How pickleball (and Penn Medicine) saved one patient’s life

By Abby Alten Schwartz 

Ronnie Recchia’s story begins on a pickleball court. 

The West Windsor, NJ resident is so passionate about playing and teaching what he calls “the greatest game ever invented” that locals know him as “Pickleball Ronnie.” 

A hybrid of tennis, ping-pong, and badminton, pickleball has unique rules—which the college kids playing near Recchia’s neighborhood in the summer of 2020 apparently didn’t know.  

Recchia liked to watch the action on the outdoor courts when he wasn’t playing. These guys were entertaining. Before leaving, Recchia shouted, “Great serve! Too bad everything about it was illegal.”   

They ended up chatting and Recchia stayed to show them some basics. One guy, Danny, returned days later with his brother and some friends and Recchia gave them lessons. Then Danny brought his dad, Clyde Markowitz, MD, and asked Recchia to teach him, too. 

The friendship born that day would later save Recchia’s life. 

A mysterious ailment 

In September 2021, Recchia, 65, woke to discover his right foot had “dropped” and he couldn’t flex it toward his leg. 

“You don’t realize this, but when you walk, you automatically bring your foot up a little bit so you don’t trip over it,” he said. Instead, Recchia’s foot hung limp. 

Recchia’s primary care physician sent him to an orthopedist, who ruled out spinal stenosis—a narrowing of the spinal canal that can cause a foot drop by compressing the nerves. A neurologist told Recchia he likely slept funny on his knee, twisting his peroneal nerve, and assured him his foot function would return. Instead, his condition worsened.  

Recchia’s entire right leg became immobile, and he felt excruciating pain along its length. He could no longer drive and began using a walker.  

Recchia had always been active. He played softball from age 18 into his mid-fifties. Now pickleball, central to his life, was in jeopardy. More than that, not knowing the cause—or trajectory—of his disability scared him. 

A team of experts 

Meanwhile, Recchia and Markowitz had grown closer in the year since they’d met on a pickleball court.  

Recchia knew his friend was a neurologist and director emeritus of the Multiple Sclerosis Center at Penn, so when Markowitz offered to do a quick neurologic exam at the park, Recchia agreed. 

Markowitz was worried. “It didn’t resonate well with me that this was just a foot drop. There was more to the story,” he said.  

In mid-January 2022, as Recchia’s condition continued to decline, Markowitz told him, “I need you to come down to Philadelphia and we’re going to get you worked up correctly.” 

Markowitz then arranged appointments with his colleagues.  

Zarina Ali, MD, MS, chief of Neurosurgery at Penn Presbyterian Medical Center, examined Recchia and determined that his disease involved more than just the peroneal nerve. She obtained additional imaging and testing and referred Recchia for further workup by a neuromuscular neurologist. 

Recchia then saw neurologist Grace Kimbaris, MD, a neuromuscular specialist with expertise in the peripheral nervous system, which carries messages from the brain and spinal cord to the rest of the body. 

Markowitz said with the complexities of the nervous system, one advantage of Penn Medicine is its variety of specialists who cover these different areas. 

Kimbaris considered possible explanations for Recchia’s condition. Was it autoimmune? Inflammatory? Infectious? Cancer? Before she could determine the cause, she’d have to pinpoint the location of his troubles.  

“There was something about the way his weakness was progressing that told me this was not a typical spine issue,” Kimbaris said. 

She consulted with other neurologists in her department, tapping into a wealth of expertise. 

“They’re all very collaborative,” Markowitz said of his colleagues, adding that whenever there’s anything that’s a bit unusual, “we’re about figuring it out.”  

Kimbaris ordered a series of tests, each yielding clues that led the team closer to an answer. Ready access to advanced diagnostics was another advantage of Recchia coming to Penn Medicine. 

