Air travel: To fly or not to fly

Air travel: To fly or not to fly

“The desire to fly is an idea handed down to us by our ancestors who, in their grueling travels across trackless lands in prehistoric times, looked enviously on the birds soaring freely through space, at full speed, above all obstacles, on the infinite highway of the air." Wilbur Wright

The aviator is correct! Probably this ‘constructive envy’ made the Wright brothers invent the first mechanical bird that flew.... the predecessor of the modern aircraft.

Air travel is the quickest means of transportation- and today, with airlines targeting the ‘common man’ by reducing airfares, it certainly is an exciting and attractive travel prospect.

Nevertheless, a word of caution! It is no flight of fancy that illness or medical conditions may be exacerbated during flights. So, before you book your flight tickets, review the compatibility of your (or companions) health with air travel. Just following a few precautions may save you an uncomfortable flight.

Here’s an overview of some aviation- related medical conditions and advice for commercial air travelers. Always consult your physician if you have a health condition and want to fly. Be sure to carry all required medication and other accessories to help you enjoy a pleasant flight.

Heart Disease and Air Travel

Patients who have had an uncomplicated heart attack or myocardial infarction are generally advised not to fly within three weeks of its occurrence. Those who have had a coronary angioplasty or bypass surgery are comparatively at lower risk; these patients may fly two weeks after the procedure, provided there are no other complications. Other heart conditions have to be evaluated individually by a physician so that the trip can be safe and comfortable.

General instructions for passengers with cardiac problems are –

• Place all required medications for the flight in your cabin baggage or carry-on luggage.
• Carry a copy of the most recent electrocardiogram, especially those with a pacemaker or other cardiac implants. (Airport security devices do not interfere with pacemakers or other implanted cardiac devices.)
• Inform airlines ahead of your flight to provide you with supplemental oxygen, in case of a medical emergency

Pregnancy and Air Travel

Women whose expected date of delivery is within a week are advised against traveling by air. Pregnant women suffering from associated problems with pregnancy like anemia, bleeding episodes or a past history of premature delivery should take precautions during air travel.

Expectant mothers who do travel by air should stretch their legs and walk about the plane to encourage blood circulation. These exercises will help avoid blood clots that may form from sitting too long in a restricted position. An aisle seat is the perfect seating arrangement for expectant mothers; they can independently move about without causing nuisance to fellow passengers. Also, to reduce fetal risk and injury due to unexpected turbulence, it is recommended to wear the seat belt low around the waist.

Other possible distressing conditions that mothers- to- be can encounter during a flight maybe -

• Motion sickness
• Dehydration
• Intestinal gas expansion

Deep Venous Thrombosis (DVT) during Air Travel

Also known as “economy class syndrome,” DVT is a risk factor in air travel. It is a type of venous thromboembolism (VTE), a process by which blood clots occur and travel through the veins. DVT affects blood circulation in the veins of the legs. A clot, formed in the larger veins (in the legs), either interferes with circulation or may break off, travel and lodge in any one of the major organs such as brain, heart, liver or lungs damaging it severely. For example, if the clot lodges in the lung and interferes with blood circulation here, the condition may worsen into pulmonary thrombo-embolism, a life -threatening situation.

Sitting for long periods in a cramped position can predispose an individual to this condition. Symptoms include pain, tenderness and swelling. Preliminary results of a new research, released by WHO, state that the risk of developing VTE doubles after a travel period of four hours or more. A most recent news release states that a Dutch study puts the risk of DVT in long haul flights at almost three times. On an average, an air passenger who sits for more than four hours on a cramped seat has 1 in 4656 chance of developing DVT.

Smokers, over-weight people and those taking contraceptive pills are also at risk. In such people, coagulability (blood clotting ability) is significantly altered making them more prone to blood clots.

Prevention includes bulkhead seating, wearing support stockings, periodic walks during the flight, isometric calf exercises and adequate hydration.

Diabetes and Air Travel

People with diabetes have to take extra care during air travel. Those, especially with type 1 (insulin-dependent) diabetes, who travel long distances by air involving time zones, have to bear in mind

• Meal schedules
• Meal type
• Monitoring of glucose level, and,
• Timing of medications

These passengers should carry all necessary medications with them during the flight. Additionally they should also have

• A supply of needles and syringes
• Insulin vials
• Blood glucose monitoring equipment and a glucagon emergency kit
• Sugared snacks

Diabetic patients, on all air travels, should carry a medical card stating the condition and dosages of medicines required.

