Our Dx changed

Lilliansmom

New member
From atypical CF to CRMS. We were at clinic today, and the doc said that although he was changing the dx., he was not changing anything else, and was still keeping them on precautions for everything. He did say that if they culture any of the main cf bugs, that they will change it to CF, but for now it is CRMS. DD cultures staph when they bronched her a few months ago, but he is not counting that.

Has this happenned to anyone else's kids?
 

Lilliansmom

New member
From atypical CF to CRMS. We were at clinic today, and the doc said that although he was changing the dx., he was not changing anything else, and was still keeping them on precautions for everything. He did say that if they culture any of the main cf bugs, that they will change it to CF, but for now it is CRMS. DD cultures staph when they bronched her a few months ago, but he is not counting that.

Has this happenned to anyone else's kids?
 

Lilliansmom

New member
From atypical CF to CRMS. We were at clinic today, and the doc said that although he was changing the dx., he was not changing anything else, and was still keeping them on precautions for everything. He did say that if they culture any of the main cf bugs, that they will change it to CF, but for now it is CRMS. DD cultures staph when they bronched her a few months ago, but he is not counting that.
<br />
<br />Has this happenned to anyone else's kids?
 
E

edan

Guest
Hi. I was just wondering what your child's stats are? Are you confident this doctor really knows what he is doing? I would get a second opinion no matter what anyway. This disease is too serious to rely on the "word" of one doctor, IMO. My daughter has 2 disease causing mutations and I flew across the country to get a second opinion on her treatment protocol. I have heard some scary things on here that patients/parents have said their doctors said.

How old is she? Is she possibly just too young to have any real symptoms present anyway?
Pancreatic status?
Fecal Elastase level?
Sweat test?
Mutations?

My daughter is pancreatic sufficient. Fecal elastase >500. Sweat test of 58. Normal lung xray. Age 4 and cultures nothing (had cultured H.Flu 2x in the last year though). But, she does have two disease causing mutations, the second of which is "milder". That said, we still do 2 treatments per day because we know it will progress, 4 if she has a cough.



Edan.
 
E

edan

Guest
Hi. I was just wondering what your child's stats are? Are you confident this doctor really knows what he is doing? I would get a second opinion no matter what anyway. This disease is too serious to rely on the "word" of one doctor, IMO. My daughter has 2 disease causing mutations and I flew across the country to get a second opinion on her treatment protocol. I have heard some scary things on here that patients/parents have said their doctors said.

How old is she? Is she possibly just too young to have any real symptoms present anyway?
Pancreatic status?
Fecal Elastase level?
Sweat test?
Mutations?

My daughter is pancreatic sufficient. Fecal elastase >500. Sweat test of 58. Normal lung xray. Age 4 and cultures nothing (had cultured H.Flu 2x in the last year though). But, she does have two disease causing mutations, the second of which is "milder". That said, we still do 2 treatments per day because we know it will progress, 4 if she has a cough.



Edan.
 
E

edan

Guest
Hi. I was just wondering what your child's stats are? Are you confident this doctor really knows what he is doing? I would get a second opinion no matter what anyway. This disease is too serious to rely on the "word" of one doctor, IMO. My daughter has 2 disease causing mutations and I flew across the country to get a second opinion on her treatment protocol. I have heard some scary things on here that patients/parents have said their doctors said.
<br />
<br />How old is she? Is she possibly just too young to have any real symptoms present anyway?
<br />Pancreatic status?
<br />Fecal Elastase level?
<br />Sweat test?
<br />Mutations?
<br />
<br />My daughter is pancreatic sufficient. Fecal elastase >500. Sweat test of 58. Normal lung xray. Age 4 and cultures nothing (had cultured H.Flu 2x in the last year though). But, she does have two disease causing mutations, the second of which is "milder". That said, we still do 2 treatments per day because we know it will progress, 4 if she has a cough.
<br />
<br />
<br />
<br />Edan.
 

