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 since that time. So about four and a half years ago, five years ago, I was like, I just don't wanna work for anyone anymore. I wanna do my own thing. And so in Dallas, Fort Worth, many of the practices, like anywhere else are owned by a big health system, which is not all bad, but just for me, that just wasn't what I wanted to do.

I wanted to provide a different thing for people. So I saw this model of direct primary care. It's like a membership, right? Think gym membership, Netflix, that kind of thing. But this, you're becoming a member of a practice. And it allows me to provide kind of care that. Is really outside of the insurance structure.

Insurance is, I do this, you pay me this, and then the insurance says whether or not that was okay or not, right? So this is more of a relationship between me and the patient. So each family pays me a set amount every month on the first and then it allows me to care for their kids in an kind of amazing way.

So a lot of what we do is over text message. I come to the house and see the. I schedule all their well visits in advance, I'm available to them when they're sick. So it's been a fun thing. A lot of growing pains, a lot of trying to figure it out. Cuz really when I started it was very unheard of.

And now thankfully, more and more pediatricians are getting out of the system and trying this out, and it's becoming a tiny bit more normalized. But also in addition to, a regular pediatric practice. So I see, kids. Big kids, little kids, babies, all the things. I've diagnosed a D H D more than I have ever in my whole life.

Being able to, see these kids for, and know them really well. But in addition to that, I wanted to do breastfeeding medicine cuz I think there's just such a void in. Care, from a physician's perspective. And there's a lot of things that I can do that a lactation consultant who, has a background in medicine but not necessarily medical.

Like a physician level type of education. So I can diagnose and treat and, all of that is best done. At someone's house. If you think about, I'm sure you, when you had babies, the last thing you wanted to do was leave your house. Yeah, I come to you for all

Dr. Diana Mercado-Marmarosh: those things.

Awesome. It's been fun. So I'm going to jump in here and say that there's so many things that you said that I a hundred percent relate to what you're saying. First of all, I also met my husband on the. So how cool is that? I met him back in the day. Gwen they had Yahoo Personals, , and it was meant to be like a joke type of thing because I, it was my first year of med school and I was just like, who can help me?

Buy lunch or dinner? Like I was a broke medical student, right? But it was more like a dare and. and here we are. But anyways, the point is that I could totally relate with that. The long distance thing. I've done some of that too. But yeah, that just shows you again how important it is to know yourself and to know.

What you want to do it and do it in your own terms, right? Because most people say, oh, no, long distance doesn't work, or da. But again, when you are mesh with what fuels you it becomes a no-brainer that you get to become a trail blazer in whatever you're doing. And it was so good. Like sometimes what we feel.

Like hurdles, like you said, oh, I didn't find somebody, somebody didn't, wasn't like, oh, I can't wait to hire you. Maybe it was like the universe letting you know to step into what you wanted to create and for you to practice medicine exactly in your own way. And again, to refuel you ended up tapping into an area that is so needed, like breastfeeding and I was, You couldn't hear me cuz I had my, myself on mute because my kids are running around like crazy here.

But when you, I was chuckling when you said I became a pediatrician and I had my own kid and I should have known everything about breastfeeding. I was laughing because, That was exactly my thought. I was like, oh my God, I'm a family medicine physician. Oh my God. I talk to people left and center about all the amazing things on why you should be breastfeeding.

In my mind, it was like peachy roasty, like they're just gonna get on my breast and it's gonna be up. Wonderful experience. And then I was so mad that I was like, what, I have to do this every two hours, like I have to, like what? And I remember also being frustrated and not having a lactation consultant to come and talk to me after breastfeeding.

They were like and I was only there 24 hours. And they're like, oh we'll set something up later. And that never happened. And so me going online and. On Pinterest or different places trying to figure out like, how can I improve my milk production or am I doing it right? Is it not and in my mind, again, it should have been just this peachy, rosy experience.

. But you don't realize, like you said, even though you've been medically told what the benefits risk are. Show you until you yourself go through it if you have the privilege of going through it. Or not , because some people decide this shit's too much work, , and so they really do. But what amazing it is that you're able to fill in the gap and teach people about how to do it.

Like you said, not. , like the medical version plus also your personal version. So tell me, when people reach out to you, what do you notice are like the most like challenging things or what do you notice? What do they usually ask you?

