YOUR GUIDE TO LIVING WELL
TUESDAY, MAY 31, 2011
Going coastal Our guide to the cleanest, safest beaches in Hong Kong >PAGE 4
THE HEAT IS ON: SUMMER AILMENTS >PAGE 7
GRILL SEEKERS: YOU CHAR WHAT YOU EAT >PAGE 8
2 NEWS HEALTH BITES
NEW IN THE SHOP ......................................................
Jeanette Wang email@example.com
Jeanette Wang firstname.lastname@example.org Gaining a toehold The fashion police frown upon these, but Vibram FiveFingers shoes have got the sports world all aflutter. With minimal material on the sole, they create a barefoot feeling that is said to promote healthy development of the foot and leg muscles. The new Performa (right, HK$1,230) has a buttery-soft kangaroo leather upper and grippy flexible soles that are perfect for yoga. Get them at Escapade Sports. www.escapade.com.hk
Summer lovin’ ’Tis the season for sun and outdoor sports – and pampering after all the strenuous activity. The Melo Awaken Journey (HK$1,450) at Melo Spa, Hyatt Regency Hong Kong, Sha Tin, includes use of the hotel’s 25-metre outdoor heated pool and fitness centre, a special welcome drink, a 60-minute body massage and a 30-minute facial. Available from June 1 to August 31. www.melospa.com
Double-duty decor Just as a plant’s food production is triggered by light, StoClimasan Colour (above, HK$6,240 for 12.5 litres) has airpurifying properties that are set off the same way. Coat your walls with it, turn on a lamp or open a blind, and the paint will reduce odours and toxic pollutants through a photocatalytic process. Available at Envirobuilding Solutions, Central; tel: 2810 0325
Gym in your wardrobe First there were shoes that promised to perk up your posterior while you walked. Now you can tone and strengthen muscles simply by throwing on an outfit. Reebok EasyTone Apparel (left, from HK$329) uses strategically placed bands that create resistance with every shoulder-raise or step, and help to straighten out your posture. Available at Reebok, Ocean Terminal; tel: 2736 7010
Cute cush for your tush Here’s a great way to get fidgety kids to sit in place: plop them on a Booster Bug (left, HK$450). The air-filled cushion works just like a fitball, creating instability that requires the sitter to engage their core muscles constantly. The result is improved posture, concentration, attention span and less restlessness all-round, says its Hong Kong-based Icelandic creator, mother of four Heida Magnusdottir. www.thebugscompany.com
APP OF THE WEEK
Rewarding full-body workout will keep you engaged ...................................................... Katie McGregor email@example.com Nike Training Club – Free Rating 10/10 It took me a mere 39 minutes to complete my first 30-minute Nike Training Club (NTC) app workout, transitioning anything but smoothly through the 22 exercises of the beginners’ Conditioning Corps class. I had expected it to take several hours, if not days, to learn all the exercises correctly, so I was thoroughly encouraged. I am a straight-line “athlete”. Put me on a path and I will jog along quite happily; put me in a step class and I will fall off the step. So fortunately, the NTC app is something you can work at in the privacy of your home. Nobody was watching as I
paused at just about every exercise transition to watch the video of the stylishly-clad Nike athlete demonstrate the exercise with ease. Nobody saw as I collapsed on the floor midway through an “opposite arm/leg superman”, dreading the “ding” for the start of a new exercise every one to two minutes. At the final “ding”, however, the soothing yet firm voice of my “trainer” congratulated me and told me that I had unlocked a Nike reward. I was thrilled and, on an endorphin high, promised myself I would carry on. The NTC app is a full-body training app for iPhone, iPad and iTouch, with more than 60 workouts put together by a Nike professional trainer. The workouts are grouped according to fitness level and goal, whether your aim is to be toned, lean or strong. You can log your progress and as you do your time,
you gain reward badges, which ultimately allow you to unlock exclusive celebrity workouts. My reward was simply being able to complete the workout within the prescribed time, which I did on the third attempt. While I choose to do the workout in the privacy of my own home, you
could do yours anywhere, which makes it a perfect app for business travellers. You can also get social with NTC; there is a Hong Kong Facebook page where you can post your results and find Nike friends. You can even go to a live NTC class with real people at California Fitness – but you won’t see me there.
The Nike Training Club application features more than 60 workouts
What the fish? Not all pisces are equal. For post-menopausal women, baked/broiled and dark is the way to go. According to a new study of more than 84,000 women, published in the American Heart Association journal Circulation: Heart Failure, those who ate five or more servings a week of baked/ broiled fish had a 30 per cent lower risk of heart failure compared with those who ate less than one serving a month. Conversely, eating just one serving of fried fish a week was linked with a 48 per cent higher risk. Passing on tuna, sole, snapper and cod in favour of darker varieties like salmon, mackerel and bluefish was also found to lower the risk of heart failure significantly. Consider the countryside Mums-tobe who move away from the city could give birth to healthier babies. Researchers at Queensland University of Technology’s Institute of Health and Biomedical Innovation in Australia have found that women who live within 400 metres of busy roads are more likely to have a premature baby by nearly two weeks. Both air pollution and noise pollution – which disturb sleep and raise stress – were considered possible contributing factors. “Pre-term and low birth-weight babies stay in hospital longer after birth, have an increased risk of death and are more likely to develop disabilities,” says senior research fellow Associate Professor Adrian Barnett. “I’m not fat; my skeleton’s growing” Now, that’s a valid excuse for those extra kilograms you may be putting on with age. In a study published last week in the Journal of Orthopaedic Research, experts at the University of North Carolina at Chapel Hill found that the pelvis (hip bone) continues to widen through one’s lifetime even as vertical growth stops by age 20. A 25mm increase in pelvic diameter could lead to about a 76mm increase in waist size from age 20 to 79, regardless of an increase in body fat. If the rest of the body is widening commensurately, this might account for a significant increase in body weight of about 0.45kg a year that many people experience during the same period, says senior study author, Dr Laurence Dahners. What a swell idea As the sea warms up in Hong Kong, it’s the perfect time to challenge yourself to an open-water swimming race. There are two coming up. On Sunday, the Sports World Summer Ocean Swim series kicks off with a 1.4-kilometre swim from Repulse Bay Beach to South Bay Beach. It’s open to everyone aged eight and over. Sign up at www.revolution-asia.com. It will be a good warm-up for the Shek O Challenge on Saturday, July 9, which features a 2.2-kilometre swim from Big Wave Bay to Rocky Bay, along with volleyball, frisbee, DJs, dancing and a barbecue. See www.shekochallenge.com. > CONTACT US Culture Editor: Janelle Carrigan firstname.lastname@example.org Health Post Editor: Jeanette Wang email@example.com General inquiries: firstname.lastname@example.org Advertising: tel: 2565 2435; e-mail email@example.com
MEDICAL 3 CASE HISTORY SLEEP PROBLEMS
The indelicate sound of slumber ...................................................... Greg Lee firstname.lastname@example.org Sleep woes can really mess up your life, but it becomes an even bigger headache when it starts affecting your partner. Daniel Cheung’s (not his real name) heavy snoring was getting from bad to worse, and his wife was complaining. The 48-year-old also noticed that he was feeling increasingly tired upon waking, regardless of how much sleep he got. Married with two children, the businessman leads a busy life juggling work and family. He did very little exercise, was slightly overweight, smoked moderately and
usually drank a couple of beers in the evenings. A routine medical check-up found that Cheung had high blood pressure. His doctor, suspecting it could be linked to his slumber woes, ordered a follow-up sleep test. The results showed that Cheung was indeed suffering from obstructive sleep apnoea (OSA), a disorder that affects one in 25 middle-aged men. Causes While it is more common in men and in those who are overweight, OSA can also occur in women and children. Smoking, drinking alcohol and prolonged sitting can also
