Question of the Week

June 5, 2006


The summer travel season is here; with it, the season for long car trips, long plane rides, and hours of sitting to get to a destination has arrived.

"No matter what the mode of transportation, sitting motionless for long periods may put some travelers at an increased risk for deep vein thrombosis (DVT). ..."

Deep vein thrombosis?

"Deep vein thrombosis (throm-BO-sis) is a blood clot that forms in a vein deep in the body. Most deep vein clots occur in the lower leg or thigh. They also can occur in other parts of the body. If a clot in a vein breaks off and travels through your bloodstream, it can lodge in your lung. This is called pulmonary embolism (PUL-mo-ner-e EM-bo-lizm), which is a very serious condition that can cause death. Blood clots in the thigh are usually more likely to break off and cause pulmonary embolism than clots in the lower leg or other parts of the body."

Most risk factors for DVT have nothing to do with travel:

"Many factors may increase your risk for deep vein thrombosis:
* Having an inherited blood clotting disorder
* Having slowed blood flow´┐Żresulting from injury, surgery, or immobilization´┐Żin a deep vein
* Having cancer and undergoing treatment for it
* Having other medical conditions, such as varicose veins
* Sitting for a long period of time, for example, on a long trip in a car or on an airplane
* Pregnancy, especially the first 6 weeks after giving birth
* Being over age 60 (although deep vein thrombosis can occur in any age group)
* Being overweight
* Taking birth control pills or hormone therapy, including for postmenopausal symptoms
* Having a central venous catheter, which accounts for almost 1 in 10 cases
Your risk for deep vein clots increases if you have several risk factors at the same time."

That said, even healthy young adults without other risk factors can be affected by DVT when traveling.

"Fitness fanatic Emma Christoffersen died suddenly from a blood clot brought on by sitting in a Qantas airline seat for 20 hours during a 10,000-mile journey from Australia. The 28-year-old from Newport, South Wales, is one of the youngest victims of deep-veined thrombosis, a sudden condition that kills dozens of airline passengers each year. ... She collapsed in the arrival hall at Heathrow airport and died before reaching hospital. Qantas said her flight from Melbourne to London was completed in two stages -- a 7.5-hour flight from Melbourne to Singapore, followed by a 1.5-hour stopover when she would have got off the plane and then a 13.5-hour flight from Singapore to London. ... The victim's mother, Ruth, 54, also from Newport, told reporters: "We were told she died from sitting on the jet for such a long time. ... Mrs Christoffersen [The victim's mother] said: "I want every air passenger to know the dangers of this condition and that it can hit young people.'"

If even those in good health with no other risk factors can get DVT, then how can anyone travel without fear?

"[P]eople can reduce their risk of getting DVT, says the American Heart Association (AHA), by taking some simple precautions on long trips."

"'People should not be afraid to travel,' says Stanley Mohler, M.D., professor emeritus of aerospace medicine at the Wright State University School of Medicine in Dayton, Ohio. 'They should just anticipate that they may be inclined to be immobile,' he says, and take precautions. A two-hour flight wouldn't be a problem, he says, but a 12-hour flight would be 'a big problem' if a person sits inactive the entire time. ... 'It's important for passengers to keep moving their legs to help the blood flow,' even when waiting in the airport terminal, says Mohler, who advises walking when possible. 'When you walk, the muscles of the legs squeeze the veins and move blood to dthe heart.' ... When traveling by car, 'Don't take a 10-hour trip without stopping every couple of hours,' says Stein. 'Get out and walk a bit.' Even if you're the driver,you still need to take walking breaks, he says. 'Pushing on the gas pedal isn't enough activity even for the one leg.'"

The concerns are real, but "People should not be afraid to travel..." Prevention is key....

"[Richard Stein, M.D.] advises avoiding regular socks with very tight elastic bands at the top and sitting with your legs crossed for long periods of time, which constricts the veins. He also urges travelers who can't walk around frequently to exercise their legs by curling or pressing the toes down, which causes the muscles to contract and squeeze on the leg veins, helping to pump the blood along. Airlines, also, are encouraging passengers to periodically move and stretch their legs. The Australian carrier Qantas, for example, offers leaflets with leg exercises that passengers can do in their seats. Qantas began printing warnings for DVT on its tickets following the highly publicized death of a 28-year-old woman in October 2000. ..."

Even for those who are not flying, many of the same methods can be used to reduce the risks on long car trips.

"Wherever possible, you should:
* exercise your legs at least every 2-3 hours - try to take regular breaks from driving. Or if you're a passenger, walk up and down the aisle of a coach, train or plane
* exercise the muscles of your lower legs (which act as a pump for the blood in the veins) while sitting - pull your toes towards your knees then relax, or press the balls of your feet down while raising your heel
* wear loose-fitting clothing
* keep hydrated by drinking water rather than alcohol and caffeinated drinks
* wear graduated compression stockings - this is particularly important for travellers who have other risk factors for DVT
If you develop swelling or pain in your leg, or have breathing problems after travelling, you should seek medical advice urgently."

Whether the travelers are retired grandparents, young adults, pre-teens, or somewhere in-between, it is important that they are educated about the risks, prevention, and symptoms of DVT.

"Symptoms of DVT, if present, usually include swelling of the involved extremity with local tenderness deep within the muscles in the area.  If the DVT occurs in veins such as those in the pelvis there may be no symptoms.  In these cases the first sign of DVT may be one of the complications mentioned above such as pulmonary embolus.  Therefore, preventing DVT is key to saving injuries and lives.  Prevention is especially important since DVT during long flights may not allow early medical intervention."

Questions of the Week:
What did you know about DVT prior to reading this? What do you think your peers and family members know about DVT, its risks and symptoms? Why might some people need this information more than others? What would you tell friends or family members who didn't believe they were at risk? What would you tell friends or family members who were afraid to travel because of the DVT risk?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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