Dropping off plus Burma

It's happening again - I have trouble staying awake during class. It has been severe enough that other people are noticing. This week, it has happened in two sessions. It occurred when the Early Psychosis Team was having a meeting discussing patients and another during a clinic, which was embarrassing since the patient noticed and complained to the doctor afterwards.

I get enough sleep last night, about eight hours, and the sleep was good, with no dreaming - that's not the problem. I have hypothesized three theories as to why this is happening. Firstly since I have gained weight and my neck has disappeared, allowing my head to merge with the rest of my body, I might have developed obstructive sleep apnoea leading to non-restful sleep. Secondly the last time I was on my current medication (escitalopram) I had the same problem of daytime drowsiness/somnolence (sleepiness to the non-medical). Lastly I have problems maintaining my concentration and I switch off easily, leading me to go into a slumber.

I'll address this issue with my psychiatrist at my next appointment. Hopefully we can sort this problem out. I know that some patients with depressive disorders are prescribed amphetamines to perk them up...

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The latest scenes from Burma are shocking but not really surprising. You wouldn't expect the military rulers to yield their power so easily, especially to some orange-clad monks. It doesn't surprise me that they are using brute force to achieve control, since they have being doing that for forty years.

As I see it, there are only two ways for Burma to achieve the democracy it so desires.

1. The citizens of Burma rise up and overthrow the junta. They tried it in 1988 democratically but it didn't work. Yet this time it might work. A great deal of people will die during the revoltion but the sacrifice would be worth it.
2. The governments of the world apply a lot of pressure to Burma. I don't just mean a few sanctions here and there. It would take total isolation of Burma to make the dictators realize they might need to yield some power. This solution is more peaceful but less likely. USA and UK have too much on their plate with Iraq and Afghanistan and they are too chicken to do anything. China do not want to ruin the economic ties it has with Burma.

I know countries do not want to interfere with other countries' internal politics and doing so doesn't mean good results (look at Iraq). Yet I know there are times this might be warranted, when the country is so poorly run and there is oppression of the citizens whilst the rulers live in luxury.

Back to school

On Saturday myself and another Old Brightonian Mary had dim sum with my old housemaster Anthony Whitestone. Mr. Whitestone (I still cannot believe I will continue address him as 'mister') had recently retired after many, many years teaching French & German at bRighton College and just so happened to be in Hong Kong on holiday. It was fantastic recollecting the days back in Chichester House and seeing how Brighton College has progressed and changed since I left. Both Mary and I have fond memories of Brighton College, enjoying our time there.

I know some people wouldn't say the same things about their secondary/high school. Mary didn't like the two previous boarding schools she went to and others don't talk about their past school experiences quite as fondly as I would. I think they are totally justified to say that their school life was crap but there must have been some good experiences - making friends of schoolmates or even teachers, sports events or boarding house experiences. I can honestly say not all of my experiences of Brighton Collge were good. My depression started during my Sixth Form years and I remember the day when I got the final letter I got rejected by all the medical schools I applied for. People say university is the best years of your life but so far it has been a negative experience for me, since my depression has progressed and having to stay four more years. That is not to say there have been good moments, making some good friends.

People fail to realize your school and university years are a defining part of you. One cannot erase the memories or events that have occurred but use them in later life for better or worse.

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I'm glad one of my favourite shows "QI" (AKA Quite Interesting) is back on television. I used part of my weekend downloading nad watching the first two episodes. I might agree with some fans the quality of the show may have dipped slightly but it is still better than most television shows around. It has a dedicated following even in the United States, despite not being shown there (one must love the power of the Internet). Added to that they have joined the bandwagon and now have a vodcast. If you want to watch it, just search "QI Quickies" on Youtube.

A good week in football

I don't expect many people to be interested in this blog entry, since it concerns football and my beloved team Arsenal. So if you happen to have no testosterone flowing through your body, feel free to turn over to another channel.

It has been a good week for me in football. Arsenal, despite selling senior players such as Freddie Ljungberg and especially Thierry Henry, were expected to struggle with a group of youngsters in their team. Yet they have confound all football pundits by playing exciting football and reaching the summit of the Barclays Premier League. They also had a great start in the UEFA Champions' League by thrashing major rivals Sevilla 3-0.

Many football pundits have been commenting on the significance of the sale of Henry on Arsenal's current performance. I think they are right in saying that the pressure has gone from the Arsenal team. They relied a bit too much on Henry. Without the great footballer, the young players can show they are not a one-man team. The likes of Adebayor and Fabregas can play as they wish without having to fit another superstar into their game plan.