ASK THE DOCTORS DR CHRISTOPHER YU Q: My eyelids seem to have been a bit swollen for the past week, but there’s no itching or pain. I’ve never had this before. What could it be? I suspect pollution. A: The most probable cause of these symptoms is an allergy. Food allergy is a common cause, but as the swelling has been present for a week, it is more likely to be something that you are being continually exposed to. In Hong Kong, contact allergy resulting from exposure to pollution, dust (house dust mites) and mould is most frequently seen. Sometimes contact lenses may be the culprit. The swelling can sometimes go down by itself, but often the recovery can be hastened by treatment with anti-allergy
eye drops. However, recurrences are common. If the swelling is accompanied by redness or pain around the eyelids or the eyeball itself, then a visit to your eye doctor is necessary to rule out an infection or unusual inflammatory disease. If the eyelid swelling is accompanied by swelling of other parts of the body, such as the ankles, then it is advisable to consult your family doctor, who may initiate tests to rule out a heart, liver or kidney problem. Dr Christopher Yu is a specialist in opthalmology. • Send your medical questions to email@example.com
increase your likelihood of developing the condition. As it occurs during sleep, many people with OSA don’t even realise that they have it. Sufferers stop breathing repeatedly through the night – from five to as many as 100 times an hour – each time lasting from 10 seconds to longer than a minute. This is usually caused by the collapse of the upper airway passages due to a large tongue or extra tissue, or not enough muscle to keep the airway open. With the body and brain starved of oxygen, deep sleep is not possible and the heart is strained. Symptoms and complications Snoring like a freight train is just one sign of the condition. Dr Paul Mok, a head and neck surgeon and an OSA specialist, says other symptoms include choking and waking up often to urinate. Sufferers might wake up unrefreshed, experience daytime drowsiness and morning headaches, and be unable to concentrate and remember things. Left untreated, the problem can increase the risk of developing serious complications, such as high blood pressure, heart problems and stroke, Mok says.
Snoring like a freight train is just one sign of the condition. Other symptoms include choking and waking up often to urinate DR PAUL MOK, OSA SPECIALIST
Children who snore need special attention – they may suffer from a lack of concentration, hyperactivity and/or a fall in their IQ. Treatment Mok recommended that Cheung make positive lifestyle changes such as eating better, exercising regularly, stopping smoking and drinking less. He also suggested continuous positive airway pressure therapy, widely considered to be the treatment of choice for OSA. The therapy involves wearing a special device or mask during sleep, which is connected by a flexible tube
to a machine that provides a gentle flow of air through the nose to prevent airways from collapsing. It’s the most effective non-surgical treatment for OSA, but it takes time to get used to the nasal discomfort, noise and inconvenience – some people never do. Surgery is another option, although Mok says it is not a cure for all. A patient’s anatomy can play a big role in the success of the operation. Large tonsils are easily treated, but those with a soft palate and tongue-related obstructions, and overweight people may not have a positive outcome. Ultimately, the effectiveness of the treatment depends on the severity of the underlying problem, Mok says. For some overweight patients, for example, weight loss goals can be difficult to achieve and may take some time. Furthermore, a patient’s motivation to have the problem fixed and their willingness to co-operate with treatment are important factors, he adds. Cheung is using the device and is making good progress in his efforts to lead a healthier lifestyle. He is smoking and drinking less, and has started to take the stairs and walk more at work.
4 COVER STORY
The coast is c Beach-goers soak up the rays at South Bay Beach in Repulse Bay. Photos: K.Y. Cheng
Want the splash without the trash? Jacqueline Yang goes searching for Hong Kong’s cleanest beaches
s the mercury rises and the city swelters, it’s time for hotheads to hotfoot it to the beach. Fortunately, in Hong Kong you never need to travel too far to cool off because there are 41 government gazetted public bathing beaches that dot the city’s coastline. But finding your place in the sun on some beaches may mean having to put up with rubbish that has washed up on shore or been left behind by inconsiderate earlier beach-goers. The most common debris found on beaches includes broken glass, plastic bags, beverage bottles, foam boxes, and food wrappers and containers. And if you venture out into the water, you might have to dodge a lot more than litter. Some beaches are polluted by sewage, usually a result of poor infrastructure – either sewage pipes do not run far enough out to sea or the waste is not
properly treated. During and after periods of heavy rain, many beaches are also likely to be more polluted for up to 72 hours, because rivers and sewage tanks overflow. Exposure to sewage can cause diseases such as gastroenteritis and diarrhoea, as well as enteric fever, hepatitis and kidney infection. Those with weaker immune systems, such as children and the elderly, may also be susceptible to viral respiratory infections. In some rare cases, exposure can be fatal. But it’s not all bad news. To keep Hong Kong’s beaches as healthy and safe as possible, the Environmental Protection Department has a comprehensive monitoring programme in place. It grades beaches on a scale of one (good) to four (very poor), based on the bacterial (E coli) level in the water from the five most recent samples that have been taken.
The government continually takes measures to improve the beach water quality by improving the sewerage infrastructure Swimmers at St Stephen’s Beach, Stanley
ENVIRONMENTAL PROTECTION DEPARTMENT SPOKESMAN
This initiative, known as the Water Quality Objective, was implemented 25 years ago. Last year, the department monitored all 41 gazetted beaches and found that, for the first time, every one complied with the objective. It is a remarkable improvement from the 93 per cent recorded in 2009, and the 83 per cent recorded between 2003 and 2008. These protocols for monitoring beach water quality are similar to those used overseas in coastal cities such as Miami, Los Angeles, Sydney and Melbourne. “In terms of bacteriological water quality, [Hong Kong’s] is comparable with those cities,” says an Environmental Protection Department spokesman. “The government continually takes measures to improve the beach water quality by improving the sewerage infrastructure.” This includes extending the network to cover villages without sewage systems, building new sewage treatment plants, and diverting polluted storm water discharge away from the catchment areas of the beaches. Volunteer group International Coastal Cleanup says better coordination and an overall strategy between the different government departments in charge of cleaning up designated areas are needed to prevent rubbish from ending up in the sea. Concerned? Keep up to date with the latest beach water quality ratings at www.beachwq.gov.hk. Or participate in the International
Hong Kong’s best and worst beaches by water quality 2010 ranking 10 best
Castle Peak Lido Ting Kau 9 Gemini Approach 5 Anglers’
Best water quality
7 2 8 6 4 3
Hap Mun Bay
Hoi Mei Wan Worst water quality South Bay 7
Tong Fuk 5km
Upper Cheung Sha 10
Source: Environmental Protection Department
Coastal Cleanup Challenge, a beach clean-up event later this year (see www.coastalcleanup.hk). Every little bit helps. Meanwhile, take the plunge at the city’s top five cleanest beaches. Hap Mun Bay Sharp Island, Sai Kung, tel: 2796 6788 This idyllic piece of Hong Kong has consistently been ranked as one of the city’s cleanest beaches – along with most of the beaches in Sai Kung district except for Silverstrand. The wild and islandstudded east coast is not as densely populated as other parts of the territory, and pressure from
Hung Shing Yeh Lo So Shing
Big Wave Bay 1
St Stephen’s SCMP
human habitation has thus been lower. Weekdays are quiet but on weekends and public holidays attendance can hit the thousands. So if you want a good spot, make sure you go early. With plenty of lifeguards along the 99-metre-long beach and a shark net set up, you can soak up the sun in safety. Work up an appetite by renting a raft, then book a pit in the barbecue area and fire up a sunset feast. The rocky shores make this a popular fishing spot. Getting there: take a kaido (a small ferry) to Kiu Tsui or Hap Mun Bay at the Sai Kung bus terminus.
COVER STORY 5
Everything under the sun to protect your skin ...................................................... Jacqueline Yang firstname.lastname@example.org Sun exposure is the most preventable risk factor for all skin cancers and skin ageing, according to Dr Kingsley Chan Hau-ngai, a dermatologist at Quality HealthCare. It is therefore important to be sun-smart while enjoying your day out. Here are Chan’s top tips. Wear sunscreen at all times Even on a cloudy day, harmful UVA rays can penetrate the clouds and cause skin damage. During summer, seek shade and avoid sun exposure when its rays are at their most intense, between 11am and 2pm. Whenever your shadow is shorter than you are, stay in the shade. Choose a sunscreen with at least SPF 30 The Sun Protection Factor (SPF) tells you how long a product will protect you from sunburn by UVB rays. If it takes 20 minutes without protection to begin reddening, an SPF30 sunscreen will theoretically protect you 30 times longer, or for 10 hours. Look for the PA grading This ranges from + to +++. This refers to the product’s level of protection against UVA rays, the UV ray that can penetrate glass windows
Lo So Shing Sok Kwu Wan, Lamma Island, tel: 2982 8252 Looking for a beach paradise? Crystal clear waters? This 214-metrelong beach is as close as it comes in Hong Kong. The tranquil spot sits between the villages of Sok Kwu Wan and Yung Shue Wan. It has showers and changing facilities, as well as a solar-powered floodlight on the edge of the bay. Because of its remote location and lack of public transport, there are rarely any crowds. Getting there: take a ferry from either Central or Aberdeen to Sok Kwu Wan, then walk down the marked path for about 40 minutes. Hung Shing Yeh Yung Shue Wan, Lamma Island, tel: 2982 0352 This 55-metre-long beach is Lamma Island’s most popular, attracting up to 600 people on weekends. As with most beaches in the Islands district (except Silvermine Bay), its distance from Hong Kong’s main urban centres means it generally enjoys good clean water. Head there in the early morning if you want it to yourself. It is well known for its clear waters and smooth sand, and is complete with a barbecue area, showers, changing facilities and a shark net for protection. First-time visitors may find the huge power station nearby a bit daunting, but you will soon get used to the view. Getting there: take the ferry to Yung Shue Wan from Central, then follow the signs from the village’s main street for about 20 minutes.
South Bay Beach South Bay Road, Repulse Bay, tel: 2812 2468 Just walking distance from Repulse Bay Beach, this 126-metre-long beach is a popular spot at weekends. It has a barbecue area and a fast food kiosk. It is fully equipped with changing rooms, shower facilities, a bathing shed and rafts for use. Chill out at the South Bay Beach Club with a drink in hand, listening to a DJ. Its fellow Southern district beaches are all in good shape, thanks to years of strict pollution control legislation and welldeveloped infrastructure that diverts storm water and treats sewage. Getting there: take the No 6 bus from Exchange Square in Central to Repulse Bay Beach and follow the marked signs to South Bay. This should be a 10-minute walk. St Stephen’s Beach Wong Ma Kok Path, Stanley, tel: 2813 1872 Located a stone’s throw from Stanley’s main beach, this 120metre-long beach is a must-visit for water sports lovers. The summer season brings strong southwesterly winds, making it a popular spot for windsurfing and canoeing. The St Stephen’s Beach Water Sports Centre (tel: 2813 5407) offers equipment and training courses to get you started. Despite the water sports attraction, the beach tends to remain quiet throughout the season. Getting there: take the 6A bus from Central’s Exchange Square to Stanley Market and walk for 15 minutes following the signs from the bus stop. email@example.com
and cause skin to age. Generally, PA++ is recommended. A sunscreen that provides protection against both UVA and UVB rays is said to be “broad-spectrum”.
wear appropriate clothing and apply sunscreen. Parents should opt for sunscreen that is hypoallergenic, fragrance-free and broad-spectrum.
Protect the young On average, people get 80 per cent of their lifetime sun exposure by the age of 18, and bad sunburn in childhood significantly increases the risk of skin cancer later in life. Children should play in the shade,
Apply sunscreen to dry skin 15 to 30 minutes before exposure to the sun Approximately two tablespoons of sunscreen is typically needed to cover exposed areas of the body properly. Re-apply sunscreen every two hours.
6 HEALTH TRADITIONAL CHINESE MEDICINE
Your well-being lies in the balance ...................................................... Rose Tse firstname.lastname@example.org When it comes to maintaining our health and well-being, Traditional Chinese Medicine (TCM) lays great stress on balance and the “middle way” in everything we do. The yin-yang theory, which is simple to understand but rich in application, forms the foundation of the practice. Yin and yang represent two opposite and yet complementary aspects of objects. They are mutually controlled and inhibited, constantly interacting through daily life, neither able to exist without the other. That’s why the symbol has a bit of white on the black side, and a bit of black on the white. The human body is an organic whole divided into a multitude of yin and yang aspects: upper body versus lower, exterior versus interior, arteries versus veins, structure
versus function, absorption versus excretion, expiration versus inspiration, and so on. When yin and yang are dynamically balanced, health is achieved. When the harmonious processes are broken, disease occurs. TCM physicians use the theory as a tool for comparative analysis in understanding the body’s structure, physiological changes and pathological developments. Beyond the body, the yin-yang concept is fundamental to how many Chinese view the world. All living beings are seen in relation to their environment. As the weather turns hot from spring to summer, yin wanes and yang dominates. TCM practitioners believe people should, therefore, change their habits accordingly to remain in harmony with the environment and adapt better to seasonal changes to stay healthy. Summer makes one energetic,
which is said to make the body’s qi and blood more vigorous. TCM claims this causes the heart to overfunction, leading to restricted lung function. To protect your lungs, it’s advisable to eat more food with pungent flavours and less food with bitter ones. That means loading up on ginger and onions, and holding the kale and celery. Sweat is the fluid of the heart; excessive sweating scatters heart-qi and weakens the mind, causing symptoms such as being easily annoyed, low spirits, restlessness and sleeping difficulties. Fend them off with sour and salty flavours. With heat and rain, the body’s fluid and electrolyte balance is disturbed, leading to lethargy, weakness, fever, thirst, lack of appetite and possibly loose bowels. Keep cool and balanced with foods such as watermelon, strawberries, tomatoes, cucumber, lotus root, bean sprouts, duck and fish.
