Beyond ADHD: A Physician’s Perspective

Dr. Diana Mercado-Marmarosh: Hello, hello. Welcome to Beyond ADHD, a Physician's Perspective. I am Dr. Dean Mecado Mage. I'm a family medicine physician practicing in rural Texas. I used to be hindered by my adhd, but I now. Made 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.

So today, I. Talk to you guys about how beautiful our brains are and how sometimes we can go down the rabbit hole and, uh, learn very useful things. And one of those useful things that I learned was about forgiveness. So, of course, you know, picture this, I am trying to, um, , I'm trying to do some of my notes.

And of course to try to help me concentrate. I turn on my candles, I turn on, uh, YouTube, and I put it, you know, on a sound that doesn't on, on a music that. That has just sounds that doesn't have any words. And of course after a little while, then you have an ad that comes up. And one of the ads that came up was, um, about a mom talking about forgiveness and how forgiveness could like help you re rely your.

And of course there I am, right? Like paying attention. , I should be doing something else, but there I am paying attention. And so then that takes me down a rabbit hole to go figure out like if h d could benefit from forgiveness and all this other stuff, right? So this shares a story and he says that his meditation teacher told them.

If I throw a stone at you and it hits you, like who are you angry with? Are you angry with the stone or are you angry with a person? And of course, amongst this, well, I'm angry with a person because the stone had like no intention of hurting me. It's like just an object, right? So then the teacher asks them, if we use that same logic, should you be angry?

The person, or should you be angry with the pain that that person might be going through and it's just maybe reacting and doing this because they went through something themselves. And so that got me thinking, you know, um, we. Tend to be your worst critics. Right? Like I remember, um, for the longest time, and, and this is something of course I've been working in the last three years to rewire my brain and, and coming to the understanding that, you know, for 6,000 years our brains have been conditioned right to.

Survive . They've been conditioned to think and like the negative, to think like, What's it gonna kill me? What's gonna kill me? Right. And I've been coming to understand that if I keep focusing on the gap instead of the gain, and if I keep telling myself that I'm falling short on stuff, um, that's not gonna get me very far.

The thing is, like the way we talk to ourselves really matters. If I keep thinking, Oh, they're gonna find out like I don't belong here, they're gonna find out I'm not good enough. They're gonna find out. Like that emotion is heavy and it weighs on me. And sometimes I would tell myself all kinds of things that I would not allow my.

Ran even my enemy to tell me, but yet I was doing it as a protective mechanism thinking that if I caused that pain to myself, there would be nobody else who could cause worse pain to me. So I was like protecting myself. So in this exercise, you know, then I went down the rabbit hole of Latino. If people are affected or, you know, become traumatized because of their adhd.

And then I found another statistic that said that 80% of people with ADHD have trauma and that that trauma can really limit their own, like self development and, and of course can affect their self worth and all self-esteem and all that stuff, right? So, One thing that caught my attention was that the act of forgiveness is not necessarily for that other person, but it's for yourself.

Like that it would benefit yourself. And that in doing so, it would help like your brain have a state of more like, um, coherent. And so I thought that was interesting. So I gave it a shot, . I was like, Let me, let me try this method that they're talking about. And what they say is that, you know, when you forgiving people or even yourself because there's so much stuff that the younger version of us did not know any better and it got us into trouble, right?

So, You forgive others, um,

you are the one that benefits and you can really forgive anything, and that

forgiving them does not mean that you're dropping the charges or ignoring what happened to you. It's just that you learned to deal with it in a different way, or you learn to maybe see their point of view. That other person never even has to know that you forgave them. Like you don't have to. Like that person doesn't even have to be or anything.

You don't have to send letter, you don't have to anything. So what they talked about was,

There wa...

Dr. Diana Mercado-Marmarosh: Hello, 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. 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, learning the new.

Hello, I so excited to be here with you today. So, um, I had a couple of interesting weeks. I went to Costa Rica, um, to celebrate my 11 year anniversary. Um, and actually we went for honeymoon, uh, to Costa Rica as well. So we decided it was probably time to go right now that we have. Little break from Covid and you know, I was like, we just need to go before, um, there's a new pandemic, like Monkeypox or something.

Right. And I booked the trip like maybe a month before we went. And you know, that's just so adhd, right? We're kind of impulsive sometimes, but sometimes those are the best decisions that we can make. Like life is too short. You gotta make sure that. You are living in alignment with what you think is important to you.

And so I wanted to talk about this week about how ADHD can be your superpower. How you don't let things kind of slow you down or get you in the way, even though life throws you some core balls. So, uh, I was hiking, um, All sudden I hear clunk. We were climbing the, uh, Ariana Volcano and I looked behind me and half of the hiking book booted had fallen off.

And my tour guide asked me the Laas, which means, are you gonna keep going? Are you. Play for it, or are you are like, are you out? Are you done basically for the trip? Right? And so that question

kind of like woke something in me. Um, it, it was such a quick question, right? It, it's funny how one question can change everything.

Can be taken in many different ways. It can be taken like, are you all in? Are you ready to play? Right? And so maybe some people would've said, Well, oh, I just have one boot. Like I can't keep going. Right? But the bottom of the soul still had something, The other part just fell off. And so, you know what I, I told them, See , which means like, yeah.

I'm gonna roll with it, see what happens. And so what happened was that I kept walking and 200 meters later, flunk here, the other part of the group fall off. And maybe some people would've thought, this is the worst thing ever. Right? But to me, like I couldn't help but laugh. Like I found myself in a situation that was so typical for me.

It just seems. First thing happened to me. For some people it might be paralyzing, but for me it would. I didn't make it mean a thing. Um, the thought were going through my mind where, you know, my ancestors probably climb the same volcano, their foot it. I'm sure I'll be okay. So our thoughts really make a difference on how we show up with the world.

Like maybe some person could have thought like, Oh my God, this is horrible. This is the end of the world. Um, but to me, I just kept thinking, this is another day, like not a big deal. And I just kept going. You know, I finished the rest of the hike. I think it was another 40. And I just kept telling myself, Hey, the universe just wants to a foot massage.

Interesting. On previous, like LA Rocks, right? And it just, it just tells you that sometimes life just happens. Right? And so at the end of the, of the excursion, I asked the tour guide. Hey, um, has this ever happened for you before? Like have people lost the whole bottom of their shoes before and he said, No, this is the first time this has happened in the last 15 years.

And you know, I was actually there with my friend Christina and her husband on this trip and. We were just laughing because my husband's like typical of Vienna, like some first time always happens, right? And so I remember when we went, um, it was prior to kids, we went to, um, a place in Australia and I think it was called Canes or something like that.

And it's supposed to be like the place to go and jump in. And scuba dive. My husband already had the scuba dive like certificate. I went through the course right there and then, um, and when it was my turn to actually apply what I had learned and go down, uh, I couldn't do it. Well, my brain was just telling me that it was gonna be one too many directions for me to follow.

I was panicking. I just could not see myself going underwater with like this oxygen. And it's so funny because like how many times do we do different things that you know, are not so scary for other people, but. Still do 'em right? But our brain is always trying to protect us in one way or another. And so yeah, I asked that same instructor how many people had like come all the way out here and they not go down.

And he said, Not many . And you know, w...

Dr. Diana Mercado-Marmarosh: Hello. Welcome to Beyond ADHD, a Physician's Perspective. I am Dr. Deanna Mecado Mage. 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.

So today's topic is one that we don't usually talk about, which is dealing emotions as a compass. I wanna share with you three tools that will help you to. To develop a way of opting out of overwhelm and to really tame your inner critic. So emotions as a compass. Everything we do revolves around emotions.

They're really the center of our life and most of us don't even talk about it. And the thing is, Coming from the medical field, emotions are not something we bring up like we have been taught or told that we should always just show up in a very professional matter, leave whatever's going on with you at the door and do not let anything dissuade you.

I'm not saying that's good or bad, but that's what we. Been told that's what it means to be professional. What I wanna offer you though is that emotions are a very healthy way of us knowing that we are still alive. Emotions are at the center of everything. I don't want you to think as emotions are good or bad per se, but the thing is that we need to see that emotions are helpful and are needed 50% of the time.

We might feel good, 50% we might feel bad. Vibrations in our body are just a way that emotions show up. Why do I say this? Emotions teach us something. They tell us if something is going on, like if we're angry, if we're mad, if we're frustrated, your body's trying to tell you something. If we're happy, if we are feeling blissful, joyful, your body's also telling you something. So emotions. Are a way for us to self regulate our environment.

The thing is that when we have adhd, there is, we don't have that two second delay that a person without ADHD has between the amygdala. And the prefrontal cortex. And because we don't have that delay, we sometimes appear to get more worked up or lose our ability to regulate, or we get mad over something that shouldn't have really cost us to feel like we are overreacting.

Example, if you're trying to get out of the door in the morning, And you're trying to get your kids ready and one is missing a sock, one is not putting on the shoes, and you're trying to give them all these directions and the kid just starts to scream and melt down. , it's probably because, too much information was coming at them at once.

