He aha ka Parathyroidectomy? Ke Kumu, ke Kaʻina Hana & Hoʻōla

ʻO ka Parathyroidectomy kahi hana ʻoki e wehe i hoʻokahi a ʻoi aku paha o kāu mau ʻāpana parathyroid. ʻO kēia mau ʻāpana liʻiliʻi ʻehā, kēlā me kēia ma kahi o ka nui o kahi hua laiki, e noho ana ma hope o kāu ʻāpana thyroid i kou ʻāʻī a mālama i nā pae calcium i loko o kou koko.

Ke lilo kēia mau ʻāpana i mea hana nui a i ʻole e ulu i nā maʻi maʻi, hiki iā lākou ke hoʻoulu i nā pilikia olakino koʻikoʻi ma ka hana ʻana i ka nui o ka hormone parathyroid. Hiki i kāu kauka ke ʻōlelo aku i kēia ʻoki e hoʻihoʻi i ke kaulike calcium maoli o kou kino a pale i nā pilikia e like me nā pōhaku kīkī, ka nalowale o ka iwi, a i ʻole nā pilikia o ka naʻau.

He aha ka parathyroidectomy?

ʻO ka Parathyroidectomy ka wehe ʻana i ka ʻoki ʻana i hoʻokahi a ʻoi aku paha o nā ʻāpana parathyroid ke hana pono ʻole lākou. ʻO kāu mau ʻāpana parathyroid he ʻehā mau ʻāpana liʻiliʻi, oval-like i hope o kou thyroid i kou ʻāʻī.

Hana kēia mau ʻāpana i ka hormone parathyroid (PTH), e hana ana e like me ka thermostat no ka calcium i loko o kou koko. Ke hāʻule nā pae calcium, haʻi ka PTH i kou mau iwi e hoʻokuʻu i ka calcium a me kou mau puʻupaʻa e komo i ka calcium hou mai kāu mimi.

I kekahi manawa, hoʻokahi a ʻoi aku paha o kēia mau ʻāpana e hoʻonui a i ʻole e ulu i nā maʻi maʻi maikaʻi i kapa ʻia ʻo adenomas. ʻO kēia ke kumu e hana ai lākou i ka nui o ka PTH, e alakaʻi ana i nā pae calcium kiʻekiʻe loa i loko o kou koko - kahi maʻi i kapa ʻia ʻo hyperparathyroidism.

Hiki i ke ʻoki ke komo i ka wehe ʻana i ka ʻāpana pilikia wale nō (inā hoʻokahi wale nō i hoʻopilikia ʻia) a i ʻole nā ʻāpana he nui e pili ana i kou kūlana kikoʻī. E hoʻoholo kāu kauka lapaʻau i ke ala maikaʻi loa e pili ana i nā hopena o kāu hoʻokolohua a me nā haʻawina kiʻi.

No ke aha e hana ʻia ai ka parathyroidectomy?

Hana ʻia ka Parathyroidectomy e mālama i ka hyperparathyroidism, kahi maʻi kahi e hana ai kāu mau ʻāpana parathyroid i ka nui o ka hormone. ʻO kēia hormone nui e hoʻoulu ai i nā pae calcium i loko o kou koko e piʻi nui loa, hiki ke hōʻino i nā ʻōkana he nui i ka manawa.

ʻO ke kumu maʻamau no kēia ʻoki ʻana, he maʻi maʻi maikaʻi i kapa ʻia he parathyroid adenoma, e pili ana i ka 85% o nā kānaka me ka hyperparathyroidism. ʻAʻole maʻi ʻaʻai kēia mau maʻi, akā hana lākou i ka hana nui o ka ʻōpū i hoʻopilikia ʻia, e hana ana i nā mea nui o ka hormone parathyroid.

Hiki i kāu kauka ke ʻōlelo aku i ka ʻoki ʻana inā e ʻike ana ʻoe i nā hōʻailona e pili ana i kou ola maikaʻi. Hiki i nā pae calcium kiʻekiʻe ke hoʻoluhi iā ʻoe, huikau, a i ʻole kaumaha, a hiki iā ʻoe ke ʻike i ka nāwaliwali o ka ʻiʻo a i ʻole ka mimi pinepine.

