Manage episode 213772110 series 1106723
Dr. McCann received a B.A. in Music from Brown University and a Master’s in Library Science from University at Albany. She went on to receive her Doctor of Medicine degree (MD) and simultaneously earned a Master’s in Public Health (MPH) in Tropical Medicine (TM) at Tulane University in New Orleans. She completed both an Internal Medicine residency at Banner Samaritan Medical Center and a Pediatrics residency at Phoenix Children’s Hospital in Phoenix, AZ.
Dr. McCann practiced medicine at the Arizona Center for Integrative Medicine where she worked and trained with renowned Andrew Weil, M.D., as one of 35 distinguished fellows in residence throughout the world.
Dr. McCann also became certified in medical acupuncture through the American Academy of Medical Acupuncture, studied environmental medicine and chelation with Dr. Walter Crinnion and biotoxins with Dr. Ritchie Shoemaker. Dr. McCann is on staff at Hoag Memorial Hospital in Newport Beach, California and has been in private practice in Costa Mesa since 2008. She founded Partners in Health at the Spring Center in August 2009.
- Do you specialize in mold primarily, or biotoxin illnesses in general? She specializes in functional and integrative medicine. It turns out that a lot of people who come in have at the root of their issues biotoxin illness and env’t toxicity.
- And along those lines: what is your take on why mold and Lyme seem to occur together so often? She thinks that Lyme and chronic infections are ubiquitous. Ticks are spreading and there is more global warming, so we’re seeing an increase in the level of burden and incidence of infection. Many people are walking around asymptomatic at some level. It takes an inflammatory response, like being in a moldy building that will exacerbate the situation. You can also see it the other way. People might be living in a moldy env’t but tolerating it ok. But then if they get bit by a tick, then suddenly they have Lyme and can’t tolerate their environment anymore. On top of that, our world is so toxic with env’t chemical burden, so heavy metals, solvents etc also contribute to our inability to manage our body burden. She sees these things interplaying quite a bit.
- Can you describe for our audience what some of the symptoms might be that would tip you off to consider a biotoxin illness as the root of their issues? Generally it’s a laundry list of symptoms and it will cover many different systems. The more weird, wacky symptoms people tend to have that aren’t easily explained, the more she thinks of this. Some of the big ones: chronic fatigue especially. This is the most common symptom. They can look like they might have other illnesses too. Could look like an osteoarthritis or fibro case, but they’ll have other symptoms too: GERD, bloating, IBS, etc. Neurological symptoms, memory, word finding problems, issues concentrating, light and sound sensitivity, blurry vision. Often neurological symptoms: tremors, tingling, numbness. Respiratory symptoms. Asthma as an adult. It’s good to think of mold and biotoxin exposure with that. When she’s thinking about mold, patients can also get dysautonomia issues, temperature regulation, balance issues, etc, Static shocks, skin sensitivity, rashes. In her own case, she had fatigue and worsening food sensitivities. She went from being gluten and dairy free to suddenly reacting to everything. The list got really long, because she was living in a moldy house.
- What is your take on why mold toxicity is suddenly such a huge problem? Why now? It is getting worse. Some of it is because we’re using a lot of antifungals in agriculture, plant stores, etc. Those are self-selecting for more toxic molds in an indoor environment that weren’t there before. Also, in CA at least, construction is very poorly done. If the house is up in 6 mo, and we build with wood and paper which are fuel for the mold. It’s a combo of the way we’re building and poor construction. We just can’t handle the total load too.
