20110913 health post

YOUR GUIDE TO LIVING WELL

HEALTH POST Acupuncture gains credibility but some remain unconvinced

>PAGE 4

Points of view TRADITIONAL MEDICINE SAVED MY SON >PAGE 6

EAT ON THE RUN: HEARTY HIKES >PAGE 10

TUESDAY, SEPTEMBER 13, 2011

2 NEWS HEALTH BITES

ASK THE DOCTORS DR CHAN LUK-YAU

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

Jeanette Wang jeanette.wang@scmp.com

Q: I have a 25-year-old son who has not been to the dentist since he was 14. His teeth are all bad, he is in absolute agony with toothaches, has pains going down his neck and is in tears. He has a phobia of going to the dentist. He takes paracetamol and ibuprofen with little effect. What can he do?

Fast track to immunity Expectant mothers who eat fish, walnut oil, flaxseed and other foods rich in a certain group of polyunsaturated fatty acids called n-3PUFA may reduce the risk of their children developing allergies in the future. The research, done on piglets and published in The Journal of Physiology, found that such a diet caused the newborn’s gut to become more permeable. Bacteria and new substances could therefore pass through the lining of the gut into the bloodstream more easily, triggering the baby’s immune response and the production of antibodies. “The end result is that the baby’s immune system may develop and mature faster – leading to better immune function and less likelihood of suffering allergies,” says Dr Gaelle Boudry, of the INRA research institute in Rennes, France.

A fest of fitness Head south on Thursday and Friday from 9am to 6pm for the two-day Aberdeen Fest and pick up some discounts or even freebies. Among the 12 participating outlets are three fitness centres – Flex Studio (2813 2212), Hong Kong Bootcamp and Elite Personal Training (both at 2552 9925). Flex, for one, is offering free health food samples, free postural pointers from qualified therapists, and special deals on group class packages, such as pilates. See www.flexhk.com for details on the festival.

Gear up for autumn Give autumn an early welcome by revamping your workout wardrobe.

For the upcoming season, adidas has launched new collections for men and women in a kaleidoscope of bright colours and designs.

Among the highlights are this hooded jacket (HK$499) and the Fluid Trainer (HK$599), a lightweight and flexible shoe that’s designed to allow the foot to move more naturally. There’s nothing like some new gear to inject some motivation into an exercise regime. www.adidas.com.hk

Two for the road a healthy motto When it comes to drinks, pacing yourself could be good for your heart.

Scientists have found that having two drinks daily decreased atherosclerosis in mice that were fed a high-fat Western diet, while seven drinks a day, two days a week, increased development of the disease. Atherosclerosis, the accumulation of plaque in the arteries, can lead to a heart attack or stroke. In moderately drinking mice, levels of LDL (or “bad”) cholesterol fell 40 per cent, but rose 20 per cent in binge-drinking mice, compared with noalcohol controls. Plaque volume and the number of inflammation-immune cells also dropped in the moderate drinkers but increased in bingers, which also gained more weight. The study was published in the journal Atherosclerosis.

A: My heart goes out to people like your son who are dentophobic and suffer unnecessarily. Dentists are trained to be more sympathetic nowadays. We are dental patients ourselves. Most of us know how our patients feel.

Many dental offices have a policy to welcome nervous new patients in a nonclinical area, like a VIP room. Patients can voice their concerns in a comfortable and non-threatening environment. When good rapport has developed, the dentist can then invite the patient into a clinical area to carry out the examination. Radiographs can also be taken at this point to gather more information. All of these are carried out painlessly and rapidly. We then can enter some meaningful discussion of options available.

There are a few simple and effective ways to help phobic patients to have dental treatment done. Music is often used to relax the patients. A patient can bring their own iPod to listen to their favourite songs and music to help them relax in the dental chair.

An oral sedative can be prescribed to prepare the patient the night before treatment. At the clinic, nitrous oxide (laughing gas) can also be used to help the patient to relax and control any pain that may arise during dental procedures.

In addition, local anaesthetic will be used to numb the operative areas so that the dentist can carry out the treatment seamlessly.

For very nervous patients, the dentist can use intravenous sedation, where you will remain conscious but be in a state of deep relaxation. That time will appear to pass very quickly, and you won’t recall much of what happened.

I am sure most dentists will do everything they can to ease your son’s fear and complete the necessary treatment to get him out of pain and restore dental health. Your son will also be pleased to know he can be free from painkillers shortly.

Dr Eric Chan Luk-yau, BDS (Liverpool U), MFGDP (Britain), is a Senior Dentist at Star Dental Alliance

APP OF THE WEEK

Remedies at your fingertips that get straight to the point ......................................................

Katie McGregor healthpost@scmp.com Acupressure: Treat Yourself US$1.99, iPad and iPhone Rating 9/10 It was 9pm after a long day at work and a humid five-kilometre predinner run. I should have been exhausted, but was unusually alert as I wrote this review.

Ten minutes earlier, guided by this app, I used sustained pressure on the HT-7 Shenmen points on both wrists for a minute or so, applied a gentle pressure on the PC-6 Neiguan point on my forearms, and then rubbed away at another two pressure points on my forehead.

The result was a wonderful clarity.

The app provides a very long directory of ailments and conditions with diagrams and notes about the recommended acupressure points for treatment. The list includes familiar cures for seasickness and headaches but also for a sudden cardiac arrest (the author does suggest that the first priority is always to apply external cardiac massage and mouth-to-mouth resuscitation.

Only if there is a third person present, then one might consider acupressure massage).

Despite containing 90 point combinations, some come up again and again. I cross-referenced with online resources and there are indeed some power acupressure points. One is the PC-6 Neiguan,

which is well known for treating seasickness – for example, seasickness bracelets that press on this point in the mid-forearm.

I have now used this app for two remedies – the first to successfully treat my sister-in-law’s seasickness.

Even if you’re an acupressure sceptic, at only US$1.99 and with the huge range of possible remedies including smoking cessation, it is worth a try. > 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

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

Eileen Aung-Thwin healthpost@scmp.com Wilson Lam, 69, doesn’t like crab dishes much. His daughter does, however, so Lam tried to rustle up a crab dinner for her one evening. But one crafty crustacean managed to escape his clutches to scuttle across the kitchen floor.

