Wednesday, March 31, 2010

90-Day Get-Less-Fat Challenge

This is totally not related to my other posts.
Luckily, this is my blog, and I have ADHD.
I get to do whatever I want.
For those that know me, I have been losing weight for a bet.
I am extremely please with the results.

On January 1, I weighed 248 lbs at 25.6% body-fat (184.5 lbs lean and 63.5 lbs fat).
Today, I weighed in at 226 lbs at 13.9% body-fat (194.6 lbs lean and 31.4 lbs fat).
That is a loss of 32.1 lbs of fat and a gain of 10.1 lbs lean in 90 days!
My waist went from 40 inches to about 35½”.

I wanted to share how I got, and hopefully will maintain, these results.

INCENTIVE/BET/POSITIVE PEER PRESSURE

One of my Kappasig brothers from MIT set up the challenge called the “90-Day Get-Less-Fat-Challenge.”
Thirteen people put $100 in a PayPal account.
The challenge was to drop body-fat percentage (Example: 20% to 10% body-fat would be 50% reduction (percentage of a percentage)).
This was chosen to level the field of men versus women or athletic versus non-athletic.
Every week, we weighed in and calculated body-fat percentage.
Most of us used the Navy body measurement formula found here.
Every month, we took pictures… to check the honor system.
There was some rivalry, but it was more of a support and positive peer pressure experience.
One brother and competitor blogged about it here.


The winner for each month wins $100.
The 90-Day winner takes $1000.
I don’t know where I stand yet.

Even if I don’t win, who would be willing to pay for a supplement or training program that costs $100 to lose half of the fat on their body in three months?
Seems like money well spent.

The competition was 90% of the results.
I am giving you the details, but the competition really made me do everything with more discipline and consistency.

DIET/NUTRITION

There is a book called, “What To Eat: Food, Not Too Much, Mostly Plants.”



I have never read the book, but the title explains 90% of my nutrition plan.

EAT FOOD
Seems simple, but look at your diet.
How much of it resembles food as it was found in nature?
If you were to map how I shop, it looks like the Greek Capital Theta.


That is I walk around the outside for fresh produce, meats, dairy, and then down the frozen food aisle.
The rest of the store is pretty much engineered garbage, and I don’t consider that food.
Not only is eating healthy and in-season food healthy, but it is also economical.


NOT TOO MUCH

Again, seems simple, but not really.
Environment triggers behavior.
The impulsivity of ADHD exacerbates this fact.
Take the time to look at your environment.
I know where my wife hides the junk food, but seeing it is my trigger.
Instead, I saw conveniently located fruit and other healthy snacks.

It was tough learning to stop when I ceased being hungry versus eating everything on my plate, in the bag, or in sight.
As I lost weight, I also needed to re-evaluate my nutritional needs often.

MOSTLY PLANTS
Eat your veggies!
Every meal that I cooked, I tried to prepare two veggie dishes.
I did not deny myself protein.
In fact, I tried to do 1/3 + 1/3 + 1/3.
One third vegetarian meals.
One third meals where meat was served “as a garnish.”
One third, normal meat servings.

There were three other things that I focused on for nutrition.

Bacon:
I ate about a ½ pound every week.
Life without bacon is not living.
I also ate a lot of eggs for breakfast.
I worked out in the morning, so I wanted a high-protein, high-calorie meal with moderate carbs to get me through the day.

Carbohydrates:
I found managing carbs was the key to fat loss.
However, I am not an Atkins or South Beach Disciple.



Finding the right balance of carbs was a constant struggle.
I do Triathlons, so I needed carbs.
When I ate too few carbs, it affected my mood and concentration.

Really, does someone with ADHD need more problems concentrating?

The key was finding the right balance.
I would go high-carb in the morning or post-workout; moderate-carb at work; and low-carb at night.
However, the right balance was always something that needed constant re-evaluation.
At night, I would need to have a high-protein snack to make sure I could sleep through the night.

