Cattle Class Syndrome and Aspirin

Friday, 11 November 2011 From Issue Vol. XIX No. 45 By  Dr. Iain Corness

As the Xmas break approaches, many of you will be getting ready to fly overseas (well, as long as you aren’t flying Qantas this week).  However, no matter what airline you choose, anybody who flies - regularly or just the annual travelers, is in danger of getting the “Economy Class Syndrome.”  This is a condition that has become prevalent with the advent of ‘long haul’ sectors, but fortunately, there are ways to prevent this happening, so read on.

Getting right down to tin-tacks, the Economy Class Syndrome is just a fancy title for a very common condition called Deep Venous Thrombosis, or more simply, a blood clot in a deep vein in the legs.  We shorten this to DVT, because we doctors like acronyms, and what’s more they easier to spell than the long names.

DVT’s occur not just in plane passengers, but in hospitals in the post operative period.  In fact, the latest figures from Australia would indicate that 50 percent of people who have orthopaedic surgery are likely to get a DVT.  Even 20 percent of general surgery patients are in line for this condition.  These are not large DVT’s I hasten to add, but are demonstrable in the blood, without their producing clinical symptoms.

And all that gets me back to my daily medication, prescribed for me by the new generation’s hope for salvation, the young Dr. Jonathan Corness, a new breed medico, about whom I am very proud - but I digress.  Dr. Jonathan prescribed one of the oldest medications in the world for me - Aspirin.  So why would this up-to-the-minute medico prescribe something as old hat as Aspirin?  Quite simply, because it works!  (Which is not something I can say without hesitation about some of the drugs available these days.)

In therapeutic doses to stop headaches and relieve arthritis, we are looking at something between 300-600 mgms four times a day for most people and Aspirin works well here. However, at that dosage you run the risk of upsetting your stomach, to actual bleeding and ulceration.  There are also people who show allergic reactions to Aspirin, from asthma right the way through to anaphylactic shock and death!  Yes, this is potent medicine.

However, there are other conditions for which Aspirin is the drug of choice, and not in the big doses either.  We are talking here of 100 mgm doses taken once a day only.  This way the chances of allergy/asthma and gastric bleeding are greatly reduced.  What the Aspirin does is work on the aggregation of platelets.  This is where the red blood cells sort of form into clumps and these become clots and are the start of the Deep Vein Thromboses (DVT’s).  And this is what happens in the Economy Class Syndrome, if you are unlucky.

Now medical science has found that by taking 100 mgm of Aspirin daily you lower your chances of heart attack, something much higher on my personal risk table than Economy Class Syndrome.  You see, clotting can occur in many areas of the body, and a clot in the coronary arteries can be extremely life threatening.  And life shortening!  And yet so easily avoided, with one little tablet every day.  You can buy baby Aspirin, but I used “Cardiprin” - this is more expensive, but comes in a push-through calendar pack, which gets me to remember to take it better than just a bottle of tablets on the breakfast table.  However, if it is your pocket you wish to look after, as well as your cardiovascular system, then the 81 mg Baby Aspirin tablets will do the trick (just remember to take one a day!)

Now getting back to flying, the secret to health in the air is purely to maintain good circulation and avoid dehydration.  To maintain circulation to the lower legs you should get up and walk around the plane once every hour.  Choose an aisle seat so you can get in and out easily.  The relative dehydration is also easy to fix - drink more water, not more alcohol!  So on the hourly walk, stop at the kitchen area and ask for a drink of water.  That’s it!  Simple.  Have a great flight.

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