Those long airplane flights to Europe, Asia, or Australia are not only a pain in the derriere, they can be hazardous to your health. The culprit is your circulation system. Prolonged inactivity slows the flow of blood in the legs and increases the likelihood clots will form. These clots can break off and travel to the lungs where they are termed pulmonary emboli. Depending on their number and size, pulmonary emboli can cause symptoms that range from mild shortness of breath to death.
We need our blood to clot. If our blood did not clot, even the slightest wound might end up being fatal as our blood would just continue to flow out of our bodies. Fortunately, nature has provided for us by developing a clotting system for our blood. When it is not flowing normally, factors in the blood cause it to form clots. Think of them as nature’s band aids. The clot forms a scab, which covers the wound and keeps our blood inside and harmful germs out. Eventually, the wound heals and the scab falls off. So far, so good.
Unfortunately, our blood clotting system, which was developed over millions of years, works best when we live as our early ancestors lived, in an almost constant state of motion. Our early ancestors were not couch potatoes. Not only did they not have couches, they could not afford to sit around or they ran the risk of starvation or becoming the meal of some large predator. Civilization has been both a blessing and a curse. Civilization provides the opportunity to live life without constant motion. Our bodies, which cannot change as fast as civilization advances, are not amused.
Prolonged lack of movement, as may occur on a long flight or a long car drive, can trigger our body’s clotting mechanism. When these clots occur, they most often occur in the deep veins of the legs, where they may cause pain, swelling, tenderness, and a sensation of warmth. The clots are not particularly harmful so long as they remain in the deep veins of the leg. When there is clot in the deep veins of the leg, it is called deep vein thrombosis (DVT).
Real trouble happens when pieces of the clot break off and travel through the veins back to the heart. The heart does not realize the clots are there and does its usual job of pumping the blood returning from the veins into the lungs to be loaded up with oxygen. The process of loading up the blood with oxygen takes place in very tiny blood vessels in the lungs. When pieces of clot arrive in the lungs, they get stuck in these tiny blood vessels and block them. Once the clots arrive in the lungs, we call it pulmonary embolism (PE). If there are enough clots, or if the clots are large enough, they can prevent the lungs from delivering enough oxygen to keep the body alive.
There are a number of risk factors for DVT besides long periods of travel in a car or plane. Over 60? Your circulation is not what it was when you were 20 and your body is more likely to form clots. Recently had surgery? The trauma of surgery tells the body that there is a risk of bleeding to death and it is time to aggressively form blood clots. Pregnant or recently pregnant? The same message is sent to the body letting it know that it needs to be aggressive in forming blood clots. Add to the list birth control pills, obesity, smoking, cancer, dehydration, heart failure, inflammatory bowel disease, and just plain bad genes.
Here are the warning signs of pulmonary embolism. See a doctor if any of these occur. If you have recently traveled, if you have signs of DVT, or if you just have risk factors for DVT, be on special lookout for any of these signs of pulmonary embolism.
- Sudden shortness of breath
- Chest pain or discomfort that worsens when you take a deep breath or when you cough
- Feeling lightheaded or dizzy
- Fainting
- Rapid pulse
- Rapid breathing
- Coughing up blood
If you are planning to travel, and especially if you have any of the other risk factors for DVT, you should consider some precautions. The most important is to move around while on your trip. Get up and walk in the aisle on the airplane, flex your muscles while sitting in your seat, drink water and remain well-hydrated. On the long car trip, take frequent breaks and walk around. For long periods of inactivity, you should also consider wearing compression stockings that will reduce the chance of clotting. If you have recently had surgery, get up and get moving as soon as possible.
Pulmonary embolism is serious. I have had a number of cases over the years in which the patient sought medical help for signs of PE but the doctor misdiagnosed him and sent him home. In each of the cases, the patient died from the PE. Don’t let that happen to you. If you think what you have may be PE, go to the emergency department as opposed to urgent care. Go even if you are in a foreign country. Be aggressive in returning to the emergency department, if your symptoms do not improve or if they get worse. Better some inconvenience on your trip than the alternative.
