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My Second Opinion Didn't Match My First Opinion -- now what? My Second Opinion Didn't Match My First Opinion -- now what?

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Unread 04-17-2002, 05:12 PM
My Second Opinion Didn't Match My First Opinion -- now what?

I have many fibroids causing severe cramping and pain each month, and my gynecologist recommended a hysterectomy. Specifically, he recommended an SCH (subcervical) where only my uterus would be removed via an abdominal incision. He said that as I have no family or personal history of cervical problems, he preferred to remove as little as possible. He also said he'd use just a spinal so I would recover more quickly, and told me how he doesn't use retractors or "bowel packing" so I should have less bruising and constipation issues, *and* I should be home within 24 hours. I've only seen this gyn for this particular problem, but I felt he exuded an air of confidence, and he has many, many years of experience. He is semi-retired with limited office hours and only does gyn work, no o.b.

As I have other health issues that could be affected by surgery, I made an appointment with my regular internist to consult with her. She agreed I needed a hysterectomy, but was totally opposed to an SCH, and said I should have a vaginal hysterectomy with removal of the cervix. In her words, "Why go though a lifetime of pap tests and possible cancer worrries when they can just take it out during surgery?" I told her about the gyn I went to and about his surgical methods (spinal, no retractors, etc.) and she laughed and thought his promises were ludicrous. She also told me to be prepared for at least a two day hospital stay, and she made me an appointment with a third doctor, an ob-gyn, who I'll meet with tomorrow.

So then, I'm feeling brain-addled. I like the gynecologist I went to and I feel that I trust him and the positive stories from his office staff (he was also voted "Best Gynecologist" in a local magazine poll ). However, I don't really know him, I've only seen him for this problem (two visits, total), and he is, well, a man. He doesn't know what a bother it is to get annual pap tests, so maybe the cervix issue is moot for him (I was concerned about possible sexual implications if I had my cervix removed, so I was happy he planned to leave it in). On the other hand, I've been going to my internist for about a year now and I really like her and how she listens to my problems, but I dislike the rather gloomy attitude she had towards surgery and the gynecologist. However, maybe she's just being realistic -- she does have surgical experience and is vice-chief of staff at a large hospital, and she's a woman who's had a hysterectomy.

I'm confused, and still have a third opinion to get tomorrow. Right now I still want the my gyn's easy surgery, where I wake up with a smile on my face and a song in my heart. However, now I'm worried he could be misleading me with his confidence. Has anyone else had opinions as different as these, and how did you make a decision?

P.S. I'm the "no health insurance" gal, and my quoted cost for everything is $12K.
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Unread 04-17-2002, 06:25 PM
My Second Opinion Didn't Match My First Opinion -- now what?

I think you really need the third opinion. The SCH doctor sounds very nice, but his approach may not be realistic. It's easy to sell a surgery when it sounds nice and painless and simple. That's not to say it wouldn't be, but most doctors will outline all possible complications, outline a variety of options, and explain why their plan is best for your condition. This guy sounds like a used car saleman! Of course his staff will say he's the best (he pays them.) And a shorter hospital stay is NOT necessarily best for you, even if you are footing the bill.

Keep in mind that even with your cervix removed, you should have periodic pap tests to rule out vaginal and other cancers (rare, but possible). Perhaps not every year, but routinely.

Your internist sounds like her approach is more conservative and realistic to me. I'd say get the 3rd opinion, and then weigh all your options carefully and sensibly. You want the best possible treatment for the whole you, not just the flavor of the month from a "factory" type doc. He may not be, but see what else is out there and trust your regular doctor and your own instincts. You'll make the right decision for YOU!!!

Unread 04-17-2002, 06:40 PM
My Second Opinion Didn't Match My First Opinion -- now what?

Dear Mudpuppy,
I think it's a good idea to get that third opinion. It will be interesting to see how it varies from the first two opinions

If you still like Dr. #1 the best, but have other thoughts about exactly what you want the surgery to include, maybe you could discuss it with him. There are pros and cons to keeping your cervix, even when you don't have a family history of cervical cancer. Some ladies report that they experience "mini" periods when they still have their cervix. On the other hand, maintaining yer cervix can make a difference during intercourse. So, this is not an easy decision.

As for the hospital stay ... some ladies are able to go home after only one night in the hospital, particularly if they had a laparoscopic hyst. Your recovery may be easier with an eipdural, rather than a general anesthetic, in terms of feeling well enough to go home that early. However, I don't think any gyn can guarantee that you'll only be there one night. Just be prepared for some of the other possibilities. Keep us posted on what you decide and what opinion number 3 was!

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Unread 04-18-2002, 05:44 AM
My Second Opinion Didn't Match My First Opinion -- now what?

I agree on the third opinion. The gyn sounds a little too charming and smooth to me. I've been in the medical industry for over 20 years and the doctors that got voted the "best", were sometimes known to those of us that were "in the know" to be the worst, but they were very politically savvy and new how to charm patients. I've seen some patients continue to rave about how great a doctor was, even after the doctor has screwed up and they should have sued.

