Flying and thromboembolism: a patient's perspective
- Aust Prescr 2009;32:150-1
- 1 December 2009
- DOI: 10.18773/austprescr.2009.074
Hannah Baird, a 38-year-old professional manager, developed a problem after the five-hour flight from Sydney to Perth.
HB: I had a deep vein thrombosis a few years ago so I wanted to reduce the risks of recurrence by drinking lots of water and moving around the cabin as much as possible. However, after standing for about 10 minutes I was asked by the flight attendant to return to my seat.
The next day my left calf was a bit sore. There was no swelling so I thought it was just some muscle stiffness from sitting down for a long time. I went for a walk to try and loosen it up, but that made no difference.
There was a low level ache in my calf that came and went. After two days my leg was more painful and swollen and the ache more continuous. As it was more difficult to walk, I went to an accident and emergency department.
AP: What did the hospital say?
HB: The doctors thought it was unlikely I had a deep vein thrombosis as my calf swelling was minimal. I had an ultrasound and was told that I had 'phlebitis'. The treatment was a daily dose of enoxaparin for six weeks. I was given one demonstration of how to inject myself and then I was discharged with no follow-up. I was told to find a general practitioner and get a referral for a nuclear medicine scan. The hospital said that I should not fly for a month, however given the impracticalities of not returning home to Sydney they agreed that flying after one week was possible. I could do little else but rest in my hotel, as it was difficult to walk.
AP: How did you manage the treatment?
HB: The injections stung a bit. I suffered bruising after my first injection, but I got better at injecting myself in the abdomen every morning. About two weeks into the six-week course my leg had improved.
At the end of the course I had a lot of syringes and needles. My local general practice would not take them because of the cost of disposal, nor could I find a pharmacy to take them. My local council has a needle disposal service, but it only operates between 9 am and 5 pm, Monday to Friday. That's not much good for people who work full-time.
AP: Did you have further assessments?
HB: I have no family history of thrombosis, I don't smoke and I was not taking oestrogens so my general practitioner referred me to a specialist for investigation. The specialists described my initial blood tests as 'strange', so just repeated them. These repeat tests did not show any clotting problems.
AP: What advice were you given for future flights?
HB: The specialist recommended that I wear stockings, drink water, no alcohol and inject a small dose of enoxaparin before and after flights, trains or car journeys of over two hours. Everybody tells you to wear support stockings, but the problem is, where do you find them? Nobody seems to know. I had to ring around a lot of places before I found somewhere that could supply them.
AP: Any other comments on your experience?
HB: When I was in Western Australia I had to use taxis to get between my hotel, the hospital, the general practitioner, the X-ray rooms, etc. Some people may have difficulty getting to their appointments if they are unable to use public transport and cannot afford a taxi.
It would be helpful to get advice about when you can resume physical activity while you are being treated for a thrombosis. I like to go to the gym, but I was unsure when it would be safe to start exercising again. About a year later I had a pulmonary embolism, so I am now on warfarin for life.