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It turns out when we evolved about 100,000 years ago, when we stood up instead of swinging from trees or walking on our knuckles, we actually developed a way of moving that was incredibly calorically efficient. We had to change our muscles in our rear, we had to change our angles of our ankle, we actually put our shoulders back, our head was more erect, and we looked forward. So not only could we see around us, we were curious as a species, we could stand up and walk, and we traveled all over the world.

The great apes don't really leave home, but humans have been leaving home to go places since we called ourselves Homo sapiens. And we traveled because maybe for new resources or new food sources, or to get stuff that we wanted, like chocolate, and pretty shells, and stuff, and feathers, and things that we wanted. And wherever we went, we took our diseases with us, and whenever we found ourselves in a new place, we met new diseases there. So now that we travel all over the world easily, we spread our diseases all over the planet. We are a traveling species.

With us in the studio is Theresa "Terri" Sofarelli. She is physician assistant, and she spent a lot of her time talking to and taking care of people who are going to travel.

I'm going to tell you a little travel story in that when I was in college... this is at the University of Colorado. It was very popular to go to Mexico during spring break, and I did, and I knew that you could get sick. So I drank out of bottles and I made sure my food was cooked, and I wanted to make sure I stayed healthy. But sure as shoot, as soon as I got back, I got Montezuma's Revenge.

Dr. Jones: I didn't even think about going to a traveler's clinic or asking, even when I was in medical school, "What can I do to prevent this and what can I do if I get it?" So talk about how you help people prepare for wherever they might be going.

Terri: What we offer in our travel clinic is a combination of things from pre-travel consult to post-travel consults if people come back sick. So in a pre-travel consult, we'll review a patient's medical history, their medications, what activities they plan to do abroad, look at their vaccine history and make recommendations on vaccines, make recommendations on malaria prophylaxis, certain activities to avoid. And also, we give them information on where to receive medical help abroad ... [and] our travel clinic is also one of the GeoSentinel sites.

We're one of 60 travel clinics around the world that collects data on return travelers, and we submit that information to the CDC to help them know when a new arising disease is occurring. And our site is unique in the sense that we've got the most number of long-term expatriate travelers coming back to our clinic. And that would include the LDS missionaries returning. Whereas a site from Kathmandu, for example, would mostly be seeing travelers coming into their clinic from out of the country for acute problems.

Dr. Jones: I think that as traveling species who goes places, we want to be well when we get there. And whether we're going for social reasons, or emotional reasons, or for whatever reason, we want to be well over there. We do want to be sick while we're there. We don't want to be sick when we get back.

Terri: So for the person that does travel abroad and comes back with any kind of unique symptoms, specifically a fever or chills, I would strongly encourage them to see a travel medicine expert, whether it's at the University of Utah or abroad.

There is a organization called ISTM, which stands for the International Society of Tropical Medicine, and they list all travel medicine providers. And this is important because if somebody with a fever goes into maybe the urgent care, or the ER, or primary care doc, and they don't tell them that they've been traveling, they might get diagnosed with a viral infection where they could have malaria, for example, which can be deadly.

There are internet brides, people that might meet through an agency where they connect people, or there are people who want to be a Facebook friend that you don't know, and then you hook up through Facebook and you want to see them.

Terri: So a couple years ago, one of our travel nurses noticed that a lot of the patients coming in for pre-travel consultation actually going to visit their internet fiancés [...] We realized that out of about, 4,000, we found probably about 40 people that were traveling to visit internet fiancés and about half were women, half were men.

And so we collected data on where they were going, how long they were staying for, and where they were traveling to meet these fiancés and realized that this was a special population that was at higher risk for problems than other travelers.

Women were usually single, they had never been married, and they were usually traveling to Africa. So we wanted to make sure we spoke to them about protecting themselves against STIs or unprotected pregnancies, being a victim of assault or victims of fraud.

Dr. Jones: The thought of traveling to meet your fiancé sounds... to me, that sounds a little risky, and you've confirmed that.

Terri: We felt like it was more risky for the women traveling because they would usually have open-ended itinerary and plan to stay with their future husband and the family of the husband, whereas the men that were traveling planned a closed-end trip with the intent to bring the bride back to United States and get married here. And that seemed safer.

Dr. Jones: Did you find out of those who went, how many came back with a bride or a groom?

Terri: We didn't do follow-up on them, but we did find though that some of the brides and grooms that would come back would leave their new partner at a certain timeframe, and that was usually related to once they got their green card at 3 months, they would leave their new partner, or after 2 years once they got residency, or even after 10 years when they got their citizenship.

Dr. Jones: That's only just slightly illegal.

I've been watching the news and seeing all these spring break parties, particularly in Mexico and Miami, with young people who were going places that they can go during the COVID pandemic. But they all go out there and nobody is in their tiny bikini with a mask that's bigger than their bikini. They're drinking stuff that makes them have bad judgment, and there they are in a super spreader event.

Dr. Jones: Have you been making any conversations with people about going during the COVID epidemic?

Terri: We are seeing an increase in our pre-travel consults for travel abroad. People have been anxious to get traveling again. We will look up a patient's travel destination and see that actually the CDC and the World Health Organization are commonly advising travelers not to go to these destinations unless it's deemed necessary. So a spring break to Mexico isn't deemed necessary [but] the country of Mexico has no regulations for travelers coming in right now.

But something to think about for everyone traveling is that when we travel from high-resource country to a low-resource country, we could be bringing the COVID disease to that area. We could be bringing a resistant strain. And they're resource-poor countries. They might not be able to accommodate or treat you appropriately. They might not be able to treat the locals if you get them sick. So we could be putting a burden on those local communities.

For me and for many people, we haven't seen our families. I have a real emotional need. I want to see my family. And people say it's not necessary, but it's necessary. I'm getting old. I might not see them again, and I just want to see them. Luckily, they all live in the United States. But for people who have family overseas, that's been a real burden for folks not to be able to go visit. That's part of the emotional domain. They feel cut off from their family.

Terri: I've been seeing that also. People do want to travel to see their family, whether it's just to see them to reconnect or for a special event, whether it's a graduation, retirement, birth of a new child. I think it's important for our mental health too to be able to connect with their family.

Dr. Jones: And funerals. I think having had a number of friends whose parents have died from COVID, but they can't have the kind of in-person funeral. A funeral is a gathering of souls and of bodies, and to be emotional together, and tell funny stories. And Zoom just doesn't cut it.

I'm thinking about people who travel for financial reasons in the sense of the financial domain. Some people travel because it's required for their work. All the traveling that I did growing up was because my father would get a job and we would just move to another country or another place. And there are people called road warriors.

Terri: I would call myself one of them.

Dr. Jones: Oh, you're a road warrior? Do you travel for work?

Terri: I travel for work and for fun [...] Another factor with the low-budget traveler historically is a little bit higher risk for infections because they are usually traveling similar to the locals where they could be on the bus, they could be staying at lower-end hotels, or be camping. So we have different education for that traveler versus someone who's going to an all-inclusive resort and having everything paid for and high-end food.

Dr. Jones: Well, I have to say that I have a fondness for street food wherever I travel, whether it's Asia or South America. I think the very best food is when you're on your feet walking through a town and you get street food. And I understand the risks involved in eating street food.

Terri: I used to eat street food. In Costa Rica, I lived with a family, ate whatever they prepared. But like I said earlier, I did get sick from that. And eating from street food, you have to just realize that the vendors usually don't have access to running water and food. Their plates that they're serving you on might not be clean. So it's a great place to get Hepatitis A and typhoid.

Dr. Jones: And amoebas.

Terri: And amoebas, yes. But if you don't eat the local food, then you're not necessarily engaging in the culture as you'd like to. So it's a hard call.

Thinking about engaging in the culture brings us to the intellectual domain. Many people travel. When I talked about when we stood up and we looked around and we are very curious as a species, we want to learn something new. And going someplace to learn something new, or see some new geography and learn about it. But when you're going someplace new, you have to learn something about the culture and there are things that you probably ought to know before you arrive.

Dr. Jones: Do you help people with some cultural awareness or give them some places to go that they can start reading about behaviors that are inappropriate?

Terri: We used to give out a handout from an organization called CultureGrams, and that would list every country and different social norms, the dos and don'ts. I don't believe we give that anymore, but that I thought was invaluable information. I personally learned in Costa Rica, for example, that if a woman goes to the bar, sits at a bar seat by herself, that means she's a prostitute.

Dr. Jones: Oh, good. That's good to know.

Terri: Yeah. And I unfortunately sat at a bar once. Or if you spend time with a single male alone that that means that you're interested in them, or that...

Dr. Jones: Looking for business.

Terri: Looking for business. So it was things like that. CultureGrams would also discussed that if you were a guest in someone's home, what would be appropriate to bring or not to bring? Or, for example, if you were going to Asia, they don't recommend sitting with your feet facing someone.

