26, just diagnosed, advice/input/kind words welcome.

LittleLab4CF

Super Moderator
Welcome to the site and welcome to the club. Late diagnosed CFers seem to have GI dominant issues and for many, it is discovered during a flare that tops all other times symptoms gang up. Fortunately the CF medical community is starting to improve the specialist services needed to address pancreatic and GI CF. For too long the GI tract has been underserved and a talented GI specialist is barely informed on proper enzyme titration, bowel motility and DIOS or Distal Intestinal Obstruction Syndrome or blockages caused by the adhesive, voluminous maldigested feces and swollen, inflamed and sticky intestinal mucosa.

My diagnosis was two positive sweat tests. I was more than a bit thrilled to finally have a diagnosis that actually fit what I had dismissed as a constellation of seriously annoying but manageable health problems. Genetic testing followed and according to my brand new CF specialist, I was just a carrier and didn't have CF.

I didn't have pulmonary CF but by chance the CFTR mutation I have does cause CF in single copies. Typically it is a nasty form of pancreatic/GI CF but it can penetrate into the lungs. Although I have had GI issues my entire life, I hit a kind of wall at age 48 and was too I'll to work by fifty. Strangely, my father had this form of CF and he died at 48.

Being tested for malabsorption will determine how much enzyme activity you still have. CFers usually have small duct disease and this usually means poor delivery of bile at best and a bag of gallstones and damaged liver at worst. Small ducts and ultra thick pancreatic juices slow the flow of this digestive cocktail down and even prevents the flow. Wherever digestive enzymes are stuck for any period, they digest whatever it is in contact with. Pancreatic autodigestion is an experience in pain that defies description and control in many cases.

The misfiring of everything in the digestive process creates havoc and a misery that is never ending. If you don't get things straight soon, I suggest you seek out Dr. Steven D. Freedman with BIDC in Boston. There are more and more places where the CF gut can be scientifically evaluated and optimized but they are still rare, maybe ten places in the U.S.

Now that your diagnosis is known, hydration, electrolytes, enzymes and good bowel habits are vital to the best quality of life with CF. Diet is always important and the needs of a diet changes. Concentrated fats and proteins are needed to bring your weight up or maintain it. A low FODMAP diet helps with bloating and a tender gut. People are often trying and swearing by gluten free and lactose free diets in particular with CF. It is hard to say for certain with gluten and lactose free diets. A tiny percentage of people are in fact intolerant.

Keeping the goals of eating and pooping normally are important to keep the focus. A normal meal that doesn't come back up and a BM that is formed and pliant are possible goals. Don't get lost in the diagnostic minutiae, worry about feeling better. As a side thought proton pump inhibitors can reduce your powerful stomach acid that kills bacteria we swallow and eat. Low stomach acid can act and feel like gastritis or excess acid. A hydrogen breath test is simple and can determine if the acid is adequate or low, resulting in bacterial overgrowth.

Best of Luck,

LL
 

Mike Brown

New member
Welcome to the site and welcome to the club. Late diagnosed CFers seem to have GI dominant issues and for many, it is discovered during a flare that tops all other times symptoms gang up. Fortunately the CF medical community is starting to improve the specialist services needed to address pancreatic and GI CF. For too long the GI tract has been underserved and a talented GI specialist is barely informed on proper enzyme titration, bowel motility and DIOS or Distal Intestinal Obstruction Syndrome or blockages caused by the adhesive, voluminous maldigested feces and swollen, inflamed and sticky intestinal mucosa.

My diagnosis was two positive sweat tests. I was more than a bit thrilled to finally have a diagnosis that actually fit what I had dismissed as a constellation of seriously annoying but manageable health problems. Genetic testing followed and according to my brand new CF specialist, I was just a carrier and didn't have CF.

I didn't have pulmonary CF but by chance the CFTR mutation I have does cause CF in single copies. Typically it is a nasty form of pancreatic/GI CF but it can penetrate into the lungs. Although I have had GI issues my entire life, I hit a kind of wall at age 48 and was too I'll to work by fifty. Strangely, my father had this form of CF and he died at 48.

