Miami VA Healthcare System

Medical Service

Program Mission

The Miami VA Healthcare System's Medical Service will be a leader, through education and research, in the delivery of effective quality care.

Program Description

All staff physicians are members of the faculty of the University of Miami School of Medicine. Comprehensive medical care is offered on both the inpatient wards and ambulatory clinics of the Medical Center. Medical Service physicians provide both primary care and highly specialized subspecialty care to our Veteran patients.

Medical Services Provided

The Miami VA Healthcare System Medical Service encompasses all facets of internal medicine. It is composed of the following sections:

• Cardiology
• Critical Care
• Endocrinology Diabetes and Metabolism
• Gastroenterology
• Hematology/Oncology
• Hepatology
• Infectious Diseases
• Nephrology
• Neurology
• Pulmonary Diseases
• Rheumatology

Research and Education

Two other major activities of the service are teaching and research. Training is provided to University of Miami medical students at the second (143), third (152), and fourth (149) year levels, to 144 internal medicine residents, and to 100 post-doctoral subspecialty fellows. Medical Service physicians are actively involved in both basic and clinical biomedical research.

All staff physicians are members of the faculty of the University of Miami School of Medicine. Comprehensive medical care is offered on both the inpatient wards and ambulatory clinics of the Bruce W. Carter VA Medical Center. Medical Service physicians provide both primary care and highly specialized subspecialty care to our Veteran patients.

Cardiology 

Mission

The board-certified cardiologist and staff of the Cardiovascular Disease Section at the Miami VA Healthcare System provides our Veterans and Service members with personalized, timely, high-quality, evidence based and cost-effective cardiovascular care using the latest technology. We provide in hospital and outpatient cardiovascular care, risk stratification, imaging and other diagnostic procedures, and interventions for complex cardiovascular disease.

Services Provided

Presently, the following services are offered at the Bruce W. Carter VA Medical Center:

• General adult cardiology
• Interventional cardiology including one of the few structural heart disease programs in the VISN
• Electrophysiology
• Advanced cardiac imaging are cardiology subspecialties that are offered
• Heart failure

We provide general cardiology and echocardiography services at the William "Bill" Kling VA Clinic. Veteran’s requiring more advanced cardiovascular services are brought to the Bruce W. Carter VA Medical Center.

The following is a list of the more commonly performed tests and procedures. If the test for which you are interested is not listed, or if you have any questions that you need answered, our staff is always available to assist you.

Some of the conditions we treat:

• Acute coronary syndromes (heart attacks or unstable coronary artery disease)
• Stable coronary artery disease and angina
• Arrythmias
• Atril fibrillation
• Atrial flutter
• Bradycardia
• Supraventricular Tachycardias (SVT)
• Non-Sustained and Sustained Ventricular Tachycardias
• Prevention of Sudden Cardiac Death in at risk patients
• Palpitations
• Syncope (passing out)
• Hypertension (high blood pressure)
• Hyperlipidemia (high cholesterol)
• Pericardial diseases
• Heart failure - systolic and/or diastolic
• Ischemic, dilated and restrictive cardiomyopathies
• Cardiac sarcoid
• Cardiac amyloid
• Non-compaction cardiomyopathy
• Valve diseases (aortic, mitral, tricuspid, pulmonic valve disorders)
• Endocarditis
• Patent Foreman Ovale (PFO) and other Atrial Septal Defects (ASD)

Diagnostic Cardiovascular Studies

• Transthoracic echocardiography
• Transesophageal echocardiography
• Electrocardiography
• 24 hr to two week heart monitoring services
• Loop recorder implants
• Technetium (Tc99) and Thallium Myocardial imaging
• Tc99-Pyrophosphate imaging (PYP) scan to assist with diagnosis of cardiac amyloidosis
• Cardiac CT for calcium scoring and Cardiac CT angiography
• Cardiac MRI for more advanced cardiovascular disease
• Right and left heart cardiac catheterizations

Therapeutic Interventions

• Percutaneous coronary interventions – balloon angioplasty, stenting
• Transcatheter Aortic Valve Replacement (TAVR)
• PFO/ASD closures
• Electrophysiology studies
• Atrial fibrillation and flutter ablations
• Pacemaker and implantable cardioverter - defibrillator implantation including the MICRA pacemakers
• Advanced heart failure therapies including home inotropes and referrals to National VA transplant centers and/or several local partners for left ventricular assist devices and heart transplantations

Critical Care Medicine

Mission

The mission of the Section of Critical Care Medicine is to provide excellence in clinical medical intensive care, critical care research and education.

