Medical Second Opinions - August 15, 2008


Hello all. It's really good to be back in the swing of things. Mentally I feel absolutely great. Workwise it's been a pretty busy week. Physically I'm up to nearly "normal" feeling. One problem is that I have been pretty much a part time employee of late, with all the medical stuff and recovery. Did a lot of working from home, too. You can see from my keyboard at right that the office needed some attention (just kidding). I worked a very busy and full week, ending with teaching a class all morning on Friday. Working does require some mental "heavy lifting," and teaching a class of precocious engineers and support personnel is physically exhausting. The class seemed to go well, and that's a good thing indeed! I was pretty aggressive getting back in the saddle this week, but pushing myself a bit is probably not a bad thing at all. A bit tired after it all. And there is lots more stuff to do in my backlog. There is no question that the person with the biggest load is my boss, and I am eager to do more to take a piece of that off her plate. I should probably get one of the signs at left for her office, though!

Today's topic is Medical Second Opinions. Everybody told me that you have to get one, and I am now getting around to it - in fact, I'm getting two! So why should everyone get a second opinion? It's not so much that you expect the other doctor to say, "Cancer? You don't have anything like that. It was all a big mistake. Never mind!" While that would be welcome news, it's not realistic. What you want the second opinion to do is validate the diagnostic procedures used, the conclusions reached, and the treatment recommended. The best outcome is that the second opinion is exactly like the first one. Grading and staging cancers is a bit of an art, though, so you might find out that another doctor thinks your case may be better or worse than the first doctor. No issue if the treatment plan would be the same, but a big issue if deciding whether to do radical surgery or not! Also the doctors have different experiences and may recommend additional tests and/or treatments for you to consider. Independence is desirable, but not mandatory. In my case one of the second opinion doctors knows Dr. Hopkins very well, so perhaps they might even collaborate some on my case. Then you have the leverage of two experts working on your behalf. And if they have different recommendations for the path ahead, you have a decision to make. So it pays to use the resources at hand. Most insurances pay for it, so why not get it done?

How to proceed? This is not so obvious. Your current doctor can recommend someone, or for more independence you can get a list of the board-certified urologists in your area pretty easily from the American Medical Association at THIS LINK. It's a difficult process to become board certified, so this means the doctors are both qualified and motivated to undergo the process. Other docs not board-certified are usually OK, too. I checked out several in Salt Lake City that might have been fine, but I chose to look for more of a "superstar" doc for second opinion. Dr. Chuck helped me find one, and we hope the effort proves fruitful. I will have to incur some travel expenses to go out of state, but it's a small price to pay. If you are wondering why I have not disclosed the name of the new doctor, it's because I want to make sure the experience is generally positive first. Then I will name him, recommend him, and publish his contact info. If you want to stay near home, going to a separate medical center in your area might be good. I looked into the Hunstman Center in Salt Lake City, and they were very prompt and helpful in responding to my email, as you can see below...
Thank you for contacting the Huntsman Cancer Institute. I am sorry to hear about your bladder cancer and I hope this information will be helpful to you. Please share this information with your physician as I am not a doctor and cannot recommend any medical advice. Obtaining a second opinion is a wise course of action with any cancer diagnosis. It provides you with a different perspective of your disease and will provide you with an additional option for treatment or confirm the opinion of the first physician. Although I cannot recommend one specific urologist, I can give you contact information for our urologic oncology department that specializes in your type of cancer. Their website is http://www.hci.utah.edu/group/urologic/program.jsp and you can contact their patient coordinator, Dustin Banks at 801-587-4381. You may also want to search for local board certified urologists at https://extapps.ama-assn.org/doctorfinder/home.jsp

Finally, I have attached a brochure that can be helpful in communicating with your doctor to make sure you have covered all of your bases. "What Questions Should I Ask My Doctor Now That I Have Been Diagnosed with Cancer?" (Huntsman Cancer Institute) http://www.hopeguide.org/hope/ResourceDetailCMD.jac?searchString=&score=0&resourceID=3429&referer=/faq.jsp I hope that this information is helpful. Please visit our Cancer Learning Center website (www.huntsmancancer.org/clc) where you can search for books, videos, DVDs, CDs, and CD-ROMs available for check out. For more cancer resources and information online, visit the HOPE Guide (Huntsman Online Patient Education) website at www.hopeguide.org. If you need more information, or if you can’t link to any of these websites, please let us know. We are happy to answer any further questions and to send you these documents in the mail. I wish you all the best.
I am preparing a list of questions for the new docs to answer during our consultations. Here's what I have so far. Your inputs and suggestions are also welcome.

Questions for Second Opinions
1) Validate bladder cancer grading (G3) and staging (T1)
2) Validate diagnosis and treatment recommendations
3) What particular risks were added due to bladder perforation during TURBT #1?
Any additional diagnostics or treatments indicated?
4) Opinion on adjunct therapies (complementary not substitutes)
Vitamins – Oncovite, fish oils,etc. (currently taking)
Modified Citrus Pectin – chelating agent (currently taking)
Hyperthermia
Hyperbaric
Others recommended or to avoid?
5) Specific Dietary recommendations?
6) If no cancer observed October 23, 2008 cytoscopy, recommended treatment
Additional diagnostics to cystoscopy recommended and when?
Additional treatments to BCG therapy recommended and when?
7) If cancer observed October 23, 2008 cytoscopy, recommended treatment
If radical cystectomy indicated, include prostate or other tissues/glands/organs?
Associated risks of not doing prostate, etc.?
If radical surgery indicated, how long can it be postponed & what are associated risks?
8) If BCG therapies continue, how long before TURBT could be indicated vice radical surgery?
It's great to live in a country where there are so many resources eager to provide help and information. I encourage you to take advantage of them and get a second opinion - or two!

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