20120911 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, SEPTEMBER 11, 2012

HEALTH POST

WHAT’S COOKING, GOOD LOOKING? >PAGE 8

WHY SMILING IS GOOD FOR YOU >PAGE 12

Into the black Guides help blind runners find their feet

>PAGE 6

Illustration: Man Wai-yee

2 NEWS APP OF THE WEEK

HEALTH BITES ......................................................

Smartphones can help you get into the swing of things ......................................................

Katie McGregor healthpost@scmp.com Golf My Way HK$38 Rating 9/10 Sometimes it does not pay to go for the “latest”, as I discovered learning to play golf through my iPhone.

Not having the will or the finances to play the sport in Hong Kong, I was lucky enough to get my first taste over the summer, playing nine-hole pitch and putt on Northern Ireland’s Royal Portrush Golf Club championship course. I was surprised to find that it was fun, but, being clueless, I played a game that was way over par and tested the patience of the group behind.

Clearly, I needed to get some training. Golf Lessons with Jay Golden was one of the latest releases at the iTunes store and at only HK$15 it seemed a good deal. I started watching the first video: “Does your grip suit your swing?”

Golden asks. With the buzzing of a helicopter in the background he continues: “What does that mean?”

And then he goes on. After several minutes of meandering thought, he still hadn’t told me much about the grip. I then understood why golfers have a reputation for being bores.

Back to the iTunes store, but this time I settled for Golf My Way, the

app by golf legend Jack Nicklaus. I argued that with all his winnings, he’d have hired a top-flight production team who would dissuade him from ponderous monologues. They succeeded.

Niklaus is informative and almost succinct. Within seconds I learned that there are 14 possible golf clubs that can be used, but that Niklaus believes that all golf shots should be played with one basic stroke. This approach is slightly controversial, but with his experience and 73 PGA Tour victories, I was more than happy to follow his simpler ethos.

Golf My Way comprises 26 videos, each about three minutes long, covering topics from grip through ball position to bunker shots. Golden demonstrated just how long three minutes can be, but Nicklaus shows just how much quality can be squeezed into a short time, and that’s what you want when you’re playing the quiet game.

Jeanette Wang jeanette.wang@scmp.com

Sip and spa for a cause If you have been craving some pampering, October is a good time to indulge at the Mandarin Oriental hotel. The Tickled Pink ManiCURE (HK$350) at its luxurious Mandarin Salon will not only benefit your hands but also the Hong Kong Breast Cancer Foundation. The manicure price includes a HK$100 donation, matched by the hotel, to the charity. You will also get a glass of rosé, a “Life Token” and a bottle of OPI nail varnish. Or if you’re just feeling thirsty, the Pink Whisper Cocktail (HK$188) at the hotel’s M bar includes the donation and token as well.

A point well made To needle or not to needle? Scientists say the benefits of acupuncture are better than sham acupuncture or none at all for treatment of chronic pain. This is according to a report in the Archives of Internal Medicine.

Researchers at New York’s Memorial Sloan-Kettering Cancer Centre analysed data of nearly 18,000 patients from 29 randomised controlled trials in the United States, Britain, Germany, Spain and Sweden. Patients who received acupuncture had lower pain scores for back and neck pain, osteoarthritis

ASK THE DOCTORS DR ANTHONY LUKE Q: As a businessman I travel a lot, and jet lag is often a problem for me.

What is the best treatment for this?

A: Travelling overseas and spending hours in airport lounges and on planes is tiring for most people.

Jet lag happens when you travel over several time zones, which affects the body’s normal circadian rhythm.

Symptoms can include sleep disturbance, fatigue, poor concentration and gastrointestinal upsets such as heartburn, indigestion or diarrhoea.

A review written by Dr Charles Samuels, a sleep expert at the University of Calgary, in the May 2012 issue of the Clinical Journal of Sports Medicine, provides insight on athletes’ jet lag. He focuses on how they recover and how sleep optimises their performance.

We can learn a few lessons from athletes to stay on top of the game.

Make sure you are well-rested before the flight to reduce sleep deficit.

During the flight, adjust your watch to your destination’s schedule so that you sleep and eat meals based on the time at your final stop. When you are trying to sleep, use appropriate

sleep aids such as ear plugs and eye masks.

You can consider using medication to control sleeping patterns, such as mild sleeping pills to doze off or caffeine to stay awake. Melatonin supplements also help.

Medication can be considered if you are taking flights that cross three or more time zones.

Samuels’ review suggests that preflight doses of 0.5 to 1.5 milligrams of melatonin have been found to be effective and that 3mg to 5mg are used for the first two to three days after arriving.

It takes two to four days to adapt to a new time zone, so consider going easy on your schedule.

Also, refer to Samuel’s review for practical travel tips, including charts with specific recommendations based on the number of time zones you will be traversing.

Dr Anthony Luke is a 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

Lead researcher Victoria Cortessis, assistant professor of preventive medicine, speculates that the drug may act through the marijuanaregulating endocannabinoid system, which has been shown to be important in the formation of sperm.

It was also found that men with a history of cocaine use had a reduced risk of both subtypes of testicular cancer – researchers suspect the drug may kill sperm-producing germ cells.

“If this is correct, then ‘prevention’ would come at a high price,” Cortessis says. “Although germ cells cannot develop cancer if they are destroyed, fertility would also be impaired.”

Marijuana hits below the belt A new study published in Cancer by University of Southern California scientists shows a link between marijuana use and an increased risk of developing testicular cancer. The researchers looked at the self-reported history of recreational drug use in 163 young men diagnosed with testicular cancer and compared it with that of 292 healthy men of the same age and race/ethnicity. Men with a history of using marijuana were two times as likely to have subtypes of testicular cancer called non-seminoma and mixed germ cell tumours, which has a somewhat worse prognosis.

