How the 'kiss of life' gives the gift of life

26 Sep 2007, ST, Mind Your Body

CPR is key in saving the lives of people in cardiac arrest. Elaine Young finds out why more people should be trained in it

Three weeks ago, 44-year-old Mr Neo Tze Siong made the news when his life was saved by three strangers who gave him cardio-pulmonary resuscitation (CPR) after he had had a heart attack.

A few days later, however, 10-year-old Jonathan Chow Kin Mun's life ended after he fell into a pool, even though he had received CPR from his father.

Why did CPR work for one and not the other?

Unlike the image portrayed on medical dramas, survival with the 'kiss of life' is not guaranteed.

But it is crucial to improving one's chances of surviving should the heart stop suddenly.

According to Singapore General Hospital, each year in Singapore, about 2,400 people develop acute heart attacks, 1,000 suffer from sudden cardiac arrest out of the hospital and another 400 have sudden cardiac arrest after reaching the hospital.

But only one in five people who suffers a cardiac arrest receives CPR, noted Mr Robin Tan, chief trainer at SGH's Life Support Training Centre.

The total survival rate for pre-hospital collapses is about 2.6 per cent.

If the victim is to have a chance, the Chain of Survival, developed in 1990 by the American Heart Association (AHA) must be swiftly followed. This protocol addressed the fact that most sudden cardiac arrest episodes occur outside a hospital, with death occurring within minutes. There are four links in the chain: early recognition and access, early CPR, early defibrillation and early advanced care in hospital.

To be effective, each link in the chain has to be executed quickly. With each minute that passes, the chance of survival decreases by up to 10 per cent.

The most common reason for a person to die suddenly from cardiac arrest is heart disease. Other causes of cardiac arrest include foreign body obstructions in the airway, drowning, stroke, suffocation, smoke inhalation and electrocution.

During a heart attack, the heart continues to pump blood, but part of the organ does not receive any blood because of a clot which suddenly and completely blocks blood flow to the heart.

If the person who has a heart attack collapses, is not breathing and has no pulse, then it is a cardiac arrest. This is when the heart rhythm becomes rapid or chaotic, so it cannot pump oxygenated blood efficiently to the brain, lungs, and other organs. This is known as ventricular fibrillation. The victim quickly stops breathing and loses consciousness.

'A person who has sudden cardiac arrest has very little time before brain damage occurs - approximately four minutes - so time is of the essence,' said Dr Lim Chong Hee, senior consultant at the department of cardiothoracic surgery at the National Heart Centre of Singapore.

The idea of CPR is to get the circulation going 'artificially', he explains. This includes providing mouth-to-mouth resuscitation and chest compression.

Chest compression mimics heart contractions and mouth-to-mouth mimics breathing, by delivering oxygen to the lungs via the mouth.

CPR is the second link in the Chain of Survival. It is the link that can buy life-saving time between the first (early access to emergency care) and third link (early defibrillation).

To defibrillate the heart is to give it an electric shock which stops it, so it can restart.

According to the AHA, few attempts at resuscitation are successful if CPR and defibrillation are not provided within minutes of the collapse.

Said Dr Lim: 'CPR can restore normal heart rhythm, especially when you are able to institute defibrillation.'

There are some risks to CPR: Even if done correctly, it could result in complications such as fractured ribs. It should also not be attempted if the person is still breathing and has a pulse, but mistakes are minimised if the rescuer is properly trained in CPR.

It is also not as effective without defibrillation but it helps to buy time by getting blood to the brain and other organs before emergency paramedics arrive, said Dr Lim.

All emergency civil defence ambulances are equipped with automatic external defibrillators (AEDs), which are portable electric shock devices. At the moment, these are not widely available - at about $3,000 per kit, that is perhaps no surprise - but this is another goal for the Singapore Heart Foundation.

Said Mr Muhammad Khair, executive officer of community education with the foundation: 'These machines are already in clinics, hospitals and ambulances but we would like to see them in every shopping centre, HDB void deck and MRT station.'

In tandem with getting more AEDs into the community, the foundation wants to see half the Singapore population - up from the current two in 10 - trained in CPR and in the use of AEDs over the next three years.

About 30,000 people, mainly health-care professionals and emergency workers, receive CPR training here every year. But that includes those who take the refresher course after two years.

This number is woefully small, considering 90 per cent of sudden attacks occur either at home or in public places, so a person's best chance of survival could be from a family member or stranger.

Said Dr Lim: 'CPR training is easily accessible and should be promoted as public education.'

Dr Patrick Tan from the Singapore Red Cross Medical Commission concurs: 'The public mindset must change from apathy and the belief that learning CPR and AED is other people's responsibility.

'Everyone should make it a point to learn CPR and AED. Don't wait for an emergency to happen and regret not knowing what to do to save a life.'

-----------------------------------

Chances of survival

The chances of survival range from zero to 43per cent, depending on the type and speed of attention:


No care after collapse
0%

No CPR and delayed defibrillation
(after 10 minutes)
0 to 2%

CPR from a non-medical person
(bystander or family member)begun within two minutes,but delayed defibrillation
2 to 8%

CPR and defibrillationwithin eight minutes
20%

CPR and defibrillationwithin four minutes; paramedichelp within eight minutes
43%

------------------------------------












The general sequence of CPR (not all steps are shown): First, establish unresponsiveness by tapping the casualty on the shoulder.

