GERM
00:00:09.440 – 00:00:11.520
Salaam. My name is Germ.

WORM
00:00:11.600 – 00:00:12.560
I’m Worm.

GERM
00:00:12.640 – 00:00:27.360
Welcome to episode 108 of the Germ and Worm Travel Health Podcast. Advice from cdc. Trustworthy or tainted? It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger, also called Germ. I’m a professor of Infectious diseases at the University of Washington in Seattle.

WORM
00:00:27.700 – 00:00:35.300
I’m Dr. Chris Sanford, also known as Worm, associate professor in the Departments of Family Medicine and Global Health, also at the University of Washington.

GERM
00:00:35.620 – 00:01:31.810
Chris, this is the podcast where we talk about travel health concerns and concerns for health in general coming to us from our listeners. Questions we’ll consider today include, should I take a baby aspirin on a jet to reduce my chance of catching a blood clot?

I’ll be hiking at 15,000ft. Will boiling water at that altitude disinfect it? Who’s the best person to ask when I have a medical question?

And what is shared medical decision making making? Anyway, a reminder to our listeners, please contact us with your travel health questions or your stories. Your tips for success.

If you have a request for a clarification on something you’ve heard on a previous episode, we would love to hear from you. Just Visit our website germandworm.com or if you prefer, drop us an email germandworm@gmail.com before we jump in our medical disclaimer.

This podcast is designed to inform, inspire and entertain. However, you should not use this podcast as clinical care before you travel. Please see a qualified healthcare professional for recommendations specific to you and to your itinerary.

WORM
00:01:32.290 – 00:01:57.010
First, Paul, we have two questions from Evelyn, who lives in Seattle. They’re both good and we’re going to answer both of them. First for you.

Evelyn writes, I’m about to trek in Peru and I wonder if the porters are boiling water to purify it because the campsites are between 14 and 16,000ft and I wonder if boiling will be needed to kill the germs and if so, is it going to get hot enough when it boils at that altitude?

GERM
00:01:57.070 – 00:05:35.420
If yeah, thanks. So how to keep your drinking water safe so what an exciting trip. I still have not trekked in Peru. It’s on my list.

So I’m excited to hear from Evelyn when they return, see how that actually went for them. And I’m really hopeful we will not hear about diarrheal illness. Chris Right, because this is someone who clearly wants to have a good time.

They want to make sure that when they drink the water that it’s safe. It’s true. We’ve talked on this podcast many times about different strategies for purifying water.

If it’s coming from a source that could be highly contaminated and being in the backcountry, Peru or otherwise, that’s a risk. So they’re right. You know, in general, if you heat something up to a certain temperature for a certain time, nothing can survive that, basically.

And the question is, what about doing it at altitude?

The problem, of course, is that what we do down here at sea level, where you and I live and work in Seattle, you know, water boils at 100 degrees centigrade, basically. And so we know that that’s a so called a true boil. That’s what we think about as being like a legitimate case of boiling.

But as we go higher, you know, there’s less atmospheric pressure to hold things back. And so the water tends to boil at low temperatures. So this is a great question.

This comes up all the time, including for me personally, when I do a lot of time in the backcountry mountaineering, can I really purify the water by boiling it at these higher altitudes? And just to be clear, the difference is pretty extreme.

In some extreme cases, if you get to 20,000ft above mean sea level, water is going to boil at about 79.9 or 80 degrees centigrade, not 100. And if you get up to 25,000ft, you know, it’ll boil at an even lower temperature still. So, number one, good news, very few people go that high.

And I have been there myself. I do not recommend for most people. Number two, it does not matter. Evelyn, you’re good. It doesn’t matter.

There’s nothing magical about 100 degrees centigrade. That’s just what we’re accustomed to because most people live and work near sea level. So that’s what we think about.

But you’re gonna be good if the team that’s helping take care of you when you’re up there really is boiling water, just bringing it to a boil is enough. There’s nothing magic about 100 degrees centigrade.

First of all, it’s going to be at a certain temperature that’s hot for a period of time to get to the boil.

Second of all, it’s okay if you get temperatures that are around 79 or say 89, let’s say 95 degrees centigrade, whatever it’s going to be at those altitudes, and in fact, the altitude you mentioned of 14, 15,000ft, you’re probably going to boil closer to 90 degrees. That is fine. And you don’t need it to boil for a certain period of time.

My practice personally is that if the water is clear and it looks like it’s not full of feces and toilet paper and stuff, just get it to your boil no matter what elevation you’re at, and that should be enough. Now do as I say, not as I do. There have been exceptions.

There might be a case where you’d want to do something more belt and suspenders approach, if you will. And I will share with you that when I climbed Kilimanjaro on the Rongai route back in 2010, you know, we stayed at the Mawenzi Tarn.

It’s a glacial tarn, which is a glacial runoff lake. It was basically green. You know what they’ve done to the reflecting pool down in Washington, D.C. that’s what this looked like.

It was literally, literally algae and green. That was the only water we had. And so the guide came to us and said, look, you know, we can either use bleach or boil, but today, can we do both?

And we said, hell, yes, please do both. And so you can do things like this in some cases, if it’s a terribly befouled and contaminated water source, do whatever you want.

Filter is one thing you could do, but I would do something beyond. So heat is king. Heat is always the right way to go.

And I’m totally fine with getting things just to a boil, no matter where you are in respect to the elevation, you should feel good about that. If you want to add a little bit of bleach, then that’s also fine too. Chris, does that sound right to you as well?

WORM
00:05:35.420 – 00:06:11.120
Yeah, indeed. And that makes it easier for travelers.

Everyone knows that water boils at a lower temperature, but there’s a technical term, htst, which stands for high temperature short time. And this is a subset of pasteurization. And the numbers for that is you need to bring the water to 161 degrees Fahrenheit for at least 15 seconds.

Well, even at 25,000ft, water boils at 168, which is higher than 161. So even at 25,000ft, if you just bring it to a boil, then let it cool, as long as the water is clear in the first place, you’re going to be okay.

GERM
00:06:11.600 – 00:06:56.420
Totally agree.

And if you don’t want to lug all that fuel up there to do these boils, we’ve talked about other strategies, including bleach, other chemical treatments, and including UV light. Remember, for UV light, you really want the water to be clear. Otherwise you can’t depend on it.

Bleach is another great opportunity to keep the water safe. Chris, we have another question from Evelyn, same questioner, and I love this one.

Also, if I’ve been at altitude in Peru for three weeks, I anticipate having a nice high hemoglobin. I presume that I will. And I’m also going to be at increased risk of blood clotting on a long plane ride home.

Do you think that I should consider taking a baby aspirin for the trip home to reduce my chance of getting a blood clot?

WORM
00:06:56.420 – 00:08:06.870
Ooh, thank you. Good question. So indeed, sitting for a prolonged period of time elevates your risk of blood clot.

And this is not a common thing, but it’s statistically significant and it’s more common dramatically in people with risk factors. People who take drugs that tend to elevate risk of blood clots would be things such as hormones. Now, aspirin thins the blood. This is true.

However, the bottom line is no, it’s not recommended to take aspirin to reduce the risk.

The reason is A, it hasn’t really been studied in large studies and also B, like every drug, aspirin has side effects because it thins the blood, it elevates your risk a bit of bleeding inside your brain, it elevates your risk of stomach and duodenal ulcers. It has other side effects.

So putting all that together, no, I would not recommend that you take aspirin, even if you’re taking something like a hormone that elevates your risk of blood clots.

I do recommend that you do the usual anti clot measures on a jet, such as remain well hydrated, hold off on alcoholic beverages, move, flex your legs, get up and walk when the pilot will let you. But in terms of aspirin, no, really hasn’t been studied, wouldn’t recommend it.

GERM
00:08:07.260 – 00:08:13.460
Let me ask you one follow up question. What about compression stockings, socks that are compression socks? What’s your opinion about that?

WORM
00:08:13.460 – 00:08:25.180
Yeah, I should have mentioned that. Definitely of benefit for reducing risk of blood clot.

And also even aside from that, it’ll keep your calves from getting all puffy after a long jet ride, which is almost inevitable for many people.

GERM
00:08:25.420 – 00:08:59.560
I love that you say that. Because of my ankle fracture, you know, I’m in this compression sock. The only time I take it off is when I’m bathing and in bed.

And so that makes me feel even better about a cross country trip I took to D.C. just a couple of days ago. Hey, Chris, another question to You.

