Beyond ADHD: A Physician’s Perspective

Beyond ADHD A Physician‘s Perspective Ep 5 with Dr. Sara Tehseen (Pediatric Hematologist based in Canada, Blood Bank Doctor)

Dr. Sarah Tehseen is a Pediatric Hematologist based in Canada,  and a Blood Bank Doctor. Apart from medicine, her interests include, volcanoes, dinosaurs, quantum physics and painting. Join us today as she share her journey; her challenges and wins!
Dr. Sarah Tehseen: Approach, cubit, curiosity, whatever you do approach with curiosity by the side, the why is going to be your saving grace.
Dr. Diana Mercado-Marmarosh: Hi, welcome to beyond ADHD, a physician's perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh. I'm a family medicine doc, with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers for three and four years of age.
Dr. Diana Mercado-Marmarosh: And in the past year, I have undergone radical transformation after discovery, ADHD coaching, and life-coaching. For the past decade, my typical day consisted of having 300 charts, backlog, a graveyard of unfinished. And a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes the last year I figured out the secret; learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius. So they too can reclaim their personal lives back. Like I have.
Dr. Diana Mercado-Marmarosh: Hello, welcome to the overachieving ADHD physicians.
Dr. Diana Mercado-Marmarosh: As we all know, ADHD is a spectrum. It affects people in many different ways and we all deal with it a little bit differently. I created this podcast to bring awareness that ADHD is a life long disease. I will be sharing with you many physicians who along there lives have had wins and challenges, but they have learned to overachieve in life.
Dr. Diana Mercado-Marmarosh: So my aim is to stop the mental stigma associated with this condition. When most people think of ADHD, they picture a little boy maybe running around and knowing people are distracting others. They don't picture somebody super and smart and intelligent and gifted or somebody who's daydreaming. So it does not have anything to do with your mental intelligence.
Dr. Diana Mercado-Marmarosh: It's just a different way of thinking. So I want to share with you that we can be adults. We can be professionals, but before I get to my very important guest today, I have to disclose something that my lawyer makes me say, which is that while today, our medical doctors, we are not your doctors. So the information that you learn here today is not meant to replace or substitute any advice of your own physician, therapist, or coach in addition, Everything that you learn here.
Dr. Diana Mercado-Marmarosh: As we share is considered our own views, our own opinions. It's not meant to represent any specific employer, hospital or healthcare system or a particular organization. All right. That was a handful. So today my special guest is Dr. Sarah Tehseen. Thank you. Hi. Hi. Tell us all about you.
Dr. Sarah Tehseen: I am Sarah. I am originally from Pakistan.
I have been in Canada for two years now. I have two boys. I have a one and a half year old and a five and a half year old. And I am a pediatric hematologist and, , blood bank doctor. Oh, wow. I enjoy painting, singing, astronomy and quantum mechanics. Oh my God. That's amazing.
Yeah. And that is once again, the fact that my brain can hold five things at the same time, but usually not one thing at a time that does not apply.
Dr. Diana Mercado-Marmarosh: We have that special gift. Yes. Yeah. I give telling people that ADHD is a gift that we just have to learn to unwrapped, but it can be a beautiful gift. Tell me, how did you get diagnosed? When did you get diagnosed here?
Dr. Sarah Tehseen: Absolutely. I, when I looked back, so I was the kid who got in the most trouble, but my parents, it's not a big end.
Like it wasn't a big population and only the person with my brother, but I got in trouble with every single adult who took care of me? I got angry very easily. It was very hard for me to self sued. I was very emotional. I lost an insane amount of things. And when I say insane, Cell phones. Cool bags. You name it? I lost it. Important documents once I got to med and stuff. Yes. I was this smart kid in the school. Who would I belong to a school system? Coming from Pakistan, like that celebrated smart, but I was always an odd smart, because I would be saying inappropriate things or talking too fast or walking too fast or stimming, like constantly moving when I'm trying to tell people something or like doodling in the class.
I'm moving my legs too much wind seemed to annoy our teacher in what? Her grade I couldn't stop myself. And yeah, so like, it's, that was how school went. And then I came, as I grew older, it became more about being very daydreamy and missing details in med school and in high school, the actual content of what I was studying was always super interesting.
It still is. And that enables me to overcome. That daydreaming aspect, but there were certain aspects of my life, which were extremely difficult for me, like personal hygiene, having to lock my door in all of my dormitory, losing things, having relationships with people, being able to keep secrets where I would blurt stuff out, not, because I meant to hurt somebody, but because.
I'm excited, any missing body language, missing social cues, being unable to, um, like lacking that, almost lacking almost that emotional intelligence, which I saw in my peers around my age. And that was something that became very prominent in med school. And I struggled a lot because of it.
Dr. Diana Mercado-Marmarosh: So did you notice that in med school, that was the first time that you notice that?
Dr. Sarah Tehseen: The story is not over yet. So in med school, in my final year, I, would extensively, I would almost say it was, I was with a group of friends that was very, difficult for me. And I think some of, a lot of my own rates made it difficult for me. A lot of their traits made it difficult for me.
So it was, it was combined activity. I ended up getting depressed for the first time clinically depressed and I received Sidella brown for about five months or so. And it really, really helped. Let's go a little Lord by then. Everybody moved away. I started studying for my exams and that was a very good place to be because studying was something which was always relaxing.
You know, in my residency, I got even going into pediatric residency. I think paying attention to the girls was a big thing. I struggled a lot with, especially in the first few months of my residency, I had moved to a new country. I was learning a new system and I had the smarts to understand the content, but I did not have the emotional intelligence almost, or the ability to pay attention to detail part.
Dr. Diana Mercado-Marmarosh: How, like, were you then more or less in your twenties? 23, 24.
Dr. Sarah Tehseen: Yeah. I was able to overcome that by being extremely anxious and telling myself I'm doomed. If I don't and they will talk me out of the residency program that they didn't add. By just triple checking, quadruple checking my work.
[And that's how it meant to in fellowship. And I did, I was, I stopped my medication. I was not medicated. I was not aware of my diagnosis then. And my fellowship, the content in a pediatric hematology-oncology fellowship tends to be obviously for very understandable. More complex, more complicated as a fellow.
Your responsibilities are a lot more than there. Even as a resident where you are expected to know a certain amount of content and then a subspecialist will help you out. Now you're training to become a subspecialist. The stakes are high, the expectations are high. The people around you relate to you different because you are different.
And I was different. Not only because I was a woman, I was also a woman of color. And I was a woman of color with an accent because I was from a different country. I had all this. It was a very difficult year. The one thing I had always relied on was being smart and being a very capable overachiever kind of a person.
And that was a year that that part was. Criticize the most. Right. And it was difficult. I started therapy. I was still not mitigated. I still did not have the diagnosis. The next year that helped a lot. Once again, I fell back to my old coping mechanisms of bringing extreme anxiety. So like when I'm on regular therapy for a patient, I learned, I didn't check it seven or eight times obsessively before I would actually put it out.
And I still do that. That is just hard to the goals. Um, uh, and, um, the other thing which developed as a consequence of all of that, because the thing I think that I struggled with the most was the anxiety that developed as a result of that constant, never ending. Criticism. Right.
Dr. Diana Mercado-Marmarosh: Would you say it was self-criticism or others criticizing you?
Dr. Sarah Tehseen: Everything? I think it was initially a lot of other criticism, right? Like, but then for the longest, for as long as I have known my inner voice has been self critical, it just got more and more and more worse. The higher I went up the chain of becoming a subspecialist and.
Dr. Diana Mercado-Marmarosh: It did for me too. Yeah, exactly. Like your voice tells you, you better get that. Right. You're going to look dumb or you're going to get somebody in trouble or yes. Or you can really harm somebody. You better double check that you better not get distracted. Like, it just keeps telling you that. And it's like, you said, it brings up fear because you're trying your best and you're in an area where you're supposed to be perfect because, do not be perfect. Exactly. Somebody's life is at stake. Right. And so, like you said, you check seven or eight times just to make sure. Did you have like a checklist that you would do?
Dr. Sarah Tehseen: I feel, I think the anxiety component of it was so strong that it was able to kinda make up for it. I did make, yeah. Then, lot of times I would make, because then I would make checklists, I will lose them when I would make checklists. I would never have the capacity. Even if they're sitting in front of my face, on my computer, I would never be able to open the folder, click on that document to look at the checklist. It just didn't happen.
I wouldn't be too much in that moment of, okay. I have to figure this out or okay. I have to get this right. Like, and that'll help me to. Yeah, that makes sense. I hope it makes sense to you because
Dr. Diana Mercado-Marmarosh: Yes, it does make sense because if you think about it, if you step back, you know, you were using your adrenaline drive and your cortisol level as a way to boost your dopamine, like you were always in like chronic, like really?
Dr. Sarah Tehseen: I have been an adrenaline junkie as long as I can remember, like when I'm studying and even now when I'm painting or when I am doing anything, which is giving me adrenaline/dopamine, I won't eat, I won't sleep. I would leave. I would be on the go.
Dr. Diana Mercado-Marmarosh: Yeah. So it does totally make sense that your body was trying to function. Any way it could to like self preserve what you want it to do, because here's the thing, like, you're, I'm guessing you went into medicine because it's a lot of work because you're passionate about it, right. Because not everybody, but I think at the end of the day, you know, nobody stays in something. They don't like, so it's like a love, hate relationship, right? Because like, you love what you're doing, but at what cost sometimes, right?
Dr. Sarah Tehseen: Absolutely. No 100%. And, I love my patients. I love my patients. I mean, their children and I have always related the best with children. Like it doesn't get better after that. It kind of gets worse as far as I'm concerned, unless you
Dr. Diana Mercado-Marmarosh: So were you diagnosed in fellowship?
Dr. Sarah Tehseen: No. That was very interesting. So this is an interesting, because, then I came to Canada. The first job that I had was not as a pediatric hematologist only. It was a part general pediatrician and part pediatric hematologist. Oh. And when I was doing Gen-ped's I just got a lot of ADHD because in Canada, gen-peds becoming a general pediatrician equals being a pediatric psychiatrist in certain outreach areas where you don't have Pete psych support.
And we have amazing pediatric psychiatry support, but it's on the phone. Like the lesser insane nobody would ever get. And what I began to realize was my ADHD boys, the most, they're the most fun. And. Like the more I hang out, this is weird. You're like crazy. I was doing my three coordination disorder question, every one of the families and not the moment.
Like my child is a bull in the China store. And I said back to him after the mall, I don't want any.
So that got me thinking that was the first time I was like, okay, this is making sense.
Dr. Diana Mercado-Marmarosh: Ha that interaction triggered it. Huh?
Dr. Sarah Tehseen: Yeah. And then my own get triggered it like my five and a half year old is exceptionally smart, but hard to self-regulate hard to self suit. Nothing seems to work in, like I was dealing with his anger and I would get quite angry myself and that was just not working out.
So I think a big trigger was that was my kids big trigger because I was like, I have to think. myself oneway or another, because if I don't, I'm not a good mom, I cannot like, I cannot do that to them and that's not fair. And the other thing was just this understanding that this is a spectrum and that on the spectrum, a lot of behaviors that I'm seeing in the children bird behaviors that I still have, or I still had, and that got me to seek the diagnosis.
So when my second son was born, For my first and I only got six weeks matleave. So it was not really a matleave, it was a recovery period. It wasn't mentorship. So it was like you were on the go. Drains tangle ever since my son was born, the older son, my, I think he became, he became somewhat of my dopamine source.
So that was actually, even though it made my life incredibly stressed and hard because of the fellow, you don't even have the money to pay for an appropriate amount of appropriate care and all that. It compensated for that someone still continues do, for which I have been very thankful . Do whatever made him my dopamine.
When my second son was born, I had a reasonable matleave because by that time I wasn't attending and I was making money and I was in Canada where matleaves are really not looked down upon or considered that six weeks is enough.
Dr. Diana Mercado-Marmarosh: Right. And that's a blessing.
Dr. Sarah Tehseen: That was the time I actually went to a psychiatrist. I got referral to the SMA, like our medical association. And I went through the psychiatrist. And start it over just saying, yeah, I've struggled with anxiety. I know I have it. I had been on SSI to a family doctor for a good two years and it made a difference and I was like, Hey, this is my life history.
And he was like, yeah, you definitely sound like that. No question asked. She did a few long questionnaires. I did a few more questionnaires and. I started, that was what I was still nursing my kid, pretty extensive. He said that was like when he was nine months and 18 months.
We're now. So almost nine, eight months ago.
Dr. Diana Mercado-Marmarosh: This is very recently.
Dr. Sarah Tehseen: It has been the last year of my life, basically that it fit together.
Dr. Diana Mercado-Marmarosh: And then I can only imagine, you know, the pandemic might've just like boiled it over, like.
Dr. Sarah Tehseen: Okay. That's interesting part. Pandemic was very suiting for me because I was not required to mask. I was not required to interact with other people that you are socially required to interact with because then ever I find interacting with people that I'm not close friends who were, let me like, do daydreaming and twiddling and fidgeting and talking about random things and laughing about random things or being so excited about the movie that I watched and looked at it.
And if you are from a small entity, you're required to keep those relationships. Right? So the fact that I had the excellent excuse to not meet with people, Well, actually good. Yeah. So I'm dreading the fact that that is over now. The fact that I could attend meetings from home meant that I could be nursing my baby and I sent him the meeting and saying,
Dr. Diana Mercado-Marmarosh: So would you say you're an introvert?
Dr. Sarah Tehseen: I don't know, but it comes to that introvert/extrovert spectrum. I do know that masking makes me very exhausted and being in situations when I'm required to be a certain way, makes me very exhausted. Pediatrics is amazing because pediatrics has not requiring me to mask. Yeah. I can talk to that teacher about the schedules that they are doing, or the Netflix show that they're watching, which probably am watching at the same time.
And real guys, I know as much about dinosaurs as my five-year-old, so it's just so much more fun. And he went with the parents. I mean, even if they are very. Like properly people up over time because it's because when they can see that I care a lot, which I do absolutely 100%. And also because they see the kids bonding.
And that provides me an avenue and my blood bank job. I'm blessed to have colleagues who are very accepting of my quirks, extremely accepting of my quirks and valuing me for my strengths and. I never thought that I will get this environment in my work ever. And especially with my experiences in fellowship and residency, I thought this would never happen.
These are the, like, I'm truly blessed. I'm truly blessed. And one of them is going to be retiring soon-ish and I think it's the circle of life. She is going to be missed very, very dearly. So that's, kind of,
Dr. Diana Mercado-Marmarosh: But I want to have you there and, and really emphasize something that is so important that you had an amazing mentor, right? Who welcomed you the way you are not having to like, be any different than yourself and you saw. Being in medicine that you could be, you, you could be human, you could be Sarah
Dr. Sarah Tehseen: quirky and loud and funny and late to meeting and still do a phenomenal job and be celebrated. Right. I, that, and that part is so hard to find so hard to find.