Lilliansmom

New member
DD is 7. She has had stuff going on since birth. She spent most of the first two years on TPN since she was unable to absorb anything through her gut. She gets pnuemonia a few tims a year. She cultured staph when she was bronched. She has had recurrent ear infections - on her 6th set of tubes, recurrent sinus infections, and has had sinus and ear polyps.

She is pancreatic insufficient. She takes creon12 - 5 with meals, 4 with snacks. She weighs 42 pounds.

I can't remember her fecal elastase level. I think I remember them saying she was putting out 29% fat. Would that make sense?

She has had 3 negative sweat tests - 56, 59, and 39.

She has the S1235R mutation.

Her most recent chest x-ray shows mild scarring in her right lung.

DS is 5. He was a preemie, but has also had symptoms since birth. He gets pnuemonia 4 or 5 times a year, dx through chest x-ray. He had a collapssed lung in January. He has cronic sinus infections, and a cough 90% of the time.

He is also pancreatic insufficient. He is on creon 6 - 3 with meals, 2 with snacks. He weighs 35 pounds.

I don't remember his fecal elastase results either, but I want to say they were normal, or close to normal.

He has ahd 2 negative sweat tests - 36 and 59.

His mutation is also S1235R.

His most recent chest x-ray shows moderate scarring in both lungs.

Our clinic is saying since they have both had numerous negative sweat tests and only show one mutation from the ambry test that is was atypical cf (now CRMS)so they are not doing chest PT. They are on contact precautions, both take Creon, AquaADEKS, and singulair. She takes previcid to help the enzymes. He also takes flovent. And both of them use simply saline. Both kids get nebs pretty much all winter since they are so junky.
 

Lilliansmom

New member
DD is 7. She has had stuff going on since birth. She spent most of the first two years on TPN since she was unable to absorb anything through her gut. She gets pnuemonia a few tims a year. She cultured staph when she was bronched. She has had recurrent ear infections - on her 6th set of tubes, recurrent sinus infections, and has had sinus and ear polyps.

She is pancreatic insufficient. She takes creon12 - 5 with meals, 4 with snacks. She weighs 42 pounds.

I can't remember her fecal elastase level. I think I remember them saying she was putting out 29% fat. Would that make sense?

She has had 3 negative sweat tests - 56, 59, and 39.

She has the S1235R mutation.

Her most recent chest x-ray shows mild scarring in her right lung.

DS is 5. He was a preemie, but has also had symptoms since birth. He gets pnuemonia 4 or 5 times a year, dx through chest x-ray. He had a collapssed lung in January. He has cronic sinus infections, and a cough 90% of the time.

He is also pancreatic insufficient. He is on creon 6 - 3 with meals, 2 with snacks. He weighs 35 pounds.

I don't remember his fecal elastase results either, but I want to say they were normal, or close to normal.

He has ahd 2 negative sweat tests - 36 and 59.

His mutation is also S1235R.

His most recent chest x-ray shows moderate scarring in both lungs.

Our clinic is saying since they have both had numerous negative sweat tests and only show one mutation from the ambry test that is was atypical cf (now CRMS)so they are not doing chest PT. They are on contact precautions, both take Creon, AquaADEKS, and singulair. She takes previcid to help the enzymes. He also takes flovent. And both of them use simply saline. Both kids get nebs pretty much all winter since they are so junky.
 

Lilliansmom

New member
DD is 7. She has had stuff going on since birth. She spent most of the first two years on TPN since she was unable to absorb anything through her gut. She gets pnuemonia a few tims a year. She cultured staph when she was bronched. She has had recurrent ear infections - on her 6th set of tubes, recurrent sinus infections, and has had sinus and ear polyps.
<br />
<br />She is pancreatic insufficient. She takes creon12 - 5 with meals, 4 with snacks. She weighs 42 pounds.
<br />
<br />I can't remember her fecal elastase level. I think I remember them saying she was putting out 29% fat. Would that make sense?
<br />
<br />She has had 3 negative sweat tests - 56, 59, and 39.
<br />
<br />She has the S1235R mutation.
<br />
<br />Her most recent chest x-ray shows mild scarring in her right lung.
<br />
<br />DS is 5. He was a preemie, but has also had symptoms since birth. He gets pnuemonia 4 or 5 times a year, dx through chest x-ray. He had a collapssed lung in January. He has cronic sinus infections, and a cough 90% of the time.
<br />
<br />He is also pancreatic insufficient. He is on creon 6 - 3 with meals, 2 with snacks. He weighs 35 pounds.
<br />
<br />I don't remember his fecal elastase results either, but I want to say they were normal, or close to normal.
<br />
<br />He has ahd 2 negative sweat tests - 36 and 59.
<br />
<br />His mutation is also S1235R.
<br />
<br />His most recent chest x-ray shows moderate scarring in both lungs.
<br />
<br />Our clinic is saying since they have both had numerous negative sweat tests and only show one mutation from the ambry test that is was atypical cf (now CRMS)so they are not doing chest PT. They are on contact precautions, both take Creon, AquaADEKS, and singulair. She takes previcid to help the enzymes. He also takes flovent. And both of them use simply saline. Both kids get nebs pretty much all winter since they are so junky.
 
M

Mommafirst

Guest
*shaking my head* I know you know what I think....this is crazy!! Your sweet kids are more symptomatic than most kids their age with full CF diagnoses. Your daughter already has permanent lung damage and scarring, but they feel she isn't worth doing PT on?? OH MY GOSH!! All the things we know about CF that extends lives comes down to preventative care... and that means chest PT before symptoms even start, and increased once lung involvement is there.

I don't want to hound you. I've responded to you before. Those sweat numbers are borderline, not negative. Those syptoms are typical CF and the ONLY thing keeping your kids from having a full CF diagnosis and all the care that goes with it is that they only have one known CF mutation. If it walks like a duck......

I think your doctors are outdated and/or misinformed and I worry about your kids' health.
 
M

Mommafirst

Guest
*shaking my head* I know you know what I think....this is crazy!! Your sweet kids are more symptomatic than most kids their age with full CF diagnoses. Your daughter already has permanent lung damage and scarring, but they feel she isn't worth doing PT on?? OH MY GOSH!! All the things we know about CF that extends lives comes down to preventative care... and that means chest PT before symptoms even start, and increased once lung involvement is there.

I don't want to hound you. I've responded to you before. Those sweat numbers are borderline, not negative. Those syptoms are typical CF and the ONLY thing keeping your kids from having a full CF diagnosis and all the care that goes with it is that they only have one known CF mutation. If it walks like a duck......

I think your doctors are outdated and/or misinformed and I worry about your kids' health.
 
M

Mommafirst

Guest
*shaking my head* I know you know what I think....this is crazy!! Your sweet kids are more symptomatic than most kids their age with full CF diagnoses. Your daughter already has permanent lung damage and scarring, but they feel she isn't worth doing PT on?? OH MY GOSH!! All the things we know about CF that extends lives comes down to preventative care... and that means chest PT before symptoms even start, and increased once lung involvement is there.
<br />
<br />I don't want to hound you. I've responded to you before. Those sweat numbers are borderline, not negative. Those syptoms are typical CF and the ONLY thing keeping your kids from having a full CF diagnosis and all the care that goes with it is that they only have one known CF mutation. If it walks like a duck......
<br />
<br />I think your doctors are outdated and/or misinformed and I worry about your kids' health.
 
E

edan

Guest
Oh my gosh. I am so sorry that you have what appears to be an incompetent doctor. What CF Clinic do they attend? You need to get a copy of their files (you should do this anyway) and RUN to another CF Center. If this were my child, I would get a second opinion from another accredited clinic and then if they confirmed what I thought (CF) then I would report that doctor because he sounds like he should not be in the position he is in.

