Dr. Donohue: Athletes should prepare for plane trips

Syndicated Columnist
Published Saturday, March 08, 2003

DEAR DR. DONOHUE: The data on athletic victims of air travel thrombosis are growing, due to the fact that they travel by air so much more often than the rest of the population. Enclosed is a table showing that of 95 victims of vein thrombosis, 85 percent were athletes. Wouldn't your readers appreciate some words from you about this? -- M.R.

ANSWER: It's long been known that long trips -- car, bus or plane -- can be occasions where blood clots form in leg veins. Prolonged sitting causes blood to pool in leg veins. Stagnant blood forms clots. So, long trips can foster leg vein blood clots.

What's dangerous about such clots is that a piece of clot can break loose from the main clot. The circulation can carry it to the lungs, where it blocks blood flow to lung tissue. The piece of clot is called an embolus. Lung tissue deprived of blood dies, just as heart muscle dies in a heart attack when heart arteries block blood flow to the heart muscle. For the heart, the official name is myocardial infarct. For the lung, the name is pulmonary infarct.

Plane rides longer than 3,000 miles (5,000 km) are the ones most likely to cause trouble.

Everyone who takes a long ride on a plane, in a car or in a bus should get up and walk whenever possible, at least once an hour. When a walk is impossible, people can contract their leg muscles while seated for three to five minutes every half-hour. Muscle contraction keeps blood moving through and out of leg veins.

It is also important to stay hydrated -- with fluids other than alcohol.

Anyone who has had a previous episode of leg vein clots should ask the doctor about taking an anticoagulant prior to the trip. Low-molecular-weight heparin is the anticoagulant often chosen.

M.R., would you be so kind as to send me the source where you got the data on athletes having leg clots? I want to have it on hand both for myself and for readers who will want to know where this information came from.

Thank you.

DEAR DR. DONOHUE: At my son's high school, the team doctor gives a painkiller shot to everyone who wants one before a game. The idea is that it will help a kid shake off the pain of minor injuries so he can keep playing. The shot is not a narcotic drug. Does this sound like a safe practice to you? -- T.R.

ANSWER: It sounds like insanity to me.

At the professional sport level, some team doctors give players a shot of Toradol before a game. Toradol is an anti-inflammatory drug, like Aleve or Advil. The reason given for doing this is the same reason given by the physician at your son's school.

Pain is not always bad. It's a signal that something is seriously wrong. Dulling pain perception robs players of an important warning to get help.

This program ought to be scrapped. If the principal won't do so, talk with a lawyer. I am certain you will get action.

DEAR DR. DONOHUE: My wife is a long-distance runner who has been running since high school. She is now 43. In addition to her running, she eats like a bird. She is so thin that people remark about it to me. She says she feels fine and has lots of energy. Are there grounds for concern about this? -- W.B.

ANSWER: There are grounds for concern.

Reed-thinness deprives a woman of a sufficient supply of fat to keep estrogen production at normal levels. Without estrogen, a woman is going to see a diminution of the number of her menstrual periods. They might stop completely.

The danger in not having enough estrogen comes from its essential role in keeping bones strong. Without it, premature osteoporosis sets in. She is definitely in harm's way.

Have a heart-to-heart talk with your wife. Ask her to see the family doctor. If she balks at doing that, tell her I said she should go.

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