Recent Airplane Flights

[Guest tearose]

Well, I just returned from a trip that had two stops in both directions. I wanted to share my experiences.

I did not want to fly from a big airport since the crowds can be a struggle to maneuver through. So, I chose a close to home airport with two stops to my destination.

I had been well hydrated and in my compression hose and compression arm sleeve since I swell in my left arm too.

On the first part of the journey, the flight was fine until the descent. I triggered on SVT run and it resolved when I finally took off my shoes leaned forward and lifted my knees to my chin. The stop over was quick and we had assistance getting to the next departure gate. The flight was again fine until descending again!!! I triggered 8 SVT's!.

I managed to break them all but I was concerned. My heart was working so hard. I wound up just sitting scrunched up in my seat until we leveled off at a lower altitude on our final landing approach. I was tired and a little achey afterwards.

On my return home flight I had problems only in the first part of the journey and this time it was during the ascent!!! This time I chose not to wear my heartmonitor and just feel my way through this. This was a mistake. The pressure was so low I actually was in pain and asked the Flight Attendant to ask the pilot what the cabin pressure was. They looked at me like what did I want to know this for! I was told that the pressure was at the lowest 8.2 psi. (Sea level is 14.9 I think.) I felt okay again once we were adequately pressurize but wow, it was so painful. I'm just a sensitive person.

So, what I learned is to try for non stop flights next time and to wear my monitor and to ask ahead of time for the cabin pressure to be maintained above 8.2 if possible.

tearose

[futurehope]

As someone who just did her first trans-Atlantic flight post POTS, and a second flight across the US, my conclusion is that traveling is stressful for sure.

First trip across the Atlantic, was non-stop. Across the US, by definition, I needed to change planes to get where I was going.

On both trips, I spoke to the airlines ahead of time and tried to get the seating I wanted. I impressed upon the airlines the severity of my condition and that my circulation does not work properly. I also have doctors' notes about needing bulkhead or First Class seating.

Also, for me personally, if I did not get the First class seating I did (it's called an upgrade and is done at the gate or within 24 hours of departure), I do not know how sick I would have been. On the trans-Atlantic flight going, I had bulkhead seating, thank goodness, but started feeling extremely ill about 3 hours into a 5+ hour flight. I wanted (needed) to recline and could not lay in the aisle, obviously. So, I did the next best thing. I was on an aisle seat at the bulkhead, and I slouched down as far as I could in the seat and raised my legs straight up onto the bulkhead. It was a necessity for me at that point or my oxygen deprivation headache would have worsened.

Returning, they had a first class upgrade available and I took it. What a difference. Those seats reclined. I've since found out that the cross-country first class seats do not usually recline, only the trans-Atlantic first class seats. So, for the first class seats across the country, the seat I want (need) is the very first seat in the plane against the window. If I recline the seat the most it will go, and lift my legs up against the corner (so as not to disturb the person next to me), then the trip is tolerable.

On the smaller short flight I had bulkhead seating on the aisle so I could stretch out my legs.

Well, I'm glad you're back. It takes some getting used to for sure.

You can check your actual seating and accomodations on the internet ahead of time to see what your airplane will have.

[mkoven]

Tearose, When you say it was painful, can you say how/where? I'm trying to get psyched up to fly soon.

[Rafiki]

I just flew from Birmingham to Dallas to London to Nairobi a total of 27 hours a few days ago. I was very nervous about making the trip but it went much better than I expected. I did fly economy (wasn't able to get an upgrade) and had an aisle seat. I wore compression hose, kept well hydrated, and took midodrine regularly. I also took two tylenol pm as soon as I got on the Dallas-London Segment and managed to sleep about 6 hours (very unusual for me). I got up and walked frequently and was very surprised how well I did. In fact I felt better then I normally do when I have flown this route before having POTS! Maybe it was all the prayer!

I am just so happy to finally be back home with my husband and son. However I have found that the higher altitude here in Nairobi is really affecting me. My heart rate is going much higher than it was before from the 50ties while sitting to 120ties standing. It went to 140 when I went up the stairs in my house and that is high for me. I'm hoping I will adjust in a few days. The midodrine is keeping my blood pressure up so I am not feeling dizzy or faint, just short of breath.

