He aha ka Stenosis Aortic? Nā Hōʻailona, Nā Kumu, a me ka Lapaʻau

Hana ʻia ka stenosis aortic i ka wā e lilo ai ka valve aortic o kou naʻau i ʻāpana a paʻakikī, e hana ai i ka paʻakikī o ke kahe ʻana o ke koko mai kou naʻau a i ke koena o kou kino. E noʻonoʻo iā ia e like me ka puka i paʻa i ka hapalua wehe - pono e hana nui aku kou naʻau e kipaku i ke koko ma kēia wehe liʻiliʻi.

Hoʻopili kēia kūlana i nā miliona o nā kānaka ma ka honua holoʻokoʻa a ulu pinepine ma nā makahiki he nui. ʻOiai ke kani nei ia he mea hopohopo, hiki i ka hoʻomaopopo ʻana i nā mea e hana nei i loko o kou kino ke kōkua iā ʻoe e ʻike hou aku i ka mālama ʻana iā ia me kou hui olakino.

He aha ka Stenosis Aortic?

ʻO ka stenosis aortic kahi maʻi valve naʻau kahi i wehe ʻole ai kāu valve aortic piha i kēlā me kēia kuʻi naʻau. Noho ka valve aortic ma waena o ke keʻena pump nui o kou naʻau a me ke kīʻaha nui loa o kou kino, e kaohi ana i ke kahe ʻana o ke koko mai kou naʻau.

Ke lilo kēia valve i ʻāpana, pono e hana nui aku kou ʻiʻo naʻau e pump i ka nui like o ke koko. Ma hope o kekahi manawa, hiki i kēia hana hou ke hana i kou ʻiʻo naʻau e mānoanoa a hoʻonāwaliwali hope loa. ʻO ka ʻoiaʻiʻo maikaʻi, he nui nā kānaka e ola ana i nā ola piha, hana me ka lapaʻau kūpono a me ka nānā.

ʻO ka maʻamau, ulu mālie kēia kūlana, pinepine ma nā ʻumi makahiki. ʻAʻole ʻike nā kānaka he nui i nā hōʻailona i nā wā mua, ʻo ia ke kumu e waiwai ai nā nānā maʻamau me kāu kauka no ka hopu ʻana i nā loli i ka wā mua.

He aha nā Hōʻailona o ka Stenosis Aortic?

ʻO ka mea paʻakikī e pili ana i ka stenosis aortic, ʻaʻole paha ʻoe e ʻike i kekahi hōʻailona no nā makahiki ʻoiai he māmā a waena paha ke kūlana. He maikaʻi loa kou kino i ka hoʻoponopono ʻana i nā loli mālie, no laila e ʻike ʻia nā hōʻailona i ka wā e lilo ai ka ʻāpana i ʻoi aku ka nui.

Ke hoʻomohala ʻia nā hōʻailona, ​​hoʻopili pinepine lākou:

• ʻEha umauma a i ʻole kaomi, ʻoi aku hoʻi i ka wā o ka hana kino
• Pōkole o ka hanu i ka wā o ka hoʻoikaika kino a i ʻole nā ​​hana i kēlā me kēia lā
• ʻIke ʻia ka luhi a i ʻole ka nāwaliwali
• Nāwaliwali a i ʻole ka māmā, ʻoi aku hoʻi i ka wā e kū koke ai
• Nā hiʻohiʻona fainting, ʻoi aku hoʻi i ka wā o ka hoʻoikaika kino
• Nā palpitations naʻau a i ʻole nā ​​kuʻi naʻau kūpono ʻole

ʻIke kekahi poʻe i ka pehu ʻana o ko lākou mau kuʻekuʻe a i ʻole nā ​​wāwae, kahi e hana ai i ka wā e hakakā ai ka naʻau e pump pono.

He aha nā ʻAno o ka Stenosis Aortic?

Hoʻokano nā kauka i ka stenosis aortic ma muli o ka nui o ka ʻāpana i lilo. Hiki i ka hoʻomaopopo ʻana i kēia mau māhele ke kōkua iā ʻoe e ʻike i nā mea e kali ai a pehea ka wikiwiki e pono ai ka lapaʻau.

