water damaged buildings and mold: controversies and overlooked issues dave w. ou, m.d. healing the...

Water Damaged Buildings Water Damaged Buildings and Mold: Controversies and Mold: Controversies

and Overlooked issuesand Overlooked issues

Dave W. Ou, M.D.Dave W. Ou, M.D.

Healing the Brain May 2015Healing the Brain May 2015

Why mold?Why mold?

My PracticeMy Practice--Most of my patients present with some combination of fatigue, Most of my patients present with some combination of fatigue,

brain fog, poor concentration, insomnia, anxiety/depression, brain fog, poor concentration, insomnia, anxiety/depression, hormone imbalances, digestive problems, musculoskeletal hormone imbalances, digestive problems, musculoskeletal and neurologic sx. Many with autoimmune disease esp. and neurologic sx. Many with autoimmune disease esp. thyroid. Some have been to university med centers with thyroid. Some have been to university med centers with unsatisfactory dx and tx.unsatisfactory dx and tx.

-Most not helped by allopathic medicine-Most not helped by allopathic medicine

Some diagnosed as CFS, FMS, depressionSome diagnosed as CFS, FMS, depression

Many diagnosed as nothing wrong with them, Many diagnosed as nothing wrong with them, hypochondriacshypochondriacs

Why mold?Why mold?

Many not helped by alternative and Many not helped by alternative and integrative practitioners who worked on: integrative practitioners who worked on: – Diet: Food allergies and sensitivitiesDiet: Food allergies and sensitivities– DysbiosisDysbiosis– Hormones: adrenals, thyroid, sex hormonesHormones: adrenals, thyroid, sex hormones– Detoxification: metalsDetoxification: metals– Nutrient replacementNutrient replacement– Treated for vector born illnesses eg BorreliaTreated for vector born illnesses eg Borrelia

Why mold?Why mold?

As I tried to understand the cause, I learned about As I tried to understand the cause, I learned about the work of Ritchie Shoemaker, MD. Author of the work of Ritchie Shoemaker, MD. Author of Desperation MedicineDesperation Medicine, , Mold WarriorsMold Warriors, and , and Surviving MoldSurviving Mold. He describes a syndrome in . He describes a syndrome in which a person with a genetic disposition is which a person with a genetic disposition is exposed to biotoxins from a water damaged exposed to biotoxins from a water damaged building, develops an uncontrolled cycle of building, develops an uncontrolled cycle of inflammation (Chronic Inflammatory Response inflammation (Chronic Inflammatory Response Syndrome [CIRS]).Syndrome [CIRS]).

DefinitionsDefinitions

BiotoxinsBiotoxins– Substance released by organisms which are Substance released by organisms which are

harmful to othersharmful to others» Eg. Staph, Shiga, E. coli, snake venomEg. Staph, Shiga, E. coli, snake venom

In CIRS, we are looking at ionophores: In CIRS, we are looking at ionophores: much smaller than above biotoxins. much smaller than above biotoxins. – Mold, borrelia, pfisteria, ciguateraMold, borrelia, pfisteria, ciguatera

DefinitionsDefinitions

Inflammation -simplified, it’s the body’s Inflammation -simplified, it’s the body’s way of removing what does not belong in way of removing what does not belong in the body.the body.

Chronic Inflammatory Response Chronic Inflammatory Response Syndrome (CIRS) from WDB (water Syndrome (CIRS) from WDB (water

damaged building)damaged building) Not mold allergy: runny nose, sinus, eyeNot mold allergy: runny nose, sinus, eye Shoemaker: Shoemaker: an acute and chronic, systemic inflammatory an acute and chronic, systemic inflammatory

response syndrome acquired following exposure to the response syndrome acquired following exposure to the interior environment of a water-damaged building with interior environment of a water-damaged building with resident toxigenic organisms, including, but not limited to resident toxigenic organisms, including, but not limited to fungi, bacteria, actinomycetes and mycobacteria as well as fungi, bacteria, actinomycetes and mycobacteria as well as inflammagens such as endotoxins, beta glucans, inflammagens such as endotoxins, beta glucans, hemolysins, proteinases, mannans, c-type lectins and hemolysins, proteinases, mannans, c-type lectins and possibly spirocyclic drimanes, plus volatile organic possibly spirocyclic drimanes, plus volatile organic compounds.compounds.

