Let the flyer beware: long trips are a killer

By MARTIN JOHNSTON and AGENCIES

Harry Cerecke struggled around Germany with a painfully swollen leg for nearly three weeks without any inkling that a life-threatening blood clot had formed in his veins.

It was only when the holidaying New Zealander's sister pointed out a newspaper article about a woman who died from a clot after flying that he realised he might have the same condition.

Emma Christoffersen, aged 28, died in October from a clot believed to have formed during a flight from Australia to England.

Her death, which prompted a British House of Lords report, brought to international attention the problem of deep vein thrombosis (DVT) caused by long-haul air travel.

The Lords report warned of the dangers, linking the condition to lack of leg space in planes.

DVT is thought to kill up to 30,000 people a year, says the British-based Aviation Health Institute.

A handful of airlines, including Air New Zealand, have decided to stamp warnings on tickets and provide other advice on lowering the risk.

Some are even increasing the "seat pitch," the distance from the back support cushion to the back of the seat in front, although this is claimed to be a result of customer demand, not related the DVT scare.

Mr Cerecke, a 55-year-old Christchurch builder, flew economy class to Frankfurt last October, with a stopover to change planes in Singapore. He travelled Air New Zealand to Singapore, and on Singapore Airlines to Frankfurt.

He first noticed problems with his left leg in Singapore, and felt miserable while visiting family in Germany. He suffered breathing problems from what he first thought was the flu and took anti-inflammatory pills for his leg.

When he realised what the problem might be, he went to a doctor, who sent him straight to a hospital. He was put on blood-thinning drugs, and it was discovered that the clot had shifted from his leg to his lungs.

"The doctors in Germany reckoned I was an inch away from death."

He was warned off flying for several weeks but eventually flew home - business class, thanks to his insurance policy.

He is still taking the drugs and has to wear a special compression stocking to prevent a new clot in his leg. A married man with two children still at home, he has to rely on a sickness benefit.

Despite the huge attention focused on DVT, it is not a new condition. Its link to long periods of immobility was noticed during the Second World War, when people spent long nights in air-raid shelters.

The term "economy-class syndrome" emerged in the 1970s, because of the perceived link to cramped cheap seats in aircraft, but that is misleading because DVT has also killed business-class passengers, who have slightly more space.

And it is not only linked to air travel. Long-distance bus, car and train travellers can also be at risk.

The New Zealand Automobile Association yesterday warned drivers to take a break every couple of hours - a French study had found that the risk was greater on a car trip of four to seven hours than on a similar-length flight.

Many researchers believe that the inactivity enforced by confined seats on long trips increases the risk of blood clots in the leg.

Normally, movement of the calf muscle helps to pump blood from the legs to the heart. But if the leg remains still or if circulation is restricted by the seat in front, blood is more likely to form a clot in one of the leg's deep veins.

If the clot is dislodged, it can travel to the lungs, causing a pulmonary embolism, even weeks later.

Airlines encourage passengers to exercise their feet and legs while sitting, and to walk around the plane.

But how practical is that, especially for hemmed-in, window-seat passengers, not to mention the difficulties of negotiating the meal trolley.

Mr Cerecke: "I had a window seat from Singapore to Frankfurt. My neighbours did not want to get up. I had to climb over them to the toilet."

In the past, he had not wanted to bother people to get up and go for a walk. But now, "If I would have to sit not on the aisle, I would not give a stuff and would just kick them out."

Doctors say people most at risk include pregnant women, smokers, those who are over 40, are overweight, have had recent surgery, have cardiovascular disease, or take oral contraceptives.

But clearly, the young are also vulnerable - 28-year-old Ms Christoffersen, for instance, and the three British Olympic team members treated after they arrived in Australia last year for training.

In addition to exercising during long flights, passengers are advised to drink regularly and minimise intake of alcohol, tea and coffee to avoid dehydration, which is linked to an increased risk of blood clots.

Some travel doctors even advise wearing the special stockings prescribed for Mr Cerecke. They help prevent dehydration by stopping body fluids swelling the leg tissue.

Dr Marc Shaw, from an Auckland travellers' clinic, says that while the benefits of exercise and blood-thinning aspirin in reducing the risk need more research, there is good evidence to support wearing the stockings, which cost about $50 from pharmacies. He recommends that all long-distance flyers over 35 use them.

Mr Cerecke says he lacks the resources to sue airlines so, like 10 other New Zealanders, he has approached the Melbourne law firm Slater and Gordon, which is coordinating a multimillion-dollar lawsuit against up to 20 international airlines for 1000 claimants, including 40 cases where deaths were linked to DVT. British lawyers are also preparing cases.

Slater and Gordon's managing director, Andrew Grech, explaining the basis of the claim, said of the airlines: "They knew there could be things done to reduce the risk, yet, mysteriously, it appears they failed to warn passengers, or at least adequately warn them."

The firm said that even in minor cases, compensation might run into tens of thousands of dollars, as victims often had to take six months off work. In cases of death, the payout might be much higher.

United Airlines said this week that it would increase the leg room for some economy and business seats. Some economy seats will increase in pitch from 78cm to 91.5cm.

"Economy-plus" seats will be for holders of full-fare economy tickets and the "most loyal customers."

American Airlines has followed suit, and others will not be far behind, says the president of American-based travel company Radius, Ivan Michael Schaefer.

Airlines in the United States are finally realising that passenger dissatisfaction has reached critical levels, he says. Airlines had been decreasing leg room to squeeze in more passengers and make bigger profits.

Air NZ says its economy seat pitch is 86.4cm on Boeing 747-400s.

Airlines told the House of Lords inquiry that increasing seat pitch by 5.8cm would raise fares by about 10 per cent.

Peter Harbison, managing director of the Australian-based Centre for Asia-Pacific Aviation, says airlines' adoption of safety warnings indicates that their lawyers are advising them to protect against legal action by trying to transfer the responsibility for the risk to passengers.

He believes that airlines are unlikely to move immediately to increase seat pitch. "But if this stays around, if this isn't just a temporary beat-up, then I think we will see some strong pressure for it."