Restaurants:
With the exception of Sushi, I avoided restaurant food like the plague.
Restaurant salads can top 1000 calories after they add oil-soaked croutons, cheap cheese, candied nuts, and dressing with high-fructose corn syrup.
A chicken breast grilled at home is much healthier than a manufactured breast injected with beef broth and constantly sprayed with oil during cooking.
Investing in some Tupperware for leftovers returned its investment in my body and wallet.

EXERCISE
I am a firm believer in physical activity.
I think positive physical activity is good for mood, body, mind, and spirit… even preventing discipline problems in children.
For too long, I was a FORMER athlete (swimmer, cheerleader, martial arts, etc.) who still thought that he was an athlete.

I started doing triathlons last year, and my complete workout log is right here.



Triathlon cardio, especially swimming, was the foundation of my program.
I did most of my workouts by waking up at 4am to help time management and not hurt family time.

I did resistance workouts once or twice a week.
I did a hybrid of the workouts found at http://www.trainforstrength.com/ and http://www.crossfit.com/

My final stats looked like this:

March's totals:
Bike: 4h 34m 48s - 55.5 Mi
Run: 6h 57m 29s - 34.87 Mi
Swim: 5h 13m 02s - 14300 Yd
Strength: 3h 05m
Spinning Class: 1h 42m
Yoga: 45m

February's totals:
Bike: 2h 31m 42s - 33.02 Mi
Run: 3h 49m 34s - 19.27 Mi
Swim: 4h 07m 37s - 11050 Yd
Strength: 4h 30m
Elliptical Training: 20m
Spinning Class: 2h 00m
Yoga: 25m

2010 totals
Bike: 8h 06m 29s - 99.91 Mi
Run: 15h 23m 27s - 74.96 Mi
Swim: 14h 22m 32s - 38550 Yd
Strength: 11h 15m
Elliptical Training: 1h 05m
Spinning Class: 5h 00m
Yoga: 1h 50m


SUPPLEMENTS

I used to a supplement junkie in college.
I am not anymore.
I normally take a multi-vitamin, calcium (I am lactose intolerant.), glucosamine, and fish oil.
For the competition, I also took:



If you are not familiar with Alli, it blocks the digestion of some of the fat that you eat.
This helps, but really, the power of Alli is in “Treatment Effects.”
Once you read about the possibility of “Treatment Effects”, you will never, ever cheat on your diet.



Fiber is healthy.
A few capsules with each meal also helps you feel fuller.

Finally:



Ideally, Creatine Monohydrate helps you regenerate ATP during high-intensity exercise.
You can read more about ATP here.


However, this was a contest, and this was my only “gamesmanship” tactic.
I am confident that it was within the spirit and ethics of the rules.
The contest was based on body-fat percentage.
It was in my best interest to not lose muscle weight.
One of the initial effects of creatine consumption is 3-5 lbs temporary increase in muscle weight.
I took 25-30 grams of creatine daily (in 5-gram increments) in the last five days to keep my lean mass from dropping.

The good news: I can lose another 3-5 lbs just from discontinuing the creatine.

I hope my results motivate you to get your health and fitness in order.

I cannot stress enough how far moderation, decent diet, consistent exercise… and really good support and/or incentive… will get you.



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Tuesday, March 23, 2010

My ADHD Story Part 6 - Current Day

Alright, back to talking about myself.

When I left off in Part 5, I had just graduated from NU and moved to California to be a first year school psychologist.

I will spare you the details and get to the important stuff.

I have worked 9 of the last 11 years in school psychology (2 years as a vice-principal), I earned my Doctor of Education from UCLA, and I currently supervise school psychologists for a living.

I got married.
You can read about that here.

I now have two kids.
I am a family man that now plays Triathlete to stay in shape, burn stress, etc.

So let's focus on the ADHD stuff.

I am really two people.

No, I don't have multiple personality disorder.
I already discussed my opinions on people with mental illness getting into psychology here.

I really am two people, and very few people know both.

First, there is Dr. Beam.

Dr. Beam is always medicated.
He is a hard-worker.
He is smart.
He is too professional, as he never purposefully steps outside of his "work" mode.
He appears organized by the way he manages his electronic devices...
just don't look at the state of his office.
He is really good at thinking "big picture" and "out of the box",
but he delegates the mundane things more than he should.
Dr. Beam has so little personality, the Autism Community would be quick to claim him as Asperger's (he isn't).

