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YOUR GUIDE TO LIVING WELL

HEALTH POST

TUESDAY, JANUARY 31, 2012

DON’T DECEIVE YOUR DOCTOR >PAGE 7

MIXED BLESSINGS: SUPER SMOOTHIES >PAGE 8

How winter’s wicked ways will send your skin over the edge >PAGE 4

The cold, hard facts


2 NEWS REMEDY

APP OF THE WEEK

Pain relief: put your back into it Active resistance method offers Is your back bothering you? Research shows that moving can be the best medicine. Here are three ways to send pain packing. 1. Stretching: a recent study claims that stretching is just as effective as yoga at reducing back pain. Stretching of any kind, whether static (you hold the pose) or dynamic (you move through a complete range of motions), can help improve flexibility and decrease back pain risk and symptoms. 2. Yoga: two recently published studies found that people who practiced yoga had less pain and more mobility than those who simply followed a self-care book on

back pain relief. Yoga combines stretching with strength and balance poses, which help shore up weak muscles and release tight ones. It’s also a stress reliever; tension can lead to a tight back. 3. Pilates: a small Canadian study found that patients with nonspecific lower-back pain who did a Pilates workout for 4½ hours a week reported significantly less pain and disability one year after starting the programme than those who simply followed a doctor’s care. Pilates strengthens the core muscles that support the spine, reducing injury risk. It also boosts flexibility, making it easier to move without pain. McClatchy-Tribune

QUIZ ..................................................... Jeanette Wang jeanette.wang@scmp.com Two Saturdays ago, a group of third-year medical students from the University of Hong Kong faculty of medicine organised a signature campaign aimed at banning television adverts for junk food during children’s programmes. Along with garnering support in the Mong Kok pedestrian area, the students also handed out 150 mandarins and information cards on the impact of a bad diet on children. They will submit the collected signatures to the Legislative Council. A recent study published in the Journal of Pediatrics found a clear link between fast-food adverts and children’s food choices. Researchers at Texas A&M International University studied 75 children aged between three and five years. All watched two cartoons separated by adverts; half saw an advert for French fries, and the others saw one for apple slices. They were then asked to choose a coupon for either one of the foods. Seventyone per cent of those who viewed the French fries advert picked the coupon for French fries, compared with 46 per cent of those who viewed the advert for apple slices. So how well do you know junk food? Quiz yourself here.

1. Nutritionists recommend that foods containing fat and sugar make up what proportion of a balanced diet? a. 10 per cent b. 15 per cent c. 20 per cent

a smoother way to train ...................................................... Katie McGregor healthpost@scmp.com The A.R.T. Method – Mat Workout by Terri Walsh US$1.99 Rating 9/10 “She looks demented,” says my husband, peering over my shoulder as I preview this app. Demented she may look, as she demonstrates her workout, but Terri Walsh is a New York celebrity trainer, apparently charging as much as US$300 an hour. To “recession-proof” her services, Walsh has introduced the economically priced US$1.99 app for her ART (active resistance training) method, which includes a demonstration video and two workout videos, each running about 50 minutes. Walsh’s slogan is: “Every BODY is a work of ART.” I admit to being hesitant to test this app because of the frenetic

pace. But when I do review the demo video, I discover that despite the fast pace, there is little jumping around because of the element of resistance. And that is something of which I approve. Walsh’s ART method works on using four resistance points; the first is at your feet. By learning to actively resist the floor, Walsh’s concept is that you work the muscles better. To demonstrate, she instructs you to place one foot onto a block and press down, imagining that you are pressing the block through the floor as your other leg lifts. “Remember the feeling,” she says, and then has you practise recreating that feeling of pushing down into the floor as you move without the block. Other resistance points are your naval and rib cage. You learn to find and close your rib cage, pulling your hip bones under the ribs without squeezing your buttocks and your

2. According to statistics in a report by the USDA Foreign Agricultural Service, Hong Kong had about 13,000 restaurants in 2010. How many were fast-food outlets? a. 5 per cent b. 9 per cent c. 13 per cent 3. Which of the following so-called value meals contains more than 1,000 calories (or half the recommended daily intake for an average woman)? a. McDonald’s Big Mac meal b. KFC two-piece chicken breast or thigh Hot & Spicy meal c. Triple O’s Original Burger meal 4. In the 2004 film Super Size Me, Morgan Spurlock eats all his meals at McDonald’s for a month. How much weight does he gain? a. 2.7 kilograms b. 5.4 kilograms c. 10.8 kilograms Answers: 1. a; 2. b; 3. all are correct; 4. c (and it took him almost 14 months to lose the weight)

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com

shoulders. Walsh claims that you will benefit more from any exercise programme by adding the concept of these resistance points to it. The full workouts start with simple enough routines, such as squats, press-ups (with three degrees of difficulty) and triceps dips – and even a bit of yoga – all done while engaging resistance points. This carries on for about 35 minutes and is an enjoyably intense workout. However, after that, Walsh starts getting extremely complex, with elevated resistance. If you can finish this, good for you. I aspire to do so but feel that the 35 minutes I spent was good enough for me.

