Making the physical personal

When you own a car, you generally get a professional to give it a periodic check once you’ve clocked a certain mileage. But do you do the same for your body?

Praram 9 Hospital, with a new programme called 9-Life, hope to encourage people to do just that. What they’re offering, however, is not your average annual checkup.

It’s a checkup tailor-made for each individual, taking into account that person’s unique background and lifestyle. After all, says Lauranee Sirikasem, senior marketing and communications manager, you don’t give a 4WD and a Benz the same sort of service. “I work in marketing. You’re a reporter,” she says. “We probably live very different lives. Why should a doctor give us each the same checkup?”

Dr Termsak Kusonruksa, executive director at Praram 9 Hospital describes the two-month-old 9-Life as being an effective and efficient way of handling middle-aged patients’ annual checkups. “There used to be a fixed menu of packages doctors followed – if you were 40, 50, or 60, say, you took a set of tests no matter who you were,” Dr Termsak says. “But we [doctors at Praram 9] found that over the years, there were a good number of cases where the standard checkup didn’t screen out a lethal disease – for instance, a cancer could go undetected.”

9-Life is a result of the doctors banding together to develop a way of ensuring such serious slips halted.

The programme involves answering a series of 45 questions on a computer, a process that takes around 15 minutes. The questions relate to a patient’s medical history, family history, lifestyle and general background. Based on the answers, the computer will draw on Thai statistics and other data – such as American Cancer Society recommended guidelines — to decide what diseases someone of that patient’s profile is most at risk of developing.

The computer will then recommend specific tests to be taken. A printed sheet will list what you need to have – and how much it costs. The patient will see an internist to discuss the initial computer-test results and any other concerns, and then where required, specialists will administer your tests and discuss in detail any conditions you might have. It’s frequently possible to have all your tests and get the results in one day. The system will alert hospital staff to remind you when it’s time for your next check-up, too.

The starting price is Bt1,200 — but that’s for someone who’s young and in a low-risk group. I’m 29, not particularly fit and have a family history of several diseases. The computer recommended around 15 tests, at a cost of Bt3,080.

It might seem expensive, but when you look at what the early detection of diseases saves you long-term, avoiding checkups actually becomes a false economy, says Dr Termsak. “In maintaining good health, we have to make a clever investment. Patients will know early about their risks, and have a chance to learn how to modify their behaviour in order to prevent diseasess – and save a lot of money.”

Dr Termsak says that the system behind 9-Life is quite simple. “It’s about using ideas and knowledge, and improving the working system, rather than about money. We have to work smarter with what we have.” The IT system that was implemented, and the increased capacity of the IT system, probably cost less than a million baht.

Yet the system is quite powerful. Your average GP might not be aware that people with a southern Chinese ethnicity are statistically more likely to develop cancer of the nasal pharynx – but the 9-Life system will immediately alert doctors when a patient of this background attends a checkup. Or your regular doctor may have scrawled in his or her notes somewhere (we all know doctors are famous for bad handwriting!) that you have a history of diabetes in your family – but might overlook this when you pop in for a quick checkup.

So what age should you get yourself into 9-Life? Dr Termsak suggests that if you’re in your 20s and 30s, and are generally healthy, there’s no need to see a doctor annually unless you have a particular family history that you should be concerned about. Once you hit your 40s, the risk of developing a serious disease rises, and the risk rises further as you age. Your chances of maintaining excellent health, however, are optimised with regular checkups – especially when they’re tailor-made to fit who you are.

When you think of 9-Life, think of cats, says marketing and communications manager Lauranee. “Cats have nine lives. They have longevity,” she says. 9-Life could be your key to a long and healthy life.

9-Life Hotline: 02 248 8020. Services available from 7am to 3pm daily.

Battling breast cancer

Twenty-eight year old Penkhra Jitjamnong found the lump in her breast when she was on a cold Phuket beach two years ago. "I touched it by accident, and knew something was wrong," she says. "I had also been eating a lot, but not putting on any weight." Despite her doctor telling her she was probably far too young to have cancer – most women diagnosed are aged over 40 – her test results showed otherwise.

Jamaican-born Liza Chang, 46, knew that she had fibrocystitic disease, a very common but usually benign condition where the breasts tend to feel lumpy and can be prone to developing cysts. When a cyst she had for more than a year seemed to be getting larger, she insisted it be removed despite doctors telling her it was probably nothing. That was October last year, and she was subsequently diagnosed with breast cancer. Following a lumpectomy in Singapore, she is currently undergoing chemotherapy in Bangkok.

There are no hard and fast rules with breast cancer. In Thailand, it is the second most common form of cancer in women after cervical cancer; globally, breast cancer is in the lead. According to the World Health Organization, more than 1.2 million people around the world were estimated to be diagnosed with breast cancer last year, while 700,000 women were expected to die from it.

