DIAGNOSIS AND TREATMENT OF CHRONIC INFLAMMATORY RESPONSE SYNDROME-CIRS · 2017-03-24 · 1...
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1 DIAGNOSIS AND TREATMENT OF CHRONIC INFLAMMATORY RESPONSE SYNDROME-CIRS Karen D. Johnson M.D., ABOIM, IFMCP www.karendjohnsonmd.com 503-371-3232 Have you been sick for a long time without any improvement in spite of multiple medical visits to different clinicians and a multitude of tests and treatments? You may have CIRS. CIRS, as the name implies, is a chronic illness. It is a cluster of symptoms that affect multiple systems in the body. It was first described by Dr. Ritchie Shoemaker, who continues to do extensive research on diagnosing, treating and understanding the syndrome down to a genomic level. (1) (5) CIRS is caused by exposure to a biological agent (biotoxin) in your environment that your body cannot clear in part because of your genetics. The biotoxin can be exposure to: 1. Mold from a water damaged building (CIRS-WDB). Up to 50% of buildings in the US have a history of water damage, 2. Lyme or co-infections from a tick bite (CIRS-LYME), resulting in inability to clear the biotoxin after antibiotic treatment 3. Exposure to a dinoflagellate such as Pfiesteria or Ciguatera. This can occur after eating tropical reef fish contaminated with Ciguatoxin or exposure to infected fish or water, 4. Exposure to blue-green algae (Cylindrospermopsis or Microcystis) in infected waterways, 5. Bite from recluse spider. Returning to the genetics I mentioned above, you may ask, why am I sick and nobody else that lives or works in the WDB is sick? Why did I not get better after I was treated with antibiotics for Lyme and other people who were treated are not still sick?
Transcript of DIAGNOSIS AND TREATMENT OF CHRONIC INFLAMMATORY RESPONSE SYNDROME-CIRS · 2017-03-24 · 1...
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DIAGNOSISANDTREATMENTOFCHRONICINFLAMMATORYRESPONSESYNDROME-CIRS
KarenD.JohnsonM.D.,ABOIM,IFMCP
www.karendjohnsonmd.com503-371-3232
Haveyoubeensickforalongtimewithoutanyimprovementinspiteofmultiplemedicalvisitstodifferentcliniciansandamultitudeoftestsandtreatments?YoumayhaveCIRS.CIRS,asthenameimplies,isachronicillness.Itisaclusterofsymptomsthataffectmultiplesystemsinthebody.ItwasfirstdescribedbyDr.RitchieShoemaker,whocontinuestodoextensiveresearchondiagnosing,treatingandunderstandingthesyndromedowntoagenomiclevel.(1)(5)CIRSiscausedbyexposuretoabiologicalagent(biotoxin)inyourenvironmentthatyourbodycannotclearinpartbecauseofyourgenetics.Thebiotoxincanbeexposureto:1.Moldfromawaterdamagedbuilding(CIRS-WDB).Upto50%ofbuildingsintheUShaveahistoryofwaterdamage,2.Lymeorco-infectionsfromatickbite(CIRS-LYME),resultingininabilitytoclearthebiotoxinafterantibiotictreatment3.ExposuretoadinoflagellatesuchasPfiesteriaorCiguatera.ThiscanoccuraftereatingtropicalreeffishcontaminatedwithCiguatoxinorexposuretoinfectedfishorwater,4.Exposuretoblue-greenalgae(CylindrospermopsisorMicrocystis)ininfectedwaterways,5.Bitefromreclusespider.ReturningtothegeneticsImentionedabove,youmayask,whyamIsickandnobodyelsethatlivesorworksintheWDBissick?WhydidInotgetbetterafterIwastreatedwithantibioticsforLymeandotherpeoplewhoweretreatedarenotstillsick?
