20121030 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, OCTOBER 30, 2012

HEALTH POST ASIAN FLUSH SYNDROME >PAGE 4

PERILS OF ONLINE SELF-DIAGNOSIS >PAGE 9

Men, how much do you you know about prostate cancer?

>PAGE 6

Learn and live

2 NEWS APP OF THE WEEK

HEALTH BITES

Polar exploration at home

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School daze If your child’s academic results are giving you a headache, it could be because he or she has one.

Children with migraine are 30 per cent more likely to have below average school performance than those with no headaches, according to research published today in Neurology. The study involved 5,671 Brazilian children aged five to 12, and their teachers and parents.

It was found that 0.6 per cent of the children had chronic migraine (migraine on 15 or more days per month), 9 per cent had episodic migraine, and 17.6 per cent had probable migraine. The link between migraine and poor performance was even stronger for children with migraines that were more severe, lasted longer, or were chronic, as well as for those who also had emotional or behavioural problems.

Katie McGregor healthpost@scmp.com DivaFit Free Rating 7/10 Do nice girls pole dance? I don’t know for sure, but from what I have seen of pole dancers, they are fit.

With DivaFit you don’t even need a pole. You can get straight into the swing of things by learning a series of floor moves and attempting the two “Sexy Sequences” for the floor.

Lessons are provided through the short videos, one for each move – and there are many moves. A written description for each gives you more information if you can’t keep up.

Given that pole dancing could be considered a dance form, I found it strange that there was no audio.

The menu filter allows you to choose pole or floor exercises, and the level and type of exercise.

Within any exercise, you can indicate whether it is “new”, “in progress” or “achieved”.

My investigation of this app focused on the floor exercises, which most of us could do at home. Many exercises are to build the strength and flexibility needed to move gracefully through the sequences.

Most are simple enough, but I watched the “fish flop” with fascinated horror. How does she do

Jeanette Wang jeanette.wang@scmp.com

that without breaking her neck? The two “Sexy Sequences” don’t seem to bear much relationship to the individual moves that you learn in this section. For example, you are required to “roll onto back for clocks, prance, one splay and rising goddess up”, but none of these moves are taught individually.

The app developers do say that the app is to be used as a fitness tool, complementing your instruction with a trained pole fitness instructor; they didn’t design it as a selfteaching tool. If you like what you see in the app, hit the online search engines and you will find pole dancing lessons in Hong Kong.

Mental gymnastics High-intensity interval training makes middle-aged people not only more brawny but brainy. The Montreal Heart Institute, working with the Montreal Geriatric University Institute, put six overweight adults through a four-month programme of twice-weekly interval training on stationary bicycles and twice-weekly resistance training. Cognitive function, maximal oxygen uptake and brain oxygenation during exercise testing showed that the subjects’ cognitive functions greatly improved due to the exercise, says lead researcher Dr Anil Nigam. The subjects’ waist circumference, particularly trunk fat mass, also decreased.

An example of high-intensity interval training: a series of 30 seconds of sprinting followed by 30 seconds of walking or jogging.

ASK THE DOCTORS DR ANTHONY LUKE Q: My 16-year-old son is a volleyball player and has been having lower-back pain for three weeks. He’s pretty sore and has to lie in bed after a long practice. Our friend’s son was diagnosed with a back tumour at age 14 and we have a family history of cancer. Does my son have cancer?

A: Although anything is possible, the likelihood of this diagnosis is minimal. The most common cause of lower-back pain in a young athlete is a stress fracture, which usually hurts when the athlete extends the back.

Musculoskeletal issues are by far the most likely causes of the majority of back pain. One characteristic of musculoskeletal pain is that it’s usually related to physical activity.

Manoeuvres that stress the back typically hurt, and rest usually makes things better. Symptoms of concern for more ominous causes of back pain would be pain at rest or at night. The

description of the pain is often deep, boring, throbbing pain. The pain may not be related to exercise.

Cancer pain associated with a bone tumour may have pressure features, since it is expanding in the bone, similar to toothache-type pain. The pain can be worse when you are lying down, since more blood flow may be directed towards the tumour.

If there are any other symptoms, such as fever, fatigue or weight loss, or if the pain is persistent despite even a week of rest, it’s good to let your physician know.

Fortunately, most complaints of back pain with young people will be musculoskeletal, and are rarely due to a cancer.

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

> 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

Something in the heir The effects of smoking during pregnancy may be very long lasting.

New research published in BioMed Central’s open access journal BMC Medicine shows that nicotine exposure also causes asthma in the smoker’s grandchildren. The dangers of smoking on smokers and their children are widely known; during pregnancy nicotine can affect a developing fetus’ lungs, predisposing the infant to childhood asthma.

Researchers from Harbor-UCLA Medical Centre, California, tested the effect of nicotine exposure during pregnancy on rats and their first and second generation pups. Exposure inside the uterus resulted in both male and female offspring having reduced lung function consistent with asthma. Second-generation offspring also had impaired lung function consistent with asthma, even though their parents were not exposed to nicotine once they were born.

It’s not you, it’s me – or is it?

At their most fertile period, women who have chosen Mr Stable over Mr Sexy are less likely to feel close to their mates and more likely to find fault with them than women mated to more sexually desirable men, according to UCLA researchers. Nevertheless, the negative feelings appear fleeting. “Even when these women are feeling less positive about their relationship, they don’t want to end it,” says Christina Larson, the study’s lead author. She adds: “We don’t know if men are picking up on this behaviour, but if they are, it must be confusing for them.” The findings will appear in the next month’s issue of the journal Hormones and Behavior.

NEWS 3 QUIZ

FITNESS WATER WORKOUTS

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Exercises that make a splash

Jeanette Wang jeanette.wang@scmp.com Canadian scientists have discovered the cause of high cholesterol: a protein called resistin that’s secreted by fat tissue. This finding could lead to improved prevention and treatment of heart disease, since high blood cholesterol is a major risk factor for heart disease and stroke.

The researchers, who presented their findings at the Canadian Cardiovascular Congress at the weekend, found that resistin increases the production of “bad” cholesterol (aka low-density lipoprotein, or LDL) in human liver cells and also degrades LDL receptors in the liver.

As a result, the liver is less able to clear “bad” cholesterol from the body. Resistin accelerates the accumulation of LDL in arteries, increasing the risk of heart disease.

