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Long COVID and CIRS share remarkably similar inflammatory pathways and symptoms. Recent research suggests Long COVID may actually be a form of CIRS triggered by the SARS-CoV-2 virus, with studies showing that Long COVID patients treated with the Shoemaker Protocol experience significant improvement. Up to 21 participants in one study showed similar metabolic and inflammatory abnormalities between Long COVID and CIRS, including failed Visual Contrast Sensitivity (VCS) tests.

Key indicators that your Long COVID might be CIRS:

• Symptoms in 8+ of the 13 CIRS symptom clusters
• Failed VCS test (92% accuracy when combined with symptoms)
• History of water-damaged building exposure before COVID
• Symptoms persisting beyond 3 months post-infection

Action Step: Take the online VCS test at VCSTest.com ($15) and complete the CIRS symptom cluster evaluation. If positive, seek a Shoemaker-certified practitioner.

While stress contributes to brain fog through elevated cortisol, CIRS-related brain fog has distinct neurological markers. CIRS brain fog results from actual brain inflammation caused by biotoxins activating microglia (brain immune cells) that release inflammatory cytokines disrupting neuron communication. Research shows cortical grey matter atrophy and nuclear atrophy visible on NeuroQuant MRI in CIRS patients, correlating with cognitive symptoms.

Signs your brain fog is CIRS, not just stress:

• Accompanied by multiple system symptoms (respiratory, GI, neurological)
• Word-finding difficulties and disorientation
• Static shocks and excessive thirst
• Worsens in certain buildings, improves when away
• Failed VCS test

Hormonal disruption is a core feature of CIRS that can mimic or worsen menopausal symptoms. Biotoxins damage leptin receptors in the hypothalamus, leading to reduced MSH, VIP, and ADH production—all critical for hormone regulation. The Shoemaker Protocol documents that reduced MSH causes the pituitary to lower sex hormone production, compounding menopausal symptoms.

Distinguishing features of CIRS vs. menopause:

• CIRS affects multiple hormones simultaneously (not just estrogen/progesterone)
• Accompanied by non-menopausal symptoms (joint pain, respiratory issues)
• MSH levels below 35 pg/mL (95% of CIRS patients)
• Symptoms improve with biotoxin binding, not hormone replacement alone

CIRS disrupts sleep architecture through multiple mechanisms beyond simple sleep deprivation. Biotoxins reduce melatonin production and cause chronic non-restorative sleep. Even with adequate sleep hours, CIRS patients experience:

• Reduced MSH disrupting circadian rhythms
• Elevated inflammatory cytokines preventing deep sleep
• Neuroinflammation affecting sleep centers
• ADH deficiency causing nighttime urination

If improving sleep hygiene hasn't helped after 2-3 months, consider CIRS testing, especially if you have other symptoms.

Several medications can mimic CIRS symptoms, but CIRS has distinguishing features. Common medications causing cognitive issues include:

• Statins (ironically used in Step 9 of Shoemaker Protocol)
• Benzodiazepines
• Antihistamines
• Some antibiotics

However, CIRS brain fog is distinguished by:

• Multi-system involvement beyond cognitive symptoms
• Failed VCS test (medication-induced fog typically passes VCS)
• Elevated inflammatory markers (C4a, TGF-β1, MMP-9)
• Improvement with cholestyramine binding

For CIRS-related brain fog, the Shoemaker Protocol is the only peer-reviewed treatment, but supportive measures help:

Natural supports while following the protocol:

1. Remove exposure - ERMI below 2 is essential
2. Bind biotoxins - Cholestyramine 4g, 4x daily (prescription required)
3. Support detox - Activated charcoal between CSM doses
4. Anti-inflammatory diet - Low amylose diet with high omega-3s (2.4g EPA, 1.8g DHA daily)
5. Nasal irrigation - NeilMed rinses to reduce MARCoNS burden

Without addressing root cause biotoxin exposure and following the sequential protocol steps, natural remedies alone rarely resolve CIRS brain fog.

