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Medicine Lakex

A newsletter to Medical Specialists and GPs throughout the Auckland, Hamilton and Northland regions
Auckland Community Pharmacies are now being profiled on
The three Metro Auckland DHBs are supporting all community • methadone dispensing pharmacies within the region to profile their professional pharmacy • emergency contraceptive pill (ECP) services on the new pharmacy section of • influenza vaccines Community pharmacies are often the first health professional contact for many patients. Services provided by community • needle exchange pharmacies are varied and while there are common services provided • trimethoprim dispensing by most community pharmacies, there are often some differences.
A webpage has been developed for each pharmacy and once this Those professional services profiled include the following
has been reviewed and approved is put live on the Healthpoint site. Each pharmacy page is accessible by interactive map, key word • smoking cessation service search or browse' by suburb. This is a great resource for GPs to refer patients to the nearest pharmacy which meets a specific need • aseptic dispensing • clozapine dispensing Over 200,000 people per month are using to
• community pharmacy anticoagulant management service access health service information. This is an easy way for pharmacy • long-term conditions (LTC) service to have a significant web presence within the community.
• medicines use review service (MURS) To view go to:

M ERCY A NGIOGRA PHY Electrophysiology & Radiofrequency Ablation Auckland Heart Group and Mercy Angiography are pleased to report that we have a comprehensive private electrophysi-ology service at Mercy Angiography, for the investigation and treatment of cardiac rhythm problems. David Heaven David Heaven We conduct complex procedures using 3D mapping technology in the treatment of Atrial Fibrillation (AF) with Pulmonary Vein Isolation (PVI) in selected patients. In addition to radiofrequency ablation we use cryoablation to interrupt abnormal electrical circuits.
Nigel Lever Health insurance companies cover most of these procedures according to agreed clinical guidelines. Drs David Heaven, Warren Smith, Nigel Lever, Andrew Gavin and Jonathan Skinner are nationally and internationally recognised experts in this area.
For more information please contact : Jonathan Skinner [email protected] Dr Warren Smith [email protected] Nigel Lever Southern Cross Affiliated Provider - Joanna Teague +64 9 623 1020 Dr Nigel Lever [email protected]- Maria McDonald +64 9 630 1961 Warren Smith Dr Jonathan Skinner [email protected] - Maria McDonald +64 9 630 1961 Dr Andrew Gavin [email protected] - Maria McDonald +64 9 630 1961 Andrew Gavin Healthpoint does not endorse or adopt the information or materials provided by any of the service providers which Healthpoint publishes, or otherwise includes, in or with this newsletter. Healthpoint accepts no responsibility or liability for any errors, omissions, offers or details in any such information or materials. Private Medical Specialists and Services
Dr Paul Dawkins –
Respiratory Physician
Paul Dawkins is a consultant respiratory
physician and honorary senior lecturer at
Middlemore Hospital. Interests include COPD,
bronchiectasis and lung cancer.
He welcomes private referrals in conditions
across the spectrum of respiratory medicine porting you including sleep disordered breathing. and the wel being of your at risk patients Assessment • DiAgnosis • treAtment • support
He has access to full lung function, sleep investigation laboratories 22 Cardiologists sharing knowledge, experience and specialisation
and bronchoscopy facilities. He aims to provide a responsive, 7 Clinics located across the Auckland region
efficient and high quality respiratory opinion for local GPs. Advanced technology and equipment
He sees private patients fortnightly at Pukekohe Family Health Care.
Phone: 09 623 1020 Fax: 09 623 1030 GP Advice Line: 0800 222 411 For appointments and enquiries: Ph: (09) 237 0280,
Referrals: [email protected] Fax: (09) 238 3377
Dr Elizabeth Baird –
Specialist Dermatologist
Elizabeth is a UK graduate who moved to
NZ in 1985. She completed her dermatology
training in NZ and Scotland.
She has been in private practice for 15 years.
Remuera Dermatology offers a friendly and
professional practice taking pride in high
standards and quality care.
Elizabeth welcomes referrals.
Urgent appointments are available.
Interests include: Based in St Heliers, Fillan Healthcare's vision is to provide the • complete mole/skin/melanoma checks highest quality private mental healthcare in Auckland.
including surgical services By having three psychiatrists and three psychologists in the same • acne, eczema, dermatitis, rosacea, psoriasis clinic we are able to offer prompt appointments for your patients • hair/nail disorders and timely clinic letters to referrers after any consultation.
• vulval dermatology.
We offer comprehensive, evidence-based care for all mental health Elizabeth is a Southern Cross Affiliated Provider disorders and specialise in ADHD, depression, anxiety and alcohol for selected services.
use disorders. All of our psychologists are DBT trained.
For appointments and enquiries:
Ph: (09) 520 2586, Fax: (09) 520 2786