CIRSCIRS

Note that CIRS is also a consequence of Note that CIRS is also a consequence of Chronic Lyme.Chronic Lyme.

This talk will focus on CIRS from water This talk will focus on CIRS from water damaged buildings but they is much overlap damaged buildings but they is much overlap with CIRS from Chronic Lymewith CIRS from Chronic Lyme

Water Damaged BuildingWater Damaged Building

What mold needs to thrive?What mold needs to thrive?

Food: Cellulose from wood and paperFood: Cellulose from wood and paper

Drywall, OSB, plywood are perfect! Drywall, OSB, plywood are perfect!

What mold needs to thrive: What mold needs to thrive: WaterWater

Water from leaksWater from leaks

Water from leaks mixing with Water from leaks mixing with wood and paperwood and paper

Dampness from high humidity in Dampness from high humidity in a basementa basement

Dampness from high humidity in Dampness from high humidity in a crawlspacea crawlspace

Dampness in HVACDampness in HVAC

““Mold Illnesses” are not just Mold Illnesses” are not just caused by moldcaused by mold

Complex ecosystem when cellulose and water mixComplex ecosystem when cellulose and water mix– MoldMold– BacteriaBacteria– Amoeba / protozoaAmoeba / protozoa– MycobacteriaMycobacteria– ActinomycetesActinomycetes– Offgassing of building materials eg Offgassing of building materials eg

formaldehydeformaldehyde

Impossible to identify a single compound Impossible to identify a single compound from a water damaged building that is “the from a water damaged building that is “the cause” of someone’s illness.cause” of someone’s illness.

Inflammagens in a water damaged Inflammagens in a water damaged building: a toxic stew well beyond building: a toxic stew well beyond

moldmold Mycotoxins – from mold. Levels influenced by Mycotoxins – from mold. Levels influenced by

other microbesother microbes 1-3-beta-D-glucans – from mold1-3-beta-D-glucans – from mold mVOCs – from bacteriamVOCs – from bacteria Endotoxins – from the cell wall of bacteriaEndotoxins – from the cell wall of bacteria Hemolysins – from bacteriaHemolysins – from bacteria ProteinasesProteinases MannansMannans

Genetic predisposition: Only 25% of Genetic predisposition: Only 25% of people can be seriously affectedpeople can be seriously affected

HLA DR/DQ from LabcorpHLA DR/DQ from Labcorp

– Encodes MHC Class II protein on chromosome 6Encodes MHC Class II protein on chromosome 6

– Over 55 haplotypes. Of those, 9 are predisposed to Over 55 haplotypes. Of those, 9 are predisposed to biotoxin illnessbiotoxin illness

» Unable to form antibodies against small biotoxinsUnable to form antibodies against small biotoxins

» Biotoxins accumulate and cause a inflammatory Biotoxins accumulate and cause a inflammatory responseresponse

– These 9 types make up 25% of the population.These 9 types make up 25% of the population.

– Explains why most people in a “sick building” feels Explains why most people in a “sick building” feels fine and do not take the minority who are ill seriously.fine and do not take the minority who are ill seriously.

» Common example: husband does not believe the Common example: husband does not believe the wife’s symptomswife’s symptoms

Genetic predispositionGenetic predisposition

– 99% of all patients with mold illnesses or Lyme have 99% of all patients with mold illnesses or Lyme have one of these 9 haplotypes.one of these 9 haplotypes.

– 98% of my patients no matter the reason for seeing me.98% of my patients no matter the reason for seeing me.

» The “see an alternative healthcare practitioner” The “see an alternative healthcare practitioner” gene.gene.

– Dr. Klinghardt says that these haplotypes increase the Dr. Klinghardt says that these haplotypes increase the potential for greater intelligence, creativity, and potential for greater intelligence, creativity, and spirituality. Sometimes the potential is never accessed.spirituality. Sometimes the potential is never accessed.

