20130115 health post

YOUR GUIDE TO LIVING WELL

HEALTH POST TELLTALE FINGERNAILS >PAGE 4

ALTERNATIVE FLU REMEDIES >PAGE 9

Arthritis comes in many forms and is striking people at a younger age >PAGE 6

Daily grind

TUESDAY, JANUARY 15, 2013

2 NEWS APP OF THE WEEK

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

Exploring the stub conscious

More strings attached Genetics researchers have identified 25 additional strings of DNA that could help predict whether a child has autism spectrum disorder. While rare, each of these DNA arrays – called copy number variations (CNVs) – have been found to double, at minimum, one’s risk for the condition. This finding adds to another 31 CNVs previously reported to have the same high impact.

Autism spectrum disorders are a group of neurodevelopmental disorders that impair verbal communication and social interaction, and affect behaviour. The research team, led by Dr Hakon Hakonarson of the Children’s Hospital of Philadelphia, first analysed DNA from 55 individuals with multiple family members diagnosed with the condition, and identified 153 CNVs potentially specific to autism. The scientists then looked for these CNVs, along with another 185 previously identified CNVs, in 3,000 autism cases and 6,000 control subjects. The study was published yesterday in the journal PLoS ONE.

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Katie McGregor healthpost@scmp.com Livestrong MyQuit Coach – Dare to Quit Smoking HK$28 Rating 9/10 With the new year, it’s time to think about cleaning up bad habits – and if you are still smoking, MyQuit may be the solution you are looking for.

The app draws up a quitting plan for you. Enter the number of cigarettes you currently consume, then you are presented with a motivation screen. Choose from family, health, financial, cosmetic or other, then key in a message to remind yourself of your reasons for quitting.

You can also upload a photo, presumably one of your family, or one of a pile of money, depending on your motivation. If you don’t have a photo or a message, the app has a default one.

The app asks for more information about your habit, including reasons and cost. You set a reminder, a quitting date, register and then you receive your plan.

The five-week plan provided for me had me go from 20 to 14 cigarettes per day in the first week, and then cut the daily rate by three cigarettes for each of the following weeks, so that I would be at zero for my chosen cessation date.

Then day one starts. If you have a craving, tap the craving button and the app provides you with a reminder of why you are trying to

stop. If you have a cigarette, likewise tap the “I smoked” button. As you progress, you can collect virtual achievement awards if you stick to your goals, and a chart shows you what you are saving each day. The chart also shows the number of times you felt a craving. In theory, this should decrease with time.

As the app advises, a support community is important, and there is an option to join the Livestrong chat community, post your own messages and follow others. Also, through the app, you can post on your Facebook or Twitter and ask your friends to support you.

If you want to go cold turkey, then your plan is much simpler: zero. But the tracking and reminders will still support you in your quest for a healthier, wealthier year ahead.

ASK THE DOCTORS DR ANN TAN Q: What days during and around my period I am likely to get pregnant? I have read that it is five days either side. If my periods are regular, how reliable would these guidelines be?

A: If you have a regular 28-day cycle, ovulation usually occurs on day 14 of the cycle – day one being the day menstruation begins. However, as sperm survive for up to 72 hours, your most fertile period is three days before and after day 14, meaning day 11 to day 17.

If, however, you have a regular 30-day cycle, then you assume that ovulation occurs always nearly 14 days before the next

Jeanette Wang jeanette.wang@scmp.com

menstruation. Therefore your fertile period would be on day 16, plus or minus three days.

To pinpoint when ovulation will occur, you can test your urine to see how much the urinary luteinising hormone levels have risen.

The hormone helps regulate the menstrual cycle and egg production.

It increases rapidly just before ovulation – about 36 hours before.

The chance of pregnancy is about 25 per cent should you try at the time of ovulation.

Dr Ann Tan is an obstetrician and gynaecologist with Mount Elizabeth Hospital in Singapore

> 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

Mouth-watering possibility Parkinson’s disease is characterised by movement problems, but a study published today in Neurology finds that the condition often presents early on with non-motor symptoms, such as drooling, anxiety and constipation. “Often people with early Parkinson’s don’t even mention these symptoms to their doctors, and doctors don’t ask about them, yet many times they can be treated effectively,” says study author Tien K. Khoo of Newcastle University in Britain. The study screened 159 newly diagnosed Parkinson’s patients and 99 people of similar ages who did not have the disease, for 30 non-motor symptoms. The patients had an average of eight non-motor problems, compared to three for the control group. A total of 56 per cent of patients had problems with excess saliva or drooling compared with 6 per cent in the control group; 42 per cent of patients had constipation compared with 7 per cent; and 43 per cent of patients had anxiety versus 10 per cent.

Teenage trysts of fate Teenage girls who have been victims of abuse or neglect are more likely to have offline meetings with internet acquaintances – opening the door to potentially dangerous and risky situations, according to research in the journal Pediatrics. In the study of 251 girls aged between 14 and 17, 30 per cent reported having offline meetings. Abused or neglected teenage girls – who made up about half the participants – were more likely to present themselves online in a sexually provocative way than other teenage girls. And these types of online profiles are more likely to lead to offline meetings, says the study’s lead author Jennie Noll, a psychologist at Cincinnati Children’s Hospital Medical Centre. On the other hand, “high quality parenting” and parental monitoring helped reduce the association between adolescent risk factors and “high-risk” online behaviour, she says.

Blow and behold Lung infections such as tuberculosis could soon be diagnosed in a matter of minutes, instead of days and weeks. A new study in the Journal of Breath Research has identified the chemical “fingerprints” given off by specific bacteria when present in the lungs. University of Vermont researchers were able to distinguish between different types of bacteria, as well as different strains of the same bacteria, in the lungs of mice by analysing the volatile organic compounds (VOCs) present in exhaled breath.