For appointments at eastMED, Ph: (09) 214 7284, Fax: (09) 963 7470
Email: [email protected]

Mr Murray Beagley –
Plastic and Hand Surgeon

Mr Michael Flint – Orthopaedic
Murray Beagley offers a broad range Surgeon - Joint Replacement,
of cosmetic, paediatric, skin cancer and Sports Surgery, Tumours
reconstructive plastic surgery in his private Michael Flint is an orthopaedic surgeon with practice - Plastic Surgery Auckland. special interests in hip and knee replacement He is now a Southern Cross Affiliated Provider and sports injuries of the knee and shoulder. for skin lesion removal and skin cancer treatment.
He is also a recognised expert in the diagnosis Murray consults regularly in Whangarei, and management of musculoskeletal tumours, Warkworth and Pukekohe in addition to his giving advice to other NZ specialists in this Auckland clinics.
challenging area.
Murray's special interests include: He is a consultant surgeon at Middlemore • dupuytren's fasciectomy and other complex Hospital in Auckland where he helps run *For skin cancer diagnosis the NZ Bone and Soft Tissue Sarcoma Unit • genitoplastic surgery (hypospadias, and treatment only. as well as teaching medical students and junior staff.
• breast surgery and abdominoplasty• otoplasty Michael is in private practice where he is available for advice and management of problems involving the hip, knee and shoulder as • eyelid rejuvenation.
well as musculoskeletal tumours.
Appointments in Remuera, Pukekohe, Warkworth and Whangarei
Ph: (09) 529 2029, EDI: mbeagley

For further information and appointments at Mercy Specialist Centre:
Ph: (09) 630 0214, Fax: (09) 630 3981, Healthlink EDI: orthclin
Email: [email protected]
Healthpoint does not endorse or adopt the information or materials provided by any of the service providers which Healthpoint publishes, or otherwise includes, in or with this newsletter. Healthpoint accepts no responsibility or liability for any errors, omissions, offers or details in any such information or materials. Private Medical Specialists and Services
Dr Phill McChesney –
Gynaecologist, Laparoscopic Surgeon,
Fertility Subspecialist
Phill is a locally trained gynaecologist who
has returned to the Waikato.
He has subspecialty expertise in:
Focus Radiotherapy is proud to have introduced Intrabeam single • complex endometriosis dose radiotherapy for breast cancer to New Zealand to replace the • advanced laparoscopic surgery 3-6 weeks of daily radiotherapy in 30% of breast cancer patients. • operative hysteroscopy This is not a new technology; used in 1995 initially for brain malignancy • menstrual disorders and expanded to the breast in 1998. The evidence for its use is from the Lancet published Targit A Trial of over 3,500 women randomised in 33 centres in 11 countries. It showed this treatment • reproductive endocrinology to be non-inferior to the standard with it favoured in the following • fertility.
analyses: side-effect profile, toxicity, cosmesis, cost-benefit and Phill also welcomes general gynaecology, patient preference. The key to its use is patient selection: women pelvic floor and colposcopy referrals.
>45 years, solitary tumour <3 cm, grade 1 or 2, node negative and In addition to general gynaecology, Phill has undertaken 3 years estrogen receptor positive.
of advanced training, making him one of the few fertility specialists in NZ to complete the Certificate in Reproductive Endocrinology Specialists include Dr Maria Pearse, Dr Belinda Scott, Dr Richard and Infertility (CREI) subspecialist qualification.
Harman, Dr Erica Whineray-Kelly.
Appointments in Hamilton, Te Awamutu and Tauranga.
Dr Stephen Benson from Mercy Breast Clinic is also accredited to For further information and appointments:
deliver Intrabeam.
Ph: (07) 839 2603, Fax: 07 839 2604
For referrals/consultations please Ph: (09) 488 9179
Email: [email protected]
or [email protected]