If I may, if our listeners have questions about their medical care, travel related or otherwise, who’s the best person to ask? Especially around medications, doses, interactions, who’s the best source of information for medication questions?

WORM
00:08:59.640 – 00:10:25.940
Well, this is timely and I would not initially. If you have an option, go to artificial intelligence. Recall that it’s not a sentient entity.

It is a predictive program based on word frequency and it’s often right and it sometimes just makes stuff up and you would hate to die because it predicted the wrong word was going to be next in its answer. So do recall that every drug has potential side effects.

And in fact, if your provider says that whatever they’re giving you doesn’t have side effects, you should be a little suspicious. The first person is the person who prescribes it. Ask the doc or the PA or the np. What are the benefits? What are the side effects?

What should I do if the side effects happen? However, often we forget, like if I get a drug from my doc, I often forget to ask all the questions.

Another really good category of professional, and I think this is underutilized, are pharmacists. They study drugs for their entire professional degree. They are whizzes.

I ask pharmacists questions all the time on drugs and they are wonderful and helpful and educated. So A, ask your provider.

But B, when you pick it up at the pharmacist pharmacy, if you get it from a lower level of training person, just say, hey, can I talk to the pharmacist? They’ll usually say yes. You shoot your questions. If the pharmacist doesn’t know what, they’ll look it up and then see, yeah, you can go online.

There’s many sources that are good online, but those would be the first two lines of professionals. I’d go to docs and pharmacists. Paul, your take?

GERM
00:10:26.260 – 00:11:15.010
I would just emphasize that, yeah, we learn a ton from our pharmacy colleagues every day. I mean, that’s who I turn to with dosing questions, with interaction questions, toxicity questions.

So if you have a pharmacist who you like and trust, that’s great. I think what you said is true. We always start with the person who’s prescribing it. Hey, I’ve got a question about this.

But the reality is that those doctor patient encounters, they’re very compressed for time, by the way. We doctors hate that. We would love to have much more time with you. That would be great.

It’s just our society is broken so we’re stuck with shorter time. So if you have neglected to ask a question because you forgot or you felt awkward because you just didn’t want to step on somebody’s toes.

Please follow up. That’s probably a really good question, and I love the idea that you could get the answer, potentially from your friendly local pharmacist.

WORM
00:11:21.090 – 00:12:24.530
Paul, a question for you. And this is really two questions. The CDC, unfortunately has been tainted in some ways by political input. As we have discussed on our shows recently.

The cdc, the center for Disease Control and Prevention based in Atlanta, Georgia, they make a lot of recommendations concerning all sorts of things pertaining to health, including immunizations and screening for various illnesses. So my first question is the cdc, are all their recommendations now corrupt from politics? And B, there’s a subset of their recommendations.

There’s a thing called the Yellow Book, which certainly is a travel doc I know about. Some lay people do. The Yellow Book is for travelers.

And basically it is a collection of recommendations for things like diarrhea and immunizations and malaria avoidance on all things related to travel. And you can get it for free@cdc.gov you can also buy a hard copy of the book if you want to.

So the second part of my question is, is the Yellow Book now corrupt due to political input under the current administration? And yes, I’m Talking about you, RFK Jr.

GERM
00:12:25.010 – 00:15:47.730
Among other nefarious personalities. You know, we’ve been very, it’s a great question. We’ve been very clear on the podcast how much we admire and respect line workers at cdc.

They’re excellent and they are working under these unimaginable circumstances.

My heart goes out to them and mad respect and gratitude for what they are doing, especially in an environment where their own ability to voice their concerns must most doubt it undoubtedly be suppressed. I cannot imagine how stressful that is to choose a career at cdc. You have to be a selfless servant.

It is such a thankless, underpaid, problematic thing to do in. In good circumstances. So, you know, for people who’ve chosen the life to serve as public health people, I think they’re amazing.

So I want to respect that and I also want to honor that and to say that most of them are still working and doing their very best to give us very high quality, to answer your question, very high quality, trustworthy information. Most of what’s in the Yellow Book, most of what’s on the website is still good, except the part that’s not. And this is the issue, right?

When someone logs on, do they know that something has been tinkered with by someone who has no business doing that or has it been left alone? Now, you and I as medical doctors, that yellow book, that really is a guide for healthcare providers, including physicians as the top audience.

So you and I can look at that and say, okay, I can tell right away what somebody has messed with. Case in point, Covid immunizations. Right. It’s very clear that if you’re going to travel, you should be up to date with your Covid shot.

And that’s true for everybody who is FDA authorized to receive the shot. That’s what we’ve been saying for years. Well, currently the yellow book doesn’t say that.

It says that if you’re pregnant or you’re a child, you should discuss this with your healthcare provider and decide if it’s right for you. That’s a mistake. It’s incorrect. Medically speaking. As an infectious diseases professor, I don’t like that. It’s not the advice that I would give.

I would say this is a routine, standard approach for all people based on the safety studies that we’ve been doing over these years of the pandemic. But there’s a political piece that we’ve talked about before.

I don’t really understand it, but there’s this madness Covid derangement syndrome, where people are just losing their damn minds. So people who don’t know the science, the epi or the virology are trying to make some kind of weird political hay out of this.

I still don’t understand how that works, but that’s what’s happening there. So there have been a small number of exceptions which drive me crazy and bananas.

The problem is that for the frontline person who might be listening to this podcast, how do you know which of those is in the. In that context? So unfortunately, I think the answer is the same.

Please do talk with your trusted healthcare provider, especially a board certified physician, about what they think is best for you heading out on a particular trip. There’s no way to replace that.

And although I think CDC remains a wonderful website that has a lot of great starting points for information, I would suggest people consult it. But that’s a prep for your conversation with someone who knows what they’re talking about. Please do not DIY it when it comes to travel health.

Well, I guess that’s what you’re doing by listening to us, so I guess that’s good. That’s what we do here on Germanware.

We want to get you thinking about things, but we would never replace a conversation with your healthcare provider. And the same is true for the yellow book. Is that your take also, Chris?

WORM
00:15:47.810 – 00:16:27.070
Yeah, I think actually most of the CDC recommendations and specifically the yellow book recommendations concerning travel are still valid.

A really good person to run the recommendations by is your health professional who probably, just as Paul alluded to, can tell the difference between what has been tainted and what has not been. Most of the info, when I look at the yellow book on malaria, it still looks good. On traveler’s diarrhea, it still looks good.

My issues come up under vaccines, as you mentioned.

Also, there’s other federal recommendations that we may get to later in this episode concerning healthy food, for example, that also have been grossly contaminated by political input.

GERM
00:16:33.840 – 00:16:57.360
Let’s talk about vaccines a little bit more because, you know, on some occasions what we’re seeing from Centers for Disease Control, for example, are recommendations that have changed a vaccine that used to be routinely recommended.

Now there’s a different language, isn’t there, Chris, where they say that we should have shared decision making before deciding to receive that vaccine. So what is shared decision making and what are your concerns with it, please?

WORM
00:16:57.440 – 00:18:58.810
Yeah, I think it’s evolved into a smokescreen screen behind which anti vaxx people hide their true intent. So what it is, I mean, it sounds good and it is good in many situations.

What it means is that the patient and the medical provider discuss pros and cons and come to a mutual decision. Well, that’s only reasonable.

The problem is that, say, if there’s for a child roughly 18 vaccines that are recommended, the doc does not have time to talk about the pros and cons of each disease and each vaccine. That would take a two hour appointment. These are default. These are phenomenally beneficial.

Beneficial by which I mean the benefit is high and the risk is low. And I think that RFK Jr and his minions are using this phrase, shared decision making, to basically make it more difficult to get vaccines.

There are areas where shared decision making is 100% appropriate, especially when there’s two equal options or when the pro and the con of an issue are roughly similar, then the doc doesn’t have a clear opinion. Then I think you should go into shared decision making.

But just by analogy, an architect does not go to the citizens and say, hey, I’m making a bridge. What kind of concrete should I use for this bridge?

A pilot does not go overhead during an approach to a landing site and say, hey, should I land northeast or southwest? Let’s see a show of hands here. There’s just some areas where there is benefit with going with expert opinion.

And this ties into the idea of False equivalence. In medicine, it’s not safe to present all sides of an issue as if all were equally reasonable. So I get it and I use shared decision making.

But to have that be the default for vaccines is going to lead, and this is the intent of its proponents, to a markedly lower national vaccine rate, which is going to lead to outbreaks of infectious diseases, which is going to kill people, including children. So the stakes could not be higher.

And like I say, I think it’s just a strategy and an attempted blockade of people getting the vaccines that is going to help them to lead a long and healthy life.

GERM
00:18:59.440 – 00:20:27.970
I agree. It’s all about trust.

I mean, trust in our expertise as medical doctors, public health officials at cdc, the approval team at fda, who labor under very, very difficult circumstances too.

Why is it that the Republican Party has decided that they should focus on us and by destroying public trust in us, that that’s going to make them more rich and empowered? It’s weird stuff. It is some wild and wacky stuff, but that’s what they’re doing. So please don’t be fooled.

And by the way, we always share that no one gets pinned down and immunized against their will. There’s always some shared decision making. This is about what is routine. This is what is recommended on a routine basis.

If you have questions about immunizations or anything else related to your health, you have to have that conversation. You have to talk to your doctor. That’s always been the way it should always be about conversations.

And if you’re with a healthcare provider who’s not willing to explain why this is what they recommend and please move on to the next person. I really hope that we can move past this concept that routine recommendations are bad. They are not. They are the opposite of bad.

We’ve come to these recommendations because we care about people and we really want people to be protected against these stupid, ridiculous, preventable infections. Nobody should have to suffer with infections unless they absolutely must.

And if we have a countermeasure, let’s use those countermeasures in the way it’s been tested and approved by our own federal government.

WORM
00:20:28.040 – 00:20:58.540
Government, yeah. There’s a long formal process that ends up in these recommendations. These things are not just shots from the hip.

Basically, the experts get together from around the country. There’s a formal board which RFK Jr has fired, to make these recommendations.

So these are very considered decisions that come at the end of a long formal process. And it really kills me to watch this just be stomped under the boot of this guy who’s making decisions based on his own conspiracy theories.

GERM
00:20:59.410 – 00:21:00.130
Amen, brother.

WORM
00:21:04.290 – 00:21:27.050
All right, Paul, change of topic. This comes from Lewis, who lives in Colorado. Lewis says, hey, I’m going to Vietnam.

I’m spending a whole month there and I’m going up north to Hanoi and down south to Ho Chi Minh City, maybe to the Mekong Delta. Do I need to use bug repellent and do I need to worry about dengue?

GERM
00:21:27.450 – 00:23:47.510
So, Louis, that’s amazing. I’m envious that you have this trip. Congrats on doing that. And yes, you do need to protect yourself against biting insects, especially mosquitoes.

The concern, of course, is for malaria, which is infection, that we have other medical countermeasures. And I think that should be part of your kit.

When you talk to your healthcare provider, make sure they know where you’re going, what you’re doing, and they should, I’m very confident, prescribe you some medication, prophylaxis against malaria. But there’s other infections too. And you mentioned dengue. That’s correct. There’s been an increase in cases of dengue reported in Ho Chi Minh city.

More than 17,000 cases recently reported by local healthcare authority, which is a twofold increase. Looks like there’s a real explosion of dengue in Ho Chi Minh. And of course, that’s also a risk in other parts of Vietnam.

Dengue, like malaria, you catch it when you’re bitten by a mosquito. Unlike malaria, we do not have a medication to use to help reduce the risk of catching it.

On the other hand, if you protect yourself against the bite of the mosquito in the first place, you can protect yourself from these and other mosquito borne illnesses, including Japanese encephalitis, for example. So I really do recommend bug avoidance measures, I.e.

Application to your skin anytime you go outside using either DEET or 20% Picaridin bug spray. That’s what I use.

And then pre treating your clothing before you go, choose what you’re going to wear as your outside clothes and treat them with permethrin spray. That’s good for a number of wash cycles and can help to reduce the risk.

But in addition, you know, you mentioned dengue going to Ho Chi Minh City. It’s interesting. I might consider getting immunized against dengue for that trip. You know, we do not have access to the Qdenga vaccine here in the United States. This is a listener from Colorado. But you can get that shot when you’re in country. And this is someone who’s going to be in rural parts and urban parts.

But Also rural parts of Vietnam it sounds like. And they’re going to be there for a month. Hey, that might be on my agenda early on in my trip to land.

Get the Qdenga vaccine and that can reduce the risk of getting dengue, either severe dengue or dengue in the first place.

If I were doing this trip and I had that opportunity, I think I would pursue the Kudenga vaccine in addition to wearing bug spray and other personal protective measures. What’s your thought on that criteria?

