I posted this on the threaded board, but I think that it's important enough to post here as well.

Given that many in our community are not always the most svelte men on earth, and even when we are we may not be the most health conscious. We already know that one member of our community had to deal with DVT on a trip to SEA.

Let's all take the minor precautions to ensure that we are as safe and healthy as possible when we travel. The following link gives some easy precautions and in seat exercises to do on the flight. These precautions, in addition to walking around on the plan when possible, should help keep bad things from happening.

http://www.jal.co.jp/e/health/


Chok Dee
Bueno Suerte


StrikeEagle

It's been a while since this message was posted however I feel the need to add to it. I had a buddy come over a few months ago to visit me in Thailand (where I live).
After a couple of weeks he was complaining of swelling in his legs. We had a trip planned to Phuket and we all went. Once there he decided he should visit the hospital as his legs seemed to be getting worse. The doctor told him to go back to Bangkok, go to Bumrungrad hospital there (we lived across the street) and then get home as quickly as possible. Well he couldn't resist a night of fucking around but then went back to Bangkok. My girlfriend made sure the doctor there took care of him. He was put on a blood thinner and some other meds and had to cut his trip short. He managed to get the airline to bump him up to first class so he would be more comfortable. After about 2 weeks I got a phone call from him and he was doing great. He was watching his diet, taking his meds and doing everything he could to recuperate.
Shortly thereafter I got an email from another buddy who informed me that he had passed away in his sleep. Apparently a blood clot had broken free and lodged in his heart or lung. Unfucking believable. He was only 42. This DVT is nothing to fuck around with....

Thanks RH for the reminder.. Cardinal Mahoney (spelling) was recently hospitalized with a blood clot in his lung after returning from the Cardinal meeting in Spain or where ever.. This same condition was mentioned as probable cause..

SE, thanks for the link.. I do similar excercises while sitting at the puter and driving in the car.. Just put it on cruise control and work those ankles.. These 3 hour drives to TJ are like similar to short flights confinement wise..

It’s been about a year since this posting section was last updated, and I keep reading about guys who are taking their first trip to SEA. So, I figured that in the interest of the health and safety of my fellow Hombres, I’d update this posting.

First off, the JAL link has changed. The new link is; http://www.jal.co.jp/en/health/index_flying.html. This is still, IMHO, one of the best web pages that addresses DVT and the risks for the over seas traveler.

I’m also going to post a copy of an article from HealthandAge.com. This article reprints a medical report from 2001 that gives a detailed explanation of DVT its risks, effects and how to avoid the problem.

This is a ‘no shit’ issue, guys. People become crippled and die from this syndrome on an all too regular basis. If you doubt this claim, just take a read or Rockhard's post above.

I encourage every Hombre who travels to take heed, and take reasonable precautions to avoid a bout with DVT.

Chok Dee

Strikeeagle

The original link is:
http://www.healthandage.com/Home/gid2=1209
***************

HealthandAge.com, from the Novartis Foundation for Gerontology

How to Avoid DVT- the "Economy Class Syndrome"

Eliot C. Heher, MD
July 2, 2001

Introduction

A recent publication of a study of airline passengers has caused quite a stir. Volunteers over 50 taking flights over 8 hours had sonography of their lower legs before and after the flight. Half of them wore elastic below-knee stockings during their flights. Ten percent of the non-stocking wearers had signs of deep vein thrombosis on their return, while none of those who wore the stockings did. [1] We reproduce here one of Dr Eliot C Heher's earlier travel health newsletters that reviews this condition, how it may occur, and how to avoid it. (Robert Griffith, Editor)

The problem

Anyone who has worn a cast for an extended period of time knows that the body needs to move to stay healthy. Unused muscles atrophy. Joints stiffen.

Immobilization can also lead to blood clots, or Deep Venous Thrombosis (DVT). In plain English DVT means blood clots in the large veins that are well below the skin. DVT usually, but not always, occurs in the legs. If a DVT stays put, it generally causes only minor problems. But a DVT can break off, completely or in pieces, and travel through the blood to distant places in the body. Once it starts moving it's called an embolus and it will usually end up in the lungs, which is called a pulmonary embolus, or PE. This is a very serious medical complication of DVT and can result in death. It is also common - among the U.S. population as a whole (not just travelers) there are probably more than 500,000 PEs a year.

Sometimes DVT/PE occurring in a traveler is called the Economy Class Syndrome because the seats in economy don't provide much room for movement. But don't think a business class or first class seat will immunize you against this malady. All travelers should be aware of this condition and take common-sense precautions.

