Empathy-Based Medicine COMFORT CLINIC PAIN MANAGEMENT

Yes. Dr. Berger has years of experience evaluating for hypermobile Ehlers Danlos Syndrome (hEDS), the only subtype of Ehlers Danlos Syndrome that is not currently genetically verifiable. They use the most current diagnostic criteria for hEDS to provide you with a diagnostic confirmation or rule-out, and if during your evaluation any prominent signs of a genetically-verifiable subtype of Ehlers Danlos Syndrome arise, they will refer you for genetic testing so that you can rule out any more serious subtypes of Ehlers Danlos Syndrome (e.g., classical Ehlers Danlos Syndrome).

No. In fact, you do not even have to be hypermobile. At Comfort Clinic, we welcome anyone who is looking for an improvement in their comfort levels. Dr. Berger’s most significant recent experience is with patients who have Ehlers Danlos Syndrome, as they have the condition themself and are highly interested in the complexity of the many accompanying comorbidities of EDS. However, they are more than equipped—both in training and in experience—to support anyone looking to feel better in their body.

At Comfort Clinic, we are well-aware of the many obstacles encountered by patients with “invisible” conditions in receiving necessary support and treatment. We are also aware of the widespread lack of basic awareness about Ehlers Danlos Syndrome among the majority of medical specialists. Therefore, we do not require a formal referral from a medical professional to schedule an appointment. However, a referral may be helpful in many instances, and may be of significant assistance in helping us target our treatment towards your specific needs. Further, if you plan to submit a super-bill to your insurance provider for reimbursement, your insurer may require a formal referral was provided in order to provide compensation for your visit with us. Therefore, if you are able to easily obtain a referral from your primary care physician or supportive medical clinician, this is preferred. Such a referral can be faxed to (510) 217-6601.

Comfort Clinic has not established a relationship with any private insurers. With insurance compensation, practices are optimally reimbursed for appointments of low complexity and short duration. Patients with complex medical concerns, including Ehlers Danlos Syndrome, are forced to attempt to fit many concerns into a short appointment or schedule multiple consecutive appointments to simply have their concerns addressed. This makes no sense in the context of empathetic and holistic pain management. At Comfort Clinic, the last thing we want is for you to feel like another number, and you are therefore able to schedule an appointment of any duration necessary in order for your optimized comfort to be supported.

Dr. Berger’s approach to medication support is focused on helping you achieve an ideal balance of improved comfort and minimal side effects. Their goal in medication management is to enable you to become as functional as possible so that you can interact with life in your most optimal way. Opioid medications are not typically known to allow for optimal health and vitality, especially when used on a constant basis or in high doses. Therefore, our clinic de-emphasizes opioid medications and focuses on medications with lower side effect profiles. However, in very specific cases, a low dose and short duration of such a medication type may be indicated.

You may schedule an appointment by visiting us at www.edscomfortclinic.com/scheduling or by calling (510) 575-9409. If you have any questions about which appointment type to choose or what the ideal duration of your appointment might be, please reach out to the above office number for assistance.

Once the appropriate procedure has been determined by Dr. Berger, as applicable, you may schedule your procedure through our website’s scheduling page, text, or phone. After scheduling online, our medical assistant will reach out to verify the appointment duration and details of your appointment.

If you are planning to receive a procedure with any level of sedation or relaxation, please stop eating foods at least 8 hours prior to your scheduled appointment. You may continue drinking clear beverages (e.g., water, electrolyte supplement drinks) up to two hours prior to your appointment. You may take any scheduled medications prior to your appointment with sips of your clear beverage. Please do not take any anxiolytics or sedatives prior to signing your consent on the day of your procedure. If you require an anxiolytic prior to your appointment, please notify our clinic at least 72 hours prior to your procedure. For all procedures, please avoid NSAIDs for at least 72 hours. If you are on blood thinners, please reach out to our clinic for specific guidelines on your anticolagulants prior to your procedure.

Not necessarily. Hypermobility is one of many associated characteristics of Ehlers Danlos Syndrome. Simply being hypermobile does not mean that you have Ehlers Danlos Syndrome, though hypermobility is a necessary component of the physical examination used to establish a diagnosis of the most common form of Ehlers Danlos Syndrome, the hypermobile subtype (hEDS).

Unfortunately, one cannot replace their body’s natural collagen by eating foreign sources of collagen. When we eat protein-rich sources—including animal or plant collagen—our body breaks those proteins down into amino acids. Those amino acids are then used as building blocks to rebuild our own collagen type. This collagen type is determined by our genetics. Therefore, there is currently no cure for Ehlers Danlos Syndrome, since it is a product of one’s genetic makeup. However, it is possible to significantly decrease the negative effects of this condition.

We accept checks, all major credit and debit cards, FSA, and HSA payments. We also offer payment plans and CareCredit. We will provide you a superbill at the end of your appointment, which can be submitted to your insurer for reimbursement. Note that due to a lack of affiliation with any private insurer, we cannot provide information or guarantee regarding the various levels of reimbursement among insurers.

We take a deposit for appointments at the time of scheduling. This deposit will apply to the cost of your appointment, and is fully refundable if your appointment is canceled 48 hours or more in advance. However, for late cancellations (less than 48 hours’ notice) and no-shows, the deposit will no longer be refundable and will be instead billed as a late cancellation charge. Note that if an appointment is rescheduled or canceled more than 48 hours prior to the appointment time, no cancellation charges will be incurred.

We would like to have received any pertinent medical history, laboratory results, and imaging prior to your appointment time so that Dr. Berger can review this together with you during your appointment. Delays in obtaining such information may impact the quality of your appointment; therefore, we will work to receive a release of information and all pertinent documents at least 24 hours prior to your scheduled appointment.

A D.O. is an osteopathic medical physician. Osteopathic physicians are trained to practice medicine and surgery not only in the United States, but the majority of countries worldwide. Note that in the United States, physicians able to provide medical and surgical services include only those with D.O. (doctor of osteopathy) and M.D. (medical doctor) licenses. In contrast to allopathic (i.e., M.D., “Medical Doctor”) training, osteopathic training is focused on treating the person as a whole—body and mind alike. Osteopathy focuses on addressing all systems of a person’s health, rather than focusing on western medical modalities in isolation. Osteopathy was established by A.T. Still, an M.D., in 1892 and has since been ever-increasing in popularity; currently, 25% of the United States’ medical students have elected to be trained in osteopathy rather than allopathy.

Dr. Berger is a board-certified interventional pain physician. They attended medical school at the founding osteopathic medical school, A.T. Still University in Kirksville, MO. They then completed a residency in anesthesiology, and two subsequent fellowships: one in pediatric anesthesia and one in interventional pediatric and adult pain management. Throughout this time, they pursued aesthetic medicine training and elective courses due to their love for artistic expression and appreciation for the natural beauty of healthful aging. They obtained triple board certification form the American Board of Anesthesiology in general anesthesiology, pediatric anesthesiology, and pain management, and then trained other physicians and physicians-in-training at Stanford University for five years. Due to their passion for supporting others who also struggle with chronic pain and who hope to age as comfortably as possible, they retired from their anesthesiology practice in favor of providing pain management and regenerative aesthetic medical services. In 2023, they opened their own private practice clinic, Comfort Clinic, so that they could focus their efforts on infusing empathy back into the medical industry—an industry that has been noted to become progressively more devoid humanity and care, which Dr. Berger believes are integral in achieving true and holistic healing.

The hypermobile subtype (Hypermobile Ehlers Danlos Syndrome or “hEDS”), formerly known as “Ehlers Danlos Syndrome, Type III”, is the most common subtype of Ehlers Danlos Syndrome. Of the 14 subtypes of Ehlers Danlos Syndrome, the hypermobile form is the only form that is not yet genetically verifiable, although there is ongoing research being done in attempts to verify the genetic marker(s) for this subtype. Since it is not yet genetically verifiable, this form of Ehlers Danlos Syndrome is diagnosed based on specific clinical examination findings as outlined by the International EDS Consortium in 2017.

