A Personal Story – D V T – The Science Of Why And Importantly How Not To!

[David48]

A personal story – DVT – the science of why and importantly how not to!

For those who don’t know, this week I discovered that I have a DVT, almost assuredly acquired during a flight home from Thailand. We discuss it here ... a-personal-story-with-a-warning-for-almost-everyone

It’s my fault … only me to blame … I relaxed … I forgot (or ignored) the information given to me … now I am paying the price.

It would be easy to include the following in the complementary thread … but it’s already deep into the discussion … so, with moderation approval, a separate thread in the Medical Forum to discuss it.

EDIT ... OH also ... don't rely just on my advice, I'm not Dr David ... please seek independant medical advice.

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Edited February 9, 2013 by David48

[David48]

... and that the first thing.

It's not like a mosquito bite, a headache or 'pins and needles' ... you don't 'feel a DVT' coming on.

Probably because you feel so comfortable, it's off your radar.

It was a week before I felt any discomfort ... long after I had forgotton about the flight.

Plus I was careful to re-hydrate after the flight - but too late - the damage was done.

The scars inside your veins last a lifetime.

The damage was done some time ago ... and the craziness of it all ... with most of us ... it's so easily preventable.

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Edited February 9, 2013 by David48

[cornishcarlos]

I feel your pain buddy.

Really disrupts your schedule for 6 months.

Mine was 6 years ago, noticed after a 4hr drive from London to West Wales but probably originated on a long haul flight the previous week.

Felt like the worst calf cramp ever, couldn't sleep it was so bad !!

Anyway, after 10 days in hospital (on Heparin shots) and 6 months on the rat poison I was all clear to travel again. Got my blood tests done and was apparently no more prone to them than anyone else, in fact the specialist told me that if everyone got an ultra sound after a long haul flight, maybe 80% would have a small DVT but never even notice it... Scary indeed..

Good luck and a speedy recovery to ya... Once you get used to the Warfarin doses, you can keep your INR levels in check with a few beers too I did it by mistake once... Takes some fine tuning..

[David48]

I'll try and keep this light-hearted ... but some serious medical info can kick us off.

You've settled into your seat, had a few beers, a meal ... and the movie has just started.

A couple of hours later, you are feeling relaxed ... you can see what is happening outside ... but what's happening inside your body?

Because you don't ask the blood to do much work ... it starts to just 'hang around' - pooling in your lower legs.

Your blood gets lazy - in some people it starts to clot. Sort of like going on strike. Just sits down and refuses to go anywhere.

The 'non-return' valves you see above sometimes stop operating efficiently ... sometimes stop working at all.

Inactivity and dehrdration are the friends of DVT.

[Sheryl]

For those who have no contraindication to it, a low does of aspirin just before a long flight is desirable.

Avoid if gastric ulcer/active gastritis or on other blood thinning agents.

[richard_smith237]

A bit of a thread bump here:

I Suffered a DVT and Pulmonary Embolism:

After Medivac and 10 days in a Singapore Hospital I was prescribed Warfarin and released. On return to Thailand I also consulted with my Dr at Samitivej Hospital in Bangkok.

As I was travelling throughout Asia Pacific it was not practical to get the weekly or fortnightly blood tests required when on Warfarin.

The blood tests are required to measure the 'clotting time' of the blood - an INR test.

Normal blood has an INR of 1.0. Doctors will recommend a therapeutic range (for myself this was 2-3).

Thus I purchased a self test kit: Coaguchek XS system (for about 25,000 baht) - After 6 months I came off Warfarin the Coaguchek kit is no longer in use. I'm selling it for 15,000 baht.

I wouldn't usually post an ad on the regular forum - I have posted the ad. in classifieds. But, I also feel that for those who have been following various DVT and taking Warfarin medication this may draw attention to a convenience not yet afforded to them.

Anyone interested please PM Me.

