Fall 2014 The Path To A Resilient Character By Elyse Elconin-Goldberg “Resilience is the capacity to respond to pressures and tragedies quickly, adaptively and effectively,” shared Isabel Stenzel Byrnes, MSW, MPH, during her inspirational presentation, “A Resilient Character: Adapting Well to Changes In Our CF,” at the 27th National Cystic Fibrosis Family Education Conference. Isabel, a 41-yearold social worker with cystic fibrosis (CF) who had a double lung transplant 10 years ago, emphasized the important role that resilience plays in adapting to changes that develop when living with CF, noting, “Change is inevitable, but how one reacts to that change has a significant impact on the emotional well being of every individual.” When living with CF, shared Isabel, we must ask ourselves how we can react to change in a healthier and more resilient way. “How can resilience be fostered within ourselves and in families coping with CF?” Thanks to neuroplasticity, our brains are capable of re-wiring how we respond to stress. “Opening to possibility,” a favorite saying of Isabel’s, suggests having a a more positive attitude, versus being stuck in the negative. When we are faced with adversity, as those living with CF frequently are, Isabel suggested that we ask ourselves if our responses to stressors are working for or against us. Isabel quoted Linda Graham, MFT, who writes about the “5 C’s” of coping with change: “Calm (keep calm and carry on); Clarity (having perspective); Isabel Stenzel Byrnes, MSW, MPH Connection (finding a network); Competence (I did, so I can!); vulnerability, hope (optimism), and social and Courage (do one new thing a day).” support (being understood). She cited a 2014 study conducted with teens with CF, Isabel stated that in CF, there are three Continued on page 4 things required for resilience: emotional CFRI ~ Research for Living ~ Partners for Life By Beate Illek, PhD For almost 40 years, CFRI’s investment in new ideas has enabled clinicians and researchers at Children’s Hospital Oakland Research Institute (CHORI) to gain new insights for the treatment of CF. I first learned of CFRI as a visiting scholar from Germany in Dr. Terry Machen’s laboratory at UC Berkeley, where I developed my interest in CF research. CFRI’s support of a vibrant CF research community had an enormous impact on my education and training as a post-doctoral researcher. CFRI provided a local network that facilitated the formation of successful collaborations, the establishment of a CF research laboratory at CHORI, and the achievement of basic Beate Illek, PhD research findings throughout my entire career. CFRI’s support of research – both directly and indirectly – has been vital to our scientific success and has resulted in many peer-reviewed publications involving electrophysiological experiments that were carried out in my laboratory. These contributions include key discoveries that pioneered the regulation of the CFTR chloride channel in airway epithelial cells and its conductivity to bicarbonate and other anions. The early discovery of genistein as an activator of mutant G551D CFTR in CF patients was made at CHORI, and paved the way for a new drug treatment of the Continued on page 18 CFRI Community Fall 2014 Editorial Chief Sue Landgraf Editors & Writers Bridget Barnes Siri Vaeth Dunn, MSW Contributing Writers Darlene Batchelder Linda Burks, EdD Mary Convento Meg Dvorak, LCSW Elyse Elconin-Goldberg Eric Frisbee Bill Hult Beate Illek, PhD Sue Landgraf Anna Modlin, MA Layout and Design Marina Michaelian Ward Photography Craig Burleigh Board of Directors Bill Hult, President Jessica Martens, Vice President Mike Roanhaus, Secretary Oscar Flamenco, CPA, Treasurer Francine Bion Elyse Elconin-Goldberg Ann Jones Doug Modlin Kristin Shelton, RRT Executive Director Sue Landgraf Director of Programs and Operations David Soohoo Program and Outreach Coordinator Notes from the Executive Director Dear Friends, As I write to you, I am sitting in my office, reflecting on the meaningful connections made with our CF community last summer. The busy days of our powerful “Zen” Teen & Adult Retreat and 27th National Cystic Fibrosis Family Education Conference, “The Changing Faces of Cystic Fibrosis: Inspiring Hope,” left us with the joy of camaraderie and a wealth of information from our excellent presenters. Looking at the brilliant prayer flags encircling my office, handmade by individuals in our community who loved and lost someone with CF, I am reminded of the urgent need to expand our programs. To that end, I am honored to announce the extraordinarily generous gift of $105,000 to CFRI’s 2015 Cystic Fibrosis Research Challenge Circle by Suzanne Freiley, in memory of her niece, Jessica Fredrick, who lost her battle with CF this year at the age of 21. Ms. Freiley hopes that her gift, which was made possible by a one-time double matching gift program from Lam Research, and constitutes the largest single individual donation in CFRI’s history, will inspire others to give generously to fund CF research and support. We are honored that Ms. Fredrick’s family would pay tribute to her by helping to seek a cure for others. More details will be presented in the next edition of CFRI Community. CFRI is in this together with you – as we have been for nearly 40 years. We are experiencing an exciting and hopeful time, as those with the double Delta F508 mutation are on the brink of receiving medications that address the basic underlying cause of the disease. Our new tagline, “Research for Living ~ Partners for Life,” reminds us that CFRI stands for hope and longevity; daily, and into the future. S CF Chef S Warmly, Mary Convento Resource Development Associate Siri Vaeth Dunn, MSW Resource Development Assistant Sue Landgraf | Executive Director and mother of an adult daughter with CF Scott Wakefield Partnership with AbbVie a recipe for success! Thanks to all who contributed recipes. We will share the final results from this exciting project in the next CFRI Community. News from the Board CFRI Community is published and distributed to friends of CFRI for free. Send address corrections and other correspondence to CFRI: 1731 Embarcadero Road, Suite 210 Palo Alto, CA 94303 Phone: Toll Free 1.855.cfri.now (1.855.237.4669) Fax: 650.404.9981 Email: [email protected] Website: www.cfri.org Dear CFRI Community, The CFRI Board of Directors is pleased to share that our CF Research Challenge has been met! Thanks to our generous CF Research Challenge Circle donors who gifted $75,000 to match designated donations dollar for dollar, we raised $150,000 to fund three additional CF research projects for 2014/2015! Our many thanks to the CF Research Challenge Circle co-chairs, Paul Quinton, a preeminent CF researcher living with CF, and Jim and Barbara Curry, longtime friends of CFRI and grandparents to Cameron, who has CF. Our With our permission, you may reproduce original information from this newsletter with credits to CFRI Community and the author. Bill Hult, President 2 Sue Landgraf, Executive Director These programs strengthened our commitment to increase funding for CF researchers to keep scientists committed to the search for a cure, while we expand the breadth of our educational programs. We must reach more people touched by CF, including families of the newly diagnosed and young children, non-English speaking families, and individuals in need of psychosocial support. We are initiating new programs, while investigating ways to effectively bring vital information about this challenging disease to those who need it the most. Continued on page 3 cfri | Fall 2014 New CF Drugs Advance Hope and Quality of Life for Patients and Their Families By Bridget Barnes “The pipeline holds more promise than ever,” declared Dr. Ahmet Uluer, referring to the progress of new therapies for the treatment of cystic fibrosis (CF). In his presentation at this summer’s Cystic Fibrosis Family Education Conference, “Cystic Fibrosis Drug Pipeline: Past, Present and Future,” Dr. Uluer, Director of the Adult Cystic Fibrosis Program at the Boston Children’s and Brigham and Women’s Hospital CF Center, and Assistant Professor of Medicine at Harvard University, covered many of the existing and potential treatments that modulate the dysfunctional CFTR protein responsible for CF, restore airway surface liquid, alter mucus, target inflammation, treat infection, and augment nutrition. Advances in the understanding of the disease and the development of these new therapies have led to improved quality of life and life expectancy for those living with CF. “The combined efforts of organizations such as CFRI, the Cystic Fibrosis Foundation, and many individuals have contributed to this growing knowledge base and are helping to develop the next generation of CF therapies,” Dr. Uluer elaborated. New therapies for this multiorgan disease that affects the lungs, colon, sweat glands, pancreas, bone, and efferent ducts must go through multiphase drug trials to assess both safety and efficacy before being approved by the US Food and Drug Administration (FDA), a process that takes 6 to 18 years, explained Dr. Uluer. Dr. Ahmet Uluer sharing updates on the CF Drug Pipeline. News from the Board Continued from page 2 deepest gratitude to the CF Research Circle donors listed on page 19. CFRI is certainly living our tagline, Research for Living ~ Partners for Life, through a vigorous focus on funding research and working with the CF medical community to ensure access to the most current CF medical/healthcare news and protocols. To that end, we are honored to announce the formation of our new Medical Advisory Board, comprised of some of the most cfri | Fall 2014 While reviewing the “cycle of inflammation and infection” esteemed members of our medical and research community. Please go to page 6 for a list of the Advisory Board’s prestigious members. We are honored by their participation and support. which causes CF lung disease, Dr. Uluer highlighted several available drugs