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Wife not responding to IV's like normal, First Bronchoscopy

tumbleon

New member
Hello, My wife is 31 with CF D508 I believe. We have a beautiful 5 year old daughter. We have been together for almost 10 years and married for almost 7.
My wife was diagnosed with CF when she was 18 months I believe. She has always taken very good care of herself and mostly just has lung issues so far. She has exaserbations on average once every year to year and a half and has to go on IV's. She has the typical culprits with Psudomoneous and MRSA. Since I first met her in 2002 she has only been in the hospital once which was back in 2002. Her baseline from 2002 till now has decreased a little from about high 60's to more recently 55-60 give or take.
From 2002 up to about a two months ago whenever my wife has had and exaserbation and gone on IV's to get a clean out and feel better and get PFT's up she has always responded to the IV drugs she was put on and they are usually the same ones each time with a little variation. She usually stays on the IV's for 2-3 weeks. Typically for her when she gets sick and feeling worse her pft's go down to the mid to high 30's and after her IV's she get back up to her baseline in about 2-3 weeks.
2 months ago my wife went into clinic as she was not feeling well and knew it was time for IV's and had been about a year since the previous round. Her pft's were about mid 30's and they recommended for the first time in about 7 year to go into the hospital for treatment. None of us were very excited about the hospital and was a little scary because she had avoided it for so long. She did not want to be away from home and our daughter and normal life. Anyway, she ended up being in for two weeks and really focusing on herself and breathing treatments and IV's. This time her pft's went up and down and did not really increase very fast or much during the hospital visit. She got up to about the low 40's over two weeks and went up to 47 after the end of the 3rd week at home on IV's and after she was off IV's for about a week was able to only reach 50. While she was in the hospital and not responding like she normally had they considered doing a Bronchoscopy to see if anything else was in her lungs that we could treat but since she got up to 50 finally, they decided it was not necessary at that time. My wife was not happy with that number as it was below her baseline and she had spent 2 weeks in the hospital focusing only on her and her treatments. She felt pretty good after but was scared she was getting worse overall.
A month later, which was about two weeks ago, she could feel that her lungs were filling up again and she was not feeling as good. She went into clinick a week ago tuesday and she was back down to the mid 30's again. She had her first bronchoscopy done to see if there is something else in her lungs that was treatable and causing such a decline so fast. They put her back in the hospital on IV's again for 3 days and is back home still on IV's with about the same results and response to the IV's she was on 2 months ago. We are just waiting for cultures to grow and can take up to 14 days for some and 6 weeks for one other.
So to say the least this is not a normal response for her and she is scared she is going to die and is just declining at this point. Everyone else has more optomisom and the clinical trial for her mutation should be available to start at the end of April. We know that she might get the placebo and she first has to qualify by maintaining a 40 pft for at least 30 days off of IV's and oral antibiotics and we are not sure if she is going to be able to do that. We are hopeful they will find something in the cultures that are treatable to get her back up to around her baseline again and we know that just a month ago she got back up to 50 which gives us hope as we know the capacity is there, but she is worried she will not be able to maintain and is just declining.
Has anyone had a similar situation and be willing to share their story? Also, any insight experience would be much appreciated.
Thank You
Worried Husband
 

tumbleon

New member
Hello, My wife is 31 with CF D508 I believe. We have a beautiful 5 year old daughter. We have been together for almost 10 years and married for almost 7.
My wife was diagnosed with CF when she was 18 months I believe. She has always taken very good care of herself and mostly just has lung issues so far. She has exaserbations on average once every year to year and a half and has to go on IV's. She has the typical culprits with Psudomoneous and MRSA. Since I first met her in 2002 she has only been in the hospital once which was back in 2002. Her baseline from 2002 till now has decreased a little from about high 60's to more recently 55-60 give or take.
From 2002 up to about a two months ago whenever my wife has had and exaserbation and gone on IV's to get a clean out and feel better and get PFT's up she has always responded to the IV drugs she was put on and they are usually the same ones each time with a little variation. She usually stays on the IV's for 2-3 weeks. Typically for her when she gets sick and feeling worse her pft's go down to the mid to high 30's and after her IV's she get back up to her baseline in about 2-3 weeks.
2 months ago my wife went into clinic as she was not feeling well and knew it was time for IV's and had been about a year since the previous round. Her pft's were about mid 30's and they recommended for the first time in about 7 year to go into the hospital for treatment. None of us were very excited about the hospital and was a little scary because she had avoided it for so long. She did not want to be away from home and our daughter and normal life. Anyway, she ended up being in for two weeks and really focusing on herself and breathing treatments and IV's. This time her pft's went up and down and did not really increase very fast or much during the hospital visit. She got up to about the low 40's over two weeks and went up to 47 after the end of the 3rd week at home on IV's and after she was off IV's for about a week was able to only reach 50. While she was in the hospital and not responding like she normally had they considered doing a Bronchoscopy to see if anything else was in her lungs that we could treat but since she got up to 50 finally, they decided it was not necessary at that time. My wife was not happy with that number as it was below her baseline and she had spent 2 weeks in the hospital focusing only on her and her treatments. She felt pretty good after but was scared she was getting worse overall.
A month later, which was about two weeks ago, she could feel that her lungs were filling up again and she was not feeling as good. She went into clinick a week ago tuesday and she was back down to the mid 30's again. She had her first bronchoscopy done to see if there is something else in her lungs that was treatable and causing such a decline so fast. They put her back in the hospital on IV's again for 3 days and is back home still on IV's with about the same results and response to the IV's she was on 2 months ago. We are just waiting for cultures to grow and can take up to 14 days for some and 6 weeks for one other.
So to say the least this is not a normal response for her and she is scared she is going to die and is just declining at this point. Everyone else has more optomisom and the clinical trial for her mutation should be available to start at the end of April. We know that she might get the placebo and she first has to qualify by maintaining a 40 pft for at least 30 days off of IV's and oral antibiotics and we are not sure if she is going to be able to do that. We are hopeful they will find something in the cultures that are treatable to get her back up to around her baseline again and we know that just a month ago she got back up to 50 which gives us hope as we know the capacity is there, but she is worried she will not be able to maintain and is just declining.
Has anyone had a similar situation and be willing to share their story? Also, any insight experience would be much appreciated.
Thank You
Worried Husband
 
