Rx for healthy air travel

With the approach of summer come plans for travel, including flying by plane for long distances. But the prospect of a long flight often raises health concerns especially in passengers who are older or have certain medical conditions. Long air travel and the related stress can have an impact on health. Here are a few trouble areas and some precautions you can take.

• Deep vein thrombosis (DVT). Not all experts agree on an association between DVT (blood clots in the legs) and air travel. Symptoms may not occur for several days, so it’s difficult to establish a cause-and-effect relationship. If there is one, it’s likely due to prolonged inactivity. Limited airline space can discourage moving about. Dry cabin air may also increase the risk of DVT.

Prolonged inactivity slows circulation, allowing small clots to form in the legs. The dehydrating effects of cabin air can promote another cause of blood clotting, hemoconcentration, which is an increase in the proportion of red blood cells to plasma (the liquid part of the blood). The body’s own clot busters kick in for most people but in those with certain risk factors, the clots can get big enough to block a vein. These include cancer, heart disease, infection, pregnancy, and obesity, as well as recent surgery or injury. Smoking also raises the risk, as do birth control pills and postmenopausal hormones.

DVT in the calf aches and gets worse over several days. The pain may be accompanied by warmth and swelling in the area around or below the clot. A clot in the thigh causes similar symptoms. The skin may redden or turn bluish. If you experience any of these symptoms, see a doctor. Be sure to mention that you’ve recently traveled on a plane.

The biggest danger of DVT is that a clot will break free and lodge in one of the pulmonary arteries supplying blood to the lungs. This potentially fatal condition is called pulmonary embolism. Symptoms include chest pain, shortness of breath, rapid breathing or pain on breathing, and fainting. It is a medical emergency.

Air travelers can do several things to lessen their risk of DVT. Here are some ways to reduce air travel-related DVT:

• If you’re not at risk of bleeding and can tolerate aspirin, take a baby aspirin (81 mg) one-half hour before takeoff.

• Wear loose clothing and comfortable shoes.

• Avoid crossing your legs while seated.

• Get up from your seat and walk up and down the aisle at least once an hour. If you’re pregnant, request an aisle seat so that you can get up easily.

• Drink at least eight ounces of water every hour or two and avoid alcohol, caffeinated beverages, and salty foods.

• Keep the space under your seat in front of you empty so you can exercise your feet and ankles occasionally.

• If you have any risk factors for deep vein clots, consult your doctor. He or she may suggest support socks or stockings.

• Jet lag. Crossing time zones often leads to jet lag, which can result in headaches, upset stomach and nausea, difficulty concentrating, and trouble sleeping. To help alleviate it, get plenty of sleep before you begin your trip. Keep well hydrated before, during, and after your flight. Change your wristwatch to the new time. As soon as you arrive at your destination, adjust your sleeping and eating schedule to the new time zone. This can be difficult if you’ve crossed many time zones, but try to force yourself to stay awake until the local bedtime and get up in the morning when the locals do and get outside in the natural light. If you simply cannot stay awake until evening on the day you arrive, nap for no more than an hour or two. Engaging in social activities can also help your body. When trying to stay awake, eat protein and vegetable and avoid starchy foods like pasta, breads, and rice. Jet lag is less pronounced when you travel west with the sun (as when going to Europe) than in an easterly direction (as when traveling to the United States).

• Air quality. A ban on cigarettes has improved air quality on air travel. Modern commercial planes provide a continually recycled mix of fresh air and air recycled from the cabin. The recirculated portion is filtered to trap dust and other particles and microorganisms, including bacteria, fungi, and some viruses. Infectious diseases are sometimes transmitted during air travel, and the effectiveness of filtering systems has been questioned. However, evidence suggests that infection is due to close contact with other passengers rather than contaminated recirculated air. Cabin air, when recycled appropriately, doesn’t appear to pose a health risk.

Because there’s so little moisture at high altitudes, the relative humidity in most commercial aircraft cabins is a low 10 percent to 20 percent. To combat the drying effect on airways, eyes, and skin, you need to drink plenty of water while flying. Bring some with you so that it’s always available. You may also want to wear eyeglasses rather contact lenses, keep a bottle of natural tears handy, use nasal saline spray, and use moisturizing lotion on your hands and face.

• Reduced oxygen and air pressure. At cruising altitude, airline cabins have lower-than-normal air pressure and oxygen levels. Blood oxygen saturation during commercial flights can be five percent to 10 percent lower than normal. If you’re in good health, your body can compensate, but if you have a lung condition, such as chronic obstructive pulmonary disease, or cardiovascular disease, you may need supplemental oxygen, even if you don’t normally use it. Ask your physician for advice several weeks before the flight. If you do need oxygen, call your airline to find out its policies and the cost. Airlines generally require advance notice.

Airline cabins are pressurized to a level equivalent to the air pressure at 5,000–8,000 feet above sea level. If you’re used to lower altitudes, gases trapped inside your body could expand, and that might create problems. Soon after abdominal surgery, for example, the expansion of intestinal gases could cause bleeding or tearing along suture lines. To be safe, consult your physician and plan to wait at least a couple of weeks before flying. And don’t fly within 24 hours of colonoscopy that involved polyp removal. Gas expansion during air travel can also be a problem for people who’ve recently had facial, eye, or brain surgery.

• Ear pain. During takeoff and landing, cabin air pressure changes rapidly, disturbing the balance of pressure between the outer ear and the middle ear. Many people feel pain when the higher pressure stretches the eardrum, the membrane separating the middle ear to the back of the nose and throat, helps to equalize the pressure on the eardrum (and cause the welcome pop you feel when the balance is restored). You can help the process by swallowing, chewing gum, yawning or opening your mouth wide. A trick called Valsalva maneuver may also work: close your nose with your thumb and index finger and exhale gently against a closed mouth.

• Disinfection. If you plan on international travel, be aware that countries are permitted to treat aircraft with insecticide to prevent importation of disease-carrying mosquitoes and other insects. The procedure, called disinfection, can involve spraying while passengers are on board. According to the World Health Organization, disinfection, if done properly, poses no serious health risk, although it may aggravate certain respiratory problems and allergies.

EXTRA TIPS FOR AIR TRAVEL

Here are some other things to keep in mind when preparing for a trip:

• If you need special food for health or religious reasons, call the airline ahead of time.

• If you have diabetes or epilepsy, carry an identification card, such as the “Diabetes Alert Card.” Also bring your physician’s name and phone number and a list of your medications.

• If you have a pacemaker or cardioverter-defibrillator, bring a letter from your doctor stating what kind it is and how it’s programmed. You may need this when you go through security.

• If you have an artificial joint or implanted metal of any kind, you may need to show airline security personnel a letter, signed by your doctor, describing its location and purpose.

• Keep all medications, in their original containers, in your carry-on bag, so you’ll have them if your luggage is lost or delayed.

• Get to the airport early so you won’t have to run to the terminal. Sudden bursts of physical activity can boost blood pressure and strain the heart.

Yes, you can safeguard your health in the air with advance knowledge and preparation!

For further information, here are two selected resources: US Federal Aviation Administration, Office of Aerospace Medicine, www.faa.gov/passengers and World Health Organization, “International Travel and Health” (online edition), www.who.int/ith.