that are significantly improving the quality of life for those with CF. They include aquaDEKs® and improved enzymes for good nutrition, inhaled TOBI®, azithromycin, Cayston®, and TIP (tobramycin inhaled powder) for fighting infection, ibuprofen for reducing inflammation, Pulmozyme® for liquefying mucus, hypertonic saline to restore airway surface liquid, and Kalydeco® for CFTR modulation. In addition, a drug application for Liprotamase, a pancreatic enzyme that improves fat absorption, is under FDA review, while numerous promising trials for other drugs are underway. For medications that target bacteria associated with worsening lung disease, a 24-week extension study of inhaled Levofloxacin in CF patients with chronic Pseudomonas aeruginosa showed prolonged improvement in lung function and quality of life. In addition, interim analysis of a long-term study of Arikace (inhaled Amikacin) in patients with Pseudomonas also appears to show longterm improvement in FEV1. “As with Pseudomonas, we need studies on how to eradicate MRSA,” Dr. Uluer stated. AeroVanc®, an inhaled dry-powder addressing persistent Methicillin-resistant Staphylococcus aureus (MRSA) is currently in Phase 2 clinical trials and shows a reduction in MRSA colonies and improved FEV1. Final results from this study will be available in 2015. Continued on page 4 CF community at Smart Patients is growing and includes parents and young adults affected by CF. The CFRI Board invites you to join at www.smartpatients.com/ cfri and become part of an even larger CF community. We are your partners for life, and want to provide you with resources that will help on this journey with CF. CFRI now has an Peace and good health, online community for CF patients and caregivers! Smart Patients is where patients and caregivers affected by complex illnesses learn from each other about treatments, challenges, and shared experiences. The Bill Hult | Board President 3 New CF Drugs Advance Hope levels. Incredible!” Vertex is planning to submit an application to the FDA for review, with possible approval in 2015. Continued from page 3 Anti-inflammatories Alpha 1 Anti-Trypsin and KB001-A are both in Phase 2 trials and appear to “clean up the cascade of infection and mucus build up caused by the secretion of neutrophils,” Dr. Uluer reported. Bronchitol (inhaled Mannitol) helps clear mucus in the lungs by restoring surface liquid in the airways. While approved in Europe and other countries, it awaits approval in the U.S. CFTR modulators are potentially the most effective, as they target the underlying causes of cystic fibrosis rather than the symptoms. One of these, Ataluren, addresses “nonsense” mutations, and as of August 2014, CF patients are being recruited for a redesigned Phase 3 trial. Another potential treatment, developed by Vertex Pharmaceuticals, is Kalydeco® combined with Lumacaftor (VX-809) for people with two copies of the Delta F508 A Resilient Character Continued from front cover in which their perceived stress was low and correlated with higher resilience, in contrast to a non-CF teenage population. The resiliency of the teens with CF was attributed to their accelerated maturity, taking of responsibility, acceptance of prognosis, regaining of control, redefining normality, social support, and problemsolving skills. Reflecting on her own experiences growing up, Isabel shared how her parents fostered resilience in her identical twin sister, Ana, and herself. With age came changes in the level of responsibility their parents expected of them. As Isabel and Ana transitioned from childhood to young adulthood, responsibilities such as learning to wash the dishes were accompanied by taking over cleaning and disinfecting their nebulizers. Learning to drive became an opportunity to drive themselves to medical appointments. Isabel shared study results that identified key factors influencing resilience in children, including a secure attachment to their parent/caregiver, their children’s internal make-up, self-calming abilities, positive emotions, a positive family environment, an external support system, and a sense of control and mastery. 4 For people with one copy of the Delta F508 mutation, Dr. Uluer imparted recent news that the Kalydeco®/Lumacaftor combination did not demonstrate a significant improvement in lung function. Dr. Uluer went on to say that Phase 2 data of Kalydeco® in combination with VX-661 “looks promising for homozygotes with a Delta F508 mutation and might be effective for Delta F508 heterozygotes using higher doses, but still has a way to go.” Dr. Uluer and Paul Quinton, PhD mutation. Phase 3 clinical trials for this combination were recently completed, and showed significant improvement in lung function and other key measures of health and, as noted by Dr. Uluer, “there was a clinically significant drop in sweat chloride In addition to the promise of new discoveries, Dr. Uluer reiterated, “We must continue to develop therapies and strategies to deliver current treatments more efficaciously.” Concluding, he shared important advice from his 70 and 80-year-old patients on keys to staying healthy: “Good luck, exercise, and fill your life with happiness.” Both Ana and Isabel were hospitalized frequently throughout their lives. Isabel detailed how she and Ana always tried to find a mental outlet, whether in or out of the hospital, to express their emotions while dealing with the daily challenges of living with CF. This included drawing, painting, photography, and writing. As her disease progressed, Isabel discovered that, “advanced disease was uninvited, but became an opportunity.” This opportunity presented itself in the form of therapeutic narrative writing. Isabel shared that through writing and telling her story, her resilience grew, noting, “Writing is a way to link the right and left brain’s responses to challenges, and fosters self-awareness, insights into behavior, understanding of others’ struggles, and a sense of one’s own growth. Additionally, sharing one’s writing fosters reciprocity, empathy and a special kind of intimacy.” Isabel became a character in her own dramatic life story: both Isabel and Ana received double lung transplants, which Isabel shared was the “ultimate redemption and reward.” In 2013, Isabel’s strength and resiliency were put to the test with the loss of her sister Ana. In honoring Ana and her memory, Isabel continues to share Isabel Stenzel Byrnes at the Transplant Games their journey of living with CF, and the challenges and opportunities it presents. Change in the life of a person living with CF is a given, but how one faces those changes is up to the individual. Isabel’s insights on resiliency exemplified courage, tenderness, sadness, and loss, and also her triumph as a survivor. cfri | Fall 2014 Cystic Fibrosis and Cancer: The Need for Awareness and Screening By Siri Vaeth Dunn, MSW While very limited research has been conducted on cancer in cystic fibrosis patients due to the small numbers involved, Dr. Van Loon shared the results of a 2012 study which analyzed data from over 41,000 cystic fibrosis patients followed at U.S. CF centers between 1990 and 2009 and concluded that, “CF patients have an increased risk of digestive tract cancers – including esophago-gastric, biliary tract, small bowel, and colon cancers – compared to the general U.S. population.” The study also reported that CF patients demonstrated an increased risk of testicular cancer and lymphoid leukemia, but a decreased risk of melanoma. Dr. Van Loon noted that, “the increased risk for digestive tract cancers was most pronounced in patients who had previously undergone lung transplantation, Dr. Katherine Van Loon is studying the incidence and implications of with most cancers gastrointestinal cancer in those with CF. arising in the bowel.” Be Done,” at CFRI’s 27th National Cystic While colonoscopies to screen for preFibrosis Family Education Conference, cancerous polyps are recommended for Katherine Van Loon, MD, MPH, Assistant the general population beginning at the Clinical Professor and clinician at the age of 50, Dr. Van Loon expressed concern Helen Diller Family Comprehensive Cancer that this may be too late for patients with Center at the University of California, San Francisco, raised awareness of a significant cystic fibrosis. Dr. Van Loon noted that a literature review “identified multiple health issue for those with CF. Dr. Van cases of colon cancer diagnosed in CF Loon discussed the increased risk for patients between the ages of 13 and 45, cancers of the digestive tract in patients suggesting that this patient population with CF, and the need to assess whether may be at risk from a much earlier age.” new screening protocols should be She also discussed a study of over 28,000 implemented for this population. Dr. Van patients with CF in the U.S. and Canada, in Loon, a gastrointestinal cancer specialist, which the mean age of onset of digestive was inspired to study the incidence and tract cancers was 32 years, while those implications of gastrointestinal cancer in between the ages of 20 and 29 had a those with CF by several of her patients notable increase in risk. facing this dual diagnosis. Thanks to advances in the understanding and treatment of cystic fibrosis (CF), people with CF are living longer; but as they age, other health complications emerge that may not be overtly CF related. In her illuminating presentation, “CF and Cancer: Who Should Be Concerned and What Can cfri | Fall 2014 Dr. Van Loon stressed that both patients and care providers need more information about the increased risk of digestive tract cancers for those with CF. Despite studies indicating that patients with CF have a higher risk and are diagnosed at a younger age than their non-CF peers, there are currently no screening protocols that take these factors into consideration. Dr. Van Loon emphasized, “because this population suffers from chronic gastrointestinal complications of CF, many early warning signs and symptoms