Terri: We also hand out a travel book that we've created at the University. And the very last page, it has essentially 10 recommendations on how to be a gracious visitor to that country. And that does include trying to reduce your environmental impact there.

So for people who are going to go on backpacking or trekking, sometimes they'll think that they can just buy all the water they need and then just toss the plastic bottle somewhere. But a lot of countries with poor resources don't have the ability to discard that plastic. And when you go on treks, whether it's Machu Picchu, you will see a lot of garbage that trekkers have left behind.

International travel often, in fact, it always has a significant environmental impact because of whatever method you used to get there, whether it's planes or trains, which have a big environmental impact. And then, of course, the stuff you carry and the stuff you leave behind in environmentally sensitive places. I think of the Galapagos as being a very popular place to visit, but we've made significant inroads, unfortunately, into the quality of the environment for the animals there.

Terri: And also, traveling to communities that haven't seen many people from the outside also affects the culture and the community.

Dr. Jones: Yes. We were traveling in Indonesia to some islands that had not seen any white people, Caucasian-Europeans, since maybe World War II. And some people in dugouts came out to the ship that we were on, and they had leprosy. So leprosy was still active in that community. And our ship's doc said although we weren't likely to get leprosy, he wouldn't let us off the boat. And they were very curious and, of course, we were all very curious, but we didn't want to do anything to harm them or for them to harm us.

So we bring our diseases with us and we pick up some from where we go. I think that's important in terms of our health.

I think of the Santiago as a long walking trip in Europe for people who take this walk, and there are spiritual conversations and churches along the way. For many people, a spiritual journey is a walking journey. People who traveled into the desert, and we think of our great prophets who walked into the desert to have insight into themselves. And of course, our very own culture has many examples of that.

People are looking to fulfill a spiritual mission or they're looking perhaps for spiritual enlightenment, and the very nature of just walking ends up being a spiritual practice. So people may travel either short distances or long distances in physical space to make some travel in emotional and spiritual space.

Terri: I don't know where this fits in, but including myself, I enjoy traveling for high adventure sports. For some people, that's a religion. To go rock climbing, ice climbing, skiing, mountaineering, scuba diving in places around the world is a form of religion in my mind.

Dr. Jones: I think so, and they're looking for a very... they do something that's very hard. Any time we do something that's very hard, it's transformative. And some people go to climb big mountains is what I think of. Climbing big mountains becomes a religious experience because it takes you out of the quotidian, the ordinariness of your day. And if you can't build it into your daily life where you are... I think of Emily Dickinson, who never traveled, or Thoreau, who said you didn't need to travel and you could get all of your inner work done where you are. But for many people, that's not quite what they're looking for and they do their inner work by doing some outer work.

Terri: I agree with that. I've traveled to some of the bigger mountain ranges around the world, and for those that don't travel, they don't understand why I would need to go see Everest or go see the Andes when I've got my own mountains in United States. So it's a hard question to answer.

Dr. Jones: I think it's a matter of phrasing what your heart... helping other people understand what your heart wants and why this is actually something that's very powerful for you.

All senses turned up
Travel with your feet and heart
To see something new

Interviewer: Parasites that spike in the summer, how to identify them so you can avoid being infected. We'll examine that next on The Scope.

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Interviewer: There's generally an uptick in parasite-related illnesses in the summertime and the question is where are they hanging out and what can you do to make sure one doesn't hop on board and try to get a free lunch from you? Kristen Case is from ARUP laboratories, which is one of the countries top labs that specialize in identifying parasites so doctors know how to treat them. Kristen, first of all, what makes an organism a parasite exactly?

Kristen: A parasite is an organism that has part of its life cycle eating or living off of another organism.

Interviewer: All right. So it doesn't have to live there all the time, just part of the time?

Kristen: Yeah, at least part of its life cycle. The word "parasite" actually has Latin and Greek bases. It means eating at another's table. "Para," meaning alongside and, "sitos," meaning food.

Interviewer: Oh, so I'm a table for this organism, essentially.

Kristen: Yes, you are its meal ticket.

Interviewer: All right. Why do you see a spike in the lab for parasites in the summertime? What causes that?

Kristen: Most of the time it's human behaviors changing. We're outside more. We're hiking. We're drinking from streams. We're swimming in pools, barbecuing, traveling, and all of those things just make it easier for a parasite to hop on board.

