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.


Blood Clot in the Leg – All about the Deep Vein Thrombosis (DVT)


A few days ago a patient came into the clinic with complaints of pain in the back of his knee after spending hours driving his car back to Washington from the east coast.  He didn’t recall injuring his leg or knee and told me that the pain was worse when he starts walking.  He also noted some swelling in the leg and ankle.  I became concerned about the possibility of a blood clot (also called a deep vein thrombosis or DVT) in his leg after hearing about his long journey because sitting for extended periods of time in a car or on an airplane are big risk factors for a deep vein thrombosis.  After the ultrasound confirmed a blood clot in his left leg, we started him on the treatment and he is doing great today.

A blood clot (also called a thrombus) can be very serious and even life threatening if it breaks and travels through the circulatory system.  If that happens, the blot clot (now called an embolis to indicate that it broke off from the main clot and is traveling through the veins of the body) can lodge in the lung and cause a pulmonary embolism (PE) which is a serious condition that causes over 50,000 deaths a year in the U.S.A.

A deep vein thrombosis (DVT) is a problem where a blood clot is created inappropriately within the vein.  Most commonly these veins are in the “deep veins” of the leg, pelvis, or thigh.  The thrombus can block or partially block the blood flowing through the vein and cause pain and swelling.

Symptoms:  These may or may not all be present:

1)      Pain – usually in one leg, or knee

2)     Swelling in that leg or knee

3)     Warmth and redness in the leg or knee area

Diagnosis:  If a medical provider suspects that you might have a DVT, there are certain tests that can be done to look for this including:

1)      Compression ultrasonography (ultrasound) which uses sound waves to allow the visualization of the blood flow through the veins of the leg.

2)     D-dimer is a blood test that is often elevated in people who have a blood clot.  It can also be elevated for other reasons, so an elevated D-dimer does not tell us that a patient has a blood clot, but if the D-dimer is not elevated and  the risk factors are low, there is less chance of the patient having a blood clot.

3)     MRI uses a very strong magnet to create photos inside the leg and is expensive so it’s not the first choice the diagnose blood clots.

4)     Contrast venography is when a small tube (called a catheter) is inserted into the vein and a liquid that shows up on x-ray (we call this contrast) is injected through the tube while xray is used to visualize the blood flow of the contrast through the vein.  We usually prefer to use ultrasound, but this test can be helpful when ultrasound is not available.

Risk factors for DVT:

1)      Some people have a genetic problem called thrombophilia which causes blood to clot more easily than it should

2)     Cancer

3)     Smoking

4)     Heart failure

5)     Pregnancy

6)     Being overweight or obese

7)     Increased age

8)     Having had a DVT or PE in the past

9)     Certain kidney problems

10)  Medications such as birth control pills or hormone replacement therapy

11)  Recent surgery – especially involving the knee, hip or pelvis

12)  Trauma – such as a fall or deep bruise where the blood vessels may have become injured

13)  Sitting for long periods of time such on a long flight or a long drive in a vehicle.  We also think about this for elderly patients who don’t move around very much

Treatment:  The goal in treating a DVT is to prevent the blood clot from dislodging or breaking off and becoming an embolism that could lodge into the lung (pulmonary embolism).  We also want to prevent the clot from getting larger or new clots from forming.

Medications can be used to prevent new blood clots from forming(anticoagulants), and other medications can be used to dissolve a blood clot (thrombolytic).  Most people might think that the primary treatment would be to dissolve the clot using thrombolytic therapy, however this is usually not the case.  The body has natural substances to dissolve blood clots that are formed inappropriately in blood vessels and we usually prefer the body to do this naturally while assisting by giving medications to prevent new blood clots from forming.  Anticoagulant medications such as warfarin or heparin are the most common agents used to treat patients with DVTs at this time.  For patients who continually develop blood clots despite being on medications or who cannot take the recommended medications, a filter might be inserted into one of the largest veins in the body (the inferior vena cava) to block the circulation of blood clots.  We strategically place the filter so that if a blood clot forms, it is not allowed to reach the lungs.

Prevention:  For patients at high risk of developing a blood clot such as a patient who just had surgery, or someone who has cancer, they might be started on anticoagulant medications to decrease the risk of a blood clot.  Some patients are fitted with inflatable compression devices that are worn on the legs and periodically fill with air and put compression on the legs and work similar to how an electronic blood pressure cuff inflates.

