2011 07 19 Health Post #9

YOUR GUIDE TO LIVING WELL

TUESDAY, JULY 19, 2011

HEALTH POST Living with gluten intolerance

Photo: Stanley Shin

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FIRST AID SKILLS EVERYONE SHOULD KNOW

LEARN THE MOVES AND DANCE AWAY THE KILOS

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2 NEWS HEALTH BITES ......................................................

Jeanette Wang jeanette.wang@scmp.com

Get jiggy You’ve seen the television series; now, dance like you’re one of the Glee crew. mYoga has introduced Glee Club, a new summer dance class set to the tunes of popular music dating back to the 1980s, including genres such as Broadway, pop and hip hop. The moves have been specially choreographed to mimic dance scenes from movies, musicals or music videos. Call 2390 7788 (Mong Kok club) or 2576 9990 (Causeway Bay club) for details.

Buzz off Nobody likes being mosquito fodder, but neither do most people enjoy the lingering smell of repellent. Para’Kito offers an interesting solution. Injectionmoulding technology is used to infuse essential oils into polymers, which are then pressed into a pellet and fitted on a neoprene wristband (HK$140 each). The oils diffuse into the air around the wearer, with a tested protection level of 70 per cent for 15 days. The waterproof, chemical-free pellets are refillable (HK$90 for two) and never come in contact with skin, which makes Para’Kito suitable for pregnant women.

It’s available at Escapade Sports.

Need for speed Want to ace that next race? Learn the secrets to running faster from Blaise Dubois, a physiotherapist whose expertise is in prevention and treatment of running injuries. En route to the World University Games in Shenzhen with the Canadian athletics team, Dubois will be in town for just one day – Wednesday, August 10. His lecture will cover topics such as biomechanics, the controversial barefoot running trend and minimalist shoes. It costs HK$200 and will be at the Hong Kong Football Club, Happy Valley, at 7.30pm. Sign up at www.therunningclinic.ca or call Hannemari at 2525 8168.

Go nuts Mixed, unsalted, raw or dryroasted – take your pick.

Whatever you choose, new research from St Michael’s Hospital and the University of Toronto shows eating 28 grams of nuts every day could help control type-2 diabetes without weight gain and prevent its complications. As a replacement for carbohydrates, nuts have benefits for both blood glucose control and blood lipids, lead researcher Dr David Jenkins says.

You snooze, you win Sleeping on the job – for 15 to 20 minutes, to be specific – may help you work better.

Studies have shown such “power naps” have a rejuvenating effect, improving reaction time and critical thinking for people struggling with drowsiness, Dr Alon Avidan, associate professor of neurology and codirector of the sleep disorders centre at the University of California, Los Angeles, says in a HealthDay report. The body’s circadian rhythm tends to dip at about 3pm to 4pm for those working daytime hours. People typically shrug off this dip, but sleep experts say it’s better not to fight it. Nap, but keep it shorter than 30 minutes for best results.

APP OF THE WEEK

Is it better to give or receive? There’s a massage in there somewhere ......................................................

Katie McGregor healthpost@scmp.com The Art of Massage with Adrian Carr US$3.99 Rating 9/10 To give is divine, but a massage in return is even better. And so I reveal that my motives for downloading this app were not altruistic.

The Art of Massage is broken down into well-shot videos in which certified massage therapist Adrian Carr demonstrates and talks you through routines focusing on different parts of the body. Each video is four to six

minutes long, although there is a 16-minute one devoted to the “lower extremity anterior” (front of the legs).

Carr has more than 35 years’ experience teaching and studying the healing arts, and uses a range of techniques from Swedish massage to zone therapy, or reflexology. These techniques are only briefly explained in the accompanying text and in the videos, so some online research is helpful to hone your skills. But a picture is worth a thousand words, and the videos will give you a fairly good idea of what you are doing.

To create a peaceful ambience you might choose to wear the earphones, but then you get tangled in the wires. The solution was for my patient – my long-

suffering teen daughter – to listen to the guided instruction with me.

But Carr has a pleasant voice and it was not too intrusive. Practice will allow us to dispense with Carr in time. The other issue to overcome is that one module does not automatically proceed to the next, so greasy fingers need to be wiped thoroughly before tapping the appropriate buttons to proceed.

It’s an annoying oversight in what is otherwise a very good app.

Because I was impressed by the rest of the app, I chose to spend the extra US$0.99 for each of the two additional modules covering “back massage part 1” (the app already includes “back massage part 2”) and “massage for the abdomen”.

I’m still waiting for my massage in return, but perhaps to give is divine. The soothing tunes, the aromas and the rhythms of the massage are almost therapeutic enough – but not quite.

> 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

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Eileen Aung-Thwin healthpost@scmp.com Jasmine Chan, 55, was a healthy individual with no physical complaints. So when a routine health check in 2008 revealed that she had a type of blood cancer rarely seen in Asians, it caught her and doctors by surprise.

A complete blood count test showed Chan (whose real name is withheld for reasons of patient confidentiality) had a level of lymphocytes – a type of white blood cell responsible for killing bacteria and viruses – that was abnormally high. Chan’s blood test showed that she had some 10 times the normal level. Although high levels can be the result of infections, Chan’s lack of symptoms and extremely high lymphocyte levels alerted doctors that a blood disorder was present.

When Dr Raymond Liang Hinsuen, director of the Comprehensive Oncology Centre at the Hong Kong Sanatorium and Hospital, analysed Chan’s lymphocytes under the microscope, he saw that the cells were mature, thereby ruling out acute leukaemia, which creates abnormal looking, immature white blood cells. Instead, chronic lymphocytic leukaemia (CLL) was a likelier fit, but the condition usually strikes Caucasians over 60 years old.

Relatively young and Asian, Chan was an unusual candidate.