Then, check for foreign objects in mouth, and flick any out with index finger. Check for breathing and feel for the flow of air from the casualty’s nose moving past your cheek. If victim is not breathing, give two short breaths and allow for lung deflation between breaths.

Finally, interlace fingers as shown, use body weight to compress chest. Perform 30 compressions.

-----------------------------------

CPR courses

The National Resuscitation Council was established in 1998. It is the accreditation body for all cardiac life support training centres in Singapore.

The National Heart Centre website (www.nhc.com.sg) lists all the accredited CPR Training Centres. Here are some heartsaver courses on offer for the public:


>>Changi General Hospital
Training Centre
Duration: 4.5 hours
Cost: $52.50
Course outline: CPR guide. Theory and practical test.
Inquiries: Call 6850-2360 or go to website www.cgh.com.sg


>>Singapore General Hospital
Life Support Training Centre
Duration: 3 hours
Cost: $53.50
Course outline: CPR guide. Participants can go on to do the four-hour AED course on the afternoon of the same day. Theory and practical test.
Inquiries: Call 6326-6884 or e-mail lstc@sgh.com or go to website www.sgh.com.sg


>>Singapore Red Cross Society
Training Centre
Duration: 8 hours (includes 120 minutes for lunch/breaks)
Cost: $90
Course outline: CPR guide. Theory and practical test.
Inquiries: Call 6336-0269 or go to website www.redcross.org.sg

How can a gout patient go vegetarian?

26 Sep 2007, ST, Mind Your Body

How can a gout patient go vegetarian?

Q The many benefits of going vegetarian/vegan have been extolled in recent times, and from what I read and hear, many vegetarians switch to soy-based and/or nuts-based food as a source of protein.

For those suffering from gout, however, neither soy nor nuts are good alternatives as both exacerbate the pain experienced in one's joints. In this case, how can a vegetarian diet be achieved and still ensure sufficient protein?

AProteins are one of the most important nutrients required in suitable amounts for healthy growth and development of the body. Although plant proteins may not contain all the essential amino acids, a simple form of protein, a complete vegetarian diet with a variety of grains, beans and pulses can complement and make up for the specific amino acid deficiency.

For instance, grains are deficient in amino acid lysine whilst pulses are deficient in amino acid methionine and consuming both grains and pulses will make up for each other's deficiencies.

Since gout is a medical condition in which uric acid crystals get deposited in the joints causing inflammation and pain, in relation to dietary intake, foods that are rich in purines should be avoided - that is, sweetbreads, anchovies, sardines, shellfish, brains, meat extracts and meat gravy.

Aside from avoiding high purine foods, maintaining a healthy body weight is important for gout patients as well. Do consult a dietitian for personalised dietary advice and management.

ASHU SHARMA, DIETITIAN AND MEMBER OF THE SINGAPORE NUTRITION AND DIETETICS ASSOCIATION

The Great Billy Workout

23 Sep 2007, ST

More than 400 people flock to DJ Billy Wang's early morning workout sessions at Kampong Java Park

By Adeline Chia

IT IS 5.30am on a Thursday in Kampong Java Park. The area is lit by the glow of street lamps and the nearby Kandang Kerbau Hospital, but a convivial buzz uncommon in other places at this ungodly hour is building.

Scores of people are busy stretching and jogging while others mill around and chat. On the ground is a curious sight: towels, mats, newspapers and bags placed neatly in lines.

Welcome to the Great Billy Workout, a mass-exercise programme led by popular radio DJ Billy Wang, 44, better known as Dongfang Billy. Dongfang means Oriental in Chinese.

Since July, some 400 people from all over Singapore have been flocking to the park for his hour-long workout from Mondays to Fridays. Saturdays draw even more enthusiasts. There is no workout on Sundays.

The workout starts at 6am but early birds stream in from 5am. All come with a strip of stretchy cloth, a flexible tool used in many of the exercises.

At 5.15am, Wang arrives without fanfare, greets some of the people and proceeds to jog 10 laps around the lake.

At 6am on the dot, streaming with perspiration, he takes his place in front of the crowd and everyone else slips into his own spot quickly.

Following his lead, they move in unison in the leafy surrounds. While the mood is no-nonsense, there is a feeling of camaraderie as some of the crowd repeat his instructions to those at the back who can't hear.

But no instructions are really needed: Everyone knows the moves by heart.

The Taiwan-born DJ, who is now a Singaporean, is an advocate for cancer prevention and cure. In 1993, he was diagnosed with leukaemia but battled it into remission. In 2003, he founded CareCancer Society (Singapore) which helps cancer patients and their families.

He travels regularly to pick up cancer prevention tips. He says he started the workout to keep himself fit and lose weight, as well as to step up his cancer prevention outreach activities.

'In July, I told my listeners about the exercise, and so many showed up. I was really touched,' says the host of a radio programme on MediaCorp Radio's Love 97.2.

He learnt the Kampong Java routine from a Japanese naturopathy centre in Osaka last year. It supposedly stimulates the flow of lymph in the body. The lymphatic system is responsible for helping fluid and waste leave the body and for regulating the immune system.