Dr. Diana Mercado-Marmarosh: But the more important thing is that you saw this role model and now you too can be a role model for others, right? Like you can, you, can
Dr. Sarah Tehseen: I can celebrate those strengths and take them where they're at, rather than expecting them to be something that they're not absolute.
Dr. Diana Mercado-Marmarosh: Yeah. And you see, I think that's a beautiful photograph.
That ADHD has because we tend to be flexible and outside the box
Dr. Sarah Tehseen: and we that's how we do it, but that's what happening. Okay, we'll do this. Oh, this happened . Like my nurses would come to me in panic. This happened, this happened, this happened this moment and I need that story. You don't want to be like, It's so easy and so natural to trouble to think on your feet, then it is to sit down in a meeting and be proper, or, um, write a note or review a part of, because of it being elaborate like in the lab aspect.
It's very interesting. It's very fun. But the part with enjoy involves looking at like operating procedures and doing quality stuff. You will have died, is difficult. And what I have noticed that ever since I have been on the stimulant, that part is getting done on time. That part is becoming a lot more easier.
So the parts of me, which we're not getting, like I'm getting enough dopamine out of my medications to get the required work. Getting up in the morning has become a lot easier. And I will say I switched from consider to dextroamphetamine. Um, right now that's what I'm because, and what I have noticed is that even with the SSR I's onboard, that combination has helped the emotional regulation a lot.
And help the, obviously the focus and attention by this there, but the emotional regulation part is also settling. And that, for that I'm very thankful. The fact that it worked, obviously, that makes you look back on your family and who has, might have it. And, and I have my opinions about it, but I talk about it at some other point, this has been a year, year and a half of discovery. I was ever, since my little one was born, it has been a year of discovery.
Dr. Diana Mercado-Marmarosh: How different is it now? That you're embracing it with a curiosity point of view, right? Like having more self-compassion for yourself and loving the way your quirks are. Like you said, what makes you, you and not having to use that internal voice telling you, like, you're going to do this wrong? Like, what if your thoughts. I'm just very thorough. I just want to make sure, like, it's always how you look at things. Right? What if you're thinking I'm just double-checking and that's okay.
Because nobody's going to ever fall to you for double-checking. But hopefully now, as you have been doing things more often, It becomes second nature to you. And hopefully with your medicine, you don't have to double-check seven times, hopefully you're double checking three times, but it's a process, right? Like you said, some things are ingrained. Right.
Dr. Sarah Tehseen: Yes. The other thing is also that I'm able to say that to people. Hey, people, I tend to forget to let me just quickly look at it and make sure I'm not missing anything. I just say that out loud. I say that to my residents. I say that to my students. I say that to my colleagues and I'm just not.
I don't hide in shame because I think that has been the biggest gift. I don't hide in shame. That's why I struggled with driving for the longest of time, because it's just so much sensory integration and it's so much stress and I would just try to put it off as much as I can. I mean, I have a license, I can, to my life, but I have a husband who loves to drive in a single car house hold so I avoid it as much as possible. And I think a big part of that had been number one, I learned really. You don't like, it's not the right of passage in Pakistan. So I learned in my residency with a woman who, whoever she from, she goes to somebody somewhere in Eastern Europe and you go like,
Hey, she would be yelling at me. When you yell at me like, like this, I go into massive shutdown. So yeah, of course, because your driving instructor is screaming at you. When you're driving here, you're not going to panic. Yes, exactly. So that was the background. And then, like I can see that I struggled with it all the more and other people do.
And I'm sure if I put in the time and effort, I will get good at it, but couldn't bring myself to, especially with so many other things in life, I just can't bring myself.
Dr. Diana Mercado-Marmarosh: Sure. Yeah, no problem. I mean, I didn't learn, to drive till I was like 17, 18 also. And I remember like, my dad was teaching me to drive and he was
So, he didn't want to pay for the course. Okay. He didn't think I should drive. But then he like wanted to, evaluate me, you know, as I was driving, to the store where I worked, I was a cashier at a grocery store and like, it wasn't even two miles away.
And I think I, it was an, like an orange light and I like ran. Like, I, I just went like curved and he was like, pull over. That's it. You're taking the class I'm driving. I was like, okay. Like, I guess. I had to be more careful, you know? And so it is what it is.
Dr. Sarah Tehseen: So I think there are two kinds of people. There are people who find joy in it.
And the ones that you find joy in it, like who actually enjoy driving, it becomes a hyper-focus just like procedures become a surgeon's hyper-focus and they're able to be really in the zone and have a good time with it. And then. Who start over. Yeah. Right. So it just, it's just what grabs your attention.
And it's so difficult for you to do things which are not your attention. And with my son, I am recognizing this more and more that, you know, when he struggles with
I'm like, okay, it's gonna be hard for. It's going to be hard for him because he has no dopamine to brush his teeth in the morning, or he has no dopamine to take a bath, or he has no dopamine to what does that he struggled with? To do whatever, like multiple things, for example, we were doing some reading and he has to use his brain for it.
Right? Like you have to make an effort, you have to make mistakes, you have to figure things out. And he's not really good at it. Nobody is right. And I'm pushing him over to, I'll be honest, but he was all excited. And I was like,
Dr. Diana Mercado-Marmarosh: But what a big gift it is for you to be his mom, because one, you now understand like, how, like that there's nothing wrong. It could be that maybe there's some dopamine or maybe he's just being a kid, but at least you're now more in tune and more aware and not going to judge him a call him lazy or whatever. Like sometimes parents, sometimes our parents mean to do well.
Right. But sometimes what they say can be kind of hurtful because they're just.
Dr. Sarah Tehseen: Say it was act and it was not just your parents, it was everybody else in your community, in your friends. Right. And it was not just one year. It was 30 years old, 35.
Dr. Diana Mercado-Marmarosh: Exactly. You internalize it. Like, it's like a character flaw, right?
Like, like you're doing it on purpose, but you're not like, this is just our brain and if we could help it, like, why the hell would we make it harder on ourselves? Right. Like, oh yeah. I love losing the keys 30 times and you know, like nobody..
Dr. Sarah Tehseen: First thing I did and the first job I got was lose the keys and those keys had the car keys on it, but not only did they have the car keys and everything else, those keys were like, , one of them would be the common keys for an office where we have our facts.
Yeah, totally. Oh, great. New job. New boss, new boss.
Dr. Diana Mercado-Marmarosh: I cannot tell you how many times in residency and in my, um, where I was working, I went to residency at Baylor college of medicine in Houston. And then I started working at strawberry clinic, which is like an underserved clinic. Do you have to Baylor, but they had lockers, you know, and you were supposed to use those like little things too, like combination.
I don't know what the combination, but if I would forget my combination. So like the janitor would come with their big flyers. Break it up. So I, so I could get into damn locker so that I could get like my coat or my stethoscope or whatever, like, you know, I would go on vacation and then I would come back and like, I forgot the code, like one week or two weeks or whatever.
Like how do you just forget that? Finally, my husband was like, okay, you need to download an app where you put all your passwords in there and that way you just need one password to get into there. I said, okay.
Dr. Sarah Tehseen: , I think, I think the other part. Which is true for a lot of ADHD people, and especially the high-functioning ones, I feel like we rely on our spouses a lot to run the life, picking kids up from school or dropping gets to school, making sure we are on time for our taxes and our appointments and our deadlines.
And, the bills are paid on time and all of that, like. I think me and my husband worked out well, that aspect very well, because he is unnaturally organized person. But think about it and that he's got that by now, but I'm going to think about it. I think that. It's probably because he has ADHD organization as is hyper focus, but that's, and that's part I definitely want to put out there ADHD can cause dysfunction in any form, just because you are organized at work does not mean you're organized in life, just because you're organized in life does not mean you're organized at work.
Some people with ADHD will have organization as a hyper-focus, which gives them dope. So they are going to be organized for the heck of it. So for some people, and that includes me, this organization and emotional dysregulation is the hardest thing to deal with for other people. It's their jobs or addictions or, learning to read and write or doing math or being hyperactive. So it's, it presents in every person differently. Even if you are a mom with ADHD and you have a child with ADHD, you're going to look very different from your kids. And that's okay. The underlying. That pathways are the same. And I think if you are a parent of a child who is struggling with this, or you yourself struggled with this, you have to, I think, it's a good idea to learn and understand how yours present versus how theirs present, because in any relationship be it. And I see that with my colleagues and my nurses, my residents, my patients, my son, my husband, my friends, anybody, if you approach things from a place of, I'm trying to understand why you're like this.
And compassion. It's lot easier both when you and for them.
Dr. Diana Mercado-Marmarosh: Yes. That's a very big point that you're bringing out that I don't want a listeners to miss that when you approach somebody from love with love, then you really are being under like curious and not judgy. And when you're curious, Then the other, person's able to share how they're thinking because they feel safe in that space and they don't feel judged because remember we already judging ourselves.
So, and then it feels horrible to be judged by the people we love because. We want to be loved, just like every other human being and to spend out for the wrong reasons, like makes us like freak out and almost shut down sometimes. Right. And so that's so important to understand, like you just said emotional dysregulation, even though in the DSM 5. It's not like seen as one of the components of ADHD in Europe.. It is okay.
Dr. Sarah Tehseen: That I didn't know because it should, because that's the biggest problem. And, I'm going to jump because I'm going to interrupt. When I was looking my son is not diagnosed at, but when I was looking at the diagnosis, diagnosed children who ended up having it, there was a study.
I don't know that it came out of, and it talked about the fact that as a preschooler or as a toddler, as a baby for them, the hardest thing was self-soothing. And that makes sense. This is the one thing they struggled with and they struggle with it as they are little babies who are not here to the night, to the point where that 26 year old and somebody tells them they don't do a good job.
This is a lifelong thing. And, and the sooner they realize that somebody is holding space for them and giving them a chance to work it out, the easier it is for them to actually learn to work it out in their way.
Dr. Diana Mercado-Marmarosh: Yeah. That's so powerful. Tell me, what are your goals in the next five years? Do you want to travel somewhere?
Do you want to go to the Hawaiian? Did he didn't want to go to Hawaii? Just want to see those plants that are able to stand right next to the volcano. And they actually stopped. They're actually able to close their forest when the knock system like a mob. So my son is very science driven. And I got science driven as a result of it.
So all the stuff about quantum mechanics and astronomy came out, and we'll just keep asking questions. And when somebody asks me a question, I have to find an answer like there is no other option and that's it, it has to be given an answer as to be fact-based, because now I'm thinking about the question.
So, that aspect of parents find annoying. I find it fun. It's caters to my natural curiosity. We already interested in volcanoes. I wanted to go to Hawaii. So are you thinking like Maui, is that what you're thinking? I'm thinking actually, I don't know, but I learned to look at a semi active Volcano or maybe like the, is it the big rock?
I don't, I don't know. Good geography. I know I've been, I've been to Maui and I've been to Honolulu and in Maui, we did see some volcanos. I'm pretty sure there's different parts in Hawaii that you could fly to, but yeah. Do your research don't take me.
Dr. Sarah Tehseen: No, no, no.
And for the short term, I definitely want to go to Victoria. I'm getting a week off in August because I have, I, I miss the ocean. I haven't been there in a while, so, and I think everyone moved here. So that's do, in terms of like goals, some of them are funny and some of them are. Passionate. I want to, as a part of my job, we did a lot of very grassroots groundwork here in Canada, which was very.
But it was a lot of work, but was very accomplishable because all the systems were set in space, but it was still a grassroots work. It was still ground work of developing something from up top. And I want to take these skills and I want to use them and maybe other countries, but definitely back then.
So I am. I'm connected with some people in Paxson who are already doing some of it and just kind of working to make it a better, better place. Obviously I keep forgetting to schedule meetings, obviously it's difficult to accomplish, but it's in the works. That's all I can say that these are two kind of this is the not so funny goal. I've wanted to have more time to me because I have finally learned that when I have more time to me, I can spend it in ways which are enjoyable because for the longest of times when I would get vacation, I'd be like, I don't know what to do with myself. I would be all over the place and I would be miserable.
And I'd be like, what's the point? And now that I know that I can do certain things and have a good time in my vacation, I want to be able to have some myself. I want to, and there's something that's skilled scares me. I dunno how much of it I can do, but the medical students and the residents and the fellows and the trainees who I see, and I think this will be true for every physician with ADHD.
I want, if I see them acting the way I acted, I want to hold space for them and give them compassion and tell them that, Hey, there is a way out of it. I may not, I don't know how I'm was. Yet disclosing my diagnosis, but I definitely want to hold space for them, even if I'm not giving them a diagnosis and maybe share skills with them that helped me and did not have, but as are on having a self-feeding inner voice..
Dr. Diana Mercado-Marmarosh: As you know, that's part of why we're doing this podcast, right. To like bring awareness and to help normalize it and to help our fellow colleagues, right? Because to you or to me, like we just knew we had to maybe work a little harder and we liked what we were passionate about what we were doing, but why do we have to work so hard?
Right? Like when there is a way a medical way to get diagnosed, right. And to help, like you said, all aspects of your life. And so, that is very important that you are going to hold space for them. And like you said, you will know at that time, what you share or don't share. But I don't know if you're aware, there is a journal that just came out the Canadian ADHD, put out the leadership journal.
July 4th was when it got published. and it's talks about physicians with ADHD and the work in the workplace. And if you haven't read it out, I'll send it to you so you can look at it. But it's really good because it really shows like. On one side, it shows like how to diagnose ADHD kind of, but then it implements, like how would you see it in yourself or in colleagues in the workplace?
So it gives you like the connection with each, each symptom and each like way of presentation. And then it just says that, Hey, be in the lookout because who you might think is unprofessional. They might be struggling and they might have ADHD and they're not trying to be unprofessional. If anything, they're putting in probably 20 or 30 hours more than you are trying to just stay on top of things.
And just having a conversation with them can like change their life. Right. And so I thought it was such a powerful journal. It was like a really good like call to action saying that as leaders, it is our responsibility to like look up. Each other, because at the end, everybody wins that person wins. Their family wins, their patients win, the whole institution wins.
So it's just, it's just a beautiful journal that I'll share with you. You haven't read it, but I think it made me feel like validated. It made me feel like, okay, finally, somebody is talking about it and it's out there, you know?
Dr. Sarah Tehseen: Yeah. I mean, and just because somebody comes across as hyper organized does not mean that they don't have it. 'cause some people will be tremendously organized, but how they it's.
Dr. Diana Mercado-Marmarosh: Yeah. Some people do have ADHD plus OCD on top of it. It's just spectrum
Dr. Sarah Tehseen: Yes, exactly.
Dr. Diana Mercado-Marmarosh: Cause that's their overcompensation mechanism. Yes, exactly. Yep. Awesome.
Dr. Sarah Tehseen: I think that's all I want to share.
Dr. Diana Mercado-Marmarosh: Awesome. Oh my God. You know that you and I could probably talk for hours.