They had infected the mice with Pseudomonas aeruginosa and Staphylococcus aureus, both of which are common in acute and chronic lung infections. The scientists hypothesise that bacteria in the lungs produce unique VOCs that are not found in regular human breath due to their differing metabolism. Breath-based diagnostics have also been investigated for multiple cancers, asthma and diabetes.

NEWS 3 MEDICAL TECHNOLOGY

QUIZ

Mussel-based surgical adhesive begins to gel

An encouraging sign that hygiene message works

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Jeanette Wang jeanette.wang@scmp.com Mussels have a knack for clinging to rocks, piers and boat hulls – and in recent years, this has inspired scientists to exploit the shellfish’s unique sticky biochemistry to develop medical solutions. The latest: stronger, more effective and safer bioadhesives for post-surgery wound closure.

Researchers at Pennsylvania State University took the biological information and chemical structure of the adhesive protein produced at the foot of the common mussel, and developed a wholly synthetic family of adhesives. Called iCMBAs, the bioadhesives adhere well in wet environments, have controlled degradability, improved biocompatibility and lower manufacturing costs.

Many current adhesives have side effects. Fibrin glues, a humanderived tissue adhesive, for example, are fast acting and biodegradable but have relatively weaker adhesion strength. They may also carry the risk of blood-borne disease

transmission and could result in allergic reactions due to animalbased ingredients.

Cyanoacrylate adhesives, or super glues, are very adhesive and set rapidly, but they break down slowly and may cause toxicity. They are often limited to external use.

Neither of these two current products is effective when used on wet tissue, which is needed for internal organ surgery. There are also no commercially available tissue adhesives or sealants appropriate for both external and internal use.

The researchers used the iCMBAs and finger clamping to close three wounds on rats for two minutes. Three other wounds were closed using sutures. The iCMBAs had 2.5 to eight times stronger adhesion in wet tissue conditions compared to fibrin glue. They stopped bleeding instantly and facilitated wound healing. They’re also non-toxic and unlikely to cause allergic reactions, although there was some mild inflammation.

“We are still optimising our formulation,” says one of the researchers, Yang Jian, an associate

Jeanette Wang jeanette.wang@scmp.com

professor of bioengineering at Penn State. The goal is to improve the adhesion strength to expand its use for things like broken bones.

In another study last month published in the online journal PNAS Early Edition, mussels inspired University of British Columbia scientists to create a gel that can be painted onto the walls of blood vessels to form a protective barrier. The gel can prevent weakened vessel walls and blood vessel plaque from rupturing, thereby avoiding a potentially lifethreatening condition such as heart attack or stroke.

Northwestern University researchers in 2010 also used a mussel-inspired glue to repair ruptures or holes in human fetal membranes, thereby avoiding premature labour or termination of the pregnancy.

“Four out of five males wash their hands.” Men who saw this sign posted in the toilet were more likely to wash their hands and run the water longer, in a study by Michigan State University published in Human Communication Research.

MSU researchers found that 86 per cent of the men washed their hands when leaving the bathroom, higher than the 77 per cent figure reported by the US Centres for Disease Control and Prevention.

The men in the MSU field experiment surveyed had selfreported washing their hands 75 per cent of the time. So, researchers posted the sign in bathrooms, along with a guide to effective hand washing, and observed the subjects.

The findings suggested that relatable, specialised messages in the bathroom can improve hand-washing behaviour. This in turn can have huge implications on public health, especially during cold and flu season.

Maria Lapinski, one of the study’s researchers, says “quality hand washing can prevent transmission of many diseases”.

Are you washing your hands the right way? Test yourself here.

1. Most cold germs are spread through a. Hand-to-hand contact b. Sneezing and coughing c. Kissing 2. You lather up your hands with soap and warm water for at least a. 5 seconds b. 20 seconds c. 60 seconds 3. You should dry your hands a. On a paper towel b. On your pants c. You don’t need to 4. How many germs can be found on the hand at any given point in time? a. 50 b. 500 c. 5,000 Answers: 1. a; 2. b (Sing Happy Birthday twice); 3. a (germs thrive in warm and wet conditions); 4. b

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4 MEDICAL CASE HISTORY

Illustrati on: Ang ela

Ho

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Angela Baura healthpost@scmp.com An insurance agent by day, and a high-action casino dealer at Las Vegas’ MGM Grand Casino by night, Sandra Yep-Lebeck, 44, knew that her immaculately manicured nails were an integral part of her image.

Yet, despite her glamorous exterior, Lebeck was sick, evidence of which lay concealed beneath those perfectly polished nails.

During a weekly manicure appointment, Lebeck’s nail technician commented on her brittle nails and the separation of the nail bed from her skin, medically referred to as “Plummer’s nail”.

“I decided to use acrylic nails to prevent the green felt at the casino from getting trapped under my nails, and to hide my nail problems from my insurance clients,” recalls Lebeck, who now lives in Hong Kong. As her nail condition worsened, she became increasingly sensitive to heat, her neck began to bulge and she experienced hair loss.

In 2000, Lebeck was diagnosed with Graves’ disease, an autoimmune disorder that leads to an overproduction of thyroid hormones – hyperthyroidism. While symptoms can include enlargement of the thyroid gland (goiter), weight loss and frequent bowel movements, it was Lebeck’s nails that first indicated an underlying health condition.