Pregnant mums in harm’s way More pregnant women – nearly one in 20 – are prescribed drugs to treat high blood pressure, including some drugs that are not considered safe for mothers or their babies, according to new research in the American Heart Association’s journal Hypertension.

Lead author Dr Brian Bateman, assistant professor of anaesthesia at Harvard Medical School in the US city of Boston, Massachusetts, says high blood pressure occurs in about 6 per cent to 8 per cent of all

(a degenerative joint disease) and chronic headaches. The study’s authors say: “The difference between true and sham acupuncture is relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to [its] therapeutic effects.” Sham acupuncture, as defined in the study, includes needles inserted superficially, nonpenetrating needles and deactivated electrical stimulation. The authors conclude that acupuncture is “a reasonable referral option for patients with chronic pain”.

pregnancies. The drugs prescribed included angiotensin-converting enzyme inhibitors and angiotensinreceptor blockers, both of which have been shown in studies to cause harmful side effects to the unborn baby. The risks during pregnancy include poor foetus growth, kidney problems and even death of the newborn. Limited information is available about anti-hypertensive drugs for pregnant women and more research is urgently needed, says Bateman.

> 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

NEWS 3 QUIZ ASBESTOS

MEMORY

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

allows the import and sale of white asbestos because it poses relatively lower health risks and because the importing of the substance has already declined significantly.

How much do you know about asbestos? Test yourself here.

Jeanette Wang jeanette.wang@scmp.com The cancer-causing agent asbestos recently returned to the headlines after residents living in a government-owned block of flats at Mount Butler were notified of inspections for the harmful substance, reportedly the first time in five years.

Residents have expressed concern for their health, although a government spokesman said the asbestos at the property was “sealed/encased in concealed locations which are normally out of reach by occupants and so its existence poses no health risk”.

In February, similar asbestosaffected blocks on Borrett Road were demolished without proper safety precautions, and residents were concerned about the demolition work’s proximity to schools and several kindergartens.

According to the US National Cancer Institute, asbestos is a group of minerals that occur naturally in the environment as bundles of fibres that can be separated into thin, durable threads.

These fibres, which do not conduct electricity, are resistant to heat, fire and chemicals.

As such, asbestos has been used widely in many industries, from construction to cars – and even in making some children’s crayons.

When products containing asbestos are disturbed, tiny asbestos fibres are released into the air. When these fibres are inhaled, they may get trapped in the lungs and remain there for a long time.

Over time, these fibres can accumulate and cause scarring and inflammation, which can affect breathing and lead to serious health problems. Mesothelioma is the most common form of cancer associated with asbestos exposure.

Workers exposed to asbestos as part of their job are at significantly greater risk of heart disease and stroke than the general population, according to research published in April in the Occupational and Environmental Medicine journal.

The three most common types of asbestos are chryostile (white), amosite (brown) and crocidolite (blue). The latter two are banned in Hong Kong, but the government

ALCOHOLISM

Drinkers’ days are numbered ......................................................

Jeanette Wang jeanette.wang@scmp.com Heavy drinking has long been known to be a risk factor for intracerebral haemorrhage, a type of stroke caused by bleeding in the brain. But a new study published today in the journal Neurology has put a figure on the grave prognosis for alcoholics.

People who have three or more alcoholic drinks per day may be at higher risk for experiencing a stroke almost 15 years earlier in life than those who do not drink heavily, finds Dr Charlotte Cordonnier of the University of Lille Nord de France, who wrote the study.

Among 540 patients with intracerebral haemorrhage and an average age of 71, one in four were heavy drinkers – defined as about 47ml a day of “pure” alcohol.

The heavy drinkers experienced stroke at an average age of 60, compared to 74 for their sober counterparts. Among the under-60s who had a stroke that occurred in the deep part of the brain, heavy drinkers were more likely to die within two years of the study follow-up than non-heavy drinkers.

Non-alcoholic red wine might be a good alternative for those looking to cut down on booze. According to a new study published in the American Heart Association journal Circulation Research, men with high risk of heart disease had lower blood pressure after drinking the wine every day for four weeks.

Researchers studied 67 men with health conditions who had the same diet plus one of the following: about 300ml of red wine, non-alcoholic red wine or about 90ml of gin. All of them tried each food-beverage pairing for four weeks.

The red wine and non-alcoholic wine contained equal amounts of polyphenols, an antioxidant that decreases blood pressure. During the red wine phase, the men had very little blood-pressure decrease and there was no change while drinking gin.

Meanwhile, non-alcoholic red wine increased participants’ levels of nitric oxide, which helps blood vessels relax and allows more blood to reach the heart and organs.

1. How long do asbestos fibres stay in the lungs? a. a few days b. a few months c. possibly forever 2. What does asbestos look like? a. dust b. whipped cream c. cotton candy 3. What non-construction product was manufactured with asbestos prior to 1980? a. baby clothing b. furniture c. books 4. How can I tell if a substance is asbestos? a. a dry sort of taste b. if it looks fluffy or flaky c. mainly by colour Answers: 1. c; 2. c (the individual fibres, however, are naked to the eye); 3. a; 4. none (suspected asbestos fibres should be lab tested)

Long-term boost to short-term problem ......................................................

Jeanette Wang jeanette.wang@scmp.com A study led by University of Pennsylvania researchers has identified key molecules that help convert short-term memories into long-term ones.

These molecules are part of a group of proteins called nuclear receptors, which could offer a target for memory-enhancing drugs, thereby alleviating some of the cognitive symptoms of conditions including schizophrenia and Alzheimer’s disease.

In the study, published in the Journal of Clinical Investigation, mice were trained to create memories of a place and event by associating a specific experience with a particular context or tone.

The scientists examined expression patterns of all 49 nuclear receptor genes. They found 13 that increased in expression in the hippocampus in the first two hours after training, including all three

members of a class of nuclear receptors called Nr4a. The scientists next created transgenic mice in which they could selectively block the activity of the three Nr4a genes.

