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Varicose veins are common presentation in primary care, but knowing who to reassure, who to investigate and who to refer isn't always straightforward. Today we are doing something different- we are going work through five real-world quick-fire cases to highlight practical assessment and management of VV’s. I am joined by Dr Sam Dunn.

Practical clinical pearls:

1. Pregnancy- Treat the symptoms, not the veins.

Compression, movement, avoiding prolonged standing and leg elevation are usually all that’s needed. Reassess 3–6 months postpartum.

2. Examine varicose veins standing up.

They can disappear when the patient lies down. Look for oedema, pigmentation, eczema, lipodermatosclerosis and ulcers—and check the pulses before compression.

3. Compression isn’t automatically benign.

Check arterial circulation first. If pulses are reduced or arterial disease is possible, assess further before prescribing higher-grade compression.

4. Know who needs referral.

Symptoms, oedema, skin changes, ulcers, thrombophlebitis or bleeding mean this is more than a cosmetic problem and warrants referral.

5. A bleeding varicose vein is an emergency waiting to happen.

Lie down, elevate the leg and apply firm pressure. If it doesn’t stop—or starts again—seek urgent medical care. Even when it stops, arrange urgent referral.

Bio:

Dr Sam Dunn. Sam is Medical Director at Palm Clinic and an experienced cosmetic medicine and vein physician. After beginning his career in emergency medicine, Sam has spent almost two decades practising phlebology and cosmetic medicine. He holds Diplomas in Procedural Phlebology, Skin Cancer Medicine and Community Emergency Medicine, and is a Fellow of the New Zealand Society of Cosmetic Medicine.

Resources:

https://www.palmclinic.co.nz/vein-care/what-to-expect

https://www.anzsvs.org.au/patient-information/varicose-veins/

https://medlineplus.gov/varicoseveins.html

Frailty is a common but often under-recognised clinical syndrome that has significant implications for health outcomes in older adults. In this episode, we explore how frailty develops, who is most at risk, and why early identification matters. We discuss practical approaches to assessment in primary care, the consequences of frailty, and evidence-based strategies to help patients maintain function, independence, and quality of life with specific discussions around Te Ao Māori perspective.

Practical clinical pearls:

• Watch for the frailty pattern: unintentional weight loss, reduced activity, fatigue, slowed gait, and falls.
• Use the corridor as part of the consult: gait speed, chair rise, grip strength, and how they move tell you a lot.
• Ask family/whānau for collateral history, because gradual decline is often noticed there first.
• Think multifactorially: frailty is linked to sarcopenia, multimorbidity, polypharmacy, social isolation, nutrition, and environmental barriers.
• Prioritize resistance training and adequate protein intake; those are among the most effective preventive strategies.
• Review medications carefully, especially sedatives, anticholinergics, and overly tight diabetes or blood pressure treatment.
• Use frailty to change decision-making: shift from disease-only management to goals-of-care and whole-person planning.
• Keep care strengths-based and culturally grounded, especially for Māori patients: focus on what matters, what supports them, and what gives them mana.
• Don’t wait until someone is clearly frail; midlife is the right time to start prevention.
• Frailty is not just a label — it’s a signal to act.

Resources:

1. Health Quality & Safety Commission New Zealand. Frailty | Te Wairuhi: Frailty care guides 2023 [Internet]. Wellington: Health Quality & Safety Commission New Zealand; 2023 [cited 2026 Jun 17]. Available from: Frailty | Te Wairuhi: Frailty care guides 2023
2. Healthify. Clinical Frailty Scale [Internet]. Auckland: Healthify He Puna Waiora; [cited 2026 Jun 17]. Available from: Clinical Frailty Scale
3. Gee S, Bullmore I, Cheung G, et al. It's about who they are and what they can do: Māori perspectives on frailty in later life. N Z Med J. 2021;134(1535):17-24. Available from: ResearchGate article

Biography:

Dr Helen Kenealy is a dual-trained General Physician and Geriatrician with extensive experience in the care of older adults. She is currently Chief Clinical and Risk Officer at Metlifecare, where she oversees clinical quality, governance, risk management, health and safety, and digital health innovation across retirement living and aged care services.

Helen is passionate about delivering high-quality care for older adults and supporting people to maintain independence, function, and quality of life as they age. She brings extensive expertise in frailty, healthy ageing, comprehensive geriatric assessment, and the healthcare systems that support older New Zealanders.

Listen here:

https://podcasts.apple.com/nz/podcast/frailty-w-dr-helen-kenealy/id1845748299?i=1000783687000

https://open.spotify.com/episode/5jbMGUOgMGMDTzBONMuOsS?si=6ef1d31419394317

#frailty #CME

We follow Temu a 62y old Maori kaumatua’s journey from his first presentation in primary care through to referral to a head and neck specialist. I'm delighted to be joined by two expert Head and Neck Surgeons from Southern Cross Head and Neck Services. Along the way, we'll discuss the risk factors and changing epidemiology of head and neck cancer, the importance of recognising red flags, appropriate investigation and referral, the value of a neck lump clinic, and the role primary care can play in improving outcomes, for Māori and Pacific peoples. This podcast is eligible for equity CME points.

Practical clinical pearls:

1. A persistent neck lump is cancer until proven otherwise

Any neck lump in an adult that persists for more than three weeks, particularly if it is firm, enlarging, or non-tender, should be considered malignant until proven otherwise. Avoid repeated courses of antibiotics without a clear indication.

2. Head and neck cancer is changing

HPV-related oropharyngeal cancer is increasingly common and often presents as a painless neck lump in younger adults, many without a history of smoking or heavy alcohol use. Do not rely on traditional risk factors to determine who needs investigation.

3. Refer first, investigate in parallel

If you suspect head and neck cancer, make an urgent HSOC/Faster Cancer Treatment referral immediately. If you arrange ultrasound or fine-needle aspiration, do so alongside the referral—never let investigations delay specialist assessment. Avoid open biopsy of a neck lump in primary care.

4. Equity requires proactive follow-up

Māori experience poorer outcomes from head and neck cancer because of later diagnosis and barriers to care. A low threshold for referral, active follow-up of missed appointments, and early involvement of Māori Cancer Navigators can make a meaningful difference.

5. Every HPV vaccination is cancer prevention

The HPV vaccine prevents multiple cancers, including cervical and HPV-related throat cancers. Use every opportunity to recommend vaccination to eligible young people and their whānau. Increasing HPV vaccine coverage is one of the most effective strategies we have to reduce the future burden of head and neck cancer. With Aotearoa aiming for 90% HPV vaccination coverage by 2030, every recommendation from primary care counts.

Resources:

1. Te Aho o Te Kahu (Cancer Control Agency). Optimal Cancer Care Pathways / Faster Cancer Treatment Indicators.
2. Weaver, A., Twine, S., Bather, M., Dowley, A., & Slough, C. M. (2024). Ethnic Disparities for Survival and Mortality in New Zealand Patients With Head and Neck Cancer. JAMA Network Open, 7(6), e2413004.
3. Lucas-Roxburgh, R. A. (2018). Human papillomavirus (HPV) associated oropharyngeal cancer: Case prevalence, diagnosis, and the potential for screening in New Zealand. Massey University.
4. New Zealand Guidelines / HealthPathways. Head and Neck Cancer & High Suspicion of Cancer Criteria.
5. Koh, S. P., et al. (2026). Economic burden of human papillomavirus-related cancers in New Zealand. BMJ Public Health, 4(2), e003800. https://bmjpublichealth.bmj.com/content/4/2/e003800

Bio:

Dr Nick Lilic is a New Zealand-trained Otolaryngologist, Head and Neck Surgeon. Following fellowship training in Edinburgh and a Master of Science from the University of London, he completed advanced fellowship training in Auckland, developing expertise in head and neck oncology, thyroid surgery and complex reconstruction. Nick is a consultant surgeon at Auckland City Hospital, a lecturer at the University of Auckland, and Clinical Director of Southern Cross Head and Neck Services.

Dr John Chaplin is a New Zealand-trained Head and Neck Surgeon with more than 20 years' experience managing thyroid and parathyroid disease, neck lumps and head and neck cancer. Following specialist training, he completed prestigious fellowships in New York and Sydney, gaining expertise in complex head and neck oncology and reconstructive surgery. John is a consultant surgeon at Auckland City Hospital, a founding member of the Australian and New Zealand Head and Neck Society, and a surgeon at Southern Cross Head and Neck Services, where he continues to play a major role in surgical...

Collaborative care is crucial in in under fuelling to prevent further deterioration and can prevent progression to an eating disorder.

