GERM
00:00:09.840 – 00:00:11.120
Caixo! My name is Germ.

WORM
00:00:11.200 – 00:00:12.080
I’m Worm.

GERM
00:00:12.240 – 00:00:25.120
Welcome to episode 69 of the Germ and Worm Travel Health Podcast. 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
00:00:25.280 – 00:00:33.750
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
00:00:34.070 – 00:02:30.260
Here’s our job, Chris: People send us questions and we do our level best to answer them based on the facts, based on the truth, based on our expertise over these many years. Today is no exception. Questions that we’ll tackle today include:
Is there plague in Mongolia? And why do I catch it from marmots?
Are there issues with sampling palm wine on my trip to Bangladesh?
Low blood pressure and hot tubbing. What could possibly go wrong?
And I love to travel, but getting there stresses me out. Can you help?

These questions and many more, they come to us from you, our loyal listeners. Please send your questions, your stories and just tips for success.

Or if you want a clarification for something you’ve heard on a previous episode, we’d love to hear from you.

The best way to get us is online: germandwormmail.com Our humble request is that if you enjoy listening to us, please follow us on the socials @germandworm and and please subscribe to this podcast or follow us on your platform. That way you’ll get new episodes each week. We’d be grateful for your favorable rating on whatever platform you use if you like Germ and Worm.

Finally, 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.

Oh, and Chris, as we’ve been reminding our listeners, we also have our website it’s up. It’s hot. It looks amazing.It’s called germandworm.com that’s where our loyal fans can find out what they want to know about German Worm. All our episodes are there. They can search the content in a search bar. And if they want to binge Germ and Worm–And yes they do–that’s a great way to do so as well. Going back through all our prior episodes, there’s also an easy way to submit questions if you don’t like using Gmail. Check us out please germandworm.com and let us know what you think.

Hey Chris, you just got back from a week floating The Salmon River. Did you catch any salmon? How did they taste? And what the hell happened on the that trip? What was going on?

WORM
00:02:30.260 – 00:04:26.960
Yeah, it was super fun. I’m relatively new to the world of whitewater rafting. What it was, it was the middle fork of the Salmon river, which is in Idaho.

It’s in this huge wilderness. It’s actually in a 2.9 million acre wilderness, which is the biggest wilderness area in the lower 48. It was six days. It was a good gig for me.

I was the faculty on it. So There was about 18 doctors and mid level practitioners and seven guides and me. So I gave lectures for an hour or two per day.

Tried not to make it too boring, but it was just gorgeous. We stayed in tents at night, didn’t see any buildings or cars or roads for six days. Some white water, not too bad, didn’t flip.

One nice thing about the trip was just by happenstance, there were a lot of other really smart medical professionals along with us. And my initial vision was to give all the talks myself.

But two of the people along with us were actually in the Air Force and they worked with what’s called SERE, which stands for Survive, Evade, Resist and Escape. And basically they train Air Force pilots and other people on jets if they’re shot down in hostile territory. How to survive in the wilderness.

And they gave talks on things like how to survive an unexpected night out. So they put up tarps just with shelters with nothing but some ropes and some sticks.

They showed how to start a fire just with a little piece of metal. So that was super interesting. Everybody on our boats, we were about, as I say, what that 25 people.

We stayed healthy, but unfortunately I heard some anecdotes about boats just ahead of us on one guy hit a boulder, broke a bunch of ribs, had to be emergently flown out on another one. Again, boat just ahead of ours, a woman, she was 70, and there were some hot pools along the way.

She went into one of the natural hot pools, had a nice soak, but when she stood up, she passed out. Completely black.

GERM
00:04:26.960 – 00:04:27.600
Oh no.

WORM
00:04:27.600 – 00:04:43.980
Face planted on rock. Injured her face, but also broke several cervical vertebrae and had to be helicoptered out emergently.

So we did well, but unfortunately we were close to some significant trauma. However, overall beautiful trip. Really whetted my appetite for more river travel.

GERM
00:04:44.060 – 00:05:00.780
Well, so yeah, thanks for that. Survived the whitewater rapids, but a hot tub made somebody deathly injured. Tell me about that. Getting out of a hot tub, passing out.