To confirm his suspicions, Liang ordered two tests: an immunophenotyping test which uses monoclonal antibodies (made in a lab rather than a person’s own immune system) to identify and

characterise the problematic lymphocytes, and a bone marrow test to investigate the extent of the suspected leukaemia.

Both tests confirmed the condition. Chan’s bone marrow had a large number of abnormal lymphocytes, which were circulating in her blood and also affected her lymph nodes, spleen and other organs. Eventually, the cancer will cause her bone marrow to fail, thereby reducing her blood count and weakening her immune system.

While a cancer diagnosis usually strikes dread in the hearts of people, CLL sufferers often have less to fear from this disease than other health conditions. An indolent (inactive or relatively benign) disease, it usually progresses so slowly that elderly patients often succumb to other health conditions before CLL becomes a fatal threat, says Liang. However, Chan was relatively young and otherwise healthy. Hence, Liang had to exercise extra caution in dealing with the cancer.

Liang’s next task was to anticipate how the cancer was going to behave, and he did so using a cytogenetic test that looks at the changes to the chromosomes inside the leukaemia cells. Specific changes to the cells, such as the absence of certain parts of the chromosomes, are reliable predictors of how aggressive the cancer will be and even how well the patient may respond to treatment.

In Chan’s case, the cytogenetic tests showed that the cancer did not appear to be fast moving and posed no immediate threat. Moreover, she had no symptoms. Liang decided that treatment was not necessary at

ASK THE DOCTORS DR TINNY HO Q: I am Indian and my skin is quite dark. I was always told only paler skin tones needed sunscreen.

However, I’ve been out in the sun a lot recently and was wondering if sunscreen was needed for someone of my complexion, and if so, what strength?

A: Darker skin does offer more protection as the more abundant pigment particles (melanosomes) inside the skin absorb ultraviolet rays and prevent them from damaging other tissue structures. This is why dark skin rarely gets sunburned or sunrelated skin cancers. But we now know it is not necessary to be sunburned for the skin to be damaged by the sun. The damage is

cumulative – little bits add up to produce photoageing, which is characterised by wrinkles, loss of elasticity, irregular pigmentation, coarseness and dryness. This is why areas exposed to the sun, such as the face and hands, almost always age faster than areas that are covered up.

So, even for those with darker skin tones, it pays to minimise ultraviolet exposure to fight ageing. Use a skincare product that offers at least SPF 30, and PPD 15 or PA+++.

If you are worried about clogging your pores, there are many brands that do not do this.

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

that time. Chan was monitored closely via quarterly blood tests.

Two years after the diagnosis, Chan’s blood tests showed that the lymphocyte levels were rising faster than before and her lymph glands started to enlarge rapidly. At that point, Liang decided it was time to take action.

Chan was given a cocktail of chemotherapy drugs and steroids, which reduced the population of abnormal lymphocytes and reduced the swelling in her lymph glands.

Liang says that although it will be several years before Chan will need further treatment, she has a higher risk of infection and must be vigilant about her health. In the meantime, she has returned to work and her normal life, carrying the mixed blessing that is a slothful blood cancer.

Illustration: Angela Ho

A disease so lazy it rarely proves fatal

4 COVER STORY

No grain,

Photo: Stanley Shin

Gluten intolerance is most often associated with a Western diet. But a study has found the condition may be on the rise in Asia owing to a change in eating habits, writes Jennifer Huang

B

read is said to be the staff of life. But if you happen to be among a small but growing number of people diagnosed with coeliac disease, a severe form of gluten intolerance, it can make you very sick.

After moving to Hong Kong a year ago, Mary Ann Voli discovered she had a high intolerance to wheat gluten, as well as eggs and sugar. For months she had felt generally unwell – low energy, constant bloating and stomach distress. “I decided to cut out gluten, sugar and lactose. And suddenly everything changed,” says Voli. “I could wake up light, go to sleep light.”

Gluten is a protein found in wheat and other grains. Sometimes referred to as a “gluten allergy”, coeliac disease is really a chronic autoimmune disorder where the intake of gluten triggers adverse reactions in the intestines and the immune system, and may cause damage to other organs and systems. It can result in a variety of serious health problems.

The disorder is estimated to affect about 1 per cent of the world’s population, most of whom remain undiagnosed.

Prevalence has been measured in a few countries in the Asia-Pacific region, but it is “extremely rare” among Chinese, says Dr Wayne H. C. Hu, a specialist in gastroenterology and hepatology.

The disease develops as an interaction of genetic predisposition and diet, often Western, which has a higher content of wheat products.

How early gluten is introduced in the diet at childhood can also be a contributing factor. “It’s predominantly a Western disease,” says Hu. “There may be a few case reports, but from the patients that I see, I haven’t diagnosed a single Chinese with coeliac.”

However, incidence of gluten intolerance might be on the rise in Asia, with the increased adoption of more Western-style diets, according

to a 2009 study conducted by Queen Elizabeth Hospital in Adelaide, Australia.

Although there may be hundreds of symptoms, the main ones are difficulty absorbing nutrients, oily diarrhoea, bloating and abdominal discomfort. Children with coeliac disease are often underweight, with vitamin deficiency and anaemia.

“You’re going to have it for life. As traumatic as that is, it’s a good disease to have, as diseases go,” says Erin Smith, 32, a New York-based blogger who has coeliac disease – diagnosed at the age of three – on glutenfreeglobetrotter.com. “I don’t need to take a treatment, pill or an

You’re going to have it for life. As traumatic as that is, it’s a good disease to have, as diseases go. I don’t need to take a treatment, pill or an injection – I can control my disease with food ERIN SMITH, NEW YORK-BASED BLOGGER WITH COELIAC DISEASE

injection – I can control my disease with food.”

Sometimes, however, this is easier said than done. When Voli had a sneaky taste of a scone at a friend’s birthday party, she was laid low for days and vowed never to break her diet again.

But her experience was the impetus for her boyfriend, Ugo Foppa, and his business partner, Alexandre Tramontin, to introduce a line of gluten-free products to Hong Kong. Although such products are sold in select supermarkets around

town, their taste and variety are less than desirable.

“Some of the gluten-free pasta is really lumpy and the aromas are not nice,” said Tramontin. So, he partnered with Piaceri Mediterranei, an Italian brand that offers a range of staples – pasta and bread substitutes, as well as cookies, cake mixes and baking flour.

“The main difference is they take out the wheat and other components that have gluten, say, the pasta,” says Tramontin. “It’s not rocket science but it is still tricky to get the same taste, texture and colour of [traditional] pasta.”

Gluten gives various doughs (think pizza, pasta, cake) their elasticity and volume. Without it, products will be crumbly, dense and dry. “Products have definitely become much better than what I had growing up,” says Smith. “As a kid, it was hard because you were ostracised for your weird food. Now, I can’t even tell you how many breads there are in the market. And they taste like real bread, too.”

Those with coeliac disease were called “banana babies” because it was thought to be a childhood disease and those diagnosed were put on a strict diet of bananas and rice. Historically, doctors have recommended diets consisting of puréed potatoes or tomatoes, beef steak, milk or just fruit.

Dining out is still a tricky proposition. Few local restaurants offer true gluten-free options. It may seem easy enough to choose foods that are not made from wheat – such as meat, vegetables, potatoes, or rice – but wheat gluten can sneak into the meal by way of additives, sauces, seasoning and bread. Even if you ask the waiting staff at a local restaurant, many may not be aware that even the ubiquitous soy sauce, for example, often contains wheat.

The consequences of such lapses might manifest themselves in different ways, including severe gastrointestinal distress, vomiting,

COVER STORY 5

no pain abdominal discomfort, nausea, flatulence and/or fatigue. Or in coeliac speak, “getting glutened”.

“The last time it happened, I felt like I was going to die. It’s the worst feeling,” said Smith. Ironically, this incident happened at a gluten-free event that she was holding. The food was wrongly prepared and she had to leave halfway through dinner.

Eric Thompson, owner of food review site Gluten Free Globe (glutenfreeglobe.com), says it’s easy to avoid “getting glutened” in China, as long as you have a good translator. “You have to ask that they make everything fresh for your order, to dust the chicken with potato or tapioca starch [rather than flour], and make sure they don’t put soy sauce on anything.”

Given the trouble coeliacs have to go through, you’d think no one would go gluten-free by choice.

But Tramontin says the demand for gluten-free products is driven not only by coeliac disease, but also by a trend that began in the US. “Although scientifically there is nothing to [support the claim], those who have gone on a gluten-free diet claim that it’s a much lighter diet and there is a higher degree of digestibility,” he says.

Publicity of the disease has risen thanks to celebrities eschewing gluten of late – most notably, Serbian professional tennis player Novak Djokovic, who attributes his improved performance to the diet change. Oprah Winfrey, Jennifer Aniston, and Gwyneth Paltrow have also temporarily turned to glutenfree dieting for purported health benefits and weight loss.

Those who adopt a gluten-free diet often reduce the amount of fried and calorie-dense foods they eat, so they naturally shed weight.

But Smith says it’s not a weightloss tool. “I tell people: I’m not losing weight because I’m still eating the same food that you are – mine just doesn’t have any gluten in it.” healthpost@scmp.com

Wholemeal recipe yields other-worldly muffins ......................................................

Melissa Clark healthpost@scmp.com Shauna James Ahern’s gluten-free whole-grain muffin recipe produces muffins so ethereal, fluffy and tender they seem like pastries from another planet – a sweet one, without gravity – and better than most other whole-grain muffins made with whole-wheat flour.

Ahern recommends making your own flour blend rather than using a store-bought mix so that you can decide what ingredients you want to include or leave out.

She uses mostly whole-grain flours in her recipes, for two reasons. One is the increased nutrition. The other is that whole-grain flours have more protein than refined flours, and a high protein content is essential to good gluten-free baking. That is why high protein and

(sadly vegetal and metallic tasting) bean flours – garbanzo and fava – are often used in gluten-free flour mixes, to bump up the protein count.

Gums are another way to help the texture of gluten-free pastries. But they are expensive and can cause stomach irritation in some people. Ahern has cut them out of her baking entirely. The proper ratio of grain flour to starch should do the trick, she says.

Gluten-free flour blend Adapted from Shauna James Ahern, Glutenfreegirl.com Time: 5 minutes Yield: a little more than 900 grams 200 grams oat flour or very finely ground rolled oats (about 2 cups) 250 grams brown rice flour (about 2 cups) 210 grams sorghum flour (about 2 cups)

40 grams corn flour or fine cornmeal (about 5 tablespoons) 150 grams potato starch (about 1 cup) 150 grams arrowroot (about 1 cup) Mix everything together and store in an airtight container.

Gluten-free apricot-walnut muffins Adapted from Shauna James Ahern, Glutenfreegirl.com Time: 1 hour plus cooling Yield: 12 muffins Butter to grease the pan 350 grams gluten-free flour mix, purchased or home-made (see recipe) ½ teaspoon baking soda ¼ teaspoon baking powder 180 grams dark brown sugar 1 teaspoon kosher salt 2 large eggs, at room temperature 1¼ cups buttermilk, at room temperature ½ cup grapeseed or coconut oil 40 grams chopped dried apricots 40 grams toasted chopped walnuts 1. Heat oven to 180 degrees Celsius, with a rack in the middle. Grease a muffin tin.

