In one of my most challenging conversations of the year, Dr Diana Kopua asks us to slow down and look differently at ADHD.

Equity CME poinst can be claimed.

We meet Wiremu, a 22-year-old Māori man who comes to primary care with his auntie after his boss suggests he might have ADHD. He is struggling to stay focused at work and complete his apprenticeship theory, and it would be easy to move quickly towards a diagnosis.

But Diana challenges us to pause.

What happens when we start with the relationship rather than the diagnosis? What does context really mean when we are assessing ADHD? And what might we miss if we focus on symptoms without understanding whakapapa, whānau, culture, identity and the lived experience of the person sitting in front of us?

This is not a conversation about finding a different checklist for diagnosing ADHD. It is a conversation about questioning whether the way we currently approach assessment is always serving our patients well.

Diana shares how Māori models of health, including Mahi a Atua and Mauri, can change the way we think about distress and wellbeing. We talk about the role of whānau, culturally safe assessment, diagnostic labels and the uncomfortable possibility that our own clinical practice can sometimes contribute to inequity.

We also ask a difficult question: when is an ADHD diagnosis actually helpful, and when might we be too quick to assume that a diagnostic label is the answer?

There are no easy answers here. Instead, Diana asks us to be curious, to sit with some discomfort and to think more deeply about what we are doing, why we are doing it, and who our approach is working for.

For GPs and other primary care clinicians, this episode offers practical ways to rethink ADHD consultations, while challenging us to look honestly at the assumptions we bring into the room.

Sometimes better care starts with being willing to stop, listen and see the patient differently.

Practical clinical pearls:

Start with the relationship, not the diagnosis. Name the purpose of the consultation, establish what matters to the patient, and check how they want to approach the conversation.

Bring whānau into the conversation early. Where appropriate, invite whānau participation from the beginning rather than treating it as an add-on to the consultation.

Use a culturally appropriate framework. Frameworks such as Mauri can help explore wellbeing and the wider context of the patient’s experience alongside diagnostic assessment.

Ask what the diagnosis will change. Before pursuing a diagnostic label, ask how it will benefit this patient, at this time. Consider whether the focus should be on potential, strengths and support as well as symptoms.

Check how the consultation felt to the patient. Before finishing, ask whether they felt respected, heard and understood. Be willing to sit with discomfort, reflect on how your own practice may contribute to inequity, and stay curious about where you can do better.

Feeling out of your depth? Upskill- see resources below.

Resources:

Te Kurahuna – Mahi a Atua – Official website for Mahi a Atua, including information about the approach, training, publications, and resources.

Kopua, D., & Skirrow, P. (2023). Racism, Mātauranga Māori and ADHD: An Interview With Dr Diana Kopua. Journal of the New Zealand College of Clinical Psychologists, 33(1), 72–78. https://doi.org/10.5281/zenodo.8187808 (Mahi a Atua)

Kopua, D. M., Kopua, M. A., & Bracken, P. J. (2020). Mahi a Atua: A Māori approach to mental health. Transcultural Psychiatry, 57(2), 375–383. https://doi.org/10.1177/1363461519851606 (Sage Journals)

Te Kurahuna Publications & Resources – Collection of Dr Diana Kopua's publications, reports, and additional resources on Mahi a Atua, Indigenous mental health, racism, and systems transformation.

About Dr Diana Kopua: (Ngāti Porou) is a consultant psychiatrist, co-founder of Te Kurahuna, and the developer of Mahi a Atua, an Indigenous approach to mental health grounded in Māori pūrākau, whakapapa and mātauranga Māori. Originally trained as a nurse before studying medicine at the University of Otago, she completed specialist training in psychiatry in 2014 and has led the development of innovative kaupapa Māori mental health services, including Te Kūwatawata and Te Hiringa Matua. Through her clinical work, teaching and research, Dr Kopua has become a leading voice on Indigenous mental health, racism in healthcare, and culturally grounded approaches to ADHD and wellbeing.

Listen here:

https://podcasts.apple.com/nz/podcast/adhd-maori-lens-w-dr-diane-kopua/id1845748299?i=1000789362552

https://open.spotify.com/episode/7AHwjYFtJqcRYl4cY5syoi?si=85d7210fdc074d69

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

Listen here:

https://podcasts.apple.com/nz/podcast/varicose-veins-w-dr-sam-dunn/id1845748299?i=1000786889860

https://open.spotify.com/episode/4gP40UOpbqu4p48SmCD4rm?si=721f49e4bd68454c

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 education and fellowship training.

Listen here:

https://podcasts.apple.com/nz/podcast/neck-lumps-w-drs-nick-lilic-and-john-chaplin/id1845748299?i=1000779189426

https://open.spotify.com/episode/4xVblAc8y2GbsJXPWZ20gL?si=1a58aa28748344e0

Disclaimer:

This podcast was supported by an unrestricted educational grant from Southern Cross Healthcare. The content was developed by the Specialist GP and the views are those of our expert speakers.

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

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