Meet Dr. Marla Dubinsky!

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Join us for a fascinating conversation with Dr. Marla Dubinsky, a trailblazer in pediatric gastroenterology and a fierce advocate for people living with inflammatory bowel disease. She shares her journey from pediatric residency to becoming a leading voice in IBD care, shaping the future of treatment and advocacy. Through her work at Mount Sinai and as co-founder of Trellus Health, she’s revolutionizing patient care by integrating resilience and digital health solutions.

We dive into the intersection of medicine and entrepreneurship as Dr. Dubinsky reflects on the mentors who shaped her path and how she’s working to make innovative healthcare solutions both impactful and commercially viable. She also highlights the importance of a holistic approach, bridging physical and mental health to empower patients in their care journey.

Plus, we explore her work in women's health, particularly in IBD management during preconception and pregnancy. Through initiatives like We Care in IBD, she’s helping to create tailored programs that support women at every stage of life. Don’t miss this deep dive into precision medicine, prevention clinics, and the future of IBD .

Links: 

• Info on Trellus Health
• Innovative programs at Mount Sinai IBD Center
• A video about Dr. Dubinsky for her Jacobi Medallion award
• The book Dr. Dubinsky mentions- "Likeable Badass: How Women Get the Success They Deserve" by Dr. Alison Fragale

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Episode Transcript

Speaker 1 (00:00):
Hi, I'm Alicia and I'm Robin and you're listening
to Bowel Moments, the podcastsharing real talk about the
realities of IBD Serve on therocks.
This week we talked to Dr MarlaDubinsky.
Dr Dubinsky is the DivisionChief of Pediatric, gi and
Nutrition, the co-director ofthe Susan and Leonard Feinstein

(00:22):
IBD Center and co-director ofthe Marie and Barry Lipman IBD
Preconception and PregnancyClinic at Mount Sinai.
She's also the CEO andco-founder of Trellis Health.
We talked to her about TrellisHealth, which is a digital
health solution that helpspeople living with IBD build
resilience, adhere to treatmentsand actively engage in their
health.
We talked to her about herpreconception and pregnancy

(00:44):
clinic and how she developedthat as a way to better serve
women and people living with IBD.
We talked to her about what itwas like to seek out mentors and
colleagues to help her fosterand advance her passion and
expertise, and we talked to herabout what it's like for her to
now be that mentor that peopleseek out to help them develop
their passion and expertise inIBD, and what it's like to build
future leaders in IBD care.

(01:04):
She's definitely a likablebadass Cheers.

Speaker 2 (01:10):
Hi everybody, Welcome to Vow Moments.
This is Robin.

Speaker 1 (01:13):
Hey guys, this is Alicia and we are so excited to
be joined by Dr Marla Dubinsky.
Dr Dubinsky, welcome to theshow.

Speaker 3 (01:20):
Thank you for having me.
I've been dying to be on theshow.

Speaker 1 (01:24):
Gosh, I hope that's the truth, because we are so, so
, very, very excited to have youon the show.
Our very first unprofessionalquestion for you is what are you
drinking?

Speaker 3 (01:33):
I've been really into because it's really cold here
in New York these days I've beendrinking.
It's not really exciting as acocktail, but it's ginger tea.
That has been like my obsessionover the past couple of months.
My husband chops up the ginger,so imagine how special that is

(01:53):
Fresh ginger tea.
My husband's Dominican, so whenhe was growing up that was sort
of it heals all elements.
Ginger tea is the answer toeverything, so he's convinced me
of such.
So that's been my.
You know my progression ishealing myself emotionally and
physically with some ginger tea.

Speaker 1 (02:12):
Actually, I am also drinking tea with you, although
mine is like an immune supporttea, so I think it does have
ginger in it.

Speaker 3 (02:17):
but similar similar story Robin.

Speaker 1 (02:20):
what about you?

Speaker 2 (02:21):
I am also drinking tea.
Oh my God, ladies, tonight Iwanted to try something
different, so I have a green teawith blueberries.

Speaker 1 (02:29):
Cheers number one.
Okay, dr Dubinsky.
Next question for you is whatis your IBD story?
What's your connection to theIBD community?
What brought you to us?

Speaker 3 (02:38):
Yeah, so my story sort of starts.
One just to also level set, isthat I don't have anyone in my
family that has inflammatorybowel disease.
That often is a driver forwhere passion leads you in terms
of trying to solve a problemthat you are personally
connected to.
What happened for me is thatwhen I was doing my pediatric

(02:59):
residency this was in early 90sactually, and I just want to
remind everybody that in theearly nineties we really didn't
have any effective, you know,approved biologic based
therapies.
We were using steroids, we wereusing nutrition for kids,
because a lot of children, youknow, had growth failure and it
was sort of like, you know,children were having to take
nutrition through an NG tube.

(03:20):
There were steroids, there was6MP, which was, which was a drug
that many were using before theintroduction of biologics, and
really there wasn't a lot.
And I just had this like thefamilies that I connected with
the most while they were inpatients because as a PEDS
resident, you're sort of reallymeeting patients and families in
the ward right Because you're aresident and you're totally

(03:43):
integrated into the service andI just had this like really
immense connectivity to theseincredible kids who were living
their best life and thenderailed like literally, just
like that day, you know,something happened.
They had increasing abdominalpain, they had, you know, a
bowel obstruction, or somethinghappened that sort of derailed

(04:05):
them completely from being thehealthy preteen or adolescent
that was going through puberty,which is already difficult, and
then having this sort of to addthis other thing that I have you
know, it's already tough beinga teen and I was just so amazed
by the resiliency of these kidsand the families and the
connection you have, becauseback then we didn't have

(04:25):
Remicator, we didn't havetherapies, that you would sit in
a chair and then you'dmagically go off and eat
McDonald's, you know, after yougot your infusion.
That was not the case, and sowe would spend days in the
hospital getting to know thesefamilies, and every time I saw
an IBD patient I always said tomyself I feel like there's so
much more to be done Now.
I also was passionate aboutliver transplant.

(04:47):
By the way, I actually wentinto PHGI Fellowship.
Fun fact to be a livertransplant physician.
I trained in Canada, I did mypediatric residency in Calgary
through the University ofAlberta, and I was really
inspired by thegastroenterologist that was, you
know, the GI team.
I was like God, how can I bethat smart?

(05:07):
Like I was just so inspiredthat this individual seemed like
he was so smart you know the GIsystem, you can't see anything,
you know it's hidden and he wasso smart about physiology,
nutrition, liver, pancreas, likeit just amazed me and I was
like I one day want to really beas smart as Brent Scott.
That was my mentor, that was myNorth star in Calgary and

(05:30):
because I really thought, alsochronic condition, clearly liver
transplant and wow, imaginetaking a six month old or a one
year old and doing a transplantand transforming their life.
I sort of felt that way,similarly about IBD patients
that if you can get them back ontrack, you've transformed a
life right, you've given themback the hope and sort of the
motivation that they can resumetheir life.