Lam (name changed for patient confidentiality reasons) caught the creature, which fought claw and pincer for its life, pinching Lam’s left hand. While the crab ended up on the dinner table, its parting snip would cost Lam one of his limbs and very nearly his life.

Several days later, Lam felt very unwell. He was running a 40degree-Celsius fever and had an excruciating pain in his left calf. He was taken to hospital where doctors found a red patch on his calf, which did not seem to warrant the degree of pain he was feeling.

Doctors noted from his records that Lam had multiple health conditions, including alpha

Within an hour of Lam’s admission to hospital, the red patch had spread to his whole leg.

His kidneys also started failing thalassemia haemoglobin H disease – a genetic condition that results in fewer than normal red blood cells, which can cause severe anaemia and a vulnerability to infections.

Doctors found out about Lam’s brush with the crustacean. Then it clicked: Lam had the flesh-eating disease, necrotising fasciitis – a possibly fatal emergency that could claim his life in a day.

Twelve cases of the disease were reported in Hong Kong in 2005, three in 2006 and 11 in 2007.

Although the bacteria causing the condition do not actually eat the flesh, toxins and enzymes are released that cause the muscles, skin and fascia – the sheath of tissue covering muscle – to die rapidly.

Seafood and seawater are known carriers of bacteria that can result in necrotising fasciitis. Lam’s symptoms, susceptibility to infections and exposure to a known source of flesh-eating bacteria helped doctors nail the diagnosis.

The anomaly was that necrotising fasciitis usually occurs over the site of the trauma – in Lam’s case, its entry point was the wound on his left hand but the infection was found in his leg instead.

Doctors had to work fast to save Lam. Dr Vincent Hau, from the department of orthopaedics and traumatology in Caritas Medical Centre, was called to the case.

Although Lam was given broadspectrum antibiotics immediately, he needed surgery urgently to remove the dead tissue and hopefully save his leg. But the bacteria in the leg was very aggressive – within an hour of Lam’s admission to hospital, the red patch had spread to his whole leg. His kidneys also started failing.

During surgery, Hau found fluid covering the connective tissue of Lam’s leg. The muscle beneath – from below the knee to ankle – was dead. The damage was so extensive that Hau had no choice but to amputate the limb from below the knee.

Still in serious condition, Lam was moved to the intensive care unit. His blood pressure was abnormally low (hypotension) with a very high heart rate of more than 100 beats per minute. He also needed to be placed on a ventilator.

Doctors continued to pump him with antibiotics while his wound lay open for doctors to monitor more closely. In the event the infection recurred, it would also make it easier for doctors to excise any affected tissue. On the third day, his condition finally turned for the better.

Blood tests and wound swabs showed that the bacteria Vibrio vulnificus was the culprit. It is often found in warm coastal waters, and hence, is common in the waters off Hong Kong in summer. Of the same genus of bacteria associated with cholera, Vibrio vulnificus is also frequently found in raw oysters, crustaceans and shellfish.

Thankfully, Lam’s wound stayed clean, and after four weeks, doctors were confident that the bacteria had been arrested and decided to close the wound.

Lam recovered well and was fitted with a prosthetic leg and went through rehabilitation.

Hau says that Lam’s case was exceedingly rare – a search of medical literature failed to yield any other examples of necrotising fasciitis occurring in a location away from the wound.

He adds that aside from wound infections, Vibrio vulnificus can also enter the body through ingestion and cause septicaemia (blood poisoning) and gastroenteritis.

People with chronic conditions are more vulnerable to Vibrio vulnificus infections.

Hence, Hau advises everyone, especially those with existing health conditions, to exercise caution.

“Wear gloves when handling raw seafood,” he says. “If you do have an open wound that is exposed to seafood or seawater, make sure you clean the wound thoroughly and watch out for any subsequent fever or other symptoms.”

Illustration: Angela Ho

Wrong side of the claw

4 COVER STORY

Pains and needles

COVER STORY 5

Doubts remain about the efficacy of acupuncture even after reams of research. But try telling that to the millions who have found relief in the ancient remedy, writes Eileen Aung-Thwin

W

hen Kenny Kon, 43, suffered sciatica in his left leg, he first turned to non-steroidal antiinflammatory drugs and then to chiropractic treatments to relieve the pain, but neither helped.

The pain lingered and made it especially uncomfortable to sit through his MBA classes. At a relative’s suggestion, Kon turned to traditional Chinese medicine for help. The TCM practitioner recommended acupuncture and inserted needles in Kon’s calf and at other points along his leg.

“Once he took the needles out, I felt wonderful,” Kon says.

“After that one session, the pain has never come back.”

Kon’s experience is one shared by a growing number of users of acupuncture worldwide despite controversial – and conflicting – scientific evidence about its efficacy.

In the United States alone, a survey in 2007 found, 3.1 million adults reported using acupuncture in the previous 12 months, compared with 2.1 million in 2002.

In Europe in the 1990s, between 12 per cent and 21 per cent of the population in various countries reported using acupuncture.

Acupuncture – or needling – is one of the best-known components of TCM. This ancient medical system teaches that one’s qi, or life force, needs to flow freely to all parts of the body to sustain health. If qi stagnates at a particular point, illness or pain occurs.

To unblock qi and restore health, acupuncture uses fine needles to stimulate specific locations – called acupoints – on the body. There are more than 1,000 acupoints that acupuncturists use to treat a wide range of ailments, including boneand muscle-related pain, allergies, fatigue, depression, digestive disorders, infertility and insomnia.

There are different methods of acupuncture – some use only needles, some run a small electric current through the needles, and others concentrate on the acupoints in the ear or the hand.

In addition to the Chinese system of acupuncture, the Koreans and Japanese have their variations of the therapy. In Chinese medicine, acupuncture is often used with moxibustion, in which a tight bundle of herbs is burned over the needles or acupoints.

It is widely believed that American interest in acupuncture took off after a journalist from The New York Times, James Reston, wrote about how acupuncture eased his discomfort after an appendectomy in 1971. Europe’s history with acupuncture, however, dates back to the 1600s.

