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Illustration: Angela Ho


Living with epilepsy and what the future holds for sufferers


Shock treatment



Yoga instruction stretches enjoyment of keeping fit


...................................................... Katie McGregor All-in Yoga 99 US cents Rating 10/10 My karma was out of line. Searching for worthwhile apps to review can make you very grumpy. So I was delighted to come across the All-in Yoga app. It is very pretty, with details such as little flowers appearing on the calendar on the days on which you do your yoga practice. It is also jam-packed with poses, videos, images and descriptions. And this is just the 99cent version. The apps’ many permutations make it very usable whatever your level. Choose from one of the dozens of ready-made routines designed for every level and aim. You can be prescribed a weight-, age- and goal-appropriate programme by the Personal Yoga Teacher function. Or you can create your own programme from the asana database. Select a programme and a voice will guide you through a series of poses, with the pose name voiced in

either English or Sanskrit, giving you a reasonable time for each pose before automatically moving on to the next one. Prop up your iPhone or iPad nearby for a visual reminder of what you should be doing. While the verbal instructions are clear enough, if you do need further assistance, a short explanatory video is provided with most poses. If that is not enough, you can also read up about the pose or check a diagram which illustrates the muscle groups that are being used. In your first download, you get a reasonable number of poses and programmes. In fact, I didn’t count them all as there were so many. You can also choose to download some free musical tracks such Camping Night, Ocean Tide and Vacation Dreams and the full 1GB of content so that you can use the app offline. This contains more poses, programmes, videos, and pictures. For an additional US$1.99 per month, or US$19.99 per year for the premium service, you get even more functionality. Although I could want nothing more from this app, my karma is now so well adjusted that I simply feel like sending them money for making me so happy.

ASK THE DOCTORS DR REGINA LO Q: After a big night out, especially on a weekday, I usually take painkillers such as Nurofen the next morning to get through the working day. Will this harm my health in the long term? A: Nurofen is a painkiller that can easily be bought over the counter. In addition to its ability to manage pain, Nurofen is also an effective anti-inflammatory medication. However, prolonged or excessive Nurofen intake may lead to the development of peptic ulcers in people who have sensitive stomachs. Therefore, Nurofen should be taken under a doctor’s supervision.

For pain control, paracetamol is a safer and preferred choice. A hangover headache, in fact, signifies excessive alcohol consumption. It is worth noting that excessive alcohol in the long run may lead to problems in health, relationships, work or finances. Alcohol reduces judgment, lowers inhibitions and may possibly increase domestic problems. It’s linked to poor performance at school or work, and an increased incidence of motor vehicle accidents. It is also found to be associated with increased risky sexual behaviour, especially among teens. Dr Regina Lo is a family physician.

> CONTACT US Deputy Culture Editor: Choong Tet Sieu Health Post Editor: Jeanette Wang General inquiries: Advertising: tel: 2565 2435;e-mail

Jeanette Wang Progress against malaria There is new hope in the fight against malaria. Tests done on mice by an international team led by scientists from the Genomics Institute of the Novartis Research Foundation and The Scripps Research Institute have resulted in a family of chemical compounds that could lead to drugs that are more effective against the Plasmodium parasite, both in the blood and liver. When a malaria-infected mosquito feeds on a person, the parasite enters the body and infects liver cells within 30 minutes. There it develops for about eight days without causing noticeable symptoms. Then it enters red blood cells, which it eventually bursts releasing toxins into the bloodstream, making the person sick. If the sufferer is bitten again, the parasite will enter the mosquito and the cycle continues. Most anti-malarial drugs work only during the blood stage, and those that do work have notable side effects. Don’t take pills; drink juice It’s widely thought that cranberries prevent urinary tract infections, so many people pop pills of cranberry extracts in an attempt to stay healthy. But a recent study published in the journal Food Science and Biotechnology shows that cranberry juice itself is far more effective at preventing biofilm formation, the precursor of infection. Researchers from Worcester Polytechnic Institute in Massachusetts tested proanthocyanidins (PACs), a group of flavonoids found in cranberries thought to give the juice its infection-fighting properties. Incubating bacteria strains in juice cultures and PACs, they found that juice cultures prevented biofilm formation, but PACs showed only limited ability. Meet the stars’ yogi What do Demi Moore, Ashton Kutcher and Cameron Diaz have in common with you? If you go for The Oriental Spa’s special Zenciel yoga sessions this week, you’ll have the same yoga teacher. Celebrity yogi Leo Zen will conduct four classes (HK$300 each) on Friday and Saturday on his Zenciel style, a blend of Kripalu, Ananda, Ashtanga and Hatha yoga. To book a slot, call The Oriental Spa at 2132 0011.

Research finds anti-cancer gene A gene that helps protect the body from squamous cell cancer (SCC) of the skin has been discovered by scientists at Monash University in Melbourne, paving the way for possible new cancer treatments and prevention in as little as five years from now. Up until now, surgical treatments were the only option for the disease. The scientists found that the gene, which has an important role in skin development in the fetus, was missing in adult SCC tumour cells. Without it, there is no signal to stop skin cells from growing, causing cells to multiply and eventually form a cancer. Though initially focusing on skin cancer, the gene is also lost in SCC that arises in other tissues, including head and neck cancers, that often prove fatal.

Study rates who listens better Twenty seconds is all it takes to tell whether a stranger is genetically inclined to being trustworthy, kind or compassionate, according to a study by the University of California, Berkeley. Twenty four couples were told to talk about times when they had suffered, with only the listener being recorded on video. A 20-second clip of the video was then shown to a group of observers, who were asked to rate which listener seemed most empathetic. Listeners who got the highest ratings possess a variation of the oxytocin (aka the “love” hormone) receptor gene known as the GG genotype. These people “displayed more trustworthy behaviours – more head nods, more eye contact, more smiling, more open body posture. These behaviours signalled kindness to the strangers,” says lead author Aleksandr Kogan.


