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I had no idea how big and how dangerous a problem this was. 25,000 in the UK and 60,000 in the USA die every year from them. That is huge. I remember the shock when that young 30 year old reporter died covering the Iraq war a few days ago when he spent 2 days cramped up in an armored vehicle on the road to Bagdad. There is a reason they send 19 year old kids into war and leave the 40 year olds behind at HQ. He got a clot and it killed him. So it can happen to anyone at any age. The biggest killer is hospitals when you are left in bed for days and you don’t keep your legs moving.
I have been on the road since the 60’s and I have always had a rule, after two hours of car travel, I pull off an exit ramp, cross the road, and head back down the entrance ramp and park and get out. I am safe here and parking on the side of an interstate is extremely dangerous, drunks come along and run right into the back of your car even when you are on the shoulder. Now any one going past me is going 25 mph. I take a pee, walk around the car, do a few knee bends, then drive for 2 more hours, fill up with gas, more knee bends. So I lose 5 minutes on the trip, what is 5 minutes. I also use speed control so I don’t have to keep my foot on the accelerator and my leg in one place.
I don’t sit behind a desk or a cpu for long before getting up and moving around. You do not want blood to pool in the bottom of your legs. I take 800 mg of aspirin a day and I keep my blood thin which makes it harder to clot and stick to my artery walls.
The kind of chair you work in all day long does matter. Choose yours carefully. At night when I watch TV, I love my Lazy Boy recliner, my body tells me when I find the right angle to relax in. I have two of them.
"We have evidence that many years ago, pilots were developing blood clots and the airlines redesigned the seats to alleviate that," by ensuring that a person's weight was more evenly distributed over the seat. An office chair almost cuts off the circulation on the back of the legs.
I don't want to wear socks with tight elastic tops, so when I take them off I have a big dent in my leg. I will fold them down around my ankles to prevent this. Since they make me take off my shoes to go through security, I walk in with rubber soled bedroom slippers, which look like moccasins. When we take off I slip my feet out of them. When we land and I get off the plane, I sit down, take my real shoes out of my bag and put them on.
I traveled over 3,000,000 miles in airplanes when flying was a joy. In the 60’s-70’s, you got steak dinners with champagne on real plates with real silver ware and they even let you have a steak knife. 2 free drinks and I were treated like a king. If you flirted with them, they would snake you a couple extra ones which I drank later on that night. Sometimes they even shared your room with you for the night and you gave the two drinks back.
The big attraction to flying back then was hustling the stews. They were all just out of high school, mostly gorgeous, great figures, and usually blond. They would hang around until they snagged a husband or pilot and be gone, then a new young one would replace her. Few stayed longer than 4 years. It was continuous hotties who never got old on you. They made them weigh in and stay trim. It was never meant to be a career job.
The ones right out of stew school you could spot and they would buy any line you put on them. They were easy. Oh well, somebody had to break them in, so it might as well be me. It was a lousy job, but somebody had to do it. Then they got a union and lawyers, and now you have grannies up there who are fat and double ugly. I call them Delta dogs, and Girle boys working the aisles, oh Brucie, can I have another bag of peanuts, now the only way to get anything is to flirt with the faggot working the cattle car. Colonel Saito comes down and I say, can I have more peanuts, she says, that will be $6 extra. They took something special and beautiful and turned it into a fargin joke and nightmare.
I mostly flew first class which was a privilege of rank and being a sales executive for a billion dollar company. Those older planes had huge seats back then up front where the big boys flew. The biggest seats was the DC 9’s, all leather, they were enormous, but back in the cattle car, seats were small. You would get up and try and get close to the stews, talk some trash to them, or maybe ask, and be let in the cockpit to say hi to the crew. It was a different world back then.
Gone are the pillows and blankets, they treat you like a POW in a Japanese prison camp in Burma. The stew, who looks like she was on the raft with Eddie Rickenbacker, her name is Colonel Saito. She say, you don’t get, nothing. We even charge for water.
http://www.imdb.com/title/tt0050212/
http://www.janerestu...acker/index.htm
And they have you crammed down into seats so small you can’t move around. You are a sardine in a can on a Greyhound bus with wings. Mic Key, flying today sucks royal dick. I don’t care if I never get on another plane; I hate the entire experience now. Too many people in too little of a space. I drive all I can unless it going out to Vegas or LA, and then flying makes sense from the East Coast.
When you get older your circulation gets worse, you are usually over weight, the seats keep getting smaller and you keep getting bigger, and you have arthritis, you get stiff real easy, and being crammed in a tight space for hours is agony for us. A youngster can handle it, old people can’t. Those over 40 have a much higher risk of a clot than somebody in their 20’s. The older you get, the higher the risk becomes. You need to take this article deadly serious; it could save your life.
Then I flew every day when I was a sales manager for a fortune 10 company, most of my flights were only a couple hours. I tried to be in a different city every day and I only went coast to coast once a month. I hopped across the country and back.
What I have cut out is the international long distance flying. My legs were killing me. I went completely around the world, circumnavigated it taking 5 weeks in 2003. I had a lot of trips that were nonstop, with 1 hr change of planes, from Atlanta to the Far East where you would be on planes for 20 hours straight. I then began to realize how dangerous that was. If I go there now, I break it up stopping in California, then Japan, then on to China. I would take 3 days to get there, and have some fun along the way.
I have had 3 around the world trips, played in over 70 countries, I have seen all I wanted to on 5 continents, so I have been there, done that, and I know longer seek or desire overseas travel any more.
They are only now beginning to realize that perhaps tens of thousands a people a year are dying from their long distance airplane ride. The Airlines know and have hid this from us. They began to pick up on this when a couple of Marathon runners in perfect health died when they came back to the USA from Europe. Because people did not die on board, but 3 days to a week later, they did not connect the death to the plane trip. They just wrote it up to old age, or a heart attack, case closed.
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UK
Last night it was claimed there would be outrage if the public realized how many lives were being needlessly lost in the UK could be prevented.
Sandra Gidley, Lib Dem health spokeswoman, said: “Far more people die of blood clots than MRSA and yet everyone is scared to death of catching an infection.
“If the public knew the scale, there would be an outcry.
“The fact that two differing pieces of guidance came out at once has not helped. Trusts don’t need much of an excuse not to implement new guidelines and many will just wait for the final guidance before doing anything.”
Today a report by the All-Party Parliamentary Thrombosis Group will show that only one in three trusts has done anything to implement guidelines for all hospital patients to be routinely assessed and treated, which were issued by the Department of Health in April.
In many other countries all patients are assessed for their risk of clots on admission to hospital.
Patients at high risk, such as those with heart failure, are automatically given drugs to prevent DVT.
This code of practice is yet to be implemented across the NHS.
Yet, as people lie inactive in hospital beds, recovering from surgery or illness, many are at risk of developing clots.
The death toll is enormous. By comparison just under 16,000 people a year die in Britain each year in a combined total of deaths from road accidents, breast cancer or Aids.
Hospital bugs, meanwhile, account for an estimated 5,000 deaths a year, with 1,000 lives claimed by C.diff and about 2,000 by MRSA.
The confusion over policy arose when, just after the DoH interim guidelines were released, a different set of procedures was issued by the National Institute of Health and Clinical Excellence. The clash led to anger from many experts and confusion among trusts.
Last week, ministers and the heads of Nice were grilled over the issue by the Commons Health Select Committee. MPs repeatedly asked why two sets of differing guidance had been released within weeks of each other.
Further confusion arose because trusts were told that the DoH guidelines were to be updated next year, when yet another report is due from Nice.
Dr Richard Taylor MP asked Health Minister Dawn Primarolo if the guidelines should now be withdrawn altogether.
Eventually she was forced to admit: “We need to find a way of managing slightly better when the Health Department is undertaking work because it needs to be giving guidance to the NHS.”
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USA NEWS:
Millions of Americans suffer from blood clots, and though most cases are preventable and treatable, 60,000 people die each year from pulmonary embolism, or blood clots that have traveled to the lung.
Deep vein thrombosis (DVT) is one of the more common clotting conditions, and occurs when blood pools in one of the body's major veins, most commonly deep in the legs. There are a number of factors that increase the risk for DVT, including long, immobilizing air flights, commonly referred to as "economy class syndrome." But many people are often not aware that simple preventive measures could save them from serious complications, or even death.
Below, Dr. Steven Deitelzweig Section Head of Hospital-Based Internal Medicine at Ochsner Clinic Foundation, offers some practical advice about recognizing and treating DVT.
What is deep vein thrombosis, and what makes it dangerous?
Deep vein thrombosis, or DVT, are blood clots that form in large veins-usually in the legs, but sometimes in the pelvic area. If these clots leave the legs, go through the blood system, and land in the lung, then it's called a pulmonary embolus (PE).
DVT can lead to swelling, discoloration and pain to the legs. It's not life-threatening, but it's uncomfortable and sometimes disabling. What becomes life-threatening is the pulmonary embolism, which 600,000 Americans develop each year.
How many people die from pulmonary embolism?
60,000 people die from pulmonary embolism every year. More people die of PE than of breast cancer, or AIDS or in highway accidents. In fact, if you add them all up together, those conditions cause fewer deaths than PE causes each year.
What are the signs and symptoms of DVT?
Fewer than half of people with DVT have symptoms such as swelling, discoloration and pain to the legs. Many times it's actually silent, and patients don't even know it's there. More than half of people have symptoms when it reaches the lungs, however, and the typical symptoms might be chest pain, shortness of breath, rapid pulse, or a cough. Sometimes a cough will produce bloody sputum. They may just black out.
Does a pulmonary embolism represent an emergent, life-threatening situation?
It can have different manifestations and different time courses. The most urgent time is the first hour or two. That's when many of the deaths occur from a pulmonary embolus. But longer-term complications can occur in subsequent hours, days and weeks.
Who is most at risk of developing blood clots?
People over the age of 40, predominantly, because the risk goes up incrementally with years. People who are obese are at greater risk. People with chronic medical conditions that may cause prolonged immobility, like heart failure or chronic obstructive pulmonary disease. People with cancer-are also at greater risk. Smokers are at higher risk. Women taking hormone replacement therapy or birth control pills are at a higher risk as well. Pregnant women are at a very high risk, and interestingly, the highest risk is right after delivery. Some of it has to do with anatomy. They had a large fetus compressing the veins, and preventing optimal blood flow. Pregnant women also undergo alterations in their blood clotting, or thinning ability. They make less of the proteins that prevent blood clotting.
Some people have what is called thrombophilia, which is a propensity for clotting. We now know that up to 1 in 10 people will have one of these genetic markers.
There's been a lot written about the risk of blood clots in airplanes, referred to as "economy class syndrome." How significant is this risk?
The economy class syndrome only becomes an issue in those who are at particularly high risk-those who have a prior personal or family history, typically. And the real risk usually involves transatlantic-type flights, typically more than seven hours. Otherwise, just being well-hydrated, and walking frequently from the front to the back of the plane, is more than adequate.
Are there effective ways to prevent clots from forming in the first place?
Yes. Almost 99% of all blood clots are preventable. If people are at risk, they should get a work up from their doctor, and find out how high their risk is. Then they can be given a drug or a nonpharmacologic agent. Things like compression devices or compression stockings can be very effective, but you need to be thinking about it and acting on it early.
For instance, the highest risk population is the orthopedic hip fracture population. If you don't do anything to help them prevent a clot, there's a 50 to 80% chance they'll develop a clot. If, however, you give them appropriate prophylaxis, you don't bring that number down to zero, but you bring it down to probably about 10 to 15% risk.
What sort of lifestyle changes can you recommend to people to reduce their chances of developing clots?
Just having one risk factor by itself is really not of any consequence. But when you start having two or three together, the risk becomes quite impressive, and reducing the number of risks becomes essential.
For instance, if you had a stroke, or if you have heart failure, and you're 65 years old, it may not be wise to start taking hormone replacement therapy, which is another risk factor for DVT. If you have a pretty immobile lifestyle, you may want to be much more proactive about getting active. You don't have to run a marathon, but you could do some exercise, certainly, that uses the calf muscles to prevent the blood from pooling in the legs.
What about DVT prevention for pregnant women?
Exercise. They should exercise, and if they have a family history or personal history of DVT, then they need to be evaluated by a vascular medicine specialist.
How is DVT diagnosed?
The diagnosis is noninvasive. All they have to do is an ultrasound. It's very accurate, cost-effective and noninvasive.
Why is this diagnosis so often overlooked?
When a patient gets hospitalized with some other condition, or a patient is pregnant, a DVT screening is not the first thing on anyone's mind. No one group of doctors typically "owns" this process. After all, there's no field called thrombology.
