Important Medical Disclaimers ..............................................................................................4
Chapter 1 | Introduction ........................................................................................................5
About the Infection-Associated Chronic Illness (IACI) Manual ...........................................5
What Are IACIs? ...............................................................................................................7
Chapter 2 | Overview of IACIs...............................................................................................8
Mechanisms of Disease ....................................................................................................8
Multiple Hits.......................................................................................................................9
Common Misconceptions about IACIs............................................................................. 11
What Is Recovery? .......................................................................................................... 13
Chapter 3 | Current Research on the Drivers of IACIs ........................................................ 15
Drivers of Disease ........................................................................................................... 16
Persistence of Pathogens in Tissue ................................................................................ 17
Pathogen Reactivation Under Conditions of Immune Dysregulation ................................ 20
Mitochondrial Dysfunction ............................................................................................... 22
Coagulation & Vascular Dysfunction ............................................................................... 24
Dysautonomia & POTS ................................................................................................... 26
Neuroinflammation & Cognitive Dysfunction .................................................................... 28
Immune Activation, Dysfunction, & Autoimmunity............................................................ 30
Microbiome Imbalance & SIBO ....................................................................................... 31
Hormonal Imbalance ....................................................................................................... 33
Mast Cell Activation & Immune Cell Priming .................................................................... 34
Chapter 4 | Clinical Care Guidance ..................................................................................... 36
Environmental Design: Creating a Cultivated Patient Experience.................................... 37
Securing an Appointment at CoRE & the Onboarding Process ....................................... 39
Care Strategy at the CoRE .............................................................................................. 41
Follow-Up: Introduction to the Team Approach After the Initial Intake ............................. 44
In-Person Assessments at the CoRE .............................................................................. 46
Optional Research Opportunities..................................................................................... 47
Assessment Procedures & Treatment Recommendations Based on Clinical Findings .... 48
The Prevention of IACIs & When Reinfection Occurs ...................................................... 68
Chapter 5 | Allied Health Approaches to IACI Care ............................................................. 70
Psychology Services ....................................................................................................... 70
Social Work ..................................................................................................................... 72
Physical Therapy & Autonomic Rehabilitation ................................................................. 73
Nutritional Guidance ........................................................................................................ 75
Chapter 6 | At Home IACI Management Strategies ............................................................. 76
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Pacing, Energy, & Assistive Technology in Complex Chronic Illness .............................. 76
Chapter 7 | Tick-Borne & Vector-Borne Illnesses ................................................................ 78
Overview of Tick-Borne & Vector-Borne Illnesses .............................................................. 78
Testing for Tick Borne & Vector-Borne Illnesses ............................................................. 80
Assessing & Treating Tick-Borne & Vector-Borne Illnesses ............................................ 81
Appendix A | Billing & Coding at the CoRE ......................................................................... 82
CoRE Assessment Order Sets & CPT Codes ................................................................. 82
Appendix B | Introduction Autonomic Rehabilitation ............................................................ 85
Autonomic Rehabilitation in Complex Chronic Illness ...................................................... 85
Spin Bike Upright Titration Protocol: A Symptom-Titrated Cardiovascular Training
Framework for Autonomic Rehabilitation ......................................................................... 93
Appendix C | Pacing, Energy, & Assistive Technology in Complex Chronic Illness ........... 104
Pacing, Energy, & Assistive Technology in Complex Chronic Illness ............................ 104
Mobility Aids .................................................................................................................. 110
Appendix D | Nutritional Guidance in Complex Chronic Illness ......................................... 113
Nutritional Guidance in Complex Chronic Illness ........................................................... 113
Appendix E | Introduction to Hypermobility Spectrum Disorders & Hypermobility Testing . 116
Hypermobility and Susceptibility in IACIs....................................................................... 116
Extracellular Matrix (ECM) Breakdown in hEDS & IACIs ............................................... 116
Neurologic Manifestations Associated with Hypermobility ............................................. 117
Subluxation & Dislocation Across the Body ................................................................... 121
Subluxation Reduction Guide for Hypermobility Disorders ............................................ 132
Proprioception Training in Hypermobility Rehabilitation ................................................. 136
Appendix F | Patient Reported Outcomes (PROs) ............................................................ 143
Appendix G | Blood Tests ................................................................................................. 160
Acknowledgements ........................................................................................................ 165
From Our CoRE Team ..................................................................................................... 165
Reviewers & Expert Contributors ..................................................................................... 166
