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Dying in vein

Up to 85 percent of endurance athletes are at risk of dieing when flying SAYS SHAUN HORROCKS

You’re on your way home from a race, and what a race it was, you pushed yourself beyond your limits, smashing your personal best, you feel great, the bruises and the scrapes are testament to your effort and you wear them with pride. You feel invincible. Those celebratory drinks numbed the pain for a while but now in the early morning light at the airport maybe you think to yourself that you might have overdone it last night, but what the hey, you had reason to celebrate and a couple of extra drinks aren’t going to kill are they? How wrong you are,

Breaking into the headlines a few years back in a media frenzy, DVT under the dubious name of “economy class syndrome” is potentially a deadly blood clot that forms in the deep veins of the calf or thigh. One in every hundred people who develop DVT dies from complications, arising if the clot dislodges and travels to the heart, lung or brain. Those lucky enough to have the clot diagnosed early face a long and protracted recovery. No one can be certain who is at risk from blood clots forming while in flight, but alarming new research shows that endurance athletes are at greater risk of developing this life threatening injury.

Once associated with long haul travel flights, recent research conducted by the British Health Authority ascertained that a flight of four hours is long enough to develop a blood clot. This concurs with another survey by The World Health Organisation (WHO) who found that one in every 6000 passengers travelling for four hours or more has the potential to develop DVT.

Studies undertaken by a health based website www.airhealth.org, show that a staggering 85percent of the victims were athletes and in particularly endurance athletes. Why? Your fitness now may be your enemy with a lower resting heart rate and a slower blood flow. Blood platelet’s can converge on narrowings in veins to form the beginnings of a clot. Being dehydrated from the race plus the diuretic effects of the celebratory drinks, your body is in desperate need of fluid. The cuts and bruises you wear so proudly, the tiny micro tears in the muscles that have not yet healed can all promote clotting. Then add in the effects of flying, being crammed into a tiny seat, that are so common on Asian carriers. The diuretic effects of flight, and more importantly the cabin pressure., blood chemistry studies conducted by Dr’s Bendz' and Schobersberger show that altitude causes pro-clotting factors to increase as the blood becomes more viscous. You are well on your way to becoming a victim.

You are vaguely aware about DVT but this is a short haul flight, so you sit back and relax, knowing your should really try to stay hydrated in flight, you asked for some water and received a few drops of tepid liquid in a small plastic cup from a harassed flight attendant. Then the seat in front of you reclines literally pinning you in your seat. After a few pushes on the seat in protest you give up and try to grab some of that much needed and well earned sleep. You awake, body contorted and stiff, feeling groggy you must have been out cold for two hours. The plane is approaching its final descent. You say your goodbyes to your fellow competitors a job well done.

A study by Dr Belcaro in the LONFLIT papers found that 4.5per cent of air travelers had clots, many people get tiny blood clots during flight that do not form into DVT and dissolves naturally over time. Known as the silent killer, symptoms rarely reveal themselves immediately and can take as long as ten days to develop, (see side bar for symptoms.) If you have cramp on the plane it could be too late.

A few days go by and one of your calves seems a little stiff as if you are suffering from a cramp or a pulled muscle behind your knee, you ignore the pain knowing in a few days it will be gone, and consider maybe getting a message. The next day the pain has intensified your leg is slightly swollen and warm to the touch. Something definitely is not right.

Often misdiagnosed in its early stages, especially in athletes who are used to a certain amount of minor ache and pains. Mismanagement of DVT can be deadly. That massage you were going to have could have broken the clot away resulting in either a pulmonary or cerebral edema. Ice packs constrict blood vessels giving the clot a chance to grow. Only the correct medical attention will save you.

You go to your physician who on seeing the size of your leg does the right thing and orders an ultrasound, the only true way to confirm DVT. Its good news and bad news, you have a clot behind your knee in the popiteal vein, its treatable and if all goes well you may be able to make a full recover and be racing again in six months or so, no one is certain. But for now you must be stabilized and started on medication immediately. You are admitted into hospital, immediately blood is taken and you’re started on anticoagulants, injections of heparin into the stomach twice a day for a week and warfarin (rat poison) that you will need to take for at least six months. These drugs do not dissolve the clot, it merely make your blood so thin that it will not co or allow the existing clot to grow. The clot will dissolve naturally by the bodies own chemicals over time.

Preventing it

So what could you have done to prevent this from happening? Mobility and hydration seem to be the key factors to avoiding DVT. Some airlines on long haul flights now inform passengers of the risk but package it softly as in-flight exercise, but it’s still a step in the right direction. Flex your toes and ankles on a regular basis this will work the calve muscle, get up frequently, stretch and walk around even at the costs of some black looks. You could have also wear flight socks a graduated compression sock that is tighter around the ankle so that blood is forced back to heart. If sleep is unavoidable, and you don’t have the luxury of the new flat beds in first class or you cant elevate your legs, only take cap naps. As for hydration, you should have known better you’re an athlete. Drink at least one cup of water an hour, avoiding alcohol and caffeine. A Japanese study has proven that by drinking electrolyte drinks during a flight then the chances of getting a clot is greatly reduced. In the study forty test subjects took a nine hour flight, half drank water the other drank electrolyte drinks. Blood tests performed on landing showed that the ones who drank the water had an increased blood viscosity in the lower legs where clots can form, where as the ones that drank the electrolyte did not.

Your lying in your hospital bed confused and depressed, you feel fine apart from your damn leg. The doctor has just informed you that you must have bed rest with your leg elevated on a pillow so not to a aggravate the injury and to ease some of the pressure from your veins. The drugs they started you on have effectively made you an enforced hemophiliac so no contact sports or playing with sharp objects for the course of the medicine. And as for mountain biking that just brought a laugh from the doctor. When can you go home? “Well that all depends on how long it takes to make you stable, for now just think yourself lucky your alive.”

 

Need to know

SYMPTOMS
Symptoms of DVT can range from mild to severe, but diagnosing it early is essential. If these symptoms present themselves within 2 – 4 days consult a doctor


• Sudden swelling in lower leg
• Cramps
• Localized tenderness
• Heat
• Bruising or discolouring of skin
• Distended veins

A far greater risk is if the clot dislodges and becomes a Pulmonary Embolism, symptoms are:


• Shortness of breath
• Hyperventilating, panting
• Chest or and shoulder pain
• Fever
• Coughing up blood

WHEN FLYING BE PREPARED
Wear flight compression socks, take along a couple of bottles of electrolyte drinks (if at all possible, what with new airline policies on liquids) for the journey and keep moving. Pre flight you may want to consider a small dose of aspirin for a week prior to flight this will help against superficial clots from forming but not venous clots

GOOD NEWS FOR ASIANS
It seems to be a purely caucation phenomena it is very unlikely if you are asian that you will suffer from the disease.

FURTHER READING

www.Airhealth.org

Is one of the most comprehensive websites on travel related DVT.