Deleting ECG item numbers in primary care – whose idea was it?

27th July 2020, Dr Chee L Khoo

GP: the brains behind ECGs

Just pause and think for just one minute. Over the last 12 months, how many atrial fibrillations have you picked up incidentally on ECG? How many silent old acute myocardial infarct have you seen on ECG in a patient with diabetes? How many ST and T wave changes have you seen on ECG which suggest ischaemia which requires further investigations?…

Medical Nutritional Therapy – why are you not prescribing it?

26th July 2020, Dr Chee L Khoo

Whenever we think about management of hyperglycaemia in patients with type 2 diabetes (T2D), we usually think about the most efficacious hypoglycaemic agent we can find (and on the PBS). If you look carefully at most management guidelines, lifestyle measures appears at the very top of the algorithm, side by side metformin. Sadly, it is often not the most prominent and usually, dismissed as an important part of the treatment algorithm.…

Goose foot – how many “toes” does the goose foot have?

20th July 2020, Dr Chee L Khoo

Figure 1

This is not a riddle. I often ask my medical students and patients this question and they all look at me strangely. How does this relate to medical science? Of course, we are talking about pes anserinus (PA). For those of you who remember your anatomy, PA relates to the 3 tendons that are attached to the medial aspect of the knee.…

GLP-1 agonists – now we have 5

12th July 2020, Dr Chee L Khoo

One month ago, we discussed Ozempic®(semaglutide) as the new GLP-1 agonist kid on the block in the treatment of hyperglycaemia in patients with type 2 diabetes (T2D). We foreshadowed that it will be coming real soon. Well, sooner than I thought. Ozempic® went on the PBS on the 1st July. What we didn’t know was what the restrictions will be when prescribing for patients with T2D.…

National Immunisation Program – a GP-friendly look at the changes

11th July 2020, Dr Chee L Khoo

Another month, another change to the immunisation schedule. You must have heard about the major changes to schedule from 1st July. There are changes to who should get the pneumonia vaccines and which pneumonia vaccine they should get under the National Immunisation Program (NIP). Oh, that is, if they don’t run out of stocks again.…

Abbreviated breast MRI – how useful is it?

8th July 2020, Spectrum Radiology

Adjunct screening with dynamic contrast-enhanced (DCE)-MRI was first recommended for women at high (>20%) lifetime risk of breast cancer, facilitating earlier cancer detection and reducing interval cancers. Even in women at average risk of breast cancer, there is evidence that they might also benefit from screening MRI.

Apart from the cost of MRI equipment, other costs include the relatively long acquisition, limiting high-volume patient throughput and interpretation times involved in a full diagnostic protocol.…

Diabetic foot ulcers – out of sight, out of mind?

29th June 2020, Dr Chee L Khoo

diabetic foot

One in three patients with diabetes will develop diabetic foot ulcers (DFU). This typically occurs in the setting of peripheral artery disease, peripheral neuropathy and trauma. Foot ulcers invariably leads to lower extremity amputation (LEA) and both are associated with significant morbidity and mortality. We know that poor glycaemic control contributes to the development of DFU and LEA.…

T1D & T2D – different beginnings, same fate?

28th June 2020, Dr Chee L Khoo

In type 1 diabetes (T1D), the β-cell die rapidly from a massive immunological assault and practically all the β-cells are quickly lost and hence, there is an absolute deficiency of insulin secretion. Using auto-antibody screening, we can define T1D. Do you realise that we don’t actually have a definition for type 2 diabetes (T2D).…

Covid-19 – should the healthy public wear face mask or not?

13th June 2020, Dr Chee L Khoo

We are not talking about whether front line workers should wear a mask or not. We are talking about masks for the general public. Even as medical practitioners, we are confused. How does the average member of the public decide whether to wear masks or not? There are so many different opinions from numerous different quarters.…

Ozempic – another GLP-1 agonist coming real soon

12th June 2020, Dr Chee L Khoo

Whenever there are multiple brands of the same class of drugs on the market, one always wonder whether the new kid on the block is a “johnny-come-lately” trying to break into an already crowded market with yet another drug or it’s really a new kid with much better credentials. We already have 4 GLP-1 agonists in Australia and now a fifth one will be out real soon.…

Homocysteine & MTHFR polymorphism – are they related?

12th June 2020, Dr Chee L Khoo

Like me, you probably have come across homocysteine, methionine and MTHFR gene polymorphism from time to time and are aware of some connection between those things and cardiovascular disease but not quite sure how to connect them together. Which patient should we be checking homocysteine levels in? What about the MTHFR gene polymorphism?…