SELF - July 2001

After a quick trip from Florida, my plane landed in North Carolina on a Tuesday night, but my ears didn't "un-pop" until Thursday morning. While airborne, I hadn't paid much attention to the staccato coughing of the guy behind me, but I thought often of the hacker over the next few, miserable days as I developed a throbbing headache and nasty cold. Can I prove that my flight felled me? No. But stories like mine are becoming all too common as record numbers of travelers cram onto increasingly crowded and delayed planes. "More and more of my patients are complaining that flying makes them sick," says Richard Mueller, M.D., an aviation medicine expert with Medical Associates in New York City. "Airplanes are jammed with people from all over the world, cross-pollinating bugs."

Despite growing concern among medical experts about the health hazards of flying-as well as numerous lawsuits-airlines have yet to clean up their act. But they may soon be forced to, thanks to a National Academy of Sciences (NAS) study on cabin air quality instigated by Sen. Dianne Feinstein (D-Calif.) She lobbied for the survey in part because she occasionally experiences headaches when she flies. "With the exception of the smoking ban in 1990, no major changes have occurred to improve the quality of air on planes," she says. The NAS study results won't be in until September. But summer is the peak travel season, so SELF conducted its own investigation to determine how friendly flying really is to your body and to glean advice on how to combat everything from foul air to filthy bathrooms. Happy landings!

"Sorry for the delay, folks-hope it doesn't make you sick."

"Since 1997, the number of flights delayed at least an hour as jumped from 1 in 5 to 1 in 3," says Paul Hudson, executive director of the Aviation Consumer Action Project (ACAP) in Washington, D.C. Those maddening holdups do more than just prompt air rage-they may cause illness. Of course, the more time you spend trapped in a confined space, the greater your chances of catching something. But ground delays are especially risky. That's because pilots aren't required to turn on the air supply until the plane is airborne. "As a result, everybody is basically recycling everybody else's air," says Vance Fowler, M.D., assistant professor of infectious disease at Duke University Medical Center in Durham, North Carolina. A dramatic example of how rapidly illness can spread during a ground delay occurred in 1979, when a planeload of passengers in Homer, Alaska, was kept waiting for three hours. Almost 75 percent caught the flu, most likely from just one person.

How to Stay Healthy:

• Take an early flight; it's less apt to be delayed.
• Ask to switch seats if you're next to anyone who's coughing or sneezing.
• Apply saline nasal spray to your nostrils; it will make it more difficult for germs to invade.

"In an emergency, oxygen masks will drop from overhead. But you might wish you had one now!"

If something went wrong with the cabin pressure at 35,000 feet, you'd certain need oxygen to survive. Yet even when everything's working perfectly, you get about 25 percent less oxygen in an airplane than at sea level-in other words, you're breathing the equivalent of thin mountain air. If you've ever felt tired, dizzy or confused on a flight, you may be oxygen starved, a condition known as hypoxia (nicknamed flypoxia). And not only are you getting less oxygen, but even once you're airborne and the air-conditioning is activated, you're not breathing air that's 100 percent fresh, says Judith Murawski, a certified industrial hygienist with the Association of Flight Attendants in Washington, D.C. About half of cabin air is recirculated. Beyond bacteria and viruses, you could be breathing in irritating fumes from heated oils and hydraulic fluids that have leaked into the ventilation system. (Though many planes have high-efficiency filters to clean the air, the filters are not required and they can't trap gases.) Exposure to these neurotoxins is linked to blurred vision, muscle tremors and inability to concentrate.

How to Stay Healthy:

• Drink lots of water (about one cup per hour of flight) to counteract the low humidity, a side effect of recirculated air.
• If you're feeling the effects of "flypoxia," ask the flight attendant for portable oxygen bottle, which most airlines stock.

"Feel free to recline your seat back-oops! Now you've got leg cramps."

In theory, that extra two inches should make you more comfortable. But when the passenger in front of you tries to get cozy, too, your sliver of space grows even thinner. Such cramped conditions on long-haul flights are linked to deep-vein thrombosis, a type of blood clot. This so-called "economy-class syndrome" is more common among people who have heart disease or varicose veins, or who are on the Pill. If a clot breaks loose, it can travel to the heart or lungs, which can be fatal. Though the death last year of an otherwise healthy, 28-year-old woman who developed a blood clot after a 20-hour flight has raised awareness of the dangerous condition, the Aviation Health Institute in Oxford, England, says even flights as short as four hours are associated with a high risk.

How to Stay Healthy:

• Walk up and down the aisle every hour or so, if possible.
• When seated, rotate your ankles and flex your feet often.
• If you have heart disease or varicose veins or are taking the pill, ask your M.D. if you should take aspirin before a long flight to thin your blood or if you should wear compression hose.

"As a courtesy to the next passenger, please wipe off the lavatory surfaces. But wear gloves!"

There are no enforced regulations for airliner cleanliness, says ACAP's Hudson, who calls the major airlines "germlines" because they are exempt from any sanitary codes. "Plus, many items that appear to be disposable, like pillow case covers, actually aren't," he says. Several studies have found blankets and headrests contaminated with disease-causing germs. We're not saying you should cover yourself in Saran Wrap, but you might want to think twice about using that blanket.

How to Stay Healthy:

• Bring liquid hand sanitizer and tissues to clean surfaces.
• Consider carrying your own pillowcase or blanket, says Diana Fairchild, author of Jet Smarter: The Air Traveler's Rx. Even those wrapped in plastic may not have been cleaned.

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Sidebar: Where's the Healthiest Place to Sit?

Prime cabin real estate varies depending on your need:

For the best air quality, sit as far forward as possible.

Worried about air evacuation? Choose an exit row.

Can't stand turbulence? Sit over the wing, midplane. That's a good spot for motion sickness sufferers, too-just make sure it's as far from the galley as possible.

For the most legroom, request a bulkhead. And an aisle seat will make it easier to get up and stretch.