Wednesday, September 2, 2015

South Florida's Best Kidney Doctors Are Also The Most Affordable

Did you know the group voted "Best Doctors" in Nephrology and Hypertension in both Fort Lauderdale and Boca Raton is also the most affordable group? We believe excellent health care CAN be delivered in an efficient and cost conscious manner. Like our "Rapid Response" same day appointments that we offer Monday through Friday, which keep our patients out of the ER and hospital whenever possible. Leaders in Home Dialysis. High rates of Transplantation. Certified Specialists in Hypertension. Best Healthcare. Cost effective Healthcare.That's our mission at The Kidney & Hypertension Group. (954)771-3929. * (Attached reviews of Drs. Valle, Bejar, and Ajuria. Drs. Waheed, Torres, and Baez have not been reviewed yet but are expected to fall in exact range of the other 3 doctors who were reviewed)

Thursday, August 13, 2015

Dr. Gabriel Valle and Dr. Carlos Bejar Again Voted Boca Raton's Top Kidney Doctors

Congratulations to our Dr. Gabriel Valle and Dr. Carlos Bejar who were chosen "Top Nephrologists" in Boca Raton, as well as Fort Lauderdale, by their peers through Castle-Connelly again this year. ABOUT CASTLE CONNOLLY AND AMERICA'S TOP DOCTORS-
The mission of Castle Connolly Medical Ltd. is to help consumers find the best healthcare. To this end, they publish a variety of books including the "Top Doctors" series, the most popular of which is America's Top Doctors®. The top doctors who are listed in their books and on website's directory were nominated by their peers in an extensive survey process of thousands of American doctors each year. These Top Doctors' medical educations, training, hospital appointments, disciplinary histories - and much more - are screened by the Castle Connolly physician-led research team. Those doctors who are among the very best in their specialties and in their communities are selected for inclusion. Doctors do not and cannot pay to be included in any Castle Connolly Guide or online directory. Congratulations Dr. Valle and Dr. Bejar.

Wednesday, August 5, 2015

Dr. Raphael Baez of The Kidney & Hypertension Group is Loved By His Patients

Dr. Rafael Baez, of The ‪#‎Kidney‬ & Hypertension Group, was born in San Juan, ‪#‎PuertoRico‬, and completed his medical training, specializing in Internal Medicine and the subspecialty of ‪#‎Nephrology‬ there as well . During his training, he was recognized as "Resident Of The Year" for three consecutive years and then "Fellow Of The Year" during his years of training in Nephrology. In 2010-2011, Dr. Baez was selected as "Chief Resident" in Internal Medicine, based on the recommendations of his professors. Dr. Báez completed his post graduate studies in Kidney ‪#‎Transplant‬ Medicine at the Brigham and Women's Hospital at Harvard University in Boston, MA. His interest in research led him to publish his study on the Pathology of Glomerular Diseases in the Journal of the Society of Nephrology of Puerto Rico. Recently, is this same magazine, he published a study on Interventional Nephrology. His publications have also been presented at the Latin American Society of Nephrology (SLANH).
His primary interest is chronic diseases of the kidney, hemodialysis and peritoneal dialysis, and transplant. His philosophy is based on developing individualized care for each of his patients, providing them with the necessary education about their conditions in order to carry out a suitable treatment plan together, as a team. He is also an Assistant Professor of Medicine (Nephrology) for the University of Miami Residency program at Holy Cross Hospital. In his spare time, Dr. Báez is dedicated to his family. He also loves sports of all kinds. He is known for his warm and approachable manner, his broad smile and positive outlook. It is no wonder his patients love him. If you would like to see Dr. Baez in either the Plantation office or in our Fort Lauderdale office on the grounds of Hol

Tuesday, August 4, 2015

High Blood Pressure Mid-Life Tied To Later Kidney Function

Let's get your blood pressure under control now. BP at mid-life predicts ‪#‎kidney‬ function in later years. Even modest elevation plays a role. For information on our ‪#‎Hypertension‬ Clinic conducted by our #Hypertension board certified physicians contact us at (954)771-3929. ://