Interviewer: Sure. That's kind of where they're hanging out a little bit more. We are where they are more often in the summer time.

Kristen: Yes.

Interviewer: Got you. So I think you've already covered some of the common summer activities where you should be concerned about parasites, and it sounds like things we all do, swimming, camping, hiking, going to a barbecue, travel, and that sort of stuff. So let's talk about the different types of parasites you can get from those different scenarios, like swimming, for example. What's lurking in that pool water?

Kristen: The most common parasite that's associated with pools is a parasite called cryptosporidium.

Interviewer: I've heard of that one.

Kristen: Yes, so crypto, a lot of people say it like that as well. It forms . . . imagine a round ball and it forms this very thick encasing around itself. It's actually chlorine resistant so the chlorine in the pool won't kill this organism. Cryptosporidium can live in a chlorinated pool for up to 10 days. So if a person who's infected with this organism or this parasite swims in the pool and then some of the organism sheds into that pool water, it could be ingested by another human being and make them really sick.

Interviewer: Yeah, because normally at the pool it's the chlorine that kills. So what kills these things? How do I know I'm not going to get one at the pool?

Kristen: Actually, there are other treatments. So if we can get a little gross, when someone poops in the pool, they have to have everyone come out and there are some other water treatment solutions that they do to try and get rid of this organism.

Interviewer: Of course, from the news, I know good enough that if I have kids and they have had some sort of intestinal issues, diarrhea or whatever, keep them away from the pool for a couple of weeks.

Kristen: Yes. I'm glad that public service announcement is working.

Interviewer: No, I heard about that. All right. So is that really something that people should be freaked out about or just aware of?

Kristen: Be aware of it. It occurs in outbreaks usually. We'll have years and years of when it's not a problem. Then, when there is an outbreak situation, that's when we need to be aware. Like we were talking about earlier, there are public service announcements usually.

Interviewer: So awareness is really your best defense against that. If it's starting to happen again, maybe stay away from the pool for a little while until it goes away. How about camping and hiking? What parasites are out in nature?

Kristen: The most common parasite in Utah is probably giardia because it can be in fresh water sources, streams, rivers, lakes, and it has wild animal hosts like raccoons, possibly. If their stool gets into the water, it's contaminated.

Interviewer: I've heard deer.

Kirsten: I think so.

Interviewer: Same thing as well. What exactly is giardia going to do to me?

Kristen: Giardia will give you a lot of intestinal symptoms.

Interviewer: And why is that? What is it doing?

Kristen: Giardia attaches to your intestinal wall and does some damage while it's getting its meal from you.

Interviewer: To avoid giardia, is just making sure you don't drink stream water enough or using iodine pills?

Kristen: Yeah, if you avoid drinking stream water, don't let your dogs drink the stream water either. Filter your water, boil it.

Interviewer: What about going to a barbecue? There are parasites even there.

Kristen: Overall, the food in the United States if pretty safe, but it is a possibility to get a tapeworm from undercooked meat such as steak, beef, pork, and even fish. So if the meat has the tapeworm in it, if the animal has been infected by the tapeworm and we consume that meat undercooked or raw, then we could get a tapeworm.

Interviewer: All right. How often does that happen? How many tapeworms do you see?

Kristen: In the lab, we see at least a couple a month. A lot of times, the people could have some travel history outside the United States and sometimes they're here in the United States, no travel history really. The most common one we see is diphyllobothrium latum. That's the fish tapeworm so eating undercooked fish. So for the sushi lovers, make sure you're going to reputable sushi restaurants. They should be using really nice, parasite-free fish.

Interviewer: And check your meat when you go to that barbecue to make sure it's cooked properly.

Kristen: Yes.

Interviewer: And traveling to other countries is a way to pick up a parasite as well.

Kristen: If you travel to another country or even here in the United States, there is potential for picking up a parasite. For example, in the eastern United States, there are a lot more ticks than there are here in Utah and there are tick-borne diseases: Rocky Mountain spotted fever, Lyme disease, many other diseases that the tick could potentially carry and transmit to a human.

Interviewer: So far, this is the first parasite that lives on the outside of you that we've talked about.

Kristen: Yeah, it does take a blood meal from another animal and so that's why we consider it a parasite as well if that's part if it's lifecycle is getting that blood meal. In the process of getting that blood meal, it can transmit viruses, bacteria that make humans really sick.

Interviewer: All right. And what are my best defenses against that?

