Economy Class Syndrome — not just for coach passengers

That cramped feeling you get from sitting in economy class could be a very real ailment.

For the last couple of years, Economy Class Syndrome — known as ECS — has been featured on evening newscasts and in a variety of health journals.

ECS is caused by Deep Vein Thrombosis, or DVT, which affects approximately two million people annually in the U.S. Deep Vein Thrombosis has become a hazard of air travel — especially for those seated in the coach cabin, where there is minimal legroom.

But ECS is not confined to the back of the plane. You may be at risk of DVT even if you fly first or business class. Among those who have experienced ECS are former president Richard Nixon, who developed the condition on his way to Russia in 1974, and former Vice President Dan Quayle in 1994 after a long plane flight.

Causes of cramping

DVT is a form of thrombosis that develops in one of the deep veins of the body. A thrombosis is the formation of a blood clot in a blood vessel. DVT often begins in the calf or thigh because blood moves relatively slowly in these areas, particularly if exercise is limited. As the blood begins to pool in an area, a clot develops which can attach itself to the wall of a vessel or, in more severe cases, become lodged within a vessel, blocking blood flow.

Studies show that ECS and DVT affect one out of every 10 passengers.

Some circumstances that increase an individual’s risk of developing DVT include a previous history of DVT; immobility that lasts for three days; increased thickness of the blood, which may be inherited or acquired; injury or trauma; major surgery in the previous four weeks, especially in the pelvis or abdomen; dehydration; obesity, and pregnancy, particularly right before or after delivery.

Symptoms of DVT include chest pain, pain in the calf or leg, swelling of the leg or lower limb and shortness of breath. But often there are no symptoms at all. Only half of patients have symptoms.

These risk factors coupled with long-haul flights seem to be a significant combination in the development of ECS.

Preventing DVT

Here are a few important precautions that may help prevent DVT:

• Seek medical advice for preexisting risk factors before flying.

• Dress comfortably, in loose clothing. Avoid tight garments and shoes. For a long flight, pack slippers or an extra pair of warm socks. Passengers in first class often receive cloth slippers; these not only keep your feet warm but also enable the blood in your feet to circulate more freely.

• Get up to stretch your legs at least once every hour.

• Avoid alcohol, which is dehydrating. The air inside planes is dry, and passengers can easily become dehydrated. Dehydration thickens the blood and may raise the risk of clots.

• Drink plenty of nonalcoholic liquids. They prevent dehydration and compel you to walk to the rest room repeatedly. It is now commonplace to see a passenger carrying a water bottle on board rather than waiting for the beverage service to begin.

• While seated, stretch your legs occasionally. Don’t cross your legs while sitting. Do partial leg lifts, and flex and extend your ankles. Tighten then release your buttocks. Press the balls of your feet down hard against the floor or footrest. Take slow, deep breaths from time to time. Several international carriers offer in-flight exercise guides and videos to aid in preventing the development of ECS.

• Wear elastic support hose during your trip. This seems to be one of the most effective methods of prevention. You can find them at Homecare America (3381 Sheridan St., Hollywood, FL 33021; phone 800/816-0181).

The specialist at Homecare America explained the theory behind the gradient compression hosiery, saying it provides the greatest compression at the ankle, gradually decreasing upward. This gradual compression prevents swelling by countering pressures inside the leg and by promoting blood flow back to the heart rather than letting it pool in the legs.

Not only will the compression hosiery, which is available for both men and women, lower your risk of Economy Class Syndrome, it will reduce ankle swelling, general leg fatigue and leg discomfort.

• Take advantage of stopovers, when it is possible to get off the plane and walk.

Dr. Larry G. Baratta is chief medical officer of Passport Health (www.passporthealthusa.com), with clinics nationwide.

Next month in this column, Dr. Alan M. Spira discusses health issues surrounding the tsunami disaster in South Asia.