It helps to exercise regularly, maintain an ideal weight and stick to a healthy diet


When clots turn deadly ...................................................... Sasha Gonzales A family friend Elizabeth, 64, broke her left ankle when she fell down a flight of stairs at home in June. As it was a clean break, her orthopaedic doctor told her she did not require surgery. Instead, he put her leg in a cast boot, reassuring her that the broken fibula (calf bone) would eventually fuse on its own, and sent her home, telling her to get plenty of rest. Elizabeth (name changed for patient confidentiality reasons) spent most of the next six weeks in bed, only getting out when she really needed to with the aid of crutches. Her cast boot was adjustable, so she loosened it whenever she needed some relief. At the end of July, just five days before she was scheduled to get her cast boot removed, she collapsed while taking a shower. Feeling light-headed and short of breath, she called out to her husband, but before he could phone for the ambulance, she passed out in his arms. Elizabeth died a few hours later from a blood clot in the lung, a condition known as pulmonary embolism. Before her fall, she was a healthy and active woman who followed a sensible diet, exercised regularly and didn’t smoke or drink. Her prolonged immobility was believed to have created the conditions for a blood clot to form in her injured leg. lizabeth had deep vein thrombosis (DVT). Her doctors later told her family that the clot in her leg broke off, moved upwards and became lodged in an artery of her lungs. The day before she died, Elizabeth had complained that her left thigh and knee were sore, but her family had no idea that her life was in mortal danger. DVT is commonly associated with long-distance flying and is sometimes referred to as “economy-class syndrome”. But long-haul travellers are not the only people at risk. Dr Nicholas Cox, a Melbourne-based cardiologist, says it is not unusual for DVT to develop in people who have been immobilised for a lengthy period, as is usually the case after hip or knee surgery, or following a severe injury when a person is confined to bed for a lengthy period.

Orthopaedic specialist Dr Yeung Yeung from Asia Medical Specialists says the prevalence of DVT is well documented in hip and knee surgeries, but not in foot and ankle surgeries. She says that calf swelling and pain can be symptomatic of DVT, and if a clot is found, the patient is usually prescribed anticoagulants to help thin the blood. Yeung points out, however, that a clot is not easy to detect and by the time any complications arise, it is usually too late to save the patient. Yeung says she advises her injured patients who are at risk of developing DVT to stay adequately hydrated during the immobilisation period, to prevent their blood from thickening. She also tells them to move their injured limb or the adjacent uninjured joints, to get their blood pumping more efficiently. “Pain control can also give a sense of security to patients and therefore encourage early mobilisation,” she adds. Other groups at risk of developing DVT include the elderly, women who are pregnant, on the pill or oestrogen replacement therapy, the obese, smokers, those who have had blood clots before, and those who have recently had congestive heart failure or a heart attack. These groups are more prone to DVT due to abnormalities with their blood clotting, Cox says. Some of these abnormalities are also inherited. So, if a close family member has or has had DVT, you are also considered to be high-risk. If you are not sure about your family’s medical history, Cox says that specific blood tests can reveal if you have a propensity to clots. If you belong to any of these high-risk groups, there are certain measures you can take to reduce the risk. Anticoagulants can help if you have had blood clots before or having just undergone certain types of surgery after which blood clots can form. You’re also advised to avoid sitting for extended periods; however, if you’ve just had surgery or are recovering from an illness or injury and require bed-rest, try to get up and move every now and again, to improve blood circulation in your legs. Otherwise, ask your doctor to recommend appropriate leg exercises which you can do every hour to keep the blood moving.

Avoiding dehydration may also help, Cox suggests. When you are dehydrated, your blood thickens and has a greater tendency to clot. And of course, whether or not you are part of the high-risk group, it helps to exercise regularly, maintain an ideal weight, and stick to a heart-healthy diet that is low in both saturated fat and cholesterol and high in fibre. If

If a close family member has or has had DVT, you are also considered to be high-risk

you’re wondering whether compression stockings can help reduce your risk, Cox says that the scientific evidence to suggest they work is not very convincing. Plus, they can be uncomfortable and difficult to get on and off. However, that’s not to say you can’t wear them, because they are a sensible preventive treatment, Cox adds.


Seizing control Many Hongkongers with this neurological disorder struggle to overcome social stigmas but these attitudes are changing, reports Wynnie Chan



The percentage of Hongkongers who would not allow their children to marry a person with epilepsy, according to a 2002 survey


arla Chan, a fresh-faced and bubbly 27-year-old, looks a picture of health. But she’s just been discharged from hospital and has become such a regular there that all the doctors, nurses and other staff know her by name. A recent decision by Chan (name changed for patient confidentiality reasons) to start a family is the reason for these frequent visits – not because of fertility issues, but due to epilepsy, a condition that has plagued her since birth. Her condition had been controlled well by taking anti-epileptic drugs, suffering from only one seizure a year at the most. But mindful that medications during pregnancy could affect the health of a foetus, Chan sought the help of her neurologist, who advised using a relatively new drug, Lamotrigine, which is thought to pose less of a risk to the developing foetus than older anti-epileptic medications. However, since Chan started taking the drug about eight months ago, she has had weekly seizures. The one that landed her in the hospital this time happened on a road outside a department store in Causeway Bay; she fell and hit her head, resulting in injury. What Chan goes through is more common than you might think. Enlighten – Action for Epilepsy, a local charity that aims to raise awareness of the condition and assist epilepsy sufferers, estimates that about 64,000 people in Hong Kong have the condition, or about nine per 1,000 people. The causes of epilepsy are known only in a minority of cases. Typically these involve some form of brain damage, such as injury, low oxygen during birth, tumours, infections such as meningitis, stroke, or abnormal levels of sodium or blood sugar. There may be genetic factors involved, but in up to 70 per cent of cases, no cause can be identified. Epilepsy awareness remains low even though it’s “the most common serious chronic neurological condition”, according to researchers from the University of Hong Kong’s department of medicine, who in 2008 conducted one of the few epidemiological studies of the condition in the territory. Because of this, sufferers are often stigmatised. “I’m embarrassed about having to carry my medication in my bag. A lot of people, including my friends, don’t really know about or understand epilepsy,” says Chan, whose eldest sister, mother and maternal grandfather all suffer from the condition. “My boss was worried that I would have a fit, so I had to give up [the beautician job] that I loved.” She says her seizures are often brought on by flashing lights, a lack of sleep or stress. Laura Ferrington, 32, who was diagnosed with epilepsy at age 15, travels frequently in the region with

her job as a sourcing manager. Her colleagues in Hong Kong and abroad have been alerted of her condition so they won’t be caught off guard if a seizure occurs, and they know what to do during and after the event. Thankfully, she has enjoyed tremendous support and understanding from her employers and colleagues. But she notices that while her Western colleagues may ask her candidly about her condition, her local friends and colleagues tend not to mention it. She often wonders how people with epilepsy are truly perceived by the local population. Epilepsy comes from the Greek word epilambanein, which means “to seize” or “to take hold of”. It affects 50 million people worldwide, with at least 2.4 million new cases occurring each year, according to a World Health Organisation report last year. From its first documentation in around 4000BC to the present, myths and superstitions have surrounded epilepsy. Until last year, the Chinese medical term for the condition, when translated, meant “crazy seizure disorder”. Psychosocial studies in China, reported last year in an issue of the journal Epilepsy and Behaviour, have found the stigma is universal among people with epilepsy and affects around 89 per cent of individuals and about 76 per cent of their families, causing loss of face and diminished self-esteem. As a result, social communication, quality of life, education, employment, marriage and having children are severely affected in people with epilepsy.