Monday, July 13, 2015

What Is Calciphylaxis and What Can Be Done About It

(From American Journal Of Kidney Diseases
Calciphylaxis is a rare and devastating disease, affecting mostly patients with end-stage kidney disease, but also affecting patients with preserved kidney function. Due to the low prevalence of the disease, high quality evidence for the evaluation and management of calciphylaxis is lacking. Most of the current evidence and recommendations are based on small studies, case reports, and expert opinion. In an article published in the July issue of AJKD, Nigwekar et al thoroughly review the current literature on calciphylaxis and provide a summary of recommendations to evaluate and manage patients with calciphylaxis, developed by the Massachusetts General Hospital’s Multi-Disciplinary Calciphylaxis Team. Clinically, calciphylaxis presents with severe painful skin lesions that are frequently complicated by blistering and ulcerations. Histologically, it is characterized by vascular and soft tissue calcification, intimal hypertrophy, and microthrombosis of small vessels, which result in necrotizing, non-healing ulcers with a high risk of sepsis. Although the pathogenesis of calciphylaxis is not well understood, several risk factors are implicated, and nicely summarized in Table 1 of the article. The dysregulation of mineral-bone disease axis clearly plays a major role in the development of calciphylaxis, but it is not the sole cause. Other risk factors include the use of calcium-containing phosphate binders, diabetes mellitus, obesity, malnutrition, female sex, autoimmune disease, hypercoagulability, and warfarin therapy. The association between warfarin and calciphylaxis is compelling because of the action of warfarin on the vitamin K-dependent inhibitors of vascular calcification. The diagnosis of calciphylaxis requires a high index of suspicion. The differential diagnosis should include the following clinical mimics: atherosclerotic vascular disease, cholesterol emboli, nephrogenic systemic fibrosis, oxalate vasculopathy, purpura fulminans, vasculitis, and warfarin necrosis. Definitive diagnosis requires a skin biopsy performed by an experienced provider. The risk of biopsy includes ulceration, superimposed infection, propagation of the lesion, and necrosis. The authors recommend punch biopsy over incisional biopsy, as it has been safer in their experience. Biopsy of the ulcer or necrotic area should be avoided because of low yield. Radiologic studies and biomarkers have not been systematically studied, and thus are currently not recommended. Laboratory studies are mainly aimed towards identifying risk factors and should be guided by the clinical presentation and suspicion. The treatment of calciphylaxis is multifaceted and includes medical and surgical interventions. The authors recommend the following disciplines be involved in the treatment plan: nephrology, dermatology, dermatopathology, a wound or burn center, nutrition, and pain management. As with other aspects of calciphylaxis, the quality of evidence for the various treatment modalities is poor, thus relying largely on observational studies and expert opinion. Data on non-uremic calciphylaxis is very limited, thus the diagnostic and the treatment approach suggested is similar to that of uremic calciphylaxis. A wound or burn center, along with dermatology teams, could recommend appropriate topical treatment, as well as weigh into the decision for surgical debridement. Hyperbaric oxygen may serve as a second line therapy for non-healing wounds. Since sepsis is the primary cause of mortality, the authors recommend a low threshold for initiating antibiotic therapy. Management of mineral bone disease involves maintaining serum calcium and phosphorus levels in the normal range, and keeping serum parathyroid hormone level between 150-300 ng/mL. Cinacalcet is recommended to treat secondary hyperparathyroidism, and vitamin D preparations should be avoided. Surgical parathyroidectomy is an option in patients who do not respond to medical therapy. Excessive suppression of PTH to <100 ng/mL should be avoided. This may induce adynamic bone disease that is a risk factor for vascular calcification. Warfarin should probably be substituted by an alternative anticoagulation in patients who develop calciphylaxis. There is no data to suggest that intensifying the dialysis prescription is beneficial in patients with calciphylaxis, and such approach is not recommended. Medical treatment of calciphylaxis is limited to sodium thiosulfate (off-label indication). Initially this drug was used in the treatment of tumoral calcinois in hemodialysis patients, but several small case studies over the last decade have highlighted the benefit of sodium thiosulfate in patients with calciphylaxis. Possible mechanisms of action for sodium thiosulfate have been proposed. One theory is that it complexes with calcium and thereby increases the solubility of calcium deposits. Recently, however, there has been more emphasis on sodium thiosulfate therapy also having antioxidant and vasodilatory properties. The recommended dose of sodium thiosulfate is 25 g in 100 mL of normal saline intravenously given towards the end of dialysis. Because there is currently no recommended blood level measurement, it is important that dosing regimens be based on the intensity and frequency of the dialysis sessions. The authors provide a table (Table 3) with suggested dosing based on pharmacokinetics simulation and treatment modality. Optimal duration of sodium thiosulfate treatment in not known, but clinical improvement is anticipated within a 2-week time frame. Improvement in pain symptoms usually precedes wound healing, and is considered an important predictor of response. In summary, calciphylaxis is a rare but life-threatening disorder with complex and poorly understood pathogenesis. Prospective clinical trials are lacking and the treatment options are limited. This excellent review by Nigwekar et al. provides a comprehensive summary of recommendations that should help clinicians taking care of patients with this challenging disease. – Post written by Olga Karasik, MD, and Abdo Asmar, MD, AJKD Blog Advisory Board member To view the article full-text or PDF (freely av

Tuesday, June 30, 2015

Are Drug Store BP Machines Accurate Enough To Base Health Decisions On

It seems these days you can’t walk into a grocery store or a pharmacy without seeing a free blood pressure machine tucked away in a back corner. As kids, we all used to beg our parents to let us give them a try, just because they were fun and free. But many individuals rely on these free machines in order to make critical decision about their health, whether for the convenience, or because the cost of seeing a health professional is just too high. Are drug store and grocery store blood pressure machines reliable enough to bear such a responsibility?
Blood Pressure & How It’s Measured Simply put, blood pressure is a measure of the force of your blood pushing against the walls of your arteries each time your heartbeats. According to WebMD, when your heart contracts and pumps blood through your veins, the pressure exerted on blood vessel walls is called systolic pressure. The pressure on the vessel walls between these heartbeats is called diastolic pressure. A standard, healthy blood pressure of 120/80 mm Hg (millimeter of mercury, a manometric unit of pressure) equates to 120 mm HG systolic pressure and 80 mm HG of diastolic pressure. You’ve no doubt had your blood pressure taken many, many times before – at nearly every visit to the doctor’s office and each trip to the hospital. Typically, a nurse or doctor will wrap a velcro cuff around your upper arm, which is then inflated either electronically or by using a hand pump. The cuff grips your arm tightly as it inflates. Then, the medical professional opens the valve of the cuff and allows the pressure to slowly fall. As soon as the blood pressure machine detects the sound of your blood pulsing, your systolic pressure is recorded. Eventually, the sound of your blood pumping disappears entirely; at which point your diastolic pressure is recorded. At least, that’s how many electronic blood pressure monitors work. Though they have become the norm, some medical practices still utilize manual blood pressure monitors, which measure the actual physical pressure inside the cuff itself. Debating the Accuracy of Free Blood Pressure Monitors Many publications and individuals have investigated the accuracy of drug store and pharmacy blood pressure monitors, with most concluding that their results are to be taken with a grain of salt. According to Mayo Clinic, drug store monitors are “not accurate enough to make health decisions regarding your blood pressure.” They note that, while free blood pressure machines may start off accurate, these machines need regular maintenance and recalibration in order to stay that way. It’s hard to say whether a free blood pressure machine inside a Walgreens or CVS has been properly cared for. Testing and calibration should be done about twice per year, or more if problems arise, but this process often isn’t regulated properly. The blood pressure cuffs on most free machines are often too small, as well. Mayo Clinic notes that the inflatable portion of the cuff should cover at least 80 percent of the upper arm for a proper reading, but free machines are usually outfitted with one-size-fits-all cuffs that don’t adjust to fit individuals. For this reason, free machines may be most accurate for medium sized individuals, and less so for people with very large or very tiny arms. Standard cuffs found on free blood pressure machines are too small for about 37 percent of the population. But what does it all mean? Let’s talk impact. One study from American Family Physician in 2005 noted that an average free blood pressure device classified 23 percent of normal blood pressure individuals as hypertensive, and 16 percent of hypertensive individuals as normal. An informal study done by CBS Pittsburgh tested 10 different machines in Walmart, Kmart, CVS, and others. The study found two of the 10 machines were off by more than 15 points when compared with a simultaneous reading done by a medical professional. Another study done by Good Housekeeping tested a number of pharmacy blood pressure machines in the New Jersey area. Of 22 total readings, they found 10 were off by more than five points when compared to readings taken by a registered nurse practitioner. Alternatives to Free Blood Pressure Machines While blood pressure machines inside drug stores, pharmacies, and grocery stores are convenient and free, and though they may serve as a helpful reference point, it’s imperative to get regular, accurate readings in order to properly make health decisions. The best option is to visit your doctor or another medical health professional in order to get a reading from their industrial grade, properly maintained equipment. Many experts also recommend home and portable blood pressure monitoring systems for a more accurate and relatively inexpensive solution. The Ozeri CardioTech unit, for example, retails for around $59.95 and comes highly recommended via over 600 Amazon reviews. Omron also makes several well-reviewed home blood pressure monitors that retail for about $60. Regardless of how and where you get your blood pressure measured, ensure you’re following best practices for an accurate reading. Many free blood pressure machines in pharmacies do not display these standard guidelines, so be sure to remember them for your next visit: Sit in a chair with your back supported Uncross your legs Keep feet flat on the floor Support your reading arm at heart level Remove your shirt or roll up your sleeve to provide a bare arm Rest for at least 5 minutes before a reading Do not use caffeine or tobacco within 30 minutes of a reading Do not take a blood pressure reading when abnormally stressed For ensured accuracy, take several readings in one sitting, about a minute apart A normal or healthy blood pressure averages about 120/80 mm Hg. Hypertension is defined as any reading higher than 140/90. If you think you may be suffering from high blood pressure, consult a medical professional to develop a treatment plan. Interested in learning more about home and portable medical devices? Read this to learn about whether mobile ultrasound apps and devices can detect deep vein thrombosis. 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Patient Instructions for 24 Hour Blood Pressure Monitor