ASK THE DOCTORS DR SAMSON FONG YAT-YUK Q: Why do my legs twitch while I sleep? A: Leg twitching is a common complaint among sleep disorders. The time when twitching occurs during sleep, together with other associated features, often helps to identify the underlying cause of this complaint. Hypnic jerks (also called “sleep starts”) are sudden and brief contractions of the body or limbs during sleep onset. They are sometimes associated with the sensation of falling in one’s dreams. When hypnic jerks are frequent and repetitive, they may lead to insomnia. Sleep-related leg cramps are caused by sudden and intense involuntary contractions (usually in the calf or foot) during sleep. The sometimes painful sensations often interrupt the sufferer’s sleep. Restless leg syndrome (RLS) is both a motor and sensory disorder during which the patient complains of a strong and often irresistible urge to move the legs, accompanied with pain or other feelings of discomfort. RLS is usually worse during rest (when sitting or lying down, and before falling asleep) and the symptoms can be immediately relieved by movement of the legs. RLS is reported to be one of the most common causes of insomnia in the US. Periodic limb movement disorder (PLMD) is characterised by repetitive periodic episodes of limb movements

Leg twitching during sleep is a common cause of insomnia. Photo: Corbis

Sleep-related leg cramps are caused by sudden and intense involuntary contractions (usually in the calf or foot)

that occur during sleep. It mostly affects the lower limbs, typically involving the big toe and ankle, sometimes the knee and the hip. The patient is not usually aware of the limb movements and the consequent disruption to the sleep pattern, but daytime fatigue can result from PLMD. Periodic limb movements can also occur in patients with RLS. Dr Samson Fong is a specialist in psychiatry and a fellow of the Hong Kong Academy of Medicine (Psychiatry)


NEWS 3 HEALTH BITES The bitter truth Teens who consume a lot of fructose may have a higher risk of cardiovascular disease and diabetes, according to researchers from the Medical College of Georgia at Georgia Health Sciences University. Fructose is found in fruit and vegetables, but processed food and drink that contain high-fructose corn syrup are believed to produce bad metabolic byproducts. The study, published in The Journal of Nutrition, analysed 559 youths aged 14 to 18. High-fructose diets were linked to higher blood pressure, fasting glucose, insulin resistance and factors that contribute to heart and vascular disease. Also linked were lower levels of cardiovascular protectors such as HDL (“good”) cholesterol and the protein hormone adiponectin. This dangerous high-fructose trend is exacerbated in teens who have fat around the midsection – another known risk factor for cardiovascular disease and diabetes.

...................................................... Jeanette Wang jeanette.wang@scmp.com Overtime works against you Working hard is good, but working too hard isn’t. According to a report published last week in the online journal PLoS ONE, the odds of a major depressive episode are more than double for those working 11 or more hours a day compared with those working seven to eight hours a day. This link was found by researchers, led by Dr Marianna Virtanen of the Finnish Institute of Occupational Health and University College London, who tracked about 2,000 middle-aged British civil servants. The correlation held true even after adjusting for various factors, such as socio-demographics, lifestyle and work-related factors.

Looking for a new angle Tablet computers may be great for productivity or entertainment, but they can also be a pain in the neck. Researchers from Harvard School of Public Health, Microsoft Corporation and Brigham and Women’s Hospital report that the best way to use a tablet is to place it higher (on a table rather than a lap), avoid low gaze angles, and use a case that gives steeper viewing angles. But steeper angles may be detrimental for continuous input with the hands, so the researchers say further studies are needed. The experts put 15 experienced tablet users through a set of tasks with two tablets, an Apple iPad 2 and a Motorola Xoom, and different viewing angles.

Born to run? What makes Usain Bolt (left) and other sprinters so fast? New research from Penn State University reveals these speedsters have different skeletal structures in the foot and ankle – a finding that may be useful in helping treat people who have difficulty walking. Magnetic resonance imaging of the feet of 16 men – half of them trained sprinters and half height-matched non-sprinters – showed that sprinters have significantly longer forefoot bones and shorter Achilles tendon lever arms. According to graduate student Josh Baxter, these allow sprinters to generate greater contact force between the foot and the ground and to maintain that force for a longer time. But he says it is unclear whether these structural differences are adaptations to sprint training or are hereditary. Other factors such as body type, limb dimensions and the presence of fast-twitch muscle fibres are also important in determining one’s sprinting potential.

HUMOUR

Words of wit and wisdom: a funny thing happened on the way to new year ...................................................... Barbara Quinn I found myself searching for some wise words and wit as the new year unfolded, and I hope you enjoy these samples. The following were gleaned from the editors of Capsules, a publication of the auxiliary of Community Hospital of the Monterey Peninsula (lovingly known as Chomp). The authors of these quips are unknown unless indicated otherwise. “Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it.” – Lou Holtz, Notre Dame football coach “I joined a health club last year. Spent about 400 bucks. Haven’t lost a pound. Apparently, you have to go there.”

“My grandpa started walking five miles a day when he was 60. Now he’s 97 and we don’t know where he is.”

“Give a man a fish and he will eat for a day. Teach him how to fish and he will sit in a boat and drink beer all day.”

“We make a living by what we get, but we make a life by what we give.” – Winston Churchill, British prime minister (1940-45 and 1951-55)

“We all get heavier as we get older because there’s a lot more information in our heads. That’s my story and I’m sticking to it.”

“There are two theories to arguing with women. Neither one works.”

“Before you criticise someone, you should walk a mile in their shoes. That way, when you criticise them, you’re a mile away and you have their shoes.”

“The advantage of exercising every day is so when you die, they’ll say, ‘Well, she looks good, doesn’t she?’ ”

“When everything is coming your way, you are in the wrong lane.”

“Knowledge is knowing a tomato is a fruit; wisdom is not putting it in your fruit salad.” “Another flaw in the human character is that everybody wants to build and no one wants to do maintenance.” – Kurt Vonnegut, American writer

“The nicest thing about the future is that it always starts tomorrow.”

“Be always at war with your vices, at peace with your neighbours, and let each new year find you a better person.” – Benjamin Franklin, one of the founding fathers of the United States I couldn’t agree more. McClatchy-Tribune Barbara Quinn is a registered dietitian and certified health and wellness coach at Community Hospital of the Monterey Peninsula


4 COVER STORY


COVER STORY 5

Winter’s wrath Cold, dry weather can affect us in a variety of irritating ways, writes Eileen AungThwin

T

he chilly weather might be perfect for indulging in hotpots and hot toddies, but Hong Kong’s cool, dry winter is no treat for your skin. Dry skin, eczema, psoriasis and rosacea can be aggravated by seasonal conditions. Here’s a guide to the most common ailments – and how to give your skin care regimen the boost it needs. Dry skin As far as dermatologists are concerned, dry skin is public enemy No 1 during the winter. Not only is the condition uncomfortable on its own, causing inflammation and itchiness, but it can aggravate other existing conditions such as eczema and psoriasis. The top layer of skin, called the stratum corneum, is made of dead skin cells and lipids (natural oils) produced by the live skin cells below. This layer acts as a shield to keep germs and irritants out and a barrier to keep moisture in. Moisture is also maintained within the stratum corneum to keep it soft and smooth. However, soapy water, harsh chemicals and detergents, the ageing process, and some health conditions can reduce the amount of lipids in the layer and, therefore, lower its water retention abilities. Dry air further hastens the evaporation of moisture from skin, resulting in a tight, rough and flaky appearance. Eczema This refers to a group of skin conditions characterised by inflammation. One type of eczema, called asteatotic dermatitis, or severe skin dryness, can afflict the elderly in particular. The ageing process often weakens the skin’s barrier function, making it more susceptible to dryness. However, dryness can become even more severe if the elderly are prone to taking hot baths with harsh antiseptic body washes and fail to moisturise, says Dr Yeung Chi-keung, honorary clinical associate professor at the University of Hong Kong’s faculty of medicine. Also known as “winter itch”, this condition can result in cracked, peeling and fissured skin. Childhood eczema or atopic dermatitis is also a common condition seen here, Yeung says. A hereditary, chronic skin disease, patients suffer extreme itchiness and inflammation of the skin, which may

be red, swollen, crusty, weeping and scaly. Dryness is an underlying cause for some of the rash symptoms, hence protecting the skin against moisture loss is an important aspect of management. Also common is contact dermatitis, which is caused by skin dryness as a result of exposure to irritants. As dryness impairs the skin barrier function, the skin is less resistant to irritants. Also known as “hand dermatitis” or “housewife dermatitis”, this condition results in red, itchy, and swollen skin with rashes and lesions. People working in health care, in kitchens and hairdressers, or other professions that require frequent hand washing, are most at risk, Yeung says.

Trade harsh soaps, hand and body washes for gentler, non-soap alternatives. Remember that lipids maintain the integrity of the skin Psoriasis The cold, dry conditions of winter are not the only aggravating factors for people with skin problems. The lack of sunlight and sun exposure also hurts those with psoriasis, which is an incurable, chronic inflammatory disease that causes red, dry patches of thickened and flaky skin. Psoriasis is caused by rapid multiplication of skin cells that result in thick, silvery patches on the skin that constantly flake off. While normal skin takes 28 to 30 days to turn over, in psoriasis, cells can turn over as quickly as two to three days, clumping together to form thick plaques of skin. Ultraviolet light from the sun is believed to retard the rapid turnover of cells, thereby bringing psoriasis sufferers some relief. Therefore, in wintertime, when there is less sunlight and people are more bundled up, psoriasis may be even worse. The cold, dry air, alcohol intake and even bacterial or viral infections, which may be more prevalent

in the colder months, can also worsen psoriasis. Rosacea Winter not only brings the cold and the wind, but also indoor heat and a temptation to indulge in hot foods and alcohol to beat the chill. Unfortunately, they all spell trouble for people with rosacea. Rosacea is a chronic skin inflammation characterised by a red face and acne-like sores. According to Dr Henry Chan Hin-lee, president of the Hong Kong College of Dermatologists, anything that causes blood vessels to dilate will irritate the skin. Chan says the condition is especially common among the expatriate community here, and many sufferers experience flare-ups in winter because they eat hotpot meals and take hot showers. Rosacea sufferers must be vigilant of the triggers of their condition during this season, he says. Our expert panel’s tips for healthier winter skin 1. Moisturise. Moisturise. Moisturise Keeping scaly skin at bay is highly dependent on the religious use of moisturisers. Although lotions are cosmetically more elegant and acceptable to users, Yeung says that oil-based preparations or petroleum jelly are the superior choice to keep skin moist. Bath oils are also a good option, he says. Chan stresses that an advantage of ointments is that they are usually free of preservatives, which can be a source of irritation or allergy for some people. He adds that a cheap and effective way to moisturise skin is to slather it with petroleum jelly, lay a damp gauze over it and wipe off after 15 minutes. This tip is not suitable, however, for acne sufferers. 2. Ban hot baths and harsh soaps The cold of winter and an annoying itch may drive many people to seek comfort in a long, hot bath, says Yeung; but while doing so might bring some temporary relief, it only worsens the skin’s dryness. Trade harsh soaps, hand and body washes for gentler, non-soap alternatives. Remember that lipids maintain the integrity of the skin structure and help retain moisture. Think of how hot water and a strong detergent makes cleaning greasy pots much more effective – squeaky clean is best used to describe cutlery, not skin.

