Dr Tio Man Kwun Peter
Specialist in Orthopaedic & Traumatology, MBBS (HK), FCSHK, FHKAM (Orthopaedic Surgery), FHKCOS, FRCSEd, FRCSEd (Orth)

Osteoarthritis is not only a problem for the elderly. With our modern lifestyles, more and more young people are beginning to suffer from degenerative joint disease. In order to have good mobility, it is necessary to pay attention to our lifestyle habits!

Osteoarthritis is a very common joint disease. Cartilage damage is the key feature of degenerative joint disorder and is caused by “wear and tear” of the joints over time. The most common symptoms are swelling, pain and inflammation, with a limited range of motion or stiffness.

Increasing Rates of Osteoarthritis in Younger Patients
Most people think that osteoarthritis is a problem for the older generation. However, orthopaedic specialist Dr Tio Man Kwun Peter points out that degenerative joint conditions begin gradually from the age of 40, with some experiencing symptoms as early as in their 30s.
The most common areas affected by osteoarthritis are the neck, spine and knees. The cause is related to our daily lifestyle, hence it is regarded as a type of urban disease. For example, long-term use of computers or mobile phones with our heads tilted forward and downwards will lead to osteoarthritis of the neck, while sitting in the office for a long time with poor posture or inappropriate seats will cause poor spinal health. Salespersons who stand for a long time, people with obesity or those who enjoy running, playing football, basketball or other high-impact sports will have long-term pressure on their feet, leading to higher chances of knee osteoarthritis.

Delaying the Progression of Osteoarthritis
Many people think that consuming more calcium tablets or food containing calcium can prevent or delay osteoarthritis, but presently, there is no cure for osteoarthritis. Dr Tio explains that calcium can strengthen the bone, but it has no effect on the cartilage.
In recent years, a common treatment has been the injection of hyaluronic acid, which acts as a shock absorber to reduce friction from cartilage motion. Each treatment requires an injection of 1 to 5 times, and its effect can last for 9 to 12 months. This can reduce the symptoms of osteoarthritis and relieve pain.

Prevention Is Better Than Cure
To maintain joint flexibility, always remember that “prevention is better than cure”. We can pay more attention to our lifestyles, such as maintaining a healthy weight to ease the burden on our joints. We must also do sufficient warm-ups before exercise, and do what is suitable for our age, weight and strength. For those with middle-age weight gain, Dr Tio suggests that high-impact exercise should be replaced by low-impact ones such as swimming, cycling or rowing, which can reduce the load on the feet and strengthen muscles.
According to Dr Tio, the popularity of smartphones in recent years has caused a dramatic increase in the number of young patients with osteoarthritis of the neck. He suggests that smartphone usage time should not exceed 15-20 minutes per hour. Do not tilt your head down, and keep your neck in a neutral position with the smartphone at eye level.
By making lifestyle changes, we can start to reduce the burden on our joints and delay the symptoms of osteoarthritis. We should also be more aware of our physical conditions. If you suffer from continuous swelling and pain in your joints, you should seek medical attention immediately to receive appropriate treatment.

Dr Tang Cheong Yu Denny
MB BS (HK), DCH (Lond), DOM (CUHK), Dip Derm (Glasg), FHKCFP, FRACGP, MRCGP (UK)

A full head of white hair tends to make people look haggard, and premature greying can even make one look 10 years older!
In fact, premature greying may affect anyone, no matter male or female, and may also signal underlying health problems.
Is there any way to promote regrowth of black hair?

Q: What causes hair to turn white? Is it related to age, physique, health or genetics?
A: Melanocytes found in the basal layer of the scalp produce the pigment melanin, which colours the hair and makes it black. Because of different factors, such as growing old and aging, melanin production gradually reduces and white hair will appear. In addition, if the hair follicle is not healthy, it will not be able to "dye" the hair and the colour of new strands of hair will not be ideal. In general, age, physique and genetics are all related to the quantity and onset of white hair.