An MRI of the lumbar spine showed some arthritis and pinched nerves, but not enough to explain his weakness. An ultrasound showed thickened nerves but couldn’t explain what was causing this. An MRI of his lumbosacral plexus (a network of nerves in the lower back and pelvis) confirmed nerve inflammation. A lumbar puncture to look for abnormal spinal fluid related to inflammatory nerve diseases was normal except for elevated protein in the spinal fluid. Not enough of a finding to stop looking for other explanations.   

Finally, a PET scan revealed the source of Recchia’s problems: cancer in his right sciatic nerve. 

A lifesaving treatment 

It was mid-March 2022 when neurosurgeon Ali performed a biopsy and Recchia was diagnosed with high-grade B-cell lymphoma. Kimbaris referred him to Stefan Barta, MD, MS, director of the T-Cell Lymphoma Program at Penn Medicine’s Abramson Cancer Center.   

Recchia’s cancer was a form of neurolymphomatosis, a non-Hodgkin lymphoma that infiltrated his peripheral nerves. Barta said what was unusual about this case was that Recchia’s lymphoma grew along the nerve, making it difficult to diagnose.  

“He did not have any enlarged lymph glands whatsoever,” Barta said. 

Recchia never exhibited the symptoms more typical of lymphoma, such as unexplained weight loss or drenching night sweats. Instead, his symptoms stemmed from nerve damage caused by the cancer. 

Because Recchia’s cancer was aggressive and inoperable, Barta consulted with his team and came up with a plan to hit the cancer hard with an equally aggressive regimen of chemoimmunotherapy—combining chemotherapy infusions with immunotherapy injections. 

“The aggressive lymphomas need to be treated, otherwise they can become life-threatening very quickly,” Barta said.  

In late March 2022, Recchia started the first of six treatment cycles. Each cycle involved a five-day stay at the Hospital of the University of Pennsylvania (HUP), during which he’d receive 100 hours of chemotherapy. Two days later, he’d return for a monoclonal antibody injection to boost his immune system, then recover at home for almost three weeks before starting again. 

Before his first treatment, Recchia was in such pain he rarely slept. “After the first 24-hour drip in the hospital, I had no more pain in my right leg,” he said. “I finally slept.” 

By mid-September, Recchia had completed all six treatment cycles plus two rounds of a special chemotherapy treatment to prevent recurrence in his central nervous system. 

His cancer went into remission. But his journey was not over. 

Regaining mobility 

Throughout his treatments, Recchia had been exercising his leg as best he could. Markowitz, a cyclist, set him up at home with a leg brace and training equipment that allowed Recchia to ride his mountain bike indoors.  

Now that his treatment was over, Recchia fully focused his attention on restoring his leg function. Chemotherapy had resolved his pain, but because of where the cancer originated, Recchia still had little feeling or movement in his right leg.  

Initially, he received in-home physical therapy through Penn Medicine Home Health. Then, in November 2022, Recchia started local outpatient physical therapy with Barbara Kutch, PT, DPT, CSCS, at Penn Medicine Princeton Medical Center.   

“She worked with me three days a week, an hour each time, and she slowly got me and that right leg of mine to start working—being functional again,” Recchia said. 

Kutch even incorporated a pickleball paddle and ball into Recchia’s therapy, which motivated him more. Though his recovery was slow, Recchia remained undeterred.  

“One day I was able to actually move my knee. The next day, I was able to move my big toe,” he said. “And before you know it, I was out of the wheelchair and walking with crutches.”  

By February 2023, Recchia’s journey had come full circle, and he was back on his beloved pickleball court, playing with a walker. “My group took it easy on me. They would hit the ball right to me and I would hit it back to them,” he laughed.  

Recchia progressed from a walker to a cane and is back to playing three times a week, using a device on his leg to keep his right foot from dropping. And he continues to see improvement.  

Above all, Recchia is grateful for the lifesaving care he received from Penn Medicine and for the friendship of Clyde Markowitz.  

“Man, he’s like a brother to me. I look at him and say, ‘Clyde, you saved my life!’ and he says, ‘Well, you taught me pickleball,’” Recchia said. “I think I got the better deal.”