Kristen: When you're out in the wilderness, especially in really green, lush areas, make sure that you're wearing insect repellent with 20 to 30% DEET. That will kill the ticks.

Interviewer: It keeps another parasite away.

Kristen: Mosquito as well, yeah.

Interviewer: And long sleeve, I'd imagine. And tuck in your pants.

Kristen: Yeah, and tuck in your pants, whenever you can, into your socks.

Interviewer: Keep them on the outside of you, away from your skin.

Kristen: Whenever you do get home, shower as soon as you can. Check your body for ticks. If you're able to see a tick that's attached to you and remove it within 24 hours, the likelihood of it transmitting diseases to you is actually reduced.

Interviewer: Oh, really? So that's good. So check your hair and check your back. Check for those ticks.

Kristen: Yes.

Interviewer: Overall, you've given us some parasites that we are more likely to come in contact with in the summertime. I don't want to freak people out. Should they be freaked out?

Kristen: Well, at ARUP, we get to see a lot of interesting parasites because we're receiving specimens from all over the United States. Some of those people have a travel history outside of the United States. Some of them don't. So it is possible, but really, the likelihood is not that great. So, have fun. Use pools. Splash around. Enjoy your summer, but just know that there is some risk out there.

Interviewer: Yeah, just be cognizant that it is out there.

Kristen: Yes.
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Announcer: Access to our experts with in depth information about the biggest health issues facing you today. The specialists with Scot is on The Scope.

Scot: Dr. Miller, you told me that one of the questions you get around this time of the year is people wanting to get an antibiotic because they are going to be doing some traveling and they are afraid that they are going to go to some country and then get a bug that's going to cause diarrhea. Is that something that you can even do?

Dr. Miller: I get that question quite frequently. People will come in and they'll say, "I'm going on a trip and I just want to make sure that when I go to this new country, I might get diarrhea. Should I start an antibiotic to prevent getting diarrhea?"

Scot: They want to do something to prevent it?

Dr. Miller: They do, and the reality is taking antibiotics can cause far worse side effects than you might even ever get from traveler's diarrhea.

Scot: I think that's hard for people to understand because it's like . . .

Dr. Miller: Well, we've got into the notion that antibiotics, there's no downside to taking them, that there's no side effects from antibiotics. That's just simply not true. The issue is using an antibiotic when you need it, not as a prophylaxis or preventative, especially when you're going traveling.

Scot: Some of those downsides from what I understand is it can mess up your gut flora and fauna in some instances.

Dr. Miller: Yeah, one of most common things we're dealing with now is C. difficile colitis, which is an awful antibiotic induced diarrhea that is very, very difficult to treat.

Scot: Wouldn't that be ironic? They want to take it to prevent diarrhea . . .

Dr. Miller: Sometimes when they take antibiotics, they actually come back with the C. difficile colitis and it's not traveler's diarrhea. They've self-induced the problem and so after diagnostics, you figure out, "Oh, my gosh. This was induced by the antibiotic that they took to prevent traveler's diarrhea," not a good situation.

Scot:Taking it before, not a good idea. What about having it with you, when you do travel, if you do get something?

Dr. Miller: Right, so that's another issue entirely. It depends on where you're going. If you're going to a third world country and you're going to be out of major urban areas and in the rural areas, probably having antibiotics prescribed by a physician that you can keep with you and understand that when you develop symptoms consistent with traveler's diarrhea, you begin to take those antibiotics. That does make sense. However, people will also request antibiotics when going to other first world countries. That's probably not necessary, unless you're in certain situations where water is unclean, but most major cities of Europe and Asia have clean water supplies and it's not an issue. Also tourists are also in the habit of buying bottled water now.

Scot: I'd heard that . . . I went to Cancun one time and I was under the impression that I should not drink the tap water there, to drink bottled water there. How would I know if where I'm going is some place that's safe or not?

Dr. Miller: That's a really good question. One of the things people can do is get on to the CDC website for travelers and look up the information about particular countries. In addition, we have a travelers clinic here at the University of Utah that can advise people on what are the correct situations under which you might want to begin taking antibiotics if you develop certain symptoms, and also in which countries you'd want to be concerned about the safety of the water supply.

Scot: It sounds like bottom line, taking antibiotics as a precautionary measure - bad idea, could actually cause worse problems, anything that it prevents.

Dr. Miller: No question about that. Yeah, absolutely. There are some things that people can do also to cut back on the risk of developing antibiotic or excuse me traveler's diarrhea, which is caused by certain strands of bacteria. Those would be making sure that the food you eat is cooked, not eating raw vegetables in areas where the water supply in question. If you're in rural areas and have the ability to purify water, you can bring now very simple water purification kits and you can use those, they're very effective. I've been camping in the back country for years and years and years and never have had a problem when I use water purification tools.

Scot: You can take those with the iodine tablets if you really need to use any of that kind of stuff?

Dr. Miller: Iodine tablets, if used correctly, you can take purification filters. They're now very small and pack easily in a backpack or a suitcase. Again, it's important to know where you're going and also to be aware of the situations you're going to be in where you're eating and the environment that you're in. That is probably more important than anything.

Scot: That knowledge of knowing what's going on.

Dr. Miller: Right. So keeping the antibiotics as a backup if you need them. That's the best.

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Dr. Miller: You're traveling and you find yourself in an emergency room in a different city, how can you get access to your medical records from your doctor where you live? This is Dr. Tom Miller and I'm going to talk about that next.

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Dr. Miller: Hi, I'm here with Dr. Mike Strong, Mike is the Chief Medical Informatics Officer for the University of Utah. Mike what about when you're in another city, you get sick, you need care, how can you get access to your doctor's records?

Dr. Strong: There's a couple of different ways that that's done. Some are easy; some are a little more difficult. If the hospital that you're visiting happens to be on the same electronic medical records system, so for example here at the University of Utah, we partner with a company called Epic that makes our electronic medical record. Many, many hospitals throughout the country are on Epic as well. If you're at a hospital that has Epic then they have instant access, they can see the whole record. They can see everything that they need to see. If you're at a hospital that has a different electronic medical record, then we do have ways of sending that information over the Internet.

Dr. Miller: This is far advanced compared to the time when we had paper charts in offices, it would be literally impossible to get that information.

Dr. Strong: Oh yeah. In the days of paper records you'd have to fax information. That would take, you know, someone having to go down, actually find the chart, figure out what part of the chart to send, then fax it.

Dr. Miller: So let's say I'm in Hawaii. I go swimming, I get stung by a big jellyfish and then I feel miserable. So I end up at the local ED. How do they get hold of my record? What do I need to tell them?

Dr. Strong: So you just need to tell them what hospital you're cared at. They can contact us; find out what system we're on.

Dr. Miller: So they could contact University of Utah at any time?

Dr. Strong: Any time. Our medical records people can send that information electronically to them if they also have a system that can accept it.

Dr. Miller: Would there be a number that our patients could use? A phone number or an email address that they could contact?

Dr. Strong: They would just call the hospital operator, our general number, and ask for the medical records department who could help facilitate that.

Dr. Miller: Our general number is 801-581-2121, and they could ask for the medical records department. That's staffed 24/7 right?

Dr. Strong: Absolutely. The other nice thing is that our electronic medical record has a patient portal, and that actually is available just through a smartphone app. Now admittedly that doesn't have the entire medical record but it has...

Dr. Miller: That's great. It has pertinent things in it doesn't it?

Dr. Strong: ...oh it has some very pertinent things. So it has their medication list, it has their allergies. It has their problem list.

Dr. Miller: Problem list.

Dr. Strong: All of those things are right available just on their smartphone, and they could just show that to the physician where they were.

Dr. Miller: So when they're in the ED the one they could do... they could either pull it up on their app if they have an app.

Dr. Strong: Yep.

Dr. Miller: And I'll ask you how they'll obtain that app in a minute. But they could also pull up their Mychart site, which is their portal into the medical record for the physician in the clinic, by typing into the Internet.

Dr. Strong: Absolutely. That'd be an easy way to do it. And that would give that physician a ton of valuable and important information.

Dr. Miller: And how does the patient sign up for either the app or the portal?

Dr. Strong: So, any time a patient comes to one of our clinics, all they have to do is say that they want to be signed up. We give them an activation code, and they go online or they go to the app store and download the app. Put in the activation code, that's it.

Dr. Miller: Would there be a way for a patient travelling in a foreign country, you know, China maybe, Taiwan, some place like that, to have a file, like a PDF file on a flash drive?

Dr. Strong: Yeah. If they were traveling and they wanted to carry important parts of their medical record. All they would have to do is come into the Health Information Department, and they could get a copy of their medical record, and put it onto a flash drive and carry that with them.

Dr. Miller: Now let's turn it around a little bit. Let's say that I'm in another city and I end up needing some x-rays. Maybe I have pneumonia and I see somebody and they have chest x-rays. I end up back home, would the facility that had the x-rays done, would they be able to send those to our facility electronically? How does that work?

Dr. Strong: They do. We actually have system here SeeMyRadiology. It's a service that we subscribe to that allows us to hook into almost any other facility and have them send us the images digitally.

Dr. Miller: How would that occur? What does the patient need to do? Does the patient need to do anything or is the doctor just able to get online and do that when the patient is in clinic with them?

Dr. Strong: Actually our radiology department helps facilitate that, so it's just like any kind of a records request. They will contact that institution where the x-rays were done and make a request.

Dr. Miller: Where could there be a breakdown in all of this for either the patient or the physician?

Dr. Strong: Well right now the biggest area is a breakdown...there are a variety of different electronic medical record vendors. And right now...

Dr. Miller: It's like railroads in the old days they had different gauge railways and they're all sort of operating on their own platforms and they don't all talk to each other.

Dr. Strong: Exactly and they don't all talk to each other. And so that's where some of the difficulty comes. The good news is that the federal government has mandated that every single vendor develop the capability of communicating with any other vendor. And, you know we're a few years away from having that totally implemented throughout the country, but it's coming.

Dr. Miller: So one, it sounds to me like most of the patients that are being seen here, all of the patients that are being seen here should sign up for the portal entry into the electronic medical records. So if they're traveling they can pull up very significant parts of their medical history, which would include allergies, and drugs, and problem lists for physicians to look at if that needs to happen. And they can do that online, in the emergency department, or doctor's office, wherever they are. That's one. And then secondly they can also have an app put on their smartphone to get into the portal as well.

Dr. Strong: Absolutely. It's really very easy.

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Interviewer: How does Ebola change your travel plans? We'll examine that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're speaking with Dr. Sankar Swaminathan. He's the Chief of Infectious Disease Division here at the University of Utah. And if you have travel plans, now you are thinking about Ebola. Does that change your travel plans, or is there something you can do?

Dr. Swaminathan: We have our travel clinic here at the University of Utah Hospital. At the Medical Center here we provide services both to people who are returning from abroad as well as people who are preparing to go abroad.
Now regardless of the current outbreak, the Ebola outbreak, there are a variety of other transmissible infectious diseases that one could pick up abroad. So we encourage anyone who's planning to travel to visit a qualified clinic or provider who can give that traveler the right advice as to what to do to keep themselves healthy, and also importantly provide them with medications that they may need to take as a preventative measure or a prophylactic medication. There may be medications that they need to just take if they get sick while there that they could carry with them.
And finally and probably just as important as anything else is having all the immunizations necessary. Now, depending on where you're going, you may need some immunizations that you may not need even in the United States. This gets very complicated, and it's a rapidly changing field, even on a weekly basis, as emerging infections crop up in places. There may be precautions that you need to take that you might not have had to take the last time.
So we provide this service not only to individuals but to groups that are traveling, for example, student groups or humanitarian aid workers. We can counsel them, give them their immunizations, give them a travel booklet and this kind of thing. We're all set up to do that.

Interviewer: So when you're getting ready for a trip, it's always very difficult to get all the things done that you need to get done. And I don't know that traveling out of the country I've ever done this before.

Dr. Swaminathan: Like you said, there's a lot of things that come up that you have to do, get your passport, this, that, and the other, but this is probably something that you should make time to do. You don't want your vacation of a lifetime ruined by this nor do you want a serious illness that's preventable. It's also in this current situation where there are so many serious threats that seem to be arising, emerging. It's important to at least prevent the ones that we can prevent.
If you come back with a fever, it rapidly becomes a potentially serious situation where many, many things have to be ruled out. The more you can help keep that from happening by preventing those preventable things, like malaria. Much of malaria is preventable. There are many other illnesses that you can get, as I said, immunization for, prophylactic medicines for. It's well worth your time.

If not here at the University of Utah, at state public health clinics, and so on. They also provide travel counseling and immunization. We work with several of these municipal health clinics, and we provide them consultation. We have physicians who are specifically expert in travel. Some who have lived in places like Bangladesh and have traveled abroad to various parts of Africa, for example.

So if you have something that you've acquired abroad, we've probably seen it. At least, one of our physicians has had some experience with it.

Interviewer: So if I'm traveling out of the country, regardless of where I'm going, I should probably stop by one of these clinics.

Dr. Swaminathan: Absolutely.

Interviewer: And if I've returned and I'm getting some symptoms of I'm getting sick, don't just blow it off as a cold or something like that, go see one of these clinics.

Dr. Swaminathan: That's right. We can provide very rapid appointments for people who are returning from travel, generally, within a day or two. If you call, we can also have one of our physicians call you back to discuss what the issues might be as well, and see how urgently you should be seen. And they can often just provide reassurance, if nothing else, when you've returned from abroad.

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Today we are talking about first aid kits. You may think of a first aid kit, you go online you buy something and it has all kinds of different things ranging from band-aids to Benadryl, to different creams and all these sorts of things. Tell you what, when I travel I don't carry any of those things. I figure a lot of things I can just buy in a pharmacy. If I need cold medicine I can go buy it. If I need Tylenol or Benadryl I can go buy it.

There are three things that I found as an emergency physician are potentially essential to keep you out of the ER. There are some reports out there, and I've talked to some people, who talk about ten hour waits in the waiting room. That is the absolute last thing you want to do over the holidays. So there are three things I carry. I'm going to tell you what those are. These may be a little surprising for you.
Item #1 to Include in Your Travel First Aid Kit: Antibiotic

The first I carry is ciprofloxacin. This is an antibiotic. You're going to need a prescription for it. You're going to need to talk to your doctor. But I will tell you why this can keep you out of the ER. If you have family members, and it's particularly females who may be more prone to urinary tract infections. That's just a horrible thing for a person to go through. You feel miserable and you need treatment.

I find when someone comes to the ER, particularly females, and they tell me, hey I feel like I have a urinary tract infection, they are right 89% of the time. The only reason they are in the E.R. is because they know they need an antibiotic. If you can just get a prescription and have a few pills of ciprofloxacin, just a simple antibiotic or if there is another antibiotic that has worked for you in the past. As long as you have a few of those pills available you can save your self an incredible amount of headache and a trip to the ER.
Item #2 to Include in Your Travel First Aid Kit: Anti-nausea Medication

The second thing I carry is an anti-nausea medication called Ondansetron. The generic name is Zofran. It's a generic medication now. It's very cheap. Again, you have to have a prescription for it. The absolute last thing you want to do, let's say you are traveling, you are in a hotel, you're feeling miserable you're vomiting, just imagine trying to get everything together, get a cab, get down to an ER, sit in a waiting room for six hours just to get back in a room, get and IV in, get some fluids and then get that same medication in an IV. That is what you're going to get. If you can just have a tablet or two of Ondansetron, again the brand name is Zofran. It is a generic. It's very cheap. If you can just have that in your travel kit, you can save yourself and incredible amount of headache. A lot of studies out there have shone that if you can just keep the pill down and drink some fluids you don't need an IV.
Item #3 to Include in Your Travel First Aid Kit: Superglue

The last thing I carry is going to sound a little bit strange but this will save you a whole lot of trouble and that is superglue. I actually take the medical form of superglue that we use for lacerations is almost the same thing as over the counter superglue. The medical form of superglue has a little bit of a chemical mixture that makes it so it burns less and irritates the skin a little less. You can even buy that online. You can find it under the brand name Derma Bond. The reason I carry this is because the third reason you don't want to have to go to the ER is for a laceration. Say you have a glass in your hand or something. It falls and breaks. You go to pick it up and a piece of glass cuts your hand. It's a simple thing that otherwise you would just put a band aid on.

You're thinking okay my tendons are all working fine. This isn't a dirty wound. I don't have a lot of stuff in there where I am concerned about tetanus or anything like that. You try to put a band-aid on or bring it together and it's just not going to work. You also want to make sure it's not a cosmetic concern. There is nothing on your face or anything like that. You are just thinking I need something to hold this wound together. Superglue will do the trick. The way you put it on is just hold the wound together, put a little bit across it, that's going to hold it in place. Then you can add a little bit more to hold that wound together. You don't want to get a lot of it in the wound. The biggest risk here is a little bit of skin irritation. It may burn a little bit. It's going to do the trick. It's going to fall off after about a week. The wound is going to heal up under that and should do just fine.

Anyway, these are my tips. I'll be honest here I am going a little bit rogue. You are not going to hear every doctor talk about these sorts of things. From my experience as an emergency physician I find pretty much everything else I can go out and by at a pharmacy if I need it. These are the things that are going to keep me out of the ER. Help me to avoid that ten hour wait or whatever I might be facing wherever I am and make life a little bit easier while I am traveling.

updated: December 9, 2022
originally published: December 23, 2013