Immobilization of any kind raises your risk of developing DVT- this includes immobilization on an airplane, in a car, etc. Other factors that can raise the risk of DVT include: regular smoking, obesity, pregnancy, use of birth control pills, dehydration, recent surgery or other medical problems requiring hospitalization, certain types of cancer or heart disease, and structural abnormalities of the veins. Some people are genetically predisposed to blood clots - so your family history is important - and senior travelers may also be at higher risk. If you've had a DVT or a PE in the past you're more likely to get one again in the future. And, keep in mind - the longer the flight or the car trip, the higher the risk.

Symptoms

Symptoms of a DVT often include leg pain or tenderness, redness, or swelling. Typically these symptoms will occur in just one leg - it's rare to have DVT in both legs at the same time. Symptoms of a PE often include chest pain, shortness of breath, and cough (sometimes with blood tinged sputum). Rarer symptoms of PE include loss of consciousness and abnormal heart rhythms. Both DVT and PE are difficult to diagnose even in a hospital. Rarely do patients have all the classic symptoms and often patients will have symptoms of PE without ever noticing symptoms of DVT.

Should you be traveling?

DVT is a serious problem. If you're at high risk (see above), you should talk to you doctor before traveling. Be especially sure to seek his/her advice if you've had surgery or been hospitalized in the last 3 months, if you're pregnant, or if you've had a DVT/PE in the past.

When traveling, follow these tips

* Get up, stretch and/or walk around every 60 minutes or so. Request an aisle seat so it's easier to do so. Bulkheads and exit rows also provide more leg space and easier entry/exit. If you can, elevate your legs intermittently during the flight.
* Drink plenty of fluids to avoid dehydration (coffee and alcoholic beverages don't count!).
* Move around and exercise in your seat, making sure the seat presses up against a different part of your legs every once in a while. Don't cross your legs for prolonged periods of time.
* Wear comfortable clothing that allows easy movement and doesn't restrict blood flow.
* More legroom is better. If upgrading to business or first class is a possibility, consider it, especially on really long trips. However, don't rest easy once you've upgraded - be sure to follow these other tips. And bear in mind that hundreds of millions of people fly in economy class each year without suffering from DVT/PE.
* Support stockings can also be helpful - see the opening remarks -so if you are a high risk individual, ask your doctor about them.
* Aspirin (which inhibits blood clot formation) may prevent DVT if taken for a few days before your trip. Very high-risk patients might benefit from small doses of the blood thinner heparin, injected under the skin. Discuss these options with your doctor.

If you develop symptoms

Seek medical attention at an emergency room or physician office. Don't ignore persistent leg pain, redness, or swelling. Similarly, if you have shortness of breath, cough, or chest discomfort, get help. The evaluation of DVT/PE involves both physical examination and diagnostic tests. Some of the more sensitive tests (e.g. the highest quality Doppler) may not be available in less well-equipped medical centers. Do your research! Treatment of DVT/PE involves blood thinners, first intravenously (a medication called heparin), then orally (usually a medication called warfarin). The duration of treatment depends on the extent of the problem but typically several months are required.

Source

* Source: Dr Eliot C Heher's Travel Health NewsLetter


Footnotes
[1] Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. JH. Scurr, SJ. Machin, S. Bailey-King , et al., Lancet, 2001, vol. 357, pp. 1485--1489

Excellent information. I just got out of the hospital after a 3 day unpleasant visit. I developed DVT in my right leg and let me tell you it is no picnic. I am now on blood thinners and a ton of other medications. My suggestion to everyone is make sure you get up and move around every few hours on these flights. I know the majority of us do an Ambien and want to wake up in in our mongering destination. Next time I go to Rio I will not do the Ambien route and make sure I move around more. If I can answer any questions on this subject as I'm going through the recoup process now please send me an email or drop me a message in the inbox. Thanks Hemp bhempen@excite.com

Hemp,

Thanks for being open about your experience. I’m sorry to hear that you have had to go through this.

Perhaps it would be beneficial for everyone on the board if you'd share a few details of your personal experience. Things like:

How'd you know you had a problem?
What did you do to seek medical care?

This sort of info could be invaluable to someone who finds himself in your shoes.

Sadly, you are now the second member of the Hombre community to personally experience this ailment. So your sharing is a big contribution. The purpose of this thread is to keep this from happening to other Hombres. I’m just sorry that this thread didn’t come to your attention earlier when it might have made a difference for you.

Best to you in your recovery. Be careful out there!


