She yawned again. The initial galvanizing excitement had worn off several hours earlier. Nanna dozed in the next seat, her little silvered head lolling against the window shade. A few more hours to go before the pilot would find the morning somewhere over the eastern Atlantic. On the ground in time for a late breakfast, and then on to the meeting place where the Irish Eyes tour guide would greet them.

She hoped the first day wouldn't entail too much walking. Her left calf ached and she fancied that the pulse could be seen through her pant leg. Still, if her seventy-year-old grandmother could make it, even after that minor stroke, so could she.

It was the limited legroom, she decided. Maybe she should get up and take a leisurely stroll to lavatory in the rear of the plane. Craning her neck, she could see the refreshment cart blocking the aisle and two attendants twisting from side-to-side taking beverage orders. The restroom at the forward part of the cabin had a family of five waiting impatiently.

She shifted in her seat, trying to stretch her throbbing leg beneath the seat in front, around the straps and pockets of the carryon she's stashed there earlier. The air seemed stale, and hard to inhale.

The bulky man, who had claimed the aisle seat and was now tapping away on the laptop perched on the tiny folding table, shot an annoyed and territorial look in the direction of her nudging foot.

"Sorry," she mumbled, tucking her feet back before her. She settled into an uneasy doze, waking when the drink trolley rattled to a halt beside them.

"Can I get you something?" the perky attendant chirped, barely waiting before turning her attention to the next passenger.

She tried to draw a full breath to answer, stunned by the sudden stabbing pain in her chest. She clutched her neighbor's arm and gasped. He glared at her, saw the panic in her eyes and turned from florid to pasty-white. He knocked his computer to the floor in his haste to call for help.

"Miss!" the man said, yanking frantically on the sleeve of the trim uniform.

As her vision blurred, she heard Nanna cry out her name and hoped that someone would take charge of the sweet old dear. Her last thought was feeling disappointed that she'd never see the county where her grandma had been a girl.

Misnamed 'Economy Class Syndrome', deep vein thrombosis (DVT) is an uncommon but frequently fatal consequence of prolonged sitting, regardless of the amenities or lack of them.

Long periods of inactivity, such as those experienced while traveling, sometime trigger clot formation in the lower leg. The symptoms are as minimal as muscle cramps or as significant as swelling, redness, and fever. The thrombus, or clot, breaks free and migrates in the veins until lodging somewhere else. If this happens in the small blood vessels of the heart, the brain or the lungs the result can be catastrophic.

No statistics are kept in the USA for pulmonary embolism (clot in lungs) specifically in air travelers but in Great Britain thirty people at Heathrow, and over two thousand nationwide, have died of PE/DVT.

Most of us can and do travel safely but at greater risk of DVT are pregnant women, smokers, cancer patients, and people with varicose veins, a history of thrombosis or recent leg or pelvic surgery. Also in danger are the overweight, sedentary, very tall, elderly, or those using hormone therapies. Travelers with diabetes or previously diagnosed cases of peripheral vascular disease should be wary, too. Sub-clinical conditions of the clotting factors can exist in otherwise seemingly healthy individuals, suggesting we all should use precautions as passengers.

There are strategies to avoid the pooling of blood in the lower extremities, which comprises the initial step of the condition. Says Lisa Miller-Rathman, a Certified Nurse Practitioner with a large cardiology group, a little common sense is the best prevention.

The average traveler is at minimal risk but can steer clear of the syndrome by moving as often as possible. Stand and walk at frequent intervals during the flight. Use layovers to walk briskly. If driving, stop regularly for light aerobics to get the heart rate up. Do leg exercises, raising and lowering your feet to prevent pooling or sluggish circulation; wear non-constricting clothing and comfortable shoes.

Stay well hydrated. It is an accepted medical fact that people with higher hematocrits (a measure of the number red blood cells per milliliter of blood) have an increased incidence of DVT. A recent study in healthy adult males indicates that sports drinks may work better than water at lowering the blood viscosity in the legs.

People with a history of abnormal clotting should check with their doctors for additional strategies or preventative medications and treatments. These may include support stockings or mild anticoagulants.

Positive family histories should be followed up with testing to determine if an underlying condition exists and what, if anything, can be recommended to decrease the risk of DVT.

Considering the trouble you had and time you took in planning this dream vacation, plus the fortitude to overcome your fears of leaving home in these uncertain times, and the effort of coordinating the wants and needs of your companions, the travel itself should not add another problem to the list of myriad possible woes in your trip.

Take your simple ounce of prevention and save worry for the big things... Like finding your baggage at the other end.

References

The Merck Manual of Diagnosis and Therapy

Diagnosis Today - Issue Three - BeckmanCoulter Magazine

The Lancaster Intelligencer-Journal - Wednesday March 13, 2002