Rebecca Collinsworth

Tag: CIRS

  • CIRS Emergency and Inpatient Care Protocol Summary

    For use in emergency departments and inpatient units managing patients diagnosed with Chronic Inflammatory Response Syndrome

    Clinical Diagnosis
    Chronic Inflammatory Response Syndrome is an environmentally acquired illness involving innate immune system dysregulation following biotoxin exposure. It presents as a multisystem inflammatory condition and requires protocol-based management to prevent exacerbation. Diagnostic support is available through recognized laboratory and functional markers.

    Clinical Risk in Acute Settings
    Patients with CIRS are at high risk of inflammatory cascade when exposed to standard treatments that do not account for their underlying condition. This includes IV antibiotic administration, contrast exposure, and failure to control biotoxin load or cytokine activity. Complications may include rapid worsening of cognitive, pulmonary, gastrointestinal, and neurological symptoms.

    Priority Labs for CIRS Patients
    Obtain as early as clinically appropriate. If limited, prioritize starred items.

    Priority 1 – Inflammatory cascade status
    C4a *
    TGF-beta1 *
    MMP-9

    Priority 2 – Regulatory dysfunction and treatment eligibility
    ADH and serum osmolality *
    HLA-DR if not already documented *
    VIP
    VEGF

    Priority 3 – General clinical status and safety
    CMP with electrolytes *
    CRP *
    CBC with differential
    ESR
    Lipase prior to VIP consideration
    Coagulation profile if bleeding history present
    Consider VCS testing if available

    Supportive Measures to Reduce Inflammatory Risk
    Binders
    Initiate cholestyramine or colesevelam per protocol to bind circulating biotoxins. Administer 30 minutes before meals and medications if tolerated. Use compounded or low-reactivity forms if sensitivities are documented.

    Hydration
    Use slow IV fluids to support electrolyte balance and toxin mobilization. Avoid rapid boluses unless urgently indicated. Monitor sodium and osmolality during fluid therapy. If ADH dysfunction is known, consider DDAVP under electrolyte monitoring.

    Antibiotic Considerations
    Fluoroquinolones and other high-reactivity antibiotics may worsen inflammatory response in genetically susceptible patients. If antibiotics are required, pre-treat with binders and consider anti-inflammatory adjuncts such as omega-3 fatty acids. Track symptoms and biomarkers during treatment.

    Environmental and Dietary Controls
    Minimize patient re-exposure to water-damaged environments. Use low-amylose meals and avoid gluten and artificial sweeteners. Review and confirm medication tolerances. Avoid unnecessary additives or contrast agents without risk-benefit discussion.

    Monitoring and Discharge Planning
    Repeat MMP-9, C4a, TGF-beta1 if clinical picture worsens
    Ensure ADH and osmolality normalize prior to discharge if they were abnormal
    Assess for VIP eligibility only after confirmation of stable inflammatory profile and environmental safety
    Include notation of CIRS diagnosis in discharge summary and advise follow-up with specialist trained in Shoemaker Protocol

    Reference Framework
    This protocol is based on peer-reviewed literature and the established Shoemaker Protocol as published in Annals of Medicine and Surgery 2024 and referenced in clinical case definitions for biotoxin-related illness. Protocol steps are sequential and evidence-based. Improper management may result in prolonged recovery or multi-system relapse.

    Annals of Medicince & Surgery
    Shoemaker Treatment Protocol

  • Why I Sip Chia Water Daily: A Small Habit That Supports My CIRS Recovery

    Why I Sip Chia Water Daily: A Small Habit That Supports My CIRS Recovery

    One of my go-to daily habits, especially during periods of heightened inflammation or system stress, is sipping chia-infused water throughout the day. I typically prepare it after dinner, adding 2 tablespoons of chia seeds to a 23.7 oz bottle of water, shaking it a few times over the first 20 to 30 minutes, and then placing it in the refrigerator overnight. This allows the seeds to fully hydrate and form a soft, drinkable gel by morning. I always give it another shake a few hours later as well. I make two bottles like this each night to use the following day—one for the morning, one for the afternoon.