The mice showed reduced memory of the location where the training took place, but their toneassociated memories remained intact.

“The mice had impairment for contextual memory,” says Ted Abel, one of the researchers.

“That is the type of memory that goes away in Alzheimer’s and schizophrenia.”

The scientists showed that the mutant mice’s short-term memory was not impaired.

They confirmed that Nr4a genes play a role in long-term memory storage by injecting the transgenic mice with a drug shown to enhance memory in normal mice.

The memory-forming ability of the mutant mice didn’t improve, however, suggesting that the drug acts upon the Nr4a genes to boost long-term-memory storage.

4 MEDICAL

Illustration: Angela Ho

CASE HISTORY

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

Eileen Aung-Thwin healthpost@scmp.com A cross-border truck driver’s life is tough and often unhealthy. Most will grab the tastiest fast food they can and then sit for 12 hours straight, only taking short breaks to stretch or visit the toilet.

Although at risk of developing a range of health problems, few long-haul truck drivers have the time, money or inclination to have regular check-ups.

That was 44-year-old Benson Kong’s lifestyle, until an accident last year landed him in the emergency room, where doctors discovered that he had diabetes.

Kong (whose name has been changed for patient confidentiality reasons) saw this as a wake-up call and resolved to treat his body better.

He changed his diet and dutifully took his medication to manage his blood sugar. But given his job’s demands, regular exercise was still a challenge.

Because Kong had never had a thorough health check, no one knew how long his blood glucose level had been out of control.

Unfortunately, it did not occur to his family doctor, who helped monitor and manage his condition, that the disease might have started damaging his organs.

It was not long before Kong noticed problems with his vision, especially in his right eye.

He started having trouble reading newspapers and watching television. He visited an optician to have new glasses made, but he continued to feel like he was looking at the world through a thick pane of unpolished glass.

When he could not see road signs clearly, putting his livelihood at risk, he knew he needed help. Kong went to see Dr David Liu Ta-li, associate professor of the Chinese University’s ophthalmology department.

By that time, the vision in Kong’s right eye had become severely distorted. Not only did the world appear blurry, but straight lines also appeared curved and a persistent shadow clouded the centre of his vision. He had to take extended leave from work.

When Liu examined Kong’s eye, it was apparent that his macula was badly swollen. The macula is the

Blots on the landscape centre of the retina where a high concentration of photoreceptors, or sensory cells that respond to light, provide 95 per cent of highresolution central vision.

The macula also acts as the eye’s natural sunblock.

The excess glucose in Kong’s bloodstream was modifying proteins and lipids into substances that damage blood vessels, including those at the back of the eye, setting off a damaging chain of events in the macula.

Fluids within the compromised blood vessels start to leak into the macula, making it swell. Proteins and serum also flood into the macula, causing inflammation which further aggravates the swelling. This condition is called diabetic macular edema (DME).

Swollen and inflamed, the macula in Kong’s right eye could no longer properly interpret light into

Not only did the world appear blurry, but straight lines also appeared curved and a persistent shadow clouded his vision

the signals that enable our brains to see, resulting in visual distortions.

Diabetic macular edema is the most common cause of vision loss in diabetic patients. According to the US-based International Diabetes Federation, some 14 per cent of diabetic patients have DME, which does not present any symptoms in the early stages.

Without treatment, some 25 per cent of those patients will have severe deterioration in their vision within three years.

Using a retinal scan called optical coherence tomography, Liu found that Kong’s macula had ballooned to double its normal size.

Kong had lost 90 per cent of normal vision in his right eye, and 10 per cent in his left. If his condition was left untreated, DME would eventually cause Kong to go blind.

The ophthalmologist presented two treatment options for Kong: the

conventional laser treatment or an intra-ocular injection.

The first option, laser, in theory stimulates the retinal cells in the macula to reabsorb excess fluid and pump it away. But it carries a risk: the laser treatment can also damage normal tissue and lead to some vision loss.

It was, however, affordable at about HK$50 per session at a public hospital. People with clinically significant DME may require three to four different laser sessions at two- to four-month intervals to stop the macular swelling.

Meanwhile, an intra-ocular drug called anti-vascular endothelial growth factor (anti-VEGF) presented a more effective and low-risk option.

VEGF is a molecule that mediates leakage in blood vessels and is naturally present in the body to help restore oxygen supply to tissues when circulation is poor. When the molecules become too excessive under DME, anti-VEGF can wipe out the surplus protein.

However, the treatment is vastly more expensive. It costs HK$9,000 per injection, with a recommended course of four to six monthly injections for successful results.

Kong could not afford the antiVEGF treatment, which is not subsidised by the government even at a public hospital. He opted for the laser treatment – but even after weeks of treatment, Kong still could not see well.

Frustrated, he turned his efforts towards securing funds for the antiVEGF treatment. It took him a few months before he could finally pay for the injections.

Under this method, anaesthetic eye drops are first used to numb the eye before a fine needle delivers the drug. Kong responded well to the treatment, and after his third injection he had regained 90 per cent of his vision.

Liu gave Kong one more round of laser to ensure prolonged results.

With Kong’s disciplined management of his blood sugar, the slight swelling in his left-eye macula also subsided. He continues to see Liu every three to four months for a check-up in case of a relapse.

Liu recommends that patients who are diagnosed with diabetes undergo tests to check for signs of macular edema. Early detection can save your sight.

MEDICAL 5 FROM THE EXPERTS

Sepsis: portrait of a swift and silent killer ......................................................

Konrad Reinhart healthpost@scmp.com Sepsis is one of the most common deadly diseases; yet it is one of the least well known. Every hour, about 1,000 people die from sepsis worldwide. The disease kills more people than HIV/Aids, prostate cancer and breast cancer combined.