– http://www.drdaveou.com/blog/?p=406 for more for more informationinformation

http://www.drdaveou.com/blog/?p=406

HLA DR/DQHLA DR/DQ

Mold and Lyme susceptibleMold and Lyme susceptible– 4-3-534-3-53

– 11/12-3-52B11/12-3-52B

– 14-5-52B: 14-5-52B:

Mold susceptibleMold susceptible– 7-2-537-2-53

– 13-6-52A, B, or C13-6-52A, B, or C

– 17-2-52A17-2-52A

– 18-4-52A18-4-52A

Lyme SusceptibleLyme Susceptible– 15-6-5115-6-51

– 16-5-5116-5-51

PathophysiologyPathophysiology

Inhalation of “chemical soup” in water damaged buildingInhalation of “chemical soup” in water damaged building

– Neurotoxic: likes nerve and brain cellsNeurotoxic: likes nerve and brain cells

– Dendritic cells engulfs toxins and presents it to T-cells Dendritic cells engulfs toxins and presents it to T-cells attached to MHC II protein.attached to MHC II protein.

– MHC II encoded by HLA DR/DQ.MHC II encoded by HLA DR/DQ.

– In non-susceptible, T cells learn to make antibodies and In non-susceptible, T cells learn to make antibodies and neurotoxins neutralizedneurotoxins neutralized

– In susceptible, defect in antibody formation so In susceptible, defect in antibody formation so neurotoxins accumulateneurotoxins accumulate


Neurotoxins activate TLR receptors which activate NFKB which then tells DNA to make Neurotoxins activate TLR receptors which activate NFKB which then tells DNA to make cytokinescytokines

– Cytokines recruit immune system cells which in turn makes more cytokinesCytokines recruit immune system cells which in turn makes more cytokines– Cytokines create sx of flu; (sx of flu caused by immune system, not virus)Cytokines create sx of flu; (sx of flu caused by immune system, not virus)– Direct cytokine effects: Headaches, muscleache, fatigue, unstable temp, poor conc, Direct cytokine effects: Headaches, muscleache, fatigue, unstable temp, poor conc,

decreased blood flow to brain and organsdecreased blood flow to brain and organs– Cytokines increase TGF beta which ultimately if chronic causes a decrease in T regulatory Cytokines increase TGF beta which ultimately if chronic causes a decrease in T regulatory

cells.cells.» T reg cells control inflammationT reg cells control inflammation

– Cytokines confuse immune system: food sensitivity esp gluten, autoimmunityCytokines confuse immune system: food sensitivity esp gluten, autoimmunity– Cytokines cause WBCs to stick to capillaries causes hypoperfusion: metabolism becomes Cytokines cause WBCs to stick to capillaries causes hypoperfusion: metabolism becomes

anaerobic instead of aerobic.anaerobic instead of aerobic.» Mitochondria can’t make enough ATP: fatigue, poor recovery from exercise, dyspnea Mitochondria can’t make enough ATP: fatigue, poor recovery from exercise, dyspnea

(post exertional malaise)(post exertional malaise)» Exhaust glycogen storesExhaust glycogen stores» Uses protein stores: sarcopeniaUses protein stores: sarcopenia


Cytokines bind hypothalamus blocking release of MSH (melanocyte Cytokines bind hypothalamus blocking release of MSH (melanocyte stimulation hormones)stimulation hormones)

– MSH, a peptide which help counteract inflammationMSH, a peptide which help counteract inflammation

– Assoc low endorphins, low ACTH, low melatoninAssoc low endorphins, low ACTH, low melatonin

– Low MSH assoc leaky gutLow MSH assoc leaky gut

– Assoc decreased sex hormonesAssoc decreased sex hormones Low ADH (Antidiuretic Hormone) : thirst, freq urination, inflammationLow ADH (Antidiuretic Hormone) : thirst, freq urination, inflammation

– People worry they have diabetes or spastic bladderPeople worry they have diabetes or spastic bladder

Low VIP (Vasoactive Intestinal Polypeptide): inflammation, air hungerLow VIP (Vasoactive Intestinal Polypeptide): inflammation, air hunger Cytokines also cause leptin resistanceCytokines also cause leptin resistance

– Leptin needed to control appetite and metabolism. With leptin resistance, Leptin needed to control appetite and metabolism. With leptin resistance, can’t break down fat cellscan’t break down fat cells

