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Dr. Guinto answers questions about APAS

This transcript is found in my book, Lost but Found as an appendix. My doctors, Dr. Valerie Guinto and Dr. Carol Gloria, have been most gracious in sharing their expertise about APAS and RID/RIF.

Hope you can support my book and share with women who may be suffering from recurrent pregnancy losses. You can get my book here. 

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In this interview, my obstetrician and perinatologist, Dr. Valerie Tiempo Guinto sheds light on APAS/APS. 

Dr. Valerie Tiempo Guinto is the Chief of Maternal-Fetal Medicine Section at the University of the Philippines-Philippine General Hospital. She was also the President of Philippine Society of Maternal Fetal Medicine in 2017 and is the Head on the Task Force on Recurrent Pregnancy Loss of the Philippine Obstetrical and Gynecological Society.

  1. What is APAS? 

Antiphospholipid antibody syndrome or APAS or APS is an acquired condition wherein the individual’s immune system harmfully reacts to the individual’s own body or self, manifesting clinically as increased clotting in the veins and in the arteries and/or pregnancy loss. The clots may break and get thrown to the circulation and affect major organ systems such as the brain, the kidneys, and the lungs. In pregnancy, it can cause repeated miscarriages or stillbirth.

  1. How prevalent is APAS in the Philippines? 

We do not know the exact number for this in the Philippines, although in my practice as a maternal-fetal medicine specialist/perinatologist, I see many mothers afflicted by this condition. According to international studies, it can affect up to twenty percent to forty percent of women who had at least two miscarriages.

  1. How is a person diagnosed with APAS? 

The diagnosis of APAS rests on documentation of the presence of two criteria: clinical and laboratory. For the clinical criteria, there should be at least one episode of a thromboembolic disorder (increased clotting and clots thrown in the circulation causing damage to organ systems) and/or problems in previous pregnancies, such as severe preeclampsia causing premature delivery of a baby, growth restricted babies, stillbirth, or repeated miscarriage. For the laboratory criteria, at least one of the prescribed laboratory tests should be positive.

  1. What are the symptoms of APAS?

People who have APAS have problems with increased clotting, which may manifest as stroke (usually before forty years old) if it’s the brain that was involved.  There may also be problems with the lungs and other organs like the kidneys, after they are subjected to conditions that would further increase clotting such as immobility, long hours of air travel, and the presence of a chronic disease or pregnancy. In pregnancy, the pregnant woman may develop preeclampsia or hypertension in pregnancy early or before the eighth month of pregnancy, repeated miscarriage, stillbirth, or growth restriction. The association of APAS with infertility, however, is still controversial.

  1. How is APAS treated? 

Thorough evaluation of the medical condition is done prior to pregnancy and involved organ systems are treated first before trying for pregnancy. While trying for pregnancy, low dose aspirin is started. Once pregnant, further anticoagulant treatment is given. In some cases, some other immunologic treatment administered by reproductive immunologists is given to further control the condition. In the baby, the pregnancy is closely monitored by fetal surveillance techniques done by maternal-fetal medicine specialists/perinatologists to see complications as they develop. These are addressed accordingly. The pregnancy is pushed to term or as close to term as possible to improve the outcome of the pregnancy. Delivery may be through vaginal or caesarean section depending on the mother’s and the baby’s conditions.

  1. Who manages an APAS pregnancy? 

APAS is a condition needing multi-specialty care. The maternal-fetal medicine specialists/perinatologists are trained to work-up before and after conception and manage women and their babies with this condition from before conception to after delivery. Maternal-fetal medicine specialists/perinatologists went through five years of medical training, four years of residency in obstetrics and gynecology, two years of subspecialty training in maternal-fetal medicine and have passed rigid examinations (written, oral, and practical examinations) to qualify as subspecialists in the practice of high-risk pregnancies. They work closely with the reproductive immunologists who administer the immunologic treatment and help control the condition in the mother.  Other specialties involved are rheumatologists (when there are connective tissue diseases such as systemic lupus erythematous), geneticists, reproductive medicine/infertility specialists (when there is infertility), other specialties in internal medicine, nutritionists, and other allied medical professionals.

Hope this helps, loves! Dr. Guinto holds clinic at Asian Hospital, St. Lukes BGC, and in Joshua Clinic near PGH. Join the APAS and RID Facebook Support Group to check her latest clinic schedule.

Think Twice Before Putting Lemon EO in your Water

Hey guys.

I have promised to become more engaged and more mindful with my craft- writing, essential oils, and everything that gives me that ‘happy’. So I made myself a commitment to update this blog at least once a week. 🙂

Two weeks ago, I launched my Youtube channel and started talking about essential oils.

The first topic that I addressed is about how powerful essential oils are and why you should think twice before ingesting them.

Truth is, I am not against ingestion. What I am against is people promoting casual ingestion of essential oils because there is a whole lot of experience (which even I don’t have) that you need to have before you could endorse the safe and proper way to take these essential oils internally.

In my Safety Masterclass with Robert Tisserand, I learned that ingestion of essential oils boils down to pharmacology. Many promoters of ingestion would often point to the French method of aromatherapy which includes taking the oils internally. This is, at times, misleading because in France, the internal usage of oils are regulated by medical professionals who know how to dose these oils properly and with the correct calculation. This means that the doses are based on the individual’s medical history – the medicines that he or she may be taking that could potentially interact with the essential oil, the weight of the person, how to convert drops to mg based on the dose you have determined (which is the main method for internal dosing in pharmacology), etcetera. You need to know about lethal doses (LD50), reference dose (RfD), the no-observed-adverse-effect level (NOAEL), and the systemic exposure dose (SED) – things that really need careful study.

So yes, internal dosing is a complicated concern that should not be taken lightly.

I would go deeper into this subject soon to share what I have learned about ingestion but in the meantime, please watch this video to see how powerful an essential oil is compared to your household alcohol. If common sense tells you you shouldn’t ingest alcohol, then maybe you’d think twice in taking that lemon essential oil, too!

Quick tip: Just take the fruit. Unlike the essential oil which is only consist of the chemical component, Limonene, the fruit would have vitamins that the essential wouldn’t have.

P.S. I will be posting about APAS videos soon. Hope you can subscribe to my channel.

P.P.S. Join me at Lana Lane EO Education Group for brand-agnostic discussion about essential oils.

Hope this helps. Enjoy!

 

The Story of the Tulip

“A tulip doesn’t strive to impress anyone. It doesn’t struggle to be different than a rose. It doesn’t have to. It is different. And there’s room in the garden for every flower.” -Marianne Williamson

A month before my target launch for the book, I still did not have a cover. I only had one idea in mind – it would be a simple cover with plain text – like Malcolm Gladwell’s books.

A good friend of mine, Regie, who has always been supportive with my passion projects and who has blessed me tremendously with his craft, sent me a study for the cover of the book.

When I received the artwork in my e-mail, I was dumbfounded.

This was it. I didn’t know what this fully meant, but I knew in my heart that this was the cover of my book. 

Despite its simplicity, the artwork had so many facets in it. The tulip (its meaning I will share in a while), the crosses that are in the text and the fading leaf. I did not give any directions to Regie but somehow, it encapsulated the soul of this book.

Antiphospholipid Antibody Disorder or APAS

THE TULIP

When I researched about the symbolism of this flower, this is what I found. It resonated with me so much that it moved me to tears. It was just the perfect flower for my cover.

  • Perfect, enduring love between partners or family members
    • The love I have for my family is unconditional and knows no bounds. 
  • Undying passionate love, whether the passion is spurned or returned
    • The love I have for my angel babies would never die
  • Abundance, prosperity, and indulgence
    • The journey to acknowledging the abundance the Universe has to offer was introduced to me this year and it could not have been more timely
  • Charity and supporting the less fortunate
    • The book was intended to support my dream to build an APAS Foundation

It was later on that I realised that this flower plays a significant role in my life – why? Because it was my wedding flower!!! How could I forget??! The synchronicity of it all was just amazing.

THE CROSSES

There are apparent crosses – the small one and the big one – both representing my two little Bastis whom I have lost. The journey to losing them has been painful but sometimes, our biggest crosses bring out the light that we can share to the world. I love the quote, “Turn your pain into purpose,” and this is what this journey has taught me – with the cross not only being a symbol of sacrifice, but of redemption.

THE FADING LEAF

Life is fleeting. In an instant, we can lose the things or people most important to us. That is the reason why we have to live mindfully. To share to the world what we have as much as we can, for as long as we can. Let us make a little space of heaven on this earth, especially to grieving mothers and women wanting to hold a little baby in their arms.

I have prayed for the cover of this book, and like many of my prayers, this has been answered. What I believe in now is a testament of this promise –

Ask and it shall be given to you. – Matthew 7:7 NIV

I pray the same for you.

P.S. You can buy the book here. Thank you for supporting this passion project.

Love,

Small Habits that Helped with my Antiphospholipid Antibody Syndrome (APAS) Pregnancies

Knowing you have Antiphospholipid Antibody Syndrome (APAS) can be devastating. For women who are recently diagnosed, it could be nerve-racking. Many are confused on how they are suffering from this condition and what could have caused it.

For so many years, I have been thinking how do we acquire this disease disorder (because yes, it is acquired). In one survey I did in the past, there were really no significant co-relation with how people get it – some were healthy-eaters, some were not; some smoked, most did not; it really is mind-boggling (maybe I should launch another survey soon!)

But upon consulting with my doctors, these were the small things that (I think) helped me a lot in managing my disorder and I am sharing them with you in the hopes that you might benefit from them, too.

Move.

Ahhhh… movement. Exercise. Walking. Whatever. More and more women are stuck in the office, crouched in front of their computers from morning til night, not seeing the sun. I know of a lot of people who are Vitamin D-deficient (me included!) and it is because we are cooped up in our offices the whole time.

