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 Dr. Berry see our patients with CIRS (Chronic Inflammatory Response Syndrome) a form of Biotoxin Illness caused by exposure to the interior of water damaged buildings. Dr. Berry is an expert in CIRS and uses Dr. Shoemaker’s protocol. She is currently part of the Surviving Mold Physicians group. As a member of the 2018 Consensus Panel of Surviving Mold physicians, Dr. Berry co-authored the CIRS Diagnostic Protocol, published in 5/2018 (see link below). In particular, she penned the section regarding the Biotoxin Illness Pathway pathophysiology.
“This comprehensive paper is the culmination of extensive collaboration between SM certified providers Scott McMahon MD, Karen Johnson MD, Ming Dooley, Lysander Jim MD, Yvonne Berry MD and Ritchie Shoemaker MD; James Ryan PhD and Michael Schrantz, IEP. This paper will serve as a definitive statement for new providers, interested professionals and patients alike.” Reference: www.survivingmold.com
New Patient Process – Biotoxin Illness / CIRS Program (New Patient Bundle)
The New Patient Bundle includes the following:
1. Chart review (120 min) with Dr. Berry
Your first appointment with Dr. Berry consists of the following: a comprehensive review of your history with particular attention to exposures to water damage and any prior attempted medical interventions; review of your prior medical records; ordering labs including diagnostic CIRS labs and other potential testing, as well as other labs to rule out other possible diagnoses; discussion of the overall treatment of CIRS. (Please note: Only particular laboratories will be allowed for the lab testing, due to special handling required for some of the send out tests and the particular assays used. Dr. Berry will discuss this with you during the appointment.) Prior to your first appointment, please complete our online Biotoxin Illness/CIRS New Patient Questionnaire, as well as the Review of Symptoms Questionnaire. Additionally, please submit to the office any relevant past medical records (including ER notes, any labs or testing ordered for your symptoms, and progress notes of physicians who have been a part of your care) two weeks prior to the first appointment for review. If you do not have these records, please sign a medical release with Natural Balance so our office can request these from the specific physician offices and testing locations. This is a mandatory part of the initial appointment with Dr. Berry so please prioritize obtaining these records. Additionally, we require you forward any documents to us digitally to cut down on possible cross contamination from documents in the Natural Balance office.
2. Physical Exam with a Natural Balance Physician: You will additionally have a physical exam with another Natural Balance Physician. During this exam, the physician will be looking for particular findings often correlated with CIRS. The exam will also help to rule out other possible diagnoses. This is mandatory and each patient will require an annual physical exam by a Natural Balance physician to continue working via telemedicine with Dr. Berry during each calendar year. This appointment will include Visual Contrast Sensitivity (VCS) testing, as well as MARCON testing.
3. Patient Education Video - At Natural Balance, we have a passion for empowering patients with insights and understanding. Dr. Berry’s patients now have access to a recording of an informative group talk that reviews the basics of CIRS. It explains what CIRS is and how it is diagnosed based on the research performed by the Dr. Ritchie Shoemaker and his Surviving Mold Physicians group. It reviews the basics on the CIRS lab testing, the Biotoxin Illness Pathway (i.e. the underpinnings of what happens inside a CIRS patient’s body during the syndrome), and the first few steps in the Shoemaker Protocol. Dr. Berry requires that all patients watch this video prior to their first appointment with Dr. Berry.
4. 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 that have been drawn based on your particular case, as well as any environmental testing or other additional testing ordered by Dr. Berry. 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: Step 1 of the treatment is an assessment for possible water damage with mold testing, as well as any remediation of your home, school, and work environment – this can be done while awaiting lab test results. Step 2 of the protocol (with the use of toxin resin binders) can be done while patients are working remove 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 St. Joe’s Reichert Health Center in Ann Arbor and LabCorp laboratories (two separate locations). Dr. Berry has meticulously worked in concert with St. Joe’s hospital to establish many of specialty CIRS lab tests. For patients who have a suitable Quest lab near them, there are some labs that can be drawn there, as well. However, Quest has stopped running several of the key CIRS labs so Dr. Berry has switched to using St. Joe’s Reichert Health Center and LabCorp for now. It is unfortunate that it requires 2 separate lab locations to accomplish the proper testing, but at this point it is out of necessity.
Natural Balance and Doctors won’t be involved in Litigation: We do get involved in litigations, depositions, workman’s compensation claims, medical disability claims, or writing for any work restrictions. Therefore, if you are seeking medico legal support, our office will not be able to assist you but can refer you to an out-of-state Surviving Mold physician who does offer such services. 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
**PLEASE NOTE – THE PRICING IS CURRENTLY IN THE PROCESS OF BEING UPDATED. PLEASE CONTACT NATURAL BALANCE DIRECTLY FOR THE MOST UPDATED PRICING. THANK YOU!
New Patient Bundle Biotoxin Illness:$1113.00 (covers all appointments in the ”New Patient Bundle” described above)
New Patient & Lab Review for Biotoxin Illness, appointments hourly: $450, prorated to length of time spent with the doctor.
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.
** NOTE THE FOLLOWING PRICING RATES BELOW ARE CURRENTLY BEING UPDATED – PLEASE CONTACT OFFICE FOR PROPER RATES
New Patient Visit (Bundle - Biotoxin Illness - with “Group Visit for ” $1113.00):
Code Description Amount
99205 New Patient Visit (120 minutes) $900.00
99354 Medical Office Visit -extra time $195.00
VCS Test $18.00
Medical Office Visit (example of a 1.5 hours lab review appointment)
Code Description Amount
99214 Medical Office Visit (60 minutes) $450.00
99213 Medical Office Visit (30 minutes) $195.00
Code Description Amount
99213 Medical Office Visit (30 minutes) $195.00
Follow-up phone or video conference visits
Code Description Amount
99443 Medical Phone Consult or Video Conference (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 in office: $18
API-Staph Nasal Culture for MARCoNS Test: $85, results in 2 weeks
ERMI: $300, results in 5 business days (price subject to change)
HERTSMI-2: $155, results in 5 business days (price subject to change)
Pricing for blood testing is not directly available through Natural Balance for LabCorp and St. Joe’s labs due to fluctuations in the pricing that are outside of our control, as well as the unpredictability if insurance will cover your testing.
However, there is an option through Direct Health (5/2018 – contract subject to change) where many of the LabCorp labs can be obtained with wholesale pricing if your insurance does not cover them. For these, Natural Balance has a contracted wholesale rate that can be supplied upon request at the new patient appointment. There is an upfront $40 fee (as of 5/2018 – price subject to change) you would pay Direct Health for this option.
Please Note: The Shoemaker Protocol calls for using the specific laboratories based on Dr. Shoemaker’s research. This includes the specific laboratories used for ERMI/HERSTMI-2 testing, blood draws, VCS testing, 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.