GERM
00:00:10.480 – 00:00:11.680
Selamat sejahtera! My name is Germ.

WORM
00:00:11.680 – 00:00:12.560
I’m Worm.

GERM
00:00:12.800 – 00:00:28.580
Welcome to episode 89 of the Germ and Worm Travel Health Podcast. Is the USA now a high risk destination? It’s 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
00:00:28.580 – 00:00:36.260
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
00:00:36.260 – 00:02:28.180
Chris, I’m so excited for today. We have really good questions from our listeners, including is caving the same as spelunking? And how do I be safe when I do either of those tsetse flies? What’s the best repellent? Scabies? How do I avoid it and what do I do if I get it?
And Nipah Virus Traveler Screening an update and advice.

A reminder to our listeners. Please contact us with your travel health questions, your stories, and your tips for success. Or if you have a request for a clarification on something you’ve heard previously, we’d love to hear from you. Get us on our website germandworm.com or send us an email germanworm@gmail.com.

Before we jump in, we always start with 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 your itinerary.

Now, speaking of travel, Chris, you and I are both back from separate trips to Latin America. I don’t know about you, but I’m still basking in the warm glow of Mexico while we were there, bad things have happened in the United States, unfortunately, and last week you and I made this painful decision that we would change our recommendations for travelers internationally who are considering a trip to the United States because of social unrest and a whole bunch of illegal and outrageous activities on the part of representatives of our federal government. We no longer thought this was safe or advisable and we put that message out on social media.

What we wanted to do is share this very quick 3 minute message with our listeners to the podcast. It’s possible that we have some podcast listeners who do not yet follow us on the socials. If you don’t, what are you waiting for?

And if you do, we’re glad that you’ll stick with us for the next three minutes. You may have heard this before. Sadly, we still think it is relevant. Here we go. Let’s roll the social media videotape I’m. Dr. Paul Pottinger, in case we haven’t met before. I’m an infectious diseases specialist in Seattle, Washington.

WORM
00:02:28.910 – 00:02:38.510
And I’m Dr. Chris Sanford, travel and family medicine physician. This short message is for our international listeners who may be considering visiting the United States.

GERM
00:02:38.750 – 00:03:09.950
Our U. S. Federal government is rapidly devolving from democracy into a fascist state. The administration’s actions are wrong across the board and especially wrong on science, health and immigration.

Today our streets are patrolled by heavily armed bands of thick thugs who are illegally abducting, beating, gassing and shooting innocent civilians. They call themselves ICE. But like all good Americans, we know what they really are: Uncontrolled killers on the government’s payroll.

WORM
00:03:10.830 – 00:03:23.150
Because of these outrageous and tragic developments, we can no longer recommend that people come to visit our country. At least until things change. We recommend that you defer all non essential travel to the United States.

GERM
00:03:23.310 – 00:03:57.360
We still remain a democracy, at least for the time being. And that means that we the people can still take back control.

And we acknowledge that the US Is actually safer than many other countries around the world.

For example, thousands upon thousands of innocent civilians are being gunned down by their own government in the country of Iran simply for the crime of raising their voice. The United States has not yet achieved that scale of crime against humanity.

Nevertheless, because things are so bad, we cannot in good conscience recommend that people come to visit our beautiful country unless absolutely necessary.

WORM
00:03:57.680 – 00:04:35.260
If you do need to visit us, please know that the great majority of us welcome you with open arms. We apologize for the current state of affairs. A few tips. Keep your passport with you at all times before you come.

Remove any texts or images from your phone that are critical of the current administration. Border agents have used this as an excuse to deny entry. Make sure someone back home who you trust has your itinerary.

And if you are approached by ICE or other police or military personnel, just do what they say. Don’t resist putting up with whatever humiliation is better than them doing something violent.

GERM
00:04:35.740 – 00:05:04.790
We love our country, but right now we do not feel like proud Americans. We hope you understand that we are not alone. Most of our fellow countrymen agree. We do not support this administration. We hate it.

And we are committed to making it better. When we do, we hope you will come visit and see our country for what it is.

For its beauty, for its cultural diversity, and for the strength and warmth of its people. That’s who we really are.

WORM
00:05:04.950 – 00:05:09.030
Thank you for hearing us. We appreciate being connected with all of you.

GERM
00:05:09.430 – 00:05:57.090
Okay. I don’t know about you, Chris, but to me that’s still painful to hear. And let’s remain hopeful that this will change very soon. It will change. The question is when? For our listeners, please stay tuned here to Germ and Worm. And as our assessment of threats to international travelers coming to the United States changes, we are very eager to give you an updated recommendation that would endorse such a plan.

Chris here’s our first question and this comes to you from Rune in Moshi, Tanzania. Rune, thank you so much for reaching out.

Dear doctors Germ and Worm, thank you for your wonderful talks. I’m enjoying these topics immensely here in Tanzania, but back to my days of diploma in Tropical Medicine and Hygiene. I have two questions. The the first is, is there any repellent that would work well against tsetse flies?

WORM
00:05:57.730 – 00:07:22.900
Thank you, Rune. First, let me talk a little bit about DEET and Picaridin. I love them both. They’re the best repellent. They go on your skin.

And the good news is they work really well against mosquitoes and they work largely well against a number of other insects. The bad news is they don’t work very well for tsetse flies. There’s a real variety of information.

What I was looking for and did not find was a number like they only work 10% as well on tsetse flies as they work for mosquitoes. I couldn’t find that, and there’s a wide range of estimates.

But the bottom line is they don’t work very well against tsetse flies, nor did I find a repellent that does work well. So I don’t have a good answer for your question. A few things about tsetse flies. They’re attracted to heat and movement and maybe the color blue.

They’re active during the day. Given that DEET and Picaridin have partial activity probably against tsetse flies, I would continue to use it.

I would also put permethrin on your clothing. And even though they don’t tend to bite at night, I would also sleep under a mosquito net at night if your sleeping quarters are not air conditioned.

So they’re better than nothing. But no, I don’t have a good chemical that works for the tsetse fly.

And this incidentally, it’s the vector for African sleeping sickness in a lot of countries in Africa. Paul, do you know of a chemical on your skin that’ll repel these things?

GERM
00:07:23.780 – 00:09:24.980
Nothing better than what you’ve just said. And just to emphasize two things, first of all, why do we care about tsetse flies? I mean, they hurt. These are horse flies, right? This is basically a horse fly when it bites you. Folks in the United States have been bit by horsefly. It hurts like hell. They’re taking out a hunk of flesh and you.

Some people say, “Oh, was I ever bitten by tsetse fly?” You know, you’ll know if you’re bitten because they hurt like crazy, not like a mosquito. Mosquitoes are stealth feeders. These guys, they’ll bite you and get out of the way because you, you will swat them immediately so they take a hunk of your flesh with you. So that’s annoying and painful.

Much more concerning of course, this is the vector for sleeping sickness, both West African and East African sleeping sickness. So the bite of a tsetse fly is not only painful, it may also carry a risk, although relatively small, of a life threatening infection.

So we don’t want to be bitten by this. So I really appreciate Rune’s question.

Full disclosure, Rune’s an old friend of both of ours living in Moshi, Tanzania and so we’re so glad to hear from him about this. So I do not know of anything better than what you’ve just said. I would say there are some things that we know are bad.

I mean, I feel quite confident that dark blue and black are colors to avoid. People who have lived and worked in East Africa over a long period of time have decided that they can create a trap.

They can attract the flies to a piece of cloth that is dark blue and black and then of course cover that with an insecticide. I don’t know what it is about the color blue and black. It makes them horny, it makes them mad, something.

They go for it, they alight on that felt piece of cloth and then they are killed by the insecticide. So if I’m going on safari, I don’t wear blue and black.

You know, there’s a theory that this may be why zebras are black and white because it confuses the tsetse fly. It’s a great hypothesis. I’ve always wondered why the zebra looks like it does. It’s the coolest looking animal.

I do not know that we have any substantive, reliable information. So should you wear definitely black and white and not blue and black? No, I would say I would not wear blue and black.

Beyond that, I don’t know what else to say. And thanks Rooney, for asking this important question.

If our members of the listening community have found something that they think really has helped them beyond what you mentioned, we’d love to hear from you. Germandworm@gmail.com.

WORM
00:09:25.140 – 00:09:50.160
Yeah, and let me throw in a testimonial. I remember being bit by a tsetse fly. I was on safari in Rwanda, and as Paul said, A, it hurt like hell, but B, it got worse. So I was irked.

So I waited until this thing lit on the glass window inside my vehicle and I slammed a big heavy paperback book against the window and I thought I heard a satisfying crunch, but when I pulled the book away.

GERM
00:09:50.240 – 00:09:52.240
Let me guess, he gave you the middle finger!

WORM
00:09:52.240 – 00:10:06.560
Yeah! This fly just flew away and glared at me and said, it takes more than that to kill me. I mean this. I slammed it hard. It would have killed a big tough cockroach. But the tsetse fly was like it had armor on it.

So these things hurt and they’re mean and they have a bad attitude.

GERM
00:10:07.120 – 00:10:11.520
Reminds me a lot of people in our own country here right now. Mean, hurt, and have a bad attitude.

WORM
00:10:15.140 – 00:10:34.340
All right, Paul, this is for you. And this also is from Rune of Moshi, Tanzania. I had a really good day hike up the Whiskey route of Kilimanjaro yesterday. It was really fun, but I woke up the next day with a horrible muscle ache. Guess I’m more out of shape than I thought I was. What tips would you have for A, preventing the aches and B, curing the aches?

GERM
00:10:34.740 – 00:14:28.920
Okay, great question. So envious that your day hike is on Kili. Like my day hikes are great here in the Cascades, but isn’t that fun to have killy in your backyard?

So glad you did it. Ruining. And next time, if I’m lucky to come back to Moshi, we’ll do it again because I haven’t been on the Whiskey trail.

Look, it’s a hard mountain and getting sore muscles is typical. I would have sore muscles too. The most important thing, of course, is do it again. For God’s sakes, go back, do it again and again.

The more we exercise in a similar way, the better those muscles will do. I think it’s important to stretch carefully, gently, before and most definitely after exercise. I do both.

I’m pretty bad about stretching before, but I’m trying to get really good Rune about stretching afterwards because I think that just lengthens out those myofibrils, the muscle cells and helps them to keep from becoming too stiff and sore. So that makes a difference. I have to tell you, hydration, I think makes a huge difference. And if you’re like me, you may be hydration challenged.

I have to remind myself to drink. I think by the time I feel thirsty, I have fallen behind.

So I in the mountains, my aspiration is to be aggressive about this and my urine will be clear as water and I’m stopping to pee on a tree like a dog all the time. I over hydra when I’m out there. You can overdo it with hydration. So I wouldn’t go too far. Sensible hydration so that your urine is clear and copious.

I think that helps too. Beyond that, I think everything else is a little bit mythological.

There’s a big movement, isn’t there Chris, into the concept of electrolyte replacement, including magnesium and other, you know, divalent metal cations, mag calcium and sodium and chloride and potassium that when we sweat we are losing these salts, if you will, from our body. Now that’s true, especially sodium chloride. Other salts are lost this way as well.

So it does make sense that having an electrolyte replacement can make a difference. I have found that to help in my own personal experience. The reason I’m a little bit electrolyte cautious is I think it’s highly variable.

What you put back is going to depend.

And I’ve been in situations in very low humidity where I’ve been sweating like crazy and high humidity where I sweat like crazy and I will see the salt crystals on my hat or my shirt and I know that my salt is out of the body. I will replace that by adding some electrolyte tablets or powder, whatever you like, back into the water.

If you do take electrolytes, whether you like it in a bean form, a candy form or whatever, make sure you put in plenty of water too. You cannot just swallow salt. That’s super bad for you. Now our questioner Rooney knows this, but to our listeners who are not also physicians, etc.

Please do it with hydration. My own personal approach is to have about 1/2 the concentration.

If I use a Nuun tablet or one of these other tabs, I’ll dissolve half of what they recommend into my drink. And for me that’s enough. You may be a salty, sweaty person, you might need more. You need to listen to your body and follow that over time.

The only other sketchy thing I’m going to share with you because it’s totally anecdotal and I just went through it a few weeks ago when I climbed La Malinche, which is a small 14,000 foot volcano in Mexico. A couple weeks ago we came back and at this lovely hacienda where we stayed, they offered Temescal. Not Mezcal, Temescal!

So Temescal is a hot wet sauna. And I went in with a couple friends, my buddies, we went into Temescal. I mean, I thought I was going to die of suffocation, asphyxiation, just overheating. It was hot as snot. They had these hot rocks where they pour water over it and gadzooks, it was too hot. And I don’t recommend Temescal for that reason. If you do, you should control the heat.

The brujas, the witches, or as they called themselves, the abuelas… Honestly, they controlled the heat. I can only tell you that as unpleasant as it was, my muscles felt. Felt super good. So good. I really was not sore, even after working pretty hard on a kind of icy and sketchy mountain.

So heat I think is good.And if you’ve got a jacuzzi Rune or a hot tub, maybe that’s another way to try to lengthen out those myofibrils after you exercise.

WORM
00:14:29.560 – 00:15:03.460
Yeah. The sad truth is that anytime you use a muscle group, especially for a long duration which you haven’t done the same activity with, it’s going to tend to be sore the next day. So probably the best way not to be sore is to do the same thing several days in a row or at do it regularly before you do it.

And probably after several days that activity will not cause any soreness at all. So usually I think soreness is just from using muscle groups that you don’t ordinarily use.

So if you’re doing something new or beyond your usual level, you’re probably going to be sore. And I don’t think there’s a full way around that.

GERM
00:15:03.700 – 00:15:05.500
And the solution is go back and do it again.

WORM
00:15:05.500 – 00:15:07.220
Yeah, yeah, yeah, yeah, yeah.

GERM
00:15:14.040 – 00:15:37.570
Okay, Chris, in a nod to our AI overlords and we’ve talked about this before, AI, is it the future? Is it good for travel medicine? You know, what’s up with this?

And what should people do with artificial intelligence in their own self wellness journey? You know, I noticed this recent article in the Journal of Travel Medicine by Flaherty and colleagues.

I wonder if you’d give us a rundown on what they have found on artificial intelligence and travel health.

WORM
00:15:37.960 – 00:17:03.520
Yeah, I won’t go into it in too much depth. We’ve talked about this before, but basically, should you use AI for a pre travel consultant?

This nice article came out in December, Journal of Travel Medicine by Gerard Flaherty and colleagues. And basically it said, no, it’s an okay place to go to get some information, but there’s some fundamental problems with over relying on it.

Basically the Major problem. And what they used was Chat GPT specifically was the information they got wasn’t specific and there was no context.

And it didn’t ask enough questions about the traveler’s itinerary, cost considerations, previous vaccines, medical history and other details. So it’s a good place to go kind of to shop around for some initial things to like get the real scoop on from a medical provider.

But there were mistakes and they talked about the first things they talked about were not the most important.

And so on another study, this guy named Haverkamp, this is clever, he went also, and this is to chatgpt, and he asked, hey chatgpt, are you able to provide evidence based medical information? Kind of a basic question, but good one to ask. And initially Chat GPT was evasive, but when he pressed it for a binary yes or no answer, it said no.

It basically said, no, I am not able to provide evidence based medical information. And I say, let’s take it at its word, use it, go there, I use it, but I don’t do anything definitive based on it and it alone.

GERM
00:17:04.720 – 00:17:11.220
So yeah, you and I may go the way of the dodo and seed our careers to AI, but today is not that day.

WORM
00:17:12.890 – 00:17:20.330
Paul, question for you. I’m reading about screening now. They’re checking fever and such at airports in Asia. What’s that all about?

GERM
00:17:20.890 – 00:19:54.360
Yeah, thanks.

So as of this recording, which is early February 2026, it’s interesting, there’s a concern in a number of countries in South Asia and Asia regarding Nipah virus. We’ve talked about Nipah on a few occasions. For those who don’t recall, Nipah virus is. It’s a potentially bad virus.

It is not usually in human beings. We think it lives out in the environment, especially in bats, including the fruit bat in Indonesia, West Bengal state, etc.

And these bats seem to tolerate the Nipah virus pretty well.

But when it gets from the bat into humans, either directly or potentially through contaminated palm wine, for example, then it’s a big deal because people are not well adapted to this virus.

The virus is not well adapted to us, and it causes a huge inflammatory, serious generalized influenza like illness, but especially with inflammation in the central nervous system, including encephalitis, meaning inflammation of the brain and meningoencephalitis. And there have been human deaths related to Nipah virus. So it’s serious. Now.

At the moment, we do not have strong evidence for sustained human to human transmission of Nipah. You seem to get it from the world and not from another person.

And unless the virus changes, we’re hoping it will stay that way nevertheless, because nobody wants to have Nipah virus on their turf, either to take care of that very sick person or to let it get out into a new area. Yet we do have reports that a number of countries in Asia and South Asia are now starting to screen travelers.

For example, West Bengal state cases are now triggering screening in Thailand and in Nepal, that if you’re traveling from that state, people on arrival at Customs and Border Protection will screen you for Nipah virus.

Now, not with molecular testing, not by swabbing your various orifices, just looking for fever, asking people if they have unexplained headache, muscle ache, neck stiffness, etc.

Arrivals in Kathmandu are now going through this process, and I think that’s happening as well for people traveling from West Bengal to India, Thailand, Malaysia, Singapore, Vietnam, Pakistan. We’re going to see more and more of these states worried about the possibility of Nipah virus coming to their shores.

If you are traveling to these areas from, let’s say, Europe or the United States, your risk of bringing Nipah virus to those states is zero. And they probably won’t even screen you. But again, if you’re coming from a highly endemic area, they may ask you these questions.

I think it’s reasonable. I’m not clear that they’ve caught any cases, but that shows the desperate state in which people take this problem pretty seriously.

WORM
00:19:55.150 – 00:20:11.470
Yeah, this is akin to the screening that was done for Covid back during the pandemic. It’s not onerous. And two, this is extraordinarily rare in travelers. So if it was me, I would still go to the places that are concerned about this.

But just FYI, you may get screened as you leave an endemic area.

GERM
00:20:16.990 – 00:21:19.780
Okay, Chris, here’s one of our award winning questions. I think we need Germ and Worm’s all time. Great questions. We have two fabulous questions from a listener called Christine in Chicago, Illinois.

They are longer than we can go through here. They’re actually excellent detail in what’s provided. But I’ll summarize very quickly from Christine.

What she says is that she recently undertook a trip to Tibet and had a stopover in Hong Kong on their way back to the United States and actually stopped in Chengdu as well.

And what happened was that this individual, Christine, was in the airport in Lhasa, Tibet, went to the lavatory and washed hands after using the toilet. And the water that came out in the bathroom was extremely cold. It was the only temperature that was in the sink was very cold water.

And during that process of washing her hands, basically she ended up developing a migraine headache. And so that’s the question. Is it possible that someone can get a migraine headache from cold water? Or was this just some kind of coincidence?

And what’s our take on this as travel health people? What would we recommend in the future?

WORM
00:21:20.410 – 00:22:53.520
Yeah, people have different triggers, those who get migraine headaches. For some people, it’s stress. For some people, it’s sleep deprivation. For some people, it can be certain times of the menstrual cycle.

And of course, sometimes it’s just random. And these are horrible headaches. People are miserable.

And then there’s various medications that help some people to have these very bad headaches resolved. And they’re often accompanied by nausea, vomiting, changes in vision.

And Christine also, as part of her question, she notes that when she got on the jet and it went up into the sky and the pressure went down, that she got better. And she asked, hey, what’s going on with the pressure maybe affecting my migraine in a good way?

So could cold water, extremely cold water, be a trigger? Yeah, people are different. It’s not the most common trigger, but yes, that could cause it in some people. And what’s up with being on the jet?

She says that as soon as the jet went up and they pressurized it. And recall, they don’t pressurize jets to sea level. They pressurize them to the equivalent of about 6 to 8,000ft of altitude.

Well, Christine, you’re exactly the opposite of most people with migraines.

I did a little literature search, and actually, for a lot of people, reduced pressure, whether it’s on a jet or even like a low pressure weather front moving into town, that’s a trigger for a migraine that brings on migraines in some people. I did not see that reduced pressure made things better. However, everyone’s different. And could that have helped? Yes.

Could it just have been coincidental and you’re getting better was unrelated to the change in pressure? Yes. But no, that’s not really a thing that I could. So if it’s related, maybe you are a medically unique specimen.

GERM
00:22:53.760 – 00:24:07.880
Well, aren’t we all unique specimens? And I think this is one way in which your uniqueness may not make you happy, but I think it’s right. This does not mean you shouldn’t travel again.

It doesn’t even mean that you shouldn’t get into cold water again. But I think you should be aware. Christine, I have to share with you that I had a really similar experience when I was climbing Aconcagua.

We had made camp at Camp 3 and I was sweaty and hot and dusty and I wanted to wash my hair. So I went to a local stream right next to camp and just stuck my head, my head. Isn’t that an old saying, Go soak your head? I soaked my head in this incredibly cold glacial meltwater and boy, it was such a mistake. I instantly regretted it because my head was instantaneously, incredibly, incredibly painful. I’m not a headache guy. I do have atypical migraines where I go blind, but not with headache. This was different. It was the cold water touching those nerves, I guess, on my head. I have never had a headache like that.

And so I was like, I’ll just go with dirty hair for the rest of this expedition. So this does happen. You didn’t make it up. I had something similar myself. Now I’ve also done a polar plunge, including in Antarctica a few weeks ago. Right, Chris? That didn’t give me a headache.

My point is you can probably still wash your hands and thank you for doing that when you come out of the lavatory, but maybe trying to avoid the most ice cold water in Lhasa is a good idea.

WORM
00:24:14.360 – 00:24:43.300
Paul, question for you. And this also comes from Christine of Chicago. We were living in Hong Kong.

We took our girls on a long trip over two days from Guangzhou to Lhasa, Tibet, and in a sleeper car, which seemed okay. Making a long story short, we got a very itchy rash. It was in between our fingers. Afterwards, turned out to be scabies. I just about died.

So what’s the deal with that? What could we have done so that we never got that damn unwelcome infestation?

GERM
00:24:43.380 – 00:27:55.200
It’s a great question. I think in particular, when Christine says she just about died, she meant of outrage, fear, and just being grossed out.

She didn’t actually just about die. But scabies, that’s something I don’t think we really talked about much here on Germ and Worm. So I really welcome that opportunity.

