Special Community Preview! The Membership Q&A Library

Special Community Preview!

The Membership Q&A Library

Check out the Cold Weather & Holidays Category

until November 30th

 

We are excited to launch a new benefit for Surviving Mold Members:

The Membership Q&A Library!

 

Each month, we’ll introduce a new category, and the Surviving Mold community will be able to access it here for 2 weeks. After the preview, the content will be available exclusively for Surviving Mold Members.

 

This month's category focuses on all things cold weather and CIRS related, just in time for the holidays and the cooler seasons.  

 

View the Membership Q&As Below.

 

Learn about the benefits of Surviving Mold Membership >>

 

Member Library Q&A:

Cold Weather-Related Questions

 

Cooler weather brings more questions, and answers! Plus, we have resources geared to help CIRS patients thrive through the changing seasons, the holidays, and always.

 

Below you’ll discover resources and answers to questions you didn’t know to ask!

 

1/ Mold growth, winter

 

QUESTION: I am ill from mold exposure but I have no symptoms in summer. I don’t understand how I get sick in winter as it is too cold outside for mold to be growing.

 

ANSWER: The illness is felt to be worsened by a few especially sensitive individuals due to outdoor exposures but with my experience the vast majority are sickened indoors. It is unusual to have absence of symptoms in summer time as the inflammatory response does not change with resolution spontaneously in true CIRS. The ecological environment that promotes microbial growth indoors is one in which there is a narrow range of temperature indoors as opposed to outdoors.

 

Understanding the diagnosis of CIRS is made from a rigorous diagnosis protocol, I would suggest starting with the online Visual Contrast Sensitivity (VCS) screening.

 

Then, if you test positive for CIRS, continue with the recommended Shoemaker Protocol™ labs and tests, looking for lab abnormalities that are required to be present to make the complete diagnosis of CIRS due to mold/water-damaged building exposure. If they are not present then the differential diagnosis process will yield an alternative diagnosis for you.

 

**You may also be interested in the Resources & Links provided below the Q&As**

 

2/ Cold weather; nasal congestion

 

QUESTION: I notice that my nasal congestion is much worse in winter time. Is that due to a seasonal variation in CIRS?

 

ANSWER: No. CIRS is not affected by cold weather with change noted in one symptom only. If you had multiple health symptoms changing that would be a different story. Certainly, if there is a problem with a multisystem, multisymptom illness appearing more in cold weather than in warm, we have to wonder about the presence of bioaerosols in HVAC duct work. Wallemia leads the list of organisms that like 50% to 60% humidity.

 

With heat systems in the winter, dry air is a common factor. You can check humidity levels with a sensor. Be sure that dry indoor air isn’t the problem contributing to your congestion.

 

3/ Use of wood stoves

 

QUESTION:  What is your opinion about wood stove use for people with CIRS?

 

ANSWER: As long as the wood is not dried inside your house and doesn’t put too much moisture in the air, your stove is the safest way to heat considering all heat ducts and mechanisms.

 

4/ Dehumidifier smells

 

QUESTION: I live in the Pacific Northwest and have installed a dehumidifier in an effort to reduce the elevated relative humidity in our home. Shortly after using a

dehumidifier we noted a musty smell that persisted despite use of hydrogen peroxide and vinegar to clean coils, filter and water collection pan.

 

ANSWER: I agree that ongoing use of a dehumidifier (or a humidifier) with problems like this is of more harm than benefit. It is quite possible that the drainage pan will need to be vented to a drain and not let stand for prolong periods of time. However, I would look at the likelihood of ongoing water intrusion as opposed to the ambient humidity as the source of your problem.

 

5/ Nose bleeds in relation to CIRS

 

QUESTION: 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?

 

ANSWER: Many people will have nose bleeds due to a variety of “benign” nasal conditions. Differential diagnosis can range from deviated septums to excessive nose picking, or because of air that is too dry, common in the winter months when heat systems are being used.

 

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 Willebrands 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 Willebrands 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 Willebrands profile in nearly 66% of patients.

 

Excessive clotting due to high von Willebrands antigen and high ristocetin associated cofactor (and also high factor 8) are additional problems that go along with this coagulation disorder.

 

Coagulation problems are commonly seen in inflammatory response syndromes as part of the over all innate immune activation that CIRS involves.

 

What this means is that if nose bleeds are associated with low levels of von Willebrands 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 re-

exposure, 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.

 

6/ Safe housing, roofing

 

QUESTION: I have come to the conclusion that I need to find a different kind of dwelling, one without a water supply above me and one without a flat roof. Are there other criteria to find a healthy living space? Should I consider moving to a dryer climate?

