GERM
00:00:00.160 – 00:00:12.640
Kuzuzangpo la! My name is Germ. I’m Worm.

WORM
00:00:13.040 – 00:00:29.600
Welcome to episode 98 of the Germ and Worm Travel health podcast. How to prepare for a high altitude trek in Bhutan. It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger. You can also call me Germ. I’m a professor of Infectious diseases at the University of Washington in Seattle.

GERM
00:00:30.200 – 00:00:38.120
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.

WORM
00:00:38.520 – 00:01:37.520
Well, Chris, we are so excited for these great questions today. They include how should I get ready for a high altitude trek in Bhutan? Oropouche virus in Mexico: What’s up with that
Is the CDC blocking publication of studies showing the COVID vaccine is good for us? And exercise on the road? How much is too much?

A reminder to our listeners. Please contact us with your travel health questions, your stories, and your tips for success.

Or you hear something that you don’t like or you want a clarification on our previous episode, just let us know, Visit our website, germandworm.com or send us an email germandworm@gmail.com Before we jump in, here is our medical disclaimer. This podcast is designed to inform, inspire and entertain, but you should not use it as clinical care before you travel, please see a qualified healthcare professional for recommendations specific to you and your itinerary. So, Chris, right now we’re on other sides of the planet. I’m here at our Germ and Worm headquarters in Seattle and you are not. Where are you?

GERM
00:01:38.480 – 00:02:18.310
I am in a lovely part of Italy. I am in Puglia, down to the south. It’s the heel of the boot. Came here with my wife a week or so ago. Spent a few days in Rome, which was super fun.

Saw stuff I’d been seeing images of all my life but had never seen in the flesh. So the Coliseum and the Vatican went down and saw Pompeii and Herculeum, another city that was buried. Super fascinating.

But now we are down in Puglia, actually on a farm in a 300 year old stone farmhouse, and we’re eating really well and talking to the locals and having a really good time. So as I was telling you before, I’m going to get no hardship sympathy on this trip.

WORM
00:02:18.950 – 00:03:12.100
What a great experience. I’m delighted to hear it. Well, I have some news as well regarding travel–indirectly. Last night I was so lucky to participate in the Mountaineers annual gala. Mountaineers, for those who don’t know, it’s a great nonprofit based here in Seattle, and it’s designed to support people for safe, fun time in the mountains. It’s open to everyone and they run on a shoestring budget. And so this is a chance for us to do some fundraising.

Anyway, I was so delighted to sit down at our table and a stranger sat down next to me. I introduced myself and he said, okay, I’m going to get this out of the way, first things first, I know exactly who you are and I’m a huge fan of Germ and Worm. And I thought that was delightful to be spotted in the wild by someone who’s one of our followers. But that’s the first time that it happened to me. So, to my new friend, David, thank you for your donations last night to Mountaineers and thanks for becoming a friend.

GERM
00:03:12.260 – 00:03:14.340
Oh, good, I’m glad to hear that.

WORM
00:03:14.580 – 00:03:20.100
Clearly, Germ Nation is thriving. The Wormiverse is growing and that made me feel really good.

GERM
00:03:21.680 – 00:03:54.380
This first question, Paul, this is for you. And this actually comes from me. I’m. Later this year, I’m going to Bhutan for the first time. I’m scheduled to be faculty.

Actually, it’s for a 12 day wilderness medicine course. I’m going to be talking for 12 days to a bunch of doctors and other medical people about survival in the wilderness.

But most of it’s at about 10,000ft. And you’ve done a lot more climbing at that altitude than me.

And my question for you is, as a guy who lives at sea level, what’s the best way I can prepare for a two week trip to that kind of altitude?

WORM
00:03:54.780 – 00:08:28.750
I mean, the best way to prepare for two weeks at altitude is to move to that altitude and live there. So that when you’re there for two weeks, it’s just like any other two weeks.

