WHAT IS DVT?
Frequent fliers, beware. Here is another reason to envy the passenger sprawled languidly in the business or first class seat at the front of the plane while you search for some leg space in the cramped economy section. Deep vein thrombosis (DVT), also called the “coach class syndrome”, refers to a clot (thrombus) that is formed in the larger veins of the lower leg or the thighs because of a prolonged period of sitting in a particular position, say during long-haul flights or long car rides. The clot formation in itself may not be a serious problem, but it could turn fatal if the thrombus dislodges from its original position and travels through the blood stream to lodge itself in the brain, lungs, heart or any other area, causing severe, sometimes fatal, damage. This is called pulmonary embolism. Statistics suggest that DVT kills between 3-5% of people who get it.
The key thing about DVT, say doctors, is that it need not occur only when you are flying or travelling. “The most common reason for a clot to take shape is prolonged periods of immobilization. If you are sitting in a cramped place, even at your desk, without any space to move your legs for a long time, the blood movement becomes sluggish or it remains stagnant,” says Rakesh Sapra, consultant cardiologist (invasive), Artemis Health Institute, Gurgaon. Even dehydration, he says, can thicken the blood and cause clotting.
YOU TOO COULD BE AT RISK
Yes, any of us could be at risk. Any long period of immobility—such as being bedridden from illness, or while recovering from surgery, or sitting for extended periods while travelling, is a risk factor. However, even if you have not been travelling, or are flying business class, but don’t move around enough, you are at risk. Long periods of inactivity may restrict blood circulation to the legs. Certain types of cancer treatment, obesity, inherited clotting disorders, altered bodily conditions such as pregnancy, or any damage to the veins, could all cause DVT, says Rajesh Malhotra, orthopedic surgeon at New Delhi’s All India Institute of Medical Sciences: “The threat of clot formation also increases in patients with certain protein deficiencies or among those undergoing any hormonal treatments such as woman taking contraceptive pills.” Older patients, who have undergone any orthopedic surgery, are also susceptible.
DVT, says Dr Malhotra, is a highly misdiagnosed condition. “It doesn’t show clinically and diagnosis is even more difficult because complications can occur even six weeks after the patient has gone home.”
The clot can occur without any symptoms or the typical warning signs. Pain and swelling in the calf, doctors say, could be a first indication. Chest pain, shortness of breath, dizziness, changes in skin colour in the leg, redness or coughing up blood should be taken seriously and the patient needs to be hospitalized immediately. A sharp pain in the leg when the foot is flexed upwards may also indicate the presence of a clot. Says Dr Malhotra: “If you have any of these symptoms soon after a long journey, or a period of immobility, you need immediate medical attention.” If you are consulting a doctor with complaints of chest pain or dizziness, it is imperative that you tell the doctor about any recent journey you undertook.
Dr Malhotra also warns against the common myth that taking anticoagulants can help ease the problem. “Never take anticoagulants on your own,” he says. Always seek medical help.”
WHAT YOU CAN DO
“The most important thing about DVT is awareness,” says Dr Sapra, adding: “It is a condition that can be avoided very easily.” Mobility and adequate space for the legs to be moved around is key, he says, to help ease the blood flow. “When you walk, the muscles of the legs squeeze the veins and move blood to the heart,” says Dr Malhotra. Curling or pressing your toes down regularly, which activates the leg muscles, are a good alternative if you cannot walk. Dr Malhotra also suggests wearing compression stockings (easily available at most chemists) while travelling. “These are very useful since they apply differential pressure on the limbs. You should avoid regular socks with very tight elastic bands at the top,” he says. Doctors say that if you are on a long flight, try to walk every two hours up and down the aisle. And if you are driving for a long period, take breaks.
Keeping yourself hydrated throughout the journey is another important factor. “If you keep yourself hydrated, the chances of the blood thickening is much reduced. Try and avoid liquor, but increase fluid intake,” says Dr Sapra.
Click here to see some simple exercises to prevent DVT.
35-year-old Richard Lord, deputy editor of the Wall Street Journal Asia’s weekend supplement, was put on Warfarin, an anticoagulant, for blood thinning, after he developed DVT during a flight between Hong Kong and London earlier this year. “Warfarin is also a common rat poison (the rat bleeds to death internally) and therefore leads to a few potential side-effects. I had a bad case of paresthesia - shooting, aching, twitching and fluttering pains in my legs and feet, and then also my arms and hands. This lasted for several months, and necessitated another trip to the hospital.” The key thing, he cautions, “is to move around a lot and drink plenty of water, not alcohol, especially if you intend to sleep”.
Doctors say the after-effects of DVT and pulmonary embolism could last up to several months even after coming out of hospital. Says Dr Sapra: “Once you’ve had DVT, the blood circulation to the area around your calf can never come back to normal because of damaged veins — it also increases the risk of more such occurrences.” Some other complications include constant pain, swelling and a permanent bluish tinge to the skin in the area.
Saurabh Singhai, 28
Quality assurance engineer, Impetus Infotech, New Delhi.
Experience: Developed DVT on a 15-hour American Airlines flight between New Delhi and Boston.
“I got up from my seat not more than twice during my flight to Boston from New Delhi, choosing to sleep most of the time. Even when I landed in Boston, I thought the pain in my calf was because of fatigue or the -10°C temperature outside. The pain persisted, and became unbearable by the time it was time for me to head back to New Delhi 15 days later. When I reached home, I couldn’t walk, my chest hurt, and I felt breathless and dizzy. I was rushed to Fortis Hospital in Noida and was in the ICU for six days. I had a pulmonary embolism and the clot from my calf had dislodged itself and reached the heart. Luckily, the clot was removed without surgery.”
Radha Chadha, 48
Managing director, Chadha Strategy Consulting, Hong Kong.
Experience: Developed DVT on a 16-hour Cathay Pacific flight between New York and Hong Kong.
“I mostly slept through my flight and even when I felt pain in my calf, and noticed a slight swelling, I ignored it. I now realize that I should have consulted a doctor straightaway. Ten days after I came back home, I had to be rushed to the hospital because there was unbearable pain in my chest. I was in intensive care for a few days and given anticoagulants. I couldn’t believe what my doctors told me: The swelling on my calf, they said, was because of a clot, which, over the week, had dislodged from its original position and reached my lungs. Pulmonary embolism, I was told, was a life-threatening situation and I had a close shave with death.”