YOUR GUIDE TO LIVING WELL
TUESDAY, FEBRUARY 21, 2012
HEALTH POST
TCM AND FERTILITY TREATMENT >PAGE 4
THE PRESSURE AND THE PAIN >PAGE 8
Doctor in your pocket
Illustration: Stephen Case
How the digital age has put well-being at our fingertips >PAGE 6
2 NEWS APP OF THE WEEK
BEAUTY
Happy trails are just around the corner for sociable set
Lead detected in most lipsticks
...................................................... Katie McGregor healthpost@scmp.com The Runner Lounge Free Rating 9/10 This app is only as good as its users, and as I seem to be the only one in Hong Kong using it, I invite all runners in the city to join me because this one has great potential. Download it, set up your membership (easy) and look for the group called Hong Kong Running. But there is more to the app than joining a group consisting of one writer who tries to run in Hong Kong. There are already a number of groups, including a popular long-distance runners’ group, a “Run to Drink Beer” group and Nike+ Runners. So far, the members are located mainly in the US. For example, under the “group wire” for the long-distance runners’ group, one member has posted a helpful description about the terrain of the San Francisco women’s marathon. In the “Run to Drink Beer” group, we learn that the Richmond Marathon in Virginia had beer at mile 20; “How cool is that?” asks one member. If you don’t want to join a group, you can drop into the lounge section and join in a conversation there. You’ll find a number of chats on the go, with running in the cold – snow that is, not our Hong Kong weather – and gaining muscle, for example. The “spot” section allows you to
post or boast about a running trail. Upload photos, describe the run, and the app will create a map of it using your location. Not all users understood this instruction: in a couple of the trails described as being in a national park or similar, the map is centred on what appears to be a residential area. Other sections are more educational, with a video blog sharing information about hydration, exercises and recipes. Be warned that this is not as sleek as more commercial apps, but it is fun and could be a great Hong Kong resource. I will do my bit and post the first Hong Kong “spot”, but as we all know, I have to be on the trail, not sitting at my desk. No cheating allowed.
....................................... Mitch Lipka If you’re going to be on either end of a kiss, you might want to consider smooching bare-lipped. Most lipstick contains lead. Lead has been banned in paint since 1978 in the US, for example, because of its toxicity at low levels, but it still shows up in small amounts in some of the best-selling lipstick brands. The Campaign for Safe Cosmetics, which conducted an analysis of a study of lead in lipstick conducted by the US Food and Drug Administration, wants consumers to know that most of the 400 different lipsticks tested were positive for the substance (http://link.reuters.com/caz56s). “Recognising that there is no safe level of lead exposure, we need to be protecting women and children from all levels of exposure,” says Stacy Malkan,
Jeanette Wang jeanette.wang@scmp.com
Q: I have fair skin and enjoy outdoor sports and being out in the sun. I have noticed that I’m getting more and more spots on my body. Should I have them checked? A: Having your spots and bumps checked by your dermatologist during a full examination of the skin is the best way to screen for skin cancer in its earliest, most treatable stage. Many people develop new spots and bumps on their body as they mature, particularly if they have had much sun exposure in their lives. Although these may be harmless “warts”, “liver spots” or “age spots”, sometimes a new or growing spot may be the early development of skin cancer. At particular risk for skin cancer are people who have fair skin that burns or freckles easily, spend a lot of time in the sun, have had bad sunburns or used tanning beds, have a close blood relative who had skin cancer, have 50-plus moles, have moles known as “atypical” or “dysplastic nevi”, have a weakened immune system, or had an organ transplant. Self-examining your skin regularly
from head to toe to look for potentially cancerous skin changes is an important habit to get into. Some of the skin cancer warning signs include a spot or sore that continues to itch, hurt, erode, scab or bleed; an open sore that does not heal within two weeks; a skin growth, mole or spot that changes in size, colour, shape or thickness, becomes asymmetrical or irregular in outline, or is larger than 6mm. During a full body examination of the skin, your dermatologist will look closely at your moles and spots from head to toe, often with the aid of a dermatoscope – which is shown to be superior to nakedeye examination for people with suspected melanoma. Regular screening leads to detection of melanomas that are thinner and thus at a more easily treatable stage. Patients at high risk will also benefit from total body digital photography (“mole mapping”), which digitally records your moles and allows for closer surveillance of certain pigmented spots to avoid unnecessary biopsies.
Are you using and abusing caffeine? If so, help is at hand. Researchers from Penn State University in the US have developed Caffeine Zone, an app to help determine when caffeine may give you a mental boost and when it could mess up sleep patterns. Having between 200mg and 400mg of caffeine in your
bloodstream – a Starbucks grande latte has 150mg – will put you in an optimal alertness zone, according to the researchers who analysed peer-reviewed studies. But it can linger in the bloodstream, and with levels above 100mg, drinkers may experience sleep problems. Users of the app can key in how much caffeine they drank, or plan to drink, when they plan to drink it, and how fast they drink it. The app will then plot how it
will affect them over time, and help determine optimal caffeine habits. The researchers – who reported their findings at the Augmented Cognition International Conference in Orlando, Florida, last year – say people who drink too much caffeine too quickly may face other problems, such as nausea and nervousness. How much do you know about caffeine? Test yourself here. 1. What is caffeine’s medical name? a. Trimethylxanthine b. Tryptamine c. Tryptophan 2. How long does it take the body to rid itself of just half the caffeine consumed? a. One hour b. Six hours c. 12 hours 3. Which illegal drug has an effect similar to caffeine on the body? a. Barbiturates b. Marijuana c. Cocaine 4. In general, which of the following plants contains the most caffeine? a. Tea leaves b. Cocoa beans c. Arabica coffee beans
Dr Gavin Chan is a specialist in dermatology
> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com
The FDA, for its part, agrees there is no cause for alarm. “The FDA did not find high levels of lead in lipstick,” FDA spokeswoman Tamara Ward says. “We developed and tested a method for measuring lead in lipstick and did not find levels that would raise health concerns.” Still, Malkan says the US government should take further steps to ensure the safety of those who use lipstick. An advisory committee to the US Centres for Disease Control and Prevention has taken a position that there is no safe level of lead for children. So why, asks Malkan, should it be OK for there to be lead in lipstick? And, in particular, for certain brands to have more than others? “There are no safety standards,” Malkan says. Reuters
QUIZ ......................................................