 

ANSWER: Whether you live in Phoenix or Miami or whether you have a home full of fabrics versus one that is Spartan in appearance, the only questions that matters is simple: is there evidence of water/moisture intrusion or not? All of the constructs that people have come up with to provide safety must ensure that the building envelope is intact; that there are no internal sources of moisture from excessive condensation or humidification, roofing leaks, or duct or plumbing problems; and that there are no sources of products from microbial origin from crawl spaces or basements.

 

Roofing must be sound and maintained no matter what type of roof it is. Dry climates have leaky pipes and roofing which can leading to water damage, too. It doesn’t take a lot of water to create enough water damage for the culprits of a moldy environment to flourish.

 

Of course, winter months in northern climates can come with ice dams and heavy snow loads that must be cleared. Proper insulation and ventilation in the attic can help keep roof temperatures uniform preventing ice dams. Gutters need to be kept clear for proper drainage year round in any climate.

 

Many people have moved to Arizona and New Mexico hoping to avoid excessive humidity. That approach is fine as long as there are no swamp coolers or plumbing indoors that could leak; or no roof changes that would permit water intrusion. A bad roof in Phoenix is not different that a bad roof in Boston.

 

Having said that, if you are one of the few that can’t live in any constructed building and have to live in a tent or in a yurt, for example, then I would put the dry Southwest higher on my list of destinations.

 

**You may also be interested in the Resources & Links provided below the Q&As**

 

7/ Mold prevention at altitude; heavy snow.

 

QUESTION: My family lives in Denver where we have the opportunity to move into a home at higher elevations but I am concerned with the amount of snow that will be on or around the house for months. How will this environmental exposure to moisture affect duct work and AC units?

 

ANSWER: I am somewhat uncertain as to your question. If duct work is sheet metal and is maintained, especially using the Air Oasis Bi-polar or iAdpapt Air filtration units, there should be no problems.

 

Snow is notorious for creating ice dams and it would be beneficial for you to have some mechanisms to prevent ice dams with snow dogs or possibly some form of a heat tape to prevent those. Proper insulation and ventilation in the attic can help keep roof temperatures uniform preventing ice dams. Gutters need to be kept clear for proper drainage as well.

 

8/ Indoor house plants; live Christmas tree

 

QUESTION: Will having living house plants or a live Christmas tree impact on presence of toxigenic fungi and other microbes in an indoor environment?

 

ANSWER: We have looked at this question of indoor presence of moist soil and plants in some detail. It was a common “Plan B,” used by desultory mold defense attorneys and their highly paid consultants that was easily refuted. We have done repetitive re-exposure protocols in 15 patients. Those results confirmed that exposure to homes with house plants does not create an increased health risk for patients with prior chronic inflammatory response syndrome acquired following exposure to interior environment of water-damaged buildings. It is not necessary to remove house plants from the home as part of remediation. Presence of house plants should not change the outcome in litigation for people who are alleging injury acquired indoors.

 

Live trees are classified as plants and do not pose an increased risk. However, they are usually placed in a pan or bucket of water. If that bucket leaks and water seeps onto the flooring and subflooring, it could theoretically foster the growth of harmful microbes. In the absence of constant, unattended leakage from the container, a live Christmas tree is a safe and a better option than a porous-material artificial tree stored over the years.

 

9/ Indoor Mold versus Outdoor Mold

 

QUESTION: Are there studies that review the difference in illness acquisition from indoor mold and outdoor mold?

 

ANSWER: Yes, the work done on the SAIIE papers clearly shows that exposure to outdoor mold is not adequate to result in reacquisition of inflammatory response syndrome in people previously sickened by water-damaged buildings. The prospective study design (called ABB`AB) is one that enables us to assign causation to exposure. To date, no outdoor exposures have shown worsening of inflammatory markers.

 

Particularly sensitive individuals, namely Erik Johnson and Jonathan Wright, have noticed abrupt deterioration of symptoms with certain outdoor exposures. Erik is well known for his discussion of “plumes” of air containing bioaerosols that have sickened him while he was hang gliding. I suggest that you review the chapters from Erik Johnson both in my books Surviving Mold as well as Mold Warriors. For others without the sensitivity of Erik and Jonathan, to date, outdoor exposures are not confirmed to sicken people.

 

10/ Saunas

 

QUESTION: Will an infrared sauna help with the detox process?

 

ANSWER: No, saunas do not directly bring about the CIRS detoxification needed for recovery. That being said, saunas usually make people feel great and have a relaxing effect, which is beneficial in a healing process. Also, since most CIRS patients in early recovery stages are not able to exercise, if this feels good to you, it is a way to break a sweat without exercise. While this is said to have some detoxifying basis, it does not remove the microbes and biotoxins associated with CIRS from the body.

 

I have no qualms about suggesting the use of saunas provided you avoid dehydration and there are no signs of water damage in the sauna structure or building envelope, of course.

