Cranky is on vacation, but I’ve lined up some excellent guest bloggers for you while I’m gone. Today I’ve got a real treat. My very own brother, Quinn, is here to give us some of his doctor knowledge.
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It’s not often that my brother Cranky and I have any overlap in our work lives, but with him leaving on his honeymoon, we thought it would be fun to have me put together a guest post that combines both our worlds. I practice Emergency Medicine in the Philadelphia area, so I wanted to pick a medical topic that would also be interesting to you frequent fliers. I settled on Deep Vein Thrombosis, or DVT, which is also incorrectly called “economy-class syndrome.”
What is a DVT?
A DVT is a blood clot in your deep veins which can often result in calf swelling, redness, and pain on one side. You can get DVTs essentially in any of the deep veins of your body, and some can be worse than others. In fact, if you get one in your thigh veins or pelvic veins then you’re in more trouble than if it’s further away from the heart in your calf veins. Often times the DVT will not cause any symptoms whatsoever, but it’s important to catch DVTs if you can.
How does a DVT happen?
There are three different things that can contribute to you getting a DVT, and together they’re called Virchow’s triad.
- Your blood vessel isn’t as smooth and healthy as it could be (endothelial damage)
- Your blood is not moving like it should…as in, you’re stuck in an airline seat for hours on end and your blood isn’t pumping (venous stasis)
- Your blood clots more than it should (hypercoagulability)
When these factors come together, clots form in greater quantities than they should. For that reason, people on oral contraceptives or hormone replacement therapy, smokers, cancer patients, pregnant women, recent surgical patients, and the elderly are all at greater risk for DVTs. Now that you know how it works, you can understand why calling DVTs “economy-class syndrome” as it has been dubbed in the press is a misnomer.
Why are DVTs deadly?
The DVT itself is less of a problem than the Pulmonary Embolism (PE) that could follow. What happens is that a big DVT clot in your deep veins can travel up from your legs towards your heart. Then it gets sent out to your lungs where all hell breaks loose. Even when this happens, you may not have any symptoms (most common), but you may also have mild chest pain, a cough, lightheadedness, or shortness of breath. There is also the potential for sudden death.
What should you do if you think you have a DVT or PE?
Seek medical attention yesterday. If you are diagnosed with one of these conditions then you will need to stay at the hospital and get blood thinning medications among other things.
How do I prevent an in-flight DVT?
As you might expect, the best way to prevent it is to control Virchow’s Triad as best you can. To keep your blood vessels smooth (avoid endothelial damage), keep in good general health. If you’re a smoker, one of the best things you can do is stop smoking. (Yes, this is yet one more reason you shouldn’t smoke.)
What about preventing abnormal clotting (hypercoagulability)? The data on aspirin and other anticoagulants is sketchy at best, and is probably not warranted unless you have already been prescribed one of these medications for a chronic condition. Prevent dehydration by avoiding alcohol and caffeinated beverages which may ultimately cause a net body fluid loss.
To keep your blood pumping (avoid venous stasis), get up and walk around every hour. If you get stuck in a middle seat and the guy next to you is snoring up a storm, try pumping your calf muscles like you’re pumping the clutch for a little bit. This helps send the blood back to your heart faster. Also, compression stockings are probably helpful, though dorky. You need to make sure you use them correctly. If you don’t pull them all the way up they can actually pinch your legs and thus increase venous stasis, which is obviously not a good idea.
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Quinn Snyder practices Emergency Medicine in the Philadelphia area. This, in case you were wondering, is far easier than growing up as Cranky’s little brother.
10 comments on “The Dreaded In-Flight DVT and How You Can Prevent It”
wow, cool post. it’s like cranky, but smart and literate.
@JFF – miaow.
Quinn, how many (if you’ve seen any) cases of DVT do you suspect are directly caused as a result of air travel, and how many are due to people sitting on the arses at the office all day?
I can only think of one DVT I have seen that was likely due to air travel, plus one that a friend of mine had. Neither developed into a PE. In general DVTs are a common Emergency Department complaint, but are rarely a result of airline travel. The data I’ve seen puts the total number of DVTs that present to the ED secondary to airline travel at <2%. The vast majority of DVT cases are elderly smokers with heart problems and some degree of limited ambulation, not young or even middle aged professionals who sit at a desk or ride planes all day.
“In general DVTs are a common Emergency Department complaint, but are rarely a result of airline travel. ”
Interesting that this nonetheless gets constant play in the media, which I suppose is ever prone to alarmism. I never understood why sitting in an airplane seat is so much worse than any other seat (though to be fair, few people work at a desk for 14+ hours straight).
If everybody on a 747 got up and walked up and down coach once every hour, there would be like 30 people up and moving around all the time. There’s no way the crew would tolerate it. They’d rather we stay conveniently stowed in our seats and then just throw an embolism once we reach baggage claim.
@ Bobber
was kidding. hoping to incite slapfight between cranky and brother.
Dear Quinn,
Thanks for the article on DVT. I have to wear surgical support due to varicose and deep vein problems(I am only 43, don’t smoke and lead a fairly healthy lifestyle as far as food, limited caffeine and activity level) so wanted to say its not “Dorky” to have the support stockings if you don’t have a choice, plus if I had started wearing them earlier in my life, it might have saved me a lot of edema and vascular damage. As a doctor, please be more sensitive.
Hi I read somewhere about a medicine that a person can taqke prior to flying to prevent a dvt attack. Do you know the name of this medicine. Thanks very much Jim
I asked my brother to comment on this, and he said: