GERM
00:00:08.960 – 00:00:11.520
Talitali fiefia! My name is Germ.

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

GERM
00:00:13.200 – 00:00:27.360
Welcome to the Germ and Worm Travel Health Podcast Episode 73: “The Tale of the Twisted Testicle.” 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
00:00:27.610 – 00:00:34.490
Hi, I’m Dr. Christopher Sanford, Associate professor in the Departments of Family Medicine and Global Health, also at the University of Washington.

GERM
00:00:34.890 – 00:01:30.870
Chris today on episode 73, as always, it’s our pleasure to answer great questions from our listeners about travel health. Some of them we’ll tackle today include can I give myself a flu vaccine? And what pneumonia shot is best for me? Safety considerations for travel to Morocco. What should I know? You talked recently about bats in a cooler. What if I have a bat in my mouth? And please tell me I will not lose a testicle tutorial during an upcoming long flight.

These questions and more. Please reach out to us with your travel questions, your stories and your tips for success. The best way to get us right online germandworm.com there you’ll find a question submission portal and access to all of our previous episodes so you can binge our content all day long.

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

WORM
00:01:31.310 – 00:01:33.510
I hear that who, the World Health Organization, has come out with new flu shot ingredients. Should I wait for the new and improved flu shot or should I get one now?

GERM
00:01:41.630 – 00:04:14.960
Thanks so much. This is a great question. The quick answer no, please don’t wait.

The news that you are seeing relates to what we are expecting for the upcoming season, meaning 2026-2027. But for this season, the recipe is already baked in and you should go out and get your flu shot soon.

As you can remember, folks, what we do here in the Northern Hemisphere with our influenza recomm recommendations, the way that flu shots are created and administered, it really comes from our colleagues in the Global south where they tend to see flu a little bit earlier than we do. We get our information for what we tend to see in our wintertime based on what they see in their wintertime.

Northern winter and southern winter are opposite to each other. So we’re very grateful to our friends at World Health Organization have decided that for the upcoming flu season, at least for the Global south, they’re recommending the following that there’d be a small change to the influenza A ingredients. One for what we call H1N1, hemagglutinin 1 neuraminidase 1, and one for H3N2.

Remember, we always mix together different influenza A ingredients in our flu shots. There’s also something called flu B and we try to include flu B as well. That actually will not change for the upcoming season.

But for the global south, the recommendation is that people start making flu shots in antis anticipation of their winter, which will come right when we in the north turn to summer. And that’ll be slightly different depending on whether the source of the vaccine comes from a chicken egg or comes from cell culture. That’s a subtlety. It just turns out that when you grow up influenza in a chicken egg, you know, some strains of flu will adapt better than others to living in a chicken egg. And that’s okay. We need to grow our flu shots in chicken eggs. But sometimes that adaptation can take the antigen, the immunogenic portion of the from the human flu and more towards chicken flu. And I love me a good chicken. I wish we could protect all our chickens. But the goal here is to protect human beings by using chicken eggs as an incubator.

So the bottom line here is that we have recommendations from World Health Organization regarding the way that they want our friends in the global South Australia, Latin America, sub Saharan Africa, that in their upcoming flu season, which will be largely in a period of months from now, what they should have. If you are living in the Northern hemisphere, this is not yet relevant for you.

Although frankly, a lot of those ingredients for the global south will ultimately come to us in the global North. Bottom line, go out, get your flu shot and don’t worry about these nice recommendations from WHO.

WORM
00:04:15.760 – 00:04:29.120
Yeah, I agree. I’d advise you to get the flu shot now.

Recall, a major benefit of the flu shot is that not only does it reduce your odds of getting influenza, but if you do get the flu after the flu shot, you tend to get a milder case, a case in which the odds you’ll be so sick you need to be hospitalized are reduced, which is no small benefit.

GERM
00:04:35.740 – 00:05:00.230
I totally agree. And you know what? That’s similar to the COVID shot, which we can talk about separately if you wish. You may still get the infection.

You just want to have a milder case. So glad that somebody asked about this,

Chris. Let’s continue that conversation. This comes to you from Callie in Cali. I love that name. I’ve ordered a flumist vaccine for myself online. It will get here in the mail soon. Did I do the right thing?

WORM
00:05:00.630 – 00:05:01.110
Yes. Flumist is equally protective as compared to. The shot for flu.You sniff it up your nose, it’s pretty easy, it’s pretty pain free. It’s approved in the US for those between the ages of 2 and 49 years of age. A benefit is just there’s no poke in the arm. It’s just this little bit of liquid that goes up your nose. Children or adults who really hate flu shots may particularly appreciate this.

