Beyond ADHD A Physician‘s Perspective Podcast
A Psychiatric look at ADHD with Dr. Nesrin Abuata
Dr. Diana Mercado-Marmarosh: [00:00:00] Come join me May 1st through the sixth, so that you can rest, rediscover your strengths, reconnect yourself and those physicians like you who are ready to leave, work at work and re-energize. This is the invitation for you. 2023 your year. Join me in Costa Rica in this really amazing, non-judgmental, intimate decision community.
I am gonna show you how to rest and how to recharge. Let's transform your brain up so that you can start to dream the life that you always wanted this year in 2020. I can't wait to learn all about what kind of year you're gonna have after this conference. Take care. Hello, hello. Welcome to Beyond ADHD, a Physician's Perspective.
I am Dr. Deanna Mecado Mar. I'm a family medicine physician practicing in rural Texas. I used to be hindered by my adhd, but I now. See it as a gift that helps me show up as a person. I was always meant to be both in my work and in my personal life. In the past two years, I've come to realize that unlearning some of my beliefs.
And some of my habits were just as important as learning the new set of skills. Well, hello. Hello. I am so excited to be sharing with you a very nice friend, colleague that I've been chatting with before we started, and I probably should have just hit record because that conversation was amazing already.
But I am so excited that she's here. She. All the things. And so hopefully I'm not gonna mess up her name. We practiced, but I'm gonna try. So, Ms. Reen Abk she is actually a family medicine physician. She's a psychiatrist, but she's an integrative addiction psychiatrist. Yoga instructor, Reiki energy healer, and the list goes on and on and on and on.
And guess what? She's an amazing person with adhd. Oh my god, I found the unicorn. Right? Sounds crazy. But as you guys know, we tend to be multi-passionate and multi curious, and we are lifelong learners. And so I am so excited to have her here today because she's gonna talk to us about the relationship that A D H D and trauma can have.
And I was just explaining to her that, you know, the more and more that I look into it that's why now I'm actually getting. I didn't tell her, but I'm working towards getting my certification also for trauma so that I can in further integrate into my course because I, I try to be very careful with my teaching because I don't want you to feel like, you know, everything I'm saying is exactly one size fits all.
There's not such thing, and I want you to try all the tools and walk away with the ones that make the most sense. But I am so excited to have her here. I would love for her to share a little bit about her story and then she can tell us a few things about trauma or anything she wants to tell us. I'm so excited.
Dr. Nesrin Abuata: So thank you Diana, for having me. I just as you said, I got training in, I'm a family medicine doc, a psychiatrist, and I feel like my life story, the overarching theme is all about integration and how do we connect the mind and the body. I am originally from Israel. I was born there, grew up there, and then I came out here from my medical training.
If you've ever been to Israel or heard on the news, we're always unfortunately making it on the news. There's a lot of trauma and. Trauma, big T trauma or small T trauma. So Big T trauma is things that are obvious that everybody sees it on the news and they're small Ty trauma, that it's the experience of what you undergo that puts your nervous system at a risk and not feeling safe.
That's a small ttra, so having grown up in that kind of place, I was just telling Diana as we started, when you're a fish swimming in the water, you don't know that you're in the water until you step out of it. And my growing up, I grew up in, in a lot of trauma without knowing it or understanding it. what you would think of as abnormal here because it's not everyday kind of life over there.
Growing up it was ki part of my life, and as I was going through med school an
Dr Stephen Lewellis
Dr. Diana Mercado-Marmarosh: hello. Welcome to Beyond ADHD, a Physician's Perspective. I am Dr. Diana Mercado Marmarosh. I'm a family medicine physician practicing in rural Texas. I used to be hindered by my adhd, but I now see it as a gift that helps me show up as a person. I was always meant to be both in my work and in my personal life.
In the past two years, I've come to realize, That I'm learning some of my beliefs and some of my habits were just as important as learning the new set of skills.
Hello. Hello. I am so excited to be here today. I have a very special guest, Dr. Steven Le Leis and I'm Might have missed up, that please. Correct.