3. Water is an enemy While drinking water to keep hydrated is essential all year round, the effect of water on the skin in wintertime is less benign. Chan explains: “When water evaporates, it makes the skin drier.” Whether you take a bath or frequently wash your hands, follow up with a moisturiser to seal moisture in. Chan cautions against spraying spring water on the face without following up with a moisturiser. 4. Use non-biological laundry detergent Chan recommends that people with sensitive skin switch to a non-biological laundry detergent. Regular detergents use enzymes to clean, and any residue of the enzymes left in the clothes can react with perspiration and cause irritation. 5. Eschew wool Although a popular fabric for keeping toasty, the itchy, scratchy texture of wool can irritate those with sensitive skin, says Chan. He recommends layering smooth cotton or silk garments instead. Rosacea sufferers might also find it easier to cope with the wild swings in temperatures when moving from the cold outside to overheated interiors if they wear layers of loose clothing. 6. Stub it out Here is another reason to quit the sticks. While smokers might enjoy the haze of warmth from inhaling smoke, especially in winter, Yeung says that smokers risk (among other things) their skin health, as the habit can also dry out the body’s largest organ. 7. Seek help Sufferers of skin conditions such as eczema, psoriasis and rosacea might have to see their dermatologists more frequently during winter to cope with any flare-ups. Poor management of eczema, for example, can result in secondary skin infections with yellow and sticky discharge. Psoriasis sufferers might have to adjust their medications to cope with the lack of sunlight that helps control their condition, Yeung says. On the bright side, Yeung adds that fungal infections such as athlete’s foot will improve during the cooler months. healthpost@scmp.com


6 HEALTH CASE HISTORY

Watertight by remote ......................................................

During a routine urinary test at the Queen Elizabeth Hospital seven years ago, doctors found an abnormality in Mr Cao’s prostate – a walnut-shaped gland that wraps around the urethra and is located between the rectum and bladder. A biopsy revealed that Cao (full name withheld for patient confidentiality reasons), 69, had prostate cancer. The tumour, however, was localised and the cancer was in its early stages so it could be successfully treated by removing the prostate. However, such an operation carried the risk of causing erectile dysfunction and urinary incontinence in addition to the risks of surgery. Despite an initial reluctance, Cao was finally persuaded by his family to undergo the prostatectomy. When he came to, he discovered it was a mixed result. On one hand, the surgery was a success and he was cancer-free, but his newfound health came at a cost: he could no longer control his bladder. Normally, healthy males have two mechanisms that enable urinary continence – the prostate and a sheet of muscle under it act as sphincters that constrict to prevent the flow of urine from the bladder to the urethra and out of the body. When the prostate is removed, only the sheet of muscle remains to compress the urethra, thereby reducing one’s bladder control. Furthermore, the nerve that controls the sphincter muscle goes around the prostate and is inevitably damaged to some degree during the prostatectomy. The damage, which is irreversible, in Cao’s case was severe – he experienced urine leakage almost constantly. As medication was ineffective, doctors advised him to do pelvic floor exercises to strengthen his sphincter muscles. Cao also tried other methods, including a penile clip, which clamps down on the penis to compress the urethra within. However, the clip would cause pain if it was too tight, but urine would

Illustration: Angela Ho

Eileen Aung-Thwin healthpost@scmp.com

leak if it wasn’t tight enough. He tried a catheter and bag, where a condom-like sheath was worn on the penis and a tube drained urine from the tip of the sheath into a bag that was strapped to the leg. But this was clumsy and inconvenient – Cao found it difficult to ensure the sheath stayed attached. Cone-shaped pads that encase the penis to absorb fluid was not an option: his leakage was severe. Finally, Cao resorted to adult diapers, which he had to change at least four times a day. Already living

on social assistance, the cost of containing the urine leaks was an additional burden. The embarrassment and discomfort of his condition wore on him. He lost sleep and grew depressed, and even contemplated suicide. After an embarrassing incident where urine soaked his pants while he was out with his wife, Cao refused to leave home. In 2010, he saw an advertisement in the newspapers for a talk on male incontinence by Queen Elizabeth Hospital’s associate consultant in

surgery, Dr Ho Lap-yin. Cao attended the talk and learned about how an artificial urinary sphincter (AUS) or male sling could help him. The AUS entails inserting a threepart device into the body. An inflatable cuff is affixed around the urethra. It is connected via a tube to a small capsule reservoir installed in front of the bladder, slightly higher in the pelvis where it holds about 20cc of normal saline fluid. Finally, a small peanut-sized control button is placed in the scrotum. When the saline fluid drains from

the reservoir into the cuff, the cuff inflates and constricts the urethra, which prevents the fluid from leaking out of the penis. When the patient wants to urinate, he will press the button in his scrotum twice, which causes the saline fluid to flow up into the reservoir, thereby deflating the cuff and releasing the pressure on the urethra. The patient can then pass urine. The saline fluid in the reservoir will slowly drain back into the cuff to inflate it and keep the patient continent until he chooses to urinate next. This method is very effective as 70 to 90 per cent of AUS users experience fewer than one leak a day. It is most suitable for patients like Cao who have experienced severe leakage, but its HK$70,000 cost is prohibitive for many. The male sling is a more recent development. A piece of abdominal or synthetic tissue is inserted into the pelvic area to replicate the function of the pelvic floor muscles constricting the urethra. It helps to strengthen the natural sphincter muscle and slightly elevates the bladder outlet higher into the abdominal cavity. This increases the intra-abdominal pressure on the bladder outlet to help keep it closed. The sling costs HK$30,000, but has a lower success rate – only 60 per cent of patients experience relief – and is only suitable for much milder cases of incontinence. Happily for Cao, the Hong Kong Cancer Fund, the territory’s largest cancer support organisation, stepped in to help subsidise his AUS treatment. Last August, he underwent treatment. After the device was implanted, Cao rested at home for six weeks to enable the inflammation in the area to subside and the tissue to heal and strengthen. During this time, he continued to use adult diapers. Then, he returned to the hospital where the AUS was activated and, immediately, the leaks stopped. Delighted with the results, Cao, now 76, helps to counsel other prostate cancer and incontinence sufferers.