2. Whisk together flour, baking soda, baking powder, sugar and salt.

3. In a separate bowl, whisk together the eggs, buttermilk and oil until well combined; add to the dry ingredients, using a rubber spatula to mix until the batter is almost fully incorporated. Add the apricots and walnuts and mix until all traces of flour are gone.

Gluten-free wholemeal apricot-walnut muffins. Photo: Andrew Scrivani

4. Fill muffin tins ¾ full. Bake until golden brown, the top is firm to the touch, and a toothpick comes out clean, about 30 minutes. Turn the tin around halfway through. Cool on a rack for 15 minutes. Run a knife along the edges of the muffins and unmold. Finish cooling muffins on a rack.

The New York Times

6 HEALTH FROM THE EXPERTS HEART DISEASE

A serial killer in our midst ......................................................

Dr Sue Jamieson healthpost@scmp.com Heart disease is the second most common cause of death in Hong Kong, behind cancer, with 2.7 people dying from it every day.

A recent survey by CV Alliance of 160 Hongkongers between the ages of 18 and 84 found more than half had higher vascular ages than their chronological ones – a result of high cholesterol, high blood pressure or high blood glucose.

It appears Hong Kong is catching up with Western statistics because of increasing risk factors, such as high cholesterol, hypertension, smoking and obesity.

In the United States, heart disease is the most common killer; one American suffers a heart attack every 25 seconds, and one dies every minute. It’s become a hot topic in a country where with more than a million people a year have heart attacks and another 195,000 suffer from “silent” ones – without pain or symptoms but leading to a weakening of the heart.

Also of concern is that, in the past, it was more or less a man’s disease, but nowadays, as a family doctor, I need to be on the lookout for women presenting with heart symptoms.

No one is sure why women are catching up with men, apart from one obvious thing – the biggest risk factor is smoking, and the number of women smoking is on the rise.

Preventing this common disease has become one way modern medicine can increase life expectancy. It’s not always easy communicating this to patients, as they don’t have symptoms of the risk factors that will lead to their death. It’s difficult to change your eating behaviour or treat your blood pressure, for example, merely on the basis of statistics.

But we can learn from the mistakes of the West. It’s our job as doctors to screen everyone for heart disease – even those who only have a sore throat – as risk factors caught early can be controlled or eliminated. Education is everything,

Risk factors for coronary disease are increasing among Hong Kong’s population.

Photo: MCT

and even in these days of internet access, many patients don’t realise what they are doing to their bodies with bad eating habits.

Coronary heart disease and the subsequent heart attack are caused by the clogging of blood vessels supplying the heart, starving it of oxygen, a vital nutrient. This often happens during exercise, as the heart’s needs more blood then.

Lack of blood supply leads to death of heart muscle tissue downstream from the blockage, and hence the characteristic chest pain or discomfort. It can also cause arrhythmia, where the electrical activity of the heart is disrupted, causing malfunction and stopping the pumping of blood to the brain, which will quickly cause death.

The clogging of the coronary arteries is like lime scale in a kettle – and newer screening tests for heart

It’s difficult to change your eating behaviour or treat your blood pressure merely on the basis of statistics disease include CT scans measuring calcium in these arteries, which is related to cholesterol deposits and blockages. The pain of this dying heart muscle is not so different from that of aching tired muscles.

However, the pain of a heart attack may vary in severity from a mild ache to a stabbing pain or, in rare cases, no pain at all.

The rise in heart disease in Hong Kong over the years has been blamed on many sources. One is an increase in fatty, sugary Western food, which leads to high cholesterol, diabetes and obesity.

Another is the increase in smoking and sedentary lifestyles, with more workers doing office jobs rather than manual labour.

Statistics in Western countries, such as Britain, can give an insight into how increasing risk factors relate to deaths from heart disease.

Two-thirds of British adults have borderline or higher cholesterol, a third have high blood pressure (half untreated), a third of men and women exceed the recommended alcohol allowance, and one-third of children are obese. Other risk factors are a lack of exercise, diabetes, gout, thyroid disease, stress and family history. The last one is the only one

we doctors can’t help you with – genes are genes.

The good news is that 90 per cent of these risk factors can be modified, and hence coronary disease and also strokes prevented. Men should start check-ups at age 35; women at 45, as before menopause their hormones protect them against heart disease.

Patients can see their GPs for yearly checks of risk factors such as blood pressure and cholesterol, as well as an assessment and advice on exercise, diet and stress. Screening tests such as exercise ECGs and calcium CT of coronary arteries can then be ordered if appropriate.

Dr Susan Jamieson is a Scottish and Harvard-educated family doctor working in Hong Kong whose speciality is the integration of science and indigenous healing wisdom; www.drsusanjamieson.com

TRADITIONAL CHINESE MEDICINE COMMUNITY SERVICE

Practitioners reach out to homes for the elderly and day care centres ...................................................... healthpost@scmp.com Practitioners from the Hospital Authority’s centres for training and research in Chinese medicine have been serving the community under an outreach scheme since 2009.

Homes for the elderly and day care centres in the same district as the Chinese medicine centres are the main target. With 41 locations around Hong Kong, more patients have access to and are able to benefit from this scheme. The practitioners provide services including general consultation, acupuncture and tui na.

The scheme’s greatest attraction for patients is its convenience. For example, a patient at a home for the elderly was affected by chronic pain, and his relatives could not afford to take care of him all the time.

Fortunately, a Chinese medicine practitioner from one of the centres was able to relieve the patient’s distress on a visit to the home. The service also cuts down the travelling time of patients and their relatives to and from clinics.

