Wednesday, April 23, 2008

Death By Travel? The Little Known Risks of DVT and Tips for Avoidance

Death By Travel? The Little Known Risks of DVT and Tips for Avoidance
Lately air travel has become more and more unreliable and
annoying due to multiple flight cancellations and travel
interruptions. Any card carrying road warrior frequent
flier can relate multiple stories of being stuck almost
anywhere due to weather, mechanical issues, personnel
problems and lately...the abrupt FAA grounding of all MD-80
aircraft. Frank's story went a little differently, though.
Frank is a road warrior in every sense of the word: he
flies often and at least monthly finds himself in another
country. When he's not flying, he's driving to another
sales call. Frank is the Vice President of a manufacturing
firm and is responsible for making all his customers
happy...something that still requires face time! Frank was
having a typical week, three cities in 5 days, when he woke
up with a red, hot swollen left leg and shortness of
breath. Frank's travels had been interrupted by the dreaded
traveler's blood clot, a Deep Vein Thrombosis, or DVT. Now
he wasn't fighting for the sales contracts, he was fighting
for his very life! This may have been avoided if Frank had
learned his risk factors and followed some simple travel
tips.

A DVT (Deep Venous Thrombosis) is a condition in which a
blood clot or blockage forms in the deep veins in the leg.
These can develop in other places in your body, but are
much more common in the lower legs. If the clot breaks free
and travels through the bloodstream, it can actually lodge
in the lung. This clot in the lung is called a PE
(pulmonary embolism), and can cause shortness of breath,
difficulty breathing and even death!

How common is DVT? Each year, 600,000 patients will
experience some kind of venous thromboembolism or DVT. Each
year, at least 50,000 and perhaps as many as 200,000
patients will die from blood clots that obstruct blood flow
to their lungs (pulmonary embolism). It is amazing that the
complications from DVT have been reported to kill up to
200,000 people a year, more than AIDS and breast cancer
combined, but no one seems to care much about it. The
airline and travel industry has given it lip service after
a few well-publicized deaths; but the general traveling
public awareness of this potentially fatal public health
concern from travel is relatively low. Who is at risk for
DVT? There are certain groups of people who are more at
risk of developing these life-threatening clots. Risk
factors include varicose veins, blood clotting disorders,
recent childbirth or pregnancy, use of birth control pills
or hormone replacement therapy, obesity, and heart disease.
The risk is even higher in patients over 40, those with
casts immobilizing their foot and ankle, a sedentary
lifestyle, smoking history, certain types of cancer,
chronic illnesses like lung disease or inflammatory bowel
disease (Crohn's or ulcerative colitis) and recent major
surgery. This is further compounded by sitting for long
periods of time in a car, airplane or train, especially
with your legs crossed. It seems like almost everyone
traveling this summer has one or more of these risk factors!

What are the symptoms of DVT? Many people have either no
warning signs or very vague symptoms prior to forming a
significant clot. The symptoms are usually: swelling in the
leg and calf, redness and increased warmth in your leg, and
pain in the inner thigh and calf. If you experience any
warning signs, immediately contact your doctor for an
evaluation. Do not mess with this potentially deadly
condition!

How is a DVT diagnosed? A simple ultrasound of the veins of
your leg can determine if you are suffering from a DVT.
Often, superficial thrombophlebitis can have the same
symptoms and is much less serious; so a timely ultrasound
evaluation is critical. Patients who receive early
treatment may reduce their incidence of pulmonary embolism
to less than 1%.

If you have risk factors for DVT and plan on taking a long
trip this season, follow these tips to reduce the
likelihood of developing a blood clot:

1. Do not travel for 4 to 6 weeks after major surgery
unless your life depends on it.
2. Exercise legs every 2 to 3 hours to get the blood
flowing back to the heart. Walk up and down the aisle of a
plane or train, raise and lower your heels while keeping
your toes on the floor, rotate ankles while sitting, and
take regular breaks on road trips.
3. Stay hydrated by drinking plenty of fluids; avoid
caffeine and alcohol.
4. Consider wearing compression stockings. These are
helpful in compressing the veins and decreasing swelling in
the legs and calf.
5. Talk to your doctor about whether aspirin or another
blood thinner is indicated due to your risk factors.
6. Exercise regularly, maintain a healthy weight and stop
smoking!

Remember, a DVT can put a real cramp in your vacation or
travel plans, and even potentially kill you! If you are at
risk, take precautions before you suffer from this possible
"killer legs".


----------------------------------------------------
Dr. Marybeth Crane is a podiatric foot and ankle surgeon
and managing partner of Foot and Ankle Associates of North
Texas, LLP, in Grapevine, Texas. She is also a veteran road
warrior and always wears compression stocking while
traveling! For more information about foot and ankle health
or to purchase compression stockings, visit my website at
http://www.faant.com or for more personal running tips read
my blog at http://www.myrundoc.com/blog.aspx

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