Kansai trip

Mention Osaka and most people think of Osaka Castle. For most of us, Kyoto means the UNESCO World Heritage Sites. Oh, and gracious geisha. But that's another story when we travel with kids.

This isn't to say I don't fancy those feudal castles and colourful shrines. Soon after my first few trips with my daughter (before the age of three), I simply discovered that there is no all-purpose definition of must-sees with children. It's worth taking a look at the Lonely Planet chapter, but a big part of getting the planning right is to keep the itinerary flexible.

When we travelled with Jasmine and her cousin to Osaka and Kyoto last week, we just made up our own version of holiday. The hotel in Osaka didn't take extra charge for kids sharing bed with us, and we're glad to know that. But then my daughter told us, upon arrival at the hotel, she wanted to create her own tatami (and there is another name for such arrangement: sleeping on the floor).

For most children (and, to be honest, for many adults), it's tempting to break the rules during holidays. The first rule, I'd say, is to withhold our judgements as long as we can - and then a little longer. For instance, when we went to the onsen in Kyoto, Jasmine asked to go to the men's baths (to make for a happier experience with her cousin).

If you love to travel with kids you can probably recall a time - plenty of times - when they come up with crazy new ideas. That's fine. One of the nicest things about travel is a break of the routine and letting the rules go out the window.

New Age

One of the thorniest questions that intrigued my daughter, when I borrowed the picture book Die neue Omi by Elisabeth Steinkellner, is the book's title.

My daughter didn't expect the title, which is translated as "my new grandma." That's a bit tricky - that grandma in her 80s is getting dementia. She forgets the way to take bath, not to mention the know-how of cooking. The theme is among a growing number of children books trying to guide the kids living with their forgetful grandparents.

My daughter will face an even greater grandparent gap, I was reminded by the Time magazine columnist Susanna Schrobsdorff. She was almost 39 when she had her child. Me too. If Schrobsdorff's daughter has a child at the same age, she'll be over 80 when that grandchild enters pre-kindergarten.

My unease doubled after I'd read the special health double issue of Time magazine. The baby in the recent magazine front cover was predicted to live to be 142 years old. That means our lives are getting longer. With that trend of longevity, alas, I'm going to live till 100.

Try as you might, it's very hard to take the news with aplomb. Even as we look forward to more years ahead, the idea of becoming a centenarian is not as funny as we might wish. At least three things dwindle as our body ages: our wallet, hard disc memory space, and muscle mass.

Think of the pectoral muscles that are going to sink with age. Gosh. I was also told that men tend to be less flexible and carry more abdominal weight (which can strain the lower back). The new age is worth preparation. And prepare I did, doing push-up and superman exercise every night since this week.

Cinderella

What do we mean when we call something a "Cinderella story"?

The short answer is a metaphorical expression of rags-to-riches, especially if there is an against-the-odds miracle - but there are plenty variants (as I recently learned from a blog). Origins of Cinderella go all the way back to 1967 (French version) and as early as the 9th century (Chinese version). For now, a Cinderella story refers to a good thing happening to someone nice, concludes the blogger.

Here, then, is my definition of the fairy Cinderella story: Have courage, and be kind.

For those of you who have watched (and go if you haven't) Disney's new live-action Cinderella movie (I went with Jasmine two weeks ago), you should remember this great secret. A secret taught by the mom of Ella, the main character in the movie: "Have courage and be kind, that will see you through all trials life has to offer."

And thanks to this movie directed by Kenneth Branagh, Ella jump-starts my daughter's cinema experience. That's her first time in the cinema. She had enjoyed the pumpkin carriage journey with Ella. Obviously I'm happy that my daughter remembers the lesson to have courage and be kind.

We watched the second movie two days ago. Not a Disney movie this time. No fairy or godmother there, and no magic spell to turn a pumpkin into a magnificent carriage. A local movie titled Little Big Master, based on a true story of an inspirational teacher (think Robin Williams in Dead Poets Society) who takes up the job of a village school principal-cum-janitor. Alas, with merely five students and on a salary of HK$4,500 a month. Dicey though it may be, the village school principal didn't cut back on how much she loves the kids; she cut their school fee instead.

There's no medium like this movie to let us know the pleasure of teaching, and the exemplary way to have courage and be kind.

Pharmacy

When I was asked to teach pharmacy students in the medical ward this weekend, I took them to see patients and talked about the way we used drugs. So we started looking at the drug chart of one patient after another. It wasn't surprising that the vast majority of us teach in this way.

A medley of case examples, in essence.

The method notwithstanding, seeing a few cases can be misleading. The plural of anecdote, as many scientists can tell us, is not data. An anecdote is something that happened to my current patient, or any patient I could remember. Alas, it's more often an outlier than not.

That's where statistics comes in.

After talking for more than an hour, I moved to stories with more patients. Those are the stories of many many patients, instead of an anecdote. I digressed and talked about how we discovered new drugs or devices that often fall short of the oh-so-wonderful promise: the oral direct renin inhibitor aliskiren and renal denervation (that had once been thought to be a breakthrough for treating people with stubbornly high blood pressure) are two "good" examples that didn't work out.

Now, move on to name those old-fashioned drugs that were dug out of the cobweb closet, but with new purpose. Think spironolactone, thalidomide, colchicine and pentoxifyline. The ideas range from a new indication of treating blood cancer by a banned pill for morning sickness to, as if by magic, using colchicine (an ancient drug known to curb joint inflammation) to damp down inflammation of a sac surrounding a sick heart. And the list goes on. They all work wonder for new indication!