He mea wikiwiki ka ʻoki ʻana inā e loaʻa iā ʻoe nā pilikia koʻikoʻi. Hiki i kēia mau mea ke komo i nā pōhaku kīkī, ka nalowale o ka iwi e alakaʻi ana i ka osteoporosis, nā pilikia o ka puʻuwai, a i ʻole ka pōʻino o ke kīkī mai nā pae calcium kiʻekiʻe mau.

ʻAʻole maʻamau, mālama ka ʻoki ʻana i ka maʻi ʻaʻai parathyroid, e hana ana i ka liʻiliʻi ma mua o 1% o nā hihia. ʻO nā kūlana laha ʻole e like me nā maʻi neoplasia endocrine lehulehu e koi pū i kēia kaʻina hana e pale ai i nā pilikia e hiki mai ana.

He aha ke kaʻina hana no ka parathyroidectomy?

Hoʻokō ʻia ka parathyroidectomy ma lalo o ka anesthesia maʻamau a lawe ma kahi o 1-2 mau hola. E hana kāu kauka lapaʻau i kahi ʻoki liʻiliʻi ma ka ʻaoʻao haʻahaʻa o kou ʻāʻī, ma kahi o 2-3 iniha ka lōʻihi.

I ka wā o ka ʻoki ʻana, e hoʻokaʻawale pono kāu kauka lapaʻau i nā ʻiʻo a me nā ʻiʻo e hiki ai i kāu mau ʻōpū parathyroid. E nānā lākou i kēlā me kēia ʻōpū e ʻike i nā mea i hoʻonui ʻia a i ʻole nā mea maʻamau ʻole, e hoʻohana pinepine ana i nā ʻenehana kūikawā e mālama i kāu mau aʻalolo pahu leo.

Inā hoʻokahi wale nō ʻōpū i hoʻopilikia ʻia, e wehe kāu kauka lapaʻau i kēlā ʻōpū i kahi kaʻina hana i kapa ʻia ʻo ka parathyroidectomy i kālele ʻia. Hoʻohana kēia ala hana liʻiliʻi i kahi ʻoki liʻiliʻi a hiki ke hoʻōla wikiwiki.

Ke pili nā ʻōpū he nui, hiki i kāu kauka lapaʻau ke hana i kahi kaʻina hana nui. Hiki iā lākou ke wehe i 3½ mau ʻōpū, e waiho ana i kahi ʻāpana liʻiliʻi o ka ʻiʻo olakino e mālama i kekahi hana parathyroid, a i ʻole e hoʻololi i kekahi ʻiʻo olakino i kou lima.

I loko o ke ʻoki ʻana, hiki i kāu kauka lapaʻau ke hoʻāʻo i nā pae o kāu hormone parathyroid i ka manawa maoli. Kōkua kēia i ka hōʻoia ʻana ua wehe lākou i nā ʻōpū kūpono a ke emi nei nā pae o kāu hormone.

Hoʻohana kekahi mau kauka lapaʻau i nā ʻenehana kiʻekiʻe e like me ka nānā ʻana i nā aʻalolo i ka wā o ka hana e pale ai i kou mau kaula leo, a i ʻole nā ala liʻiliʻi e hoʻohana ana i nā ʻoki liʻiliʻi me ke kōkua o nā kiʻi kūikawā a i ʻole nā mea hana ʻoki.

Pehea e hoʻomākaukau ai no kāu parathyroidectomy?

Hoʻomaka kāu hoʻomākaukau ʻana me kahi loiloi olakino piha e hōʻoia ai ua mākaukau ʻoe no ke ʻoki. E nānā kāu kauka i kāu mau lāʻau lapaʻau, ʻoiai nā mea hoʻoheheʻe koko, a hiki iā lākou ke noi iā ʻoe e hooki i kekahi mau lāʻau lapaʻau ma mua o ke kaʻina hana.

Pono ʻoe e hoʻonohonoho i kekahi e hoʻokele iā ʻoe i ka home ma hope o ke ʻoki ʻana, no ka mea, ʻaʻole hiki iā ʻoe ke hoʻokele i ke kaʻa i ka wā e ola ana mai ka anesthesia. E hoʻolālā e loaʻa i kahi hoaaloha a i ʻole ʻohana e noho pū me ʻoe no nā hola 24 mua ma hope o kāu kaʻina hana.