In recent decades, the Western medical community has conducted reams of research into this ancient therapy. But the research findings are as mixed as the types of reactions that acupuncture seems to elicit.

Advocates hail acupuncture as a safe, gentle and effective alternative to drugs or surgery, producing results where allopathic medicine fails. Detractors slam it as a sham remedy built on astrology or superstition. On one hand, the World Health Organisation recognises acupuncture as an effective treatment for a list of 44 conditions – including sciatica, headaches, lower back pain, knee pain, depression and allergic rhinitis – and to relieve side effects of chemotherapy and radiotherapy.

Yet a review in the New England Journal of Medicine last year of acupuncture research concluded that “real acupuncture treatments were no more effective than sham acupuncture treatments”.

Recently, however, a Hong Kongbased study by researchers from Columbia University in New York and the University of Hong Kong explained scientifically – for the first time – the therapeutic effects of acupuncture.

From tests first done on rats and rabbits, and then on 30 HKU student volunteers, the team found that

Acupuncture is a skill.

The chance of success with acupuncture increases when you are treated by a skilled acupuncturist ACUPUNCTURIST CHEW SAY YEOW

acupuncture worked most effectively when the needle was on the acupoint, but was still effective, to a slighter degree, if it was off the acupoint.

They said that when a needle, oscillating mildly, pierced tissue, it sent slow-moving acoustic waves into the muscles that triggered calcium flow. When the calcium interacted with white blood cells, it produced endorphins, which mitigated pain, migraines, hot flushes, nausea and other illnesses.

The study was published in the European Journal of Physiology in June after eight years of research.

Associate professor Zhang Shiping, of Baptist University’s School of Chinese Medicine, says there are generally two types of research – benchtop research and

clinical trials. Bench-top research looks at how acupuncture works and the biological effects that needling elicits in the body.

For example, US researchers from the University of Rochester Medical Centre, Boston University School of Medicine and the National Institutes of Health found that acupuncture increases the body’s production of a natural painkiller called adenosine by 24 times, and the levels remained high for an hour after treatment. Mice with both inflammatory and neuropathic pain experienced relief after acupuncture raised their adenosine levels.

Clinical research, on the other hand, investigates how effective acupuncture is in treating conditions such as migraine, fibromyalgia, lower back pain and so on. While bench-top research shows that acupuncture does stimulate a biological response in the body, it is in the clinical trials that controversial findings often result.

Clinical trials investigating the efficacy of acupuncture now use the same high standards of evaluation as those used in drug testing. These single- or double-blind, randomised, controlled trials are designed such that the administrators and/or the randomly assigned subjects are unaware of whether they are in the experimental, or the placebo, or alternative treatment group.

Under these trial conditions, acupuncture does not appear to produce consistent results. The problem, however, Zhang says, may lie not with acupuncture but with the design of the clinical trials.

The allopathic medical community expects investigative clinical trials to administer the medical drug or therapy in a standardised manner to all subjects for a proper evaluation of the therapy’s efficacy.

Hence, researchers will usually pick several acupuncture points that relate to the condition being treated, apply needles and then observe the effects, Zhang says.

But these findings are not necessarily meaningful beyond the trials, because the conditions of the trial are not true to clinical practice.

In practice, TCM practitioners are likely to use a combination of therapy modalities. For instance, TCM holds that a frozen shoulder is caused by a cold pathogen, which must be expelled using heat.

Infrared heat or moxibustion is often used to do so, in addition to acupuncture. Hence, if acupuncture is used in isolation during a clinical trial, then the healing effect may be diminished.

However, in a clinical trial, other treatment modalities are excluded,

because the researchers want to focus on the effects of acupuncture alone, and standardisation requires that variables presented by other modalities be excluded.

Moreover, such strict standardisations fail to recognise TCM’s individualistic approach to therapy, says Chew Say Yeow, president of the Singapore Acupuncture Association.

In TCM, two people presenting with the same set of symptoms may actually have different root problems, which must be treated differently, Chew says. In addition, he questions the skill of the acupuncturists who administer the therapy in the trials.

“Acupuncture is a form of manipulation, a skill,” Chew says.

“Much like how you have different skill levels of doctors and surgeons in Western medicine, the chance of success with acupuncture also increases when you are treated by a skilled acupuncturist.”

Chew explains that acupuncture is more complex than merely pressing a standard set of acupoints for standard results.

“Administering acupuncture is similar to prescribing herbal medications – you need to know which groups of acupoints work well together to treat individual conditions. Some ailments can be treated by stimulating a single acupoint; others need specific combinations of acupoints,” he says.

“In addition, you must look at the individual patient’s unique combination of body constitution and symptoms and be able to address them holistically.”

Moreover, he says, the duration and strength of the stimulation by the needles can create varying effects – strong and continuous stimulation with needles will have a purging effect, whereas mild stimulation helps to strengthen and tonify the body.

Zhang suggests that it may be more effective to evaluate acupuncture’s efficacy using pragmatic clinical research, which looks at how effective a therapy is when compared to no therapy or another type of treatment. In such trials, acupuncture is generally shown to create consistently favourable results.

But some researchers take issue with pragmatic trials because they show practical success but do not actually determine efficacy.

Users, however, are not waiting for Western science’s validation of acupuncture. Finding the therapy generally safe and with few side effects, people such as Kon are willing to brave the needles for a shot at relief. healthpost@scmp.com

6 HEALTH

TRADITIONAL CHINESE MEDICINE

How I became a brew believer ......................................................

Eileen Aung-Thwin healthpost@scmp.com It started like one of his many colds.

DS (short for darling son), my almost-four-year-old boy, had a stuffy nose that also leaked like a broken tap.

Our medicine cabinet was already fully stocked with a kaleidoscope of coloured syrups that doctors claimed would unclog and dry up his nose. Most of the time, none of them really worked. We usually had to hunker down and wait for the cold virus to run its course in two weeks or so.

DS’ colds often seemed to last longer than I imagined other children’s did. He also seemed to catch them faster than you can say “germy preschool”. His preschool teacher had the gall to complain that DS was not in school enough.

While the Tiger Mum in me toyed with the idea of pulling him out of preschool altogether, my laidback husband, DH (darling husband), shrugged off each cold as another step on the long road to building childhood immunities.