of gastrointestinal malignancy – for example, abdominal pain, constipation, and anemia – may be masked or attributed to other etiologies, resulting in delays to diagnosis.” In an effort to develop new cancer screening protocols for CF patients, Dr. Van Loon is currently enrolling subjects for a study of adults with CF, aged 30 and older, who will undergo colonoscopies and screening. Support for her research has been provided through a cystic fibrosis oncology research fund established in memory of Anabel Stenzel, who had CF and lost her battle with small bowel cancer in 2013. Results of this important and timely study will guide the development of recommendations for gastrointestinal cancer screening for those with CF. Anabel Mariko Stenzel 5 CFRI Announces Formation of Medical Advisory Board Beate Illek, PhD Bill Hult Julie Desch, MD Honoring the Extraordinary: CFRI’s Annual Awards Recognize Our Community Heroes By Siri Vaeth Dunn, MSW Each year at our National Cystic Fibrosis Family Education Conference, CFRI honors individuals that have made extraordinary contributions to the cystic fibrosis (CF) community. Nominations for the CFRI Professional of the Year and the Dave Stuckert Memorial Volunteer of the Year were received from across the nation, and a panel of judges comprised of prior award winners selected the outstanding honorees. This year, CFRI’s Board of Directors also introduced the CFRI Partners in Living Award in Memory of Anabel Stenzel. The 2014 Professional of the Year Award was presented to Beate Illek, PhD, a brilliant researcher at Children’s Hospital Oakland Research Institute (CHORI) who has achieved key discoveries including: the conductivity of CFTR to bicarbonate and other anions in airway cells; the discovery of genistein as an activator of G551D mutant CFTR activity; the characterization and establishment of novel CF bronchial epithelial cell models; and the discovery of a malfunctioning bacterial defense mechanism in CF airway cells. In addition to these accomplishments, Dr. Illek has established a CF research student program at CHORI to inspire new leaders in the field. Dr. Illek exemplifies outstanding dedication and commitment to the CF community. Bill Hult, CFRI’s intrepid Board president, was awarded the 2014 Dave Stuckert Memorial Volunteer of the Year Award, created in honor of this dedicated CFRI volunteer who lost his battle with CF in 1989. Since joining CFRI’s Board of Directors in 2004, and his election as President in 2008, Bill has helped to expand CFRI’s capacity to meet the needs of a broadening CF community, while ensuring CFRI’s financial and organizational health. Serving as Board liaison on the Research Advisory Committee (RAC) and developing strategies related to CFRI’s long-term vision, Bill exemplifies an unflagging commitment to CFRI’s mission. CFRI’s Board of Directors inaugurated a new award this year, the CFRI Partners in Living Award in Memory of Anabel Stenzel. Ana, a former CFRI Board member, was a beloved member of the CFRI community; a strong woman with CF who lost her battle with cancer last year. The recipient of this new award is selected by CFRI’s Board of Directors. Nominees must have CF, have supported CFRI through volunteer and/or fundraising efforts, and embody the qualities exemplified by Ana, including courage, initiative, determination, adherence to medical regimen, community service, and positive coping. The first recipient of the CFRI Partners in Living Award in Memory of Anabel Stenzel was Dr. Julie Desch. Dr. Desch received her medical degree in pathology from Stanford University School of Medicine. She has been a dedicated CFRI volunteer for many years, previously serving on the Board of Directors, and sharing her medical and scientific knowledge through membership on the Research Advisory Committee. She has been a presenter at CFRI’s Discovery Series, and has authored articles for this newsletter. Dr. Desch is the founder of New Day Wellness, a nonprofit organization with a mission to coach and train wellness to people with chronic illness. Dr. Desch exemplifies Anabel’s spirit through her courage, positive attitude, and volunteer service to CFRI. Congratulations to these outstanding individuals! 6 CFRI is honored to announce the formation of our new Medical Advisory Board, comprised of some of the most esteemed members of our medical and research community. We are grateful to these individuals for sharing their expertise and experience so as to ensure CFRI has vital information and access to the most current CF-related news and protocols. Julie Desch, MD Founder, New Day Wellness Deborah “DJ” Kaley RN, MSN, AE-C, CPN Pulmonary Nurse Case Manager Bay Area Pediatric Pulmonary University of California San Francisco Benioff Children’s Hospital Oakland Thomas G. Keens, MD Director, Cystic Fibrosis Care Center Children’s Hospital Los Angeles Professor of Pediatrics Physiology and Biophysics Keck School of Medicine University of Southern California Paul Quinton, PhD Nancy Olmsted Professor in Pediatric Pulmonology Professor of Biomedical Sciences University of California Riverside Department of Pediatrics Rady Children’s Hospital University of California San Diego School of Medicine Kristin Shelton, RRT Respiratory Coordinator CF/Pulmonary Clinic Stanford Children’s Health Ahmet Uluer, MD, DO Director, Adult Cystic Fibrosis Program Division of Pulmonary and Respiratory Diseases Boston Children’s Hospital and Brigham and Women’s Hospital Assistant Professor of Medicine Harvard Medical School cfri | Fall 2014 The CF Journey: Where We Have Been and Where We are Going By Linda Burks, EdD Taking us on a time travel trip from medieval Europe to the 21st century, Thomas G. Keens, MD, Director of the Cystic Fibrosis Care Center at Children’s Hospital Los Angeles, and Professor of Pediatrics, Physiology and Biophysics at the Keck School of Medicine at the University of Southern California, engagingly presented, “Where We Have Been and Where We are Going” in the field of cystic fibrosis (CF) at CFRI’s National Cystic Fibrosis Family Education Conference. With the median life expectancy for those with CF now in the early 40’s, medical advances have come a long way since CF was first noted in German folklore as a hex, when tasting salt while kissing a newborn was seen as a sign the baby would soon die. In 1938, life expectancy for those with CF was less than one year. Two years later, CF was recognized as an autosomal recessive disorder. Incorporation of the Cystic Fibrosis Foundation in 1955 raised Thomas G. Keens, MD research awareness, while the establishment of the first CF Centers in 1961 improved care and increased the median age of survival to 10 years. CFRI was established in 1975. At that time, few with CF survived their teens. An historic milestone was reached in 1989 when the CF gene was identified. With the cfri | Fall 2014 discovery of the cystic fibrosis transmembrane conductance regulator protein (CFTR), it seemed a cure was close by. That trip has taken longer than first expected. CFTR regulates chloride transfer in and out of the cell. The improper function of the chloride channel creates sticky mucus and an excess of salty sweat, and many organ systems are negatively affected. Pancreatic enzymes are produced, but the thick mucus prevents them from reaching the intestine to aid digestion. Scarring occurs in the pancreas and liver. The heavy mucus weighs down cilia in the lung lining, enabling bacteria to develop, resulting in damaged lungs. These symptoms have been treated by new therapies – including Pulmozyme®, azithromycin, TOBI®, and Cayston® – that have generally increased overall lung function. A primary focus now is preventing acute exacerbations, which typically result in dramatic loss of lung function. Researchers seek to understand what causes the dip in FEV1 following an exacerbation, and whether it is gradual or sudden. With newborn screening for CF now standard in all 50 states, many mutations (nearly 2,000 thus far) have been identified, and as Dr. Keens explained, this enormous number further complicates the search for a cure. Mutations are classified in two main categories: one where little to no CFTR protein is found on the cell surface; the second where CFTR is on the cell surface, but fails to function properly. Observing that disease severity may be predicted by the percent of functioning CFTR, the goal of new therapies is to modify CFTR so that 30% of the protein functions properly. Recent research on CFTR modifiers has demonstrated exciting results. The potentiator Ivacaftor (VX770 or Kalydeco®) has been shown to produce 50% CFTR function for those with the G551D mutation. For those with two copies of the Delta F508 gene, the combination of Ivacaftor with Lumacaftor (VX809), a corrector that brings CFTR to the surface, is promising. Initial results from Phase 3 studies indicate significant improvement in FEV1, body mass and quality of life. Unfortunately, little difference was found for those with one copy of the Delta F508 gene. It is an exciting time. As new treatments to prevent disease progression are discovered, the possibility of further lung and pancreatic damage can be kept at bay. As Dr. Keens compellingly shared, we are on the cusp of a new generation of treatments for CF and are converging on a cure. 7 There in the Room: From Survival to Healthiness with Cystic Fibrosis By Darlene Batchelder Mary ElizaBeth Peters is a survivor. The 33-year-old theater artist and CF educator from Boston, Massachusetts, received a double lung transplant in 2010. In her moving presentation, “More than Survival: A Pursuit of Healthiness,” given at CFRI’s 27th National Cystic Fibrosis Family Education Conference, Peters used the stage to give voice to her own unique cystic fibrosis (CF) experience, as well as to the journeys and stories of others touched by CF. When she isn’t on stage, Peters works with children with disabilities, publishes a blog, directs theatre productions, and