Our case:

Marnie is a 22-year-old woman with a two-year history of amenorrhoea. She exercises at high intensity every day, is underweight, and describes that she is lacking her usual zest for life.

She has undergone a thorough medical assessment, and the diagnosis of low energy availability (LEA) has been made with other secondary causes of amenorrhoea excluded. Marnie has already seen a dietitian, engaged a trainer and understood the need to increase her energy intake, reduce her training load, and incorporate regular rest days. Despite understanding the advice, she is struggling to make these changes.

Practical clinical pearls:

1. Engaging in food restriction and high exercise can be a trigger of onset of an ED in vulnerable individuals

2. There can be a gradual transition and progression from under-fuelling and over-exercising for reasons associated with sport goals to an ED which at times can be difficult to differentiate

3. People with REDs display symptoms and traits reminiscent of those seen in people with an ED (cognitive and behavioural rigidity, habit and rule based behaviour, difficulty not engaging in exercise

4. Once an ED has become activated treatment of the ED will need to become priority, i.e., treatment will need to go beyond addressing the physical sequelae of REDs

5. Early intervention is crucial.

Expert bio:

Dr Megan Ogilvie is the Business Director at ERH Associates Subspeciality expertise in menopause, PCOS, athlete hormone health. PMS/PMDD, VSCs and gender-affirming medicine. Megan completed her endocrinology training in Auckland and then undertook a fellowship in London at St Bartholomew's and University College of London Hospitals. Since returning to New Zealand, Megan has worked in both general and reproductive endocrinology at Fertility Associates and at Auckland District Health Board, and now at ERH Associates. Megan has particular reproductive endocrine interests in menopause, polycystic ovarian syndrome, gender-affirming care, as well as athlete hormone health and energy deficiency. Megan was a founding member of WHISPA (a medical advisory board to High Performance Sport New Zealand, now disestablished) and has run training workshops for High Performance Sport NZ in the area of female athlete hormone health. Megan is the New Zealand representative on the board of the Australasian menopause society.

Dr Roger Mysliwiec is an Auckland-based medical specialist with extensive expertise in psychosomatic medicine and eating disorders. Trained in Germany, he has over 35 years of clinical experience across hospital, public sector, and private practice settings. He previously served as Clinical Director of Auckland’s Regional Eating Disorders Service (1999–2014) and has played a key role in developing and strengthening eating disorder services in New Zealand.

His clinical work focuses on assessment and treatment of anorexia nervosa, bulimia nervosa, binge eating disorder, and ARFID, particularly in adults and older adolescents. He integrates evidence-based psychological therapies including CBT, MANTRA, SSCM, and adolescent-focused approaches, alongside neuroscience-informed psychotherapy.

Dr Mysliwiec also provides specialist consultations, medication reviews where appropriate, and multidisciplinary treatment planning. In addition, he is an experienced supervisor and educator, mentoring clinicians and contributing to professional development in eating disorders and mental health across New Zealand and Australia.

Resources:

Australian Institute of Sport. Female Performance & Health Initiative: Education modules [Internet]. Canberra (AU): Australian Sports Commission; [cited 2026 Jun 17]. Available from: https://www.ausport.gov.au/ais/fphi/education. (Australian Sports Commission)

De Souza, M.J., Williams, N.I., Misra, M. et al. 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 1: State of the Science and Introduction of a New Adolescent Model. Sports Med 56, 327–373 (2026). Available from: https://doi.org/10.1007/s40279-025-02333-z

Everett S. Optimizing Performance Nutrition for Adolescent Athletes: A Review of Dietary Needs, Risks, and Practical Strategies. Nutrients. 2025;17(17):2792. doi: https://doi.org/10.3390/nu17172792.

Gallant TL, Ong LF, Wong L, Sparks M, Wilson E, Puglisi JL, Gerriets VA. Low energy availability and relative energy deficiency in sport: a systematic review and meta-analysis. Sports Med. 2025;55(2):325–339. Available from: https://doi.org/10.1007/s40279-024-02130-0

Gould RJ, Ridout AJ, Newton J. Relative energy deficiency in sport (RED-S) in adolescents – a practical review. Int J Sports Med. 2023;44:236–246. Available from: https://doi.org/10.1055/a-1947-3174

Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073–1098. doi: https://doi.org/10.1136/bjsports-2023-106994

Listen here:

https://open.spotify.com/episode/5QdH4aQrAnt5weLop0pTqR?si=3155a7cc6fef4381

https://podcasts.apple.com/nz/podcast/underfueling-early-intervention-w-drs-megan-ogilvie/id1845748299?i=1000777449686

The Weight of the Future: Are We Getting Adolescent Obesity Treatment Right?

Samuel is a 15-year-old European boy who has always been overweight. Over the past year, he’s gained a further eight kilos, and his BMI is now in the obese range. He’s otherwise well and active playing rugby.

His mum comes in with him today. She’s tried reducing food portion size and limiting junk food at home, but with little success. They’re asking what else they can do, and specifically whether a medication like a GLP-1 RA might be an option. They feel they could afford it for about a year to help get him back on track. As the GP, you’re unsure how best to approach this case. What do you think?

Practical clinical pearls:

1. Obesity is common in childhood and adolescence in New Zealand, with Pacific peoples disproportionately affected, followed by Māori. Management should always be approached with an equity and culturally safe lens.
2. Adolescent obesity should be managed as a chronic, lifelong condition rather than a short-term weight-loss problem. Successful treatment usually requires sustained lifestyle change supported by whānau, schools, and healthcare teams.
3. A holistic management plan is essential. Alongside nutritional advice and physical activity, consider psychology input, family-based interventions, group programmes, and addressing sleep, mental health, stigma, and socioeconomic barriers to care.
4. GLP-1 receptor agonists are emerging as an effective option for some adolescents with obesity, but gastrointestinal side effects are common and discontinuation rates remain high. Starting with very low doses and titrating slowly can improve tolerability.
5. Families should understand that stopping GLP-1 receptor agonists commonly leads to significant weight regain, often within a year and sometimes exceeding the original weight lost. Research is ongoing into combining GLP-1 therapy with gut microbiome interventions alongside intensive lifestyle modification, with the hope of improving long-term weight maintenance. Watch this space.

Bio:

Wayne Cutfield is Professor of Paediatric Endocrinology and co-director of the highly successful Gut Bugs Research Programme. He was previously Director of the Liggins Institute and previously Director of a Better Start National Science Challenge. He single handedly established paediatric endocrinology in Auckland which has grown in to a national referral service. His research achievements and leadership in paediatric endocrinology have been widely recognised with the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes Norman Wetenhall Medal for research innovation, the University of Auckland’s Gluckman Medal for outstanding research contribution, the Royal Australasian College of Physicians Child Health Division Howard William’s Medal for clinical leadership and the RACP pinnacle award the College Medal for outstanding impact and leadership in medicine and research. He has published >350 articles in journals that include the New Journal of Medicine, Lancet, BMJ and Nature and has an H Index of 85.

References:

Hashemi, Ladan et al. “Associations between Specific and Cumulative Adverse Childhood Experiences, Childhood Obesity, and Obesogenic Behaviours.” European journal of psychotraumatology 16.1 (2025): 2451480. Web.

Rahimi, Mehdi, Allen Bartley, and Ladan Hashemi. “Childhood Overweight/Obesity amidst Migration, Socioeconomic Factors, and Obesogenic Behaviors: Insights from the Growing Up in New Zealand Study.” Ed. by António Raposo. Advances in Public Health 2023 (2023): 1–10. Web.

Hashemi, Ladan et al. “Associations between Specific and Cumulative Adverse Childhood Experiences, Childhood Obesity, and Obesogenic Behaviours.” European journal of psychotraumatology 16.1 (2025): 2451480. Web.

Listen here:

https://podcasts.apple.com/nz/podcast/the-weight-of-the-future-w-prof-wayne-cutfield/id1845748299?i=1000775543755

https://open.spotify.com/episode/51OZdA07VjFoAAgEIsXhoX?si=158e5ed969174f69

#glp1 #obesitymedicine #universityofauckland

This episode explores burnout in healthcare, its definitions, warning signs, systemic causes, and strategies for prevention. Dr. Louise Kuegler interviews Dr. Jo Prendergast, a psychiatrist and expert on mental health in medicine, to shed light on how clinicians can recognise and address burnout effectively.

Practical pearls:

• Burnout is a system problem, not a personal failure.
• Burnout affects both emotions and the nervous system—both need support.
• Physical symptoms and withdrawal are early warning signs.
• Small recovery moments, like slow breathing, quickly reduce stress.
• Stress spreads through teams; calm and vulnerability do too.
• Leaders set the tone by modelling boundaries and honesty.
• Peer support turns isolation into connection and resilience.

