It’s “Voggy” out there… What are the long term effects of vog (volcanic pollution)?

shutterstock_153524036Vog is a form of air pollution that results when sulfur dioxide and other gases and particles emitted by an erupting volcano react with oxygen and moisture in the presence of sunlight. The word is a portmanteau of the words “volcanic” and “smog“. The term is in common use in the Hawaiian islands, where the Kīlauea volcano, on Hawaiʻi Island (aka “The Big Island”), has been erupting continuously since 1983. Based on June 2008 measurements, Kīlauea emits 2,000 – 4,000 tons of sulfur dioxide every day.

Vog poses a health hazard by aggravating preexisting respiratory ailments, and acid rain damages crops and can leach lead into household water supplies. The U.S. Geological Survey’s Hawaiian Volcano Observatory is closely monitoring gas emissions from Kilauea and working with health professionals and local officials to better understand volcanic air pollution and to enhance public awareness of this hazard.

Like smog, the presence of vog reduces visibility. Moisture in the air causes vog particles to enlarge, decreasing visibility still further. On the Island of Hawai`i, people often turn their headlights on during daylight hours when driving in vog, and vog sometimes limits visibility for air traffic.

By Roger Mari –

KEWALO BASIN (KHNL) – Months of heavy vog might have some wondering what the long term affects the sulfur oxide in the air has on our health.

A respiratory expert shared information on a study of volcanic pollution.   The results might come as a surprise to many.

Leading the ongoing research is Doctor Elizabeth Tam.  She believes volcanic pollution or vog can trigger an asthma attack in people including children already diagnosed with the condition.

“We don’t think volcanic air polution actually causes asthma,” said Dr. Tam.

The March eruption of Kilauea’s Halemaumau crater sent large amounts of sulfur dioxide into the air making for more voggy days this year.   Not ideal for photographs, jogging and other outdoor activities, but the vog provides the perfect lab for research.

“There have been times we’ve been in the schools studying, doing our thing and the air polution is much more than before,” Tam said.

The group of children were first examined before they were teens.   Voggy days had the usual effects on them as they would on those who were otherwise healthy.

“We get more of the upper respiratory effects nose, eyes, stinging throat etc., but it doesn’t appear to be asthma,” said Tam.

Researchers including Doctor Tam, will continue the study on the select group of children which began six years ago.

“We’re actually studying the long term effects of the kids, so we continue to study the children which is good,” she said.

So far vog does not appear to be the cause of asthma in the select group of big island children.

But one thing is certain, island residents could be living with vog for years to come.

The idea is to study the children as they grow up.   They were as young as 12 to 14 when research began.

The plan is to monitor their respiratory conditions until they are 18.


Why is the Side of My face Drooping? All about Bell’s Palsy

shutterstock_142857034A few weeks ago a family brought their son in to the clinic because one side of his face including his eye and lips were not moving symmetrically with the other side.  Of course they were worried about the possibility of him having a stroke.  He’d had an upper respiratory infection that started about one week before and had a slight fever with runny nose.  He’d never had any neurological problems before.  He had a condition called Bell’s Palsy.

Bell’s Palsy is a problem with the nerves on one side of the face and it causes the muscles of the face to have decreased ability to move.  The muscles of the face can become weak or even paralyzed.  Patients often complain that one of their eyelids starts drooping or they drool out one side of their mouth.  When they smile, one half of the mouth doesn’t seem to move.

Most people who get Bell’s palsy recover entirely but a small number of patients have symptoms for the rest of their life.

Causes:  Inflammation of the facial nerve on one side of the face is the cause of Bell’s palsy.  A virus is the cause and there is some evidence that it’s the virus that causes cold sores (Herpes Simplex Virus – HSV) that causes the condition.  Other viruses may cause Bell’s palsy however including the viruses that cause Chicken Pox and Mononucleosis.

Symptoms:  When the facial nerve because inflamed from the virus, and the nerve may swell and get pinched as it travel’s through some tight spaces in the face.  If this happens it can cause weakness and even paralysis of the muscles of the face so you may see:

1)   Drooping of one eyelid

2)   Eyebrow that sags

3)   Corner of the mouth that does not move or sags

4)   One eye might not close completely

5)   Loss of taste in the front of the tongue

6)   Loud noises may cause pain on the side of the dysfunction

If your eye is not able to fully close, this can lead to dryness of the eye, so it’s important to seek treatment to prevent eye damage.