ASK THE DOCTORS DR GAVIN CHAN
co-founder of the campaign – a nonprofit coalition of environmental and cancerprevention groups. Malkan’s group wants the FDA to set a limit for how much lead lipstick can contain and to study whether there are any dangers to having the substance applied to human lips, particularly the lips of children and pregnant women. “We know that ingestion of lipstick happens. It gets into our bodies,” she says, noting that lead accumulates in the body. The group says that five of the nine lipstick brands with the most lead are sold by L’Oreal, the world’s largest cosmetics maker. L’Oreal’s “Colour Sensational” Pink Petal had the highest lead level of any lipstick tested, at 7.19 parts per million. Children’s products sold in the US are forbidden to have more than 100 parts per million of lead. “The FDA’s independent study, which will be published in the May/June 2012 issue of the Journal of Cosmetic Science, confirms that lipsticks pose no safety concerns for the millions of women who use them daily,” L’Oreal says. “The lead levels detected by the FDA in the study are also within the limits recommended by global public health authorities for cosmetics, including lipstick.”
Caffeine can keep you alert; too much can deprive you of sleep. Photo: Corbis
Answers: 1. a; 2. b (if you drink a Starbucks grande latte at 3pm, about 75mg will still be in your body at 9pm); 3. c; 4. a (as high as 5 per cent caffeine content; cocoa beans 0.2 to 0.4 per cent and Arabica about 1 per cent)
NEWS 3 HEALTH BITES
HEPATITIS
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A silent killer remains at large
Jeanette Wang jeanette.wang@scmp.com Cellphone use drives a wedge Can mobile phones make you less socially minded? A recent study by researchers from the University of Maryland’s business school suggests that is the case. Experiments were conducted on separate sets of college students of both genders and generally in their early 20s. It was found that after a short period of mobile phone use, the subjects were less inclined to volunteer for a community service activity compared with the control group. They were also less persistent in solving word problems, even though they knew their answers would translate to a monetary donation to charity. “The cellphone directly evokes feelings of connectivity to others, thereby fulfilling the basic human need to belong,” the researchers say, resulting in reducing one’s desire to connect with others or to engage in behaviour that may benefit others.
The hand we use, and the things we choose Our own bodies can be a powerful influence when it comes to making decisions, according to research reviewed in Current Directions in Psychological Science. It’s an idea that Professor Daniel Casasanto, a cognitive scientist at the New School for Social Research in New York, terms “body-specificity hypothesis”. He has found that, in general, people tend to prefer the things they encounter on the same side as their dominant hand. When participants were asked to choose between two products or job applicants, or which two alien creatures looked more trustworthy, right-handers routinely chose the option on the right side of the page, while left-handers preferred the one on the left. “People like things better when they are easier to perceive and interact with,” Casasanto says.
Arsenic and brown rice Organic brown rice syrup, a sweetener used in many organic foods, may be a hidden source of arsenic, according to a new study published in Environmental Health Perspectives. Dartmouth College researchers tested commercial products containing the syrup – 17 infant formulas, 29 cereal bars and three energy shots – and compared them with similar products without the sweetener. Two formulas had listed the syrup as the primary ingredient, and these had arsenic levels that were more than 20 times greater than the other formulas. One of the formulas had a total arsenic concentration that was six times the US Environmental Protection Agency’s safe drinking water limit of 10 parts per billion. The cereal bars and energy shots using the syrup also had higher arsenic concentrations than those without it. Rice may be particularly prone to contamination because it pulls in arsenic, a natural metalloid, from soil. The risk of certain cancers or heart disease are said to be slightly elevated in drinking water with a certain level of arsenic.
Dogs are a woman’s best friend, too Mothers-to-be trying to maintain a healthy weight may want to consider adopting a dog. A new study that assessed data from more than 11,000 pregnant women in Britain has found that those who owned dogs were about 50 per cent more likely to achieve the recommended 30 minutes of activity per day – through brisk walking. “We are increasingly seeing that exercising with a dog can lead to improved motivation and effectiveness,” says Dr Sandra McCune, research programme manager at Waltham Centre for Pet Nutrition, which collaborated on the study with the University of Liverpool. “Together with a balanced diet, it could therefore help towards ensuring a healthy pregnancy.” The research has been published in the online journal PLoS ONE.
...................................................... Jeanette Wang jeanette.wang@scmp.com Consider this: viral hepatitis affects an estimated 500 million people around the world – more than 10 times the number affected by HIV/Aids – claiming about one million deaths per year. One in 12 people live with chronic hepatitis B or C, which together are the leading cause of liver cancer in the world, accounting for 78 per cent of cases. The hepatitis B virus was first discovered in 1965, almost a whole generation before the first reported cases of Aids in 1981. Yet, hepatitis still lacks the same level of awareness, advocacy and funding as HIV/Aids. Last year marked the 30th anniversary of the war – active and vocal and at times militant – against Aids. But what of hepatitis? “Despite knowing about the different forms of viral hepatitis for many decades, and of their impact, the political response to hepatitis B and C lags far behind that of HIV,” said Professor David Thomas, a HIV expert and chief of infectious diseases at the Johns Hopkins School of Medicine in Baltimore, Maryland. “Surveillance and diagnosis of viral hepatitis remain woefully under-resourced and many
The hepatitis C virus under an electron microscope. Photo: Corbis countries seem yet to realise that treatment not only saves lives, but the broader public health benefits of treatment often outweigh the cost.” One advantage of playing catch up is the ability to learn from the past, and that’s exactly what the global viral hepatitis community plans to do. Two days ago, leaders from the community, as well as WHO regional experts, met in Taipei at a symposium organised by the
Coalition to Eradicate Viral Hepatitis in Asia Pacific. The meeting, which took place at the 22nd Conference of the Asia Pacific Association for the Study of the Liver, discussed what can be learned from the HIV/Aids experience, in particular lobbying governments to improve public health policies. A survey by the World Hepatitis Alliance published last year found that most governments from the Western Pacific and Southeast Asia considered viral hepatitis an urgent public health issue, but that the extent and effectiveness of existing policies varied greatly across the region. Global collaboration and co-operation, as seen from the HIV/Aids experience, are key if any significant progress and public policy reform is to be achieved to reach the goal of eradicating – or at least managing – hepatitis, said Thomas in his keynote speech at the symposium. “The HIV/Aids advocacy community blazed a trail for all those living with the disease. They have pushed and pushed and they haven’t shut up,” said Charles Gore, World Hepatitis Alliance president. “Their efforts over 30 years offer us in the viral hepatitis community so many important lessons, and it would criminally stupid to ignore them.”