On the other hand, you have a woman who is a surgeon and chief of staff at a hospital AND she's had a hysterectomy. Sounds like she would be much more credible to me.
Unread 04-18-2002, 09:03 AM
My Second Opinion Didn't Match My First Opinion -- now what?

I had to decide that also, the doc said it was up to me, and to look on the internet at various sites and see the pro's and cons.

Well I was leaning toward keeping my cervix and decided not to just from reading these posts and what they had on the internet.

Well after I had my ultrasound done, they had found that I had several nathobian cysts on my cervix, so the doc is taking that also, which is fine.

But there are good sources out there and in these posts.

Unread 04-18-2002, 10:24 AM
My Second Opinion Didn't Match My First Opinion -- now what?

I also think the 3rd opinion is a good idea, especially since you've had 2 and they said differently.

As for the cervix...I usually agree with leaving alone anything that's healthy...but, I went my first 35 years of life with normal paps every year and then wham! I had severe endocervical dysplasia...3 times. Now, what if I had my hyst before that started happening and then got the yucky results...more surgery! So, I'm glad I had mine removed and very much relieved. I don't miss it one bit.

Another consideration is that the TVH is usually the least expensive if there are no other repairs or complications. Abdominal & LAVH cost about the same. With TVH, you are usually in the OR a shorter time, which means less anesthesia time and usually don't have to stay in the hospital quite as long.

Good luck with your decision.
Unread 04-18-2002, 10:51 AM
Whatever it takes

First, I was a cash customer also, so make sure you ask for a cash discount...they do like real money and will discount. My Dr fee was 4,000 and hosp stay private fancy hospital with private room was 9,500 (surg Thurs, left Sun at noon). Surgery was an abdominal hyst (a supracervical) (kept cervix and ovaries).

Second get a 4th opinion if you need it. And read EVERYTHING you can before making the decision. Make it based on facts, not on emotions generated by personalities.

I went to a gyn out of the yellow pages (I am from a foreign country and came here for surgery)...and the first gyn said the surgery was necessary. I went to a 2nd Dr and he said, no urgency, if there were no symptoms, relax and think about it. No big deal.

Well, I was really confused. So, I asked questions, read on the internet (which is how I find this site) and sorted thru it all. Then I went back to my original gyn who was an older woman who had a hyst in her forties, and I told her what the 2nd opinion (male Dr) said. I made the decision to let her son in practice with her, do the surgery. He said an ab hyst was necessary as my uterus was too large for vaginal. I kept my cervix because no history of cancer and I wanted to keep whatever was healthy.

Yes, true I had no symptoms (that I knew of, looking back I see the fibroids were using much blood and that is why I was so tired at the end, and pain I had attributed to other things), but when the Dr cut me uterus was so enlarged and covered entirely with tumors. My opinion is that if I would have waited, I surely would have developed symptoms and my incision would most likely have had to be longer or even a vertical incision.

So, get all the opinions you need to feel good about your decision. And even after you've scheduled your surgery, keep asking questions for your own peace of mind. Ask us, ask your Dr, whatever it takes.

Hope this helps you. We wish you well....let us know what you've decided.
Unread 04-18-2002, 12:36 PM
My Second Opinion Didn't Match My First Opinion -- now what?

In some ways I feel as if I've done the first doctor a disservice by making him seem like a "smooth talker". In fact, he discouraged surgery and encourged a "wait and see" attitude with meds for pain, and it was *me* who insisted on surgery. I just wanted to get it over with. He schedules an hour for each appointment and I've never felt rushed and I never feel like there are any stupid questions -- he was also really good about showing my partner and I diagrams of what I was dealing with. He's had many, many years of experience as a teacher of laparoscopic surgery, so the fact he suggested a non-lap surgery made me feel that he was doing what was best for me, not best for him. I apologize if I seem defensive, but I don't feel I portrayed him in the best light. So far, he's been great.

As for my third opinion, I was only able to talk to her on the telephone but she's definitely a "remove the cervix" kind of doctor. She sounded very nice and took a lot of time with me (at no charge), but she was very opposed to an SCH and recommended a TVH. However, here's where we get to the ironic part -- the reason I only spoke to this doctor on the phone was because I had to cancel my appointment in light of finding out that my last pap was abnormal! So, now the SCH does seem like a bad decision, so it's back to the first doctor to finalize his opinion before I can seek a second one!

It's all been so bizarre -- the fibroids and pain out of nowhere, the unexpected medical costs, and now the first abnormal pap of my life just days before surgery. It just keeps getting more and more interesting (that's a wry smile filled with irony, by the way)
Unread 04-18-2002, 02:15 PM
My Second Opinion Didn't Match My First Opinion -- now what?

Wow, thanks for filling us in on your latest news. The details about your first gyn sound good ... an hour per appt, that's amazing! Now that you've had an abnormal pap, it does sound like maybe you need to get more details and reconsider the cervix issue.

Keep asking questions, make sure you are comfortable with whatever is planned. Let us know what you decide and how you are feeling about everything. We'll be here for you every step of the way.


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