E73: The Physical Domain of Exploring

Katie: Welcome back to the "7 Domains of Women's Health." Today, we're starting a new series on exploring. This is where we're going to tackle life's big questions, like, "Why climb Mount Everest?" or "Why did I sign up for that 6:00 a.m. yoga class?" Whether you're reaching the summit or finally touching your toes, exploring starts with an important mix of curiosity, asking, "I wonder if I could," perseverance whispering, "Just five more minutes," and self-transcendence shouting, "I did it."

I'm Katie Ward. I'm an inveterate explorer, and a professor at the College of Nursing at the University of Utah, and a nurse practitioner in women's health.

When we think of exploring, physically going somewhere is what usually comes to mind. But we're going to think about exploring in a bigger way and as far as taking your first steps into any new territory.

So with me today is my co-host and pioneer of this podcast, Dr. Kirtly Jones. Dr. Jones has been blazing trails in reproductive medicine and charting courses for countless medical students for a whole career.

Kirtly, will you tell us about your exploring background?

Kirtly: That was a lovely introduction, and yes. Well, I was born in Germany. My father was there on a Fulbright scholarship, and I think they were either going to go take the scholarship or have a baby, and they did both.

And then I spoke Spanish before I spoke English from my very early years in a mining town in Mexico, and moved every two to four years around the country and then all around the world and explored with my geologist father. Then after that, it was all about biology and medicine, the greatest continuing exploration for the rest of my life so far.

So I have loved exploring about exploring for this new "7 Domains." Are you a neophile? Do you just love trying out new things in new places? Are you a neophobe? Just give you the same toast and tea for breakfast each morning and are happy with your regular routines. A little shy about new things and places? Are you a neophiliac, going maybe a little too far afield for your own good health?

Well, today in the Virtual Scope studio, we are talking with an expert in travel from the physical domain. Terri Sofarelli shared with us some of her advice and her own adventures when we did the 7 Domains of Travel. You can work the magic of your search engine and just plug in "7 Domains of Travel," and it will take you to Episode 15 of our podcast on the "7 Domains of Women's Health."

Kirtly: Welcome back, Terri.

Terri: Thank you for having me back. It's good to see both of you.

Katie: And true confessions here, Terri, Kirtly, and I worked together at Planned Parenthood 25 years ago. And although our careers have gone in different directions, we're all pretty excited to get to still work together on this podcast.

Terri is a bilingual physician assistant. She works at the University of Utah in the inpatient infectious disease consulting team and then also in the outpatient tropical and travel medicine team. She's been a Peace Corps volunteer in Costa Rica, where her focus was teaching environmental education in schools.

Terri, welcome. It's great to get to work with you again. Tell us about how you like to explore.

Terri: So travel and adventure are near and dear to my heart. I feel like I've been exploring since I was a kid in the woods behind my house. And then when I saw an aerial photo of Boulder, Colorado, when I was 17, I knew I had to go to school there sight unseen.

And then at 21, when graduation was approaching and student loans were coming due, I learned about the Peace Corps and served two years down there in Costa Rica. And I've been traveling and exploring and having adventures ever since.

I even actually came up with an acronym for this sense of love and need for experiences. And I coined it NEED, which stands for "new experience every day."

Kirtly: Oh, yeah. That's great.

Terri: The only inclusion criteria is you just need to know about it, and you are in the club.

Katie: Yay.

Terri: Yeah. And that can be anything from a scary outdoor adventure like a long endurance run, climbing a big peak, to walking your dog a different way around the park, trying a new food. So it doesn't have to be life-threatening, but it's just a way of looking at things and keeping the newness and experience.

Kirtly: It's life engaging. That's the magic part of it.

Katie: I like that. Can we borrow that for the rest of the episodes?

Terri: You can.

Katie: I'll just refer back to your NEED.

Well, what I wanted to do is through the physical . . . We're going to concentrate on the physical domain of exploring. And so I wanted to start a little bit with some of the benefits of exploring.

Kirtly: Well, the physical benefits of exploring new places, physical activity, new smells, new sights, new tastes, hopefully without new bacteria, is what we are hardwired for.