GERM
00:05:24.070 – 00:06:41.170
Yeah, it’s really interesting that people have this choice to protect themselves from flu at home. I mean, anything that gives people a choice is good.

I am not personally the world’s biggest fan of this vaccine only because, well, as a live attenuated vaccine, it may not be right for everybody. And folks who have relative immunosuppression might not respond to it as well. There might be relatively contraindicated to get it.

So you definitely do need to talk with your physician or qualified healthcare professional before you order it online. This requires a prescription. The promise of the laiv, the live attenuated intranasal vaccine. This was supposed to be the best stuff ever.

I mean, you’re putting the germ right where you breathe in. The actual infection in the nose. It should be the best. That has not turned out to be the case.

In fact, we do not have evidence that this is better than the intramuscular shot. I’ve always thought it was a little weird, give yourself a shot in the shoulder for something you breathe in through your nose.

But they are felt to be, at least in the current setup, to be relatively similar in their effectiveness as each other. If there’s somebody who is acuphobic, they really are afraid of needles. They. I have patients like this, Chris. You probably do too, in your practice.

Some people just don’t want to get a shot or they don’t want to go to a doctor’s office to do it. I think this is a nice opportunity. And so to Callie. And Callie, I think you did great and I’m glad you raised this good question.

WORM
00:06:43.330 – 00:07:06.430
Okay, question for you, Paul. And this is from Monty. I just turned 65. Hooray. And at my annual checkup, my regular doc recommended that I get a pneumonia vaccination using something called Prevnar 20. I asked whether I could get the newer 21 Valent shot instead, and my doc said no, they still stop the 20 valent version. I told him I’d wait for the newer stuff. Did I make a mistake?

GERM
00:07:06.830 – 00:13:03.880
Oh, thanks, Monty. No, you did not make a mistake. It’s a great question and I’m glad to help answer this question generally.

Again, the quick answer, the TLDR is please do get back with your physician after you’ve heard what I have to say and let them know what your decision may be. So very quickly, this is about the pneumonia shot. What is pneumonia and how do you have a shot against pneumonia? Well, there’s no such thing.

Actually. We call it the pneumonia shot. Pneumonia is a disease, right, Chris?

This is an infection of the the lung, which involves consolidation, meaning we can see the infection when we do a simple chest X ray.

All kinds of germs can give you pneumonia, but the leading cause in the United States is a particular bacteria called streptococcus pneumoniae, or strep pneumo for short, for those in the know.

So strep pneumo is the leading cause of bacterial pneumonia in the United States, and we are so very fortunate to have a family of vaccines against this infection. It’s really important because pneumonia is a rotten disease and some of our listeners will have suffered from pneumonia.

You’re laid low, you’re sick, you have fever, you can hardly get out of bed and indeed, you’ll be miserable. That’s the good news. The bad news is it can actually be deadly.

And actually strep pneumoniae, strep pneumo, that causes pneumonia can also cause invasive disease where it gets into your bloodstream, where it gets into your brain, your spine. That’s called invasive pneumococcal disease, or ipd. And these vaccines are pretty darn good at reducing your risk of catching ipd. So I’m a big fan.

We’re very lucky that one of our colleagues, one of the great giants in the field called Dr. Robert Austrian, did this work back in the 1950s, 1960s, 1970s at University of Pennsylvania, right. When everybody said strep pneumo is no longer a big deal. We have penicillin. This stuff’s going to go away. Austrian said, I don’t think so.

I think it’s going to become partially resistant to penicillin and we would just do better with a vaccine. Fast forward half a century. He was exactly correct.

There is relative resistance to penicillin, although thank goodness in most cases we do have alternatives to penicillin to use.

But he labored away, I think, in the basement or the attic or something of hospital University of Pennsylvania, and invented the first pneumococcal vaccines. Those were called polysaccharide pneumococcal vaccines. Polysaccharide, meaning there are different serotypes of strep pneumo. It’s not one germ. It’s at least 24 different germs or one germ with 24 different coats.

And what he realized was that if he could make a vaccine to the little sugars on the surface, that he could give you relative immune against getting sick with pneumococcus. That was the polysaccharide vaccine, and it saved a lot of lives. But it’s not a great vaccine.