Then, there is Eric.

Eric is the exact opposite of Dr. Beam.
He is fun, but does stupid things.
Seems smart, but he says REALLY stupid things.
Eric has a lot of acquaintances, but only a few close friends.
Eric experiences a lot of joy... and frustration.
Eric misses so many social cues, the Autism Community would be quick to label him Asperger's (He isn't. Really!).

My wife says that Eric is more fun, but Eric is also the one that tends to annoy her the most.

People that know Dr. Beam cannot believe that he has a social life or a sense of humor.

People that know Eric cannot believe that he has a responsible job -- or any job for that matter.

Dr. Beam leaves work social functions early so that he does not need to do damage control for Eric's behavior when the Concerta wears off.

The time that Eric spends un-medicated helps the medication work better when Dr. Beam takes his Concerta.

The only common thread,
aside from the obvious fact that they are the same person,
is that few people are ambivalent about Dr. Beam or about Eric.
They both seem to illicit a strong response in people
-positively or negatively.

(Aside, I think that I find it revealing that I actually morphed the two identities in the name of my blog... Dr. Eric.)

There are some positives and negatives in running two identities.
For me, there is no option.
At work and career, Dr. Beam needs to be medicated and constantly struggles to remain in control and organized.
Otherwise, I might not be a good bread-winner for the family.
However, Eric is really who I am.
Eric represents both the highs and lows in life.
Dr. Beam is just kind of there - no fun -no problems - no personality.
Eric is the guy in the party who either makes people laugh or shake their head in disbelief.

I think that the previous paragraph has a HUGE implication in dealing with children taking ADHD drugs.
Think about it.
The biggest subjective side-effect of many ADHD medication is that we do not feel like ourselves.
I feel like someone else on Concerta.
How many adults communicate the following to kids who take ADHD medication?

Oh no, someone did not take their meds today!

Who are you? You are such a good kid when you take your medication, where did that kid go?

etc. etc. etc.

When people say these things, this is what I hear, and I suspect many children do too:
If you are someone else when you are on your meds, and I like you better when you are on medication, THEN I don't like the real you.

Wow! Those little comments can slip out so easily, but how many people realize what they may be communicating?


Where does this leave me?
What are the lessons learned?
Here is what I have learned reviewing my story:

1 - There may be something in here that others can benefit from.
However, in the end, this is really about one individual.
I cannot assume that what is true for me is true for others.
Be wary of professionals or peers that do not maintain that vigilance.

2 - I would have benefited from earlier diagnosis and treatment.
However, diagnosis alone has no inherent value.
It is what we do with that label that matters.


3 - My doctor did a good job of slowly and systematically titrating my medication to figure out the right balance of maximizing therapeutic benefit while minimizing side-effects.
I assumed that was the norm.
It is most definitely not.
Many issues that people have with medication is incorrectly labeled as a problem with ADHD medication.
In reality, it is probably an issue with how the medication was prescribed.

4 - I have encountered many great people along my journey.
I need to make an effort to re-connect and, possibly, mend some bridges.
I do well with my wife and kids, but not with friends or extended family.
The question, do they even really care to reconnect with me or not?

5 - There are many more chapters still to write.
Struggles to face.
Challenges ahead.
In particular, how does ADHD affect my parenting?
Will my children have the same neurological challenge?
If so, will it be a blessing, or a curse?


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Wednesday, March 17, 2010

ADHD - Medical Diagnosis or can school staff diagnose or challenge a diagnosis?

I have been having discussions with a lot of people regarding challenging versus surrendering to a medical diagnosis, especially ADHD.


Here is what I have found.


- The United States Dept. of Education is firmly against school personnel giving the "medical" diagnosis of ADHD. The rationale is focused solely on school staff not intruding on the medical doctor/family dynamic. School staff should not be giving opinions that could impact the administration of medication.
(Of course, one of the DOE's primary source was the American Association of Pediatrics (AAP), who, surprisingly, takes an extremely M.D.-centric view of the universe.) The AAP stance is that the DSM-IV criteria should be followed.


