I accompanied my family on a safari to RSA 4-13 June 2006 recounted in the thread family safari. On 19 June I started having left-sided chest pain which developed into a bad case of pleurisy by the next day. Fearing a deep vein thrombosis and pulmonary embolus from the airflight, I sought medical attention. An enhanced CT scan showed nothing on the afternoon of 20 June, but the pleurisy got worse and I went to the ER late the evening when the pain got unbearable and I could not catch my breath. A repeat of the CT showed a pleural effusion and the next morning x-rays showed left lower lobe pneumonia, a worsened pleural effusion and a partial collapse. I am a very healthy 51-year- old and normally work out 3 times a week and run about 20 miles a week. I have never had a lower respiratory problem before. Of course, all the doctors thought that this illness must have had something to do with the trip to Africa. To further confuse the issue I did not have a fever, a high white cell count, or a cough. I spent 3.5 days in the hospital on morphine, antibiotics, etc. I finally coughed up some bloody sputum, but the culture came back negative. I continued to have chest wall pain on inspiration for about three weeks and even now have some lower left chest pain on some days. I took me several weeks to get back to my normal exercise regimen and finally ran 5 miles night before last. The doctors never figured out why I got sick.

Of course I have wondered about the long airflight but I did drink lots of water and get up and walk around. The aircraft was sprayed with something while we were refueling at Sal Island. I understand that this is somekind of disinsection, but don't know what the chemical was. There were all those other people on the airplane and there were some sick college students a few rows over. My personal feeling is that either I got a chemical pneumonia from the spray or I may have had a DVT and PE smaller than the CT scan could show.

I am posting this not only for information for other travelers, but also to see if anyone else has had similar problems from a trip to Africa.

My brother asked me, "were it worth the trouble?" I said, "what trouble."

BigBuf, I'm an ER doc, and I think your suspicions about possible PE are justifiable. Do you know if a D-dimer was run? (usually elevated w/DVt and PE). PE is frequently fatal. I take aspirin and Plavix before and during long flights/trips in hopes of preventing same. Actually I was on Plavix & aspirin the whole time on recent 3 week trip to TNZ because of a recent coronary stent. Didn't have any bleeding problems, but the tsetses filled-up quick.

Your case is very interesting.

Just in general, have you done much flying in the course of work or play over the years?

I'm wondering if you may have had a small bleb on your lung that popped, and then was sealed against the chest wall. Depending on the nature of the insult to the lung tissue you can get a leakage of blood or a clearer "transudate" type of fluid.

You already know what happens with fluid/iritation in the pleural space.

For some reason, a solitary bleb is not horribly uncommon in athletes. We had a very fit pilot in my squadron who dropped a lung while flying in an F-4. His initial bleb was a bit larger. He eventually had to have the lung wall glued down to the chest wall with a Tetracycline "wash".

A chemical pneumonitis would likely have been more widespread.

Usually there is a fair amount of thrombosis layed down before it starts flaking off and heading North, but anything (as in anything) can and has happened in medicine. I'm more and more amazed that any of us survive a long as we do.

LD

The D-dimer was negative as well. I forgot to mention that I did have some discomfort in my posterior knee and proximal right calf the day or two after we got back. It was minimal and not worsened with Homan's sign. I do not fly much and this of course was a very long flight.

I think it is interesting and somewhat aggravating that most days I feel fine now, but occasionally, like yesterday, had a bit of discomfort where the pleurisy was so bad. No increase in pain on inspiration and I can peg the inspirometer they gave me.

I appreciate the comments. I think the idea of some asprin and lots of fluids and frequent walks during a long flight are good advice!

bighuff32,
I would guess that you are a physician too, considering your grasp of the subject, and appreciation of Bro'lawndart's rundown.

D-dimer is not 100% either, and what you say is sure suggestive of a small PE/DVT.

As mysterious as this is, I would consider screening for some other thrombotic disorders like protein C or S deficiency, antithrombin deficiency, elevated plasma prothrombin levels, antiphospholipid antibodies, and hyperhomocysteinemia, the latter of which might be simply from folate, B12 or B6 vitamin deficiency.

I would never take Ambien and sleep sitting up in a cramped airline seat all night. Also, I take an aspirin daily whether I need it or not.

I am up and walking the aisles at least every 2 hours, and reading all the way there and back. Jet Lag is less of a problem too, because I get to sleep quickly in the first evening on the ground.

Being a medico, I am quite used to 36 hour days and have no problem doing that going and coming.

Now I must stop sounding like a flea, but I hear hoof beats and look for zebras AND horses.

I have been a physical therapist for over 28 years so I have somewhat of a grasp of the medical stuff. I am certainly not up on the other thrombotic disorders you mention, but will take these up with my MD. I have often said that when you hear the sound of hoof beats, look for horses, not zebras...but now that I have been to Africa, and I am looking like one myself, I shall look for more zebras!

bighuff32,
The thrombotic workup would be to make sure there is not some reason to put you on Coumadin for life, or correct some other deficiency like the B-complex vitamins, or make sure it was not an autoimmune pneumonitis like lupus. Unlikely.

Maybe a combination of factors created a mule instead of a horse or zebra. As you and lawndart say ... a chemical pneumonitis, a small lung bleb popped, a small DVT, a viral or atypical infection ...

You survived! Live long and prosper.

Sorry to hear that you got sick. I often wonder about the spray on the plane. I travel a lot because of work (mostly to Asia). I never get sick after the Asian flights, but every time I go to Africa (where they spray) I get a terrible head cold that lasts for a week or better. I know what they say, but for me I believe it's the spray.

Hi,

I don´t know what they spray planes with but last time I flew to SA the SAA stewardess hosed us down with something that induced nausea in quite a few people (is it even legal to spray people with this sh-it?).

But as LD said, a chemical pleuritis would probably have been more widespread. I had a 19 yo recruit that came to the infirmiry with diffuse swelling of the left arm, no miscoloring etc and the swelling was isolated from the shoulder to the wrist -not the hand mind you.

Just in case I sent him off for a Doppler -trombosis of the left subclavia!

And nothing to explain this -shit just happens.

Hey Buff,

A note on the D-Dimer test: Most hospital labs still use the old semi-quantitative test, which uses plasma and latex bead agglutination. They should have given you a range-like-result (like <200, or 400-800). The newer tests give actual quantitative results (like "820" or 1500", etc, and we now get much higher numbers, and more often). It was probably low enough not to indicate PE, i.e. your "negative" result. I'm not a Doc, just a clinical lab scientist.

Interesting thread. I guess I'll be taking aspirin before I go.

Good luck!

quote:

Originally posted by bighuff32:
"were it worth the trouble?" I said, "what trouble."

Quote from Jeremiah Jonson! one of my all time favorite movies about old time hunting, by a known anti hunting actor!

I got chimical pueumonia from black flagg bug killer sprayed in my little shop, where I worked all night one winter,20 yrs ago, and damage to my lungs is still evident on my recent PET scann for after cancer treatment screening! Keep a close watch on your lung damage, to avoid a problem later! Glad you're feeling better!