It doesn’t give us the strength or the durability, the longevity of immunity that we all deserved. Fast forward, of course, to the current family of vaccines, exactly what Monte is asking about.

Those are called the pneumococcal conjugate vaccines, where we do not only focus on some of the surface sugars, the serotypes, but we conjugate it to a protein, which the immune system absolutely will get to know, and it really pisses off our immune system. So it definitely boosts the effect of those vaccines. To Monty’s question, that’s correct. Currently, we have two conjugate pneumococcal vaccines.

One that has 20 valences, 20 types, one that has 21 types. Why not wait for the 21 type? Isn’t 21 better than 20? I wish it were just that simple.

So, generally speaking, I do agree with our advisory committee on immunization practices that adults should get.

Anybody age 50 or above should get this vaccine, and that Those below age 50 from, let’s say, age 19 to 49 should also get either of these vaccines, whatever’s available, if they have any of a number. Right, Chris. Of risk factors, and the list is quite long.

Anybody with any chronic illness, any chronic lung disease, it’s quite amazing how many people can benefit from either of these vaccines. Now, Monty asked about which of the two might be better, 21 or 20. It’s a little bit subtle. The 21 Valent is not just one more valence.

It’s a little bit different. It contains a different ingredient mixture of the different serotypes.

And they created this because they found that as Americans age, we have started to shift the kind of pneumococcus that we are likely to get infected by. Based on our predecessors getting their own pneumococcal vaccines, and based on our kids and our grandkids.

I don’t know that Monty has grandkids, but hopefully Monty does have young people in his life that he enjoys spending time with, and hopefully they’ve all been immunized with pediatric pneumococcal prevention as well because this is a leading cause of meningitis, life threatening infection in kids.

As more and more American kids are immunized against meningitis due to pneumococcus, that has shifted or changed the profile of pneumococcal serotypes that adults are likely to get infected with. So the quick answer is 21 might indeed be better. But there’s a wrinkle to the story, right, Chris, and that’s the west coast of the United States.

Here in the west coast we tend to see a lot of bad infection, aggressive invasive disease due to something called Strep pneumoniae. Serotype 4. Serotype 4 is a baddie for reasons I can’t fully explain.

What I can tell you is that serotype 4 is present in the current Prevnar 20, the 20 VAL, but it’s not present in its competitor 21 VALENT. Long story short, either of these is great and I would urge Monty to get whichever he can get his hands on.

Reality is that although it’s not official guidance for those who may be at high risk of serotype 4 because they live on the west coast of the United States or because they may be at high risk epidemiologically due to being marginally housed, people who inject drugs, people who work in healthcare, who are infrequent contact with people living in a desperate fringe portion of our society, there may actually still be a benefit to Prevnar 20. Chris, what we really need is something that’s going to get all 24 valences.

And I’m just holding my breath, crossing my fingers and my toes for us to get something that’s going to go after all of these. We don’t have that yet. Meantime, either of these would be totally okay. Monty.

WORM
00:13:04.520 – 00:13:13.840
Yeah, I agree. The most important thing is to get one on board, either the 20 or the 21 Valent for everyone pretty much over 50 years of age and younger. People with chronic medical conditions and this would be pretty much anything. Chronic heart disease, lung disease, disease, liver disease, if you smoke, if you have diabetes, me, I would take whichever the Medical facility has and I’d not wait for the one that might be theoretically a little bit better.

GERM
00:13:29.060 – 00:13:56.120
I agree totally.

And you know, if something comes along in the future, Monty, which I actually think is likely, you may be due for a boost depending on your medical situation with something that’s newer and even better. So get what you have, feel great about it, and feel great about what’s coming down the pike?

Chris, a question to you about travel to Morocco. Is Morocco always safe and a calm place to travel?

WORM
00:13:56.440 – 00:13:57.880
Oh, thank you for this question. My wife and I a year ago spent a month in Morocco, had a lovely time. We took the ferry from Tarifa, Spain, to Tangier. We saw Chef Shaouen, also known as the Blue City. Went to Mule, Idris, loved Fez. Got lost in the Medina right away. I went to Mamouche, which is near Merzouga, down in the desert. Rode camels, which was super fun. New experience for me. Went to Amlugi, which is a tiny village in the Atlas Mountains, then Assyria on the coast, then Marrakech, and then flew home. Overall, it’s a really low crime country. We felt safe everywhere.

However, as with most countries, there can be protests sometimes, and at times the protests can turn violent. They actually, starting in late September, were some big protests all over Morocco.

And this was in response to allegations of government corruption and there was some violence. And so I’ve got some general advice. If you’re around a protest, pretty much in any country, one, just back off, don’t join in, don’t take photos.

In a lot of countries around the world, protests can turn violent with a little warning. So is Morocco safe? Usually? Yes. Is it totally reasonable and fun to go to? Yes. Is it always safe? Of course not. And if you see a protest, just back away. Protest is not a spectator sport.

GERM
00:15:26.530 – 00:15:46.540
I’ve never been to Morocco. I’m really looking forward to it. There’s so many interesting features about it. The culture, the history, the food, and just the natural beauty.

The Atlas Mountains. I’m looking forward to it. Thanks, Chris, for that reminder about protests. That’s always a good guide.

Regardless of Morocco, we really should keep our nose out of other people’s political pain whenever possible.

WORM
00:15:55.980 – 00:16:04.200
All right, Paul, this is a question for you. Would you give us your take on those recent reports of all of these hikers stranded on Mount Everest?

GERM
00:16:04.680 – 00:19:01.630
Yeah. Thanks for this. Ripped from the headlines on Mount Everest. Look here we are recording this October 8, 2025.

And hopefully by the time our listeners are hearing this, this entire debacle will be behind us. Quick answer. There’s nobody stranded on Everest. There’s nobody on Everest.

It’s the wintertime, and you can’t safely climb Everest in winter in most cases because there’s such a big snow burden.

If I understand things correctly, is that on the northern or Tibetan side of the mountain, you know, there’s a paved road that the Chinese laid in after they occupied Tibet, they decided to pave a road right up to base camp on the northern side. And that means that anybody can get into a bus or a car and drive to Mount Everest Base Camp.

And as the snows start to fall, you know, you may be separated from that base camp by greater and greater distances. But even this time of year it is possible to get close. Within about 20 miles of that side of the mountain. You get a beautiful view of the mountain.

And just to spend time in this incredible austere and interesting part of the world.

Evidently that’s what’s happened in the case of many, many tourists who are there, I think to look at Mount Everest, a snowstorm came and that left them stranded and not able to drive down. I don’t think things are dire. They should have a source of heat, they should have source of water, therefore for.

And of course they should have food to sustain them until snow plows or something comes along and they can actually drive home and keep their, their planned schedule. So I’m not too worried about those folks on the Tibetan side.

Unfortunately, this same storm system of course comes up from Bay of Bengal and it can dump a ton of rain down low or snow up high. That does seem to have happened in central Nepal. There are blizzard conditions there, massive flooding.

This has triggered landslides, roads are out, bridges are out.

In fact, as we record this, we have records of more than 47 people, ordinary citizens in Nepal who have died and one who has died in similar circumstances in Tibet. So this is a catastrophe and it’s such an interesting place. It’s the most vertical country in the world.

The infrastructure is not as strong as it could be and it’s the common people of Nepal who are suffering. Now there is report, unfortunately we just got of one person, a Korean mountaineer, age 46, who did die on Mera Peak, that’s not Mount Everest, although it’s part of the same chain. And unfortunately somebody did die, I think related to avalanche activity there.

Bottom line, if you’re thinking of visiting Nepal, and I hope you do, please do it. But please also know that there are some times of year which will prevent you from safely traveling to certain parts of that country.

The same is true for Tibet, where in this case, apparently a bunch of folks are hanging out. If you’re interested in this and you want to learn more, please see the blog of my friend and a well known mountaineer called Alan Arnett.

And if you go to AlanArnette.com. Alan keeps a wonderful blog. It’s probably the greatest reliable source of truth in this area. And it’s something that I do recommend to our listeners.

WORM
00:19:02.350 – 00:19:16.730
Yeah, I agree. The media can be somewhat sensationalizing about things and if they can attach a well known name to a story, maybe that’ll get more clicks.

So I think the name Everest was slapped on this just to get more attention.

GERM
00:19:17.450 – 00:20:05.060
Yeah, we didn’t do that, did we? We avoided the temptation for this episode. We just went with something innocent and benign called the “Tale of a Twisted Testicle.” So I thank goodness we didn’t fall into that trap.

Okay, Chris, a question to you. Speaking of twisted testicles, Chris, this question comes to you from Anonymous in Mount Vernon, Washington.

