GP Voice

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“Health, performance and conduct concerns among older doctors” – A set up in progress?

April 15, 2018,  Dr Chee L Khoo

If it was a headline conclusion in any other medical publication, we would be combing the study looking for holes, validity, statistical significance and clinical relevance. We would be checking that the conclusions drawn were correct and valid conclusions that arose from the data. But when it was the Medical Board which released the headline, most of us, kind of, accepted the conclusions of the study without questions.…

Prostate Cancer – to screen or not to screen

April 15, 2018, Dr Chee L Khoo

Last fortnight we review the PI-RADS score in relation to prostate MRI and i thought we might go through a real case study and how it relates to general practice. Otherwise well 42 year old gentleman with no family history of prostate cancer or any other hormone related cancers presented for general check-up in 2011  in addition to the usual coughs and colds.…

Getting T2D to target – two heads better than one

April 15, 2018, Dr Chee L Khoo

To get our patients with type 2 diabetes (T2D) to glycaemic target using oral agents,  you can either use an SGLT2 inhibitor (SGLT2i) or a DPP4 inhibitor DPP4i) after metformin (with or without a sulphonylurea) but not both. If you stop a DPP4 inhibitor to start a SGLT2ior vice versa, in general, the HbA1c remain unchanged.…

Metformin in pregnancy – where are we now?

April 2018, Dr Chee L Khoo

Another day, another study published on the good or bad about metformin use in pregnancy. There is a lot of confusion and unknowns about the benefit or safety of metformin to the mother-to-be or to the long-term outcome of the baby. When there is a lot of conflicting data coming our way, we need to sit back and look at the overall picture of hyperglycaemia in pregnancy and its management before we can make sense of these studies.…

Complementary vs Conventional Medicine – it doesn’t have to be like that!

April 2018, Dr Chee L Khoo

The term complementary medicine refers to a group of diagnostic and therapeutic disciplines that exist largely outside the institutions where conventional health care is provided and taught. The wide range of disciplines classified as complementary medicine makes it difficult to find defining criteria that are common to all.

In Germany, a significant proportion of doctors have additional qualifications in chiropractic, homeopathy and naturopathy.…

Multi-disciplinary care of T2D – does it work in primary care?

April 2018, Dr Chee L Khoo

Multi-disciplinary care (MDC) is often hailed as THE comprehensive management for patients with type 2 diabetes (T2D). We refer these patients to podiatrists, exercise physios, dietitians, diabetes educators and sometimes, endocrinologists. Now, that is MDC, isn’t it? We are part of the MDC team. Do we see the benefit that is often hailed from MDC?…

Ketosis may improve glycaemic control – can we use it in T2D therapy?

April 2018, Dr Chee L Khoo

Ketogenesis is the production of ketone bodies (KB) when glucose levels decline and the glucagon:insulin ratio is high. When the body is deprived of glucose, KB act as an alternative fuel source for brain, heart, kidneys and skeletal muscles. KB have also been shown to have other physiological functions including lower glucose levels.

To understand the potential therapeutic implications of KB, we need to revise our knowledge about KB metabolism.…

Prostate MRI – A case study

A 60 year old man presents with a rising PSA despite several previously negative transrectal prostate biopsies. A prostate MRI demonstrates a circumscribed small region of low T2 signal intensity within the left lateral peripheral zone at the gland base. This region demonstrates moderately restricted water diffusion and avid early enhancement after intravenous contrast. This appearance is consistent with a region of high grade prostate cancer.…

A GP guide to understanding prostate MRI – the PI-RADS scoring system

April 2018, Dr Chee L Khoo

Forget about whether PSA screening saves lives or not. What is the next step when a PSA level comes back elevated. Obviously if the PSA is >10 or much higher, they need referral to a urologist for biopsies. What if it is trending high or is significantly higher than the age related reference range? Patients are increasingly having prostate MRIs performed the results are reported as PI-RADS scores.…

Statins and Muscles – worse than we think

March 15, 2018,  Dr Chee L Khoo

“Doc, my muscles feels tired every time I try to exercise”. Are these patients just unfit or is it the statin or is that just another excuse? Between 7-29% of patients on statins report muscle complaints (depending on who reports them). Often these symptoms are exacerbated with physical activity and exercises. Muscle soreness, muscle pains and muscle tenderness are probably relatively easier to quantify in patients but non-specific muscle fatigue are much harder to pin down.…

Metformin during pregnancy – Goldilocks principle strikes again!

March 15, 2018 Dr Chee L Khoo

Hyperglycaemia during pregnancy has significant metabolic consequences for the mother, the pregnancy as well as for the offspring’s future health. It is tempting to assume that keeping the glucose lower during pregnancy must be beneficial for both parties. Metformin has been used in women with PCOS, GDM and obesity during pregnancy in an attempt to improve pregnancy and foetal outcomes but this practice is not based on solid scientific evidence.…

Image Guided Glucocorticoid Injections – What goes where?

In the last issue of GPVoice we read about the what sub-type of spinal stenosis might benefit from glucocorticoid injections.  Apart from spinal stenosis, there are many other joints, bursa or soft tissue that may benefit from glucocorticoid injections. It can sometimes be confusing as to what joints or soft tissue may be amenable to injections and what modality of imaging may assist the injections.…

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