Coping with the clot
At 30,000 feet in the air, Alaa Abdel-Ghani's well-being took a nosedive
I guess I'm not very lucky. The odds of developing deep vein thrombosis from a long plane flight are thought to be only one in several million. I am that one. But then again, luck has not entirely deserted me: one in every 100 people who develops the thrombosis dies. Obviously, I remained with the Group of 99.
Deep vein thrombosis is a blood clot you get from being seated too long, possibly on long-haul flights. It goes by several names: traveller's thrombosis, "Economy Class Syndrome" -- because of the belief that cramped conditions in coach class contributes to the clot -- and, most popularly, DVT. Personally, I would also call it ABC: how life changed After the Blood Clot.
Former US Vice-President Dan Quayle, one of the condition's more prominent sufferers, had to curtail flying for a time a few years back after developing blood clots in his lungs. But DVT's most famous victim was a seemingly healthy 28-year- old British woman who died from a blood clot after a 20-hour flight from Australia to London.
In October 2000 Emma Christofferson was sitting on a Qantas plane on her way home to England after a three-week holiday in Australia. Towards the end of the 12,000-mile journey, Christofferson began to feel unwell. She had been sitting in her economy class seat for a long time and may have dismissed her suffering as one of the irks associated with travel.
After disembarking at Heathrow, Christofferson made her way to the arrival hall with the other passengers. Suddenly, unable to breathe, she collapsed.
Christofferson was dead before she reached hospital. She became one of the youngest victims of DVT and her death made headline news across the world.
A post-mortem confirmed the cause of death resulted from DVT. While Christofferson was sitting in her seat, a blood clot developed in her leg, eventually making its way to her lungs. The result was what doctors call a pulmonary embolism -- the blocking of a major artery to the lung. The effects were fatal.
What sets Christofferson and myself apart is that I lived to tell the story. It was summer last year and I, my wife and our three children were vacationing, first in Holland, then in the United States. After five days of sightseeing in Amsterdam, we readied for the longer vacation in Virginia where we were to stay with relatives for several weeks.
The KLM flight awaiting us that July morning was a full house and I got stuck with what was probably one of the worst seats in the house. My ticket placed me dead centre in the cabin, with four seats to the right of me and four to the left.
Before take-off, an in-flight video advised travellers to exercise while the airplane was aloft. It did not say why we ought to do like Jane Fonda and anyway, I would have been too shy to do it in front of other passengers.
One exercise suggested walking around the aircraft in loping strides with bent knees. This, the advisory said, will pump more blood up to the brain but what it failed to mention is that this will also make you look like Groucho Marx.
I did not want to act like Jane or look like Groucho. Besides, it quickly became evident that getting to either aisle for a walk would be a difficult proposition, as I would have to negotiate between strewn hand luggage and several protruding legs. And anyway, I didn't think that in these post-11 September days, the passengers, mostly Americans, would take too kindly to a middle-aged male of Middle Eastern looks prowling the aisles every once in awhile for apparently no good reason -- and doing so on a plane headed for Washington DC.
So I decided to sit it out. I sat... and sat, for eight hours, never getting up once. By the time we had landed at Dulles Airport I had, unbeknownst to me, become stricken with DVT.
Airlines and some researchers have rejected any relationship between air travel cramped or otherwise -- and DVT. They say DVT can happen anywhere and to anyone who leads a sedentary life, whether in a car, on a bus, a train or in your home or office. Anyone immobile for a long time -- hospital patients, taxi drivers and television addicts -- could be struck down. Airlines are also quick to say that the impact that low cabin pressure and oxygen levels may have on the condition is still in the research stage.
But there was no plausible explanation of how I got DVT other than via a fateful plane ride. Excluding the Dutch trip, I do not sit for hours on end anywhere and even in a city like Cairo, where the lack of decently paved sidewalks makes walking an ordeal, I love to walk all the same. As for special risk groups, I am not overweight and the last time I looked, I was not pregnant nor was I taking birth control pills. I have nothing to do with heart disease, people who have had a clot before, those with relatives who have suffered one, people who have had recent surgery or those who have had a stroke or cancer.
I concede that I am over 40 and a heavy smoker, making me somewhat at risk. But having crossed the Atlantic on a flight in which I stayed put the entire time, plus the data linking air travel to DVT, I put two and two together and could only come up with deep vein thrombosis.
Unlike Christofferson, I did not fall ill on the plane nor did I collapse following the flight. In fact, I felt nothing for the next 10 days. I had what is described as a "silent clot" -- as long as it's moving in the blood, you don't feel it. But you certainly feel it when it stops because it has blocked the flow of blood somewhere. Like roulette, though, you never know where it will stop.
I had woken up one morning and made my usual visit to the bathroom. But after just a few steps I stopped. I could not continue and had to sit down, panting heavily. I felt like I had run a mile when in fact I had walked no more than five metres.
It was a frightening experience and there was more to come. Two days later, I began to experience pain on my left side, near the armpit, so excruciating I would fall to my knees.
I needed immediate medical attention but with just a few days left in the United States, I decided to wait until I returned to Cairo before seeking help. In hindsight the decision could have proved fatal. A blood clot was evidently lodged in the lung area.
The day of the flight back home, my chest pains and heavy breathing had all but disappeared -- but my left calf had swollen dramatically.
Still unaware of what I had, on another eight-hour flight from Washington DC to Amsterdam en route to Cairo, not once did I leave my seat.
Back in Cairo, a Doppler ultrasonography detected a clot in the lower left leg. Treatment included 20 injections over 10 days of an anti-coagulant plus bed rest with the affected leg constantly propped up.
For the next two months there would be no particular problems until another episode of breathing difficulties sent me to the hospital twice, including a five-day stay in the intensive care unit of Qasr Al-Aini. As it was explained to me by my doctor the clot, as it developed in size, had shed pieces called emboli. The emboli had floated through the blood system and travelled to major arteries in the lung, causing the shortness of breath.
Because of many genuinely helpful nurses, there was little to do in ICU save take oxygen sessions and reflect on why things had gone so wrong for me. Maybe somebody doesn't like me; then again, if this was a test from God, maybe He does. I still don't have all the answers, but my faith has definitely been energised.
And life has definitely become worth living. At work and at home I have occasional off-days but I have come to value all kinds of days.
The blood clot is gone, having turned into a strand of dead fibre in the foot. But there is always the chance of a repeat performance. Deep vein thrombosis can be chronic with recurrent episodes. Tests showed I had lost 40 per cent of my ability to breathe and that it would take six months to a year to breathe normally again. I will take blood thinners for the rest of my life and will continuously wear a compression sock to support the veins and reduce swelling. One post-clot problem has been insomnia. I spend many nights unable to sleep for fear of never waking up again.
With all the problems the clot caused, you would think I would have sued KLM; I probably would have lost. In London last December, a British court blocked an attempt by survivors of DVT and grieving relatives of those who died to sue 27 airlines, among them KLM, over claims that cramped seating on planes put passengers at risk of potentially deadly blood clots. The 55 would-be plaintiffs claimed they developed DVT because airlines did not advise them to move around during long flights. But the judge said the clots did not constitute an "accident" under the Warsaw Convention. Airlines are liable for damages only in the case of an accident under the treaty.
Still, there have been minor victories for passengers. Shortly after Christofferson's death, Australian airliner Qantas began printing cigarette pack-style warnings on tickets about the danger of blood clots. Such a measure could help some passengers. It might have helped me.
