20120724 health post

TUESDAY, JULY 24, 2012

Illustration: Wai-Yee Man

YOUR GUIDE TO LIVING WELL

Poshpitals How private hospitals are rolling out the red carpet for well-to-do patients >PAGE 6

CRICKETER HITS CANCER FOR SIX >PAGE 5

CYCLING CEO IN PEAK CONDITION >PAGE 11

2 NEWS APP OF THE WEEK

HEALTH BITES

Beeb runs rings round rival

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Alcohol linked to child abnormalities Mothers-to-be, it’s a good idea not to drink alcohol. New research has shown that heavy drinking during pregnancy is very likely to result in a child with abnormalities – sometimes physical but most frequently neurological ones associated with learning, behaviour, language or mental function. The study, to be published in Alcoholism: Clinical and Experimental Research, screened 9,628 women in Chile during their first prenatal appointments and found 101 had at least four drinks per day. Detailed data regarding alcohol consumption was collected during their pregnancies, and their children were evaluated up to 81⁄2 years of age by clinicians unaware of their alcohol-exposure status. The data was matched with 101 pregnant women who reported abstaining from alcohol. About 80 per cent of the children had one or more abnormalities within the diagnostic criteria of fetal alcohol syndrome.

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Katie McGregor healthpost@scmp.com BBC Olympics vs London 2012 Both free Rating 9/10 for BBC Olympics, 5/10 for London 2012 According to the BBC Olympics app, there are 39 athletes from Hong Kong participating in the London Olympics. Go Hong Kong! But according to the official London 2012 Results app, the athlete list will “officially be announced on July 13”.

It is now 11 days past that date, and this gaping hole in the official app is not encouraging.

The BBC app is a pleasure to view and navigate; clear text and images with videos and news. A schedule tab allows you to view the events playing out on any particular day; for example, tomorrow the Games kick off (unofficially – the opening ceremony is on Friday) with soccer. The app write-up promises detailed results for every event and a medals table. And a week before the start of competition, the app was also relaying news of exhibition matches.

There are guides to individual sports with latest news, but also a short history of that sport in the Olympics, and even why participating in it is healthy. We learn that a canoe slalom burns 287 calories per hour, and fencing burns a worthy 408 calories per hour.

You’ll also find write-ups about athletes, including Hong Kong’s, who will compete in various sports.

The London 2012 app – officially called London 2012: Official Results App for the Olympic and Paralympic Games – makes full use of the

controversial spiky style used for the logo and, as a result, is not as pleasant to look at. Beyond the aesthetics, it also features a schedule that you can browse by date or by sport. We are also promised details of all the sports; latest news, pictures and background information – and athletes’ profiles.

Promises aside, a highlight of the app is that you can customise it in the “My Games” section, selecting a country, or a selection of sports or athletes you want to follow.

You can also set reminders. The BBC app tries to be clever and gives you the results based on your location, which, for the international Hong Kong app user, may not be a good match.

It is disturbing that the official app is so lacking this close to the Games. One hopes that it is not an omen of the Games to come. I’ll be sticking with the BBC.

ASK THE DOCTORS DR ANTHONY LUKE Q: I don’t really understand osteoporosis and what is recommended for monitoring. I’m an active and healthy 54-year-old woman.

A: Osteoporosis is a disorder resulting in weak and fragile bones. Being female and ageing are risk factors, as oestrogen levels and bone density decrease when one is post-menopausal. Other risk factors include previous fractures – especially those involving the spine – family history of fracture, low body weight and current cigarette smoking.

The most common test to measure bone density is called a DEXA bone density test. The current recommendations are that an individual should have their bone density tested if older than 65, or after age 50 with any risk factors. There is a useful website (shef.ac.uk/FRAX/tool.jsp) where you can get an estimate of your fracture risk assessment tool (FRAX). This can help judge future action steps to monitor the progression of osteoporosis.

Jeanette Wang jeanette.wang@scmp.com

Exercise and adequate vitamin D and calcium intake are important early treatments to prevent poor bone mineral density. The recommended daily intake is 1,000mg of calcium for adults up to age 50. Women over 50 and men over 70 should increase their intake to 1,200mg per day. The recommended daily vitamin D intake for adults up to age 70 is 600IU (International Units) and increases to 800IU after age 70.

Since you are under 65 and suggest you do not have any risk factors, your risk for osteoporosis is low. A bone density test would not be typical at this time.

Remaining active with some modestimpact physical activity (brisk walking or jogging) and resistance training will help you maintain good bone health.

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

> 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

Liver cancer connected to lost molecule New research offers hope for a novel way to treat liver cancer, the third-leading cancer killer worldwide. Ohio State University scientists have found that the loss of a regulatory molecule called microRNA-122 leads to liver cancer, suggesting that developing a drug that restores levels of this molecule could slow tumour growth. The molecule is found mainly in liver cells and plays a major role in regulating cholesterol in the body, but it’s lost in some people with hepatocellular carcinoma (HCC), the most common form of liver cancer. The study, published in the Journal of Clinical Investigation, manipulated levels of microRNA-122 in mice. Lacking the molecule, the mice livers developed fat deposits, inflammation and tumours that resemble HCC. When the molecule was restored to normal levels, the size and number of tumours were dramatically reduced, with tumours making up 8 per cent on average of liver surface area in treated animals versus 40 per cent in control animals.

Lung function helped by vitamin D Vitamin D may protect you against the negative effects of smoking on lung function, according to a new study published in the American Journal of Respiratory and Critical Care Medicine by Brigham and Women’s Hospital researchers in Boston. A group of 626 adult white men were tracked over a 20-year period to examine the relationship between vitamin D deficiency – levels of 20 nanograms/mm of blood and below – and the rate of lung function decline. “We found that vitamin D sufficiency had a protective effect on lung function and the rate of lung function decline in smokers,” says lead author Dr Nancy Lange. “These effects might be due to vitamin D’s anti-inflammatory and anti-oxidant properties.”

The study, however, has limitations because the data is observational only; vitamin D levels fluctuate over time; and the group consisted of all elderly men. Also, the health hazards associated with smoking far outweigh any protective effect that vitamin D may have on lung function.