Your summer diet should contain more vegetables and fruit to stimulate the appetite and provide your body with enough fluids. Warm and cooked foods ensure the digestive system work more effectively; too much greasy, raw and frozen food can damage the digestive system and lead to a poor appetite, diarrhoea or stomach upset. It’s a Chinese tradition in summer to make soups for clearing summer heat, eliminating dampness and promoting digestion. Yin-yang balance, however, though maintained within certain
limits, is neither static nor absolute. This is represented in the symbol, where each side has a thick and thin dimension. When winter returns, yang will wane and yin will dominate once again, and your diet should change accordingly. Life is a constant cycle of imbalances and rebalances; tuning your mind into the theory of yin and yang could help you find your middle ground. Rose Tse is the editor of shennong.com, a subsidiary of Integrated Chinese Medicine Holdings
FROM THE EXPERTS
Why stress chills your hands and feet, kills your libido and upsets your tummy Illustration: Corbis
...................................................... Dr Susan Jamieson email@example.com Hong Kong has always been a stressful city to live in. There are the long working hours, constant travel, incessant deadlines, as well as the hard-driving perfectionism in providing service for money. On top of that, we’ve got to deal with the “background stresses” of noise and pollution. Too much to do in too little time soon leads to burn-out. Increasingly sophisticated technology, which should help our stress load, actually doubles it, as we are now expected to meet an increasing number of demands – and instantly. As a general practitioner for 23 years, I’ve seen increasing stress take a toll on patients’ well-being. Almost any physical ailment in the body can be directly caused or increased by our hectic lifestyles. It’s estimated that 60 per cent of family doctors’ consultations are directly related to stress. Stress biology and physiology Our stress mechanism is the ancient “fight or flight” responder. Thousands of years ago, when our nervous and hormonal system evolved, we were built to react to scary or threatening situations by using several biological mechanisms. The main physiological reaction is secreting adrenaline and cortisol hormones to help us run or fight an opponent. These physical actions, during caveman days, were a great antidote to stress. These days, the main stresses
have changed – increasing workload, fear of underperforming and losing a job – but the resultant fear is the same. Adrenaline causes muscles to tense and bunch, leading to tight shoulders and neck muscles, tension headaches and constant back pain. The natural way to get more oxygen to muscles that need to fight, hyperventilation, leads to an imbalance of oxygen and carbon dioxide in the lungs. Unfortunately, oxygen is a very inflammable, energising gas – not what we need when trying to feel calm in the face of an office argument. Carbon dioxide, on the other hand, is a calming gas, but over-breathing lowers it. Blood gets diverted from nonemergency-response parts of our body, such as the gut, fingers, toes and sexual organs. Chronically stressed people tend to have cold hands and feet, low libido and digestive dysfunction. They spend a small fortune going to doctors to try
to diagnose the cause of their diarrhoea or abdominal bloating – which ironically takes up more time, money and anxiety. Talk about a vicious cycle. It’s now scientifically proven that the physiological stress response in the long term lowers our immune systems, which fights off not only bird and swine flu but also cancer. Every minute, immune cells effectively mop up abnormal cells – cancer cells – that circulate in the bloodstream. It gets worse. The brain diverts blood from the prefrontal cortex in the forehead, which is the newer part – well, 40,000 years old – to the “reptilian” brain (above the spinal cord), which deals with survival. The brain also “short circuits”, disconnecting the communication between its right and left sides. So, instead of out-thinking a problem, it under-functions. Simple solutions for stress First, all movement is good
movement. Muscles get stretched and worked, “feel good” hormones are released under exertion into the bloodstream, and circulation increases in muscle and all over the body, metabolising toxic residue of stress hormones and any stagnation in lymph or blood. Breathing is key: whether it’s yoga, swimming or running, make sure breathing is done in a controlled manner through the nose, not mouth. Do something on a regular basis – 20 minutes daily is better than one hour twice a week. Second, stay away from stimulants. One cup of java in the morning and a glass of wine in the evening will do. In a stressed person, caffeine stimulates the already burdened and perhaps burned-out adrenals, and even a coffee at lunch has been proven to reduce sleep quality. Alcohol has a similar effect on slumber; it hinders the restorative sleep cycles at night, making us wake up feeling tired. A glass of wine really does relax us, but the problem is we want more. The body gets used to the relaxing effects, requiring more and more for the same effect. Chemically, it’s an initial relaxant but a long-term depressant. Finally, eat vegetables (especially green), cereals and a generally balanced diet. You may glaze over this cliché, but here’s why diet is important in terms of chemistry. There are relaxing hormones produced in our brains when we laugh, exercise or make love – the same ones stimulated by antidepressants such as Prozac. These hormones are chemical substances
made up of basic building blocks, and if we don’t give the body proper nourishment to provide these, we will have less of them. For supplements, magnesium and vitamin Bs will support and calm the brain and nervous system, as will essential fatty acids (fish oil, evening primrose or flax). Sugar is evil – a pity, but true. Stressed-out patients crave a quick sugar energy fix like a cake or mocha. But this leads to insulin release, which causes blood sugar to plummet. The body then craves more, while swinging between high and low blood-sugar levels. The brain, which uses 25 per cent of the body’s sugar, does not function well with these fluctuations. It isn’t easy to advise patients, however, as the average person will say: “I understand what you’re saying and I agree, but I really don’t have time to do any of the things you’ve suggested. That’s why I’m so stressed. I don’t have time to do anything, and my family life is suffering. “When there’s time and I’m less stressed, I’ll address these issues. But in the meantime, I really need a short-term solution. Can you prescribe xyz? I read about it on the internet.” I understand, I tell them. But it’s important to understand the body’s stress response, too, because a quick fix can go only so far, while stress can go a long way in affecting health. Dr Susan Jamieson is a Scottish- and Harvard-educated physician whose speciality is the integration of science and indigenous healing wisdom. www.drsuejamieson.com
HEALTH 7 LIVING WELL COMMON AILMENTS
The dog days of summer ......................................................
