DVT : Flying without dying

Patrick Middleton (who’s had it) takes a realistic look at Deep Vein Thrombosis

The scare over DVT, as Deep Vein Thrombosis is usually called, has blown up over the few years. Discussion has sometimes had a wildly alarmist tone, summed up by my title which was intended to get you reading. I found out about the condition after I had flown into Sydney on my annual trip to Australia. The next day, jet-lagged but otherwise feeling fine, I set out on my usual Sydney refresher, a brisk walk around the Botanic Gardens. Towards the end of my two-hour circuit my left leg felt a bit painful but I got through the rest of the day without trouble and, after a harbourside dinner with Lucienne Joy (remember her?), I went to bed.

“The risk is always there…”

I awoke at about 02h30, early even for me. I realised that that same left leg was now badly swollen, very painful and unpleasantly discoloured. I got out of bed and immediately fell over. I rang the concierge and told him my problem. “Sounds bad, mate. I’ll call a cab and you’d better get round to St. Vincent’s.” Within 30 minutes I was in the emergency room at Sydney’s best known public hospital—and I had quickly learned that I had a clear case of DVT. I stayed in for the rest of the night and on the following day I had a battery of tests and injections and was prescribed medication for the rest of my stay and the homeward journey. One of the several doctors who looked after me explained how DVT usually happens: during prolonged immobility, as during a flight, blood gathers in the lower legs, coagulates and so a clot forms. Death can occur if this fragments and part of it moves into the lungs and causes a pulmonary embolism.

The common view of DVT is misleading in several ways. This has it that overwhelmingly at risk are those over 50, travelling long-haul and in Economy. Not so. Research prompted by press-led alarm over the condition has contradicted each of these points. Around half of all victims are under 40 (some very much younger), a significant number have been travelling in front cabins (I was in Business) and one recorded case in six has concerned a short-haul passenger. Conclusion: the risk, as when crossing the road, is always there.

“Taking precautions”

Certainly, it is greater for some people than for others. It remains true that older fliers seem more likely to suffer, especially if they have a history of circulatory problems; there also seems to be a greater risk for those who’ve recently had surgery or undergone aggressive anti-cancer therapy. Women are more prone to DVT than men, and particularly if they are taking the contraceptive pill or receiving hormone replacement therapy. To assess your own risk factor you can look at a useful website at www.travel-medicine.info. This confirmed what I’ve been told by my cardiologist that my tendency to high blood pressure—happily, now yielding to treatment—makes long-haul flying inadvisable for a while. Incidentally, airlines are often accused of seeking to ignore the problem. British Airways, however, is widely regarded as doing a very good job on this score with its website—www.britishairways.com—which covers risk, symptoms and avoidance. 

When you read one of those DVT press reports—like that of a 30-year old U.K. policeman who died suddenly after flying home from his honeymoon in Hawaii—you might well feel like taking precautions. And so you should. First, avoid flying with carriers who offer an absolute minimum of seat-space to their passengers. The worst offenders are charter companies, notably Monarch and My Travel (neither fly into Nice, mercifully) whose aircraft have been described as “flying torture-chambers.” Among a handful of airlines especially generous in terms of cabin roominess, I’m glad to find Malaysia which has some good long-haul fares priced from Nice. Next, it’s worth checking out your degree of risk, if necessary with a doctor. Cardiologists are especially savvy about this.

“Most people survive”

If you are at risk you can get an anti-coagulant product (including some presenting in self-injected form) for use before, during and after the flight. Aspirins, I’m told, aren’t always adequate. Another common recommendation is the wearing of compression stockings. On board, it’s important to avoid prolonged immobility, but the advice to walk about a lot is not always easy to follow and cabin crew are usually unhappy with persistent wanderers. In-seat exercises (BA hands out instructions on these) are helpful but, for some, tiresome. Dehydration doesn’t help, so lay off the booze and drink a lot of water. If, despite all this, you end up with the symptoms described don’t panic. Most people survive. Get round to a hospital fast, preferably St. Vincent’s…

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