4 MEDICAL TCM
Herbal ...................................................... Margaret Wee healthpost@scmp.com
A combination of traditional Chinese therapies and Western medicine is more effective in treating infertility than Western medicine alone. Photo: Xinhua
CASE HISTORY
Senior has a marrow escape ...................................................... Eileen Aung-Thwin healthpost@scmp.com Mabel Wong, 85, had been feeling tired. Her health had always been good, but her recent bouts of fatigue were growing worse. She also started to feel short of breath, and her family members noticed that she looked pale and wan. Initially, Wong (whose real name has been withheld for reasons of patient confidentiality) tried to brush her symptoms off as a passing phase or a natural decline of energy that came with age. But the fatigue grew worse and lingered for two months. When Wong felt so weak that she could no longer leave the house, she finally sought medical help. Tests showed that Wong was anaemic, with a low red blood cell count and a haemoglobin count of six grams per decilitre of blood, which is about half the normal level. A low count of haemoglobin – the protein molecule in red blood cells that carries oxygen – would have caused her breathlessness. Wong’s red blood cells were also abnormally large, and she had low levels of white blood cells and
Wong’s red blood cells were also abnormally large, and she had low levels of white blood cells and platelets platelets. Her doctor suspected that something was wrong in her bone marrow, where red and white blood cells and platelets are made. He ordered a bone marrow biopsy, which showed the presence of a high percentage of very primitive blood cells called blasts. When blasts fail to mature properly into normal blood cells, it results in an excess of blasts and a shortage of normal blood cells. Healthy marrow has less than 5 per cent of blasts present. When a patient has between five and 20 per cent of blasts in the bone marrow, they have myelodysplastic syndrome (MDS), a bone marrow disease in which damaged blood-forming cells
continually create defective cells and cause low levels of normal blood cells. If blasts exceed 20 per cent, it would be due to acute myeloid leukaemia (AML). Wong had 15 per cent blasts present in her bone marrow. She had high-risk MDS, meaning there was a high chance it could progress to AML. With AML, the abnormal cells reproduce very fast and quickly replace the healthy ones, thereby drastically reducing the body’s ability to carry oxygen, fight infections and clot blood. AML can kill within months. The cells in her marrow also showed complicated chromosomal abnormalities, adding to a gloomy prognosis. Wong had a decision to make. Although she was living abroad with family members at the time, the vast majority of her family and friends were back in Hong Kong. She considered that the toll of an illness such as MDS would be better shared by her large network of loved ones back home. Furthermore, the comfort and familiarity of her surroundings during a difficult time of illness might also help shore up her mental and emotional resources.
Infertility seems to be a problem in Hong Kong, with one in six couples unable to conceive naturally, according to the Hong Kong Society of Reproductive Medicine. Many turn to Western, Chinese, or a combination of both medical schools to find a solution, and recent studies indicate traditional Chinese medicine (TCM) may have one. A study at Tel Aviv University in Israel, published in last month’s Journal of Integrative Medicine, found that a combination of TCM therapy – herbs (Paeonia alba and Chuan xiong) and acupuncture – and intrauterine insemination (IUI) resulted in conception by 65.5 per cent of the test group, compared with 39.4 per cent of the control group, which had only IUI treatment. The test group had 29 women aged between 30 and 45, and the control group had 94 women aged between 28 and 46. Dr Shahar Lev-Ari and Keren Sela of the university’s faculty of medicine say TCM aims to correct imbalances in the body’s natural
MEDICAL 5
Illustration: Angela Ho
l help for the inconceivable energy flow, promoting well-being. They say there are several theories as to why Chinese medicine can be beneficial to fertility rates, including the possibility that herbal remedies and acupuncture can affect the ovulation and menstrual cycle, enhance blood flow to the uterus, and enhance endorphin production and secretion to inhibit the central nervous system and induce calm – all of which can contribute to successful conception. The link between TCM therapy and the menstrual cycle is further supported by a University of Adelaide study funded by the Australian government. With findings published in November by the journal Complementary Therapies in Medicine, the researchers reviewed eight clinical trials, 13 other studies and case reports – a total of 1,851 infertile women – that compared the efficacy of TCM with Western drugs or in vitro fertilisation treatment. The overall analysis suggested that Chinese herbs were more effective: an average of 60 per cent pregnancy rate over four months compared with 30 per cent achieved with standard Western drug treatment. The difference, say the
researchers, appeared to be due to TCM practitioners’ careful analysis of the period when it’s possible for a woman to conceive. Unlike Western fertility treatments, which aim to increase the chance of pregnancy through implantation, TCM aims to balance and heal the body to allow for natural conception. In traditional practice, the key to fertility is the health of the kidneys. “In Chinese medical theory, the kidney is the internal organ which is responsible for reproduction, growth and ageing. Kidney deficiency is the most common cause of infertility,” explains TCM physician Chew Say Yeow, president of the Singapore Acupuncture Association. The kidneys are the centre of the body’s yin and yang. Kidney yin moistens and nourishes the body’s organs and tissues, while kidney yang warms and promotes the functions of the organs and tissues. A kidney yin deficiency in women may lead to irregular menstruation, including light discharge without blood clots, dizziness, red tongue with little fur, insomnia and a rapid pulse. In men, it causes poor sperm count and poor quantity and
Wong decided to move back to Hong Kong and seek treatment. She turned to Dr Raymond Liang, director of the Comprehensive Oncology Centre at the Hong Kong Sanatorium and Hospital, for help. Liang’s first priority was to help Wong feel better. A blood transfusion gave her immediate relief as the healthy blood was able to carry oxygen throughout her body and energise her. Next, he considered her treatment options. If Wong had been younger than 60, Liang might have proposed a bone marrow transplant. But such a rigorous therapy now would take too great a toll on her body. So instead, Liang used a chemotherapy drug that acts as a demethylating agent. Methylation of DNA is a process that controls whether a gene is turned on or off. An increase in methylation causes some genes that regulate cell division and growth to turn off, promoting cancer or abnormal cell growth. With MDS, where damaged cells also divide abnormally, interfering with the methylation process would potentially turn back on the gene that suppresses cell division, and
allow the body to regain control of cell growth. The prescribed chemotherapy drug, azacitidine, also helps by killing the fast-dividing cancer cells. Unfortunately, it has only a 50 per cent response rate. For three months, Wong received drug injections for seven consecutive days each month. During this time, Liang continued to give her blood transfusions every two to three weeks. After three treatments, Wong’s white blood cell and platelet count had climbed back up, and she no longer needed the blood transfusions. To know how well the drug was working, Liang ordered a bone marrow biopsy. It showed that the number of blasts had been reduced to 7 per cent. However, the drug is no cure for MDS. Liang hopes that the treatment will delay the onset of AML, buying Wong some time and a better quality of life. Wong will continue the treatment until it stops being effective. In the meantime, Wong has reclaimed some normality in her life. She enjoys mahjong games and eating out with her friends and family.