But listen, I’m so excited you’re doing that because I’ve never been to Bhutan, so I’m envious. I have friends who’ve done it. You’ll be another to join that elite crew. So I’ll tell you my thoughts about this.

You know, for those who don’t know, Bhutan is, you know, it’s not too far from Nepal, it’s not too far from India, it’s not too far from China. It’s far from everywhere. Therefore, it’s in the middle of nowhere. But it is high. And I think this is why you’re raising this good question.

You will be at these elevations you talk about. So how to get ready for this? First of all, get ready for the beauty, because it’s meant to be a spectacular place.

Mostly parts of it are largely above tree line.

So it’s a different kind of landscape than we get here in Seattle, which is exactly why you’d go to try that out and see what that looks like and get ready for the people. I mean, it’s notorious for its gnh, the Gross National Happiness Index. Right.

They’ve decided that their biggest thing that they can have and import and export is happiness. Although, you know, unemployment is still a real factor.

And I think for quality of life of people living there, it’ll be interesting, Chris, to talk with them about what their true happiness level is. But it’s by reputation spectacularly beautiful, very welcoming people and a great place to go. And it’s hard because you’re up high.

So obviously you need to train, right? And that means your lungs, your legs and your feet especially. I would not minimize foot care. This is usually, as you said, a trek.

People will be walking. That’s going to be you. So make sure that your feet and your shoe gear are dialed.

Do not buy a fresh pair of hiking boots and then head off to Bhutan because once you get a blister, it’s going to be a mess. So if you ever have questions about foot care, please do see the German Worm episode called Extreme Feet in the Extreme Heat.

Our interview with Kyle Allred pac to get some tips on good foot care. But of course, you know, the more you walk, the stronger you get for your legs and your lungs. So that is important.

And anytime you can get at elevation would be helpful.

So, Chris, for you, that means that you and a lucky friend or two should spend time in Mount Rainier National park trying to get up above 5,000ft to get used to that. I think that when you get to new sleeping elevations, it’s reasonable to look at the opportunity to take acetazolamide.

We talked about this in an episode just recently. Evelyn asked a question about how to dose this. And so that’s worth looking at.

As you recall, the typical guidance is 125mg twice a day for the first three days that you achieve a new sleeping elevation. So if your trek is relatively flat, high but flat, let’s say you’re going to be around 10 or 15, 12,000ft.

You know, for day after day, you don’t necessarily need to take acetazolamide every night, just those first three nights that you’re at that new sleeping elevation. So that’s the physical part. I think it’s important to protect yourself against infections.

And yes, there are major challenges in Bhutan as With most of the world around sanitation, so the risk of diarrheal illness is substantial. That means, number one, protect yourself against the diarrhea that you can and the food borne waterborne illness that you can.

And that’s the typhoid vaccine. So you need to make sure that you’re up to date with typhoid protection.

There’s an oral pill you can take which will last about five years for most folks. There’s also a shot vaccine in the muscle of your shoulder and that’ll last you a couple of years. So make sure you’re up to date on that.

And then this is one of those, wrap it up here, see what else you think, Chris. But this is one of those locations where water safety should not be taken for granted. And that’s why you’re doing the vaccine.

But remember that vaccine against typhoid, that’s one of many, many, many flavors of diarrheal illness you can get by drinking the water. You do need to assume that your water should be treated and so have a treatment plan and I would say a backup plan.

So for me, the way I do this, if the water looks clear and I’m about to drink it, it’s in a Nalgene bottle, for example, I would use a UV sterilizer, SteriPen or generic version of that into the water. Really use it. I would also bring some aqua tabs, meaning chlorine dioxide tablets, just in case that doesn’t seem to work.

Or if the water that I get, it looks a little bit cloudy. You know, remember, the UV works great, but only if the water is totally crystal clear. And you can always, of course, do both.

So, Chris, that’s, that’s my vision, is that you’re going to do this and have a great time. What did I not cover? What else are you worried about?

GERM
00:08:31.160 – 00:08:32.280
Well, can I call you?

WORM
00:08:33.080 – 00:08:53.400
You can call me and you get what you pay for. I mean, I’m going to be too damn far away to do much of anything. Oh, we didn’t talk about this.

The happy news about being on these high treks in Bhutan, not a lot of bugs because there’s not a lot for them to eat or drink except for your very living flesh. So at these high elevations, you should not be concerned for malaria prevention, for example. So that’s one way to try to simplify things.

GERM
00:08:54.360 – 00:08:57.160
Super. Thanks. And I’ll probably have more questions. I’ll hit you up.

WORM
00:08:57.400 – 00:09:24.100
Okay. Keep us informed. Germ and worm will be watching.

Alright, Chris, here’s a question to you. We haven’t talked about this illness for a while and it seems to be, seems to be changing. Last time we talked about it was episode 57, and here we are at episode 98. But please remind us, what and where is Oropouche?

GERM
00:09:24.820 – 00:11:02.340
Oh yeah, funny word for an expanding illness. It is a viral illness and it causes symptoms that’s similar to dengue fever.

So people get a fever, some joint pain, and it’s spread not by mosquitoes, but by midges, these little biting insects. Where it is primarily is south and Central America and the Caribbean. And actually there have been some fairly large outbreaks in those countries.

Other things this can cause would be headache, muscle pain and rash. Usually goes on for a week or so. There’s no vaccine, but I’ll talk in a minute about how to bring risk down.

There was a fairly big outbreak Even in the US almost 100 cases came back to the US I read a report back in October of last year, all of them from Cuba. But what caught my eye recently was this has very recently expanded to some parts of Mexico.

So in mid April in Mexico, there were a number of cases of this. And that’s a brand new thing there. It had never been found. So it’s probably expanding. It is not spread within the United States currently.

It may be with global warming and increased tourism, but it’s not currently. So there’s no specific treatment for it. It’s a virus. Antibiotics don’t work.

The main thing to know about this is to bring your risk down not only of Oropouche, but also other things transmitted by insects, including dengue. Usual stuff, deep or picaritin to skin, permethrin to clothing. Sleep under a bed net unless you have air conditioning.

So I still go to all of these places. I wouldn’t keep me away, but I also put, you know, appropriate bug repellent stuff on my skin and clothing.

WORM
00:11:03.380 – 00:11:54.140
Well, I, you know, as I said before, number one, I don’t want to catch this virus. Number two, what a great name for a dog. My dog is called Leo, but if I had a new dog, I would call him Oropuchi. So I think it’s all humor aside.

It really is a vexing, problematic viral infection. And what an example, right, of something that we really need a good vaccine for.

I wish I could get a shot, you know, before I go to these exciting places and to the people who live in these locations, thinking about parts of Mexico too, you know, it’s a real concern. So hopefully we can get somebody in charge globally and nationally who understands that these Neglected viral infections are still really important.

We need vaccines, we need better vector control, we need a plan. So let’s keep our listeners tuned for what we’re thinking about with respect to this vexing infection.

GERM
00:11:55.100 – 00:12:19.250
Yeah, agree. Alright, Paul, change of topic question for you.

I read this is kind of hard to believe, but I read in reputable journals that the current head of the CDC, Dr. Jay Bhattacharya, he actually blocked publication of a good study showing that the COVID 19 vaccine prevents hospitalizations. Is that true and can he do that?

WORM
00:12:20.770 – 00:18:07.560
Well, apparently that is what’s happened. We’re reading this in real time. And here we are in late April 2026. And yep, this is the latest insult and outrage.

So what’s the story here about what has happened administratively? And then what’s the truth as best we understand it scientifically?

Until just recently, CDC was headed by someone called Jay Bhattacharya, who apparently is a medical doctor. This is someone who runs both Centers for Disease Control Prevention and National Institutes of Health. These are not the same.

