Why You Need a Second Opinion

Early in the summer I wrote about a good friend who was diagnosed with ovarian cysts and endometriosis. She saw a gyn oncologist because there was a small chance it was cancer (thankfully, it wasn’t). The doctor drained the cyst and started my friend on  oral contraceptives to control the hormonal shifts that contribute to endometriosis (which contributes to the cysts).

A couple of weeks ago, however, my friend texted me to say that her leg/foot was really hurting. She thought she might have a deep vein problem. I immediately told her to go to urgent care because it might be a blood clot, which can be quite serious. Her own primary care physician had left his practice, so found another that took her insurance.

Here’s her story:

“I went to the primary care physician my insurance company recommended. I specifically asked her if my leg problem could be a blood clot and she said “no” and sent me to a sports medicine doctor who then sent me to physical therapy. My leg still hurts and I thought they were wrong so I decide to go back to the gyn oncologist  who sent me to the emergency room. I have superficial phlebitis which is not life-threatening. But what if it was? I’m so disgusted with my health care.” The ER doctor told her the clot was likely caused by the birth control pills, something neither the primary care doctor nor gyn oncologist nor orthopedist had suggested, and told her to call the gyn immediately.

But wait. . . it gets better. She called her gyn oncologist back and left a message.”That was Monday, and when I didn’t hear from my doctor by Wednesday, I called her office to see if it was okay if I still took birth control,” she said. The nurse she spoke to told her she didn’t have a blood clot and that it was totally fine for her to continue taking the birth control because her leg problem had “absolutely nothing to do with the birth control. I asked if that was the doctor’s opinion or her opinion. She told me she looked at the charts and that’s what she saw from the doctor’s notes. I told her that’s not what the ER doctor said and demanded to speak with my physician. She said she’d have her call me. By Friday I still didn’t hear from anyone so I called again and finally got an appointment.”

My friend had stumbled into our Kafkaesque health care system. By now she’d seen or talked to four doctors, none of whom were talking with each other, and received three different answers.

When she finally saw the gyn oncologist, the doctor told her to continue taking the birth control pill along with a low-dose aspirin for now, but that she would need a full hysterectomy and oopherectomy to resolve the endometriosis. The doctor  also wanted her to switch from the birth control pill to Lupron, an injectable drug used to treat men with prostate cancer and women with endometriosis, which shuts down ovulation effectively putting you into chemical menopause. She couldn’t stay on Lupron long-term at her age (42), however, because the lack of estrogen could lead to osteoporosis.

The doctor never did blood work to see how close my friend was to menopause; she never suggested a progestin-only birth control pill, which would have removed the threat of blood clots and still controlled the endometriosis; she never did an ultrasound to see if the cysts had returned; she’d never done a laparoscopy to confirm the diagnosis of  endometriosis; and she never told my friend about the side effects she’d experience with Lupron, such as hot flashes, night sweats, headaches, and the plethora of other menopause-related symptoms including reduced libido and vaginal discomfort/dryness. Obviously, she’d also never told my friend about the risk of blood clots with the birth control pill she was taking.

Thankfully, my friend did her research and made an appointment with another gynecologist. This doctor conducted a complete physical examination, during which she didn’t feel any cysts. She ordered an ultrasound to check for small cysts that might need watching, switched her  to a progestin-only birth control pill, and reassured her that a hysterectomy was the absolutely last resort to consider.

So, for now at least, my friend is spared early menopause and a very serious surgery that would cost more than $50,000 and take weeks of recovery.

All because she got a second opinion.

Do you get second opinions?

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