However, this bout of what we thought was a regular cold turned out to be a protracted battle against an allergy flare that lasted nine months. But it also took us down a surprising path to recovering my son’s health.

DS quickly developed a fever and greenish mucus, which prompted a trip to the paediatrician, who prescribed a week’s course of antibiotics for a diagnosis of sinusitis. The fever went away, but the sniffles and stuffed nose did not.

A month later, the fever and coloured mucus returned. This time, the paediatrician ordered two

weeks’ worth of antibiotics. She said the double dose should ensure all the bacteria in his sinuses were good and dead. Worried that all the good bacteria in his gut would be, too, I asked for an accompanying prescription of probiotics.

The paediatrician also suspected that DS had allergies that were compounding the sinusitis, so she gave him allergy medicines such as Zyrtec and Singulair.

Again, while the fever subsided, there was little improvement to his other symptoms. Worse, he started waking up in the middle of the night to vomit copious amounts of clear or white phlegm. We had a little pail on standby next to his bed every night.

DS also snored – loudly. Even from the living room, I could hear him struggling with each breath. The nightly vomiting and battle for breath took a toll. DS had dark circles under his eyes and was often sleepy in the daytime. Even his daytime breathing was noisy, and he could only breathe through his mouth.

By now, DS’ symptoms had lasted almost two months and he had burned through three bottles of antibiotics. Someone recommended that he see a paediatric allergist.

Despite having been told by several doctors in the past that allergy testing was a painfully expensive and pointless exercise, we were driven by desperation to give even the painfully expensive (it was) and pointless (to some extent) a try.

The allergist said DS’ condition was too bad for him to be taken off the allergy medicines for a skin-prick test to be done. DS needed a blood test. One heartbreakingly slow and painful blood-drawing session later, we found out that DS was allergic to house dust mites.

He was given more allergy medication and steroidal nasal sprays. We even bought a rather expensive dust mite killing spray so I could carpet-bomb beds and sofas with it.

Over the next seven months, DS had to be given three more bottles of antibiotics (I heard another version of the “good and dead” spiel), countless bottles of Zyrtec, sleeves upon sleeves of Singulair pills and many bottles of nasal sprays. While the mucus dried up and the night vomiting stopped, DS still couldn’t breathe through his nose or sleep without snoring.

Were we really going to gamble our child’s health on a relatively uncontrolled industry?

The allergist even suggested removing DS’ adenoids and tonsils so he could breathe better. But DH and I baulked at the idea of putting our child through surgery. We wanted to exhaust all possible options before cutting anything out of him.

At about this time, I had finished writing an article for Health Post about traditional Chinese medicine.

Although I had pooh-poohed the idea of TCM as a young adult, age (and my research for the article) prompted me to keep an open mind and give it a try. After all, allopathic medicine had given us discouraging

results. I hoped TCM would be as safe, gentle, effective and free of side effects as its advocates said.

But DH and I also had our reservations about TCM – we’d read our share about scandals involving tainted, fake or plain dangerous Chinese herbs. Were we really going to gamble our child’s health on a relatively uncontrolled industry?

We decided that we’d pay a little more and seek out a wellestablished TCM brand to have some assurance of quality and safety.

I took DS to a TCM clinic an hour’s drive away that claimed to be child-friendly. The practitioner spoke only Putonghua and sent us away with barely two words and a week’s worth of pulverised herbs to be mixed in water.

DS surprised me by chugging the earthy-smelling herbal brew with little complaint. I guess the heaping spoonful of honey I mixed in there helped. There was little change to his condition, however.

Unwilling to give up on TCM so soon, I tried another clinic close to my home. This TCM practitioner was much friendlier and said DS had a lot of “hardened mucus” in his nasal cavity that needed to be drained. So she gave him another week’s worth of pulverised herbs conveniently apportioned into little sachets. This time, the herbs did seem to have the intended effect.

After three days, thin, watery mucus started to flow.

Unfortunately, the mucus soon turned green. DH’s first reaction was we should head back to the paediatrician for antibiotics, but I resisted. Six bottles of antibiotics in six months was quite enough of an assault on my son. I took DS back to the TCM clinic.

This time, a different practitioner was on duty. A portly old man who spoke a good smattering of English, he inspected DS’ nostrils, took his pulse on both wrists, inspected his tongue and proceeded to give me a 20-minute lecture on the foods to feed him and to avoid.

Basically, I had to give him a wide variety of food and avoid chicken, wheat noodles, fried foods, fast foods and other “heaty” nosh for the time being. I groaned inwardly, because almost all of DS’ favourite foods were on the banned list.

Still, mealtime struggles were better than listening to DS snore strenuously.

The practitioner also gave DS a new combination of pulverised herbs to be taken three times a day.

Two days later, DS’ greenish mucus turned clear. By the end of the week, all of his symptoms had disappeared. He no longer snored, sniffled or breathed through his mouth.

After nine fretful and sometimes heartbreaking months, my son was finally symptom-free. Some nights, I still stand outside his door marvelling at the sound of silence as he sleeps.

I know it sounds incredible. I would hardly have believed it myself if I hadn’t witnessed DS’ amazing recovery.

These days, when DS falls sick, I turn to TCM first, not last. I also pay extra care to the food that he eats, as I have come to accept that the qualities of food extend beyond their basic nutritional value.

I have certainly not ruled out allopathic medicine. But for mild ailments, I now rely on TCM’s holistic and natural approach to support my son’s health.

HEALTH 7 TREATMENT

When doctors become patients ......................................................

Eric D. Manheimer

Frank Sinatra’s greatest hits album, filtered through the jet engine noise of the Varian linear accelerator, was not what I felt like hearing at 9am. I made a mental note to bring a Steely Dan CD for my next appointment.

I was strapped to a hard metal sheet, and the technician had just bolted my head down using a black mask that had been heat-moulded to the contours of my face. The sheet and I would slide first up and then back in an overhead arc that would send high-energy electrons into my head and neck from computerised data sets outlining my throat cancer and its spread into adjacent lymph nodes.

I wasn’t a doctor any more; I was a patient.

That was almost three years ago.

