Healthwise Maui

Q: I’ve read that Maui now has a new oncological surgeon. Can cancer patients be treated on Maui now or are there still certain procedures that need to be done on Oahu or on the Mainland?

Dr. Derrick Beech, surgical oncologist, Maui Memorial Outpatient Clinic: The recent arrival of a surgical oncologist (also known as a cancer surgeon) on Maui has added to the capabilities of our existing surgeons and expanded the range of care provided on Maui, providing Maui residents the opportunity to receive their cancer treatment without leaving the island. Specializing in treating patients with complex malignancies, areas of expertise for the new surgeon include liver, pancreatic, stomach, breast, colon and rectal cancers; melanoma; and sarcoma. High-risk patients or people with a strong family history of cancer can also receive genetic testing and genetic counseling, when appropriate (especially for breast, ovarian and colon cancers).

Q: What causes high blood pressure?

Dr. Anil Punjabi, cardiologist, Ohana Heart: Blood pressure is essential for maintaining perfusion to vital organs, such as but not limited to your kidneys, brain, gut and muscles. Your blood pressure is a product of the amount of blood the heart pumps out and the tone/resistance of your arterial blood vessels. Based on changes in your body, different hormones regulate this to create an even level of perfusion, known as homeostasis. It is incredible how our bodies have adapted the ability to regulate the amount of blood. The brain senses whether we are dehydrated and sick versus if we are running a marathon. High blood pressure or hypertension usually occurs when there is an increase in the blood volume being pumped out or an increase in the resistance of the blood vessels, which is primarily dictated by the muscles that live in the artery walls.

The most common type of high blood pressure is benign essential hypertension, now renamed primary hypertension, since it really is not benign. No one has a clear understanding of its mechanism, but we do know that there is a complex interplay of blood volume with hormones created by your kidneys and adrenal glands. There are certain risk factors to look out for that increase the likelihood of high blood pressure, such as older age, obesity, family history, being of African American ethnicity, having a high sodium intake, alcohol consumption and physical inactivity.

In other cases, high blood pressure is a secondary consequence of another process, such as kidney disease, sleep apnea, blood vessel issues, side effects of both illicit and prescribed drugs or from hormone imbalances.

Many people with high blood pressure have no symptoms. Even though it’s silent, the long-term consequences can be life altering or even fatal. High blood pressure is one of the largest risk factors for having a stroke, developing heart failure, kidney failure or even having a heart attack. That’s why it’s important to talk with your doctor about getting checked. If you do have high blood pressure, he/she may recommend additional tests to determine the cause, and they might ask you to monitor your blood pressure at home.

There are many lifestyle changes that can help control blood pressure, including reducing your salt intake, eating a heart-healthy diet with plenty of fruits and vegetables, maintaining a healthy weight, limiting alcohol consumption and exercising regularly. But if those changes aren’t enough, your doctor can also prescribe medication to help keep your blood pressure at safe levels.

* 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.


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