FROM THE EXPERTS

A ray of hope for prevention and treatment of chickenpox ...................................................... Jeanette Wang jeanette.wang@scmp.com Though commonly found all year round in Hong Kong, chickenpox tends to be more active in the winter months, and a recent discovery could explain why. Dr Phil Rice, a virologist and researcher at St George’s, University of London, has found that the acute infectious disease is much less common in places with high ultraviolet ray levels, compared to those with low levels. During winter and spring, UV rays are at their lowest, which could explain the peaks in chickenpox cases.

Rice, whose study has been published in Virology Journal, believes UV rays can inactivate the virus, Varicella zoster, on the skin before it spreads to another person. Since the Hong Kong Department of Health added chickenpox to its notification system in February 1999, the number of cases annually has fluctuated. The record is 17,940 notifications in 2007; last year saw a four-year high of 12,378 cases. However, the pattern of peaks and troughs within the year has remained largely the same. Rice believes his discovery could lead to fresh ways of preventing and treating chickenpox and its relative, shingles.

Chickenpox mostly affects children under the age of 12. Photo: Corbis

Chickenpox mainly affects children under age 12, and though highly infectious, is generally mild and self-limiting. It spreads through droplets or air, or contact with the discharge from a patient’s blisters. It usually takes one to two days before rashes appear, first on the body, then the face, arms and legs. These itchy spots start out flat and then become fluid-filled blisters which dry up in three to four days to form scabs. Recovery typically takes two to four weeks. Those with weakened immunity, pregnant women and newborn babies are more likely to suffer from severe complications such as pneumonia and encephalitis.

Infection in early pregnancy may lead to abnormalities of the foetus. There is no cure but symptoms can be eased with medication. Wear clean cotton gloves while sleeping and avoid contact with others. Most people develop immunity to chickenpox after infection, but the virus may remain silent in the body and appear years later as shingles. To prevent infection maintain good hygiene. Vaccination is effective – about 90 per cent of people vaccinated gain immunity. For more information, go to the Centre for Health Protection website at www.chp.gov.hk


HEALTH 7

Omitting vital medical details, such as allergies and ongoing medication, or not being truthful when consulting your doctor can have serious consequences. Photo: Corbis

MEDICINE

Truth hurts, but lying can kill ...................................................... Sasha Gonzales healthpost@scmp.com Many of us have lied to our doctors at some point in our lives, or at least not divulged the entire truth when questioned about our symptoms or lifestyle habits. Perhaps it was the fear of being scolded or ridiculed that stopped us from being completely honest. Or we might have been embarrassed about coming across to our doctors as lazy, forgetful or irresponsible. “I have high blood pressure and high cholesterol, and I’m on medication for these conditions,” says Jessica Lim, 40, a private tutor. “I eat a lot of fatty foods and I don’t exercise as often as I should, but of course my doctor doesn’t know this. When she asks how I’ve been keeping, I always lie that I’ve been eating healthily and working out because I don’t want her to judge me.” Another woman flat-lined during an operation several years ago, all because she forgot to tell the anaesthesiologist she was on medication for her thyroid condition. Fortunately, doctors managed to resuscitate her. “I can’t believe omitting that one detail nearly cost me my life,” she says. Forgetting to share important information with your doctor is one thing, but it’s just as bad to lie or withhold the truth,

says Dr Winnie Mui, a general practitioner at Dr Lauren Bramley and Partners in Central. You might think you’re saving yourself some grief, but the reality is that you could be putting your health or life in danger. “When you withhold information, whether intentional or not, your overall medical care is potentially compromised or, at best, not maximised,” Mui says. “And the consequences can be extreme: for example, death from anaphylaxis if you’re given medication that you’re allergic to, like penicillin, or overdosage if you forget to tell your doctor that you’re already on something similar.” What you should never, ever lie about, Mui adds, are your allergies, medical history and the medications you’re on. Any information that’s relevant to your current care should also be divulged. “In Hong Kong, it’s common for patients to go ‘doctor shopping’, where they see different doctors for the same condition,” she says. “Medications are duplicated, and there is no continuity of care.” In one case, she had a walk-in patient who admitted to seeing multiple doctors over the course of one month for coughing and slight rib pain. The patient was given numerous cold medications and painkillers. After examining him, Mui found that he had a ruptured

Physicians have probably heard of, seen and treated many extraordinary cases, so whatever you say is unlikely to shock them DR WINNIE MUI, GENERAL PRACTITIONER

lung, and immediately sent him to the hospital for a potentially life-saving procedure. “Had he just said he’d been coughing a bit, I might have dismissed the problem to be a common cold,” she says. Medical check-ups are far from a stress-free experience. A lot of people dread these visits, which might explain why some of us are never completely honest with our doctors – to get out of their offices as quickly as possible and spare ourselves the nagging. One man, aged 38, says his general practitioner always lectures him about his long work hours and shocking eating and drinking habits. He says it’s bad enough that his wife already gives him a hard time. “To avoid the nagging, I keep the conversation short and don’t go into specifics with my doctor. I have a host of health issues, and I don’t think he’d be happy to know that I don’t take care of myself. He might even take me off certain medications that I really need,” he says. The man says he hasn’t told his doctor about the chest pains and breathing problems he’s been experiencing lately. “I’m just scared he’ll tell me off or give me bad news,” he says. But doctors are there to help, heal or guide their patients back to health – not judge or reprimand. Mui says if you feel uncomfortable with your practitioner, stop the

