Help; swollen heavy legs and solutions
 

Mrs Bilbo suffers from swollen legs on most of her flights, generally Ryanair, easyJet, Jet2.com within Europe. I'd like to fly UK to New Zealand which is 2 x 12 hour flights. She has tried tight socks but even so it is not a pretty sight and makes her holidays a misery for the first few days so I can understand that 24 hours of it would put her off.

What would you recommend?

Mrs. B clearly has a circulatory issue, either local to the legs or central from a cardiac or major blood vessel problem. All are risk factors for deep venous thrombosis on a long flight, and you are contemplating two. A full medical work up, possibly including cardiac and/or vascular specialty evaluation, is in order. As this plus tests of treatment options can be time consuming, it would be wise to start now.

Definitely consult a doctor. But also consider paying for lie flat business class seats, I no longer take suffer through flights that long in economy, although I "pay" in FF miles.

Hi, thanks for coming back to me with such sensible advice. No her circulatory system is fine we've had it checked a few times and if anything she is too fit it is just her fluid retention that is the issue.

I have no problem with the idea of business beds (Air NZ you get a bed) but Mrs B would like evidence they help, do you know of any papers that support with evidence or is it mere hype?

Consult your MD.
Biz seats to keep legs up.
Walking to help circulation.

https://www.mayoclinic.org/foot-swel...s/faq-20057828

No scientific evidence here but I can vouch for flying and being able to keep legs elevated has eliminated this issue for me. Being of a certain age, we no longer fly economy except on short flights within the US. Maybe she should give it a try and see if this is the answer.

No evidence, it just seemed "reasonable" that that having her legs horizontal or even elevated would be an improvement. But it depends on why the fluid retention is happening, which is surely a question for the medical profession.

A little checking on the web turns up the suggestion that one should cut back on salt and increase potassium intake.

Has her physician prescribed a diuretic to reduce the fluid retention? They work for me but I haven’t needed to use them while flying. Yes, to lie flat beds in Business Class even when not sleeping. They can be adjusted so you are not entirely flat but your legs still are stretched out flat. We know that if we are taking long haul dlights that we need to dly Business Class or stay home.

Elevating your legs (ideally so they're above your heart) is standard stuff for avoiding/reducing edema. I'd do a combination of lie-flat business class and compression hosiery, along with mandatory walkies during the flight.

I'd also look for airlines that offer Boeing 787s or Airbus A350s. The higher cabin air pressure those planes offer also will help with in-flight comfort, less dehydration and *possibly* some benefit on edema.

I like the idea of higher cabin pressure.
Thanks for all the other ideas.
Any actual evidence?

I completely agree. We no longer fly coach on any flight over six hours. I used to get very swollen ankles on those flights, and it's worrisome to think about circulatory problems that can lead to very bad outcomes. We can sometimes upgrade with points, but often we just factor in the price of the lie-flat beds on longer flights as a part of our travel expenses. The other good thing about business class seats is that there is usually good opportunity to get up and wander around the cabin - more space and not so many passengers in that space.

Also - drink lots and lots of water. No alcohol, and try to limit excess salt.

https://www.usatoday.com/story/trave...tion/96677564/

17 expert tips on how to stay healthy on an airplane and what flying really does to your body | Daily Mail Online (Yeah, it's the Daily Mail, but still...)

Thanks Gardy, as you say the Mail!. Still interesting to see the actual comments of people in the industry say stuff like "suggests" with little actual evidence. The USAtoday link looks very interesting though how the aircraft materials will deal with problems of jet-lag ( a clock differential problem) I guess they mean all the other causes that make the pain of flying worse.

So pressure and better humidity I like, bed I like. Any more actual evidence?

If her circulation is fine, I'd be even more concerned that this happens every time she flies. And would definitely ask the doctor what the cause of her problem might be. And what his/her advice would be.

Drinking extra fluid is the exact opposite of helpful, especially alcohol!
So - positional edema - which is what this is - occurs when the intravascular pressure in the dependent limb (foot/ankle) is greater than what the circulatory system can accommodate. The cardiovascular system is essentially a closed circuit. Anything that interferes with fluid volume getting back to the heart (venous return) increases risk of swelling (edema.) Essentially, when blood return is impaired the build up of pressure in the extremities leads to leaking of fluid into the local tissue. To minimize the symptom, take measures to decrease the pressure that impairs venous return - i.e., elevate the legs so the feet are closer to the level of the heart, avoid clothing and positioning that constricts at the waist, walk at regular intervals to take advantage of the milking effect of the calf muscles, increase venous return via use of pressure gradient stockings with sufficient force to make a difference (there are different pressure strengths available.)

Re: the 787 - I've found the humidity and pressurization to be nice, but on some carriers the spacing of economy seats is brutal, so check the pitch and seat width. A lie flat or at least business class recline seat on just about any aircraft is better than a 787 coach seat.