Being tested for malabsorption will determine how much enzyme activity you still have. CFers usually have small duct disease and this usually means poor delivery of bile at best and a bag of gallstones and damaged liver at worst. Small ducts and ultra thick pancreatic juices slow the flow of this digestive cocktail down and even prevents the flow. Wherever digestive enzymes are stuck for any period, they digest whatever it is in contact with. Pancreatic autodigestion is an experience in pain that defies description and control in many cases.

The misfiring of everything in the digestive process creates havoc and a misery that is never ending. If you don't get things straight soon, I suggest you seek out Dr. Steven D. Freedman with BIDC in Boston. There are more and more places where the CF gut can be scientifically evaluated and optimized but they are still rare, maybe ten places in the U.S.

Now that your diagnosis is known, hydration, electrolytes, enzymes and good bowel habits are vital to the best quality of life with CF. Diet is always important and the needs of a diet changes. Concentrated fats and proteins are needed to bring your weight up or maintain it. A low FODMAP diet helps with bloating and a tender gut. People are often trying and swearing by gluten free and lactose free diets in particular with CF. It is hard to say for certain with gluten and lactose free diets. A tiny percentage of people are in fact intolerant.

Keeping the goals of eating and pooping normally are important to keep the focus. A normal meal that doesn't come back up and a BM that is formed and pliant are possible goals. Don't get lost in the diagnostic minutiae, worry about feeling better. As a side thought proton pump inhibitors can reduce your powerful stomach acid that kills bacteria we swallow and eat. Low stomach acid can act and feel like gastritis or excess acid. A hydrogen breath test is simple and can determine if the acid is adequate or low, resulting in bacterial overgrowth.

Best of Luck,

LL

Thanks for the long reply, the funny thing is that's not the first time I heard that doc's name brought up :p Unfortunately with Boston being about a 6 and a half hour drive, idk how I'd be able to see him reguarly. And yea I have problems with my bile already, elevated indirect bilirubin, upper right quadrant pain, bile reflux. None of my tests/scans showed stones, but when I got my hida scan my gallbladder did not show up during the first two hours of the test, not until they added the cck, but they didn't go into detail as to why,
 

Printer

Active member
Mike:

I was dx at age 47 after years of digestive issues. Two comments, now that you have been dx your entire life will improve. The other thing is that you must be seen at an Approved Cystic Fibrosis Clinic by a Cystic Fibrosis specialist. Your current Doctor can treat you for everything else but you need a CF Specialist.

Bill
 

Printer

Active member
Mike:

Don't be afraid to see Steve Freedman, even once. He will put a plan together for you that your CF Specialist can follow. Wait until the Spring, we have much to much snow for a trip here now.

Bill
 

Mike Brown

New member
Mike:

I was dx at age 47 after years of digestive issues. Two comments, now that you have been dx your entire life will improve. The other thing is that you must be seen at an Approved Cystic Fibrosis Clinic by a Cystic Fibrosis specialist. Your current Doctor can treat you for everything else but you need a CF Specialist.

Bill

Hey Bill, yea hopefully I can get some meds that will help on Thursday. I'm going to be going to an Adult CF clinic at Robert Wood Johnson in NJ I believe for my main specialist, but will try to set something up to see Dr. Freedman in the spring like you said, because I've heard good things and a lot of reccomendations for him. Is that the specialist you go to?
 

becabee

New member
Hi. I was just reading here and saw your post. My grandson is 9 and has a rare CF gene. He is mostly sinus and gastro. However if he does get colds it hits him hard and as he ages his lungs are getting more affected. My daughter is 28 and also has 2 CF genes and the sweat test came out negative. Drs have told her she has CF, others say she doesn't have it but she has bronchitis and Pneumonia more than she doesn't and coughs up blood. I believe she has it. She has always had bowel problems but Drs. never tested her for CF when she was young. She showed no signs of it except that issue until she had pneumonia about 4 years ago I wish you luck.
 

Printer

Active member
Mike:

I am seen at Boston Children's for my CF but I see Steve for my Gastro issues that are CF related. Look into the train to Boston. The Back Bay Station is a short cab ride from BIDMC and you can do the round trip in the same (long) day. Steve only sees patients on Friday's, so you could plan a weekend in Boston if that works for you.