(05:53):
And I felt similarly aboutthese chronic liver condition
patients who would gettransplant.
So I was always in this veinthat when I think about and I
mentor others, they say like howdid you get from there to there
and what made you choose to goto Montreal and then Los Angeles
?
I actually always followed.
I always say the guy or thegirl, what does that mean?
There was a physician atUniversity of Montreal on the

(06:14):
French side.
I am an Anglophone, I'm fromMontreal, but the University of
Montreal is the French side.
The McGill is the English sortof the Anglophone side, although
it's multilingual, but in termsof primary language French.
At the University of Montrealand one of the physicians who
had recently joined trained witha physician in France called
Alagiel.
Now there's a syndrome namedafter Alagiel which is Alagiel

(06:36):
syndrome and I thought, oh myGod, I need to go where the guy
who trained with the guy who hasa disease named after him,
that's a liver disease.
So I always sort of have thislike vision in my head and the
theme doesn't stop when I talkabout the next move in getting
me from here to there was.
You know, I wanted to go causeI said, if that person trained
with like one of like theleaders in the field, that

(06:59):
person is going to help, mentorme and train me to hopefully be
similarly a leader in that field.
So that has been my philosophyvery strategic, not manipulative
, but strategic in attachingmyself to folks who can actually
help me go from A to B andthereafter, or at least get me
to where I think I'd like to beand may see something in me that
I didn't know I had.

(07:19):
Right, those are like thequalifications that I always
sort of strive to do.
And so in the end, six monthsin, I fell completely like head
over heels in love with theresearch that was being done in
Crohn's disease and ulcerativecolitis.
I sort of felt like I was likecheating on Alagil.
You know, I went to whereAlagil's mentee was and I was no
longer interested in Alagil orliver.

(07:39):
But I really bonded with mymentor at the time, who was the
division chief at the time andhe was an IBD expert and you
know he sort of said like whatdo you want to do if you don't
want to do liver?
I said I really like what youdo, I love IBD, I love, you know
, the work that you're doing.
He was more of a basicscientist and I'm really a
clinician and he said well, doyou want to do research?

(08:00):
I said, yes, I'd like to doresearch.
So he gifted me with a projectthat ended up really
springboarding my interest inprecision medicine,
pharmacokinetics, drug levels,drug monitoring.
It sort of created this path,but I was doing it pre-REMI, so
there was no story aboutinfliximab and drug levels and
it was in another drug which wewere using before.
And in order to come back toMontreal, quebec has limited

(08:24):
spots.
You have to leave the provincebecause it's a little bit
different than in the US and youhave to go and learn something
and bring something that theydon't already have in the spots
that are being filled byphysicians that were in Canada,
but specifically Quebec.
So he sent me, you know, hegave me options and he said well
, I'm working with this guy.
Again, the guy concept comes upand it's the guy.

(08:44):
And I was like who is the guy?
And he said, well, his name isSteph Togan and he happens to be
the first author on the firstever Remicade paper in Crohn's
disease in the New EnglandJournal of Medicine.
I thought that's another guy.
So I like went all right,montreal, los Angeles, I met
with Steph and it was like loveat first sight.
I was like I want everything.
I want everything you're doing,feeling, saying, and I just

(09:07):
like, again, you get inspiredand you get excited about the
passion and I followed passionthat's, I guess, a nice way of
saying I've actually followed mypassion and others have, you
know, given me and shared withme their passion and sort of led
me and then I reallyjumpstarted my career at
Cedars-Sinai with Steph and he,you know I I had gotten a

(09:29):
chronic colitis grant and I wasreally getting my research legs.
And the cool thing was is thatbecause at the time Canadians, I
didn't have my, I didn't have amedical license, I was a fellow
, I was a research sort offellow and I was on something
called a trade NAFTA visa, whichis back then, and the rules
were that you don't see patients, you don't examine them, you
don't have an.
You know, it's just you'redoing research and you're really

(09:50):
focused on doing research.
So I audited my MPH at UCLA, hada backpack, was in school with
like students at UCLA, like Icompletely just like, was open
to everything I wanted to absorb, eat, sleep, drink, research
and really figure out what mypath is going to be.
And when Steph said, well, whatdo you want to do next?
And I said whatever, I want tobe you, but in pediatrics.

(10:12):
So I'm giving you sort of thebackground of like how it really
is.
It's about those that inspireyou and see something in you and
want you.
Like if Ernie had not sent me toSteph, my life would be very
different.
I'd be in Montreal I'd still beat the University of Montreal,
probably, you know, and having avery different life.
I would have had a verydifferent path, which I'm sure I
would have been enjoying,loving, happy, but that's just

(10:33):
who I am.
It's like wherever, as long asI'm doing good stuff and I'm
helping to change people's lives, it doesn't matter where I'm
actually stationed.
You know, it's just that I havepatients, and so I stayed at
Cedars for 16 years and thoughtthat I would start and end my
career looking at the Hollywoodsign on West.

Speaker 1 (10:50):
Third, street in LA.

Speaker 3 (10:51):
And an opportunity had arisen and my personal life
was such that my husband has adaughter and she was young and
we had met and decided that I'mgoing to move to New York
because that's where him and hisdaughter were from.
And so for the first time, Iactually had to make a decision
where I put my personal life.
This is a true difference in asyou mature.
This for young folk out thereto understand is that it was

(11:14):
always about career, career,career, and it wasn't that I was
selfishly about myself.
It was actually about how muchcan I give to others and really
answer important questions andgive as much to my patients, my
families, and create novel waysof approaching, you know, this
disease.
And then I put my personal lifefor the first time in a lens,
like before my professional, andaround the time that I was

(11:36):
thinking what am I going to do?
Am I going to go into privatepractice?
Am I going to be ready to leaveeverything I had just sort of
invested my entire existence in?
But it was okay.
I felt like I had done good,you know, and I was ready to say
if I needed to take a break orhave a different path at that
point.
It was worth it because mystepdaughter needed her father
and her stepmom at that point,and so it just so happened at

(11:58):
the same time there was anopening at the Mount Sinai
Abundance Center, the birthplaceof Crohn's disease.
Who and fun fact when I firststarted as a research fellow at
Cedars-Sinai and I thought tomyself, how am I ever going to
get?
Because as a young,impressionable fellow, you're
like don't you want to work atMount Sinai?
Like everything was happeningat Mount Sinai, it's the
birthplace of Crohn's disease.

(12:18):
It was like this really, youknow giants in the field that
were still practicing and werepeople that I would see on stage
when I was a fellow.
I was like I need to work there.
But you know, it took me 16years.
I married a guy from New York.
That was probably a good, agood strategic.
I told you I'm strategic.
That was one example of.
But the idea was that it justhappened that there was opening

(12:41):
and Bruce Sands, who's a veryclose colleague and friends of
mine, who runs the adult GI side, me and John Fred really formed
the IBD directorship, me moreon the clinical ops side, him
leading some of the researchstuff, and it was a marriage
made in heaven and I was able totransition there and run the
IBD operation, run the GIdivision, and I've just invested

(13:01):
more of my life, imagine,imagine, thought there was not
much more you can do, but I'mcompletely inspired and continue
to try and be as innovative aspossible, to try and change as
many lives as possible.
And that is the story of how Isort of got interested and then
doubled down and have continuedto double down and has led to a
lot of the things that I'm surewe'll get into as to like why,

(13:25):
how and all of that.
But I think it kind of givesyou an idea of like where my
mindset is and how I sort oftracked my path so that I can be
in a position to help as manypeople as possible.

Speaker 2 (13:36):
First of all, that was delightful to hear how
passionate you are about IBD.
As a patient, I want to saythank you.
Thank you so much for sharingso much.

Speaker 1 (13:46):
Sorry to the liver folks, sorry guys.

