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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.  

Saturday, June 13, 2015

Juliette Valle, age 13, Dr. Valle's daughter, is Ursula in "The Little Mermaid"





Tuesday, June 2, 2015

What You Need To Know About Peritoneal Dialysis

PERITONEAL DIALYSIS: WHAT YOU NEED TO KNOW Before dialysis was available, total kidney failure meant death. Today, people with kidney failure can live because of treatments such as dialysis and kidney transplant. What is dialysis? Dialysis is a way of cleaning your blood when your kidneys can no longer do the job. It gets rid of your body's wastes, extra salt and water, and helps to control your blood pressure. Are there different types of dialysis? There are two kinds of dialysis. In hemodialysis, blood is pumped out of your body to an artificial kidney machine, and returned to your body by tubes that connect you to the machine. In peritoneal dialysis, the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles. How does peritoneal dialysis work? A soft plastic tube (catheter) is placed in your belly by surgery. A sterile cleansing fluid is put into your belly through this catheter. After the filtering process is finished, the fluid leaves your body through the catheter. There are two kinds of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis (CAPD) Automated Peritoneal Dialysis (APD) The basic treatment is the same for each. However, the number of treatments and the way the treatments are done make each method different. CAPD is "continuous," machine-free and done while you go about your normal activities such as work or school. You do the treatment by placing about two quarts of cleansing fluid into your belly and later draining it. This is done by hooking up a plastic bag of cleansing fluid to the tube in your belly. Raising the plastic bag to shoulder level causes gravity to pull the fluid into your belly. When empty, the plastic bag is removed and thrown away. When an exchange (putting in and taking out the fluid) is finished, the fluid (which now has wastes removed from your blood) is drained from your belly and thrown away. This process usually is done three, four or five times in a 24-hour period while you are awake during normal activities. Each exchange takes about 30 to 40 minutes. Some patients like to do their exchanges at mealtimes and at bedtime. APD differs from CAPD in that a machine (cycler) delivers and then drains the cleansing fluid for you. The treatment usually is done at night while you sleep. What kind of peritoneal dialysis is best? The type of peritoneal dialysis that is best for you depends on your personal choice and your medical condition. Your doctor will help you to choose the one that is best for you. What are the pros and cons about being on peritoneal dialysis? Some doctors feel that CAPD and APD have several benefits when compared to hemodialysis. With continuous dialysis, you can control extra fluid more easily, and this may reduce stress on the heart and blood vessels. You are able to eat more and use fewer medications. You can do more of your daily activities and it is easier to work or travel. However, there are some people for whom peritoneal dialysis may not be appropriate. The abdomen or belly of some people, particularly those who are morbidly obese or those with multiple prior abdominal surgeries, may make peritoneal dialysis treatments difficult or impossible. Peritonitis (infection of abdomen) is an occasional complication although should be infrequent with appropriate precautions. When making a decision about the type of treatment, you should take into consideration that peritoneal dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Peritoneal dialysis is an effective form of dialysis, has been proven to be as good as hemodialysis. Peritoneal dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used. How are treatments paid for? All types of dialysis are expensive, but, for most patients, the federal government now pays 80 percent of all dialysis charges, while private insurance or state medical assistance pays the rest. If you would like more information, please contact us. © 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.

