GERM
00:00:09.600 – 00:00:11.760
Nomaskar! My name is Germ.

WORM
00:00:11.760 – 00:00:12.720
I’m Worm.

GERM
00:00:12.800 – 00:00:26.320
Welcome to episode 119 of the Germ and Worm travel health podcast, Face Flush: Revenge of the Toilet? It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger, also called Germ. I’m an infectious diseases specialist at the University of Washington.

WORM
00:00:26.540 – 00:00:31.740
Hi, I’m Dr. Chris Sanford, also known as Worm Family Medicine Doc, also at the University of Washington.

GERM
00:00:31.900 – 00:01:18.200
Chris, here are some of the zany and important questions that we’re going to answer today. Are you at risk of catching malaria if you transfer at an airport? Who should get shots for flu? COVID 19 and RSV this fall? Toilets.

What can they do to you? How high can that flush spray go? And Bangladesh? And measles? What’s the real risk?

A reminder to our listeners, please contact us with your travel health questions, your stories, and your tips for success. Just Visit us online germandworm.com or shoot us an email germandworm@gmail.com.

Our medical disclaimer: This podcast is designed to inform, inspire and entertain. But before you travel, please see a qualified healthcare professional for recommendations specific to you and your itinerary.

Chris, what’s up with your own upcoming travel plans?

WORM
00:01:18.840 – 00:01:39.300
Yeah, I’m still recovering from Burning Man, where I just spent nine days, and actually we’re going to do a dedicated episode on that in coming weeks, and I’m preparing to go off to Bhutan and Brunei.

I’m teaching a wilderness medicine course in Bhutan and then I’m taking a little side trip to Brunei for my own interests, just because I’m in the neighborhood. And Paul, what about you? Where are you off to soon?

GERM
00:01:39.780 – 00:02:19.330
Yeah, what a great question. So some work in D.C. and then some vacation time and a little bit of work in South Africa, which will actually be my first time to South Africa.

So I’m looking forward to that and look forward to some content coming from Brunei, Bhutan and South Africa here on Germ and Worm.

Chris, a question to you. Is it possible for someone to catch malaria at an airport?

And I raise this because of this recent, really heartbreaking and honestly slightly outrageous story of people working at the Frankfurt airport catching malaria and in some cases dying of that infection. What’s going on?

WORM
00:02:19.570 – 00:03:35.760
Yeah, it’s a real thing. It’s called airport malaria. And just back up a little bit. Malaria is transmitted by mosquitoes. It is not spread person to person.

But what has happened very rarely at airports, Frankfurt and elsewhere is that a mosquito from a country with malaria will enter the jet and stay there and fly to a country where there’s not malaria, such as Germany, it’ll come out and it’ll bite someone and cause malaria. For tourists and just ordinary people transiting through an airport, it’s really close to a non issue.

I would not certainly recommend bug repellent just because you’re going through an airport or taking a anti malaria medication. But yeah. Throughout recent decades there have been a small number of cases of this.

And tragically just recently, six employees in Frankfurt, Germany in the past summer were found to have malaria and two of them died. So when it happens, it’s a big bad thing and it’s happened before. There were also some cases also at Frankfurt in 2019 and 2022. So it’s super rare.

It can happen, but it’s not really actionable.

So me, if I was going pretty much any airport in the world, unless I was already taking a malaria drug because of the country, I would not use any additional protection just because I was going through the airport.

GERM
00:03:36.080 – 00:05:22.640
This is just such a discouraging story. And it reminds me, this was written up in the New York Times.

An American who had transferred in Heathrow, going not to or from any tropical place, who was diagnosed here in the US Southwest with malaria after a febrile illness, anemia. That diagnosis was made by an advanced practice provider in the hospital who happened to be from a country where there’s a lot of malaria.

And I think they were in New Mexico. And he said, you know, this looks to me like, this looks to me like malaria made the diagnosis and was correct and saved that US citizen’s life.

So this has happened in airport workers and tourists, but it’s rare as hen’s teeth. I’m just so sorry that people were not even thinking about this.

In the case of these two people who apparently did not survive, Malaria is very treatable. You just gotta make a diagnosis. You will not treat it by accident. It’s a specific treatment. So we have to be thinking about malaria.