That's the way we are. We tend to be like into everything and understand each other without really having to explain much, you know, and even though we're a little bit different, we're still kind of the same and it's so nice to see that across cultures, like this is something that is seen like, and this is something that it's okay.
And, it brings us closer. Just one last question, in case like somebody wanted to reach out to you, maybe they wanted to ask you a question or something. Would you be comfortable giving an email address or a website where they can look you up?
Dr. Sarah Tehseen: I think if there's a website, I would prefer that, , the website have to be linked to by email. Otherwise I will never check the website, but yes, that should be fine.
Dr. Diana Mercado-Marmarosh: Okay, perfect. So we will get that information out to you guys. Is there any one last piece of advice you would like to share? You gave us lots of awesome advice. But if there's one last thing.
Otherwise, we will close it up because I loved everything you said.
Dr. Sarah Tehseen: Oh, thank you, approach cubit, curiosity, whatever you do approach with curiosity by the vibe, the vibe is going to be your saving grace and the ones who have kids. And they have ADHD, the first words that get thrown around are conduct, and they're going to be an addict in the future.
They're going to be sociopath and they're going to be this. They're also Einstein. They're also scientists. They're also anyone that I know who is like exceptionally successful in their field. And when I say successful, I don't mean like they're making a lot of money or have a big house or a car or a stable job.
I mean like people who actually broke the grounds of discovery. I am sure they were on the new neurodiversity spectrum somewhere. Find what you love, find what your kid loves and then grow it, grow it with every single piece that you have, because I can promise you that it will, it will change the world.
Yes. I've started speaking very well. And that's between you and me. I mean, you can say whatever. I did not use to speak like that. I was a very stumbling over. Stumbling over myself, making sure that I am not saying something which is offensive. It that's changed a lot. That's amazing because you stepped into yourself, you, started to be curious and you embraced yourself and that made the whole difference.
Yeah. Well, we made part of the difference because of the work in progress.
Dr. Diana Mercado-Marmarosh: And that's the thing, right? Like that's the part that we're here to keep it real. Like we're not here to pretend like life is perfect, but at the same time, we want to say, we are passionate about what we're doing. You can do whatever you want.
Sometimes it can be a little bit challenging, but anything that's worth pursuing can be challenging and it's not that you're going to become better or the person once you accomplish it. Because if we keep trying to get to a destination, you're going to miss the journey. So the point is trying to live in the moment and keep remembering, like you said, why am I doing this?
when you live in the moment, Then you're already happy that whether you accomplish it or not, it's who you had to become. To pursue whatever you were becoming, that's going to make the whole difference. And like you said, taking time for yourself is going to be how you feel your own cup, so that then you can turn around and be present for everybody else.
And make the world a little better. Right? Some days it's awesome. Some days it sucks, you know, it's 50, 50, but that's okay. That's part of being human. As long as we keep showing up, that's all that has to happen. Right. So it was such an honor to talk to you today. There you have it guys. So please tune in.
[If you want to give me any feedback or ask any more questions, please reach out to me at overachievewithadhd@gmail.com. And we will see you next time.
As someone who understands that time is your most valuable asset, I am so honored that you have shared your time with me. Please click the subscribe. And join my Facebook Group: Beyond ADHD A Physician's Perspective so that you never miss an opportunity to create time at will. Do share this podcast with your friends. So they too can learn to live life and stay in their own lane.

Beyond ADHD A Physician‘s Perspective Ep 4 with Dr. Emily Shaw (Family Medicine Physician, Life Coaching for Community-Minded Physicians)

Dr. Emily Shaw is a Family Doc in Sonoma County in CA. She does Lifecoaching in Community Minded Docs. She also has ADHD and winning it! She has many inspiring experiences along the way and is proud of what she is today, what she has been accomplishing to doing to help her community and peers. 
 
Dr. Emily Shaw: But my ADHD wasn't causing a problem in my day to day work as a primary care provider, my brain just sort of, I I've, I own the way that my brain works and I like, and I love myself. And I have this journey for, for me of not just accepting who I am and how, you know, the tendency that my brain has to do certain things.
That really just like loving that part of myself and knowing that's part of who I am.
Dr. Diana Mercado-Marmarosh: Hi, welcome to beyond ADHD, a physicians for. Podcast. I am your host, Dr. Diana Mercado-Marmarosh . I'm a family medicine doc with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age. And in the past year, I have undergone radical transformation after discovering ADHD, coaching, and life coaching.
For the past decade, my typical day consisted of having 300 charts, backlog, a graveyard of unfinished projects and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes the last year, I figured out this. Learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius.
So they too can reclaim their personal lives back, like I have.
So I created this podcast to show people that ADHD really is lifelong and that the people I'm bringing are awesome physicians who are going to share with you their wins and their challenges, and some tips and ways how they are overachieving in life.
So my aim is to stop the mental stigma associated with this disease and to re, to remember that. It's not ADHD is ness, not just our kids, but it's also us as adults. And we are here to provide that service to you today. So before introducing a wonderful physician to you, I have to disclose that little disclaimer while me and my guests are medical doctors.
We are not your medical doctors. So. Please do not substitute any advice that we share here today, uh, with those of your own physicians, therapist, or coaches. So any advice that you do learn here, please remember that those are our own views and opinions. Okay. If they're not meant to represent anybody that we are employed by any hospital or any particular healthcare system, or we're going to station.
Well, that was a handful, but my lawyer made me say that. Okay. Onto the exciting things today, we are going to meet with Dr. Emily Shaw. And let me see if she can introduce herself, Dr. Emily's job. Please tell us all the things.
Dr. Emily Shaw: Hi, so yeah, I'm Emily Shaw, I'm a family doc in Sonoma county in Santa Rosa, California, and I am a life coach for community minded docs.
And, that's a little bit about me. I, I also have ADHD and, you know, just like anybody else, I've had it since I was a very little kid and. And, you know, have had many different experiences along the way, but, uh, but I'm proud of who I am today and what I've been accomplishing and what I've been doing to, to help my, to help our community and to help my peers.
And honestly, being a, being a coach now for, for docs who really care about service and who are really service driven has honestly been now one of the most fulfilling things I've done.
Dr. Diana Mercado-Marmarosh: That's awesome. When were you diagnosed? Did you kind of already feel like you perceived that you might have something that was maybe a little bit more different than your classmates?
Like, were you a child or were you a teenager or what did you, do you remember?
Dr. Emily Shaw: Yeah for me. My sort of diagnosis journey was, cause I also have a reading disorder, so it's like, you know what people used to call it dyslexia. And so I think my parents were always concerned growing up in school that I was, I was a very slow, like I, I didn't learn to.
Until much after a lot of my peers. And when I did learn to read, I was super slow and reading out loud was always something that I was a little bit embarrassed about in school. Growing up. I wasn't the, as much, I guess my parents would maybe say that I was a little hyperactive, but I don't know that I met the hyperactive, criteria for the diagnosis.
I've always been like super extroverted person. So I was always like bubbly and you know, that kind of thing, but I have more of the inattentive. type. So I was, I, my parents didn't actually, get me formerly tested until I was in high school. And at the end of high school, I don't remember exactly how old I was, but I remember the whole process.
It was like three days. It was very interesting for me as, as you know, slightly older person being tested. It was really an interesting process to go through. but, and I was always in like the, the gate classes, like the gifted and talented classes growing up and everything. So I, I always, had been able to compensate to a certain degree, like just by, I guess working harder, you know, or reading things over and over and over and over and over again, and like literally highlighting, oh my gosh.
My, all my textbooks growing up were like highlighted in like five different colors. Cause I missed the highlighter in order to like actually read it. You know, and then I, my light, like the part that was important. Oh my
Dr. Diana Mercado-Marmarosh: So did you happen to have a system with your highlighters? Like was blue, like meaning one thing or red mean something?
Dr. Emily Shaw: Yes. Yes. I totally had that. It was the yellow was just to like read and then it was the pink or the blue or the orange. That was like the actually something more important and then I would underline it if it was even more important. Yeah.
Dr. Diana Mercado-Marmarosh: It's funny you say that because I actually did the same thing, unaware that I was trying to help my brain.
So like I would use a green one for anything, like when I was studying for medical school. The green one was anything like positive or good. The red was anything negative. And I would try to make like list of things like opposites to each other so that I could spatially remember the information, but the color was what would like trigger the memory.
It was so weird, but our brains just work a little bit differently. Right. And they, we find tricks of how to enhance it. Yeah.
Dr. Emily Shaw: So I wasn't diagnosed until I was a little older and, just sort of like worked out my own coping things. And I started using medication when I was in college or maybe senior year of high school.
And no, I think, I think it was actually in college. So, I remember that it was like, I went to brown. It was the, like the school psychiatrist that I met with.
Dr. Diana Mercado-Marmarosh: And, how did you, did the medication work? Did you have to try different ones in order for you to feel like that was?
Dr. Emily Shaw: Oh, I felt super lucky because I only tried two things.
I only tried one thing before then I tried another thing that ended up being the thing that worked. And so for me, I tried Adderall first. It like made me so dry. I couldn't even, it was like, whoa and interrupted my sleep too much. And the, and so, and actually the second thing that I tried was the methylphenidate, the Ritalin.
And even at relatively low doses, it actually was working well for me and in a short acting pill because I found that. For me personally, I didn't like the medication definitely worked. Like I could feel it kick in and I could be. Then concentrate on what I was reading and actually, and actually like pay attention in class, which, you know, my classmates were shocked at how much, I didn't know.
They'd be like, oh, so-and-so like the teacher said this and it'd be like, I don't remember that at all. It was shocking how, when I would take it, I would like, actually know what they said. And then when I didn't, I was missing like half the lecture, but I love. That instead of taking a long acting thing, I could take something short acting so that, so I could be, you know, more myself, you know, when I, when I didn't feel like I needed it.
So that's what helped for me, you know, even like 10 milligrams was, I think what I took for, for awhile, through residency and, but I haven't actually taken any medication for a long time. I only use it for myself now. Like if I have to study for the boards or sit there for the boards tests on the computer for like a million hours.
Dr. Diana Mercado-Marmarosh: So what strategies are you using to cope? Are you doing exercise or do you have to plan? What are you using?
Dr. Emily Shaw: I mean, I don't really know how scientific this is, but honestly I've really felt like. Two, major things for me have made a difference. One is that I actually switched jobs. So, I mean, before it, wasn't my ADHD, wasn't causing a problem in my day to day work as a primary care provider.
But what I found challenging was that, Like getting my notes done, not because of a time thing or anything, but just, like, you know, my reading stuff, like reading through documents or different little things were just sort of piling up and not because of like what everybody else, not everybody else, but like a lot of the common things that other people experienced, like there's just not enough time to do this.
Or like, uh, It was, I've just never been efficient. I've never like my, my brain just sort of, I own the way that my brain works and I like, and I love myself and I have this journey from, for me of not just accepting who I am and how, you know, the tendency that my brain has to do certain things.
But really just like loving that part of myself and knowing that's part of who I am, the me switching out of primary care and actually not having like the in-basket stuff and, the notes to write in the same sort of way, and working in a more acute care setting where the visits are targeted has created has made that a lot easier.
So like I'm getting home on time and I, right. There's like things don't weigh on me and I have two little kids. I have, my older daughter is turning five next week and my younger daughter's two. And, so switching to like a shift job. In an acute care setting where things are really narrowed and focused, was really great for me.
The other thing that has been really great, I think, but I don't actually know what the evidence is, is that we're like a whole foods, plant-based diet sort of family. And, I really do, my experience has been that, I'm a lot more clear generally if I eat healthier.
Dr. Diana Mercado-Marmarosh: I eat healthier. Yeah. I mean, Again, you are highlighting how you understand how your brain works or your tendencies and you're using those strengths, right? You administrative work sometimes can be boring for us and repetitive stuff can be boring for us. So you have found a way to use those gifts, of like acuity and targeted and to work for you. And at the same time, you're going to share with us about your coaching, how you're doing something that is really driving your passion, which that together really motivates you so that you have a reason, like you said, you have a reason to go to home to your family, right? And you don't want to come home and continue doing in-basket stuff. Right. You want to go home and be fully present. And so all that is very important. And there is evidence out there that I've been reading about in the last year that the low fat, sorry, the low sugar diet.
Makes a big difference because we get, so sometimes we don't realize that. We're drinking alcohol or we're eating sugary stuff to try to increase the dopamine in our brain. And when you eat a clearer, healthier plant-based diet or, not so much sugar, you are able to, like you said, don't have that brain fog so you can think better and make better decisions.
Yeah. So, I think you really are figuring it all out. Can you tell us about your program that you have coming up?
Dr. Emily Shaw: So, I run a 12 week coaching program for, like I said, for community minded physicians who are looking to sort of improve the way that they experience life. Like, you know, basically I want people to be able to have it all. You know that quality life, the balance, the getting home on time, the, like all of that, you know, the relationship with their spouse that they want. Honestly the relationship with themselves that they want. And so my program is a CME approved and so people can even see any money for it. And it's a combination of, weekly groups and, individual one-on-one coaching every week as well.
Uh, it's called my first 24. It's like sort of the first 24 hours of the rest of your life. And it's been, like I said before, I mean like really the most fulfilling and amazing thing that I think I've done professionally, which says a lot because, you know, I was doing primary care for the underserved before, and that, like, that filled my cup, you know? But this is so fun and it's so amazing to see people become the person they want to be. And, I'm like really up right now.
Dr. Diana Mercado-Marmarosh: Yeah. And it's coming there's one coming up soon, right?
Dr. Emily Shaw: Yeah. So I just literally started recruitment, like enrollment for this next group. That's starting, August 29th, yesterday I had my first two consults yesterday.People who want to sign up, so I'm excited about that, but, and the current group that's is finishing they're graduating tomorrow. Today's Friday. They're they're graduating tomorrow. so I'm really proud of them and I'm really excited for the next group. And, I also have an alumni program, so it's not just like we have this program and then, and then, you know, you're, I want people to fly. Right. I want people to fledge and, and, you know, but at the same time, it's really helpful for people to have sort of like, continued support in some capacity. So I also have an alumni program for the people after they graduate.
Dr. Diana Mercado-Marmarosh: Okay. That's awesome. So what are your big goals in the next five years? If you don't mind sharing with us?
Dr. Emily Shaw: Oh, geez. I've been having multiple, multiple people asking me about like an in-person retreat, you know, like one of the lovely things about, all the virtual stuff that's been going on since COVID has made it, so that. That I thought when I originally was going to be a life coach that I was gonna just like help local Sonoma county docs. And I was going to have a little office that I could just walk to and, and like group space and, you know, be outside. And, what has happened now is that like, people from Canada are coming to my program. People from all over the country are coming to my program and I'm getting to meet people from all over the place.
It's so exciting. But now, so because. Of that sort of more global sort of thing that's happening or the opportunity that presents itself. So many people want to get together in person. And so one of my goals for the next couple of years is actually putting on, an alumni retreat, like a family retreat.
Cause, you know, people get to know each other over the course of 12 weeks and they really like each other, you know, and we'd become like their little family and, and we have a, you know, continued community. We have a Facebook community. And, so that's one thing I want to do. Another thing I want to do is actually do like for people who actually aren't in the program to do some sort of in-person like weekend thing or something like that.
Another goal of mine is to actually work less at my regular job. Because it's not that I don't want to stop doctoring. I love doctoring. I like really love what I'm doing and the service that I'm providing. But I really love this stuff too. And this has been my hustle year, sort of like, you know, I've been doing this now for a little over a year. And I don't want to be working 40 hours a week anymore. You know, I like I'm, I'm thriving in it. I love it. And I feel like I'm present with my kids and everything, but I actually don't want to be doing this much.
Dr. Diana Mercado-Marmarosh: Did you, uh, did you go to the life coach school as well? Yeah, so I just completed it, uh, in July. And I really want to say, like, in the last year I feel like going through that process and being coached, has really like opened up all kinds of like limiting beliefs that I didn't even know I had, and it's been such a growth year. and like, when you say that you go through these courses and, you know, most people are like, what are you going to do? Talk about feelings. That's so weird, right? It, but you don't realize that your feelings are really coming from that thought that you think it's a fact, right? Because that thought keeps coming up multiple times throughout the day on different things you're doing. And when you start. Have somebody hold space for you and tell you, Hey, you know what? It's just like an opinion, right? Like that's not really, that's not really true, right. Just because you're thinking it, it doesn't make a true all of a sudden, your world just starts to become like endless possibilities. And like you said, now you are getting to realize you can create your life on purpose by design.
Right. And now you're getting to share. With all these people and they themselves are having a transformation that ripples, right. It's not that they just changed themselves. They changed how they show up for everybody else around them.
Dr. Emily Shaw: Yeah. And people can, I mean, the other story here is that like, I I've wanted to be a life coach for like 13 years ever since I was in med school. And so like, you know, part of my story. Like you can do what you want to do, like that dream that you had, like on the back burner for a long time, that you know, maybe isn't as like fancy or sexy as being a doctor to some people, that you can do the thing. And I'm going to make like over a hundred thousand dollars from coaching this year and right.
I can make a living as a life coach for docs who like work at community health centers and who, or, or who are specialists who like really care about, about the people that are serving, you know, I never would've thought that.
Dr. Emily Shaw: And there's more and more and more of us, we are really going to change the culture of medicine. We really are.
Dr. Diana Mercado-Marmarosh: And you know, and I don't know if you had this, believe it or not, but. At the beginning when I started, like, I would get so nauseated, like saying out loud how much I was going to charge somebody. But like now I've come to realize that, you know, it takes a special type of person to become a life coach. You already know you're going to serve like you just gonna serve. Right. But in the process of earning the money, and even if you give it away to charity, who do you become to become that person? And so it's such a beautiful thing that you are doing. So happy that I have a chance to share this with the world.
Now I know people are going to be like, how do I get in touch with Dr. Emily Shaw? Can you give us a webpage or an email so that they can hear about your program?
Dr. Emily Shaw: Sure, so my website is pretty simple. It's like www.emilyshawmd.com. So E M I L Y S H a w md.com. I think that's the easiest way. You know, people can reach out to me via email, like it's Emily Shaw, M D coaching@gmail.com.
It's really long, so people can reach out to me via email. Like they can look, they can follow me on Facebook or Instagram. Yeah.
Dr. Diana Mercado-Marmarosh: Awesome. Well, there you have it. If you're ready to change your world and everybody's world around you come talk to Emily Shaw. Okay. thank you again for tuning in take care.
Dr. Diana Mercado-Marmarosh:  Bye-bye, someone who understands that time is your most valuable asset. I am so honored that you have shared your time with me. Please click the subscribe button and join my Facebook group beyond ADHD if Physicians Perspective so that you never missed an opportunity to create time at will. Do share this podcast with your friends, so they too can learn to live life and stay in their own lane.
 

Beyond ADHD A Physician‘s Perspective Ep 3 with Dr. Arun Rao (Bariatric Surgeon, Medical Director of Sarasota Memorial’s Bariatric and Metabolic Health Center)

Dr. Arundathi (Arun) Rao is a medical director of Sarasota Memorial’s Bariatric and Metabolic Health Center, she oversees the full range of medical, surgical and support services provided by Sarasota Memorial Hospital and its bariatric team. She has 3 kids, and into photograph; just like our previous guests, who have ADHD, she’s also overachieving in her career, and life in general.
Dr. Diana Mercado-Marmarosh: Hi, welcome to beyond ADHD, a physician's perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh. I'm a family medicine doc with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers or three and four years of age. And in the past year, I have undergone radical transformation after discovering ADHD, coaching, and life coaching for the past decade, my typical day consisted of having 300 charts, backlog, a graveyard of unfinished projects, and a lack of time awareness. I didn't realize that I was not filling my own. I was running on fumes the last year. I figured out the secret learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius. So they too can reclaim their personal lives back, like I have.
So today what we have is a very special guest, but before we go to all of that, I need to give you some pointers. So as we know, this podcast is to explain awareness of ADHD and how it's a lifelong disease. And I will be sharing with you physicians who will share their wins and their challenges along with any tips that they've learned to over achieve with ADHD. My aim is to stop mental stigma associated with this condition. Most people think of ADHD. Sometimes they think of a hyperactive child running around, but I want to bring to you that perspective that sometimes it could be adult mom, a teacher, a physician.
With this in mind, I want to show you that ADHD is an infinite and it's presented in many different ways with different people. So we will talk about the latest scientific data. We'll talk about different books and resources that have helped us. And like I said, I will bring you amazing physicians to share their life stories.
And just like I've shared with you guys before, I need to give you a disclaimer while me and my guests are medical doctors, we are not your medical doctors, meaning that, anything you learned here is not meant to replace or substitute any advise of your own physician therapists or coaches. In addition, anything you hear here doesn't mean that it is being represented by other people.
Meaning it's our views. It's our opinion. It's not represented by the people that we work for. The employers, the hospital, or any particular healthcare organization. I know I have. Say that my lawyer is proud when I say this part. So I have to get that out of the way. But today we have a very special guest Dr. Arun Rao, and I want to introduce her. She is in Florida. And so let's talk to her today. Tell us about yourself.
Dr. Arun Rao: Hi. So incredibly thankful to be a part of this podcast. I am a bariatric surgeon in, , Florida, , actually in Sarasota. I'm the director for bariatrics of a major hospital. And, I'm also a general surgeon, but my passion is truly, , bariatrics and I've got three little kids, seven, seven and 11, but me through my paces when I'm not at my paces at work.
Okay. I am blessed with three ADHD children that I have had to manage along the way, but they teach me more and more about this every day. They, they show me that every day that the, basically there are different versions of ADHD and how they present symptom-wise things that happen during the day. It's very much an individual thing. It's not a blanket statement if you will. So, but I am blessed to be their mom and they're amazing kids. And yeah, those are my big things. So I'm excited to be here.
Dr. Diana Mercado-Marmarosh: So you have twins cause you said seven and seven.
Dr. Arun Rao: Yeah, they're a handful, but interestingly enough, the way that their ADHD manifests is completely different. I mean, they're boy, girl twins, and my son is he's. He is, gosh, he's a joy. But he is probably my biggest challenge, a lot more issues with temper and, you know, early on, I could just tell something was going on when even when he was young, young, where he couldn't communicate. And I think initially a lot of his problems came from the fact that he.
Communicate, but he is very much someone who with medication can accomplish a lot. And I have to maneuver my way around things when he's not medicated. And, , my seven-year-old daughter is amazing, but she does require a very low dose of something in order to really get, get things accomplished in a meaningful way.
So amazing kids. And my 11 year old was my first dip in the ADHD pool or when it came to kids. So we've grown through the process. And while there are difficulties here and there overall, it's been such a blessing to just have amazing kids that do amazing things.
Dr. Diana Mercado-Marmarosh: Now, can you tell me about your diagnosis? Like how did that come about?
Dr. Arun Rao: I gotta be honest. I wasn't, I was younger at a time when ADHD was not really something people were looking at. And the first time as an adult that I can look back and go, well, that explains, that was, I was thinking it was like in the second grade, I think my teacher's name was Ms.
Gretchen, and she was this, she might've been an amazing teacher, but I knew she was gunning for me, and I can see it in my head where I was at a desk and it was one of those. Tiled floors, vinyl, tiled floors. And I kept tapping my feet, like the whole time, just tapping my feet. And I just, she would say stop and I would keep doing it.
And eventually she got so angry with me that she moved the table, my desk, and my chair in one fell swoop. They weren't attached. And she just pushed me all the way to the back of the room up against the wall. Like, because I, so you know, it wasn't, I didn't want to listen to. It's that was what was going on then.
And you know, of course all the report cards. Oh, she's really smart. But if she could just focus or she could just, you know, it just, all of these report cards fell into line. Unfortunately, I didn't figure this out until right before my surgical boards. And so, oh yes. You want to talk about. It was it my whole life.
I mean, high school was no big deal college. I tanked, I completely tanked in college. There was nothing I could do. I just felt so helpless and I felt really dumb. I felt like everybody could get it, but me and why did I need to read it eight times? And I really just kind of, I kind of gave up and I was actually told my mom, pre-med counselor.
I needed to find something else to do with my life because there was no way I was ever going to get into medical school. So heartache after heartache, after heartache. And, you know, after talking with a number of people about just my frustrations and wanting to share that with somebody, which was really difficult, you know, they said, you know, you have all of these symptoms, have you looked into this?
And then I started doing my own research and, then I finally like, literally I was studying, I had got like six weeks of studying for surgical boards. And I just had basically hit the ceiling on this and went and discussed it with somebody and sat down and teased it out. And, and that was the tipping point for me.
But I went through a lot of bad stuff before I got to that point.
Dr. Diana Mercado-Marmarosh: So in college, you said you tanked. Like where you, I understand you said you were reading and like trying to do everything as much as best as you could, but you felt like frustrated and they told you, forget it. There's no way you can be a physician.
You need to do something else. Like, what were you trying at that point? Like, were you trying like extra tutors? Were you talking it out to people to like, understand how to learn different things? What did you do?
Dr. Arun Rao: So I, you know, I basically tried to isolate myself in my room and I had all of these grandiose plans and it would always end up like I would read the same page.
Like I would get to a certain point cause I, I wouldn't be able to tolerate to a certain point and then there'd be this huge gap and I would read it over and over and, and, and it just, it never penetrated. If there was nothing at a certain point. Now I will tell you the other thing that I didn't realize is that the majority of meaningful studying occurred after 11 o'clock at night, which is not great.
Right. I mean, it's not great, but when I talk about that with like the therapist and. You know, people that I had spoken to, they said, you know, a lot of times ADHD, people do better when they're exhausted because they don't have the ability to tolerate all the noise that usually gets in the way on a regular basis.
So the fact that I was exhausted or I was tired or sleepy actually led my lent itself to doing better learning, because any time before 10 or 11, Nothing was getting in the door, nothing. And so I actually, I really did very poorly in undergraduate and I took time off. So I basically, I did research at a hospital.
I waited tables. I was, you know, I was always doing multiple jobs because my parents were furious. I've got those typical Indian parents that are like, what are you talking about? You know, you know, they didn't understand me. They didn't understand. They thought I was just this goof-off that just wasn't ready to be serious.
And so it made it even more difficult. And then I just said, you know, I can't. After having such a bad experience with college after really trying to give it my all and not getting anywhere with it. I said, I just need a break. It doesn't mean I don't want to still do this, but I need a mentor for like two years or so.
I basically just, I did some research at a hospital. I, you know, kind of, and finally, one day I was like, now I'm ready. I really need to get back to it. This is what I was meant to do. And I went to, I went to a program up in Boston for a year. It was, I definitely engaged in more ways and I did much better.
But I, again, I kind of overloaded myself with work and the majority of studying came at night and because I lived in an apartment by myself, there was no other influences really, but that time became my golden hour was late, late nights studying and. I still took a lot for me to do, but eventually I was able to kind of bring up my GPA, bring up my science GPA and I applied and I didn't get in, in the states.
And so I ended up going to a foreign medical school and, you know, again proved to be harder. But this time I had a roommate who really helped with the process of learning because I started incorporating multiple other ways of getting the information. So it was like, I would sit and we would discuss it with them when I had more.
It was almost weird when I had more distraction and more conversation going on. It also absorbed better. I did more study groups. I did more, there was definite I'm a more visual learner. I figured that out a little bit better. So it was multiple things that allowed me to kind of get through the process in medical school.
And I think as I got older, you know, it just became a little bit easier, but I think it was because I had people in my life who lived with me, who were all going through the same process. And, you know, we worked together a lot to get things like that done.
Dr. Diana Mercado-Marmarosh: So did you ever think like in college or in medical school, like, it shouldn't be this hard.
Like, did you ever think there was something wrong with you or did you just think, well, this is just the way I am.
Dr. Arun Rao: I just basically got to the point where I'm like, you're just not smart enough to do this. Like, that's what, it never ever dawned on me. I mean, at some point when you go through the stuff, like you go through psych and you go through these different things and, you know, it's kind of, you're like, this sounds awfully familiar, you know?
Like, why does this sound so familiar? But I first went to the point where I just wasn't smart and I was just going to have to work harder, but I wasn't smart enough and I wasn't going to do it. Like my roommate in medical school was, she was like a book. Like she could just read something and it would be in her head.
She didn't have to, you know, work as hard obviously. I mean, she just, she could absorb it like, that. And so even more. So I was like, and now I was blaming it on age because of course all my med school people were younger. So I was like, You know, it's just not coming. So for the majority of my life and even now, and it's one of the things that really pushes me to get my kids treated and to have the therapy they need, as I never want them to think that this diagnosis equals loss intelligence, it really does.
It's quite the opposite if you know how to reign it in and control it in a productive way. And so. I mean, I think my kids have really taught me so much more about this than I ever got as an adult child, et cetera. It really, through my kids, I'm learning so much about how this works.
Dr. Diana Mercado-Marmarosh: And so finally, somebody told you, okay, maybe you have ADHD.
So you went to, was it a general doctor or did you go straight to a psychiatrist? Do you remember what that was like?
Dr. Arun Rao: I went to a general doctor and the workup is not, obviously is not as thorough as if you were to go to a therapist or a psychologist or psychiatrist rather. And the only reason I know that now is because my kids see a psychiatrist and he really teases it out.
I'm like, oh, okay. That makes sense. You know, but I went to a general doctor. I almost felt like the diagnosis was too easy. Like they're like, oh yeah, here it is. You know, because quite honestly, I do think that there are people that aren't really ADHD that take the medications because it gives you hyper-focused.
If you're not really. You know what I mean? If the diagnosis is really isn't there, it can give you that hyper focus, but it's not the right way to go, obviously. So I just felt initially I was like, this is too good to be true. This can't be working the way it is. I mean, it was like, I mean, just the tables flipping the way that they did and me sitting there going wait, did I just studied for an hour straight and actually not have to read something three times?
Get it. Like I had to almost, it was so funny cause I did all these no cards. Like I was trying to sell hard for surgical boards to just get it into my brain. I wrote it, I looked at it, I drew it. I, everything that worked in medical school, I really was trying to just cram into my brain and it just wasn't going. And then I got this medicine, I was like, this can't be right. So I would go back to the flashcards and like quiz myself to make sure I didn't just read it and was focused, but that I actually was absorbing it. And it was just. I mean a light bulb went off and I mean, it was just amazing. It was just amazing.
So yeah, I mean, it was definitely, it was a life changer, really?
Dr. Diana Mercado-Marmarosh: So, you know, I don't know if you heard of this book, ADHD, 2.0, it's by Dr. Hallowell, on there, I read it in the last year, maybe in the last six months. And for me it was also life changing. Like I finally understood like myself and the diagnosis and like a lot how I treat my patients because I'm a family medicine doc, and I do see patients with ADHD and I finally got what he was saying.
He was saying that, you know, adults that are diagnosed, that we've had it all along, but we tend to compensate because either something's interesting or we just, you know, Some people call a stubborn or some people call it as determined. We like find ways to get to it, but then you reach a point to where either you have the birth of a child or you have, you get to college or you get to like medical school, law school, something that really challenges you, or you get like, you become like the boss, or something where you, your executive function just tips over, even though everything you were doing before you were finding ways, it's like gets oversaturated. There's doesn't matter what you do, how many more hours, whatever it, you just can't. And that's why it's so hard sometimes because they're like, I see you doing all these other things and you do it so well, but you can't do like something simple sometimes it's really weird because. What might be simple to you is complicated for somebody else, but first something complicated for somebody else, it's like a walk in the park. So that book, if you haven't heard about it or read about it, you might want to look into, it might help you tease out a lot of this stuff.
And he talks about like, How in the last five years, they realized that they can use MRIs to pick up the different areas in the people with ADHD versus not ADHD and how they light up in different, right. Versus the left side of the brain. As we know, some of us are like, we think, and we are creative. Right.
Okay. So it lights up differently for ADHD. So now there's a lot more evidence and, it's just not like you're saying how some people are like, oh, I just can't concentrate. Give me a pill. No, but like now they're finding all these other way. Of course they're not using that to diagnose right now, but at least it's really cool to see scientific data coming out and all that. Are your, are you a first generation here or you always been here?
Dr. Arun Rao: So I was born in India. Moved when I was three. So I've lived here most of my life.
Dr. Diana Mercado-Marmarosh: The reason I questioned that is my I'm Mexican American and my, and I was born here, but, I lived in Mexico. Tele was 10. I was born in Texas and I lived in Mexico. I was 10, but there are studies that show that ADHD is genetic.
And it's also, it shows that the immigrant parents usually, you know, because it takes Coronas right. To like, move out of your country to go somewhere else, to start a whole new life, not even knowing how, but the belief that you're going to do it. Like. So there's a lot of information that is showing that immigrant people, and it's usually genetic because you have to really like it. Make sense. You have to be the Explorer and be creative and figure out. When you don't know how you're going to figure it out, but you're going to figure it out. So, I asked that because you know, I've been interviewing different physicians and some of them like, you know, they come from Egypt, they come from all over.
Right. So it's just, it's so interesting. How ADHD is a spectrum. Like you said, you can see it in your own kids, how it presents differently. And at the same time, how there are certain things that are. Our traits and it's not like a character flaw. It's just, that's the way it is. You know, you take the med and then, like you said, it's not like you were not smart.
You were it's just that the way your brain was functioning was not letting you. Do it all at once. It's like having 25 tabs open and you're trying really hard, but we all know how slow the computer can be. If you have 25 tabs open, lower it down to one or two, it's so much better, right?
Dr. Arun Rao: Yes. And you know, my three kids, I think my oldest is more like I was as a kid.
And when I speak with her, it's interesting. Cause I can almost see it happening. She'll have something to tell me, but she'll have four sentences and they're all trying to get out at one time. So, you know what I'm saying? Like, she, she knows what she wants to say, but because they're all trying to cram out at one time, it just comes out as this kind of like, well, I, and you could just see it all working.
So yeah, I a hundred percent get that. And interestingly, my dad ADHD, my sister is a physician. Mom's a physician. She doesn't seem to have this issue, but I'll tell you, I mean, it is just, I mean, it's crazy. And I think that. Understanding the fact that it is not a sign of intelligence or lack of intelligence in fact it's a sign of higher intelligence that even the product or the ability to get there. And I will tell you with my oldest, one of the things that confused me for a while is if I put her in front of a television set, she has focused, like there could be a bomb next to this child will not notice it at all.
I mean, if that's the way it is when I told the therapist, I'm like, I don't get it. I mean, I think that she just doesn't want to focus. I think she just he's like, that's not how this works. There can be things that will focus you like that. It's the majority of other stuff that you just can't seem to bring yourself to.
So that's also was a part of me that felt like I couldn't be ADHD. Cause there were some things that could hold my focus. Like surgery could hold my foot, you know what I mean? Like it can hold my focus, but.
Dr. Diana Mercado-Marmarosh: Because you're so interested in it. You love it. It's aligned with your passion.
Right. But how about you? But I'm not like, Ooh, I can't wait to do my dishes and my laundry. Like, those are just things that I'm just like, ah, you know what you're doing them. Right. But it's not like it's in the area where your passion is aligned. Right.
Dr. Arun Rao: Yes. A hundred percent. So, but that was the confusing piece for me, especially with her.
And it explained also for me, cause for, you know, after. Training. And I say in training and when I had my kids, I wasn't medicated. After, after my exam, I was for a little bit. And then I was like, do I really need it? And honestly, I don't know that I needed it because I was in surgery all the time and I was good.
I was focused. I didn't feel like I didn't feel like there was anything specific that required that much attention that I couldn't give it. And then things kind of changed, you know, like I, as I get older and I was like, what I realized is that the piles on my desk were piling up. Because I wasn't finishing things completely.
So my ADHD issues led to significant anxiety, lack of sleep at night because I just could not finish things unless it was specific to, so I mean, even at night when I'm like in bed and we're watching TV, I'm into what we're watching, but I'm playing games at the same time on my phone and texting, you know, it's just this constant drive. I don't know. It's crazy.
Dr. Diana Mercado-Marmarosh: Looking for dopamine from different places so you don't get bored.
Dr. Arun Rao: Gosh, I mean, it's, it's crazy and there's, there's very rarely a time. I'm not doing two and three things. And I feel like sometimes I actually feed off of that, which isn't great. You know, so I've had to go back to the medicine in order. Cause now I'm a director, I've got more responsibility outside of the surgery suite.
And so. Not only that, but even just being a parent, who's a surgeon and having to schedule and keep organized. And I don't know how I would do it at this point without having the medication that's necessary to be able to, you know, get me through that day.
Dr. Diana Mercado-Marmarosh: That's what was going to bring me to this question is like, how do you think your diagnosis impacts or affects those around you?
Like your family and your friends? Like, so you notice when you take the med your. A lot more there
Dr. Arun Rao: and I'll tell you, my sister is not medicated, but she'll like, she makes fun of me all the time. Cause we'll be in the car and she's, she'll be having a conversation with me and we're talking and she's like, it's like, you're sitting in the car, you're talking the next thing you go in depth in a conversation, you'll be like, squirrel.
Completely unrelated, not even close to what we're discussing and I'll sit there and I'll go. But when you said this, it made me think of this, which may lead me to this. And she's like, you just need to stop.
Oh, well, hers is not as difficult to manage as mine has been. And I think the more stuff I've got to juggle actually feeds into it and makes it more difficult to focus, you know, in life in general. So yeah, it, it makes a difference. Yeah.
Dr. Diana Mercado-Marmarosh: So I'm in that book that I was telling you about, they talk about how ADHD has two times.
It's now not right now. And usually the not right now, like we forget about it. So unless we write it down or we keep a, like a little nugget somewhere that's. Like you said, like, if you were doing a paper, , filling out some work and then you didn't have all that information. Right. Then you're like, oh, I'll do it later.
But then later, like you just it's out of your mind that you forgot. So like, oh, dang. And then it could be months by the time, like, oh, there are, the papers are still there. It's almost like you become blind to them, even though they're right there, right in front of you.
Dr. Arun Rao: Oh my gosh. It's so true. You know, the other thing is like I carry a patient phone, I carry a personal phone and the patients are like texting me throughout the day, or if I'm in the operating room and I'll be like, okay, I'm going to answer that phone.
And sometimes I actually have to do something physically to my phone or have them wrap it a certain way. So it triggers me after the case to make that phone call or communicate with that person. So you do kind of compensate that and that's even with the medication. So it's not always going to be a perfect scenario, but it's definitively better.
You know then that, and I'm gonna also say that recently I took up photography. Like it's always been something I've enjoyed, always something that like in the, like, I try to take these interesting pictures and I never, I sat down. I'm like, Hey, I don't have any hobbies. Like I'm either a hundred percent doctor, a hundred percent wife and mother there's like literally nothing in between.
And I'm like, I really want to be more three-dimensional with my own, you know, with me. And I was thinking about it and photography popped up. I honestly think that I would not get to a point where I want to think about a hobby for myself. If I didn't have good control over the things in my life right now, I would feel overwhelmed and incapable of adding anything.
But this, that, this allows me to be far more dedicated to things, because I know I can accomplish them as opposed to adding things to a list that you know is going to be forever growing.
Dr. Diana Mercado-Marmarosh: Right. And, and I think that's a very important trick or technique. Really, I call it self care because when you are doing things that, again, go back to what brings you passion or something that intrigues you because it's different, or you're wanting to learn about it.
Then you are prioritizing what needs to stay on your schedule and what can be delegated right. Making sure that you do make a commitment to yourself to have that specific time to do that, that, that photography, right. Or for some people is running or sleeping or different things. But it's important because, I don't know about you, but with me before learning how ADHD work in the last year, I had no time for me.
Like, it was always like kids, you know, or work or whatever. And like, I didn't know. I could ask my husband, Hey, can you watch them for 30 minutes so that I can actually go for a run or like, I can meditate or I can journal or something. I just. Like, you know, that's not something I can ask for because I haven't done all my other jobs, but like now I'm like, okay, well, if I have to prioritize me, because when I prioritize me, then I feel my own cup and then I can show up more mindful and more present with whatever I am doing.
So, like you said, it's kind of like having a structure for the thing that you love. Can do everything else more efficiently.
Dr. Arun Rao: That's the thing is like, I don't want to be like, I don't want my career to define who I am. Like I see this all the time. I see people wanting to retire, but especially there are some older surgeons, older doctors in the community that are trying to retire and I see them come back after a retirement party.
What are you doing? They never develop that side of themselves. And, you know, as ADHD folks, I'm sorry, we are creative. Like that is definitely one of the traits. And I see it in my kids, my son, oh my gosh. He's got a million Legos, Amelia. My daughter loves to draw my seven year old will get on the computer and draw amazing things just from a little tutorial.
And Maya's always been like taking pictures or, you know, painting. They love it. I, you know, I dropped them off. You know, one of the local art places and make for two hours, there are good. So I feel like I want to foster my own growth. And, one of the things I've realized about ADHD is it doesn't even in a particular person, it changes as you get older, as you move into other parts of your life, it's not a black and white.
It's not like here's your diagnosis, here's your stuff. This is how you fix it. Go ahead. There are different aspects to this, even as an individual that you go through. Based on how you manage before you ever figured out something was, was not right. You know, so,
Dr. Diana Mercado-Marmarosh: And just like you've said, like, based on whatever's going on in your life can lead to anxiety and depression, in addition to you having your ADHD right.
Or life sometimes happens, you know, we're grieving something, you know, so. Take us in different places. And like recently I've been learning about like hormones and stuff. So like menopause, like can really affect people with ADHD. So it's, unfortunately, some people don't get diagnosed until then, which, you know, it's hard, but it's also important as we're learning more things to keep an open mind and to be curious, because.
Even then people are like, well, they're 50. Why do they need their meds for you're like, dude, some of us lived to be 90, like 40 of them, like being able to do like a productive life. Like I still have some people that I've diagnosed like later in age and they still tell me, doc, this was life changing.
I can't like finally write my music or like do all these things that you just that's the thing with our brain. Like, we're still curious. I feel like we're long term students, like we are constantly learning because we're curious.
Dr. Arun Rao: Yes. And that's the thing is adds quality to life in retirement, right? Like I know, I remember I can clearly remember my dad taking like a glass class when we were, we lived in like Arizona and he had this little work bench and, but he would never finish.
Any of his product. I don't recall ever seeing a finished product and you now he's older. He doesn't really want to do it. And I'm like, when, you know, you can finish something to completion the impetus to want to start both so much higher and you know, your desires improve. Quite honestly, the directorship here has led to so many cool developments because they've given me kind of a cart launch to develop things.
And I kind of made a mental list when I first got here, what I wanted to accomplish. I've literally in four years I have, I actually have created two other clinics. I've been able to hire, dietician, just different things to make the clinic better, to give the patients things that can support them. I mean, by making.
By giving myself the opportunity to use that creativity and see the need and fill the need. It gives me the opportunity to be a better doctor to fulfill the needs of my patients. I mean, it's just, it's awesome. And I go forth with that and I become even more persistent when I know it's a good thing. And it allows me to accomplish so much more on a regular basis.
Really. It does.
Dr. Diana Mercado-Marmarosh: Yeah, that's a wonderful that you're bringing that up. Cause that's what I was going to ask you. Like what are some, , reflecting, like what characteristics make you a great doctor? And like you just said, it's your ability to see the big picture. You don't know how it's going to get there, but you just, we are dreamers.
Right? And we are changers and it doesn't matter how long it take, but this is how I want it to look. I don't care how the details don't tell me what the details, just make it happen.
Dr. Arun Rao: That's ahundred percent because it's all, it all starts with vision. Right. And maybe the vision isn't what the final, but usually the final picture is better than the vision because all of these pieces just start to come together.
And so, I see when I first came here, I begged, four years ago, please get me telemedicine, get me telemedicine. Because one of the things in bariatrics that ends up happening is the patients just disappear. They feel like either they feel overly confident. They've got it. They don't have to worry, dah, dah, dah, dah, or it's just too hard or they've moved somewhere and they can't find the person that will help take care of them and keep them going.
So I begged for telemedicine for four years every year. Oh no, we're not ready. We're not ready. And then, and the funny thing is they gave me telemedicine before COVID hit. So it was really that just persistence of look, neurology's got it. Why can't we, I really think this is important. And the next thing you know, I'm helping to spearhead the initiative when COVID hits, you know what I'm saying?
It's just, it's crazy. So, yeah, it's pretty crazy. It's awesome.
Dr. Diana Mercado-Marmarosh: What are your goals for the next five years? Have what are you envisioning like in terms of traveling with your family maybe, or, , anything in your career or any new hobbies that you would like to do?