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[shadesofgrey49]

How do you get a doctor's note for first class seating? Does that mean you pay less?

Ascents and descents are terrible.

[MelissaCrystal]

I took to flights back and forth from SF to LA just recently---and I'm in good POTS health right now (not perfect but very functional). I was really curious if I got better at flying. Basically, it just made me feel drunk, I could barely keep my eyes open, and my vision kept going in and out any time the plane went up or down. I could feel my blood pool and flow according to the planes movements, it was really gross. But the most interesting thing is that the whole time I was on the plane, I was getting visual disturbances. It's like my eyes were tingling and I could see patterns the higher we got---like a vortex of blurriness/static. Was the weirdest thing ever. When we got lower, it'd go away. I was a little worried when my respiratory system became a bit depressed a couple times, I had to make sure I was breathing correctly and I told the flight attendant about my condition and to make sure to check me if I pass out, but overall it was pleasant feeling drunk lol Flying is such a weird experience for us.

[futurehope]

Oh yes, I forgot, steep ascents and descents and steep turns left me unable to see until "my blood flow" equilibrated. I made up that terminology. LOL I mean, the vertigo passed rather quickly. I did not stay weirded out. Also, depending on the cabin pressure, I think, I could get rather groggy (sleepy) from the lack of oxygen. I did not care about that.

As for First Class seats, no they were not given to me cheaper because of medical necessity. I had to pay for the upgrade when available, and if I asked for it within 24 hours of takeoff, it was the cheapest that you could get a First Class seat. I paid in the hundreds extra (above and beyond the cabin price) when I did it this way. It was worth it for me.

[valliali]

Oh my gosh, I had the SAME exact thing happen to me when I flew over a year ago, and I posted about it on the dysautonomia boards forever and while it definitely seems that everyone has their own unique reactions to flying, I hadn't heard of anyone else having issues with SVTs during flying. Mine were PSVTs and they were also triggered only during the descent the first time, and then the ascent the second time. It was HORRIBLE. I couldn't break mine, and my PSVTs cause extreme panic and heart pounding. They are very very symptomatic and then to be trapped in the plane, oh my, it was my worst nightmare. I haven't flown since, and I honestly can't say that I will until this is controlled. It is very disheartening because my family is on the east coast (I'm on the west) and one of my parents is ill so I would love nothing more than to be able to fly home. But my experience was that bad. I am on propranolol now, which I wasn't at the time (though I was on metropolol and had sucked them down like candy during the flights when I realized I was going to have serious heart problems). The propranolol seems more effective for me so I have wondered if my heart could handle it. But I am so sensitive to pressures and I can feel the pressures in my body get really out of whack when the outside pressure is low (major head whooshing, blood whooshing in ears, neck fullness, etc).

[ajw4790]

Wow! Everyone has different, yet similar stories in that the altitude and pressure greatly effects them. I recently flew from St. Louis, MO to Miami back and forth. It was my first time flying in over 10 years, and since my diagnosis. I felt the most symptomatic when they were pressurizing the cabin, then next most symptomatic on descent, then ascent, and both trips were quite turbulant the entire time... So, that got me a bit as well. The worst may have been skid abruptly to a stop in Miami... Worst landing me and the rest of my family have ever had. Not sure why it was necessary, but it was fun!

Thanks everyone for sharing your story and what works and doesn't. I may have to fly again in the near future and between my experience and what you guys suggest, I have learned a lot!

[ramakentesh]

The day I got on a plane to return home to melbourne Australia from LAX I felt pretty **** good, maybe just a little tired, but I hadnt had one slighlt boute of dizziness in 7 months - the second day after I landed after the 22 hour flight it was all back to square one...

[valliali]

can anyone make sense of this? i do fine at altitudes up to 10,000 feet, so I am not sure why I don't do well on the plane. I have wondered if it's my anxiety that is making me symptomatic, or if it's actually the flying.

[megan2]

I know for me, when I fly my oxygen levels drop (I have a pulse-ox and I measured in air). This causes severe tachycardia and I seem to go in and out of consciousness when we're up in the air. I did wonderfully when I flew with oxygen. But oxygen is really expensive (100 per flight segment!).

