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Economy-Class Syndrome

How Long Distance Air Travel Can Affect
Your Health

Thrombophlebitis. Sounds scary, doesn't it? Now try saying it five times fast. Still sounds creepy, eh?

It is a rather serious condition, perhaps that's appropriate.

Thrombophlebitis, more commonly known as deep vein thrombosis or sometimes referred to as "economy-class syndrome", has been brought to the forefront of medical community after a number of people have died from the condition after having flown on lengthy flights. The first in a recent string of deaths related to this condition was 28-year-old Briton Emma Christoffersen, a physically fit woman who collapsed after arriving in London from a 12,000-mile flight from Australia in October 2000.

Every year, DVT strikes about one in every 2,000 people in the general population, with the risk greatest in those over 40, those with a personal or family history of blood clots, those with cancer, blood diseases or heart conditions, and those who had recent surgery on the hips or knees, according to the Venous Educational Institute of America. Passengers on airplane flights longer than five hours, where passengers remain seated and immobile, pose higher risks. The institute also says it occurs more frequently in pregnant women, those who have recently delivered, and those taking a contraceptive or hormone replacement therapy.

Recently, the American Public Health Associationand the Centers for Disease Control and Prevention urged all healthcare providers to take a more active role in preventing deep-vein thrombosis. Findings of a national survey showed that 74 percent of Americans are largely unaware of the condition and more than half (57 percent) of respondents could not name any common risk factors or pre-existing conditions that could lead to its development.

What is deep vein thrombosis?

Deep vein thrombosis occurs when a blood clot and inflammation develop in one or more of your veins, typically in your legs, according to the Mayo Clinic.

There is increasing evidence that immobilization in airline seats for long flights puts people at risk for deep vein thrombosis. The condition occurs when a thrombus (blood clot) forms in one of the large veins, usually in the lower limbs, leading to either partially or completely blocked circulation. The condition may result in health complications and death if not diagnosed and treated effectively. The major risk associated with DVT is the development of a pulmonary embolism. PE can occur when a fragment of a blood clot breaks loose from the wall of the vein and migrates to the lungs, where it blocks a pulmonary artery or one of its branches. In some circumstances, deep vein thrombosis may also contribute to other serious medical problems such as heart attack and stroke.

What are the symptoms of DVT?

Deep vein thrombosis may not cause symptoms until the blockage severely interrupts blood flow. Then, you may experience symptoms, such as:

  • pain

  • sudden swelling in the affected leg

  • enlargement of the superficial veins

  • reddish-blue discoloration

  • skin that is warm to the touch

Contact a doctor immediately if you experience these symptoms.

As mentioned above, if untreated, DVT may cause serious problems. A clot can grow in size and block other veins. In addition, portions of the clot may break away from the vein wall and travel through the veins into the lung, where it can lodge in a pulmonary artery. This condition is known as pulmonary embolism, and the traveling clot is called an embolus. Pulmonary embolism can be life threatening if the embolus blocks the main pulmonary artery or if there are many clots. Pulmonary embolism can be treated with drugs that dissolve the clot and restore normal blood flow. You should get medical help immediately if you experience any symptoms of pulmonary embolism:

  • a feeling of apprehension

  • shortness of breath

  • sharp chest pain

  • rapid pulse

  • sweating

  • cough with bloody sputum

  • fainting

What can I do to prevent DVT?

1. During Travel:

  • Stand up and walk around at least hourly

  • Exercise your calf muscles by going up on tiptoes several times while standing

  • Drink adequate fluids — at least 1 liter per 5 hours of flight

  • Avoid alcohol as it increases the stickiness of platelets and promotes fluid loss

  • Avoid crossing legs or prolonged awkward hip or knee positions whenever seated

  • Wear loose fitting clothing when traveling

2. Stop Smoking

3. Lose Weight

4. Discuss with your doctor family and personal history that might pre-dispose you to DVT and increase your risk during travel.

  • Discuss whether folic acid will help you prevent DVT.

  • Discuss whether therapeutic compression stocking, and/or an anticoagulant would be helpful to you in preventing DVT

5. The effectiveness of the use of aspirin as a preventive measure for deep vein thrombosis is controversial

6. Elevate your legs when possible.

(Sources: American Public Health Association, NASA Occupational Health Program)

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