Speaker 2 (13:48):
Yeah, sorry liver people, but we got her Too bad.
It was no offense.
No person like nothing personalhere.
Yeah, how do you feel now aboutbeing?
The guy for so many otherpeople.

Speaker 3 (14:00):
When I get asked that question I think about it.
So last year, you know, therewas an award at Mount Sinai
called the Jacobi Medallion,which is not to tell you like
that.
I want it's less relevant,because who cares really?

Speaker 1 (14:11):
But at the end of the day.

Speaker 3 (14:13):
The reason for it was thinking about the path and the
role of being a mentor andhelping people to continue to
inspire and aspire and to feelthe responsibility that I have
for the folks who have helped meunderstand that the
responsibility now is for me toensure there is a legacy.

(14:36):
I realized very clearly thatit's not about me and that was
interesting.
I just want to say that when Iwas at Cedars, it was all about
me because I didn't have fellows.
I ran the IBD boutique.
It was like Cedars is a reallycool place because IBD is sort
of its own institution, almostwithin the GI division.
We didn't have a division, Ididn't have fellows.
I had rotating fellows andfolks from UCLA would come over,

(14:58):
but it was like a really coolsort of almost private practice
field but in a hospital typesetting.
So the idea being is that I wasthinking about when I was
switching to Mount Sinai.
One of the things I needed toremember is that this is no
longer going to be about me.
This is going to be abouttaking everything that I've done

(15:18):
, thought about, learned,acquired, you know, greatness,
great ideas and seeing what atrue leader is.
That is what I need to do hereat Mount Sinai and was I ready
for that?
Was I ready to no longer bejust about me?
It's like a really interestingphenomenon and it wasn't that,
as I noted earlier, it wasn'tlike it's all about Marla, but I
say, like my career and tryingto like bulldoze through and

(15:40):
make these discoveries andrealize that what it is really
about this maturity as youmature in your career is it must
be about the next generation,because people with IBD will
continue to suffer from IBD.
It doesn't stop with me, itdoesn't stop with infliximab, it
doesn't stop with you know, itjust doesn't stop.
And I really want to be able tomake sure that there is a long

(16:03):
legacy of folks who willcontinue to deliver innovation,
transformative approaches tocare for folks suffering from
IBD.
And in order for me to do that,it means I need to switch and I
need to make sure that thereare multiple future generations.
So I sort of at this medallionceremony, when I gave my
acceptance speech or my thankyou speech, I really recognized

(16:24):
the immense responsibility thatwhat it means to be the guy, the
gal, the person is that youneed to be intent, you need to
own it and you need to be a rolemodel and sometimes I catch
myself.
If I'm responding in a certainway or emailing and one of my
mentees is on it, I have toactually say, like Marla, they
see you, they will mirror theirbehavior through you.

(16:46):
So it's not just about beingthe guy, but it comes with, so
in a good way.
I love the aspect that it'simportant for me to be
intentional in the way I speak,the amount of planning I put
into every meeting, because it'simportant for me that I am
perceived in the way that I wantothers.
It's not and it's not about doI?

(17:07):
Yes, I care about what otherpeople think because I have
taken on the responsibility tobe a role model to others.
So I want to be seen in acertain way.
I want to be an inspiration toothers, and so part of it is how
I present myself and thatincludes the way that I think
very carefully about my wardrobe, think very carefully about the

(17:29):
way that I speak, the way thatI lecture, the way that I
educate, the way I interact, andthat comes with intent, which
is why I say that understandingthe responsibility that I've
taken on has been reallyinsightful for myself to
practice that and to ensure thatI'm truly.
You know, perception meetsreality.
Cause that is actually one of adifferentiator for me is when

(17:51):
I'll have someone say, you know,you're exactly the way I
imagined you to be, and I'mthinking, oh God, what does that
mean?
Before we get into, you knowwhat that means.
But it's that you know, I hadthis vision.
Or just people will ask myfellows oh, what's it like to
work with her?
They're like it's exactly whatshe's like when she's up on the
podium.
There's nothing different.
That is Marla.
So you know, it's.

(18:11):
That's important to me andthat's why I make that
perception reality.
Comment is that that is beingthe guy or being the person.
I really take that role.
Probably, aside from being awife, a stepmom, being from
there for my family, it is oneof the most important things I
take very seriously isresponsibility, and I think my

(18:31):
team, they know that becausethey know that I will always
make sure that they're first.
That's what a mentor-menteerelationship needs to be and
that doesn't always happen,which is why I sort of take on
that role and have taken it onseriously and take a lot of
pride in knowing that there'smany future, the guys and the
being put into leadershippositions and talk to me about

(19:05):
you seeing that evolution beingpart of that evolution and kind
of how far has it come.

Speaker 1 (19:09):
But where do you think it needs to go?
What's still not there yet?

Speaker 3 (19:12):
Yeah, it's funny I was thinking about as I was
saying to Guy I was like ittruly was.
It was like you were like partof the guys and I was always
part of the boys, like it wasjust a thing.
You know, there was like threeor four of us.
It's me, maria Abreu.

Speaker 1 (19:26):
Uma.

Speaker 3 (19:27):
Mahadavan.
I'm talking older school womenthat were originally in this
doing advanced fellowships.
There wasn't that many of us.
Like you know, maria and Itrained together at Cedars as
well.
We overlapped and then she cameto Mount Sinai and then I came.
We are sisters from anothermother, so it was like the
original.
You know those in the U S, therewasn't many and there was no

(19:48):
vision in my mind.
This is important.
What I'm, what I'm going to sayis that I never saw gender,
which means I didn't experiencewhat a lot of women see Now.
Is it entirely possible that Ijust had my head down and
bulldoze right through anddidn't even pick my head up to
even pay attention?
I would venture to say that'sprobably the case and that is

(20:08):
what we have.
A lot of us have in common sortof grew up in a very sort of,
you know, male dominated field.
Ibd, gi is much better.
It's many more than it was.
It's still more to come, butIBD, there are some incredible,
powerful, incredible women inthis space and it's, like you
know, truly.
I'm into this, and you'll get mederailed when I tell you that

(20:30):
I'm reading this book that I wasrecommended called A Likeable
Badass and so what it is, sothat I could just even make it
clear as to where I've seen andinstead of me saying badasses in
terms of like these women are.
But what has become interestingis we are seeing leaders that
are both warm, compassionate andassertive, not cold and

(20:51):
aggressive, sort of the extremeof a likable badass we're
talking.
You know, we have this spectrumof warm and cold and assertive
and aggressive, and women have alittle bit of a more difficult
time.
The expectation is that we'reboth warm and assertive.
That is the goal that we allwant to be.
Now, a lot of women who may not, who may be one of those and
full, you know, on the spectrumof more cold or shy or whatever

(21:12):
the concept viewed as notcompassionate or not likable.
Those are the likable badasspieces.
That a likable badass is theidea that you're warm, you're
compassionate, but you also getshit done.
That's sort of the concept andlearning about that and teaching
some of even my NPs, and so youknow, talking about what that
means and when I look at thefield now and again, maria

(21:35):
myself, uma, probably fit intopretty well the reason why
you're probably part of the crewand there was no, like I said.
I'm sure many people have tried, but we just went like what?
I don't even see you, so I'mjust doing my thing, like
whatever you're.
That's your problem.
That is not my problem.
I don't see myself through mygender, I see myself through my
work and I put my head down andI tell all my young faculty if