He says: 'The Japanese masters told me, 'There is no copyright to this exercise. Take it overseas and teach others'.'

The crowd comprises middle-aged aunties, the elderly, some young ones, a handful of cancer sufferers and those wanting to lose weight.

The exercise involves stretching the arms, back and legs, usually done while pulling the cloth strip tight with the hands.

At one point, participants sit down and slap their faces, heads and bellies 150 times each to stimulate blood circulation. Near the end of the routine, they stand in a line, massage the person in front of them and finish with shouting 'Oh yeah, ni zhen bang!' (Mandarin for you are great) to their neighbours.

'Slimming down and fighting cancer can be done only in a group. We need to motivate each other,' says the 1.8m-tall Wang, who has gone from 88.6kg to a trim 71kg.

He is not the only one seeing the benefits. Retiree Angel Tan, 57, says: 'Following his food recipes on his show and his exercise, I went from an XL to S or M.'

Madam Lin Ai Lin, 58, who used to suffer from knee and ankle pains, says she can walk four flights of stairs without sweating. The retiree adds: 'I've lost 10kg since I started.'

But some take offence when LifeStyle suggests that his star power might be a vital attraction. Housewife Yoyo Chia, 45, retorts: 'I'm not exercising because I'm chasing Billy. It's the morning and you're sleeping like a log while I'm here working up a sweat. So who benefits?'

At 7am, when the gentle morning sun spills into the park, most people hurry off to work, breakfast or back home to prepare themselves to listen to Wang's radio programme from 10am to 1pm.

As for Wang, it's back to his nearby Thomson Road penthouse for a shower and a breakfast of vegetables and fruit before the bachelor heads to the MediaCorp studio for work.

Of his hectic schedule, he says: 'Am I tired? Of course. But when I see the faces of those who show up, it's definitely worth my time.'

---------------------------------

Work out at home, too

CAN'T make it down to Billy Wang's early morning workouts? You can do the exercises at home.

All you need is a thin, stretchy strip of cloth about 1.5m long, preferably cut from a T-shirt.

The moves are said to stimulate the lymphatic system by stretching different parts of the body.

This is a selection of poses from the workout, and they are not in the order done at the park.



# With legs two shoulder-widths apart, roll the cloth until they are a handspan apart. Bend forward and hold for eight counts. Do eight sets.



# Hold the cloth above your head. Then bend to the right to stretch the body. Count to eight. Do four sets. Repeat with the opposite side.



# Wrap the cloth around your hands and lift them above your head, shoulder- width apart. Keep feet together and head facing up. Hold for eight counts. Do eight sets.



# Stretch the cloth around biceps with hands in fists pushing at the small of your back. Bend backwards with knees bent and look up. Hold for eight counts. Do eight sets.



# With legs two shoulder-widths apart, stretch out arms and hold the cloth behind your back. Turn the body to the right. Count to eight. Do four sets. Switch sides.


# A DVD has been made of the workout but it will be given only to ticket-holders of 365 Let Love Begin - Top 10 Cancer Fighter Awards at Singapore Expo's Max Pavilion on Oct13 from 2 to 10.30pm.

Tickets at $28, $48, $68, $88 and $100 from www.tdc. sg or call 6296-2929.

Stints of stillness make you happier

19 Sep 2007, ST, Mind Your Body

Focus on nothing but breathing in and out for20minutes a day and you really will feel happier,
according to researchers in the US who have studied the brains of Tibetan lamas

I have spent a fair amount of time at silent Buddhist retreats staring into inner space and coming to the conclusion that enlightenment isn't going to be happening in this lifetime.

But now when I do find the motivation to sit on the cushion, I imagine a cheerleading squad of a brain researchers waving reams of data.

This data suggests that spending 15 or 20 minutes a day concentrating on the in-out movement of the breath, or a repeated word or mantra - or damn near anything besides the usual rambling, self-obsessed inner monologue - is a good thing, whether anybody reaches nirvana or not.

This scientific movement first took shape in the late 1970s when a young meditator and molecular biologist by the name of Jon Kabat-Zinn founded a stress-reduction programme at the University of Massachusetts at Worcester in the United States.

His notion was that if you stripped away the robes and the gongs and even the smiling image of the Buddha himself, what was left, the cultivation of a calm, non-judgmental mental awareness - 'mindfulness' - might be of great benefit to people suffering chronic pain.

Almost 30 years later, more than 16,000 people have passed through the Centre for Mindfulness' Mindfulness-Based Stress Reduction (MBSR) programmes. (Log on to www.umassmed.edu/ cfm/index.aspx for more details.)

Studies have found that psoriasis sufferers who included MBSR in their therapy saw their sores heal four times as fast, and that programme graduates made more antibodies when they were injected with a flu virus.

'You're just sitting and following your breath,' said Harvard researcher Sara Lazar in wonderment.

'What's going on in the brain?'

Professor Richard Davidson at the University of Wisconsin, the leader in a new wave of research attempting to tease out the brain chemistry of meditation, has invited Tibetan lamas into his lab to find out.

Their electroencephalograph readings reveal that they are generating gamma waves, associated with attention and learning, for minutes. Most people can manage this for only a few seconds at best.