“Nails and surrounding tissue can tell you a lot about a person’s health,” explains Alexandra Duff, podiatrist at PhysioMotion in Central. “Our nails are made of keratin, a hardened protein. Like hair, when you are healthy your nails look good but when unwell, they become brittle and damaged.”

Duff checks for changes in her patients’ nail shape, contour, texture and colour at every consultation.

Discolouration under the nail can indicate rheumatoid arthritis, bacterial infections, tumours, Reiter’s syndrome (a form of arthritis), liver cirrhosis, or malignant melanoma, a deadly form of skin cancer, she says. While discolouration of the nail plate may simply be caused by nicotine stains or excessive use of nail varnish, it can also indicate fungal or bacterial infection, ulceration, Darier’s disease (a rare inherited skin

How to nail a problem condition), lymphoedema (swelling of body parts due to excess accumulation of protein-rich fluid) and nutritional deficiencies.

As a photographer Sara Young, 35, relies on her hands. Yet, she recalls a time when she hesitated to pick up her camera and draw attention to her hands and nails.

“I was 16 weeks pregnant when my nails began to turn white. There were purple bits, too,” Young says.

“Towards the end of my pregnancy, my whole nail was white. I knew that

If you notice changes to the condition of your nails or the surrounding skin, seek advice ALEXANDRA DUFF, PODIATRIST

there was nothing wrong with the baby, but there was something wrong with me.”

Following a blood test, Young learned that she was calcium deficient, and her baby was taking her back-up resources. She was prescribed calcium and magnesium supplements for the duration of her pregnancy and gradually her nail plate returned to normal.

“The condition of your nails can highlight numerous nutritional deficiencies,” says Jennifer

Sheppard, founder of Downtown Detox, a company that provides tailor-made nutritional cleansing programmes. Deficiencies in protein or vitamin B can cause fragile nails, she says. Spoon nails with vertical ridges can indicate iron deficiency, and dry, dark and rounded nail ends can suggest vitamin B12 deficiency.

“If you are vitamin deficient, it’s best to obtain nutrients from fresh food and then take quality health supplements,” says Sheppard.

According to Duff, discolouration of the lunule – the crescent-shaped whitish area at the base of the nail – can be scarring from injury or a sign of congestive cardiac failure, malignant melanoma or alopecia (hair loss). As Lebeck discovered in 2008, alopecia can also cause textural changes to the nail.

“Seven months after my son was born, my hair started to fall out. I had put this down to hormonal changes but then I noticed deep ridges and white spots in my nails close to the cuticles,” she says.

Lebeck’s endocrinologist confirmed that she had alopecia caused by her thyroid condition. He advised her to let it run its course. “It was only when the ridges in my nails grew out and the deep grooves disappeared that I knew that I was getting better,” she says.

According to Duff, deformity of the nail plate can indicate eczema, anaemia, dermatitis, cardiac insufficiency and chronic lung disease. Abnormalities around the nail can be caused by nail biting and cosmetic damage or paronychia (infection or inflammation of the surrounding skin), epithelioma (malignant changes to the skin), onychocryptosis (ingrown toenail) and peripheral vascular disease.

“If you notice changes to the condition of your nails or the surrounding skin, seek advice from a podiatrist or dermatologist,” says Duff. “I have seen clubbing of the nails where the patient turned out to have lung cancer. I have also seen melanomas, ulceration and gangrene under the nails. Catching these early can be a life-saver.”

Lebeck, who continues to enjoy fortnightly manicures, stresses the importance of looking beyond aesthetics. “I have learned from my two medical situations to always check my nails,” she says.

MEDICAL 5 ORGAN DONATION

Faith hinders life-saving gift ......................................................

Amrit Dhillon healthpost@scmp.com For the father of teenager Payal Mathur, it was a decision he had hoped he would never have to make.

Payal died instantly after being hit by a truck just outside the Indian capital, New Delhi, in August last year. Several days later, doctors declared her brain dead. It was just three days before her 18th birthday.

“It was a very emotional and hard decision for us. But we knew our daughter had gone and it would be a good deed to help others live by donating her organs,” says her father Ajay (names have been changed for reasons of confidentiality).

At BLK Super Speciality Hospital in Delhi, Payal’s kidneys, eyes and liver were harvested and given to waiting patients the same day.

In India, such gestures are rare.

The country has one of the highest road fatality rates in the world. More than 125,000 Indians die every year – 14 every hour – in road accidents owing to reckless driving habits. Of these annual fatalities, around 20,000 donate their organs.

But overall, India has one of the lowest organ donation rates in the world – 0.05 donations per million people, compared with Hong Kong at 4.2 patients per million, or Spain at 35 patients per million.

If the road death figures could be matched with the huge need for organ donations, millions of Indians suffering from liver or kidney failure or other ailments would live. Most die after a very long wait.

The ease with which people can donate organs varies enormously from state to state, with some maximising red tape in such a way as to deter all but the most determined, and others minimising the bureaucracy. Tamil Nadu in south India, for example, boasts the much higher figure of 1.2 donors per million people.

In a country where power, connections and money can get you virtually anything, organs stand out as the exception. Top politician Vilasrao Deshmukh died of liver cancer last August after waiting in vain for a donor.

Imagine, therefore, the plight of ordinary people such as garment exporter Jagdish Brara from Chandigarh, northern India, whose heavy drinking led to liver disease at the age of 51. “I’ve been waiting six months and it’s getting desperate.

When I was healthy, I was totally unaware of this problem. Now I’ve told my wife and parents to become donors so that other people can live,” says Brara.

Public awareness is beginning to improve owing to families such as the Mathurs receiving widespread publicity, people hearing of the death of a friend or relative while waiting for a donor, or realising how

A student draws on the wall of a cemetery in Bangalore to increase awareness of an eye-donation campaign. Photo: AFP

a donation has saved the life of someone they knew.

In Kerala, even before the Mathurs featured in the media, all the 2,000 adult residents of Pootharakkal village pledged to donate their organs to the Kidney Federation of India after their death.

They were inspired by a Catholic priest, Father Davis Chiramel, who had given the village electrician a new life by donating a kidney to him two years ago. Both of them spread the word in the village and their campaign gained traction in September last year with the signing, en masse, of consent papers.

Father Davis plans to collect one million organ donation consent papers. “It is simply human

kindness to let others live but not enough people apply their minds to the issue,” he says.

And in the state of Maharashtra, where organ donation is a particularly cumbersome and slow business, the government plans to print college admission forms with a new column for students who wish to donate their organs.

For those who agree, their willingness will be noted on their identity cards and driving licences.

The policy was conceived following the shock over the death of Deshmukh, who was a former chief minister of the state.

But cultural and religious impediments to widespread organ donation remain. Hindus

It is simply human kindness to let others live, but not enough people apply their minds to the issue FATHER DAVIS CHIRAMEL

0.05 Number of organ donations per million people in India, which is among the lowest donor rates in the world

A funeral pyre in Mumbai. Many Hindus believe the body should be “whole” at the time of cremation. Photo: AFP

tend to believe the body should be “whole” at the time of cremation for funeral rites to be conducted properly.

“Some Hindus say it is both impure and disrespectful to the dead to remove their organs. The idea of taking an organ out of a corpse and inserting it into another is frowned upon because a dead body is regarded as impure, and so transplanting a bit of it into a live body compounds the impurity,” says Swami Akhilesh, a Hindu priest in New Delhi.

Even those who admire the idea of organ donation can, when faced with the prospect of their relative’s body being tampered with, change their mind.

When the famous Bengali author Sunil Gangopadhyay died last October, his entire family knew that he had pledged his organs.

After his cremation, they revealed that they had disregarded his wishes. “It’s a very personal matter, basically, and every family is different. We simply could not go through with it,” his son Souvik was quoted as saying.

Mathur says it was a shame that the family went against the author’s wishes, but can understand the emotional struggle.

“You have to take the decision when you are paralysed by grief.

You’re in shock. I didn’t want my daughter’s body to be cut open. But it seemed selfish not to give her organs and she would not have approved of a selfish act,” he says.

6 COVER STORY

Worse for wear S

cott Taylor has always been a passionate athlete, playing rugby, football, tennis and squash. But four years ago, his love for sport was dealt a crippling blow. It all began with groin pain.

“It was like I pulled a muscle in my groin,” says Taylor, 31, the managing director of executive search firm Webbe International.

“The niggling pain I felt got worse and worse. On some days, I couldn’t take any pressure on it and I limped when I walked.” He was eventually diagnosed with hip osteoarthritis.

Osteoarthritis, a disease usually seen in the elderly whose joints and cartilage are damaged by wear and tear, is showing up increasingly in young people. Also known as degenerative joint disease, the condition is the most common form of arthritis, of which there are more than 100 types.

Arthritis, a joint disease in its many painful and debilitating forms, does not just affect the elderly, writes Elaine Yau Gout, another form of arthritis, is also striking younger people in greater numbers. The most common form of inflammatory arthritis, it’s characterised by painful and swollen joints, usually the big toe joint. It’s caused by high levels of uric acid in the blood, which leads to the formation of small crystals in joints and tissues.

Dr Daniel Ng Kam-hung, rheumatologist and executive committee member of Hong Kong Arthritis & Rheumatism Foundation (HKARF), says the

Scott Taylor’s passion for sport resulted in hip osteoarthritis. Photo: Warton Li

rising incidence of gout is caused by excessive consumption of meat, seafood and alcohol, which increases uric acid levels in the body.

Lifestyle factors – the rise of the weekend warrior and of obesity – are also the key culprits for more cases of osteoarthritis in young people, according to Benjamin Chow Kai-pun, a specialist in orthopaedics and traumatology.

Ironically, both reasons are at opposite ends of the healthy lifestyle spectrum.

“Those weekend warriors whose muscle and tendon lack training on weekdays put themselves at high risk of injury when they engage in excessive sports on weekends.

For obese people, their weight weighs on the joints and speeds up wear and tear,” says Chow. The most frequently affected joints, he says, are the wrist, knee and hip joint, and the spine.

More cases of rheumatoid arthritis, a debilitating genetic disease and the second most common arthritic condition, are detected – but mainly because of better awareness and advances in diagnostic technology. In the past, rheumatoid arthritis patients were often wrongly diagnosed as having joint wear-and-tear, Ng says.

Rheumatoid arthritis is, in fact, a chronic autoimmune disorder characterised by persistent inflammation around the joints, predominantly in the wrist and fingers. The disease causes pain, swelling, stiffness and loss of function and can result in tissue destruction. About 1 per cent of the world’s adult population has the condition, with women being three times more likely to suffer from it.

But there is new hope for relief for the growing number of arthritis sufferers. The Hong Kong Arthritis & Rheumatism Foundation Jockey Club Patient Resource and Training Centre – the first of its kind in the city – was recently opened in Sham Shui Po, with a HK$1.65 million donation from the Jockey Club.

The centre houses the offices of HKARF and three self-help organisations: the Rheumatoid Arthritis Association, Ankylosing Spondylitis Association and Psoriatic Arthritis Association. It also provides pain management workshops, programmes for physiotherapy and occupational therapy training and exercise classes.