How does that happen? And most importantly, what can we do to make sure it doesn’t happen to us.

WORM
00:05:00.860 – 00:05:59.370
Yeah. My first thought, of course I don’t know what happened, I wasn’t there.

But the most likely scenario as that she vasodilated in the hot water so all her blood went to her skin. She was very comfortable. But then when she stood up abruptly, she didn’t have enough perfusion to her brain and so she passed out.

So I think it was a matter of vasovagal or hypoperfusion to the brain. And some things you can do to bring the odds down of that one is to stay well hydrated.

So things that will dehydrate you is A not drinking enough water and B drinking things like alcoholic beverages. So staying well hydrated.

And then when you stand up, stand up slowly and just stand there for a minute or even get up slowly and realize you may be a little wobbly on your feet. And when you get out of the hot tub, use a third point of stability. Put your hand on a rock or a cane or something like that.

But just to go from a comfy hot tub to abruptly standing up can really make the blood flow to your brain go down, which could lead to you passing out.

GERM
00:06:00.490 – 00:06:59.310
Well, it’s great to hear. And you know, I know there’s also a related issue in young kids who don’t tend to run with a low blood pressure.

But if they go from hot to very cold out of the hot pool into the cold river, they can also just stop breathing. This odd phenomenon called the mammalian diving reflex or mdr. So even in young kids I feel like getting into these cold pools.

It’s Wim hof, it’s Polar Bear Club. It’s like this popular thing. Please don’t do it alone.

I mean this is my humble request if you’re going to do these crazy skinny dipping in the Arctic sub freezing waters. I have friends who do this. They love it.

Please just don’t go by your for all these reasons for low blood pressure issue, getting out of the hot for just stopping breathing. You know you can’t people literally passing out when they hit the cold, all of those issues.

Please, please do it with a friend and please tell us your successful stories and happy tales. But if you had a near miss with this, we’d also love to hear from you. Germanwormmail.com.

WORM
00:07:04.650 – 00:07:18.810
And Paul, on a related topic, let’s talk a little bit about hypothermia. You’ve been with all your mountain climbing to some very cold places.

What are some general thoughts you have on hypothermia what it is, how to avoid it and what to do if you think it’s happening. Yeah.

GERM
00:07:18.810 – 00:08:08.770
Thanks. Hypothermia. So hypo is the medico Latin it just means low. Thermia means temperature.

So low temperature by definition in humans we say that your temperature is too low. If your core is below 95 degrees Fahrenheit, that’s 35 degrees Celsius. And that can be very dangerous. Right.

Because we require a certain, well, we’re supposed to be warm blooded animals. Right. All of our physiology requires core temperatures above that range in order to function properly.

All kinds of bad things can happen if the core temperature goes too low. And of course this can be life threatening. So, yeah, I have been lucky to climb some tall mountains.

People say, oh, how cold was it on the top Everest? I mean, that particular day when I was there, the winds were pretty good. So I don’t think we ever got below minus 20 Fahrenheit on that day.

WORM
00:08:08.850 – 00:08:10.210
Oh, veritably toasty.

GERM
00:08:10.210 – 00:08:12.770
Yeah, I mean that’s, that’s warm compared to Mount Vinson.

WORM
00:08:12.770 – 00:08:13.090
Right.

GERM
00:08:13.090 – 00:12:53.670
In Antarctica when we were closer to negative 40. The reason I like negative 40 is that’s where Celsius and Fahrenheit are the same. And it’s, it’s cold as hell, but it’s a dry cold.

So the point is, I’ve been in some cold situations, but honestly I’ve never been hypothermic. The only time that I came close was it was in Berkeley, California and when I was in medical school.

I had lived in Berkeley for a couple of years before med school.

We moved back east so I could go to med school in Connecticut and, and then came back for spring break and I just missed my mountain biking so much because there’s not a lot of mountain biking in Connecticut. I love Connecticut. Not a lot of mountain biking. So when we went back, I really wanted to do this. So I rode my.

Well, it wasn’t my bike, it was my sister in law’s bike and it wasn’t kitted out for me, but I took it anyway.

