Dr. Yvonne Berry
Dr. Yvonne Berry is a board certified Family Medicine Physician who developed impressive skills and knowledge related to Biotoxin Illn... read more
CIRS (Chronic Inflammatory Response Syndrome) – A form of Biotoxin Illness
We are fortunate to have both Dr. Berry and Dr. Berke see our patients with CIRS (Chronic Inflammatory Response Syndrome) a form of Biotoxin Illness caused by exposure to water damaged buildings. Both of our doctors use Dr. Shoemaker’s protocols.
New Patient Process – Biotoxin Illness / CIRS Program (New Patient Bundle)
The New Patient Bundle includes the following:
1. Chart review and Physical Exam with the Doctor (120 minutes): Your first appointment with Dr. Berke consists of a comprehensive history and physical examination, ordering Biotoxin illness labs, HLA genetic testing, and discussion of the overall treatment of Biotoxin illness. For the convenience out of state patients, this first interaction may be split into two components, including a 60 minute video conference to collect history and order labs, and a subsequent 60 minute in office physical examination. This allows out of state patients to obtain lab work on the same day they schedule the physical examination, since we require that specific lab testing sites in our area be used for the sake of testing accuracy. Initial physical examination will include Visual Contrast Sensitivity (VCS) testing, as well as MARCON testing. Prior to your first appointment, please complete our online Biotoxin Illness/CIRS New Patient Questionnaire. Please submit to the office any relevant past medical records two weeks prior to the first appointment for review.
2. Teaching Session at Natural Balance with Dr. Berry – In a Small Group Setting with 5 to 7 patients and their family members (3.0 hrs) - At Natural Balance, we have a passion for empowering patients with insights and understanding. During this session, will be covering information about Dr. Shoemaker’s cutting edge protocols for CIRS, and our clinic’s approach to working with patients. Prior to this appointment, you will have completed our online New Patient Questionnaire. Prior to the group visit, the Doctors will have reviewed every patient’s medical history to ensure this interaction will be meaningful and productive. There will also be time for open group Q&A. Patients are encouraged to bring their significant other, or in the case of a child, both parents should attend if possible.
3. Additional Chart review by the Doctor: Depending on the complexity of the patient’s past medical history and prior medical records, the doctor may require additional time to read the past medical record and organize a medical chart summary. A chart review fee may be required, and this will be decided on an individual basis at the discretion of the doctor.
Please note: All the above interactions are part of the “New Patient Bundle”. The bundle however DOES NOT include any additional testing, subsequent visits to review lab results, or follow-up appointments.
What to Expect Next for Biotoxin Illness Patients?
Lab Review Visit: After the your New Patient Bundle appointments, you will be ready to review labs. This appointment is typically 2 hrs long, and it will be scheduled 6-8 weeks after your physical Exam.
Assessment and remediation of your environment: Treatment starts after the lab review. However, step 1 of the treatment is a mold assessment and remediation of your home, school, and work environment. Step 2 of the protocol (with the use of toxin resin binders) can be done while patients are working to mitigate the biotoxin exposure in their environment. However, please be aware that no further steps in the protocol can be done until the patient is in a “safe” environment.
Follow-ups: Patients are asked to follow up every 6 to 8 weeks, with the appointments lasting between 60 to 90 min.
Frequent Visits to the Ann Arbor Area: Active treatment of CIRS requires retesting about every 2 months at Quest and LabCorp laboratories (two separate locations). Dr. Berry has meticulously worked in concert with two sites in our area to train their staff to perform the labs properly and avoid erroneous data. That is why we require patients to use these two locations whenever they are working with our CIRS doctors.
Natural Balance and Doctors won’t be involved in Litigation: Our passion and focus will be to help your body feel better. For this reason we choose not to get involved in litigations, depositions, workman’s compensation claims, or writing for any work restrictions. Therefore, if you are seeking medico legal support, our office will not be able to assist you. However, we are more than happy to continue to treat you from a medical perspective.
Length of Treatment
There is no known cure to CIRS at this moment. Our treatments are aimed to make your condition stable, and help you to manage it in the future. Typically, the Active Treatment Phase could last anywhere between 1 year to a few years, depending on the severity of your own condition. Once the Active Treatment Phase is over, patients will come back to see us about once a year for retesting.
We hope you have found this information helpful and we look forward to working with you. Please contact our office and ask for Lili Boggess, our Clinic manager if you have any further questions! 734-929-23696, extension 11.
Please also visit the following link to learn about Insurance questions: Insurance & Payments
General Pricing Information
New Patient Bundle Biotoxin Illness:$893 (covers all appointments in the ”New Patient Bundle” described above)
New Patient & Lab Review, Follow ups for Biotoxin Illness, appointments hourly: $370, prorated to length of time spent with the doctor.
Pricing & Diagnostic Codes
Natural Balance is out of network for all insurance, and we do not bill your insurance. We will provide you with a itemized superbill for every encounter with the appropriate E&M codes to submit to your insurance for reimbursement to you directly. However, please understand that we have literally given up on trying to figure out the whims of insurance and cannot guarantee you will be reimbursed as such. For your reference, we have included the codes and pricing we use for the New Patient Bundle and additional new and existing patient visits, phone consults, et cetera to assist you with checking with your insurance company ahead of time if you wish.
