Adult Cystic Fibrosis Clinic - health support services

The CF Nurse Coordinator oversees the operation of the patient clinics, including outreach clinics and patient video conference sessions;  liaises with other members of the CF team, inpatient Clinical nurse Leaders, Home IV nursing, BC transplant Program, BC Children's CF Program, CF Canada, and the CF Canada Nursing Advisory Group.

The Clinic Coordinator, in conjunction with the CF Team, participates in nursing education on patient units.

In conjunction with the CF Clinic Nurse Coordinator, the CF Clinic Coordinator manages the care of the CF outpatient community, organizes CF clinic visits, and manages the CF Data Registry. 

Vitamins and minerals are needed for the normal growth, function, and health of our bodies. People with CF need extra vitamins and minerals for good health.  It can be difficult to meet these needs because of malabsorption, increased needs, and a poor appetite especially during times of illness.

Some of the specific Vitamins and Minerals that are known to be higher risk for deficiency in CF are:

• Vitamins A, D, E and K and others.  More information can be found here.
• Calcium, Iron, Zinc  More information can be found here.

About 85 percent of patients with CF have pancreatic insufficiency. This can lead to varying difficulties with digesting and absorbing nutrients from food.  As a result, many people with CF find it a challenge to maintain and gain weight.  It can also lead to vitamin and mineral deficiencies which can affect many different systems in the body. 

Supplementing with enough pancreatic enzyme replacement can be a tricky thing.  Your Dietitian, Pharmacist and Doctor will help to optimize your pancreatic enzyme replacement therapy (PERT) to help you digest your food properly.  Some of the symptoms of inadequate PERT are bulky stools, loose stools, foul smelling stools, greasy stools, pale looking stools, abdominal cramping, bloating, flatulence and difficulty with maintaining or gaining weight despite adequate intakes. The CF Foundation has a  thorough article about Enzymes and how they work. 

One of the unique problems that can develop in someone with CF is a condition in which the bowel or intestine may become partly blocked.  This can cause a lot of pain, bloating, cramping and nausea.  About one out of every 10-20 people with CF get DIOS. More information about what DIOS is, how to recognize it and how it is best treated from the CF Canada website.

Osteopenia and osteoporosis is a condition in which the bones become more porous.  This can lead to weak bones which can lead to fractures.  Making sure your diet is adequate in calcium, vitamin D, and vitamin K is an important step in making sure you are meeting your body’s needs for maintaining strong bones.  Along with nutrition, weight bearing exercises and resistance exercises like walking, running, and weight lifting will help to keep bones strong. The Cystic Fibrosis Foundation website has published information about bone health in CF. 

As people are living longer with CF, some other conditions like impaired glucose tolerance and diabetes are becoming more common.  In the adult clinic at St. Paul’s Hospital, we are seeing about 40 per cent of our patients with different degrees of impaired glucose tolerance and diabetes.  Please click on the links from Cystic Fibrosis Canada  for more information about CF related diabetes, how it is diagnosed and how it is treated in CF. 

The CF Foundation website has a section on Diabetes that covers what is CFRD, diagnosis, management and what research is being done.

Information on impaired glucose tolerance can be found here. 

If you are registered with a CF Clinic in British Columbia and you are registered for Fair Pharmacare, you will have access to coverage of nutritional supplements and a group of vitamins and minerals once you have reached your Pharmacare deductible.  These supplements are covered under Plan D under the BC Pharmacare Plan.  Not everyone needs nutritional supplements to maintain their weight and nutrition but if it becomes necessary, your CF Team may recommend them.  A prescription from the CF Clinic is necessary to get any products listed on Plan D to have it covered by Pharmacare.  Please contact the CF Clinic if you require a prescription. 

A list of eligible products covered by Pharmacare under "Cystic Fibrosis (Plan D)" can be found here. 