The diagnosis and treatment of sepsis poses a medical emergency; between a third and half of patients with sepsis die. If diagnosed and treated in the first hour following presentation with sepsis, the patient has more than an 80 per cent chance of survival. After the sixth hour, this drops to 30 per cent. It’s crucially important that the early symptoms of sepsis are recognised and treatment accessed, where possible, within the first hour – the “golden hour”.

Sepsis arises when the body overreacts to an infection, causing the immune system to go into overdrive and setting off a series of reactions that can lead to widespread inflammation and

blood clotting. It causes an impairment of blood flow and oxygen transport to the tissues, including the vital organs. It may lead to shock, multiple organ failure and death, especially if not recognised and treated early.

There are three stages of sepsis: the first stage, caused by infections such as flu or dental abscesses, is common and doesn’t usually require hospital treatment – it’s possible to treat it at home with antibiotics. The second stage is considered “severe”, when the functions of vital organs start to get affected. The third stage, septic shock, is when blood pressure drops to a dangerously low level, preventing vital organs from receiving enough oxygenated blood.

Despite the fact that a patient with sepsis is about five times more likely to die than a patient who has suffered a heart attack or stroke, the disease is still not recognised or afforded the same urgency as these critical care conditions. If a patient stumbled into an emergency room clutching his chest and barely able to walk, he would be treated

Sepsis is often misdiagnosed.

Photo: Sciepro

It arises when the body overreacts to an infection, causing the immune system to go into overdrive

immediately. Yet symptoms of sepsis are less widely appreciated and so present a more deadly threat.

Awareness is the number one cure for sepsis. Raising recognition of the disease and increasing the number of patients treated in the golden hour is the single biggest attempt we can make to save lives.

Sepsis is still not treated as a medical emergency because many cases and deaths are misdiagnosed and attributed to underlying infections, such as pneumonia.

The signs and symptoms of sepsis include a rapid heart rate, difficulty breathing, low blood pressure, a change in behaviour (confusion, drowsiness or slurring words – patients can appear drunk), hypothermia, diarrhoea, changes in skin colour and a sore throat.

The recognition of these warning signs should not only occur among emergency room staff, but among all health care professionals who should be able to initiate treatment.

But real change in levels of awareness can only be driven from the top of the professional health care sector and policymakers.

The Global Sepsis Alliance (GSA) and its members have joined together to issue a call to action to bring the tragedy of sepsis mortality to the attention of health policymakers at a national, regional and global level. To do this, they are asking everyone to support the first World Sepsis Day, which will take place on Thursday.

However, while waiting for the policymakers to stand up and take notice, many hospitals are already committed to setting up schemes that introduce briefings on sepsis for hospital workers.

Only a global approach to tackling sepsis and reinforcing recognition at every level will drive an initiative to reduce the amount of deaths in every country.

Konrad Reinhart is the chairman of the Global Sepsis Alliance, a coalition of 250,000 intensive and critical care physicians. More than 1,000 hospitals and organisations around the world – including 13 on the mainland and one in Hong Kong (the Society of Critical Care Medicine) – will be supporting World Sepsis Day

6 COVER STORY

Blind

faith

Specialist guides are giving visually impaired runners the freedom of the road.

But taking the first step requires a lot of courage, as Charley Lanyon finds out

I

n 2010, two teams of four runners completed Hong Kong’s Oxfam Trailwalker 100-kilometre race in about 32 hours, without sleep, stopping only briefly to eat. Both teams finished about halfway through the field of 600 teams – which is remarkable when you consider that four of the runners were visually impaired and the other four were their guides.

Kate Cheung Fung-oi, a marathon runner and running coach, was a driving force behind their success: “Everybody said it was an impossible challenge, but the runners said they could do it and I believed in them.”

Worldwide, blind marathon runners are not a new phenomenon.

Some visually impaired runners such as Britain’s Simon Wheatcroft even train and compete unaided. In June, Wheatcroft was a torch-bearer for the London Olympics. He used his smartphone for guidance.

But blind runners are still relatively new in Hong Kong largely because they lacked support until about four years ago. Cheung was among the first coaches to volunteer her services. In 2008, Cheung’s running coach started working with the blind, and invited her to help.

She jumped at the opportunity.

Cheung has been fascinated by the lives of the blind since her college days, when she worked with visually impaired children on the local sailing programme, AdventureShip. She realised the children were confident, focused and determined to learn despite their handicap.

After college, Cheung started running. She ran her first race, the Trailwalker, in 2006 and has since run 20 marathons. To date, she has guided runners through five ultramarathons and marathons, and several shorter races.

More visually impaired people take up the sport in Hong Kong every year, and there is a push to get blind children interested in competitive running. Cheung

Charley Lanyon is led blindfolded through Happy Valley by guide runner Kate Cheung recently set up a programme called 101, which teaches visually impaired secondary school students how to run. It also shows their sighted peers how to act as guides, so that they can run together.

This is how it works: guides and runners are linked by a strap. The guide runs slightly in front of the runner and the strap is kept loose, rising and falling with the runner’s strides. The guide keeps the runner on track, and helps him to avoid obstacles, as well as providing a steady commentary about the surroundings, and the incline of the track. Guides also offer support and encouragement.

“You have to observe their feelings, speak a lot, and tell them what’s going on,” Cheung explains.

“You have to ask them, ‘How do you

I am stronger physically, and I am more persistent.

My boss even told me that my work attitude is better GALANT NG, BLIND RUNNER

feel? What are you thinking?’ I talk constantly during the race, not just as a guide, but as a coach, too.”

Runner and guide are united by more than a strap – over many training sessions they develop a deep trust and respect.

Running blind can be a terrifying experience, and it is that emotional bond, strengthened through constant communication, that gives the runner the confidence to keep going.

The actual running is only the final step in what can be a long process. Many blind runners, even those who lost their sight later in life, have never run before. So they need to be taught. Coaches employ the “ABC technique”.