(21:58):
you pick your head up to lookaround right and left to see if
that's happening, you know youmissed your opportunities.
I'm very clear that if you'reworried about your gender,
everyone else is going to bethinking about your gender.
So you just get work done andlet the work speak for yourself.
You know, and I feel that a lotof incredible women, especially
younger generation andmid-career, are just like

(22:19):
incredible role models and it'sso exciting to see and I love,
you know, being on panels withthem and I love being in a room
and you know we all needinspiration, no matter what
right.
We all need still mentors,still role models, to say this
is possible.
So I think for me that's sortof been my driving force and and

(22:40):
, like I said, I am sure thereare plenty of times that gender
came into play, but my mentorsdidn't matter.
They saw something in me and Iwas showing them value.
And if you show value, itdoesn't matter what your gender
is, just show value to anyoneyou can.
Who's then going to keep askingyou?
Because you always get shitdone, and that's sort of the
concept is, but being warm andkind, both practicing powerful

(23:04):
speech as well as powerlessspeech.
You don't have to always havepowerful speech, you know, just
learning that is reallyimportant, and so that's sort of
my thing now is to say how canI help others gain those skills
that really may create barriersfor them?
They don't have to be me.
I told them, one of me is likeso much enough that you know
that's not what I'm asking for.
I just want to share with yousome features or characteristics

(23:27):
that can allow you to go fromhere to here.
One of the things I did late inlife was I actually got an
executive coach.
I got someone who can help methink about executive function.
I wanted to understand how doesmy brain work.
Now you think, 56 years later,marla, you would know how your
brain working.
You probably could havepredicted what your brain was
going to say.
However, I needed to understandwhat are my limitations, how to

(23:50):
manage up, how to bring peoplein for things that I'm just it's
.
I'm not my strength.
Let's say I don't lead withempathy.
That's a true fact.
That I don't lead with empathyit doesn't mean I'm not
compassionate or warm, it justmeans that accountability and
the way that I lead a team isthere's accountability and
kindness, right, butaccountability comes first.
That's more of an executivesort of CEO kind of mentality.

(24:13):
And I remember thinking, oh myGod, I have low.
My empathy quadrant is lowestof all.
And everyone could have guessedthat if I show my brain all the
time and I show the fourquadrants, it wasn't like it was
zero, it just wasn't like thestrength.
And so I remember saying to myexecutive coach oh my God, I can
never lead a team.
I'm not empathetic.
She's like no, that's not whatyour executive function is going
to be.
You are going to organizeeverything, you're going to take

(24:36):
people from A to Z.
You're going to be a strategist, you're going to be, you know,
you're analytic.
That's the strength you have.
And you'll bring in people whocould help on the quadrant of
selective empathy, as my friendssay, so that you bring empathy
out when it needs to be.
And so learning all of that hasreally been over the last like

(24:56):
five years.
I've really embraced as I'vematured in myself.
I've took me a long time tounderstand why I say the things
or why my brain sees things in acertain way, and it has helped
me, I think, be a better leaderand really bring the right
people around me and admittingwhat I don't know at this stage

(25:17):
and saying, well, that's not howI'm best skilled, it's not like
I'm going to learn a new thingat 57 years of age, you know.
So I need to know what I'mreally good at so that I can
surround myself with folks whocan complement where maybe I
have some limitations.
So that's also been anevolution.
So I think that also thevulnerability around
understanding what yourstrengths and limitations are as

(25:39):
a leader has also worked for me, meaning in a good way.
I've wanted to put in that workso you could see by the therapy
session we're having that I'vereally disclosed sort of what,
the evolution of being the guyand how I've created, you know,
for myself goals to beintentional and to be as much of

(26:00):
a role model as I can andaspire, you know, to inspire
others to continue to createtheir path and their unique way
of leading in the field.

Speaker 1 (26:08):
Speaking of sort of learning new things.
One of your interests isdigital health, and that is
definitely like an up and comingarea that continues to evolve.
How did that interest start?
Where did it start?
And then how did you parlaythat into your venture, trellis
Health?

Speaker 3 (26:22):
It's funny, it goes back to your role model.
So Steph Targan is like thescientific entrepreneur of all
time.
He started Prometheus Labs andstarted Prometheus Bioscience.
That was acquired by Merck for$10.8 billion and I have watched
Steph like literally I'vestudied him, you know, not
creepily, but studied him in hishow he takes what helps people

(26:46):
and wants to scale, wants toensure that not just the folks
that are in the four walls atthat time at Cedars had access
to what he believed to besomething that can help 10
million people worldwide orwhatever the concept at that
point not just the thousandsthat were showing up at Cedars
and I saw how his passiontranslated into discovery and

(27:08):
innovation.
I kept watching him do it and itstarted with the patient
wanting to solve her problem,figuring out how to solve the
problem, building the right teamto solve the problem, and then
saying I'm going to scale this.
I think there's a marketability, I think there's a
commercializable strategy here,and so I sort of have been
taught by the master, in myopinion, and I remember, you

(27:30):
know, back then, being anentrepreneur and commercializing
your know-how.
It's like docs who sort of wentinto pharma.
It was like the dark side, likehow do you justify making money
, you know, really, that's how Ithought that what we do best is
, you know, we, we help people,our ideas are worth something,
and if it means that you'regoing to make a little bit more
money for all the incrediblework and know how that you put

(27:54):
into changing people's lives,it's not the dark side, you know
, and this was like a lot.
So I remember staff, you know,and all the conflict of interest
disclosures, and it was like Ijust remember, you know, and he
really taught me that if youfeel that you can do something
that is going to help millionsof people, you put your head
down and you keep doing that andyou break through sort of the
noise because, knowing how manylives you can change, you will

(28:16):
not have a problem going tosleep at night, and that was
really sort of important, youknow, and I sleep well, just so
you know.
So you know, the idea being isthat when I saw what stepped in
and I came to Sinai and you knowthe field had evolved so much
to a point where it was nolonger acceptable to treat
patients' symptoms and worryabout their colonoscopy results

(28:40):
and that our drugs were greatbut we still had a therapeutic
ceiling.
And I really believe thatunless we treated the whole of a
person, not just the physicalsymptoms, not just the
colonoscopy ulcerations, andgetting a Mayo score like that
doesn't matter, because mypatients want to live their best

(29:00):
life and they wanted to be seenby the whole of them and that
means mind and body.
And it used to be that.
Oh, we said.
Well, the reason why you'redepressed or anxious is because
when your symptoms, you knowyou're having situational
anxiety or your mood will getbetter when we get your symptoms
better.
And that was a real ignoranceon a lot of our side and we

(29:20):
really didn't sort of take intoaccount the real role of
inflammation in brain health, inmental health, in emotional
health, and we kept thinkingthat if we just got your
symptoms better, oh, you won'thave anxiety, you won't have
depression, you won't have, youknow, any medical PTS whatsoever
, like, oh, an osteopath, wejust got to get you, you know,

(29:42):
sorted on.
You know completely.
You know we all knew it wasdifficult.
But, iomy, back, we just got toget you, you know, sorted on,
you know, completely.
You know we all knew it wasdifficult, but I don't think we
understood that we can help.
And I think that was a realswitch over the last sort of
decade plus like a little bitmore than a decade.
And I remember going to anadvisory board and I met Lori
Kiefer.

