Pilot Dies of DVT

[BYOD]

SIA A345 Ultra Long Range Capt collapse after flight and dies. Investigations indicated the 49 year old pilot had passed away after being struck by DVT. So this is a sad reminder to all the dangers of DVT on long flights. Best take the pee break even if you dont need it.:(

[Stumpie]

You are right, one should never under estimate the danger, but I wonder what the exact reason for his DVT was? I was an airline pilot for over 30 years and suffered twice in the last 10 years from a DVT. Fortunately I was referred to a top man at the local University Hospital. He discovered I suffered from a gene defect known as Factor V Leiden. This meant that I was susceptible to clotting. After the first DVT I was allowed back to flying but had to inject myself with an anti-clotting agent (lasted about 24 hours) before each flight. The second DVT occurred while on leave and being hit on the leg with a heavy wooden shelf. The resulting trauma caused a clot and that was the end of my flying career. Too many people, both aircrew and passengers, are unaware of this condition and others of a similar nature and the press with its banner headlines about "Economy Syndrome" have not helped. Especially passengers are wont to think it is flying that causes a DVT. This is probably the result , the cause being perhaps a medical condition they themselves are carrying.

[9Ws]

When did this happen? Anyone know the pilot's name? Asking coz I know a couple of pilots on SQs 345s.

[LegsUpLucy]

I really think this should serve as an alarm bell to all flight deck crew of the dangers to sitting for long periods,i also think airlines and the CAA dont look after crew welfare enough;they should be reviewing the 900hr flying limits,it is not a healthy environment and thier should now be calls for more restrictive FTLs on the grounds of aircrew health....

[got caught]

Sorry to intrude on your forum, and condolences to the pilot's friends and family.

As stumpie states, there are underlying conditions, such as his inherited gene, trauma, and forced immobility, which predispose people to dvt formation.

I'm not sure whether the incidence of dvt's in long haul pilots has been demonstrated to be greater than that of joe public, statistically- my more learned colleagues on the medical & health forum may know better than I. Last I heard, there have been some studies commissioned, but I havn't seen any results.

I'm sure I,m preaching to the converted, but the usual measures which cut down the risk of dvt should be encouraged- calf pump exercises, maintain hydration, and avoid alcohol 24 hrs prior to flight is the usual advice to people travelling long haul. Compression stockings can be used for those at risk, but I'm not sure if pilots would fit into this category.

Anyhow, 49 is too young to die.

[Captain104]

Gentlemen,

forgive my stupid question. Are you talking about " deep vein thrombosis" which occurs when the flow of blood is restricted in a vein, and a clot forms? ;)

Regards

[Grunf]

YEap, deep vein trombosis.

It can be related however to periferral arhtery desease meaning poor perifferal circulation.


Too bad that this is recognizied only recently as a vast problem.

[wdh]

Prone-ness to thrombosis is called "thrombophilia" (should you wish to go Google-ing).

There are many genetic causes.
Factor V Leiden is present in about 1 in 20 europeans.
Inherited from one parent, it gives an approx 8x increased risk of thrombosis. Inherited from both parents, the risk soars to 80x.

In the UK these conditions are little known - and rarely tested for.

My mother suffered a PE (blood clot in the lung) - ambulance and a week on Oxygen. My brother had a DVT. His (french) doctor had the tests done. And discovered Factor V Leiden.
My mother went to her doc with his results - and the doc agreed that she ought therefore to be tested (result: positive) and because of that she is not coming off anticoagulant 6 months after her PE, as had previously been decided.

Now, if it hadn't been for the brother's episode and his french tests, the NHS wouldn't have bothered to check for this condition. They hadn't at the hospital or the GP's.

If you have *any* family history of Thrombosis, especially if you are a European Caucasian, you ought to become aware of this stuff.

Take a look -
http://www.thrombosis-charity.org.uk/aboutthrom_thrombophilia_congenital.htm

[None]

What did these people do or not do that resulted in DVT?

