YOUR GUIDE TO LIVING WELL
TUESDAY, JULY 10, 2012
HEALTH POST CASE HISTORY: STONE FREE >PAGE 4
IT’S ALL IN THE BLOOD >PAGE 8
Runs for your money The best snowboarding destinations in Asia
>PAGE 6
2 NEWS HEALTH BITES ...................................................... Richard Lord healthpost@scmp.com
APP OF THE WEEK
Power of Pilates in your hand ...................................................... Katie McGregor healthpost@scmp.com Learn Pilates HK$15 Rating 10/10 Cool, splashy dragon boat season has finished and running in this heat is quite repulsive, so Pilates offers a cool summer option. The app aims to help you lose weight and tone muscles without any machines, mix up your workout routine with something new and fun, and master Pilates in 30 days. It does sound like a tall promise but on my first date with the app, I huffed and puffed my way through both the beginner and the intermediate sessions, and had fun. In the cool of my bedroom, I watched the 10 short videos that demonstrated each of the 10 beginner moves, and then got down on my mat to work through the final video, which brings the moves into a sequence. Each move is done 10 times and the whole routine took about 10 minutes. Moves include leg circles, where you lie on your back and wave one
leg at a time at the ceiling; hip lifts; several “prep” exercises which are designed to start strengthening muscles so you can attempt the intermediate sessions; and roll ups. When I googled: “Why can’t I do a roll up?” after the session, I was relieved to read that people love to hate rolls ups, and that one of the reasons people can’t do rolls ups is because of our tight lower backs, hamstrings and hips, brought about from sitting at desks all day long. At that point I took a peak at the intermediate exercises and they looked even more fun. I realise the roll ups, and any variation will take time, and that’s OK. The videos are hosted on YouTube, but can be downloaded onto your iPhone. Each comes with a written description of the exercise, and modifications if you are struggling with the full exercise. You can also hit “favourites” and create your own library. If you do make it through beginner and intermediate, you can also work through the advanced moves and finish with the “Put it All Together” session. This combines all 30 moves into an “intense calorie-burning workout”.
ASK THE DOCTORS DR ANTHONY LUKE Q: I’d like to exercise more, but I don’t want to go to the gym. My favourite activity is to walk. What’s the best way to maximise my walking for fitness? A: Walking is a great way for many people to exercise. It’s easy, convenient, and economical. One way to help monitor your walking and assist in measuring fitness is using a pedometer or step counter. A pedometer can help an individual “keep score” of the amount of exercise, counting steps instead of calories. A baseline level of activity can be initially measured by averaging your daily number of steps over the course of four days. A rough estimate of activity suggests that 1,000 steps equals about 10 minutes of brisk walking. You can challenge yourself to increase your average score weekly or stay on a steady, consistent programme. A highly active adult should walk at least 10,000 steps
Diabetes on the increase in China If you thought that diabetes was a problem that mainly affects the West, think again. A new study has found that childhood diabetes rates are nearly four times higher in China than they are in the United States. The study, a joint project involving The University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety, Chinese Centre for Disease Control and Prevention based on data from 29,000 people over 22 years, found diabetes rates of 1.9 per cent and prediabetes rates of 14.9 per cent in Chinese children aged seven to 17. Extrapolated across the entire population, that suggests 1.7 million diabetic children and a further 27.7 million considered pre-diabetic. Researchers say the rise in diabetes incidences parallels increases in cardiovascular risk, and is caused by the population of China becoming increasingly fat.
Preserved in silk A key hindrance to getting medicines to people in countries with poor infrastructure could become a thing of the past – thanks to the humble silkworm. Researchers at Tufts University School of Engineering in the US have discovered a way to store vaccines and other heat-sensitive medicines, without refrigeration, for months and possibly even years. The secret is a new material made from a silk protein that comes from silkworm cocoons and can be made into a number of different drug-storage devices, including microneedles, microvesicles and films. The ultra-thin material is likened by the researchers to nanoscale bubble wrap. Many drugs lose their potency if not stored at a certain temperature. The MMR vaccine, for example, usually degrades rapidly if not refrigerated, but retained 85 per cent of its potency after being stored for six months in the new silk material at both 37 and 45 degrees Celsius.
You’ll need a stroke of luck on weekends If you go to hospital with a serious condition at the weekend rather than on a weekday, your chances of a good outcome are worse – or at least, they are if you have a stroke in Britain. A study in the Archives of Neurology of stroke patients admitted to hospitals under the British National Health Service found that the chances both of receiving urgent treatment and of things working out well were significantly lower on Saturdays and Sundays. The so-called “weekend effect” has been identified before with other conditions and in other countries, but never before with stroke. Overall, patients admitted at the weekend did worse on five of the six metrics measured by the study, including rates of same-day brain scans, and of sevenday, in-hospital mortality. That equates to about 350 potentially avoidable in-hospital deaths each year.
per day; children should walk at least 12,000 steps. Pedometers are typically inexpensive, but look into their accuracy, as you want to make sure the step counts are good estimates. Another activity measurement option is an accelerometer, which is becoming more available as technology improves. Accelerometers are starting to be included in other devices, such as music players and cell phones. Some accelerometers can measure movement in three dimensions, which can give more information about non-linear activities, such as sports. If you want to keep things simple, use a pedometer – unless you’re into gadgets, in which case you can take a look at the new accelerometers that are available. Dr Anthony Luke is an associate professor of clinical orthopaedic surgery at the University of California, San Francisco. Reprinted with permission of the American College of Sports Medicine’s ACSM Fit Society Page
Fertility drugs found to reduce breast cancer risk Using fertility drugs can reduce your risk of breast cancer, as long as the treatment fails. A study published in the US Journal of the National Cancer Institute found that breast cancer rates among women who used the drugs but didn’t conceive were significantly lower; while among those who got pregnant, rates were about the same as among women who had never taken them. Researchers believe that natural changes to breast tissue during pregnancy are modified by the drugs. They raise oestrogen levels, usually associated with an increased risk of breast cancer. The study’s authors suggest that the specific drug responsible for lowering the risk may be clomiphene, a selective oestrogen receptor modulator. It’s cancelled out in successfully treated women because of increased exposure to ovarian hormones and the natural short-term increase in risk caused by pregnancy.
> 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 Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888
MEDICAL 3 QUIZ CATS ......................................................
their brain and muscles, hiding from the immune system within “cysts” inside cells. Postolache stresses that further research is needed to learn more about the connection between T. gondii and suicide. Test your knowledge of the parasite below.
Jeanette Wang jeanette.wang@scmp.com
SUNBURN
Too much sun results in RNA damage to your skin cells ...................................................... Jeanette Wang jeanette.wang@scmp.com We are reminded time and time again of how much sunburn hurts. But what exactly happens during this reddish and painful experience? Researchers at the University of California’s San Diego School of Medicine have found, using both human skin cells and mouse models, that the biological mechanism of sunburn – an immune response to ultraviolet radiation – is the result of RNA damage to skin cells. Reporting their findings in Nature Medicine, the scientists say it could open the way to eventually blocking the inflammatory process, and have implications for a range of medical conditions and treatments.
Diseases such as psoriasis are treated by UV light, but a big side effect is that this treatment increases the risk of skin cancer DR RICHARD GALLO, STUDY AUTHOR
RNA, or ribonucleic acid, is a type of molecule very similar to DNA, the hereditary material in humans and almost all other living organisms. RNA plays an active role in cell processes such as biological reactions and protein synthesis. Principal investigator Dr Richard L. Gallo and his team found that UVB radiation – the part of the electromagnetic spectrum that causes sunburn – fractures and tangles elements of a special type of RNA inside the cell that does not
directly make proteins. Irradiated cells release the altered RNA, causing healthy, neighbouring cells to start a process that results in an inflammatory response intended to remove the sundamaged cells. This process is what we see and feel as sunburn. “The inflammatory response is important to start the process of healing after cell death,” says Gallo, professor of medicine and paediatrics at UC San Diego School of Medicine. “We also believe that the inflammatory process may clean up cells with genetic damage before they can become cancerous. “Of course, this process is imperfect and with more UV exposure, there is more chance of cells becoming cancerous.” With this discovery, the scientists hope to explore how to help patients with conditions related to UV light exposure. “For example, diseases such as psoriasis are treated by UV light, but a big side effect is that this treatment increases the risk of skin cancer,” says Gallo. “Our discovery suggests a way to get the beneficial effects of UV therapy without actually exposing our patients to the harmful UV light. Also, some people have excess sensitivity to UV light, patients with lupus, for example. We are exploring if we can help them by blocking the pathway we discovered.” Meanwhile, Gallo says it’s still not known how gender, skin pigmentation and individual genetics may affect the mechanism of sunburn. “Genetics is closely linked to the ability to defend against UV damage and develop skin cancers,” he says. “We know in our mouse genetic models that specific genes will change how the mice get sunburn. “Humans have similar genes, but it is not known if people have mutations in these genes that affect their sun response.”
A cat can be comforting to own, but the purring pet could also be harming your health. A study published last week has found that women are at increased risk of attempting suicide if they’re infected with a particular parasite spread through contact with cat faeces or from eating undercooked meat or unwashed vegetables. Toxoplasma gondii (T. gondii) hides in cells in the brain and muscles, often without producing symptoms. The infection, which goes by the name of toxoplasmosis, has been linked to mental illness, such as schizophrenia, and also to changes in behaviour. Researchers from the University of Maryland in the US and the University of Aarhus in Denmark analysed data from more than 45,000 Danish women and their babies. The study’s findings were published last week in the Archives of General Psychiatry. “We can’t say with certainty that T. gondii caused the women to try to kill themselves, but we did find a predictive association between the infection and suicide attempts later in life that warrants additional studies,” says Teodor Postolache, the senior author and an associate professor of psychiatry who’s director of Maryland’s mood and
Face of a killer? Photo: Corbis anxiety programme. “We plan to continue our research into this possible connection.” The study found that women infected with the parasite were 50 per cent likelier to attempt suicide compared with those who were not infected, and the risk seemed to rise with increasing levels of the T. gondii antibodies. Previous mental illness did not appear to significantly alter these findings. Postolache’s research team in Maryland was the first to report a connection between the parasite and suicidal behaviour in 2009. T. gondii thrives in the intestines of cats, and it is spread through oocysts passed in their faeces. All warm-blooded animals can become infected through ingestion of these oocysts. The organism spreads to
1. How can humans become infected by T. gondii? a. Changing infected cats’ litter trays b. Drinking water from a contaminated source c. Not washing kitchen knives after preparing raw meat before handling another food item 2. What in the estimated rate of T. gondii infection among the world’s population? a. One in three b. One in 10 c. One in 20 3. True or false: a pregnant woman can pass the parasite on to the foetus. a. True b. False 4. True or false: there is a vaccine to prevent toxoplasmosis in humans. a. True b. False Answers: 1. all are correct; 2. a; 3. a (infected pregnant women may miscarry, give birth prematurely, or have babies with eye or brain damage); 4. b (hygiene is the best prevention)
4 MEDICAL CASE HISTORY
a Ho ngel on: A trati Illus
Stone deals tough guy a low blow ...................................................... Eileen Aung-Thwin healthpost@scmp.com Sam Wong, 39, is a tough man with a tough life. He makes a living as a labourer, relying on his strength and hardy attitude to get by. When Wong (whose name has been changed for patient confidentiality reasons) started having pain when urinating and developed a swelling in his scrotum, he saw a family doctor. He was treated for a urinary tract infection with antibiotics, even though scrotal swelling is not a typical UTI symptom. The medication failed to reduce the swelling, which grew larger and more tender by the day. Wong also noticed that his underwear was frequently stained with a yellowish, pus-like substance. Every time he passed urine, it was agony. Despite the grievous pain and disturbing symptoms, the tough-minded Wong tried to soldier on. When the pain in his groin was finally too much for him to bear, Wong showed up at the emergency room of Kwong Wah Hospital, where doctors were shocked to see that his scrotum had ballooned to the size of a large orange, about 8cm in diameter. A urology team headed by consultant Dr Law In-chak was quickly assembled to tackle this unusual case. Dr Ringo Chu Winghong, an associate consultant, and Dr Wayne Chan Kwun-wai, a urology resident, were also called in. Meanwhile, Wong felt the urge to urinate but was unable to. Nurses tried to insert a urethral catheter to drain the urine but found that the catheter simply could not pass up Wong’s urethra. Chan then performed a cystoscopy, where a thin, lighted viewing tool was inserted into Wong’s urethra. He found that the passage was completely obstructed by a massive stone. The urgency now was to drain Wong’s bladder to relieve his growing discomfort. Since the urethral catheter failed, Chan had to use a suprapubic catheter where the drainage tube was inserted into Wong’s bladder via his abdomen. Then the focus turned to the stone in Wong’s urethra. An urgent computed tomography scan of Wong’s pelvis showed that an enormous 4cm-wide stone was lodged in the urethra near the prostate, at the base of the penis. The average urethra is less than 1cm at its widest point. The scan also showed that fluid collection around the stone was what swelled the scrotum to such proportions. Wong was immediately prepped for an emergency operation. The standard treatment
for a lodged stone was to push it back into the bladder. But the stone tere was much too large to be moved up the urethra. Using a special rod inside the cystoscope called a Lithoclast, Chan had to break the stone into pieces using a jackhammer effect. The fragments were removed using miniature forceps inside the cystoscope. Both had to be taken out of the urethra with each fragment as the extended claws gripping the stones were too wide to be withdrawn back into the cystoscope. The cystoscope and forceps had to then be reinserted into the urethra to collect the next fragment. This laborious task took the surgical team three hours. After the stone fragments were finally removed, the team saw that Wong’s urethra had a pouch on the side of its wall called a diverticulum. Urethral diverticula are very rare, and when they do occur, they tend to develop in women. Diverticula can also develop as a result of trauma, such as childbirth or injury. As Wong says he has never had a groin injury, his situation was extremely unusual, and it is possible that he might have been born with this defect, says Chan. He explains that a diverticulum presents a problem because urine can collect in the pouch and stagnate. Minerals in the urine start to crystallise in the concentrated waste fluid, and the crystals collect to form the stone. The stagnant solution is also prone to breeding infection, which also promotes formation of the stone.
Doctors were shocked to see that his scrotum had ballooned to the size of a large orange After surgery, Wong had a urethral catheter inserted besides the suprapubic catheter already in place. The fluid, pus and urine in the pouch also needed to be milked daily. After two days, Wong was able to pass urine himself and the urethral catheter was removed. Its removal also helped the pus to pass out naturally along the urethra, and the swelling in his scrotum gradually diminished. One week later, Wong was discharged. Chan advised him to return for surgery to remove the diverticulum to prevent another episode of fluid retention and calculus formation. On the day of the surgery, Wong failed to show. Chan does not know why Wong decided to skip surgery.
MEDICAL 5 CPR
Safety in numbers ...................................................... Amy Norton When somebody suffers cardiac arrest in a public place, the odds of survival are better when more than one bystander comes to the rescue, according to a Japanese study. But the researchers, whose report appeared in the journal Resuscitation, said that there was no survival advantage to having multiple rescuers for cardiac arrests suffered at home, where most occur. “An increased number of rescuers improves the outcomes of out-of-hospital cardiac arrests,” wrote study leader Hideo Inaba of Kanazawa University Graduate School of Medical Sciences. “[But] this beneficial effect is absent in cardiac arrests that occur at home.” The American Heart Association (AHA) and other groups say that everyone should learn cardiopulmonary resuscitation, or CPR, which generally means “hands-only”, or just chest compressions without any mouth-to-mouth breathing.
Studies have shown this is just as effective as the traditional way when it comes to helping adult cardiac arrest victims. The Japanese study found that among more than 5,000 adults who went into cardiac arrest outside a hospital, the odds of surviving were up to two times higher when more than one person tried to help. Six per cent of victims were alive one year later when three or more “rescuers” were there, versus 3 per cent with only one rescuer. When two people responded, the survival rate was 4 per cent. The researchers did not know if all of those rescuers performed CPR. Some may just have tried to help in some way, they noted. Still, the findings do show that the more bystanders who jump into action, the better, says Michael Sayre, an associate professor of emergency medicine at Ohio State University in Columbus, who is also a spokesman for the AHA. “The study confirms the importance of bystanders responding to cardiac arrest, and the importance of early CPR,” he says.
