Just read an interesting piece in Consumer Reports ShopSmart magazine, January 2012 issue. If you are taking, or thinking of taking, a more standard omega-3, this could be helpful for you.

They tested for:
Do they show the listed amount of omega-3 fatty acids EPA and DHA?
Do they properly disintegrate, show sign of spoilage, or contain contaminants such as lead, mercury, dioxins, or PCBs?

Even brands they recommend contained detectable levels of most contaminants, even though many claim they’re free of them. Consumer’s still recommends them because they don’t exceed USP and other regulatory limits.

Check with your physician before taking fish-oil supplements because they can interfere with some medications. Dr. Cerulli generally suggests high grade fish oil for her AD/HD patients. She tailors the dosage to at least 2,000mg combined EPA+DHA for adults and 1,000mg for children. Some patients need to increase in order to target specific clinical symptoms such as depression. Talk with her if you are taking omega 3 or have questions about your dosage.

Jay and I have taken other more expensive ones to get the EPA/DHA ratio we were looking for…

Here are the 9 that passed all their tests listed in order of price based on cost of taking 1000 milligrams of EPA and DHA daily-the dose they say is recommended for heart health. Check with your doctor to tailor this for you.

1. Spring Valley Omega 3 Walmart
2. Finest Natural Walgreens
3. Walgreens Omega 3 Concentrate
4. Barlean’s Organic
5. Nature Made 1200 mg
6. Vitamin Shoppe Meg 3
7. Carlson Super omega3 gems
8. Norweigian Gold Ultimate Fish Oil’s Critical Omega
9. Nature’s Way

NO
1. Kirkland Signature Omega 3 Costco
2. Nordic Naturals Ultimate Omega
3. CVS Natural
4. GNC Triple Strength
5. Nature’s Bounty Odorless
6. Sundown Naturals

I hope this is helpful for you.

Best to you,

Szifra

P.S. The article suggests keeping them in the freezer or eat with meals for reduced fish burps…

The study period was from 1986-2005 and included data from over 1.2 million children and young adults. No increased risk was found for those patients taking ADHD medications. In fact the heart risks for current users of ADHD medications were slightly lower than the risk for non-medication users or for those who had taken medication previously.

Bottom line is that the risk of cardiovascular problems exists at the same rate whether you take ADHD medications or not. If you or your child are considering treatment, this large government funded ADHD medication study can hopefully put your mind at ease that the risks, at least for heart side effects or stroke, are minimal.
See NEJM.ORG for the online article (10.1056/NEJMoa1110212) published Nov 1st, 2011.

The Virtual AD/HD Conference is a unique event that brings together the top experts in AD/HD. Join an international community of people affected by AD/HD, including adults, parents, spouses/partners, doctors, therapists, advocates, coaches, counselors, and many more. Rather than the time and expense of attending a physical conference, the Virtual AD/HD Conference brings the experts to you!
You can learn more about the conference, review the full conference agenda, and read testimonials from people who have attended here: http://addmanagement.com/affiliate.html?w=vac&p=cerulli
5 reasons why I recommend the Virtual AD/HD Conference:
1. You’ll access the top AD/HD experts from the comfort of your own home or office.
2. You’ll get the latest information and strategies on the most important topics in AD/HD. The conference topics cover everything from children to adults, from parenting to marriage, and from alternative treatments to medication management.
3. You’ll connect with a supportive group of your peers. The conference is attended by hundreds of people who understand the challenges of AD/HD.
4. You’ll participate at your own pace. You can choose to attend the sessions live via phone or Internet, or you can download the presentations later. The presentations and materials are available online for 3 months after the close of the conference.
5. You’ll skip the costs and hassles of traveling to a conference. The Virtual AD/HD Conference is cost efficient because it removes the need for hotels, airports, babysitters, and expensive restaurants.
The Virtual AD/HD Conference takes place October 3-6. I think the conference is a great opportunity to connect with your peers and get all the tools you need to succeed from the top experts in the world of AD/HD. I hope you’ll consider joining us!
Once again, you can learn more about the conference, review the full agenda, and read testimonials from people who have attended here: http://addmanagement.com/affiliate.html?w=vac&p=cerulli
The Virtual AD/HD Conference promises to be a value packed 4-day event. Hope to “see” you there!
Warm Regards,
Theresa Cerulli, M.D.

http://www.youtube.com/watch?v=wF1YRE8ff1g

Szifra

Traditionally when medication is first approved by the FDA there is a patent placed on the newly “branded” drug. After a certain number of years the patent expires and any other company is welcome to make a copy-cat “generic” of the drug. Is there any difference between the original and the copy? Yes. Does it matter? That depends on who you ask. My opinion -ultimately it depends on the person taking the drug – the patient!

