Dr. Kwak-Kim or Dr. Coulam?

[stacy_brooke]

Hi, I'm new to this forum and am looking for some advice. I'll start with a little background info. I was very blessed to have a healthy son 3 years ago, but since his birth my husband and I have been suffering recurrent miscarriage while TTC #2. I am currently having miscarriage #4. My RE already dx'd me with some clotting issues (compound hetero MTHFR, protien S deficiency) so I was on heparin injections/BA/foltx this pregnancy and my treatment has failed me. My RE is now recommending I see a reproductive immunologist for further testing. I highly suspect autoimmune issues because I already have a few known autoimmune issues, namely hashimotos thyroid, psoriasis, and mild endo. My autoimmune issues seem to flare up in pregnancy. I am lucky to live in the Chicago suburbs so I am thinking of going with either Dr. Kwak-Kim or Dr. Coulam since I will be able to see them in person. I'm wondering if anyone can give me any recommendations on which Dr. I should go with? Thank you so much for your help.

[poohbear]

Stacy,
Sorry to hear about your losses. I do not know much about Kwak and only Coulam through Millenova where I did my testing. Sounds like you should do more testing. Hopefully one of the other ladies may have some info.

[sdeut]

Stacy - I just started to see Dr. Kwak she seems very understanding and knowledgable. I go in next week for my protocal.

[MPTTC3]

(Children Mentioned)

Stacy,

I saw Dr. Kwak-Kim through 25 weeks of pregnancy with my twin pregnancy during late '07/08. Her protocol for me was IVIG every 3 weeks, Lovenox, high doses of progesterone, extra folic acid, Fish oil, and Prednisone. Dr Kwak-Kim seemed to be a very caring/understanding physician at first. She prescribed IVIG every 3 weeks, and it took a toll on us financially as our insurance didn't cover it. Despite telling her our financial woes with the IVIG each time she ordered it for me, she knew we'd do anything for a healthy pregnancy/babies. Thank God I gave birth at 39 weeks to beautiful healthy twin baby boys despite not seeing her after 25 weeks. Dr. Kwak-kim continued prescribing IVIG. I think up until 25 weeks pregnancy, it was nearly $30,000 out of pocket that we paid. I had some problems at 8 weeks pregnancy with bleeding and called her up for an emergency call on my way to the ER, and she was very slow to respond and not very caring during that emergency. That's the only real complaint that sticks out. Thankfully, everything came out okay. Her office staff and personal RN were always concerned about lunch too and also when 4PM rolled around; so beware. I did end up seeing Dr. Coulam for a second opinion, and I saw her twice. When Dr. Kwak-Kim had kept precribing the IVIG (and we were near broke at $3000/dose every 3 weeks!), Dr. Coulam's office seemed very professional. She ran some labs (that cost a lot of money too), and she said that I didn't need to continue the IVIG. So, I quit seeing Dr. Kwak-kim at 25 weeks. I was also being seen by a high-risk maternal-fetal medicine group, and they were way more responsive than Dr. Kwak-Kim's office (minus the IVIG). If you have specific questions about my experience, I'll be more than happy to answer them.

[stacy_brooke]

Thanks for your replies ladies. I actually already decided to have my records sent to Dr. Kwak-Kim, mainly because I've read so much about Dr. Beer and how wonderful he was, and I liked that she used to work with him. I hope I made the right decision.

MPTTC3-I'm sorry to hear Dr. Kwak-Kim's office wasn't very responsive to you, that makes me nervous. I'm also nervous about the cost of IVIg if it turns out I need it. (I'm thinking I probably will.) I have Blue Cross Blue Shield, I think I've read that they sometimes cover it so I'm hoping they will but I'm not going to count on it. I'm happy to hear your twins made it here safely.

sduet-Good luck with your protocol. KUP on how it goes.

[sdeut]

Stacy - I am afraid that I will need IVIG also and about the cost. I have BCBS and I have heard sometimes they cover it and sometimes not.

I will tell you I have called twice and left a message for a nurse because I need TSH # sent to RE and they returned my call within 1/2 an hour both times hopefully that will continue.

I will say that it took me 3 weeks to get the initial visit, then it is about 2 weeks for the b/w and because she was on vaca another 2 weeks for me to meet with her about protocal. So I meet with her 1 week from today and I will let you know how it goes.

Good luck to you keep me posted.

[stacy_brooke]

sduet-I just printed the forms off Dr. Kwak's website and mailed them on Tuesday, and I also went to my RE's office and filled out the form to have my medical records sent over to her. So hopefully they will call soon to set up my first appointment. I can't wait to get the ball rolling. Lets just cross our fingers that BCBS covers our IVIg if it turns out we need it.

[sdeut]

Stacy

Well I had my appointment with Dr. Kwak today and I am overwhelmed (you can read about it in my overwhelmed post).

She knows so much and gets a little technical in her explination. She spent over an hour with us and then a nurse came in to make sure we understood everything.

My insurance covered my appointment with her and all the testing. I am trying to find out about IVIG (It is about $2800 w/o insurance so we could afford like 1). I have been getting the run around so now as it stands they need a medical necessity note from Dr. Kwak so we will see.

[chelsharmony]

hi ladies, i was referred over to Dr KwaK-kim as well from my RE here in Milwaukee, apparently they do a lot 2gether. My RE here does a lot of IVIg treatments however they said i may want to see her since my NK are very high (per nurse). I was told my ins would cover and then when it came down to paying - they dont cover it. $5K for 2 treatments. They wanted me to do 1 treatment this week (CD8) after Femara 5mg and then again another treatment next week and then again every month after a BFP (god willing).
I am unable to do the treatment this week cuz of ins issues and not knowing i was going to have to pay. The nurse here was helpful giving me different codes to try and get insurance to pay since they said some of the treatments are covered (convenintly not mine tho, lol).
Wondering if you truly believe that this will give you the baby you want so badly? i am 35, DH 34, no issues fsh 7, i ovulate on my own and have 2 children that are from a previous marriage that i never had any issues conceiving.
Also, have you read that taking colostrum can help lower the NKcells?

[anns]

Loved, loved LOVED seeing Dr. Coulam. In fact I cried when I left their office at 12 weeks!

I can't say enough how they were the most fantastic clinic to work with - and Dr. Coulam hands down the best doc of my entire process.

If Cololstrum helps with NK cells I'm going to be really bummed we tossed that small jar of 'colostrum/gold milk' that I pumped for my preterm (now 2.5 yo toddler) But it was 2.5 years old, we had to move the freezer to our new house.

I had elevated NKs, inhibin B of 15, homozygous MTHFR, APA positive, uterine adhesions, PAI and HPA-1 issues. I did acupuncture and boiled/drank chinese herbs, IUI with gonal F, vaginal viagra, estrace, crinone, fish oil, baby aspirin, Lovenox AND I had a cerclage (cervical stitches at 23 weeks, gestational diabetes and delivered a healthy girl at 35x5) I conceived 3, but only carried one to term.

My next pg (I'm 40, so who knows) is hopefully going to be an unmedicated conception, though I don't know if I can reverse my NKs, so IVIg may be in my future. We've decided IVF is not in our future and I don't think we'll do an IUI either. There is a study linking gonadotropins to a higher level of relaxin hormone which causes incompetent cervix, and we nearly lost my daughter to it. I will be stitched shut again at 16 weeks, but the risk is very high.

AnnS