We explore from time to time since we started to crawl. And then, as little babies, we loved exploring. New things wire our brain for a little dopamine hit. This is hardwired. We get a little dopamine hit with something that might be a little bit new, and it makes us excited and engaged. And the physical part of exploring improves our strength and our cardiovascular system.

There are also characteristics of true explorers that enhance our longevity and our psychological health, and Katie touched on that at the beginning. That is true explorers have not only curiosity, which is part of who we are as a species, but they have persistence and self-transcendence, working hard at it and going beyond yourself. You put these together, and you're building the foundation for a longer and more engaged life.

So that's my take on putting together the biological enhancement by dopamine, the persistence that you get physically that makes you stronger, and self-transcendence, which makes life worth living.

Katie: Awesome. So, Terri, it sounds like you do a lot of really intense outdoor activities. How do you get in shape for that?

Terri: Yes, like you said, I do engage in a lot of different outdoor activities, and depending on what the sport is or the adventure, I train accordingly. So if I'm going to go do a high alpine rock climb, I will go to the gym a couple of times a week for weeks beforehand. I'll do cross-training. If I'm going to altitude, I'll go sleep up at altitude to get myself ready for the altitude.

If I'm going to do a long-distance run, I will just run continuously every week, every month, as much as I can. I'll try to engage other friends to go with me.

If I'm going on a big ski trip, I'll take a ski class beforehand to get myself ready for that.

I recently did an open-water swim down in the Virgin Islands, and so I was swimming beforehand to try to re-create that scenario, but I didn't anticipate the dense salt water that caused abrasions up against the bathing suit or the saltwater pouring into the goggles.

But yeah, I think that the training piece is critical beforehand because I think it's easy to sign up for an adventure, a race, a run, but it's hard to actually do the training beforehand. But it's worth it. You'll have a better experience once you're there.

Katie: Yeah, I almost think that training is really where the physical change happens. The goal is the thing that motivates me, but it's the training that actually gets me in shape for something.

Terri: Yeah, and I think engaging friends to do that with you is also helpful for exercising, making you accountable. If you have someone who's doing the activity with you, they'll train with you.

Katie: Yeah, it's a big motivator, I think. I think that exploration, whether it's something physical and tough like you're doing or just deciding to take up a new craft and taking up knitting or something, there is a bit of background research that needs to go into it and a little bit of a thought about what's it going to take, what's the physical investment, what's the financial investment, what's the space. So yeah, any time you're going to take up something new, you've got to give it a little thought. Who are your friends that can go with you?

And I don't want to confine our exploring to just traveling, but often, that's exploring that we do a lot. So I do want to talk a little bit about how we move around the world and how that's maybe changed a little bit since COVID. Maybe you can just share with us a little about what you do when you're helping people prepare for exploring a new place in the world.

Terri: Ideally, before someone does travel internationally, they do make an appointment with the travel clinic two to four weeks beforehand. During that visit, we do have the travel nurses who will review a person's medical history, surgical history, medications, and look closely at their itinerary, what they're planning to do, different risks that they might be engaging in. And they'll share information about that destination and how to stay safe.

So for example, we'll give recommendations on required or recommended vaccines. And since COVID, there have been a handful of new vaccines that are out. They're not necessarily recommended for everyone. It's depending on the person in your destination. But new vaccines since COVID are the chikungunya vaccine, monkeypox, tick-borne encephalitis, and also dengue.

Kirtly: I want all those. I want all those now just in case those bad viruses come to Utah. Sign me up.

Terri: Well, come to clinic. We'll see if you qualify. And then also with COVID, I hope that there's increased awareness of transmission of upper respiratory diseases and that people are more aware to stay masked or not to travel or engage in close encounters with someone else if they do have an upper respiratory infection.

Katie: Yeah, I feel like people's behaviors changed a fair amount. And I see people traveling who are clearly being a little bit more cautious about wearing a mask, especially in crowded places like airplanes and airports.

Terri: Yeah. I've seen people who have the courage to ask fellow travelers to cover their mouth or offer them a mask without a fight ensuing. So that's encouraging.