Another benefit of the scheme is the prevention of disease. As the Chinese medicine classic Huangdi Neijing says, the best doctors treat you before you are ill, good ones

This philosophy emphasises a shift to disease prevention and health care as a way to nurture life

treat you just as you fall ill, and mediocre ones treat you when you are already ill. This philosophy emphasises a shift to disease prevention and health care as a way to nurture life. It is especially useful for residents of homes for the elderly, who are prone to chronic and degenerative diseases. Chinese medicine practitioners are able to give valuable advice for primary and secondary prevention.

The aim is to guide the elderly to a healthier lifestyle, including maintaining an appropriate diet, striking a balance between work and rest, massaging acupuncture points and doing tai chi or qigong.

The second level of prevention involves the practitioner discovering the illness before it evolves to later stages. To keep the yin-yang balance of the human body, practitioners will tailor treatment methods to changes in body type, season, stage of disease and environment.

In future, the scheme could serve as a community network ensuring a continuum of health care. Society will benefit from fewer disease and shorter waiting times for health care.

Information provided by Hospital Authority Chinese Medicine Department

8 HEALTH When applying CPR, compress at a rate of at least 100 times per minute

FIRST AID

Keep your finger on the pulse ......................................................

Margaret Wee healthpost@scmp.com Every second counts when someone stops breathing. “For every minute that you do not perform cardiopulmonary resuscitation (CPR) on a cardiac arrest victim, the survival rate drops by up to 10 per cent. After 10 minutes, the victim will have almost no chance of survival,” says Abdul Rasheed Doad, training director at the Singapore First Aid Training Centre.

With demand rising for ambulance services – 646,000 calls were made last year in Hong Kong – the Fire Services Department recently started providing postdispatch simple first-aid advice over the phone.

This means if someone at home happens to have one of three common emergencies – bleeding, dislocation or fracture of limbs, or burns – you could treat them right away before the ambulance crew arrives, Such immediate attention could mean the difference between life and death. This view is backed by the World Health Organisation, which says “bystander first aid” should be encouraged. “Most deaths in the first hours after injury are the result of airway compromise, respiratory failure or uncontrolled haemorrhage,” says the WHO. “All of these conditions can be readily treated with basic first aid.”

You might just save a life one day.

unconscious and stops breathing, tell a bystander to phone 999 and begin CPR.

Here are first-aid skills everyone should know: Cardiopulmonary resuscitation Heart disease is the second leading cause of death in Hong Kong after cancer, according to the Department of Health. For a victim of cardiac arrest, timely CPR can be life-saving, as the brain can only survive without oxygen for about three minutes – and an ambulance in Hong Kong takes an average of 12 minutes to arrive.

The American Heart Association’s new guidelines for CPR are easy to follow, even for untrained rescuers: • Tell a bystander to call 999.

• Position the heel of one hand on the midpoint between the nipples.

Place your other hand on top of the first with your fingers interlaced.

• Press down so you compress the chest at least 5cm for adults and children, and about 4cm for infants.

Compress at the rate of at least 100 times a minute – singing the Bee Gees’ Stayin’ Alive will help keep you in rhythm.

• Continue compressions until medical help arrives. If there is more than one rescuer, rotate the task of compression every two minutes. If an Automated External Defibrillator is available, follow the instructions on the device while maintaining compressions.

Choking Cardiac arrest is dire, but rare compared to choking. “[Choking] is

Choking is one of the most common accidents among young children and the elderly SPOKESMAN, HK ST JOHN AMBULANCE

one of the most common accidents among young children and the elderly, who may choke on food or small objects,” says a spokesman for the Hong Kong St John Ambulance.

A person who is choking usually has their hands clasped around their throat and will be unable to talk.

Immediately perform the Heimlich manoeuvre on the victim, to dislodge the choking object through rapid abdominal thrusts.

• Ask just one question: “Are you choking?” If he nods, tell him you are going to help.

• Stand behind him, place your arms around his waist, and bend him forward.

• Make a fist (palm facing down) against his abdomen, below the rib cage and above the navel.

• With your other hand, grasp your fist and push into the upper abdomen with hard and rapid upward thrusts until the object is expelled.

• If you are unable to dislodge the object and the victim becomes

Bleeding Profuse and uncontrolled bleeding may lead to shock and even death, because the body’s tissues get starved of oxygen and nutrients and can’t function. The most important thing is to staunch the blood flow as quickly as possible.

If gloves and sterile supplies are not available to treat bleeding, improvise. “Clean sandwich bags or tissue packets are fine to use,” says Lucy Clarke, managing director of Emergency Care Training Hong Kong. “Tissues can also be used as padding – they can be soaked off later if they have stuck to the wound,” she adds.

• Put on disposable gloves to protect yourself from infection.

• Lie the victim down and cover him if necessary, to prevent loss of body heat. Elevate the legs to prevent fainting by increasing blood flow to the brain.

• Remove any obvious dirt or debris from the wound by rinsing with plenty of clean water. Large or deeply embedded objects should be left intact.

• Apply pressure directly on the wound using a sterile pad or any clean cloth, until the bleeding has stopped (typically about 10 minutes or less). Pressure can be maintained by bandaging the wound securely. If blood seeps through, add more absorbent material.

BE A CERTIFIED FIRST-AIDER Getting certified in first aid is a great life skill to have. “First aid isn’t rocket science,” says Abdul Rasheed Doad of the Singapore First Aid Training Centre. “It’s simple to learn and apply. By taking a first-aid course, not only will you develop knowledge and skills, you will also allay your fears and build confidence to step forward in an emergency.”

Here are first-aid certificate courses recognised by the Hong Kong government.

• Hong Kong St John Ambulance, www.stjohn.org.hk • Hong Kong Red Cross, www.redcross.org.hk • Occupational Safety & Health Council, www.oshc.org.hk • The Auxiliary Medical Service, www.ams.gov.hk In addition, the Fire Services Department offers a CPR training course for family members and friends of cardiac patients free of charge. Call 2640 3708

FITNESS 9 SWEAT DANCE CLASSES

If gym’s a bore, take to the floor ......................................................