Yes, with proper treatment following the Shoemaker Protocol. VIP nasal spray has been shown to restore grey matter volume in multiple brain nuclei in CIRS patients. Recovery timeline:

• Initial improvement: 1-3 months with biotoxin binding
• Significant improvement: 3-6 months following protocol
• Full recovery: 6-12 months for protocol completion
• Brain structure restoration: Documented with VIP therapy

Critical: Patients remain vulnerable to re-exposure. The "10-minute rule"—symptoms within 10 minutes of entering a building indicate unsafe conditions.

Visible mold is just the tip of the iceberg for CIRS patients. Water damage in buildings allows growth of fungi, bacteria, actinomycetes, and mycobacteria—all potential CIRS triggers.

Visual signs:

• Black, green, or white growth on walls/ceilings
• Water stains or discoloration
• Peeling paint or wallpaper
• Warped walls or floors

Non-visual indicators MORE important for CIRS:

• Musty or earthy odors
• Symptoms worsen in specific rooms
• Failed ERMI test (must be below 2 for CIRS safety)
• History of water damage (even if remediated)
• Symptoms in 6+ CIRS clusters among occupants

"Black mold" (Stachybotrys chartarum) is overemphasized—all water-damage molds can trigger CIRS. The toxic mold myth makes people think they should only take action if certain species are present, when all significant indoor mold growth is dangerous to CIRS-susceptible individuals.

Stachybotrys characteristics:

• Black or dark green appearance
• Slimy texture when wet
• Powdery when dry
• Grows on cellulose materials (drywall, wood)
• Requires chronic moisture

Critical: HERTSMI-2 testing focuses on the "Big 5" molds most associated with CIRS: Stachybotrys chartarum, Aspergillus penicillioides, Aspergillus versicolor, Chaetomium globosum, and Wallemia sebi.

Yes, but the focus on "black mold" alone is misguided for CIRS. Research shows Stachybotrys fragments—even without toxins—cause brain inflammation through innate immune activation. However:

• 24% of the population is genetically susceptible to ANY biotoxin
• Actinomycetes (bacteria) cause 42% of CIRS cases vs. mold's 7%
• Even one spore of Stachybotrys in ERMI testing indicates a serious problem
• All water-damaged building organisms can trigger CIRS

CIRS involves 13 distinct symptom clusters—having 6+ suggests evaluation, 8+ is consistent with biotoxin illness:

The 13 CIRS Symptom Clusters:

1. Fatigue, weakness
2. Muscle aches, cramping, joint pain
3. Headache
4. Light sensitivity, red eyes, blurred vision
5. Sinus problems, cough, shortness of breath
6. Abdominal pain, diarrhea
7. Cognitive issues, memory problems
8. Difficulty concentrating, confusion
9. Disorientation, mood swings
10. Temperature regulation problems, excessive sweating
11. Excessive thirst, increased urination
12. Numbness, tingling
13. Vertigo, tremors, metallic taste

Most CIRS patients are misdiagnosed with depression, anxiety, PTSD, chronic fatigue syndrome, or fibromyalgia.

CIRS patients need specialized remediation beyond standard mold removal. Standard remediation often fails CIRS patients because:

• Must achieve ERMI below 2 (not just visible mold removal)
• Requires small particle remediation (0.1 microns)
• Need post-remediation verification by independent IEP
• Should follow ANSI/IICRC S520-2024 standards minimum

Finding CIRS-appropriate remediation:

1. Request contractors familiar with Shoemaker Protocol requirements
2. Verify they understand ERMI/HERTSMI-2 testing
3. Ensure independent post-remediation testing
4. Add $2-5/sq ft for small particle remediation
5. Check SurvivingMold.com IEP consensus statement

CIRS-level remediation costs more than standard mold removal:

• Standard mold remediation: $500-6,000
• CIRS small particle remediation: Additional $2-5/sq ft
• ERMI testing: $285-290 (pre and post)
• Independent verification: $500-1,500
• Total for 2,000 sq ft home: $8,000-20,000

Cost factors:

• Extent of contamination
• Building materials affected
• HVAC system involvement
• Contents remediation/disposal
• Post-remediation clearance testing

Coverage varies significantly and rarely covers CIRS-level remediation.

• Most policies exclude mold unless from covered peril (pipe burst)
• "Sudden and accidental" water damage may be covered
• Chronic moisture issues typically excluded
• CIRS-specific remediation considered above standard
• Document everything for potential coverage/litigation

Tips for coverage:

• Get mold inspection before filing claim
• Document water damage source thoroughly
• Request "like kind and quality" replacement
• Consider public adjuster for large claims

CIRS patients should NEVER attempt DIY mold removal. Reasons:

• Disturbing mold releases massive spore/fragment clouds
• Even dead mold fragments cause immune activation and brain inflammation
• Cross-contamination risk to entire home
• Won't achieve ERMI below 2 without professional equipment
• Re-exposure causes "sicker quicker" response

When DIY is acceptable (non-CIRS only):

• Less than 10 sq ft affected
• No water damage history
• Non-porous surfaces only
• Proper PPE available
• No CIRS-susceptible occupants

For CIRS evaluation, ERMI or HERTSMI-2 testing is essential, not visual inspection.

Testing hierarchy for CIRS:

1. ERMI Test - Gold standard, tests 36 species, $285-290
2. HERTSMI-2 - Tests "Big 5" molds, $155, included with ERMI
3. EMMA Test - Includes mycotoxins, $400+
4. Air sampling - Supplementary only, misses history

ERMI uses DNA-based MSQPCR technology to quantify mold species and compare to national database. CIRS patients need ERMI below 2 or HERTSMI-2 below 11 for safety.

Q: ERMI vs. professional inspection - which is better?

A: Both serve different purposes for CIRS patients:

ERMI advantages:

• Quantifies specific species DNA
• Provides historical contamination picture
• Required for Shoemaker Protocol
• Objective numerical threshold
• Can be DIY collected

Professional inspection advantages:

• Identifies moisture sources
• Finds hidden mold growth
• Provides remediation scope
• Documents for insurance/legal

ERMI's limitation: composite sampling from multiple rooms makes source identification impossible. Best practice: ERMI for CIRS evaluation + professional inspection for remediation planning.

Don't test for just black mold—test comprehensively with ERMI/HERTSMI-2.

HERTSMI-2 specifically tests for Stachybotrys chartarum along with four other critical species. Any detection of Stachybotrys (even 1 spore) indicates serious concern.

Collection methods:

• Vacuum method: Best for carpeted homes
• Swiffer method: For hard floors/no carpet
• AccuCloth: Preferred for pets/hard floors
• Send to Mycometrics or EnviroBiomics
• Wait 4-6 weeks post-remediation before retesting

CIRS patients and genetically susceptible individuals should never attempt mold removal.

For non-CIRS individuals, small areas (<10 sq ft):

1. Seal area with plastic sheeting
2. Wear N95 mask, goggles, gloves
3. Spray with antimicrobial (not bleach)
4. Remove affected drywall entirely
5. HEPA vacuum thoroughly
6. Dispose in sealed bags

Why CIRS patients must avoid:

• Re-exposure causes enhanced inflammatory response
• "Sicker quicker" phenomenon documented
• Cross-contamination to belongings
• Impossible to achieve ERMI <2 with DIY

Prevention requires controlling moisture and understanding building science:

Moisture control:

• Keep indoor humidity 30-50%
• Fix leaks within 24-48 hours
• Ensure proper ventilation (bathrooms, kitchen)
• Grade soil away from foundation
• Clean gutters regularly

For CIRS patients specifically:

• Test new homes with ERMI before moving
• Avoid ground floor/basement apartments
• Choose newer construction when possible
• Install HEPA filtration systems
• Monitor with annual ERMI testing

Post-remediation maintenance:

• Run HEPA filters continuously
• Check ERMI annually
• Address water intrusion immediately
• Consider preventive CSM if re-exposed