    While chia is a plant-based source of alpha-linolenic acid (ALA), it’s important to understand that ALA is not a substitute for the higher-potency EPA and DHA that are often recommended as part of recovery support strategies. For individuals following protocols like the Shoemaker Protocol, therapeutic levels of EPA and DHA may be necessary to support inflammation regulation. Chia water is simply one way I support hydration, digestive ease, and metabolic steadiness in a gentle, food-based format.

    For many people, it just looks like an interesting hydration choice. But for those navigating Chronic Inflammatory Response Syndrome (CIRS) or any health picture that places a demand on digestion, hydration, or systemic resilience, this practice has become a small but steady source of daily support.

    It helps me feel more hydrated throughout the day. My system tends to lose water faster than average, especially during active detox or stress. The gel-forming nature of soaked chia seeds slows water absorption and seems to help maintain hydration longer than plain water. That steady, gradual absorption makes a noticeable difference in how well I retain fluids and feel balanced.

    It supports digestion without being demanding. Each tablespoon of chia seeds contains around 5 grams of fiber, a blend of soluble and insoluble types. This supports my natural elimination rhythms and helps maintain regularity without the push of stimulant-based aids. When my body can’t tolerate much food, chia water keeps things moving gently without adding stress to the system.

    It offers plant-based omega-3s that complement my overall nutrition plan. Chia seeds are naturally low in histamine and rich in ALA, a plant-sourced omega-3 fatty acid. While ALA isn’t converted very efficiently into DHA or EPA, I still find it valuable as a foundational nutrient that supports my overall wellness and helps maintain a balanced internal environment.

    It helps keep my energy and mood steady between meals. Even when I’m not eating much, chia water helps buffer those ups and downs by slowing how fast glucose hits my bloodstream. This creates a more stable curve of energy release throughout the day, which matters a lot when my body is under strain.

    It adds trace minerals and gives me a nutritional edge when my intake is limited. Chia seeds contain magnesium, calcium, iron, and potassium. While the amounts are modest, they support basic functions like nerve conduction, muscle coordination, and electrolyte balance—all areas that tend to get taxed when I’m dealing with environmental stress or nutrient loss.

    How I use it throughout the day: my morning bottle supports hydration and regularity, especially if I’m easing into the day without food. My afternoon bottle helps me stay alert and grounded when energy wanes or food doesn’t sit well. I sip each bottle slowly over 3 to 4 hours, letting my system absorb what it needs without the overwhelm of heavier intake.

    Why this practice matters for me. CIRS affects multiple systems at once, and managing it calls for daily practices that work with my body instead of against it. I’ve found that chia water adapts well to the variability of my needs, supports my routines, and helps me stay on track with minimal effort or cost.

    For anyone living with complex health challenges—including CIRS, mold sensitivity, or other inflammatory responses—chia water may offer gentle support. It’s food-based, easy to tolerate, and fits into most therapeutic nutrition plans. As always, work with a provider to ensure it’s right for your unique needs.

    And best of all, it’s easy to integrate even on days when energy is low or food is limited, whether that’s due to post-exposure fatigue, a flare of immune activity, or the general weariness that often follows periods of detox. When my system feels overloaded and I can’t do much else, chia water gives me something consistent, nourishing, and simple to lean on.

  • The Shoemaker Protocol: How to Train Your Body Before “Playing the Game”

    The Shoemaker Protocol: How to Train Your Body Before “Playing the Game”

    Chronic Inflammatory Response Syndrome (CIRS) is a complex condition triggered by biotoxin exposure—commonly from mold, water-damaged buildings, or Lyme disease—that disrupts the body’s ability to clear inflammatory toxins. The Shoemaker Protocol is widely regarded as the gold standard treatment for CIRS. While it’s structured in a clear, stepwise sequence, what’s often overlooked is that real-world healing sometimes requires flexibility rooted in decades of patient observation.

    I’m grateful the provider guiding me through recovering from CIRS has over 30 years of experience treating it. While he does have his patients follow the Shoemaker Protocol, he includes a slight but clinically important adaptation: don’t start with binders.

    Why Hold Binders Until the Body Is Ready

    Over the decades, he’s observed that many patients experience acceleration reactions when cholestyramine (CSM) or Welchol are introduced too soon. These reactions are often due to the degree of cytokine elevation already present in the body. That’s why he holds binders until the body is ready.