We offer many interventions including trigger point injections, sympathetic plexus blocks (e.g., stellate ganglion block, celiac plexus block), peripheral nerve blocks with subsequent radiofrequency ablation or pulsed, non-ablative radiofrequency treatments, peripheral nerve stimulators, botulinum treatments (e.g., “Botox® for migraine”, TMJD, hyperhidrosis, etc.), intra-articular joint injections, regenerative medicine treatments (e.g., prolotherapy, PRF, PRP), various epidural steroid injections, and additional, personalized techniques aimed at limiting medication requirements and improving function.

At Comfort Clinic, we offer services aimed at helping you feel good in your body and good in your skin. Whether you are looking for a diagnostic work-up for Ehlers Danlos Syndrome, chronic pain management support, intravenous hydration, or regenerative aesthetic treatments aimed at slowing and reversing the signs of aging, we have you covered. You can stop by Comfort Clinic to receive a little extra support in your health and body, no matter the form that may take.

The goals of aesthetic services at Comfort Clinic are to use the body’s natural regenerative processes to reverse or slow aesthetic signs of aging. We focus on a natural aesthetic result, so that you can feel as good in your skin as you do in your body without drawing attention away from your gorgeous self. Services offered include botulinum treatments (e.g., Jeuveau®, Xeomin®, Botox®) for fine lines and wrinkles, radiofrequency skin tightening (NuEra® All-In-One), regenerative medicine (e.g., PRF, PRP) for skin smoothing and hair regeneration, and gender-affirming aesthetic services.

Dr. Berger offers empathy-based pain management support. They will work with you to determine what combination of lifestyle optimization, medication management, and/or interventional support are the most likely to allow you to experience life in the most optimal way. The goal with all modalities is to help your nervous system focus away from your pain signals, enabling you to improve your function and optimize your life experience.

For evaluations, please arrive 30 minutes prior to your scheduled appointment time in order to allow time for check-in, medication review, vital signs intake, and provision of complimentary beverages. For procedural appointments, we prefer you arrive 30-45 minutes prior to your appointment time. We have saved your entire appointment duration for your visit, so you will not be turned away if you arrive late during your appointment slot. However, late arrivals will significantly limit your face-to-face time with Dr. Berger, as completion of the above check-in process will still be required prior to your visit. Please note that every 60-minute appointment includes 40 minutes of face-to-face time and 20 minutes of post-visit documentation time (i.e., 33% post-visit documentation allotment).

Please arrive 30-45 minutes prior to your scheduled procedural appointment. If you are late to your procedural appointment, you will be billed from the scheduled start time of your procedure. If you are significantly late to your appointment, we may unfortunately be required to reschedule your appointment.

This can vary significantly from procedure to procedure, and body to body. Procedures involving local anesthetic can begin to take effect within 15-30 minutes and last a few hours; it is common to experience a “bruised” feeling or soreness after such procedures. Local anesthetic tends to wear off within the first 24 hours of your procedure. For procedures involving steroids, the typical onset of effect is somewhere between 1-7 days. For procedures involving botulinum products, the pain relief tends to begin somewhere between a few days to 14 days after the procedure. However, it may take multiple treatments to begin to see analgesic effects from botulinum. Finally, for radiofrequency treatments, effects tend to have become notable by post-procedural week 8, although they may begin to take effect much sooner.

Virtually all body systems can be affected by EDS. The musculoskeletal and nervous systems are likely most commonly involved, causing joint pain and instability, muscle and myofascial pain (e.g., muscle spasms, “fibromyalgia”), neuropathic pain (e.g., small fiber neuropathy, isolated neuropathy) headaches (e.g., migraine, occipital neuralgia), and symptoms of dysautonomia (e.g., “POTS”, orthostatic hypotension, temperature dysregulation, hypohidrosis, hyperhidrosis). Other systems affected include the integumentary system (e.g., easy bruising, poor wound healing, abnormal scars), gastrointestinal system (e.g., nausea, dysmotility, constipation, visceral hyperalgesia, ARFID), immunological system (e.g., MCAS), and neuropsychological system (e.g., anxiety, depression, language disorders, ADHD, autism)