Health concerns

Swine flu pandemic

The number of confirmed cases of Swine Flu (H1N1) across the world continues to grow. The World Health Organisation’s current pandemic alert level is Phase 6. This is characterised by human-to-human spread of the virus in more than one WHO region. The alert phase refers to the geographical spread of the pandemic, not its severity.

About to travel overseas?

Medical screening for the Swine Flu virus (H1N1) has been introduced by local authorities at several airports for passengers arriving on international flights. Containment measures may be introduced or changed with little or no notice. You may be required to undergo further tests if you show flu-like symptoms.

Some countries have put quarantine measures in place for people travelling from affected countries, or in one case at a hotel where an infected person had been staying. British nationals who find themselves quarantined overseas should contact their nearest British Embassy/Consulate who will be able to offer consular assistance, though access may be limited due to the quarantine restrictions.

There is a dedicated free phone number for all British nationals to call if they are concerned about the current Swine Flu outbreak

00 44   (0)207 928 1010

AIR TRAVEL ADVICE  By Dr Mark Denny, The Health Centre, Royal Holloway University of London

During the Summer holiday season, many of us embark on short-haul and long-haul flights to a myriad of destinations.

Below is some useful information and advice for potential air travellers:-

Contraindications To Flying

• Uncomplicated myocardial infarction within 10 days; if any complications during recovery, 3-4 weeks; non-stabilized or severe heart failure; unstable angina; open heart surgery within 10 days.

• Acute deep vein thrombosis until stabilized on antiocoagulant therapy. Cerebrovascular accident (stroke) uncomplicated within 10 days; brain surgery within 10 days; epileptic attack within 24 hours; sub-arachnoid haemorrhage within 10 days.

• Major chest surgery within 2-3 weeks: pneumothorax; pneumonia; short of breath after walking 50 metres; requiring continuous oxygen therapy.

• Abdominal operation including keyhole surgery within 10 days: gastrointestinal bleed within 3 weeks.

• Acute sinusitis, otitis media: tonsillectomy within 1 week; middle ear surgery within 10 days; wired jaw (unless escort present, trained and in possession of wire cutters).

• Intraocular surgery or penetrating eye injury within 1 week; eye surgery involving intraocular injection of gas until an ophthalmologist confirms complete resolution of the gas; acute retinal detachment.

• Gross behavioural disturbance.

• Acute infectious diseases while in the infective stage.

• Terminal illness – if there is a high risk of the patient dying on the aircraft.

• Within 24 hours of scuba diving.

• Fractures in plaster (air can be trapped in plaster casts, leading to limb compression as the air expands). In the case of standard plaster and the journey lasting less than 2 hours, wait for 24 hours after application. Wait for 48 hours if the journey is longer than 2 hours. No need to wait if the plaster is bivalved (split).

• Pregnancy after the end of the thirty-fifth week for long journeys and the end of the thirty-sixth week for short journeys (the week applies to the return journey); multiple pregnancy, history of premature delivery, cervical incompetence, bleeding, increased uterine activity throughout the third trimester.

Deep Vein Thrombosis (DVT)

Pain and swelling, tenderness and redness at the back of the leg below the knee. This is not the same as the mild ankle swelling experienced by many during long flights. DVT also usually affects only one leg and may feel worse on bending the foot up to the knee. Commonly, the symptoms develop hours, days or, in some cases, several months after the journey. Though a clot reaching the lung is rare, the symptoms are breathlessness, chest pains and, in severer cases, collapse.

If you should experience any of these symptoms, swift action is necessary. See your GP, or if this is not possible go to an        A and E Department. Blood-thinning drugs can dissolve clots harmlessly, although they may take some time to fade away.

Who is most at risk?

Immobility or lack of exercise in cramped conditions for a long time, especially if not in an aisle seat, can slow the return of blood to the heart and allow it to pool. It is a major underlying risk and sets the scene for clots to form in those who are already at risk or who may be, unknowingly, at risk. Pressurised cabins and dry air might also play a part.

Check your risk rating for DVT and/or clots reaching the lungs – pulmonary embolism.

• Low 

Risks rise with age. Very tall, short or obese. Previous or current leg swelling. Recent minor leg injury or body surgery. Extensive varicose veins.

• Medium 

Recent heart disease. Pregnancy or taking oral contraceptives or hormone replacement therapy. Recent major leg injury or body surgery. Family history of DVT.

• High 

Previous or current DVT. Known clotting tendency. Recent major surgery, such as hip or knee surgery, or stroke. Cancer or chemotherapy. Paralysed lower limbs. See your GP before a trip for a risk assessment if you have a family history of DVT or could be at high risk.

Should you wear flight socks?

The Health Department says they may be advisable for those at high risk. Flight socks have built-in graduated compression from ankle to knee. This helps the body’s natural pump to return blood to the heart, improves circulation and prevents ankle and calf swelling.  Take advice on fitting from a pharmacist or supplier. Socks that are too loose have no effect. It too tight, they could compress veins and make matters worse. Your ankle and calf measurements are the key to choosing the right sock.

How to exercise your veins

Virgin Airlines recently informed passengers from Heathrow to San Francisco that 10 circuits of the cabin would be one mile. Yet airlines, for all their onboard leaflets and healthy tips, are not keen to encourage lengthy air marches of several hundred passengers!  However, it helps to get up to stretch and shake your legs. The next best thing to tramping round the cabin is to exercise at your seat. Some airlines suggest upper body exercises. These might make you feel more energetic but do not lower the risk of DVT in your legs. Possibly the easiest solution is one of the new inflatable exercising foot cushions.

Some are slippery, too small or disappear under the seat. The best of the bunch, according to a recent report in Which, is the Airwalker from Huntleigh Healthcare. Unlike most products, this one simulates real walking and exercises calf muscles effectively. You move air from front to back of the cushion and vice versa, rather than from side to side. Exercising every 30 or 60 minutes for five to ten minutes would help to keep swelling at bay.

An alternative is to take along a salsa tape and try the Tip Tap Rock, which simulates real walking. This is contained in The Little Book of Healthy Flying by Glenda Baum, who pioneered Aquarobics. The book’s exercises could prove entertaining for bored children.

In-flight advice

• Beat dehydration by drinking as much water as you can. It helps to increase circulation.
• If you drink alcohol, drink an equivalent amount of water (or more) at the same time.
• Start in the airport. Walk about and drink plenty of fluid.
• Aspirin is not recommended to “thin” the blood and avert clotting unless you are already taking it for a medical reason. Some people are allergic to it and the medicine can cause bleeding in the stomach. Consult your GP first.
• Sleeping for many hours in a cramped position is not recommended, though it is fine if you can afford to lie out in first class/business class luxury. Sleeping pills are not generally advised. “they increase immobility, “ says the Health Department. Use only with discretion or after talking to you GP. Carry out exercises at your seat to boost your circulation before a snooze.
• Don’t cross legs – it constricts veins and slows circulation