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In December, 2008, American Airlines became the first airline to settle a lawsuit filed by a passenger who suffered deep vein thrombosis, popularly dubbed "economy class syndrome" because it often afflicts passengers who ride in cramped poorly-designed seats of commercial airlines.
Although there was little fanfare at the time, the settlement was closely watched by airlines around the world, which have been defending themselves with mixed results against suits by passengers who have developed blood clots in their legs during long-distance flights.
The plaintiff's lawyer in the American Airlines case, Mike Danko, told Lawyers Weekly USA that he believes there are tens of thousands of potential DVT cases throughout the world.
Danko estimated that thousands of people die or are seriously injured each year from blood clots resulting from long-distance air travel, yet many people - including lawyers - remain unaware of the extent of the problem.
"It's very serious and extremely widespread, yet for some reason it's been incredibly quiet," said Danko, whose law firm in San Mateo, Calif., is one of the few in the U.S. that has filed suit.
Paul Weinberg of Weinberg & Garber in Northhampton, Mass., said he is awaiting the results of an autopsy before deciding whether to file his first DVT case.
Weinberg, who has litigated several cases against airlines for failure to have defibrillators on planes, was first approached by his client, the widow of a man who died during an overseas flight, because she believed her husband died of a heart attack.
However, initial autopsy results showed that the man may have died of DVT. Further tests are needed before the results are conclusive.
"There's not much doubt in my mind that long flights do increase the likelihood of developing a DVT," said Weinberg, citing a medical study concluding that persons who do not wear support hose during long flights are at a much greater risk of developing thrombosis.
Plaintiffs claim that a combination of factors - the high altitude and dry air aboard flights, plus the fact that passengers sit still for a long time on poorly designed seats - increases the risk that blood will coagulate in the legs. If a clot in the leg dislodges and travels to the lungs or brain, it can be fatal.
While DVT occurs more frequently in flights longer than six hours, even shorter flights present a danger, Danko said, noting that airlines are obligated to warn passengers of the danger and to advise them to stand up and walk around at least once an hour during a flight.
Some airlines - already reeling financially from the global recession and the post-9/11 plummet in air travel - deny any connection between air travel and DVT.
Others are relying on their interpretation of the Warsaw Convention, which severely limits liability for international flights. Since this type of litigation is still new, there is no appellate ruling on this issue yet, Danko noted.
Not Limited To United States
"Economy class syndrome" litigation is not limited to the United States.
Cases have been filed in England, and a law firm in Sydney, Australia, has 800 plaintiffs in a lawsuit against 20 airlines worldwide, including the families of 36 people who died after long-distance flights.
Danko's client developed a blood clot in his leg after an American Airlines flight from Paris to New York. While the client's injuries weren't long-term, he had about $7,000 in medical bills.
The suit was filed federal court in Houston, where American Airlines is headquartered. After the judge ordered the parties into mediation, the case settled in December for a confidential amount. (American Airlines confirmed that the case was settled but declined to make any further comment on DVT litigation, an airline spokesman told Lawyers Weekly USA.)
Danko also represents a 43-year-old man who claims he developed a blood clot after a flight from Atlanta to London. He is now entirely paralyzed except for some eye movement, although his cognitive functioning remains normal. Another of Danko's cases involves a man who dropped dead immediately upon deplaning in Hawaii.
While Danko and others claim the airlines have known for years that DVT is a serious threat, it wasn't until a study was published on Sept. 13, 2001, in the New England Journal of Medicine that the issue was brought to the attention of the medical community, he said, noting that the study demonstrated that the danger of pulmonary embolisms increases dramatically on flights of longer than six hours.
Although the 2001 article documented blood clots in just five cases per million among airline passengers, Danko contended that studies currently under way indicate a much higher risk.
"The medicine is interesting and emerging, and it turns out from studies they're doing now that perhaps one out of 10 people who get off long-haul airline flights have developed a clot of this type serious enough to kill them," said Danko.
Some passengers don't develop symptoms until a few days to a few weeks after the flight, noted Danko, an aviation law specialist who got his first DVT case about a year ago after a 37-year-old woman required emergency open-heart surgery.
