waiting... Might be CF... confused and lost

SweetP3esmama

New member
I'm new to this site so here's a little background. My son, now 13 months, was born in Jan 2012 by emergency c-Section due to Placental Abruption. He lost a good deal of his blood and ingested and inhaled blood . He was resuscitated at birth and again later that same day . He was transferred to Childrens National in DC where he was placed on a hypothermic bed for 3 days to help reduce his brain swelling and a ventilator for several days then O2 in addition to every other tube in every part of his body. Upon being released from the NICU 2 weeks later he was still very rattly, slightly mucousy and congested but we were told this was due to him healing from the vent.

we were told he may not walk or talk, and most likely would have major hand / eye coordination problems. So far, he's walking like a champ, running even. Babbles nonstop and has no problems with coordination for a 1 year old...Hurdle #1 passed. This is where the new scare began. My husband discharged from the military in March and we returned home with no healthcare and no pediatrician. One of my sons delivering doctors tracked my number down and was frantically calling me to inform me that his second set of newborn screenings showed elevated IRT scores. After a brief freakout, we got health insurance and a pediatrician who referred us for the sweat test. We waited and waited and finally had it done and the results came back negative. WHEW! Hurdle #2 passed... Little man continues to be sick though, non stop respiratory illness. He gets diagnosed as having reflux... zantac helps a little but he's still very rattly in the chest, always sounds like he needs to cough but just... won't. Finally gets diagnosed as asthmatic after having bronchitis and croupe and "allergy" like attacks.

So now, up to the current time. My son sees a pulmonologist who is also a CF specialist. She asked if he had been tested for CF because in addition to his respiratory issues, he also had digestive problems. She saw he'd had the sweat test and said ok.. it's negative and he's just asthmatic. After spending the past 2 months on Pulmicort, Advair, DuoNeb, and Prednisolone, they decided that sometimes momma's incessant asking deserves some attention and they ordered the DNA Ambry on him. After some thought, and further looking around I thought that maybe he has BPD because of his traumatic neonatal experience. I spoke with his pulmonologist who agreed but said we needed to wait on his test results before ruling out a diagnosis. BUT, she was leaning away from CF.

I got the call yesterday that his DNA results were back in and that they indeed came back with 2 mutations. But they are still unsure as to how to diagnose him. They say one of the genes is a CF gene and the other is unknown (P.R31L and P.3967S) we have a ton of appointments set for the rest of the month... Barium swallow to check his anatomy cause he's constantly choking, another sweat test, not really sure what they are looking for in that? A bronchoscopy, genetics counseling, regular pulmonology check up... regular peds appt because little bum is sore from constantly pooping...


I don't really know what I'm supposed to be expecting... I didn't get a yes... I didn't get a no. So here we are again... waiting on an answer and what we're supposed to from here. I'm wondering though if anyone else has an experience like this.

thank you for your time and patience
 

Ratatosk

Administrator
Staff member
DS was diagnosed at birth due to a bowel obstruction. Mostly has digestive issues. With his digestive, pooping issues, I would ask them to do a fecal elastase test to see if he's malabsorbing fat. Could be he's pancreatic insufficient and needs enzymes to digest. Also they should do a cf throat or sputum culture to see if he's growing any cf bugs, although they'll most likely do that with whatever they collect during the bronchoscopy.

Bring a notebook along with questions to ask the doctors during appointments. Also with his respiratory issues, ask them about chest physiotherapy and/or the vest to keep his lungs clear.
 

SweetP3esmama

New member
She did say they would be doing cultures and I know she tested his mucous from his throat at our last appointment and it was clean. I can only be happy about that... Maybe this is silly but the ever obsession with poop watching gets to me every day because while his movements are NOT formed and sometimes not even digested... generally a lovely shade of orange or neon green... if it was CF related, pancreatic insufficient... would I be seeing mucous there?
 

Printer

Active member
Sweet:

Is your son being seen at an APPROVED CF CENTER by a CF Specialist and a CF Team? There is a sweat test that is done locally and it is not the same as in a CF Center. The other thing that bothers me here is they found 2 MUTATIONS but say one is "UNKNOWN. The test was for CF MUTATIONS so it is either a known mutation or it is not a known mutation. CF testing DOES NOT test for "unknown" mutations.

You need to be seen at an APPROVED CF CENTER by a CF SPECIALIST. ASAP.

Bill
 

SweetP3esmama

New member
HI, we are being seen at an accredited center. And his first sweat test was done there also initially before he was even referred to be there as a patient with the pulmonologist (which is also the CF specialist/clinic) . I guess that is where my confusing is also. If he has two mutated genes... how is it unknown as to whether the second is or isn't a CF gene? How did we have the Ambry panel done to get a definite answer... get the answer of he has 2 mutated genes... here are the genes. We know one is for certain one is a CF gene but the second is unknown... I was told he could have CF or he could just be a carrier with out of control asthma and digestive issues...

I've been fighting alot so far and will continue to do so to get proper answers and treatments for my kiddo. But now I don't know what to ask for...
 

2005CFmom

Super Moderator
What I am hearing is that your son has 2 mutations, but that it is unknown whether or not his second mutation is disease causing. But it is clear that your son does have symptoms that can be attributed to CF. If I was in your situation I would ask that my child be treated as if he has CF... do the standard CF medications and airway clearance for his age, along with the regular CF blood / sputum test. If the doctor doesn't give it a title of CF yet, it really doesn't matter. At least your son would be getting treatment that could help him (even if it is not CF) while you do further testing. If further testing doesn't reveal a different disease/disorder, I would think that they could then say that more likely than not, the second mutation is disease causing and then could officially diagnose him with CF. I agree with Ratatosk about getting a fecal elastase test. At least then you would know whether or not he is malabsorbing fat. This could tip the scale for or against a CF diagnosis.

edited to add
I think all CF centers are struggling what to do with patients that have 2 CF mutations, but it is unknown whether or not the mutations cause disease. They know that preventative treatment is best, but they also know that the treatment burden for CF is heavy. Is it better burden someone with the diagnosis who wouldn't ever exhibit symptoms, or do you just follow them closely and not treat until symptoms arise?