If you or someone you know is having symptoms that you think might be related to a blood clot or DVT, I recommend that you have them evaluated immediately.

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


Pulmonary Embolism (PE) – Blood Clot in the Lung

shutterstock_94626226A patient who regularly competes in Iron Man Triathlons came into the clinic tonight with complaints of pain with taking a deep breath.  She had coughed up some blood once today and complained that it hurts when she takes a big breath in.  She is an athlete and remembered running in a race about three weeks ago and developed pain in the right calf and behind the right knee.  That pain has been improving over the last few weeks.  As you can probably guess by the title of this blog entry, she had a blood clot in her lungs.  Actually she had large blood clots called pulmonary emboli in both lungs.  She required transport emergently to the hospital for treatment.

Definition:  A pulmonary embolism (PE) is a blockage of one of the blood vessels to the lungs.  These are usually caused by a blood clot that travels from somewhere else in the body, most commonly from the legs.  Other causes of blockages to the blood vessels in the lungs are air bubbles, or from tiny pieces of fat.

A pulmonary embolism is a serious condition that is a medical emergency.  A blocked artery or vein in the lung can make it hard to breath and can lead to damage to the lungs and can even cause death.

Most of the time the blood clots start in the legs, or in the pelvic area and then move along the veins and travel to the lungs.

Symptoms:  People who have blood clots in the lungs might complain of:

1)   Sharp, stabbing pain when they take a breath in

2)   Coughing up blood

3)   Rapid heart rate

4)   Trouble breathing or feeling short of breath

If you have any of these symptoms, it is important to call 9-1-1 and be evaluated in the hospital.  Do not try to drive yourself to the urgent care or to the hospital yourself.

Risk Factors:  There are some factors that can increase the chance of having a blood clot in your lungs including:

1)   Having a family history of blood clots or blood clotting disorders

2)   Having recent surgery – especially on the knees, lower legs or pelvis

3)   Smoking

4)   Taking birth control pills or estrogen replacement

5)   Having a previous history of DVT (Deep Venous Thrombosis) or PE

6)   Having a history of heart failure

7)   Patients with cancer

8)   History of kidney problems such as nephrotic syndrome

9)   Having a recent trauma or injury with a large clot (hematoma) – more likely to cause DVT if it’s in the legs

Diagnosis:  To diagnose a pulmonary embolism, special tests such as a special x-ray called a CT scan (Cat-Scan) with contrast.  During this test, the patient has special a detailed x-ray of the lungs while contrast (a solution of medication that can be seen under x-ray) is put into a vein (usually in the arm) and circulates through the lungs and rest of the body.  The CT scan is used to see the blood vessels and determine if a blood clot is present.  There are other tests to determine if a pulmonary embolism is present as well such as a ventilation/perfusion lung scan, but we usually use CT scan instead because it is easier and less time consuming.  If we suspect that there might be a blood clot in a patient’s leg, we can perform a vascular ultrasound to look for blood clots in the vessels of the legs.

Treatment:  We start treatment of a pulmonary embolism without delay to prevent a new blood clot from forming and to reduce the chance of enlargement of the existing clot.  Usually your own body’s enzymes dissolve the clot.  We treat patients by anticoagulation.  That means that we give medications to reduce the body’s abilities to form new blood clots – this is also sometimes called using “blood thinners.”  It isn’t actually thinning the blood however.  For patients who are at high risk for forming new blood clots, we sometimes put small screens or “filters” in a major blood vessel such as the inferior vena cava to prevent a new blood clot from reaching the lungs.

Most of the time we use a combination of oral anticoagulation medications such as Coumdin and also use an injectable medication such as heparin.  Patients who have pulmonary embolisms often stay in the hospital for a few days and receive intravenous heparin to prevent more blood clots from forming.  It takes a few days for the medication that is taken orally to become effective, so during this time the patient is giving the heparin either through an IV or the heparin is injected under the patients skin.

Patients who have had a PE usually take the Coumadin (also called Warfarin) for a minimum of three months.  Some doctors recommend that patients with a PE take Coumadin or something similar for the rest of their lives.  Other medications to prevent blood clots might be used if the patient is pregnant or cannot tolerate Coumadin.

Prevention:  Patients who are in the hospital and confined to the bed for extended periods of time are usually started on a prophylactic dose of heparin each day or special compression devices on their legs to prevent blood clots.  People who are on long air plane flights, car, bus or train rides should get up regularly and stretch their legs to help prevent the development of the blood clot in their legs (DVT).  Patients who have had recent surgery often use heparin injections even at home for a few days to help prevent the development of a blood clot in their leg.

If you or someone you know if having symptoms of a pulmonary embolism (PE), they should dial 9-1-1 and go to the hospital immediately.  They should not attempt to drive to the hospital or urgent care.

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


Proper Use of Asthma/Reactive Airway Inhalers













Today a patient came into the clinic and said that his asthma inhaler wasn’t working.  He’d been diagnosed with mild asthma last week and his primary care physician gave him an albuterol inhaler to use when his asthma flairs and he starts coughing.  He had his inhaler with him, so I asked him to demonstrate how he uses it.  He promptly put the inhaler to his lips and sprayed the inhaler into his mouth and then took a big breath in.  I was able to see that he wasn’t getting the medication into his lungs efficiently, and since this is a common problem when using inhaled medication, I decided that the subject needed some attention.

Using an inhaler can actually be quite challenging, and I find that most patients medications are only effective if they are used properly.  If you use the inhaler correctly the medication is delivered to the lungs where it works to control your symptoms.  If you are not using your inhaler correctly, little or no medication reaches your lungs and your asthma or reactive airway symptoms will not be adequately treated.

Asthma inhaler types:  Most asthma inhalers are meter dose inhalers (MDI’s) and deliver a small spray of liquid medication such as albuterol (aka Proventil or Ventolin).  Since 2008, new inhaler canisters have come out that use a propellant that does not damage the ozone layer.  They are known as HFA inhalers and have a different taste compared to the previous inhalers and are also more expensive. The spray is also softer, but works just as well as the older inhalers.

The other type of asthma inhaler is called a dry powder inhaler (DPI).  This type of inhaler has a small amount of powder that you breath in.  It has less taste, but the powder can fall out if you tip the device down towards to ground.  This type of inhaler is used commonly with medications such as the Advair diskus.

Spacer devices:  A spacer is a device that is basically a small tube that allows the medicine to have a little extra time and space to get down into your lungs rather than be deposited in the back of your mouth or on your tongue.  It is not required to use a spacer, but it is highly recommended.  If you don’t have a spacer to use with your inhaler, you can make one using an empty cardboard toilet paper roll.  You put the spacer over the mouthpiece of the MDI and then put the other end of the spacer in your lips and inhale the medication from the metered dose inhaler through the spacer and into your lungs.

Before using a metered dose inhaler MDI for the first time:

1)   Prepare the inhaler by shaking it for 5 seconds

2)   Prime the inhaler by pressing down on the canister with the index finger to release the medication.  Hold the inhaler away from your face to prevent the medication getting into your eyes.  Press the canister down again 3 more times

3)   After using for the first time, it does not need to be primed again unless you don’t use it for more than 2 weeks.

Technique for using a metered dose inhaler (MDI):

1)   Shake the canister for 5 seconds

2)   If you have a spacer (recommended), insert the MDI into the spacer and hold the MDI upright with the index finger on the top of the medication canister and the thumb supporting the bottom of the inhaler.  Some people find that using the other hand to hold the spacer is easiest.

3)   Breathe out normally

4)   Close your lips around the spacer.  If your spacer has a mask, hold the mask tightly to the face.  If you do not have a spacer, close lips around mouthpiece or hold at a position about 4cm from your mouth.

5)   Keep your tongue away from the spacer opening/mouthpiece area

6)   Press down on the top of the medication canister with the index finger to release the medication

7)   At the same time as the canister is pressed, inhale deeply and slowly through your mouth until your lungs are completely filled – this should take about 4-6 seconds

8)   Hold your breath in for as long as possible – 10 seconds is recommended before breathing out.

9)   If a second puff of medication is recommended, wait about 15-30 seconds before repeating the procedure for the second puff. Remember to shake the canister before each puff

10)  Recap the mouthpiece

11)  Rinse your mouth with water rather than swallowing after the treatment.  This is recommended especially after using an inhaled cortisone medication to prevent developing thrush

*Tip:  If you’re having difficulty timing your breath while spraying the medication, there are inhalers that automatically release the medication when you take a breath.  An alternative is to use a spacer or a dry powder inhaler (DPI).

Cleaning your MDI:  Your inhaler must be cleaned at least once a week to prevent blockages.  The manufactures recommend cleaning the mouthpiece at least once per week.

1)   Remove the canister but do not wash the canister or put it in the water

2)   Run warm water through the top and bottom of the plastic mouthpiece for 60 seconds

3)   Shake off the excess water and allow the mouthpiece to dry completely overnight

4)   If you need to use your inhaler before it is dry, shake off all the water, replace the canister and test spray (away from your face) two times before using

5)   Remember to clean your spacer

How to determine when your inhaler is empty:  You can’t always know when your inhaler is empty by shaking it because some propellant remains in the canister when all the medication is gone.  Some inhalers have a dose counter (Ventolin-HFA and Proventil) to track how much is used.  If your inhaler doesn’t have a counter but you use it regularly (2 puffs twice per day), you will need a refill in 30 days.  Write the date you will need a refill on the canister with a permanent maker to remind yourself.

If you don’t use your inhaler very often, write the date you start using it on the canister in permanent maker and consider getting a refill in 3-4 months.

Dry powder inhalers (DPIs):  These types of inhalers have a small dose of dry powdered medication in them.  They deliver a very fine powder to the lungs when you breathe in.  The advantage of using a DPI, is that you do not need to coordinate the squeezing of the canister with your breathing.  You must be able to breath in more forcefully with a DPI than with a spray type inhaler to ensure that the powder gets into the lungs.  These types of inhalers might be more difficult for patients who cannot breath in very deeply.  It’s also important not to exhale into the device before breathing in so that you don’t scatter the powdered medicine before it’s inhaled.

How to use a DPI:

1)   For single use devices, load a capsule into the device as directed

2)   Breathe out slowly and completely (but not into the mouthpiece or you will scatter the powdered medication before you have a chance to breathe it in).

3)   Place the mouthpiece between your lips

4)   Breath in through the mouth quickly and deeply over 2-3 seconds

5)   Remove the inhaler from your mouth and hold your breath as long as possible – 10 seconds is recommended

6)   Breathe out slowly

Cleaning a DPI:  Do not use soap and water.  The mouthpiece can be cleaned with a dry cloth.

For more information about asthma, here is a list of resources:

Center for disease control and Prevention 

American Academy of Allergy, Asthma and Immunology

American Lung Association


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


Altitude Illness

shutterstock_163362512Much of this information comes from Peter Hackett, MD, a wilderness medicine expert on mountaineering and altitude related illness and treatment.

Altitude illness is usually due to the stress of decreased oxygenation in the setting of an individual who is not acclimatized.  It can happen at any altitude over 8,000 feet and usually occurs during the initial ascent.

Two areas of the body that are most affected by altitude illness are the brain and the lungs.  When altitude illness strikes the brain it is divided into two groups called Acute Mountain Sickness (AMS) and High Altitude Cerebral Edema (HACE).  Lung injury is usually due to lung edema called High Altitude Pulmonary Edema (HAPE).

Risk factors for altitude illness:

1)   Genetic susceptibility

2)   Live at an altitude of less than 3000 feet

3)   Fast rate of climb/ascent

4)   Past history of high altitude illness (HAI)

5)   Age less than 50 years old (for Acute Mountain Sickness – AMS)

6)   Heavy exertion/exercise

7)   Pre-existing illness (especially for High Altitude Pulmonary Edema – HAPE)

Acute Mountain Sickness (AMS): Diagnostic Criteria

1)   Recent gain in altitude

2)   Headache and any of the following

  1. Gastrointestinal upset
  2. Fatigue or weakness
  3. Dizziness or lightheadedness
  4. Difficulty sleeping

3)   Feels like a hangover

Treatment of Acute Mountain Sickness:  Usually gets better on it’s own.  Average duration of symptoms is about 16 hours.  It may persist for weeks at higher altitudes however.  There may be progression to High Altitude Cerebral Edema (HACE) with or without High Altitude Pulmonary Edema (HAPE).  It responds well to descent/treatment.

1)   Oxygen therapy

2)   Descent

3)   Hyperbarics

4)   Acetazolamide (Diamox) – 125 to 250mg every 8-12 hours – start taking the day before travel until day 2 or 3 at altitude.

5)   Hyperventilation

6)   Dexamethasone 4mg every 6 hours – careful because this can lead to adrenal failure if used at high doses and if it’s not tapered gradually.

7)   Treat symptoms of headache with ibuprofen/naproxen, codeine, etc. and nausea with Zofran or Phenergan

Acetazolamide Prophylaxis:  125-250mg twice a day (5mg/kg/day) starting the day before travel and continued until day 2 or 3 at altitude.  If allergic to sulfonamides (sulfa) be cautious.  Side effects of the medication are dose related.  More commonly a feeling of numbness/tingling, metallic taste in the mouth, generalized fatigue, nausea and blurry vision can occur.

Prevention of altitude sickness:

1)   Go up slowly in staging – avoid a sea level to 9,000 foot climb in one day

2)   Sleep at a max of 2000 feet higher elevation each night

3)   Acclimatize to 10-12,000 feet before going any higher

High Altitude Pulmonary Edema (HAPE):  Symptoms

Early:  Fatigue, weakness, dry cough, shortness of breath with activity.  May progress to increased respiratory rate, increased heart rate.

Late:  Pink or blood-tinged sputum from lungs, crackles heard with stethoscope in the right axilla/arm pit.

Treatment for HAPE:  Oxygenation is the highest priority.  Descend with minimal exertion.  For mild/moderate cases use bed rest with oxygen.  For severe illness use high flow oxygen with descent and perhaps a hyperbaric bag.  There is some thought about using pulmonary vasodilators such as calcium channel blockers, nitric oxide, Viagra and/or Dexamethasone.

Preparation:  Take a medical kit with Diamox and dexamethasone and albuterol inhalers.  If you’re with medical providers, you may have access to nifedipine or Viagra also which may be helpful.

For more information:



3)   Auerbach’s Wilderness Medicine

4)   DuPoint Travel Medicine

5)   Tintinelli Emergency Medicine

If you are interested in learning more about wilderness medicine, a great resource for information is the wilderness medicine society:

This document is for informational purposes only.  Please consult your medical provider before attempting high altitude travel.


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

Scott Rennie, DO


Accidents in the Water – Drowning and Near Drowning

shutterstock_106770593I credit the information that I’ve learned and presented here to Karen Van Hoesen, MD who is an expert in Wilderness Medicine and has specialized training in Dive Medicine and water related injuries and illness.

Drowning is the 3rd most common cause of accidental deaths in the U.S, and the leading cause of death in children < 5 years old.  Every year drowning accounts for a least 500,000 deaths worldwide and about 4,000 fatalities in the US.  2005 WHO Definition:  “Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.”

There are several factors that are common to drowning:

1)   Age:  More common in toddlers and teenage boys

2)   Location:  Most frequent in home swimming pools, bathtubs and buckets

3)   Sex:  More common in male than female

4)   Race:  Happens more commonly in ethnic minorities

5)   Drugs:  Being under the influence of alcohol contributes greatly to drowning accidents (more than 50% of adult drowning deaths are believed to be alcohol related).

6)   Trauma:  More common secondary to diving or falls

7)   Drowning is the leading cause of death in Scuba

The effects of drowning on the organ systems involve spasm of the larynx, and flooding of the lungs with water causes loss of surfactant (a fluid that helps keep the small air sacs of the lung open).  The decreased oxygenated blood flow leads to decreased cardiac output and abnormal heart rhythms may occur. Decreased oxygenated blood to the brain causes damage to the brain in multiple areas.   Decreased blood flow to the kidneys can lead to kidney failure.

Clinical presentation of the drowning victim:  There is a broad spectrum to how they look clinically.  They can be alert or comatose.  They can have signs of decreased blood flow such as blue tone to the skin, or have signs of coughing, increased respiratory rate, increased heart rate and low grade fever.  A chest X-ray may be normal or can show signs of severe damage to the lungs called ARDS (acute respiratory distress syndrome).  Imaging of the brain might show swelling.

Early complications (within 4 hours) of Near Drowning:

1)   Spasm of the upper airway

2)   Vomiting with breathing in vomit

3)   Hypothermia

4)   Seizures

Late complications (after 4 hours) of Near Drowning:

1)   ARDS – Lung failure

2)   Anoxic-ischemic encephalopathy – brain damage due to low oxygen

3)   Pneumonia due to inhaling water

4)   Lung abscesses

5)   Renal failure

6)   Sepsis – overwhelming infection of the body

 Near Drowning Treatment (Before reaching the Hospital):  Training in basic life support is very helpful!

1)   Call for Help!