Your doctor has requested that you undergo Ambulatory Blood Pressure Monitoring (ABPM). ABPM may be done to get a more accurate measurement of your average blood pressure, or because you have different readings in the doctor’s office than at home, or for other reasons. This test has been available for years, and many thousands of patients have undergone this test without difficulty. This is a safe and painless test. You will wear a portable blood pressure monitor on your arm for 24 hours. For your visit, please wear a shirt or blouse with loose fitting sleeves
The blood pressure cuff will be placed on your upper arm under your clothing, directly against the skin. The cuff connects with a rubber tube to the monitor. This is a small box about 3 by 4 inches in size that can be worn over your shoulder with a strap, attached to your belt, or carried in a large pocket in your clothes At night the cuff is kept on, and the monitor is placed next to you in your bed or under your pillow. You will not be able to take a bath or shower while wearing the cuff and you should not plan to do heavy exercise (that is, exercise to the point where you sweat a lot). Otherwise, you should go about your usual daily activities, including work, household tasks, and so on. The monitor will take a reading every 15 minutes during the day, and every 30 minutes at night. While a reading is being taken, the cuff will inflate and squeeze your arm firmly, just as the blood pressure cuffs used in the office or in stores do. While the cuff is inflating and deflating, it is best to try to avoid moving your arm, as this may interfere with the reading. If the monitor has trouble getting a reading, it may re‐inflate in a minute or so to try a second time. We strongly urge you to leave the cuff on for as close to 24 hours as possible. If the cuff is simply too uncomfortable (which is rarely the case), you can remove it by peeling cuff off of your arm. Do not press any of the buttons on the monitor itself. When you return the next day to have the cuff removed, the medical assistant will take off the cuff and you are free to leave.  

Black Americans Are At High Risk of Kidney Disease. Click Picture To Learn What Can Be Done

Black Americans Are At High Risk of Kidney Disease. Click Picture To Learn What Can Be Done
A Black Kidney Transplant Patient Warns Other Members of the Black Community of the Need To Be Aware of Their Increase Risk of Kidney Disease and What They Can Do About It

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Van C. (Dr. Gabriel Valle's patient-kidney-University of Miami, Cathy O. (Dr. Carlos Bejar-Kidney at University of Miami),Will E. (Dr. Ajuria-kidney-Miami Transplant Institute;Bob I. (Dr. Valle's patient, University of Miami-Kidney), Orlando T. (Dr. Valle's patient, University of Miami, kidney), Sara A. (Dr. Valle's patient, kidney, University of Miami),Steve I. (Dr. Jorge Ajuria's patient, kidney, University of Miami),Sandy L. (Dr. Carlos Bejar's patient, kidney, University of Miami),KATHY C. (kidney-University of Miami, patient of Dr. Valle,MARTIN O. (Dr. Valle patient-Heart/Kidney -University of Miami), ROBERT I. (Dr. Valle's patient Kidney at University of Massachusetts), DREW P.(kidney-University of Florida),BILL L. (University of Florida-kidney), BARBARA L. (University of Miami-kidney), FRANCIS L. (kidney at U. of F.), JONATHAN I. (kidney-at U of F), THERESA L. (kidney-pancreas at University of Miami),JEFF T. (kidney at University of Florida), TERESA R. (kidney-University of Miami), JEANNIE O. (kidney-University of Florida), ELOISE O. (Univ of Florida), JOHN E. (kidney-University of Florida), GENE J. (Kidney-University of South Florida), CAL. M. (kidney- Florida Transplant Hospital in Orlando), TERRY A. (Perfect Match! University of Florida-kidney), TIM A.(kidney-University of Miami), GLORIA R. (kidney -University of Miami), BRAD R. (Kidney (and never on dialysis!!)-at University of Miami),(*both Brad and Gloria got kidneys on the same day!!!), BELINDA (kidney-University of Miami), TOM (kidney-University of Miami), JIM E. (Kidney-University of Miami), HERBERT A., (Kidney-University of Miami), Belinda R. (University of Miami-kidney),




South Florida's Top Nephrologists-(Left to Right) Drs. Ajuria, Hernandez, Bejar, and Valle

Living longer by living smarter.

Living longer by living smarter.
find 20 minutes a day to meditate. It reduces stress, lowers blood pressure, and reduces signs of aging.


Click picture to learn what PD is all about from a Nurse Clinical Educator