CONDITIONS WE TREAT

Case Criteria

Chronic Inflammatory Response Syndrome

With respect to Dr Ritchie Shoemaker, we have added Chronic Inflammatory Response Syndrome (CIRS) to the realm of our treatment protocols. Dr Pfeiffer has begun the process of becoming a c   oveted certified practitioner in the “Shoemaker Protocol.” It is noted that in 24% of the population, a genetic disposition can make them susceptible to CIRS. Chronic Inflammatory Response Syndrome is a progressive multi-system, multi-symptom illness caused by exposure to biotoxins including, but not limited to mold, Lyme, viruses, parasites, and other related infections. Patients may carry a multitude of misdiagnoses such as chronic fatigue, fibromyalgia, lupus, MS, depression, anxiety, ADD, PTSD, IBS, Parkinson’s, Alzheimer’s, and many more. Because of certain genetic markers, the majority of people are not susceptible to CIRS, but in the other 24% of the population, their immune system is unable to recognize biotoxins and therefore cannot adequately eradicate them.

Biotoxin Illness Symptom Clusters
Fatigue
Weak
Decreased Assimilation of New Knowledge
Aches
Headache
Light Sensitivity
Memory Impairment
Decreased Word Finding
Difficulty Concentrating
Joint Pain
A.M Stiffness
Cramps
Unusual Skin Sensitivity
Tingling
Shortness of Breath
Sinus Congestion
cough
Excessive Thirst
Confusion
Appetite Swings
Difficulty Regulating Body Temperature
Increased Urinary Frequency
Red Eyes
Blurred Vision
Sweats
Mood Swings
Ice-Pick Pain
Abdominal Pain
Diarrhea
Numbness
Tearing of eyes
Disorientation
Metallic Taste
Static Shocks
Vertigo
CIRS Case Criteria:
  1. Symptoms consistent with biotoxin illness. 6 of the symptom clusters listed above is grounds for a thorough diagnostic workup and 8 symptom clusters is consistent with biotoxin illness.
  2. History consistent with biotoxin exposure to WDB's, toxicogenic blue green algae, tick bites or consumption of reef fish.
  3. Visual Contrast Sensitivity testing to assess and document capillary hypoperfusion from neurotoxins.
  4. Genetic predisposition as determined through HLA haplotype
  5. Presence of genomically active MARCONS in the nasal cavity.
  6. An abnormal rise in pulmonary artial systolic hypertension during exercise
  7. Biomarkers consistent with CIRS: neuro-regulatory, neuro-endocrine, neuro-immune, inflammatory, vascular and endocrine abnormalities.
See steps of the Shoemaker Protocol for expanded review of biomarkers and their use in helping to correct CIRS.

When case criteria are met, proceed with the Shoemaker protocol.
Sequential treatment steps [see treatment steps pyramid below] must be followed step by step without any changes in sequence or skipping steps.

Dr. Shoemaker recommends repeating a VCS test and checking innate immunity labs after each successive step of the protocol. (repeat abnormals of the following biomarkers: MMP9, C4a, TGF-B1 and CD4+CD25++T-reg levels)
Treatment Steps

Bioidentical Hormone Replacement for Men and Women

Hormone Replacement: As we age, there is a natural decline of certain hormones which is known as menopause in women and andropause in men. For women this can present in symptoms such as hot flashes, vaginal dryness, decreased libido, sleep disturbances, anxiety, fatigue, and depression. For men, symptoms may include decreased libido and stamina, decreased muscle mass and strength, erectile dysfunction, low energy, fatigue, and reduced body hair. Beyond natural decline in hormone production, many lifestyle choices, foods, medications, and disease processes can contribute to inadequate hormone production.  

Our hormone replacement therapy is available to men and women and is done in the form of pellets which are placed in the subcutaneous tissue of the patient’s upper buttocks. The patient will have an office visit with a Vero Clinics provider at which time lab work is drawn to determine each individual patient’s adequate dosing. Men are offered testosterone pellets and women are offered testosterone pellets and, depending on hormone levels, a possible estradiol pellet. Additional supplements and prescriptions may be offered depending on the patient’s labs. Women are often times prescribed progesterone, which has been shown to have a positive effect on sleep and mood. Less commonly, hormone creams may be prescribed through the same process of a provider visit and lab work to determine dosing. Labs are repeated at specific intervals to check hormone levels, and pellets are replaced approximately every 4-6 months.

     
Diagnosing 
    • A visit with a provider is required at which time the provider will obtain a comprehensive health history, including a complete hormone panel. A return appointment is scheduled in approximately 2 weeks to review labs and to determine the need for hormone replacement at a customized dosing.

Treatment 
We strive to individualize your hormone needs while maintaining our philosophy of root cause driven care. We use bioidentical hormone replacement therapies, as these hormones are derived from plant sources and chemically comparable to the hormones your body makes. 
    • Bioidentical pellet HRT 
        ◦ A customized dose of hormone pellets is placed subcutaneously by the provider. The pellet method allows for continuous release of hormones over a 4-6 month period. Women are typically prescribed a compounded dose of progesterone to be taken in conjunction with HRT. 
    • Bioidentical compounded hormone creams and compounded oral progesterone 
        ◦ Customized dosing of estrogen and testosterone in cream base to be applied daily with an oral compounded dose of progesterone daily
    • Testosterone cypionate injections for men with customized dosing and safe monitoring of dosing 
    • Due to inherent risks of therapy, patients will be required to adhere to a schedule for follow-ups and lab work to continue bioidentical HRT therapy.

Price
Variable pricing will be noted with use of bioidentical cream HRT as those are considered prescriptions.
Bioidentical pellet HRT for women is $350.00 per insertion and for men is $750 per insertion.  
Any required lab work, added supplementation and consultation are not included in the price.

Lyme Disease

Lyme disease is a common infection caused by tick or other insect bites, and most experts believe that it is also sexually transmitted. Acute Lyme disease often presents with a rash and flu-like symptoms. If the acute infection is not noticed or not diagnosed correctly, it can lead to persistent symptoms known as chronic Lyme disease. Up to 50% of patients with post Lyme disease syndrome (post LDS) or chronic Lyme infection have no recollection of a rash or bullseye sign. Symptoms of chronic Lyme or post Lyme disease Syndrome according to ILADS include: 

    • Fatigue
    • Cognitive dysfunction
    • Headaches
    • Sleep disturbances
    • Migratory myalgia and arthralgia
    • Numbness and tingling
    • Neuropathic pain
    • Depression and anxiety
    • Musculoskeletal problems

 Cameron DJ, Johnson LB, Maloney EL.. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease.Expert Rev Anti Infect Ther. 2014 Sep;12(9):1103-35. doi: 10.1586/14787210.2014.940900. Epub 2014 Jul 30.Review.

Traditional antibiotics, such as doxycycline, are the first line of treatment with acute Lyme illness; however, for long term treatment they are likely not efficacious and may even make the illness worse by destroying the gut flora, which is where 80% of the immune system is derived. They can also lead to the formation of persister cells and stimulate the bacteria to form biofilms, which likely make future antibiotic use inert. In the 24% of people susceptible to CIRS, even an initial correct diagnosis and treatment of acute Lyme can still leave these patients with long term complications. The goal of treating Lyme disease is to kill off the infection while improving and optimizing the patient’s immune system.

Diagnosis 
    • Visit with a provider to obtain a comprehensive health history and physical exam
    • Complete wellness lab evaluation 
    • Igenex Lyme disease testing with co-infection panel 
    • In most cases Chronic Lyme or post LDS is a diagnosis that includes clinical history, physical exam and supporting labs, according to ILADS.  
    • Patients will then be seen 4-6 weeks after initial encounter to review lab results and discuss a customized plan of care. 

Lyme Treatment
Ozone therapy- addition during the argentyn 23 protocol
Ozone therapy as a stand alone 
*each patient case is reviewed with a provider at a follow-up appointment and a plan of care will be developed in congruence with patient input. 

Mold

Mold is known to cause life altering primary and secondary infections. Mold exposure has been shown to cause long term effects such as asthma, fatigue, weakness, memory loss, insomnia, anxiety, depression, brain fog, trouble concentrating, pulmonary fibrosis, difficulty breathing, and confusion. There are treatment options for patients who have been exposed to mold, but the patient must also eliminate the source of the mold in order to reach full recovery.  

Diagnosis
Mold toxicity can be diagnosed by obtaining a detailed history of the patient’s symptoms, along with lab work looking for specific markers including C4a 

Mold toxicity treatment
Treatment for mold toxicity can vary depending on the patient, IV Ozone therapy, Ozone sauna, and different chelation methods. Chelating is used as a way to bind toxins in our system and to eliminate/excrete those toxins.
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