Is it simply sitting in the seat for 3+ hours?

Did these guys have symptoms of numbness (a leg falling asleep)?

Does anyone know what symptoms they had after the flight?

Did they have difficulty walking up the jetway?

Or was it something that developed hours after the flight...maybe some kind of discomfort in a leg?

I wonder if there were previous flights where they had similar discomfort which cleared up after a few days? A type of "warning."

[Dani]

May I remind everyone that best prophylaxis against all these kind of deseases is regular body exercise, no smoking and moderate drinking - in short: a healthy lifestyle.

Foremost train your cardiovascular system: jogging, swimming, biking, skating, skiing. Keep your body weight (index) low and eat less fat (new schools promote not to eat too much processed carbonhydrate).

This also applies for passenger, not only for crews!

Healthy flying!
Dani

[GlueBall]

Company policy suggests that cockpit crew not leave the upper deck in flight, but I always take a stroll through the entire main cabin. :ooh:

[guclu]

A doctor once told me to strecth tight the lower leg muscles during flight. That's what I am doing.

The bad side of ultra/long haul flying is that not only during flight but also before the flight you have to rest and after the flight although you did not make much "physical effort" you are tired and you take rest again.

So for a 10-13 hours flight it makes something like

- 8-10 hours time in bed
- 1 hour preparing for flight
- 1 hour going to the airport
- 1hour 30min briefing and going to the a/c
- 10-13 hours flight
- 30 min disembarktion
- 1-1 hour 30min getting out of the airport and going to hotel

So it makes a total of 22hours 30 min to 28 hours.

If you go to sleep when you arrive at the hotel then add extra 8 hours to the above hours.

You are not making "physical activity" during this time ! Only small walkings that is it.


Guclu

[LegsUpLucy]

I think there should be a review of policies at some airlines who ban thier crew from having a walk through the cabin.I think it is essential with this job...it is a very sedentary life.
My average day at a low cost airline involved 12hr duty(sitting)...driving home m25 2hr(sitting)...then straight to bed exhausted (sleeping)...

I'm sure this is what a lot of guys do week to week....not the most active of lifestyles,but maybe this is a wake up call to lead a more active life for some,and policy setting changes for airlines.

[Skipness One Echo]

Are you guys now prisoners on the flight deck? Allowed to furtively use the bathroom when the passenger's attention is diverted?
Shame - I remember being invited upstairs to visit the flight deck of a BA 747-200 going east from Miami to Gatwick. Educational, informative and a joy to see the world from up there. The crew were all professional and appreciated a little intelligent conversation (honest) as a little diversion. It being the middle of the night and all.
Now we live in different times. What I would say to all the people who hate our way of life is go and live your own lives your own way, without our help. Give us back our technology, our aircraft, our ideas and live in the middle ages if you wish. That way the Captian might get to meet the passengers again...... civilised that.

[er82]

Having had both my brother and father suffer from blood clots, their doctor told them that whenever they go on a flight longer than about 2hrs, they should take aspirin.
Every long-haul flight we go on now, we all take 1 aspirin the day before the flight, 2 the day of the flight, and one the day after.

Hadn't really thought about it at work as most flights are around 3 hrs, but maybe I'll start taking it a bit more regularly.

[IHL]

BYOD:

It is an interesting topic. Is there a newspaper reference available?

[Fountain Pen]

Well this looks like its becoming a problem, and yes there is quite a lot on DVT, just go to google or whatever your search engine is and type in DVT, there is quite a bit of information there...I know, as I got DVT last year flying across the Atlantic a few times.

It was not pleasant, as I didn't know what was wrong with me...I could hardly walk from the aeroplane to the terminal without stopping and I'd be totally out of breath after a few steps.

The next day I felt something move in the back of my leg from the upper thigh past the knee then my whole left calf became very swollen and hot to touch.