Very briefly, what is scabies? It’s a skin infection caused by an infectious mite. So it’s not exactly an insect. It’s a microscopic animal, basically, that gets into your skin and lays eggs and it causes an intensely painful and itchy, itchy, irritating rash. Now the classic story is exactly what we heard here.

Close contact with soiled linens, bedding–could be a towel–something where somebody else who had this infection has touched and it wasn’t then cleaned properly. So it can be spread directly person to person. But often, not often, it’s through these inanimate objects. We call them fomites and textiles and bedding and linens is very evocative of that. We’ve talked a lot about bed bugs here. This is not exactly the same, but it’s evocative of that, isn’t it?

And when you’re attacked by these things, you know it. There’s very rare to have a subtle case. People really itch, especially the web spaces between fingers and between toes. That’s the good news.

The bad news is that if you have a reduced immune system, you may actually get something called disseminated scabies. We used to call it Norwegian scabies, which, it’s not Norwegian at all.

That’s an old fashioned term, but you may still run across that in the literature. And in that case, people have crusts over their entire body.

And we have to, number one, kill these little animals and number two, reconstitute the immune system. So you’d asked here, Christine, how to avoid this. You have to avoid it by lying down on bedding that you think is clean. And I’m sure you did.

You didn’t have much choice, did you? From Guangzhou to Lhasa, that’s a train. You get on the train, you just don’t know what’s been taken care of.

And whoever was supposed to do the laundry didn’t do their job. That’s not your fault. So this is one where you can choose a hotel that’s not a quote unquote fleabag hotel.

That may reduce the risk, but it doesn’t take it to zero. Very much like what we talked about with bed bugs. It can be hard to avoid. Treatment is different, by the way. There’s no vaccine for this.

We don’t give people medication to prevent it. We deal with it when it arrives. Number one, kill the animals.

And that is with a combination of topical insecticides, or in this case, miticides against the Sarcoptes scabii organism that causes this. There’s a number of topical medications that can be used. They typically have permethrin in them as one of the active ingredients.

And then number two, in severe cases, we can also give an oral medication that’s called ivermectin. Ivermectin is a fascinating medication because we usually use it to prevent river blindness onchocerciasis in West Africa.

But it’s also got broad spectrum activity against worms in animals and in humans. And it can work in this case. As well. I don’t usually give ivermectin to people. In this case, we usually use topical treatment. Some people can’t have topical treatment or it doesn’t seem to work. That’s when a travel medicine person you see when you return would consider giving a dose in addition of ivermectin.

I really hope this doesn’t come back and I hope it doesn’t turn you off of visiting these exciting places. Christine, we’re glad you’re traveling and we appreciate your questions a lot.

WORM
00:27:55.520 – 00:28:21.670
Yeah, putting this scientifically in. Exactly. You had bad luck. High risk would be.

Suppose you’re staying at a hostel, a budget place, and they don’t even clean the sheets in between people. That’s high risk to get this. Low risk. Upper end hotel. If I was in a train, I would sleep on whatever sheets they gave me. And usually that’s safe.

And in fact I’ve done that. I’ve had good luck. I’ve never had scabies. I don’t see how you could have avoided this. So I’m sorry it happened.

GERM
00:28:21.910 – 00:28:43.970
I mean, you could have avoided it by not seeing Tibet. And this is, as my friend Dr. Chris Sanford would say, it’s a low tax for seeing high places. And I’m glad you did. I’m just sorry that happened to you.

Chris, here’s a question to you. The question is this. We’ve had this question from a couple listeners. What’s the difference between caving and spelunking? And if I choose to do one or the other, how should I do it safely?

WORM
00:28:44.370 – 00:31:23.260
Yeah, these actually are related terms and some people use them inter exchangeably. But reading a little bit about this, the sort of lower level, more amateur activity, is spelunking.

So if you go with a guide on a route and you don’t have to crawl and you don’t have to use ropes, that’s spelunking. If you’re more adventurous, maybe you’re even going exploring. Going in a cave that hasn’t been fully explored before, that’s called caving.

So sort of caving is the pro level, spelunking is the amateur level. But some people use these to mean the same thing. And actually I had a really interesting experience just a few weeks ago.

I was in Belize with my wife and we did what’s called the ATM case in Belize.

This is a Mayan cave and it’s one where archaeologists have decided to leave the skeletons and the pottery intact where they were found back in the late 1980s. So it’s rather arduous. You have to swim 30 or 40ft to get into it. You go with the guide. We had life vests, we had helmets with lights.

But it was just fascinating to wade through a river for a couple hours and then come across these skeletons and pottery still where they were found that were, were in place for 1200 years. So it kind of made me want to do a little more of this.

That’s probably, I have to call it spelunking since I was with a guide in terms of best practices. This was a good group we were with.

That’s actually the first one is if you go with a guide, read about the guide in advance because they can get you in a dangerous situation if they don’t do it right. We had light vests, we had backup lights, we had lights on our helmets, few other things. Don’t do it by yourself.

And this seems like I wouldn’t need to say it, but obviously it’s safer if you can go with a few people. So always have a group of at least three or four people. Don’t just have one flashlight.

If you have one flashlight and it goes out, you are in a world of hurt. So the Recommended number is 3. Have a headlamp and a backup and a second backup. Wear clothing that keeps you warm.

Tell somebody on the surface, same as when you go backpacking, tell somebody back home where you’re going, what your plan is, when you plan to come back and at what time. They should alert the rescue folks when you’re climbing, maintain three points of contact and avoid jumping.

And also, and I’ll say this lastly, see Paul, if you want to add to this, check the weather forecast. Remember those boys in Thailand who were trapped in the cave? That was because there was unexpected rain.

So if it’s a high rain time, some caves, and this is actually true of the ATM cave in Belize that I was in, you can get trapped. And actually not long before my wife and I were in there, some people were trapped for several hours in these caves due to flooding due to rainfall.

So those are a few tips to. To make it a more safe activity.

GERM
00:31:23.500 – 00:33:10.860
It is such a fun thing to do. I love exploring caves. I’ve done it on a number of occasions, including scuba diving. Just want to amplify what you said. Do not do it alone ever.

I mean, if you, if you’ve been in a cave many times, you can still get in trouble. So never go alone. Always go professionally guided. And watch your head. I just. You’re going to knock your noggin you really do want to have a helmet.

This is makes a big, makes a big difference for sure. If you know there are other considerations. Other things live in caves like bats. I mean I’m friend of the bat. They eat mosquitoes. I hate mosquitoes.

That’s all good but bats carry diseases. We talked about Nipah virus before. They also can have rabies, they can also have Marburg virus. They can also have histoplasmos.

So there are other threats from an infectious disease perspective that can be there. If you’re with a professional guide, they’re going to guide you onto which cave is safe.

And if you do that, look, some people really do explore deep caves on multi day expeditions. I’ve never done that. It looks incredibly interesting, but that’s a whole different beast.

They’re going to have respirators to keep out infections, including histoplasmosis. That’s one of the classic ones. So this can be done safely if you do it safely. I don’t know how else to say it.

Everybody, thank you so much for joining us here on episode 89 of Germ and Worm. As always, we welcome your questions on travel health. Just send them to us or your tips for success. Funny anecdotes we’d love to hear from.

Send us an email germanworm gmail.com or visit our website germandworm.com if you enjoy what you hear, please let us know. Subscribe, rate us favorably and spread the word with friends, family and on the socials. Those are free ways to support this podcast. I’m Germ.

WORM
00:33:10.860 – 00:33:14.660
I’m Worm. It’s a big planet. See it in good health and we’ll.

GERM
00:33:14.660 – 00:33:35.630
See you next time.

This podcast is designed to inform, inspire and entertain, but it does not establish a doctor patient relationship and therefore the podcast should not replace it. 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 the University of Washington or UW Medicine.