CIRS Shoemaker Protocol Step #8

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. What could possibly be left to do?!

Step #8- CORRECTING LOW PLASMA VEG-F

First off, what does the word “plasma” mean? It is just a fancy word for blood. So, in Shoemaker step #8, we are working to correct low levels of VEG-F in the blood. In about a third of CIRS patients, the polypeptide vascular endothelial growth factor (nicknamed “VEG-F”) will be low, in another third VEG-F will be high, and in the remaining third VEG-F will be within a normal range [3]. VEG-F plays a pivotal role in the creation of small blood vessels and in oxygen delivery to the capillaries [2]. Low VEG-F is our biggest concern in CIRS as it can drive shortness of breath, fatigue, cognitive issues, and muscle pain [2]. “A deficiency of VEG-F results in loss of neuroprotection with noted increased permeability of the blood brain barrier as well as capillary hypoperfusion” [6]. That’s a mouthful. What does it mean? Well, a low level of VEG-F in the blood can leave your brain in a bit of a vulnerable state as the barrier that typically surrounds it become increasingly permeable or “leaky”. Yikes! In addition, low levels of VEG-F can lead to hypoperfusion… this just means decreased blood flow to a place where more blood should be flowing. Do no freak or fear… treatment for low VEG-F mirrors treatment of elevated MMP meaning we use very specific doses of high-dose omega 3 fatty acid supplementation (otherwise known as fish oil). You gotta love it when in the midst of a complex medical illness, you can kill two birds with one stone!  

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].