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Jewish World Review April 19, 2001 / 26 Nissan, 5761

Michael Woods

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Consumer Reports

How to avoid blood clots on long trips -- MILLIONS of people who take to the air and roads for long summer vacation trips should be aware of a potentially deadly health threat misnamed "economy class syndrome" (ECS).

It involves formation of blood clots in veins in the legs after sitting for long periods. The clots may travel through blood vessels to lodge in the lungs. The result: A pulmonary embolism, which plugs a blood vessel in the lungs and damages lung tissue.

A variety of medical problems can cause such a blood clot, called a deep-vein thrombosis (DVT), aside from long periods of sitting. Almost 900,000 Americans develop DVTs annually, and 70,000 die.

Nobody knows how many result from extended periods of sitting during travel. Estimates range from 5 percent to 60 percent of the total.

ECS got its name years ago after doctors found a link between blood clots and sitting in the cramped economy class seating on long-haul airline flights.

Muscle contractions in the legs during walking squeeze blood vessels and helps to move blood back to the heart. Sitting for hours without exercising those muscles allows blood to collect or "pool" in the leg veins. Clots may form in the stagnant blood.

Sitting or lying down for long periods anywhere - not just in an airplane - can increase the risk of DVT. Doctors in some cities, for instance, see an increase in DVT almost every spring. It occurs as retirees who wintered in the south or southeast take long automobile trips back to northern cities.

Newer studies question whether passengers in economy class really do have a higher risk of blood clots than those in business class or first class. Nevertheless, airlines take the risk seriously. Some - including British Air, Quantas, Japan Airlines and Cathay Pacific - now warn passengers on long-haul flights about DVT, and offer advice on prevention.

People who are at high risk for DVT should pay special attention. Included are individuals with obesity, diabetes, heart disease, cancer and recent injuries (such as severe sprains or bruises) to the lower limbs. People over age 60 also are at higher risk, along with pregnant women and women who smoke cigarettes and take birth control pills.

How can travelers reduce the risk? Here's advice from the airline medical experts:

- Drink plenty of non-alcoholic, caffeine-free fluids before and during the flight to prevent dehydration that can thicken the blood.

- Don't sleep for long periods unless you're in premium seating that allows stretching and elevating the legs. Even then, have someone wake you every few hours.

- Avoid sitting with the legs crossed for long periods.

- Stand up and walk whenever possible.

- Every hour or so do a few minutes of simple exercises that activate the calf muscles and help push blood through the veins.

One involves extending your legs straight out. With heels resting on the floor, flex the ankles by pointing your toes as far up toward your knees as possible. Then point toes toward the floor.

An alternative exercise if there's no room to extend the legs is just as simple: Put feet flat on the floor, and press down with the balls of your feet while raising the heels. Then with heels on the floor, raise the balls of your feet.

People on long automobile trips should follow the same advice, and also make frequent rest stops to walk and stretch the legs.

In addition, be aware of symptoms of deep-vein thrombosis, which may appear days after prolonged travel. They include sudden pain, cramping, or swelling in one lower leg.

If symptoms occur, check with the doctor and mention that you've taken a long trip and suspect a clot.

Michael Woods writes for Toledo Blade. Comment by clicking here.


© 2001, SHNS