Katie: I mean, we did learn an important lesson, I hope.

What about other things with traveling, like jet lag? Do you use melatonin or an app? How do you tell people to prepare for being in a different time zone?

Terri: So jet lag, as you may know, is worse when you travel in the eastern direction. There is an app called Timeshifter, which I personally haven't used, but it looks like it's based on trying to transition a person's circadian rhythm using light, sleep, caffeine, and melatonin.

Ideally, you could try to change your sleep habits to parallel your destination, but that can be difficult. And this app, I think, apparently helps you to do that.

There are also prescriptions that you can use, but we don't prescribe those at the travel clinic. Some of the ones that are more controlled substance, things like Ambien or Sonata, Lunesta, Rozerem, Remeron, Trazodone, are all medications you could get from your primary care provider.

Kirtly: Those are all sleepers. Those aren't wakers. Sleepers have their downside because then sometimes you wake up pretty groggy, and you're not sure where you are, and it's probably not the best choice.

Terri: Right. So if those medicines are used, we specifically ask or encourage travelers not to use those together, not to use them on the flights, not to use them with alcohol, not to use them at altitude.

But once you do arrive in your destination, try to stay awake during daylight hours and sleep when it's dark, try to avoid caffeine prior to going to sleep, and avoiding alcohol for at least 48 hours in that transition, and not to schedule anything of dire importance, like a meeting or a presentation, right after your arrive at your destination.

Katie: Right. What's made a big difference for me is, one, compression socks. That has made flying for a long time a lot more comfortable. And I have this little sling that I hang from the tray table in front of me so I can get my feet up off the ground. And that has made flying so much more comfortable.

Terri: We do also recommend the compression stockings, especially for travelers going longer than six to eight hours. And that can help reduce your risk of deep vein thrombosis or blood clots in your legs. And it just makes your legs feel better because it helps to increase the circulation.

So on that note, we also recommend that people stay hydrated during the flight so that you have to get up and walk to use the bathroom. That helps, again, keep the blood flowing in the legs.

Katie: Yeah. So thinking about, besides travel, other explorations that people might do, let's say you're going to start a new training for a regimen. Do you use any things that help motivate you, like Fitbits or watch-based things to help you get in shape for an activity?

Terri: Yes. There are a lot of great apps. I do have the Apple Watch, and there are programs on there that you can click on to start your minutes or your time for when you're doing certain exercises. So I do use those, but I haven't personally used Fitbits.

I go back to the old tried and true. For me, I use these little stickers, like smiley face stickers that I put on the calendar. If I do an hour of this sport or this exercise or this training, I give myself a sticker. That's one of my motivators.

Katie: It's funny how the . . . But I think it's been helpful to have a little thing that pays attention, whether it's . . . I can't think of the name of the app that I've been using. Strava. That's what it is. As I'm walking and collecting miles, my son will notice that, and he'll send me a little, "Way to go." And I think that way we're leveraging technology, it's been helpful in staying motivated and engaged and setting goals and achieving them.

A lot of the internet-based stuff for me has changed how I explore the world. So having Google Maps or AllTrails, I've used that in all kinds of different countries, and it's been so helpful. Rideshare apps that work everywhere I go, or Google Translate. There are so many things that just really opened up the world for me.

It's made me very dependent on my cell phone, and I had to buy a whole new cell phone on the fly once because I couldn't figure out how to travel without it anymore.

Kirtly: Oh, no.

Katie: Kirtly, how do you use the internet for your exploration?

Kirtly: My exploration? Well, we're going to talk about cognitive exploring in the intellectual domain of exploring, but I've been a map explorer since I learned about maps, and that was about 70 years ago.

So my mom would pull up a world map and point with a finger to a place like Australia and say, "Kids, how would you like to live here?" And she would point on the map or point on the globe, because that meant we were moving again.

But once I learned how to read a topographic map in my teens . . . and I did that for actually a job filling uranium drill sites that were only marked on a topographic map. But then I could explore the terrain from the comfort of the library.

And now with Google Maps on my computer, I can explore the world. I use the internet to take me deeper into any topic. But I'm careful to look at multiple sources, because you can't just trust one. So if you're looking at the place that you're going and some influencer has been paid money to say really nice things about the place, I think you need to go farther and deeper to really make sure that you're getting . . . So that means exploring.

I love to explore medical science with what I call a pub crawl. Now, that is not exploring adult beverages from pub to pub, but it's actually exploring the National Library of Medicine's source of research called PubMed. So a pub crawl is wandering my way through a topic that interests me.

And usually then I get sidetracked because there's an article that mentions something else, and then I have to go look that up. I can be gone all day.

Katie: Yeah, for sure. You can get down a whole rabbit warren of places.

Kirtly: Yeah, you can. But when I come back out, I'm a lot smarter about something than I was before.

Katie: I want to talk a little bit about the modern explorer's first aid kit. Again, we've probably talked about this a little bit the last time we covered travel, but I think having a little discussion about what you carry with you . . . Obviously, it's going to be different depending on where you're going, and you go different places. But what are the essential things you never leave home without?

Terri: That is a great question. So, in my first aid kit, I usually have things to tend to wound care, bandages, medicine for pain relief, like anti-inflammatories, ibuprofen, Tylenol, aspirin. If I'm traveling abroad, I would be looking very strongly at whether there's malaria there and treat for that, medicine for traveler's diarrhea, altitude sickness, motion sickness.

Within the travel clinic, we also, depending on a person's destination and goals, do encourage them to bring condoms, emergency contraception, treatment for traveler's diarrhea.

And then also on my trips, I usually often bring a repair kit because you can be in a remote area, and if your gear breaks down, you can be in a lot of trouble and not be able to get out of there. So that's another really important part of my kit that I bring.

Katie: I mean, I've been caught off guard. I usually don't need an inhaler, but I was on a trip once and I got a little upper respiratory infection. It was in a place that was very smoky, and I was having an asthma attack for a week. I didn't have my inhaler with me, and I couldn't get my hands on one. So now that's something I take with me. Even though in my day-to-day life I don't need it every day, now I keep one in my travel kit.

Kirtly: Well, I think as a gynecologist, I'm always concerned that people have something for a period that you might not think is going to come, but it happens. So it's always good to have some menstrual pads or tampons or whatever you're using as backup with you.

And then, Terri, I don't know what you do for people who are going to travel when they're pregnant, but there are some specific concerns about exploring while you're pregnant. And in the first 12 weeks of pregnancy, as many as 15% to 20% of pregnancies will miscarry, and sometimes that can be a problem with heavy bleeding and infection. Being far away from medical care can be an issue.

I talked with one of our guests, who's going to be with us in the emotional domain, who told me the story of helping a crew member on a Russian icebreaker in the Antarctic who was miscarrying and bleeding heavily, and it was an emergency at sea.

And so it's a good thing not to get pregnant while you're in an extended traveling situation. That's where your contraception matters.

And if you are pregnant, things like underwater exploring and diving during pregnancy is not particularly advised. Now, that doesn't mean you can't put on your scuba stuff and go down 10 or 15 feet. But deep underwater diving is probably difficult.

There are big changes in altitude in the third trimester, so you don't want to go too deep in the water, and you don't really want to go too high in the air because in the third trimester, that can lead to low oxygen. That's bad for the fetus, and it can lead to premature labor.

So be sure to drink clean water and eat food that's well cooked, and that means staying away from raw cheeses that can carry listeria. That can cause serious problems in pregnancy.

But Terri, what's your advice about travel during pregnancy?

Terri: So during the pre-travel intake, we do ask travelers if they're currently pregnant or planning to be pregnant, and then we would give similar advice to what Kirtly is recommending. But if they're planning to become pregnant, we do encourage them to delay that pregnancy, specifically if they're going to areas where you could get viral infections like Oropouche, Zika, chikungunya, dengue, which could adversely affect the fetus.

And then we also do need to alter malaria medications for people who are pregnant and traveler's diarrhea medication. So we prescribe accordingly.

And if they are advanced in pregnancy, we do encourage them to bring all of their OB/GYN records in case they do have a miscarriage or early pregnancy abroad, so someone knows their history.

Katie: That's a good idea. So much to know. It sounds like a really good idea to come in and see you before you travel.

Any new thing can be physically challenging, and I think, Kirtly, you were talking before about there's sort of a dopamine hit that comes with doing something new. So that's maybe the thing that propels us to try something new.

I was thinking about that, and also thinking maybe what propels us is we're uncomfortable in our current space and we're seeking out something new that is providing comfort. I guess I'm thinking more about human history.

Kirtly: Wherever you go, there you are. So be careful with that.

Katie: But I think often when we do something new and exciting, it means taking on a little bit of physical discomfort, whether you're starting a new exercise regimen and you're working out your muscles, or you're taking up running and you're getting blisters. I think that's where that persistence comes in to kind of keep going when things get uncomfortable.

I was hoping that we could share some stories. Terri, I bet you've got some great ones about places you've gone that then became an uncomfortable spot, how you overcame that.

Terri: Yeah, there are a lot of them. I think I anticipate that there's going to be uncomfort, and I accept that part. I know within a certain group of friends, we talk about adventures as type 1 or type 2 fun. Type 1 fun is something you anticipate to be a positive and good experience, and it is, whereas type 2 fun can be hard or challenging or difficult during, but afterwards, once you've completed it, you can look back with fondness and recall that it was worth the experience.

I've done some long-distance runs, and that was challenging in the sense that you had to run for . . . I ran the Wasatch 100, which essentially runs from North Wasatch, down through the Wasatch Mountains, and ends up in the backside of Park City. And that covers over 2,400 feet. You're running throughout the day and the night, through different temperatures.

In training for that, I know that some of the advice was that if you can get through half of that training, so if you could do a 50-mile run, you should be able to do the 100. But that half of that training was physical and half of it was mental. So there's a really important component to the mental aspect and keeping yourself going.

I was able to have a handful of friends come and pace me throughout the second half. And I specifically asked these friends to come in with a positive attitude, tell me stories, don't mention the word "quit."

I needed their support to get through that, and to encourage me to eat and drink. As you're pushing yourself that long, you're getting tired, you have pain, you have blisters, you're losing your toenails, you're getting nauseated, you have possible vomiting, there could be diarrhea, there's cramping. I tried to have a third-person perspective and just watch the pain and symptoms come through. And I was able to finish that race, which was exciting.

I think when taking on a new adventure, it's also important to look at what your goals are for that. For me, I wanted to just finish it, I wanted to have a good experience, and I didn't want to come in last. But the people that come in last on some of those runs, though, they do get a big crowd cheering them on.

Katie: That is just amazing. And yeah, I've seen people finishing that.

Kirtly: It sounds like labor. Sorry, guys. I hate to say that. It really sounds like a two-day labor, but maybe that's just my obstetrician in me.

Katie: Did you get to that point where you felt like you transcended yourself?

Terri: Absolutely. Yeah, I think with these challenges . . . I mean, like you said, you're stepping out of your comfort zone. You're relying on yourself. You're giving yourself certain goals or aspirations. Then to complete them is really empowering.

I mean, it's similar to what I would imagine walking on fire would be like. To give yourself a goal and then to achieve it, it gives you a good sense of self-worth, self-being. You connect with the people that you're doing that with.

Specifically, if I'm doing a sport where there's a little bit more danger, like whitewater rafting or kayaking or backcountry skiing, and there's an accident or an avalanche, you're relying on your partners to take care of you and help you out of those. That personal connection is even stronger in those scenarios.

Katie: Yeah, and that may be one of the other benefits of being a species of people who explore. We do bond to each other through those adventures and shared difficulties.

So this is just the beginning of our expedition into exploration. In the coming weeks, we're going to be talking about the social aspects of exploring, the emotional landscape of it, the intellectual heights of a new challenge, and we'll also cover environmental paths and financial frontiers, all the way into your spiritual inner space. So we hope you'll join us for all seven of these episodes.

You can find this episode and all of the "7 Domains of Women's Health" wherever you get your podcasts, and at womens7.com.

In the meantime, we encourage you all to take that first step into a new space because the world is waiting for you.