When it comes to people with Crohn’s disease or ulcerative colitis serving in the military, the usual policy is that the two things are incompatible. The reason being that people living with an inflammatory bowel disease (IBD) need care and treatments that are incompatible with being deployed. However, sometimes there are other considerations, as Dr Daniel Rausa describes. Dr Rausa was diagnosed with Crohn’s disease while serving in the Navy, and he has advice for people who live with an IBD and want to serve or who want to pursue a medical career. He also describes why it’s so important to follow up and stay on top of transition of care when leaving military service.
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[Music: IBD Dance Party]
Amber Tresca 0:00
I’m Amber Tresca and this is About IBD. I’m a medical writer and patient educator who lives with a j-pouch due to ulcerative colitis. It’s my mission to educate people living with Crohn’s disease or ulcerative colitis about their disease and to bring awareness to the patient journey.
Welcome to Episode 122!
In the United States, the inflammatory bowel diseases are mostly seen as being incompatible with military service.
I’ve talked with people who had their military career cut short after being diagnosed with an IBD while serving, and an Air Force Pilot who was able to continue in his career after ostomy surgery for ulcerative colitis. You can listen to episodes 120, 104, 96, and 86 if you want to hear those stories.
So there’s a no-IBD policy in the military But there also seems to be cases where there are extenuating circumstances, Like so many other things when we’re talking about IBD: it’s individualized.
Amber Tresca 0:58
I connected with Dr Daniel Rausa, who is a Navy veteran, a physician, and a current gastroenterology fellow in New York. He also lives with Crohn’s disease.
He describes how he was diagnosed when he was in the Navy, what he considered before disclosing his diagnosis to either peers or patients, and why the transition of care when leaving the military can be a tricky time for people living with IBD.
Amber Tresca 1:24
Dr. Rausa, thank you so much for coming on About IBD
Daniel Rausa, DO 1:27
Thank you. I appreciate you inviting me.
Amber Tresca 1:29
So first off, would you take a minute to introduce yourself to our listeners?
Daniel Rausa, DO 1:33
I am Daniel Rausa. I grew up and born and raised in New York, went to undergraduate, the University of Virginia, and then I went to medical school back home at the New York College of Osteopathic Medicine. I went to medical school on a scholarship with the United States Navy, the health professional scholarship program. So afterwards, I commissioned as an officer as a medical officer there and did my residency at the Naval Medical Center in Portsmouth, Virginia. And then after that, I served as a board certified internist and hospitalist in North Chicago. And now I’m a gastroenterology fellow in New York.
Amber Tresca 2:03
That’s fantastic. So you mentioned your Navy career. And that’s kind of how we connected on Twitter. I asked a rather random question. And you came back that your participation in the military was something that you wanted to talk about further. And it’s something that I’ve been very interested in interested in over the years. So I saw on your bio, that you live with an IBD. So what what motivated you to join the Navy?
Daniel Rausa, DO 2:33
I always want to be in the military? Well, well, before I wanted to be a doctor, I think at some point, before I went to college, I tried to figure out how to make those, those worlds merge. And I found that there was this scholarship program. And that’s ultimately what I chose to pursue. But well, before I wanted to be a doctor, I wanted to be a pilot. So this is not not quite the same. But I found that I had a passion for medicine. And ultimately, I always wanted to serve. So I was very, very happy to be a navy physician.
Amber Tresca 3:04
Because you do live with an IBD as you told me on Twitter. How did that all start? How did your symptoms start? Where were you in your career in the Navy? And when did you finally get a diagnosis?
Daniel Rausa, DO 3:16
I first sit there was actually started when I was an intern. It was, it was Christmas Eve my intern year and I was on my gastroenterology rotation. And I had I had terrible abdominal cramping. And that had come after I tried to eat healthier as an intern and 10 trying to exercise.
Daniel Rausa, DO 3:36
So I assumed that was something I did to myself. But it was just progressing throughout the day. And it became so bad that you know I ended up having to go to the emergency room on Christmas Eve and and I found that I had an obstruction. At that time they attributed the obstruction to some scarring that I had from an appendectomy when I was a kid, and I was satisfied with that. I didn’t want anything to potentially derail my Navy career and I didn’t give it much thought I just as long as I didn’t, I didn’t need surgery. That was that was fine.
