Dr. X took an extensive headache history and was surprised to learn that no doctor had ever done this before. After writing almost an entire page of notes, he told me he wanted to order several tests. Aside from a range of blood tests, he also wanted me to have an MRI and a Cardiac Echo. He explained that during the Echo, the doctor would inject agitated saline into an IV and watch the path of the bubbles on an ultrasound screen. This test would show if my heart had a hole in it or not. I'd never heard of this test before, and I'd never heard of migraines being connected to the heart, but I figured, he's the doc, right?
I had an MRI just a couple days later. Later that same day, Dr. X's office called to tell me the MRI was clear, all they found were some minor nasal polyps that could be cleared up with a nasal spray.I went back to the same clinic a week or two later for the Echo. I kind of had a feeling that's what it was, so I wasn't very surprised when the test confirmed a hole in my heart. Due to the positive test, the doctor performed another test, this time on my brain. This test is called a TransCranial Doppler test (TCD). A TCD is essentially the same bubble test they performed on my heart, but the ultrasound watches the bubbles that enter my brain and can actually count them.
After the TCD, the doctor told me that the hole is called a PFO (Patent Foramen Ovale) and that it is fairly common. He said mine didn't look severe and that he did not think the PFO was causing or contributing to my migraines. I wasn't really convinced. It just didn't feel right. I posted on Facebook about it later that day and found that a lady in my ward knew a thing or two about PFOs. Not only had she worked at the American Heart Association, but her dad had suffered from a PFO. She told me I should contact her dad's cardiologist, Dr. Y. She told me he was the best in the country.I waited to hear from X's office. They called me within a day or two and repeated what they had heard from the doctor who did the tests. Luckily, they felt the same way I did. They told me that Dr. X wanted a second opinion and that he was referring me to a Dr. Y. I thought, "Perfect." Dr. X's office set an appointment for me for June.
Between the time when the appointment was set and the appointment itself, I found out I was pregnant again and was able to see my OB, Dr. Z. She and her nurse encouraged me to keep my appointment with Dr. Y when I told them about the PFO.So David and I headed to Dr. Y's office. The first thing they did was repeat the bubble test, although I found that for some reason, they know what they're doing better than most who perform the test. They said they actually disprove about 80% of these tests performed by others. This was the case for me as well. The report they had from my first test essentially said I had a minor PFO that wasn't sending many bubbles to my brain. The test at Dr. Y's showed that I actually have a pretty large PFO. The tech used the word "severe" when he looked at the images. What befuddled the tech was that the TCD (the brain bubble test) showed similar results to the first TCD I had. So the two tests were essentially contradicting each other and the poor tech had no clue as to why.
So we waited a little over an hour after that to talk to Dr. Y. When he finally arrived, he was able to give us some more answers. He said that I indeed had a severe PFO, which is actually called a "large shunt" PFO.
The reason the two tests seemed to contradict each other was because I also have what he called a "pocket defect", which essentially means that the flap that covers the hole creates a pocket and can hold some blood in my heart. This is extra dangerous because the held blood can more easily cause a stroke. This is also called an Atrial Septal Aneurysm.
Then he goes on to tell me that the connection between migraines and PFOs is still being researched quite a bit. Although migraines were what pushed me to get tested for the PFO, the real danger was the stroke risk. The discovery of PFOs has been fairly recent and it is always linked to stroke or stroke risk. They found that many strokes were happening with seemingly no cause, but that a large percentage of these stroke victims had PFOs. After these PFOs were closed, most stroke victims reported improvements. Dr. Y mentioned that the people who have strokes, usually, are females with PFOs who suffer from migraines. Why, that's me!
Oh yeah, there's more. I also have a genetic clotting disorder that was found after my first miscarriage. This disorder is minor for normal people, but for someone like me who is at an increased risk of stroke, this disorder becomes more of a problem. The fact that I have miscarried twice also put some strikes against me.
Bottom line was that the recommendation was closure of the PFO, but due to my pregnancy, the surgery was not scheduled. Dr. Y told me to come back after the baby was born. He said it is possible to perform the surgery during pregnancy but it can only be done in the second trimester and they don't do it unless they feel it is neccessary. In the meantime, I am to take Heparin injections every 12 hours. The one disclaimer he told me was that if I had any stroke symptoms while I was on the Heparin, everything changes. The surgery would be done during the pregnancy because my risk would be much greater. I started planning for surgery sometime in the spring or summer of 2012.
These next three images explain the connections between PFO and stroke. They are from a pamphet I received from Dr. Y's office. 
As you can tell, I am at an extremely high risk for stroke. Everything was going along as planned until July 3rd. I had started getting a mirgaine in the afternoon but it took awhile to get really bad. Around 6pm or so it was pretty severe and I was just waiting until 10 so I could take my Heparin and go to bed. I was watching a movie with David and David's brother, Job, and Job's wife, Jessie. Right about 10pm, all of a sudden my right arm felt weak and had tingles all over it, similar to how you'd feel after lying on your arm for a long time, but I was lying on my back. I told David and it and he said to just see if it would go away. It moved up my shoulder and eventually started in my leg. It did not go away. I tried calling my dad, mom, and also woke up my sister-in-law (she's an internal medicine doctor) to ask for advice. In the end, David and I decided to go to the hospital. We went to the ER. They took me in right away and eventually did an MRI. The MRI came back clear and they said that what happened was what's called a complicated migraine, which essentially means that my migraine was so intense that it gave me stroke-like symptoms. I found that there was no way for me to tell the difference between this and a real stroke and because of the PFO and my being at such a high risk, I basically had to come to ER every time so they could tell me for sure either way. Joy.
The day after the holiday I called Dr. Y's office to report to them what had happened. They returned the call a couple days later and told me that Dr. Y had decided to go ahead and move forward with my closure. They asked how far along I was (almost 13 weeks at the time) and wanted the schedule the surgery for the first week of August. I told them I'd be out of town until the 7th, so they scheduled surgery for August 9th, a Tuesday. And so, ladies and gentleman, I will finally reach the wizard, and he'll be able to give me a much healthier version of my heart.
I hope this helped you better understand PFOs and what's been going on in my life recently.
