I actually think this is one of the best POTENTIAL uses for a device like Compex. I'm not aware of any studies to this point, so take with whatever grain of salt. But e-stim is one way to keep muscles firing even when you are sedentary. I had this same thought after I raced Ironman Melbourne and had a 16hr flight home two days later. I had just started using the Compex, but after that flight, I thought, "I should have put that on for the flight." E-stim devices are clear for carry-on luggage.

Like everyone, I've done (and do) the compression tight thing as well. But for long flights (haven't had one, ironically, since Melbourne) after an Ironman, I'd definitely do e-stim.

Totally not intending this as a "go out and buy this device" post. I agree that this is a serious issue, and I wonder if there aren't some easy tricks to address it. I know there are the classic tips like "get up every hour" and that. But, IME, after an Ironman, on a long flight, all you want to do is sleep and sit. Doing yoga in a tiny seat or getting up to navigate the narrow aisles is great in theory and all...

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"Non est ad astra mollis e terris via." - Seneca | rappstar.com | FB - Rappstar Racing | IG - @jordanrapp

Anything to keep the blood flowing in (and more importantly out of) the extremities is a good thing in those situations

This happened to me earlier this year. I was out west attending client meetings. After my last meeting, I went for a long run. When I got back to my hotel, I decided to check out and catch the redeye flight home. I ended up with a window seat in the last row of the plane. The two guys next to me slept the entire time. I spend the entire 5 hours in a cramped position.

Within a couple days, I was experiencing calf pain. I thought it was typical overtraining as I was ramping up for the Boston Marathon. The pain persisted and I finally went to the Doctor. Turned out that I had 4 superficial blood clots running up my entire leg.

I won't bore you with the details of my recovery. But, the key thing that I learned was that it wasn't the flight that caused my clots, It was the cramped conditions. The lesson that I learned was that you need to get up and walk around every hour to ninety minutes. This isn't limited to planes either, this is true for long car rides.

One last bit of advice. Everyone should be taking a baby aspirin every morning.

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What I do: http://app.strava.com/athletes/345699

My husband ended up with double PEs and in ICU last Christmas caused by surgery and a genetic factor. He has seen a number of Hematologists for treatment and again when he had emergency surgery a half year later. None of the Hematologists I spoke to have seen an increased incident of blood clots in endurance athletes as I always ask about it. It makes me think that in their practice they don't see enough endurance athletes to see the connection and/or it isn't discussed in literature about the risks. Even when endurance athletes go to ER with symptoms of blood clots seems ER docs can miss them as it is not typical for very fit people. We need to raise awareness for sure. Those folks that race long and travel soon afterwards put themselves at risk and most don't even know it.

You're lucky it was only a superficial DVT ("only", not meaning to belittle it or your recovery). My first pulmonary embolism episode (yeah, I had two of them, and that I am writing means I survived both) came a few weeks after racing a hot Wildflower half, drinking that night, and then a 5 hour car ride home (with maybe one stop). Morphine did not begin to touch the pain I was experiencing when I was finally admitted, after 6 weeks of mis-diagnoses, to the ER.

Doctor was looking for a long flight or recent surgery (he probably would have discounted the 5 hour flight, they are talking 8+) and didn't buy the wildflower story, but after a full raft of hematology tests, i had no other physiological factors.

Like most things, it's probably not one thing that causes them, but a cascade, especially when traveling - low resting heart rate, micro damage and tears to muscles, dehydration, immobilization, all adding up to a problem

It also bothers me when I read threads here from people asking if they should drive "X" hours home after an ironman or other endurance event, and are met with "don't be a pussy" responses (without any advice as to moving around, rehydration, etc)

I went in as a relatively fit 46 year old with shortness of breath that did an Ironman a few months before. When they hear hooves they think horses, not zebras :)

A few thoughts as a DVT / PE survivior, and one who has studied this a fair amount:

• Awareness is absolutely very low on this issue, especially among athletes. We are a ticking time bomb of the right conditions at times.
• My understanding is that baby aspirin will do nothing to alleviate the risk. Aspirin works on the proteins in your blood that cause clots in your arteries, hence the reason it may be prescribed for people with A-Fib. It will not do much (if anything) to prevent clots in your veins (DVT). When I was diagnosed, I tried to get my doc to let me try aspirin, etc. to prevent future occurrences. His response "Aspirin won't do anything", although he never explained it. It wasn't until more research by myself that I found out why. *edit* - as noted below, aspirin regimen carries other health risks, as well. Consult your doc before starting one and know why you are doing it.
• Jordan, of the tools at your disposal, I would say that your Normatec boots would be a much better prevention tool that your Compex. I am not aware of any indications for e-stim to help prevent blood clots (it may well exist, however). But compression therapy is routinely used in hospitals to prevent clots in bed-bound patients. That said, unless you are in business class, good luck using your Normatecs on a plane
• Hydration and movement are still the best bets for preventing DVT's on long flights / car rides. Drink plenty of water and get up regularly. I suppose the one advantage of drinking enough is that it should force the second option on you, whether you wanna get up or not!!

By sheer coincidence, I am at our company's factory this week, working on something that I hope to be able to market to address this issue in the future. Whether I am given the resources to develop it remains to be seen. My company pretty much sucks at product development unfortunately and suffers mightily from NIH Syndrome (Not Invented Here). Our corporate office is in Taipei and they have a history of ignoring new product ideas that don't originate there. We'll see......

ETA: Saw this quote in the article:


And that, in a nutshell, is why I had to stop bike racing and now compete in tri's. Crashing and having internal injuries is a major concern 9especially an internal brain injury). Sure, it can happen in a tri or when training, but not having to go through corners elbow-to-elbow at 30+mph with other guys definitely alleviates my risks!!

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Chicago Cubs - 2016 WORLD SERIES Champions!!!!

"If ever the time should come, when vain and aspiring men shall possess the highest seats in government, our country will stand in need of its experienced patriots to prevent its ruin." - Samuel Adams

No everyone should consult their Dr.

My mom had my dad on it you know because she read on the internet everyone should. My dad was having some blood work done got some weird results and in trying to sort it the Dr narrowed it down to the baby aspirin which for him could have been much worse then what it was possibly preventing.

Not saying that you shouldn't and it doesn't have benefits, just saying it isn't as simple as everyone should just go do it.

Having had multi-bi lat PE and flying long haul once / twice per month, I think the two most valuable things to do are mobilise frequently and remain hydrated.

Hydrate before going and continue to hydrate on board