consultation and ask or look for another physician. “It’s important to find a doctor you’re comfortable with and can confide in,” she adds. If you’re the sort of person who is embarrassed about sharing certain private details, it helps to know that the doctor has probably seen and heard it all. Says Mui: “The more seasoned physicians have probably heard of, seen and treated many extraordinary cases, so whatever you say is unlikely to shock them.” And you can trust your doctor to keep your medical information confidential, because all doctors are legally bound to do so, unless the patient needs to make an insurance claim. It’s crucial to make the most of your time with your doctor, so use your visit to ask questions about your condition. The more information exchanged, the better off you will be. Mui says her patients often say: “I have questions for you, but I just can’t remember.” If you’re prone to forgetfulness, she suggests writing down your concerns beforehand and bringing that list to the consultation. A final important point: keep your health records in order. In Hong Kong, patients receive a discharge summary each time they are admitted to hospital. Mui says: “It’s a good idea to keep these for future reference, especially if you have multiple medical conditions.”


8 DIET NUTRITION SMOOTHIES

Fine blend is a runner’s friend ...................................................... Elle Kwan healthpost@scmp.com Dietitian Sally Poon is gearing up for her first Standard Chartered Hong Kong Marathon this Sunday. Of the 70,000 runners, 37,000, including Poon, will participate in the 10 kilometre event. Knowing the importance of preparing for such a race early, she embarked on a training programme three months ago, first running for 20 minutes three times a week, and gradually increasing each session by five to 10 minutes each week until she could run for an hour straight. Her diet has also come under scrutiny. In order to make the most of each training session, Poon has a healthy high-carbohydrate meal beforehand, and replenishes with a carb-rich snack afterwards. However, Poon, who regularly appears on local television with nutritional advice, knows not everyone pays as much attention to preparation. “This is why you see so many accidents. You see pictures [in the newspapers] of people fainting on the road,” she says. Many participants, especially in the 10 kilometre event, are new to running and may not know how to prepare for the race, Poon says. This is why she jumped at an invitation from the organisers to create some nutritional recipes to help runners boost their performance – or simply avoid passing out. Smoothies were a natural choice. “They are easy to ingest and are full of nutrients,” says Poon. She concocted four tempting varieties: mixed berry, tropical, green tea soy and chocolate soy (see below). Each smoothie packs between 33 and 42 grams of carbohydrates per serving. For the sedentary person, this could be a diet-wrecker, but for runners, carbs are invaluable. Stored in the body as glycogen, it’s the first source of energy during exercise. When it runs out, the body begins to use protein or fats, which can have a negative impact on the runner. “For faster recovery, you don’t want your body to use too much glycogen in the muscles because that will leave you tired and depleted,” Poon says. That being said, carb-loading – eating a high-carbohydrate diet in the days before a race – is only necessary in those running longer events. Those taking part in the half and full marathons should take seven to 10 grams of carbohydrates

Power of four: Poon’s pick of the mixes ...................................................... Elle Kwan healthpost@scmp.com Anyone running in this weekend’s Standard Chartered Hong Kong Marathon might want to consider these smoothie recipes, developed by registered dietitian Sally Poon in collaboration with the race organisers. They’re also great for anyone looking for a healthy breakfast or snack. Add four ice cubes for each recipe if you fancy a cold drink, or simply blend ingredients until frothy and

drink immediately. Each recipe makes two servings. Tropical fruit smoothie 250ml unsweetened orange juice 200 grams low-fat vanilla yogurt 250 grams pineapple chunks Mixed berry smoothie 250ml skimmed milk 200 grams low-fat vanilla yogurt 125 grams strawberries 125 grams blueberries Fresh mint (for garnish)

Chocolate soy smoothie 250ml calcium-fortified chocolate soy milk 1 ripe banana, roughly chopped 200 grams low-fat vanilla yogurt 1 tbsp chocolate powder (for garnish) Green tea soy smoothie 250ml low-sugar calcium-fortified vanilla soy milk 200 grams low-fat vanilla yogurt 1 ripe banana, chopped 2 tbsp green tea powder (plus extra for garnish)

per kilogram of body weight per day, for about three days leading up to the race, Poon advises. “So, for instance, a 65 kilogram marathon runner should aim to have 455 to 650 grams of carbohydrates a day,” she says. The amount of carbohydrates in these healthy drinks is similar to that of a standard 300ml bowl of white cooked rice (50 grams), but they offer other benefits. The berry recipe is full of antioxidants. Half a banana goes into each serving of the green tea soy or chocolate soy, providing potassium, vital for replacing fluids. On race day, a smoothie may be the perfect pre-run breakfast. A lot of runners can’t face the thought of eating so early – the first flag-off is at 5.30am. Others may turn to fast food, one of the few eateries open at dawn. Foods high in saturated fats or sugar do not provide long-lasting energy, and can be bulky and difficult to digest.

[Smoothies] are easy to ingest and are full of nutrients SALLY POON (ABOVE)

Watch out, though, if you don’t normally drink milk in large quantities. Race day is not the day to start a new eating habit, and the relatively high milk content of smoothies could upset stomachs. The only other time to avoid a smoothie is during a run itself: Poon says only water or sports drinks will provide the necessary hydration. Runners should make sure they slow down at every station, drinking one to two cups of fluid. Waiting until thirst hits usually signals dehydration has set in. So, rev up your blenders and get ready to run.