This mandates that each of the three stages of a good stride is given

a letter: A, when the knee is raised; B, when the foot strikes the ground; and C, for the back kick. Guide and runner swing their bound arms in unison. As the strap rises, so does the opposite leg. This way the pace and rhythm of the strides can be kept steady.

When you watch an experienced blind runner and guide, it can look easy. But the experience can be terrifying at the start. Running blind is disorienting, and the mind is at a constant, often taxing, level of hyper-awareness.

According to blind runner Galant Ng, a rehabilitation and education specialist at the Hong Kong Society for the Blind, the first run can be very scary. “Normally, I don’t walk very fast, so I wasn’t used to running. I started very slowly,” says Ng. Aside from the physical fears, there are profound emotional challenges to overcome.

Blindness can be intensely isolating. For many, putting their trust in another person does not come easily. “Many people are not born blind. Maybe after 10 or 20 years of sight, they can’t see any more,” says Cheung.

“So they are very afraid; they don’t want to leave their house. It’s important for them to open their heart, to accept other people’s help.

Sports can build that confidence.”

I put on a blindfold and allowed Cheung to guide me around the Happy Valley running track. I felt immediately helpless. Within 10 seconds I felt disoriented. I would take a step, and be sure I was about to tumble into the trees lining the path, even though they were at least two metres away.

After just a minute or so of jogging, Cheung noticed that I was shaking so violently that she could feel it through the strap.

She told me to relax, making her presence known through the tension in the strap. “The trees are on your left, the football pitch is on your right, and the path is at 12

COVER STORY 7

Visually impaired runner Galant Ng exercises at Happy Valley sports ground. Ng says that being able to run with a guide has made him more confident. Photos: Nora Tam, May Tse o’clock, straight ahead,” she said.

She showed me how to keep apace with her and we started to jog. Those first few strides were frightening.

With every step, I felt as if I was about to crash into something. I could not relax my muscles, and the tension made my neck and shoulders ache.

Without visual stimuli, one’s balance fails. I felt that I was in constant danger of stumbling, that I could not run in a straight line. Just getting my foot to meet the tarmac took enormous focus.

Then there was the isolation, a kind of loneliness. I needed help and I understood what the runners meant when they emphasised the importance of communication.

In those rare moments when Cheung fell silent as we ran, all my fears would flood back. When she

did speak, I was calm. She talked constantly, alternating between chat and practical advice. As my trust in my guide grew, I was able to relax and enjoy the experience. There was a real pleasure in relinquishing control to another person.

Still, it was such a relief to remove my blindfold after the run. I still can’t fathom how the blind runners completed the Trailwalker race.

For them, running seems to be about more than achieving the impossible. It changes their lives in profound and positive ways.

“Running has really expanded my social circle. I have more friends now,” says Ng. “Today I am stronger physically, and I am more persistent.

My boss even told me my work attitude is better.”

Marathon running has helped

Runners are linked by a strap

him reorganise his life. He has become driven to set up harder challenges for himself.

He wants his accomplishments to show the world that the blind are capable of anything.

Ng’s greatest challenge was pairing blind runners with deaf guide runners. “It is much harder because of the communication problems between the deaf and the blind,” he says. But trust often grows between guide and runner, and sometimes friendships blossom.

Cheung was also involved in these pairings. “If one person is blind and another is deaf, you would think they could not have a connection,” she says.

“One can’t see the signs, and the other can’t hear. The one thing they can do is be patient and have the same goal.

“After they’ve been running for a very long time, they build up a relationship. It is wonderful.

They can just touch hands and they know ‘Oh, you want a drink of water.’”

After 18 months of training together, the pairs were able to compete in a marathon. Ng felt triumphant. “Now I feel equally comfortable running with my deaf guide runner as I do with a hearing guide runner.” Despite the support that is now available, many visually impaired people are reluctant to take up running because they are scared or lack confidence.

Ng has some good advice for them: “Just take your first step and you won’t be scared. Running is about your legs and your heart, not your eyes.” charley.lanyon@scmp.com

8 DIET/ FITNESS THE TASTE TEST LOW-FAT COFFEE

GREAT STRIDES SINGAPORE

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Lush hour

Jeanette Wang jeanette.wang@scmp.com Wolfgang Puck Vanilla Fusion Iced Coffee HK$19 for 251ml, City’super Wolfgang Puck, the Austrian celebrity chef and restaurateur, says this organic coffee uses Tahitian vanilla – rather than Madagascan or Mexican – to give the drink a full flavour and sweet aroma. Each bottle contains 120 calories and 2.5 grams of fat.

Verdict: the sweetness and the vanilla overpower the espresso flavour.

At 21 grams of sugar per bottle – more than five teaspoons – it’s not really surprising.

Tully’s Coffee – Barista’s Black HK$17 for 285ml, City’super The healthiest way to enjoy coffee is to have it black so it is calorie- and sugar-free. The only nutrient found in this drink is sodium – just a trace, at 26mg per 100ml.

Verdict: although I’m more used to having coffee with a splash of milk, this had a pleasant bitterness and a fabulous intense espresso flavour.

The recently completed gardens surrounding Marina Bay Sands hotel.

Photo: Craig Sheppard

HEALTHY GOURMET

In search of the beauty in the feast ......................................................

Andrea Oschetti healthpost@scmp.com

Starbucks Coffee Frappuccino Light HK$22 for 281ml, City’super The artificial sweetener Splenda goes into this coffee, resulting in a drink that has 40 per cent fewer calories and 60 per cent less sugar than regular mocha. That comes up to 100 calories, three grams of fat and 11 grams of sugar per bottle.

Verdict: creamier than Puck’s version but similarly too saccharine.

Drink only occasionally, as excessive consumption of artificial sweeteners is linked with adverse health effects.

