litter pickups. I picked up trash at two different parks. This helps because the community is nice and clean and sidewalks and the pond are not filled with trash. If you’re on a boat and something falls over you can drive back and get it. This helps because picking litter in the water helps the environment a lot. I volunteered to be in a PAL karate parade. The parade inspires community to come together and I helped with the little kids. As a black belt I set an example for the little kids about peaceful conflict resolution. PAL’s is affiliated with D.A.R.E. (Drug Awareness Resistant Education) by participating in PAL’s activities it makes me a good example and it’s about keeping dopey kids off the street. I won’t do street drugs.

Name one major thing that you can do to help your community to be a better place or to make a difference in the world. This can be an invention or volunteering or organizing a group project. Be sure that this is different than anything that you have discussed in the boxes above. Refer to both the Quest and Goal portion of the lesson for ideas. How can doing this make a difference in the world?

I am going to a nursing home to share a Shabbat service for the residents and I am taking my brother and his therapy dog Max with me. Since Scott did his assignment Max graduated to therapy dog. The residents can’t get out easy or go to synagogue and they like to see young people and dogs.

Why is it important to become a good citizen? It does not matter if it means just following the laws like obeying the speed limit or becoming the president of the United States. Why should people work to do good things in society? Be specific and use concrete details to support your opinions.

In Judaism and in my Bar Mitzvah training we do a volunteer activity for repairing the world. In Hebrew it’s called, Tikkun Olam. I want to set a good example to other people. All the activities I talked about above “repair the world.” Good deeds are called mitzvah. Mitzvah can be big or small. They all add up.

Name one person that you have learned about throughout the Quest To Be The Best Game that you feel made a big difference in the world. Who is this person? What did he or she do? Why is he or she important? You may need to quickly go back through some of the past modules to refresh your memory.

King Hammurabi of Mesopotamia made a lot of rules. He set the motion for future civilization. His rules applied to everything that happened in Mesopotamia. Modern society has applicable rules and laws but punishment not as gruesome (sadly). His most famous rule “Eye for an eye, tooth for a tooth” is very understandable.

Garden Bug

2010-10-17T22:46:00.003-04:00

My Container Garden has come a long way since my areogarden and window sill attempts. Gardening has become very popular and I have learned so much especially from Lauren (and Gail) (jackpot containers), Gerry (raised rows), and my mom(squarefoot). In the past I learned and admired Elizabeth's garden in Georgia. All had wonderful gardens this past year making it look so easy, I knew what I wanted this year. I want greens and herbs easy to grow and those that most of the plant is continuously edible through the growing season. I want greens I can clip and add to a salad. I want greens to clip and put in my blender.

My garden is close to my front door. I had several containers already going with basil, mint, aloe, sage, and oregeno. Over at Lauren's we had a lot of growing containers and I decided to bring some back to my house so I can access these types of greens easy (several times a day if all goes well). I have had a lot more fun doing this than I would have thought. John has helped with hauling big loads and the younger boys like spraying the hose and getting dirty. Numerous garden systems would have worked, I decided to make use of my resources.

For the record I added a mixture of course vermiculite, peatmoss, and compost to all my containers. At the surface of each pot, I added lime and Ric's fertilizer (US 1 Fort Pierce). I also mixed in a little coffee grinds. (Thanks to Dino). I am recording this so if it works or doesn't work, I can remember what to do or not to do next time.) I got started on this seasons plantings Sept 26 when I noticed it cool down a little. I got all my soil ready ahead of time before bringing plants home. I've done a little at a time.

Also I am going to use much of the greens as young plants, unless it grows fast. I have planted some of these plants before and then wait and wait for a mature plant only to be disappointed because I can't keep up with watering, bolting, then death. If Sam'sClub can sell Baby Spring Mix, I can grow and harvest it young!

This is what I got planted:

Arugula in center, Romaine (right), cilantro (top)

Kale - I loved having Kale available to me last growing season... salads... kale chips... stir fry ... pairs well with garbanzos in soups. Lauren suggested to me to have 16 plants at my house with as much as I liked it. So that's what I planted yesterday. This kale is from Lowe's. Over at Lauren's, the kale is from a local specialty nursery. Kale is the most nutrient dense green. Period. My kids like it. If it grows well, I am eating it everyday.

Collards - Not my fav when mature., but it looked healthy, and I can add baby leaves to my smoothies for nutrient variety.

Spinach - We didn't have much luck growing this last year at L's... one more try...

Chard - I understand it grows like weeds around here. I like it in my smoothies and salads. Had a few seeds and a few starer plants. I mixed them into one 18 inch container.

Rosemary, Ginger, stevia (top),: parsly, red sails, chard, (bottom)

Cilantro - I have missed fresh cilantro over the summer to add to salads, beans, guacamole. I can't wait. This is growing from seed I had from my aerogarden, but decided to put it in soil instead.

Parsley - Used a starter plant this time and I want to get more into the habit of adding parsley to salads, etc... Love it with hummus.

Basil - This should be easy for me to continue growing in containers.

Chives - My favorite batch is garlic chives that Jyl gave me. It grows despite me ignoring it. (I talk about people like everyone knows everyone.) I have several varieties of chives continuously growing.

Red Sails (Lettuce) - A starter plant from Ric's Nursery. It is growing fast and I am clipping outer leaves.

Romaine ( ans misc lettuce varieties)- Looks like I will be enjoying baby Romaine and if it grows big, all the better. Also if I keep things young, I can fit more plants in one space.

Aloe - Aloe is a vegan source of B12. I clip a small piece and add it to my smoothie.

Sage- I don't use this much, but it keeps growing despite little attention.

Cuban Oregano - started from a clipping from Irma, John's mother. It grows fast and easy. I add it to anything "Italian." I am wondering if I can dry it and powder it. I have a lot and I think my boys would use it more if it didn't overwhelm them with a big leaf. If I clip it and leave it on my counter, I swear it grows. If you want a clipping just ask.

Purslane - This is an edible and nutritious weed, growing all around my house. I am going to keep a batch intentionally for eating. It can go in smoothies. A google searched revealed that it mixes well with arugula and balsamic.

Cherry Tomato - I have never had luck with patio tomatoes. This is my biggest experiment. I am doing exactly what the nursery lady said to do (her name is Denise, too). Do you like my trellis? It is closet shelving from our remodel. My mother gave me this idea. This plant is growing fast. Cross your fingers!

