Unlike other doctors whose theories have been presented in this newsletter, Ritchie Shoemaker is unknown to most in CFS and FM circles. However, the editors felt that his theories, test and treatment should be made available to our members. Consider them, buy the book if you are intrigued and discuss it with your doctors. (Chapter 15 will likely be of most interest to them.)

Dr. Shoemaker's diary-like, rambling book appears to contain a truly significant breakthrough in testing and treating neurotoxin-mediated illnesses. Numerous dramatic recoveries are recounted, and the significant improvement of one of our own members prompted this article.

Dr. Shoemaker's strength lies in water-borne illnesses such as Pfiesteria and Ciguatera, as well as Lyme Disease. (Many believe a significant portion of CFS and FM cases are actually undiagnosed chronic Lyme, in part because Lyme testing is reportedly very unreliable.) Dr. Shoemaker seems to have a great deal of knowledge and experience in these areas. However, he does not appear to have the same depth knowledge regarding CFS or FM. The test and treatment he utilizes are likely an important piece of the CFS and FM puzzles, but not the whole picture. For a subset of CFS and FM patients, however, his approach could well lead to significant improvement, even recovery.

THE START: FISH KILLS
Ritchie Shoemaker, MD, named Maryland's "Family Physician of the Year" in 2000, graduated from Duke University Medical Center and has practiced medicine along the Pokomoke River for more than two decades. In 1997, shortly after fish started dying from a one-celled microorganism called Pfiesteria, patients began flooding his clinic with strange symptoms. He realized only those who had been in contact with the river were coming down with the mysterious malady. The symptoms included fatigue, achiness, memory problems, headaches, diarrhea, sensitivity to light, congestion, abdominal pain, asthma-like shortness of breath, and numerous other complaints.

He put in 100-hour weeks seeing patients, doing research, and contacting specialists. The result was a theory, an inexpensive test, and a simple treatment that totally cured Pfiesteria patients. A similar problem in Florida and the Caribbean came to his attention, where people were eating fish contaminated with a microorganism called Ciguatera. His protocol had the same results: dramatic cures. Another one-celled life form called cylindrospermoposis killed alligators, fish, and pelicans in several Florida lakes, and caused illness in local residents. Those treated with his protocol rapidly improved.

THE THEORY
Dr. Shoemaker states, "[These new diseases] are caused by "toxins released by living organisms." Until recently, most of these organisms were relatively harmless. He is convinced that "the emerging epidemic of chronic neurotoxin-mediated illnesses has been spawned by our rapidly changing ecosystem."

Dr. Shoemaker calls Pfisteria, the first such illness he encountered, "a biological mutation, a pollution spawned microorganism armed with a toxic weapon that makes people sick." He discovered that copper and fungicides used in local agriculture wash into the water and destroy the algae upon which Pfiesteria feed. In response, it mutates into a dangerous new form that feeds upon fish, killing them and making humans ill. (Ironically, the same substances that destroyed its original food source and triggered the shift also destroyed the larger microorganisms that fed on the toxic form, keeping it in check.)

Though the sources of these illness-producing toxins vary, the toxins all share a similar structure. The toxins cause chronic illnesses because they are both fat and water soluble, thus the body cannot eliminate them. Regarding Pfiesteria, Shoemaker says, "the toxin could move from cell to cell without ever entering the bloodstream. It did its ugly damage in fatty tissues scattered throughout the body." It dissolved in water for transport, but "delivered its toxic punch through fat-containing tissue", moving through muscle, brain, lung, bile and neural cells.

Dr. Shoemaker also theorizes that these toxins disrupt the electrical field of cells by dragging potassium inside. "Like a car battery with a huge positive terminal but only a tiny negative input, the cell cannot provide enough power to sustain normal life processes." The toxins may also disrupt sodium and calcium channel receptors, attack enzyme reactions involved in glucose-processing (disrupting energy), and even attach themselves onto parts of the cellÌs DNA, wrecking havoc.

THE TREATMENT: CHOLESTYRAMINE
(aka CSM or Questran) Dr. Shoemaker knew that if he could bind these toxins in the intestine, he could "drain the toxins from the brain, lungs and bile of any infected patient." He found his answer in cholestyramine, an inexpensive, 40-year-old, FDA-approved medication. It removes the toxin from the bile in which it's dissolved, preventing it from being reabsorbed and circulating endlessly throughout the body. Patients who pick up a water or fish borne toxin often experience complete relief within days of starting this treatment.

The good news about organic toxins (those produced by living things) "is that the defects are not durable. Unlike damage produced by heavy metals, the effects of organic toxins can be reversed, and the patient's health restored, but only ifÝtoxin-binding therapy is employed."