[richardjm65]

DVT is no small matter - although it is frequently, (and rather casually), referred to as 'economy class syndrome'. In my own case, I had not been on a flight for several years, so it had nothing to do with flying. If your leg feels swollen and a bit hot, and there's a bit of an ache, get yourself to a hospital. The procedure then will usually be blood tests to establish INR and also to check if there could be nutritional deficiencies. In my case, I was lacking potassium. So, in my hospital bed, I went onto an intravenous drip to re-hydrate, which was supplemented to replace potassium, and when that was accomplished, the next step was a Doppler ultrasound scan to locate and quantify the size of the clots.

That done, a foot to thigh compression stocking was the next step, with instructions to sleep with the affected leg elevated. Next, virtually painless injections of Heparin in the belly button area for a few days before switching to Warfarin tablets - the reason being that Heparin has an almost immediate effect, whilst Warfarin takes a little time to become useful. At this point, it's important to understand that the meds provided do not do much for the existing clots. They are really to thin the blood to prevent further clotting. The body's own defence system is supposed to deal with the slow assimilation of the clots.

This is the high risk period, because if the clot, or parts of it, break free and travel on through the circulatory system, it fetches up in the lungs, where it causes something called a pulmonary embolism, which, if you're unlucky, could be fatal.

Since you are now on Warfarin, the most important thing is to establish the correct dosage, which is ascertained by frequent blood checks. If your blood is too thin, you have a problem. If your blood is too thick, you also have a problem - this is the reason for those checks and the doctor will adjust your Warfarin dose according to your INR results. This is crucial.

You may expect, if all goes well, to be under treatment, with repetitive checks, for about 12 months. From thereon, as David has said, the veins never quite recover their original integrity and elasticity and you should pay particular attention to proper and adequate hydration, a healthier diet and some modest exercise to prevent the possibility of further incidents of blood pooling in the lower limbs.

DVT is a serious condition - do not ignore the symptoms.

[David48]

^^ Great post above and concur with everything written ...

EDITED to add ...

This is the high risk period, because if the clot, or parts of it, break free and travel on through the circulatory system, it fetches up in the lungs, where it causes something called a pulmonary embolism, which, if you're unlucky, could be fatal.

Yes ... this happened to me ...

... I was lucky!

Edited September 15, 2013 by David48

[Tywais]

Just noticed this topic and good information. I remember when I used to do a lot of flying each year from the US to several Asian countries I had researched a lot of different things before each trip. One was DVT which at the time didn't seem to be well known, or at least not publicized heavily, but was aware of it. So I always drank a lot of fluids, usually orange juice, and every hour or so get up and have a walk about and stand for a while. Those trips were up to 25 hours long. I understand if prone to it that wearing pressure stockings/socks can help prevent it.

[Sheryl]

Taking low dose aspirin before the flight (and again during if traveling for more than say 12 hours) is also advisable precuation. I always do this.

[David48]

Just a reminder to those who travel often.

Do the exercises recommended, do get up and walk around a bit, keep the fluids up and as Sheryl mentions, some low dose Asprin does help as it 'thins' the blood a little.

Plus what Tywais mentions that wearing pressure stockings/socks can help prevent it

Don't let what happen to me, happen to you.

.

[Tolley]

I took to wearing compression stockings on flights after I noticed that my feet would throb and feel funny a days or so after a long haul flight.

I am not sure if it was precursor to DVT but I don't have any problems when I use the compression stockings.

[h90]

Taking low dose aspirin before the flight (and again during if traveling for more than say 12 hours) is also advisable precuation. I always do this.

And drinking a lot (not meaning beer) to ensure you aren't dehydrated which happens easily on flights

[rhythmworx]

Have you had any blood tests done to check if your heterozygous?

[David48]

Have you had any blood tests done to check if your heterozygous?

Mate, I had to look up that word ... and I'm still none the wiser.