According to the functional MRI data, they also show an unusual amount of brain activity in the left side of the pre-frontal cortex, associated with positive emotions. So they are more alert and happier than the rest of us.

In another of Prof Davidson's studies, even a bunch of stressed-out Silicon Valley types who had taken a single eight-week MBSR course registered more activity in the 'happy' part of their brains, dovetailing with their own reports that they were feeling more positive about life.

The underlying explanation for what's going on here can be summed up in a word that scientists in the field repeat like a mantra - 'neuro-plasticity'.

Contrary to what the medical world long believed, the brain is continually changing, both the number of neurons and their arrangement, in response to the mind's daily encounter with the world.

So it follows that it's possible to 'Train Your Mind, Change Your Brain', the title of Newsweek writer Sharon Begley's recent book on the merger of meditation and neuro-science.

Buddha was all over this 2,500 years ago: 'All that we are is the result of what we have thought.'

But now, we've got some pretty fancy tools to drive home the point that practice makes plastic. Harvard's Dr Lazar compared the brains of experienced American meditators to a matched control group and found that certain parts of their cortex, involved in attention, were on average 5per cent thicker, a difference most pronounced in her older subjects.

She's now embarked on a study that focuses on ageing subjects to see if regular 'cushion time' might buy us protection from the shrinking cortexes and mental declines that were thought inevitably to accompany old age.

But Dr Lazar, not yet 40, doesn't have to be personally convinced that the benefits of meditation show themselves before you get old. 'I notice the difference when I'm not regularly sitting,' she admits. 'I drive more aggressively in traffic.'

- FEATUREWELL

-----------------------------------

Clear out the internal jabber

If we were to speak out loud the disjointed monologue that runs through our heads most of the time, we'd be locked up for being nuts.

Buddhist meditation comes in many different flavours (Tibetan, Zen and Vipassana are the major ones) but the common premise is this: if we can tamp down the internal jabber, we will get in touch with a calmer, wiser self, which is less tethered to the ego and its constant cravings - for novelty, attention, power, sex, food, name your poison.

The means to this end is usually 'one-point concentration'. In a relaxed position (purists sit on a cushion, legs crossed), you bring all your attention to a single neutral thing like a repeated word or mantra or, more basic still, the in-out movements of breath.

Beginners (and oft-lapsing veterans) should try to establish the rhythm of a daily sit, 10 to 20 minutes in the morning or evening.

This solitary ritual may be enriched by finding a group in your area or spending a weekend or multi-day retreat offered at a growing number of meditation centres. Read the non-sectarian Buddhist quarterly Tricycle for more such information.

Be aware that as you get comfortable on the cushion and prepare to settle in, your mind will inevitably bombard you with inane trivia, sex fantasies or Really Important Things You've Got to Take Care of Right Now!

But it's all part of the drill.

In the popular 'insight' or Vipassana style of meditation, when you become aware of these mind games, you will simply return to the exercises, focusing, for instance, on the feel of the air moving through your nose.

It's a kind of enlightenment, one screw-up in concentration at a time.

- FEATUREWELL

Men scared of women with perfect figures

13 Sep 2007, New Paper

WOMEN, take heart and junk that diet.

According to a survey by UK women's magazine MORE, men are perfectly happy with a woman's 'wobbly bits' if she knows how to have a good time.

According to the survey, most men are not able to handle the 'pressure' of sleeping with a woman with the perfect figure.

The survey involved 1,000 men and women, reported the New Zealand Press Association (NZPA).

According to the editor of More magazine, Lisa Smosarski: 'Men like curvy women who look after themselves and have sex appeal, women who know how to have a good time without worrying about their calorie intake.

'Some men feel intimidated by women with super bodies and find it hard to talk to a body-perfect woman, let alone take their clothes off in front of her.

'The truth is, men are happy with us the way we are - it's women who point out our flaws.

' It's time we did ourselves a favour and relaxed a bit.'

The basis for Ms Smosarki's comments were the findings of the survey.

Around 88 per cent of men surveyed admitted that sleeping with the 'perfect' woman, figure-wise, would put 'too much' pressure on them.

Only 1 in 10 men preferred women with ' a great body who's dedicated to diet and exercise'.

And 88 per cent said that they would choose a woman with 'wobbly bits who's up for a good time'.

IDEAL FIGURE

So who were the most desirable women according to the men?

About 56 per cent stated that a man's ideal female body included a small waist and a big bottom.

American actress Scarlett Johansson was listed as the celebrity with the most ideal shape, according to 44 per cent of the respondents.

But in the face of such beauty, 9 out of 10 men said that they would not want to take off their own clothes in her presence.

The second most attractive shape, according to 34 per cent of men, were women with big breasts and bottoms.

In this category, singer Beyonce Knowles scored as the second most desirable body among the current crop of celebrities.

Only 6 per cent of men said that they desired skinny women.

Not surprisingly, only 3 per cent of men wanted to see 'Posh Spice' - Victoria Beckham - nude, despite her toned and taut body.

Other figure attributes that men like in women include a 'flexible' body, (40 per cent), soft (41 per cent) and curvy (90 per cent).

Think rounded tummies are undesirable? Around a third of the men (35 per cent) said that a rounded stomach was desirable.

