Vacation/Travel Supplement

Know the symptoms: Travelers need to exercise to avoid blood clots

By Thomas J. Rillo (Special to The Criterion)

Travelers—and especially senior citizens—need to be concerned about “a clear and present danger” associated with inactivity during long trips.

More and more retired Catholic seniors are embarking on pilgrimages to a variety of holy sites and shrines. Places like the Holy Land, European cathedrals, monasteries and convents, and such holy Marian sites as Fatima, Lourdes, Medjugorje and Tepeyac are frequent destinations for pilgrimages.

For senior pilgrims as well as those who are not elderly, long-distance traveling can be hazardous to their health. This danger can be life-threatening and has often resulted in death.

The silent enemy who travels with pilgrims—whether on an airplane, train or bus—is deep vein thrombosis (DVT), which kills more Americans than automobile crashes, breast cancer and AIDS combined. But many people are not aware of this danger and do not even know its name.

Deep vein thrombosis is usually precipitated by long periods of inactivity in cramped airline seats or other conditions that limit mobility. It begins in the leg with a blood clot that can move to the lungs and cause pulmonary embolism. Death can be the result of a DVT condition.

Many older adults are at risk just by sitting for a long period of time on long-haul flights.

DVT symptoms include discoloration or redness of the skin, sharp chest pain, tenderness, breathlessness, a fast pulse, excessive sweating or coughing up blood-stained phlegm. Take these symptoms to an emergency room quickly because they are signs of pulmonary embolism.

Deep vein thrombosis occurs when a blood clot forms, usually in a leg. Most blood clots dissolve, but a clot that breaks off can be fatal.

A study published in The New England Journal of Medicine found that the rate of pulmonary embolism among airline passengers increased as the distance increased.

The risk of DVT seems to increase during air travel because sitting still for a long period of time slows the blood flow and increases the thickness of the blood while compression caused by tight airplane seats can cause blood vessel lesions.

Another study published in The British Medical Journal’s Nov. 8, 2003, issue found that the risk of getting a blood clot or pulmonary embolism was highest within two weeks of taking a long flight. The subjects were 5,400 patients admitted to hospitals in Western Australia from 1981 through 1999.

The conclusion was that the annual risk of developing a blood clot increased 12 percent if one long-haul flight was taken each year. Because of Australia’s geographical location, long-haul fights are necessary for anyone traveling to or from that country.

Most airlines have no consistent policy of mentioning deep vein thrombosis to their passengers. Air France, Asiana and Northwest Airlines are among those who point out the potential danger in their flight publications and recommend that passengers do the exercises shown in the magazine.

Some airlines advise passengers to do seat exercises as part of their in-flight videos or in booklets and onboard airline magazines. However, many airlines do not call attention to the explicit health warning of DVT.

Airline passengers should be warned about the potential risk of DVT at the time of the reservation or supplied with this health information at the ticket counter.

Airlines need to promote healthy flying, especially on

long-haul flights, by telling passengers to stay hydrated, move around a lot, avoid drinking alcohol, do the suggested seat exercises and possibly wear compression stockings. Links to hosiery companies that produce compression stockings can be found on Internet search engines. These stockings do not have to be dowdy in appearance.

It would benefit tour guides and spiritual directors, such as priests or monks, to avail themselves of the information that is published about deep vein thrombosis. This article can be included with other literature sent to pilgrims.

Searching the Internet will also provide a research tool for educational information about DVT.

With airlines decreasing seat room by installing additional seats or building airplanes with greater passenger capacity, it becomes imperative for travelers to become aware of and articulate about the risk and symptoms of deep vein thrombosis.

Travelers also need to know what exercises they can do to minimize the potential risk of DVT. We cannot assume that all airlines will warn people about this health risk and pass out DVT information or provide in-flight videos that demonstrate seat exercises.

There are certain basic exercises that a person can do to keep the blood flowing in the legs and minimize the risk of DVT. Since it starts in the legs, we should concentrate on exercising the legs first. There also are exercises that a person can do in the seat to benefit the upper body.

Seat exercises for the legs

• Begin with the feet. Start with foot rotation by lifting the feet up and drawing circles with the feet. Move both feet simultaneously or one foot alternately.
• If you cannot hold your feet off the floor or there is limited room, keep your heels on the floor and draw circles with your feet.
• Next do the foot swing with the feet slightly apart and the heels on the floor, and lift your toes upward. Swing your toes simultaneously outward and inward in rapid motion.
• The foot roll is next. With the feet close together, roll to the outer edge of each foot and then back. You should feel the pressure of the floor on the outer edge of each foot.
• Toe raises are simply lifting the toes off the floor with the weight onto each foot.
• Heel raises are simply lifting the heels off the floor with the weight forward onto the ball of each foot.
• To do the knee lift with ankle flexion, grasp your knee with both hands and lift the leg upward toward the chest. With foot elevated, draw small circles, first in one direction and then in the opposite direction. As a variation of this exercise, move the foot downward and upward in a plantar motion with the knee still lifted.
• Hip abduction and adduction can be done by simply moving your knees outward and then inward. Begin with both feet together and place your hands to the outside of each knee. Apply steady pressure and move the knees apart. Then bring the knees together without the pressure. Repeat outward with pressure. Next, place your hands on the inside of each knee with feet slightly apart and bring the knees together while applying pressure with the hands. Move the knees outward with no pressure. Repeat.
• Do at least 10 repetitions for each of the seat exercises described.

Congratulations! You have now done each exercise for at least 10 repetitions and have caused increased circulation in your legs without getting out of your seat. You have attempted to hold the deadly enemy DVT at bay.

Remember that many of us are at risk from prolonged inactivity in any condition that limits mobility, whether that involves traveling by airplane, train, bus or car as well as being confined to a sickbed.

Not just the elderly are in danger of experiencing deep vein thrombosis. Also at risk are people with other health conditions, such as pregnancy, a smoking habit, being overweight, recent surgery, hormone therapy, heart disease, some cancers and other reasons for limited mobility.

While it is true that most senior pilgrims will not have many of the previously mentioned health conditions, they will have some that will endanger them to the risk of becoming ill from DVT.

Deep vein thrombosis knows no age limit and sometimes even attacks the conditioned athlete.

Nearly half of the people who develop a dangerous blood clot in their legs are under 50 years of age.

If you suspect that you have DVT symptoms, see your doctor immediately. There are quick and responsive tests that will identify the existence of deep vein thrombosis.

Don’t forget to get up and move around throughout your mode of travel as often as possible.

God wants you to travel to holy places. He wants your traveling retreat to be as spiritually fulfilling as possible. He has provided this writer with the information to save your life. He has also chosen a senior pilgrim to write this story.

Nothing is impossible for God. If this article saves just one life then it has been worth the effort to write it.

(Thomas J. Rillo is a member of St. Charles Borromeo Parish in Bloomington and is an oblate of Saint Meinrad Archabbey. He is a retired professor from the School of Health, Physical Education and Recreation at Indiana University in Bloomington. His background includes physical education and kinesiology as well as environmental education.) †