As you revel in the heat of a Hong Kong summer, it pays to remember that the hotter weather and higher humidity can give rise to a host of seasonal health issues. So, maximise your fun and stay healthy with this guide to avoiding the season’s most common health problems. Heatstroke Perspiration is the body’s way of cooling us down, but hot and humid conditions can sometimes overwhelm this natural ability to dissipate heat, leading to heat exhaustion or heatstroke. Infants and the elderly are less able to control body temperature and are at greater risk, says Dr Regina Lo Chung-man. How to stay healthy: your body needs water to perspire. Hence, dehydration can make you more prone to heatstroke, so drink lots of fluids. Avoid exercising in hot, humid conditions, advises Lo. Be vigilant against heatstroke symptoms – if detected early and immediate corrective action is taken, a sufferer can recover in 10 to 15 minutes. What to watch for: early signs of heatstroke include dizziness, nausea, fatigue, chest discomfort and excessive sweating. If you feel unwell, immediately cool off in the shade, drink fluids, and loosen clothing to ventilate sweat and help
Never overdo exercise and stop if you feel uncomfortable. If you exercise outdoors, train indoors first DR REGINA LO CHUNG-MAN
the body dissipate heat. Help a victim by fanning them and spraying water on them, or applying a wet cloth to the neck, armpit and groin. If they continue to feel unwell, have difficulty breathing, appear confused or hallucinate, get medical help immediately, or it could lead to seizures, coma or death. Expert tip: “Know your body,” says Lo. “Never overdo exercise and stop if you feel uncomfortable. If you intend to exercise outdoors, train indoors first.” Hand, foot and mouth disease A usually mild viral infection, hand, foot and mouth disease commonly affects children and, occasionally, adults. Outbreaks of the disease – which bears symptoms such as fever; a rash on the palms of the hands, soles of the feet and the diaper area; and painful sores in the mouth – are more common during summer for reasons unknown, according to a spokesman for the Health Department. In the first 18 days of this month alone, the Centre
Eileen Aung-Thwin firstname.lastname@example.org
for Health Protection recorded nine cases; there were just two cases altogether for March and April. How to stay healthy: the virus is found in an infected person’s stool, saliva and blister fluid, and can survive for long periods on surfaces such as on toys, table tops and floors, so good personal hygiene is key to avoiding the disease. Teach children to wash their hands frequently and thoroughly with soap and water. What to watch for: Dr Paul Leung Chik-wa, a paediatrician, advises parents to seek immediate medical attention if a child appears very irritable, drowsy, vomits repeatedly, has convulsions, shortness of breath or is running a high fever (above 39 degrees Celsius). Complications are rare but can be severe and include viral meningitis (infection of the lining of the brain and spinal cord), viral encephalitis (potentially fatal swelling of the brain) and polio-like paralysis. Expert tip: Leung encourages cleaning of surfaces with a solution of one part bleach to 99 parts water. Double the strength of the bleach solution for surfaces contaminated with blister fluid or vomit. Victims should stick to a soft, liquid diet and avoid acidic foods such as oranges, which can aggravate oral discomfort. Influenza More than just your common cold; influenza is a highly contagious respiratory tract illness that can lead to deadly complications. A Health Department spokesman says Hong Kong experiences seasonal influenza peaks in winter and summer, but the reasons are unclear. How to stay healthy: the influenza virus is carried in airborne droplets exhaled by infected people, and transmission occurs when those droplets land on the mucous membrane (eyes, nose and mouth linings) of another person. Annual vaccinations and good personal hygiene will help. What to watch for: Dr Kenneth Tsang Wah-tak, a specialist in respiratory medicine, advises seeing a doctor immediately if you experience persistent fever, shortness of breath, chest pains, or coughing, lots of mucus or phlegm, or if you cough up blood. In severe cases, a victim can deteriorate in a matter of hours, he says. Pneumonia is the most common cause of influenza-related deaths, although a host of other complications such as heart inflammation and meningitis can also occur. Expert tip: “If someone coughs or sneezes near you, hold your breath and walk away,” Tsang says. If you
get sick, taking prescription antiviral medication in the first 24 hours can reduce the severity of symptoms and their duration by a day. Sunburn We all know not to roast in the sun intentionally, but even 15 minutes outdoors can lead to sunburn. The ultraviolet (UV) rays in sunlight also cause pigmentation, accelerate ageing and increase the risk of skin cancer. How to stay healthy: Dr Tinny Ho Tinyee, a specialist in dermatology and venereology, advises staying indoors at midday when UVB rays that cause sunburn are most intense. When outdoors, stay in the shade and wear
protective accessories such as widebrimmed hats, sunglasses and longsleeved clothing. Apply the right amount of sunscreen – about 1.5ml (½ teaspoon) for the face, and 35ml for the body (or a teaspoon each for the arm, leg, front and back of body). What to watch for: reddened skin, of course. To soothe inflamed skin, apply cool water or aloe vera gel – but avoid using heavy moisturisers that “trap” the heat in. In severe cases, doctors may prescribe corticosteroid creams and oral anti-inflammatory painkillers. Expert tip: Ho says that while a dry Tshirt offers sun protection of SPF7 to 10, a wet T-shirt does not reflect UV rays well and offers only SPF3 protection, so use special UV protective clothing instead. Skincare with antioxidants such as vitamin C, and oral antioxidants such as fern plant extract can provide additional protection. Food poisoning Bacteria flourish in heat, which is why food poisoning cases peak in the summer months. The good news is that the number of cases has steadily decreased over the past four
years, says a Health Department spokesman. Dr Michael Cheng says public education efforts have helped improve hygiene at food outlets, thereby reducing food poisoning outbreaks. How to stay healthy: foods can be contaminated at any point in the preparation and serving process. The best defence is to eat foods that have been cooked well and recently, says Cheng. Refrigerate leftover food only once, and cook it thoroughly before serving. Personal, food and environmental hygiene are also important. What to watch for: dehydration – the body can quickly lose fluids through vomiting and diarrhoea, possibly leading to death. Young children in particular can dehydrate quickly because water makes up a bigger proportion of their body weight, says Cheng. See a doctor quickly if you are producing very little or no urine, if there is blood or mucus in the stools, if there is excessive vomiting that does not respond to medication such as Gravol, or if the diarrhoea is very severe. Expert tip: “Whether you’re in Hong Kong or travelling, just remember: boil it, cook it and peel it or forget it,” Cheng says.
NUTRITION BETTER BARBECUES
Griller tactics to keep you in shape
...................................................... Joanna Hughes email@example.com The classic barbecue menu of hamburgers, sausages, chicken wings, thick rib-eye steaks and pork ribs may be the high point of a warm weekend, but it isn’t exactly health food. Besides being loaded with “bad” cholesterol, carcinogens can be created when the meat is grilled at too high a temperature. Macaroni or potato salad (mayonnaise, salt, sugar and refined carbs) do not help the arteries or the waistline. But cooking out does not have to be bad for you. In fact, your grill may be the healthiest way to cook – if you follow these tips: Use indirect heat This means the fire is on one side of the grill and the food is on the other. You’ll need a grill with a hood or cover for this. The best example: beer-can chicken. Pioneered by grill guru Steven
Raichlen, this involves cooking a whole chicken held up by a can halffilled with a liquid – usually beer, though anything from tea to fruit juice will do, too – in its cavity. The chicken is cooked from the insideout, so it is never raw inside, thus avoiding food poisoning. The bird comes out golden and succulent. Go to www.barbecuebible.com for directions and ideas. Tempting though it may be, don’t eat the skin. Marinate Think soy sauce, five-spice powder and a touch of honey; lime juice, Thai fish sauce, chilli and garlic; pineapple juice and ginger; or tandoori seasoning and yogurt. Marinades allow you to use leaner cuts of meat and poultry without sacrificing tenderness or taste. The seasoning for your favourite foods can be transformed into a marinade with a bit of imagination. In a rush, for example, you can turn low-fat salad dressing (preferably all-
natural) into a marinade. Especially good on chicken is McCormick’s yuzu and green pepper salad dressing, available at bigger ParknShops. Cooking tip: to tenderise leaner cuts of meat, use a marinade with citrus in it. Put the marinade and the meat in a zip-lock bag, squeeze out all the air and marinate in the refrigerator.
marvellous. Do not shuck the corn, but soak in cold water for about half an hour before grilling. Cooking tip: generally, the veggies go on first, especially in the case of corn.
