Beyond ADHD: A Physician’s Perspective

Spiritual Cleansing with Dr. Oxana Ormonova

Dr. Diana Mercado-Marmarosh: Come join me May 1st through the sixth so that you can rest rediscover your strengths, reconnect with yourself and those physicians like you who are ready to leave work at work. And re-energize. This is the invitation for you to make 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. So that you can start to dream the life that you always wanted this year in 2023. I can't wait to, um, learn all about, uh, 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. 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 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 today. I have a dear friend of mine who has also actually been one of my coaches and, um, I have her here and I'm so excited. Uh, That we are gonna be talking about, uh, energy. We're gonna be talking about how sometimes we get so drained and we wonder like why we are so tired.
And this is, um, my physician friend. This is Dr. Oxana Ormonova. And I'm might have mispronounce that, but I'd like to call her Dr. Oxana Ormonova. So tell me a little bit about yourself, Dr. Oxana.
Dr. Oxana Ormonova: Well, um, thank you so much Janna, for having me here. It's such a treat, but, um, anyway, so I was born near Mongolia and I grew up in Siberia and I went to medical school in Siberia.
And since I was a child, I was very intuitive and I could see things that people could not perceive, right? Yes. And at the same time, I was very, very sensitive. I was sensitive to other people's emotions, um, other people's problems, what they were going through. And, uh, my mom was a physician and I used to make rounds with her, you know, in the hospital when I was four years old.
So, and I always wanted to help people and I always wanted to heal people. So naturally I went to medical school and. Even when I was in medical school, after my lectures, I will go to local clinic and I would put, um, I did hands-on healing where I will put hands-on, uh, people and they were getting better, so their pain was going away.
Uh, they were saying like, oh my God, what did you do? Right? Um, finally, I'm, I'm feeling better and I would go home and I would be just, You know, exhausted. I, I will be just go straight to bed. And I was not realizing back then that I was putting, you know, taking all the energy and absorbing all the emotions.
All the pain, and I was, um, taking it on. And then, um, also many years ago in my training, I was doing, um, rheumatology elective. And of course I was, uh, thinking, oh my God, it's going to be so easy. It's not a surgery rotation. Right. I can, um, get plenty of sleep. It's going to be like a, you know, uh, almost like a vacation, you know?
Right. And so after a few days working, and again with outpatient clinic in this rheumatology, Office office, I started feeling depressed. I was getting all the aches and pains, my joints were hurting, and I was young and I said, what's the heck, what's going on? And I was looking to, um, my attending and she said, oh, it's, it's okay.
I feel like that all the time. And she said, why don't you start taking, um, just. Small dose of antidepressant, you can just take half a pill of antidepressant. And I said, oh my God, I'm in the beginning of my medical training. If I start taking antidepressant now, what I'm looking down through, this is not a solution.
And so, um, and throughout my journey, journey, um, I've been on a, again, um, I tried a lot of different me meditations and, um, You know, I'm always been a seek of truth and so forth, so, and it's made me realize how much as a physicians, we are taken on and you and I see, you know, you are aware of that too. We taken our patients, uh, pain.
We are taking out patients suffering. We are trying to solve the problems and so it's interesting. When I start reflecting, uh, and again, I've worked as a hospitalist for, um, 20 years, almost 20 years, and I start reflecting. I was like, my God, um, why I am sometimes still feeling tired and when I start counting how many patients I've seen throughout my, you know, including med school residents and so forth, and ballpark was at least more than such a thousand patients.
And then I also. Okay. These physicians, we deal with pain and suffering on a daily basis. Um, sometimes we deal with most challenging cases, right? And so I also start thinking how many professions out there in the world who do something like that. It's really right. So it gives you perspective. Where you realize, oh my God, it's not very, something wrong with me.
It's not underachiever or loser or, um, not capable, but it makes you realize, oh my God, this is a lot what I'm dealing with. This make sense?
Dr. Diana Mercado-Marmarosh: Yes. Um, I think as physicians, we just assume that we're supposed to do everything for our patients and then some, right? Mm-hmm. And then we don't realize that sometimes like we have to be the most important patient in the room if we don't take care of us.
Like that could be very draining. But like you said, some of us, um, I'm gonna make a general statement, but usually females tend to. Be more in tune with what, uh, the oth the patient in the room is sharing. And sometimes we, yes, we take our time with them, but like you said, we feel like it's our duty to like solve all of their problems like so many times, like I.
I've been like getting onto good Rx to find the cheapest like medication at the cheapest store so that I could get to them. Like I'm pretty sure most physicians just write the prescription and walk out of the room, but I would put myself in their shoes. If I didn't have insurance, I would want somebody else to go the extra mile.
Mm-hmm. And, and again, it's not that, uh, it's good or bad, it's just that being aware. If you do that on top of whatever's already expected, like it can drain you even more and more and more because of the current system, the way it's set up. Mm-hmm. It's not meant to give you that flexibility to be able to do those kind of things.
Dr. Oxana Ormonova: Yes, and this is exactly what I was going to talk about too, because again, most of us, we go to medical school because we want to help people, we want to heal people. Just like you said, we put our heart and soul in trying to, um, help patients. And exactly what you said, it's not about just providing treatment, it's trying to find a placement, trying to find a nursing home, or, um, somebody's homeless, you know, you try to find place for them.
Right. And so, um, and because people, we are dealing. We're in so much fear. We're in emotional pain, we're in physical pain. And because of that, you, us as a physicians, we see us as like we we're trying to grab onto us, right? We are, we in survival. And so, um, and we're like, okay, this is a person who can help me, right?
And so it's, and, and I don't blame them because this is the way as I add. And so it's almost. When somebody is drowning and you're trying to save them, if you are not careful enough, they will drown you. Right? Because we panic, we an anxiety, they're grabbing onto you. And so it's almost energetically this is how it is.
And um, uh, this patients and in our me medical system, because also medical system is set on principle where patients come to the physician and they go. You are my doctor, fix me. And you probably heard it so many times, right? And we, it, the system said that, okay, patients give all the responsibilities for their health and we put it on a doctor's shoulder and so many of us against raw medical training, it's, it's expected.
We trained like sad and, but exactly what you said. You have to make yourself a priority even when you're on a plane. You know, if I go, okay, put oxygen mask first on yourself, and then put it on your child. Right? So at least you know, airlines got it. Right. So hopefully our, you know, our medical, you know, society and system get, you know, catch, catch up with it.
Yeah. And so, and what happened? As Einstein's, you know, you can't argue with Albert Einstein. He said, everything is energy. So our emotions, our feelings, our thoughts, our en vibrations of our, um, bodies, it's all energy. And so all of us, we are like radio stations. We absorb, um, everybody, you know, our, everybody else, emotions, thoughts.
So, and a lot of times people don't. That some of the feelings we're having, it's not even their own, they're picking it up from a loved one or, um, from their patients. From their clients. I, I work with a lot of coaches too. And so w you know, there is a lot of anxiety in the world right now and, uh, people don't realize, oh, the reason I'm feeling.
Because I'm tuning in and picking it up from what's going on in the world.
Dr. Diana Mercado-Marmarosh: Yeah. So how did you first start to realize that? Okay, so you, like you said, you realized that. All this world is is energy. We are energy. And most of us will always say we're depleted of energy. Mm-hmm. Most of us say, oh my God, I'm so drained, or, I'm so exhausted, I'm so tired.
Like how did you, during all those years, like how did you finally learn to like manage your energy or, or to be more mindful about it so that you wouldn't continue to allow yourself to be so depleted? Mm-hmm. That's a
Dr. Oxana Ormonova: great question. And again, it's. Many, many years of, uh, trying different meditation techniques and, um, practicing different, um, again, um, tools and so forth.
What I realized, oh wait, and it's actually, um, this is a great story. Two days ago I was, um, talking to Mel's physician and I was telling him, oh, I'm going to be, um, talking, uh, on a podcast about how to maintain. Energy boundaries, and so you're not picking up, uh, patient's energies. And, and he's retired and he said, oh, why would any physician want to learn that?
He said, physicians just build walls and this is what works, right? He said, oh, you know, we, we just built walls so we, we are not. Absorbing. Cause, you know, patients pain and emotions. Why would somebody want to learn something different? Isn't it amazing? Yeah. And, and I was just, oh my God. So this person saw that this is actually the way to, to go about it.
And, and I don't notice, notice again, a lot of us doing that. So I would say I'm noticed more male physicians maybe doing that compared to female physic. But again, it doesn't work in a long, in a long term. So let's say if you are running a code and you have to tune out everything around you, um, let's say yes, you are in, you know, in that space for whatever, 30 minutes, one hour.
But if you don't snap out of it and it keeps you, you carry it on for many years, um, days after days. Then it starts affecting your relationship with yourself, right? It's because you are not processing it. So you still, the building falls out of resistance, out of, again, trying to protect yourself. So, and then it starts affecting your own relationship with yourself.
And that's why, you know, there is so much suicide and oppositions with so much depression. It affects your relationship with your children. Um, your loved. So it's not a solution. Does this make sense? What,
Dr. Diana Mercado-Marmarosh: what? Yeah, yeah. Like energy is meant to be, emotions are meant to be like a compass. Like, uh, you know, to understand happiness, we have to understand pain.
Cause we need to understand one from the other, right? And yes, like you said, there's periods of time. It is beneficial to kind of turn ourselves off like in the middle of a code so that you become, quote, unquote objective in whatever you're doing. Mm-hmm. And you focus on that. But after the fact, if you don't reflect or even take two seconds to realize that you were dealing with life and debt situation, that you, that life is fragile, like, mm.
Like if you don't look at like, what if that would've been me on the table, or what if it would've been my family member or, or my husband, or whatever. Right. Like if you don't reflect the humanity of it. Mm-hmm. Like you could miss the opportunity of what you were in front of. And when we don't reflect on it, I mean, even though while you're going through it, it sucks.
Mm-hmm. If you don't reflect on like being grateful that you are still breathing, that you are still here, right? Then you miss the opportunity to process. Like what a beautiful gift you could have given to that person if you brought them back and now they had a chance of X, Y, Z for many years to come, right?
Mm-hmm. Or if you didn't bring them back, knowing that you did the best that you could in that moment in. Yeah. And so, uh, so I think in, in terms of that, I can see why it's a protective mechanism and I can see why it's helpful, but I can also see that if you do that one too many times without the reflection part of it, mm-hmm.
You can get lost.
Dr. Oxana Ormonova: Mm-hmm. Yes. And this is what I see in, again, in so many of my clients, they say, I feel disconnected, or I have a hard time forming connection with people or, and, and most importantly, um, having true connection with yourself. So with your own emotions, right? And so, And
Dr. Diana Mercado-Marmarosh: again, and I think Covid, sorry to interrupt you.
Mm-hmm. I think Covid did a number for all of us. Like yes, it ma it forced us to realize that maybe before we had a community we could tap into and like you felt like, oh, they can help me. They can help me. Mm-hmm. But then when everybody was functioning from a place of fear, from a place of like, oh my God, I'm gonna bring X, Y, Z to my nanny, or to mm-hmm.
Blah, blah, blah. To my elderly neighbor, I'm gonna be the one getting them sick. They're gonna die. You then kept away, right? We were no longer in community, and all of a sudden you were even more drained because you didn't have that extra help that you needed, and therefore you were even more depleted with your energy.
And again, we were functioning from a place of survival like you were just. Trying to survive. And then well, and, and for some people like that's primary care physicians, but I know some like specialists that were told like, we don't need you go sit down. They were like in heaven because they're like, Woohoo, I have to get one third of my patients.
Right. So like mm-hmm. But at the end of the day, I think it was tiring and draining for physicians because while everybody. Or were forced to take a stop and reflect, or not reflect, but at least take a stop. Like we were never given that freedom. Mm-hmm. To take a stop or like, unless you quit because you know you had some mobility or you felt like you couldn't handle whatever, or whatever your point was.
It's not that you couldn't handle, but you made a personal choice, right? Mm-hmm. So for the most part, I feel like in the last three years there's been a. Cultural, mental physician, mind awakening. Mm-hmm. Realizing that maybe being drained. I wasn't drained when I was at home. Maybe this is not the norm.
Maybe I shouldn't be drained all the time. Right.
Dr. Oxana Ormonova: Because it's, again, we, we are so used to it through medical training. Um, it's, it's like it almost becomes a norm. And I still remember when I was a resident and I would be like, oh my God, I'm on call every 36 hours. And some older physicians would say, oh, why are you complaining?
Um, when I was in my medical training, when I was a physician, I was on call every single day. Yeah. So it's was, and this was a standard, right? So this was, you know, expectation and it's. Interesting. You know, what I see with some of the, um, some of my clients who have a D H D, and again, I work, uh, with a a D G clients, so I, I see it on a different, um, again, on a different level.
So I, coming from perspective, looking at energy, um, again, being intuitive, um, being a spiritual healer and what I see, um, in a lot of people who have a d h. They have tremendous amount of creativity. They're super creative. Um, a lot of them have a lot of energy. And so what's happening is you, you again, especially, you know, when we are kids, right?
Our school system is trying to put everybody in a box. It's like a cookie cutter right system. And so a lot of those kids, they don't fit in. It's, you know, they have maybe more creativity that other kids have in, in, in the class. And so, and then we, you know, we get labeled you too much or, you know, get quiet or, um, don't, don't talk.
Right. And so, um, and another thing is, again, a lot of them I see they're very, very cap. But because through their life, again, even since, um, we were kids, we maybe were invalidated, we were criticized. So it's, you know, it starts, um, affecting them in a, in a, in the long ground. And sometimes I think about, um, little Mo.
You know, when he was a child and every, you know, and he was super creative. So I think if he was, um, you know, in present time and he was in school, he would be labeled a A D H D, right? So, because people, um, didn't know, would not know how to handle, handle him and handle his creativity. So, and another thing I noticed because.
ADHD people, a lot of them have a lot of creativity, so people around them, I mean, they recognize in some ways how capable the person is, and they go like, oh, why don't you do this? You have so much energy, or Why don't you do that? And then sometimes you taking it on and on and you end up with, you know, your, your plate is full.
So, You can't catch up with all those things on your plate. And then those people who gave you all those tasks start criticizing you. They're like, oh, you better time management. Or, um, but you didn't finish that. So, and like you said, learning, like what you're learning is how to maintain boundaries, right.
Or how to set boundaries and, um, which is so, so important.
Dr. Diana Mercado-Marmarosh: Yeah. So, uh, it's, it's coming to understand that you. There's certain executive functions and some of the, some of them we are better at than others. Like, you know, maybe you're good at planning. Mm-hmm. Maybe, but maybe you're not so good at task initiation.
Right. So you can plan, but you're not gonna ever start the task. Or you have a lack of awareness of how long it's gonna take you, you know? Mm-hmm. A time, uh, or you feel like, Have a month and then before you know it, it's like I have a week. Oh my God. You know? And, and so I think realizing that, why are we saying yes before looking at our calendar?
Like maybe we've been conditioned to say yes and we don't wanna feel like we're disappointing somebody. Yes. So that boundary there might not seem like a big deal. But if you just kind of said, Hey, let me look at my calendar and I'll get back to you. Like, it's gonna save you so much drama, because then you're gonna realize, oh, I was already overbooked.
Or you're gonna realize you were not even in town that week and you said yes to something. Right? And so I think we, we forget that part of these boundaries have to do with, again, the in. Realization that we wanna belong. And, and it's not that we're trying to people please, but we want them to like us. And of course we wanna say yes to everything.
Mm-hmm. But saying yes to everything you're, that you're saying no somewhere to something. And it's likely something to yourself that involves you and your self-care and your self rest. So, um, those boundaries, when you implement them, they're really meant to be there to protect your energy and.
Dr. Oxana Ormonova: Exactly what you said.
And, and another I want to add is because again, I see people with, uh, A D H D, they have a lot of creativity, a lot of creative energy is, uh, learning how to channel it. So, because when you have so much, right, you could do this and you could do that, and you can do, um, you're so capable, you can do 10 other things.
So choosing, um, again, what you were mentioning, prioritizing, so it's, oh, Or even when I see a lot of people have a lot of gifts, again, creative energy, it's all our self-expression. And so one thing you choose as, for example, you can choose as your career. Another thing you choose as your hobby. So another thing you choose, you know, as your second hobby, whatever it is.
So then it's you channel link your creative energy. You streamline in it, right? So then it's creates less that, um, it's like, oh my God, you know, I don't know what I wanna do. Um, and then sometimes you, um, maybe people don't accomplish, um, what they want to do. So, but again, I just want to validate, um, those people who have a D H D who are listening to this podcast, I want to validate them that, again, some of their.
What problems we're experiencing is because we have a lot of creativity, we have much more creative energies than, you know, maybe people around them. And we have a lot of energy because creative energy is, it's energy. So we just, uh, one types of
Dr. Diana Mercado-Marmarosh: energy. And I, and something that came up, um, and I can't remember if it came up during one of our coaching sessions when you were coaching my group or when you were coaching.
Oh, uh, when I went to one of your workshops was the, the fact that some strategies that are meant to protect us. Sometimes don't because we don't give ourselves the time to implement them. Like the sleep, right? The exercise, like, uh, the low carved diet, like sometimes we don't realize that those do play a role in there somewhere.
And then we wonder, why can't I focus long enough, right? Mm-hmm. And, and we don't realize that all those are affecting how we're showing up.
Dr. Oxana Ormonova: Absolutely. And. As we were talking, um, again about how we absorbing, um, others, our patients energies and so forth, it's, you know, first the key is awareness. Even recognizing that, validating yourself, going like, oh my God, I've seen in my life thousands and thousands of patients.
Um, how many people out there in the world even capable of doing what I'm doing? I. So many times my friends would say, I don't know how you do it. I would never be able to do what you do. And so, and given ourselves a break when let's say you are on your day off and you're beaten yourself up because you're like, oh my God, laundry's piling up and I have no energy to get to this, you know, pile of laundry.
So give yourself a break. Don't beat yourself up and realize. I am going through a lot. What I am dealing with is a lot. And so then you st instead of invalidating yourself, you start validating yourself. You start recognizing your power. You start recognizing your capabilities. And another thing, what I, uh, teach people might be helpful is when you start feeling, for example, sad or depressed, or you're feeling anxious, you can ask.
Wait a minute. What I'm experiencing right now are those my feelings or I'm picking it up from somebody else because majority people on the planet, we are not aware that we are constantly picking up other people's emotions and thoughts and including with thoughts. You know, if you're thinking something, um, you know, And your life is doing okay and all of a sudden you start, you know, having some weird thoughts.
You can ask yourself, okay, are those my thoughts? Or I'm picking it up from somebody else. So yeah, and then you can ask like just such simple think, you can ask your awareness and say, okay, my awareness, I want to be aware of my own feelings. Please, let's shift my own feeling. So, and again, everything starts with awareness.
Dr. Diana Mercado-Marmarosh: Yeah. Yeah. Everything does start with awareness because again, if we just assume that, that what I'm feeling or experiencing is because of something I did directly. Mm-hmm. Um, like we might miss that. You know, we, we can control our thoughts and feelings sometimes when we're aware, but if we're not aware, we, we feel like we're giving away all our energy to other people.
Right. Um, and, and we all have had those difficult patients sometimes where you just feel like exhausted and drained. Like they wanted 20,000 things. Then you're like, oh my God. And they're like, energy vampires. It's like, gimme back my energy. Take back your monkey. Like I don. I don't wanna keep your monkey, you know?
Um, but I think having tips and strategies to protect and refuel our energy would probably like be something that you guys can start to implement today. And it could be very, well be something like, um, Being mindful before you walk in the room, like making sure mm-hmm. That you know you're fully present and making sure that after so many patients, you're taking a break or you're for five minutes of meditation or just a water break, or just going outside, like something that is not like patient related.
That, I mean, just throughout the day, sometimes we charge your phones because it's dying. Like why wouldn't we recharge ourselves? Yes.
Dr. Oxana Ormonova: It's so important what you said. I love you. The analogy you said, we chat your forms. I was like, oh my God. This is, this is, um, such a great analogy. And also, um, you know, having this, like you, just exactly what you said, having a system in place where however it works for you, so is a, you have to have a, um, you know, After you see five patients or, um, whatever it is, or you have to after work, at least walk in nature for five minutes.
So, and also recognizing that we are all different and recognizing what works for you or what works for somebody else might not work for you. So for somebody seeing 25 patients a day, it's not a big deal, but maybe for you. Um, seeing 15 patients a day, this is your limit, right? So, um, after 15 patients, you, oh, 10 patients, whatever, whatever is the number.
And so not invalidating yourself because somebody else, um, achieving more or, um, seeing more patients, right? Because we are all, all very, very different. And when I'm teaching, uh, physicians and coaches about how maintain. Energy boundaries a lot of times, um, because it's exactly almost like, you know, built like this physician said, oh, we just built walls.
What's a big deal? Uh, but it's coming out of resistance, coming out of fear. And so when uh, people tell me like, oh, uh, how do I protect my energy? And I teach them it's not about protection. Because again, when we think about protect. They're coming out of like, we have to wall something off. And so I'm saying, oh, you're just learning how to maintain it.
How to maintain and replenish. So then you are not, again, you are not trying to, um, build like a, a wall wall or fortress around you because you phrase it.
Dr. Diana Mercado-Marmarosh: Um, yeah. So when we're asked to multitask, We might be able to do one or two things. Exactly. Then you throw like five things on there. Then you can quickly see why our brains become overwhelmed or anxious or mad.
Like we are like, you know, we don't wanna be bothered, and so, mm-hmm. I think those are the type of boundaries that you have to understand your own limits so that you don't get to the place where all of a sudden you look like you're just blowing off steam. Mm-hmm. Because you weren't even aware that.
What steps did I miss three decisions ago? Instead of just saying, no, I can't do this, or, no, let me do it this way, or let, or let me ask a clarifying question. What is the priority here? Is the priority seeing that patient right here in the clinic? Or is it seeing the patient in the hospital or is it writing this, uh, these orders that you just brought and you pulled me out of the room for like, what is the true priority here so that we can reach.
Whatever needs to be reached at the end of the day. Mm-hmm. Without feeling like you are the one who's depleted and then being labeled as, you know, misunderstood or not the team player. And then, uh, we get ourselves into trouble.
Dr. Oxana Ormonova: Yes, exactly. And you know, when I, one of the tricks I, I do, and sometimes I teach also, Physicians, it's, you know, after you see a patient and you get out of the, you know, came out of the room and you washing your hands, but while you're washing your hands, you can just imagine that any energy you picked up from the patient just drains down the sink, right?
You just washing it off, like you cleansing it all from your energy field. Um, all the pain, all the emotions, and just being, again, aware of it or being mindful about. And then you just go, oh, I just wanna feel my own energy. Um, I want to be rep. Replenish is my own vitality, my own life force. Um, so this is something what people can do.
And again, our system is built on. I don't know about your training, but when I went through my training, it's almost like you're supposed to feel your patient's. And I heard, and you probably heard too, from so many patients, um, I would try to cheer them up and I would be, okay, you know, let's make you feel better.
Let's, you know, get you home. Um, and they would be a, oh, you don't know what I'm feeling, so you don't know what I'm going through. You are not feeling my pain. And it's almost like accusation. So, and sometimes again, this is, um, how we trained. Oh, we have to, we have to do that, but it doesn't help our patient.
It doesn't help us. And this was again, what I teach, um, physicians. It's how do you, what's the difference between being in sympathy to somebody, being in sympathy to your patient versus, um, being in a state of compassion, which is very, very different. Yes, this is would be another great reminder.
Dr. Diana Mercado-Marmarosh: Yeah, those are amazing tools and tips there.
Okay, so if people wanna reach out to you, where can they find you? Uh, do you have an email to share or, um, should they just reach to me or how should we, where can they, you have a website you can share with us? Yes. They can find
Dr. Oxana Ormonova: me on, uh, my website and it's Divine Wellness MD dot. I'm also on Instagram, the same name, divine Wellness mg.com.
You can email me, uh, and my email is aana and divine wellness mg.com. And uh, I'm also Lincoln. So yes, would love to connect and I love your podcast and I love, um, how you're helping physicians with A D H D and. Yes, you are a trailblazer.
Dr. Diana Mercado-Marmarosh: Thank you. Now, if my physicians just started paying attention because we have wandering attention mm-hmm.
Um, what is one takeaway point you want them to have?
Dr. Oxana Ormonova: Well, is again, to recognize how capable they are to recognize that part of the label. The society labels them as a D H D. Because they have a lot of creative energy. They have a lot of energy and learning how to channel it in the right direction and use it to their advantage, instead its resume becomes like a destruction, right?
So, um, this would be take away, be besides what we already talked about. Talked
Dr. Diana Mercado-Marmarosh: about. Awesome. So what do you hope to do for fun in the next three? Oh,
Dr. Oxana Ormonova: well, um, I enjoy teaching. I enjoy teaching physicians and, uh, coaches and, um, doing my one-on-one coaching. So, and um, yes, building the practice, serving people, and, uh, it's my, my passion again after Any, any travel
Dr. Diana Mercado-Marmarosh: plans?
Oh,
Dr. Oxana Ormonova: always. I love to travel, so, and I love to travel to foreign. So, um, I love learning about different cultures and meet people from different parts of the world. Awesome. Yes, definitely.
Dr. Diana Mercado-Marmarosh: So, all right, well, thank you so much for your time and for your amazing advice. And there you have it. You, you guys have to start implementing some of those energy boundaries.
It could be as simple as remembering to allow all the energy that is not yours to be back to its source and you keep yours and. Being willing to, to ask yourself, what is draining me? What can I let go of and what is refueling me? What can I do more of? Because the things that are fueling you probably have really good dopamine for you, and you should do more of those so that you can show up better in the world.
Thank you for spending your time with me. I really believe that time is your most valuable. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website@hdlivecoach.com where you can find out about my upcoming coaching group classes, as well as free masterclass and other exciting events that are happening.

