Beyond ADHD: A Physician’s Perspective

Dr. Grace Esan: I want to be able to give a voice to woman, a lady, a gentleman, a child who's not being diagnosed and does not know how to get to the next level so that their doctors are able to help them.

Dr. Diana Mercado-Marmarosh: Hi, welcome to Beyond ADHD, A Physician's Perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh. I'm a Family Medicine doc, with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age.

And in the past year, I have undergone radical transformation after discovering ADHD coaching, and life-coaching. For the past decade, my typical day consisted of having 300 charts backlog, a graveyard of unfinished projects, and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes. The last year I figured out the secret; learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius. So they too can reclaim their personal lives back like I have.

So I am really excited today. I am talking to one of my friends, Dr. Grace Esan, she's a pediatrician in Evansville, Indiana. And she's Nigerian American who grew up in Legos, Nigeria. She received her medical degree from the college of medicine, University of Legos. She completed her pediatric resident trainee at the Brooks Le'Veon Hospital Center in Bronx New York City.

And she's a certified pediatrician. She specializes in the treatment of infants, children and adolescents at all stages of the growth development with the emphasis on ADHD, anxiety, depression, and oppositional defiant disorder. She's been in medical practice for over 20 years. Dr. Esan is happily married and she's the mother of two beautiful children and her pet chihuahua.

So please, please, please, everybody listen up to Dr. Esan. She's here to share everything. How are you doing today?

Dr. Grace Esan: I am very well. Thanks for having me.

Dr. Diana Mercado-Marmarosh: I am so excited. I am doing well myself. I just got back from a Disney vacation with my family. So I am still in the process of recovering and getting back to work.

You know how we were a little slow after those vacations. We were smart this time around because, we did Disney break Disney break instead of like all the way straight, like we've done in the past. So that was good. We need a break sometimes. All right. So I understand that, you were diagnosed with ADHD yourself.

Would you mind sharing with me the circumstances surrounding your diagnosis? Were you surprised at all?

Dr. Grace Esan: Actually, yes. I was quite surprised. It was, it was a self-diagnosis really, because I was evaluated a friend of an adult friend of mine who was having trouble. She's having lots of trouble at work.

Punctuality to work, timeliness to get projects done. And then now it was now extending into the home where she was forgetting to take the kids where she needed stick the kids too. So I got to an adult self reporting screen and I took it home to her and I had her feelings out and whilst I was feeling it out, I was just looking through the questions that was the first time I'd actually looked at the questions for an adult.

I'd done the Connor's, I've done the Vanderbilt for kids, but I've never actually looked at it on an adult scale. So I'm looking at this adult screen and I'm like, yes. Oh my gosh. That was so I had this aha moment. I'm like, oh my gosh. So after thinking about it for a few weeks and actually acknowledging the fact that yeah, most of those things are true and they're struggle for me.

Then I, went down and they said with my family physicians. For how to actually do a formal evaluation and come up with options for me.

Dr. Diana Mercado-Marmarosh: Were you surprised, like you said you were surprised, but were you like when you looked at it, were you surprised in the sense that may maybe many people in your family behaved or acted or did certain things in a certain way. And so you just didn't think anything of it or what were you thinking? Like, were you one who was tardy or what, what was the things that like, kind of gave you that, oh, maybe there's something.

Dr. Grace Esan: Okay. So definitely tardiness is an issue because I, definitely suffer from time blindness.

I started to do stuff and I totally, I have no concept of how long it takes to do anything things that I think should take five minutes, actually take an hour and things I should take an hour, actually, five minutes. So, punctuality was kind of a problem. The ability to actually be having a conversation with you while I'm actually listening to a conversation over there or doing two other things at the same time that just came naturally to me, , it wasn't anything that I thought.

So I really didn't think that I just thought it was me. I didn't think it ...

Dr. Jessica Daigle: Having that sense of control and order is what allows you to be able to move forward. Like you need to .

Dr. Diana Mercado-Marmarosh: Hi, welcome to Beyond ADHD, A Physician's Perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh. I'm a family medicine doc, with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age.

And in the past year, I have undergone radical transformation after discovering ADHD coaching, and life-coaching. For the past decade, my typical day consisted of having 300 charts backlog, a graveyard of unfinished projects, and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes, the last year I figured out the secret; learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius. So they too can reclaim their personal lives back like I have.

Dr. Diana Mercado-Marmarosh: Well, hello? Hello. I am so excited today to have one of my good friends. Dr. Jess Daigle. She's a board certified Pediatrician. She's an ICU doctor and founder of mom and me. By Jess Daigle MD and upcoming in-home virtual postpartum care service. This may, that will provide medical care to newborns and education to the mamas, along with emotional and practical support during their fourth trimester.

Her heart is towards mamas and their little ones. She loves to educate console and reassure families. She's on a mission to help moms ditch, overwhelm, and feel competent in their new lives so that they can reconnect with themselves and embraced motherhood with confidence and joy. So I am so excited. I want to her to tell us how she ended up being able to do all these things.

