Ke manaʻo nei ʻoe i kekahi manawa he ʻūmiʻi iki kou umauma, e like me ka ʻū ʻana? A i ʻole he paʻakikī iā ʻoe ke hanu i ka wā e hoʻoikaika iki ai ʻoe? I kekahi manawa hiki ke hana ʻia kēia mau mea e nā pilikia me nā valves i loko o ko kākou puʻuwai, e hana ana e like me nā puka. I kēia lā e kamaʻilio mākou e pili ana i kahi maʻi e pili ana i ka Aortic Valve, kekahi o nā "puka" koʻikoʻi loa i loko o ka puʻuwai. ʻO kēia ka mea a mākou e kapa nei he `(Aortic Valve Disease)`.
He aha maoli kēia `(Aortic Valve Disease)`?
I ka ʻōlelo maʻalahi, ʻae ka valve aortic i ke koko e kahe mai ke keʻena pamu nui o kou puʻuwai (ka ventricle hema) i ke kīʻaha koko nui loa (ka aorta) e lawe ana i ke koko i ke koena o kou kino. Hana ia e like me ka puka nui o kahi hale. E noʻonoʻo e pili ana, pono e wehe a pani kēia puka i ka manawa kūpono.
- Ke wehe ʻia: I kēlā me kēia manawa e paʻi ai ka puʻuwai , pono e wehe piha kēia kiwikā, e ʻae ana i ke koko āpau e kahe i waho o ka puʻuwai, i loko o ka aorta. A laila wale nō e hoʻolako kēlā koko i ke kino holoʻokoʻa me ka oxygen a me nā meaʻai.
- Ke pani ʻia: Ma hope o ke kahe ʻana o ke koko i waho, pono e pani pono kēia kiwikā, e pale ana i ke koko mai ke kahe hou ʻana i loko o ka puʻuwai.
Inā ʻaʻole hana pono kekahi a i ʻole kēia mau mea ʻelua, a laila ke kamaʻilio nei mākou e pili ana i kahi maʻi i kapa ʻia ʻo `(Aortic Valve Disease)`.
ʻElua ʻano nui o kēia, ʻeā?
ʻAe, ʻelua ʻano nui o ka `(Aortic Valve Disease)`. 1.
`(Aortic Stenosis)` - Ka haiki ʻana o ka valve: ʻO kēia ka manawa e haiki ai ka puka o ka puʻuwai, ʻo ia hoʻi ka aortic valve, a ʻaʻole hiki ke wehe pono. E noʻonoʻo ua wehe iki wale ʻia ka puka. A laila, ʻaʻohe wahi lawa no ke koko e kahe ai mai loko mai o ka puʻuwai. Pono ka puʻuwai e hana ikaika e hoʻokuke i ke koko ma o kēia puka haiki. 2.
`(Aortic Regurgitation)` - Ka liki ʻana o ka valve: ʻO kēia ka manawa ʻaʻole e pani pono ka puka. Inā ʻaʻole e pani pono ka puka, e hoʻihoʻi kekahi o ke koko i puka mai i loko o ka puʻuwai. E like me ka wā e hiki ʻole ai ke pani pono ʻia kahi piula wai, e liki ana ka wai.
ʻO ka mea nui, ʻoiai inā loaʻa iā ʻoe kekahi a i ʻole nā mea ʻelua o kēia mau maʻi, ʻaʻole paha ʻoe e ʻike no kekahi manawa. ʻO kēia no ka mea ʻike pinepine ʻia nā hōʻailona ma hope o ka holomua iki ʻana o ka maʻi. No laila he mea nui e makaʻala i kēia.
ʻO wai ka mea i ʻoi aku ka paʻakikī o ka loaʻa ʻana o kēia maʻi?
ʻOiai hiki i kekahi ke loaʻa i kēia kūlana i kapa ʻia ʻo "Aortic Valve Disease," ʻoi aku ka nui o ka pilikia o kekahi poʻe. ʻO lākou kēia:
- Nā kānaka ma luna o 60 mau makahiki: I kou wā ʻelemakule, hiki ke loli nā kiwikā.
- ʻO ka poʻe i hānau ʻia me kahi ʻokoʻa iki i loko o ko lākou mau valves puʻuwai: No ka laʻana, aia kekahi kūlana i kapa ʻia ʻo " Bicuspid Aortic Valve ". ʻO ka maʻamau, ʻekolu mau leaflet o ka valve aortic. Akā, ʻelua mau leaflet o kēia poʻe.
