BLOOD CLOT WHILE FLYING: DEEP VEIN THROMBOSIS DVT THE LITANY OF AIRPLANE PASSENGER WOES GROWS: A FLURRY OF LAWSUITS HIDDEN DANGER OF LONG HAUL FLYING OR SITTING
ECONOMY CLASS SYNDROME Long Airplane Flights and the Reports of Blood Clots
Economy Class Syndrome and the Blitz of London
You are sitting on a crowded airplane stuffed like sardines in a flying sardine can perhaps wedged between two other "happy" travelers. Flight delays, security hassles,obnoxious passengers. You think what else can happen? How about a DVT causing a pulmonary embolism, a blood clot in your lungs? Just when you thought it was safe to fly the not so friendly skies, yet another headache is added to the litany of airline traffic woes!
A post here recently talked about the so called Economy Class Syndrome. People who sit on airplanes in one position for too long are at increased risk of developing blood clots. An article has appeared in the New York Times.
"Most business travelers have heard about the outwardly healthy 28-year-old British woman who collapsed and died shortly after getting off a 20-hour flight from Australia to London two years ago. They also probably know she died of a blood clot that formed in her leg and traveled to her lung -- most likely a result of prolonged sitting in cramped quarters.Yet do most air travelers know the best way to avoid her fate is to stretch and walk around the cabin regularly to get the blood pumping?" "In the last year, a flurry of lawsuits has been filed around the world, contending ..failure on the part of air carriers to inform passengers adequately about the malady, known as deep vein thrombosis"
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What do former wrestler a.k.a Governor of Minnesota Jesse Ventura, Olympic ice skater Tara Lipinski and one in 5000 airline passengers have in common? The answer? They have already had or will get a blood clot. Not only do people have a fear of flying they also have a fear of flying and developing a blood clot. The phenomenon of developing a blood clot while flying has been labeled "Economy Class Syndrome". It has been associated with sitting in one position for a long time. Remember TV Correspondent David Bloom who was said to have succumbed to a blood clot while covering the Iraq War? Even the people huddled in the Underground during the Blitz of London suffered from increased blood clots.
The Internet medical journal PLOS Medicine has a new study of Economy Class Syndrome. They calculated that for the under 40 group that they studied the risk of a blood clot was 1 in 5000. But they suspected it would be higher in the general population.
They figured that
Probably one of the most important things you can do is to walk around during the flight. Not to sit in one position for long periods of time. Prolonged immobilization is one of the risk factors for a blood clot.
There have been many stories in the press about blood clots while flying in an airplane. For example Dangerous In-Flight Blood Clots and Cramped Flights Fatal Blood Clots and also the story of a woman who had a blood clot after a transatlantic airplane flight and a rugby player who says he got a blood clot after a long flight from Australia.
What is Deep Vein Thrombosis
Tara Lipinski, the Olympic figure ice skater, was shocked she said, when she developed a blood clot after surgery Lipinski Glides Past Surgery Complications . But there are many things besides prolonged immobilization that can possibly predispose to the formation of a blood clot. They are called deep vein thrombosis because they tend to occur in the deep veins that run deep inside the legs (although DVT also comes from elsewhere such as the pelvis) versus the more superficial veins that you can see on the outside of your legs, called logically the superficial veins. A clot in the superficial veins is called phlebitis. Here is a diagram of the deep veins of the leg
Symptoms of a DVT
Symptoms of a DVT can include:
What are Causes of Blood Clots: Tests for Pulmonary Embolism
But it's more than just immobilization that increases risk for blood clots. Take for example the case of a twenty something woman who came to see the doctor because of a hard to describe discomfort or pain in her side. It had bothered her for the previous two days and when she had gone to see her regular physician the nurse had done a urine test and sent the woman home. But the woman had felt so bad that she and her husband went to see another physician
Closer questioning revealed that the woman had been on birth control pills and had injured her leg earlier in the week.
Now the doctor was suspicious of a blood clot.Birth control pills and trauma to the extremities are both risk factors for blood clots.The doctor sent her to the hospital where a test called a spiral CT scan demonstrated a blood clot in her lung. This woman had two things that increases chances of a blood clot.
Virchow's Triad for blood clots
Over one hundred years ago a physician name Virchow elucidated Virchow's Triad: three circumstances associated with an increased chance of a blood clot:
In light of this it's easier to understand this list of some of the things associated with an increased chance of blood clots:
So What's a Pulmonary Embolism?
Pulmonary Embolism and Deep Vein Thombosis DVT are Related as Blood Clot in Leg Can Travel thru Heart Into Lung
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Former Governor of Minnesota and wrestler Jesse Ventura had a pulmonary embolism the night he was scheduled to wrestle Hulk Hogan as you can read in this account of Jesse Ventura's pulmonary embolisms. And David Bloom, the television correspondent who was said to have had a blood clot as a result of prolonged time traveling in an armored vehicle. A pulmonary embolism is a blockage in an artery in the lungs caused by an embolus, a blood clot that has traveled from another place in the circulatory system such as a vein in a leg or in the pelvic area to the lungs to become a blood clot in the lung. Here you can see a diagram of the mechanism of a pulmonary blood clot embolism
The Symptoms of a Pulmonary Embolism Blood Clot in the Lung
Symptoms can include:
How do They Test for Pulmonary Embolism and for a DVT Blood Clot
The Ventilation Perfusion Test (The VQ Scan) and the Spiral CT Scan
The two most prominent tests for a pulmonary embolism are the VQ Scan and Spiral CT. Oxygen is exchanged between the air and the blood in the lungs. Thus there is ventilation of the lungs and also perfusion in the lungs by the blood. If there is a blood clot blocking some part of the lung one would expect to see a mismatch where there is not an approptiate blood flow to an area of the lung because of the clot blocking the area.
The perfusion scan is performed by injecting a radioactive substance with a short half life into a vein. The patient´s lungs are scanned to detect the location of the radioactive material as blood flows through the lungs. The ventilation scan is performed by scanning the lungs while having the person inhale radioactive gas with a short half life.
The Spiral CT Scan
The Spiral CT Scan is a newer and more sophisticated relation of the old CT scanner. It has detectors that rotate rapidly in a spiral and can image an area much faster than the older CT, so fast that it can get the whole image while a person holds their breath. Original CT scanners would spin 360° in one direction and make an image , then spin 360° in the other direction to make another cross section. Between each image, the machine would stop completely and reverse directions while the patient table was moved forward incrementally. The spiral CT scanner rotates continuously and can scan entire anatomic regions in less than a minute.
Ultrasound and D Dimer
DVTs are most commonly detected by the use of an ultrasound scan of the legs or affected area.
Blood tests can also give a good indication that there is a thrombosis which is a fancy word for blood clot. A blood test for something called D Dimer measures the levels of a by-product of clotting material that can be used to help rule out a blood clot. Since other things besides a dvt can give a positive D Dimer test it can't be used alone to diagnose a dvt. A positive D-dimer indicates the presence of an abnormally high level of fibrin degradation products in the body and indicates that there has been significant clot (thrombus) formation and breakdown in the body, but it does not tell the location or cause. An elevated D-dimer may be due to a a number of other conditions besides a dvt. But a neagtive D Dimer is useful in ruling out a blood clot.
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