quality of seminal fluid. Its symptoms include premature ejaculation, restlessness, feeling hot at night, thirst and dark scanty urine. A rapid pulse is also common in men. A yang deficiency may result in prolonged menstrual cycles, lack of menstrual discharge, lower back pain and a lack of sexual desire. Men will suffer symptoms such as fatigue, impotence, low libido and pale tongue. Low sperm count and poor motility generally affect older men. A slow pulse is common. The liver and spleen are also important. A weak spleen may lead to blood deficiency because of poor circulation and anaemia. It manifests as late, absent or pale and scanty periods, dizziness, dry skin, pale tongue, abdominal pain after menstruation and weak pulse. Qi stagnation or deficiency in the liver can lead to abdominal pain, clotted and dark flow, tension and premenstrual breast tenderness. Heat and dampness also contribute to infertility. “Heat and damp diseases are normally caused by spicy food or an unhealthy diet high in saturated and trans fat, leading to overweight,” Chew says. An accumulation of damp heat in
the genital region can result in abnormal discharge from the penis, painful urination, jock itch and a yellow tongue coating. In women, it manifests as irregular, delayed or absent periods, blood clots in menses, weight gain, and white, sticky vaginal discharge and more. Finally, emotional factors play a crucial role. Stress, depression and anxiety can often affect fertility as they cause imbalances in yin, yang and qi, and can affect energy levels. To determine the cause of infertility, TCM physicians examine their patients by listening, smelling, inquiry and taking the pulse. A treatment plan is then formulated. TCM treatments for fertility may consist of herbal formulations, acupuncture treatment or both. These remedies are hundreds of years old and are considered safe to use, even in tandem with Western treatments. “It is a misconception that TCM herbs would be contraindicated with other Western medicines,” Chew says. “Herbal remedies for infertility usually have a nourishing effect or moisten the yin deficiency. In fact, experience has shown that many herbs actually supplement the effects of Western treatments
and enhance the overall well-being of the patient.” TCM can boost the effectiveness of Western treatments by increasing the stimulation of follicles and blood flow to the testicles to increase sperm count, and improving the thickness of the uterine lining. It can also be used to alleviate discomforts and side effects associated with Western treatments, such as hormonal injections. However, caution is advised. For instance, patients on blood thinners such as aspirin or warfarin should not take herbs that help to clear blood stagnation. This is where informing the physician about existing treatments and diagnoses by Western doctors is helpful. “There is likely to be a synergistic benefit with TCM and Western medicine if the TCM doctor really knows what he’s doing,” says Western fertility specialist Dr Milton Leong Ka-hong of the Women’s Clinic in Central. “This is because while Western medicine is symptom-directed and simple, TCM is complex. It involves symptoms caused by different qi deficiencies, so diagnosis is not easy. Combination medicine can also exert very different pharmaceutical effects.”
6 COVER STORY
Life in yo Mobile technology is delivering health services across the globe and empowering individuals to take responsibility for their own well-being, writes Amy Russell
I
t wasn’t too long ago that the mobile phone was a luxury, a brick-sized contraption that could only make calls. These days, not only is it pervasive – with 5.9 billion cellular subscriptions worldwide or a global penetration of 87 per cent – but the mobile phone has also taken on many new functions. Of these, its role as a health care tool has attracted particular attention in recent years. Innovative advances in the use of mobile technology in health care have evolved into a new field called mobile health, or “mHealth”, which is medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices. “Mobile health is a very broad opportunity; what can be deployed can vary from basic SMS [short message service] and phone calls to more advanced technologies,” says Jeanine Vos, head of mobile health at GSMA, an organisation working with more than 800 mobile network operators globally to develop mobile solutions.
The field’s potential is certainly being recognised. The UN included mHealth as a key innovation to achieve the goals outlined in the Global Strategy for Women and Children’s Health launched in New York in September 2010, while the World Health Organisation included a module on mHealth in the 2009 global eHealth survey. As the WHO puts it: “The use of mobile and wireless technologies to support the achievement of health objectives has the potential to transform the face of health service delivery across the globe.” In Hong Kong alone, there are more than 14.4 million mobile phone subscriptions – more than double the number of people in the city – according to the regulator, the Office of the Telecommunications Authority. Although not widespread, there have been a number of mHealth initiatives here. FindDoc is an award-winning free local phone app that allows users to efficiently research, find and make an appointment with the best doctor for them. Released last year but set to go fully live with the booking system next month, it is the brainchild of philanthropist Kevin Yeung Ka-wei, neurologist Dr Michael Lim and technologist Ivan Ng Chun-yin. Users enter their location, insurance plans, and/or
83 Percentage of the 114 member states surveyed by the World Health Organisation that offer at least one type of mHealth service
the speciality they require, and FindDoc then displays physicians’ schedules in real time, along with their credentials, to help patients select a suitable medical practitioner who best fits their needs. Mobile communications operator CSL provides a mobile link service designed to help elderly patients live more independently. A specialised device with an embedded mobile chip is able to track a person’s whereabouts. There is also an emergency alarm function, and a speaker to provide active guidance. Last year, the Health Department’s Tobacco Control Office launched a free Chineselanguage iPhone app, Quit Smoking, which offers advice, tracks quitters’ progress and issues reminders according to individuals’ smoking habits. English and Android versions are scheduled for release later this year. In the area of traditional Chinese medicine, the Health Department is using mobile technology to promote standards for the safety and quality of herbal medicine under the Hong Kong Chinese Materia Medica Standards project. An iPhone app brings together traditional medicine and new technology, providing academics, researchers, traders and the scientific community with easy access to the monographs of reference standards on commonly used herbs in Hong Kong. There are two broad categories in the sphere of mHealth, according to Vos: wellness and self-management services, where there is no medical professional involved, and services involving a doctor, nurse, or carer tracking treatment compliance. A UN report published online in September in The Lancet highlights some innovative ways that mobile technology is being used to improve the health of poor women, newborns and children in low- and middle-income countries. In some remote areas, health workers equipped with fetal monitors and wireless ultrasound transmit information by phone to a clinic. A South African project called Cell-Life sends text messages to HIV-positive mothers to provide helpful tips and reminders for appointments and medications. Interactive software installed on mobile phones help frontline health workers give individualised treatment to acutely malnourished children in Tanzania. According to the WHO, most mHealth projects in developing countries to date have focused on HIV and malaria primarily, with
COVER STORY 7
our hands Self-management must be reasonable and easy. Smartphone technology makes it easy for patients to track important health information DR MARK GAYNOR, ST LOUIS UNIVERSITY
