A Discussion About Wilderness Medicine – Hawaii Public Radio January 6, 2014

Here’s a link to a discussion I had with Dr. Kathy Kozak about Wilderness Medicine on Hawaii Public Radio on 1/6/14.


Listen Here:


Happy New Year,

Scott Rennie, DO


30 Things to think about when moving to Hawaii

Honl-Beach-1Many of my friends and family members ask me about what it’s like to live in Hawaii.  There are many things that are great, and a few things that you might not have considered.  I decided to write down a list of things that I learned about after moving to Hawaii.

1)   You will become instantly popular with your friends and family who live on the mainland.  Try to get a place with a spare bedroom so you can accommodate visitors.

2)   If you have a pet, consider getting your animal’s rabies vaccinations up to date well in advance of moving.  The animals need to be current on their vaccinations and they also need to get blood work done to prove that they have built up immunity to rabies.  It can take up to 4 months to get this process done and if you prepare ahead of time, it might save you being away from your pet.

3)   If you want to ship your pet to Hawaii from the mainland, you’ll also need to have your pet given a good bill of health from your local veterinarian.  Some airlines don’t allow certain dog breeds to fly in the hot summer season (think Boxer or dogs with Brady cephalic heads).  It’s also expensive to ship them and if they’re a larger breed, they will likely need to ride in the cargo hold and my dogs and I aren’t too fond of that idea.


4)   The weather can be great, but it isn’t always sunny.  Sometimes we have VOG (Volcanic Fog) from the active volcano on the big island that clouds the skies.  It looks similar to smog that you might see in LA or another big city.  If you have allergies or asthma, you might benefit from bringing your eye drops, antihistamine or an albuterol inhaler with you.  It can rain very hard suddenly and without much warning if you live in certain areas of Hawaii.



5)   Traffic in Honolulu and Waikiki can be horrible.  We’ve all heard this before, but I moved from Seattle and thought we had bad traffic there.  Ha!  You might also consider that many people on the roads are visiting from other places (even other countries) and aren’t familiar with the roads.  Also if you drive in rural areas like the famous road to Hana, be prepared for some small roads, one-lane bridges and some areas where there’s not any protection between you and falling over a large cliff beside you.  Drive carefully!




6)   The food is amazing.  If you’re visiting Honolulu and enjoy trying different kinds of foods – Asian, Hawaiian, Portuguese and a fusion of many others, you won’t be disappointed especially if you have a chance to get outside of Waikiki.  The restaurant selections on islands other than Oahu might be a less abundant however.

7)   It’s expensive – gasoline, groceries, eating out, movies, and many other things can cost quite a bit more than on the mainland!  You knew that already though, and as you learn where to go shopping (think Costco if there is one on the island you visit) you will learn how to adjust. If a grocery store offers a membership or discount card, get it!  I usually don’t spend as much money on “extras” here though.  When I want to enjoy a day off, I usually don’t spend any money visiting the beach!

8)   Things rust and wear out quickly if you don’t take care of them.  Wash your car once a week if you can, then wipe it dry so you don’t get hard water spots.  Then wax your car to protect the clear coat!


9)   Be patient!  Sometimes things move slower – traffic or lines at the cash register for example. It’s a fact of life. Try not to get frustrated; it will make your day more enjoyable.

10)  Get to know people who’ve lived here for a long time.  They can show you places and teach you things about the islands that you will not learn in a book or blog post.

11)  If you ship a car to Hawaii, it’s a process to get the registration changed to Hawaii.  Just take a day off work and plan on spending the whole day to get this done.  Even if you have car insurance from a large company like State Farm or Farmer’s, you’ll need to get a local agent.  Once you have your auto insurance agent and your new insurance ID card for Hawaii, you can go get your car safety inspected.  These inspection stations can be busy, and they’ll check the tint color of your windows, your signals, mirrors and if your car checks out, they will give you a slip of paper that you can bring to the department of licensing.  You may have to wait in line at the DOL for half a day, so be prepared.  Bring something to read and some snacks and don’t forget to take a number.  Licensing your car in Hawaii might be more expensive than in your Mainland State.  Once your car is registered, you need to drive back to the safety inspection office and have them stick a safety sticker on your car.  I told you it was a process didn’t I?

