February 22, 2012

JAPAN: Emperor's care process grows more open

TOKYO, Japan / The Japan Times / News / February 22, 2012

Trying to make the Imperial family appear less aloof toward the public, Emperor Akihito has become more open about his health, in contrast to his father's era, when such information was usually kept under wraps.
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Pre-op: Emperor Akihito is greeted by doctors as he arrives Friday at University of Tokyo Hospital before his surgery.POOL
Although the handling of information surrounding medical care for an Imperial family member has changed with the times, so too has the type of treatment, with the Emperor opting for an invasive procedure — heart bypass surgery — that in a previous era may have been avoided.
On Saturday, the Emperor, 78, underwent a coronary-artery bypass for angina after an angiogram showed a narrowing of two of his three coronary arteries.
While it was possible for him to continue to receive nonsurgical medical treatment, the Emperor, based on advice from his physicians, decided to go through with the operation as a way to improve his overall health and continue to carry out his duties.
The doctors said the four-hour operation was a success and the Emperor is on a recovery track.
His choice to have surgery to correct the heart problem and the announcements about the process have shown that information about his health has become more open and that there are now more treatment options for members of the Imperial household.
While the increase in openness involving medical care may have played a part in the change, it also likely comes from the Emperor's desire to be fit enough to fulfill his official duties and his willingness to choose an aggressive form of treatment.
"There may be an unstable period for a while (after the surgery), but I very much hope that he will pass this time and begin taking walks every morning and playing tennis," said Ichiro Kanazawa, the Imperial household's main doctor.
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Mission accomplished: Juntendo Hospital surgeon Atsushi Amano speaks to the press after the successful heart bypass surgery on Emperor Akihito at University of Tokyo Hospital on Saturday.POOL
This situation is in stark contrast with his father, Emperor Hirohito, known posthumously as Emperor Showa.
In April 1987, he threw up at a ceremony for his 86th birthday and three months later collapsed at an Imperial villa in Tochigi Prefecture. That September, he had intestinal bypass surgery, the first time he underwent a surgical procedure.
Some of his physicians, however, were against the idea of conducting open abdominal surgery.
And when he was diagnosed with cancer in a pathological test conducted just after the operation, the Imperial Household Agency refrained from disclosing the truth to the public and instead announced that he had chronic pancreatitis.
The agency did not inform him about his cancer, but told then Crown Prince Akihito about his father's condition and the course of treatment.
Akira Takagi, then chief physician to the Emperor, later explained that the agency did not inform the monarch about the cancer so he would be able to live a long life without any pain by avoiding aggressive treatment. The Imperial Household Agency is more open about how it handles the current Emperor's health.
In 2003, when he underwent surgery for prostate cancer, the agency openly announced that cancer cells had been found and did not hesitate to disclose that he was to start receiving hormone treatment to prevent a recurrence, and that an exercise regimen was to be introduced to avoid brittle-bone disease, a side effect of hormone treatment.
Partly behind this is the Emperor's unwavering stance that the public must be informed when he has to change the schedule of his official duties or undergo medical treatment.
"Emperor Showa and the current Emperor are both scholars in science," said an agency official familiar with the earlier era. "They judge their own health conditions scientifically and have trust in medical treatment. The only difference is perhaps the times."
On how to manage the Emperor's health following his heart surgery, an Imperial Household Agency official pointed to stress as one of the major factors that may weigh on his condition going forward but added that simply cutting down on his official duties may not be the answer to reducing stress.
Isao Tokoro, a professor at Kyoto Sangyo University who has written several books related to the Imperial family, suggested that the Emperor's sons — Crown Prince Naruhito and Prince Akishino — should share his burden of conducting official duties, except for those involving state affairs.
"Even if he does not go to as many places in person, it is still possible (for the Emperor) to express sympathy for the people," Tokoro said, adding that many survivors of the devastating earthquake and tsunami last March were encouraged by a video message he released.
(C) The Japan Times

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