Training & Nutrition - If you fly ...

I'd heard about DVT long before I developed one, but I always heard they happened to a certain "profile" of people:

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Deep_vein_thrombosis
Some of the risk factors that may contribute to the formation of a thrombus include:
- Coronary heart disease
- Being overweight or obese
- Cigarette smoking
- Pregnancy
- A high dose combined oral contraceptive pill
- A susceptibility to 'stickier' blood and a family history of DVT
- Sitting still for long periods of time
- Recent surgery or injury
- Some types of cancer
- Congestive cardiac failure
- Previous thrombosis.

http://hcd2.bupa.co.uk/fact_sheets/html/Deep_Vein_Thrombosis.html#4
You are more likely to get a DVT if you:
- are over 40
- are immobile, for example, if you have had an operation (especially on a hip or knee) or are travelling for long distances - and so are not able to move your legs
- have had a blood clot in a vein before
- have a family history of blood clots in veins
- have a condition causing your blood to clot more easily (this is called thrombophilia)
- are very overweight (obese)
- have cancer or have had cancer treatment
- have heart disease or circulation problems
- are a woman taking a contraception pill that contains oestrogen, or hormone replacement therapy (HRT)
- are pregnant or have recently had a baby

http://www.nhlbi.nih.gov/health/dci/Diseases/Dvt/DVT_WhoIsAtRisk.html

http://www.virtualmedicalcentre.com/diseases.asp?did=662&page=1#Who_gets_it

And so on ... you can Google it and see site after site of the same sort of stuff.

~~~~~~~~~~
But that's not me. I don't fit the profile. I am over 40 (just), but I'm a fairly slender (within a "normal" weight range), active, non-pregnant, non-smoker who does not have cancer, serious heart issues, or any previous issues with clotting. And I was on the BCP but only for about 2 months before my DVT. I'm the one hiking up and down the airport between flights to get the blood flowing, and drinking lots of water. I didn't figure there would be any chance I would develop a DVT.

What I've begun to wonder is ... could it be that athletic people should be added to the profile? Since my DVT, I've heard of a lot of very active people who have developed DVT, and of some who have died from it.

Rowan and I have been wondering if the lower resting heart rate that athletic people develop increases the chances of blood pooling in the feet during extended periods of immobility, such as long flights.


~~~~~~~~~~
I've started doing a bit of research on this, and came across these (and other articles):

http://www.active.com/cycling/Articles/Hidden_danger__DVT_in_endurance_athletes.htm
"Did you know that 85% of air travel thrombosis victims are athletic, usually endurance athletes? [www.airhealth.org/athletes.html, July 11, 2004]"

http://www.stoptheclot.org/News/article126.htm
"Measures that the athlete and, for that matter, the non-athlete should take to minimize the risk for DVT or PE are listed in table 3. For the athlete the most important ones are probably to (a) avoid dehydration, and (b) take breaks when traveling long distances."

Unfortunately, there isn't much research being done on the athlete and DVT ... yet ... but it does appear to be an issue. There also isn't much information out there on getting back into shape after DVT and particularly while a person is still on Warfarin.


~~~~~~~~~~
So ... if you're quite active, and if you fly long distances for cycling events or other travel adventures, you are not immune to DVT. Instead, you may be more prone to it than the sedentary traveller next to you. Keep hydrated on your trip, get an aisle seat, and move around the airplane. If you do experience any sort of cramping on the flight or soon after the flight, get it checked ASAP. The sooner you get it checked and taken care of, the easier the recovery process is.

If you've got an office job where you sit for long periods of time, you might also want to get up and walk around once an hour or so. It'll burn more calories, clear your head ... and perhaps help prevent DVT.

You might be onto something with athletes and DVT.

Saying you were "only on BCP for a couple of months before" your incident doesn't mean it's not a risk factor. Certain forms of birth control are known to put you at risk for clotting disorders; my mom ended up with many pulmonary emboli at about age 30, likely from birth control. She had no other risk factors, either.

I do appreciate your efforts and discussions about this issue. Many of us are undereducated on the risks.

I don't think spending many hours in a seat on an airliner is any different from sitting for several hours on a bus or, for that matter, in front of the computer for hours and hours (which I and many others do).

Moving about in an airliner, especially one flying over areas where severe turbulence is common (through jet streams, for example) is probably a greater risk factor than DVT, since you could end up breaking your neck against the cabin ceiling in the event of a turbulence incident. When I fly, I remain in my seat throughout, with the safety belt on, and I recommend everyone else to do the same.

I'd heard about DVT long before I developed one, but I always heard they happened to a certain "profile" of people:

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Deep_vein_thrombosis
Some of the risk factors that may contribute to the formation of a thrombus include:
- Coronary heart disease
- Being overweight or obese
- Cigarette smoking
- Pregnancy
- A high dose combined oral contraceptive pill
- A susceptibility to 'stickier' blood and a family history of DVT
- Sitting still for long periods of time
- Recent surgery or injury
- Some types of cancer
- Congestive cardiac failure
- Previous thrombosis.

http://hcd2.bupa.co.uk/fact_sheets/html/Deep_Vein_Thrombosis.html#4
You are more likely to get a DVT if you:
- are over 40
- are immobile, for example, if you have had an operation (especially on a hip or knee) or are travelling for long distances - and so are not able to move your legs
- have had a blood clot in a vein before
- have a family history of blood clots in veins
- have a condition causing your blood to clot more easily (this is called thrombophilia)
- are very overweight (obese)
- have cancer or have had cancer treatment
- have heart disease or circulation problems
- are a woman taking a contraception pill that contains oestrogen, or hormone replacement therapy (HRT)
- are pregnant or have recently had a baby

http://www.nhlbi.nih.gov/health/dci/Diseases/Dvt/DVT_WhoIsAtRisk.html

http://www.virtualmedicalcentre.com/diseases.asp?did=662&page=1#Who_gets_it

And so on ... you can Google it and see site after site of the same sort of stuff.

~~~~~~~~~~
But that's not me. I don't fit the profile. I am over 40 (just), but I'm a fairly slender (within a "normal" weight range), active, non-pregnant, non-smoker who does not have cancer, serious heart issues, or any previous issues with clotting. And I was on the BCP but only for about 2 months before my DVT. I'm the one hiking up and down the airport between flights to get the blood flowing, and drinking lots of water. I didn't figure there would be any chance I would develop a DVT.

What I've begun to wonder is ... could it be that athletic people should be added to the profile? Since my DVT, I've heard of a lot of very active people who have developed DVT, and of some who have died from it.

Rowan and I have been wondering if the lower resting heart rate that athletic people develop increases the chances of blood pooling in the feet during extended periods of immobility, such as long flights.


~~~~~~~~~~
I've started doing a bit of research on this, and came across these (and other articles):

http://www.active.com/cycling/Articles/Hidden_danger__DVT_in_endurance_athletes.htm
"Did you know that 85% of air travel thrombosis victims are athletic, usually endurance athletes? [www.airhealth.org/athletes.html, July 11, 2004]"

http://www.stoptheclot.org/News/article126.htm
"Measures that the athlete and, for that matter, the non-athlete should take to minimize the risk for DVT or PE are listed in table 3. For the athlete the most important ones are probably to (a) avoid dehydration, and (b) take breaks when traveling long distances."

Unfortunately, there isn't much research being done on the athlete and DVT ... yet ... but it does appear to be an issue. There also isn't much information out there on getting back into shape after DVT and particularly while a person is still on Warfarin.


~~~~~~~~~~
So ... if you're quite active, and if you fly long distances for cycling events or other travel adventures, you are not immune to DVT. Instead, you may be more prone to it than the sedentary traveller next to you. Keep hydrated on your trip, get an aisle seat, and move around the airplane. If you do experience any sort of cramping on the flight or soon after the flight, get it checked ASAP. The sooner you get it checked and taken care of, the easier the recovery process is.

If you've got an office job where you sit for long periods of time, you might also want to get up and walk around once an hour or so. It'll burn more calories, clear your head ... and perhaps help prevent DVT.

I've been wondering about that since you first mentioned it. When I have a very high mileage year, and then start to reduce my riding, I sometimes get cramps from not riding. They seem to be more frequent, stronger, or triggered sometimes by sitting with my knees bent instead of straight out.
If I move my legs in a way that mimics the pedaling motion, the cramps will go away. ??? I wonder if the position changes the circulation?

Yes, I would imagine the position would change the circulation. When your knees are bent, you're restricting circulation.

I've been told that you've got to move your feet in order to pump the blood up your leg ... so basically, ankling ... point your toes, then bring your toes up, and repeat. If you're in a situation where you have to remain seated for any length of time, straighten your legs, and keep moving your feet.


But even better than moving the feet is getting up and walking. I'm not supposed to go on drives for longer than about 1-2 hours without stopping, getting out and walking up and down the rest area. Same with sitting at the computer. But apparently flying is even worse than being in a car/bus/train or at a computer for extended periods of time because of the altitude change.


