Bloody nipple discharge – a cause for concern?

14th January 2023, NIA Diagnostic Imaging

Despite the availability of modalities such as mammography, MRI and galactography, ultrasound still has a role in breast imaging. Ultrasound provides high resolution portrayal of normal and abnormal breast parenchyma as well as clear depiction of lactiferous ducts and the terminal duct-lobular unit where masses can form (4). This is particularly useful when investigating women presenting with a bloody nipple discharge.…

NAFLD vs MAFLD – what’s in a name?

4th January 2023, Dr Chee L Khoo

steatosis

The term non-alcoholic fatty liver disease (NAFLD) was first coined by Ludwig in 1980. It was rather an exclusive diagnostic term to exclude the other liver disease from being included in the definition. If your liver disease relates to excessive alcohol intake, drugs or autoimmune conditions, it cannot be included in the diagnosis.…

Colorectal cancer – is aspirin any good in prevention?

CRC

4th January 2023, Dr Chee L Khoo

The most recent US Prevention Services Task Force (USPSTF) recommendations pour cold water onto its use in primary prevention of CVD in April 2022 (1). We explored the details and rationale behind that turnaround recently. The recommendation for use of aspirin for prevention of colorectal cancer is lumped in together with the recommendation for CVD prevention.…

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.…

Denosumab – how long can you be on it for?

24th December 2022, Dr Chee L Khoo

There have been a number of contentious safety concerns regarding the prolonged used of denosumab. The original FREEDOM trial demonstrated efficacy in reducing vertebral, hip and femoral fractures over 3 years of denosumab therapy. There was a further 7 years extension to the original trial and the report was published last year. There were some suggestions a few years ago that patients might, perhaps, need a drug holiday after 5-10 years on denosumab but there is increasing evidence of rapid reduction in bone densitometry (BDM) after denosumab is stopped.…

Coronary artery calcium score – more than just a score

18th December 2022, Dr Chee L Khoo

CAC score

Making a decision whether to treat patients with lipid lowering agents is relatively easy in patients who either have symptomatic cardiovascular (CV) disease or have a very low risk according to our CV risk assessment. It is a bit more difficult in the intermediate CV risk group. We have to consider the cost and adverse effects of initiating lifelong preventive therapy versus the potential benefit to the patient.…

Pelvic pain in first trimester – differential diagnosis

13th Decemer 2022, NIA Diagnostic Imaging

Pelvic pain

Pelvic pain is a common presentation in general practice. It becomes a little bit more complicated if that occurs during the first trimester of pregnancy. To the usual gynaecological and non-gynaecological causes, we have to add the other obstetric causes of pelvic pain. The obstetric causes during the 1st trimester can be a serious concern and should be treated as an urgent matter.…

Elevated Lipoprotein a – what are the treatment options?

12th December 2022, Dr Chee L Khoo

We explored lipoprotein a (Lp(a)) as a significant residual risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis in August this year. We looked at the strong and log-linear association between elevated Lp(a) and cardiovascular (CV) events. While the new PCSK9 inhibitors, notably alirocumab, has been shown to modestly reduce Lp(a) levels (and is associated with a small reduction in CV events) in the ODYSSEY trials, we do not have any agents that specifically lower Lp(a) approved yet (1).…

Lecanemab for early Alzheimer’s – does it really work?

11th December 2022, Dr Chee L Khoo

You would have heard the exciting hype about lecanemab in the treatment of early Alzheimer’s disease. It’s all over the news and it is getting many patients excited. The Alzheimer’s disease community has become accustomed to false hope, disappointment, and controversy. Existing “treatments” of AD can hardly be called treatment as they can only slow down the progression of the disease (if it indeed work at all).…

Knee MRI under Medicare – who qualifies?

1/12/2022, Spectrum Medical Imaging

We all see lots of knee problems in general practice. History and examination obviously is important but it will be nice to have confirmation in cases where there may be dual pathology. MRI of knee is an excellent tool which can confirm and exclude various soft tissue injuries which makes a significant difference in their prognosis and management.…

Can low carb diet work in your practice?

24th November 2022, Dr Chee L Khoo

low carb

One of the problems in primary care in trying to keep up to date is that 1) there is just so many guidelines we need to keep track of 2) we don’t when the new guidelines are updated. It is often mentioned that, on average, it takes 16 years when guidelines are published before it lands on our desk and be adopted in practice.…

HF management in general practice – do we have to wait for the cardiologist?

21st November 2022, Dr Chee L Khoo

Have you noticed that we don’t use the term “CCF” anymore. The heart doesn’t have to be congested (as in fluid overloaded) to be in failure. We think about how the heart is not performing to its best to pump blood to all parts of the body that requires bloods. We call that heart failure because the heart has “failed” to pump blood adequately to tissues requiring blood.…