Closing Pandora's Box

For Angie, a young mother of two, coming to AltaMed Health Services marked a turning point. At 31, she connected with Kathy Wilson, M.D., OB-GYN, whose compassionate approach helped heal years of fear shaped by past traumatic medical experiences. Today, Angie continues to rely on AltaMed for the trusted care she once struggled to find.

On her first visit with Dr. Wilson, Angie carried a file containing paperwork documenting all her procedures from her previous gynecologists and other medical records. She disclosed all her medical history, including multiple surgeries.

“I remember jokingly telling Dr. Wilson, ‘I am a Pandora’s box,’” says Angie. Dr. Wilson laughed and asked why she would describe herself in that way.

Angie responded, “Because even though I don’t know what’s wrong with me, I am full of surprises.” She told Dr. Wilson that she went in for an appendectomy in 2010. As the surgeon removed her appendix, it burst. Then, when the surgical nurse took a sample to pathology, it revealed the presence of cancer cells.

Angie then found out that those cancer cells had spread—at the age of 18, she was diagnosed with colon cancer.

“I had half of my small intestine, and half of my large intestine removed,” says Angie.

At that first visit, Dr. Wilson, who serves as the AltaMed Associate Medical Director of Women’s Health, explained the need for an endometrial biopsy. Angie was hesitant given her painful previous experiences, but eventually agreed to the procedure. Dr. Wilson gave her local anesthesia before the procedure, which Angie found less painful than in the past. The biopsy showed that Angie had atypical complex endometrial hyperplasia — overgrowth of the endometrial cells with a 25 percent to 30 percent chance of having underlying endometrial cancer.

“We needed to sample all the tissue in the uterine lining to make sure that Angie didn’t have cancer. And that is done hysteroscopically in the hospital,” explains Dr. Wilson. “In a hysteroscopy, the doctor inserts a thin, lighted camera called a hysteroscope into the uterus to visualize the lining of the uterus. We can see the tissue, polyps, or any structural abnormalities.”

On June 15, 2022, Angie was scheduled for a hysteroscopy with Dr. Wilson at Adventist White Memorial Hospital, a partner hospital with AltaMed. A day earlier, she had a pregnancy test and a COVID test at White Memorial as part of the routine preoperative process. 

As she waited in the hospital bed and texted her mother, the registered nurse came in to her room with a sense of urgency. “I remember her grabbing the curtain, and she pulled it so hard, it scared me,” recalls Angie. “And she says, ‘Sweetie you’re pregnant.’I was sure it was a mistake, so I asked them to repeat the test because my boyfriend and I had been trying to get pregnant for so long.”

The second test also confirmed the pregnancy. The nurses told Angie they could not go through with the hysteroscopy.
Then, Dr. Wilson came to the temporary room where Angie was waiting. “Angie was shocked and elated at the same time,” recalls Dr. Wilson.

“I remember telling Dr. Wilson, ‘I told you from the very beginning. Remember I told you that I was a Pandora box? Anything could happen with me,’” says Angie. “It was a miracle.”

Dr. Wilson explained to Angie that pregnancy is somewhat of a treatment for atypical complex hyperplasia. The endometrial tissue in her uterus created a cushion so that the pregnancy could implant.

“When a woman is pregnant, she’s not ovulating, she’s not making any more endometrial tissue,” says Dr. Wilson. “The focus is now developing the embryo, which then becomes the fetus. As a result, the uterine lining doesn’t grow.”

Yet, Angie’s pregnancy was high risk for multiple reasons, says Dr. Wilson. Her medical history was highly suggestive of Lynch syndrome— a condition which predisposed her to uterine cancer. She also had major surgeries in the past.

Dr. Wilson referred Angie to maternal fetal medicine specialists. She also performed regular ultrasounds using leading-edge equipment at AltaMed for the mother-to-be. During a 20-week ultrasound, Dr. Wilson noticed that Angie had a very short cervix, which not normal for somebody who never had babies before.

That condition created another level of complexity. Dr. Wilson performed a cerclage procedure on Angie to stabilize her pregnancy. A cerclage is where a “purse string” suture is placed around the cervix to keep it closed.

Angie also used progesterone to help with any further cervical shortening. She proceeded to have an uneventful pregnancy.

“The baby’s growth was normal,” says Dr. Wilson. “At 37 weeks, we removed the cerclage in the office. And she delivered Ethan 11 days later.”

With Angie’s second pregnancy, Dr. Wilson already knew the history of her cervical insufficiency. With access to high-tech ultrasound equipment at AltaMed, Dr. Wilson was able to keep accurate measurements on the cervix and get the cerclage done sooner. Precise tracking decreases the chance of spontaneously rupturing the membranes when a cerclage is placed too early or losing the pregnancy.

“She had a nice healthy pregnancy, and then got the cerclage removed again at 37 weeks, which is full term. She delivered her second child, Noah, at 39 weeks,” says Dr. Wilson.

“I’m eternally grateful to Dr. Wilson for everything that she has done for me,” says Angie. “It was a roller coaster of an experience. She goes above and beyond for her patients, and she’s one of the best doctors. I actually have a friend that recently found out she was pregnant. And my first instinct was to tell her to see Dr. Wilson. I texted her: If you don’t have an OB yet, go to AltaMed and ask for Dr. Wilson. She is the best doctor to me. She is top-notch. And trust me, she’ll take care of you. You’re in good hands with her. Dr. Wilson is everything.”