Farewell to Mike East

This month we sadly say goodbye to one of our most treasured colleagues and a founding member of Oxford Women’s Health, Michael East.

From this month, Mike will no longer be working in Christchurch but will be doing some part-time work in Auckland before he eventually retires. After 43 years of working in Obstetrics and Gynaecology in Canterbury, he will be sorely missed by his colleagues and patients but says it is time to see and do some other things in life while he is fit and able. Sailing and spending time on his family’s lifestyle block are top of mind right now but new sights and experiences are also beckoning.

When asked for highlights from his career, he said he simply loved coming to work everyday. “It has been an immense privilege to have been allowed into the lives of so many people, especially when I am now seeing the second and sometimes third generations of some families.”

“Emotionally, I believe O and G to be one of the most rewarding of specialties.”

He said the awe of witnessing and assisting at the birth of a baby, which first inspired him to become an Obstetrician and Gynaecologist, has never left him. “It is just such a privilege and I knew instantly that I wanted to be part of that.”

He particularly enjoyed the collegiality of working with General Practitioners in obstetrics. “They knew their patients and their families so well. It was very special to have them providing that continuity of care.”

Mike said since the early 1980s when he began his career, Obstetrics and Gynaecology have been transformed by medical advancements. “When I started, we were still using cat gut for sutures and diagnostics were very limited. There was certainly no advanced laparoscopic surgery.”

To ensure his career has remained challenging, Mike has always been interested in understanding and using the latest technology from laparoscopy to robotics. He was at the forefront of developing and introducing new advanced laparoscopic techniques to New Zealand and was one of the first gynaecologists in the country to use robotics.

He says he will be watching advancements in this technology with interest, predicting that over time there will be greater robotic autonomy in surgical procedures. 

Dr Mike East

In 1996, Mike, fellow O & G specialists Mike Laney and John Doig; Colorectal Surgeon Richard Perry and General Surgeon Paul Fogarty; and businesswoman Sue Suckling set up the Oxford Clinic, the forerunner to Oxford Women’s Health. After the Christchurch earthquakes and significant damage to the Oxford Clinic building, Mike became one of the founders of Forté Health where Oxford Women’s Health is now based in Christchurch.

“One of the main reasons for setting up Oxford Clinic was to provide laparoscopic surgery for endometriosis and we were the first group to do comprehensive resection of the disease locally,” he said. “Back then, it was quite a unique thing for New Zealand to have a surgeon owned and operated hospital. In other private hospitals, you were always lobbying to get the equipment you needed but at Oxford Clinic we had much more control over our environment. It triggered the opening of similar clinics in other parts of the country.”

“I have always liked to challenge the status quo and if possible find better ways of doing things. Seeing that transform into improved quality of care and outcomes for patients has been very gratifying.”

Mike said he wanted to thank everyone who had put their trust in him to care for them, especially those who had trusted him to perform their surgery. “It has been a responsibility that I have always taken seriously and never lightly or for granted.”

With Oxford Women’s Health now having  “24 consultants in a strong multi-disciplinary team, and a wonderfully dedicated nursing team”, he said he knows his South Island patients will be well cared for. 

“Together this special team provides ‘Centre of Excellence’ care, and I know that will continue well into the future.”

Study uses canine superpower for early ovarian cancer diagnosis

Every 48 hours a woman in New Zealand dies of ovarian cancer, most often because the disease was detected too late.

It’s a statistic that Pauline Blomfield of K9 Medical Detection has set her heart on turning around, with the help of her team of highly trained dogs and the clinical expertise that she has gathered around her. Among her supporters are the specialists and nurses at Oxford Women’s Health. 

Pauline, who has a long history of working with dogs, had always wondered why their olfactory superpowers were employed in everything from sniffing out drugs to finding explosives and tracking fugitives but had never been consistently used to detect human disease.

“We have known for a long time that dogs can be trained to detect anything that has an odour. The use of this natural diagnostic tool to support and add value to the health system seemed a logical progression,” she says.

So, she set up K9 Medical Detection NZ – a Dunedin-based charitable trust dedicated to improving the health of New Zealanders through specially trained dogs identifying cancer and other diseases from urine samples. Work into detecting a variety of cancers including bowel, prostate, and ovarian has followed.

Ovarian Cancer Trial
“Thanks to our very generous business and community sponsors, we have been able to make ovarian cancer a major focus in the last two years, and I am very excited by what this might mean for New Zealand women,” Pauline says.

“If ovarian cancer is detected at stage one, women have a 95 per cent survival rate at five years. At stage four it is 15 per cent. If dogs can reliably detect and alert to the odour released from ovarian cancer in urine samples, whether it is stage 1 or 4, it will mean this new test could add value to the existing blood test and make a strong case for fast investigation.”

“The blood test is only a marker, not a diagnosis and isn’t reliable. A positive or negative K9MD test would provide another important layer of information.”