Seamus, makes sense to me and different pressure stockings is interesting. Any papers anyone?

I don't think you will a study done on this or documentation other that the opinions noted in links here which does include Mayo clinic. If you are looking for near absolute certainty I don't think you will find it. However most of the suggestions are reasonable so I think you have to either skip it or take a calculated leap of faith.

Good luck.

Not that I don't believe you, but I am surprised that drinking water would not be a good idea. Is it because the lack of hydration will decrease the pressure in the circulatory system? Is that a good thing? Thanks in advance for any info about this.

Be careful with the diuretics. I have a relative who was on a cross country flight who regularly takes them. She didn’t feel very well, got up and passed out in the aisle, lost control of her bowels (not dangerous but embarrassing) . She had her entire family on the flight - children, grandchildren, other family. They thought she was dying and it was extremely traumatic.

A doctor passenger checked her out and thought it was from dehydration due to the diruetic As soon as they landed she went to a hospital and it was confirmed that this was the problem.

bilbo - see article at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081237/

scdreamer - staying normally hydrated is good, but extra fluid just makes the problem worse. Not an issue for most people but someone who tends to have this problem would want to be judicious.

If you are stuck in a middle seat and want to use muscular pumping to move fluids out of the lower legs, be a musician. Classical musicians toe tap leaving the heel on the floor, while jazz musicians raise and lower the heel keeping the toes on the floor, or so it has been said. Doing both kinds of tapping pump the leg muscles and squeeze blood upwards. A hundred taps of each type for each leg will move a bunch of fluid.

Perhaps someone has already said this and I missed it, but not only do they make pressure stockings with different levels of pressure (or tightness, if you will), but they also make the kind that go all the way up to the upper thigh. If socks don;t suffice, you might try these. (Note also that "tight socks" are not at all the same as proper pressure stockings.)

Indeed, NewbE, therapeutic hose are made to provide graduated pressure - more at the foot/ankle and decreasing up the leg in order to promote venous return. To just wear tight socks woulds actually be a hazard

Thanks everyone very helpful
I see you ref the Mayo clinic, as a Brit I have no idea who they are, do they do original research in this area or are they a bunch of GPs. Any advice?

The Mayo Clinic is one of the preeminent medical research centers in the US. It's hard to name a UK equivalent, but Edinburgh University's medical school probably comes closest.

Thanks Gardy. So, vets and doctors, great. :-)

billo, does she have trouble with blood clots. I had a similar reaction when I flew (even short distances) with swelling of my legs. If she goes on a treadmill or stairmaster and has intense pain in her legs when she walks or climbs, if she has unusual bleeding or pain in her legs when she rubs or messages them then she may have blood clots that can travel to the brain, heart, lungs.

nanbee - to clarify that symptom (intermittent claudication) indicates vascular insufficiency but not necessarily clots.

Hard to do on a plane, but if there is anyway to elevate her leg (crazy I know, but perhaps on your lap) and do hard massage from the ankle to the knee, it helps. It was recommended to a friend by her doctor. It works for me really well.

As someone else said, cut the salt and increase potassium. That was also the advice from my doctor. Start cutting the salt a couple of days before the trip. It is so easy to eat a bag of chips or something similar and that really makes it worse. It is funny that you can be dehydrated and still have your legs swell, but that happens to me, so plain water works. Coke or caffeine makes it worse.

Does she have any signs of swelling other than when she flies? The reason I ask is that I have just come thru a horrendous bout with lymphedema... started with swelling feet and proceeded up my lower legs. I live in NYC, but even so, it took me forever to get a proper diagnosis and treatment. Most doctors looked at me and send me to a rheumatologist suspecting RA. If she has no indications of a similar problem she might consult a physical therapist or doctor about getting prescription compression stockings. They are expensive but are more effective than anything sold "over the counter."

One other thought.

I don't know if you are retired, or if you have the means for this. But... What if after the first flight, you visited the USA or wherever your first 12 hour flight ends. Stay for two days. And then go on to New Zealand. The same in reverse on the way home.

I haven't read all the responses so I apologize if this was mentioned by someone else. My ankles would swell, even on 3 hour flights. I've recently cut out most processed food (read: high sodium foods) and on my last flight, my ankles did not swell at all. Granted, it was only about 3 hours, but it was a big improvement. We're flying economy JFK to LIS on April 30, and business class to Tanzania August 1, and I plan on getting compression socks for both me and DH for both flights. In any case, maybe Mrs. Bilbo should watch her sodium intake for several weeks prior to flying.

You can also order the low sodium meals on your flights.

Happy Travels!

that is interesting seamus. I had those symptoms but they were caused ultimately by blood clots. I eventually had a Pulmonary Embolism and after taking blood thinners the clot dissolved and the symptoms disappeared as well. Do you have any other suggestions. Should I talk to my GP and find out if I also have thin arteries as well?
Thanks.