2011 07 05 Health Post #7

YOUR GUIDE TO LIVING WELL

TUESDAY, JULY 5, 2011

HEALTH POST Lead-contaminated ceramics found on Hong Kong’s shop shelves

>PAGE 4

Photo illustration: Emilio Rivera III

Toxic soup

MENTAL ILLNESS – LABELLED FOR LIFE

THE NEXT HEALTH TOURISM DESTINATION

>PAGE 6

>PAGE 8

2 NEWS HEALTH BITES Send the right signals Texting motivational messages to a smoker can more than double the odds that he or she will kick the habit, a new report published in The Lancet says.

Researchers at the London School of Hygiene and Tropical Medicine split 5,800 smokers who wanted to quit into two groups: one received motivational texts (such as “Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over”) and the other got non-motivational texts. Participants’ saliva was tested to verify quit rates – which were 10.7 per cent in the former group and 4.9 per cent in the latter.

Print sprints We’ve never heard of this exercise, but we reckon it’ll soon be a popular office workout, following a study that shows walking to the photocopier can contribute to cardiorespiratory fitness. The findings, published in Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine, show that accumulating at least 30 minutes of incidental physical activities – such as walking around the office, doing housework or climbing stairs – can benefit fitness and long-term health. So, walk down the hall and speak to a colleague instead of sending an e-mail or chatting online.

Hip hugger Great for fitness and travel, the Spibelt (HK$199) is sleek and expandable and won’t bounce or slide during your activities. Don’t be fooled by its small size – it’s stretchy enough to hold a phone, money, keys and more. It’s available in navy, sky blue and black from Escapade Sports, www.escapade.com.hk

Jab for junior Babies born to mothers who get flu shots while pregnant are 45 per cent to 48 per cent less likely to be admitted to hospital with laboratory-confirmed flu, US researchers say in a recent report. The study’s lead author, Dr Katherine Poehling, an associate professor of paediatrics at Wake Forest University Baptist Medical Centre, says mothers pass antibodies through the placenta to help the baby. It’s great news for children younger than six months, who are the most susceptible to being admitted to hospital for flu among all children but for whom doctors do not recommend a flu vaccination.

A spacial deal Two’s company, so grab a buddy and book yourselves a 90minute massage or facial (from HK$1,300 per person) at The Oriental Spa, The Landmark Mandarin Oriental – and the second person enjoys the same treatment completely free. It’s valid until midSeptember from Mondays to Thursdays, 9.30am to 3pm. Tel: 2132 0011

APP OF THE WEEK

Work off that Civvy Street flab with the help of drill sergeants ......................................................

Katie McGregor healthpost@scmp.com British Military Fitness: My Fitness Instructor US$4.99 Rating 10/10

A fitness trainer in your pocket

To shed the final kilo or so in the last three weeks before my beach holiday, I needed to increase the tempo of my exercise regime.

Something hard-core and military seemed the best approach.

Navy SEAL Fitness was the first app I considered, since US Navy SEALs are renowned for being super-fit. But judging from the App Store write-up, I thought the app was nothing more than a comprehensive manual.

Para Fitness looked more promising, with photos and daily

You’ll be led by an instructor routines, but it was missing the vital ingredient: live instruction. I would be lucky to get my heart rate up at all if I had to stop after every exercise to check what came next.

Third time lucky: My Fitness Instructor proved to be the drill sergeant I was looking for. In fact, I have a choice of Mark Donaldson, a former Royal Marines physical training instructor, or Jim Preece,

who honed his instructional style in the Australian Parachute Regiment.

To track your progress, first measure your current fitness through a test of push-ups, sit-ups and a bleep test (a multi-stage, 20metre-run test). All this is clearly explained, so don’t worry.

Then you work out. Put on your headphones and head off for the mandatory warm-up, and your instructor will guide you through the rest. Each routine is just over 30 minutes, including cooling down, and seems to be different. The exercises are simple – jogging, star jumps, press-ups and so on – and the programmes are designed to be done without equipment. I have yet to reach the end of their library, but the app claims to have over five million workout combinations.

The app is aimed at encouraging, rather than torturing, you. So within

each routine there are different fitness levels to choose from. If you do need to catch your breath, hit pause. If you feel a bit lost, watch a short video of an instructor showing the correct form. You can track your heart rate before and after by tapping on the screen as instructed.

I’ve definitely felt the pain with the programme, but it’s as hard-core as you want it to be.

These instructors may bark, but they can never bite.

> CONTACT US Culture Editor: Janelle Carrigan janelle.carrigan@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

MEDICAL 3 CASE HISTORY

Treatment proves easy to stomach ......................................................

Eileen Aung-Thwin healthpost@scmp.com

Illustration: Angela Ho

Marcus Fung (name changed to preserve patient confidentiality) knew something was badly wrong even though he felt no pain and wasn’t in great discomfort. Not only did he pass black stools, he had just vomited blood. Fung, 55, was rushed to Prince of Wales Hospital.

In the emergency room, the doctors knew there was bleeding somewhere along his gastrointestinal tract, because Fung’s stools indicated blood had passed through his digestive system. Fung’s haemoglobin levels were measured to assess how much blood he had lost. Haemoglobin is the protein in red blood cells that carries oxygen and gives these cells their shape. It is measured in grams per 100ml of blood. Fung had lost three grams, indicating substantial blood loss.

An endoscope was put down Fung’s mouth and into his stomach, washing and sucking away the blood so that the doctors could see the condition of the stomach lining.