The other thing to say is I was just at the Frankfurt air, you know, a few days ago during a transfer from, going from Europe, coming back here to the United States. It’s super nice, people. Boy, that’s a bad airport. It was just so chaotic.

And in fact, Julie went online, my wife, I think the term she put into the web search was Frankfurt Airport. What the hell is going on? And there’s a whole sub stack and Reddit group about people saying it’s the craziest airport. Right now.

They’re trying to renovate it and it’s chaos. And a lot of the times passengers are not going from plane into the airport. You go down these stairs. So it’s a lot of planes that park on the ramp.

And I wonder if that’s where this. Well, these are ramp workers. Indeed. So the point is the mosquitoes might be in the cabin.

I think they’re in the wheel wells and other little puddles in the undercarriage of these airplanes. So could happen to anybody. Don’t panic. And you don’t have to avoid Frankfurt for this reason.

Just know that you’re getting into a world of chaos at their airport.

WORM
00:05:22.720 – 00:05:52.330
Right.

And I have to say that in general, healthcare providers in the US and Canada and probably the whole world are not very good at diagnosing malaria, particularly if the person has not been in a malaria country.

I saw this study recently that the average person with malaria in the United States, even if they have been in a country with malaria, has to see 3.5 medical providers before they get the correct diagnosis. And it takes seven days. Well, that’s bad with a life threatening illness like malaria, which can kill you within a day or two.

GERM
00:05:53.220 – 00:06:12.340
That’s right.

And so if you happen to be one of those people and you’re bouncing from doctor to doctor with fever and anemia, just raise the question, hey, doc, could it be malaria? You might be right, Paul.

WORM
00:06:12.820 – 00:06:23.940
This is a short question which is going to require a long answer. Now that it’s fall, who should get a flu immunization, a COVID 19 immunization and the immunization for RSV.

GERM
00:06:24.660 – 00:12:20.590
Yeah, thanks. These are infections that traditionally are greater threat in the fall. So it’s a perfect time to talk about it.

Most folks are used to thinking about this, by the way, why does it happen in the fall? I think it’s people going back to school, it’s transmission within schools, it’s people being indoors more. Who knows?

There may be a number of factors, but there is usually a seasonality to these respiratory viral infections. And so, happy news, science progress. We have countermeasures. They are called vaccines. It’s not perfect. Sometimes you just need to wear a mask.

Sometimes you need to avoid certain gatherings. There’s other stuff you can do to stay safe, but vaccines are a huge part of that. So I really appreciate the question.

And it’s more complicated now than it’s ever been before.

Not because the viruses are worse, not because our vaccines have changed, but because we’ve got a crazy person in the White House who’s trying to make trouble.

So let me give you guidance that comes from all the professional societies, including it, Society of America, the American Academy of Pediatrics, American College of Obstetricians, Gynecologists, you name it, and the Vaccine Integrity Project. We’ll talk about all that.

And then where there’s a difference in what you might see in the federal level official guidance, which is no longer necessarily good. I’ll call that out, too. We’ll start with flu. The flu.

Dangerous, miserable, and something that we can reduce the risk of catching or at least make it less bad when we get it. That’s your flu shot. Everybody, including Centers for Disease Control, agrees that Every American age 6 month and above should get their flu shot.

I’m just going to say it again. If you’re six months or older, if you can hear my voice and understand the language I’m speaking, you need your flu shot.

If you have a shoulder and you’re more than six months old, that’s what your shoulder’s for, to get your flu shot. I think that’s important to do as soon as you can, ideally before the end of October. The exact best time to get your flu shot.

Is it now, end of September? Is it early October? Either one is fine. The best shot you can get is the one that you do get. They’re all good. There are some different flavors.

We talked in recent episode about the new MRNA kind, flusiva, which is a good one to get, but you don’t have to have that.

The key is that if you’re over age 65 and you’re not getting flusiva, you want to get the higher dose of the traditional chicken, egg or tissue culture one. And so I think that’s, that’s an important thing to say if you’re thinking about this question. Get your flu shot.

If you’re age 6 months or above, and everybody seems to agree on that.

Currently, number two, rsv, that’s the respiratory syncytial virus, another respiratory virus that is threat to everybody, but especially bad in people who are older, those with a reduced immune system. And there’s a special threat in the transmission to very young infants and newborns.