Biotoxins from Lyme follow the Biotoxins from Lyme follow the same pathsame path

Symptoms of Lyme and mold are identical Symptoms of Lyme and mold are identical according to Dr. Shoemakeraccording to Dr. Shoemaker

Symptoms according to Dr. Symptoms according to Dr. ShoemakerShoemaker

FatigueFatigue WeaknessWeakness


Memory ImpairmentMemory Impairment Difficulty concentratingDifficulty concentrating Poor memoryPoor memory Decreased word findingDecreased word finding Decreased assimilation of informationDecreased assimilation of information ConfusionConfusion DisorientationDisorientation Mood SwingsMood Swings


HeadacheHeadache VertigoVertigo Light sensitivityLight sensitivity Red EyesRed Eyes Blurry VisionBlurry Vision TearingTearing Metallic TasteMetallic Taste


Sinus CongestionSinus Congestion Shortness of Breath Shortness of Breath CoughCough

Abdominal PainAbdominal Pain DiarrheaDiarrhea Appetite SwingsAppetite Swings


Night sweatsNight sweats Difficulty regulating body temperatureDifficulty regulating body temperature Excessive thirstExcessive thirst Frequent urinationFrequent urination Increased susceptibility to static shocksIncreased susceptibility to static shocks


AchesAches CrampsCramps Morning joint stiffnessMorning joint stiffness Joint PainJoint Pain

Unusual painUnusual pain Ice pick painIce pick pain


Numbness Numbness TinglingTingling

Other associated symptomsOther associated symptoms

Adrenal dysfunctionAdrenal dysfunction Non restorative sleepNon restorative sleep Food sensitivityFood sensitivity AutoimmunityAutoimmunity

I suspect CIRS when:I suspect CIRS when:

Diagnosis of CIRS-WDBDiagnosis of CIRS-WDB

Exposure to a water damaged buildingsExposure to a water damaged buildings Symptoms consistent with CIRSSymptoms consistent with CIRS Tests and labs consistent with CIRSTests and labs consistent with CIRS

Visual Contrast SensitivityVisual Contrast Sensitivity

Measures the ability to distinguish shades of Measures the ability to distinguish shades of greygrey

Reflects blood flow to the retinaReflects blood flow to the retina Developed by the military to screen pilotsDeveloped by the military to screen pilots Abnormal in 93% of CIRS patients per Dr. Abnormal in 93% of CIRS patients per Dr.

ShoemakerShoemaker http://www.survivingmold.com/store1/http://www.survivingmold.com/store1/

online-screening-testonline-screening-test

VCS VCS

Normalizes as patient recoversNormalizes as patient recovers

LabsLabs Labs: (see http://www.survivingmold.com/diagnosis/lab-testsLabs: (see http://www.survivingmold.com/diagnosis/lab-tests

– TGF beta (Cambridge Biomedical)– most sensitive, not as specificTGF beta (Cambridge Biomedical)– most sensitive, not as specific

– Complement C4a (NJH) – not LabcorpComplement C4a (NJH) – not Labcorp

– HLA DR/DQ (Labcorp)HLA DR/DQ (Labcorp)

– MSH (Melanocyte Stimulating Hormone) (Labcorp)MSH (Melanocyte Stimulating Hormone) (Labcorp)

– MMP 9 (Matrix Metalloproteinase)MMP 9 (Matrix Metalloproteinase)

– VIP (Vasoactive Intestinal Polypeptide)VIP (Vasoactive Intestinal Polypeptide)

– VEGF (Vascular endothelial growth factor)VEGF (Vascular endothelial growth factor)

– ADH / OsmolalityADH / Osmolality Radiology: NeuroQuant MRIRadiology: NeuroQuant MRI

Proving exposureProving exposure

Urinary mycotoxinsUrinary mycotoxins

Tests for ochratoxins, trichothecenes, and Tests for ochratoxins, trichothecenes, and aflatoxinsaflatoxins