Accurate statistics on the incidence of breast cancer in Thai women are elusive. "There’s a problem with reporting," confirms Boonpanore Na Songkhla, a former oncology nurse who worked for 12 years in the US and is now customer service manager at BNH. "Often on the death certificate it will say that someone died say, of heart failure, when the underlying cause was breast cancer."

For Bangkok, where statistics are probably the most reliable, it’s estimated that around one woman in every 5,000 will be diagnosed with breast cancer – a rate higher than the rest of the country, but similar to rates in developed countries.

The most important key to surviving breast cancer is early detection and treatment. According to the American Cancer Society, when breast cancer is detected and it remains confined to the breast, the five-year survival rate is almost one hundred per cent.

And although self-examinations are important, they are not enough to ensure early detection. "If you can feel a lump in your breast, there’s a fifty per cent chance that it may spread through your system," says Dr Pornthep Pramyothin, a surgeon at Samitivej Hospital.

Mammograms, on the other hand, can detect lumps that you can’t yet feel yourself. So should you head off and have one?

"Guidelines for when to start screening for breast cancer vary between different national cancer bodies around the world, and between hospitals," says Connie Larkin, co-ordinator of the Bangkok Breast Cancer Support Group (BBC), which was founded just two years ago. "We tend to promote the American Cancer Society’s guidelines because they are the most conservative."

These suggest that:

· self-examinations be done monthly from the age of 20;

· a clinical breast exam be done every three years until age 39; and

· an annual mammogram and a clinical exam be done from the age of 40.

The majority of women, however, are still reluctant to be tested. "There are now facilities all over the country, and we have the technology to detect breast cancer in its early stages," says Dr Sankiat Vayakornvichit, a gynaecologist at Samitivej Hospital. "The problem is getting people to go and be examined. Please have a physical exam once a year – not just for a pap smear, but for a breast exam. It’s an integral part of a woman’s check up."

Thai women are not tested as commonly as those in western countries for two reasons. Firstly, there’s a cultural tendency to be very modest about one’s body and put off seeing a doctor – who is still usually male – until it’s too late. "Thai women are not open about their bodies, so they don’t like seeing a doctor for a checkup," says Boonpanore. "And they don’t like to self-examine themselves."

The second reason is simply a lack of health education, but this is something the Ministry of Public Health is working to improve. In the past, the ministry campaigned using brochures to encourage women to self-examine and have regularly check-ups, but they weren’t very successful. "So instead they switched to holding local concerts, and they now get popular singers [such as Apaporn Nakhonsawan] to encourage women to have both pelvic and breast exams," says Boonpanore.

Whether you find a lump and get it checked out, or you’re just going for a routine check-up, there is always the possibility that you may have cancer. "When diagnosed, women often go into shock," says Boonpanore. "Get yourself together, stop and think before making decisions about your treatment. You need to get some support – this could be your family, your loved ones."

The treatments available in Thailand are the same as those in western countries, but the treatments sought are not, largely for economic reasons. In the public system, economic conditions mean that doctors take care of essential problems only. "Chemotherapy is probably not used as much as in the west. It’s very expensive, so surgery is popular instead," says Boonpanore. "In the States, breast reconstruction is common, but here, they don’t even talk about it in the public system."

If you have the money then, you can take care of the medical side of the things. But whether you can afford the best medical care or not, you still need to be mentally and emotionally strong if you’re going to beat cancer.

"In America, support groups are very prevalent," says the BBC’s Larkin. "Even in a couple of other places in Asia, but not Bangkok." That’s why, when several of her friends were diagnosed with breast cancer, she took matters into her own hands and started the BBC. Now the group is providing inspiration to more and more women – but they are facing some obstacles when it comes to actually reaching out to the women they want to help.

Penkhra, for instance, asked nurses on numerous occasions about whether there were any support groups for people like her. Eventually a nurse gave her a brochure about the BBC. "I’m so happy I found out about them. They’ll tell you about what to do if you lose your hair, how to feel good about yourself and stop thinking about being sick."

Penkhra has now recovered and is returning the favour to other patients by remaining active in the BBC. "If there’s someone new, I want to help her. I lost my hair – if someone is going to lose their hair, I’ll tell them to look at me," she says, indicating her now healthy locks.

Liza woke up after her lumpectomy in Singapore surrounded by a group of women she had never met. "They greeted me, told me they were from the [Singaporean] Breast Cancer Support Group. They had all sorts of information for me, but I had to tell them I was leaving in two days for Bangkok."

So Liza began her search here for a similar group, but to no avail. "Three weeks after I was into chemo, my husband told me to not leave the hospital until I had an answer!" Liza says. Finally, she was given a BBC brochure.