10 FITNESS/ DIET WALKING HOME

Above and beyond the wall ...................................................... Rob Lilwall healthpost@scmp.com

For the last week or so of our 5,000kilometre Walking Home From Mongolia adventure, my expedition partner Leon McCarron and I have been following the Great Wall of China westwards along the ridges and valleys of northern Shanxi. Unlike the postcard perfect stone sections of the Wall near Beijing, here it consists of a one to three metre ridge of crumbly yellow earth, covered in grass and dotted with regular watchtowers (five-metre columns of yellow earth). But while the wall may not be as well endowed here, it has still been a magical experience to walk along it. The watchtower silhouettes mark out a path to the far horizon. It has also been an incredibly

exhausting leg of the journey, as the wall does not simply follow one ridgeline, but dances from ridge to ridge, plunging into the valleys and gullies in between. With all the scrambling up and down, and zigzagging along paths, we estimate we were walking about three kilometres for every two kilometres’ progress. This rugged country is sparsely populated and we have had to keep our eyes peeled for cave villages where the local shepherds and farmers live. These villages consist of homes and stables literally dug out of the hillside, with the roofs covered in grass and mud. People in these parts have lived in such dwellings for thousands of years, and in fact there are still over 30 million cave-living people in China. The villages are usually built on the sun-facing southern slopes of hills, and as we are walking from the north, it’s possible not even to see

Lilwall (above) beside the Great Wall; cave dwellings in northern Shanxi (below left). Photos: Rob Lilwall them until literally walking over the top of them. We often stop to fill up our vacuum flasks with hot water, and the inhabitants, although slightly taken aback by our sudden arrival, are generous and friendly. Mainly older people and their grandchildren remain – due to the mass migration of young people to the cities. We have been invited to stay the night with them several times. Their houses are always the same layout – two bedrooms on either side of the hallway. In the bedrooms, there is a kang (a bed platform which fits about four people, heated by a coal fire underneath it), a stove and a television. Other nights, we have camped out; and one night we slept inside an abandoned cave house, which was considerably warmer than sleeping under the stars. As we walked, we sometimes came across watchtowers encased in stone. Some even had stairways still functioning. While defence was of course a primary function (or intention) of the Great Wall, historians are undecided about its effectiveness. It was also undoubtedly an

The inhabitants, although slightly taken aback by our sudden arrival, are generous and friendly

incredible supply line across the breadth of the empire, and a way of demarcating its boundaries. Even after its original functions became obsolete, in more recent times it has become the servant of various ideologies. American writer Peter Hessler, in his book Country Driving: A Journey Through China from Farm to Factory, points out the shifting meanings and interpretations of the wall: Sun Yat-

sen said it was a great engineering feat; Mao said it was a forerunner of national defence; author Lu Xun in the 1920s said it hemmed China in; Japanese invaders in the 1930s took their photos beside it to bolster their territorial claims; while the daily government newspaper China Today says it is a symbol of multiethnic unity. For me, walking along the wall last week made me think of the organisational power of the past empires of China. It is incredible. We follow the wall to the mighty Huang He (Yellow River), which the wall crosses on its long march into the western deserts. We are not following it though; we’re heading south and downstream along the river, in the direction of home. But there are still another 3,500 kilometres to go. Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of a motivational talk, a book, and a National Geographic TV series. Every week, he will write about the progress of Walking Home From Mongolia, which is in support of the children’s charity Viva. www.walkinghomefrommongolia.com

EAT SMART SESAME FLAMINGO ROLL

Lighter and whiter: the reworking of a French classic ...................................................... Jeanette Wang jeanette.wang@scmp.com White sauce, also known as bechamel sauce, is traditionally made by whisking scalded whole milk gradually into a mixture of equal parts butter and flour by weight. A staple in French cooking, it forms the base of many other sauces, such as Mornay (add cheese) and creme (add heavy cream). This recipe from the Bayview Restaurant Sashimi Oyster Bar in Causeway Bay features a version that uses low-fat milk and no butter. The result: a healthier dish that packs just 291 calories and 4 grams of fat per serving.

For the white sauce 50ml low-fat milk 50ml water ¼ tsp salt 3 tbsp plain flour ¼ clove minced garlic

• Heat white sesame seeds without oil over a low heat until golden brown. Set aside. • Bring mixture of low-fat milk, water and salt to the boil. • Add the plain flour slowly and stir until thickened. Set aside. • Use the back of a cleaver to pound chicken fillets until flat. • Spread minced garlic over the chicken and place strips of celery, carrot and mushroom on top. • Roll up and steam until well done. • Cover in white sauce and sprinkle with sesame. Serve.

• Rinse the skinless chicken fillet, celery, carrot and king trumpet (also known as king oyster) mushroom. • Drain and set aside. • Cut mushroom into strips.