    Instead, binders are introduced once the patient has cleared ongoing exposure and completed a foundational phase that sets the body up for successful detox. If I were to use a sports metaphor—successful environmental avoidance is like making the team. You’ve identified the problem, committed to recovery, and removed yourself from the harmful environment. But you’re not playing the game yet.

    No binder, no supplement, and no dietary tweak can undo daily or chronic re-exposure. It’s like trying to bail water from a sinking boat without plugging the leak. This step is non-negotiable. That said, hydrating and eating well while in ongoing exposure remains beneficial. It simply won’t be enough to fully address the systemic inflammation that results from chronic biotoxin exposure.

    Prepping the Body: Training Camp for Healing
    My provider teaches that before starting binders, patients must establish three foundational habits. This is the training camp phase before stepping onto the field:

    Low Amylose Diet
    Amylose is a form of starch found in grains, bananas, root vegetables, and processed foods. It also hides under the label “modified food starch,” and if a starch is listed in the ingredients, it almost always includes amylose, which constitutes 5 to 35 percent of most starches. Artificial sweeteners are also excluded. Removing these sources of inflammation is essential to regulate immune function.

    EPA/DHA at Therapeutic Levels
    The protocol indicates EPA and DHA should be dosed between 3,000 to 4,000 mg daily for at least one to three weeks before introducing binders. This supports inflammation resolution and cell membrane stability.

    Adequate Hydration Habit
    I’m not talking about just drinking water when you’re thirsty. I’m talking about building a hydration routine—measured, structured, and consistent—so your body has the fluid it needs to transport toxins safely, per the Shoemaker Protocol.

    Now You’re Ready to Play the Game

    Once these three foundations are in place, my provider teaches that binders can be introduced with greater safety and improved tolerance. At this point, the patient is no longer inflamed from daily exposure, has reduced inflammatory inputs, and has supported their body’s readiness to move toxins out.

    You Deserve a Team, Not Just a Checklist

    Healing from CIRS isn’t a solo mission. It’s okay to ask for support. I offer CIRS Awareness & Resource Support Calls via Zoom if you feel that’d be helpful. During our conversation, I’ll listen to your story, share insights from my lived experience, and offer supportive tools, education-based resources, and coaching guidance on how to move forward with self-advocacy and environmental awareness, including contact information for qualified CIRS providers I know.

    You are far from alone. Support is available. With the right guidance, you can stop guessing and move forward with confident clarity.

  • Creating a Safe Home Environment as Part of Your Wellness Support

    If you are living with Chronic Inflammatory Response Syndrome (CIRS), your environment plays an essential role in your healing journey. Even small changes can help your body shift from defense mode into rest, repair, and balance. For readers managing ADHD, CPTSD, or executive function disorder, this post provides simple, digestible steps you can take without overwhelm.

    Why your home environment matters

    Your body responds to your surroundings all day and night. When your space contains hidden mold or water damage, your immune system can stay on alert, making it harder to regulate energy, sleep, focus, mood, and digestion. When you reduce these triggers, you give your body space to heal and return to a calmer baseline.

    Gentle, practical steps to support your environment

    You do not have to change everything at once. Start small with these easy-to-follow steps:

    • Declutter one small area at a time: Choose one drawer, one shelf, or one corner. Reducing clutter helps improve airflow and makes cleaning easier.
    • Use a vacuum with a HEPA filter: This removes small particles and reduces dust that can hold onto mold fragments.
    • Check for visible moisture regularly: Look at windowsills, under sinks, and near appliances weekly. Write it down or set a recurring reminder.
    • Run a dehumidifier in damp spaces: Basements, laundry rooms, and bathrooms can benefit from keeping humidity below 50 percent.
    • Wash soft fabrics often: Curtains, bedding, and upholstery can collect dust and mold spores over time.

    These small changes reduce the environmental burden gently, making your space feel lighter and safer without needing a major renovation right away.

    Tools to help with executive function

    • Use sticky notes or phone reminders to break tasks into tiny steps.
    • Create a simple checklist such as “Check under sink” or “Run dehumidifier.”
    • Celebrate when you finish one area, no matter how small—it counts.

    Why this helps your wellness journey

    Improving your home environment is one of the easiest ways to support your body’s natural healing processes. Even small improvements can make your home feel calmer, safer, and more supportive as you continue your wellness work.