Airway clearance is a cornerstone of self-management in CF, and many different techniques exist for CF patients to choose from. At this time, there is no evidence that any one technique is superior to the others, and different methods will suit different people depending on a variety of factors including lifestyle, stage of lung disease, personal preference, finances and comfort. For a good short overview of the commonlyused techniques, CF Canada’s website has a list with brief descriptions. Less commonly used techniques and devices are also included on that page, but are not officially endorsed as it is felt that further research is required.

For a more detailed discussion of individual techniques with extensive references, please see the “Blue Book”, put together by the International Physiotherapy Group for CF.

Your clinic physiotherapist is happy to discuss airway clearance with you at any time, and can assist you in choosing a technique that works for you.

The most commonly used pieces of equipment for CF treatments are compressors, nebulizers and airway clearance devices. These are available for purchase through a variety of vendors in BC. Please consult your clinic physio or pharmacist to determine what equipment you should be using to take your medications.

In order to function properly, and to prevent possible infection, most equipment needs to be cleaned regularly, and some of it needs to be replaced at regular intervals. Nebulizers should be replaced every 6 to 12 months, as should compressor filters. Compressors themselves should be replaced when they are no longer functioning well (3 to 15 years depending on the model and amount of use).

A group of Canadian CF physiotherapists has put together a document about equipment cleaning, and it covers all of the commonly used airway clearance and nebulization devices. At the very least, airway clearance devices and nebulizers should be cleaned in warm soapy water (use a mild dish soap like Sunlight), rinsed and air dried after each use. These devices should be disinfected at least once per week. There are several ways to do this. Most Pari equipment is safe in the dishwasher on the top rack, which is fine if your dishwasher gets hot enough to kill bacteria (>70°C or 158°F for 30 minutes). If it doesn’t, boiling for 10 minutes is the next-easiest method. Soaking for 10 minutes in rubbing alcohol or 30 minutes in 3% hydrogen peroxide is also an option. Soaking in a solution of 3 parts water to one part white vinegar used to be recommended; however, there is some question as to whether vinegar kills pseudomonas effectively, so we no longer recommend this method. Rinse the devices with sterile water (water you boiled for 10 minutes or sterile water you purchased) and allow to air dry on a clean surface.

Don’t clean the nebulizer tubing. Replace it when you get a new nebulizer.

Here are links to some commonly-used equipment suppliers in BC, plus the link to the website that sells the eFlow system and its replacement parts in Canada:

• http://www.vitalaire.com/
• http://www.westcaremedical.com/
• http://www.medprorespiratory.com/
• http://www.londondrugs.com
• http://www.agecomfort.com
• https://www.trudellmed.com/ca/en-CA/

Salbutamol and hypertonic saline can be taken with any jet nebulizer, even one with a mask.  The Pari LC Plus or Trudell AeroEclipse II should be used for antibiotics (unless the drug comes paired with a specific device); the Pari LC Star or Trudell AeroEclipse II should be used for Pulmozyme.

Usually, this is equipment-related. With a fully-functioning compressor and the correct nebulizer cup, most meds shouldn’t take more than 15 minutes to run through, and some take much less than that. If it is taking much longer, it may be because the nebulizer is worn out and needs to be replaced, or the compressor filter might be clogged, or there may be a problem with the compressor itself. If more than one nebule is added to the cup (e.g. mixing hypertonic saline and ventolin), it may be that there is just too much volume for the nebulizer to work efficiently. Additionally, most meds don’t need to be run until the nebulizer is bone dry. Having a few drops leftover (up to 1 mL in the case of Tobi) is okay.

The eFlow Rapid is available through  this website. Go to the search field and enter "eRapid" for information about ordering this item or replacement parts for it if you already have one.

This type of exercise helps to increase the efficiency with which the body uses oxygen, and regular aerobic exercise can lead to better endurance and better quality of life. Some examples of aerobic exercise are walking, running, swimming, stair climbing, hiking, cross-country skiing, cycling, rowing and some types of dancing, among others.

