A patient’s rapid recovery from a rare and debilitating condition has highlighted the benefits of a multidisciplinary team working together to find the root cause of an illness and seeing treatment through to completion.
This was the case when 44 year old Pfuluwani Ronald Murwamuila underwent surgery to remove a potentially life threatening tumour and bounced back so quickly that he was able to complete the 2022 Comrades Marathon. He recently surprised the group of doctors who treated him by arriving for his check up, bearing his medal.
“When Mr Murwamuila came to see me in March last year, he was in really bad shape,” says Dr Helena Oosthuizen, an endocrinologist practising at Netcare Pretoria East Hospital. “He could barely walk, which – for this energetic runner who is normally incredibly fit – was a truly worrying sign. I could see time was of the essence and we admitted him to hospital.”
For Mr Murwamuila, living through the experience was unnerving. “Running is my life and I have always been extremely fit but I had started to feel tired and had begun to notice some swelling in my stomach and face. I went to see my GP who referred me to Dr Oosthuizen and before I knew it I was dealing with something far more serious than I ever thought would happen to me as such an active and previously healthy person,” he says.
|Pic: Mr Pfuluwani Ronald Murwamuila (centre); with two of his treating doctors who practice at Netcare Pretoria East Hospital, endocrinologist Dr Helena Oosthuizen (right); and cardiothoracic surgeon Dr Hugo Sarli (left). Mr Murwamuila gave his doctors a pleasant surprise recently by arriving for his check-up bearing his 2022 Comrades Marathon medal following treatment for a rare and debilitating condition.
Dr Oosthuizen explains that Mr Murwamuila presented with severe hypokalaemia, or extremely low levels of potassium in the blood, and was diagnosed with Cushing syndrome, which can occur when the body produces too much of the steroid hormone cortisol.
“Because of Mr Murwamuila’s low levels of potassium, I suspected that his Cushing syndrome was ectopic, as these two conditions are known to be linked,” explains Dr Oosthuizen. “Ectopic Cushing syndrome is very rare and occurs when a tumour develops outside the pituitary or adrenal glands, secreting a particular hormone that controls the production of cortisol.
“While his symptoms pointed to this explanation, in order to reach a conclusive answer we had to remain persistent and collaborative in our joint efforts,” she says.
As a firm believer that a multidisciplinary approach often yields the best outcomes for patients, Dr Oosthuizen approached her colleagues practising at Netcare Pretoria East Hospital, Dr Jacqueline Smit, a physician who oversaw Mr Murwamuila’s care while he was admitted, and Dr Samuel Fourie, a clinical and radiation oncologist who would be best placed to perform the required nuclear scans and radioisotope studies.
According to Dr Smit, while one of the scans revealed a mass in the area between the wall of Mr Murwamuila’s chest and his right lung, the only way to really know if this was an ectopic tumour was to operate – a decision that could not be taken lightly.
The team consulted with Dr Hugo Sarli, a cardiothoracic surgeon practising at Netcare Pretoria East Hospital and after discussing possible outcomes together with Mr Murwamuila, it was agreed that operating would be the only feasible way to give him a fighting chance.
“We had been trying to address the hypokalaemia with oral potassium supplements at first but the results were not nearly what we needed them to be, and it was necessary to supplement him through a central line. Clearly a solution to the root cause was needed that would allow him to get on with his life,” says Dr Smit.
Dr Oosthuizen adds that had Mr Murwamuila’s condition been left unaddressed much longer, his overall health and mobility would only continue to decline. Further down the road he would be facing cardiovascular issues and potentially a host of other serious health concerns. Needless to say, without swift medical intervention, the prognosis was very poor,” Dr Oosthuizen says.
Ten days after Mr Murwamuila was admitted, he underwent surgery with Dr Sarli to remove the mass and post-operatively the team was able to confirm that it was indeed an ectopic tumour that had been the root cause of his condition. Dr Smit notes that Mr Murwamuila’s potassium levels normalised quickly thereafter and just five days later he was well enough to be discharged.
“I felt an immediate improvement in the days and weeks following the surgery, and while I needed to rest at home for a couple of months and regain the strength that I had lost, by the end of June I was able to begin walking for exercise and I started to feel human again.
“However, I really wanted to get back to full health as soon as possible so I started to think about a goal to work towards and of course, being a serious runner that goal was the 2022 Comrades Marathon. I had run it six times before but due to the COVID-19 restrictions it had not taken place for two years. The 2022 race was the Comrades’ comeback and I saw it as my chance to make a comeback for myself,” says Mr Murwamuila.
Dr Oosthuizen points out that a patient experiencing a similar type of health event would normally take 18 – 24 months to regain their strength and recover but Mr Murwamuila was determined not to miss the 2022 Comrades Marathon and began to train in September 2021, just six months after his operation.
“I was so out of shape that I trained alone at first, as I did not want to hold my running crew back. In January 2022 I did my first half marathon of 21 kilometres and that inspired me to keep going. Later in the year I qualified for the Comrades and when the big day came I managed to finish in seven hours and 40 minutes.
“The sense of achievement was enormous, remembering what I had gone through just a little over a year before and that I was now back to being so fit I could even finish before others who had been able to train for longer. Since then I have had another check up and I feel so lucky to be healthy once more.
“2022 has definitely been a better year for me and I would like to thank the doctors and the staff at Netcare Pretoria East Hospital for identifying the cause of the problem and for making sure that I got better,” he says.
Dr Oosthuizen will continue to monitor Mr Murwamuila but she notes that she and her colleagues have been astonished at their patient’s rate of recovery. “We found enormous value in drawing on one another’s expertise in bringing Mr Murwamuila to the successful end of his treatment.
“When I last saw Mr Murwamuila he mentioned that he is looking forward to the 2023 Comrades. It is wonderful for us all to see him continue to go from strength to strength and we wish him all the best for that next milestone,” concluded Dr Oosthuizen.
Notes to editor
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