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ThisisexplainedbyyourHLA(HumanLeukocyteAntigen)profile.Eachpersonhasanindividualprofilethatallowsourimmunesystemtorecognizeornotrecognizebiotoxins.Somepeoplecanbemoldsensitive,somecanbeLymesensitiveandsomecanhavemultiplesensitivities.Eachindividualprofileindicateswhetheryourbodycanefficientlyclearthatbiotoxinornotclearit.Approximatelyone-quarterofthepopulationissusceptibletomoldtoxins.AbloodtestcandetermineyourHLAprofile.Thereare2maincomponentstoourimmunesystem.Theinnateimmunesystemiswhatwewerebornwith.Itistheinitialdefenseagainstforeigninvaders.Whenconfrontedwithaninvader,theimmunesystemreleasessignalstothebodythatthereisdanger.Thebodyrespondsquicklyproducingchemicalsasthefirstlineofdefensetodestroytheinvader.Thisisnonspecificandcouldbecomparedtodumping“bleach”ontheinvader.Thesechemicals(notreallybleach)arewhatmakeusfeelsoillwhenweare“comingdownwithsomething”.Itisusuallynotthebugitselfthatmakesusfeelthiswaybutthehostresponsetotheillness.Thesecondpartoftheimmunesystemistheadaptiveimmunesystem.Thisisamuchmoreprecisesystemandratherthandumpingbleacheverywhere,producesantibodiestospecificallyremovetheinvader.Ittakestimeforourbodytomakeantibodiesspecifictotheinvaderandthereforewehavetheinnateimmunesystemasthefrontlineofdefense.Now,somepeoplelacktheabilitytomakeantibodiesagainstcertainbiotoxins.ThisiswhatIwasreferringtoabovewithHLAtypesthatcannotrecognizecertainbiotoxins.Ifthishappens,thetoxinscannotberemovedbytheadaptiveimmunesystemandpersistinourbody.Ourbodydoeshaveabackupplanwhichisnotveryefficient.Ourliversecretesthebiotoxinintothebilewhichisdumpedintothegut,howeverthesebiotoxinsareverytinyand95%ofthemarequicklyreabsorbedinthegut.Thisisfurthercompoundedifourproblemismoldtoxicityfromawaterdamagedbuilding(WDB)andwehaveongoingexposure.So,whathappens?Theinnateimmunesystemcontinuestodoitsjobintheonlywayitknowshowandkeepsdumping“bleach”ontheproblemandthepersonbecomesmoreandmoreillwithtime.
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HowdoyouknowifyouhaveCIRS?Dr.ShoemakerhasspecificcasecriteriaforCIRSdiagnosisandtheseinclude:1. Exposurehistorythatincludesoneofthefollowing:livingorworkingina
WDB,historyofatickbite,onsetofsymptomsafterbecomingillfromeatingreeffishorexposuretobluealgaeordinoflagellates.ExposuretoWDBcanbeverifiedbypresenceofvisiblemoldgrowth,mustysmellsorapositiveERMI(EnvironmentalRelativeMoldinessIndex).ERMIisatestdoneonthebuildinginquestionbyobtainingdustsamplesthatarethenevaluatedforthepresenceofmoldfragmentsorsporesthatwereintheairandsettledinthedust.ERMItestingcanbeorderedfromhttps://www.mycometrics.com.
2. Yoursymptomscannotbeexplainedastheresultofanyotherillness.Thisincludestakingacompletehealthhistoryanddoingathoroughphysicalexam.
3. YouneedtohavemultiplesymptomsinmultiplesystemsofyourbodytobediagnosedwithCIRS.Dr.Shoemakerhasdevelopedasymptomcharttoevaluatepatientsformultisystem,multi-symptomillness:
Youneedatleast1symptominatleast6ofthe13symptomclusterstobeconsideredforCIRS.8of13symptomclustersindicatesahighprobabilityofCIRS.