“While there is currently no cure for arthritis and rheumatism, we believe the centre can make a huge difference to the well-being of these

patients by providing physical and psychological support,” says Douglas So, Jockey Club executive director of charities.

Taxi driver John Sin Man-wai, 40, who has ankylosing spondylitis, a form of rheumatoid arthritis that causes inflammation in the joints between the bones of the spine, suffered with severe back pain for a decade before getting the correct diagnosis at age 30.

The doctor told him the disease was very rare and incurable. “I thought my life was over. I spent much money doing all types of therapy, including acupuncture, Chinese massage, physiotherapy – all to no avail,” says Sin. “With severe back and waist pain, I needed crutches and I walked slower than an elderly man.”

Then in 2005, a passenger who learned of Sin’s condition told him

COVER STORY 7

Taxi driver John Sin Man-wai does stretching exercises, which alleviate pain from ankylosing spondylitis. Photo: May Tse

about the Ankylosing Spondylitis Association. The self-help group has provided great support.

“Quite a lot of young to middleaged adults suffer from [the condition]. There’s also treatment for it, such as stretching exercises and water therapy,” says Sin. “My condition improved a lot and I can walk like a normal person now.”

But avid athlete Taylor hasn’t seen much improvement in his condition, despite having arthroscopy in 2009. The surgery is a minimally invasive procedure where an endoscope and a special drill are inserted into the hip joint through tiny incisions. He will have hip replacement surgery this month.

Health Department figures show that osteoarthritis affects nearly half of elderly people, 80 per cent of whom experience it in the knee. In

young adults, however, the problem spot is the hips. Many have early onset hip arthritis because they played a lot of sport during childhood, says Jason Brockwell, medical director with Asia Medical Specialists and an orthopaedic hip surgeon specialising in young adult hip problems.

“In the bones of children, there’s a growth plate at the top of the thigh bone. We think the growth plate gets slowly pushed in the wrong direction by playing lots of sport.”

Femoro acetabular impingement (FAI) is the cause of most hip arthritis cases, says Brockwell. It is caused by too much friction between the ball (femoral head, or highest part of the thigh bone) and socket (acetabulum, or the part of the pelvis that meets the thigh bone) of the hip joint.

“As the growth plate is affected

Weekend warriors whose muscle and tendon lack training on weekdays put themselves at high risk of injury BENJAMIN CHOW KAI-PUN, SPECIALIST

by sport, the ball becomes slightly elliptical, instead of round,” he says.

The wear starts to appear at about 12 years of age. “Then every time the hip is moved, it is like pushing a square peg into a round hole, damaging the cartilage and eventually causing arthritis.”

Brockwell says the condition was only recognised about 15 years ago, and not all doctors are aware of it.

Instead, he says, patients with typical vague groin or buttock pain are often diagnosed with a “groin strain” or “sports hernia”. “I don’t think [they] exist,” he says. “The hip joint is usually the problem.”

The prognosis for athletes doesn’t look good. Brockwell’s youngest patients are athletes.

Patients who do intense sports – those that involve repeatedly bending and twisting the hip, such as racquet sports and fencing – get

symptoms at a very young age, and might need an operation at age 15 or 16. Those who take part in less intense sports might get problems in their 20s and 30s.

The best treatment for FAI is arthroscopy, but Brockwell says the surgery is only for people who still have some cartilage left. Severe cases require a hip replacement.

Still others, he says, have “silent FAI”: the young adult feels no pain but arthritis quietly develops, and when pain does strike, it’s too late and a hip replacement is needed.

Hip arthritis is very common in the West but less so in Asia. But this might not be the case for long.

“We might see more of this problem as Asia gets richer, and more young people play sport instead of just study,” says Brockwell. elaine.yau@scmp.com

8 DIET HEALTHY GOURMET

THE TASTE TEST SPELT ......................................................

Jeanette Wang jeanette.wang@scmp.com

Dorset cereals Tasty Toasted Spelt Flakes HK$85 for 690 grams, City’super Spelt is the distant cousin of modern wheat – an ancient grain with a rich, nutty flavour. This British product blends spelt flakes with roasted hazelnuts and almonds, pumpkin seeds, juicy pineapple, dates and flame raisins.

Verdict: I expected spelt to taste like cardboard, but the toasted and malted spelt flakes are slightly crisp and sweet, and complement the chewy dried fruits and crunchy nuts perfectly.

Fashion designer Julie Levine was looking to build her confidence in the kitchen when she contacted Andrea Oschetti. Photo: Warton Li

Courage of her confections ......................................................

Andrea Oschetti healthpost@scmp.com Do you love cooking but get nervous when you invite guests for dinner?

Cooking at home is an opportunity to eat healthily and a source of joy.

It also has a therapeutic side: while concentrating on cutting, measuring, tasting, peeling and stirring, daily worries and troubles fade away and peace is regained.

Many clients are fascinated when I cook in front of them. They tell me of their love for cooking, but confess that they would be terrified to make dinner for 20 people. Even hosting four friends at home is stressful.

I’m not a trained chef. My postgraduate degree is in business administration. My first step to build confidence was to cook, cook and cook, as often as I could. It was beautiful to open a bottle of wine with my wife, put on some good music and cook together.

But the real breakthrough in my confidence and skills was when I started to cook with professionals. I wrote to chefs in cities I was travelling to and asked them to host me in their kitchens for a day or two.

Remarkably, most said yes.

And I still do it now: I get lots of new ideas and practise skills.

Most of all, it generates meaningful travel experiences. This year I cooked in restaurants in Tel Aviv,

I learned simplicity tastes good. There is no need to overcomplicate a dish to make it exciting JULIE LEVINE

Ramallah, Tokyo, Koh Samui, Buenos Aires and Milan.

