Ritchie Shoemaker - State of the Art Answers to 500 Mold Questions

Copyright 2014 by

Ritchie C. Shoemaker, MD

All rights reserved

Permission to reproduce in any form
must be secured from the author.

Please direct all correspondence and orders to

Ritchie C. Shoemaker MD

500 Market St Suite 103
Pocomoke, Md 21851

Printed in the United States of America

ISBN: 9781483533643

PREFACE

Sickened by moldy buildings? Need facts and answers fast? Here is your guide: State of the Art Answers for 500 Mold Questions . Thorough and reliable, 500 Answers is as current as one can find on a subject where bad information abounds. But, as far as sick people go, what I write here will need to be updated when we finally have genomic information. The world of diagnosis and treatment of chronic inflammatory response syndromes (CIRS) acquired following exposure to the interior environment of water-damaged buildings (WDB) now relies on proteomics and differential diagnosis. Call it mold illness, if you will. You need to know the latest and best information about human health effects caused by wet, moldy buildings and the importance of understanding human health effects before remediation begins. The time to share what really is going on in sickened people has been with us for nearly 20 years, yet so much just plain wrong information is out there. Our knowledge has reached new levels as therapies like use of vasoactive intestinal polypeptide (VIP) show us where we need to go to reduce reactivity and stop the systemic inflammation of CIRS-WDB.

But, the final frontier of diagnosis and treatment comes from differential gene activation caused by the many entities found in the indoor air of WDB. We know that genomics is such a big deal; how long do we have to wait to add the vitally important gene information? We think the coming scientific revolution will likely happen before Thanksgiving, 2014. We won't just be talking about genetic susceptibility then, but also gene activation and gene suppression. We wont be focusing just on commensal coag neg staphs but we will be discussing reversal of the known genomic effects these supposedly benign organisms have. We wont be talking about using pro-biotics as just a good idea any more; we could be discussing the differential anti-inflammatory effects of such use of bacterial supplements to correct abnormal metabolomics from the gut. Thanksgiving is just five months away.

So why write this compendium now if use of genomics will lead us to an entire new plane of understanding? This answer is simple: at www.survivingmold.com (SM) we are still getting the same Top Ten questions routinely. The information gap between established readers of SM and new visitors tells me that we still have a lot of information and understanding to share with people interested in this increasingly common, and increasingly complex medical problem.

And when genomics arrives, the information gap could become a chasm overnight.

I read comments from mold patients and mold docs that tell me that a lot of really bad information about human health effects is still out there. Some ideas are just silly but others are dangerous, as affected patients might actually believe them, spending huge amounts of money and suffering untold medical and social loss as a result. Whether the bad ideas are from the Inspector General of the EPA, the (intentional?) absence of anything useful from the CDC, or from a mold profiteer taking wheelbarrows full of money in exchange for false hope doesnt matter. False knowledge is dangerous.

Aldous Huxley told us that the key to understanding is casting out false knowledge. We apply his wisdom in this short book of 500 Answers to prepare for the arrival of new knowledge and new understanding from the human genome that is just around the corner.

Based on what we already know about the proteomics of CIRS, the days of ignorance about the pathophysiology of CIRS should be over, but just as we now celebrate useful therapies, we also know that our understanding has been shaped by less than one hundred blood tests. Compare that understanding to what we can mine from data sets of activity of 22,000 genes.

500 Answers includes new discoveries like the information we obtain from NeuroQuant that shows that the inflammation of CIRS causes the development of a distinctive fingerprint of injury to the central nervous system found just in CIRS-WDB patients. Better still, use of NeuroQuant shows us that the ability to correct the inflammatory response will in turn show correction of localized areas of grey matter atrophy in the brain. This result of treatment is unheard of in the world of brain injury. If you want to confirm that your executive cognitive functioning is due to exposure to WDB, do a NeuroQuant as part of the full work up.

If you simply want to know what to do to obtain a diagnosis that is accurate and begin therapies that work, 500 Answers is a must read. If you need solid information on how to go about testing your home, school and workplace to see if those buildings could be making you sick, 500 Answers is for you as well.

If you dont have any experience with human health effects cause by wet buildings, and you are understandably overwhelmed by the fuzzy science on the Internet, 500 Answers is your portal to a sharp vision of what is wrong and what needs to be done.

500 Answers has a complete Table of Contents, a roster of the many acronyms used and an index that will help you find out quickly what you want to know. The information in 500 Answers is correct but when we add genomics, the jargon terms and new information is going to require a steep learning curve. We welcome you to learn what you need to know now. We will help you with the new understanding too when the time comes.

Ritchie C. Shoemaker, MD

Pocomoke, Maryland

STATE OF THE ART ANSWERS TO 500 MOLD QUESTIONS

1.23andme

I have 23andme genetic testing but cant find a way to understand HLA SNPs vs. the specific tests recommended. Also, I have been told I have protomyxzoa rheumatica infection. Please help.

The future of medicine will include accurate genomic testing. I have little knowledge of the basis for the use of 23andme testing in clinical medicine. I am happy to review any data that you have that supports specificity and sensitivity of these tests underlying clinical illness.

It is my opinion that use of SNP testing is fraught with a significant possibility of error as mere presence of an SNP has nothing to do with gene activation/suppression. Presence of a SNP tells us nothing about regulation of the entire gene by microRNA.

I have never been able to confirm a diagnosis of protomyxzoa infection though I have seen a number of patients who have had testing done by Dr. Fry's lab in Arizona.

I am happy to review any data that you have to confirm this diagnosis with a particular eye to objective proteomic findings separate from findings on peripheral smear.

Please forward these findings to the website so that I may be of assistance to you.

2.Absence of HLA susceptibility and illness

Is it possible to become ill and stay ill without one of the HLA haplotypes associated with susceptibility?

Yes, we see approximately 95% of cases having one of the six HLA haplotypes that in turn comprise 24% of the normal population. That means 5% of ill people (cases) do not have HLA-driven susceptibility. The good statistical news is that for those 5% their prognosis is much better than those of the other 95% of cases. Treatment is still necessary for the non-HLA susceptible individuals. Even though they dont have the HLA we are accustomed in seeing in cases, they will not self-heal. The standard response to the predictable response of how does HLA alone determine susceptibility that I have used in the past is that biology is never 100% and HLA research is in its infancy. That statement is still correct. In order to perform the research needed to show how defective antigen presentation is occurring, we would need a very large prospective study to be done on a multi-site basis.