The study also showed that the protein impairs the effectiveness of cholesterol-reducing drugs called statins, which are used in the treatment and prevention of cardiovascular disease.

Dr Shirya Rashid, senior author of the study and assistant professor in the department of medicine at McMaster University, notes that 40 per cent of people taking statins are resistant to their impact on lowering blood LDL – and high blood resistin levels may be the cause. She believes the study could pave the way for revolutionary new therapeutic drugs, especially those that target and inhibit resistin and thereby increase the effectiveness of statins.

High blood cholesterol can lead to a build-up of plaque in the artery

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Jeanette Wang jeanette.wang@scmp.com

walls and narrowing of the arteries, causing atherosclerosis which can make it more difficult for blood to flow through the heart and body.

Being overweight also increases the likelihood of high blood pressure and diabetes, compounding the risks of heart disease and stroke.

Test your knowledge of cholesterol here.

1. Cholesterol is needed to make vitamin D and some hormones, build cell walls, and create bile salts that help digest fat. Cholesterol is produced in the a. Liver b. Kidneys c. Brain 2. High-density lipoprotein (HDL) is called “good” cholesterol because

a. It helps keep your blood from clotting b. It keeps cholesterol from building up in the lining of the arteries c. Your body produces more of it as you get older 3. A diet that helps keep blood cholesterol levels in check includes a. Limited amount of saturated fats b. Limited intake of animal products c. Increased intake of fibre 4. How is high cholesterol treated? a. With diet changes b. With weight management and physical activity c. With medication Answers: 1. a; 2. b; 3. all correct; 4. all are correct

Running or cycling can be tough if you’re overweight or suffer from joint problems or injuries, but that doesn’t mean you have to lay off exercise altogether. Take your workout to the pool and you’ll get the same aerobic benefit but with less wear and tear.

Researchers at the Montreal Heart Institute in Canada made healthy study participants do exercise tests on both land and water cycling machines (with water up to chest level). They increased their intensity minute by minute until exhaustion set in. It was found that the subjects’ maximal oxygen consumption – which tells you whether it was a good workout – was almost the same using both types of cycles.

“If you can’t train on land, you can train in the water and have the same benefits in terms of improving aerobic fitness,” says Dr Martin Juneau, prevention service chief at the Montreal Heart Institute.

His study colleague Dr Mathieu Gayda, a clinical exercise physiologist, adds: “Exercise during water immersion may be even more efficient from a cardiorespiratory standpoint.”

The researchers found that the heart rate of participants was a little lower in the water. “You pump more blood for each beat, so don’t need as many heartbeats because the pressure of the water on your legs and lower body makes the blood

return more effectively to the heart. That’s interesting data that hasn’t been studied thoroughly before,” says Juneau.

In the book Advanced Marathoning, authors Pete Pfitzinger and Scott Douglas note that deep-water running with a floatation vest is a total-body exercise that works your legs, trunk and arms, and positively stresses your cardiovascular system. Several studies have verified that runners can use deep-water running to maintain aerobic fitness, lactate threshold, running economy and time-trial performance for at least six weeks.

A useful rule of thumb, write the authors, is that heart rates during water running are about 10 per cent lower than during land running.

For example, if you get your heart rate up to 140 beats per minute in the water, that’s roughly equivalent to 156 beats per minute during normal running.

Water running. Photo: Corbis

RESEARCH SUDDEN CARDIAC DEATH

Arresting figures on matters of the heart ......................................................

Jeanette Wang jeanette.wang@scmp.com

Survival can increase to 75 per cent when early CPR is used with an AED in the first few minutes DR BETH ABRAMSON

adolescents and just 9 per cent of events in adults happened during moderate or vigorous exercise.

These findings dispel a myth that sudden cardiac death often takes place during rigorous physical activity. “Put it this way: if you have a 13-year-old kid who is not the star athlete who dies at home watching television, it doesn’t make the news,” says Krahn. “But if the same kid is a high-school quarterback or hockey star, then it’s covered.”

How can unrecognised heart

Image: Corbis

Is exercise dangerous? It seems so, with cases of young, healthy athletes collapsing suddenly and dying of cardiac arrest while playing sport becoming more common.

But a new study by researchers from the University of British Columbia in Canada suggests that while it is a problem that warrants attention, don’t blame sport.

Reviewing coroners’ reports, Dr Andrew Krahn and a team of researchers found there were 174 cases of presumed sudden death in Ontario, Canada in 2008, in people aged two to 40 years.

Heart disease was present in about seven in 10 cases, 78 per cent of which was unrecognised. Most victims were male between the ages of 18 and 40.

Most events (72 per cent) occurred at home. Only one third of events involving children or

disease be caught before it causes sudden death, particularly in young people?

Krahn suggests more attention be paid to possible warning signs such as fainting. He believes that teachers, coaches and an increase in public awareness may be key to

detecting risk, thereby ensuring prevention and formal medical evaluation and therapy.

“I would advocate careful screening of people who faint, and educating health care professionals, so when warning signs present themselves, they are recognised and

the information is passed on to the right people,” he says.

Dr Beth Abramson, a researcher with the Heart & Stroke Foundation of Canada, says training in cardiopulmonary resuscitation (CPR) and placement of automated external defibrillators (AEDs) in schools, arenas and gyms – making them “as available as fire extinguishers” – can save many lives.

“The odds of surviving a cardiac arrest can increase to up to 75 per cent when early CPR is used in combination with an AED in the first few minutes,” Abramson says.

The importance of AEDs was demonstrated this past summer when NHL hockey player Brett MacLean, 23, suffered a cardiac arrest at an arena in Ontario during a pick-up game with friends.

Players immediately performed CPR on the ice, while a spectator retrieved the AED in the arena. Through their swift actions, MacLean survived and is recovering.

4 HEALTH FROM THE EXPERTS ASIAN FLUSH SYNDROME

Red alert ......................................................

David Tan healthpost@scmp.com While sitting in a bar in Singapore on a Friday evening earlier this month, watching revellers around me celebrate Oktoberfest, the annual German beer festival, it suddenly occurred to me there was a lot of red in the room.

Not the furnishings nor the attire of the party-goers, but their faces.

Ruby red, cherry red, tomato red; every shade in the spectrum was on display, from a glowing pink to a shade that can best be described as lobster rouge.

Sound familiar? Try it the next time you are out painting the town red; count the number of flushed faces in the room. Chances are it will be about half the number of people there.

“Oh, it shows that my circulation is excellent,” is a common riposte I hear. Another one is: “Proof that my liver is working!” These beliefs are widespread and, unfortunately, dangerously misguided.

What is Asian flush syndrome?

Asian flush syndrome is, as its name suggests, prevalent in Asia and common in people of Chinese, Japanese and Korean ancestry.

The syndrome is caused by variation in two different genes.

The first is a variant in the gene that encodes for an enzyme, alcohol dehydrogenase, which breaks down alcohol into acetaldehyde. A whopping 80 per cent of Asians have a gene variant that vastly increases the efficiency of alcohol conversion to acetaldehyde, by up to 100 times.

So far so good.

The second gene variant is for another enzyme, called acetaldehyde dehydrogenase (ALDH2), which metabolises acetaldehyde, making it less efficient than normal.

Acetaldehyde causes blood vessels to dilate, resulting in the characteristic flush, and also raises the heart rate.

Breaking down alcohol faster but taking longer to metabolise, acetaldehyde leads to two important consequences.

First, you will likely not feel the much-hyped “buzz” that comes with drinking alcohol because your body breaks it down much faster than others.

Second, acetaldehyde builds up in your saliva and hangs

around in your body for longer than normal because of the second gene variation. And here’s the punchline: acetaldehyde is more toxic than alcohol and is a well-known carcinogen.

Some people skirt around the issue by taking antihistamines and other over-the-counter drugs to stop themselves from turning red. Even if such self-prescribed drug cocktails work, they only mask the effect and do not treat the cause. This is even more dangerous, because it lulls drinkers into a false sense of security while the acetaldehyde continues to linger in their blood.

In fact, research has shown that people who experience Asian flush syndrome have a far greater risk of developing oesophageal cancer and other digestive tract disorders. For example, someone with a single copy of the ALDH2 variant who consumes two beers a day has a tenfold greater risk of oesophageal cancer. Oesophageal cancer is hard to detect and is one of the deadliest cancers.

And yet, public education about Asian flush syndrome is desperately lacking. Granted, there have been large efforts to warn the public about the dangers of excessive drinking.

However, for those dealt a poor hand in the game of genetics, even moderate drinking could be a potential health hazard.

This is compounded by the expansion of the alcoholic beverage industry in Asia.

The booming alcohol industry in Asia Alcoholic drinks have a long history in Asia; evidence points to brewing in China from about 7,000BC and in India from 3,000BC. Of the global alcoholic beverage market, the AsiaPacific comprises a quarter, worth US$258 billion, and is growing at 4.4 per cent annually, according to the consultancy Accenture.

Beer is one of the more popular tipples in Asia and, recently, the Asia-Pacific region became the world’s biggest beer consumer.

According to a BBC report, Asians drank 69 billion litres of beer last year compared to 57 billion in America and 51 billion in Europe.

China is now the world’s biggest beer producer, brewing 44 billion litres in 2010, twice that of the US at number two.

In Southeast Asia alone, alcohol consumption jumped 6 per cent between 2010 and 2011, with

Vietnam, Thailand and the Philippines at the top. In Singapore, a report in the Singapore Medical Journal stated that alcohol consumption in the country doubled between 1992 and 2004.

The rise in alcohol consumption in Asia is believed to be a direct result of alcoholic beverage manufacturers seeking developing markets for growth now that the American and European markets are saturated.

Witness the recent tussle between Heineken and a Thai billionaire over Asia Pacific Breweries (APB). Heineken eventually closed the deal to own 90 per cent of APB, giving it full ownership across Indonesia, Singapore, and Thailand.

Identifying the trend for brewery behemoths targeting Asia, Gerard Rijk of financial institution ING Group said to Bloomberg Businessweek: “When you’re looking for high growth, Thailand and China are two very crucial markets.”

Alcohol industry giants aren’t afraid to push their product at all costs, even to the detriment of public health, says Mary Assunta of the Consumers Association of Penang.

“Transnational alcohol companies use unethical advertising and marketing tactics to get customers, particularly among the lower economic sector of society.

Alcoholic drinks are advertised as products which will bring sexual prowess, success and power,” Assunta says.

Even more disturbing are advertisements that claim health benefits of alcoholic beverages such

Transnational alcohol companies use unethical advertising and marketing tactics to get customers MARY ASSUNTA, CONSUMERS ASSOCIATION OF PENANG

Mug’s game: many Asians may be risking their health for the sake of a drink.

Photos: Bloomberg, Reuters

as DOM Benedictine and Choya Umeshu. On television and in print, these drinks are promoted as health restorative tonics, often recruiting celebrities to push their product on an adoring public. These are misleading and dangerous.

Governments and health care providers need to up their game Excessive alcohol consumption is already a growing public health problem in America and Europe. In Asia, which is now aggressively targeted by the alcoholic beverages industry and where the genetic odds are stacked against a large proportion of the population, I believe the growing risk of alcohol-related diseases is a ticking time bomb.

What can we do about it? Firstly, Asian governments need to recognise that there are risks, particular to many of their citizens because of their ethnic genetic predisposition. The alcohol problem needs to be tackled differently from countries elsewhere.

Education is paramount.

Governments need to communicate the genetic basis of Asian flush syndrome and its associated risks so that misguided beliefs about the rosy glow are dispelled. Efforts need to be sustained for years to educate an entire generation who will then teach their children. Government agencies should track public perception of alcohol and the Asian flush syndrome to monitor the issue.

With massive anti-tobacco campaigns rolled out across Asia, governments should apply their

MEDICAL 5 CASE HISTORY

An end to the daily grind ......................................................

anti-smoking strategies to tackling alcohol abuse as well. Singapore slaps a high tax on alcohol to limit consumption but, with incomes rising, the cost of alcohol is less prohibitive than it used to be.

Taking on the alcoholic beverage transnationals will be no easy task.

These companies sponsor events and perform many philanthropic activities in a bid to boost their soft power and image in the eyes of the public. These efforts also allow them to circumvent limits on direct advertising in mass media.

Governments should draw up more restrictive guidelines to control the types of corporate social responsibility activities in which the alcohol giants engage.

On the health care provider front, primary care doctors can play an important role in educating their patients. By asking patients about their drinking habits, doctors can monitor the situation on the ground and provide information about the dangers of Asian flush syndrome.

Asia has a largely unnoticed public health issue on its doorstep.