This type of exercise primarily strengthens the muscles, but can also help develop the aerobic capacity to a limited extent. It involves lifting weights that challenge the muscles for a series of repetitions, and includes body weight exercises like push-ups and pull-ups. Strength training can be done at a gym or at home, and a good basic program can require very little equipment and a reasonable time commitment. 

Strength training is beneficial to men and women of all ages. 

It can be very helpful to work with a qualified trainer when first starting out, as proper execution of strength training movements can help prevent injury and maximize benefit. The CF PT can assist with one-on-one coaching or providing references to resources in the community.

Stretching is of particular importance to people with CF because a lifetime of coughing can have long- term effects on the body. Maintaining muscle length and strength throughout the body can make breathing easier and prevent the pain that can come from muscle stiffness and joint dysfunction.

Yoga and Pilates are options that can help develop flexibility and core strength and can be of great benefit to people with CF, though not all instructors are well-trained and one should choose carefully. Certain postures may need to be modified to suit individual needs, especially for those who have acid reflux symptoms or significant sinus disease. A good teacher should be able to provide an alternate exercise that will have similar benefit but less risk of flaring up symptoms. For infection control reasons, people with CF should use their own mats and props in group classes as much as possible, and observe good hand hygiene procedures before and after class.

Usually, this is not a worry. If anything, exercise can help to maintain or increase  muscle mass. Eating within 30 minutes of finishing a workout can help with recovery and retention of or increase in muscle mass. For those who lose weight easily, the post-exercise snack should be calorie-dense and contain protein, carbohydrate and fat. Chocolate milk or soy milk is an easy solution, especially as fluids need replenishing after exercise as well. Boost or other nutritional supplements are useful in this context, too. Real food is always the best choice if there is more time to plan and prepare post-exercise snacks ahead of time. Sandwiches are a convenient and versatile option. Pancreatic enzymes should be taken with snacks, as directed by the CF dietician, and blood sugar checks should be done pre- and post- exercise, or as directed by the endocrinologist.

At this time, there is no evidence to support this approach. Most studies have shown that exercise on its own is inferior to the combination of exercise plus an airway clearance technique in terms of secretion clearance. It is recommended to do both.

Ultimately, the best exercise for any individual is the most enjoyable and accessible one for that person. Weight-bearing exercise is recommended for maintaining bone health. Non-weight-bearing exercises such as swimming, cycling and rowing can be a valuable part of an exercise program, but shouldn’t make up the program in its entirety when bone density is low. Alternating these exercises with brisk walking or running can be helpful. Strength training exercise should be done on two or more days per week.

The best and most accurate way to do this is to have a cardiopulmonary exercise test (CPX or CPET). These can be arranged through the CF Clinic. The test involves riding a stationary bike while hooked up to machines that measure heart rate, blood pressure, oxygen consumption and carbon dioxide production. It usually lasts less than 10 minutes. The results will show how efficiently your body is working compared with the average for people your height, weight, age, sex and race. It can help the clinic physiotherapist or another exercise professional design an exercise program that will help improve fitness by making sure the intensity of the exercise is appropriately challenging for one’s measured level of ability.

Supplies needed:

1. Vials of tobramycin 40 mg/mL 
2. Alcohol swabs
3. 5 mL syringes
4. 10 mL sterile sodium chloride 0.9% (‘normal saline’) OR ampoules with no rubber top
5. 20 gauge needles 
6. Sharps container

How to prepare the tobramycin for nebulization:

1. Prepare clean area for mixing tobramycin for nebulization, and wash your hands thoroughly with soap and water.
2. Uncap the plastic covers from the vials of tobramycin and normal saline (if using the vials).
3. Use the alcohol swab to clean the rubber tops of the vials.
4. Attach a needle to a new 5 mL syringe. 
5. Pull back 2 mL of air into the syringe and insert into the top of the tobramycin vial
6. Pick up the syringe needle and vial with one hand, making sure the needle is always below the liquid line.
7. Push the syringe plunger to release the air into the vial and pull back 2 mL of the tobramycin into the syringe. Add the 2 mL to the nebulizer cup.
   1. 2 mL = tobramycin 80 mg 
8. Dilute the tobramycin with enough sterile normal saline to give a final volume of 3 mL in your nebulizer cup (i.e. you will need 1 mL of sterile normal saline)
   1. Pull back 1 mL of air into the syringe 