THE TEST: FACT
Functional Acuity Contrast Test
One specialist Dr. Shoemaker contacted was Dr. Ken Hudnell, a principal investigator for the Neurotoxicology Division of the Environmental Protection Agency. He introduced Dr. Shoemaker to a remarkable test used to detect damage caused by neurotoxins. This inexpensive, five-minute test involves looking at a series of wave patterns printed on a card. Dr. Shoemaker states, "This method of measuring the brain's ability to perceive contrasting shades of white, gray and black has been described as a five-tone hearing test for the eyes."

The retina is "actually a ÎmicrocosmÌ of the brain", enabling this test to confirm the effects of toxins on the optic nerve and the visual cortex of the brain. The FACT exam "can separate changes in visual functioning caused by neurologic problems from those caused by toxins." This test indicates who is a candidate for CSM treatment, then provides a means of monitoring its effectiveness. This $275 testing device can be ordered from Stereo Optical Company of Chicago. (1-800-344-9500)

LYME DISEASE
Dr. Shoemaker has treated hundreds of chronic Lyme disease patients, and believes it "represents the most debilitating and agonizing form of neurotoxin-mediated illness." According to Dr. Shoemaker, Lyme is "found in nearly every state, yet the majority of physicians refuse to acknowledge its reality." In 1999, a researcher demonstrated that Borrelia, the Lyme spirochete, manufacturers a neurotoxin. Thus antibiotic treatment alone will always be inadequate because it will not eliminate toxins.

The Lyme spirochete cannot move well in the rushing current of the bloodstream. It crawls alongside the blood vessels, avoiding blood-borne antibodies and immune defenses (and blood tests?). This makes diagnosing and treating Lyme disease very difficult and controversial. However, Dr. Shoemaker has found a patient's FACT score to be a far more reliable indicator of Lyme than any other blood or urine test. When CSM treatment was used in combination with antibiotics, 90% of the patients in one study found relief from their symptoms. An additional drug is used because the Lyme toxin produces an "intensification reaction ten times worse than any herxheimer." Pre-treating Lyme patients with pioglitazone (Actos) reduces this initial intensification of symptoms. He also uses Mepron with CSM in the many Lyme patients who are co-infected with Babesia.

FM & CFS
Dr. Shoemaker believes that endogenous (internally produced) toxins are causing symptoms in FM and CFS. He suspects that the problem in FM may involve an abnormality in the production of neurotrophic factor, a substance that stimulates the growth of neural tissue at injury sites. (One researcher infused neurotrophic factor into the brains of Huntington's and Alzheimer's patients. They developed "trigger-point pain" and "diffuse aching" that went away when the infusions stopped.) Dr. Shoemaker asked 20 FM patients to come to his office and take the FACT, all showed neurotoxic injury. To his dismay, many refused treatment because of ongoing disability or personal injury claims. Those taking the CSM treatment have experienced startling improvement, as long as they stay on the protocol.

Dr. Shoemaker is "convinced that CFS is a neurotoxin-illness, even if the toxins are produced internally." He theorizes that "a virus with the uncanny ability to actually become part of human DNA" may be involved. One of his CFS patients had been terribly ill for 20 years. Her FACT exam was positive, she responded dramatically to CSM treatment, and returned to full-time work. Another CFS patient ill for 10 years reported that after two weeks of treatment her energy began to return. She can now walk, go to the mall, drive, sleep well, and work again. Like FM patients, CFS patients must remain on the drug indefinitely. Symptoms return when the drug is stopped, supporting the concept of toxins being continuously generated inside the body.

MCS, Mold, SBS
Dr. Shoemaker addresses the prevalence of fungi and chemicals in the chapter on Sick Building Syndrome (SBS). This test and protocol often help those affected by mold. He finds that Multiple Chemical Sensitivity (MCS) is found much more commonly in patients with SBS than other illnesses, and MCS patients are often helped by pioglitazone.

Young People with ADD or Learning Disabilities
Finally, Dr. Shoemaker has treated many young people labeled "learning disabled", "anti-social" or "ADD/ADHD", only to discover that they show a deficit (abnormality) on the FACT exam and experience dramatic improvement in behavior and academics when treated with CSM.

Art Raines, an MD mentioned in the book and familiar with this test and treatment, has offices in Cleburne, Ft. Worth, and Dallas. You can contact any of his offices by calling 817-645-3967.

Desperation Medicine, an account of a doctor extraordinarily committed to helping desperate patients often dismissed by other medical professionals, is a book well worth reading