Daniel Rausa, DO 4:07
You know, I thought it was frustrating because it was obviously something I couldn’t do much about but it got better on its own. I was admitted overnight, I was able to get home on Christmas and that was that. And then life went on as usual.
Daniel Rausa, DO 4:19
Until three months after I graduated residency, I was I was seeing my clinic as as, as an internist and it happened again, and it was probably the most severe thing that I had had and I knew the same sort of thing was happening. So I got I went to the emergency room. And there is where things kind of changed is where they identify that there was there was a lot of changes in on my CAT scan that made it look like I had Crohn’s disease and they they treated me as though that was an IBD flare until proven otherwise.
Daniel Rausa, DO 4:49
And ultimately, I needed the decompression with the NG tube for a bowel obstruction and I stayed in the hospital for a few days and followed up with a gastroenterologist afterwards. And one thing led to another and I was only diagnosed with with Crohn’s disease that primarily affected my terminal ileum.
Amber Tresca 5:05
And where were you in terms of your Navy career at this point? Were you still in the Navy?
Daniel Rausa, DO 5:11
I was Yeah. So the way kind of works in the Navy is when you finish residency, you get stationed as a hospitalist or an internist when you’re graduated internal medicine residency, so that it’s called your staff tour. So I was an independent, board certified physician at that point, I was seeing my patients I was after I was like, fully trained. So I completed my morning. I’m seeing my patients and in the hospital. But I was, yeah, I was. I was an active duty internist at that point.
Amber Tresca 5:40
So what were your experiences with NG tubes Before you had to have one yourself?
Daniel Rausa, DO 5:46
Yeah. Yeah. I mean, it never looked like a comfortable situation. You but when you get one, I’ll you know, I’ll never forget this story. But when I when I got my NG tube, when I was in Chicago with my significant bowl obstruction, it was not going well, when they were trying to place it. And my wife was outside the room. And, and she, you know, she was overhearing how, how difficult it was, and at some point the staff came out and told her that I wasn’t tolerating it. And I think that didn’t sit well with her. Because she’s also a physician. And so it’s not so much a matter of, of tolerating it, it’s a matter of of, it’s just, it’s difficult. It’s difficult to, it’s difficult to be…
Amber Tresca 6:34
When you need it, you need it
Daniel Rausa, DO 6:36
When you need it, you need it.
Daniel Rausa, DO 6:37
And so, since I’ve gotten my own couple NG tubes, it’s been a very different experience, especially as the gastroenterology fellow I think, you know, a lot more a lot more empathy and sympathy for the patients that need one. So we do our best to, I do my best to make sure that it goes in as smoothly as we can get it in.
Amber Tresca 6:56
Have you ever told anybody while you were placing it or while you were in the room while one was being placed that you have had one yourself?
Daniel Rausa, DO 7:04
Yeah, afterwards it has come up. Because there’s always a lot of the similar similar things, you know, it’s difficult to swallow it’s uncomfortable. Yeah. And discomfort. So what I normally normally tell people is, hey, you know, I’ve been here I’ve had this, I know how uncomfortable it is, here’s some of the things that helped for me, and let’s see if they’ll help for you.
Amber Tresca 7:24
That’s really great. I mean, I’m sorry that you had to go through that experience, but it’s really good for your patients.
Daniel Rausa, DO 7:28
You know, I say now more than ever, there’s nothing that makes you a better doctor, like being a patient. Nothing.
Amber Tresca 7:36
So how did this all work, though, when you were diagnosed, and you were still in the Navy, I’ve talked to a couple of other veterans that it was kind of almost like, you know, immediately that was the end of their military career. How did that work for you?
Daniel Rausa, DO 7:50
I knew the writing on the wall. And perhaps that was one of the reasons why I never really thought about my initial obstruction as an intern much more as because I think I was in some element of denial.
Daniel Rausa, DO 8:00
And I remember even speaking to the gastroenterologist I worked with in the Navy and told him what was going on. I told him that it was chalked up to scarring from an appendectomy, he kind of looked at me, like that didn’t make a whole lot of sense for somebody my age. And he did suggest at that point, looking a little further, but again, I didn’t want to go look for things that were going to potentially derail my training. And I think I was I was satisfied with I was feeling well, and let’s just, let’s see what happens. You know.