Ifthesecriteriaaremet,additionaltestingwillbedone.AsimpleadditionaltestincludesVisualContrastSensitivitytesting.Thistestisdoneinmyofficeandisnotthesameasavisiontesttoassessyournearandfarvision,butisatestthatmeasuresyourabilitytodiscerncontrast.Visualcontrastperceptionisimpairedinasignificantnumberof
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peoplewithCIRSasaresultoftheeffectthebiotoxinhasonreducingtheflowofbloodinthebloodvesselsaroundtheopticnerve.Labtestsarethenordered.Mostpeoplehavehadextensivelabtestsdonealready,howevertestsforCIRSspecificallylookathowyourimmunesystemisrespondingtoabiotoxin.Thetestscanindicateifyourinnateimmunesystemisbeingoverstimulated.StandardlabtestsdonearetypicallynormalinCIRSandifabnormalusuallyaretheresultofsomeotherproblem.FiveofthefollowinglabtestsorderedneedtobeabnormaltodiagnoseCIRS:1. HLAhaplotypedetermination(asdiscussedabove).24%ofthe
populationhaveanHLAtypethatmakesthemsusceptibletoCIRS-WDB.However,havingthehaplotypedoesnotmeanyouwillgetCIRS.Youstillneedtheexposure.95%ofpeoplewithCIRShaveasusceptiblehaplotype.
2. MSH(alphamelanocytestimulatinghormone)level.Thisisaprotein
releasedfromthehypothalamusandpituitaryglandinthebrain.Itcontrolsmelatoninandhormonelevelsincludingsexhormonesandcortisol.MSHaffectsmucusmembraneintegrity(thinkleakygut),regulatesourimmunesystemandcontrolsinflammation.IfMSHislow,manysymptomswillbeexperiencedincludingheadache,brainfog,chronicfatigue,sleepdisruptionandchronicpain.ChronicpaincanbeamajorsymptomwithCIRSandresultsfromreductioninournaturalendorphinproductioninadditiontotheinflammatoryeffectsofcytokines(signalingmoleculesthatresultfromstimulationoftheinnateimmunesystem).NormalMSHrange:35-81pg/ml
3. MMP-9(MatrixMetalloproteinase-9).Itsreleaseistriggeredbytheinnateimmunesystem.MMP-9contributestoincreasedpermeability(leakymembranes)bydissolvingaproteinintissuetoallowmoleculestopassmorereadilyoutofbloodvessels,intojoints,thelung,nervesandthebrain(2).Thisisneededinanacuteinjurytogetthefighting
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powertothesiteofinjury,butisverydangerouslongtermastherewillbeongoingdeliveryofinflammatorycompoundsintotheabovetissues.NormalMMP-9range:85-332ng/ml
4. TGF-beta-1(TransformingGrowthFactorbeta-1)isaconductorofourimmunesystem(3).IfTGF-betaisinthenormalrangeitkeepsbalancebetweenthesideofourimmunesystemthatneedstobealerttofightanintruder(pathogenicTcells),butyetnotbesoactivethatourimmunesystemattacksourowntissue.ThiscontrolismanagedbybeneficialTregulatorycells(T-reg)andThelpercells.WhenthereisimbalanceanddeficiencyofT-regcells,auto-immunediseasecandevelop.ElevatedTGF-betanotonlysignalsourbodytokeepmakingcellstofighttheintruderbutthesesamecellshaveapositivefeedbackandstimulatetheproductionofmoreTGF-beta.HighlevelsofTGF-betacanleadtoremodelingoftissueinlungleadingtoshortnessofbreathandasthmalikesymptoms.Otherorgansinthebodysuchasliver,heartandkidneycanalsobeaffected.NormallevelTGF-beta-1isunder2380pg/ml
5. ADH(AntiDiureticHormone)andosmolality-ADHassistsincontrollingthesaltandwaterbalanceinourbody.Inanormalsituation,ifwearedehydrated,ADHoutputincreasestopreventdiuresis(urination),andthiswillthereforeconservefluid.ADHisproducedinthebrainandstoredinthepituitarygland.ItsreleaseiscontrolledbyMSH.ThedysregulationinnormalproductionofMSHaffectsADHlevels.Thisresultsinsymptomsofheadaches,increasedthirst,frequenturinationandifsevereenough,ourbodytriestosweatouttheexcesssaltresultinginincreasedsusceptibilitytostaticshocksfromthesodiumpresentontheskin.NormalrangeADH:1-13.3pg/ml;Osmolality:280-300mosmol
6. VEGF(VascularEndothelialGrowthFactor).VEGFisproducedbythebodytostimulatethegrowthofnewbloodvessels.InitiallyVEGFlevelsriseasaresultofdecreasedbloodflowtothetissueastheresultofcytokinesattractingstickysubstancestotheliningofbloodvesselscausingwhitebloodcellstobecometrapped,blockingthebloodvessel.
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Thereishowever,asubsequentdeclineinVEGFasaresultofprolongedelevationofTGF-beta-1.Unfortunately,theblockageinthebloodvesselspersists,worseninganalreadycompromisedbloodflowtothetissue.NormalrangeVEGF:31-86pg/ml
7. C4aandC3a.Thesearesplitproductsofthecomplementsystem.Theybothareanaphylatoxins(causeallergicreaction).Biotoxinsstimulatetheinnateimmunesystemtoproducethesesubstances.Complementsplitproductscanresultinswelling,histaminerelease,contractionofsmoothmuscles…essentiallyallthesymptomsofanallergicreaction.Highlevelsresultinincreasedsymptoms.InordertoproduceC3a,youneedamicrobialcellmembranepresent.Thisthenrequireslookingforaninfectiveagent.LymeisoneinfectionthatneedstobeconsideredwithelevationofC3aNormalrangeC4a:lessthan2830ng/ml;NormalrangeC3a:lessthan940ng/ml
8. VIP(VasoactiveIntestinalPeptide)ismadeinthegut,pancreasandbrain.Itisinvolvedinreducingtheinflammatoryresponsebyregulatingtheimmuneresponse(4).TreatmentwiththissubstancecanrestoremanyoftheimbalancesandsymptomsseenwithCIRS.NormalrangeVIP:23-63pg/ml
9. CortisolandACTHlevels.MSHcontrolsreleaseofACTHfromthepituitarygland.ACTHisreleasedinresponsetostressandstimulatestheadrenaltoproducecortisol.ThereisaninitialriseincortisolinCIRS,howeverasthestressoftheillnesspersists,dysregulationisseeninbothlevelsofACTHandcortisol.Normalrange:ACTH:8-37pg/ml;AMCortisol:4.3-21ug/dl
10. MARCoNS(MultipleAntibioticResistantCoagulaseNegativeStaphylococcus).MARCoNSisfrequentlyculturedfromthebackofthenoseinpeoplewithCIRS.ItdoesnotusuallycausesymptomsandisnottobeconfusedwithMRSA.Itisnotaninfectioninthetruesenseoftheword,howeveritturnsonfurtherdamagingcytokines.LowMSH
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predisposestodevelopmentofMARCoNSbyimpairingmucosalimmunefunction.MARCoNScantheninterferewithproductionofMSH,compoundingtheproblem.MARCoNScanresideinbiofilmwhichprotectsitfromourownnaturaldefensesandfromantibiotics.MARCoNScanalsoaffectgeneticsbycontrollingwhichgenesareturnedofforon.CultureforMARCoNSisobtainedbytakinga2-3inchDEEPnasalcultureandsendingitforAPIStaphculture.Normalresult:Negativeculture
AdditionallabteststhatalsocanbeabnormalinCIRSinclude:1. Leptinisahormoneproducedbythefatcells.Leptincontrolsourappetite
andalsoallowsourfatcellstobeburnedforenergy.LeptinattachestotheleptinreceptorinthehypothalamusofthebrainandisresponsibleforcontrollingtheproductionofMSHandbetaendorphin(asubstancethatisournaturalpainreliever).Cytokinescrossthebloodbrainbarrierandbindtoreceptorspreventingleptinfrombinding.Thebodytriestocompensatebyproducingmoreleptin.Thiscyclecanresultinweightgainandinabilitytolosebodyfatinspiteofdietingandexercise.Normalrange:Women:1.1-27.5ng/ml;Men:0.5-13.8ng/ml
2. VonWillebrand’sPanel.vonWillebrand’sdiseasecanbeacquiredasaresultofelevatedC4alevelinCIRS.Itresultsineasybleeding,inparticularnosebleeds.Thiscomplicationisrare.TestinginvolvesavonWillebrand’spanelandnormalresultsindicateabsenceofthedisease.
