Understand Environmental Testing Options

Eric Gordon, M.D.

Hello, hi, welcome to another edition of Mycotoxins And Chronic Illness. Today is gonna be one of those educational days, so I think we’re all gonna learn a lot, myself included. It’s my pleasure to be talking to Michael Schrantz. He is the founder of Environmental Analytics and his company is involved with helping you and me figure out how significant your indoor air quality and just your house, your residence, and your office space are. How much is that affecting your life? And so, welcome, Michael, let’s start off and tell me how you got involved in this field.

Michael Schrantz

Yeah, absolutely, and by the way, an absolute pleasure to be speaking with you today. For me, it was a 16 year old kid working in an air conditioning company, making minimum wage, trying to pay the basic bills. But along that journey, I was involved in air conditioning, which as many of us know is a driving force, a pathway, even potentially a source of contamination in homes. And at a very early age I was learning about air flow, and pressure differentials, and how a home breaths or a building breaths, it’s referred to, a lot of times, as a living organism. And it went from being just a nine to five type experience to, “Hey, we’re going out and we’re actually solving problems.” Homeowners having complaints of my air smells or any number of situations, and we were actually starting to figure out the cause or sources. 

And so, as a kid looking probably for some level of validation and success, I found that I was understanding things that many people were missing and that ultimately led to getting higher levels of education, certifications, board awards and all that good stuff. And gosh, it’s hard to put it all on a 30,000 foot perspective, but went from your traditional boots on the ground, inspections for mold, and radon, and asbestos to one day being introduced to this concept of working with people who have chronic illness, I didn’t even know what that was at the time, and realizing that these folks don’t appear to be reacting to obvious exposures that may be even a lay person may be able to point at and say, yeah, that’s a problem in your house. And that fascinated me, it did. I tried to figure out, well, what kind of tests can we do? And so, fast forward to 2021, I’m exclusively now working with clients around the globe, predominantly virtually, sorting through it all, trying to understand the health, the issue there, the exposure concerns, and balancing that with a pragmatic approach of saying, okay, well, it makes sense to do this, it doesn’t sense to do that, and working with these clients so they can ultimately figure out is their building making them sick?

Eric Gordon, M.D.

And that is, I was gonna say, it’s the million dollar question. And unfortunately it can cost you close to that .

Michael Schrantz

Yeah, there’s some people listening right now that aren’t laughing.

Eric Gordon, M.D.

No, I know. You started off thinking that you have a small leak behind the kitchen sink and you’re not feeling well and yeah, your life can be upside down if you’re sensitive enough. And that is what’s so interesting about it, your issues here are the same thing we see in all aspects of toxicology. Its toxicology was designed to figure out what kills you and we’re dealing with what makes you ill and we’re making what makes, at this point, still a small subset of the population ill. Unfortunately, I think that subset’s growing, but it’s still a small number and that’s what is so frustrating to the people. So getting back to how you work. I really wanna get to how you test because that’s what we’re all hung up on, is how can we measure something ’cause we want a number that unfortunately I already have enough experience with and talk to you enough to know that it’s hard to find a magic number. It’s more like gonna be something that we’re gonna have to use with judgment once again. So, tell us, how do you first look at a house?

Michael Schrantz

When you’re dealing with an IEP, and maybe I should take a quick second and clarify that, indoor environmental professional, basically an individual who is consulting the environment. This individual, he or she, it’s similar in a lot of ways to a clinician’s approach initially with a patient, there’s the client’s intake, “Why are you calling me?” “Well, I think I’m having exposure.” “Why, where are the areas of concern or history?” “Well, we had a water leak in this location and this place over here smells funny.” And usually you use that information to create a crude hypothesis of, well, here’s what I think. And then of course, again, 30,000 foot, and we can dive into any specific point you wanna go into, but when it comes into the assessment, really it starts with a visual assessment. I got to tell you a pair of eyeballs and a flashlight are probably the most effective tools that an assessor can use to check the exterior of their home, is there bad drainage issues? Do we have landscaping too close to the exterior walls with sprinkler systems spraying the walls? And there’s a hidden mold problem in one of your, that sort of thing, inside looking for evidence of water staining and damage. 

Ultimately sitting back down with the clients and talking to them about that. Well, I’ve identified five things in this example, two of them are pretty flat tire or what we’d call obvious problems, and you might get into recommendations to remediate that area, but there might be two or three areas that are suspect and let’s face it, if you go into someone’s house and say, for example, you have a water staining or a little bit of damage on the bottom shelf underneath your kitchen, the homeowners, shockingly, aren’t surprised to want to spend four or $5,000 to remediate that on an assumption. So, they might want you to perform some additional sampling in the home to answer these questions, such as do I have a microbial source underneath that kitchen sink cabinet, or what is my normal fungal ecology in the house? Is it normal compared to background levels outdoors? Or is it elevated ultimately to produce a report for these patients that say here’s our findings, here’s what we recommend, and then you would end up hiring a third-party company to do the actual work.

Eric Gordon, M.D.

Yeah, I have so many questions, and I wanna be careful not to miss our time. But if it’s not too much of a distraction from getting information out to people, that idea of indoor and outdoor ecology has always, when I first started getting ERMIs back years ago, which are the kind of genetic testing of microbiology, I guess. That was going on there, they’re basically doing PCRs to identify quantities of molds.

Michael Schrantz

Pretty much.

Eric Gordon, M.D.

Yup, so, but indoor outdoor air, the outdoors is supposed to have all these things there, the indoors is supposed to have a lot less. So, that’s what just confused me, that ERMI score, I always just found, almost mislead, at least to my mind was misleading, it’s just.

Michael Schrantz

No, I have these talking points that I mention to a lot of clients that I try to inject into conversations depending on where we’re at. And I’ll say a few of them here, is ERMI, which was originally an EPA study that was done Environmental Relative Moldiness Index looked at 36 criteria molds, mold species. There’s way more than a 36 depending on what study you read, could be between 50,000 and half a million. But the point is that they did the study and they took a look at the homes that they were sampling and said, these molds seem to be better indicators of water damage in a home. And then these molds are better indicators of outdoor communication. And I would agree with you that it’s an evolution. So, in 2006, when ERMIs were commercially published and available for use, I think everyone thought the only thing you could do with an ERMI was look at the score. Oh, my score is a 10, my score is a 20, and then you go on the ground.