Bueno Suerte,

StrikeEagle




(Message edited by strikeeagle on March 07, 2003)

Thanks StrikeEagle - That's what great about this board in addition to sharing mongering stories we all come together to try and help each other. Like I said earlier I just got out of the hospital after being diagnosed with DVT. Here is a little recap of what happened: I went to Rio last September and had a fantastic trip. About a month after returning home I started having pain in my leg and just thought it was arthritis or I hit on let - the pain went away and month after month I had other pain and went away etc. During this time I also had to drive a lot for my business. Month after month I was having pain and just grinned and bared it. We'll two weeks ago I woke up and felt a lot of pain in my leg again and within a few hours it started swelling and became hot and very hard. I then went to the emergency room and was diagnosed with DVT. They instantly admitted me and started blood thinners as they said this was "life threatening" as the clots could break away and go to my lung and kill me instantly. I spend 3 days in the hospital getting shots in the stomach with the blood thinners. Upon release I had to continue giving myself shots in the stomach for about another week in addition to taking COUMADIN. Here I am 2 weeks later still in pain, taking all kinds of drugs (by the way all these drugs do have an affect on the PILOT LIGHT which FIRES MY FURNACE if you know what I mean). Any way I hope to be better shortly but will be on these blood thinners for several months.
RECOMMENDATIONS:
On long flights, get up and move around and keep the circulation going as best as you can.
On driving in the car, stop at least every few hours and do the same.
Don't assume as I did that it was just a charlie horse, arthritis, etc. See your Dr. as soon as you can.
I was lucky and caught it in time or it could have been all over.

I hope that my experience will help prevent my other Hombre Buddies from having this happen to them. If it will help just one it will have been worth it.

Any questions contact me.
I hope to be back in Rio in a few months and we'll have a beer. Thanks - Hemp

Great post Hemp. Sometimes we all think we are "Superman" on these trips. Sure we conquer the monger world but something like this will quickly show us that we are human. DVT happens alot more to older people but more and more people are getting it. It's no joke. Even executives that travel in first and business class get it because of lack of movement.

As the article mentioned, try to get up and walk around as much as possible. When I'm not taking an Ambien I get up about every 1.5 hours and go to the bathroom. Even if I don't have to go just to take the walk. I think sometimes people think I'm nuts because I'll be in Business class and walk to the back just for the walk to stretch my legs.

As the article mentioned, try to get seated in a bulk head seat or an exit row. Remember that the exit row aisle seats still recline. I always get an exit row aisle seat if I don't fly business. There is tons more leg room. Many people think the seats don't recline in exit rows but that isn't the case with aisle seats.

Websites like AA.com allow you to select your seats immediately after buying it. If not, you can call and request one right away. Priority will be given to those with Premier Status.

Try to upgrade to business or first class if at all possible. I know it's not possible for many mongers on a budget but it's definitely worth it sometimes. I wouldn't shell out thousands of bucks for a ticket but I would shell out $600 or $700 extra sometimes to fly business. I wasn't going to post this and keep this little secret to myself but I'll post for the benefit of my "brothers".

Airlines like American Airlines have something called "Systemwide VIP upgrades". They are given to Executive Platinum members (i.e. guys that fly 100,000 miles a year or more). They give each member 8 of these system-wide upgrades a year. They used to be good any time but now they are capacity controlled but it's still easy to use them on most international flights. You can go to Ebay:

http://search.ebay.com/search/search.dll?cgiurl=http%3A%2F%2Fcgi.ebay.com%2Fws%2F&MfcISAPICommand=GetResult&query=American&categoryid=&ht=1&category1=1310&SortProperty=MetaEndSort&BasicSearch=&from=R2&catref=C3

They are called VIP System wide upgrades. Again, they are not cheap, usually adding $600 - $700 on a round-trip ticket but considering a business class ticket is usually $5,000 - $7,000 it's well worth it. Example: On a recent trip to London, I bought an economy ticket for around $500 with taxes. I paid $500 for 2 upgrades and paid a grand total of $1,000 for a $6,000 ticket.

Most of these guys get complimentary upgrades anyway because their companies pay for a full-fare ticket and they can upgrade free so these guys sell their certificate to ticket brokers or on Ebay. They usually go for about $300- $400 @. A certificate is good up to 3 legs on ANY international trip.

Something to think about. Keep in mind American voids these if they knew you bought them. Say you got them from a friend as a gift. I know one dude that bought some for a trip and went up to the ticket counter and said he bought them on Ebay. The ticket agent immediately voided his upgrade and took his certificate.

Good luck all.

I'm glad to see this section. I was diagnosed with DVT after returning to the U.S. from carnaval in Rio last year. The pain in my leg did not appear until after about three weeks. It became more painful everyday. I would describe it like a charlie horse that does not go away. Anyway, I was finally diagnosed and started with shots of lovenox. The lovenox lasted for about 6 days. After that I was taking warrafin. To this day I still need to take the blood thinners. My leg is still not 100%. The pain is gone but the leg just feels funny. The doctors say that there is no permanent damage, but I'm not so sure about that. After having been through something like this, I can honestly say that you don't want to go through it. WALK, STRETCH, and HYDRATE on all flights. I am a 29 year old guy in decent shape and it happend to me.

