Monday, June 29, 2009

Not So Fast about Billy Mays

The unfortunate pitchman Billy Mays suffered an untimely death, but despite quick denials to the contrary, his airplane trip may just have been the trigger that resulted in the pulmonary embolism which constituted the mechanism of his demise. Much has been written about the relationship between air travel and pulmonary embolism, most notably by Lapostolle et al, in the New England Journal of Medicine, September 13, 2001. Their study revealed a significant relationship between air travel, particularly long trips, and fatal pulmonary embolism during or relatively soon after landing. Their thoughtful conclusion, after analysis of the data, was that passengers must engage in prophylactic behavior during the flight, such as adequate fluid consumption, alcohol avoidance, no smoking, avoidance of constrictive clothes, use of support stockings, avoidance of leg crossing, frequent changes of position, and walking or moving the legs often during the flight. Mr. Mays' autopsy revealed, in addition to the pulmonary embolism, abundant cardiovascular disease, and that fact alone must alert us to the risk posed by transporting many adults with such advanced pathology without having screened them for the risk of pulmonary embolism. The scenario is that Mr. Mays suffered pulmonary embolism after his air trip, and that may well have accounted for the fact that he told his wife he didn't feel well that night. A reasonable cautionary note should be that we warn potential air travelers that they should undergo regular cardiovascular screening, and should indulge in the preventive measures suggested in the Lapostolle study.

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