Newborns can get a very significant respiratory syndrome from this, the respiratory syncytia. What’s a syncytia? It’s a bunch of dead cells that stick together. These kids can get a terrible. It’s not even really a pneumonia, is it, Chris?

It’s a plumbing problem. It’s this goo and crud that sloughs off in the lining of their airways and floods the air, makes it hard for them to breathe.

So it’s life threatening and very serious in young kids. So we need to protect them as well.

The way we do that is to say, hey, if you are an American citizen and you are age 75 and above, you should get at the moment a single lifetime RSV shot. If you had your RSV shot in that category within the last couple of years, at the moment we’re saying you’re good to go.

Now, honestly, my prediction is that will change. Based on scientific data, it may be that this becomes an every five year booster or that every 10 years we have to do so.

Over the course of time, as we get more experience with this vaccine, we’ll know how durable that protection is. But for the moment, we say if you’re 75 and above, it’s one and done. If you’re between ages 50 and 74, you can also get a single shot.

If you’re at high risk for the complications of RSV and severe RSV disease, that’s people with underlying lung condition that would include asthma, reactive airways disease, and also people with reduced immune system. Right. That’s important as well.

And finally, if you’re pregnant, very important for you to get immunized between weeks 32 and 36 during September through January, those high risk season, if you happen to be in that phase of pregnancy. We want expecting mother to get her flu shot so that she can make antibodies against RSV that protects the mom.

But more importantly, those antibodies will transfer to baby in pregnancy through the placenta. And that way when the kid is born, they have at least temporary protection against that severe flavor of RSV infection we were talking about.

If that opportunity is missed, we still have the opportunity to passively immunize the baby.

The same shot we give to mom, we do not give to the newborn, but we can give antibodies created in a lab that can temporarily reproduce what hopefully they could have gotten from mom as well. So there’s strategies in those kiddos as well, and that’s agreed upon by all these professional societies and Centers for Disease control.

Finally, there’s COVID 19. This is where the difference is most stark between what professional societies recommend and what CDC recommends.

So those medical societies, and I agree with them, recommend a COVID 19 vaccination for all infants 6 months to 23 months for adults age 19 and older, and for everyone age 2 and older who’s at high risk of severe illness. So if you’re an infant between age 6 months and 23 months, get your shot. If you’re a grown up 19 and above, get Your shot.

And if you’re between age 2 and age 19, get your shot. If you’re at high risk of severe disease. Most young kids in that category, age 2 to 19, get a mild illness, but some don’t.

Some will have complications and so they should get that shot. CDC unfortunately does not say that. They just say, talk to your doctor. Have individual shared decision making.

Talk to a doctor or a pharmacist about this and make up your own mind. I like that when we talk to doctors and pharmacists, we have good conversations. I’m not against that.

What I am against is the idea that this, instead of being a routine recommendation, is now something that feels more optional. I don’t like that. I think that’s a mistake. And I do recommend against that particular approach from a public health perspective.

Chris, what’s your thought on all this?

WORM
00:12:21.220 – 00:13:21.420
Yeah, I agree with you. I think shared decision making used to be a legit concept, but I think it has become a red herring now used by anti vaccine people.

Meaning don’t get this routinely. Maybe there’s as many pros and cons pros as there are cons for getting it. Talk to your doctor. It’s complicated.

Now, if a doc is going to recommend for a kid 18 vaccines, do you think the doc and the patient can discuss the pros and the cons and the side effects in the statistic of each of 18 different illnesses during a visit? It’s not realistic.

So obviously parents can opt in or out for these vaccines, but the more routine they are and they’re presented, I think the better. I think this creates a false equivalence that there’s as many pros and cons. Now what about side effects? Full disclosure, do these have side effects?

Of course they do. Everything we do in medicine has potential side effects. Taking a Tylenol has potential side effects.

GERM
00:13:21.420 – 00:13:22.700
Autism, I think it gives you autism.

WORM
00:13:23.740 – 00:14:36.300
There you go. Yeah, including autism. Gargling with Listerine has side effects. So what are the side effects of these three vaccines that Paul just talked about?

Bottom line, they tend to be transient and mild. So yes, you can get a sore arm, you can even get a low grade fever, you can get a rash, you can get some achiness. Doesn’t happen to most people.

Happens to some people. Goes away fairly shortly in the great majority of time.

But the important point, to say it in one sentence is the benefit of all three of these is hugely more significant than the drawback. It’s like 100 to 1. So are there side effects? Yeah, everything has side effects. But Are the side effects big and bad enough not to get the vaccines?

Heck no. And study after study shows the safety of these and the people who get these have a lower rate of illness and death.

And just one side note, one subset. There have been studies that have come out recently looking at red states versus blue states.

Basically, Trump supporting states have a lower rate of getting COVID 19 vaccination than have a higher rate of getting COVID 19 and dying of COVID 19. So currently we’re in the bizarre place of where people are dying because of their political beliefs. So are there side effects? Yes.

Are the side effects mild? Yes. Are these excellent vaccines that we recommend? Heck yes.

GERM
00:14:36.460 – 00:15:51.820
We just need to make it easier for everybody to get protected.

There’s a super fascinating study that just came out in the journal called Vaccine, where they just talked to people in the last season, 2025, about their willingness and interest in getting immunized against COVID 19 or the FL. Super fascinating.

Even among people who said that they were willing to get the shot by the end of that season, only they had 39% of those people who still hadn’t been vaccinated.

And even among people who said they would probably or definitely get the shot, respectively, 66% were unimmunized by the end of the season, and 24% of people who said they were definitely gonna get their Covid shot never actually did. So the point is, even if you’re more than vaccine curious, you’re vaccine committed. We still have too many barriers to getting this done.

I don’t think these are folks who change their mind.

I think these are busy Americans who are trying to scrape in the world’s worst economy to figure out how they can put food on the plate, much less you’re going to make them stand in a line or fill out some kind of papers to get these shots.

It should be easy access, should be more aggressive, and we should really work with those communities that are traditionally underserved medically anyway, multiple social and economic failings when it comes to this. So hey, German Worm nation, thank you for sticking with us.

If you have stories or tips for success about your own journey to get these vaccines, just drop us an email.

WORM
00:15:51.820 – 00:16:17.160
Germanwormmail.com yeah, it’s confusing because there’s a bazillion products on the Internet that claim to make you live longer, and 99% of these are bogus. They only make a little bit of money for the people who make them.

There’s only actually a small number of things that have been proven that will Improve your health overall. It’s things like wearing a seatbelt. It’s for a small hassle. You get a tremendous health benefit.

But others include vaccinations for these three illnesses.

GERM
00:16:17.640 – 00:16:32.180
Amen, brother.

Chris, a question to you from of our listeners who says, I’m going to Bangladesh next week. There’s a thousand deaths there currently due to measles. Should I worry about this?

WORM
00:16:32.660 – 00:18:27.640
Well, RFK Jr. Has gone on record as stating that measles can be treated with vitamins and chicken soup. Yeah, well, even if there were, sorry to break the news, but that doesn’t work. That is not curative for measles.

Measles, big bad viral infection kills a lot of people around the world. And yeah, Bangladesh is having a huge outbreak now. Something 150,000, 170,000 cases. Cases over a thousand deaths.

And it’s tragic, but this is what happens when a population is not immunized for measles. And I’ve, you know, I’ve dealt with measles in patients in places like Uganda and it’s tragic.

You have parents who love their children, their children die because they didn’t get vaccinated. The parents are devastated. It’s. Every death is horrible. So, yeah, everybody, whether they go to Bangladesh or not, should be immunized from measles.

It’s real easy. You just get two shots at least a month apart. Most people are good for life.

Given in the US as a combination vaccine, mmr, measles, mumps, rubella, and as a sideline, that executive order that Trump did in August is nutso, where he says, no, this must be separated into three separate shots, one for measles, one for mumps, one for rubella. There is no reason to do that and there’s many reasons not to do it.

One reason not to do it is it’s not available in the US as single disease vaccine. It’s going to take years if they do it to ramp up. Another thing is compliance.

It’s hard enough to get parents to bring their kids to the doc once, but to spread that out over three visits or six, given that it’s two, think how much more difficult that would be for working parents. And it’s been looked at in study after study.

And we interviewed recently somebody who’s both a doctor and working on a PhD in immunology, Dr. Rachel Barr, and she pointed out that your body can deal with hundreds, if not thousands of different antigens or shaped molecules every day. We’re touching dirt and germs and all this stuff every day.