Here's more info:
http://www.airhealth.org/athletes.html
http://www.airhealth.org/misconceptions.html

Interesting topic. I think you're onto something here. My blood pressure's low and in times of inactivity I feel like the flow slows down and blood begins pooling in my feet. I may be wrong, but I think this is what caused my pins and needles and calf troubles. My doctor said Paresthesia, in most cases, is still a mystery, but there's a theory that it's caused by a shortage of oxygen in the cells. If my blood is pooling.. less oxygen.. paresthesia (increased clot risk) although like you, I don't have any of the predisposing conditions.

I think you're right. Maybe it's that our bodies are so used to movement that when we stop for a few hours they can't cope. Whereas the chronically inactive have built up a kind of immunity to it..

I don't think spending many hours in a seat on an airliner is any different from sitting for several hours on a bus or, for that matter, in front of the computer for hours and hours (which I and many others do).

It is actually a little different at altitude. The air pressure is lower (even with a pressurized cabin), and the air is very dry. Dehydration is a big problem when flying.


Moving about in an airliner, especially one flying over areas where severe turbulence is common (through jet streams, for example) is probably a greater risk factor than DVT, since you could end up breaking your neck against the cabin ceiling in the event of a turbulence incident. When I fly, I remain in my seat throughout, with the safety belt on, and I recommend everyone else to do the same.

Do you have any statistics around serious injury from turbulance? I've flown many millions of miles (it's part of my job), and I wouldn't be suprised if more people get injuries from turbulance than experience DVT, but I'd guess that most of those injuries happened with the seat belt light on, and they are seldom serious (I don't have stats either, just a guess). I've only been a couple flights in all my years with turbulance that would really throw a person around the cabin to cause life-threatening injuries. On those flights, we had plenty of warning and believe me everyone was strapped in before the bad stuff (during which most of the plane was crying and praying). What I do see all the time are people that completely ignore the fasten seat belt sign and move around during mild turbulance, which results in a possible injury, especially if the turbulance gets worse.

Sorry if I come across as argumentative, I just think your advice to stay seated at all times is mis-guided and it's better to get up and stretch your legs when you have a chance (just like the airlines recommend).

The idea that endurance athletes might be at higher risk is certainly interesting. I'll definitely make more of a point to stay hydrated and stretch my legs in the future.

The humidity of the air in an airliner cabin is equivalent to that experienced indoors during winter (at least here, ca 15-25 %rel). I can't see how pressure would have any effect on blood clotting over such short durations (when exposed to lower pressure, and thus oxygen, the body responds by increasing platelet count to enable the blood to hold and transport more oxygen, but that doesn't happen that quickly). Cabin altitude is limited to 2400 m/8000 ft by international regulations, so it's not extremely high. Some new airliners will have even lower cabin altitudes at typical cruise altitudes.

I just think your advice to stay seated at all times is mis-guided and it's better to get up and stretch your legs when you have a chance (just like the airlines recommend).

The idea that endurance athletes might be at higher risk is certainly interesting. I'll definitely make more of a point to stay hydrated and stretch my legs in the future.

+1

I didn't take the whole getting up and moving around thing seriously ... after all, I'm not overweight, sedentary, and old. And yet, 16 hours into a 17 hour flight I developed DVT. And believe me you DO NOT want to develop DVT. Not only did it come close to killing me, but I've been fighting with it for 7 months now, and am only just now starting to get my cycling strength back. I'm excited now when I can do a 50 km ride ... where pre-DVT I was knocking off 150+ km rides with no problems at all.

And apparently I'm one of the lucky ones because DVT did not kill me, and I don't appear to have ongoing vein damage.


Now obviously, if there's a lot of turbulance and the seatbelt sign was on, you would want to remain seated. But most flights aren't turbulant all the time ... and if there was an extended period of turbulance, then you'd do the foot exercises I described above where you point your toes and bring your toes up to stretch your calves and get the blood flowing.

The sad thing is that CAT can strike suddenly and without much warning, if any. And when it does, if it's strong enough, you could end up with your head striking the cabin ceiling, breaking your neck (yes, that has happened and will happen again).

Read more about CAT here: http://en.wikipedia.org/wiki/Clear-air_turbulence

The sad thing is that CAT can strike suddenly and without much warning, if any. And when it does, if it's strong enough, you could end up with your head striking the cabin ceiling, breaking your neck (yes, that has happened and will happen again).

Read more about CAT here: http://en.wikipedia.org/wiki/Clear-air_turbulence

Again, I think you are ignoring the statistical likelyhood. Your link points to a single death 13 years ago from a very unlikely (although possible) event. Compare that to over 2,000 DVT flight-related deaths every year in Britain alone from people flying into Heathrow (just did a quick search).

