20120410 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, APRIL 10, 2012

HEALTH POST Care, comfort and dignity for the terminally ill

>PAGE 6

Human touch

TV HITS AND MEDICAL MYTHS >PAGE 4

SEE THINGS IN A NEW LIGHT >PAGE 8

2 NEWS ASK THE EXPERTS Q: My husband and I are trying a no-sugar diet, but we are confused.

Almost everything we eat has sugar in it. So is it OK to eat natural sugar when you are trying to do no sugar?

A: Sugar is a carbohydrate plants produce from being exposed to the sun.

So “natural” sugar usually refers to sugar as it comes directly from nature. For example, sucrose (a two-part sugar made of glucose and fructose) is found naturally in sugar beets and sugar cane and other fruits, vegetables and grains.

Fructose is the primary sugar in fruit, honey and agave. Lactose is the natural sugar in milk and yogurt.

Unless you have a medical condition that excludes any of these foods, the sugars derived from fruit, vegetables, grains, milk and yogurt provide the main energy source for your brain, nerves and muscles. These sugars come conveniently packaged with an array of vitamins, minerals and other life-sustaining nutrients.

Sugar derived from fruit, vegetables and grains can be also be refined into

HEALTH BITES crystals and other forms for use in cooking, baking or to sweeten coffee or tea. These are collectively known as “added sugars”. Sucrose (or table sugar), molasses, maple and corn syrups are a few examples.

Sugar has many redeeming values.

It gives flavour to food; feeds yeast, which helps bread rise; holds moisture; tenderises, and helps to brown baked goods.

Food labels are confusing. All sugars in a food – both natural and added – are combined in the “sugar” category on the label. So the sugar content of raisin bran cereal, for example, will reflect the raisins as well as any added sugar or honey.

All this said, many of us eat too much sugar, which can make us gain weight and harm our health. You can reduce your intake by cutting back on foods such as sugar-sweetened beverages and desserts.

Run for your lives With the unveiling of its latest publicity campaign “adidas is all in”, headlined by star athletes such as David Beckham, the global sports brand has launched a local initiative to help get you off the couch. “Are You Ready to Run?” is a mobile game that anyone can play: simply scan the “start point” QR code found in the brand’s street and print advertising across the city. Then, within 72 hours, run to the assigned adidas store to scan the “end point” code and share it on Facebook.

For your efforts you’ll enjoy discounts on ClimaCool gear and be entered in a lucky draw. Go to adidas.com.hk/running for details.

Barbara Quinn is a registered dietitian at the Community Hospital of the Monterey Peninsula in California

Think before you drink Consider carefully what you wash medication down with. Some beverages can interact with drugs, lessening their effectiveness or even posing health hazards. ● Grapefruit juice: this citrus slows down enzyme activity needed to process more than 50 drugs. ● Milk: calcium makes it harder for the body to absorb some prescriptions, such as thyroid medication. ● Orange juice: look out for symptoms of too much potassium in your system, such as muscle cramps. ● Green tea: vitamin K can decrease the effect of blood thinners such as warfarin (Coumadin).

Prevention magazine

QUIZ KNEE INJURIES ......................................................

Jeanette Wang jeanette.wang@scmp.com Unless you’ve been living on another planet, you probably know that NBA star Jeremy Lin had surgery last week to repair a torn meniscus in his left knee and will be out of action for at least six weeks.

Will the New York Knicks’ point guard be 100 per cent fit afterwards?

Only time will tell, but research shows that nearly 15 per cent of all athletic injuries to the knee involve the meniscus, and the breakdown and loss of this tissue ultimately leads to the joint disease osteoarthritis.

Every healthy knee is supported and protected by a pair of menisci, a type of cartilage located within the knee joint between the thigh bone and lower leg bones. The main functions of this C-shaped tissue are cushioning, absorbing shock, enhancing stability and distributing the weight within the joint.

Though knee osteoarthritis is associated with age-associated wear and tear on the joints, and is more

common among women than men, other risk factors include obesity, previous trauma, and activities involving high load-bearing or frequent knee-bending, according to the Centre for Health Protection.

So, basketballers, skiers, cyclists, runners, and golfers, for example, may be accelerating the degeneration of their joints, and/or the risk of meniscus damage.

Do you know how to keep your knees healthy? Test yourself here.

1. A 1998 study of local Chinese in Hong Kong found that men who were overweight were how many times more likely to have knee osteoarthritis than their normal-weight counterparts? a. 2 b. 5 c. 8

Dental X-rays linked to brain cancer Frequent dental X-rays may increase your risk of developing a type of brain tumour called meningioma, according to a study published today in Cancer.

Ionising radiation is the primary environmental risk factor for meningioma, which develops in the membrane that surrounds the brain and spinal cord.

Researchers from the Yale University School of Medicine in New Haven and Brigham and Women’s Hospital in Boston studied data from 1,433 patients aged from 20 to 79 years who were diagnosed with the disease between 2006 and 2011. A control group of 1,350 people with similar characteristics but without the tumour was also studied. Compared to controls, individuals who had bitewing exams (where an X-ray film is held in place by a tab between the teeth) at least once a year were 1.4 to 1.9 times as likely to develop meningioma; those who had panorex exams (which are taken outside of the mouth and show all of the teeth on one film) at least once a year were 2.7 to three times as likely to develop the tumour.

2. How much greater compressive force does walking in two-inch heels have on the knee compared to wearing flats? a. 12 per cent b. 17 per cent c. 23 per cent 3. Research suggests anti-inflammatory drugs work best to relieve knee pain from osteoarthritis over a maximum time period of: a. Three months b. Six months c. One year 4. Which of the following are symptoms of knee osteoarthritis? a. Aching pain upon movement that improves with rest b. Creaking sound during knee movement c. Pain when climbing stairs Answers: 1. b; 2. c; 3. a; 4. all are correct

New York Knicks’ Jeremy Lin will be out of action for at least six weeks.

Photo: AP

> 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

Fad diets offer slim benefits A recent study confirms that the secret to weight loss is what we’ve long known but have chosen to avoid: eat less fat and exercise more. In the study, published today in the American Journal of Preventive Medicine, the authors say “self-reported use of popular diets, liquid diets, non-prescription weight loss pills and diet foods/products were not associated with weight loss”. Researchers from Harvard Medical School and Beth Israel Deaconess Medical Centre in Boston analysed data from more than 4,000 obese individuals in the US with a body mass index of 30 or more 12 months prior to the survey. Two in three people reported trying to lose weight; 40 per cent said they had weight loss of at least 5 per cent, and another 20 per cent lost 10 per cent or more. Other successful methods include weight loss programmes and using prescription weight loss medications. Studies show that even a 5 per cent weight loss has health benefits, says lead author Dr Jacinda M. Nicklas.

NEWS 3 PREGNANCY

APP OF THE WEEK

Autism linked to maternal obesity, diabetes

Contributors add to trail mix

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

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

Jeanette Wang jeanette.wang@scmp.com Young women, here’s a compelling reason to lead a healthy lifestyle: do it for your future children’s sake.

Diabetic or obese mothers are more likely to have a child with autism or other neurodevelopmental disability, according to a major study published yesterday in the journal Pediatrics.

Researchers affiliated with the Medical Investigation of Neurodevelopmental Disorders (MIND) Institute at the University of California, Davis, found that obese mothers were 67 per cent more likely to have a child with autism as normal-weight mothers without diabetes or hypertension. Obese mothers were also more than twice as likely to have a child with another developmental disorder.

Diabetic mothers are nearly 21⁄3 more likely to have a child with developmental delays than healthy mothers. The proportion of diabetic mothers who had an autistic child was higher than in healthy mothers, but not statistically significant.

Among autistic children, those born to diabetic mothers had greater deficits in language comprehension and production, and adaptive communication, than those born to healthy mothers.

Even among non-autistic children, those born to diabetic

mothers exhibited impairments in socialisation besides language comprehension and production compared with those born to healthy women.

The study surveyed 1,004 mother-child pairs (the children between two and five years old) from diverse backgrounds in California. There were 517 children who had autism; 172 with other developmental disorders; and 315 were developing normally.

The participants’ demographic and medical information were obtained through a questionnaire, telephone survey and medical records. So what is the connection

between metabolic conditions and brain development?

The study authors note that obesity is a significant risk factor for diabetes and hypertension, and is characterised by increased insulin resistance and chronic inflammation.

In diabetic – and possibility pre-diabetic – pregnancies, poorly regulated maternal glucose can result in prolonged fetal exposure to elevated maternal glucose levels, which raise fetal insulin production and result in chronic fetal exposure to high insulin levels.

Because high insulin production requires more oxygen use, this may result in depleted oxygen supply to the fetus. Diabetes may also result in fetal iron deficiency. Both can harm fetal brain development.

“The sequence of events related to poorly regulated maternal glucose levels is one potential biological mechanism that may play a role in adverse fetal development in the presence of maternal metabolic conditions,” says Paula Krakowiak, a biostatician affiliated with the MIND Institute.

According to a University of Hong Kong study in 1997, 5.49 children in every 10,000 in the city are diagnosed with autism spectrum disorder. Autism shows in poorer social interaction, communication deficits and repetitive behaviours, and often is accompanied by intellectual disability.

Katie McGregor healthpost@scmp.com EveryTrail Free Rating 9/10 This was a happy find. Sitting on a ferry, heading out to Lamma for a hike around the back of Sok Kwu Wan, I did a belated web search to get an idea of how long the walk might take, and up came details of a hike that had been posted through this app.

This particular hike had been part of a beach clean-up, and had taken 11 hours for what I knew would be a two- to three-hour hike. But I got an idea of what I was in for from the posting of the distance, elevation and even the views, as this person had also posted photos.

The ferry journey went quickly as I downloaded the app and tried to get an understanding of how it worked so that I, too, could post my trail. The app uses the phone’s global positioning system. As you walk, run, ski, sail, paddle or cycle a route, you can stop to take photos, which are plotted onto the map to provide a comprehensive log.

The app also gives you room to write a short story and provide tips about your journey, either as a memento for yourself or a guide for others. You can also share your results on the EveryTrail website

(everytrail.com), Facebook or Twitter via your phone or computer. The ability to edit from a desktop is particularly useful as, for example, my walking companion had also taken some photos, which I later added to the trail.