ʻO nā ʻano nui e komo pū ana:

• Stenosis aortic māmā: Ua emi iki ka wehe ʻana o ka valve, akā ʻaʻole paha ʻoe e loaʻa nā hōʻailona
• Stenosis aortic waena: ʻOi aku ka palena o ka wehe ʻana, a hiki iā ʻoe ke hoʻomaka e ʻike i nā hōʻailona i ka wā o ka hana ikaika
• Stenosis aortic koʻikoʻi: ʻO ka wehe ʻana o ka valve he ʻāpana nui loa, a pinepine nā hōʻailona me nā hana i kēlā me kēia lā
• Stenosis aortic koʻikoʻi: ʻO kēia ka pae holomua loa, kahi e hiki ai i nā hōʻailona ke hana ma ka hoʻomaha

E hoʻohana kāu kauka i nā ho'āʻo e like me nā echocardiograms e ana pono i ka nui o ka ʻāpana o kāu valve. Kēia e kōkua iā lākou e paipai i ke ala lapaʻau kūpono a me ka papa hana nānā no kāu kūlana kikoʻī.

He aha nā Kumu o ka Stenosis Aortic?

Hoʻomohala ʻia ka stenosis aortic no nā kumu like ʻole ma muli o kou makahiki a me ka mōʻaukala olakino. ʻO ke kumu maʻamau i nā mākua kahiko ka hana ʻelemakule maoli, kahi e kūkulu ai nā waihona calcium ma ka valve ma hope o kekahi manawa.

Eia nā kumu nui a nā kauka e ʻike ai:

• Calcification pili i ka makahiki: Hoʻoulu ʻia nā waihona calcium ma nā lau valve i kou wā e ulu ai, e hana ana iā lākou i ka paʻakikī a me ka ʻāpana
• Nā hemahema naʻau congenital: Ua hānau ʻia kekahi poʻe me nā valves aortic kūpono ʻole e ʻoi aku ka maʻalahi i nā pilikia
• Fever rheumatic: ʻOiai ʻaʻole maʻamau i kēia lā, hiki i kēia maʻi keiki ke hōʻino i nā valves naʻau ma hope i ke ola
• Radiation therapy: Hiki i ka radiation umauma mua no ka mālama ʻana i ka maʻi kanesa ke hoʻopili i ka hana valve ma hope o nā makahiki

I nā hihia kakaikahi, hiki i kekahi mau kūlana genetic, maʻi puʻupaʻa, a i ʻole nā ​​maʻi autoimmune ke kōkua i nā pilikia valve. Hiki i kāu kauka ke kōkua i ka hoʻoholo ʻana i nā mea i alakaʻi i kāu kūlana kikoʻī, ʻoiai i kekahi manawa ʻaʻole maopopo ke kumu pololei.

I ka wā e ʻike ai i ke Kauka no ka Stenosis Aortic?

Pono ʻoe e hoʻokaʻaʻike i kāu mea lawelawe olakino inā loaʻa iā ʻoe nā hōʻailona e hōʻike ana i ka stenosis aortic, ʻoi aku hoʻi inā ʻoi aku ka maikaʻi ma hope o kekahi manawa. Hiki i ka loiloi mua ke hana i kahi ʻokoʻa nui i nā hopena olakino lōʻihi.

E ʻimi i ka mālama lapaʻau inā ʻike ʻoe:

• ʻEha umauma a i ʻole kaomi e hele mai me ka hana kino
• Pōkole o ka hanu i wehe ʻole ʻia i nā hana maʻamau
• Nāwaliwali a i ʻole nā ​​hiʻohiʻona fainting
• Luhi maʻamau ʻaʻole e hoʻomaikaʻi me ka hoʻomaha
• Pehu i kou mau wāwae, kuʻekuʻe, a i ʻole nā ​​wāwae

E kāhea no ke kōkua pilikia koke inā loaʻa iā ʻoe ka ʻeha umauma nui, fainting koke, a i ʻole ka pilikia nui o ka hanu. Hiki i kēia ke hōʻailona e pono ai kāu kūlana i ka mālama koke.

ʻOiai inā ʻaʻohe ou hōʻailona, ​​e haʻi i kekahi mōʻaukala ʻohana o nā pilikia valve naʻau i kāu kauka i nā kipa maʻamau. Hiki iā lākou ke paipai i nā ho'āʻo palekana e hopu i nā pilikia hiki ke loaʻa i ka wā mua.