Every time I wake up at hospital, I cry. I don’t want my husband, family or friends to know CARLA CHAN, EPILEPSY SUFFERER

A survey of public attitudes to epilepsy in Hong Kong reported in the journal Epilepsia in 2002 found that nearly one-third of the people interviewed reported that they would not allow their children to marry a person with epilepsy, and 25 per cent of employers said they would terminate the employment of a person with epilepsy. Bullied and teased at primary school, Chan was forced to change from the popular morning sessions at school to afternoon classes. At secondary school, she was not


of epilepsy confused, weak and tired. These seizures can last up to half an hour. At other times, I might just blank out and lose awareness for a second or two without any warning or after-effects.” Epileptic seizures are recurrent and random, triggered by abnormalities in the brain that cause a group of nerve cells in the cerebral cortex to become activated simultaneously, emitting sudden and excessive bursts of electrical energy. This causes a temporary disruption in the normal

The risks of seizures include physical injuries, [near] sudden death, psychological disturbance … depression is common DR EDMUND WOO KIN-WAI, NEUROLOGIST

messaging between nerve cells in the brain. A seizure’s effect depends on the extent and location in the brain where this electrical hyperactivity occurs. When both sides of the brain are involved in synchronised discharges, this results in generalised seizures, which can be characterised by a loss of consciousness with muscle contractions and involuntary jerky movements (grand mal or tonicclonic seizures), or a short period of loss of consciousness only (absences). The other variety, called partial seizures, occur when abnormal electrical activities affect only part of the brain. Partial seizures consist of subjective experiences or involuntary motor activity, or both, with or without loss of consciousness. “The risks of seizures include physical injuries, sudden unexpected death [Sudep], psychological disturbance … depression is common, especially when the seizures are poorly controlled,” neurologist Dr Edmund Woo Kin-wai says. In two-thirds of cases, epilepsy is well-controlled with medication and sufferers experience no side effects. The other third, for whom medication does not work, could turn to surgery. The most common involves operating on the temporal lobe, the area of the brain behind the forehead between the ear and the eye, where most seizures originate. A study by University College London published in

Illustration: Angela Ho

allowed to participate in any physical activities after having a seizure during her first physical education lesson. “Sometimes I get a warning feeling [aura] before a seizure, I might notice a strange smell or a painting might move like a scene from a martial arts movie, or a table might float,” says Chan, who married her childhood sweetheart last year. “I might cry out loud at the beginning of a seizure, my arms and legs will stiffen [tonic] and then they will jerk [clonic]. I’ll fall down and when I come round I’ll feel

The Lancet last month found that 63 per cent of patients were free of seizures two years after surgery (excluding simple partial seizures), 52 per cent after five years, and 47 per cent after 10 years. When she had that seizure in the Causeway Bay, Chan recalls people pinching her arms and legs and slapping her to try and wake her up. “Every time I wake up at hospital, I cry,” she says. “I don’t want my husband, family or friends to know because I know they worry about me. I don’t want their pity or sympathy, either, so I don’t tell them.” She did, however, contact Stephanie Wong, a senior social worker at Enlighten, who first came to Chan’s aid seven years ago. During a dark period of her life when Chan lost her mother, she came across Enlighten’s website. Answering Chan’s initial e-mail for help, Wong at first supported and provided counselling via text messages and e-mails. Since then, Wong has been a pillar of support for Chan and many others suffering from epilepsy, organising peer group learning and sharing sessions, providing counselling when needed, accompanying sufferers to neurologist appointments, and helping them understand the regimen of drugs. Enlighten has helped Chan meet and share her experiences with people of the same age who are in a similar position, and it’s helped her find hobbies that have filled the void left by losing her job. She remains upbeat and doesn’t let epilepsy stop her living a normal life, though she’s put aside her dreams of motherhood for the time being and is tapering off Lamotrigine. Ferrington, too has never let epilepsy stop her doing anything she wanted to. She hopes, however, that people will lose their fear of the condition and the people who suffer from it. “Try to be understanding when people lose control during a seizure, and don’t judge them for what they say and do,” she says. Enlighten’s vision is exactly that: “to build a community that is accepting and understanding of those with epilepsy that enables them to lead vibrant and active lives in Hong Kong”. Claudia Schlesinger, CEO and founder of Enlighten, says: “It’s taken seven years for a sanction from Beijing to officially change the Chinese translation for epilepsy. Now the condition is translated as ‘brain seizure disorder’. It’s our mission to provide support and care to those affected by epilepsy and to remove prejudice through community education.” Additional reporting by Eileen AungThwin. For more information on epilepsy, visit or call 2820 0111


Invisible shutdown tough to live with ..................................................... Eileen Aung-Thwin One moment, 15-year-old Laura Ferrington was in her friend’s bedroom the morning after a sleepover, happily chatting with her friend; the next, she found herself on her back, looking up at paramedics leaning over her. Disoriented, confused and scared, Ferrington could make out the worried faces of her friend and her parents as the paramedics carried her out of the room. But she had no memory of what happened between the conversation and the paramedics’ arrival. A chaotic whirl of events followed as she was whisked to hospital, where doctors ran tests and ordered scans. Ferrington found out that while talking with her friend, she had suddenly collapsed midconversation. Her body then jerked and thrashed about in a grand mal seizure, a type of epileptic fit. Several months of tests and three more seizures later, doctors diagnosed her with epilepsy. The diagnosis came as a shock to Ferrington and her parents. She had never known anyone with epilepsy, and even today, about 17 years later, Ferrington has yet to see anyone have a seizure. More frustratingly, doctors were unable to offer her an explanation as to why she was suffering from epilepsy. Despite the slew of computed tomography (CT) scans and electroencephalograms (EEG) that she underwent over the years, doctors could find nothing wrong and said her scans were all normal. Her diagnosis was largely based on her experiencing repeated seizures. But a pattern did start to emerge. Ferrington’s seizures tended to occur once a month and were linked to her monthly menstrual cycle. They also tended to take place in the morning, which meant that she was often home when they occurred. They usually lasted about three to four minutes.

Ferrington has no recollection of the few minutes before, during and after each seizure, and typically remains a little dazed for about 15 to 20 minutes after the seizure stops. Although Ferrington was given the only available medication at the time – Epilim – the drug failed to keep the monthly seizures at bay. But she refused to be held back by her condition. She continued to pursue her studies and social life and, mysteriously, the seizures stopped after she turned 20. But they returned just as suddenly when she was 26 and about to move to Hong Kong with Richard, the man who became her husband. The first time he witnessed her having a fit was in their Hong Kong

One of the greatest dangers that people with epilepsy face is the risk of injury when they are gripped by a seizure home. He heard a strange sounding scream from Ferrington as the sudden muscle contractions forced the air out of her lungs. He turned around in time to see her fall face forward on to their dog’s bed. Although Ferrington was lucky to have her fall cushioned by the dog’s bed that day, it doesn’t always happen like that. One of the greatest dangers that people with epilepsy face is the risk of injury when they are gripped by a seizure. Earlier this year, Ferrington was out walking the dog by herself when a seizure struck. She fell face first onto the pavement and knocked out all her front teeth and broke her jaw. She is undergoing a year’s worth of surgery and treatment to repair the damage.

Sometimes Ferrington will come to with a black eye or covered in bruises. “I seem to be constantly at the osteopath because of back problems,” she says. The couple have learned to watch for warning signs of an impending seizure. As the fits often happen near her period, Ferrington is especially alert during that time. She avoids alcohol and tries to get enough sleep. Sometimes before a seizure, she will have trouble concentrating and keeping pace with a conversation, and at other times, her limbs might involuntarily jerk. Ferrington will then stay indoors or somewhere she cannot hurt herself. But at other times, there is no warning. While Ferrington and Richard take living with epilepsy in their stride, there are some questions. After four years of marriage and at age 32, Ferrington has thought about starting a family. Although her seizures have worsened in the past few years, her neurologist in Hong Kong started her on new antiepileptic drugs, which have worked well. After a year on the medication, she has had only two seizures in the past six months. Unfortunately, there is not much data about how her medication will affect an unborn child, and she is concerned about the risk of deformities. According to the US-based Epilepsy Foundation, for babies whose mothers take seizure medication, the risk of birth defects is 4 to 8 per cent, compared with 2 to 3 per cent for all babies. It can also deprive the babies of oxygen and increase the risk of miscarriage and stillbirth. Ferrington is also worried about falls during advanced pregnancy, but she and Richard maintain an open, positive attitude towards living with epilepsy. Richard’s advice: “If you live with someone who suffers from seizures, learn to read the signals and try not to make a big deal of it. The actual situation [during the seizure] is stressful, but it doesn’t last long.”

A “spike” of electrical activity in the brain’s neurons is responsible for the seizures in epileptics. Photo: Corbis


And nothing but the tooth ...................................................... Dr Mishi Khanna You take pretty good care of your teeth. You brush and floss daily. You don’t have toothaches. So, unless there’s a problem, you don’t need to see your dentist regularly, right? Wrong. Your mouth is a window, and the colour, texture and general state of your teeth provide clues about your overall health. Examples: • Cardiovascular disease Some research suggests that heart disease, clogged arteries and stroke may be linked to oral bacteria, possibly due to chronic inflammation from periodontitis. • Endocarditis Gum disease and dental procedures that cut your gums may allow bacteria to enter your bloodstream. This can cause infections in other parts of the body. • Pregnancy and birth Gum disease has been linked to premature birth and low birth weight. • Diabetes This condition reduces the body’s resistance to infection, adding to risk of gingivitis, and inflammation caused by bacteria in plaque. People with poorly controlled blood sugar may develop more frequent and severe infections of the gums and bones that hold teeth in. • Oral cancer This is one of the most common cancers. Indications may include bleeding sores, lumps or thick, hard spots, as well as a change in the way the teeth fit together. • HIV/Aids Problems, such as lesions in the mouth, are more common in people who have HIV/Aids. • Osteoporosis Weak and brittle bones may be associated with periodontal bone loss and tooth loss. • Alzheimer’s disease Tooth loss before age 35 may be a risk factor. • Eating disorders These include anorexia nervosa and bulimia, which rob the body of vitamins and minerals. Without proper nutrition, gums lose their healthy pink colour and become tender, with a tendency to bleed. Bulimia can cause erosion and discolouration of the teeth from stomach acid. Other symptoms include swollen salivary glands, dry mouth, sensitive teeth and loss of tooth enamel. So, here are some signs and symptoms you should be aware of: Dry mouth (xerostomia) A permanently dry mouth is one of the symptoms of diabetes. The condition causes blood vessels in the salivary glands to thicken, slowing down the removal of toxins and flow of saliva, drying the mouth and making the gums prone to infection. Action: if you don’t smoke and are not taking medications such as painkillers and cold remedies, look for other symptoms of diabetes such as blurred vision, recurring thrush and an insatiable thirst with a frequent need to urinate. If any are present, get a blood test. Bleeding, painful gums You most likely have gingivitis, which is caused by a build-up of plaque due to poor oral hygiene. Plaque hardens into calculus (tartar). Tartar build-up can lead to gingivitis and periodontal disease. Poor diet, stress, too much alcohol or spicy foods can lead to too much

acidity in the system, which can inflame gums. Frequent sore throats are also indicators of gum infection. Action: brush and floss your teeth at least twice a day. Use a mouthwash. Change your toothbrush at least every three months. Always replace your toothbrush after a sore throat or tonsillitis, because bacteria on the bristles can spread to your mouth and throat. Avoid cigarettes, alcohol and fatty, sugary and sticky foods, which may aggravate your digestive system. Eat more fruit and vegetables and take a vitamin C supplement. Ulcers Most mouth ulcers appear when your immune system is suppressed. In rare cases, mouth ulcers can be the earliest warning sign of throat, tongue or mouth cancer. Action: in most cases, ulcers clear up of their own accord in a week to 10 days. You should try to relieve stress during this time, and avoid spicy or acidic foods. Reduce inflammation by using a mouth ulcer preparation such as Bonjela. If you have a lump or ulcer in the mouth, gum, tongue or throat area that doesn’t disappear within two weeks, see your doctor. Inflamed lump on the gum You could be pregnant. Such a lump, which is large and often overlaps a tooth, is called an epulis and is common during pregnancy. They result from hormonal changes – oestrogen makes the gums more sensitive and prone to inflammation – and disappear after giving birth. Very rarely, a severe gum inflammation (which doesn’t respond to treatment) may indicate a blood disorder or leukaemia. Action: check if you are pregnant. If you are, visit the dentist regularly. Eroded enamel, chipped and sensitive teeth According to the Hong Kong Dental Association, acidic drinks are causing an increase in loss of tooth enamel. This exposes the underlying dentine. As dentine is darker in colour than enamel, the teeth can also look stained and discoloured. Action: cut down on fizzy drinks and improve your oral hygiene. Brush your teeth for two minutes at least twice a day, but wait at least an hour after a fizzy drink, as the drink softens your enamel and brushing will only make the problem worse. Worn-down teeth Worn-down teeth, especially in a younger person, are nearly always the result of teeth grinding. It usually occurs at night, and many people may be unaware they are doing it. Action: try using a mouth guard. Cut stress before bedtime by finding ways to relax, such as listening to music. Bad breath (halitosis) Stomach disorders, indigestion and occasionally liver disease can all cause bad breath, but usually it is caused by tooth decay, gum disease, smoking or eating pungent foods. Action: breath fresheners, or simply chewing parsley, can minimise bad breath from certain foods. Brush and floss teeth regularly. If your bad breath hasn’t cleared up after two weeks, consult your dentist.

The condition of your mouth, teeth and gums can reveal a lot about your overall health. Photo: Corbis


Incentive to prevent, treat ...................................................... Jacinta Read While health is vital to all, regardless of gender, there are two reasons for the special emphasis placed on women’s health. First, a huge number of the conditions that affect women are preventable and easily treatable. Second, the way in which a woman looks after herself is very likely to influence her family. “We’re better off because we have more knowledge and the ability and power to seek more knowledge,” says Dr Zara Lok, a specialist in obstetrics and gynaecology at Prince of Wales Hospital. At our current rate of medical and scientific advancement the future is looking bright. Here are a few reasons: Breakthroughs in reproduction “Many women delay pregnancy until they have established their careers,” says Dr Christelle Swanepoel, a general practitioner who has worked in private and public health care in South Africa and Britain. “There are more types of contraception available, and women have strong opinions about which type they prefer. Because of the delay in pregnancy, there are also more women seeking advice on fertility and assisted conception [in vitro fertilisation (IVF), intra-cytoplasmic sperm injection, etc].” EmbryoGen is a fertility breakthrough that has been 20 years in the making – specifically for women who have experienced miscarriages after IVF. Research focused on growth factor signals for a healthy embryo in a normal environment. Dr Sarah Robinson, a reproductive biologist at the University of Adelaide, is largely responsible for the development of EmbryoGen, and describes the treatment as “a major paradigm shift for reproductive medicine”. EmbryoGen is 100 per cent safe and natural, and contains a signalling molecule called GM-CSF that protects the embryo from stress. Clinical trial results showed a 40 per cent increase in implantation success for women who had miscarried. IVF children are often smaller at birth, which can lead to multiple challenges later on in life. There is evidence that EmbryoGen may also result in larger, healthier babies. HPV vaccine Cervical cancer vaccines are arguably the most publicised recent

breakthrough in women’s health. Cervical cancer is usually caused by an infection of human papillomavirus (HPV). The vaccine will be given to pre-teenage girls before they become sexually active, although it also shows evidence of benefiting older women and even men, with its effectiveness in preventing genital warts. This vaccine will not replace a woman’s need for regular pap smears. “Cervical cancer has no symptoms until the disease has progressed, but it has pre-cancerous stages that are easily detected and treated,” says Swanepoel. “It is important to start a screening programme in your 20s, to do regular breast self-examinations, and to start having regular mammograms in your 40s to 50s [or earlier if there is a strong family history].” Accurate fitness assessment An improved chart has been developed to gauge what a woman’s fitness level should be at any given age. A woman whose exercise capacity is less than 85 per cent of her age-predicted level is at a higher risk of death. Until very recently, women were measured on the men’s nomogram chart to determine fitness levels. The problem is that women generally can’t compare to men on these tests, leading to inaccurate results, such as a woman might be told she is at a higher risk of death than she really is. The principle of distinguishing between the sexes when it comes to exercise and general fitness is relevant to all women. Personal trainer Dora Hardaway, a pre- and post-natal specialist at Pure Fitness, says: “Hormones are the defining factor that separate men and women, and as a trainer, I don’t train women in the same way that I would train men. Females have monthly cycles and, depending on what stage they are in in their lives, have different needs.” Hardaway takes a holistic view of female clients and their reasons for working out. “If we measure a woman’s scores against the old nomogram chart, with ‘false’ results, even a client who has been training religiously could be discouraged, never mind those who are new to the gym. The gap between where they are and where they need to be may seem impossible to bridge.” Menopause Women who go 12 months with no menstrual flow are considered to be entering menopause. Aside from the

well-known symptoms of hot flushes, palpitations, depression, irritability, anxiety, and mood swings, it is a fact that menopausal women have diminishing bone density due to their lowering levels of oestrogen. Hip fractures are common in elderly women, and a study at the Centre for Health Research in Portland, Oregon, has shown that the odds of death are twice as likely in the 12 months following a hip fracture. The calcium intake of Hong Kong Chinese women is among the lowest in the world, making them likely candidates for poor bone density and hip fractures. This is a clear instance of knowledge being power: focus on hip fracture prevention could dramatically reduce the mortality rate of this age group. Blood tests’ predictions of when menopause will occur are improving, up to three or four years before it takes place. While the prevention of fractures is ideal, all is not lost for those who have experienced one. The recent use of osteoporosis drugs has yielded good results in treating bone fractures and promoting faster recovery. Tried and true There are plenty of ways to stay healthy. “I encourage women to practise regular contraception and pap smear screening when appropriate,” says Lok, at Prince of Wales. “I’m very conscious about diet and exercise. I think this contributes immensely to a woman’s health.” Swanepoel adds: “Many women neglect their health when they have children. Unhealthy mothers won’t be able to support their children as well as healthy mothers. And although women’s health focuses on specifically female issues, women still suffer from other illnesses.” She urges women to adhere to good diets and cardiovascular exercise, along with regular and thorough check-ups. Breakthroughs lie not only in the area of medical advancement, but also in the socioeconomic sphere. The government is educating Hong Kong people through various media campaigns and by promoting health services available to all. “Because women’s issues are discussed more openly in society and media, it creates a channel for discussion between family members, as well,” says Lok. “People are also more open in discussing women’s health problems, so they will be more assertive in asking about their problems.”