I'm kind of in a similar situation to your wife right now in terms of where my PFTs are, except I haven't cultured MRSA yet. I understand how frustrating it can be to experience such a substantial decline in PFTs, as I myself have gone from around 90% in my late teens into the 30-40% range now at 25 yoa. In my case, the decline happened gradually. I was very involved in tennis and basketball throughout high school, and over the years it's become harder and harder to sustain the same levels of physical activity. For me, the inflammatory component of CF has been particularly hard to manage as I cannot tolerate Prednisone very well due to my CF related diabetes. However, I have adjusted to my "new baseline" and try not think too much about where my PFTs are frankly. I do what I can physically to stay in shape, which lately has been more anaerobic than aerobic exercise, and am just looking to continue my research into ways that I can lower CF lung inflammation, which still isn't that well understood unfortunately.
Sinus rinses have helped me since I started doing them twice daily. Also, I feel that N-Acetyl Cysteine is currently keeping inflammation down and helping to keep my cough productive rather than dry, which it tends to get this time of year. I find that the water soluble "fizzy" tablets from this company have been most effective for me: http://www.pharma-nac.com/

*However,* I would be very careful about starting any new supplements because they may actually bring on more inflammation. Preferably wait until you have finished IV antibiotics, start with low dosages, and monitor your airways with a peak flow meter if possible to make sure the supplement is actually having a desirable effect and not actually causing more inflammation.
I really hope that your wife maintains and/or improves upon her PFTs--I wish I could be in the 50s right now, so I am quite envious <img src="i/expressions/face-icon-small-smile.gif" border="0">. However, the progression of CF is different in all CF patients and I do not think that PFTs are the end all, so do not get too depressed if the numbers are not where you want them to be. I have heard many instances of the numbers fluctuating and patients being told they should consider lung transplantation who would later regain what doctors' thought was permanently lost lung function.
Even though we now have this drug--Kalydeco--that partially corrects the chloride channel defect in patients with the G551D mutation, the bottom line is that CF is still poorly understood, and while PFTs are an important parameter in monitoring the progression of this illness, they are not a perfect measure of where you are. I would say let the numbers be a guide, but do not let them define your state of mind <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
I'm kind of in a similar situation to your wife right now in terms of where my PFTs are, except I haven't cultured MRSA yet. I understand how frustrating it can be to experience such a substantial decline in PFTs, as I myself have gone from around 90% in my late teens into the 30-40% range now at 25 yoa. In my case, the decline happened gradually. I was very involved in tennis and basketball throughout high school, and over the years it's become harder and harder to sustain the same levels of physical activity. For me, the inflammatory component of CF has been particularly hard to manage as I cannot tolerate Prednisone very well due to my CF related diabetes. However, I have adjusted to my "new baseline" and try not think too much about where my PFTs are frankly. I do what I can physically to stay in shape, which lately has been more anaerobic than aerobic exercise, and am just looking to continue my research into ways that I can lower CF lung inflammation, which still isn't that well understood unfortunately.
Sinus rinses have helped me since I started doing them twice daily. Also, I feel that N-Acetyl Cysteine is currently keeping inflammation down and helping to keep my cough productive rather than dry, which it tends to get this time of year. I find that the water soluble "fizzy" tablets from this company have been most effective for me: http://www.pharma-nac.com/