3. Screeningforpresenceofauto-immuneantibodies.ThereareseveralthatcanbeabnormalasaresultofelevationofTGF-beta-1.Twoexamplesareanti-gliadinantibodieswhich,ifpresent,resultinglutensensitivityandanti-cardiolipinantibodieswhichcancauseclottingdisorders.
4. CD4+CD25++T-regs.Theseareimmunecellswiththesespecificmarkers
onthecellsurface.ThesecellsincreaseasMSHlevelsriseandindicateanimprovingimmunesystem(3).LowlevelsofT-regsincreasethechanceofallergyandautoimmunity.Thelevelsofthesecellscanmonitorprogressoftreatment.
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CD4+CD25++levelsshouldbegreaterthan18%
5. Hormonetesting.TestosteronelevelsmaybelowasaresultofdecreasedproductionofLH(LuteinizingHormone)andFSH(FollicleStimulatingHormone)fromthepituitary.TestosteronelevelfallsevenfurtherasaresultofincreasedaromataselevelsinCIRS.Aromataseisanenzymethatconvertstestosteronetoestrogen.Testosteronelevelsmaybelowandestrogenlevelselevatedwithsymptomsoftestosteronedeficiencyandestrogenexcessinbothmenandwomen.TestingincludesDHEA-S,testosteroneandestradiollevels.Normallevelsvaryforsexandage.6.PAXGenetestingisbeingdevelopedbyDr.Shoemakertofurtherunderstandtheeffectofthebiotoxinonourgenesandtheresponsetotreatmentatageneticleveltofurtherassistindiagnosisandtreatment(5).ADDITIONALSCREENING-NEUROQUANTCRANIALMRIAnMRIofthebrainthatisadditionallyinterpretedwithasoftwareprogramcalledNeuroQuant.NeuroQuantmeasuresthevolumeofdifferentareasofthebrain(6).ThiscanbeverydiagnosticbecausetheabnormalitiesseenwithCIRS-WDBaredifferentfromCIRS-LYME.PeoplewithCIRS-WDBwillhaveshrinkage(atrophy)ofanareacalledthecaudatenucleusaccompaniedbyswellinginotherareas.CIRS-LYME,howeverresultsinatrophyoftheputamen.Thistestcanalsomonitorprogressoftreatment.NeuroQuantisalsobeingusedintheBredesenprotocoltomonitorpatientswithcognitiveimpairment.
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ThisisanexcellentflowchartDr.ShoemakerdevelopedtounderstandthecourseofCIRS:
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TREATMENT-YESTHEREISHOPE!Treatmentisstepwise,startingatthebottomofthepyramidandmovingup.Jumpingstepswillnotassistinmorerapidrecoveryandmayactuallyinterferewithrecovery.Dr.ShoemakerusesthistreatmentpyramidincorrectingabnormalitiesinCIRS:
AteachstepretestingofVCSandinnateimmunemarkerssuchasMMP-9,C4a,TGF-beta-1,CD4+CD25++T-regsandanypreviousabnormalitiescanbemonitoredtoassessprogress.1. Thefirststepisremovalfromexposureandthisprimarilyappliesto
CIRS-WDB.Thisisthemostdifficultforpatientsformultiplereasonsincludingcostandattachmenttopersonalitems.ERMItestingis
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indicatedtodeterminewhereexposureisoccurring.Theworkplacemayneedtoalsobetested.Symptomaticimprovementwillnotoccurifongoingexposuretothebiotoxincontinues.TheprofessionalassistanceofanIndoorEnvironmentalProfessional(IEP)isstronglyrecommendedtoassistinevaluationandremediation(7).Theaffectedpersonshouldnotoccupytheaffectedbuildingduringremediation.Repeattesting,eitherwithERMIorHERTSMI-2whichstandsforHealthEffectsRosterofTypeSpecificFormersofMycotoxinsandInflammagens(seehttps://www.mycometrics.com)isrequiredbeforere-enteringtheaffectedbuilding.Inflammagensarechemicalsthattriggeraninflammatoryresponseinthebody.