They can't follow all those things. So I wanna explain to you that emotions, are just a way for us to also make decisions. And so what happens is that, As you, you sometimes don't realize that people with ADHD can, we tend to be a couple of years behind our peers in terms of our cognitive development and our emotional development.

There's studies that show that. We are about 25 years of age when we really become who we're meant to be. And for some with adhd, it's fun until the age of 30. So when you're asking a kiddo, to do X, Y, and Z, or even us, when you're asking us to do all kinds of things, we become overstimulated.

So the first tool that I want you to talk about or acknowledge is that emotions can be a way for us to gauge our environment. It's in awareness. It's a engagement of what is going. And then be aware of this so that when you do have that moment where a lot of things are being thrown at you and you feel overwhelmed or you feel stimulated, over stimulated, just knowing.

That we don't have that two second delay can keep you or prevent you from going into this self blaming, self hating, self criticizing reminiscence, where you're like telling yourself that what's wrong with me? Why am I so slow? Why am I doing this again? I told myself I wasn't gonna react. Being aware.

Can help you name the decision, can help you tame that emotion that you're having. So don't think as emotion as like something good or bad. Just look at it as a source of information and ask yourself like, Huh. I wonder if I, When was the last time I ate, When was the last time I slept? When it was the last time that I did something?

We as human beings are so unique in the sense that we are able to think about our thinking, and so the tool that I want you to give yourself is this pause, create. A safe ward or make the decision ahead of time that if you have this flat of emotion, having the awareness that this is something that is normal for ADHD people, now you can create a way to give yourself that gift of the pause so that you don't make it mean anything and you don't go down a rabbit hole.

Criticizing yourself and blaming yourself for not quote ...

Mel C: They would always put my clinical skills in the morning cuz that's when I perform better. So I work with the and I say, Look, this is my problem. This is when I focus best. I struggle to learn at the best of times, but I am very capable as you know. Can you please do this to maximize my learning? If you give me this clinical skills class, that is really important for my learning.

If you put me in the afternoon, I'm just gonna sit there and be a good, go and be quiet. But I'm not gonna take anything in.

Dr. Diana Mercado-Marmarosh: Hello? Hello. Welcome to Beyond ADHD, a Physician's Perspective. I am Dr. Deanna Mecado Mage. 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 unlearning some of my beliefs and some of my habits, I'm excited to share all these skills.

Well, hello. Hello. I am so excited today to have a very cool guest on our podcast and uh, her name is Melissa Carlin and she is from first Australia. She's actually a third year medical student, so it's so cool for us to correlate our time zone differences. Likely she figured it out for me. That's not my sort of genius.

I would show up at the wrong time , but I am so happy that she's here and I'm gonna let her tell us a little bit about herself and, uh, how we met. Mel C: Hi Diana. Thanks so much for having me on here. This is really interesting. It's really cool. Um, yeah, so where did we meet? We met, I made a, a Facebook group, um, for doctors and medical students with adhd.

Um, and we met on there. Um, I noticed you'd post some, uh, A couple of posts that were quite interesting about some courses and things that you do. Um, and then you, you got in touch with me and that was really cool. So, um, yeah, so I made that group just, uh, I noticed there was a lot of, uh, medical students and doctors with adhd, but they don't tell anybody about it.

They, same with their depression and anxiety. They keep it a big secret. Especially, I don't know what it's like anywhere else in the world, but especially here in Australia, uh, there's still a lot of stigma.

Dr. Diana Mercado-Marmarosh: Yes. You know, that's so important that you created a safe. Place for people to come and join in a community that like-minded people could correlate and relate with each other because like you said, unfortunately there's still a lot of stigma and this is why I do this podcast and this is why now I'm like talking to anybody who would hear me about like changing the way that ADHD is perceived cause like we forget that.

What we're thinking really influences how we show up in, in the world, right? Like, if we're thinking this is the worst thing ever, or we're thinking, Oh, this is fascinating, I wonder like what, what it could help me in or whatever, right? Like it could just make a difference on how you then show up. Um, you know, in 2016, they.

Did a research or they did like a survey of medical students and they asked them, in the us they asked them like, how many had di uh, diagnosis of adhd and like, interestingly enough, like one third of the class had it. Yeah. So like, and, and so I'm pretty sure it's. Under, like reported and under. Absolutely.

And probably likely undertreated, you know, And so

Mel C: we've done this thing in Australia, so wa I think worldwide, uh, at Perth where I am for some reason, it's got the highest rate of a ADHD diagnosis and treatment, highest rate of Dexamphetamine prescription and. I literally saw a post on Facebook yesterday saying that it had risen by 20,000 prescriptions this year, uh, since five years ago.

But they always report it as a bad thing. Yeah. And they always report it, and then you'll see in the comments like, Oh, it's over prescribed all these addicts, blah, blah, blah, blah, blah. And I'm like, Nobody's reporting how much the cholesterol prescriptions have gone up this year. Why do you care about add, Why do you need to post that?

And, and, and, um, rev everybody up in the public who has no idea. But yeah, back, back to what I was saying before, um, Uh, when I started med school. So I've had it since childhood and uh, always got my accommodations and I sat my first exam in first year medical school in, uh, the special accommodations room where I have my isolated exams cuz I'm well aware of my accommodations.

So I sat there, there was one other student, I don't know if they had add. Um, but yeah, so I was there on my own and, and then, That was his first semester. And then at the very end of the year when we sat the last lot of exams, all of a sudden there was 10 extra people there. They all, um, all had d ADHD all their life.

And they finally, I think med school finally had very su...

Dr. Tonya Caylor: Let them be wrong about you. That was a powerful statement that the first time I heard it was like, Oh wow, okay. Because it just, it gave me freedom to let go of the control because I think we get socialized in medicine to really. Perform and we want good grades. We want the a plus with extra credit when the gold Star.

And and that performance based approach really highlights we are caring what other people are thinking, and so it's not that we don't care. It's not like we wanna have a terrible reputation, but it's like giving up control and trusting that if you show up as your best self, your reputation is gonna be fine.

Hello.

Dr. Diana Mercado-Marmarosh: Hello. Welcome to Beyond adhd, a Physician's Perspective. I am Dr. Deanna Mecado Mage. I'm a family medicine physician practicing in rural. 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, I'm excited to.

Hello. Hello. I am so excited today. I have a very special. And you won't believe it. She is in Alaska today. So it was fun getting our time zones to line up. And her name is Dr. Tanya Taylor, and she's a family medicine physician. And I have the pleasure and privilege of meeting her actually last year.

And it was a very cool. It was the Physician's Coaching Summit and we hit it off the very first night over our doors and some wine talking about how Covid has really led us all to come to an awakening that mental health is there and that we would probably all sub functioning, but now we've realized that.

We've put ourselves through unnecessary suffering, and she's actually on a mission to help educate residents and physicians and all the healthcare industry to be able to realize that, they have choices and they can make choices. And so I am so thrilled to have her here today, and she's gonna give us lots of good tips and share with us her journey.

So would you like to give us a little bit more information about you? If I missed. Yeah. Thank you

Dr. Tonya Caylor: so much for having me here, by the way. And I we really did. So I'm Tanya Taylor, family physician, academic physician coach up in Alaska, although I coach remotely throughout the lower 48. That's what, that's the term that we use out here.

And it was a great conversation because you and I, when we first met, realized that we had similar purposes and and you also had a very keen interest on. Academics, trainees who were struggling with ADHD and time blindness and those sort of things. And my passion has always been the residency level, academics and seeing that there were ways that you would be able to help that same population and with your expertise.

And it's an area that I love to coach in. And so it was a great conversation. I and we started like brainstorming. How could the people who follow and listen to me and the residents that I work with gain for those who have a d type tendencies or just time blindness or just want a little bit of a calm in the chaos.

And then me being able to talk to the followers that you have about. Ways to identify areas of unnecessary suffering and really begin to not only, survive, but flourish in their chosen careers. Yeah, that's how we got here. So thank you for having me. Yeah.

Dr. Diana Mercado-Marmarosh: So I'm so excited about this particular topic because I, I think that we don't realize that we are just future of habit, right?

And sometimes, We think we have the most efficient systems. . Yeah. But we realize that some of those systems actually might need to be upgraded because some of the underlying beliefs, or they're old software, they need to be updated. And we don't realize that, some of the, because we haven't questioned some of those things like that we ourselves, Adding to the suffering that we were sharing with everybody else.

And we don't realize that, we have choices. So today I think I wanna hear your experience. What have you seen in helping residents is there anything that stands out to you? That, maybe to them is not obvious, but to you, because now you have this expertise and you're able to see it from a detached lens and you're not in it with them per se.

You have the ability to hold space and help them see that maybe some of those things that they're doing are, are not really true, and their brain is telling them that. Yeah, I think that's,

Dr. Tonya Caylor: I kinda, you hit the nail on the head there with that description because not just residents but faculty and all attendings and whether they struggle with a d type tendencies or not.

We do have these habits and we have these ingrained thought patterns. That don't service well. So one of the largest areas of taking back...