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| Sunday, 13 January 2002 |
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Features |  |
| News Business Features Editorial
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Traveller's thrombosis by Dr. D.M.S. Karunaratne, Economy Class Syndrome is a medical condition caused during air travel for long periods of time associated with cross country and international flights. It occurs not only in the Economy Class of a plane, but Business Class, First Class, and even the Cockpit. The term "Economy-class syndrome" first appeared in 1977 in a paper by Symington and Stack and is widely used to refer to flight-related Deep Vein Thrombosis (DVT). The pressure at which the heart pumps blood through the arteries is substantially dissipated by the capillaries, making the return through the veins less vigorous. The heart is located in the chest, and blood thus has a long way to return from the feet - from which the flow is also hampered by the effects of gravity. To assist that return blood flow, the main leg veins are dep inside the leg muscles and contain a series of non-return valves enabling muscle action to augment the pumping action of the heart. DVT is a condition in which a small blood clot or thrombus (thrombi in the plural) forms mainly in the deep veins of the legs . Such clots can be present without symptoms or signs, but may give rise to swelling of the affected leg, sometimes accompanied by pain (particularly when the foot is flexed hard upwards) and local tenderness. It has been known for many years that clotting in blood vessels (thrombosis) is associated with: poor circulation or stagnation of the blood; excessive coagulability (thickening leading to increased tendency to clot) of the blood; and abnormalities in, or damage to, the walls of the blood vessels. The presence of one or more of these factors (known medically as Virchow's Triad) leads to an increased possibility of blood clotting in an otherwise healthy person. It is estimated that Economy Class Syndrome kills more than 100 international flight passengers each year. Up to 20% of the total population is thought to have some degree of increased clotting tendency, largely from inherited or acquired biochemical, metabolic or blood abnormalities, and this indicates that there might be a "natural" underlying incidence of DVT in the general population associated with those factors alone. Retrospective studies indicate that the "natural" incidence increases rapidly with age, averaging overall about one case per thousand people per year. High risk factors Economy Class Syndrome is more commonly seen with the following: Increasing age above 40 years, pregnancy, former or current malignant disease, blood disorders leading to increased clotting tendency, inherited or acquired impairment of blood clotting mechanisms, some types of cardiovascular disease or insufficiency, personal or family history of DVT, recent major surgery or injury, especially to lower limbs or abdomen, oestrogen hormone therapy, including oral contraception and HRT, increasing duration and frequency of long distance travel, other factors include; Depletion of body fluids causing increased blood viscosity, varicose veins, obesity, current tobacco smoking, immobility, elected or enforced, seating constraints, particularly leg-room and seated posture, including when asleep, wearing of tight undergarments or movement-restricting clothing, height compounding mobility, seating and posture constraints, for smokers, enforced non-smoking altering physiology and psychology. Symptoms Economy Class Syndrome Symptoms to watch for up to 30 days after air travel. Leg symptoms (Deep Vein Thrombosis, DVT) may appear during flight or in the next few days. Sudden swelling in one lower leg. (A little swelling in both legs is normal in flight.) and cramp or tenderness in one lower leg, often behind the knee is common. Chest symptoms (plumonary Embolism, PE) usually appear 2-4 days or more after the initial blood clot, which you may not have noticed, shortness of breath, rapid breathing, panting, cramp in your side, painful breathing, chest pain accompanied by shoulder pain, fever, coughing up blood and fainting (often the first sign, especially in older people). Prevention Frequent leg flexing, as described below, is the best preventive for Economy Class Syndrome. You need to activate the muscles enough to push the blood through the veins. Extend your legs straight out in front of you and flex your ankles, pulling up and spreading your toes, then pushing down and curling the toes. If your shoes limit toe movement, just make the effort and don't worry, or remove the shoes. Sleeping is dangerous, unless you can count on being wakened (by an alarm watch, perhaps) to move the muscles. Avoid sitting with your legs crossed for more than a few minutes at a time. If you are at heightened risk for blood clots, talk to your doctor about possibly taking anticoagulant and or wearing medical compression bandage (Tubigrip). The biggest risk factor is a personal or family history of blood clots. Some studies say Asprin is effective for preventing DVT; others say it is not. Prevention / precaution Those with no known predisposing factors it is recommended to move around in seat and in cabin as much as practicable, exercise calf muscles whilst seated by half-hourly flexing and rotating of ankles for a few minutes, avoid excess of alcohol and caffeine-containing drinks, both before and during flight. Drink only water or non-caffeinated soft drinks or juices when thirsty or feeling dry. It is recommended that airlines and their associates reappraise their current practices in relation to not only the provision of information for passengers but also the design of the cabin and cabin service procedures. The following are the main points: (a) Easily available authoritative information on DVT and travel; (b) High-profile pre - and in-flight preventive advice; (c) Active encouragement of in-flight mobility and preventive leg exercises; (d) Elimination of restraints and constraints on seating and eating, and on sleeping comfort; (e) Improved seat space and leg-room to a healthy minimum, together with increased availability of pre-bookable more spacious seating at reasonable additional cost; (f) Freedom and space to move around, with minimum limitations on aisle access due to cabin service activities; and (g) Reduced availability of alcohol and other dehydrating beverages with increased availability of re-hydrating drinks. After the September 11 attacks, should this take a back seat to security issues? More lives are ruined or ended every single day bay economy class syndrome than the number of people on board all four of the hijacked airliners. |
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