Treatment:  We don’t have any specific treatments for Bell’s palsy, but seeing a medical provider may be helpful to:

1)   Ensure the proper diagnosis, because the symptoms may be confused with a stroke or other neurological problems which can be dangerous if not treated appropriately

2)   Prevent damage to the cornea of your eye from dryness

3)   Steroids such as prednisone may be given to reduce the swelling of the affected facial nerve – this works better when started within the first 2-3 days of symptoms

4)   Antiviral medications such as acyclovir are sometimes given in hopes that they will help the body overcome the virus more quickly, however studies have not found any added benefits from using antiviral medications for Bell’s palsy

Recovery/Prognosis:  People who have less severe symptoms seem to recover more rapidly and have a better chance of full recovery.  If you are getting better within the first three weeks, the chances are better that you will totally recover.  A small group of people however have permanent moderate to severe muscle weakness in their face from Bell’s palsy.

Rare effects:  If there is severe damage to the facial nerve, it may heal in a disorganized fashion.  I have one patient who was bothered by tears coming from their eye when they salivate (before eating).   I’ve also had a patient whose eye would close whenever he smiled.  Fortunately this is not common with Bell’s palsy.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


All about Bloody Noses – Epistaxis

shutterstock_80516140A patient came into the urgent care today with a bloody nose after being hit with a baseball in the nose while playing catch.  The bleeding was so intense that blood was actually coming up through the tear ducts of his eyes.  His nose had been bleeding for about an hour prior to me seeing him and by that he came to the exam room the bleeding had almost stopped.

Nosebleeds can be dramatic and frightening but usually they stop on their own without need for intervention by a doctor.  I do however have some recommendations about what to do if you get a bloody nose (also called epistaxis) that will not stop.

1)   If your nose has been bleeding for awhile and is not stopping, blow all that goo that’s in the affected nostril out. This might cause the bleeding to increase temporarily and that’s ok.

2)   Get into a comfortable position and relax.  Don’t lay on your back, just sit up straight.

3)   If you have some Afrin (Oxymetazoline)

spray into the affected nostril.  It’s a nasal decongestant and causes the blood vessels to shrink down and this slows the bleeding down

4)   Grip the soft part of your nose  – both notrils (do not grip the bony part of the nose as that will not stop the bleeding).  Hold pressure over the nose for 15 minutes.  This is easier said than done.  You need to have a watch with you and actually keep holding pressure without letting go for the entire 15 minutes.  I’ve asked patients to hold pressure for this period of time and watched them let the pressure off after 2 minutes, thinking that they’d held for long enough, so make sure you have a watch and time this procedure.  If you take the pressure off too early, the bleeding will restart

5)   If, after performing all the above treatments your nose is still bleeding then you need to come in for evaluation.

There are two main types of nosebleeds.  The most common type is the anterior nosebleed that starts towards the front of the nose and causes blood to flow out through one of the nostrils.  The other type originates in the back of the nose near the throat.  Posterior nosebleeds are much less common and can be serious because stopping the bleeding can be more difficult.

When to seek medical care:

1)   The bleeding makes it difficult to breathe

2)   You become disoriented or light-headed

3)   The bleeding doesn’t stopped after you’ve tried the steps above

4)   You’ve recently had nasal surgery

5)   You’re having other symptoms such as chest pain

6)   You’ve had facial trauma and may have broken your nose

7)   You’re bleeding won’t stop and you’re taking a blood thinner such as Coumadin or Plavix

Prevention:  Some people seem to have issues with frequent nosebleeds.  Part of the reason is that sometimes the mucus membrane inside the nose become dry.  When that occurs the skin can rip or tear more easily and cause bleeding.  Also if the inside of the nose becomes itchy, often a patient might scratch the nose in the middle of the night and not realize it, causing trauma to the skin, bleeding and scab formation. The first line of prevention involves keeping fingers out of the nose.  I also recommend using a small amount of petrolium jelly (Vasoline) applied to the skin inside the nose to moisturize the skin and prevent bleeding for those people with recurrent nosebleeds.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


Doctor, you Say I Have Allergies? Are you Sure?

shutterstock_126144308Spring is here, and so is the pollen count.  I’ve had countless patients who’ve come into the clinic lately suffering from season allergies.  Seasonal allergies can cause symptoms in the nose, the eyes and the throat.  The nasal passages are the areas that are affected by most people with allergies.  Allergic rhinitis is the term that we use in the medical field to refer to the inflammation of the nasal passages due to allergies.  The inflammation can cause a variety of symptoms including sneezing, itching, nasal congestion, runny nose and post-nasal drip (the sensation that mucus is draining from the sinuses down the back of the throat).