awareness campaigns implemented via text messages. Now, in some remote communities, where patients may have to walk for hours to see a medical professional, phone companies are launching helplines, reachable on any type of handset. For more advanced economies, mHealth could benefit those with chronic conditions. Measuring devices such as blood pressure monitors might be connected to mobile handsets, with daily information sent over a network to a doctor, eliminating the need for constant check-ups, and thus freeing up time for patients and doctors. Smartphone technology may also offer a solution to better management of health care costs, says Dr Mark Gaynor, an associate professor at St Louis University’s school of public health in the US. “The only way to cut the cost of caring for people with chronic conditions is to enable the patients to self-manage their health,” says Gaynor, who was part of a research team that implemented an interactive diabetes selfmanagement system in China in 2009. “In order to do that, though, self-management must be reasonable and easy to do. Smartphone technology makes it easy for patients to track important health information.” Looking forward, it will be important for governments to explore ways to fund mHealth effectively if it is to be part of the health care of the future. According to a WHO report, mHealth: New Horizons for Health Through Mobile Technologies, published last year, of 114 member states surveyed – including China – 83 per cent reported offering at least one type of mHealth service. Many countries offered four to six programmes. The four most frequently reported mHealth initiatives were
health call centres (59 per cent), emergency toll-free telephone services (55 per cent), managing emergencies and disasters (54 per cent) and mobile telemedicine (49 per cent). With the exception of health call centres, emergency tollfree telephone services, and managing emergencies and disasters, about two-thirds of mHealth programmes are in the pilot or informal stage. The Health Department says it “recognises the importance and growing use of new media in communicating health issues with the community and improving public health.” The Hospital Authority, however, reports vaguely that it is “still exploring the use and application of mHealth in clinical operation”, suggesting there is room for greater awareness. Some medical professionals may worry that mHealth will replace some of their work, with technology detracting from traditional patientdoctor interactions. However, Vos says: “Often these technologies are about supporting the role of the health care professional, not eliminating that relationship.” Tapping into current technologies is vital, she says, but stresses that these solutions must be fitted carefully around existing health care systems. Nancy Finn, author of last year’s e-Patients Live Longer, The Complete Guide to Managing Health Care Using Technology, believes more education is needed. “Physicians need to be educated so they can help their patients become empowered and engaged,” she says. “[And] patients need to understand how to find reliable, credible health information on websites and social networks.” Alex Backer – founder and CEO of QLess, a US company that aims to eliminate waiting times in surgery waiting rooms by making use of
mobile phones to hold patients’ places – agrees. “The biggest obstacle to the implementation [of mHealth] is that people don’t yet know about it,” he says. If mHealth is really going to move forward, Vos says partnerships are key. “It’s about bringing together both the health care and the mobile ecosystems,” she says. “Generally speaking, a mobile network will work with either a hospital, foundation or a specialist interest group like a diabetes trust.” Phone companies can thus be better informed how their technology can be adapted to specific uses. So what is the future for mHealth? In her book, Finn predicts that “when a child is born, a digital health record will be created that will belong to that individual for the rest of his or her life and in which every health transaction, test and procedure will be stored. A microchip embedded in the arm or foot of that baby will point to the health record so that wherever in the world that individual seeks care, the record will be available.”
Finn also foresees wearable electronic devices, such as watches, that will remotely monitor implants and medical conditions, as well as the widespread use of telemedicine, so that doctors anywhere can be guided by top specialists. Embedded microchips and smart implants may sound a little far-fetched right now. But given the pace of mobile saturation in a market such as Hong Kong, it seems likely our health will increasingly rest in our own hands. amy.russell@scmp.com
Illustration: Stephen Case
8 HEALTH/ FITNESS
Comfortably
...................................................... Andrew Dembina healthpost@scmp.com
WELLNESS MASSAGE
Whether projected with a clinical or relaxation slant, massage doesn’t only feel good, but can be good for your health, too. Historically, it played an integral part in body maintenance: Chinese acupressure, Indian ayurveda, Japanese shiatsu, Thai and other Southeast Asian manipulations have been charted for centuries; likewise in Europe and the Middle East, with steaming, scraping and rub-downs in bathhouses. One of the most recent studies of the efficacy of massage, produced last year by Seattle’s Group Health Research Institute, showed the therapy may be better than medication or exercise for easing lower back pain in the short term. Other research-backed benefits include a heightened immune system, a drop in the stress hormone cortisol, immediate relief for advanced cancer patients, and alleviation of pain and anxiety for post-surgery patients. The common belief that having a massage after working out improves muscle blood flow and helps get rid of lactic acid is a point of contention. A 2009 study by Queen’s University, Canada, found that massage impairs blood flow to the muscle after exercise,
therefore also impairing the removal of lactic acid. But there’s no doubt about the pain-relieving properties of massage. Dr Kenneth Sun Lun-kit, a specialist in orthopaedics and traumatology at the Hong Kong Orthopaedic & Spine Centre, says massage is medically beneficial. “It is a physical treatment to relieve muscle tension and stiffness in the early stage of musculoskeletal pain management,” he says. “It makes use of the ‘gate control theory’ to ameliorate muscle and fascia [tissue layer between skin and muscle] pain.” The gate control theory is the idea that physical pain is not a direct result of activation of pain receptor neurons, but rather its perception is modulated by interaction between different neurons. Massage is believed to be effective as it suppresses pain sensations where nerve fibres enter the spinal cord, which sends impulses on to the brain. “Massage works on a holistic level,” says Kathryn Cousins, treatments manager at The Oriental Spa at the Landmark Mandarin Oriental. “Even basic massage techniques stimulate each of the body’s systems, resulting in a feeling of true well-being ... On a different level, care and touch from a therapist during a massage adds to feeling of self-worth and being nurtured,
Massage works on a holistic level. Even basic massage techniques stimulate each of the body’s systems, resulting in a feeling of well-being KATHRYN COUSINS, TREATMENTS MANAGER, THE ORIENTAL SPA
which allows for a feeling of wellbeing after treatment.” Clinical psychologist Dr Melanie Bryan adds that massage helps people get away from their thoughts. “It allows people to become more attuned to their bodies – areas of tightness, stiffness, pain and other stress-related physical difficulties,” she says. But is there one massage technique that’s better than the others? Registered physiotherapist and traditional Chinese medicine practitioner Kerry Fung Wai-yip says each style of massage has its own special benefits, if applied correctly. He says acupoint or shiatsu massage can stimulate acupuncture
SWEAT ADVENTURE SPRINTS
Living on the ledge ...................................................... Jeanette Wang jeanette.wang@scmp.com Bored with Bowen Road runs? Craving a little adventure? Try the Bonaqua Mountain Hardwear Action Sprint series. Now in its 10th year, the annual series – the brainchild of Action Asia Events director Michael Maddess – has built up a strong following of fitness enthusiasts looking for fun that literally takes them off the beaten track. Think scrambling over rocky outcrops, scurrying down river gullies, climbing up steep hills and down waterfalls, ocean swims and pounding dirt trails. “A lot of these sections just throw people completely outside their comfort zone, which is what we want to do – but only to give them a taste of adventure,” says Maddess. “They will overcome these obstacles and the satisfaction will kick in after the race.” Participation has grown from about 100-plus people per race to a field capacity of 400 (for safety’s sake). The series, says Maddess, was created because people asked for a shorter version of the Action
Asia Challenge Adventure Race, which involves some 50 kilometres of trail running, mountain biking, ocean kayaking, rock scrambling, orienteering and rope skills. Many people couldn’t find the time to train for such a long, technically demanding race. “They loved the idea of something adventure-related to get their mind off work,” says Maddess. Mark Western, 45, started competing in the series three years ago and has finished on the podium in a few races. Here are some of his tips on taking part.
involve some big hills where I really push myself – and are done exclusively on the trail. I find that if I really push myself, I need at least one or two days to fully recover – which is paramount.
1. Do a recce If you want to do well, you need to know the course beforehand. A good mental map of the course can translate into a smart and effective race strategy. For slower runners, knowing the course will cut at least 15 to 20 minutes off your overall time, and five to 10 minutes for the faster runners.
4. Build mental toughness Develop your ability to ignore pain. The next time you’re grinding your way up a hillside and your thigh muscles feel like they’re sizzling on a barbecue, ask yourself: “Can I endure this pain and keep moving?” Of course you can. The human body is an amazing machine. Just keep pushing it and it’ll get easier.
2. Quality over quantity When it comes to training, my personal philosophy is less is more. I train only twice a week. I make sure those two sessions are run at close to race pace –
3. Travel light It’s just a sprint, so you don’t need three litres of water, six energy gels, two bananas and/or any other gear. Keep it simple, travel light – your time will reflect it. The same goes for your choice of shoes – try to find a light pair of trail running shoes. I do all trail races in my super-light road runners.
5. Nurture the tummy I try to get away with eating and drinking as little as possible before and during a race. I figure the more food and fluid I’ve got bouncing
around in my belly, the less efficient I am. In fact, there was an article in Outside magazine a couple of months ago on “The 6 Biggest Nutrition Mistakes” and one mistake was eating too many solid foods directly before or during a race. The article said: “Solid foods are typically less nutrient-rich than liquid fuel, plus they take more energy to process. You can perform almost indefinitely on liquid fuel.” Other nutrition titbits to consider: hydrate heavily the day before a race, and eat your pre-race meal at least two to three hours before the start gun goes off. 6. Massage thy muscles Over the past year or so I’ve learned the importance and effectiveness of self-massage the night before a race. I spend 15 to 20 minutes working my thigh and calf muscles, making sure the fibres are loose and soft and there are no knots. It works wonders. The sprint series starts on March 4 in Repulse Bay, then heads to Mui Wo (April 1), Sai Kung (April 15) and Discovery Bay (May 6). Fees start from HK$220 per race. For more details, go to www.actionasiaevents.com
Bonaqua Mountain Hardware Action Sprint participants tackle a river gully in Tai Tam Country Park Photo: Action Asia Events
FITNESS 9
thumbed points and achieve a balancing effect on the body; oil or aromatherapy massage can help soothe and calm; Thai massage is good for stretching muscles and improving joint mobility; Chinese massage improves one’s general condition; and sports or deep-tissue massage is good for muscular recovery. It all depends on what you’re after. For energising the body and mind, Cousins recommends Swedish or Thai massage; for soothing the body and reducing stress, try aromatherapy massage. Tobias Lee, a physical/manual therapist at The Body Group, tailor-makes treatments after talking to and examining his clients. His method, based on therapeutic sports massage and performed with oil, tends to be vigorous. “I move in and out of trigger point release work when I discover congestion in tough fibres – or knots, as some people call them. Deep tissue work is done when necessary,” he says. “I treat around 85 to 100 people a month, with sports-related issues, postural pain, pregnancy discomfort and for stress. It affects 99.9 per cent of my clients.” In the back pain study by Seattle’s Group Health Research Institute, lead study author and institute director Daniel Cherkin was surprised that, for up to a year, relaxation massage or structural
massage worked better than the “typical” medical approach of drugs and physical therapy. At The Oriental Spa, Cousins says guests with specific concerns are usually treated with massage in conjunction with another form of therapy, such as physiotherapy and acupuncture. Guests are also advised to disclose medical information to therapists to ensure the correct treatment is being given. Sun advises that massage should only be done with medical consent following a diagnosis, and should not be the only means of pain management. He’s also wary of unnecessarily strong massage: orthopaedic surgeons, he says, occasionally encounter cases of broken bones in areas that have been weakened by undiagnosed bone tumours after strong massage. “I would recommend only gentle massage,” says Sun. “Many think forceful massage is an effective way to relieve their muscle pain. In fact it can do more harm than good, since repetitive trauma to the muscle may lead to fibrosis and even more tightness and pain.” Fung says that this “no pain, no gain concept” is a myth. Lee agrees: “[Strong massage] can hurt if the person is not warmed up, and make them tense their muscles even more, thus fighting against the therapist.”