Dr. Stephen Lewellis: Yeah it's Luis. It's a hard one. All my patients get it wrong, so don't worry about it All ,
Dr. Diana Mercado-Marmarosh: Dr. Leis. And I think I messed it up again, but don't worry about it.
I'm gonna call him Dr. Steven . No worries him for today. He's in a and he's an amazing husband, of course, father, and he's trained in NYU and Stanford. He's a board certified. An investor and outside of his medical practice, he's passionate about spending time with his family and in strengthening the collective voice of physicians on social media, educating fellow physicians about personal finance and life.
Planning and investing in private real estate. As you can see, he's multi-passionate and I love this about him. And so today we're gonna have an interesting discussion about what is going on with him. He shared with me that he recently came to realization that he has a D H D diagnosis. And as you guys know, in my podcast, I've interviewed many female physicians and a few male physicians and we were just having this discussion about, I would love to talk to everybody because it's so important to have the perspective of different voices cuz their matter, our stories matter and a is a spectrum.
So I'm so excited to have him here today. Would you share with us what's been going on in your life lately?
Dr. Stephen Lewellis: Yeah. Can I call you Diana? Is that okay? Yes, of course. Great. Or Dr. Diana I am very grateful to be here. First of all, it's really nice to be on your show and I'm really impressed with what you've built so far.
And I'm happy to tell you a little bit about myself. But as with a, we can get a little time tracking. A little warped for us. If I'm going too far, just cut me off and go down a line of questioning. But again, my name is Dr. Steven Luis, and I live in a relatively small town in central Wisconsin, wasa, Wisconsin.
I'm a practice here as a board certified medical dermatologist. Hi, . And I am at home as well with my wonderful and very supportive and lovely wife and two small children. So we have that in common. I have a three-year-old boy and a seven month old girl. So lot of changes recently, and my job was relatively new.
I've been there for a year and a half. Finished residency in 2019 right into the pandemic with kids and jobs. So a lot of changes happened at once and a lot of challenges, and that led me down a road slowly and a little bit painfully, but finally a road to really addressing some underlying mental health issues that.
Suspected maybe in the past, but never had the never was intentional enough to address them or was brave enough or whatever it was until it really reached a tipping point in 2022. Essentially, that was the year that I took charge of my mental health, and I've already seen dramatic changes just from that probably about a six month journey since I first asked my primary care doctor to help me with what I was
Dr. Diana Mercado-Marmarosh: struggling.
He said hi to my daughter who just came and jumped in . And so if you guys are wondering who is he saying hi to ? Yeah, sorry. No. I, no, I'm just clarifying . But she's walking away. . But I wanted to ask you what do you mind sharing what you were struggling with? I, you said time blindness was one.
Dr. Stephen Lewellis: Sure. Yeah. Time blindness. I
Interview with Andrea Wadley
Dr. Diana Mercado-Marmarosh: hello. Welcome to Beyond ADHD, a Physician's Perspective. I am Dr. Diana Mercado Marmarosh. I'm a family medicine physician practicing in rural Texas. I used to be hindered by my adhd, but I now see it as a gift that helps me show up as the person I was always meant to be. Both in my work and in my personal life.
In the past two years, I've come to realize, That I'm learning. Some of my beliefs and some of my habits were just as important as learning the new set of skills.
Hello. Hello. I am so glad to be here today. I have an amazing friend. From Dallas, Dr. Andrea Wadley, and she is actually the owner and head pediatrician at 1 27 Pediatrics. It's a really cool setup that she has going on. She is a home visit. Only direct primary care, pediatric and lactation practice, and she's able to provide convenient and really high quality evidence-based care.
In your house. Like how amazing is that? And she also helps with breastfeeding medicine consultations. So yeah, I'm so excited to have her here. And she does all kinds of education on breastfeeding, but this is probably her passion project and she's gonna share some nuggets about.