Trim away fat While you are at it, take the skin off chicken breasts, legs and thighs. Slip a sharp knife under the skin and while lifting, cut away the membranes that attach the skin to the meat.
Pre-cook Pork ribs (if you must indulge) can benefit from five to 10 minutes in a microwave set at 70 per cent power before they go on the grill. Flavour tip: use a simple vinegar sauce to baste ribs instead of a sugar-rich commercial sauce. Honey Dijon mustard is also a good choice. Bake potatoes in the oven until tender, then finish them off on the grill for crispy skin.
Add veggies Best bets: onion, capsicum, zucchini and aubergine. Cut them into manageable chunks (too small and they will slip through the grill), drizzle very lightly with olive oil and add a sprinkle of sea salt, lemon juice, garlic and dried or fresh herbs. Corn on the cob is also
Skinny it down Mix minced beef or lamb with ground chicken or turkey for burgers. Cut full-sized steaks into smaller portions. Go easy on the mayonnaise, ketchup and brown sauce. Substitute hamburger and hot dog buns with wholegrain pita bread or wraps. Instead of dessert,
grill slices of fresh sliced pineapple. Instead of sugar-laced drinks for the kids, make sun tea. Simply fill a large glass jar with water, add several bags of fruit-flavoured herb tea (such as Celestial Seasonings Mandarin Spice from ParknShop) and let it sit. Go fishing Salmon and tuna steaks are perfect for grilling. (Wherever possible, use sustainable varieties or wild-caught fish.) You can be as creative as you like; a little mist of olive oil and a squeeze of lemon is one option, or you can try herb and spice crusts. One that works well on tuna: crushed Sichuan peppercorns, cumin powder and ground white pepper thickly pressed into both sides of the steak. Wrap it up More delicate fishes can be cooked in heavy duty aluminium foil. Simply place it on the foil, add seasonings, fold the foil to seal securely and grill over direct heat.
RECIPE FOR HEALTH PORTOBELLO BURGERS
Carnivores will be patty in your hands with this low-fat, low-calorie burger ...................................................... Josh Chu firstname.lastname@example.org
Who knew this wasn’t beef? Photo: K.Y. Cheng
The Portobello mushroom may have been born for the barbecue. A pat of butter, a smother of crushed garlic, a sprinkle of herbs and seasoning, toss it on the grill for a few minutes until the juices run and tuck in. The nice thing about this recipe is the minimal waiting for growling stomachs. What also makes the flat-topped fungus great is that it can be marinated and roasted, baked, stuffed or grilled – without falling apart. It has a meaty bite and loads of flavour, which carnivores would definitely approve of. Always pick plump, dry and firm mushrooms, with a sweet, earthy aroma. To clean them, simply wipe them with a paper towel. If you must wash them, a quick rinse will do. Drain quickly and cook soon.
Give this recipe a go. It has 200 fewer calories than a hamburger – a Portobello mushroom has about 30 calories and no fat, while a hamburger patty (85 grams) runs to about 235 calories and 16 grams of fat, according to the Mayo Clinic. To make it even healthier, omit the brown sugar from the onion jam and substitute the aioli with pesto . Then sit back and watch the meat-lovers get converted. Portobello burgers with onion jam Serves 4 Ready in 40 min For the onion jam 4 tbsp extra virgin olive oil 4 onions, thinly sliced 4 thyme sprigs, lightly bruised Salt and black pepper to taste 100g soft brown sugar 100ml red wine vinegar
For the aioli 3 egg yolks 2 tsp white wine vinegar 1 tsp Dijon mustard 4 garlic cloves, crushed Salt and white pepper to taste 300ml olive oil For the burger 4 large Portobello mushrooms 1 tbsp extra virgin olive oil Salt and black pepper to taste 4 Scottish baps or burger buns 50g baby spinach leaves To make the onion jam, heat the oil in a saucepan and gently fry the onions and thyme sprigs with some salt and pepper on a low heat for 20 to 25 minutes until soft and golden brown. Discard thyme sprigs and stir in the sugar and vinegar. Simmer for six to eight minutes until the sauce is jam-like, then leave to cool. This can be prepared a day ahead.
For the aioli, place the egg yolks, vinegar, mustard, garlic cloves and a little salt and pepper in a food processor and blend briefly until the mixture is frothy. Then, with the blade running, gradually add the oil through the processor funnel until the sauce is thick and glossy. Add a little boiling water if the sauce is too thick. Adjust seasoning to taste. To finish the burger, brush the mushrooms with olive oil and season with salt and pepper. Cook on a hot grill for two to three minutes on each side. Meanwhile, toast the buns until lightly browned. Fill each roll with spinach leaves and a mushroom, and spoon on the onion jam and aioli. Serve at once. Josh Chu is the general manager and executive chef of Posto Pubblico, an Italian restaurant in Soho that uses locally sourced organic fruits and vegetables.
FITNESS/DIET 9 STEP RIGHT UP: WEEK 2
Get into your stride with perfect poise ...................................................... Jeanette Wang email@example.com Walking comes naturally as we go from baby to toddler, so having a walking coach seems like a joke. “Most people are sceptical that they need one, because they think walking is just about putting one foot in front of the other,” says Freeman Lee, an International
Association of Athletics Federationscertified track and field coach. “But actually, a lot of time is needed to correct one’s walking posture and gait, which could be wrong owing to tight muscles in the shoulder or back, or weak leg or buttock muscles.” With the right posture, your breathing and circulation will improve. You will be able to distribute your weight more evenly,
Head up Keep the head level, with chin parallel to the ground. Focus on looking Look forward, about four to six metres in front of you. To look at a closer object, lower your eyes, not your whole head.
avoiding injury and maintaining a healthier back, hips, knees and ankles. You will be able to walk further and faster without feeling tired as quickly, says Lee. Follow these tips and focus on your walking form this week. Join coach Freeman Lee this Thursday, June 2, at 7pm at Causeway Bay Sports Ground for a free walking clinic. To sign up, e-mail firstname.lastname@example.org
THE TASTE TEST MOVIE MUNCHIES Stand tall, walk tall Keep the back straight – draw a straight line from the ear down to the shoulder, hip, knee and ankle. Pull in your abdominal muscles and squeeze your buns.