They found a 1cm-wide ulcer where his gastric acids had eaten into

ASK THE DOCTORS DR TINNY HO Q: I am thinking of buying a moisturiser with a sun-protection factor (SPF) of 30, because it seems convenient not to have to apply another product to my skin. But do cosmetics with a sunscreen provide adequate sun protection?

A: It does not matter whether it is a “moisturiser” with sun protection or a “sunscreen”, which usually has moisturising properties anyway, as long as it provides adequate protection against both types of ultraviolet rays, UVB and UVA. Both UVB and UVA can cause skin ageing, pigmentation and skin cancer. However, only UVB causes sunburn. Sunscreens used to be designed mainly to prevent sunburn, so emphasis was put on UVB protection. SPF reflects only the degree of UVB protection, not UVA. Only relatively recently have we known more about the effects of UVA. Unfortunately, the labelling of UVA protection, unlike SPF, is not mandatory in most countries, and not unified. To be safe, look for skin-

care products with specific UVA protection – choose products with persistent pigment darkening (PPD) greater than 15 (PPD is the equivalent of SPF for UVA) or “PA+++” (PPD greater than eight).

Skincare products labelled as “sunscreens” usually put more emphasis on broad-spectrum UV protection than “moisturisers with SPF”. As Hong Kong is hot and humid most of the time, I often advise my clients to use a sunscreen without a moisturiser during the daytime. They would then be more likely to apply enough sunscreen – about half a teaspoon for the face – to achieve the intended level of protection. The SPF value rises with the thickness applied, but no one likes applying another thick layer of sunscreen if the skin already feels oily after moisturising.

Sunscreen is the most important skincare product against ageing.

Dr Tinny Ho is a specialist in dermatology and a member of the Health Post advisory panel

Sunscreen is advisable, without added moisturiser. Photo: Oliver Tsang

the stomach walls and hit a blood vessel. Blood poured from the ulcer into the stomach cavity, causing Fung to throw up blood.

The uncontrolled internal bleeding meant he could potentially lose blood pressure and go into shock within an hour or two. About 10 per cent of patients with a bleeding peptic ulcer die.

In light of this medical emergency, Dr Joseph Sung, the vicechancellor of Chinese University, was called in. Sung, together with Dr Samuel Giday of Johns Hopkins University, was leading a study that used a new procedure called Hemospray to treat bleeding peptic ulcers.

With Hemospray, an endoscope was inserted into Fung’s stomach and a proprietary powder with special clotting qualities was sprayed into the stomach, stopping the bleeding almost instantly. Sung says the powder is similar to that used by the US army in field conditions to stop bleeding from open wounds.

“The beauty of this method is how easy and effective it is,” says Sung. “The entire procedure, from investigating the bleeding to using Hemospray to stop it, takes just 30 minutes.”

Hemospray does not require as much skill as conventional treatments. Conventional methods involve injecting epinephrine or other drugs to constrict the blood vessel; inserting a special heatgenerating device into the endoscope to “cook” the ulcer; or placing a clip on the punctured blood vessel. All these require an endoscopy expert with precision skills who might not be readily available.

Twenty years ago, doctors would have given patients blood transfusions and operated on them to suture the bleeding vessel. In some cases, the part of the stomach with the ulcer and injured blood vessel would have been removed. That would have left the patient with a lifetime of digestive problems.

Three days after the Hemospray, Fung had a repeat endoscopy. Sung found that the bleeding did not recur and that the rest of the Hemospray powder had been washed away by the stomach’s natural acids.

Fung is now on anti-ulcer medication. When the ulcer has fully healed, Sung will decide whether to give him antibiotics. Hemospray has so far been used on about 20 patients with very good results, Sung says.

4 COVER STORY

Poisoned Lead-contaminated ceramics are still a local problem despite tight regulations, writes Jennifer Huang that target tourist trade. Only one shop in SoHo warns customers, in a tiny notice, “Not for food use. Glaze contains lead.”

Using store-bought LeadCheck swabs from the United States, we found six items with high concentrations of surface lead.

Almost all had gaudy Oriental patterns similar to the toxic ceramics seized by Hong Kong

authorities in the 1990s. Four were ornately enamelled flat-bottomed spoons, and the other two – a mug and a soy dish – had traditional pink-and-yellow Chinese porcelain schemes.

Two other bowls and a teacup had lead on the external lip. Traces of lead were detected on a dish and a spoon, but at much lower levels of concentration.

Certainly, this ad hoc test lacked the scientific protocols that would deem our findings conclusive, but it

does suggest that extra care should be taken when selecting dinnerware and cutlery. More conclusive results on how much lead is actually leaching into food would require laboratory analysis.

Our tests were conducted after speaking to Dr Gerald O’Malley, a physician in emergency medicine and director of clinical research at Thomas Jefferson University Hospital in Philadelphia, in the United States. This year laboratory tests found that about one in four ceramics bought in Philadelphia’s Chinatown – all imported from China – were lead-positive, with levels of leaching up to eight times the permissible level.

Lead has long been

Photographs: Stanley Shin

I

f you’re still using the ornate ceramic cutlery and crockery that first adorned your family dining table, maybe it’s time to let go. Recent research has turned the spotlight back on ceramics as a source of lead contamination, a hot topic in Hong Kong in the 1980s and 1990s.

An investigation by Health Post found some ceramics from shops around town that tested positive for surface lead.