Who is affected:  Allergic rhinitis (also called hay fever) affects about 20% of people of all ages.  Patients who have asthma or eczema have a higher chance of developing allergies.

Causes:  Symptoms of allergic rhinitis are caused by a reaction in the nasal passages to small airborne particles known as allergens.  These particles could be pollen, dust or dust mites.  These particles can also cause reactions in the lungs such as asthma or in the eyes (allergic conjunctivitis).

Symptoms:  The term “rhinitis” refers only to nasal symptoms, but many patients experience symptoms in their eyes, throat, and ears.

1)   Nose:  watery nasal discharge, blocked nasal passages, facial pressure, loss of taste, post-nasal drip, nasal itching, sneezing

2)   Sleep:  daytime fatigue, frequent awakening at night, mouth breathing, difficulty performing work

3)   Eyes:  swelling and blueness of the skin below the eyes, red eyes, itching, clear discharge

4)   Throat:  sore throat, hoarse voice, itching

5)   Ears:  popping of the ears, itching of the ears

Diagnosis:  A physical exam by a medical provider usually is usually all that is required to make the diagnosis, however further testing can be done to identify the allergen. Allergy and asthma specialists often perform testing for patients to determine the substance that they are allergic to.

Treatment:  Identifying the triggers that provoke allergic rhinitis is important so that patients can reduce exposure.  Sometimes recalling events prior to symptoms starting such as a recent camping trip, visit to friend’s house who has animals or spending time on a farm may be helpful.  Noting the time, date and potential allergens in the school as well as home and work can be helpful.    Other possible treatments include:

1)   Nasal irrigation and saline sprays

2)   Nasal glucocorticoids such as Fluticasone

3)   Nasal antihistamines such as Astelin

4)   Oral antihistamines such as diphenhydramine or cetirizine

5)   Oral decongestants such as Pseudoephedrine

6)   Nasal decongestants such as Afrin

7)   Mast cell stabilizers such as Cromolyn

8)   Leukotriene modifiers such as Singular

Skin testing can be performed by allergists to help determine the allergen so that it can be avoided in the future.  Sometimes allergy shots are recommended to help the body become accustomed to the allergen with the hope that repeated exposure will reduce allergic symptoms.

There are several sources of information to determine the allergen/pollen count in your area.  One example is below:

Accuweather.Com – Dust, Dander and Pollen Counts USA

To find an allergy doctor in your area, the American Academy of Allergy, Asthma and Immunology’s Find an Allergist Website is:

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


Mononucleosis – The Kissing Disease

shutterstock_52284313Contrary to the name, this isn’t a type of disease that you actually want to catch.  It’s an infection that causes symptoms including fever, sore throat, enlarged lymph nodes (often in the neck), and fatigue.  It’s more common in young adults than younger kids to the elderly.  Most of the time, it’s not a serious illness but it can lead to being out of school or work for a significant amount of time due to extreme fatigue.

Causes:  The infection is caused by Epstein-Barr Virus (EBV) and can be spread from one person to another by kissing, drinking from a glass of an infected person or sharing eating utensils.  Young children who are infected with EBV usually don’t develop symptoms like young adults.

Symptoms:  The most common symptoms of mono can take 4-8 weeks after exposure to develop and may be:

1)   Sore throat

2)   Enlarged lymph nodes in the neck

3)   Fever greater than 100.4 degrees F (38 degrees C)

4)   Fatigue that can last for several months

Complications:  The most worrisome problem that can occur after having mononucleosis is enlargement of the spleen.  Actually, it’s the increased chance of rupturing the spleen after accidentally falling on it during an activity or sports event that is the problem.  Normally the spleen is somewhat protected under the left rib cage and is not usually exposed.  It can become enlarged about 50% of the time after having mono, so we usually recommend avoiding sports activities or heavy lifting that might risk trauma to the spleen to those who have been diagnosed with mononucleosis.

Diagnosis:  The diagnosis is usually suspected based a physical examination of the patient, however a blood test can be done to confirm the diagnosis.

Treatment:  Since the infection is due to a virus, antibiotics are not useful to treat the illness.  The goal is to reduce the unpleasant symptoms and allow the immune system to heal the body.