Fitness factor The explosive dynamic movement will get the heart pumping while the isolations target those smaller assist muscles.

Jennifer Huang healthpost@scmp.com Even the least graceful among us at one time or another have entertained the fantasy of being a great dancer – like a would-be Tony Manero, who daydreams about unleashing a fierce strain of Saturday Night Fever on the disco floor.

Many of these fantasies are an escape from the mundane. “A lot of girls are coming to class after work with their office clothes, holding their notebooks,” says Nataliia Bikmullina, who teaches burlesque, aerial and pole dancing at the Aerial Arts Academy in Causeway Bay. “But when they’re here, all they want to do is let it all go. They just want to do a sexy crawl.”

Classes that incorporate dance elements with a fitness focus have become increasingly popular at studios and fitness centres for both men and women. “Many are bored with their regular workouts,” says Kerry Tsang, an instructor at Central Dance Studios. “I’ve seen a lot of mums come in to shake off their everyday lives and be a different person for an hour or so.”

After the success of films such as Black Swan, places that offer ballet classes in Hong Kong have seen a bump in enrolment, according to Tsang. Newcomers have the opportunity to emulate Natalie Portman’s ballerina, without the paranoia and psychodrama.

For non-professional dancers, the motivation to dance is part fitness and part imagination. It incorporates dynamic movement to daily routine, frees the body from its ordinary patterns and allows one to indulge in the occasional Flashdance fantasy. Here are some of the “in” things in dance today: Aerial dance What is it? A fusion of dance and climbing, where the dancers are suspended in mid-air, employing a low-slung aerial hoop and silk.

Fun factor “Part of the fun is those memories of going to the circus, seeing the dancers, and feeling deep inside that we wish we could do

Pole dance What is it? Think strip club, but without the sleaze.

Fun factor “The girls are [at first] all self-conscious and awkward,” says Tessa Yung, a pole-dance instructor at Aerial Arts Academy. “But by the fourth class, they let it all go and want to feel sexy.”

Fitness factor In the early stages, dancers will work on their strength and flexibility to make the spins look nice. Advanced pole dancing involves gymnastics and works out the core.

Dancing Bollywood-style like actress Mallika Sherawat takes a lot of energy and is a lot of fun. Photo: Reuters that,” says Bikmullina. “But also, it is like going back to childhood, when we did crazy stuff with our bodies, without fear.”

Fitness factor It takes upper-body strength to hoist yourself up to various positions on the hoop, and core strength and flexibility to stay up there.

Adult ballet What is it? A combination of grace and power that makes leaping in the air and spinning on tiptoes deceptively easy.

Fun factor It’s exhilarating learning to spin without getting dizzy.

Fitness factor Ballet is a highly disciplined and precise performance dance. Beginners’ ballet emphasises posture and body consciousness and, over time, will create lean muscle and improve flexibility.

Bollywood What is it? You’ve seen it in Slumdog Millionaire. It’s a combination of Indian classical and folk dance, sometimes with Arabic, Latino or Western influences.

Fun factor The choreography is flirty and playful. It is impossible to look cranky when you’re Bollywood dancing. Also, it’s an opportunity to break out that choli crop top and matching wrap-around sari skirt.

Fitness factor There is a lot of jumping around, exaggerated hip swings and movement in the chest, which makes for a good cardiovascular workout.

Ceroc What is it? An updated version of jive with salsa and rock mixed in. It’s gaining popularity in Hong Kong.

Nightclubs around town hold Ceroc nights where people partner up and freestyle.

Fun factor It’s social. “You meet people because of the way you learn and change partners,” says Cecile Hora, a Ceroc instructor at Centre Stage in Central. “I’ve made a lot of friends here, and I’ve even seen people find their husbands and wives.”

Fitness factor The footwork is relatively uncomplicated and easy to pick up. “When you’re just

beginning, you’re learning the steps, so the music is slower,” says Hora.

“But normally I’m out of breath after five minutes of dancing.”

Zumba What is it? Touted in the media as the latest fitness craze, it combines merengue, salsa and hip hop into a dance workout.

Fun factor It feels like a wedding reception in Miami with people of all ages dancing in synchronisation to infectious rhythms.

Fitness factor Zumba is designed to be interval training, alternating between cardiovascular and fatburning workouts.

Hip hop What is it? Hip hop dance can refer to different styles depending on the person you’re asking. For purists, it’s the old school locking and popping. For others, it’s what you see on MTV. Fun factor It may be fun to imagine yourself as a b-boy from the streets or an extra on VH1. At the heart of hip hop is the music.

Flamenco What is it? A Spanish dance that comes from the gypsy tradition of Andalucia. It is extremely popular in Japan and Taiwan, and is just starting to take root in Hong Kong.

Fun factor Beginners may be attracted to flamenco for its percussive foot-stomping and swishy skirts. But those who stick with it love it for its intense expressiveness. “Flamenco draws out your emotions,” says Alice Ng, an instructor at Oasis Dance Centre in Wan Chai.

“I became addicted to it; there were times where I could have danced for 20 hours straight.”

Fitness factor Flamenco requires nimble feet for the intricate footwork and a strong back. When performed at full speed, it can make you sweat.

Belly dance What is it? An erotic Middle Eastern dance, in which women with bare midriffs create undulating rolls with their hips, belly and chest.

Fun factor Shimmy your cares away.

Some claim the dance also enhances the sensitivity and intensity of a woman’s sexual pleasure.

Fitness factor It is a low-impact exercise that works on isolation of the ribcage and hips. Making those belly rolls, hip drops and shimmies look controlled requires strength in even the smaller muscles of the abs, hips and gluteals.

