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Head shot of Dr. Bunt

Guest post by:
Christopher Bunt, M.D.
Family Medicine
MUSC Health Primary Care Ben Sawyer

Primary care is full of uncertainty. A patient comes in with a chief complaint, we ask some questions, perform an exam, maybe order some tests, and then we come up with a possible answer for our patient. It is rare that we are 100 percent certain about a diagnosis. 

It can be frustrating for patients and physicians to have this level of uncertainty. “I don’t know” does not reduce stress in someone’s life, let alone in a doctor’s office. But, that is the nature of most interactions in the health care system.

However, there are some things in primary care, and in this case, all of medicine, that are 100 percent certain.

Here is one three-part certainty that can save a life:

1a. If you smoke tobacco, STOP! 

1b. If you don’t, NEVER START! 

1c. If you are a health care provider who interacts with a patient who smokes, TELL THEM TO STOP!

Yes, behavior change literature says that we should assess whether or not someone is ready for change. But if we as healthcare professionals don’t make a strong statement about the benefits of quitting tobacco, who will? 

You might be thinking, how big of a problem is tobacco? Yes, over the last ten years, the number of smokers in the US has declined, and now sits at 15 percent (36.5 million people) of the population.

However, cigarette smoking remains the leading cause of preventable death in the US, causing over 480,000 deaths (one in every five deaths) per year. Moreover, 16 million Americans live with a smoking related disease.*

Some patients have made the transition to e-cigs, because they are hopeful that they are a healthier alternative.  We don’t have long term data since they are relatively new.  However, we do know that e-cigs contain multiple harmful chemicals, including those that cause cancer.  They are not the ultimate answer, and often just switch one addiction for another.

It is well understood that what doctors recommend matters. Unfortunately, our message can get lost in all of the other issues that we focus on in a primary care visit. 

If we can get our patients to stop smoking, we will save more lives from this success than all of the treatments we recommend to control diabetes, hypertension and high cholesterol, COMBINED!

So, if you are a provider, please give as strong a statement as you can to your patient who smokes that they NEED to quit.

If you are a patient, anticipate that providers will be telling you to stop every single time they interact with you!  Maybe it is frustrating, or even irritating to hear this every visit.  But, aren’t you going to the doctor for answers?  Most of the time, that answer is uncertain.  But not always, and not in this case. 

This certainty will save a life.  Maybe even your own. 

Ready to quit? Ask your primary care provider for help.  We have multiple different strategies that work.  And we are committed to helping you quit!

Need additional help or have questions?  Call the national tobacco cessation quitline, 800-QUIT-NOW.

*CDC Stats: Smoking and Tobacco Use

A new way of rebuilding the breasts of women who have mastectomies is getting good reviews from patients. Shari Frontz, a patient who is also a nurse anesthetist at another hospital, had pre-pectoral reconstruction at MUSC Health. "I think the results look amazing. I’m very happy with the results," she says.

Dr. Ulm and patientInstead of putting the implant under the muscle, the surgeon places it over the muscle. Doctors say it's less painful and gets more natural-looking results than sub-pectoral reconstruction. It can be done immediately after a mastectomy, or, if the woman would prefer to wait, she can have the implants added later.

Pre-pectoral breast reconstruction has only been available in the U.S. for a few years, and it's still only done at select hospitals. MUSC Health is one of the first sites in the state to offer it. Plastic surgeons Kevin Delaney and Jason Ulm specialize in the procedure.

"Basically, it’s an option for almost anyone who is getting a mastectomy," Delaney says. "Most commonly that’s breast cancer, but it's also for women who are getting prophylactic mastectomies, if they have the BRCA gene, for example." BRCA genes raise the risk of breast cancer, and a mastectomy can reduce that risk.Dr. Ulm and Dr. Delaney

Pre-pectoral breast reconstruction is also an option for women who have had sub-pectoral breast reconstruction and are having problems with their implants. Ulm says the procedure can make a dramatic difference. "If everything goes as planned, the feel and shape and the way the breast looks are much improved. Much better."

He says pre-pectoral breast reconstruction is not safe for women who have had radiation because their blood flow is different and they have an increased risk of complications.

Guest Post by:
Stephanie Davey, ATC
Certified Athletic Trainer
MUSC Health Sports Medicine

Good News!  The Cooper River Bridge Run is only six weeks away. So if you’ve started your training, the end is near. If you haven’t started, there is still time! The first thing, after deciding to sign up for the race, is to set a finishing goal. The goal will help you to focus your training to enhance performance and prevent injuries.

If this is your first race and you haven’t been running, your main goal should be finishing. Beginning with a walk/run program will help minimize your injuries and help keep you motivated. Aim to run four to five days per week. Your runs should last 30 to 60 minutes with your longest training run being around five miles. The ratio of walking to running depends on your level of fitness. A good place to start is 1 minute running:1 minute walking. As you progress, increase your running by a minute or two every few runs.runners on the beach

In addition to your training runs, you also need to incorporate cross training, strength training and rest days. Cross training should be a low impact activity such as cycling, swimming or training on an elliptical. Your cross training should last at least an hour. It will help increase your cardiovascular endurance without the additional wear and tear on your body. This will also keep your legs fresher and increase your performance on your runs. Strength training should be a balanced program that incorporates your upper and lower body and your core. Squats, lunges, calf raises, planks and push ups are good exercises to start with. Focus on higher repetitions and lower weight where you can maintain correct form. If you’ve previously done yoga or Pilates, feel free to continue. Both could be used as strength or cross training. Lastly, you should have at least one rest day. Rest days allow your body to heal from the wear of training. If you don’t give your body a chance to heal, you risk an injury. If you feel you need to do something on your rest day, try going for a walk or gently stretching.