I was stuck in the West Indies for 5 days and eventually crewed back to the U.K. still not inderstanding the problem...then I though it would just go away, but no so I went to see a GP and he rushed me of to hospital where it was confirmed as DVT.

Heprin Injections then on Warfarin to maintain an INR of 2.5 or there abouts, for min of 4 months but usually 6 months...you are considered unfit to fly as the CAA does not allow you to fly while on this medication.

I had lots of tests, to see if I were pre disposed to DVT...I was not, however, I will not trust it, as we can see it can kill. within days another pilot ended up in hospital as well with PE (pulmonary embolism), which is DVT, he was out for nearly 6 months.

Seems like its to do with lack of oxygen on long flights, dehydration, previous history of DVT of which you may not be aware of, being over weight, and so on...but I see it very dangerous and I was lucky, because if that clot breaks away and travels to your brain of heart, you can imagine what could be the result.....:(

[petitfromage]

Did this really happen?

Nothing in the Straits Times over the last few days and no one at SIA is backing the story?

[got caught]

er82- can I ask that you take medical advice before taking such measures ?

What's good advice for your dad and brother, may not be good advice for you !:cool:

[filejw]

I've had a DVT and still fly.I make the effort now to get up every 2 to 3 hrs,drink lots of water up to 2 liters on an 8 hr leg and I carry a Sports Cord and due some leg exercises in my seat after I get up .Having a good diet and riding my bike lots helps too.:cool:

[Stumpie]

Hey guys, I do not think some of you are thinking straight. Most of your suggestions are common sense, which one hopefully accepts pilots have! Sure an Aspirin will help. Drinking copius amounts of water helps, as well as a balanced lifestyle. But, what I would really like to put across, is the ignorance many of us, (myself included until it hit me right between the eyes!) have regarding DVT's.

There seems to be too many people that still consider the main danger to be a long flight. If you take precautions and are NOT predisposed, ie do not have Factor V Leiden or one of the other similar conditions, then you like the majority will probably be ok. However, should you know of anyone in your immediate family that has had either a DVT or venous problems eg during pregnancy, then I would suggest you get a blood check and determine whether you are predisposed to clotting. If you are, then you are pre-warned and can take the appropriate measures such as injecting Heparin before a long range flight.

Some of you have asked what the symptoms are. Initially nothing or perhaps a twitchy feeling in your leg or foot. I felt that a vein in my foot was perhaps enlarged and was being irritated by my sock or shoe. The second time I knew exactly what was happening as I had, had prior experience. Next comes excrutiating pain once the vein blocks and will not allow the blood to flow. This pain by the way will continue, even during blood thinning treatment until the clot has been cleared. The danger of course is a small portion or the whole clot breaking loose and travelling to your lung,heart or brain, making you either very sick, killing you or perhaps worst of all turning you into a vegetable! Believe me, getting breathless when the clots go through ones lungs is not a pleasant feeling and shutting ones eyes at night hoping to wake in the morning is not to be recommended.

I am not trying to scaremonger here but, I am sure there are people out there that perhaps should take notice.

[Fountain Pen]

Guys, please don't treat this lightly....when my Vascular Surgeon said I was clear and can go back to flying....it was me that wanted to know if I was predisposed to clotting...so he said ok we will do a Thrombphilia test...6 files of blood is taken and it takes a few days for the result to come in...its obviously a complex test...the result was ok and I was not predisposed...

So why did I get DVT... another factor of DVT is if you had a major operation within the last 6 months....I did...I had a Kidney Stone removed in my left kidney...which I think was the contributing factor of me getting DVT as I had quite a bit of discomfort in my left kidney area that day as we set of from London to the Caribbean, when we landed was when I could hardly breathe...

I see a link here, for years I have been a big tea and coffee drinker when flying...hardly any water, so my urolgist said the reason I had a kidney stone was that am dehydrated all the time and I should drink 3 liters of water a day...I find that hard to do....but here again dehydration is 1 cause factor of DVT...of course anothe reason I got a kidney stone was that I tend to consume to many purine food...

