As teachers and long-time proponents of Chronic Inflammatory Response Syndrome (CIRS), we felt that a compendium of current educational and scientific materials on the Chronic Inflammatory Response Syndrome (CIRS) had a place in the approach to the CIRS patient. In our existing training courses, the basics of CIRS medicine is the source of our curriculum. Call the current courses CIRS 101 and CIRS 201, if you will. Fundamental to our courses is student participation in discussion of published papers, often leading to deeper questions regarding the art of CIRS practice. The growing course work, and level of student engagement show us that students want — and need — greater exploration of the topic, access to the primary literature and opportunities to demonstrate mastery of the subject.

What we have put together are informal chapters regarding opinions of skilled practitioners based both on published data and on bedside experience that should help guide new CIRS practitioners through the complex maze of treating this unique patient population. These chapters show the art of CIRS Medicine used by the authors. We cover the subtleties and nuances of exposures, symptoms, labs, physical exam, ancillary studies, use of medications and some of the cutting edge science, transcriptomics, that are brought to bear on the fundamental question, “How can we help the CIRS trainee become an expert?”

We will also feature new dynamic published papers that impact our current thinking about inflammation in CIRS, namely (i) metabolism; and (ii) mycotoxin measurements in urine.

We include eight demonstrative cases written up by members of the Surviving Mold CIRS Academy. We are grateful for permission provided by each of these authors (see below) to use their excellent studies for educational experiences. Here we see a merging of art and science of CIRS Medicine that translates into an answer to the question, “How do I sort out differential diagnosis and quickly identify the right approach to helping complicated patients?”

Finally, we include published papers that serve as a journal club for our students. Here are the scientific foundations of CIRS Medicine. Sample teaching questions range from the obvious (what is the study design?) to the essence of science (based on these data, how can you logically apply them to patient care?).

We all have our dreams for the future, like hopes and fears all rolled up into one package. We have asked Drs. Shoemaker, McMahon and Heyman to share with us their ideas on the expansion of CIRS Medicine-what is possible now and what will be possible in the future.

To help on this quest, we have included a research module based on the work of Ken Hudnell PhD and Ritchie Shoemaker MD that forms a starting point for good scientific studies.

Finally, the advances in transcriptomics tell us far more about metabolism and inflammation than any writings published to date. These are exciting times!

Taken together, the chapters, papers and sidebars of The Art and Science of CIRS Medicine are part of the ever-expanding extrapolation of CIRS to medicine in general.

Shoemaker

Books