- If someone is looking to buy a house, or build a new one, are there any red flags to look for in terms of building materials or construction that make a house more susceptible to mold, even if there isn’t any already present? When looking for a house, if it’s current construction, part of it depends on the market and part on the level of sensitivity. Patients need to become advocates for themselves and have a sense of their level of sensitivity. If they’re feeling relatively healthy, they might be better able to walk into a building and smell mold. If you smell a musty smell, there’s mold there. Check out the place using nose and eyes, and look for areas where there might be water damage. Usually it will be hidden, though: in the walls, water leaking behind the walls or a sprinkler system hitting the walls. Those are things that need to be considered. If they want to make sure, there are a variety of tests we can talk about to do pre-emptively. In a hot market, it’s tricky. No seller is going to wait for you to get a mold test back. When looking at new construction, she watches places go up fast: frames aren’t covered, and if it rains, it rains. If it hasn’t totally dried out, then you seal that in. In many instances, you’re better with concrete, bc that won’t become moldy, and plaster instead of sheet rock (older forms of building). Then also take into consideration what your materials should be, if concerned about env’t chemicals. Most of the chemicals we’re exposed to are in our homes. We want to avoid formaldehyde in particle boards, and the chemicals in the foam that they use in building, too.
- What exactly is an ERMI vs a HERTSMI test? If someone is looking to test their house or workplace for mold, why is it so important to get these rather than a non-specific mold test? What are the kinds of tests they DON’T want to get, that won’t give them the right information? This is hotly debated: Dr Shoemaker maintains that ERMI is the best, and that’s what we should use. We could use HERTSMI too — some indoor professionals will argue that the air trap test is better. We have to ask what the question is that we’re asking, and from that standpoint, pick the best test. If you smell mold in the bathroom and you think there’s a water leak in the bathroom, you want to test in a way that will access that information. So collect the dust with ERMI or HERTSMI under the sink. Or even open the wall socket and swab in there. If the question is “is the house moldy in general,” that requires a different way of looking at the problem. You might want to do a whole house screening, and you might still want to test in the areas where you’re more likely to have a problem (where the water pipes are). She’s sometimes recommended collecting the dust off the HVAC system as a way of testing the whole house. In terms of ERMI and HERTSMI: the former is DNA PCR looking at 36 different molds. Some are mycotoxin producing and some are not. You get a composite score. The higher the score, the more concerning the situation: the more mycotoxin producing molds. HERTSMI is just looking at 5 mycotoxin-producing molds and they grade the spore count to give you a HERTSMI score. They don’t always correlate, so you have to use the information and understand the info you’re trying to answer when interpreting it. If they think the house is moldy, and it has a musty smell, and it may be in a particular part of the house, do you need a mold inspector? They will analyze the entire house, in all the places that there might be water damage. They can hopefully help the patient identify where they want to do additional testing. Usually a combination of tests can be most helpful. She was in an incredibly moldy house and had an inspector come in to get a baseline outside and a sample in the kitchen where they knew there was a problem. Then they did wall samples in all the places in the house where it appeared there was water damage. With those pieces of information, they could compare the outside ambient air to the inside house air to what was actually in the wall cavity and make a good determination overall.
- If someone is looking to hire a remediation company for mold, what are some of the most important questions to ask to make sure they do it right? She’s been more reliant upon her inspectors to refer her to a remediation company. You want to make sure that whoever is doing the inspection doesn’t have a vested interest in finding more mold than there necessarily is. The inspectors write the treatment plan for the house. The more thorough the inspection, the more thorough the remediation should be. Understand that the remediators are there to remove the moldy parts of the house. They aren’t necessarily going to identify plumbing leaks contributing to the problem and solve it. They probably won’t rebuild and reconstruct whatever has been removed. You would need a contractor to do that. She learned the hard way: she had to become her own general contractor. She needed to find a remediator and find the people who would identify the leaks and fix them. They weren’t the same people. In terms of other questions: find out how they will protect the rest of the house. They should put up negative pressure barriers so that any of the work and materials that get removed won’t be spread throughout the house. You need to ask how they’re going to use air filtration systems and what they’ll do to prevent it from coming back. Some remove the damaged material, paint or do fogging. Sometimes the inspectors will recommend a level of cleaning.