And to have one person doing both, of course, is crazy. Why is that happening?

Because the last person to run CDC quit because they were being micromanaged and treated like a fool by the head of HHS, which is called RFK Jr. So in protest, that person has left. In other words, CDC has been leaderless for all this time.

But one thing the interim leader, Jay Bhattashari has done is to quash this report which was due to be published in the Morbidity Mortality Weekly Reports, MWR.

We’ve talked about MMWR before in the context of the fact that for the first time, so far as I know, in its long and illustrious history, that publication was stopped right after the appointment of RFK Jr over a year ago. We were outraged at that time that he had just said no more communications from CDC until I like what I see. I guess that’s what he was trying to do.

And here again we now have this interference of an administrator with the epidemiologists and scientists at Centers for Disease Control. Why this person, Jay Bhattacharya, has very clearly been anti vaccine for quite some time, a skeptic of vaccines doesn’t like and I think probably just doesn’t understand how vaccines work. That’s my interpretation of the public remarks that he has given before. So here’s an example.

What we have is a way to try to understand when we do something in public health, is it good, is it bad, is it helping? So the best way we can do that with Vaccines is to talk about it. Don’t sweep it under the rug. But let’s really look at this.

And I don’t care if you’re talking about COVID 19 or seasonal influenza. You know, the technology is there for immunizing against both of these infections. And the way to do surveillance is the same as well.

So how do we know if things are working? We do a vaccine effectiveness study, and this is what our friends at CDC have done using a test negative case control design.

So the way this works is that when someone presents drugs for care because they have an acute respiratory illness, they’re tested to see what they have. Believe it or not, most people do not get tested.

But if you’re sick enough to go to a doctor or another qualified healthcare professional, they may choose to test you. And not just to diagnose and treat based on their hunch. Let’s do a real test. These tests are precise, although not perfect, but very, very good.

And so we can see what tests are positive and what tests are negative and then decide whether that person was protected or not, relatively by asking them that simple question. Did you get your vaccine? So are you sick enough to see a doctor? Did you have a positive or negative test and did you get your vaccine?

And you just line those things up and then you decide. More broadly, does this give us a sense for how well these vaccines are working?

And this is the same technique that was used to show the relatively low impact of this particular season’s influenza vaccine that was published in MMWR, I think, just a month or so ago. Likewise, they’re now doing the same thing with COVID 19, and that shows that it is a favorable process.

Specifically that your risk of going to see a doctor or having to be hospitalized is basically cut in half if you’ve received the COVID 19 vaccine versus if you have not. I’ll say that again. If you get your Covid shot, you are half as likely to need to see a doctor or to be admitted to hospital. That’s huge.

It’s not perfect. I mean, of course, I Wish it was 100%. If that were true, we wouldn’t even have to have this stupid conversation.

But it’s really good and certainly superior to this year’s flu shot.

And yet J. Bhattacharya has apparently told MMWR that they could not publish, even though that report had gone through multiple levels of scientific vetting and discussion and approval of that editorial board.

People who are involved in Centers for Disease Control have been interviewed and said on the record they cannot Recall this ever happening before, that an administrator would supersede what the scientists there are saying.

So this really feels to me, Chris, like yet another example of people who don’t know what they’re talking about in a position of power and are making a bad decision. The hope here is that things will get better. We’ll see. So since this has happened, we do have a new director named for CDC.

That’s someone called Dr. Erica Schwartz, who is apparently a real physician, also an attorney, also a public health expert, so different from Jay Bhattacharya. She’s also served previously in the federal administration of this particular president, the last time they were in power. So we’ll see.

My hope is that this will be a true physician and that Dr. Schwartz will be someone who we can rely upon and trust. I think the bar is set. It’s a low bar and hopefully she’ll do better than Jay Bhattacharya. We’ll see. Stay tuned here to German Worm.