Dr. Andrea Wadley: Really. , it's mostly what we talked about. So they think it's gonna be easy so they don't prepare themselves.

So there's a lot with breastfeeding that happens and it's a lot of it is time sensitive. So our bodies do certain things because of the way our hormones work, right after delivery. And if we don't do the things that we need to do, really in the first week of the baby's life, breastfeeding for the long term becomes a lot hard.

Breastfeeding is very hormone driven in the first, seven to 14 days of life. And that's great. So every mom who's ever had a baby makes milk whether she wants to or not during that time period. But if you don't do the things that you. Putting the baby to breast really often, having an effective latch, all those things early on, then it becomes a lot harder.

So a lot of times moms come to me after they've done all of that, or not done all of that, or been given really bad advice. And they're. They're crying and they're in pain because they aren't able to breastfeed, successfully like they've wanted to. So cleaning up on the backside of that is a lot of what I do.

A lot of handholding, a lot of putting hands on mom's backs and saying, Hey, I cried every day and it's okay, we're gonna do this together. And changing their perspective on. You know what success really looks like, and maybe their goals are gonna be a little different now, but it's okay. And this is where we're starting and this is what we can do now.

So that's a lot of what I do. I deal, I see a lot of moms who are in pain and we talk through that and what to fix with that. I talk a lot of moms out of tongue tie is the reason for everything as far as problems go. And it is a big problem, but it's not the reason for everything.

Dr. Diana Mercado-Marmarosh: So maybe are you able to help with those tongue tie or do you refer them to. .

Dr. Andrea Wadley: So if the baby's young enough, I actually can do a pH autotomy, which is, clipping the tongue tie as a home visit, which is amazing. So I did a lot of them as a newborn hospital doctor, and I've adapted some of those techniques and I'm able to do them at the house.

So I do them on referral. So if I'm seeing a baby for the first time for breastfeeding problems, I tell them, I think maybe the tongue tie is an issue, but you. Giving them the options that they have. But yes, definitely a lot of the pediatricians in town will refer to me because they know that I'm not gonna do it for everybody unless I think it's necessary.

Dr. Diana Mercado-Marmarosh: Yes. Yeah, so it's so good that again you're able to bring all these tools and use them right there. And it's so good to have. Like I said, I think you're a trailblazer because a direct primary care is something that recently, like maybe the last two years I've heard more about, but you started this almost five years ago, and so you have really shaped it.

To be able to optimize how you take care of them. It's almost blending the old school doc, so to say. When, where they say yeah we're gonna. , you and I, were gonna do this way despite what insurances say or how long, or how much time they tell us we have to do to talk. And so you have that unique perspective.

And like you said, being in their home makes a big difference. For us to diagnose with adhd, we need to , look at not just one setting, not just how are they doing at work or how are they doing at school. You need to be able to be like, okay, how do they do at church? How do they do in their sports?

How do they do at home? How do they do at work or their environment? And so it, like you said, you have that perspective of insight. Tell me you have a D H D without telling me a D H D when you walk into their home. Yes. You're able to. Easily see maybe some piles of stuff that they haven't done or different things like that.

And I'm not saying that everybody has the same way, but you learn to pick up on things that are not so obvious. And us with a d h. You, we have this timeline is staying. So us getting to a doctor's appointment sometimes it's a challenge on itself. . So how amazing it is that you can come to my house and I just have to stay put where I was supposed to be and I'm always on time for your visit, so to say.

So that would be that. That's so good. Yeah. So I think it's so important with that. Now tell me. What have you noticed? Might be some tips that you could give. Many times when during the birth of your first kid or as you have more than one kid, , even if you don't have a D H D sometimes A D H D can get diagnosed then because again, the executive function and emotional regulation.

Is actually amplified. The needs are amplified and we don't realize that the systems we had for ourselves or for one kid maybe are not enough for for now. And then you throw in not sleeping or having the breastfeeding. Being a little bit more work than we anticipated and you can see why our brain can feel like it's in a fog all the time.

What are some of the tips that you have shared with your new moms? Do you have them through checklists? Do you have them? Ask for help from a neighbor or so they can sleep. What are some of the tips that you have noticed have been helpful at since you do this breastfeeding all the time, like to this is second nature for you.

