Get a second opinion from a world expert – without leaving your front room

Fear your doctor’s got it wrong? Now YOU can take control . . .

SeVeN months after nearly losing my leg during an emergency operation, I sent my medical notes to a hospital 3,700 miles away. the Fedex box bulged with 26 pages of letters; 54 sheets detailing ultrasounds, X-rays, pathology results and blood transfusion reports; eCG readings of the electrical activity of my heart; five CD-roms of Ct scans; specifics about my operations; hospital discharge notes and so on.

I was taking advantage of a little-known but increasingly popular opportunity to get second opinions from some of America’s (and, therefore, the world’s) best hospitals and doctors. Not that I don’t trust doctors here, but I faced a devil’s dilemma: what to do after a spectacularly failed operation?

My problems had begun months earlier, when a fierce pain in my calf made walking difficult. An ultrasound at the Royal London hospital revealed an aneurysm — a ballooning portion of artery — behind my right knee.

the cause of aneurysms is unknown, although they are more common in older men and may be linked to clogged arteries and, in the case of knees, stresses on the arteries when the leg bends and straightens.

I was told if my aneurysm was left untreated, blood could clot in it, shutting down blood flow — and some clots might travel down to the foot. either scenario could lead to amputation of the lower leg.

the solution was to remove that portion of the artery, bridging the gap with a graft.

My operation last December seemed to be a success. Out of hospital in a week, I was soon walking. But less than a month later, I was readmitted with a deep wound infection and needed further operations.

the first, to clean out the wound, failed to defeat the infection. the second removed the graft, leaving an 8cm gap. the gamble was that, over time, more blood would flow through the smaller blood vessels to keep the leg supplied.

there followed a third emergency operation at 5am one day to deal with heavy bleeding. I had to be given ten units of blood — about the amount the body contains — and doctors began discussing the chances of me losing my leg or my life.

But after more antibiotics, I kept both, and was discharged five weeks later. some infection remained and I continued to take antibiotics, but nothing more could be done in hospital. the hope was that my body would naturally keep the infection under control.

WALKING was more difficult and painful than before the operations, unsurprisingly seeing as how there was little real blood flow to the lower leg. My foot was effectively dead — white and cold — but it still managed to be immensely, relentlessly painful. Drugs and exercise meant it got just enough blood — and, therefore, oxygen — to be what the surgeon euphemistically called ‘viable’.

the dilemma? Whether to live on permanent heavy painkillers and cope with a limited lifestyle, or repeat the operation to fit a graft, which had nearly cost me my life.

My specialist said only I could decide. that’s when I discovered online second opinions.

the service began in America in the late Nineties and has grown quickly.

‘All the big, prestige hospitals in America are involved,’ says Jonathan Linkous, chief executive officer of the American telemedicine Association.

Dr Joseph C. Kvedar, an associate professor at harvard Medical school, started organising second opinions four years ago. that first year there were 100 to 150 cases; today there are about 1,000, with half outside of the united states.

hospitals list an array of conditions on which they can offer a second opinion. Dr Kvedar says he can call on about 4,500 specialists, adding: ‘We can pretty well guarantee a world difficult. the difference between the American system and us is that we use GPs to make referrals to specialists. Patients don’t refer themselves.’

(though for some patients — including this one — this difference is a positive, making the u.s. system seem less protectionist and puts the patient in charge.)

Although many patients are rewarded only with peace of mind when specialists endorse their original diagnosis and treatment (itself an important return), treatment can change radically for some.

testimonials on the Cleveland website include one from Dr Lucy sauer from Florida, whose daughter was told she had a rare heart deformity necessitating surgery. Cleveland’s doctors examined tests and MRI images and concluded there was no deformity.

In another case, susan Walaska, from Iowa, was told a mitrial valve prolapse (when the flaps in one of the heart’s valves don’t close tightly) required an operation. her second opinion suggested she didn’t need surgery, at least for now.

As well as the standard fee, I paid £90 for courier delivery of my data.

so, was it worth it? My answer is a resounding yes. My four- page conclusions arrived three months after my first parcel was sent, from Dr Mehdi h. shishehbor, a specialist in interventional cardiology and endovascular interventions. expert in your condition no matter how rare.’ And the other hospitals make similar promises.

I decided to seek a second opinion from the Cleveland Clinic in Ohio, which has repeatedly come out top in this medical area (as ranked by the u.s. News and World Report survey, which analyses 5,000 American hospitals).

After registering online, I was asked for credit card details. the fee is not charged until the second opinion is sent, and you can pull out without charge before this.

the cost varies with the condition, and ranges from Cleveland’s $565 (about £365), the amount I paid, to harvard hospital’s $1,100 (about £710). there can also be extras, such as paying for test results to be reviewed.

And then the work begins. First, I had to complete a 56-page questionnaire. the hospital also requires a lot of additional information (hence the bulging Fedex box).

Your condition determines what this demands, but collecting it involves time, energy and persistence. Gathering data from two hospitals and a surgeon in the uK took me more than two months.

the drawback is that the consultant does not examine the patient. however, the hospitals offering the service say doctors have evolved techniques to compensate.

Alex Nason, of John hopkins Medicine in Baltimore, Maryland, says: ‘In the past, you had a physician who would hold a film up to a light. Now they are looking at their monitors and making decisions there.’ But uK experts have doubts. Dr Linda Patterson, clinical vice-president of the Royal College of Physicians, explains: ‘An online consultation with someone you’ve never met seems

DR shIshehBOR was born in Iran and is a poetry lover, I was told. his CV is filled with qualifications, awards and published papers.

I had half hoped for a miracle cure. this was not to be. Nevertheless, I thought his report brilliant, summing up my problems and the pros and cons of the different steps I could take. My impressed GP said it contained information about my condition that she had not known from my uK notes.

the advice read: ‘It appears that you have exhausted all options.’ except for more surgery. ‘Because of what you have gone through and the residual infection that may still be present in your leg, the risk would be high,’ it stated.

Apart from a suggested drug change, I was doing everything right. In the uK, one drug — naftidrofuryl — is prescribed on the Nhs to increase the amount of oxygen carried in blood. he preferred another called Cilostazol (more than three times the price).

My surgeon offered it on private prescription, but advised against it because of side-effects.

Dr shishehbor said I should only have surgery if I could no longer accept the physical limitations caused by the leg, or if the leg came into danger. Any operation, his report said — giving detailed reasons — would carry a risk of amputation.

so when my surgeon asked what I’d decided, I said I would accept any lifestyle changes to avoid surgery, including taking permanent heavy painkillers and adjusting my life.

Although I’m past retirement age, I am a full-time journalist and author. Before the operation, I was in helicopters with trauma doctors and had been operating undercover in China investigating sweat shops. that level of activity would have to end.

I would also have to limit the energy I could put into being taught ballet by my four-year-old granddaughter.

‘I didn’t want to press you either way,’ said my surgeon, after a long silence. ‘ But that’s what I hoped you’d decide.’