There are thousands of trails uploaded – from hiking to fishing trips – in places from Hong Kong to Yosemite National Park in California to the lakes of Enniskillen in Northern Ireland. The “search nearby” function uses your location to list trails, or you can search by entering a location and activity – and thus get inspiration for your next trip.

4 HEALTH

MEDICAL MYTHS

Reality check for drama ......................................................

Richard Lord healthpost@scmp.com The patient lies immobile, and the droning beep from the heart monitor and the flat line across its screen suggest there’s only one possible course of action left. The defibrillator paddles are fired up, someone shouts “Clear!” and the patient is given a jolt of juice.

Nothing happens. Another jolt.

Still nothing. The paramedic gives it one last, despairing try – and, miraculously, the screen flickers

into life, the heart monitor’s beeping becomes rhythmic again, and the patient splutters back into consciousness.

We’ve all seen it a thousand times, on every TV medical drama from ER to Grey’s Anatomy. But there’s one problem: it doesn’t reflect reality. Defibrillation works on hearts that aren’t beating properly, but not on hearts that have stopped.

People love medical dramas.

Besides being entertaining, they often do a good job of educating people about medical conditions

Myth: you can defibrillate someone who’s flatlining As mentioned, you can’t. “Often on TV, a patient will be defibrillated after their heart has stopped beating, and this is unrealistic,” says Dr Jason Schiffman of the medical school at the University of California, Los Angeles. “For defibrillation to work, the heart must still be beating, and beating in a certain pattern called a shockable rhythm.”

Specifically, says Sarah Walker, certified first aid instructor at Matilda International Hospital, “defibrillation can only be used in cases of ventricular fibrillation or pulseless ventricular tachycardia – heart rhythms that are erratic, fast and unco-ordinated”.

and the inner workings of hospitals.

But these dramas also make an awful lot of mistakes and, in doing so, help to perpetuate some of the most common medical myths.

Some of these myths are ethical, some procedural. Many are just silly, and infuriate medical professionals who see their difficult jobs being misrepresented. People tend to believe what they see on television, and some myths, if applied to real life, could have alarming consequences.

Here are a few of the most common medical misconceptions.

away traight tients s iagnostic a p e s o gn ed d dull an us on th ually dia s can us 1, given its foc is often a very r o t c o d Myth: offender No t what tic pep. ga to injec a House is and the need a bit of dram gnosis by doin etimes , h ia s it m s d o e w a s his e at proc cess tests. T rk to en arriv out pro drawn- V, doctors oft ordering a few kes some wo of the ta n it , a n “On T ination and e fm if oft son Sch geles. t more xam quick e in real life. Bu on,” says Dr Ja fornia, Los An ’, s li g happen t what is goin niversity of Ca ntial diagnosis t with u e n U r o e te e fe r is if figu ons l at th called a ‘d ts are at are c l schoo medica s create what’s e diagnoses th tient. Then tes f o a r “Docto a list of all of th n about the p ealistic aspect ns.” o r which is able informati noses. The un ry rare conditio g il e the ava to rule out dia pically have v ty d e ts r e n tie ord that pa House is

Myth: doctors do everything in a hospital Television routinely shows doctors performing every task from taking X-rays to analysing laboratory samples, to putting patients to sleep and dispensing medicines. In reality, hospitals have different staff – such as radiologists, lab technicians, anaesthetists and pharmacists – who do these things. And in contrast to what you see on television, nurses not doctors perform the overwhelming majority of bedside patient care. Plus, real-world doctors are rarely experts in every single type of surgery.

“In the modern hospital, the division of labour is very well defined, and there is typically a specialist for every aspect of care,” says Schiffman. “Part of the reason for this has to do with reducing errors and legal liability. For example, although most internists and surgeons are capable of interpreting imaging studies like X-rays, radiologists will still provide a reading so that it is less likely something is missed.”

HEALTH 5

Myth: a person having a fit should be held down and something put in their mouth “It is not advisable practice to either restrain a person having a seizure or insert anything in their mouth,” says Sarah Walker from Matilda . It’s better to move objects away to prevent self-injury, put something like a sweater or blanket under the victim’s head, and gently roll them on their side. “Do not restrict limb movement; instead, hold the body loosely and gently in the side-lying position,” she says. Any object in the mouth may cause choking.

Myth: CPR always revives patients Cardiopulmonary resuscitation regularly brings cardiac patients back to life on television. “CPR does not restart the heart,” says Schiffman. “The purpose of CPR is to keep oxygenated blood flowing to the brain to prevent brain damage.”

Walker adds the chances of reviving someone who’s suffered a cardiac arrest are low – though much higher if CPR is initiated immediately.

Myth: doctors are omniscient Watch enough television and you’ll get the idea that the right doctor can cure anything, and there’s a medicine to treat every condition.

“This is pretty unrealistic,” says Schiffman.

“Modern medicine is capable of amazing things, but there are often cases where the doctors aren’t able to figure out what the problem is while the patient is in the hospital and just end up treating their symptoms.

Similarly, doctors are human beings, and even the best are capable of making mistakes.”

Myth: hospitals are hotbeds of romantic and sexual intrigue Exhibit A here is, without a doubt, Grey’s Anatomy, a series in which the fictional Seattle Grace Mercy West Hospital spends more time as a place of romantic and sexual intrigue than it does treating people. In most places, there’s no specific prohibition against relationships between medical staff. Romantic relationships between doctor and patient, though?

Really not good for the medico’s career.

CPR is performed (top) to maintain the flow of oxygenated blood to the brain; instruments of myth – defibrillator paddles ...

“Clear!” (left). Photos: Corbis

6 COVER STORY

Handl Palliative care improves the quality of life for many terminally ill patients.

Elaine Yau talks to carers, sufferers and their families

G

aunt bodies ravaged by debilitating illnesses, bedridden patients groaning in pain, and grief-stricken relatives about to lose their loved ones: these painful images would make most of us wince. But for palliative care nurse Rachel Ho Yin-fun, it’s all in a day’s work.

For years she had worked at the gynaecology ward of Prince of Wales Hospital in Sha Tin. In 2005, a woman in her 40s – a cervical cancer survivor admitted for a series of routine health check-ups – asked Ho every day if her health report was ready. Too busy with work, Ho could only tell her that it wasn’t.

When the woman finally received the report, it showed that her cancer had relapsed. She checked herself out of hospital without the doctors’ approval and killed herself the next day. This tragedy motivated Ho to transfer to Bradbury Hospice in Sha Tin, to devote her time to tending to the terminally ill.

“I felt so bad that no one was there to take care of her emotions,” says Ho. “I wanted to do something that could lessen the physical and psychological pain of patients, and accompany them in their final journey in life, giving them support and hope.”

Together with a partner, she is in charge of 80 patients in Sheung Shui and Fanling, visiting five patients at their homes every day. Ho treats symptoms and assesses conditions to see if a change of medication is needed. She also counsels family members who may suffer from

emotional problems, even after their loved ones have died.

Ho is one of about 200 full-time home-care workers for the terminally ill under the Hospital Authority. According to the authority, 15 public hospitals provide palliative care services, with more than 300 hospice beds. As more than 40,000 people die in the city every year, doctors in palliative care say the demand for hospice services far outstrips supply.

A comprehensive hospice system is also lacking. In a 2010 survey by Britain’s Economist Intelligence Unit that measured the “quality of death index” in 40 places, Hong Kong ranked 20th, behind Taiwan (14th) and Singapore (18th). Britain, where hospice care originated, topped the list.

With demand rising because of an ageing population and increasing longevity, more needs to be done in this health care area. Palliative care’s importance was highlighted in the World Health Organisation global brief for last Saturday’s World Health Day, themed “Good health adds life to years”.

“We need to ensure that everyone can live with dignity until the end of their life. Yet in many countries, access to effective pain relief is extremely limited and millions lack access to palliative care,” states the WHO report.

The benefits of palliative care on patients’ well-being and life expectancy are well researched.

A study published in 2010 in the New England Journal of Medicine

The tragic suicide of a patient whose cancer had returned prompted veteran nurse Rachel Ho to leave the gynaecology ward to pursue a career in palliative care. Photo: K.Y. Cheng

COVER STORY 7

ling with care

Man Wai-ling (wheelchair) with her sister and primary carer Cheuk-yu. Photo: Nora Tam followed 151 lung cancer patients at Massachusetts General Hospital in Boston. The 74 patients who received standard oncological care survived for a median of nine months. The others, who received standard care and visited the hospital’s outpatient palliative care unit within three months of diagnosis, lived for nearly a year.

Decked out in warm colours and soft furnishings, Sha Tin Hospital’s palliative care unit is filled with the clatter of mahjong tiles and music.

Occupational therapists and physiotherapists help patients stretch muscles for rehabilitation.

Wheelchair-bound Man Wai-ling, 50, who has metastatic breast cancer that has spread to her bones, credits the centre with lifting her spirits. She has been going there for physiotherapy twice a week since August.

“There was a time when I dreaded going to hospitals. I was afraid of all those tests. When my family came to visit me, I grimaced and scowled, which added to their unhappiness,” says Man. “But my fellow patients here don’t look ill at all. I have learned to be positive as I don’t want my family to be upset any more.”

Her sister and primary carer,

Early provision of palliative care can bring a huge difference to the welfare of the terminally ill DR LAM PO-TIN (BELOW), HEAD OF PALLIATIVE CARE AT UNITED CHRISTIAN HOSPITAL

Man Cheuk-yu, 56, a cancer survivor, was taught how to take care of her sister by the centre’s doctors and nurses. “[Wai-ling’s] condition has greatly improved.

And I am supported by the service, too,” Cheuk-yu says.

Dr Raymond Lo See-kit, consultant in geriatrics and palliative medicine at Sha Tin Hospital and Bradbury’s chief of service, says the scope of palliative care has widened over the years.

In the beginning, it was confined mostly to terminal cancer patients.

Hong Kong’s first palliative care medical team was set up at Our Lady of Maryknoll Hospital in 1982. The Society for the Promotion of Hospice Care was formed in 1986, and six years later, it started Bradbury, the city’s first and only stand-alone hospice.

The Hospital Authority took over the operation of Bradbury in 1995 and, in the following years, developed palliative care services in public hospitals. The society helps train those hospice workers and, through public education, also works to erase taboos linked with death. Since 2010, Lo says Hospital Authority palliative care services have been extended to end-stage organ failure patients.

With the cosy setting and caring staff, Bradbury is like a resort. My husband passed away peacefully WONG YA-YEE (ABOVE)

Dr Lam Po-tin, head of the palliative care unit at United Christian Hospital in Kwun Tong, visits two patients’ homes a week with another doctor and nurses.

Lam says the unit, with about 10 day-care places and 15 hospice beds, provides pain management not available in ordinary wards through medication and collaboration with pain management specialists and anaesthetists. “But given the limited number of places, many patients die without receiving palliative care treatment,” Lam says.

Misconceptions about palliative care are another hurdle. “When we suggest palliative care to family members, they think that we are giving up on the patients,” says Lam. “[But] early palliative care can bring a huge difference to the welfare of the terminally ill. Depending on the disease, a patient can live for months or years after diagnosis.”

Lo says Bradbury advocates earlier provision of palliative care – from the time patients are diagnosed with an incurable disease. “Instead of being a pessimistic treatment, palliative care is filled with optimism ... Some patients tell us that their time in our unit is the best time of their lives.”

Andy Ho Hau-yan, a research officer with the University of Hong Kong’s Centre on Behavioural Health, says the city has a long way to go before it catches up with the West in terms of hospice care, partly because of a lack of co-ordination between health care workers that deprives Hongkongers of the right to die with dignity. He says that “do not resuscitate” statements signed by patients are not legally binding in Hong Kong. Doctors, therefore, make decisions for the patient at their discretion. Ambulance staff will also do their best to keep the patient alive for fear of being sued.

Ho also says that patients are not allowed to die at home in Hong Kong, unlike in the West. Family members or homes for the elderly have to send for an ambulance to get the dying patient to hospital.

Corpses at hospitals are put in crowded morgues, with some subject to the “further indignity” of an autopsy. “All these add to the trauma of families,” says Ho. Undoubtedly, more can be done.

But whatever little the city has at the moment has helped.

Wong Ya-yee’s husband, 80, was transferred to Bradbury two months ago. He had had a stroke in August, and after his condition started to deteriorate in November, Ho started visiting the couple at their home every day.

“He was happy to come here,” says Wong, 65. “With the cosy setting and caring staff, Bradbury is like a resort. His condition improved. Due to his bulky stature, we couldn’t bathe him for months, but he got frequent baths here. My husband passed away peacefully last month, surrounded by family.” elaine.yau@scmp.com

8 MEDICAL FROM THE EXPERTS

Detect and survive ......................................................

Dr Edmund Cheong healthpost@scmp.com Periodic health care for individuals comprises two fundamental elements: appropriate treatment for current illness, and appropriate preventive care to lessen future health decline.

Over the past century, preventive health care has become an important aspect of medicine, leading to significant improvements in overall health and quality of life in the community. Through screening, medical practitioners are able to spot the onset of many illnesses and provide effective monitoring of preexisting conditions and prescribe appropriate treatment and care.

Common health conditions such as cancer, cardiovascular and infectious diseases can be better managed through appropriate preventive care to reduce patients’ suffering and financial burdens.

Cancer Cancer was the leading cause of death in Hong Kong in 2010, and breast cancer has been the most

common cancer among women since the early 1990s. It accounted for 24 per cent of all new cancers in women in 2009, according to the Hong Kong Cancer Registry. There are some risk factors that can be identified and addressed through periodic health screening. For women with a family history of cancer, screening can be offered as a form of preventive care.

Cancer of the colon and rectum (colorectal cancer), which accounted for 16.7 per cent of all new cancer cases in 2009, is the second most common cancer in Hong Kong behind lung cancer (16.8 per cent). Certain risk factors for this cancer are associated with patients’ lifestyles, which can be identified easily through periodic screening.

Such modifiable risk factors include diet, physical inactivity, obesity, alcohol consumption and smoking, which can be managed through lifestyle changes. To detect colorectal cancer early, screening procedures are recommended for individuals aged 50 to 75.

Most people may not be aware that cervical cancer – the seventh most common cancer in women,

Mammography is a commonly used screening tool for breast cancer, the most common type among Hong Kong women. Photo: Cor

CASE HISTORY

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

Eileen Aung-Thwin healthpost@scmp.com As an artist, Jessica Liu relied on her perfect vision to capture her creativity on canvas. But with age, she found that she had to lean back farther and farther from her paintings to see them clearly as she worked.

By her 50th birthday, she had to wear reading glasses with a 200degree power to paint. Presbyopia, or what people jokingly call the mark of middle age, had set in.

Dr John Chang So-min, a specialist in opthalmology and director of the Guy Hugh Chan Refractive Surgery Centre at the Hong Kong Sanatorium and Hospital, explains that the eye’s lens – which focuses images on the retina to enable clear vision – is naturally springy and elastic. It is suspended in the middle of the eye by thousands of “strings”, which are attached to a circular muscle that surrounds the lens.

When the eye looks into the distance, the circular muscle relaxes away from the lens, pulling on those suspension strings which then stretch and flatten the lens. When the eye looks at something close, the muscles contract to allow the lens to thicken

The initial multiple rings around each light source had reduced to a single, well-defined halo and increase its refractive power so that the image is “brought forward” to rest on the retina. “This is our autofocus mechanism,” says Chang.

Age and continual exposure to ultraviolet light harden the lens, which can no longer thicken sufficiently for clear, close vision.

Reading glasses are then needed to help bend the light.

Liu (name has been changed for patient confidentiality reasons) hated her glasses. Fed up with the inconvenience she now had to suffer, she consulted Chang for glasses-free options.

Chang gave her a choice: Lasik eye surgery or lens exchange surgery.

Lasik is a well-established procedure that gives almost instant results. Liu had perfect distance vision so Chang could use Lasik to

correct the presbyopia by making her non-dominant eye nearsighted by 200 degrees. She would have monovision: her dominant eye would be used to see distant objects, and the other would let her see close-up objects clearly.

Chang explains that most of us have one eye that is naturally dominant, meaning the brain “prefers” the vision from that eye and registers it more prominently.

Hence, if Chang blurs the vision in the non-dominant eye, the brain will not perceive it as much.

But monovision has drawbacks.

Liu would lose stereopsis, or the ability to see with both eyes clearly.

This can cause problems with gauging distance, making activities such as going down stairs or parking a car a challenge. In Chang’s studies, he also found that nearly five out of 1,000 patients are unable to tolerate monovision and would feel dizzy and nauseated.

Using Lasik to correct for farsightedness is also less stable than correcting for nearsightedness. About 30 per cent of patients will slowly become farsighted again. Moreover, Liu’s presbyopia could continue to worsen. This would entail more corrective procedures in the future.

With lens exchange surgery,

Illustration: Angela Ho

Artist puts focus back on her work

rbis

DIET 9 EAT SMART SEA CUCUMBER

A prehistoric treat from the deep ......................................................

Jeanette Wang jeanette.wang@scmp.com which accounted for 3.7 per cent of all female cancers in Hong Kong in 2009 – is one of the most preventable forms of cancer.

The risk of cervical cancer can be significantly lowered by HPV (human papillomavirus) vaccination, practising sexual precautions and screening with periodic cervical smears.

Cardiovascular disease Heart disease was the second leading cause of death in Hong Kong in 2010, and stroke was fourth.

Assessment of cardiovascular risk can be performed using widely available statistical tools.

To detect colorectal cancer early, screening procedures are recommended for individuals aged 50 to 75

Chang would make a 2.2mm micro-incision in Liu’s eye, remove the gelatinous content of the lens and replace it with an artificial multifocal lens that could fully correct the maximum range of presbyopia, yet give her perfect distance vision.

This surgery is advantageous because it’s a permanent solution: Liu gets to keep stereopsis and her chances of needing glasses again were very low. In Chang’s experience, more than 90 per cent of patients become spectacles-free.

But it also carries risks and side effects. First, there is a 1-in-2,000 risk of retinal detachment. This however was far lower than the 1-in-56 risk for shortsighted patients, because people such as Liu with perfect vision or farsightedness have slightly shorter eyeballs, which means the retina is not stretched as thin.

Second, there was a 1-in-10,000 risk of eye infection that could result in permanent loss of vision.

Third, Liu will also likely suffer from halos in dim light, and glare and sparkles with bright lights. Chang says wearing sunglasses in bright light would reduce the glare and after some time, the halos might diminish.

But 60 per cent of patients suffer permanent halos.

The modifiable risk factors include diet, smoking, high blood pressure, abnormal blood lipids, physical inactivity, obesity, diabetes and excessive alcohol use. These factors account for most of the causes of a first heart attack. They can be identified easily through screening, and the risk can then be reduced through lifestyle changes and appropriate drug therapy under a doctor’s guidance.

Infectious diseases There are vaccines available for the prevention of various common types of infectious diseases, such as influenza, pneumococcal pneumonia, hepatitis A and B, tetanus and pertussis (whooping cough). Some of them need updating with boosters after a certain time. Periodic health screening offers an opportunity to review the vaccination history with the primary care physician and to bring the programme up to date.

Dr Edmund Cheong is the medical director at ParkwayHealth Medical Centre in Central

Chang warned that Liu’s perception of colour might also change after the surgery. The eye’s natural lens not only hardens with age but also yellows. However, the artificial lens is completely clear, so colours will appear brighter.

As with Lasik, some lens exchange surgery patients might still need glasses to use a computer.

Utterly frustrated with having to wear reading glasses, Liu opted to take care of the problem once and for all with the lens exchange surgery.

She chose to operate on both eyes at the same time – the odds of a simultaneous infection being one in two million.

After the surgery, Liu jokingly told Chang she was enjoying her “free laser show” and the pretty “Christmas trees” and sparkles. Six months later the sparkles were gone.

Although she still saw halos at night, the initial multiple rings around each light source had reduced to a single, well-defined halo. But she was not fazed. To her, it was a small price to pay for a glasses-free existence.