2. Removalofbiotoxins.ItisimportanttounderstandifyouhaveCIRS-
WDBthatyouDONOThavemoldgrowinginyourbody.Instead,youhavetoxinsfrommoldexposure.YouDONOTtakeanti-fungalmedicationstotreatthisillness.
Cholestyramine(CSM)isadrugthatisapprovedforcholesterolloweringandisbeingusedofflabelinthistreatmentapplication(thatmeansitdoesnothaveFDAapprovaltotreatthiscondition).CSMhasapositivechargeandstructurethatattractsthenegativelychargedbiotoxinsthatarepresentinthebile.Thebiotoxinsareirreversiblyboundandeliminatedinthestool.CSMisnotabsorbedhoweverdoeshavesideeffectsofconstipation,gasandbloating.Thedoseis4gramsin6ozofwaterfollowedbyanother6ozofwater,4timesdaily30minutesbeforemeals.Itcanbindtoprescriptionmedsandsupplementsandtheseshouldbetaken1hourpriortoCSMor2hoursafter.Constipationmustbeavoided.Dietaryfiber,magnesiumandotherbowelstimulantsmayberequiredtopreventconstipation.Analternativetreatmentisaprescriptiondrug,Welchol625mgandisdosed2tabletsthreetimesdailywithmeals.ThisdrugisalsoFDAapprovedtotreatelevatedcholesterol.Welcholisonly25%aseffectiveasCSMasabinder,howeveritcausesfewerGIsideeffects.Itisalsomuchmoreexpensive.Somepeoplebecomeillwithbindersandthisislikelytheresultoftheirmobilizationofmorecytokines,especiallyMMP-9.Sideeffectscanbereducedwithhighdose(3-4grams)omega-3supplementationdailystarting1weekbeforestartingCSM.
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TreatmentwithbindersiscontinueduntilVCStestresultsarenormal,symptomsarethesameascontrolsandlabresultshavenormalized.Alowamylosedietisveryhelpfulinreducinginsulinlevels,reducinginflammationandassistinginweightloss.(8)ThisdietisrecommendedalongwithCSM.
3. EradicationofMARCoNS.IfMARCoNStestingbyAPIStaphswabispositiveitneedstobetreatedafteronemonthoftreatmentwithCSM.ThetreatmentforMARCoNSiswithBEGnasalspraythatismadebyacompoundingpharmacy.ItcontainsBactroban0.2%,EDTA1%andGentamicin0.5%inabasethatimprovesadherencetomucousmembranes.Dosingis2sprayseachnostril3timesdailyfor1month.Thesprayisirritatingandcanresultinnasalburning,congestionandnosebleeds.Thiswillallresolveaftercompletingtreatment.Repeatcultureneedstobedoneposttreatment.Ifthecultureremainspositive,otherfamilymembersordogsmaybethesourceofre-infection.Catsareoffthehookhere!
4. Glutenfreedietshouldbefollowedifglutenantibodiesarepresent.
Thisdietshouldbefollowedforaminimumof3months.Retestingshouldbedoneandifantibodiesarestillpositive,thelikelihoodofceliacdiseaseneedstobeconsidered.Eliminatingglutenalsoreducesamyloseinyourdiet.Manypeopleareglutensensitiveasaresultofleakygutandmostfeelbettereliminatinggluteneveniftestingisnegative.Itisworthatrialwithnorisk.
Itisimportanttoallowhealingtooccuronmanylevelsandthefoodweeatprovidesinformationtoourcellsthatcanbegoodorbaddependingonourchoices.Avoidingtoxicexposuretothebestofone’sabilityreducestheoveralltoxicburdeninthebody.Eatorganicwheneverpossible.Payattentiontowhatyoueat,theairyoubreatheandwhatyouputonyourskin.