He aha nā Kumu Pōpilikia no ka Stenosis Aortic?

Hiki i kekahi mau mea ke hoʻonui i kou manawa e hoʻomohala ai i ka stenosis aortic, ʻoiai ʻo ka loaʻa ʻana o nā mea pilikia ʻaʻole ia he manaʻo e hoʻomohala maoli ʻoe i ke kūlana. Hiki i ka hoʻomaopopo ʻana i kēia mau mea ke kōkua iā ʻoe a me kāu kauka e makaʻala no nā hōʻailona mua.

ʻO nā mea pilikia nui loa e komo pū ana:

• Makahiki kahiko: Hoʻonui ka pilikia ma hope o 65 mau makahiki, ʻoi aku hoʻi no nā kāne
• Ke koko kiʻekiʻe: Hoʻokomo kēia i ka pilikia hou aku i kāu mau valves naʻau ma hope o kekahi manawa
• Cholesterol kiʻekiʻe: Hiki ke kōkua i ka kūkulu ʻana o ka calcium ma nā lau valve
• Diabetes: Hiki ke hoʻoikaika i ka hoʻoino ʻana o ka valve
• Pāpā: Hōʻino i nā kīʻaha koko a hiki ke hoʻopili i ke olakino valve
• Maʻi puʻupaʻa maʻi: Hoʻopili pinepine ʻia me nā palena calcium a me ka phosphorus

Kekahi poʻe e kū i ka pilikia kiʻekiʻe ma muli o nā mea hiki ʻole iā lākou ke kaohi, e like me ka hānau ʻia ʻana me ka valve aortic bicuspid (loaʻa ʻelua mau lau ma mua o ʻekolu) a i ʻole ka loaʻa ʻana o ka mōʻaukala ʻohana o ka maʻi valve. ʻOi aku ka nui o nā kāne e hoʻomohala i ka stenosis aortic ma mua o nā wahine, ʻoiai hiki i nā wahine ke hoʻopilikia ʻia.

He aha nā pilikia hiki ke loaʻa o ka Stenosis Aortic?

ʻOiai e holomua mālie ana ka stenosis aortic, ʻo ka waiho ʻana iā ia me ka mālama ʻole ʻana i ka wā koʻikoʻi ke alakaʻi i nā pilikia koʻikoʻi. ʻO ka ʻoiaʻiʻo maikaʻi, me ka nānā pono a me ka lapaʻau, hiki ke pale ʻia a mālama pono ʻia nā pilikia he nui.

ʻO nā pilikia hiki ke komo pū ana:

• Heart failure: Ke lilo kou ʻiʻo naʻau i nāwaliwali loa mai ka hana nui ʻana
• Nā kuʻi naʻau kūpono ʻole: Hiki i ka ʻiʻo naʻau pilikia ke hoʻomohala i nā ʻano uila kūpono ʻole
• Nā clots koko: Hiki i ke kahe koko maikaʻi ʻole ke hoʻonui i ka pilikia clotting
• Make naʻau koke: ʻOiai he kakaikahi, ʻo ia ke kumu e pono ai ka mālama koke i nā hōʻailona koʻikoʻi
• Stroke: Hoʻopili pinepine ʻia i nā kuʻi naʻau kūpono ʻole a i ʻole nā ​​clots koko

Ke kani nei kēia mau pilikia i ka hopohopo, akā e hoʻomanaʻo e hana pinepine lākou wale nō i ka wā e waiho ʻole ʻia ai ka stenosis aortic koʻikoʻi. Kūpono ka nānā maʻamau me kāu hui olakino e hōʻoia i ka hopu ʻia ʻana o nā loli a me ka mālama ʻia ma mua o ka hoʻomohala ʻana o nā pilikia.

Pehea ka Diagnosis o ka Stenosis Aortic?

Hoʻomaka pinepine ka diagnosis o ka stenosis aortic me kāu kauka e hoʻolohe ana i kou naʻau me ka stethoscope. Ke hoʻolohe nei lākou no kahi ʻano kikoʻī o ka murmur naʻau e hōʻike ana i nā pilikia valve.

Inā manaʻo kāu kauka i ka stenosis aortic, e kauoha paha lākou i kahi echocardiogram mua. Hoʻokumu kēia ho'āʻo ultrasound ʻeha ʻole i nā kiʻi neʻe o kou naʻau, e hōʻike ana i ka maikaʻi o ka wehe a me ka pani ʻana o kāu valve. ʻO ia ka ho'āʻo kūpono loa no ka loiloi ʻana i ka hana valve.