Q: If white hair suddenly appears, what health problems should we take note of?
A: Sudden onset of white hair may reflect problems with the immune system or endocrine system. For example:

• An imbalanced or overactive immune system may attack other organs, causing imbalance in the body. If this happens in the skin, it will lead to skin allergy. In the event that it occurs in the scalp, white hair will appear.
• Anaemia will lead to a lack of nutrients in the whole body, and white hair will grow as the scalp does not have enough nutrients.
• Hormonal imbalance causes the body to give wrong instructions or hair follicles may fail to receive instructions to produce enough melanin.

Q: What can we do to reduce white hair or even regrow black hair?
A: We can try to delay the onset of white hair by making changes in our daily lives. Develop the habit of going to bed and getting up early so that the body has enough time for self-repair. This can also help to improve hormonal imbalances. In addition, pay attention to stress levels. The body will release cortisol when we face stress. If we cannot reduce our stress effectively, our bodies have to allocate energy to create more of the stress hormone cortisol, which will in turn slow down the body’s other functions. If there is so much stress that it causes sleep problems, production of growth hormone and melatonin will be negatively affected, resulting in the onsetof white hair. The intake of vitamins A and E can help to encourage production of melanin. Regular scalp massages or the use of laser devices can also promote blood circulation to reduce white hair.

Ms Tong Ka Ping Kate
Hong Kong Registered Psychologist of Hong Kong Psychological Society (HKPS), MA in Counseling Psychology (Adler School), BA (Specialized Honors in Psychology, York), Associate Member of APA

It is a common fact that Hong Kongers have sleep problems. Let’s examine the causes, how they affect us and find ways to improve our quality of sleep.

A 2011 study by the Hong Kong Hospital Authority, Hong Kong University and Chinese University of Hong Kong discovered that 15% of its 900 participants had sleep problems. Of that 15%, 85% suffered from insomnia, 60% have had problems sleeping for over 2 years and 25% took sleeping pills. This reflects the high prevalence of sleep problems among Hong Kongers.
It is normal for people to experience sleeplessness now and again. Most of the time, not sleeping well is a temporary situation and does not require any treatment. Lack of sleep, however, has negative effects on our physical and emotional health, mental processes, energy level, work performance and relationship with others. We are functioning at our full potential only after we’ve clocked a good night’s sleep.
The National Sleep Foundation recommends that adults between the ages of 26-64 get 7-9 hours of sleep every night. If you find yourself constantly lying awake in bed at night, or that your daily routine is disrupted by lack of sleep and you are not able to function properly, chances are you may have a sleep problem. It is important to seek assistance from a family physician or a sleep specialist if you have any concerns.

Causes of Sleep Problems
Physiological – Being ill will disrupt your sleep pattern due to the discomfort that comes with it. Taking medications may result in oversleeping, which will further disrupt your body clock. Other causes include hormonal changes during menopause and pregnancy, as well as ageing.
Psychological – Your sleep will be affected when you are overwhelmed by the stresses of life and work. Other reasons include stresses from major life events, like divorce, grief or sudden loss of loved ones.
Behavioural – Consuming too much alcohol or caffeinated drinks, drug abuse and unhealthy lifestyle habits can affect the quality of our sleep. We also over-stimulate ourselves by using smartphones, watching TV, playing computer games or surfing the Internet late into the night. All these behaviours cause sleep disorders.
Environmental – The sounds, light and temperature of our surroundings, and the quality of our beds affect our sleep. Doing shift work as well as caring for newborns or unwell family members can also lead to sleep problems.