- The above fact does not interfere with the assessment of ADHD for educational purposes or legal requirements under IDEA or 504. They are treated as two separate issues. However, the DSM-IV is the prevailing criteria for eligibility.


So apparently, they are two completely separate diagnostic criteria that use the exact same diagnostic criteria!? (Although one requires specific educational impact.)


Therefore, school personnel don't HAVE to accept someone else's diagnosis for ADHD at face-value, but they do have to perform their own assessment and due diligence.


Likewise, we cannot require that someone gets a medical diagnosis before we would, say, consider a 504.
(I hope my mental health practitioner who asked this question is reading.)


We are responsible for pursuing the matter ourselves.

References:
http://www2.ed.gov/rschstat/research/pubs/adhd/adhd-identifying-2008.pdf
DISCLAIMER - The diagnostic conversation seems overly simplified and watered-down to me.

http://www2.ed.gov/policy/speced/guid/idea/letters/2000-4/hoekstra112100definition.4q2000.pdf

Quotes:

Under IDEA, each public agency—that is, each school district—shall ensure that a full and individual
evaluation is conducted for each child being considered for special education and related services. The
child’s individualized education program (IEP) team uses the results of the evaluation to determine the
educational needs of the child. The results of a medical doctor’s, psychologist’s, or other qualified professional’s
assessment indicating a diagnosis of ADHD may be an important evaluation result, but the
diagnosis does not automatically mean that a child is eligible for special education and related services.
A group of qualified professionals and the parent of the child determine whether the child is an eligible
child with a disability according to IDEA.
Children with ADHD also may be eligible for services under
the “Specific Learning Disability,” “Emotional Disturbance,” or other relevant disability categories of
IDEA if they have those disabilities in addition to ADHD.

***
Section 504 was established to ensure a free appropriate education for all children who have an impairment—
physical or mental—that substantially limits one or more major life activities. If it can be demonstrated
that a child’s ADHD adversely affects his or her learning—a major life activity in the life of
a child—the student may qualify for services under Section 504. To be considered eligible for Section
504, a student must be evaluated to ensure that the disability requires special education or related services
or supplementary aids and services.
Therefore, a child whose ADHD does not interfere with his or her
learning process may not be eligible for special education and related services under IDEA or supplementary
aids and services under Section 504.
****



Here is my take:

1 - School Psychologists have (or at least should be expected to have) the training and expertise necessary to formally diagnose any DSM-IV Disorder.
In fact, for many diagnoses, the battery used by school psychologists is better than many used in practice by many others in practice. This is supported by the fact that, in California, Licensed Educational Psychologists (LEP's) in practice are allowed to diagnose and bill for diagnosis in private practice with no additional training in this realm. Of course, individual results and competency will vary.

2 - Having the training and ability does not mean that they should be going down that road very often. Any time school psychologists working for an educational agency stray from education code and education-based decision-making things get precarious.

The decision if/when to focus on clinical diagnosis should be deferred to the chain-of-command at any given agency.

I expect all of my staff to be fully competent in diagnosing ADHD or any DSM-IV Disorder.

This is best done sparingly when we need to undo a previous diagnosis or to update a better differential diagnosis, and only when there are true treatment implications at stake. Too often, I see it done to quibble with other practitioners over "who is right" and not to forward a discussion on how to best serve a student.

For example, my last assessment was to refute consideration of an Asperger's Syndrome diagnosis from a quickie assessment performed by Dr. Buy-a-diagnosis and maintain the team's focus on the student's Emotional Disturbance/Mental Health and ADHD needs.

In this regard, I started with Ed Code but added DSM-4 for added emphasis.

Even then, I don't formally diagnose, I stick with the "walks like a duck, acts like a duck, quacks like a duck" type of language.

For example, I use language that perfectly matches DSM-4 criteria without announcing that I am doing that.

For ADHD, I may say, "There is no evidence of signs, symptoms, or impairment prior to the age of 7. Furthermore, the following cannot be effectively ruled out as alternative explanations. In fact, the evidence suggests that these are more likely causes of the presenting...."



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Friday, March 12, 2010

Analysis Paralysis – Why does everyone think testing solves everything?