    Take action

    In the next post we will include an educational call to action on when and why to consult a CIRS-literate professional and how to keep your wellness journey moving forward.

  • When and Why to Consult a CIRS-Literate Professional

    If you have been working on improving your home environment and still feel stuck in symptoms, it may be time to bring in additional support. A CIRS-literate professional understands the complexities of Chronic Inflammatory Response Syndrome and how the environment interacts with health. This post offers gentle guidance on when to seek expert help and why it can make a meaningful difference.

    Why a CIRS-literate professional matters

    Not all health professionals or inspectors understand the unique needs of people with CIRS. A CIRS-literate professional is trained to recognize subtle environmental risks, interpret complex reports like ERMI and HERTSMI-2 accurately, and work alongside your care team to guide next steps that match your healing goals.

    When to consult a professional

    Here are some simple signs it may be time to reach out:

    • You have made changes in your home but symptoms remain or return
    • You feel overwhelmed interpreting your environmental test results
    • You want help planning remediation or future testing
    • You suspect your home has a history of water damage you cannot fully evaluate alone
    • You are considering legal action, insurance claims, or landlord disputes and need proper documentation from licensed professionals

    How to make this step easier for readers with ADHD, CPTSD, and executive function disorder

    • Choose one professional to contact first and schedule a brief call or email inquiry
    • Ask clear questions such as Do you work with clients managing CIRS and Do you provide written next steps
    • Keep a short list of contacts and notes about their responses so you feel organized

    Why this step helps your wellness journey

    A CIRS-literate professional can reduce confusion, save you time, and help you make decisions with confidence. Their guidance ensures you are not missing hidden details that could be contributing to ongoing symptoms. Working with the right expert helps your wellness plan feel clearer, calmer, and more achievable.

    Thank you for reading this series. You are not alone on this path. Small steps and thoughtful guidance can help you create a safe, supportive environment so you feel more empowered in your wellness journey. Reach out anytime if you have questions or want help getting started.

  • How to Interpret Environmental Test Results with Your Care Team

    Once you have completed environmental testing, you will likely receive a report full of numbers and technical terms. For many people with Chronic Inflammatory Response Syndrome (CIRS), this part can feel overwhelming, especially if you live with ADHD, CPTSD, or executive function challenges. This post is designed to simplify that process and help you feel confident moving forward.

    Why context matters

    No single test can tell the whole story. An ERMI or HERTSMI-2 score gives you valuable data, but interpreting these results must happen in the context of your symptoms, your home history, and your wellness goals. A space might show some mold species on testing but may not be the root cause of your symptoms unless other factors confirm it.

    Working with your wellness team

    Your care team may include your primary care provider, a mold-literate clinician, a licensed massage therapist, or a health coach. Together, they can help you review the test results alongside your symptom history, daily routines, and past exposures. This is where your wellness team shines—they help translate lab numbers into a personalized plan you can follow.

    How to keep this step clear

    For readers with executive function challenges, try these steps:

    • Highlight or circle the key scores in your report such as your HERTSMI-2 score.
    • Write down the range for that score so you know what it means (for example low, moderate, or high risk).
    • Take that summary with you when meeting with your wellness team so you are ready to discuss next steps.

    Questions to ask during interpretation

    Here are three simple questions you can ask your care team:

    1. Does this score suggest that my environment could be affecting my symptoms?
    2. Are there specific changes or repairs we should prioritize?
    3. How often should I retest after making improvements?

    These questions keep your conversation focused and ensure you leave with a clear plan you can act on.

    Why this step helps your wellness journey

    Interpreting test results with guidance reduces confusion and worry. It helps you make decisions based on your unique situation, not just numbers on a page. It ensures that your next steps are meaningful and supportive of your long-term wellness.

    Take action

    In the next post we will talk about how to begin creating a safe home environment as part of your healing journey, with simple, gentle changes that can make a big difference.

  • What to Expect from a Thorough Home Inspection for CIRS Concerns

    If you are exploring your environment as part of your wellness journey with Chronic Inflammatory Response Syndrome (CIRS), it helps to know what a complete home inspection should include. Many inspections focus only on visible signs of mold or moisture, but a CIRS-sensitive inspection goes much deeper.

    Why a detailed inspection matters

    For individuals with CIRS, small overlooked environmental factors can keep symptoms going even when spaces look clean and fresh. Not all water damage risks are obvious. Hidden areas can harbor contaminants that affect sensitive individuals long after repairs appear complete.

    Not all materials labeled as safe truly are

    Many products are advertised as waterproof or mold resistant, but that does not always mean they meet the safety needs of a person with CIRS. Materials can meet basic building codes and still allow for mold growth under the right conditions.

    Dr. Jill Crista, author of Break the Mold, highlights that CIRS is often missed because inspectors or contractors rely on standard labels rather than understanding the unique risks for sensitive individuals. Damage behind walls, under floors, inside HVAC systems, or in remediated areas can go unnoticed without careful attention.

    What should a thorough inspection include

    When working with a qualified inspector, make sure they will evaluate:

    • Behind walls especially where there was past water damage
    • Under flooring including under carpeting or vinyl layers
    • Inside HVAC systems such as ducts, filters, and condensate pans
    • Inside crawl spaces, basements, and attics
    • Any areas that have been remediated in the past

    These areas are common sources of hidden moisture or contamination that can prolong symptoms even after superficial cleaning.

    How to prepare if you have ADHD, CPTSD, or executive function disorder

    To make this process easier:

    • Write a list of areas you want checked before the inspector arrives.
    • Ask the inspector to provide a written report with photos for each area.
    • Keep a running list of what they inspect so you feel clear and informed.

    This approach helps reduce decision fatigue and gives you an easy reference for follow-up steps.

    Why this is worth your effort

    A detailed inspection is one of the most helpful ways to understand whether your space is supporting your health. It helps you avoid ongoing frustration and gives your wellness team a clearer picture of what may be affecting your symptoms.

    Take action

    In the next post we will talk about how to interpret your environmental test results in context with your wellness plan.

  • Why Testing Settled Dust Offers Better Insights Than Air Tests

    When checking your home or office for environmental triggers that could contribute to Chronic Inflammatory Response Syndrome (CIRS), it is important to understand how testing works. Many inspectors test only the air but that may not give you the full picture. For those with CIRS, settled dust holds the history of past exposures and can provide more helpful information.

    Why settled dust matters

    Air quality can change quickly. Opening a window or turning on the HVAC system can make an air sample seem fine even when hidden contamination remains. Dust, however, collects particles over time. Testing this dust helps reveal past problems and exposure risks that may still affect your health even if the air smells fresh and looks clean.

    Using the right lab: EnviroBiomics

    EnviroBiomics is a lab many CIRS-aware professionals trust for Environmental Relative Moldiness Index (ERMI) and HERTSMI-2 testing. These tests help measure molds most associated with water-damaged buildings and can guide next steps in making your space safer.

    If legal action may be needed, remember this important detail: Florida law accepts test results only when they come from a licensed professional. This means you should not collect your own dust samples if you want results that could hold up in court. Proper chain of custody matters. A licensed inspector can help ensure that all samples are collected, handled, and documented correctly from start to finish.

    For readers with ADHD, CPTSD, and executive function disorder

    To reduce overwhelm here is a simple plan you can follow:

    • Make one list of places where dust collects such as vents, baseboards, under appliances, inside closets.
    • Contact a licensed inspector and ask them how they will collect and submit samples to EnviroBiomics.
    • Write down each step they give you so you can follow along clearly.

    Why this approach helps your wellness journey

    Settled dust testing gives a more complete story about what is happening in your space. It helps identify hidden risks so your wellness team can understand the environment’s role in your symptoms. You can then take informed steps to reduce exposure and feel more supported on your healing journey.

    Take action

    In the next post we will talk about why requesting a HERTSMI-2 score is a valuable tool and how it builds on the results from dust testing.

  • Understanding the Importance of Requesting a HERTSMI-2 Score

    When you are exploring your home environment for potential contributors to Chronic Inflammatory Response Syndrome (CIRS), it is not enough to simply test for mold. Knowing how to interpret those test results is just as important. This is where the HERTSMI-2 score comes in.