Effects of Sleep Deprivation
Ever heard of the term “beauty sleep?” It is actually sleep that a person needs in order to feel and look healthy. This was proven in a 2013 study done by University Hospitals Case Medical Center in Cleveland, Ohio, which found that sleep-deprived women showed signs of premature skin ageing and a decrease in their skin’s ability to recover after sun exposure.
It is obvious that sleep is necessary and beneficial for our health. In fact, scientists have discovered that sleep plays a crucial role in developing our immune system, metabolism, memory and learning abilities.
Short-term sleep deprivation can affect our judgement, mood, ability to learn and retain information. It may also increase the risk of serious accidents and injury. If left untreated, chronic or long-term sleep deprivation will develop, leading to a host of health problems such as obesity, diabetes, tremors, cardiovascular diseases, growth suppression and even early death.

Ways to Improve Our Sleep
If you have problems sleeping, here are a few suggestions for deep, restful sleep:

• Develop good sleeping habits. Get up and go to bed at the same time, and try not to sleep in on weekends. Eat healthily and avoid consuming caffeinated drinks 4 hours before bed. Smoking also affects sleep, besides jeorpadising your health. Keep your bedroom dark, cool and quiet.
• Prepare yourself for sleep. Take at least half an hour to wind down before bedtime. Listen to soothing music or practice a relaxation exercise. Leave the to-do lists for tomorrow. Thinking about them in bed will only add to your worries and cause sleeplessness.
• Turn off your smartphones. The light emitted from our electronic devices could interfere with our sleep, so it’s best to turn them off before bedtime.
• Medicate, but only if necessary. Sleeping pills should only be taken over a brief period and under a doctor's strict supervision. Do note that they are a temporary solution and not a cure for insomnia.
• Manage your stress. Face the causes of your stress before they lead to further health issues. Learn to be positive and optimistic.
• Nap less. Do not nap after 3pm as it will affect your sleep at night. If you absolutely have to, remember that naps should be no longer than 30 minutes.
• Don’t check the time. Staring at the clock when you can’t sleep will only lead to frustration and make you feel more awake. Get up to read a book or magazine, listen to music or do something less stimulating until you fall back to sleep.
• Exercise regularly. Exercise can improve sleep and mood. However, avoid exercising 3 hours before bedtime. Adopt the habit of brisk walking for 20-30 minutes after dinner, which will make you sleep better.
• Avoid alcohol. If you rely on a nightcap to fall asleep, stop this immediately. A glass of wine may help at first, but as the alcohol level in your blood drops, it will wake you quickly in about 2-4 hours. Once this happens, it will be difficult to fall back to sleep again.

 

Ms Tong Ka Ping Kate
Hong Kong Registered Psychologist of Hong Kong Psychological Society (HKPS), MA in Counseling Psychology (Adler School), BA (Specialized Honors in Psychology, York), Associate Member of APA

Juggling family and work commitments can be stressful for working women, but there are ways to manage and achieve a happier and more balanced life.
Achieving work-life balance is a challenge for most people working in Hong Kong. A 2016 survey conducted by Swiss investment bank UBS revealed that employees in Hong Kong have the longest working hours among the people surveyed in 71 cities worldwide. They clocked an average of 50 working hours a week and received fewer holidays than their counterparts in the other cities.
More and more women in Hong Kong have joined the workforce in recent decades, with some picking up significant roles in traditionally male-dominated domains. At the same time, they still need to devote time to taking care of the family and themselves. The multiple demands on their limited time can cause stress and negatively impact their moods and emotions. Some women may feel lost at work, or feel guilty about neglecting their families, friends and personal needs. They may also receive complaints from their loved ones about not participating in and engaging with the family. Some may feel unhappy, sad or depressed, angry, anxious and helpless. After they live an imbalanced lifestyle for a significant period of time, their stress levels are generally high. Physical symptoms of stress, such as headaches, digestive problems, muscle tension, chest pain, racing heartbeats, and especially sleep problems, are often presented. Yet, some women may keep going on with their lives despite their high stress levels, until they can no longer maintain them.
It is important to take care of yourself and manage any negative emotions that arise from work-life imbalance. Here are a few tips to help you overcome negative emotions and organise your personal and work life to achieve balance.

Stop and Take a Break
Losing yourself at work? Feeling helpless about your current situation? Feeling stressed, sad, or anxious? Are your family and friends constantly complaining that you do not have time for them? Do you feel physically and mentally drained? Losing your motivation at work and in life? If your answer to these questions is "yes", it is time to really stop and think about what kind of life you want. Realising the harmful effects of work-life imbalance is the first step.

Take Care of Yourself
Manage your emotions. Slow down and listen to your own needs. What is making you sad or angry? Try to think of your situation with a positive attitude and focus on changing it by finding a solution, instead of letting the negative emotions pull you down. Get enough rest and sleep. Eat healthily and exercise regularly. Spending time in nature can have a therapeutic effect on your emotions.

Relax and Release
Learn to relax and reserve time every day to practise relaxation exercises. These can help you relieve stress, ease anxiety, and improve your mood and quality of sleep. There are many different types of relaxation exercises, from yoga, meditation and breathing exercise to mindfulness training; find one that you feel most comfortable to practice.

Seek Support
Share your feelings and thoughts with your family and friends. They may not be able to solve your problem, but they can provide support and a listening ear. No matter how strong you are, receiving support from others and feeling accepted can help to boost your mood. You should also identify any irrational thoughts about your life, self, other people around you and work, then work on changing them. If you are unable to do so, consider looking for professional assistance.

Manage Your Work
Focusing on what you can control will give you a sense of empowerment. On the other hand, spending time on things you cannot control will leave you feeling helpless and frustrated. It is important to understand that you cannot work 24/7 – even a robot needs to be recharged. Remember you are human and having time for yourself, for fun, and for your family and friends is essential for your mental well-being. Discuss with your superior and human resource colleagues to find a solution for your situation. You should also remember that you can help yourself by changing the way you look at your work and life.

Reorganise Your Life
Develop an action plan – this can help to guide you to use your time wisely. For example, you could set aside Sunday mornings for yourself and the rest of the day for your family without any work distractions. Discuss with your family how all of you can spend quality time together. Ask them how they would like you to participate in the family and let them know you need their patience and support while you work on achieving a balance.

Dr Ace Lee
Specialist in Endocrinology, Diabetes & Metabolism, MBBS (HK), MRCP (UK), FHKAM (Medicine), FHKCP

With bone loss associated with ageing, middle-aged and elderly women are more likely to develop osteoporosis than their male counterparts. Here we explore the causes of osteoporosis and ways to prevent and treat it.

Many people do not understand osteoporosis, and think that low back pain or knee pain are symptoms of it. Dr Ace Lee, a Endocrinology, Diabetes & Metabolism specialist, explains that there are often no symptoms of osteoporosis at first, and a fracture may be the earliest sign of a problem.

Causes of Osteoporosis
The causes of osteoporosis can be divided into two groups – congenital and acquired.
Congenital causes: race, gender and family history of osteoporosis or fracture.
Acquired causes: lack of vitamin D or calcium; lack of exercise; being underweight (less than 45 kg); menopause; history of hyperthyroidism, rheumatism or malabsorption; and long-term usage of steroids, proton pump inhibitors or certain anti-epileptic drugs. Smokers or women with early menopause at around 40 years old are also more prone to osteoporosis.
Dr Lee adds that because hormones have an impact on bone mass, women will experience particularly rapid bone loss in the first 10 years after the onset of menopause. In addition, men can also develop osteoporosis even though they do not have the problem of menopause. Their risk is lower than women, but men should also take osteoporosis seriously.