However, one in ten men (11 per cent) said that love handles were off-putting as were flat chests, stretch marks, hairy armpits and hairy nipples.

Only a minority (14 per cent) said they found a tattoo a turn-on.

Pork can be quite healthy

12 Sep 2007, ST, Mind Your Body

Is pork rejected by meat eaters because of its tough and chewy bad press? Elaine Young finds out why this lean meat should be back on the menu

Last year, 89,017 tonnes of pork arrived in Singapore. And by the looks of this year's import figures from the Agri-Food and Veterinary Authority, more and more pork is being eaten by Singaporeans.

From January to March, 23,737 tonnes of pork was imported mostly from Australia, Brazil and Indonesia.

But although nutritionists say pork has less fat than a skinless chicken breast, most people regard it as a fatty meat.

To put the pig in a more favourable and flavourful light, nutritionist Jamie Liow of the Heart Wellness Centre at Singapore Heart Foundation and dietitian Nehal Kamdar of Raffles Hospital provide the facts:

MYTH: PORK IS A FATTY MEAT

FACT: Pork, just like beef, can be divided into different cuts, each of which has a different fat content. For example, 85g of roasted pork loin has about 13g less fat than 85g of roasted pork shoulder.

Some cuts of pork can be leaner or lower in fat content than other meats. An 85g pork loin chop has less fat than a comparable amount of skinless chicken thigh. The pork contains 6.9g of fat, while the chicken has 9.3g.

The leanest cut is tenderloin, followed by sirloin chop, loin, and top loin. Meats sold in a supermarket usually have a label stating the type of cut.

MYTH: PORK IS DRY AND TASTELESS

FACT: Overcooking is usually the culprit. Be careful, especially when you are grilling or pan-frying pork chops. Thin cuts are especially prone to overcooking.

Cook pork over medium heat and turn it over only once. Remember that meat continues cooking even after it has been removed from the heat source. Cut the pork across the grain to keep it tender. Marinating can also help.

When cooked, pork meat should be juicy and tender with a slight rosy hue in the centre.

MYTH: PORK IS A WHITE MEAT.

FACT: Pork is a red meat, and an important source of iron. This is because of the presence of two iron-containing proteins, which are involved in oxygen transportation and storage. When both iron and oxygen are present, these proteins turn red.

MYTH: PORK IS NOT VERSATILE

FACT: It can be used to substitute meats in many dishes. If you are thinking of having Western tonight, try pork chop instead of chicken chop (and remember not to overcook it).

Or rather than having stir-fried chicken strips, replace the chicken with pork instead.

Pork can be stir-fried with vegetables, or it can be added to stews, porridge or soups to enhance the flavour.

Pork floss can also be incorporated into sandwiches for a protein boost!

MYTH: PORK HAS LITTLE NUTRITIONAL VALUE

FACT: Pork is one of the best sources of thiamine. Thiamine is necessary for the metabolism of carbohydrates. It is also essential for the growth and repair of nerves and muscle tissues, and helps to control appetite. Pork is also a good source of riboflavin, a vitamin which plays an important role in the release of energy from food and in cell division. Riboflavin also maintains healthy skin and eyes.

My grandfather has bile-duct cancer

2 Sep 2007, ST

Traditional Chinese Medicine (TCM) experts answer your queries in this fortnightly column. Remember, you should not self-medicate. Always consult a practitioner.

My grandfather is 70 and has been diagnosed with stage-three bile-duct cancer (cholangiocarcinoma). Can TCM help him?

Cholangiocarcinomas (bile-duct cancer) are tumours that arise from the bile-duct epithelium, which is the internal tissue of the bile duct. The cause is unknown but they are more likely to occur in people born with abnormalities of the bile duct like choledochal cysts.

Stage-three bile-duct cancer occurs when cancer cells affect the main blood vessels that take blood to and from the liver. It may also occur when these cells spread to the small or large intestines, the stomach or the abdominal wall, or affect lymph nodes in the abdomen.

In TCM, bile-duct cancer is likely due to a deficiency in the functions of the spleen, liver and kidney, a stagnation of qi and blood, 'heat? and 'dampness', as well as insufficient yin of the kidney and liver.

Chinese medicine, acupuncture and moxibustion can help improve your grandfather's condition by strengthening his immune and digestive systems so that recovery time is shorter in the event that he needs to undergo surgery. They can also help reduce the side effects of chemotherapy such as fatigue and weight loss.

He should avoid smoking, alcohol and spicy food to reduce 'heat' and 'dampness' in the organs.

Information provided by Ms Lim Lay Beng, a TCM physician at YS Healthcare TCM Clinic in The Adelphi...

Happy feet and shoes that fit

26 Aug 2007, ST

A Sunday Times weekly training plan for first-time marathoners who seldom run beyond 10km

By Jeanette Wang

LIKE fairy-tale princess Cinderella, runners too can find happiness in well-fitted shoes.

The perfect sole-mate can also help you avoid blisters and injuries.

Seasoned runner Paul Sng, 35, who runs about 40km weekly, learnt the importance of wearing the right running shoes the wrong way.

'I've worn shoes that were too narrow. My little toe got bruised and the toenail on the second toe turned black and fell off,' said the car salesman, who has six toes on his left foot.

'Another time, my shoes were too tight and my heel hurt like crazy, so I had to cut short my run.'

Worse injuries could befall a runner wearing the wrong shoes.

Dr Jason Chia, Changi Sports Medicine Centre's associate consultant sports physician, stressed on the importance of picking the right shoes for your foot type (see graphic).

He said: 'Inadequate support or cushioning in shoes can lead to injuries such as plantar fasciitis (heel pain) and shin splint.'

He added that a narrow toe box could cause pain in the forefoot, while loose-fitting shoes could cause blisters owing to excessive movement.

For longer races, such as marathons, he recommended shoes with more cushioning for better shock absorption.

He said: 'The number of steps taken to run a kilometre can be from 800 to 1,200. Each of these steps can exert forces of two to three times your body weight on landing.'

His advice is to buy shoes in the evening when the feet are slightly bigger. This will ensure that the shoes will not be too tight.

When trying on shoes, make sure to wear socks and lace up the shoes.

Ensure that there is a one thumb space in the toe box and enough room between your heel and the heel counter when your feet are pushed snugly forward.

Abdominal muscles exercises

05 Jul 2007, ST, Urban

According to Mr Singapore 2006, it's how you work out, not how much, that makes the difference

Mr Singapore 2006 Dennis Lau is a walking advertisement for his personal approach to exercise. Lau, 24, who is in his final year of material science and engineering studies at Nanyang Technological University, doesn't work his body to the bone to get his lean, sculpted physique.

Instead, he 'targets' the muscles he wants to work, making them reap every ounce of benefit from the exercise.

He explains: 'You can do a sit-up and, if you let other parts of the body get involved, you won't get maximum benefit from it.

'On the other hand, if you force the abs (abdominal muscles) to do all the work, you don't need to do too many.'

Proving his point, Lau confesses that he works out just three times a week: each session involves an 8-to-10km outdoor run, followed by some exercises like push-ups, chin-ups and crunches.

Normally, you'd expect a guy with his physique to be training at least five times a week. A thrice-a-week workout regimen is usually good for people who just want to avoid going up a size or two in their dress size.

But it must work for Lau because there is not an ounce of fat on his 1.76m, 68kg frame.

Of course, there is more to his ripped physique than just exercise - that oft-overlooked factor, diet.

'In order for anyone to have a ripped look, especially the abs, the body fat content has to be low, like 15 per cent. Otherwise, no matter how much you work out, all the muscles will be built under a layer of fat,' he says.

As for the exercises he recommends here - the sit-up and the static crunch can be done by anyone, while the reverse crunch will be tough for beginners - he suggests you start with 10 repetitions of each, without any rest between them, to complete a set. Aim to do three sets.

Lau has one more tip: Rotate the order of the three exercises from time to time. This forces the muscles to develop because they don't get used to a fixed sequence.

---------------------------------

For lower abs

Lie on your back, palms on the floor. Lift your legs and buttocks off the floor as you exhale, then shoot your legs up towards the ceiling and crunch your abs. Hold, then return to start.





For upper abs

Lie on your back with knees bent and hands behind your ears. Lift your upper body about 30 to 40 degrees and crunch your abs hard. The rest of you should be relaxed. Do 15 to 20 times.




For upper and lower abs

Lie on your back, hands stretched over your head. Lift your upper body and legs simultaneously and hold for as long as you can, letting your abs do all the work.

No-wheat sweet treats

04 Jul 2007, ST, Mind Your Body

Want dessert but cannot stomach eggs, dairy products or sugar? Suki Lor meets a mother who turned those challenges into a business

Desperation, they say, gives birth to invention and so it was for Ms Sabreena Andriesz. 'My daughter couldn't eat wheat and dairy products since she was little, so I made stuff for her,' recalls the 43-year-old psychotherapist, who experimented with making cakes without eggs, dairy products or sugar.

Her daughter is now nearly 15, and a mother's devotion has been transformed into a business. The Conscious Choice offers cakes and cookies that are completely free of wheat and gluten.

Ms Andriesz was no mere hobbyist at the start. She had graduated from the Cordon Bleu culinary school in London in 1982.

But her home-based venture happened by chance more than two years ago, she says. She served a wheat-free cake to a friend who owned a cafe. The friend loved it and asked Ms Andriesz to supply cakes for her eatery. Her cakes and biscotti, a crisp Italian cookie, are now regular items at Whatever Cafe in Keong Saik Road in Chinatown.

There are 17 types of cake, four varieties of cookie and two versions of biscotti. Her cakes have luscious flavours: almond orange, carrot walnut, zucchini cashew, honey tofu, pineapple upside down and chocolate.



Besides being free of wheat and gluten, some of the cakes are also dairy-free. Canola oil is used in place of butter in the case of dairy-free cakes.

For flour, she uses mainly rice, millet, tapioca, buckwheat, soy, corn, potato or arrowroot. She also uses aluminium-free baking powder, bought from the United States.

Ms Andriesz also offers confections which are egg-free and sugar-free. She uses xylitol, a low-carbohydrate sweetener derived from the bark of the birch tree and other sources.

