Breast cancer – should we offer risk reducing medications?

26th September 2019. Dr Chee L Khoo

We put patients at high risk of cardiovascular events on statins as primary prevention. We sometimes put patients with high risk of cerebrovascular disease on aspirin to prevent strokes. What about patients who are at high risk of breast cancer? Now, these are not patients who already had breast cancer. We are talking about patients who have not had cancer but are at higher than average risk of developing breast cancer.…

Is the incidence of Coeliac Disease really increasing?

26th September 2019. Dr Chee L Khoo

Everyone seems to be worried about coeliac disease (CD) these days. Everyone else is on a gluten free diet anyway. The naturopaths are also homing in on this bandwagon. How accurate are those blood tests? Or to be specific, what is the specificity and sensitivity of the serological screening tests? Why do we still need a duodenal biopsy?…

A patient with complex, advanced stage type 2 diabetes – where do we start?

14th September 2019. Dr Chee L Khoo

We all have patients similar to this presenting to the practice not that infrequently. This is a real case that I came across just recently. Joanne was referred to the practice by a friend of a friend. She had just been discharged from the local hospital after three weeks following amputation of the lateral two toes of her right foot.

Immune check point inhibitors, microbiome and antibiotics

13th September, 2019. Dr Chee L Khoo

Checkpoint molecules are key regulators of the immune system. These checkpoint molecules are expressed by T cells and are essential for maintenance of immunological tolerance by preventing the unimpeded activation of T cells. Tumour cells capitalise on these checkpoint molecules to protect themselves from attacks by the immune system. Checkpoint therapy block inhibitory checkpoints, restoring immune system function.…

Double diabetes means double jeopardy

10th September 2019. Dr Chee L Khoo

Have you noticed that most patients with type 1 diabetes (T1D) are not only small and petite but are often devoid of muscles when diagnosed. Insulin is a growth factor and without endogenous insulin, muscle growth is often stymied. We can’t push insulin therapy too hard because it will result in hypoglycaemia. Patients with T1D generally have normal lipids (especially triglycerides) and don’t have elements of metabolic syndrome.…

Pancreatic cancer screening – why are we not there yet?

10th September, 2019. Dr Chee L Khoo

Let’s face it. We all dread the diagnosis of pancreatic cancer in any of our patients. There aren’t too many red flags that we can rely on to warn us that something is not right with this deep seated abdominal organ. Many of the symptoms are either subtle or non-specific like nausea, intermittent epigastric pain, nausea, weight loss, loss of appetite or back pain.…

DOMTRU GP Diabetes Injectable Workshop Masterclass 2019

It’s here again. The DOMTRU GP Diabetes Injectable Workshop Masterclass will be held at Mercure Hotel, Liverpool on Sunday 10th November with a totally new agenda. Over the last 12 months we have presented numerous articles detailing the multiple trials and guidelines surrounding the usage of the new GLP1-Ras and insulins. There are now 5 different GLP1-Ras in Australia all with their different pharmacokinetics, cardiovascular outcome data and PBS listings.…

Pain Management – getting straight to the point

Spectrum Medical Imaging, Liverpool

Different surgical procedures are used to treat patients who do not improve with non-operative therapies. Rapid deterioration is uncommon and symptoms often wax and wane or gradually improve. Surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.…

Psst! Wanna fly for free?

28th August 2019, Dr Chee L Khoo

Now, most of us travel overseas a lot. We have already seen how to get lounge access in a previous article. It would be nice if you could also use your frequent flyer points during peak season and fly for free as well. What if you don’t have enough points? Well, what if I can get you more points for free so that you can use those points to fly for free.…

Lipid guidelines – what’s new in 2019?

23rd August 2019, Dr Chee L Khoo

Remember we used to have lipid targets for patients with diabetes and patients with cardiovascular disease. Life was simple then. Just follow those numbers. Then the 2013 ACC/AHA guidelines told us to throw away those targets and put everyone with cardiovascular (CV) risk above a certain figure on maximally tolerated statins. It’s kind of set and forget strategy.…

Adding ezetimibe to statins in the elderly – should we bother?

13th August 2019, Dr Chee L Khoo

Although persons 75 years or older account for 6% of the population, they account for more than 65%of all deaths due to cardiovascular disease (CVD) (1). We know from numerous trials that intensive treatment to reduce lipid levels reduces CV events in patients after they have an ACS (2). What about elderly patients (>75 years old)?…