Week of April 22, 2024

1/ NeuroQuant

Q: A physician writes, I have observed symptoms consistent with projection frequently in my practice. For example, an adult will over-hear something said in the kitchen by a family member and within a few minute is repeating the same thought as his own. Is there any inflammatory basis to this?

A: These kinds of abnormalities in executive cognitive function are typical of those seen with atrophy either of the caudate or the putamen. NeuroQuant can show these abnormalities with 10 minutes of MRI time.

2/ No-amylose diet during treatment

Q: Do I need to be on the no-amylose diet while taking cholestyramine?

A: No. The only people for whom I use the no-amylose people are those using medications in attempt to lower leptin, MMP-9 and PAI-1. If you feel better on this diet and want to stay on it, that is fine with me. I have advocated its use to help in weight loss since 1977. I am always interested to see a new diet come along that simply follows the concepts of no-amylose (South Beach, Paleo; the list is long).

3/ Non-porous possessions

Q: Can mold spores attach to stainless steel, glass, including kitchen utensils and kitchenware?

A: Non-porous materials such as glass, plastic, steel and wood can be cleaned. For cleaning I usually recommend consideration of use of quaternary ammonium (“quat”) compounds available commercially as opposed to bleach or industrial products like Sporicidin. The quats that I recommend are sold under trade names such as Windex, Formula 409, Fantastic and interestingly, Clorox.

4/ Nose bleeds

Q: I have had a few bloody noses this year that seem to appear out of the blue. Could that be related to exposure to indoor environments with mold growth?

A: Many people will have nose bleeds due to a variety of “benign” nasal conditions. Differential diagnosis can range from excessive nose picking to air that is too dry, deviated septum and sometimes sinus problems as well.

Unusual inflammatory illnesses like Wegener’s granulomatosis can also be added for the very unusual case. As far as wet buildings go, it is not uncommon to find acquired von Willebrand’s deficiency in those with CIRS. Two large studies, from Italy, each showed approximately 20 people out of 100,000 had this unusual condition of low ristocetin associated cofactor, low multimer formation and low von Willebrand’s antigen. This abnormality was found in nearly 3% of mold patients! We have been measuring the Quest von Willebrand’s profile (VWF; note the profile from LabCorp is not worth using) with data in over 4,000 patients. We see abnormalities in one or more components of the von Willebrand’s profile in nearly 66% of patients. Excessive clotting due to high von Willebrand’s antigen and high ristocetin associated cofactor (and also high factor VIII) is an additional problem that goes along with this coagulation disorder.

Coagulation problems are commonly seen in inflammatory response syndromes as part of the innate immune activation that CIRS involves. If nose bleeds are associated with low levels of von Willebrand’s factors then treatment is disarmingly simple using DDAVP to mobilize endothelial reservoirs of monomers of vWF antigen. We look for changes in vWF with re-exposure to wet buildings. On Day one of reexposure, also called SAIIE (Sequential Activation of Innate Immune Elements), we see Factor VIII fall rapidly with recovery starting on Day 2. This doesn’t result in bleeding. On Day 2 and then Day 3, we see a fall in ristocetin-associated co-factor. If bleeding is going to occur, it happened on Day 4.

5/ Physician resources and training

Q: I have been sickened since I was exposed to a water-damaged building in Ontario. I saw 10 different physicians without benefit. I have now moved to Florida with subsequent deterioration of my health. ERMI was reported to be 189. My local doctor is willing to certify in your course. How can I help him?

A: Fortunately, we have an ever-enlarging number of physicians who have certified in treatment of CIRS. The site has a list with physicians in the “pipeline” who have their offices in Florida, NC, NY and NH. Your local physician is welcome to begin the training process to learn about CIRS and the published Shoemaker Protocol™. The first level of training, the Proficiency Partners online program gives practitioners the information they need to diagnose, prescribe, and treat CIRS/biotoxin illness patients in a flexible, condensed format. They will also be able to network and review cases with the other Shoemaker Protocol™ trained partners and practitioners. There is also a second certification level for practitioners who wish to specialize in CIRS.

You and your physician can get started immediately, and he can continue to treat you as he undertakes the course.