The power of green to help us breathe easier The judicious placement of grass, climbing ivy and other plants among the stagnant air of Hong Kong city streets could help reduce levels of two of the most worrisome air pollutants by eight times more than previously believed. Past research suggested that trees and other greenery can reduce pollutants – nitrogen dioxide and microscopic particulate matter (PM) – from the air by less than 5 per cent. But a new study, published in the journal Environmental Science & Technology, shows the effects of greenery are greater: the concentration at street level of nitrogen dioxide can be reduced by as much as 40 per cent and PM by 60 per cent. The authors suggest building plant-covered “green billboards” in these streets to increase the amount of foliage.

NEWS 3 QUIZ

ONLINE HEALTH

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This was considered the true marker of sustained tolerance, the scientists say. A year later, all 11 reported eating eggs and products containing eggs without symptoms as frequently or as infrequently as they chose. The rest of the 35 were able to tolerate higher doses of egg with only mild symptoms.

How much do you know about allergies? Test yourself here with this quiz by the University of Arkansas for Medical Sciences.

Jeanette Wang jeanette.wang@scmp.com Looking for a way to treat your child’s allergy to a certain food?

New research shows that feeding your child increasingly higher doses of that very food can eliminate or ease reactions in most cases.

It may sound counter-intuitive, but a study published last week in The New England Journal of Medicine adds to a growing body of evidence that the approach – known as oral immunotherapy – can, over time, condition the immune system to tolerate the food with minimal or no reaction.

The study, conducted at the Johns Hopkins Children’s Centre and four other US institutions, looked at egg allergies. Recent, smaller studies conducted at Johns Hopkins and elsewhere have shown that the approach can also be useful in treating children allergic to milk and peanuts.

The researchers say the results are promising but caution that, at present, oral immunotherapy is still considered experimental and should not be used outside a strictly controlled research protocol.

In Hong Kong, an estimated 5 per cent of children have food allergies.

Some outgrow them, but for many they are lifelong and require complete avoidance to prevent serious or life-threatening reactions.

In the study, conducted as part of

1. Which of these body systems causes allergic reactions? a. Lymph b. Immune c. Autonomic

In Hong Kong, an estimated 5 per cent of children have food allergies the National Institutes of Healthfunded Consortium of Food Allergy Research, 35 of 40 children treated with egg immunotherapy over 32 months experienced improvement.

The five children whose condition did not improve dropped out of the study, four because of allergic reactions related to treatment.

Eleven of the 35 eliminated their allergies – they were able to have 10 grams of egg protein (equivalent to a large egg) without any symptoms after the treatment period followed by abstention for four to six weeks.

2. An allergen is anything that triggers an allergic or hypersensitive response. Which of these could be an allergen? a. Dust b. Food c. Nickel jewellery 3. What does the body release to combat allergens? a. Plasma b. Epinephrine c. Histamine 4. The most severe form of allergic reaction is known as anaphylaxis.

What happens? a. Blood pressure drops b. Breathing becomes difficult c. Runny nose develops Answers: 1. b; 2. all are correct; 3. c; 4. a and b

YouTube shows the way to beat and treat vertigo ......................................................

Jeanette Wang jeanette.wang@scmp.com Beyond airing videos of Justin Bieber, Lady Gaga and others that numb the mind, YouTube has the potential to spread useful and critical health information that is often ignored.

A study published today in Neurology, the medical journal of the American Academy of Neurology, has found that watching videos on YouTube may be a new way to show the treatment for a common cause of vertigo, which can go untreated by physicians.

Benign paroxysmal positional vertigo (BPPV) is an inner-ear disorder that is a common cause of dizziness. It can be treated easily and quickly with a simple technique known as the Epley manoeuvre, whereby the patient lies on his or her back and the therapist performs a sequential movement of the head into four positions.

But study author Dr Kevin Kerber of the University of Michigan Health System says: “Often the manoeuvre isn’t used and people are told to wait it out or given drugs.”

For the study, Kerber and colleagues searched YouTube for

videos showing the manoeuvre and rated their accuracy.

Most of the videos demonstrated the manoeuvre accurately.

Comments posted regarding the videos showed they were used by both health care providers and patients.

However, the videos lacked information on how to diagnose BPPV. Further, some comments indicate that people without BPPV may be trying the manoeuvre to treat dizziness from other causes, says Kerber.

The team is also working on projects to test the effectiveness of video interventions on patient outcomes.

In the meantime, check out these other YouTube channels for some useful health tips.

American Council on Exercise youtube.com/user/ACEfitness/ Instructional videos for safe and effective workouts.

US Food and Drug Administration youtube.com/user/ USFoodandDrugAdmin Videos on everything medical.

What the Heck Are You Eating with Joy Bauer youtube.com/user/EverydayHealth Myth-busting about everyday food.

4 MEDICAL CASE HISTORY

o la H nge A : ion rat t s Illu

Virus puts the boot into team ......................................................

Eileen Aung-Thwin healthpost@scmp.com The public health agency of Seattle and King County in the US state of Washington received a call alerting it to an outbreak of acute gastroenteritis among participants at a soccer tournament held in the county one weekend.

About 2,000 children from 120 schools in Washington and Oregon participated in the tournament.

The players, chaperones and organisers had eaten at many hotels and restaurants in the area.

The potential fallout was huge.

Officials quickly contacted colleagues at the health departments in Washington and Oregon to help ascertain the scope and reach of the problem. At the Oregon Public Health Division, Dr William Keene, senior epidemiologist with the Acute and Communicable Disease programme, took the call.

The three health agencies swiftly co-ordinated the investigations.

Washington health officials contacted the organisers of the tournament – a task made easier by the comprehensive list of participating teams at the tournament website. Seattle and King County contacted the food establishments in the area to check for reports of food poisoning. Keene and his assistant, Dr Kimberly Repp, followed up with the known victims of gastroenteritis who were from an Oregon soccer team.

Within an hour or two, it

became apparent that the outbreak was limited to members of that team, as organisers and eateries reported no complaints of illness.

Although the outbreak was much more contained than Keene and his colleagues had initially feared, Keene now needed to find out how the illness had spread. Although the impact of the outbreak was limited and unremarkable, investigations led Keene to an exciting discovery that affirmed a hard-to-prove theory that scientists had held for years.

