Decided to update my blog after 6 months of neglect!
Since I last blogged I have been skiing, 4wdriving, finished uni placements and exams, visited Kangaroo Island, went to the Australian Open tennis & have been quite involved with the Kalydeco campaign in Australia. I was also interviewed by a TV program about the current delay regarding Kalydeco availability in Australia: 730 Report Story
Last September I also had my first IVs on Kalydeco. We decided that after 1 year of Kalydeco, given that I used to have IVs every 3-4 months, that it made sense to use IVs to get my lungs in the best shape possible. I had also dropped very slightly to 66% after visiting South America.
After two weeks I was at 69% and my cough had decreased significantly (less sputum, lighter green, thinner). I didn’t feel that different, but my varying energy levels are more related to CF diabetes.
In September I also started taking insulin (fast acting with meals high in carbohydrate), however I have had numerous issues with what may be an allergy to the insulin. It has been quite painful to inject, we are still working on this, and potentially may try tablets (although generally tablets are not the preferred CF treatment option). When I have injected insulin it has worked well; my energy levels improve significantly and I feel less tired after eating.
I have also had ongoing issues with reflux and possibly gastritis recently. Always fun waking up at 4am with a stabbing pain in your stomach!
So overall the lungs are going amazingy well, still stable after almost 1.5 years of Kalydeco. I find it hard to believe (as it is just so different to before) how little my lung function varies, mostly staying betwen 69-70. I have never been this stable, especially with no physiotherapy and minimal medications. However, I am having reasonable issues with the diabetes in particular, but it is not surprising given that I am 28. Hopefully this will improve soon.
Photos from my ski trip last September at Perisher:
Keith and I on the chairlift
Just like a rollercoaster, my health has had ups and downs over the last 28 years.
Kalydeco has helped my lungs significantly; my FEV1 has been stable at close to 70% for one year and I have only had IVs once in the last year, a 20 year record.
However I noticed that my energy levels have not matched my new lung function. My energy levels have improved, but not to the same extent that I have heard about with others on Kalydeco. Although I have been attending university much more often, and completing subjects unlike last year, I have struggled to keep up at times. In particular I have often felt tired in the afternoons and evenings.
I assumed this was normal CF tiredness. I think I’ve been tired since about 2008. This seems normal to me, I really cannot understand people who jump out of bed in the morning. And who aren’t tired. To me this seems very abnormal.
I came back from South America and my lungs were slightly below my new baseline of 70%. We decided it was time for my first IVs for two reasons 1) I had dropped slightly to 66% and 2) I still have pseudomonas in my lungs and have not had IVs yet, so it made sense to try IVs to get my lungs in the best possible shape.
I decided it would also be a smart idea to monitor my blood sugar levels. I have had impaired glucose tolerance since 2001, with OGTTs between 11 and 15. This means I have been pre-diabetic for about 12 years. For the last few years my self monitored blood sugar levels were 8-9 after meals on average and insulin was not needed. I am supposed to monitor these sporadically and generally have done this when on IVs.
After monitoring my blood sugar levels for a few weeks, I noticed they are higher now. I am about 10-12 on average after a reasonable size meal. Below about 8 is normal. I noticed that when I am high (above about 9), I feel tired. Sometimes I also had a headache. I realised that this potentially fits with what has been happening all year, I have often felt tired after lunch and dinner, and in April-May I had frequent headaches late evening.
I had another OGTT and this time it was 22. I felt terrible, first I was high, very tired, and basically could not function and use my laptop. Then 5 hours later I was down at 2.4 and felt terrible as I was really low. This is reactive hypoglycemia, with CF diabetes my insulin response is delayed, so I often get high and then low. I first felt reactive hypoglycemia in 2006.
So how does this relate to the rollercoaster? Well I feel that my lungs have been pretty much ‘fixed’ for now. I hoped that CF diabetes might be avoided (along with other CF complications) now that I’m on Kalydeco. Sadly this has not happened, and it appears that the CF diabetes has been having a pretty significant impact on my energy levels. I have just started taking insulin, I am hoping this will help.
Kalydeco & Cystic Fibrosis Diabetes:
My doctor mentioned that they had heard that blood sugar levels could vary more once on Kalydeco. I looked back through my named patient program information and found that it was suggested that close monitoring of blood sugar levels was needed, as high and low blood sugar levels can occur. I have heard anecdotally that some people have needed to increase their insulin dose after starting Kalydeco or that their blood sugar levels have increased. However, I have also read a recent article that suggests that Kalydeco may help increase the amount of insulin (and hence decrease the blood sugar levels). At this stage this is based on a very small study, it will be interesting to see the results of larger studies. In my case I was in the pre-diabetic category for many years, so it is not surprising that I am now diabetic. I hope those who start at a young age/before significant damage can avoid these types of complications.
– Recent research suggests almost half of those with CF will develop diabetes by age 30.
– Recent research also suggests that few people with CF have normal glucose metabolism. It is thought that all CF patients with pancreatic insufficiency have a degree of endocrine insufficiency (ie decreased insulin), however many CFs still have near normal glucose metabolism as their pancreas can compensate.
