second opinions -- how do they work?

[Andrew'sMom]

OK... this may be a dumb question, but this is the first time we have ever done this...
We will be heading to Cleveland Clinic next week for a second opinion on Andrew. Cleveland has been calling us all week letting us know what they need, and today they called to have us get copies of the echo tapes (which our hospital is not easily wanting to give up).
So here's my question ... for a second opinion consult, does the dr actually do an exam or do they basically just review all the info sent to them and just render their opinion? I was under the impression that the Cleveland folks would do their own echo & eaxm there, using their own equipment & techs who they know...??
Anyone...???
Thanks!

 

[Marguerite53]

For my second opinion I merely made an appointment and had my cardio fax/mail all my reports/statistics over prior. (I did not bother with the film) The extent of the exam was for the surgeon to listen to me (stethascope), ask me questions, review my tests, and then talk about himself. We discussed valve types, his hospital and staff, his success rate, etc.. For me, it was to reinforce the whole reality of it. Yes, here are 2 unrelated surgeons who agree that now is the time and I am making a good valve choice. Beyond that, it was a personal chemistry and an insurance thing.

Because you are going to the prestigious Cleveland Clinic I think you have every right and the good sense to ask them about whether they will take their own tests. I'm not familiar with your son's situation. Depending on the variables (how soon, which procedure, etc.) I should think that they would tell you which of your previous tests/procedures do not give them what they need to make a proper opinion, if in fact, they are inferior.

Be sure to make your list of questions -- even if they are the same questions you asked the first surgeon. I did find great comfort in seeking 2 opinions....it just helped make it more true, somehow.

Good luck!

Marguerite

 

[MikeHeim]

I'll post my story just to be a contrarian. I didn't get a second opinion, and actually the thought never crossed my mind. Even though my symptoms were not very bad (especially compared to some of the other stories I have heard on this site), they were still present and I had absolutely no doubt that something was wrong. Finding out that it was my mitral valve and that it required heart surgery was a bit a shock (understatement), but I actually felt a bit of relief finally knowing what was wrong with me. I had an initial echo, which led to a TEE, which led to an Angiogram. All of those tests showed severe regurgitation, so I was satisfied that the diagnosis was correct. In addition, my symptoms pretty much exactly matched what I found on WebMD, so I felt further confirmation. Finally, all my tapes and test results were reviewed by the surgeon, who also confirmed the diagnosis.

In retrospect, I guess I could have went to a second Cardiologist, but if that person had said that there was nothing wrong with me, I would have known that it wasn't correct. What would that have gained? Something was the matter, and there was no reason to believe that the first Cardiologist had it wrong. I guess I considered the surgeon to actually be the second opinion.

Of course, my attitude was that I wanted to be fixed immediately after I found out what the problem was. I guess a second Cardiologist could have advocated waiting for a couple years before surgery, but I couldn't stand living with the problem and didn't see any advantage to putting it off. Some others on this site have taken a different tact, which is nothing more than a matter of personal choice.

 

[Lynlw]

hi we have had a few second opinons over the years for Justin. when we were looking for a new ped card, we had the records sent ahead but then when we went to the docs they did their own echos , xray ekg, ( and Boston even decided at the last min to do a stress test, the reason i'm even mentioning this was because it wasn't planned so Justin of course wore sandals to we had to go back to the hotel to get him sneaks, they thought they would find a pair of shoes for him to wear until we told them Justin wears a size 13 mens, so now if he doesn't wear sneaks to the Pc, we try to always have a pair in the car)I think they may want have a copy of the last echo, to look at , to compare how things were so they can tell if he is getting worse or pretty much the same, themselves instead of relying on a written report w/ someone elses interpretation.
When we doing 2nd opinions for the surgery he had just had a cath, so CHOP wanted all his records and a cd of the cath. they went by those tests done at St Chris and the meeting (which was free) was to discuss what they would do, what valves they recomend how they would do the incision since it was known ahead of time his heart was fused to his sternum w/ scar tissue. Luckily all the docs for the 4 hospitals we talked to had the same plan, which was a huge relief to me since I was afraid they would have comletely different ideas and I would have to decide who was right.
Good Luck
Lyn

 

[gijanet]

Hi, Jen!

Hi, Jen!