This column features recipes provided by the Health Department as part of its EatSmart@restaurant.hk campaign. For more information, visit restaurant.eatsmart.gov.hk

Recipe (serves one) 100 grams skinless chicken fillet 4 strips celery 4 strips carrot 1 piece king trumpet mushroom Large pinch white sesame seeds

The sesame flamingo roll recipe calls for low-fat milk and no butter


WELL-BEING 11 PERSONAL BEST

A test on the roof of the world ...................................................... Walter Cheung healthpost@scmp.com Branded as one of the world’s most challenging and toughest endurance ultras, the Himalayan 100 Mile Stage Race enables adventurers to savour the breathtaking vistas of four of the five highest peaks in the world. Friends agreed that it was no mean feat for me to finish the 160-kilometre race, which climbed to nearly 3,658 metres – more than seven times the height of Hong Kong’s tallest building, the International Commerce Centre. Even more incredibly, I did it without getting blisters or ankle sprains amidst the rugged, winding terrain littered with sharp stones. Bart Yasso, of Running USA Hall of Champions fame and chief running officer of Runner’s World magazine, tried the race years ago and pronounced it difficult. Yasso failed to finish the race as he had twisted his foot on a rock. His ankle “swelled like an air bag”, he wrote in his book, My Life on the Run. First held in 1991, the annual Himalayan 100 Mile Stage Race last year attracted 40 participants from 15 countries. Runners were aged between 22 and 71. Among the competitors were a 33-year-old US fund manager who had taken part in some 200 marathons or ultras, and a 64-year-old retired German teacher who prided herself on having completed more than 100 such competitions. Race champion Deon Braun of South Africa summed up the course as “brutally hard”. Offering stunning views of Everest, Kanchenjunga, Lhotse and Makalu, the race has been described as “the most scenic race in the world” by Athletics Weekly, and “the world’s most beautiful marathon” by Runner’s World UK. Having run the New York Marathon where two million boisterous spectators added to the euphoria, it was another kind of encouragement to be cheered on by village kids and rifle-toting Indian soldiers on the border between India and Nepal. Yaks, sheep and ponies on hillsides shrouded in mist or

Stage 1 Maneybhanyjang-Sandakphu Stage 2 Sandakphu-Molle-Sandakphu Stage 3 Sandakphu-Molle-Phulet-Rimbik Stage 4 Rimbik-Palmajua Stage 5 Palmajua-Maneybhanyjang

Distance 38.6km

200km

CHINA

32.2km

NEPAL 42.5km 20.9km

INDIA

Start/finish

Maneybhanyjang 2,012m (elevation)

Phulet 3,469m

Rimbik 1,935m Palmajua 1,999m

Illustration: Martin Megino clouds imbued us with a sense of peace and harmony. Gorgeous landscapes and great support aside, the race posed huge challenges: distance obviously, but also high altitude, steep ascents and descents, and temperature swings (from near zero to about 30 degrees Celsius). On one of the five race days, thunder and rain lashed down, making conditions treacherous. Although I have done the Trailwalker (100 kilometres), Round the Island (65 kilometres) and Green Power Hike (50 kilometres) in Hong Kong, and the Two Oceans Marathon (56 kilometres) in South Africa, this proved to be a daunting race for me. Was I worried? You bet. I trained up to 14 hours at the weekend, following my usual work week of more than 60 hours. The longest training day was nine hours – over hills and roads, and in the gym. I was training so hard that I couldn’t stop yawning. Even during a holiday in Sydney, I slogged a total of 160

At the post-race celebration party, a 31-year-old journalist openly admitted that he cried when he saw all the majestic summits

kilometres on a treadmill over 11 days. The icing on the cake after finishing this defining race was that my 17-year-old son, who is studying in Sydney, was motivated to do a solo 11-kilometre run five days after I crossed the tape. He did a 14kilometre run another five days later. “It might not be much to you, but it was a lot for me,” my son, a swimmer, declared in an e-mail. “You did great by just finishing. I’m proud of you.” Dr Trisha Leahy, chief executive of the Hong Kong Sports Institute called my adventure an “amazing achievement”. “Congratulations on completing another successful ultra in the Himalayas,” wrote Dr Simon Yeung Sai-mo, senior vice-chairman of the Hong Kong Amateur Athletic Association, in an e-mail. “You are a great role model for middle-aged men, particularly office executives.” For my wife, who had asked church friends to pray for my safe journey, it was more a huge relief than anything else.

THE TASTE TEST DUMPLINGS

Time flies. It has been 10 years since I was lured into running marathons by a Hang Seng Bank colleague, Yeung Tze-kong, at a time when I was struggling with the middle-age syndrome. I have, in turn, inspired not only my son, but also colleagues, friends and relatives. Among them, secretary Pauline Chan Yuk-ling has done 10 races in the past seven years. Now in my 50s, I have done 31 marathons and ultramarathons in 15 locations on five continents. I have pounded away a combined distance of more than 1,500 kilometres. That’s longer than the distance between Hong Kong and Shanghai. At the post-race celebration party, a 31-year-old journalist openly admitted that he cried when he saw all of the majestic summits. I guess what is so memorable about this particular run is that it not only gives immeasurable satisfaction, but also humbles the racers. It provides food for thought to us mortals.

Fresh To Go Chinese Chives Iberico Pork Dumpling 210 grams for HK$33, City’super These dumplings, made in Hong Kong, live up to the claim of being “fresh, natural, premium, healthy”. The filling is plump and meaty, and packs a delicious natural flavour. Verdict: You get what pay for – these were the best we tried by far.

........................................ Jeanette Wang jeanette.wang@scmp.com

East East Shrimp Dumplings 112 grams for HK$12, City’super For the price, these Hong Kong-made dumplings are surprisingly tasty, with a good balance of mushroom and prawn in a smooth thin skin. Hold the soup pack, though – it’s a blood pressure bomb with 1,136mg of sodium. Verdict: Throw in some noodles for a quick and cheap meal.

Molle 3,552m

Sandakphu 3,601m

27.4km

Wan Chai Ferry Shanghai Wonton 205 grams for HK$15, City’super Generously filled with vegetables and pork, these dumplings from mainland China had a pretty good flavour, but the packaging makes it clear that flavour enhancers have been added. The skin was also a tad thick and floury. Verdict: Unless a dumpling craving has to be satiated immediately, pass on these.


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