If using a sterile normal saline vial:

1. Insert the needle into the rubber top of the normal saline vial 
2. Pick up the syringe needle and vial with one hand, making sure the needle is always below the liquid line.
3. Push the syringe plunger to release the air into the vial and pull back 1 mL of normal saline into the syringe. 

If using a sterile normal saline ampoule:

1. Do not pull back air into the syringe
2. Insert the needle into the opening of the ampoule 
3. Pull back 1 mL of normal saline into the syringe.
4. Remove the needle syringe from the vial (or ampoule) of normal saline, then add to the nebulizer cup along with the tobramycin. Recap the needle syringe and discard in designated sharps container.
5. Inhale the tobramycin solution by nebulizer, as directed by your doctor.
6. Opened vials of tobramycin are stable in the refrigerator for 7 days. Used sterile normal saline vials can also be kept in the fridge, but should be thrown away after 24 hours. 

For the afternoon/evening dose:

1. Follow the same technique and procedure as Steps 1 to 11.

*NOTE: A new needle and syringe should be used for each dose to maintain sterility

Dose of nebulized tobramycin: 

Tobramycin 80 mg (2 mL + 1 mL sterile normal saline) nebulized twice daily after physiotherapy.

*NOTE: If you experience airway irritation when nebulizing tobramycin, please inhale 2 puffs of salbutamol (Ventolin®) 15-20 minutes before your tobramycin.

Supplies needed:

1. Vials of colistimethate 150 mg
2. Alcohol swabs
3. 5 mL syringes
4. 10 mL sterile water OR ampoules with no rubber top
5. 20 gauge needles 
6. Sharps container

How to prepare the colistin for nebulization:

1. Prepare clean area for mixing colistimethate for nebulization, and wash your hands thoroughly with soap and water.
2. Uncap the plastic covers from the vials of colistimethate and sterile water (if using the vials).
3. Use the alcohol swab to clean the rubber tops of the vials.
4. Attach a needle to a new 5 mL syringe. 
5. If using a sterile water:
   1. Pull back 3 mL of air into the syringe 
   2. Insert the needle into the rubber top of the sterile water vial 
   3. Pick up the syringe needle and vial with one hand, making sure the needle is always below the liquid line.
   4. Push the syringe plunger to release the air into the vial and pull back 3 mL of sterile water into the syringe. 

If using a sterile water ampoule:

1. Do not pull back air into the syringe
2. Insert the needle into the opening of the ampoule 
3. Pull back 3 mL of sterile water into the syringe.
4. Remove the needle syringe from the vial (or ampoule) of sterile water, then insert the needle into the rubber top of the colistimethate vial. 
5. Inject the 3 mL of sterile water into the colistimethate vial. Remove the needle syringe from the vial and recap the needle.
6. Gently swirl the colistimethate vial until the powder has dissolved. Do not shake the vial, as this may cause the medicine to foam. If foam develops, let the vial stand until it settles. (If foaming occurs during nebulization, may let reconstituted vial sit in refrigerator for 30-60 minutes).

Measurement and administration of dose:

1. The strength of the colistimethate solution in the vial is 50 mg/mL (150 mg in 3 mL).
   1. One 150 mg dose is 3 mL of solution (i.e. one vial provides one dose)
2. Pull back 3 mL of air into the syringe used for reconstitution. Insert the needle into the rubber top of the reconstituted colistimethate vial.
3. Pick up the syringe needle and vial with one hand, making sure the needle is always below the liquid line.
4. Push the syringe plunger to release the air into the vial and pull back 3 mL of colistimethate solution (3 mL = 150 mg colistimethate).
5. Add the 3 mL of colistimethate solution to your nebulizer cup. Recap the needle syringe and discard in designated sharps container.
6. Before nebulizing colistimethate, first inhale 2 puffs of salbutamol (Ventolin®), to help minimize airway irritation. 
7. Inhale colistimethate solution by nebulizer, as directed by your doctor.
8. Reconstituted vials of colistimethate are stable in the refrigerator for 24 hours. Used sterile water vials can also be kept in the fridge, but should be thrown away after 24 hours. 