So the idea that these three things would overwhelm your immune system and are better for you if you give them.

GERM
00:18:27.800 – 00:19:02.210
Separately is just the opposite of true 100%. And this is a cautionary tale. Let’s not make America measles again. Let’s not go this way.

I see that our country should be a leader in helping this and other nations where they’re just having trouble with their economy, their healthcare system. We should be leaders. And certainly the easiest way to do that is to lead by example. We’re not doing that.

The risk of measles is higher today than it’s been in the United States in 35 years. So if this is not something that should be a wake up call to us as a society, I don’t know what is.

WORM
00:19:08.050 – 00:19:28.890
All right, we’re going to change the tone here. Here on the Germ and Worm Travel Health podcast, one of our favorite topics is anything involving toilets. And this recent study came out.

Paul, maybe you can tell us about it. Maybe some alarming data about that toilet flush and the spray and the flying up, and maybe it’s as high as your face. Can you elucidate us?

GERM
00:19:29.850 – 00:22:40.220
A flush in the face? We’re not talking about being flushed with blood. We’re talking about being flushed by a toilet in your face. Yeah. So here it is.

This is a journal called Science of the Total Environment. And at a quick glance, I thought it was Science of the Toilet environment. So no Science of the Total Environment, which I’ve actually never heard of.

I’m sure it’s a great journal. Aerosol and Bio Aerosol Generation from Toilet Flushing, A Systematic Review and Risk Factor Analysis.

So a group of very dedicated and maybe bored scientists went back and said, hey, how risky is it to flush a toilet? Are you going to get splashed with aerosols, meaning small droplets of toilet water when you flush the toilet?

And the answer is, hell, yes, they’re correct. This doesn’t surprise anybody. When you flush a toilet, some of those little water droplets get up to head and face height.

That’s just, just part of our crappy world. And I want to be totally clear about this.

Number one, if you’re in your own household, do you need to worry about getting flushed in the face with your own toilet? No, because the germs that you just pooped out are the ones that are coming right back to you in the face.

So within a household situation, this is very, very rarely an issue.

I suppose if you had someone who’s being treated for a diarrheal illness, I Actually do recommend that people have their own dedicated commode if they’re having infectious diarrhea. That can help to potentially reduce the chance of spreading things around.

My sense is that having this come from the toilet through the air is actually lower risk compared to direct hand to mouth contact, sexual contact, et cetera. But that’s a thing. And, you know, the simple thing to do, of course, is to close the lid.

That can substantially reduce the height of the plume, that toilet bouquet and bloom of droplets.

But when you’re in a public commode situation, airport transit or whatever, sports stadium, number one, in my experience, those toilets, boy, they flush like crazy. They’re very hyper. They’re turbo turds. And that actually is a thing. This is what they’re talking about here.

Number one, there is no lid because I guess they don’t want to clean them. At least in the men’s room. Ladies, you may have something else going on in the men’s room. There aren’t. There’s no lid on the commode.

Number two, hell yes, you’re going to get sprayed with poopy water. And it’s part of living in our poopy, poopy world. This is usually not an issue.

We don’t really understand fully how diarrheal illnesses spread around. I think when it comes to certain very hardy organisms, actually this could be a thing.

One person has norovirus, has diarrhea in the stadium, somebody else comes along, you could get infected this way. But I think we should just say, don’t be paranoid. Please don’t hold it in. If you got to go, you got to go.

And if there’s an option to close the lid, you’re outside of your own home, close the toilet lid and then, and then poop and otherwise, you know, just know that this is a potential risk. By the way, what about men in urinals when the urinal flushes? Remember, folks, the urine that comes out of our body is basically sterile.

And there may be a few germs in there, but nothing of concern. So that’s one of the benefits of being in a urinal situation, I suppose, is you’re just not going to catch something.

Not likely to catch something from the urinal aerosol. From a toilet aerosol, it’s possible.

But I think just because you get a microscopic flash in the face of droplets does not mean that it’s going to make you sick. Just means that we live with other people. And, well, the old saying from Jerry Kersh, the world’s Covered in human stool.

The only question is how deep. And when it comes to flushing in these public areas, it can be deep indeed.

WORM
00:22:40.700 – 00:23:35.700
What I’d like to see, what we need is a study.

I’d like some University to take 1,000 college freshmen, put various pathogens, Salmonella, Shigell, in toilets, flush those toilets, have these freshmen stand above it, and then just see who gets sick. That would really define if this is just kind of a sensational topic or really a public health hazard.

That study, believe it or not, would have trouble clearing the committees that look at safety with research in universities, what they call human subjects committees.

And whereas it’s gross, the idea of pooping in a toilet and then this aerosol plume comes up, there’s not data that it causes bad things, but then again, it certainly is theoretically possible that it does. Does. So is this a risk? We don’t know. Is it gross? Yes. I. I’m not going to change my behavior, but it’s kind of fascinating that this.

I may need to subscribe to the Science of the Total Environment. What else are they looking at?

GERM
00:23:35.860 – 00:24:01.070
I think we should start our own journal, the Science of the Toilet Environment. Look, I poop when you gotta close the lid, when you can wash your hands every time. That’s my advice.

Chris, question to you in a much more serious and sobering note, would you please give us an update what you understand about the outbreak of Bundabujo infection, AKA Ebola outbreak in Congo, please?

WORM
00:24:01.150 – 00:24:59.590
Yeah, it’s bad in a nutshell. The really big famous Ebola outbreak in West Africa, different part of Africa between 2014 and 16, biggest on record killed 11,000 people.

The current one is on track to surpass that. So it’s growing rapidly. It’s not contained. Already there have been over 6,000 cases with 3,000 deaths.

And the reason this is concerning is it’s not well controlled. There are not the public health measures in place that are containing this. They are not giving vaccines to everybody on the periphery of this.

And this is partly a failure in cutbacks in public health. It’s really expensive to go in, but it’s more expensive to let it get bigger and then go in later. So it’s big, it’s bad.

I think there’s a little bit of fatigue in the media about this. This has fallen off the headlines, but it’s still just this tsunami which is getting bigger every week.

And I’m worried about just how big it’s going to get.

GERM
00:25:00.070 – 00:26:34.240
Yeah, totally agree. It’s just, it’s outrageous. It’s Heartbreaking.

It’s a chance for the United States, I think, to lead and that’s absolutely, unfortunately not happening. Under our previous administration, the United States Agency for International Development would have been in a leadership position here.

Now we are not. The good news is that other nations have stepped up.

So there is an experimental vaccine which is being deployed to this area to try to see if we can create, as you mentioned before, a ring of protection if we know that there’s an outbreak to immunize everybody as quickly as possible and of course to learn more about that vaccine, to ensure that it’s safe, but to recognize that this is an emergency. And so the use of that vaccine should be studied aggressively, should be regulated and it should be deployed equitably.

Unfortunately, the vaccine that we have for the other so called Zaire strain of Ebola does not seem to be effective against the Bundabugio strain. They really are different viruses.

So good news is that other people, even if the United States is not currently leading in a big way, other nations are stepping up that way. We thank them and let’s see if we can bring this under better control. The germs don’t care who you vote for. They don’t care what color hat you wear.

They’re just out there as a potential threat. There is no Bundabugio transmission in the United States where I happen to live and work. That’s great, but that could certainly change.

And why not take care of each other?

If we want to really secure our borders and secure our people and make sure that we’re all safe and healthy, let’s do that as a species, regardless of political affiliation and international boundaries. Anyway, that’s my ethos and I know that’s yours too. Chris.

WORM
00:26:34.320 – 00:26:52.780
Yeah, with jet travel, germs travel around the world very quickly. So the main reason to try to limit the devastation is because of what’s happening to the people in Africa.

But this could come back and bite us in a big way. And I hope we’re not stupid enough to wait until this thing comes to the US before we start paying more attention to it.

GERM
00:27:03.340 – 00:27:28.310
Everyone, thanks so much for joining us on episode 119 of Germ and Worm. As always, we welcome your questions on travel, health, send them along or your tips for success suggested corrections. We’d love to hear from you.

Send us an email germandworm@gmail.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 on the socials. Those are free ways to support this podcast. I’m Germ.

WORM
00:27:28.470 – 00:27:31.110
I’m Worm. It’s a big planet. See it in good health.

GERM
00:27:31.670 – 00:27:54.190
We 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 belong to Dr. Sanford and Dr. Pottinger alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.