Non-invasive liver elastography – a new era in liver disease assessment

May 15, 2018, Dr Ahmed Mayat (Medical Imaging Campbelltown)

Gold standard for diagnosis and staging of liver fibrosis is liver biopsy.  This is, however an invasive procedure with its associated complications.

Liver Elastography is a simple non-invasive method to assess liver fibrosis.  A special ultrasound pulse measures the propagation speed of sound waves through the liver parenchyma.  This data can be acquired during the normal liver ultrasound examination. …

Hepatitis C treatment in general practice – my first case

May 15, 2018, Dr Chee L Khoo

Kylie was known to have chronic hepatitis c infection for many years. She had been busy for the last 2-3 years being pregnant. We talked about anti-viral treatment as soon as she finished with breast feeding her last baby. She had heard about these wonder drugs curing her hepatitis C infection.

When Kylie was ready, we went through the motions:

Pre-treatment Asssessment – the 6 Cs

  1. Complications of liver disease
  • Co-factors for liver disease progression
  • Signs of liver disease
  • Presence of cirrhosis -consider Fibroscan for any patient with hepatitis C.

CT and US Guided Injections – what goes where for what conditions

Interventional procedures have evolved and improved over time since epidural injection was first introduced for low back pain and sciatica in 1901. One of the major contributors in the improvement of these interventions is the advancement of imaging guidance technologies. The utilisation of image guidance has dramatically improved the accuracy and safety of these interventions.

It is sometimes confusing to know what injections go where for what conditions?…

Opioids or codeine not recommended? What do we do with patients with severe back and leg pains?

May 1, 2018 Dr Chee L Khoo

Chronic, persistent low back, lower extremity pain, and radicular pain may be secondary to disc herniation, disc disruption, disc degeneration, facet joint disease, spinal stenosis, or post lumbar surgery syndrome resulting in disc-related pain with or without radiculitis. The specificity and sensitivity of the symptoms and signs are low and therefore, not as reliable as we think in getting to the precise diagnosis.…

Smoking, alcohol, hot tea and oesophageal cancer – how are they related?

May1, 2018, Dr Chee L Khoo

We all know that smoking and alcohol are associated with increased risk of oesophageal cancer. A recent large study from China looked at 456,155 people and found 1731 esophageal cancers over 9.2 years. They noticed that there was an interaction of hot tea with smoking. Smokers who drank burning hot tea daily had double the risk of oesophageal cancer compared with non-smokers who only occasionally drank tea.…

SGLT2 inhibitor/DPP4 inhibitor combo under PBS – sorting out the confusion

May 1, 2018 Dr Chee L Khoo

When I wrote the article last fortnight about new SLT2 inhibitor/DPP4 inhibitor combo now on the PBS, the situation was still very confused. Since that article, more information has  come to light. Yes, we are allowed to use both DPP4 inhibitors (DPP4i) and SLGT2 inhibitors (SGLT2i) together when patients with type 2 diabetes (T2D) if the HbA1c is >7.0%.…

“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?…