"It’s been fantastic," Liza says. She finally found out where to buy a wig, and met people she could discuss treatments with. "And people just call out of the blue to see how you’re doing."

Health professionals agree that talking about your problems, and getting emotional support from people who have gone through similar experiences can be beneficial. "The mind/body connection is very important," says Boonpanore. "Once you get your mind onside, once you know that other people care, that these people support you, you’re given hope. The support group helps women obtain hope. Without hope, everything falls apart."

Nevertheless, Boonpanore thinks that it might take some time for the idea to catch on for women around the country. "Around the world, a woman is a woman, and when a breast goes, you know something is different. We all feel the same. But the way Thai women cope and express their feelings can be different. Women haven’t really come together here yet to fight for things for women. The support group – it’s a start, a good start."

Contact details

Samitivej Hospital: 392 0011

Bumrungrad’s Horizon Regional Cancer Centre: 667 1020

The Bangkok Breast Cancer Support Group: 300 3245

Selecting a shampoo

We’ve all sat in hair salons and smiled nervously as our stylist has suggested buying an expensive salon shampoo. We’ve thought about that Bt80 bottle of pleasant-smelling shampoo sitting at home in our shower recess and wondered, "Is the extra price for that really worth it?"

Paying around Bt300 to 400 for a salon-sourced or upper-end brand name shampoo can seem extravagant. But stylist Schai from Schai Coiffeur insists that price is an important indicator of quality. "The formula and the ingredients are very different [between cheap and expensive shampoos]. Salon shampoos are more targeted towards hair types, and they’re more concentrated than supermarket shampoos."

Salon shampoos today are all of a comparable standard – the important thing is finding the right product for your hair type, and this is where your stylist’s advice is paramount. "It matters who you buy from," said Schai . "They must understand the products they are selling, and know whether they are going to be good for your hair."

If you’re on a tight budget and your hair is in good nick, Schai has good news: a general shampoo probably won’t harm your hair. "Those shampoos are just not helping your hair as much as they could be. But the cheapest shampoos, which have more detergent, could dry out your hair," he warned.

The quality of a shampoo is to an extent determined by its pH (a number on a scale of 1 to 12 that measures acidity or alkalinity). Human hair and skin has a pH of around 4.5 to 5.5, while shampoo has a higher alkalinity or a pH in the range of six to 10. This higher alkalinity opens the hair shaft, and lets the shampoo get inside to clean.

The Attitude’s hairstylist John Moy explains that good shampoos have a pH of seven to eight. "Those nine to 10 – the soapier ones – are likely to leave the hair shaft slightly open, which makes the hair look dull." So the degree of foam you get from your shampoo is not, contrary to popular belief (and many advertisements) a good indicator of its effectiveness.

Joico, one of the newest salon brands in Thailand, has a range of 300ml shampoos, including Chelating Shampoo Resolve, for maximum cleansing (Bt350), Treatment Shampoo Biojoba, for chemically damaged hair (Bt430), and Lavei Deep Cleansing Shampoo (Bt320). Paul Mitchell’s line includes Shampoos One, Two and Three (250mL). One is for daily use (Bt235), two is for daily use on oily hair (Bt235) and three is to get rid of buildup (Bt255). Sebastian this month launches its Laminates range, which adds a Cleansing Polish (Bt395, 250mL) to their other shampoos, including Mohair , Spandex and Stark Naked Shampoos (all Bt395, 250mL).

Heading outside the salons, Boots Tricologie line includes shampoos labelled Rejuvenating, Nourishing and Deep Cleansing (all Bt340, 250mL). The Origins haircare range, available at Central Chidlom and Ladprao and The Emporium, carries shampoos The Last Straw(Bt590) for conditioning, Clear Head (Bt490) for daily use, No Deposit (Bt 490) to get rid of buildup and Snow Removal (Bt490) for dandruff control. The Body Shop has a selection of shampoos in its Palmshine range, including a Rebalancing Shampoo for oily hair (Bt230, 250mL), Conditioning Shampoo for dry, damaged or colour-treated hair (Bt230, 250mL), Volumising Shampoo for fine/flyaway hair (Bt230, 250mL) and Deep Cleansing Shampoo (Bt320, 150mL).

Once you have the right shampoo, to put it to work Mr Moy recommends that you lather your hair for one to two minutes to allow it to get used to the water and the shampoo. Concentrate on your scalp and roots, and use the balls of your fingertips rather than your fingernails, which can damage the scalp. Rinse and repeat, as by the second wash the hair shaft will be open and able to be really cleaned. "This second wash is especially important for people who use styling products," he said. "If these accumulate, they’ll lead to problems later on." Finish with a conditioner.