Bio:

Dr Jo Prendergast is a psychiatrist, keynote speaker, author, comedian, and breast cancer survivor. She combines clinical expertise, humour, and lived experience to make mental health conversations engaging and relatable. A graduate of the University of Otago Medical School and a Fellow of the Royal Australian and New Zealand College of Psychiatrists, Jo has worked in mental health services across New Zealand and Australia for more than 30 years.

Jo is the author of When Life Sucks, commissioned by HarperCollins, and an award-winning comedian. She has three solo comedy shows and has toured to international festivals across Australia and the UK. A sought-after keynote speaker and media commentator, Jo regularly appears on television, radio, and podcasts, and is known for making complex topics such as mental health, resilience, and wellbeing both accessible and entertaining. Jo is available for keynote presentations, conferences, corporate events, media interviews, and live performances.

Resources:

Prendergast J. Dr Jo Prendergast [Internet]. Available from: https://drjoprendergast.com/

HarperCollins Australia. When Life Sucks: The Practical and Effective How-To Guide to Parenting Your Teen Through Tough Times [Internet]. Available from: https://harpercollins.com.au/products/9781775541998_when-life-sucks-the-practical-and-effective-how-to-guide-to-parenting-your-teen-through-tough-times-from-an-expert-psychiatrist-and-comedian-for-fans-of-maggie-dent-celia-lashlie-and-nigel-latta

Krebs L, Jung L, Arrich J. Prevention of burnout syndrome in physicians: a systematic review and meta-analysis. Wien Klin Wochenschr. 2026;138(5-6):167-178. doi:10.1007/s00508-025-02601-y.

Tsatiris D. Physician Burnout: How to Rise Above a Broken Healthcare System as a Practicing Clinician. 1st ed. London: Routledge; 2025. doi:10.4324/9781003473923.

Listen here:

https://podcasts.apple.com/nz/podcast/clinician-burnout-w-dr-jo-prendergast/id1845748299?i=1000773646680

https://open.spotify.com/episode/5hlyWpPXYAWbjNSdczRmtz?si=ae8f51c9e81741ee

We’re joined by Wayne Cutfield, a paediatric endocrinologist at Starship Children’s Hospital and Professor at the Liggins Institute. Co leader of gut bugs research team. We explore antibiotic use in children, the impact of antibiotics on the developing microbiome, and practical strategies for clinicians to prescribe appropriately while supporting long-term child health.

Antibiotics are one of medicine’s most important discoveries, dramatically reducing deaths from infectious diseases. However, widespread and sometimes unnecessary use, particularly in children has raised concerns. Emerging evidence suggests antibiotic exposure may be contributing to shifts in the epidemiology of chronic and autoimmune diseases that cannot be explained by population changes alone.

Practical clinical pearls:

1. Antibiotics continue to be overused in infants and young children in New Zealand, although prescribing trends are improving. When antibiotics are needed, choose the narrowest-spectrum antibiotic for the shortest effective duration.
2. Early antibiotic exposure alters the gut microbiome. Observational studies have linked this with higher rates of childhood obesity, allergic disease including asthma and eczema, type 1 diabetes, and even later mental health conditions such as depression and anorexia nervosa.
3. Breastfeeding remains the gold standard for healthy microbiome development. Encourage exclusive breastfeeding for around six months where possible, as this supports immune development and microbial diversity.
4. When infants require formula feeding, consider formulas containing human milk oligosaccharides (HMOs), which may help support a healthier gut microbiome more similar to that seen in breastfed infants.
5. Diet matters once solids are introduced. Encouraging a “rainbow” of fruits and vegetables, alongside lean meats and high-fibre foods, helps promote microbiome diversity. For families in Auckland whose child requires antibiotics, consider referral to Professor Wayne Cutfield’s ongoing clinical trial investigating HMOs versus placebo following antibiotic exposure in early life. See the study link in the podcast bio.

Bio:

Wayne Cutfield is Professor of Paediatric Endocrinology and co-director of the highly successful Gut Bugs Research Programme. He was previously Director of the Liggins Institute and previously Director of a Better Start National Science Challenge. He single handedly established paediatric endocrinology in Auckland which has grown in to a national referral service. His research achievements and leadership in paediatric endocrinology have been widely recognised with the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes Norman Wetenhall Medal for research innovation, the University of Auckland’s Gluckman Medal for outstanding research contribution, the Royal Australasian College of Physicians Child Health Division Howard William’s Medal for clinical leadership and the RACP pinnacle award the College Medal for outstanding impact and leadership in medicine and research. He has published >350 articles in journals that include the New Journal of Medicine, Lancet, BMJ and Nature and has an H Index of 85.

Resources:

Hindson J. Post-antibiotics microbiome restoration driven by diet. Nat Rev Gastroenterol Hepatol. 2025;22:462. doi:10.1038/s41575-025-01090-8.

Lizumi T, Battaglia T, Ruiz V, Perez-Perez GI. Gut microbiome and antibiotics. Arch Med Res. 2017;48(8):727–734. doi:10.1016/j.arcmed.2017.11.004.

Professor Cutfeilds antibiotic study. https://www.auckland.ac.nz/en/liggins/in-the-community/clinical-studies/clinical-studies-babies-children/oak-study.html

Listen here:

Who should receive vitamin D in pregnancy and infancy? We focus on risk identification, prevention strategies, and the clinical recognition of deficiency, including nutritional rickets. Vitamin D deficiency remains an important and preventable issue, particularly in at-risk populations. To explore this topic, we are joined by Professor Ben Wheeler, a Paediatric Endocrinologist and Paediatrician.

Practical clinical pearls:

· Universal infant supplementation works best

Provide vitamin D supplementation to all infants up to 12 months, regardless of feeding method, ethnicity, or perceived sun exposure, as risk-based approaches miss vulnerable babies.

· Maternal vitamin D status shapes infant health

Maternal deficiency during pregnancy directly affects neonatal vitamin D stores and future bone health, making antenatal supplementation an important prevention strategy.

· Sun exposure is not a reliable strategy in infancy

In New Zealand’s high-latitude environment, sun exposure alone is inconsistent and carries skin cancer risks, so daily supplementation is preferred for infants.

· Test selectively, supplement proactively

Routine vitamin D testing is usually unnecessary in asymptomatic women and infants; focus instead on guideline-based supplementation and prevention in at-risk populations.

· Recognise rickets early and act urgently

Consider vitamin D deficiency and nutritional rickets in infants with poor growth, delayed milestones, hypotonia, bone pain, or irritability. Hypocalcaemia and raised ALP are important clues, and suspected rickets requires urgent same-day paediatric discussion and possible hospital admission.

Bio:

Professor Ben Wheeler is a Paediatric Endocrinologist and Paediatrician working for the University of Otago and the Southern District Health Board.

His research focuses on access to and use of new technologies for children and young people affected by diabetes, as well as factors that impact on glycaemic control in diabetes. He also has a research interest in vitamin D and bone health during pregnancy, lactation, and infancy. He has a number of collaborations ongoing in these areas, and usually multiple clinical trials or studies running in these areas at any one time.

Resources:

https://static.info.content.health.nz/docs/health-pros/topics/maternity/national/companion-statement-vitamin-d-sun-exposure-pregnancy-infancy-nz.pdf

https://www.starship.org.nz/guidelines/vitamin-d-deficiency-investigation-and-management/

https://bpac.org.nz/2025/vitamind.aspx

Wheeler, Benjamin J et al. “A Brief History of Nutritional Rickets.” Frontiers in endocrinology (Lausanne) 10 (2019): 795. Web.

Simm, Peter J et al. “Editorial: Childhood Rickets—New Developments in Epidemiology, Prevention, and Treatment.” Frontiers in endocrinology (Lausanne) 11 (2020): 621734. Web.

Listen Here:

https://podcasts.apple.com/nz/podcast/sun-stores-and-supplementation-vitamin-d-in-pregnancy/id1845748299?i=1000769448088

https://open.spotify.com/episode/6UiuK9TgKYFg8A3xXNIwN3?si=8f5ae56c48f9434a

Dr Louise Kuegler and Dr Sid Ogra explore the assessment and management of eyelid lesions in primary care. They discuss a clinical case of a 67y female with a non healing lesion on the eyelid. Unpacking how to distinguish benign from malignant lesions, highlight key red flags such as non-healing or changing lesions, and emphasise the importance of early recognition and timely referral. The conversation covers common conditions including actinic keratosis, basal cell carcinoma and melanoma, along with practical strategies such as thorough history-taking, clinical intuition, and the use of photography for monitoring. Preventive approaches, including sun protection and awareness of risk factors, are also discussed to support better patient outcomes.