If you ask, have I had my blood tests for 'Sticky Blood' ... the answer is yes and no. Yes, I have had a full blood screen and no, no generic abnormalities ... completely normal blood.

.

[Langsuan Man]

Any long period of inactivity can hasten the advent of DVT, not just airline travel. I developed it when I had a broken leg yet the doctors, both in Thailand and the US, could never explain why it appeared 5 months after my convalescence ended while I was very active to increase muscle strength

My US hematologist has me on a daily regimen of warfarin. Fortunately, I do self testing every two weeks and so far three years later my INR levels are consistently within normal range

I have been told by numerous sources that I will be on it for the rest of my life since keeping me on it is less risky than having it develop again

[rodknock]

i had a dvt in 2005. i was an automotive technician. i did not do any flying and was very active. a dvt can strike any one any time!

i have a greenfield vena cava minor filter in me and am on wafarin for life. i self check every week.

learn the symtoms of one. if you fly, please follow safety directions and precautions when flying. when i flew to Thailand on China air there was an article about dvt and flying and suggestions on the back of my ticket. it is a silent killer! it is not the dvt that kills you, it is the pulmanry emboliusm.

[Aussieroaming]

David..be careful for the next few flights. A work mate of mine got DVT flying from Australia to Africa for work. We flew ever 6 weeks in business class and he still got it. I only mentioned the class to show even with ample leg room it can occur. Very nasty illness if not managed.

6 months later he flew to work and he died in transit due to a massive heart attack that was attributed to the previous DVT. I remember his leg was pretty swollen and sore at the time. Allegedly a clot travelled to his heart.

[rhythmworx]

Thankfully modern science has invented low molecular weight heparin for prophylaxis, otherwise I'd have to get the train there or take 5 or 6 planes with a 24 hour stop off off per flight.

[wpcoe]

For those who have no contraindication to it, a low does of aspirin just before a long flight is desirable.

Avoid if gastric ulcer/active gastritis or on other blood thinning agents.

If the flight is long-haul, say 12 hours or more, would it be advisable to take a second dose mid-flight?

[David48]

For those who have no contraindication to it, a low does of aspirin just before a long flight is desirable.

Avoid if gastric ulcer/active gastritis or on other blood thinning agents.

If the flight is long-haul, say 12 hours or more, would it be advisable to take a second dose mid-flight?

Depends on how much you took the first time.

'Low dose' Aspirin is usually a 80 mg tablet.

Where a 'standard' Aspirin tablet is usually 300mg .. but you might have 1 or 2 ... then not have one for weeks/months.

So, IMHO, for a flight, if you have one 80 mg Aspirin tablet, you could take 1 every 4 hours for a slow release beneficial effect.

[David48]

For those who have no contraindication to it, a low does of aspirin just before a long flight is desirable.

Avoid if gastric ulcer/active gastritis or on other blood thinning agents.

If the flight is long-haul, say 12 hours or more, would it be advisable to take a second dose mid-flight?

Depends on how much you took the first time.

'Low dose' Aspirin is usually a 80 mg tablet.

Where a 'standard' Aspirin tablet is usually 300mg .. but you might have 1 or 2 ... then not have one for weeks/months.

So, IMHO, for a flight, if you have one 80 mg Aspirin tablet, you could take 1 every 4 hours for a slow release beneficial effect.

[Jip99]

^^ Great post above and concur with everything written ...

EDITED to add ...

This is the high risk period, because if the clot, or parts of it, break free and travel on through the circulatory system, it fetches up in the lungs, where it causes something called a pulmonary embolism, which, if you're unlucky, could be fatal.

Yes ... this happened to me ...

... I was lucky!

As this thread has been resurrected it may be worth reinforcing the message by telling you that Richard's post was so prophetic - he died nearly a year ago from a pulmonary embolism.

[ThaiMike4u]

Just a note..bring you're own Aspirin with you to Thailand for the flight back home, because it's not longer available over the counter...only on prescription..!