ANDROGEL FINALLY ARRIVES - 1 July, 2010

Androgel is transdermal testosterone. It comes in sachets of 50 mg testosterone in 5 mL of gel. Allowing for a 10% absorption rate, the 5 mg that passes through the skin will supply the requirements of most men who are testosterone deficient. Without the need for needles, this form of androgen treatment may appeal to those who are needle phobic. Men on anticoagulant or anitplatelet medications in whom injections are contraindicated (for fear of bruising at the injection site) may also consider this. Check if you are testosterone deficient using this scorecard and see your doctor to discuss treatment if so.

 

EASD RAISES CONCERNS REGARDING LANTUS USE - 1 July, 2009

The European Association for the Study of Diabetes has voiced concerns regarding the safety of insulin glargine. In its July issue of Diabetologia, 4 papers and an editorial relating to a possible link between insulin glargine (Lantus insulin) and cancer were published. EASD has recommended that glargine users with concerns not stop glargine but to consult with their doctors. The papers are available for download by going to the EASD website.

 

HYPERBARIC OXYGEN Therapy for DIABETIC FEET - 30 April, 2008

It is frightful to see patients with diabetes come in with feet such as the one shown in the top picture. In this patient, the ulcer on the big toe has not healed in six months, risking infection spreading up the foot or into the blood stream. The dusky color of the other toes is indication that they too are at risk of ulceration. These patients usually end up having to undergo surgery to remove a toe or part of the foot. This results in much morbidity and in problems walking. In carefully selected patients, hyperbaric oxygen therapy may offer a ray of hope. The treatment involves putting the patient into a chamber (not unlike decompression chambers used by divers who suffer "the bends") filled with oxygen under pressure. This environment allows better oxygen perfusion of the wound, and a possibility that surgery may be avoided. The lower picture shows healing of the ulcer after 20 seesions of hyperbaric oxygen therapy.

 

Shrinking LARGE THYROIDS with rhTSH & Radioiodine - 18 Nov, 2007

The usual treatment for LARGE thyroid glands such as the one on the right has been to use thyroxine medication or to have it surgically removed. Thyroxine use is rarely successful in large glands, whereas surgery can be expensive and may result in an ugly scar. Radioiodine has been shown to be exceptionally effective when combined with recombinant human thyroid stimulating hormone (rhTSH). In June 2007, Bonnema and co-investigators determined that median goiter volume reduced 34% in the group treated with radioiodine alone. In comparison, the group treated with radioiodine combined with rhTSH showed greater reduction of 53%. Local experience with this combined modality of treatment will grow as rhTSH (Thyrogen) has now become available in Singapore. As of today, two patients of mine have had this treatment both with excellent results.

INCRETIN and Type 2 Diabetes - 27 Jul, 2007

Incretins have long been known to play a role in blood glucose control. Januvia (sitagliptin, DPP4 inhibitor) and Byetta (exenatide, an incretin mimetic) are the newest medications targeting the incretin mechanism available for treatment of Type 2 diabetes. The former is orally active, the latter administered by injection. Locally, clinical experience with these agents is limited as they have only recently been approved for prescription in Singapore. In the light of controversy regarding Avandia (rosiglitazone) use and heart disease, these agents may be considered in patients deemed unsuitable for rosiglitazone. The video on the right is from the Eli Lilly company, explaining how Byetta works.

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LEVEMIR  -  Long acting INSULIN - 1 Jan, 2007

LEVEMIR, Insulin Determir, is a long acting insulin that has achieved the holy grail of insulin therapy. It has answered the call for an insulin effective for 24 hours, without peaks which characterize the older insulins. This significantly reduces the risk of low blood glucose (hypoglycemia) in diabetic patients. NovoNordisk has on record that I am the the first doctor in Asia to use this preparation, which was approved for prescription in Singapore April 2006. My experience with Levemir has been nothing but positive.

 

NEBIDO  -  Long acting TESTOSTERONE - 25 Nov, 2006

NEBIDO is a long acting testosterone preparation expected to be approved for prescription in Singapore August 2007. Ahead of product approval, I have been using Nebido on my patients on a "named patient basis". To date I have about 30 patients using Nebido regularly, most of whom are happy to receive 4 injections yearly versus 17 or more injections of shorter acting preparations. Nebido is useful in restoring vigor to men deficient in testosterone and in maintaining male characteristics before and after gender reassignment surgery. Unfortunately, this treatment will not be cheap. Schering has set the price to be nearly $360 a dose. Learn more at www.nebido.com

 

I'm using PROTOS for OSTEOPOROSIS - 1 Oct, 2006

PROTOS (PROTELOS, in Europe) is Strontium ranelate, a novel class of medication recently approved for use in osteporosis. Like Like Fosamax (alendronate), Protos slows bone resorption, with the additional benefit of increasing bone formation. Protos may be safely used in patients intolerant of alendronate or as initial therapy for osteoporosis.