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.…

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.…

Breaking free from osteoporosis

14th November 2022, NIA Diagnostic Imaging

Currently, dual energy X-ray absorptiometry (DEXA) is the gold standard in Australia for the measurement of bone mineral density (BMD). Utilising extremely low radiation and certain analysis such as the patient’s BMI, T-score and Z-score, DEXA can effectively diagnose osteoporosis or osteopenia, enabling managing clinicians to determine the extent of bone loss for clinical decision making, which subsequently helps prevent broken bones.…

Omega-3 supplements – a fishy tale just got more fishy

14th November 2022, Dr Chee L Khoo

fish oil supplements

We all have patients with high triglycerides (TG) that warrant intensification of our lipid lowering treatment. Statins are efficacious in reducing total cholesterol (TC), increasing high density lipoprotein cholesterol (HDL-C) and reducing low density lipoprotein cholesterol (LDL-C). Statins also reduce triglycerides levels but often these patients have residual hypertriglyceridaemia that warrants the addition of a fibrate to get our TG to target.…

Diabetes Foetal Programming – before the beginning…

13th November 2022, Dr Chee L Khoo

Gestational diabetes mellitus (GDM) is one many factors that changes future generations. Maternal overnutrition, and excessive gestational weight gain with or without GDM lead to foetal overgrowth, and “programs” the offspring with an increased risk of obesity and type 2 diabetes mellitus (T2D) in childhood and adulthood. The aetiology of obesity and T2D is multifactorial and involves complex interactions between genetic, environmental and behavioural factors.…

Medicare rebatable angiography – navigating the complex criteria

28th October 2022, Spectrum Medical Imaging

We all know how Medicare makes our life all that much more difficult when they keep changing the rules. This is particularly the case when it comes to ordering angiographic studies. We often have to order angiogram to exclude arterial occlusion or embolism or arterial rupture or dissection. These cases are usually acute and urgent in nature and we don’t have the time to refer them to our favourite specialist colleagues.…