For the afternoon/evening dose:

1. Follow the same technique and procedure as outlined above, using a new 5 mL syringe.

Dose of nebulized colistin: 

Colistimethate 150 mg (3 mL) nebulized twice daily after salbutamol (Ventolin®) 

*NOTE: 

- A new needle and syringe should be used for each dose to maintain sterility

- If using a rapid nebulizer (e.g. eFlow), a lower dose may be required – please discuss with your CF team

1. Bronchodilators first (e.g.salbutamol), to open up the airways.               
2. Mucolytics second (hypertonic saline or pulmozyme), to loosen/thin secretions
3. Wait 30 minute (if possible)
4. Do airway clearance next.
5. Steroids (e.g Pulmicort)
6. Antibiotics (Tobi, Cayston, colimycin etc.)

Medical coverage, which is coverage for things such as doctor’s visits, hospitalizations and lab tests, is provided for all BC residents through MSP. All BC residents must apply themselves for MSP either online or by phone. Check  The BC Ministry of Health website for information and application.  

Medications for BC residents are covered through Fair Pharmacare. Under Fair Pharmacare you will pay a yearly deductible for your medications which is calculated based on your yearly income.  If you are low income you will pay a lower deductible. Some people pay no deductible if their income is very low. After the full deductible is paid all of your eligible medications will be covered by Pharmacare. This is why registration for Fair Pharmacare is so important for CF patients, even if you have a benefit plan at your work place.

You must be registered for MSP in order to register for Fair Pharmacare. It is easy to register for Fair Pharmacare online or by phone with your income tax information. More information, and the application, can be found on the Fair Pharmacare website.

Some people have extended health benefits through their workplace, or their parents for younger patients, which may provide them with extra coverage for medications or other therapies.  Each benefit  is different, so check with your employer or Human Resources department to find out what is covered for you.

Employment Insurance is a Canadian federal program. Many employed people qualify for Employment Insurance Sickness Benefits when they are unable to work temporarily due to illness. If you have worked enough weeks and you qualify you will be eligible for a certain number of weeks per year of EI Sickness Benefits due to illness.

It is important to know that after opening a claim there is a period every 12 months that is considered a "waiting period," which means you will not be paid any benefits for this period. This is why it is important to apply for EI benefits right away when you are off work sick so you get EI Sickness Benefits when you need them.

EI Sickness Benefits are paid at the same rate as regular EI. There is a weekly cap at which point no higher amount is paid; this cap changes year to year. Click here for up-to-date information about EI rates and the cap. 

For more information or to apply for EI Sickness Benefits click here.

EI  may ask you to provide a Medical Certificate signed by your doctor so it is a good idea to have one signed to keep on hand just in case. Click here for a copy of the Medical Certificate for your doctor to sign.

You may be employed in a job that provides what is known as Extended Health Benefits (EHB). Often these benefits include short-term and/or long-term disability benefits. This means you will have financial support through your work place during times you cannot work due to illness. Every work place benefit plan is different, and not all work places have these plans, so it is important to check with your Human Resources department (HR) about what benefits are available to you.

If you work you have contributed to the Canada Pension Plan (CPP). This is a federal program which provides both retirement benefits and disability benefits to Canadians who have worked enough years. To qualify for CPP Disability (CPPD) usually you must have worked for at least 4 years out of the last 6 years, but there are circumstances where you will still qualify even if you have worked less than this. If you are very young and have not worked yet, or have worked very little, you may not qualify for CPPD. 

