Maddening and Tragic

Sandra MacKay-Nicoll is convinced that if her mother had known about the condition, she would have made sure that she and the 14 blind athletes she accompanied would have taken precautions against it on their 17-hour flight from Johannesburg to New York.
     “It’s very maddening, it’s tragic, it’s unbelievable,” she says.
     Joan MacKay took a couple of steps off the Boeing 747 at JFK last August and fainted on the jetway. Seven hours later, she was pronounced dead at Jamaica Hospital in Queens.
     “When the coroner said it wasn’t her heart, we thought, well, God, what is it?” MacKay-Nicoll recalls.
     Her 61-year-old mother, who lived half the year in Amelia Island, Fla. and half in Montreal, was quite fit. She often walked five miles along the beach and had a treadmill in her home. She managed the Canadian blind lawn bowling team and was flying home with the team from the International Paralympic Championships when she collapsed.
     The coroner’s office attributed her death to pulmonary thromboembolization — the complication that results when a blood clot forms in a deep vein, breaks free and travels through the heart to an artery in the lung, where it blocks blood flow.

Stationary for 17 Hours

That was the first MacKay-Nicoll had heard about the condition and its link to long plane rides. And she’s sure her mother had never heard about it before, either.
     Some carriers do offer advisories. Northwest Airlines, for instance, runs an in-flight aerobics video on long-haul flights and recommends passengers get up and stretch and drink water every two hours.
     But South African Airways, the airline MacKay flew, does not. So she remained in her window seat in row 47 on the Boeing 747 for some 17 hours without even a trip to the restroom.
     South African spokeswoman Ann Gillespie says that MacKay showed no signs of distress before she collapsed after stepping off the plane. While the incident was rare, she said that a precautionary video is “worth considering.”

Not Just Economy Seats

Despite its moniker, economy class syndrome is not confined to the back of the plane. When former Vice President Dan Quayle was treated for a blood clot that reached his lungs in 1994, doctors suspected long plane rides were the source. And he wasn’t a regular in coach.
     Air travel is not the only — or even primary — time the blood clots can develop. They form during long periods of inactivity, which slow the blood flow. The condition also can develop, for instance, as a result of prolonged immobility due to surgery or a limb set in a cast.
     Usually the clots form in veins in the legs and lower abdomen, but they can develop in other parts of the body as well. The symptoms vary, from swelling to cramping. Often, they’re mistaken for something else, says Rayman. Sometimes passengers who develop clots don’t seek treatment for days after the flight — which is one reason the frequency is difficult to track.
     Although anyone can develop blood clots, certain people are more vulnerable, including pregnant women, people who are overweight, smokers and those with coronary artery diseases and certain blood conditions. Those with higher risks should consult their physicians before flying.
    Generally, the clots are absorbed into the bloodstream. If they aren’t, physicians can treat them with drugs that dissolve the clots and prevent others from forming and, occasionally, surgery. If a clot reaches the lung, emergency medical assistance is required.

Preventative Measures