A few of the cakes - including sticky date, festive fruit and honey tofu - are sweetened with fruit, honey or fructose.



Each nine-inch cake weighs between 1kg and 1.5kg, and is priced from $40 to $60.

Ms Andriesz, who was born in Sri Lanka and grew up in Saudi Arabia, says she has to be very organised to juggle being baker, corporate coach and trainer, and psychotherapist. She has a Master's degree in Social Science (Counselling). Singapore has been her home for the past 18 years.

Orders can be placed online at www.theconsciouschoice.com. Cakes are baked the night before a delivery to ensure freshness. They can be collected from Ms Andriesz's home or delivered (except on public holidays) for a fee of $10 per trip.


The Conscious Choice
8 Bishopswalk
Tel: 6735-4880
Email: cake@theconsciouschoice.com
Website: www.theconsciouschoice.com

Makeup can make you sick, says expert

23 June 2007, New Paper

IF you apply makeup every day, you are absorbing almost 5lb (2.2kg) of chemicals a year into your body, it is claimed.

Mr Richard Bence, a biochemist, told British paper The Telegraph that this is more dangerous than swallowing the chemicals as they get absorbed straight into the bloodstream.

Mr Bence, who spent three years researching conventional products, said: 'We have no idea what these chemicals do when they are mixed together, the effect could be much greater than the sum of the individual parts.'

Many women were found to use more than 20 beauty products a day in the process of dolling up, while nine out of 10 put on expired makeup.

Some synthetic compounds involved have been linked to side effects ranging from skin irritation to premature ageing and cancer.

Warnings over using out-of-date lipstick and mascara have also been issued by the Royal College of Optometrists, which believes such items are a 'hothouse' for harmful bacteria.

Among chemicals under scrutiny are parabens (para-hydroxybenzoic acids), which are preservatives used in products including soap, shampoo, deodorant and baby lotion.

Traces of parabens have been found in breast tumour samples, although its link to the development of the cancer is disputed.

Sodium lauryl sulphate, used to help create lather in soaps, shampoo, shaving foam, toothpaste and bubble bath, can cause skin irritation.

SAFETY CLAIMS

However, the Cosmetic, Toiletry and Perfumery Association claimed there was no reason for worry because the products were covered by European Union rules requiring them to be safe.

A spokesman said: 'The cocktail effect is an urban myth.

'We do know how different chemicals react individually and can predict how they interact with each other and this is taken into account when the safety of products is assessed.'

Don't be too harsh on families who abandon kin

23 June 2007, ST Forum

THE article, 'Long-stay mental patients strain IMH' (ST, June 11), highlighting the plight of patients at the Institute of Mental Health who have been abandoned by their family, paints a sad story, placing the blame on irresponsible relatives and society in general.

Little does the reporter or the lay public know the burden of looking after a patient with chronic mental illness.

Mr Raymond Anthony Fernando's letter, 'Govt support needed to care for the mentally ill' (ST, June 22), is atypical only because he has chosen to shoulder his burden instead of dumping his wife at IMH.

By doing so, he sacrificed a significant portion of his life. His is not the worst-case scenario because his wife has recovered. For the families of mentally-ill patients who do not achieve a remission, the burden can be overwhelming.

While I do not condone the families abandoning their relatives at IMH, I can understand why they do so.

I would like to praise IMH for doing a great job in keeping these mentally-ill patients off the streets and giving them a decent quality of life. The alternative would be to deinstitutionalise these patients, as is the politically-correct policy in Western countries. This would result in many of the patients ending up as vagrants or bag-people, with maybe a few ending up in prison.

We need more chronic stay facilities, not just for chronic psychiatric patients but also adult patients with mental retardation and other handicaps who are now physically too big for their elderly parents to look after; likewise for demented patients who may be difficult to nurse at home.

While we would like the families to take on the care-giving responsibility, as a neurologist I have seen the lives of all the family members ruined by one ill relative, through no fault of their own.

Let's be realistic: If we find ourselves in the situation of these families, what would we do? If I were a patient, I would certainly not wish to burden my family or society. But as a 'First World' society, we owe our less-fortunate members a minimum quality of life with dignity.

Assoc Prof Lee Wei Ling

Depression

What I read from Mark Chan's interview with "Life" strike a chord with me.

I too suffered from depression since i was a teenager. And frankly, I couldn't talk about it either. Talking about depression seems to trivialize the issue.

Hmmm....maybe I can blog about it some other time? Let me think about it.

------------------------------------

Mark the Other Actor

04 Jun 2007, ST

The less-trodden path he has chosen has not been an easy one, especially since he has been suffering from depression since he was a teenager.

I bring this up as it had been mentioned in a previous newspaper interview, but it is not a topic he is comfortable with. He says he does not know the cause.

'I was never able to talk about it when I was young and that really hampered me. If you can't talk about it, you feel it's a problem which cannot be solved,' he says, his eyes reddening.

He copes with the condition now through exercise, socialising and some techniques he has devised over the years.

For example, he carries bottles of fragrances with him everywhere he goes to perk himself up, and he promptly brandishes two as examples - Garofano by Lorenzo Villoresi and Comme des Garcons 2.

As he puts it, he does not want people to know about his depression because he does not want them to pity him.