Practical clinical pearls:

• Most eyelid lesions are benign (however as they are in a functional place, if large may still need to be removed)
• Malignant lesions are usually treatable if caught early
• Red flags to watch for: Loss of eyelashes (Number one by far). Non-healing areas of skin or styes that after 3/12 have not resolved as expected- this could be sebaceous cell carcinoma. Bleeding and ulceration.
• If uncertain of diagnosis→ refer early

Speaker Bio:

Dr Sid Ogra, MBChB, FRANZCO

Specialist in Oculoplastics (eyelid and tear duct disorders) – adults and children

Specialist in cataract surgery, including premium lenses and refractive correction

Dr Sid Ogra is a well-established ophthalmologist with subspecialty expertise in oculoplastics and a busy cataract surgery practice. He provides care across Auckland and Queenstown, seeing both adult and paediatric patients.

Sid graduated with distinction from the University of Auckland and completed his ophthalmology training across Auckland, Rotorua and Wellington. He then undertook an Oculoplastic Fellowship in Hereford, UK (2019), further refining his surgical skills in eyelid and tear duct disorders.

He has also completed observerships at the Byers Eye Institute at Stanford (USA) and Samsung Medical Centre in Seoul (South Korea), gaining additional international experience in advanced ophthalmic care.

Sid is committed to a collaborative approach, working closely with patients to ensure they are well informed about their condition and treatment options, and supporting shared decision-making to achieve the best possible outcomes.

Resources:

Bernardini, Francesco P. Management of malignant and benign eyelid lesions. Current Opinion in Ophthalmology 17(5):p 480-484, October 2006. | DOI: 10.1097/01.icu.0000243022.20499.90

Sun, M. T., Huang, S., Huilgol, S. C., & Selva, D. (2019). Eyelid lesions in general practice. Australian Journal of General Practice, 48(8), 509–514. https://search.informit.org/doi/10.3316/informit.554448397575586

Listen Here:

Are GLP-1 receptor agonists putting your patients’ eye health at risk? Here’s what you need to know.

GLP-1 receptor agonists are revolutionising diabetes management, offering significant weight loss and cardiovascular benefits. However, there is a potential link to eye disease, particularly in those with pre-existing conditions.

Recent studies suggest that while these medications improve overall health, they may cause a temporary worsening of diabetic retinopathy due to rapid improvements in blood glucose levels. This is important for primary care, as patients need appropriate assessment and counselling before starting treatment.

Before prescribing, ensure a recent retinal screening has been completed, especially for higher-risk patients. Close monitoring in the first few months is essential to detect any early complications.

Practical clinical pearls:

Rapid weight loss can worsen diabetic retinopathy.

Start low, go slow, and monitor the retina in diabetic patients.

Ensure retinal screening has been completed within the last 12 months before starting treatment.

If retinopathy is present, initiate cautiously and arrange closer ophthalmology follow-up.

Advise all patients to seek urgent review if they develop any visual symptoms.

Ocular complications are rare in non diabetics, but important to recognise early.

Report any suspected adverse events to Medsafe to support ongoing safety monitoring.

Guest bio:

Assoc Prof Rachael Niederer PhD, MBChB, FRANZCO

Ophthalmologist | Uveitis and Medical Retina Specialist

Rachael attended Auckland University Medical School from 1997–2002 and won the highly prized Sir William McKenzie Award for Early Excellence in Eye Research.

She completed her PhD on corneal nerves and keratoconus in 2008 and was awarded the Vice Chancellor’s Best Doctoral Thesis award.

Rachael completed her ophthalmology vocational training in both Auckland and Hamilton and, in the RANZCO final examination, achieved a gold Howsam Medal for the highest marks in Australia and New Zealand.

She completed her fellowship at Moorfields Eye Hospital in London, specialising in uveitis and medical retina. In 2016, she was appointed Senior Medical Ophthalmologist at Greenlane Hospital and, in the same year, was the RANZCO college representative for Auckland ophthalmology trainees.

In 2019, Rachael was appointed Senior Lecturer at the University of Auckland, Department of Ophthalmology.

In late 2025, she was promoted to Associate Professor at the University of Auckland, recognising her ongoing contributions to ophthalmology, education, and research.

Rachael’s research interests are extensive and include more than 140 publications in international journals and over 60 presentations at New Zealand and international conferences. She is an investigator in the Zoster Eye Disease Study and has a particular interest in uveitis and the epidemiology of eye disease.

She is also committed to reducing inequalities in access to eye care within the community.

Resources:

MedSafe NZ Pharmacovigilance - https://medsafe.govt.nz/

American Diabetes Association Screening Guidelines - https://diabetes.org/diabetes/medication-management/retinal-screening

Green Lane Eye Clinic - https://aucklandeye.co.nz/

Rachael Niederer - Auckland Eye - https://www.aucklandeye.co.nz/specialist/assoc-prof-rachael-niederer/

GLP-1 Receptor Agonists Overview - NICE - https://www.nice.org.uk/guidance/ta543

Listen Here:

#GLP1 #EyeHealth #DiabetesCare

What if that red, painful breast isn’t an infection — and antibiotics aren’t needed?

Mastitis is now seen as a spectrum, often inflammatory rather than infective. Treating it as routine infection risks overprescribing and missing early, effective care.

Talking to Lactation medicine physician Dr Yvonne Le Fort we unpack the case of Kim, a well 26-year-old female, three months postpartum with a tender, erythematous breast, we cover:

When mastitis is inflammatory vs infective

What early management should prioritise

When antibiotics are actually needed

Red flags and when to escalate

Practical clinical pearls:

• Mastitis is a spectrum — it may be inflammatory and is not always due to infection.
• Initial management of lactational mastitis- includes pain relief, reducing breast oedema, and addressing hyperlactation.
• Milk culture – consider if symptoms persist despite antibiotics, or if mastitis is recurrent or prolonged.
• Antibiotics – not all cases need them. Use only for systemic symptoms or if no improvement after 24–48 hours. First-line: Flucloxacillin. If penicillin allergy: Clindamycin
• Breast abscess or mass – refer urgently for imaging ± surgical drainage.
• Non-lactational mastitis – usually infective; requires antibiotics and close follow-up. Refer early if cancer suspected.
• Inflammatory breast cancer can mimic mastitis — maintain a high index of suspicion.

Guest bio:

Dr Yvonne LeFort, a family medicine doctor trained in Canada, has practised breastfeeding medicine for over 20 years and runs a private breastfeeding clinic on Auckland’s North Shore.

She is a dual Fellow of RNZCGP and CCFP (Canada), an IBCLC, and a Fellow of the Academy of Breastfeeding Medicine (ABM). She serves on the board of the New Zealand Breastfeeding Alliance (NZBAA), supporting evidence-based breastfeeding education for all medical and health care colleagues.

Currently, she is a professional advisor to La Leche League New Zealand, a member of NZLCA, and the founder of a Breastfeeding Medicine RNZCGP Peer Review Group.

Yvonne has recently completed a Post Graduate Diploma in Digital Health from Otago University.

She has provided both formal and informal education for IBCLCs and medical colleagues, helping to upskill healthcare workers with the knowledge needed to provide best-practice care when consulting with breastfeeding dyads. She has presented nationally and internationally on a wide variety of topics.

Yvonne is the first author of the ABM’s Position Statement on Ankyloglossia and Breastfeeding Dyads (2021), a contributor to New Zealand Aotearoa National Guidance for the Assessment, Diagnosis and Surgical Treatment of Tongue-Tie in Breastfeeding Neonates, and a co-author of Complications and Misdiagnoses Associated with Infant Frenotomy: Results of a Healthcare Professional Survey (International Breastfeeding Journal, 2022), along with several other clinical protocols.

Resources:

https://www.redwhale.co.uk/content/the-mastitis-spectrum

https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

https://www.tewhatuora.govt.nz/for-the-health-sector/specific-life-stage-health-information/maternal-health/breastfeeding/breastfeeding-problems/mastitis-and-breast-abscesses/

https://tewhatakura.nz/guidelines

Listen here:

https://podcasts.apple.com/nz/podcast/mastitis-spectrum-in-the-lactating-indivdual-w-dr/id1845748299?i=1000760964999

https://open.spotify.com/episode/3hf6RuGQvdDZtpBbTaq1xt?si=919166e299a94d8c

Hyperbaric oxygen therapy (HBOT) which is used across a wide range of acute and chronic conditions, but for most clinicians, it remains something of a mystery outside of diving-related emergencies.