Protecting your hair

Hot, polluted and humid: Bangkok is your hair’s worst nightmare. Add blowdryers, curling tongs and hot hair rollers to the equation and your hair’s going to need all the help it can get if it’s going to remain strong and healthy. Thankfully, an increasing range of protective products are now hitting the shelves – but you don’t necessarily have to spend up big to keep your hair looking beautiful.

Blowdryers, curling tongs and hot hair rollers are by far the most damaging to the hair. "The sun, after all, does not equal 220V of heat," says The Attitude’s hairstylist John Moy. "These items are directly damaging and ruining the hair at the technical level."

The way you use your heating implements can help minimise damage to an extent. For instance, when blow drying your hair, stop when it’s ninety per cent dry instead of fully drying it; and don’t hold curling tongs to your hair any longer than necessary.

But for complete protection, investing in a heat protection product is necessary – particularly for chemically treated hair, which is already damaged and easily susceptible to further damage. In general, such products work by coating the strands of your hair with a protective film, so the heat of your blow dryer or other heating implements won’t burn or dry out the hair shaft.

"Look for products that have a moisturiser, as these will be nourishing for your hair," said Mr Moy. "Really, they are all good. It comes down to what the client likes, and how much they want to spend. If you don’t want to spend anything at all, don’t colour or perm your hair in the first place, and don’t use heating tongs."

Hitting salon shelves worldwide this month is a new range of Sebastian haircare products called Laminates, which includes a Hair Spray Finishing Polish (Bt475, 250mL) with silicones to protect hair from heat damage. The Body Shop’s Palmshine range, launched earlier this year, includes a Conditioning Mask for normal hair (Bt470, 150mL), with contains shea butter, a jojoba oil derivative and conditioning agents to protect against heat damage.

Those with dry, damaged or colour-treated hair should instead try the Intense Conditioning Mask (Bt470, 150mL), with similar ingredients. Or, suitable for all hair types, there’s the Leave-In Conditioner (Bt320, 150mL) that features shea butter and a conditioning agent, again to protect against heat damage.

Many products now incorporate UV protective ingredients too. Tigi Protein Protective Spray (Bt390, 240mL), designed for hair that’s coarse or dull, protects it from UV rays plus heating products; The Body Shop’s No Hassle Detangling Spray (Bt320, 150mL) contains a heat-styling protection ingredient plus a sunscreen.

For those who don’t necessarily blowdry their hair, but spend plenty of time in the sun, there are specialised products too. Boots’ Tricologie haircare range includes a waterproof protective gel, Protect & Condition Swimming Gelle (Bt260, 150 ml), while L’Oreal’s Kerastase range includes a Solaire Huile Protective Spray (Bt450, 100mL).

But there’s good news for your wallet if it is just sun protection you’re after. "You can really use any moisturiser, or even Johnson’s Baby Oil – just a touch over the surface of your hair," said Mr Moy. "Specialised products are really just gimmicks."

Schai Coiffeur’s Schai adds that not everyone needs to use sun protection products. "It’s an extra. If your lifestyle means you face a lot of exposure to the sun, then these products will help keep your hair colour stable, and prevent your hair from drying out."

The condition of your hair should also help determine whether you use such products. "If your hair is not in good condition, or it’s coarse, protective sprays will be more effective. But if your hair’s in good condition, it doesn’t matter a lot."

Makeup can help you save up

Buying a new lipstick or a new eyeshadow can be a great pick-me-up, but if you tend to impulse buy makeup too frequently, it can also eat into your budget. A good way to save cash while also keeping up with the latest trends in makeup is to get a complete makeover when the urge to spend bites.

Many cosmetic counters offer a makeover service for free if you are interested in buying some of their products. Spending over a certain amount at a number of counters, however, makes you eligible for scheduled makeup classes that are more in-depth. Several brands also have separate specialised institutes that you can attend for lessons – some completely free, others charging an amount that you can then redeem against a purchase of their products.

Bobbi Brown provides a free no-obligation makeover to interested customers at their counters located at Central Chidlom, Ladprao and Pinklao, Emporium and Zen. Appointments are recommended, so call in advance. If you spend more than Bt5,000, however, you become eligible to register to attend a three-hour workshop conducted once a month in the relevant department store’s classroom. Class size is limited to 15 to 20 people, with everyone given their own station of cosmetics to use. One teacher takes the class, with seven or eight makeup artists assisting the class.

For the month of July only, Red Earth customers at Central Chidlom, Ladprao and Bang Na are being offered a free day-long class if they purchase Red Earth products to the value of Bt2,800. Normally, customers are provided only with a free short suggestions as to how to wear their makeup at counters.