My daughter has never had pneumonia or bronchitis. She has no scarring. She takes no enzymes. She was hospitalized once, but it turned out to be a virus and they were extra careful. She doesn't have asthma. No baseline cough. Vitamin levels were in the normal range on her first blood draw (a week after we found out at age 3). No allergies. No asthma. Yet, she DOES have CF and it will progress eventually. We do at least 1 dose of a bronchodialator per day plus 1 pulmozyme. We were doing HTS, but now she seems to have tonsils and adenoid problems, and the HTS seems to exacerbate that so she is off it for now. We do vest 2x/day.

Again, her sweat test was a 58 and that is not negative, it is borderline and right in line with those who also have the 3849+10kbc->t mutation. They are finding new mutations all of the time...1500 and counting. It is possible they just haven't found your childrens' second mutation yet.

Will insurance still approve things like pulmozyme ($2000/month) The VEST ($14,000) and other super expensive necessary items if your children don't have the CF diagnosis?

I am so sorry you are having to go through with this right now....
 
E

edan

Guest
Oh my gosh. I am so sorry that you have what appears to be an incompetent doctor. What CF Clinic do they attend? You need to get a copy of their files (you should do this anyway) and RUN to another CF Center. If this were my child, I would get a second opinion from another accredited clinic and then if they confirmed what I thought (CF) then I would report that doctor because he sounds like he should not be in the position he is in.

My daughter has never had pneumonia or bronchitis. She has no scarring. She takes no enzymes. She was hospitalized once, but it turned out to be a virus and they were extra careful. She doesn't have asthma. No baseline cough. Vitamin levels were in the normal range on her first blood draw (a week after we found out at age 3). No allergies. No asthma. Yet, she DOES have CF and it will progress eventually. We do at least 1 dose of a bronchodialator per day plus 1 pulmozyme. We were doing HTS, but now she seems to have tonsils and adenoid problems, and the HTS seems to exacerbate that so she is off it for now. We do vest 2x/day.

Again, her sweat test was a 58 and that is not negative, it is borderline and right in line with those who also have the 3849+10kbc->t mutation. They are finding new mutations all of the time...1500 and counting. It is possible they just haven't found your childrens' second mutation yet.

Will insurance still approve things like pulmozyme ($2000/month) The VEST ($14,000) and other super expensive necessary items if your children don't have the CF diagnosis?

I am so sorry you are having to go through with this right now....
 
E

edan

Guest
Oh my gosh. I am so sorry that you have what appears to be an incompetent doctor. What CF Clinic do they attend? You need to get a copy of their files (you should do this anyway) and RUN to another CF Center. If this were my child, I would get a second opinion from another accredited clinic and then if they confirmed what I thought (CF) then I would report that doctor because he sounds like he should not be in the position he is in.
<br />
<br />My daughter has never had pneumonia or bronchitis. She has no scarring. She takes no enzymes. She was hospitalized once, but it turned out to be a virus and they were extra careful. She doesn't have asthma. No baseline cough. Vitamin levels were in the normal range on her first blood draw (a week after we found out at age 3). No allergies. No asthma. Yet, she DOES have CF and it will progress eventually. We do at least 1 dose of a bronchodialator per day plus 1 pulmozyme. We were doing HTS, but now she seems to have tonsils and adenoid problems, and the HTS seems to exacerbate that so she is off it for now. We do vest 2x/day.
<br />
<br />Again, her sweat test was a 58 and that is not negative, it is borderline and right in line with those who also have the 3849+10kbc->t mutation. They are finding new mutations all of the time...1500 and counting. It is possible they just haven't found your childrens' second mutation yet.
<br />
<br />Will insurance still approve things like pulmozyme ($2000/month) The VEST ($14,000) and other super expensive necessary items if your children don't have the CF diagnosis?
<br />
<br />I am so sorry you are having to go through with this right now....
<br />
<br />
 

Lilliansmom

New member
Thanks guys. I am very frustrated. See, the problem is, I have no idea where to take them for a second opinion. We live in Boston, and where we go is where everyone goes. Our doctor today said that he had discussed their cases with a group, so I am assumming that even if we saw another doctor at this clinic, we would get the same answer.