When the public understands the nature of Asian flush syndrome, they can then make educated decisions on their alcohol consumption habits. Until then, governments and doctors must work together to stave off the problem before it is too late.

David Tan is a post-doctoral researcher at the A*STAR Institute of Medical Biology, Singapore. This article was first published in Asian Scientist magazine (asianscientist.com)

Madam Chong, 50, knows that familiar feeling. It starts with a twinge in her knee. Then, over time, the pain builds to a crippling crescendo that on some days will cause her to fall in mid-step, and on others will send her to the emergency room begging for relief.

Chong (whose name has been changed for reasons of patient confidentiality) had been down the painful road before.

Five years ago, osteoarthritis in her left knee had damaged one-third of the joint and required a surgery called partial knee replacement to repair the damage and restore her mobility.

Since her surgery, osteoarthritis had slowly but surely overtaken her right knee as well, causing her to walk with a pronounced limp when she was not writhing in agony. Age, overuse and excess weight had worn down the cartilage in the joint. In fact, age and obesity are two of the key risk factors in developing this painful condition. Chong’s work also required her to do manual work and some heavy lifting, further stressing her vulnerable joint.

With osteoarthritis, the water content and protein make-up of the cartilage that helps cushion the joint degenerates, causing inflammation, pain and swelling.

The inflammation then stimulates new bone (spurs) to grow. When the cartilage is worn down, bone will rub on bone.

Doctors found that Chong’s right knee was badly damaged by osteoarthritis, and surgery was her best chance for long-term relief. But the waiting list for knee surgery at the public hospital she visited was long. Chong could only wait.

She turned to painkillers, regular massages and icing the knee when the pain flared. In a bid to keep her comfortable while waiting for surgery, doctors gave her injections to manage the pain and increase the lubrication within the joint. But these conservative treatments failed to give Chong real relief.

Her doctors then became aware of a new partial knee replacement method being employed by the Orthopaedics and

Illustration: Angela Ho

Eileen Aung-Thwin healthpost@scmp.com

The high-precision, minimally invasive surgery left Chong with a smaller scar and shorter recovery time Traumatology Department at the Hong Kong Sanatorium and Hospital, and referred her to its director, Dr Stephen Wu Wingcheung. The hospital was conducting surgery on its first few suitable patients for free.

Wu explains that the knee comprises three parts – the patellofemoral joint where the patella (knee cap) meets the femur (thigh bone); the medial femorotibial joint, which is the inside of the joint where the femur meets the tibia (large shin bone); and the lateral femorotibial joint, which is the outer part of the same joint.

Chong’s patellofemoral joint and medial femorotibial joint were worn down and damaged. But as the lateral femorotibial joint was still healthy, she was a good candidate for partial knee replacement surgery. The medical team was employing a new surgical method using Asia’s first Robotic Interactive Orthopaedic (RIO) system that promised greater surgical precision and better results.

Using a combination of a computer-assisted navigation system and robotic arms, RIO can detect even a 1mm deviation of the implant position, says Wu. He says that placement of the implant position is the trickiest aspect of the surgery, and the biggest factor in determining its success in removing pain and the longevity of results.

Chong agreed to the surgery.

Computed Tomography scans allowed a computer to generate a three-dimensional map of Chong’s entire knee joint before the surgery. This, in turn, helped the medical team visualise, plan and simulate the surgery, including which parts, and how much of the

affected bone to remove, and where to place the implants, before the actual execution.

Moreover, the rotating burr, which cuts away the assigned bone, is programmed so that it is limited to the pre-assigned cutting zone to avoid removing excess bone.

The software can also quantify the soft tissue tension, says Wu, so that the medical team can express and adjust the “stiffness” of the muscles and other tissue in precise, scientific terms. Previously, doctors could only express the tightness of a joint in subjective language.

The high-precision, minimally invasive surgery left Chong with a smaller scar and shorter recovery time. It also left as much healthy bone intact as possible so that future surgeries, if necessary, remain possible, says Wu. Chong was delighted with the results. Her previous knee surgery required her to be on medical leave for six months. This time, despite a more extensive surgery of her right knee, she was walking and swimming one month later and back at work 40 days after the operation.

6 COVER STORY

What m

Results of Health Post’s prostate cancer and men’s health survey A hundred men were polled earlier this month through an online form and street surveys in Central. Here are the results. cancer affects both About one in 30 men will be ? Prostate ? men and women. diagnosed with prostate cancer during his lifetime.

The most important ? risk factor for prostate cancer is ageing.

Prostate cancer symptoms begin ? with urination troubles, such as difficulty in urinating, pain during

antigen (PSA) tests ? Prostate-specific are always accurate.

urination, and frequent urination.

False

71%

True

29%

Answer: False Prostate cancer starts in the prostate gland, a walnut-sized structure that wraps around the urethra (the tube that carries urine out of the bladder) and is part of the male reproductive system.

False

19%

True

81%

Answer: False According to the American Cancer Society (ACS), about one in six men will be diagnosed with prostate cancer during his lifetime, but only one in 34 will actually die of the disease.

False

37%

True

63%

Answer: True The ACS says about two-thirds of all prostate cancers are diagnosed in men older than 65.

False

36%

True

64%

Answer: True Prostate cancer that is more advanced may cause these symptoms, but the disease in its early stages may not cause any symptoms at all.

False

64%

True

36%

Answer: False The test measures the blood level of PSA, a protein that is produced by the prostate gland. According to the US National Cancer Institute, a higher PSA level means a higher likelihood of prostate cancer. However, there are additional reasons for an elevated PSA level, and some men who have prostate cancer do not have elevated PSA.

COVER STORY 7

men don’t know One of the most frightening things about prostate cancer is the lack of awareness of the disease, says Jeanette Wang

P

disease, answering “true” to the statement: “About one in 30 men will be diagnosed with prostate cancer during his lifetime.”

In reality, according to the American Cancer Society, prostate cancer will affect one in six men in their lifetime – but only one in 34 will die of it, as most prostate cancers are slow-growing.

About one in three people did not know that the most important risk factor for prostate cancer is ageing – prostate cancer is rarely found in men below the age of 50.

The Health Department notes that other risk factors include family history of prostate cancer, and physical inactivity, though the causes of prostate cancer are not yet fully understood.

Another one in three people did not know that prostate cancer symptoms begin with urination troubles, such as difficulty in urination, pain during urination and frequent urination. Other symptoms include stiffness in the lower back, hips or upper thighs. That said, these symptoms are usually caused by advanced prostate cancer. The disease in its early stages may not cause symptoms at all.