So yes now, when I fly I will wear compression socks, I will get and move as muct as possible and streach my leg muscules as much as possible, I will drink a lot more water and keep away from tea and coffee, I take a low dose asprin now every day to dilute my blood a little....

Legally...you cannot fly while you are warfarin medication, in the USA the FAA will let you fly as I uderstand it but its on a dispensation....at the moment the CAA or CASA in Australia will not, I don't know about the others...so if my Throbphilia test would have shown that I was a natural clotter...I would have to be on Warfarin for the rest of my life...which means I can't fly period at the moment under the CAA rules...

My Vascular Surgeon said that Warfarin is a dangerous drug and should be used very carefully...I didn't like taking it as it made me feel sleepy at times a weak and a need for lots of blood tests to keep modifying the dose as it affects the INR depending what foods you eat...so all a nasty business this....but we all need some knowledge on this subject so as to prevent it occuring where we can......



:ugh:

[acbus1]

Interesting thread.

Can anyone explain how these socks work, please ("compression socks" someone called them).

I believe they are tight around the leg.......doesn't that slow the blood flow (by restricting it)? Wouldn't slow bloodflow encourage clotting?

Whatever theory someone (hopefully) comes back with, does it apply in everyday life? i.e. Would wearing these socks be beneficially in general, not just for flying?

[gregm]

Can anyone explain how these socks work, please ("compression socks" someone called them).

I believe they are tight around the leg.......doesn't that slow the blood flow (by restricting it)? Wouldn't slow bloodflow encourage clotting?

Stops legs swelling up because of poor circulation.

My dad had a heart attack in 1991, rather serious event with muscle damge, he took 12 months to recover and to get back to work. Now he is still working part time at the age of 75.

He flies 3 or 4 times a year Sydney to Perth etc has been to Singapore & Hong Kong from Sydney in recent years.

My father would not fly without compression stockings.

Blood clotting occurs when the blood stops moving, or moves slowly.

Anyway my understanding is that the main role of compression stockings is to stop the blood just sitting in lower limbs because of poor circulation
If you have ever taken your shoes off on a long flight and find them a tight fit when you put them back on, this is an example of blood sitting in your feet resulting in your feet swelling up. Happens to me and I suggest to most people.

As SLF I normally take an asprin prior to a long flight, due to its effect of thinning the blood and thus improving circulation. My theory is that this will reduce the possiblity of DVT and a cardiac incident whilst on a long flight.


http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/Deep_Vein_Thrombosis.html

[Fountain Pen]

Well I think that's their official name I'm not sure...but readilly available at some chemist stores I guess....or at least at places that sell physio stuff etc...

Believe me they are very comfortable to wear...bit of a pain to get on the first time as its virtually made of elastic material, you put them on and they come up to the knee...then you can put on your normal socks and there you are no one will know or see your compression socks unless you lift the bottom of your uniform pants half way up your leg and you can see the sock....

I've got white ones, but they come in black as well and other colours, but they are nice to wear and at the end of a hard day when you get them off you can feel that they have been doing their job well....people who have bad cases of Varicose Veins they wear them all the time...but I think for pilots its just while flying, as on the ground you get exercise and good circulation with plenty of O2...

Another factor of DVT is lack of Oxygen....sitting at a cabin altitude of 6500 ft all day.... some good deep breaths out of the mask it seems will also prevent DVT.... compression socks prevent pooling in your legs below the knees...I have a tendency to sit for quite a long time without even moving a leg muscle, then have to make a consceous effort to move myself around, to get blood circulating...

I'll do some reaserch and find out the physics behind it and post it.....the NHS put out a flyer on DVT its excellent, the DVT department at a hospital should have one, "there must be a simpler way of Avoiding DVT" its called.....:ok:

[Old Smokey]

A sideline note to those using Aspirin is that it must be taken every day of your life, not just immediately before the flight.