Swing the arms Keep shoulders relaxed. Swing arms naturally and comfortably with each step, at about waist level. Elbows should be bent at about a 90degree angle and kept close to the torso. Relax hands and loosely clench fists.
Heel and toe As the leg swings forward and straightens, land heelfirst on the ground. Keep the ankle flexed, with toes pointed at about 45 degrees upwards. The foot should roll forward and push off from the toes to begin the next step. As hip flexibility improves, you will naturally develop a slightly longer stride.
If you feel the urge to snack, go for the healthier option ...................................................... Jeanette Wang email@example.com Michael Season’s Baked Cheese Curls, Hot Chili Pepper HK$25 for 156g bag, City’super If fat weren’t an issue, I’d still be eating these – that’s how good these curls are. Made with organic cornmeal, baked with healthy oils and loaded with cheddar cheese, they have half the fat (4.5g) of regular cheese puffs and contain no gluten, artificial colours or flavours. Habanero peppers add a fiery kick. Verdict: officially addicted to it. I licked my fingers until every orange morsel was wiped out. Orville Redenbacher’s Smart Pop Gourmet Microwave Popcorn, Butter HK$17.90 for four 35g bags, VOle’ Would you wolf down three quarterpounders with 12 pats of butter in one sitting? I wouldn’t, and that’s why I’d been avoiding popcorn, after American researchers found that a medium-sized serving plus a medium soft drink packed as many calories, fat and sodium as that heart-stopping meal. Smart Pop, fortunately, has reclaimed popcorn from its bad rep. Contains 100 calories, 2g fat and 4g fibre per 6.5cup serving. Verdict: this tasty 100 per cent whole grain snack is actually good for you.
Coach Freeman Lee Ping-chiu. Photo: May Tse
Take it one step at a time ...................................................... Freeman Lee firstname.lastname@example.org Week 2 Mon Walk an easy 20 min Tues Core training Wed Walk an easy 30 min Thurs Core training Fri Walk an easy 20 min Sat Rest Sun Walk an easy 30 min Training tip Always warm up for your workout by walking for two to three minutes at a relaxed pace, followed by stretching. Repeat after the workout to cool down.
Let’s Do Organic Fruiti Bears Gummies HK$30 for four 25g bags, City’super First, the bottom line: Candy – high in calories yet low in nutrients – is bad for you. Even if it is organically sweetened and coloured by organic fruit and veggies, and made with apple pectin instead of gelatine, like these gummies are. A packet of these contains 100 calories – or a 20minute power walk – a lot of calories (and effort) for just about seven soft and chewy bears. Verdict: for a sweet fix, this beats high-fructose corn syrup any time.
Ben Sin (above without cap) joins in and warms up (bottom right) with the Altius Dragons (bottom left). Photos: Edward Wong
Novice feels sting in dragon’s tail Training with paddling team is far more physically demanding than Ben Sin imagined It’s hard to believe that the Dragon Boat Festival (also known as the Tuen Ng Festival), one of the liveliest and most vibrant celebrations in Hong Kong, actually stems from a tragedy in folklore. Legend has it that in 278BC, Chinese scholar Qu Yuan drowned himself in what is today’s Hunan province as a protest against corrupt rulers. The next day, disheartened local villagers, who revered Qu, paddled boats out to the river, beat drums and threw rice into the water, believing the noise and food would keep fish from devouring Qu’s body. They arrived too late. Nevertheless, dragon boat races and ceremonial offerings of rice became an annual affair to symbolise the valiant attempt to rescue Qu. Competitions have been held in China for hundreds of years, but it was Hong Kong that turned it into an official sport in 1976 – and has been helping to globalise the sport by heading the International Dragon Boat Federation. The sport is booming. According to Raymond Ma Siu-wing, chairman of the Hong Kong Dragon Boat Association, a record number of teams participated in tournaments last year. “Half of the world’s dragon boat teams are in Hong Kong,” adds
Ma, 59, whose association is officially sanctioned by the government. Ahead of the Dragon Boat Festival on Monday, when thousands of paddlers will take to the water, including more than 140 teams in Stanley, I make a date with the Altius Dragons to find out what all the fuss is about. I have never been on a dragon boat before but, as someone who leads an active lifestyle, I think it is going to be easy. How hard can sitting down and paddling be, right? Arriving at Sai Kung pier on a Tuesday night, I am greeted by a bevy of twenty-something butts – everyone is bent over, stretching. “You’re late. Quick, join the warm-ups,” says coach Shek Chihung. Nicknamed “Fei-hung”, after the legendary Chinese folk hero, Shek is a veteran rower with a stern attitude. We stretch our thigh muscles, which, from an outsider’s point of view, don’t seem so important for paddling. I ask why, to which Shek responds, flatly: “Just do it.” Next come upper-body stretches, followed by the dreaded “30x30x2” – 30 push-ups and 30 sit-ups, twice. The Altius Dragons are a diverse bunch: the 30-plus members range
from public relations women in their 30s to young married couples to middle-aged men. But it’s a closeknit group; there’s plenty of banter and laughter during the warm-up. I am already breaking into a bigger sweat than I had expected to, and this is before we’ve even got into the boat. Once on the boat, Shek explains the art of paddling; it’s rather systematic with three basic movements: • the ready position – paddles are held vertically, with the blade (tip of the paddle) centimetres above the water’s surface, elbows locked, shoulders squared, eyes ahead; • enter – in one swift motion, the blade is thrust into the water. If done right, the water should not splash; • pull back – the move that makes the boat go forward; paddlers pull back on the paddle in one synchronised, fluid motion. The beat is provided by the drummer, seated at the front of the boat. Much like my dancing, I have trouble keeping rhythm, as my paddle strikes other paddles repeatedly. “If you think following the beat now is hard, imagine doing so during competition, when there are about seven other drums
pounding at once,” says Grace Cheng Wai-shan, a 15-year-old veteran of the sport. As I chug along, team members correct my form. “Your shoulder is too stiff!” “Stop slouching!” “You’re paddling too slowly!” “You’re paddling too fast!” Then my leg cramps up. “This is why you have to stretch your legs,” says Shek. “To get balance on a rocking boat, your legs have to remain stiff and kick off the ridges in the boat.” Fifteen minutes and about 300 rows later, I am back on shore, floored and sore to the core. What I did was nothing: these guys practice once or twice a week, two hours at a time, with most members coming straight from work. For many, dragon boating is not just great exercise, but a social experience. “I initially joined a dragon boating team to meet friends and bond because I was new in the city,” says Karen Carmen, a teacher at the Canadian International School and a member of the Lamma Ladies team for the past two years. Although she joined for fun, her competitive spirit soon took over. Carmen now captains the team,
BOAT TO BASICS • With more than 300 dragon boat teams in Hong Kong, rowers shouldn’t have trouble finding a team to join. Most accept new members, and the annual membership fee (ranging from HK$500 to HK$1,500) covers all you’ll need. • There is no gear to buy, as dragon boats and paddles are provided by the clubs, which are usually paid for by sponsors or rentals from the Hong Kong Dragon Boat Association. (A typical boat costs up to HK$50,000.) • All dragon boats (and paddles) in Hong Kong meet the association’s size specifications: 11.6-metres long by a metre wide. • Tournaments are held year-round and include men’s, women’s and mixed races. Each boat seats 18 to 20 people, and races are usually 500 metres long.
