Sarcopenia – can we measure it and how bad is it?

10th December 2023, A/Prof Chee L Khoo

Old and weak?

We don’t get old and weak. Actually, if we get weak, we become old. We all see that in practice. It doesn’t matter how old our patient is. When they become weak, they slow down. They can’t walk very far and they don’t. They become weaker and weaker. They have difficulty get off a chair.…

LDL-C – is lower necessarily better?

9th December 2023, A/Prof Chee L Khoo


We know how effective statins are in lowering cholesterol levels. Lowering of cholesterol levels, especially LDL-C, have been shown to incrementally reduce adverse cardiovascular events in patients with atherosclerotic disease. We have data to show that for every 1 mmol/L of LDL-C reduction there is a 23% reduction in cardiovascular events, which means, the lower the better (1).…

Acne – the ABC of management in primary care

27th November 2023, A/Prof Chee L Khoo

Although moderate to severe acne is pretty common in primary care, our management tends to be haphazard. We have our favourite topical and oral therapy but I am not sure that that is evidence-based nor pathophysiological in our approach. When all else fails, we refer on to our friendly dermatologist. I recently attended a brilliant lecture at the Melbourne GPCE presented by Dr Ryan de Cruz, a Melbournian dermatologist.…

Genetic carrier screening on MBS now – what does that mean?

25th November 2023, A/Prof Chee L Khoo

genetic carrier screening

Reproductive genetic carrier screening for cystic fibrosis (CF), spinal muscular atrophy (SMA) and fragile X syndrome (FXS) has become available on the Medicare Benefits Scheme (MBS). Screening for those three conditions is recommended for all couples prior to, or in the early stages of pregnancy. Great but what is this genetic screening all about?…

Precision medicine in diabetes – are we there yet?

30th October 2023, Dr Chee L Khoo


When we think about precision medicine, we usually think about some fancy, expensive genetic tests that can help us determine ahead of time who is at risk of some serious diseases. This may allow us to target these patients early and reduce morbidity and mortality. There is connotation that only the rich in rich countries can afford these tests and once again, patients in low and middle income countries (LMIC) will miss out on these state of the art expensive tests.…

COPD – which puffer/s?

10th September 2023, Dr Chee L Khoo


We looked at the new understanding of the pathophysiology of COPD last fortnight. Armed with that information, we may be able to make sense of which puffer to use for which patient and what to escalate during their exacerbations. We already do that but, I must admit, rather haphazardly. It, kind of, depends on what samples I have in the drug cupboard or when the last pharma rep came to sell their ware.…

That receding hairline – what treatment is best?

Androgenetic Alopecia

13th August 2023, Dr Chee L Khoo

Many of the male doctors are slowly losing the battle against male pattern alopecia. It’s either thinning or receding. For those who are not there yet, it’s coming. We are also seeing women joining the club. Androgenetic alopecia (AGA) is the most common form of hair loss in humans affecting 80% of Caucasian men and 50% of Caucasian women.[1].…

Alzheimer Disease treatment – another kid on the block?

26th July 2023, Dr Chee L Khoo

First it was aducanumab then lecanemab. Now it’s donanemab. All of them purportedly showed statistically significant improvement in clinical outcomes although the “significance” is hotly debated. Although aducanumab was the first to be approved by FDA (June 2021), the limited clinical improvement together with the increased risk of severe adverse effects meant that aducanumab is no longer used these days.…

Anti-platelet therapy with PCI – what do you need to know?

29th April 2023, Dr Chee L Khoo

anti-platelet therapy

We have a increasing number of patients who has undergone a percutaneous coronary intervention (PCI). This could be in the acute setting of an acute coronary syndrome (ACS) or electively during an exploratory angiogram. Stents used to be bare metal. Then came the first-generation drug eluting stents. The latest generation drug eluting stents are better at reducing subsequent thrombosis of the stented and unstented coronary segments.…

Neuropathic pain – what works and what doesn’t?

25th April 2023, Dr Chee L Khoo

We may not have many patients with neuropathic pain but patients with neuropathic pain can be heartsinks. Most of the time, nothing seems to work. It can be quite frustrating when anti-depressants after anti-depressants don’t work. The old tricyclics often don’t work either. What about pregabalin? Nope. What about gabapentin? Nope. What about long-acting opioids or tramadol?…

Familial hypercholesterolaemia – is it really that rare?

9th April 2023, Dr Chee L Khoo

Familial Hypercholesterolaemia

One of the most important contributor to atherosclerosis is elevated cholesterol levels. Familial hypercholesterolaemia (FH) is a genetic disease that manifests as a disorder of cholesterol metabolism by mutations in hereditary genes usually in an autosomal dominant manner.  Data suggest that 1 in 200 Caucasians are heterozygous for FH and that 1 in 160,000–300,000 are homozygous, which are much higher prevalence than those estimated a decade earlier (1).…

Coronary artery calcium score – who do you trust?

29th December 2022, Spectrum Medical Imaging

Last week we explored coronary artery calcium score and looked at how the score is really more than a score. There is a lot more details than just a number in the report. Spectrum also has a team of subspecialist Cardiac Radiologists and Cardiologists who are trained in cardiovascular imaging interpretation. The report has details that allows us to proceed to the next stage of the cardiovascular risk assessment.…