Keene and Repp interviewed the people who had fallen ill – seven in all – to establish a time line and to reconstruct the events. Repp also visited the victims to obtain stool specimens. They found that all seven people started falling ill with vomiting and/or diarrhoea on the Monday night or early Tuesday morning after returning from the tournament on Sunday.

Based on the symptoms, Keene suspected that likely culprit was the norovirus, which is the leading cause of gastroenteritis worldwide.

The stool specimens confirmed Keene’s suspicions.

Norovirus victims usually start exhibiting symptoms 36 to 38 hours after exposure because it is highly contagious. Therefore, Sunday’s lunch became the main focus of investigations to unearth the source of the contagion.

Keene and Repp learned that the victims had eaten Sunday’s lunch in the hotel room – the food was purchased in Oregon before the drive to Washington for the

If the girl did not even return to her room to retrieve her belongings, how was the virus transmitted? tournament. Lunch consisted of sandwich bread, sliced meat, potato crisps, commercially made cookies and fresh grapes.

Their findings showed that no single item was the likely source of the virus. Although the cookies had a higher statistical association with the sickness, only four of the victims had eaten the cookies.

However, when Keene treated the cookies, crisps and grapes, which had been stored in one bag, as a single variable, he found the statistical link to the illness.

The investigators were baffled, however, as to how the virus came to be on a bag of food. It was highly unlikely that the items were tainted at the source of production or sale.

There were no other significant reports of similar sickness in the area.

Repp went back to interview the team members. She returned with a crucial piece of news: a 13-year-old girl had fallen ill before everyone else.

The girl started feeling ill on

Saturday night and had left her roommates to spend the night with a chaperone. While in the chaperone’s hotel room, she started to vomit repeatedly and also suffered bouts of diarrhoea.

The next day, the chaperone drove her back to Portland. The chaperone later also fell ill with acute gastroenteritis.

However, the girl did not have any contact with her teammates once she started being symptomatic. She was also absent from the Sunday lunch and had not touched any of the food items.

Keene says that an ill person becomes infectious only when they start vomiting and having diarrhoea as the virus is carried in the body fluids. To infect another person, the virus has to be ingested. If the girl did not even return to her room to retrieve her belongings, how was the virus transmitted? Also, there was a 12-hour gap between the onset of her symptoms and the exposure of the rest of the team.

Keene and Repp continued to dig for answers, making round after round of calls to mine the team members for more information.

The mystery was finally solved when it came to light that the chaperone looking after the girl had done a most unusual thing: store the reusable grocery bag containing the lunch items in the bathroom.

When the girl vomited, the virus aerosolised in the bathroom and settled on various surfaces, including the grocery bag and its contents. Then people handled the contaminated bag and food items.

By a stroke of luck, Keene learned that the grocery bag in question had eventually been left on the kitchen table in the home of the chaperone. The chaperone then left on a short business trip and fell ill during that time.

In the meantime, her family members also handled the grocery bag and also became ill.

Keene obtained the grocery bag two weeks after the tournament and had it tested for the norovirus.

The results were positive.

Scientists have known that a norovirus can be transmitted via fomites or inanimate objects. But the role of fomites in an outbreak have been difficult to assess decisively, as environmental surfaces are seldom tested for the virus in the event of an outbreak.

In this case, though, Keene was able to reconstruct the sequence of events and prove that the grocery bag and its contents had been contaminated through airborne transmission and became a source of the disease outbreak. So, people can get sick by simply touching contaminated surfaces.

The difficulty with controlling a norovirus outbreak is that only a minute amount of virus is needed to make you ill and it is hard to kill.

Keene recommends that victims be confined to using a designated bathroom, if possible, for the duration of the illness.

All environmental surfaces, including door knobs, taps, toilet flushers and other such items, should then be cleaned with a 10 per cent household bleach solution.

MEDICAL 5 COMMUNITY

Batsman smashes India’s cancer of silence ......................................................

Amrit Dhillon healthpost@scmp.com It can’t be confirmed, but it’s almost universally believed in India that the country’s most famous politician, Sonia Gandhi, went to the US last year for cancer treatment. She, her family and her ruling Congress Party are silent on the subject.

This used to be the typical pattern in India among the rich and famous: after being diagnosed with cancer, slip out of the country to get treatment at a foreign hospital so that no one would ever find out.

The stigma attached to the disease has ensured that every Indian, rich or poor, keeps it a secret.

The family retreat into a fortress. The word is never uttered.

Singh has done in India what Betty Ford did with breast cancer in the US. He broke the silence HARMALA GUPTA, CANCER PATIENT

But finally someone has smashed the silence. After being diagnosed with lung cancer in February, national team cricketer Yuvraj Singh, 30, told reporters his reaction was: “How can it be me? I’m an athlete. I run six hours a day.” Once he had accepted the diagnosis, he chose to be open about it.

Singh sought treatment abroad, not to keep it a secret, but because he feared a media circus outside his hospital room every day if he stayed.

From his bed at the Cancer Research Institute in Boston, Massachusetts,

Indo-Canadian actress Lisa Ray

he kept updating his Facebook profile and posting tweets, giving his fans updates on his treatment and the state of his emotions with candour, saying he was inspired by cyclist Lance Armstrong’s account of his battle with cancer.

Singh has chronicled his emotions on having chemotherapy, losing his hair, nausea (posting pictures of himself looking ashen-faced and exhausted), moments of low spirits and what kept him going – his mother and the affection of his fans.

Asked why he has been so honest, he says: “I made a mistake in ignoring it. I was coughing, coughing up blood sometimes and not able to breathe on one side, but I was so concerned with my cricket that I didn’t get it checked. I want people to be aware so that they don’t make the same mistake.”

One person who was thrilled with Singh’s openness was New Delhi cancer survivor Harmala Gupta. “No one around me had ever had cancer or survived it, it seemed, because no one had ever talked about it,” she says.

Gupta’s battle with lymphoma began two decades ago, and in that time, she has fought to destroy the stigma of cancer in India. She also runs a free home-care programme that treats patients with dignity.

“Singh has done in India what Betty Ford did with breast cancer in the US,” she says. “He has broken the silence. I am sure it will have a very positive effect on others because he is an icon.”

But actually, there was someone before Singh: Indo-Canadian actress and model, Lisa Ray, who has made her home in India.