An AHA doctor demonstrates hands-only CPR to an office worker in New York last month. Photo: AP Inaba’s team found no clear reason why there was no survival advantage to having multiple rescuers when a cardiac arrest occurred at home, and Sayre agreed that many factors could be at work. Among others, those who are out and about when cardiac arrests strike may be relatively healthier. Cardiac arrests in the elderly and frail are likely to happen at home. CPR alone cannot restart the heart when it stops, but it can keep the flow of blood and oxygen moving until medical help arrives. So along with performing CPR, bystanders need to
Experts have pointed out that humming the Bee Gees’ 1970s hit Stayin’ Alive will help rescuers find the 100BPM rhythm
immediately call the emergency services for help. “Hands only” CPR is easily learned, with or without a class, Sayre says. The AHA has a teaching video on its website (heart.org). The basic instruction is to give strong, steady chest compressions at a rate of 100 per minute. Experts say that humming the Bee Gees’ 1970s disco classic Stayin’ Alive will help rescuers find that rhythm. “Learning CPR is something people often feel that they can put off,” Sayre says. “But you never know when you’ll [need] to act.” Reuters
6 COVER STORY
By the board
Where are the best places to go snowboarding in Asia? Miriam Hanna Deller finds out
Gulmarg, India (right) Gulmarg is located in the disputed region of Kashmir. At an altitude of 2,650 metres, it is India’s premier winter resort. In the late 1920s, British colonials used it as summer hideaway. Twenty years later it was developed as winter resort. Gulmarg’s popularity grew in the late 1990s, when the legendary Gulmarg Gondola finally started its operations. At a astonishing 4,150 metres, it is the highest operating gondola in the world. Once on top of top of Mount Apharwat, riders can access incredible backcountry tours, take one of the drag lifts further up or descend a vertical drop of 1,400 metres. If you are up for the ultimate experience, book yourself on a heli-boarding trip or go backcountry
riding with the experts. There are great packages on offer, as well as the chance to book single powder runs. More information is available online at kashmirheliski.in and ridehimalayas.com. Getting there From Delhi, it takes about 3½-hours to get to Gulmarg. A short flight to the summer capital, Srinagar, and a two-hour drive gets you to the snow. Best time to go from January to March Stay at Highlands Park, think charming colonial vibe where hot water bottles, chai and firewood is delivered to your room. Eat at the Downhill Fast Food Vegetarian Restaurant $$$ HK$500 per day for accommodation, food and tickets
Auli, India Savour pure nature and conquer your fear of heights at Auli, nestled in the Garhwal Himalayas, at an altitude of 2,500 to 3,050 metres. Snowboarding here is recommended only for more advanced riders. Once at Auli, you are rewarded with views of the Himalayan belt. Some of the world’s highest mountains are in sight, including Nanda Devi (7,817 metres), Kamet (7,756 metres), Mana Parvat (7,273 metres) and Dunagiri (7,066 metres). A 500-metre-long ski-lift and an 800-metre chairlift link the upper and lower slopes.
Getting there The best option is to travel from Delhi by road. From Delhi to Rishikesh it is just under 250 kilometres on National Highway No NH-47. The climb from Rishikesh to Joshimath is 257 kilometres and takes about eight hours – on a truly harrowing road. Best time to go from January to March Stay and eat at Cliff Top Club, Auli, clifftopclubauli.com, there are some government-run budget huts near Auli, and a few local options for food. $$$ HK$400 to HK$900 a day for accommodation, food and tickets
A
re you looking for something a little different for your Asian winter holiday? Hurtling downhill while standing sideways is no longer regarded as an outlandish way to enjoy the snow. Snowboarding is now the world’s fastest growing winter sport. Since gaining popularity in the United States in the late 1970s, snowboarding has built a strong following in Europe. For the past decade or so, there has been a dedicated scene in Asia. Snowboarding is a distinctive sport. Simply being in nature with friends, the freedom one feels on a board and the adrenaline rush of speeding down a mountain are experiences to be savoured. When you’ve finally mastered that 360, it seems there are no limits to what you can do. Creativity is the force that drives all participants, from beginners to professionals, to new heights. Here is our best-of list on where you can enjoy snowboarding: from the more unusual destinations in India to the famous family resort in Japan. Take your pick, grab your board and hit the snow. Catching some big air in Niseko
Taking summit Apharw
Auli in t
Niseko, Non-st uncom powder great se you sho for chil snowpa the day free-rid Hirafu includi open u into an There a for the Getting Fly to N They le (HK$37 Best tim Stay an on your checkin $$$ dai
COVER STORY 7
Changbaishan mountain range
in the sights at the t of Mount wat in Gulmarg
the Garhwal HImalayas, India
, Japan top snowfall for weeks on end is not mmon in Niseko. If you are up for endless r (12 metres per season is about what it gets), ervice and many off-piste choices, this is where ould head. Snowboarding schools offer lessons dren and adults. There is a half-pipe and a ark at the base of the Hirafu Gondola. During y it’s not too crowded, as Niseko is more of a ding paradise. Nights get busy, as the Niseko area lights up a large portion of the mountain, ing the more advanced upper terrain, which is ntil 9pm. After a day enjoying the powder, dip n onsen – a hot spring usually located outdoors. are quite a few in Niseko; check with your hotel nearest one. g there New Chitose Airport and take the bus to Niseko. eave every 30 minutes and cost about 3,850 yen 75, round trip). me to go from end of November to May nd eat options are plentiful and really depend r budget. powderlife.com is a great source for ng all options online. ily expenses of at least HK$2,500
If you are up for the ultimate experience, book yourself on a heli-boarding trip or go backcountry riding with the experts
Phoenix Park Ski Resort, South Korea Seoul is latest hip hot spot in Asia. Decent snowboarding is only a stone’s throw away at Phoenix Park Ski Resort in Pyeongchang county. Shuttle buses from downtown Seoul take 2½-hours and are free for season pass holders. The terrain park and half-pipe are popular among the locals and are well maintained. Rental equipment is available; the costs vary depending on the type of equipment and rental hours, but are around HK$30 to HK$60 per session. The resort boasts 17 slopes, and riders get around on eight ski lifts, state-of-the-art gondolas, and
six conveyer belts. Nearby hotels provide a constant supply of people – not only for the mountains but also for the many nightclubs. Be prepared for some long party nights getting a taste of soju. Phoenix Park is the right choice for younger crowds who don’t mind queuing on weekend mornings after dancing the night away. Getting there Fly to Seoul and take a shuttle bus Best time to go from December to February Stay and eat at Phoenix Park Resort Hotels $$$ HK$600 a day includes accommodation and meals
Skiers at Phoenix Park Ski Resort in South Korea
Changbaishan, China Located on the border between North Korea and China, Changbaishan is a big hit among locals during spring and summer. In recent years, winter tourism has also picked up. Despite the terrain being all backcountry on the west side of the mountain, more and more riders come here to enjoy the perfect snow conditions from January to March. It’s best if you bring your own gear – rental is scarce and this is a place where you definitely want to have proper equipment. The word on the grapevine is that the luxury hotel conglomerate Starwood Hotels plans to open branches of its Westin and Sheraton hotels in August. There are more modest living options in the nearby Songjianghe village or at the main gate of Changbaishan National Nature Reserve. Those places provide great value and you have a chance to dive into village life in an immensely friendly community. Getting there Fly directly from Beijing, daily flights are available Best time to go from January to March Stay and eat at the Landscape Days Inn at the main gate to Changbaishan or try the different local cuisines – all heavily infused with Korean flavours $$$ about HK$620 per day hotel and meals. The admission to Changbaishan/ticket for snowboarding is pricey at HK$500 per day.
Porters in front of the 8,611-metre peak of K2 on the border of the Xinjiang Uygur Autonomous Region. Photos: Corbis, Ivan Roslyakov, Dmitri Kiyono, Ch Yoo
The Wild West: Xinjiang, China Situated along the breathtaking Tian Shan mountain scenery, Tianchi Resort is a guaranteed adventure. The half-pipe and the terrain park are both great spots for beginners and intermediate riders who want to brush up on their skills. Locals have a lot going on during the main weekends of the season, so watch out for the inevitable high ollie contest or some snowboard club outings that you can join. Count on powder runs – especially in January, when the snow conditions are at their best. The resort is expanding, but already boasts a nice hotel and restaurants. Accommodation ranges upwards from HK$400 per night. Rental gear is available and prices range from HK$70 for
clothing to HK$300 for gear, depending on the rental hours. Urumqi, the capital of the Xinjiang Uygur Autonomous Region, is about 80 kilometres away. Take in Xinjiang’s diversity – the many ethnic groups with their distinctive music, dancing, customs and culinary offerings. If you happen to get tired of snowboarding, take a break and hop on a horse to explore the surroundings. Getting there Fly to Urumqi and then take local transport or taxis to the resort Best time to go from January to March Stay and eat directly at the resort $$$ about HK$860 per day, includes hotel, meals, tickets and rental gear
8 MEDICAL TREATMENT
A fresh spin on self-preservation ...................................................... Nicole Chabot healthpost@scmp.com
Platelets are separated from blood cells like these and injected into the body. Photo: Corbis
Platelet Rich Plasma (PRP) started as a treatment for healing wounds, and then for injuries to tendons (such as tennis elbow), the rotator cuff of the shoulder, and osteoarthritis at joints like knees, hips and ankles. Now, researchers are studying its effectiveness for treating cardiovascular disease, with even the cosmetic industry looking to get into the action. Dr Steven Sampson, founder of the Orthohealing Centre and clinical instructor of medicine at the David Geffen School of Medicine at University of California, Los Angeles, has used PRP on thousands of patients over five years. He says it’s popular with patients who don’t want to take drugs to stop pain or have surgery, and who like the idea that they are using their bodies to heal themselves. In PRP, the patient’s blood is spun in a centrifuge to separate the red blood cells, which are removed leaving a clear plasma packed with platelets, irregularly disc-shaped bodies that release growth factors for the body to heal itself. The plasma is injected using ultrasound imaging to the injury site. Sampson says that after using it on European football players, he saw 50 per cent faster recovery times. “The sooner we get hold of an injury if we believe it is not healing appropriately or needs a boost to avoid surgery, the better. “With chronic injuries, we have to restart the healing process by creating some early inflammation. This process takes weeks to months. Older injuries may require more injections – up to three. A newer one may require a single shot.” He says that successful outcomes also lie in ensuring the correct indication for treatment, as well as ensuring that the PRP reaches its intended target. But the medical community is divided on the effectiveness of the treatment. Researchers from New York’s Hospital for Special Surgery, presenting a study at the American Orthopaedic Society for Sports Medicine’s Specialty Day in San Diego in February this year, found PRP to be ineffective. The trial involved 79 patients split into two groups: those who received platelet-rich plasma with a fibrin matrix (PRFM) and those who didn’t. (PRP is used interchangeably with PRFM, which is the term used most often in conjunction with soft tissue augmentation.) Standardised rotator cuff repair techniques were used for all patients, as well as post-operative rehabilitation protocols. The tendon healing was evaluated using ultrasound at six and 12 weeks post-operation. “Our study demonstrated no real differences in healing in a tendonto-bone rotator cuff repair. In fact, this preliminary analysis suggests
As more clinical studies ... show its success, PRP is likely to become more mainstream DR PATRICK GOH
that the PRFM, as used in this study, may have a negative effect on healing,” says study author Dr Scott Rodeo. A 2010 study by The Hague Medical Centre in the Netherlands, published in the Journal of the American Medical Association, also refutes the efficacy of PRP. Among 54 patients aged 18 to 70 years with a chronic injury of the Achilles tendon, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity. Anecdotally, however, it’s another story. PRP’s fans include professional athletes such as New York Yankees baseball player, Alex Rodriguez, who had Orthokine therapy, a type of PRP therapy, on the recommendation of LA Lakers star basketball player Kobe Bryant late last year. Dr Patrick Goh, specialist sports physician at Sports Medicine International in Singapore, has had repeated success using PRP on patients over four years. “One of my early patients was a late-40s tennis coach with a moderate-sized calf muscle tear who we returned to play in two weeks,” he says, adding that the expected time without PRP would have been four to six weeks. “Another was an over-40 recreational football player with cartilage wear and tear, who was unable to run for two months. He was treated with PRP and went on to play a full game a week later.”
WHAT IS PRP? Platelet-rich plasma (PRP) treatments have been used by plastic and maxillofacial (mouth, jaw and neck) surgeons for more than two decades to improve the healing of wounds and bone grafts. In recent years, it has also been used by orthopaedic surgeons and sports medicine specialists. It’s a relatively simple process: a patient’s blood is spun in a centrifuge, then red blood cells are removed, leaving a platelet-rich plasma with enhanced clotting ability. This plasma (PRP) is then injected into the patient’s injured area. Common applications in sports medicine include: • Tennis elbow • Achilles and patellar tendonitis • Rotator cuff tendinopathy
But Goh says this speed of recovery is not the norm for PRP, which usually takes four to six weeks. He treated competitive waterskier Mark Amin with PRP for a cartilage tear and bursitis on his shoulder, and Hong Kong-based businessman Leslie Koh for tennis elbow and knee joint pain. Amin, who has had PRP on both shoulders over two years, says healing time for his condition took longer than Goh’s average – about eight to 10 weeks, but during this time, movement in the shoulder area was unrestricted and pain free. “It is a safe and non-invasive treatment in line with my preference for ‘self-healing’, albeit assisted. Other treatments were only a source of temporary pain relief, but did not tackle the root cause,” says Koh. “The procedure was done within an hour. After a day or two of rest, I started on some light stretching exercises to loosen up the joints, and after five days, began some strengthening exercises targeting the muscles that had been injured or that had supported the injured joint,” says Koh. Last year, leading PRP researcher Dr Allan Mishra and colleagues at Stanford University Medical Centre, studied the effects of platelet cell therapy on cardiac function after inducing a heart attack in a pig model. The therapy, which contains white blood cells in specific ratios and concentrations in addition to platelets, was found to enhance the amount of blood pumped out of the ventricles by 23 per cent. In another 2011 study, Mishra and colleagues induced cardiac ischemia (blood restriction) on 28 mice and then injected them with either a proprietary formulation of concentrated platelets and white blood cells called RevaTen or saline. Mice that received PRP after ischemia had significantly better cardiac function. Additionally, less scar tissue was found in PRP-treated hearts than in the control group. Coronary heart disease is the leading cause of death in industrialised nations, with nearly half a million heart attacks each year, and near-epidemic numbers of patients suffering heart failure. “[The use of PRP for cardiovascular disease] is a pertinent topic as there is an epidemic of cardiovascular disease in the US and abroad, and, therefore, more natural, cutting-edge therapies are needed,” says Sampson. “As more clinical studies are done and demonstrate its success, PRP is likely to become more mainstream,” says Goh, adding that the treatment will find new applications, such as in the cosmetics industry. PRP is already being used to rejuvenate the skin or scalp, and the treatment can improve signs of ageing like fine lines and sunken, dry skin. It can also be used on the body to stimulate regrowth, including the hands, neck and scalp for hair loss.
MEDICAL 9
TRADITIONAL CHINESE MEDICINE
Life’s itch tapestry ................................................................ Wynnie Chan healthpost@scmp.com Prickly heat, the blight of many during Hong Kong’s hot humid summers, is an itchy rash characterised by small raised red spots that cause an itchy and/or intense prickly sensation on the skin. It can develop anywhere on the body but is more commonly found on the creases in the skin such as on the neck, armpit, groin, thighs. The body regulates excess heat by sweating: the evaporation of sweat from the skin’s surface has a cooling effect. Dead skin cells and bacteria often accumulate in the sweat glands during the process. Prickly heat develops when the sweat ducts become blocked and the sweat can’t escape. Instead, it seeps into nearby skin tissue causing small pockets of inflammation which appear as a rash. Gianna Buonocore, Traditional Chinese Medicine (TCM) practitioner at the Integrated Medicine Institute, Central says: “The condition often occurs during the summer months, when sweat is trapped in the pores. These hot skin rashes may be accompanied with low grade fever and a yellow sticky coating on the tongue.” Mint is supposed to help bring the rash to the surface and is thought to benefit itchy rashes in general and is widely used for this in TCM.
Cooling mint in ice can help beat the heat. Photo: Corbis
10 DIET THE TASTE TEST POMEGRANATE JUICE
HEALTHY GOURMET
...................................................... Jeanette Wang jeanette.wang@scmp.com
Eat for the beat
Biotta Pomegranate HK$68 for 500ml, ThreeSixty Unlike the other two products, this isn’t pure pomegranate juice; this 100 per cent organic Swiss product is a combination of white tea, agave concentrate, pear purée and aronia (a type of berry) juice. The packaging advises to enjoy a glass of this before each meal to “enrich your diet”. Verdict: the added ingredients balance out the tartness of the pomegranate and make this a more palatable drink.
...................................................... Andrea Oschetti healthpost@scmp.com
Nature’s Sensation Organic Pomegranate HK$23.50 for 250ml, ThreeSixty This 100 per cent fresh-pressed fruit juice is not from concentrate and has no added sugar or additives. In other words, this is as pure as bottled pomegranate juice gets. A product of Turkey. Verdict: the most tart of the three, but not too dry, so it goes down pretty easily. Best served ice cold.
