24th November 2022, Dr Chee L Khoo
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.…
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.…
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.…
14th November 2022, Dr Chee L Khoo
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.…
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.…
28th October 2022, Dr Chee L Khoo
It’s great that we have so many glucose lower agent classes that helps get our patients’ glucose to target. But no matter how powerful these agents are, patients have to keep to some form of a diet. I always tell my patients “no matter what medications I put you on, I cannot compete with your diet”.…
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.…
28th October 2022, Dr Chee L Khoo
Point-of-Care Testing (POCT) is defined as laboratory testing conducted close to the site of patient care, typically by clinical personnel whose primary training is not in the clinical laboratory sciences, or by patients (self-testing). In theory, POCT which produce results within minutes can assist in management of a number of chronic diseases. It could be useful in patients whose adherence to appointments is often an issue or in patients who are time poor and would prefer to attend the practice as infrequently as possible.…
23rd October 2022, Dr Chee L Khoo
The UKPDS 33 demonstrated that intensive glucose control had significant microvascular benefits over a 10-year period in patients with newly (< 6 years) diagnosed type 2 diabetes (1). Overall, there was a trend towards macrovascular benefits during that period but did not reach statistical significance. The participants were followed up for another 10 years after the study was published in 1997.…
13th October 2022, Dr Chee L Khoo
Obesity, type 2 diabetes mellitus (T2D), fatty liver disease, and cardiovascular disease (CVD) are complex and very inter-related cardio-metabolic conditions. Most of these conditions have lipids derangements as a major contributor to complications. While the link between lipids, in particular LDL-C, and CVD is linear and robust, there is still residual risks after aggressive treatment with lipid lowering agents.…
13th October 2022, Dr Chee L Khoo
Patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) are not only more likely to progress towards renal failure requiring dialysis or renal transplant, but also have a greater lifetime risk of cardiovascular (CV) morbidity and mortality (1). This is not surprising though, as both the kidneys and the heart share the same pathophysiology.…
28th September 2022, Spectrum Medical Imaging
Injections around joints, tendons and bursa can be tricky. Unless you are trained to know where to insert the needle, it is all a hit and miss. If the patient doesn’t respond to the injection, you really don’t know whether it didn’t work or because it was not in the right spot. That’s when image guided injections come handy.…