WHERE TO GO

Dancing ballet adds grace and reduces fat.

Photo: Reuters

Aerial Arts Academy, Causeway Bay, tel: 2375 8088; www.aerialartsacademy.com Central Dance Studios, Central, tel: 2537 0713; www.danceclassesinhongkong.com Amico Studios, Wan Chai, tel: 2827 9233; www.amico.com.hk Ceroc Hong Kong, various locations, tel: 6695 0084; www.cerochongkong.com Ivailo & Alyona, various locations; www.ivailoalyona.com DanzStage, Tin Hau, tel: 3162 0037; www.danzstage.com.hk Come Dance Studios, Tsim Sha Tsui, tel: 27811465; www.comedance.net Pole Paradise Studio, Sheung Wan, tel: 2543 0198; www.poleparadisestudio.com Oasis Dance Centre, Wan Chai, tel: 2522 6698; www.oasis-dancecentre.com

10 FITNESS Anita Pallenberg (left), and Gram Parsons (right) and his wife, Gretchen, listen to Keith Richards playing guitar in Richards’ villa on the Cote d’Azur, France, in 1971. It seems unlikely Richards would have envisaged his memoir being used as a keep-fit aid. Photo: AFP

PERSONAL BEST

Keith Richards on my treadmill ......................................................

Julia Sweeney healthpost@scmp.com I have found a way to endure a treadmill workout. No, not endure ...

I’ve found a way to look forward to my treadmill workouts.

I don’t want to exercise. I want to read and watch movies. And eat. I like that a lot, too. I also really enjoy drinking alcohol, including some high-calorie cocktails. These desires necessitate I have a regular exercise programme or I will slide into an obese alcoholic lethargy that will surely reduce the years I can do what I want to do – which is to eat, drink, watch movies and read.

I own a treadmill. My treadmill goal is simple: burn 500 calories. To do this, I need to be on the treadmill for one hour; 60 never-ending minutes. And then I have to do it again and again, four or five times a week, every week.

I start walking at a rate of 4.8km/h. After three minutes, I increase the speed by 0.1km/h each minute, so that at 10 minutes I am at a speed of 6.1km/h. I also take the incline from 3.0 to 5.0 during that time. I need this type of extended ramp-up, because I have such a strong aversion to my treadmill that it must be easy-peasy to start. I think of myself as a wild animal that has to be coaxed gently into the captivity of the exercise machine.

When I get to 10 minutes, and I have 50 minutes left, I move my arms around in some way for three minutes – punching forward,

An unlikely running companion punching above my head, flapping my arms like a bird, or pulling them back as if I’m rowing. On the alternate three minutes, I walk with my hands on the bars.

For me, 6.1km/h is just short of running, and I absolutely refuse to run. I hate it so much. I thought it was because I had big, breasts and it hurt just to jog. I would have to hold on to them to run, which made me look ridiculous. I looked as if I was trying to escape from being sexually assaulted by my own hands. In any case, I had a breast reduction, and I still don’t want to run.

Here lies the problem: this regime is really hard and boring.

Hard and boring are terrible attributes for something you must do.

The problem is the mind. The mind does not want to work out. It’s incredibly tedious.

Music helps, but making perfect

workout playlists takes time. I am so pernickety about music that this task can become a black hole that sucks away my day. And because I get bored with the list quickly, I would have to do another list too soon. I don’t want to take the time for that.

So here is my secret: audiobooks.

When I first considered listening to audiobooks, I was snobby about it.

In my opinion, only the blind could listen to audiobooks with dignity. I figured people who listened to audiobooks were those who needed to be read to – like children. I imagined halfwits who listened to romance novels while eating sweets.

But that is all wrong. There are a lot of fantastic audiobooks out there.

There are written masterpieces, with equally excellent performances by narrators. And they have an ingredient music does not have: they are compelling. You want to find out more.

You have to discipline yourself not to listen to the audiobook except when you’re on the treadmill. Then the workouts become something you look forward to.

It is the key. You will find yourself wondering: “What is going to happen next? I better get my butt on that treadmill.”

Yes, there are some lame audiobooks. But here are a few I’ve listened to recently that I loved.

(I download my books from audible.com. I get only unabridged books.) Guardian News & Media

HEAR YE, HEAR YE Life, by Keith Richards and James Fox The secret greatness of this book is Joe Hurley, who narrates 70 per cent of it.

Johnny Depp reads a couple of the first chapters and a couple of the last chapters, and he’s good, but Joe Hurley is great. In fact, Joe Hurley is better at portraying Keith Richards than Keith Richards. (Richards reads the first and last chapter.) This audiobook is 23 hours long. I alternated listening to this with playlists of Rolling Stones songs I love.

John Lennon, the Life, by Philip Norman Another long one, 181⁄2 hours for the first volume and 14 hours for the second. I alternated listening to this with Beatles playlists.

Nothing to Envy, Ordinary Lives in North Korea, by Barbara Demick Excuse me, but I must insist you listen to this book. This is a mandatory one. It’s so well written; beautiful and terribly sad. Demick interviews North Koreans who have escaped and weaves together a narrative that’s astonishing. It’s the best audiobook I’ve listened to in the last year.

Destiny Disrupted: A History of the World Through Islamic Eyes, by Tamim Ansary An engaging history of Islam. Ansary was born in Afghanistan and now lives in San Francisco. He’s a wonderful writer, and it was enlightening and even inspiring to listen to – and he narrates the book himself.

Your Brain at Work, by David Rock This is a brain science and, I guess, a self-help book. Rock takes all the recent brain knowledge and understanding – the parts that are really useful for ordinary people – and presents it as a story, in a play format, which makes it very easy to comprehend and then to remember.

