Transcript

Lindsay Genzel (00:04):

This is Refocused with Lindsay Genzel and you are listening to episode 10, part two episode, 10 and half. You have your ADHD diagnosis. Now, what?

Hello and welcome back to the podcast I told you about and am now delivering on, look at that growth you guys. I’m Lindsay Genzel and I have ADHD. I was diagnosed two months shy of my 35th birthday, about a year and a half ago. And I went into building my treatment plan with no guidance or insight or really anything.

And my goal with this episode and the one before it, is to give you a clearer understanding of what you can and should do after receiving your ADHD diagnosis. Just as ADHD is different for everyone, so are the ways to treat it. And what works for me, might not work for you. And it’s also important to keep in mind that what’s right for me right now, might not be right for me in a year or two years or even six months from now.

If you’ve been here before, you know these details Refocus with Lindsay Genzel is produced in partnership with ADHD Online, a telemedicine healthcare leader committed to providing affordable and accessible assessments and treatment options, including medication management and teletherapy. We are in the midst of gearing up for ADHD awareness month in October and the international conference on ADHD, that’s being held in Dallas this November.

And I’m so excited about the ideas we’re throwing around and working very hard on not getting distracted by all the shiny objects around me. That said, if you’re interested in sharing your story on Refocus with Lindsay Genzel, I would love to hear from you. My direct email is podcastADHDonline.com and you can find me on social media at Lindsay Genzel and at Refocus Pod. I also encourage you, wherever you’re listening right now to take a minute and subscribe, rate and review Refocus with Lindsay Genzel, it’s a very simple way to support the work we’re doing

Today I’m sharing a conversation I had last week with Dr. Rafi Mohamed, the division chief of medicine and interim chief medical officer for ADHD Online. Dr. Mohamed connected for our chat from her home office in Texas. I connected from the closet of my childhood bedroom, in the small town where I grew up. I was visiting my mom. And of course in my manic attempt to get out of the house on time, forgot all of my recording equipment and my computer charger.

So a shout out to Monty at the Radio Shack in New Prague, Minnesota for making sure I was still able to get my work done, despite my brain’s best attempts at sabotage. And to tip, if you ever have to record yourself talking for any reason, find yourself a closet with lots of soft things in it, clothes, linens, your prom dresses from 2002, 2003 and 2004 that your mom refuses to get rid of. I bet you didn’t know that tulle and satin were so good for makeshift recording studios.

Have I mentioned that people with ADHD can be incredibly resourceful when they need to be? Anyway, I realized as I was preparing for my conversation with Dr. Mohamed that while I’d interviewed her before for the podcast, I’d never asked her about her why. With so many specialties available in psychology, I opened our conversation by asking her to share a bit about her motivation for focusing in on ADHD.

Mr. Mohamed (04:05):

So I’m board certified in preventive medicine in public health. And my training is in, looking at the bigger picture, the overall care. And during the pandemic, I just, it was very evident, the fragmented healthcare that we have. And a lot of patients couldn’t even get to see their specialists or their primary cares. And so when I saw the position for ADHD Online, I was like, “Oh this is amazing. This is the vulnerable population, who all of a sudden may not have access to care.”

Lindsay Genzel (04:46):

One thing that’s important to note with this podcast is we are presenting information for people who maybe were diagnosed at ADHD Online, maybe we’re diagnosed at their primary care provider and it could have been a month ago, it could have been 10 years ago. And so everyone’s at a very different place in life, but I think it’s so important to have a conversation around, what you do following the diagnosis. Because for a lot of people, the lead up to actually getting there, to the appointment, to filling out the assessment, that can be full of stress and anxiety and fear. And it’s that, well, the what if. What if it comes back positive? What do I do then? And I love the fact that ADHD Online has a very set plan in place for every single patient, to make sure that they know what their options are.

Mr. Mohamed (05:46):

So once a patient has their diagnosis, they’re able to go to their primary care or their own specialist, or they can come and see a provider through ADHD Online. Once they go to their patient portal, they’ll have access to providers in their area and they can make an appointment based on their availability. And then at that point, they’ll have a live visit with their provider.

And at that point we have access to their full assessment, to their medical records there. So it’s very much a conversation kind of like, “What brings you here? Why are you seeking treatment now? Where does your ADHD affect you?” So our visits are tailored to our patients. We want to know, “What does an average day look like? What time do you wake up? What time do you go to bed? If you’re working, what does that look like? If you’re home, what does that look like?” So that way we can figure out the appropriate treatment regimen.