This spring, the Archives of Internal Medicine published a study showing that doctors might recommend different treatments for their patients than for themselves. They were far more likely to prescribe for patients a potentially life-saving treatment with severe side effects than they were to pick that treatment for themselves.

Understandably, people are worried that this means doctors know something they’re not telling their patients. But my own experience with illness taught me a simpler truth: when it comes to their own health, doctors are as irrational as everyone else.

I had squamous-cell carcinoma of the throat, a pea-size lesion first, then the cancer spread to my lymph nodes. I knew that this was a bad actor; I’d seen the disease and its consequences many times while wearing a white coat, a stethoscope dangling from my neck, at a patient’s bedside.

At the beginning, I knew intellectually what was in store for me. I allowed myself to be a patient, to trust my doctors and let them lead me through the treatments and complications and side effects that rolled out with alarming regularity. I submitted to a brutal treatment regimen that had not changed in more than 40 years.

Two thousand units of radiation a day for 35 days, with high doses of platinum chemotherapy, followed, a year later, by a dissection of the right side of my neck to remove the lymph nodes in which the cancer had reappeared.

I soon realised I had no idea what kind of rabbit hole I had fallen into.

For my doctors, it was all about the numbers, the staging of my cancer, my loss of weight and strength. For me, too, it was about the numbers: the six feedings I

My experience has taught me that when it comes to their own health, doctors are as irrational as everyone else pushed through the syringe into the plastic tube in my stomach every day; the number of steps I could take by myself; how many hours before I could grind up the pill that let me slip into unconsciousness.

But it was also about my world progressively shrinking to a small, sterile, asteroidal universe between the interminable nausea and the chemobrain that left my head empty and feverish, between survival and death.

Survival was a percentage, and not a horrible one – 75 per cent if I completed the treatment regimen, according to my doctors. But more and more I found myself thinking about what would happen if I was in that 25 per cent. If I completed the regimen and the tumour came back, there were no other treatment options. It was morphine and palliative care. I was 58 years old. Death was a 100 per cent certainty, eventually. So did it matter?

During one particularly desperate hospitalisation, after receiving blood transfusions and a drug to stimulate my white cells, I decided that I had had enough. I refused further radiation and chemotherapy. I lay in my bed and watched the events around me – the distress of my family, the helplessness of my doctors – without anxiety, comfortable that I had made the correct decision.

My doctors couldn’t override it or persuade me to change my mind, but, luckily, my wife, Diana, could and did. From my mental cocoon in the hospital bed, I could sense Diana at my side. “You’re going to finish the treatment,” she said softly. I did not have the energy, or perhaps the will, to disagree. She wheeled me down herself to finish my radiation treatments in the basement of the hospital.

My dreams of dying were not the products of anxious moments of terror. The life force had simply slipped away and made me ready to die. It had also rendered me incapable of making the right decision for myself. My disease was treatable and the odds were favourable. My doctors were professional and gentle but ultimately could not decide for me.

When neither doctor nor patient can make the right decision, it is

vital to have a caring family – though even here the legal and ethical issues are complicated.

Next week it will be three years since I first noticed the hoarseness that was a symptom of cancer, and I am back to work and a busy life. But my illness has changed me profoundly as a physician. Even having lived through this illness, I’m not sure that I would be any better prepared if I had to relive it again. No amount of doctoring can prepare you for being a patient.

If anything, it’s that recognition of vulnerability as well as expertise that makes me a better doctor today. The New York Times Eric D. Manheimer, the medical director of Bellevue Hospital Centre, is the author of the forthcoming memoir Twelve Patients.

“My illness has changed me profoundly as a physician.” Photo: Corbis

8 HEALTH WELL WOMAN

Regaining control of a wilful bladder ......................................................

Margaret Wee healthpost@scmp.com Laughing comes spontaneously for most people. But for 59-year old retiree housewife Queenie Lau, it’s a cause for embarrassment – she leaks urine when she laughs.

Lau has urinary incontinence, which she thinks was brought on by her habit of holding her bladder for long periods.

She is not alone. A survey commissioned by the Women’s Health Alliance of Hong Kong Primary Care Foundation earlier this year found that one in three women surveyed had experienced urinary incontinence. Like Lau, 80 per cent of respondents said that the problem occurred when they sneezed or laughed out loud.

Incontinence can happen to anyone, though it is much less prevalent in men, and is highly treatable According to the Hong Kong Continence Society, up to 70 per cent of women with incontinence suffer in silence for reasons such as embarrassment, belief that the condition will go away eventually, or the misconception that incontinence is normal for women, the sick and the elderly. In fact, incontinence can happen to anyone – although it is much less prevalent in men – and is highly treatable with success rates of up to 60 per cent.

Simply put, a person with the condition leaks urine involuntarily.

“We don’t need fancy tests to confirm incontinence. As long as the patient complains that urine comes out involuntarily through the urethra, she is having urinary incontinence,” says Dr Ida Mah of the Hong Kong Urology Clinic.

The average adult bladder can hold up to 550ml of urine and relies on its sphincter and detrusor muscles to fill and store urine. The sphincter muscle controls the flow

of urine out of the body, while the detrusor muscle in the bladder wall must stay relaxed to allow the bladder to expand to accommodate urine.

Most people will feel the urge to pee when there is about 200ml of urine in the bladder. Those with incontinence, however, may leak urine at any time. In patients with stress incontinence, this is due to weaknesses in the sphincter muscles and the pelvic muscles that support the bladder and urethra.

Urine may leak out during activities that place pressure on the abdominal area, such as laughing, coughing, sneezing or running.

“The underlying cause is usually pelvic floor laxity associated with childbirth,” Mah says. “Women who have repeated vaginal deliveries especially with big babies are at increased risk. Obesity is also a risk factor.”

The other main type of incontinence is urge incontinence, which occurs as a result of involuntary bladder muscle contractions stemming from neurological problems or bladder irritation. “The patient will complain of frequent urination and urgency of urination. When she feels the need to go, she has to go immediately. If she tries to hold her bladder, she may leak urine before she manages to reach the toilet,” says Mah. Incontinence is treated according to its type. For stress incontinence, prevention is better than cure. Mah advises all women to practise pelvic floor exercises called Kegels soon after delivery, while those who are already experiencing incontinence can do so under the guidance of a continence nurse.

Surgery is an option for patients who do not see an improvement in their condition despite doing pelvic floor exercises. The most common is the tension-free vaginal tape (TVT) procedure, where a mesh tape is placed under the urethra to act as a sling to support it. The tape is inserted through small incisions in the vaginal wall and abdomen, and does not require stitches to keep it in place. “TVT is a minimally invasive surgery with a success rate of more than 90 per cent,” Mah says. “The patient only needs to stay in hospital for a day or two and can resume her daily activities soon after discharge.”

For those with urge incontinence, medication is the mainstay of treatment. Drugs are prescribed alone or in combination with others to relax the bladder muscles and prevent involuntary bladder contractions. In severe cases, botox may be injected into the bladder muscles to paralyse them.

However, the effect lasts for less than a year in most patients.

Bladder retraining under the supervision of a continence nurse may also help. Patients will be taught to develop a schedule of times when they should try to urinate, and consciously try to delay urination between these times. The voiding interval is then gradually increased, until the patient is able to control urination and limit it to once every three to four hours.

Lifestyle changes play as big a role as drugs, surgery and Kegels in managing incontinence. Avoid alcohol and coffee as they have a diuretic effect, leading to increased urine production. Losing those extra pounds can also help, as the added weight places more pressure on the abdomen. And if you’re a smoker, kick the habit. Smoking is a known bladder irritant, while the chronic smoker’s cough can damage pelvic floor muscles. With a few smart lifestyle choices, and a good urologist, you’ll soon regain control of your bladder.

HOW TO DO KEGELS Kegel exercises – named after its inventor Dr Arnold Kegel, the late assistant professor of gynaecology at the University of Southern California School of Medicine – strengthen the pelvic floor muscles, which support the uterus, bladder and bowel. You can do them discreetly at any time, even when you’re pregnant. Here’s how: 1. Find the right muscles An easy way to isolate the muscles is to try to stop the flow of urine when you’re in the toilet. Once you’ve succeeded, relax and empty your bladder completely. Do not make it a habit of starting and stopping your urine stream, as this can weaken the muscles and cause urinary tract infection due to retained urine in the bladder.

2. Repeat While seated or lying down, contract your pelvic floor muscles, hold for five seconds, then relax for five seconds. Repeat this for up to five times, then try to increase the intervals to 10 seconds each. Remember to breathe as you do this, and keep your abdominal, thigh and buttock muscles relaxed.

3. Make it a habit Aim for at least three sets of 10 repetitions daily, and do it at fixed times throughout the day; for example, during every commercial break when you watch television.

DIET 9 NUTRITION KIWI FRUIT

New Zealand’s berry of plenty ......................................................

Mathew Scott healthpost@scmp.com It’s no coincidence that the region that surrounds the New Zealand city of Mount Maunganui is known as the Bay of Plenty.

Nature has smiled on this land, from its rolling hills, through to its sweeping valleys that reach out to a wide blue ocean. Settlers who reached this far-off destination – both Maori and Western – could hardly believe their luck.

Farms first sprouted up around the Bay of Plenty in the 1870s but it wasn’t until the 1920s that the locals hit on the quirky little product that would make the region famous.

The “Chinese gooseberry” (Actinidia deliciosa or yang tao) first arrived in New Zealand thanks to a curious school teacher named Mary Isabel Fraser, who visited Yichang in China’s Hubei province in the early 1900s and tucked away seeds in her luggage after taking a fancy to the fruit. Once the Chinese gooseberry vine had been planted

in the country’s North island, it thrived – and nowhere more so than in the Bay of Plenty.

Local farmer Hayward Wright set his mind to developing a local variety of the Chinese gooseberry, and by the late 1920s the “Hayward Kiwifruit” had hit market stalls, taking its name from the farmer and from the flightless bird that is New Zealand’s national emblem.

“These days 80 per cent of New Zealand’s kiwi fruit production comes from the Bay of Plenty,” says Matt Crawford, government relations manager at Zespri, New Zealand’s largest kiwi fruit marketing body, based in Mount Maunganui. “Farmers here found the perfect microclimate for the fruit with rainfall all year round, volcanic soil and decent blasts of sunshine, too.”

The little fruit packs a powerful dietary punch. Kiwi fruit contains the natural enzyme actinidin, which helps break down proteins for easier digestion, as well as high levels of vitamin C and iron.

“Quite simply, though, it tastes

good,” says Crawford. “But the health and nutritional aspect of the fruit is one of its real advantages. Its vitamin C, potassium, fibre and digestive properties have helped it be recognised as what people today call a ‘super fruit’. It might be small but it really holds its own.”

The preferred method of consumption, New Zealanders say, is just a simple “cut and scoop” but kiwi fruit has also found uses as a garnish (on traditional pavlovas, for example) as well as an incredibly effective meat tenderiser.

Kiwi fruit consumption has grown dramatically in the past two decades – with global production doubling to about 1.3 million tonnes produced annually. Part of that success has been due to the emergence of the Zespri Gold variety on the market, a new strain developed 14 years ago which comes with yellow flesh and a sweeter taste than the earlier green Hayward.

“The gold is a sweet tasting fruit which has really found a home in the Asian market and with the Asian

palate,” says Crawford. “We continue to search for new varieties with about 100,000 different plants in the ground at any one time trying to find the next breakthrough or the next star performer.

“It’s important that they have the right attributes, including nutritional attributes. This year we have three new varieties out there – two golds and a green – so

it’s a matter of constant development.”

Zespri alone sends more than 100 million trays of kiwi fruit to 60 countries annually, with Hong Kong and China accounting for about 10 per cent of sales. “China and Hong Kong are big markets for the fruit,” says Crawford. “In 2004 we sent 400,000 trays in China; last year we sent about 10 million.”

New Zealand farmers account for 30 per cent of the global trade in kiwi fruit in terms of volume, but 70 per cent of the value – due to the consistent quality of their produce.

China remains the world’s largest producer of yang tao but almost all the produce grown is consumed domestically. But such has been the rise in demand that China is now supplementing its own crop with imports from the world’s other kiwi fruit growing nations – Italy, Chile and most certainly New Zealand.