Don’t trust a fat chef. The gourmand who ate dishes swimming in butter is a hero of the past. Today we know better: we know the impact of food on our bodies and have discovered new cooking techniques to achieve higher levels of sensory pleasures without compromising our health.

Trust someone who looks healthy to do the cooking for you. As with all skilled chefs, he will have the same goal of serving a feast for your palate. But his personal practice of healthy eating will make him realise the horror of the unhealthy practices used in kitchens to cut corners.

Practices like adding a block of butter to a serving of gnocchi, which has been left standing for five minutes, to make it moist again. The healthy chef is likely to put additional effort into managing his time, thus avoiding the extra fat. No good chef will ever serve something he would not eat himself. And I like to eat what a healthy person eats.

The new generation of top chefs looks healthy, not fat. I travel extensively to visit and intern in exciting restaurants worldwide, so I can master new styles and develop new ideas. Whenever I find excellence, there is a beautiful person behind it: Luca in Tokyo, Benedetta in Puglia, Yuval in Tel Aviv, Peter in Macedonia.

Real beauty is looking healthy, fit and full of energy. This can be achieved by everyone. It does require moderate exercise; but most of all, it calls for healthy eating.

Food is central to us, because we are what we eat. The beautiful are never those who eat sad food or tasteless calorie-restricted dietary meals. They are never those who cling to the latest diets. Healthylooking people always follow traditional diets. They eat everything, but in moderation.

They don’t count calories, they eat slowly, and limit sweeteners and other refined carbohydrates. They nourish themselves with real food.

That is to say, food their grandmother would recognise. They

I like simple food … overly altered or mixed flavours tend to ruin the essence of it DIDEM SENOL, ISTANBUL CHEF

avoid artificial nutrients and are troubled by exotic superfoods. Most of all, they have a good relationship with food, which is a source of happiness to them.

Didem Senol is a beautiful woman, and one of the most interesting chefs in Istanbul. After she graduated in psychology, she went to New York to pursue what she loves most: cooking.

A few years ago she went back to Turkey, where she recently opened one of Istanbul’s most exciting eateries. Leave Istanbul’s tourist scene behind and walk through the Karaköy area and you will find Lokanta Maya (lokantamaya.com), where Senol makes people happy with her cooking skills.

The secret behind her beautiful, healthy looks? Senol says she eats everything. “I love ingredients that are in season and fresh. I like simple food and believe that overly altered or mixed flavours tend to ruin the essence of it. Seasoning is an important craft that good chefs master to accentuate the real flavour of the main ingredients.”

DIET/ FITNESS 9

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Troy de Haas healthpost@scmp.com The moment you step off the plane in Singapore, it’s not hard to see why it is known as the “garden city”, with its lush tropical vegetation and manicured lawns.

Unlike most Asian cities, the entire place is spotless and the locals are a friendly and law-abiding bunch. Spitting is a criminal offence, for example, and talking on your mobile phone while driving can cost you three nights in jail and five lashes of the cane.

Singapore enjoys a consistent summer of about 30 to 32 degrees Celsius almost all year round. As a runner, you will immediately notice the thick, humid air.

The city’s parks and streets are full early in the morning, with locals of all ages enjoying their daily tai chi and dance routines.

In recent years, running has taken off in the island state, with races held almost every two or three weekends – many of them even clashing on the same day.

Best running spots • Singapore Botanic Gardens: located in the heart of the island just a few minutes’ jog from Orchard Road and many of the city’s leading hotels. With more than 20 kilometres of mostly tarmac paths and 53 hectares of greenery, it offers

Lokanta Maya has a limited menu that changes constantly. It serves both traditional and street food that is not usually found in a restaurant. Senol adds her own creativity to traditions, making dishes that we love with a modern twist and a lightness of touch.

Lokanta Maya is a temple for people who like to eat good, not fancy, food: these are the modern gourmands. The result is a restaurant which is always full. Last year Senol was voted the best chef in Istanbul, and international food critics flew in to taste her cuisine.

Roasted sardines with pine nuts and lemon zest is the first of several appetisers that Senol serves me.

Simplicity, taste, seasonality and freshness – they’re all on this plate.

Ever true to her values, she recently opened a new lunch-only restaurant, Gram.

“We do things in small batches.

Every day we start afresh,” Senol says. “My vision is for Gram to be a bakery which uses the quality ingredients that Istanbul doesn’t see any more.”

spectacular running opportunities away from the traffic.

Nearest MRT stations: Botanic Gardens and Orchard • East Coast Park: this 14-kilometre seafront road runs between the airport and city and is enjoyed by cyclists, in-line skaters and runners alike. It is ideal for a longer run, and offers the chance for a jog on sand and grass.

Nearest MRT stations: Mountbatten, Eunos and Bedok.

• Esplanade and Gardens by the Bay: get your racing shoes on as you take in the Formula One racetrack and the new gardens surrounding the Marina Bay Sands hotel.

Nearest MRT stations: Marina Bay, City Hall and Bayfront • MacRitchie Reservoir Park: the boardwalks along the water’s edge and off-road trails through the forest are favourites of nature lovers and exercise enthusiasts. Run along Singapore’s only treetop walk above the forest canopy.

Nearest MRT station: Caldecott • The Southern Ridges: this ninekilometre chain of green, open spaces spanning the hills of Mount Faber Park, Telok Blangah Hill Park and Kent Ridge Park is mostly connected by nature pathways and bridges.

Nearest MRT station: HarbourFront

The main event: Standard Chartered Marathon Singapore After last year’s successful run, which attracted some 65,000 participants, the International Association of Athletics Federations made it a certified “Gold Label” race, ranking it among prestigious tilts such as the London, Berlin and New York City marathons.

Singapore is only the fifth Asian country and the first in Southeast Asia to achieve this. Just 10 years a go, the event drew only 6,000 runners.