Lindsay Genzel (06:42):

I know from my own experience, I was diagnosed from my primary care provider. And the people I saw were very well versed in ADHD, but it wasn’t their specialty. And then as soon as I was diagnosed, I actually had a friend reach out. And they said, “I’m very interested in speaking to someone about ADHD, but I don’t know where to start. I don’t know how to bring it up. I’m afraid that if I go to my primary care provider and I bring up ADHD, they’re going to think that I’m just here to get a prescription.” They were very, very aware of the stigmas that come along with ADHD and with medication. And that’s the great thing about ADHD Online, is you’re going into these appointments and everyone knows why you’re there. It’s specialized care.

Mr. Mohamed (07:30):

A hundred percent. And the thing is, when you’re coming to us, we know why you are at this party. It’s not like, “Oh, I don’t know if I belong here.” No, you do. You’re here. And let’s talk about it. Our visits are not in a sense, you don’t have to validate you have ADHD. We know that’s there. Some of my patients, they’re so excited to be here, but they had to fight so much to get here, constantly telling the doctors, “I have it. I did this, I did this, I did this.”

So some of my patients are like, “I’m so happy that I don’t have to … I don’t have to fight you. You understand. You are telling me what I’ve been trying to tell other people.” So I think that’s the validation, is what I think our patients like. They’re like, “Finally, someone is saying what I’ve been experiencing all this time.”

And at ADHD Online, we see every kind of ADHD, because everyone’s ADHD, it always presents very differently because everyone’s day to day is different. At the same time, when you see so much of it, you can pick up on those certain things. So I think patients also like that, because they’re like, “Well, you’re focusing it for me. You’re not thinking of it. Well, like other boys do this, so this boy should also do this.” You know what I mean?

Lindsay Genzel (08:35):

Absolutely. It’s like if I went to the doctor for a sinus infection, they might treat me the exact same way that they would treat the patient who came in before me. But as you said with ADHD, it is so hyper focused to each individual person and it has to be.

And I think the thing that we sometimes forget is the treatment plan that you have now might have to be adapted for who you are in six months or another year. Or if you change jobs or you move or you become a mom. That’s the thing with ADHD. It changes as we grow and it’s good and it’s bad, but you have to kind of understand that you need to be flexible.

Mr. Mohamed (09:17):

Yeah. A hundred percent, every phase of your life requires a different you. And what does that look like? We don’t know. And sometimes, you build up certain coping skills where it’s like, “You know what? I can do this.” Sometimes you can’t. And that’s where we come in. That’s where we can figure out what are the best tools, whether it’s medication or it’s therapy. And just arm you with the right tools, so you can make that phase of your life even better.

Lindsay Genzel (09:42):

I was in therapy prior to my ADHD diagnosis. So when I was diagnosed, it was just essentially going, “All right, I’m adding another person into this arsenal of tools and ADHD is something that they focus on.” And it’s been a fantastic addition into my self care and how I live my life. But I imagine that there are some people who come in, who might be hesitant about therapy, because we have this outdated idea of therapy.

I joke it’s like the very Frazier Crane, like on the couch. And that is it sometimes, but therapy for ADHD can be things like organizational skills, working on how to stay focused during the day and set up a schedule for yourself. And there’s really an accountability side to it. When you’re speaking to patients and you’re explaining this whole person mentality over treatment, how do you walk them into the idea of therapy?

Mr. Mohamed (10:51):

So with ADHD, there is a problem with executive functioning. And executive functioning as an adult could be time management, it could be organizing things. It could be managing the house, home chores. With everything we do as adults is considered executive functioning. So if you don’t do laundry, you don’t have clothes. That could be a big problem.

So I incorporate therapy almost immediately. I like to tell my patients, “Hey, we have teletherapy in your state. If this is something you are interested in, please do look into it.” But most of my patients, once they’re on the right medications, once they feel like they have a better hold of their day to day, they actually require four therapy on their own. They’re like, “I feel like I have a better hold of all my million tabs in my brain. Now I want to be able to build a better foundation.” So in order to combat ADHD or work with ADHD, you have to have the right therapy. You have to have the right medication. Everything has to work together, in order to build those better habits.

Lindsay Genzel (11:57):

One thing I have found with therapy is it’s really awesome to have someone I can turn to for accountability, who is not someone I spend time with in my everyday life. I think I have struggled in life when that accountability is with someone who is very close to me, like my boyfriend. I’ll say, “Hey, can you make sure that I do this?” And then even though I’ve asked him to help me, if he comes back to me and is trying to hold me accountable, if I’m not in the right space, I get very irritated.

Mr. Mohamed (12:35):

Oh yes. I think ADHD in relationships, that’s a whole nother topic. But definitely I think it’s nice when you have an outsider who is holding you accountable for certain tasks and stuff. But if it’s somebody who you see every day, if it’s someone you live with, then it’s hard to sort of see them that way, because you’re just like, “Wait, you didn’t put the dishes away earlier. I don’t want to talk to you right now anyways.” And you may not bring the right head space, so it could turn into a whole other thing.

Lindsay Genzel (13:05):

Yes, yes. And no one wants that. We want to take as much of that out as possible.