On August 11, 2008 I was an overweight 99kg and my liver was not functioning properly. I’d held a gym membership for five years, but had used it only four times and my track record with weight-loss programmes was not good. I had also developed spinal problems that forced me into bed twice a year. I was deeply unhappy, but somehow managed to live with this failure despite the success in other parts of my life. One day later, I started a sevenday detox at Kamalaya Koh Samui, a wellness sanctuary and holistic spa resort in Thailand. It was an amazing experience:
Years of bad habits and a sedentary lifestyle brought issues with my liver and intestines deliciously healthy food in a stunningly beautiful environment. At the end of the week, I had lost 5kg, felt more energetic and had developed an appetite for exercise. By September 28, I weighed 87kg, my tastes had changed and I was eating plenty and healthily, without feeling deprived of the things I like. I had also started running regularly, and
by November 28 I tipped the scales at 81kg. It was then that I ran my first half marathon. I was hooked. Three-and-a-half years later, I am a competitive triathlete and runner, my back issues have disappeared and my liver is functioning perfectly. I am fit and look years younger. I have always loved food and wine, and I continue to enjoy them. So what happened at Kamalaya? Basically, years of bad habits and a sedentary lifestyle brought issues with my liver and intestines so that they no longer did their jobs properly, and my whole body suffered as a consequence. The Kamalaya programme restarted my internal engine. Rather than working on calorie intake, it focused on making my body work again. I am now passionate about
healthy living. And good health starts with good food: we are what we eat, physically and emotionally. Many people think you can’t have healthy, nutritious food that tastes good. With this weekly column, I aim to prove them wrong. We will feature recipes that summarise my four principles of healthy cooking: mindfulness, nourishment, flavour and positive indulgence. Let’s start with flavour: when I cook, my goal is to bring out food’s natural taste by respecting the ingredients using light cooking techniques, such as this spin (below) on a usually heavy lasagne dish. The best flavours are to be found in high-quality fresh food, herbs and spices. Sugar, fat and processed foods are often used to disguise inferior ingredients.
ANDREA’S OPEN BUCKWHEAT LASAGNE This is a simple recipe for open buckwheat lasagne, thyme-scented mushroom and oven-baked goat cheese with a light basil pesto. The buckwheat flour is free of gluten and highly nutritious. Pom Wonderful HK$29 for 236ml, ThreeSixty This 100 per cent pomegranate juice from concentrate is said to be packed with powerful antioxidants that help neutralise free radicals. The Californian manufacturer claims the benefits are backed by 47 published medical studies. Verdict: tart, bitter and very dry; so much so that it lingers and irritates the back of the throat. Not one for quenching a thirst.
Ingredients 200 grams buckwheat flour 200 grams mushrooms 50 grams goat’s cheese 2 bunches thyme 3 bunches basil 3 tbsp extra virgin olive oil 2 cloves garlic 100ml vegetable broth 1 tbsp grated parmesan 10 grams pine nuts
Mix the flour with water and knead the dough for a few minutes until you obtain a smooth and even consistency. Roll the dough and cut it into rectangles of 10cm. Cut the mushrooms into slices and cook them in a sauté pan. You do not need olive oil when you sauté vegetables; a little bit of water will do. When cooked, set aside and sprinkle generously with fresh thyme. Cut the goat’s cheese – which has the lowest fat content among cheeses – into medallions 1cm thick. To prepare a light version of the traditional pesto, put basil, oil, garlic, parmesan, pine nuts, vegetable
broth and a pinch of salt in a mixer and blitz briefly. Lay the squares of lasagne on an oven tray covered with greaseproof paper. Place the mushrooms on the lasagne and finish with a medallion of cheese and a twig of thyme on top. Put the tray in the oven at 200 degrees Celsius for 10 minutes. Remove, place the open lasagne on a plate, garnish with the light pesto and serve. Buon appetito. Healthy Gourmet is a new weekly column by private chef Andrea Oschetti. He can be reached at andrea@fioreblu.com
PUBLIC HEALTH 11 OBESITY
Regulation the missing ingredient ...................................................... Kelly Brownell healthpost@scmp.com This is an important time to reflect on the need for public health communities round the world to review their relationship with the food industry. Many political bodies, foundations, and scientists believe working collaboratively with the food industry is the right way to effect change. They seem to assume that this industry is somehow different from others. They believe that because people must eat, the industry is here to stay and, like it or not, working with it is the only solution. Based on my 30 years of experience in the public health and policy sectors, I believe this position is a trap. When the history of the fight against obesity is written, the greatest failure may be collaboration with and appeasement of the food industry. I expect history will look back with dismay that despite the baby steps taken forwards (such as public-private partnerships with health organisations, “healthy eating” campaigns, and corporate
Selling less food pits the food industry’s financial goals against public health goals. It cannot be left to regulate itself; shareholders won’t accept selling less social responsibility initiatives), the food industry fights viciously against meaningful change (such as limits on marketing, taxes on products such as sugared beverages, and the regulation of nutritional labelling). The obesity problem has the industry’s attention, and they are doing things. The question is whether these things are meaningful or the predictable behaviour of an industry under threat that tries to stop rather than support public health efforts. The soft drink industry gave Children’s Hospital of Philadelphia a US$10 million gift at a critical time when the city was considering a tax on soft drinks. These are the efforts the industry makes to undermine public health goals and protect industry interests, and they are entirely predictable. The US food industry has had plenty of time to prove itself trustworthy. It has been in high gear,
making promises to behave better, but it merely creates the impression of change while larger attempts to subvert the agenda carry on. Besides the massive resistance to the soft drink tax, witness the wholesale attack on marketing standards proposed by the Interagency Working Group. The worst example may be the issue of how food is marketed to children. The industry launched the Children’s Food and Beverage Advertising Initiative, designed to “shift the mix of foods advertised to children under 12 to encourage healthier dietary choices and healthy lifestyles”. Objective reports, however, have shown a tidal wave the other way, marketing caloriedense, nutrient-poor foods to children. In fact, if any change is occurring, that marketing campaign is on the increase. Companies boast of introducing healthier options, and at least one report cites this as evidence that market forces (consumer demand for better foods, for example) will be the best motivator for companies to change. But introducing healthier processed foods does not mean unhealthy foods will be supplanted, and might simply represent adding more calories to the food supply. Also, the companies have not promised to sell less junk food. On the contrary: they now offer ever larger burgers and portions, introduce ever more categories of sugared beverages (sports drinks, energy drinks and vitamin waters), find ever more creative ways of marketing foods to vulnerable populations (such as children), and increasingly engage in promoting unhealthy foods in developing countries. The food industry, like all industries, plays by certain rules. It must defend its core practices against all threats, produce shortterm earnings and, in so doing, sell more food. If it distorts science; creates front groups to do its bidding; compromises scientists, professional organisations and community groups with contributions; blocks needed public health policies in the service of their goals; and engages in other tactics in “the corporate playbook”, this is simply what it takes to protect business as usual. The parallel scenario is collaboration with the tobacco industry. Often heard is that “people don’t have to smoke, but they must eat” and that “the tobacco industry was simple – just a few companies and one product – but food is much more complex”. Tobacco is an interesting parallel, but is by no means the only one. The 2008-09 world economic crisis was fuelled in part by too little oversight of financial institutions, but we all
Manufacturers are waging a concerted campaign against the proposed soft drinks tax. Photo: AP need banks. Requiring air bags in cars was stalled for years by the car industry, but we need cars. What needs scrutiny is the food industry’s attempts to create foods that thwart the human body’s ability to regulate calorie intake and weight. Whether overconsumption is a consequence simply of hyper-palatability brought about by extreme processing or an addictive process, it is a predictable consequence of the current food environment.
