large_diver
Contributor
Thought this article was informative for tose of you taking long plane flights to exotic dive vacations. This is from the on-line Wall Street Journal.
This is a rather long post -- I didn't post the link since you have to have an on-line subscription to the WSJ to view.
===================================================
International Carriers Address
Threat of Coach-Class Syndrome
By MELANIE TROTTMAN
Staff Reporter of THE WALL STREET JOURNAL
LONDON -- Farrol Kahn never boards a flight without first donning a pair of knee-high compression stockings. He eschews alcohol on the flight and makes a point of getting up regularly to walk about the cabin.
Janet and Gerald Steeples, a retired couple from a London suburb, began popping aspirin two weeks before their 12-hour flight from Heathrow to Hong Kong. Tucked in a carry-on next to her sewing kit, Mrs. Steeples, 67 years old, had four big bottles of water. "No wonder it's heavy, because of those wretched things," she said.
A growing number of travelers and airlines are emphasizing new preflight rituals such as these, thanks to mounting concerns about a medical condition known as coach-class syndrome. It describes a fate that can befall passengers on long flights: immobility, cramped seating and dehydration combine to cause fatal blood clots.
Low Profile --
Doctors have been aware of the problem for years, but the science has been loose and the issue's profile has been low. But the death last September of Emma Christoffersen, a healthy 28-year-old who sat in coach on the Sydney-to-London route, has riveted the attention of many overseas passengers and carriers. Adding to the anxiety: Many common practices on airlines can contribute to the syndrome, including alcohol service, long periods when movement in the cabin is restricted, and the cramped quarters and infrequent supply of beverages in coach.
British Airways, the carrier on which Ms. Christoffersen flew coach to Sydney, started handing out warning pamphlets to its passengers in February and has posted similar information on its Web site, suggesting in-seat ankle exercises to minimize risk. Qantas, the Australia-based carrier that Ms. Christoffersen flew back to London, took similar steps, providing a health leaflet with tickets and advising hourly in-seat exercises and occasional walks in the cabin.
Singapore Airlines has included prevention tips in its in-flight magazine, video and seat-back documents. Dubai-based Emirates Airlines has purchased inflatable footpads designed to boost blood circulation in passengers' legs by allowing them to exercise in their seats.
Slow Response --
In the U.S., where Ms. Christoffersen's death has drawn less attention, carriers have been slow to react. UAL Corp.'s United Airlines has run an occasional column on the topic in its in-flight magazine. In May, it put warning cards in premium-class seat pockets and plans to add them to coach in July.
Northwest Airlines says it shows a 10-year-old video with stretching and yoga exercises to promote healthy movement on long international flights. Continental Airlines says it is planning an in-flight wellness video.
AMR Corp.'s American Airlines and Delta Air Lines are doing even less about the problem, whose medical name is deep-vein thrombosis, or DVT. American, the world's largest carrier, discusses DVT and its risk factors on its Web site but also says it is skeptical about a link to flying, asserting: "There is no evidence establishing that DVT is caused by air travel." Delta hasn't taken any steps at all, a spokesman says.
'Travel Tips'
Mike Wascom, a spokesman for U.S. airline trade group the Air Transport Association, says the group has given its member carriers a "travel-tips" brochure including health advice related to blood clots, but U.S. carriers mightn't have sounded louder warnings because that could unnecessarily alarm passengers. DVT isn't unique to aviation, says Mr. Wascom, adding that if airlines need to warn passengers based on immobility risks, so, too, should movie theaters showing the three-hour film "Pearl Harbor.'' "A little common sense goes a long way here," he says.
Mike Reynolds, a 60-year-old home restorer near Rochester, N.Y., says he could have used a heads-up from American. Flying to Paris from New York last October, Mr. Reynolds, in good health, says he was oblivious to the risks of coach-class syndrome. "On that particular flight I did everything wrong," he says, noting that he had wine with dinner (it can dehydrate), didn't drink enough other beverages and stayed mostly still as he tried to sleep through the overnight flight.
Four days later, he started having chest pains, then shortness of breath, which led to six days in a Paris hospital on intravenous blood thinner. He says his recovery was quick and lucky considering the chronic problems DVT patients can have. "I believe my injury was terribly avoidable," says Mr. Reynolds.
American Airlines spokesman John Hotard confirms the airline has communicated with Mr. Reynolds but declined to comment further on the matter. He did say that passengers who write to American about developing blood clots on its flights would be referred to the airline's insurance department about filing a possible claim.