- ʻAno hānauNā kānaka me ka maʻi puʻuwai (`(Congenital Heart Disease)`).
- ʻO ka poʻe i loaʻa i ka radiation therapy ma ka umauma: Hāʻawi ʻia ka radiation therapy ma ka umauma no kekahi mau ʻano maʻi kanesa (e.g., Hodgkin Lymphoma). Hiki i kēia ke hoʻopilikia i nā valves i ka hala ʻana o ka manawa.
- ʻO ka poʻe me ka maʻi puʻuwai Rheumatic: ʻO ka fiva Rheumatic, kahi e hoʻomaka ai ma ke ʻano he maʻi ʻāʻī, hiki ke hōʻino i nā valves puʻuwai.
Ma nā ʻāina e like me ʻAmelika a me ʻEulopa, ua manaʻo ʻia kēia ka maʻi maʻamau a weliweli loa o nā maʻi valve puʻuwai. Ua ʻōlelo ʻia he 6 o 10 mau make ma muli o nā maʻi valve puʻuwai ma muli o kēia. ʻO ia hoʻi, inā ʻoe e hoʻohui i nā maʻi valve ʻē aʻe a pau (mitral, pulmonary, tricuspid), ʻoi aku ka nui o nā make.
He aha nā hōʻailona o kēia?
E like me kā mākou i ʻōlelo ai ma mua,
ʻaʻohe paha he mau hōʻailona i nā pae mua. Eia nō naʻe, i ka holomua ʻana o ka maʻi, e hoʻomaka paha ʻoe e ʻike i nā mea e like me:
- ʻEha a ʻeha paha ka umauma: Manaʻo paha ia e like me ke ʻūmiʻi nei kekahi i kou umauma.
- Syncope: Ka nalowale koke ʻana o ka ʻike.
- Nā palpitations o ka puʻuwai: Manaʻo paha ʻoe e wikiwiki koke ana kou puʻuwai, a lohe paha ʻoe i kahi leo "kuʻi" i loko o kou umauma.
- Dyspnea: Paʻakikī ka hanu ʻana , ʻoiai ke hana nei i kekahi mea, hoʻoikaika kino, moe ʻana, a hiamoe paha i ka pō.
- ʻEdema (pehu ʻana o nā wāwae a me nā kuʻekuʻe wāwae): Pehu ʻana o nā wāwae haʻahaʻa.
No ke aha e hana ʻia ai kēia? He aha nā kumu?
Aia kekahi mau kumu e ulu ai kēia '(Aortic Valve Disease)'.
- Pau ka valve me ka ʻelemakule: ʻO kēia ke kumu nui. E like me nā ʻāpana o ka mīkini e pau ka ʻino me ka hoʻohana ʻana.
- Maʻi Puʻuwai Rheumatic: E like me ka mea i ʻōlelo ʻia ma mua, hiki i ka maʻi rheumatic ke hōʻino i nā valves.
- Maʻi puʻuwai hānau: No ka laʻana, loaʻa kahi valve aortic bicuspid.
- Ke koko kiʻekiʻe : ʻO ka loaʻa ʻana o ke koko kiʻekiʻe i kekahi manawa hiki ke hoʻopilikia i nā valves.
- Nā maʻi kīwila o ka puʻuwai (endocarditis): Ka hōʻino ʻia o nā kīwila ma muli o ka maʻi bacteria.
- Nā ʻeha a me nā ulia kaʻa ma ka umauma.
- ʻO ka Aneurysm Aortic Thoracic: Ka pehu ʻana o ka aorta.
- ʻO ka ʻoki ʻana o ke aortic: He haehae ʻana i ka paia o ka aorta.
- ʻO ka radiation therapy i ka umauma (no nā mea e like me ke kanesa).
He aha nā kumu pilikia?
Aia kahi pilikia kiʻekiʻe o ka hoʻomohala ʻana i kēia maʻi me nā mea e like me:
- Inā ʻoe ma luna o 60 mau makahiki.
- Inā he mānoanoa a me nā waihona calcium i loko o ka valve (Aortic Valve Sclerosis) (i kēia hihia, ʻaʻole i ʻoki ʻia ka valve, akā hiki ke lilo i hōʻailona mua o ka maʻi).
- Inā he kīnā kiwikā hānau kou, ʻoiai hoʻi ka `(Bicuspid Aortic Valve)`.
- Inā ua loaʻa iā ʻoe ka maʻi rumatika ma mua.
- Inā ua loaʻa iā ʻoe nā maʻi valve puʻuwai (endocarditis) ma mua.
- Inā loaʻa iā ʻoe kekahi mau maʻi olakino (no ka laʻana, Marfan Syndrome, Ehlers-Danlos Syndrome, Lupus).
Aia kekahi mau pae o kēia maʻi?
ʻAe, e holomua mālie ana kēia maʻi. Hoʻohana nā kauka i ʻehā mau pae e wehewehe i kona koʻikoʻi:
- Pae A (Ma ka Pōpilikia / Pae A): Ke hana maikaʻi nei kāu valve aortic i kēia manawa, akā aia iā ʻoe ma ka liʻiliʻi hoʻokahi kumu pilikia no ka hoʻomohala ʻana i ka maʻi.
- Pae B (Holomua): He maʻi palupalu a kaulike kēia o ka Aortic Valve. Aia kekahi mau loli iki i ka hana o ka valve, akā ʻaʻohe ou hōʻailona i kēia manawa.
- Pae C (Asymptomatic Koʻikoʻi / Pae C): He ʻano koʻikoʻi kēia o ka maʻi valve aortic. ʻAʻole paha ʻoe e loaʻa nā hōʻailona i ka wā e hana ana i kāu mau hana maʻamau. Eia nō naʻe, hiki iā ʻoe ke ʻike i nā hōʻailona i ka wā o kahi hoʻāʻo koʻikoʻi hoʻoikaika kino.
- C1: Hiki i ka puʻuwai ke pamu i ke koko i lawa i ke kino.
- C2: ʻAʻole hiki i ka puʻuwai ke pamu i kēlā nui o ke koko (ʻoi aku ka liʻiliʻi o ka Left Ventricular Ejection Fraction - `(Left Ventricular Ejection Fraction)` ma mua o 50%).
- Pae D (Symptomatic Koʻikoʻi): Loaʻa iā ʻoe ka maʻi valve aortic koʻikoʻi e hoʻoulu ai i nā hōʻailona i kou ola o kēlā me kēia lā. I ka wā mua, hiki ke ʻike ʻia nā hōʻailona i ka wā hoʻoikaika kino, akā ma hope, hiki ke ʻike ʻia nā hōʻailona ʻoiai ʻaʻole ʻoe e hoʻoikaika kino.
He aha nā pilikia e hiki ai i kēia ke hana?
He maʻi koʻikoʻi kēia, a inā ʻaʻole mālama pono ʻia, hiki iā ia ke alakaʻi i nā pilikia koʻikoʻi.
ʻO ka pilikia maʻamau a weliweli hoʻi, ʻo ia ka hāʻule ʻana o ka puʻuwai . ʻO ia hoʻi, ʻaʻole hiki i kou puʻuwai ke pamu i ke koko lawa i kou kino. Hiki i kēia ke alakaʻi i ka nalowale o ka hana ma kou kino holoʻokoʻa. ʻO nā pilikia ʻē aʻe:
- Ka puʻuwai kūpono ʻole (`(Arrhythmia)`).
- Maʻi hohola.
- Paʻa koke ka puʻuwai (`(Paʻa koke ka puʻuwai)`).
- Hahau (`(Haʻu)`).
Pehea ʻoe e ʻike ai i kēia? He aha nā hoʻokolohua a nā kauka e hoʻohana ai?
Hoʻoponopono nā kauka i kēia maʻi ma ka nānā ʻana iā ʻoe a me ka hana ʻana i kekahi mau hoʻokolohua kūikawā ʻē aʻe. I ka wā o ka hoʻokolokolo ʻana, e hana ke kauka i kēia mau mea:
- Nīnau lākou e pili ana i kou mau kūlana olakino, e like me ka loaʻa ʻana o ka maʻi puʻuwai i kekahi o kou ʻohana.
- Ke nānā ʻia nei kāu mau hōʻailona koʻikoʻi (ke koko, ka helu pulse, a me nā mea ʻē aʻe).
- Hoʻolohe ʻia ka puʻuwai me kahi stethoscope (`(Auscultation)`). Inā lohe ʻoe i kahi kani puʻuwai ʻē (i kapa ʻia he `(Murmur)`), he hōʻailona paha ia o ka `(Aortic Valve Disease)`.
- Hana ʻia kahi ECG (electrocardiogram). Nānā kēia i ka hana uila o ka puʻuwai.
Eia kekahi,
ʻo ka `(Echocardiogram)` (Echocardiogram) ka hoʻāʻo nui a maikaʻi loa e ʻike ai i ka `(Aortic Valve Disease)`. Hoʻohana kēia i nā nalu kani alapine kiʻekiʻe (`(Ultrasound)`) e kiʻi i nā kiʻi ola o ka puʻuwai a me nā valves. Hiki i kēia ke hōʻike i nā mea āpau mai ka wehe ʻana a me ka pani ʻana o ka valve a hiki i ka holo ʻana o ke koko i hope. ʻO nā hoʻokolohua ʻē aʻe paha āu e loaʻa ai:
- Ka Hoʻokomo ʻana i ka Catheter o ka Puʻuwai (`(Ka Hoʻokomo ʻana i ka Catheter o ka Puʻuwai)`).
- ʻO kahi scan CT o ka puʻuwai.
- He kiʻi X-ray o ka umauma.
- He angiogram coronary (`(Coronary Angiogram)`).
- Hoʻāʻo Hoʻoluhi Hoʻoikaika Kino (`(Hoʻāʻo Hoʻoluhi Hoʻoikaika Kino)`).
- ʻO kahi MRI o ka puʻuwai.
He aha ka lāʻau lapaʻau?
Aia ka lāʻau lapaʻau i kekahi mau kumu, me ke ʻano o ka maʻi valve aortic āu e loaʻa ai (stenosis, regurgitation, a i ʻole nā mea ʻelua),
pehea kona holomua (kahua), a me ke koʻikoʻi o kāu mau hōʻailona. E loiloi kāu kauka i kou kūlana a ʻōlelo i ka hoʻolālā lapaʻau maikaʻi loa nāu. Hiki i nā koho lapaʻau ke komo pū me:
- Nā lāʻau lapaʻau: ʻAʻole hiki i nā lāʻau lapaʻau ke hoʻōla piha i kou pilikia valve. Akā hiki iā lākou ke kōkua i ka kaohi ʻana i nā hōʻailona, hoʻēmi i ke kaumaha ma kou puʻuwai, a hoʻēmi i ka pilikia o nā pilikia. Hiki i ke kauka ke kuhikuhi i nā lāʻau lapaʻau e pale aku i nā puʻuwai puʻuwai kūpono ʻole, hoʻohaʻahaʻa i ke koko, kaohi i ka cholesterol, a mālama paha i ka hāʻule ʻana o ka puʻuwai.
- Valvuloplasty: He hana liʻiliʻi kēia ʻaʻole pono kahi ʻoki nui. Hoʻokomo ʻia kahi paipu liʻiliʻi ma kou wāwae a lima paha, a hoʻohana ʻia kahi pōpō ma ka hopena e hoʻonui i kāu valve aortic i haiki. Inā loaʻa iā ʻoe ka stenosis aortic, hiki i kēia ke hoʻomaikaʻi i ke kahe koko ma o ka valve. Eia nō naʻe, he hopena manawa pōkole kēia.
- ʻO ke ʻoki ʻana i ka valve o ka puʻuwai: Ma kēia kaʻina hana, e hoʻoponopono ke kauka ʻoki i kāu valve aortic a i ʻole e pani iā ia me kahi mea hou. ʻO ka valve hou he valve ʻiʻo paha a i ʻole he valve puʻuwai mechanical i hana ʻia me kahi mea e like me ka metala. I kekahi manawa, hana nā kauka i ke ʻoki valve me ka coronary artery bypass grafting (CABG) a i ʻole kekahi ʻoki puʻuwai ʻē aʻe.
- Hoʻololi i ka Valve Aortic Transcatheter (TAVR): He koho hou ʻo TAVR, he koho minimally invasive ia no ke ʻoki puʻuwai hāmama kuʻuna. Ma kahi o ka hana ʻana i kahi ʻoki nui ma ka umauma, hoʻokomo ʻia kahi paipu liʻiliʻi ma o kahi kīʻaha koko ma ka wāwae e hoʻokomo i kahi valve aortic hou i loko o ka puʻuwai, a hoʻopaʻa ʻia ka valve kahiko i loko.
- Ke Kaʻina Hana Ross: He kaʻina hana kēia e pono ai kahi valve aortic hou, ʻoi aku hoʻi no ka poʻe ma lalo o 60 makahiki. Hoʻololi ke kauka lapaʻau i kāu valve aortic me kāu valve pulmonary ponoʻī (ka valve e lawe ana i ke koko mai ka puʻuwai a i nā māmā), a laila hoʻololi i ka valve pulmonary i wehe ʻia me kahi valve pulmonary donor. He kaʻina hana paʻakikī iki kēia.
Aia kekahi mau ala e pale aku ai i kēia?
ʻAʻole maʻalahi ka pale ʻana i ka maʻi valve aortic. Hiki ke hana pinepine ʻia e ka ʻelemakule, ka maʻi puʻuwai hānau, a i ʻole nā kūlana olakino lōʻihi e paʻakikī ke kaohi. Eia nō naʻe, hiki iā ʻoe ke hana i kēia mau mea e hōʻemi i kou pilikia a mālama i kou mau valves puʻuwai i ke olakino e like me ka hiki:
- E hōʻalo loa i nā huahana paka a me nā lāʻau lapaʻau leʻaleʻa. He mea ʻino loa kēia no ka puʻuwai.
- E hoʻoikaika kino no 30 mau minuke ma ka liʻiliʻi i ka hapa nui o nā lā o ka pule. ʻOiai kekahi mea maʻalahi e like me ka hele wāwae a i ʻole ke kaʻa paikikala, ua maikaʻi nō ia.
- Ke maʻi ʻoe, ʻoiai inā loaʻa iā ʻoe kahi maʻi bacteria e like me ka strep throat, e ʻike koke i ke kauka. Inā ʻaʻole mālama ʻia, hiki i kēia ke lilo i ka fiva rumatika a hōʻino i nā valves o ka puʻuwai.
- E lawe i nā lāʻau lapaʻau i kuhikuhi ʻia e kāu kauka (e laʻa me nā lāʻau lapaʻau no ke koko kiʻekiʻe a i ʻole ka cholesterol) me ka pololei a me ka manawa kūpono.
- Inā loaʻa iā ʻoe kahi maʻi valve, e ʻike pinepine i kāu kauka no nā nānā ʻana i hiki ke mālama koke ʻia. ʻO ka wā mua e ʻike ʻia ai, ʻoi aku ka holomua o ka mālama ʻana.
He aha kāu e pono ai e ʻike i ka wā e noho ai me kēia maʻi?
Ke ʻike ʻia ʻoe me ka maʻi Aortic Valve, pehea e pili ai iā ʻoe ma muli o nā mea he nui. ʻO kēia mau mea ka wā i ʻike ʻia ai ʻoe,
pehea ka holomua o ka maʻi, a me kou olakino holoʻokoʻa. He mea nui e kamaʻilio ākea me kāu kauka e pili ana i kou wā e hiki mai ana. Hiki iā lākou ke hāʻawi iā ʻoe i kahi manaʻo maopopo no ke ʻano o kāu pane ʻana i ka lāʻau lapaʻau a me nā mea e manaʻo ai. E hāʻawi kāu kauka iā ʻoe i nā ʻōlelo aʻoaʻo e pili ana i nā loli o ke ʻano o ka nohona a pehea e hiki ai iā ʻoe ke mālama iā ʻoe iho i kēlā me kēia lā. E hahai pono i kēia mau kuhikuhi, a e nīnau i kāu mau nīnau. Hiki i kāu kauka ke paipai i nā mea e like me:
- E hoʻohana i kahi papaʻai olakino no ka puʻuwai (e like me ka Mediterranean Diet): E ʻai i nā mea kanu, nā huaʻai, nā legumes, nā iʻa, a me nā meaʻai waiwai i ka fiber. E hōʻemi i ka paʻakai, ke kō, a me ka ʻaila.
- Hoʻoikaika Kino: Eia nō naʻe, ma muli o ke koʻikoʻi o kāu Maʻi Valve Aortic, hiki ke loaʻa iā ʻoe nā palena hoʻoikaika kino. He mea nui e nīnau i kāu kauka i ka mea āu e hana ai a me ka mea ʻaʻole pono e hana.
- E hoʻōki loa i ka puhipaka a i ʻole ka hoʻohana ʻana i nā huahana paka ʻē aʻe.
- I mea e pale ai i nā maʻi kīwila puʻuwai (endocarditis), he mea nui e mālama pono i kou mau niho a me kou mau ʻāʻī: He mea nui ka palaki ʻana i kou mau niho i kēlā me kēia lā a me ka ʻike mau ʻana i ke kauka niho.
Āhea wau e ʻike ai i ke kauka?
E haʻi aku kāu kauka iā ʻoe i ka pinepine o kou pono e ʻike i kāu kauka.
He mea nui e mālama ʻoe i kāu mau manawa a pau. E hana kāu kauka i nā hoʻokolohua maʻamau, e like me ka echocardiogram, e nānā i kou puʻuwai a me ka hana valve. Hiki i kēia mau hoʻokolohua ke kōkua
i kāu kauka e ʻōlelo i ka lāʻau kūpono a hōʻemi i ka pilikia o nā pilikia e hiki mai ana.
E kāhea koke i kāu kauka inā ʻoe:- Inā e ʻoi aku ka ʻino o kou mau hōʻailona (e like me ka ʻeha o ka umauma, ka pōkole o ka hanu).
- Inā ʻoe e hoʻomohala i nā hōʻailona hou.
- Inā loaʻa iā ʻoe nā hopena ʻaoʻao mai kāu lāʻau lapaʻau.
Āhea ʻoe e hele ai i ka lumi pilikia?
Inā loaʻa iā ʻoe kekahi mea e like me kēia
, e hele koke i ka lumi pilikia o ka haukapila kokoke loa, a i ʻole e kelepona iā 1990:- ʻAʻohe pilikia inā e maule ʻoe a nalowale paha ka ʻike.
- Inā hāʻule ʻoe i ka wā e lawe ana i nā lāʻau hoʻokahe koko (e like me Warfarin, Aspirin). Hoʻonui kēia mau lāʻau i ka pilikia o ke kahe koko i loko inā hāʻule ʻoe a ʻeha paha.
- Inā he mau hōʻailona o ka maʻi i loko o kou ʻeha (ʻulaʻula, pehu, kuni, pus ʻala ʻino) ma hope o ke ʻoki ʻana a i ʻole ke kaʻina hana.
- Inā loaʻa iā ʻoe nā hōʻailona o ka hōʻeha puʻuwai ("(Symptoms of a Heart Attack)`): ʻeha nui o ka umauma, paʻakikī ka hanu ʻana, ʻeha e pālahalaha ana i ka lima hema, ʻāʻī, ʻāwae, hou, nausea, luaʻi.
- Inā loaʻa koke iā ʻoe ka pilikia nui o ka hanu ʻana.
- ʻO nā hōʻailona o ka hahau ʻana: ka mae a nāwaliwali paha ma kekahi ʻaoʻao o ke kino, ka ʻōlelo ʻole, ke kūlou ʻana o kekahi ʻaoʻao o ka maka, nā loli koke o ka ʻike, a me ka ʻeha poʻo nui.
Hiki ke hopohopo a hoʻoluhi ka ʻike ʻana ua loaʻa iā ʻoe ka maʻi valve Aortic. He mea maʻamau kēlā. Akā ʻo ka nūhou maikaʻi, me nā lāʻau lapaʻau holomua o kēia lā, hiki iā ʻoe ke hōʻemi nui i kāu mau hōʻailona, hōʻemi i kou pilikia o nā pilikia, a ola i kahi ola olakino a ikaika. Inā ʻoe e hopohopo nei a hopohopo paha no ka wā e hiki mai ana, hiki i ke kamaʻilio ʻana me nā poʻe ʻē aʻe me ka maʻi valve puʻuwai a me ke komo ʻana i nā hui kākoʻo ke kōkua. E nīnau i kāu kauka e pili ana i ia mea.
No laila, he aha nā mea nui loa e pono ai kākou e lawe i ka home mai kēia moʻolelo?
ʻO ka maʻi valve aortic kahi maʻi e hoʻopilikia ai i kahi valve koʻikoʻi loa i loko o ko kākou puʻuwai a hiki ke koʻikoʻi loa. Akā
, mai poina inā ʻike mua ʻia, ukali ʻia e ka ʻōlelo aʻoaʻo lapaʻau kūpono, a mālama pono ʻia, hiki ke hoʻomalu maikaʻi ʻia. Inā loaʻa iā ʻoe kekahi mau hōʻailona, ʻoiai ka ʻeha o ka umauma, ka pōkole o ka hanu, ka luhi, a i ʻole ka mae ʻana, mai hoʻowahāwahā iā ia me ka manaʻo he "mea ʻē aʻe."
E ʻike koke i ke kauka a loaʻa ka ʻōlelo aʻoaʻo. E hoʻomanaʻo, ʻo ka mālama ʻana i kou puʻuwai ke kōkua nui loa hiki iā ʻoe ke hana nou iho! ʻO ka puʻuwai olakino ke ʻano o ke ola olakino.
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