Our 40 test samples – dishes, bowls, cups and utensils – were all ceramics intended for food use and made in China. They were acquired from both high-end and discount houseware stores, private households, cookware retailers, restaurants, and ceramics shops

COVER STORY 5

chalices used in ceramic ware, as a glaze to give a glass-like finish that allows bright colours and decorative patterns to show through, and as a decoration to bring out rich or intense colours.

But lead is toxic to many organs and tissues, including the heart, bones, intestines, kidneys, and reproductive and nervous systems.

In children, exposure to lead can impair the development of the nervous system and have a wide range of effects, including lower IQ, attention deficit disorders, hearing loss, brain damage and even death.

Based on the consumer safety laws in Hong Kong, ceramics are not supposed to pose risks of lead exposure. The Consumer Goods Safety Ordinance requires manufacturers, importers and suppliers to ensure ceramic wares are reasonably safe. That is, lead released from bowls, plates and eating utensils should not exceed the maximum limits set by the British Standard – for plates and bowls, not more than 0.8 milligrams per square decimetre and 4 milligrams per litre respectively.

Hong Kong customs conducts safety spot checks on samples in the market and keeps watch on products reported unsafe by local, mainland or overseas authorities.

Bright glazes do not always indicate a high level of lead content.

Much of the lead in the clay and the pigment will dissipate if fired in the kiln at a high enough temperature and for a sufficient length of

time. Surface quality is also important, as tiny cracks will allow heavy metals embedded in the clay to leach out. This is why even ceramics with no pigment might be lead-positive.

The maximum leachable lead permissible in liquid, says O’Malley, is five parts per million (ppm).

“We found levels that were sky high, many, many times higher than allowable compliance,” he says of the cups, plates, bowls and utensils bought in Philadelphia’s Chinatown.

“Some of the items such as the soup ladles were at 36 to 40 ppm.

“My concern is that this phenomenon is a kind of unrecognised source of lead exposure in a population that isn’t tested for it,” O’Malley says. “Once you have it in your body, it’s too late – [especially] for children and pregnant women who are much more sensitive with development.

It’s ridiculous to accept it.”

Some experts, however, are not overly concerned about the risk of lead exposure from ceramics.

Once you have [lead] in your body, it’s too late – [especially] for children and pregnant women DR GERALD O’MALLEY

“I do not believe that the amount leached from glazed ceramics would constitute a health hazard unless infants and children are involved,” says Dr Hani ElNezami, associate professor of food toxicology at University of Hong Kong.

Statistics on blood-lead levels of the general Hong Kong population are scarce because there have not been any large-scale studies conducted on this issue. Lead poisoning is uncommon; only a few cases are recorded every year at the Hong Kong Poison Information Centre and United Christian Hospital Toxicology Training Centre, according to the institutions’ director Dr Lau Fei-lung. He says many cases may remain undetected because those with elevated blood-lead levels may appear to show no

symptoms of the condition and therefore are unlikely to seek treatment at a hospital.

Besides, ingested lead exposure can come from multiple sources – including vegetables, drinking water, shellfish, heavy metals in traditional Chinese medicine, and even lime-preserved century eggs.

“There are no cases of lead poisoning from plates, as it would be difficult to prove the poisoning comes solely from this source,” Lau says.

What’s more, over the past 20 years there have been fewer failed ceramic samples. Before the Consumer Goods Safety Ordinance came into force in 1995, it had been relatively common: more than half of the samples failed the lead tests conducted by the Consumer Council in 1986 and 1991.

“Since 2009, Customs has drawn 40 samples of ceramic ware for testing by the government laboratory,” says Jessie Law, senior information officer at the Customs and Excise Department.

“All the samples were found in compliance with the safety requirements specified in the safety standard.”

Less than 5 per cent of samples tested in a private commercial laboratory failed to meet the safety standard, according to Joey Lau of the Hong Kong Standards and Testing Centre. Andy Ko, technical director at China Dragon Inspection and Certification, reported similar results, where 95 per cent of samples submitted to the lab by manufacturers and buyers passed the test.

Still, Lau cautions consumers against using these ceramics.

“It is well known that those brightly-coloured ceramic wares contain a lot of lead in the paint and we advise against using them to contain food.”

The next step for O’Malley and his research team will be to

determine the biological effect on patients in Chinatown by testing subjects who use the neighbourhood health clinic.

“We’ve done such a good job of [eliminating the use of] lead in petrol and paint,” says O’Malley.

“We may be missing an opportunity to make it a real positive step towards a better environment for children.” healthpost@scmp.com

WHERE LEAD LURKS Possible sources of lead • Vegetables and cereals – due to movement of lead in soil to groundwater • Drinking water – may be contaminated by lead soldering in water pipes • Shellfish – may be contaminated by accumulated water and sediment • Century eggs – lead oxide may be used in manufacturing process • Highways – from markings and soil • Petrol, batteries, paints, crystal glassware and food cans – lead commonly used in production process • Traditional herbal remedies – may contain heavy metals • Bathtubs – glaze may contain surface lead that could leach into bath water.

• Game meat – may be contaminated by lead bullets Symptoms of lead poisoning • Sluggishness and fatigue • Abdominal pain • Vomiting • Constipation • Learning difficulties • Decline in mental functioning • Pain, numbness or tingling of the extremities • Muscular weakness • Memory loss • Mood disorders

6 HEALTH FROM THE EXPERTS

Label becomes a life sentence ......................................................

Dr Richard Lau healthpost@scmp.com What comes to mind when you think of mental illness? Would it be a disoriented man wandering the streets? Or perhaps a serial killer?

Psychological terms are used to diagnose people based on their symptoms and their impact on everyday activities. Such labelling is useful in resolving the complexity of symptoms we must grapple with, yet it can lead to many problems.

Labels often stick and, like tattoos, can leave a permanent mark. Mental illness has received a lot of negative portrayals in the media, resulting in the stigmatisation of sufferers.

A classic case in point is a study conducted in the 1970s. To determine how accurate hospitals were in distinguishing people who were mentally ill and those who were not, researcher David Rosenhan got himself and his associates admitted into mental hospitals as pseudo-patients. They gained entry by claiming to hear voices saying “empty”, “hollow” or “thud”, and were admitted with the diagnostic label of “schizophrenia”.

They then started to act as normal people and measured the time it would take for the staff to recognise this and release them.

None of the staff identified them as pseudo-patients during their stays of one to seven weeks. Instead, everything they said or did was regarded as pathological behaviour.

Rosenhan and his team initially took notes secretly to avoid raising the suspicions of the staff. But they soon realised their caution was

Photo: Oliver Tsang

unnecessary, as the staff never showed any interest in their note-taking. Nursing records indicated that the pseudo-patients “engaged in writing behaviour”, as if it was a symptom related to their diagnoses.

The pseudo-patients’ real personal history was also interpreted in such a manner.

For instance, one of them reported having a close relationship with his mother but a relatively distant one with his father. But in adolescence and beyond, the situation reversed and he was closer

Mental illness has received a lot of negative portrayals in the media, resulting in the stigmatisation of sufferers

to his father. Although this is quite common in many families, the medical case summary recorded that the pseudo-patient manifested “a long history of considerable ambivalence in close relationships” and displayed an “absence of affective stability”.

Those regarded as mentally ill are also often depersonalised. Nurses would discuss a patient’s condition openly when he was in the ward, and one even adjusted her bra in front of a room of male patients as if there was no one there. Intriguingly, many of the patients in the hospital

recognised the pseudo-patients as actors, and often asked them their purpose.

The hospitals were not happy with the study’s findings. In response to their criticisms, Rosenhan said he would send pseudo-patients again in the next few months and challenged the staff to identify them.

Among 193 candidates, 60 were identified as fake or suspicious by the staff. Yet this again demonstrated the effects of labelling, as Rosenhan never did send any more patients to the hospital.

Such biases are not confined to a particular setting or a certain group; they often occur in our everyday life.

It is worse for those who have mental disorders, because these labels do not come off within a certain time frame, as was the case with Rosenhan and his associates.

They carry these markers for life and may be subjected to more prejudice than the research team was.

Although these individuals are often cast in a dark light and are seen as dangerous, most violent people do not suffer from mental illnesses.

In fact, people with mental disorders are more likely to be victims rather than perpetrators of violence.

What we need is more understanding and acceptance, instead of ostracising those who are different from others.

Dr Richard Lau is the director of psychological services with the Whole Person Development Institute and a former assistant professor in the faculty of medicine at Chinese University

TRADITIONAL CHINESE MEDICINE

Nothing but the pith will do for herbal researchers ......................................................

Jeanette Wang jeanette.wang@scmp.com The tasteless, pale-looking herb Medulla junci may be unattractive, but it is commonly used in Hong Kong to treat a wide range of emotional and physical problems.

As its Chinese name meaning “wick herb” implies, the white or pale yellowish-white herb is slender, cylindrical and about 90cm long. The stem, from a plant named Juncus effusus L (Juncaceae), is collected from late summer to autumn, sun dried, the outer part removed and the pith straightened out or tied in a small bundle to become Chinese medicine.

One of 574 herbal medicines listed in Hong Kong’s Chinese Medicine Ordinance, it can be used to eliminate excessive “heart qi”, literally “fire in the heart”, which can lead to a range of problems including insomnia and restlessness, difficulties and pain in urination, and ulceration in the mouth or on the tongue.

But it seems people here have been short changed.

Researchers working on the Health Department’s Hong Kong Chinese Materia Medica Standards (HKCMMS) project discovered that what was prescribed and sold here was the whole plant rather than just the pith.

The latter contains much higher levels of the active ingredients – dehydroeffusol and effusol – than the rest of the herb.

So the department issued letters to Chinese medicine practitioners and traders to alert them to the research findings and remind them to observe the ordinance, which states that only Medulla junci’s stem pith should be purchased and used in herbal preparations.

This Chinese herb is one of 60 commonly used in Hong Kong that possess established safety and quality standards under the HKCMMS project, which was launched in 2002 with the aim of safeguarding public health and ensuring the availability of good quality Chinese medicine. With the

project’s first three phases completed – and three volumes of the internationally acclaimed “HKCMM Standards” published in 2005, 2008 and 2010 respectively – the department is now aiming to further develop standards for another 140 herbs by next year.

Research for phase four, which covers 36 herbs, is complete and is expected to be published at the end of this year. Research for phase five has begun.

As before, the principles and parameters for research and laboratory analysis have been laid down clearly and objectively by the project’s International Advisory

Researchers discovered that what was prescribed here was the whole plant rather than just the pith

Board, a panel of world renowned experts who evaluate and endorse research results.

To expedite the whole process, other research institutions in the region, like China’s National Institute for Food and Drug Control, have been brought in to join the project, which includes research teams from six local universities. China Medical University, Taiwan’s first academic institution to provide Chinese medicine and pharmacy programmes, was also recently engaged for sample collection and research under phase five. .

As interest grows in the use of Chinese medicines both in Hong Kong and around the world, a well-established and internationally recognised set of standards for Chinese herbs is expected help ensure that only the safest, highest quality and most effective medicines are made available to consumers.

Information provided by the Health Department

8 HEALTH MEDICAL TOURISM

Vietnam: just what the doctor ordered

Skincare treatments in Vietnamese clinics can be booked around sightseeing trips, with savings of up to 70 per cent on prices elsewhere.

Photo: AFP

......................................................

Gemma Price healthpost@scmp.com Vietnam’s health care has undergone a revolution in recent years as luxurious hospitals, dental clinics and cosmetic centres continue to proliferate to cater for a rapidly growing domestic and international market.

The International Medical Insurance Journal lists Malaysia, India, Thailand, Singapore, the Philippines and South Korea as the most popular medical tourism destinations in Asia. Thailand and Singapore lead the charge, together accounting for 64 per cent of the Asian market in 2008.

But Vietnam is shaping up to be a top regional competitor. There are no official figures, but local centres say their business is increasing between 50 per cent and 100 per cent a year.

“Our practice has grown 60 per cent every 12 months,” says Dr Wade Brackenbury, who established the American Chiropractic Clinic in Ho Chi Minh City six years ago. “About 20 per cent of our clients are from

overseas: roughly half from the [United] States and Europe, and half from Asia, with Hong Kong residents representing the largest proportion of the latter.”

The Westcoast International Dental Clinic has also seen strong growth, with Hongkongers now comprising the fifth-largest group of foreign patients behind Australians, Americans, Canadians and New Zealanders.

“The number of patients we see from Hong Kong is up 50 per cent from this time last year,” says clinic founder Dr Andrew Tsang.

Vietnam’s first trump card is price. “In the States, you’ll pay US$600 to see a physiotherapist for one session,” says Brackenbury.

“Because of the practice methodology in Asia, and Vietnam especially, we can provide a considerable amount of treatment using different modalities – chiropractic, physio and so on – for less than US$100.”

Basic staff wages and the cost of running offices in Vietnam is much lower than in Bangkok, and centres pass this savings on to their clients.

What’s more, hospitals registered

FOLLOW THE PRESCRIPTION Hong Kong plastic surgeon Dr Daniel Lee recommends that prospective patients: • Go to a doctor who speaks your language and conducts a thorough Q&A. Interpreters might not understand the implications or subtleties of the information given and received.

• Find out the centre’s policy on post-treatment complications.

• Ask around: inquire at the Medical Council in Hong Kong, or ask your local general practitioner whether your chosen clinic has a good reputation.

• Keep detailed notes about the consultation process and every stage of treatment.

• Take your time. If you’re on a short holiday and have to make a decision on the spot, it might result in a less well-informed one.

under Vietnamese infrastructure law can import US$15 million to US$18 million of equipment, technology and general hospital supplies, taxfree. And because the law prohibits imports of old technology, patients can be sure that they will be treated using the most up-to-date equipment.

FV Hospital, a modern facility in Ho Chi Minh City accredited by the French National Authority for Health, recently launched a full suite of medical tourism packages, offering itineraries that combine procedures like Lasik and plastic surgery with five-star resorts and sightseeing.

“Our rates for hip replacement are about 60 per cent of the price in Thailand, and not even 40 per cent of what the surgery would cost in Singapore, yet our patients receive exactly the same quality of care,” says FV’s general director, Dr JeanMarcel Guillon.

Hospitals and health care centres are staffed by both local and expatriate doctors. Most local doctors have trained overseas in their specialities, and many at international centres are Viet kieu –

The number of patients that we see from Hong Kong is up 50 per cent from this time last year DR ANDREW TSANG, CLINIC FOUNDER

overseas Vietnamese – doctors who were raised in developed countries, trained abroad and usually have 10 or 20 years of international experience in their discipline. In addition some centres, such as FV, have specialists visiting all year long.

For lesser procedures, there are many other clinics. Orient Skincare and Laser Centres, for example, specialises in non-invasive cosmetic treatments, such as wrinkle reduction and botox. Much like a waxing appointment, many of these treatments can be booked around meetings or sightseeing trips, and with savings of 40 per cent to 70 per cent on prices elsewhere.

“We’re on a par with large-scale dental practices in terms of quality, but with a more personalised feel,” says Tsang.

His patients agree it’s faster and cheaper to get an appointment and fly in for a procedure than to see someone in Hong Kong.

Paul Kember, 48, a British architect based in Hong Kong for the past 15 years, had extensive work done at Westcoast. Two root canals, four crowns, three composite filling replacements, three wisdom teeth extracted and a front bridge were replaced over two weekends a month apart. Along the way, he saw the sights with his partner. He says: “A very good company in Hong Kong quoted me HK$100,000 for the work, whereas at Westcoast it cost just under HK$20,000 for

comparable care and professionalism.”

As appealing as it may be, Professor Raymond Liang Hin-suen, president of the Hong Kong Academy of Medicine, advises caution when going overseas for serious procedures. “I don’t think there is a good source of information for patients in Hong Kong when considering overseas treatment, and the information that is available online might not be entirely reliable,” he says “Furthermore, it’s stressful to seek treatment overseas, as patients don’t know the place, and they don’t have the much needed social support.

“Hong Kong has good medical care, and the standard is high. You should seek advice from your local doctors first.”