[ramakentesh]

Spent a lot of time trying to work it out in my case since it doesnt always do it. Perhaps its oxygen saturation or nitric oxide levels which are both effected by flight, but most likely its an unknown. it feels in my case like something is being 'depleted' when i fly. No idea what. Ive spoken to doctors - some dismiss it, others say its not good but have no explanation. So your answer is probably as good as mine LOL.

I do remember reading about Alastair Nicholson an Australian footballer who came down with CFS and it was always worsened by flying to the point where he had to fly at a lower altitude and have oxygen the whole time.

If I ever fly again - and Im not in any hurry let me tell you - Ill try oxygen and maybe some nitric oxide substrates. But i have no plans for another relapse, this one is hanging around too long by it self anyway! LOL

[valliali]

rama, do you have the same affects if you spend a long time at high altitudes? say the same altitudes that planes are pressurized to?

[Guest tearose]

As I reflect back on the flights, I don't think that supplemental O2 would have helped all the issues. My whole body was reacting to the poorly pressurized cabin! I wished I could have wrapped my entire body in a big compression wrap!!!

I wonder how to simulate the lower cabin pressure and see if O2 improves our ability to manage flight? I don't want to volunteer for the experiment however!!! I get chest tightness and serious fatigue after that many SVT's.

[firewatcher]

Conf Proc IEEE Eng Med Biol Soc. 2007;2007:6679-81.

Heart rate and cardiovascular variability at high altitude.

Bernardi L.

Department of Internal Medicine, University of Pavia, Italy. lbern1ps@unipv.it

Primary effect of hypobaric hypoxia on the circulation is a direct vasodilatory effect on the peripheral circulation, which is normally prevented by a sympathetic-induced vasoconstriction. Most of the clinical methods for testing the baroreflex sensitivity only evaluate the cardiac-vagal branch of the baroreflex, but at altitude it is also of importance to test the vascular effects of the baroreflex. This is possible by directly measuring sympathetic efferent activity (by microneurography) or by directly stimulating the carotid baroreceptors (by the neck suction). By cyclical stimulation of the carotid baroreceptors, neck suction-synchronous reflex oscillations could be observed in a large number of signals, including RR interval, blood pressure, microcirculation, muscle sympathetic nerve activity. An increase in fluctuations at the same frequency of the stimulus was considered an evidence of the ability of the carotid baroreceptors to modulate a given physiological signal. The sinusoidal neck suction was set at 0.10 Hz (low-frequency stimulation), or to a frequency close to- but distinct from- the respiratory signal (0.20 Hz, high frequency stimulation, whereas respiration was fixed to 0.25 Hz). The method is noninvasive, without side effects connected to use of drugs, and evaluates both the response to the heart and to the blood pressure of the baroreflex. The altitude-induced sympathetic activation was evidenced in sea level natives by a decrease in RR interval, an increase in blood pressure and in the 0.1Hz components of cardiac and vascular signals. The arterial baroflex was active on RR interval and also in blood pressure, even during acute exposure to high altitude, thus indicating that it was counteracting and modulating the increase in sympathetic tone. Signs of exaggerated sympathetic activation were evident in subjects with severe acute mountain sickness, while successful therapy was associated with a restoration of autonomic modulation. Conversely, sympathetic activation was reduced( and baroflex enhanced) in himalayan high altitude natives (they have high blood pressure and high hematocrit.) In conclusion, a comprehensive understanding of the mechanism taking place during the adaptation to high altitude requires a multisignal approach, also integrated with equipment designed to provide specific provocative tests, such as those necessary to measure the cardiorespiratory interactions.

PMID: 18003558

If hypobaric hypoxia directly dilates vessels, then you are getting hypotension and increasing tachycardia from the sudden change in pressure. If you are anemic, it will be even worse since the body cannot compensate due to lack of red blood cells to carry any oxygen. As dysautonomiacs, we can't adjust to rapid changes in position or pressure, which is exactly what flying is! It won't do much for "normal" people, but flying changes our fundamental homeostasis which is precarious at best. I used to get super anxious when flying, and I still don't like it...it is exhausting!

My best guess at least.