Ray was diagnosed with multiple myeloma, a malignancy of the plasma cells in the bone marrow considered fatal, in June 2009 at the age of 37. Her refusal to hide her illness was covered in the Indian press but had less impact than Singh’s case because she spends only half her time in India.

Nonetheless, her blog was both brutally honest and humorous – how she was ravenous all the time from the steroids, the impact of other drugs, how she refused to let the disease “tyrannise” her, and how her body shape and weight fluctuated wildly during treatment.

Ten months later, Ray was cancer-free and has since championed the cause of stem cell transplant treatment, which she describes as “like being reborn from the inside out”.

Dr Bhawna Sirohi, oncologist at the Artemis Health Institute near Delhi, has treated many well-known people for cancer.

She admires Singh’s frankness.

“It will lead to increased awareness and to people going for check-ups if there is something amiss,” she says. “At the moment, 60 per cent of my patients come to me when it’s already too late.”

Cricketer Yuvraj Singh, right; young fans, left, pray for their hero’s recovery at Amritsar in February.

Photos: AFP

6 COVER STORY

The

W

ith floor-to-ceiling glass windows overlooking the lush greenery of Lion Rock, the private room on the 11th floor of Union Hospital in Tai Wai boasts all manner of luxurious amenities.

A massage chair, flat-screen television, a remote control for your air conditioner and blinds – nothing in the room suggests this is a place where patients recover from surgery. All the tubes, suction and oxygen pumps, and other medical equipment are hidden behind cabinets mounted on the wall.

“Such design ingenuity can help patients forget that they are in a hospital,” says Cheng Sze-man, nursing officer of Union Hospital’s private ward. “Having a nice environment to rest in also speeds the recovery process.”

The private hospital is among several that have set up luxury wards to cater to the rising number of affluent patients.

Private hospital administrators say the establishment of luxurious private wards can help diversify their businesses and satisfy the big demand for superb hospital care from well-to-do mainland, overseas and local patients.

Of the 12 private hospitals in Hong Kong, eight feature luxury wards. Most of these made their foray into the luxury market in recent years. The latest to jump on the bandwagon is St Teresa’s Hospital in Prince Edward, which opened its luxury ward last year.

Located on the seventh floor of the hospital’s main block, the ward has 22 private rooms and two suites, which cost more than HK$20 million to build. Private rooms start from HK$3,000 to HK$4,000 per night; suites, which occupy half the floor, cost HK$11,000 to HK$15,000 per night.

The suites have marble flooring and a secret passageway leading from the car park so that guests can have the utmost privacy. The toilet is an advanced model with a seat warmer and an automatic seat cover that lifts and closes before and after use. There is a television set in both the bathroom and separate guest room.

Chief nursing officer Florence Chiu Sau-chu says the renovation caters to an increasing number of wealthy mainland patients who are demanding the best facilities and services. “We have regular private rooms that cost HK$1,000 per night.

But they have long waiting lists.

Patients often ask us whether we have something better which can be booked on shorter notice.”

Hence the new luxury ward, which is a big improvement on the private wards of the past.

suite life Private hospitals are answering the call for more luxury rooms, writes Elaine Yau

“The two suites in the past were large but lacked luxurious features like separate guest rooms. Now, aesthetic concerns have been taken into account. Everything is grand, so visiting relatives, not just patients, can have a comfortable stay.”

Even the staff in luxury wards have been given a makeover.

Matilda International Hospital in Central, which launched its private ward last year, introduced new uniforms this year.

“The design of the uniform matched that of the lobby better,” says a hospital spokesman. “Many of the staff there worked in hotel, airline and other customer services sectors before, so they know how to serve people. We even employed chefs from five-star hotels so that patients can enjoy hotel-style food.”

Matilda has eight private rooms at the medical, surgical and paediatric ward that cost HK$2,970 per night, with two VIP rooms costing HK$4,000 per night. In 2008, the hospital launched a day-case unit with five private rooms, where outpatients or those admitted for routine check-ups without needing to stay overnight can recuperate in comfort. Each room costs HK$1,445 per day.

Both Hong Kong Sanatorium and Hospital in Happy

Everything is grand so that visiting relatives, not just patients, can have a comfortable stay FLORENCE CHIU SAU-CHU, CHIEF NURSING OFFICER, ST TERESA’S HOSPITAL

Valley and St Paul’s Hospital in Causeway Bay opened their luxury wards in 2009, devoting entire floors to deluxe rooms.

The drive to develop luxury wards to attract big-spending medical tourists from the mainland and overseas has become more urgent in light of the recent government decision to ban mainland women from giving birth in private hospitals from next year.

Baptist Hospital in Kowloon Tong has been looking for ways to plug the expected loss in revenue from gynaecological services. The hospital admitted more than 10,000 pregnant mainland women last year, accounting for 80 per cent of all delivery cases.

A Baptist Hospital spokesman says they will enhance other services at the hospital in response to the ban. “We will redeploy our manpower and resources,” he says.

“Concrete details are being discussed. They will be finalised at the end of this year.”

By 2014, the hospital will have a new block and 100 beds with deluxe private and private rooms, says the spokesman. It already has 19 private rooms which cost HK$2,800 per night in its luxury wards.

The aim is to make patients feel like they’re at home. “There’s a microwave, refrigerator and two televisions in the room, with one television mounted on the ceiling for reclining patients. The large windows offer a panoramic view of the Kowloon peninsula, and soft and wooden colours in furnishings are used to create a cosy environment,” says the spokesman.

Of the eight hospitals outfitted with deluxe wards, Union Hospital boasts the most luxurious – the six suites with jacuzzis cost from HK$4,800 to HK$8,000 and can be joined together to form a super deluxe suite costing a whopping HK$45,000 per night. Only one celebrity has opted for such extravagant treatment.

With collapsible partitions, the suites can be customised to form

varying sizes. The 11 smaller private rooms on the same floor cost from HK$2,300 to HK$3,500. A designer for the Four Seasons hotel was brought in to help with the design at the 11th floor luxury ward, which opened in 2006.

Compared with the regular rooms at the hospital that cost HK$550 to HK$680 per night, patients at the luxury ward enjoy a host of special services.

The patients are served by a team of 18 nurses, with one in charge of three to four patients. One day before admission into hospital, patients get a call reminding them to observe a midnight fast and other matters. Rooms will be cleaned only when patients are out for testing or check-ups.