More importantly, she was thrilled that the world around her looked brighter and more colourful with the new lenses, and Liu could take to her art with new vision.

Soft and slimy, the sea cucumber couldn’t be further from the cool vegetable it’s named after – apart from its shape. The bottom dweller, of which there are more than 1,000 species, ranges in size from 2cm to a few metres long and has been around for 400 million years.

Several species form a regular part of some Asian diets and are employed in traditional folk remedies to treat impotence, heal wounds and reduce joint pain. It is also believed to contain compounds that fight ailments such as cancer, arthritis, sports injuries, tendinitis and other inflammatory diseases.

But according to the American Cancer Society, there is little reliable scientific evidence to support any of these claims.

However, that shouldn’t stop you from enjoying this recipe from the Regal Palace Restaurant at the Regal Hongkong Hotel in Causeway Bay. “Sea cucumber is a low-fat, low-cholesterol seafood which is also rich in protein. Its nutritive value is comparable to meat,” says Sylvia Lam See-way, president of the Hong Kong Dietitians Association.

“Double-boiling [cooking in a pot inside another pot of hot water]

lets the sea cucumber maintain its flavour.”

Double-boiled sea cucumber, mushroom and bok choy Serves 1 4 sea cucumbers 8 pieces bok choy Some Chinese wolfberries, rinsed 8 dried longans, rinsed 4 dried shiitake mushrooms, rinsed

600ml water ⁄5 tsp salt

1

• Blanch sea cucumber and bok choy.

• Place all ingredients in a pot. Add water and salt.

• Double-boil for two hours and serve.

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

10 WELL-BEING

WALKING HOME

Leon gets his shot

Leon McCarron sets up a shot in Shanxi province. “After cycling along the south coast of China last year, I really wanted to see more of this amazing country.” Photo: Rob Lilwall

FIT & FAB

Socking it to you with some TLC ......................................................

Rachel Jacqueline healthpost@scmp.com With career highlights that include spending time with Sylvester Stallone on the reality television show The Contender, training with Mike Tyson, and coaching Australia’s first winner of The Biggest Loser, Lawrence Tauasa’s career seems more fitting of a celebrity trainer than a professional boxer.

The Samoan-Australian’s star-studded career has enabled him to travel the world while fighting his way into the top rankings. He has an impressive professional boxing record of 32 wins, nine losses and one draw, as well as four title belts to show for it.

But despite his enviable career, Tauasa, 33, says he can’t stand the sport. “Boxing is this thing that I can’t get the better of until I am world champion. I hate it so much that I want to conquer it. I want to

smash it,” says the head boxing trainer at Jab Mixed Martial Arts Studio in Central.

On April 26, he will step into the ring against Australian boxer Grant Horwood for the Universal Boxing Organisation International Heavyweight Title at the Kowloonbay International Trade and Exhibition Centre (Kitec). If he wins, Tauasa will have a shot at the world champion heavyweight title later in the year – and a chance to finally love the sport.

Even though Tauasa maintains a fierce presence both in and out of the ring, the father of two is a trained home care nurse and a self-proclaimed “softie” at heart.

He also has a soft spot for food – his training regimen is not complete without his daily ritual of steak and eggs for breakfast.

Last year you trained women to fight in a white-collar boxing match. Who makes a better boxer – men or women?

Training women is easier than men. Guys have an ego problem when it comes to boxing and always seem to have something to prove. Women work their way through the problems and prefer to learn the science of boxing.

They are smarter than the guys.

Can anyone box?

Anyone can box, as long as they have a goal. It doesn’t matter what it is – to lose weight, to fight, to become more confident – you just need a reason to be there because it’s a demanding sport. But I encourage everyone to box as it’s a great way to boost your confidence. It’s really easy to teach and it’s really easy to learn.

Boxing is a brutal sport; what motivates you to get in the ring?

Boxing is brutal, but it is also well controlled. It’s a science and there is more to it than just punching someone’s face in. It is a like a chess game: make the wrong move and you take a hit. I am motivated

to be a world champion and to support my growing family.

What’s the hardest lesson you had to learn in boxing?

My dad, who trained me as a kid, used to make me run home if I lost a fight. When I was 12, he made me run for 30 kilometres in the dark. I hardly lost a fight after that. I learnt to be strong and train hard. Looking back, I know he had a good reason to push me and he saw something in me that I didn’t see. I’m grateful to him for that lesson; he taught me to be a man.

How do you prepare mentally for a fight?

Leading up to a fight, there is a lot of training and preparation to make sure you are ready to step into the ring. I spar regularly against a range of different boxers. I don’t train for my opponent, I train to be ready for anything. But on the day of a fight I try not to over-think and

instead spend time with my family. Before my last fight, I watched Tangled and Snow White and the Seven Dwarfs with my daughter. Disney movies are a great way to take your mind off things.

What would you be doing if you weren’t a boxer?

I would be a nurse. In fact, I consider myself a nurse and not a boxer. I see boxing as a really good hobby. It’s given me an opportunity to travel, gain a worldwide profile and do things I wouldn’t otherwise have done.

But I have a soft spot for people in need. I love seeing the change in people and their progress when I’m nursing. In some ways, it’s like training boxers – I love seeing that growth and the boost of confidence.