In this episode, we explore what HBOT is, how it works, and when it’s indicated. Using a clinical case as a starting point, we discuss the approved uses, contraindications, practicalities, and emerging areas of interest — including concussion and long COVID-19 infection.

Practical clinical pearls:

1. HBOT has well-defined, evidence-based indications, and referrals should be made only to accredited facilities.
2. For decompression illness and arterial gas embolism, air or gas embolism, carbon monoxide poisoning, sudden acute hearing loss consider referring urgently for hyperbaric assessment.
3. Confirm the facility’s accreditation and safety protocols before referring.
4. Discuss suitability with a hyperbaric service early if in doubt.
5. Be cautious about non-accredited “wellness” HBOT clinics promoting unproven benefits. Do no harm.

Guest bio:

Simon Mitchell is an anaesthesiologist at Auckland City Hospital, a diving physician at North Shore Hospital, and Professor of Anaesthesiology at the University of Auckland.

He is widely published, with two books and over 170 scientific papers or chapters, including co-authorship of the 5th edition of Diving and Subaquatic Medicine and the Hyperbaric and Diving Medicine chapters in the last four editions of Harrison’s Principles of Internal Medicine.

Simon has twice served as Vice President of the Undersea and Hyperbaric Medicine Society (USA) and received the Behnke Award for scientific contributions to diving medicine in 2010. Since 2019, he has been Editor-in-Chief of the Diving and Hyperbaric Medicine Journal.

Outside of medicine, Simon has had a long career in sport, scientific, commercial, and military diving. He has participated in exploratory wreck and cave diving expeditions worldwide and in 2002 performed what was then the deepest dive to a shipwreck. In 2023, he was part of the Wet Mules expedition to the Pearse Resurgence in New Zealand, where a 230 m hydrogen dive was conducted — the first of its kind in over 30 years. He is a Fellow of the Explorers’ Club of New York and was named Rolex Diver of the Year in 2015.

Resources:

·Undersea and Hyperbaric Medical Society. HBO Indications [Internet]. Available from: https://www.uhms.org/resources/featured-resources/hbo-indications.html

·National Center for Biotechnology Information (NCBI). Hyperbaric Oxygen Therapy: Patient Selection [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499820/

·UpToDate. Hyperbaric Oxygen Therapy [Internet]. Available from: https://www.uptodate.com/contents/hyperbaric-oxygen-therapy#H19

·U.S. Food and Drug Administration (FDA). Hyperbaric Oxygen Therapy: Get the Facts [Internet]. Available from: https://www.fda.gov/consumers/consumer-updates/hyperbaric-oxygen-therapy-get-facts

·National Center for Biotechnology Information (NCBI). Hyperbaric Medicine Overview for Wound Healing [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459172/

·Mitchell SJ. Decompression illness: a comprehensive overview. Diving Hyperb Med. 2024 Mar 31;54(1 Suppl):1–53. doi: 10.28920/dhm54.1.suppl.1-53. PMID: 38537300; PMCID: PMC11168797.

Please see local healthpathway for regional advice.

Email me:

thespecialistgp@outlook.co.nz

Listen here:

Apple : https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299

Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg

What if the rough, scaly patch you freeze in clinic today is just the visible part of widespread sun damage? Treating only what you can see may mean missing the bigger risk.

We explore how recognising and treating the entire sun-damaged area reducing progression to squamous cell carcinoma and improve long-term outcomes.

I’m joined by dermatologist and Mohs surgeon Dr Chin-Yun Lin, who shares practical, primary care–focused guidance on choosing and using field therapies for actinic keratoses.

Using the case of Simon, a 55-year-old builder with significant sun exposure and multiple lesions on his face and hands, we discuss:

1. What “field treatment” really means in everyday general practice
2. When to move beyond spot cryotherapy and treat the whole area of sun damage
3. How to choose between topical 5-fluorouracil, imiquimod, and photodynamic therapy
4. Preparing patients for treatment reactions and improving adherence
5. When to refer and when you can confidently manage in primary care

This episode is full of practical tips to help you manage sun-damaged skin more effectively and reduce your patients’ long-term skin cancer risk.

Practical clinical pearls :

1. Patient Education is Key: Reinforce sun protection, ongoing self-examination, and adherence.Explain that AKs are precancerous, not benign warts—early treatment reduces risk of SCC.
2. Preparation of the Skin Improves Efficacy: Gentle debridement, keratolytic creams (urea or salicylic acid), or low-potency retinoids before topical therapy can enhance penetration and response.
3. Field Treatment is Often Preferable for Multiple Lesions: When you see multiple AKs or “field cancerization,” topical therapies (like 5-fluorouracil, imiquimod, or diclofenac) can treat visible and subclinical lesions simultaneously.Pick therapy based on patient tolerance, adherence, and skin location.
4. Treatment Selection Depends on Lesion and Patient Factors:5-FU: aggressive but effective, may cause intense inflammation—good for thicker or widespread AKs. Imiquimod: immune-stimulating, good for thinner AKs or for patients who prefer intermittent dosing. Photodynamic therapy (PDT): alternative if topical therapy fails or not tolerated.
5. Monitor for Flare or Incomplete Response: Mild irritation is expected, but severe inflammation, erosion, or ulceration may require pausing treatment. Non-responding lesions should be reevaluated for biopsy, as persistent AK may hide squamous cell carcinoma (SCC).
6. Refer to a dermatologist: if the diagnosis is unclear, or if the lesion requires expert excision or specialized management.

Resources:

https://www.rnzcgp.org.nz/events/ongoing-events/gp-dermatology-course/

https://dermnetnz.org/topics/actinic-keratosis

https://dermnetnz.org/cme/lesions/topical-treatment-of-photodamage

https://dermnetnz.org/topics/5-fluorouracil-cream

https://dermnetnz.org/topics/imiquimod

Guest bio:

Dr Chin-Yun Lin is a Dermatologist and accredited Mohs micrographic surgeon. His specialty interests include the treatment of skin cancer, melanoma, dermatitis, psoriasis, acne, pigmentary disorders, and cosmetic dermatology.

After graduating as Dux of Macleans College in Auckland, he went on to complete his undergraduate medical degree with first-class honours at the University of New South Wales in Australia.

He undertook Dermatology advanced training at tertiary teaching hospitals in Auckland, Hamilton, and Christchurch. Further Dermatology training and a Mohs surgical fellowship were undertaken at St Vincent's Hospital and the Skin Hospital in Sydney. He is also a Fellow of the American College of Mohs surgery.

Dr Lin has won various Dermatology awards such as the Trans-Tasman Scholarship for best registrar presentation at the New Zealand Dermatological Society Annual Conference, and the best poster presentation at the Australasian College of Dermatologists Annual Scientific Meeting.

Dr Lin also takes interest in clinical teaching and research. He is a registered education provider for the RNZCGP. He has published several papers in peer-reviewed journals, and presented at international conferences such as the World Congress of Dermoscopy. He has written a practical course for GP’s on dermatology- link in resources.

Dr Lin has also served on the reviewers’ panel for the Australasian Journal of Dermatology.

Email me:

thespecialistgp@outlook.co.nz

Listen here:

Apple : https://podcasts.apple.com/nz/podcast/field-treatments-in-sun-damaged-skin-w-dr-chin-yun-lin/id1845748299?i=1000755425551

Spotify: https://open.spotify.com/episode/3CPztsA04YtvzodwM7s2AI?si=c3ed7ee2635f4f83

Do we really hear our patients? Or just listen long enough to respond? In today’s fast-paced clinics, true listening is often the first casualty. Yet it’s far more than courtesy: it’s a clinical tool that builds trust, uncovers what matters most, improves outcomes, and even protects clinicians from burnout.

I talk with Maureen Bisognano, President Emerita at the Institute for Healthcare Improvement and global leader in healthcare quality. We explore how curiosity and “proximate listening” can transform patient care, what telehealth teaches us about paying attention, and leadership strategies to create a culture that truly listens.

We also share Bill’s story- a 90-year-old patient whose case shows how listening can be the difference between misdiagnosis and the right care.

Listening isn’t optional—it’s essential.

Practical clinical pearls:

• Start with “what matters.” Asking “What would make a good day for you?” or “What’s most important for you today?” often reveals the patient’s real priorities and builds trust quickly.
• Use open-ended questions wisely. Replace “Do you have any questions?” with “What questions or concerns do you have?” it affirms curiosity and doesn’t add much time.
• Sit when you can. Even a moment sitting down makes patients feel heard and cared for, and increases satisfaction.
• Let design help you. Face the patient while typing, use an AI scribe, reduce noise or distractions where possible, small environmental shifts signal attention.
• Empower through listening. Ask colleagues “What do you think?” or “If you were in my chair, what would you change?” to invite practical solutions and strengthen teamwork.
• Foster resilience by sharing stories. Creating moments to eat together, debrief, or reflect with peers reduces burnout and builds a culture of support.

Guest bio:

Maureen Bisognano, President Emerita and Senior Fellow, Institute for Healthcare Improvement (IHI), previously served as IHI’s President and CEO for five years, after serving as Executive Vice President and COO for 15 years. She is a prominent authority on improving health care systems, whose expertise has been recognized by her elected membership to the National Academy of Medicine (IOM), among other distinctions. Ms. Bisognano advises health care leaders around the world, is a frequent speaker at major health care conferences on quality improvement and is a tireless advocate for change. She is an Instructor at the Harvard School of Public Health. She chaired the Advisory Board of the Well Being Trust, co-chairs the Massachusetts Coalition for Serious Illness Care with Dr. Atul Gawande, and serves on the boards of the Commonwealth Fund, Indiana University Health and Nursing Now. Prior to joining IHI, she served as CEO of the Massachusetts Respiratory Hospital and Senior Vice President of The Juran Institute.

Resources:

Berry LL, Bisognano M, Twum-Danso NAY, Awdish RLA. The Value — and the Values — of Listening. Mayo Clin Proc. 2025;100(9):1482-1486. doi:10.1016/j.mayocp.2025.06.002

Abrahams R, Groysberg B. How to Become a Better Listener. Harv Bus Rev. 2021 Dec 21. Available from: https://hbr.org/2021/12/how-to-become-a-better-listener

Email me:

thespecialistgp@outlook.co.nz

Listen here:

Apple : https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299

Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg

How comfortable are you managing Mary? She’s 45, fit, still having regular periods, but struggling with poor sleep, anxiety and irritability. Is this stress or the start of perimenopause?

Dr Louise Kuegler talks with reproductive endocrinologist Dr Megan Ogilvie about the early, often missed phase of the menopausal transition. Long before cycles become irregular, fluctuating hormones can drive mood change, worsening PMS and PMDD, migraines, joint pain and sleep disturbance, leaving many women feeling unlike themselves.

We explore why perimenopause is a time of heightened mood vulnerability, who is most at risk, and how to recognise symptoms that do not fit the classic teaching.

The discussion moves into practical, primary care management, including when to consider SSRIs, the combined oral contraceptive pill, menopausal hormone therapy, or cycle suppression, and how to navigate the growing interest in natural therapies safely and realistically.

A clinically grounded, myth busting conversation designed to help you spot perimenopause earlier and treat with confidence.

Practical clinical pearls:

Early symptoms: Mood changes may precede menstrual changes; affect ~25% of women. Symptoms can mimic cardiology or rheumatology presentations.

Alternative preparations: Have a limited role; use with caution and be aware of potential interactions.

Combined oral contraceptive pill: Can provide both symptom control and contraception.

Menopause Hormone Treatment: Use initially as a cyclical trial, then consider moving to continuous therapy after 6–12 months. Annual review once stabilised. Always consider ongoing contraception needs. Investigate abnormal PV bleeding.

Consider newer agents and cycle suppression for PMS/PMDD: Seek specialist input if needed.

Guest bio:

Dr MEGAN OGILVIE Business Director at ERH Associates Subspeciality expertise in menopause, PCOS, athlete hormone health. PMS/PMDD, VSCs and gender-affirming medicine. Megan completed her endocrinology training in Auckland and then undertook a fellowship in London at St Bartholomew's and University College of London Hospitals. Since returning to New Zealand, Megan has worked in both general and reproductive endocrinology at Fertility Associates and at Auckland District Health Board, and now at ERH Associates. Megan has particular reproductive endocrine interests in menopause, polycystic ovarian syndrome, gender-affirming care, as well as athlete hormone health and energy deficiency. Megan was a founding member of WHISPA (a medical advisory board to High Performance Sport New Zealand, now disestablished) and has run training workshops for High Performance Sport NZ in the area of female athlete hormone health. Megan is the New Zealand representative on the board of the Australasian menopause society.

Resources:

https://www.menopause.org.au/images/stories/education/docs/AMS_Diagnosing_Menopause_Symptom_Score.pdf

https://www.menopause.org.au/hp/information-sheets/perimenopause

Magraith K, Stuckey B, Baber R. Perimenopausal Hormone Therapy Assessment and Prescribing. Medicine Today. 2022 August (23):61-67

Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. J Womens Health (Larchmt). 2019 Feb;28(2):117-134.

Faculty or Sexual and Reproductive Healthcare. FSRH Guideline for women aged over 40 years. Contraception for Women aged over 40 years. FSRH Clinical Effectiveness Unit; 2017(Amended 2025. (To download: https://www.fsrh.org/standards-and-guidance/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/)

Email me:

thespecialistgp@outlook.co.nz

Listen Here:

Apple: https://podcasts.apple.com/nz/podcast/the-specialist-gp/id1845748299

Spotify: https://open.spotify.com/show/3485r5V7iF251QH9dpnC1i?si=356c46bdbbf44219

Dr. Louise Kuegler and Dr. Sid Ogra discuss the clinical presentation, implications, and management of hooded eyelids. They explore the functional and cosmetic concerns associated with this condition, emphasising the importance of proper assessment and referral pathways. Dr. Ogra shares insights on the surgical options available, the criteria for referral, and the long-term outcomes and patient satisfaction associated with eyelid surgery. The conversation highlights the often-overlooked functional component of hooded eyelids and the need for primary care physicians to recognise and address these issues.

Practical clinical pearls:

Ask about function, not just appearance. Patients may present for cosmetic reasons, but targeted questions about visual fields, eye strain, or difficulty with reading/driving often reveal functional impairment.

(Function is more commonly impaired than you think and most patients with this issue present for functional reasons)

Use simple examination tools. A visual field test, photographs, or even observing brow elevation can help demonstrate functional impact in primary care before referral.

(All important markers of functional impact are easy to diagnose without special equipment)

Document carefully. Insurers and specialists often require evidence of functional impact (e.g., reduced visual fields, visual obstruction) — clear notes and photos can strengthen a referral.

Blepharoplasty has evidence-based benefits. Beyond cosmesis, studies show improvement in visual fields and patient-reported outcomes — it can be both functionally effective and cost-effective when appropriately indicated.

Know your referral pathways. Many specialties perform this surgery, but referral for functional assessment should occur when there is any concern about impairment or underlying eye pathology.

Guest bio:

Dr Sid Ogra. MBChB, FRANZCO. Specialist in eyelid and tear duct disorders (Oculoplastics) – in adults and children. Specialist in Cataract surgery including premium lenses and correction options:

• Oculoplastic Fellowship, Hereford, UK 2019
• Observerships in Stanford (USA), and Seoul (South Korea)

Sid is a well-established adult and paediatric eyelid specialist and also has a busy cataract surgery practice. He is also servicing Queenstown as well as most regions in Auckland.

After graduating medical school (with distinction) in Auckland, Sid knew that Ophthalmology was the right fit for him. He completed his Ophthalmology training in Auckland, Rotorua, and Wellington, and was able to travel to the UK to further refine his skills in Oculoplastic surgery. Further experience followed at the prestigious Byers Eye Institute in Stanford, USA, as well as Samsung Medical Centre in Seoul, South Korea.

He has a strong belief that doctors and patients must work together as a team to achieve the best results. This means empowering his patients with all the relevant knowledge, discussing the options, and coming to a decision together regarding the best fit for them.

Resources:

Domela Nieuwenhuis, I., Luong, K. P., Vissers, L. C. M., Hummelink, S., Slijper, H. P., & Ulrich, D. J. O. (2022). Assessment of Patient Satisfaction With Appearance, Psychological Well-being, and Aging Appraisal After Upper Blepharoplasty: A Multicenter Prospective Cohort Study. Aesthetic Surgery Journal, 42(4), 340–348. https://doi.org/10.1093/asj/sjab389

An, S. H., Jin, S. W., Kwon, Y. H., Ryu, W. Y., Jeong, W. J., & Ahn, H. B. (2016).