12)  It can be hot and muggy, especially in the summer months.  There are days when the trade winds aren’t blowing or the “Kona” winds blow up from the south and the weather can be a bit uncomfortable for those of us who are not used to the humidity.  The trade winds usually keep it pleasant because they blow a cool breeze over the islands but don’t count on that 100% of the time.  You may want to have an air-conditioner where you live.  Do you pay the electric bill?  See #7 about things being expensive in Hawaii – including electricity.

13)  There are centipedes, cockroaches, scorpions, geckos, lots of different birds, frogs, and of course mosquitos.  I don’t mind the geckos, birds and most frogs – I enjoy them except when they occasionally keep me awake at night.  Centipedes, scorpions, cockroaches and mosquitos I don’t like however I learn to take proper precautions to avoid them.  Take your trash bags outside every night before you go to bed!


14)  Be persistent if you’re trying to reach someone be telephone or email.  I learned that sometimes people don’t get back to you right away.  If you’re trying to rent a house or apartment, or conduct any form of business be persistent (not annoying) because sometimes people in Hawaii might not call or email you back immediately.   Because this can be frustrating for me sometimes, I try to get back to other people as quickly as possible.

15)  You don’t need as many clothes.  Pick out a few pairs of shorts, aloha or T-shirts, some slippers, sunglasses and a hat and you’re ready for most days. On work days, wear some nice lightweight pants and shoes.  Even most business professionals don’t wear a tie (even most doctors) but you’ll want to check with your employer on their standards.  You might need one lightweight sweatshirt or sweater but unless you’re spending lots of time on Haleakala, Mauna Kea or one of the other mountains you probably won’t need a coat.

16)  Wear sunscreen every day.  The sun here is intense and you can get burned very quickly.  I can’t tell you how many tourists that I’ve treated for sunburns while working as a physician in Hawaii.  Melanoma, and carcinoma of the skin are also very common.  You’ve probably seen people who have wrinkly skin and walk around with amazing suntans all the time but you don’t want to be one of them.

17)  Be aware of scooters and motorcycles.  They’re sometimes hard to see and are very common in Hawaii.  You might be more aware of them than you want to be if you hear them racing down Ala Moana Boulevard at 1am.

Lahaina motorcycles

18)  Watch what you eat.  As I mentioned in #6, the food is great but if you eat too much local food like rice, macaroni salad, lau-lau, Portuguese sausage, and Loco-Moco you might end up gaining weight quickly.  We have more diabetic patients here in Hawaii than anywhere else I’ve worked.


19)  Flying from one Hawaiian island to another can be expensive.  I’ve been to all of the major islands (except Niihau and Kahoolawe) and I can say that the cost per mile of flight is more expensive in Hawaii and anywhere else I’ve been.  A one-way ticket to Maui from Oahu is around $100 per person unless you find a special deal.

20)  Having a small car might be an advantage especially if you live on Oahu because parking can be difficult, and gas prices are high.

21)  If you buy things on the Internet, be aware that shipping prices can be extremely expensive!  You may often pay more to ship an item to Hawaii from the mainland than what the price of the item is.  Look for free shipping or have things shipped to the mainland and bring them with you if you travel back and forth.

22)  You will hear people talk pidgin – the local language that is actually a mixture of many different languages.  You may not understand it but if you live here long enough, you will learn some of the words.


23)  There are natural disasters such as hurricanes and tsunamis here that you might not be used to on the mainland.  Register yourself and your family with the emergency contact registry and get a weather radio.  Consider getting a ham (amateur) radio license to be able to communicate in a disaster.


24)  Hawaii does not have daylights savings time.

25)  Don’t leave items in your car in plain sight.  This isn’t just in Hawaii but anywhere.  I’ve heard many stories about tourists who arrive in Hawaii and drive right to Costco from the airport with their luggage in their car only to come back from shopping to find everything gone.

26)  Each island in Hawaii is different.  I’ve met so many people who have been to Hawaii year after year and they come to the same island and often stay in the same place.  Each island has it’s own charisma and things about it that make it unique. Kauai is the most beautiful place I’ve been, Oahu has something from everyone, Maui has a unique valley and some of the best windsurfing in the world, Lanai has a couple great resorts and is very expensive to visit, Molokai has awesome sea cliffs and also has Kalaupapa, a place where patients with leprosy (Hanson’s disease) were quarantined and the Big Island has an active volcano and some of the most amazing places to star-gaze in the world.  Check them all out before you decide where you want to live.  Learn the difference between the Big Island of Hawaii and the island of Oahu where Honolulu and Waikiki are.

27)  Living in Hawaii is not a 24/7 vacation.  I’ve worked longer hours in Hawaii than any other job since residency.  There are some weeks that I never get to the beach.

28)  The school system is different than the mainland.  I don’t have children, but if I did I would learn all I could about public versus private schools and where the best schools are in Hawaii and take that into account when deciding where to live.

29)  Some people get “island fever” also known as “rock fever.”  They have a feeling of being trapped on the island.  I’ve never experienced that feeling but I recommend that you try living in Hawaii for a few months before deciding that you want to up-root your family and move here permanently.

30)  This list is a work in progress and will change as I live here longer.

I hope that you’ve found some of this information useful.


Scott Rennie, DO

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.

Taking a dog to Hawaii: Reduce quarantine time to a few hours

shutterstock_65981935Moving to Hawaii sounds great right?  But what about your pets?  Are you aware that there are laws about bring your pets into the State of Hawaii?  It can take up to three months for your dogs to go through a quarantine or similar program.  Here’s some information that I’ve found online which is quite helpful.  I found this info on a blog called Dog Jaunt and I give credit to that source for this info:

Friends of ours have a house in Maui and have kindly offered it to us as a vacation getaway. Fantastic! I thought, but how sad I’d be to leave Chloe behind. If we brought her with us, how sad to leave her in quarantine for the first five days of our visit (though it would be an excellent excuse to schedule a reallylong getaway). Our friends pointed out, however, that Hawaii’s new-ish (since 2003) quarantine program has a “5-day-or-less” option, and while I’d been focusing on the “5 day” part of the name, nearly 90% of the pets traveling to Hawaii are released to their owners within a few hours (FY 2005 data).

Getting your pet directly released takes money (including your vet expenses and a $165 fee charged by Hawaii) and effort, but if you jump correctly through all the hoops, your dog will be in your hands only a few hours after your arrival in Honolulu. The Department of Agriculture’s official checklist (PDF) walks you through the required steps. Summarized briefly, they include:

  • Correct rabies vaccinations — Your dog has to have been vaccinated at least twice for rabies in her lifetime. The vaccines must have been administered at least 30 days apart. The most recent vaccine must have been administered more than 90 days before your dog arrives in Hawaii, but within the vaccine manufacturer’s stated booster interval (that is, your dog must still be covered by her most recent booster when she arrives in Hawaii).
  • Working microchip — Your dog must be microchipped, and the chip must be working properly.
  • OIE-FAVN rabies blood test — Your vet has to send a blood sample to an approved laboratory, which will run this test to determine whether your dog has sufficient levels of rabies vaccine in her blood. At least 120 days must pass between the day after your dog’s blood sample reaches the lab and the date of your dog’s arrival in Hawaii. (That assumes, however, that your dog’s test result is successful. If it isn’t, your dog will need to be re-vaccinated, and a new blood sample will need to be sent in. To be safe, give yourself plenty of time for this step.)
  • Long-acting tick treatment — “A veterinarian must treat the pet for ticks with a product containing Fipronil or an equivalent long-acting product labeled to kill ticks (Revolution® is not acceptable) within 14 days of arrival.” Frontline is an example of a product containing Fipronil.
  • Timely delivery of supporting documents – Original documentation of both rabies vaccinations and the original of a health certificate from your vet, plus a completed Dog & Cat Import Form AQS-278 (PDF), signed by your vet and notarized, must arrive at the Rabies Quarantine Branch more than 10 days before your pet arrives in Hawaii. To save time, enclose the $165 fee (cashier’s check or money order).
  • Timely arrival at quarantine facility — Be sure to schedule your flight so that you arrive in Honolulu before 3:30 p.m. According to the department’s website, “it may take up to one hour for the airlines to transport a pet to the Airport Animal Quarantine Holding Facility and animals not arriving at the facility by 4:30 p.m. will not be released at the airport that day.   Pets arriving in the late afternoon and evening will be held overnight until inspections are completed the following morning.”