Dill - for cucumbers! And matza balls!

Ginger - I have not harvested any. I have established plants from L's and the farmer's market.
Rosemary - You can't kill rosemary. I just wish I knew more to do with it.

Peppermint and chocolate mint- the mints go well with chocolate bliss and I cut the greens and toss in with some salads.

Bay Leaf - I have a very small plant. Irma's grew huge. It's nice to have a fresh bay leaf.

Thyme - I don't seem to use this much, but still I am glad to have it for when I need it.

Pepper - John picked banana pepper. We got starter plants from the nursery.

Arugula - from seed and was ready to harvest in 2 weeks. I like that it is so close to my front door.

Artichoke - another experiment. Perhaps I am just curious. If it survives, it won't be ready for months, unlike everything else here.

Stevia - Going to clip a leaf and add it to my smoothie. I like the variety in the green's I can put in my smoothies. Obvioulsy I don't intend to put every green in everyday. I like the variety.

garlic - I buried a few garlic cloves. We'll see what happens. The whole plant is edible and I can clip the top no matter what happens underground and use as chives.

Wow! That's a lot and that's not including my citrus trees. I caught the garden bug.

If the harvest is good, you can read more at raw on the river.

Speech Therapy

2010-10-16T20:13:00.000-04:00

David is making progress in speech and speaking at a great pace. The other day he was chatting away with "Lunch Box" Julie at Nutrition World and she asked him if he was nine years old. He explained that he just turned seven. She told him that he spoke so well that she thought he was older. Ironically we were at Nutrition World following a speech therapy appointment. And he was speaking clearly to her. Maybe 'cause she made him some good lunch. I have had a hard time motivating my boys, but someone thinking he was older than 7 was like magic.

We found the perfect therapist, Libby, at Lawnwood, for David. She's motivating him with the indoor swing. For example, if he could hold a long sound /ssssssssssssssssssssssssssssssss/ he got to swing for a long time. Another time if he could continue to think of words that begin with the /k/ sound she kept him swinging, but as soon as he paused the swing stopped. He also had to say the word correctly.

She also was using erasable crayons on the mirror (cool idea for teaching) to list all the words he said. I want a swing in my house. For me. :) Looks like fun.

Another game she plays with David is having stacks of two different drawings with one sound difference. Like "ski and key" or "go and dough" and "corn or torn." She asks him for the cards and he has to listen and give her the right card. Then he has to ask (speak correctly) to get them back. He is learning to use his throat when he enunciates. These games don't involve much reading ability. David is eager to please Libby and he has also quickly learned the name and sounds of his letters as he learns to pronounce them correctly. He is much more aware of phonemes and breaking 3 letter CVC words apart into sounds and spelling with tiles. He is aware of letters everywhere and trying to read them.

With the letters names and sounds mastered David is able to work with me at home on his BartonReading Level 2 lessons. We bring his tiles to therapy and some of his books and Barton worksheets and Libby is really good at using them to merge them into her lessons. David is very excited to tell her what he has learned at home.

I like this little desks that "trap" him in place. At home he is wiggling all over the seat and table. I like the mirrors in front of their work place because they look at their mouths and feel their throats during many of the lessons. I've been taking him twice a week most weeks and it has been well worth our time.

Thoughts on Breast Cancer Awareness

2010-10-10T23:22:00.001-04:00

October is Breast Cancer Awareness Month

By all means if you are breastfeeding and have a problem, a mammogram and ultrasound are compatible with breastfeeding. You don't have to wean. You don't have to pump and dump. If you have a good supply you may want to consider nursing just prior to the mammogram so you don't squirt. But if you do squirt, no big deal, really.

Now, I confess, I have not gotten into the pink ribbon campaign or other breast cancer awareness campaigns because I am not sure what we are suppose to be aware of?

1. Get your mammogram? Is that what the pink ribbon means? The current recommendation is baseline at 40 and every other year till 50, than once a year. Somewhere in 70's it becomes optional. (Feel free to correct me if I am wrong or you disagree.) (1/2 my patients want annuals in their 40's, 1/2 delay or space apart)

2. Is the pink ribbon a reminder to donate to breast cancer research or cure?

3. Does it stand for something else or a combination of reminders.

I am not comfortable wearing something I am not quite sure what I know it stands for. Especially if there is a chance I might disagree with it.

Second confession, I have not had a mammogram or breast ultrasound, or any other alternative diagnostics. I missed my baseline, 42, and 44 yo mmgs. Wow! I would have had three by now. And more if they called me back for additional views which is a very common request by Radiologists who over-read. And more if I had a doctor that ordered them annually without discussion.

In my last post, Jenny encouragingly commented that women who breastfeed for a long time (such as yourself) have about a 0% chance of ever getting breast cancer =). Her comment sparked me on to write this post.

Early in my professional breastfeeding career along term breastfeeding expert, was diagnosed with breast cancer, and it is hard for me to forget that. After reading the book, The China Study, I found a compelling argument that one of the increase risks for breast cancer (or any cancer is animal protein). The author actually feels we are in much better control of cancer than one would think we are by manipulating our diets to a plant-based diet. It's been a long time since I read the book, but this is what sticks with me. I continue to think of all the daily toxic and chronic exposures we pile up on our selves and never have any detox. That is why most of us should have cancer screening tests. I am consuming a a high raw plant based diet, not exclusively plants, but very AWARE of high antioxident, anti-cancer types of foods. Because of my diet, I'd like to think I have reduced what little risk I had to even more minimal. I also think about how devastating breast cancer would be and it is no joke. I find peace knowing that my breasts have been used to their fullest capacity over the past 14 years.

That brings me to the next point. Like everything else, I individualize my recommendations for others. Some people may need an earlier baseline, some may be like me and want to delay the baseline (there is also risk to unnecessary exposure). Some may need annual mmgs in their 40's. Family history is an important consideration in the litigious community. Our 40th birthday milestone makes many of us aware of the damage we have done to our bodies and past damage may not always be able to be undone. The greastest benenfit of screening mmgs is probably in our 50's.

In my personal breast cancer awareness outreach the suggestions I have: lactate longer for your benefit, provide milk for your daughter for her risk reduction, eat more plants, less animal products, more wholefood, avoid nicotine and second hand smoke, and consider the other toxins in your life. Since I don't follow breast cancer awareness groups that close, let me know if there is a group who promotes the power of lactation and detoxification in their breastfeeding awareness campaign.