- What binders do you prefer for biotoxin elimination (cholestyramine, colestipol, activated charcoal, Zeolyte, bentonite clay)? She tends to gravitate toward activated charcoal and clay. Those are generally well tolerated. It depends on the person’s tolerance. Some people prefer one over the other. She doesn’t love cholestyramine or colestipol; she’ll use them if necessary. The former is a powder and it smells foul. If you’re prescribing from a conventional pharmacy, it contains aspartame. Some of that may be financial too: they can’t afford the compounded, clean cholestyramine. Colestipol and Welchol are 25% as effective at binding some of the biotoxins. One of her mentors teaches that the cholestyramine is better at binding ochratoxins and less at some of the other toxins. There may be a possibility of the urine mycotoxin testing to see which is most appropriate. She sometimes will use chlorella and adjusts the dose by tolerance: 1 cap once a day of one of them and titrate to bowel tolerance. Sometimes she’ll do muscle testing. She doesn’t do Zeolyte. The other supplements: phosphatidylcholine is invaluable in helping patients recover from biotoxin illness and chronic infections. Not necessarily the liposomal version. Mycotoxins are tiny and they can pass in between cells. This is a building block of every cell of the body, and it is well tolerated by most people. No toxic effects. The only caveat is that in sensitive people, if you give it to them too fast, they might have a detox reaction, so she starts slowly and then works up. With bentonite: just puts it in water and people drink it. Sometimes they might encapsulate the powder.
- Do you ever test for mycotoxins directly, or do you just stick with indirect markers like TGFb1, complement c3a and c4a? She doesn’t test everyone for mycotoxins bc the tests are expensive: $300-700 or so. She does one of them through a test that accepts Medicare. It may depend on the person too, how sick they are and how high a priority it is. Personally she doesn’t find that it is essential to have that test. In terms of the blood testing that Shoemaker has taught us: the TGFb1 requires special handling. It has to be sent to Cambridge Biomedical. Has to be spun down twice and sent on dry ice to Cambridge. Then they started sending it to Viracor instead. The reference range changed and the numbers changed a little bit. She has done thousands of TGFb1 on people over the years. Most of the time, people would have it between 4-5000. But the levels didn’t always correlate with the severity of illness. There are some cases where it will be high and some where it will be low. Not just mold drives TGFb1 so it’s harder to interpret. She will still occasionally order it as a screening. But taking a good history of the medical complaints and a house history. The same thing with c4a: it has to be sent on dry ice, has to go to National Jewish. Quest did it for awhile and they stopped. She’s had patients with c4as who are deathly ill around 3000. Others feel totally fine with 20K. It’s more about the history.
- Do you have any great testing recommendations for solvents? She hasn’t found a good test for this. Genova has a test; so does Great Plains and US Biotek. If the primary treatment is going to be some form of detox: sauna, binders, alkalinization, coffee enemas, colonics, etc, then we don’t necessarily have to know exactly what the toxin is. They’ll feel better just with the detox protocol.
- Why does mold exposure so often lead to MARCoNS? What is the causal connection there? She doesn’t have the answer to this. Some colleagues find that it’s really important. Some don’t test for it and don’t think it’s relevant at all. She’s decided that it’s not a requirement of the Shoemaker protocol. But if there’s chronic rhinorrhea, chronic sinusitis, some kind of URI issue — even if she doesn’t suspect mold, she might check.
- When might you send a patient for a NeuroQuant MRI? Dr Mary Ackerley has done more on this than she has. She’s looking at all the money that these patients have to lay out and whether that will change what she does. Is it necessary A young man came to see her asking for a NeuroQuant, and he had substantial atrophy based on the reports: and he now is terrified of this. But what she’s doing isn’t any different than it would have been without the NeuroQuant, and now he’s scared about that. Some of the benefits: she does order them sometimes, and there are a few additional reports on the NeuroQuant that Dr Ackerley is teaching the community about (the morphology report and the flare lesion report and the triage report) — she’s still learning about some of these additional reports as to how useful they might be in managing patients.
