MERRY CHRISTMAS FROM PONTE VEDRA BEACH FLORIDA

                                                          THE STOWERS FAMILY

A KIWI CHRISTMAS IN FLORIDA

                     Our second year celebrating christmas in Florida while living in New Zealand.

Valitin Fuster's Cardiology Symposium NYC

Pahutukawa New Zealand's Christmas tree

           The Pahutukawa are in bloom it's Christmas time and all is well in New Zealand!

The Rolling Stones 50 Years On Tour

FUN NIGHT OF ROCK AND ROLL IN AUCKLAND AT MT. SMART STADIUM WITH   FIREWORKS DURING THE ENCORE. MAY BE THE LAST TIME THE STONES PERFORM LIVE AND I WAS THERE.

Son's First Rainbow Trout

     Fly fishing on the Mohaka river during labor day weekend at Poronui Lodge near lake Taupo.

Farewell Spit

                                   Cape Farewell the northern most point of the North Island

                                       My son Jeffery jumping his way through New Zealand

GOD DEFEND NEW ZEALAND - Short version

FIRST TIME VOTING IN THE NATIONAL ELECTION

ALL BLACKS VS AUSTRALIA AT EDEN PARK

Had the opportunity to take my wife Bonny and my son Jeffery to the holy shrine of New Zealand rugby Eden Park in Auckland. We saw a rugby clinic put on by the All Blacks as they thrashed the Australian Wallabies 51-20 to win the Beldisloe Cup.

New Zealand Residency

Atrial Septal Aneurysm with Large PFO on Bubble Study

55 year old with no risk factors for stroke presents with right hemianopia, some right hand clumniness and expressive and receptive dysphasia. CT of the brain confirms left middle cerebral ischemic stroke. Transthoracic 2D Echo demonstrates a atrial septal aneurysm with a large patent foram oval.

                                   Bubble study shows large right to left shunt across the PFO.
Patient was started on warfarin and will undergo percutaneous closure of the PFO with Amplazer occluder device under TOE guidance in Wellington.

HOME FOR A WEDDING AND GRADUATION

                                    Yippee ci yo from daughter Kirsten's new home in Texas!!

                                             Jeffery youngest sons graduation CU Boulder

                                               The whole family out for graduation brunch.

                               Group of Kiwi's we met at my sons graduation in Boulder, Co.
                                With Amen my former consultant at Palmerston North Hospital.

                                               Niece Ashley and Ron at wedding in Conn.

                                                                    The happy couple

                                                                    Ron and Marilyn

GOLF IS BETTER IN NEW ZEALAND!!!

                                             Hole overlooking the cliffs at Cape Kidnappers
New Zealand golf is laid back uncrowded and involves some spectacular scenery. Your partner holds your score card and you hold his. No mulligans or gimme putts but a very low key relaxed good natured atmosphere. So come to the land of the long cloud and experience kiwi golf. Kia Ora!

CARDIAC TAMPONADE AND EMERGENCY PERICARDIOCENTESIS

Since moving to New Zealand I have become very impressed by the number of cases of cardiac tamponade that require emergency pericardiocentesis. From malignant effusions, misplaced surgical staples, to post op valve replacements this is a essential life saving skill that all cardiologists here need to develop. I would like to present a case that I was involved in of a middle age man from who presented with breathlessness cardiomegaly, left upper lobe apical mass and a left pleural effusion.

On exam the patient was short of breath had a systolic blood pressure of 90mm with a 15-20mm pulses paradox. The patient had a urgent 2D Echo which demonstrated a large pericardial effusion with collapse of the right ventricle in diastole.  

The patient was taken urgently to the procedure room and elevated to a 30-45 degree angle 2 D Echo of the 5th intercostal space left parasternal view demonstarted a acceptable location for paricardiocentesis. The area was sterilized with antiseptic cleaning fluid and sterile drape applied. After local anesthesia with 2% lidocaine a pericardiocentesis needle was inserted anteriorly into the pericardium after again confirming on ultrasound that this was the optimum location. Bloody fluid was withdrawn while continuously pulling back on the syringe. The syringe was disconnected from the  needle and bloody fluid was dripped on a cloth 4x4 to confirm in did not clot. A soft-tipped guide wire was then inserted and the needle withdrawn. A small incision was made over the entry site and a dilator catheter is inserted to enlarge the track. A multiple side-hole pigtail catheter was then inserted and the guide wire removed. Multiple 20cc syringes were then used to withdraw over a liter of bloody pericardial fluid.