I've been meaning to write this out for a while and now my thoughts are flowing with more thoughts. I feel about an inch deep in a very broad topic. There is plenty I haven't touched on. Is this topic of interest to my readers and is it worth writing more on?

David's Squirrel and Butterfly

2010-10-05T23:29:00.001-04:00

These two coloring pages were in David's Phonological Awareness Skills Program (PASP). For a while he got stuck on "squirrels" and colored me a million brown squirrels. Finally, I helped him picked some color and as a result, I got a psychedelic rodent and nuts. I REALLY like it. I want to frame it. Hoping for a a co-ordinating drawing, I finally got him interested in coloring the butterfly.

Arts and craft skills don't come easy in my house. I am sure that I've posted before on a teacher who blamed our homeschooling for the older boys not being able to color, cut, glue, etc...

I am not good at it, so she's right, I don't spend much time coloring or with crafts. We have plenty of other skills so no big loss.

Also, with undiagnosed dyslexia (and diagnosed) fine motor skills are often lacking. These are the skills needed for arts and crafts. Uncorrected dyslexics often hold their pen or crayon with the thumb crossing to compensate for lack of fine motor at the finger tips. I spotted this immediately in David and have been able to show him how to hold a crayon and have some control. His coloring is so much improved because of all the brown squirrels he colored.

Besides a great opportunity to hang his art like its a Mona Lisa--to me its much better-- he got the essence of our house. He used colors that go with the inside. As for the outside, we have two mature acorns trees, dropping nuts and attracting lots of squirrels. We also just planted Mexican Petunias, which are purple. His art is perfect to display! Now to get mats and frames and decide which room to hang these in.

World Cultures: Aztec Life

2010-09-28T21:39:00.000-04:00

I want to share another assignment from World Cultures. Since my boys did this class together it was interesting for me to see how they processed the same information and came up with their own creative response. If I was ever concerned they would cheat, exactly the opposite was the case. They would have nothing to do with each other. They did not want to help each other a bit.

This assignment was to write from the perspective of a Spanish soldier who is conquering Aztec; What would be the first impression of the Spanish soldier of the Aztec culture? My boys REALLY like pretending they are soldiers. This was a perfect assignment for them to show their potential. Also, when the boys get assignment grades the teacher cc's me and it comes right to my bberry. How cool is that?

It is really hard getting motivated to do BartonReading with Scott. He is progressing well overall. He tells me he doesn't think Barton's necessary anymore because he reads well.... OK, then, you can enroll in FLVS Language Arts becausee you need to be in some LA curriculum.

No hesitation... Let's do Barton.

So here is the boy's work.

I met the Aztec people in the Island of Texcoco six days ago. They are so different than most people. The Aztecs believe in almost 1000 gods and they give us presents like gold because they think we are gods. Little do they know were going to kill them and take their land. They are savages and they are disgusting and they should be slaves. Although they are disgusting they made some beautiful buildings like temples aqueducts and paved roads.

