including > media
hype and reality > ten tips
Here in the United Kingdom, we have been bombarded
of late through the media with scare stories on so-called "economy
class syndrome", the potentially lethal risk to travellers on long
haul flights from blood clots. Such a thrombosis - or DVT - can result,
as we all now unhappily know, from the pooling of blood in the lower
leg during long periods of immobility while travelling, exacerbated by
the cramped conditions of limited legroom in aircraft.
Symptoms include, classically but not invariably, painful swelling in the lower
leg. Statistics have not been forthcoming in the past but it is now believed
that perhaps thousands die each year in the UK from the effects of DVT with an
increasing and worrying number probably as a direct result of flying.
A few years ago, I featured briefly in the press as being at death's
door, laid low in a Sydney hospital with such a thrombosis. At
least one UK paper had me already a goner - not particularly helpful
when I was trying to play down the seriousness of my plight for
the sake of our children and friends.
It was all as a result of an accident during a concert tour of
the Americas when I took a tumble on a slippery stage in Lima,
Peru, tearing up the Anterior Cruciate Ligament (ACL) in one knee.
Foolish trooper that I was, I continued with the tour in both
pain and wheelchair for another two weeks until I could get back
to the UK for surgery.
Flying almost daily from concert to concert with one leg strapped
up in a knee brace and struggling manfully on crutches, I checked
in with four separate specialist doctors in Bolivia and Costa Rica
as well as Philadelphia and Richmond, USA, to monitor the situation.
Only one of these doctors gave any warning as to the dangers of
travel in this condition, suggesting that I take an aspirin before
the long flight back to the UK - but without really explaining
The UK surgeon who examined me prior to the knee surgery gave
little hint as to the risks I might have already endured and offered
only the same advice regarding the taking of aspirin before the
horribly long flight to Australia due to take place a couple of
weeks later when our concert touring schedule resumed.
I travelled out economy while my wife and the rest of the band
flew business class. Mind you, I bought myself three economy seats
so I could sit sideways with my bad leg horizontal and stretch
out (almost) for a sleep.
After the first two Australian concerts I was in such pain throughout
the knee and lower leg that I contacted the UK surgeon to express
my fears and concern. I did not, however, exhibit the severe swelling
associated with a DVT and was told categorically over the telephone
that I did not have a blood clot.
But something didn't feel right with the leg - a deeper and more
sinister feeling than just the dodgy knee - so, after a brief discussion
with a worried hotel doctor, I took myself off to a Sydney hospital
and insisted on an ultrasound scan to determine that, hopefully,
no clot was present. Alas, the scan showed a huge and life-threatening
clot stretching from just above the ankle to the upper thigh, just
below the groin. Within two shakes of a Kangaroo's whatsit, I was
in a different hospital and under the care of a doctor specialising
in the treatment of such cases.
He explained that perhaps one in five people have a double vein
system where, in the event of a clot, blood finds its way back
up to the heart via alternative routes without displaying the degree
of swelling normally associated with the condition. Indeed, he
further amazed me with the tales of relatively large numbers of
passengers arriving in the great Down Under with DVT and suggested
strongly that, as the major destination in the Southern hemisphere
for long-haul European flights, Australia possessed medical facilities
which were, in his opinion, way ahead of other countries in diagnosis
and treatment. My experience and ultimately my eventual recovery,
more to the point, tend to endorse his humble view.
The dangers of the clot suddenly breaking up with pieces finding
their way to my heart and lungs were solemnly explained and the
realistic chances of survival in this event (not bloody good, mate!)
were dutifully absorbed by this now strangely fatalistic patient.
In fact, late one night there was a bit of a scare when I became
suddenly breathless with elevated pulse and was close to passing
out. I found the strength to summon my wife by telephone from her
hotel to say goodbye in person while they strapped on the oxygen
mask, rosary beads and prayer mat. Now it may have been the hospital
food (unlikely, for such fair tucker) or the sight of Damon Hill
having a particularly bad race on my hospital room TV (possible):
but if it was a bit of clot attempting to cut me off from the balmy
Sydney night breeze drifting through the open window, I still prefer
not to think about it too often.
Our good Aussie Doctor also expressed the view that the clot may
have been there prior to my travel to Australia. The chances were,
he thought, that the clot had begun to form even prior to surgery
back in England due to all the previous travel and immobility of
the limb. Why then, I wondered, had the surgeon not carried out
a routine scan before the operation - or at worst - before my departure
to Australia? "Good question," was the reply. "We
do routine scans here on folks with knee and hip injuries, even
young and fit athletes, and especially after carrying out operations
Another surgeon, responsible for my physical rehabilitation and
a specialist in sport injuries, was more scathing, claiming that
the UK was horribly behind the times regarding surgical procedures
for knee injuries as he had found when visiting the UK on lecture
tours and hospital teaching demonstrations.
Oh quaint and archaic Blighty. She giveth and she almost taketh
After three weeks of blood-thinning drugs, elasticated compression
hose (industrial grade support socks) and serious physiotherapy
from some brutal antipodean task-masters more used to driving on
the recovery of football players and track stars, regular scans
revealed that the clot had reduced enough for me to risk the flight
Several months of daily Warfarin (Yes - the rat poison) treatment
to keep the blood thin and increase clotting time meant a daily
reminder of the potential perils of flying for a living. Several
more scans later the clot was effectively gone and minimal damage
was evident to veins and valves. I had been warned back in Australia
however, that I might be susceptible to a further incident and
advised to take certain precautions.
MEDIA HYPE AND
In recent weeks, many holiday travellers have been made aware of the risk through
TV and the press and are confused and concerned as to how to minimise that
risk. We are given to believe in the so-called "economy class syndrome" as
if only the poor folks in the back of the plane need worry. Rubbish! In first
class on Concord or in business class on a 747, you stand a small but real
chance of suffering from a clot if you remain immobile for the duration of
the journey and compound things by imbibing the full complement of freebie
food and booze. Once the fellow in the seat in front reclines all the way for
the overnight snooze, you will be as firmly trapped as if you were in the grip
of 32 seat-pitch-inches of economy torture. "Immobility syndrome" might
be a far better description.
"Embarassment syndrome" might also describe the plight
of the window seat occupant or the poor schmuck-in-the-middle who,
desperate for a mid-flight tiddle - especially given the copious
quantities of water we are supposed to drink - can't quite bring
himself to disturb the neighbouring and corpulent aisle-dweller,
out for the count on sleeping pill and six lagers, headphones askew
and drooling from one or other of his many chins. And, even if
he makes it to freedom, our window-hugger is likely to encounter
the "return to your seat" clear air turbulence message
or the flight attendant with the aisle-blocking drinks trolley
attempting to service the needs of four hundred passengers with
a thirst for something stronger to mix with the water.
well-meaning wag proposed recently that the airlines should supply
complementary in-flight support stockings for the passengers. Come
on! The real thing is a heavy duty and not inexpensive item. It
comes in various sizes and grades of elastic tension according
to need. It must be tight fitting but not too tight. Some resemble
the ladies' stocking of old: some are open-toed and reach to just
below the knee but with a looser rim around the top to prevent
garrotting the lower limb. To carry on board, say, four sizes (S,
M, L, and XL), there would have to be in excess of a thousand pairs
of such compression hose on a wide body jet to meet the needs of
Far better that these items might soon become available for sale
at the Chemist or gift shop in the terminal before departure.
Oh, wouldn't it be luvverly if there was an extra aisle in the
larger jets so that no-one was more than one seat away from an
escape route, whether for evacuation in the dubious event of landing
on water or simply for the evacuation of one's own water. The airlines
might be desperate for our business but they are not commercially
suicidal. Perhaps things may go that way in a few years time but
for now, we have to make the best of a far from ideal mode of travel.
Our fortunes aren't necessarily that much better travelling by
road either. Incarcerated in the back of the family charabanc,
you just have to be a little concerned at the prospect of granny
making it in one piece to visit the in-laws in Cornwall. Especially
after that hip-replacement operation and no DVT scan afterwards.
A rough back-of-the-envelope calculation suggests to me that,
for around £20 per scan, an Ultrasound DVT scanning machine
plus operator might be situated close to the arrivals hall in every
airport servicing international flights. A passenger suffering
from DVT-like symptoms could be scanned in a few minutes - a very
few if no clot is present - and emergency cases detected and dealt
with immediately, rather than the next day when it has so often
proven to be too late.
The scan is completely painless and involves smearing the inside
of the leg with a rather sexy jelly to aid contact with the hand-held
probe which is moved smoothly up and down the inside leg. The image
on the monitor tells the operator if the veins are clear and blood
pumping or if there is some degree of blockage. The procedure is
actually quite pleasant and trouserless gentlemen should beware
that a stiffy may result.
Would it be possible to claim for such cost on our holiday travel
insurance? I must read the small print. Still, we will have to
wait for some real entrepreneurial initiative to see such machines
waiting to greet the distressed arriving passenger. Sir Richard
Branson, take note.
Studies in the field of travel-related DVT will take at least
a year to bring about meaningful evaluation, we are told, and the
airlines are being understandably cautious in responding to criticism
and claims from sufferers. In the meantime, don't just literally
sit back and think of England: I don't since I travel frequently
in my profession - perhaps sixty or more flights a year, many of
TEN TIPS FOR THE TRAVELLER
So, what have I learned from my experience and what might we all do to make
sense of the advice from the experts, however impractical it sometimes sounds?
Well, the jury might be out on the question of aspirin but I have
no hesitation in advising anyone with no adverse reaction to that
humble little pill to religiously use it for cramped journeys of
more than, say, three or four hours duration. But you don't need
a whole standard 300mg tablet: a modest child's aspirin of 75mg
will do just fine. If you can't find that dosage, then half or
even quarter of a regular pill will do. Don't leave it until you
are airborne to swallow: take the small dose the night before travelling,
just before leaving home and again during the journey. If you have
any doubts about using aspirin, consult your doctor.
You can buy or order compression hose from any decent pharmacy.
I would recommend class 2 knee-length hose with open toes. Suggested
manufacturers include Scholl and Duomed. It's important to know
your size so the pharmacist can supply the correct item. Before
you go shopping, measure round your ankle, the widest part of the
calf and around the knee. If you want the full-length version,
measure round the widest part of the thigh as well. It's best to
measure as soon as you get up in the morning before your legs swell
slightly as a result of sitting or standing for any length of time.
Put on your fabulous and exotic new accessories in the airport
loo or in the departure lounge. Trying to heave them on in the
confines of your economy seat may prove difficult and remember,
they have to be on properly: no wrinkling or crooked seams, chaps.
You can put your regular socks back on top of the eerily flesh-coloured
compression hose if you feel just a teensy-weensy bit too Nora
Although these stockings may look impossibly small, they should
be a relatively tight fit. If you haven't had time to take your
measurements, medium should be about right for the average slightly
built male or healthy full figured female. Small would be fine
for petite folks. Large and extra large for the big and bigger,
beefier types. Compression hose cost in the range of £15
- £20 and can be bought singly as well as in pairs.
Drink plenty of water during the flight. Lay off the alcohol although
a glass of wine won't hurt so long as you drink plenty of water
too. Remember, alcohol will add to the dehydration problems of
Eat lightly and think twice about popping a sleeping pill, especially
if you are a deep sleeper. Wear loose clothing for comfort and
to minimise constriction around the thighs and knees. Try not to
sit with crossed legs for too long and, if you are short or your
feet don't reach flat to the ground, put a rolled-up coat or pillow
below your feet, raising the legs to prevent pressure from the
seat edge to the area under the knee.
Don't, for heaven's sake, feel embarrassed to ask your neighbour
to move so you can stretch your legs or visit the toilet. Just
try to lever yourself up using the arm rests rather than to swing
like some demented monkey on the seat back in front of you where
I, or another potential subscriber to air-rage, might be trying
to enjoy a little beauty sleep.
I invariably request an aisle seat, as do all of our band members
and crew. Now, obviously we can't all manage that on a full flight
but if you are travelling alone, check in early and go for it.
Family groups don't worry so much about climbing over each other
to get to the aisle and are usually happy enough in rows of three
I still can't help but feel that a 1 x 3 x 3 x 2 configuration
of seating giving three aisles would greatly aid our wide body
long haul jet travel. No one would have to negotiate more than
one seated person to access the aisle. The resultant extra aisle
would reduce economy seating availability by ten per cent but I
for one would rather pay a little more for the flexibility of seating,
especially when travelling alone.
every hour - or even more often - by flexing the feet while seated.
Keeping the heel on the floor, raise and lower the rest of the
foot, rather like operating a foot pump. Do this for a couple of
minutes at a time. Try to get up and move about the cabin at least
three times on an eight hour flight. Choose your moment when the
drinks and food trolleys are not active and the seat belt sign
is not on.
Raising the knees alternately up to waist height is a good little
exercise while standing in the aisle or a quiet corner near the
loos or galley. Raising and lowering the heel up behind you with
bent knee helps uncoil stiff and sore legs. Bobbing up and down
from flat heel to tip-toe helps too. All these simple routines
will work well to stimulate circulation.
If you can, travel with only such hand luggage as will fit unselfishly
in the overhead lockers. Leave that precious legroom under the
seat in front to stretch your legs. Remember, you paid for that
luxurious two cubic feet, or so, of vital space: don't waste it
by stuffing it full of all the things you forgot to pack last night
and jammed into the Tesco's carrier bags at the last minute.
If you are in what may be determined as the high risk categories
- overweight, recently injured or operated on, professional athlete
(odd, I know), suffering from any circulatory problems or having
a family history of thrombosis - do please consult your doctor
before travel. It's a fair bet your local GP is brushing up right
now on the subject given all the recent publicity.
And if you ever find yourself sitting next to me on an eleven
hour hop to LA, please, please don't hesitate to ask me to let
you past my hard-won aisle seat on your way to exercise those little
Hell, I might even join you.