writes. Her book, Unto the East: Words in Waiting, is the story of her wait for a double lung transplant. She began her opening night presentation by asking everyone to answer the questions, “What can you do that others cannot?” and “What can’t you do that others can?” In doing so, she invited us all to consider that regardless of our varied abilities, we each have unique stories to share and it matters that we share them. Confessing that she was “bored with her own biography,” Peters shared what others with CF suggested she explore in her presentation, including: “Acceptance of the disease, the emotional effects, as well as physical;” “How freaking tired we are – I am not lazy, I am exhausted;” “The psychological effects;” and, “This is 8 or noon on a Sunday in the hospital when no one is around and you can’t get a pass off the floor to go buy a Snickers bar and your family is at home eating lunch after church. We are there, in the room…We are there in the room when a person is diagnosed with cystic fibrosis. We are there in the room at a graduation party we worried wouldn’t come. We are there in the room when it’s time to start using supplemental oxygen. We are there in the room when you win a swim meet. We are there in the room when you have to go in the hospital the Wednesday before the prom. We are there in the room when you get married. We are in the room when you get divorced. We are in the room when your wife/ husband leaves you a year after transplant and you wonder why this happens Mary ElizaBeth Peters so often with so many people you know. We are there in the room we are uniquely linked by many common experiences. when you first get listed for transplant. We Peters shared her distincare there in the room when your kid goes tive CF experiences as to kindergarten. We are there. In the room. part of an online CF We are present. ” women’s group. Despite In closing, Peters read her moving and the challenges placed autobiographical poem, “My Sister Died upon those with CF to on a Sunday,” noting that she decided to join together, Peters share it, “not to make us all sad and cry, movingly conveyed the though that might be the case. I chose to deep connections that present it because it highlights an important can be forged online, fact – your life is not someone’s movie. It’s and the support and your real life. It’s happiness and it’s sadness, sense of community and the good days and bad days are all your that results. The following excerpt real, real life. And that’s your story and you was created by the women in the group, inspired in part by the Vagina Monologues should tell it.” poem, “I was there in the room.” Beth eloquently encouraged us to reflect on and tell our unique stories. Everyone “We meet online and we are . . . present… has one; and the authentic expression of We are in a tiny internet room where it, amidst the sadness and challenges of we can share with each other at 4 in the morning when we can’t sleep or 9 in the CF, can lead to acceptance, connection, morning when the spouse left for work better health, and happiness. an invisible illness – you might not look sick but you can still be really sick.” The varied responses made it clear that while our individual experiences with CF are unique, cfri | Fall 2014 CFRD: Current Issues & Future Strategies By Siri Vaeth Dunn, MSW Cystic fibrosis-related diabetes (CFRD) impacts nearly 40% of young adults with cystic fibrosis (CF). CF causes scarring to the pancreas, thereby destroying a large percentage of the insulin-secreting cells. Left uncontrolled, CFRD can have a significantly negative impact on lung function and mortality. Yet as Antoinette Moran, MD, Professor and Division Chief of Pediatric Endocrinology at the University of Minnesota compellingly shared during her presentation, “The Sweet Evolution of CFRelated Diabetes,” at CFRI’s 27th National Cystic Fibrosis Family Education Conference, early diagnosis and insulin intervention can reverse this trend, while new “corrector” and “potentiator” drugs in the CF treatment pipeline might “fix” the problem by increasing insulin production. high blood glucose levels create an ideal environment for the growth of opportunistic bacteria in the lungs of CF patients. Early diagnosis is key, and Dr. Moran questioned whether earlier screening Insulin helps the body to use nutrients in food to produce Dr. Antoinette Moran energy, gain weight, and build muscle. As noted by should be implemented, because, “in the Dr. Moran, “Essentially all cystic fibrosis ‘pre-diabetic’ period – years before the patients are insulin insufficient,” leading actual diagnosis of CFRD – nutritional to “muscle and fat breakdown, difficulty gaining or maintaining weight (particularly status and pulmonary function begin to decline.” Early CFRD symptoms include muscle), and impacting lung function.” increased thirst and urination, the inability The insufficient amounts of insulin are to gain or maintain weight, poor growth even more detrimental during times of in children, and an unexplained and rapid infection and steroid use. drop in lung function. But Dr. Moran Many studies have documented the stressed, “There may be no obvious negative impact of diabetes on survival symptoms!” While oral glucose tolerance in CF. Both hyperglycemia (high blood testing (OGTT) is usually conducted glucose) and insulin insufficiency have a annually after a patient turns 6, there negative impact on CF lung disease. As are indications that many children have explained by Dr. Moran, “There is normally impaired glucose at a much younger age. no glucose in airway secretions, but in CF, Dr. Moran discussed a study in which airway secretion glucose is elevated when OGTT is conducted with infants beginning plasma glucose is above 144 milligrams at three months old that may provide new per deciliter.” A study of CFRD patients insights related to the ideal age to initiate undergoing constant glucose monitoring glucose testing. found they spent nearly 50% of each day above this level. This is significant, because Dr. Moran stressed, “Insulin provides a clear cfri | Fall 2014 benefit and is the definitive treatment for all patients with CFRD (with or without fasting hyperglycemia).” Currently, 41% of children with CF tested at ages 6 to 10 years have abnormal glucose tolerance, leading Dr. Moran to ask, “Should we be treating pre-diabetes with insulin?” A new, multi-center placebocontrolled study will explore whether this is the case. Dr. Moran raised the possibility that the new “potentiator” and “corrector” drugs to treat CF could help those with CFRD, citing a small study that showed that “Ivacaftor increased insulin secretion by 66% – 178% in four out of five CF patients ages 6 to 52 years with the G551D mutation.” Dr. Moran pondered whether those with “pre-diabetic” glucose intolerance levels would also be candidates for early treatment with these new therapies. Dr. Moran stressed that while high mortality rates for females with CFRD used to be the “worst scenario,” this has been reversed at her center because, “controlling CFRD Those with CF-related diabetes must closely monitor their blood glucose levels. makes the difference.” She added, early intervention and aggressive insulin therapy “reverses chronic nutritional and pulmonary decline in CFRD, thus improving survival.” 9 The CFRI Teen and Adult Retreat: A Zen Experience! By Anna Modlin, MA This year’s CFRI Teen and Adult Retreat was a great success. The retreat included several Zen-themed activities -– Tai Chi, SoulCollage® and guided imagery. We were fortunate to have Dr. Steve Singh and Dr. Elena Sandoval, surgeons from CFRI’s “Zen” Teen and Adult Retreat provided a place for St. Luke’s Lung Transplant reflection, camaraderie, information, and fun. Center in Houston, lead a question and answer session, and we have lost, no matter how long ago. also had a session on adoption. Rap Unfortunately, this year we said goodbye sessions were scattered throughout the to some of our longtime friends, Ana S., retreat, during which attendees provided Steve P., and Nahara M., along with many emotional and social support to one friends from past retreats and CF camp. another. The week was filled with sharing, They are missed but never forgotten, and fun and laughter, all while observing the memorial was a moving tribute. We stringent cross-infection guidelines. We ended the week with a hilarious talent participated in entertaining games of show and skit night. The snack room was Wiffle ball, and some people even gloved overflowing with goodies: special thanks up to throw around a football. Most to the Johsts at Grocery Outlet and to attendees picked secret buddies at the Whole Foods for their donations. During beginning of the retreat, and presented the week, new friendships were made, and awards to their “Buddha buddies” at the bonds deepened with old friends. Despite awards ceremony. We held our annual being a little tired from all the fun, I left candlelight memorial, at which we lit the retreat hopeful, emotionally filled, candles and told stories about those we refreshed, and recharged! Donate Life: Even Those With CF Can Donate! By Siri Vaeth Dunn, MSW Many members of the cystic fibrosis community have received the gift of lung transplantation. But many more are waiting. It is extraordinarily easy to become an organ donor, as every state has an online registry. Most importantly, express your wish to be a donor to your family, friends and physicians, and include your wishes in an advance directive or will. You do not need to be young to be a donor: In 2013, 35% of deceased donors were over 50 years old, and of these, many were over the age of 65. You also do not need to be in perfect health. In 2013, Gianna Altano lost her battle with CF while waiting for a lung transplant. She 10 in turn, donated her kidneys and corneas. That same year, Ana Stenzel lost her battle with small bowel cancer after living with CF and receiving two lung transplants. She also donated her corneas. Tissue Bank International has selected Ana to be an honoree on Donate Life America’s float at the annual Rose Parade in Pasadena, California on New Year’s Day, 2015. By being an organ donor, these women – and many others – have helped extend and improve the lives of people in need. CFRI’s 27th National Cystic Fibrosis Family Education Conference Thank you to our generous sponsors and supporters who helped to make this year’s event a tremendous success. Sustaining Sponsors Genentech, Inc. Novartis Pharmaceuticals Vertex Pharmaceuticals Chiesi USA, Inc. Platinum Level AbbVie Boomer Esiason Foundation Gilead Sciences Gold Level Forest Laboratories Foundation Care Pharmacy Cystic Fibrosis Services Pharmacy Silver Level Electromed, Inc. RespirTech Med Systems Cystic Fibrosis Pharmacy – Florida Modern Health Pharmacy Hill Rom Supporters Pari Kendal Hall and Brad Huntzinger Prodigy Press, Inc. Sofitel San Francisco Bay If you have not yet registered to be an organ donor, go to www.organdonor.gov for the latest information and links to register in your state. The design for Donate Life America’s 2015 Rose Parade float cfri | Fall 2014 California’s CF Newborn Screening: Lessons Learned and Future Implications By Eric Frisbee Attendees at CFRI’s 27th National Cystic Fibrosis Family Education Conference were honored to have Martin Kharrazi, PhD, MPH, present “Reflections on Detection of CF and CRMS in California Newborn Screening.” Dr. Kharrazi, Research Scientist Martin Kharrazi, PhD, MPH Supervisor with the California Department of Public Health Genetic Disease Screening Program, was instrumental in the design, implementation, and evaluation of California’s unique 3-step newborn screening model for cystic fibrosis (CF). All 50 states in the U.S. include cystic fibrosis in their newborn screening (NBS) programs, as early detection of CF offers the opportunity for early intervention and improved outcomes. NBS methods and models differ by state. Each state program checks for a chemical produced by the pancreas called immunoreactive trypsinogen (IRT) as a first step. When IRT levels are elevated, most states’ CF screening programs test for a panel of 23 mutations in the CF transmembrane conductance regulator cfri | Fall 2014 (CFTR) gene. Newborns with one or more mutations are referred for sweat chloride testing. The California program selectively tests for 40 severe and ethnically diverse mutations on its panel, and further tests the blood spot by DNA sequencing when a single panel mutation is found to look for additional mutations. Only newborns with two or more mutations are referred for diagnostic follow up at CF Centers. Dr. Kharrazi’s presentation gave insights on the increasing number of infants with CFTRrelated metabolic syndrome (CRMS) that are being identified through NBS. In California, CRMS is diagnosed in infants with a high IRT value who have two CFTR mutations (one CFTR panel mutation, and at least one CFTR mutation from DNA sequencing in trans), a negative or intermediate sweat test result of sweat chloride values <60 mmol/L, and no clear CF symptoms. Some infants with CRMS convert to CF in the first several years of life. The others may be at higher risk of CF in the future or of having problems in the airways and sinuses, intestines and pancreas, or the reproductive tract as they age. California started newborn screening for cystic fibrosis in July 2007. The objectives for the design of the California NBS program include: using a 1 blood spot screening model; focusing on severe cases of CF; identifying at least 90% of all Hispanic, Caucasian and African American cases; reducing the burden of false positives, false negatives, sweat tests, and costs, while maximizing case detection; providing efficient reporting of NBS results; diagnosing and following up on positive screenings through accredited CF Centers. Since the introduction of California’s CF NBS, there have been over 3 million births in the state. During this period, the CF NBS program had a case detection rate of 92.7%, with 421 cases detected by NBS out of 454 total CF cases. In addition, during this time, NBS identified 539 CRMS cases (90 per year), and 1,919 CF-carriers (320 per year). “While an initial goal of the California NBS was to focus on severe CF cases, with the ultimate diversity of CF mutations – 400 in total – and with the identification of many newborns with CRMS, the California CF NBS program continues to evolve,” stated Dr. Kharrazi. CF is not always a straight-forward diagnosis. Knowing your CF-causing mutations is critical in getting the right treatments. Disease-causing mutations with varying clinical significance will require new research to understand CFTR-related disease manifestations over time. NBS education will be refined, highlighting the importance of genetic counselors trained to help families deal with the uncertainties of the NBS results, and the uncertain health implications related to certain genotypes. Additional resources can be found at the following websites: California Newborn Screening Program, www.cdph.ca.gov/NBS and CFTR2 Project, www.cftr2.org Many new CFTR mutations have been identified since the implementation of California’s CF newborn screening program. 11 CFRI’s 27th National Cystic Fibrosis Family Educa Save the Date: July 31st – August 2nd 2015 12 cfri | Fall 2014 ation Conference cfri | Fall 2014 13 April 1, 2014 — August 31, 2014 Our “In Memory of ” and “In Honor of ” pages provide the opportunity to honor a person, family, or special event, or to remember a loved one. If you want your donation to honor or remember someone special, please include the person’s name and address with your donation. At your request, we will send an acknowledgement of your gift to the person you designate. Please mail your contributions to: CFRI 1731 Embarcadero Rd. Suite 210 Palo Alto, CA 94303 14 Donald Aasen Carol A. Adelman Marcus Adelman Sonya L. Akister Henry G. Allison Gianna R. Altano Rosemary Altano Mrs. Anderegg Edward Andreini David Armknecht Jodi Armknecht Richard Arnold Kathleen C. Baldwin Rose E. Balsley Roger Baroody Gino Barsanti Betty Ann Beard Anne C. Beltrame Barbara Bennetti Patricia Berndt James W. Bertolini Amy Bienenstock Wendy Bosarge Greg Brazil Dave Brewer Marty Brown Ellis Bryant Kyle Butler Kenneth Cady Carol Carey John Carey Sandra Cochan Ryan Coelho Kelly L. Colgan George Colla Leon Cramer Rachel Crocker Caroline Daly Irene Day Guido De Chellis Matthew DeGregory Charles Delgado Neva L. DeVore Jim Edwards Jennifer Eisner Trevor Fenn Charles M. Fontana Jerry Fox Charles Fraker Georgette Francis Bob Franks Jessica Fredrick Jerry, friend of Denise Morgan & family Judy Gaal Marie Gagliardi Laura Gale Aaron Gallagher W. Erby George Royce Goertzen Diana Goodman Robert Goodrich Douglas Graham Christina Groleau Stephanie Halling Virgil Hanson Warren A. Harden Vivian Hartman Mark Holmes Tracy Holmes Jennifer House Christopher Ireland June L. Jackson Jennifer M. Jameson Orzella Jemas Edward J. Jensen Karen Johnson Penelope Johnson Mary Jones Kathy & Peter Judge Kurt Keonig Kitty Kious Lori Kipp Bridget Klein Jeffery Kreth David Kroepfl Jane Ellen Kulik Carolyn S. Leavitt Dawn Longero Jennifer Longoria Joseph A. Losier Stephanie MacArthur Robert Mackey Christine Magee Betten Marks Jason Marshall Jordan Marshall Ken Martin Paul Mathews Nahara Mau David McAfee Karen Melvin Nancy M. Melvin Teresa Messer Jennifer Mieuli Matthew Mitchell Jessica Mobley Bob Moore Brian Moore Mike Moore Loretta Morris Roger Morris Leanor Mott Lynette Moulton Dana Munsey Kimberly Myers Elizabeth Nash Kim Nelson Kim & Scott Nelson Julie O’Leary Jennifer Ortman Dellene Ott Matthew Ozoskey Barbara Palys Joseph J. Pausner Lisa Pearne Scott Petersen Sean Peterson Steven Peterson Jon Prater Timothy Quinton Teresa Ravetto Catherine Rawlings Jaimee B. Renfrow Melissa Reta Winn Riske Joshua Roberts Katie Robinson Pamela Rockhold David Rolefson Thelma Drogin Rosenthal Marsha Rounds Billy Ruffner John Runge Randy Rupracht Siobhan H. Ryan Michelle Sanderson Maureen Sazio Kathy Schaal-Wood Dhea Schalles Linda Scherschel Joseph M. Sinnaeve Tammy Smerber Brian Smith Anabel M. Stenzel Robert C. Stewart Charlie Stockley Delinda Syme Bill Syms Christy Tegard Steven Tegard Patricia Thibault Thibault Family John Trask Louis A. Trigueiro Mary Tripp Roy Tripp James Tyrrell Jennifer Uskoski Rory & Jerry Vaeth Jodi L. Voller Aslaug Walters Tom Walton Sean Waltrip Nicky Wastell Irene Way Delores Wegner Tara Weir Maurice Wernli Hayley C. Wester Beverly L. White Sue White Tina Wilkerson Crow Cynthia Witman cfri | Fall 2014 April 1, 2014 — August 31, 2014 Connor Acheson Gordon P. Adelman Lisa Allen Sadie Anderson Hatsuko Arima Stenzel Beth Arvidson Jessica Arvidson Colby Babcock Julie Baker Kyle Baker Robert Balsley Casey Banos Bridget Barnes Lucy Barnes Jamie Barry Darrell Batchelder Joseph Batchelder Marilyn L. Bates Makinnon Baugh Marin Baugh Baugh Family Evelyn Baughman Jamie C. Beasley-Killinger Maggie-Faye Bendz Brett Bennett Amanda Bergman Moretto Allison Best Sallie Best Aidan Biggar Oliver Biggar Brian Burks Linda Burks Isabel Stenzel Byrnes Sean Campise Andrew Carl Ryan S. Carlstrom Justin Carnie Ruthie Carnie Lauren Catron Maureen Coffy Eleanor Collins Lauren Colonna Cameron Cornell James Cornell Cornell Family Barbara H. Curry Carmen Curry cfri | Fall 2014 McKenna H. David Stacy Dean Tracy Del Real Gordon DeVore Ben Dippner-Robertson Josh Dodami Jason Dolan Tess Dunn Tracey Efird Daniel Ellett Hayden Ellett Kyle England Timothy Estabrook Janelle & Andre Estournes Tommy Evans Isaac Farfan Kristin Favero Konvolinka Billy Federal Theresa Fenimore Johnnie Figueira Victoria Flamenco Kathleen Flynn Flynn Family Jacob Fraker Joseph Fraker Cody Franks Emily Fredrick Jessica A. Fredrick Rhonda Fredrick Taylor Frisbee Sean Gallagher Jenise Giuliano Larissa Giuliano Mark Glisson Elyse Elconin-Goldberg Ruth Goldberg Jen Goodwin Emily Gorsky Barbara S. Greenberg Bonnie Grossman Alejandra Guzman Sonya Haggett Hampton Twins Jean Hanley Julianna Harding Monica Harding David Hardy Kathy Hardy McKenna Hardy T.J. Hardy Alyssa Harvey Lisa Hendley Susan Hoffman Jeremiah Holdaway Joshua Holdaway Courtney Hollis Nicholas Hollis Andrew Hotson Drew & A. Hotson Erinn Hoyt Kristen Hoyt Clark Huddleston Noelle Hunt Alexander Jenkins Barbara Jensen Lindsey Jensen Darren Johst Laine Jones Michelle Jones Peggy B. Jones Wedding Guests of Amanda & M. Jozkowski Franny Kiles Edward Kinney Shae Kish Ray Knudsen Julianne Kobernus Eleanor Kolchin Jason Konkel Kathy Konkel Santosh M. Krishnan Sally Kusalo Steven Kusalo Daniel Lagasse Douglas Lagasse Susan Lane Stacey Lawn Kody Lawrence Barbara Lenssen Joey Librers Tara & S. Linehan Michael Livingston Ruth Livingston Alyson Lowery Emily F. Lucas Joseph Madrigali Larissa Marocco Eric Marten David Martin Rose Martini Gary Masching Elizabeth A. Mayer Tessa McCarthy Beth McMullen Rachael & Rebecca McMullen Kelly H. Melle Stacy Melle Jackie Merrill Linda Meyer Hannah Mitchell Anna Modlin Amanda Morelli Amanda Moretto Richard Moss Chuck Nelson Kate Nelson Jessica Nett Lindsey J. Nijmeh Erin O’Dell Scott Parks Michelle Lynn Payton Brie Peters Kelley Phillips Alex Prator Todd Primack Justin Raines Briauna Red Albert Reet Cara Richardson Rebecca Roanhaus Ben Robertson Abby Robinson Ann Robinson Carl Robinson Robinson Family Dale Roeder Taylor Rolefson Alanah Rosenbloom Ben Sanford Bridget Schmidt Janice Shaul Kerry Sheehan Kandra L. Smith David Soohoo Ethan Spain Lisa Steiding Karlye Stein Blaine Strohn Brian Tacke Alonzo Tatem Heidi Tegner Geyer Adam Thompson Corky Thompson Lauri Thompson TJ Lisa Tingley Todd Trisch Robert Turk-Bly Siri Vaeth Chris Vallee William Vogt Devin Wakefield Hayley C. Webster Jean C. Webster Christopher Wernli Pat Williams Kareese Wilson Nina Wine Amanda Wood 15 Tips for Living an Extraordinary Life: Adult Panel Discussion At CFRI’s 27th National Cystic Fibrosis Family Education Conference, during a panel discussion, “Tips For Living An Extraordinary Life,” five adults living with cystic fibrosis (CF), ranging in age from 19 to 49 years, generously shared their personal experiences and perspectives on living life fully. Moderated by CFRI’s former executive director, Carroll Jenkins, MA, the panelists – Adriana Duffy-Hörling, JD, Danielle Mandella, Anna Modlin, MA, Sara Umber, and Robert “Bob” Wright – explored issues related to employment, health insurance, disclosing one’s diagnosis, adherence to treatments, and the pursuit of life goals. Members of the audience had numerous questions for the panelists, who provided a wealth of information during their honest, and often humorous, replies. CFRI is grateful to our panel participants! 16 cfri | Fall 2014 Pain Free: Management Strategies in Cystic Fibrosis By Bridget Barnes In his lively talk, “Beyond the ‘Ouch Factor:’ Pain Management in Cystic Fibrosis,” at the recent 27th National Cystic Fibrosis Family Education Conference, Stephen Jones, MS, RN, CPNP, ET, noted that many people living with CF have chronic pain, and stressed the importance of determining the underlying cause and not just treating the symptoms. Wearing numerous hats at Children’s Hospital, Albany Medical Center in New York, Mr. Jones has worked for 31 years as a Pediatric Nurse Specialist, Pediatric Nurse Practitioner, and Enterostomal Therapist. Over the past several years, he has focused his attention on pain and discomfort in CF patients. and adults living with CF – interferes with activities, lowers the quality of life, and negatively impacts participation in daily health care. Children with more frequent pain experience worse physical and social functioning and increased CF-specific symptoms. Because pain is associated with survival, assessment and treatment of pain are crucial. Mr. Jones reported that a 2012 study found that pain is an equally common complaint for acutely ill and clinically stable adults. Pain intensity was consistent regardless of disease severity and, “pain can come from many sources because CF affects many organs.” In determining the physiological Stephen Jones, MS, RN, CPNP, ET “In America we love to treat the symptom and not the cause,” Mr. Jones explained, “but what works for one person, doesn’t work for another. Pain is a subjective indicator that something is going on,” and has sensory, emotional, cognitive, and behavioral components that are interrelated with environmental, developmental, sociocultural, and contextual factors. According to a 2007 study, children have fewer adaptive skills when pain is present, and pain early in life might lead to longterm consequences affecting growth and development. Abdominal pain – the most common discomfort in children cfri | Fall 2014 and psychological components influencing pain, Mr. Jones asked, “So the real questions are: Is it physical pain? Or is it fear, frustration, anger, or anxiety, because narcotics won’t touch these – they are psychological.” In order to determine pain relief, it’s important to understand the exact words used when a child or adult is describing pain, as every patient is different, with a different threshold and endpoint. Whether one experiences chronic or acute pain, Mr. Jones explained “it is important to stay in tune with quality of life.” Chronic pain is defined as lasting more than three months and can include sleep disturbances, and changes in appetite, activity and mood, however, overt physiological symptoms are often absent. Acute pain is sudden, sharp and localized, and results in increased heart rate, sweat, pallor, and increasing anxiety. The Joint Commission on Accreditation of Healthcare Organizations (JACHO) 2000 Standards for Pain Management considers pain “a fifth vital sign,” and decrees, “patients have the right to appropriate assessment and management of pain.” In 2013, Haverman, et al, reviewed databases from 1995 – 2012 and found 50% of patients communicated about pain with their medical team, and 25% communicated with their friends or relatives. The transition from acute to chronic pain seemed to occur around three years of age. A 2008 study found that abdominal pain is caused by a myriad of triggers including constipation, irritable bowel disease, enteric pathogens, pancreatitis, peptic ulcer disease, and biliary issues. Another study found that over 70% of adults, irrespective of clinical status, reported pain in one or more areas that interfered with important physiotherapy treatments. In children and adolescents with CF, the effect of recurrent pain on their quality of life significantly reduced physical functioning, vitality, and overall perception of their health. While these children had reduced pulmonary function, their pain had a greater impact on their quality of life. A 2014 study at one CF center assessed the prevalence of depression and identified risk factors in children with CF. Of 190 patients, 9% had a documented diagnosis of depression and 50% were on antidepressant medications. “One thing led to another led to another,” Continued on page 18 17 Pain Management with breathing techniques, music therapy, healing touch, guided imagery, and hypnosis. Pharmacological treatments are the second line of defense, and include aspirin, ibuprofen, naproxen, or acetaminophen, followed by narcotics if necessary. “Narcotics focus on the central brain and have side effects such as constipation and dependence.” Opioids might be required for acute and chronic pain in severe advanced illness and lung transplant. Continued from page 17 Mr. Jones said, adding, “psychological and emotional components are key in pain assessment and management.” Knowing that pain exists in CF, Mr. Jones talked about pain scales, which are designed as either uni-dimensional (i.e. only one sensory component) or multidimensional, which are useful in looking at the characteristics and impact of persistent pain conditions when additional and more in-depth information is needed. Management of pain in CF “is a balancing act.” For acute pain, Mr. Jones recommended non-pharmacological methods to treat and control any underlying secondary condition first, including therapeutic play for children, distraction, relaxation along Research for Living Continued from front cover underlying chloride channel defect in 4% of the CF population. The recent characterization and establishment of novel cell models for CF, such as CF epithelial cell lines, conditionally reprogrammed CF cells, and induced pluripotent stem cells will continue to advance cell-based therapies and personalized medicine approaches for CF patients. Recently, I have focused on the discovery of a multi-component bacterial defense mechanism that does not work properly in CF airway epithelial cells, and our laboratory is exploring the idea that CFTR and its partner in crime, bicarbonate, are involved with the CF airways’ weak natural defense. I am excited to study this antimicrobial defense system and test its utility to combat bacterial and fungal infections, as it holds promise to delay the onset of chronic infections in CF children. The 2010 Annual Report of the CF Foundation Patient Registry found that lung infections occur in 40% of children with CF ages 6 to 10, and 60% of teenagers up to age 17. This new line of research is timely and critical because it may translate to the clinic and improve early treatment of bacterial infections in young CF patients. Personally, CFRI’s annual National Cystic Fibrosis Family Education Conference, which brings CF health care professionals and research scientists together with 18 Management of pain is a balancing act. In concluding, Mr. Jones listed important “remember points” to consider when managing pain. “Use appropriate assessment tools, don’t under medicate, remember there is no one ideal medication, and consider the patient’s developmental level, especially for children. We want to keep everyone pain free.” CF patients and their families, has taught me what it means to live with CF, and has put faces behind