Some of the difficulties that can happen during breastfeeding time and how maybe taking some of those steps can be helpful to implement For any of us who have a D H D or any of us who feel like we might all of a sudden have something that feels like A D H D because of the new responsibilities during this amazing and exciting and challenging time of our lives.
Awesome. So thank you for coming. I'm so excited you're here
Dr. Andrea Wadley: today. Thank you for inviting me. This is exciting.
Dr. Diana Mercado-Marmarosh: Tell me how did you decide to do what you're currently doing? Because, I'm, did you envision this all along when you started off, like in residency into pediatrics, or what were
Dr. Andrea Wadley: you thinking?
Yeah, so I was. In pediatric training in San Antonio actually. And I had a pediatrician mentor, so my advisor was always telling me that I should start my own practice, and I told her she was crazy. So I never ever had that desire when I was in residence. C my husband and I actually met via the internet while I was in San Antonio and he was here in the Dallas Fort Worth metroplex.
So we met, we dated, we married and we were long distance for that whole time. We got married at the end of my intern year of residency, which was crazy. Why would anyone do that? And then we lived apart for the first two years of our marriage, so I moved back to the Dallas Fort Worth metro.
And it was. , it's really hard to find a job. As a pediatrician, as a doctor, you think the world will want me, and nobody wanted me, it felt like. And , I looked all around town and then I found this amazing job as a newborn hospitalist. I worked there for eight years. Loved every minute of it.
Loved helping moms and babies in the hospital during the first few days of the baby's life. But there was always something inside of me that was missing that I am pediatrician, so I wanted that. And as the corporate structure of medicine continued to press down on.
My heart and my soul . I had my own child during that time and just missed having time with her just because someone else was telling me what my schedule was gonna look like. So as a result of all of those things, I decided I wanted to start my own practice. So in the middle of that, having my own child as well and trying to breastfeed I was a physician.
I thought I knew everything, right? I'm a pediatrician. I take care of moms and babies, and I know everything about breastfeeding. Oh my gosh, I didn't. So it was soul crushing right to, to try and breastfeed my own child. All of those things mixed together and prompted me to want to start my own practice doing pediatrics as well as breastfeeding medicine.
So lactation consults. And then I looked at the horizon of medical care at that time, and it's only gotten. Maybe worse sin
Sluggish Cognitive Tempo Disorder
Dr. Diana Mercado-Marmarosh: I am so excited to talk to you guys today about something that is called Sluggish Cognitive Temple Disorder. They used to think that it, was a category of A D H D. They weren't sure, but now they're working on figuring out that it's totally separate from A D H D, although they can correlate.
And I wanna. Explain the differences between them and explain that because it's so important for you to be aware whether you have that in A D H D or if you just have that and not a D H D because the treatment that you use is different. And yeah. So I think it's so important. Okay, so sluggish cognitive temple disorder is something that is been talked about a lot or by Russell Barkley.
He is a clinical professor of psychiatry from Virginia Treatment Center of children in Virginia in Richmond Virginia. But anyways I learned about this sluggish cognitive temple disorder during one of his presentations while I was working to become a clinical certified life coach for A D H D.
He has a Barclay rating scale for the sluggish cognitive temple disorder. And on there he talks about some of the characteristics that really make it stand out different from A D H D. So when you think. The Barclay Rating Scale. He wants you to think, to wonder whether you have you're somebody who is daydreaming excessively if you're having trouble staying alert or awake during boring situations.
Whether you're somebody who is easily confused, whether you're somebody who is spacey or seems to be like in a fog. Mind seems to be elsewhere or who is staring off into stage, or whether you're somebody who feels lethargic or more tired than others, or whether you feel like you just. Have no energy.
You're slow moving or sluggish, or whether you are somebody who seems like you're having a hard time processing information as quickly or as accurate as others, or whether you feel like you are withdrawn like you get lost in thoughts, or you seem to be very slow to complete a task.
So the important distinction that he makes or that he wants you to differentiate this from A D H D is that it seems like A D H D is more of a productivity disorder and he wants you to think of sluggish cognitive temple more as. Accuracy disorder. I thought that was important to point out.