The woman, a marathon runner, had flown to Paris to run the Paris marathon. More than two weeks after she returned to the U.S., she suddenly collapsed. Her physician had recently read the New England Journal of Medicine article, asked whether she'd been on any long-haul air flights, and correctly diagnosed a blood clot.
Charles L. Coleman II of San Francisco, who is representing Air France in the case, said he could not comment about the litigation at this time.
Athletes Vulnerable
Athletes are particularly prone to flight-induced DVT, Danko said, because after rigorous exercise their muscles are bleeding, if only in minute amounts.
Although DVT can happen to anyone, pregnant women and recent surgery patients are also at greater risk.
Once a passenger develops a blood clot, even a permanent injury is not sustained, that person remains susceptible for life, Danko said.
"I don't know why that is, but it's a fact that doctors tell everyone with DVT: Once you've had a blood clot, you're at risk the rest of your life," he said. "Anecdotally, you find people who after having one blood clot, they have several others. Dan Quayle had multiple incidents of DVT related to air travel."
Danko, who has sued a number of airlines, including United, Lufthansa and Delta, contends that the industry has known about the problem for years but "kept it to themselves."
As long ago as 1974, many airlines redesigned the seats used by pilots in the cockpit to decrease the chance of blood clots, but did not make the same changes to passenger seats, he said.
But the New England Journal of Medicine article has made a difference, Danko said.
"Most industry groups now concede - partly because of the New England Journal of Medicine article - that there is a relation between long-haul air travel and blood clots," he said.
Warsaw Convention
Because international flights are governed by the Warsaw Convention, which provides that airlines are liable only for "accidents," the law on DVT cases is still developing.
The key issue is whether DVT is an "accident."
"The cases say that an accident is something other than the passenger's internal reaction to the normal operations of the flight," Danko said.
Some airlines deny any connection between DVT and air flight, while all of them claim that DVT is not an "accident" but rather an internal reaction to flight.
While the airlines may appear to have a strong case that DVT doesn't meet the definition of accident spelled out in the treaty, Danko said he believes plaintiffs will prevail on this issue.
"We see it as an accident because airlines failed to warn the passengers of the risk or what steps to take to mitigate that risk," said Danko. "The airlines are saying it's not an accident because it's the passengers' internal reaction to the operations of flight. We're arguing back, if that's so, then the airlines are saying it's normal to get a blood clot. But it's not, because it doesn't have to happen if you take these other steps to prevent it."
If DVT is an accident under the Warsaw Convention, then airlines are strictly liable up to the first $144,000 of a plaintiff's damages. After that, the plaintiff is entitled to recover the rest of his damages if he can prove the airline did not "take all necessary measures to avoid the accident," Danko said.
Those measures should include a strong warning to passengers that they should get up and walk around during a flight, Danko said, and that they should drink plenty of water. Industry guidelines were released two years ago suggesting that airlines tell passengers to exercise during long flights, but this isn't enough, Danko claimed.
"Some airlines will say in a video at the beginning of a flight that there are exercises you should do in your seat. But they don't tell you that failure to do them could lead to potentially deadly blood clots," he said.
Danko said he believes there is one legal theory that could circumvent the Warsaw Convention regardless of how the courts rule on the "accident" issue. His cases are also alleging a claim regarding the design of passenger seats, which he believes contributes to DVT.
"We have evidence that many years ago, pilots were developing blood clots and the airlines redesigned the seats to alleviate that," by ensuring that a person's weight was more evenly distributed over the seat, he said, arguing that these claims should proceed under conventional product liability law since the Warsaw Convention does not apply to manufacturers.
December was a busy month for DVT litigation, with trial courts in Australia and London issued contrary rulings. In London, a court found that DVT is not an accident and therefore the airlines are not liable. However, the Australian court ruled the opposite way.
Also in December, a Texas court ruled DVT could be an accident, Danko said, while last August, a federal court in California ruled that DVT was not an accident.
"So you basically have four decisions, none of which are binding since they're all trial courts," said Danko, who currently has two cases awaiting decisions on pretrial motions in federal courts in California.
One of those cases is the first case he filed, involving the marathon runner. When he filed that case last year, it was the first he knew of in the U.S. Now he knows about 20 other lawyers around the country who have taken DVT cases.
"Most of them are saying that because of the cost involved - assuming they don't have a statute of limitations problem - they'll take a 'wait-and-see' position," he said.
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