Eric Gordon, M.D.

That never made sense.

Michael Schrantz

Well, and I tell you what happened, is early on, I started taking outdoor control samples, both the air, like a long eight hour air sample qPCR. So the same DNA type analysis and a surface dust, which is a bit tricky, but trying to find representation of molds that are outdoors to then compare to see what we think is normal fungal ecology to one of your questions, is what is normal fungal ecology? Because a home in Miami, Florida in the summertime is gonna look different than a house in Tucson, Arizona in the summertime, by way of the molds available in the ecology, their physiology, what they need to grow. And in one home might look like you have a bad ERMI score to make your point. And in fact, it is just the normal background of outdoor molds, but in another home that ERMI score could reflect a problem. 

So, a lot of the more seasoned IEPs, myself included, have steered well away from the ERMI score, and instead are looking more forensically at the individual mold species and using some database, some experience to say in plain English, this mold appears to be elevated. It doesn’t fit here or this mold does, and then ultimately try and guide patients to answer two questions. The first question is does your house reflect normal fungal ecology? Meaning only molds that you think would come from the outside, for those listening as a reminder. And of course the second point is if not, does there appear to be an area in the home that we can zone into, we can focus on, like I’ll be darn, the basement area is really bad and we’re gonna spend our time looking there.

Eric Gordon, M.D.

Right, what you’re describing is just, yeah, good clinical history and physical. So, you’re deciding what facts are really relevant, because that’s so helpful. And we’ve tried to learn as catch-as-catch-can, but, yeah, we’ll have to sit in on one of your courses, haven’t you given some at ISEAI, I believe?

Michael Schrantz

Done some webinars, International Society For Environmentally Acquired Illness, a nonprofit. We’ve done some courses to really take a little bit deeper dive into basic fundamentals, but it’s not easy. There’s a lot of times people will ask us, well, Mike, what level, what number, quantity of mold is bad versus good? Again, that depends on what is your normal ecology. And there’s a couple, listen, I could throw you a couple. If you had, and this is really convenient for me to use, but chaetomium globosum or hydrophilic mold on that panel, if it was a hundred or higher, I think that’s almost a black and white evidence that you might have very well a problem in the home. 

But, and I’ll land my airplane real quick with you, just to say that there’s more to consider, you have to consider even where you sampled. If somebody sampled off a floor near the entry to their front door and they have wood chips as part of their landscaping, maybe that chaetomium came from their landscaping. So sampling has never been meant, although somehow at some times it’s marketed that way, to defend people who’ve ordered the kits not knowing it’s never been meant to be some easy interpretation. Unfortunately some of the directions that’s out there, would lead certain patients to think sampling the environment and interpreting it is as easy as ABC and it’s not.

Eric Gordon, M.D.

Yeah, well, I think you can say we’ve made a mistake. Many people continue to make that same error when they measure the various sears markers, the C4-As and TGF beta ones, they think they mean something out of context of the patient. They’re just not, they’re absolutely-

Michael Schrantz

It’s not black and white, it’s a relationship.

Eric Gordon, M.D.

It’s not black and white. They’re associated with lots of different conditions, you have to look at the whole picture. The number does not give you the diagnosis. And I guess, we understand that in medicine, but I was hoping that you could make it simpler.

Michael Schrantz

To your point that in fact, we get that a lot. And, in fact, it’s been an eye awakening, it’s been a moment of clarity for me of how presumptuous and how little people know which I took for granted. I just assume everybody knows that it’s more complicated, but it’s not. Normal fungal ecology is very tricky, and knowing when to spend the money is the right way to guide these folks to say, well, it does make financial sense to sample to identify baseline, or identify exposure. Or no, save your money and remediate this obvious issue and spend the other money on the back end of it, or to create a sanctuary, like an environment that would not grow mold in the future by just controlling humidity, for example. There are so many different avenues and so many things that people can get hung up on in this process. It’s essential to be working with people that you trust and who know what they’re talking about.

Eric Gordon, M.D.

Yeah, well, that is a difficult thing ’cause since we interact with professionals to do home remediation, hopefully never. But when we do, it’s rare that most of us don’t get experienced. So, you don’t really know how to judge it very much. So, a lot of it is going on faith. So, let’s go through, if you would, I’d love to just, lead me through your, I dunno, your top, we’ll start with your favorite test and then we’ll circle back to your favorite, what I’d call clinical issues, which is basically things that you see in the home or you hear about that really point you in the direction. In fact, you can do that either way you’d like but both I think would be really helpful for people. What are the, what I call clinical clues and what are the lab clues?

Michael Schrantz

Sure, I think the big piece, and I’ll circle around with my favorites and why I prefer them in terms of sampling when it’s needed. But I wanna preface that we don’t go into any home thinking that sampling is required. Again, sampling is not only limited but it can be expensive, and quite frankly, who cares what your ERMI score is. Presumably if it was good, an example, if you’re still not recovering and your clinician who knows what they’re doing still feels that you’re having a mold exposure in the house, low hanging fruit issues, for me, in my experience have been crawl spaces notoriously are problematic. And if you think about it, cold, dark, damp, sometimes having major drainage issues and it’s not a small area in the home. Oftentimes it represents the floor plan in terms of square footage. So, it’s an issue of volume. 

Basements, especially finished basements, moisture coming in, not always the leak that you can see, but getting into the wall cavity and creating problems that are hard to find. So, basements are always a challenge. A lot of times in the more hot and humid climates, I referred to Miami, Florida earlier as a great example, air conditioning systems, the evaporator coil, that’s the part of the system that cools the air, notoriously can have microbial growth because they’re under such high demand and removing so much moisture. But once you get past that, those sorts of things, other than your typical, well, anybody can have a leak underneath the kitchen sink or a vanity, or next to their water heater. That’s kind of a common denominator thing. Usually houses with flat roofs versus a pitched roof, a house that has a flat roof is designed to be a sealed roofing system, and so by that metric is more out to fail eventually, especially in Arizona where we have a lot of Santa Fe flat roof style homes and we’re being cooked by the sun all the time, and it’s inevitably going to create some pathways for moisture to enter when we get our monsoon rains. And then there’s lesser things like condensation issues in the winter time. 