The Body Shop offers several types of makeup classes. Their 90-minute basic class costs Bt1,500, but you can redeem up to Bt1,200 on any Body Shop purchase, effectively making the class Bt300. If you don’t want to buy any products, the class costs Bt590. Heading out into the world of work? They have a specialised 90-minute class on interview makeup, priced at Bt1,500, with a Bt1,000 rebate offered, or a flat Bt690. A two-hour advanced class isBt1,500, with Bt900 redeemable, or a flat Bt690. A 60-minute trend lesson will keep you up with what’s happening this season. Cost is Bt1,500, with Bt1,200 redeemable, or pay Bt590 for just the class. Classes are available only at their Central Ladprao and Pinklao stories in Bangkok, and at Central Airport in Chiang Mai.

Clarins and Lancome have their own institutes located at The Curve Lane, Central Chidlom. At Institut Clarins Paris, a one-hour class costs Bt2,000, but this amount is then redeemable against the purchase of any Clarins products. At Lancome Institut de Beaute the classes are longer: a ninety-minute class will also set you back Bt2,000, and again this amount is redeemable against purchases of Lancome products. Lancome also has group classes: take yourself and three friends along for a three-hour class that will cost each of you Bt1,500, then choose products up to that amount for your rebate.

Shiseido also has its own institute with beauty consultants to provide advice on their products free-of-charge. Individual customers are encouraged to drop by, while groups of five to 10 people can book in advance for a series of free lessons. One bonus here is that there’s no pressure to buy – products are not for sale at the institute, you need to head to a counter once you’ve decided whether you like what you’ve tried.

Clinique counters provide demonstrations to customers on how to apply their products, but they also have a special workshop event coming up from August 20 to 31. At selected counters customers can register from August 1 to be entitled to make an appointment for a full at-counter makeup lesson during that period. Bookings are limited.

Vitamin C: Helping in the defense of your skin

Your skin will be smoother and more fresh looking; fine lines will disappear; your skin will be brighter and lighter. These are the various claims cosmetic companies make for vitamin C, and in theory the vitamin can indeed help your skin in several ways.

Firstly, Vitamin C is an antioxidant, which means it helps neutralise toxic "free radicals". These are the byproducts of chemical reactions that take place in the body. Smoking, exposure to sunlight and pollution, stress, drugs and a poor diet can all lead to an increased production of free radicals on the surface of the skin. In turn, free radicals speed the skin’s aging process and may also contribute to skin cancer and inflammation. Applying topical vitamin C assists in destroying free radicals, and reduces their harmful effects. "I do use vitamin C cream because it’s an antioxidant," says Samitivej Hospital’s Dr Wilai Thanasarnaksorn, adding that its application also helps prevent new pigmentation in the skin.

Secondly, vitamin C helps in the skin’s production of collagen – an important structural protein of the skin – that slows as a body gets older. When vitamin C is properly delivered to skin cells, it can help reduce fine wrinkles and improve the skin texture, often described as a "boosting" or "rejuvenation" of the skin by cosmetics companies.

In practice, however, there are two major difficulties in getting vitamin C to work. First of all, vitamin C molecules are relatively large and therefore very difficult for the skin to absorb. In dermatologists’ clinics, a process called iontophoresis – where a small electrical charge is administered to the skin – may be used to encourage the molecule to be absorbed. It costs around Bt1000 to 2000 depending on the product used, but is usually used to treat medical conditions such as melasma.

The other problem is that vitamin C is highly unstable. In the presence of air or other oxidizing agents such as light, vitamin C is converted to an oxidized form that benefits neither collagen synthesis nor free radical scavenging. In fact, in poorly prepared or stored products, the vitamin C may be oxidized by the time you apply it to your skin. "The stability of the vitamin partly depends on the process used when making the cream," Apex Skin Centre’s Dr Natipat Supaninachart says. "It can disintegrate within a couple of months of being on the shelf [even unopened]."

There are numerous vitamin C products available for the consumer wanting to test the for themselves. "It’s very hard to say which products are better," says Dr Natipat. "But the main benefit for any vitamin C product off the shelf is its moisturising effect."

If you’d like to give it a go on your own, The Body Shop has a citrus-fragranced vitamin C range, which includes Skin Boost (Bt990 for 30mL), Intensive Night Treatment (Bt990 for 30mL) and SPF 15 Daily Moisturiser (Bt790 for 50mL). The Body Shop emphasises vitamin C’s usefulness as an antioxidant, and claims its products will leave the skin feeling smooth and softer.

Helena Rubenstein also has a range. Available in Thailand since January, it includes a Super Energy Serum (Bt 2,800, 6.8 mL x 4 bottles), Moisture Mousse (Bt1,750 for 200mL), Daily Activating Fluid with SPF15 (Bt 1,850 for 50mL) and Super Energising Cream (Bt1,700 for 30 mL or Bt2,200 for 50 mL) and Anti-Fatigue Eye Care (BT1,500 for 15 mL).