Hiki i nā ho'āʻo hou aku ke komo pū:

• Electrocardiogram (ECG): E nānā i ka hana uila o kou naʻau
• Chest X-ray: E hōʻike i ka nui o kou naʻau a me kekahi wai e kūkulu ai
• Cardiac catheterization: Pono i kekahi manawa e kiʻi i nā ana kaomi kikoʻī
• CT scan: Hiki ke hāʻawi i nā kiʻi kikoʻī o kou ʻano valve
• Stress testing: E loiloi i ka pane ʻana o kou naʻau i ka hana kino

Mai hopohopo inā kauoha kāu kauka i nā ho'āʻo he nui. Hāʻawi kēlā me kēia i ka ʻike like ʻole e kōkua i ka hana ʻana i kahi kiʻi piha o kou olakino naʻau a e alakaʻi i ke ala lapaʻau maikaʻi loa no ʻoe.

He aha ka Lapaʻau no ka Stenosis Aortic?

ʻO ka lapaʻau no ka stenosis aortic e hilinaʻi ana i ka nui o kou kūlana a inā ʻoe e ʻike ana i nā hōʻailona. No nā hihia māmā, hiki i ka nānā pono ke mea wale nō e pono ai i ka mua.

Hiki i kāu papahana lapaʻau ke komo pū:

• Nānā maʻamau: Nā echocardiograms manawa e hahai i ka holomua
• Nā lāʻau lapaʻau: E mālama i nā hōʻailona a pale i kou naʻau
• ʻOihana hoʻololi valve: ʻO ka lapaʻau hoʻoholo no nā hihia koʻikoʻi
• Transcatheter valve replacement (TAVR): Kahi koho emi invasive no kekahi mau mea maʻi
• Balloon valvuloplasty: Hoʻohana ʻia ma kahi kakaikahi, ʻo ia hoʻi ma ke ʻano he ana manawa

No ka stenosis aortic koʻikoʻi me nā hōʻailona, ​​hoʻomaopopo pinepine ʻia ka hoʻololi valve. Hiki i kēia ke kani hopohopo, akā loaʻa i kēia mau kaʻina hana nā helu holomua maikaʻi a hiki ke hoʻomaikaʻi nui i kou maikaʻi o ke ola. E kūkākūkā kāu hui naʻau i ke ala kūpono loa no kāu kūlana kikoʻī.

ʻO ke kī ʻaʻole ia e kali lōʻihi loa ma hope o ka hoʻomohala ʻana o nā hōʻailona. ʻOi aku ka maikaʻi o ka hoʻoponopono mua i ka wā e ola maikaʻi ana ʻoe ma mua o ka kali ʻana a hiki i ka wā e hōʻino nui ʻia ai kou naʻau.

Pehea e lawe ai i ka mālama home i ka wā o ka Stenosis Aortic?

ʻOiai ʻaʻohe ala e hoʻihoʻi ai i ka stenosis aortic ma o nā loli nohona wale nō, hiki i ka mālama pono ʻana iā ʻoe iho ke kōkua i ka hoʻomālie ʻana i ka holomua a mālama iā ʻoe i ka ʻike ʻana i kou maikaʻi loa. E noʻonoʻo iā ia e like me ka hāʻawi ʻana i kou naʻau i ke kākoʻo maikaʻi loa.

Eia nā mea hiki iā ʻoe ke hana ma ka home:

• E lawe i nā lāʻau lapaʻau i kuhikuhi ʻia e like me ke kuhikuhi ʻia: Mai haʻalele i nā doses a mai ho'ōki me ka nīnau ʻole i kāu kauka
• E nānā i kou kaumaha i kēlā me kēia lā: Hiki i ka hoʻonui koke ʻana o ke kaumaha ke hōʻike i ka wai e mālama ʻia
• E noho ikaika i loko o kou mau palena: E nīnau i kāu kauka i ka pae o ka hoʻoikaika kino e palekana no ʻoe
• E ʻai i ka meaʻai olakino naʻau: E kau i nā hua, nā mea kanu, nā huaola holoʻokoʻa, a me nā protein liʻiliʻi
• E kaupalena i ka ʻai ʻana o ka sodium: Kēia e kōkua i ka pale ʻana i ka wai e kūkulu ai a hoʻemi i ka pilikia ma kou naʻau
• E pale i ka puhi a me ka kaupalena ʻana i ka waiʻona: Hiki i nā mea ʻelua ke hoʻonui i nā pilikia naʻau