Effects of upper lid blepharoplasty on visual quality in patients with lash ptosis and dermatochalasis. International Journal of Ophthalmology, 9(9), 1320–1324. https://doi.org/10.18240/ijo.2016.09.15

Email me:

thespecialistgp@outlook.co.nz

Listen Here:

Apple: https://podcasts.apple.com/nz/podcast/hooded-eyelids-w-dr-sig-ogra/id1845748299?i=1000747579880

Or wherever you get your podcasts.

#HoodedEyelids #Dermatochalasis #FunctionalEyelids #Ophthalmology #OculoplasticSurgery #Blepharoplasty

Decompression illness, an umbrella term that includes decompression sickness and arterial gas embolism which may occur after diving, aviation, and spaceflight. with Professor Simon Mitchell we explore what happens in the body during these conditions, the key risk factors, and how they can present with sometimes subtle and nonspecific symptoms. Simon discusses how to recognise and assess those who may have decompression illness, the role of investigations, and the principles of treatment including recompression and hyperbaric oxygen therapy. We also cover who to call, what to expect in the management pathway, and clinical pearls for primary care and emergency clinicians.

Practical clinical pearls:

Decompression illness is an umbrella term covering decompression sickness and arterial gas embolism occurring after diving, aviation, and even spaceflight.

Symptoms most commonly present immediately or with in the first hour of resurfacing.

Sick divers need urgent assessment including a thorough neuro examination.

First aid includes 100% oxygen, Non-steroidal anti-inflammatories and IV fluids and consider recompression.

Talk to a friend at the NZ Emergency diving services by calling 0800 433 711- they will advise next steps including the need for evacuation to a hyperbaric oxygen chamber.

If diving overseas consider joining DAN- Divers alert network, use their insurance and call them if you run in to trouble USA +19196849111

Guest bio: Simon Mitchell is an anaesthesiologist at Auckland City Hospital, a diving physician at North Shore Hospital (Auckland), and Professor of Anaesthesiology at the University of Auckland.

He is widely published, with two books and over 170 scientific papers or chapters, including co-authorship of the 5th edition of Diving and Subaquatic Medicine and the Hyperbaric and Diving Medicine chapters in the last four editions of Harrison’s Principles of Internal Medicine.

Simon has twice served as Vice President of the Undersea and Hyperbaric Medicine Society (USA) and received the Behnke Award for scientific contributions to diving medicine in 2010. Since 2019, he has been Editor-in-Chief of the Diving and Hyperbaric Medicine Journal.

Outside of medicine, Simon has had a long career in sport, scientific, commercial, and military diving. He has participated in exploratory wreck and cave diving expeditions worldwide and in 2002 performed what was then the deepest dive to a shipwreck. In 2023, he was part of the Wet Mules expedition to the Pearse Resurgence in New Zealand, where a 230 m hydrogen dive was conducted — the first of its kind in over 30 years. He is a Fellow of the Explorers’ Club of New York and was named Rolex Diver of the Year in 2015.

Resources:

Mitchell, Simon J, Michael H Bennett, and Richard E Moon. “Decompression Sickness and Arterial Gas Embolism.” Ed. by C. Corey Hardin. The New England journal of medicine 386.13 (2022): 1254–1264. Web.

Mitchell, Simon J et al. “Pre-Hospital Management of Decompression Illness: Expert Review of Key Principles and Controversies.” Diving and hyperbaric medicine 48.1 (2018): 45–55. Web.

https://www.nzunderwater.co.nz/emergency

https://dan.org/

Local healthpathways.

Email me:

thespecialistgp@outlook.co.nz

Listen Here:

Apple: https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299

What does it mean to be a Specialist GP — and why does it matter?

In this episode, I’m joined by Dr Samantha Murton, Fellow of the Royal New Zealand College of General Practitioners (FRNZCGP). Together, we unpack what Fellowship really represents, why the title Specialist GP is so important, and how it sets us apart from general registrants or other health professionals.

We talk about the training pathway, the value of the title, and how recognition translates into patient trust and safer care. Sam also explores the international perspective — why family physicians in the UK are paid on par with hospital specialists — and asks why New Zealand still lags behind.

This conversation is a call to action: for GPs to proudly use their specialist title, for patients to understand its importance, and for all of us to advocate for recognition and pay parity in primary care.

In this episode we cover

• What FRNZCGP means and why it matters
• Why the title “Specialist GP” makes a difference
• The importance of distinguishing Specialist GPs from other health professionals
• The training pathway and what it represents
• How recognition impacts patient care and trust
• International comparisons: the UK vs New Zealand
• Why advocacy is crucial for the future of General Practice
• What we can each do to support the cause

Email me

• thespecialistgp@outlook.co.nz

Listen Here:

• Apple: https://podcasts.apple.com/nz/podcast/specialist-gp-why-recognition-matters-w-dr-samantha-murton/id1845748299?i=1000743708878
• Spotify: https://open.spotify.com/episode/1955idYIvAmXOyO9tuSMC2?si=QqgAmS_VSjGeGP_LedYnrQ

Dr. Louise Kuegler discusses the rising prevalence of oral tobacco and nicotine products, particularly among youth in New Zealand, with Dr. Jude Ball. They explore the differences between oral tobacco and nicotine products, their usage patterns, safety concerns, and the implications for public health. The conversation also touches on the role of these products in smoking cessation, regulatory challenges, and the need for further research in this area.

In this episode we cover:

1. Who is using oral nicotine products
2. Safety and harms
3. The role of oral nicotine in smoking cessation
4. A case discussion
5. Policy, advocacy, and guidance
6. Looking forward

Practical clinical pearls:

1. Know what’s out there – pouches and lozenges are on the rise.
2. Ask routinely – patients may use them alongside smoking or vaping.
3. Safer ≠ safe – risks include nicotine dependence, oral disease, and cardiovascular harm.
4. Evidence is limited – they don’t outperform proven NRT.
5. Advocate – clinicians and parents should push back against normalisation of nicotine and call for strong regulation.

Guest bio:

Dr Jude Ball is a senior research fellow affiliated to the ASPIRE Aotearoa tobacco control research centre University of Otago, HePPRU, and the Adolescent Health Research Group (the team behind the Youth 2000 survey series). She joined the Department in November 2014 with a background in critical psychology, health promotion and applied research. She completed a PhD in 2019 exploring the drivers of long-term trends in adolescent risk behaviour, in particular smoking, cannabis use, binge drinking and sexual behaviour. Her research focuses on the impact of the changing social context on youth trends, and the inter-relationships between smoking and other risk behaviours in young people. Alcohol and drug harm and mental health promotion are also areas of research interest.

Resources:

https://www.phcc.org.nz/briefing/oral-tobacco-and-nicotine-products-quitting-aid-or-teen-addiction-risk

https://www.phcc.org.nz/briefing/oral-nicotine-products-expanding-nicotine-marketplace

https://www.phcc.org.nz/briefing/can-oral-tobacco-and-nicotine-products-help-people-stop-smoking

https://www.phcc.org.nz/briefing/nicotine-pouches-and-young-people-evidence-aotearoa-new-zealand

https://vapefreekidsnz.org/

https://www.asthmafoundation.org.nz/resources/quit-vaping-reference-guide

Email me:

thespecialistgp@outlook.co.nz

Listen Here:

Apple: https://podcasts.apple.com/nz/podcast/oral-tobacco-and-nicotine-products-in-aotearoa-nz-w/id1845748299?i=1000742210847

Spotify: https://open.spotify.com/episode/2oubyAdg31qly39OtvfGLV?si=3YdIDBoJSDeZq7XhCP6rXg

Suicide continues to be a major public health issue in Aotearoa New Zealand, touching every clinician working in primary care. General Practice is often the first, and sometimes only, point of contact before a suicide attempt — meaning GPs are uniquely placed to identify risk, provide support, and intervene early.

In this episode of The Specialist GP, host Dr Louise Kuegler speaks with Dr Cheryl Buhay about the latest suicide data, key risk and protective factors, and effective management strategies. Together, they discuss how primary care teams can safely assess and manage suicide risk, when to escalate concerns, and how to look after themselves and colleagues affected by suicide.

The conversation also explores the importance of clinician wellbeing, collaboration with specialist services, and building confidence in these difficult but crucial consultations.

Key Discussion Points

• Current suicide data and inequities across age, gender, and ethnicity
• The most common risk factors and protective factors in suicide prevention
• How to conduct a safe, empathic, and thorough risk assessment
• When and how to involve specialist mental health services
• Support options for clinicians following patient suicide or distressing events

Practical Clinical Pearls

1. Risk assessment runs parallel to diagnosis – consider both static and dynamic risk factors across social, mental, and physical domains.

