10th September 2023, Dr Chee L Khoo
We looked at the new understanding of the pathophysiology of COPD last fortnight. Armed with that information, we may be able to make sense of which puffer to use for which patient and what to escalate during their exacerbations. We already do that but, I must admit, rather haphazardly. It, kind of, depends on what samples I have in the drug cupboard or when the last pharma rep came to sell their ware.…
27th August 2023, Dr Chee L Khoo
I thought I knew how to diagnose COPD when I see one. I thought I knew everything I need to know as a GP in managing COPD. I mean, how hard can it be? LABA, LAMA +/- ICS. If in doubt, put them on a triple puffer. Might be a bit of an overkill but what is the harm?…
13th August 2023, Dr Chee L Khoo
Many of the male doctors are slowly losing the battle against male pattern alopecia. It’s either thinning or receding. For those who are not there yet, it’s coming. We are also seeing women joining the club. Androgenetic alopecia (AGA) is the most common form of hair loss in humans affecting 80% of Caucasian men and 50% of Caucasian women.[1].…
26th July 2023, Dr Chee L Khoo
It is coming up to 10 years now when we, as GPs, were suddenly not allowed to prescribe TRT for our patients with low serum testosterone levels. The rationale cited at the time was that testosterone replacement therapy (TRT) was potentially harmful because we were told that TRT is associated with increased cardiovascular risk in men with hypogonadism.…
26th July 2023, Dr Chee L Khoo
First it was aducanumab then lecanemab. Now it’s donanemab. All of them purportedly showed statistically significant improvement in clinical outcomes although the “significance” is hotly debated. Although aducanumab was the first to be approved by FDA (June 2021), the limited clinical improvement together with the increased risk of severe adverse effects meant that aducanumab is no longer used these days.…
12th July 2023, Dr Chee L Khoo
It’s almost a year since we foreshadowed the arrival of finerenone and it’s finally on the PBS, albeit with the usual and expected very restricted criteria. We discussed finerenone’s impressive cardiovascular and renal outcomes in patients with heart failure and chronic kidney disease. We further discussed why finerenone is a better mineralo-corticosteroid receptor antagonist (MRA) than what we have at the moment, spironolactone and eplenerone.…
25th June 2023, Dr Chee L Khoo
A few weeks ago we explored familial hypercholesterolaemia (FH) primarily in adults. The issues we touched on were how not so rare FH really is and further, how aggressive we should target the LDL-Cholesterol (LDL-C). As we know, commencing lipid lowering agents is only the first step. The next step is to agree on what the LDL-C target should be in this patient based on the cardiovascular risk of the patient.…
28th May 2023, Dr Chee L Khoo
Hypertriglyceridaemia has always played second fiddle to hypercholesterolaemia for a long time. Studies after studies have demonstrated the cardiovascular benefits of cholesterol lowering therapy. You might know that most of these clinical trials excluded patients with hypertriglyceridaemia. Does that mean that hypertriglyceridaemia doesn’t matter? We know hypertriglyceridaemia inflict oxidative damage to vital metabolic systems and organs.…
NIA Diagnostic Imaging, 14th May 2023
Colorectal cancer (also known as bowel cancer) is the third most prevalent type of newly diagnosed cancer and the second deadliest type of cancer in Australia. CRC generally arises from the inner lining of the colon and is often characterised by polyps, which, if left undetected, can transform into aggressive malignancies. Despite the fact that optic colonoscopy is the golden standard for the detection of colorectal cancer, CT colonography (CTC) is regarded as a non-inferior alternative.…
14th May 2023, Dr Chee L Khoo
When we think about diabetic complications, we usually think about microvascular and macrovascular complications. We don’t often think about dementia as a diabetic complication. Diabetes has consistently been associated with an increased risk of dementia and its subtypes (Alzheimer’s disease and vascular dementia (1). As many with diabetes, especially T2D, are being diagnosed at a younger age, dementia relating to diabetes will increasingly be diagnosed and diagnosed at a younger age.…
29th April 2023, Dr Chee L Khoo
We have a increasing number of patients who has undergone a percutaneous coronary intervention (PCI). This could be in the acute setting of an acute coronary syndrome (ACS) or electively during an exploratory angiogram. Stents used to be bare metal. Then came the first-generation drug eluting stents. The latest generation drug eluting stents are better at reducing subsequent thrombosis of the stented and unstented coronary segments.…
25th April 2023, Dr Chee L Khoo
We may not have many patients with neuropathic pain but patients with neuropathic pain can be heartsinks. Most of the time, nothing seems to work. It can be quite frustrating when anti-depressants after anti-depressants don’t work. The old tricyclics often don’t work either. What about pregabalin? Nope. What about gabapentin? Nope. What about long-acting opioids or tramadol?…