After the 3-0 win on Wednesday night, I thought things couldn't get better but they could. Jose Mourinho left Chelsea, either walking out or being sacked. Either way, Chelsea are in a team in turmoil - their trusted and successful manager has gone and they are playing like old grannies. I think they are effectively out of the title race, especially since their next game is against the resurgent Manchester United.

Arsenal have a relatively easier game against bottom club Derby County. I would love for Arsene Wenger to rest a few players and try some youngsters, something along the lines like this:

Almunia
Hoyte
Toure
Senderos (Song if still unfit)
Clichy
Bendtner
Fabregas
Flamini
Walcott
Van Persie
Eduardo

I know Arsenal won't be able to thrash Derby County that much (not on the par of 6-0 ala Liverpool) but I do expect them to win comfortably.

Speaking truthfully

I was just reading in the South China Morning Post here in Hong Kong that many of the world's language are in danger of extinction. Of the 7000 languages, many whom don't have a written form or dictionary and where one in Northern Australia only has one speaker left, about half will disappear soon for various reasons, including the death of the only speakers, the lack of recordings or documentation and the domination of other languages.

I found it ironic that the languages that are retained are spoken badly. Here in Hong Kong, many of the youth cannot speak Cantonese fluently. Rather they don't use Cantonese predominantly, inserting (very bad) English into their daily lives. Even my mother, who was raised in a predominantly Cantonese-speaking background, has trouble writing some Chinese characters. Isn't any wonder that with this amount disrespect for even your own language that languages over the world are dying out.

Even the proper use of English is a dying trend. With the increase use of text messaging on mobile phones and online chatting, there has been a tendency to use abbreviations of common words, such as "tomorrow" (tmr) and "your" (ur). I don't mind using this when you're text messaging or online chatting, when time is of the essence, but when you're are using this kind of language in wall postings or emails, I think I draw the line. When most of us are proficient enough to touch type, I don't think you're wasting much seconds if you can type out the whole word.

So why am I complaining? It doesn't matter what language you use as long as your are communicating your message but I would think people like Shakespeare would be turning in their grave if they knew what we were doing with the language they brilliant used. At times I struggle to understand some acronyms people make up and the bad English some of my peers use. I also struggle to interpret some abbreviations.

I'm not asking people to use the word "floccinaucinihilipilification" or "pseudopseudohypoparathyroidism" but don't use "lol" in spoken conversation (it has happened before).

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During psychiatry I have been relieved to learn one of the long-term side effects of antidepressants is weight gain. At least this fact can account for the enormous hump I see when I look down.

Growing up

In the local Hong Kong newspaper, the local universities are considering making medicine a post-graduate degree. You would get more mature doctors but the scheme would be more expensive. A number of young doctors have complained that they are already mature enough and they shouldn't mistake age for maturity.

I would support the idea making medicine a post-graduate degree. Some people will be more mature for their age but this has come through life events. There is no substitute for experience and this breeds maturity. I look at my class peers and I see a lot of them are totally immature. They don't treat patients with the respect they deserve and I don't think many make the right decisions. Their attitude and behaviour, on and off the wards, are not what I call mature. That is the reason I don't like allowing students to enter early into medicine.

At least making medicine a post-graduate degree would allow young adults to decide at a later age whether or not to study medicine. I find a few of my peers regret entering medicine. If you made medicine a post-graduate degree, maybe they could study something that interests them before deciding whether or not to become a doctor. I find it quite unbelievable young people have to make life decision in their teens. We have to choose which GCSEs we have to take, which affects what A-levels we take, which decides what degree we can study, which affects what job we can get.

When we have such a long life in front of us and our decision making abilities don't mature until we're about twenty five years old, why can't we enjoy our youth and study something we're interested in?

Reversal of state

For those who read my blog at the original site, you may have noticed that I have changed the parameters around, utilizing the full space. It looks better on a 1024x768 resolution. For those using an 800x600 resolution, sorry.

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When I enter a depressed mood, it is difficult to implement all the psychological techniques I have taught by my psychiatrist. I have been in therapy for nearly five years and have been given various methods to try to help reverse my depressed mood. THe most obvious method is not to think so negatively but to analyze the situation in a positive manner: "It is so good that you have come this far, not a lot of people can do this." Another method is to take a third person approach and analyze the predicament in an objective manner: "It is natural that the teacher only marked you as 'fair' instead of 'good' since you haven't been turning up for classes. It is something you can improve upon." Relaxation techniques have also been mentioned, trying to remember that I am in control and not my depression.