Instead, he wants to be judged on his musical achievements, such as the prestigious chance to present his 2004 work Opiume to the director of the Paris Opera at the end of this month.
An opera lover in Paris who chanced upon his work helped to set up the meeting.

Looking subdued, he ends the interview on a sombre note: 'Life is not easy, and for many musicians, the lifestyle alone is cause for depression because as a composer, you spend long periods alone.'

'I believe in truth and beauty and I want my work to reflect that. It doesn't matter whether people know what I struggle with,' he adds.

'I would like to have some privacy but I also want my work to be out there so that people can be moved by it. And that is what keeps me going.'

I like being a guinea pig

20 May 2007, ST

I see the greater good in doctors sticking wires and needles in me, all in the name of science

By Chua Mui Hoong

I USED to think only desperately ill people with no choice opt to be guinea pigs in medical trials.

You know, that you have to be gaunt, dying, in pain, with no other recourse, before you would sign up for some untested treatment that may or may not help you.

Then I became a guinea pig myself, when undergoing cancer treatment in Boston five years ago.

And I realised two things: that you don't have to be desperate to consent to be a subject in a clinical trial. And that, hey, some of it can be downright fun.

At that time, I was a graduate student at Harvard, just 20 minutes away from one of the top-ranking cancer centres in the United States.

The centre is chock-full of clinician-scientists doing 'translational research', a term that I've begun to see more frequently in Singapore nowadays, but which was already bread-and-butter for the Dana Farber Cancer Institute back in 2002.

I was approached to do no less than three clinical trials and said 'yes' to all.

The first was serious. It gave me access to a new, promising drug called herceptin. Later, as I read more about the drug, I felt truly proud to have participated in a piece of medical history.

For the herceptin trial for breast cancer patients was part of a worldwide network of clinical trials on the drug that would yield striking results.

All sorts of doctors all over the world, including in Boston and Singapore, were collaborating to find out how effective the drug was against late-stage breast cancer, against early-stage breast cancer, what combination of drugs make it most effective, how much of it should be given, how frequently, and for how long.

For a few years after my treatment, I would follow news from the annual conference of the American Society of Clinical Oncologists religiously, knowing there would be some new study, some new insight, new information, from the wide-ranging herceptin trials.

Another clinical trial I took part in was a bit more painful. It involved having a wire-guided biopsy, which meant having a wire inserted into the breast (ouch).

I don't remember the details, but I recall I was sold on it when the doctor explained that if the trial worked and the wire helped locate the tumour accurately, it meant women in future may not need to undergo painful mammograms immediately after surgery.

I decided to be heroic. I also liked the radiologist, who said he read mammography films with his breakfast (the way I read The Straits Times with mine). I agreed.

Then there was the fun trial, to see if relaxation techniques help reduce patients' stress after surgery.

It involved having a very nice young research assistant sit by me and hold my hand before any surgical procedure. She would talk to me in a soothing tone, and ask me to visualise being on a beach, in the forest, or some such relaxing place. I would fill up questionnaires on my state of mind before and after.

For a few weeks after that, I had to take cheek swabs that would measure my stress levels, and send them in large envelopes to the laboratory. I never thought anyone would be interested in my saliva!

I said yes to all three trials for various reasons: to gain access to a promising new drug; because taking part in them didn't seem to hurt me much but may help others in future.

Underlying all these reasons, the culture of the hospital also mattered a great deal.

I had opted out of the university hospital to be treated here, at a cutting-edge cancer research centre. I knew the treatments I benefited from were built on the efforts of past generations of patients, doctors and benefactors. It felt natural to contribute my bit to this virtuous cycle.

Also, I trusted my doctors. Indeed, I rather liked the idea of being treated by doctors like the radiologist so interested in their work, their idea of breakfast reading is scanning mammogram films.

Most importantly, I had faith that the research process would safeguard my interests.

For example, that my privacy would be assured, that insurance companies won't get hold of my data, and that if initial findings uncovered something wrong with the drug I was on, that I would be told, and the trial stopped.

This last aspect - faith in the process - is crucial in Singapore's attempt to change mindsets to get Singaporeans to be more receptive to taking part in clinical trials, which is a necessary precondition to the Republic becoming a biomedical hub.

The Health Ministry is currently working to make medical records electronic and more easily accessible for good health planning.

A recent report recommends giving medical researchers easier access to patient information, but with controls put to safeguard privacy.

My antenna went up at the first bit: make it easier for researchers to access information? We all know how leaky and gossippy Singapore is, how much it resembles a close-knit village and not an anonymous urban metropolis.

Do you want any researcher who may or may not be a doctor, to be able to find out things about you?

But the second bit was more reassuring: about privacy protocols.

From what I understand, the idea is to make it easier for researchers to get hold of medical information, without them being able to figure out who the patient is.

This way, aggregate data on diseases and patients can be built up and shared easily without patients' consent having to be sought for every bit, and yet not compromise patient confidentiality.

As is well known, Singapore has no laws, and little tradition, to safeguard privacy. If anything, the need for public health or public safety will always trump the individual's right to privacy.

That being the case, more needs to be done to assure Singaporeans that their privacy will be safeguarded, and that, even when they sign up to be guinea pigs, their interests will be safeguarded.