Phyllis Kanki, an infectious-diseases professor at the Harvard School of Public Health, told me she traveled business class as much as possible in part because of the ability to elevate her legs, a way to lessen the risk of DVT. “The first thing I do once the plane takes off is to elevate my feet. It makes a big difference,” she said. “The trouble with diagnosing DVT after long trips is that so many things are going on. You get off the plane, you’re fatigued, everything feels weird, so it’s really easy not to get the right cues. If you were at home, you would pick up on them immediately.”
Several people told me about the physician John LaMontagne, deputy director of the National Institute of Allergy and Infectious Diseases, who died suddenly in 2004 from a pulmonary embolism after leaving a plane in Mexico City. I called his former boss, Anthony Fauci, to learn more about what happened.
“It was an extremely tragic situation,” said Fauci, who is also a physician. “John was sitting in the very back of a crowded plane going into Mexico City. He was seemingly doing fine, and as he was going through the passport line, he had a pulmonary embolism, and it essentially killed him right then and there.”
Fauci, one of the country’s premier AIDS scientists, said he walks a lot on flights, even if he clogs the aisles. “I have always been extremely attentive to the dangers of flying, so I spend a lot of my time walking down the aisle and getting in people’s way,” he said.
He explained how sitting in a cramped airplane seat for a long time could cause clotting: “If you are sitting down and the under part of your knee is constricted, when you bend the femoral vein, it creates more blood statis,” or stagnation, which causes blood platelets to clump up and form clots, he said.
But Victoria Day, a spokeswoman for Airlines for America, a trade association, said in an e-mail that there’s “no specific link between air travel and DVT. The risk of developing a DVT during air travel is about the same as being seated for the same period of time at a desk, in a movie theater, on a bus or in a car.”
I decided to reach out to a Web-based clearinghouse of information on DVT called ClotCare. The doctor who founded the organization, Henry Bussey, said the site receives more than 500,000 hits a month.
Bussey said that the few studies on DVT showed that long-distance flying could be a “substantial risk.” But he also said that those who had a tendency toward clotting were older people with poor circulation, women who were on hormonal medicine and people with a genetic condition that allows clots to form more easily, not necessarily people who frequently travel long distances. He suggested that my DVT could have been caused by a genetic disorder that made me predisposed to clotting.
So what does this mean for me?
I can’t say just yet. After I’m off my anti-clotting medicine this spring, my doctor will test my blood to see if I have a genetic disorder. The result matters. And what will I do when I need to fly to Manila or Addis Ababa or some other distant city? I will probably shoot myself up with an anti-clotting medicine before each flight that is longer than six hours. I’ll wear knee-high compression socks to prevent my blood from pooling in my legs. And I’ll walk up and down the aisles, drink lots of water and avoid beverages that dehydrate me.
I dodged a bullet twice. No need to do it again.
Donnelly is a freelance writer specializing in global health and the author of “A Twist of Faith: An American Christian’s Quest to Help Orphans in Africa,” to be published later this year.
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