Daniel Rausa, DO 8:00
So when I was diagnosed with Crohn’s, I remember my gastroenterologist told me, Hey, you know, I’m pretty, pretty confident that this is going to be Crohn’s disease. And I remember even then I was trying to sort of convince, convinced myself that it was it was probably something else. And a lot of that was because it was going to completely alter…When you get diagnosed with something like Crohn’s disease, you in the military, you have to go, at least in the Navy, you have to go on a medical board.
Daniel Rausa, DO 8:51
And majority of the time because of the medicines and the disease itself, it does result in an inability to continually serve in the capacity and your job. But for me, because my job was very unique in the military, they were able, they found me fit for continued service after my medical board, and I was able to continue to see patients.
Daniel Rausa, DO 9:12
But it did make me non deployable, which is sort of a separate determination. And that was that was what changed everything. I mean, I joined the military, because I wanted a unique way of medical training. I wanted that unique experience. Afterwards, I wanted to see the world. I wanted to do different things that were not typical of what my civilian counterparts were doing. And so when I found out that I was really non deployable, that sort of changed everything. I felt like I was, I felt like I was mostly wearing uniform and coming to clinic and doing the same things that I could have been doing otherwise and that was that was a blow.
Amber Tresca 9:48
How did you cope with that? Was there something that helped you deal with that? It’s you know, kind of your whole life taking a different taking a different turn and in a couple of different ways, not only diagnosis but then for your career as well,
Daniel Rausa, DO 10:01
Yeah, I mean, I think I sort of told myself it was, hey, what’s more important is that you’re healthy, and that you’re getting healthy, that deploying, and like this would be a disaster situation, you really couldn’t be performing the job that I was being sent to do.
Daniel Rausa, DO 10:17
And, you know, I think, to some degree, that was, I was able to sort of rectify what was happening with that. And then there’s a number of people along the way that I met, that are really great mentors and friends in the military, that that sort of put it into perspective for me, and they said, You know, I see a lot of people deploy, but it’s not necessarily the only way that you’re, you’re performing your service, you know, that you’re, you’re doing the job. And that was helpful.
Amber Tresca 10:44
Now, you are a fellow and you’re pursuing gastroenterology. Did this diagnosis cause you to pivot in that way? Or were you always going that way?
Daniel Rausa, DO 10:53
You know, that comes up a lot, I think, especially with my colleagues and my current program, but, you know, to be honest, I always had sort of attraction to gastroenterology while before I even found out I had Crohn’s and IBD is, is definitely a unique interest for me now. And I, you know, it’s certainly it speaks to me in a very different way.
Daniel Rausa, DO 11:15
But, you know, as it so happens, it’s not the reason why I necessarily chose to go into gastroenterology, the plan was sort of in motion before, before I ultimately got my diagnosis. But, you know, I do believe that it gives me some strengths to to approach patients who do live with IBD a little bit differently.
[MUSIC: About IBD Transition]
Amber Tresca 11:54
I want to talk to you for a minute about disclosing because obviously, you disclose people around you know that you have IBD, some might say that perhaps maybe it’s something that one should keep quiet: on the down low. When pursuing a medical career, what went into your thought process with disclosing and openly discussing that you live with IBD, as a physician?
Daniel Rausa, DO 12:20
As a physician, going back into training, after being out of training for a period of time, you come to learn the environment that you want to work in, especially going into a field like gastroenterology. If there was if I was able to find a program that was able to sort of empathize or at least identify that this is somebody who is comfortable with with speaking about what has happened to him, you know, it sort of has shaped him in him as a doctor and a person in many ways. And this is somebody that we want to work with, because of those lessons learned, in addition to many other experiences.
Daniel Rausa, DO 12:55
But I always felt that if if you are going to be excluded, because of disclosing a particular situation, that that’s not necessarily the place I want to be. But I ended up finding a fantastic program. And and everybody’s been super supportive. And it’s exactly the place that was meant for me.
Amber Tresca 13:17
Do they call you in when it’s time to place NG tubes?
Daniel Rausa, DO 13:21
I think they know that I’ve a little bit of an aversion.