When generics are manufactured, the FDA allows a slight deviation from the amount of active ingredient compared with the original branded version of the medication. Maybe Brand X has 32% of the active ingredient and Generic X has 30%. Probably not a noticeable difference clinically for most people. But, where brands and generics differ the most are in the filler components – the stuff that literally holds the tablet together. These filler components can be completely different, resulting in the pill looking nothing like the original one. The size, shape, and color may be may be unrecognizable when you go to pick it up at the pharmacy. The name – the generic name – may be unrecognizable as well. This is a source of many frustrated phone calls to our office from patients worried that the pharmacy gave them the wrong bottle.

Rule of thumb is that most generics will work fine for most people. However, there are some exceptions so certainly let your doctor know if you are experiencing any change in symptoms or side effects when going to a generic. For example, you could be allergic to the red dye coating of generic Y that wasn’t in brand Y. Or your child may have trouble swallowing generic Z because it’s twice the size of brand Z.

Cost cutting is generally driving the substitution of generic medications in place of the brand. That’s good news if both drugs are equally effective for you. But if you have noticed differences in effectiveness or side effects, ask your doctor to contact your insurance company to do a “Prior Authorization” requesting coverage for the brand. It will usually take 3-5 business days for your insurance company to respond to the doctor’s request so patience and planning are helpful in these situations.

ADHD is known to be highly genetic. Approximately 77% of the time someone diagnosed with ADHD has the condition because of the genes they carry. However, genes are not the only factor. Researchers are finding other issues can “correlate” with ADHD. In this recent study published in January’s Journal of Pediatrics researchers show that neonatal health is an important risk factor for ADHD.

An astounding 980,902 children born in Denmark between 1988-2001 were monitored. The baby’s health immediately after birth was measured by commonly used Apgar scores. Then all children were followed from age 3 until a diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came first.

The results – The lower the Apgar score the greater the risk for the child developing ADHD. Compared with children with Apgar scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children than with Apgar scores of 1 to 4 and 63% higher for those with Apgar scores of 5 to 6.

Doctors concluded from this study that a low Apgar score is associated with risk of ADHD in childhood. Perhaps low Apgar scores and ADHD share common causes, or a low Apgar score reflects at least one possible pathway leading to ADHD.

So, when I read a recent Boston Globe article on Billy Starr, the founder of the Pan Mass Challenge, I instantly thought of many of my compellingly interesting, non-cookie cutter clients and their strengths.

 You might also find it interesting, so I’ve attached it. (For those of you want to scan, I bolded the parts that made me wonder about ADHD, and took a few sentences out for brevity.)

 Pedalers of Hope  Boston Globe, November 12, 2010

The older I get, the more I realize how little I know, which is exactly what I was thinking as a guy named Billy Starr described the annual event he founded and runs known as the Pan-Massachusetts Challenge.

I had heard of it. Everyone’s heard of it. It’s a bike ride, a big one, in which cyclists in Spandex solicit money from friends to pedal unimaginable distances over a couple of days.

And then these maddeningly cheerful people give the proceeds to a worthy cause.

For the record, he looks like his name, with a mop of sandy hair parted Pete Rose-style in the middle and an athlete’s build that makes him look a decade younger than his 58 years. He is in constant motion, arms flailing, head bobbing, even when he thinks he’s sitting still. The guy rides his bike up Mount Washington on a Sunday with less effort than another man might lug a bowl of Brigham’s ice cream to the couch to watch the Patriots on TV.

His Pan-Mass Challenge headquarters is located in an utterly charmless single-story building in a generic Needham office park.

Things get worse inside. There were cords everywhere. The staff apparently collects trash for a hobby. There’s neither reason nor rhythm to how desks are scattered. The place makes the Globe newsroom seem like the Four Seasons Dorchester.

Billy Starr is proud of this, too. In his separate cinderblock office, I ask him how the Pan-Mass Challenge (PMC, in the lingo of those around it) compares to, say, the Avon Walk for Breast Cancer, or the Walk for Hunger.

He looks stunned.

“We raise more money in Massachusetts than all of them combined,’’ he said.

Where do you rank in terms of the biggest events like this in the country?

Now he looks hurt. “We’re the biggest in the world.’’

… tonight, at Fenway Park, he will present a check for $33 million to the Jimmy Fund and the Dana-Farber Cancer Institute, the entire proceeds from the August ride.

… the PMC’s total contribution to Dana-Farber to a mind-boggling $303 million in cold, hard, lovable cash over 31 years. Dana-Farber is the exclusive recipient of PMC money.

To put this in perspective, you would basically need a charity with $650 million in assets — nearly the size of the Boston Foundation — to reliably spin off $33 million a year in grants. And that charity is going to have a lot more than the half-dozen staffers that the PMC does — and a more expensive office.

Dana-Farber’s chief executive, Edward J. Benz Jr., is unequivocal in the importance of the PMC to his institution. “We couldn’t give the care we want to give, or have the cutting-edge research we want to conduct, if it wasn’t for the PMC,’’ he told me.