While flashy facilities can spice up an otherwise dreary hospital stay, Cheng of Union Hospital says a personal touch is key to giving patients a good impression. This includes catering to personal preferences, such as wake-up times and mattress softness.

“We will record [the preferences] so that the patient doesn’t have to mention it again during his or her next stay with us,” says Cheng, adding that the hospital has many return patients.

Even Chinese geomancy is factored into the design. Discarding chronology, the room signage at the ward omits the number four, which is associated with death in local custom. Room numbers end with eight or nine, which is associated with fortune and longevity.

Although 30 to 40 per cent of the clientele in Union Hospital’s luxury ward are expectant mainlanders, Cheng says that the ban next year won’t affect their business at all.

“Luxury wards are the future trend in all private hospitals. With a new block under construction, we foresee that we will get more and more rich patients. Besides pregnant patients, we serve all kinds of people, including expatriates who work on the mainland but return to Hong Kong to seek treatment.”

Despite the rush to develop luxury wards, Private Hospitals Association chairman Alan Lau Kwok-lam says investing in luxury offerings should not be the future direction of private hospitals.

“The space occupied by a luxury bed can accommodate eight to 10 regular beds,” he says. “We are suffering from a shortage of beds.

The four sites earmarked by the government for the development of private hospitals are mostly for day-to-day, not luxurious, services.

The development of luxury wards is the policy of individual hospitals, not the general direction of the whole sector.” elaine.yau@scmp.com

IN SICKNESS AND WEALTH Eight of the 12 private hospitals in Hong Kong have luxury wards.

All rates are on a per night basis.

Adventist Hospital, Stubbs Road – private rooms from HK$2,980; VIP rooms from HK$3,800

8,000

$

• The top price per night, in Hong Kong dollars, of one of Union Hospital’s six jacuzzi-fitted suites

Baptist Hospital, Kowloon – private rooms from HK$2,800 Canossa Hospital, Old Peak Road – private rooms from HK$2,550 Hong Kong Sanatorium and Hospital, Happy Valley – private rooms from HK$3,180; suites from HK$10,390

Matilda International Hospital, Mount Kellett Road, The Peak – private rooms from HK$2,970; VIP rooms from HK$4,000 St Paul’s Hospital, Causeway Bay – private rooms from HK$2,280; deluxe rooms from HK$3,600 St Teresa’s Hospital, Prince Edward – premium private rooms from HK$3,000; premium suites from HK$11,000 Union Hospital, Tai Wai – private rooms from HK$2,300; suites from HK$4,800; super deluxe suite HK$45,000

COVER STORY 7

Clockwise from below: Cheng Sze-man, nursing officer at Union Hospital, says a personal touch is key to a patient having an enjoyable hospital stay; Union Hospital has the most luxurious private rooms; a private room at Baptist Hospital, which has 19 private rooms but is expanding; a private room at Matilda International Hospital, which also has two VIP rooms in the medical, surgical and paediatric ward. Photos: Dickson Lee

8 ALTERNATIVE THERAPIES

TRADITIONAL PRACTICES

When smoke gets in your thighs ......................................................

Sunory Dutt healthpost@scmp.com

Vaginal steaming requires evidencebased proof which is not yet available DR JAYANTA DE, PROFESSOR AND HEAD OF OBSTETRICS AND GYNAECOLOGY, MVJ MEDICAL COLLEGE AND RESEARCH HOSPITAL

It’s known by different names throughout the world – chai-yok in Korea, ratus in Indonesia, ganggang in Malaysia, bajos among Mayan healers and Venus smoke in North America.

A centuries-old practice more common on the Asian subcontinent, steaming of the female genitalia over a pot of herb-infused boiling water is known for its curative effects on health and fertility. It is said to reduce stress, fight infection, clear haemorrhoids, regulate menstrual cycles and aid infertility, among other health benefits.

And the practice is making something of a comeback. In Singapore, for example, Babies Bellies Javanese Massage & Spa offers a 20-minute treatment at S$50 (HK$310). The spa’s managers claims it has seen a steady increase in the number of women who request the treatment, especially post-pregnancy.

And it is catching on in the US where the upscale Juvenex Spa in New York has a 30-minute Gyno Spa Cure for US$75, while Tikkun Holistic Spa in Santa Monica, California, offers a 30-minute V-Steam treatment for US$50.

There is folk wisdom – and even some logic – to support the idea that the carefully targeted steam may provide some physiological benefits for women.

But there are no studies to document its effectiveness, and few Asian doctors we questioned had even heard of it.

Dr William So, a specialist in Reproductive Medicine at Premier Medical Centre, says: “There’s no peer-reviewed information [on vaginal steaming] in medical journals.

“The first concern is the possibility of the moist heat causing burns to the sensitive region. And how much of the active ingredients are absorbed is questionable. There’s no way for us to assess its efficacy.”

Dr Jayanta De, professor and head of obstetrics and gynaecology at MVJ Medical College and Research Hospital in Bangalore, India concurs: “Though lots of claims have been made regarding its gynaecological remedial capabilities, it requires evidence-based proof which is not yet available.”

A typical session begins with chai-yok, or a pot of boiling water infused with 14 to 20 herbs. The primary herbal ingredients are mugwort and wormwood, which have alleged antibacterial, antiviral and antifungal properties.

The moist heat opens the pores of the tissues it comes into contact with.

The use of specific herbs adds layers of different healing benefits. The combination of herbs works to nourish, tone, heal, bring in fresh oxygenated blood, promote cleansing, and make supple the vaginal and uterine tissues.

In South Korea, many women steam regularly after their monthly periods, as it’s believed to boost circulation, supplying nutrition to the lower part of the body.

Martha Tilaar Salon and Day Spa, which has branches across Indonesia, lists on its website the 120-minute Ken Dedes Princess Ritual as one of its signature indulgences.

The package begins with a massage that claims to “increase blood circulation, soothe nerves and muscles”. It’s followed with a hot, herbal bath and a “unique feminine smoking ceremony that aims to cleanse a woman’s sexual organ and remove unpleasant odour”.

“You sit on a stool without a seat, just the frame. The therapist prepares a concoction of herbs that are smoked with small pieces of incense-like objects.

This is placed under your stool and the fragrant smoke rises up between your legs into your nether regions,” says Ana Ow, a mother of two who tried the treatment at the Martha Tilaar Spa in Bintan.

