Rebecca Collinsworth

Tag: shoemaker protocol

  • 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

  • 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.