Report C4a results, questions in PANS / PANDAS (Lyme included) Posted January 13, 2016 You're right, Shoemaker does have blinder on and I'd love for him to be more balanced. But your other labs do seem to support mold as a possible issue. My DD had high C4a (8000)- which from my readings, only seems to go high from lupus, lyme or mold. From there, like Mama's dr, our LLMD did some of the other Shoemaker tests. DD's MSH was undetectable. Her issue seemed to be mold and MARCONS. No, the MARCONS swab isn't painful. Paying for the various treatments - that was painful. We did CSM for several months but I can't say I noticed any huge benefit. It wasn't expensive at all but DD couldn't drink the stuff. It was nasty. So I put it into empty gel caps and she took those. Not sure if the gel cap somehow made it less effective, but it was the only way she was going to swallow any. I think of CSM as a stop gap measure. For DD, the only thing that got her feeling well again was to remove her from exposure (school building) and then fight a long battle with MARCONS. It's really hard to get rid of and can bring so many of the same symptoms as Lyme - muscle pain, fatigue, headache, nausea, dizziness, brain fog... Shoemaker's paper on C3a and C4a is here http://www.jacemedical.com/articles/C4a%20C3a%20testing%20for%20Lyme%20disease.pdf I haven't read it in awhile but I seem to recall he ends up saying elevated C3a is lyme and C4a is more mold. I can tell you my son didn't get better from lyme until we got him out of the same moldy school building that caused my DD so much trouble. So it's not like you can't have both lyme and mold issues. But go with your gut.