A physician strongly suggested taking naproxen sodium as a preventive and said it was better than aspirin. It is a non-prescription drug, which costs about the same as aspirin.

As a physician I highly recommend first class !!
It's better than both aspirin or naproxen.

SE writes "These precautions, in addition to walking around on the plan"

Well the only plan I want to be on is the no getting DVT plan. I am sorry for you guys that have had this happen. Of all the worries of overseas mongering and one of the most dangerous is one on the plane thats gotta stink.

I do not do much air travel and I am constantly not moving my legs when I go to the cinema. I go to the movies at least once a week in TJ and one time after watching Lord Of the Rings my leg was so bad I couldnt even walk down the steps. My girlfriend had to help me all the way to the collectivo. Most people know it as "Sleepy legs" and this info I read here has made me more aware that more serious problems can occure if I do not move around during the movies. That one day it took damm near 2 hours for me to walk normal again.

I hope that never happens again and thanks for the info guys play it safe !!

take care
Milkman

Milkman - The medical people told me even little things like moving your feet up and down while sitting at your desk at work can help. On long flights like to Rio it is extremely important to keep the circulation going. DVT can happen many months after these long trips without even being aware of it. Once again to everyone regardless of your age, keep those legs moving. DVT is extremely painful and life threatening if not diagnosed promptly. I was diagnosed about 3 weeks ago and am still in pain and leg is swollen. Once again be careful on those long flights. If there are any Doctors or Medical personnel on this board your comments would be appreciated and I'm sure very helpful.

Thanks again Hombres
Hemp

Here is some more information on DVT. If nothing else I hope it can help just one person.

Hemp

Ways to prevent DVT while flying include:


Your blood becomes thicker when you are dehydrated, increasing risk of clots. So try to drink an 8-ounce glass of water every two hours when flying and avoid alcohol and coffee, as they are dehydrating.
Try compression hose. They are available over the counter at surgical supply stores and cost about $15 per pair. Even better are tailor-made support hose, made based on a person's leg measurements. Such support hose work by keeping blood flowing and preventing pooling of stagnant blood.
Book a seat in an exit row, a bulkhead seat, or an aisle seat.
Walk up and down the aisle about once an hour.
Wear loose-fitting clothing.
Don't smoke.
While in your seat, contract your calf muscles from time to time by clenching your toes. Another exercise, suggested by British Airways: Bend your foot upward, spread your toes, and hold for three seconds -- then point your foot down, clench your toes, and hold for three seconds.
People at high risk of blood clots should ask their doctors whether to take aspirin before flying to inhibit blood clotting.
Don't cross your legs or sit on the edge of your seat, since these positions can reduce blood flow in your legs.

Above all, if you think you have a DVT, head immediately to your doctor or an emergency department, because immediate evaluation and treatment can be lifesaving.

The chances of an individual without risk factors for DVT getting a clot even on a prolonged flight are miniscule. I think the risk is being overblown in this thread. If you are not pregnant, do not take birth control pills , do not smoke,do not have cancer or varicose veins, are under 65 years of age, do not have genetic clotting disorder, there is little reason to fear getting a DVT. The only precaution needed is to walk around every few hours and move your legs occasionally. If you do have risk factors as above - aspirin or motrin like products do NOT prevent venous clots- only arterial clots. The best prevention is same as above but more frequently. Agree with suggestion to keep well hydrated also. Surgical stockings would be hot and uncomfortable on a long flight and of minimal value.

Well it happened to me as well. Very painfull and my experience parallels Hemp's for the most part. I was traveling heavy and had trouble with upgrades on MUM-ZRH-DFW legs. Crashed out on Zanac out of BOM. Slept twisted up for 10 hours and 10 days later I was in the hospital. Doing everything that Hemp did to recover. Going to Thailand in a few weeks, but have the First Class upgrade in hand.

Gitano I am happy to hear you are doing better. Guys since we have had first hand experience DVT is very serious and fatal in many instances. Gitano and I were both fortunate. Thanks for the update and good news Gitano. Guys please be careful on those long flights regardless of your age or physical condition. Move around as much as you can and drink plenty of water and you will be fine. - Thanks Hemp

Besides thinning the blood, another reason to stay really well hydrated is that it will make you get up and walk to the bathroom every 30 minutes.

Joking aside, the University of Arizona recently experienced the death of their star female basketball center because of a blood clot that moved from her leg to her lungs. Not quite sure if the clot was from DVT or year old knee surgery.