- Do you ever use VIP nasal sprays? What are the concerns associated with this? She uses this very little. For the most part, she focuses on doing detox. By the time they get to the VIP in the Shoemaker protocol, they don’t need it. She hasn’t used it much. She was given it personally and didn’t notice a thing. Shoemaker is very clear that you have to be out of the moldy building, give the first dose in the office, and check labs immediately afterwards. Her sense from her colleagues is that generally it’s well tolerated and it may be very beneficial in some patients. Sometimes they may have to take tiny doses and take a long time to ramp up. We have a lot of other tools in our tool kit. If her patients are doing sauna, colonics and coffee enemas, IVPC and the binders, they generally don’t need VIP.
- What does an MMP-9 elevation tell you, and is there anything you specifically do about this in terms of treatment, or is it the same protocol you’d use regardless? Same question for VEGF and ADH. She has found them less and less valuable over time. Since we’re still in the learning phases of how to manage biotoxin illness — maybe start with urine mycotoxin testing as a baseline and some of these tests. If the VIP is less than 23, at LabCorp only (can’t send it to Quest), then we can follow that. If, doing all the other things we know to do, it doesn’t come up, then perhaps consider VIP. Hers went up without taking it. The MSH — she used to use it a lot more. She would test it and some people would be non-detectable. A normal range is supposed to be >35, but most people are in the 20s or less. It’s not supposed to change. The MMP-9 means a lot of other things. It’s not just about biotoxins: it could be high in COPD and a variety of other states. She hasn’t found it useful. ADH: she’s tested that and if it’s low, she gave one person DDAVP to try to help their urinary frequency and they didn’t tolerate it. Ask the question, what will you do with the information?
- What’s the deal with the low amylose diet? Why is this helpful, and who is it helpful for? Low amylose: amylose is grains. Want to avoid those, but on this diet, corn is ok. But corn is the most moldy food source out there. This isn’t useful if people are going to eat a lot of moldy corn. She has a slide in her lecture about the contamination of the corn in the horse feed in Texas in the 70s. They developed liquefaction of the brain. The owners realized this was from the feed. The horses recovered — but that same corn continued to be used in the human food sources. Lots of hispanics ate a lot of corn in that area and the rates of neural tube defects skyrocketed. The usual rates of spina bifida are 4/10K and the rates were 3 and 4 times that in that area. So the diet: her recommendation is a modified ketogenic diet, removing the grains for people in a moldy environment. We have to stop eating moldy food. Shoemaker didn’t think this was important, and she does.
- You mention ISEAI: The International Society of Environmentally Acquired Illness. Can you tell us what that is? She’s on the board. Several of the early adaptors with Dr Shoemaker had a philosophical split and they went on to create this. These folks were interested in learning and teaching about mold exposures and environmentally acquired illness, including env’t chemicals and toxicants in this rubric, working together to be more inclusive of the practitioners and more expansive in their ways of getting people to wellness. There is no right way to treat these folks. We have to use all the tools in our tool kit. We need to identify food sensitivities, heal leaky gut, etc. They are in the process of formulating their inaugural event in the Phx area in May 2019. They anticipate an amazing panel of speakers. She thinks this is a place where practitioners and lay people alike can learn about how to get themselves well. There are different levels of membership too. It will be a fabulous conference and a great resource. They intend to create a certification program so people can have a good foundation of how to treat biotoxin illness and will be pooling resources so that this is as scientific as possible. For more info, see https://iseai.org/
Contact Dr McCann: https://www.thespringcenter.com/
A few extra resources: to deal with the trauma of mold illness, check out Annie Hopper’s work, Wired for Healing.
For vagus nerve dysfunction, check out the work of Steven Porgus on the Poly-Vagal Theory, or Stanley Rosenberg: Accessing the Healing Power of the Vagus Nerve.
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