So why do I keep getting depressed moods despite being taught these methods? Why do depressives or any other psychiatric patients keep relapsing into their conditions? I think the phrase "easy to say but hard to do" comes to mind. Once I enter the pathological state, reverting back to the normal state is not so easy. Once you are in that state of mind you keep thinking negatively or bizarrely. You quickly become neurotic/psychotic and that is why you need outside help, just to remind you you're not useless or you're not crazy & think that the teachers want to kick you out of school.

I think this is the aspect what most people don't understand about psychiatric diseases. Although most people can reverse their sadness or paranoia quite easily, once a patient goes into those modes it is difficult to reverse and may require help from other people.

The beginning of a downward spiral

When I first started out this blog, my intention was to give an insight to how somebody with depression lives. Up till now I haven't had a true depressive episode which I could write about... until now.

The signs were there for quite a while. I had been having poor concentration and motivation to study when my current psychiatry clerkship started about two weeks ago. I have also started to become slightly paranoid at how one of my teachers has treated me. I don't if it is because I missed a day of teaching because I had the flu or that she knows I have failed miserably before and have depression and just wants me kicked out of medical school. She just seems to treat me differently from everybody else in the group. Seeing my friends again hasn't helped either. I like seeing my friends but when it comes down to what we have been doing, this is when I get depressed. They have amusing tales of what has happened at work, which friends are getting married, what interesting patients they have seen and where they have been on the holidays. And what do I bring to the table? Absolutely nothing. I try not to become aware of this but it just depresses me so much that I don't want to see my friends.

This has culminated in an awkward experience today which I rather not talk about (since my mother actually does read this blog) but has lead me to bring my psychiatrist appointment early. I know if I don't see anybody soon, it would all spiral downwards and in two weeks time I would seriously considering how to jump off a tall building without a parachute. People think it is easy to apply the brakes at this juncture but it is not, especially when you have this mode of thinking.

Beehives and crew cuts

It's a funny thing about people and haircuts. People are willing to go to different doctors for even the same trivial disease such as an upset stomach or flu and have their financial assets managed by different institutions and banking services but with their hair (most markedly in guys) they are only willing to allow their one and only trusted barber/hairdresser/hairstylist to cut their hair. I think it boils down to appearance and 'giving face'. If you get a crummy haircut or hairstyle, it is noticeable and permanent (at least for a few months), which can cause aggravation and much ridicule from peers, friends and family. You want hair to be managed by someone who at least won't turn treat it like a hedge and create something extravagant and a bit too eye-catching for you taste.

That is why I am always a customer of my current hairdresser, which has earned me another type of ridicule from my parents. Why continue to be a patron of his business, now that he has moved out of the Chinese University of Hong Kong to Tai Wai? I know he is now more expensive (from HK$60 to HK$120) but he is more convenient - he's just next to the KCR station whilst in CUHK, I would have to catch a bus up to the barber shop. Actually the service is much better now, with better shampooing and personal service (I cannot believe, as a straight guy, I'm writing about this kind of stuff). Yet the main reason while I still continue to see my hairdresser for a haircut, apart from the fact that he does my hair the way I like it, is the conversation. Like me, he is an Arsenal supporter and not just one who trivially looks at the results & emerges whenever we lift a trophy. He knows some of the youth players, stays up at night to watch the games (which is better than me) and can discuss tactics with me. It is difficult to find that level of conversation in some people. He also asks me how I'm doing, which is nice. It is just nice to talk somebody who has a rounded personality and is not totally focussed on medicine.

I like my hairstyle nice and simple. I ask my hairdresser to cut my hair as short as possible without me looking like some punk. After about two months it becomes too long and I have to go back to my hairdresser again. It looks fine and I'm happy with that. Other people, and especially in Hong Kong, seem to have very different hairstyles which I don't find attractive. There are guys and girls who seem to have a hairstyle where it looks like they have just woken up but they have paid a stylist HK$500 to intentionally mess it up. I have seen women who have that intentional hump in the middle of the hair. I know it supposes to be fashion but from my own perspective, I don't like it. I don't know about other guys but I still prefer ladies to have hairstyles that are plain and simple. I prefer ladies with shoulder length hair (nothing too long), with a bob (like Teri Hatcher as Lois Lane in "The Adventures of Lois and Clark" or Julia Stiles in "The Bourne Ultimatum") or in a ponytail.