WORM
00:23:47.660 – 00:24:53.190
Chris? Yeah, the Qdenga vaccine looks better and better as I read about it. It’s a live vaccine. It gives protection for all four serotypes of dengue.

And unlike a prior dengue vaccine, you don’t have to have any kind of testing before you get it one imperfection. But reality is it is a two dose series three months apart. You don’t get full protection until you get the second dose.

So you’ll get partial protection after that first one. But you would need to get a second one at least three months later. It could be more.

I actually plan on getting this vaccine sometime in the next or two because I do so much travel to where dengue is common. So if you’re just going to an urban place for a few days, probably not worthwhile.

But if you’re the kind of traveler like me and Paul, who are always going to equatorial places where there’s dengue, you might put this on your itinerary. It’s available in about 40 countries, a lot of European countries, some tropical countries. You could see a doc, get a prescription, get the vaccine.

Maybe it would give you a good reason to go to a place that’s fun to go to is to make it a vaccine trip. But for you there, yeah, the first shot would give you partial protection.

GERM
00:24:53.670 – 00:25:29.320
I love that.

And Louis, based on what I think the vibe is of the trip, you know when you talk to your healthcare provider, please ask him about Japanese encephalitis immunizations as well. And that’s one that’s also mosquito borne.

It’s also a virus in the flavivirus family and it can be bad and is very effective prevention with the Japanese encephalitis vaccine. Chris Speaking of vector borne infections, we have a listener who’s anonymous and that’s totally fine.

Traveling soon to Argentina and they’re wondering if they may be at risk of catching chikungunya.

WORM
00:25:29.720 – 00:26:17.560
Yes. First, what is chikungunya, besides a funny sounding word, viral illness spread by mosquitoes, symptoms somewhat similar to dengue fever.

And joint pain. And it is an emerging illness.

It’s getting more common in a lot of tropical countries around the world and actually including Argentina and there’s been a fairly big outbreak there recently. They’re getting about 160 cases a week. And this has been going on since March, particularly up in the northwest. So we’re talking around Salta.

So is it an issue? Yes. And I would at a minimum use bug spray for this. I’ll let Paul talk a little bit about the vaccine in a minute.

But at a minimum I would do the usual DEET or percaritin to skin, permethrin to clothing and that would bring risk down. Paul, what about the vaccine?

GERM
00:26:18.120 – 00:28:04.160
Yeah, I got the Vimkunya vaccine before I traveled to Sri Lanka recently. There’s a lot of chikungunya in Sri Lanka so my wife and I both got it. And my. This is a viral like particle. It’s not live attenuated. So it’s.

In other words, it’s totally safe. Even if you’re an immunosuppressed person, you’re not going to catch chikungunya by getting the vaccine.

And our own experience was a little bit of muscle tenderness. It’s a shot in the shoulder. So I had a tender shoulder the next day and after that nothing. No fever or other illnesses.

I do have contact with other recipients who happen to have gone through a little bit of fever and achiness. Generally I always think that’s a good thing when they get that because it tells you the immune system is doing something.

But anyway it’s not a solid correlate of immunity. The bottom line is that that is a vaccine that I would recommend also for someone visiting Salta.

By the way, what is Salta and other areas near Mendoza? You know these are wine growing regions of Argentina.

It’s just incredibly beautiful, pastoral, great places to go and unfortunately a little bit of chikungunya. So let’s think about how to prevent that moving forward. To this listener I would say get your get your Argentina on and get your Vimcuna on.

Everyone, thanks so much for joining us here on episode 108 of Germ and Worm. As always, we welcome your questions on travel health. Please send them to us or your tips for travel success suggested corrections.

We’d love to hear from you.

Just send us an email germandwormm@gail.com or visit our website germandworm.com if you have enjoyed this episode, please subscribe, rate us favorably on your device and spread the word with friends, family and please follow us on the socials. Those are free ways to support this podcast.

WORM
00:28:04.160 – 00:28:07.850
I I’m Worm. It’s a big planet. See it in good health and we.

GERM
00:28:07.850 – 00:28:29.650
Look forward to seeing you next time.

This podcast is designed to inform, inspire and entertain, but it does not establish a doctor patient relationship and so it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure.
The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinions of University of Washington or UW Medicine.