Kwak-Kim Appointment

My appointment with Dr. Kwak-Kim was yesterday.  I can give you a couple of tips right off  the bat:

1)  Her wait time to get an appointment is around 3 months, and at this point is when they tell you that you have to fast for 12 hours prior to your appointment, drink 32 oz of water and not be on your menses.  By the time my appointment came around, I forgot all of this and called to inquire of any pre-appointment requirements.

2)  If you google "Dr. Kwak-Kim address" you will come across the address of Rosalind Franklin University. This is where we wound up first!  You want the address of the Reproductive Medicine Center.

3)  Be prepared to be there for about 3.5 to 4 hours - if your significant other accompanies you, he will not be able to accompany you until it is time for your Dr. Kwak-Kim consult which is the last portion of your appointment.

The appointment started off with the usual handing over your ID and insurance card.  My appointment began at 7:30 and I was promptly seen by ultrasound at 7:30.

He did an external ultrasound with a full bladder and then after emptying my bladder came a very detailed internal ultrasound.  He was very thorough and described his findings.

His findings:

• Poor blood flow to uterus 
• Good blood flow to ovaries
• Ovaries twice as big as they should be 
• Ridiculously thin lining for Day 10 (3.6)
• Small uterine fibroid 

I then waited a bit and went over to see the nurse practitioner.  I was ready to disrobe and the assistant stopped me. I only had to disrobe from the waist up! First time for everything.  She performed a physical exam and felt my thyroid could use an ultrasound.  Went back to the ultrasound tech and there were no abnormal findings with my thyroid. 

Then came blood work - I had about 17 vials of blood taken, and I have already had a lot of testing done.  So ya, lots of blood. Thank goodness my weak veins cooperated. 

We then waited about 30 minutes to see Dr. Kwak-Kim. At this point, my husband described it as travelling up this tall mountain to see this esteemed doctor.  Yep, it felt exactly that way.  We had already been there three hours before finally seeing "THE doctor". 

She is one intelligent woman.  She can write upside down for goodness sake. 

She was most concerned with my homozygous PAI mutation.  I plan on giving PAI a blog post of its own.  As of right now, she wants to start me on Metformin, even though none of my tests came back with insulin resistance.  She believes the tests will show my PAI level elevated, so wanted to get started tackling that issue ASAP.  She also wants me to follow a strict low carbohydrate diet. In essence, being homozygous PAI means my PAI levels are most likely elevated and Metformin has been used in cases to lower them.  My genetic makeup (PAI mutation) makes my body hold onto carbohydrates more than the average person - leading to insulin resistance, diabetes etc.  In her words, "You can eat the same plate of pasta as the woman next to you, but you will gain 3 lbs and the other woman will not gain an ounce." Oh, yes. Yes, indeed. 

She was also concerned about the poor blood flow to my uterus. She recommended 400iu of Vitamin E and continued baby aspirin right now.  She said that the blood thinning protocol will be tackled once my other blood tests come back.  

She also wants to keep my methylfolate dosage and B vitamins the same for right now in regards to MTHFR.  She will adjust if needed, after receiving my blood test results back. 

She believes my enlarged ovaries and thin lining are caused by my body pretty much "shutting down" after this last egg retrieval. It's very evident I had mild OHSS. She does not anticipate ovulation any time soon.  This makes complete and total sense after my last ridiculously long cycle after my last egg retrieval.  I hope she is right, and my body bounces back.  In the meantime, no heavy lifting, cartwheels or trampoline action.

She is not concerned with the fibroid, as its tiny and not causing me any issues.

I was ridiculously anxious before this appointment, and let me tell you it all fizzled away after meeting with the wonderful staff of Dr. Kwak-Kim's office and herself. 

I am glad I made the appointment, and look forward to hearing her plan of action regarding her findings.