Today in my Bristol Clinic I met George who developed a deep vein thrombosis after a long haul flight. I was shocked to hear that the diagnosis was delayed despite 2 telephone calls to NHS Direct and despite visiting his GP practice. With George’s permission, I’d like to share his story as I think there are some important lessons to be learnt.
During a long haul flight at night back home, George found it very difficult to get comfortable but eventually he rested his leg on the seat in front and then he fell asleep. He describes the position he was in as “awkward”. When he awoke, he felt a severe pain in his left calf. His leg was not swollen, red or hot but George was very concerned that he might have a deep vein thrombosis (DVT). He called NHS direct on 2 occasions and was reassured that he did not have a DVT, but that he had “pulled a muscle” and that he should use ice and painkillers. Unhappy with this advice, George eventually saw a doctor at his practice (not his usual GP). Once again, because there was no swelling or other signs in his leg, George was reassured confidently by the GP that he did not have a DVT. At this point, George did not accept the advice of the “experts” and refused to leave the surgery until he had a blood test for a deep vein thrombosis. George had done his research and he knew that a simple blood test could help to either confirm or refute the diagnosis of DVT. Reluctantly, the doctor agreed to do the blood test which he said would be normal. George received a phone call the next day from the practice to say that the blood test was abnormal and that he should go to hospital for an ultrasound scan immediately. The ultrasound confirmed the presence of the serious deep vein thrombosis requiring treatment with anti-coagulants (blood thinning medication) for 3 months.
Had it not been for George’s insistence that a DVT be excluded, the diagnosis would have been delayed even further and the outcome for George might have been very different. Fortunately, after anti-coagulation, the clot in the deep veins has gone. However, had the diagnosis not been made, George might have suffered a fatal pulmonary embolus (clot on the lungs).
The blood test is called D-Dimer. A normal blood level will correctly exclude a DVT in 95% of cases and a raised blood test raises the possibility and should lead to an urgent ultrasound scan of the deep veins.
Fortunately, DVT after long haul flights is not common. More likely is that we may experience discomfort and swelling in our feet and ankles. This familiar problem occurs because our calf muscles are not active and do not squeeze the blood out of the leg vein circulation back to the heart. Many of us are concerned about the risk of deep vein thrombosis (DVT) after airplane travel and this can be fuelled by stories of healthy young travellers suffering from a fatal blood clot that has developed in the legs and moved to the lungs (embolism). Although varicose veins do not cause DVT, many experts agree they may be an additional risk factor when travelling. Here are my tips for maintaining the health of your veins when flying:
- Wear good quality medical grade compression stockings. My favourite is the Sigvaris flight sock www.sigvaris.co.uk. If however you suffer from diabetes or leg circulation problems, seek advice before wearing compression stockings or flight socks and in any event make sure you are properly measured and fitted.
- Do the in-flight exercises demonstrated before take-off.
- Leg flexing exercises while seated result in substantial increases in blood flow in the deep vein system.
- Take a walk around the cabin every two hours (when safe to do so).
- Avoid sleeping on the flight if at all possible, even on the night-time flight.
- Stay hydrated.
- Avoid beverages such as alcohol which may dehydrate you.
- Wear loose comfortable clothing.
- Put your hand luggage in the overhead locker to give yourself more leg room.
If you have had a DVT in the past, if you have recently been discharged from hospital or if you are receiving treatment for cancer see a vein specialist who may suggest you are treated with blood thinning medication or even that you delay your flight. Deep vein thrombosis is sometimes very difficult to diagnose. About 50% of people who develop a DVT have no signs whatsoever. If however you have swelling or discomfort in one leg after a flight, or if you suffer from shortness of breath or pains in your chest following your flight seek medical advice urgently. Don’t be reassured unless you have had a D-dimer test or an ultrasound scan. For the majority, taking these simple precautions will maintain the health of your leg veins.