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DAVID D

WHAT ABOUT THE SECOND OPINION?

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There is always questions about second opinions.  The most common question seems to be, "did you get a second opinion"?.  Often it is posed as a suggestion such as, "why don't you get a second opinion"?

I've been hearing about the second opinion thing for 50 years and I still do not understand.  If you get a "second opinion" and it differs from the initial opinion what do you do?    Go with the one that your well meaning friends suggest?    Go with the one which is least painful?   Flip a coin?  Consult an astrologist?

I happen to be caught up in this dilemma.  One surgeon says he can not operate,  the second opinion says bs , of course we can operate. 

Which one would you choose?   Why???

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I never got a second opinion.  My cancer was fairly straightforward and the pulmonologist's and surgeon's explanations and recommendations lined up with the reading I'd done.  I also was very confident of their expertise.  

If one of the surgeons says s/he can't do surgery, that option is out, for that particular surgeon.  Based on what you've described, I would be feeling a bit uncomfortable about the fact that that doctor didn't make a referral to an oncologist for some other type of treatment, making me a bit less confident, maybe, in that doctor's judgment.  I don't believe you've told us what it is about your wife's situation that leads him to believe that surgery is inappropriate.

Let me ask you this--the patient is your wife, not you.  What does she think about all of this?  What does she want to do?  What are her primary concerns?

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David,

You are posing a Descartes dilemma: “I doubt, therefore I think, therefore I am”.  You want a sure answer but will still have doubt. One can never remove doubt. All decisions carry consequences.  Only a no decision yields no consequence but no results either. 

I would choose the surgeon who will operate. Why?  First, surgery provides the best path to no evidence of disease and no recurrence. Second, the operation decision is still reversible. My surgeon always reminded me that if things didn’t look good on opening me up, he’d close without completing. 

Stay the course. 

Tom

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Tom makes a great point.  If it turns out, once the surgeon is in there, that it will not be possible to complete the surgery, the surgeon will close up and go to Plan B.

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I didn’t get a second opinion either.  My treatment plan is pretty straightforward but would definitely consider a second opinion if the treatment isn’t effective.   

It’s pretty common to get conflicting recommendations & the frustrating part is the doctors aren’t the best source of guidance.  One of my friends who is a breast cancer survivor really shopped around & ended up with a fourth opinion.  She chose the surgery option (recommendation #4).  Was a good call as she’s cancer free 15+ years.  

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Tom Galli, LexiCat    I understand the logic behind your reasoning however in my case I don't think it fits.

The first surgeon that was consulted had decided against surgery on the basis of her PFT results. He felt that her lung condition was such that all surgical options should be ruled out.  His decision seemed to be straightforward and I was willing to accept it until ...after noticing that her oncologist was definitely surprised and possibly confused by the surgeons decision I decided to consult with her pulmonologist. The pulmonologist was also surprised and confused and suggested another PFT which we agreed to do. The second  PFT showed similar results as the first thus ruling out a mistake.  The pulmonologist was in disagreement with the surgeon and he let me know it.  At my request he arranged a consultation with another surgeon at a different facility. The second surgeon looked at the test results and said that she would do the surgery.  

My wife and I have decided to proceed with the surgery however I don't think its as simple as closing it back up if she thinks it is warranted. She is going to remove a lobe and hope that lung function is good enough to provide a reasonable quality of life for the future.  If after a recovery period it is found that the first surgeon was right, there is no going back and replacing the lobe. 

Thoughts?

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David,

No there is no going back and replacing the lobe, correct.  Have you seen a radiation oncologist about using precision radiation instead of surgery?  SBRT, IMRT and IGRT can very effectively deal with a small tumor causing much less loss of lung function.

I guess short of precision radiation, you've got a hard decision to make.  I know how cumbersome oxygen can be.  I had it for about six weeks after one of my surgeries.  Walking around my home reeling out plastic tube was a major pain.  Then carrying a portable unit in public was no fun either. So I understand but I can't help you make the decision.

Stay the course.

Tom

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David I'm in the same situation as your wife. My surgeon said he "would" do the surgery but is almost certain I will need o2  forever. He said since I am an active employed person that enjoys a social life and traveling he would recommend treatment via radiation and chemo. The radiation and oncology docs agreed with no surgery and said that my lifestyle would remain active after treatment. I did get a 2nd opinion and they agreed.  Now they need a brain MRI and bronchoscopy to check the lymph nodes and we can finally get this ball rolling.  Wishing the best for your wife and you

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