Wow!

I just finished a long week of discussing requests for testing. I had two IEPs with attorneys that were almost a day long each. I also discussed testing referrals with some mental health practitioners. Then, I come home to check some of the parent-support and advocacy chat-rooms on the internet.

ONE THEME:

How do we request testing?

They have to test if you request it in writing!

Disclaimer: The conversation with the mental health practitioners was a completely positive experience. All of the questions regarding testing were information-seeking questions on how to best serve their clients. I only mention it because of the timing. That day was book-ended by two days dealing with three lawyers. Two were about as okay as lawyers get, but one fit two stereotypes – of lawyers and of people that try to hide their stupidity with pure obnoxiousness.


Why are people so obsessed with testing?


Don’t get me wrong. If no one required testing, there would be a lot of unemployed school psychologists in the world. It is not that I am against testing. I just do not have patience for not doing things right. Case in point, I asked for, and received, a neuropsychology book for Christmas. I read books like this for pleasure.



Why do we have Individualized Education Programs (IEPs) in the Individual with Disabilities Education Act (IDEA)?

IEPs exist so that we can develop services and accommodations so that an Individual With Exceptional Needs (IDEA’s fancy way of saying “Students with disabilities”) can receive an educational benefit in the Least Restrictive Environment possible so that a student can access their Free and Appropriate Public Education (FAPE).


Almost everything that we do is a means to that end.

What do assessments do?

- They can help us determine if a student qualifies for services under IDEA in the first place. ( No, I am not touching assessment versus Responsiveness-to-Intervention today. I will reserve that post for a day when I feel like provoking jihad from the religious extremists on both sides.)

- They can help assess needs, if we do not already know what those needs are.

- They can help us differentiate if it helps us choose a better plan. You may be considering a different intervention depending on why you think a problem exists. Treatment for social withdrawal may be different when it is caused by social anxiety versus the social withdrawal of someone with Asperger’s.

I get accused of stone-walling assessments because I always ask the same questions when I get assessment requests for a students already in special education.

1. What is the evidence of educational benefit? There are many sources of data already out there. Grades, state testing, formative assessments, progress on goals, work samples, progress notes, etc. If the student is progressing, don’t test. Just keep fine-tuning your plan as you get more feedback and information.

2. What do we know about the kid’s strengths and needs?

3. Does each need have a decent plan?

4. Finally, what questions do we want answered?

The first three questions focus on the necessity to assess. If we do not need to assess, don’t. This is important to someone who works in high schools. Often, we have plenty of information, but someone needs to stop and analyze it all. Other times, the test scores are great measures of how over-tested or test-averse a student is— but nothing else. When we get kids struggling in school, their butts need to be in classroom seats whenever possible. We can potentially do more harm when we take a struggling student out of the classroom for an assessment that will not yield any new, beneficial information.

The fourth question really gets to the bottom line. Test data is like any information. There is no inherent face-value. It is neither good nor bad. What we do with information determines value. Assessments are the same way.
We cannot seek the answers until we ask the right questions.

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Thursday, March 11, 2010

Collaboration with Mental Health Professionals

I had the opportunity to meet with mental health professionals from several agencies today.

The topic was on how schools and mental health agencies could best collaborate.
I will be posting responses on the best practices that I have experienced for collaboration.

The main questions asked were:

How do you help a client access services in schools?

What are the differences between educational and mental health assessments?

Where do mental health practitioners fit into Response-To-Intervention?

How to contribute to IEP Meeting.

I will work on posting my advice to these question soon.

Thanks for being a great group today!

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Saturday, March 6, 2010

CASP MEMBERS - Please vote for me for President-Elect!

For those of you that saw me at that CASP Convention, you know that I am running for President-Elect.

I would appreciate your vote!

Full Members Vote Here.

(Make sure you log in using your member log in name first!)

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Monday, March 1, 2010

Presenting at CASP in Santa Clara this week!

For those attending the conference for the California Association of School Psychologists, please say, "Hi!" or check my presentation.

I will be presenting on how to handle difficult IEPs, but I will be all over the place.

I would love to meet you and talk shop!

www.casponline.org




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