Telemedicine Update
Due to changes in the Telemedicine laws, Dr. Gruning is only accepting new patients from states he is licensed in. This is currently only Florida, although applications are pending in Texas and North Carolina. He is also pursuing a Kansas Telemedicine license.
The following states have Telemedicine exceptions that will require patients to be seen in our Fort Myers office for an annual visit and then can be seen in their state for telemedicine follow up visits for the next year: Ohio, Illinois, Alabama and Minnesota.
New and existing patients residing in states outside of Florida, unless located in one of the exception states, must come to our Fort Myers office for each visit, or be physically located in Florida and provide written email verification of that at the time of each visit. Patients not wanting to do this should consult the survivingmold.com website for a Shoemaker practitioner in their state.
What kinds of patients do you see in your office?
Our practice emphasis is on those with Chronic Inflammatory Response Syndrome (CIRS), also known as Biotoxin Illness (Mold Illness). This can include patients with Fibromyalgia, Chronic Fatigue Syndrome, Autoimmune Disorders, Post Covid Syndrome (Long COVID), Vaccine Injury Syndrome, and other types of Environmental Toxicity. Biotoxin patients are typically ill from a Water Damaged Building (WDB) and the 30 different organisms, toxins and inflammagens found inside. Over 50% of the buildings in the US are WDB’s and 24% of the population is genetically susceptible to get sick from the organisms present. We also treat other Biotoxins such as Post-Lyme Syndrome, Red Tide, Blue Green Algae, Ciguatera, and Brown Recluse Spider bites. COVID is also a Biotoxin that we treat acutely and chronically.
As part of our holistic, Functional Medicine model, we provide care for Thyroid disease, Adrenal Fatigue, Leaky Gut and Hormone imbalances. Our patients have typically been to 10-15 (some to over a 100!) other doctors and practitioners seeking help for their problems before coming to us. Many have spent over $50,000 on non-covered medical expenses and repeated expensive remediations. If patients follow Dr. Gruning’s comprehensive advice, and stick to his treatment plan, the financial drain will come to an end and they will get better!
How do I become a patient in Dr. Gruning’s medical practice?
Dr. Gruning is a highly sought after Christian CIRS physician with patients from all over the United States and several other countries. He is semi-retired and does not need to continue to see patients. He continues in practice because he has been called by the Lord to care for those with CIRS. He takes his calling very seriously and works extremely hard to bring healing and hope to his very complex patients.
In order to become one of his patients, you need to do a 10 minute free new patient consult with Dr. Gruning. During this visit, you and Dr. Gruning can evaluate if you potentially have CIRS and if this is the right place for you to receive CIRS treatment. Due to the number of patients coming to us, we need patients that are fully informed and totally committed to following his instructions and the Shoemaker protocol. You must agree to follow up with us at regular intervals, usually monthly (or sooner if problems occur). Otherwise, you will not get better.
If Dr. Gruning decides he can help you and invites you to be a new patient in our practice, and if you decide that this is the right place for you to receive the treatment you need, then you must complete our new patient paperwork and return it to us. We will then schedule you for a new patient visit, which may take several months. We do maintain a list of flexible patients for last minute visit cancellations. If you do not keep your appointment for any reason within 24 hours of the visit, then you would need to pre-pay in order to schedule another new patient appointment.
Non-compliance with office policies and procedures is not acceptable as it uses up valuable professional and administrative staff time that could be used to care for other patients. Our professional and administrative team work extremely hard to help our patients navigate the protocol and the medical system in order to recover from CIRS. We have a very busy practice and provide care for some of the sickest and most complex CIRS patients in the nation. Our team consists of dedicated Christians who understand our patients are stressed and often not able to think clearly and remember things. We are very patient and forgiving. However, our team must be treated with patience, courtesy and respect. Staff abuse will not be tolerated and is a reason you would be discharged from our practice.
Does your practice accept health insurance?
Sorry, we do not participate in any health insurance plans, including Medicare and Medicaid. You are free to submit any office visit charges to your insurer for out of network reimbursement, if applicable. Medicare patients must sign a waiver that they will not submit for reimbursement under federal laws. You can also use your insurance for needed diagnostic tests, such as labs and MRI’s, and prescription medications. Insurance plans do not adequately compensate us for the time we spend with our patients and all of the work we do behind the scenes to get our patients well. This includes answering patient phone calls, emails, and text messages; acquiring and reviewing test results; calling patients with results and updates to the treatment plan; providing test orders and handouts; ordering prescriptions; dealing with medical records requests from attorneys and insurers; completing disability, FMLA and other forms; and answering patient questions. We also interact with other members of the treatment team concerning your care.
What does it cost to see Dr. Gruning and his team of professionals?
We have tried to keep our costs as low as possible compared to similar practices around the nation. The first visit with Dr. Gruning is $440.00 and lasts an hour. During this time, he will review your history in detail and perform a pertinent exam (unless this is a telemedicine visit). He will then discuss his impressions with you and order necessary diagnostic tests. He will give you handouts and review homework assignments with you.
The second visit is typically an hour and costs $420.00. During this visit, Dr. Gruning will review all test results with you in detail and present a comprehensive treatment plan. You will be given handouts and he will review those with you. Any additional tests needed will be ordered. Prescriptions will be sent to the appropriate pharmacy.
Subsequent visits are usually 20-40 minutes depending on the time needed to address problems and questions. Patients either see Dr. Gruning or Grace McGill, APRN. This is charged at $420/hour or $140.00 for every 20 minutes. These visits are usually monthly to start and then will be at longer intervals as you improve.
Due to the numerous requests we are now getting from our patients for special letters (landlord, HOA, employer, insurance company, other physicians), Dr. Gruning will have to charge for his time generating these. The cost is $70.00 for every 10 minutes.. Letters for attorneys will require more time and a higher cost, which is usually paid by the attorney.
The protocol for detoxification and immune system repair includes supplements that are likely not covered by insurance, but may be covered in an HSA or FSA account. The basic regimen runs roughly 360.00/month/person and usually lasts 4-6 months.
The toxin binders used in the Shoemaker protocol are medications and will have additional costs. CSM is from a compounding pharmacy and is generally not covered by insurance; it runs about 100.00/month/person. Welchol is the alternative and is covered by insurance at whatever copay you have; for cash patients it runs about 30.00/month/person at the Mark Cuban Cost Plus Pharmacy online. These binders would also be covered by an HSA or FSA account. The basic regimen again lasts 4-6 months, but may take longer depending upon your completion of the protocol steps (i.e. removing yourself from exposure).
There may be additional supplements needed, based on your condition, and additional medications, such as a compounded nasal spray if needed to treat MARCONS, and a peptide called VIP if you are not progressing or have ongoing brain deterioration.
These costs are temporary and a small price to pay to get your life back!
What diagnostic tests will I need?
Dr. Gruning will decide at your first visit what diagnostic tests are needed for your condition. The goal is to search for the underlying causes of your symptoms. If he suspects you have CIRS and have not had prior testing, or if you have had old or incomplete testing for CIRS, then laboratory tests will be ordered as per the Shoemaker protocol. This will include HLA genetics, brain hormones, cytokines, autoimmune markers, vitamin and nutrient levels, and multiple hormone levels (thyroid, adrenal, sex hormones). Most adrenal and sex hormones will be assessed through saliva testing, which is the most accurate method. Some blood tests must be done at Labcorp and some at Quest. He will attempt to order most tests from the lab that your health insurance covers.
Environmental testing of your home or workplace will be reviewed in detail with very specific instructions given on the lab to use and how to collect the samples. Remember, CIRS is not just mold illness. Bacteria such as Actinomycetes and gram negative bacterial Endotoxins are even more important than indoor toxic molds. They all must be sought and eliminated or you will not get better. This testing is fairly expensive, not covered by insurance, but is critical to your recovery. Additional testing may be recommended by an IEP if they come to your home or workplace.