the disease. Based on this, I developed a passion to train the next generation of CF scientists. In 2005, I established the summer student program at CHORI in partnership with the Elizabeth Nash Foundation, to provide oneon-one training and hands-on lab experience in CF research. To Beate Illek, PhD, with fellow researcher Horst Fischer, PhD, and two date, 16 college participants in the 2013 CF Summer Research Program. students have participated, several of whom are personally to the SF Bay Area and matching them impacted by CF. I am also honored to serve with the most promising collaborative on CFRI’s Research Advisory Committee CF-related projects. Thus far, 19 research and as the Fellowship Administrator for scientists and 32 fellows have participated their Elizabeth Nash Memorial Fellowship in more than 30 CF research projects. Program. Founded by the brilliant and Thanks to CFRI’s research support, over visionary Dr. Jonathan Widdicombe, the 200 publications have been produced. program serves as an incubator to grow CFRI brings hope of a cure for CF. a new generation of CF scientists, by Together we can do it! attracting the best postdoctoral fellows Research for living ~ Partners for life. cfri | Fall 2014 CFRI’s CF Research Challenge Fund A Success! Three New Projects Funded Thanks to the Leadership of the 2014 CF Research Challenge Circle Donors CFRI wishes to warmly acknowledge the members of our 2014 CF Research Challenge Circle, who generously contributed $75,000 so as to match – dollar for dollar – donations to our CF Research Challenge Fund. Thanks to their generosity, and that of our CF Research Challenge donors, $150,000 will be designated for three additional cystic fibrosis research projects in 2014-2015. For those of you who are inspired by the leadership shown by our Circle members, please join us! Together, we can support the innovative research that will lead us to new treatments, and ultimately, a cure. 2014 CF Research Challenge Circle Honorary Co-Chairs Jim and Barbara Curry Paul Quinton, PhD Francine and Joel Bion Dave and Kaye Cartnal CFRI Board of Directors Crossfit Ridgecrest Benefit Suzanne Freiley Insight Safari Carroll P. Jenkins Katie Knipp Marc and Sue Landgraf Fred and Linda Milanovich Doug and Robin Modlin Elizabeth Nash Foundation David and Marcella Soohoo Tim and Ann van Oppen Vertex Pharmaceuticals, Inc. Sandra K. Wilson Estate Zumbathon Benefit Christian and Darnelle Zimmerman For information on how you can join our 2015 CF Research Challenge Circle please contact Sue Landgraf, Executive Director, at 650.404.9975. cfri | Fall 2014 Help Us Pursue Our Mission Together We Can Provide Support for Living and Research for Life • DONATE TO THE 2015 CF RESEARCH CHALLENGE CIRCLE CFRI has launched the CF Research Challenge Fund to raise funds to support additional CF research projects. Become a member of the CF Research Challenge Circle, and your gift will be used to encourage and match gifts from donors and will be restricted to research programs. • 40 Years – 40 Events: HOLD YOUR OWN FUNDRAISER Big or small, we appreciate them all! Zumbathons, concerts, cupcake sales, dinner parties with a special guest of honor, bocce ball tournaments – come up with an idea and we will support you! • MOTHERS’ DAY TEA Our Mothers’ Day Tea continues to be CFRI’s largest fundraiser. Because every day is Mother’s Day, we have expanded our fundraiser to take place year-round. Please contact us if you would like to become a Tea Sender. For those who wish to use the Internet to reach out to friends, colleagues and family members, you may also take advantage of our Virtual Mothers’ Day Tea. It is fast, easy and fun! • TRIBUTES IN HONOR OF, AND IN MEMORY OF Any gift to CFRI can be made in honor or in memory of a loved one. Your loved one’s name will appear in our newsletter, CFRI Community, and if requested, an acknowledgement will be sent to the person you designate. • GIVING GIFTS OF STOCK TO CFRI Giving a gift of appreciated stock to CFRI is easy and rewarding. You will not pay capital gains tax on stock that has appreciated over the years. You will receive an income tax charitable deduction for the fair market value of the stock on the date of the gift. If you hold stock certificates that you wish to donate to CFRI, contact us for instructions on how to complete the transaction. • CHARITABLE PLANNED GIVING Planned giving offers benefits for donors that often include increased income and substantial tax savings, while providing the opportunity to meet your philanthropic goals and provide positive tax benefits. • ATTEND A CFRI FUNDRAISING EVENT Whether you want to golf, wine taste, or mingle while bidding on exclusive auction items, we have an event for you! Upcoming events include: — Wine for a Cure, a food and wine extravaganza at the Purple Orchid Wine Country Resort and Spa in the Livermore Wine Country, on October 19th, 2014. — Sixty-Five Roses Benefit Concert with Tess Dunn and Special Guests at Moe’s Alley, Santa Cruz, on December 14, 2014. • VEHICLE DONATIONS If you have a car, boat, recreational vehicle, or motorcycle that you no longer need, please consider donating your vehicle to CFRI. This contribution is tax-deductible, and we will coordinate the transfer of property. Visit our website for details on making a donation. For more information please contact Mary Convento at 650-404-9975 or [email protected] 19 Cystic Fibrosis Quality Of Life Program Draws Focus To The Body-Mind Connection By Meg Dvorak, LCSW “If you are only treating the body, you are treating half of the patient.” – Norman Cousins, 1989 The Cystic Fibrosis Quality of Life (CFQofL) Program: A Living Legacy of Peter Judge was developed in 2008 to expand awareness of the body-mind interconnection in chronic disease and to encourage treatment for both. The CFQofL Program Advisory Board, chaired by Dr. Richard Moss, Professor Emeritus of Pediatrics at the Stanford School of Medicine, undertook an extensive literature review of the bodymind interconnection. The review, primarily gleaned from research projects undertaken by specialists in cancer and other chronic disease, showed that improvement in the psychological, social and spiritual wellbeing of patients improves their physical condition, quality of life, and in some situations, survival. With the wealth of information available from these studies, as well as ongoing studies specific to CF, the CFQofL Program brought together a consortium of chronic disease specialists, professional caregivers, patients, and family members to work collaboratively on a variety of projects, with the goal of educating our professional and Connecting mind, body and spirit lay communities on the need to include psychosocial and spiritual counseling in the overall treatment for cystic fibrosis. The board has partnerships with the Stanford School of Medicine at the Center 20 Psychological and social well-being is linked to improved health and quality of life. for Education in Family and Community Medicine, the Community Center for Health and Wellness at Sofia University, and CFRI to promote awareness and develop programs to help CF patients. with transportation or health barriers. The CCHW also offers a monthly support group for caregivers of CF patients. These programs are currently under-utilized, and CCHW hopes that more patients in the SF Bay Area will take advantage of these One such program, developed and managed opportunities for support. by the CFQofL Program, offers a sliding scale for individualized counseling services at the Another of the board’s projects is The Community Center for Health and Wellness Peter Judge Memorial Fund, established (CCHW) in Palo Alto, California. The CCHW and maintained to assist adults with CF counselors are to pay for costs associated with getting trained by to Stanford hospital for care, including experts in the gas, tolls, meals, and lodging. For more CF community information about the fund, please contact (including Meg Dvorak at (650) 518-9976. Dr. Moss and Editors’ note: While the programs others from the Stanford teams) discussed above were created to serve the cystic fibrosis community residing near to understand the Stanford CF Center in California, they the complex serve as an excellent model of effective psychosocial issues associated collaboration between cystic fibrosis centers and community organizations to with cystic meet the needs of those with CF. There is fibrosis – stress, grief, depression, a vital need for programs that address the psychological, social and spiritual well-being body image, of cystic fibrosis patients, which have been insecurity, documented to improve their physical insurance and finances, problems with health and quality of life. It is our hope relationships, and addiction. No one in that Ms. Dvorak’s article inspires others to need of counseling is turned away due to lack of funds, and counseling sessions explore the possibility of duplicating this impactful model in their communities. may be conducted by phone for those cfri | Fall 2014 The 30th Annual Cystic Fibrosis Benefit Tournament Raises over $60,000 for CFRI The 30th annual Cystic Fibrosis Benefit Tournament, held on August 4th, at the illustrious Pasatiempo Golf Club in Santa Cruz, California, raised over $60,000 to support CFRI’s vital research and programs. Spearheaded by Scott Hoyt, father of two daughters with cystic fibrosis (CF) and manager of Pasatiempo Golf Club, the tournament brought together 170 people committed to supporting the search for a cure. “Many people associated with the tournament deal with the disease on a daily basis, and we are all so thankful for the caring support,” Scott expressed. One of the largest groups in attendance, “Team Becca – Becca’s Bro’s,” was there in support of Becca Roanhaus, daughter of long-time CFRI Board member Mike Roanhaus, and included many of Mike’s fraternity brothers from college. Major sponsors of the event included the Mike and Dea Roanhaus family, HDR