The tables were turned recently when Julie Levine, a KoreanCanadian fashion designer living in Hong Kong, contacted me, asking me to host her in my kitchen.

She had heard of me through a friend, and she felt that working with a chef would provide a better learning opportunity than taking a culinary course.

Her main goal was to build her confidence in the kitchen. “I love cooking. I follow recipes and sometimes deviate from them, through trial and error,” says Levine.

“My husband and friends think I’m good, but I lack confidence. I never think my dishes are perfect, although everyone eats them. But maybe they are just hungry.

“I feel limited and don’t cook for more than six people but I want to be able to cater for larger groups. I

saw you cooking for 16 guests and you were very calm about it: this is how I want to be.”

I was more than happy to have her for a week in my kitchen, to experience how I cooked for and hosted my clients’ private dinners.

Cooking is an art, not a science, and there are often contingency plans for when things go wrong.

That is a skill cookbooks don’t teach.

It requires experiencing what happens in real kitchens.

Levine was nervous when I rang – her worst fear was that I was like Gordon Ramsay, the British chef notorious for his hot temper and foul mouth. “If you had turned out to be like him, I would have probably stopped cooking for the rest of my life,” she says.

She was also afraid she would burn the roast or overcook the pasta.

So she didn’t tell a soul about our meeting, until after the first night.

When her friends did hear about it, they were shocked and surprised.

It took an act of courage for Levine to step out of her comfort zone, but from the moment she started cooking, it was a great experience. It always is.

“I learned that simplicity tastes good. There is no need to overcomplicate a dish to make it exciting. The secret is to use a few outstanding ingredients,” says Levine. “It was interesting to learn how you took the different

personalities of the guests into consideration. Most of all, I gained confidence.”

Levine was eager to taste the food she prepared, which is important for a cook. Her favourite was the chocolate cake.

Amedei chocolate truffle cake

Biona Organic Spelt Spaghetti HK$45 for 500 grams, Just Green Spelt is said to contain more protein and vitamins than wheat. Although not gluten free, it can be tolerated by some people with wheat allergies – meaning this product could appeal to those who can’t stomach typical durum wheat pasta.

Verdict: has a rougher texture and is heavier than regular pasta, which may not appeal to everyone.

140ml water 75 grams non-refined sugar 200 grams Amedei 70 per cent chocolate 135 grams butter 3 eggs 20 grams flour • Put a pan on the stove and melt the sugar with the water.

• When the liquid comes to the boil immediately remove from the heat and add the chocolate, broken into small pieces, and stir. Add the butter.

• Whisk the eggs and mix them with the liquid.

• Sift the flour and add it to the mixture.

• Place in a round baking tray covered with parchment paper and put in the oven at 180 degrees Celsius for 20 minutes. Put a tray full of water at the bottom of the oven.

• When cool, rest the cake in the refrigerator for at least four hours.

Healthy Gourmet is a weekly column by private chef Andrea Oschetti. cuoreprivatechef.com

Seitenbacher Musli #1 Natural Body Power HK$71.50 for 454 grams, Gourmet This all natural cereal from Germany is targeted at “active and sporty men and women”. It combines wholegrain spelt with raisins, wholegrain oats, peanuts, sunflower seeds, barley flakes, apples, hazelnuts and wheat germ.

Verdict: muesli tends to be dry, but this mix has just the right balance of natural sweetness and moistness.

Instantly jazzes up plain yogurt.

DIET 9 WINTER HEALTH

Fight flu the natural way ......................................................

Gabriella Clarke healthpost@scmp.com The colder weather brings Hong Kong’s peak flu season, with viruses spreading like wildfire through schools, offices and public spaces.

At low temperatures, the flu virus’ outer covering hardens to a rubbery gel that can protect it as it passes from person to person, according to a 2008 study by the US National Institutes of Health. When it’s warmer, the gel melts, and isn’t tough enough to shield the virus against the elements.

The Hong Kong government has made a push to improve immunity this flu season, with people most susceptible – children, the elderly, medical officers and those with chronic illness – encouraged to get free or subsidised injections.

There are many alternative remedies that claim to prevent and treat flu. We look at whether they really work.

Echinacea Echinacea is a collection of plant species used for treating infections, inflammation and other ailments.

Clinical trials on its efficacy have produced conflicting results.

A recent study by the Cardiff University Common Cold Centre – reportedly the largest ever, involving 750 people – showed that taking three daily doses of Echinaforce, a common form of the herb extract, for four months reduced the number of colds. The duration was also reduced by an average of 26 per cent. The study was partially funded

by A. Vogel, makers of Echinaforce, and published in the journal Evidence-Based Complementary and Alternative Medicine.

In another study, published in 2010 in the Annals of Internal Medicine, University of WisconsinMadison researchers found that Echinacea had little impact on the common cold. The trial, involving more than 700 people aged 12 to 80, showed that patients who got Echinacea saw the duration of their cold reduced by seven to 10 hours.

“But this did not have a large impact on the course of the cold, compared to blinded placebo or to no pills,” says lead researcher Bruce Barrett.

He adds there were no side effects, so there is no reason sufferers should stop using it.

Echinacea is thought to work by stimulating the immune system.

Elderberries Elderberry, or elder, has been used historically as a topical treatment for wounds, and taken orally for cold and flu.

According to the University of Maryland Medical Centre, chemicals in elderflowers and berries help reduce swelling in

mucous membranes and help relieve nasal congestion.

A study review of the effect and efficacy of elderberry fruit (Sambuci fructus) was published in Phytotherapy Research in 2009. A number of studies – several in vitro, one on chimpanzees and another two in humans – suggested the elderberry extract Sambucol may be useful against viral influenza.

However, the researchers add that the “effects of elderberry fruit preparations from studies should be backed by more rigorous studies before they are recommended.”

Vitamin C Affordable and found naturally, it is thought to help immune defence due to its antioxidant properties. But since the discovery of vitamin C in the 1930s, its efficacy in treating lung infections and colds has been questioned.

According to a review of 30 studies by the Australian National University and the University of Helsinki, unless you run marathons, you won’t get much protection from colds by taking a daily dose. The studies were conducted over several decades and included more than 11,000 people who took daily doses of at least 200mg. The review also showed that vitamin C doesn’t reduce a cold’s length or severity.

However, the scientists found that people exposed to periods of high stress – marathon runners, skiers and soldiers on sub-arctic exercises – were 50 per cent less likely to catch a cold if they took a daily dose of vitamin C. Vitamin C is not considered toxic, but high doses can cause stomach upset. Individuals prone to kidney stones should be cautious about taking high levels over long periods.

Zinc According to a review of 15 clinical trials published in The Cochrane Library in February 2011, zinc supplements reduce the severity and duration of illness caused by the common cold. It was found that zinc syrup, lozenges or tablets taken within a day of the onset of cold symptoms reduce the severity and length of illness.

At seven days, more of the patients who took zinc had cleared their symptoms compared to those who took placebos. Children who took zinc syrup or lozenges for five months or longer caught fewer colds and took less time off school.

However, lead researcher Meenu Singh notes that it is difficult to make a general recommendation regarding zinc intake, as little is known about the optimum dose, formulation or length of treatment.

Zinc is said to work by coating the virus and stopping it from entering the body through the nasal passages, and from replicating.

Stores are full of natural remedies for colds and flu, but do they really work?

10 FITNESS MARATHON MANIA WEEK 7 ......................................................

Rachel Jacqueline healthpost@scmp.com There was more fizzle than bang in my run this week as I was struck with a case of the runner’s blues. I hit the snooze button repeatedly, missed my runs, and made up excuses during speed sessions to avoid finishing all the repetitions.

Training for a marathon requires time, effort and a high pain tolerance – not to mention focus and determination – so it’s not surprising the inspiration to run is lacking.

Fatigue and depression are ultimately a way for our body to protect itself from overtraining, says Jiang Xiaobo, sport psychology officer at the Hong Kong Sports Institute. Runners of any stage and ability are susceptible.

“Our brain is always monitoring stress throughout our mind-body network and when it increases to a level that our brain senses as too high, it shifts into ‘protection mode’ to trigger a series of conscious and subconscious actions that result in low motivation, burnout, pain and loss of focus,” he says.

The first step in avoiding a dip in motivation is to get real with yourself, says Jiang. “Don’t aim too high or be unrealistic,” he says.

While it’s important to set goals, biting off more than you can chew may leave a negative impression, making it tougher to find the motivation to keep going.

Next, find the true source of your inspiration, says mental health and sports performance counsellor, Laura Walsh.

“You need to have a big why,” says the former Hong Kong triathlete. A sense of achievement, a cause, competition, and often vanity, are common motivators to run, says Walsh. “But vanity alone cannot be enough. You need another reason to get out there.”

Make a habit of it Schedule in your runs every week so they become part of your routine, says Walsh.

“Habit is everything. If you can do it at the same time every day, it becomes a habit just like brushing your teeth,” she says.

Be accountable Log your training so you can see progress. “It’s inevitable you will hit points in your training, where any gains are small and incremental.

Having a log will show your development, no matter how seemingly insignificant,” she says.

Plus, you will feel guilty for not filling in the blanks each week. Adding extra details, such as how you felt, perceived effort, conditions and nutrition may also help you to establish patterns and identify what went wrong.

Buddy up “You should never underestimate the power of social motivation,” says Walsh. It’s harder to let up on your training when someone else is involved.

A running buddy, coach or joining a running group will help you stick to your training goals and provide you with extra support.

Laura Walsh (left) helps writer Rachel Jacqueline regain some spring in her step along the Bowen Road jogging track in Mid-Levels. Photo: Dickson Lee

Running on empty Set small goals along the way “Give yourself opportunities to win little victories along the way,” says Walsh.

Signing up for a small race before the big day or cracking a personal best will help you to stay engaged.

“Make sure your targets are achievable but still challenging,” she says.

Get your training in early Willpower is like a muscle and you can only exercise it so much on a daily basis, according to Walsh. “If you have a tough job that is going to suck you dry by the end of the day, you’re not going to have enough willpower to go out for that run,” she says.

Schedule in your training sessions early to take advantage of your early morning resolve.

Look after your health and get enough sleep “The level of your willpower relates to your diet and sleep deprivation,” says Walsh. The more tired you are, the less motivation you are going to have and the less you will feel recovered. Aim for eight

hours sleep a night and take it easy on yourself during intense training, skipping booze and late night revelries. “You only get out what you put in,” she says.

Buy a new running outfit “Even if I’m not supposed to run that day, I can’t resist if I have a new pair of running shoes,” says Walsh. The better you look and feel in your running gear, the bigger the spring in your stride.

Visualise “Come up with a good mantra that can keep your brain anchored to your goals in tough times,” says Walsh. According to sports motivation guru and author of Lore of Running, Tim Noakes, our brains will tell us to give up before our body will, so it’s important to keep a strong mindset to withstand the low moments.

Visualisation techniques – such as imagining yourself running over the finish line and focusing on the positive feelings that follow – will help you overcome the urge to quit.

