Colonoscopy

A colonoscopy is a test to check inside your bowel. This test can help find what's causing your bowel symptoms.

Colonoscopy has the advantage of being both a diagnostic and therapeutic test, as it can detect polyps, and then, often allows these to be removed colonoscopically, reducing the chance of them progressing to become bowel cancer.

A long, thin, flexible tube with a small camera inside it is passed into your bottom. You'll be given some bowel preparation ( strong laxatives ) and follow a special diet for a couple of days before the test, so your bowel is clean.

You will be sedated and monitored for the test. This is not a full anaesthetic, you will be breathing for yourself throughout the procedure.

This involves either the surgeon or an anaethetist giving you both pain killers and sedation.

The use of sedation will mean that you must have someone to take you home and stay with you that night.

Gastroscopy

Gastroscopy is a procedure developed for investigating symptoms from the oesophagus (gullet), stomach, and duodenum (the first part of the small bowel).

A gastroscope is a flexible thin tube, which has a minute video camera at the end, allowing a direct view of the gut. It also allows us to pass down instruments to take biopsies and sample the lining of the gut.

This scope is done with a special spray to numb your throat. Patients can also opt to have  sedation.

The use of sedation will mean that you must have someone to take you home and stay with you that night.

Skin Cancers and Soft Tissue Lumps

The Manuka St Specialist Centre has a purpose-built minor procedures room, separate from the Manuka St Hospital theatre suite.

This means that Ros can undertake minor procedures under local anaesthetic in the same location and avoid the additional costs from Manuka St Hospital that accompany the use of the main theatre suite.

Skin cancers, including melanoma, and soft tissue lumps, such as lipomas,  can be excised quickly and efficiently in this setting as a day case procedure.

Ros is Southern Cross affiliated for all such procedures and her team will happily facilitate the process of a claim with them or any other insurance company.

Hernia Repairs

 A hernia is a defect through the muscle wall causing a lump.

Most hernias occur within the abdomen, in a number of different sites.

Common hernias are:

• epigastric (top of abdomen)
• umbilical (belly button)
• inguinal ( groin)
• incisional (related to previous surgery)
• major ventral (large hernia of the front of the abdominal wall, requiring a major repair with mesh)

Hernia repair surgery involves returning the displaced tissues to their proper position. In most hernia repairs a mesh patch is sewn over the weakened region of tissue.

Ros is happy to undertake all different types of open hernia repair and will meet and explain what is involved with diagrams to explain.

Some hernia repairs will be covered by ACC if related to trauma and Ros and her team can work through the process of involving ACC with you.

Breast

Finding a breast lump is a scary event for anyone and can feel quite overwhelming.

Fortunately, the majority of lumps will not turn out to be cancerous, however early assessment by a specialist to ensure this is key.

Ros is skilled at managing both benign (non-cancer) breast disease, as well as the workup, diagnosis, and surgical management of breast cancer and pre-cancer.

After completing her training as a General Surgeon, Ros  did a further  2-year breast fellowship, focusing on breast preservation and remodelling to ensure that whenever possible the breast can be preserved with the best cosmetic result.

 In some instances of cancer, it is not possible to save the breast and a mastectomy (removing the entire breast) is required.

In these cases, discussion around the possibilities of either immediate or delayed reconstruction will be had. 

Ros works closely with Chris Adams, a Plastic Surgeon from Wellington Plastic Surgical Institute and Hutt Hospital, who sees Nelson patients in Nelson and Wellington every month.  They often operate together in cases requiring reconstruction.

Ros set up the first multidisciplinary meeting  (MDM) for cancer in the Top of the South back in 2008. All patients with questionable clinical findings, abnormal imaging, or proven cancer are discussed at this meeting which happens weekly. 

The  MDM team includes pathologists, surgeons, radiologists, oncologists, a breast physician,  as well as specialist breast nurses.

This ensures that all the local experts in the field of breast disease have reviewed the case and all perspectives are explored as part of the decision-making.

This allows Ros to help navigate her patients through the patient-focused shared decision-making they have to undertake. 

Following surgery, you will be rediscussed at the MDM to make an ongoing plan.

In Breast cancer patients there is sometimes a need for radiotherapy or chemotherapy and Ros will refer you for this and liaise with other specialists.

Following your treatment, Ros will monitor you with regular follow-ups over the next few years and arrange ongoing imaging surveillance and medical therapies.

Thyroid Surgery

What and where is the Thyroid Gland?

The thyroid gland is an endocrine organ in the midline of the neck, just below the Adam's apple.

The thyroid makes and stores hormones that help regulate the heart rate, blood pressure, body temperature, and the rate at which food is converted into energy. Thyroid hormones are essential for the function of every cell in the body.

It consists of a right and left lobe joined across the front of the windpipe by a strip of thyroid tissue, the isthmus.  

Thyroid Surgery

Many thyroid problems can be treated with medication, and Endocrinologists manage most medical thyroid disease.

Sometimes surgical removal of the thyroid is required.

Common reasons to operate are::

• Thyroid tumour. Benign and malignant ( cancerous and non cancerous )
• Symptomatic goitre- pressure symptoms such as hoarse voice, swallowing difficulties, and breathing difficulties
• A thyrotoxic gland (hyperthyroidism) that cannot be controlled with medication or radioactive treatment.

Thyroid surgery can involve the removal of half (Hemithyroidectomy) or all (Total Thyroidectomy) of the thyroid gland.

The workup for surgical thyroid disease usually involves a Thyroid Ultrasound, (USS) and sometimes a needle test  (Fine Needle Aspiration (FNA)).

Ros is skilled at bedside thyroid  USS and FNA. She can perform these tests in her clinic room, allowing her to give you immediate diagnostic information. 

On occasions, a formal ultrasound by a radiologist will be required to clarify the risk of an individual nodule (lump) in the thyroid. This will be arranged by Ros with Pacific Radiology.

Parathyroid

What and where are the Parathyroid Glands?

The parathyroid glands are small, oval-shaped glands, the size of a lentil. They are located behind the thyroid gland posteriorly in the neck. Their position is very variable. Parathyroid glands produce parathyroid hormone ( PTH), which plays a key role in the regulation of calcium levels in the blood. Normally, the glands release just enough PTH to keep calcium levels normal. Disease can upset this balance.

Parathyroid Surgery

Parathyroid surgery is indicated when a patient develops Hyperparathyroidism.

Hyperparathyroidism is a condition in which one or more of your parathyroid glands become overactive and release (secrete) too much parathyroid hormone (PTH). This causes the levels of calcium in your blood to rise. (hypercalcaemia),

Left untreated, high levels of calcium in the blood can lead to a range of problems.

The most common symptoms are:

• fatigue
• depression
• memory loss
• bone aches and loss of bone density
• kidney stones and deterioration of kidney function

The commonest reason for this overproduction is a single benign adenoma. Less commonly it is gland hyperplasia (enlargement of all the glands), or very rarely a carcinoma.

The mainstay of treatment for this disease is the surgical removal of the faulty gland or glands.

The workup for parathyroid surgery involves a special type of CT to try to assess which gland is causing the issue and to minimise the extent of surgical exploration.

Ros will organise this through Pacific Radiology.

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