The mind reels. The main thing, however, is to get moving as soon as the idea of a Hawaii vacation crosses your mind. And once you’ve jumped through these hoops, you buy yourself a period of time (since the blood test results are good for three years) during which return trips to Hawaii will be significantly easier.

There is one further wrinkle to tell you about: Since 2007, visitors willing to jump through a couple more hoops may be allowed to request direct release of their pets from the airports on the neighboring islands of Kaua`i, Maui and in Kona.

The last twist, of course, is that only Korean Air allows dogs to fly in-cabin to Hawaii, and the only Korean Air flight going to the islands departs from Korea. That leaves me with the following unpleasant choices: (1) Go to Maui while Chloe stays in Seattle at a kennel or with a petsitter; (2) Take Chloe with us, but under the plane; or (3) Travel with Chloe to Korea and then to Honolulu. Argh! [8/15/11 I’m thrilled to report that this paragraph is now out of date. I’ve just learned that Alaska Airlines is now allowing small dogs and cats to travel in-cabin to Hawaii, as of today’s date.] The point of this post, though, is that once you and your dog arrive in Hawaii, quarantine rules needn’t stand in the way of a great island vacation.

The First 10 things to do when you move to Hawaii

shutterstock_143660524Dr. Rennie has moved to Hawaii, and there are quite a few good tips for those of you considering relocating here.  Aloha Tony, a realtor in Hawaii has some great suggestions which I will mention here:

1)  Change your license plates. This takes only a few minutes and you can do it at a satellite city hall. There are a few branches around the island. You’ll need Hawaii car insurance and a safety test, which you can get at almost any gas station. Driving around with out of state license plates is a dead giveaway.

2)  Change your cell to an 808 area code, Hawaii’s only area code. Don’t make your new friends and co-workers in Hawaii dial long distance, it’s just a reminder to us that you’re not from here. You have to change someday, just bite the bullet.

3)  Get a map. Learn all the freeways, highways, and major city names. Hawaii roads are very confusing, and very unforgiving if you make a mistake. You’ll drive around Honolulu very frustrated if you don’t learn the roads, so do it.

4)  Related to #3, drive around the whole island of Oahu. Get to know what cities look like, how long it takes to drive around, and familiarize yourself with your town. Being familiar with roads is a good way to feel at home.

5)  Subscribe to the local paper, or at least read it online. This will teach you what local people are thinking and talking about. When you can talk with locals about property taxes and water quality, you sound and feel local. The two papers we read are the Honolulu Advertiser and the Star Bulletin.

6)  Get involved in a social group. There are plenty of other ways to get involved, especially if you have kids. If you don’t meet people outside of work, you’re going to be lonely, and eventually you’ll go back to where you came from. Try kids sports, or an adults softball team, or a book club. Just do something other than sit at home being lonely.

7)  Buy some Aloha wear. Shirts, dresses, seat covers, stickers, whatever. Show the Aloha spirit and you’ll look and feel more local. Until you own some Aloha shirts, you’re not at all a Hawaiian resident.

8)  Find a local restaurant that you like and go there more than once. Just having a place that you like, a familiar place, will make you feel more at home. Pick a favorite place in Oahu and become a regular. You’ll be amazed how much this will help you in many ways. Having a routine helps.

9)  Get in the water. Celebrate your move to Hawaii by enjoying our amazing warm ocean! If you pick up a water sport as a hobby, you’ll really love it here. People who get in the water tend to appreciate Hawaii much more. I prefer surfing, but there are dozens of options.

10)  Change your driver’s license. This one is #10 for a reason. It’s a total pain to get the license. You have to go to the only office on the island that does this, which is in Kalihi, and stand in line for a long time unless you get there at 7am, which means driving in traffic. When you get your license you’ll really feel like a local. You get a Kamaaina rate (local rate) and hotels and some restaurants.