Part II- When the Doctor Becomes the Patient – Dr. Robert Pugach


Author: Robert Pugach, M.D.

I write this on our return flight from San Francisco, after my HIFU treatment on Tuesday. My thoughts are still fresh so here goes…

In the weeks leading up to my treatment, I was surprisingly calm. I can honestly say that I never had a moment of fear, anger, panic or any of the other emotions that many of my patients have shared with me in over 30 years of treating this potentially lethal, terrible disease.

The reason for my attitude was that, in my case, it was not terrible. As I shared before, my cancer was diagnosed at the earliest possible stage. The odds are overwhelmingly likely that it will never return. What that translated to for me was that I was in charge of my cancer instead of it being in charge of me. I was spared the fear that patients experience when they are told that their cancer is extensive or aggressive and, potentially, not curable.

There was a second reason for my calmness that I identified as the day of my HIFU treatment approached. I had complete and total confidence in my doctor. I had the luxury of knowing him well for ten years when we travelled out of the country with our patients to treat their cancers with HIFU. When you watch someone in the OR, a fellow doctor like me can tell instantly what his skill level is. In Michael Lazar’s case, he is as good as one can get and is a true professional.

So, fast forward to May 8. Kim and I worked a full day. For me to take several days off typically means paying the penalty of having to work extra hard beforehand and afterwards to accommodate patient needs. Office hours ended at 4:00 and we were in our car headed for LAX 15 minutes later. Our flight to San Francisco was uneventful. Kim had a snack on the plane but I could only watch because I was on a clear liquid diet in preparation for the next day. There is nothing good about a clear liquid diet. I think the orange Jello was the best but I don’t care how many flavors exist for Jello – none of them come close to a good burger. And, of course, while on that liquid diet I think every billboard or TV commercial I saw had something to do with food!

May 9 – I awoke at 4:30 am to do my preparation for HIFU. I’ll spare you the details but most of my time was in the bathroom. The bottom line (pun intended) is that the HIFU treatment probe is put into the rectum so it must be clear of any particulate matter so the ultrasound beams pass unheeded into the prostate.

A 5 minute taxi ride deposited us at the San Francisco Surgery Center. It’s in a fabulous art deco building. But, once inside, it’s like any other OR setup. They have a wonderful and caring staff. The anesthesiologist had a presence that gave me confidence. An IV was stared, Kim gave me a hug and kiss and I walked down the hallway to the OR. I laid down on the table and the last thing I remember was being given some oxygen through a mask…

I woke up in the recovery room 4 hours later and saw Kim’s smiling face. She looked happy so I knew things must have gone well. I was a bit groggy but pain free and comfortable. Dr. Lazar told me my procedure went perfectly – good words to hear! Kim had been kept posted about my HIFU progress throughout the case and she wrote her own blog about it. Within an hour or so after waking up I was ready for a wheelchair ride to a taxi to spend the afternoon in our hotel room.

There was no pain. I mean it – NO pain! The catheter was a bit uncomfortable. I had no ill effects from the excellent anesthetic technique used so my clear liquid diet of the previous 24 hours was replaced with clam chowder and a pizza. By 6:00 pm I was hungry again so we accepted an invitation to a dinner meeting with a urology group in the Bay area considering adding HIFU to their practice. I was the poster child as Dr. Lazar introduced me as the patient he had treated at 7:30 a.m. that day. They were amazed. I was pleasantly surprised too, as I learned that what I had always told my patients about how good they would feel afterwards was now proven to me to be true. Instead of having the common side effects of radical surgery, or contemplating 7 weeks of radiation, I felt great and enjoyed a Ruth’s Chris steak and a good Cabernet!

Have I learned anything from this experience so far? Absolutely! I know how good it feels to have a potentially serious or lethal disease diagnosed at a stage where it doesn’t frighten you. I’ve learned how wonderful and enduring a good doctor-patient relationship can be and how a good bedside manner does more than many medications in helping a patient feel good. I’ve learned, as I did 7 years ago, how wonderful it is to have the positive energy, good thoughts and love of friends and family to get one through a challenging time.

What a remarkable 48 hours – I went to San Francisco with prostate cancer and came home cancer free.

Stay tuned for my final blog after my recovery is complete!

To read all about how Dr. Pugach’s journey with prostate cancer began, click here to read Part I.

About the Author
Dr. Robert Pugach is the fourth most experienced HIFU practitioner in the U.S. and one of only a few certified HIFU teachers and proctors. He first trained with Sonablate HIFU in 2006 and since then has treated or been involved with approximately 400 HIFU cases.

Pugach is the medical director of Pacific Coast Urology Medical Center, the first urology practice centered on minimally invasive treatments of urological conditions. It continues to be at the forefront of new, innovative technologies like High Intensity Focused Ultrasound (HIFU). Read More.

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