What began in 1980 with a group of 36 friends raising $10,000 has turned into 5,000 cyclists raising money from 230,000 contributors to ride as many as 190 miles over two days, all of it staffed by 3,100 volunteers. Starr founded the ride after his mother, cousin, and uncle died of cancer in the 1970s.…

Brian McGrory is a Globe columnist. He can be reached at mcgrory@globe.com

 P.S. If you have ADHD, I hope this story helps you recognize and appreciate the gifts of your biology.  And, for spouses and partners, please take a moment to recall what attracted you to the high-intensity, creative, different-minded man or woman you are with. Wouldn’t it be great if Billy Starr’s partner (if he has one, I didn’t research that!) was able to recognize how much his temperament (maybe ADHD, I don’t know) fueled the success of this amazing project.

Szifra@BirkeConsulting.com

www.BirkeConsulting.com

www.SzifraBirke.com

978-446-9600

ADA is a civil rights act that evolved from anti-discrimination laws in the workplace. It is not an extension of special education laws such as the IDEA, which supports that handicapped or underachieving kids are entitled to remedial services that facilitate success. Instead the goal of the ADA is to prevent discrimination and ensure equal opportunity for individuals with disabilities. So contrary to popular belief, ADA was NOT intended to facilitate success! It is important to understand this distinction in the law for those seeking accommodations and for their clinicians.

Although the original ADA was signed into law in 1990, an Amendments Act was added in 9/2008. Later the Department of Justice (DOJ) proposed additional rules for law, including testing guidelines for accommodations. The final DOJ rules of the Amendments Act were not enacted until very recently in July 2010. The good news is that the Amendments Act is designed to apply less stringent criteria to establishing disability, but extensive documentation will still be required, generally including testing from a qualified professional with details of why each specific accommodation is being requested. NOTE: Diagnosis does not equal disability. In other words having a diagnosis of ADHD does not automatically qualify you for services.

Since the final ADA Amendments Act was just recently enacted (July 2010) there have not yet been any court cases to establish a baseline. We do not yet know how this will play out in the court system. If you are considering pursuing a case based on the ADA, at least make sure you build it on the concept of anti-discrimination – the true intent of this law and its amendments. For academic or workplace accommodations, I would recommend seeking a diagnostic evaluation that includes neuropsychological testing, which is done by a neuropsychologist (PhD). Neuropsychological testing offers the strongest case for accommodations.

Frequently I have patients arguing that because they have ADHD or a learning disability that academic conditions must be set to ensure their success. This idea is false. Neither IDEA (Individuals with Disabilities in Education Act) nor ADA guarantees success. ADA is an outcome neutral, anti-discrimination law with origins in the civil rights act of 1964, while IDEA supports that underachieving children and entitled to remedial services to facilitate success. Success is still rightfully left in the hands of the individual to achieve.

Theresa Cerulli, M.D.

B.B. King’s lament, “nobody loves me but my mother,” is sad enough, but then he postulates that she could also be lying, leaving him loved by no one. When you hear the artist sing out those words, the blues never sounded so blue. Who are we if we are not even certain of a mother’s love? I enjoy listening to B.B. King, but I will have to admit to cringing every time I hear this particular line. As a therapist, I work with too many people for whom the words are not simply lyrics, but rather a way of being in the world. For those who grew up in environments when loving parents were in any way absent, or untrustworthy, what does the voice inside of their head’s say? I imagine it sounds like, “if I wasn’t loved by my parents, no one will ever love me, and if I couldn’t trust my parents, I will never be able to trust anybody.”
How tragic! Think about it, going through your day-to-day life never allowing yourself to be fully connected to another person. Never allowing yourself to go beyond having a superficial relationship, always assuming that it can never be completely real…never fully trustworthy…never something you can really count on.

It’s quite a dilemma, isn’t it?

When others disappoint us, even from an early age, the truth is that we still have opportunities to find connection in the world, even if it’s from places we never expected to find it. For example, consider inmates in high security prisons. When inmates from these facilities are released, recidivism rates are typically quite high. If, however, inmates are paired with dogs for 12 to 18 months prior to their release, the rate of re-incarceration is nearly zero. What then did the connection with a canine provide the human? The answer is the same as what we had hoped we had gotten from parents…unconditional love.

Finding love requires us to be open to the possibility of love. We need to imagine ourselves as loveable. This can be tough work but it is clearly possible. One only needs to look at the example of the former inmates and what they learned about the unconditional nature of relationship to appreciate the potential of new experiences. Too many of us lament the loss of parents, siblings, spouses, and other family members without ever attempting to find those loving, affirming and sustaining relationships elsewhere. I have seen those connections occur in therapy groups, in adoptive homes, in faith communities, between close friends, and yes, with animals. Isn’t it time for all of us to consider who we have in our lives who would willingly, perhaps gleefully, enter our lives as loving mothers and fathers, sisters and brothers, friends and soul mates. It is never too late for that!
Best,
Walter

“Walter is a credible, personable therapist with an interactive style that works. He cares deeply about his patients and is committed to their growth and well being. I am grateful that I can count on Walter to care for the children and adults in our community.”

Theresa Cerulli, M.D.

Walter Sherburne, Psychotherapist
walter@sherburnecounseling.com
www.sherburnecounseling.com
978-470-HOPE