Second Opinions

[pcmodem]

Hello, I'm hoping that you guys can help, based on your experience.  First, a tiny bit of background.

My girlfriend had a routine Echo done about a month ago, during which the found an enlarged right side of her heart.   We went to a cardiologist here in NYC who came highly recommended.  The office performed another Echo as well as a saline injection test.  They (and I) were able to see bubbles clearly floating from one side of the heart to the other.   According to the doctor, she's got a hole ">20mm in size" with some mild to moderate valve leakage (mitrial and tricuspid).  Her (systolic?) pressure was 32, he said normal was 25 - if thats any help.  

He told her there was an experimental clamshell procedure, and proceded to do his best to scare the **** out of her about how it cold possibly fail and she'd go into cardiac arrest, etc. et al, and that her only option is open heart surgery.  This made her burst into tears, which made him get very stern with her.

Which leads me to my question.  Obviously, we arent very happy with this doctors "bedside" manner.   He really doesn't seem to be very interested in giving us any information, just giving us orders for follow up visits - and one sniff from my poor girlfriend sends him into a tirade.  I understand that he's a good physician - does clinical teaching at a rather famous teaching hospital in the city, and is good at what he does.   We've never gotten a "second opinion" on anything like this before, and we're at a loss for what we should do.  Should we set up an appointment with another cardiologist and have them try to get all her charts from the current cardio?  Should we ask for copies ourselves first?  Is it even worth getting a "second opinion" before we have the esophagial and catheterization tests done?  I appreciate any suggestions you all might have in this regard.

Also, is it even possible through just an echo and saline test to be so sure that her only option is cutting her chest open to do the surgery?   This "experimental" nearly 10 year old surgery he downplayed seems to be the route of choice in any searches I do on the internet - and he didn't even vaguely mention minithoracic or robot assisted surgeries.  I dont want to get my hopes up, as your standard internet-dwelling junky, I've researched things on the net I thought were locks before, only to find out the "expert" is right in most cases - this is one I really and truly pray that he is just not mentioning all the other options available.

Thanks

[degrassi]

like I said....they usually like their own tests, but you are certainly entitled to anything done on your body.

[Jillejam]

I definitely agree that you need to ask for your records, and ask them for the complete set including tapes and discs.  I am in the process of getting all of my medical records, I want to have my own complete set for myself.  Also, my first episode happened on vacation in three different hospitals, it is a painful process getting records but worth it.  Please don't let some academic DR push you or your girlfriend around and make you feel intimidated or stupid.  THEY WORK FOR YOU!  I have been lucky so far with great doctors that are willing to sit down and go over every little question.  My one doctor told me that you have to be your own number one advocate.  There are plenty of talented docs out there, just need to find the one that is perfect for you.  Good luck!
Jill

[tanns]

In my son's case, I actually had the 2nd surgeon call the first surgeon for the results.  If you feel uncomfortable asking for them (and some docs will charge if YOU take them), have the other doc call for them and all you should have to do is sign a release.  But if the first doctor is professional enough he will respect the fact that you are going for a second opinion and not "jumping the gun" on the news you were given.  You are paying them darn good money for their service, don't feel intimidated by them.  

For me though, all the echos I've had, I've never taken any echo reports or films with me.  The Mayo Clinic actually asked for "the facts" only.  Nothing subjective, like reports and such.  And even then, they ran all their own tests anyway.  

I hope it all works our for both of you!

[Momto3]

Hi and welcome.  I'm so sorry to hear about what you and your girlfriend are going through.  It is difficult enough to find out about a "heart problem."  The last thing you need is to be lectured and made to feel uncomfortable.  I second the thoughts on a 2nd opinion!  You may end up back with Dr. NOBEDSIDEMANNER, but you will be better prepared to handle the news and procedure if you have a confirming opinion.  

Personally, I would not feel comfortable with a doctor who goes off on a "tirade" because of a patient's reaction.  Tears and fear are normal and healthy reactions, most doctors know that.  I really believe that you will be able to find an excellent physician with a bedside manner that best suits your girlfriend.  

Lastly, I think your girlfriend should be able to obtain a copy of the echo tape and report.  Have her call the doctor's office and find out about getting a copy of the tape and reports.

Good luck and best of everything to yo both!!  

Connie

[degrassi]

another doctor might want to do his own echo.  Many specialists don't trust another machine.  BTW, I have found that some of the most abrasive doctors are the best....they don't have to schmooze the patient.

[pcmodem]

thanks for the feedback - tanns, how do you suggest I go about getting the relevant information / data from the cardiologist?  It seems as though alot of the useful echo data is just that - data, is there anything unseemly about me asking for a copy of all of it?

[tanns]

My son needed surgery at a very young age.  The surgeon that came highly, highly recommended ended up having ZERO bedside manner and was so cold and "mean" I cried after the surgery consult for a couple days.  We did go for a second opinion and found the results to be the same thing.  I called my son's pediatrician and he layed it on the line for me, did I need to feel warm and fuzzy inside or did I want the best pediatric surgeon in town?  We chose the cold, insensitive one for the surgery even though it made cry.

I always, always advocate having a second opinion.  I've done it both ways, mentioned to the 2nd doc that it was a second opinion and not mentioned it and kind of went to get there opinion that wasn't biased by another finding.  It is hard though, you can easily get into a best 2/3, best 3/4 and so on.  For anything cardiac related, I would do a second opinion and possible head to the Cleveland Clinic or Mayo.  Just an opinion.  I personally had the best experience at the Mayo Clinic and would do it again.  Amazingly thorough and very, very organized.

Good luck to you both.

[Itschuck2c]

Check out Mt Sinai hospital in new york. They are a teaching hospital and from what I understand they have an excellent cardic program. Just google mt sinai and then search for cardiac care center.