The moves follow a long history of findings on blood clots and lengthy travel, but doctors have largely viewed the data as anecdotal. Long periods of immobility have for decades been linked to blood clots, and doctors knew of flying-related DVT as far back as 1954 through a case published in the New England Journal of Medicine.
Still, no one is sure how common clot formation on airplanes is, in part because a large-scale epidemiological study has never been conducted. But recent studies in Britain, Japan and France have raised enough red flags to help spur further research.
"I think that the growing body of evidence is important and very concerning," says Dr. Sid Smith, chief science officer of the American Heart Association.
Here's what happens in the body: Long periods of immobility cause legs to swell because not all the blood gets pumped out. Clots -- or clumps of cells -- sometimes form in the deep veins of the calf and leg muscles. If clots move through the bloodstream to vital organs of the body, they can kill. In the lungs, for example, a clot can cause pulmonary embolism, blocking airflow.
Planes, Trains and Automobiles
Sitting still in cars, trains and buses can lead to deadly clots, too. But suspicions are rising that conditions in an airplane cabin -- such as the high altitude, which can decrease the oxygen absorbed into the blood -- might exacerbate the risk. Some doctors believe the dry cabin air accelerates dehydration, although the issue is widely debated. Dehydration, in turn, heightens the risk of clotting, some medical professionals say.
"If you are dehydrated, that makes the blood thicker because there's less water in it. And that's not good for preventing blood clots," says Dr. Lynn Smaha, a cardiologist and a past president of the American Heart Association.
Neither is sitting for hours -- something airlines push more than ever because of worries about turbulence. And while business-class passengers get plenty of legroom and frequent beverage service, coach-class passengers get neither.
At big airports overseas, recent studies have shown a stream of postflight clot-related deaths. Ashford Hospital, less than a mile from Heathrow, documented 30 cases over three years in which people collapsed and died of pulmonary embolism after long flights. Ten of the 30 deaths came from the Sydney-to-London route.
A hospital clinic at Narita Airport in Tokyo found 25 similar deaths over eight years. And doctors believe the numbers are higher, since fatal blood clots can go undetected for days, or weeks, after a flight. Many passengers who suffer symptoms -- such as pain in the chest, soreness in the leg or shortness of breath -- are unlikely to seek immediate help, especially as they scramble to head home or on to other destinations.
A study published this spring in the Lancet, a British medical journal, found that one long-haul traveler in every 10 could be at risk for "symptomless" DVT -- small clots, most of which dissolve harmlessly.
"Blood clots are probably much more common than we originally thought," said Dr. John Scurr, a vascular surgeon at Middlesex Hospital in London who started the study of 200 passengers in 1998. The study offered evidence that elastic, below-the-knee compression stockings may reduce the risk. None of the passengers wearing them developed symptomless clots. A dozen who did not wear the stockings did develop clots. Four of those 12 required treatment.
The DVT issue underscores a conflict between what may be good for passengers and what's good for the airlines. Retrofitting planes to create more space would cost hundreds of millions of dollars industrywide and give carriers fewer seats to sell. (American last year added more room in its coach cabin, a move it touted as an added passenger comfort.) More beverages on board would drive up costs and could require increased staffing on flights. And while avoiding alcohol is advised to prevent dehydration, many passengers want it, and the airlines profit from selling it.
Waiting for a Drink
Airlines say their beverage service in coach is adequate, but they generally have no set policies. On a recent 10-hour flight from London to Dallas, American offered beverages six times in coach. On a nine-hour British Air flight in the other direction, business-class passengers received almost constant beverage service, about every 20 minutes. On the same flight, coach passengers were offered beverage-cart service only five times during the nine hours.
Doctors say passengers should drink something each hour on a flight, avoiding caffeine in addition to alcohol because it can also dehydrate. Older passengers are advised to take aspirin to thin the blood. Medical experts also say passengers should move about the cabin every two hours. But heightened concerns about turbulence-related injuries have airlines leaving fasten seatbelt signs on more often. Even without the turbulence, the narrow aisles can be difficult to maneuver.
"You can say 'get up, move around.' But in reality it's not feasible," says Dr. John Belstead, a surgeon in Ashford Hospital's accident and emergency department who conducted the study of DVT-related deaths at Heathrow.
Two British researchers coined the term "economy-class syndrome" in a 1977 medical journal. It fell to Farrol Kahn, an itinerant journalist and perfume researcher, to bring it into the popular lexicon. Mr. Kahn, 58, studied medicine but dropped out. He worked as a journalist in South Africa and England and stumbled into aviation issues while creating aromatherapy remedies for jet lag at a French perfumery.