E hāʻawi kāu hui ʻoki iā ʻoe i nā ʻōlelo kikoʻī e pili ana i ka ʻai a me ka inu ʻana ma mua o ke ʻoki. ʻO ka maʻamau, pono ʻoe e pale i ka meaʻai a me nā wai no 8-12 mau hola ma mua o kāu kaʻina hana e pale ai i nā pilikia i ka wā o ka anesthesia.

E hoʻomākaukau i kou home no ka hoʻōla ʻana ma ka hoʻonohonoho ʻana i kahi wahi hoʻomaha ʻoluʻolu me nā uluna keu e mālama i kou poʻo i luna. E kūʻai i nā meaʻai palupalu a loaʻa nā pūʻolo hau i mākaukau, no ka mea, hiki i kēia mau mea ke kōkua i ka hōʻemi ʻana i ka pehu ma hope o ke ʻoki.

Inā puhi ʻoe, e hoʻāʻo e haʻalele a i ʻole e hōʻemi i ka puhi ʻana ma mua o ke ʻoki ʻana, no ka mea, hiki i kēia ke hoʻomaikaʻi i kāu hana hoʻōla. Hiki i kāu kauka ke ʻōlelo aku i kekahi mau mea hoʻohui a i ʻole nā lāʻau lapaʻau e kōkua i ka mālama ʻana i kāu pae calcium ma mua a ma hope o ke kaʻina hana.

Pehea e heluhelu ai i kāu hopena parathyroidectomy?

Hoʻoholo ʻia ka holomua ma hope o ka parathyroidectomy e ka hoʻi ʻana o kāu calcium a me nā pae hormone parathyroid i nā pae maʻamau. E nānā kāu kauka i kēia mau pae i loko o nā hola ma hope o ke ʻoki ʻana a e hoʻomau i ka nānā ʻana iā lākou i ka wā o kou ola ʻana.

ʻO ka pae maʻamau o ka calcium maʻamau mai ka 8.5 a 10.5 mg/dL, akā e noʻonoʻo kāu kauka i kāu kumu pilikino. Pono ʻoe e ʻike i ka hāʻule ʻana o kāu pae calcium i loko o 24 mau hola ma hope o ke ʻoki ʻana inā ua holomua ke kaʻina hana.

E hoʻāʻo ʻia nō hoʻi kāu pae hormone parathyroid maʻamau. ʻO ka pae PTH maʻamau mai kahi 15 a 65 pg/mL, a pono e hoʻoponopono ʻia kēia mau mea i loko o nā lā a i ʻole nā pule ma hope o ka wehe ʻana i nā ʻōpū hana nui.

I kekahi manawa, hiki i kāu pae calcium ke hāʻule haʻahaʻa loa no ka manawa pōkole, kahi maʻi i kapa ʻia ʻo hypocalcemia. Hana ʻia kēia no ka mea pono nā ʻōpū parathyroid i koe i ka manawa e hoʻoponopono ai a hoʻomaka hou e hana pono ma hope o ka hoʻopaʻa ʻia ʻana no ka manawa lōʻihi.

E nānā kāu kauka i kāu mau hōʻailona a me nā hopena o kāu lab. Hiki i ka hoʻomaha ʻana mai nā hōʻailona e like me ka luhi, nāwaliwali o nā ʻiʻo, a i ʻole ka noe noʻonoʻo ke lawe i kekahi mau pule a i ʻole mau mahina i ka wā e hoʻoponopono ai kou kino i nā pae calcium maʻamau.

ʻO ka nānā ʻana i ka wā lōʻihi e pili ana i ka nānā ʻana i ka hoʻomaikaʻi ʻana i ke olakino o ka iwi, ka hana o ka puʻupaʻa, a me ka hōʻoia ʻana e hoʻomau ana kāu mau ʻōpū parathyroid e hana pono. ʻO ka hapa nui o nā kānaka e ʻike i ka hoʻomaikaʻi ʻana i ka paʻa o ka iwi a me ka hana o ka puʻupaʻa i nā mahina ma hope o ke ʻoki ʻana.

Pehea e mālama ai i kou ola ma hope o ka parathyroidectomy?

Ke nānā nei kāu ola i ka mālama ʻana i nā pae calcium a me ka ʻae ʻana i kou ʻāʻī e hoʻōla pono. ʻO ka hapa nui o nā kānaka e hele i ka home i ka lā hoʻokahi a i ʻole ma hope o ka noho ʻana i ka haukapila i ka pō, ma muli o kā lākou pae calcium a me ke olakino holoʻokoʻa.