It's a testament to the mantra why we need old friends.

Rock or Scissors

Not every child is interested in the game of Simon Says or Duck Duck Goose, headstand or cartwheel, hopscotch or thumb war. But nearly every child is born with a preference to play rock-paper-scissors.

A typical kindergarten kid should be able to follow the simple rules of "rock crutches scissors, scissors cut paper, paper covers rock." Of course, when your kid is small, be sure she has enough chances to win. Wait until she's mastered the game (and you have congratulated her) before giving her the chance to be a loser. Chances are your toddler will throw a tantrum when you beat her for more than three consecutive games. Hey, let's face it, that's an important lesson for the children to learn. Put on a happy face, but don't laugh at her.

And there is so much to observe how your kids play the game rock-paper-scissors. Now, if you have little kids, you already know that there are times they'd rather win the rock-paper-scissor game than a lottery. Even if we don't teach them the tricks to win - and generally, we don't - they made up their own strategies to beat you. I still remember Jasmine giving me "hint" to choose scissors (so that she can play rock on the next throw) when she was four-year-old.

Playing the game fairly isn't always easy. But understanding the reasoning to outsmart the opponent is what I keep to myself. I learn a few tricks to gain the upper hand. First of all, the throws are not equally common; scissors is the least popular choice, and men favor rock. Another pattern is the stereotype of loser; a player who loses is more likely to switch to a different throw the next time. Many of them even unconciously "copy" the sign that just beat them. The third trick is trash talk; announce what sign you're going to throw, and then do exactly what you said. Most players would have thought otherwise.

But I just keep my mouth shut. Teaching my five-year-old daughter these tricks simply makes me feel bad. The little voice in the back of my head reminds me how it sounds like passing on the hacking software to crack passwords.

Load

Carrying a heavy backpack is very much like yoga. It can - and, in fact, it is supposed to - give you shoulder ache unless you have the know-how to gain control of your mind and body.

My backpack was pretty overloaded today. That's my daughter's school field trip, and I went too. I brought with me the camera, a box of puzzle game, a picture book about all of our 206 bones (and about 450 bones for babies, in case you don't know), four story books from Biff, Chip and Kipper series. My daughter carried her own camera, lunch box (for my lunch, too) and water bottle. Okay. That's not all. We had colour pencils, sketch book and so forth.

We just knew that the backpack is for fun, and we felt okay with each of our backpacks. None of us thought too much about the weight of our backpacks.

I'm a firm believer in Lena Horne's dictum "It's not the load that breaks you down, it's the way you carry it."

On the way back from the field trip, one of the boys in my group told me his backpack was way too heavy. As a parent volunteer, I should help him.

"I can see that your backpack is huge. Let's see - okay, do you want me to help you?" I asked.

The boy nodded.

I thought I should carry his backpack. But this is not exactly what happened. Or at any rate, this is not what I expected. My daughter came up and volunteered to carry the backpack for her classmate. We both smiled, put on the backpacks, and off we went. It was hard to say who was prouder, daughter or father.

Bully

Bullying is common.

I knew bully guys existed. I had heard about their dirty tricks from my school peers, I had to run away from them in the playground when I was young - if only I could know how to kill them when they bullied my younger sister.

It just happen. Everywhere. School peers, siblings, athletic coaches, doctors and even consultants. I've met them all. And yes, that's terrible.

Will bullying shape our health? Yes, even in monozygotic identical twins, according to a large study of these pairs who have, by definition, the same DNA.

To prove that upbringing and victim experience by bullying make a difference, the researchers identified 28 pairs of twins from the age of five. These twins were not easy to find. Some of them were separated into different classrooms, and the recruited twin pairs had to have one of them being bullied whereas the co-twin never experienced bullying victimization. In other words, they shared the same DNA but the bullying experience diverged.

The researchers invited these twins into the laboratory at the age of 12, and tested each child's buccal cells' DNA for methylation. They also collected each twin’s saliva to measure the cortisol level when subjected to situational testing. The test included public speaking and mental arithmetic competition; they were told they were in competition against their co-twin in order to get a prize.

How did the twins’ results compare?

It turned out that these genetically identical twins had surprisingly different results. Those who had a history of being bullied had a much higher DNA methylation and much lower cortisol response. Presumably, the bullied kids were surviving through an adaptive epigenetic mechanism. That means the kids tune down a serotonin transporter gene called SERT by more DNA methylation, and thus less protein that can be made to move the neurotransmitter serotonin into neurons. The more SERT gene is turned off, the more blunted the cortisol response.

Cortisol is a stress hormone that will surge during crisis. High levels of cortisol, in turn, can throw our immune system - something that keep us from bacteria and virus - out of whack.

Doesn't it make sense? The twin being bullied day after day would then cope better by avoiding the stress hormone storm.

If you take a deep breath and a step back, I think you'll agree with me that, in a way, the bullied twins learned their survival skill in a hard way but successfully. The rest of us have learned likewise.

Now, you might think that adding bullying to the equation would result in a tough and resilient kid. If only life were so simple. Before you pray for similar bullying exposure for your children to turn off the cortisol response, just a quick reminder that blunted cortisol response in long run can cause serious problems such as depression, and this can pass from one generation to the next.