Fyi

Editor's Note: It's easy to forget that the time we spend in flight counts as office hours. While those who fly for work may be focused on prepping for the big meeting, being in flight for a good portion of your week carries health risks. Below is a story about the dangers of "Economy Class Syndrome." This is an extreme case, and it shouldn't deter you from flying, but it's worth reading because it's another health story that illustrates how staying aware and informed can help save your life.

By Eamonn Toland
Before I collapsed shortly after getting off a plane, I had no knowledge of deep vein thrombosis. I had been traveling in business class on a 13-hour flight from Hong Kong to London.


The Times

Eamonn Toland was only 29 when he suffered a blood clot after spending 29 hours in the air over three days.


As I walked off the aircraft a blood clot had traveled from my leg to my heart, where it fragmented into "showers" of pulmonary embolisms. These, in turn, clogged the arteries between my heart and lungs, cutting off the supply of oxygen to my brain.

In a split second my life was to change forever. In the days and weeks that followed, I tried to find out why this had happened to me, a fit, non-smoking 29-year-old with no predisposition to blood clots.

I discovered that a mixture of complacency and scepticism has for years prevented airlines and doctors from warning passengers about the dangers of "Economy Class Syndrome," a term coined in 1977.

Doctors have known for 60 years that prolonged immobility increases the risk of suffering a blood clot. This is why hospital patients wear stockings after surgery — the support they offer helps to pump blood faster through the legs of the otherwise immobile patients. Low oxygen pressure and dehydration have also been shown to be risk factors.

This is probably what caused my blood clot. I had flown into Hong Kong to run a workshop over a weekend. Between Friday and Sunday I spent 29 hours in the air; and worked the rest of the time. When I boarded the plane for the journey home, I was tired and thirsty.

While on the plane, I slept for five or six hours in my seat with my seatbelt loosely fastened. Since I am tall, I wasn’t able to turn over while I slept. I woke up with a mild cramp in my right leg — the only warning that I was suffering from DVT. As I walked off the plane, I felt as though I couldn’t breathe, and I passed out. When I came to, I couldn’t speak or feel any sensation in my right arm. I was rushed to Ashford Hospital, where I was quickly given Heparin, the anti-clotting drug.

I had no idea how lucky I was. According to the American Heart Association (AHA), one in ten patients who suffers an embolism will die without prompt treatment. Many others suffer brain damage or have limbs or genitals amputated.

According to the AHA, fewer than 20 percent of patients suffering from a pulmonary embolism show any clinical symptoms. After four days in the hospital I was allowed home, but had to take Warfarin, another anti-clotting drug, for six months. I had to avoid sports that could result in sprains and fractures, and I was warned that sudden fluctuations in alcohol consumption could be fatal. I wasn’t finally given the all-clear until weeks after I had finished the treatment, when a thrombophilia test confirmed that I was normal. I have not flown since.

It has been estimated that 3,000 people in Britain suffer from DVT due to long-haul air travel every year — potentially 90 of those die each year as a result. With the publicity after the death of Emma Christoffersen, a 28-year-old who died within minutes of leaving a 23-hour flight from Australia, people are amazed that airlines do not do more to warn people of the risks.

It is almost impossible to prove how many people suffer DVT as a direct result of air travel. No statistics are kept of the number of people who fall ill on planes, and even if they were, they would be of limited use. Symptoms "often do not appear until several hours or even days after the journey," according to American Airlines’ medical department.

In the absence of hard evidence, many doctors are sceptical about the likelihood of suffering DVT due to air travel. They cite the many other risk factors that can cause it, such as birth control pills, pregnancy, smoking, surgery, fractures, cancer, obesity, old age and hereditary factors.

Airlines don't issue warnings for fear of alarming passengers. Since my incident my company has issued warnings with every ticket provided to our 65,000 consultants around the world. The advice suggests that passengers walk up and down the aisle every hour, drink lots of water and avoid caffeine and alcohol. For those who are not allergic to aspirin and do not have stomach ulcers, taking an aspirin before the flight will help thin the blood.

Raising awareness is the key to reducing the number of deaths. The House of Lords in Britain recently reported on the dangers of DVT and air travel and asked airlines to warn passengers of the risk and to advise them about the steps they can take to reduce the risk. We may never know how many people suffer DVT due to air travel, but we can be certain that improved guidelines will help save lives.

That is horrible!! I am going to send it to my Dad. He flies all the time.

True, but I'm more worried about this happening at my DESK than on the way to Spain.

And I KNOW that my pocketbook would suffer considerably from First Class Ticket Price Syndrome!

Leche

Hi

This is a true fact of Flying in Economy Class. Recently a Young Lady died after a flight from Australia to England (23 hours with 1 stop for about 1.5 hours).

I have been lucky (?) in my work to have flown to many destinations around the World (FF points were great for Holidays), and ALWAYS made it a point to get up every 2-3 hours and go to Toilet, walk around the Plane, stand and talk to others for at least 30 minutes. I have even been known to do Stretching exercises in the aisle. This all has the effect of keeping the Cardio-vascular system on track and helps you feel better as well. I even do this on the shorter (up to 4 hour flights) that we have within Australia as well as the Long Haul (23 hours) International Flights.

But please don't take this a lecture. It is very important to be aware of this problem, and as the old saying goes: "prevention is better than the cure"

David

Yeah, I guess that is where the benefits of hyperactivity come in. I can't sit still for long periods without going NUTS, so I fidget like crazy, get up and move around.

Forget the 1st class. For the cost difference of one of those tickets I could travel around Spain for three weeks.

You are right though Leche, sitting at your desk staring at a computer for four hours before getting up to take a break doesn't do much to help the old circulation...

Whew!! NOW I'm glad Mama Rosa missed that 10:30pm connection in Atlanta to New Mexico AFTER having flown for the previous 12 hours (Madrid->NYKennedy with 1-hour ON plane waiting->Atlanta) and we had to spend the night (at Delta's expense) and then catch the next day's 7pm flight. Imagine how a 75-year old woman would feel flying seated during 17 hours! Still, she'll HAVE to do this on the way back next month. Poor thing.

Saludos, MadridMan

I have been complaining for years about insufficient seating space on airplanes. When I dropped a pen and did not have enough space in which to bend over the pick it up, I decided that my air travel days were over--the rest of my traveling I'll remain content to do it on a roomy bus or train.
Cantabene