I honestly do not know what to do. They are seeing their GI doctor at the same hospital next month. He has seen them from the time they were babies, even going to another hospital's NICU to see DS when he was born. He was the first one to bring up CF when DD was little. He ordered the Ambry after her sweat test came back borderline. I love him and trust him, and plan on talking to him about what he thinks is the best thing to do. Maybe he can give us a name for another opinion.
 

Lilliansmom

New member
Thanks guys. I am very frustrated. See, the problem is, I have no idea where to take them for a second opinion. We live in Boston, and where we go is where everyone goes. Our doctor today said that he had discussed their cases with a group, so I am assumming that even if we saw another doctor at this clinic, we would get the same answer.

I honestly do not know what to do. They are seeing their GI doctor at the same hospital next month. He has seen them from the time they were babies, even going to another hospital's NICU to see DS when he was born. He was the first one to bring up CF when DD was little. He ordered the Ambry after her sweat test came back borderline. I love him and trust him, and plan on talking to him about what he thinks is the best thing to do. Maybe he can give us a name for another opinion.
 

Lilliansmom

New member
Thanks guys. I am very frustrated. See, the problem is, I have no idea where to take them for a second opinion. We live in Boston, and where we go is where everyone goes. Our doctor today said that he had discussed their cases with a group, so I am assumming that even if we saw another doctor at this clinic, we would get the same answer.
<br />
<br />I honestly do not know what to do. They are seeing their GI doctor at the same hospital next month. He has seen them from the time they were babies, even going to another hospital's NICU to see DS when he was born. He was the first one to bring up CF when DD was little. He ordered the Ambry after her sweat test came back borderline. I love him and trust him, and plan on talking to him about what he thinks is the best thing to do. Maybe he can give us a name for another opinion.
 

LouLou

New member
It's not about diagnosis it's about keeping our kids healthy. Has your children been with this care center through this previous winter with infections that turned to pneumonia? My son has S1235R and G551D. He sees Dr. Marie Egan at Yale. I think it is worth your while to come down to see her for a consult. You should be treating your children more aggresively. What 's the harm? I really wonder with your dr's motivation is? Why would you not want to arm a parent with how to do CPT? Is he looking to minimize the nubmer of CF patients he follows? My husband and I wonder if statistically speaking it would look better for the center to give a CRMS diagnosis than an CF diagnosis. Do yu know if CRMS cases are entered into the registry? I really wonder if late diagnoses are going to become like the ***** child of the cf world where no one wants them (like ceapcia cfers seeking transplant) since the statistical outcomes are so much poorer. It sounds like your kids cases are quite advanced. I'm sorry. Please do smething for them. Call Dr. Egan tommorrow. Or something.
 

LouLou

New member
It's not about diagnosis it's about keeping our kids healthy. Has your children been with this care center through this previous winter with infections that turned to pneumonia? My son has S1235R and G551D. He sees Dr. Marie Egan at Yale. I think it is worth your while to come down to see her for a consult. You should be treating your children more aggresively. What 's the harm? I really wonder with your dr's motivation is? Why would you not want to arm a parent with how to do CPT? Is he looking to minimize the nubmer of CF patients he follows? My husband and I wonder if statistically speaking it would look better for the center to give a CRMS diagnosis than an CF diagnosis. Do yu know if CRMS cases are entered into the registry? I really wonder if late diagnoses are going to become like the ***** child of the cf world where no one wants them (like ceapcia cfers seeking transplant) since the statistical outcomes are so much poorer. It sounds like your kids cases are quite advanced. I'm sorry. Please do smething for them. Call Dr. Egan tommorrow. Or something.
 
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