It was there that he began researching and writing aviation-health books in his spare time. Eventually, he became a full-time passenger-health-rights activist, starting the Aviation Health Institute in 1996 with funding from corporations that bought memberships in return for literature and advice on employee flight health.
He was dogged in his efforts to get support from the airlines. One former U.S. airline executive says that despite his refusals, he repeatedly got calls to his mobile phone from Mr. Kahn at odd hours and on weekends asking for research funding. Mr. Kahn also pleaded with British Air, but the largest carrier in Europe politely, and repeatedly, declined. Then the communication became tense. He openly criticized the airline for its lack of support of his efforts; British Air accused him in a letter of libeling an airline doctor.
British Air's director of health services, Dr. Sandra Mooney, confirms the correspondence. "We work with people who are considered experts in the field,'' she says. "We will only tie our name to that level of quality."
In September, Mr. Kahn received a phone call from a reporter one Sunday night saying a young, physically fit woman had died after a long airplane flight.
"I'd been expecting this. In a way, I thought it would get greater attention because of her age," he says.
He was right. Emma Christoffersen, who worked as a salesperson for British retailer Marks & Spencer PLC, was a skier and a lover of other active sports. She was in Australia with a friend for an adventure holiday. At the end of her return flight to Heathrow Sept. 30, she collapsed in the airport, where no pulse was found. She was pronounced dead hours later after attempts were made at both the airport and the hospital to resuscitate her. The cause of death was determined to be a pulmonary embolism.
In the days following Ms. Christoffersen's death, Mr. Kahn emerged as a chief expert on the dangers of DVT. He made headlines saying the death was preventable had governments and airlines issued warnings.
"Suddenly, we were getting results," says Mr. Kahn.
Ruth Christoffersen, Emma's mother, joined Mr. Kahn's crusade, angry that airlines knew of the danger and weren't warning passengers. "Why has this gone on for so many years, and nobody has done anything about it?'' she said.
In March, the World Health Organization held a conference of international experts specifically aimed at air travel and DVT. The meeting, held in Geneva, drew world-wide participation from airline doctors and from the International Air Transport Association, a trade group representing more than 270 carriers. Mr. Kahn acted as a delegate. After the conference, the association agreed to collaborate with WHO on long-term epidemiological studies of the effect of flying on the development of blood clots.
This is a rather long post -- I didn't post the link since you have to have an on-line subscription to the WSJ to view.
===================================================
International Carriers Address
Threat of Coach-Class Syndrome
By MELANIE TROTTMAN
Staff Reporter of THE WALL STREET JOURNAL
LONDON -- Farrol Kahn never boards a flight without first donning a pair of knee-high compression stockings. He eschews alcohol on the flight and makes a point of getting up regularly to walk about the cabin.
Janet and Gerald Steeples, a retired couple from a London suburb, began popping aspirin two weeks before their 12-hour flight from Heathrow to Hong Kong. Tucked in a carry-on next to her sewing kit, Mrs. Steeples, 67 years old, had four big bottles of water. "No wonder it's heavy, because of those wretched things," she said.
A growing number of travelers and airlines are emphasizing new preflight rituals such as these, thanks to mounting concerns about a medical condition known as coach-class syndrome. It describes a fate that can befall passengers on long flights: immobility, cramped seating and dehydration combine to cause fatal blood clots.
Low Profile --
Doctors have been aware of the problem for years, but the science has been loose and the issue's profile has been low. But the death last September of Emma Christoffersen, a healthy 28-year-old who sat in coach on the Sydney-to-London route, has riveted the attention of many overseas passengers and carriers. Adding to the anxiety: Many common practices on airlines can contribute to the syndrome, including alcohol service, long periods when movement in the cabin is restricted, and the cramped quarters and infrequent supply of beverages in coach.
British Airways, the carrier on which Ms. Christoffersen flew coach to Sydney, started handing out warning pamphlets to its passengers in February and has posted similar information on its Web site, suggesting in-seat ankle exercises to minimize risk. Qantas, the Australia-based carrier that Ms. Christoffersen flew back to London, took similar steps, providing a health leaflet with tickets and advising hourly in-seat exercises and occasional walks in the cabin.
Singapore Airlines has included prevention tips in its in-flight magazine, video and seat-back documents. Dubai-based Emirates Airlines has purchased inflatable footpads designed to boost blood circulation in passengers' legs by allowing them to exercise in their seats.
