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    Posted: Mar 20 2014 at 11:51pm
Dear all,

I have written on this topic before but The Cleveland Clinic (ranked number in the country for heart disease) just released a new u-tube video by their head of the Cardiovascular unit. Yes, it is not breast cancer but I feel the principle is the same.


I feel it is very important to get a second opinion from a knowledgeable source. Many oncologists make their patients feel uncomfortable about getting a second opinion and that is very unfortunate.

I have seen several second opinions on pathology reports show that the tumor was not TNBC but rather HER2+ which meant that Herceptin could be used, often in combination with various other drugs. I have also seen inaccurate HR+ pathology reports when in fact the tumor was TNBC.

In metastatic cases have seen pathology work not done because the oncologist 'assumed' it was TNBC again. A second opinion that included ordering a new biospy revealed it was HER2+.

I have seen cancers found on a diagnostic ultrasound or breast MRI, when ordered by a new oncologist, not found on a screening mammogram.

I have seen chemotherapies recommended without the patient getting proper cardiac screening. A patient I was helping was deemed unfit for treatment by a second opinion doc who ordered a MUGA scan and then further cardiac testing.

I have seen a clinical trail recommended that was an important effort when the first opinion doc was not even aware of the trial. And yes, there are no guarantees with clinical trials. There are no guarantees with any of this.

I have seen chemotherapies recommended when the patient was terminally ill and the second opinion oncologist explained why in his opinion the treatment might do more harm than good.

Sure, there must be other examples. Please share with us if so inclined.

Also, to be fair, having a second opinion that differs from the first may make it extremely difficult for a patient to decide and sometimes a third opinion is helpful. But isn't it comforting when then second opinion absolutely reaffirms the first?

I fully recognize that many people on the site do not have the ability to get a second opinion, for a variety of reasons but before you give up, it is possible that our insurance company, even an HMO, will pay for at least part of it. Check with them, please.

Wondering if anyone here benefitted from a second opinion? or feels they were harmed? Again, please share.

Please remember, as the Cleveland Clinic surgeon said in the video, "you are not working for your doctor; your doctor should be working for you." And that means, to me, that a knowledgeable oncologist will always put the patient's interest first and welcome a second opinion. A knowledgeable oncologist in difficult cases, may even encourage the patient to get a second opinion.

And in severe cases when the patient is experiencing e.g. very difficult pain, that is not being managed effectively by the oncologist, a referral to a supportive care services group that includes pain management specialists may yield a better result for the patient. And the constipation that often accompanies pain meds may also be better handled by a supportive care group. Ditto nausea issues. Ditto psycho social issues.

with my love to all here,

Steve


I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 21 2014 at 7:33am
If I could offer one advice to someone newly diagnosed or facing a recurrence, it would be to seek a second opinion.  I believe it will give a patient more information to make an informed treatment decision.  

I sought a second opinion when I had my recurrence.  When I found out I recurred and she suggested a clinical trial, I told her I wanted to seek a second opinion.  She had no problem with it and even helped me get the appointment when the other facility's scheduler was dragging their heels.  The 2nd onc agreed with the treatment plan.  After I finished the clinical trial, I needed radiation treatment.  This time I actually sought three opinions.  The first was the rad onc where I was being treated, then a second opinion at MD Anderson.  The rad onc at MD Anderson had worked with a rad onc in my city on research studies and suggested I meet with her.  They even helped me get an appointment within a day with this third rad onc.  I really liked the third rad onc and the time she spent with me.  All three rad oncs agreed on the same radiation treatment plan so I felt I was making the right decision and have no regrets.  

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Mar 21 2014 at 9:13am
Thanks Steve for starting this thread.
   Your examples point toward the bottom line which is that when we start out on our personal journey of fighting Tneg we need to get the very best foundation possible beforehand. And at best the foundation can be elusive because let's face it, we are ignorant of the medical language, we're stressed, and Tneg isn't just complicated but it's treatment is different than the +side. Because Tneg doesn't historically offer as many options as the +bc it's all the more important to identify what, where and when.

At worst, the foundation for your treatment can be missing a critical piece of information or mis-identifying a piece. Second chances are not as effective as first chances but 2nd opinions are often more effective than 1st opinions.

