Dr. Kwak-Kim was very fast in typing up the letter explaining my diagnoses and need for treatment and monitoring. She emailed it to me early yesterday afternoon and already faxed it to my OB’s office. I knew a couple of these complications/risks, but not all. It definitely makes sense why we have to treat this situation so carefully and seriously. I am not taking any chances, and I don’t want my doctors to either.
And again, I’m fine with waiting longer in between ultrasounds if necessary. I just want to make sure spot and I are receiving the best care. Ultimately, it’s up to my doctors to determine what I need, based on my specific case (now that we have all the information). I trust Dr. Kwak-Kim completely and will follow all of her orders. She was the only doctor who ever took the time to find out what was wrong with me and how to fix it. Only 6-7 months after starting her treatment, I finally got my sticky BFP.
I’m sure everything will be fine. I’m so thankful for how well everything is going. It’s better to be safe than sorry though. This baby means the world to me, and I will fight and do whatever is needed to keep myself and spot healthy. I don’t care what local doctor I see, as long as they take things seriously. I’m looking at high risk docs/MFM and will ask for a referral if necessary. I wouldn’t be surprised if my OB says I need a high risk doctor anyway, after reading the letter. I’m surprised I wasn’t already referred, but there was a communication gap – since Dr. KK is out of state. Just a little harder & more confusing to coordinate care. We are working on it though.
January 29, 2013
RE: Lisa Bailey
Dear Dr. Rouse:
Lisa Bailey is a patient at the Reproductive Medicine Clinic at Rosalind Franklin Health System. She is being treated for immunologic and hematological disorders affecting her health and unborn child. Mrs. Bailey had been diagnosed with the following disorders which increase her risk of having complications during her pregnancy. We recommend short term follow up monitoring through ultrasound technology to ensure the well being of the pregnancy and Mrs. Bailey’s health.
Mrs. Bailey is being treated for the following disorders. These disorders increase her risk of intrauterine growth retardation (IUGR), intrauterine fetal death (IUFD), preterm labor and delivery, preeclampsia, and maternal stroke.
NK related (DX: 288.8 other specified disease of the white blood cells)
Mrs. Bailey has been diagnosed with increased Natural Killer cells. Down regulation of cells is necessary to achieve a successful pregnancy outcome without preterm labor and delivery, preeclampsia and intrauterine growth restriction.
APA (DX: 279.4 autoimmune disease, not elsewhere classified)
Mrs. Bailey demonstrates presence of antiphospholipid antibodies. This condition results in recurrent pregnancy losses, intrauterine growth retardation (IUGR), intrauterine fetal death (IUFD) and occasional maternal complications during pregnancy such as thrombosis, stroke and transient ischemic episodes.
TH1/TH2 Cytokine Ratio / TNF (279.10 Immunodeficiency with predominant tcell defect, unspecified)
T lymphocytes were investigated based on their cytokine producing capabilities. Mrs. Bailey has increased T Helper 1 to T Helper 2 ratio indicating an inflammatory immune response.
T Helper 1/T Helper 2 cytokine ratio reflects the ratio between two opposing T Helper immune responses. An elevated ratio reflects the dominance of TH-1 cells (represented by secreting TNF and IFN), which are cytotoxic and pro-inflammatory; as against the TH-2 cells (represented by secreting IL-10) which are important pregnancy.
Tumor Necrosis Factor (TNF): TNF is a T-Helper 1 cytokine produced by activated macrophages, T cells and other cells and has many biological activities on the immune and other systems. TNF is considered a major inflammatory mediator.
For these reasons I recommended treatment of the disorders as well as close surveillance through ultrasound technology. Frequent monitoring (as frequently as weekly) is medically necessary to detect detrimental changes requiring emergent treatment changes.
I hope this will answer any questions you may have regarding her care.
JOANNE Y.H. KWAK-KIM, M.D.
Director, Rosalind Franklin University Center for Women’s Health
Professor Obstetrics and Gynecology
Professor Microbiology and Immunology
Rosalind Franklin University of Medicine and Science