 

I am aware there are many claims, primarily from environmental medical physicians, that infrared saunas do magical things. As you might expect, I asked to see confirmatory before and after data. None has ever been produced. If you believe the infrared sauna benefits you and you feel healthier doing it, then by all means, keep doing it. It is then a helpful adjunct

 

11/ Flu shots

 

QUESTION: I have been diagnosed with having silicone implants creating a biotoxin illness. Should I get a flu shot?

 

ANSWER: Flu shots are widely used for patients independent of underlying inflammatory problems. We have no data showing that even the 4-3-53 or 11-3-52B people have an increased incidence of adverse affects compared to control populations following flu shots.

 

We know that individuals with ongoing innate immune activation and abnormalities inantigen presentation are theoretically at risk for absence of a protective antibody response to a variety of vaccinations including influenza.

 

High risk groups including those with pregnancy, nursing, indolent malignancies such as CLL, and individuals over the age of 65 with respiratory problems should absolutely be vaccinated in my opinion. Simply having an innate immune response syndrome does not mean that you can not get a flu shot. Without knowing your case it is impossible to make reasonable suggestions other then to discuss the risks of a flu shot versus benefit with your physician. If you are in a high risk group and have CIRS, I suggest finding a Shoemaker Protocol™ Practitioner and/or a specialist in your area of risk to examine the best solutions for you.   

 

Influenza vaccinations can be complicated in that each of the flu vaccines available in the last years have only covered 10%-40% of influenza strains seen in the U.S. at any given time. Use of flu vaccine for an unknown type of influenza is difficult to justify. Given that there are 6 separate influenza preparations available, I think it makes more sense to wait until there is an outbreak of flu in which the serotype is identified before automatically requesting a vaccination. Having said that, if you are in a high risk group then proceed with the vaccination.

 

12/ Viruses

 

QUESTION: I am suffering from chronic fatigue for one year and have been diagnosed as having reactivation of Epstein Barr virus. Will your program help fix viral illnesses?

 

ANSWER: No, we know of no mechanism for either cholestyramine or Welchol or any of the steps of the biotoxin pathway to successfully treat viral illnesses.

 

I am aware that Dr. Nancy Klimas in Miami (now in private practice) has diagnosed illness as being caused by reactivation of Epstein Barr virus and has used successful treatment protocols in the past. These patients do not have chronic inflammatory response syndromes as is typically found in biotoxin patients.

 

As always, I would hope that the diagnosis of Epstein Barr virus reactivation is

confirmed after a rigorous differential diagnosis has been applied. At one time some physicians felt that chronic fatigue syndrome (CFS) had a viral source. CFS was initially blamed on the Epstein Barr virus (Yuppie flu) followed by a surge of interest in HHV-6A as the viral culprit. Recently, there was a huge international uproar about a retrovirus called XMRV that appeared in so many CFS patients but not in controls. Many CFS docs felt they had finally found the cause of CFS and began to treat putative CFS patients with anti-retroviral meds used in HIV patients. I seem to recall that Dr. Joe Brewer was a leader in this approach. I had direct communication with one such patient (also a physician) who was unequivocally improved by the HIV drugs.

 

None of these diagnoses of a viral cause of CFS have been supported by the passage of time. If you have Epstein Barr virus, remembering this is herpes virus, the antiviral in wide use for herpes infections could provide an opportunity for you to consider a different form of therapy separate from treatment of CIRS. The fact that so many viruses have been ruled out as a cause of CFS has no bearing on clear testimony from patients like Erik Johnson (featured in a well-written book published on-line [and at Amazon] recently by Lisa Petrison, PhD of www.paradigmchange.com) that exposure to WDB underlies the illness of many people diagnosed with CFS. Erik has written chapters in my books, Mold Warriors (2005) and Surviving Mold (2010). These chapters are must

reads in my view for anyone diagnoses with CFS.

 

13/ Ice skating rinks; locker rooms

 

QUESTION: I began developing neurologic symptoms in association with competitive figure skating beginning at age 8. Could I have acquired a pediatric illness that bothers me to this day?

 

ANSWER: The problem of excessive moisture in arenas usually can be traced to locker room facilities. Whether the locker room is in an ice skating rink, basketball facility or indoor swimming pool, locker rooms as a general rule are made of concrete and block without much air flow permitting organisms like Aspergillus penicillioides ample opportunity to grow on clothing and cellulose materials.

 

Most commonly, most people with neurologic symptoms will have abnormal levels of TGF beta-1. Now that we know that there is a fingerprint for neurologic injury to the blood brain barrier, in part mediated by TGF beta-1, we can use volumetric software programs such as NeuroQuant to identify whether or not persistent neurologic problems are due to inflammatory responses acquired following exposure to the interior environment of water-damaged buildings.

 

You may be interested in the Shoemaker Protocol™ Quick Start Guide which will direct you through the first diagnostic steps to check your symptoms and confirm CIRS.