Dr. Arun Rao: So, you know, I literally, I mean, when I say I just started with the photography thing, I mean, my camera came in the mail last week.
So it's like really new. And I met an amazing PMG with, you know, with our process that has actually mentored me in the process of photography. Cause she's a photographer, so it's been great. But I really, for me, the, the key is to make sure that I am, assisting my kids because of course with children, you know, it's an ever-changing situation in terms of the meds.
Is this working? Is this not? And as a parent, you know, I can honestly say I've had a parent in my office, boo hooing. I mean the big tears telling me that she just found out her child has ADHD. Why are you crying? She's just looking at me like you're crazy. And so I started saying, listen, your child is probably well above average intelligence, do not take this as a negative thing.
You're you need to empower your child to use this diagnosis to do great, great things. So, you know, I mean, I really, that. Journey with my kids right now and really making sure they're on the right meds and the right dosage. It doesn't change their personality. They're getting the most out of school.
They're pushing ahead. Like those things are going to be critical in the next five years for me, as they move forward in their education. And as far as work is concerned, oh my gosh, sky's the limit. So I opened a medical weight loss clinic. Designed to help patients who already had surgery. I take all comers.
It's been an incredible experience already, but my last goal, which I haven't quite accomplished, but I'm starting to kind of step towards that is I wanted to create a family program. You know, I wanted to develop a program where it isn't just the one family member who has diabetes and has the issues coming to me for surgery.
And then I'm putting them back into a situation with an entire family that has a similar problems or headed in that direction. But have no guidance. So my goal is to start very small, maybe five families a year where we take the entire family and change their thoughts about nutrition and lifestyle changes and their thoughts on how food works.
So that maybe the next generation won't find themselves in my office, you know? Yeah. That's and I'm actually, you know, I've actually got a book that I'm contemplating and it's interesting. Cause it's one of my patients, is I've been thinking about it forever, but my patient came to me and said, I he's a well-known person, so he's come to me.
And he said, I want to write a book with you. And so although pieces are starting to slowly kind of come together, but I mean, man, I'm just excited. You know, ADHD did not bring the excitement for a very long time, but, I don't look at the climb anymore. I look at what the view's going to look like at the top, because I finally feel like I'm going to get through the climb and I'm going to be able to see at the top, whereas before I did not feel that way I could only see the obstacles.
Dr. Diana Mercado-Marmarosh: It's so wonderful. How you, you just described the mind shift that has happened. That has. Instead of feeling like, man, I have this, what the hell? It's not like I have it. Yeah. Guess what's going to happen. Right. And start to just visualize the possibility of being able to do whatever you want to do.
And having people around you to support you in doing what you're doing, because it does take a village, right. To be able to help us with our kids, to help us with, um, the vision of, of empowering the whole family. Like you just said, not just that one person that came and was your patient, but the culture so that, like you said, going forth, this is just not something that happens again, because your culture, that's how you eat or that's how you share the love with each other. Right. Learnings at the, excitement should be from the activities that we do, not the culture of eating, because like, I don't know about your family, but I'm sure it's like my family, we eat. Cause clearly we're happy.
We're sad. Like somebody was born, somebody died, like, you know, our everything, right? Yeah. And, so you celebrate other people's like holidays, not even your holiday. right. And so you just have to learn like being in a family, like together, playing board games or different things. It doesn't have to entail all the foods.
Dr. Arun Rao: It engaging. I tell people all the time, the people, you know, it's not the food that's on your table. It's the people around your table exactly. To change that focus. And when it comes to ADHD, you go from being. You know, over basically overwhelmed and overpowered to be, to being empowered, which is such a huge shift.
Dr. Diana Mercado-Marmarosh: Yes. Awesome. So tell me if my listeners wanted to get in touch with you to either ask you something about your kids or just to ask you about how do I get in touch with his family thing that you're doing or to become one of your patients?. Where can they email you somewhere or do you have a website to share with us where they go?
Dr. Arun Rao: You know, my practice is at Sarasota Memorial hospital. It is the public hospital. It is the biggest hospital in Sarasota. And, I, if you just Google my name, the, page, all the pages kind of come up and we're still in the midst of developing these pages, but you know, the beautiful thing is with telemedicine the reach just grows and I'm not here to say I am the best out there. But it's imperative that people. Fight for themselves and their, for their life. And the interesting thing about Sarasota has changed my thoughts on obesity and bariatrics and health in general, because I went from a population that was really 50 and under to a population.
The majority of my patients are 65 to 80 years old. I'm talking about going into surgery at 79 and 80 years of age. Doing just phenomenal, phenomenal things. And so I encourage patients no matter where you are in your life to fight for your life, fight for that quality. And if it means, having the conversation starting the discussion, you know, you can always sit there and be discouraged where you're at or realize that if you don't move, you're going to be here in the same spot for years to come.
It's a big journey. I'm not going to lie no matter which way you go, this is a big dream, but it's going to be worth it. And if you start that journey, You're going to be so much further along and then you get to look back and go, oh my gosh, I'm so glad I started. So definitely, you know, there are great providers, great bariatric surgeons in every community.
You certainly want to search for somebody who has an ASMBS certification. That is a quality designation. Our program is meant to help as many people as possible. We are, by the way, very excited because in October, we were initially doing that one clinic for three days a week, we went from two days to three days administration just called them and said, we want you up to five days by October.
Dr. Diana Mercado-Marmarosh: That's amazing. Awesome. Well, there you have it. Is there one final piece of advice you might want to share right before we close? I know you dropped all kinds of amazing, you know, advise already. And especially what you just said, like that can be applied for anything, like fight for your life, whether it's for exercise, for getting an ADHD coach for, getting a family physician or a cardiologist or some therapist, anybody who really understands you. And if you don't like what happens, go get a second opinion, right? Like that's the part that is really important until you find somebody that understand where you're going and both together work as a team to get there, because I mean, you are great and I am great as a physician, but that doesn't matter if the patient is not ready.
Right. And so when the patient is ready, the teacher shows up. So, so that's how that happens. So, thank you so much, but anything else you want to share really quick with us?
Dr. Arun Rao: I mean, I just think that, you know, the power of the mind is something that is just, and I tell people all the time, even as a bariatric surgeon and I say, you know, we have people who gain their weight back definitively true.
But if I operated up here, Nobody would ever gain their weight back. And that goes for everything in life. And you know what nobody's going to fight for you. You have to fight for you and you only get one life. Don't say you're too old. Don't say you're too young. Those are just excuses. You've got to find the right doctors to help you to be the best you at every stage in your life.
And so I encourage people to just be advocates for themselves. And if you're not happy, that is so critical. I can't tell you how many people I've met that have seen another physician who was. Oh, oh, I don't know. And I'm like, whoa, my goodness. If it doesn't feel right. Don't give up, go find somebody. You, everybody has that sixth sense.
You got to listen. So, you just, you gotta fight for yourself. And, I'm so glad that I had a chance to talk with you. I hope that, you know, our, our discussion today helps somebody make a better choice or, you know, search for something better in their life. I think that's critical.
Dr. Diana Mercado-Marmarosh: Yes, you so much, Dr. Rao. It was a pleasure to talk to you. You're such a delight and there you have it kids, and adults, as you see, we're all kids at heart, we all always want to be, empowering ourselves to try new things and challenge yourselves. But just like that, you have to remember that new things are new for a reason.
So don't be so hard on yourself. Start with a beginner's mind and explore it and have fun with it and keep trying to empower yourself because that's the only way we improve. It's not to compare ourselves to others, but to compare ourselves with ourselves so that we improve. Our own quality of life so that we then show up better for everybody else because we are happy.
So thank you again for listening to this week's episode with the overachieving ADHD physicians. I really enjoyed, my awesome physician today that I got to share with. And if you guys have any topics you all want to talk about, or any feedback you want to share with me, send me an email at overachievewithadhd@gmail.com and y'all have a good one.
As someonewho understands that time is our most valuable asset. I am so honored that you have shared your time with me. Please click the subscribe button and join my Facebook group Beyond ADHD, A Physician's Perspective so that you never missed an opportunity to create time at will. Do share this podcast with your friends. So they too can learn to live life and stay in their own lane.

Beyond ADHD A Physician‘s Perspective Ep 2 with Dr. Nina Mara Di Nicola (Emergency Medicine Resident, Physician Health Fellow helping and supporting other physicians and their wellbeing)

Dr. Diana Mercado-Marmarosh: Hi, welcome to Beyond ADHD, a Physician's Perspective podcast. I am. Dr. Diana Mercado-Marmarosh, I'm a family medicine doc with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age. And in the past year, I have undergone radical transformation after discovering ADHD, coaching, and life coaching.
For the past decade, my typical day consisted of having 300 charts, backlog, a graveyard of unfinished projects and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes the last year. I figured out the secret learn to stay in your lane. So now my mission is to help others develop systems that tap into their sown of genius.
So they too can reclaim their personal lives back, like I have.
So as we all know, ADHD can affect people in different ways and people deal with it in a different way. So this podcast is created for adult professionals to have a community. Where they can come and share whatever their wins are, whatever their challenges have been and how they've learned to over achieve.
And strive. Right? So when most people think of ADHD, usually their mind goes to that hyperactive kid who can't stay still in a classroom. Right. They're kind of annoying and distracting others, but they never remember the females who are sometimes calm and sometimes just daydreaming and they're trying really hard to focus, but they just can't. And guess what, both kids can become adults. And this is where the data gets lost. Sometimes people think that as adults, you out-grow this, and that's not the case. So I am going to be talking to you guys about ADHD, how it can be a gift. But you need to learn to unwrap it. So throughout this podcast, I will be bringing you the latest scientific data.
I will bring you different strategies and I will bring you amazing human beings who have, and are striving in their fields. But  before getting started, I have to give you a disclaimer. Well, me and my guests today are medical physicians. We are not your doctors. What that means is that the information that you will learn here is not meant to replace or to substitute any of the advice or information that your own physician there best or coach gives you.
In addition, any advise share here is considered our own views and opinions. They're not meant to represent. Any other employers, hospitals, or particular healthcare organizations. I know that was a handful. I hate to say that, but I had to, my lawyer's going to be so happy anyways, now that we got that out of the way this week, I am so excited to talk to you about a very special guest.
I have Dr. Nina Mara Di Nicola is a former Physical Therapist, turned Emergency Doctor. Who has completed her residency in emergency medicine at my Gill university and Montreal, her diagnosis of ADHD was given to her in her first year of residency. It triggered a journey into a world of pharmaceutical and non-pharmaceutical management to optimize her functioning and overcoming.
Her special interest reside and wellness led to complete a fellowship and physical health and wellbeing at UC Davis and her former research on resident mistreatment. She founded ADHD peer group for postgraduate medical alert. Where she facilitates months, monthly meetings to share resources and practical tips and tricks. When she isn't studying for her Canadian emergency medicine, Royal college exam, she can be found running on the lashing canale, playing the piano. Learning Cantonese doing yoga and meditating with her cat Livo fed. So I probably butchered a lot of those words, but don't worry. We're going to hear it from her first hand, please. Everybody woke up. Tell us Dr. Nina, tell us all the things.
Dr. Nina Mara Di Nicola: Oh, thank you so much. That was a very kind introduction. Thank you, Diana. So they call you Diana. So I guess the one thing, the one thing you, uh, you got wrong was my fellowship. It's physician health actually, that's important. So it's actually about, helping other physicians and supporting their wellbeing, and that was a fellowship year I did, or a six month program I did through UC Davis last year. Okay.
Dr. Diana Mercado-Marmarosh: Amazing. Thank you for clarifying that. That is a very important distinction. Okay. So two. What were the circumstances that led you to get this diagnosis? You, found that in your first year of residency, tell us all about it.
Dr. Nina Mara Di Nicola: So, I had suspected it many years ago, but I, you know how it is with ADHD, I sort of put off or did not make my way to access the diagnosis. And like it took literally. Probably 10 years between that moment where I started to really suspect it. And as a matter of fact, my father is a child psychiatrist and my father. He's the one that suggested it in me, but really in my mid twenties. And that was sort of, despite the fact that I had very typical symptoms as a child, like, you described that kind of very active child, often a boy, but. I was that very active child in the classroom. Interrupting all the time. I actually had to be put, like I got a separate desk that was sort of behind a wall, that they created in my classroom just to keep me physically separated from the group.
What happened though, with, since I was doing very well academically, they just kind of pass me through. And there was always a mention in my report card that, you know, I should, not talk so much or kind of control my behavior. But since I had A's everywhere, they just kept me going and nobody thought.
At that time to actually look into what was happening. So what happened was finally in residency. I guess I just wasn't really performing like at the expected level and not because I wasn't trying and it, something just seemed really off to me. Like, why is this so difficult? And, at that time I met with a psychiatrist and after one session together, just listening to my story of my childhood and like throughout my life, she diagnosed me with severe mixed ADHD. And, that's it. That's how I got my diagnosis.
Dr. Diana Mercado-Marmarosh: Perfect. You know, it's interesting what you just said. It, I kind of followed the same, scenario. Like I too was that kid and, who like both my parents had to come and sit in the classroom because I was disrupting everybody. And they would give me extra homework and I would do the homework. But then I was still disrupting. So like you said, I, academically I was doing fine, just like you were saying. And so they didn't think anything of it. I'm curious, whether prior to your diagnosis, like, did you perceive it, like you said, your, your dad had kind of mentioned it to you and you kind of thought maybe there was something, but did you always think there was something off or no?
Dr. Nina Mara Di Nicola: You know, I think I really didn't put all the pieces together. Even, when I received my diagnosis, it took another really another two years, two, three years, like I'm now in my starting my fifth year of residency. So I would really say it took that long. It took three, four years for me to really understand how much. What I just assumed were my own character traits and flaws. How much of that was reflected in this diagnosis.  And it's, it's amazing, like so many parts that, I just, you know, it's, you're so used to living in your brain and you just think this is, this is life. This is how it is. And you know, other people might get frustrated with me for certain things, but I never really saw them as a problem. And it really wasn't until I was medicated for the very first time that I started to pick up on these little details and I started to understand, oh, okay. I see how that could be frustrating for someone else.
I could give you an example. It was, I had, I had this recurring argument with my Partner at the time where I would, you would get home. I would reach into, well, I would look for the keys. First of all, which you know is very, it could take like a couple minutes to find my keys. I'd be looking at all my pockets. I didn't know where I put it in somewhere in my backpack. I can't find them.
Finally. I get all my stuff out of my bag. I get my keys out. I would, so we have this like key, this electric pass at the front door. Just to open the main door. So I would get it out. Finally open up the front door. Then from that front door to my actual door of my place is like maximum 25 steps. Okay.
And somehow between the front door and my door, I would lose the keys again. So I would put them back somewhere in my bag. I wouldn't be thinking about it. My head is somewhere else. I'm totally like absorbed in thoughts and conversation when we get to the front door and now I have to start the process again.
