How to die from an airplane flight without crashing

More travellers may be dying by just sitting in airplanes every year than in actual airline crashes. Traveller’s Thrombosis – more popularly known as Economy Class Syndrome – is the moniker attributed to the occurrence of often fatal condition of deep vein thrombosis (DVT) in people who travel long distances by aircraft.

According to the International Air Transport Association (IATA) (http://www.iata.org/) there were 502 airline fatalities in 2008. In contrast, The Lancet (http://www.thelancet.com/home) one of the world’s leading medical journals, published an analysis as far back as 2001 estimating that 1 million cases of DVT related to air travel occur in the U.S. every year with 100,000 of these cases resulting in death (Lancet, September 8, 2001, p. 838).

DVT usually refers to a blood clot in the legs – specifically in a “deep vein,” a vein that accompanies an artery. A clot (thrombosis) can interfere with normal blood circulation but can cause a more serious problem when it breaks off and travels through the blood stream (embolism) and lodges itself in a critical organ such as the brain, lungs, or heart causing serious or even fatal damage, most often in the form of a pulmonary embolism. According to the American Medical Association (AMA) (http://www.ama-assn.org/), more than 600,000 people suffer from DVT in this country every year, and more than 60,000 of them will die from pulmonary embolisms.

DVT is usually associated with confined or relatively immobile situations such as driving for long distances or sitting at a computer desk for extended periods of time, but it can occur even in a hospital bed. Hardly surprising, DVT has become particularly associated with cramped airline seats, hence the term “economy class syndrome.”

It is the relative immobility – the lack of physical activity – that apparently precipitates the clotting even in otherwise healthy individuals, although physical conditions such as obesity, smoking, sedentary lifestyle, high blood pressure, pregnancy, or even the use of birth control pills may exacerbate the possibility of DVT. Other risk factors include casts that immobilize the foot and/or ankle, certain chronic diseases, or recent major surgery. Although DVT can occur in any age group, it occurs most frequently among adults over 60.

DVT often has no warning signs. The most common symptoms are usually a swelling and pain in the leg or calf with some possible redness or increased warmth. A major catch is that sometimes the symptoms don’t show up right away. Sometimes it might take several hours – or even days – before they show up. Not much warning, but these symptoms – particularly after traveling – should dictate an immediate sense of urgency to call to your doctor to check things out.

It is much more common than you think. Many may remember NBC reporter David Bloom, just 39, who died of DVT in 2003 after his visit to Iraq where he was subjected to sleeping and traveling in cramped vehicles such as his famous “Bloom Mobile,” an army tank recovery vehicle retrofitted to accommodate his reporting. As a result of Bloom’s death, his wife Melanie Bloom (http://www.msnbc.msn.com/id/7074940/), now works with the Coalition to prevent DVT, a group of more than 50 organizations working together in a united effort to raise awareness of DVT among consumers, healthcare professionals, policy-makers and public health leaders.

Former President Richard Nixon was reported to have suffered DVT on the presidential jet during his visit to China, which was given as the reason for his inability to give evidence at the Watergate inquiry. Former Vice-President Dan Quayle was also reported to have suffered from DVT after he returned from Europe. And, more recently, former Vice-President Dick Cheney developed DVT in his left leg after an overseas tour to the Asia-Pacific just a few years ago. (Source: March 6, 2007http://www.timesonline.co.uk/tol/news/)

More people suffer from DVT annually than heart attack and stroke and more people die from DVT than breast cancer and AIDS combined. In fact, fatal DVT-related PE may be the most common preventable cause of hospital death in the U.S. Yet, surprisingly, almost three-fourths of Americans have little or no awareness of either DVT or PE, according to the American Public Health Association (APHA).

“This is a public health crisis,” says Dr. Samuel Goldhaber, associate professor of medicine at Harvard Medical School and DVT expert at Boston’s Brigham and Women’s Hospital, who authored a study in the American Journal of Cardiology (http://www.ajconline.org/) (www.usatoday.com/news/health/2004-01-21-deep-vein_x.htm)

In the study, Goldhaber and his team surveyed 5,451 people with DVT at 183 locations over six months. Two-thirds of the patients were overweight or obese, which increases the chances of developing DVT/PE. Other patient characteristics in the study:
• 50% suffered from hypertension (high blood pressure)
• 38% had surgery within 3 months before the clot was discovered
• 34% were immobile within 30 days of DVT diagnosis
• 32% had cancer

Of the 2,726 patients who were hospitalized when diagnosed, only 42% had preventive care.

So, how DO you reduce the risk of DVT? Move! The next time you travel by air, get up from your seat and move around the plane as much as possible. Walk up and down the aisle, stop and stretch your legs, stand up on your toes do everything possible to use the muscles in your lower extremities several times during the course of your flight. The longer the flight, the more often you should move around. There will be times when airline regulations will require that you remain seated with your seatbelt fastened, but there will also be ample opportunity to move around the plane without restriction during flight. Wearing elastic compression socks or tights can also help.

Having recently returned from a lengthy cross-country flight, I was amazed at the number of passengers who never moved from their seat during the entire flight – even to go to the bathroom (that’s another story). It was as though they felt compelled to remain seated regardless of their discomfort. Get up and move – your life might depend on it.