LimitationsLimitations– Hundreds of other mycotoxinsHundreds of other mycotoxins– Severely ill patients do not excrete mycotoxins Severely ill patients do not excrete mycotoxins

into their urine so the test looks normalinto their urine so the test looks normal– Can not distinguish between inhalation, Can not distinguish between inhalation,

ingestion, or colonizationingestion, or colonization

Air testingAir testing The standard test by industrial hygienists and The standard test by industrial hygienists and

mold inspectorsmold inspectors Never recommended by the vast majority of Never recommended by the vast majority of

mold specialistsmold specialists

Air testing limitationsAir testing limitations

Measures mold spores ( > 2.25 µm) Studies Measures mold spores ( > 2.25 µm) Studies show that for every spore, there are 300-500 show that for every spore, there are 300-500 fragments (1 µm)fragments (1 µm)– The vast majority of the inflammagens are in The vast majority of the inflammagens are in

the fragments.the fragments.– Air testing can not detect fragmentsAir testing can not detect fragments– Mold plates can not detect fragmentsMold plates can not detect fragments– Small fragments travel deeper into the lungsSmall fragments travel deeper into the lungs

Limitations of air testingLimitations of air testing

A 5 minute sample measures at best, A 5 minute sample measures at best, 0.013% of the volume of a 2500 square foot 0.013% of the volume of a 2500 square foot homehome

Assumes the mold produces spores Assumes the mold produces spores constantlyconstantly– Wrong! Can be intermittently produced.Wrong! Can be intermittently produced.

Assumed equal distribution of sporesAssumed equal distribution of spores– Wrong! Uneven distributionWrong! Uneven distribution


Example: Lousy at detecting stachybotrysExample: Lousy at detecting stachybotrys– Spore is very heavy and does not travel far. Spore is very heavy and does not travel far.

Often can’t travel to the spore trapOften can’t travel to the spore trap– Studies have shown high levels of mycotoxins Studies have shown high levels of mycotoxins

with zero spores with air testing.with zero spores with air testing.


No agreed upon standards for what is safe No agreed upon standards for what is safe for a genetically susceptible individualfor a genetically susceptible individual


To do correctly, must take multiple samples To do correctly, must take multiple samples per room multiple times over a 24 hours per room multiple times over a 24 hours period.period.– $$$$$$

Dr. Shoemaker jokingly says the main Dr. Shoemaker jokingly says the main reason to do air testing is to defend the reason to do air testing is to defend the landlord with “normal” results.landlord with “normal” results.

But I don’t see any moldBut I don’t see any mold

In a German study looking at homes in In a German study looking at homes in which mold was visually confirmed after which mold was visually confirmed after tearing down walls, only 25% had positive tearing down walls, only 25% had positive air tests.air tests.

Mold testingMold testing

Best is ERMI (Environmental Relative Best is ERMI (Environmental Relative Moldiness Index) from MycometricsMoldiness Index) from Mycometrics– PCR analysis for 36 moldsPCR analysis for 36 molds– Statistically, score > 2 is a problemStatistically, score > 2 is a problem

HERTSMI-2 from MycometricsHERTSMI-2 from Mycometrics– Checks for 5 moldsChecks for 5 molds– Less expensiveLess expensive– Statistically, score > 10 is a problemStatistically, score > 10 is a problem

ERMI / HERTSMIERMI / HERTSMI

Dr. Shoemaker has correlated the results of Dr. Shoemaker has correlated the results of the ERMI/HERTSMI with what causes the ERMI/HERTSMI with what causes symptoms & lab abnormalities in his symptoms & lab abnormalities in his patients.patients.

In my experience, the most useful screen In my experience, the most useful screen for safety in a genetically suspectible for safety in a genetically suspectible individualindividual

Limitations of HERTSMI/ERMILimitations of HERTSMI/ERMI

It is known that some people will still get sick in a It is known that some people will still get sick in a home with a “good” scorehome with a “good” score

Results can be skewed by improper collectionResults can be skewed by improper collection Mold inspectors and industrial hygienists don’t Mold inspectors and industrial hygienists don’t

know anything about it and will want to do air know anything about it and will want to do air testingtesting

Does not detect mVOCs, endotoxins, beta glucans, Does not detect mVOCs, endotoxins, beta glucans, etc. May explain good scores, but sick patient.etc. May explain good scores, but sick patient.

Other testing for “mold”Other testing for “mold”

Autonomic Response Testing by Dr. Autonomic Response Testing by Dr. KlinghardtKlinghardt– Can detect pattern of mycotoxins in a personCan detect pattern of mycotoxins in a person– Can detect pattern of mycotoxins in a person’s Can detect pattern of mycotoxins in a person’s

environment: air, HVAC filters, walls, floors, environment: air, HVAC filters, walls, floors, ceilling, clothingceilling, clothing

– Helps to guide and monitor treatment optionsHelps to guide and monitor treatment options

Treatment optionsTreatment options

Shoemaker protocolShoemaker protocol OthersOthers

Shoemaker TreatmentShoemaker Treatment

1) Removal of exposure (remediation, 1) Removal of exposure (remediation, moving) – most critical step.moving) – most critical step.

2) Removal of biotoxins2) Removal of biotoxins– Cholestyramine, WelcholCholestyramine, Welchol

3) Correct inflammation: c4a, TGF 3) Correct inflammation: c4a, TGF ββ, , VEGF, MMP 9, MARCONS, VIPVEGF, MMP 9, MARCONS, VIP

As lab parameters improve, so does the ptAs lab parameters improve, so does the pt

Shoemaker ProtocolShoemaker Protocol

Shoemaker ProtocolShoemaker Protocol

http://www.survivingmold.com/shoemaker-http://www.survivingmold.com/shoemaker-protocol/Certified-Physicians-Shoemaker-protocol/Certified-Physicians-Shoemaker-ProtocolProtocol

The Shoemaker protocol according to each The Shoemaker protocol according to each certified practitionercertified practitioner

Other treatment strategiesOther treatment strategies Patricia Kane (PK Protocol) – IV Phosphatidyl Choline (Essentiale from Patricia Kane (PK Protocol) – IV Phosphatidyl Choline (Essentiale from

Switzerland), Phenylbutyrate, Glutathione, and Folinic AcidSwitzerland), Phenylbutyrate, Glutathione, and Folinic Acid Antifungals – pharmaceutical oral and nasal sprays; botanicalsAntifungals – pharmaceutical oral and nasal sprays; botanicals Sinus lavageSinus lavage Other binders: zeolite, clay, chlorella, charcoalOther binders: zeolite, clay, chlorella, charcoal SaunasSaunas Colonics, coffee enemasColonics, coffee enemas OxygenOxygen Glutathione, alpha-lipoic acidGlutathione, alpha-lipoic acid ProbioticsProbiotics Immunotherapy- Laser immune modulation and Applied PsychoNeurobiology Immunotherapy- Laser immune modulation and Applied PsychoNeurobiology

(APN) by Dr. Klinghardt(APN) by Dr. Klinghardt

Integrating other approachesIntegrating other approaches

Dietrich Klinghardt, MD, PhD– 7 factorsDietrich Klinghardt, MD, PhD– 7 factors Functional MedicineFunctional Medicine

Ensuring proper gut functionEnsuring proper gut functionFood sensitivitiesFood sensitivitiesHormones: adrenals, thyroid, sexHormones: adrenals, thyroid, sexDetoxification – liver, lymphatics, kidneysDetoxification – liver, lymphatics, kidneysToxins: mercury, aluminum, RoundUpToxins: mercury, aluminum, RoundUp

Integrating other approachesIntegrating other approaches

Infections: Lyme and co-infections, yeast, Infections: Lyme and co-infections, yeast, viruses, parasitesviruses, parasites

NutritionNutritionEMFsEMFsInterference fieldsInterference fieldsDental: amalgams, cavitationsDental: amalgams, cavitationsUnresolved psychoemotional traumaUnresolved psychoemotional trauma

RemediationRemediation

3 steps3 steps– Correct water intrusion / dampnessCorrect water intrusion / dampness– Remove contaminated building materialsRemove contaminated building materials– Clean all surfacesClean all surfaces

EPA guidelinesEPA guidelines

Used by most remediation companiesUsed by most remediation companies Often insufficient for those with a genetic Often insufficient for those with a genetic

susceptiblitysusceptiblity Most remediations I have seen have failed.Most remediations I have seen have failed.