Pono paha ʻoe i nā mea hoʻohui calcium a me ka huaora D i ka wā mua, i ka wā e hoʻoponopono ai kāu mau ʻōpū parathyroid i koe i kā lākou hana hou. E kuhikuhi kāu kauka i nā ʻano kikoʻī e pili ana i nā hopena o kāu hoʻāʻo koko a hoʻoponopono iā lākou e like me ka mea e pono ai.

E nānā i nā hōʻailona o ka calcium haʻahaʻa, hiki ke komo i ka ʻūlū a puni kou waha a i ʻole i kou mau manamana lima, nā ʻiʻo ʻiʻo, a i ʻole ka hopohopo. Hoʻomaikaʻi maʻamau kēia mau hōʻailona i ka wā e paʻa ai kāu pae calcium, akā e kelepona i kāu kauka inā koʻikoʻi a mau paha.

E mālama i kāu ʻoki ʻana ma ka mālama ʻana iā ia i ka maʻemaʻe a me ka maloʻo, a e pale i ka hāpai ʻana i nā mea kaumaha a i ʻole nā hana ikaika no kahi o 2 pule. Hiki i ka hapa nui o nā kānaka ke hoʻi i ka hana ma ka pākaukau i loko o kekahi mau lā, akā pono paha nā hana kino i kahi manawa hoʻōla lōʻihi.

Hiki ke ʻokoʻa a nāwaliwali paha kou leo i ka wā mua ma muli o ka pehu ʻana kokoke i kou mau kaula leo. Hoʻomaikaʻi maʻamau kēia i loko o nā lā a i nā pule, akā e haʻi i kāu kauka inā mau nā loli leo ma mua o kekahi mau pule.

He aha nā hopena maikaʻi loa ma hope o ka parathyroidectomy?

ʻO ka hopena maikaʻi loa ka loaʻa ʻana o nā pae calcium maʻamau a me ka hormone parathyroid e mau ana i ka wā lōʻihi. ʻO ka hapa nui o nā kānaka e ʻike i kēia kūleʻa, me nā helu hoʻōla ma mua o 95% ke hana ʻia e nā kauka lapaʻau i ʻike ʻia.

ʻO nā hopena maikaʻi loa e pili ana i ka hoʻomaha ʻana mai nā hōʻailona i lawe iā ʻoe i ke ʻoki ʻana i ka wahi mua. Nui ka poʻe e ʻike i ka hoʻomaikaʻi ʻana i nā pae ikehu, ka maikaʻi o ka naʻau, ka noʻonoʻo maopopo, a me ka nāwaliwali o nā ʻiʻo i loko o nā pule a i nā mahina.

ʻO nā pōmaikaʻi lōʻihi e pili ana i ka pale ʻana mai nā pilikia koʻikoʻi e like me nā pōhaku kīkī, ka nalowale o ka iwi, a me nā pilikia o ka naʻau. Hoʻomaikaʻi pinepine kāu hana kīkī, a hiki i kou mau iwi ke ikaika i ka manawa e like me ka hoʻoponopono ʻana o ka calcium.

Hiki mai nā hopena maikaʻi loa ke mālama ʻoe i ka mālama maʻamau a lawe i nā mea hoʻohui i kuhikuhi ʻia e like me ke kuhikuhi. E nānā kāu kauka i kāu holomua a hoʻoponopono i nā lāʻau lapaʻau e hōʻoia i ka noho ʻana o kāu mau pae calcium i ka pae olakino.

He mea nui ka hoʻomaikaʻi ʻana i ka maikaʻi o ke ola, me ka nui o nā kānaka e wehewehe ana i ka manaʻo e like me lākou iho ma hope o nā makahiki o nā hōʻailona maʻalahi ʻaʻole lākou i ʻike e pili ana i ko lākou kūlana parathyroid.

He aha nā mea pilikia no ka pono o ka parathyroidectomy?

He mea nui ka makahiki a me ke kāne i kou pilikia, me nā wahine ma luna o 50 e pili pinepine ʻia. Loaʻa i nā wahine postmenopausal nā helu kiʻekiʻe o nā pilikia parathyroid, ma muli paha o nā loli hormonal e pili ana i ka metabolism calcium.