Chalothorn Vashirakovit is put through the gruelling TRX exercise regime at Pure Fitness. Photo: Jonathan Wong
BRIDAL BOOTCAMP WEEK 3
Why the suspension is killing me ...................................................... Jeanette Wang jeanette.wang@scmp.com It was a hot and sweaty Valentine’s Day for Chalothorn Vashirakovit, spent with two straps and a guy. But it’s not what you think. The guy was Matthew Ha, his personal trainer from Pure Fitness in Admiralty; the straps were the TRX Suspension Trainer, a body weight training tool; and the programme involved three sets of a challenging, full-body circuit that caused Chalothorn’s heart rate to skyrocket and muscles to quiver. “[TRX] certainly looks easier than it is,” says Chalothorn, 30, who is halfway through a six-week Pure Fitness training programme to lose weight and lean up for his wedding next month. “It’s my favourite form of circuit training so far. It’s great for muscle toning and I really feel the muscle burn after every exercise.” Created and designed by a Navy Seal as a way to train for combat in the field, it’s no surprise how tough working out on a TRX can be. Using one’s body weight, it develops core body strength and joint and muscle stability. By doing a circuit of exercises with little rest in between, it works both strength and stamina. The great thing about the TRX is it can be as easy or hard as you like, simply by changing the body position. For example, when doing a push-up with hands holding the straps, the more upright you stand, the easier it gets. Ha didn’t go easy on his trainee. Among the advanced exercises dished out were the “runner” (push-up position with
feet suspended in the straps and legs doing the running motion) and “side plank” (body on its side supported by the lower arm and feet suspended in the straps). “I definitely had to clench my teeth every time I did those moves,” says Chalothorn, an investment associate with a global investment firm. Ha was suitably impressed. “He’s very good for a beginner. He understands quickly what is needed and he has good body awareness.”
TRX is great for muscle toning and I really feel the muscle burn after every exercise CHALOTHORN VASHIRAKOVIT
Trainer Matthew Ha. Photo: May Tse
The three weeks of hard work he has so far completed under Ha and boxing coach Jimmy Leung are starting to show. The latest measurements show that Chalothorn’s body fat has dropped from 18.2 per cent to 17.1, and he’s put on 2.7kg of muscle mass. Although his weight has gone up from 74.3kg to 76.6kg (because muscles are heavier than fat), he says he’s “pretty happy” with his progress. “However, I’ve not given up hope of losing 5kg by the end of this programme,” says Chalothorn. Keeping to a strict diet over the next three weeks is imperative, says Ha. To that end, Chalothorn’s fiancée, Melina Lee, has agreed to stop taking him on food hunts and trying out new restaurants. She says she’s had to change her lifestyle to accommodate Chalothorn’s fitness regime, which had been non-existent for the past four years. “We can hardly meet for dinner during weekdays as he is either working or at the gym ... Even if we do meet, I’m limited to his diet, which is a low-carb meal with plenty of protein,” says Lee. “On the days that he goes to the gym, he is so tired and is asleep by 11pm. He also now factors our nights out based on his gym schedule the next day.” But greater love hath no woman than she who lets her man work out on Valentine’s Day night. “I guess, after all, she wants to see my jawline at the end of the six weeks as much as I do,” says Chalothorn. “I made it up to her with a yakiniku dinner the day after – no carbs involved, of course.”
10 WELL-BEING WALKING HOME
What’s missing in action ...................................................... Rob Lilwall healthpost@scmp.com I have now been walking home from Mongolia for more than 90 days. In that time, Leon McCarron – my partner on this expedition – and I have been awed by the beauty and power of nature, humbled by the kindness of strangers, and thrilled by the fun of exploring ancient lands. At the same time, we’ve regularly been cold, hungry, afraid, angry, alone and, most of all, exhausted. As we walked along an empty road beside the Yellow River and traipsed through yet more mountains in Shanxi province in the past week, I’ve found myself starting to really miss not only my wife, but also Hong Kong. I think I have reached a point on the expedition where I’m starting to remember the things that I normally take for granted. They now seem like amazing gifts that I’ll be very thankful for when I get back. What are these things? 1. My wife, Christine. Now, more than ever, I understand her love. Her sacrifice and support in letting me go on this expedition is amazing. Wow, I’m crazy to have left her for so long. 2. My bed. For the past three months,
on only a handful of occasions have I known where I would be sleeping that night. I have slept in my tent on all kinds of terrain, shared a large communal bed with shepherds in a cave house, and stayed in all manner of cheap local road houses. It’ll be good to be home and have a bed to sleep in every night. 3. Money. We carry contingency money, but rely on automated teller machines that accept foreign bank cards where we can get 2,000 yuan (HK$2,460) at a time to keep us going a few more weeks. A couple of weeks ago, we realised we were running out of money but knew we’d reach a decent-sized town a couple of days later and probably would be able to withdraw some. However, when we got there, it turned out to be a small town with very local banks. On the map we saw another town 50 kilometres away, so we hiked hard for a day and a half, but when we arrived, the same thing happened. We had somehow spent our contingency money and were now down to our final 26 yuan. We went to a shop and spent it on 10 packs of instant noodles and a small sausage, which, along with a few leftover biscuits, would be our food for the next three days.
We eventually reached the Hukou Waterfall, which, despite being a tourist destination, had no ATM. We now had no money and no food, and were very hungry. This left us with our only option (besides begging): paying someone to drive us to the nearest big town and back overnight – and so we were able to get money. We’ve often heard the saying that if you have money in the bank or some spare change in your wallet, then you are richer than 92 per cent of people on the planet. I doubt I’ll ever be able to fully understand how hard such lives must be, but this minor experience has taught me a big lesson about not taking for granted money and the ability to access it and earn it. 4. My passport. I hold a British passport, which has given me safe access to more than 50 countries by plane, bicycle, foot, boat and bus. I complain a bit when I have to pay for a visa, but I should not take for granted the freedom and ability to travel – and even the protection – which this passport gives me. More than half the people in the world do not even have a passport, and even if they did, they would face many travel restrictions.
This minor experience has taught me a big lesson about not taking for granted money and the ability to access it
Rob Lilwall (above); expedition partner and cameraman Leon McCarron interviews villagers in Shanxi province (right)
EAT SMART
Nutritious and delicious with a twist ...................................................... Jeanette Wang jeanette.wang@scmp.com You may be wondering what the difference is between eliche and fusilli. A search on the internet shows the terms are synonyms for “propellers”, or spiral-shaped short-cut pasta. The spiral shape is ideal for pasta as it catches and holds sauces well. The following recipe has been provided by Charlie Brown Cafe in Tsim Sha Tsui.
The pasta, which is made with flour, eggs and salt, gets its three colours naturally – red from tomatoes, green from spinach, while the yellow comes from the egg yolks. “Adding a wide variety of vegetables to eliche pasta, tricolori enhances its flavour and texture,” says Ivy Ng, president of Hong Kong Nutrition Association and a registered dietitian. “Vegetables and mushrooms are low in calories. You can enjoy them without any worries.”
Stir-fried tri-coloured eliche pasta with vegetables and pesto sauce Serves 2 200 grams tri-coloured eliche pasta 1 piece Chinese bean, cut into short strips 4 pieces baby carrot 3 pieces baby corn, diced ¼ piece zucchini, diced 3 pieces white mushroom, sliced 2 tsp olive oil 4 tsp garlic, minced 4 tsp onion, diced ½ tsp salt 1 tsp coarse black pepper
• To make the pesto sauce, blend the pine nuts, basil and garlic in a food processor, then combine with olive oil. • Cook pasta in boiling water for five minutes, drain and set aside. • Cook all vegetables in water, set aside. • Heat oil in a frying pan. Sauté garlic, onion and pasta. • Add vegetables, pesto sauce and seasoning, stir-fry for about five minutes. Serve.
Eliche (or fusilli) pasta with vegetables and pesto sauce
Recipes provided by the Health Department as part of its EatSmart@restaurant.hk campaign. For more information, go to restaurant.eatsmart.gov.hk
Illustration: Stephen Case
For the pesto sauce 10 grams pine nuts 10 grams basil 1 clove garlic 2 tsp olive oil
5. My friends and family. I meet many people on the road – nearly all of them good people. While this is a privilege, I miss the depth of friendship which I can get by staying in one place. 6. My health. For much of the past two months, I have been walking in pain – mostly with a foot injury, and also blisters, knee pain, shoulder pain, and occasional illness. I suppose health is the thing we most take for granted. We realise what an incredible gift good health is only when we’re in pain or ill. In the past week, my foot injury feels almost fully recovered, and the rest of my body seems to be rising to the challenge of 35 to 45 kilometres a day. I’m reminding myself to take for granted neither my health, nor the privilege of being able to do a sevenmonth walking expedition through Mongolia and China – the most epic and incredible of lands. Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic TV series. Every month in Health Post, he will write about the progress of his new expedition, Walking Home From Mongolia, which is in support of the children’s charity Viva. www.walkinghomefrommongolia.com
WELL-BEING 11 THE TASTE TEST PISTACHIOS ...................................................... Jeanette Wang jeanette.wang@scmp.com Krisca Pistachios 150 grams for HK$50, City’super These California pistachios from the self-professed “nuts specialist” are oven roasted and very slightly salted. The result: a healthy way to enjoy the protein-packed, dietary fibre-rich nut. Verdict: crunchy and full-flavoured. An ideal mid-afternoon snack.
Santa Barbara Pistachio Company Raw Kernels 340.8 grams for HK$115, City’super Unroasted and unsalted, these are pistachio nuts at their most natural. The lack of processing means they are creamier and less crunchy, but no less delicious. Because they are shelled, they’re more convenient to eat – and overeat. Verdict: great for cooking. Try grinding them with basil, garlic and olive oil to make pesto.
PERSONAL BEST
How to blow those clouds away ...................................................... Alex Gazzola healthpost@scmp.com Negative thinking is undoubtedly the biggest contributor to “brain drain”. If your thoughts are tired and low, you’ll feel tired and low. It’s all very well to be told to think positively to get your little grey cells buzzing again, but in practice the concept is nebulous at best. So, how to turn a cloudy idea into reality? Here are five expert tips to get your emotional energy firing, both now and in the long term. Lift your head a fraction ”One of the easiest things to do to give yourself and your energy a quick pick-me-up is to raise your chin by at least 2cm and smile,” says Tanya Arturi, a personal image consultant and stylist with Colour Me Beautiful in Britain. “Pulling your shoulders back or raising your arms also provides an instant uplift. Your posture often portrays your emotional well-being, so changing it can be a very powerful energiser.” Forget about the moon and stars “Neither the stars, the moon, any astrological chart or ideas about fate determine your destiny. You do, and you only,” says life coach and motivational speaker Paul
If you suppress negative emotions totally ... you’ll ultimately be drained of emotional energy PAUL McGEE, LIFE COACH
McGee, who’s better known as the “Sumo (Shut Up, Move On) Guy”. “Taking control of your life and deciding that you are the author of your own script helps you cope through tough times that drain your emotional vibrancy. When you know where you’re going, you have something to look forward to. Not taking control robs you of the energy you get from knowing you can change anything.” Create and savour positive anchors An anchor, says mind and body therapist Gloria Thomas of Reshape Lifestyle Company in London, is a conditioned response that links something you hear, feel, taste or smell with a state of mind. “If you want to increase your positive emotional energy, you need to incorporate more of these positive anchors in your life,” she says. “The smell of home-baked bread may serve as a healthy anchor to positive memories of your mother’s kitchen, for instance.” Another anchor could be listening to music which you associate with happy times, or tapping into the feeling of glowing health you get from a gym workout. Write your way to self-honesty ”You can become drained of emotional energy if you’re not
being true to yourself,” says Arturi. “Sit down with a pen, paper and timer. Then, for five minutes, write down all the things you love. If you get stuck, don’t stop writing, and instead write ‘I don’t know what to write’ over and over until you think of more. Don’t stop until the timer goes off, and don’t read what you’ve written yet. Next, do the same with all the things you hate. Afterwards, compare the two lists. Are you doing enough of the things you love? This process serves as a reminder of what’s important to you and what your personal values are.” Let yourself be a hippopotamus Sometimes it’s important to allow yourself to slip down a notch on the emotional energy scale in order to invest in a greater long-term supply. “When things are tough, allow yourself to wallow, just like a hippopotamus,” says McGee. “Some ‘hippo time’, as I call it, or just down time, might involve going to a cafe, for a walk in the woods, or to the gym. If you suppress negative emotions totally and deny that you’re hurt or experiencing problems, you’ll ultimately be drained of emotional energy. “A short period of ‘hippo’ will empower your emotional state in the long run.”
Blue Diamond Roasted Salted Pistachio Nuts 170 grams for HK$47, City’super This is how most people enjoy their pistachios – roasted and salted – but if health is a concern, take note: it contains 564mg of sodium per 100 grams, compared with 119mg for Krisca’s and zero for the Santa Barbara Pistachio Company’s. Verdict: tasty but lip-crackingly salty.