I think the worst hairstyle for a lady is to have it short like a guy and I would say the opposite for a guy, to have it long like a lady. I'm a traditionalist when it comes to hair for the sexes. Yet I have always wondered why gals have to have their hair long and guys short. I remember reading from somewhere that in prehistoric times women with long hair would be easier to catch by men, acting something like a handle.

I know I would prefer to keep my hair short. It is much easier to handle - it requires less shampoo and I don't have to comb or gel my hair in the morning.

Transfer review

One of the worse aspects of being in the health care profession is the chronic exposure to infections. So what happens when I come back from a two week break? I get the flu. Naturally my parents say I get the flu because I don't exercise enough and I have an imbalanced diet of not enough fruit and vegetables. I think they have a point but I also think that being a medical student you will naturally contract infections due to your frequent hospital visits.

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August 31st was a great day for all football fans, being deadline days for transfers. Barring signing free agents or loaning out players to clubs in the lesser divisions, the roster will be set until next year with no further additions. I rather like the transfer windows as it bottles all the excitement into a small time frame. I know that managers hate the concept of certain periods where you can buy and sell players but it hasn't caused any problems.

So how did each Premier League club in their dealings? In this blog entry I will review each club's transfer activity. So if you're not interested in football (i.e. you're gay or a woman), you might want to turn away now.

Arsenal

I was rather disappointed with my club's transfers. Naturally losing two influential, experienced and high-scoring players in Theirry Henry and Freddie Ljungberg was devastating but Wenger didn't properly replace them, only bringing in Eduardo da Silva. Arsenal didn't need Diarra or Sagna. What I would have like bought in was a scoring midfielder, since that department seems deficient in Arsenal. If Hleb, Rosicky or Fabregas don't score from midfield, who will?

Aston Villa

O'Neill has silently built his squad up but I'm sure he had difficulty attracting players. He still hasn't found the right back he required, playing Craig Gardner and Olof Mellberg in that position, whilst Liam Rosenior and Glen Johnson were available. Seven first team players were swept out, notably Steven Davis but he has improved on the quality by bringing in Scott Carson, Curtis Davies, Zat Knight, Nigel Reo-Coker and Marlon Harewood. O'Neill still doesn't have all the players he requires but he's getting there. Aston Villa fans have to be patient.

Birmingham City

Steve Bruce has opted for quantity and not quality. His squad was threadbare in the summer but with the introduction of four loan signings plus seven permanent deals he managed to bring up the numbers. Whether or not that will sustain his side in the top division remains to be seen. From the new players, only Oliver Kapo seems likely to make an impact, although Stuart Parnaby and Franck Queudrue will help bolster the back line.

Blackburn Rovers

A rather quiet transfer window for the Rovers but did add Roque Santa Cruz, which should be an excellent addition to the squad. Like Aston Villa, they did have difficulty finding a right back but seem to be happy with Brett Emerton fulfilling the role for the time being. Probably they were more glad to keep all the core players, with Bentley, Pedersen and McCarthy all rumoured to leave.

Bolton Wanderers

New manager and new players were the norm at the Reebook stadium, with thirteen players coming in. However it does not seem that they are gelling together plus the rumours of star players leaving the club has rocked the stability of the team. Anelka has stayed but Faye has left. What I figure to be Bolton's problem is they are playing too centralized in their 4-3-3 formation. They are not using their wide players quite literally, with Braaten and Wilhelmsson hardly featuring at all. Sammy Lee has to turn things around soon, otherwise he will be the next person through the door.

Chelsea

If one team has fulfilled their transfer criteria, it is most likely Mourinho's men and on the cheap as well. They reduced their central midfield quota with Diarra and Geremi going, whilst the incompetent Boulahrouz has gone out on loan and Johnson has been sold to Portsmouth. The one player they are going to miss is Robben but with Malouda coming in as a direct replacement, the grieving period will be brief. I still question Sidwell's move to Chelsea (probably for the money) but bringing in Pizarro, Alex, Ben Haim and Belletti has made sure that Chelsea are equipped in all departments. Now it is just a matter of getting the best out of Shevchenko...

Derby County

Billy Davies' men were always going to struggle, whoever they brought in. Thankfully they bolstered the one area they needed - the forwards - with Robbie Earnshaw and Kenny Miller coming in, to help out Howard. Other than that, bringing in Todd and Davis helps bring experience to the back line whilst Eddie Lewis will finally get the chance to prove himself at the top flight.