Doctors in Vietnam say they have spent a lot of time and money implementing systems to ensure every patient can be completely confident about booking a trip.

“Our treatment co-ordinator builds a plan from scratch from conversations with the patient, usually via e-mail or Skype,” says Tsang. “Our preparations are so accurate before the visit that most clients are astounded to find everything carried out exactly according to plan.”

FV Hospital has an international patient officer who works via e-mail and phone to find out what they expect in terms of pricing and outcome, and ensures everything is finalised as much as possible before making appointments.

“If patients have complications immediately after the surgery, they simply extend their stay, just as they would in their home country ... and we follow their progress once they have returned home,” Guillon says.

In the rare event there’s a posttreatment problem, Tsang says Westcoast will cover the cost of follow-up treatment in that patient’s home country.

FITNESS 9 BABY BOOMER FITNESS

Billie Jean’s back and bouncing ......................................................

Melissa Murphy Billie Jean King is back playing tennis in New York’s Central Park with gusto after double kneereplacement surgery. And at 67, she’s encouraging all ages – especially baby boomers – to exercise and stay fit.

But she also says it’s forgivable if you can’t match the workouts you did when you were young.

King, who inspired a generation of women and men to pick up a racket in the 1970s, didn’t play tennis for nearly two years before getting new knees. She needed about a year of rehabilitation, working out for 21⁄2 hours, five days a week to regain the strength and range of motion to get back on the court.

When the pain was intense, she imagined “a bright, sunny day in my head. And I pictured hitting the first tennis ball again”.

King realised that goal last year at Wimbledon, four months after surgery. She sneaked onto Court 16 and hit a few shots with friend Roz Fairbank while her partner, Ilana Kloss, snapped pictures.

This year, King celebrates the 50th anniversary of her first Wimbledon doubles victory. She went on to win a record 20 Wimbledon titles in singles, doubles and mixed.

At the tournament, which ended on Sunday, she was photographed at Wimbledon sitting behind Prince William and Kate Middleton in the Royal Box. To stay in shape these days, the winner of 39 grand slam titles heads to her neighbourhood gym and public tennis courts. She doesn’t use a personal trainer because she travels so much, and when travelling she uses a hotel gym.

She recently travelled in a twoweek span to Philadelphia, back to New York, then to Washington while promoting her World Team Tennis league, which features Serena and Venus Williams, 52-year-old John McEnroe and other stars in nine cities from July 4-24.

Here, King shares her insights on working out, the proper mental approach and diet.

Her advice for boomers? Increase the frequency, lower the intensity and listen to your body.

What is your exercise routine?

My age group should do a half hour, five days a week. What that means is, I’m walking, doing the bike, lifting weights or playing tennis. I love it when Ilana and I go to Central Park and play tennis. It’s fantastic. I go to Equinox to do lower and upper body stuff. Do a lot for my back; I need to be doing a lot for my core. I do the leg presses, the leg curls, abductor

and adductor. I have a bike at home, so if worse comes to worst, that’s my back-up. I’ll turn on the television and pedal.

This was your eighth knee surgery.

What was life like before the doubleknee replacement?

I got to the point I couldn’t even walk two blocks. I had my first operation at 23 when I was No 1 in the world, and it’s been downhill ever since in terms of function. I used to take a taxi two blocks to get to my workout.

My life was closing in on me. It kept getting less and less, and then it was really getting disheartening.

Now I’m pain-free if I want to play tennis or take a walk in the park. I’m going through this mindset change now. It’s amazing. My first reaction is: “Oh, I can’t – oh, yes I can do that.” I can go up and down stairs. I wasn’t able to do that a year ago.

How has your thinking and approach to fitness and exercise changed over the years?

The most important thing is frequency. You don’t have to do as much as you think. Like walking 30 minutes, five times a week is good. I would never increase more than 10 per cent at a time.

People will do 20 minutes on the bike, and the next day they’ll do 40.

Nuh-uh. If you’re out of shape, don’t do that.

Figure out ways to keep your motivation. On days I’m not motivated, I will say: “OK, just get on the bike or walk for five minutes, and if you want to stop, fine.”

I give myself permission. I’ve only once in my whole lifetime stopped, when I realised I was sick.

Every other time, I end up doing at least 25 to 30 minutes. So then it’s done for the day; it’s great. I would go without exercising if I wasn’t careful.

What are your eating habits like now?

I try to cut down on carbs. I’m older; my metabolic rate probably is not as fast. I figure I’m burning three calories a minute on the bike. I’m not as intense as I used to be, so that makes a difference. It suppresses your appetite to go slowly on the bike or walk and go longer. I was playing senior tennis [after retirement] for a while, but then I gained a huge amount of weight.

Then I went on Nutrisystem, and that really helped me lose. I lost 35 pounds [about 16kg]. Then I got too

Listen to your body, what’s going on with your joints, your muscles … Boomers are into fitness BILLIE JEAN KING

Billie Jean King (above); at the French tennis Open women’s singles final in Paris, 1972 (top); and at Wimbledon in 1969 (left).

Photos: AFP

thin with the knee stuff, and now I’m a little overweight. So it’s hard for me to get to where I want to all the time.

I struggle.

You were a perfectionist on the court.

Do you forgive yourself for the limitations of age or worry about it?

It’s a blessing for me to walk on the court. Then I go: “OK, I just want to hit one ball that feels like it used to.”