If you do not have health insurance, Dr. Gruning will discuss with you the options that you have for testing. He has a lot of experience working with CIRS patients on a budget. If you are pursuing a legal case, certain testing will be needed to support your case. You will have to obtain these tests as a cash patient.
A special brain MRI called NeuroQuant will be ordered after discussion with you at your visit. It is extremely important. It is generally covered by your health insurance. If not, you will be able to obtain it as a cash patient. Only certain MRI facilities offer this testing. It is vital if you are pursuing a legal case.
Some patients will be asked to get a GENIE test, which measures mRNA or transcriptomics, which tells us what your genes are doing at that moment in time. It is very accurate for CIRS, describing where you are in the process and the state of your immune system. It is not covered by insurance and is expensive, requiring a blood draw at a special facility and shipment on ice. This is most important for legal cases and for those not responding to the protocol as anticipated.
You will be directed away from needless testing that wastes a lot of resources that Dr. Gruning wants you to save for ensuring that your home environment is safe for recovery. This includes urinary mycotoxin testing, which has been documented and published to not have any relationship to environmental mold exposure.
What if I don’t have health insurance?
You don’t need health insurance to see us. We are a cash practice. We try to keep our prices affordable for those that desperately need our services. If you are financially stressed, you may be able to qualify for care at Christian Medical Ministries and the Mold Illness Treatment Centers. This is only available for those living in Florida. Dr. Gruning founded this in 2010 and cares for Fibromyalgia, Chronic Fatigue,Biotoxin Illness and other patients there using the same treatment protocols we use in our practice, without all of the expensive diagnostic tests. Most of the treatments are free to those who qualify. This is the only free medical clinic in the United States sspecializing in the care of CIRS patients and the only free medical clinic providing care for patients with acute ands chronic pain without the use of any opioids or other controlled drugs. You can find links to the clinic website on our home page and under “Resources.” You can contact the clinic director to see if you qualify.
How do you work with Nutrition with Judy?
Dr. Gruning and our team are working together with Judy Cho and her incredible team at Nutrition with Judy (NwJ) to help the Carnivore Community heal from CIRS. Dr. Gruning and Judy collaborate often. NwJ does CIRS coaching and online support that is essential to manage all of the steps of the protocol and recover from this illness. They have packages of services available, including laboratory testing, and you can decide how you would like to proceed. Our team will work with you regardless of which direction you choose, to help you heal from CIRS, while being sensitive to the Carnivore lifestyle.
Will you work with my attorney?
Dr. Gruning and our team are used to working with attorneys, as opposed to many CIRS practitioners. We prefer attorneys who are experienced in caring for those with CIRS and have successfully litigated these cases. While we do not seek out patients with attorney representation, we are willing to work with them as they seek to prove our patients were potentially sickened by their environment. Dr. Gruning has testified many times as the treating physician. He is not an expert witness. Legal cases require a different level of testing if Dr. Gruning is going to be asked to testify on your behalf. It is extensive. Patients must be extremely compliant with the treatment regimen so that documentation is present to support the serious nature of your illness and your attempts to get well.
Is Dr. Gruning a specialist in Biotoxin treatment?
Dr. Gruning is Board Certified in Emergency Medicine, a specialist in this area of medicine. His area of practice concentration is Functional Medicine, specifically Biotoxin Illness. There is no Board Certification in Biotoxin Illness, so there are no “specialists” in that area, only those who are treating very sick patients according to the available information. However, there is a program under Ritchie Shoemaker, MD and Surviving Mold, the leading international experts in this area, for physicians to qualify as a Proficiency Partner, demonstrating the necessary knowledge to care for Biotoxin patients. Dr. Gruning has completed this certification and has spent many hundreds of hours of research and study to learn to care for Biotoxin Illness patients over the past 17 years. He is constantly in communication with other Biotoxin professionals, around the nation, sharing information and the latest data. He has treated over 2000 patients with Biotoxin Illness.
Does Dr. Gruning provide primary care services?
Dr. Gruning’s practice emphasis is on caring for those with Biotoxin Illness. He does not provide primary care services and we encourage patients to keep their relationship with their primary care provider for their other needs, such as Hypertension and Diabetes. We will work with your other health care team member as needed for your care.
Why does Dr. Gruning follow Dr. Shoemaker’s protocols? Aren’t there others on the internet?
Dr. Gruning thoroughly investigated Biotoxin Illness when he decided to enter this field in 2005. He found Ritchie Shoemaker, MD and the Surviving Mold community the only place for reliable, science-based, data-driven, peer reviewed and published knowledge in this area. This is still true today. Many others on the internet have protocols, books and supplements/treatments based on their own personal experience. Your response should always be, “Show me the data!” Where is the peer-reviewed, published data to support their views? Dr. Shoemaker and our Surviving Mold team around the nation have treated over 100,000 patients with this. The data has been published. The science behind these illnesses has been defined and is being updated daily. NO one else can claim that. Beware of opinions. If it sounds too good to be true, it is probably not true.
What if my home is sick? Do you have people to help me?
We will instruct and assist you in testing your home or workplace for Biotoxin organisms, including toxic molds and bacteria. If there are unsafe levels found, Dr. Gruning will recommend competent, local professionals, with experience working with CIRS patients, to assess and remediate your environment if you are located in SW Florida. You cannot heal from Biotoxin Illness until you are out of exposure. Dr. Gruning provides training to local environmental professionals in the latest knowledge and techniques in assessing and treating Water Damaged Buildings. He works with those who have the highest ethics and are committed to helping those who are suffering from these exposures. It is important to only hire those HVAC and remediation companies who understand the complexities of this illness and are keeping current with the latest information on treating your environment. If you are outside our area, Dr. Gruning will advise you on how to find the right professionals to help you.
Do you sell supplements?
We do not sell supplements, but recommend products that Dr. Gruning uses as part of his treatment plan for our patients. These are moderately priced and have been researched to ensure their quality and efficacy. We use an online service called Fullscript for patients to be able to obtain needed supplements and treatments. Patients are not required to purchase supplements from Fullscript and are free to buy them on their own. However, we insist that they are of the same quality or they will not help you in your quest to heal and you may react to them, sometimes severely. Beware of ordering products like these on Amazon or other online stores as there are many “knock offs” from China and other places of dubious quality. Many of our supplements are from Pure Encapsulations, known for their high quality and purity. On our Fullscript site, patients can purchase supplements with a 10% discount if they wish, especially if they are not local, and then the supplements are shipped to them directly.
I am having problems with brain fog and can’t remember things. Do you have someone who can help me navigate all of this?
Most of our patients are having cognitive issues and difficulty with memory, focus and concentration. Dr. Gruning provides handouts that are very detailed and reviews them with you at your visits. He also works in collaboration with several CIRS coaches to whom he can refer you to help you through this. These coaches have extensive training and are devoted to CIRS patients and their unique nutritional and detoxification needs. We also have counseling available since many patients are struggling with depression, anxiety, and PTSD. These professionals can provide both individual help and group sessions, often through online platforms and Telehealth visits. Their costs are very reasonable.
My problems are very complicated and I have been told by my doctors that I am beyond hope and I will just have to live with this. Can Dr. Gruning handle me?
We have been caring for those considered “beyond hope” for many years. There is no one beyond hope! If anything, our God is a God of hope. Our team is used to dealing with very complex patients that have not gotten better in other traditional and alternative medical practices. Biotoxin patients frequently have many serious and debilitating symptoms and conditions that need to be managed comprehensively. Following the right treatment plan, things will get better. Most of our patients heal completely and return to a functional level in life, family and work. There is hope for the tired and hurting!