A Conversation with author and fellow life coach Simon Arnold

Dr. Diana Mercado-Marmarosh: Come join me May 1st through the sixth, so that you can rest rediscover your strengths, reconnect with yourself and those physicians like you who are ready to leave, work at work, and re-energize. This is the invitation for you to make 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 so that you can start to dream the life that you always wanted this year in 2023. I can't wait to learn all. What kind of view you're gonna have after this conference? Take care. 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 a personal life. In the past two years, I've come to realize that unlearning some of my beliefs and some of my habits, We're just as important as learning the new set of skills.
Hello. Hello. How is everybody doing today? I have a very special friend with me today and I'm excited because I've been wanting to get more men to come to my podcast so that we can share all the resources. So I have a very special guest his name is Simon Arnold. And he comes all the way from Germany and isn't it exciting?
And he's here to talk to us about his journey with how he got diagnosed with A D H D, but also he's actually like changing the world. He has a book and it's called The 13 Hour Life Coach. And so I wanted to just bring him here and. Have him talk to us about why he wrote the book, and I will explain a little bit about his book a little bit later.
But first I wanna introduce you to him and hear how he came about. And I, some of this that I'm asking is in the book, so you gotta. Buy the book, but he will, he'll give us
Simon Arnold: a preview. Yeah, exactly. Thank you so much Diana, it's so nice to see you again. Really? So yeah, I'm the 13 hour life coach and I was diagnosed with a D H D Wow.
Three years ago now. And I went to a psychologist and he basically flipped his book through with what ADHD was and said, I think you're right. And I was like I'm right here. And I needed to help myself. There was really no. Help for adhd, certainly three years ago, and I wrote, I think about 107 strategies to help me live with A D H D.
And And I find them to be working. So yes, .
Dr. Diana Mercado-Marmarosh: Awesome. I'm gonna just read what the back of his book says, because this is gonna give us so much material to dive into the conversations of this book. Simon realized one day that the external life. Distractions had disappeared and that he could read and comprehend a book for the very first time.
And he came to face with his inner voice. We all know about that inner voice, right? He was recently diagnosed with a D H D and he labeled his inner voice or he Big Mo and Big Mo basically, Is able to add clarity to his life while he's on medication. So that's the key here. He feels like he's able to concentrate for about a full 13 hours while he's on medication and every da every day.
When Big Mo leaves, then he realizes that he's thrown into a world of confusion together. Big Mo and Simon. Learn to figure out a D H D in a unique way of using diaries. So he's able to understand himself through those moments of clarity. Not only does he do that, then he turns around and he creates a successful.
Group in his town in Germany so that he could, they could each help each other learn strategies every day. He has clarity and then confusion, but obviously a strong bond happens now here he is being a coach for others. So tell us what was it like to finally get
Simon Arnold: medicated? Okay, so I was, It was during my diagnosis process, really.
My son already had ADHD and was medicated for it. I was completely under doctor's orders, allowed to take a tablet just to see how it, worked in my body really. And I took it and I found that my outer distractions were all gone. Diana the sound of the trees, the chirping of the birds at the windowsill, the yeah the cars three, three roads away.
I would hear them on a daily basis and all of a sudden I just had clarity and that was really the first and we can go in into this later. I'd search for 34 years for this. And I got to where that I where I wanted to be since I was eight years old. I knew something was wrong with me from the age of eight years old and I was determined to find out what it was.
And it was a d h D really. Yeah, the, I could concentrate for about four hours, I think. I knew exactly how I was filing paperwork at the time and I was like, wow, that goes there and that goes there and that can go in the bin. And my inner voice came out and I call him Big Mo and we can go into this bit later.
Big for just the feeling I have when he's around and mo for the moments that he's here with me. So that's really the start of everyth.
Dr. Diana Mercado-Marmarosh: So when you were eight years old, you said you knew. What was it that you knew? What did you feel like? Did you look around and people concentrating? Or did you feel like you were daydreaming so much?
What did you knew? At the age of
Simon Arnold: eight, I can. I can go right back to the exact, not the exact day, but I can go right back to the moment in my mind, sitting on the on the red thick carpet in England, of course, where I grew up and yeah, I was eight and I just sat there and I thought, There's something different with me.
I'm different to everyone else. I had to go on belief in faith hope and faith, and, but I had to find out what hope and faith meant, to be honest, at the age of eight. So it took a few years to get there, but I had the, I always had the inner feeling without having the inner voice. That something was wrong and I was determined to find out what it was.
Dr. Diana Mercado-Marmarosh: That's good that you had enough insight there and that even if it took three decades , to finally get the diagnosis. When you did it finally made sense. And that's also a sign of like understanding that we are always on our journey and we're always gonna be life learners. And realizing if you're not at a place where you want to be, Or things are not exactly as you wish them to be.
Like you have the opportunity to change stuff. And in your book, I was kinda amazed by some opportunities that you took . Oh, thank you. . You decided you wanted to become a physical therapist, is that correct? And you decided I'm not gonna do it here in my hometown. Lemme just go to another country and see what that's like.
Can you tell us what that was about? ?
Simon Arnold: Oh my God I'll never forget that I was on the computer at home when we had dial up internet. It goes bing bing. And then, The, the sound, it takes forever. And my mother was in the living room and I said, yeah, I just I feel so great. And she goes, why'd you feel so great?
I said, I've just booked a course for physiotherapy at the Best Physiotherapy school in Australia. And she says, How much that cost and I showed her what it cost on my credit card statement online. It was 6,700 pounds that I paid straight off, and she nearly fell off the chair in amazement. ?
Dr. Diana Mercado-Marmarosh: Yeah.
So people with A D H D are risk takers, right? ? Yeah. You describe what I think most of us with A D H D in the book about having a dream and going for the dream, but sometimes, unfortunately, the dream doesn't always pan out like you wish it would. Would you tell us a little bit about. Yeah.
Simon Arnold: Wow. It was the dream to be a physiotherapist.
So in England, we say in English, we say in England we say physical therapist. You say physical therapist. That's right. I over I, I basically, When I paid for the course in Australia, I had, I knew no one in Australia. I didn't have any money, put it on the credit card, but somehow I came, and this is where it comes from this, I somehow run into people or they come into my lives and it's hey.
My parents live like 20 minutes from the schoolwork the university where you wanna study from, so I went to Australia and due to the executive functions and memory recall, really, I just didn't have a clue. And it, I can I describe it now as just having a mind that's like a siv.
And that, whatever information comes in, it just goes straight out. Nothing stays. So I re, over a long time I tried in Australia with no funds to go further. I didn't have any money for shoes. I had to phone up my father and get, yeah, that was hard. Brunelle in London first year, no idea.
Didn't have flu. And then in Berlin, As well. And bear in mind, I spent all my free time at a friend's private practice from the age of 17. So the first attempt for physio was about 2025, so I had a good five years of solid experience in the area and still didn't do, and still even today didn't pass it.
Dr. Diana Mercado-Marmarosh: Yeah. And so I bring that up because, I'm pretty sure if you had decided to practice physical therapy, like you would've been amazing because you picked it all up from experience, right? But again, you didn't know what you didn't know. You didn't know that your executive function, attention to detail organization, you name it, right?
Giving you the possibility or ability to only capture written stuff in a short window. And so you were picking up parts of it and your knowledge was not necessarily reflected on what you had learned in. The actual experience of being there and doing the things, and I'm sure everybody complimented you on your bedside manner and ability to, for you to optimize the treatment to each person because of how much you were so in tune with it.
But it was. The written part could have kept you out or maybe you didn't have enough time to finish test or different things like that, right? And so I bring that up because people always say, okay, they graduated from blah, blah, blah. As if the degree is what makes a person. Have the ability to quote, unquote, be labeled as success story.
But it's not that, and it's a, it's an understanding that you, there's so many different areas of knowledge and so many different things and all those, at the end of the day, while they might seem like filled experiences, their still experiences, that what I see. Got you to bet on yourself and bet on your dream and keep trying and trying.
Most people probably without a d h, ADHD would've given up after the first or second time , right? But. Not somebody who knows their why and what they want to do and so that is something that is to be admired. And all those experiences, they don't negate us. They actually propel us and they continue to help us because now you can relate to all your clients that you're teaching with a d h, ADHD because you understand exactly.
Drive and that almost stubbornness. But at the same time, it's excitement, right? Yeah. It's like a mixture of both. It's excitement for the unknown and, yeah. And I know like you're ready to move to a new country, right? Yeah. You wanna tell us about that, ?
Simon Arnold: Yes. I've wanted to move to Seattle for three years, so if anyone can help me out, please help me out.
And . It really starts in the morning with meditation and, just imagining being there and just using all different techniques possible. Yeah, just to be able to experience it. I think I said to you recently that, three years ago a and Seattle was really the A D H D hub.
Somehow, I'm not sure whether it is now, but it was really big on A D H D, which is strange because h d's coming out more now. It was different three years ago. Yeah, that's my goal. Pretty much everything at home here in Germany is pretty much sold and my goal is to land in Seattle with two suitcases at the end of September.
Dr. Diana Mercado-Marmarosh: Woohoo. That's around the corner. , how exciting. Let I wanna ask you about that group that you formed in Germany when you finally got diagnosed with A D H D. Like what were you thinking? What was propelling you? Like, why did you decide to make this group?
Simon Arnold: Okay, so I'd written the book. I actually launched the meet up h d in the , bay where I live in Southern Germany, the group.
And it ran for 13 months. Once a week I would go and either to a park where we could go for a walk or into the town 20 kilometers away. And a lot of the time, to be honest, I just turned up hoping that people come. To be honest, I had my little A for a D, H, D, not adhd. So everyone I go, Hey, oh my God, these are the weird guys.
I just wanted a, I just wanted the A, so it looks like maybe it's insignificant, right? Except to my group. I knew that other people needed help cuz I didn't get hit. That's why ,
Dr. Diana Mercado-Marmarosh: and how was it? What did you, I know you went with no expectations and I know you went because you didn't want others to go through what you went through.
What kind of friendships did you develop?
Simon Arnold: Here's the twister. Okay, so the meetup group ran for 13 months. People would continuously write to me and say, yes, I'll be there. And I turn up at the event. And there was one summer in particular. It was so busy for my d h d brain in a beer garden. It was so full.
The lady had given me a table in the middle of all of these hundreds of people, and no one turned up. Basically the characters like Riker in the story for the walking and everything else. That's really experiences of my own because A D H D didn't have the open following like it does now. I am really sad to say actually.
For 13 months, not one person turned up. And then three days after I canceled the course, I met the first person and just had the most amazing connection ever with our, with both of our inner voices. And and we helped each other. But that was hard. That was hard. So I basical. I all the stories in, the walking and the, and everything in the chapter, which I'm talking about.
They're all my experiences, but I real experiences, but I put them into different characters to explain it so much better.
Dr. Diana Mercado-Marmarosh: And that's the thing with a D H D, like sometimes we overcommit or sometimes. We are just not good at timing. . Yeah, true. We have the best intentions. Yeah. And so sometimes it just doesn't happen.
Or like you said, three years ago, label was not something necessarily to scream at the top of your lungs. Because even for me, you, we, you and I had this conversation. Three people knew I had a D h D three years ago. Yeah. Yeah. And now it's I say it like it's sky's blue type of thing.
Yeah. But it's because of the work that we have to do with the inner voice, like you said, because our mind might tell us that we are broken. And and it's a running thing and we don't want anybody to know that we're broken, and it's not true. It's just our mind is different. It's like being left-handed instead of right-handed.
And there's nothing wrong with that. It's just that you maybe weren't aware that your innate thing was this way and we being conditioned to do it the other way due to culture, due to society due to expectations of gender roles, you name it, and so again, that also shows your ability to keep showing up, right?
Like you kept showing up regardless. Yeah. And so all those seem like it's the bittersweetness of it, like you said, like when you decide, okay, screw this , and then you have the most basic conversation. It's almost like society's okay, fine. I guess the universe will conspire against you to make it work.
Yeah. Thing is, like you said, you're getting closer to the A D H D hub in Seattle, and hopefully in November we can meet in person at the chat conference. That'll be great. . Yeah, like there you will see like your tribe, like every single person in the room, just picture like 2000 people a, d, adhd.
, and they're giving like lectures and they'll be giving the lecture and then halfway they're. What was I saying? And everybody's laughing. They're he, and they're like, no, I'm serious. I lost my train of thought.
Simon Arnold: Where was I? . Yeah, exactly. It went out that way. . Yeah.
Dr. Diana Mercado-Marmarosh: And so it's like the norm.
And it's funny, and it, and you don't have to explain it because people just know and yeah. So I think that your book. So good at explaining some of those cultural cha like some things that, like you said, I grew up in UN, in England, and then you going and marrying your wife from Germany and living in Germany and the difference in their style of speaking and.
You trying to make sense of all of it. And it's in, in us realizing that we, with a d, adhd, I think we, we learned to use people pleasing skills to survive and at some point we don't realize that. No, I just have to be myself. Like I don't have to do anything else. And we forget who ourselves our true, authentic self is, but it is this work.
This is why now you're a life coach to help us to be ourselves. And so what do you think was like one of the hardest thing in, in writing this book? Because like to me, I'm amazed like one day maybe I'll write a book, but to me right now that's something that's oh my god, that's mind blowing.
But I know you. Thousands upon thousands, about thousands of pages that you write, and this is how your mind helps you clarify things. What do you think was the funnest or hardest thing in writing this book?
Simon Arnold: The easiest thing was actually spending two days every day for a year and a half writing the book.
That was what, then people are in one. The 1% of writers that actually do this, I wasn't as good as Stephen King. Stephen King managed three hours a day. I think JK Rowling managed two, two hours a day, and I wanted to stick with that. And I did. I did that quite easily with my journalism background.
I'd written a diary every single day since 2006, every single day, so I could actually compare. Was different now than it was back then. I had half maybe a quarter written a book on culture as well. And I pretty much put everything together. But there's a really good point that I just wanna bring out actually.
Of course I live in Germany. I speak fluent German, which is fine, but I actually never felt part of society in England. I never felt part of society in Australia and also in Germany. So that means that I've never. I've belonged to any, anyone or anywhere. And this is where self-care comes from. If you've got no sense of belonging to other people or social systems, like I've got zero.
You build up the insight because that's where it all comes from, right? And I know that for my whole life. Hopefully with the A D H D chat conference and this area, this is my tri. But up until right now and this day I've I've always had to do it by myself and lead from myself, through myself as, give myself as much confidence as possible to go on, that's, if that answers the question.
Dr. Diana Mercado-Marmarosh: Yeah. And that's one of the hardest thing I think because our brain is conditioned to not think that way. Our brain is conditioned to think in the negative to make us think no, let me keep you safe. Cuz that's gonna be bad if you do that. And you're right, like community.
And belonging, like those are the things that are primitive and need needfulness. Like we all want to be loved and accepted. And if one of those two is threatened, like our identity or self-worth or self understanding of self, like just get shattered and exactly. That's why I created the A D H D group for physicians.
And again, it was not because here I am and I got all my shit together, but it's because I have figured out some steps and I wanted to share that. And in normalizing it. You then learn more steps and you learn from each other and you enhance each other and it, and we're not doing it again cuz we're broken, but we're doing it because we're just trying to be curious to see if there's a different way.
And all along you have to be that true. Both internal true leader and also that like referee no stop. You're being, you're gone way too far in. But at the same time, like we know that sometimes our brain like will tell us things and it can be traumatic and that's why it's important to realize that inner dialogue and that self-reflection, whether it's through meditation or it is through writing is so powerful when we actually sit down and do it because makes you focus.
like it makes you focus on what it is that you're trying to put on paper, right? Like not just sentences and sometimes yes they can free flow, but then you can go back and understand what you were trying to point at. And it's so much easier. And I think that most of us don't want to sit down and do that because we have this sense of it has to be right the first time, but.
You didn't learn to walk the first time like you needed to try different things. So that was genius that you gave yourself two hours every day because it's not in wanting to do two hours for two weeks and putting all this pressure on yourself to have this perfect product, but it was a, the muscle, the repetition, the trusting of yourself that something from there was gonna be life changing or worth sharing with the world.
Simon Arnold: Yeah. They, they say when you've written a book then the work starts. You have to basically every day you have to promote the book, of course. And just keep going. Do you wanna know the reason why I started the podcast, which by the way, next week is its first year anniversary.
Woohoo. So tell us. So I'd written the book and I was like, is this for real with this a d h D? Am I the only one experiencing this? And my first ever episode was called Blackouts, right? That I just basically came to the. Realization that there's no way I could have a blackout because I couldn't store the information in my brain anyway.
Cause it was like a si coming out. Yeah, I did a whole season, of course, 13 episodes, you're magic
Dr. Diana Mercado-Marmarosh: 13, huh? .
Simon Arnold: Yeah. It's amazing. And and then I spoke to Annie Bush a a brain coach and she actually said about, the free frontal cortex with the medication actually getting the signals and.
Retaining the information and basically said that blackouts, what I'd said on the very first episode was true . And and then the guest series started and I was like, Hey, we've got stuff in common as well. You feel the way I feel, whether it's male or female. And then of course we met, didn't we?
And, Narissa Bower and everyone I wanted then of course, To move from normal people with a D H D to medical professionals like yourself to actually say this is how we all feel as a generation and the people. Let's put it to the doctors and see if it holds water.
And it did. I'm running in typical A D H D style for the one year anniversary. I'm running three seasons at. So I'm running the Kids Edition ages six to 12. The Gen Z edition 13 to 19 for girls, young women, adolescents and season nine, which is adults. Can I explain what, what's coming , please do.
I'm now launching within the next week a it's called the gen. High functioning d h D program for the ages of 13 to 19, and it's a 12 week course. The mothers that have got in contact with me, especially for girls as well, from the ages of 13 to 19, we have a half an hour conversation twice a week.
It's what's gonna happen. We go through a theme. I'm very flexible with what they need to go through. It's always best that, a parent actually accompanies the teenager during the chat as well. Whatever age it is, really boy, boys or girls or young adults. And we just go there and we just do this together and just make progress in the best way possible.
Dr. Diana Mercado-Marmarosh: That's awesome. Yeah. Yeah. It's so good to be able to have a community of the same age group and it doesn't matter. Once we are adults, like we all. Mingle and stuff, but there is a difference when you're talking to kiddos versus when you're talking to adult. And so it's good that you are giving them each their space to be able to have that flexibility.
But yeah, that's her A D H D we. Yeah, there was a time also, like I just realized, like in January, I started my 10th cohort. I didn't realize it was my 10th cohort. Like I've just been doing this for about two years. But in one moment in time, just like you, I had three cohorts going at the same time, plus a full-time job, plus you name it, right?
And. . When we get excited about something and we are aligned with our purpose of what is meant to be, it doesn't feel at work. It feels so much fun. And then you're like, oh my God, I'm getting a little tired. Maybe I should slow down a little or reevaluate how to do things. But yeah, that's so cool. So tell me more about do you have another, like bookwork or is it just going to be your coaching for.
Simon Arnold: The second book's already written. . Yeah. I just need to basically edit it and then publish it. Perfect. There's lots of things going forward there. Lots of things. .
Dr. Diana Mercado-Marmarosh: That's amazing. Can you do one, you ready for the sec? The second one's written and now it's gonna give published soon. That's so
Simon Arnold: good.
Yeah. Yeah. And I talk about quantum theory. I will really go deep into metaphysics and actually. It is really neuroscience kind of geeky stuff, to be honest in certain areas. But also and people have said to me, how can you do this A D H D stuff? It's really heavy. And I said if you look at me, it's, I don't make it heavy at all.
We know that there's some real serious issues. If I can explain a serious issue actually The re the time when I was writing my book, there was a Canadian study. And this is what has gravitated me towards teenagers actually is the fact that the suicide rate for males was 5% and it was 9% for females.
And then they did, so that was April, 2020. I think. I'd have to have a look at the source. The middle of 2000 and 21 males had gone up to 9% and women had gone up from 9% to 23 and a half percent. I always crying my eyes out, Diana, when I was reading this stuff. I thought, this is a call to arms and I'm in a really good position to do this, so let's do this.
So even with that information, and you as a doctor, I'm sure you hear a lot of these real life events and causes and everything, but we have to know that, push it to the side, carry on with our work, keep it all upbeat, find new ways to move forwards and just make everyone's life so much better.
Dr. Diana Mercado-Marmarosh: Yeah. You are hitting on something that is so real. Again, Prior to the pandemic, we really didn't talk about mental health like, or we really didn't talk about A D H D because we just assume it's a kid being shy in the back of the room, or it's a kid being disruptive or whatever. Kid being lazy, right?
They're not doing their work as they need to, and we just dismissed it, but it was. Okay. Quote unquote, because they had a community they could still come back to, like they had a teacher, they had a coach, they had different people they could do, right? Then pandemic happens. Then all of a sudden it's you and mom doing home homeschool or doing virtual thing or doing something, and it's.
Not that human connection that would have allowed you to understand more stuff, right? And all. And maybe if they are on the computer, what are they doing? They're looking at social media at the picture, perfect thing, and da. And people don't post all their shit. They post all their beautiful things.
And you don't know that pe everybody's going through something different, but you. You don't understand that sometimes the reality is not the reality and you orchestrate all these things. And unfortunately, I've had this conversation too with a lot of ER physicians and I and I see it as a primary care doctor, but a lot of ER physicians say, I used to have one or two suicidal teenagers, like every three to three.
They're like, now I have five per shift or 12 hour shift. That's crazy. And again, and it goes back to not putting mental health front and center and this is why like you and I connected because I think we're both on the same mission of normalizing the need to use all the tools and not make one be better than the other.
While medication yes, can bring clarity. It's not gonna fill in all the other gaps. It's not going to help you set up those behavioral systems. It's not gonna help you to realize you need to go run or to meditate or to dance or to take pause, , or to do all the other things. And so it's so important to know that and then to go forth and change different ways and like you said, we are doing, knowing the why we're doing.
Is what's so important and a lot, and sometimes we, I don't know about you, but we all go into like the you should be doing this for free because da. And it's yeah. But all those hours of me studying and trying to give you the best tools and understanding and grasping like.
It's still work and it's not just work. It's amazing value that you're going to provide to hopefully alter the trajectory of that person's life. And it's not just for that, but when people pay, they pay attention. , they pay attention. And so I'm so glad that you looked at that data and I know it's coming because you have your kits and you would.
Thought not to be a sadistic of one of your kids, right? My, one of my nieces like had to be hospitalized, because of suicidal ideations. And you would think, okay, where did I go wrong? How come I miss this? I'm the aunt, I'm the one who, but again, everybody is in their own world.
And you don't think about that. You think about how can, here we are, how do we go forward? What do we do? What's the next step? How do I, how do we, what does she want? What do you know? And so she's doing so much better now. But it takes a community, it takes a village. It's not just like whatever.
And did I talk to her about coaching? Yes, of course I did. But not in a sense like you should like. Think yourself something else, but in the sense that, hey, we don't realize that our thoughts sometimes can be playing tricks on us. Like they're not the real thing, right? Yes. And so realizing that there's always a choice and not making a choice is still a choice.
Can help them feel empowered when they feel like they don't have any say so, because you know their parents are gonna say this, or their teachers are gonna say that and their friends are gonna say that. So it's so important to realize that we all can do something for someone. And sometimes it's just sharing the stories that can allow somebody else to see.
There, there might be a different way.
Simon Arnold: And I just wanted to pick up, actually, even though I knew there was something wrong at the age of eight, I always thought, keep yourself healthy. Keep yourself going. I was never addicted to anything. I didn't do any drugs. I never smi, I hadn't even picked up a cigarette before, and just to do that is, is pretty cool. When so many people just find it difficult. And, another thing, when I was medicated for the first time, I thought, oh wow, this is how people can actually think. This is cool. And then I was really disappointed that so many people just don't take the opportunity to.
Realize the best in their lives really. And when I do, I just wanted to put an extra thing in really that even though maybe unfortunately I haven't been through addictions and everything else, I've seen every manner of in as a physiotherapy assistant in medicine, in cancer unit, in the drugs and rehab.
Orthopedics and trauma and you name it, everything. And that's really where all the experience comes from. It's okay, I haven't had it myself, but I've experienced it from others and this is how we go forwards.
Dr. Diana Mercado-Marmarosh: Awesome. Thank you. This has been an amazing conversation, . Of course. I'm sure we can go and dissect so many other things, but tell me if.
Where can people find you? Where can people get in touch with you? All right,
Simon Arnold: they can find me on LinkedIn. And that's for the course, the high functioning, gen Z course for the teenagers 13 to 19. Just find me on. On LinkedIn, write me a dm and or to my email address. I'm also on Facebook as well.
Simon Arnold or the 13 Hour Live Coach. Instagram is where you see some really cool pictures there and things. My book is best purchase by lulu.com, the 13 hour Life Coach. And the podcast. Yeah. Available on all, pretty much all podcasts provide us the 13 hour live coach.
And it just it's just good for consistent information about A D H D. And of course, I keep all the records there just in case maybe you, Diana, you're like let's have a look at executive functions. Which one can we go back to? So it's just you can pick and choose. A D H D area that you want to find, so please check me out on all those areas Really.
Dr. Diana Mercado-Marmarosh: Awesome. And do send me some of those links so I can put 'em on the show notes so that they can Yes. Will get straight there. Now if my people just started tuning in, because sometimes we have wondering attention, what would be one or two takeaways that you would want them to have from our conversation today?
Simon Arnold: I just wanna tell everyone that they're not broken. Okay. It's like, we are just fine. We just need to use different strategies that, you know that Eva I have, and this is the thing that maybe Diana knows a bit more about a certain area. And we are, we're fine. We are good as we are. We just need to celebrate ourselves and just live our lives really.
If you've got adhd, remember that you are not broken. You are perfect the way that you are. And if you do need any help, just find the best person suited to you really to go
Dr. Diana Mercado-Marmarosh: forwards. Okay. One last question. What do you hope to see yourself doing for fun in the next three years? More fun.
Simon Arnold: For fun. I intend to speak to so many people using sign language.
I love it. It's something I can use for my hands for and just yeah, just being able to communicate with so many more people in into world now that I've got this opportunity.
Dr. Diana Mercado-Marmarosh: Awesome. Thank you so much for being here. I do not know sign language, but maybe I could dance with you. That would be closing up
Yeah, of course. .
Simon Arnold: Yeah.
Dr. Diana Mercado-Marmarosh: Thank you for spending your time with me. I really believe that time is your most valuable asset. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website@hdlivecoach.com where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happening.

Parenting Hacks To Keep You Sane

Dr. Diana Mercado-Marmarosh: Come join me May 1st through the sixth so that you can rest rediscover your strengths, reconnect with yourself and those physicians like you who are ready to leave work at work. And re-energize. This is the invitation for you to make 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. So that you can start to dream the life that you always wanted this year in 2023. I can't wait to learn all about what kind of year you're gonna have after this conference. Take care. 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 unlearning some of my beliefs and some of my habits were just as important as learning the new set of.
Okay, so today's theme is one that I've been coaching a lot of my clients on, which are. What are the parenting hacks that could keep us sane? So A D H D, and how to chill or how to keep us sane. And so I'm so excited to talk to you guys about this. It's a discussion that is real. So here's some strategies that might be helpful and please feel free to send me a text or an email.
Leave a comment in the podcast letting me know if these are some of the hacks that you yourself are using or you want to use. If you tried them, did they work out or not? I can't wait to share the story. So first of all, , you need to establish a routine. Children with A D H D tend to thrive on routines and structure.
How we do this, it doesn't have to be necessarily step by step, but the more that you have a daily routine regarding meals or homework or playtime and bedtime, the more likely you can provide stability and predictability for your child. Number two, use some visual aids. These could be anything like calendars or chore charts to-do lists.
They can be very helpful, not just for the children, but also for you so you know what's coming up. And I have found some of these really nice big. Chore charts or to-do lists like at the Dollar Store or the Dollar Tree, and they can help your child stay organized and stay focused on the task. And it could be very rewarding to just check it off, know what is expected next.
Number three, provide positive reinforcement. This is a very powerful tool that can. Help your child realize that they have gifts and they have strengths. And no matter how small a task is that they completed, it can help to boost their self-esteem and to encourage good behavior. So if you notice that they picked up their laundry and they actually went.
Put it where it needs to be done, thank them for that. Or if they, if you notice that they took off their shoes and they left them in the same place where you had already had a discussion that they should be at, so that you know where to find them, like positive reinforcement can really make a difference.
Or saying, Hey, I really like how you handle that, or, I really liked what you did with that interaction, can make a big difference. Number four. Is mindfulness. It's a technique that can help you manage stress and stay calm in the face of a challenging situation. When we as parents are practicing mindfulness, it can be a way to role model for your kid that they.
Can to stay present in the moment and practice. Mindfulness can be done in different ways. It might be that you stepped out into nature and took a walk for a few minutes. It might be that you did a three minute Headspace meditation or that you did a three minute tapping solution meditation, or it could be you chose to slow down long enough to see what was going around you and being more present.
Another hack number five is to really prioritize physical activity. Regular physical activity can improve focus and attention for children, and of course with poor parents as well. And I say a hack could be that as soon as the kids get get home from school, take them to the playground take 'em just to do a walk around the house in the neighborhood if possible.
Or make sure that they are involved in sports, dance or any other active hobbies because when you're doing this, what you're ha what is happening is you're increasing the dopamine that they have, which then helps them to have enough. Energy to be able to do the homework or the task. Most of us want to go directly to the homework and then to the food or to different things, but when you are able to first prioritize physical activity, you have a way of it actually increasing the dopamine, which will increase your reserve.
Number six, limit distractions. I know it seems like almost common sense, but if you're able to minimize the distraction in your child's environment, such as turning off the TV or putting away electronic devices during homework or during Lunchtime or during dinnertime or during bedtime, like all that is going to cost them to be having attention that is dispersed throughout.
So this can help your child focus better and complete tasks way more efficiently. Number seven, encourage healthy sleep habits. Getting enough sleep is crucial for children with a D H D. So it can really help them refuel their energy and sometimes we might have to set alarms to remind us that it's time to go to sleep.
So these are just some of the few strategies that can help parent. Kids with a D H D, and of course you have to remember that each child is unique and that it's a D H. D is like a spectrum. And what might work with one of your kids might not necessarily work with the other. Be curious, stay curious, stay in awareness.
Realize what might be going well, and really take note like what worked well, what didn't be patient. Find the right strategies for your child, and with the support and resources you can help your child succeed. Thank you for spending your time with me. I really believe that time is your most valuable.
Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website ahdlivecoach.com, where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are.