The reality is that if people are to lose weight, the industry must sell less food. This pits the food industry’s financial goals against public health goals. The food industry, like other industries, must be regulated to prevent excesses and to protect the public good. It cannot be left to regulate itself because shareholders won’t accept selling less. Regulation, not collaboration, is the key. Respectful dialogue with industry is desirable, and to the extent
industry will make voluntary changes that inch us forward, the public good will be served. But to take the obesity problem seriously will require courage, leaders who will not back down in the face of harsh industry tactics, and regulation with purpose. Kelly Brownell is a professor of epidemiology and public health at Yale University. This article was first published in the open-access journal, PLoS Medicine
12 WELL-BEING HAPPINESS
Blissful thinking Sasha Gonzales healthpost@scmp.com When your world seems to be falling apart, you can always count on someone telling you to look on the bright side. It’s as if positivity is something you can summon at will. But what if happiness really was within your control, and all you needed to do to experience profound joy was to change a few small things in your everyday life? Far from being a kooky new-age idea, the “happiness as a choice” philosophy is really about taking responsibility for yourself, says Dr Timothy Sharp. He’s the founder and “chief happiness officer” at The Happiness Institute, Australia’s first organisation devoted to enhancing happiness in individuals, families and organisations. It’s about taking your emotional health into your own hands by making the decision to be happy, by looking for real solutions instead of focusing on your problems, and by interpreting what happens to you and around you differently to preserve your mental wellbeing. That is, looking at the glass half full instead of half empty. “Happiness is a term that covers a range of positive emotions,” Sharp says. “But it should be noted that no one can be 100 per cent happy 100 per cent of the time. True happiness involves recognising that, as humans, it’s normal to experience the full range of emotions including ‘negative’ ones. “The key is responding to and managing these negative emotions so that they don’t unduly or excessively impact on functioning and that they don’t persist for too long. It is also important to try to learn from unpleasant and difficult circumstances.” Happiness is not about having money or material possessions, because whatever positive feelings we derive from these tend to be short-lived, Sharp says. “What really contributes to real and meaningful happiness are variables such as good quality relationships, optimistic thinking, compassion for others, the ability to identify and utilise strengths, and the practice of strategies such as appreciation and gratitude.” We asked five happy individuals how they manage to keep smiling. Find out what happiness means to them and put their tips to good use when that positive emotion seems elusive. Maya Calica Someone wise told me that what we ought to aspire for – more than happiness – is joy, or a deep sense of knowing everything is going to be just fine. When something negative happens to me, crying helps to release the sadness and stress. I also read books that relate to my situation, of people who’ve survived
it or are going through it, as a source of inspiration. Life is not always perfect, but the great thing is that we get to choose our reaction to it.” Melissa De Silva To me, happiness is living a life of creativity, freedom, fulfilment and love. Being creative is at the core of who I am, and I do this every day through writing fiction and art. Even cooking satisfies me on days when I don’t have the energy or time to do anything more ambitious. And yes, the world can seem depressing at times, but why would I want to let external forces control how I feel and think? I choose not to seek out negative information and only read about things that uplift me. I also choose not to expend energy on people with a negative outlook. Life is too short to be miserable. Illustration: Lau Ka-kuen
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Cimone-Louise Fung Happiness to me means being grateful for everything in the now. It’s about not regretting the past and not wishing for something to occur in the future. I have learnt that attachments to things or people are never going to make you happy. Only you can make you happy. Waiting for something to happen – like losing weight, a marriage proposal, getting a dream job or winning the lottery – is putting off our happiness. We think that if we get those things, they will make us happy, but in reality we have to be happy in the present moment for those things to come. It’s always in that order. Jono Fisher I do believe that happiness is a choice, but it’s important to not see it as trying to maintain a particular “positive state”. I think happiness is more about our motivation and learning to accept ourselves and what is happening in our lives rather than trying to manufacture certain emotional states. One way to be happy is to ask yourself what you can do to make someone’s day. Then take the time to notice what images, thoughts or people come into your mind. Once you know what person or thing you want to do, do it in a spirit of playfulness and fun. You might even try doing it anonymously. Dedicating your life to making other people happy is one of the great secrets to real joy. Yeo Khim Noy Decide to be happy and do what it takes to feel that way. Happiness is what you must find within yourself. Once you’ve found it, you can share those vibes with others. I’m happiest when helping people and giving them time and attention. It makes me feel really good knowing I am making a positive difference. When something negative happens to me, I just take it as a life lesson. I ask myself what I can learn from it instead of being bitter, vengeful and angry. Then I count my blessings.
It is about not regretting the past and not wishing for something to occur in the future CIMONE-LOUISE FUNG