By Dave Svinarich
“Dave you need to get to an emergency room, I think you may have a DVT.” “No way,” I said, “I’m 40 years old and in excellent health, it’s just a sprain!” I thought that was the end of the conversation until he called my wife later that night and impressed upon her the importance of getting me to a hospital. That worked!
We were coming to the end of a very successful plains-game hunt in Namibia and the last full day of the safari found us looking for a Burchell’s zebra. Although this plains zebra is more at home in the savanna grasslands and open woodlands, we had spent most of the afternoon pursuing a small herd in the steep foothills of the Auas Mountains, which surround Windhoek, the capital city of Namibia.
The herd was definitely aware of us, because we would no sooner crest one hill, when the herd would slip over the next hill. Finally, with evening beginning to set in, we carefully crawled to the crest of yet another hill and spied the herd milling around across a small valley on the opposite hillside. I nestled the .375 H&H over my day pack and took careful aim at a mature stallion that was standing off to the side of his small herd of mares. He took the shot hard and tumbled 30 or 40 feet down the hill, finally coming to rest in a small depression on the steep hillside. We had spent the better part of a day climbing in the foothills after those zebra, and I was footsore and exhausted by the time we finally loaded the stallion onto the bed of our Toyota truck.
The next morning, we were up early to catch a flight from Windhoek to Johannesburg, South Africa and then onto Atlanta, Georgia. The 8,400 mile flight to Atlanta was nearly 17 hours long and I spent much of that time trying to rest in my cramped economy class seat.
Two days after my return home, I noticed some pain in my right calf and quickly dismissed it as some pulled muscles which likely occurred as a result of chasing those zebras up and down the steep hills. By the third day, my lower leg and foot had begun to swell but I was sure that the swelling was just due to soft tissue damage. One of my best hunting buddies, who happens to be a physician, was eager to hear all about the hunting trip and it was only as an afterthought that I mentioned my leg to him. At that moment, the conversation turned serious.
“Dave you need to get to an emergency room, I think you may have a DVT.” “No way,” I said, “I’m 40 years old and in excellent health, it’s just a sprain!” I thought that was the end of the conversation until he called my wife later that night and impressed upon her the importance of getting me to a hospital. That worked!
In the emergency room, I was immediately put into a wheelchair and instructed not to get up or move around. A Doppler ultrasound quickly confirmed the presence of a blood clot in my right leg and I spent the next couple of days in the hospital on anticoagulation therapy, and then the next six months as an outpatient on various anticoagulants. I was lucky. A DVT or deep venous thrombosis, is a serious medical condition, and a pulmonary embolism or PE, which can result from having a DVT, can be fatal.
What are DVTs and PEs?
A DVT is a blood clot which typically forms within a vein running deep inside a leg or arm. It occurs most frequently in the lower legs and often results in an increasingly painful, swollen calf that is warm to the touch. However, DVTs can also occur elsewhere in the body, and there may be no symptoms whatsoever. Also, symptoms may not occur for several days after travel. A pulmonary embolism or PE, occurs when a portion of the blood clot breaks off and travels to the lungs where it blocks blood flow leading to lung damage or even death.
Nearly 500,000 Americans will get a deep venous thrombosis (DVT) this year and up to 100,000 will die from a resulting pulmonary embolism (PE). To put this into perspective, that is equal to the number of deaths caused by prostate, breast and colon cancer combined. One-third of those survivors will be left with long-term health problems. For some people, a DVT or PE may be a singular event. However, having even one DVT or PE means you are at an increased risk, and about one-third of these people will have another occurrence within 10 years. Men are also three times more likely than women to have a recurrence.
How do travel-associated DVTs and PEs occur?
Sitting immobile in cramped positions for long periods of time is the most significant determinant in the development of travel associated DVTs and PEs. Because this is a common occurrence on long flights, the condition has been popularly called the Economy Class Syndrome. Lack of muscular activity, particularly in the legs, allows blood to pool in the lower extremities and promotes the formation of blood clots. For otherwise healthy individuals, the risk of developing a travel-related blood clot is relatively low. Your level of risk depends both on the duration of travel and if you have any additional risk factors. These risk factors include such things as age (risk increases after age 40), obesity, smoking, recent surgery or trauma, use of estrogen containing contraceptives, hormone replacement therapy, active cancer or recent cancer treatment, limited mobility (e.g. leg cast), varicose veins, any clotting disorders, previous history of a DVT or PE or history of a DVT or PE in a close family member. Many people who develop travel-associated blood clots will have one or more of these risk factors. If you have any of these risk factors, speak with your doctor well in advance of your next trip to see about any special precautions or medication you should take.
Despite the common term, Economy Class Syndrome, DVTs or PEs are not specific to airplane passengers or riding in economy seating. In fact, they can occur following any prolonged period of inactivity. That being said, there is recent evidence suggesting that reduced oxygen levels and reduced air pressure found on commercial flights may also contribute to the formation of blood clots.
Prevention of DVTs and PEs
The single most important step you can take to prevent the occurrence of a travel associated DVT or PE is to keep moving. Get up and walk around at least once every hour and perform in-seat exercises such as ankle circles, foot pumps, leg raises, shoulder rolls and thigh stretches, every 30 minutes or so. Many airlines also provide helpful advice in their in-flight magazines on exercises that you can do while seated during a long flight. Try to get more comfortable seating (bulkhead, aisle, emergency exit seating, business class, first class or extra leg room seating), and leave ample room for your feet underneath the seat ahead of you. In addition, be sure to drink plenty of water, limit alcohol consumption, wear comfortable shoes and avoid tight-fitting clothing.
Conclusions
When it comes to reducing your risk of travel-associated DVTs and PEs, prevention is definitely the best medicine. Move around often, stay well hydrated and, if you have known risk factors, talk to your physician about additional measures you can take. Knowing the symptoms of a DVT or PE and seeking prompt medical attention can also reduce the likelihood of long-term complications, or possibly save your life.
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Reduce Your Risk of Developing a DVT or PE
- Wear comfortable shoes and loose-fitting clothes
- Wear proper fitting compression or flight socks
- Do anti-DVT exercises every half hour
- Walk around at least once every hour
- Stay well hydrated
- Avoid drinking alcohol or taking sleeping pills
- Keep the space under the seat in front of you empty so you can exercise your feet and ankles
- Try to get seating which will be less cramped (bulkhead, aisle, emergency exit seating, business, first class or extra leg room seating)
- Be careful about leg rests that compress calf or behind the knee
- If you have any risk factors for deep-vein blood clots, such as a previous DVT, consult your doctor for additional recommendations
Warning Signs of a DVT
- Swelling/pitting edema in the affected limb
- Gradual onset of pain, tenderness or muscle cramping which gets worse with time
- Increased warmth in the affected limb
- Dilated superficial veins
- Skin discoloration (Redness or Bluish discoloration)
Warning Signs of a Pulmonary Embolism
- Sudden or unexplained shortness of breath
- Coughing up blood
- Sharp chest pain, particularly when taking a deep breath
- Rapid pulse
- Heart palpitations
- Fainting, dizziness or collapse
- Sweating
- Anxiety
- Rapid breathing
Please note that the information contained within this article is not intended to take the place of qualified medical advice or treatment. Both DVT’s and PE’s are serious and potentially life-threatening medical conditions. You are urged to take appropriate precautions and immediately seek qualified medical attention in the event that you suspect you have a DVT or PE.