And what he was saying is that when you wanna think about this, whenever with a D H D, we know that it's not. One part. But with A D H D, it's more like the executive function. It's the emotional dysregulation, it's the processing and the implementation and the planning.
So there's so many other stuff, but people with a D H D, some of them, they tend to have Endless amounts of energy, and I guess that's what people usually say about me, but we also have to remember that it's a spectrum. But what makes this a little bit different from A D H D? It seems like there is a slowness to the behavior.
There is a slowness in the information processing, and there seems to be some mental confusion or slow activity instead of like impulsiveness that can be seen in a D H D. And I wanted to point that out because I know I had several clients and I've had several of my own patients where they just come and they tell me.
I am so tired I cannot seem to focus long enough what people are telling me. So I want you to be aware of this possibility because we might incorrectly label them as a D H D and give them the treatment for A D H D, and then that was not the right diagnosis and it might not help. And interestingly enough what Dr.
Barkley says is that we're not even sure if this naming of this disorder is correct because luggage cognitive temple disorder it might not be appropriate to be labeled that because it almost implies that you have a cognitive deficiency and it might not be, it's just that maybe the processing speed of it is a little bit slower.
And so he thinks like maybe it would be better to call it like a concentration deficit per se. But anyways there was a recent study in the Cincinnati
3 questions to ADHD Declutter Your Life with Ease
Dr. Diana Mercado-Marmarosh:Hello. Hello. Welcome to Beyond A D H D A Physician's Perspective. I am Dr. Diana Mercado Marmarosh. I'm a family medicine physician practicing in rural Texas. I used to be hindered by my A D H D. But I now see it as a gift that helps me show up as the person I was always meant to be, both in my work and in my personal life.
In the past two years, I've come to realize that unlearning some of my beliefs and some of my habits were just as important as learning the new set of skills.
Hello. Hello. I am so excited to be here with you today. Uh, we are definitely in January, 2023 now, and I wanted to start out this year, right? I wanted to remind you guys why we do what we're doing. Um, we forget that. Our growth is optional. , we always think that, you know, we have to wait until the new year.
We have to wait till Monday. We have to wait until whenever to start making a change. But the thing is, you really don't, someday is not a day on the calendar, right? You really have to decide what your intentions are for 2023 and go for it. And so this. Um, my intentions continue to be, to grow and continue to be, to only do the things that like light me up and the things that will, um, give me peace of mind and the things that will make a big impact in humanity.
And as you guys know, I'm on a mission to really. Medical field, uh, to really disrupt the way a D H D is viewed, uh, so that people can realize that mental health. Really important and realizing front and center that our emotions, um, can be used as a compass is, um, I think one of the key things that people are not aware.
And so with that, I want to talk to you about three questions that I always, um, Teach in my A D H D course, and I want you to implement them. Ask them of yourself today so that you can gain so many hours back. Okay? And I'm gonna ask you these questions and I want you to really, they're so simple that you're gonna be like, really?
That's all . But I guarantee you that if you start to apply, You're gonna save at least three hours of your day, at least. Okay. And it will start to add up and you will start to be, um, in alignment with what you want to do. And yes, I know that change sometimes is hard and I know that accountability is one of the ways to really, um, bring it in.
Yeah. And so with that in mind, You know, I want you to be aware that I'm here to help you in any way and. The prize of my course, as you know, is going up. Um, well, they should already gone up. Uh, you know, January 1st I was gonna start charging a 4,500, but I've decided that, you know, I have a D H D too, and I've decided that sometimes we all need a little extension and that un unfortunately, life is not dress rehearsal, but being kind and being human and being generous is the most important thing.
Because, you know, life should be abundant and it should always come back. So because of that, I am going to extend the deadline of my, of, of charging. So instead of, uh, going up to, uh, 4,500, um, which it will go up, , it will go up by, um, February 1st for sure. Um, I want you to use this as an opportunity to invest in yourself.