“It felt like a sauna or steam room just for that area. I felt refreshed and clean after it.”

Ow says she would recommend the treatment because she believes in Asian homeopathic remedies.

“Rituals such as these have been passed down from generation to generation for healing and rejuvenating purposes, way before Western medicine came up with clinical treatments and drugs that may act on symptoms but not heal from within.”

Bang Wei-tin, a writer, has also tried the treatment. “It lasts about 15 minutes and can be almost unbearable. Steaming is said to beautify and tighten the vagina wall and make sex better. A gynaecologist said it could open up the uterus, but I didn’t feel any side effects.”

The staff at Babies Bellies admit that the ganggang treatment hasn’t been scientifically proven, but they believe the fact that it has been passed down through generations is validation of its efficacy in drying up stitches post-delivery, reducing excessive discharge and helping to tighten the vaginal wall. But they warn that the steaming shouldn’t exceed 20 minutes.

Obstetrician-gynaecologist Margaret Polaneczky of The Blog That Ate Manhattan, says: “I’d avoid the vaginal steam spa. Especially if you are prone to yeast infections, since yeast loves a warm, moist environment.”

Women who experience heavy menstrual cycles should avoid vaginal steaming during their periods.

If you have a vaginal infection, open wounds, sores, or blisters, do not know if you are pregnant or think you may be, the treatment is definitely to be avoided.

And if you have genital piercings, you might want to take them out. The heat could cause the piercing to scald you.

ALTERNATIVE THERAPIES 9

MIND-BODY WELLNESS

Who would

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

Jennifer Huang healthpost@scmp.com Can you improve your memory, concentration and vitality through a combination of natural herbal concoctions and chiropractic techniques? The Brain Boosting Package offered by the Holistic Central Medical Practice claims to achieve all that.

The first part of the HK$5,800 package involves a comprehensive interview about my medical history with naturopathic physician Dr Benita Perch.

We discuss standard medical issues such as chronic illnesses, surgery, medication, diet and family history. The conversation also covers those recurring subclinical concerns that, in spite of repeated tests and examinations, have never been fully resolved at the GP’s office.

In my case, this includes mysterious fits of sneezing, reactions to unidentified but persistent allergens, recurring fortnightly urinary tract infections, irregular bowel movements and general fatigue.

“Natural medicine is about using natural substances with a clinical application,” says Perch. In natural medicine, physical and emotional symptoms are not separate. So it’s just as important to take the whole basket of symptoms into consideration.”

Besides discussing key issues during my first visit, we also go over the details of my health, both the psychological and the personal – from setbacks in my career and quarrels with my husband to a recent recovery from a five-year eating disorder. Perch prescribes a course of green powder capsules, probiotics, and a homeopathic remedy.

It is the first time that I’ve encountered homeopathic medicine. The small, white pills are slightly sweet, like enlarged granules of sugar – three of which I am told to dissolve under my tongue daily.

These are dilutions of herbal or mineral essences and work on the body through vibrations or

have guessed? frequencies, Perch says. The greater the dilution of the ingredient, the more potent the medicine.

The second half of the treatment involves an examination by Dr Wendy Yang, who specialises in chiropractic techniques. She explains the body’s physiological responses to threat called “fight or flight” whereby certain stress hormones are triggered to ready the mind and body for survival.

Although it is a short-term response, city life can present episodes of extreme daily stress that can keep urbanites in a state of tension.

“The tension we store in body can be stress from work, low levels of built-up stress, or conditioning patterns from when we’re five years old,” says Yang. “When people first come in their bodies are still on guard, in fight or flight mode. It’s a good way for me to unravel that shell, take off the armour.”

I fill out a brief questionnaire, rating my different levels of wellness on a five-point rubric. Yang checks my posture and then has me lie face down on a table to check the tension patterns in my body. With her fingertips, she touches a spot on my lower back – a “spinal gateway” that functions as a valve of sorts for the body to regulate tension.

According to Yang, I store a considerable amount of tension deep in the L4 and L5 lumbar segments which can’t be resolved in a half-hour session. She asks me to turn around, lying on the table supine, and instructs me through a series of deep breathing exercises where my hands are placed on my chest, then midsection, and finally

If [a problem] has been going on for more than five years, then it’s not something that I can fix in two weeks DR BENITA PERCH, NATUROPATHIC PHYSICIAN

lower belly. She sends me off with some “mind-body” breathing techniques to practise at home every morning after waking.

Breathing while lying in bed in the morning feels pretty good. For the first few days, something in either capsules causes a mild case of loose stools. The belly bloating does go down a bit in the three weeks.

However, after the initial session, I am disappointed by the lack of noticeable improvements.

In part, the name “Brain Boost” is a bit of a misnomer. No amount of herbs or dilutions can create mental powers not there already. Still, I entertain some notion that the treatments might bestow an extraordinary mental acuity.

After three weeks, the homeopathic vibrations and the mind-body breathing start to seem like nonsense. The treatments are fairly harmless. Beyond that, they seem to have little effect.

I mention as much to Perch when I return to her office for a follow up. But as she asks me some targeted questions, I realise there have been some subtle changes. For example, the bowel movements have been much more regular. Also, the minor bladder infections that have persisted throughout much of my adult life have disappeared.

Although the sneezing fits haven’t gone away, they are less frequent.

The bloating in my stomach feels much reduced and I am more motivated to run or to practise yoga.

And during the entire course of the treatment, I have not had a spat with the husband.

How much of this can be

attributed to the treatments? I have experienced some, if undramatic, improvements. But it’s hard to say whether it’s a result of the Brain Boost or just circumstantial.

It’s at this point that Perch asks whether I like thunderstorms and furry animals. She also asks whether I like to dance. Yes to all of these, I reply, adding how it is odd that she should ask. In a conventional doctor’s office, a patient’s personality has little bearing on prescriptions. But it does make a difference in holistic medicine as the approach is to treat the overall condition – physical, psychological and dispositional.

Perch says that on my first visit, the state of anger was apparent, like a dark cloud hanging over me. But this agitation appears to have abated substantially and she wants to prescribe a different homeopathic dilution more appropriate to my current disposition.

