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Women In Wellness: Katie Sagaser of JunoDx On The Five Lifestyle Tweaks That Will Help Support People’s Journey Towards Better Wellbeing

An Interview With Candice Georgiadis

As a part of my series about the women in wellness, I had the pleasure of interviewing Katie Sagaser, MS, LCGC.

Katie Sagaser, MS, LCGC, is an ABGC-board certified genetic counselor and the Director of Genetic Counseling at JunoDx. Prior to joining JunoDx, she was an assistant professor of Gynecology & Obstetrics in the Division of Maternal Fetal Medicine at the Johns Hopkins University School of Medicine, where she worked as a reproductive genetic counselor for 6.5 years. She is also a member of the National Society of Genetic Counselors (NSGC), the Society for Maternal-Fetal Medicine (SMFM), the International Society of Prenatal Diagnosis (ISPD), and the Inter-Society Coordinating Committee for Practitioner Education in Genomics (ISCC-PEG).

Thank you so much for joining us in this interview series! Our readers would love to “get to know you” better. Can you share your “backstory” with us?

My parents were midwestern transplants to the DMV area, and I grew up in a rural area of Maryland’s Eastern Shore. Early on in my grade school education, I knew I wanted to pursue a career that explored biological underpinnings of human behavior. Most of all, I knew I wanted to help people! I discovered genetic counseling in my first semester of college while double majoring in Biology and Psychology. I learned that genetic counselors can specialize within their practice much in the same way as other healthcare providers, and the specialty of reproductive genetic counseling was an area in which I felt a lot of familiarity. The church my family attended devoted many hours of volunteer effort with local pregnancy centers. Although these centers weren’t medical clinics, that exposure provided me with a deep appreciation for the very vulnerable nature of pregnancy — that is, not everyone has the tangible, financial, or other practical resources they need to support their growing family; not everyone has easy access to high-quality medical care; not everyone comes from a supportive family environment with potentially built-in, low- or no-cost childcare; and most of all, not everyone has a “smooth” pregnancy experience, whether medically, emotionally, or otherwise. Additionally, growing up in the church in the early 2000s, sex education wasn’t discussed very openly. I always had lots of questions — not just about human biology itself, but also about reproduction, women’s health across the lifespan, and, perhaps most of all, why folks weren’t talking about this stuff! The discipline of reproductive genetic counseling seemed to combine virtually all of my interests into one career path; here, I could truly help people within pregnancy or considering pregnancy as they learned potentially life-changing information and navigated the transitions that might be prompted by that information.

Can you share the most interesting story that happened to you since you started your career? What were the main lessons or takeaways from that story?

My transition from academic medicine to a healthcare start-up is probably the most interesting story of my career!

I spent >6 years working as a reproductive genetic counselor at Johns Hopkins Hospital. Eventually, I earned a faculty appointment as an Assistant Professor of Gynecology & Obstetrics in the Johns Hopkins University School of Medicine, which is a relatively unique honor and distinction for a professional with a master’s degree (as opposed to a M.D. or D.O.). I absolutely loved working in the clinic and in academic medicine — I was constantly surrounded by and collaborating with world-renowned experts from a variety of different medical disciplines on a fascinating spectrum of clinical care scenarios. Working in our Maternal Fetal Medicine division and in the Center for Fetal Therapy at JHH, seeing “exceptional” cases was quite the norm.

Despite all of the pride I had in my role at Hopkins and the amount of fulfillment I received through serving as a clinical provider and educator there, I noticed an “itch” to be more creative, to scale access to reproductive genetic counseling services, and to make a bigger impact within the repro world somehow. I remember describing these desires to a colleague, who gently corrected me that my perceived “itch” was actually a “giant rash!”

I’d never before considered any sort of a career opportunity within a start-up. I can’t emphasize enough the manner in which my life revolved around academic medicine. Still, when I found JunoDx and learned more about their mission to democratize access to reproductive genetic testing, I knew was on the right path.

It’s awfully terrifying to submit your resignation to a job that you do love deeply. I worried about how I might be perceived within my field as I transitioned from academia to industry, and I worried about how the change would impact my family — as surely, the effort involved in start-ups was not likely to be small! The decision to leave Hopkins and join the team at JunoDx (which was fewer than 20 people, at that point!) was one that I discussed at length with my family, my therapist, and my closest friends, and I am so thankful for their support as I explored this major life transition. Now, feeling fully part of the JunoDx family and knowing I am daily working to make a difference on a country-wide level, I am so glad that I had the courage to make the change. Life is far too short to be anything other than furiously happy, and if you recognize an opportunity to chase that furious happiness — you might want to explore it.

Can you share a story about the biggest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

One of the biggest mistakes I made early in my career — and one that I’m still learning from — was overcommitting my time. As a newly graduated healthcare professional with an abundance of passion, it was far too easy to say “yes” to absolutely every single career-related opportunity, even outside of my actual 9–5 job in the hospital setting. Between a jam-packed schedule, little time for hobbies or self-care, and several years of a grueling commute up I-97 and around the Baltimore Beltway, I soon found myself completely exhausted and well on the way to burning out. It took a few fairly significant moments of awakening to realize the extent to which I might be jeopardizing not only my sustained future in this field, but also my mental health, if I chose to keep at such a frenetic pace. Now, I try to make it a priority to only say “yes” to those opportunities about which I feel the most passionate, or which specifically align with my goals.

