BOBÌåÓý

On a Friday in November 2011, 67-year-old Dave Hwalek noticed blood in his urine, which prompted him to schedule a doctor’s appointment. He remembers watching the nurse studying his CT scans.

“I’m no medical expert, but I saw her measuring something and knew that had to be cancer,� the retired Navy pilot said.

Dave spent three anxious days awaiting the results. On Monday, he received the news he so dreaded: There was a carcinoma in his right kidney. Dave’s doctors wanted to remove his kidney because the 3½-inch carcinoma had engulfed it with cancer cells.

Worried about his future, Dave immediately called his girlfriend Beverly, who was on a trip to India. Her response: “Let’s get married now.�

Despite being made a widow by the same cancer in a previous relationship, Beverly would become Dave’s rock throughout his treatment. In fact, she would find the doctor who would save Dave’s life, University of Florida Health radiation oncologist Paul Okunieff, MD.

No one would likely have predicted his case's twists and turns over the next 12 years.

Radiosurgery and new hope

After his kidney was removed, Dave began a treatment called tumor immunotherapy. Its goal is to help the body’s immune system find and attack cancer cells. In February 2012, at a three-month checkup post-surgery, doctors found something unusual in his pancreas.

Dave’s oncologist at the time determined that the abnormality was a malignant lesion. The only treatment he was given was an anticancer drug called Sutent, which has a varying success rate depending on a patient’s specific situation.

Frustrated, the couple went to bed. Beverly couldn’t stay still.

“We went to bed that night, and she got out of bed at 3 a.m. and stayed up all morning researching options,� Dave said. “And that’s when she found Dr. Okunieff.

By morning, Beverly had found a doctor she believed was her husband’s best bet.

“I had never heard of anyone treating a pancreas, but I felt confident that it would be saved,� Dr. Okunieff said.

Dr. Okunieff believed stereotactic body radiation therapy, or SBRT, also called radiosurgery, was the best treatment option for Dave’s condition.

“With SBRT, you’re actually giving an immense dose to the tumor and trying to give really low doses within a small margin of the edge of the tumor,� Dr. Okunieff said.

Okunieff’s plan involved treating the lesion while leaving the pancreas mostly unharmed. After five days and a lot of “zapping,� as Dave described it, the lesion on his pancreas was gone.

The unsolved question

In the years that followed, Dave remained under Dr. Okunieff’s watchful eye. An oncologist at the VA, Dr. Okunieff kept an eye out for any sign of recurrence. Between his six-month appointments with Dr. Okunieff, Dave went for annual checkups in Fort Lauderdale.

After Dave shared the test results from this checkup with Dr. Okunieff, he was told to hurry to the nearest emergency room. Dave had developed an autoimmune disease that caused him to have a dangerously low number of platelets, particles in the blood that help the blood clot. Two days into his hospital stay, Dave’s platelet count was still too low.

Doctors warned that any procedure involving the slightest amount of bleeding was off the table � even a simple teeth cleaning could spell trouble. To increase his platelet count, Dave went back on immunotherapy treatment.

After one of his weekly checkups, Dave tested positive for COVID-19. After one high fever, two weeks of quarantine and three days of bed rest, Dave was no longer contagious, and his symptoms were gone.

During a routine follow-up with his oncologist in Fort Lauderdale, he noticed a shift in her tone as she reviewed his labs.

“Mr. Hwalek, what exactly have you done in the last two weeks?� she asked.

To their astonishment, Dave’s platelet count had climbed to 172,000, within the normal range. This was nothing short of remarkable for a patient who had struggled with low platelets so recently.

Some physicians, like Dr. Okunieff, believe COVID-19 may have triggered a shift in Dave’s immune system, leading to his unexpected recovery. Others remain unsure, with no clear explanation for the sudden improvement.

Targeting the next challenge

In February 2019, a familiar foe returned: the lesion on the tail of Dave’s pancreas, the one treated in 2012, had come back.

“It was his same old cancer, coming back to life here and there,� Dr. Okunieff said. “And then I would treat it.�

A new concern arose after successfully treating the lesion in May 2021. Two areas near Dave’s lungs began to worry his doctors. Because a biopsy could have caused severe bleeding, Dr. Okunieff and his team chose radiosurgery again. The treatment worked.

But the challenges kept coming.

In December 2022, Dave developed a cyst, again, on the tail of his pancreas. Although it wasn’t cancer, both Dr. Okunieff and Dave’s VA oncologist agreed to treat it as a precaution. In May 2024, doctors found a nodule on Dave’s thyroid. Thanks to his stable platelet count, Dave underwent five weeks of radiation and had the nodule surgically removed.

Throughout his many years of highs and lows, Dave said he felt fully supported by Dr. Okunieff and his care team through every appointment, treatment, round of radiation and surgery.

“My wife and I swear by the guy,â€� Dave said. “If that’s a reflection of BOBÌåÓý, then we think very highly of it.â€�

Trust, tenacity and time

Twelve years and more than six procedures later, Dave reflects on his journey with clarity and gratitude. Despite over a decade of treatments with Dr. Okunieff, he says, “I’ve never had a bad day.� For the former Navy pilot, resilience wasn’t just a mindset. It became his way of life.

“If I were not retired and all this happened to me, say I was in my 40s and had to work, I wouldn’t have missed a day of work besides my surgeries,� Dave said.

Dave’s strength, paired with deep faith in his care team, made all the difference.

“He trusted me,� Dr. Okunieff said. “It’s amazing how patients will trust you with their most prized possession: their lives.