Insulin dosage may vary depending on the direction of travel. If one travels eastward, the days would be shorter which means lesser insulin, while westward travel is just the contrary.

Travel associated stress is another factor that must also be taken into consideration; it is wise for diabetic passengers to frequently monitor their blood glucose as well as urinary ketone levels during the period of travel.

Earaches during Air Travel

‘Popping’ of ears and earaches because ears do not ‘pop,’ are common ailments of air travel. It is worse when one has a cold as the ears are blocked. The reason why most babies and young children wail during takeoff and landing of flights is due to such ear discomfort.

Air travel involves rapid changes in air pressure and this causes a difference in air pressure within the ears. This in turn, manifests as these temporary but uncomfortable ear conditions. To remain comfortable, pressure changes on both sides of the eardrum (the inner ear and outer ear) must be equalized. For this, the Eustachian tube within each ear must open frequently and wide enough. The best method to ensure this is yawning! So, yawn as often as you can! Another method is swallowing. Chewing gum or toffee enables continuous swallowing and that is why airlines offer toffees just before takeoff!

If yawns and swallows do not do the trick, here is another way to combat this discomfort and unblock your ears:

• Shut your nostrils using the thumb and fore - finger.
• Suck in a mouthful of air.
• Now, force the air into the back of your nose as if trying to blow your thumb and finger off your nostrils.

If you hear a loud pop in your ears, you have successfully unblocked your ears! (You may have to repeat this quite often during takeoff or landing.)

For babies, the best bet is to let them suck on a bottle or pacifier; they must be dissuaded from sleeping, especially during descent.

A word of caution:

• While inflating your ears, do not use force. The correct technique is to create pressure using the cheek and throat muscles.
• Postpone an airplane trip if you have a bad cold, sinusitis or have recently undergone an ear surgery.

Other Medical Conditions

People who have recently had a major surgery are advised to wait seven to ten days before a flight, provided there are no other complications. The reason given by experts is that in such patients, the internal gas may expand, rupturing sutures causing hemorrhage or perforation. (For example, intestinal gas expands by 25 percent by volume at a cabin altitude of 8,000 feet.) Medical devices like urinary catheters or feeding tubes that have pneumatic components are affected by gas expansion. Such devices, attached to passengers, must be capped off during takeoffs and landings.

Passengers with a recent fracture in cast or splint can travel comfortably. However, casts made of plaster or fiberglass must be "bi-valved" to prevent circulatory problems. They should be well designed to facilitate swelling in the affected extremity. Many airlines do not permit pneumatic splints; if used, some air must be expelled before departure to allow for possible gas expansion during the flight.

Air travel involves a low-oxygen environment; it is known that in adults, with respiratory disease, it increases the risk of low blood levels of oxygen. In the absence of clear clinical data on the effects of a low oxygen environment on premature babies (who do not have well developed lungs) and neonatals with lung disease, it is best such infants have their respiratory function checked before being taken on a flight.

Patients with anemia must undergo medical assessment before embarking on a flight. Anyone with a hemoglobin level below 8.5 g per dL (85 g per L), as in sickle cell anemia, should have an oxygen supplement.

Scuba divers, who dive only once a day, should wait at least 12 hours after a diving session before flying. Otherwise, they are at risk for developing decompression sickness. For those who undertake multiple dives or others who require decompression stops, an additional time of 24 hours is recommended before flying.

Flying is contra-indicated in people with neuropsychiatric problems like -

• Epilepsy
• Violent or unpredictable behavior
• Recent skull fracture
• Brain tumor

If flying is unavoidable, expert medical advice should be sought and strictly adhered to. The airlines must be informed in advance and proper permission obtained.

Jet lag, a physiological reaction to traveling long distances in relatively short periods, is common among air travelers. Following a few simple techniques can prevent its symptoms

• A good night’s sleep before a flight
• Drink alcohol only moderately
• Eat a well balanced diet
• Adjust to the new time zone soon- remain active during daytime and follow local mealtimes
• Exercise moderately to adapt to the change and to get sleep.

People susceptible to motion sickness should

• Ask for a seat over the wings or by a window
• Choose to fly by a larger airplane
• Not consume alcohol 24 hours before the flight and in flight
• Keep the seat belt fastened
• Have an air bag handy

Your flying experience can be made pleasurable and comfortable –all you have to do is simply follow medical advice and take a few precautions - so, go ahead and book that ticket!