(30:02):
So Lori Kiefer is sort of likeliterally like the queen of, you
know, gi psychology, healthpsychology in general, but also,
you know, in the realm of GI.
And I saw her talking alanguage I had never heard
before, which was the concept ofresiliency and self-efficacy,
meaning confidence and abilityto bounce back from adversity,

(30:23):
and that we're all bornresilient.
Stuff happens.
We get a challenge in our lifeand it is binary.
There are two roads to go down.
We either go down the stressresponse and languish, or the
resilience response and flourish.
It is that binary Again, youcan tell.
I get obsessed and need to havewhatever that is and figure out

(30:46):
a way on how to spread the word,because it's like evangelical
for me If I could help spreadthis message about this new,
different way of thinking aboutpeople with chronic conditions
and not waiting for people todevelop anxiety and depression,
but actually proactively givingthem the toolkit and mitigating

(31:06):
and building the resilience andthe tools and the insight to be
able to be more confident thatyou can self-manage with your
medication, you know, orwhatever else is happening, that
I need to empower people to bein control of their health and
control was not defined by youknow why you have rectal
bleeding or how many stools youhave, which is our typical Epic
checkbox or whatever, and we'dgo right.

(31:28):
Here's your count protectinglevel.
Your white count was fine.
Your next visit will be in sixmonths and I'll scope you, you
know, and rule out colon cancer.
I mean, that is like that is nottreating the whole person and
so, fun fact, I sort of figuredout a way where I called her
after the meeting.
She was in Chicago and I saidyou know, I really love your
self-efficacy scale because shehad developed one for

(31:49):
adolescents.
So I sort of said would youmind?
This is my way in to try andget her to come to New York?
I said I'd love to collaborate.
Would you mind if we did astudy with your self-efficacy?
And before the phone call endedI said oh, and by the way, do
you have any reason why you'dwant to come to the Northeast?
Like my whole family's in NewJersey, I've been looking for an
opportunity to come.

(32:10):
She had an amazing opportunity.
She was doing a stop, a Jillwork with the amazing team at
Northwestern, but her realpassion was about taking her
skill and really changing thelives of people with IBD.
And this was an opportunitywhere we could do it together.
So I said give me three weeks.
And this was an opportunitywhere we could do it together.
So I said give me three weeks.
And in those three weeks Ineeded to get approval to open a

(32:32):
new position, get philanthropyto fund a resilience-based
program talk to our Dean aboutand he's a resilience expert.
So it was really cool becausehe was I was really obsessed
around.
Has anyone ever really appliedthe concept of resilience
outside of trauma or in themental health space or prisoners
of war or any kind of physicalor sexual trauma?
And it was never really done.
Understanding that Lori's workwas really trying to bring this

(32:56):
positive psychology field intochronic condition management, I
was like totally, you know,obsessed and so it was great.
So I called her back and I saidall things are go, we'd love to
be able to have you come andbuild an entire resilience
program wrapping around thepatients, the providers, their
medication and really elevatingthis patient-centered whole

(33:19):
person model.
And when I saw the results ofseeing a great doctor I mean I'm
saying anyone in the IBD centerplus a good medicine, because
we have good meds, plus beingwrapped around and empowered by
these resiliency concepts andmindset, and seeing that people
were not going to the ED, wewere lowering the rates of

(33:40):
surgery, people were staying ontheir medication, we were
annihilating hospitalizations,we were significantly reducing
ED visits.
We were actually, I said,lowering surgeries, decreasing
mental health comorbidities.
I said this is not somethingthat only people who have the
resilience to drive over theGeorge Washington Bridge or get

(34:00):
through the tunnels to come tothe Upper East Side.
This needs to be available toas many humans on this planet as
we can.
And I said to her hold tight,give me three weeks.
This is like my typical I needthree weeks to sort this out, to
map it out.
And I went to our tech transferoffice and I said you know, I
know that you're used to.
You know transferring moleculesor potential mechanism of

(34:24):
action or maybe treatments orbiomarkers.
I feel that healthcare is goingin a way that if we had a way
to digitize and package whatwe're doing at Sinai and be able
to scale it digitally, we willchange millions of people's
lives and we're going to save alot of money to the healthcare
system.
That was like the rosy way ofthinking about that.

(34:45):
Value-based care was more oftalk at that time.
Now it's getting into morepolicy and a lot more health
plans are really, you know,concentrating on value, meaning
better outcomes, less costs, sothat we can continue to get good
outcomes for our patients, etcetera.
So I told that to my techtransfer office and the officer
and they said so.
I told that to my tech transferoffice and the officer and they

(35:13):
said well, here's a seedincubator fund.
Can you digitize Lori'sassessment that she had built us
a developer to work with?
And they were really supportive.
And then they put us throughsome entrepreneur kind of
courses and we had somewhat of aroadshow where there were

(35:36):
different investors who came andone of the investor groups
really liked the idea.
They had done some investmentin other two other Sinai
projects and we're very thought,wow, this is cool, this is a
different way of technology thatSinai is developing and we'd
love to be involved.
So we got a seed investor whogave us some seed investment to
start building the platform,building a skeleton team Lori
and I were co-founders at thetime and continued for a while

(35:57):
to be that and we're able to geta CEO in place as well as a few
sort of minimum employees thatwere working on the digital
health side of it and grew thebusiness and we actually raised
money publicly.
So Trellis Health is thescaling of the resilience
program at Sinai, I should note.
So Trellis was born in July of2020, right in the middle of the

(36:21):
pandemic and we went public onthe London Stock Exchange
because they have this reallycool mechanism that small
startups or early stage couldraise money and do it publicly
instead of privately.
So there's sort of you knowpluses and minus to everything,
but at that time there was a lotof desire to invest in digital
health care, especially if itwas mental health or behavioral

(36:43):
health, especially after whathad transpired.
And the word resilience wasvery sexy.
I mean, even Obama was usingthe word resilience.
I mean, everybody loved theword resilience, didn't quite
understand that it's not AngelaDuckworth.
You know resilient employees.
This is really about beingresilient in the face of an
obstacle, such as a physical,you know, chronic health
condition.
But same constructs, you know,being positive, optimism,

(37:04):
self-regulation, empathy,self-compassion.
You know disease acceptance.
Those are sort of constructsthat are not dissimilar except
for the disease acceptance part.
And so we built the platformbetween you know 2020 and then
launched our first realcommercial program with
UnitedHealthcare in March of2023 in the Northeast.

(37:27):
So we were providing Lori'smethod and the program, which is
both a digital as well asreal-time coaching.
So we've got trained folk whoare empowering people, and
United was covering the cost ofthe program, which, for anybody
would know, that's really amomentous occasion to have a
health plan who says weunderstand that this will help

(37:49):
our members but also, of course,consider the benefit to the
cost, and so that's sort of youknow where Trellis started,
which was in the health planbusiness.
But we definitely haverecognized and expanded our
approach, that we've alsorealized that you know we need
to expand to patient support ingeneral.
That includes, you know,supporting patients on various

(38:10):
therapies and being part of.
You know the goal is to wraparound and be part of patient
support programs, knowing that acopay assistance card is
supported but it's notsupporting the whole of me and
really starting to expand andreally develop ways of also
helping patients in clinicaltrials, because you know
clinical trials are verystressful.
You've failed a lot of meds,potentially the optimism that

(38:32):
this med is going to work andI'm going to get a placebo.
So being able to help peopleget themselves ready for
clinical trials by building theresiliency to get into a trial
is also like my passion and mydream is to, you know, get new
drugs to the market but getpeople to get into these trials
so that we can actually bringeven more innovation.