Dr. Jessica Daigle: Well, thank you so much, Diana, for having me. I'm so grateful to be here today and to share my story with moms, because I've really been there. I always wanted to be a pediatrician, which I think that was just a God given quality, but it became, it started to have more meaning after I had my own kids. Because essentially you have to go through something to kind of really understand someone else's experience. It's not enough just to have the education, the experience lends more meaning to how you can help. And so my first, baby it was a miscarriage, so that was hard, definitely for a lot of reasons.

It was my first clue into like grief dealing with grief and guilt and shame when it comes to losing a baby. Thinking about what if and what could have been. And then, God blessed me to have my second child. But he was all preterm. So he was born at 31 weeks and I actually was on bed rest with him for nine weeks in the hospital just to have him at 31 weeks.

And so, he had only been a later at first, but then he did fine acquire a feeding tube and things like that, which is typical for a new, preterm infant in the NICU. And then when he came home, I thought, you know, okay, But exhale, we can just kind of get on him growing and then he had to go back on tube feedings.

And so that was emotional because I was still finishing the last part of my training. And that was hard. And then, my third child ended up being a premature infant as well. So I've definitely had the experience of, of new mom and NICU mom actually at the same time. So my first baby that I brought home ended up being a NICU baby.

So, you know, on top of the newness of taking care of a baby, now you have a baby that has medical challenges. And so, that was definitely stressful and overwhelming, but by, you know, creating systems and understanding how to assess my knees and, and how to get what I needed, allowed me to get through it.

And so, but that foundation alone, coupled with the work that I do in the hospital, taking care of preterm infants and, just even normal newborns and seeing moms go through the concern and worry about being able to. Take care of your babies. You know, it is scary as new and unless you babysat babies before, you know, it really, you really don't know a lot about what you're doing and you kind of learning on the job training is what I call it.

And so just want to be able to be that guide for them, that mentor, that advisor, consultant, strategist, all of that, is what moms need to be able to set the right tone for their postpartum journey and their motherhood journey as well.

Dr. Diana Mercado-Marmarosh: That's amazing. So like you just said, you live this experience yourself, where you're already on track to becoming like a pediatrician and a NICU physician?

Dr. Jessica Daigle: Yes, I was actually, cause I, I read this book when I was younger. And my mom was like, why are you reading such a heavy book? But it was called The Long Dying of Baby Andrew. And it was about this family, Robert and Peggy Stinson who had this really extremely preterm infant. He was un...

Dr. Weili Gray: You know, your life is worth it. We only get to live once. So get to know yourself. What, is the life that you want to live? And what's stopping you because whatever is stopping you, there are ways to overcome that. Live the life that you want and live it now because tomorrow may not be there.

Dr. Diana Mercado-Marmarosh: Hi, welcome to Beyond ADHD, A Physician's Perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh. I'm a family medicine doc, with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age.

And in the past year, I have undergone radical transformation after discovering ADHD coaching, and life-coaching. For the past decade, my typical day consisted of having 300 charts backlog, a graveyard of unfinished projects, and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes, the last year I figured out the secret; learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius. So they too can reclaim their personal lives back like I have.

Oh, my goodness. I am so excited today to have a dear friend with me. It is a very, very special treat that you guys have today is Dr. Weilli Gray. She's a board certified sleep integrative and lifestyle medicine physician say that fast three times who practices in Vermont. She is also a Registered Life Planner and the founder of Dare To Dream Physician, where she offers life planning and host a weekly podcasts. So excited to have you here. I want to ask you all the things, but first, first of all, we'll start with, how did you decide to become a life planner in addition to all your other hats, all those board certifications.

Dr. Weili Gray: Yeah, well, first, thanks so much for spontaneously inviting me on your podcast. You know, we, we had like a, what two hour notice and that normally I would like run away from that, but I went with it. So I'm super excited to be on here. And, regarding the question of, you know, why am I doing a million things?

Like, you know, I already have all these board certifications. I practice. As a sleep physician at the hospital in rural Vermont. And, about a year ago was actually when I accidentally I call it like I accidentally got life planning. And in this workshop where I got life planning, I was, I had so much clarity in a short period of time on what is it that what's the life that I really want to live? What, are my dreams? And not just like, you know, like we all, I mean, both of us are physicians and, you know, at some point we had dream of becoming a physician, but, you know, once we became one, it was like, well, is this it? Is there more, you know what, that's not the end of her life right there.

And so just having that long view on my life and saying the things that, maybe I'm scared of right now or the things that are causing me distress. And, to, to really put that in perspective and say, well, this is what I want in my life. This is what I want to accomplish. This is the legacy that I want to live, you know, where do I really want to be?