The HPV vaccine protects women from cervical cancer, and men and women from genital warts. Photo: Martin Chan

Reduced muscle mass that comes with age can be prevented. Photo: NYT


It’s inactivity, not ageing, that makes people ‘old’, study finds ...................................................... Gretchen Reynolds Is physical frailty inevitable as we grow older? That question preoccupies scientists and the middle-aged, particularly when they become the same people. Until recently, the evidence was disheartening. A large number of studies in the past few years showed that after age 40, people typically lose 8 per cent or more of their muscle mass each decade, a process that accelerates significantly after age 70. Less muscle mass generally means less strength, mobility and, among the elderly, independence. It also has been linked with premature mortality. But a growing body of newer science suggests that such decline may be preventable. Exercise, the thinking goes, and you might be able to rewrite the future for your muscles. Consider the results of a stirring study published last month in the journal The Physician and Sportsmedicine. Researchers at the University of Pittsburgh recruited 40 competitive runners, cyclists and swimmers. They ranged in age from 40 to 81, with five men and five women representing each of four age groups: 40 to 49, 50 to 59, 60 to 69, and 70-plus. All were enviably fit, training four or five times a week and competing frequently. Several had won their age groups in recent races. They completed questionnaires detailing their health and weekly physical activities. Then the researchers measured their muscle mass, leg strength and body composition, determining how much of their body and, more specifically, their muscle tissue was composed of fat. Other studies have found that as people age, they not only lose muscle, but the tissue that remains can also become infiltrated with fat, degrading its quality and reducing its strength. There was little evidence of deterioration in the older athletes’ musculature, however. The athletes in their 70s and 80s had almost as much thigh muscle mass as the athletes in their 40s, with minor, if any, fat infiltration. There was, as scientists noted, a drop-off in leg muscle strength around age 60 in both men and women. They weren’t as strong as the 50-year-olds, but the differential was not huge, and little additional decline followed. The 70and 80-year-old athletes were about as strong as those in their 60s.

“We think these are very encouraging results,” says Dr Vonda Wright, an orthopaedic surgeon and founder of the Performance and Research Initiative for Masters Athletes at the University of Pittsburgh Medical Centre, who oversaw the study. “They suggest strongly that people don’t have to lose muscle mass and function as they grow older. The changes that we’ve assumed were due to ageing and therefore were unstoppable seem actually to be caused by inactivity. And that can be changed.” Other recent studies have produced similar findings. Last year, researchers at the Canadian Centre for Activity and Ageing, for instance, examined muscle tissue from older competitive runners, checking for the density of their motor units, a measure of muscle health. In multiple earlier studies, people over 50 have been found to possess far fewer muscle motor units than young adults. But that wasn’t true for the sexagenarian runners, whose leg muscles teemed with almost as many motor units as a group of active 25-year-olds. Running, the scientists wrote, seemed able to “mitigate the loss of motor units with ageing well into the seventh decade of life”. Of course, the volunteers in both Wright’s and the Canadian study were, for the most part, lifelong athletes. Whether similar benefits are attainable by people who take up exercise when they are middle-aged or older “isn’t yet clear”, Wright says, “although there’s no reason to think that you wouldn’t get similar results no matter when you start”. Other questions about the impacts of exercise on ageing muscle also remain unanswered. “We don’t know what kinds of exercise are best,” Wright says, and, in particular, whether endurance exercise is necessary for muscle sparing or whether weight training might be as good or better. Scientists also haven’t determined just how much activity is required to maintain muscle mass, or how intense it needs to be. “What we can say with certainty is that any activity is better than none,” Wright says, “and more is probably better than less. But the bigger message is that it looks as if how we age can be under our control. Through exercise, you can preserve muscle mass and strength and avoid the decline from vitality to frailty.” The New York Times


For wife, alone again, naturally ........................................... Christine Lilwall “Latitude: 44.79694 [North], Longitude: 110.16588 [East], GPS location. Date/time: November 14, 2011, 3.03.09am PST [Pacific Standard Time, US]. Message: ‘First day okay – cooking dinner! Stars cool’.” This was the first message I received from my husband, Rob, via a one-way satellite device on day one of his Walking Home From Mongolia expedition, a 5,000kilometre trek to Hong Kong via wintry China. I was on a work trip to Britain, complaining about the chilly autumn; he is somewhere in the Gobi Desert, where it is minus 20 degrees Celsius. With no internet connection, he’s unable to write this week, so I’ve decided to share a bit about what it’s like being the wife of an adventurer. When most people find out about Rob’s six-month walking expedition this winter, I usually get asked, often along with a sympathetic look: “How are you doing with him being away?” I’m not sure how my wellmeaning friends and acquaintances expect me to respond. Smile brightly and joke about enjoying not having a messy flat to tidy up? Break down in tears? The trouble is, I’m not too sure myself. My first experience at keeping a relationship alive long-distance began when Rob and I parted after three months of dating in Hong Kong in the summer of 2005. Rob was on a three-year bicycle expedition, and as he pedalled southwards to Australia via the Philippines, Indonesia and Papua New Guinea, I relocated to London for work. I still remember those days, working away furiously in my shiny office, when my motherly personal assistant would come in holding a somewhat crumpled-looking

envelope stamped by a postman in some exotic country. Despite the near indecipherable scrawl, I relished every one of Rob’s letters, penned late at night in his tent. On my lawyer’s salary, it was easy to call Rob in most places, including on a mobile phone he managed to borrow on a hillside in Afghanistan, and I even travelled to see him during holidays. Friends and colleagues would listen with bemusement as I told them how many hours’ time difference we had at any one point as he cycled into different time zones. (I was baffled to learn that Nepal was GMT +5.45 – why the 45 minutes?) That is, if they actually believed me – some thought he was a completely made up boyfriend. When Rob first brought up the idea of walking through China last year, I was, naturally, not that excited. Our lives are very different now compared with our longdistance dating relationship, and even Rob’s original estimate of the trip taking four months seemed a bit long for a couple who had been married for less than two years. (The current estimate is six months.) I would be lying if I said I had no issue with it. But I knew Rob isn’t the sort of man who can sit still at home and is always yearning to do things which most of us wives might consider dangerous and irresponsible. We both enjoy married life, and are loving settling into life in Hong Kong. At the same time, I couldn’t avoid seeing that, for some reason foreign to me, even after a long, lifechanging, three-year bicycle trip, he still loves adventures and longs to push himself beyond the usual limits (though I hasten to add he was perfectly happy watching DVDs and eating ice cream every night, too). If I had a choice, I would obviously prefer to have Rob by my side. The two weeks since we parted have not been smooth sailing,