which competes in up to eight events a year, including overseas. The spirit of dragon boating can be life affirming. That’s true for the women of Dragons Abreast, a team made up of breast cancer survivors. May Kwong Yin-mei, 50, joined them three years ago after beating breast cancer in 2007. She says although she was healed physically, she was scarred emotionally and needed some form of bonding. “When I found Dragons Abreast and met other people in a similar situation, that really eased the fears and doubt from my heart,” she says. Locally, there are many opportunities to race: six government-sponsored events per year, with 30-plus smaller ones at Sai Kung, Chai Wan, Shau Kei Wan, Sha Tin, Tai Po, Mui Wo and Stanley. The annual blue riband event, organised by the dragon boat association, is held in mid-May. Ma, the association chairman, who has been paddling for more than 20 years, says: “Because we’re an international city with so many different cultures, there are very few things here that are distinctively Hong Kong, and I feel dragon boating is one of the few things that is Hong Kong. It is our sport.” email@example.com
WELL-BEING 11 PERSONAL BEST AUTOIMMUNE DISEASES
...................................................... Joanna Hughes firstname.lastname@example.org “I read about Sjogren’s syndrome in medical school, but I’d never seen it before,” Dr Yeo Swee Lynn says. “And now I’ve seen two cases in just one week.” Yeo was visiting me in the intensive care unit of Singapore’s Gleneagles Hospital, where I had been for a week. The diagnosis was lupus and Sjogren’s syndrome, and if I hadn’t felt so bad, I think I would have been terrified. Just before Christmas 2008, I felt extremely tired, but put it down to long hours at work. I developed painful mouth ulcers and made a mental note to see my dentist after the New Year. Then, out of the blue, I started getting fevers so high that I couldn’t get warm. Alarmed, my husband rushed me to accident and emergency services, where the doctor gave me a jab of steroids and sent me home. Twelve hours later I was back. This went on for a few nights until, wrapped in thick blankets and lying on the floor of the emergency room, I heard a doctor say: “This girl is really sick.” Sick enough to be transferred to Gleneagles, where there was an available bed in the intensive care unit; at the time, I was so confused that I thought I was there because it was the only free bed, and not because I was that sick. I was tested for every kind of tropical disease under the sun, and the results all came back negative. And even in the icy path of the air con, (I cried for a blanket), the fever refused to break. Finally, my face broke out in a rash, the distinctive wolf mask that gives lupus its name. Immediately, the doctors knew what to do and began a course of more tests and treatments involving dermatologists, rheumatic specialists and neurologists. They had a diagnosis: not only did I have lupus, but also Sjogren’s syndrome. This particular autoimmune illness features inflammation in glands responsible for producing tears and saliva. Inflammation of the glands leads to dry eyes, mouth and lips, which can cause other problems, such as gum infections. In my case, Sjogren’s syndrome came hand in hand with systemic lupus erythematosus, which can strike any organ in the body, including the skin. Essentially, autoimmune diseases occur when the body mistakes its own organs and tissues for pathogens (infectious agents) and begins to attack them. Why the body does this is only beginning to be understood. There is some basis for a genetic predisposition (my paternal grandfather died of it), and other research indicates that viruses and some bacteria could be responsible. Women are afflicted more than men, which might indicate a hormonal link. There’s not even a canonical list of which diseases are autoimmune. There are at least 80,
with some, like lupus and Sjogren’s syndrome, positively identified, and others subject to debate. Between 1998 and 2002, pharmaceutical companies pumped nearly US$500 million into research on drugs to alleviate the symptoms of autoimmune disorders. Scientists are identifying potential markers and causes. And the on-the-ground medical community is more aware of what one author has called “the autoimmune epidemic”. In a way, I was very lucky; autoimmune diseases can be very hard to diagnose. Many people, especially women, go from doctor to doctor; many times their symptoms are dismissed or not taken seriously. Some of the diseases can be identified through blood tests for specific agents. Others cannot, and doctors have to carefully observe symptoms and listen to patients. Of course, “I’m feeling very tired, irritable and am running low-grade fevers”, which are the most common symptoms of autoimmune disorders, can cover any number of illnesses. And while some autoimmune diseases affect specific organs or systems, others, such as lupus, can be systemic. Looking back after I was diagnosed, I saw many things in my medical history that now made sense: mosquito bites that caused my entire arm to swell, unexplained sustained high temperatures, a susceptibility to fatigue, even a sudden increase in my normally textbook-perfect blood pressure. But those are just some of the symptoms, and they often mimic those of other illnesses. When I first heard I had lupus, I was afraid. Ten years earlier, I had been in a clinic waiting room where the woman next to me was crying in that angry sort of way people cry when they’ve just been given very bad news. She told me she had lupus and as far as she was concerned, it was a death sentence. I knew that the famous American author Flannery O’Connor had died of it, as had her father. The good news is that autoimmune diseases can, for the most part, be managed. The immuno-suppressive drugs I take have side effects – some immediate, like nausea, and others longer term. I have to go for tests every six weeks or so to check everything from protein in my urine to haemoglobin and white blood cell counts. The hardest thing is explaining the disease to friends. “So when will you be over it?” is the usual response, and it’s hard for them to understand that I will never be cured. (I call this the “House syndrome”, where, at the end of the episode, the slightly mad doctor fighting demons of his own finally identifies the disease and – in most episodes at least – pulls back the patient from the jaws of death.) In my case, I’ve had flares, where my temperature will spike for no apparent reason. I get vitamin B12 shots to help overcome the fatigue and vitamin D3 to help ease the aches. I cannot go out in the sun without covering up; even a slight
Illustration: Angela Ho
When your body ﬁghts itself
Many people ... go from doctor to doctor; many times their symptoms are dismissed or not taken seriously
burn will result in rashes and even sores. I am subject to attacks of shingles and I am frequently dizzy. People who have autoimmune disorders react in different ways, but most often there is depression. One girl in my support group in Singapore contemplated suicide. Diagnosed at 17, her symptoms of fatigue caused her to lose her job, and she became despondent when she thought she would never live a normal life. I became very angry for a time and refused to acknowledge that I couldn’t do everything I used to do. I hated taking my medication. I stayed out late and got up early. I was going to be normal or die trying. I ran into an acquaintance at one of the many doctor’s clinics I visit on a regular basis; I didn’t recognise her
because her face was swollen from the high doses of medication she had to take. The last time I’d seen her, she was at an art gallery opening, happily clacking along in her Prada heels. “Now,” she said, “I stay in the same pair of yoga pants for two weeks at a time – I’m that tired and aching.” We traded information: where to get chewing gum (banned in Singapore without a doctor’s prescription, but needed to stimulate the production of saliva to combat dry mouth); which dentists knew about treating gums; why we can’t get Botox any more. And yet, I noticed as she picked up her month’s supply of medication, she tucked them into the latest “It” bag. And I thought, yes, I can do this.