But if you’re a little sceptical now, perhaps wait for a few years before giving the products a go. "Companies who are serious about vitamin C are working hard on how to diffuse it into the skin better, and how to stabilise it," says Dr Natipat, adding that vitamin C is a substance of current great interest to dermatologists.

Sharp ways to stay healthy

While many in the West consider acupuncture to be an "alternative" medical treatment, it has been practised for up to 5,000 years in China. It’s perhaps ironic then, that Samitivej hospital physiatrist Dr Chirapan Vinaikulpong finds that it’s her western patients who request acupuncture rather than her Thai patients. "This might be changing, but most of my Thai patients are afraid of needles. Europeans are afraid of chemicals."

Acupuncture is the insertion of very fine needles about one to two centimetres into the skin of the body to influence its health. It is first mentioned in the world’s oldest medical text, the Huang Di Nei Jing, which theorises that the body has an energy force, called qi (pronounced "chee"), running along twenty "meridians" or pathways. There are up to 2,000 spots where these meridians reach the surface of the skin; placing a needle on them will affect the qi that runs through them. Qi itself is influenced by the opposing forces of yin and yang, which represent positive and negative energy. Acupuncture is believed to keep the balance between yin and yang, so it allows the normal flow of qi throughout the body.

There is no scientific explanation of how acupuncture works, but a number of theories have been offered. One popular theory suggests that pain impulses are blocked via acupuncture from reaching the spinal cord or brain. Others variously suggest acupuncture releases narcotic-like chemicals, endorphins or neurotransmitting chemicals, such as seratonin and noradrenaline.

Since the 1970s, the World Health Organisation has recognised that acupuncture can help treat many ailments. These include neuromusculoskeletal conditions, such as arthritis, neuralgia, and neck/shoulder pain; psychological disorders such as depression; circulatory disorders such as hypertension; addictions; respiratory disorders, such as allergies and bronchitis; and gastrointestinal conditions. Since then it has been formally recognised in the US that acupuncture can help with even more afflictions, including carpal tunnel syndrome, asthma, migraines and menstrual cramps.

As a physiatrist, Dr Chiraporn treats mostly patients with neuromusculoskeletal problems. In her experience, she says acupuncture definitely has an anti-pain effect and that her patients usually request acupuncture when their medication starts to lose its effect. "But I have observed that acupuncture also regulates the recovery of musculo-skeletal problems. It works best when the problem is simple and acute, and there are no underlying mental problems."

However, Dr Chiraporn says that the effect of a treatment session does not last long. "It depends on the patient – in some, it lasts for two to three hours, in others up to a week." This is why traditionally, for chronic problems, patients were treated every day in China. "But this is difficult to achieve in Bangkok, so I usually recommend two to three sessions per week," she says. The length of a session depends upon the treatment, but usually involves the use of six to 10 needles.

There is no regulation of practitioners of acupuncture in Thailand, but the Shanghai University of Traditional Chinese Medicine has run a three-month course in Thailand since 1998, which some 120 to 150 Thai physicians have completed. Patients who want to ensure their practitioner has a qualification could check to see if they hold a certificate from that course as a minimum requirement.

"The entire concept of traditional Chinese medicine is that when you look at a local problem, you look at the whole too," Dr Chiraporn says. As such, acupuncture is not the complete solution to health problems. "Meditation, exercise and diet are also important. Acupuncture can combat some very painful symptoms, but it is also the duty of the patient to work to fix their problems."

Samitivej Hospital:381 6807
From Bt500
Department of Medical Services: 590 6127
From Bt200
Sirindhorn National Medical Rehabilitation Centre: 591 3569
Price depends on doctor
Bangkok General Hospital: 310 3011
Bt700 for first visit, Bt560 for second and further visits
Huay Chiaw Hospital: 223 1351
From Bt200
Bumrungrad Hospital: 667 1000
Bt100/pack of ten needles, then fee depends on doctor
Yan Hee General Hospital: 879-0300
Bt400 to 500

Alpha hydroxy acids: Good for the skin?

Alpha hydroxy acids, or AHAs, have been used in low quantites for cosmetic purposes for centuries – Cleopatra bathing in milk is one legendary instance of the use of lactic acid – but they only reached the mass Thai market in the mid-90s, where they’re still going strong.

What are they?
Alpha hydroxy acids are a group of simple, structurally related organic acids that are derived from fruit and milk sugars. Glycolic acid, from sugar cane, and lactic acid, from soured milk, are two of the most common ones used and recommended by doctors to improve the skin. Others AHAs include mandelic acid from apples, tartaric acid from grapes and citric acid from citrus fruits.

How do they work?
As one’s skin ages, it becomes less able to shed unnecessary dead skin cells; the build up of these cells can leave the skin’s surface looking dull. Alpha hydroxy acids, when applied to the skin, stimulate and increase the epidermal cell turnover, a process known as exfoliation. There is some scientific evidence that professional treatments, which can contain up to seventy per cent of an AHA, leave the skin feeling more elastic and smooth, while reducing the visibility of wrinkles and fine lines.