Program Description

The patient care responsibilities of the section are for the Medical Intensive Care Unit/Intermediate Intensive Care Unit and the Respiratory Therapy Unit.

Intensive Care Units
The intensive care units provide expert, coordinated multidisciplinary care to critically ill medical, cardiac and post-operative patients. In addition to conventional intensive care practice, the section offers advanced ventilator and dialytic therapies as well as approved investigational treatments for a variety of severe conditions.

 

Endocrinology Diabetes and Metabolism

The Miami VA Healthcare System offers comprehensive, expert care for all endocrine conditions. Endocrine disorders affect your hormones, which control many different functions throughout your body.

Our experts determine the cause of your symptoms and develop a customized treatment plan that offers you the best possible results. You receive personalized attention and the latest approaches from a team with endocrinology expertise.

From advanced diagnostic testing, specialized care in the hospital, and a full range of outpatient services designed for your convenience, the Endocrinology Section at the Miami VA Healthcare System offers complete care, both in person and virtually through the VA’s Video on Demand Platform.

Conditions Treated

• Adrenal Gland Conditions
• Calcium and Bone Mineral Problems
• Diabetes
• Endocrine Cancers
• Hyperparathyroidism (Primary)
• Hyperparathyroidism (Secondary)
• Obesity
• Osteoporosis
• Pituitary Disorders
• Polycystic Ovarian Syndrome (PCOS)
• Thyroid Disorders

Gastroenterology

The Gastroenterology team at the VA Miami Health System includes doctors who are highly skilled experts in preventing, diagnosing, and treating digestive disorders. This includes diseases of the gastrointestinal (GI) tract, gallbladder, bile duct and pancreas.

Our experts are committed to delivering the latest, proven diagnostic techniques and treatments to our patients. During your appointment, you and your doctor will discuss the best treatment for you based on your age, the severity of your condition, and your tolerance of specific medications and procedures.  You receive personalized attention and the latest approaches from a team with gastroenterology expertise.

From advanced diagnostic testing, specialized care in the hospital, and a full range of outpatient services designed for your convenience, the Gastroenterology Section at the Miami VA Healthcare System offers complete care, both in person and virtually through the VA’s Video on Demand Platform.

Conditions Treated

• Abdominal Bloating
• Abdominal Pain
• Appendicitis
• Barrett’s Esophagus
• Bile duct stones and disease
• Celiac Disease
• Change in Bowel Habits
• Cholangitis
• Colonoscopy
• Constipation
• Crohn’s Disease
• Diarrhea
• Diverticulosis and Diverticulitis
• Early Satiety
• Gallstones
• Gastritis
• Gastroesophageal Reflux Disease (GERD)
• Gastroparesis
• Heartburn
• Hemorrhoids
• Indigestion
• Irritable Bowel Syndrome (IBS)
• Lactose Intolerance
• Pancreatitis
• Peptic Ulcers
• Stomach Flu (Viral Gastroenteritis)
• Ulcerative Colitis

Hematology/Oncology

The Hematology/Oncology Department at the Miami VA Healthcare System is dedicated to providing our Veterans and Service members with the highest quality care. We offer outpatient chemotherapy at our dedicated cancer center.  Our team consists of physicians, nurse practioners, physician assistants, pharmacists, social services providers.

Services Provided

We work closely with other services at the Medical Center to provide comprehensive care to our veterans with malignant and benign hematology and cancer including chemotherapy, radiation oncology, interventional radiology, general surgery, full diagnostic imaging (including PET scans), palliative care and pathology to provide individualized treatment plans for each patient.