But it doesn’t work if you only do it

Habit is everything. If you can do it at the same time every day, it becomes ... just like brushing your teeth LAURA WALSH, PERFORMANCE COUNSELLOR

RACHEL’S DIARY I didn’t hit my stride this week. The festive season didn’t help, nor did last-minute travel plans, but I still managed to get some mileage and a speed-work session in. Niggling iliotibial band issues are still causing me some strife, but I’m on the mend. I’m rationalising this week as nature’s way of a forced rest.

Looking forward to getting back into it with renewed vigour next week.

once, Walsh says. “You have to keep up the positive mental imagery daily. It’s like training in itself.”

Mix up your training They say change is as good as a rest. “Incorporating some cross-training will help to build your cardiovascular fitness while being a little easier on your body,” says Walsh. “Our bodies are adaptable and get really good at doing one thing, such as running.” A shake-up will help stimulate and build different muscles in the body while keeping things interesting.

Couch time If all else fails, give yourself a break, as you probably need it.

“There is nothing worse than losing your mojo or dreading your workout,” says Walsh. “Besides, tomorrow is always another chance to go for a run.”

Marathon Mania is a 12-week series leading up to the Hong Kong Marathon on February 24. For more preparation tips, go to facebook.com/hkmarathon

WELL-BEING 11 FIT & FAB

Come hull or high water Barbara Yendell, who sailed round the world as a novice, at the helm.

Photo: Barbara Yendell

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

Rachel Jacqueline healthpost@scmp.com As a photographer and surf ski distributor, Barbara Yendell spent her life watching action from afar.

But that changed in 2011 when she set sail around the world, competing against other novice sailors in the renowned Clipper Race. At the time, she barely knew her way around a boat, and was scared of the open water Before taking on the challenge, she had her doubts. “I thought, ‘Is there any way I could do it?’ The fear factor, being out on the ocean on this enormous yacht in these extreme conditions,” she says.

But England-born Yendell, a Hong Kong resident for 22 years, just couldn’t let the opportunity go. Less than a year later, she handed over the reins of her business, dug into her savings and undertook four weeks of training. She set sail with a crew of 40 other rookies in July 2011, battling high seas, roaring winds and herself. Eleven months and 65,000 kilometres later, Yendell and her crew of Gold Coast Australia

emerged as the winners of 12 out of 15 of the race’s stages – a Clipper record.

It wasn’t just the experience of a lifetime, but an experience that made her life, she says. “It’s so tough, incredibly challenging, terrifying and exhilarating. We sailed though remote waters, dodged icebergs, endured hurricane force storms and drifted for days in the doldrums,” she says.

There were countless hair-raising moments, and no training could prepare her for the exhaustion of ocean sailing. Her daily routine was split into four-hour cycles – on deck, attending to duties such as cleaning and cooking, followed by precious little sleep.

“Once you get all your wet weather gear off, you’d only get about 21⁄2 hours’ sleep, if you could fall asleep. They say that’s enough, but in actual fact you feel awful,” she says.

Yet the trials and the tears were worth the lasting impact the experience has had on her life.

“Before the Clipper, I didn’t know what direction to go in,” she says.

“Suddenly there was this focus.

Everything I was doing was towards this goal.”

Though she sometimes still gets scared in the water, sailing is now a part of her everyday life. She is training to be a skipper and hopes one day to become a yacht master.

What was the scariest moment of the Clipper Race?

When we left Cape Town heading for Western Australia, we dipped into the [strong westerly winds] Roaring Forties in the Southern Ocean. There was very big wind and high seas. It was night and in that weather the boat suddenly spun on its side, wrapping the spinnaker [the front sail] around the forestay [the metal rod running from the bow to the top]. It was mayhem. While usually you could steer yourself out of it, as it was early in the race, the crew was still inexperienced. The skipper had to get on a harness and climb up to get the spinnaker down.

He was hanging from a rope, and because of all the wind he kept getting thrown around like a rag doll.

We thought he was dead. That was my first memory of being absolutely scared beyond belief.

There must have also been a feeling of excitement as well?

At that point, no. Looking back on those early times, I was just really scared. I had knots in my stomach, wondering what was going to happen next. But there was an incredible wildness in it all, which was also beautiful. We didn’t see anything for weeks. There were no aircraft overhead, no boats. It’s strange, you feel like you’re at the bottom of the world. There was a sense of excitement in that.

Was there a moment when everything felt right?

There were definitely a few, certainly when experiencing the natural beauty and peace. Being away from computers, phones and technology, and realising there’s so much more to life than the frenzied life we live here in Hong Kong. We’re so trapped in our little shell of obligations and have pressures on our time. But out there you slip into a different zone and it’s very calming. You know what you have to do, and when you have to do it. And you realise you don’t need all the trappings of modern life. As long as

you’re dry, you’ve got some clothes and something to eat, those are the main things.

What is the greatest lesson you’ve learned from the race?

You can push yourself so far beyond what you think is possible. When you think you’ve reached your highest level of fear or tiredness, or wanting to get off really badly, you can go beyond it. I remember a moment in the Pacific Ocean where I was in the “snake pit” [where there are a lot of ropes and winches] during a horrible storm and had to be ready to throw up ropes or slam different things. I was so frightened.

But after the storm had passed, I just thought, “I got through that”. It’s amazing how tough you can be, if you really have to be.

What’s been the biggest change in you?

I don’t think I take so much notice of what people think any more. I used to be very concerned about what people thought about me. Now I just think, “I don’t really care, actually”.

Looking back on it, I feel an enormous sense of achievement.

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JANUARY 15, 2013 SOUTH CHINA MORNING POST