Ways to Increase Bone Mass
We reach “peak bone mass” and have the strongest and densest bones generally around age 30. After that age, our bone mass begins to decrease. To boost our “peak bone mass” and prevent osteoporosis, we should begin to increase our intake of vitamin D and calcium, as well as do more exercise, from adolescence.
Although our skin can make vitamin D using ultraviolet rays from the sun, studies have found that vitamin D deficiency is a common problem around the world, even in sunny Singapore. The amount of vitamin D found in salmon, tuna and mackerel is considered high compared to other foods, but it is still not enough to meet our daily needs. Hence it is difficult for us to rely only on food to get enough vitamin D. People who do not spend a lot of time outdoors can consider taking some supplements that contain vitamin D.
According to the National Institutes of Health in the US, individuals between the ages of 1 and 70 need 600 international units (IU) of vitamin D per day, while those over 70 years old need 800 IU per day. Meanwhile, the recommended daily amount of calcium is 1,000mg for children 4-8 years old, 1,300mg for those aged 9 to 18, and 1,000mg for individuals aged 19 and above.
Dairy products are high in calcium. For people who only consume small amounts of dairy in daily life, they can take calcium tablets, drink calcium-fortified soy milk, or eat tofu with gypsum powder. In addition, salt causes the loss of calcium, hence we should avoid foods with high salt content.
When it comes to sports, the most effective way to improve bone health is weight-bearing exercise. This includes brisk-walking, going up slopes, hiking, running and climbing stairs. It is important to note that not all exercises are weight-bearing. Take swimming and cycling for example: although they can help to form and maintain strong muscles, and are extremely beneficial for the heart and blood vessels, they are not the best ways to build strong bones.

Accurate Assessment of Bone Mass
If you want to know whether you have osteoporosis, the most accurate way is to perform a dual-energy X-ray absorptiometry scan (DXA scan) to assess the risk of future fractures by measuring the bone density of the lumbar spine and hip. For women of menopause age who have never done a bone density test, Dr Lee highly recommends they go for a bone mass examination in order to get an appropriate assessment and be able to take preventive measures before the onset of rapid bone loss. In addition, anyone who has suffered fractures in adulthood should also have their bone mass checked so that osteoporosis can be detected early and appropriate treatments can be administered to lower the risk of fractures.
If women experience a rapid decline in bone mass after their menstrual periods stop and there are no other factors to indicate other causes, doctors may prescribe drugs to help slow down bone loss. If there is onset of osteoporosis or fractures, doctors will prescribe special osteoporosis drugs to boost the patient's bone mass and reduce the long-term risk of fractures. Dr Lee stresses that symptoms and treatments are different for every patient, hence a doctor's professional advice should be taken into consideration before taking any medication.

Dr Wong Bun Hung Christopher
Specialist in Cardiology, MBBS (HK), FACC, DABIM, DABIM (Cv), DABIM (Interventional Cardi)

As we grow older, we need to pay attention to our vascular age to keep our body healthy. Keeping blood vessels young and flexible can effectively prevent a variety of cardiovascular diseases.

Every part of our body relies on the continuous supply of oxygen by our blood vessels to maintain a normal function. Vascular ageing causes calcification, hardening, loss of elasticity, plaque build-up (the build-up of fatty deposits) and even blocked supply of blood, resulting in various problems. Cardiologist Dr Christopher Wong explains that vascular age is not necessarily the same as our chronological age. In addition to ageing and functional deterioration, other factors affecting vascular age include genetics, high cholesterol, long-term smoking, hyperglycemia and high blood pressure. The above factors cause our vascular age to be greater than our chronological age.

Methods of Examining Vascular Age
At present, there are 3 ways to determine a person’s vascular age:
1. Pulse Wave Velocity
This method is more commonly used in research centres. Researchers use an instrument to measure the pressure, flow volume and velocity of the blood travelling from the carotid arteries to the femoral arteries. The information is then used to analyse the stiffness of the blood vessel walls. If the arteries are hard with loss of elasticity, the pressure will be greater when the heart is pumping blood. The blood therefore flows faster, with a higher pulse wave velocity recorded.
2. Carotid Intima-Media Thickness (CIMT)
This method is more commonly used by doctors who use ultrasound to measure the thickness of two layers in the carotid arteries called the intima and media. This allows them to estimate the vascular age and vascular stiffness and to check for the presence of plaque build-up in the blood vessels to assess the risk of heart disease or stroke.
3. Framingham Risk Score
This method has been used clinically for many years and is very simple. By examining indicators such as age, sex, total cholesterol, HDL cholesterol and blood pressure, as well as whether he or she is diabetes or a smoker, the likelihood of a heart attack in the next 10 years and the age of the heart is estimated. The score tables can be found online and in mobile apps. As there is no need to use special equipment and a blood test can easily provide information such as cholesterol, blood pressure and blood sugar levels, Dr Wong says we can perform an initial risk assessment on ourselves.