Some homes suffer from this quite a bit, even offline, you and I were talking briefly about somebody you knew who lived in a coastal area where they might just be having an ambient moisture problem in their wall because it’s not insulated or breathing properly, but it’s not because of anything to do with rain or a flood that occurred. So, we’re usually looking for big things, of course, because that usually translates to the low-hanging fruit. But when those things don’t present themselves to where it’s obvious it needs remediation, I walk to your kitchen sink, there’s mold growing everywhere, I don’t need to sample that unless there’s some medical or legal aspect of it. But if that’s not the case, then people ultimately look at doing sampling and there are two thought processes about sampling, the first thought process is what kind of sampling can I use to actually locate a source? I think it’s in this wall, I think it’s under this cabinet, I think it’s in the ceiling cavity, you don’t typically take a five minute spore trap sample, or even an ERMI dust sample in the living room to pinpoint that source. 

Normally you’ll do something like a cavity sample, which as the name implies, it’s drilling a tube into this wall or cavity of concern and taking a sample. You might use some proprietary technology like Michael Meter, which I’m happy to mention in this case, which looks at fungal enzymes and when done correctly can help you locate sources. You can bore or scope a wall, a little bit more intrusive now, you’re cutting into the wall a little bit, but the point is that focus is looking for it. And sometimes the other way or approach is what’s my exposure? Does my house reflect normal fungal ecology? Is it elevated throughout the house or just in the basement versus the main floor, you can imagine there’s a lot of examples. And when you get into that big question, which probably is why you asked the question in the first place, it’s gonna be biased, but I actually did a study with the EPA, I think it was 2010 or 2011. It was in a gymnasium at a school comparing spore traps samples with the ERMI dust samples. And long story short is we were able to identify a source, ironically, in a wall in the end that we picked up with the dust sample that we missed with 32, I think it was 32 five minute spore traps samples that missed. 

And so, the ERMI or qPCR analysis in my experience has been, from a total picture perspective, the best option for people. The question would be, why? Well, certainly not cost. They are one of the most expensive options, so that would be a con, not a pro, but they do identify species, spore trap sampling doesn’t. And if somebody comes back and tells you, “You have Cladosporium in your house, and you have Cladosporium outside,” but they don’t speciate it, what if it’s a different species? So, it’s not as forensic, you don’t have that resolution. The other thing that’s huge about qPCR that maybe some of you don’t know is that it identifies fragments. And here’s what I mean, for every one mold spore, depending on the reference that you have, and you can go on “IEP Radio”, my podcast, and find these resources, for every one mold spore, there’s anywhere between 300 to 500, some would estimate more, fragments from the same source. So, in plain English, for one spore there’s three to 500 fragments. Those fragments can not be picked up with spore trap sampling. Those fragments can not be picked up with Petri dishes or culturing samples. Those fragments, if there’s DNA, and it’s one of those 36 molds, can be picked up with that qPCR analysis. So, I find it to be the most forensic because it can detect exposures that sometimes are missed, especially, Eric, when you’re dealing with patients where your concern is a low dose environmental exposure concern.

Eric Gordon, M.D.

Okay, that is usually helpful. And, just, again, ’cause we see this all the time, people walk into the office and they want to get a thousand dollars or $3,000 worth of testing, and they wanna get that before they come in to talk. And you can do that, it’s your money, some of you, it’s your insurance company’s money, but it makes a lot more sense to walk through the place and see what the obvious problems are. Get a history before you do lots of testing. Now, but again, but I can still see there are some people who just wanna know do they have an elevated C-reactive protein? They have something that suggests that there’s inflammation in their body the same way they’re just wondering, is my house putting me at some kind of risk.

Michael Schrantz

And the problem is not what you said. And I would argue, there’s probably a handful of people listening right now where they’ve been blessed with the ability to afford that $3,000 example, the vast majority it’s not the case. What I have seen plague our industry too much is there are companies, environmental testing companies, that whether they use some variation of scare tactic or not, whether they believe it themselves or not, will throw the total buffet package of options of sampling. And the argument will be, well we might not be able to detect this, or we might well not be able to detect that if we don’t do this sample. And my counter to that is that, a lot of times, a given sample like qPCR is served as a surrogate, you’re not trying to test for every known contaminant. And if you’re worried about, for example, bacteria or mycotoxins, this is not a perfect solution but just a simple example. 

You don’t have to test for every organism and every toxin, you can focus on a panel because the idea is if you’ve had a water event that’s substantial, odds are it will be represented in that one sample and you’re going to remediate or clean, likely, the same way than if you had spent two to $3,000 more in additional, I will call it, supplemental sampling as an important disclaimer. I’m not saying this to you, blindly, I get it, there are exceptions, I deal with those three to four times a day with clients that you would say, yeah, you’re right, your doctor’s saying this and this is a focus point. So, let’s in addition to this, let’s have you take this sample because it will help them clinically. The point is to be conscious, is to be aware and to pay attention and not just blindly say, I think you should spend $8,000 in environmental sampling, and then you end up recommending the same thing that you would have recommended with a thousand dollars.

Eric Gordon, M.D.

Yes, that is, except unfortunately, when people are sick and their health feels precarious, they’re not able to work, it’s easy to get panicked into doing everything but I would agree with you that rarely serves because it’s without clinical information, numbers alone rarely give a diagnosis, it’s nice, I always tell people, if you broke a bone, the x-ray’s clear, but if you sprain your ankle our tests are not so hot. Maybe the MRI will pick it up, but again, we’ve upped the ante quite a bit, let’s start off with the physical exam and see what we got. So, but getting to that, so you’ve gone through a lot of what I call the physical exam. The walks through the home, the obvious to your practice, your profession, the low hanging fruit places where there’s usually water accumulation or damage. Basically, do you feel that a visual inspection of roofs is good enough or, how do you feel about further work?