“Juan” Scott Coquelet

~~~~

Today I was following orders from Hernan Cortes. We went to the capital city of Tenochtitlan. Which is located in a small island in the center of Lake Texcoco. All of my fellow soldiers and me were having mixed feeling about the way they live. One of my friends said to me “Guillermo, look over there. Altars for human sacrifice! I don’t think this is a good idea. Maybe Hernan made a mistake.” We were all shocked and awed. I noticed some walls had calendars on them. I glanced at it for a few moments and I saw 260 days on it. I wonder where they got that from. I also saw some of their ‘writings’ if that’s what they call it. They were pictures and I can only guess that they probably were words in their culture. Hernan Cortes wanted to take and steal all of their gold and riches so we started to fight. We lost many men, but they were defeated.

Guillermo William Coquelet

World Cultures: Contributions for All

2010-09-26T13:53:00.000-04:00

Scott and William are about to finish World Cultures. I wanted to share Scott's writing. William hasn't done this one yet. Through out the class, they learned about the contributions of all the major cultures, Greece, Rome, China, etc... This last projest was about how they can contribute to society. I am really proud of what Scott wrote. This was all him. He needed minimal proof reading help from me. It takes him a long tme to peck and hunt. Typing (not reading, not writing, not originality) was what slowed him down. Next FLVS class is keyboarding. Scott told me that this lesson played to his strength because he is good at contributions.

Name anything that you are already doing to contribute to society. What is it and how is it a contribution? This can be something simple or something big.

I do a lot for society. One of them is that I am a first degree black belt so my karate teacher tells me to teach the new kids. That helps society because in karate there is something like the Code of Chivalry [from Midieval Times]. I tell them that karate begins with courtesy and ends in courtesy so they can be good citizens.

Name three simple things that you CAN do to help with your family or your community. What are they and how can they help? Refer to the Quest portion of the lesson for ideas.

1. I can help my community by recycling.

2. I can help my family by doing more work around the house like make the beds and take out the garbage, recycling, and compost.

3. Another way I can help my community is to not pollute.

Name one major thing that you can do to help your community to be a better place or to make a difference in the world. This can be an invention or volunteering or organizing a group project. Be sure that this is different than anything that you have discussed in the boxes above. Refer to both the Quest and Goal portion of the lesson for ideas. How can doing this make a difference in the world?

My dog is a certified as a Canine Good Citizen and I’m going to make him a therapy dog so he can continue to go in to nursing homes and give the people love. He is already friends with people with special needs like Down’s Syndrome, who use to be afraid of dogs. This is my contribution because I trained my dog to make other people happy. This is what I can do to make a difference in the world.

Why is it important to become a good citizen? It does not matter if it means just following the laws like obeying the speed limit or becoming the president of the United States.Why should people work to do good things in society? Be specific and use concrete details to support your opinions.

It is important to be a good citizen. If people didn’t care then the world would be crazy. I can be a good citizen by doing good in school and being courteous. Also I can pick up after myself.

Name one person that you have learned about throughout the Quest To Be The Best Game that you feel made a big difference in the world. Who is this person? What did he or she do? Why is he or she important? You may need to quickly go back through some of the past modules to refresh your memory.

Alexander the Great made many war strategies that militaries around the world still use today. He helped spread Greek culture around the world. Most important I am named after him and I am Great, too.

Our Awesome Sukkah

2010-09-24T20:09:00.001-04:00

Part of my commitment to the boys Bar Mitzvah training is doing new activities we haven't done before in observance of the Jewish Holidays. Part of the holiday, Sukkot, is to build a temporary shelter to dwell in, called a Sukkah, during this season of fall harvest.

One problem, is, is that we are not a DIY family when it comes to crafts and wood work thus, I couldn't imagine how we would pull this project off. But we did. We got 9 1x 2x 8 at Home Depot. We used every bit of the wood. We cut 7 to 6 1/2 feet for the length and height. We used the short end for reinforcement. We cut 2 in half for the width. I have seen my husband drill, but I never seen him use a saw. The boys were all into it. I like seeing them do things together. Before you knew it, it was built. Barely any fighting or sibling rivalry. whew. We did it at night in the car port with a clear sky and full moon.

In the morning the boys and I cut back our palms and native plants for decorations. Being in Florida there is not much food to harvest this time of year, but the trees needed pruning and it worked out well to give us an excuse to do yard work.

So far its stood up to some rain fall. More wind and it would be down. We've had some snacks and meals in it and guests. As you know we have a great view of the river from our sukkah (and my husband's boat trailer made a good workhorse for sawing his lumbar). We have had a lot more fun and laughs with this than I would have imagined.

I once was in another blog called Homeshuling. This would be a good example of homeshul. (shul = temple)

I am guessing part of my husband's motivation to do this is because he wants Tiki on the deck and this is like a preliminary step or practice to see if he can handle a bigger project. My boys brought a lot more history and information about the holiday and blessings that they have learned from their Hebrew school. I actually am impressed how much they know. Max, our dog, ate the holy fruit. That makes him our Rabbi now.

Here is a back view. The beauty of a sukkah is the decorations, companionship, and of course food. Since the fall harvest is suppose to be eaten in the sukkah and there is none, I prepped a few raw (next best thing) desserts to encourage the boys participation: almond joy (from Greensmoothiegirl), oat meal cookies (from Nicole the Fitness Freak, date bars from Kristen's Raw). This gives John a good excuse to use the grill as we set up right by it.

The frame itself does not have to be beautiful, a rough shack built by hand is ideal, but it sure does look like we new what we were doing! I am so glad we did this!

Double Birthday Party

2010-09-11T20:35:00.001-04:00

William and David have birthdays a week a part. We moved William's birthday celebration up a week. Basically he planned most of it out himself. So you see what he planned; an airsoft tourney. William and Scott and 4 other boys actively played. David was happy that his babysitter Nate and Nate's little brother came over to hang out with him inside. I was kind of glad to have another responsible adult here. David is no longer "almost 7," "practically seven," or "just about seven." He is seven. Never in my life would have I imagined I'd be hosting an airsoft party. I am impressed how much the boys know about their weapons and equipment. I had a chance to speak to parents and make sure everyone knew what was going on.It looks to me like they all had a great time. They started by shooting targets on the dock and I saw they were responsible. Sigh. Honestly I think my kids are military bound. I am the mother of a US soldier and I don't know it yet. (Do black belts enter at a higher rank?)

The part of the party I planned was this birthday cake. I knew what I didn't want. I really don't like grocery store cake. You should have seen the smile on the boys face when I brought it home.William was especially grinning ear- to-ear. My friend Gerrie owns S & S take out in downtown Ft. Pierce. Everything they make is fresh, and local and/or organic.I knew it would be delicious for the boys. I confess, I had a piece too and it wasn't just a strawberry AND then I finished David's piece. (But I did have my green smoothie and uncooked soup earlier today!) Light airy, layered with strawberries, and huge! Topping was a whip cream base.