The Health Post survey was done to ascertain the level of knowledge of prostate cancer among Hong Kong men ahead of Movember – or “the

rostate cancer awareness campaigns often focus on early detection through identification of symptoms and screening, but results from a recent survey of local men conducted by Health Post have shown perhaps a basic biology lesson is first in order.

Nearly 30 per cent of the 100 men polled earlier this month thought that prostate cancer affects both men and women. This shows a frighteningly low level of awareness for a disease that is growing at the fastest rate among all cancers affecting Hong Kong men.

Prostate cancer is a disease that forms in the tissues of the prostate, a walnut-sized gland in the male reproductive system. According to the latest Health Department statistics, it’s the third most common cancer among Hong Kong men, affecting 45.2 per 100,000 people in 2009. In 1999, the rate was 18.3 per 100,000 people. Experts believe the rising incidence may be due to a Westernised diet, an ageing population and improved diagnostic techniques.

So women are obviously spared – but this is not the only fact that many respondents to Health Post’s true-or-false quiz got wrong.

More than 80 per cent underestimated the extent of the

Overall quiz scores 1 correct

Treatment for prostate cancer The survival rate for early ? ? always causes impotence or detected prostate cancer incontinence. is over 90 per cent.

False

79%

True

21%

False

21%

True

79%

1%

1%

2 correct

4%

16%

Answer: True Because so many prostate tumours are low-grade and slow growing, survival rates are excellent when prostate cancer is detected early.

of male respondents to the Health Post survey underestimated the prevalence of prostate cancer

month formerly known as November”, when men sprout moustaches to raise funds and awareness for prostate cancer.

Fifty-five of the 100 respondents were enlisted through e-mails to friends, friends of friends, and colleagues, and the rest through a street survey over a weekday lunchtime in Central.

The respondents, all men, were aged from 18 to 63, with an average age of 35.8 years. About two in five were Asians – mostly Chinese.

Occupations ranged from students to sportsmen, administrative staff to professionals in the fields of finance, education, aviation, engineering, property, media and marketing.

Only five of the 100 respondents answered all seven quiz questions correctly. More than 20 per cent

All correct

5%

Annually

31%

Fewer than once every two years

28%

How often do you exercise a week? (at

> CONTINUED ON PAGE 8

Have you heard of Movember?

Would you be willing to grow a moustache for Movember?

Yes

Yes

least 30 minutes of moderate to vigorous exercise per day)

Every day

62%

7%

50%

3-6 days 3 correct

Answer: False It’s not true that all men experience complications following surgery or radiation therapy for prostate cancer. The side effects can also be highly dependent on age and physical condition.

80%

How often do you get a health check-up?

None correct

got three or fewer correct – meaning they “failed” the quiz. Clearly, more education is needed on prostate cancer.

With Movember launching officially in Hong Kong this year, hopefully there will be more conversations about the disease.

After all, that’s a goal of the annual campaign that first began in Melbourne, Australia, in 2003 as a joke among some friends to bring the moustache back in fashion.

“The moustache has been really powerful in getting guys to talk about their health,” says Greg Rafferty, 36, manager for Movember Asia. “Guys the world over don’t engage with their health as well as they should, and I think Movember has given them a platform to start those kind of conversations.”

In the first year of Movember, 30 “Mo Bros” participated, raising no money. The following year, the moustaches were grown in aid of the Prostate Cancer Foundation of Australia – 450 participants raised A$54,000. Last year, more than 854,000 people worldwide raised a total of A$124 million (HK$997 million) for charities in 14 official campaign countries, and also for Movember’s global prostate cancer research programme.

According to the Movember

58%

6 correct

14%

5 correct 4 correct

32%

27%

Never had one

18%

When I feel like it

23%

0-2 days

35%

No

38%

No

50% SCMP

8 COVER STORY

Why do men see a doctor less often than women? ......................................................

Jeanette Wang jeanette.wang@scmp.com

Movember Asia manager Greg Rafferty and his moustache. Photo: May Tse

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Foundation, the not-for-profit Australian-based organisation behind the campaign, Movember has had “a significant impact on [the] health-related behaviour of its participants.” Research shows that 71 per cent of participants talked about men’s health, 84 per cent convinced others to take action, and one in five participants went to see a doctor specifically because of Movember.

Health Post’s survey showed that only about 30 per cent of the respondents have annual health check-ups. An annual physical exam can not only help identify health problems you may not be aware of, but also address known medical issues and help build up a good relationship with a doctor. That way, when problems arise, the right care can be given.

Hong Kong is one of seven new countries to join Movember this year and, along with Singapore, marks the campaign’s first official foray into Asia. It’s a timely move: while the incidence of prostate cancer remains much lower in Asian nations – specifically China, Japan, South Korea and Singapore – than

Often, a moustache doesn’t look great, so it’s a badge of honour that says ‘I’m going to take part’ GREG RAFFERTY, MOVEMBER ASIA

in North America, there is a clear trend of increasing incidence in these four countries, according to a study by the US Department of Defence’s Centre for Prostate Disease Research.

The study, published earlier this year in the Journal of Carcinogenesis, noted that when prostate cancer is detected in many Asian nations, it is typically due to the onset of symptoms and at an advanced stage. And this relatively high rate of advanced prostate cancer detection has been blamed on the lack of a mass screening effort.

With the UN predicting a population of six billion in Asia by 2050, and with life expectancy rising,

the number of prostate cancer cases is likely to continue rising in Asia.

Rafferty says Movember might make its presence official in the mainland in two years’ time, and possibly India, too.

An official campaign means that funds raised will go towards prostate cancer initiatives in that country, benefiting the local community. In previous years, Movember was unofficially in Hong Kong with an estimated 500 participants, mostly expats. Funds raised went to these expats’ home countries.

This year, 35 per cent of all money raised by local participants will go to the Hong Kong Cancer Fund to support its patient care services. The remainder will fund research by a local scientist, who will be part of Movember Foundation’s global collaborative research programme. But Rafferty says the No 1 aim of Movember is still to raise awareness for men’s health – the money is secondary.

“People are more inclined to donate and fund-raise the more people engage in the campaign and the more we can demonstrate the outcomes we’re achieving through the funds. It’s not something we push or particularly worry about. We know that it will happen,” he says.