Return to work/school:  I usually recommend going back to work or school after you have not had a fever for 24 hours.  An enlarged spleen due to the infection can take a few weeks to return to normal.  During this time the patient should not participate in activities that risk rupturing the spleen such as playing contact sports, or anything that put you at risk for falling.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


My Jaw Clicks and Hurts – All About Temporomandibular Joint (TMJ) Problems

Photo credit:

The mandible of the jaw is a modified hinge joint that is supported by muscles and allows you to chew your food.  The joint that allows this movement is the jaw joint, called the temporomandiublar joint or TMJ.  It is located just in front of your ear.  You can feel the joint by putting your finger on your cheek in front of your ear and open/close your mouth.

Inflammation of this joint can cause pain and that can sometimes be confusing because the average person often does not think about this area as a source of pain.

Symptoms of TMJ inflammation can be:

1)   A dull pain in the jaw muscles on one side

2)   Pain around the ear that can be confused for an ear infection

3)   Jaw pain that can sometimes make you think you have a tooth infection

4)   Neck pain or tenderness

5)   Pain when chewing food

6)   Popping when opening your mouth

7)   Difficulty opening your mouth widely because of pain

8)  Headache

Causes:  Because the jaw is a hinge joint, it can become inflamed with arthritis.  Other possible causes are:

1)   Stress that causes jaw clenching

2)   Teeth grinding – especially at night when you are asleep

3)   If your teeth/bite is not quite right, sometimes a dentist can help adjust this

Treatment: For many people the symptoms occur only occasionally and do not last very long. There is not a “usual” treatment for TMJ.  Treating the cause of the problem is the goal, and that might be fixing your teeth/bite or decreasing stress that might lead to jaw clenching or teeth grinding.  Dentists will sometimes fit patients with a dental appliance that helps protect the teeth and also decreases grinding.  For some people this has been very helpful in reducing the pain from TMJ.   Other possible treatments include:

1)   Medications to reduce inflammation and relieve pain such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, etc.) or muscle relaxants

2)   Jaw exercises that stretching of the muscles around the TMJ

3)   Stress reduction and biofeedback to decrease teeth griding/clenching

4)   Appropriate dental care

5)  Avoiding actions that cause your symptoms such as yawning, singing or chewing gun

To find a dentist in your area, the American Dental Association has a useful Dentist locator:

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


I’m having ear pain, but the doctor said there was no ear infection – what is Eustachian Tube Dysfunction?

shutterstock_742214The Eustachian tube connects the middle ear to the back of the throat and nose.  It equalizes the pressure of the ear and is often responsible for the pop sensation that you may feel as you are gaining elevation if you ride on an airplane or drive your car up a mountain pass.  If there is a problem with the Eustachian tube, the air pressure inside the middle ear becomes different than the outside air pressure.  This leads to pain and a pressure sensation of the ear drum.  It can also caused decreased hearing on the affected side.  In the medical profession, we use the term “barotrauma” to describe this phenomenon.

Symptoms of Eustachian tube dysfunction (ETD):

1)   Ear pain – this can feel just as painful as an ear infection

2)   Trouble hearing

3)   Ringing in the ear

4)   Feeling dizzy

5)   Feeling pressure or fullness in the ear

Most of the time Eustachian tube problems are not serious and they get better on their own.  They rarely can lead to a more serious problem such as:

1)   Middle ear infection

2)   Torn eardrum

3)   Hearing loss

If a child has Eustachian tube problems for long periods of time, they can have language or speech problems as a result of not hearing well.

Causes:  Anything that make the Eustachian tube swollen or inflamed such as recent upper respiratory infection or common cold, allergies, sinus infection or sudden air pressure changes (happens when people fly on an airplane, scuba dive or drive in the mountains).

When to seek medical help:  If the symptoms are severe, getting worse or are not improving within a few days.

Treatment:  The treatment of Eustachian tube dysfunctions is tailored to the individual patient and the cause of the disorder.  Some possible treatment options might be:

1)   Nasal sprays – for example Flonase, Nasonex, or Rhinocort

2)   Oral antihistamine medications such as Benedryl, Zyrtec, Claritin or Allegra

3)   Oral or topical decongestant medications such as Sudafed or Afrin nasal spray

4)   Surgery:  Most of the time ear tubes are not needed for this problem, however some people do have tube placed in the ear drugs to help with this disorder

5)   Special ear plugs that are used on an airplane, or when driving that help decrease the pressure on the ear drum.

Otolaryngologists are doctors that specialize in the Ears, Nose and Throat (ENT).  If you are looking for an Otolaryngologist in your area, the American Academy of Otolaryngology has a useful locator on their website:

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO