Ka Wai Ola - Office of Hawaiian Affairs, Volume 1, Number 6, 1 August 1984 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Health Questions by Kekuni Blaisdell, M.D.

This I lth eolumn completes mau pane (answers) to mau ninau in last month's issue piliana stroke, the third leading cause of death in Hawai'i and Amelika, and another major illness for whieh we po'e Hawai'i (Hawaiians) rank first amongall lahui (ethnic groups) in Hawai'i nei. Q. What is the best treatment for my Papa, age 62, who has a stroke with paralysis of his left side and pilikia speaking? Can he be cured? A. Mahalo for permitting me to wala'au (talk) with your kauka (doctor) and to see your Papa in ka haukapila (hospital) so that 1 may pane your ninau specifically. Mahalo also to your Papa and 'ohana for permission to share this information with your other po'e heluhelu (readers). Your Papa appears to be receiving the most suitable therapy currently available.. At the time of his admission to ka haukapila six weeks ago, his kauka and the neurology specialist arranged a CT (computerized tomography) head scan. The CT film (Fig. 1) revealed a small region of decreased density in the right brain characteristic of recent infarction, rather than increased density typical for kahekoko (hemorrhage).

As explained in my previous eolumn, infarction means death of tissue from inadequate blood flow. As also described previously, infarction, as in your Papa's case, could have resulted from either a thrombus (a clot forming on the vessel wall) in the brain, or an embolus (a clot lodging in a small vessel after being carried there by the koko (blood) from a larger vessel, such as the right carotid (neek) artery. One reason for suspecting embolism is that a special echogram (picture of reflected vibrations) disclosed significant narrowing of your Papa's right neek artery, whieh means atherosclerotic wall thickening and possible thrombusembolus formation. This is why a neurosurgeon has been called to see your Papa concerning the advisability of removing the thickened portion of his neek vessel wall (endarterectomy, Fig. 2), or inserting a by-pass arterial graft to restore adequate blood flow around the narrowed segment of the artery (Fig. 3). These procedures may have been the surgery you saw on TV. These operations would have no effect on the stroke your Papa has already had, but they could prevent recurrence. Minamina your Papa was not able to attend his mo'opuna'a's puka ana (graduation). Aka (however), ka lomilomi your Mama gives him daily and the haukapila physical therapy have helped him relearn certain skills by training the remaining, uninjured portion of his brain, and other nerves and muscles and joints, so that now he ean help pull himself up with his

lima hema (left arm), and he ean use his wawae hema (left leg) to walk with a walker. Prompt bedside attention, reassurance, supportive conversation by 'ohana and speech therapy have helped him to talk again, and restored his selfconfidence and motivation to become independent. Because thromboembolism is a likely continuing process, your Papa is receiving an anticoagulant (blood-thinner), and aspirin, an anti-platelet drug, to prevent recurring blood-hardening and another stroke, but they have no effect on the thrombus and presumed embolus already formed, nor on the infarction that has already occurred. Your papa's kokopi'i (high blood pressure) is now under control with restriction of food pa'akai (salt) and calories, and with resulting loss of excess body fat. So now he no longer needs any anti-kokopi'i medication. Maika'i loa! Can your Papa's stroke be cured? "Cure" implies complete and permanent recovery. lnasmuch as there is no currently available treatment that ean restore or replace the dead cells in the infarcted region of your Papa's brain, true

cure is not now possible, even though your Papa may regain full function of his limbs and speech. Recurrence depends on how readily the muhiple causal and risk factors for stroke in his case are controlled. We now know that atherosclerosis, whieh is the main underlying disease leading to your Papa's stroke, begins in childhood, and seems to be promoted by three factors in addition to kokopi'i already referred to above: too mueh dietary fat, including cholesterol, physical inactivity, puhi paka (cigarette-smoking), and inappropriate coping with stress. lt has also been demonstrated that control of some of these factors ean reverse atherosclerosis in experimental animals. These are "life-style" factors that we as individuals, and especially all of us po'e Hawai'i and our kamali'i (children), ean and should be controlling now, rather than waiting until after we are disabled by stroke. This is the basis for the view by some experts that atherosclerosis and its two major complications — stroke and heart attack — are diseases of modern western urban living, with special virulence for more-recently-westernized peoples, such as us Polynesians. Does this mean that our kupuna kahiko (ancestors) did not have such disorders and that we have aequired them because we have adopted haole ways? More about this concept and its implications for more effectivepreventive health measures in our next eolumn. Meanwhile, e mau ha'awi mai i mau ninau ola, ke 'olu'olu (please continue to send me your heakh questions).

BRAIN CT SCAN

lnfarction

Right

Left

Fig. 1. Brain CT scan sho\\s a dccreascd dcnsity on thc right rcprcscnting infarction, such as from thrombosis or cmbolism.

ENDARTERECTOMY

Atherosclerosis - with thrombosis

-Carotid (neek) artery

A B C Fig. 2. (A ) Partial obstruction of a neek artery bv athcrosclcrotic thickening and thrombosis with dccrcased bloodflow, that ean also bc responsiblc for embolism and infarction of thc brain. (B) Surgical rcmoval of thc inncr atherosclcrotic thickcning is callcd cndarterectomy. (C) Normal blood Jlow is restored after surgical rcpair, with no furthcr embolism and infarction unlcss athcrosclerosis and thrombosis recur. (After McDowell, 1980).

BY-PASS GRAFT

Graft— i ! ! I

- Atherosclerosis ~Carotid (neek) artery

Fig. 3. A by-pass graft in a neek artcry assurcs adcquate blood flow to the brain around occlusive atherosclerotic thickcning of the vessel wall. (After McDowell, 1980).