Regards,

Old Smokey

[Red Mud]

When this topic was started it created an informative and possibly life-saving discussion. I spend two hours in the car to/from work only to sit at my desk and then fly for a few hours in aircraft that don't always allow a little saunter within the cabin. I also tend to ignore the nature calls until after landing which seems to set me up as an ideal candidate for DVT. I wouldn't have thought much of it but a few months ago I had what felt like a cramp in the lower portion of my right calf. Despite repeated stretching it still continues to tighten and ache and now a similar sensation is developing in my other calf. After having read this thread, I think a quick trip to my surgeon is in order. It may be nothing but ...
Thanks.:ok:

[LegsUpLucy]

I think it would be really useful to lobby the CAA on this,perhaps via Balpa or similar organisations.
We are bombarded with leaflets on CRM etc. i think perhaps we should be getting facts and health advice on all aspects of flight deck concerns on this topic from the approriate authority!!

[Fountain Pen]

Yes I think its a good idea...DVT is a curse and not only that if all pilots are aware of the possible causes and recognizing the the symptoms, will go a long way if only of saving lives....

Its the dehydration from sitting at 40,000 ft and the lack of O2 and of course not moving enough...big culprits...may be some of us that are concerned, get this Thrombphilia test, found out if you are predisposed...

I think that being on Warfarin should not stop you from flying...after all you will be out for about 6 months, its not a pleasant medication and your potential for bleeding is high due to some little injury for instance...

Your right....CAA should put something out to allert pilots of this problem that seems to be appearing, aviation medicine section should formulate something to educate everyone for prevention of this problem.

Also kidney stones....if you look up the CAA website and get on to kidney stones...its up there with heart attacks, you are grounded until all stones have been removed and CAT scans show that you are clear...mine was discovered by just blood in the urine, but an attack will make you pass out I have been told by doctors...

Then the CAA will want x-rays every 2 years to see if the stone is re-occuring, as the probability is high, I'm due for my x-ray next year, BUT it to me its all interrelated...WATER is the key....:hmm:

[Thomas coupling]

There's that advert on TV currently that shows a DVT moving along a vein towards the heart/brain in SMOKERS - creepy to watch.
About a year ago, I learned from my father in law that a colleague of his was sitting at home with some friends when he started to complain of a pain in his thigh which then moved to his abdomen, then his chest, his neck and minutes after he complained of this 'uncomfortable pain' he was dead from a stroke!!!!
All this was witnessed by about 6 people...... Creepy.

Aspirin has too many side effects.

Try lots and lots of H2O........and keep moving.

[scanscanscan]

British Heart foundation booklet advises you not to sit still for longer than 20 mins....so where does that put the long haul pilot?

[Whirlybird]

There's something here I don't understand. :confused: Why should DVT be any more likely in an aircraft than, for instance, sitting at a desk or PC for long hours, driving from one end of the country to the other (you don't change gear much on motorways), etc etc? Is it more likely? Or is it just that suddenly we hear about it a lot?

Also, is there any evidence that the socks work? I bought some, found them constricting and uncomfortable, and gave up wearing them. I prefer loose clothing on flights, not nasty tight socks that some expert thinks will work.

I now do on long flights as a passenger what I've always done - sleep. Lots! Being only 5ft 2ins, I can manage that quite comfortably in any seat, and I do. I change position as often as I do in bed at home, and being someone who wrestles with the bedclothes in their sleep, that's quite a lot. I don't worry about DVT at home, and I don't worry about it on flights either.

OK, let the flaming start. :)

[Fountain Pen]

Its more likely in an aircraft because of dehumidified air that comes into the cabin at high altitude and of course reduced amount of oxygen...thus the blood becomes thicker because of it....then if you don't move for quite some time, then there is a high probability a clot will form....