Are you getting a second surgical opinion or are you just getting another card's opinion of Andrew's current state? Believe it or not, we have never gotten another card's opinion. There is a team of cards at our local children's hospital and they discuss each "interesting" case in group, so we actually get several opinions all at once.........keeping in mind that they are all from the same institution. And our old PC was wonderful and we trusted him implicitly.........even toyed with the idea of moving to South Carolina just to have him back.......... Anyway, he was always very honest and told us if there were any differing opinions and which cards thought what.

As far as surgical opinions, well, we probably win the prize on that one. We have sought out a total of five "second" surgical opinions. With the exception of the last one - Dr. Mee in Cleveland, our PC was very supportive and did all of the work for us. I e-mailed each surgeon I wanted an opinion from. They told me what they wanted - PC reports, first surgical report summary, cath report, and the latest echo tape, and our PC took care of the rest. (The only reason we did the last one ourselves was because our PC had already moved to SC.) Then we just waited to hear back. They didn't even have to see Katie.

As far as wanting another institution's and PC's opinion, I would want them to do all new testing. It wouldn't hurt to have an old echo tape for comparison purposes, but I would insist on all new tests. To prove my point, Dr. Bove was going to attempt a biventricular repair on Katie. He thought it was doable based on the cath report from Cook's (our local children's hospital). However, when we went up for surgery, he found that the cath report had some erroneous information. The cath doctor had determined Katie's complete AVSD was balanced, when it was not. It is unbalanced. He stated that Katie's IVC was occluded when it is actually interrupted. Anyway, this changed the gameplan considerably and we had to fall to the backup plan of the glenn. THe next cath, needless to say, he insisted that we have done there in Michigan. Sorry to ramble...........all this to say that I would want all new testing. Just my two cents.

Let us know how that visit goes and I truly hope it puts you back in the waiting room for a long, long time. Many hugs. J.

 

[mtkayak]

It never hurts to get a second or third opinion esp. if it gives you comfort (for lack or a better word) in knowing exactly what the diagnosis is. Today, in bigger Clnincs, a team of cards usually work together. So when you go you have a least 2 or 3 card listen to you and they discuss what your options are. By reading some post on this board, it doesn't sound like my card is very conservative. He recommended surgery right away even though I was assymptomatic. He thought it was wise to operate while I was still in good health. I questioned it but it made good sense, higher success rate, speedier recovery rate and no permanent damage if I waited too long. I had a cath done and the resident surgeon confirmed it. I then chose an "out of state" surgeon to do my operation. My local card sent all my records to the surgeon and after he reveiwed them, he agreed as well. So, to me I was satisfied that I needed surgery after I was examined by 2 cards and 2 surgeons. It really didn't require me going outside of my hospital to seek a second opinion. In my eyes, I had 4 opinions. The operating surgeon, I met the day before surgery so I took comfort knowing that he would listen to me before he opened me up

 

[Christian]

If you're actually visiting the Clinic, I'd be very surprised if they don't do an exam and an echo themselves.

When my wife first went up there, they asked for her tapes just to have some history. But she had an echo and independent exam every time she went to Cleveland.

 

[Andrew'sMom]

Thanks all for your responses. I am grateful to have a little insight on what to expect. Yes, we are actually visiting CCF. This is not a surgical consult, just looking for another evaluation of his current state of well-being as I have been noticing some things that are making me worry... tiring much more quickly than other kids on his soccer team (one mom commented to me last week .. he just looks flat out exhausted -- half-way through the game), more frequent complaints of heachache and several complaints of chest pain. It may turn out to be completely unrelated to his BAV & ascending aorta dilation... but I figure what can a second opinion hurt at this point...

 

[PJmomrunner]

I've had two surgical consults. Neither surgeon ever looked at a report. They didn't want them--were only interested in the actual images--echo, TEE, CT. I hand carried them on the day of the appointments and got them back after the appointments. (I like the idea of having them on-hand myself for comparison's sake--if I switch cardios or seek a third surgical opinion.) The first surgeon saw the echo and TEE and ordered the CT (at his tertiary care facility--U of Chicago), the second surgeon at U. of Michigan saw the echo, the TEE and the first CT from U of C and a second CT done locally three months later (nervous patient requested 2nd ). Second surgeon set up six month return visit with new CT to be done just prior at U. of M.--also said to have no more CT's done locally.

 

[ks1490]

They may just want the echo tapes so that they can see if there's been any change or progression in the condition since your last echo was done.

I'm a huge believer in second and third opinions since I only found out about my condition by going to my current cardio for a second opinion. I had gone to my initial cardio for a few years who never picked anything up. You never know when someone could be entirely well-meaning but incompetent.