While Rob Lilwall is on his 5,000-kilometre adventure, his wife is coping with being home alone. Photo: Rob Lilwall though it’s been much better than I had expected, and for that I’ve got to thank God, our families and friends. Speaking to friends who have spouses who travel extensively with their work has also helped. It’s not quite clear to me what the next six months will look like. I actually find it unhelpful to think about it as a six-month period; frankly, I can’t really cope with the idea of being separated from my husband for so long. Thankfully, I should be able to visit him every six weeks or so in various locations in China as the boys pause for a rest. In the meantime, I’ll keep busy with the children’s charity Viva, for which we are raising funds through

When Rob first brought up the idea of walking through China last year, I was, naturally, not that excited

Rob’s expedition. Viva is a big reason we’re willing to make the sacrifice. Viva’s work with children at risk around the world is strategic, cutting edge, and critically needed. Next week I’ll share more about that. Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic TV series. Every week in Health Post, he will write about the progress of his new expedition, Walking Home From Mongolia, which is in support of the children’s charity Viva. www.walkinghome


Valencian tradition a healthy alternative to fried rice ...................................................... Jeanette Wang Hongkongers love their fried rice, but the dish is loaded with oil and low on vegetables and nutrients. Paella, a Spanish favourite, is perhaps a healthier option. In the Valencian dish, the rice is cooked by boiling it together with a mixture of sautéed vegetables and seafood in a specialised shallow pan called a paella. Medium-grain rice is used as it absorbs more liquid and stays relatively firm. Saffron is added for colour and flavour. This reduced-fat and -salt variation by The English-Speaking Dining Society of the Chinese Cuisine Training Institute, however, can be done in any frying pan, using long-grain rice and omitting the

saffron. You could call it a local take on a Spanish tradition. To make it even healthier, use brown rice. Carrot and seafood paella Serves 4 300 grams long grain rice 11⁄2 carrots 3 ⁄4 onion 3 ⁄4 green capsicum 3 ⁄4 red capsicum 80 grams clam meat 100 grams medium-sized prawns 100 grams fish meat 100 grams squid meat 1 tbsp olive oil 100ml chicken stock 8 mussels 1/2 tsp fine salt Ground white pepper to taste • Wash and strain rice.

• Grate carrots, keeping the juice. • Dice onion and capsicum into 1cm cubes. Set everything aside. • Wash all seafood and keep them in separate bowls. • Slice fish meat and cut squid into rings. • Preheat 1⁄2 tbsp olive oil in a pan and sauté the rice. • Add clams and carrots. • Meanwhile, heat another pan with remaining olive oil and slightly sauté onions, capsicum, prawns, fish and squid. Season and place everything on top of the rice. • Add chicken stock and mussels. • Bring to a boil, then lower heat and cook for 15 minutes. This column features recipes provided by the Health Department as part of the department’s campaign. For more information, visit

This carrot and seafood paella is lower in fat and salt


When the temperature drops, even a salad shop needs a warm-up ...................................................... Elle Kwan The Dressed chain of salad shops have made their name in Hong Kong as a leader in providing raw leaves and delicious dressings, but come winter, those cold salad dishes welcome a warming lift. Dressed’s co-founder and executive chef, Justin Smolev, created this minestrone as a great warmer in colder weather and filled it to the brim with healthy winter vegetables, including kale. Mixed, as it is here, with creamy squash, sweet carrots and aromatic oregano any residual bitterness left in the leaves

Justin’s minestrone by Dressed salads, at IFC mall in Central. Photo: May Tse

is reduced, leaving only healthgiving nutrients. And in a soup this brightly coloured, the dietitian’s favourite daily recommended rainbow of veggies appear all together in a single dish.

1 tbsp oregano 1½ cups water 50 grams red kidney beans, rinsed 50 grams cannelloni beans, rinsed 50 grams pasta 1 cup shredded kale Salt and pepper to taste

Justin’s minestrone Makes 1.3 litres

• Melt butter and oil in a stock pot. • Add onions and garlic. Sweat over a medium heat for five minutes. • Add squash, carrots, celery, potatoes, oregano and water. • Simmer for 20 minutes. • Add beans, pasta, and kale and simmer for another 20 minutes, or until all ingredients are cooked through. • Season with salt and pepper.

15 grams butter, chopped ½ cup salad oil ½ cup chopped onions 2 tbsp minced garlic ½ cup butternut squash, cubed ½ cup carrots, cubed ½ cup celery, sliced ½ cup Idaho potatoes, cubed


Kale: veggie packed with leafy goodness ...................................................... Elle Kwan The sign outside the organic shop advertised a delivery of kale; unusual, since the vegetable is relatively hard to find in Hong Kong. We have come to call Chinese kai lan kale, but these bunches of green leaves are rougher in texture, softly furling at the edges with thinner stems than their Chinese cousins. Both are classed as cruciferous vegetables. They come from the same family branch of classification and are related to broccoli, cauliflower, collard greens, cabbage, bak choi and even wasabi. Indeed, most of these veggies carry at least a hint of a bitter tang, which is reminiscent of wasabi’s nostrilcleansing strength. Cruciferous vegetables are extremely important to a healthy diet, being high in vitamins, antioxidants and beta-carotene, and kale is a winner when it comes to nutrient levels. Rich in vitamins D and K, website also says that the green leaves pack 17 times the amount of vitamin C found in carrots and seven more times the amount of carotene in cabbage. A great source of non-dairy calcium easily absorbed by the body, it’s a choice for those who are lactose intolerant or do not like dairy. Kale is known for its abilities to ward off cancers, says Benita Perch, a naturopathic doctor with the Holistic Central Medical Practice. Research shows that phytonutrients such as sulforaphane, evident in kale, can prevent cancer. Qualities in kale also help the body detoxify bad types of oestrogen and help create good oestrogen, which helps fight female problems such as breast cancer. And because kale is high in fibre, it can help bind cholesterol in the gut so the body does not absorb it.

Eating cruciferous vegetables as a part of your daily intake will have a positive impact on your overall health. “You should be looking at a minimum of four servings of vegetables,” says Perch. “At least three of these servings should be cruciferous.” She recommends raising this level to five to nine servings of vegetables with at least three cruciferous options for anyone with a history of cancer. Her recommendation is to start the day with a dose of kale, via a smoothie. Remove stems and add a bunch of the leaves along with highantioxidant berries, juice, and some protein powder or flax seeds. “It’s pure nutrient. Berries and kale are a great start to the day,” says Perch.

A good supply of prana for the mind means a stress-free, powerful, positive and peaceful mind SHYAM NARAYANAN, YOGA INSTRUCTOR

She isn’t the only one singing the praises of kale. Shyam Narayanan is a yoga instructor with Pure Yoga and a vegetarian. He says it’s a vegetable brimming with prana, which yogic tradition says gives life force and acts as a building block for the mind. “It is the energy behind all mental activities. Since the body will become an inanimate object without the mind, prana is essential to both. A good supply of prana for the mind means a stress-free, powerful, positive and peaceful mind,” he says. Eating healthy vegetables such as kale helps keep the mind positive and focused, he says. “It boosts vitality and enhances creativity.”

Narayanan enjoys kale lightly steamed with ginger. Steaming is the best way to maintain the high levels of nutrients available. In the southern states of the US, where collard greens are popular, the leaves are prepared by adding oil and bacon, for a comforting recipe that works just as well with kale. In Ireland, both cabbage and kale is mashed with potatoes to make the dish colcannon, a hearty winter classic. It can also be shredded and sautéed with a dash of olive and garlic in the pan. Kale, like kai lan, can have a bitter tone. To help eradicate this, sprinkle vinegar, which also helps preserve the calcium and vitamins, plunge in water and soak for a few minutes, advises Andrew Lam, a founder of Providence Family Farms, which grows organic produce in Jiangxi province and delivers all over Hong Kong. He also says pairing shredded kale with other mixed leaves in a salad helps to draw out sweetness in lettuce and other ingredients. Are you now convinced of the benefits of kale and wanting to rush out and try it? It may take some searching. In Hong Kong, few supermarkets seem to carry kale, but Providence Farms says it has both kale and kai lan coming into season and is ready to deliver. Otherwise, a hunt of farmers’ markets and independent health food shops may prove fruitful. Just Green, an organic shop on Graham Street in Central, stocks kale chips made by Lydia’s Organics, and this is one nutritious snack option, delivering benefits of fresh kale without any cooking. If in doubt, kai lan does share many of the nutrients, and most of the recipes above work with the Chinese leaf. Kai lan, of course, is available in any market or supermarket, but if you can find the other kale, go ahead and grab a bunch.

WELL-BEING 11 THE TASTE TEST ALMOND BUTTER ...................................................... Jeanette Wang Ceres Organics Almond Butter 300 grams for HK$89.90, ThreeSixty This rich spread from New Zealand is made from only organic almonds – lightly roasted and ground – and salt, and is therefore as natural and wholesome as almond butter gets. It’s easy to stir and spreads on smoothly. Verdict: great with toast and, I’d imagine, with satay or a chicken stirfry, too.

Michal Bucek is a fitness trainer and award-winning athlete. He says his 60-year-old father is his role model for leading a healthy life. Photo: Felix Wong

Meridian Natural Almond Butter 170 grams for HK$54, city’super Roasting almonds in their skins before grinding them gives this speckled butter a very earthy taste. Made in Britain, it’s stickier and denser than the Ceres butter, and hence a bit harder to stir and spread. Verdict: I’d like it better if it had a stronger almond than earthy flavour.


Beyond the treadmill ...................................................... P. Ramakrishnan Michal Bucek, 30, a personal trainer and a top triathlete, has a list of achievements so long it could take up this whole page. He recently returned from the Holy Grail of triathlons, the Ironman World Championships in KailuaKona, Hawaii. A few weeks later, he finished third amateur overall at the Taiwan 70.3, a half-ironman in Kenting. He’s in the best shape of his life, but he has worked hard for it. Some people are naturally thin, but Bucek isn’t one of them. Growing up in what is now Slovakia, he was the odd one out within his active family, who often kayaked, ran and swam together on weekends. “I was very overweight, and I was super lazy,” says Bucek. It’s hard to believe that when you see him stream past the finishing line, clad in some unforgiving spandex. The turning point, he says, came at age 17, when he began to look for a girlfriend and become self-aware. He started a triathlon

training programme, and has kept fit ever since. He’s following in the footsteps of his 60-year-old father, a member of the International Olympic Committee who still stays in great shape. “When I see my father, I’m still inspired. Others tell me I am their role model. I, in turn, see my father as mine,” Bucek says. Are age and weight factors in becoming a triathlete? It doesn’t matter if you are middle-aged or overweight. You can start anytime as long as you train properly. It’s got nothing to do with age; it’s more about selfconfidence and commitment to the sport. If you are mentally ready, it can be done. Why are more people leaving the comforts of a gym to try out adventure sports? Because it’s a quicker way to lose weight. In fact, the fastest way to get in shape is probably to train for and do a triathlon. In a big fitness centre, 99 per cent of the time the focus is on weightlifting and not on endurance. Running on a treadmill is boring; you feel like a hamster going nowhere.

When you train outdoors, you burn more calories, especially in Hong Kong, as conditions are tough. So, you can burn 40 to 50 per cent more calories. The humidity, the temperature, the fact that your body is not very comfortable, unlike in a carpeted gym, makes your heart rate go up. So you never work indoors? I do workouts with my clients indoors, in a gym. I work on making their muscles stronger. It’s not about building big muscles, but strengthening them. Do people lose confidence after the initial burst of excitement that comes from starting training? I’ve never had to push a client; they come in motivated. They train for results, and you can see results quite quickly. They come by themselves, and they train on their own when I’m away. I’ve never had to babysit a client. I want people to love what they do. If they don’t, it’s selfdestructive. If they do, even if it’s raining, they’ll get the right gear and still train because they’re passionate about the sport.

How often do you train personally? Whenever I have some free time. Between work assignments, I work out. Early mornings are great for me. I work late hours, but I’m lucky that if I’m training a client, I can do the sport with them. So I’m training all the time. I ride my bike to see my clients. I don’t take a bus or cab. In Hong Kong, that can be very dangerous, but I have no choice. I wear all my safety equipment and pray my instincts are sharp in traffic. Are Hongkongers in it for vanity or for health? Both. It’s 50/50. At first, I trained mostly Westerners. That has changed. I used to train mostly women, and that has changed. Now more local residents, and more men, are coming in. People realise that the body is a machine, that must be looked after. More do it for health, and they see quick results, which encourages them to keep training. Is there a motto you follow? Anything is difficult if you don’t really want to do it. Everything is easy if you have the commitment.

Barney Butter Almond Butter Crunchy 284 grams for HK$76, city’super Almonds, evaporated cane juice, palm fruit oil and sea salt meet in this buttery spread from California. Its consistency is more like traditional chunky peanut butter, but it claims to be healthier, with 50 per cent less saturated fat. Verdict: creamy and loaded with almond nuggets; this is addictive.

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