Need help understanding my diagnosis

bleedblue711

New member
I am a white male, 28. A blood test showed I was positive for two mutations, r117h and Delta f508. I have had multiple cases of pancreatitis and recently discovered I have CBAVD (missing vas deferens and cannot have children without IVF). Is there anyone else with the same mutations? I feel bad posting here when I know there are many others who have it way worse than me but I did not get a good explanation from my Urologist and my appointment with a Pulmonary doctor is not until June. I hope someone can help.
 
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jricci

Super Moderator
I imagine you’re feeling overwhelmed. It’s a lot to process. I’d push for an appointment before June, if for no other reason than for your mental state. Waiting 3 months to speak to a specialist after being blindsided with this diagnosis is too long! Make sure your appointment is at a CFF accredited center. This link will help you find one: https://www.cff.org/Care-Centers/Find-a-CF-Care-Center/
There’s a wide range of severity of symptoms with CF, even with people who share the same mutations. There’s been a breakthrough medication called Kalydeco that has been recently approved for your mutation, r117h. It treats the underlying cause of CF. I’m sure the doctor will mention it to you at your appointment. I don’t think there’s been any studies looking at the effects of Kalydeco and pancreatitis done yet, but it helps with pulmonary and sinus issues.

Hope this helps some.
 

Printer

Active member
bleedblue:

jricci said almost everything that I would say in replying to your post. I will repeat that it is critical that you contact an APPROVED CYSTIC FIBROSIS CENTER and see a CF SPECIALIST.

You will see my mutations on my signature below and I showed the same symptoms that you show. Once you get to a CF Specialist, your health will truly improve noticeably.
 

kchapman

New member
I have the same mutations, Delta f508 and r117h, with the 7T variant, and I'm taking Kalydeco. There are 3 variants of r117h, and usually there will be a 2nd genetic test done to determine which one you have. 5T is the worst, 7T is in the middle, and 9T is the lightest of the 3 variants. Generally, all 3 of these are milder versions of cystic fibrosis mutations, and most people with Delta f508 / r117h are pancreatic sufficient. Having mild CF issues isn't always mild; it can turn into full-blown CF at any time, and just means that the real problems may show up later as you age. The fact that you've had pancreatitis a few times is a concern, as most mild cases don't have bad digestive issues. Plus, people with the milder mutations almost always have CRMS, CTFR-related metabolic syndrome, without ever going through the full diagnosis of CF. My sweat test levels never got above 29 (not even borderline CF), but I still ended up getting a lung infection with MAC/MAI 5 years ago.

MAI or MAC is an atypical mycobacterium that's just about everywhere, and most people are immune to it, unless they are an immunocompromised host. The effects are just like tuberculosis and it's nearly impossible to get rid of. Since starting Kalydeco a year and a half ago, I'm not really coughing up anything anymore, and my sweat test levels are down to 13, which is totally normal. I feel so much better, especially knowing that a CF drug can get rid of an otherwise incurable mycobacterial infection. Just to clarify, MAI or MAC can be cleared, but it almost always returns to a good host, as it's prevalent in soil, wet places like your showerhead, and the environment. Thanks to the Kalydeco, the only amount that shows up in my sputum anymore is through a DNA probe, which means that the levels are really low.

I didn't start getting sick until I was 38, although I got my genetic diagnosis when I was 33 and pregnant through prenatal screening. I still checked in with the CF clinic annually, until they found the MAI in my sputum, and then they wanted to see me more often. I'm incredibly grateful that my condition was carefully watched until problems inevitably showed up, and I'm even more grateful that I was able to get help from Kalydeco without ever having had full-blown CF. Having partially functioning CTFR channels still causes problems, and the prevalence of MAI/MAC infections are seen more often in people with the mild mutations; the people with full-blown CF are more prone to pseudomonas. So, even if your sweat tests (which you'll eventually get) aren't at CF-diagnosis levels, you might still get more health issues as you age, but you can get help from Kalydeco. It's really effective for me. As for your pancreatitis, it should help with that too, as Kalydeco works throughout your body, although it won't improve damage that could have happened from any scarring from a previous pancreatic attack.

The only real downside is having to get such expensive medicine ($311k/yr). But try to get it ASAP, before Trump changes policies. If you live in a poor state that requires a 10% co-pay of specialty medicines, you'll be out of a lot of money getting it. I live in NY state, which has a maximum of only $60/month for co-pays on specialty medicines. Still, in a state with such good healthcare (the NY state health exchange will survive even Trump), it was difficult to get approved. Don't expect your insurer to give you an approval without you calling back and checking in on things multiple times. After a few months of jumping through hoops, they told me that I needed a complete eye exam first. And then, after that, I had to call and expedite things a bit more. It took at least 2 months, but it could take you even longer. As far as the price of this medicine is concerned, do not feel guilty about taking the medicine. The pricing issues are between the insurance, public policies, and the drug manufacturer, and you can express your opinions to them, but don't avoid taking the medicine as a way to protest. It really works for our particular mutations.
 