Slow Response --
In the U.S., where Ms. Christoffersen's death has drawn less attention, carriers have been slow to react. UAL Corp.'s United Airlines has run an occasional column on the topic in its in-flight magazine. In May, it put warning cards in premium-class seat pockets and plans to add them to coach in July.
Northwest Airlines says it shows a 10-year-old video with stretching and yoga exercises to promote healthy movement on long international flights. Continental Airlines says it is planning an in-flight wellness video.
AMR Corp.'s American Airlines and Delta Air Lines are doing even less about the problem, whose medical name is deep-vein thrombosis, or DVT. American, the world's largest carrier, discusses DVT and its risk factors on its Web site but also says it is skeptical about a link to flying, asserting: "There is no evidence establishing that DVT is caused by air travel." Delta hasn't taken any steps at all, a spokesman says.
'Travel Tips'
Mike Wascom, a spokesman for U.S. airline trade group the Air Transport Association, says the group has given its member carriers a "travel-tips" brochure including health advice related to blood clots, but U.S. carriers mightn't have sounded louder warnings because that could unnecessarily alarm passengers. DVT isn't unique to aviation, says Mr. Wascom, adding that if airlines need to warn passengers based on immobility risks, so, too, should movie theaters showing the three-hour film "Pearl Harbor.'' "A little common sense goes a long way here," he says.
Mike Reynolds, a 60-year-old home restorer near Rochester, N.Y., says he could have used a heads-up from American. Flying to Paris from New York last October, Mr. Reynolds, in good health, says he was oblivious to the risks of coach-class syndrome. "On that particular flight I did everything wrong," he says, noting that he had wine with dinner (it can dehydrate), didn't drink enough other beverages and stayed mostly still as he tried to sleep through the overnight flight.
Four days later, he started having chest pains, then shortness of breath, which led to six days in a Paris hospital on intravenous blood thinner. He says his recovery was quick and lucky considering the chronic problems DVT patients can have. "I believe my injury was terribly avoidable," says Mr. Reynolds.
American Airlines spokesman John Hotard confirms the airline has communicated with Mr. Reynolds but declined to comment further on the matter. He did say that passengers who write to American about developing blood clots on its flights would be referred to the airline's insurance department about filing a possible claim.
The moves follow a long history of findings on blood clots and lengthy travel, but doctors have largely viewed the data as anecdotal. Long periods of immobility have for decades been linked to blood clots, and doctors knew of flying-related DVT as far back as 1954 through a case published in the New England Journal of Medicine.
Still, no one is sure how common clot formation on airplanes is, in part because a large-scale epidemiological study has never been conducted. But recent studies in Britain, Japan and France have raised enough red flags to help spur further research.
"I think that the growing body of evidence is important and very concerning," says Dr. Sid Smith, chief science officer of the American Heart Association.
Here's what happens in the body: Long periods of immobility cause legs to swell because not all the blood gets pumped out. Clots -- or clumps of cells -- sometimes form in the deep veins of the calf and leg muscles. If clots move through the bloodstream to vital organs of the body, they can kill. In the lungs, for example, a clot can cause pulmonary embolism, blocking airflow.
Planes, Trains and Automobiles
Sitting still in cars, trains and buses can lead to deadly clots, too. But suspicions are rising that conditions in an airplane cabin -- such as the high altitude, which can decrease the oxygen absorbed into the blood -- might exacerbate the risk. Some doctors believe the dry cabin air accelerates dehydration, although the issue is widely debated. Dehydration, in turn, heightens the risk of clotting, some medical professionals say.
"If you are dehydrated, that makes the blood thicker because there's less water in it. And that's not good for preventing blood clots," says Dr. Lynn Smaha, a cardiologist and a past president of the American Heart Association.
Neither is sitting for hours -- something airlines push more than ever because of worries about turbulence. And while business-class passengers get plenty of legroom and frequent beverage service, coach-class passengers get neither.
At big airports overseas, recent studies have shown a stream of postflight clot-related deaths. Ashford Hospital, less than a mile from Heathrow, documented 30 cases over three years in which people collapsed and died of pulmonary embolism after long flights. Ten of the 30 deaths came from the Sydney-to-London route.
A hospital clinic at Narita Airport in Tokyo found 25 similar deaths over eight years. And doctors believe the numbers are higher, since fatal blood clots can go undetected for days, or weeks, after a flight. Many passengers who suffer symptoms -- such as pain in the chest, soreness in the leg or shortness of breath -- are unlikely to seek immediate help, especially as they scramble to head home or on to other destinations.
