CIRS Shoemaker Protocol Step #6

As we covered in the last five 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). What’s next?

Step #6- CORRECTING ADH/OSMOLALITY

Dysregulation in the production of antidiuretic hormone (ADH)–also called vasopressin–and a disproportionate serum osmolality are commonly seen in CIRS [3]. This is yet another consequence of diminished melanocyte stimulating hormone (MSH) [2]. Symptoms associated with disruption of this hormone are associated with intravascular dehydration and may include drinking more than the average bear due to increased thirst as well as heading to the toilet more frequently due to increased urination [3]. There can often be misdiagnosed “migraine” headaches… the headaches are a real thing but as Dr. Shoemaker often says, it is because the brain doesn’t appreciate sitting in pickle brine. An easy way to think of the dysregulation occurring is simply to say that the salt/water balance in your body gets off kilter. This dysregulation in the production of antidiuretic hormone (ADH) and the disproportionate serum osmolality that co-occurs are commonly seen in CIRS and are often a key player in postural orthostatic tachycardia syndrome (POTS). I know I will get a shout-out from my POTS people when I say that dizziness can occur with position change. Strangely, an increased incidence of static shocks may also occur... oh, the look of recognition on a person’s face when I ask them if they dread touching light switches or avoid doing so altogether by using their elbow as an alternative method! If levels of ADH are low, then your medical provider may use a medication called DDAVP for a short period of time.

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 October 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].