Travelers Thrombosis – Precautions and prevention

Anti-Embolism StockingsFor many decades now and especially since the beginning of the IT boom, Indians have been settling down in all parts of the world, for business, work or other purposes.  The one thing common to all the Indian diaspora is their strong ties with their homeland, especially to their friends and relatives living in India.  This has resulted in a lot of travel back and forth making Indians among the largest populations of frequent long distance travelers.

Most families travel once a year to their home land and in turn parents who reside in India travel abroad to spend time with their children and grand children on a regular basis.  This article is specifically for the elderly who travel by air to be with their family and shows how some simple precautions can reduce the chances of Deep Vein Thrombosis(DVT).

The elderly who travel long distances by air are at high-risk of what is being called Travelers Thrombosis.  In medical terms this is known as Deep Vein Thrombosis (DVT) and  Pulmonary Embolism sometimes collectively called Venous Thromboembolism.  DVT is a common medical condition in the population. The disease process in DVT occurs because of blood clotting, most frequently in the large veins of the calves. Sometimes these clots break free and travel up the veins through the heart to lodge in the arteries of the lungs. This related condition is known as pulmonary embolism (PE), and it may cause sharp chest pain or breathlessness. PE may be life-threatening if the embolus (circulating clot) is large.

Causes for DVT can be both acquired and inherited.  The Inherited ones could be due to deficiency of one or more of Antithrombin, Protein C, or Protein S.  Additionally people with blood groups other than O are also at slightly elevated risks.

The acquired causes include:
1.  Old age.  [Most of our parents]
2.  Major surgery or orthopedic surgery [Many of our parents go through knee replacement surgeries.  This is one major cause for DVT].
3. Cancers, especially pancreatic.
4.  Immobilization, sitting in one position for long hours, and travel, especially by air. Bed-ridden patients also are at high-risk.
5.  Hormonal replacement therapy.

There are several other causes which are not limited to older people.  Please refer wikipedia for more details.

DVT can be quite painful and even life-threatening.  Here are some precautions you can take when traveling by air:

1.  Drink plenty of non-alcoholic fluids.  Ideally water, fruit juices, and isotonic drinks.
2. Regularly massage your calves and mobilize/rotate your ankles
3. Wear comfortable, loose clothing that does not restrict blood flow.  Light cotton wear is ideal.  Saris and salwars are fine. Avoid tight jeans.
4. Move around during transit breaks.  Avoid moving around in the cabin during the flight as you risk injuries due to turbulence.
5.  Be vigilant for the symptoms of DVT, in particular pain in the calves, during and for up to a month after long flights. If symptoms occur, seek medical advice without delay.

Finally, there are stockings called Anti-embolism stockings that apply about 15 -20 mm Hg of pressure at the ankle and reduced pressure as they go up the leg. These stockings help in preventing DVT.  They come in various sizes and in two models – Above knee, and below knee. At Rs. 800 to Rs. 1200 a pair, they are a steal when you consider how much pain and suffering they may actually save you from.

It is important to choose the right size and type for them to be effective.  Too loose and they will not have the desired effect and if they are too tight, they may become like a tourniquet and restrict blood flow.  Similarly some people find the thigh-length stockings uncomfortable and just end up rolling it down till their knees.  These people are better off buying the below-knee model at the outset.

Before measuring, please ensure that there is no edema (swelling due to fluid collection), deformity of the leg, arteriosclerosis and skin conditions such as dermatitis.  You can take measurements while lying down or standing up.  There are basically 3 measurements you need to take – thigh circumference(g), calf circumference(c) and ankle circumference(b).  Then compare these against the size chart provided by the manufacturer to choose the one closest to your requirements.

If you are a senior citizen and are traveling by air, don’t leave home without it.  You can buy your Anti-DVT stockings here.

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