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MUSC Health Blog

Date: Feb 14, 2017
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.


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