Integrative cancer care:

• Assist patients and families understand their diagnosis
• Coordinate longitudinal care including treatment and surveillance
• Chemotherapy Pharmacist
• Dedicated Dietician and Nutritional counseling
• Supportive care and symptom management
• Chemotherapy administration at infusion center

Therapeutic procedures:

• Chemotherapy
• Immunotherapy
• Phlebotomy
• IVIG infusions
• Iron Infusions

Hepatology

The Division of Hepatology at Bruce W. Carter VA Medical Center in Miami Florida is committed to delivering comprehensive, patient-centered liver care to our veterans. We provide diagnosis, prevention and treatment of liver disease and strive to meet future challenges through research, education and innovation.

Patient Care

Veterans are cared for by hepatologists (liver specialists) who specialize in liver disorders including viral hepatitis, fatty liver, alcoholic liver disease, autoimmune liver disease, metabolic liver diseases and liver cancer.

General Hepatology clinic

As a part of your care, liver specialists at the Bruce W. Carter VA Medical Center work with a team of specialists from many areas of medicine, as part of our whole-person approach to tailor your treatment to your individual needs.

Hepatologists provide management and treatment for many conditions, such as:

Alcoholic hepatitis	Cystic liver disorder	Hepatocellular carcinoma
Alcoholic liver disease	Drug induced liver injury	Hepatopulmonary syndrome
Alpha-1-antitrypsin deficiency	Esophageal varices	Liver tumors (benign or malignant)
Ascites	Fatty liver	Nonalcoholic fatty liver
Autoimmune hepatitis	Hemochromatosis	Nonalcoholic steatohepatitis
Biliary duct strictures	Hepatic encephalopathy	Primary biliary cholangitis
Budd-Chiari syndrome	Hepatitis A	Primary sclerosing cholangitis
Cholangiocarcinoma (bile duct cancer)	Hepatitis B	Sclerosing cholangitis
Cirrhosis	Hepatitis C	Wilson’s disease

Tests and procedures

Additionally, we offer several endoscopic and diagnostic services, for example:

1. Diagnostic and therapeutic endoscopy including biliary stents, banding of esophageal varices and endoscopic treatment of gastrointestinal bleeding.
2. Vibration Control Transient Elastography (VTCE) also known as FibroScan, a non-invasive way of measuring liver steatosis and fibrosis.

Liver Transplant Clinic

Our staff includes board-certified transplant hepatologists who are specifically trained and experienced in providing medical evaluation and consultation for veterans with acute or chronic liver failure, as well as evaluation services for pre-transplant care and management of post-transplant needs.

Liver Tumor Clinic

Our Liver Tumor Clinic cares for patients with both primary and metastatic tumors. This unique program combines the expertise of various departments to offer timely, innovative, and compassionate care to veterans affected by these liver tumors. 

Infectious Diseases

The staff of the Infectious Disease section at the Miami VA Healthcare System provides our Veterans and Service members with the highest quality, most cost-effective health care services available.

The Infectious Disease section of the Medical Service provides clinical and epidemiological expertise for dealing with virtually any infectious disease problem that may be encountered, be it a urinary tract infection caused by E. coli – or an epidemic due to SARS CoV-2, both in the inpatient wards and the outpatient clinics.  It carries out these activities by direct involvement in the management of individual patients, or indirectly as consultants, advisors, and educators.

Education is an integral component of the Section’s activities.  Much of it is carried out at the bedside on the inpatient consultative service and in the ID Clinic, but also through lectures, conferences, and other modalities.  The Section is a key site of training for Infectious Diseases fellows, Internal Medicine residents, Podiatry residents, medical students, and pharmacy students. Lastly, all members of the Section are involved in research in areas of their personal interest and expertise.

Specific Activities

• Inpatient consultations
• E-consultations
• Outpatient consultation and care via in-person visits, video visits and telephone visits:

• Diagnosis and management of suspected or known infectious diseases.
• HIV diagnosis and management
• Pre-exposure prophylaxis (PreP) for veterans with high risk for acquiring HIV infection
• Supervision and monitoring of veterans receiving intravenous anti-infective therapy at home
• Travel medicine
• Screening for Sexually Transmitted Infections (STI)

Nephrology

The Miami VA Healthcare System offers comprehensive, expert care for all nephrology conditions. Nephrology includes the care and treatment of patients with acute or chronic kidney disease and renal replacement therapies (Dialysis and kidney transplant). The kidney and hypertension specialists at the Miami VAMC treat patients with common and rare kidney disorders in an environment that fosters collaboration and innovation in diagnosis and treatment. Our specialists work together in a coordinated team environment to provide innovative and compassionate clinical care.