Relationship of ADHD with parent and child with Dr. Totulope Alugo

Dr. Diana Mercado-Marmarosh: 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. 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 unlearning some of my beliefs and some of my habits were just as important as learning the new set of.
Hello. Hello. I am so excited today I have a very special guest, Dr. Ta Lupe au. A Lugo is a child and adolescent psychiatrist who helps to empower youth mental health by providing diagnostic assessment and treatment as well as educational to parents and caregivers about these disorders and how to ensure that they look after their own mental.
While caring for their children. She's the founder of St. John Kapp and the Emotions Ambassador Program, where she's actively involved in education and advocacy and our. Which is the area of youth mental health. She's the host of Walking on Eggshells with Dr. Talu podcast and has a YouTube channel under the name St.
John Cap. So today's topic, obviously, if you haven't gathered anything from what I just said, is very important because it always feels like we're walking on eggshells either with our kids or sometimes ourselves, whenever. A D H D is a diagnosis and so I'm so happy to have her here today to share her experience about why she is doing what she's doing.
Dr. Totulope Alugo: Thank you so much. Thank you for having me today.
Dr. Diana Mercado-Marmarosh: Awesome. You have a son, is it a son or a daughter that was diagnosed with a
Dr. Totulope Alugo: No, I don't. I just have I'm, cause I'm a psychiatrist, I deal with this every day in my clinic.
Dr. Diana Mercado-Marmarosh: Gotcha. So it feels like you have a thousand kids, huh? ?
Dr. Totulope Alugo: Yes. They're like my kids really
Dr. Diana Mercado-Marmarosh: Yes. Yes. Because you see them grow up. , you see them from day one and all the way till they're 18, so it feels like you, you have a thousand kids. . .
Dr. Totulope Alugo: I watch them go from elementary school to, they go to university. So I'm like a mom in that area. ?
Dr. Diana Mercado-Marmarosh: Yes. So tell me what got you into this special like niche, because I know you could focus on anything.
You could focus on why this tell me.
Dr. Totulope Alugo: I did a general residency in psychiatry, but then I did a rotation in child adolescent psychiatry and I just, Really loved it because I realized that I had an opportunity for early intervention because I believe that if you can intervene early, you can change a child's trajectory.
And you can also help a family really early by treating a child.
Dr. Diana Mercado-Marmarosh: Yes. Yes. You're so correct. I'm often. Shocked how it makes such a difference as we're growing up, right? Things that people might do can really. Enhance or sometimes not so much enhance how we ourselves interact with the world, and especially before the age of seven.
It can make a big difference, but that doesn't mean that you can't unlearn or you can't support them later on when more knowledge comes. comes along. Of
Dr. Totulope Alugo: course, of course. Whenever you get an intervention, it's always helpful. Yes.
Dr. Diana Mercado-Marmarosh: . What have you noticed that, when you do tell mom or dad, hey, your kid has a D H D, what have you noticed is usually the reaction.
Dr. Totulope Alugo: We get a variety of reactions. For some parents they already know because they already see the challenges at home school is telling them Your child is different. They're on the go all the time. Teachers are stressed out. So personally, for those kids who are hyperactive or impulsive, parents are almost always.
Already have a great idea. A few parents would say, oh, he's protect the younger ones. They're just boisterous. And so that way they bit up reluctant. But for the inattentive ones, I find they're being diagnosed much later and parents are saying things like, they're careless, they're lazy, they're just not paying attention to detail.
So it's really a mixed bag that I get.
Dr. Diana Mercado-Marmarosh: Yeah. And you're so right, like parents sometimes, , sometimes they know that their kid is, the way they tell me is my kid's high maintenance or they're have, they're a ball of energy and I know that, they're sometimes too much. When the kid feels like they're too much, that can also be
It could go both ways, right? But, When their kid, like you said, is just in the back of the class daydreaming, you label them as careless sometimes or not caring enough like you said. And it can be frustrating cuz they're like, how do I get them to get motivated? And sometimes, like you said, it's a neurological thing,
So it, it's so important to be able to have that awareness to even realize and then sometimes they're smart. And because they are attuned to whatever the subject is and they're passionate about then they have a mixture, right? Like you'll have somebody who does really well in one area.
And then another, not so much because they find it boring or they, there were too many steps in there that they couldn't follow along. And so you have a frustrated parent sometimes.
Dr. Totulope Alugo: Yes, I see so many of those kids who are doing really well at school, but at home there's so much tension because they're forgetting that chores, the living appliance is on.
They're just not meeting deadlines with, homework and stuff like that. Yeah. So it can be a real tension point between parents and the teenagers particularly.
Dr. Diana Mercado-Marmarosh: So once you have this awareness that you walk them through to make the diagnosis, what do you usually like? Tell the parent or tell the kid.
Dr. Totulope Alugo: I provide information on the disorder. It's a neurodevelopmental disorder, so I say, look, it's nothing that you've caused. It's not your fault. It's a disorder of the way your brain is wired. May have been inherited of your small, more than likely, and then provide practical steps to move forward.
One, I want 'em to educate themselves as much as possible on the diagnosis. So pro I provide them resources for them to understand the diagnosis, and then based on the impact on their functioning, then we then look at treatment options. But I always say there's some medication, there's some non-medication options that everybody needs because they're important for life.
So things like, Having lists, using alarms, reminders, those practical strategies, they're important. And then for the parents, depending on the age of the child, I really want to provide information on how they communicate with their child. So for example, for the younger kids, I would say to get your child's attention, you need to calm down to their level.
If that means holding. Getting down your knees, looking them in the eye, and then giving them the instruction, breaking the information into small, manageable steps such that it's not too longwinded. And then, providing information to school because you want the teacher to understand that this child has challenges and needs things to be done differently.
So really education is one of the key things that I like to provide after a diagnosis. .
Dr. Diana Mercado-Marmarosh: Yes. That's so key because that becomes an empowering tool, empowering method to be able to create systems for them and for the parent too, so that they can have strategies so that they don't feel anxious or mad or angry or overwhelmed and they have a way to take care of them, and take care of themselves.
Let's talk about emotions because I keep saying that emotions are a compass, right? Because emotions really can be helpful, but can they can get us into trouble also, when you're not aware that A D H D can have an emotional component to it, then it leads to some meltdowns or they could lead to some melt.
What have you noticed in this
Dr. Totulope Alugo: area? Oh, that's very common because you see a lot of e easy frustration. So for a child who is unable to focus, who is constantly in trouble they're anxious because number one, it's difficult to focus. The teacher is calling on them, they're losing chunk of information.
They're being labeled sometimes by parents or other kids, and so that is stressful. So you'd see a lot. Emotional outbursts, just, easily easy, frustration, anger. And don't forget, sometimes parents themselves also have a d h D. So even though they know that their child has h d, they know that this is not their fault.
But then before they can put the breaks on themselves, they've let rape, but they're yelling or screaming, so it can become a real negative situation. or if care isn't taken. So really providing information about, putting bricks on yourself. Self care, managing your emotions is important, but also helping people around to understand that this child is struggling and need support and not judgment is also important.
Dr. Diana Mercado-Marmarosh: Yes, those are all very important keys like, I have a pediatrician that works with me and she's been there for 20 something years. And so I'm so grateful that she's there because she's obviously a ball of knowledge, but she always tells me Dr. Mercado I'm sending you the parents because I'm sure.
I can see it, and I'm like thank you. Send them over. Because it's takes an astute person who's paying attention and who and who understands that this can be genetic. Yes. And while we might put all the interventions for the kiddo or try to, if you yourself are not putting your own max.
Your oxygen on or your, either you or your husband, or both, right? Then it might be a lot of, more of a challenge instead of an easier transition for both of you and the things that can help the kid could also help you, right? If you have an awareness that you need certain things before you walk out the door, like your keys, your purse, like X, Y, and Z that can. Deescalate how quickly the morning routine can turn into something stressful. , yes, . Yeah. And the same thing with like homework, right? If you know that exercise or play is gonna release some dopamine, like having room for that on the schedule on purpose, before maybe you do jump onto the homework.
Because if you went for a walk, even if it was 10 minutes with your kid outside in nature, All of a sudden you've increased some of their dopamine and then they're might able to come and sit down and jump into the homework a little bit more easier instead of you and them arguing that I can't do it right now, and it goes back and forth.
So yes, handling the emotions. That can come with the diagnosis. And then not only that, but how do you handle as you are implementing it, right? Because we keep looking at other people and sometimes we're like it's working in their household. How come it's not working in mine, ? And you forget that everybody A little bit different.
We all want to be doing certain things, but at the end of the day, how you do 'em is what is gonna make the difference in how then they have tools to do it later on.
Dr. Totulope Alugo: Exactly. I think we are really being intentional and realizing the individuality of your own family situation is important because we can't be comparing.
That's not always helpful. You can always get good information from other families, but not constantly compare. I think it's important to be intentional, to be practical, but also give yourself some grace. Because sometimes as parents we beat ourselves up so much for anything that doesn't go well. And remember your child doesn't.
Perfect parent. Your child just needs a good enough parent. And so I said to parents, you don't have to be perfect, just good enough. It's fine. .
Dr. Diana Mercado-Marmarosh: Yes. You're so right. Realizing that we're always trying our best and sometimes we didn't have information available to us. I'm Mexican American and like I didn't get diagnosed.
So I was, in my first year of med school because when I looked around in my family, we all kind. . That's the way we were, like, we were loud sometimes and we would get angry and then like we would be over it and then, we would be a little bit forgetful and sure, this at three o'clock for the party, but everybody showed up like at three 50 or four or whatever.
Everybody was on their own time and we weren't sure that was like a cultural thing or that was just an A D H D thing. Or if, we. Lost track of time somewhere, because we're always like busy people. And so it's understanding that, sometimes just the way our environment is.
It might also be like not hindering the diagnosis because I like the word that I'm trying to say is that there's evidence out there that, in minorities, Sometimes it gets diagnosed later on because we we don't realize that's nothing that they Nobody's diag. Nobody's taught us about it.
Yes.
Dr. Totulope Alugo: And I'm from Africa myself, and I would say the same thing, the understanding of A D H D, the stigma associated with any kind of diagnosis really delays things. And then there's a cultural aspect. We have this African time, any party, it's not fashionable to get there on time. . So is that because of a D H D or just because that's the cultural norm?
It's hard to understand. But I really see that a lot in the Africans who, whose kids have coming to see me. And parents just feel like they've being labeled, they've been unfairly targeted when it may not be the case. So that understanding in our communities definitely needs a lot of educating.
Dr. Diana Mercado-Marmarosh: Yeah. And I think you and I will get along just fine. We'll get along, we'll get them to the same at the same time. . But my husband my husband's white, so he jokes around all the time. He's whose party is this? What time is it on? Is it like on Regular time or like your time . And I'm like, be quiet.
And he's I just wanna go. He's cause because he hates being late. And not that I, I don't mind being late, but like you said it's a norm. Sometimes we go back and forth, right? Because there, there's this time blindness component to it that. Sometimes, like you said, could be culture, but sometimes we really have no idea of it.
And that can impact, right? If you are in a certain setting and you don't have flexibility of time in your work or if you're trying to get on a flight, right? That might not be okay at all. No.
Dr. Totulope Alugo: Yes. For a parent who probably has a D H D I think the way to figure out if this is a cultural habit or whether it's something more, is really knowing when you can be late. If it's okay to relate to a family gathering, but not to work, not to the airport, If you cannot make those, navigate those differences, then maybe it's time to get an assessment.
Maybe there's much more going on than just it's okay to believe because of my culture.
Dr. Diana Mercado-Marmarosh: Yes, exactly. Yeah. With a D H D sometimes, like if you ask us what time, how long it's gonna take to do a certain task, we don't have that awareness. I have to count on purpose the time before I gather the stuff to start the task.
like we go straight to the task. We tell you it's gonna take me 30 minutes or 10 minutes or whatever, right? But we don't tell you because we just don't associate it together they call it like the recipe, like you need the ingredients, then you need the middle part, like yes. And then you need the cleaning up, the stuff.
And for us, we just go straight to the middle assuming that we have everything and sometimes we don't have everything. And that's where some of that can get us into trouble. Yeah. Yeah. So sometimes my, my, one of my screening question, To my, to parents or is how many times did you have to reschedule this appointment before you actually got in to see me?
Because that could be a tall tale that, , they missed it three times or they didn't have it on their calendar or something like that. It's
Dr. Totulope Alugo: true, and I think just being aware of that for a parent is important. I have some colleagues, for example, who have only just realized that in their forties that they need to really schedule themselves, give themselves time, have everything written out, have a spouse that would remind them, have their kids, remind them, but that self management is important.
That definitely is important.
Dr. Diana Mercado-Marmarosh: Awesome. So tell me. What do you think is one of the key things to enhance the wellbeing of the kids? Like you, obviously you already told me, go set reminders and that, and talk to the teachers, but like for that kiddo who is like wanting to do the things, like what do you think?
you would really emphasize for them?
Dr. Totulope Alugo: Start with the basic thing. So for for every child, adequate sleep is important, healthy diet, healthy exercise is particularly important, like you said earlier on, to increase the dopamine, to burn energy. Strategies like using fidget stools, having a, like a Fiji or paper meat.
Then teaching them to, set reminders, set tasks for themselves, ask for help if they need to. Those are strategies I will be highlighting first and foremost before anything else is those basic pillars of health. And then the A D H T specific ones things to reduce hyperactivity tend to improve their attention.
And also for the older kids, if you know that you're gonna be, for example, an example is overspending. Some kids will say, oh, I went to the store to get one thing and I came out with 10 things. I'll say maybe leave your card at home and just bring enough cash for that one item. So those are some of this, the practical strategies that they could a child could.
To manage their symptoms and of course, talk to your healthcare professional. If all that isn't working there, all there may be an extra layer of help that may be necessary, medication and so on and so forth. The most important thing is talk to your healthcare professional.
Dr. Diana Mercado-Marmarosh: So where can people find you?
You are just a ball of energy and you have all those stuff that you have the right thing to support the parrot and the kid. Where can people find you?
Dr. Totulope Alugo: So have a blog at ww dot saint john cap.com and that's capital Double P. Then I also have a podcast working on eggshells with Dr.
Tolu on. Platform where you can find podcast. So Apples, Spotify, e t C I'm on YouTube at St. John Cap, also on Instagram and Facebook. So there's a lot of places where you can find me ,
Dr. Diana Mercado-Marmarosh: please go find her, follow her love everything she's doing. Okay. I always ask people this question, if people just started tuning in, because we have wondering attention, what is a one nugget you would want them to walk away with?
Dr. Totulope Alugo: Having A D H D can be a great blessing because I think, people are super creative, so you have strengths. So always think of your strength and not just the downside of having a diagnosis. Think of your child's strength. Your child has unique qualities. Focus on those unique qualities and not just on some of the challenges that you may be seeing that they.
Dr. Diana Mercado-Marmarosh: So Dr. A Lugo, tell me what you are hoping to do for fun in the next three years. In
Dr. Totulope Alugo: the next three years, I'm hoping to go on a vacation with friends. I'd like to go on vacation week, a girl trip, so I'm hoping for to do a girl trip in the next three years. We did one about seven years ago, so it's time for another one.
where do
Dr. Diana Mercado-Marmarosh: you wanna go?
Dr. Totulope Alugo: Probably Europe, the Mediterranean, maybe. Enjoy cruise .
Dr. Diana Mercado-Marmarosh: Awesome. Please invite me so I can come a lot . Yes. I love, I'm doing this Go trip . Thank you so much for your time and it's always great to chat with you.
Dr. Totulope Alugo: Thank you very much for having me. It's been great being here.
Have a great day.
Dr. Diana Mercado-Marmarosh: You too. Thank you for spending your time with me. I really believe that time is your most valuable asset. Please subscribe to the. Share with your colleagues and don't forget to check out my website@hdlivecoach.com where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happy.

The Importance of Taking Frequent Breaks with Dr. Mary Leung

Dr. Diana Mercado-Marmarosh: Come join me May 1st through the sixth so that you can rest rediscover your strengths, reconnect with yourself and those physicians like you who are ready to leave work at work. And re-energize. This is the invitation for you to make 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. So that you can start to dream the life that you always wanted this year in 2023. 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. 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 a 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.
Hello. Hello. How are we doing today? I am so excited to have a dear friend with me, Dr. Mary Leung, and she is in New York, but. She is actually from Hong Kong and I am so excited to talk to her today. She's a, he heon physician who is actually helping other physicians start to live the life of their dreams.
So She herself is gonna tell us her journey, but she realized that charting was not the thing to do every day, all the time, . And so we are gonna have a conversation on why it is important to realize that it, you know, you can take breaks, you can reset, you can do things your way. And whether you have a D H D or.
You can still live the life of your dreams. And she's here to share her story and to share how she's now helping others do the same.
Dr. Mary Leung: Wow. Thank you for the amazing introduction. Time . Anytime.
Dr. Diana Mercado-Marmarosh: Anytime, .
Dr. Mary Leung: All right. So I guess a little bit about myself. Yes. I grew up in Hong Kong and both. Parents of physicians, I mean, they're retired now.
But when I was growing up they would they, they really loved their career and what, what they, what they were doing. And sometimes they would talk about, Patients like what they would do with each other during dinnertime. So for me it was a natural exposure to medicine and being a doctor and I thought, you know, grow, growing up I was always taught to always help people, you know, whatever we can do to help, help.
And so it was just natural for me to to say, Hey you know what? I wanted to be a doctor too, just to help. And my parents never forced me into medicine. And my other siblings, they're not in medicine at all. And so I think this medical path was just a natural thing for me. I think it suits my personality too,
So so then fast forward to. 12th grade that my parents decided to send me to the United States to study. And that was 12th grade and of course, senior year in high school, it was kind of a cultural shock. And I went from not speaking English outside of English class at school to speaking English all the time.
And I remember I had to translate, you know, in my head from Cantonese to English before I, I would speak, you know, sentences and And I was taking all these advanced courses, American history, that I didn't know much about and applying to colleges all at the same time. So it was and of course living away from home.
So all these things came together. And I think even though it was quite a different and stressful year, it really helped. Who I am and it really make me grow a lot as a person.
Dr. Diana Mercado-Marmarosh: So, Mary, tell me during that time, did you decide which boarding school you wanted to go to or like how did you arrive which one you were coming in the US.
Dr. Mary Leung: Oh yeah, so I am I actually applied, so it was kind of like a college entrance process and so how I chose was I actually only applied to two boarding schools. And they're both in the, you know, northeast region new England region. And only because a couple of my friends went to those schools already.
So I was like, well, you know, I wanted to be with them. So I just applied to two. And I ex thankfully, actually, Accepted by both of them, and I just chose the one that my good friends were in . So
Dr. Diana Mercado-Marmarosh: Yeah. And that brings up a good point, right? Like that we sometimes become brave or, because, I mean, that's bravery and courageous to like uproot yourselves, especially your senior year when you're like, this is supposed to be the cheer year.
I'm just gonna write it out and like finish and then move on. Right? But. Yeah, you took a, a flinch, but then you did it with the knowing that I'm gonna go with my friends. Right. So like, It's always so amazing how, what we're able to do when we feel like there's a support system there. Even though, you know, you don't know exactly how things are gonna turn out, but you know that there might be one or two humans on the other side that you can lean into and then it'll work out, right?
So I think this is so true about life. I really think, and. and, and I think that's how you, you bet on yourself to come and do that. And then you bet on it's gonna work out. And then like you said, it was stressful, but you were seeing the big picture on the other side. Did you know you wanted to do med school at that time?
Or you were too young at that time, you think?
Dr. Mary Leung: Yeah, I think I can't exactly pinpoint when I wanted to become a doctor, but. Pretty young age, and I think at that time I was already, you know, pretty set on becoming one. And. You know, studying in the, in the US was kind of like part of the rite of passage.
And I think, you know, as you mentioned, I think we as human beings, we, you know, our desire to belong is very strong. You know, I, I, I think we're not designed to be alone. And so, you know, if we have some commonalities with other people, You know, we tend to lean for them. .
Dr. Diana Mercado-Marmarosh: Yeah. Awesome. Okay, so tell me, so you do all the things and then you, how did you get where, where did you end up doing residency and or when did you realize, okay, my God, this way of medicine, this charting thing, this is not my thing.
Dr. Mary Leung: Yeah, so so medical school and then residency, you know, I actually. Chose to be in New York because of my husband. And we met when we were in medical school and I mean, I was in medical school and he was in dental school at, at that time. And so because his family is from here, you know the New York area.
So, so I chose, okay, you know what since I already moved 8,000 miles away, I might as well be. Someone's family. And so, so I did and for residency and fellowship, I just, you know, stayed in the same program. I think at that time I didn't really realize charting was really a big thing because we never have a lot of patient load.
Like of course, inpatient. doing consultations was very busy. But, you know it was, I never really had the outpatient experience with a full load of patients. So only when I started to become an attending So after fellowship I took my first job, and this is still my first job. And that I joined five other physicians in the, in a group.
So it was a private group practice. And that, you know, several years later, it actually became a part of the hospital practice. So anyway when I first started, I already have some patients to start with. And three months after I was in the group one of the doctors retired. So I had even more patience.
And so very quickly I had a pretty full load. But at that time we were still using paper chart. . So with the paper charts, I'm those who actually still remember it's actually a lot more simple. And People actually tend to document less. And of course there would be a challenge to read some someone's handwriting sometimes, but it was, the charting time was pretty short and, and a lot of times you would just kind of jot notes down when you're seeing the patients because you would bring the physical paper chart with you.
So so charting wasn't really a big problem. At that time only when, maybe like about 10, 11 years ago when we transitioned to the electronic system that was, you know, that started to become a problem. I mean, I've used, you know, of course, electronic records before you, you know, even when I was in training.
And in the hospital too, but with a full load of patients. I mean, at that time I was seeing, you know, 25 to 30 patients at that time. And so electronic charting was really a big problem. And I think a couple things. It's like I, you know, I had the notion that, oh, I wanted the, the chart, my notes to be You know, need to very organized, very detailed.
And so, so that was one thing. Second thing was I had to believe that I had to keep my patients appointments as punctual or as on time as possible. So what ended up happening was that, oh, another, actually one more thing was I felt like I had to really. To show that I was paying full attention to my patients, and because of that, I felt like it was kind of rude to chart in front of the patients.
So all these things add together that I was sacrificing my charting time till the end of the day, you know, for a lot of the charts, not all the charts, but you know, probably sometimes even half the. And what ended up happening was even though my official on paper clinic day would end at four o'clock, I, I wouldn't, you know, go home until past seven.
And a lot of times I didn't even have my charge done. But I wanted to go home because my kids were young at that time and I wanted. Catch them a little bit and send them to bed and and I would, you know, do more charting. Most of the, the nights. And so, you know, that kind of went on the cycle started again and again and I was just, Really feeling tired.
I didn't feel like I had a life. I I, I felt like I wanted to quit many, many times. But then I felt stuck because I was like, well, you know, what else could I do? I, you know, we, we weren't financially capable of. Me not working. And then I also didn't want to move because I felt like I had my, you know, married family.
Now I had my new friends and I, and I just, you know, I, I felt belong here. And I mean, I still do, but at that time I just felt like, you know, to, for me to pick up everything to move, it was just too much for me. So, so that, you know I think that went on for quite a few years. Really. Until the pandemic hit , that's when everything happened.
Right. Everything on re said. Yeah. . Yeah. So, so the pandemic hit and then of course, you know, I was seeing a lot of oncology patients and and they, they had to, you know, Get treatment, get the chemotherapy. So we were trying to kind of just really choose or select who absolutely had to get chemotherapy.
to, to get therapy. And the other people, if we thought that they could delay or even switch to some oral regimen or something like that, we would try to do that just to minimize the hospital or, you know, the, the patient load. So at that time I was. On average, seeing about a third of the patients as opposed to my full load.
And I was able to get home on time or even earlier than on time and I, I was amazed. I was like, wow. That's what it feels like. You're like,
Dr. Diana Mercado-Marmarosh: I can have a life ,
Dr. Mary Leung: yes. Well, I didn't really want the pandemic, but this actually opened my eyes to what feel like to be a human being again, to have life outside of work.
And, you know, I, at that time I picked up baking. I, you know, I was like doing all these things with my kids and, and it was, I, I felt even so I. You know, I mean, I did and I didn't realize how unhappy I was. And then in the pandemic, I actually felt like I lit up inside and I felt like, oh wow, you know, there, there was hope that I could actually enjoy medicine again and just have this little idea that what if I could feel the same way and.
Go home, you know, on time when the pandemic was over or when I had a full of patience again. So then at the same time is I was. Introduced to life coaching. I had no clue what that was. I thought coaching was just for sports, you know, for, you know for athletes. And so I was curious. So I, and, and then it was happened to be like physicians who were coaches.
And so then I joined a women physician coaching group program. And that really, Turned me upside down in a very, really, really good way. I just learned that, well, you know I'm actually in control a lot of the times and I also I get to decide how I feel based on how I view things. That really kind of, it makes sense, but then I never thought of it that way.
I mean, we were never taught that. We just, you know, we just think that, oh, you know, what our situation is is the cause of, you know, it's the cause of the problem. It's it's how we are. We can't really change things. But but what it's. Really important. It's actually how we view the situation. It's kind of like, you know, if it's snowing outside, like someone would think that, Hey, yay, you know, I can play in the snow with my dog.
Or another person would think that, oh no, you know, I have to shovel the snow. That that is really not a pleasant thing to do. You know? So, so I think how we view things is really affect how we feel. And so, so then I thought, well, . How about, you know, instead of having to chart all day on nights, you know, is it possible to, to actually cut down on my charting so I could go home on time and spend with my kids?
So at that time I was working with my coach and we were just really working on how. You know, how my day was structured and we figured out that a lot of the times was during first half of the day I was pretty good, you know, was able to keep up with the charting with the patients. But the second half of the day, what was happening was I was thinking that, oh, you know, I had half more days to to work.
Getting tired. I don't really want to do this much longer. And and so all these things just make me feel like. It was a burden and I was getting kind of frustrated. I was getting tired and I was shutting down mentally. So because of all that, that I was, you know, really slowing down physically and mentally.
And so I wasn't able to keep up with my charts and, and then of course, came the end of the day that I was even more tired, and And having a pile of charts to do, and I started to forget the details of the patients. I was like, okay who had a murmur again? Or, you know, like am I mixing little things up?
I mean, of course, major things I wouldn't mix up, but just tiny little things and, and, and so that got me even more frustrated, and, and so, so then, So then I was kind of redirected to say, okay, what do you ultimately want? So I really, my ultimate goal is really to spend more time with my family. So to do that is I had to go home on time.
And to be able to go home on time is I had to be you know, I have to finish my charts right. And so, so what kind of energy to use to finish a chart is actually I learned that in general there are, You know, positive energies and negative energies. So, you know, the negative type of energy or fuel are kind of like the stress, the frustration, the anger, you know, that those type of negative emotions as opposed to.
The positive emotions. Those are like the focused, determined gratitude content, you know, that those types. So and I also learned that the negative emotions, even though they can push you to do things, They don't last long, or, you know, you will feel even more burnt out after using them for a while.
So by choosing or deliberately to use the positive emotions, it's long lasting and it actually makes you feel happier, you know, afterwards. So my field was focused and. Determination that, you know, I, I have the, my end goal in mind. And and, and of course, you know, with the charting strategy is also important, but the mindset part is really what fuels everything, right?
And so so I focused on really seeing a patient doing the chart and and I decided that, you know what? I'm just going. be focused on that one patient at a time. So when when the patient is telling me things, it's okay to also, you know, Do my charts at the same time because it's all about that patient.
And it actually saves me time so I don't have to remember it afterwards or forget some things that the patient told me beforehand. So, so then just with more and more practice that I was slowly able to go home half an hour earlier, a little bit more, a little bit more, and now I'm actually going home, you know, as opposed to past seven and still.
Work to do. I'm going home five to five 30 with everything done. Awesome.
Dr. Diana Mercado-Marmarosh: Wow. So many nuggets you gave in there. And I wanna point out some of the things, you know it's interesting how, like you just said, people will interpret. A certain situation differently, right? Like the pandemic is a neutral thing.
Like, but what you think of it made all the difference, right? Like one person could have thought this is the best thing ever. Kind of like what you thought, right? Or another person could have thought, this is the worst thing ever. Right. A and then that happens, right? But so for you, because you were a specialist and because of how dangerous the situation, procedures, and different things were you, your workload went to one third, right?
Mm-hmm. for me, being primary care doctor, my workload went up. It didn't go down. Mm-hmm. because, Because there was, we just had to be the front line as primary care doctor, right? So for me, it unraveled the situation of like, oh shit, I can't keep doing what I'm doing because this is not working out. And for you, it unraveled, oh my God, is this what life is supposed to be like?
And so it, it was like different thoughts, but they eventually both got us to the same thing, which. Are we practicing the way we want to practice? Like are we, like, who has ownership of our time? Right? Like, and why is somebody else's time more important than mine? .
Dr. Mary Leung: And I think yes, that's a very important thing and, and I think a lot of us feel like we blame that, oh, I don't have time, I don't have time to do this or that.
But in actuality is you know, we all have 24 hours a day and we actually. Get to take ownership of the time that we have and we get to plan, you know, what we want to do. And notice that I say get to not should or have to. It's like, you know, I feel like when we say we get to is that we, we are in control.
We, we, you know, we have a choice what you'll
Dr. Diana Mercado-Marmarosh: do. Yes, exactly. And I think that statement that you just made is what makes all the difference when you decide. That you do have a choice and not making a decision is still a choice. And we don't realize that because I think in medicine we've been told always do first for the patient, always do da, da, da, da, da.
And. Yes, of course I wanna take care of my patients, but the day that I realized that I had to be the more important patient, that if I wasn't right then it didn't matter exactly how well I showed up for them because I wasn't Right. and, and not, and not right. As in like, you know, but you know what I mean?
If you're not rested, if you're not. A hundred percent happy that you're there. It over some, you don't even realize you're burned out at times because you've been doing, like you said, the same cycle over and over and over for a while. You thought this is the way it's, it's supposed to be, but then when you get a taste of what it could look like, then you're like, It doesn't have to be this way.
Like who taught us that we are supposed to do all this stuff outside of work? Like who, who, where, or how is this acceptable? Right,
Dr. Mary Leung: exactly. And it's just like, you know, as you mentioned that until we get better or get a taste of being better, we never realized how bad we were feeling. And, and a lot of us physicians, I think.
me included, that I didn't realize that I was burnt out, you know and you know, I was, you know, more angry. I was you know, just kind of more tend to really shorten temper. Although not show it all the time, you know? And, and I, you know, Just realized now that, hey, at that time I was really, really burnt out because I was not happy, I was dissatisfied, I was frustrated, stressed, all these things.
And and also it's like since I'm a hematologist, oncologist have to throw in this, it's like for example for patients with anemia, you know, they would be walking in, it's like, oh, I feel a little bit tired. And, and meanwhile they, they're very, very anemic to the point that. Actually want to think about doing a transfusion.
And but then since they're, you know, young, healthy, otherwise, I'm like, okay, you know, take some iron, you know and then we'll see you back in a couple weeks. Right? And so, so when they came back for follow-up, they're like, wow, I feel so much better. I didn't realize how bad I felt, and this happened over and over again, so I.
You know, and it's kind of like also with cataracts, right? You know, they didn't realize that they were seeing the different colors until they had the cataract surgery that, oh, it's like, oh wow, the wall, the wallpaper looks like that color. So I, I feel like yes, for me is, you know, with the pandemic, of course I did not want the pandemic to happen for People's Health, but for my experience, what's really an eye-opening experience and that.
I really think that everything happened for a reason and that I was also, you know, being introduced to coaching and I was able to change my clinic day really. 180 degrees and I, I now even have time to, you know I mean I, I had time to get my coaching certification and and also now helping other physicians to go through what I went through.
It's crazy how
Dr. Diana Mercado-Marmarosh: we, you went from. Not having enough time to all of a sudden having all the time to even like become a coach yourself and help other people. So tell us what that's been
Dr. Mary Leung: like. Yeah, and I think also that how I feel is so much different from, say, if you asked me three years ago I think the most common emotions that I had up three years ago was I.
Stressed, I was overwhelmed, frustrated. And now I feel, I feel, you know, I really feel grateful. I feel content. I feel actually, you know, joy and even though I'm actually doing more things than before, I don't feel like I'm doing more things because to me, At work doing my full-time attending job, I am helping patients for the most part, the way that I want to help them.
And and I also get to connect with them in a human way, you know, more, more than just talking about their illness or dead diagnosis. And outside of work is I also get to do what I love to do. I just, you know, Discovered that I love coaching and for myself and to help other people. So, so this to me, does not feel like work.
And I, I really, I learn a lot and I learn a lot from, from, you know people I coach too. So I feel like this two-way street is really enriched me emotionally and mentally. And I also, you know, learned. Take good care of myself because you know, as you mentioned in the Be, you know, I always thought.
Really taking care of others first before me. I was like, I didn't have to take care of myself. What is that? And I would just be, you know, thinking about my patients, my family, friends, and without really taking good care of myself. And of course with coaching, I realized that. Hey, you know, we, we have to take care of ourselves first.
We have to, you know, otherwise we won't be able to give what we don't have. And if it's kind of like on the airplane, you know, they always tell us to put on. Our own oxygen mass before helping others put, put theirs on. So it's the same way that is, if you don't have the fuel to, to go on, if you're running dry, you just can't give your full, your best to your patients or your family.
Dr. Diana Mercado-Marmarosh: Yes, that's, that's exactly what I always say. So tell me, was taking breaks one of the ways you took, you put your own oxygen on?
Dr. Mary Leung: Yes. So, So another thing that I learned is, you know, I, I, I used to think that I, I should just be going on, you know, especially at work. Just go straight and without any breaks because I would be saving time.
By not taking breaks. Like I would just be taking the absolute necessary bathroom breaks. That's before my bladder burst. And and sometimes I even think twice before going, so, so then I just realized that that wasn't really helpful because. As I was going on and on and on, I was just really getting tired and I was slowing down physically and mentally.
And and then I realized that, hey, you know what? , many things take breaks. Like, you know cars need a break to refuel. And you know, a lot of engines, they don't run all day, all night long. They need to be turned off. And so we, as you know, reliving breathing human beings, we gotta do the same. And I think a, a lot of actually, Companies, schools, they understand the concept, but maybe not so much in the medical field or in physicians.
You know, like schools, they have scheduled recess, lunchtime, right? A lot of big companies, they also have scheduled breaks, you know, lunchtime. But for some reason in the physician realm of things even though. Lunchtime is scheduled. A lot of times we choose not to take it because we thought that, oh, you know, we need to catch up this, catch up that, so that is really not healthy.
And I feel like, you know, with the break time of interrupting what you're doing constantly is you get to rest, you know, you get to rest your, your brain, you know, just to take a break because sometimes you don't realize that how overdrive your. You're, you know, really. Being in the state of so, so and especially physicians, like we think that we're super beings.
You know, we think that we're exempt from physical turmoils sometimes, you know, or we forget about that. We're human beings . So, so I think that's really important to, to take a break. And this is from me, the no break physician that had passed. Right? So taking a break you get to also, you know, recharge, you know just, just really Take taking even just a mental pause of what you're doing or just get up and walk.
You know, that, that really kind of like briefs, some fresh air and just simple things like that. It doesn't even have to be a long time. Like it could just be a couple minutes and then, and then you f you know, you feel refreshed and you know, then, then your brain can actually refocus. Better afterwards.
And, and also, you know, there is a chance for you to regroup. Kind of like even a, a quick chance for you to reflect on, oh, did I do this right? Or what if after the break, you know, maybe I wanna do things a little bit differently, you know, just have the time to, to pause and explore and and get ready to experiment something else if you need to.
And I think recharging our body is just so important that you know, we get drained and as we talked about earlier, that, you know, as we run dry, we really can't perform at the optimal. You know, situation that it's, it's just not very helpful for our patients or for people around us. So I think, you know, taking these scheduled breaks is very important.
And I also want to just quickly mention that. Even though it's important to take these scheduled breaks to, you know, reset, recharge, renew, re refuel, it is important to minimize the unscheduled breaks. So the unscheduled breaks that I refer to are like say if you get interrupted by. Your coworkers unexpectedly, or if your mind is wandering off and thinking that, oh, you know, what is on social media, a Facebook, or, oh, I heard this email notification.
Let me go check my email. So those are kind of the unscheduled pricks. And if. Kind of entertain the, your mind to go ahead and do that. You'll end up, you know, being distracted and you'll end up taking more time to finish the work.
Dr. Diana Mercado-Marmarosh: Yes, those are such important nuggets. Again, if you have a D h D or not, if you implement these strategies, they can really make a difference.
Like we all get into this like, routine, routine, routine, which routines can be very. Fault, but when we are not slowing down enough to reevaluate whether that routine is actually. Helping us and providing us, refueling us with energy or if it's actually taking away from us. And, and then if you don't give yourself that space, you might miss it.
And so you're so right about the breaks. Like most of us wanna keep going, going, going, because we think we're in the flow, but we don't realize we're. walking at like, you know, turtle speed. Mm-hmm. instead of like just, you know, rabbit speed or whatever speed you wanna be at. And, and, and realizing that some days we are gonna be at turtle speed and that's okay.
And some days we're at rabbit speed and, and it is what it is. But realizing that, You are choosing, or you're conscious, or you're aware that you are doing what is supported for you makes a big difference. So, Mary, where can people find you? Because I'm sure they're like, okay, I gotta, I gotta learn more about her.
We gotta work together, we gotta do some things. Tell me what, where can they find you?
Dr. Mary Leung: Yeah, so thank you. So I have the website is www.shiningwithgratitudemd.com and cuz you know, I, I have that name. It's because I really feel so grateful and I just want everyone to feel the same that. That we're just thankful for our situation, good or bad, because it's always teaching us something.
And and I always feel like we can choose to be grateful for whatever is, you know, coming to us and we can work hard to improve our lives. And so, so that's my website and I offer one-on-one coaching for physicians. And you can also find me on Facebook, Mary Lung, and LinkedIn at Mary Lung.
Dr. Diana Mercado-Marmarosh: Awesome. So I always ask this question of my, of my guests. So let's say that my my listeners just tuned in. Cause you know, we have wondering attention. What is one nugget you want them to take away?
Dr. Mary Leung: There's so many nuggets, right? . So I think the one thing is that you are in control. I think that, you know, even though there are situations, of course there are things that we cannot control, but just control what you can control because there are actually, if you explore it there are more things that you can do than you.
Than you think at first. And and for whatever things that you cannot control, don't argue with it. But just think of ways that what you can do to improve the situation if it's something that is, you know, according to your plan.
Dr. Diana Mercado-Marmarosh: Awesome. So be flexible, but also have a plan in mind so that you can try to get to your destination.
Yeah. So for in the next three years, what do you hope to do for fun?
Dr. Mary Leung: For fun, well, I always love to spend time with my family. I love traveling and so I would like to travel more and and of course, you know, to visit my family in Hong Kong. And just to go to different places before my kids grow up and go to college.
Dr. Diana Mercado-Marmarosh: Awesome. Well, thank you so much for spending time with us and giving us your story. And as you heard it, guys and girls It is important to realize we all have a story and our story matters, and we can change your story if we don't like the way it's going, right? Like that's the thing we, we don't, sometimes we don't even realize that we didn't like the way it was going, right?
We have no awareness. But what if we could find ways? To work smarter instead of harder because all of us became physicians. Or by working hard. I mean, even if, you know, us, Mary had two parents with who were physicians and some of us have never had that opportunity and we didn't even know what we were walking into.
But Came through because we put in the work that, and, and now what about we put in the work so we can actually enjoy what we're doing, like and so that it could be easy or easier or it could feel like, it feels to marry and me that this is fun. Like we get to design it and, and have that privilege to support others to practice medicine also in their
Dr. Mary Leung: own.
Yes. And, and yes, it is possible to enjoy life and medicine again.
Dr. Diana Mercado-Marmarosh: Thank you so much. Thank
Dr. Mary Leung: you. Thank you for spending your time with me.
Dr. Diana Mercado-Marmarosh: I really believe that time is your most valuable asset. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website@hdlivecoach.com where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happening.

Essential Oils with Dr. Ann Huntington

Dr. Diana Mercado-Marmarosh: Come join me May 1st through the sixth so that you can rest rediscover your strengths, reconnect with yourself and those physicians like you who are ready to leave work at work. And re-energize. This is the invitation for you to make 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. So that you can start to dream the life that you always wanted this year in 2023. I can't wait to learn all about what kind of year you're gonna have after this conference. Take care. 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 unlearning some of my beliefs and some of my habits were just as important as learning the new set of.
Hello. I am so excited to be chatting with you guys today about a really cool topic that most of us might not be aware about. And so it's, you're in for an amazing treat. Today we are gonna be talking about essential. Oils, and I want to introduce you. A real close friend of mine, Dr.
Ann Huntington. She's actually a physician. She's an internal medicine trained hospitalist medicine physician, and she's also a fellow of the American College of Physicians. And she. She's been very busy during this pandemic. She has lots of expertise in quality, patient safety, peer review, privileging and credentialing.
And she was actually the director, medical director of over 50 hospitalists. And she was able to successfully lead them through this pandemic and help all the patients and her colleagues. She really believed in lifestyle. And she thinks that this is the foundation to medical care and integrative medicine.
And she is actually the founder and c e o of give more Naturally it's l C and it All about essential oils, and she's launching an unbranded C m E course for physicians on the safety and research of essential oils as an integrative tool. So she's gonna tell us all about how she got into this area and if there's any tools or tips that might be helpful for focusing or for improving our mental health.
So I'm super excited about today's. So Dr. Huntington, as I've always, everybody probably already heard it in my intro, but you and I are having a conversation as two colleagues, but these are just our opinions, right? These are not meant to be Taken as we are their physician.
So they have to go talk to their own physicians and figure out whether this is for them. But anyways, Dr. Huntington, tell me how you got into this essential
Dr. Ann Huntington: oils. Thank you and thanks for having me. I'm excited to be here. Thanks for that introduction. I guess I'll go backwards to my outpatient practice for about seven years after I finished residency, I was an outpatient doc, primary care internal medicine doc.
And then I also did inpatient medicine as well, a hybrid role and As I got into that role, I realized there were so many things that I wish I could do that I just didn't have all the tools for. I could certainly help people control their chronic diseases, very complex situations, and, get tight control of their diabetes and their hypertension and really help them.
But I started delving into lifestyle medicine and as many people know and our listeners will know, lifestyle medicine is really the status and practice, study and practice of medicine through a healthy lifestyle. So through whole food, plant-based medicine whole food, plant-based diet, regular exercise, appropriate sleep and stress management, and reducing toxins and healthy relationships, and all of those things, and that really became a foundation.
For my practice, I really was focused on helping people, get healthier that way and really helping people get off of unnecessary medications that may be, a polypharmacy situation. As we would say, lots of side effects from those. Some of those were absolutely necessary to continue, but.
I focused on that quite a bit and then I would have all these patients come to me and say they would be taking all these supplements and I had no clue what they were talking about, or I didn't know their research on them or the safety. And you probably had that as well. We didn't really get trained on any of that.
I didn't get trained on nutrition or on. Supplements or vitamins or integrative medicine that wasn't part of my medical training, but I was always curious. I was open to hearing what my patients were trying to do to improve their wellness, improve their help. And I had one patient who told me she was using essential oils, and I remember sitting in the exam room, trying to, listen, and I just looked up at her, raised an eyebrow and I was like, I don't know anything about these.
I know they potentially can cause skin irritation, that's all I know. And I couldn't help her. And she didn't push the, she didn't push the conversation. We moved on to other things, but I really couldn't help her in that way. And I know that. Some of my patients who really had a they wanted a natural approach.
If I couldn't answer their questions, they would go elsewhere. They would seek out other, kind of practitioners or people on the internet or Dr. Google or whoever to try to find out the answers to their questions. And so in the background of all of that, I reached out to a friend one day when my kids just had cough and congestion.
This was several years ago before the pandemic and. I knew it was self-limited. I knew they were gonna be okay. It wasn't a big deal but I knew that, we could have a rough few days. And so I reached out to a friend who I knew had some essential oils, and for whatever reason, I, asked her, do you have anything that could help this?
And she sent me home with a diffuser, a little water reservoir that can vaporize some of these and some samples of certain certain essential oils. She taught me how to use it. and I went in, my kids were going to bed. I, tried it on myself first it was okay, and then I put it in their room and just I, stood outside as I turned it on and they were, settling down and it, within a few minutes I realized that their cough and congestion had subsided a bit.
They were, better. They went to sleep. They were much better the next morning. And because of the timeframe on, just seeing this and seeing the historical nature of, what would happen, I realized that they actually did something that they were biologically active.
That was my first kind of light bulb moment where I realized, that I needed to look into this more. And so I took a deep dive into this at that point and started looking at the research, started looking at the safety, started looking at the different use. And we can talk more about the different nuances to that, but it was a it's been a fascinating journey.
Somewhat of an overwhelming journey because there was not information out there that could it was really difficult to find the information that could satisfy a medical doctor to really learn about these. So it has taken me years to learn, to research, to experiment, experiment with these, to use them in my home and, with other folks to help them improve their wellbeing.
So it's been a journey, but it's been really exciting. I'm excited to share it with my physician colleagues, many of whom are already using these but don't know much about them, and they're interested to learn.
Dr. Diana Mercado-Marmarosh: Awesome. In your current practice what do you mainly use them for? Do you use them for the cough like you're saying now?
Or do you use them for more energy? Do you use them for or do you use them or what are you how is that working into your current
Dr. Ann Huntington: It's a great question. So I am now about four years ago I left my outpatient practice and did have been doing just hospital medicine. So it's a very different environment than I would use in my outpatient practice.
There are, there's plenty of research in the hospital with these, and I won't get into it here, but I do, share how docs can learn more about this. The health system that I have uses essential oils. They don't use super high quality , and so I don't think they know how to really use them.
So we're working on that. And some protocols, some of the health systems that use them know how to use them much better and have different protocols and we can talk about some of those ways. I remember going into one of my patient's rooms who was there for bowel issue and Was quite nauseated, having a lot of nausea, and we were giving a lot of medications to help her reduce her nausea.
And as I walked in the room that day, I smelled peppermint. And I was like, oh, it's pretty distinct. You walk in the room, you can smell it. And a nurse had put some peppermint essential oil on an absorbent pad, on a little card and taped it to right by her head to the hospital bed right near, near her.
and it was interesting, and that wasn't something that I prescribed. They have a kind of a protocol and it was interesting that her, nausea, she seemed to feel like it helped that day, that she potentially, required a few lessons. Issue was, symptoms were a little bit better controlled as she got through this issue that we were treating that we were treating separately.
And that was a really interesting scenario to see that, that in the hospital setting there are uses for these. And there's some, some other uses that health systems are using often a lot for calming. And there's some potential, in as we learn more about these as physicians learn more about these, there's some potential.
To be able to, really help people get through their difficult situations in the hospital. That's currently where we're using it. And then of course there's a lot of physicians using them in the hospital. Anesthesiologists are using them in the perioperative setting and also some surgeons.
And then there's certainly in the outpatient setting, these are being used quite a bit and recommended and educated.
Dr. Diana Mercado-Marmarosh: Awesome. And Have you yourself used them to help you with like focus or with any type of like energy or what have you used them
Dr. Ann Huntington: for? Yeah, that's a great question.
We use them for a lot of things. It depends on the situation. The more you learn, and especially as physicians, the more you know the mechanisms of action behind them, the more you know how to use them. So we'll talk about properties and then I'll talk about some specific oils that we. When you look at some of the properties of these essential oils, they're basically, and we're gonna take a dive back into organic chemistry.
So the docs who are listening, they, hopefully you don't have some bad memories from your organic chemistry days, . Cause we're gonna go back to a little bit of organic chemistry, but the way that these plants help protect themselves is through these essential oils, or there's, often tiny little oil sacks in the leaves, in the flowers, in the bark that can help protect the plant against disease, against pests and help pollinate and things like that.
So there's some beneficial properties for the plant. And this is derived from c. From a specific chemical constituents that occur in this, in these oils that have different properties. So when we're thinking of, calming benefits, , one of the, most calming chemical constituents is olol, and that is found in lavender and multiple other essential oils.
And when you see some of the very, calming essential oils you wanna look for lolol in the chemistry. And there's, of course others. So lavender is one that, that can be very calming and many of our listeners will, Probably had some stress in their lives and probably had some situations where they feel a little bit anxious or they feel a little bit worry.
And a lot of people will use lavender as the most commonly used essential oil. It's the most commonly studied over a thousand research studies and a lot of studies in the United States even and around the world on lavender itself. Roman camo is another one that, that people will use for calming.
And often, we use these two in kids as well, when kids are a little bit anxious and that can, really help do some calming. And I will say one of the most common ways to use these is through aromatherapy, and a lot of people will be familiar with that term. Where we can use it in a diffuser, like I mentioned, where you've got a little water reservoir, you put a few drops of essential oil in, and these essential oils are volatile, meaning they evaporate from liquid to gas at room temperature, and so they can go out in the air.
And the mechanism is like when you take bread out of the oven and you can smell it, you can smell the aroma. Or when you take cookies out of the oven, it's a little bit different. But these are. Little tiny micromolecules that evaporate in the air and can really exert their beneficial effect.
Some other ways that people use aromatherapy could be, like I mentioned with my patient on an absorbent pad or cloth. Sometimes they can be in a little dish and you can, take the lid off the little dish or cup and be able to get that aromatherapy or inhale that sometimes people will just smell them from an open bottle.
And if you, I've got one here. Just smell that aroma that can be very calming or soothing. Some people will put a drop in their hand, rub it together and inhale. So there's different ways to do aromatherapy and certainly massage. Folks who are massage therapists have used these a lot and will use sometimes massage aroma therapy where they'll, use, get that aroma benefit.
Also, the topical benefit, that's another way to use these. the topical way where these can absorb into the skin. You have to be very careful and know what you're doing when you use these topically. Because every, not everything that you put on your skin is good for the skin. And and sometimes skin can be very sensitive to this.
But that's another way to use these. So when you're thinking of and feel free to jump in if you have any other specific questions about that, but then when we're thinking about, alertness or sometimes. Sometimes people will use ones that can help with a little bit of uplift and citrus oils have been felt to really provide a lot of uplift and a lot of, some happier thoughts.
So we think of orange for example. Most people love the smell of orange. And when you extract the essential oils from the orange peel or rind the chemical constituent limine in many of the citrus oils can be very uplifting and beneficial. . And then one of my other favorites is is peppermint.
And peppermint has a very kind of cool, clear aroma that can really, feels like it open up your airways if when people use like really strong peppermint gum, for example, it's often in flavorings when they use, peppermint gum or sometimes peppermint tea or even a drop of pepper.
I, I will do a drop of peppermint in my mouth for breath freshening. And that really can open up your sinuses and make you feel more alert. So people will often pair citrus oils with peppermint, for example, to help. Maybe when they're studying to help them focus or when they're trying to do a difficult task, they may pa you know, pair those together to help them focus a little better.
And that can be a really fun way to use. I'll stop there and see if you have any other, , any other specific questions, but that's a, that's a few of the ones that I use. There's some others but just a way to think about it. Either the calming side or the, uplifting side or even the, focus side, mental alertness.
Dr. Diana Mercado-Marmarosh: Yeah. So I think that there is this is important to bring up because some people. To get in the zone or to get activated or to get yourself like ready to do a task that maybe sometimes we're not like, oh, I can't wait to do that task, right? , if you have a way to help yourself either.
For me it's candles I like to turn on candles and. Again, maybe it's the smell of it that just gets me there. I haven't tried essential oils yet, but I'm definitely open to trying something like that because the smell of the candle kind of helps me calm down or be more at ease and And so I could imagine, like you said, if you are with somebody who understands how much of it and what and when it could be very beneficial as a way for you to get yourself in that zone or get yourself To think about something different.
Because just like for some people it might be music that activates them. For some people it might be smells, right? For some people it might. And so I think this is a way for us to also consider, and like you said, you. Done some of this research and you understand that, we all try teas of different sorts, right?
And they are plant medicine, right? , all our medicines eventually are derived from something, right? And they are, it is just a different tool or it's a different method.
Dr. Ann Huntington: Absolutely. That was one of the reasons why I thought this was so important to share, is it is another tool. It doesn't mean that it replaces all of our other tools, but it really can enhance and augment our ability to, just really improve our lives with an additional tool.
And I agree. It often comes, our success in life often comes down to our routine. And I am reading the book Atomic Habits. I'm not sure , if you're reading that book. Yes. But it's a fantastic book that talks about, how life is really built upon our systems and our beliefs and then that leads to our habits.
And if we can have good habits that help us be successful, then we are often, very often to accomplish those tasks that we need to, even if they're difficult And One of the things that I've learned recently is if we're able to celebrate in a way, once we complete that ha that task, having just that pattern of Yep, I'm gonna do a difficult task.
I'm going to, get my setup where I need it to be, to improve the chances that I will get this done. And then I have a little way to celebrate and take a break. Once I've completed that, before I move on to my next task can be really Improve that, ability to do that and also improve our satisfaction in getting things done.
So that can be really fun. I know that, oftentimes when we are. Worried about focus. And this is, certainly when we're on screens a lot or when we are super tired, that can really reduce our ability to focus appropriately. And I think lifestyle is foundational, right? Having a healthy diet where you are really taking in the nutrients that you need to be fueled, hydrating getting good sleep at.
Really doing all of those things can help improve our chances of being able to focus, being alert, awake, not having that afternoon slump where we're super tired, right? We crash and then we, sometimes people fuel with coffee to get up, but, All those things are little habits that we can do that, a thousand habits can make for, really big changes in our lives.
And this is just one of those that can add to that routine. It's really fun. Yeah.
Dr. Diana Mercado-Marmarosh: And I'm sure like, Having some awareness of on these when you can't necessarily use some medications like for when you're pregnant or when you have other chronic conditions that maybe your autoimmune puts you more compromised.
Having the ability to again, reach to something more natural is just a way to also enhance, right? Or sometimes just being aware. Some people can't swallow pills or some people can't, so again, it's having different delivery methods that can really make a difference. So I think, yeah, it's so important.
Yes. And with Atomic Habits What they say is if you're able to habit stack, right? So if you add something like a pair with something that you don't like to do with something that you enjoy doing, and it's like you said, you're rewarding yourself for doing the thing that maybe you need to do or want to do.
And that can make a big difference. So for me, That means turning on the music and dancing to Shakira Aquin. I don't wanna do the dishes right . So it, it's or listening to a cool podcast or a good audible book while I'm doing the dishes. So it is just a way to figure out how can I still do the task or if I, and not make it be so hard with I like using and I've.
I like using the candle that usually has e equi, I can't even say the word eucalyptus. Is that how you say eucalyptus? Uhhuh. . Yeah. Eucalyptus. Does that, have you learned anything on that or does that have any type of, is there a eclipsis oils? I don't know why. I feel like that smell helps me to focus.
I don't know if there's anything with it or not, but I've, no, we all become a creature of habit. . , when you. Something and then is working. You don't change it, you just keep going to the same thing.
Dr. Ann Huntington: Yep. Exactly. Yeah, that's a great point. So everybody's so different. We're all so different.
Our body chemistry is super different. Just our preferences are different and sometimes. Different smells we really like, and then sometimes we really don't like 'em, and especially, as you mentioned through pregnancy, we can sometimes really, crave certain things and then the next week you're like, Nope, that's disgusting,
So it can change. But yeah, we should, so eucalyptus there is an essential oil that's eucalyptus and one of my family members grew up in California and loves Eucalyptus because it's there as well. And just that clean ar. And we actually use eucalyptus in the shower. When you're heating up the water just before you step in, you can drop a few drops of eucalyptus and have you get your little spa experience for a little while, and that can improve your day.
One thing to mention as we're talking about different preparations of these, that these products that contain essential oils is the quality. And it's interesting, the essential oil market is crazy. It's multi-billions of dollars and it's everywhere. Essential oils are every. But there's a distinction between the therapeutic, just the aroma and the therapeutic use.
The, you. I guess I should back up and say essential oils are in our food supply. They're used as flavorings in our food. They're used for, to enhance the flavor. Sometimes they can be used in our skincare products, in our candles, like you said, certain lotions, certain shampoos. And then, in massages that we would get, with an aromatherapy massage and then, on a therapeutic side.
And so sometimes we may be getting eucalyptus or lavender or tea tree in some of our product. But some of these products may actually not contain very much of the exact, of the actual essential oil because they're either diluted with other, other chemicals or other things that are in there.
And you may have very little of the chemistry to actually have a therapeutic benefit beyond the aroma. So that's one kind of distinction for, especially for the physicians who are listening, we're so used to having medi medications be pharmaceutical grade where if you say, all right, I'm gonna, prescribe a certain medication at a certain dose, you're pretty confident that you're gonna get that dose without much variation, right?
The supplement and nutraceutical industry totally different. Unregulate. You've got, lots of different suppliers and lots of different methods of processing and lots of things that, may not be what you what you think they are. So that's another thing to keep in mind when people are thinking about essential oils because they're everywhere.
But. It can be difficult to distinguish what are the highest quality and what are not diluted with a lesser expensive oil or with a vegetable oil without telling, telling the consumer. So that's something to keep in mind. When you're looking for high quality, make sure that there's a few, things that we can share with our listeners to find a higher quality essential oil if they're just buying the essential oil.
Look for the the name and the name of the essential oil and the parts of the plant that's used. Look for the Latin name that should be list. And it should be in a glass bottle rather than plastic. It should be in a kind of amber color to protect it from light and heat.
And it should be, it should smell like the plant. And some of us don't even know what the plants smell because some of them we may have never heard of or never walked through a field of lavender or, some of those are more common. Those are just some ways ideally it would say organic and it would be wildcrafted and it would, really be therapeutic grade.
Although there's many that will say their therapeutic grade and they may not be. So there's, it's pretty tricky to find a really high quality essential oil. I would look, certainly a, there's a lot of websites you. , sharing these, selling these. And very few of them actually, share a lot of the scientific knowledge and a lot of the, the.
Chemistry in the background behind them. So that's something to, just be aware of. But can be really, I don't wanna Go ahead. Put,
Dr. Diana Mercado-Marmarosh: put you on the spot or Oh, yeah. But do you have one that, or two or three that you sometimes like, or do you, that you refer people to buy from or is that something that you're still like working
Dr. Ann Huntington: out?
That's a great question. I'm gonna answer that in a little bit indirect way by saying yes there's certain companies that are better than others and and so I have, found one that I stick with very generally in a lot of physicians. Stick with them. I don't share it publicly.
Because I'm not promoting any certain company, but there are ways that, that I'm working on to be able to share with people because people are asking me all the time where do you get the yours and how do you find them? One thing to look for from a testing standpoint, and this is really important to make sure they do G C M S testing or gas chromatography, ma mass spectroscopy, and that they actually probably label their lot number or batch number so that you can look up where this came from.
Now GC m s is not the only way to test. Some companies do just GC m s, but there's far more testing that goes into having the highest quality essential oil. So I would say look for a company that really does. Very extensive testing. Not just G C M S, but different other types of testing, organoleptic testing and some of the others.
My website actually has some information on testing that's much more detailed. And so there's ways to do that and to at the companies and look at the sourcing, where they get these from. Do they get them in the lab? Do they make them in the lab? Do they get them from. Small family farms or for, from commercial farms or from a lab.
Those are all important questions, but yeah it's a really interesting process. If you're getting a $5 essential oil at the supermarket, you're probably not getting the highest quality. They're expensive to produce. Whether it be, distillation or other. They can be pretty ex, expensive and they can also take a lot of plant matter to produce concentrated essential oil.
So what would
Dr. Diana Mercado-Marmarosh: be a roundabout that you would think, okay, maybe we're on the right track, like a $50 one with saying something along, like you said, a glass and then amber looking container. And if they put something about G C M testing, then maybe we're in. Way, would it be something around the $50 mark just so that our, of course, everybody has to do their own investigation , and like we said, that we're not here to give you a physician advice and you still have to check with your own physician to make sure there's no contraindications with the current meds you're on yourself.
But just so that we have something in our minds of what we're going towards since maybe this is a thing we're all excited about and we're gonna go
Dr. Ann Huntington: exploring. Yep. It's a new thing. It's a whole new skillset set, actually. So it depends on the, it totally depends on the essential oil.
So citrus oils are relatively inexpensive somewhere in the 10 to $20 range, depending on the amount. It depends on how much. And then, lavender, peppermint, a little bit more expensive. In the 20 to, 20 to $30 range. And then something like Rose, which takes, tens of thousands of rose blossoms to actually, you.
Create enough essential oil for rose, essential oil can be a hundred, a couple hundred dollars. So it really depends on the essential oil. Some are just more costly to produce than others. I would say. This is, my website give more naturally. Dot com has information on testing and a lot of information on that, that people can can look for.
And they can certainly subscribe to my email list and we'll give a little bit, information over time about this and can certainly follow me. It has taken me a long time to learn about this and it can be overwhelming to people because there's so many options on the market and people wanna make the right choice and people wanna, try things out.
And I, and one other thing we should say is, as we've, as you've appropriately mentioned, yeah, we're not given medical advice. These actually aren't FDA approved. They're not regulat. And they're, I can't say that they cure or prevent, treat, any of the diseases, but I think they can help augment some of the ways that people are trying to feel good and trying to improve their quality of life.
So that's my biggest focus. But it's a fun it's a fun exploration. It's fun way to explore
Dr. Diana Mercado-Marmarosh: and learn. And so tell me about your fun exploration that has now led you to like your passion. Project that is now your big business, right? So tell us about that, because I think you're really gonna disrupt the field of medicine in a good way.
And I know you have a course, so tell us about
Dr. Ann Huntington: all of that. Yeah, thank you. Because it took me so long to learn about this and to sift through all the research and to learn the safety and to learn really how to use these effectively, I created a course for physicians, a virtual course. On what I wish I would've known when I started this process.
A way for docs to learn in a much more succinct way. They can learn the research, they can feel confident about the safety as much as the information as we have on some of the most common essential oils. And they can learn about the market and the industry and where things can go wrong. So that, that's what I've done.
It's taken me a long time to compile all this information together, but it's entitled an evidence-based Approach to Essential Oils. And it's a virtual course that has c m. It is it's four weeks. It has some live q and as well. This is just for physicians and pharmacists and dentists at this time.
And then, there will be other information for folks who are not physicians, et cetera, in the future. But it's a really great way for docs to just learn the basics and take a deeper dive into the research and the safety and learn how their patients are using these. And part of the reason I created this course was because our patients are using.
All the time. I will often have patients coming in to the hospital and say, oh, I use this. And I'm like what do you use it for? And then we have a conversation and they're already using these and sometimes they get good education, sometimes they don't get great education and they don't know about 'em really well.
And that's a concern in the industry where you have, sometimes salespeople that are teaching, they're trying to sell. There's a varied degree of education and it's gonna be different than having your physician educate you about these. Look at your whole wellbeing, look at the medications you're on, the medical conditions you have.
What your kidney function looks like and liver function looks like, and all of those things to make sure that they can give their best recommendations. So that's why I created it. It's gonna be really fun. It's launching next week and we'll be we've got some information out there, but I'm super excited for people to take a deep dive and learn with me.
It'd be. .
Dr. Diana Mercado-Marmarosh: This could become a vertical for them too, right? If they decided that they wanted to turn around and look into it in the future, as you continue to educate them they might decide that they, they might. Find a company that, that they really trust, with sa and who knows, right?
This could be something just like some people say, oh, here's some vitamins that you can try. This might be something ju It's not anything different than that. This is some essential oils that you might wanna try to enhance your mental health to enhance your energy level, to enhance , your overwhelm it to decrease your overwhelm and enhance your stress-free life.
Dr. Ann Huntington: ?
Yeah. Yeah. I think there's so much opportunity for us to learn additional tools to, help improve our quality of life and really they're, there's, they're so versatile because of, the way the chemistry is. They're just so versatile. They can be used in a lot of d.
Situations. We use them, like I mentioned, everywhere from helping, calm things down to, before sleep, to putting a little tea tree in my kids' really smelly tennis shoes, to help improve the aroma and everywhere in between. There's so many ways to, to use these.
And once, once you learn a lot about them, then you can. Feel more confident. It is, it's interesting. Some people use them far too much, I think, and they still, we still have to be careful because they're, people will say, oh, they're a hundred percent natural, they're a hundred percent safe.
That's not exactly true. There's always, a another side to everything. So people need to learn about these. But I think there's some really good benefits and so many physicians are, doing integrative medicine practices now. They're getting additional integrative training. There is some essential oil education in some of the integrative medicine training, but not as much as what I've, put together as a really good standalone course.
But they're, people are interested in their, telling their patients and giving them additional tools and paying it forward, which I think is really fun. Yeah.
Dr. Diana Mercado-Marmarosh: And I would be really interested in figuring out how I could help, like the parent of the kid who just is at their.
It's n right? Where they're like, oh my God, how do I, yeah. And or my Alzheimer patient who is just, does not have the awareness of why they are sound downing or why they're doing X, Y, and Z. Yeah. Like how cool would it be as a family member to have a tool. a help and to have the right tool, that is, yeah. Like you said, with the help of somebody who understands these and not just somebody who might take advantage of you cuz you're trying to do your best for them and you don't know what you're getting, right? Yeah. But, . Yeah. I think, like I said, I think this is a new tool that one should definitely look into because like you said, they're still using it, so you might as well understand what they're using so that yeah, you can facilitate the discussion because you, most of us think, oh, they're not paying attention to us or whatever, but they are like, if you they bring me all their supplements because I'm very open mind and. How much are you paying for that? That's my first question I asked. I'm like, did you realize these are just all vitamins? And I read it to them and I'm like, as long as you realize what's in here, and as then, and if you're okay with it, let's try it. Give it a three, four months of it.
And then if you really see a big like enhancement, why not? But if you don't notice a difference, then I don't want you spending in that, and so we have that discussion. Yeah, because sometimes they're not aware that what they are taking, they're double or triple taking it because they're also taking a supplementation of that specific vitamin B12 or that specific vitamin C and sink and all this other different ones, plus the multivitamin, plus the whatever they bought.
On the internet or something. Exactly. So I think it's so important for us to realize that when we are asking our patients, or even ourselves when we are, like, sometimes we don't mention all the other stuff that we're doing right. When we they ask us. Cause we're like, oh, that wasn't prescribed.
They don't need to know, but forget. Yes. It might like, it might have some enhancement or diminishing return. Unaware to you that you're oversaturated on something, right? Yeah, exactly. I really love what you're doing and like everything, sometimes we don't know why we are passionate and we hyper focus on something , but we gotta use that as.
As a tool to help others because you already did all the research. I'd rather come to you and just tell me what I really need to know Exactly. Because I don't wanna go and
Dr. Ann Huntington: figure it all out, yeah, I totally agree. We don't have time for that. . Exactly.
Dr. Diana Mercado-Marmarosh: Work smarter, not harder, .
Dr. Ann Huntington: Exactly. Exactly.
I think that's so true. And going back to what you said about the mom, with the kids I do know that sometimes, sometimes kids, especially if they are, neuro. They maybe not, they may be a little cautious to try something new. It may be a little overwhelming for them.
And we're always cautious about what we put on kids' skin and things like that. Sometimes the moms will put the oils in their hair. and hold the kid that's, really upset and that can really provide some calming benefits. That's a little mom hack that we use because it can really really help soothe them and can really, be another way to redirect the situation similar to, like you said, your patients with, that are elderly and that may be a little agitated that can, that can really be soothing as well.
There's some fun and potentially really beneficial ways to use these. But it's, yeah. I think it's, the possibilities are endless. And really the opportunity is really fantastic. I will say my course has a significant safety component because as a physician I wanna make sure you know that what I'm doing is safe.
And of course, there's so much information out there. There's no way I could compile all, 20,000 plus. But we will talk about interactions. We will talk about specific patient populations and conditions and what to be cautious of, because I want docs to be empowered with the informations that's out there.
It, it's gonna be out there. The patients often are like, oh, that, that sounds great. I'm gonna try it. They're just like, Great to jump at it. And the docs on the opposite end of the spectrum are like, Ooh, that's new. That sounds woo. It sounds like snake oil, . I'm really nervous about that.
Is that safe? And so you've got people on the opposite ends of the spectrum, and there's nobody in between creating a balance to say we just need to, we need to bridge that gap. And so this is an effort to bridge the gap of what's happening right now. Educate physicians who are open-minded and who are willing to learn and also educate patients like, You can't use 30 essential oils and not expect, these are still metabolized in the body.
They may interact with your medications. They may, cause issues. You need to, there needs to be some balance here too. And ultimately for those people who are listening who are like many of my really hardcore lifestyle Madison colleagues. Absolutely, I agree. Lifestyle is foundational, right?
This is not going to reverse the effects of your fast food intake or your high sugar intake. Oh, oh man, . So this is a way to augment a healthy lifestyle and really improve that quality of. So I gotta throw that in there. .
Dr. Diana Mercado-Marmarosh: Yes. You have to point that out too much or too little of something.
It always gets us into trouble. So tell us again, where can people find you? Yeah,
Dr. Ann Huntington: so my company is Give More Naturally. The idea is to give more tools, more hope, and more help. And it is www dot give more naturally dot. And you can subscribe to our email list, even if you're not a physician, you can subscribe.
And then the course again is for physicians, pharmacists, dentists, cuz actually dentists are using them in their practice. They may not know some of the dental treatments have some clove and other essential oils in them. And It will, the registration's open now again at C M E for those who are, can get reimbursed.
And then it will close next week and we'll get it started. And
Dr. Diana Mercado-Marmarosh: I talked her into giving us a code for listening. So would you mind sharing a code with us today, ? Yes.
Dr. Ann Huntington: Yeah. So for those folks who listen to Dr. Diana's podcast, we have a 10% off. So you would, when you go to check out type in podcasts as your coupon code, and I'll give you 10% off for this for listening to this session.
So I'm grateful for you to have and be on and being able to share this message.
Dr. Diana Mercado-Marmarosh: Okay. So before you go, I always ask everybody this. These two last questions. The first one is, let's say, the audience that you have right now, we tend to have wondering attention. So if you just started listening right now, what is the takeaway point you want them to take away
Dr. Ann Huntington: today?
Yeah, great question. Essential oils in general are safe. They are effective if you get the right quality and know how to use them and they can really be a positive force for good in your life and in your patient's. But it's a lot of work to learn. So for the docs out there, come and take the course, listen and learn, and we will continue to learn together.
Awesome.
Dr. Diana Mercado-Marmarosh: One last question. In the next three years, what do you see yourself doing for fun?
Dr. Ann Huntington: For fun? Ooh, that's a great question. I as similar to many of the docs and other people that are listening, I have lots of interests, so I have to narrow. I still, I think this is really fun to share, this message with people.
So there will be some consulting opportunities. I think educating medical students and residents will be really fun, and I've had some of those opportunities. And then I love to travel, so I speak Spanish, so maybe we'll go to Costa Rica sometime together. and and love to, I really love to, connect with people and I think that's an amazing aspect of my job as a physician.
And also, an interest on the.
Dr. Diana Mercado-Marmarosh: Hey, I would be like tax write off. I have to go test the original source of this essential oil, right? Like
Dr. Ann Huntington: all over the world. Go collect some, right? ? Yep. There. Yeah. Some of the companies, there's an opportunity go visit those places where they source the essential oil, so that could be an opportunity.
Hey, you and I, we gotta talk, . That's right. That's right. Let's plan.
Dr. Diana Mercado-Marmarosh: Awesome. Thank you so much for coming. It's been a pleasure. You having
Dr. Ann Huntington: you. Thank you so much for having me. Have a great day everybody. Thank you for spending
Dr. Diana Mercado-Marmarosh: your time with me. I really believe that time is your most valuable asset.
Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website@hdlivecoach.com where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happening.

How steroids can accelerate your ADHD with Brittany Panico

Dr. Diana Mercado-Marmarosh: [00:00:00] Come join me May 1st through the 6th, 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 2023. 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. 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 unlearning some of my beliefs and some of my habits were just as important as learning the new set of.
Well, hello. Hello everybody. I am so excited today. I have a very special friend with me, Dr. Brittany Panico, and she is from Arizona and she's a physician. She's a rheumatologist. She's an. Autoimmune guru. Okay. A guru. Okay. So she's gonna talk to us about all the things but I wanna tell you about her because it's very special.
She is a board certified internal medicine doctor, and she's an also adult rheumatologist with experience both in inpatient and outpatient. And she is, Her platform is that we need to make sure we are doing this together. So she's an advocate for shared decision making and she really wants you to realize that we're a team here that you know, while I might not know everything, you might not know everything, but when we put our heads together, Everybody wins Your health wins.
And she is the chief of rheumatology at Summit Rheumatology and Gilbert, Arizona. So today we're gonna have a really cool talk about how sometimes steroids can make her A D H D misbehave a little bit . . Also, we're gonna talk about how sometimes we need to be aware that, again, when we are deciding that the course that we are getting from using certain medications are not, Exactly what we want.
We have to have this conversation about decision making so that we can pivot or figure out what the next best thing could be. So, without further ado, I wanna invite Dr. Brittany Panko today to share with us how she got excited about rheumatology.
Dr. Brittany Panico: Thank you so much Dr. Mercado. So Yeah, I'm really excited to be here and basically, like Dr.
Mercado said, I practice adult rheumatology and really, really want my patients to be a part of the team. So when we talk about medications, when we talk about diagnosis and what that means to you as a patient, , it's really important that we're all on the same page together. So excited to chat about different things that can contribute to either A D H D exacerbation or more trouble concentrating or trouble at work or at school or at home.
So yeah.
Dr. Diana Mercado-Marmarosh: So how did you land with ad with rheumatology? Like is that something you knew you wanted to do all the long, when you were in medical school or, or did just come about once you were like deciding towards the end?
Dr. Brittany Panico: So I became interested in a rheumatology actually, after a dermatology rotation.
I noticed that a lot of patients with psoriasis were coming in and really struggling with wanting to talk more about their condition, about more about how they felt, how their bodies felt. And in dermatology it was about treating their rash, their psoriasis, and we would see patients. You know, talk about medications, talk about prescriptions, and then the attending would often say, now you go see your rheumatologist.
And I didn't really know what rheumatology was at that point, but it really triggered me to think about. Okay, if, if this specialist is sending you now to this person, what is so special about that team that can fix the things going on? So I really started paying more attention to the way that rheumatologists kind of fit a lot of the pieces together.
And we're often kind of referred to as the problem solvers when things don't seem like they're going right or when we don't have an answer. Patients will often be sent to rheumatology to try to understand the puzzle of what's happening. So I really, really enjoy that problem solving approach. And then also it's just a really exciting time in the time of biologics, the time that so many new medications are coming out and really can change the way.
Patients feel and we can see it happening. So it's really, really exciting just to be a part of a field of medicine where we can really impact somebody's way of life for the better. And I just love being a part of that. Awesome.
Dr. Diana Mercado-Marmarosh: And. in your years of, of practicing have you seen a lot of us with a D H D come through to your clinic or some of us, or what have you noticed with like, the use of steroids?
Dr. Brittany Panico: So I definitely try to pay attention to that. If a patient talks about. Diagnosis of A D H D and how that might impact the way that they're feeling, because again, we're trying to put all of the pieces together with, with the person and what's going on, so, A lot of times in rheumatology, we focus on the way medications interact with each other, and I think that's really important when we consider the use of steroids or prednisone is the most common one that we use because a lot of people not in rheumatology are nervous about prednisone and patients come in oftentimes already having that kind of mindset of, oh, I can't really be on this, or, oh, I know it's gonna do something to my body.
And we use prednisone to calm down inflammation. That's our most powerful way to. Control of the inflammatory process, the fastest or quickest way. So I do find that, you know, we have to talk to patients and we have to, to talk together about the way that this medication might make you feel. So if you're already somebody who is trying to, you know, use systems to concentrate or have very specific ways of, of categorizing time, for example, steroid.
Are another way to rev up your system. So you might feel like you're caff the caffeinated version of yourself. So if you're sensitive to that, then steroids are probably gonna make you feel that even more powerful. And so, It's really important that we talk about potential mood changes or distractability or just ways that you might feel like you're kind of jittery inside when you're on something like Prednisone.
So it, it's something that I definitely sit down and talk with my patients about. and if they don't like how they feel, for example, if you're having trouble with insomnia or staying awake too long, or balancing your mood or feeling more anxious or more depressed or angry, or have changes in your temper, then it's really important that we talk about those things so that we can adjust the dose of your medication or modify how you're taking it.
Dr. Diana Mercado-Marmarosh: So did you say D caffeinated version or caffeinated?
Dr. Brittany Panico: Caffeinated version . Okay. Steroids give you more energy.
Dr. Diana Mercado-Marmarosh: Okay, gotcha. And so if they take the steroids and then they use their own medication, I mean, again, and some of the, some of us are on many me medications, so you, we can't simplify. And again, we're not trying to be your physicians per se, we're just having a discussion here.
And you have to check with your own physicians to get all the specifics for. Specific situation, but just so that I understand let's say you have somebody who takes a D H D medications and it's a stimulant, and then they take the steroid, it might enhance, like, and therefore they might have more anxiety.
Is that what we're saying?
Dr. Brittany Panico: Yes, yes. So sometimes I'll recommend to patients that they kind of stagger how they take their two medications or multiple medications so that you're kind of getting more of like an even flow throughout the day instead of those dramatic ups and downs of, of the feeling that you get.
And so, a lot of times, Prednisone as well can, if you take it too late in the day, kind of like a D H D medication, if you take it too late in the day, you can have trouble sleeping. So it is recommended that, that we talk about ways to, to help with that and sometimes just staggering the way you take your medications can be really helpful.
Dr. Diana Mercado-Marmarosh: Yeah, I mean we, like you said, sometimes we underestimate. The possible interactions or possible. Things that can happen. I remember not too long ago, maybe two or three months ago, I had a patient who came in and you know, she was having severe, severe headaches and I, and I wasn't sure if it was because she was withdrawing from the medication for A D H D because some people can have headaches whenever they're don't drink enough water.
Or, you know, if they went from a regular medication to an extended release medication and. I decided it would be cool to kind of reset her headaches or her with five days of steroids, . And sometimes that works wonderful for some people and for her, not so much. I think she was back within like two or three days and she's like, I don't know what happened, doc, but my husband says I'm a raging, blah, blah, blah, blah, and I cannot be on these two meds together.
And so I'm. And so again, we don't realize sometimes because it could be that, I mean, I've given that treatment a thousand times to somebody with headache and they've done wonderful and I've given the, you know, the A D H D and, and sometimes you don't. Think together until they come back and you're like, oh yes.
Okay. Yes. I, I see. And and so they swear they don't wanna be on one or the other, but I'm like, no. I think it was the combo of each, I think you would be okay if you just had to do steroids, if you have bronchitis or if you have an asthma attack or something like that. And like you said, being mindful of when can I take it and not taking them together exactly.
At the same time. Right. And then also, like, did you. Lunch, they just skip everything else. Right. And, and so it, it's so important to talk about this because both of those mets can be so common, right? And we don't, because they're so common. Sometimes we don't slow down enough to evaluate like what else is going on.
And so, yeah, that you. That's why I'm asking these questions and then we think back at our experience and you're like, oh yeah, I remember that scenario. .
Dr. Brittany Panico: Exactly. And sometimes too, when we think about the dosage, right? If you're on a chronic medication, let's say for adhd, you're getting the same dose pretty much all the time, and then you try something new or short term like steroids.
Sometimes our dose that we would think of, we just have to lower that for certain people and just think, okay, maybe try half a tab instead of the whole thing at once. But yeah, everybody reacts differently and, and again, a lot of times patients get really angry and upset that we should know better, but we don't necessarily know how medications are gonna affect individuals and.
What makes it so powerful to provide that feedback? Like you said, you know, if your follow up wasn't supposed to be for a week or so, but you're really, really struggling with how you feel, check in with us sooner so we know that you're struggling because if we don't hear from you, we don't know what's happening.
Dr. Diana Mercado-Marmarosh: Yeah, exactly. We cannot read minds, right, and and that's the thing too, like sometimes when things are going so well because they're going so well, you're like, oh, I don't think I need that anymore. You'd be surprised how many times like people just stop taking their antibiotics or they stop taking their anxiety or depression meds, or they stopped taking their blood pressure meds because they're like, but it's been so good and I'm.
Because you were on it. That's why it was so good. . And then they start like saying, but then it stopped being good. And I'm like, well, how long has it not been good? And then you like backing up and trying to find out the half-life. You're like, yeah, that's why, because now it's almost a hundred percent outta your system.
And, and so. This is why it's so important to have a conversation. Of course, we don't know all the possibilities that could happen. We're not like, if we knew that this is gonna cause a harm to you, why would we prescribe it? We would never do that. Like we took a oath first, you know, harm. But this is why we.
We need feedback because there's no way that we would know one way or the other. And if it is going so well, like you said, again, come tell us because then there's ways that we, of course, the less meds that you're on, we're happier because you know, less interactions. But we can help you like taper off so that we do it in a safe way so that.
Maybe you are in the, we get you to one fourth the dose of what you currently are on, but it still gives you that benefit that you need. And so that's why it's so important, like you said, to have that conversation.
Dr. Brittany Panico: Exactly. And you, you mentioned the tapering part too. So as a rheumatologist, a lot of. Our medications to wean off of them are designed to taper.
So just like I'm sure you talk with your patients all the time, don't abruptly stop something, you may have to slowly taper off of it. And that's true in rheumatology too. We don't want our patients to just cold Turkey stop something because. You mentioned the headaches or kind of those withdrawal symptoms that can happen with some of our medications too, so definitely that's part of the process as well.
Dr. Diana Mercado-Marmarosh: Is there any other medications other than steroids that you've noticed that can sometimes have interactions or Like for any mental health stuff that you've noticed or, or anything that just like as a primary care physician who's listening might be, you know, keeping that in the back of our
Dr. Brittany Panico: minds.
Definitely. And I think we kind of, you know, Talked with the about the prednisone as sort of a negative side effect, but a lot of the positive stuff that we're seeing, especially for patients with rheumatoid arthritis, with lupus and with psoriatic arthritis, is that the biologics or the injectable medications actually have a really positive effect on mood.
And things like anxiety and depression. And so the longer that a patient is in remission, meaning controlled disease from that condition, so controlled rheumatoid arthritis, controlled lupus, controlled psoriatic arthritis, then a lot of the mental health aspects are getting a lot better as well. So I've had several patients who come, About three months later and have been able to cut back on the dose of some of their medications, like antidepressants, anti-anxiety medications, just because they feel so much better in regards to their underlying autoimmune condition.
So I think that's a really powerful thing too, is that as we're following up with our patients, What aspects are getting better because you are on treatment for your other things and maybe we can start to taper some of those medications that have been pretty long term for people. So that's something that I really encourage my patients to talk to their primary care.
Team members about is, you know, I'm feeling a lot better, I'm having less pain, I'm having less anxiety, less depression, I'm sleeping better, I'm exercising, eating healthier. At what point am I able to maybe consider cutting back to see if, if I can manage and feel good with less medication?
Dr. Diana Mercado-Marmarosh: Yeah, you bring such a good point.
Like I am constantly. Cutting or taking away some of the blood pressure medication because their blood pressure was uncontrolled because they were in pain and now that their arthritis is controlled, like you said, now they don't need like three blood pressure medications because of course, even though I was giving them medications for the pain or whatever, like.
When you are living with chronic pain, like it's crazy, and then all of a sudden you start on methotrexate or you start the rheumatologist finally like can get in to see them and they can get them on the right thing and they come back. They're like, no, I feel great. I feel great. Like, no, I haven't used.
That Tramadol doc, I don't need it. Or, or, and then your, their pl blood pressure is like, I'm like, are you feeling okay? It's like nighty over, like, and I'm like, look, like testing them over and over. And they're like, I feel great. I'm like, are you dizzy? They're like, no. And I'm like, okay, well let's cut this off.
Right? Because like you said, all of a sudden you don't realize that we are like, pain can affect us in so many different ways. Right. You, you, you can feel hopeless or helpless and, and so you don't feel like. You know, you can function and so all of a sudden when you start to, yeah, you should be looking, how can I get off of some of the medications or decrease the dose.
So maybe you don't need 40 milligrams of Paxil, you just need 10 now. And, and like, we wouldn't know again because. We're so used to, this is what we've been doing forever. But then again, like you said, what is getting better and, and keep looking at it because sometimes medicine keeps focusing on like, what's wrong, what's wrong, what's wrong, instead of what is Right.
Dr. Brittany Panico: Right. Exactly. Yeah, and, and I'm glad you mentioned the pain aspect of it too. I see that a lot with my gout patients. Once we finally. Gout under control, then the need for pain medication specifically can go away. Meaning that you can completely come off of things like tramadol or narcotics if you've been using them and, and blood pressure, kidney function.
There are so many things that can start to go right once you treat the underlying issue that was making those. Become problematic in the first place. So exactly this, this whole philosophy doesn't apply just to depression or anxiety or A D H D. It applies to, to the whole body function as well.
Dr. Diana Mercado-Marmarosh: Yeah, because I mean, so much can change because if you were taking like.
The max dose of ibuprofen, the max dose of Tylenol. And like we were very careful watching your kidney, right? Because it was like right at the tip and all of a sudden I had to send you to that specialist and that specialist. Right? Like it, it, it's so important to realize that we, we are the whole system, not just one part of the, of the system.
Right? And so, yeah, I, I think it's, And of course when you, you realize that your insomnia was also steaming from your anxiety, and now you started to treat your anxiety, oh, maybe you don't need a sleepy medication because you're no longer anxious about that . Right? And, and so it goes round and round and round, but it's, it's so important that.
And I know sometimes it feels like we don't have enough time to talk about all the things, but if you, in general, before you go to the doctor's appointment, can like brainstorm what is going well, like that can help facilitate the discussion and then figure out where to go from it. From there, tell me more.
Like what your passion is in, in your practice? Like what, what, like what lights you up, .
Dr. Brittany Panico: So I'm really passionate about in a couple of things, but I think at the heart of what really lights me up is finding areas where we're sort of ignoring a population of patients. So, One of the things that I'm doing in my practice Summit Rheumatology, is we've created a gout center of excellence and we're really focusing on trying to network and reach out to the community about properly treating gout, and that can be.
Either through oral medication, there's an IV medication that we use, and really just identifying that gout is a problem that a lot of people suffer with and live with, and just periodically will seek care when they're having an event or a flare. Rather than addressing gout as a whole body systemic issue.
So there's a lot more research being done, a lot of work going into, you know, helping educate all sorts of, you know, medical specialties, primary care, podiatry, surgery, orthopedics, even cardiology about how gout fits within all of. Systems. So that's what I'm working on currently and I'm really excited about that.
I also really, really like treating psoriatic arthritis because again, it's kind of one of those sort of under-recognized fields where patients will most often, you know, see a dermatologist for psoriasis. But then not really realize that their back pain, for example, is related. They may just think, oh, I have back pain or neck pain, and I go to a chiropractor and it gets better after I'm adjusted.
But in reality, it might actually be related to the psoriasis and be a form of psoriatic arthritis, and that can be episodic for people too. So a lot of times these more episodic conditions are hard to identify. And I think just helping patients understand that there is access to rheumatologists, even when it seems like we're few and far between.
And so I'm just really trying to, to get the word out and help patients understand that. You know, a lot of the conditions, a lot of the things that you feel like are not related to anything else are actually tied to an arthritis syndrome. So those are the two things that I'm most passionate about. I also really like to treat osteoporosis.
That's another gap in care, especially in my area that. Patients who fall and break a hip are then not necessarily treated for thinning of their bones, right? We kind of just think, oh, the surgeon fixed it and I'm mobile and I'm doing okay. When in reality, we wanna treat the reason that it happened in the first place.
So that's another sort of avenue that I'm trained to target as well.
Dr. Diana Mercado-Marmarosh: Yeah. And realizing that, you know, it is part of the preventative, right? Like you need to have your DEXA scan so that you can see if you're preo osteopenic already, and maybe you need to be started on something and don't wait until you had the fracture, right?
Like, like do it beforehand. And especially if again, you might have other comorbidities that. Can predispose you, and not necessarily just age-wise, but like whatever medical conditions you might have and medications that you might be on that can, I don't wanna say ages a little more, but in a way they kind of do.
Right? So we just gotta be aware that it's not just the age per se, but that, you know, a 50 year old might. Very different than a 70 year old that looks like the 50 year old. And the 50 year old looks like the 70 year old. Right. Not looking but like in terms of bone wise and health-wise. Right. And so it's so important to keep all that in mind.
And yes, I so much about this thoratic arthritis, like you said, sometimes we don't, I think as primary. Physicians, you might get a glimpse of it more than if you just are somebody who's like in urgent care or in the hospital where you might not see them as often. Because like you said, sometimes they might come in for the back pain and oh, by the way, I'm so stressed.
And then like this rash came up, doc and I, it always comes up when I'm like, so stressed about taking this test. And you, you, you might not put it together until , you know, they've come up several times or somewhere you put psoriasis or somewhere somebody else put arthritis and you're like, ha. Like, is it happening at the same time or not?
Right. And and like you said, when you do finally get that diagnosis right, oh my God, it's like life changing for them. And I
Dr. Brittany Panico: think too, there's there we're kind of in this sort of split. Chasm right now where, where a lot of us have, you know, patients that are younger and maybe around our age. And then we also have patients who are aging and, and friends who have aging parents and really trying to fit that spectrum of, you know, disease processes of preventative for the younger folks.
And then we're reacting to things from. Our older patients and trying to put those together and make sense of it. So I really do try to, you know, not only as I'm taking care of a patient but may be younger, you know, also addressing as they have aging parents who may or may not live in the same town as they do.
You know, there's ways that we can help prevent things in that population as well. Yeah.
Dr. Diana Mercado-Marmarosh: And like something and now I'm gonna go off a little bit off course, but I thought it was something that I, I found it interesting and I don't know if you knew this or not, but I read like a study saying that sometimes when your, your, the mom has like arthritis, like that, that might increase the risk for like a D H D or bipolar by 50%.
But I don't really know if. Like like just coincidental, you know, because it could be that, you know, some people sometimes, as we. If the mom had gestational diabetes, then they might have diabetes later on. And sometimes people can have autoimmune conditions and then that can like predispose people for other stuff.
I, and I mean, at the end of the day, D H D is genetic, right? And so we don't know if there is direct associations or not. And I don't know if you have ever. How about any of this data yourself? Do you know? I haven't
Dr. Brittany Panico: read that particular study, but I do think that it's really fascinating because when we think about.
childhood events and how that can lead to health conditions as adults. It is very interesting if a parent is struggling with a chronic disease that maybe isn't treated optimally or isn't diagnosed and acknowledged how that affects the home, right? So, right. If I'm a mom and I'm in pain and struggling to get out of bed every day, my children are gonna be affected by that.
And as my children grow up and realize, What is quote unquote normal for their household that then will translate to the next generation and can develop into health conditions in, in that own person. So we're, we're in this phase where things that our grandparents or parents didn't really acknowledge or didn't have the tools to even be able to address when they were in their thirties or forties even.
How that's affecting, you know, us or our children. And, and so the more that we can get patients to see their doctor regularly get treated for the things that they're facing and just have these conversations about how to get help and how to address things that they're struggling with, that's only gonna help our children as.
Go through this process as teens and young adults be more comfortable with preventative medicine as well.
Dr. Diana Mercado-Marmarosh: Yeah, exactly. You, you bring such a good point because like you said, sometimes we just think, well, this is the way it's always been like, you know growing pains or you, whatever you name it. And people don't realize that yes, there could be juvenile arthritis.
Yes. There could be like depression in a kid, or there could be, you know, other things that are going on that are not just oh, they'll get over it, type of thing. Right. And, and so, Sometimes, I mean, our parents are always doing the best that they can with what the knowledge they had. But like you said information being at our fingertips, we should it's okay to get a second or third opinion sometimes just to make sure we're not missing anything.
Mm-hmm.
Dr. Brittany Panico: exactly. Awesome.
Dr. Diana Mercado-Marmarosh: Well, where can people find you? Do you only do in-person or do you do virtual too in Arizona? Or how, how can people cuz I know there's a lot of people with gout and sciatic arthritis and now that people know, okay, she understands my d h adhd, she can help me. Like, I'm sure they're gonna be coming to you.
How can they find you?
Dr. Brittany Panico: Well, I would welcome that. So I'm at Summit Rheumatology. And you can find me@summitrheumatology.com and we have a you can fill out a form if you're interested in becoming a patient. I do do in-person and virtual appointments to all of Arizona, so currently only licensed in Arizona, but I am looking to expand that.
So hopefully soon I'll have some updates there. But yes, in-person virtual summit, rheumatology. And then I'm also on Facebook and Instagram, az like Arizona AZ room, r h u m Doc, d o c AZ room Doc.
Dr. Diana Mercado-Marmarosh: Perfect. Thank you. With my podcast, I say you have people who are listening and sometimes we have wondering attention, and so we just tuned in and we just started p ta paying attention right this second.
What is the takeaway point that you would want them to walk
Dr. Brittany Panico: away with? So my best advice as a rheumatologist is to just ask for help and be a part of the decision making. So I love it when patients come in prepared for their visit and ready to talk about how they feel. and just being involved in their health healthcare decisions is the most empowering thing that we as physicians can impart to our patients.
Awesome.
Dr. Diana Mercado-Marmarosh: And I always ask this question too what are you hoping to do for the next three years
Dr. Brittany Panico: for fun? Well, that's a good one. So I'm hoping to travel more. I have three young boys and we're just really excited to get out there and, and see a little bit more of Arizona and to travel. So that's my goal for the next couple years.
Dr. Diana Mercado-Marmarosh: So are you hoping to like, go to the mountains, go to the beaches? Like I, I'm trying to see this big picture
Dr. Brittany Panico: here. , , so all over. We haven't been to the Grand Canyon yet, yet. I think that'll be a fun one for, for the kids. And then we love beach vacations. We have family in California, so exploring more of California.
And we came from the Midwest. We moved from Chicago, so taking them back to that area would be fun as well. But my son, my older son is almost ready for the national parks perk at school, so I think we'll take advantage of that as well.
Dr. Diana Mercado-Marmarosh: Awesome. Thank you so much for sharing all your knowledge today and being here.
And all the people in Arizona are so lucky to have her there. So, but everybody else who's not in Arizona, hang tight, follow her, listen to her content, and she's expanding soon, so you'll get to get in on that too. So thank you so much. And again, remember it is a conversation between the doctor and the. We don't know everything.
You don't know everything together. We can put it together but do pay attention to what's going on with you because you are with you 24 hours and we don't know unless you tell us what's going on. So thank you so much again for coming and it was a pleasure to have you today. Thank you. Thank you.
Thank you for spending your time with me. I really believe that time is your most valuable. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website@hdlivecoach.com where you can find out about my upcoming coaching group classes, as well as free masterclass and other exciting events that are happening.

Take 5 seconds and reflect with Marshall Lichty

Dr. Diana Mercado-Marmarosh: Come join me May 1st through the 6th, 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. Welcome to Beyond ADHD, a Physician's Perspective.
I am Dr. Diana Mecado 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 unlearning some of my beliefs.
And some of my habits were just as important as learning the new set of skills. Oh my goodness. I am so excited today. I have an amazing treat. New Year, new goals, right? So I have a really good friend of mine here. It's really so important to have him here. He's one of been one of my guest coaches and.
Been treat and the, it went wild. My group went wild when we had him. He is actually an a lawyer and his name is Dr. Oh, sorry. I'm so used to saying doctor. But he is an honorary doctor in our group. Okay. So Marshall Litchy and I might have mis spelled or Miss said that, but he's here and he will tell us all about himself.
And he actually has a D H D and he coaches lawyers with a D H D. What an amazing service that is. And he has his podcast and he's just changing the world on his end. And so I'm so happy to have him here today. Marshall, would you tell us a little bit about us about.
Marshall Lichty: Yeah, you bet. I'm Marshall Litchy and yeah, I'm a lawyer, a Juris doctor, which the JD doesn't quite have the same ring that the MD does.
And yeah, I practiced law. I do no real lawyering these days, but I practiced law for about 15 years. And I was 43 when I was diagnosed with a D H D. For a lot of folks it will resonate with them that I had a kiddo who was having some STR struggles in school and we got curious about it and brought 'em to a specialist doctor, diagnosed him.
And as we were sitting in that meeting room, the doctor says, kinda looks at my wife and says, Now is there anybody else in the family that you know that has any of these characteristics? And all the heads snap over to me. And and then I got, I did some assessment and I did a full on assessment. I did the whole nine yards and kind of diagnosis.
And my life has been very different ever since then in almost all good ways. At the end of.
Dr. Diana Mercado-Marmarosh: Tell me, when you look back and they were asking you those questions, could you see all those characteristics in yourself as a kid, as a as a, high school and college? Could you see any of those things?
What stood out? To you.
Marshall Lichty: I think I, I was talking about this with a client of mine yesterday. If you're the mango juice and you're trying to read the label, you have a hard time doing it because you can't see the label, you're inside the bottle. And I think there were some elements of it that I saw plain as day, but some of them I just didn't. Really see them or I didn't know what I didn't know. And it was the, as diagnosticians, yes. Any, anybody who has a clinical practice knows that there's a gaping difference between somebody who really has thought about what they might have and they've been on the internet and they might be, Self-diagnosing a bunch of stuff, but they've been in the symptoms, they've been in the differential diagnosis, and they know what to play with so that it makes your job easier.
Sure, you gotta talk 'em down from having cancer, but at least they have talked about, I have this and I have this and I have this and I have this. And they can talk about it in a way that shows that there's been some self-reflection. And for me, that was the most interesting part was watching my son go through.
It led to this process of self-reflection, talking to my spouse about it and. Doing all of the research and looking for resources, and that's when I realized that there were no meaningful resources for lawyers with A D H D. And as I started thinking about what all of the implications of executive function challenges would be for a lawyer, I was.
Gobsmacked. I was like this is a huge challenge for lawyers because our jobs in many ways are just dripping with executive function. And I found very quickly that that there was a big need for what I was. Going through myself, great fortune of writing a book with some friends about how to run a small law firm and the book did well and we believed it.
It's a good book. I believe this stuff in there, but I owned a small law firm. I had a really hard time implementing some of the things, some of the things that we had written in the book and finally it started to make sense to me where those struggles were. It wasn't that I was lazy or crazy or stupid or any of those things.
The places where I struggled. Were reflected in some patterns that I was then able to see. Medication made a difference. Tools and tips and hacks and tricks made a big difference. And so starting to view my life as a search for healthy dopamine and healthy neurotransmitter processing has become a real joy for me.
Sometimes augmented by, not sometimes every day augmented by controlled substances, but also augmented by. Exercise and meditation and planning and sleep and a whole bunch of other things. And with those things, I feel like I've honestly never been in a better spot professionally. So it's, it has been a huge blessing for me.
Dr. Diana Mercado-Marmarosh: Yeah. And probably personally too, right? Because now, like you said, now you're choosing meditation. Now you're choosing, I don't know if you're exercising or not, but now you're at least more conscious that there. Like you said, a dopamine menu you can tap into whenever you need it versus before, maybe we didn't even have that awareness and we were going to go get that sugar or that.
Drink after work or whatever because we didn't realize that was gonna motivate us or keep us, push us through the deadline that we needed to commit to. And he and unaware of that, sometimes we could have been self judging, right? Or we could have been like, oh my God, I'm trying to lose weight, but I keep going to go get the cookie at 3:00 PM Like, who am I?
And like all this shame that can Keep us from growing or becoming or reaching all those damn goals that we keep making and like we don't really follow through because we didn't know, we didn't have the tools to be able to follow through or we keep trying to do things the way, like you said, it works for everybody else.
This is great. That's right. Checklist for A, B, and C. And if you don't have a D H D to do and it works beautiful but. We forget that with a D H D, what really drives us, our passion really trumps sometimes, although we do need that somebody to help us be organized and help us with some of the checklists that we ourselves on purpose, things are needed, right?
Because there's some things you can't ignore that are needed to, in order to be able to do. If you have a, you had a client and you knew that their. Case was, on Monday at 3:00 PM like you couldn't show up on Monday at 4:00 PM because then you missed that window. There was no window of oh, I had it on the wrong time and Maybe at 2:00 PM had somebody told you, okay, Marshall, are you in your car?
Are you driving towards whatever? And it sounds silly, right? But our brain wouldn't have given us the opportunity. We would've literally wanna be driving out of our thing at two 50 thinking we're gonna get there by three and have plenty of time and have the, the parking space and everything, right?
And aware that, oh God, we wanna keep doing things until the last minute because our. is just wired that
Marshall Lichty: way. , that's right. Yeah. The the classic time optimism. I love the phrase time optimism, cuz it puts a little spin on that predicament that we get ourselves into. One of the things that I've really been thinking a lot about lately in the context of A D H D for adults who are diagnosed later Is and I haven't seen medical research on it, certainly not peer reviewed.
And so this is anecdotal, it's observational. But I am fascinated by what I believe to be really significant parallels between people who are late diagnosed with A D H D, usually smart people with HighQ who are late diagnosed. Yeah. And the C PTs d literature. I'm fascinated by a complex PTs d as a. I don't know what it is, whether it's A L.
There is a lens through which you can look at either one of these and see a ton of parallels. And while I know that they are separate what I have begun to wonder about is whether there are elements of A D H D that increase perhaps dramatically the likelihood of a young person having an experience with parents during attachment.
That leads to C P T S D fascinating. Thing for me to play with and think about. And so I want to say it to this group because it's just something that I've been chewing on and I know that there are legitimate doctors in this group who are capable of thinking about this at a higher level. For me it's a curiosity.
It's something that I've been playing with, I've been trying read and research, but I think there are so many interesting elements of having D H D and beginning to work on that chain cycle that you mentioned. That is as much of the work as. Yeah. And in a lot of ways that people work through C P T S D, they are very similar to what we talk about, at least the emotional aspects of working through A D H D.
So anyway, I don't know what thoughts you have about it, if any, but that's something I've thought a lot about, as you mentioned,
Dr. Diana Mercado-Marmarosh: shame. Yeah. And so I think that's such an important. Topic that you point pointed it out to, I just interviewed a physician. She's wonderful, and she has 10,000 certificates.
Like she's family medicine, she's like psychiatrist in functional medicine, Reiki. And she actually, interestingly enough, her area of interest is. Addiction medicine and she talks about this correlation of trauma and and so I think you're onto something because me and her had a discussion and of course we had the discussion after I stopped recording.
I was like, God damn it, we should have recorded that. But that brings it up to the fact that I was talking to her, re realizing. That, most of our experiences up to the age of seven like really shape us into how we react with the rest of the world going forward. And so I was sh telling her that, I grew up in Mexico till I was 10, and then not until I came over here Sure.
All of a sudden, like I was meant to do certain things in a certain way, and them calling my parents was not enough. It meant that. My mom had to come and sit there physically for me to behave. And again, it was not because I wasn't doing my work because they would give me work and then they would give me more work and I would do all that work.
And you could see that my mom sitting there did not keep me from not asking questions or being disruptive, right? And so then they had to bring my dad in to do that. And so how she was talking about how that must have been traumatic for me to. Be myself, right? Because my dad would've probably spanked me because, my dad you're pulling him out of work.
This means money. This means like livelihood, right? And how like .
Marshall Lichty: . Now if y'all are listening right now, you're hearing a catch. Sons voice over there. Yes. We're talking about
Dr. Diana Mercado-Marmarosh: so the well meaning, right? Like well-meaning, well-intentioned. This is how teachers were taught they needed to do that.
And we were talking a conversation earlier, you and me about how I'm in a place in my life where really rethinking how can we. Help a society like, meaning like how can we make laws to where everybody is so inclusion. So instead of making it obvious that your kid has a D h D, how can we bring in tools and be like, Hey, in the front of the class, here's all these gadgets that can help you like to concentrate.
If you can use them like quietly under your desk and it's not distracting you, but they're using you to get you to still pay attention. But it's of like a side thing in the back and then. in the class can go and grab it. Now is you're not self-identifying you as a D H adhd. Only the people with A D H D can have this gadget to help them concentrate.
But anybody in the classroom can use this tool as if it's a tool and if it's no longer a tool, then you take it away because now it is distracting. That's right. Teaching. Teaching people tools. Right? And or how can I have those timers that are visual timers so that when you just say five minutes are up, people don't know what five minutes are.
But if they have a clock that says, oh, five minutes, and it, you can see the little red and then you're like, oh, okay, closer and then because of five minutes you implement it where then you turn around and you tell, Hey, okay, this is a time. Your friend next to you can tell you, did you catch the assignment?
Can we share each other? Can you group, instead of, again, making it seem like, oh, you're the only one that didn't catch it because you were so distracted in your dreams, like now you're working as a team, everybody works together. You're not making it mean a thing that you're asking questions, right? So why is that stemming from that now?
Now I can go back and see it was traumatic to have my dad sitting right next to me and. I'm praying for my life. Obviously that's not my life, but in my mind, I'm freeing for my life to be embarrassed. That's to be spanked out here in front of everybody. So used
Marshall Lichty: to disappoint, right? Realistically, that's what we're talking about at the end of the day.
And you ta, I I think you touched on some really interesting stuff there. The first one that I'll mention just on the side is that timer that you're talking about. The product is called a time timer. Yeah. And you can get it on Amazon. They have it in different colors. It's a whole, it's a whole thing.
And they're great. It works. For my kids. I had a client last week hold one up. He's I got a new time timer for Christmas for my in-laws and I've been using it and it actually helps with Poros or with other, tactics to stand tasks. So yes, time timer. But the other thing that I wanna mention, this is one of the reasons that you and I connected and immediately felt like kindred spirits was because your vision aligns with mine, which is to see that two things are true.
First, your parents were doing their best Exactly. And their. Probably led to some really tough experiences for you that you're probably still scarred. Working through. Yeah. The same is true for your teachers. They were doing their best. The opportunity that we have is to talk about D H D in a different way, to empower people, to educate folks, parents and teachers and coworkers and partners in our medical practices and things of that sort, which is why.
I think it brings us around to something that you and I talked about before we started recording, which was I think that A D H D accommodations or accommodations that in general are great for everyone. So yeah. For example, in your personal practice, you now have scribes available to all of the physicians in your group.
Yes. That began as a need that you. Yes, for executive function, for order for capturing notes, and you are out and about. Anybody who's listening to your podcast knows that you are out with being a D H D and talking about, and you've got a podcast and group coaching available. A great value, by the way, for anybody's like you are doing the thing.
So it would be bizarre to not be. Coming out at work about your adhd, but there are a lot of people who are not fortunate or not so bold or not confident that they're not gonna see ramifications at work. And for them if they have h adhd, but it's on the down low, you've made the world better.
But guess what, even better. And this goes back to your point about being a student in a classroom with a teacher who is aware of the benefit of fidgets and distractions. Now we get to have scribes in your. And all 10 physicians benefit dramatically, which means your patients benefit dramatically. And it's all because we made the world a little bit better for one person who had a D H D, and I think that is beautiful.
Now you, like I said, You volunteered to say, I have D H D. Yeah. But in a practice where people want to be accommodating, where we want to have our diversity and inclusion efforts front and center, we need to be thinking about what it looks like to do d e I for folks with Neurodiverse brains and feels like there's resistance to it.
The fact of the matter is, most interventions and accommodations for people with ADHD help every. I love that. I love that you did it. I love that your work is now, at least in part, built around coaching people to understand that in the medical profession because that has, that is just an absolute force multiplier Yeah.
To have physicians on the frontline, of course, working on their own d h adhd or the h ADHD that their kids have. They're sitting in clinic and they can talk to people about what this looks like. They can be advocating for accom. In their practices, not because they think anybody else has a D H D, but for their benefit.
I
Dr. Diana Mercado-Marmarosh: love that. Yeah. Yeah. And I think it it was, like I said, it was such an empowering thing that you were, you said yes to this complete stranger to be like, Hey, do you want a conversation with me about A D H D? Do you wanna come and coach my group? Like it was such a benefit for the physicians to be able to hear your side and to be able to hear, you know that if you don't feel like you want to say you have adhd, like you don't have to and that's okay, but you can still show up and tell them, I work best when blah, blah, blah, blah, blah.
When like I have my own nurse, when I am not moved from like this room to that room, like you just keep me in these two rooms when I am next to a window, when I have the ability to use. Phones and nobody's talking to me like it sounds. That's right. Silly. But we sometimes when we are employed with somebody else, we feel like, oh, I just have to follow all the rules.
This is the way it's always been. I don't want my job a jeopardy. I'm on the, I'm on the fine line because I keep getting those damn emails that I haven't closed my notes. And I can't ask for how dare can I ask for something for me to help me to do what they want me to do and so I thought it was so good that you.
Piece of advice from it, and I know you weren't doing it for everybody, and everybody's own case is their case. Just like when we say from, we're not giving medical advice, we're not giving legal advice here, but it's good to at least have a general understanding of how you can still empower yourself.
To ask for things. And look, it took three years of me asking for scribes. It's not like it happened overnight, right? And it's not like it's gonna happen, but it, at the end of the day, you had to realize how much does it takes us to replace us and to replace, a physician can take anywhere from a hundred to a million dollars a year just to replace you depending on what you do.
And so if you could say, I work best. When I have learners and I love to teach medical students, that's what I want. Or I work best when I don't have learners and I don't wanna teach medical students, I just want to do surgeries and this is my area, or I work. Like, how wonderful would it be that every time you show up and you do, what are your strengths and you feel so aligned?
Everybody benefits, like it's just a ripple effect instead of being like, yeah, no, that's not possible. And ours on virtual scribes, they don't, they're not even in the room. Like how amazing is that? Right?
Marshall Lichty: Listen, one of the things that I think is absolutely critical about this part of the discussion, first of all, let me back up cause I want a little bit of credibility in the room. When I was a lawyer in my first job, the first seven-ish years of my legal career were, was representing doctors in medical malpractice lawsuits. I then spent three years suing doctors in medical malpractice lawsuits.
So I have. A lot of experience with what it looks like for doctors to do well, for them to chart well, for them to follow on patients well, for them to do the things that not only provide great patient care, but keep them out of trouble. That has me thinking very often, weirdly, often. About the struggles that doctors have when they have a d h D and the point that I think is critical, listen the medical profession is not one where you go blasting from the rooftops that you've got, d h D, that you've got depression, that you've got anxiety, that you've got a substance abuse problem, that you made a mistake that you think you possibly might have potentially made a mistake.
It is no place for that. We're trying to change that and I think there's interesting movement around that, but we all know the stigma around not being perfect. In medicine, the idea that we would be suggesting that you're gonna march into your clinic or march into the hospital or march into your patients and say, Hey, guess who's got a D H D over here?
Nobody knows what it means. There are a ton of misconceptions about what that is. You will lose your practice, you will lose your patient. I don't think that's exactly true, but there is certainly that perception and there's certainly that here. And so the point that the doctor's making is how do. Try to have a different relationship with our lives and our practice in a way that doesn't threaten our livelihood.
And so that point about having a strengths based approach to navigating your practice is, I think the quintessential one. We wanna talk about takeaways. We wanna talk about tips and acts and trick, tricks and all that shit to navigate ADHD as a doctor in practice, I think this is it. You cannot lead a strengths-based.
Life if you don't reflect on your strengths. This is the time of year when I spend time with clients. Obscene amounts of time with clients trying to plan, planning our years, planning our quarters, planning our months, planning our weeks, planning our days, learning new habits, using new software, using new tools and templates and new workbooks and all kinds of, everybody's out there buying their brand new planners and all this shit.
There is a belief that we can change by just looking forward at what we want. If you are in a position where you are struggl, The single best thing that I can believe that I believe that you can do is start working on giving yourself permission to every day, if possible, reflecting on what it is like to be you.
That didn't go very well. That went great. I loved that. I hated that. That was a great piece of music I listened to on my commute while I was late. That was a great piece of art I saw, man, did I hate that patient? Boy, I never want to talk about doubt again. That is the worst thing in the on the planet.
These are things that benefit us because as we reflect and we give ourselves permission to not be doing something, to not be putting out a. Stop. Be feeling guilty that we didn't close our note. Be like, I don't have time to reflect. I have to go close the note. I don't have time to plan. I have to go see the next patient.
I don't have time to plan. I have to throw my scrubs in the laundry. The point is, we don't give ourselves permission to do things that we know will benefit us. And if you can start today carving out just a little bit of time to reflect on yesterday, on last week, on last month, on last quarter, on last year, that gives you a relat.
With what you like, what you don't like, what you're good at, what you're not good at, and that. Is what allows you to then go use a strengths-based approach when you're asking for accommodations. It is not my expectation that you're gonna march into one of your partner's offices and say, gee, I need scribes in the office because I work better with scribes.
If you can look back at the last year and say, every single time that I get in trouble here. When I get behind, when I get anxious, when I miss things, when my patients are upset, when we get fiery emails from, other providers, it is because of things that ascribe could fix. I don't want that anymore.
I want this practice to be better. I am at my best when I can have those things taken care of, so I can put my big, huge ass, powerful brain to work on solving real health problems. That message, Is gonna resonate every single time, but it's only through reflection and retrospective that you're able to talk about that in any meaningful way.
And so really as we enter 2023, if I can encourage you to give yourself one gift. One gift this year. It is find time, hopefully every day, even if it is just a little teeny, tiny bit of time. This is not a Woowoo gratitude journal. It's not Brene Brown. God bless her soul. I love her. It's not Glennon Doyle.
It's not. This is, think about how it went. Observe what you liked and didn't like. What would be better? What would be less good and hold. And then do it again tomorrow. And by the end of the year, you're gonna know a lot more about yourself. And I guarantee you that will lead
Dr. Diana Mercado-Marmarosh: to good change. Yeah. That's such an amazing, powerful thing.
Like you said, it's seems like we keep telling ourselves we don't have enough time, but if on purpose. Like growth is optional, like growth is intentional. Like you on purpose have to reflect so that you can see, yes, this work, this does not work. And it's seems so simple and it seems like why would I wanna pay anybody to tell me that?
Because again, it's so simple, but it's in the accountability and in the implementation and in seeing. What it's doing for everybody else around you who this is now the community that you're on purpose signing yourself up to be in. So like I'm sure that's why your clients are kicking ass now because they're coming and you're having that one-on-one or that group coaching with you to be able to do that and it's simple.
So simple that we're like, go do it tomorrow. We'll do it tomorrow. We'll do it tomorrow, and then tomorrow never comes. And then you wonder why you're still in the same damn horse race that has, nothing's changed. Although you have the best intention at the beginning of the year or the beginning of the month, or you name it every Monday you start to say you're gonna work out right.
But someday is not. A day in the calendar, like you really have to give yourself five minutes. And it sounds silly that I'm asking you to do five minutes, but oh my God, the five magical minutes make a difference. If you wake up with the intention of what am I doing today for five minutes, like on purpose, what is my fun, what is my priority?
Is my priority to go pick up my kids so I can see him at the soccer practice is my priority to close my notes, my priority to not miss my doctor's appointment. Like it, it sounds silly, but if your priority is. To do that. Then at the end of the day, if you just spend another five minutes, did I do my priority?
Why or why? love
Marshall Lichty: that. Yep. I think that is a beautiful loop that is virtuous in that if you can, and you do your five minutes, I'm sure that you've mentioned that on the podcast in Televis before. Sure. For me, when we talk about habit formation, when we talk about, putting things into our subconscious, I don't care if it's five, honestly, you get credit for starting if you even exactly.
Think about doing it today, right? . Yes. If you can do five minutes, that's great. And if you can do five minutes in the morning planning and setting intentions, and if you can do five minutes in the evening doing retrospectives and reflecting, great. That seems like a wonderful virtuous cycle. But if you can spend five seconds.
In the morning with one priority, and if you can spend five seconds in the evening with one reflection, that is a win. We are busy. There is not enough time, and the only way that we change that is by setting different priorities. And that is a message that I hear loud and clear from you. It doesn't mean that you need to put all of the other priorities that are crowding in on you to the side, right?
What it means is you can carve out, this is like the please. Whatever it is, the Juvenile Diabetes Research Foundation or whatever, say, for the price and a cup of coffee, you can. And that's what we're talking about for the, yeah. For the amount of time that it takes you to open Insta and scroll through the first four posts, you can also do a little bit of reflection or a little bit of intention setting.
And if you give yourself permission to do that, not to stop looking at Insta or TikTok, but instead to say, I'm gonna. Spend five seconds beforehand just doing a quick reflection. Now we're talking. So anyway, we got a little bit down a rabbit hole there, but I think it's No,
Dr. Diana Mercado-Marmarosh: But it's an a, a useful tool or that obviously you can do today.
Marshall Lichty: This, you don't have to plan your year. You don't have to talk about 2023. You don't have to talk about your five year life plan. You can do that fucking today. You can do it right now. In fact, I have an idea, doctor, with your permission, I'm not trying to hijack your podcast, but what if we, yeah, what if we shut the hell up for a minute, you and.
Yeah. You give a little direction to your people about what they might do and maybe we have them set their intention. Cause it's, for you and I, it's the morning. Yeah. People listen to it. But what if we have them take a little bit, five seconds, 10 seconds to reflect on yesterday and a little bit of time to set an intention for today, and then we just make 'em, do it.
Not make
Dr. Diana Mercado-Marmarosh: them whatever We encourage them to. We offer them the space too. That's
Marshall Lichty: right. The margin. Yes. Yeah, I don't know your.
Dr. Diana Mercado-Marmarosh: Listen, listening to us, they're already listening to us, so you know, why not now Give yourself the gift of those five seconds. So we'll both be quiet for five seconds to let you think of what your priority is for today.
All
Marshall Lichty: So that's what we're gonna do. We're gonna do one five second. Intentional priority setting. Pick one priority and say it to yourself out loud. If you're in the car, if you're in the subway, if you're listening to this in a group and there are a thousand people in the waiting room waiting for you, say it out loud what your intention is.
Then we're gonna interrupt you to tell you that it's five seconds, and then we're gonna tell you to do another five seconds, and this one will be to reflect on. Some period of time when there was earlier today or yesterday or last week, and find one thing that you can observe that you liked, that you hated, that you were good at, that you weren't good at all.
Okay, doctor, you're up.
All right. I got one. I'm gonna put my groceries away
Dr. Diana Mercado-Marmarosh: before my next call. My five seconds was, I'm gonna be on time for my appointment for my massage. That was my priority for today.
Marshall Lichty: Self-care and being unsound. Damn, that's next level. All right. Should we do five more seconds and do a little reflection?
All right. Here we go.
All right. What do you
Dr. Diana Mercado-Marmarosh: got, doctor? I am I'm smiling because yesterday, I finally had a, an amazing time with my kiddos painting. I didn't have my phone on me. I went and I left it to charge, and I, it was beautiful because I was not on call and I did not have my phone on me, I've been working on being present when I am present and not just texting while I'm doing an activity.
Marshall Lichty: I love that. Mine was I've been talking a lot about goals with people and I have a really tortured relationship with goals and so I did some kind of frame shifting for people and instead of goals, I was calling them very specific plans. . And so I have this hashtag V S P that I've just been like scratching out on stuff like V S P V S P.
If I wanna get anything done, I need a V S P. And so this morning I didn't sleep well at all last night. So this morning I got up and I did a V S P. For a project that I wanna accomplish this year, I wanna build a cedar strip canoe before the ice comes in next October. And I got a pretty good start on A V S P for my canoe building plan.
And that was great. And so the reflection really is vs p's feel good. And normally I wouldn't give myself time to think about that project and plan it out. But I did and that's what I thought. And the five confession was probably a little bit longer than five seconds. Neither one of us actually had a clock on, but yes, that's what
I
Dr. Diana Mercado-Marmarosh: did with my time.
Yeah. And that's the thing, right? Even though it seemed, we are not sure exactly what five seconds mean to either of us, because we don't have the time awareness and we don't have a clock. And this was a totally spontaneous thing, but you quickly saw how it was not a whole minute and how it was plenty of time for you to give yourself that gift of just thinking through.
The top of the mind without overthinking, without da, what came up? And it didn't take that long for you to realize what came up. And if we just give gift ourselves, that gift of awareness again goes back to awareness. What a difference it would be. I've been I was just telling Marshall before we start I'm so excited about my upcoming February schedule I've been toying with the idea of having more time to play and it took me a year to say, okay, I'm gonna have Thursdays off.
And so for a whole year I had Thursdays off and then it, and I kept thinking, no, I want more. I wanna play more. I wanna play more. And so finally on Thursday, this past Thursday, I was like, you know what? I got it. I'm gonna have Monday and Tuesday. I'm gonna find me a daycare where I can drop my kid off a little bit earlier and they have flexibility where my hub can pick up in the afternoon and then I don't have to feel like I have to rush outta clinic.
I'm gonna stretch my days Monday and Tuesdays off Wednesday, Thursday, Friday is clinic. And then instead of being here and there on call, I'm just gonna be on call Monday through Monday. But then that. The rest of the three weeks, I don't have to worry about having the phone attached to me so that I could actually be present with my family and not feel like I'm gonna miss something important.
And so it seemed like it was an instant thing. and then I talked to my manager on Friday and she's yeah, let's implement gifts. It took years. Years and me getting to the realization that, oh, I can have all the things. Oh, I can make containers so that I'm fully present wherever I'm at, wherever I'm at.
But again it took a community, it took self reading books, it took reflection. It took asking me, what do I want? Despite, and me working through oh, what are people gonna think? You're just working three days a week. I'm like, who gives a shit what I think I care what I think. I care what I want.
And if I'm happy, I it's so important. So anyways, I love it. I know that we, I just
Marshall Lichty: love it. That's, that is such an incredible thing to share with. We are not talking about doing something over. We're not talking about waving a magic wand and all of a sudden being a different person. This is toil and pain and joy and suffering and glory and grit and all of it, and it doesn't happen overnight.
But the message that I believe is real and true, and this is what I tell my lawyer clients all the time, a D H D Brain. In white collar professions will change the way that we work. We are creative. We see systems differently. We are entrepreneurs. We see change. We don't always know how to do it, but.
That's what other kinds of brains are for. Yeah. And that's okay. We will change the profession, but we need to give ourselves space and time to do that. And hopefully the gift that you can give yourself today is the opportunity to set some intentions and the opportunity to reflect a little bit and.
And be
Dr. Diana Mercado-Marmarosh: brave to to believe in what you need. Four out of the six physicians jumped on to this new way of doing it. They're all gonna do it exactly the same. Some of them might be off, Thursday, Friday. Some of them might be to do Thursday. Who, but they're gonna have three days a week.
But you just don't know. I'm not doing it for them. But like you said, everybody benefits when you decide to show up for you and for yourself. And we're changing the culture of medicine where you can have all the things where you can be who you want to be. Remember that you need to be around the community that's gonna support you to do that.
So of course, I know I could talk to you for tens of hours and it's gonna be amazing. Me too. It would be magnificent. And so I would definitely have to have you come back. That's what I was gonna say this, but tell us how, when people, yeah. Where can people find you? Because I know they have friends or lo who, have lawyers who would benefit your service.
Or they have a spouse who have, has ADHD and is a lawyer. Where can they.
Marshall Lichty: Like a true A D H D. I have a pretty good website that isn't, all the way done and perfect, but I would like it to be, it's at the J D H D. Dot com, the jd H D all one word.com. And I have a podcast called JD h d. It. I haven't released an episode in Forever and ever, and I have a bunch of shame about it, but there's some good stuff in there.
Interviews with Ned Hollowell, who's a world famous A D H D physician. Gary Johnson, my personal psychologist who is. Frigging genius when it comes to A D H D. So go listen to some podcast episodes if you're interested in it,
Dr. Diana Mercado-Marmarosh: and I could totally share today's podcast and you can put it on there and we can relive it.
And while we're double right.
Marshall Lichty: Why not? Doctor, as always, thank you. Please invite me back to the group and if anybody's listening to the podcast and you want to chat join the group and then I'll see you
Dr. Diana Mercado-Marmarosh: in the group. One last question. I know you have to jump off. What do you hope to see yourself in the next three years?
For fun, one thing. Oh, I'm gonna build this
Marshall Lichty: canoe and then I'm gonna paddle it around and I'm gonna build a house on a river and I'm gonna catch trout out of it and it's gonna be fucking amazing.
Dr. Diana Mercado-Marmarosh: Awesome. Thank you for coming. It was a blast. Audios. Thanks, doctor. Thank you for spending your time with me.
I really believe that time is your most valuable asset. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website@hdlivecoach.com where you can find out about my upcoming coaching group classes, as well as free masterclass and other exciting events that are happening.

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 and training and putting on a different lens, I began to see things differently. I began to tap into different sensations in my body and that's when I made the B Mind body connection and. . The trauma really lives in the body because we talk, we tend talk about mental health and psychiatry as in these are your thoughts, these are your experiences, but we don't bring the body into it.
And I learned that you can't separate the bind and the body. The trauma lives there. That's where what I call the crime scene happened. And you have to go back to the crime scene with tools, but you need to go back if you want to have that kind of openness. And healing in your mind. And so that's kind of how my path started.
So really, I feel like I was born for this role in a way given my path. And somewhere along my training, I felt like bringing in mindfulness and yoga. And yoga does. They, we always talk about linking the mind and the body. That's how I added, I call it the psychospiritual. So that you combine both the spirituality and the mental health and then you brain yoga and the body and so you don't separate.
So I tend to think of things like if you have a hair braid, you know, you braid and it's three strands. And so there is the mind, and then there's the body, and there is the spirit or spirituality and you braid it together and trauma. Changes the nervous system and impacts us in so many different ways that we don't want to just have one.
The more tools you have, the better you're equipped to address every part of you. Because before we started recording, I sang Diana about being in relationship with things and shamanism in different parts of shamanism. We're always talking about how can we be in relationship and as physicians when we are getting training, as medical students, we're always thought that the central.
Thing to any practice that you do is your relationship with your patient. You can have the best treatment plan, the best surgical intervention, the best techniques, but if you do not have that relationship with your patient, you are, you're basically on shaky ground. So bringing in, again, all these tools to help reinforce and healing the different aspects of our relationships with ourselves internally, but also external.
It's kind of where my path basically has been. So it's windy, but in a way it integrates. We talk about also being an integrative psychiatrist because integrative means that, again, we look at the whole picture, mind, body, medicine and soul. The food that we eat, the relationships that we have, the communities that we belong to, the histories that we come from, the land that we live on.
So it's multifaceted in that. And over time I've come to think of addiction as lack of connection. So when I hear people talking about addiction and I treat addiction, I'm always listening for where the disconnection happened. Because where the disconnection happened, the trauma happened, and that's where addiction rushed in.
Wow. That's
Dr. Diana Mercado-Marmarosh: such an incredible insight. And you know, I think because I'm thinking just like you are thinking, I people say that I'm more flex or less or whatever, when people are telling me that, you know, oh, that they're smoking or that they're drinking, or that they're doing cocaine or they're doing this or that, or whatever.
And, and when I ask them, well, how did. How does that help you? Like does it help you to concentrate? Does it help you to not feel numb? Like, like does it help you sleep? They're looking at me like I'm crazy because I'm asking them, how does it help you? Because obviously we're not doing something just to do it, and nobody says, oh, can I sign up for more pain?
Please. It, it must be helping them in some way. You know, just like, you know, when people with anemia come in and they're like, well, I'm, I'm wanting to eat the, the dirt. Like, what's wrong with me? And you're like, well, yeah, there's iron in there. Yeah, of course you're wanting to eat the dirt. And so it's so good that you pointed that out that addiction can be the lack of a connection to something.
And sometimes it could be like you're going for the cocaine because you don't have enough dopamine, or you're trying to also fill in a void. Maybe you were neglected and then you realize that food or this or that would fill in. Void. Right. And And it's so good that you have been able to use all your experiences, like they say, to really not just treat the body, not just treat the mind, not just treat the spirit right, but to put 'em all together, like as a human being, , and to really like see it from that angle.
Like, man, that's amazing. And, and like you said, sometimes you have to go through stuff yourself, unfortunately, like your pain becomes your progress or your, your speaking gigs, so to say, right? Mm-hmm. because you understand it and, and you can then turn around and, and say it, and, and it's like you can finish that other person's thought, thoughts, because again, you, you understand it.
Can you, can you, If you want to share, you don't have to. Can you tell me when you realized that you, yourself also had a d H D? Did that happen during childhood or was it like an adulthood?
Dr. Nesrin Abuata: No, it didn't happen during childhood. And again, it's when you also come from minority groups, which I do come from minority group.
There's not enough awareness about mental health and there's not seeking of mental health. And I didn't realize it up until the end of my psychiatry residency. So I was about done with residency, about to. And I was, when you're high functioning, which I was very high functioning, it didn't call for any assessment.
And so I, I functioned, I got everything done. It took a lot of effort, but I got it done. So, but if something would take somebody 50% of the effort, it would take me 150%. But I got so used to doing that all through my life that that was not new. And it wasn't until I began actually practicing that. People were sitting across from me with the patients and somehow when I was sitting with them listening to their stories, something clicked in my mind.
So somewhere between the end of my residency and at the beginning of my actual practice, I realized their blind spots were my blind spots. So a lot of times in A D H D, we were just talking about that before we got on the recording, you have time blindness you miss certain things and conversations.
You miss certain things with the order, the emotional overwhelm seems to be out of proportion to what is going on. All these things, but you're so steeped in that kinda like that we're talking about the fish in the water, you know, recognize that not everybody else is in that water. Yeah, so I would say the window to my understanding myself was through self-awareness.
And why did it? Why it happen at that time? I am not sure. Was it because I was ready? Was it because I was out of residency and all that pressure that comes on you? Maybe that's my guess. But I learned from that, that the window to anything is a self-awareness because then things change once you become self-aware.
And that's why I always ask my patients when I meet with them, if they know what's your motivation for change? What changed? What did you learn? And if they don't have the answer, that's okay, but I'm always putting my finger on the. Where is this leading? What are you learning as you go? Because I was have, one of my journeys on self-reflection and self-realization happened was that window somehow opened and once it did, I was able to change things.
Dr. Diana Mercado-Marmarosh: Yeah, self-awareness. It, it's the first thing that I, I always keep telling people if you're not, Then there's nothing you can do after that , because again, like you said, you're not even aware, you're swimming in in the, in the water. You're not even aware of that. So how can you then do something with it, right?
Mm-hmm. . And so, yes. From awareness, then you can move on to like processing it or realizing, yes, I, I'm gonna take an action or not, or realizing I'm going to regroup or what, what is the next things you have to do? Mm-hmm. , but. I'm so glad that you had that insight because I don't know if you would've had that insight if, if it would've made a difference again, because you would've kept doing it, and that's the thing.
And then if people, that's the theme, right? Like people don't realize how hard you're working because you make it seem so easy. So everybody else's who's looking in, but they don't realize that they're hanging on by sticks because you, maybe because you are in the, in, in the passion of it that you keep going it because it, it's aligned with you.
Dr. Nesrin Abuata: You know, the other thing too that I've. Reflected on, but I also work with children, adolescents. Our sense of identity starts from when we are, when we're very young and who we are, and it gets formed in school and with classmates and in families and communities. And along with that comes our executive functioning, understanding the world and a child in classroom who misses some of the instructions but doesn't wanna get in trouble and falls behind and then starts.
Developmentally, they will start blaming themselves when they're the age group of elementary school. It's very what we call ego systo. So if something bad happens outside, that means something is bad with me. Instead of thinking, okay, what else is going on? And so a level of a six or seven year old cannot explain to you, I was not able to understand the instructions because I got distracted.
And so you start picking up these, I think of them as rocks of your identity. You know, you put 'em in a backpack of who you are and you start picking it. So then by the time you're older and then somebody comes and tells you, do you have awareness of what's going on? You're so attached and fused with your backpack with the rocks.
What are you talking about? The backpack is so sewed into me. I can't take it off. And that's, that's a hard thing. It takes time. So, Diagnosis is the beginning with the awareness. But it takes time to unpack all these patterns in the brain because there are pathways, and these pathways will are well worn out with thinking over and over.
So these thoughts of, I am not good enough having the imposter syndrome, I am not gonna succeed. Nobody's gonna believe me, I can't do it. They come a lot of times from such a young age that you have to travel back to that age to undo. Along with skills and therapy and all sorts of stuff too. So awareness is the beginning, but there's a whole lot of path behind it too,
Dr. Diana Mercado-Marmarosh: you know?
Yeah. And that's why I constantly keep telling people that coaching is about one of many things, right? That you need to use all the tools, like you need to use therapy, you need to use cognitive therapy. You need to use systems like people helping you. You need. Use meds like you need to exercise, like it's one of many things and you shouldn't do it one thing only and and help it happen.
Right? And, and like you said, like when, when you love your parents so much and you want to do the best that you can at school, You're gonna work really hard unaware that you might just miss the mark because you didn't have all the tools. But, but you're doing it because of your impassion with that.
Like you said, you think it's your, it's you, there's no other thing but you. And, and so I remember like when we were finally in. In the US and my dad like had to come and sit down because when my mom would come and sit down in the teacher's classroom, like I wouldn't be quiet. I would still be like, I would do my work and I'd be running around screaming and like I was done.
Like, and they, and she would be like, well give her more work. And they would give me more work and I would do the work and then like, because I would keep doing the work, they'd be like, Well, forget it. We're just gonna skip her grade and we're just gonna skip her grade. And we're just, and so my dad would come and sit down and not until my dad was sitting there, like, I would be like, okay, I'll sit I don't wanna spanking in the middle of the classroom.
Like, you know, and, and, but because like you, we were talking about machismo and different things before, like, you know, my dad was like, Why am I missing work for this little girl to like, you know, I'm gonna give her a spanking here at the middle of the class. And I was like that. That was like, again, maybe traumatic, like right.
Traumatic that, oh my God, I'm gonna get a huge spanking. So that's what like, Shut me up to sit down and be quiet. But it was because I was fearing that he was gonna give me spanking and I was gonna be embarrassed, right? Mm-hmm. And, and so it's not like my A D H D got it got taken away from me. Like I, I was just having to react to the environment based on what was going
Dr. Nesrin Abuata: on.
Yeah. And in a, you know, in a perspective, when we look at the world, Through the lens of a six or seven year old, you're small, you're not big you're not in control. There's all these authority figures between teachers and parents. It doesn't mean the parents are gonna spank you, but there's that threat.
The nervous system perceives it as I'm not safe and what I need to do to stay safe in the context of, oh, I'm not doing what I'm supposed to be doing. It's already my fault. So that is a form of. And that becomes internalized. And then we carry that sense of shame with us and then shame. When it takes over the brain, we no longer have language to describe it.
It becomes stored in the body. And that's where when I keep talking about the mind and the body connection, then when I go back to the roots of the shame, we have to go back to the body to unpack it. Yes.
Dr. Diana Mercado-Marmarosh: You're so right. I hadn't told anybody about my diagnosis about A D H D because I was in such shame, and then when it was pointed out to me, A D H D was just a circumstance that you could decide what you wanted.
It was like saying that the sky was blue or it was saying like, I had high blood pressure, or I had cancer, or I had anything else and that I, what I made it mean was up to me. And I was like, well, no way. Like why would I wanna shame myself? Why would I wanna think like that did not. Take a while for me to process and to realize and, and of course now I feel like I'm speaking from a healed wound or healing wound, not a bleeding out he imaging wound.
Right. Because at that point I, like you said, I didn't have the language, I didn't have the connection, and I remember like multiple people asking me questions about feelings and I. What do you want from me? Like , there was no words because I was so used to putting all those things aside because maybe it was too scary to like sit in the shame or sit in the embarrassment, or it might paralyze me and not help me to do whatever needed to be done in order for me to go forward or do X, Y, and Z.
Dr. Nesrin Abuata: And you bring up a good point about how. . We learn how to be with our feelings from a very young age. When our parents can model it for us, when they can sit with us with the difficult feelings. When we're small feelings, feel like they're huge and we can't manage them, we can't digest them. Having parents that can parent and they can model it for you and digest it for you and make it small enough they can manage it, then you're able to connect with the feeling and be present with it and express it without getting overwhelmed, not being able to, or not getting help.
That is a form of trauma. The nervous system can't tell the difference between what's true and what's true. That's why the business the movie industry makes a lot of money because you sit in front of a TV screen and in your brain, when you watch somebody fall off the horse, you fell off the horse.
And so imagine when you're a child and, and even as adults, your nervous system sees that. It doesn't know what's true or not. And so if the nervous system picks up, this is dangerous. It has to react in. Really, the nervous system has limited pathways of how it can react. The first way it's gonna be fight or flight.
That's the first basic one. If there's a danger, can I fight it off or do I run? If not, then can I freeze? Can I play possum? Because the danger will pass away. Maybe they'll ignore me if I'm quiet. And then if that doesn't go away and the person is still undergoing the threat, then we end up with that last one that you said, that paralysis, that shutting down, that numbing, and the nervous system keeps moving between these three until we've processed it and healed it and integrated.
And imagine being six years old, you're not gonna be able to do all these. And that's where the parent or the therapist or adults helps you manage too, because part of an executive function, and you mentioned that too, is emotional regulat. And I think executive functional skills should be taught to all kids in school, but we don't do that.
And then you add a D H D, it's even harder to access emotional regulation skills. And also people with A D H D are more, they might, I always have a suspicion that people feel their emotions a lot stronger and deeper and more intensely than somebody else. And so the skills are really important to. So if somebody gets mad or angry, they'll say it goes from zero to five.
But with a D H D, the intensity is really high. So that's gonna take a lot more skills and a lot more intensity to calm it down too. And then you add to a trauma and then trauma intensifies because of the way the brain is also processing what happened too. Yeah.
Dr. Diana Mercado-Marmarosh: So I would you just describe exactly is like rejection, sensitivity, dysphoria.
Right. And so, The difference between that is that with a d h, adhd, like you said, it goes straight into the amygdala , and it goes straight there. And it doesn't like have that two second delay with the with the prefrontal cortex like most people do. And, and, and that's why you, it looks like, what the hell?
It just happened. Like what? And then five minutes later you're like, back to your peachy self and they're wondering what happened. Because they're so short-lived, like sometimes less than two hours. It's not like enough to say like, this is like anxiety, or this is like depression, or this is a mood disorder, which they can all coincide of course.
But in general, again, if you're not even aware of that, How can you begin to unpack it and how can you begin to, and it's so interesting, like when I ask my clients like, okay, can you describe like everything you love about yourself and can you describe everything you hate about yourself? Like every time they describe everything about everything they hate about themselves, it's all about their A D H D tendencies and, and they don't realize that it's.
Their character flaws, but it's their A D H D. And when you point it out to them, they're like, oh. And so it's such an, like, like you said, you, you internalize it like it's you and it's you all along and you don't realize, yeah, it starts and ends with you, but if you don't have an awareness, you cannot modify it.
But
Dr. Nesrin Abuata: then you add the layer of trauma where in trauma, the person to whom the trauma happened is unfortunately a. And in that kind of context, the victim gets blamed already. And it's very common for people that undergo trauma to have survivor guilt, to blame themselves in general, regardless of what age it happens as adults, as children.
And it happens because as children, it happens because the brain, like a, like I was saying, it's ego dystonic. Meaning that the belief goes with who they think they are because a child cannot believe. Let's just say their caregiver is abusing them, whether it be physical, emotional, or neglect, the child cannot come to accept such a horrible idea that the person that I have to rely on for my life.
Can kill me is hurting me. That kind of idea or belief results in the child feeling disconnected, and we are born and wired for connection. Connection equals our survival. It doesn't matter what kind of connection it is. Ideally we want a nurturing war mutual connection, but if it's a poor connection, any kind of connection, our nervous system will seek it out, that it will adapt our beliefs to actually make the connection work.
So that means that I cannot. in order to make the connection alive with the parent. As a child, I can't believe that the parent is bad because then who wants to have a connection with the parent? That's bad. But you can live with a thought about yourself. Something is bad with me. I am bad, but it's okay to be in connection with my parent.
And you can take that into adulthood again, when a trauma happens for an adults, no matter what it is, the survivors a lot of. They blame themselves that I cause it. What happened? It must be on me. Because alternative is to believe that really you were not in control of what happened, and to believe that you were not in control of what happened.
That's a very scary place to be at, and that is that kind of lack of connection. Connection to the self because connection to the self gives a sense of power and empowerment and voice, and in trauma, that source of agency and empowerment and voice is taken away. Unfortu. ,
Dr. Diana Mercado-Marmarosh: what are some things that you think.
Tools to help them to start or to even like identify if they, there's, they're being in the victim phase or if they can help themselves to process this trauma, like you said, the trauma store stored in the body.
Dr. Nesrin Abuata: I would say it depends on what phase the person in, because I was telling, talking to you about being in the fight or flight phase, in the freeze phase or in the collapse phase, in the fight or flight phase.
You can process things and you can notice. Because your heart rate is gonna be up. You might have tension in your bodies. You might have more thoughts of anger being animosity against other people, getting into fights, fight or flight. You can notice it. Or other people can now comes in the piece of awareness.
Can you learn to tap into what stage of trauma level you're in? And that starts with the body, noticing your body, noticing the tension, noticing a heart racing with anxiety attacks, noticing are you having back pain? Are you having headaches? Are you having shortness of breath? These sorts of things cue you into, okay, I might be in my fight or flight response.
My body is in that kind of trauma. The other one that I was talking about, the freeze part. That's where somebody feels, they tell you, I feel paralyzed. I feel like I can't take action or socially, it becomes what we call fawning. Fawning is when we're talking, Diana, I tell you what I think, I, I know what you want to hear, so I can't show you who I am because it's not safe and I had to find, I have to hide myself.
Finding is I fake it in front of you with the belief that hopefully, if you like me enough, we're gonna be. You know a lot of people because the fight or fight, we're not fighting every day. We're not arguing every day. It's not that common per se, but the fawning is there a lot. And then the last stage is the the numbness part.
And that's where somebody says, I can't connect to my fear. People cannot even tell me they're not in touch with their feelings. That's when they tell me, I just feel blah. And that's when I begin to wonder and to ask and to kind of bring in the awareness. Are you feeling numb? You can't feel, and then I ask, can you track your body?
Are you aware of your body in space and time? Are you in touch with your toes, with your feet, with the hold of your body? A lot of times in trauma, especially when it's chronic and for a long time, people are in their head having left their. So how to tap into the trauma so you can do something out. Like I said, you start with the body and you see what the sensations are and follow that.
Sometimes you might be able to start it on your own, but a lot of times you can need the help of somebody, like a therapist or a coach or a trusted loved one. It's hard to face it alone because it overwhelms the nervous system.
Dr. Diana Mercado-Marmarosh: Yeah. You bring in such amazing points, like, yeah, this is amazing. Oh my God.
Yeah. I'm like, my brain is going like amazing. Like I'm big of all kinds of things like I wanna have you at like I do. And I'm just like, okay, slow down. But it's amazing because again, when you start to see the connections, you cannot unsee the connections. And like you said, if you just work through each area of it.
It just opens you up to stop carrying all that heavy little rocks that you didn't even know you kept putting in there and put putting in there and, and you don't realize how easier it would be if you just unpacked those rocks that what got us here. And we're, we're trying to go. We don't need all that.
Like if you can learn or unlearn and so much of the unlearning, I feel like this is what I keep saying in my course. We get taught first, do everything for your patient. And, and I say, the day that I realized I was the most important patient in the room was the day that I realized that if I wasn't okay, but if I wasn't taking care of my mind, my body, my spirit, everyth.
Then I, I was just gonna come and then my patient was gonna get me at 20%. They were not gonna get me at like 50, 60, 80% because I wasn't the first patient in the room. And, and so that was such like a mind shift for me. And then that's when I started realizing, okay, so it does start an end with me, but I'm gonna need a lot of help
Dr. Nesrin Abuata: No, but you bring up a good point about how in healthcare, The message that's propagated as we get training as physicians, that the patient comes first and you are expected to run on empty, empty tank, even from our training. And imagine then growing up in an environment where the connection with the caregiver was poor whether that be actual physical outright abuse, but a lot of times the most common from abuse is neglect.
And so when you grow up in that kind of environment and that kind of connect, And caretaking where you are neglected and in that child's mind to take care of things and make the connection work, then the child has to become the caretaker. That child has to fill in all the gaps in order for the relationship to work.
In their mind, it doesn't make sense because adult will do whatever they wanna do, but in the child's mind, I can fix it, right? It's on me to do it. If things are not going right, I caused it. I am the beginning and the end of it. Just what you're saying in a dysfunctional. And so then you bring that to becoming professional caregivers.
We put ourselves last, we run on empty, and in a way, we perpetrate the same form of self neglect in these sorts of growing up young relationships. Professionally. I don't think our patients want us to self neglect. I don't think our patients want us to harm ourselves. I think that's the last thing they want.
They want a doctor who. Fully present with them, fully connected. My patients, I can tell when I walk into a room that they care about me because they ask me, how are you And I, I won't go details. I say, I'm okay, but I can tell they care about us as humans and we're not there. Talk about ourselves, but they do care about us.
And so what kind of message do we send them when we come into the room and we are running on. They already struggle with the relationships and patterns and trauma. Well, they have run on empty too. And so then you have two people with that sort of background, an internal attachment system with trauma and neglect, and in a way we're not helping each other out.
So how do you learn to heal inside so that they can, you can run on a full tank and energetically people can feel that, patients can feel how their doctors are doing. They might not say any. But we as people can tune in, we're intuitive. We're intuitive human
Dr. Diana Mercado-Marmarosh: being. Yes. So much to that. Again, like my brain is just like going like, oh my God, amazing.
I could share like 10,000 stories about what you just said and, and, you know, giving us ourselves permission, like you said, to have those conversations with candid conversations. Like you'd be surprised how many times I told the. I know you're not making the list cuz I didn't make my own list either. But I guarantee you that if you do X, Y, and Z and I'm gonna see you back the next week cuz I want you to tell me that you did X, Y, and Z.
What a difference it makes. And they just look at me and I'm like, I know because I was doing it too. But when you start putting yourself first again, the ripple effect that happens, and again, I'm not talking about like putting yourself and I tell them, You are in self neglect if you're not in self-care.
And I didn't even know what self-care was before. And and it sounds such cliche-ish because most people are like, oh, she probably means she's over there on the golf course and getting her nails done. And no, I mean, like eating sleepy baby, like the basic ADLs of, of life. Right. And, and when I say that out loud, they look at me and I'm like, yes.
That is self neglect. It is because you're not aware that you need your basic things and you don't, and again, it goes back to like maybe you're a mother and you just think you do all that first, or you've been, you are a physician and you've been told you're patient first, or you are the oldest one. And so you think you, you have the responsibility, like all these things that we again, get to reinterpret and then.
Ooh, I can see how that could have been traumatic or I, I am taking on somebody else's idea of what. Ideal for me, . And again, I didn't make the plan. They just told me this was the plan. And so you were well and told that this is what's going on. Right. And yeah. Wow. I mean, so many insights that you're giving and so many amazing pros.
So, Do you take do you do coaching? Do you do consulting? Do you, do you just see your patients in the psychiatry addictive treatment? Or what are, what are the things that you how can people find you? Because I'm sure they're gonna be like, oh my God, I can't wait to talk to her. She's
Dr. Nesrin Abuata: amazing.
Yeah. I do different things. I have my own private practice and so I see, I see patients there as patients. And then I also work at Addiction Center too. And then I also do provide coaching and. And I do teach, I have like classes online too. My website is my first, I'll type that in the, in the link here.
But my website is my first and last name, md.com. So N E S I N A B U A T A md.com. And so you can find me there, you can reach to me there. I have a YouTube channel. I have a podcast too. Yeah,
Dr. Diana Mercado-Marmarosh: tell us all of those so that they can
Dr. Nesrin Abuata: find. So my podcast is actually called My Grandmother's Blessings, and it's very, it's, it's kind of like 10, 15 minute short stories that are meant to inspire people to reflect.
So I bring a story, I bring an experience, and then ask the question so that you can internally reflect going back again to that self-awareness and awakening inside. And I love that podcast because I loved my grandma. I was very close to her and she helped. in a way. We were talking about the adult that sits with you through your feelings and processing and teaching you and digesting things for you.
And my grandma was that, and I hope that everybody listening to this can identify having that person or that source of love, because that can be from our pets that can ground us and help us emotionally regulate. So I was inspired by my grandma, so I called them my grandmother's and then blessings because kinda like you're saying how you go through stuff and the difficulty can become your medicine, it can become your wisdom.
So my hope with these stories that I share are, can you be inspired? Can you learn something? Can you reflect? And so you can, if you type it on Google, you can find it. So that, and then my YouTube channel is also under my name, Rin Abu, and also my website. And then I have a Facebook group Under Mind Alchemy, which is the name of my clinic.
And I called my, my clinic that because I really believe in mindful transformation. Amazing.
Dr. Diana Mercado-Marmarosh: So as you know, people listen to us have a D H D, and sometimes they tap out, although they shouldn't have tapped out because this is an amazing episode. But if they did, because we have wondering mine, what would you want them to take away if they just started listening?
Right.
Dr. Nesrin Abuata: Two words that come up. Three. Well, three words, self-acceptance, self-awareness, and embodiment. Know when you are breathing, can you feed your body. These are the three words, because if you can build that kind of building block, then you can process through things.
Dr. Diana Mercado-Marmarosh: Awesome. And the last question I always ask people, What do you hope to see yourself for fun in the next three years?
Dr. Nesrin Abuata: I would like to be able to do these what do you call them? They're like, they're trapeze. You can be doing the trapeze in the air. But you have to have a lot of core strength. And I've been working on my body and then we always talk about A D H D to me, you have to be in your body. It's the, this is the most healing thing.
So I've been challenging my body, so if I can build enough strength to be doing trapeze in the air, that's what I would like to be doing for fun. It's
Dr. Diana Mercado-Marmarosh: amazing. The reason I ask that question is because like when we go back to dopamine and fun is a fastest way to tap into dopamine, right? And so if you are doing something for fun, you're definitely refilling your cup and you're definitely gonna step up to whatever comes your way because you are in the fun mode.
I love that question. Awesome. Well, it was such a pleasure to have you and I can't wait to continue to interact with you and I'm sure I'm gonna. Beg and pray that you come and be one of our guest coaches in my program because I think we all can benefit again from that connection. And yeah, I'm already thinking of 10,000 things that I want to do.
So this is amazing, right? This is our A D H D. We can just feel the energy and the energy guides us there. So thank you again for for coming. It was such a delightful convers.
Dr. Nesrin Abuata: Oh, thank you for having me, and I hope that when people are listening, they're building these awareness and just, you know, never start with one question and then see what leads you.
Dr. Diana Mercado-Marmarosh: Thank you for spending your time with me. I really believe that time is your most valuable asset. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website@hdlivecoach.com where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happening.

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.
What else?
Dr. Stephen Lewellis: Sure. Yeah. Time blindness. I think we're We're the dreamers. We people often say so that was one thing I struggle with. Little things that I noticed about myself at work. I would be pretty overwhelmed with getting all the tasks done that I needed to, especially charting. I would always finish my charts on time cuz I I'm.
Pretty high achiever. So I wanted to get that done. I very much did not want to take charting home like I did in residency. So I made it a priority to finish most of what I could at work. But it was stressful. And if I was ready, getting ready to see a next patient and one of my staff members was presenting to me about the patient I would still be ha have half my brain on the chart that I was trying to finish.
And then I would. Asking them to repeat something they said five or 10 seconds ago. And I began trying to identify things that I may be doing that I was blind to. That may be really annoying other people in my life, whether it's people at work or people at home. And that was one of them my nurses and medical assistants and me.
Always laugh when I walk straight past the exam room that I'm supposed to go to because I, even though it's a short walk, I start thinking about something else and they just wait till I turn around and come back and we're all laughing. So little stuff like that, but also just feeling overwhelmed with the amount I needed to get done.
Another thing was I'm a dermatologist. They a lot of people in my field see a very high volume of patients and I have always felt very overwhelmed about the possibility of that or the prospect of that. Been difficult to grow into a higher volume practice. And I've wondered, is that just me or is there something that I could some coaching or counseling or medical therapy, whatever it is that it's not just me.
It's something that there's a reason for that. I feel like why is everyone else having such an easier time with this than me? So those are the, some of the things at work that I noticed. There were also things just with interpersonal relationships that just got to eventually got to a tipping point.
And I started questioning is there something about me that I need to address? So that I stopped getting in. These loops that we get in with certain people. And rather than trying to see what they're doing that's wrong, , and get introspective a little bit and get some help. So that, those are the general things that I noticed at work and at home.
But I think there was some tipping points in 2022 that made me get there as. I'm happy to be as open as possible on this show. I had a I have two brothers but one of them in June of 2022 unexpectedly passed away. And that was a pretty big shock and a trigger for evaluating some things in my life and just working through that trauma and that.
Led to some difficulties in other places and processing that and I, that's when I finally went to my primary care doctor, who I'm very grateful for. I have a wonderful family medicine physician at the place where I'm an employee an employee as well, and he just talked to me about what could be going on.
And we got down a road of trying to address a couple different things and happy to expand on that as.
Dr. Diana Mercado-Marmarosh: Perfect. Thank you so much for sharing and of course, I'm sorry about your brother passing away. Thank you. It is, sometimes in, in those trialing moments in our life where of course we don't realize that we've been carrying such a heavy load.
And for some people it might seem. You're doing it so easily, , but they don't know. They're just seeing the tip of it. They don't know everything that you're magically doing underneath. To just stay afloat, . And and I'm so glad that you're highlighting both aspects of A D H D.
And I joke around too. I'm like, either you cry or you laugh. I think I'd rather laugh because it gives me dopamine, . Yeah. So then at least we're onto the right track. But like you said, it's not until you look back that you're able to be like, oh, that's been there all along. And it's, and like you just mentioned A D H D, it's so important.
It to be identified in different settings. If it's just, okay, it's just happening at work, or it's just happening at the house, or it's just happening, blah, blah, blah, then you wonder if it's really a D H D or you're just bored, then you don't wanna be there. Sure. But when it is happening in multiple places, and like you said When you start being curious instead of judgy.
Yeah. And you then can start to, to shift because you then start to see patterns that maybe were not obvious because you weren't looking for them because this is the way you've been all along. But yes. That's one of the things with adhd that. A lot of people think it's that we don't focus, but we do.
We sometimes we even overfocus whenever we are on a certain task, like you were saying, if you're trying to do your chart, you're like, yes, you wanna hear them, but you're trying to do your chart . . That was one of the things I had to learn too, and I think you're already onto it, that when people come and are telling you something, I have to on purpose and I got coached and told to do this and so I'll give you the tip if you're not doing it yet.
I tell them, gimme. Give me a minute. Let me finish my thought. Yeah. And then you can have my attention and it's, at first it feels really uncomfortable to have somebody standing right next to you for what seems like an eternity. Yeah. But it's really 45 seconds or less usually. Yeah. But you don't realize that in doing that you actually.
Save yourself at least five minutes. Because what happens is that somebody who doesn't have a D H D can easily jump from one thing to the other. But for us it's task switching. And so in the task switching, it takes us a little. To go back to where we were at, especially we didn't give ourselves a nugget, and so it, it sounds weird, but if you really do, just ask them for 45 seconds so that you can document what you were thinking and then you listen and then you document whatever else they were gonna tell you.
Yeah. Then it's gonna be so much smoother for you and it's gonna be so much smoother for them. They're like you just said, they're not repeating themselves five times and it less frustrating for them for sure. Yeah. Yeah. And they would rather sit there or not sit there cuz sometimes they're standing.
Yeah. But it's gonna take them, those 45 seconds they can rearrange exactly what they're gonna tell you anyways. So that it's more effective for both of you. And I had to tell them later on, Hey, I'm not trying to be rude, it. I have h adhd and it took me a while to get to the dag to get comfortable to me to even say it out loud.
Yeah. But now I'm just like, there's an ADHD moment and I just laugh. Yeah. And like I tell them I'm doing this to help them with. and me with the communication. And so I use timers now, like you said, timeline is, yeah. So before I walk in the room, my nurses start the timer and then they'll come and they knock on my door, and then they ask Dr.
Marca, you need anything? And then I'll be like, yes, I need ua, or yes, I do, whatever. And so you could use that and be like, yes, I need a biopsy, or, yes, I need this, or whatever. And so now, I'm family medicine, so I do have a lot of patients with H adhd and I treat patients with adhd and I tell 'em, look, they're gonna come knock on their door.
They're gonna, this is my external cue. Yeah. So don't think that, it's just you e everybody's gonna get this external cue. And even though I've been using this trick and. The day that I forget to set it, oh my God. The, they're just are like, she's taking too long. What's going on? And then they go look at the timer, ah, she forgot it or something, and so now it becomes like a game with my patients. Oh, we have to meet the timer, hot dog. I'm like, yes, let's meet the timer. And I say this because you could make. Blind spots be something that you can enhance. So your pain points can become your progress.
And like you said, in this six months of you even getting this diagnosis , you've had some light bulb moments that now you're like, huh, okay. And yes, it can lead to a lot of misinterpretations with other people sometimes. Yeah. Yeah. I don't know if you know this or not, but like people with a D H D, the way we answer questions is how we're feeling sometimes in the moment.
And some other times is what we're thinking in the moment and how we're feeling and thinking. Sometimes they don't match up. . And so if I ask you the same question tomorrow, you might answer something different. And that's not a problem. I understand that. But other people who don't have a D H D, that's a big problem cuz they're gonna be like, but yesterday you said, and I'm like, yeah, that was yesterday,
And they're like, ah. And if you ask somebody without a d h, adhd, the same question, whether it's today or 10 years from now, they're gonna answer you the same exact way. And so that's just a little tip for you to know. Thank you. So that. You ever have a miscommunication with your wife if she doesn't have adhd or with a patient or somebody else, you could just be like, Hey, sometimes, We're all meant to change your mind.
So that's a, like not making it mean a thing, but at least be aware so that it doesn't lead us into trouble. Some somewhere . So that's a key for inter a key point for interpersonal relationships or communication strategy.
Dr. Stephen Lewellis: I like that. Just to your point there I. A lot of people on the outside who have not had experience with the diagnosis could see things as, using d h ADHD as an excuse.
Oh, that's my d h d, but or a reason to be. But I think the important distinction is that you are, we're talking about tips and things that we, no, we're not trying to change other people. We're trying to change our. To adapt to a world that is having certain expectations of us, and it is on us to make those changes and, but still have that, realize those things and take those actions rather than just saying, yeah I have adhd.
That's why I didn't, I asked you to repeat yourself, or that, that would be very frustrating. I think. It's certainly an important distinction to make in terms of people who are dealing intentionally with. Their uniqueness,
Dr. Diana Mercado-Marmarosh: I guess. Yes, exactly. I think to your point, that's what I'm saying.
Like I feel like a D H D starts and ends with us. Yeah. What I mean awareness, right? Yes. Because when you are. Aware that this is something that you're working towards. This is something that on purpose, you are trying to make sure, quote unquote, I'm not annoying them, but I am respecting them, but I'm also respecting myself how I think, how I learn, how I do things.
So it's a communication strategy, not to say, oh, please excuse me, I have adhd, but it's Hey, I, because I have H adhd, this is how a tool that I'm trying to implement so that we both communicate better. And so it, again, it goes back to the awareness. And you don't even have to say you have h d if you don't want to.
You can just say, I have noticed that I work best when, and then you just say da. When I have a quiet environment, when I have my own Nurse when I have my own, ma, when you help me start my note. When you put the first sentence in my h p I, like you, you can just say, I work best, Quinn.
And that's sad, right? Like I said, it took me a while to say I have d h, adhd and you don't have to. But now I'm like, I say I have h adhd, like the sky's blue because it is blue outside. And labeling things can sometimes. For, and again, it's not an excuse, but it's just okay. It's just like saying, Hey, I have blood pressure and I shouldn't be having salt or something.
Or I have diabetes and I should be careful with how much sugar I have. And so I think it's, again, creating just an awareness. People with ad with diabetes have their bracelets as says, I'm a diabetic. And again, I'm not saying you should go walk around and see I have ADHD everywhere.
But the point is that, again, if, and I now use this for myself, if I am doing something that seems like it's overwhelming me or it's too hard or whatever, hard means, right? I take a step back and I'm like, where's my d h d? And hands in this or what have I not done? ? Have I eaten? Have I taken a break?
Am I trying to do three things at once? Just like what you do with a kid, right? Like when they're crying have they eaten? Are they have a poopy diaper? What's going on? The basic things because. something is causing us to feel like overwhelmed. , there probably is an easier path.
It's just that we might be trying to do the dreamy thing of doing 10 things at once with our A D H D, yeah. With that being said in terms of the volume that you were talking about, When I was, going back when I was a medical student in a resident I think like dermatologists would see something like, I don't know, like 30 to 50 patients a day or something like that.
And I was always like, mind blown because, as a family medicine doc, 20 and we're like, we're like choking ourselves or 2020, some people see 25 or something. Yeah. I don't know. But I was never one of those. And if I was seen like about 20 something, I was like dying and I was always like two hours or three hours behind and I'd be like, wow.
Still here. Why don't they wanna see somebody else? And then they'll be like, no, we waited three months for you. Or six months for you. Exactly. Yes. Yes. And then I was like, you
Dr. Stephen Lewellis: probably listened to them. You take the time you're, they lo they, and they're willing to wait for that. But it still weighs on you that you're Exactly,
Dr. Diana Mercado-Marmarosh: yeah.
Yeah. So was that happening to you?
Dr. Stephen Lewellis: Oh yeah. The, that I've always intentionally kept my volume to a manageable degree, but I am trying to scale up right now and I'm trying to actively think of strategies for how I can do that rather than just do things the way I've always done and just try to do it more, more efficiently without actually putting in strategies to help that and systems to help that.
And I think this whole journey has. Making me a lot more open to that and excited to see more patients rather than dreading seeing more patients, which I would have been before. And that's, so I've been in a unique situation because I was, I worked at One place for about two years, right out of residency 2019 to 2021.
And then I changed jobs for a number of reasons and moved so I had to, I was building up a scaling up my practice and building up a panel of established patients. And it becomes a little bit more routine when you're not seeing so many new patients every single day. And then I started over two years and I started over, and now I'm about a.
And a half more than a year and a half into the new one and getting close to, seeing patients back again, which is great. But still seeing a lot of new patients every day. So that also makes it hard to scale up. Seeing someone back is a lot different than establishing a relation, brand new relationship with someone.
So I am being more intentional trying to think of systems and again, with the medication and with the just known knowing about these things about myself it makes it more exciting and more like a game and rather than something, rather than I'm running from a bunch of tigers or something.
Dr. Diana Mercado-Marmarosh: Yeah. So important, everything you just said systems are, are the key. And that's what I teach in my, I have a 12 week c m e group coaching. And I, and exactly what you just said, it's all about systems. It's about realizing your strengths. It's about where do I delegate?
Where can I change, where can I keep what is working? Yeah. And where can I. Take away steps, right? So that, maybe it's not you who has to keep running out and to go. Form every single time that you wanna explain this skin condition to your patient, right? Maybe it's having a binder there already that you just pull out one from and you give, and then that's it.
Or can the instructions be given by the nurse afterwards? Where can you shave off a few minutes here and there You can work at the top of your game. And like you said, how can you make it fun? That's the first thing that we do when they come to my course. I'm like, okay, what do you do for fun?
And they're looking at me like, are you crazy? I just told you I don't have, I don't have enough time. And I'm like, I know. What are we gonna do for fun? Let's schedule that in first. And they're looking at me like, What? And I'm like dopamine we don't have enough. So if we have a dopamine menu, then we can pull out stuff.
So instead of you going for the twinki, like you go for a chewing gum or you do a two minute app of a meditation or something else, right? And they're looking at me like I'm crazy. And I'm like, yeah, and where's your time off? And they're like, what? And I'm like, yes. Where's your time off? I need to know where your.
You're sleeping, eating, resting, what are you doing? That and yeah. So I think it's so important, like you said, to approach it from like new lens, right? , like now you can step into it and say, how can I do more, but not working myself harder but smarter now. Yeah. Yeah.
Dr. Stephen Lewellis: Yeah. And it's.
It's definitely a game changer and I think a lot of physicians narrowing it down, a lot of physicians who bridge or branch into physician entrepreneurship. Certainly. I think a lot of the root of that is wanting to have a bigger impact and reach more people and we get frustrated in. how non-scalable our day-to-day work is.
And you just have to be there and there's only one of you, and you just have to be there for every patient. And there's just, I can't see 90 patients a day. I just physically can't see that. Maybe I could see 50, but I would be probably miserable. And my patients wouldn't be as happy. So there's a sweet spot somewhere.
So there is room for growth, but it's capped, certainly. And so a lot of people who are ambitious like yourself and want to impact people in a different way and have have a small business as well, or a big business are drawn to things like group coaching, things like online courses, things that are scalable, but still you're putting your heart and your passion into them.
But it doesn't. Every aspect of it doesn't rely on you being in a room with one person. So that's a trend that I'm seeing at least, and which is amazing because there's so many great people, great doctors out there now helping other doctors. And we're at such a critical point where so many doctors are struggling more so than in the past.
And it's it's not position healed by self. It. Is it other docs helping helping them? Cuz we have such a unique perspective and unique challenges. What you're doing is awesome. Just the other, I think some people at this point are like, oh gosh, another coach like that. I, it's such a cliche, but we could have.
10 people coaching on physicians with a D, adhd, and there wouldn't be enough, not this one. And I just love what you're doing and I think more and more people are gonna be doing it, but it's not gonna get saturated because it's such a need out there.
Dr. Diana Mercado-Marmarosh: Yes. Thank you so much for sharing that.
Yes like you're saying coaching is such a new thing and yes, it seems like physicians are, I'm so glad that they're doing it. It's still, when you look at it, the ones that I know so far, maybe there's two. Hundred of us, at least the ones I know, but Huh. There's what millions of us who are positioned.
So again it just goes back to everybody is multi-passionate and like you are into real estate, like , a lot of us like run away from money, we're like, oh no. And so to you this is your stone of genius and who knows, maybe you would go into that or not.
Something that is so easy for you that you're like, why would people pay for this? People will pay for what they're not really your second one, , people would pay for for whatever their pain point is, right? Yes. So that's what it. What is important, but at the most important thing is like you just said, what gives you passion?
What would you do? What would you continue to do, like five years from now, 10 years from now? And how can you have a bigger impact? Because, you could easily set up a course on investing and like you said, that's scalable, right? Because you're now helping the masses and. would be so glad to be educated about something.
Or you can even set up a course about like, how to identify certain conditions. Even for physicians, like you could be like, Hey, this is for primary care doctors. Like this is the things you can do in the, in your office before you, you come and help me. Yes. And then how many more like. Patients in a, in you have taken care of, like indirectly, right?
. So like for me, like I feel like as I'm helping my A D H D physicians, I'm, he, I feel like I'm helping like thousands of patients because you are seeing all those other patients for me. So instead, I, like you said, there's only one of me and I can't see all of them, and yeah. So it's just so important to.
Leverage our MD degree because automatically we have credibility and automatically if we are aligned with what we're doing, like the money just flows. Yes, And that's something that obviously we need to get coached on because as physicians we're not used to like charging for all her advice that we give freely every day.
At the end of the day you serve and you earn, and then you're able to use that again to enhance the wellness of you, your family, and everybody around you. So it, it makes an impact long way. But we were also talking earlier I was asking you, in my in my coach I have 90% females in it, and I'm not really trying to exclude any males.
And so I was asking you do you think like coaching is something new that maybe that's why phy male physicians haven't flocked into it or we were just chatting you? You can be honest. You don't have to.
Dr. Stephen Lewellis: I think this is a really interesting point of discussion. Could be. Few episodes in and of itself, probably or a great panel discussion actually with a couple women coach, a couple female coaches, a couple male coaches discussing it.
And first of all, the numbers are obviously skewed anywhere on social media women towards men and I we're, I know we're talking binary right now. It's just for the ease of conversation. But it's certainly skewed. I think women. In general better at putting themselves out on social media.
I think a big one is that women are much more supportive of one another and eager to work in a group that's a very comfortable for women, at least what I've seen to be in a group of other women because of what they've. From, the patriarchy and it's a, may feel like a safer space.
And your group is not only for women, you're saying, how do I get more men? But there are a lot more groups for women only than there are for men only that I've come across in terms of coaching and things like that. Another thing is I think men are less likely to seek it out. We. Just typical I have a lot of patients, men who are there for a, 60 year old guy who's there for a skin check.
And the reason is my wife told me to go . I never have a woman who's in for a skin check who tells me, my husband told me to go. That never happens. So that's another thing. It's that vulnerability thing. It's the met weather, it's the machismo that you just don't want to admit it or just, Whatever it happens to be.
But I definitely don't think that, like you had mentioned, someone told you that, eh, no. Men may be better at delegating or something like that. Definitely not. I think women are in general, especially. Women who are professionals, who have families burdened with mu many more tasks. And we call it emotional labor, if you will than men typically.
Certainly that's how it is in my relationship. And so women will naturally get more overwhelmed and actually seek help because they are, they hold themselves as such a high standard, especially when they're trying to, when they're a. A mother and a wife. And a professional. So that's in a nutshell why I think those things are, and maybe it's part of the marketing, but I don't think that's the core root of it.
And I find myself, I don't know why, but I am drawn to female voices in this space. Most of the podcasts I listen to, and I guess that's because most of them are women. But I will listen. There's several podcasts that I listen to that are. Exclusively marketed to women whether it's coaching or investing.
And I just like their voices. I like the way that they work together. And I'm a little bit turned off by like the. The Instagram ad I'll get, that's all of a sudden in my face is this macho guy on his private jet telling me how he has this hundreds of thousands of dollars of passive income coming. And that's just I kind of scroll by and it's, but that's just me.
There are plenty of people who are drawn to that. But I'd love to talk about this more. I think it's fascinating and there are a couple male coaches that I know, physician coaches who are awesome. And I think we need a lot more. It will balance eventually, but it's a area to a disparity that.
Is ripe for
Dr. Diana Mercado-Marmarosh: something to trust. Hey, maybe that's an opportunity to step into, to be a male coach or a realtor. Here I am putting words in your mouth. But the point is that I think you having that perspective can also help you later on with whatever you decide to do because you have that insight.
And yes, I. Think that collaboration is key in, in, in entrepreneurship. Like I was just having this discussion yesterday with my husband because I was like, no, I am gonna do ethical marketing. And then he's, we were just going back and forth and he's be ready to be eating alive. And I'm like, I don't care.
I go this is how I do my business. I do it from a place of integrity. I want feedback. And then he's Some people don't work that way, like it's cutthroat. I'm like I don't have time for that type of stuff. I go, they're not working with me if that's what they're expecting, and so we were going back and forth on that and he's you are in your own little la land when it comes to business.
And I'm like, and so if it's working. Yeah. And, but we were just having that discussion about how sometimes marketing can tell you one thing and then you get into it and you're like, no, I don't feel like I. That, and so I was like, I'm gonna give feedback on that.
And he's you don't do that. You're cutting yourself out. And I'm like, I want feedback. If my shit's not what I'm saying, it's gonna be, I wanna, he's you're different . He's not everybody wants to know that. And I'm like, oh.
Dr. Stephen Lewellis: You're, yeah, you're attracting your people your customers are out there and yeah, I think, like your husband mentioned, being in la land like that, to me that's the same as saying you're being authentic to yourself and that's why people are drawn to you.
That's why your customers are drawn to you like Kevin Kelly this several books, amazing journalists and Techn. I think I think he ran Wired for a while. If he doesn't still has a very famous blog post called 1000 True Fans. And that's the sort of gist of it is that's all you need. That is it's very much less about having 6 million Instagram followers than those.
100 people who are your people and though who very much feel like you are authentically serving them. And that's why they say the riches are in the niches and all those sayings and stuff. You can, the, I could have a course on helping dermatologist with a D H D. Find their first rental real estate property and like that.
And that's just a joke, but it's also not Yeah.
Dr. Diana Mercado-Marmarosh: And I don't, I dunno where to invite you to find your people . Yeah. Because again, like you said, I am part of an A D H D physician only group that like, I'm so grateful to be there. There's a thousand of us. And you wouldn't think that there's like a thousand of us, right?
Because again, some of us don't talk, but. When you are there, like you should just see the memes that are there, , some like somebody posted last night. In that group, they said the question was asked by the interviewer, are you somebody who works hard? And then the person answered, of course, I work hard.
All the time, more than I need to and should, in all aspects of my life. , yeah. And again it's just a funny joke, but at the same time, it just goes back to sometimes we're doing it harder than it needs to be, and can we slow down? Can there be any better way? And can we laugh about it and be like, huh, okay, let me backtrack and let.
Do it in a different way or knowing, okay, no, this is what works. I'll just gonna do it this way or not, right? But yeah. Yeah. So thank you for having this insightful discussion and I think I am so glad to be catching you, like you said, on an earlier stages of your diagnosis, but I do wanna point out, like you said, it was, Probably having two kids around like a seven month old adds more responsibilities than what we were used to.
Plus you having your practice, plus working towards scaling it plus unfortunately your brother passing away, it, it was just like, The perfect, beautiful storm . It was, yeah.
Dr. Stephen Lewellis: So bridging into trying, finally really committing to doing things, entrepreneurial things as well. And I, the one thing I didn't mention, but it's it somewhat obvious from her age, my, my daughter was born on May 23rd.
My brother died the first week of June and we closed on the first investment property the first week of. So that was a lot and it was a combination of wonderful, joyful things and awful things. And I probably mo couple months after that ended up in my primary care doctor's office, sending him a pretty desperate message one night and then we had a good conversation the next.
Day or something cuz he's really responsive and he got me on a journey with some help of other people to a what feels like an entirely different person. And I have to work through that as well because other people in your life, when you're transforming yourself in a positive way that feels positive to you, you could feel you could appear foreign to other people and.
Intentionally working through that right now. Because it's a dangerous zone for sure. They're like, who are you now? What the I'm more myself. I'm a better version of myself, but I'm appearing very different and it's a shock and it can seem inauthentic.
Dr. Diana Mercado-Marmarosh: Yes. Oh my God. Like you said, this is a whole other conversation that we could probably dive into.
I know you're, you wanna close it off three or four episodes, but thank you for pointing it. Because like I said, yes, oh my God, we could definitely go into it into so many things and so many stories and so many conversations that I'm happy to be back on some other time I don't. Yes, of course. Yes.
I could definitely jump on on that. But again, it's the key of awareness of that. I think you're so ahead of the game and staying intuitive and in perspective and if like you just stay on the same thing thinking this is. Growth. Think about it like, to become a butterfly, like you have to be a caterpillar at some point, right?
And and growth hurts
Dr. Stephen Lewellis: growing.
Dr. Diana Mercado-Marmarosh: Pains all that. Growing pains. Yeah. And but the people that are gonna appreciate what you're going through. Yeah. Or those that obviously are always gonna be there. But sometimes the people that We're benefiting from our lack of boundaries sometimes.
Yeah. Interesting. They have the hardest time because they're so used to you being three people, and and now you're like, no, I'm trying to set healthy boundaries for me and for my family and sometimes it it can appear like you're cold or indifferent. Things like that. But it's so insightful again, that you are having these conversations and that you are working through that because it becomes important.
And so let's let me just ask you, where can people find you if they wanna chat with you?
Dr. Stephen Lewellis: Yeah, sure. I am becoming more active on LinkedIn. I'm really enjoying interacting there and offering some perspectives both in terms of general dermatology matters, as well as kind of personal finance and real estate.
And then on Instagram, I am not as active, but a great place to connect with me as well at Lou. Md just my last name, then MD and I also have a smaller account for my real estate investments that is Happy Monday Real estate on Instagram. And that name may be obvious why I chose it, but I'm just, that's part of the reason I bridged into entrepreneurship and other kind of establishing horizontal levels of income.
And other, adding pillars to my financial table because it's really, I want to look forward to Monday and I wasn't always looking forward to Monday. And I, and now it's much easier already because I've identified some things I was struggling with, but I want it to be even better in the future.
So those three places are the main areas to reach out to. Thank you.
Dr. Diana Mercado-Marmarosh: So as we've been talking about when we are in our zone, we sometimes space out . So if my audience just started paying attention right this second. Yeah. What is one takeaway or two takeaway points you would want them to take away from this episode?
Dr. Stephen Lewellis: I would say it's never, I have two. Number one is it's never too late to ask for help. I received help just in 2022, was my year of help mental health. And I received help with both chronic anxiety, which I knew I was struggling with, and adhd, which I did not know I was struggling with.
And both addressing both of those has changed my life already. And the second would be that there are tipping points and watch out for those tipping points. And if you go through something and all of a sudden things are falling apart you may be you may be at a tipping point where you need some help.
And investing in the expertise of others investigating real time and money and the expertise of others. The one of the best investments you could make.
Dr. Diana Mercado-Marmarosh: And one last question. What do you do? What do you see yourself doing for fun in the next three years? For
Dr. Stephen Lewellis: fun. I would, so I'm excited for my son.
He'll be next winter, he will be four years old and we're gonna have him on our local ski mountain here. We live in a small town, but we're very lucky to have a pretty darn good ski resort. So he'll be up on skis and I'm so excited to just see him doing that and my wife. Love skiing as well. We lived in Utah for a year and that was incredible.
So I'm excited to get back into that because we have gone away from that with the two very little kids. So that'll be fun. I'm just excited to have, yeah watch my son do gymnastics or dancing or skiing or whatever he happens to love. And spending more quality time with my wife and family as.
And able to get a control on the things that were stopping me from being, owing them, the very quality presence that I was not giving them until until I learned to get a handle on the things I was struggling
Dr. Diana Mercado-Marmarosh: with. Thank you so much for sharing, and as I shared with you, fun is the key.
Yeah. Keep having fun and keep striving to what's to towards what's meaningful for you so that you can practice medicine in your own terms. And so you can be, like you said, present for your family, because that's why we do what we do. We wanna be available in all the relationships in our life, whether it's with our patients, with our clients, with our family, right?
Relationships are always key. So thank you again for coming. So great to have this discussion, and I'm sure we're gonna have multiple other discussions because these are important conversations to have because not until you realize that, oh, this is a D H D thing, or this is a interpersonal thing, or this is a thing that people are just not discussing.
Can we start to have shifts and we, and awareness is the first step, and then you can go forth.
Dr. Stephen Lewellis: Yeah, the A awareness you just mentioned and I the one book that many of your listeners might know of, but it's a book called and it's really meaningful to me cuz it's the last book recommendation that my brother gave me before he passed away.
But it was one, it's one called What Got You Here Won't Get you There. And it's all about identifying in high achievers. You got to medical school, you got through residency, you got that. , but what got you there is not gonna get you to that next very different place. And it's all about identifying the things about yourself that may be really annoying to other people or grading or just holding you back in certain ways.
And it's it's much harder to do that introspective work and identifying that, yeah, there are some things about you that aren't so great and you can address. So I think that is a great one for people who. Looking for personal growth to check. Even though you didn't ask for a recommendation,
Dr. Diana Mercado-Marmarosh: No, thank you.
That's actually one of my models, so thank you for pointing that out. How crazy that we have solve these serendipities. I
Dr. Stephen Lewellis: I heard you mention it before. Yeah. And it
Dr. Diana Mercado-Marmarosh: triggered, it reminded me of it. Good. Thank you so much and again, it was a pleasure having you.
Dr. Stephen Lewellis: Likewise. Thank you very much for the opportunity and I wish you all the best with your practice medically coaching podcast, all of that.
I hope we can keep in.
Dr. Diana Mercado-Marmarosh: Bye bye-bye. Thank you for spending your time with me. I really believe that time is your most valuable asset. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website at A D H d.live coach.com. Where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happening.