Let’s jump to our main focus. When it comes to health and wellness, how is the work you are doing helping to make a bigger impact in the world?

I work specifically within the reproductive healthcare space at Juno Diagnostics, a women’s health company focused on improving equitable access to prenatal care.

Juno Diagnostics was founded by industry experts within the non-invasive prenatal screening (NIPS) space who were dissatisfied with disparities in universal access to reproductive genetic screening technologies. Modern prenatal screening tests, such as cell-free DNA based NIPS (also referred to as “non-invasive prenatal testing” or “NIPT”) exist to empower pregnant people to make informed and autonomous decisions during their reproductive experience. The analysis of a maternal blood sample can offer expectant parents an insight into relatively common fetal chromosome variations that may impact their delivery planning and other preparations. Since the first commercial NIPS assay was introduced in 2011, there have been multiple professional society guidelines and practice bulletins surrounding its recommended use, including a 2020 practice bulletin from the American College of Gynecology and Obstetrics (2020) which endorses cell-free DNA based NIPS as the most sensitive and specific prenatal screen for common chromosome variations. This practice bulletin goes on to recommend that NIPS should be offered to every pregnant person, regardless of risk — a remarkable distinction to guidelines of the past, which recommended NIPS only for high-risk pregnancies (such as those in pregnant patients age 35+ years at delivery, or those with atypical ultrasound findings). Despite the recommendations of ACOG and other professional organizations, and the proven performance of cell-free DNA based NIPS in fetal aneuploidy detection, not all patients are offered this option as part of their prenatal care — nor are they uniformly presented with information on the benefits and limitations of NIPS and its alternatives, such as traditional maternal serum screening or prenatal diagnostic procedures (e.g., chorionic villus sampling or amniocentesis), in a manner in which they might reasonably make an educated and informed decision. Prenatal care visits are often scheduled in blocks of 60 minutes or less (and sometimes in blocks as small as 20 minutes!), and a prenatal care provider cannot reasonably be expected to be able to address all of their patients questions, complete any necessary physical examination, discuss the relevant prenatal care information for that gestational age, and review basic information about chromosomes, DNA screening, and the advantages and limitations therein with such a short amount of time. Furthermore, NIPS coverage from insurance payers often lags behind medical guidelines and society recommendations so that a screen like NIPS is not universally covered by all health insurance plans. These leads to very complicated and often frustrating conversations within the context of a medical appointment, as a patient may have only heard cursory information about the abilities of NIPS, but the provider may feel compelled to express reluctance in ordering this screening due to the common experience of the patient receiving a high bill (often $1000 or higher) without a “high risk” medical indication.

At Juno, we believe that everyone deserves equitable access to the opportunity for information such as that can be afforded through NIPS and other reproductive genetic studies. We are developing the first NIPS to be collected from the comfort of home so that expectant parents can have cell-free DNA based NIPS using a few drops of blood and no inconvenient trips to the lab. In so doing, we aim to offer a more affordable and accessible NIPS experience for everyone.

As the Director of Genetic Counseling at Juno, it’s my task to scale pre- and post-test genetic counseling education by creating dynamic and engaging genetic counseling multimedia content. I also review the implications of genetic screening results with JunoDx patients, so that even if they’re physically quite far away from face-to-face genetic counseling services, they never have to feel alone and without expert review of screening and other concerns that pertain to their pregnancy experience.

Can you share your top five “lifestyle tweaks” that you believe will help support people’s journey towards better wellbeing? Please give an example or story for each.

Go to therapy! In our culture, it’s unfortunate that there can be so much stigma surrounding this vital mental health resource because it is truly indispensable. Due to an ugly combination of overcommitted time and general self-neglect, I didn’t pursue mental health services until after the tragic death of one of my cherished mentors and friends. However, by committing to weekly therapy appointments in the immediate wake of this loss and beyond, I was able to not only clarify more about how to navigate the complex emotions surrounding the enormous loss, but also what I wanted, needed, and (dare I say it) deserved from both work and life.

Make time for the things that recharge you. For me, this is sunshine and music. My childhood home was in the woods, which was a beautiful experience in itself, but I recall how much my mom would look forward to getting “out of the woods” and into the sunshine. A lot of this has seeped into my own adult life, as I find myself craving natural light both in my living environment and when I’m feeling especially stressed or burnt out. Now, living in Southern California, being able to escape to our shared patio workspace and handle my deliverables while soaking up the sunshine has so tremendously improved my overall mental health and wellbeing. Vitamin D is magic, as far as I can tell.

Listen to your body — you know it better than anyone else, and generally, what it’s telling you won’t lead you astray. When you’re feeling creatively stifled, stressed, or encumbered somehow, consider how you might physically expand as a response. Can you take a quick jog, or short stretching session where you can physically take up space and metaphorically reclaim your spot in the world? What other cues does your body give you to which you need to pay better attention — rest, hunger, thirst, play, or otherwise?