Tickets for Tauasa’s bout plus six other fights organised by Def Boxing on Thursday, April 26 at Kitec are available from def.com.hk.

WELL-BEING 11 THE TASTE TEST CANNED CORN ...................................................... ......................................................

Why did you decide on this trip?

After cycling along the south coast of China last year, I really wanted to see more of this amazing country. I also knew that I wanted a change from cycling. It’s a brilliant way to travel, but I wanted to see just one or two countries at a much slower pace.

When I reached Hong Kong, Rob asked me to do Walking Home From Mongolia. This idea fit very well with my own thoughts and is an amazing career opportunity.

Rob Lilwall healthpost@scmp.com For the past five months, I have been walking home from Hong Kong to Mongolia with a young, professional adventure cameraman, Leon McCarron, who is filming the journey for a National Geographic television programme.

In this week’s column, I ask Leon a few questions about his experiences during this gruelling journey through China.

How has this journey differed from your expectations?

Ha, ha. Longer, harder, tougher.

Filming in conditions of extreme cold (or more recently, heat) – on top of carrying a 25kg pack for 13 hours a day, through rugged terrain, six days a week – has been a challenge, to say the least.

In terms of my expectations of China, I knew enough to know it is a country where you have to expect the unexpected. So, in that regard, it has been as I imagined: China is a place of madness and wonder.

What made you want to be an adventure cameraman?

I’ve always loved going on adventures and challenging myself.

Another passion was being creative, and camerawork was an exciting outlet for this creativity. After finishing a degree in film studies, I was trying to decide what to do with my life, and I suddenly thought “why not combine the two things I love into a career?” It seemed like a perfect fit to become an adventure cameraman.

What other big expeditions had you been on before Walking Home From Mongolia?

I try to live an adventurous lifestyle, and do at least one adventurous thing a month. When I lived in England, I used to pack my tent and take budget flights to Europe. On one of these trips in Poland, I was bitten by a rabid dog. In 2010, I went on a one-year bicycle trip around the world, starting in New York, and heading on across America, New Zealand, Australia and Southeast Asia, finishing in Hong Kong about a year ago. I had a few adventures with tornadoes, flooded rivers and robbers, but I loved it.

McCarron and Rob Lilwall (right)

We have had many crises and have got through them all with our friendship intact LEON McCARRON

What were the highs?

The Gobi Desert. I think I have discovered a real passion for deserts.

Also, the arrival of the first signs of spring after a long, hard winter – the first day not wearing gloves, the first bits of blossom, and seeing life breathing back into the world.

And the lows?

The relentless battering of winter.

Around January, I had reached a point where I could not remember what it was like to not have numb hands when I was filming, and I knew I’d have to endure this for a couple more months.

The other difficult aspect has been the relentless toll of the journey on our bodies. We never seem to be

totally free from exhaustion and minor injuries.

What is it like walking with Rob? I first knew about Rob when I read his book, Cycling Home From Siberia, before I went cycling myself.

I then managed to meet him a couple of times in London and New York, and he and his wife Christine invited me to come and stay with them when I reached Hong Kong on my bicycle. Then Rob told me about the expedition.

We didn’t actually know each other very well when we set off for Mongolia.

But over the months of walking, we have worked very well as a team.

We both take life with a pinch of salt and keep a sense of the absurd about what we are doing, so we have found it pretty easy to get along.

I have always felt you find out how well you get on with someone during times of crisis and trial – and we have faced many on this expedition and have got through them all with our friendship intact.

At the same time, walking with anyone for this length of time can put pressure on any friendship, and so that has been difficult.

I should mention that on expeditions Rob is a smelly person. I did not believe feet could smell that bad. One thing I’m most looking forward to after this is over is not waking up to the smell of Rob’s feet.

Jeanette Wang jeanette.wang@scmp.com

S&W Whole Kernel Corn 410g for HK$8.90, Market Place by Jasons I’d been buying this brand over others because of its low price, but now I realise why this Thai product is so cheap: it contains corn, water, sugar and the additive, citric acid.

Having enjoyed the two other products, I realise this doesn’t taste much like corn, either.

Verdict: tough kernels and an artificial flavour.

Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic television series. Every week 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. walkinghomefrommongolia.com Organics Whole Kernel Corn 425g for HK$16.90, Market Place

by Jasons This US Department of Agriculturecertified organic corn – grown in the “rich and fertile soil of the Midwestern US” – is said to be harvested when “perfectly ripe and processed within two hours”. The pale yellow kernels are canned with only water and sea salt.

Verdict: crunchy, juicy and subtly sweet, it’s almost like eating corn freshly shucked from a steamed cob.

Boxing is a like a chess game: make the wrong move and you take a hit LAWRENCE TAUASA

Champion boxer Lawrence Tauasa.

Photo: David Wong

Green Giant Original 340g for HK$13.90, Market Place

by Jasons Made in France, this is unlike the first two products in that it’s not swimming in liquid in the can.

Without the need to be drained and with a ring pull top, it’s a convenient on-the-go snack or light meal.

Verdict: sweeter and juicer than Organics’, but with less crunch.