Even at the blood bank, they keep the blood slowly moving so as to prevent clotting, as the doctor told me if blood is stationary it will clot, then if you are predisposed to clotting, then you could be in serious trouble....so the compression socks will help blood from pooling in your legs and thus maybe prevent at DVT forming.

[Bob Viking]

So what do you advise that I do, after several hours sitting behind a tanker strapped to my exploding armchair?! So far I've stuck to a careful regimen of motoring the seat up and down every so often and turning upside down when I'm far enough from the tanker to not scare the cr@p out of them!
BV;)

[Fountain Pen]

Bobless!!!...what can I say...you have read the thread...figure it out for your self...there are so many factors....you will god willing live to be a hundred...so why worry....unless your exploding armchair gets you first....:O

[Carrier]

The owner of the operator I fly for has used Warfarin for many years. He has a licence and flies regularly. Perhaps standards are different in the African country we live in. In September he had a heavy nosebleed. This has happened before. At dinner that night quite by chance I happened to meet someone from Los Angeles who specialises in the human blood system and writes university papers on the topic. I mentioned my boss’s problem. The expert confirmed that Warfarin has a very thin tolerance between an inadequate dose and too much. He also has the same problem as my boss. He advised that there is a much better product available that he uses. This is called Plavix. He suggested that my boss should ask his GP to look into Plavix to see if it will be suitable for him. Anyone using Warfarin might want to do the same. I mentioned it to my boss upon returning to base. I am not sure if he has taken this up as I have since seen him with a similar nosebleed. Perhaps Plavix is not obtainable here or is too expensive.

More than two decades ago in Canada before I had any thought of flying, let alone flying for a career, I came across an interesting fitness book written specifically for pilots. I bought a copy on the basis that if it works for pilots it should be more than adequate for the general population. I have had no reason to regret this purchase. Indeed, I consider that this book, or an equivalent, is an essential part of any professional pilot’s kit.
Title: Canadian Pilot’s Fitness Manual
Author: David Steen
Publisher: Delacorte Press/Eleanor Friede, One Dag Hammarskjold Plaza. New York, NY 10017
ISBN 0-440-03670-4
Published 1979
This was written in co-operation with the Canadian Airline Pilots Association and the Fitness Institute of Toronto. My version dates from before DVT became well known. I suspect that a current edition would include reference to DVT. Even without reference to DVT I consider this book to be well worth having for any professional pilot. The DVT issue can be added by using the handouts from airlines.
I suggest any pilot who is remotely concerned with personal fitness and retaining a medical validation should have a copy.

[Fountain Pen]

Yes Carrier....what your expert says is correct...my INR reading was just so unstable...it was difficult to maintain @ 2.5...

reason is my diet....I like a drink and my choice is red wine....the foods I eat is another factor...especailly foods that contain vitamin K....throws everything out of balance while on warfarin....

The FAA in the States will allow you to fly while on Warfarin...but that is on an application and an approval...

CAA is considering its stance, and maybe will go the FAA way....at the moment CASA in Australia will not alow you to fly as the CAA in the U.K.....

Its all to do with the lack of O2 and dehydration....and as Long Haul is becoming more frequent with the A-380 etc....this will become even more prevalent...

As I said before...WATER is the key....:D

[wdh]

Carrier:...has used Warfarin for many years. ... {The expert} advised that there is a much better product available that he uses. This is called Plavix. He suggested that my boss should ask his GP to look into Plavix to see if it will be suitable for him. Anyone using Warfarin might want to do the same
Errr..?
I believe Plavix is an alternative to Asprin, acting similarly against platelet clump formation, and therefore not really an alternative to Warfarin, which acts rather differently.

Anyone on Warfarin that suffers a severe nosebleed really should get their INR (clotting/bleeding propensity) checked fairly urgently... (there are more serious potential sites of bleeding...) And I would have expected anyone that had been on Warfarin for "several years" to be well aware of that.