"It makes the skin look fresher, brighter and younger," confirms Bumrungrad Hospital dermatologist Dr Niyom Tantikun. He recommends having one treatment per week for four weeks for the best results. Patients with more sensitive skin – such as those with fair skin – should instead have treatments just once a month.

Once the initial series of treatments is over, the results can be maintained by using weaker over the counter creams once or twice a week. "These creams for home use usually contain a concentration under ten per cent," says Dr Niyom, adding that you should check the product label for information.

The most common side effect, whether AHAs are used at home or under a doctor’s supervision, is reddening of the skin. Complaints in the US have, however, also included swelling, burning, blistering, bleeding, rashes, itching, and skin discoloration. "Doctors should start with a low concentration and increase the strength only when there is no adverse reaction," says Dr Niyom.

DIY vs seeing a doctor
Due to the uncertainty involved in an individual’s reaction to a treatment, it’s advisable to head to a qualified dermatlogist for treatment, rather than a beauty clinic. Samitivej Hospital dermatologist Dr Nalinee Sutthipisal says, "Doctors can better manage the side effects that may occur. They also know about the many different concentrations of products, the pH levels and so on, and are more likely to know what the effect on an individual’s skin will be," Dr Nalinee says.

The extent of exfoliation that occurs will depends on the concentration of the AHA, the other ingredients in the produc, its pH level and, of course, the particular AHA used. "It’s the size of the AHA molecule itself matters," Dr Nalinee explains. "Glycolic acid, for instance, is a smaller molecule, so it has a stronger effect. It’s more difficult to control."

For this reason, she personally prefers to use a mixed fruit acid (which has larger molecules) on her patients, as she believes this maximises the benefits of the treatment, while reducing any long term side effects.

Long-term effects are unknown
Since AHAs have been used for such a short length of time, the jury is still out on their longer term effects. Studies have found that since AHAs strip away the skin’s outer layer, a patient will be more sensitive to the sun. This can lead to an increased risk of photoageing (the ageing of the skin caused by the sun) and skin cancer. For this reason, doctors strongly advise that patients undergoing AHA treatments, or using AHA over-the-counter creams, always wear a sunscreen.

Rajtevee Polyclinic
Mahatun Plaza, Ploenchit Rd
Tel: 252 9251
First time free, then five treatments for Bt1500.

Samitivej Hospital
133 Sukhumvit 49
Tel: 381 6807
Bt600 per treatment

Bumrungrad Hospital
33 Sukhumvit 3
Tel: 667 1000
Usually Bt700, but can vary according to doctor

Bangkok Nursing Home Hospital
9/1 Convent Rd, Silom
Tel: 632 0550
Bt600 to 1000

Bangkok General Hospital
2 Soi 7, New Petchaburi Rd
Tel: 318 0066

Give your baby a healthy start

You may not be planning on falling pregnant soon, but if you’re of child-bearing age it’s still worth knowing about folate, one of the B vitamins. In the US, over half of all pregnancies are unplanned, and as folate is needed both before and during the first weeks of pregnancy to help prevent birth defects, women planning pregnancy should ensure they are taking enough.

Folic acid is the synthetic form of folate, found naturally in foods such as citrus fruits, tomatoes, whole grain products, dried beans and peas, leafy dark green vegetables such as broccoli, brussels sprouts, and spinach, berries, liver and asparagus. Folate is important for the formation of red and white blood cells. A mild deficiency, which according to Samitivej Hospital nutritionist Dr Kumpol Sriwattanakul is quite common, can lead to anaemia, while in more severe cases it may lead to megaloblastic anaemia, a condition affecting the red blood cells.

Folate is required for DNA synthesis, and DNA itself allows cells to develop properly, including those in a foetus . If a woman is deficient in folate during the first 28 days of pregnancy, there is an increased likelihood that her baby will have a so-called neural tube birth defect, such as anencephaly or spina bifida. A baby with the former does not develop a brain, and will be stillborn or die soon after birth, while a baby with spina bifida will be born with a defect of the spinal column. Spina bifida manifests as a mild case of scoliosis, or more severely as paralysis and bladder or bowel incontinence. Around one third of spina bifida sufferers also have slight to severe mental retardation.

Bangkok Nursing Home Hospital obstetrician Dr Boonlert Triam-amornwooth says that it was debated for a long time whether or not folate deficiency could lead to neural tube defects, but the World Health Organsiation concluded four years ago that it could. "It now recommends that women preparing for pregnancy take about 400 microgrammes to one 1 mg of folate a day at least one month before pregnancy." Doctors usually recommend a 400 mcg daily intake to most people anyway.