We’ll give you our ratings and reviews of how Dr. Schwartz does. I think she deserves a little bit of a honeymoon or a grace period to get settled in, to start doing things.

My hope is that this decision will be reversed and that this high quality study will see the light of day. And number two, that she’ll lead this very important agency with dignity and with scientific mind and with an open heart.

Chris, what do you think about all this?

GERM
00:18:08.990 – 00:19:07.910
The initial stuff that I’ve read about Dr. Erica Schwartz is favorable. I read that she is strongly pro vaccine, that she’s science based, she’s evidence based.

So we’ll see if her science and her training and her expertise can come through that large administration. But I have guarded optimism.

It drives me nuts when someone like rfk, a big conspiracy fan, talks about how measles is a minor illness and it’s, it’s not that bad. He doesn’t know about it. He’s not a doc. He hasn’t taken care of people with it.

And just recently in Bangladesh, for example, there was a big outbreak because they have a very low rate of immunization there and it killed over 100 children. So it’s a big deal. It could be a big deal again in the U.S. if the vaccination rate goes down. So to have Bozo in charge is infuriating.

But I am made a little optimistic that Erica Schwartz seems to be a out and out pro vaccine doc. So, you know, stay tuned.

WORM
00:19:08.470 – 00:19:48.680
Agree. And just again to emphasize if one of your takeaways to our listeners is if you have any doubt, please do not.

In general, yes, you really should be updated with your COVID 19 vaccine.

And we’ll continue to talk about that as the respiratory season, which is now hopefully heading down a little bit, but we’ll continue to talk about that. Okay, Chris, here’s a question to you. This is from me to you, and it’s about dengue. We’ve talked about dengue many times.

We’ve talked about the fact that there is a vaccine in other parts of the world. But should people really get that vaccine when they travel internationally to prevent dengue?

GERM
00:19:49.640 – 00:22:05.690
You know, great question, and the answer is my favorite answer when I’m a doctor. It depends on, and there’s not a consensus among medical authorities or bodies that issue recommendations for this, but I’ll share some thoughts.

So first, dengue fever, viral illness present in about 100 countries around the world, spread by mosquitoes, causes fever and joint pain. And there’s now a vaccine for it. There was one in the US that was taken off the market. There’s a new one, entirely different, called qdinga.

The good news is it’s a good vaccine. You don’t have to get any lab tests before you get it. It covers all four serotypes of dengue. Pretty good efficacy, not 100%, but better than 50%.

And if you get a booster, it’s up to 91% efficacy of preventing hospitalization.

But the kicker for our listeners in the US Is it’s not available in the US it’s made by a Japanese company called Takeda, and it has regulation gone through. And it’s available in about 40 countries around the world, including a lot of Europe, European countries, but not the U.S. so should you get it?

Well, the CDC doesn’t really say. And when I look at different regulatory advisory groups, some flatly say, get it for some countries.

So, for example, there’s this very high quality commercial group called Shoreland Travax that my clinic subscribes to.

Very good infectious disease doctors put this together and they flatly recommend dengue vaccine for all travelers to areas where it’s commonly spread. And this would include Thailand, Cambodia, Laos, Brazil, Nicaragua.

And they recommended for most, maybe longer term, everybody but short term, urban people going to Vietnam. So what to do with that? I plan on getting this.

I haven’t had it yet, but I travel so much to countries with dengue that I’m planning on getting this the next time I go to, I don’t know, France or the UK or maybe I’ll look for it here in Italy. I would say it’s low priority.

If you’re short duration in urban it is higher priority and I’d recommend it if you are longer duration in rural, more likely to be exposed to mosquitoes. Exactly where I draw that line I can’t tell you. That’s a good question for your pre travel doc.

So a long way of saying yeah for a lot of people I think it’s a good vaccine but it’s not something everyone should get who’s going to a country with dengue.

WORM
00:22:06.650 – 00:22:39.680
And I’m eager to get this shot myself and I really just wish it would be easier to get here in the good old US of A.