Common mistakes with Common mistakes with remediationremediation

Failure to locate all water sourcesFailure to locate all water sources Painting over mold stains by landlordsPainting over mold stains by landlords Bleach – totally ineffectiveBleach – totally ineffective ““Mold killing” disinfectant sprays, fogs, and gizmos – dying mold release Mold killing” disinfectant sprays, fogs, and gizmos – dying mold release

mycotoxins; mycotoxins are already deadmycotoxins; mycotoxins are already dead

– No study has shown that any products (including EPA “approved”) removes No study has shown that any products (including EPA “approved”) removes all mycotoxinsall mycotoxins

– Chemically sensitive people often react to these chemicalsChemically sensitive people often react to these chemicals Ozone machinesOzone machines Failure to remove inflammagens on all surfacesFailure to remove inflammagens on all surfaces Contaminated remediation equipmentContaminated remediation equipment UV lights in HVAC (can generate ozone)UV lights in HVAC (can generate ozone)

Remediation failureRemediation failure

Most attempts at remediation failMost attempts at remediation fail– Overreliance on air testingOverreliance on air testing– Using ERMI/HERTSMI often make Using ERMI/HERTSMI often make

remediators look badremediators look bad– Sometimes can’t find all moisture sourcesSometimes can’t find all moisture sources

Potentially helpfulPotentially helpful

HEPA filters – may not capture all fungal HEPA filters – may not capture all fungal fragments or mVOCs – (same with fragments or mVOCs – (same with facemasks)facemasks)

Potentially helpfulPotentially helpful

Bee propolis vaporizers Bee propolis vaporizers (www.beehealthyfarms.com) (www.beehealthyfarms.com)

EM-1 Microbial Inoculant by Teraganix – EM-1 Microbial Inoculant by Teraganix – still evaluating but may help reduce still evaluating but may help reduce mycotoxins - spray a few times per weekmycotoxins - spray a few times per week

Caution: Often more than just Caution: Often more than just mold causing one’s illnessmold causing one’s illness

I have had a number of cases that once a I have had a number of cases that once a patient’s mold exposure was resolved, new patient’s mold exposure was resolved, new layers took center stage such as metal layers took center stage such as metal toxicity, Lyme and co-infections.toxicity, Lyme and co-infections.

Important to use a framework such as Dr. Important to use a framework such as Dr. Klinghardt’s 7 factors to consider all Klinghardt’s 7 factors to consider all possibilities for a person’s symptoms.possibilities for a person’s symptoms.

To learn more:To learn more:

www.survivingmold.com – Dr. Shoemaker’s sitewww.survivingmold.com – Dr. Shoemaker’s site Facebook – Avoiding MoldFacebook – Avoiding Mold www.paradigmchange.me www.paradigmchange.me http://www.betterhealthguy.com/mycotoxins - http://www.betterhealthguy.com/mycotoxins -

Excellent article by Scott Forsgren, Dr. Neil Excellent article by Scott Forsgren, Dr. Neil Nathan, and Wayne AndersonNathan, and Wayne Anderson

http://www.ncbi.nlm.nih.gov/pmc/articles/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654247/ - Dr. Janette Hope’s review articlePMC3654247/ - Dr. Janette Hope’s review article

Remediation resourcesRemediation resources

www.moldcontrolonabudgetwww.moldcontrolonabudget www.createyourhealthhome.comwww.createyourhealthhome.com

One of the better sites on remediation by May One of the better sites on remediation by May DooleyDooley

http://www.survivingmold.com/legal-resources/environmental/condensed-remediation-plan-for-small-microbial-particles

Take home pointsTake home points

Many of your patients may have mold Many of your patients may have mold toxicity as part of their total loadtoxicity as part of their total load

Start with having your pts run a VCS at Start with having your pts run a VCS at www.survivingmold.comwww.survivingmold.com

Start running a couple of the labs esp TGF Start running a couple of the labs esp TGF beta 1, C4a. Run HLA DR/DQ if have ins.beta 1, C4a. Run HLA DR/DQ if have ins.

www.bridgestohealthatl.comwww.bridgestohealthatl.com

[email protected]@bridgestohealthatl.com

Dave Ou, M.D.Dave Ou, M.D.

water damaged buildings and mold: controversies and overlooked issues dave w. ou, m.d. healing the...

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water slide

water damaged building

paper slide

borrelia slide

basement slide

crawlspace slide

formaldehyde slide

ciguatera slide