And my partner at the time was like, what is wrong with you? Why do you keep, like, why don't you just keep them out? And I was like, what are you talking about? Because in my head, So much time had passed and so much had happened in the 25 steps that it didn't even make sense to me. Why you would expect someone to do that?
Like, it seemed crazy at the time anybody would have that much. Awareness. Right? So, it was like literally the same argument every time. And the first time I actually started my medication, my stimulant medication, I came home from work. I, took my keys out of my bag. I tapped them on the door. I held them in my hand.
I walked up to my front door and I unlocked it. And then I just started laughing because all of a sudden I understood why that was like something frustrating. Right. And I could not have imagined that. So taking the medication was one thing that opened my eyes in a major way that I could not have understood before.
And then on top of that, like it took years of reading about it, listening to podcasts, reading books, and seeing what other people were describing as symptoms that I actually started putting all the pieces together.
Dr. Diana Mercado-Marmarosh: Right right now. Let me tell, let me ask you this. Did you feel like prior to your medication, like you had 25 tabs open?
Dr. Nina Mara Di Nicola: Oh yeah. And
Dr. Diana Mercado-Marmarosh: And then like you take this medication all of a sudden there's like two or three. There's not like 20.
Dr. Nina Mara Di Nicola: So I remember, I was home. Like I, so I had to go through a lot of different medication adjustments to figure out. The right dose, the right medication. I had a lot of side effects, so I really went through lots and lots of, medication changes.
And at one point I was home. I think I needed to study or something. So I took, I took like an extra dose to see if that would help, like a kind of short acting dose and all of a sudden. I realized that I could hear my fridge humming and I had never heard my fridge humming in my life. And I realized that the reason I could hear my fridge is because all the noise in my head actually quieted down.
And it was like, it was such an amazing moment. I remember I went and I made a post about it on our group that we have like a private group, right. For physicians that have ADHD and. And it was like, guys, I can hear my fridge. I had no idea that my fridge made noise. So there were a couple moments like that where, you know, really when I was very optimally medicated that I noticed the thoughts would completely quiet down.
But I have to say that's rare. Like even now with medication, most of the time, there's still a lot going on, but I can. I can focus on a conversation, a task way, way, way, way better than before. So, yeah,
Dr. Diana Mercado-Marmarosh: So that's very interesting because yeah, it definitely makes a difference when you're able to hear other things outside of you, because you actually don't have your own thoughts running, 10,000 times.
And it's so interesting. I don't know if this happened to you, but when, prior to medication, like, or maybe on the days, I don't know if there's days that you don't take medication, but when you're talking to your friends, like, you're so busy trying to like, listen to what they're saying, because in your mind, you already went to 10,000 places and you're trying not to interrupt them because then you're going to forget what you, what the connection you were going to make with them.
Dr. Diana Mercado-Marmarosh: Did you notice that?
Dr. Nina Mara Di Nicola: So I do want to say I take my medication every single day. And my psychiatrist was really very, felt strongly about this. And the first thing she told me, because I asked her, I said, okay, so I take these when I go to work. And she said, Nina, your relationships don't take a vacation. Your relationships don't have a weekend, right? So you need to take these every single day. Because at that time, when I was seeing her for this, I had just gone through a major breakup. Like it was clear from my just listening to my story, that ADHD had really strongly affected my relationships and that, insight that she had to tell me, no, you take these every day. I think that was really genius of her actually, because I, really, I do that. I mean, you know, sometimes once in a blue moon, I might skip a dose. Sometimes if I'm switching over to night shifts, But almost like I'm very diligent actually about taking my medication
Dr. Diana Mercado-Marmarosh: Thank you so much for pointing that out. You know, a lot of people have this, this thinking that like what you just said, like, oh, I only take it when I'm going to take a test or I only take it when I'm at work or I only take it when whatever right. But like you just said, you have to come home, you still have to be a friend. You still have to be a daughter.
You still have to be a girlfriend or a wife or a mom. Right? And why does work only get to have the best version of Nina? Right. No, like you just said your relationships do not go on vacation just because you think you are. Right. So that's very important to point out. And why do you think people don't want to take their vacation, their medicine?
I think it has to do with they’re thinking that they're going to get addicted right. To stuff.
Dr. Nina Mara Di Nicola: It's really interesting. So I've never personally had this concern about getting addicted. I know some people have this concern, but I didn't have. In my mind, but what I've noticed is myself and pretty much everybody I know, and I do run a support group for residents with ADHD.
So I'm in contact with quite a few other people, you know, in my position that have ADHD as well as a whole network of physicians. And I think what happens is it's this tricky thing where the ADHD brain, is a little sneaky. It's like, it doesn't like to follow rules, right. That's kind of one of the big issues, right?
So there's this real tendency. Not because they don't want to take it, not because they don't like it's, it's like this little rebel voice in your head saying like, oh, you don't really need that today. You can skip. And I find almost everybody I know at some point, especially early on will try to skip their medication or stop their medication.
Like I stopped my medication for almost, I think, six months of my residency, because I was having a lot of tolerance issues and they were trying, like, I was trying to non-stimulant medication to see if that was sufficient. And then at one point I just realized that. What have I been doing for the past six months?
Like I haven't been studying, I haven't been doing my research project. Like this is not okay. And I sort of woke up and I would say it really took, it has taken like three, four years for me to accept that I need this every single day I take it. I wake, I wake myself up one hour before my alarm clock is supposed to wake me up.
Like the real alarm clock. I wake up, I take my medication. I can't even think about it. I'm half asleep. I take it, I go back to sleep and when I wake up, it's working and that was like the single most. I mean, there's a lot of things that, that made a huge difference, but that made a huge difference because instead of getting up, having to think, do I need it? Should I take it forgetting to take it or not? I have some time, some days I just, I didn't know if I had taken it. And then, yeah, so it was never, it's funny, like my brain off-meds sort of doesn't really think there's a problem. It's like, oh, everything's fine. I'm fine. And then sometimes it would be like someone else that was pointed out to me and I'd be like, oh, oh, am I acting different?
And they're like, yes, you just spent like 20 minutes opening one time. It was, I literally, I was supposed to, my mom was coming over and I needed to clean my place up. And for some reason, Off medication Nina decided it was time to open my piano. I have like a beautiful, upright channel, open it up and start, like, I don't know what I was doing.
I was like looking at the chords and I was like the cords inside the account. And at the time my, my partner was. Okay. Um, I think we need to, like your mom's going to be here in the hour. Like you need to clean up and, and then, and then the next question was like, have you taken your medication? And it's like, oh no, I have not taken my meds.
Like, that's why, so you know what it did. It was a lot of external input in the beginning. People noticing the difference. And it was enough that eventually I convinced myself, like I had to convince myself that this was it. I have to take it every day. I have to be disciplined about it. And I think it's funny, this concern about being addicted because.
If you're addicted to something, you don't try to convince yourself not to take it. Right. Exactly. So that really goes against the whole addiction theory. But I'm not, I'm not an addiction expert I share.
Dr. Diana Mercado-Marmarosh: Okay. But I just bring this up because I feel like part of the community always brings. Question to me, like I know when I have patients who have ADHD and they're starting on their meds, they always ask me, okay. I just give it to them when they're at school. Right. Well, you tell me, do you want them to clean the room on the weekend? Like, do you want them to be able to play in the tournament on Saturday and Sunday? I'm like, no, you'd give it to them every day. I wouldn't take away the medication for somebody who has diabetes or high blood pressure.
Why would I take away a medication on a weekend for somebody who clearly has been diagnosed as needing it? Right. So, thank you so much for pointing that out. That is so important. Because we are impulsive people. We are very creative and very spontaneous people and sometimes accidents can happen. If we are not, you know, all there so to say.
Let me ask you this, what do you think are some of the best resources that have helped you in this last three or four years that you told me that you've been discovering yourself?
Dr. Nina Mara Di Nicola: Great question. So I have a list. I had to sit there and I thought about all the, all of these little things that helped me on my, on my journey. One of the first things was, you know, I went to the library I'm, uh, I went to the bookstore. I'm I'm a reader. I'm the kind of girl that as soon as there's a problem, I want to read everything about it. So I went to, this bookstore and I just started looking at all the books on ADHD. And I came across this one called ADHD friendly ways to organize your life.
It's by Judith Kohlberg and Kathleen Nadeau. And this is a fantastic book. It goes through every chapter and it's totally. Written for people with ADHD, the way they format things, the way they like highlight things and there's boxes and it's super like fun to read. And each chapter is just a short chapter where they focus on one little issue, that's quite common with people with ADHD in terms of their organizational abilities. And it was through that book that I recognized that so many of my lifelong struggles we're actually not stubbornness, but common traits associated with ADHD. One of the, one of the big ones there is not opening my mail.
So I have a habit of opening my mail maybe once every six months. Now let me tell you Diana. Probably my most expensive, bad habits
Dr. Diana Mercado-Marmarosh: I was about to say that's a very expensive ADHD tax you're paying their girlfriend.
Dr. Nina Mara Di Nicola: The last time I did or a couple of. I think a year ago, I went through this process of opening all my mail for the past year that had accumulated and I had to pay thousands of dollars in late fees for things like my property tax. And just like so many things I hadn't paid my license. Thankfully I hadn't driven. So like, oh my gosh. These little, like, I don't actually, I don't actually know how neuro-typical people remember to do all these things because it's, to me, you know, we have this, very interesting sense of time, which is now, or not now as you, as the, you mentioned earlier,
Yes. So, but what was comforting to me, I really thought this was like a Nina problem. Like Nina doesn't, whatever it is. It's the rebel in me. I don't like to open my mail. It's just strange thing. And then when I read this book, they talked about this, about mail backlog, about how it's common for people to not open mail for like months and months and years.
And I was like, oh my gosh, This is not just me. Right. And there was such a freedom with that. And like, it made me feel better. It made me feel like I was less broken, less stupid. Like I used to think it didn't make sense. Right. Because I, was a physical therapist. I had gone through all this education, all this university, you know, then med school.
Well, before med school, I remember thinking like, I know I'm smart, but I act really stupid sometimes. Right. I lose things. I can't figure out how to like wash dishes and sort them properly. Like these little simple things. We're complicated for me and really complicated things were easy for me. And it was always like that my whole life I would get, I would score top grades on the hardest exam.
And then I would make little mistakes on the stupidest things. So that, you know,
Dr. Diana Mercado-Marmarosh: They would tell me this, like I would do similar thing. They would tell me the Diana you are booksmart. But you're not street smart. And I would always get myself in trouble. Like you just that like the complicated things. No problem. I got it. But the common sense things. Forget it.
Dr. Nina Mara Di Nicola: When I got into med school, I remember more than anything feeling like, oh good. Now people will believe me that I'm saying. Like how sad is that? It's so crazy that I felt like I had to prove something because something didn't quite make sense. I felt like I wasn't really living to my full capacity.
So that was, so that book was one of my big resources, a couple more, I'll mention the ADHD for smart ass women podcasts that Tracy Otsuka that you were on. That podcast, you know, I remember. I don't know how I found out about it, but I, I think I probably just found it on Spotify because I, I love Spotify.
I love music. I like, I have music playing almost 24 7 if it's not actually playing it's playing in my head. So, and I discovered that podcast and, you know, every episode she's interviewing people and she's talking about, knew about different concepts associated with ADHD. And I, I completely identified.
Almost everything she talked about in that podcast. And it blew my mind, like how much of who I thought was me. And like, this is my personality. Like those are ADHD traits.
It's, it's fascinating. Um, you know, and then my other resources where the people around me, I have an amazing ADHD coach. Her name is coach Maddy or Madeline Cote here in Montreal.
She really helped me reframe my challenges, uh, challenge my negative self-talk and really learn to believe in myself. Because, what we've discovered is that children with ADHD because of their ADHD gets so many negative messages, they get way more negative messages than the average child. And that has an impact on you.
And you start to talk to yourself in that way. And I see this all the time with my, um, my co-residents with ADHD is that people just start to. Doubt themselves and blame themselves and think like, oh, what's wrong with me? Why did I do this? Whereas, my coach really helped me understand like, oh, that's my ADHD.
Why did that happen? Exactly. Like getting curious, as you said, get curious, ask questions and don't. Don't judge yourself, like, Accept that that's, that's part of who you are. You're a human being. Even if you're a doctor, you're a human being right. At the end of the day, we're all humans and humans are going to make mistakes.
And that's how we got. So I would say those are my, my best resources and my psychiatrist. I don't know if I can name, drop her, but her name is Dr. Valerie... She's been fantastic. She's walked me through like so many medication changes. She's gone so far as to treat my migraines, which no doctor has ever treated in my life.
I've had migraine headaches since I was seven years old. And it took a psychiatrist to say, Hey, maybe we should treat these migraines so you can tolerate your stimulants. So that's been amazing. Now I have migraine treatment and she always advocated for the non-pharmacological management in the form of sleep diet and exercise, which is not easy to implement as a resident.
Let me tell you that. But the more I pay attention to those things. The better. My life is 100%
 Amazing! Let me ask you this because some people don't don't understand what the difference is between like a physician and like a coach. Could you differentiate those for me a little bit?
Dr. Nina Mara Di Nicola: Sure. Well, obviously a physician is somebody who has medical training. Um, if you're talking specifically about, well, I guess the physicians that would be involved with ADHD are physicians. So family interests and, well, my psychiatrist really. So I've had. Lots of, meetings with my psychiatrist. So first of all, they diagnose, right? So we're the ones who are actually giving you this diagnosis after evaluating you and applying, uh, the clinical criteria.
And I would say my psychiatrist directs my care, especially with the medications. So she's finding everything, responding to whatever changes, that need to be done. But ultimately, and I think early, very early on, we identified that I would need more, like I would need more coaching, something more, behavioral, and she doesn't provide that.
So at that point, I used, I think initially I was doing more therapy, like psychology, work with, with, actually I was lucky and my therapist actually had ADHD and told me, like, I was very open about it and actually had training in ADHD. So that was, that was quite, interesting. But even then therapy is going to be more like reflecting and maybe going back to previous issues in your life and trying to kind of cognitively work through problems and feelings where coaching is much more strategic and like, okay, let's, let's implement strategies now. Let's, analyze what needs to be done now. And sort of, she would really help me like look at the big picture, figure out what I needed to take care of and then, and then try different strategies. And it was just in the beginning with my coach, it was a lot of trial and error and, and a lot of it was this reframing.
So. My therapist did that with me to that work of like, okay. I would say, oh, I had a really bad day. And I remember my therapist saying, what does that mean to you? And I was like, you know, it's just really distracted. And I did a whole bunch of stuff, but I just feel like unsettled. Like I had done laundry and done some cleaning and done some studying and like, I did all kinds of stuff, but I didn't feel good about it.
Just my, like I felt chaotic. And I remember her saying to me, Nina, a bad day is when you don't get out of bed. And I was like, oh, okay. Like the, I feel like we put the bar so high for ourselves. We put ourselves like, oh, you didn't like run a marathon today and right at the five hours, that's a useless day.