Where yes folks, I am still trusting in general of our pharmaceutical supply, but I will get it overseas when I get my next opportunity and I’ll share that experience with all of you so and hope you do the same. Chris if folks here listening today have been overseas and gotten the shot, let us know.

We’d love to hear about your experience where, what, how, how much you paid for it, etc. Please let us know germandwormmail.com or just visit us online. Germandworm.com.

GERM
00:22:47.440 – 00:22:56.960
So Paul, I have to be careful asking this next question because we are social media, but when it comes to medical topics, to what extent can you trust social media?

WORM
00:22:57.520 – 00:24:43.720
You can trust social media to the extent that you go to one place, germ and worm. We love having people follow us online. So consider the source. Consider the source.

You know, one of the things that prompted this question, I appreciate it. Apparently, you know, Joe Rogan has said, I’ve heard of this person. I think apparently he’s a wrestler or a comedian or something.

Somebody’s podcaster says COVID vaccine made by Pfizer probably had a conservative estimate of killing between 470,000 and 600,000 people. People killed by the vaccine. All of which is completely and totally false. So there’s many other falsehoods.

I call them lies, but I think legally we’re supposed to call them falsehoods that are circulating out there. Here’s a few of them, one of them that I hadn’t heard of until recently. This idea that people should swallow methylene blue.

Apparently in TikTok this has been something that people are promoting to swallow methylene blue. Let me make it very clear folks. Methylene blue can be used in medical science for people with certain unusual disorders.

But 5% of people and up to 15% of African Americans are deficient of glucose 6 phosphate dehydrogenase G6PD. If you’re G6PD deficient along with 5% of the world population. It could kill you because it’s a terrible interaction.

So I would not get my methylene blue off of, off of TikTok and just swallow it for any old reason. We’ve seen trends for people on social media diagnosing themselves. This happens in my practice all the time.

Someone who feels poorly and they hear about something on the socials and they decide that, that, you know, applies to them somehow. Well, what other harmful myths have you seen or heard of online, Chris?

GERM
00:24:44.520 – 00:25:45.200
Well, there’s a lot. One thing I see is these really muscular young men talking about how their physical body is an ideal that other young men should shoot for.

And they talk about supplements and injections and hormones and things like that. And these people, they don’t look healthy.

There’s a lot of health issues and there’s not good science and they’re not doctors and they’re popular and they have a lot of views and I worry that a lot of people are making themselves sick trying to imitate these people. Also there’s a lot of self diagnosis. There’s a lot of what I call hey, you’re sicker than you think.

So even if you feel good, that’s the first sign of this particular mental illness or other illness and people are bored and I mean, and I’ve clicked on these things and oh, maybe you feel okay, but maybe you’re bored because you have ADHD or some other thing, which is a real thing. But I think it can be over diagnosed and it’s impossible to self diagnose.

So I think again, social media can convince people for whatever end, often commercial, that they have a condition that they don’t.

WORM
00:25:47.040 – 00:26:36.670
So bottom line, can you trust social media?

I mean you should be skeptical of everything you see online and everything you read, whether it’s from the socials or something that looks like it’s legitimate news. This is the era we live in. So we know that you’re listening to us right now by choice. I certainly hope you’re not tied up and forced to listen to us.

So you’ve chosen to listen to us. We appreciate your trust. We will continue to try to give you the best information we can.

And no doubt there are other sources out there that are trustworthy. But be curious and be skeptical. Alright Chris, we know we should stay healthy when we’re on the road, but is it possible to do too much?

Can you get too much exercise when you travel?

GERM
00:26:37.700 – 00:29:20.350
Yeah, great question and the answer of course is yes. Now first exercise is about the most beautiful medical intervention in the world. Better than a drug, practically better than genetics.

So if you want to live a long time, the first thing you should do is have a regular exercise routine. Also, if you can continue it when you travel, you’ll feel better, you’ll get over jet lag quicker, your mood will be better.

However, there’s an American tendency to assume that if something’s good, that more is better. And that’s not true of anything of a medicine or a supplement. But it’s also not true of exercise. So two caveats.

One is don’t exercise too much and I’ll get into specifics in a minute. Number two, only exercise if it’s safe.

I worry when I see some, for example, bicyclists who are so insistent on bicycling that they bicycle on busy roads with no shoulder for bikes and there’s trucks. And also if it’s super smoggy, I don’t think exercise outdoors is a good idea.

So if you’re going to, I don’t know, Delhi at a high smog season, maybe don’t do outdoors exercise. Probably the harm of the smog is going to be worse than the benefit of the exercise in terms of how much there’s a wide range.

I mean, a good minimum of 20 minutes three times a week, that’s a good minimum. But there’s maximums.

A good amount might be up to 150 minutes per week, but maybe don’t do more than four to five hours of cumulative hardcore exercise. Really, you know, heart pounding, sweat inducing stuff per week. So max four to five cumulative hours.

So if you’re in the gym or cycling or jogging two hours a day, seven days a week, that’s probably too much. And actually I looked at some recent cardiovascular data that looked at exercise and sort of minutes per week and death rates.

And it’s not a straight line, it’s a U shaped curve. So the worst is none at all. And then it’s better if you’re doing 20 minutes three times a week, five times a week.

But the folks who were doing like 14 hours a week of heavy aerobic exercise had a higher death rate than those doing less. So at a certain point it is out and out deleterious. So exercise good 20 minutes three times a week is a good minimum.

There’s not really an optimal that I’m aware of, but you know, if you’re doing 20, 30 minutes five times a week, that might be in the ballpark. And you should not just walk. But ideally I mean, walking is better than nothing, but do something that makes you sweaty and breathless.

So if your hotel has an elliptical trainer, or if you can get to a pool, or if you can jog or if you can swim in a safe way, get your heart rate up, that’s better than a more sedate activity. So, Paul, that’s my spiel on that. What’s your take?

WORM
00:29:20.510 – 00:31:32.760
I mean, my take is the same and my advice is just a cautionary tale. I think we’ve all seen and read about people who go on vacation and decide to start exercising, which is a great resolution to make.

But please do not overdo it, especially when you’re away from home. My point is, and Chris, I think you agree, consistency is everything.

And, you know, doing a new exercise program from the beginning, starting something new and different when you’re on vacation, it can be okay. But please don’t overdo it.

I mean, if you’re somebody who hasn’t spent a lot of time on those treadmills or ellipticals, just take it easy, for God’s sakes. Please do not overdo it. The quality of that equipment may not be reliable. What if the machine breaks?

And heaven forbid you actually end up getting symptoms of something that would show myocardial ischemia, that you’re somebody who’s actually discovering for the first time as an adult human being that actually you need to see a doctor before you intensify your exercise. So the point is, please exercise. Please do it on the frequency that Chris says, and please start it at home before you leave.

And if you take off with a plan to do a big marathon or some other ultra experience, you need to work up to it. That gets us back to the first question about you, Chris. Your upcoming trek in Bhutan.

I would not send you over there if you weren’t already a fit guy who likes to walk and hike to begin with. So just wanted to put that out there. Everyone, thanks so much for joining us here on episode 90 of Germ and Worm.

As always, we welcome your questions on Travel Health. Please send them to us along with your tips for success or suggested corrections. We would love to hear from you. Email is good: Germandworm@gmail.com or visit our website germandworm.com if you’ve enjoyed what you’ve heard today, 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 Church Worm.

GERM
00:31:32.760 – 00:31:35.400
I’m Worm. It’s a big planet. See it in good health.

WORM
00:31:35.560 – 00:31:57.000
We look forward to seeing you next time.

This podcast is designed to inform, inspire and entertain, but it does not establish doctor patient relationship and so it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure.

The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.