And so when you look at that long-term perspective, it puts all these other things into context and the things at that point about a year ago, I was in a lot of. pain and suffering. Like, I, I felt like things were a lot of things were happening to me that, I felt like helpless and, just, I felt like I couldn't, I didn't have a grip on my life anymore and I had just turned 40 at the time.

So it was like, wow, is this what a midlife crisis? It was like, and, and so that's how life planning, transformed my life. And that's why I decided to, you know, pay it forward and become a life planner and help others, who might be suffering some, something similar, also have their transformation.

Dr. Diana Mercado-Marmarosh: Yeah. You know, that's so interesting. What you just shared, how sometimes it is through stress that we, I mean, I don't want to say we hit rock bottom, but we get to a point where we have that question. Why am I doing this? Right. Like, what is the point of all it is? When did I decide that being a physician meant X, Y, and Z.

And I think COVID really did a number on getting several of us to ask ourselves those questions and to wonder whether being a physician was just one part of it. And how could you then leverage it to do something else? That'd be enough physician didn't define you and that your interest. And ways, like you said, designing your life on purpose instead of just deciding that it happens to you.

Right? That's how I always felt. Turning off fires, not like me on control. Like that's how I felt prior to coaching. And definitely it's so interesting how we all sometimes get to that point in our lives. And sometimes, unfortunately some of us don't have that moment because we're so busy ru...

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...

Emotions

Dr. Diana Mercado-Marmarosh: Emotions. A lot of us tend to think that we should always be feeling happy that we should not have any pain ever. We always feel like the pursuit of happiness is, should be something we strive for, but emotions, whether they're good or bad. They all teach us something.

Hi, welcome to beyond ADHD, A Pysician's Perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh. I'm a family medicine doc, with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers for three and four years of age.

And in the past year, I have undergone radical transformation after discovery, ADHD coaching, and life-coaching. For the past decade, my typical day consisted of having 300 charts, backlog, a graveyard of unfinished. And a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes the last year I figured out the secret; learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius. So they too can reclaim their personal lives back. Like I have.

A lot of us tend to think that we should always be feeling happy that we should not have any pain ever. We always feel like the pursuit of happiness is, should be something we strive for right? But emotions, whether they're good or bad, they all teach us something. They really happen, based on a thought. And we don't realize that the thought is what eats to the emotion and then the emotion guides, some of the feelings and some of the actions that we take.

And so this week I want to bring into a discussion, emotional regulation and people with ADHD, even though the us DSM five diagnosis does not count emotional dysregulation as one of the six Fundamental features of ADHD to get to be diagnosed with. And it is used in other parts of the world, like in Europe.

And it makes sense, right? Because we all can get flustered. Whenever we get frustrated with a task that we're not able to complete. And I don't know about you in the last year when I started to get curious and discover about my ADHD, I started to realize that there were certain behaviors that I was doing.

I sometimes felt like I just could not bring myself to stop doing it. I would say little lies because I felt like I didn't want to displease anybody. I didn't want to upset anybody. I didn't want to hurt anybody's feelings. I didn't want to feel rejected. And I remember there was one episode with my husband years ago, before I had kids that I was like, so excited about cooking.

And I remember baking a chicken and I don't even know all the specifics about it, but I think he had told me like, don't use that Rosemary spice because it was expired or I don't even remember what, but I think I forgot, you know, how it is. They tell you something and you're like, well, yeah. And then you forget.

And then of course I was so excited to have cooked this chicken that I was going to show him that I should have done it. And he asked me whether I had cooked a chicken. And even though internally, like my voice was saying, yeah, just say, yes, I couldn't like I had this like immediate sense of fear that if he knew that I had used the rose mary, he will no longer like me.

And she had like the chicken, like all the thought and effort that I was, I had put into this meal with a little sh**. So logically I could have jumped, answered Yes. I did cook the chicken and then allow him to make the decision. To decide if we wanted to eat the chicken or not. Because I had used a rose mary that he had inquired me about, but I could not get out of the loop of lying.

I couldn't say yes. I just think he gave me multiple chances, and I just could not. And so he knew I was lying. He could obviously see that the amount of the. That was used and it resulted in like us not talking for a few days. And it was a very painful experience because I'm an extrovert. And of course, with ADHD, you make things seem like worse than they are.

And so at that time, I didn't realize like, there's a name for that. There's a name for it. It's called Rejection Sensitivity Dysphoria (RSD) which is something that. shifts or if they're short lipped sensations, it's an emotional dysregulation that is triggered whenever you feel like an intense pain, because you feel like you might be rejected.

You might be cheesed. You might be criticized. You might start to judge yourself and you don't realize that you're lying to try to avoid feeling those feelings. And so I ended up, like I said, it was horrible for me because he wasn't talking to me and he ended up saying like, why are you lying about that? What else are you lying about?

Of course I wasn't lying about, to me, like a small little lie didn't mean anything because I thought I was trying to protect them, but he made up a good point. Like, why do I have to li...