Dr Boonlert says that taking a folate supplement with multivitamins before getting pregnant will also help reduce the risks of foetal abnormalities of other organ systems. "And it helps increase the chance of pregnancy too, by about six or seven per cent."

While it’s vital during the first days of pregnancy, the need for it continues for nine months, so obstetricians usually prescribe a folic acid supplement of around 800mcg per day. "Pregnant women definitely need extra folate because the total amount they get from food will not be adequate – no matter how good their appetite is."

Recent research has also shown that folic acid may help prevent heart disease by lowering the body’s levels of homocysteine, an amino acid thought to increase clot formation in the blood. High levels of homocysteine may also be linked to osteoporosis, strokes, and Alzheimer’s disease. But until clinical trials are completed, the jury is still out both on whether the amino acid is damaging and whether folate can truly help.

"Taking a folate supplement can have benefits in many ways and almost without toxicity at all," says Dr Boonlert. In fact, in January 1998 a US law was passed requiring foods such as flour, bread, rolls, corn grits, cornmeal, rice and noodle products to be fortified with 0.43 mg to 1.4 mg of folic acid per pound of product.

Nevertheless, once out of those childbearing years do not unnecessarily overdo your folate intake. A high intake might complicate the diagnosis of pernicious anaemia, which occurs commonly in older people due to a vitamin B12 deficiency. Extra folic acid can mask the symptoms of the condition, which may lead to permanent nerve damage if untreated.

Plastic surgery for the body

Plastic surgery is not limited to the face. Two of the most popular procedures carried out on the body are liposuction, a procedure which removes fat from certain locations on the body, and augmentation mammoplasty, the surgical insertion of either saline or silicone implants to increase the size of the breasts.

Liposuction is a procedure in which deposits of fat are removed to recontour an area of the body. Through a tiny incision, a cannula (internal suction probe) is inserted and used to suck out the fatty layer that lies under the skin. The cannula is pushed and pulled through the layer to make tunnels like those in Swiss cheese; fat cells are broken up and then suctioned out. While not a substitute for dieting and exercise, liposuction can remove areas of fat that won’t respond to traditional weight-loss methods. According to plastic surgeon Dr Amorn Poomee, women request liposuction most commonly on their hips, thighs and abdomen, while men ask for the procedure to be done on their abdomen, love handles, and breasts. ("Men hate having breasts!" says Dr Amorn.)

During the past few years, liposuction has benefited from the development of several new techniques, the most popular of which is the tumescent technique. This technique uses saline containing a local anesthetic, which is injected into the fatty tissue. The injected area is therefore anesthetised, so no general anaesthetic is required. The liquid causes the compartments of fat to become swollen or "tumesced", and these larger compartments allow the cannula to move more smoothly under the skin. This technique allows for the use of much smaller cannulae – an important benefit, because when the tunnels mentioned above eventually collapse, ridges remain; and the bigger the cannula, the bigger and more noticeable the ridges. "It take a longer time to do the operation, but the results are much better than five years ago," says Dr Amorn.

Although they are rare, complications can occur. Risks increase when several areas are treated in one session and a large volume of fat is being removed, as the operation time is lengthened. Fat or blood clots can develop and block the lungs, leading to death; excesss fluid loss can lead to shock; and infection can occur. Surgeons will usually reduce the risk of complications by dividing surgery on multiple sites into several sessions.

Augmentation mammoplasty, a surgical procedure to enhance the size and shape of a woman’s breasts, is another popular procedure. The surgery is performed on women who believe their breasts are too small; to increase the size of the smaller breasts that follow pregnancy; to balance a difference in breast size; or to reconstruct a breast following surgical removal.

The two-hour procedure beings with an incision being made under the breast, around the areola, or in the armpit. The surgeon then lifts the breast tissue and skin to create space behind the breast tissue or under the pectoral muscle – placing them under the latter is believed by some to reduce the likelihood of the breasts hardening later on. The implants are then inserted. The surgery can be done using a general anaesthetic, or a local in conjunction with sedatives. Patients can head home immediately, or stay in hospital for one to two days if they prefer. Swelling can take up to five weeks to disappear.

Complications can occur. The most common problem is called capsular contracture. This occurs if the area around the implant tightens, and leads to the breast hardening. It can usually be rectified by further surgery. Excessive bleeding may occur; if it is severe, another operation may be required. Infection can also develop around an implant – most frequently within a week of surgery – requiring its removal (it can be reinserted later on). There may also be a change in nipple sensitivity, and occasionally implants break or leak. With saline implants, the salt water will be absorbed by the body with no side effects. With silicone, however, there may be further complications, with reports of silicone leading to "connective-tissue" disorders. However, no definitive link has been found. In the US, silicone implants are banned except on a case-by-case basis, but in Thailand, both types are available.