Amber Tresca 13:25
So maybe not your favorite thing. So going through this process of being diagnosed while you were still in the Navy, do you have advice? This is this is a thing that happens to people, especially because IBD is a disease of young people. Do you have any advice for anyone else that’s going through that process? Not only with dealing with the diagnosis, but dealing with the way that it is going to change your relationship? And it’s going to change your ability to serve, maybe in some in some way?
Daniel Rausa, DO 13:58
Yeah, unfortunately, I think it’s going to be an uphill battle for quite some time for patients who do have IBD trying to join the military. You know, I think that there is a particular way that the military views, what they do. And if you are not able to sort of fulfill that that obligation, without exception or with any potential limiting factors that may pose a problem, but that doesn’t mean you shouldn’t try and I think you should, you should continue to try to get a waiver and I think there are certain jobs, especially in the Navy, where that may be okay. And it really just depends on very unique circumstances.
Daniel Rausa, DO 14:35
So I can’t I can’t say that there’s a blanket statement out there for her whether or not it’s going to be an issue and it certainly you may get a waiver for it. I hope that whoever does evaluate that package is looking at that in a very individual way. But I will say this, I think if there’s that drive to serve, you got to you got to follow it. And I think it you owe it to yourself to to with your diagnosis to still try to see if you can get that package. And at the end, if it doesn’t work out, it’s not because you didn’t try.
Daniel Rausa, DO 15:07
But if you are in the military and you do have a diagnosis with IBD, one of the most important things that you can do is to make sure you get plugged in for care. And they a lot of a lot of folks in the military, a little reluctant to do so because of the same reasons that I ran into, and I was lucky enough to stay in. But I think a lot of people like pilots or spec warfare, you know, it’s a complete change in whether or not you’re able to do your job. And I, I can understandably, relate to their desire to sort of keep that from getting into their medical record.
Daniel Rausa, DO 15:42
But, you know, it’s really the long, it’s the long term that you got to look at. I mean, I think if you don’t have your health in the future, that’s, that’s a real, that’s a real issue. So what I would encourage anybody in the military to do is, is if, if that does come up, make sure you get plugged in for care, because you’ll you’ll, you’ll be thankful for that download download on the line.
Amber Tresca 16:00
Right? Yeah, that, you know, there’s, it’s one thing to voluntarily disclose, it’s another thing to be diagnosed and then have it in your record. And I think if you were diagnosed in a way that it was perhaps not in your record, then you have to be concerned about care, because IBD being a progressive disease, you know, you need treatment to make sure that it doesn’t, that it doesn’t get any worse. So there’s a consideration there as well.
Daniel Rausa, DO 16:25
Right? The worst thing that could happen is, is something comes up, and nobody knows that you have this issue, and you’re in the middle of the ocean, and you have real medical emergency on your hand.
Amber Tresca 16:36
Oh, my. And that’s frightening.
Daniel Rausa, DO 16:41
It’s not something anybody wants. That’s just the way you gotta look at it. And you know, is that you want to be in the in the best place possible. And I think anybody living with IBD knows that. You really gotta surround yourself by by a good team of, of healthcare providers and support network, because when things when things do go wrong, you want to make sure they’re handled correctly.
Amber Tresca 17:00
Dr. Rausa, there is transition of care that takes place when you’re leaving service. How does it all work for you? And what kind of advice do you have for other veterans who live with an IBD, who are going through this process?
Daniel Rausa, DO 17:15
So whenever you know, when your Separation Date is in the military, it’s best to just start doing that transition as early as possible, I think every everybody’s chain of command is is going to emphasize that, but especially for your healthcare. So if you have been diagnosed with IBD in the military, that’s going to be something that comes up for a VA related claim. And it’s something that that you should pursue, because that does sort of establish you with VA care afterwards.
Daniel Rausa, DO 17:41
And, and everybody’s situation is very unique and very different. But that’s definitely a safe, that’s a safety net for a lot of folks. And you know, and it should be. And so what happens is, when you do separate, and you you receive your rating for IBD. What that does is it allows you access to the VA system, and you enroll with the VA and I would encourage everybody to do that as quickly and as early as possible. Just because getting those medicines or establishing that care is going to take a little bit of time.