K9MD dogs, Hunter (German Shepherd), Hogan (a Golden Labarador gifted by the NZ Police), and Skye (Black Labrador) are working on the trial, with Hogan and Hunter having so far achieved almost perfect marks for specificity and sensitivity to the disease. “The results are quite remarkable but there are several stages left to go before anything can be rolled out,” Pauline says.

Urine samples needed
At the moment, the trial needs a minimum of 800 individual urine samples from women of varying ages and geographic locations, who do not have ovarian cancer and meet specific criteria. Ideally, these people will be referred via their GP or specialist

Pauline Blomfield pictured with Levi 

but self referrals can be made by contacting nurse@k9medicaldetection.nz  

Self referrals are currently only open to women in Christchurch, Wellington, Hamilton and Invercargill, where there are K9MD nurses available to receive samples. More nurses are being recruited in other parts of the country as funding becomes available. People who have been diagnosed with ovarian cancer can also self refer to assist in the research by contacting K9MD’s Clinical Research nurse at the email address above.

“While all samples are anonymised by individual barcodes, and patient confidentiality is maintained throughout the research, nurses will be informed if any samples linked to their patients are identified as requiring further investigation. The nurse will then contact the person or their GP and discuss next steps,” Pauline says.

Pauline says she is incredibly grateful for all the support she has received so far from medical professionals, academics, and the scientific community in New Zealand and internationally. This includes collaboration with teams in Australia and France. The Royal Canin Foundation in France is financially supporting K9MD’s ovarian cancer research.

To find out more about K9MD’s work on ovarian cancer visit https://www.k9md.org.nz/research/ovarian-cancer-clinical-trials

Canine superheroes
A dog’s sense of smell is the superpower that drives K9MD. While a human has five million scent receptors in their nose, a dog has up to 300 million. In real terms, this means a dog has the ability to detect a teaspoon of sugar in two Olympic sized swimming pools of water.

Along with an exceptional nose, K9MD’s dogs must have a strong work ethic, show enthusiasm and be willing to perform any task. They also need to have an excellent temperament and be calm and confident in any environment and around people.

In return they are provided with a warm and loving foster home, picked up and dropped off for work each day, and have their own vet nurse to ensure they are leading a happy, healthy, dog friendly life. This includes regular walks in residential areas and runs on the beach and at a farm.

Tips for reducing stress in the holiday season

The holiday season can bring joy, connection, and celebration, and it can also bring stress. Between family dynamics, financial pressure, travel, loneliness and grief for some, it’s easy to feel overwhelmed at this time of the year. In this article, Dr Amy Montagu shares five simple tips from the Oxford Women’s Health clinical psychologists that you can implement to help reduce stress over the holiday period.

1.     Breathe baby...! Breathing can literally reset your nervous system in two minutes. Search online for physiological sigh, diaphragmatic breathing, box breathing, and find which one works for you. Practise this breathing for two minutes each day.
If/when you notice you are feeling quite nervous or anxious, take a moment and breathe for two minutes to bring your stress level down.

2.     Move: Exercise/movement is an antidote to stress. Bring some stretching into your day; take a wee wander around the block; find a nice trail nearby; or put on your favourite tune or Christmas carol and have a dance!

3.     Micro-moments: Carve out moments during your day to stop, pause, and breathe. Write “stop, pause, breathe” on sticky notes and place them around the house in the bathroom, garage, on the fridge etc. Each time you see the note, take a

Dr Amy Montagu

moment and do what it says.

4.     Be aware of your boundaries with people and time: It can be easy to take on too much, so be conscious of this. Boundaries protect your peace, not create distance. Saying no can sound like: “I’d love to, but I am at capacity. This is what I can do...”

5.     Savour the good: Write down, talk with someone, or pause to think about one good thing that happened during the day. You have to find one, no matter how small! What was it? What did it make you feel? And where did you feel this in your body? This is a fabulous practise for boosting mood and bringing down stress.

Have a wonderful holiday period, and if the stress is too much, please reach out to the appropriate service for support.
You can text 1737 or Crisis Team on 0800 920 092.

Navigating contraception and menopause

Contraception may be a distant thought for women seeking support during menopause, but it is an important discussion to have with your General Practitioner. In this article, Oxford Women’s Health Menopause GPs Dr Victoria Price and Dr Lauren Goldschmidt discuss some of the options available.

As we approach perimenopause and menopause, contraception may no longer be a primary focus - but it needs to remain on the radar. Fertility decreases as we age and by the time a woman reaches her 40s, the chance of a natural conception reduces significantly each month. However, the possibility of conceiving naturally does not completely fall to zero, and surprise pregnancies can occur. This is particularly important given that research shows a growing number of women in midlife are beginning new relationships.

