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06-04-2009, 10:47 AM
Are You Healthy Enough to Fly?

In-flight medical emergencies are now more common than ever, with nearly two billion people flying each year, including many older people with chronic illnesses such as heart and lung disease. More sophisticated aircraft make extended flights of 18 hours or longer more available, which can intensify conditions that could cause problems while also increasing the amount of time people are out of reach of medical care. Since one out of every seven in-flight medical emergencies requires diversion, it?s important to realize that flying when it might not be safe for you not only endangers your health -- but also can affect everyone else on your flight.

Mark A. Gendreau, MD, senior staff physician and vice chair of Emergency Medicine at Lahey Clinic Medical Center and assistant professor of emergency medicine at Tufts University School of Medicine in Massachusetts, has studied this problem, publishing his findings in the February 19, 2009, online edition of The Lancet. He explained some of the risks and offered advice on air travel for people with medical conditions.

People who already have health problems are more vulnerable to the environmental and physiological changes associated with air travel. The most common in-flight emergencies are neurological (ranging from fainting to seizure to stroke), respiratory and cardiac emergencies. If you have any known medical problems, Dr. Gendreau advises consulting your doctor about whether it is safe for you to fly -- most especially if it is a long flight.


People who have undergone surgery within three weeks of air travel can face a variety of increased risks. Circulation is affected by long periods of sitting. Blood begins to pool in the calves, raising the risk of potentially fatal blood clots (deep-vein thrombosis or DVT). Risk is higher on flights longer than eight hours.

Reduced cabin air pressure causes gases in the body to expand by as much as 30%, which can lead to abdominal cramping, particularly if you already have a digestive disorder or have undergone abdominal surgery. In rare cases, it has even caused stitches in surgical incisions to open.

Following surgery, to be on the safe side...

Wait at least two to three weeks to fly. If you must fly sooner, discuss possible precautions with your surgeon.
Be sure you?re fit enough to fly. According to Dr. Gendreau, you should be able to walk about 160 feet or climb a flight of stairs without experiencing chest pain or getting out of breath.
Wear graduated compression stockings. Available at pharmacies, these stockings keep blood moving in your lower legs. They?re also a good idea if you are pregnant or obese, have varicose veins, smoke or take birth control pills or hormone replacement therapy.
Sit on the aisle. An aisle seat allows you to stretch your legs and get up and walk around the plane more easily.
Do seat exercises. When seated, perform simple exercises such as rotating your ankles or alternately pointing your heel and toe. Take advantage of foot rests and change position frequently.
Stay hydrated. To reduce dehydration, which increases risk of developing blood clots, drink plenty of water and avoid alcohol and caffeine.
Wear loose and comfortable clothing. Avoid tight pants and other snugly fitted garments, especially around the waist and lower extremities (excluding graduated stockings).


Reduced oxygen levels are also problematic for people with cardiac or pulmonary problems, such as an uncontrolled heart rate, heart failure or chronic obstructive pulmonary disease (COPD). Dr. Gendreau told me that nearly one in five passengers with COPD experiences at least mild respiratory distress during flights, due to reduced oxygen coupled with low humidity. The post-surgery tips above also hold true for those with chronic medical conditions like these, says Dr. Gendreau. Additional precautions include...

If you have COPD or an acute episode of asthma, don?t fly until it is under control. If you have fluid in your lungs, an uncontrolled heart rate, heart failure or pulmonary infection, ask your physician whether it is safe for you to fly.
Discuss possible supplemental oxygen requirements with your physician. Before traveling, if necessary, get a statement of need and a prescription for compressed supplemental oxygen from your physician. Be sure to give the airline this information when you book your ticket -- and be aware that the law requires they make necessary accommodations.


Although the aircraft ventilation system is designed to minimize the spread of infection, the truth is that germs can still spread in an aircraft cabin. Their low humidity dries out the mucous membranes in the mouth and nose that normally act as a natural barrier to disease-causing microbes. Even healthy people can leave the plane with an impending case of the sniffles courtesy of an ill seatmate -- it?s of even greater concern if you are undergoing cancer treatment, taking immunosuppressant medications or have HIV.

Also practice good hand hygiene. Contagious microorganisms get into our bodies when we touch our eyes, nose or lips with our hands, notes Dr. Gendreau. He recommends bringing aboard an alcohol-based hand wash gel -- use it before eating (whether at the airport or on the plane)... after boarding... whenever returning to your seat from the lavatory (even if you?ve washed your hands)... and after leaving the airport.

American air travelers can feel confident that US consumer safety mandates are the best in the world, says Dr. Gendreau. Federal regulations require commercial aircraft in the US to carry emergency medical kits and an automated external defibrillator (AED). For international travel, carefully check the policies of individual airlines before booking your ticket.


Mark A. Gendreau, MD, senior staff physician and vice chair, Emergency Medicine, Lahey Clinic Medical Center, assistant professor of emergency medicine, Tufts University School of Medicine, Burlington, Massachusetts.