Who Needs Vascular Age Testing?
Obvious symptoms such as angina, excessive panting on exertion and dizziness after exercise will appear only when the blood vessels have hardened by more than 50 per cent to 70 per cent. Therefore, Dr Wong suggests that men over the age of 45 and women aged over 55 should consider an ultrasound exam done on their carotid and leg arteries, even if they are not experiencing any symptoms. These groups of people are considered to be at medium to high risk of cardiovascular diseases and are also more likely to develop high blood pressure and high cholesterol. An ultrasound exam can assess their vascular stiffness and determine the presence of plaque accumulation.
It will be good for people with diabetes to be tested as they usually have cholesterol and triglyceride abnormalities, which will accelerate vascular sclerosis and they are at two to three times risk of heart disease and stroke than an average person. Dr Wong explains that medically, having diabetes is considered to be equivalent to having coronary heart disease and doctors should treat patients with diabetes the same way as they would when managing coronary heart disease, so diabetic patients should pay special attention to their vascular health.
If an ultrasound exam shows that the blood vessels are stiffened, doctors usually prescribe cholesterol-lowering or statin medications, in addition to advising patients to control their diet. The doctors will also advise these patients to repeat the ultrasound exam every six months to two years, according to their conditions, to determine whether the rate of hardening of the blood vessels is under control.
If a patient’s condition is serious, the doctor may advise him or her to undergo further checks – usually computed tomography – to determine whether there is coronary occlusion. Dr Wong highlights that the computed tomography scan involves radiation exposure, which will increase the life-time risk of cancer to a certain extent, albeit to a small extent. Therefore, patients need to have a risk assessment done and should only have the scan done if necessary.

Problems Caused by Vascular Aging
As blood vessels run through the whole body, vascular ageing affects every part of the body. The most direct impact is on the heart, causing problems such as myocardial infarction, angina and heart failure. If the brain does not have enough blood flow, there is a risk of stroke or dementia. If there are renal vascular issues, renal failure or secondary hypertension may ensue.
Furthermore, people who smoke regularly or suffer from severe diabetes are more likely to suffer from peripheral vascular disease, which causes pain in the legs while walking. In severe cases, foot ulcers and gangrene may develop and may even lead to amputation.
Dr Wong explains that in some cases, vascular ageing will affect the large and small intestine, causing patients to develop abdominal pain after eating. However, this usually coexists with other cardiovascular diseases. Generally, stomach aches are not related to cardiovascular problems so there is no need to worry too much.

Reduce the Risk of Cardiovascular Disease
To keep our blood vessels healthy and young, we must start with healthy habits in our daily life. Dr Wong says that the priority is to pay attention to our diet. It is best to consume low saturated fat, low-cholesterol foods and not to eat too much red meat and dairy products. When drinking milk, opt for skim milk. We should also reduce consumption of foods rich in sugar and carbohydrates, and effectively control our blood pressure. Dr Wong also explains that excessive alcohol can increase the blood pressure and at the same time, cause weakening of the heart muscle, therefore his advice is not to drink more than one glass of wine a day.
On the other hand, it is also important to develop the habit of exercising regularly. The American Heart Association recommends at least 150 minutes of exercise per week. Dr Wong highlights the importance of persistence, i.e. exercising for an average of 20 minutes or so every day. He also advises smokers to quit smoking as they have a much higher risk of cardiovascular disease than an average person.
By maintaining good daily habits, we can ensure good vascular health and live healthily and happily every day!