 

See also the Shoemaker Protocol™ resources included below.

 

14/ Swimming, indoors

 

QUESTION: I feel that swimming is a wonderful exercise to help patients recover from CIRS. Is an indoor pool safe?

 

ANSWER: The excessive humidity indoors from pools and spas is a giant area of concern for creating a habitat suitable for growth of toxigenic organism. If you have an indoor pool I would be monitoring HERTSMI-2 on a regular basis with the cost of monitoring simply being added to whatever kinds of maintenance costs are involved. Don’t forget that swimming is arduous; exceeding the anaerobic threshold in CIRS patients occurs easily in a swimming workout. Better to make sure anaerobic threshold is improved by following the exercises described in Surviving mold and then taking on swimming.

 

For your holiday relapse prevention kit…

The featured seasonal FAQ for you:

 

QUESTION: Can you take CSM or Protocol medications as a preventative measure?

 

It’s important to first understand that the medications alone will not restore or maintain your health. Recovery requires removal (and/or remediation) from the contaminated building/s that triggered the CIRS reaction. These two parts of the recovery equation are necessary for thriving with CIRS.

 

With this understanding in place, many patients do elect to use low-dose cholestyramine or Welchol as a first-layer of prevention before venturing into a new environment.

 

I routinely recommend that people keep Welchol with them in the glove compartment of their vehicle so that they can use something for treatment on an urgent basis (although not as effective, Welchol can be taken with food where CSM needs to be taken on an empty stomach).

 

A step-by-step look at using CSM preventatively:

 

• If you choose to use CSM preventatively, it’s recommended to take it at least two hours before you go into a new building.

 

• It’s also a good idea to call ahead and ask the building owner, manager or maintenance supervisor if there’s been any known water damage, and how old the building is. Most all buildings over 20 years old have had some water damage.

 

• If you choose to visit the new building, do an initial visual inspection before deciding to remain in the environment. Monitor yourself for symptoms for 10 minutes. If no symptoms appear after 10 minutes then it’s likely safe for you to stay, but stay tuned to any physical reactions.

 

• If any symptoms appear at any time you are in the environment, leave as quickly as possible and take cholestyramine and Welchol for a week monitoring changes in symptoms.

 

• Some common symptoms to pay attention to are: feeling nauseated, developing a headache, shortness of breath, coughing, a sore throat, feeling “queasy,” or just not feeling well.

 

• Within 24-36 hours, take the Surviving Mold Visual Contrast Sensitivity Test (VCS) to confirm CIRS and track the symptom progression or recovery.

 

Dosing schedule for cholestyramine:

 

Initiate one scoop of cholestyramine taken four times a day (on an empty stomach) for at least three days, and usually one week, to assist in prevention of reacquisition of illness.

 

Should there be persistent symptoms, I would recommend that labs measuring of C4a and TGF beta-1 also be performed.

 

If no symptoms arise in the new environment after 10 minutes…

 

After the initial 10 minute inspection and trial period, it is possible that the home or building is safe for you to visit. However, continue on Welchol or cholestyramine for another 72 hours to see if new symptoms appear. Symptoms can arise in just a few minutes or kick in later. It will depend on your susceptibility level as well as how much the building is compromised.

 

If you do develop symptoms…

 

If possible symptoms arise, be sure to take note of the exact symptoms for future reference as they are typically reproduced each time you encounter a toxic environment. You will be able to recognize them quickly in the future.

 

If you remain ill beyond one week of CSM/Welchol treatment then it is time to involve your physician and obtain labs to document where you are.

 

When taking any protocol medications, always consult with your Shoemaker Practitioner for accurate dosages and the best course of action for you.

 

For in-depth information on CSM or the Protocol medications, Dr. Shoemaker’s CSM or VIP medication modules are available for purchase at survivingmold.com.

 

 

RESOURCES

 

Shoemaker Protocol™ Labs, Testing & Information:

 

A List of Most Frequently Requested Protocol Resources >>

 

Key Resources for CIRS Patients >>

 

The Shoemaker Protocol™ Quick Start Guide >>

 

Find a Shoemaker Protocol™ Practitioner or Partner >>

 

Shoemaker Protocol™ Labs & Testing Resources >>

 

Q&As about Resources & Info for Attending Physicians >>

 

Thriving through the Holidays: Tips & Resources for Relapse Prevention Blog >>

 

 

 

Housing, Maintenance & Remediation Resources:

 

 

The 2021 Indoor Environmental Consensus Statement on Remediation >>

 

The Rigorous (Spring) Cleaning & Maintenance Checklist >>

 

Condensed Remediation Plan by AerobioLogical Solutions >>

 

AerobioLogical Solutions Remediation Investigation Report >>

 

This report provides images and citations to help determine the safety, culprits and causes of possible water damage in a home including basement areas.

 

The House Hunting with CIRS Guide >>