Interested men can register at hk.movember.com. Start with a clean-shaven face on November 1, and groom your moustache for the entire month. Women are encouraged to do their part, too.

“Mo Sistas are a huge part of our campaign,” says Rafferty. “Over 50 per cent of our donations globally have come from them.”

He says women can get their partner or male friends to take part, and encourage them along the way by complimenting their moustache, “even if she has to lie a little bit”.

“Often a moustache doesn’t look great … so it’s really a badge of honour that says ‘I’m going to make a difference and take part’,” says Rafferty. “Besides, a lame moustache tends to generate more conversation.”

Additional reporting by Joanna GwynneJones and Crystal Ha Cheuk-yu

According to the annual report by the Movember Foundation, men worldwide live shorter lives than women and suffer more from heart disease and cancer. Health risk factors are also more common among men, including smoking, alcohol abuse, obesity, suicide, and work and road accidents.

In spite of this, men access health services less frequently than women and when they do visit the doctor, they typically present late, thereby denying themselves the chance of early detection and effective treatment of common diseases.

In the Health Post survey, we asked some respondents for their opinion on why men seem to care less or talk less about their health than women. Here are some of the replies. (Some respondents wished to remain anonymous while others would give only their first name.) ● Men don’t realise how important

maintaining health is. Most consider fitness to be the same as health. In general, they don’t consider the health of organs, blood, circulation and the mind to be part of fitness.

As they haven’t been brought up to consider health in this way, they limit their talking to fitness issues: muscles, endurance, strength, etc. If they were brought up to speak about or consider the effect of food, stress, work, environment, they would speak about it as a matter of course.

Anonymous, 46, works in education ● In my opinion, I don’t think it is

that they don’t care. It is more a poor level of understanding and awareness to health risks.

Malcolm Leigh, 37, sales ● It’s embarrassing to discuss

personal issues, especially when related to sexual matters.

Justin Choo, 34, veterinarian ● That is an Anglo-saxon male

mentality. Latin males and Latin culture care a lot about their health, the same as Latin women do.

The same might be said for some

Asian cultures: for example the Koreans are, on the whole, very health-minded people.

Andrea Cassandro, 30, senior manager ● Personally, acknowledging the

symptoms in the beginning is the hardest part – it’s easier to just ignore it and hope it goes away.

And there is an unwillingness to be seen as a hypochondriac, wasting a GP’s time.

Christopher Smith, 24, airline pilot ● Men are more private than

women. Men tend to have a few strong relationships with other men, but are not willing to talk about health issues with them. Men see illness as a weakness they do not want to share with others.

John Hamilton, 43, IT manager ● Women have menstrual cycles,

deliver babies, nurse those babies and take care of those around them.

Because of this, they have always counted on each other to give advice in these areas as well as others.

There has always been a built-in network – mothers, sisters, girlfriends – where they can bounce off any health questions they may have, openly seeking advice.

Andrew, 49, banker ● I think women are better at

communicating through dialogue, discussing emotions, choices and problems; whereas males are more action-oriented, where the goal of communication is more to achieve something, rather than discuss their own personal issues with others.

Paddy Kirkland, 25, teacher ● Men seem to keep these things

private. I had a non-benign prostate problem 15 years ago and talked freely about it.

As a result, a few years later two of my work colleagues approached me for a chat since they were having problems in that area.

I packed them off to their doctors and as it turned out both had a benign problem. With early detection, they were both treated and came back to work. The big message to men is: talk about it.

John, 63, pilot

Men tend to be more reluctant than women to discuss health problems.

HEALTH 9 SELF-DIAGNOSIS

Confessions of a ‘cyberchondriac’ ......................................................

Sunory Dutt healthpost@scmp.com With the wealth of information available online, most of us have turned to the web to self-diagnose our (real or imaginary) symptoms or illnesses.

It’s led to a whole community of “cyberchondriacs” who, more often than not, end up committing a double jeopardy of self-diagnosis and misdiagnosis based on what might be misinformation culled from online sources.

A recent study published online in the Journal of Consumer Research suggests that when the symptoms are our own, self-diagnosis via the internet – or anywhere but a doctor’s office – too often leads to inaccurate, worst-case conclusions. A simple headache due to fatigue or dehydration may turn into a brain tumour in one’s mind.

Research suggests that people tend to overestimate their own risk for serious ailments than when thinking about someone else’s symptoms. “Given the same set of symptoms, people will overestimate their own likelihood of getting such rare, often serious, diseases than that of other people,” says study co-author Yan Deng-feng, a doctoral student at the Hong Kong University of Science and Technology.

This type of thinking can have downsides, write Yan and co-author Jaideep Sengupta in their study report, often leading “to mistakenly diagnosing oneself as possessing a serious disease, causing both unnecessary anxiety and wasteful medical expenditure”.

They add that, “mistaken selfdiagnoses of this sort are particularly likely given the ease of information access on the internet, which frequently leads consumers to engage in ‘symptom-matching’ exercises”. Says Yan: “We advise people to see a real doctor.”

In another recent study published in the Journal of Paediatrics, a team of US researchers checked the accuracy of information on infant sleep safety available on the internet using Google. It created 13 key phrases to reflect specific recommendations from the American Academy of Paediatrics for infant sleep safety, and the first 100 search engine websites were analysed for each phrase.

Of 1,300 website results, 28.4 per cent provided information that was

MedicineNet medicinenet.com “A good general website for laymen for various medical conditions since its articles are written or reviewed by physicians.

Dermatology-specific sites would be aad.org and bad.org.uk.

Both are the main websites maintained by the American Academy and British Association of Dermatology respectively so the information is accurate.”

Dr Gavin J. Chan, specialist in dermatology at SkinCentral in Hong Kong

Mistaken selfdiagnoses are likely given the ease of information access on the internet

“Uptodate.com is another dependable website. It’s used by medical professionals almost exclusively for everything. It has recently developed a patient site and it is very comprehensive. I print handouts out from this site for my patients to take home and read.”

Dr Sunita Mishra, medical director, Swedish Medical Group in Seattle

YAN DENG-FENG

not relevant to infant sleep safety.

When these websites were excluded, 60.8 per cent of the websites provided accurate information.

Blogs, retail product reviews, and individuals’ websites had the highest percentage of inaccurate information regarding infant sleep safety. News websites were accurate only half of the time.

