Inadequate milk supply? Try fenugreek

One of the frequent problems I encounter in everyday practice is that new moms don’t always produce enough breast milk. This is usually problematic, especially in the first few days when breastfeeding needs to be established. The mother is exhausted and in pain, and baby won’t stop crying because she is hungry. Sounds like a recipe for disaster, doesn’t it!

Fortunately, there is a solution that has been around for centuries. It is a little natural herb that can be safely taken by breastfeeding mothers. Fenugreek is a known supplement in many parts of the world, and there is clinical evidence and science to back it up.(link : )

Fenugreek is what is known as a galactogague herb. That means it helps increase breast milk production. It mimics the estrogen precursor. In the United States, it is available as capsules or tea. You can also find the natural seed in some ethnic food stores.

Where I grew up, it is served to new moms as a pudding. I ate a ton of it during the first few days after I had my daughter. I recommend it to all the new moms in my practice, and they rave about it.

If you want to try it, scroll down for the recipe of Fenugreek Pudding (Madidat Hilba – مديده حلبه). This is by far the tastiest way to enjoy it in my opinion!

Be warned however, fenugreek has a musty / maple syrup odor to it, and it is excreted in sweat. Once you achieve adequate levels, you will smell a little musty! But have no fear, that goes away in a few days.

Fenugreek is known to lower blood sugar. Please make sure to talk to your doctor before you try any new supplements or medications.

Have you tried fenugreek? What is your experience with it?

Fenugreek Pudding Recipe:


2 cans evaporated milk .

4 tbsp sugar (you can vary this according to taste) – I have a sweet tooth!

1/4 cup Fenugreek seeds.

1 Tbsp corn starch

1 Tbsp flour

1/4 cup cold milk

In a medium sauce pan, pour the 2 cans of evaporated milk , fenugreek and sugar and bring to a boil. While that is going, in a bowl dissolve the the flour and cornstarch in cold milk. Once the ingredients in the saucepan are starting to simmer, turn down the heat to medium low, then add the cold milk/flour/starch mix to the pan and keep mixing constantly with a whisk. You want to mix it frequently so it doesn’t clump. It should develop the thick pudding consistency. You may need to add more milk/starch/flour to the mix if you are not getting it to be thick enough. This should take about 10-20 minutes. Once you are happy with the consistency, pour your yummy pudding in bowls and let it cool.



Back with a Whoop! What you need to know about Pertussis.

Pertussis, also known as whooping cough has been in in the news a lot lately. And for good reason too. There has been an increase in the number of reported cases throughout the country, including right here in Central Florida. So far this year there were 35 confirmed cases in Orange, Osceola and Lake counties according to the Orange county Health department, compared to 11 last year! ( Thats a 300% increase)!!

  • What is whooping cough / Pertussis?

Pertussis is a respiratory infection caused by bacteria called Bordetella pertussis. It is also called whooping cough because of the characteristic sound of the cough it causes.The illness has 3 phases. Each phase lasts about 2 weeks. The first phase usually starts with a runny nose, mild cough, and pink eyes.This phase is difficult to distinguish from a regular cold. The second phase is an increasingly severe cough that can last 2 to 4 weeks. The cough usually comes in spasms and ends with a high-pitched whoop. Often the coughing causes a child to vomit or his or her face to turn red or blue. Coughing spasms are usually worse at night. In infants, whooping cough is a very serious illness and the baby may need to be hospitalized. The third phase is recovery. This may last another 2 to 4 weeks as the cough slowly improves.

  • Treatment is difficult. In most cases by the time the illness is diagnosed it is far too late in the disease process for treatment to be effective.
  • How can whooping cough be prevented?

It is important to have your child immunized against all preventable illnesses, including whooping cough, at regularly scheduled health checkups. A type of tetanus-diphtheria-pertussis booster called a Tdap shot is now recommended for all teens and adults to protect themselves against pertussis. Getting vaccinated with Tdap is especially important for families with new infants. you can ask your pediatrician or Family doctor if they provide this vaccine.

Whooping cough is a very dangerous disease, especially for babies. The risk of suffering and death caused by whooping cough is far greater than the possible side effects of the shot. Complications of whooping cough can include pneumonia, seizures, and death. The risk of having neurologic problems or long term damage from the current vaccine is very low. Your healthcare provider will discuss any possible side effects with you.

There are 2 main ways to prevent the spread of whooping cough:

  • vaccinate exposed children
  • give antibiotics to anyone who has been exposed to the disease.

Recently and article was published in the NEJM suggesting that immunity from the current vaccine is short lived. In my opinion, the problem with this study is that it was conducted in California where there is already a high rate of unimmunized children or children on alternate schedules. This basically diminishes herd immunity and may lead to these findings.

It’s also a part of being human to lose immunity to infections, both from natural infection and from vaccines. Over time, our bodies forget how to protect against infections. This study points out that the new generation of children who have had only “acellular” pertussis vaccines may need additional boosters to keep them safe. Time will tell. New recommendations may come out later this year or next.The best practice is to make sure your child is up to date on their vaccines, and that teens and adults have received their booster as well. This will definitely help decrease the spread of infection. Ask your pediatrician or Family doctor if getting the vaccine is right for you and your family.

The Insurance Debacle!

Now that it has been 2 months into the practice, I am starting to finally see the insurance payments coming in. Awesome, right?!  Ehhh…

Let me explain this to you and you tell me your thoughts:

Patient X has Medicaid, this patient came in for a well visit, but he also happened to have some ear pain. so doing the reasonable thing, I did the appropriate assessment for the well visit part such as measurements, calculating BMI, checking the child’s vision, assessing him for any developmental problems or behavioral problems and discussing all the details of what is relevant to his age.

Now for the ear pain part of the visit, it’s a different assessment, and he needed a prescription, not only that but he had a lot of wax in his ears, which I went ahead and removed.

At this point all this patient’s issues are addressed.Now comes the billing part:  For insurance claims, one must submit an itemized list of things that were done and hope the insurance will pay for all the work.

In this particle instance, Medicaid decided to pay me only for the ear wax removal $37!!

Apparently I am not allowed to perform multiple “procedures” in one visit. Unfortunately this a game that one has to play to try to get the best reimbursement rates from the insurances. Is it ridiculous?! Abso-freakin-lutely!

What difference does it make if I do the procedures in one day verses have the patient come 3 separate times to get the same done from an insurance stand point?! The work is being done either way! How is having parents miss work and their children miss school repeatedly  reasonable according to the insurance company.

Unfortunately for me, a solo practitioner with my overhead and bills to pay, this type of reimbursement is not sustainable, and I unfortunately have to comply with the way the insurance company is going to pay me. I really hate that I have to do this…

What are your thoughts on the matter?


Moving In!

I am very excited to share with everyone the great news, we have finally moved in to our brand new office.  Please feel free to stop by and say hi. We can register your child and get him or her established with us. So far the insurances that we are currently accepting are :

– straight Medicaid



and some Tricare.

Please be patient with us as we sort out all the red tape we have to go through to become providers with your insurance providers. Whats your insurance company? Let us know so we can become providers!