April 2009 General Conference: Our Father’s Plan—Big Enough for All His Children

Elder Quentin L. Cook of the Quorum of the Twelve Apostles teaches in his conference address that even though our journey may be fraught with tribulation, the destination is truly glorious.
The doctrine of most churches is at odds with revealed truth, and this makes it difficult for some to accept. This should not come as a surprise.

My principal concern is for the honorable people on the earth who are open to religious faith but have been discouraged or confused by incorrect doctrine. For instance, with respect to the doctrine that revelation still exists, some very good people have been confident that the Church could not be true because they have been taught, and therefore believe, that the heavens are closed and there will be no additional revelation, no scripture, and no pronouncements from heaven. Let me emphasize that this widely held belief is not scriptural, but it is a stumbling block to some.

In Joseph Smith´s time, the vast majority of churches taught that the Savior’s Atonement would not bring about the salvation of most of mankind. The common precept was that a few would be saved and the overwhelming majority would be doomed to endless tortures of the most awful and unspeakable intensity. The doctrine revealed to the Prophet Joseph a plan of salvation that is applicable to all, including those who do not hear of Christ in this life, children who die before the age of accountability, and those who have no understanding.
At death, righteous spirits live in a temporary state called paradise. Alma the Younger teaches us that paradise is ¨a state of rest, a state of peace, where the righteous shall rest from all their troubles and from all care, and sorrow.”
The unrighteous spirits dwell in spirit prison. It is described as an awful place, a dark place where those fearful of the “indignation of the wrath of God” shall remain until the resurrection.
Because of the Atonement of Jesus Christ, all spirits blessed by birth will ultimately be resurrected, spirit and body reunited, and inherit kingdoms of glory that are superior to our existence here on earth.
At the resurrection, the spirit prison or hell will deliver up its captive spirits. Jesus came into the world “to be crucified for the world, and to bear the sins of the world, and to sanctify the world, and to cleanse it from all unrighteousness.”

The Savior said, “Let not your heart be troubled. . . . In my Father’s house are many mansions. . . . I go to prepare a place for you.” A succinct summary is provided in the book of Moses: “For behold, this is my work and my glory—to bring to pass the immortality and eternal life of man.”

A loving Father has provided a comprehensive and compassionate plan for His children “that saves the living, redeems the dead, rescues the damned, and glorifies all who repent¨. Even though our journey may be fraught with tribulation, the destination is truly glorious.

April 2009 General Conference: Learning the Lessons of the Past

Covering a topic that has been rehashed so many times before, Elder M. Russell Ballard of the Quorum of the Twelve Apostles makes the topic ring with new vitality as he reminds us in his conference address that we live in perilous times. He quotes the aphorism, ¨Those who do not remember the past are doomed to repeat it.”

He refers to a number of examples of cyclical behavior, from scriptural accounts in particular. There is a consistent theme of blessing and prosperity, then reoccurring periods of apostasy and spiritual darkness, followed by repentance and restoration of the Lord´s grace and blessings.

Our Heavenly Father loves all of His children, and He wants them all to have the blessings of the gospel in their lives. Spiritual light is not lost because God turns His back on His children. Rather, spiritual darkness results when His children turn their collective backs on Him. It is a natural consequence of bad choices made by individuals, communities, countries, and entire civilizations. This has been proven again and again throughout the course of time.

One of the most important lessons we learn from this is that actions do have consequences, for good or bad, individually and collectively. We learn to avoid the mistakes of the past by studying the lessons of history and culture. Herein lies the accumulated wisdom of past generations. Through their learning we can leverage and avoid some of the pitfalls of these perilous times.

We live in an era when the boundaries of good taste and public decency are being pushed to the point where there are no boundaries at all. The commandments of God have taken a beating in the vacillating marketplace of ideas that absolutely rejects the notion of right and wrong. Certain factions of society seem generally mistrustful of anyone who chooses to live according to religious belief. And when people of faith attempt to warn others of the possible consequences of their sinful choices, they are scoffed at and ridiculed, and their most sacred rites and cherished values are publicly mocked.