I wish somebody would've given me this, uh, opportunity when I was a medical student. When I was a a resident. When I was a, an attending, I, obviously, this is why I created the course because nobody told me about it or told me how my A D H D brain works, and every day I see posts that basically say, Help, I'm about to get fired because of my A D H D or people with A D H D are not even aware that there's resources there.
And other colleagues are asking questions on different Facebook groups, um, what they can do to help their colleague out because they have a great personality and they're amazing with their patients, but the administrative stuff is getting in the way. And so I want you to be aware. Our internal environment, um, sometimes mirrors or external environment.
And, and some of you are already getting my emails, a
How My ADHD saved the Holidays
Dr. Diana Mercado-Marmarosh: Hello, hello. Welcome to Beyond D H adhd, A Physician's Perspective. I am Dr. Diana Mercado Marmarosh. I'm a family medicine physician practicing in rural Texas. I used to be hindered by my A D H D, but I now see it as a gift that helps me show up as the person I was always meant to be, both in my work and in my personal.
In the past two years, I've come to realize that I'm learning some of my beliefs and some of my habits were just as important as learning the new set of skills. Well, hello. Hello. How are we doing? Then? A couple of weeks since I joined and did a podcast. I would say that I'm. Blame it on the weather, kind of like Southwest did, uh, this holiday week, right?
But life happens and I am just gonna roll with it. But today what I wanna talk to you guys about is how my. Adhd and not just mine really, but I think my family's h adhd, uh, help salvage the holidays and how we have, we've been having an amazing time because of our h adhd. Probably most people would feel, um, very, very, uh, overwhelmed with the change and the fact that, you know, The fact that, uh, anything that we went through this week, so for example, um, my week started off, uh, our vacation started off on December the 22nd, and we left Austin and we decided this year there's 12 of us.
And we, this is something we've decided beforehand that we, we, we decided that instead of giving each other gifts, like physical things that we would try to give each other experiences, uh, to decrease clutter, to improve bonding time to, uh, improve connectiveness. And so in doing so of. During Thanksgiving, , we were, uh, planning our vacation for Christmas.
So just six weeks away, right? Uh, we decided we wanted to have, well, we, we've been talking about it, that we wanted to have, uh, snowy, uh, White Christmas. And so , typical a d h, adhd, uh, and of course some wine involved. Uh, we were looking, uh, places to go find this quote unquote magical snow, right? So when we were planning for it, we were planning, we started off looking into New York because my husband's parents are in New York, and then we considered a Denver, and then we considered, um, salt Lake City.
And so due to the fact that, um, maybe it would be too much to ring 12 relatives to visit my in-laws, uh, we decided, uh, and it was kind of like short. Notice type of thing. Uh, and also due to cost as well, we were looking at the price of the flights and looking at the price and the availability to go from point A to point B because we wanted to rent, uh, 12 passenger van or, or a van that would have the.
Capacity. Uh, we ended up using the, we, we outlined what we thought was important. We knew that we wanted snow. Uh, we knew that we wanted, um, a way to transport to get to the places we weren't so, Skiing on, like, uh, necessarily skiing. Uh, but we wanted to at least be able to go tub, be, uh, or to goat sledding and to have the ability to make a snowman.
So those were like our big things. And of course we wanted to be together. We wanted to find a hotel or an Airbnb, um, that would accommodate all 12 of us. So with that in mind, we ended up, uh, using Southwest and, uh, we were looking at flights and stuff like that. And of course, we all know that we, once we decide on something, we can like hyper focus and we can make stuff happen, right?
So what I'm saying is that our ADHD brain, while it doesn't sometimes. To go off the course of what we had decided to do. It is very good at adopting to whatever is currently in front of us and being able to, um, Adjust and pivot, right. So when we started our vacation, uh, on December 22nd, uh, we went from Austin and we decided that, uh, we were going to Salt Lake because in Salt Lake City we could stay, um, , you know, uh, a few in little towns kind of like Midway or um, park City, and, uh, we could get the snow that we wanted and we could experience the city and just.
You know, we didn't come with a full agenda