5. Correctionofhormonelevels.ThisisdonecarefullywiththeadditionofDHEA.EstrogenandDHEA-SlevelsneedtobemonitoredwhileontreatmentandDHEAwillbediscontinuedwhenlevelsreturntonormal.
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DHEAisahormonethatisconvertedtotestosterone.LessconversiontoestrogenoccurswithDHEAthanwithtestosteronesupplementation.Iftestosteroneisgivendirectly,itwillbeconvertedtoestrogen,worseningtheimbalanceinbothmenandwomen.Thisimbalancewillresolveoncetheunderlyingoverstimulationoftheinnateimmunesystemiscorrected.
6. CorrectADH/osmolality.DDAVPisaprescriptionformofADHandcan
beusedcautiously0.2mgeveryothernightfor2weeks.This,again,isofflabeluse.Dailyweights,monitoringbloodpressureandforedemaneedstobedonewhileontreatment.ADH/osmolalityandelectrolytelevelsneedtoberetestedin2weeksafterstartingtreatment.
7. CorrectelevatedMMP-9.Thisinvolvesreducinginflammationwitha
lowamylosedietand3-4gramsofomega-3dailyforonemonth.IfthereisnoimprovementActos45mgdailyfor10dayscanbeused.Actosworksbyreducinginsulinresistanceandinflammation.ItsusehaslostfavorbecauseofablackboxwarningbytheFDAofdevelopingbladdercancerwithlongtermuseofover1year.
8. CorrectVEGF.Treatmentwithlowamylosedietandhighdoseomega-3
supplementationshouldbecontinuedifVEGFabnormalitiespersist.ThefinalstepintreatmentwithVIPnasalspraywillalsoaddressthis.
9. CorrectelevatedC3a.Theunderlyingcauseneedstofirstbeaddressed.
IfitisduetoLyme,thisneedstobetreated.Auto-immunediseasessuchaslupusalsoresultinelevationofC3a.Aftertheunderlyingcausehasbeenaddressed,inflammationandC3alevelsarereducedwithhighdose(80mg)statins.Pre-treatmentwithCo-Q10200mgdailystarting10daysbeforethestatinreducestheriskofsideeffects.Musclepain,fatigueandelevationofliverenzymescanoccurwithhighdosestatins.
10. CorrectelevatedC4awithVIPnasalspray50mcg/0.1ml,1sprayin
alternatingnostrils4timesdailyforminimumdurationof4months.Whensymptomsimproveandlabvaluesnormalize,dosagecanbereducedto50mcgtwicedailyfor1month.BeforeVIPcanbeused,thefollowingrequirementsmustbemet:VCStestingmustbenormal,
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MARCoNStestingisnegative,lipaselevelisnormalandERMIislessthan2orHERTSMI-2lessthanorequalto10.Thefirstdoseshouldbeadministeredintheofficeandpatientmonitoredwithpreandpostlabs.Ifnoadversereaction,lipase,C4a,TGF-beta-1,MMP-9andanyabnormallabsshouldbecheckedin1month.VIPneedstobediscontinuediflipaseelevatesorabdominalpainorrashdevelops.
11. CorrectelevatedTGF-beta-1.Losartan(adrugtolowerbloodpressure)
producesadegradationproductthatlowersTGF-beta.Dosageis12.5mgdailyandincreasedto25mgtwiceadayiftolerated.Ifapersonalreadyhaslowbloodpressure,itmaynotbetoleratedandVIPnasalspray,withtheabovedirectionsandguidelinescanbesubstituted.NotethatotherbloodpressuremedicationsdonothavethesameeffectasLosartan.