Samples of pericardial fluid were sent for analysis cytology, C&S and biochemistry etc. There was marked improvement in the patients blood pressure and 2D Echo confirmed nearly complete resolution of the pericardial effusion. The pig-tail cannula was sutured in place and connected to a negative pressure vacuum. It is important to leave the drain in until the drainage from the pericardium stops. There is roughly a two liter capacity of the pericardium so until you drain more than two liters of pericardial fluid you should not be concerned about further accumulation of pericardial fluid. When the pericardium is dry the patient will start to develop discomfort from the pericardial drainage tube.

The patient became completely asymptomatic and was able to walk out of the hospital 3 days later.
Cytology of the pericardial fluid unfortunatley returned positive for adenocarcinoma. We all felt we had saved this man by our prompt actions and had given him a few more weeks or months of quality time with his family. Kia Ora from New Zealand!
PS: Don't try to drain traumatic pericardial effusions without a Heart Surgeon being present!

Doubtful Sound

                                                           Sunset over Doubtful Sound
      Doubtful Sound was our second adventure in Fiordland. It is much larger than Milford Sound and    
       is much harder to get to. We flew to Queenstown in the early light of Friday morning.
      We rented a car in Queenstown and drove 2 hours to Te Anau. The next day we got on a boat and            
       went across Lake Manapouri to the power station and boarded a bus to Doubtful Sound. In
        Doubtful Sound we were greeted by the crew of the Fiordland Navigator for our overnight
        cruise.

Fiordland Navigator

Kayaking

Swimming

Doubtful Sound is deep in the wilderness and we were able to see a large colony of Fur

Seals and Fiordland Crested Penguins.

Doubtful Sound was a ever changing landscape. From a brilliant red, orange and blue sunset to a morning mist with water like glass and clouds hanging over the mysterious mountains.

Doubtful Sound was a four day adventure opposed to the four hour adventure on Milford Sound.

Kia Ora from the South Island of New Zealand!

Fiordland, Milford and Doubtful Sound

Milford Sound from 10,000 feet.

                                                  Early morning kayakers on Doubtful Sound.
Fiordland is a World Heritage site that is the home to the renowned Milford Sound and Doubtful Sound. It is located in the south-western corner of the South Island. Bonny and I took our daughter Kirsten and Julian to visit Milford Sound last month. We flew there on a beautiful day with clear blue skies from Queenstown over snow filled glaciers to Milford Sound Airport.

Boarding Air Milford in Queenstown.

Helicopter landing on glacier below us.

Flying between the snow capped mountains.

Arriving at Milford Sound.

                                                           Mitre Peak on Milford Sound

                                       Waterfall cascading down the cliffs into Milford Sound

                                                       Kirsten and Julian under the falls.

                                       Flying past cruise ship on return flight to Queenstown.                                       What a wonderful day roundtrip flight over snow capped mountains and glaciers with a boat cruise down Milford Sound all in just over four hours. One of the highlights of our year in New Zealand!
     Kia Ora and on to Doubtful Sound our next adventure in the South Island of New Zealand.



















                                                                                                                         

JUMPING OFF A MOUNTAIN IN QUEENSTOWN

Woke up Sunday morning and decided to take my daughter Kirsten up a mountain and jump off.

Kirsten's 24 and visiting us from Austin, Texas with her boyfriend Julian. She is taking a break before starting on her masters degree in advertising at the University of Texas. She had just gotten a GOPRO

and wanted to do something adventurous that she could film. We signed up with GFORCE paragliding and met Ricardo and Brandon our pilots and prepared for our launch off the mountain.

                  Unfolding the chute and getting into our harness for launch off the mountain.

Step,step,step run and you're airborne!

Flying high above lake Wakatipu.

Pure joy gliding over the mountains!

Banking hard right into a turn.

Flying over the evergreen forrest.

Coming in for a landing.

What a wonderful experience to have with your love ones. Pure exhilaration gliding through a brilliant blue sky.

Come to New Zealand and we will take you to jump off a mountain!

Kia Ora from the adventure capital of the world.