The Shoemaker Protocol™ Quick Start article will help you through the initial steps, one of which is taking the online VCS test as the first step in the diagnostic process. The VCS will check your symptoms and give you and immediate pass/fail with a print out for your physician.

Your physician may be interested in the Shoemaker Protocol™ Essays on the site by the certified practitioners. The essays describe each step of the Shoemaker Protocol™ in the practitioners’ words.

There are more “Physician Resources” located in a main category on the Surviving Mold Home Page, as well as testing and lab order sheets, which will give your physician an overview of the labs normally done to confirm whether or not you have been injured by indoor environments.

Your physician is also encouraged to contact Dr. Shoemaker’s office for assistance or if he has any questions for Dr. Shoemaker.

6/ Omega 3

Q: What is the dose of Omega 3 fish oil?

A: I rely on daily total dosing of the Omega 3 fatty acid called EPA to be 2400 mg or greater. The DHA Omega 3 fatty acid should be taken in a daily dose equal to or greater than 1800 mg. If the dose can be divided into one capsule taken three times a day with food that is the easiest way I know; there are a variety of companies that sell enteric preparations that make taking this very high amount of Omega 3 tolerable. When I started with Omega 3 therapy in the mid 1980’s, following a paper published by the Ochsner Clinic of New Orleans showing benefit of Omega 3’s in rheumatoid arthritis, they advocated 12 capsules a day that led to the total dose that I use now. Now that so many companies make safe Omega 3 products that are not contaminated with mercury, the total dose is still the same but the number of capsules is far less.

7/ Ongoing therapy with ongoing symptoms

Q: I have been exposed to water-damaged buildings for over 9 years. I am currently being treated with CSM three times a day for four months but I don’t feel like I am getting better. What could be wrong?

A: I hope that before your treatment with cholestyramine (CSM) began that a data base was obtained, especially a nasal culture looking for biofilm forming coagulase negative staphs. We know for people who have this unusual organism (we call it a “commensal”) there will not be expected improvement with cholestyramine alone. We also note that cholestyramine is supposed to be taken 4 times a day and not 3. Be sure to look for other necessary modalities to be treated. These modalities are summarized in the paper in Health (VIP, published 3/13). For example if you have antigliadin antibodies, gluten must be removed from your diet. If you have androgen problems or ADH/osmolality problems, the abnormalities must be corrected. If your VEGF is to low, that must be raised. If C4a is remaining too high or TGF beta-1 is too high, then those abnormalities are treated with separate interventions. Cholestyramine is a useful first step but the reason there is an 11 step protocol is that cholestyramine alone with not fix every aspect of the complex inflammatory illness that is acquired following exposure to a water-damaged building.

8/ Outdoor environmental exposures

Q: I have relocated from California to Arkansas. Where we are is far more humid compared to where we were in California. I have seen mold in the bathroom. In addition I now have cognitive issues, headache, skin irritation, sore throat and excessive upper airway mucus production. Will moving back to a dry environment improve my health?

A: It sounds like you are beginning a journey which will involve documentation of the kind of molds growing indoors together with understanding the source of your multiple health symptoms. Fortunately, your journey is one that others have taken before and the path is clearly delineated for you. I would suggest that you look at the diagnostic section of this 146 website for the Physicians Order Sheet to get an idea of what labs are normally done to confirm whether or not you have been injured by indoor environments. If objective illness parameters are present, treatment protocols are readily available. They all are peer reviewed and published.

Well over 99% of my patients are sickened by interior environments that have excessive humidity and water damage but not outdoor environments. If you read Mold Warriors and Surviving Mold, both have chapters written by Erik Johnson who documented outdoor exposures as causative of his illness syndrome. Others have made similar observations although no one to date has done the proper lab testing to prove beyond a reasonable doubt that their observations are correct. I would strongly suggest that you read Erik’s chapters in those books if you are bothered by outdoor humidity. Having said that, with over 99% of the people affected by indoor environments only, it is important to realize that low external humidity (whether you are in the high dry plains west of the Rockies in Colorado or Arizona) does not protect from illness if there is leaky plumbing or leaky roofs permitting water intrusion indoors in those areas. Similarly, living in Fort Lauderdale will not guarantee illness if there is ERMI