It has come to my attention that there has been some confusion about
that I saw a few weeks ago for tongue-tie. I'd like to clear
A.L. was brought to my attention by mom's
child birth educator. She
that mom asked your nurse for a consult to see me at the medicenter. It was
to me that your office nurse stated that your office never refers
to the medicenter.(Is this really, true?) The child birth
educator asked me
what the proper procedure was to get a breastfeeding referral, for suspected
had an opportunity to meet with Dr. Robbins [CMO, Vice President of Medical Affairs] to see how I should go about
breastfeeding referrals. Dr. Robbins suggested I call you directly.
With moms permission I did call to speak with
you about the anticipated
tongue-tie clipping. Your office manager sped things up and gave us a
referral number. For
the babies sake, I wish now I had talked to you
Mom brought the baby in. I observed how the baby was latching
prior to doing
anything else and noticed this baby had a disorganized suck and tongue-tie.
No wonder mom has so much
pain with breastfeeding.
Regardless of the frenotomy, it was apparent to me that this baby needed
therapy with a
speech pathologist who is trained in infant feeding problems.
As you know I recommended a Cynthia Andric to mom. This therapist
experience working with me s/p tongue-tie. It is my impression that your
office staff thinks the frenotomy I did
caused the poor suck.
It is, also,my understanding that the office staff has a problem with me
If the staff has any questions about my credentials to do a
Robbins or Chris Freidman in Risk Management
or the A.A.P, itself, can be
I went through the proper channels at Martin Memorial to have privileges to
a frenotomy. Current information about frenotomy shows that delaying the
procedure leads to a down hill spiral of breastfeeding
and sucking problems.
It is unfortunate this mom did not get the referral much sooner.
It is my impression that
your staff actually expressed their dissatisfaction
with my judgement, evaluation, and procedural skills to the mom
therapist I recommended. Specifically they said, "This office will never
refer to Dr.
Punger again." Are
you aware that your staff is making those calls for you?
Additionally, your staff has made a big-deal about who to
refer the therapy
to. The staff made a referral to a speech therapist who I have been told
admitted that her knowledge
in infants s/p frenotomy is limited and mom
should go to the experienced therapist I suggested.
Your staff needs
an inservice and update on frenotomy and tongue-tie. May I
suggest a video by Evelyn Jain MD. The Lactation Consultants
at MMHS have a
copy of the video. Dr. Jain and Brian Palmer DDS, both specialist in
ankyloglossia, also have websites
explaining tongue-tie, which are easy to
find in a search and I often recommend to patients.
I am only informing
you of staff problems. But if you have any problems with
my skills or credentials feel free to contact me directly, if
you would like
to discuss this case with me or any other breastfeeding concerns let me
know. I'd be happy to help. The
patients need us to openly communicate.
Denise Punger MD FAAFP IBCLC
International Board Certified Lactation Consultant