FYI: Not all “approved” CF centers have CFF accreditation. Medical schools tend to make their own rules and many have self-accredited clinics of all kinds including CF.
Late diagnosed CFer's are crawling out of the woodwork. In the recent past, ER visits for pancreatitis diagnosed 170,000 with CF, through genetic testing. It appears that late diagnosis of CF is about to become the majority. Not to worry, I think CRMS or Cystic fibrosis Related Metabolic Syndrome will take most of this population.
My CF diagnosis came on the heels of a record case of pancreatitis. A pancreatologist/CFGI doctor familiar to many adult CFers, Dr. Steven D. freedman suspected CF and ordered a sweat chloride test at Boston Children's Hospital. Before the test even started, they objected because there wasn't a test data table for a person my age (then 52). With the resources of Harvard's medical school library, a workable table was assembled within a few hours. A repeat test was higher yet and with my health issues, I was diagnosed on the basis of the sweat chloride test. If I remember correctly, Boston Children’s and Harvard planned to do a formal study to establish adult test numbers. In either case, adults now have an age table.
As for being marginalized by a CF specialist doubting someone 59 would have CF, the remark is insensitive but statistically valid. Having a positive sweat test discounted is both insensitive and statistically wrong. This is why Printer and others are a bit incredulous that a CF specialist at an approved CF center would take such wild swings. As great as CFF is, the focus changed about five years back. Instead of the traditional financial aid for CF families, they dove head on to find a cure. Advanced genetic testing and our knowledge of cell genetics technology was ripe for the attempt. It was worth every penny of the now hundreds of millions of research dollars.
Undoubtedly your doctor was relying on statistics when he/she told you weren’t a likely candidate for CF. The list of conditions that would also cause a positive sweat test is exactly? Exactly, any condition that will cause a false positive for CF might as well be CF. life threatening electrolyte imbalance, pancreatitis (chicken or egg?) and other issues involving clogged hyperactive endocrine glands like the adrenals, thyroid and such. If your heart isn’t jumping out of your chest, chances are, it is CF. There is no subtle condition that could show 90 on a sweat test.
The sweat test is still the Gold Standard because it directly measures the chloride imbalance present in a particular type of sweat gland found in the skin and moist mucosa lining the oral and nasal cavities, the gut and all glands or gland-organs like the pancreas and thyroid.
The same Dr. Freedman has been racking up CF diagnoses from a very significant number of adult idiopathic chronic pancreatitis patients. Such was my case once the sweat chloride test was confirmed. Then genetic testing revealed a mutation known to cause pancreatic/abdominal havoc in single copies.
The world of CF is a tiny place and in the rarified air of an Orphan Disease, the average doctor doesn’t have CF medicine on the tip of her/his tongue. A number of contributors have regaled us with questions from medical professionals like “at what age did you contract CF?”
Genetic testing is refined to the point where any and all mutations are identifiable. Mammalian genetics is confounding by nature. Cystic Fibrosis is a single gene, mammalian genetic disease, something truly rare. There are a couple thousand variants of this mutation and the clean Mendelian genetics has failed to hold true. All of the wild variations in CF that weren’t necessarily predicted could explain a great deal about late diagnosed CFers.
Classic CF carriers, those who only carry one mutation and no other errors like long T polymorphisms, are said to have mild versions of certain CF issues in some cases. Sinus and head infections, frequent but treatable chest infections but almost always CF issues of the pancreas and gut.
By contacting CFF.org you will find a nearby Cystic Fibrosis Foundation chapter either by State or region. I suggest calling the chapter representative closest to you. I go to the Adult CF Clinic at National Jewish Health (NJH) a leading respiratory center. Here’s the rub. Late diagnosed CFer’s represent a fast growing population and most of us have been winging it with regular specialists having no focus on CF. An adult GI doctor who is current on CF isn’t going to be found at every approved CF center.
In fact the Cystic Fibrosis Foundation is quick to admit that they are scrambling to establish top notch Adult CF clinics. I recently contacted the Colorado CFF chapter looking for an adult CF GI specialist. The person I talked with told me I was already seeing the regional go-to guy. She remarked that everybody was scrambling to build up Adult CF resources.
Not all doctors are extraordinary and not all doctor-patient relationship meshes perfectly. Most CF specialists have been on a steep learning curve concerning CF genetics. Three years ago CF was KNOWN to be an autosomal recessive disorder requiring two copies of the same CFTR mutations. Otherwise, you were an asymptomatic carrier. I am pretty good in genetics and appreciate how this certainty was likely to be blown away.
It is especially frustrating when a doctor begins by making you sound like a fool. I understand why doctors gleefully tell you what you don’t have. And I understand how infuriating it can be when clearly you need an answer to what you DO have. Adult CFers may live in Dallas but come to Denver or live in California and the go to Boston. If local resources aren’t up to snuff, contact the Cystic Fibrosis Foundation and complain.
Welcome to the club,
LL