Health

Immobility, Circulatory Problems and Deep Vein Thrombosis (DVT)
Contraction of muscles is an important factor in helping to keep blood flowing through the veins, particularly in the legs. Prolonged immobility, especially when seated, can lead to pooling of blood in the legs, which in turn may cause swelling, stiffness, and discomfort.

It is known that immobility is one of the factors that may lead to the development of a blood clot in a deep vein, so-called “deep vein thrombosis”, or DVT. Research has shown that DVT can occur as a result of prolonged immobility, for instance during long distance travel, whether by car, bus, train or air. The World Health Organization (WHO) has set up a major research study to find out if there are any factors that might lead to the risk of DVT being higher for air travel than for other causes of immobility.

In most cases of DVT, the clots are small and do not cause any symptoms. The body is able to gradually break down the clot and there are no long-term effects. Larger clots may cause symptoms such as swelling of the leg, tenderness, soreness and pain. Occasionally a piece of the clot may break off and travel with the
bloodstream to become lodged in the lungs. This is known as pulmonary embolism and may cause chest pain, shortness of breath and, in severe cases, sudden death. This can occur many hours or even days after the formation of the clot.

The risk of developing DVT when travelling is very small unless one or more other risk factors are present. These include:

• Previous DVT or pulmonary embolism
  
• History of DVT or pulmonary embolism in a close family member
  
• Use of oestrogen therapy–oral contraceptives (“the Pill”) or hormone replacement therapy (HRT)
  
• Pregnancy
  
• Recent surgery or trauma, particularly to the abdomen, pelvic region or legs
  
• Cancer
  
• Some inherited blood-clotting abnormalities.

Precautions
The risk of a passenger who does not have any of the risk factors above developing DVT as a consequence of flying is small and the benefits of most precautionary measures in such passengers are unproven and some might even result in harm. Some common-sense advice for such passengers is given below.

Moving around the cabin during long flights will help to reduce any period of prolonged immobility. However, this may not always be possible and any potential health benefits must be balanced against the risk of injury that could occur if the aircraft encounters sudden and unexpected turbulence. A sensible compromise is to walk around in the cabin, e.g. go to the bathroom, once every 2–3 hours. Many airlines also provide helpful advice on exercises that can be carried out in the seat during flight. It is thought that exercise of the calf muscles can stimulate the circulation, reduce discomfort, fatigue and stiffness, and it may reduce the risk of developing DVT. Hand luggage should not be placed where it restricts movement of the legs and feet, and clothing should be loose and comfortable.

Wearing properly fitted graduated compression stockings may be helpful. These compress the calf muscles and improve the flow of blood in the deep veins. They may also help prevent the swollen ankles that are quite common on long flights. However, they need to be the correct size to be effective and passengers should therefore ask their doctor or a travel medicine clinic which type would be appropriate for them.

In view of the clear risk of significant side effects and absence of clear evidence of benefit, passengers are advised not to use aspirin just for the prevention of travel-related DVT.

Those travellers who are at most risk of developing DVT may be prescribed specific treatments, such as injections of heparin. Cabin crew are not trained to give injections and travellers who have been prescribed these must either be taught to give the injections themselves or make other arrangements to have them given by a qualified person.

Handling Nausea
That uneasy feeling in your stomach (or sometimes head) is probably nothing but a bout of travel sickness. But don't worry - there are things you can do to alleviate that unpleasant feeling:

• Never travel on an empty stomach . Contrary to popular belief, it heightens airsickness rather than suppressing it. Light food such as fruit, vegetables, salad, cookies, and chocolate bars are recommended as snacks before and during a flight.
• Do without coffee, black tea, alcohol, nicotine and spicy, fatty food!
• Vitamin-B1 helps. It plays a substantial role in transmitting nerve impulses and restores your bodily sense of balance. Food rich in Vitamin-B1 are artichokes, fish, oatmeal, natural rice, asparagus, wheat products and pork.
• Drink some ginger tea before your flight. You can buy it at a pharmacy or health food store, or it's easy to make yourself. Simply pour hot water over a few slices of ginger root, let it draw for 10 minutes, pour it through a sieve, and sweeten it to taste with honey.

For Diabetics
As a diabetic, following a strict diet based on calories and 'bread units' (BUs) can be very difficult in foreign lands. But resist exotic food which may lead quickly to a metabolic disorder. Caution is also advised in the face of the culinary delights offered during a flight. Every diabetic who must take insulin injections would be well advised to consult their doctor before their journey on the dosage and type of injection and have a travel injection plan drawn up. In the case of diarrhea and vomiting, you should consult a doctor who will check your body's liquids level and if necessary adjust your insulin dosage.

For Women
For women on the contraceptive pill, experts advise you to take an extra pill when traveling on Westbound flights, because the day lengthens by at least six hours. Here, too, we recommend that you consult your doctor before your flight.

The information contained here is based on World Health Organisation (WHO) website,
http://www.who.int/ith/en/. Viva Macau strives to keep the information updated but does not guarantee its completeness and accuracy.