Hiki i kekahi mau maʻi genetic ke hoʻonui i kou pilikia, me nā maʻi neoplasia endocrine lehulehu a me ka familial hypocalciuric hypercalcemia. Inā he mau lālā ʻohana ou me nā pilikia parathyroid, hiki iā ʻoe ke hoʻonui i ka pilikia o ka hoʻomohala ʻana iā lākou iho.

Hiki i ka hōʻike ʻana i ka radiation ma mua i kou ʻāʻī, ʻoi aku hoʻi i ka wā kamaliʻi, ke hoʻonui i kou pilikia o ka hoʻomohala ʻana i nā maʻi parathyroid ma hope o ke ola. Aia kēia i nā lapaʻau radiation no nā maʻi ʻē aʻe a i ʻole nā ​​hana lapaʻau kahiko i hoʻohana i ka radiation.

Hiki i ka maʻi kīkī lōʻihi ke hoʻopilikia i kāu mau ʻōpū parathyroid, i kekahi manawa e alakaʻi ana i ka hyperparathyroidism lua e pono ai ka lapaʻau ʻoki. Hiki i ka nele o ka huaora D koʻikoʻi i nā makahiki he nui ke kōkua i nā pilikia parathyroid.

Hiki i kekahi mau lāʻau lapaʻau, ʻo ia hoʻi ka lithium i hoʻohana ʻia no nā maʻi naʻau, ke hoʻopilikia i ka hana parathyroid i ka manawa. Hiki i kekahi poʻe e lawe ana i ka lithium no ka manawa lōʻihi ke hoʻomohala i nā adenomas parathyroid e pono ai ka wehe ʻana i ka ʻoki.

He aha nā pilikia hiki ke loaʻa o ka parathyroidectomy?

ʻO ka pilikia maʻamau ka haʻahaʻa o ka calcium, e pili ana i ka 10-30% o nā kānaka ma hope o ke ʻoki. Hoʻoponopono maʻamau kēia i loko o nā lā a i ʻole nā ​​wiki e hoʻomaka hou ana kāu mau ʻōpū parathyroid e hana maʻamau.

Hiki ke loli ka leo inā pili ke ʻoki i nā aʻalolo e hoʻomalu i kou mau kaula leo. ʻO ka hapa nui o nā loli leo he manawa pōkole a hoʻoponopono i loko o nā pule, akā ʻo nā loli leo mau e hana ʻia ma lalo o 1% o nā hihia ke hana ʻia e nā kauka lapaʻau i ʻike ʻia.

He mea maʻamau akā hiki ke loaʻa ke koko a i ʻole ka maʻi ma ka pūnaewele ʻoki. ʻO nā hōʻailona e pili ana i ka pehu ʻana, ka ʻulaʻula, ka mahana, a i ʻole ka wai mai kāu ʻoki, a pono kēia i ka lāʻau lapaʻau koke.

ʻO ka hypoparathyroidism mau kahi pilikia maʻamau akā koʻikoʻi kahi e wehe ʻia ai ka nui o ka ʻiʻo parathyroid, e waiho ana iā ʻoe e hiki ʻole ke mālama i nā pae calcium maʻamau. Pono kēia i ka hoʻohui calcium a me ka huaora D i ke ola.

I ka wā maʻamau, hiki i nā kānaka ke loaʻa i ka hyperparathyroidism mau a i ʻole ka hoʻi hou ʻana inā ʻaʻole i wehe ʻia ka ʻiʻo maʻamau a i ʻole inā ua pili nā ʻōpū he nui. Pono paha kēia i ka ʻoki hou a i ʻole nā lapaʻau ʻē aʻe.

ʻO nā pilikia maʻamau loa e pili ana i ka pōʻino i nā mea kokoke e like me ka esophagus a i ʻole nā moku koko nui, akā hiki mai kēia ma lalo o 1% o nā kaʻina hana ke hana ʻia e nā kauka lapaʻau akamai.

I ka manawa hea wau e ʻike ai i ke kauka ma hope o ka parathyroidectomy?

E hoʻokaʻaʻike koke i kāu kauka inā loaʻa iā ʻoe nā hōʻailona koʻikoʻi o ka calcium haʻahaʻa, me nā spasms ʻiʻo, nā ʻeha nui, a i ʻole ka ʻūlū e laha ana ma waho o kou waha a me nā manamana lima. Hiki i kēia mau hōʻailona ke hōʻike i nā pae calcium haʻahaʻa.