J Physiol. 2003 Feb 1;546(Pt 3):921-9.

Sympathetic neural overactivity in healthy humans after prolonged exposure to hypobaric hypoxia.

Hansen J, Sander M.

Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen, Denmark. jimhansen@dadlnet.dk

Acute exposure to hypoxia causes chemoreflex activation of the sympathetic nervous system. During acclimatization to high altitude hypoxia, arterial oxygen content recovers, but it is unknown to what degree sympathetic activation is maintained or normalized during prolonged exposure to hypoxia. We therefore measured sympathetic nerve activity directly by peroneal microneurography in eight healthy volunteers (24 +/- 2 years of age) after 4 weeks at an altitude of 5260 m (Chacaltaya, Bolivian Andes) and at sea level (Copenhagen). The subjects acclimatized well to altitude, but in every subject sympathetic nerve activity was highly elevated at altitude vs. sea level (48 +/- 5 vs. 16 +/- 3 bursts min(-1), respectively, P < 0.05), coinciding with increased mean arterial blood pressure (87 +/- 3 vs. 77 +/- 2 mmHg, respectively, P < 0.05). To examine the underlying mechanisms, we administered oxygen (to eliminate chemoreflex activation) and saline (to reduce cardiopulmonary baroreflex deactivation). These interventions had minor effects on sympathetic activity (48 +/- 5 vs. 38 +/- 4 bursts min(-1), control vs. oxygen + saline, respectively, P < 0.05). Moreover, sympathetic activity was still markedly elevated (37 +/- 5 bursts min(-1)) when subjects were re-studied under normobaric, normoxic and hypervolaemic conditions 3 days after return to sea level. In conclusion, acclimatization to high altitude hypoxia is accompanied by a striking and long-lasting sympathetic overactivity. Surprisingly, chemoreflex activation by hypoxia and baroreflex deactivation by dehydration together could account for only a small part of this response, leaving the major underlying mechanisms unexplained.

PMID: 12563015

One more:

Clin Physiol Funct Imaging. 2002 Sep;22(5):301-6.

Cardiac baroreflex control in humans during and immediately after brief exposure to simulated high altitude.

Roche F, Reynaud C, Garet M, Pichot V, Costes F, Barth?l?my JC.

Laboratoire de Physiologie GIP-E2S, PPEH, Service d'Exploration Fonctionnelle CardioRespiratoire, CHU Nord, Facult? de M?decine Jacques Lisfranc, Universit? Jean Monnet, Saint-Etienne, France. frederic.roche@univ-st-etienne.fr

To examine the baroreflex response in humans during and immediately after acute hypoxia exposure, the cardiac baroreflex sensitivity (BRS) was studied using adaptation of RR intervals in response to spontaneous systolic blood pressure fluctuations (sequences methodology) in 11 unacclimatized subjects. All measurements were made under fixed breathing rate, and realized consecutively at baseline level (20 min), at an inspired oxygen concentration of 11% (15 min) and again under normoxic conditions (20 min; recovery period). The spontaneous baroreflex response decreases progressively during hypoxic exposure, causing a tachycardic response at this FiO2 without any significant alteration of the systolic or diastolic blood pressure. The magnitude of decrease for this variable at the end of exposure averaged 42.9 +/- 15.6%. The simultaneous spectral analysis of heart rate (HR) variability in hypoxic condition confirmed an alteration in the parasympathetic activity (HFnu: -17.8 +/- 30.9% versus basal conditions, P < 0.01) counterbalanced by an exaggerated sympathetic activity (LFnu: +33 +/- 42.4%, P < 0.05) at the sinus node. Interestingly, we could observe an enhanced cardiac baroreflex response during the period following the inhalation of the hypoxic mixture (+130.6 +/- 15.6% of basal conditions, P < 0.001). There is a relationship with a significant and abrupt increase in the parasympathetic control of HR (mean HR reached 111 +/- 8.1% of the mean basal HR, P < 0.01). These results suggest that brief exposure to hypoxia under rate-controlled ventilation is associated with a significant alteration in the spontaneous cardiac baroreflex. This important cardiac autonomic imbalance is followed by a significant increase in the cardiac parasympathetic drive even after the disappearance of the hypoxic stimulus.

