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After eight months of unrelenting nausea, David Dean was miserable and nothing seemed to help. Then a Mayo Clinic palliative care specialist took another look and recommended a new medication. That eliminated the nausea and enabled the former triathlete to once again exercise, travel and do the things that make his life full.
After chemotherapy and two surgeries to remove his left lung to treat lung cancer that had been diagnosed in 2017, David Dean was cancer-free with a new lease on life.
But following his second surgery in July 2018, David, a retired college professor, began experiencing severe and persistent nausea. The man who had run 75,000 miles and biked 50,000 miles — a distance that included cycling four times from coast to coast — couldn't enjoy the second chance he'd been given.
"I had nausea 24/7, and nothing would stop it. I was very depressed," David says. "Along with the nausea, I coughed all the time. I couldn't eat, and my weight dropped 20 pounds. I looked like a human scarecrow."
David started taking an antidepressant, and his Mayo Clinic oncologist, Rami Manochakian, M.D., prescribed anti-nausea medications. David also was evaluated in Gastroenterology and Hepatology, Otorhinolaryngology and Neurology at Mayo Clinic in Florida. But he couldn't shake the nausea, and it began dragging down his outlook on life overall.
"For 75 years, I felt wonderful," David says. "I didn't see any point in hanging around much longer if I felt this way."
David's persistent nausea, and the accompanying depression, also took a toll on his wife of 38 years and their family. Due to his condition, David was unable to travel to visit his three children and six grandchildren, and he couldn't participate in the family's Thanksgiving celebration.
New sense of hope
Then David was referred to Maisha Robinson, M.D., a Mayo Clinic neurologist and palliative care specialist, who says that despite an extensive evaluation, there was no obvious cause for David's persistent nausea. After a consult in March 2019, Dr. Robinson started David on a new anti-nausea medication that had a different mechanism of action than the others he had tried.
After that visit, David felt more optimistic. "You can tell when you walk in how much Dr. Robinson loves her job," he says. "She was very professional and very empathetic. She wanted to know how I felt."
Along with being in better spirits after his consult with Dr. Robinson, David's symptoms also began to lift. "Within 48 hours of taking the medicine, my nausea was gone," he says. "The cough went away, too."
"You can tell when you walk in how much Dr. Robinson loves her job. She was very professional and very empathetic."
David Dean
The purpose of palliative care is to improve quality of life for people who have serious or advanced medical conditions. "The psychological hold that severe illness can take on people is underestimated," Dr. Robinson says. "Even when people have overcome their medical condition, they may still have depression, nausea, pain or anxiety, which can benefit from palliative care."
David's situation was well-suited for the care Dr. Robinson offers. "He told me, 'For the first time when I left your office, I had hope things would get better,'" Dr. Robinson recalls. "When he said that, I thought, 'That's what I want to provide to people.'"
Better quality of life
During a follow-up appointment two months later, David told Dr. Robinson that his appetite had markedly improved. He had gained weight, and he was able to be more active, walking 3 miles a day.
"Most importantly, his mood was significantly better, and we were able to lower the dose of his antidepressant medication," Dr. Robinson says.
"The work I do gives me so much satisfaction. … The core of what we do is to make the lives of people better."
Maisha Robinson, M.D.
With the improvement in his symptoms, David was excited to go on the annual trip to Ixtapa, Mexico, that he and his wife have taken for the last 20 years, with the exception of 2018 when he was feeling so horrible. "We get up in the morning and walk on the beach. We sit on the deck and look at the ocean," David says. "Being here makes me and my wife very happy."
That's just the type of outcome Dr. Robinson is aiming for in her work. Her experiences caring for people with serious and often devastating neurologic disease during her neurology residency helped her see that palliative care was her calling.
"The work I do gives me so much satisfaction. We're working in partnership with people's primary doctors in managing the whole person," Dr. Robinson says. "The core of what we do is to make the lives of people better. To know the care I gave Mr. Dean greatly impacted his quality of life gives me so much joy."
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