E kelepona i kāu mea mālama ola inā ʻike ʻoe i nā hōʻailona o ka maʻi a puni kāu ʻoki, e like me ka ʻulaʻula nui, ka mahana, ka pehu, a i ʻole ka wai e like me ka pus. ʻO ke kuni ma luna o 101°F (38.3°C) ma hope o ka lā mua e pono ai ka nānā koke.

E ʻimi i ka mālama olakino inā loaʻa iā ʻoe ka pehu ʻāʻī nui a i ʻole ka pilikia o ka hanu a i ʻole ka ʻai ʻana. ʻOiai he mea maʻamau, hiki i kēia mau hōʻailona ke hōʻike i ke koko a i ʻole ka pehu e pono ai ka mālama wikiwiki.

E hoʻonohonoho i kahi manawa ukali inā mau nā loli o kou leo ​​ma mua o 2-3 pule a i ʻole inā ʻike ʻoe i kou leo ​​e nāwaliwali ana ma mua o ka hoʻomaikaʻi ʻana. Hoʻoponopono ka hapa nui o nā loli leo ​​ma ko lākou iho, akā pono paha nā pilikia mau i ka loiloi.

E hoʻokaʻaʻike i kāu kauka inā manaʻo ʻoe ua luhi loa, huikau, a i ʻole kaumaha i kekahi mau pule ma hope o ke ʻoki ʻana, no ka mea, hiki i kēia mau mea ke hōʻike i nā kaulike calcium e pono ai ka hoʻoponopono ʻana i kāu mau lāʻau lapaʻau.

Nā nīnau i nīnau pinepine ʻia e pili ana i ka parathyroidectomy

Q.1 He maikaʻi anei ka parathyroidectomy no nā pōhaku kīkī?

ʻAe, hiki i ka parathyroidectomy ke kōkua nui i ka pale ʻana i nā pōhaku kīkī i hana ʻia e nā pae calcium kiʻekiʻe. Ke hana nui nā ʻōpū parathyroid i ka hormone, hele ka calcium nui i loko o kou koko ma kou mau kīkī, e hoʻonui ana i kou pilikia o ka hana ʻana i nā pōhaku kīkī i hana ʻia me ka calcium.

Ma hope o ke ʻoki kūleʻa, hoʻi nā pae calcium i ka maʻamau, e hōʻemi nui ana i kou pilikia o ka hoʻomohala ʻana i nā pōhaku kīkī hou. Nui ka poʻe i ʻike e hoʻoponopono loa ʻia kā lākou pilikia pōhaku kīkī ma hope o ka parathyroidectomy.

Q.2 Ua hana anei ka calcium haʻahaʻa ma hope o ka parathyroidectomy i nā pilikia mau loa?

He manawa pōkole ka calcium haʻahaʻa ma hope o ka parathyroidectomy a ʻaʻole ia e hana i nā pilikia mau loa. Pono ka manawa o kāu mau ʻōpū parathyroid e koe e

Hiki paha i kekahi mau hōʻailona e like me ka ʻeha o ka iwi a i ʻole ka nāwaliwali o ka ʻiʻo ke lōʻihi ka manawa e hoʻoponopono piha ai. Hoʻōla nā kānaka a pau i ko lākou wikiwiki ponoʻī, a e nānā kāu kauka i kou holomua me nā hoʻokolohua koko maʻamau a me nā nānā.

Q.5 Pono anei au e lawe i nā mea hoʻohui calcium mau loa ma hope o ka parathyroidectomy?

ʻAʻole pono ka hapa nui o nā kānaka e lawe i nā mea hoʻohui calcium mau loa ma hope o ka parathyroidectomy. I ka wā mua, pono paha ʻoe i nā mea hoʻohui calcium a me ka huaora D i ka wā e hoʻoponopono ai kāu mau ʻāpana parathyroid i koe a hoʻomaka e hana maʻamau hou.

E hoʻemi mālie kāu kauka i kāu mau mea hoʻohui i ka wā e paʻa ai kāu pae calcium. Nui ka poʻe hiki ke hooki i ka hoʻohui ʻana i ka hopena, akā pono paha kekahi e hoʻomau i ka lawe ʻana i ka huaora D a i ʻole nā mea liʻiliʻi o ka calcium no ka wā lōʻihi.