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Dr. Anderson: Danger of Blood Clots
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Dr. Anderson: Danger of Blood Clots
Dr. Eric Anderson, a charter diplomat of the American Board of Family Practice and a former president of the New
Hampshire Academy of Family Physicians, is a regular contributor to Travel Tips 'n' Tales. He is widely traveled and
published, having written a travel health column for Travel 50 & Beyond and a weekly online column, Ask The
Doctor, for The New York Times Syndicate.
Dr. Anderson invites you to send your questions regarding travel health issues to email@example.com
Q: My parents are in their early seventies and are making their first long haul
flight (10 hours) in 16 days time. They are both in very good health
although my father has a touch of arthritis and varicose eczema on both
legs. This means that after periods of sitting his legs get very stiff.
Apart from buying him special socks, advising him to drink lots of water and
to regularly stretch his legs, I was wondering if you could give me any more
advice, as I worry terribly about him. He is hopefully going to have a
bulkhead seat but this cannot be guaranteed and he may end up with a normal
A: I can understand your anxiety. There has been a lot of talk recently about the
cramped seating in airliners today and the incidence of pulmonary embolism
where blood clots go from passengers' leg veins to injure their lungs.
Blood clots in travelers is not a new issue: It has long been known that
sitting a long time in automobiles can create the same problem. A physician
in Albany, NY once reported blood clot admissions to hospitals along the NY
Thruway increased the further west drivers went nonstop from NYC. So sitting
anywhere for a long time -- with legs bent and veins behind the knee
compressed -- puts people at risk.
Distance is important.
Australian physicians are especially interested in
this matter as Australians have to travel so far to get to Europe and the
United States. Their studies show the incidence of embolism increases after
journeys of 3000 miles and, especially, 6000 miles. Another way of saying
this is: flights of longer than 12 hours carry increased risk. Although
airline embolism has been tagged "Economy Class Syndrome" it statistically
affects equal numbers of first, business and economy passengers. It's the
distance that seems important and whether the traveler has other risk
Age is one of those factors.
In one evaluation the incidence doubled after
the age of 70 compared to the rate for those aged 60. Males and females were
equally affected. Obesity is another concern as is pregnancy, being on
hormone replacement or birth control pills, having a family history or
personally having had a previous episode of blood clotting or attacks of
heart failure or recent leg injury or pelvic surgery. Prior prolonged bed
rest predisposes to embolism as does sickle cell anemia and cancer.
Now we come to Dad
It's taken time to get to the point, Kate, but once we understand the risk
factors we can see what might be helpful. The bulkhead seat may not be the
answer if it's too close to the actual wall in front. Sometimes the space
below the seat in front of any row allows legs to be stretched out more than
a bulkhead seat. It's not likely that Dad would be able to convince the
airline desk that he should get an exit row. American Airlines does have
more room in economy than most airlines but word is it may be reconfiguring
its seats back to the tighter industry standard.
So what can Dad do?
Some of this you have mentioned. He can walk each day
before the flight as much as his arthritis allows. Swimming and dancing are
alternative activities for those with more time before they fly. He should
wear loose clothing -- like sweats -- and wander around the airport lounge
until he boards the plane (the walking stimulates venous return to the heart
whereas sitting in the lounge or standing there lets it pool in the legs).
He should drink plenty water for the few days that precede the flight and
during it. He should avoid smoking and alcohol during the flight. Some
doctors feel if there is no contra-indication to aspirin he might take one
adult aspirin the day before and the day of the flight but this is
controversial because of aspirin's side effects. One study of 13,000
patients who had undergone hip surgery showed the incidence of post
operative pulmonary embolism dropped 43 percent when patients took aspirin
for four weeks after surgey. Most physicians feel that good quality elastic
compression stocking make a difference, too, but if your father has
varicose eczema he probably already wears them.
The benefit of walking around the cabin at intervals has to be considered in
light of the possibility of turbulence when passengers strapped in their
seats clearly are safer then those in the aisle. While seated he should do
exercises and massage his ankles and calves and move his legs occasionally
and try not to sit for periods with his legs crossed. A study of 135 million
passengers who arrived in Charles de Gaulle Airport in Paris found 56
patients who had to be hospitalized with pulmonary embolism and, of those,
only three said they vacated their seats and walked the aisle during the
flight. So walking around the cabin seems to be helpful - and, note the
numbers: the incidence of this problem is not high.
That is an important final point. A British study suggests that "white
knuckle passengers" are more at risk of pulmonary embolism because their
nervousness causes adrenaline release with its increased risk of blood
clotting. So what we need to do with your parents is make helpful
suggestions but not so overstate the concerns that we frighten them and ruin
what is presumably going to be a great vacation.
NOTE: Lorry Patton's Travel Tips 'n' Tales would like to remind you to always consult with your personal physician
of each page of this website. Dr. Anderson's opinions are not necessarily the opinions of Lorry Patton or Travel Tips 'n'