Everyone else licked their plates clean. It was so worth a special order cake. William requested all white with strawberries, in case you are wondering.

Two First Degree Black Belts and a new Brown Belt

2010-09-10T21:47:00.003-04:00

There are lots of high ranking belts at my house.William and Scott got their first degree embroidered belts tonight with the name and dojo in Japanese. In 6 months they get their certificates and are officially recognized as black belts in any school not just their school. I also show some of their friends they train with. All the older boys are the same rank.

David, is a brown belt. He's preparing for his black belt about a year away. As of today, he is still 6 and except for Shihon Joe who is tying the new belt on, he is one of the youngest brown belts. Shihon is the Grand Masters Son and probably was the only other young brown belt. David has been training since his 5th birthday.

Hearing Evaluation

2010-08-27T16:18:00.000-04:00

David had his hearing evaluated yesterday. He passed without any trouble. I didn't think he had a hearing problem, but its good to know for sure. David is kind of liking all this special attention and all the activities his "teachers" have him do. He really likes Dr. Slack, the ENT where he had his hearing checked. After the test, David said, "I should get my ears checked, since I never listen to him." I quickly responded, "Since now we know your hearing is good, I expect you to listen to me!"

I am going to get David (and William) an eye exam soon with Dr. Olivos. I don't think they are having any problems with vision, but again, just to be sure as we are investing a lot of time into remediation curricula. We have great resources around us, might as well take advantage of the thorough evaluations. Scott had an eye exam done before we started his reading program.

Then we'll go back to the dentist, blahh....

So our first week of school went ok. I had to do some extra nagging to get one of the boys to do some extra work. There has been no XBOX all week. I am going to virtual school now to double check all assignments are in and we can hopefully relax for the weekend....

2nd Day Speech Therapy

2010-08-25T23:04:00.001-04:00

David's first day of speech therapy was an evaluation. No surprise to me that he has profound phonological deficiencies.

Today was his first day of treatment. Therapy was pretty interesting. The therapist sat in front of a mirror with David and named the parts of the mouth and neck. She had David tell her what his palate felt like to the tip of his tongue. They looked inside each other mouths. They felt each others vocal cords work with vibrating sounds. David easily recognized when the vocal cords weren't involved. David is a very co-operative student.

This is what I found most interesting. He can't pronounce /s/ well. He lateralizes his tongue too much and only a short sound comes out. (Hopefully I explain that right.) To motivate and reward him to get it right, she sat him on swing and told him to say letter sounds. For a short sound, like /k/ he only got a short ride; as long as it took to say the sound. She told him to think of a longer sound. He immediately thought of /sssssssssssssssssss/ and he got a long ride as he took a deep breath in and exhaled out and said /s/ for a long time. They played that for a bit.

When we got home I had David give his brothers a lesson (practice in disguise) from what he did today. He repeated everything verbatim. Something dawned on me. A few blog posts ago, I explained how David couldn't blend CVC words because he made everything sound like a vowel.

For example CAT:

When he tries to blend /cat/ he says /caa/ /aaa/ taa/. Like it is three syllables. And then he doesn't recognize the word he is sounding out. I could not get him to shorten his sounds to blend.

Now was my chance to reiterated to David that these 3 letters have short quick sounds in this word. He was eager to try it and he successfully did sound out the word cat. And as easy as sounding out cat may seem, he has never been able to do that.

John has been in a little denial that the boys have dyslexia. As we talked tonight. I pointed out things to John that he hasn't thought about. My readers know we have profound to severe dyslexia on both sides of immediate family. But John only writes checks and medical notes. He does not type, text, facebook, e-mail, compose creative writing or any writing for that matter ( I write his letters). He does not read novels (or my blog). His handwriting is the worst of the worst physicians. He reads his medical books, contracts (in detail) and magazines. His studying has always been methodical. He says he remembers everything he hears (heard) in class. I don't think John is a severe dyslexic, but don't expect to communicate quickly, if at all, in writing with him. I definitely see language patterns in my house. John is mild. Scott is profound, David is worse than Scott. William didn't learn to read at an early age, but I don't see any dyslexia in him. They are fortunately all geniuses.

Weaning -- Part 1

2010-08-16T13:06:00.003-04:00

I happen to be in an extremely important phase of breastfeeding rarely ever talked about, I guess because there is not too many people who know much about the phase I am in, although certainly plenty who will want to pass judgement (that I am still lactating at my age :) ). I want to remember some of the significant dialogue that goes on in my house and here is my chance to share.

Me: David, how old are you?

David: Practically 7. ( It was 6, than 6 1/2, now it's practically 7.) ( I am practically 45.)

Me: David are you going to nurse past your next birthday.

David: Sure. What difference does one more make?

Scott: David, what if I told your karate class you have night-nights.

David: Who cares? I am practically a brown belt.

David asks me: Why do you call it night-nights.

Me: What do you think it should be called?

David: Breasts.

I explained to David it's easier for babies to call it night-nights (or nah-nahs, or milkies, etc...) when they are babies because, they go to sleep and call going to sleep going night-nights. I explain to him in public it's more acceptable for a mother to say to her baby, "Do you want night-nights" instead of "Do you want breasts?" Night-nights implies a bonding connection of love.

Me: Do I still have milk?

David: Mmmmmmmmmmm

Me: Why do you still nurse?

David: Cause it's soft.

Me: If it's soft and there is no milk, why does your mouth go there?

David: It's soft right here.(and he shows me).

These two photos in this post were recently sent to me by Shannon Mitchell, my friend, in Tampa. They were taken prior to the hurricanes my family tried to get away from. It was the first time I had seen the photos since they were taken 6ish years ago and it really took me back to that time and to the mode of parenting that I was in. Time just passes way to quickly, especially in relation to our babies. Who'd ever think that the cute little 8 month old would have so much to say about breastfeeding. He was just a baby yesterday. The cute little girl is Shannon's daughter.

I've got lots more to share on this subject. The title of my post gives away the bittersweet ending. I hope you are interested in staying tune.

Dyslexia, Habits and Such

2010-08-07T11:02:00.000-04:00

A speech/dyslexia question for Science Geek,

I finally have two leads for local speech therapists to look into for David. You wrote me a comment before about LiPS program and Earobics on the computer to help improve his auditory discrimination and memory. It's been a along time since we dialogued, so I wanted to know to know if you think those are still the best two programs to inquire about.

David recognizes a "c" makes a /c/ sound, but when he speaks he says /t/. Cat is tat. Isaac is Izit.
When he tries to blend /cat/ he says /ca/ /a/ ta/.
(I am trying to keep a list for when we do go into therapy, so I may add more here. Also, my list may potential help other readers recognize problems.)

Bedwetting

People come to my blog searching for an association between bedwetting and dyslexia. I am not aware of an association. (Leave a comment if you have tho ughts on this.) Scott has never been a bedwetter. David is a bedwetter. The DDAVP, time, diet, awareness, whatever, seems to have helped a lot. He rarely takes the medication (he took it about 3 months and rarely wets the bed now. The urge to void wakes him early in the morning and he gets out of bed himself.

Nailbiting
me- yes
john -never
William- yes
Scott- never, has long, strong claws
David - bit them to the bone, and all of a sudden I notice he has long strong claws like Scott. I am not sure what changed this summer.

I get asked about how to clip baby's nails. Personally, I bit them off my babies and did not like using clippers. When they nursed on the right, I bit their right hand nails and vice versa. Mittens get in the way of a good latch. If you got to use them, take them off when you breastfeed. Would you eat with mittens on? Don't you want to look at those cute naked little hands all the time?

Did you see David in the paper?

2010-07-29T17:52:00.000-04:00

My two younger boys had a great time at day camp for 4 weeks. David was even in the local paper; This is a great photo of him at camp in the paper with the Rabbi and his friend Isaac, who he especially liked being with.

Scott and David participated in many sports and especially like soccer. They went to Rapids Water Park, Lion Country Safari, Rock Climbing at the Y, ice skating, laser tag and more. Scott enjoyed asking the Rabbi questions. Scott and David learned many songs in English and Hebrew. I was told that my kids were a pleasure to have, whew....

But the most exciting contribution camp has made to my household is that we are now infested with silly bandz? Is yours? Boy, I wish I thought of that idea first.

Who's been reading PTM?

2010-07-23T22:13:00.000-04:00

Sweet Natural Child

Massachusetts's Friends of Midwives

Thank you for taking the time to share your feedback and kind words to encourage new mothers.

Anyone else reading?

July

2010-07-09T23:20:00.000-04:00

I usually expect July to be a bit slower paced month for me. Office work has always been seasonal and the pace really drops off with so many people traveling out of the area. I could count on a few weeks to do some organizational stuff and catch up in other areas of my life. Not this July. I am super busy in the office (which I am fortunate and grateful for your business). And I am busy at home.

I am also taking another test this summer. Perhaps I am not as busy as I think but the pressure of another exam is hanging over me and taking up mental space. Did you know that doctors take so many exams once they are "done." I don't know about other specialties, but it seems like it never ends for me. I am taking the 10 year rectification for IBCLC in 2 weeks. I've been a lactation consultant for 10 years! I've never been really that great at exams. The exam itself is the obstacle. Not the studying. It's been an opportunity to re- read Dr. Newman's books, The Breastfeeding Atlas by Wilson-Clay and Hoover and read for the first time Ina May Gaskin's Guide to Breastfeeding. I am half way through and like her perspective with current issues of concern to new mothers.

I didn't plan on any camps this summer. My boys generally don't like them and it's usually very tough to haul them back and forth. Scott and David are enjoying a day camp organized by Chabad. It's a well-rounded camp with sports, crafts, baking, singing, and friends all immersed in Jewish culture. The one week we signed up for has become a month. David has been enjoying his friend and Scott loves all the new physical activities particularly soccer. They have been on field trips to the Lion Country, ice skating, mock rock climbing, and gymnastics. They have more to look forward to next week.

William is not in camp, in case you are wondering. Scott and David want to make it to karate after a long camp day. William and Scott are both taking World ~~Tortures~~ Cultures in FLVS. Actually it is not torture at all. The boys are enjoying it. Much easier than Math. Scott is not having any problem with the reading. One lesson was to pretend you were a world leader and make laws appropriate for current times with punishments that fit the crime ( and why its a law). I will leave you with Scott's list:

1. No verbal acts of racism or you will go to jail for up to one year. Racism is a bad and turns countries against each other.

2. Don't throw cigarette butts on the ground or you will have a hard day of community service. It is nasty pollution.

3. Don't put make-up on while you are driving because you need to watch the road. The punishment is you will have to wear clown make-up all day.

Worth the Wait...

2010-06-29T18:26:00.002-04:00

While I was away....

My mother (decorator) and her friend Bruce (Upholstery) did an amazing job in my house. If any of you recall the photos of what this room looked like before the remodel, this is an amazing transformation, even from just the way the room looked empty in the morning. (and not to mention from my previous house, that I would not dare invite anyone in) I am excited to have so a warm inviting homey room. I've managed to keep TV's and electronic hook-ups out of this great room and it has become a very comfortable reading and coversation area (and viewing room). Bruce suggested the idea of two sofas and the swivel chairs. When you are not facing the fire or conversation, the chairs easily turn to face the dining room or the river view outside.

I joked and said the chairs are also breastfeeding friendly. If you don't want to feed in front of the company you can swivel around and face another way. :)

Bruce put new fabric on my Grandmother's 65 yo chair (in dining room) to co-ordinate with our colors and other pieces. He also arranged my built-ins to display some of my favorite photos and things. I love John's old electric guitar setting out. On the other side of the divider is my Grandmother's 90ish (maybe?) year old radio that still works. She never knew why I wanted that thing. I think it looks great.

I like the mix of old and new and all the colors and balance of shapes. I wouldn't have had it in me to make this room look so comfy. They picked out my couches, chairs, and coffee table in Orlando going by good memory. My mom e-mailed a few photos and I barely had time to think about it. I was like. just whatever you think looks good. Mom and Bruce delivered too! And hung up the window treatment! Thanks mom and Bruce! (Will you do the rest of the house?)

Check out more photos on my mom's blog.

Contact Ross Upholstery @ 407-880-3331

Buying or Selling Real Estate or

need help with decorating, contact Maxine @ 407-718-8323

Your home should be your castle and reflect your personality.

Bruce asked the million dollar Question.

Would I build or remodel again?

Yes, I must admit, I would again.

It was worth the wait...

Bar Mitzvah Lessons

2010-06-17T12:41:00.002-04:00

We just finished up a lesson this morning for the boy's upcoming Bar Mitzvah Ceremony, The weekend of Feb 12th 2011. The Ceremony will be Saturday morning, but our weekend will be full of fun. We are so fortunate to have Cantor Debbi Ballard come to our house monthly to tutor with weekly phone calls inbetween.

We use a combination of resources from the internet and prayer books that the boys are familiar with. Max gets to be present for everything. Scott is reading the V'ahafta in Hebrew. He covered the English translation on the side so he can't cheat.

David is enjoying lessons too, although he isn't officially studying. He has some important Blessings he will sing in Hebrew at the ceremony.

For the next few weeks the boys assignments will be to continue to practice the V'ahafta, the Torah Blessing, and will be writing an essay about six things they are grateful for.

Schooling Progress

2010-06-08T22:50:00.004-04:00

Ugh. I can't seem to get into an effective pattern of predictable lessons that my boys can count on. They are pretty much enjoying that "mom has other priorities" right now. My school room is better off left with the door shut and the unpacked boxes hidden.

William is dragging through Virtual Math. I was helpful to him in previous math, but I can't concentrate on it AT ALL NOW. I haven't picked up a Math book for Scott since I packed it before our move. David is doing a lot of adding and subtraction in his head and in real life. He's progressing naturally and with my conscientious push.

William and Scott are strong solid readers. William will do Virtual English next year. For Scott I intend to progress him through BartonReading and follow her advice for writing, but since he is actually doing a lot of independent reading and research it is hard for me to get motivated. Barton keeps him dependant on me to explain everything. I am thinking of putting both boys in the same Virtual Social Studies class. They won't be so dependant on me to teach each lesson because it is designed for them to do without mommy. I think Scott is ready. Then maybe I won't feel so guilty about not having daily learning time with him. David is not a natural reader. He's a genius in other ways, but can't get d and b and t and f straight ((pulling my hair)) let alone the rest of the sounds.

We are definitely in Bar Mitzvah training mode. William and Scott both have weekly tutoring. Scott and David will be going to camp for 1-2 weeks at Chabad coming up soon. My boys are enjoying this far more than they will admit.

We knew our house would be a great place for boys. Between the great outdoors, construction and decorating diversions, animals and native wild life, water sports, my boys have every reason not to want to open their curriculum.

At one of the beaches near us it is common to see dolphin, hermit(?) and rock crabs and other marine life. We are fortunate to have friends with horses, chickens, and all sorts of pets to entertain us. The boys love all animals. Scott actually did some research on lizards and skinks after I accidentally dug up eggs in the garden.

My mango trees are producing and we have or had herbs, lettuce, tea grass, aloe and other edibles growing in our garden and have helped our friends and family with their edible and ornamental gardens.

There is karate which they are going to for the rest of their lives. :)

There is plenty of opportunity for learning through our experiences. I just wish I could get on track. But I'd rather be on David's Jet Rider.

Florida Shower at Sunset

2010-06-05T20:48:00.003-04:00

Permission to Mother Feedback

2010-06-03T22:07:00.003-04:00

It's really neat to find out in my google reader and google alerts who is reading my book, Permission to Mother. My favorite feedback is reading about how my book has benefited my young mom readers.

Thanks Jenn for dedicating a blog post to me. I love your thoughts about Breastfeeding as Medicine. Recently one of my boys had an eye infection and I told him that if I still produced milk, I would use breastmilk in his eye. Instead we used yicky eye drops... then I got the eye infection, too.

I've met Jenn once, but I never met Gretchen, who's post about Permission to Mother came to me in my alerts on the same day I read Jenn's post. I am glad you came across my book in your library. :)

Thank you for the feedback via your blogs.

Finally... We can put our feet up...

2010-05-30T15:55:00.004-04:00

It's been busy here: remodeling, moving, renting out the old place, house decorating, unpacking, conference, jury duty, house guests, busier than expected office schedule and more. Finally this weekend John and I can put our feet up! This little tropical paradise is at one of our neighbors Memorial Day celebration. Btw-- Now that I know what I am missing. I am getting a hammock (if I have a chance to shop). My plan for the holiday weekend was to commit to nothing except what was important to John and my boys (john picked the party.) . Thank you Trish for grabbing my camera and snapping this cute photo of me and John. I appreciate it so much.

David has missed me during long working hours. He's been extra clingy. And since I posted about it below, he keeps telling me how awesome I am. He counts the hours till I come home. He had fun pretending like he's a little baby asleep in a sling. It was funny putting him in the sling because he had to stand on a chair next to me and step into it. He got his fix quickly and went back to the games. He says babies love being carried in slings because it feels great being next to mommy. Yep, he even called me mommy.

We tried having a mock Shabbot service on Friday at our own dining table. I've thought about doing this before, but in-line with keeping low key and close to home without responsibility to anyone but ourselves this weekend, we finally gave it a try. We went at our own pace and read and re-read the various songs and blessings as the boys asked a lot of questions. Although we enjoy (kind of) attending with a congregation, it's not always on our time table or our comprehension level. I expected my boys to be restless and bored. Surprisingly, William and Scott argued about who should get to read more. (so we read twice). I had no idea that William learned and remembered several songs from TBI and he made a wonderful contribution to our "service." David is learning some simple blessings like the Sh'ma and Shabbot Shalom, so we let him sing it solo. He is very proud of his cantor-like skills. The boys pointed out parts we missed and want to include next time. Seriously, since service offers a time to remember the sick, the departed, and those fighting overseas for us, it gives us an opportunity to rembember those special to us. This was a far bigger success than I imagined. They are getting weekly tutoring for their Bar Mitzvah, but I feel like we need to be doing activities in the interim to keep it fresh and meaningful. We will definitely do this again.

Put John in charge of the wine and William in charge of the oneg (the snacks afterward) and we should be all set.

Off to enjoy more quite time.... :)

I was going to ditch this table and chairs...

2010-05-21T22:44:00.007-04:00

John and I bought a table and chairs 13 years ago. William was in a high chair. We used it in the huge eat-in kitchen that we had. John and I often laughed because the two of us ate at the big pristine table together wondering what we would ever do with the rest of the space. As the years went by we filled the seats with hungry kids and wore them out (the chairs). They looked terrible and I certainly hated anyone in to see this mess and all the other worn out stuff we accumulated. The table also looked small now with all of us seated around it.

We left these old chairs and table at our previous place. We did not bring them on the moving truck with us. I could not stand the thought of filling our newly remodeled house with something so old and damaged. Several times before I covered up the cushions myself (you can see several layers of previous prints). Now the handles were broken, the paint was chipping, and the frames holding the cushions were damaged. When the company handling our rental saw the table and chairs left behind, they offered to paint them and deliver them to us. They were pretty excited with the results.

My mother took the broken cushions and frames to her Upholsterer and Decorator in Orlando.And now I have a fabulous dining room set, that goes perfect in my new house! I love it!Let me add, what a treat it was to get the opinion of a professional decorator along with my mother's decorating advice (with pick-up and delivery) because this kind of stuff doesn't come natural to me.

Ross Upholstery, Apopka, Florida, 407-880-3331

Green Belt Brown Stripe Karate Promotion

2010-05-21T22:37:00.002-04:00

David got promoted to Green Belt with Brown Stripe tonight in the Police Athletic League Karate. He's so little and way too cute to have such a high rank. He's known karate his whole life :) , active since he's been 5.
William and Scott weren't scheduled to advance this testing. At the black belt level they don't rank up quarterly. But they got to fight the pending black belts and be a part of the excitement. Our family loves this karate program.

Are your physicians available by e-mail?

2010-05-02T18:19:00.003-04:00

I am curious if any of you (near and far, especially those not in my practice) have email/text/face book/twitter/social media access to your primary care physician or your children's physicians?

Does the electronic availability include clinical questions consults vs. appointment requests and questions for the business office?

Does the availability of a physician (or front office) by email influence your choice of who you pick as a primary care provider? Or not a big deal. Or do you prefer telephone if you could have contact outside of an office visit?

Thank you for leaving a comment with your experience.

He missed me!!

2010-04-27T23:21:00.003-04:00

After 5 long days, he missed me. For conference, on Thursday, I was gone for 14 hours, left early Fri and came home late Saturday. Left Sunday morning and came home late that evening. Jury duty was on Monday from early morning and I got home 3 ish.

David spent a significant part of that time with his favorite babysitter, Nate. David looks forward to Fridays when Nate is like another big brother to him. David counts the days till when Nate comes back. He calls it Nate o'clock, which is close to 8:00. If I come home for lunch when Nate is over, David is glad to see me leave again (so Nate can stay longer).

When I finally came home on Monday, David asked if I was going to any more meetings (like he asks if I was going back to work for the afternoon).

"Why, you want me to go to another meeting?"

"No, I want you to stay home with me."

I was surprised. I don't think he's every asked me to stay home! At least not recently. Trust me, I was aware of how long I was gone compared to my usual routine and trying to make my presence at home as optimal as I could. BUT, I did not expect a request to stay home and a " I miss you!".

David was glad I left only for a few hours today. He followed me all around in the yard, he took a short happy walk with me, and he enjoyed a favorite chapter book I read to him (Roscoe Riley). He was very loving today.

I was wondering if after the long weekend with Nate he would forget all about you-know-what. Sure enough he wanted his comfort, almost being very demanding about it and clingy upon my return and more.

I struggle with being away for long hours from my kids. Lots happens. David has been dry at night for a few weeks. He had some accidents around the time of our move. He's been good as we got more into a routine. A few nights this weekend he forgot his bed wetting medication before falling asleep and he seems to be be doing very well without right now with it. So, we are going to see if it lasts!

He lost a bottom tooth this weekend. The tooth fairy is still trying to recoup and recover from being away and needs to acknowledge this soon!

While I am updating about him, when I get my routine together, I have no doubt that he will be doing Barton Reading for dyslexia. I have not seen one ounce of reading progress in him in our down time from lessons over the past few months. One thing I have noticed: since Barton Reading is the only approach he knows, he does not have frustration with letters or a distaste for reading. It may not come natural, but there is no aversion to reading. The older boys had tried many programs that didn't work and got frustrated when it didn't work. David loves looking for letters he recognizes like "d" but no independent or spontaneous learning when it comes to reading.

BTW-- Our judge and lawyer had 30 jurors to pick out 6. They could not agree on 6 Americans to serve as jurors for this case and after 7 hours sent us home. Amazing, couldn't pick 6! What a waste.

Jury Duty

2010-04-25T22:31:00.002-04:00

Tomorrow, I am reporting to the court house to see if I am selected to be a juror. While that is a noble responsibility, I must admit, I am brain overloaded after four days of a great conference, I miss being with my boys because I was gone for long days, and I have a full schedule in the office this week, that may have to be post-poned. I hate not being available. I have never been called to jury duty so I suppose I am due.

When I am done and caught up (if I ever catch up) I can't wait to share more about the conference and also tell you more about the most common vitamin deficiencies and supplements. I tested my levels 3 years ago. On my way home today from Boca, I HAD to stop by the office to review my results, I was so curious. My results then were the catalyst for change and I was deficient in the most common. So was John...

If you need anything office related, John and Sarah will be in the office tomorrow. I may not be available to respond to e-mail.

If I get dismissed early. I am not telling anyone. :) I am going to hide and relax and tell you I put in a full day at court. :) No one but us will ever know. I am going to crash now....

Age Management Conference

2010-04-24T19:10:00.003-04:00

I've spent the last three days at an Age Management Conference with the compounding pharmacy I often refer to, Bellevue Pharmacy. I've met much of their team finally, like I've known them forever, even though most of our work has been done by email.

I've wondered what is the specailty of "age management." It turns out to include many things I already do. There are several models of age management practices out there. The model partly sponsoring this conference has a location in Boca Raton and offers comprehensive:
low-gylcemic diet counseling
fitness eval and exercise scripts
nutraceuticals
disease risk assessment
hormone optimization

After comprehensive evaluation you get a personalized plan. They serve as consultants, not as your primary doctor.

It is great to be amongst many physicians with open minds. Many physicians who are healthy and fit and live this lifestyle themselves. They draw in many patients who are 40-55 and want to have better quality of life. This sounds like the fastest growing part of my practice. Yet, I also provided this kind of care in the context of my background with preconception, pregnancy, postpartum and preserving BREASTFEEDING. AND I am still your primary care doctor if you want me to be. AND I haven't been charging Boca prices. Additionally I offer intracellular vitamin analysis and food sensitivity. The conference didn't give the details of the nutrition plans they teach to patients. I am not sure exactly what diet protocols they are teaching, but I am very comfortable emphasizing and discussing a plant-based diet. (I like the term low-glycemic" that they used.)

There was lots of discussion on Vitamin deficiency. Anyone want to guess which vitamin they feel is the most common deficiency? I am sure curious to look back at my last vitamin labs (before I improved my eating habits) and see if I was chronically low. I am also curious to repeat my testing now that I've been eating better and make sure I am not missing anything.

I purchased a new " toy" at the conference. I am very comfortable removing warts, skin tags, moles, and precancers and annoying little lesions with histofreeze. Now, I've got a precision tool to expand the kind of lesions I can remove without a needle, including very, very small lesions in sensitive places. I'll tell you more about this soon.

This conference also hosted a 5k fun run this morning. Yeah, I am very happy to say I ran the whole thing in 40 minutes. It was really 3.2 miles, a little more than a 5k. I haven't run a 5k in over 14 years. I haven't run 3 miles in that long, but with my gym work outs this was the next step. I LOVED the fitness presentation they gave and hope to talk more about that soon on the blog.

Postpartum Home Visit

2010-04-16T22:03:00.003-04:00

Thanks Kristen for including my book on your Green Mommy Blog's recommended reading list, especially when there is so many good parenting books out there.

Also thanks Jessica for taking the time to put your review on amazon. Any other new (or old readers thinking about adding a review to my amazon page. I still appreciate it and love the feedback.
~~~~~~~~~
I was requested at a home visit this week to check on a three day old. Mom had had successful breastfeeding experiences before and was concerned about why her nipples were sore with this baby. She thought perhaps the baby was tongue-tie and wanted me to check it out. She ask me to come to her house because she didn't want to take the baby out for two weeks. Many moms don't go out with new babies because of germ phobia (which is a good reason) and may have been a partial reason in this case. I was really inspired by what I observed when I walked into the house.

A calm, serene environment.
Mom and sister present to be support and solely focused on mom's need.
Naked baby lying on chest of topless mother IN bed. (This is what mom intended doing for two weeks minimum, if not longer, and was the main motivation for not taking the baby out for 2 weeks.)
A birth quilt hanging on the wall. Each square made by the different guests at her blessing way. Each square with positive affirmations. I loved it!
A stack of healthy birth books on the bedside table.
Lovely black and white framed photos of the prior pregnancy and babies. (I liked decorating my own room with pregnancy art when I was preparing for my home birth.)
I never did elimination communication. When the baby gave her signal their was a a wee baby bowl ready to catch the meconium and they did catch it.
I didn't see a baby crib or bassinet or other container any where in sight. :)
Positive vibes everywhere.

I just thought how peaceful a scenario for a postpartum mom with new baby and how few of us get to enjoy this quiet time with our babies. Thank you for allowing me into your home.