Week of June 24, 2024

1/ Foreign and Airline travel QUESTION: I have used VIP with success for my 4-3-53 haplotype. I often travel out of the country and wondered what is the best way to help with mold exposure. ANSWER: The problem of exposure to indoor environments that are contaminated includes air travel, especially international flights that fly at altitudes that fly over 35,000 feet. Specifically, the air turnover inside these big planes is supposed to be one turnover for every 45 minutes. At 40,000 feet, the ice-cold air needs to be heated before it is distributed thereby adding additional costs to the air turnover. As if that problem of stale air is not enough, the air is re-circulated through filters that are often not changed quickly and end up being heavily contaminated according to flight attendants who have contacted this site in the past. I have no photos or data to back up this hearsay evidence of contaminated filtration systems. Use of VIP for acute exposures is in its infancy but as opposed to older therapies that relied on problematic agents such as erythropoietin, while effective but risky, VIP is much safer in high doses provided VIP can be kept refrigerated. Given the existence of at last half of our buildings in the U.S. being moldy, the problem is worse in other countries. Look at some of the construction techniques you see in U.K. and you will understand my concern. Interestingly, very old buildings, such as dank castles in Scotland or dungeons in Ireland rarely have toxigenic organisms found in those areas. If you are able to keep VIP chilled that is the best way to be protected while traveling overseas in addition to full dose Welchol or cholestyramine. The dose for acute exposure is much higher than four doses a day; people with 4-3-53 especially will need to be looking at 16-20 doses a day. Alternatively, finding a compounder to make VIP for you overseas is worth the time that it would take to arrange this needed event. Fortunately, Australia has a compounding pharmacy available that can make VIP that works. I don’t know about U.K and the continent. If you are frequently in UK, Europe, or Canada, you may be interested in working with Shoemaker Protocol™ practitioners who serve these areas. View our International Practitioner List You may also be interested in Dr. Shoemaker’s comprehensive CSM and VIP learning modules. 2/ When do you begin CIRS testing after exposure? QUESTION: I went camping this past weekend and shortly after we turned in for the night, one of my friends developed a significant cough, headache and congestion. Another friend had a flare of her pre-existing asthma. We left after one hour. Is it better to begin diagnostic testing or seek medical care immediately or wait to see if symptoms reside? ANSWER: Exposure to any number of environments can cause the acute onset of respiratory symptoms without necessarily being CIRS, the inflammatory response syndrome caused by exposure to, mainly, water-damaged buildings, including the possibility of campers or automobiles. Classic chronic inflammatory response syndrome will present multiple symptoms throughout multiple body systems for over a month and does not subside without treatment. We cannot definitively say that will apply to an exposure of less than 3 hours associated with an illness affecting one body system (the respiratory system as stated in the above references) of less than 3 days. If the triggered symptoms are intensifying, by all means seek medical diagnosis and care. For those with a predisposition to CIRS/mold illness, it can be triggered in as little as 10 minutes, or it may take up to a 2-3 weeks before the full-blown effects are experienced. You mentioned that you are beginning to feel better now several days after your exposure. If you are not experiencing increasing symptoms and they are residing, it would make sense to observe and not initiate treatment. If you find your symptoms are ongoing, intensifying, or developing, having an online visual contrast sensitivity diagnostic test (VCS test available on the Surviving Mold site) done now provides a reasonable basis to look back 2 weeks from now to see whether this is developing into a syndrome. If the VCS test is positive at this date, the likelihood that this finding will resolve on its own is quite low. If your physician does not find a basis for symptoms that are not subsiding, it would be reasonable to having baseline CIRS labs done, including C4a and TGF beta-1, together with MMP-9, as the acute exposure is not likely to have enough time to lower MSH and VIP but did have enough time to drive up inflammatory responses. A lab order sheet and physician’s resources are available on the Surviving Mold site for your attending practitioner as needed. If your VCS shows you are a candidate for CIRS, your next best step is to begin testing and diagnosis with a Shoemaker Protocol™ practitioner to guide you in managing this complex illness. For more information on CIRS/mold illness and the Shoemaker Protocol™ diagnostic and treatment pathways, download our free “Got Mold?” Guide. 3/ VIP, availability QUESTION: Is it possible for individuals to purchase VIP? ANSWER: Pharmacies can purchase VIP in bulk for compounding in the U.S. As your question appears to be coming from Sweden I do not know what the regulations are for your country. VIP is available by prescription to private patients. 4/ MTHFR QUESTION: I recently found out I have the MTHFR gene. If someone is MTHFR positive will mold remediation and treatment protocol remain the same? ANSWER: Yes. This is a commonly observed finding, seen in about 80% of our patients. The vast majority of patients are heterozygous. There is no need to adjust treatment for this common genetic change. 5/ 23andMe, allergy, and urine testing QUESTION: I don’t know if I have a mold problem or not. I did the 23andme gene test and I am positive for the HLDA mold gene. I took my VCS test and that is normal. My antidiuretic hormone level is elevated and I have a high urine osmolality test. I drink one glass of water a day. I have no mold exposure that I know of but I had a skin allergy test that showed environmental allergies. My serum iron and ferritin are both normal but are at the bottom of the normal range. Could this be due to mold exposure? ANSWER: You have raised many significant issues that are best answered in a private tele-consultation with me (available via telephone) or with any of the Shoemaker Protocol™ Practitioners, and not just a short answer for frequently asked questions. I will try, however. I am unfamiliar with the documentation from 23andme regarding adverse effects of the HLDA mold gene. I am happy to read such information. Please forward at your earliest convenience. We do not look at urine osmolality; we look at plasma osmolality. The relationship of antiduretic hormone to simultaneously measured osmolality is often disrupted in CIRS, independent of whether an exposure to a water-damaged building is the cause or not. Urine testing does not provide any conclusive information in diagnosing CIRS. Allergy testing will look at acquired immune responses and not innate immune responses. The skin allergy test has no relationship to the CIRS symptoms derived from exposure to water-damaged buildings. With normal serum iron and ferritin, even though those numbers might be low normal, there is no diagnosis that can be made. If there were problems with hemoglobin, hemolysins, transferrins, or intestinal malabsorption of iron, those would be important elements to know to assist you with your concerns about iron. 6/ 23AndMe QUESTION: I had my genes tested by 23AndMe with an opinion rendered by Livewello. The latter makes sense of the raw data from 23AndMe. Can you show me what the rsID numbers are for the gene markers mentioned on Survivingmold.com? ANSWER: I am not familiar with Livewello but would be happy to take a look at your report. Please forward that to the site and I will be glad to review. Remember the simple presence of a gene does not tell us anything regarding gene activation and will not reveal levels of regulatory control. Further testing is necessary. 7/ Urine testing for mold toxicity QUESTION: I was wondering if there are any resources on SM on interpreting results from urine metabolites testing for mold toxicity. ANSWER: There is no interpretation for urine analysis as Dr. Shoemaker does not use that in his protocol nor does he support urine testing. There is no proven data. 8/ Air conditioners, window QUESTION: Are window air conditioners safe to use? ANSWER: The air conditioning devices that we used to see in countless homes in the summer are becoming a thing of the past with wider use of central air conditioning. For those people still using portable units there will predictably be a significant amount of condensation created as the air conditioner dehumidifies and cools ambient air. As long as that moisture is vented to the outside there will be no adverse effects on microbial populations indoors. I would recommend that a portable air conditioner be cleaned thoroughly before beginning use.