CIRS Shoemaker Protocol #9

In reading proceeding blogs, you’ve caught onto the idea that chronic inflammatory response syndrome (CIRS) and erythromelalgia (EM) can be related. You’ve learned that the first step in recovery from CIRS and therefore EM is removal from exposure. This can mean moving away from or remediating a moldy home but can have other implications if something other than mold is driving your illness. You learned that the second step in treatment is taking a binder to remove the toxin that your immune system can’t see and therefore tag and remove.  This is typically a prescription medication- either colesevelam or cholestyramine. You read that the third step involved treating something nicknamed “MARCoNS” that can live deep in the nose of those with CIRS. These multiple antibiotic resistant coagulase negative staphylococci can impair the boy’s ability to produce normal amounts of  melanocyte stimulating hormone (MSH). This is a problem because adequate MSH is pivotal to recovery from biotoxin-induced illness. You read that the fourth step is testing to detect antigliadin antibodies. We defined the difference between gluten sensitivity that can happen in CIRS and celiac disease. You’ve learned about the importance of correcting abnormal androgens (AKA- out-of-whack hormones). In Shoemaker Step #6 you learned all about correction of dysregulation in the production of antidiuretic hormone (ADH)–also called vasopressin–and a disproportionate serum osmolality which commonly seen in CIRS. In step #7, you learned of the importance of correcting elevated MMP-9 as an over-abundance can lead to inflammation in the brain, nerve, muscle, lungs, and joints. In step #8 you learned about all things VEG-F and how a drop in it can drive shortness of breath, fatigue, cognitive issues, and muscle pain. What in the world could possibly be left to do?!

Step #9- CORRECTING C3a

Complement system proteins like C3a are important for proper immune function, yet as is often the case, too much of a good thing can prove to be problematic [2]. A simple blood draw helps our medical provider assess your C3a. If you have an elevated C3a, it indicates persistent bacterial colonization in your blood or tissues [3]. Yikes! What does that mean? This bacterial membrane in your blood or body may be Lyme disease, but it could also be related to something else entirely [3]. If your C3a is elevated, your medical provider will put on their detective hat and try to figure out what bacterial membrane is driving an elevated C3a. Treatment varies depending on what your medical provider discovers but may include 1 month of high-dose statins such as Zocor 80 mg daily.  

Sometimes, we will alternatively see a low C3a. This is less worrisome as it most likely means your immune system simply still has some recovering to do. Not to worry… it’s wise and is simply getting reorganized. By following the Shoemaker protocol- like me- recover you will!

You can read about CIRS Shoemaker Protocol starting from the beginning at Step #1 here.

You can read more about my journey as a medical provider hellbent on healing her own erythromelalgia here.

Read about healing my chronic inflammatory response syndrome (CIRS) and how that connects to EM here.

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[1] S. Low, W. Robbins and V. Tawfik, "Complex Management of a Patient with Refractory Primary Erythromalalgia Lacking a SCN9A Mutation," Journal of Pain Research, vol. 10, pp. 973-977, 2017.

[2] R. Shoemaker, K. Johnson, J. Lysander, Y. Berry, M. Dooley, R. James and S. McMahon, "Diagnostic Process for Chronic Inflammatory Response Syndrome (CIRS): A Consensus Statement Report of the Consensus Committee of Surviving Mold," Internal Medicine Review, vol. 4, no. 5, pp. 1-47., 2018.

[3] M. DiTulio, "Surviving Mold," 23 March 2015. [Online]. Available: https://www.survivingmold.com/DRAFT_OF_SCIENTIFIC_SUPPORT_-_DITULIO.pdf. [Accessed 23 October 2021].

[4] R. Shoemaker, Proficiency Partners Lecture, 2018.

[5] Surviving Mold, "12 Step Protocol Overview," [Online]. Available: https://www.survivingmold.com/legal-resources/12-step-protocol-overview. [Accessed 23 October 2021].

[6] R. Shoemaker, S. McMahon and A. Heyman, The Art and Science of CIRS Medicine, 2018.

[7] R. Shoemaker, Surviving Mold, Baltimore: Otter Bay Books, 2010.

[8] J. Abel, "Surviving Mold Shoemaker Protocol Certified Physicians," [Online]. Available: https://www.survivingmold.com/docs/Shoemakers_Protocol_for_publishing.pdf. [Accessed 24 Octover 2021].

[9] L. Leo, "Surviving Mold Shoemaker Protocol Certified Physicians," [Online]. Available: https://www.survivingmold.com/docs/Treatment_of_CIRS_Leonard_Leo.pdf. [Accessed 24 October 2021].

[10] Surviving Mold, "Biotoxin Pathway," 12 December 2005. [Online]. Available: https://www.survivingmold.com/docs/biotoxinpathway.pdf. [Accessed 25 October 2021].

[11] J. Janus and E. Johnson, "PHG Foundation- University of Cambridge," 1 December 2020. [Online]. Available: https://www.phgfoundation.org/explainer/transcriptomics. [Accessed 30 October 2021].