Just walk in and do it. Most of us forget like. What we went through during those shows period of time because we were just trying to survive it.

Dr. Andrea Wadley: Yes, exactly. So I don't have adhd, but I do take care of parents most. I actually, I take care of kids, but definitely parents who have h adhd and I have a.

A chronic disease that kind of gives me that sense of adhd. Things that have worked for me and things that work for moms might be different. So as a new mom, I probably had some postpartum anxiety. You just feel crazy during that time. Just everything is just, Crazy. Your hormones are making your emotions amplified, your lack of sleep, your physical demands of being a new mom.

All of those things amplify anything that you probably already had. And like you said were coping with because you had strategies. So for new moms, for breastfeeding moms with a D H D, I would recommend some things that kind of I do to just manage my own life right now. But to write things down it's number one.

So that's my number one tip is to write things down. Which breasts did you feed from last? Write it down. Or put a little pin on your shirt, or, something that is a visual cue that will remind you. There are probably about 1.2 million. Apps or more for new moms now. So picking an app on your phone that can keep track of things like, your breastfeeding, your formula feeding your diaper changes, all of those things that your pediatrician's gonna ask you.

When you go to the appointment, you're like, I don't know, I just barely got up this morning. So if you have it all written down that will. It will help you to see your progress with breastfeeding as well. I'm feeding every two hours, I'm feeding every three hours, I'm feeding every hour.

Maybe there's something going on that's wrong and having that, written log will help your physician, your lactation consultant. Know how to help you better as well. Another tip for me would be, it's a big thing for me and it was a hard thing and it's a transition to a new mom, is protecting your sleep.

Babies are biologically designed to be awake at night because they're used to this. Dark environment all day and they don't know day and night and they like to party in your belly all night. , when you were pregnant, you remember that? Trying to sleep and the baby's having dance party.

Yeah. So that doesn't change much when they're born. Doing some helpful things with sleep for the baby as well as sleep for yourself will help your. Status a lot. I usually recommend in the first couple of weeks of life, the baby's out in the bright environment during the day.

Even though babies sleep most of the day in the first few weeks having them out in the bright sunlight in a room with light coming in, the noise of your other children or your animals or the phone or, all those things. So they're starting to get used to.

The wakefulness cycle and then at night making everything as boring as possible. Trying not to turn on too many lights, trying not to have this sweet, interactive conversation with them, but just doing the boring thing of feeding and putting them back down. In the early days will go a long way to reset their circadian rhythms.

And the other piece of it is babies need to eat at night, and breastfeeding, unfortunately, I unfortunately, the way it was designed is they have to eat at night. Their bellies are only so big, their breast milk is so efficient and they just need to eat pretty frequently. So you, in order to protect your sleep if this is something big for you in A D H D, which I know it is, and a lot of mental brain change sort of things.

Is to get help. So depending on your budget and your, support at home, maybe it's something your husband can get up and feed some pumped milk in the middle of the night so you can get a stretch of sleep. Maybe if your budget allows you hire someone like an overnight doula or like a newborn specialist I'm gonna be interviewing a newborn special doula overnight person in the next few weeks on.

Grand live and she does amazing things. She comes in and she cooks for the family and she helps the baby get into a sleep routine. And she helps you, whether you wanna breastfeed the baby and she does all the rest, or whether you want her to feed, some pumped milk or some formula even in the meal.

Fine. So it depends on your budget, but there's people that will help you. And then, maybe you don't have a supportive spouse or you can employ the help. A family member, maybe your sister can take a few weeks off and come help you, or maybe a cousin or, a teenager can come in as a mother's helper during the day.

Just there's all sorts of ways that you can protect your sleep and trying to get. Some consolidated sleep that will help your mental state. And then, the other thing the last tip which goes along with the protecting your sleep is asking for help. Having all those people in your life that can help you do all the other things, caring for your other child doing the laundry, cooking a meal, those kinds of things.

I think a lot of why women with ADHD or not, Don't succeed with breastfeeding is that no one helps them. Breastfeeding is a full-time job in the first few weeks. And so those are the big three things that I would say. There's

Dr. Diana Mercado-Marmarosh: more. So I'm gonna, I'm going to recap what you said.