Architecture, Star One Credit Union, the Kirkorian Family Foundation, and the Scott and Anne Hoyt family. Becca Roanhaus surrounded by members of Team Becca, who golfed and raised funds in her honor. Scott shared how meaningful it was to have people with CF participating at the tournament and banquet. “It was very special, as tournament participants see the impact of their support. The life expectancy for those diagnosed with CF has more than doubled since the start of this benefit golf tournament, and the quality of life for those with the disease has drastically improved due to the advancements in treatment and medications.” The 31st Annual Cystic Fibrosis Benefit Tournament will be held next summer on August 3rd, 2015. Mark your calendars! In addition to golfing at a “top-100” course, you will help bring hope to those living with cystic fibrosis. Ask the Experts Panel: A Rare Opportunity A highlight for many conference attendees at our annual National Cystic Fibrosis Family Education Conference is the “Ask the Experts” panel, in which conference speakers make themselves available to the audience for 90 minutes to answer a wide range of unscripted questions. This year’s cfri | Fall 2014 moderator was CFRI’s Siri Vaeth Dunn, MSW, the mother of a young adult with CF. Participants on the panel included (from left to right): Ahmet Uluer, MD, DO; Katherine Van Loon, MD, MPH; Stephen Jones, MS, RN, CPNP; Thomas Keens, MD; Marty Kharrazi, PhD, MPH; and Isabel Stenzel Byrnes, MSW, MPH. Expanding its impact, the session was live streamed to the online cystic fibrosis community, and viewers were able to email their questions to be asked in real time. The recording of this informative panel will be posted on CFRI’s website, www.cfri.org 21 27th National Cystic Fibrosis Family Education Conference The Changing Faces of Cystic Fibrosis: Inspiring Hope DVD Order Form Presentations from CFRI’s 27th National Cystic Fibrosis Family Education conference are available on DVD format. $5.00 for each disk and $20.00 for all 4 disks. Order Disk Topics / Speakers D1 Mary ElizaBeth Peters, Theatre Artist and CF Educator, Boston, MA More than Survival: Pursuit of Healthiness D1 Thomas Keens, MD, Pediatric Pulmonology, Children’s Hospital Los Angeles, Los Angeles, CA D2 Ahmet Z. Uluer, MD, DO, Division of Pulmonary and Respiratory Diseases, Boston Children’s Hospital, Boston, MA D2 Antionette Moran, MD, Division of Pediatric Endocrinology Medical School, University of Minnesota, Minneapolis, MN D2 The Resilient Character: Adapting Well To Changes in Our CF Isabel Stenzel Byrnes, MSW, MPH, Social Worker, San Francisco Bay Area D3 Beyond the Ouch Factor: Pain Management in CF Stephen Jones, MS, RN, PNP, Children’s Hospital, Albany Medical Center, Albany, NY D3 CF and Cancer: Who Should Be Concerned and What Can Be Done Katherine Van Loon, MD, MPH, Gastrointestinal Surgery and Oncology Clinic, UCSF Medical Center, San Francisco, CA D3 Reflections on Detection of CF and CFTR-Related Metabolic Syndrome (CRMS) in California Newborn Screening Martin Kharrazi, PhD, MPH, California Department of Public Health, Richmond, CA D4 Tips For Living an Extraordinary Life | Adults With CF Panel Discussion Carroll Jenkins, MA (Moderator) D4 Ask the Experts (Panel Discussion with Conference Speakers) Thomas Keens, MD; Ahmet Uluer, MD, DO; Katherine Van Loon, MD, MPH; Martin Kharrazi, PhD, MPH; Stephen Jones, MS, RN, PNP; and Isabel Stenzel Byrnes, MSW, MPH – Siri Vaeth Dunn, MSW (Moderator) Where We Have Been and Where We Are Going The Therapeutic Pipeline: CF Research Updates The Sweet Evolution of CF-Related Diabetes (CFRD) Send your order to: Cystic Fibrosis Research, Inc. (CFRI), 1731 Embarcadero Road, Suite 210, Palo Alto, CA 94303, USA Fax: 650.404.9981, Phone: 1.855.cfri.now or order online at www.cfri.org. Thank you! Name Address City Phone Total Number of Disks 22 ZIP E-mail Payment Method: Credit Card Type / Number Signature State Check Credit Cash Total Amount $ Expiration date CF Relationship cfri | Fall 2014 Thank You for Your End-of-Year Support! As autumn begins, and the end of the year draws nearer, many of us begin to plan our year-end gifts to those charitable organizations that are important to us. We hope you will consider CFRI when making these decisions. We are fortunate to have a dedicated and caring community that believes in the work of CFRI and supports our mission to fund research, provide educational and personal support, and to spread awareness of cystic fibrosis. Your end-of-year gift is greatly appreciated and central to the work we do. This year you might think of giving through: • the enclosed CFRI Community remit envelope • a donation of stocks or other marketable securities • our online donation program at www.cfri.org • your company’s Workplace Giving program • a vehicle donation • the CFRI Special Gifts letter coming to you in December • participation as a 2015 CF Research Challenge Circle Donor Whatever you are able to give is greatly appreciated. Depending on the type of gift, you may receive additional tax deductions. It is always prudent to review your charitable giving with a financial advisor. Thank you for your support this year, and for your continued commitment to CFRI’s mission in 2015! For more information, please contact Sue Landgraf, Executive Director at 650.404.9975. 40 ars – For ty Eve e Y y nt s rt o F Stay Tuned! In 2015, CFRI will celebrate 40 years of supporting innovative research and services to the cystic fibrosis (CF) community. In honor of this auspicious anniversary, CFRI will soon launch an exciting “40 Years – 40 Events” project. We hope to inspire a minimum of 40 separate fundraising events across the country with CFRI as the beneficiary. Please join us! The ideas are endless, including concerts, bowl-a-thons, cook-offs, 10k runs, auctions, car washes, and more! What’s your idea? Imagine the CF research, education and support services we could fund with this collective fundraiser. To get involved, please email [email protected], or call 650-404-9975. cfri | Fall 2014 Save the Dates CFRI’s Discovery Series “Taking CF to College” Cindy Marota Director, Accessible Education Center San Jose State University Tuesday, October 14, 2014 6:00 pm – 7:30 pm Crowne Plaza Hotel Palo Alto CFRI’s Wine for a Cure Sunday, October 19, 2014 Purple Orchid Wine Country Resort & Spa in the wine country of Livermore, CA Spectacular wine, food, music, auction, & celebrities: A fundraiser for CFRI’s research, education and support programs! Book Signing With Isabel Stenzel Byrnes: The Power of Two Second Edition Thursday, October 23, 2014 7:00 pm Books Inc. (Town & Country Village) 855 El Camino Real, Palo Alto, CA CFRI’s Discovery Series “Gastrointestinal Challenges in Cystic Fibrosis: Enzymes, Laxatives, and Beyond” Julie Matel, MS, RD, CDE Lucile Packard Children’s Hospital Stanford Tuesday, November 11, 2014 6:00 pm – 7:30 pm Crowne Plaza Hotel, Palo Alto, CA Sixty-Five Roses Concert Event With Tess Dunn & Special Guests Music, Auction, Tacos, & More, Benefitting CFRI Sunday, December 14, 2014 7:00 pm Moe’s Alley, Santa Cruz, CA www.moesalley.com For more information about any of these events, please call 1.855.cfri.now (1.855.237.4699) or email [email protected] 23 Nonprofit Organization U.S. Postage PAID Palo Alto, CA 1731 Embarcadero Road . Suite 210 Palo Alto, California 94303 Permit #24 Change Service Requested CFRI’s mailing list is confidential. We do not sell our list, nor do we give out any names or addresses under any circumstance. CFRI Mission Cystic Fibrosis Research, Inc. exists to fund research, to provide education and personal support, and to spread awareness of cystic fibrosis, a life-threatening genetic disease. CFRI Vision As we work to find a cure for cystic fibrosis, CFRI envisions informing, engaging and empowering the CF community to help all who have this challenging disease attain the highest possible quality of life. Visit our website at: www.cfri.org for more information about us and about cystic fibrosis. Wine for a Cure – Please Join Us On October 19! Wine for a Cure promises to be a crowd pleaser. Held at the gorgeous Purple Orchid Wine Country Resort and Spa in Livermore, the event will bring together some of the most notable vintners from the region, including Steven Kent, La Rochelle, McGrail Vineyards, Bodegas Aguirre, and De Fina Family Cellars. Bountiful gourmet food will be provided by On the Vine, while live and silent auctions, complete with jewelry, sports tickets and luxury vacation packages, will tempt guests to bid for a cure. Special celebrities will be in attendance, including Hollywood actor Todd Purple Orchid Wine Country Resort and Spa Giebenhain, who lives with CF; San Francisco 49er great Bill Ring; drummer Professor and Director of Stanford Medical Center’s Pediatric Cystic Fibrosis Center, in and percussionist Adam Topol; and singerrecognition of his inspirational dedication to songwriter Tess Dunn, who lives with CF. providing the highest quality of care to children The event will be held on Sunday, October and teens living with cystic fibrosis. 19, from 4:00 to 7:00 pm, with a special VIP Generously sponsored by Vertex Pharmaceuticals, reception from 3:00 to 4:00 pm, featuring library wines from the Steven Kent portfolio, AbbVie, Chiesi USA, Inc., and the Pleasanton Lions Club, Wine for a Cure will support CFRI’s the opportunity to mingle with event vital programs, bringing hope to those living celebrities, and an intimate performance by recording artists, Adam Topol and Tess Dunn. with cystic fibrosis. The Caregiver of the Year Award will be presented to Dr. Carlos Milla, Associate To purchase tickets online, please visit: www.cfri.org/wineforacure.shtml For their generous support of CFRI Community, special thanks to: Chiesi USA, Inc. • Genentech Call toll free: 1.855.cfri.now Cystic Fibrosis Research, Inc. a 501(c)(3) nonprofit organization Federal EIN# 51-0169988
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