Held on the first Sunday of December each year, participants come from all over the world.

There are friendlier distances – 10 and 21 kilometres – for those who are not ready for the full 42.195kilometres.

If you would like to participate as a team, the Ekiden involves six runners completing the race in a relay format. And to make it a family-friendly affair, there is a 750-metre Kids Dash.

The race routes for 2012 have yet to be announced, but organisers have said it will be revised from last year in response to the bottlenecks towards the end of the course.

What is certain is that there will be three different starting points for each distance category and the course will be scenic.

Last year’s marathon started at the Orchard Road shopping strip,

a typical, easy 10-kilometre morning run, I can lose up to 1.5kg in sweat,” she says.

Running has taken off, with races almost every two or three weekends – many of them even clashing on the same day wound through the shop-lined streets of historic Chinatown, along the F1 Pit Building and Singapore Flyer, then headed out of town for an out-and-back lap of the breezy East Coast Park.

The last 10 kilometres went past the Marina Bay precinct and finished at a massive open field downtown called the Padang.

The humid Singapore conditions make this a tough race even for elite runners.

Australia’s Suzy Walsham, who has lived in Singapore since 2007 and won the women’s halfmarathon in 2008, says: “The finish is right in the [central business district] and is extremely well set-up with hospitality tents, music, displays and, most importantly, plenty of toilets.

“Although the course is flat and fast, you can forget fast times as the heat and humidity take their toll. On

Après run • Singapore is famous for dining and shopping. A must-try is the chilli crab at No Signboard Seafood at East Coast Park.

• Getting around is easy all the signs are in English and everyone speaks the language, The MRT is cheap too.

• After a tough day of running and shopping, try the fish reflexology foot spas around the city. Soak your feet in a tank as tiny fish nibble your dead skin cells away.

Singapore transit Just passing through? There are still things to do.

• Fewer than five hours: take a dip in the airport’s own rooftop swimming pool in Terminal 1. Jog the indoor carpeted passageways linking the three terminals.

• Five to 12 hours: a city tour operates from Changi International Airport for anyone who has more than a five-hour transit between flights.

The tour is funded by the Singapore Tourism Board, and it’s free.

• More than 12 hours: check into one of many airport hotels, from which you can run along East Coast Park.

This is the second Great Strides, a sixweek series of city running guides by Troy de Haas, sports travel manager of Flight Centre.

So it is with untold sadness that I think of the bakery products that are made in Shenzhen, and those pastries with a long shelf-life that are common in Hong Kong. Those things take away our beauty.

Roasted sardines with pine nuts and lemon zest Serves 4 600 grams sardines 1 lemon A handful of pine nuts A bunch of parsley Extra virgin olive oil, salt, pepper • Toast the pine nuts in a pan and grind them in a food processor.

• Grate the zest of the lemon and mix it with the nuts, adding salt and pepper.

• Pour olive oil and the juice of the lemon over the sardines. Put the nut mix on top.

• Place in the oven at 190 degrees Celsius for 15 minutes. Add chopped parsley before serving.

Healthy Gourmet is a weekly recipe column by private chef Andrea Oschetti, andrea@fioreblu.com

10 Tuesday, September 11, 2012

SPECIAL REPORT: MEDICAL PROGRAMME

Doctors get right training Nursing school’s family medicine curriculum is helping to fill a skills gap. Reports by Andrea Zavadszky

Dr Joseph Chan says it is vital to learn from real cases, not just books. Photo: Edward Wong

W

of Hong Kong (HKU) in medical teaching programmes.

The training in family medicine specialisation is offered to fully qualified resident doctors working for the hospital. Applicants already

hile Hong Kong’s health service is recognised as among the best in the world, the local sector has been struggling with an increasing demand for doctors, and a decreasing supply.

Derrick Au, head of human resources at the Hospital Authority, has pointed out that the increasing demand has been caused by an ageing population requiring more carers, the opening of new hospitals and advances in health programmes.

“With only 250 doctors graduating a year, the supply has been behind for the past five to 10 years,” he says.

At the same time, a shortage of nurses is a worldwide phenomenon, with the situation aggravated by the pressure an ageing population puts on medical systems.

The Hong Kong Sanatorium and Hospital (HKSH) has been ready for

the challenge for a long time: its nursing school dates back to 1927 and, apart from nursing, it also provides programmes for medical students, family doctors and those studying for specialist degrees.

The six-year programme of training family doctors was accredited by the College of Family Medicine and has been running since 2001.

“At the time of accreditation, the college looked into everything, from our facilities, teachers and nurses to how we do the screening and how we keep records. They check every five years to make sure you uphold your standards,” says Dr Joseph Chan Woon-tong, deputy medical superintendent and head of the department of women’s health and obstetrics.

He worked as a resident medical officer at the hospital in the 1970s, and assumed his present position in 2003 to help the collaboration between HKSH and the University

This is our way of ensuring quality, giving back to society and to the medical fraternity DR JOSEPH CHAN, DEPUTY MEDICAL SUPERINTENDENT, HKSH

have a medical degree and three to four years’ work experience. The hospital now has six trainees, with two more starting this month.

While 12 years ago HKU helped

HKSH to provide the training, the hospital now has its own trainers.

Teaching works like a close mentorship and one specialist can have only a maximum of three trainees.

Chan says in medicine, more than in any other profession, you can only learn so much from books and it is vital to learn from real cases.

That is why HKSH has also been offering introductory training to all fourth-year students of HKU since 1998.

“Every year, we have about 10 groups, 12 to 15 students at a time.

They spend two weeks each with us,” Chan says. “Our objectives are to allow students to experience the student-doctor relationship, be exposed to areas more readily available in private hospitals, such as Lasik surgery and plastic surgery, and experience the way services are provided.”

They learn management skills and have job rotation in the

departments, including a mentor’s day when they shadow a doctor who works in the field of their interest.

