Maryke du Toit – Whipple Warrior

Despite a severe complication from a nuclear medicine treatment, Maryke du Toit, who has metastatic pancreatic cancer, would have it again if she had the choice.

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Maryke du Toit (53) lives in Pretoria, Gauteng with her husband. They have three children, aged 28, 25, and 17.

In the peak of the COVID-19 pandemic, in June 2020, Maryke experienced an intense pain under her rib cage that radiated to her back. Even though she took muscle relaxants and rested, the pain worsened, so she went to casualty.

She was treated for abdominal pain while a sonar and CT scan were done and was diagnosed with pancreatitis, with the doctor commenting that her pancreas was a funny shape. Two days later an MRI was done twice; the diagnosis changed to pancreatic cancer.

“The diagnosis was a shock and unexpected! I always hoped to spare my children from such pain. My mother received a breast cancer diagnosis in her thirties and lived with the condition for over twenty years. She passed away when I was 22, which had a profound impact on my life,” Maryke explains.

Whipple procedure

Maryke underwent a Whipple procedure to remove the 5cm neuroendocrine tumour (NET) in the head of the pancreas. “It was an immensely gruelling surgery. I remained in ICU for four days. However, what made it worse was, it was during the height of COVID, when visitors were not permitted in hospitals and COVID-related fatalities were at a peak” Maryke adds.

When Maryke was discharged three weeks later, she weighed 42kg and could only eat small portions of mashed foods or baby food. She was given pancreatic enzymes to help with digestion. During a slow eight-week recovery, she experienced Whipple attacks (painful spasms) and gradually transitioned to solid food.

A side effect from the Whipple procedure is Type 3c diabetes (a type of diabetes caused by damage to the pancreas that isn’t autoimmune which affects its ability to produce insulin). Maryke manages this with her diet. “I researched diabetes and nutrition, how to read food labels, identifying foods to avoid, understanding carbohydrate content, and so on. At first, I monitored my blood glucose every time after a meal. But now, five years on, I check it weekly, and last year August, I stopped taking pancreatic enzymes,” Maryke says.

Liver metastasis

In January 2021, a follow-up appointment showed a slightly elevated cancer marker, leading to a confirmed diagnosis of metastatic disease to the liver, but the pancreas was clear. “I was so sad…then the question of: what does metastatic cancer mean? What now? Looking back, I experienced some carcinoid flushing (a sudden reddening and warming of the skin, typically on face and neck, which is when NETs excrete hormones), so that was probably an early sign.”

In April 2021, Maryke underwent a liver resection for five lesions. Three months later, the lesions were back, and she started octreotide hormone injections (every 28 days) as a new treatment to manage the symptoms and slow down the disease. This continued for 24 months, with Maryke having a few flushings in-between, and hair dryness and loss as a side effect.

In April 2023, unfortunately the liver metastasis progressed. “This was really a tough moment for me. I took time to process, tried my best to handle things and be strong.”

The next option was nuclear medicine: four rounds of Lutetium-177 (Lu-177) DOTATATE therapy, also known as peptide receptor radionuclide therapy (PPRT). Each round occurred every two months. Maryke didn’t experience any adverse side effects. “This treatment was hope for me,” says Maryke.

Perforated stomach ulcer

In September 2023, Maryke again experienced severe pain in her abdomen and recalls feeling a pop sound. She was rushed to surgery as she had a perforated stomach ulcer. “I remember thinking, today is not a good day to die. I’m not ready.”

Once she recovered, she continued with Lu-177 treatments.

Severe complication

“Unfortunately, during my sixth nuclear treatment, the Lu-177 and DOTATATE separated causing an abnormal biodistribution with a very prominent update throughout the bone marrow and no uptake in the liver metastases or kidneys. The pharmaceutical company was notified and investigated immediately. I was given injections to help with flushing it out my system. In addition, the South African Health Products Regulatory Authority (SAHPRA) was notified,” Maryke explains.

“At that time, I felt perfectly fine and probably didn’t completely understand the full consequences – I still travelled to Cape Town on a business trip, was out and about and living life as usual.”

“Two weeks later, my blood counts dropped significantly low, and I was hospitalised, receiving blood and platelet transfusions as well as injections to increase white cells. As no positive responses were obtained, a bone marrow biopsy indicated permanent damage to my bone marrow, making a transplant the most viable option.”

Maryke remained in isolation in hospital for three weeks and received further blood and platelet transfusions almost every second day.

Her brother, visiting from Australia, was tested to see if he could be a possible bone marrow donor, but he was only a 5/10 match, and with no eligible matches found in SA, the search continued abroad.

The mom of three carried on working from hospital. Commenting on this, Maryke says, “It helped me maintain focus and diverted my attention from my illness and surroundings.”

The increased risk of infections led to another hospital stay and treatment for infection, shortly after being discharged.

Up until December last year, she continued with transfusions every week, and remained in isolation at home, when finally her white cell count started to increase after trying a booster injection once more.

Following continuous boosters, Maryke’s bone marrow reignited. Due to this Maryke never needed a bone marrow transplant and was officially taken off the transplant list this January. “The haematologist explained that my case was unprecedented in their experience, and that they were gaining new insights as it represented a first-case scenario for them.”

Maryke currently still takes injections to boost her red blood cells.

Current health standing

“Despite the nuclear adversity, the Lu-177 treatments reduced the metastases by more than 80% since inception. I’m grateful and have no regrets, as I’m uncertain where I would have been without this treatment – still hoping to receive more in future, when the time is right.”

Maryke has resumed octreotide hormone injections. Her most recent MRI scan indicated no disease progression.

Focusing on milestones

“The unwavering support I’ve received from my husband, sons, daughter, friends, family, doctors, and work colleagues has been my bedrock. Their encouragement and understanding have lifted me in moments of uncertainty, and their presence has made even the most daunting days feel possible. My husband’s steadfast love and partnership has offered comfort and strength, while my children’s devotion—each in their own way—has given me purpose and hope. Friends and family have surrounded me with warmth and laughter, even my work colleagues, through compassion and flexibility, have helped me maintain a sense of normalcy and belonging. It’s this circle of support, that sustains me,” Maryke says.

“One of the best sayings is Faith over fear. You must have faith that God is in control, and everything is in His hands. I know it’s hard but without faith, it’s even harder.”

“What helps me cope, is to focus on milestones: special moments I get to spend with family, friends, and loved ones, like another Christmas, birthday or holiday. Celebrating my daughter’s wedding this year filled me with immense gratitude, and my hope is to see my youngest son finish his matric year. It’s in these moments—when hope quietly outshines uncertainty and gratitude becomes a daily practice—that’s when my resilience flourishes.” Maryke says.

For Maryke, the act of savouring each milestone, from family celebrations to simple togetherness, reflects the significance she places on these experiences. She gathers comfort from supporting others, understanding that compassion is both a gift and a lifeline. Each day, she chooses to embrace peace, to nurture harmonious relationships, and to let grace guide her gaze beyond the horizon of the unknown. Her journey is a reminder that courage is often woven from gentle threads: small acts of kindness, a steady belief in possibility, and that happiness is found not only in triumph, but in the art of cherishing every fleeting moment.