If you must trawl the web, doctors recommend searching credible health websites. But it’s still no substitute for patient-doctor communication. Here are a few health websites trusted by the medical fraternity.

Mayo Clinic mayoclinic.com “I usually use the Mayo clinic website. I think it is easiest to navigate when looking up a condition. It gives background on diseases in easy-to-understand terms and then outlines treatment options. I also like it as the Mayo Clinic is a reputable medical organisation and I trust most of what I have seen.

Medline Plus nlm.nih.gov/medlineplus “It’s a good site for basic medical information. It’s easy to understand and is not supported by any advertisements, and doesn’t endorse any products or companies.

“For skincare, more specifically cosmetics and personal care products, I’d suggest Cosmeticsinfo (cosmeticsinfo.org). I don’t have any unbiased sites to recommend to the public on the subject of aesthetics; most are very advertisement-driven.

Beware of forum sites as some are penned by authors who have treatments sponsored, so the views are not totally objective.”

Dr Georgia Lee, aesthetics doctor based in Singapore

WebMD webmd.com “It’s the best known and most comprehensive. Look up some conditions; it’s for laypeople. As a physician, I do not recommend anyone research his or her condition on the internet. That said, if you have an ailment, go to the American Medical Association site or American Dental Association or the American association of whichever branch of medicine your condition is dealt by.”

Dr Natasha Mathias, dentist and owner of Sparkles Dentistry for Children in New Jersey

Wikipedia wikipedia.org “The three sites that I use regularly to check on diagnosis and dosage are Wikipedia, Medlineplus (nlm.nih.gov/medlineplus) and Medicinenet (medicinenet.com). All three are easy to understand and most importantly they have the various trade names of drugs, which vary around the world. Also, as the US has a very high rate of litigation, I use the US sites more. Occasionally I’d search deeper, but then it would be to counter-check the US sites using a British site.

The Swiss and Japanese sites are hard to use because of the software and website, but they contain a wealth of knowledge on new and very interesting medications, more suitable for doctors.”

Dr Bernard Cheong, partner at Lifeline Medical Group in Singapore

10 DIET THE TASTE TEST HOT CHOCOLATE

Margaret Xu, head chef of Yin Yang restaurant in Wan Chai, believes in a from-farm-to-table philosophy and modernising old dishes such as her yellow earth chicken. Photos: May Tse, Margaret Xu

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

Jeanette Wang jeanette.wang@scmp.com

Meiji Milk Cocoa Drink Zero Sugar HK$39 for 98 grams (seven sachets), Marketplace by Jasons I tend to find most hot chocolate too sweet. So this sugar-free drink is great, as I can tailor its sweetness to my preference. I felt it didn’t need any sugar at all. Made with water, that’s just 57 calories and 1.4 grams of fat per serving.

Verdict: rich chocolatey flavour but very thin when made with water; so use milk for a more indulgent treat.

HEALTHY GOURMET

Straight from the earth ......................................................

Andrea Oschetti healthpost@scmp.com

Café Direct Sao Tome Luxury Hot Chocolate HK$45 for 300 grams, Marketplace by Jasons This 100 per cent natural pre-mix contains delicate cocoa called criollo from the West African island of Sao Tome, also known as “Chocolate Island” for its top quality cocoa.

Three to four heaped teaspoons sets you back just 62 calories.

Verdict: lives up to its “luxury” status: rich, intense chocolate with just enough creaminess.

Swiss Miss No Sugar Added Cocoa Mix HK$37 for 125 grams (8 sachets), City’super Swiss Miss is an American favourite that dates back to the 1950s – it was one of the first full-flavoured dry cocoa mixes, originally served during flights. This version uses the sugar substitute sucralose and hence has less than half the calories of regular hot cocoa.

Verdict: very sweet, weak and artificial chocolate flavour, and thin drink texture. Next please.

More than a decade ago, when organic farming was given little attention in Hong Kong, chef Margaret Xu started championing the from-farm-to-table process at her vegetable garden and secluded kitchen in Yuen Long.

“Organic is not a business opportunity, it is a life choice,” says Xu. “Organic farms take longer to grow crops, they require more labour, and their output is not reliable. [But it] improves the environment, gives us healthier food and, possibly because of the higher cost, helps us to eat less.”

When it comes to eating locally grown food, I have reservations. Xu says eating locally is a lifestyle choice, not a gourmet choice.

Locally grown foods are not necessarily the best, although they have a better carbon footprint.

Eating locally starts by cooking or ordering local traditional dishes that require local ingredients: for example, eat steamed chicken with dried lily flower with black fungus and not a caprese salad.

The famous mozzarella di bufala is not simply Italian; it is the local product of a few selected municipalities of four regions in central and southern Italy.

The cheese’s distinct qualities mainly depend on the local milk, environmental conditions and the traditional working methods of the specific area of production. So authentic mozzarella cannot be sourced locally in Hong Kong. I would not advise to order bak choi in Naples either.

Xu is a gourmand, a great chef and a veteran organic farmer. She has attempted to grow almost everything in her vegetable garden and fruit orchard.

I asked her to help me make the right grocery decisions. For my private kitchen I want to source locally when it makes sense, and keep importing the ingredients from Italy that don’t grow well here.

“Many vegetables and fruits can grow in Hong Kong’s subtropical climate,” says Xu, “In winter we can grow Western-style vegetables and, in summer, Asian ones.”

My mission is to rediscover and reinvent traditional dishes which are now outdated MARGARET XU, CHEF

Unfortunately, my favourite tomatoes don’t do well in Hong Kong. Xu says: “You need a lot of sun and dry weather, Hong Kong is too humid for good tomatoes.”

She lists figs, lemons, beetroot, cucumbers, sweetcorn, fennel and carrots as good home-grown choices. But eggplants, pumpkins, zucchini, basil and most fresh herbs, melon, peach, orange, and apple will not impress a gourmand.

It is helpful to discriminate when choosing fish and meat. I think fish from the warm waters of the Pacific

Ocean will never be as succulent as that from the Mediterranean and, personally, I am sceptical about the water quality of the local catches.

I am a lover of organic food. This is how my grandmother and everyone of her generation and before her used to eat. But I have come to realise that “organic” matters more for some products than others, particularly if the choice is between eating them non-organic and not eating them at all.