Dr Jovina Goh – Endocrinologist,
Diabetologist & Specialist Physician
MercyAscot Neck Lump Clinic
Jovina is a NZ trained endocrinologist and New Zealand's first truly ‘one stop' specialist neck lump clinic.
specialist physician of Malaysian Chinese descent. She speaks fluent English and conversational Now there is a service that provides a specialist radiologist, pathologist Mandarin, Cantonese, Malay and Hokkien.
and surgeon in each of our Neck Lump Clinics. Your patient receives an immediate diagnosis and treatment plan at one appointment. Jovina is currently working as a consultant at Contact our practice manager for an appointment today: Middlemore Hospital and now offers a private clinic at the MacMurray Centre in Remuera. Email: [email protected], Mob: (022) 450 2245
Healthlink EDI: aklheadn

She welcomes referrals for patients needing specialist care for all aspects of endocrinology and diabetes, including: To find out more about our head and neck services visit the
MercyAscot website

1. thyroid, parathyroid and calcium disorders2. diabetes3. osteoporosis and Paget's disease Making Endoscopy easy
4. pituitary and adrenal disorders six days a week
5. polycystic ovarian syndrome (PCOS); male hypogonadism MercyAscot Endoscopy has extended its service to six days a week so your patients have 6. hypertension management.
the opportunity to have their procedure on For appointments and enquiries, please contact the
MacMurray Centre: Ph: (09) 550 1080, Fax: (09) 550 1081
They have also made referring your patients 5 MacMurray Road, Remuera, Auckland
directly to Auckland's largest group of leading endoscopists easy. You or your staff can simply: • call 0800 4 ENDOSCOPY (0800 43 63 67) • fax a referral form* or• refer online via Healthlink EDI: escopema.
Together with the 22 endoscopists who work with them, If you are interested in profiling
MercyAscot Endoscopy offers the most comprehensive service in Auckland: gastroscopy, colonoscopy, bronchoscopy, ERCP and TOE yourself and your services please
at two convenient locations - Takapuna and Epsom. Recent quality audit results and patient satisfaction surveys point to email: [email protected]
the outstanding care they provide for patients and their relentless commitment to quality. or phone (09) 630 0828
*If you do not have a MercyAscot referral pad please call their
friendly team on: (09) 623 5725 (Epsom) or (09) 486 4346 (Takapuna)
or visit

Healthpoint does not endorse or adopt the information or materials provided by any of the service providers which Healthpoint publishes, or otherwise includes, in or with this newsletter. Healthpoint accepts no responsibility or liability for any errors, omissions, offers or details in any such information or materials. Private Medical Specialists and Services
Mr John Mutu-Grigg –
Jonathan Wheeler –
Plastic and Reconstructive Surgeon
John is a NZ trained orthopaedic surgeon. Jonathan has been working in Auckland since After training he spent a further two years 2010 after returning from overseas fellowships in some of North America's most prestigious in Brisbane, Australia and Toronto, Canada. hospitals, sub-specialising in hip and knee He is one of two Plastic Surgeons in New Zealand replacement and hand and wrist surgery. who have completed sub-specialty craniofacial John's practice is a combination of both surgery training through the Royal Australasian general and sub-specialist orthopaedic surgery. College of Surgeons and has appointments as He is happy to consult and/or provide advice to an honorary senior lecturer at the University of GPs on any orthopaedic condition. Auckland and an associate editor for the plastic He has a public post at North Shore Hospital and consults in private surgery education network. around Auckland. He has rooms in Henderson (west), Ponsonby and Ascot (central), Ormiston (south and east) and from January, Albany Middlemore Hospital and Starship Children's (north). He also operates around Auckland for patient convenience. Hospital are where his public practice is based and his private John works very hard to see all referrals within 2-3 weeks. If it is practice is in Remuera. He is experienced in the following areas: urgent and the patient is happy to travel he can see patients within • skin surgery and treatment of skin cancer and melanoma • Southern Cross Affiliated Provider for skin cancer diagnosis For appointments Ph: (09) 845 2509, Fax: (09) 845 2510
Healthlink EDI: johnmutu, Email: [email protected]
• body surgery including abdominoplasty, liposuction, breast reductions and augmentation • facial restoration and rejuvenation
• adolescent and paediatric skin and soft tissue problems.
For appointments and enquiries Ph: (09) 529 5782, Fax: (09) 524 6043
Dr Paul Ockelford –
Haematologist, Haematology@Gilgit
Paul is consulting at 15 Gilgit Rd Specialist
Centre, Epsom. He is available to see patients
with both malignant and non-malignant
disorders of the blood, including those with
abnormalities of bleeding and clotting. He is
Mr Rupert van Rooyen –
a senior clinician with wide experience.
Paul was previously the Director of Clinical Rupert came to New Zealand in 2002 from Services at Diagnostic MedLab and is a former South Africa, where he obtained his MBChB at chairman of the NZ Medical Association. the University of Stellenbosch. He completed He works part-time at Auckland City Hospital where he directs the orthopaedic training in New Zealand, and Thrombosis Unit and maintains an active clinical research programme.
returns from fellowships in musculoskeletal For further information and appointments: Ph: (09) 623 7506,
oncology and lower limb arthroplasty in Fax: (09) 623 7519, Email: [email protected]
Brisbane and Bologna. He is currently at Waitemata DHB, and offers his services in private where he is happy to see patients with hip and knee problems, and also of a general orthopaedic nature.
Mr Matthew Tomlinson -
He is setting up his rooms at 119 Apollo Drive in Albany, and Orthopaedic Foot & Ankle Surgeon
also consults at Fred Thomas Health in Takapuna and Silverdale Matt is an orthopaedic surgeon with a Medical Centre.
dedicated interest in the area of foot and For further information and appointments:
ankle surgery. He has considerable expertise Ph: (09) 280 3344, Fax: (09) 280 3345, Mobile: (021) 529 366
in dealing with all types of foot and ankle Healthlink EDI: rupertvr, Email: [email protected]
problems with over 15 years of experience in
this specialty area.
Some of the areas that Matt deals with include:
• arthritic conditions
• accidents affecting the lower limb or foot
• sports injuries
• deformities
• bunions
• minimally invasive surgery
• congenital problems
• arthroscopy of the foot and ankle
• ankle replacement
• revision surgery.
For further information and appointments at Mercy Specialist Centre:
Ph: (09) 630 0214, Fax: (09) 630 3981, Healthlink EDI: orthclin
Email: [email protected]

Healthpoint does not endorse or adopt the information or materials provided by any of the service providers which Healthpoint publishes, or otherwise includes, in or with this newsletter. Healthpoint accepts no responsibility or liability for any errors, omissions, offers or details in any such information or materials. District Health Board News
Auckland DHB
Northern Region Clinical Pathways:
GP training up-skilling at
Auckland DHB

Are you interested in learning more about the management of problems in ORL, general medicine and dermatology?These departments have agreed to host GPs in outpatient clinics, in theatre or on ward rounds depending on your interest. If you are interested in attending please contact Rosamond D'Souza at Auckland DHB on: (09) 307 4949 ext. 23208 or email [email protected]. Dr Stephen Child who is organising this project will then liaise with the department and yourself to organise a suitable time.
New Pathways added in September 2014:
• Asthma - Acute Paediatric Auckland-Waitemata DHBs have signed a Health Alliance agreement for • Asthma Management - Chronic primary care. Deputy Director of Funding Tim Wood says all signatories believe it will lead to significant improvements in services for enrolled • Cough > 4 Weeks patients. In addition, Tim sees this as a strengthening of the relationships New Pathways added in August 2014:
between Mana Whenua and Mataawaka organisations, the Boards and • Heart Failure PHOs. The plan, at a high level, is to drive improvement by: • Constipation - Paediatric • creating the conditions for patient and whanau-determined care through the locality approach • An updated version of the Sore Throat Pathway (2014) • increase integration of services and social services building capability and New Pathways added in July 2014:
capacity across the sector supporting, where appropriate, infrastructure • At Risk Individuals development within primary care Pathways Currently in Development:
• reducing health inequalities through a reorientation of the sector • Acute Lower Back Pain • supporting clinical governance through engagement with clinicians and design of services and change processes • Rheumatic Fever • driving performance through quality improvement, transparent reporting and effective mechanisms for public accountability.
• Pneumonia in Aged Residential Care• Women's Health (Heavy Menstrual Bleeding)• Irritable Bowel Syndrome Clinical pathways are a tool to promote and optimise organised and efficient care. This allows for patient-focused evidence-based best practice. Over the last few months there By application of agreed process management, pathways provide have been a few updates to the continuous quality improvement and standardise care processes. material on the various sites: The development team for each pathway published on this site include the 1. update on the DEXA criteria making it clear that repeat DEXA requests Regional Work Program, the Northern Region District Health Boards and need to be discussed with a geriatrician prior to request a group of specialists and general practitioners. Please use the feedback 2. guidance on risk assessment and management of patients with a family buttons on the pathways if you would like to provide your feedback.
history of breast cancer.
Healthpoint Pathways currently has 50 pathways live with new clinical Based on feedback we will be working on making the options for vasectomy pathways added every month.
available on the urology site given there is no publicly funded service.
With the advent of a new drug for managing MS we will work with
Nicole McGrath to develop guidelines and when to consider these
and how to access them.
If there are other gaps in information on hospital services, please let us
know so we can address them.
We do see a steady stream of eReferrals coming in to the wrong service.
These appear to largely be from locums so can we ask that you orientate
them to the local Northland services. Ensuring they can access Healthpoint
and know where to find information to guide their hospital referrals would
prevent delays in patient care.
Di Davis
GP Liaison Northland DHB
021 830 938

Healthpoint does not endorse or adopt the information or materials provided by any of the service providers which Healthpoint publishes, or otherwise includes, in or with this newsletter. Healthpoint accepts no responsibility or liability for any errors, omissions, offers or details in any such information or materials. District Health Board News
Counties Manukau
Services undergoing a complete
information review

Counties Manukau Health Volunteers
As a regional service Community Alcohol and Drug Services (CADs) information for referrers and the public has undergone a complete review Volunteers play an important part helping with patient and visitor experiences with significant changes. The new information will outline more clearly and there are many volunteers helping at Counties Manukau Health. service expectations, deliverables and referral criteria and a number of Middlemore Hospital has a variety of volunteer roles and over the next months will be expanding numbers to an army of volunteers assisting all Specific service information has been split into the following: over the hospital. CADs Counselling Services, CADs Medical Detoxification Services, No medical training or experience is needed and training will be given. CADs Auckland Opiate Treatment Service and CADs Altered High And if you are a medical professional not now practicing, we'd love to hear from you.
There are also great resources and information available for medical The types of roles our volunteers do are: professionals including: • direct visitors to wards and answer general questions Alcohol and other drug resource kit • make tea for patients in the discharge lounge as they await a lift home Patient presenting to GP requesting support to withdraw from alcohol • collect patient feedback on their stay and what could be improved Alcohol abuse – assessment • read a book or play cards with a patient who doesn't have visitors Alcohol screening tools • help feed a patient, or help them walk after an operation MOH legal requirements for prescribing and other. • garden; CM Health would like to establish a volunteer gardening crew The Elective Surgery Centre (ESC) at North Shore Hospital has
to maintain our gardens and develop some new ones.
also updated information on what they provide, access criteria and general information for the public.
If you're interested email [email protected] who will provide the relevant application forms and explain the process, which includes a Northern Region Fertility Service
police screening. The Northern Region Fertility Service (NRFS) provides coordination of Counties Manukau Health bio-containment facility
referrals for funded fertility services for the Northern Region publicly (Auckland, Waitemata, Counties Manukau and Northland region).
CM Health has established a bio-containment facility to treat and contain highly infectious diseases, following international concern about the latest From May 1st 2014, there were three providers of publicly funded fertility outbreak of Ebola virus disease.
services in the Northern Region.
While the risk to New Zealand from Ebola remains unlikely but possible, These are:
CM Health has worked with the Ministry of Health, Auckland Regional • Fertility Plus Public Health Service, other DHBs and primary care to develop a comprehensive plan to respond to any suspected case of Ebola in a • Fertility Associates traveller arriving from overseas, or family or friend who has had close contact with a traveller.
The three facilities offer a range of specialist Assisted Reproductive Technology (ART) assessment and treatment. If you have patients who The team at CM Health has expertise in treating serious infectious would benefit from and are eligible for this service please go to the service diseases, and staff are trained and prepared to care for patients in page on Healthpoint for all the referral criteria and expectations.
the unlikely event of an Ebola case presenting to Middlemore Hospital.
Information on the bio-containment facility can be found on CM Health Infectious Diseases Healthpoint page.
Recently added or amended guidelines
CM Health Urology have developed multiple guidelines and pathways
and these are now live on their site.
Access, training and feedback
If you have any GPs or practice nurses new to your practice or who may
like a quick training session on accessing and using Healthpoint please
contact Nikki Rhind, Primary Care Communications Co-ordinator,
and she will arrange a time to visit.
If you have any feedback or requests for referral information
please either contact Nikki Rhind directly or click on the
feedback box found on all clinical information pages.
[email protected] Ph: (09) 276 0044 ext. 9077

Healthpoint Limited manages a web based portal of
information about health services, which helps the public
and referrers better understand and use health services.
Better understanding means more effective use, leading
to better health outcomes and less cost.
Healthpoint does not endorse or adopt the information or materials provided by any of the service providers which Healthpoint publishes, or otherwise includes, in or with this newsletter. Healthpoint accepts no responsibility or liability for any errors, omissions, offers or details in any such information or materials. Dr Anil Sharma – Gynaecologist
FRCOG FRANZCOG DGM Dip Legal Aspects Med Pract
Anil is UK and NZ trained and has a special interest in HMB, urogynaecology, endometriosis and fibroids.
He also undertakes advanced hysteroscopy, laparoscopic hysterectomy and ovarian cystectomy. He also
offers colposcopy and loop excision (LA). His clinic has a nurse manager, a pelvic floor physiotherapist
and a urodynamics nurse. He believes in informed choice where treatment options exist and this includes
hysterectomy, Mirena and Novasure Ablation. He has the largest NZ series of the latter. His design award
winning clinic is at Ascot Central and he undertakes visiting clinics in the East and North Shore.
Enquiries and appointments practice manager - Anne Whineray
Ph: (09) 520 0745, Fax: (09) 520 0743

Heavy Menstrual Bleeding (HMB)
HMB is excessive menstrual loss (around 20% of women) that interferes with a woman's physical, social, emotional and / or material quality
of life. There are several effective treatment options available so it is ethically and medico-legally appropriate to discuss these. A woman's
perception of the disruption her HMB causes is the important determinant of subsequent treatment.
Causes can be physical (endometrial polyps, fibroids, adenomyosis and most importantly but least commonly, malignancy and hyperplasia).
Non-physical causes include dysfunctional hormonal cycles (the overall commonest cause), coagulopathies and iatrogenic (e.g. copper IUCD).
A history (including severity, erratic versus regular bleeding and other symptoms including postcoital and intermenstrual bleeding) and a
bimanual and speculum exam are useful to plan subsequent management.
• FBC & ferritin (eligible for Pharmac Mirena if Hb <120 or ferritin <16) • HCG if pregnancy possible / suspected • age over 45 years • tests for PCOS if suspected • coagulation tests and / or TFTs if suspected • current smear.
• unopposed oestrogen therapy / Tamoxifen• FH of endometrial cancer.
• where 3 months of medical treatment for above patients has failed • these patients don't need endometrial biopsy or scan before • any irregular or erratic bleeding medical treatment • uterus size greater than 12/40 (needs USS if any pelvic mass) • regular cycle • significant anaemia • normal uterine size on examination • risk factors for endometrial hyperplasia (see other table) • no risk factors for endometrial hyperplasia (see other table).
• endometrial thickness on scan > 12mm• fibroid(s) >3cm.
• Iron therapy.
• This is an impedance-limited (safety mechanism) radio-frequency • Cyclical Tranexamic Acid (1-1.5g QDS for up to 5 days of menses) thermal endometrial ablation (usually as a day case under GA in NZ). Suitable patients have a thorough evaluation including hysteroscopy D and C at the time and a relatively normal sized uterus. No further pregnancies should be planned as these can • Provera 10mg TDS for 3 weeks then taper every 3rd day (effective implant on the myometrium leading to complications. at stopping very heavy bleeding).
Future contraception is needed (e.g. condoms, vasectomy or • The LNG-IUS (Mirena) is an efficacious reversible contraceptive device. concurrent tubal ligation). Over 2 million procedures have It generally offers satisfaction rates for treatment of HMB in up been performed worldwide and the 5-year satisfaction rate to 80% with around 20% amenorrhoea at one year. Women can is above 90% with amenorrhoea in up to 75% of women. have 3-6 months of irregular bleeding / light spotting). Contraindications include previous classical caesarean section or Side effects include weight gain, depression, acne, and headaches. incisional myomectomy. Side effects include cramping for 1-2 days Overall a reasonably well-tolerated low invasive treatment option and a thin watery discharge for a few weeks. Complications such for women with uteri smaller than 12/40.
as thermal bowel injury are rare, estimated to be less than 1 in 10,000.
• Hysterectomy eliminates HMB and is also indicated for large
fibroids and endometrial cancer. Whilst normal ovaries are usually conserved at hysterectomy, there is a small risk of premature menopause and possibly a small increased risk of prolapse. The surgery is major in nature and involves a 2-4 day stay with 4-6 weeks for full recovery on average. (If submucous fibroids are the cause these can be resected hysteroscopically). Management is not always straightforward but if in doubt always consider a transvaginal USS and possible referral. A pipelle biopsy can be of use. A more detailed article is available please email [email protected].
Healthpoint does not endorse or adopt the information or materials provided by any of the service providers which Healthpoint publishes, or otherwise includes, in or with this newsletter. Healthpoint accepts no responsibility or liability for any errors, omissions, offers or details in any such information or materials.


Material safety data sheet

MATERIAL SAFETY DATA SHEET Product Name: Martin's Permethrin® SFR Termiticide/Insecticide This product has been prepared to meet the requirements as defined by OSHA Hazard Comm. Std., 29 CFR 1910.1200: the EO Directive, 91/155/EEC and other regulatory requirements. The information contained herein is for the concentrate as packaged, unless otherwise needed SECTION 1 Company and Product Identification Control Solutions, Inc.

Safety and tolerability of solifenacin add-on therapy to α-blocker treated men with residual urgency and frequency

Safety and Tolerability of Solifenacin Add-on Therapyto ␣-Blocker Treated Men With Residual Urgency and Acronyms AE ⫽ adverse event Steven A. Kaplan,*,† Kurt McCammon,‡ Roger Fincher,§ BOO ⫽ bladder outlet obstruction Allam Fakhoury储 and Weizhong He储 BPH ⫽ benign prostatichyperplasia From the Weill Medical College of Cornell University, New York, New York (SAK), Eastern Virginia Medical School, Norfolk,