    What is a HERTSMI-2 score

    HERTSMI-2 stands for Health Effects Roster of Type-Specific Formers of Mycotoxins and Inflammagens. It is a simple scoring tool that focuses on five types of molds most closely linked to water-damaged buildings and CIRS. While the ERMI (Environmental Relative Moldiness Index) gives a broad mold profile, the HERTSMI-2 pinpoints molds that matter most for people sensitive to environmental triggers.

    This focused score can help guide decisions about remediation and help your wellness team understand what risks may still exist even after cleanup efforts.

    Why this matters for readers with ADHD, CPTSD, and executive function disorder

    Environmental test reports can feel overwhelming. The HERTSMI-2 score distills complex lab data into a number you can track easily, making it simpler to understand whether your environment supports your healing.

    The role of EnviroBiomics and legal considerations

    EnviroBiomics offers reliable testing and can calculate the HERTSMI-2 score from dust samples. Always confirm that your inspector knows how to request this score and include it in your report.

    If you think you may need these results for any legal reason, remember that Florida requires licensed professionals to perform the collection and that chain of custody procedures must be followed precisely. This ensures your results will be valid and useful if you ever need them for insurance claims, landlord disputes, or legal action.

    How to keep this process simple

    Here’s a clear plan for anyone who feels overwhelmed by paperwork or decisions:

    • Ask your inspector specifically if they will calculate and explain the HERTSMI-2 score as part of your report.
    • Request that they highlight this score clearly in your final documentation.
    • Keep a copy of your report in a single folder or file so it is easy to find later.

    Why this helps your healing journey

    By requesting a HERTSMI-2 score, you gain a simple clear number that helps you understand your space and supports informed decision-making with your care team. It brings clarity to a complex topic and makes your next steps easier to plan.

    Take action

    In the next post we will look at what to expect from a thorough home inspection and why not all waterproof or mold resistant materials are CIRS safe.

  • How to Choose the Right Expert for Environmental Assessment

    5 Essential Questions

    If you or someone you care about is navigating Chronic Inflammatory Response Syndrome (CIRS), finding the right environmental professional is a key step in supporting wellness. Not every inspector understands the unique needs of someone managing CIRS, so it helps to go in prepared.

    This guide is written to help readers with ADHD, CPTSD, and executive function disorder break this task into clear, manageable steps that feel less overwhelming.

    Why your inspector matters

    A certified inspector who understands CIRS will look beyond typical mold concerns. Many inspectors focus only on visual mold or moisture, but CIRS requires a deeper awareness of hidden risks and how even small environmental factors affect sensitive individuals.

    Five essential questions to ask before hiring an inspector

    Before hiring an inspector, ask these five questions to confirm their experience and fit for your needs:

    1. Do you have experience assessing homes or offices for clients with CIRS?
      Look for a professional who has worked with individuals managing this condition and understands that not all water damage is visible.
    2. What testing methods do you use for CIRS-related concerns?
      Ask about their approach to testing settled dust (not just air samples) and whether they use methods like ERMI or HERTSMI-2 scores.
    3. Are you familiar with current research and resources such as Shoemaker Protocols or Break the Mold insights?
      This helps ensure your inspector is educated and current with the best practices that support your healing journey.
    4. Can you explain your process in clear steps that I can track easily?
      If you have ADHD or executive function challenges, you want a professional who can give a clear plan in writing, with easy-to-follow instructions.
    5. Are you licensed in Florida and do you follow chain of custody protocols?
      In Florida, test results must come from a licensed professional to be valid for legal purposes. Make sure your inspector meets this requirement if you may pursue legal action later.

    Why these questions help

    These five questions reduce decision overwhelm by giving you a simple checklist. You can use a notebook or note app to jot down answers as you interview potential inspectors.

    Extra support for executive function

    If you feel unsure how to ask these questions, you can email them in advance so you have written responses. This makes it easier to review later or ask a friend to help evaluate the answers.

    How this supports your wellness plan

    Choosing a qualified, knowledgeable inspector means the information you gather will actually help you and your wellness team decide next steps. It ensures that your time, money, and effort are going toward results that matter for your health.

    Take action

    Set aside 20 minutes this week to research inspectors and schedule calls or emails. Even one contact made today is a positive step toward creating a safe, healing space.

    In the next post, we will explore why testing settled dust offers clearer information than just testing air samples and introduce a trusted lab that can help, along with important legal details for Florida residents.