*However,* I would be very careful about starting any new supplements because they may actually bring on more inflammation. Preferably wait until you have finished IV antibiotics, start with low dosages, and monitor your airways with a peak flow meter if possible to make sure the supplement is actually having a desirable effect and not actually causing more inflammation.
I really hope that your wife maintains and/or improves upon her PFTs--I wish I could be in the 50s right now, so I am quite envious <img src="i/expressions/face-icon-small-smile.gif" border="0">. However, the progression of CF is different in all CF patients and I do not think that PFTs are the end all, so do not get too depressed if the numbers are not where you want them to be. I have heard many instances of the numbers fluctuating and patients being told they should consider lung transplantation who would later regain what doctors' thought was permanently lost lung function.
Even though we now have this drug--Kalydeco--that partially corrects the chloride channel defect in patients with the G551D mutation, the bottom line is that CF is still poorly understood, and while PFTs are an important parameter in monitoring the progression of this illness, they are not a perfect measure of where you are. I would say let the numbers be a guide, but do not let them define your state of mind <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
Another thing I wanted to add... You should talk to your doctor again about the actual PFT values your wife needs to have in order to qualify for the clinical trial. I studied healthcare law and economics in college and it seems these standards are created not primarily with a concern for patient safety, but to minimize the researchers' and doctors' legal liability, as they obviously don't want to face a lawsuit if something goes awry. It might be helpful if your doctor is willing to negotiate on this point. I mean if your wife's PFTs are stable at 35-40% for a month, then why would she not qualify? I myself will raise this question next week when I see my doctor. It really does not make sense when you think about it; someone with stable PFTs at 39% cannot qualify but someone with 41% qualifies...the difference between 39 and 41% is only a few milliliters of air really and the PFT devices themselves have a small margin of error...
 
Another thing I wanted to add... You should talk to your doctor again about the actual PFT values your wife needs to have in order to qualify for the clinical trial. I studied healthcare law and economics in college and it seems these standards are created not primarily with a concern for patient safety, but to minimize the researchers' and doctors' legal liability, as they obviously don't want to face a lawsuit if something goes awry. It might be helpful if your doctor is willing to negotiate on this point. I mean if your wife's PFTs are stable at 35-40% for a month, then why would she not qualify? I myself will raise this question next week when I see my doctor. It really does not make sense when you think about it; someone with stable PFTs at 39% cannot qualify but someone with 41% qualifies...the difference between 39 and 41% is only a few milliliters of air really and the PFT devices themselves have a small margin of error...
 
Incomudrox, I am really looking forward to hearing more info about Nrf2 and CFTR function. I had previously come across this article, http://dev.ersnet.org/uploads/Document/38/WEB_CHEMIN_5818_1264776571.pdf

which seemed like a pretty exhaustive list, so I am really curious to see your research.
 
Incomudrox, I am really looking forward to hearing more info about Nrf2 and CFTR function. I had previously come across this article, http://dev.ersnet.org/uploads/Document/38/WEB_CHEMIN_5818_1264776571.pdf

which seemed like a pretty exhaustive list, so I am really curious to see your research.
 

beleache

New member
Hi Worried ,
I understand how frustrating & frightened you both are. The drs. are doing the right thing by looking for the culprit & then treating it w/ the proper abx. To me, this is so important ! It sucks to be put on one abx only to find out after a few weeks it was not the best choice of meds.
I think its wise when you have a little one to go into hosp for treatment. I know its hard but I do feel you get better care/rest. I was curious what your wife's meds are ? Does she do any inhaled abx ? or oral abx on a regular basis ?
I know its hard to exercise when not feeling well, but perhaps after treatment your wife can go to Pulmonary Rehab ? I am in a program now hoping to improve my lung function. I love it & exercise is a good way to improve your #'s , her dr. would have to write a script for this.
I hope you guys get the answers you need & that she feels better very soon ! Take care & keep us posted. <img src="i/expressions/face-icon-small-smile.gif" border="0"> joni
 

beleache

New member
Hi Worried ,
I understand how frustrating & frightened you both are. The drs. are doing the right thing by looking for the culprit & then treating it w/ the proper abx. To me, this is so important ! It sucks to be put on one abx only to find out after a few weeks it was not the best choice of meds.
I think its wise when you have a little one to go into hosp for treatment. I know its hard but I do feel you get better care/rest. I was curious what your wife's meds are ? Does she do any inhaled abx ? or oral abx on a regular basis ?
I know its hard to exercise when not feeling well, but perhaps after treatment your wife can go to Pulmonary Rehab ? I am in a program now hoping to improve my lung function. I love it & exercise is a good way to improve your #'s , her dr. would have to write a script for this.
I hope you guys get the answers you need & that she feels better very soon ! Take care & keep us posted. <img src="i/expressions/face-icon-small-smile.gif" border="0"> joni
 

Incomudrox

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>StefanDOMINATECF</b></i> Incomudrox, I am really looking forward to hearing more info about Nrf2 and CFTR function. I had previously come across this article, http://dev.ersnet.org/uploads/Document/38/WEB_CHEMIN_5818_1264776571.pdf which seemed like a pretty exhaustive list, so I am really curious to see your research.</end quote>

I sent you a PM.
 

Incomudrox

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>StefanDOMINATECF</b></i> Incomudrox, I am really looking forward to hearing more info about Nrf2 and CFTR function. I had previously come across this article, http://dev.ersnet.org/uploads/Document/38/WEB_CHEMIN_5818_1264776571.pdf which seemed like a pretty exhaustive list, so I am really curious to see your research.</end quote>

I sent you a PM.
 
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