PAE experience with Dr. Aaron Fischman at Mount Sinai West (NYC)

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For someone like myself, who suffers from OCD, and anxiety in general, the impact that Dr. Aaron Fischman (IR extraordinaire) has had on my ability to confirm the ideal treatment, and actually proceed with a PAE, is incalculable. While I knew of his knowledge and experience in the relatively new area of PAE when I got in touch with his office, I was not prepared for an incredibly busy doctor to call me just to chat about my condition, before we had even made an official appointment -- this has never once happened before, and I have had some truly special people as physicians. What immediately convinced me that Dr. Fischman was the right person to move on with for a PAE was his ability to see my condition from my perspective, understanding what my highest priorities were, and working with me to define the parameters associated with a decision to go ahead with a PAE, if that was indeed, my choice. Having done an extensive amount of reading and research, and with a career as an engineer in R&D, multiple emails to Dr. Fischman with lists of questions were inevitable. What further distinguished him from any other physician I can think of was his prompt responsiveness to all of those emails, including late nights (up to almost 11 pm) and weekends, and clearly noted sense of humor in responding to my OCD-driven, but also research based (think: PubMed.gov) concerns. When I had sent just too many questions to be answered clearly during the day by smartphone, he suggested we chat by phone (again, going up to close to 11 pm on a Saturday night) to address my last minute questions and concerns. But it was his presence at a critical moment during preparation for the PAE procedure, when I was literally getting ready to jump out of the hospital bed and head for home, thinking that this was just a "dry run" for the day I would really go through with a PAE, he knew exactly how to respond to my last, greatest fear about a hypothesized complication from the procedure.

It's not just critical to have the knowledge and skills of an expert in the field, but that those are complemented by the ability to empathize, coupled with a truly positive attitude about going forward with a treatment for which there are never any 100% guarantees of outcomes. It's quite possible that I would not now be writing to relate how incredibly well I feel the day after the PAE (with absolutely no sense of anything having been done, the only artifacts being a couple of bandages and some nice ID jewelry). Despite my desire to be awake during the procedure, I had the confidence in Dr. Fischman to let him use some sedation, knowing that it would probably be best for my systemically in terms of recovery, but that also demonstrated the confidence I had in his abilities to perform what is known as an extremely difficult procedure (I've watched countless video recordings of PAE's, many of which feature Dr. Fischman), while leading fellows in IR training through it at the same time. As reported, the procedure to embolize both sides of my prostate, including a large median lobe, were quite successful, so my thanks go out also to those fellows who will go on to be the primary physicians for others like me in the future. We came from New Hampshire for this, and never thought twice about the distance, or cost of staying close by for several days to be close to Mt. Sinai if any side effects or complications arise. Indeed we would have flown across the country if necessary to have Dr. Fischman as the IR who would not only do a flawless procedure, but allow me to go through with it due to his empathetic, positive, encouraging nature. Thanks also especially to his wonderful PA, who handled so many of my related questions that she had particular knowledge of, in being just as responsive as Dr. Fischman, and another real human contact during the stressful period leading up to our trip, and right on up to her help with a prescription problem while we were on our way down to NY. I was really looking forward to meeting her but wasn't able to that day, but if this PAE is as successful as I believe it will be, I will now probably not get that chance.

I will be, and already have, been recommending that my brother, and a sizeable cohort of fraternity brothers, that they consider a consultation with Dr. Fischman if they are experiencing the almost inevitable onset BPH / LUTS conditions. The last thing to say is that my wife referred to yesterday as "A Mighty Day", and that does capture the sense of leaving Mt. Sinai and the care of everyone there with what I am absolutely convinced will be a new lease on life, and the ability to go back to doing work that I hope will have some positive impact on others, while "firing on all cylinders", instead of sputtering along as I have been for the past two years.

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    Just some background info to put my post about my PAE w/ Dr. Fischman in context -- he measured my prostate at 120 cc / grams using CTA (that I had at MGH in Boston -- also highly recommended!). I had three incidents of acute urinary retention in the past two years, which was the primary reason for my seeking a PAE. I could have easily just put up with frequency, but knowing from the CTA reading that my bladder wall is starting to thicken, and what I believe were two incidents of UTI's recently, along with the fact that prostates may just continue to grow (and can never be shrunk w/ PAE more than, say, 50%), this seemed to be called for. PAE not only reduces the density of the alpha adrenergic receptors, which can trigger urinary retention, but also reduces the conversion of testosterone to DHT (primary signal for prostate tissue growth), reduces the density of the prostate, and also then the size of the prostate. This is a four pronged approach to solving this problem, and I'm feeling really lucky that I found Dr. Fischman, and that PAE is now a cutting edge technique with some substantial amount of experience gained by an array of IR's who write papers, teach, and go to professional meetings to share their knowledge.

    About 10 days out I have had absolutely no pain of any kind whatsoever. I did have one incident about three days after the procedure where I felt that I had to use a catheter, as it seemed I was in retention (and I was not willing to wait for it to get worse, possibly causing me more trouble to get the catheter in). Dr. Fischman wrote back that at that point in time, after the procedure, the prostate inflammation had probably peaked, and it would be all downhill from there -- he was spot on! What I am noticing at this point is perhaps a slightly better flow, but most markedly, a much more reliable flow, which is way more important to me than the actual flow rate. I've also slept longer, by accident, without having to go, (I'd been setting my alarm for every two hours so that I can wake up and pee, not wanting to get into a situation that seems to have been occurring where the longer I go overnight between trips to the bathroom, the sketchier it gets from a flow perspective when I finally do pee (and sometimes it's scary enough that I feel that I might go back in to urinary retention again). This afternoon I also noticed that it had seemed to be much longer than usual between the times when I felt I needed to pee, but that is something I should start to make note of. At this point, however, nothing much is expected as far as prostate size reduction (although alpha adrenergic receptors could have started to die off within hours of the procedure, I believe), so I'm quite happy with the modest, but reliable results so far. I should also say that for about two days during the first week post procedure I felt like I had a bad case of the flu, and a sense of sluggishness probably lasted over a week or more (it seems like I'm maybe 80 - 90% over that feeling by now, 10 days out).

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      A quick note about taking alpha blockers (I was taking, and still am, for a short while, Silodosin). I just today discovered that they not only block the alpha adrenergic receptors in smooth muscle (like prostatic smooth muscle, which can clamp down on the urethra), but they also affect neurotransmitters like serotonin and dopamine, as alpha receptors affect both of these neurotransmitters and are widely distributed throughout the brain. One thing I don't want to do is mess with neurotransmitters (unless you are taking something like an SSRI under a doctor's care for say, OCD or anxiety or a related issue). So I'm really happy that having a solution like PAE, which is so much more fundamental than alpha blockers in solving BPH / LUTS problems, allows us to avoid taking drugs which we may think only target our BPH symptoms, but in fact may have much more wide ranging, uncalculated effects on our mood, cognition, motivation, etc.

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