2. Maintain a high index of suspicion – approach with empathy, curiosity, and non-judgement.

3. Don’t overlook broader risks – such as poor self-care, child safety, or physical health deterioration.

4. Watch for paradoxical calm – a patient who suddenly appears serene after deep distress may be at increased risk.

5. Use the team – involve nursing, community, and peer supports early.

6. Seek help when unsure – contact local mental health triage or crisis services for immediate consultation.

Clinician Wellbeing

Caring for someone at risk of suicide can be emotionally demanding. GPs are encouraged to access support through:

• EAP programmes (RNZCGP, MAS, MPS)
• Skylight Trust – 0800 299 100 | www.skylight.org.nz
• Aoake te Rā – free counselling for people bereaved by suicide | 0800 000 053 | www.aoaketera.org.nz
• After a Suicide NZ – www.afterasuicide.nz

Email: thespecialistgp@outlook.co.nz

Website: https://www.thespecialistgp.co.nz/

Dr Louise Kuegler and Professor Ian Reid explore osteopenia—what it means, why it matters, and how it fits into fracture prevention. Drawing on the latest evidence, including Prof Ian Reid’s and Prof Mark Bolland's work, we discuss diagnosis, lifestyle strategies, treatment thresholds, and patient-centred approaches to protect bone health and prevent future fractures. An update for Zolendronate use is also discussed especially in the context of osteopenia.

In this episode we cover:

• Definition of osteopenia and its prevalence
• Risk factors and the role of exercise in bone health
• Assessing fracture risk
• Management strategies for osteopenia
• The importance and role of Menopause Hormone Therapy
• Recent advances in Zolendronate's role in Osteopenia and Osteoporosis
• Addressing osteopenia in men

Practical clinical pearls:

1. Aim for a BMI >20 to protect long-term bone health. Educate adolescents and young adult women that being underweight increases lifetime fracture risk.
2. Screen by fracture risk, not osteoporosis alone. Start with a risk calculator such as FRAX or Garvan; use DEXA only to refine risk when the calculated risk is moderate or uncertain.
3. Zoledronate is effective across age groups and bone density ranges. Evidence supports use both preventively in women in their 50s and therapeutically in women ≥65, including those who are osteopenic. Dosing frequency should follow study protocols (e.g., every 18 months in older women; every 5–10 years in preventive regimens).
4. Vitamin D has a role in those at risk of deficiency. Particularly useful for people in rest homes, those with dark skin, or those living in low-sunlight regions (e.g., South Island).
5. Avoid calcium supplements—prioritise dietary sources. Supplements offer minimal benefit for bone density or fracture prevention and carry risks (kidney stones, constipation, potential cardiovascular effects). A balanced diet that maintains a healthy BMI (>20) is preferred.

Resources:

Reid, Ian R, and Michael R McClung. “Osteopenia: A Key Target for Fracture Prevention.” The lancet. Diabetes & endocrinology 12.11 (2024): 856–864. Web.

 Reid, Ian R, and Michael R McClung. “Osteopenia: A Key Target for Fracture Prevention.” The lancet. Diabetes & endocrinology 12.11 (2024): 856–864. Web.

 Bolland, Mark J et al. “Fracture Prevention with Infrequent Zoledronate in Women 50 to 60 Years of Age.” The New England journal of medicine 392.3 (2025): 239–248. Web.

 https://osteoporosis.org.nz/wp-content/uploads/2024/09/ONZ-2017-Guidance-for-New-Zealand.pdf

Email me:

thespecialistgp@outlook.co.nz

Listen here:

Apple: https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299

Spotify: https://open.spotify.com/show/3485r5V7iF251QH9dpnC1i?si=qQ2CUMa-SRSWMfha2HRjXA

What are the realities of sexting and porn exposure among young people — what’s normal, what’s harmful, and how clinicians can respond with empathy and insight. To help unpack this, Dr Louise Kuegler is joined by Dr Claire Meehan, Senior Lecturer in Criminology at the University of Auckland. Through a real case, we discuss what happens when intimate images are shared without consent, and how to guide conversations that move beyond shame and fear toward trust, consent, and safety.

In this episode we cover:

• How common sexting is among teenagers, and why many view it as normal or positive

• What happens when images are shared without consent — and how to respond clinically

• The role of gender, double standards, and victim-blaming

• How pornography shapes expectations and behaviour

• What parents, teachers, and clinicians can do to help young people navigate digital consent

Practical Clinical Pearls:

• Normalise the conversation — sexting and porn exposure are common; avoid shame.

• Reframe risk, don’t moralise — talk about consent, trust, and relationships rather than “don’t do it.”

• Encourage rapid disclosure — reassure teens they won’t be punished for speaking up.

• Address gender and power — challenge double standards and affirm that harm lies in the breach of consent.

• Promote healthy alternatives — guide young people toward credible, age-appropriate sexual health education.

Dr Claire Meehan is a Senior Lecturer in Criminology in the Faculty of Arts at the University of Auckland. Her research focuses on how young people navigate digital technology, sexuality, and consent — including their understandings of pornography and the sharing of intimate images. She holds a PhD in Criminology from the University of Ulster and postgraduate degrees from Queen’s University Belfast. Claire is the author of The Politics of Porn for Young People in New Zealand and the forthcoming Young People and Sexual Consent in the Digital Age.

Resources:

Meehan C. ‘They’re Much Too Young’: The Entanglement of Porn, Pleasure and Age in Sex Education. J Sex Res. 2025 Jul;62(6):1028-36.

Meehan C. Talking with Girls about Porn. In: Mazzarella SR, editor. The Routledge Companion to Girls’ Studies. Abingdon: Taylor & Francis; 2024. p. 375-86.

Meehan C, Wicks E. Consent Isn’t Just a Girl’s Thing: Gender, Consent and Image Based Sexual Abuse. In: James-Hawkins L, Ryan-Flood R, editors. Consent: Gender, Power and Subjectivity. Milton (or London) : Taylor & Francis; 2023 Nov. p. 197-209.

https://netsafe.org.nz/ Netsafe NZ, helping NZ to be safe online

https://stopncii.org/ Stop Non- consensual intimate image abuse. StopNCII.org introduces innovative technology that is used by tech and industry companies to protect people from the sharing of their intimate images online.

https://takeitdown.ncmec.org/ This service is one step you can take to help remove online nude, partially nude, or sexually explicit photos and videos taken before you were 18.

What does kindness really look like in healthcare leadership — and why does it matter? In this episode of The Specialist GP, Dr Louise Kuegler chats with Dr Nicki Macklin about how visible, consistent acts of kindness can reshape culture, improve staff wellbeing, and strengthen relationships across clinical teams. They discuss the misconception that kindness is “soft,” and why it actually supports accountability and safer decision-making. You’ll hear practical ways leaders can embed kindness into systems so patients, teams, and organisations all benefit.

In this episode, we cover

1. The difference between empathy, compassion, and actionable kindness
2. How leaders can embed kindness into systems and culture
3. Real-life examples of kindness driving lasting change in healthcare settings

Practical Clinical Pearls

1. Empathy and compassion are vital, but kindness is what turns good intentions into real change.
2. Kindness isn’t just a feeling, it’s an action, small, deliberate, and visible.
3. Tiny acts of kindness, done consistently, build trust and reshape workplace culture.
4. Kindness doesn’t make leaders weak, it makes them credible and strong.
5. For kindness to last, it must be built into systems, not just left to individuals.
6. Patients benefit also when leadership is kind. Patients engage, they are safer and have better health incomes.

Email me

1. thespecialistgp@outlook.co.nz

Visit our website

1. https://www.thespecialistgp.co.nz/

Episode Overview 

 Welcome to the first episode of The Specialist GP! I’m Dr Louise Kuegler — Specialist GP and medical educator — and in this episode, I introduce the podcast: a space where real listener-submitted clinical cases are explored with expert guests, turning them into practical, evidence-based guidance you can apply straight away in your consulting room. Each episode is designed to leave you with clear, actionable clinical pearls that make a real difference in your practice. 

 In This Episode We Cover 

• How the podcast works: sourcing real cases from listeners. 
• Partnering with expert guests to build practical management plans. 
• How episodes are CME-eligible and include an equity-focused lens. 
• A preview of upcoming cases this season, including osteopenia, risk assessment, gut health, and more. 

 Practical Clinical Pearls 

• Real cases make learning directly applicable to your daily practice. 
• Expert insights help you build robust, evidence-based management plans. 
• Episodes are clear, concise, and immediately useful for busy clinicians. 
• CME points can be logged, including under the equity-focused domain. 

Listen here:

• Apple : https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299
• Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg

Contact me:

https://www.thespecialistgp.co.nz/