But in your case, 2 mutations and symptoms, I would think that getting on a CF treatment protocol would be warranted.
 

Ratatosk

Administrator
Staff member
She did say they would be doing cultures and I know she tested his mucous from his throat at our last appointment and it was clean. I can only be happy about that... Maybe this is silly but the ever obsession with poop watching gets to me every day because while his movements are NOT formed and sometimes not even digested... generally a lovely shade of orange or neon green... if it was CF related, pancreatic insufficient... would I be seeing mucous there?

I would ask for copies of the culture reports. I do that every time ds has one, as I've gotten calls that ds is clear, only to find out he is culturing something. I also found that the final report on the cf culture is usually only a day or two after the sample was taken -- usually takes awhile for things to grow, most cf clinics don't give out final reports until after a week. -- And yes this is at our local CF clinic, which is accreditted, which is WHY we travel elsewhere for cf care. Not all cf clinics are the same unfortunately, some are proactive, some are not. :(

DS' poo was never greasy. Usually orangish yellow, sometimes with flecks of green. Because he was mainly formula fed, it smelled kinda like feta cheese (sorry TMI). Was also soft and fluffy like cake frosting. Frequent, too. Until we got his enzyme issue straightened out he would stool several times a day, sometimes I'd change the diaper three times DURING a diaper change. Ugh!
 

SweetP3esmama

New member
Oh my goodness... My bug was breastfed until he was 8 months. I was purely pumping with him because of everything that happened during his birth and I just couldn't keep up with it! So he started on formula and I feel like the nasty poo part has just gotten nastier! I always hated the "is it greasy" cause he was breastfed! But... the kid poops more than my first two EVER did. I cloth diaper... and have given up the past month because I just can't keep up with it with all his nasties!
 

SweetP3esmama

New member
Thank you so much for sharing with me and for your answers. We're at such a confused state right now. I feel like I'm doing the right thing by pestering the docs, I don't feel that we are over paranoid. I just don't personally KNOW anyone else to share these experiences with.
 

Beccamom

New member
Have you googled CFTR 2 or tried John Hopkins genetics to ask about interpreting your child's genetics? My clinic would diagnose your child CRMS and I would ask for preventative treatments for mucus clearance and that your child be followed in the CF clinic.

Has your child had a fecal elastase test on the poop to determine pancreatic insufficiency?

Best wishes.

QUOTE=SweetP3esmama;926091]Thank you so much for sharing with me and for your answers. We're at such a confused state right now. I feel like I'm doing the right thing by pestering the docs, I don't feel that we are over paranoid. I just don't personally KNOW anyone else to share these experiences with.[/QUOTE]
 

Ratatosk

Administrator
Staff member
Oh my goodness... My bug was breastfed until he was 8 months. I was purely pumping with him because of everything that happened during his birth and I just couldn't keep up with it! So he started on formula and I feel like the nasty poo part has just gotten nastier! I always hated the "is it greasy" cause he was breastfed! But... the kid poops more than my first two EVER did. I cloth diaper... and have given up the past month because I just can't keep up with it with all his nasties!

its my understanding that breast milk is more easily digestible, so a lot of times stool issues get worse when one switches to formula
 

SweetP3esmama

New member
I did do the CFTR2 search and I found the first gene but I can't find anything on the second. We're scheduled for a Bronchoschopy for next week (just bawled my eyes out over that whole procedure) and pulm and genetics the following week and another sweat test on the 2nd. I'll ask about the fecal test because there is obviously something going on there too.

Have you googled CFTR 2 or tried John Hopkins genetics to ask about interpreting your child's genetics? My clinic would diagnose your child CRMS and I would ask for preventative treatments for mucus clearance and that your child be followed in the CF clinic.

Has your child had a fecal elastase test on the poop to determine pancreatic insufficiency?
 

Beccamom

New member
I know any anesthesia is scary as a mom, but know many of our kids including mine have had bronchoscope. My daughter did very well. She had upper GI bronchoscope and sinus surgery all together and came home that day. My daughter took versaid which is a liquid Tylenol and something else that makes them forget the whole thing. Since your child is young maybe you can ask for baby PFTs while he is sedated anyway.

I did do the CFTR2 search and I found the first gene but I can't find anything on the second. We're scheduled for a Bronchoschopy for next week (just bawled my eyes out over that whole procedure) and pulm and genetics the following week and another sweat test on the 2nd. I'll ask about the fecal test because there is obviously something going on there too.

Have you googled CFTR 2 or tried John Hopkins genetics to ask about interpreting your child's genetics? My clinic would diagnose your child CRMS and I would ask for preventative treatments for mucus clearance and that your child be followed in the CF clinic.

Has your child had a fecal elastase test on the poop to determine pancreatic insufficiency?
 
S

stephen

Guest
Please don't feel that you are "pestering" the doctors. You son does appear to have real issues. The doctors should be willing to talk with you, explaining their thoughts and findings, and to answer all your questions to your satisfaction.

They also should feel comfortable with you seeking other opinions, and even recommending where you might go.

Wishing you and your son the best.
 
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