2)   Mouth-to-Mouth in shallow water or stable surface – do not wait for ambulance

3)   Do not give chest compressions in the water

4)   Do not give Heimlich maneuver

5)   Give oxygen at highest concentration available (if you have an oxygen tank)

6)   Think about head or neck trauma

7)   Rewarm the patient

Outcomes:  90% of children survive submersion.  68% of patients need CPR, success of resuscitation at the site of the drowning/near drowning is key.  Poor outcomes are more common for those patients who don’t get CPR until they get to the hospital or are submerged for more than 10 minutes.  Cold water is beneficial because it tends to decreases the oxygen needs of the body.

Prevention:  Pool covers, pool alarms, and fences around pools can be very helpful. Supervise young children when around water. Train young children in aquatic programs for infants and toddlers.  Have personal floatation devices available.  Do not drink alcohol or use illicit drugs if you are around the water!

This document is for informational purposes only.  Please seek training by a medical professional to help prevent water related injuries.  I highly recommend that everyone get basic life support training.  To find the nearest place to get CPR training for the non-medical person, check out: (American Heart Association)

If you are interested in learning more about wilderness medicine, a great resource for information is the wilderness medical society:

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


Washington Statewide epidemic of Pertussis (Whooping Cough)

shutterstock_163366394From:  Washington Department of Health

Pertussis (whooping cough) spreads easily by coughing and sneezing. The number of reported whooping cough cases continue to rise in our state. On April 3, 2012, the Secretary of Health declared a statewide epidemic of pertussis.

Symptoms of pertussis vary depending on age.


Infants with pertussis may have trouble feeding and breathing and may turn bluish. Many infants are unable to even cough. The disease is most serious in infants, especially those not fully protected or too young to get the vaccine.

Babies and young kids:

Babies older than six months and kids with pertussis can have severe coughing spells that make it hard to eat, drink, breathe, or sleep. At this age, the cough is often followed by a “whooping” sound, which is how the disease got its common name. Kids may also vomit after a long coughing spell. Whooping cough can cause pneumonia, seizures, brain damage, and death.

Babies with whooping cough are often hospitalized.

Older kids and adults:

With older kids and adults, the disease can be quite mild or can cause several weeks of exhausting coughing. Babies usually get whooping cough from caregivers or family members who don’t realize they have the disease, like older brothers and sisters, parents, and grandparents. Research shows that it’s most common for moms to pass on the disease to babies.

How to protect infants and young kids:

Anyone with a persistent cough, especially if it includes fits of coughing or causes vomiting, should seek medical care. There is a vaccine to prevent pertussis in older kids and adults called Tdap. All pre-teens, teens, and adults should get the vaccine, especially those in contact with babies. The vaccine can help stop the spread of the disease to babies.

Anyone with a cough should avoid being around infants. Not all coughs are whooping cough, but without testing, it’s better to avoid the possible spread. If it’s not possible to avoid being around infants, cough into a tissue, then wash your hands thoroughly, or wear a surgical mask to prevent the spread of bacteria.

Age Groups at Risk:  All

Fact Sheets: 

Vaccine Information:
    • Kids should be immunized in the first 18 months of life with a four-shot series of the combination vaccine, DTaP. It includes diphtheria, tetanus, and pertussis. Kids who get all four doses before their fourth birthday should get a fifth dose before starting kindergarten or elementary school. The fifth dose isn’t necessary if the fourth dose was given on or after the fourth birthday. This combination vaccine is not given to people over age seven.

DT vaccine is available for kids under seven who can’t tolerate the pertussis (whooping cough) component.

Ages 7-10: Tdap Vaccine

  • Kids aged 7-10 years who aren’t fully immunized against pertussis (such as, those who didn’t complete a series of pertussis-containing vaccine before their seventh birthday) should get a one-time dose of Tdap vaccine.

Ages 10 and up: Tdap or Td Vaccine

  • One dose of Tdap vaccine is recommended for adolescents aged 11 or 12 years in place of one Td booster. Kids at least 11 years old are required to show proof of Tdap vaccination. One dose of Tdap vaccine is also recommended for older adolescents aged 13-18 years and adults aged 19 through 64 years.
Vaccine Information Statements:  There is no separate Vaccine Information Statement for combination vaccines.
Related Information from the Department of Health:

Centers for Disease Control and Prevention:

Sounds of Pertussis

For the latest information on infectious disease, I recommend checking out the website for the Centers of Disease Control: