Friday, July 05, 2013

Clexane For Travel, Post-DVT

The worry about flying long haul flights, and making sure you are doing all you can to avoid a fatal blood clot is something that is as important as checking you have enough pages in your passport. Maybe more so!

I have had a blog reader contact me with questions about travel after having a DVT, and so I thought I would share those flight strategies for anyone else who may be in need of the same reassurances, an example of how travel does not need to stop after having a DVT, and how best to manage your fears about getting another one.

Cassie says she Googled “traveling with Clexane” and found my blog. She told me that she had her DVT and PEs 4 years ago, and was finally in the process of planning more travel - “I figure at 30, I can't give up on seeing the world just because I need an injection or two”. Cassie asked me some questions about her upcoming trip, and we swapped diagnosis, ongoing leg symptoms, the variable medical advice we have both received, and travel precaution stories. We also talked about sharing our discussion here, to add to the limited information there is out there about post-DVT travel, and to share the precautions I take when flying.

Cassie has a very similar story to mine in terms of her DVT diagnosis and lack of factors other than travel, with “No underlying predisposition to clotting, just some very long travel days on a bus in Turkey, several lengthy flights, being on the pill and a big dose of bad luck!” Neither of us have been found to carry genetic factors predisposing us of clotting like this. She also had calf pain during her travels, and dismissed it as a cramp. Sounds oh so familiar!

You can read about mine here, in terms of diagnosis, treatment, and getting back on the plane!

Cassie and I have both exchanged how lucky we both consider ourselves to still be alive and well, given the DVTs experienced, and the point of travel for them to our respective lungs. She asked me a series of specific questions, to help her prepare for her trip, to know a little about what to ask for from her doctor, and also how to be ready to inject herself in the belly with a syringe of blood thinning medication!

Having had a DVT cannot be the death of the travel bug, and your travel plans – so here is my post-DVT travel advice:
  • Once you have a prescription for clexane from your doctor, with the dosage based on your weight and risk factors, I suggest following up the filling of the script with your pharmacy a little in advance from your flight date – the first time I got one filled, the smaller country chemist I went to was not sure of their supplies, and thought they may have needed to order some in.
  • Getting to a point of actually giving yourself a needle is the hardest part, for sure. But I figure if that's what I have to do, then so be it! I give myself an injection before a long haul flight, and also after the flight.  My rule of thumb is once per 24 hour period, and then if it's a long haul flight that usually means one before and after to cover the time differences. For a shorter flight, like an 8 hour one, I usually just give myself the one jab before the flight.
  • I wear the compression stockings for flying, and get up and walk the lap of the plane every couple of hours - like at the end of every movie. I have accepted that flights are no longer a place for sleeping for me now, so I just treat any flight as a serious movie marathon!
  • I always ask for an aisle seat, and stretch out when I can. I often let my seat buddies know that I have no issues with them disturbing me during the flight so that they can get out – such an opportunity will ensure I get up and walk around at least to the back of the plane and back again myself.
  • Needle disposal is a challenge, for sure. I don't carry a sharps container with me when I travel, but I have found some sharps disposals in bathrooms around the world (mostly in non-Aussie airports, actually), but not many. I usually just wrap them back in their packaging and throw them out that way. Not the best option, for sure. I sometimes carry them with me until I find somewhere a little more equipped to handle such delicate rubbish.
  • I have never had a security issue carrying needles, which I have been surprised about. The first couple of times I carried a letter from my doctor explaining why I was carrying syringes in my hand luggage, but now I have become pretty lax about that because I have never been questioned!
  • Keeping a couple of needles in my hand luggage, and then a bigger stash in my checked baggage, is my usual strategy for ensuring I have enough supplies for my trip, and some sort of safety net in case I lose one of my bags.
  • In terms of travel insurance, I have been advised that I don't need extra cover (which I got on my first post-DVT trip), because without the presence of blood factors we have as much chance of getting a DVT as the next person. I am not really sure about that, but I agree that we are not really classed as having a pre-existing condition. I would imagine there would be an insurance fight in the event that I had another one though, knowing what the insurance world is like!

My policy about when to inject and when not to, is to err on the side of prevention. I would rather give myself a jab and be over cautious, than wish I had have, and have a trip ruined, wind up in hospital not being able to fly for a month, and  be made to be on warfarin for life, or the worst case scenario, that's for sure! In addition to flights, I have given myself clexane for overnight train travel, and also long bus rides.

Following all of this has still left me feeling anxious about leg pain on a flight, or the days afterwards, on occasions. And this treatment plan is not a guarantee, especially if you seek out anecdotal stories. The need to trust your instincts to get any persistent leg pain checked out is needed, and if your calf is hard, or if you are out of breath, an Emergency Room visit is a must!

I would also recommend compression stockings, or wearing sports skins, to everyone taking a long haul flight. Plus the tips to get up and walk as often as possible, and to keep hydrated, should be everyone’s plan also – better to be safe! Sitting cramped up all those hours is just not good for anyone!

*Please note – this post should by no means replace consulting with your doctor, or following the instructions given for your particular risk factors of a DVT.

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