Michael Schrantz

To be honest with you, I think it’s a trick question. I think I’m joking, of course. I think that you would wanna look and inspect everything. A lot of times there are limitations, the inspector doesn’t want to go on a 612 pitch roof because he’s afraid he’s gonna fall off it. He’s not expecting the roof and to defend my fellow IEPs is a little bit here, other than that one, is to say that, well, oftentimes on like a pitched roof or something like that, the villain is a pinpoint hole, it’s a small breach, it’s not something that, “Oh my gosh, I found a 12 inch by 12 inch hole.” It’s not like an asteroid went through your house. So, you visually probably won’t be able to see it that easily. Flat roofs sometimes can present evidence of cracking around weak joints in areas that could suggest that water’s getting in. 

A lot of times getting into the attic when you have availability is huge, because you’re, to use an expression, looking underneath the hood and saying, well, if something is getting through, I can see with my flashlight water staining or worse, that will help me pinpoint that. So, yes, absolutely roofs should be included when possible. I think it all boils down to how big of a bite do you wanna take? If you have an inspector that’s gonna look at your 2000 square foot home, he’s gonna take a big look from the house from the outside and go, where are the low-hanging fruit? Do I really think it’s that roof that looks to be in good condition? Can I peek at the roof via the attic and spend 10 minutes there? Or should I focus on that crawl space that smells musty and the two areas in the house that have obvious water damage, it’s a balance. What we wish we could do to the homes versus how we normally prioritize them might look different from one home to the other, but given the surface area of a roof, it stands to reason that you’d at least take a peek at it or discuss it.

Eric Gordon, M.D.

I have one more. I don’t wanna, I’d really wanna go to testing, but I just one minute, I’ve always wondered, for your experience and people you’ve worked with, you were mentioning several tools to ascertain whether there is some excess humidity or water in the wall without making holes. Is there any particular technology that you think is better to do this?

Michael Schrantz

You might be referring to an infrared camera, IR camera, they’ve been used now for the better part of a decade and really more of a common staple. How we would normally use them, is an initial screen tool. I will say that if the inspector identifies an anomaly, a temperature difference, ’cause it’s not looking for moisture, it’s not looking for mold or bacteria, it’s looking for temperature differentials. And the idea is that if there’s a leak, it’s recent, you might get a cool spot on the screen that might suggest a leak, but it’s always followed up with a moisture meter, a non-intrusive moisture meter. So in short, if I have a anomaly that’s by my ceiling, you’d get on the ladder and you stick a moisture meter up there, and you’d say this is in fact recent. I will tell you this only because I don’t want the listeners to go out and stay buying infrared cameras. Like anything else, it’s an art beyond the science, not every thermal anomaly is a water leak and changes in R value of your building materials will show these darker spots and that’s just normal. And so, it can be tricky, but I absolutely think an IR camera is a great tool to help us identify recent water intrusions.

Eric Gordon, M.D.

That’s the important thing here, the recent.

Michael Schrantz

Yeah, it doesn’t address the one that happened five years ago and the wall has dried out and you still have a mold source, but it might help us identify a recent breach or leak.

Eric Gordon, M.D.

Yeah, and just how long do you find that mold can, I mean, without moisture, how long can mold be growing versus just be dormant, any just universe ideas?

Michael Schrantz

Yeah a big picture, I’m not a microbiologist and I’m sure there was one listening right now, they would say, well, depending on optimal conditions. And then it would state once the moisture has been removed, it would be a matter of a day or two, maybe three, where eventually the mold, if it doesn’t have moisture, it’s not gonna continue to grow despite the nutrients. What I can also tell you about the dormant comment is you can have a mold source that’s a couple of decades, two or three decades old. Obviously there’s a number of situations that can affect the decay rate of a particular mold, but mold is organic and we’ve seen heavy loads of lumberyard mold in a house that was originally built, in my particular case, I think it was the early mid ’80s and so it was over 30 years old and very much there. And we actually found it with sampling initially done in the home. We stumbled upon it, couldn’t figure out why we were getting these weird anomalies on the sample. But the point is it can be a while. 

So, if you’re an individual, let me just put this together for you. If you’re somebody who’s having an inflammatory response to mold, so it’s not a pathogenic disease, I’m afraid I’m gonna get aspergillosis in my lungs. And in order for that to happen, it has to be alive. In other words, dead or alive, it’s still a concern, then it would still be a concern for you to try and find it. And a moisture meter might not help you find an old leak from five years ago. That’s why bringing in an experienced IEP who can look for secondary signs, like why is that baseboard a little bit swollen or separated from the one wall that’s underneath the window but everywhere else it looks good. And looking for the subtle evidence of, oh, well there’s a low point and water could accumulate there to ultimately steer you in the client to say, well, this could be a problem, and here’s what we think we should do to either confirm that, or if it’s that obvious remediate it.

Eric Gordon, M.D.

Yeah, judgment keeps coming, it keeps coming to be the bugaboo here.

Michael Schrantz

It is.

Eric Gordon, M.D.

It really is. So, people are doing a lot of ERMI testing, a lot of looking for volatile, organic compounds, can you just give us an overview of the tests that are available, that are out there.

Michael Schrantz

If we’re referring to what’s available in the professionals toolbox, the most common ones are now spore traps, which are not recommended, but definitely used because they’re cheap, affordable, quick, easy to do. Petri dish, culturing samples, looking for viable molds that will grow on some auger plate, and certainly qPCR, some of the folks listening know that there’s ERMI, that we’ve already discussed, those are the staples testing used a lot for assessing exposure. To your point about microbial volatile organic compounds, or MVOCs, there are tools available, sorbent tube testing, which will sample for those MVOCs, which predominantly will be used to help identify active issues. And microbial VOCs traditionally, aren’t gonna be produced by dormant mold, they’re gonna be produced by active mold growth. And so, if you find elevated levels, like say, for example, in the bottom of a wine cellar on a house built in the late 1800s, you’ll probably have a microbial source in there, and it probably isn’t surprising to anybody listening that the would be elevated.

Do I think it’s a go-to, not always, it really depends on the client, are they complaining of musty smells? But maybe they’ve done a couple of DIY ERMIs and it’s come back not really showing much. Maybe we would look at that, MVOCs are whimsical, they’re there one moment they’re gone the next. And so, it’s all about saying whether you have an MVOC source or not, do you still wanna do something else like qPCR? Those are probably the top four. There are some folks out there doing mycotoxin in the dust. Another way of looking for sources in the home by far my biggest experience and knowledge is working in the qPCR angle and looking for evidence of signs that would otherwise be missed by some of those other technologies.

Eric Gordon, M.D.

It’s the science behind our sensitivity to mycotoxins and all the ins and outs since it’s mostly animal based at this point, because as I always tell people, the veterinarian world is far, far ahead of us in dealing with the issue of mycotoxins. That adds a level of complexity when we start looking at mycotoxins in the environment. obviously if you are exquisitely sensitive to the mycotoxins, that it’s going to be worth your while if nothing else is panning out.

Michael Schrantz

Working through, just like you said earlier, in a pragmatic way to say where’s the low hanging fruit and then taking it one bite at a time, if it’s even needed. There’s other technologies out there, some of you listening know about gram-negative endotoxin bacteria, gram-positive Actinomyces studies, that sort of thing, those are another newer technology that we’re looking at. And on the clinical part there’s been some emerging science and claims that piece of it is also an exposure consideration. Again, common denominator, water damaged buildings, mold and bacteria can grow. It’s challenging, we’re still learning as IEPs how to really interpret it I think with the same level of precision that we can with the qPCR, or even some of the other mold sample choices that we mentioned a moment ago. 

But at the end of the day, if it’s any consolation to those listening, we’re still using the same tools. Holistically we’re still looking for where there could be a moisture source, where could it be nutrient rich, we’re still using the same flashlight, we’re still using the same moisture meter. And so, while the clinical world learns, and fights, and debates, and evolves with what truly is an exposure concern, the IEPs half dodged that bullet by saying, “Well, we’re still looking for the common denominator, which is moisture.”

Eric Gordon, M.D.

Yeah, I think that’s really an important point to make, is that, we interviewed Dr. Shoemaker and he feels very strongly that it is the Actinomyces and a lot of other of these gram negative bugs, gram-positive Actinomycetes, but gram-negatives that people are reacting to, or it’s not them but some of the volatile organics that they produce, yet, as you say, the source is still water, they need food.

Michael Schrantz

And it’s complicated even further because what we’re starting to appreciate even more, and we’ve always known about the outdoor environment, that’s why we were doing outdoor control samples to begin with, is like, what should be a good baseline in this house? But what I’m personally seeing is that even there’s a lot of influence when it comes to gram. 32nd example, we had a house in Canada where the whole issue, the whole focus was an endotoxin exposure. And after interviewing them, and listening to the lack of any real known history in the home, we had them actually sample the outdoor environment, they were on a farm land with pastures. And would it shock you to find out that the endotoxin counts outside were orders of magnitude higher than the indoor? And it was just a moment of pause and a reminder to the audience that we’re so focused and we should be when there’s a concern for exposure to water damaged buildings. I’m not making less of that, I’m in that industry, but that we shouldn’t have tunnel vision, we should think that some of this could be outdoor influenced and that changes the narrative. Now you’re not going down a rabbit hole of trying to locate a problem that never was in your home, now you’re focusing on how we can create more of a sanctuary in the home knowing we live next to a pasture that is rich in gram negative bacteria.

Eric Gordon, M.D.

Wow, yeah, and then it comes to how we can lower the inflammatory status of that individual and maybe turn on or off a few snips so they can actually survive in that environment rather than having to move. That’s always the, thankfully, we’re not taking a lot of time to move, or not, that is the one of the more difficult but often important decisions to make if you’re really reacting.

Michael Schrantz

It’s scary, but it’s something we talk about and it’s not something that we throw at you with a glossy textbook and say, you have to do this for those of you that have gone online to social medias and read horror stories of some people who have gone through that experience, it’s not to take away of those people’s experiences. They are the ones that have lived it, but it doesn’t mean that their experience is a projection of your situation. I think what you need to do is focus, meaning you, the patient who might be in that situation, is to focus on professionals who can walk you through pragmatically and say, we get it, we understand if you had all the money in the world, you’d burn down the house, and rebuild it up, and check every piece of lumber going into the house. But since that’s not an option for 99.9% of the population, now we need to get real with the pocketbook so long as it honors the clinicians concerns and this whole model of when we think they’re having an exposure. It’s like, okay, this is now a game of chess. 

The doctor has made an initial claim, we think there’s exposure, here’s the rationale why, we want you to address your home, there’s gotta be a countermove, that’s not sell the home, that’s not throw everything out. It might be that you might be one of those unlucky few where it was a very bad situation, and they do exist, I’ve worked with them. But in my experience, the vast majority of people are salvageable situations that can be restored to basically a pre-loss condition if you just slow down and check the science and apply what we do know about the world we live in. And the world we live in is not a bubble on Mars, we’re surrounded by mold and bacteria, the same mold species that are growing inside of the house when you’ve had water damage. And it’s funny how we don’t have, this is an important point, it’s important how we’re not prejudice, I use the term here, when the mold species came from outside, that’s a normal background, but the second it comes inside and grows, we treat it like it’s plutonium. 

And for any clients who’ve worked with me in the past, they’ve likely heard me say that a number of times ’cause it’s true. We need to empower our clients with more knowledge about what is normal and start working with clients who are professionals, who are going to acknowledge that piece, because unfortunately you made some comment earlier, Eric, that I totally agree with, which is judgmental. It’s an art beyond science, mold doesn’t get into your home and stay static at equal concentrations, it’s constantly fluctuating, it’s a moving target. And our goal as an IEP is to try and locate if there’s a source or if what you’re experiencing is coming from the outdoors.

Eric Gordon, M.D.

And that is crucial. And what I always recommend or insist is, I use the idea of moving is intimidating, is to just move out, but don’t move everything, just move yourself out of the environment.

Michael Schrantz

We use the term mold sabbatical, is that what you’re referring to?

Eric Gordon, M.D.

Yeah.

Michael Schrantz

Well absolutely.

Eric Gordon, M.D.

Just make sure. ‘Cause the thing I hate and I’ve seen it so many times is that people get, sort of, internally by the idea that the house is making them sick, and the only salvation, and especially when your nervous system has gotten involved, and you’re really in that fear and illness place, which is just not in, how you said, I always tell you, I always want people to relax and take a step back, and then I have to remind, my favorite saying, is, it’s hard to learn how to swim when you’re drowning. It’s hard to step back when you’re feeling terrible, but still go someplace else, don’t sell the house, until, I always say go to the beach, so that’s not funny, but if you don’t have a desert, if you’re near the coast, just go to the seashore and sit on that, do you feel any better after a few hours sitting on the beach?

Michael Schrantz

For those people that are symptomatic, it is a good, I was gonna say cheap, and I guess it depends on the situation, it can be a cheap experiment for you to try because the road to recovery is usually not defined in days or weeks, it’s more like once maybe even a couple years. And so, you’re looking for trend data, but even those people who aren’t symptomatic, and I know there’s a significant percentage that say, I don’t feel any different when I go in or out of my home. This concept of a mold sabbatical or getting out of the house, we toss that idea with a number of clients, when, again, you’re beyond the technical piece here, there’s the personal piece. What are your options? What’s your budget? Can you get away from the house? Do you have kids? And working through it, it’s very unique for each person and saying, well, you know what? 

You sound like you can go away for three months and boy, wouldn’t that be something, if you did go away and work with your clinicians so that at the end of that three months, and I’m making up the timeframe right now, but that you revisit with your clinician and retest whatever biomarkers you find, it could be cytokines, it could be neurocan, whatever cluster of symptoms, whatever it can be for you to see if you know what, during that three month period you got markedly better. And that is like a good news, bad news potential. The good news is you got better, the potential bad news is could that suggest that your home is in fact a culprit, and that may just be enough to nudge your spouse who’s not on the same page with you, hello, that they need to start focusing on this house, especially if you guys wanna keep the home. 

And so, again, it’s weighing out, you’re the fulcrum as a professional, and you’re using the weights of their personal situation to say, well, if your budget’s $5,000 you don’t have a lot of options here, but I know plenty of people that are willing to spend, if needed, 20, 30,000 wisely to improve their sanctuary, because these are the same patients that go, “20, 30,000? I’ve spent a quarter million dollars or a hundred thousand dollars in treatments and other things,” and so it’s like, “Yeah, let’s try to salvage this house if we can,” but let’s do it reasonably so you don’t have to drown yourself and get to a point where you’re bankrupt or you’re filing for divorce.

Eric Gordon, M.D.

Yeah, thank you. That is so important because this is a family unit and often there’s one or two people who are ill and one or two who are doing fine and that makes it very, very difficult. And the other thing that I always want people to remember is that though, and people argue about the data, but I can say clinically, there’s almost no question to me that there are people who become colonized, whether it’s in their sinuses, or in their guts, or somewhere, but they are colonized, and them moving from home to home to find salvation is the royal road to divorce .So, please, when people tell you to move, but also make sure that the person who’s giving you that advice, if it’s your clinician, has really thought about it, could you be harboring some of these things that are creating the symptoms? 

Just always go back to do we know what’s going on? Because we are dealing with a whole, I said, mycotoxin and chronic illness, is because chronic illnesses can look like mycotoxins and mycotoxins can look like chronic illnesses, and we get attached to our diagnoses, we all do. When you’ve been sick for a while and nobody knows what’s wrong with you, and then finally, you find it on the internet. In fact, actually, to be fair, I think a lot of patients these days are diagnosing themselves and sometimes doing a very good job of it. Or your cousin had it, or you finally found a physician who says, “Hey, I think this is what’s going on with you.” Remember that the symptoms look a lot alike for a lot of these illnesses.

Michael Schrantz

There’s a lot of overlap.

Eric Gordon, M.D.

There’s a lot of overlap. So, that’s where just always step back and make sure the people you’re getting advice from are thinking. I think that’s what Michael is being really clear about, is how important it is for this judgment, because all these tests and we love tests, and from talking to Michael, he is an expert at what these tests mean. But the fact that he’s an expert in it lets him know that he has to use judgment, he can’t just take the numbers. And I think, in fact we just mentioned that, one of the issues that we were talking about before we started was how different companies, different techniques will give you numbers that you can think are the same. And I know that Michael will talk a little bit about that ‘because I think that’s crucial.

Michael Schrantz

We run into a lot of challenges. I’ll give you an example of a qPCR, and then, if I remember Petri dish, with qPCR-

Eric Gordon, M.D.

I just wanna remind people again, qPCR is what we usually do for ERMI, ’cause I’m always coming back to that because we throw these words around.

Michael Schrantz

Yeah, that’s fair. And for the record, since we’re clarifying, it’s needed, is the reason I try to do a better job of saying qPCR is because when we say ERMI, it’s natural for the lay person to think we’re referring to the ERMI score, which is the same score that you hear us saying we don’t have a lot of faith in. So, he’s right though. That analysis can be collected nowadays in a number of ways, and it can have totally drastic meanings. There are labs, for example, where you collect the dust sample and the units of measurement are not what was originally in the study, which was technically cell equivalent but they now say spore equivalent, or spore equivalent per milligram of dust, that’s a unit of measurement. And there’s some labs that don’t report in that unit. So you have a hard time interpreting, does 10 have a particular mold spore equivalent per milligram of dust mean the same thing if it’s something different, like say milliliters or any other measure. 

And to that point, say for example, there’s companies that will, or I should say inspectors, that will take a swab and literally send it in. And now it’s not per milligrams of dust or per milliliter, it’s literally spore equivalence per sample. And here’s the takeaway, is, it’s important for you to understand that just because you have a result doesn’t mean you do or don’t have a problem. It’s important for you to have a clear understanding, appreciation of what the units mean and so that you can translate it. And that falls under the responsibility of the laboratories, and it falls under the responsibility of the IEP to educate you so that you don’t start assuming things. You take a swab sample in your ductwork and you get an ERMI score, that’s not how the original methodology was done, it wasn’t done using a swab, it was done taking 18 square feet of surface dust off the floor, again, that was modified and accepted. 

There was a study later on that approved other similar methods, but not a swab. So, taking care and consideration that just because you ordered an ERMI doesn’t necessarily mean it’s gonna be reported the way the original methodology does provide. I think with the Petri dish sampling, going now to another methodology that’s commonly used, and this is whether or not you are doing a DIY sample, we could transition into that if time allows, but we’re having a professional do it is the type of auger. There are different mediums, augers that are used in these dishes that support or benefit certain mold species over others. Some molds need a dryer auger that they would proliferate in, but molds like Stachy won’t grow on it, they need something like cellulose augur, as just an example. 

And my point is that if you’re using one auger and you don’t get a finding back, it doesn’t mean that you don’t have a mold that maybe you’ve been concerned about, the auger matters. And so, I guess all of that being said, these are one of the things that we normally talk about with clients that initially start with DIY type of sampling without seeking professional advice first ’cause they obviously want to save money and I totally appreciate that. But one way to avoid that is working with a professional who knows these basic things to guide you. Even if you end up doing some DIY, you can at least do it but with professional guidance.

Eric Gordon, M.D.

Well, on that level, like the Petri dish, I said, ’cause, God, we’ve been doing those, we used to do a lot of them actually less now, especially with COVID. We’d have them take pictures after three days and send them to us, and, but so tell me how do you like to collect them? If you’re gonna use a Petri dish, where do you like to place it? How high, how low? How long do you like to leave it exposed for? What’s your take on that?

Michael Schrantz

I would say, probably to start that, use and placement of Petri dish samples depends on the questions we’re trying to ask. If the questions we’re trying to ask or the hypothesis is I think we have a mold source in the basement, and I think it’s active, then I might do a combination of a qPCR sampling, the ERMI, in that same basement in combination with a Petri dish sample, and then it becomes a question of, well, which auger, and nowadays there’s all different ways you can do this, but you can send a sample off and have the lab use two or three types of auger that offer a wider spectrum for different molds to grow on. And then look at that again, comparing it still to outdoor controls. Because again, if you live in Miami, Florida, it’s gonna look different than Tucson, Arizona. And then saying, okay, do I see a relationship? Some companies, just a side note, but absolutely related to this discussion is sometimes it’s not just comparing indoor to outdoor, but inter zonal comparison, basement to main floor.

Eric Gordon, M.D.

That’s what I was gonna ask you, because that’s something, yeah, it’s obvious, but I wasn’t aware that companies are actually doing that using your location ’cause that makes a huge difference, and we were just doing it kind of like, well, if you had more than six colonies that have a certain size, you have a problem.

Michael Schrantz

Let me defend the doctors out there real quick with the IIP 3D sampling since everyone’s wondering. So, there’s nothing wrong with starting with a DIY assessment. The idea is you’re not trying to sell the farm, you’re not trying to solve world peace, but you’re looking for an initial indication to help direct you, the patient, you, the clinician, especially when you are dealing, by the way, with that disgruntled spouse that I had mentioned briefly earlier. And in doing that, inter zonal comparisons could be a useful tool. We had them set plates at breathing zones, like sitting down, laying down throughout the house, maybe next to the bed, next to the lazy boy in the kitchen.

And some of you are already thinking, well, you’re gonna have normal different loadings like in the kitchen versus the living room, you’re absolutely right, that’s my point, it’s not easy to interpret. But you might find that, oh my goodness, we did these different samples, including the bathroom that had a previous leak, and even with it being a bathroom there was an order of magnitude. The Petri dish was overloaded, it was too numerous to count on the dish. That might be a red flag to say, something’s not right in this bathroom because it seems to be so localized versus homogeneous throughout, if it was homogeneous throughout, that could just be normal background, we need more information. 

But the point is there’s nothing wrong with it because the initial entry to Petri dish sampling pales in to some of the more expensive DIYs, is why, in your defense, many clinicians start with it, is they understand there’s limitations but when you have a client who’s wishy washy in terms of wanting to do anything. And by the way, this is very common to those listening. Or if maybe the diagnosis is not just mold, you’d mentioned that chronic illness, could be a bunch of things, and maybe it’s a gut issue or something to that effect, here’s to my point, is you don’t wanna invest thousands or a thousand dollars to do sampling, but you’re willing to invest a couple hundred and just see where it takes you. Here’s the takeaway, regardless of what you find, I don’t think you can make any hard conclusions. I think what it will do is it will take you from a 30,000 foot perspective of the unknown and zoom you down and to say, well, at least I think we’re in this particular ballpark, that will help you and the clinician justify should we do more forensic sampling, like qPCR analysis. At this point, just say, “You know what, that’s all I need to see.” You need to contact an IEP and get them involved and quarterback this project for you or conversely, “We don’t see much at all, we’re gonna pursue another course of treatment that’s not really looking at the environmental exposure, it’s looking at another issue such as gut, as an example.”

Eric Gordon, M.D.

Right now I think that’s a great one. And I really like that tip of like, you’re looking at the differentials between the different rooms. If you’ve got one hot room and everything else looks pretty good, there’s a problem.

Michael Schrantz

There very well could be, and that’s where you explore it. I think the conversation that would follow that one example is, well, why do we think that? And then that critical thinking comes into play, well, let’s talk about that environment.

Eric Gordon, M.D.

Yeah, is it a closed off bathroom-

Michael Schrantz

Yeah there you go.

Eric Gordon, M.D.

That you neglected to ventilate. That’ll give you a hint, an easy place to start.

Michael Schrantz

Yeah, so no problem with Petri dish sampling as an initial screen, especially when we’re not aware of a territory, conversely, not related to sampling, but on the client or the patient that walks in the clinician’s door, if they’re starting to name off three or four areas in the house that have had a history of leaks or its musty basement, or that sort of thing, in my experience, and I know it probably comes across bias given that I’m an IEP, is you should skip that step of Petri dish sampling unless there’s some clinical need for it and get straight to working with an IEP, because the very limitations of any of these samples, all of which have limitations could miss something that an inspector might be able to identify onsite.

Eric Gordon, M.D.

That makes perfect sense. And again, we want clean cut answers, we want tests, but we’re dealing with a living organism in the house. I don’t think people realize is that it’s not it’s not steel, it’s wood, wood, or stone, or brick, and things or organic materials and things breathe or don’t breathe, and they produce, yeah, I think we’re back to, black and white isn’t very often available when it comes to a chemical test. So, on your website, do you have specific recommendations on anything? I don’t wanna put you on the spot here.

Michael Schrantz

I already have a good, cleverly prepared answer for you on that one, I’m joking, because of the challenges that we work with. Years ago, I actually went on a very well-known social media group and tried to answer questions. I wanted to be that guy that was on these groups and answering questions, and it ended up being a nightmare for me personally, because it never ended, and there were no boundaries, and there was so much bad information, I was literally becoming nauseous. So I said, “Well, I wanna be able to give back.” And so what I did is I created a video cast, it’s free, and it’s called IEP, the letters, iepradio.com. And on there are common topics, a four-part remediation series, so that you can educate and empower yourself with what does this look like? It walks you through the steps, it’s why it’s four parts. Differences in comparing air sampling versus dust sampling, that’s Episode Two. 

Tips for people renting, things to consider, things to look for when buying, that’s Episode 25, we cover the air conditioning system, heck, we cover limbic system issues. And so, the purpose of that is I wanted to give you folks good information for free because there’s just not enough of us IEPs out there. But it’s also so difficult. We were talking earlier offline about analogy, is clinicians, understandably, want to be able to assess and interpret the environment with ease and that’s to me the same as me saying, well, I wanna be able to diagnose a person clinically as an IEP, and most clinicians would say, well, it’s very difficult, it’s the same thing with the environment, it’s not easy. The industry makes it seem easy with a kit, but it’s not full. The interpretation, where to sample, when to sample, why would you sample that window seal this time but maybe not the next time. 

Those little details matter because we’re not testing something that is linear, easy, or something based off of diffusion, like if you have a source that you can sample anywhere and it will represent itself equally unlike a blood sample. And I know there’s even some arguments about blood samples from different locations but mostly that’s a diffusion thing. You’ll get the same result, that’s not the environment, the environment is very heterogeneous. If you have a mold source in the master bedroom, there’s a good chance that it’s going to look like ground zero in the master bedroom and not so much in the other rooms nearby, there are exceptions. So, getting an IEP involved I think is absolutely key, free information for you to go on “IEP Radio” and to plug an organization, there’s a couple, but the International Society For Environmentally Acquired Illness, .org, so, it’s the letters, I-S-E-A-I .org, has a, get help page. And if you go to that page, you can type in your zip code and then type in whether you want a medical professional or an IEP, and it’ll pull up a map and show you who’s in your area.

I strongly recommend that if you’re someone out there that’s listening and maybe you need clinical help, or you’re looking for an IEP who can help you either boots on the ground or something virtual, a lot of us now are offering virtual services, so where we can help people, I work with people around the globe. You can go to that source, you can do a background check and make sure it’s a good fit for you, that would be step one if you’re stuck. If you’re working with a clinician and they’re taking you down the right path, and you’re working with an IEP, or you need to work with one, and they’re taking you down the right path, may I just say to you, congratulations, you’re one of the exceptions.

Eric Gordon, M.D.

Yeah, no, thank you, Michael. That is such helpful advice, because you see, the more you learn, it’s just like when you go to the doctor, if you know something about the illness you can say so much time and money because you don’t sit there paying for a lesson. And if you understand the words your inspector is using you can ask the right questions, you can help them focus much better if you know how they’re thinking.

Michael Schrantz

The occupant ends up being the ambassador for best practices and ends up being that person when a consultant comes out to your house and you’re looking for the signs, when a remediation company gives you an estimate and you’re looking at it cross-eyed because the estimate for $12,000 and you don’t know where to start, there is a wealth of free information that you can go to both on ISEAI and, actually, “IEP Radio” to at least have a starting point. Is it gonna solve every concern you have? No, but if you’re 80% better than you were before, you’ll be more able to focus on that 20% and you’ll be able to identify some of the bad things that are out there, like companies that wanna fog chemicals that can cause you an actual exposure problem. There’s other issues that are beyond the scope of our interview today, but it will help you prepare for this is what best practices can look like. And then it goes down to, are you seeing that or not with this individual?

Eric Gordon, M.D.

And that is well. So, I wanna thank you, Michael. This has been really helpful and just another plug for ISEAI. We’ve interviewed during this series, Dr. Mary Ackerley, whose was one of the founding members of ISEAI. I think you were right up there right in the early.

Michael Schrantz

I was a board member, she’s one of the big dogs in the beginning, absolutely.

Eric Gordon, M.D.

In the beginning, helped get going, and Dr. Lauren Tessier was interviewed by Dr. I think Jill Carnahan. All people who’ve been on the board, or are on the board of ISEAI, because this is an organization that has really realized that we need data, and we need to understand what we’re doing. And they’re really working at educating doctors and educating patients as best we can and trying to do what Michael has spent his life doing with these tests, trying to evaluate what’s best practices? ‘Cause this medicine is a bit of the wild west and we’re doing our best .

Michael Schrantz

ISEAI’s a great place to take a look at for your professionals, just another quick shameless plug Eric, they’re right in the center of it for those professionals who are interested in learning more about that, please go check it out. You don’t have to become a member but we’d obviously appreciate the support. More importantly, you’ll have access to discussions and we have all sorts of committees growing research and development. We’re looking at some of these tough topics that we talked about the day to sort through the minutia and get more consensus coming up with a system that can be used universally to map these particular problems and try and prioritize them and save you thousands of money, and I should probably say thousands of headaches, is it’s not black and white. If it was black and white, it would already be sold on Amazon. We are still at learning stages, and you just wanna pair yourself up with a good community, ISEAI is definitely one of those organizations.

Eric Gordon, M.D.

And thank you so much Michael. It was a great, great learning experience, and I really will encourage everyone to check out “IEP Radio” because I think that’s where they’re gonna get the nuts and bolts, they’re gonna let them understand and ask the right questions as they move forward, ’cause a healthy house is really gonna make a big difference to a healthy life.

Michael Schrantz

Absolutely, thank you very much, Eric.

Eric Gordon, M.D.

A pleasure, be well.