Talent Is Overrated, by Geoff Colvin The basic idea is that there is no such thing as talent; it’s all about focused practice. This book changed the way I parent my daughter, and the way I work.

These books alone add up to 100 hours of listening. That’s 100 x 500 calories = 50,000 calories. That’s a lot of cocktails and beurre blanc. If I hadn’t replaced those burned calories with eaten ones, I would have lost almost 6.8kg right there. That is great value. Plus, I learned a lot while doing it.

WELLBEING 11 FIT & FAB

It’s synch and swim for busy boss ......................................................

Jeanette Wang jeanette.wang@scmp.com

NBA Asia managing director Scott Levy has his sights on the half-Ironman.

Photo: Nora Tam

Despite having a mother who was an aquatics instructor, Scott Levy, 45, could barely swim. So when she died in 2005, the New York native decided to learn as a tribute to her and put a time line to the goal by signing up for a triathlon that year. Since then, the father of two teenage boys has completed many triathlons and will race his first half-Ironman (1.9 kilometre swim, 90.1kilometre cycle, 21.1kilometre run) in the Philippines next month.

“The great thing about triathlons is that you race to beat your own personal best,” says Levy, the senior vice-president and managing director of Hong Kong-based NBA Asia.

“And while I like to be in the first quarter to third of finishers, you won’t see me on the podium any time soon.” With family responsibilities and business travel for nearly half the year, just completing a triathlon is worthy of a medal.

How do you find the time and motivation to train for triathlons?

Not surprisingly, it’s tough. In addition to triathlons, I play basketball and softball regularly. I wake up at 5.30am and train before work. The hardest part is the travel.

I’m on the road about 40 per cent of the time, and the jet lag and wide range of hotel facilities can make it difficult to maintain a routine. I have to be really flexible with my training programmes, and sometimes I go for long stretches without swimming or biking.

Any tips for keeping fit while on the road?

• Dive in. Start exercising as soon as possible upon arrival. If I can get a 45minute workout in – especially a relaxed swim – before going to sleep the day I arrive, I usually sleep better and get on schedule more quickly.

• Eat right. I try to eat seafood, lean meat and lots of fruit and vegetables.

This helps my metabolism adjust and catch up with the rest of my body. I also drink lots of water and carry energy bars so I always have

something healthy when I’m hungry.

Starbucks helps when I’m struggling to get through the day.

• Find friends. Given all the travel I do, I now have friends in many cities who can join me for a run. Having someone to show me the trails and, more importantly, force me to get out of bed, makes the whole process much easier.

• Sleep, drink water and stretch on the plane. I can sleep anywhere. I’m usually a bit behind on sleep, so I often fall asleep before the plane leaves the runway. Upon boarding, I immediately adjust my watch to the landing time zone and then try to sleep as if I were already there. During

the flight, I drink lots of water and get up frequently to stretch. I also use noise-cancelling headphones. All these things make a huge difference.

laughing and within 100 yards you’re covered in mud. I have yet to dive into the range of adventure races here in Asia, but I plan to do so this year.

We hear you excel in muddy, crosscountry races. Any reason?

I’m not sure “excel” is the right word but I love to get off-road and dirty. I don’t like running on pavement for long distances, and Hong Kong offers so many different areas to run offroad. When I was in the US, I regularly competed in a race called the Leatherman’s Loop, which involved long, deep mud pits, river crossings and other tough terrain.

The music is cranked, everyone is

You run races in aid of Fred’s Team (a cancer fund-raising programme) and the Leukaemia & Lymphoma Society.

What inspired you to do so?

Running for a cause makes the whole experience more meaningful. There are so many worthy charities for which to raise funds, and with groups like Team in Training, the support network is great. Also, the opportunity to have a positive impact on the lives of those affected is great motivation during the race.

Which would you rather be: an NBA player or a professional triathlete?

It’s a close call, but probably a basketball player. The creativity and teamwork necessary make basketball such a great game. I’d really enjoy holding the Larry O’Brien Trophy during the Championship parade.

Your wife, Ilene, is a first-degree black belt in Goju karate and trains in Chinese kung fu. Who’d win in a fight?

I’m pleased to say that in nearly 19 years of marriage we’ve never had to test this. However, having been the practice dummy for each new technique my wife has learned over the years, I wouldn’t stand a chance.

THE TASTE TEST FROZEN DINNERS

A convenient, tasty meal if you’re not overly hungry ...............................................

Jeanette Wang jeanette.wang@scmp.com Organic Bistro Savory Turkey HK$69, City’super At first, this looked like an unappetising mess, but I’m glad I gave it a chance – the beans are crunchy, the turkey moist, and the lentil-quinoa pilaf fluffy and flavourful. If only all frozen dinners tasted this good.

Verdict: Don’t judge this by its looks; at 370 calories and 10g fat, it makes for a delicious, nutritious dinner.

Lean Cuisine Salisbury Steak with Macaroni and Cheese HK$46, City’super Salisbury is not steak but minced beef and other mashed-up ingredients shaped to resemble one. This one looks and tastes like economy-class food from a lousy airline.

The mac and cheese is slightly watery, has a fake cheese taste and lacks bite.

Sure it’s lean (260 calories, 8g fat), but you’ll be wanting real food after this.

Verdict: For a quick dinner, I’d have a peanut butter and jelly sandwich instead.

Weight Watchers Wild Salmon & Broccoli Wedge Melt HK$45, City’super It’s ironic they call this a melt, because that’s what the serving tray did when I put it into the oven. The meal is easy on the eyes, nose and taste buds.

It’s smothered in a creamy sauce, and the potato wedges are nice and crisp. The salmon is passable.

Verdict: A tasty dinner, but at only 297 calories and 10.7g fat, you’ll be left hungry.