And I went from downtown Berkeley up to Mount Diablo and then back and there’s a little ridge, the Berkeley hills that you got to get over to do this and okay, you know, I knew the weather was bad. It was going to rain like crazy. There was this cold spring rain. This happens in the East Bay once in a while.

It actually rains usually on the weekends. And I got out and caught out in the rain and I knew this was going to happen and I Didn’t care, because this is my only chance to go mountain biking for months and months. And gadzooks, I got so flipping cold because when I would go downhill, I would get this huge wind that would rush past me. I was drenched, utterly drenched. And I didn’t exactly pass out, but I, first of all, bonked, meaning that I consumed every shred of glycogen in my body.

Second of all, it was just extremely cold. And the only thing that kept me going was, for God’s sakes, don’t stop. I knew that if I stopped moving, I would lose my thermogenesis creation of heat. And so ironic that out of all my mountaineering expeditions, the coldest I ever got was just wearing a T shirt and shorts in Berkeley, California.

So the point is that it doesn’t have to be in these extreme situations. It doesn’t have to be in a frozen wasteland. Hypothermia can happen in any combination. When we get the right mix of water, moisture, and wind.

That I think, is the biggest thing. Now, if you jump into a frozen lake, you’re going to freeze. I mean, I get it, but this can happen to us at any time.

And so I really want people to be thoughtful about their moisture content and their wind protection, the two things I did not do on that particular day. So what can people do about this? You know, if you avoid doing that.

And number two, if you’re with someone who’s gotten into this situation, understand you need to get them dry and you need to get them warm. And at a certain point, the body loses its ability to rewarm itself. That’s where we have truly burned through. I said I bonked and lost my glycogen.

When you have lost all of that fungible energy, you go to ketogenesis. That takes time. And so the ability to burn your own flesh, if you will, that can be a slow process. These people may need to be passively rewarmed.

Meaning, number one, skin to skin contact. Yes. Get naked with your. With your friend or the person who’s going to save your life. And all the dry clothes you can put on.

I don’t even recommend this. Maybe a single dry layer for modesty’s sake. Dry underwear, dry T shirt, that’s it. Nothing more.

And then you get into the same sleeping bag or enclosed space with someone who is euthermic, normal body temperature, and their passive heat will transfer to you.

And then the other thing we do simultaneously, of course, Chris, is we let them rewarm from the core so you really want to get hot drinks into that person. I don’t care if it’s bone broth or bug juice or what are you going to give them, it’s warm water, tea and coffee is all fine.

You need them to, you need to relight the furnace if you will. So that’s another important part of this.

I do have a friend, very close friend of mine, who almost died this way on the top of Tahoma, usually called Rainier, after high hypothermia set in at the very tippity top of one of the routes on, on Tahoma called Liberty Ridge. And they got stuck in a windstorm as they hit the top and they all basically almost froze to death. But there are steam caves on the top.

So their guides were, it was a whiteout, but they somehow found these steam caves, got into the ice and set up a little camp. And for those who were most cold, including my friend, strip naked, pat dry and then get into a sleeping bag with someone else.

And that way they were able to survive until the hot drinks could come. So this happens and as long as you can recognize this early, you can get on it.

You’re looking for someone who looks cold, someone who’s stumbling, the mentation is not working right and they just look and feel cold to the touch. That’s a big deal. It’s not only about frostbite, losing the tips of your toes. They should never happen in the modern context.

It’s about genuine failure of our physiologic processes. Chris, let’s say that somebody really is found down extremely cold and you can’t even feel a pulse.

What advice would you give to somebody who’s trying to rescue another person?

WORM
00:12:53.670 – 00:14:26.030
One really helpful indicator of how severe the hypothermia is is are they shivering or not? Shivering is a good thing. Shivering means your neurologic system is still working. You do that as a reflex. The muscle activity warms up your body.

So if someone is shivering, they’re probably going to do okay, you want to warm them up. But it’s not quite the emergency. If they’re not shivering and they’re really cold, that’s a bad sign.

That’s a severe, it’s even a life threatening sign.

So suppose I find someone who’s down and they’re not shivering, the first thing I do is tell whoever I’m with to call 911 or activate the Garmin inreach or what have you because this is a life threatening emergency. Then I feel for a Pulse and I feel for a long time because you don’t suppose I don’t feel a pulse, but I only check for 15 seconds.