Friday, May 29, 2015

Urine Tests Detects Cancer and Diabetes in Study

By Robert F. Service 28 May 2015 4:00 pm 3 Comments Most of us think of bacteria as the enemy, but each of our bodies harbors trillions of microbes, most of them beneficial or benign. Now, you can add two new friendlies to the list. This week, two groups of synthetic biologists seeking to repurpose living microbes for human benefit report genetically modifying bacteria to detect cancer in mice and diabetes in humans. Clinicians have sought to exploit microbes for more than a century. Beginning in 1891, an American bone surgeon named William Coley injected more than 1000 patients with bacterial colonies in hopes that they would shrink inoperable tumors. The treatment sometimes worked, in part because the microbes preferentially seek out tumor tissue, which is rich in nutrients yet has few immune cells to knock out any pathogens. But the results were uneven, and with the rise of radiation and chemotherapy, the approach fell out of favor. More recently, synthetic biologists have begun to modify bacteria to fight cancer and other diseases—engineering them to secrete toxins inside tumors, for example. A couple of these therapies have even made it into clinical trials, though none have been approved yet. Far less effort has been directed at using bacteria as a test for disease. Sangeeta Bhatia, a biomedical engineer at the Massachusetts Institute of Technology (MIT) in Cambridge, and her colleagues previously worked on cancer detection using metal nanoparticles. In the presence of a tumor, the particles would release snippets of proteins called peptides that could be detected in the urine. Unfortunately, Bhatia says, the signal was often too weak to serve as a clear indicator of disease. Bhatia’s team then realized that bacteria offered a potentially superior option. The researchers knew that microbes with a taste for tumor often penetrate the masses as they grow and replicate. So Bhatia’s group joined up with a team led by Jeff Hasty, a bioengineer at the University of California, San Diego, to reprogram bacteria that could be fed to mice and, in the presence of cancer, would produce a luminescent signal with a simple urine test. They started with a harmless strain of bacteria called Escherichia coli Nissle 1917, which is commonly added to yogurt and other foods as a probiotic to promote digestive health. First, they fed the bacteria to mice and confirmed that the microbes crossed the gut and colonized tumors in the liver. They engineered the bacteria to produce a naturally occurring enzyme called LacZ when they encountered a tumor. Next, the researchers injected mice with compounds that were precursors for light emitters. These were two-part molecules made up of a sugar linked to luciferin, a luminescent molecule. When bound together, the pair doesn’t emit light, but LacZ acts like a pair of scissors that cuts the two apart. So, in mice that had liver cancer populated by E. coli, the LacZ produced by the microbes released the luminescent compound, which was then excreted in the animals’ urine, turning those samples from yellow to red. What's more, Bhatia and her colleagues report in the current issue of Science Translational Medicine this week, while conventional imaging techniques struggle to detect liver tumors smaller than 1 square centimeter, this approach was able to flag tumors as small as 1 square millimeter.
In a separate study also reported in the current issue of Science Translational Medicine, researchers led by structural biochemist Jerome Bonnet of the University of Montpellier in France followed a related strategy to detect a key sign of diabetes, namely elevated glucose in the urine of human patients. The researchers added genetic circuitry to the bacteria so that they produced a large amount of a red fluorescent protein once the concentration of glucose in their surroundings reached a certain level. In this case, however, the team’s strain of E. coli wasn’t injected into people first, rather simply added to urine samples, where they produced a color change. For now, this approach isn’t any better than a standard glucose meter. But because the detection scheme can be repurposed to detect other targets, it could serve as a platform for a broad array of future diagnostics. “They are both nice advances for the field,” says Jim Collins, a synthetic biologist at MIT. But he cautions that both approaches remain years away from being approved for clinical use. Tim Lu, also a synthetic biologist at MIT, agrees. “Taken together this pair of papers demonstrates that synthetic biology will be useful not only for therapeutics but diagnostics as well.” That might just give bacteria a good reputation after all. Posted in Biology, Health in Study

Friday, May 8, 2015

Dr. Gabriel Valle and Dr. Carlos Bejar named Top Doctors In Nephrology for 15th Year in a Row

Congratulations to Dr. Carlos Bejar (left) and Dr. Gabriel Valle for being named "Top Docs" in Nephrology by Castle-Connelly Medical Ltd. which is done by survey of their physician peers and local academic centers on who they would chose if they needed a doctor in that specialty-in this case-Nephrology/Hypertension. They are featured in the May-June issue of both Gold Coast magazine and Boca Life magazine. We are so proud of them! (This is the 15th consecutive nomination for both of them.) — at The Kidney & Hypertension Group.

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