Our experts determine the cause of your symptoms and develop a customized treatment plan that offers you the best possible results. You receive personalized attention and the latest approaches from a team with nephrology expertise.

From advanced diagnostic testing, specialized care in the hospital, and a full range of outpatient services designed for your convenience, the Nephrology Section at the Miami VA Healthcare System offers complete care, both in person and virtually.

Conditions Treated

• Acute kidney injury
• Chronic kidney disease
  • Renal replacement therapies (Dialysis)
• Glomerular conditions
• Tubulointerstitial kidney diseases
• Hypertension
• Kidney transplantation (referral and management after transplant)
• Autoimmune conditions involving the kidneys
• Electrolyte, fluid and acid-base imbalances or disturbances

Neurology

The Neurology team at the Miami VA Healthcare System is comprised of a group of board-certified Neurologists who are highly skilled in the diagnosis and management of complex neurological conditions. Our physicians are committed to providing excellent clinical care by developing a customized treatment plan tailored to each patient.

Our Neurology experts deliver highly specialized and comprehensive treatment to patients with a multitude of neurological complaints in both the inpatient and outpatient settings. Sub-specialty expertise is available in the fields of Epilepsy, Movement Disorders, Multiple sclerosis, Neuro-immunology, Sleep disorders, Stroke, and Neuromuscular Diseases including Amyotrophic Lateral Sclerosis.

The Miami VA Hospital is a Primary Stroke Center. The facility is also recognized as an Epilepsy Center of Excellence with an active EEG lab and Epilepsy Monitoring Unit and has a fully certified sleep center by the American Academy of Sleep Medicine. All members of the Neurology team are actively engaged in teaching by affiliation with the University of Miami Neurology Resident and Fellowship programs.

The Neurology department provides advanced diagnostic testing, comprehensive in-patient neurological care, and a full range of specialized outpatient services. Appointments are available both in person and virtually through the VA’s Video on Demand Platform with the aim of providing optimal care at your convenience.

Conditions Treated

• Alzheimer’s Disease
• Amyotrophic Lateral Sclerosis (ALS)
• Cluster headache
• Dementia
• Diabetic Neuropathy
• Dystonia
• Epilepsy
• Essential Tremor
• Guillain-Barre Syndrome (GBS)
• Headache
• Idiopathic Intracranial Hypertension (IIH)
• Lewy body Dementia
• Migraine
• Multiple Sclerosis
• Myasthenia Gravis
• Myopathy
• Neuropathy
• Neuro-myelitis Optica (NMO)
• Narcolepsy
• Obstructive sleep apnea (OSA)
• Parkinson’s Disease
• Psychogenic non-epileptic seizures (PNES)
• REM Sleep behavior disorder
• Restless Leg Syndrome
• Stroke
• Sleep Disorders
• Transient Ischemic Attack (TIA)
• Tremor

Rheumatology

The staff of the Rheumatology Section at the Miami VA Healthcare System is dedicated to providing our Veterans and Servicemembers with the highest quality, most cost-effective and evidence-based health care services available.

Rheumatology care, in person visits, telemedicine, infusions and intra-articular therapies are offered at the Bruce W. Carter VA Medical Center. The following is a list of the more commonly treated conditions and procedures. If the condition you are interested having evaluated is not listed, or if you have any questions that you need answered, our staff is always available to assist you.

Rheumatic Conditions

• Rheumatoid Arthritis
• Systemic Lupus erythematosus.
• Gout and other crystal induced arthritides
• Psoriatic arthritis
• Ankylosing spondylitis
• Reactive arthritis
• Arthritis associated with inflammatory bowel disease
• Systemic sclerosis
• Sjogren’s syndrome
• Raynaud’s
• Myositis
• Vasculitis
• Polymyalgia rheumatica
• Giant cell arteritis
• Osteoarthritis
• Osteoporosis
• Paget’s disease of bone
• Sarcoidosis

Therapeutic Procedures

• Intra-articular joint injections
• Carpal tunnel injections

Infusion Center

The Bruce W. Carter VA Medical Center has a full-service infusion center, staffed by experienced nurses in the administration of chemotherapy and biologic drugs.