That’s not long enough. Really don’t want to do CPR on a cold person unless you’re 100% sure they don’t have a pulse. Because a cold heart is very, what we call irritable.

Irritable in the sense of if you bug it, it could go into a life threatening rhythm. So maybe check for a pulse for 60 seconds, even 90 seconds. Then if you’re really sure they don’t have a pulse, you can consider cpr.

But it’s an emergency and the main thing to do is activate emergency services. But don’t wait for emergency services before you try to warm them up with something like this. You warm them and then transport.

So yeah, call for 911 if you have cell reception. But then do what Paul was just talking about with warming the person up because it’s going to take a while for the ambulance to get there.

GERM
00:14:26.190 – 00:14:52.930
When I was a wilderness EMT, the saying was no one is dead until they’re warm and dead. And in other words you may miss the pulse. And people can go into these cryogenic states, if you will. Is frozen like a block of ice. That’s different.

Please, you need to take care of yourself. I wouldn’t try to rescue someone who’s obviously dead. But if they are not frozen, it is amazing how there are these miraculous survival stories.

So thanks for that. Good tip.

WORM
00:14:52.930 – 00:15:08.310
Yeah.

Eric Weiss, a doctor who ran the recent Wilderness Medicine conference in Snowbird, says that someone is not dead until they’re warm and dead unless they’re dead. So if they’re a block of ice, you can’t do CPR on that. So there are times where you, you just give up.

GERM
00:15:08.950 – 00:15:33.240
Yeah, unfortunately this, this does happen. I’ve seen that.

Chris, a question to you. This. It’s an anonymous questioner. That’s always fine. It’s flu season. Is there going to be an updated flu vaccine available to us or has the FDA or CDC blocked that?

WORM
00:15:34.590 – 00:16:30.670
Thank you for this. No, there was just a CDC ACIP Advisory Committee on Immunization Practices meeting recently and no, the flu vaccine is still available.

They are recommending though that people get the single dose vials which don’t have any thimerosal in them. So take home points. A, get a flu shot, it’s good for you. Flu is common. It’s recommended for everybody above six months of age.

B, most of the flu given in the US is From single dose vials which does not contain thimerosal. However, if you get it from a multi dose vial, that’s still okay.

Thimerosal does have a little bit of mercury in it, but it’s not the dangerous kind, methylmercury, which tends to accumulate in things like fish, but it’s ethylmercury which your body excretes very quickly. However, if you have a concern about thimerosal, just get it from a single dose vial and that has no thimerosal in it.

GERM
00:16:31.460 – 00:17:17.280
Yeah, agree. I got my seasonal flu shot a couple days ago. My primary care was just time for my annual checkup and I said please give me both my Covid shot and my flu shot. They didn’t even have the COVID shot in stock yet. By the time our listeners hear this, I will have accomplished that.

But I was happy to get my flu shot too. It is formulation has changed this year to reflect what we think people are likely to deal with. It’s 100% safe.

And for this whole mythology and the dark conspiracy theories about thimerosal. Love thimerosal. Amazing stuff. It keeps our supply safe and it is harmless. And we know that because we have endless studies looking at this.

Nevertheless, the good news for all of us is that there’s actually very few suppliers that even use thimerosal any longer here in the United States. Everyone should get their flu shot.

WORM
00:17:17.520 – 00:17:28.190
Yeah.

Whether you’re staying local or even if you’re going to, you know, Canada or Europe, a high income country like that, I think a fall Covid and a flu shot are among your top priorities. Vaccine wise.

GERM
00:17:28.580 – 00:17:29.060
100%.

WORM
00:17:30.980 – 00:17:49.540
Paul, next question for you. And this actually is a follow up for a young person in Mongolia, young woman taken humira.

And turns out there’s a news report of bubonic plague, of an outbreak of that there. Does this change your overall opinion about the safety of that trip?

GERM
00:17:50.020 – 00:20:48.810
Yeah, we did. Thanks. We did answer a question from someone in general.

If they are on adalimumab, one of these TNF blockers, a biologic agent for immunosuppression, could they go to Mongolia? And our uniform result was yes. Hell yes, you can go. And here are some of the things to think about.

We did not have this news report of plague and so this caught our attention. We’re hoping to follow up. The bottom line doesn’t change. Yes, it’s still perfectly safe.

Should be perfectly safe to go to Mongolia with the thoughtful planning that we talked about last time. But what about plague? You had me at plague. It doesn’t sound good. We’ve talked about how this is a bacterial infection. It’s caused by a bacteria called Yersinia pestis. And here in the United States we actually have that experience of bubonic plague, including in California.

We talked about that on a recent episode too.

In this case, what we’re seeing is something very similar, I think, to the experience here domestically as well, that you get varmints, little furry critters running around out there. In this case in Mongolia, it turns out to be the marmot.

For those who don’t know, it’s not just a fancy overpriced couture of athleisure wear, it’s also an animal. And the animal, they’re beautiful creatures. We have them here in Washington State. It look, it looks like a, it looks like an otter.

It looks kind of like a beaver, but different tail. They don’t live in the water, they live up on the land. These are mountain varmints and they’re super fun. They’re beautiful.

And under no circumstances should you touch one because they don’t like people. They’re terrified of us. If you cornered one, it might actually bite you. And for God’s sakes, don’t hunt one down and eat it.

And if you were going to eat it, please cook it.

So the bottom line here is that I think this experience of bubonic plague, it’s a very serious, miserable, life threatening infection treated with antibiotics. But you don’t want plague.

And the way you avoid it is you just don’t mess with the marmots, give them their space, let them run around, reproduce and make their furry way through the world. But if you’re going to hunt one and kill it, you may get into trouble with this kind of infection or other infections.

They have not evolved to be our food and we have not evolved to eat them. And so like any other varmint, you might hunt and kill out in the boonies, you could get a number of infections. This is one such example.

So to our listener who recently asked about going out there on an immunosuppressed regimen, oh, hell yeah. I would not have bush meat of any flavor. This is one of those.

And number two, if there’s someone who, let’s say the scenario is you’re in a yurt, you’re being hosted by that family, they offer you a scrap of meat. We’ve talked about this before, right, Chris? There are different ways for you to politely and respectfully decline.

Is a tiny single scrap of marmot meat likely to give you plague? It seems very unlikely to me. If it were not well cooked, I would not eat it, period.

I personally would decline and say this is not good for me, but make it clear that I’m saying thanks to them. What’s your thoughts about marmots, raw or otherwise?

WORM
00:20:48.890 – 00:21:28.750
Yeah, I agree. It’s interesting. Plague usually when it’s spread, is spread by fleas. That’s what spread the bubonic plague, the Black death in the 1400s.

Fleas leap off of rodents and they bite you and they spread this bacteria. Mongolia is a bit unique in that the transmission there is primarily not fleas, but it’s raw marmot meat, which is apparently a delicacy there.

So yeah, just like you said, I wouldn’t eat any kind of raw meat because other animals can spread other diseases if you eat them in a raw state. And in general, heat is your friend. I mean that’s all pasteurization in is heat. I wouldn’t drink raw milk either.

So the same basic food guidelines you follow here, I would follow a broader as well.

GERM
00:21:29.950 – 00:21:47.150
Amen, brother.

Okay, Chris, question. I like this one so much. Anonymous that’s just fine. Dear Germ and Worm, the two of you claim to be travel health experts. Are you board certified in travel medicine?

WORM
00:21:47.230 – 00:22:57.590
Oh thank you. No we are not. But we have a good excuse.

There actually is no board certification in travel medicine or tropical medicine or global health or volunteer work abroad or wilderness medicine. We’re both docs, we’re both MDs. I’m a family medicine doc. That’s what I took the boards in.

Paul is an infectious disease board certified specialist now. So no, we’re not board certified. There is no board certification in that. But we have been doing this for decades and decades.

We do both have degrees in tropical medicine. We have what’s called Diploma Tropical Medicine and Hygiene. I got mine in Lima, Peru. Paul got his in London in the uk.

We’ve also both been working in travel clinics for decades and we both also have written and edited books both for laymen and doctors on travel and tropical medicine. So we’ve been in the trenches in academia and in private practice. We’ve worked abroad. So we have been doing this for a long time.

So yes, we do call ourselves experts because it’s a fairly small niche and we do it more than most other doctors. But as to your exact question, are we board certified in travel medicine, I have to say say no.

GERM
00:22:57.830 – 00:23:13.590
And Chris, you’ve also passed the Certificate of Knowledge, right? You hold a Certificate of Knowledge in clinical tropical medicine and Travel health.

The C-TROP Med exam that’s provided by the American Society of Trop Medicine Hygiene. Tell us a little bit more about that exam.

WORM
00:23:13.750 – 00:23:44.140
Yeah, you bet. That’s probably the closest thing there is to a board exam in tropical medicine.

So this is a big good international society, American Society, Society of Tropical Medicine and Hygiene and they give this fairly rigorous exam that has about a one third failure rate annually and it’s if you pass it, which I did, then you get this certificate in tropical Medicine and Travelers Health. So it’s sort of a Good Housekeeping seal of approval. However, I don’t need that to practice. It’s just a little thing that I put in my cv.

GERM
00:23:44.860 – 00:24:01.330
Yeah, thanks for this. My hope is that people will look for these kinds of qualifications when they meet with someone from Travel Health.

I really want to make sure that when people do choose their Travel Health specialist they are dealing with someone who’s qualified and also compassionate and that they enjoy talking to. If that’s not happening, you may need to shop around.

WORM
00:24:10.210 – 00:24:21.410
Paul, this is for you. This is a good question. Someone’s going to Bangladesh and they read something in the headlines about Nipah virus in Bangladesh. What’s up with that?

That? Yeah.

GERM
00:24:21.410 – 00:26:42.530
Nipah virus. I call Nipah. I actually don’t know which. I think Nipah is probably correct. I call it Nipah virus. N I P A H. What is Nipah virus? It’s bad.

I mean this is a virus that is rare cause of encephalitis and life threatening infection usually in Bangladesh and elsewhere in South Asia. We’re not totally sure about the story of this. It’s so uncommon, Chris, that the method of transmission to people is not fully settled.

It has looked in the past as though one common mechanism may be not unlike other viruses from bats, flying foxes, that that may be the natural reservoir. For reasons we still don’t understand, these are mammals that tolerate viruses much better than we do as humans.

I think the viruses have adapted better to that particular mammal, but they can sure spread it to us. So one idea is that if you’re in Bangladesh or elsewhere in South Asia, you should avoid intimate contact with bats and fly and foxes.

Well, here’s a case of someone who actually did not have that direct contact. Instead this is a child, tragically that was reported to die in August.

That’s notable because that’s not when people typically get Nipa virus in Bangladesh. That’s usually from December to April. There’s also an adult, some Adults, two men and a woman who, who died and they had consumed raw palm SAP.

The SAP of the palm tree is a biological product. It’s an agricultural product. It is used, for example, in the preparation of palm wine.

Palm wine is a delicacy and it’s a popular thing for people well beyond Bangladesh. It’s true elsewhere in South Asia and other parts of the tropical world. Unfortunately, that does seem to be the link for the adults.

The child, as it happens, does not, not known to have consumed palm wine. They don’t know how that kid got it. Was it from a bat? Was it from some other source? We’re not sure.

The bottom line here is that if you’re anywhere in the world, for reasons we’ve talked about many times, I do not want people to have intimate, close contact with bats. And when it comes to palm wine, question, this is going to be offered as a delicacy or something from a host. Chris, what’s your.

I’ve actually never had it, so I can’t tell you how good or bad it is. It’s supposed to be delicious. Chris, what’s your advice to people who may be offered a drink of palm wine?

WORM
00:26:43.160 – 00:27:12.290
You know, in general, I avoid alcoholic beverages that are home brewed because infectious issues are not the only ones. Sometimes the brewing process can end up containing methanol, which can make you go blind. It can kill you.

Also, there can be heavy metal toxicity depending on the still. So in general, try to have your alcoholic beverages be things that are made in official breweries.

They go when you open them and that’s a general marker of safety.

GERM
00:27:12.690 – 00:27:42.580
I agree with you. And that’s not just to taint the people’s thoughts about palm wine, but any alcohol.

So if it’s Waraji, a banana based product in Uganda, I would give the same exact advice. Please, respectfully, politely, just say no.

Okay, Chris, here’s a question to you from someone who says, I really enjoy traveling internationally, but sometimes it’s a lot. Why does international travel stress me out and what can I do to reduce my travel stress? I do love to travel.

WORM
00:27:42.980 – 00:28:32.150
Thank you. It’s a myth that travel is entirely stress free.

I think certainly the advertisers from Airbnb to the airlines sort of give you this image that you will have fun all day, every day, from the moment you get up to the moment you go to bed. And I like to travel, but there’s always some stress. There’s always some mishaps, some boredom, some frustration, some tedium.

So a few thoughts that can Bring down stress. One is if you have the time, get to your destination and come back more slowly.

Fifteen, 20 years ago, when I used to go to Africa, I would take three or four jets straight back to back and I’d get there after 36 hours just feeling terrible. What I do now if I have time is I take a flight and then I spend a night maybe in Europe and then I take a second flight when I’m feeling better. So slow down a little bit. Another is for the first day you’re probably going to be jet lagged, so don’t on your first day schedule a bunch of activities.

I usually schedule the first day where I take a nap and eat and go to a coffee house and do things like that. Also be realistic concerning personal growth. I think it’s great to travel. I think it does lead to personal growth.

But you’re not going to instantly become someone else. And you shouldn’t stress out if you’re not. Invariably when you travel, you take yourself with you and you will be the same person in a new place.

And there may be some subtle changes, but if you’re anticipating an immediate epiphany, you’re probably going to be disappointed. I wouldn’t plan too many unpleasant tasks. Something I’ve been guilty of is maybe I’ve been feeling for years I should read a particular book.

It’s kind of boring and I think I’ll read it on this trip. It’ll be a great time. But then I’m abroad and I find that if the book was boring in Seattle settle, it’s also boring in the new place.

And it’s kind of a chore and I usually throw it away. So don’t make it a time to sort of catch up on all your life tasks. Also, don’t plan on doing something like learning an entire language.

In a short amount of time. You can make inroads on a language, but languages take years to learn. As a rule, take something that comforts you.

I take journal, sometimes I take a music player. But if you like a teddy bear or what have you, take something that takes you to your happy place. It definitely can be stressful.

One other thought, and this is getting a little metaphysical, but don’t decide in advance where you’re going to have your travel epiphany. So suppose you want to go to Machu Picchu and you’ve always imagined that it’s wonderful. Well, it is wonderful.

But I would encourage you to be open to your special moment for your entire trip. It may happen at a bus station or a restaurant or just talking to somebody on the sidewalk.

And you can’t plan your special moment and it doesn’t always happen at the famous attraction. And I’ll say lastly that travel is not for everyone. As much as Paul and I like to go abroad, some people like routine.

Some people are put off by novel experiences, a different bed every night. So I think there’s a lot of upsides to travel. Then again, if you hate it, that’s okay. Stay in the United States, traveler.

GERM
00:30:51.620 – 00:31:56.160
Know thyself. I mean, it’s such good advice. And all these are great tips.

I think one person’s adventure will be another’s torture, and I really am grateful that people are thinking about the things that get them excited to travel and the things that put them off. Think about it ahead of time, work through these processes and that can make it a less stressful process. Foreign thanks for that great question.

And everyone, that’s a wrap for episode 69 of Germ and Worm. As always, we welcome your questions on travel health. Just send us your questions, tips for travel success or suggested corrections.

Yep, we’re open to that too. Get us by email germanwormmail.com or find our question portal right on the website Germ. If you’ve enjoyed this episode, please subscribe.

Follow us, Rate us favorably and spread the word with friends, family and on the socials. Those are free ways to support this podcast. I’m Jerm.

WORM
00:31:56.240 – 00:31:59.200
I’m Worm. It’s a big planet. See it in good health.

GERM
00:31:59.200 – 00:32:19.570
See you next time.

This podcast is designed to inform, inspire, and entertain, but it 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 do not necessarily represent the opinions of the University of Washington or UW Medicine.