You just make smaller goals, different goals. Coming back from this knee replacement, I had to really think in degrees, literally [in terms of knee bend]. It’s important to play more tennis, but play half an hour to 45 minutes instead of trying to play an hour and a half. Instead of doing marathons, do 10 kilometres.

Listen to your body, what’s going on with your joints, your muscles. I know boomers are into fitness and taking good care of themselves. And now they’re at the age they still want to be active. [They say:] “I want to still play tennis and do this and keep running.” They’re pretty demanding, which is good, because that’s why we’re living as long as we are.

What’s your role as a member of the President’s Council on Fitness, Sports and Nutrition?

It’s amazing being on this council.

There’s Michelle Kwan, Grant Hill, Chris Paul and doctors. Our job is to get the word out. You can’t believe the findings with exercise and taking tests at school or reading or math tests. They go way up. If they’re going to take an exam, they have the kids work out for 20 minutes, and they take it immediately because the circulation is going; the brain’s got more oxygen. They do much better on tests. Now we have the scientific stuff behind it. I knew it before, because I knew how I felt. But now we have the scientific stuff to back it up.” Associated Press

10 DIET NUTRITION BENEFICIAL CHOICES

Give comfort foods a clean bill of health ......................................................

Melvin Hoe healthpost@scmp.com Your standard meal choices aren’t set in stone. Here’s how to give your daily diet a nutritional kick.

Beating a hangover The usual: a full English breakfast of fried eggs, bacon, fried bread, baked beans and black coffee Our pick: poached eggs, toast with jam and a sports drink A hangover is caused primarily by dehydration and low blood sugar levels, says Kendy Tam, a registered dietitian and a Hong Kong Nutrition Association committee member. As such, you’ll need to get the fluids in immediately. Water is good, but go one step better and replenish with a sports drink containing electrolytes.

A study in the American Journal of Clinical Nutrition showed fructose found in fruits (or jam, in this instance) help eliminate toxic byproducts from alcohol metabolism.

Eggs are quite possibly the kicker in the hangover-beating mix. A component in eggs known as cysteine can limit the toxic effects of an alcohol by-product known as acetaldehyde (the major culprit in hangovers), says Carmen Lo, a registered dietitian. “In a study on rats, the animals were given a dose of acetaldehyde; the rats that received cysteine had an 80 per cent survival rate,” she says. Although these effects can’t be extrapolated to humans yet, adding eggs to your breakfast isn’t a bad deal, since they’re high in protein and contain a bevy of beneficial nutrients that bode well for your health.

The huge amount of fat and calories in a full English breakfast doesn’t make it worth its while. However, oily, fatty foods (like a fish and chips dinner) can work before your drinking session, since food and fats delay the absorption of alcohol into the bloodstream. As for coffee, while caffeine has some effect in dilating blood vessels and alleviating headaches, it’s also a diuretic and can cause you to become even more dehydrated.

Ordering a steak The usual: grain-fed prime rib Our pick: grass-fed sirloin Granted, most bovine enthusiasts would prefer the creamier, fattier flavours of marbled meat. But it’s not the wisest option, since beef has more saturated fat compared with other meat types, says Tam. Red meat has also been linked to bowel cancer risk, so it’s not advisable to eat more than 500 grams of it per week. We’ve got a solution, though.

You don’t have to turn vegan; just choose a different cut.

At a restaurant, go for cuts like

sirloin, tenderloin or T-bone, says Lo. A sirloin cut can contain less than 10 per cent fat, while prime rib can contain up to 40-50 per cent fat.

Make it better by choosing beef from grass-fed cows, instead of grain-fed, says Tam, as the former has less saturated fat. In fact, the fat in grassfed beef tends to have more hearthealthy omega-3 fatty acids, as well.

What’s more, beef contains minerals like zinc, choline, B-vitamins, and iron, says Lo. Making a sandwich The usual: white bread, butter, ham and iceberg lettuce Our pick: wholemeal bread, margarine, roast chicken and Romaine lettuce For starters, don’t use white bread.

“There are 1.9 grams of fibre in one slice of wholegrain bread, whereas refined white bread has only 0.6 grams ,” says Tam. The excess fibre delays digestion, so wholegrain bread gets absorbed more slowly by the body, keeping you fuller for longer. This gradual absorption of nutrients also means your blood sugar levels don’t rise as much, and you’ll be less likely to have hunger pangs. Plus the refining process that creates white bread removes the bran and germ of the grain, stripping it of nutrients, says Tam. While butter is touted as a natural product versus artificial margarine, Lo recommends the latter, as butter contains high levels of saturated fats. Look for margarine made from vegetable oil with minimal hydrogenation. “Look for a margarine that contains less than 0.3 grams of saturated fat, and less than 1.5 grams of trans fat per 100 grams,”

says Tam. Iceberg lettuce has one of the lowest nutritional contents available. Tam advises switching to other greens such as Romaine, which contains more vitamins A, C, K and B-6, beta-carotene, folic acid, niacin and riboflavin than iceberg.

If you’ve been using processed meat in your sandwiches, stop; nearly all processed meats contain sodium nitrite, an additive that can cause cancer. A study in the journal Pulse has linked frequent processed meat consumption with a 67 per cent increased risk of pancreatic cancer. Better option: buy a roast chicken from the supermarket and shred it for sandwich filling.

Ordering fast food The usual: straight-cut French fries Our pick: curly fries Deep-frying piles on the calories because the potato absorbs extra oil when it’s immersed in it. A serving of fries yields more than three times the calories of an equal serving of baked potato, says Petrina Lim, a Singapore-based nutritionist. When carbohydrate-rich or starchy foods are heated to high temperatures, acrylamide – a potentially cancercausing chemical – forms.