Who still needs contraception?
Lauren: If your final period happens under the age of 50, reliable contraception will need to continue for two years. If it occurs between the ages of 50 and 55, you will need to continue using contraception for another year. Once over 55, all contraception can be stopped, even if your periods continue or are changing. If you don’t have periods because you are using a Mirena®, taking the progestogen-only pill, have had endometrial ablation, and in some cases are receiving Depo-Provera®, your GP may recommend a Follicle-stimulating hormone (FSH) blood test to advise on the best options.

The most reliable contraceptives at more than 99% effective, are the Mirena®, the copper IUD, tubal surgery, and vasectomy. Sitting at about 93-99% effectiveness are the contraceptive injection, vaginal ring, and The Pill. All need to be used at the right time and according to instructions to be reliable. Less effective methods include external and internal condoms, diaphragms, natural family planning, and the withdrawal method.

Here, Dr Price and Dr Goldschmidt discuss some of the options available:

Mirena®
Lauren: The Mirena® works by thinning the endometrium lining and thickening cervical mucus, so most women will end up with no bleeding. Side effects are low and it may be better tolerated by people who have had previous issues taking hormones. The longer a Mirena® can be used, the longer bleeding and spotting will decrease. I always try and encourage women to leave a Mirena® in for at least three months if possible and, if all goes well, try another six months and continue from there. Some women don't like using a Mirena® but they are straightforward to remove. While New Zealanders can now use the Mirena® for eight years for contraception, it’s important to remember that if used alongside MHT, the time period remains at five years.

Copper IUD
Lauren: The copper IUD is another very effective contraceptive that can last five or 10 years, depending on the device. Toxic to sperm, the copper IUD prevents the implantation of a fertilised egg. It suits women wanting or needing to avoid hormonal options, and those who prefer to have a period. The copper IUD can cause heavier, longer, and more painful periods. These symptoms may also happen during perimenopause, resulting in a difficult combination that you may want to avoid.

Implant (Jadelle®)
Victoria: This works by thickening cervical mucus, inhibiting ovulation, and thinning the endometrium. It involves a minor surgical procedure to insert two rods containing progestogen into the upper arm. It is more than 99% effective but is often less popular due to the common side effect of irregular bleeding.

Depo-Provera® injection
Victoria: While Depo-Provera® has an efficacy of 99.8%, it needs to be given every 12 weeks and on time. The injection prevents ovulation, has low side effects, and causes high rates of missed periods, so can be a popular choice. Some people will put on weight but those who like Depo-Provera®, get on brilliantly with it. 

Dr Lauren Goldschmidt

Dr Victoria Price 

Because it suppresses estrogen, long-term use can cause low bone density and osteoporosis, so it’s a good idea to discuss these risks with your GP.

Short acting contraception
Victoria: The combined oral contraceptive pill (The Pill) uses estrogen and progestogen to inhibit ovulation. It also thickens the cervical mucus and thins the endometrium. When used perfectly, The Pill is 99% effective, but this drops to 93% in ‘real life’ terms. If you skip the placebo pills, menstrual blood loss can be reduced which can be popular during perimenopause. For some people, taking estrogen will not be suitable, for instance if they have a history of breast cancer, venous thromboembolism, or migraine with aura. The combined oral contraceptive pill should also not be used by smokers aged over 35 and is not recommended for women over 50 due to increased cardiovascular risks.

The progestogen-only pill
Victoria: Often referred to as the “mini pill”, the progestogen-only contraceptive pill (POP) works by thickening cervical mucus and can be used when taking estrogen is not appropriate. Options available in New Zealand include Noriday®, Microlut®, and Cerazette®. Noriday® must be taken within a three-hour window to remain effective and can be associated with more side effects, such as irregular bleeding. Cerazette® contains desogestrel, one of the newer generation progestogens, and has a 12-hour window. Pharmac announced it would fund Cerazette® earlier this  year, which was excellent because it is a popular option. It is more likely to cause missed periods, suppress ovulation, and help with period pain.

Barrier methods
Victoria: With perfect use, condoms are 98% effective but lots of mishaps can happen, so they are generally considered to have an efficacy of 88%. They have the added bonus of preventing sexually transmitted infections (STIs). This is particularly important because research shows a growing number of women in midlife are beginning new relationships. For women who have previously been married or in a long-term relationship, regular STI testing may not be on their radar. Research has found quite low rates of STI testing in women during midlife.

Permanent methods
Victoria: If you are looking at more permanent options, tubal ligation and vasectomy are recommended. Tubal ligation is 99% effective and performed through a laparoscopy or laparotomy under a general anaesthetic. Often, it will be offered during a caesarean section or laparoscopy performed for another reason. While not as easy to access, tubal ligation is appealing to women who are concerned about the side effects of other contraceptive methods. Vasectomy is the only method that allows the male partner to be responsible for contraception and is 99% effective. It involves a minor surgical procedure under local anaesthetic.