Daniel Rausa, DO 18:13
So before you leave the military, make sure in your last weeks to months, just see your doctor’s make sure you have plenty of medicines to account for that time period afterwards, after you leave the military. And when you establish with the VA or your your physicians, as a civilian, because whether that’s through the VA or through the the civilian network of care, it’s going to take some time to get those medicines and you may have to get prior authorizations, which which many people in the civilian healthcare system are very familiar about who live with IBD.
Daniel Rausa, DO 18:45
And those prior authorizations do take time. And if your dose has been adjusted in any way, you know, that may get declined at some point. And there may be additional information that needs to be submitted. So just the worst thing that can happen is you interrupt your medicines or interrupt your therapy, so do everything that you can to make sure there’s a nice seamless transition. And then when you do find care, or are looking for care outside, I would start that process before you get out of the military. That way you you have somebody that you’ve identified as somebody who you’re gonna feel comfortable with and who you want to continue your care with.
Amber Tresca 19:17
So start early, and then I’m assuming also you have to stay on top of it with the paperwork and responding to anything that that comes up so that you get things dealt with quickly and following up.
Daniel Rausa, DO 19:28
Absolutely. Yeah. And there’s a lot of I think the VA has a lot of great resources to help people navigate their system when they’re especially when they’re a recently discharged. Veteran. So I think there’s a lot of great resources that will help you navigate that system, and it can be very intimidating. It’s a very big, big system. It’s very new for a lot of people, especially people who spent many years in the military don’t know anything else. So just make sure that you’re utilizing those resources available to you because it can certainly help. Yeah,
Amber Tresca 19:57
And unfortunately IBD is all about follow up.
Daniel Rausa, DO 20:01
That transition to care, unfortunately, is where a lot of things fall through fall through the cracks. And you know, you’re due for, if you’re due for a colonoscopy, if you’re you’re you’re needing medicine, if you’re due for bloodwork, I mean, there’s a lot of things that that you don’t want to fall behind on.
Amber Tresca 20:15
I talked to somebody who this transition of care took like six months, I don’t know if that’s common or not, but…
Daniel Rausa, DO 20:20
Amber Tresca 20:23
Daniel Rausa, DO 20:24
I was able to use both, you know, I had insurance through my job, and then I got rated with the VA, and I did both of them in parallel. And it turns out, and I never would have expected this, that the VA was quicker.
Amber Tresca 20:37
Daniel Rausa, DO 20:38
Yeah. But I also came from a hospital Chicago, that was a VA DoD merged facility. Right. And so I was familiar with how the VA work, but that, you know, it can be definitely overwhelming for people who have no idea how the healthcare system works, which is tough, too, because when you’re when you’re younger, let’s say you’re at 19 years old, I mean, that makes it even that much harder.
Amber Tresca 20:57
And being faced with IBD. And not knowing how to navigate any of this. Because being previously healthy.
Daniel Rausa, DO 21:06
I wrote my own rebuttal letter to my, my prior auth that was denied. And I wrote, you know, I sent my name along with my gastroenterologist, who said there’s in, and that’s very unique, you know, I mean, that sort of expedited things, because we know how to, I know how to speak the language. And, you know, I was thinking about it the whole time that I was going along with it, how do people do this?
Amber Tresca 21:27
How does, how do people who are just who are not in medicine? And who expected to have a completely different life…
Daniel Rausa, DO 21:33
Amber Tresca 21:34
…supposed to navigate this.
Daniel Rausa, DO 21:35
Like I said, it’s a huge learning experience. And, you know, it’s make for a lot of reasons. As a gastroenterologist, those things are, I think, are helping me a lot more, right? There’s an urgency that comes with all this.
Daniel Rausa, DO 21:50
It’s not like a, there’s not, it’s not something that you can handle from like nine to five, Monday to Friday, because people run out of medicines, and it’s not really their fault. And that was, the other thing, too, is a lot of people have reasons for having a reluctance or a hesitancy to start medicines. You know, and I think, from the medical field, we look at things from a very sort of objective standpoint, right, like, well, that risk is still low of certain certain complications.
Daniel Rausa, DO 22:14
But I was on the other end of that, where I recognize that that’s a very low risk, but that’s still magnitudes higher than the average person.
Amber Tresca 22:21
Yeah, still…still a risk. And what is your risk tolerance, essentially, in terms of complications versus your risk tolerance of medication, all that swirls around in the ether. It’s hard to prove a negative, that’s always my thing. It’s really hard to prove a negative and say that if you don’t take this medication, this is something that might happen to you. Well, maybe it won’t.