The spread of the major kiwi fruit-growing nations across the southern and northern hemispheres also means the fruit is these days available year round.

RECIPE FOR HEALTH KIWI SALAD

Green and gold – now that’s a winning combination ......................................................

Mathew Scott healthpost@scmp.com Brown rice, roasted nuts and kiwi fruit salad This salad is great on its own or served with grilled chicken or fish.

Serves 4-6 Ready in 25 minutes

A meal on its own or great served with grilled chicken or fish. Photo: Zespri

For the salad ¼ cup pumpkin seeds, toasted ¼ cup sunflower seeds, toasted ¼ cup pine nuts, toasted ¼ cup almonds, toasted

¼ cup pistachios, toasted 2 cups cooked brown rice (or couscous or quinoa) 1 medium green kiwi fruit (may be dried) 1 medium gold kiwi fruit (may be dried) Mesclun salad greens, or cos lettuce For the vinaigrette 2/3 cup light olive oil 1/3 cup white wine vinegar 1½ tsp whole grain mustard 2 gold kiwi fruit, peeled and diced Preheat oven to 150 degrees Celsius. Spread seeds and nuts on

baking tray and bake for 10 minutes. Alternatively, brown them in a non-stick frying pan for four to six minutes. Leave to cool.

Cook brown rice as per package instructions.

Make the vinaigrette by combining all ingredients in a bowl and blending until the mustard has emulsified.

In a salad bowl toss the brown rice, toasted seeds and nuts with the green and gold kiwi fruit and mesclun greens. Drizzle vinaigrette over salad.

Recipe courtesy of Zespri

10 FITNESS

The Dragon’s Back section of the Hong Kong Trail offers fabulous views of Shek O. Photo: Edward Wong

SWEAT EAT ON THE RUN

Five great ways to walk off that hearty breakfast ......................................................

Pete Spurrier healthpost@scmp.com Here are a few of Hong Kong’s best hikes – and excellent eateries to fuel up before and after the journey.

Cheung Chau (3km/1.5 hours) This fishing isle has many people but no vehicles, making for a safe family walk.

Arriving by ferry from Central, turn right from the pier onto the busy waterfront. U Can Cook on Praya Street (2981 6533) serves filling Western fare to start the day: pasta, soups and baked potatoes. The island’s Hung Shing temple, built in 1813, looks out over a tree-shaded plaza. Behind it are the ruins of a Qing-dynasty hospital.

At the top of School Road, pass through iron gates into the gardens of the Kwan Kung Pavilion, dedicated to the red-faced god of war. Follow Peak Road and Fa Peng Road to the sands of Afternoon Beach, popular for windsurfing.

Follow the coastal path past a bronze-age rock carving to the longer beach of Tung Wan. You can cut across from here back to the pier. There are plenty of seafood restaurants on Cheung Chau, but for something different, the Japanese-run Hometown Teahouse (2981 5038) is popular for its sushi, red bean buns and tea sets.

Sai Kung (6km/3 hours) The long-distance trails across the hills of Sai Kung are sun-baked in the summer. Beat the heat by following this forest hike instead.

Start at Colour Brown (2791 7128) in Sai Kung’s old town for coffee and croissants, or Classified (2529 3454) on Sha Tsui Path for eggs Benedict. Take bus 94, or a green taxi, to Pak Tam Chung in the country park.

A bridge leads over the river to the Sheung Yiu folk museum – a walled village which now houses an exhibition of rural life. Turn uphill into the woods as you pass the village to join the Sheung Yiu Country Trail, a level track that offers lovely views of Port Shelter and its many islands. You can cool your feet in streams along the way.

The trail exits near the dam of High Island Reservoir; turn left to return to Pak Tam Chung. For lunch try Hebe One O One (2335 5515), which has a terrace overlooking Hebe Haven, for oysters, mussels or seared tuna salad.

The Dragon’s Back (8km/2.5 hours) This easily accessible walk on Hong Kong Island is a weekend favourite; quick to get to and suitable for families.

Take bus 9 from Shau Kei Wan MTR bound for Shek O; tell the driver you want to go to Big Wave Bay. Bring a packed breakfast and eat it on the beach, or order a hot bowl of noodles and fried eggs at the Big Wave Bay Café (2809 4933) just back from the surf.

Your walk starts at the back of the village. Hong Kong Trail signs point upwards into the forest. After a short climb, you join a level paved road which bears left to meet an earthen path again. You’re shaded

by trees until the path makes a quick ascent to the Dragon’s Back ridge, and from this airy section there are fine views over Shek O and the South China Sea. As you descend to Shek O Road, look across Tai Tam Bay to Stanley.

Staying on the near side of the road, take the bus back down into Shek O. Refresh with mint lemonade at Shining Stone (2809 2227).

Specialities include salmon lasagne and home-made rosemary bread.

Lamma Island (5km/2 hours) The path from one side of Lamma Island to the other is often too crowded for

comfort. This alternative route crosses less-visited parts of the island.

paté at a terrace table overlooking the harbour.

Take the ferry from Central to Yung Shue Wan and fortify yourself at the Bookworm Café (2982 4838) with a fruit bowl or free-range eggs on toast.

Return to the pier and take the steps uphill beside the post office.

It’s easy to follow the coast north, shaded by bamboo and banana trees all the way. The path dips down to a quiet beach and climbs again to a viewpoint overlooking the Western Harbour.

Soon you enter the scattered village of Pak Kok; then, shortly afterwards, a tiny hamlet with its own jetty. Follow the path ahead through long grass to join a paved track that leads to the shore; this spot has expansive views of Hong Kong Island across the channel.

This wide road, which carries no traffic, was built by Hongkong Electric in the 1970s. The cables that supply all of Hong Kong Island’s electricity pass beneath your feet.

Follow the road uphill. The Lamma wind turbine appears on your left, and from the bank on your right, you have birdseye views of Yung Shue Wan. On its descent, the road forks – take either way down; they both meet the busy path which runs between Yung Shue Wan and the beach at Hung Shing Yeh. Back on the village’s main street, head to Green Cottage (2982 6934) for organic wholewheat pizza, artichoke salad or mushroom

Lantau Island (11km/5 hours) Hong Kong’s largest island is a place of mountains and monasteries. This challenging hike crosses Lantau Peak, Hong Kong’s second highest.

