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DVT and Pulmonary Embolus: learn from me


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#1 sdingeldein

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Posted 16 October 2011 - 04:25 PM

A lot of people who dive here travel a lot and travel great distances. Everyone has likely read the information in the airplane magazines about getting up, moving around, doing static exercises to keep blood circulating in your legs. And perhaps some have heard of people getting deep veinous thrombosis (DVT) and perhaps also a pulmonary embolus (or more) from the DVT. Of course it's always someone else (Serena Williams, Mary Chapin Carpenter) . . . until its you.

I developed pain in my right calf 3 days after returning from Hawaii that felt like a muscle strain. However it didn't get better and a few days later I noted some swelling in the lower right leg. Off to my doctor and doppler studies were done (ultrasound) and found DVTs in both legs. The left one was completely asymptomatic. Even more surprising is that a CT of the chest showed several pulmonary emboli (none blocking an artery) mainly in both lower lungs (where blood preferentially flows). I was also 100% asymptomatic from the PEs . . .

So into the hospital for heparin acutely and to start coumadin. Lovenox shots in the belly upon discharge (my wife enjoyed giving those, lol) and now my coumadin level is perfect 2.5. Back to work doing cataract surgery tomorrow. While unclear it appears I will be on coumadin 6-9 months and then can return to diving (coumadin and diving is controversial and advice depends on how conservative the dive doc is).

So here are the points:

1. Get up and move around. Do lower leg exercises. Trips over 4 hours increase the risk significantly. The irony of my trip is that I had First Class Seats for the first time (God'll teach me) and so I was able to sleep for 4 hours and my guess is that contributed. Sitting in window seats doubles your chances of getting a DVT, so tell the lard butt in the aisle seat sleeping that you have to get up or you might die on him.

2. Consider getting compression stockings, particularly if you have any venous stasis at all, are over 50, or are overweight (like me but down 20 lbs with 20 more to go).

3. Don't ignore any lower extremity pain after long trips (plane or car).

Edited by sdingeldein, 16 October 2011 - 04:26 PM.

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#2 okuma

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Posted 16 October 2011 - 05:44 PM

We are both in our early 70's not overweight and now wear the compression socks on all flights!
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#3 loftus

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Posted 16 October 2011 - 10:12 PM

Glad to hear you are doing well; the silent PE's is pretty scary.
Extrapolating from operating room data; one should walk /exercise the legs at least every 2 hours, and move the feet and stretch the calves much more frequently than that when sitting.
I would add, that one does not have to be over 50, or overweight. Particularly female, on birth control, and smokers are at risk .

Edited by loftus, 16 October 2011 - 10:15 PM.

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#4 sdingeldein

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Posted 29 November 2011 - 06:51 PM

Glad to hear you are doing well; the silent PE's is pretty scary.
Extrapolating from operating room data; one should walk /exercise the legs at least every 2 hours, and move the feet and stretch the calves much more frequently than that when sitting.
I would add, that one does not have to be over 50, or overweight. Particularly female, on birth control, and smokers are at risk .


Also being tall is a risk factor and it turns out PEs happen in 50% of DVTs (more sensitive testing like spiral cts have changed the numbers).
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#5 MikeVeitch

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Posted 29 November 2011 - 09:47 PM

good info thanks. One question, what does sitting in a window seat have to do with it? Just the fact you are less likely to get up frequently or something else?

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#6 Steve Douglas

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Posted 30 November 2011 - 09:08 AM

Coumadin is a serious blood thinner. I hope you will not have to be on it for long. I know a gal who will be on it the rest of her life and she has to constantly take various precautions and tests. I do hope you recover. In first class, I assume you were laying down in a full 180 position so I doubt that that was a contributing factor. However, sitting up in cramped spaces certainly would contribute to that. Sorry you have had to go through it. Good luck on your recovery, hope it comes soon.
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#7 jonny shaw

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Posted 01 December 2011 - 09:12 PM

I'm always open to swap my economy seats for your first class if you like?

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#8 Drew

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Posted 02 December 2011 - 05:39 AM

I think I have an impractical solution to inflight DVT:

The only way to fly (IF you can get pass that damned new website!)

;)

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#9 TheRealDrew

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Posted 02 December 2011 - 06:40 AM

I think I have an impractical solution to inflight DVT:



But you are still limited to one carry on and one checked bag ;)

Yeah, that definitely looks like the way to travel. Had a few flights with big chairs/converts to bed and some nice space, but MAN that is the way to go.

Other than having your own jet of course....

Well back to playing the lottery.

#10 Steve Douglas

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Posted 02 December 2011 - 09:17 AM

I think I have an impractical solution to inflight DVT:

The only way to fly (IF you can get pass that damned new website!)

;)



I was so bummed to hear that Delta and Singapore Air are no longer partners. A few years back I flew to Singapore on Singapore Airlines in first class using my Delta miles. Can no longer do this and I am pissed. I have a ton of Delta miles and not many places to go with them.
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#11 bvanant

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Posted 02 December 2011 - 12:21 PM

I was so bummed to hear that Delta and Singapore Air are no longer partners. A few years back I flew to Singapore on Singapore Airlines in first class using my Delta miles. Can no longer do this and I am pissed. I have a ton of Delta miles and not many places to go with them.
Steve

There's always Minneapolis. ;)
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#12 Fontaine

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Posted 03 December 2011 - 12:48 AM

I was so bummed to hear that Delta and Singapore Air are no longer partners. A few years back I flew to Singapore on Singapore Airlines in first class using my Delta miles. Can no longer do this and I am pissed. I have a ton of Delta miles and not many places to go with them.
Steve


KLM, Korean Air, and Air France are part of Delta miles, that should get you around the world a few times.
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#13 loftus

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Posted 03 December 2011 - 03:42 AM

KLM, Korean Air, and Air France are part of Delta miles, that should get you around the world a few times.

Korean Air is a notch below Singapore, as for the others, fugedaboudit!

Edited by loftus, 03 December 2011 - 03:43 AM.

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#14 Drew

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Posted 03 December 2011 - 06:54 AM

But you are still limited to one carry on and one checked bag ;)

You get 2 pcs of hand luggage and 2 pcs of checked. You get 4 if you are in their high status Krisflyer program. A hint for those who are PPS or Solitaire, their website is so crap now that even if you have a confirmed check in email, they may not have your reservation at the airport! Make use of this to your advantage! :);)

Korean Air is a notch below Singapore, as for the others, fugedaboudit!


The only airline I think is better than SQ is Virgin Atlantic. Service is better and they actually do upgrades. I'm waitin' on Branson to expand and wish he'd stop concentrating on outer space and dominate flights below the stratosphere!

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#15 bvanant

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Posted 03 December 2011 - 10:08 AM

You get 2 pcs of hand luggage and 2 pcs of checked. You get 4 if you are in their high status Krisflyer program. A hint for those who are PPS or Solitaire, their website is so crap now that even if you have a confirmed check in email, they may not have your reservation at the airport! Make use of this to your advantage! ;);)



The only airline I think is better than SQ is Virgin Atlantic. Service is better and they actually do upgrades. I'm waitin' on Branson to expand and wish he'd stop concentrating on outer space and dominate flights below the stratosphere!

We fly a lot and in my opinion from the U.S. to Asia I think Cathay (at least in First and Business) are a whole lot better than SQ; we have had lots of problems on SQ. I like V Australia too, and in Business Class they are the only airline I know that has a separate ladies only restroom on the plane. My wife liked that touch. Qantas upper class is hit and miss; some flights are OK others are not so much. If the rumors are true that American is likely to be "harvested" by US Air then maybe we can try Singapore again since they are partners.
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#16 Drew

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Posted 03 December 2011 - 11:58 AM

I agree that CX is good and the Marco Polo program is much more inclined to upgrade Diamond Platinum members on a regular basis. Krisflyer is the stingiest program I've ever been part of! CX even remembers birthdays with a cake at various airports, but I think it's because I complained a lot at those airports ;). But the LAX-SIN SQ direct flight is just faster and the food (esp special meals) and service are still better (but slipping) than CX.
I do feel SQ is slipping quickly with the website and also some of their shorter haul planes are just terribly uncomfortable! I'm actually thinking of using CX more often because they are also cheaper and I don't mind stopping in HK for a day to hang with friends. The CX beds are the same as Virgin Atlantic (which is 49% owned by SQ). I guess it's a matter of priority but I like the flight to be comfortable with good food and service. CX tends to do better with customer satisfaction on the ground (upgrades etc). If I didn't use SG as a base for Asian travel, I'd use CX more often, plus the Star Alliance pack do have better routes than One World.

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#17 Barry4158

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Posted 03 December 2011 - 02:46 PM

I wonder if taking a baby aspirin before the flight would decrease the risk of PVT.

#18 bvanant

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Posted 03 December 2011 - 03:28 PM

I wonder if taking a baby aspirin before the flight would decrease the risk of PVT.

It appears from the literature that compression stockings are the best bet, aspirin which won't hurt doesn't help much unlike it's role in arterial clot prevention. Walker (Scott Med J, 2011, p 183) did a meta analysis of most of the published travel literature and that was his conclusion. There is speculation on the role of hypobaric hypoxia activation of coagulation but I don't know of any studies that have looked at this directly.
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#19 loftus

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Posted 04 December 2011 - 06:32 AM

It appears from the literature that compression stockings are the best bet, aspirin which won't hurt doesn't help much unlike it's role in arterial clot prevention. Walker (Scott Med J, 2011, p 183) did a meta analysis of most of the published travel literature and that was his conclusion. There is speculation on the role of hypobaric hypoxia activation of coagulation but I don't know of any studies that have looked at this directly.
Bill

Companies like Jobst make compression hose that are a great substitute for regular socks; I don't even purchase regular socks any more. I have worn them every day since I was in my surgical training and they make a huge difference to the way my legs feel at the end of the day.
Short of the more high powered IV anticoagulants which are of course not a consideration in this discussion, probably the single most important thing to minimize DVT is muscle compression / contraction. Even if you are unable to get up and walk, I think there is value to flexing and extending the feet repeatedly and frequently while sitting down, really feeling the calf stretch and compress. This is probably the best way to mimic the effect of the intermittent compression devices we use during surgery. Other factors that appear to have an effect are exercise including walking, and staying well hydrated even in the days prior to flying. So it can't hurt to stretch, exercise, hydrate with anything but alcohol etc even while waiting for your flight.

Edited by loftus, 04 December 2011 - 06:36 AM.

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#20 tdpriest

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Posted 04 December 2011 - 06:56 AM

There's a certain amount of scaremongering here, as well as a couple of offensive remarks about those of us who are more comfortably unholstered than others (and book aisle seats so as not to crowd the poor unfortunate in the window seat). Hydration, gentle exercise, compression stockings are all useful, but another factor, often overlooked, is the predilection for alcohol during long-haul travel: well worth avoiding it! Loftus is quite right.

Anticoagulant treatment after pulmonary embolism is a double annoyance: not only do you have to take and monitor the medication, but you can't dive until it's stopped.

Tim

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