Elder Ballard counsels for each of us to strive to gain a faith and testimony of our own. His advice is that testimony is built the same way it has always been, and there are no technological shortcuts, despite all the gadgets that have proliferated these days.

And how do you get such a testimony? Well, there’s no new technology for that, nor will there ever be. You cannot do a Google search to gain a testimony. You can’t text message faith. You gain a vibrant, life-changing testimony today the same way it has always been done. The process hasn’t been changed. It comes through desire, study, prayer, obedience, and service. That is why the teachings of prophets and apostles, past and present, are as relevant to your life today as they ever have been.

Utah Places: South Slope of the Uinta

Everything unique and beautiful about Ashley National Forest is characterized by this blossom. Though Sego Lillies (Chalocortus nutallii) are found throughout the west, Utah claims this one as the state flower, and for good reason. A thing of beauty and the greatest practical utility, these flowers dot the ground in season in the middle elevations. I look for them to be heaviest in sparsely covered grasslands and sagebrush areas.

Where the Sego blooms in great profusion, there look for the freedom of the hills. That ever-elusive quality may be hard to find and difficult to keep, but it is always worth finding.

Million Dollar Baby

I watched this film today and it left disturbing questions unanswered.

The film is about the humane touch of boxing in the midst of blood and brutality. Morgan Freeman plays a part in the film, and sometimes narrates in the background, as if telling the story through recollections of the past. Ultimately, the plot comes down to euthanasia. Clint Eastwood finally decides that life on a respirator is not what his star boxer would want, and he pulls the plug on her, and she dies. End of story.

Very sad.

Very real scenario for me to face personally.

What is the worth of a life that is artificially supported? I have already asked myself that question, many times. What you decide is up to you. But it may be something any of us could face, any day. Impossible to predict.


What protection do we have against being held captive against our own wishes by medical technology?

On the one hand, there are artificial breathing apparatus, intubation devices, so-called heroic measures.

And on the other, there are living wills, DNR orders, and bureaucratic measures.

Nothing is certain...

Rehab progress 32

What is commonplace about establishing a routine when nothing is routine? I find myself struggling in another round of rehabilitation effort, which is discouraging. To keep starting over again at a point I have surpassed before makes it all seem somewhat futile. Imagine learning the alphabet again and again, only to forget and be forced to start training over again at some fundamental that you know very well was easily surpassed in previous performances.

But I can´t know that. If I had spent the time idly laying around, I have no idea what level of performance my mental or physical state would be, to say nothing of other considerations. Exertion is good for the soul, if no other benefits accrue. I suppose that must be as true in my case as it is for any other. I hold myself as unremarkable in every respect.

This week in PT sessions, I am working to maintain the half-mile in ten minute pace on the treadmill and 2 miles in ten minutes on the stationary bike. That is about the same level I could reach last March and September. Setbacks have pushed me back, but I am determined that keeping on is the only course for me. I will not quit. Ultimately I want to set the pace to cover 3 miles in 40 minutes on the treadmill, which is where I was last July and October. I´ll keep at it.

The norm for me seems to be to have another brain attack every six to twelve weeks. They vary in severity. Clearly, I will keep having them, unless something changes in the conditions that are causing them. And that is not likely. The real questions I am left with: Exactly when the next will occur, and how severe will it be? It seems only time -- and heaven -- can answer.

Toxic Shock?

Toxic Shock Syndrome.... as well as other kinds of horrific shock!

Darrin proceeded to collapse after the grad ceremony, and has been in the hospital since he had a black-out episode at home, shortly thereafter.

He has a skin rash and fever, but the doctors were not too certain what to make of it. The initial diagnosis was scarlatina, which generally responds pretty well to certain antibiotic treatments. Becky suggests that it sounds more like toxic shock symptoms. Apparently, either type more or less directly results from some kind of systemic strep or staph bacterial infection. The specific treatment may depend on how testing shows that cultures respond to specific anibiotoics. As the case may be, I´m certain his attending knows more than I do about what Darrin might be suffering from.

Anyway, after initial stabilization, they tranferred him from Castle Valley in Price to Utah Valley in Provo. He has a medical team of doctors and nurses in attendance, and if they should miss a beat, Ruth is there to catch them. Castle Valley is an adequate facility, but the resources are limited there. UVRMC is a better place for critical care, and the staff will be sure that Darrin gets the care he needs now.

Our most fervent prayers and best wishes to Darrin and family. I am sorrowful when I know that any suffer, and I know this is a trying time for them.

Darrin,

Please get well soon, and recover fully. Your family needs you, here and now, all of us.

Physiology 101

In physiology, medicine, and anatomy, muscle tone (aka residual muscle tension or tonus) is the continuous and passive partial contraction of the muscles. It helps maintain posture, and it declines during REM sleep. It is not to be confused with the concept of toning in physical exercise.
Unconscious nerve impulses maintain the muscles in a partially contracted state. If a sudden pull or stretch occurs, the body responds by automatically increasing the muscle's tension, a reflex which helps guard against danger as well as helping to maintain balance.
The presence of near-continuous innervation makes it clear that tonus describes a "default" or "steady state" condition. There is, for the most part, no actual "rest state" insofar as activation is concerned.
In terms of skeletal muscle, both the extensor and flexor muscles, under normal enervation maintain a constant tone while "at rest" that maintains a normal posture.
Cardiac muscle and smooth muscle, although not directly connected to the skeleton, also have tonus in the sense that although their contractions are not matched with those of antagonist muscles; their non-contractive state is characterized by (sometimes random) enervation.

Physical disorders can result in abnormally low (hypotonia) or high (hypertonia) muscle tone. Another form of hypertonia is Paratonia, which is associated with dementia.

Paratonia or gegenhalten is classified as a form of hypertonia with an involuntary variable resistance (i.e reduced ability of a muscle to stretch) during passive movement (i.e a movement without effort). The disease develops during a period of dementia and the degree of effect is dependent upon the disease's progress. Paratonia was classified very recently by experts, and is unrelated to the much more typical spasticity associated with spastic diplegia and simlilar forms of cerebral palsy.
Clasp-knife response refers to a stretch reflex with a rapid decrease in resistance when attempting to flex a joint, usually during a neurological examination. It is one of the characteristic responses of a upper motor neuron lesion.
It gets its name from the resemblance between the motion of the limb and the sudden closing of a claspknife after sufficient pressure is applied.

Although seemingly a stretch reflex when flexing a joint, force from the muscle during the attempt to flex a joint is actually thought to be caused by the tendon reflex of the antagonistic muscle of that joint, which is an extensor muscle that becomes stretched. In upper motor neuron lesions, muscle tonus may increase and resistance of muscle to stretch increases. However, if sufficient force is applied, limb resistance suddenly decreases.

Neurology 102

A somatic reflex arc is one in which there is the simplest possible arrangement of elements to permit a response to stimuli, and in which the final element in the chain is skeletal muscle. In the crude sketch given here, you see the basic elements of this system. 1 is some sensory transducer in the periphery, for example, a Pacinian corpuscle or other tactile sensor in the skin. Shown here in blue is 2, the pseudo-unipolar sensory neuron in the circuit. Its soma is physically located in a craniospinal ganglion (pictured here as a dorsal root ganglion, but it could also be on a cranial nerve). Drawn in black is 3, an interconnector neuron, whose soma is found in the CNS. Drawn in red, 4 is a motor neuron whose soma is in the ventral horn of the gray H of the spinal cord. The last element involved is 5, the effector organ, which in the case of this type of arc, will always be skeletal muscle.

Here's how the system works: something impinges on the transducer, which causes the afferent fiber of the pseudo-unipolar sensory neuron to fire. That signal is transmitted via its efferent fiber into the CNS, specifically into a synapse with an interconnector neuron in the dorsal horn of the gray H. That neuron then sends a signal to a synapse with the motor neuron in the ventral horn. The afferent motor fiber (axon) of the motor neuron—which may actually be several meters in length—leaves the CNS and terminates at a motor end plate on some myofiber. When it fires it initiates contraction of 5.

Notice that this loop is completely independent; it's not necessary to have CNS involvement beyond the "relay" at the interconnector neuron. Let's say you inadvertently put your hand on a hot stove burner. You will of course immediately remove it, and in doing so you are making use of this type of arc, bypassing conscious thought. In fact, the sensation of uncomfortable heat makes it to the CNS after the motor response to withdraw your hand is initiated. In other words, you move your hand away before you "know why" you're doing it. Of course, it's possible to override this loop with direct CNS input. As is always true, the Brain is The Boss. If you really, really want to, it's possible to hold your hand on that hot burner, ignoring the somatic reflex. Some people have done things like this, but most of us haven't got that level of willpower.

The doctor is testing your somatic reflex arc when he taps your knee with a rubber mallet and studies the knee-jerk reaction. The impulse of the hammer tap travels to the spinal cord and back to the effector muscle, in a reactive arc. Diagnostics can be derived from observing the speed and tone of the reaction.

Amateur Pshrink V

I am pretty partial to this disorder too. I feel just like this lady looks in the picture, much of the time. Only doing other things distracts me from sometimes tearing my hair out with tears of despair and hopelessness.
I like all of the DSM disorders, as a matter of fact. I am thinking of collecting them, like baseball cards...

Somatoform disorder (also known as Briquet's syndrome) is a psychological disorder characterized by physical symptoms that mimic disease or injury for which there is no identifiable physical cause or physical symptoms such as pain, nausea, depression, and dizziness. Somatoform disorder is a condition in which the physical pain and symptoms a person feels are related to psychological factors. These symptoms can not be traced to a specific physical cause. In people who have Somatoform disorder, medical test results are either normal or don't explain the person's symptoms. People who have this disorder may undergo several medical evaluations and tests to be sure that they do not have an illness related to a physical cause or central lesion. Patients with this disorder often become very worried about their health because the doctors are unable to find a cause for their health problems. Their symptoms are similar to the symptoms of other illnesses and may last for several years. People who have Somatoform disorder are not faking their symptoms. The pain that they feel is real, and they feel what they say they are feeling.

A person faking their symptoms may have factitious disorder (an unknown psychological cause for making oneself sick) or malingering (making oneself sick for personal or monetary gain; i.e. disability, insurance, etc). This is not at all related to the Somatoform Disorder, however.

A diagnosis of a Somatoform disorder implies that psychological factors are a large contributor to the symptoms' onset, severity and duration. It is important to note that Somatoform disorders are not the result of conscious malingering or factitious disorders.
The Somatoform disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association are:

• Conversion disorder
• Somatization disorder
• Hypochondriasis
• Body dysmorphic disorder
• Pain disorder
• Undifferentiated somatoform disorder - only one unexplained symptom is required for at least 6 months.

Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria).

• Somatoform disorder NOS

Additional proposed somatoform disorders are:

• Abridged somatization disorder - at least 4 unexplained somatic complaints in men and 6 in women
• Multisomatoform disorder - at least 3 unexplained somatic complaints from the PRIME-MD scale for at least 2 years of active symptoms

These disorders have been proposed because the recognized somatoform disorders are either too restrictive or too broad. In a study of 119 primary care patients, the following prevalences were found:

• Somatization disorder - 1%
• Abridged somatization disorder - 6%
• Multisomatoform disorder - 24%
• Undifferentiated somatoform disorder - 79%

In my case, I suspect false pregnancy would be tough to carry out, and right now I´d settle for a reasonable duration of urinary retention prior to wetting my diapers.


But in other words, we can´t explain what is wrong, but we gotta tell the insurance company something, so we made up this fancy title that means ¨we don´t know what is wrong, but this fella is REAALLY SICK!¨

Amateur Pshrink IV

Dr. Moench drew this cartoon on a napkin, when my parents came to get me from the nut hatch at LDS Hospital many years ago. This is one diagnosis from the DSM that is pretty straight-forward.

Major depressive disorder (also known as clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it is also used to describe a more temporarily depressed state of mind, more precise terminology is preferred for the disorder in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of all people who commit suicide have depression or another mood disorder.
The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status exam. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 30 and 40 years, with a later peak between 50 and 60 years. Major depression is reported about twice as frequently in women as in men, although men are at higher risk for suicide.
Most patients are treated in the community with antidepressant medication and some with psychotherapy or counseling. Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT), under a short-acting general anaesthetic. The course of the disorder varies widely, from one episode lasting months to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses. Current and former patients may be stigmatized.
The understanding of the nature and causes of depression has evolved over the centuries, though many aspects of depression remain incompletely understood and are the subject of discussion and research. Psychological, psycho-social, evolutionary and biological causes have been proposed. Psychological treatments are based on theories of personality, interpersonal communication, and learning theory. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine, and dopamine that are naturally present in the brain and assist communication between nerve cells. Monoamines have been implicated in depression, and most antidepressants work to increase the active levels of at least one.

Major depression is a serious illness that affects a person's family, work or school life, sleeping and eating habits, and general health. Its impact on functioning and well-being has been equated to that of chronic medical conditions such as diabetes.
A person suffering a major depressive episode usually exhibits a very low mood that pervades all aspects of life and an inability to experience pleasure in activities that formerly were enjoyed. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self hatred. Other symptoms include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide. Insomnia is common: in the typical pattern, a person wakes very early and is unable to get back to sleep. Hypersomnia, or oversleeping, is less common. Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. The person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries according to the World Health Organization's criteria of depression. Family and friends may notice that the person's behavior is either agitated or lethargic. Older depressed persons may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements. In severe cases, depressed people may have symptoms of psychosis such as delusions or, less commonly, hallucinations, usually of an unpleasant nature.

Depression is a major cause of morbidity worldwide. Lifetime prevalence varies widely, from 3% in Japan to 17% in the US. In most countries the number of people who would suffer from depression during their lives falls within an 8–12% range. In North America the probability of having a major depressive episode within a year-long period is 3–5% for males and 8–10% for females. Population studies have consistently shown major depression to be about twice as common in women as in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this. The relative increase in occurrence is related to pubertal development rather than chronological age, reaches adult ratios between the ages of 15 and 18, and appears associated with psychosocial more than hormonal factors.
People are most likely to suffer their first depressive episode between the ages of 30 and 40, and there is a second, smaller peak of incidence between ages 50 and 60.The risk of major depression is increased with neurological conditions such as stroke, Parkinson's disease, or multiple sclerosis and during the first year after childbirth. It is also more common after cardiovascular illnesses, and is related more to a poor outcome than to a better one. Studies conflict on the prevalence of depression in the elderly, but most data suggest there is a reduction in this age group.
Depression is often associated with unemployment and poverty. Major depression is currently the leading cause of disease burden in North America and other high-income countries, and the fourth-leading cause worldwide. In the year 2030, it is predicted to be the second-leading cause of disease burden worldwide after HIV, according to the World Health Organization. Delay or failure in seeking treatment after relapse, and the failure of health professionals to provide treatment, are two barriers to reducing disability.
The World Health Organization updated its report The global burden of disease in 2004. Their "Years Lost due to Disability", or YLD, is a measurement of the equivalent years of healthy life lost through time spent in states of less than full health, and they state that in all regions, "neuropsychiatric conditions are the most important causes of disability, accounting for around one third of YLD among adults aged 15 and over." Specifically, unipolar depressive disorders are the leading cause in both males and females, in high-income countries and in low- and middle-income countries.