Are you seriously suggesting that 2000 people passing through Heathrow airport die from DVT every year? That's an insanely high number! If that were true, I think the civil aviation authorities would impose severe health restrictions on air travellers immediately.

I don't know, or know of, anyone among my relatives, friends and acquaintances having even had DVT, let alone died from it.

And again, people are seated for just as long, in comparable environments at work, and DVT seems absent from there. No, I simply don't think this is as big an issue as you're trying to make it.

Are you seriously suggesting that 2000 people passing through Heathrow airport die from DVT every year? That's an insanely high number! If that were true, I think the civil aviation authorities would impose severe health restrictions on air travellers immediately.

I don't know, or know of, anyone among my relatives, friends and acquaintances having even had DVT, let alone died from it.

And again, people are seated for just as long, in comparable environments at work, and DVT seems absent from there. No, I simply don't think this is as big an issue as you're trying to make it.

No actually I thought that number was crazy high also, but my point is that it's a much, much bigger number than people that die from turbulance. Unfortunately, the news media loves the turbulance stories (almost like a crash), but DVT isn't that dramatic (just someone's health issue). And yes, I personally know 2 people that have had DVT bad enough to go to the hospital after flying and have met several others while flying (of course, I fly a lot and I'm typically sitting next to other people that fly a lot).

Take a look at the following link. I know these are 'internet' numbers and there are inconsistencies between them, but it would be hard to argue that there are not hundreds or thousands of people that die each year from DVT worldwide related to airline travel. I really believe you are way more likely to have significant medical issues from DVT than a significant health issue from turbulance (even if you ignored the fasten seat belts sign). As they say, we can agree to disagree.

http://old.disinfo.com/archive/pages/article/id942/pg1/index.html

Excerpt:

Frequency

Flight-related DVT is not being studied systematically, so it's difficult to tell how many people have been affected by it. According to The Age of Melbourne, Australia, some studies report that every year 30,000 people die from flight-related DVT around the world.

At the beginning of this year, Ashford Hospital in Surrey released a report estimating that at least 2,000 people die of flight-related DVT each year in Britain alone. In fact, DVT kills at least one person per month at London's Heathrow airport.

The Aviation Health Institute estimates that every year in the UK 30,000 people develop DVT--mostly non-fatal cases--because of flights.

In December 2000, a doctor at the Nippon Medical School clinic at Tokyo's Narita Airport said that 25 people--including an American pilot�have died from DVT at the airport in the past eight years. In addition, 100 to 150 people are treated for the condition every year at the airport.

The actual number of people who developed flight-related DVT is likely to be much higher, especially if the clot doesn�t result in death. Many articles on the subject quote medical authorities who note that clots may not make themselves known till days, weeks, or longer after a flight. Plus, even if the person sees a doctor, the connection to air travel may not be uncovered.

The US government doesn't keep statistics and no nationwide studies have been done, but the Airhealth.org Web site has extrapolated some figures.

We do know that each year 800,000 people are hospitalized with blood clots, and an additional 70,000 die. If we take the lowest rate of flight-related DVT found in the studies--5 percent of clot patients (mentioned above)--that still equals 40,000 people hospitalized and 3,500 dead each year in the US due to blood clots formed on airplanes.

Remember, that's a conservative estimate

And yes, I personally know 2 people that have had DVT bad enough to go to the hospital after flying and have met several others while flying (of course, I fly a lot and I'm typically sitting next to other people that fly a lot).

Flight-related DVT is not being studied systematically, so it's difficult to tell how many people have been affected by it.

Many articles on the subject quote medical authorities who note that clots may not make themselves known till days, weeks, or longer after a flight. Plus, even if the person sees a doctor, the connection to air travel may not be uncovered.

The US government doesn't keep statistics and no nationwide studies have been done, but the Airhealth.org Web site has extrapolated some figures.


It is hard to get accurate statistics on DVT because people don't die or look seriously injured or whatever right there on the airplane. In my case I thought my left calf had cramped from sitting for so long. It was 6 weeks later before other symptoms showed up to make me think it was not a cramp after all. I put it together, that it came from flying, because I knew when the symptoms started, but some people don't have symptoms. All of a sudden one day they are coughing up blood and are diagnosed with a pulmonary embolism. If that happens a month or two after a flight, the connection might not be made.

And since I've developed it, I've met numerous other people who have had DVT too, mostly flight related.

They've actually got a name for it: "Economy Class Syndrome" ... although apparently people in First Class are just as affected by it.

http://www.economyclasssyndrome.net/howbadisdvt.html
http://www.americanheart.org/presenter.jhtml?identifier=3010041



CdCf makes the comment, "And again, people are seated for just as long, in comparable environments at work, and DVT seems absent from there." ... which is not true either. People who sit too long can develop DVT too. But in a work/office environment you are encouraged to get up and move around. You get up to make yourself a cup of coffee. You get up to go to the toilet. You get up to go get something off the printer. You get up to talk to a coworker about something. You get up to go for lunch. Etc. Etc. You don't come in to work at 8 am, and sit at your desk till 4 pm.

But on a flight, that can happen. I've done it, I've observed other people doing it. They get onto the flight, they are served their meal, they go to sleep ... and they don't get up and move around at all for 8+ hours. On a 15-hour Sydney to Vancover flight I sat next to a guy who did not move from his seat the entire flight. I consider him very, very lucky if he didn't end up in hospital a few weeks later.

I'm not suggesting (and neither is all this information) that we should pace the airplane for 15 hours, but rather that if we take flights that are more than just a few hours long, that we should get up every 1-2 hours and walk to the toilet or do a lap around the plane or whatever ... just like we would if we were in an office job.

But I am suggesting that it may be particularly important for those of us who have lowered our resting heart rates through exercise to get up and move around periodically and/or to pump the blood in our legs by moving our feet (as described in an earlier post).

On average, there are only 60 in-flight injuries per year caused by turbulence. It does happen but not in the same numbers as DVT. Consider a low-dose Aspirin regime about a week before an extended flight. DVT's are also not as deadly as being portrayed here. They happen frequently and are successfully treated frequently. It is best to avoid them by performing exercises as described above. Stay seated and stretch when you use the restroom.

They happen frequently and are successfully treated frequently.

Apparently if you figure out you have a DVT and get it treated within a week or two of developing it, the recovery process if fairly quick. But if you wait, like I did, they can still be successfully treated, but it takes a long, long time. It's been 7.5 months since I developed mine and I'm still struggling with it. I still have one clot (which is a vast improvement), but it is a long uphill battle getting back to where I was last May pre-DVT.

When I had the ultrasound diagnosing the clots (my left calf was chock full of them, and I had one behind the knee and a large one in the thigh completely blocking a vein), I spent 14 days in hospital getting abdominal injections ... 25 injections in total. After about 4 or 5 days in the hospital, the nurses got me up to go walking. I made it around the block that day, but it took forever. I could walk about 20 steps before I had to stop and regroup and rest and then begin walking again. Very gradually I built up and on New Year's Eve Rowan and I walked about 5-6 km quite briskly. In September, I got back on the bicycle again, and my first 6 km ride felt like a strenuous 60 km ride. Very gradually I built up and am now doing 50 km rides fairly comfortably. But I still can't hop on the bicycle and do the long distances I used to be able to do.

And I have to visit the Dr (84 km round trip) about once every 2 weeks to get my INR levels checked because I'm still on Warfarin and because I still have one clot left. Until that clot is gone and my INR levels have finally stabilized for a couple months, I will remain on Warfarin, and I will make the regular visits to the Dr.

I'm not sure if it is just that I'm out of shape, or if the clot is still causing problems or if it is the Warfarin, but I get tired much more easily than I used to, and I find it harder to do the things I used to do.

So yes, DVT can be successfully treated ... I'm sure one day mine will be categorized as a successful treatment. And it hasn't killed me, fortunately, although the Drs and nurses told me if I'd waited much longer there was a good chance it would have. But meanwhile it has taken a 7.5 month (and counting) bite out of my life.


Even if they are not as deadly as being portrayed by the statistics posted here (and I suspect the 2000 deaths a year attributed to flight-related DVT is accurate), they can still be very big problem for a person who was normally very active and would like to remain so. Not too many cyclists I know would be too happy about giving up or cutting way back on their cycling for half a year or a year.

The point of this thread is not to make people believe that if they fly they are going to die of DVT, the point is, however, to raise awareness that DVT does not just happen to the "profile" people ... the overweight, old, and sedentary crowd. It happens to those of us who are in shape too, perhaps just as often as it happens to the overweight, old, sedentary group. Because we cycle a lot, we are not immune to DVT ... we may even be more prone to developing it.

I would like to see more studies done on athletes and DVT, and if anyone here knows of any, please post a link.

~~~~~~~~~~~~
Now about aspirin ... I was under the mistaken impression that ibuprofen had the same effect as aspirin, so I took ibuprofen before and during my flight. But I was wrong. When they say to take aspirin, they mean aspirin.

Being well hydrated is a good idea as well. Not only does the hydration help, but you'll have to get up to go to the toilet more frequently ... like once every 1-2 hours or so, and that helps too. :)

I fly for a living and did have a nasty encounter with a DVT as well. My big problem was related to coumadin so please be careful while on it Machka! I hope you have a full and complete recovery. I feel for you.

Hi, Machka. I just saw this thread and wanted to send you best wishes. DVT is very scary, I read something recently claiming that sitting at work for long periods can be dangerous as well. My family has a long history of vascular trouble, so it's something I worry about. I've never been able to sit still on flights of just 2-3 hours because my feet and legs start to swell and hurt. If I can't walk around due to turbulence, I do calf raises and lift myself off the seat several times using my legs. I also get hydrated and stay away from alcohol.

10 years ago my then girlfriend started using birth control that lasted six months. It was one of the implant devices. She developed clots and her friend had issues as well. Both were only 18 at the time. I think that the risk of blood clotting is higher with the long-term products being offered, though I haven't any studies to back it up.

Hope you've been able to otherwise enjoy your endless summer!

I fly for a living and did have a nasty encounter with a DVT as well. My big problem was related to coumadin so please be careful while on it Machka! I hope you have a full and complete recovery. I feel for you.

What problem was that? So far it just seems to be making me more tired than I usually am.

I'd actually like to see airplanes install handles on the sides of the seats and poles periodically along the way, like they have in transit busses, to allow people to walk a bit and hang onto something.

I'd also like to see the airplanes on the long-haul flights have a standing area ... like a small collection of narrow, shallow booths where you could go and stand, leaning against the back of the booth, and perhaps harnessing yourself in if it got turbulant. You could stand there for a while and read or watch TV or whatever ... just something for a change of position. The flights between NA and Australia are so long ... usually about mid-flight I desperately want to do something other than just sit there.

But ... I don't suppose there's really any chance they'll do that.

What problem was that? So far it just seems to be making me more tired than I usually am.

It is a long story but I was taken off the flying roster for 3 weeks while my INR was stabilized. I then went on a 10 day trip during which I became quite fatigued as well. Other symptoms started showing after about a week and when I went home, I drove straight to a hospital for a blood test. My INR target was 3.0 and my actual was 13.3. I had also developed a large GI bleed. I collapsed shortly after having the test and had lost about 60% of my blood.

5 days and 17 units of plasma later, I was discharged but felt horrible for 6 months.

Watch for internal bleeding, It is quite obvious!

I'd actually like to see airplanes install handles on the sides of the seats and poles periodically along the way, like they have in transit busses, to allow people to walk a bit and hang onto something.

I'd also like to see the airplanes on the long-haul flights have a standing area ... like a small collection of narrow, shallow booths where you could go and stand, leaning against the back of the booth, and perhaps harnessing yourself in if it got turbulant. You could stand there for a while and read or watch TV or whatever ... just something for a change of position. The flights between NA and Australia are so long ... usually about mid-flight I desperately want to do something other than just sit there.

But ... I don't suppose there's really any chance they'll do that.


Like bicycles, weight is everything when it comes to economics of flight. I quite like the idea and installing horizontal grab bars under the overhead bins wouldn't be difficult but it would add weight and expense.

Certification by the feds would also be a huge issue. There used to be standing space in some long haul aircraft but they were again seen as too much expense for too little benefit. I remember people standing at a bar smoking on some international flights.

Liability is also huge these days so when turbulence is encountered, the seat belt light cmes on.

The latest threat of terrorist activity has also added impetus for restricting passengers to seats.

Good thoughts but I am afraid you are correct, it won't happen.

But ... I don't suppose there's really any chance they'll do that.

Yeah they don't give a damn. If they did, they'd put wire mesh over the engines to stop birds getting sucked in. Although life saving it'd cost them more in fuel..

machka

i think you'll be on an endless quest if you are looking for an answer to why it happened to you. all these studies and statistics will never explain the actual cause and things like cardiovascular disorders are just not fully understood. whenever they say a typical high risk person is like this, there will always be a not insignificant proportion of non-typical victims too. trying to find an anwswer can become a source of frustration.

I'm not so much looking for an answer to why it happened to me ... I have a pretty good idea about that ... it's more that since I developed DVT I've become aware of a lot of fit, athletic people who have also developed DVT and both Rowan and I began thinking that perhaps it wasn't just a coincidence. It may make sense that our lower resting heart rates might not allow the blood to be pumped back up the leg as quickly and efficiently as someone whose heart rate is higher.

Anyway, I'm hoping this might also raise awareness among those who fly long distances to tour or to go to cycling events. There will be a whole crowd of people heading to France for the PBP in 2011, for example. Even if we are fit, we are not immune to DVT ... and DVT can take quite a chunk out of the lives we would like to live.

And now you have me scared. I've recently had a couple of accidents (skiing, not biking) and have been sitting for unusually long periods, though never for more than 1-2 hours. Now I've developed weird cramping in my right quad - like 10% of the muscle and always in the same place, and usually after I just get up from sitting and go down stairs. Never had anything like it. Seems to be getting worse. I'm trying to get back to it and have started doing easy roller rides and it even cramps on the rollers, though I can ride through it. This morning I went for a walk and it cramped then, too.

I've had cramps and pins and needles for a while now. Slightly worried about what's going on as well.

Genetics must play a part. Poor circulation runs in my family. My mother's hands go white when it's cold. My feet go pale and icy cold when I stop exercising. I need rest to heal the tendons, but movement to get blood to them :/

I suppose it's everything in moderation, seems like the healthiest option.

And some alcohol to thin the blood. Maybe that'd help circulation on the long haul flights, providing you weren't dehydrated.

If you're really curious consult this article.

Eur J Vasc Endovasc Surg. 2004 Jul;28(1):1-8.
Non-traumatic lower limb vascular complications in endurance athletes. Review of literature.
http://www.ncbi.nlm.nih.gov/pubmed/15177226?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=3
Ehsan O, Darwish A, Edmundson C, Mills V, Al-Khaffaf H.

Department of Vascular Surgery, Burnley General Hospital, Burnley, Lancashire, UK.

OBJECTIVES: To review the importance, clinical features, investigations, management and prognosis of non-traumatic vascular injuries, affecting the lower limbs of endurance athletes. DESIGN: Review of literature. MATERIALS AND METHODS: A literature search was conducted from Medline, Pubmed, the National Electronic Library for Health, Google and Yahoo search engines for related articles and case reports regarding non-traumatic vascular complications involving the lower limb of endurance athletes. CONCLUSIONS: Non-traumatic vascular complications affecting the lower limbs include endofibrosis, stenosis/kinking of iliac arteries, dissection of external iliac artery, adductor canal syndrome, popliteal entrapment syndrome, chronic exertional compartment syndrome and effort-induced venous thrombosis. These are important as they affect athletes at the peak of their career and can be confusing to diagnose. The management is relatively well documented and produces good results in short term but the long term results are not known.

Do you have to pay for the full article?

I couldn't find a way to download it.

I've had cramps and pins and needles for a while now. Slightly worried about what's going on as well.

Genetics must play a part. Poor circulation runs in my family. My mother's hands go white when it's cold. My feet go pale and icy cold when I stop exercising. I need rest to heal the tendons, but movement to get blood to them :/

I suppose it's everything in moderation, seems like the healthiest option.

And some alcohol to thin the blood. Maybe that'd help circulation on the long haul flights, providing you weren't dehydrated.

Alcohol dehydrates which is what you don't want. Take a low dose Aspirin (acetylsalicylic acid) daily until you can see a doctor for an Ultrasound.

On genetics, I would also recommend a Leiden Factor 5 ( http://en.wikipedia.org/wiki/Factor_V_Leiden )blood test to determine if you have a clotting tendency.

there are a whole bunch of anti clotting foods which basically work by making the platelets tend to stick together less. A few examples are onion, garlic, cinnamon, black grapes, cayenne pepper, apple cider vinegar, green tea etc. there are a lot more. may well improve circulation generally. but if you are feeling the pins and needles, don't delay and go see the GP. if there is a problem they can put you on preventative drugs immediately. don't assume it's nothing. assume it is something until the professionals tell you otherwise.

do some surfing for anti clotting foods and you will be surprised.

Thanks for valuable input Machka, and I hope you have a quick recovery. I went twice to Hawaii (from Norway) this last year and both times I had a bad time with my calves. Most people around seemed fine but on the long leg from LA to London I had to move around a lot because my lower legs were restless and swollen. (no alcohol on BA and I drank alot of other fluids). I also wonder if my cyclist legs are more prone to this problem and consider using pressure stockings for my next long flight.

it looks like it can happen to anybody irrespective of fitness.

some sports news today. national team level pro sportmen can get it randomly too.

http://news.bbc.co.uk/sport1/hi/football/teams/b/bolton_wanderers/8503800.stm

it looks like it can happen to anybody irrespective of fitness.

some sports news today. national team level pro sportmen can get it randomly too.

http://news.bbc.co.uk/sport1/hi/football/teams/b/bolton_wanderers/8503800.stm

One again it makes me think that fit people are quite possibly more prone to developing DVT than a) researchers etc. think they are; and b) than perhaps the "average" person who is neither obese and sedentary nor particularly athletic.

If you start looking you'll discover all sorts of athletes who have developed DVT.

And I still think it has something to do with the lower resting heart rate.

I've had chronic problems with DVT...

Warning signs for me were:

bad veins in left leg
hard to bruise or get skin scratched ie my blood was thick
legs falling asleep after a few min of sitting such as on the toilet, etc.
computer related periods of inactivity at work and home

Day of first DVT I did a lot of squating installing new door nobs around my house followed by 2-3 hours on the PC. The squating injured my already bad left leg veins triggering the initial DVT which then continued to clot up my whole left leg during the evening and night. In the morning I could hardly walk due to pain.

Spent a year on a blood thinner. Now I excersise - lost 35 lbs. and take a lot of supliments:


Fish Oil- daily to twice daily
Flax Seed Oil- daily
Butcher's Broom - almost daily
Horse Chessnut Complex - every 3 or 4 days
Vitamin A, E, D, Baby Aspirin - every other day
Folic Acid - daily
Nato Kinase - every once in a while or when I feel leg pain (can help disolve clots, only natural substance to do so)
Apple Cider Vinerger with mother - 2-3 times a week with honey and water
Garlic

I reclotted a few months ago for no apperant reason other than spending a weekend being inactive and trying a new suppliment black current seed oil which is supposed to help prevent clots but could have had the opposite effect on me, who knows.

A routine of excersise and the supplements have helped me. Long trips and drives have been OK. Just had to make sure I took more of the blood thinning stuff - aspirin, vit E, etc. as well as get out and walk, fidgit my feet and legs.

Also, I have to watch my vit. K intake as it tends to help the blood clot up.

I've had chronic problems with DVT...

Warning signs for me were:

bad veins in left leg
hard to bruise or get skin scratched ie my blood was thick
legs falling asleep after a few min of sitting such as on the toilet, etc.
computer related periods of inactivity at work and home

Day of first DVT I did a lot of squating installing new door nobs around my house followed by 2-3 hours on the PC. The squating injured my already bad left leg veins triggering the initial DVT which then continued to clot up my whole left leg during the evening and night. In the morning I could hardly walk due to pain.

Spent a year on a blood thinner. Now I excersise - lost 35 lbs. and take a lot of supliments:


Fish Oil- daily to twice daily
Flax Seed Oil- daily
Butcher's Broom - almost daily
Horse Chessnut Complex - every 3 or 4 days
Vitamin A, E, D, Baby Aspirin - every other day
Folic Acid - daily
Nato Kinase - every once in a while or when I feel leg pain (can help disolve clots, only natural substance to do so)
Apple Cider Vinerger with mother - 2-3 times a week with honey and water
Garlic

I reclotted a few months ago for no apperant reason other than spending a weekend being inactive and trying a new suppliment black current seed oil which is supposed to help prevent clots but could have had the opposite effect on me, who knows.

A routine of excersise and the supplements have helped me. Long trips and drives have been OK. Just had to make sure I took more of the blood thinning stuff - aspirin, vit E, etc. as well as get out and walk, fidgit my feet and legs.

Also, I have to watch my vit. K intake as it tends to help the blood clot up.

you may want to think about drinking green tea. most of what you list I've seen advised for clot prevention and blood thinning, but green tea is also given as a drug interaction warning for anticlotting drugs for perhaps over thinning. So even the drug companies accept that green tea is an effective blood thinner.

Yes, I do drink green tea as well... about 3 - 4 times a week. I forgot to list niacin (daily) which is great for circulation.

The vein specialist I went to said one way to look at DVT is as the body's way of trying to correct an unhealthy vein by clotting and closing it up just as they do through lazer treatments for varicous veins. That is an interesting perspective to consider when talking about athletes who may damage healthy veins and capilaries through over use and over exertion over a period of time.

Doesn't green tea have high levels of Vit K?

not too high, if you drink it in moderation.

One again it makes me think that fit people are quite possibly more prone to developing DVT than a) researchers etc. think they are; and b) than perhaps the "average" person who is neither obese and sedentary nor particularly athletic.

If you start looking you'll discover all sorts of athletes who have developed DVT.

And I still think it has something to do with the lower resting heart rate.

It could just as well be that people who exercise a lot have a better knowledge of their own bodies, and notice small changes more easily, and/or are better at understanding that the pain/problem is unusual and not likely to be connected to any other activity.

Doesn't green tea have high levels of Vit K?

i know what you are getting at. vit K hinders blood thinners like warfarin but not anti platelets drugs like clopidogrel which acts by limiting the platelets from sticking together. Warfarin works differently. I think i read something about preventing the fibrin forming the fibres that start the clot and vit K promotes this effect thus countering the warfarin. Green tea apparently is an anti platelet and so acts in the same way as the clopidogrel and so may over-do it.