I still view 2nd opinions as good opportunities to get a handle on the information, for someone to translate the medical jargon so I can understand it. It's a less than happy comment that sometimes the best doctor has the worst bedside manner. And sometimes the oncologist most adept at taking care of a patient doesn't have the right clinical trial for a specific tumor.

Getting a 2nd opinion is also a good time to check your insurance to be sure that the doctor you choose is in your network, so a call to your carrier is also a good idea.

Donna, reading your comment I was brought back to again thinking that by being as thorough as you were may have saved your life. It took a lot of hard work and courage to follow through, I'm ever so glad you did.
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote nancykind Quote  Post ReplyReply Direct Link To This Post Posted: Mar 21 2014 at 9:16pm
i didn't realize some docs don't like their patients getting 2nd opinions.  i'm not sure i could stay with that doc in fact.  my patient navigator offered to set up a 2nd opinion anywhere i wanted during our very first conversation - within 1/2 hour after i got the diagnosis. 

i too encourage 2nd opinions at any time.   knowledge is good!  options are good!  confusing sometimes, but good! 
Lg lump never visible on any films but found 9mm. Lump 1/25/12, DX 1/31@50yrs IIIC/TN/DCIS/INV, Margins Unclr, Ki67 40%,Gr2. MX L 2/24. 3.1cm total. 11/17nodes. AC/T 2xWk,33rads. 12/12 MX R. 9/13 NED!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 20 2015 at 6:30pm
LBBC:  Ask the Expert: Getting a Second Opinion

This January, LBBC expert Paul B. Gilman, MD, answers your questions about when it's best to ask for a second opinion, how to go about getting one and what to do if your health insurance restricts who you can see for treatment and how to talk to your current team about your desire to seek more information from others.

If you want to know more about the process of getting a second opinion, get tips for talking with your care team about your concerns and learn when to seek another opinion, ask our expert today.

Read our expert's responses.

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote SagePatientAdvocates Quote  Post ReplyReply Direct Link To This Post Posted: Jan 20 2015 at 8:00pm
Dear Donna,

Thank you very much for the link to LBBC's second opinion info.

The hallmark of an outstanding oncologist, in my opinion, is a physician who welcomes and even encourages a second opinion as long as that second opinion is from another source that is considered knowledgeable.

There is no place, especially here, for oncologists who arrogantly tell a patient that they have all the answers. With TNBC, unfortunately, no one has all the answers. I have seen, as an example, ACT work for my daughter for over ten years now. Other women, with what appeared to be an identical diagnosis were not so fortunate and for others various protocols have worked.

As the years go by we are confronted with new information that TNBC is not just one disease and eventually as we learn more, I believe, the various subtypes of TNBC will be further identified with, hopefully, eventually more tailored treatment that will be efficacious. 

In the meantime, it is on us as a community to advocate for ourselves. To try to become more knowledgeable and question our physicians and to try to learn more facts from conferences, peer reviewed research studies and by trying, if possible, to expand our horizons by reaching out to other Breast Medical Oncologists. 

For many here, our healthcare system remains broken and it is almost impossible for many here to have the ability to seek a second opinion. HMOs strongly discourage second opinions. The economics of traveling, cost of consultations, time away from work, child care, etc. etc. make it extremely difficult for most to expand their network of care. So, I do understand the difficulties, all too often, and I am totally sympathetic to the challenges many here face regarding second opinions BUT if you can manage to reach out and if your primary Breast Medical Oncologist is caring, nurturing, understanding and wise sometimes new information/possibilities will unfold. 

I think it is worth the effort to at least, explore, the possibility that a second opinion from a qualified BMO with a new perspective might be feasible.

And, again, unfortunately, at times there is no magic but I have also seen many cases where outcomes were improved. 

The strength of this forum is the dedication of women like Donna, Beth, mainsailset and many, many others (my apologies to names not mentioned) who continue to research for all of us and generously share their thoughts/time and offer encouragement to all here. And the dedication of the TNBC Foundation and the research efforts they are supporting with grants is so crucial, as well. By the way LBBC is a wonderful organization and I commend TNBC Foundation for working together with them on different projects such as Metastatic Breast Cancer. It is this spirit of cooperation that will help our community become more knowledgeable, in the long run. 

My heart remains with all here,

Steve



I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Feb 18 2015 at 2:52pm
Bumping for new members.  

If others have stories to share about the value of second opinions, please post them.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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