A study published this spring in the Lancet, a British medical journal, found that one long-haul traveler in every 10 could be at risk for "symptomless" DVT -- small clots, most of which dissolve harmlessly.
"Blood clots are probably much more common than we originally thought," said Dr. John Scurr, a vascular surgeon at Middlesex Hospital in London who started the study of 200 passengers in 1998. The study offered evidence that elastic, below-the-knee compression stockings may reduce the risk. None of the passengers wearing them developed symptomless clots. A dozen who did not wear the stockings did develop clots. Four of those 12 required treatment.
The DVT issue underscores a conflict between what may be good for passengers and what's good for the airlines. Retrofitting planes to create more space would cost hundreds of millions of dollars industrywide and give carriers fewer seats to sell. (American last year added more room in its coach cabin, a move it touted as an added passenger comfort.) More beverages on board would drive up costs and could require increased staffing on flights. And while avoiding alcohol is advised to prevent dehydration, many passengers want it, and the airlines profit from selling it.
Waiting for a Drink
Airlines say their beverage service in coach is adequate, but they generally have no set policies. On a recent 10-hour flight from London to Dallas, American offered beverages six times in coach. On a nine-hour British Air flight in the other direction, business-class passengers received almost constant beverage service, about every 20 minutes. On the same flight, coach passengers were offered beverage-cart service only five times during the nine hours.
Doctors say passengers should drink something each hour on a flight, avoiding caffeine in addition to alcohol because it can also dehydrate. Older passengers are advised to take aspirin to thin the blood. Medical experts also say passengers should move about the cabin every two hours. But heightened concerns about turbulence-related injuries have airlines leaving fasten seatbelt signs on more often. Even without the turbulence, the narrow aisles can be difficult to maneuver.
"You can say 'get up, move around.' But in reality it's not feasible," says Dr. John Belstead, a surgeon in Ashford Hospital's accident and emergency department who conducted the study of DVT-related deaths at Heathrow.
Two British researchers coined the term "economy-class syndrome" in a 1977 medical journal. It fell to Farrol Kahn, an itinerant journalist and perfume researcher, to bring it into the popular lexicon. Mr. Kahn, 58, studied medicine but dropped out. He worked as a journalist in South Africa and England and stumbled into aviation issues while creating aromatherapy remedies for jet lag at a French perfumery.
It was there that he began researching and writing aviation-health books in his spare time. Eventually, he became a full-time passenger-health-rights activist, starting the Aviation Health Institute in 1996 with funding from corporations that bought memberships in return for literature and advice on employee flight health.
He was dogged in his efforts to get support from the airlines. One former U.S. airline executive says that despite his refusals, he repeatedly got calls to his mobile phone from Mr. Kahn at odd hours and on weekends asking for research funding. Mr. Kahn also pleaded with British Air, but the largest carrier in Europe politely, and repeatedly, declined. Then the communication became tense. He openly criticized the airline for its lack of support of his efforts; British Air accused him in a letter of libeling an airline doctor.
British Air's director of health services, Dr. Sandra Mooney, confirms the correspondence. "We work with people who are considered experts in the field,'' she says. "We will only tie our name to that level of quality."
In September, Mr. Kahn received a phone call from a reporter one Sunday night saying a young, physically fit woman had died after a long airplane flight.
"I'd been expecting this. In a way, I thought it would get greater attention because of her age," he says.
He was right. Emma Christoffersen, who worked as a salesperson for British retailer Marks & Spencer PLC, was a skier and a lover of other active sports. She was in Australia with a friend for an adventure holiday. At the end of her return flight to Heathrow Sept. 30, she collapsed in the airport, where no pulse was found. She was pronounced dead hours later after attempts were made at both the airport and the hospital to resuscitate her. The cause of death was determined to be a pulmonary embolism.
In the days following Ms. Christoffersen's death, Mr. Kahn emerged as a chief expert on the dangers of DVT. He made headlines saying the death was preventable had governments and airlines issued warnings.
"Suddenly, we were getting results," says Mr. Kahn.
Ruth Christoffersen, Emma's mother, joined Mr. Kahn's crusade, angry that airlines knew of the danger and weren't warning passengers. "Why has this gone on for so many years, and nobody has done anything about it?'' she said.
In March, the World Health Organization held a conference of international experts specifically aimed at air travel and DVT. The meeting, held in Geneva, drew world-wide participation from airline doctors and from the International Air Transport Association, a trade group representing more than 270 carriers. Mr. Kahn acted as a delegate. After the conference, the association agreed to collaborate with WHO on long-term epidemiological studies of the effect of flying on the development of blood clots.
