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Rob's Travel Information Page
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Travel, we do so much of it for our work and (much less) for fun. Here
is a my collection of favorite sites for all aspects of travel.
Quick Links:
- Essential links (IMHO)
- Things Austrian/German
- Airlines
- Rail Travel
- Car Rentals
- Hotel info and booking
- Travel guides
- Camping and National Parks
- Maps
- Travel Health
- Miscellaneous travel tips
- Products
- University of Utah links
- TripIt If you are not using
this, you do not really travel enough.
- Delta Air Lines.
This is our local airline so we are faithful and mostly happy.
- SeatGuru.com, the tool to
select the best seats on any flights.
- TripAdvisor, seems to be
emerging as the main site for reviews of places and especially
accommodations.
This topic took on special importance when I experienced a deep vein
thrombosis (DVT) and pulmonary embolism (PE) in August 2013. I recovered
fine but it could have been a whole lot worse and it increased my awarenes
of the risks and options for prevention. Many thanks to Matt
Rondina, MD,, Co-Director of the University of Utah Thrombosis Center,
for his help and his providing these pointers.
Take this risk seriously, it can happen to you.
There are other medical topic related to travel and here are some that
might be useful for you:
-
Traveling with Diabetes , an article by Zack Pearce, which is
part of a commercial site Insurancewith.com selling different forms of medical travel
insurance. I have no experience with the company or its products.
NPR Stories related to clots, DVT, and PE
The Bottom Line?
Annette always tells me to stop being a professor and "Get to the bottom
line!" With DVTs and travel, the bottom line is not so clear but the
clearest summary for me is as follows:
- Prevalence/Risk:
- Overall the prevalence of DVTs from travel is low in people
without risk factors. 0.5% according to one of the sources.
- Risk of pulmonary embolism is even lower, extremely rare in
flights of less than 8 hours, 5 per million in flights over 12
hours.
- Genetic risk factors: there is, as with all things, genetic
risk and evaluating this is costly and may not be conclusive.
This has to happen on an individual basis, under the guidance
of a specialist. (
Matt Rondina, MD, would be a great place to
start).
- Acquired risk factors:
- Pregnancy or recent delivery within 6 weeks
- Congestive heart failure, pneumonia, chronic obstructive
lung disease.
- Leg varicosities
- Obesity (body mass index > 30 kg/m2)
- Tall (> 185 cm or 73 inches) or short (< 165 cm or 65
inches) stature.
- Prior DVT with ongoing risks
- Age: Older age, with increasing risk after age 40.
- Prevention:
- Moving around during flight is clearly a good idea. Walking
around the plane, flexing leg muscles, etc. all seems to help.
- A related concern is that sleep through the flights for long
periods, especially when upright, may be a risk. Some suggest
we should only nap on flights and not use alcohol or sleep
medications to encourage sleep. Leave the sleeping for a bed
after arrival.
- Hydration does NOT seem to matter, other than perhaps
indirectly by increasing frequency of trips to the WC. But
there is no evidence of dehydration being a causal factor to
DVTs. Everyone recommends it but there is no evidence that it
helps for DVTs.
- Similarly, Aspirin is not recommended as it is not effective
for the prevention of venous thrombosis.
- Compression stockings (below the knee, 20-40 mm Hg) are NOT
indicated for general use, but seem to be effective. Again, unless
there is risk, there is no indication for their general use,
certainly not for flights of less than 3 hours. The selection
of these is bewildering but this site is recommended by some, here is another.
- Prophylactic medications: this one is controversial and should
only happen after consulting with your physician. The good news
is that modern anti-coagulants like Xarelto (Rivaroxaban) exist
and are easy to take. Most other approaches involve injections
(Enoxaparin (Lovenox)) or ramp up over a week and careful
control through blood tests (Warfarin (Coumadin)). But this
really is not a place for self-medication!
So what is my bottom line? I am at elevated risk because of previous
DVT and PE and I am going to take Xarelto before any long (> 3 hours)
flights. I am going to make a point to get up from my seat more often and
to exercise my legs during the flight.
My previous risk factors were age (a depressingly recurring theme) and some
small, previous varicosities. This is not much risk in the overall scheme
of things but clearly enough. My DVT came on a flight to Glasgow, Scotland
via Minneapolis and Amsterdam and I was upgraded to first class on the
first two legs, slept for a few hours. DVTs are not restricted to coach
class. In the subsequent ultrasound scan of my legs, there was evidence of
a previous DVT in the other leg.
Last modified: Sat May 5 12:58:00 MDT 2018