Anonymous says, I knew of a guy who, during a long international flight to Europe got what turned out to be a twisted testicle. He ended up being admitted to a hospital. I know twisted testicles are a thing. The condition was part of the episode of The Pitt. But is this travel related? And even if it’s not, what would you do if it happened while you were traveling? How do you know if you have a twisted testicle?

WORM
00:20:05.380 – 00:21:12.230
When a testicle rotates, it can twist the spermatic cord and that can cut off the blood supply. So basically, testicular torsion is when a testicle twists and this can just happen spontaneously. It tends to hurt like hell.

It swells and it’s actually a dangerous condition. If the blood supply is cut off for very long, the testicle can die and not be functional. And this can lead to infertility.

So this can happen just randomly or it can happen after strenuous exercise. Sometimes cold weather or family history can be a factor. Usually it’s in adolescents and younger men.

So the most common ages for this are between 12 and 18 years of age. It’s a surgical emergency.

So basically, if you get a swollen, painful testicle, you don’t know what it is, of course, if it’s a torsion or something else, but you should seek medical attention immediately. So is it travel related? Not usually. It’s a rare thing. It’s a random thing. But it can be related to strenuous exercise which can go along with travel.

So is that whole story in that episode plausible? I would say yes.

GERM
00:21:12.550 – 00:22:27.740
Yeah, totally agree. I remember from medical school one of the heuristics we learned was “time is testicle.” You know, that we really just should not–I was going to say should not sit on these cases–that’s a terrible way to say it, but if someone comes in with the so called acute scrotum (it’s the wrong term. It’s not an acute scrotum. I don’t care about the scrotum. That’s skin. I want to know about the contents.) But anyway, you’ll hear it called an “acute scrotum.” That’s an emergency for this exact reason.

And there are just so many cases of people, especially adolescent men and boys-to-men who have been embarrassed about it or who have minimized it and have really been reluctant to seek care because it’s a private part of the body and they just don’t want to call attention to it. This is a mistake. So whether it’s the context of you or someone you know, please take it seriously. Please get into healthcare person.

By the way, why doesn’t this happen every single day, bBased on the anatomy? There is a little piece of tissue called the gubernaculum. It’s a tether that prevents this from happening.

And sometimes that tether gets overwhelmed or it’s not big enough or whatever. So this is a real thing. And I just thank goodness I’ve never had this condition myself.

I am, as we record these episodes, I mean, I am now crossing my legs and hunching over in sympathetic pain just even thinking about this poor person. And please, please, please do not minimize this and get it taken care of.

WORM
00:22:31.660 – 00:22:53.680
All right, Paul, question for you. And this is from our Torn from the headlines. Washington Post had a recent story.

This unfortunate tourist ended up with a wild bat in her mouth and 21,000 in medical bills. And I’ll let you detail what happened with this.

But basically, what should you do if you accidentally get an exposure like this from bats and from rabies?

GERM
00:23:14.400 – 00:24:56.030
Yeah, what the hell? And so this I had not heard this story until I looked it up. In fact, we were able to find this in the Washington Post.

I think it’s a true story of a normal healthy person who went to photograph the Grand Canyon was out at dusk, I think, and there were bats flying around, eating mosquitoes, doing bats’ good work.

One of them somehow got between her face and the back of her camera. And when she it was on her face and understandably she screamed.

And somehow the bat took the opportunity to hop briefly into her mouth for one or two seconds. And that I think both parties involved said this is not a good thing to happen. So the bat got out of her mouth and flew away.

And so she was left having appropriately, thank goodness she did go to seek health care to an urgent care place, I think, in Flagstaff, Arizona. And they did the right thing, which was to give her Post exposure profile, prophylaxis against rabies. That’s correct.

I think the hooker for this particular story is that for various reasons, she actually was without healthcare at the time that this happened. Right, Chris? And so she ended up with nearly $21,000 in medical bills related to her post exposure prophylaxis, which she did.

She knew this was important to keep herself alive. It’s just a bummer that she happened to be between, you know, healthcare plans because she was between employers or something like this.

And so, folks, I don’t know what to tell you. Nightmare number one, getting a bat in your mouth. Nightmare number two, having to pay for that exposure without health care.

And so I’ve always thought it was ridiculous that our healthcare is linked to who happens to pay us. I don’t like that at all. But here’s yet another example of why this is bad news to our friends who are listening.

Dude, if you get a bat in your mouth or anywhere on your body, you gotta, you gotta deal with it. You do not minimize it. And I would say, you know, the biggest risk factor is to be bitten or licked by a bat.

I had never thought of this scenario of a bat in your mouth. That is high risk, full stop. And there’s just no two ways about it. You got to get post exposure prophylaxis.

I’m sorry, this person was out 21 grand and I’m glad that they’re going to live to photograph another day.

WORM
00:24:56.270 – 00:26:32.580
Yeah. So basically back to some info on rabies. It’s a viral illness. Once symptoms develop, it’s fatal. We do not have a treatment for it.

It can be transmitted by any mammal. So we’re talking dog, cats, rat, bats, monkeys, not fish, not birds, not insects.

In most of the world, including Asia and Africa, the most common way of getting this is a dog bite. But in the US it’s rare.

But those cases that have been spread, usually the animal that causes the infection, the vector is a bat or a raccoon or a skunk or a fox.

And so any bite you get where you could have a potential exposure to mammal saliva, such as a dog bite, wild dog, or a scratch from something like a bat, you need to treat it like a rabies exposure and don’t wait for symptoms that would be too late, Basically you get a bite, go see a doc. And if you’re at elevated risk, either by work or by your leisure activities, you want to get the pre exposure series.

Whether or not you’ve had the pre exposure series, you need to get treatment after exposure but you need less if you’ve had the pre exposure series and you need more if you haven’t had the pre exposure shots. This lady just had bad luck. There was nothing you could do. But one thing in your future maybe you can do is don’t pick up the bat on the trail.

If it looks like maybe it’s sick and it needs help, I hate to be cold hearted, but just leave it be. Similarly, I would discourage you from petting animals outside of the US especially in low income countries. And this would include dogs and cats.

GERM
00:26:33.380 – 00:26:49.240
I could not possibly agree more.

Okay, Chris, here’s a question to you. I love this. What’s the safest and healthiest way to get from an airport to the local downtown?

WORM
00:26:49.870 – 00:27:48.120
I would be wary of the guy who approaches you randomly at the airport. Usually these people 99 times out of 100 are reasonable and honest. But you may bump into the occasional nefarious character.

It’s better to go to the official taxi line. This may be a little more expensive, but the odds are higher that you’re going to get an upright person.

Also, sometimes there’s a kiosk inside the airport. You go there, you pay a pre agreed upon fee and that tends to be secure. Or sometimes you can take a bus.

Recently I was at airport, I forget where there was no taxi line. 10 guys came at me from different directions. I didn’t know who to pick. I just picked the guy who wore a necktie.

The other guys looked a little more casual. I realized this is no guarantee of getting an upright character. But things worked out very well. So in general, try to go as formal as you can.

Go to the taxi line, go to the kiosk and avoid just the guy in street clothes who offers you a good deal.

GERM
00:27:48.360 – 00:29:31.700
I think that’s right.

And it certainly could be that if someone’s on a very tight budget that they’re going to use, take a bus or do some other form of mass transit that may actually be faster and safer in many cases. I gotta say this is not my area of focus or concern. But I am.

I’m the kind of guy who will actually do a little bit of research ahead of time, just find out what’s the airport transfer transit scene. And that could be from a trusted friend who’s been there or on the good old wikisphere trying to figure out what’s going on with local transfers.

My issue is that when I come off one of these long flights, I’m just whipped. I’m so, so tired and groggy that I just want to know that I have a smooth transfer.

In some cases I will have arranged ahead of time, many cases I don’t. But I just want to know what that actually looks like. That helps me to relax. I guess some people would have an adventure getting out of the airport.

To me, that’s not the place to have the adventure. It’s a place to be potentially preyed upon. So I was really happy to hear this particular question.

Everyone, thanks so much for joining joining us on episode 73 of Germ and Worm. As always, we welcome your questions on travel health. Just send them to us or your tips for success suggested corrections we’d love to hear from you.

Visit our website germandworm.com that way you can submit questions, reach us through the portal, and also search for prior episodes and binge German Worm to your heart’s content. If you’ve enjoyed hearing us, please subscribe, follow us, rate us favorably on your device and spread the word with friends, family and on social media. Those are free ways to support this podcast. I’m Germ.

WORM
00:29:31.700 – 00:29:33.580
I’m Worm. It’s a big planet. See it in good health

GERM
00:29:35.140 – 00:29:57.790
And we’ll See you next time. This podcast is designed to inform, inspire and entertain.

However, this podcast does not establish a doctor patient relationship and therefore 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 and do not necessarily represent the opinions of the University of Washington or UW Madison.