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“Trust me, I am a doctor” – don’t take that for granted!

15th August, 2018, Dr Chee L Khoo

Opinion article 

“Trust me, I’m a doctor” is so universally accepted that we don’t even have to say it. Patients know that they can trust us implicitly. What are we asking patients to trust us with though? The current debate or argument about the pros and cons of opt-in or opt-out with MyHealthRecord may endanger the trust patients have in their doctors.…

Oral glucose tolerance test – what should the 1 hour reading be?

15th August 2018, Dr Chee L Khoo

Diabetes can be diagnosed using a myriad of criteria – fasting glucose >7.0mmol/L, 2-hour post prandial  >11.0 mmol/L or HbA1c > 6.5%. There are limitations to each of those tests and it is not one size fits all. The myriad of diagnostic tests allows clinicians to choose the most appropriate test for our patients based on their individual characteristics.…

Stroke Prevention – are two agents better than one?

15th August 2018, Dr Chee L Khoo

Following an acute coronary event we know that two anti-platelets are better than aspirin alone in preventing further coronary events. What about a cerebro-vascular events? Following a mild CVA or a TIA, we would normally commenced aspirin to prevent another stroke especially in the first 90 days. Would adding another agent to aspirin be better in preventing further strokes?…

The many faces of hypoglycaemia

2nd August, 2018, Dr Chee L Khoo

I first met Jack 14 years ago when he was diagnosed with T2D from an OGTT in 2005. He was a 47 years old then.  He was a busy businessman with no time for exercise and eating out fairly regularly.  His BMI back then was 34.7. He was already on treatment for hypertension and dyslipidaemia.…

Prostatic arterial embolisation – another option for BPH

1st August, 2018, Dr Chee L Khoo

Benign prostatic hyperplasia (BPH) is increasingly more common when men gets older. Transurethral resection of prostate (TURP) is still the gold standard treatment for most patients. Since alpha-adrenergic antagonists (also called alpha blockers) came to market, TURP is performed a lot less often. 5-alpha reductase convert testosterone into 5-alpha-di-hydrotestosterone (DHT), which is responsible for prostate hypertrophy and blocking this enzyme prevents further prostate growth.…

Lynch Syndrome – what GPs need to know

1st August, 2018, Dr Chee L Khoo

Although one third of patients with colorectal cancer (CRC) have a family history of cancer, only 5% of all patients with CRC have an identifiable cause to their cancer predisposition. Most of these identifiable predispositions are inherited mutations in genes that regulate growth processes in colonic stem cells and/or genome caretakers which ensure the only good clean DNA is passed on to the next generation. …

After Metformin, which agent is better?

1st August, 2018, Dr Chee L Khoo

After metformin and sulphonylurea, under the PBS we can choose between a DPP4 inhibitor, an SGLT2 inhibitor, a thiazolidinedione or a GLP1-RA injectable. Because of the potential adverse effects of cardiac failure with thiazolidinedione, realistically, it’s a three horse race. The cost effectiveness of each of the class of agents has not been explored thus far.…

Healthy lifestyles – how useful are they?

1st August, 2018, Dr Chee L Khoo

We all know that unhealthy lifestyles are major risk factors for many chronic diseases and premature deaths. Many studies previously have reported that reduction in these unhealthy lifestyles can lead to increase in life expectancy of between 7.4 to 17.9 years in Japan, UK, Canada, Denmark, Norway and Germany 1-4. It would really be helpful during a consultation with our patients if we can quantify the benefit of these measures on the various chronic diseases and life expectancy.…

Omega 3 oils & CV disease – does it help?

July 15, 2018, Dr Chee L Khoo

I must declare my personal interest in this discussion. I have been taking omega-3 fish oil supplements for years to reduce my triglycerides. I am also on a statin for my hypercholesterolaemia and the fish oil is to treat the residual hypertriglyceridaemia. A recent study confirm the efficacy of this approach1. However, does the addition of fish oil and reduction of triglycerides translate to improvement in cardiovascular (CV) outcomes?…

Diagnosing Diabetes – is one reading enough?

July 15, 2018, Dr Chee L Khoo

Diabetes can be diagnosed if fasting glucose is >7.0 mmol/L, 2 hour post prandial > 11.0 mmol/L and/or HbA1c >6.5. However, clinical guidelines recommend that we repeat testing within a “short period of time” to reduce the possibility of a false positive result. Sometimes, repeat testing may not be possible or not uncommonly, patients may be lost to follow up.…

Gastrointestinal Malignancies in Cystic Fibrosis

July 15, 2018, Dr Chee L Khoo

It’s always sad to lose a patient due to complications of a disease. It’s even harder if the patient is another doctor especially if the disease has well recognised complications. Many of you may have read about the sad story of Dr Rana, known to have cystic fibrosis, who died of complications resulting from an unrecognised bowel obstruction.…

Tamsulosin for renal calculi – does it help?

July 15th 2018, Dr Chee L Khoo

Have you noticed that an increasing number of patients with renal stones discharged from emergency department are prescribed tamsulosin. It makes perfect sense, doesn’t it? Tamsulosin is an alpha blocker and by inhibiting the smooth muscles in the ureter, it facilitates the passage of stone into the bladder. Does it really? It’s logical but is there evidence that it works?…

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