This is not an excuse to indulge in fast food, but curly fries are the lesser of two evils. A study in the Journal of Food Science found curly fries contained lower levels of acrylamide – up to 163 per cent less – than straight-cut fries. Because curly fries have a larger surface area, they take less time to cook and to achieve the flavour of regular fries. Curly fries contain 22 per cent less oil and 26 per cent less salt, as well. Better still, if you can help it, don’t eat fast food.

For starters, use wholemeal bread for your sandwiches rather than white

FITNESS/DIET 11 SPORT FOR HEALTH ULTRARUNNING

Football f lab to f it and fab ......................................................

Jeanette Wang jeanette.wang@scmp.com

Eric LaHaie switched from banking to sports retail.

Photo: Jonathan Wong

It’s hard to believe Eric LaHaie once played American football professionally, but that was 20kg, five years and another country ago.

Since moving to Hong Kong from New York in June 2008, the Maryland native, 30, has switched jobs (investment banking to sports retail) and sports (to ultrarunning).

LaHaie, the vice-president of global sales at RacingThePlanet, is training for the Sahara Race in October, a 250-kilometre selfsupported multi-day race. He’s done two others, winning the Gobi March in 2009 and finishing second at the Atacama Crossing last year.

How did you go from football player to ultrarunner?

I played American football from age five through university, and then professionally for a couple of years in Europe, so for most of my life I focused on a different type of fitness – speed and strength, more than endurance. I was done with football at age 25 and picked up running to stay fit. I moved to New York and did the NYC Marathon in 2006. When I started training for that, just doing five kilometres was a struggle.

After that I dabbled in running a bit (when I wasn’t chained to my desk), but it wasn’t until I moved to Hong Kong that I became an ultrarunner. It was really the trails and local races that got me hooked, and I slowly increased the time I spent running.

will go wrong. So you just have to ride out the lows, enjoy the highs, and just live in the moment and keep moving forward.

How has the transformation changed you?

I am down about 20kg from my football days (95kg to 75kg). I have also become way more patient and calm mentally and emotionally. My training mimics my daily life. I used to live a fast and aggressive lifestyle, and now I am more chilled out.

Ultras train you to act this way, as there is no perfect race: you will feel down at some point or something

What do you enjoy about doing these ultra events?

I love the feeling of being out in nature and being part of it. Many times it is just you and the desert or the mountain, and you feel at one with the earth. It is also the challenge that draws me in, the great feeling you get from setting a goal and then accomplishing it.

But looking back, what I think I will remember most about these

ultras is the people. There are so many determined, strong-willed individuals who might not be the best athletes but who compete with their hearts. They will push themselves and never give up.

Many people must be jealous that you work in a company that’s directly related to your sport.

Yes, I think there are loads of people who would love to have my job. But it is not all fun and games as it is still a business, and I often find myself working longer hours than I did when I was in investment banking.

And with the amount of time I spend

training when I have a race, I often feel that all I do is work and run. But I love it.

We explore all the great trails for three to five hours in the morning and then chill for the rest of the day.

What’s a typical day like for you?

Up at 8.30am and in to work around 9am. I spend the next 10 to 12 hours sourcing gear for the store, servicing customers and building the business. Then I wrap up and go for a night run somewhere on Hong Kong Island (normally The Peak or Bowen Road) for one to three hours.

Then I head home, eat, watch a little television and hit the sack.

Weekends are what I live for. It’s when I do my long runs with friends.

At the rate you work out, do you eat anything you want?

This is a big misunderstanding, because a healthy diet is just as important as exercise. That said, my diet is not always the best, as when you run as much as I do, you can get away with eating a lot. Sometimes I still eat as if I were 95kg, and it is not always the healthiest stuff. But I am changing my diet a bit now and trying to eat more raw foods, with a focus on fruits and veggies.

THE TASTE TEST: CRUNCHY PEANUT BUTTER

Rough or smooth? It’s all a matter of paste Jeanette Wang jeanette.wang@scmp.com MaraNatha Organic Crunchy & Roasted Peanut Butter HK$59.50 for 454g, City’super This is as natural as peanut butter gets. The only ingredients are organic, dryroasted peanuts, double ground for a consistency I found too smooth for a product labelled as “crunchy”. Because it’s all natural, oil separation occurs, so it needs to be stirred before each use (this can be tedious).

Verdict: good for peanut butter purists, but not if you like crunch with every bite.

Fifty 50 Low Glycemic Peanut Butter HK$48 for 510g, City’super First, peanut butter is naturally low-glycemic, so to highlight it on the jar is quite cheeky. That said, this version scored high for its great roasted, buttery taste and spreadability. Unlike the MaraNatha, this one contains hydrogenated vegetable oil to prevent separation.

Verdict: slightly crunchier than MaraNatha, but could definitely do with more peanut chunks.

Whole Earth Crunchy Organic Peanut Butter HK$40.50 for 227g, City’super You can tell this peanut butter is special just by how it looks – speckled with little red bits. That’s peanut skin, and it’s what gives this spread a great nutty, wholesome taste. It also contains palm oil (to prevent separation) and sea salt, which I feel enhances the taste of the nuts.

Verdict: great crunch, but can be dry and hard to spread – so complement it with a bit of jelly.

Photos: Nora Tam

...............................................