12. CorrectlowVIP.Ifrecoveryhasnotyetoccurred,VIPnasalsprayisto
becontinuedwiththeaboveguidelinesanddosage.VIPnasalsprayhasmanybeneficialeffects.VIPdownregulatescytokines,raisesVEGF,CD4+CD25++T-regs,restorescircadianrhythm(sleep),regulatesauto-immunity,restoresnormalhormonelevelsbydownregulatingaromatase,increasesendorphins,improvesexercisetoleranceandhasbeenshowntonormalizegenomics.VIPcanalsohelppeoplewithmultiplechemicalsensitivitiesbydownregulatingolfactorydrivenneurons.Avoidingre-exposureiscritical,howeversometimesunavoidable.Peopledonotwanttoliveinterroroftravellingoutsideoftheir“safebubble”.Ifre-exposureoccurs,identifyingthesourceisbeneficialtopreventrepeatexposure.RetestVCSandlabmarkersandifabnormal,retreatwithCSM/Welchol.Continueupthepyramiduntilsymptomsresolveandmarkersarebackinthenormalrange.PeoplewhohavehadCIRShaveatendencytobecome“sicker,quicker”uponre-exposure.Preventionisbest.CIRSisaverymisunderstooddiseaseatbestanddeniedbymanyatworst.ThankstotheresearchanddedicationofDr.Shoemaker,who
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followedtheevidence,thereisnowclinicalvalidationsupportedbythousandsofcasesforthediagnosisandtreatmentofCIRS.Itisimportanttounderstandthepathwaythebiotoxintakesinourbodywhichresultsinacascadeofsymptoms.Thisunderstandingprovidestheknowledgeofthehowandwhythesetreatmentstepsaretakeninordertoreversethedisease.Thisdiagnosisisnotmadeeasily.Asoutlinedabove,multiplecriteriamustbemet.Thediagnosisisthenvalidatedwithnumeroustestswhichanalyzetheeffectofthebiotoxinonmultiplesystemsofthebody.TestsrangefromVCStesting,multiplelabtestsincludingdetermininggeneticsusceptibility,MRIvolumetricimaging,andnowDr.Shoemakerisonthecuttingedgewithhisgenomicresearch.Thiswill“personalize”diagnosisandtreatmentbyunderstandingwhatthebiotoxinisdoinginyourbodyatacellular/geneticlevel.Thisisanexcitingfrontiertobepartof.Forme,itprovidesaveryimportantpiecetoapuzzleofchronicillness.
References:
1. Shoemaker:“Survivingmold-WhatisCIRS”December2014.http://www.survivingmold.com/news/2014/12/what-is-cirs/
2. Al-Sadi,Rawat,Ma:InflammatoryBowelDiseases:February2017.MMP-9
ModulationofIntestinalEpithelialJunctionPermeability.http://journals.lww.com/ibdjournal/Abstract/2017/02001/P_272_MMP_9_Modulation_of_Intestinal_Epithelial.275.aspx
3. Noack,Miossec:AutoimmunityReviews,June2014.Th17andT-regcell
balanceinautoimmuneandinflammatorydisease.http://www.sciencedirect.com/science/article/pii/S1568997214000081
4. Ganea,Hooper,Kong:ActaPhysiologica,December2014.The
neuropeptidevasoactiveintestinalpeptide:directeffectsonimmunecells
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andinvolvementininflammatoryandautoimmunediseases.http://onlinelibrary.wiley.com/doi/10.1111/apha.12427/full
5. Ryan,Wu,Shoemaker:BMCMedicalGenomics,April2015.Transcriptomics
inCIRS/Ciguatoxinhttps://www.ncbi.nlm.nih.gov/pubmed/25889530
6. Shoemaker,House,Ryan:NeurotoxicologySeptember2014,Structural
brainabnormalitiesinpatientswithinflammatoryillnessacquiredfollowingexposuretowaterdamagedbuildings:AvolumetricMRIstudyusingNeuroQuant.
https://www.ncbi.nlm.nih.gov/pubmed/24946038
7. Berndtson,McMahon,Ackerly,Rapaport,Gupta,Shoemaker:MedicallysoundremediationofwaterdamagedbuildingsincasesofCIRS.January2016.
https://www.survivingmold.com/docs/MEDICAL_CONSENSUS_1_19_2016_INDOOR_AIR_KB_FINAL.pdf
8. Maier:TheNo-Amylosediet.August2013http://www.livestrong.com/article/335261-the-no-amylose-diet/#ixzz18n8hXyTi