The US-based Environmental Working Group has identified which fruits and vegetables have the most pesticide residues and are the most important to buy organic. These include: apples, celery, sweet bell peppers, peaches, strawberries, nectarines, grapes, spinach, lettuce, cucumbers, blueberries and potatoes. Conventionally grown products that are “cleaner” are onions, sweetcorn, pineapples, avocados, cabbage, sweet peas, asparagus, mangoes, eggplants, kiwi, cantaloupes, sweet potatoes, grapefruit, watermelons and mushrooms. Given the high prices and limited availability of organic produce, this list helps me make my grocery decisions.

Xu continues to champion the farm-to-table approach at a small restaurant, Yin Yang, in a historical three-storey building on Ship Street, Wan Chai. She employs traditional Chinese cooking techniques, such as stone-grinding grains and woodfired roasting in terracotta oven pots, because she is a firm believer that old, slow-cooking methods are the best way to preserve taste.

But she also has a contemporary attitude. “My mission is to rediscover and reinvent traditional

dishes which are now outdated – to make them fresher, healthier and suit our modern living style.”

One of her signature dishes is the yellow earth chicken, named after the yellow terracotta urn in her kitchen, in which it cooks.

“They used to hang chicken to roast, like we see for Peking duck, which helps the fat drip off,” Xu says.

“In the old days it was made with spices that would overpower the modern palate. I have developed a version of this traditional dish that tastes more elegant.”

You can also make the dish at home with the recipe below.

For the next month, this column will focus on people in Hong Kong like Xu who make our city vibrant through creativity, gourmet food and a health-conscious mindset.

Yellow earth chicken Serves 4 2 tbsp extra virgin olive oil 1 tbsp fresh ginger, chopped 1 stem of curry leaves 1 tbsp sea salt 1 fresh chicken 1 tbsp mandarin wine 1 tbsp rock salt • Prepare the marinade by mixing the olive oil, ginger, curry leaves and sea salt.

Let the flavours mingle overnight.

• The next day, season the inside of the chicken with the marinade and the mandarin wine. Season the outside with the rock salt.

• Roast in a preheated oven at 225 degrees Celsius for 45 minutes.

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

WELL-BEING 11 FIT & FAB

The best I can be ......................................................

Rachel Jacqueline healthpost@scmp.com Tania Harris’ path to triathlons was paved with failure. After nine miscarriages, two stillbirths and a pulmonary embolism within four years, the executive coach embraced the sport as a way to experience success in her life.

“I was spiralling downwards without realising it,” says the 50-year-old from France.

During her depths of depression four years ago, Harris attended a talk given by some runners who had competed in the 2009 Racing the Planet desert ultramarathon in Namibia, a 250-kilometre, sevenday race. She was inspired by one of the female runners, Joanne Eades.

“Her story was all about achievement and it resonated with me because I felt like a failure – a woman who could not have a baby,” says Harris. “I had professional success but personal failure.”

At the same event, she struck up conversation with Philip Penaloza, the president of the Hong Kong Triathlon Association, who encouraged her to take part in a sprint distance triathlon – a race that consisted of a 750-metre swim, 20-kilometre bike ride, and fivekilometre run – that was taking place in five months. Without hesitation, Harris signed up.

At first, she couldn’t run a kilometre without running out of breath. “My husband said I looked like a cross between a duck and a grasshopper,” says Harris.

She didn’t know how to swim front crawl, and so would stop halfway across a 50-metre pool, exhausted. She didn’t have good control of her bicycle, and fell off three times before she got the hang of it. But she persisted, completing the race in a time of one hour, 37 minutes and 23 seconds.

“The race itself was beyond my expectations,” she says. “Of course, I came last out of the water, and because I’d pushed so hard on the bike, my legs were like jelly on the run. But I did it, and I wasn’t even the last person to finish.”

Since then, she has completed the Laguna Phuket Triathlon (1.8kilometre swim, 55-kilometre cycle, 12-kilometre run), and finished second in her age group twice at the annual Hong Kong ITU Triathlon: in the sprint distance in 2010, and in the Olympic distance (1.5-kilometre swim, 40-kilometre cycle, 10-kilometre run) at this year’s race.

These days, she trains three to five times a week for each discipline.

“I love a challenge. It’s what gets me up in the morning,” she says.

Tania Harris started competing in triathalons to help with the depression she faced after a series of miscarriages. Photo: May Tse Did you ever think of giving up during training for your first triathlon?

No. My motivation to take part was strong. I always had in mind my two children that I’d lost – Xenia and Flavio – and I was doing it for them.

It was so painful, you have no idea.

But I just couldn’t give up. It was my way of making it right.

broken?” I couldn’t help but laugh. I was also lost and asked them for directions. As I pedalled off, I went between two poles and fell over again, grabbing hold of one of the poles for balance, and sliding down, while the trio laughed at me. I was laughing, too. It was more than comical.

What’s your most memorable triathlon moment?

The most amusing is when I tried to unclip my cleats during my first cycling session. I went out to Tung Chung on my own at 6.30am. I stopped to rest and the inevitable happened: I unclipped one foot, lost my balance and totally flopped on the floor in front of three good-looking cyclists.

I tried to look cool when I heard one of them say, “Apart from your ego, darling, nothing

Are you healthier now that you are a triathlete?

These days I am more aware of having a good diet to feed my body.

I never used to eat meat, and now I’ve discovered that I need more protein when training as much as I do. When you push your body to its limits, you need to replenish it.

Is the sport about the individual or the team?

In order to better myself, I can’t just do it on my own. It’s my team that

along. I don’t know if I could have kept going if it hadn’t been for him.

My husband said that I looked like a cross between a duck and a grasshopper

How do you find balance?

It’s not easy. At some points I have balance, and at other times I don’t.

It’s definitely difficult to achieve. It depends where you want to take your passions, such as sport and work. I think the best way is to realise that you can’t do everything.

keeps me going and makes me better. I remember at last year’s Laguna Phuket Triathlon I was losing focus. One of my teammates from the Hong Kong Dragons Triathlon Club passed me, noticed I was struggling, and ran with me for the next two kilometres.

I knew he was much stronger, but out of the goodness of his heart, he stayed with me and pushed me

What keeps you going these days?

I often ask myself why I am doing this. For me, it’s all about personal bests, and the challenge itself. There are always going to be a lot of people faster than me.

Succeeding requires a lot of mental strength, and it is about being inspired, rather than worrying about anyone else.

I just keep thinking, “I can do this.

I am doing this for me”.

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OCTOBER 30, 2012 SOUTH CHINA MORNING POST