(38:53):
So you could see that mypassion for what I do in my day
job and what I continue to beextremely passionate about has
been able to take that and beable to sort of bring that to
Trellis to expand access for asmany people as we can and also
integrate, empowering people andreally building happiness and
health for as many people as wecan, has really been what Lori

(39:16):
and I wanted Trellis to be, andthat's what it is today.
I will tell you that two plusyears ago I was asked to take
over as CEO of Trellis.
So I talk about why I did mybrain.
I needed to make sure thatbefore I took on being executive
of an operation in something,I've never been a CEO of a
publicly traded company Maybe Iwas born a CEO, but not of this

(39:38):
public traded company, right, Ithink I had that mindset, but I
wasn't sure that I knew what todo in my medical you know world
and I knew how to build aprogram, et cetera.
But those skills remain andthat's why my brain was so
important, because it showed methat these are my strengths.
This is not my strength how tobuild a team.
And so I've been doing both,both my work at Mount Sinai and

(40:00):
my consulting and my speakingand my developing programs, and
then also leading the team atTrellis Health.
So that is sort of the reallyit all comes down to.
What are you most passionateabout and what can I do to help
as many people as I can wasreally what gave birth to you
know, the foundation of Trellis.

Speaker 2 (40:20):
I really hope that in 2025, you are able to
accomplish your goals in theexpansion process.
I mean, all the patients wholisten to the show know and you
know from treating us that it'slike, uh, you're good for a
little while and then somethinghappens again, and so it's like
a.
It's a never ending cycle ofreminding yourself that you have
to be resilient and notwallowing or you know saying,

(40:43):
okay, I'm going to wallow inthis for a little bit because it
really sucks, but now I needthat little push to get back to
the other side of thinkingpositive and being resilient and
really sharing that.
So I'm excited about whereTrellis can go.
Yeah.

Speaker 3 (40:56):
I'm excited, so we'll know.
I think that you know we'reheading in the right direction
and it comes from the rightplace.
You know, and listen, I alsohave to be realistic that not
all startups succeed.
You know, just in general, likeI'm also, you know, realistic.
But I feel like when you havethe right people, you have the
right intent, you have the rightpassion, that you're doing good
and good science and goodbusiness and good people and,

(41:19):
hopefully, good outcomes.
And that's sort of the attitudeyou know.
You have to be resilient.
Oh my, I can't tell you.
Every day there's a differentemotion and you know that bounce
back and you could absolutelykeep feeling like those bobo
balls and you know, and you keepcoming back.
I am not going away.
You know that concept of that.
I'm punching that thing andyou're like keep it coming.
I'm going forward, I'm going tobounce back even further.

(41:42):
And I think that's the conceptsof really trying not only in
our daily lives and what I talkto my patients about really
focus on them and empoweringthem and understanding the fact
that so many more decisions needto be made when you have a
chronic condition compared towhen you don't, especially one
that involves bathrooms, unknownwhat's going to happen.

(42:02):
I may eat something.
You have to plan so much more.
There's enough decisionswithout IBD and then adding IBD
and we just don't get thatMeaning typically, providers,
we're very good at sticking inour lane, but we need to be able
to, you know, expand andunderstand what else our
patients needs, and that's sortof the premise between trying to
wrap around patients andproviders as much as we can.

Speaker 2 (42:24):
I want to talk about women's health.
You're a pediatric GI and andadult.

Speaker 3 (42:29):
So I realized that if there were two populations that
needed extra attention, it'swomen and children.
And so, funny enough, theextension this goes back to my
Cedars days is that after Marialeft, like I was it, I was the
female gastroenterologist whodid IBD.
So because I always I'm alwaysinvolved in adult trials, I

(42:51):
wasn't seen as like, oh, you'rea pediatrician only, but you do
both adult speeds.
This is historical.
But because I was the onlywoman, it was sort of intonated
you must know something aboutpregnancy.
It's like, well, I've neverbeen pregnant, but yeah, I got
two X chromosomes, maybe I do.
So it just became by defaultthat Marla's going to see these

(43:11):
patients and she's going to tellthem about the safety of the
meds.
Because back then there wasonly a few of us who were
actually involved in sort ofeven safety of these biologics
in pregnancy and sort of doingthe work.
Uma Mahadavam really wasleading you know the story and
we were doing a lot of work atCedars as well.
So it sort of made sense and soI would see them, I'd say your
meds are safe.
And back then we, and so Iwould see them, I'd say your

(43:45):
meds are safe, and back then weonly really had Adalimumab or
Humira and Remicade at that time.
There was nothing much else.
Because we know ofrevolutionary revolution until
2016 and beyond, really, or 2014, with fet stop their meds and
they should continue.
And it just started snowballingafter that.
And then I was going through myown fertility struggles and
really realized that women wantto talk to women.
Women want to talk about sexualfunction, they want to talk

(44:05):
about pelvic floor and they'renot talking to my colleagues,
about my male colleagues, notbecause they wouldn't be
receptive, but it's not beingbrought up.
So my female patients weren'tbringing it up and you know,
talking about sexual health,sexual quality of life, it just
wasn't happening.
And so when I was developingthese really you know key
relationships with a lot ofthese women that I was seeing
for my colleagues at the time tosort of help them get pregnant,

(44:28):
they would hand them to meduring pregnancy was almost like
, oh my God, I'm not touchingthem during pregnancy.
I'm like no problem, you'rewith me for 10 months and then
I'll hand you back.
I will give the gift back toyou.
Know, you gave me a gift for meto be able to help you get
pregnant and stay pregnant, andthen you'll see me next time.
You know we'll come back.
So I committed to sort ofmanaging them during this time
that a lot of folks wereuncomfortable and it's true

(44:50):
there wasn't as much data as wehave now.
Piano registry hadn't been, youknow, finalized, so no one knew
really was it safe?
And so I was bold to talk aboutit and be able to say we'll get
you through this and we'll workthrough it and our preliminary
data looks like it's safe.
You know, being authority in ithelp people feel more
comfortable around it.
And then I started a clinic atCedars where I really felt after

(45:12):
my fertility journey that Iwanted a maternal fetal medicine
specialist with me in theclinic.
This was like a novel sort ofthing.
So I went to the head of OB atCedars at the time and she
thought it was great and westarted doing clinics whereby I
would see a patient and thenthey would move from my room to
her room at the time, and it wasgreat because they still got us

(45:34):
on the same day.
But then I realized, ooh, Ithink I could even do something
more amazing whereby we're allin one room together patient
there, everybody surrounding onemessage, no confusion, no
inaccurate information center oftruth, this is where it happens
and triage them to whoever theyneed.
And so when I was coming toMount Sinai, before I even

(45:56):
started, I wanted to be surethat I can have adult privileges
, so I can see adults, but alsothat the maternal fetal medicine
team would be interested incoming to the IBD center and
running a clinic with me so thatwe were together seeing the
patient and preconceptioncounseling her pregnancy.
And, honestly, it's been 10years and I just had it today,

(46:19):
and it is like the favorite dayof my life Every Wednesday that
I'm in eye prep clinic havingconversations about the most
emotional time in our femalepatients' lives be able to say,
you know, oh, don't worry, we'regoing to get you pregnant.
This is what we're going to do,having a plan, having a timeline
, telling them what we need toget you well and why control of