Yang re-examines my back. The tension is still there, she says, but the type of stress is different than before, broken up a bit and closer to the surface as opposed to where it was – embedded deep in my lower lumbar segments. I fill out another questionnaire to compare my wellbeing against that on my first visit.

“Generally, with the course of treatment, this kind of improvement usually takes more than two or three visits,” says Yang. “So I’m quite happy with what you’ve reported, just looking at the numbers and where you’re at.”

“Actually, your situation was more complicated,” says Perch when I ask how my experience differs from other patients. Others who have tried Brain Boosting mostly complain of stress, anxiety, fatigue and problems sleeping.

Perch has also treated women for PMS and painful menstrual periods as well as patients with irritable bowels, chronic fatigue syndrome and fibromyalgia. Treatments are customised for each person.

“If [a problem] has been going on for more than five years, then it’s not something that I can fix in two weeks,” says Perch. “Otherwise, I’d be a miracle worker.”

10 DIET NUTRITION SEA BUCKTHORN

It won’t help you fly, but it has benefits ......................................................

Sunory Dutt healthpost@scmp.com Legend has it that the sea buckthorn was the preferred berry of Pegasus, the mythological Greek horse, for its flight-inducing qualities.

A relatively recent entry to the list of “rediscovered” foods, this unassuming orange berry, native to Europe and Asia, might not help lesser mortals like us take to the skies, but it’s making its presence felt in the medical world for its health benefits.

Sea buckthorn is available in the form of supplements, oils, essences, or even cosmetics. Its juice was the official drink used by Chinese athletes during the 2008 Beijing Olympics and they won 51 gold medals.

Pharmaceutical company Tangut, which introduced seaberry essence to the Hong Kong market in January, claims the berry has brought relief to many people suffering from mouth ulcers by accelerating healing and boosting immunity.

A study by the University of Saskatchewan in Canada and the Indian Institute of Technology have discovered that sea buckthorn berries contain a potent mixture of

vitamin A, K, E, C, B1 and B2. In fact, the berries provide 10 times more vitamin C than oranges and are the third-highest source of vitamin E in the plant world.

Also found were high levels of omega-3 fatty acids, amino acids, folic acid and flavonoids that help to strengthen the immune system and heart and provide protection from disease. It’s interesting that it’s the only plant known to contain essential fatty acids 3, 6, 7 and 9.

The superfruit is said to contain more than 190 bioactive nutrients and has a high abundance of some of the rarest and most powerful antioxidants in the world.

A report in the Indian Journal of Medical Research in 2009 said sea buckthorn berry extract had a positive effect on human cancer cells in certain situations.

These berries, taken since the time of Genghis Khan, are rich in antioxidants that inhibit “bad” cholesterol oxidisation, or LDL, which could fight cardiovascular disease. When LDL is oxidised, it sticks to the lining of blood vessels.

Consuming the berries is said to prevent clogged arteries.

One component of the sea buckthorn’s oil, palmitoleic acid, is also present in human skin, which explains why it is used for healing

Sea buckthorn berries are high in a range of vitamins. Photo: Corbis

burns, wounds and skin diseases. It was used to heal burn victims of the 1986 nuclear disaster at Chernobyl, Ukraine. Russians use the oil on cosmonauts to help heal radiation skin burns that occur when they re-enter the earth’s atmosphere.

In a June 2006 study, Chinese researchers investigated the therapeutic effects of the oil on burn wounds by applying the oil to the dressing. This treatment was given to 151 burn patients, who experienced reduced swelling and pain as well as faster skin regrowth than the group receiving only petroleum jelly treatment.

Experts believe sea buckthorn’s mix of fatty acids signals the body to

stop storing fat, and celebrity nutritionist Dr Oz says it melts fat immediately. Adequate amounts of vitamin B12, found in sea buckthorn, help halve the rate of brain atrophy, which can lead to Alzheimer’s disease and dementia, a study by Oxford University and the University of Oslo found.

Every part of the plant multitasks as a food or medicinal source.

• Leaves Sea buckthorn tea has no caffeine, is rich in proteins, vitamins and minerals, and has traditionally been used for improving the digestive system and skin.

• Berries Especially in Germany and France, sea buckthorn is sold as fruit juice or as an ingredient in

non-alcoholic and alcoholic mixed beverages. The pulp is also used to make jams and compotes.

• Oil Often commended for its antiageing properties, sea buckthorn oil is used to treat acne, burns, skin ulcers, and various types of dermatitis, including eczema. It has been reported to give amazing results in a shorter time. It’s also been proven to help keep mucus membranes lubricated, relieve constipation and strengthen teeth.

Because of its nutritional and botanical characteristics, no reports of adverse reactions or side effects of the oil have appeared yet. Even so, it is always wise to consult your doctor before using the supplement.

HEALTHY GOURMET

Dinner in a bag: now that’s what I call nourishment ......................................................

recipe that is healthy and delicious, offering a depth of flavours that is sure to satisfy.

Al cartoccio, Italian for “in parchment”, is a healthy, simple and fast way to cook food in your oven and yet keep all the nourishing qualities on your plate.

It’s perfect for large dinner parties when you don’t have much time to keep track of what is being cooked.

Andrea Oschetti healthpost@scmp.com Food should come first in our lives, and above all it should be nourishing. This is my third principle for healthy eating, after flavour and mindfulness, which we discussed in the first two columns.

To prepare nourishing foods, use the freshest ingredients – organic when possible – and light cooking techniques. Choose ingredients that are rich in vitamins, minerals and antioxidants. Aim for a meal which provides a balanced set of nutrients, which are naturally anti-inflammatory, anti-ageing and stimulate different organs.

Avoid sugars and processed food.

Use top-quality oil, preferably raw.

Use whole grains or high-quality flours and limit the amount of dairy and meat in your diet.

Mediterranean sea bass al cartoccio with pistachio cream Sea bass is ideal for this recipe, but any flaky white fish will suffice Good food is medicine for the body that protects us from common diseases and the development of allergies and other intolerances. Good food is a key component in any healing process

and makes us look and feel good.

Best of all, good food gives us the energy we need to engage in exercise, which is fundamental to our well-being.

