So I decided a few months back to head to Stanford's CF Center for a consultation. As many of you who know me know, checking out other CF Centers is a fav pastime of mine. Well, not really, but I did go to Minnesota in 2006 and I visited Cincinnati this summer so this will make my 3rd excursion.
I originally didn't have much of an agenda when I made the apt to see Dr. Weill, Director of the Adult CF Center at Stanford. But I've been dealing with a decreased FEV1 the past few months which has lead to ABPA suspicion, so the consultation ended up being perfect timing.
I'll first list my initial top line impressions, then I'll go into specifics about my personal care and his subsequent recommendations.
- Infection control was not as stringent as my clinic. Scales aren't wiped down after each patient; chairs at the nurse's station and the actual examination room aren't wiped down; blood pressure cuffs aren't changed in between patients nor are they wiped down; CF patients aren't given masks/gloves when they check in; doc, nurses, PFT tech didn't gown up when around me; I'm a MDRPA patient so all of this was VERY surprising to me and very very different from my clinic.... i thought for sure what my clinic did was CFF protocol!!!! bleh
- The clinic is very tech savvy: they post patient education days on the web; I was encouraged by Dr. Weill to email him; the clinic was riddled with posters encouraging patients to check out their website or to research such and such thing on another website
- The clinic is very multi-disciplinarian - ENT works extremely closely with Pulm, as does Gastro and Allergy; this is NOT the case with my CF team by any stretch of the imagination and I think that this close link improves patient outcomes.... CF is NOT simply a "mucus in the lungs" disease by any means!!!
Background Before Visit
Just so you have some context behind my visit. I haven't had fevers, increase in sputum, increased fatigue or decreased exercise tolerance yet my FEV1 is down by about 10%. I did, however, have to discontinue cromolyn sodium for 5+ months because the manufacturer disc. Thankfully the past 2 weeks I was able to get the med back but the thought is that maybe discontinuing this med that has caused massive inflammation (from the severe environmental allergies I have or maybe the aspergillis that I've culture for 5+ years).
Doc back home did an IgE aspergillis specific (1.83 was the result - high). Home doc not convinced it's ABPA because I'm not wheezing, etc.
CT Scan has showed no fungus balls, but rather slight increase in mucus plugging and slight increase in broncheactasis since last CT scan 12 months ago. I have been switched from flovent MDI to Advair to see if the long acting bronchodilator helps with inflammation. I'll be re-doing PFT's on Monday, Dec 8.
Another issue I've been having the past 12 months is night sweats. Hormones have been checked; OGTT done; not eating high carbs right before bed; TB tested; the whole 9 years. ENT and doc hypothesize it might be sinus junk but I don't really look bad enough for surgery.
Stanford Visit Findings
A few fun things that I think will be useful moving forward:
- Regarding ABPA, Dr. Weill couldn't be sure because he didn't have the CT scan (will send to him when I get a hard copy) but he told me that he does an IgE test every clinic visit for his patients. If the # is >1000, patients get 1 week of steroids and voriconazole even if they aren't showing symptoms. Something I will be thinking about when further examining my ABPA possible issue
- Interesting rinkle in the year long night sweat saga: Dr. Weill feels that my decrease in lung function and night sweats could be due to nocternal aspiration of gastric juice due to bad GERD. He says he has done some barium test (ph probe, mannometry, and esophagram.) and many CFer's show no other GERD symptoms but they're aspirating and it's causing inflammation/harm to the lungs. So I'll be investigating that and increasing my PPI dose from once a day to twice a day (btw i have since increased my PPI dose from 1x to 2x a day and night sweats are gone since December 2008. YEY! i will soon be looking into doing the above mentioned tests anyway, though...)
So I have a bit to talk to my doc about when I see him on Monday. But I think these two tidbits of info were helpful for me and might be for anyone out there looking for answers to night sweats or interested in aggressively treating inflammation/fungal troubles.
Let me know if you have any questions/comments/advice/etc. This was a great trip and I just may put Denver or UNC next on my list of clinics to visit in the coming years.... it's always nice to see what everyone else is up to :)