CIRS Shoemaker Protocol Step #5-
As we covered in the last few 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 a great deal. Let’s continue to walk through the steps of CIRS treatment together…
Step #5- CORRECTING ABNORMAL ANDROGENS
Deficiency in secondary androgens (testosterone and DHEA) may be a problem in 40-50% of people with CIRS due to upregulation (or excess) of aromatase [2, 6]. What the heck does this mean? Your hormones are out of whack! In addition, those with low vasoactive intestinal peptide (VIP) may have elevated estradiol levels [6]. A normalization of MSH production during treatment will correct androgen issues if no other cause in contributing [2]. What the heck is MSH? Review Step #3 and Step #4. The good news is that with the protocol, androgens usually reset on their own [3]! Your CIRS savvy provider will avoid testosterone replacement [3]. This is due to a predictable conversion of testosterone to estrone and estradiol when aromatase is upregulated in CIRS [2].
In some cases, your provider may determine giving DHEA in the form of a “aromatase challenge” is necessary. If this is part of your treatment, they will explain the steps. None of us feel well with hormones gone haywire, but the happy news is that the Shoemaker Protocol can almost magically correct this and so much more!
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].