From Central, take the ferry to Mui Wo, also known as Silvermine Bay. Fuel up at either China Bear (2984 7360) on the waterfront next to McDonalds or the smaller Caffe Paradiso (2984 0498) nearby; both do a full English breakfast.

Take any bus and alight at Nam Shan, a few stops up the hill, marked by a wooden Lantau Trail archway. Follow the signs to the Tree Walk. Past the helipad with views over Mui Wo and down stone steps there’s a crossroads where you must turn left, then right, to join the South Lantau Country Trail.

Don’t go straight ahead or you will be climbing Sunset Peak.

The trail is a natural path of earth, stones, roots and leaves. It emerges from the forest with rewarding views of Sunset Peak, its rocky outcrops, and the bay of Pui O, backed by green hills. It’s a fairly level walk to Pak Kung Au, the highest point on Tung Chung Road.

Cross the road to follow the trail up and over Lantau Peak – a great vantage point for surveying the whole island. Be warned, though, the descent is steep.

Feel virtuous by finishing with a cheap and healthy vegetarian lunch at Po Lin Monastery’s restaurant (2985 4736). Buses run back to Mui Wo or Tung Chung.

WELLBEING 11 THE TASTE TEST SUGAR-FREE CHOC ......................................................

Jeanette Wang jeanette.wang@scmp.com Bel Arte Gianduja HK$23.50 for 45g, Great The sweetener maltitol is used in place of sugar in this bar, which unfortunately makes it bland and blah. If you must eat it, proceed with caution: in some people, maltitol may cause intestinal discomfort and even diarrhoea.

Verdict: Good, smooth texture, but otherwise unappetising.

Perlege Milk Hazelnuts HK$46 for 85g, Great I had high hopes for this bar, because I’ve never had bad Belgian chocolate. Unfortunately, replacing sugar with maltitol made it taste and disintegrate in the mouth like milk powder. One bite was enough.

Verdict: According to my colleague, it’s “10 for packaging, zero for taste”.

Fifty 50 Low Glycaemic Almond Chocolate Bar HK$29.50 for 80g, Great This bar uses a sweetener called isomalt, which is metabolised slowly by the body and hence doesn’t cause a spike in blood sugar. Being sugarfree, however, doesn’t mean it’s guilt-free: half a bar packs 190 calories and 17g fat.

Verdict: Best of the three bars, but it still lacks the smoothness and creaminess of regular chocolate.

FIT & FAB

Runaway trainer ......................................................

Jeanette Wang jeanette.wang@scmp.com

Ask anyone about the one thing that they’ve done daily for the past eight years, and they’ll most likely tell you: sleep and eat. Ask Clive Saffery and the answer you’ll get is: run. The last day he says he didn’t run was December 30, 2003.

Sleep has certainly taken a back seat to running on several occasions for the 56-year-old Briton, such as during multiple 100-kilometre races worldwide, and most notably at the 135-mile (217-kilometre) Badwater Ultramarathon in California’s Death Valley in 2009. It was his third time finishing the infamous foot race – arguably the world’s toughest – with his best result coming 10th (39 hours, 55 minutes, eight seconds) in 2000.

“I love events that are so totally wacky that only the truly mad would enter them,” says Saffery, the Hong Kong-based CEO of Swire Beverages China, on what draws him to ultramarathons. “I’ve been invited to do a 260-kilometre race in Greece next year, but I need to get a lot fitter than I am currently.”

That’s not to say Saffery – a father of two who’s married to Jacqui, a top masters endurance athlete – is out of shape. This Saturday, he’ll be doing 1.7-kilometre loops non-stop for 12 hours around Crissy Field in the San Francisco One Day race. He hopes to complete at least 60 laps, or 100 kilometres.

Does he consider himself addicted to running? “No,” says Saffery.

Spoken like a true addict.

How did you get started in running?

I started running very early and soon found out I had a lot more endurance than other people. I did my first 50-mile ultra when I was just 12 years old. After playing lots of other sports and coaching football, I got back into running again in the late 1980s. The achievements I’m proudest of are setting two different records at Trailwalker UK (both of which still stand) and coming 10th at Badwater.

How do you manage to juggle training, work and family? Is there time left for anything else?

I travel nearly all week, every week and usually only spend the weekend at home. When I’m on the road, I always run first thing in the morning, as my day gets taken over after that. In Hong Kong I will run both mornings, lunchtimes and sometimes evenings, as well. I work about 12 hours a day. I see my wife at dinner when I’m in Hong Kong, and we try and train together at weekends, but she’s got so good, she’s leaving me behind.

I read a lot of books, 50-60 a year.

I’m passionate about modern soul music and spend hours listening and mixing tracks for my iPod. I’m writing a book on a year of eating weird food in China. I also produce a newsletter and calendar for endurance athletes. I relax by taking my kayak out for a paddle, but I

Clive Saffery, shown here training at Black’s Link, says he has run every day for nearly eight years. Photo: Dickson Lee know I should do more biking. I don’t watch television apart from sport, and I don’t go to the movies.

How long will you keep this up?

At least until May 2017, when I will celebrate 50 years of running ultras. I don’t think anyone has done that.

seriously, and I passionately believe in the mantra of a balanced healthy active lifestyle. All companies should do everything they can to get people away from their desks. It’s not just about getting people to participate in sport, it’s about the simple things like taking the stairs, not the lift.

Something I’m lucky enough to do is have meetings on the move while looking at stores in China. We’ve had lots of our people participate in events. Some have asked me for training programmes.

Do you make it a point to inspire your staff to exercise too?

Absolutely. I take my job very

Which is harder: running a company or an ultramarathon?

Both have great days, and both have

When the going gets tough during a race, what keeps you going?

I keep telling myself I’m more experienced and mentally tougher than everyone else.

miserable days, but eventually if you stick to the plan, both end up OK in the end. The key to both is having the vision to look up when things are tough and stay focused on the destination.

What are three things you can’t live without?

Sense of humour, family and friends, and Manchester United (soccer).

Compete this sentence: crossing the finish line of an ultramarathon is better than ... waking up with a hangover, but it will probably hurt even more the next day.