Decided it was time for a summary post about my new health on Kalydeco.
I have been on Kalydeco for 11 months through the Named Patient Program, a program where Vertex supply Kalydeco to those who are very unwell. Kalydeco is the first medication that treats the underlying cause of Cystic Fibrosis in patients with the G551D mutation.
Before Kalydeco my lung function was 41% and very unstable. I was in hospital every 3-4 months. I was on medications that treated the CF symptoms; these were becoming less effective as I grew older.
For the last 11 months my FEV1 has been stable at approx 70%. This is amazingly stable compared to before; for 20 years my lung function has varied up to 20% from month to
month, now I am stable for the first time in my life. This is my highest in 3 years.
I have stayed out of hospital for 11 months, which is a 20 year record (I am currently on IVs for mostly prophylactic reasons, I will post about this soon). Before Kalydeco I had over 60 hospital admissions, equalling 3 years of my life.
Every aspect of my health has improved with Kalydeco, I have gained 6kg, I can run up stairs, I can sleep without coughing and I’m attending uni more often. My sweat test results have improved from 102 to 40. This is much lower than the point (60) associated with the CF diagnosis.
Previously I did not plan further ahead than 5 years. At the age of 28, with a life expectancy of 37, I knew transplant was edging closer. Thanks to Kalydeco I now don’t have to plan around hospital and CF, instead I can plan to have a family, a career and to grow old with my lungs.
I hope that Kalydeco can become available to everyone around the world who may benefit as soon as possible. Kalydeco is not approved in Australia yet; we are trying to speed up the reimbursement process and would appreciate your support on facebook and twitter.
Images from Dec 2011 and May 2013. Inflammation and scarring appear white, this has improved significantly on my second xray.
I was just looking through my blog and this post feels like deja vu, very similar to my China post.
Everything was going amazingly well during the first two weeks of our trip. We then visited Santiago and it felt like there was more pollution there than China. I think my lungs are more sensitive to smoke and pollution now compared to 10 years ago, when we did not have the non smoking laws in pubs etc. In Santiago I also seemed to get a slight cold, this slight cold took off and became a lovely chest infection. Within a few days my cough was the worst it had been since Dec 2011 (pre Kalydeco, when I had kidney failure). It was very productive, I would huff and there were endless crackles and could cough non stop whilst bringing up sputum. It felt so thick, but maybe I have got used to the thin mucus with Kalydeco. The coughing was exhausting.
I started Cipro on the first day but only took it for one day as I needed to take Voltaren (and my doctors are hesitant about me being on both together). We were hiking in Patagonia (I wasnt going to let a cough stop me from hiking in Torres del Paine), and my hip started playing up (ongoing issues with a labral tear). This meant I had significant pain with walking and I judged this to be more deserving of a medication!
I hoped Kalydeco would get rid of the cough on its own, but it continued to get worse, and a few days later I reluctantly swapped Voltaren for Cipro. By this stage my CF / ‘smokers cough’ was back. After a few days I started to get a little better, but this is the slowest I have improved since being on Kalydeco. I have now had 10 days of Cipro and then 10 days of inhaled TOBI (once home). Friday last week I was thinking I may need IVs as I was not that much better. But I have improved since then, so I am hoping I can avoid IVs. I am still coughing more than normal though.
My lung function machine wasn’t working whilst away, but when I came home it was 66%. It was 65% today, after 10 days of inhaled TOBI, so I am not sure what my doctors will say. I am guessing it may have dropped to 60-65% whilst away (based on how I felt, I wasnt that puffed out, just coughing a lot). Although the sputum was thicker than normal, and in much much greater amounts, it was still light green. Sorry for anyone who didn’t want that detail, but I think its important! Despite the cough, Kalydeco appears to have stopped my FEV1 from dropping that much, and my level of infection doesn’t seem to be too bad. Previously this would not be the case, I would be in the 40s and would struggle to recover.
After 10 months of a very stable, minimal cough situation, my sense of normal changed. I forgot what my CF felt like before. It was such a shock to have crackles when going to sleep (very annoying), to be able to cough and clear sputum with no end in sight (exhausting) and to have the annoying sputum stuck in your throat that you can’t clear. This reminded me just how much I rely on 2 tablets per day. Also reminded me how grateful I am that I was able to access Kalydeco and that Kalydeco has helped me so much.
I’ll add some more photos next time- despite my health we still had a great time during the second two weeks. We visited Torres del Paine, the Perito Moreno glacier, Buenos Aires and Uruguay. Looking forward to my next adventure already 🙂
I wrote this post about a week ago but have had limited access to the internet…
I spent about six days in Cusco (3400m) and the surrounding areas. After about two days my headaches stopped and I had no other symptoms. My oxygen saturation plateaued at 90% but continued to drop to about 75% with exercise (eg a few min of climbing stairs). After the first two days I was able to climb the stairs faster and felt less puffed out. I was also able to spend several hours walking around, walking quickly on flat ground and downhill (same speed as normal), but a little slower than usual uphill.
Whilst at 3400m my body would have reacted to my lower than normal oxygen saturation and produced more red blood cells (part of the acclimatisation process). I felt fine despite the 90% saturation (where I would normally have symptoms), as I had more red blood cells to carry the oxygen, so overall my amount of oxygen was higher. It would be interesting to know my blood gas levels and my red blood cell counts, but sadly I can’t test that myself!
Whilst we were based in Cusco at 3400m, I spent a few hours at 3800m. I noticed the difference straight away, struggling more uphill and at rest my oxygen saturation decreased to 85%. When we went down to 2000m (near Machu Picchu), my oxygen saturation increased to 95-97%, and I was able to carry luggage uphill and felt close to normal. I returned to 99% when we flew back to Lima 🙂
Overall my lungs coped very well with the altitude and I acclimatised quickly. My cough/other symptoms did not change, so far Kalydeco has been keeping my lungs stable 🙂
In terms of the holiday, Cusco, the Sacred Valley and Machu Picchu were all amazing! We are now heading to Santiago, Patagonia and Buenos Aires.
Just sorted through hundreds of photos:
Sacred Valley- yes they are gum trees in the background, seems they like using the aussie trees to build houses
I first researched Machu Picchu several years ago and realised that the closest airport was 3400m, Machu Picchu was 2400m and the Inca Trek reached 4200m. I then realised that there are two ways to reach Machu Picchu, either the Inca Trek or by train.
Ideally it would be best to travel from sea level to 3400m slowly, however bus trips here are very slow/windy/long so the best option is flying. This means I decided I was going to travel from sea level to Cusco at 3400m, then take the train to Machu Picchu. I would have liked to do the trek however I knew that the risk of altitude sickness would be quite high, and if I had a problem it would be hard to leave the trek (few roads) and get back to Cusco. I also knew that I might have problems at the altitude of 3400m alone. So the train seemed like the best option.
3400m has about 65% of the amount of oxygen at sea level.
I bought a cheap oximeter online so I could monitor my oxygen saturation. I knew it was likely that I would be fine but I bought this just in case I had significant altitude symptoms.
Just for fun I compared my values to Keith’s (both 97-99% at sea level, above 95% is normal):
On arrival: Gen 84%, Keith 79%
10min-4hr: Gen 89% (HR90-100), Keith 90% (HR90)
After climbing steps for 3min: Gen 76% (HR155), Keith 85% (HR115)
1min later: Gen 89%, Keith 87%
Overnight: Gen 82-85%, Keith 89%
Next day: Gen 89-91%, Keith 90-92%
So overall Keith and I are stable at about 90%, but I desaturate more with exercise and overnight. Interestingly he desaturated more initially, but recovered quickly.
Yesterday I had a headache and tingling in my fingers, today just a low level headache. Keith has had no symptoms. Overall I was expecting to be much more short of breath and to have more symptoms at this altitude. I know that without Kalydeco and with a lower level of lung function the symptoms would have been worse, it probably would not have been a smart idea to stay at 3400m. If anyone out there is reading this and thinking I am close to 70% FEV1, so maybe I would be ok at a high altitude as well – everyone is different and some people at 90% FEV1 can desaturate faster than those with lower lung function. Last year I did the altitude simulation test (set to the pressure in a plane- equivalent to 2500m or 73% oxygen) and I desaturated to 90%, then stayed at 90-95 (this was at 50% FEV1). This is the best way to know how you will go with an increase in altitude.
I will post again in a few days about how I am going with the altitude.
In terms of the holiday, we are having a great time & have visited Lima, the Amazon and are now in Cusco for a few days before visiting the Sacred Valley and Machu Picchu. I will post a couple of photos later 🙂
Information about altitude sickness (from Intrepid)
“Altitude sickness is the reaction of the body adjusting to decreasing amounts of oxygen. Normally, the higher the altitude, the less oxygen available for the body to carry on normal functions. Altitude sickness most commonly occurs from above 2,800 metres (9,200ft) but this is different for everyone – there is simply no way of knowing your own susceptibility prior to being at altitude thus it is vital you monitor your own health. Symptoms may be mild and subside/go away after a day’s rest, or if it is ignored it could lead to death. Symptoms can appear within 1-2 hours although most often appear 6-10 hours after ascent and generally subside in 1-2 days as the body adjusts to altitude. They may reappear as you continue to go higher.
Symptoms usually occur gradually & can be one or a combination of the following: Headache, Loss of appetite, Disturbed sleep or drowsiness, Irritability, Fatigue, Nausea/vomiting, Dizziness and Swelling of hands, feet & face.
If the body is unable to adjust to altitude these symptoms will persist and, if they are left untreated, altitude sickness may progress to High Altitude Cerebral Edema (HACE) or High Altitude Pulmonary Edema (HAPE). Both can be fatal if ignored.”
Thank you to everyone who submitted PBAC comments. We are looking forward to the July PBAC meeting, we need Kalydeco to become available for everyone with G551D asap!