CPPD benefits are not based on family income. Even if you have money in the bank or you have a partner who makes a good salary you are still entitled to CPPD benefits if you qualify. It is important to know that CPPD is taxable income. Also CPPD provides financial support only; no other health benefits such as coverage for medications, dental work or medical equipment are provided through CPPD.

The CF social worker can assist you in completing the CPPD application. For more information on qualifying for CPPD and how it works, click here.

To download the CPPD application package click here.

This is a provincial program and you must live in BC to qualify. You may be eligible for disability benefits provided through the Ministry of Social Development and Poverty Reduction (MSDPR) in BC if your daily activities are impacted significantly due to illness. This is known as a Person With Disabilities designation, or PWD.

PWD benefits are based on financial need. You will not qualify if you have too much money in the bank, if you have certain other sources of income or assets of a certain amount, or if you live with a partner who makes too much income.  Because of this you must first submit an application to Income Assistance (IA) before making an application for PWD. That allows the ministry to calculate your income to see if you qualify for PWD. If you do qualify the ministry office will then provide you with a PWD application which you will need to bring to the CF social worker so the social worker and doctor can complete it once you have filled in your section.

Unlike Canada Pension Plan Disability (CPPD) you may qualify for PWD even if you have never worked or you have worked very little. Often younger people who have not worked enough to qualify for CPPD will qualify for PWD if they are considered eligible due to their level of disability and finances.

PWD provides financial support for housing and living expenses, but also provides some medical services support. For example,  if you are granted PWD status you will not have to pay  for any Pharmacare deductibles on Pharmacare covered medications. Most CF medications fall into this category. There is also some basic dental and equipment coverage provided, for example compressors needed for nebulizing some CF medications are covered.

On PWD you are allowed to make a certain amount of earned income per year without losing any of your PWD benefits. You may be able to attend school while on PWD, but it is important to discuss this with you local MSDPR office.

Legal Aid BC has put out a number of easy to understand guides to income assistance and disability benefits in BC.  There are four guides people living with CF will find useful. Click on each to see the guides.  
1) Your Welfare Rights: Applying for Welfare Online | Legal Aid BC;  
2) Your Welfare Rights: How to Apply for Welfare | Legal Aid BC; 
3) Your Welfare Rights: Welfare Benefits | Legal Aid BC; 
4) Your Welfare Rights: When You're on Welfare | Legal Aid BC

To make an online application for Income Assistance in order to apply for PWD benefits click here.

WorkBC provides job search support and training possibilities to all British Columbians, including those who living with disabilities and chronic conditions. People living with chronic conditions such as CF may qualify for support from a case manager depending on their circumstances. For more information on WorkBC click here.

Disability Alliance BC (DABC) has put together a very helpful guide on working with a disability (including chronic conditions such as CF). The guide covers issues such as: What are my legal rights and protection in the workplace? What can an employer ask? What is the employer’s duty to accommodate? You can access the guide here.

Known by various names, most colleges and universities have accessibility service centres which assist students with disabilities and chronic conditions. If you have frequent CF exacerbations, challenges due to the amount of daily CF treatments you have to complete, limited energy, or any other issues related to living with CF that may impact your studies, register with the centre at your school. The staff there can advocate on your behalf if you need to be miss classes or assignments due to an exacerbation, or if you need other supports due to CF health related issues

Examples of student accessibility service centres are included in the links below. You can check your institution's website for your school's services.

• https://www.sfu.ca/students/accessible-learning.html
• http://rcsd.uvic.ca/
• http://www.vcc.ca/services/services-for-students/disability-services/

There are numerous grants and bursaries available for post-secondary programs. Some of these will be specific to people living with chronic conditions and disabilities, others are more general. There are bursaries and grants which go unclaimed every year because no one has applied for them.

The best source for up-to-date information on what grants and bursaries may be available to you is the financial counsellor at the college or university you want to attend.  The internet is another important source for bursaries and grants.