Mr. Mohamed (13:10):

Yeah. Yeah. Right. And I think when you have ADHD too, you have this level of constantly trying to please people or the self guilt. And if it’s somebody who you care for, you don’t want to hurt their feelings. You don’t want them to hurt your feelings. So even something little as like, “Oh, I thought I reminded you.” And it could turn into like, “What do you mean?” And another whole situation.

So when it’s a therapist, when it’s somebody else who specializes in ADHD, they know how to ask the right questions. They know how to take your energy and use it the right way. So I think that’s important. I think it’s important to find the right person, who has the right tools.

Lindsay Genzel (13:54):

I haven’t taken the assessment through ADHD Online. What sort of information is the patient given and how should they look at digesting that? What’s really important to pay attention, after they’ve taken the assessment and they receive their diagnosis?

Mr. Mohamed (14:10):

So our assessment is a lengthy assessment. The assessment starts off with basic demographic information, medical history, we’ll also include social history, family history. The will have questions on anxiety, some for depressive symptoms. So at the end of it, when the psychologist gives the diagnosis, it’ll also tell you which criteria you me, in order to meet that specific diagnosis.

At the same time, if within that assessment, someone may answer positive to some questions on the anxiety side or more on the depression side, or it may say something like patient mentioned to have history of substance abuse in the past, or has a poor sleep habit, please look into these things. So it’s not just, “Oh, you have it. This is what you have.” But it gives you other information too, because symptoms of ADHD, symptoms of depression, symptoms of anxiety, medical conditions like thyroid dysfunctions or poor sleep, all the symptoms kind of blend in together.

We can’t ever tell you what you have is … and no one can ever tell you what you have is 20% ADHD and 40% anxiety. But our goal here is to tell you that, “Yeah, you meet criteria for ADHD, but all these other things are also going on. So let’s talk about how all of this affects you.” Now is the root cause ADHD, or is something else happening? So it gives us a framework to sort of understand the overall mental health.

Lindsay Genzel (15:34):

One of the symptoms that comes with my ADHD is impulsivity and a little bit manic. And I was diagnosed and immediately, like the next day started medication and it worked out great for me. But everyone’s scenario is going to be different. So once someone gets their diagnosis, how should they proceed moving forward? What do they need to do right away? And what are some of the things they should consider as they’re working with their specialist on a treatment plan?

Mr. Mohamed (16:10):

So once they’re diagnosed, the important thing is to meet with a provider to talk through that diagnosis. Now that I know I have ADHD, more of the impulsive type. So let’s talk about what does that mean to me? And it’s important to understand how that impulsivity plays into your day to day. Again, that could present with binge eating disorder. Maybe it’s that going out and just buying a lot of things for no reason, or just going to the Dollar Store and buying the entire Dollar Store, instead of one thing.

The impulsivity can present in different ways. So let’s see how that is affecting patients day to day. So it’s important to sort of talk through those symptoms and talk through that diagnosis. And then after that point, it’s medications is one route, therapy is one route, or also not doing anything is one route. Just because you have a diagnosis doesn’t mean you have to have a medication or that it has to be treated.

The idea is that for some patients, now that they know they’re like, “I feel better that I know, and that’s all I wanted to know. I just wanted to talk it out. I just wanted to be able to talk to somebody who knows about ADHD.” But at that point, they may want to just do some therapy on their own or just think about it and then come back, tell us a month or two later, that’s fine.

The medication, I think starting medications starting, which medication to start, I think that’s a very personal choice. And for some patients, they want to do it. For some patients, they’re like, “You know what, at this time I’m just going to do some therapy. I’m just going to think about it, but I’ll be back.” For us, it’s important that we have that open communication with them. We want them to know we are here. We are here to help. So anytime you want to come back, you can always come back and then we can always talk more about it.

Lindsay Genzel (18:01):

Lots of great stuff coming down the pipeline for Refocus with Lindsay Genzel. And of course, Dr. Mohamed will be back to share her expertise with us. Dr. Mohamed, thank you so much for being with us today.

Mr. Mohamed (18:11):

Thank you so much for having me.

Lindsay Genzel (18:19):

Refocus with Lindsay Genzel is a collaboration between me, Lindsay Genzel and ADHD Online, a telemedicine healthcare leader offering affordable and accessible ADHD assessments, medication management, and teletherapy. You can find out more by visiting ADHDonline.com. The show’s music was created by Louis [inaudible 00:18:42], a songwriter and composer based out of Perth, Australia, who was diagnosed with ADHD in 2020 at the age of 39.

A huge thank you to Dr. Rafi Mohamed for joining me this week. She’ll be back next week as we dive into treatment options. And we’ll start with stimulant medications. Remember to subscribe, rate, and review wherever you’re listening now and join us next week for another episode of Refocused with Lindsay Genzel.