PMID: 12487001

Edited December 20, 2009 by firewatcher

[firewatcher]

Doesn't take much!

Aviat Space Environ Med. 2002 Jul;73(7):632-4.

Reduced baroreceptor reflex sensitivity and increased blood pressure variability at 2400 m simulated cabin altitude.

Sevre K, Bendz B, Rostrup M.

Department of Cardiology, Ullev?l University Hospital, Oslo, Norway. knut.sevre@ioks.uio.no

In a hypobaric chamber nine healthy volunteers were exposed to an atmospheric pressure corresponding to 2400 m above sea level. This is similar to the lowest air pressure encountered inside pressurized commercial airplanes. Heart rate and blood pressure were monitored beat-to-beat in the supine position with a non-invasive device. Blood pressure variability and heart rate variability were measured in the mid-frequency band; subsequently, baroreceptor reflex sensitivity (BRS) was calculated with the transfer-function method. Compared with baseline, there were reduced BRS and increased blood pressure variability at 2400 m (16.5 +/- 3.1 vs. 13.2 +/- 2.0 ms x mm Hg(-1) and 5.4 +/- 1.3 vs. 8.2 +/- 1.1 mm Hg, respectively; p < 0.05). We conclude that autonomic cardiovascular control was disturbed during acute exposure to an air pressure corresponding to 2400 m.

PMID: 12137097

[firewatcher]

I'd be interested in seeing if compression, hydration and supplemental iron increase during the week before flying helps for anyone flying in the near future.

[Guest tearose]

Great research.

I personally was in a compression garment and my 40mm hose. I was very hydrated and I am not anemic but do have slightly odd shaped red cells which carry less oxygen (elliptical) and I take a good daily vitamin.

I suppose going up to the 40-50mm hose could be done but that is one horrific job. I guess for me, if I need to fly in the future, I would have to try it. Additionally, I am going to sit in a curled up position all during the ascent and descent periods!

[ramakentesh]

I stayed a week in a town in Mexico at 8,000 feet and I didnt feel great, but not terrible. It was the flight that messed me up - could have just been sitting for 22 hours? I dont know what it was.

[Guest tearose]

It just dawned on me that for those who were okay on a flight...the cabin pressure may have been more adequately maintained!! I know I asked the attendant to ask the pilot what the cabin pressure was whenever I was in distress.

I wonder for those who were fine during ascent and descent...what was the cabin pressure?

[firewatcher]

I was OK on my flight, but I was very well hydrated, compressed and my hematocrit is too high. It was also a short flight (less than 2 hrs.) I would think that if you print out these articles and show your doc, you could get a prescription for O2 for the flight. If you prepare, it might be less of a problem, but I think we will always have an ANS overreaction.

[firewatcher]

I stayed a week in a town in Mexico at 8,000 feet and I didnt feel great, but not terrible. It was the flight that messed me up - could have just been sitting for 22 hours? I dont know what it was.

Well, you started with 22 hours of high altitude and dry air, then stayed at altitude with no acclimation. Then you flew again, I would think that the overreaction just continued. I spent a couple days at 8000 feet in Yellowstone Park and felt like I was drunk. I was slurring my words and all. Who knows?! There is quite a lot of research on the baroreflex and altitude, just no answers.

[valliali]

Interesting research, thanks firewatcher!

I actually feel better at higher altitudes, if that makes any sense to anyone. I recently stayed for three weeks at about 8,000 feet and felt great!!! In fact, before I left for the trip, I was feeling really horrible and I live at sea level. I was really nervous about going up in elevation because I assumed my reactions to flying were due to the elevation. Then I got up and spent those three weeks feeling like totally cured! During that trip, we also drove through some pretty sudden elevation changes - like 11,000 feet back down to 7,000 and I had no reaction except for my ears, which is a whole other issue.

So it just makes me wonder. It could have been because I do a million times better in a dry climate (which thank god the planes are - the drier the better!).

It is so interesting how so many of us are sensitive to the same things, but for seemingly very different reasons!

[erik]

Hard to imagine the baroreflex stuff wouldn't be at least a part of the problem. Maybe rapid changes are worse than effective altitude too.