Our bodies are meant to move. Of course, these are the things that I know just now as I take a conscious effort in taking charge of my health. But I think our sedentary lifestyle is really one of the causes of APAS. This is just my theory but hear me out — why are there more and more people diagnosed with the condition – the condition after all is related to blood and circulation. There are already some studies that link extended periods of sitting to developing clots – find them here and sedentary lifestyle as one of the leading factors in cardiovascular diseases – link here. Maybe we have this blood clotting problem because of this, we don’t know!

I lived in my office cubicle for so long. I looooved my job – I was the Corporate Junkie, after all. And I hated exercise. But at the time when I was overhauling my lifestyle to get pregnant, I jogged every day. It wasn’t much but it was one step better than nothing. To date, this is still a work in progress on my part.

You are what you eat.

 

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I am the world’s unhealthiest eater. I moved to Manila in 2005 and I was alone, trying to climb the corporate ladder. I didn’t have relatives here and lived with friends who were also busy climbing their own corporate ladders. Because of this ‘isolation,’ I picked up bad habits easily. I relied on fast food because I didn’t really cook (and cooking only for yourself without anyone to share it with is just sad). I lived on soda, burgers, canned goods and pancit canton.

I was reading Bo Sanchez’ Awaken the Healer in You just the other day and that was when I realised that my disorder could have been brought about a lot because of the way I ‘took care’ of my body. You are what you eat, after all.

When I visited Dr. Regina, a Traditional Chinese Medicine (TCM) doctor, one of the first things she told me was to eat healthy: drink warm water everyday (avoid cold drinks if you are conceiving to keep your body warm for conception), eat green leafy vegetables (I made green shakes), avoid fast food, give up coffee and soda (totally the hardest I needed to do).

Be on deep sleep from 11pm to 3am.

I claimed I was insomniac. Maybe I was. Maybe not. Maybe I just wanted to sleep late for the fear of missing out. Our world today lacks sleep. One proof of this is the bestseller oil in my shop is actually something that aids people to have a more restful sleep! There are so many distractions – 24/7 Facebook and Instagram, Netflix, Mobile Legends, CoC, you get the drift!

Dr. Regina told me that for a woman to be able to have a baby-ready body, we need to sleep and allow our body to rest and repair itself. What does this mean? That we have to sleep from 11pm to 3am because this is the time when the body is supposedly doing its optimal job in bringing our body back to homeostasis. Today, I found this to be true. Sleep is the most important thing in my life and I feel better each time I am able to get those much needed hours of snooze.

Go out in the sun!

I already mentioned this above – we are like vampires hating the sun.

A lot of us are Vitamin D-deficient because we are indoors most of the time. There have been recent studies showing promising data that Vitamin D helps with fertility, both in men and women. So before popping that pill (which is the most convenient way on how we do it now), do it cheaper and more naturally.

Go out and bask in the early sun. Recharge your body with its warmth – things we learn in kindergarten 🙂

Drink your water.

Ahhh. I was a cactus. Seriously. I lived on coffee and soda and while yes, they have water, they were unhealthy.

Our blood needs pure water to efficiently carry out its tasks. The body needs to be well-hydrated to carry out its functions. Dehydration causes high blood pressure in diabetic patients, can cause mitral valve prolapse and thromboembolism and so on. These are all related to the circulatory system. APAS is related to our blood quality and when I think about it, I am really the best candidate for the condition because I hated water so much. Sigh. The small things we take for granted.

So yes, again, things we learn in kindergarten. Drink those eight glasses every day (note to self, haha).

Be still.

 

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Everything starts from the inside.

I dabbled into meditation back in 2013 when I was trying to conceive because I suffered from a lot of panic and anxiety attacks. I had panic attacks when my period was about to come and of course, I had anxiety attacks when they finally came. Funny (but not so funny actually during that time) thing is, I had attacks when my period came and I had attacks when my period was delayed, thinking – what if my body was already killing my baby without me knowing it again? It was a crazy time.

I don’t know where I read it or who introduced it to me but the practice just came to me somehow. I downloaded the app Omvana and meditated (it was really more of listening to the meditations in the app) each time I needed it and it really curbed those moments when I was really going crazy.

Now, it has been a daily conscious practice and it has always, always grounded me in love, serenity, and with the knowledge that I am where I should be.

And pray.

 

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In prayer, we ask. In meditation, we listen. And I couldn’t agree more.

Prayer has given me comfort at the time when everything was on a cliffhanger. Especially when you are battling with this oh-so-unpredictable disorder, prayer should always be your armour of strength. There are many cases when we have done everything that we could to have a successful pregnancy but still, we lose our babies. And while this could be devastating, this only proves one thing – it is really not in our hands.

My husband and I lived by this: we would do everything we can in our power (go with the treatments, etc.) and then let God to the rest. Because really, at the end of the day, there are no assurances. There are no guarantees. But there is always hope that whatever will happen will happen in its own time and reason.


I hope this list somehow helps you with your journey. While I linked to medical studies, these are just my own theories based on the research that I do and from my own experiences. Nothing that I mentioned here is rocket-science – mostly just the basic tenets we have learned when we were younger but something we have totally taken for granted.

Let me know what you think and please feel free to share your good habits, too, to help others! 🙂

Love,