Rick O’Keefe was used to standing out for his tennis skills. With an impressive 4.5 National Tennis Rating Program score, he was an active member of the Little Rock, Arkansas competitive scene. But in May 2023, an injury would put both his tennis career and his life at risk—and attract attention for a far different reason.
“He connected on a backhand, and all of a sudden, he felt severe pain, with no impact and no fall,” remembers his fiancée, Elly Rumbach. “He went to the ER, and they told him he had a broken clavicle bone. When his shoulder didn’t heal after six weeks, he was referred to an orthopedic oncologist at the University of Arkansas for Medical Services for further treatment.”
A CT scan followed by a bone biopsy showed that O’Keefe was suffering from renal cell carcinoma, or kidney cancer, which had spread to his collarbone. It also revealed that O’Keefe had an extremely rare condition known as a horseshoe kidney, which occurs when the two kidneys are connected by an isthmus, or bridge, creating one large, horseshoe-shaped kidney.
A horseshoe kidney forms during fetal development, and often has no side effects. That means most people with horseshoe kidneys are unaware they have them—until they’re discovered incidentally, as in O’Keefe’s case. But the condition would have a profound impact on his treatment.
While the tumor initially responded well to oral chemotherapy, and O’Keefe learned to play tennis left-handed, progress soon slowed. After a year, it became clear that the tumor would have to be removed. That’s when O’Keefe started looking for surgeons—and began to realize how few had ever operated on a horseshoe kidney.
Searching for Expertise
“The first surgeon we met with was willing to do the procedure,” Rumbach recalls. “But we wanted someone who had experience with a horseshoe kidney. We met with another physician and actually booked a surgery date, but again, they hadn’t worked on a horseshoe kidney.”
“Shi-Ming Tu, MD, Rick’s oncologist in Little Rock, had previously worked at a hospital in Houston that specializes in cancer treatment,” Rumbach continues. “He referred Rick to a kidney surgeon in Houston in the hope of finding him the right doctor for his procedure. We booked a flight to Houston, as they required an in-person consultation.”
“Then, things started to fall into place,” Rumbach says. “We had a snowstorm in our area, so I had a little time on my hands, and I Googled ‘urology surgeon who’s taken a cancerous tumor out of a horseshoe kidney.’ Two names came up: a surgeon in New York, and Dr. Eun at Temple. I called the surgeon in New York, and I didn’t get an answer. Actually, I still haven’t heard back. But then I called Temple, and I got a live person on the phone who transferred me directly to Roma Chinappi, Dr. Eun’s administrative assistant. She got the ball rolling by scheduling a teleconference with Dr. Eun the following Tuesday, and even sent us an overnight prepaid label for Rick to use to mail his medical records and scans.”
“We spoke with Dr. Eun for an hour on the teleconference,” Rumbach says. “We both loved him, and we knew he was the right guy. He was so easy to talk to, and he told us, ‘I’ve done horseshoe kidneys. On some days, I do kidneys all day long.’ After that, we cancelled Rick’s surgery in Arkansas. We were supposed to leave for Houston the day after the teleconference, but we diverted our flight to Philadelphia.”
When Experience Matters Most
“On a weekly basis, we see people from all over the country: from Texas, from Alabama, from Florida,” says Daniel D. Eun, MD, who is Professor of Urology and Director of the Robotic Urologic Surgery Clinical Fellowship at the Lewis Katz School of Medicine, as well as Chief of Robotic Surgery and Director of Minimally Invasive Robotic Urologic Oncology and Reconstructive Surgery at Temple University Hospital. “They either find us through online research, or they have a unique problem and their urologist says. ‘I really need you to go to Philadelphia.’”
Patients travel thousands of miles to see Dr. Eun because of his vast experience with some of the world’s most challenging urologic cases. “I’ve always been involved with unusual cases,” Dr. Eun explains. “It’s part of what I do, and I find it fascinating. I’ve operated on about 25 horseshoe and ectopic kidneys, which are kidneys that aren’t in the typical location, and each one has been unique.”
Those idiosyncrasies make removing horseshoe kidneys tumors especially challenging. “If a tumor is on the posterior side of a traditional kidney, you can just flip the kidney so it’s easier to access,” Dr. Eun says. “But on a horseshoe kidney, you can’t do that: the isthmus makes it so that the kidney may not be able to flex. In Rick’s case, the tumor was actually right in the center of the isthmus, which made locating the blood supply even more difficult. With traditional kidneys, you might have a variance in terms of two or three veins, but for the most part, you know where the blood supply comes from. But in a case like this, imaging isn’t going to tell you the source of the blood supply, and if you get into trouble, it can lead to catastrophic bleeding.”
That’s when having an experienced surgeon makes all the difference—and why O’Keefe’s insistence on finding a physician who had operated on horseshoe kidneys turned out to matter a great deal. “When I started Rick’s procedure, I found that his blood supply was extremely complicated,” Dr. Eun says. “In his case, it was better to do the surgery ‘off clamp,’ or to forego clamping the blood vessel. That’s not something junior or less experienced surgeons usually like to do, because there’s comfort that comes with clamping the kidney’s blood supply.”
“When an inexperienced surgeon encounters a complicated blood supply, they might also want to remove the whole kidney, or to cut the patient open to do the procedure more quickly,” Dr. Eun continues. “But we were able to pivot effectively, save Rick’s kidney, and take out the entire tumor. We also divided the isthmus and separated the two kidney moieties, so he now has two separate kidneys.”
“You Really Don’t See That Anywhere Else”
“Once we made the decision that we were definitely going to come to Philadelphia, my prayer was, ‘This is a long way. Close the door if this isn’t where we’re supposed to go,’” Rumbach says. “But I just feel like things fell into place. Dr. Eun had a cancellation and got us scheduled for March 13th, which we found out is World Kidney Day—and March is also National Kidney Cancer Awareness Month! And then when June—Rick’s mom—and I were in the waiting room, Dr. Eun came out and spoke to us for about 45 minutes after the surgery and told us all about how they got the tumor out.”
“You really don’t see that anywhere else,” O’Keefe says.
“It wasn’t just Dr. Eun, either,” Rumbach continues. “All throughout the day, I saw doctors speak with patients’ families: leaning in, making eye contact. Their body language showed how much they cared. I think that makes a big statement about how the doctors are here. And we had the best experience with the organization we stayed with, too: Hosts for Hospitals. Our hosts, a retired physician and his wife, live in Chestnut Hill, and were so accommodating. They picked us up at the airport late in the evening, let us borrow their car to go to dinner, and even dropped us off at the airport when it was time to return home.”
O’Keefe is now in recovery from his successful surgery, and will continue to be treated by his medical team in Little Rock—including Dr. Tu and Julio Olaya, MD, to whom he wants to extend a special thanks—for stage IV cancer in his right clavicle. But that didn’t stop him from making the most of his time in Philadelphia. Just days after his procedure, he and his companions made their way to the Art Museum to snap a triumphant photo next to the Rocky statue.
It was a fitting image for a champion who never gave up—and, according to Dr. Eun, O’Keefe might not be finished with our city quite yet.
“When we were talking about the follow-up visit, they asked, ‘Well, do we have to come back here?’” he laughs. “I jokingly said, ‘Well, only if you want to give me a hug.’ So I think they really might come back to Philly for that return trip.’”