Right. So there's that reframe. So does that help kind of separate
Dr. Diana Mercado-Marmarosh: So I wanna thank you so much for pointing it out. What I want to point out here for our listerners, is that there's not one right way of helping ourselves when we have ADHD, right? Like I am not like pro or against medicine. I am not pro or against exercise, I am not pro or against coaching. Of course, I'm going to be biased and tell you to do all the things, especially to do coaching because I'm a coach too, because I have now seen how it has transformed me. But what I want to say here is, they can all beautifully work together and compliment each other because they all have a part that helps to unlock our brain and gets us to the next place of where we want to be.
Not because we have to, not because that's, what's going to make us like, feel like we're finally on broken, but because. We people with ADHD are like the dreamers and the shakers and the ones that don't just think, oh, well that's the way it's always been. Let's just leave it that way. We're the ones who are like, well, that shit ain't working.
How do we change that? Right. And when we start asking those questions that other people sometimes don't ask, we think outside the box and we need to have the ability to. Take into action without judging ourselves. Like you just said, like as kids, because we weren't maybe doing, or even asking, we come up, those, we weren't fulfilling our potential or where we thought we could.
We learned to use the inner critic or the judge voids in us to motivate us, to keep growing, to keep up, to keep up. Come on one more thing. You got to look at the big picture. You're going to become a doctor. You can do this two more hours. Oh, you have an eight for five. It's okay. You got this. Like, like it pushes you, but not from a place of like, oh my God.
Look how amazing Nina’s doing it. Look at everything she just got done today. No, your brain's like, what the fuck girl? You haven't done all 20 things. And like everybody around us, it's like doing two things. Right. But we need to do 20 things. Right? So the coach allows you to see what thoughts we think are helpful, but really are not.
And to see how much you are actually doing, how much of a bad-ass you are like, oh my God, look at everything we shared. You have established a way for residents to feel supported, right. For the wellbeing of not just yourself, but those other people around you who have ADHD. You don't really even talk about like, because of stigma or whatever.
Right. And you are allowing people to really voice and grow right. And empower them. I have to make, I'm going to just ask you a couple of more questions cause I want to value your time, but I'm pretty sure that the listeners are like having a ball, listening to everything you're saying. Tell me, what is the key to living successfully with ADHD?
Dr. Nina Mara Di Nicola: So I think the key third, two keys. Okay. And we've touched on them, but to bring it all together, number one is learning about your brain working with it and not against it. Don't try to fit into what society expects. One of the resources I didn't mention earlier, but I love is the How to ADHD YouTube channel. This is hosted by Jessica McCabe. She's a young woman who has ADHD. And she actually gave a Ted talk that blew my mind. You guys have to watch this Ted talk and she talks about how he took her up into her twenties to like mid twenties, late, late twenties until she got her diagnosis and then started to really use, be able to use all this untapped ability. She had, she had actually been labeled as gifted as a child and was writing like high school grade exams in grade school. But because of her executive dysfunction, it wasn't coming together and she wasn't able to kind of make something of herself. And in this talk, she says, if you judge a fish by its ability to climb a tree, it will live its whole life believing. It is stupid. And, and she says you're not a failed version of normal. And I find that that's just so key to recognize that. For fish, we need to swim. And if everyone else is climbing a tree, like that's cool, but we're going to be over here, fishing, swimming. So that's really important. And then the number two thing is building community.
Having other people with ADHD. To turn to when you experienced the unique challenges that come with this diagnosis, it really is a lifelong journey of finding strategies to manage symptoms. And it really helps to be surrounded by others who are on that same path. Something my coach always tells me or used to tell me a lot in the beginning, but now I got it, was you have ADHD, your brain seeks variety and novelty. So don't expect the systems we put in place today to work forever because in a couple of weeks, your brain's going to get pretty bored of your systems. And that's when you have to, which he says is re-sparklize it, make it sparkle again, shake it up a little bit, make it pretty right.
And I think approaching it as this lifelong journey. Is the most important part, because if not, you're going to get really frustrated. If in three months your perfect system didn't work anymore. Be like, expect it, expect that you're going to have to keep working on this. And that's kind of all the fun. So just keep going.
Dr. Diana Mercado-Marmarosh: So what are your goals for next year? Tell us.
Dr. Nina Mara Di Nicola: I have so many goals. Diana. I am like. Yes, this is very ADHD, but I will tell you so many goals. So number one, I need to finish this residency I'm in and I want to finish it really strong. That means ACEing my Royal college exam, which is in eight months. And I also want to do some moonlighting so that I get to experience being an independent practicing physician before I have to go out there in the world completely on my own.
So, those are like my major career goals right now. I'm also learning Cantonese. So that's been, you know, that's a journey. I definitely want to get better on that. I had originally told myself six months, I had six months to become conversational in Cantonese. I'm not quite there yet. I'm now, like about seven months in, but you know, it's amazing.
I do it a little bit every day and I've picked up. Quite a lot. And then my major, if I go beyond the next year, but kind of moving forward into the future, I would say my major goal is finding a career path that will allow me to integrate my passion for physician health and wellbeing with my emergency medicine training.
I really want to keep working with physicians with ADHD. I'd love to develop like a screening tool that we could apply to residents to help them identify who would need further testing. Because I think so many, like I've seen so many residents who get picked up in residency and sometimes it's because things aren't going well.
And by that point, you know, they've already, some might have some negative, stereotypes about them or perceptions about them. So if we could pick these people up earlier, maybe medical school or when they get into residency, I think we could really help them. Also, I have this longer term goal of just working towards changing the culture of medicine.
And that's what you're trying to do with your podcast. Right. I think, medicine is trying to fit us into little boxes and is not really celebrating the diversity within the community. You know, rather than having us have to apply for special accommodations. Like in my residency program, you can go to. Specific, you know, office for students with disabilities and apply for special accommodations.
And let me tell you, Diana, some of the accommodations, some of the residents I work with have been given, okay, you have the right to take notes during a patient interview. You have the right to look at your notes when you are reviewing a case, those sound to me like pretty normal things that people would.
needing as he can be with a diverse set of strengths, not everybody has a perfect memory. And the fact that we have to ask for accommodations and go through a process to be given the right to take notes when someone is giving us their detailed, complex medical history that we have to get right, because we're using that information to treat them. That actually blows my mind.
Dr. Diana Mercado-Marmarosh: Yeah. I mean, when you go to the restaurant, when a waiter comes and tells you what you want to order, right? Do you look at them like they're stupid because they can't keep straight. Whether you want jalapenos or cheese on your burger, like come on, right?
Dr. Nina Mara Di Nicola: I used to be a waitress. So I'm nodding over here so hard because. The first thing they taught me was, Hey, you take a piece of paper, you draw a grid, there is your table, and you have to write the meal that each person at that table ordered, I worked in a buffet and they would have like 12, 20 people tables.
And if I didn't write it down, then nobody's going to get their salad and their soup. Okay. Exactly. Well, that's normal and it's normalized. So why to normalize this in medicine, normalize the fact that. We are human beings and we forget things and that's okay. And it doesn't make you a bad doctor and it doesn't make you anything. It's just makes you human. Right?
Dr. Diana Mercado-Marmarosh: Dr. Nina, it's been such a pleasure to talk to you. I know you are going to be changing medicine. I know your fireball. I can hear it. So I know our listeners are would be dying to get in touch with you to put you on their YouTube channels, to put you on their next movie, to put you on their books so that we can change ADHD physician's world.
Okay. How can they get in contact with you?
Dr. Nina Mara Di Nicola: So you can, I'm pretty old school. I have an email address and I have a Facebook account and that's pretty much it for me. So you won't find me on any other, I honestly, I don't, I couldn't handle having any more social media accounts. So, basically you can find me on Facebook at Nina di Nicola, and my email address is nina.dinicola@gmail.com. I could spell it out. It's Nina, N I N A and Di NiCola is D I N I C O L A.
Dr. Diana Mercado-Marmarosh: And I will put that information on the bottom of the podcast so people can reach out to you. And I would definitely list out all the resources that you said, because those sound amazing.
So there you have it, guys. You heard a rockstar. She is here. She is making noise. She is changing medicine and. I want to thank you for joining us for the overachieving ADHD Physician podcast. It was such a pleasure to talk about everything that Dr. Nina had to share with us today. As you see, sometimes the symptoms are there, and even when we do get diagnosed, it takes us a little bit of time for us, become curious with our brain and use all the resources around us. And even when we get it just right, our brain knows it likes to spice it up. So re sprinkle it like she, like she said, and keep on doing the best that you can have a good. Thank you.
Dr. Diana Mercado-Marmarosh: Someone who understands that time is our most valuable asset. Please click the subscribe button and join my Facebook group beyond ADHD, A Physician's Perspective so that you never missed an opportunity to create time, at will. Do share this podcast with your friends. So theytoo can learn to live life and stay in their own lane

Beyond ADHD A Physician‘s Perspective Podcast The Pilot Episode

Hi, welcome to Beyond ADHD, a Physician's Perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh, I'm a family medicine doc with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age. And in the past year, I have undergone radical transformation after discovering ADHD, coaching, and life coaching.
For the past decade, my typical day consisted of having 300 charts, backlog, a graveyard of unfinished projects and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes the last year. I figured out the secret learn to stay in your lane. So now my mission is to help others develop systems that tap into their sown of genius.
So they too can reclaim their personal lives back. Like I have. Name it to tame it. Name your fear. Mine was not being good enough. I was afraid others would find out I had eight. I was afraid that I will be judged for not having my own shit together. The pandemic did a really good job at amplifying that belief.
I share my story in this podcast so that you can see that I'm no different than you it's been less than a year. Since I first went on a podcast and shared with the world that I too had ADHD and that I got diagnosed during my first semester of medical school and that as a physician, having ADHD could actually be a gift because it allowed me to figure out I didn't need to have the answers in one minute.
Like the standardized tests make us feel like we do. I was able to take my time listening to the patient's story. And analyze it in different angles. And sometimes yes on the fly. I would tell them, let me look this up. So the thing is that having ADHD is a neutral situation. It's whatever thoughts you're having about the diagnosis that is going to cause you to feel a certain way.
For me, I was feeling ashamed. I felt imposter-like, I felt like. People were going to know that it was just a fluke, that I was in the room. I went to a medical school where only 20 of us were minorities and the rest of my 200 classmates were white. So I felt like my grades were not stellar and that I compared myself to them. And I thought that, you know, they might've made a mistake. Why did they let me in? And so having ADHD was never in my radar, having ADHD for me meant I was no longer perfect when I grew up. I've thought that by doing everything right, like getting good. I was going to earn people's love. And so when I got diagnosed with this, I thought, oh my God, that's it I'm broken.
I'm never going to be perfect. And again, what does perfectionism mean anyways? Um, as a kid, it man's acceptance. Right? And we all think that we're going to go a certain way. We're going to get the perfect job. We're gonna have the perfect house. We're going to have a perfect marriage. The thing is that nobody tells you that life is a journey and that getting to all those goals doesn't mean like life is any easier. You have to enjoy the journey along the way. So when I was finally diagnosed to me, instead of being a relief, it was more like, like a shock, I guess. And I didn't want anybody to know. So, like I was saying, like, if I looked around, everybody in my family behaved the way I behaved, so it was never really in my radar and it makes sense.
Right. It's genetic. So I did really well on the things that I enjoyed. I excelled in high school academically. I remember being pulled in and being told you're number two, out of a class of 700. When I was a junior in high school, and I was a little surprised by that, honestly, because I thought I was doing what everybody else was doing study.
I didn't realize that I was, you know, quote unquote on top of my class. But looking back, there was always signs that I had ADHD. I mean, I was, I remember my dad one time was, driving with me as I was learning to drive and I almost ran a red light. Well, it was orange, it was yellow. Okay. It was yellow.
And I knew I could make the turn. And I remember him being so flustered with me and he was like, pull over, pull over, pull over. I'm going to drive. You're gonna, you're scaring me. And so it is that we've lived life on the edge. It is that we're always under minding how much time things are going to take. And of course I was running late to work like always, right.
We tend to be the dreamers. We tend to always tell you how long something's going to take you, but we don't tell you the time that it takes before and after the completion of certain tasks. So in. You know, I excelled, why probably part of the process was that I was running 10 miles a day. I was in the cross country team and yes, I made the varsity team as a sophomore, junior and senior.
Not because I was fast, but because of the fact that everybody around me was not Passy. And I was the only one who kept showing up to the practices. And I was the only one who kept doing what. So I am a first generation Mexican American student who attended college and medical school. And I remember when I first got diagnosed, I was being evaluated for anxiety and for depression, because to me not passing.
Test meant I was letting down, not just myself, but like all my family. Like I had to be a role model when I was the oldest of three. And I felt like I have to set the example. They did tell me during my testing, I had a neuro psych testing. They told me that I was at that point, performing like two, two years, I guess, below where I should be.
And because of that, They told me that, uh, my English was a little bit behind, but they said that I was doing okay. Everywhere else. So I didn't have anxiety. I didn't have depression. It just seemed to get worse. Whenever I felt like frustrated because I couldn't complete the tasks that they wanted me to complete during those tests or in any test for that matter.
So, um, I learned to speak English when I was 10 after my family moved to Texas from the border and here in south Texas. And you know, I looking back, I was always a kid running around. I was always getting in trouble. My dad had to come and sit down. My mom had to come and sit down in the classroom because even though they would give me more work and more work, I would complete that work.
And then at some point they just started promoting me every four to six weeks, they would up me up a grade, and so eventually I, matched where I had to be. The thing is with people with ADHD, we always keep showing up. Right. And I think that the fact that you keep showing up and that you keep saying what other people are not wanting to say, sometimes this promotes you and this makes you a leader..
And so, you know, I was a high school vice-president of the NHS club. I was the secretary of the honor society in the, in St. Mary's university. You know, I was the chief medical officer at the residency. I was the 2013 resident teacher award, a resident for teaching others. You know, you just keep showing up and you are willing to put in those small steps and eventually they add up.
So sometimes, you know, we forget that we need to put ourselves first. And during this whole pandemic, I came to realize that I did not do that, that I had a love, hate relationship. Right. Like in the sense that I love my patients, but I didn't know how to set boundaries with my time. Like, I didn't know how to, not how to ask politely for me not to be interrupted at certain times. I was just not aware of the time management aspect. So in this last year, I've actually discovered life coaching and ADHD coaching. And that has led me to a growth that has been transformational for me.
And so all this is an introduction to explain to you why I am putting together this podcast.
My goal here is to show you how I, Diana Mercado-Marmarosh, Family Medicine Physician is able to give you the ADHD perspective. As someone who understands that time is your most valuable asset. I am so honored that you have shared your time with me. Please click the subscribe button and join my Facebook Group: Beyond ADHD, A Physician's Perspective so that you never missed an opportunity to create time at will. Do share this podcast with your friends, so they too can learn to live, life and stay in their ow