Here is an example of a simple

4 sea bass fillets (150 grams each), or any flaky white fish 1 bunch Italian parsley, chopped A touch of fresh grated ginger 2 cloves garlic, finely chopped A handful of capers Juice of half a lemon A pinch of salt and pepper 3 tbsp water or fish stock

For the pistachio cream 150 grams tofu 4 cloves garlic A handful of pistachio nuts • Place a fillet of sea bass on a large sheet of baking paper • Add parsley, ginger, garlic, capers, lemon juice, salt and pepper • Add the water or fish stock. Wrap the baking paper into a pouch and close it with a string • Place it in a 180-degree Celsius oven for 10 minutes • For the pistachio cream, place the tofu, garlic and pistachio in a mixer and process until smooth (who says you need cream to make a delicious sauce?)

• Place a generous dollop of the pistachio cream on the fish and serve • Buon appetito.

Healthy Gourmet is a weekly column by private chef Andrea Oschetti. He can be reached at andrea@fioreblu.com

WELL-BEING 11 FIT & FAB

THE TASTE TEST POPCORN

Pushing through the pain ......................................................

Rachel Jacqueline healthpost@scmp.com Nicolas Faquet, the Hong Kong CEO of online insurance company DirectAsia.com, ensures his own healthy life through a passion for cycling.

Before the city wakes most mornings, Faquet, 39, has already cycled his favourite route from Causeway Bay to The Peak – not once, but three times.

The bike fanatic has four top-of-the-range bikes in four locations – Hong Kong, Singapore, Spain and at his holiday house in Phuket, Thailand. And that’s not all of his collection.

So strong is Faquet’s passion that if he’s going to be in another part of the world, he always brings a bike.

“I love seeing new places on my bike when I travel; being free, no need to prepare, no need to do anything – just get on your bike and go.”

Earlier this year, he pedalled his passion into his company by sponsoring a team of amateur cyclists in Hong Kong. Team DirectAsia’s 13 riders race in the territory and the surrounding region. In time, Faquet hopes to grow the team to 20.

But 12 years ago, Faquet would not have recognised the cycling devotee he has become. A French

expat living in Singapore, Faquet smoked, drank and partied regularly and never exercised. “I was not living a very healthy lifestyle,” he admits. In December 1999, with the pending new millennium, Faquet decided he was going to do things differently and threw himself into triathlons.

While triathlons didn’t stick, cycling did. He has cycled in many races in Hong Kong and overseas and logs up to 400 kilometres a week, training every day.

With each bike worth up to HK$100,000, it’s a large investment and one he admits is a waste of money, given the marginal competitive advantage the extra expense provides. But for Faquet, it’s also an insurance against failure.

“That way I know that if I stuff up, it’s not the bike,” he says. “It’s because I’m not good enough.”

Describe yourself without cycling Overweight, drinking a lot and probably still smoking. These days I don’t go out much because of cycling, except in the off-season.

When you know you’re going to wake up at 5.30 the next morning with guys who are stronger than you, you don’t go out partying.

What do you sacrifice for cycling?

If anything, it would be sleep. I wake up early on weekends, so I never get

a sleep-in. I’m usually out and back before mid-morning. I’m lucky to have such an understanding wife.

How do you pull yourself through the tough moments on the bike?

I always rationalise that it’s only five minutes of your life. If you don’t give it your best, you’re going to regret it; it’s nothing in the grand scheme of things, and that pain will disappear.

One of my favourite quotes is “pain is temporary; shame is permanent” That gets me through.

You say it’s not about winning. If not, then what is it about?

It’s about pushing yourself and suffering. Yes, suffering. I think cycling is a masochistic sport. You put yourself in a situation where you’re struggling and you can’t breathe; everything is painful, but you keep pushing. That feeling of fighting against yourself is very rewarding. You say to yourself: “I’m not giving up. Even if I lose, at least I was there.” That’s the exciting part.

Beyond that, the health aspect is also important, plus the sense of adventure. You see a lot of things when you ride as much as I do.

Do you think your French roots help you in cycling?

Probably. Even though I didn’t start cycling until I was older, I have been watching the Tour de France since

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Jeanette Wang jeanette.wang@scmp.com

the early 1990s. I have always found it a great sport. I used to take a day off to watch the final stage every year. Some of my family are pretty good cyclists, but I always watched from afar.

What do you consider your greatest success on a bike?

I recently completed an 800kilometre bike ride from the Thai border to Singapore, called the Trans-Malaysia Express. It was a big achievement. It took us – a group of 17 guys – 43 hours, during which we slept for a total of just three hours.

Overall, we raised more than S$90,000 (HK$554,000) for a Singaporean charity that cures cataracts in Indonesia. My company, with its 80 employees, raised S$7,000. I like to try and set an example for my staff.

Newman’s Own Organics Pop’s Corn HK$45 for 281 grams, ThreeSixty The fat-conscious will be pleased to know that organic palm oil, and not partially hydrogenated oils or trans fatty acids, are used in this microwave popcorn.

The box contains three individual “pop and serve” bags, each packing 123 calories, 5 grams of fat and 4 grams of dietary fibre.

Verdict: light, fluffy and just salty enough, with real butter flavour.

If you could change anything about cycling, what would it be?

The danger factor. I’ve seen so many friends get into bad crashes. You know each time you climb on a bike you may not come home. It’s bad in Singapore and in Hong Kong.

There are a lot of skills that are important to reduce the risk, but sometimes it’s just random. The more you ride, the more experience you will gain, but on the other hand, the more you ride, the more exposed you are to danger.

Wild Harvest Organic Original Microwave Popcorn HK$35 for 255 grams, ThreeSixty This has almost the same ingredients as Newman’s, sans butter, so each serving has considerably less fat at 2.5 grams, 120 calories and 4 grams of dietary fibre. If you’re bored with plain popcorn, the box has a recipe to dress it up into something sweet and spicy.

Verdict: light and crisp but a bit too salty.

Nicolas Faquet likes to see new places from the saddle when he travels. Photo: Nora Tam

Organic Gold Rush Popcorn Kettle Corn HK$27 for 141 grams, City’super This handmade popcorn is made the old-fashioned way – one batch at a time in a fire-burning kettle – and contains just four ingredients: popcorn, expeller pressed soya bean oil, evaporated cane juice and sea salt. Each 30 gram serving packs 150 calories, 8 grams of fat and 3 grams of dietary fibre.

Verdict: with a perfect balance of sweetness and saltiness, this variety is thoroughly addictive.