New Patient Visit (Bundle - Biotoxin Illness - with “Group Visit for ” $953.00):
Code Description Amount
99205 New Patient Visit (120 minutes) $740.00
99354 Medical Office Visit -extra time $195.00
VCS Test $18.00
These codes are submitted in the same superbill with the Group Teaching Session ( 3.0 hours).
Medical Office Visit (example of a 1.5 hours lab review appointment)
Code Description Amount
99214 Medical Office Visit (60 minutes) $370.00
99213 Medical Office Visit (30 minutes) $195.00
Code Description Amount
99213 Medical Office Visit (30 minutes) $195.00
Follow-up phone visits
Code Description Amount
99443 Medical Phone Consult (25-30 minutes) $195.00
To learn more about what to expect as our patient, make sure to read all three tabs below.
What to do Prior to your Initial Visit with our Doctors
- Our office will send you an e-mail with all the new patient paperwork. You need to complete the the forms 1 week prior to your visit.
What to expect during and after your visit
- Much of the time is spent reviewing symptoms, educating about CIRS from exposure to water damaged buildings, and advising testing and treatment.
- Billing will be based on the amount of time spent for the consult.
- For phone consultations, our doctors will forward your treatment plan and any other necessary documents via email to you, following your consult.
Follow up patients: will be expected to have following items available at the time of the consult:
- A log of major symptoms affecting your quality of life.
- A log of responses or reactions/side effects to treatments; the progression of your graded exercises if they were prescribed.
- Questions you would like to discuss during your visit.
- A local pharmacy number.- For phone consults, a reliable phone. Landlines work best for extended calls. If using a cell phone, please be in a location with good reception.
- Childcare arranged, if necessary.
Please Note for Dr. Berry’s Patients: She only manages CIRS from water damaged building exposures. She uses the diagnostic and treatment protocols based on the clinical research of Ritchie Shoemaker, MD, a well-known CIRS specialist. All other diagnoses will require care from your primary care physician or other medical specialists. Annual routine physical exams are a mandatory requirement for patients under our care.
The following tests are not covered by any insurances (prices noted):
VCS test: $18
API-Staph Nasal Culture for MARCoNS Test: $85, results in 2 weeks
ERMI: $300, results in 5 business days
HERTSMI-2: $155, results in 5 business days
A pricing list of biotoxin test from Quest can be obtained upon request.
- Alpha MSH: $191 (as of 3/14)( test code 010421)
- HLA DRB 1345, DQB1 testing ~$600 (test code 167120)
Please note that these prices are subject to change by LabCorp.
Please confirm pricing directly with LabCorp if you need to verify pricing. LabCorp Customer Service – 800-473-9702
Please Note: Dr. Shoemaker’s protocol calls for using the specific laboratories based on his research. This includes the specific laboratories used for ERMI/HERSTMI-2 testing, blood draws, and nasal cultures. In particular, Dr. Shoemaker has seen erroneous results when other laboratories were used. Therefore, it is imperative that patients use the laboratories at the specific locations where our clinic recommends
What are biotoxins?
- They are toxins produced by or derived from microorganisms.
- The type of biotoxins involved in Biotoxin Illness are ionophoric – extremely small molecules capable of moving from cell to cell.
- They stay nestled in the cell membrane, the outer layer of the cell.
- There is only a minute amount of biotoxins found in the bloodstream. Therefore, a blood test will not detect these biotoxins
How are biotoxins transmitted? Biotoxin-producing microorganisms or biotoxins from such organisms can enter the human body through the following routes: inhalation, ingestion, and/or animal bites, such as from specific spiders or ticks.
Why doesn’t the body remove them? Normally, biotoxins are removed by antibodies formed in the human body. The body is able to excrete the biotoxins out of the body via the stool once they are bound to antibodies. Most people are able to produce these antibodies and will therefore not develop Biotoxin Illness. However, some people are genetically unable to form the antibodies against specific biotoxins. Without antibodies, the body is unable to excrete these biotoxins and hence they impact the body adversely.
What do ionophoric biotoxins do to the body? Chronic biotoxin carriage results in the following: Chronic inflammation due to an innate immune response, Neuronal dysfunction (often reversible once biotoxin is removed), Hormonal imbalances and Autoimmune issues. The body responds to the biotoxins by releasing large amounts of inflammatory molecules (e.g. cytokines, TGF beta-1, complement factors). This is called an innate immune response. This inflammation is the body’s first line of attack against any foreign material, including biotoxins. In people with properly functioning immune systems, the innate immune response is turned off once the biotoxins are removed. However, in Biotoxin Illness patients, antibodies are not formed to the biotoxins. The unremoved biotoxins continue to trigger an innate immune response. This leads to persistent release of inflammatory molecules, resulting in chronic inflammation, which can eventually lead to hormone imbalances and autoimmune issues.
Biotoxin Illness is considered a type of “Chronic Inflammatory Response Syndrome” (CIRS). Dr. Ritchie Shoemaker, a renown Biotoxin Illness specialist, has discovered a sequence of abnormalities that occurs in patients who have CIRS caused by biotoxins. He calls the sequence the “Biotoxin Pathway.” Please refer to the following link for very detailed information on the topic.
It only takes 15 minutes of exposure to biotoxins to initiate this overwhelming innate immune response.