Doctors studying specialisations in surgery, eyes and orthopaedics also come to the hospital for threemonth stints.

“It is very expensive as the hospital pays for their salaries and private doctor insurance, which is very costly,” Chan says.

However, the hospital believes that supporting learning will generally stimulate the atmosphere of progress and increase the quality of medical science at the hospital.

Chan says: “We believe that through teaching and learning we will grow together and everybody will be learning, both students and teachers. Indirectly, patients will benefit. This is our way of ensuring quality, giving back to society and to the medical fraternity.”

The hospital also has a wellorganised continuing medical education programme.

Students entitled to blow their own trumpets As the Hong Kong Sanatorium and Hospital (HKSH) prepares for its 90th anniversary, a group of 23 young nurses are excited about performing at the celebratory dinner for more than 2,000 guests. Part of the hospital’s 120-strong nursing student body, the group have formed an accomplished orchestra with violins, pianos, drums, flutes, cellos and other instruments. This illustrates their high education, although the two-year Higher Diploma in Nursing course takes candidates from Form 6 up.

“This year, we have received 5,200 applications for 60 places,” says Manbo Man, HKSH’s director of nursing services. “Then we got permission to accept up to 70 students because the competition was so fierce.”

Nurses attend an anatomy class (left) and receive clinical training from instructors from the University of California.

She says they look for students who have good interpersonal skills and attributes such as being caring and patient. They look at academic results and whether the applicants have had any exposure to social

work, as that is a sign that they are seriously interested in this field.

Shortlisted candidates have a group interview to test their communication skills.

The programme includes a

variety of subjects, from medical sociology and nursing theory to public health, anatomy, physiology and pharmacy, plus general education and language classes. To graduate and be able to register in

the Nursing Council as enrolled nurses, students have to attend 1,100 hours of lectures and 3,000 hours of clinical practice.

HKSH has had an enrolled nurse course since 1927, and the new higher diploma was accredited in 2010. Out of the 60 students of the first intake who graduated this year, 42 students gained admission to university to study for a bachelor’s degree. With an exemption in certain subjects, they can complete their degrees in four years.

HKSH offers an interest-free loan to pay university fees and pays the nurses’ full salaries during their clinical practicum, which takes another eight to nine months. Those who remain with the hospital will have several chances to further their studies and specialise.

SOUTH CHINA MORNING POST SEPTEMBER 11, 2012

11

12 WELL-BEING uen n: Lau Ka-k Illustratio

PERSONAL BEST

Go the extra smile ......................................................

Jemma Rogers healthpost@scmp.com I’ve always thought that smiling was contagious. When someone smiles at you on the street, you can’t help but smile back. It’s amazing how little things seem to make the day that much brighter.

Smiling is considered an important indicator of positive emotion and confidence. It has also been said that smiling can make stressful situations more tolerable.

A new study by the University of Kansas reveals that if you smile at someone, not only are you brightening up their day, you are also benefiting your own health.

It was found that smiling can have positive effects on the heart. Those who smiled during stressful situations had a lower heart rate and recovered faster, bringing new meaning to the saying “grin and bear it”. So cheerful people might just be onto something.

It’s perhaps an especially timely study for Hong Kong, a city where

nearly one in six people suffers from anxiety or depression, according to the interim government report, the Hong Kong Mental Morbidity Survey 2010-13.

Major depressive disorders will become the second-biggest contributor to the global burden of disease by 2020, according to the World Health Organisation.

Previous studies have shown more than 300,000 Hongkongers suffer from depression, and three times more women than men.

Based on projections from the latest population figures, about 700,000 middle-aged women in Hong Kong are at high risk of developing depression. The University of Kansas study is the first of its kind to examine the effects that smiling has on the body while under stress.

“We wanted to scientifically examine if smiling through a stressful situation could actually have physiological benefits,” says researcher Tara Kraft.

Her team recruited 169 subjects from Midwestern University – all healthy 18-to-25-year-old men and women. They were screened for any facial muscular disorder prior to testing and then randomly assigned to one of three groups: neutral expression control, standard smiling and Duchenne smiling group.

A standard smile uses muscles around the mouth whereas a Duchenne smile is when the muscles around the mouth and eyes are engaged.

The participants were told they were being tested on their ability to multitask so as to prevent awareness or reaction to smiling. They were also all previously taught the correct smiling method.

The subjects were put through a stressful situation. They were asked to complete a two-minute mirror star-tracing task: place their nondominant hand inside a box and repeatedly trace a star by looking at a reflection of the star in a mirror.

They were asked to be as accurate with their drawings as possible, while being given incorrect information regarding performance.

They were also told they would be rewarded with chocolate if they

We wanted to examine if smiling through a stressful situation could have physiological benefits TARA KRAFT, UNIVERSITY OF KANSAS

managed to reach the unattainable goal that was set.

After this, participants had a fiveminute rest and were then asked to submerge their hand in iced water for one minute before having another five-minute rest and repeating the process. Throughout the exercises the participants were asked to produce a Duchenne smile, a standard smile or remain neutral.

The subjects were tested to see how their hearts handled the stress.

When we are stressed, our heart beats faster, as part of our “fight or flight” instincts.

Those who were smiling had a slower heart rate and a faster recovery rate than those who had a neutral expression. But the difference between those who had a Duchenne smile and a standard smile was not significant.

Although smiling is not considered the same as happiness, it is an indicator. It is often thought that facial expressions are a consequence of emotions felt by an individual. But according to the selfperception theory by social psychologist and professor emeritus at Cornell University, Daniel Bem, if a person acts happy they will become happy.

Kraft says the results of the study were what the team had expected: that smiling is good for your health because it reduces the harmful effects of stress on the heart.

“Between the participants and researchers, we were smiling through the entire process,” he says.

If only everything in life could be cured with a smile.