Q: What are the most common types of trauma injuries you see on Maui?
Dr. Arthur Chasen, surgeon: I’d estimate that out of around 4,500 trauma cases that we see each year, about 700 are severe enough that the patient is admitted to the hospital. Unlike a big city hospital, we don’t see many things like gunshot and stab wounds, so the most common trauma we see is from blunt-type injuries like motor vehicle accidents and falls. Things like wearing a motorcycle helmet and using a child safety seat can make a big difference.
One of the main differences between Maui and places on the Mainland is how much ocean-related trauma we see. That includes everything from “tossed by a wave” patients who hurt their neck or back, to people with propeller injuries from being hit by boats, to the occasional shark encounter. We actually work with people like ocean safety officers and hotels on education and injury prevention.
Q: Does the Pacific Cancer Institute work with alternative therapies when a cancer patient makes that request?
Dr. Benjamin Fallit, radiation oncologist, Pacific Cancer Institute: I see many patients who want to incorporate alternative medicine into their cancer treatment regimen, and I feel it’s important to understand their preferences and meet them if it can be done safely.
When a patient wants to use alternative therapies, I first try to learn as much as I can about them, to make sure they won’t be harmful or have a negative interaction with radiation. While we don’t provide alternative therapies ourselves, we work closely with outside practitioners when patients request it. I never want a patient to turn away from traditional cancer treatment because they feel their belief system or experience isn’t being respected.
Q: I’m starting dialysis, and my doctor told me I need to have an artereovenous fistula created. What does that mean?
Dr. Michael Dang, thoracic and cardiovascular surgeon: You’re not alone — many of the dialysis patients I see are confused about why they need a fistula. It comes down to the needles that are used during hemodialysis. They’re much larger than the needles you usually see when you get a flu shot or have blood drawn. In fact, the vein in your arm isn’t large enough for these needles, so we need to make it bigger.
To create the fistula, a surgeon will connect the vein in your arm to an artery. The artery will then start pumping a higher volume of blood into the vein, increasing the pressure and causing the vein to expand and pop up under the skin slightly. This makes it possible for the needles to be inserted so that you can receive dialysis.
Most people find the fistula doesn’t bother them at all, but in some cases they can get bigger over time or need to be changed after a few years. When that happens we can place another fistula in the other arm, or even in the legs.
* Physicians, providers and administrative staff who practice at Maui Health System hospitals and clinics answer questions from the public in “Healthwise Maui,” which appears on Thursdays. Maui Health System operates Maui Memorial Medical Center, Maui Memorial Medical Center Outpatient Clinic, Kula Hospital & Clinic and Lana’i Community Hospital and accepts all patients. To submit a question, go to the website at mauihealthsystem.org/contact.