E makaʻala i kou ʻike ʻana i kēlā me kēia lā. E mālama i kahi moʻolelo maʻalahi o nā hōʻailona e like me ka pōkole o ka hanu, ʻeha umauma, a i ʻole ka luhi maʻamau. Kēia ʻike e kōkua i kāu kauka e hahai i ka holomua ʻana o kāu kūlana.

Mai kānalua e hoʻokaʻaʻike i kāu hui olakino inā ʻike ʻoe i nā hōʻailona hou a i ʻole inā ʻoi aku ka maikaʻi o nā hōʻailona e noho nei. ʻOi aku ka maikaʻi o ka nānā ʻana a me ka hōʻoia ma mua o ka hopohopo ʻana i ka noʻonoʻo.

Pehea ʻoe e hoʻomākaukau ai no kāu kipa kauka?

ʻO ka hoʻomākaukau ʻana no kāu kipa e kōkua i ka hōʻoia ʻana e loaʻa iā ʻoe ka mea nui loa mai kou manawa me kāu mea lawelawe olakino. Hiki i ka hoʻomākaukau iki ke kōkua iā ʻoe e ʻike hou aku a hōʻoia i ka pane ʻia o kāu mau hopohopo āpau.

Ma mua o kāu kipa:

• E kākau i kāu mau hōʻailona: E komo pū me ka wā e hana ai a me nā mea e hoʻomaikaʻi ai a i ʻole ka ʻoi aku ka maikaʻi
• E papa inoa i nā lāʻau lapaʻau āpau: E komo pū me nā lāʻau lapaʻau, nā lāʻau lapaʻau ma luna o ka counter, a me nā mea hoʻohui
• E hoʻomākaukau i kāu mau nīnau: E kākau iā lākou i ʻole ʻoe e poina i ka wā o ka kipa
• E lawe mai i kahi mea kākoʻo: Hiki iā lākou ke kōkua iā ʻoe e hoʻomanaʻo i ka ʻike a hāʻawi i ke kākoʻo manaʻo
• E hōʻiliʻili i kāu mau moʻolelo lapaʻau: ʻOi aku hoʻi nā ho'āʻo naʻau a i ʻole nā ​​haʻawina imaging mua

ʻO nā nīnau maikaʻi e nīnau ai e komo pū ana: Pehea ka nui o ka stenosis aortic? Pehea ka pinepine e pono ai iaʻu nā ho'āʻo hahai? He aha nā hōʻailona e pono ai iaʻu e nānā? Aia nā hana e pono ai iaʻu ke pale aku? I ka wā hea paha e pono ai iaʻu ka hoʻololi valve?

E hoʻomanaʻo, makemake kāu hui olakino e kōkua iā ʻoe e hoʻomaopopo i kou kūlana a ʻoluʻolu me kāu papahana lapaʻau. Mai kānalua e noi no ka wehewehe inā ʻaʻole maopopo kekahi mea.

He aha ka lawe nui e pili ana i ka Stenosis Aortic?

He kūlana hiki ke mālama ʻia ka stenosis aortic i ka wā e hopu ʻia ai i ka wā mua a nānā pono ʻia. ʻOiai ke kani nei ka diagnosis e like me ka mea kaumaha i ka mua, e hoʻomanaʻo i nā lapaʻau i kēia lā ʻoi aku ka maikaʻi a emi invasive ma mua o ka wā ma mua.

ʻO ka mea nui loa ka mālama ʻana i ka pilina maʻamau me kāu hui olakino a ʻaʻole hoʻowahāwahā i nā hōʻailona inā hoʻomohala lākou. Nui nā kānaka me ka stenosis aortic e ola ana i nā ola piha, hana me ka mālama pono a me ka lapaʻau.

E kau i kou manaʻo i nā mea hiki iā ʻoe ke kaohi: ka lawe ʻana i nā lāʻau lapaʻau e like me ke kuhikuhi ʻia, ka noho ikaika i loko o kou mau palena, ka ʻai maikaʻi, a me ka mālama ʻana i kāu mau kipa hahai. Ua hana nui kou naʻau no ʻoe i kou ola a pau, a i kēia manawa ua hiki mai ka manawa e hāʻawi iā ia i ke kākoʻo e pono ai.

E hilinaʻi i kāu hui lapaʻau, e noho ʻike e pili ana i kou kūlana, a mai kānalua e hoʻokaʻaʻike i ka wā e loaʻa ai iā ʻoe nā nīnau a i ʻole nā ​​hopohopo. ʻAʻole ʻoe wale nō i ka mālama ʻana i kēia kūlana, a me ka mālama pono, hiki i kou manaʻo ke maikaʻi loa.

Nā Nīnau Pinepine e pili ana i ka Stenosis Aortic

Hiki ke ho'ōla piha ʻia ka stenosis aortic?

ʻAʻole hiki ke ho'ōla ʻia ka stenosis aortic me nā lāʻau lapaʻau, akā hiki ke mālama pono ʻia me nā kaʻina hana hoʻololi valve a i ʻole TAVR. Hiki i kēia mau lapaʻau ke hoʻihoʻi i ke kahe koko maʻamau a hoʻomaikaʻi nui i kou maikaʻi o ke ola.

Pehea ka wikiwiki o ka holomua ʻana o ka stenosis aortic?

ʻO ka maʻamau, holomua mālie ka stenosis aortic ma nā makahiki he nui, akā ʻokoʻa loa ka wikiwiki ma waena o nā kānaka. Hiki i kekahi poʻe ke loaʻa ka stenosis māmā e noho paʻa no nā ʻumi makahiki, ʻoiai kekahi poʻe e ʻike i ka holomua wikiwiki. E nānā kāu kauka i kou kūlana me nā echocardiograms maʻamau e hahai i nā loli a hoʻoponopono i kāu papahana lapaʻau e like me ia.

Palekana anei ka hoʻoikaika kino me ka stenosis aortic?

ʻO ka palekana hoʻoikaika kino e hilinaʻi ana i ka nui o kāu stenosis aortic a inā loaʻa iā ʻoe nā hōʻailona. Hiki i nā kānaka me ka stenosis māmā ke hoʻoikaika kino maʻamau, ʻoiai nā poʻe me ka stenosis waena a koʻikoʻi paha e pono paha e kaupalena i nā hana kiʻekiʻe. Hiki i kāu kauka ke hāʻawi i nā kuhikuhi hoʻoikaika kino kikoʻī ma muli o kāu kūlana pilikino a hiki ke paipai i kahi ho'āʻo hoʻoikaika kino e hoʻoholo i nā pae hana palekana.

Pono anei iaʻu e lawe i nā mea hoʻohaʻahaʻa koko ma hope o ka hoʻololi valve?

Inā pono ʻoe i nā mea hoʻohaʻahaʻa koko ma hope o ka hoʻololi valve e hilinaʻi ana i ke ʻano o ka valve āu e loaʻa ai. Pono nā valves mechanical i ka lāʻau hoʻohaʻahaʻa koko ola, ʻoiai ʻaʻole pono nā valves tissue i nā mea hoʻohaʻahaʻa koko lōʻihi ke ʻole ʻoe e loaʻa nā kūlana ʻē aʻe e like me ka atrial fibrillation. E kūkākūkā kāu hui naʻau i nā pono a me nā pōʻino o kēlā me kēia ʻano valve e kōkua iā ʻoe e hana i ka hoʻoholo maikaʻi loa no kou nohona.

Hiki i ka stenosis aortic ke hoʻokumu i ka make koke?

ʻOiai hiki i ka make naʻau koke ke hana me ka stenosis aortic koʻikoʻi i mālama ʻole ʻia, he mea kakaikahi ia a hana pinepine wale nō i ka wā e hoʻowahāwahā ai nā kānaka i nā hōʻailona koʻikoʻi no nā manawa lōʻihi. ʻO ia ke kumu e nui ai ka ʻimi ʻana i ka mālama lapaʻau inā loaʻa iā ʻoe ka ʻeha umauma, fainting, a i ʻole ka hanu koʻikoʻi. Me ka nānā pono a me ka lapaʻau koke, he haʻahaʻa loa ka pilikia o ka make naʻau koke.