(46:40):
inflammation is important.
Running away from the meds andthe OB saying to you to stop
your med and all kinds of that.
I said, if you did not hear itfrom this mouth, it is not true.
That's like I've become, youknow, sort of trying to be
evangelical about you.
Call me whatever someone saysto you if you haven't heard this
and then you get conflictinginformation anywhere else, call

(47:02):
me, write me in the portal, I'llclarify.
But it is really the ability totake women who have literally
walk in the room, I could tell,holding their breath, you know,
holding their pelvic floor andjust waiting for me to tell them
that it's going to be okay.
And then by the time they leavethe office they're, like you
know, ready to go to sleep.
They're so relaxed and so happyand I breathed for the first

(47:25):
time.
And you know, leading up to theappointment today, one of the
patients, the husband, said oh,we were told nothing happens
until you see Debinsky.
And that's like a funny thing,cause it's like, yeah, I stand
in the way of getting pregnant.
And your other opinion, likeusually, I say you know, I am
part of it, I helped you getpregnant.
But it's not quite the same.
Although I have asked for me tobe named, some of the babies we

(47:46):
named Marla, even a middle name.
That's not happened.
But anyway, that ability tosort of just take all of the
misinformation, the stress,anxiety, getting newly married,
your husband, you know, wantingto have a family, you're not
sure, because someone may haveonce told you, it doesn't matter
what, and then to be able toturn that like 180 and just have

(48:08):
them walk out knowing that it'sall going to be okay and I'm
regardless of what's going tohappen.
I'm going to be okay and I'mregardless of what's going to
happen.
I'm going to make sure thatthey get what they want and that
their motherhood journey isgoing to begin and go wherever
they want it to.
I leave it to their choice.
But it's kind of been, you know,really just the most fulfilling
aspect and because I actuallycould not get pregnant.

(48:30):
So my experience with fertilitytreatments et cetera, has
helped me develop relationshipswith young women who are, you
know, who don't know about that.
They, they just think they canget pregnant and someone told
them, you know, or they don'tknow, about the impact of the
hormones on their pregnancy, sothey never wanted to do it
because they were told that Ican't, I don't know how patients
do it, because they were toldthat this is I can't.

(48:51):
I don't know how patients do it, because the amount of
information, some accurate, mostnot that people's experiences
aren't always the same and it'slike, I feel, the fact that we
have this program that is ableto really be the center of truth
for them and you know it'schanged so many lives and the

(49:13):
babies that we have, you know,born out of it and it's just
been really.
I mean, I love managing youngchildren and their families of
people of all ages, but theability to take this population
and give them the gift ofmotherhood, of which they didn't
know they could even have, likeyou can't even describe what my
Wednesday feels like.

(49:33):
So it's just the best feelingand that's like really for me.
Why having and training?
So Zoe Gottlieb, which is ayoung faculty who trained with
me in this clinic environmentand has just got a big grant
from Helmsley to do the firstever prospective fertility
registry, do you know that whenpatients ask, does IBD decrease

(49:57):
fertility, that we have neverstudied that prospectively and
all we say is well, in oldretrospective studies that have
measured success of fertilitybased on live birth registries.
To me a lot can happen betweenconception and a live birth, and
so the fact that we don't evenknow truly that.
People who had J-pouch surgerythere's literature that says

(50:20):
that it may decrease yourfertility and it probably does,
because when you just dissectthe rectum and create that final
, you know the J-pouch, thatsure, but it doesn't mean that
your uterus can't carry as manybabies as you want.
It just means that the plumbingmay not allow that you get
pregnant, naturally.
You know, some folks weresaying you can't even get
pregnant if you've had a J-pouchand some of the data is all
over the place.

(50:40):
So Zoe and I and EugeniaSchmidt, who's at the University
of Minnesota, who also trainedat Sinai and went and scaled
this iPreg clinic concept andthat's sort of the pay it
forward for me as a legacy, Iwas saying, is that they were
able to get a grant fromHelmsley.
It will be the firstprospective fertility registry
to finally answer a questionthat impacts 1.5 million women

(51:02):
in the US and probably 4 or 5million globally for IBD Does
IBD, yes or no, impact myability to get pregnant?
Do my meds impact?
Does surgery impact?
Does my social determinant helpAll of it and create sort of a
risk profile so that we canquickly get someone to a
reproductive endocrinologist andnot wait until you're 44.
And age limits you from gettingpregnant, because everyone's

(51:25):
always told you no, you have towait till your disease is
completely better, but there'snothing that they're doing to
control the inflammation.
No one gave them an additionaltreatment to actually control
the inflammation.
That's why it's like the amountof lives we can change in a one
hour visit where all we do istalk, we listen to the story, we
listen to their goals, weensure that we're making the

(51:46):
right decision and get them tothe right team at the right time
in terms of fertility if theyneed it, et cetera, and managing
the mental health aspect ofthat postpartum depression.
And it's a whole other thingthat truthfully so blessed that
we have that at Sinai and peoplecan get access to us.
But as part of that and you cansee my theme of scalability that

(52:08):
it doesn't stop here is Icreated an organization.
Myself and Susie came from MayoClinic like way back in the day
when we were almost fellows, Ithink, which I'm not how long
ago that was, but as long.
I already told you in the 90s Iwas a Peds resident that we
started an organization calledwe Care in IBD.
The intent of that originally,way back was when it was me
Susie.
I left Susie out.
Sorry me, susie.

(52:29):
Uma, youie, uma.
You know, maria, coreIBDologists was.
We wanted to create anenvironment where other women
could be empowered to go intoIBD.
But then I realized, when Ireally took a step back and said
where's the need Is that we'regetting more and more female
leaders.
There's more emphasis onleadership at AGA, acg, wecare.
I need to think outside ofgetting women to manage more

(52:50):
women with IBD.
I need more women to have avirtual preconception clinic
online so I can totallytransition the website, which is
wecarenibdcom, to be entirely apreconception clinic.
So I've taken all of theresearch, all of the knowledge,
all of the data and I put itonto the website so it gives you

(53:12):
everything you would get if youcame live in person.
You get all of the mostimportant up-to-date information
and we have a directory of allthe women that are involved in
managing Women With IV acrossthe country, based on state.
So really, really cool stuff.
So you could see the end of theday, there's nothing that stays
just in my head.

(53:32):
Two is it doesn't just staywith me, it doesn't just stay
with my patient.
My goal is to make sure thateverybody, no matter where you
live, who your insurance plan is, who your doctor is, that you
get what I believe to be whatyou deserve in terms of gold
standard care, and that's sortof been the theme of whatever

(53:53):
I've done.
I have scaled, you know,whether it's through clinics,
out on the website, throughTrellis, through my legacy
building future leaders.
My vision has been, as I notedbefore, is, if I can touch as
many people's lives as I canthrough the work that I am
passionate about, then I go backto I say, when I put my head
down on that pillow, I feel goodthat I've done good today, you

(54:15):
know, and that's really whatdrives me in my in my passion
for this field.

Speaker 2 (54:19):
It is so obvious that you are a woman that gets shit
done, likeable badass.
Now I have a challenge for you.
What about the next stage inwomen's lives?
What about perimenopause andmenopause?
From my own personal experienceI know hormone fluctuations
affect my IBD and perimenopauseand menopause is like trending

(54:41):
right now because of Gen X.
So what is the next stage?
How do we get peopleresearching that?
How do we get people findingout about hormones and a lot of
the symptoms of perimenopausemimic symptoms of you know that
you could be experienced if youhave active inflammation.
So, marla, solve that one.
Get other people involved inthat.

