PFO, Birth Control, and Boobies! Oh my!

[ESG]

I will start this post by saying I have made an appointment with my doctor already, but am trying to gather information in the meantime. I have already found a lot of useful info on the board, but if any of the doctors or anyone else has some info, please help me!

I have been scuba diving for almost 4 years. I am an active OW instructor, active cave diver, and do at least two decompression dives per week in addition to open water training dives with students. I am overweight (BMI 29.2). I am taking the birth control Yaz (almost happy after switching from nuvaring and a non-brand name pill). In August I began to have migraines (first in my life) which prompted my switch to Yaz from the other pill. Since switching I have had three migraines (so three in about three months), whereas prior to the switch they were more severe and frequent.

I have had two cases of suspected DCS that I am aware of. In one case (5/26/2008)I had a skin rash, bruising of my stomach, thighs, and butt, and an itchy throat. Did not seek medical attention (I know I should have, I opted for sleep instead of a chamber ride symptoms started at about 12am). The other case I had bruising of my left breast and itchiness, breathed pure O2 for about an hour and symptoms went away. Both dives were over two and a half hours, but decompression schedule was followed (first dive I may have been cold/dehydrated, second dive I was well hydrated and warm).

I plan on having a test for a PFO, but I am wondering why this onset of migraines so late in my life (maybe not that late, I am 23)? I know the diving, birth control, pfo all have a connection but I don't know where that puts me. Also, any advice on getting my insurance to cover testing and closure? I have a gut feeling I have a pfo (in addition to a lot of evidence I have read about).

 

[Dr. Doug Ebersole]

As you have probably seen in your researching of your symptoms, the connection with PFO and DCS is very controversial as 25% of the population has a PFO but not 25% of divers get bent. Usually, PFOs are implicated in Type 2 DCS episodes (especially vestibular) which are "undeserved". As you may have found out there is also an association of PFOs with migraine headaches (with aura). It is also controversial but some people favor closing PFOs in these patients to reduce their migrane symptoms. The one published trial in this area was designed to show "elimination" of migraine headaches by PFO closure and the trial was "negative" though it did show a marked decrease in symptoms.

I would not be overly concerned about a PFO with the symptoms you've reported in your post, but with your decompression diving and two presumed DCS events it would be reasonable to be checked out. Usually, most insurance companies will cover an echo (either transthoracic or transesophageal) for the diagnosis of decompression sickness but if your physician feels your symptoms could have been a TIA (transient ischemic attack -- "mini-stroke") this code will almost always be paid for. Just my 2 cents.

Bottom line -- see you physician. If you still have questions contact DAN and get referred to a physician knowledgeable in diving medicine in your area.

By the way, and I'm a cardiologist who does close these things for a living so this is not entirely a bunch of internet heresay.

 

[ESG]

Hmm, TIA huh? Thanks for the tip.

I will be seeing my doctor in the next few weeks so hopefully I can get on the road to figuring out what is going on with my body.

I am hoping to take trimix training in the spring, but don't feel it would be a good idea without having the test done.

Thanks a lot for your post Debersole!

 

[Dr. Doug Ebersole]

Let me know if I can be of any additional help. Best of luck.

Doug

 

[Sas]

I will start this post by saying I have made an appointment with my doctor already, but am trying to gather information in the meantime. I have already found a lot of useful info on the board, but if any of the doctors or anyone else has some info, please help me!

I have been scuba diving for almost 4 years. I am an active OW instructor, active cave diver, and do at least two decompression dives per week in addition to open water training dives with students. I am overweight (BMI 29.2). I am taking the birth control Yaz (almost happy after switching from nuvaring and a non-brand name pill). In August I began to have migraines (first in my life) which prompted my switch to Yaz from the other pill. Since switching I have had three migraines (so three in about three months), whereas prior to the switch they were more severe and frequent.

I have had two cases of suspected DCS that I am aware of. In one case (5/26/2008)I had a skin rash, bruising of my stomach, thighs, and butt, and an itchy throat. Did not seek medical attention (I know I should have, I opted for sleep instead of a chamber ride symptoms started at about 12am). The other case I had bruising of my left breast and itchiness, breathed pure O2 for about an hour and symptoms went away. Both dives were over two and a half hours, but decompression schedule was followed (first dive I may have been cold/dehydrated, second dive I was well hydrated and warm).

I plan on having a test for a PFO, but I am wondering why this onset of migraines so late in my life (maybe not that late, I am 23)? I know the diving, birth control, pfo all have a connection but I don't know where that puts me. Also, any advice on getting my insurance to cover testing and closure? I have a gut feeling I have a pfo (in addition to a lot of evidence I have read about).

I am not a doctor or anything but I have suffered severe migraines in the past and it was solely due to the birth control I was taking. I was not 100% clear from your post if the migraines started when you started birth control? I gathered that when you switched to Yaz (not sure what that is sorry), they reduced?

My migraines started when I was 15, and I was hospitalised at one point with a suspected stroke. All kinds of tests were run - EEG, ECG, CAT, MRI - and nothing was found. I was put on epilepsy medication for a while as they thought I had epilepsy but it had no effect. The migraines continued until I was 21 and I visited a number of doctors and neurologists about it with no luck. One day I got fed up with my migraines again as they were getting more and more frequent and went to a new doctor, who's first question was 'are you on the pill?' Anyway, I'd been asked that before but no one commented on the fact it might have had an effect. My migraines had actually started when I started taking the pill at 15 and gotten worse over the years (I'd never put two and two together). She said to switch to the Progestogen only pill and since that I have had only two migraines in the last few years.

Not sure about insurance stuff, all my testing was all paid for by the government, apart from a $20 contribution towards my MRI.