And then you can chime in if anything I missed. But write it down. So writing it down helps you to not have to always try to remember what's going on, so it helps you just stay present in the moment and you touched on something that's so important, visual, something visual to have.

Like you said, put on a pin or something that says, okay, the last one I did was the right, so then when I'm gonna start breastfeeding, you don't, you put them on where the pin is not, and then after you're done, move the pin, so that if you're, you always start where the pin is, not because you already used that one last, again, it almost seems so simple, but when our brain can't remember, you're going off of which one hurts less? Oh, I think I fit with that one. Like you're like doing that type of scenario to try to figure out which one it was. And then, yeah, I remember them asking like, how many hours, how frequent.

You're like, I don't know. Why am I supposed to know they, and sometimes you're. Forever. It feels like they're just attached, like they never came off and you're already asking me to put them again. And so again, if somebody explains to you what you should expect or not, that can just make the awareness, makes all the difference.

And like you said It takes a village. It really does. Like you just said, it becomes almost a full-time job. I was so mad. I remember being so mad at, I was like, this is my maternity leave, it's a leave. And my husband's you're not on vacation. And I'm like, no. If I thought I was gonna have a little bit of break for me, like, when is my break?

And you almost, if you don't have, like you said, that help. I'm so grateful that my mom came and stayed with me. The first six weeks. That was such a relief because but I did not ask for enough help at night. Like you said. I have plenty of stored breast milk. Why couldn't I had s. Said, Hey mom, why don't you keep the baby right there?

And I'll sleep. Or why don't for that night I did not know to do that. Or I did not know to ask my husband to get up like my husband. I remember being mad sometimes cuz my husband's like, why I never sleep anyways. And I'm like, then. now it's so resentful because, but then I never asked.

So yeah, you don't know that you can ask for help. Again, now looking back, it's so obvious, but while you're going through it, it's not obvious. And then you have this sometimes physician complexity, oh, I can do all the things like you, blah, blah, blah, blah, blah. Or, Motherly instinct, or whatever you wanna call it, where you feel like you're responsible to do all the things.

But if we look back the way society is, like in, in some cultures, like you do have like multiple family members living in your household, so you have multiple hands to help you with childcare with. Nourishment of your kiddos emotional and intelligence, right? And so we don't realize that we were never meant to do all the things.

We weren't meant to be the, the cook, the cleaner, the nurse, the wife, the physician, the lawyer, the bill collector, the, we weren't meant to do 10,000 roles, but here we are and. Like you said, protecting your sleep. My God. That's how we recharge, right? Like when we, if we're able to sleep at least six or seven hours, like the next morning, we feel like we have a full battery instead of just at 20% and not aware why we're so groggy or so angry, or so mad, or so tired, or so bloated, or you name it, right?

And again, you don't realize that all that is normal. Because of the lack of sleep. And and sometimes, even if you've never had a kid, and if you're a physician who's gone through any type of residency, , or med school, by that means. During those rotations, you know what I'm talking about, like your brain sometimes becomes a fog or anytime you were studying for a board exam or something like that.

Like your environment is such where you're pulled in so many directions sometimes. That you don't realize that how important sleep is. And again, the importance of just writing it down, you have something to look at instead of trying to remember because our short-term memory is helpful right there and then you write it down long-term, forget it.

I have no idea. Like you said, I just woke up , what do you want from me? And yeah. amazing gift that you could give yourself by asking for help, I think that's the smartest thing. I, again, if I would could go back, that's what I would have done. I would have invested in a breastfeeding specialist who would've shared everything you just shared with me.

And I would've definitely have invested in having like you said, like somebody come help even for a few hours during the. So I can sleep or I can or even having somebody come do my laundry or anything like that. Because again, then it gives you time for you so that we don't feel guilty that we're we needing to do.

We, you are choosing to do all this for this baby, but at the same time you're like, where's my time ? And so it's that dynamic and I'm so glad that you're speaking about this because this helps to create boundaries, but it also helps to create a support system that is a healthy support system for yourself.