Plants are powerful! Prioritizing a plant-based diet and lifestyle can offer so many physical and emotional benefits. If you’re exploring a transition into a diet which emphasizes plant-based nutrition more than in the past, you might consider keeping a short journal of how the foods you eat impact the way that you feel in both the physical and emotional realm.

Practice non-attachment as much as possible. You are only human, and nothing in life is permanent.

If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?

I’ve lived in both very rural and very urban areas (e.g., downtown Houston, downtown Baltimore), and across the geographical spectrum, I think that the issue of access to healthcare and wellness resources is one that’s fairly universal in the United States. What I’m about to suggest is hardly a novel movement, but I’d like to see a world in which more intentional efforts, including financial resources, are directed towards community health centers. Traditionally, many people in rural settings have needed to travel quite a distance to access primary care, let alone any specialized services such as a consultation with a genetic counselor. Even in a much more urban context, the resources required of a working adult to step away from a day-time job, coordinate child- or elder-care, and coordinate transportation to a medical appointment can pose seemingly insurmountable challenges which can discourage many from routine health maintenance. The COVID-19 pandemic has vividly illuminated the ways in which we must use telehealth services to the benefit of our patients and communities, and I think that continuing to invest in the telehealth capacities of community health centers can only promote a more equitable future in healthcare. If a person were able to connect with not only their in-person, local allied health provider or advanced practice provider at a community health center, but also take part in a virtual consultation with a specialist located much further away, I think this would break down so many of the access issues commonly encountered in the traditional healthcare space. We often take for granted our ability to seamlessly connect to the Internet — that is, until we’re in a remote location and the service isn’t so great, or the Wi-Fi is acting up on a work-from-home day and we need to turn off the camera. What components of routine health and wellness appointments/consultations that don’t require a physical examination could be performed from within a community health center which offers high-speed, reliable Internet connections for its patient’s video appointments? What could the world look like if there was inter-state reciprocity for the licenses of healthcare providers, so that someone in Idaho who really needs the services of an ultra-specialized provider in New York would be able to receive these services without needing to travel?

Community health centers can also offer incredible resources for sexual health and wellness, including STI prevention, STI testing, pregnancy tests, childbirth and childcare classes, and, in many instances, early prenatal care. Investing in not only these centers but also in mutual aid funds which promote access to comprehensive reproductive healthcare across the lifespan will promote a better, more “well” world in which every person might have more equitable access to healthcare

What are your “5 Things I Wish Someone Told Me Before I Started” and why?

1) Listen to others more than you speak. It’s common for those early in their career to feel the need to defend themselves or justify their actions. However, if you maintain an attitude of genuine curiosity, ask open-ended questions, and daily work to meet folks exactly where they are, you’ll learn more about both others and yourself in the process.

2) Be gentle and realistic with yourself. Growth is not necessarily linear, and both successes and failures are not necessarily as great nor as terrible as you think they may be, respectively.

3) Ask for feedback! You’re not doing yourself or anyone else any favors by trying to meet expectations that haven’t been clarified, or by guessing on how well your past performance has been received. Make it part of your work routine to ask for opportunities for continued improvement — not just in your annual review.

4) Find a mentor — like, yesterday. Mentorship is invaluable in your professional and personal growth, and the sooner that you can align with someone you trust and who truly has your best interest at heart, the better!

5) Connect and engage with others in your field (and related fields) as frequently as possible. I am so thankful for the #GeneChat and #MedEd Twitter communities, as well as similar spaces on Clubhouse, TikTok, and YouTube, for the way in which these social media platforms have brought us together for connection and collaboration.

Sustainability, veganism, mental health and environmental changes are big topics at the moment. Which one of these causes is dearest to you, and why?

This is a great question! I’ve followed a vegan/plant-based diet and lifestyle since 2017, but prior to that time alternated between vegetarian and pescatarian diets since ~2009. I feel very strongly that veganism is a spiritual discipline for me; that is, it’s my way of honoring the spirit of the universe or the divine in all sentient beings. I want to navigate the world in a manner that actively reduces harm and promotes good to all I may encounter, and I view veganism as one way that helps towards this goal. Because spiritual disciplines are also important to my mental health, I see these topics as being very connected in my own life. In addition, following a plant-based lifestyle is one of the most concrete ways that a person can reduce their impact on the environment. As such, I perceive veganism, sustainability, and environmental movements as being inextricably interwoven and equally important.

What is the best way our readers can follow you online?

Stay up to date with reproductive resources, new product launches, and all things JunoDx on Instagram (@junodiagnostics), Twitter (@JunoDiagnostics), Facebook (@junodiagnostics), and through our blog (https://junodx.com/resource-center/)!

Thank you so much for sharing these important insights. We wish you continued success and good health!

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Candice Georgiadis

Candice Georgiadis is an active mother of three as well as a designer, founder, social media expert, and philanthropist.