Everton

Moyes pulled off a big coop but getting Yakubu to sign for the Toffeemen and now has the perfect partner for Johnson. Other good additions include Jaglieka and Baines but he still could have done with Nugent in his line up. Unlike Bolton, Everton seem to do well without playing any really wingers, with Arteta and Osman filling out the wide roles. Moyes will hope this tactic will continue to bring in the points, otherwise the lack of wingers is noticeable within the squad.

Fulham

Probably the busiest team in the transfer market, even right up to the end, Sanchez has brought in bringing in about ten players but also letting quite a few go. Notably Rosenior, Knight, Queudrue and Bouba Diop has gone but Baird, Hughes, Stefanovic, Konchesky, Seol, Davis, Murphy, Cook, Bouazza and Kamara have come in. After spending all that money, the pressure will be on the former NI manager to start producing the goods.

Liverpool

Along with Manchester United, Liverpool have brought in the most exciting players during the transfer window. Torres, Babel and Benayoun will definitely make an impact. They didn't lose any key players so expect Liverpool to challenge and probably win the title this season.

Manchester City

With Shinawatra's (corrupt?) money, Eriksson has been making headways in the transfer market with buys nobody knows. A lot of dead wood in the likes of Corradi, Dickov, Trabelsi and Sinclair has been casted whilst wantaways Barton and Distin have found other Premier League clubs willing to pay them bucket loads. Bojinov and Bianchi have been added to a floudering forward line up whilst exciting players in the form of Geovanni and Elano flourishing in the midfield. Corluka and Garrido has added stability in the defence. So far Eriksson hasn't done so badly but remember this is a marathon and not a sprint.

Manchester United

You probably wouldn't have expect Manchester United to need another forward at this stage of the season, with Nani and Anderson being added to already an abundance of wealth. With Smith and Rossi leaving, Solskjaer retiring plus Rooney and Saha permanently injured, it leaves Tevez as the only capable forward leading the line. Ferguson will hope Rooney will recover soon. Richardson and Heinze leaving won't be too much of an impact but Hargreaves finally joining after a prolonged transfer saga will help bolster the midfield, which didn't require bolstering in the first place.

Middlesborough

Losing Yakubu and Viduka would have upset Gareth Southgate's plans but he did bring in good replacements in the form of Mido, Aliadere and Tuncay. Southgate finally filled up the right side of his team with Gary O'Neil and Luke Young, finally bringing some balance to his squad.

Newcastle United

Sam Allardyce wheeling and dealing has brought the type of players the Magpies needed. Beye, Rozenhal, Capaca, Faye and Jose Enrique will help stop the goals leaking in, whilst Barton will add some steel to the midfield. Viduka and Smith bring quality to an already good strikeforce. Now the hard part of Allardyce's job has begun - winning trophies.

Portsmouth

With Russian money, Redknapp has sufficiently added to his squad. Nugent and Utaka have been good additions but Redknapp wanted Yakubu or Anelka. Adding Johnson, Distin, Hreidarsson, Muntari, Mvuemba and Bouba Diop will add quality to the squad, so like several managers with new money, he will have to bring in good performances.

Reading

Like Blackburn, a rather quiet transfer window although they didn't have to add much to their squad. Losing Sidwell and Seol was a big blow but have sufficiently replaced him with Fae, Rosenior and Cisse. Rather worryingly they have an abundance of options at centre-back which Coppell hasn't gotten rid of.

Sunderland

Surprisingly Roy Keane hasn't been raiding his old club Manchester United with loan deals of youngster but has bought in old boys Richardson and Higginbotham. He has been making his own way in the transfer market by bringing in Gordon, McShane, Halford, Anderson, Harte, Chopra and Jones but whether or not they have the quality to stay up is different. Probably the most important players will be Gordon and Chopra.

Tottenham Hotspurs

Bringing in Darren Bent when they already had three good strikers seems an abundance of riches they did not need and by early results it seems so. Probably they would have better spent the money by reinforcing the left hand side of the team, which they did with Gareth Bale but still require a left winger. Some excess weight has been shedded, in the form of Murphy, Mido and Ziegler but they not going to cry over those losses.

West Ham United

Alan Curbishley has been acting like a kid with a blank cheque at a toy store, bringing in players left right and centre. Ljungberg, Solano, Faubert, Parker, Camara and Bellamy have been added but have been balanced by the loss of Tevez, Harewood, Konchesky, Benayoun and Reo-Coker. Again with buying players brings more pressure on the job.

Wigan Athletic

Bringing in Titus Bramble seemed a large gamble but Wigan are in the top half of the table, so far it is paying off. The most notable addition is Sibierski and Koumas who have been contributing to Wigan's climb up the table. However they are still my favourites to be relegated this season.