April 2018, Dr Chee L Khoo
Forget about whether PSA screening saves lives or not. What is the next step when a PSA level comes back elevated. Obviously if the PSA is >10 or much higher, they need referral to a urologist for biopsies. What if it is trending high or is significantly higher than the age related reference range? Patients are increasingly having prostate MRIs performed the results are reported as PI-RADS scores.…
March 15, 2018, Dr Chee L Khoo
“Doc, my muscles feels tired every time I try to exercise”. Are these patients just unfit or is it the statin or is that just another excuse? Between 7-29% of patients on statins report muscle complaints (depending on who reports them). Often these symptoms are exacerbated with physical activity and exercises. Muscle soreness, muscle pains and muscle tenderness are probably relatively easier to quantify in patients but non-specific muscle fatigue are much harder to pin down.…
March 15, 2018 Dr Chee L Khoo
Hyperglycaemia during pregnancy has significant metabolic consequences for the mother, the pregnancy as well as for the offspring’s future health. It is tempting to assume that keeping the glucose lower during pregnancy must be beneficial for both parties. Metformin has been used in women with PCOS, GDM and obesity during pregnancy in an attempt to improve pregnancy and foetal outcomes but this practice is not based on solid scientific evidence.…
March 15, 2018
Dr Jenny James
General Practice Drug and Alcohol Advice and Support Service
The Opioid Treatment Accreditation Course is currently being restructured by the University of Sydney, Discipline of Addiction Medicine. The new format training is expected to commence by 1 June 2018.
As a measure to manage the waiting list for accreditation training, an interim course is being be offered.…
March 2018, Dr Chee L Khoo
Several meta-analyses of randomised clinical trials showed that ketogenic diets induce a long-term significant improvement in body weight, diastolic blood pressure, triglycerides and HDL-cholesterol, when compared to low fat diets. However, rapid weight loss may cause a transient rise in plasma triglycerides which can contribute to impairment in cardiac function in the short term.
The heart has a very high energy demand, which is met almost entirely by the mitochondrial oxidation of fatty acids and carbohydrates.…
March 2018, Dr Chee L Khoo
We all know a bit about d-dimer. We all know that it can be a useful marker for the diagnosis of venous thromboembolism (VTE). It can be used to guide the optimal duration of anti-coagulation in VTE. It is also useful in assessing the risk of recurrence in patients who already had a VTE event especially in patients with cancer.…
February 2018, Dr Chee L Khoo
“Doc, is there a test for cancer?” I’m sure you have many a patient asking for a blood test to screen for cancer. Some of you may be tempted to order a CEA or a CA-125 without being familiar with their sensitivities and specificities (that’s another story on another day). An international group of researchers recently described a blood test, called CancerSEEK which purportedly can detect eight common cancers.…
Patients with diabetes commonly have significant dysfunction of the immune system leading to chronic inflammation in many organ systems. It is not uncommon to see patients with T2D suffering from oral and periodontal disease which has been shown to worsen the diabetes disease. What is less known but shown in many studies is that periodontal disease is associated with development of diabetes. …
February 2018, Dr Chee L Khoo
It’s frustrating isn’t it when managing patients T2D. Patients adhere to diet and lifestyle the best they can, the HbA1c is “on target” but yet we have to keep layering more tablets or injections over time to maintain the constantly deteriorating glycaemic control. Can we do better than accepting without question the “progressive nature of T2D”?…
January 2018, Dr Chee L Khoo
GPs from the Fairfield area did us all proud in south west Sydney. They were part of the B Positive Program which demonstrated that with training, increased community awareness and coordination, primary care patients with chronic hepatitis B received anti-viral treatment which was 3X higher than the average uptake in Australia. The pilot program also increased GP and community awareness of Chronic B Hepatitis (CHB). …
November 2017 – Dr Chee L Khoo:
Aortic stenosis (AS) is the most common valvular heart disorder in Australia. About 3% of people >75 yo have AS and most are diagnosed on incidental auscultation of the precordium or when echocardiogram is done for other reasons. The valve progressively narrows over years leading to cardiac failure. Sadly, once symptomatic, AS is rapidly fatal and often valve replacement is necessary.…
Unhealthy eating
We have all been brought up to advise reducing total fat and saturated fatty acid intake, based on the presumption that replacing saturated fatty acids with carbohydrate and unsaturated fats will lower LDL cholesterol and should therefore reduce cardiovascular disease (CVD) events. Several meta-analyses of randomised trials and prospective cohort studies8–10 and ecological studies,2 largely done in European and North American countries showed either no association or a lower risk between saturated fatty acid consumption with total mortality and CVD events.…