Speaker 3 (54:59):
I have to develop a whole program around that.
Okay, listen, someone gives mea challenge.
As you noted, I get shit done.
It will, something will happen.
But yes, the goal would be tosay is that you're're 100% right
.
There is a growing interest in Iuse the term aging population
meaning things that arehappening.
You know used to be 65, thenstart to be, you know those that

(55:22):
are 16 and above.
But one of the interest isdefinitively around bone health,
postmenopausal and role ofhormones, especially.
You know I deal with women, whoyou know for osteoporosis.
I'll just take that as anexample.
You know I deal with women whoyou know for osteoporosis.
I'll just take that as anexample.
You know, osteoporosis could bea side effect of just
malnutrition, could be a sideeffect of steroids, longstanding
steroids.
Then you add age and you knowwhat men is safe, what men

(55:43):
should they be on.
How does that impact blood clotrisk if I'm on hormone
replacement therapy?
And what if I want to useRENVOC, which is a drug that may
have, you know, all kinds ofstuff?
You're right, there is notenough.
I'll be a hundred percent agreewith you that it itself is a
special population and I thinkthat part of the next generation

(56:06):
, which hopefully this willstimulate someone to say this is
an area that I could reallybuild a career around and that's
why I'm always about I tellthem.
I am like can you imagine beingon an interview for a
fellowship with me and I say toyou that I'm not going to talk
to you about you know, thefellowship schedule, because
you'll learn that from everybodyelse, or how many calls you're

(56:27):
going to have, or, with thescope, how many scopes you get?
I said, what I would like youto think about is I want you to
think that the next three yearsin training for fellowship is
you need to think about yourinterview today and choosing a
place that in three years fromnow, when you're interviewing
for your first job, what's thatgolden ticket?
Do you want a career or do youwant to just pass your boards

(56:47):
and find a general GI job?
If you want a career, sinai isthis is what we do.
You know, for me, it's aboutcreating opportunities and
creating careers and whenthere's a need and a gap, that's
where it all starts.
It's sort of, you know, startsgrassroots, right, like it's
organic.
It's like wow, robin just askedMarla about what's happening
here and nothing's happeninghere and then tomorrow I'm going

(57:09):
to go tell my young facultythat they need to do this, you
know.
So these are.
This is how it starts Like.
It's that organic that we hearfrom patients what the needs are
, what the gaps are, and try andfill them and do the work to
make sure that we're addressingthe entire sort of life cycle of
someone with a disease.
It's not just about the 18 yearold going to college.
It's not just about the 32 yearold who wants to get pregnant.

(57:30):
There's also the postmenopausalfemale patient who's struggling
with, still has IBD.
That hasn't changed.
But now I have new challengesthat we're not addressing.
So I agree with you.
So I think definitely that is agap.
Similarly, sexual health is agap.
Focusing on, I'm obsessed withpelvic floor these days, meaning
I'm explaining to a lot of mypatients that you know having a

(57:53):
chronic disease where urgencyand just sort of you know the
anxiety around urgency, havingan accident, you know all of
that that impacts your pelvicfloor and if you're walking
around anxious about having anaccident, I mean that is going
to impact your pelvic floor andthen we get you pregnant and
you've got all this weight inyour pelvic floor.
You know I do a lot ofdiscussions around pelvic floor

(58:16):
and pelvic floor therapy and sothat's why, you know, I'm very
open about everything and evenif I have never seen something,
it won't be like I'll be.
It definitely can't be IBD orcan't be your medicine.
I'll be like, hey, I've alwaysseen things once that changed
from how I was before.
Now it's like everything'spossible.
I have no idea.
I would just say I've neverseen it, so it's always possible

(58:37):
.
And then you know, there arenew things that we see.
But I think, robin, you bringup a really important idea.
So if anyone is out there who'sinterested in knowing what's
happening in this space, I thinkyou know creating some buzz
around the importance of thisarea for women with IBD.
Beyond all the amazingness,everything changes after you've
had your babies, et cetera.

(58:58):
What are we doing about that?
So, yeah, so you know, I thinkthat there's so much more we can
do.
Oh my God, if only there wasmore time in a day.
You know, I think that we allalso just the responsibilities
we have clinically.
You know it's gotten a lotharder for docs because they
have to produce and we're, youknow, have to be in clinic, do
more scopes.
It's amazing that research isgetting done, and I think that's
all because there are certainparts of in the country, certain

(59:22):
programs in the country, likeSinai, which is all about a
future generation of researchers.
And you know, we're evenstarting a prevention program at
Mount Sinai where we're goingto create a clinic where we will
see first degree relatives andwe will start giving
environmental and dietaryinterventions that have been
looked at as being risk factors,like there's so much going on.

(59:44):
And so, yeah, we're going tochange, continue to change the
world and lives of people withIBD, and that's just what we do
and we'll continue to do it withpassion and grit.
Right, that's it.
And you guys are the warriors,by the way.
We're just trying to, you know,help as much as we can.
That's why we wake up every dayand do what we do continue to
change and impact as many livesas possible.

Speaker 2 (01:00:06):
And we appreciate it.
After all of that informationthat you just gave us, what is
the one thing that you want theIBD community to know?

Speaker 3 (01:00:14):
Although progress has made and incredible treatments
and we've come to thisunderstanding about treating the
whole you, the amount of workthat is being done in this space
is exponential.
I mean we are not sitting backdrinking Mai Tais or ginger tea
going.
We've done the work, you know.
We figured out this drug, thatdrug Absolutely not.

(01:00:36):
We are continuing to sort ofit's like peel back the onion
and the more we peel the onion,the more we find things where we
can even do better.
And I think the future of moreprecision medicine, more like
the oncology world, the ideathat I'm even mentioning that
we're actually going to build aprevention clinic so that folks
who are worried about the nextgeneration imagine if we can get

(01:00:58):
to a day where we can say thereare things we can do to lower
the risk of in those at risk,you know, of getting IBD.
So I mean we're thinking reallyboldly like we're not stopping
here, we're looking for newtreatments, we want to give you
the treatment that is most goingto match your biology and we're
going to get there early andwe're going to start being
really innovative aroundprevention strategies.

(01:01:19):
So there's some really coolstuff happening.
And to note that we're notsitting back.
If anything, we're doublingdown.
So I think that the excitementaround the discovery and the
fact that we're doubling down onwhat is possible, I think I
hope inspires and gives hope toeverybody, because what do we
have if we don't have hope andoptimism right?

(01:01:41):
So I hope that my journey willinspire and give hope to others
in terms of on the professionalside, and I hope patients
understand that there are folksjust like me that are waking up
every day to try and makepatients' lives better.

Speaker 1 (01:01:54):
Dr Dubinsky, it has been an absolute joy and
pleasure to have you on the show, Thank you.
Thank you so much for comingand spending some time with us
this evening and sharing so muchof your experience and wisdom
with our folks.
I think it's going to be reallygreat and thank you everybody
else for listening and cheerseverybody.

Speaker 2 (01:02:10):
Cheers everybody.

Speaker 3 (01:02:15):
Hi, this is Marla, and if you enjoyed this episode,
please rate, review andsubscribe to bowel movements.