Bill
 

Printer

Active member
becabee:

The world is full of Doctors who can't even spell CF much less Dx or treat it. Your daughter and grandson should be seen at an Approved CF Clinic by CF Specialists. Ignore everything that is said by Doctors who are not CF Specialists.

Bill
 
D

daniela.l

Guest
Mike,
Don't be discouraged by this overwhelming new diagnosis in your life. It may feel like it's too much at the beginning, but you get used to it and learn to live with it. As I'm growing up and maturing, I find it best to communicate with someone as a coping mechanism. It has helped me a lot to look at the positivity in my life despite my CF. Also, I have somewhat the same diagnosis as you, but vice versa! My CF mutation has severely affected my lungs and not my digestive system. When I was young, I did take pancreatic enzymes, but the doctors stopped them years later and have been doing good without them! This is a very rare mutation that affects about 5-10% of people with CF. This to me is kinda cool because I have a very special, rare gene mutation :)
It looks as though you are on the right track to getting diagnosed with the sweat test. I was born in Mexico and developed lung problems since birth but doctors could never pin point the cause until I got a sweat test here in the US.
Eating and nutrition is a HUGE thing to focus on with CF. Protein and calories are the main thing to work on! I hope your nutritionist guides you to a good diet so you can gain weight back and feel better! And hopefully you won't develop lung problems (I think those are harder to manage).

Best of luck,
Daniela
catchingyourbreaths.wordpress.com
 

Mike Brown

New member
Hey, I was wondering are digestive enzymes safe to take with pancreas flare ups? I know when you have pancreas attacks your lipase is high, so would taking enzymes with lipase make this worse or is that totally different? Just wondering because I can't get into my cf center until march and have no one else to ask prior to that.
 

triples15

Super Moderator
Hey, I was wondering are digestive enzymes safe to take with pancreas flare ups? I know when you have pancreas attacks your lipase is high, so would taking enzymes with lipase make this worse or is that totally different? Just wondering because I can't get into my cf center until march and have no one else to ask prior to that.

Hi and welcome Mike! Sorry you needed to find us here at cf.com, but glad you did.

I've had pancreatitis many times, and always wondered the same thing. I always thought it seemed odd to take enzymes if your lipase/amylase levels are already elevated. I, however, have not had pancreatitis now for several years *KNOCK ON WOOD*, but if I remember correctly, I DID take enzymes while easing back into eating solid foods but took a few less than I normally would. After all symptoms were gone and I felt I was in the clear and went back to my regular diet I took the full dose of enzymes.

Like I said thought, my memory is fuzzy, and this was just me. So I wouldn't take my word for it! :) It just sounds like we have the same logic on the issue. My actual advice would be to call the CF clinic and ask to speak to the nurse. Let them know your situation, that you have an appointment scheduled etc, and ask what they would recommend regarding the enzymes. Can't hurt to try. :)

Good luck to you, and I hope with your diagnosis you find some solutions and some relief!

Take Care,

Autumn 34 w/CF
 

Mike Brown

New member
Hi and welcome Mike! Sorry you needed to find us here at cf.com, but glad you did.

I've had pancreatitis many times, and always wondered the same thing. I always thought it seemed odd to take enzymes if your lipase/amylase levels are already elevated. I, however, have not had pancreatitis now for several years *KNOCK ON WOOD*, but if I remember correctly, I DID take enzymes while easing back into eating solid foods but took a few less than I normally would. After all symptoms were gone and I felt I was in the clear and went back to my regular diet I took the full dose of enzymes.

Like I said thought, my memory is fuzzy, and this was just me. So I wouldn't take my word for it! :) It just sounds like we have the same logic on the issue. My actual advice would be to call the CF clinic and ask to speak to the nurse. Let them know your situation, that you have an appointment scheduled etc, and ask what they would recommend regarding the enzymes. Can't hurt to try. :)

Good luck to you, and I hope with your diagnosis you find some solutions and some relief!

Take Care,

Autumn 34 w/CF

haha yea, cause I know pancreas flare ups cause elevated lipase, but didn't know if it worked the other way around, as in can elevated lipase useage cause pancreas flare ups. I'll call and ask them today, wasn't sure if it was a dumb question or not, so I figured I'd ask the board on here first :p
 
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