mediven travel


		Medical Information Check your Risk

	The medi travel fact sheet	Information about Traveller's Thrombosis
	Compiled by:- Mr John Scurr FRCS Consultant Surgeon, The Middlesex Hospital, London	Contra- indications Tips and Advice
	You are about to embark on a long journey and we wish you well. The facts contained in this sheet have been compiled from existing medical data and are designed to ensure that you arrive on holiday in the best of health, that you take appropriate precautions whilst there, and on your return flight to ensure maximum enjoyment. This information is intended for passengers with no known medical problems. For passengers with medical problems, we would strongly advise you to see your general practitioner. He should be in a position to advise you on whether or not you require specific medication or treatment prior to travel.
	History
	For more than 75 years people have been travelling in aeroplanes. Just over 40 years ago the jet aeroplane was introduced, followed in the last 25 years by jets which can travel increasing distances. The cost of airline travel has decreased, enabling people to travel further afield to more exotic destinations. With inter-continental travel we have recognised jet-lag and a variety of non-specific ailments which affect people who travel. Most of these problems wear off with no long-term effects. Over the last ten years, and more recently over the last three years, there has been a recognised associated between the development of clots in the leg and long distance airline travel. Currently studies are being undertaken to establish the true incidence of this and to see what effective measures can be taken to prevent this problem occurring.
	Deep vein thrombosis and airline travel
	An association between airline travel and deep vein thrombosis has been suspected for several years. In a recent study, this association has been shown to exist in more than 10% of passengers travelling economy class. The problem is by no means restricted to the economy class and can occur to travellers in all parts of the aeroplane. Clots occur in the leg when the blood slows down, ie due to lack of exercise, when the blood thickens, either because of an abnormality with the blood or from simple dehydration due to not drinking enough water. Another cause of blood clotting in the legs is pressure on the veins, particularly behind the knees and in the calves from the seats. There may be other factors which will increase the risk of clotting in the legs, including lower oxygenation in airline passengers. Clots in the leg are not confined solely to airline passengers and have been described in passengers travelling long distances on buses and trains.
	How will a clot in the leg become apparent?
	Most clots in the leg have no signs or symptoms. They are small and after the flight simple exercises and walking around will allow the clot to dissolve without any long-term effects. Sometimes a small clot caused by flying will grow into a much larger clot. A much larger clot can cause long-term damage to the veins, leading to problems in later life. If the clot enlarges to a greater extent a piece can break off and travel to the lungs, giving rise to a condition called pulmonary embolus. A pulmonary embolus can cause pain in the chest and shortness of breath or, if it is large enough, can actually result in a collapse, sometimes leading to death. The development of a large clot in the leg is relatively rare and similarly it is relatively rare to see this clot travel to the lungs. It is clearly better to prevent the clots from starting in the leg than to treat them after they have arisen.
	Prevention of clot
	It is clearly better to prevent a clot developing in the legs and the prevention depends on an understanding of things that make you more likely to clot. Increasing the blood flow through the legs and preventing the veins from stretching can be achieved by wearing class 1 elastic stockings. These have been shown to be effective in reducing the number of clots in the main veins in airline passengers. If you have large varicose veins we would recommend that you had those treated. It is important to wear an elastic stocking which covers the veins fully and does not aggravate them, particularly veins behind the knee. It is important that during the flight you do leg exercises, bending the foot up and down. If you can get out of your seat and walk around the aeroplane, then we would recommend that you do that, again, to encourage the blood flow through the main veins. It is important that you drink plenty of water during the flight and avoid excessive amounts of alcohol. Alcohol, combined with a lower than normal cabin air pressure containing dry air, will lead to dehydration. We would recommend that you drink half a litre of water every hour during the flight. If you can take an aspirin tablet, then it is wise to take an aspirin on the morning of departure. Some people are already taking aspirin to prevent problems with their circulation.
	High risk passengers
	Some passengers are at much greater risk of developing a clot in the leg than others. The older you get, the greater the risk. If you have had a clot in the leg before, then you are more likely to develop a clot if you fly. If you have had recent surgery, particularly major surgery, your clotting system has been activated and this may increase the risk of developing a clot. If you are suffering from a serious medical illness, particularly cardiovascular problems or cancer, then again, the risk increases.
	Advice to high risk passengers
	If you are a passenger who fits one of the above categories, then we would strongly recommend you seek advice from your general practitioner. In addition to the elastic compression stockings and drinking plenty of water on the flight, he may recommend thinning the blood. It is now possible to thin the blood by a simple injection which can be administered by the person travelling.
	For further information about veins, varicose veins, clots and elastic stockings visit the following websites: http://www.jscurr.com http://www.mediuk.co.uk	Top
	At 11th may 2001 medi uk Ltd had conducted a press conference at the Royal College of Physicians in London. There the clinical study published in the Lancet the same day was presented. Have a look to the live video Webcast. (minimum requirements to listen to the broadcast : The Windows Media Player software, downloadable free and at least 14.4Kbps connection to the Internet)
	Clinical study: Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial published in: The LANCET, Volume 357, Number 9267, 12 May 2001, pp. 1485–89.