LittleLab4CF

Super Moderator
I have the same mutations, Delta f508 and r117h, with the 7T variant, and I'm taking Kalydeco. There are 3 variants of r117h, and usually there will be a 2nd genetic test done to determine which one you have. 5T is the worst, 7T is in the middle, and 9T is the lightest of the 3 variants. Generally, all 3 of these are milder versions of cystic fibrosis mutations, and most people with Delta f508 / r117h are pancreatic sufficient. Having mild CF issues isn't always mild; it can turn into full-blown CF at any time, and just means that the real problems may show up later as you age. The fact that you've had pancreatitis a few times is a concern, as most mild cases don't have bad digestive issues. Plus, people with the milder mutations almost always have CRMS, CTFR-related metabolic syndrome, without ever going through the full diagnosis of CF. My sweat test levels never got above 29 (not even borderline CF), but I still ended up getting a lung infection with MAC/MAI 5 years ago.

Wow! I'm impressed with your entire post and it's apparent that you are privy to information not commonly available. I quoted your description of the polymorphisms 5T, 7T, and 9T because I want to learn more about them. So far I have a single quote from a scientist at Ambry Genetics speaking about the disease causing characteristics of these alleles.

Could you give us a little reference material on the above subject of polymorphisms​? Anything will help, even if it was a verbal explanation. Literature on 5,7, and 9T alleles ranges from the CFTR2 database that doesn't acknowledge any connection with CF to my most recent visit with my CF specialist who noted my 7T, 7T polymorphism, including it as a disease causing/contribution to CF.

Don't misunderstand me. I am genuinely interested in anything you have, even a summary given to you by a doctor. I don't often quote my sources of information, I have had my fill of scientific writing, and my writing is technical enough without foot notes and numbered references​. I have seen one reference to the potential severity of the T poly's and it seems like the author was ranking severity opposite to your information. My single reference is three years old and now with my doctor amending the emphasis on my T polymorphism, I'm missing something.

Thanks in advance for your efforts.

LL
 
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bleedblue711

New member
I have the same mutations, Delta f508 and r117h, with the 7T variant, and I'm taking Kalydeco. There are 3 variants of r117h, and usually there will be a 2nd genetic test done to determine which one you have. 5T is the worst, 7T is in the middle, and 9T is the lightest of the 3 variants. Generally, all 3 of these are milder versions of cystic fibrosis mutations, and most people with Delta f508 / r117h are pancreatic sufficient. Having mild CF issues isn't always mild; it can turn into full-blown CF at any time, and just means that the real problems may show up later as you age. The fact that you've had pancreatitis a few times is a concern, as most mild cases don't have bad digestive issues. Plus, people with the milder mutations almost always have CRMS, CTFR-related metabolic syndrome, without ever going through the full diagnosis of CF. My sweat test levels never got above 29 (not even borderline CF), but I still ended up getting a lung infection with MAC/MAI 5 years ago.

MAI or MAC is an atypical mycobacterium that's just about everywhere, and most people are immune to it, unless they are an immunocompromised host. The effects are just like tuberculosis and it's nearly impossible to get rid of. Since starting Kalydeco a year and a half ago, I'm not really coughing up anything anymore, and my sweat test levels are down to 13, which is totally normal. I feel so much better, especially knowing that a CF drug can get rid of an otherwise incurable mycobacterial infection. Just to clarify, MAI or MAC can be cleared, but it almost always returns to a good host, as it's prevalent in soil, wet places like your showerhead, and the environment. Thanks to the Kalydeco, the only amount that shows up in my sputum anymore is through a DNA probe, which means that the levels are really low.

I didn't start getting sick until I was 38, although I got my genetic diagnosis when I was 33 and pregnant through prenatal screening. I still checked in with the CF clinic annually, until they found the MAI in my sputum, and then they wanted to see me more often. I'm incredibly grateful that my condition was carefully watched until problems inevitably showed up, and I'm even more grateful that I was able to get help from Kalydeco without ever having had full-blown CF. Having partially functioning CTFR channels still causes problems, and the prevalence of MAI/MAC infections are seen more often in people with the mild mutations; the people with full-blown CF are more prone to pseudomonas. So, even if your sweat tests (which you'll eventually get) aren't at CF-diagnosis levels, you might still get more health issues as you age, but you can get help from Kalydeco. It's really effective for me. As for your pancreatitis, it should help with that too, as Kalydeco works throughout your body, although it won't improve damage that could have happened from any scarring from a previous pancreatic attack.

The only real downside is having to get such expensive medicine ($311k/yr). But try to get it ASAP, before Trump changes policies. If you live in a poor state that requires a 10% co-pay of specialty medicines, you'll be out of a lot of money getting it. I live in NY state, which has a maximum of only $60/month for co-pays on specialty medicines. Still, in a state with such good healthcare (the NY state health exchange will survive even Trump), it was difficult to get approved. Don't expect your insurer to give you an approval without you calling back and checking in on things multiple times. After a few months of jumping through hoops, they told me that I needed a complete eye exam first. And then, after that, I had to call and expedite things a bit more. It took at least 2 months, but it could take you even longer. As far as the price of this medicine is concerned, do not feel guilty about taking the medicine. The pricing issues are between the insurance, public policies, and the drug manufacturer, and you can express your opinions to them, but don't avoid taking the medicine as a way to protest. It really works for our particular mutations.

Thank you so much for the information and explanation. I have the 7T & 9T. I will give an update after I meet with my doctor in June. Thanks again.
 
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