My girlfriend really needs your help.

[A_Ron21]

My girlfriend and I have been dating for almost three years. I'm going to make this as concise as possible.

Last fall - started taking Yaz, 2 months into it - syncope with very low blood pressure. Stopped Yaz and started microgestin. No further episodes, until -

Started taking Ocella (Yazmin) in February and in March - syncope again, this time with normal blood pressure. She discontinued all birth control immediately upon the first syncope episode.

Since then, she has had the dizziness, near syncope, anxiety, IBS, and DEBILITATING headaches. She normally gets migraines, which is why she started the drug, but since she stopped she has been having head pain. Debilitating pain on the right side of head radiating to the back, which dissipated slightly over time but is starting up again.

Her symptoms are pretty much not going away, and I am trying everything I can.  I know a little bit about human biology, but I've exhausted almost all of my sources of information. She needs to go to a major academic hospital, but, when you don't have health insurance, its tough.

Tests she has had so far:

EKG
EEG
MRI (head)
Holter Monitor
CT scan (head)
Stress Echo

All normal.

Diagnosed with Neurocardiogenic Syncope and IBS. Which I think is baloney, because she was perfectly healthy before, except for the occasional migraines (at this point I need to clarify that there is a difference between the classic migraines she had before and the head pain she has now).

I want to point something out now - all of the other symptoms have gone away, now that she is 4 months out from stopping the drug. However, the one that remains is the consistent head pain, which is starting to get worse.

Also, she was told by a doctor that she has clicking in her Temporo (spelling?) mandibular joint which may be a cause of the pain.

If anyone can provide me with any additional information, please help. I have a couple ideas on why this is happening, but I'm just a student and I can only do so much. I can clarify items or provide more information if necessary. She has seen several ER doctors, 3 family doctors, and a neurologist.

[Dr Santos]

Hi,
How is your girlfriend? Vertigo usually results from a problem with the nerves and the structures of the balance mechanism in the inner ear. Presyncope, on the other hand, as you pointed out may be caused by a drop in blood pressure or orthostatic hypotension and from inadequate output of blood from the heart. The EKG and echo of the heart has cleared any heart issues. And birth control or hormonal pills can indeed have effects on the body's hormones. The progestin in Yasmin is a spironolactone analogue that works on the kidneys. However, there are not enough clinical evidences directly linking usage to blood pressure effects in humans. Taking Yasmin can also cause blood potassium levels to increase over time as well may have interaction with other medication she is taking. Hang on, and check with her doctor regularly. Take care and best regards.

[A_Ron21]

Dr. Santos, I have another question I was wondering if you may be able to answer. It is about the syncope episodes that my girlfriend had. Today she went to the gym to run and ended up feeling like she was going to have a syncope episode. Right now its been about 3 hours and she is just starting to feel better.

Now, my question is, since she had an echo that showed her heart was ok, do you think it could possibly be related to her kidneys? This is my reasoning: since the progestin in the Yaz interacts with the renin-angiotensin-aldosterone system (since its an analogue of spironolactone), do you think that this could have somehow caused a lasting effect in her kidneys that, when her body is stressed (exercising), they aren't able to produce enough renin, and so her blood pressure drops as a result of the lack of angiotensin that is supposed to constrict them?

Its very frustrating and scary to have this happen to her on and off without having any real treatment or diagnoses simply because she does not have health insurance. Her doctor refuses to refer her to anyone or to order additional tests. But I think that obviously since nothing is resolved then thats what should be done.

[Dr Santos]

Hi,
Thank you for your update. I hope she is feeling better. A magnetic resonance angiogram (MRA), like MRI, uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the body. With MRA, both the blood flow and the condition of the blood vessel walls can be seen using a contrast material. If the medications are not helping at this point, complementary and alternative medicine such as relaxation and biofeedback techniques may also help. Take care and warm regards.

[A_Ron21]

Hi Dr. Santos, thanks for replying. She hadn't seen a gynecologist because the only healthcare provider she was able to go to was through her school. Currenty her new PCP won't give her a referral to one either. I'll have her ask about an MRA, and reply when I get some new information.

[Dr Santos]

Hi,
How is your girlfriend? It is good that the tests done were all normal. Was she seen by her gynecologist prior to her intake of  birth control pills? An MRA will indeed help rule out any conditions of the vasculature. It would also help if she identifies possible triggers that worsen her headache. There is a migraine tracker here in Medhelp that may help. Take care and do keep us posted.

[A_Ron21]

Well, the thing is, she does not come from a well-to-do family, so she doesn't have health insurance. She can't afford it, because she just graduated college and has yet to find a job or graduate school. Unfortunately, its a long wait for anyone to get seen by a oral surgeon so we're not quite sure what to do. She may check some free clinics but honestly, when you don't have good health insurance, the quality of the care you get *****.

I'll have her ask her doctor about an MRA though. She gets free family doctor visits from a donated services program in our county. Thanks for the advice!

[Londres70]

Any labs?

Sounds like these drugs did a number on her nervous/vascular systems.  I hope she reported this to the FDA because some of these drugs are put on the market and are NOT tested extensively; this is my belief.  On the other hand, some people's physiology just do not do well with certain drugs.  

TMJ(Temporomandibular Joint Disorder) can cause debilitating headaches too.  Has this been followed up?  An Oral Maxillofacial Surgeon diagnoses and treats this.  

I think the drugs caused all of the problems.  The only other thing I could recommend is a MRA of the head; this scan focuses on the vasculature of the head.  It is NOT an MRI.  

If I were her I definitely would NOT try anymore BC pills EVER.  

[A_Ron21]

Sorry, some additional information I forgot. She has been given a number of different drugs to help, so I'm going to list them here.

Ibuprofen
Tylenol
Hydrocodone
Ketorolac (Toradol - the injections actually work well for ~4 hours)
Topomax (Stepped up to 100mg daily dose, had bad side effects, came off it.)
Frova
Sumatriptan
Relipax
Naproxen
Excedrin Migraine
Midrin

Both her and I agreed that she should try to stop taking NSAIDs as much as possible to avoid the rebound associated with those. If I think of anything else, I'll add it.