And the thing is, like you just said, throughout your life, you're gonna need boundaries and you're gonna need create systems. So why not start at the beginning to. To get it there, right? So it's so good. So where can people find you? Now I'm pretty sure everybody's gonna be like, I need that. I'm in Dallas

I need that. So

Dr. Andrea Wadley: I am on Facebook at 1 27 Pediatrics. I'm on Instagram at 1 27 Pediatrics, and it's spelled. . I am also working on releasing a breastfeeding course at the end of the month. So you can find that through my 1 27 pediatrics page, or you can go straight to breastfeeding.one 27 pediatrics.com.

My hope and dream and goal is, To, start with a basic breastfeeding class and then build from there and make a community where women can feel supported and, educated and learn about breastfeeding ahead of time, and then be supported during the process. And then I am on my 1 27 Pediatrics Instagram page on Fridays.

I call it Fridays, with Dr. Wadley. I'll be doing Instagram. This month, the next few months of, bringing in different people that help support breastfeeding moms. Looking ahead, I have a, OBN next week we're gonna talk about the hormones of breastfeeding, and then after that, a sleep consultant.

And like I said, an a overnight. Postpartum doula. So those are some people that are coming up just trying to support women in that. And then if you're interested in my practice, you need to live near Colleyville, Texas. So we're just outside of the airport here in Dallas, Fort Worth.

I also have a satellite office, another pediatrician who works based in Alito. So we're glad to take you into our practice if you're in the, those areas. As well as I do breastfeeding consults for women in Tarrant County, so the Fort Worth side of Dallas Fort Worth. Sometimes if you're a physician mom and you talk me into it, I'll go to Dallas and do a breastfeeding consult over there as well.

So I do those one time. Outside of my practice. But if you join the practice as a new mom, you get all of those benefits, within your membership as well.

Dr. Diana Mercado-Marmarosh: Okay, ladies, pull the strings. . . Yeah. What an amazing niche that you're doing. Again I wish I would've had this kind of support when I was going through it and what a great way to support your patients and the moms and.

It's such an amazing thing. But as the audience listening to this sometimes zones out and that's one of our gifts. But we do re refocus from time to time. So if we just started listening right this second, what are some like. What is the takeaway point that you would want them to have?

Dr. Andrea Wadley: Gosh, I think just knowing that breastfeeding is hard and it's hard for everyone. So everyone I talk to has a story about how hard it was and that it's okay, and then it's normal and still women succeed. And then the other thing is ask for help. Women, especially physician women, high function.

In society type women, we don't ask for help and we need it and it's okay. It's hard, but ask for help and you

Dr. Diana Mercado-Marmarosh: can do it. Okay. Quick question. What do you see yourself doing in the next three years? For fun? For

Dr. Andrea Wadley: fun. So as a part of the. Andre Amne Business School. We focus on having a life, right?

So I am planning vacations, so my 10 year old, my nine year old is turning 10 this year. So we're gonna do a 10 year old adventure somewhere probably in the mountains. Has to do with, getting in a boat and doing white water. It's one of her favorite things. Oh, fun. Eventually traveling abroad would be a thing for our family.

And

Dr. Diana Mercado-Marmarosh: then what plays abroad? Have you started

Dr. Andrea Wadley: brainstorming? Yes. So my husband lived in England briefly, so he's always wanted to take us there. So that would be our goal. Maybe not this year, but maybe next year.

Dr. Diana Mercado-Marmarosh: Cool. Yeah. It's so important for us to not forget to incorporate fun into our lives because, It drives us, it fuels us, it motivates us, and it keeps us on track. And we can't forget that, this life is not. Dress rehearsal, right? This is our life. We get one shot. So why not be intentional about it and why not enjoy it along the way? So thank you so much for coming today. It was such a pleasure to have you like again, some of the things that you shared today almost seems so simple, but it's those simple things that can make a world of difference and can really help us set up routines.

And systems to support us and to then the ripple effects that happens when you are supported. Everybody else went also. So thank you so much for doing what you're doing and the people in Dallas don't realize how lucky they are to have you. And hey, maybe later on we can talk you into doing texts wide breastfeeding course.

That's something for you to consider. . Or who knows, maybe you can do a course to teach the physicians as well so that we can turn around and provide care for our own people. All right. You take care. Have a good one. Thank

Dr. Andrea Wadley: you. You too.

Dr. Diana Mercado-Marmarosh: Thank you for spending your time with me. I really believe that time is your most valuable.

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