By Len Pigg, F133119
National Vice President, Rocky Mountain Area
A few years back, my wife, Joan, and I flew from Hong Kong to Los Angeles with only brief stops in Tokyo to refuel and in Honolulu to clear customs. Although we fortunately had seats with plenty of legroom, the long flight had taken its toll. Upon our arrival in Los Angeles, our feet had swollen so badly that we could hardly put on our shoes.
More recently, in my role as an FMCA area vice president, I push the limit and commit myself to destinations that require long hours in the motorhome cockpit. I’m sure many of you do, too. After one such trip, in which we drove from Cincinnati, Ohio, to Pagosa Springs, Colorado, 1,450 miles in less than three days, I met not one but two FMCA members who related to me that they had to have medical attention for blood clotting in their legs. It had quite possibly been brought on by prolonged travel.
Realizing this problem may be more prevalent than I first thought, upon my return to Phoenix, Arizona, I enlisted the help of Dr. David Sealy, who specializes in internal medicine, and asked him to write about the seriousness of the condition. I also asked him to offer his advice as to how we can avoid the problem, or at least minimize the condition.
Here are his comments:
“All of us have probably noticed that our legs may be swollen at times after prolonged travel when we have been confined and relatively immobilized in either a highway vehicle or an aircraft. Our questions to consider are: 1) What is the cause and the medical significance of this swelling? 2) What associated conditions might elevate our medical concern? 3) What preventive measures or treatment would be appropriate?
“The leg swelling is caused by slowing of the venous blood return due to loss of muscular contraction of the leg and also mechanical compression of the venous flow from pressure on the back of the legs by the seats. This slowed blood flow is associated with increased clotting tendency. The result of slowed blood flow and excessive clotting tendency can be formation of clots in the veins deep in the legs that return blood to the heart and lungs for oxygenation. The breaking loose of a leg clot can result in a so-called pulmonary embolism after the clot floats through the heart and is pumped into the lungs, where it blocks the circulation. This can be a deadly situation, from either a single large clot or multiple small ones.
“The risk of developing a pulmonary embolism related to leg swelling is relatively small for most of us, but there are several medical conditions that significantly increase this risk and should elevate our concern. These include immobilization for more than three days, typically associated with surgery or a broken bone; pregnancy; congestive heart failure; prior pulmonary embolus or leg clot; cancer diagnosis; significant obesity; estrogen treatment; or clotting disorders. Multiple medical studies show a strong correlation between travel length and increased risk.
“The most important preventive measure is to move the legs. Obviously, the best is to walk and exercise the leg muscles — probably every two hours at a minimum. Passively exercising the leg muscles by regularly pushing against the floor is a good alternative. Other common prevention includes maintaining good hydration with fluids, avoiding constrictive clothing, avoiding crossing one’s legs, and refraining from smoking. Those who have risk factors noted above should discuss their particular situation with their physician prior to engaging in extended travel.
“There is no medical evidence that aspirin is effective in preventing leg clots. Some travelers might well be treated with anti-clot medication during their extended travel, but that would be an individual decision determined with their physician.
“Those who desire more detailed information on this topic should refer to the New England Journal of Medicine issue dated September 13, 2001. It provides a study of airline travelers and is also a good reference to other articles.”
In early August, members of the Executive Committee received a voice mail from FMCA president Jeff Jefcoat. He had been admitted to the hospital after experiencing chest pains. Shortly thereafter as I was preparing to leave Arizona for the Rocky Mountain Ramble in Colorado, I received a phone call from Jeff telling me that although he was feeling well, his doctor strongly advised him to curtail some of his travel plans, since his schedule, as planned, would require prolonged sitting at the wheel of his Blue Bird. What happened to me and my wife, to Jeff, and to others could happen to you. However, it may be preventable. Drive fewer miles each day, thereby reducing the hours at the wheel. Above all, do as the doctor ordered: rest and exercise often!