For more information, read this article written by a Canadian CF patient. While it was written quite a number of years ago it still provides helpful information on how he fully financed his university education through grants and bursaries. 

Here is a short list of links for sources of grants and bursaries. This is only a brief list, there are many more out there. 

• http://www.scholarshipscanada.com/index.asp
• http://www.disabled-world.com/disability/education/scholarships/disability-scholarships-canada.php
• http://www.campusaccess.com/financial-aid/scholarships-bursaries.html

If you have a student loan you can also apply for the B.C. Access Grant for Students with Disabilities if you qualify. 

You should always get travel medical insurance for a pre-existing condition before leaving the country. This insurance is available from many different companies, but it is important to understand exactly what is covered. While the clinic does not specifically endorse any particular insurer, make sure to speak directly with whichever company you decide to use. You will need to provide them information about when you were last ill and when you last changed medications, as this impacts on the kind of pre-existing condition coverage you will need.

The St. Paul’s CF Clinics has adult CF patients living all over BC and the Yukon and patients need to travel to St. Paul’s for clinic visits, treatment, and hospitalization. Travel to clinic can be challenging and financially difficult if you are coming from far away, especially if you are low income. If you are on PWD you can get your medical travel covered. As noted earlier, the BC CF Subsidy Program also assists with some accommodation and travel costs.  And if you are below a certain income, Hope Air can also assist with travel, accommodation, travel form the airport to CF clinic, and even some food costs. https://hopeair.ca/ Speak to your social worker if you have concerns about travel to clinic.

You may qualify for this refund if you receive the Disability Tax Credit (DTC) or have a "permanent mobility impairment." This would include people with such poor lung function that they are unable to use public transit. You must have this mobility impairment confirmed by your doctor.

Learn more

You may qualify for this rebate if you are on provincial disability benefits (PWD) or have a "permanent impairment of movement." This can include people such poor lung function that they are unable to use public transit. You must have this mobility impairment confirmed by your doctor.

Learn more

Depending on your lung function and fatigue level, you may qualify for a SPARC Disability Parking Pass.  This allows people with mobility issues, or limited energy due to respiratory or other conditions, to utilize disabled parking spots. For more information or to download an application form click on the SPARC website.

DABC is an organization that advocates for and supports people living with disabilities and chronic conditions. They provide great information and resources through their website, their publications, and advocacy programs.

The DABC website also has a page on programs you may be eligible for if you are on PWD.

Friends for Life is a non-profit organization in the west end of Vancouver which provides free complimentary and alternative healthcare services to people in BC living with life-altering illnesses. The services they provide include massage, yoga, acupuncture, counselling, meditation and more. All of the practitioners are professionals in their area and volunteer their services to Friends for Life. Speak to the CF clinic social worker about applying to become a member of Friends for Life.

• CF Canada
• CF Canada Resource Guide 
• CF Care BC 

Advance Care Planning (ACP) refers to the plans everyone should have in place for their health care in case they are unable to make decisions for themselves, whether they have a chronic condition such as CF or not. This includes conversations with family and friends about your wishes, making sure your legal representative is someone who you trust to respect your wishes, and sometimes means having a written leagal document such as a Respresentation Agreement available to family friends and healthcare providers. The My Voice document was put together by the Ministry of Health so that all British Columbians have a universal guide and document for ACP. It is a fairly easy to use guide with good examples of why ACP is important for all of us. Speak to your CF social worker for more information and assistance with ACP.

The Disability Tax Credit (DTC) provides a tax credit to people with CF who qualify, generally on the basis of how much secretion clearance, nebulized medications, and some other treatments they do on a weekly basis. This is a federal program and you can read more about it here.

The Registered Disability Savings Plan (RDSP) is unique to Canada. It allows people who receive the DTC to put money into an RDSP, which can be set-up through a bank or a credit union, and to receive matching grants from the federal government. The aim is to assist people living with disabilities and chronic conditions to save money for the future and for retirement. Read more about it here.