Good luck and most importantly "Have Fun!"

Headshot of Dr. Oyer

Guest post by:
Samuel L. Oyer, M.D. 
Specialist in Facial Plastic and Reconstructive Surgery

Facial paralysis is a devastating condition with a wide variety of causes. Although this condition is uncommon, it can profoundly affect a person’s facial function related to vision, nasal breathing, speech, swallowing, and emotional expression. Equally impactful are the effects on a person’s appearance, social interaction, and psychological function which can lead to poor self-esteem, isolation from social activities, and depression. Facial paralysis affects every person differently. Some people recover completely without intervention, others recover partially but are left with troubling impairments, and some have absolutely no recovery. Too often, patients are told that “there’s nothing more that can be done” for their problems or that their amount of recovery is “good enough.”

The goals of treatment of facial paralysis include limiting the symptoms associated with paralysis, improving the functional deficits, and restoring as much facial symmetry as possible to minimize the impact on a person’s quality of life. This in turn improves not only the physical, but also the social, emotional, and psychological aspects of the condition.

The treatment options for facial paralysis are as varied as the many causes of the disorder. These can include medication, physical therapy, injectable treatments such as Botox or filler, and surgery. There is not a simple recipe for treatment because every patient is different, and often a combination of treatments are recommended. Patients who are engaged and actively participate in their own recovery tend to do better, regardless of treatment type, than those who take a more passive role.

While facial paralysis often affects one entire side of the face, much attention is given to restoring a person’s smile. A smile is an integral part of a person’s identity and loss of a smile not only impacts a person’s ability to express emotion, but also impairs how that person is perceived by others. Older treatments focused on fixed suspension of the paralyzed side of the mouth with a sling to improve facial symmetry, but contemporary treatment aims to restore not only the position of the mouth but also movement of the mouth to recreate a smile whenever possible. Depending on the type of paralysis, this is often best achieved by replacing the damaged facial nerve with a different, functional nerve.  

The facial nerve travels from its origin in the brain and exits the skull beneath the ear before passing through the parotid gland and dividing into numerous branches across the face to supply over a dozen muscles on each side. It serves as the power source to the muscles, much like an electrical cord plugged into an outlet. When the facial nerve is damaged and can no longer signal the muscles to move, a different nerve can be used as a power source for the facial muscles like splicing in a new cord from a different outlet. This only works if the attachment between the facial nerve and muscles is intact and is limited to the first one to two years following onset of paralysis. Donor nerves can come from the intact facial nerve on the opposite side of the face or from a nerve normally directed at a jaw or tongue muscle such as the masseteric or hypoglossal nerve. This nerve transfer takes up to six months to begin working after surgery, but can help restore tone to the facial muscles and movement of the natural muscles that create a smile.

If too much time has passed since paralysis or there is no more connection between the facial nerve and muscles, then a different source of movement must be used to recreate a smile. This involves repositioning a different muscle with its nerve supply from adjacent areas in the face or from distant areas in the body. The temporalis muscle is a chewing muscle that connects the lower jaw to the side of the head above the ear. This muscle can be detached from the lower jaw and attached to the corner of the mouth to suspend it. This means that when that person clenches his or her jaw, the muscle tightens and lifts the corner of the mouth in a smile. Another alternative is to transplant a muscle from the inner leg to the face. This muscle connects to the corner of the mouth and is attached to an artery and vein in the neck for blood supply along with a nerve graft to the opposite side of the face or to the masseteric nerve on the same side. After a period of four to six months the nerve attachment will allow movement of the transplanted muscle to create a smile on the paralyzed side.   

Although none of these treatments perfectly restores what has been lost in facial paralysis, each can help improve the dynamic motion of a lost smile and rebalance facial symmetry as part of an overall treatment plan. Additional treatments may be involved to help improve symmetry and function around the nose, eyes and forehead. Each of these is tailored to the specific needs of the individual. With proper treatment, many of the negative impacts of facial paralysis can be improved allowing people affected by this condition to maintain a good quality of life and remain active in their work and social lives.

The humerus makes up the “ball” of the “ball and socket” shoulder joint. A humerus fracture can occur from a fall directly on the shoulder or arm. This injury is common in both the elderly population with low impact falls, as well as the younger population with high impact injuries from activities like mountain biking and riding a motorcycle. A proximal humerus fracture is the most common type of fracture and makes up the third most common fracture in geriatrics.Dr. Eichinger headshot

MUSC shoulder and elbow surgeon Dr. Josef Eichinger explored the controversy on treating the “unreconstructable” proximal humerus fracture at the Southeastern Fracture Symposium this past month. While hemiarthroplasty is an option, Dr. Eichinger discussed that reverse total shoulder arthroplasty is the superior treatment for these severe fractures. With better range of motion and patient outcome scores from multiple studies, the literature confirms that reverse total shoulder is the better option if you are suffering from this type of injury.

The reverse total shoulder replacement reverses the anatomical design of the shoulder, placing the socket on the humerus and the prosthetic ball on the glenoid. This allows for better range of motion without an increased risk of dislocation. Combining this innovative shoulder replacement with a complete anatomical repair of the tuberosities, the MUSC Health Shoulder and Elbow service ensures you and your shoulder receive the best treatment and can get back to your daily life.


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