Daniel Rausa, DO 22:43
Maybe it won’t.
Amber Tresca 22:43
So maybe I won’t take the medication.
Daniel Rausa, DO 22:47
it’s just a…It’s honestly, it’s a matter of like being able to even have that conversation with people, right. Like, everybody’s got their reasons. Everybody’s got their way to view and, and just, I think, appreciating that because I’ve been there. Right? I’ve asked them questions that they undoubtedly were looked at, like they were unreasonable questions for care.
[MUSIC: About IBD Transition]
Amber Tresca 23:28
You are already along your path, you were already a physician when you were diagnosed. There are other physicians that live with IBD as well. Do you have any advice for any maybe of the younger people who are thinking about a career in medicine and who live with an IBD? How can they pursue that? What should they think about?
Daniel Rausa, DO 23:48
You know, I think the words empathy and sympathy come up quite a bit in medicine. And when you do have a chronic illness, and you’re your sort of life has been changed by that, I think that makes you a stronger clinician in many ways.
Daniel Rausa, DO 24:03
And I do think that if you’re sort of grappling with with that question about whether or not to go into medicine, because of something you’re struggling with, what I would say is that this is likely going to make you stronger in many ways, it’s likely going to allow you to relate to your patients in very unique ways, and many other people can’t. And that’s what’s most important is that your ability to relate, you know, you can learn the things that come with medicine, but it’s hard to teach that ability to relate to your patients and and so that’s that’s that X factor. I think that really that really makes a difference.
Daniel Rausa, DO 24:38
So I would say allow that to be a driving factor to pursue medicine. But don’t don’t let it limit you because it’s it’s so easy to allow things like that to limit you throughout your life and, you know, prevent you but instead just let it motivate you.
Amber Tresca 24:55
Thank you. I agree with that completely. You mentioned your wife what kind of medicine does she practice?
Daniel Rausa, DO 25:01
She’s a pediatric cardiac intensivist
Amber Tresca 25:04
Oh my goodness. That’s serious.
Daniel Rausa, DO 25:06
She’s pretty smart. Yeah, she’s a she’s smart woman very lucky.
Amber Tresca 25:10
Do you have kids?
Daniel Rausa, DO 25:11
We do we have. We have two we have a four week old. 24 week old. Yeah, we have a 20 month old and a four week old.
Amber Tresca 25:18
Oh my gosh, bam, bam, right together. So. So how are you making that all work this career and little kids?
Daniel Rausa, DO 25:26
Amber Tresca 25:27
Daniel Rausa, DO 25:28
Life finds a way. You make it work.
Amber Tresca 25:32
Well, I appreciate your time and talking to me. Your story is really impactful in a number of ways. And I look forward to seeing what you do next.
Daniel Rausa, DO 25:41
Great. Thank you for having me. I appreciate it.
[MUSIC: About IBD Theme]
Amber Tresca 25:50
Hey, super listener. Thanks to Dr. Daniel Rossa for sharing his knowledge and experience. I’ll tell you the story of how this episode came about. Twitter is the place not only where I share news and events and information, but also sometimes where I parked my stray thoughts.
Amber Tresca 26:06
My stray thought one day was to ask people what was the part of their IBD journey which they want to discuss, but nobody ever asks them about. Dr. Rosser replied that it was his Navy career. Of course that made my ears perk up. And I was relentless in tracking him down and convincing him to talk to me.
Amber Tresca 26:24
You can follow Dr Rausa on Twitter as DanielRausaDO which is D-A-N-I-E-L-R-A-U-S-A-D-O. Links to a written transcript, everyone’s social media handles, and more information on the topics we discussed is in the show notes and on my Episode 122 page on AboutIBD.com.
Amber Tresca 26:46
You can follow me, Amber Tresca, across all social media as About IBD
Amber Tresca 26:51
Thanks for listening and remember until next time, I want you to know more about IBD.
Amber Tresca 26:58
About IBD is a production of Mal and Tal Enterprises.
It is written, produced, and directed by me, Amber Tresca.
Mix and sound design is by Mac Cooney.
Theme music is from Cooney Studio.