Since travelling is literally my business, you can imagine how often I get asked about my favorite (and least favorite) airlines.  It’s a subject about which I’m not coy – there are airlines that are distinctly better and worse than others.  As I come to the end of another year of travel, I’m ready to share for the first time my preferred rankings with one and all.

Without further ado, here are my 2011 rankings:

Best to Worst Airline Rankings

• Delta
• Kingfisher
• Alitalia
• Jet Airways
• Iberia
• Swiss
• British Airways
• Malev
• SN Brussels
• American
• EL AL

Best Airline: Delta

Why Delta?  Two reasons set Delta above the rest of airline carriers:

1)    Excellent frequent flier program.  If you fly as much as I do, being able to earn miles or upgrades in a generous, hassle-free manner is reason enough to fly Delta.  They constantly enticed me with bonuses during the year that made it very easy to reach the top elite status and rewarded me handsomely once reaching.

2)    Excellent customer service.  Delta demonstrates that it values its customers. After a couple of unforeseen incidents with Delta flights (as happens with all carriers), we received immediate letters of apology as well as monetary compensation.  In certain instances they went above the call of duty to make sure we were properly satisfied.

Worst Airlines:  American and EL AL

Why American?  With its next to the bottom rating, American Airlines may seem a surprising choice, but here’s why this airline ranked so low:

1)    Poor customer service.  My opinion of American’s customer service dropped tremendously in the past year.  Perhaps their loss of customer focus coincides with the company going into bankruptcy.  Frankly, the most caring people I’ve met recently at American are the sky caps who work at their airports.  Other than that from check-in agents ate their Flagship Counter to the Admirals Club their level of service on and off the aircraft declined tremendously in 2011.   You’ll be seeing much less of me on their aircraft in 2012.

2)    Poor aircraft quality.  I’ve noticed a dramatic decrease in the quality of the company’s aircraft.  In the past month alone I was on two aircraft (transatlantic) in which video systems didn’t work and with seats that wouldn’t recline (in business class mind you).   The flight attendants were able to do very little but furthermore their customer service could do no more thana right a standard apology letter (not even directly addressing the issue).

Why EL AL?  What a disappointment!  The reasons are many:

1)     Frequently lost or damaged luggage. I’ve lost luggage on EL AL flights on numerous occasions in 2011.  Never have I been offered so much as even a toothbrush.  (As a matter of fact, it was stated by their less than friendly customer service agent  that they wouldn’t provide one, and we should be lucky that they would deliver it.)  Lost luggage has sometimes arrived days later, damaged at that with EL AL willing to take (rather I should say deny) any responsibility.

2)    Poor customer service.  When incidents such as lost or damaged luggage occur, there seems to be no one with whom to speak about the problem.  Months after an incident, compensation is still not received.  When something goes wrong, there’s a tendency to blame “security” and if that doesn’t work it’s always the passenger’s fault!  At EL AL the “customer is always wrong”. For 2011 EL AL truly has earned the reputation as the worst customer service around.

3)    Poor employee attitudes.  It’s not just responses to customer service incidents that highlight this problem.  EL AL employees seem to treat customers as cattle, rather than people. There’s no recognition – I’ve heard in all cabins on EL AL (yes even in first class) passengers referred to as seat numbers rather than by name.

When I flew EL AL in 2011 I was made to feel that they think they are doing me a favor by letting me fly, even when I’m sitting in business or first class.   The attitude is pretty amazing.  Let’s face it:  as much as airfare costs, people like to feel a bit pampered – or at least respected — when they fly.

To be fair, here are the rules I’ve given myself: My rankings focus only on airlines with which I personally flew in 2011, and only airlines with which I had at least two flights were included in the ranking list. I had at least eight flights each on three of the airlines which anchored the top and bottom of my listings – Delta, American, and EL AL, so I felt particularly comfortable in rating them.  (Because I didn’t have at least two flights on any Asian carriers, these airlines were omitted from the rankings, but I suspect that they would have received top scores if they had been eligible for inclusion.)

As a business person in the travel industry, I may be more sensitive than most to the airline that either goes the extra mile (no pun intended) or treats me with less than the utmost courtesy.  But success in the travel industry is based primarily on people’s perception of their customer service and how they are treated during a travel experience.  The 2011 best and worst airlines may have some lessons for all of us about how to do – or not do—business.  Let’s see who may care as we enter 2012.

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Part VI: Prevention

Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering.  Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid.  Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences. In this final article I wish to give a “shout out” and thanks to the hundreds of friends who rushed to my side and stood by me (literally) and via email and phone (got your messages even though I never answered the phone) and of course to Carol (who made sure we got the keys to the house) and to my children – Adina, Ilan, Gilad and Dafna who each have contributed to my recovery but more important to my education of Life with a PE and PE with Life!

My Story

As I’ve mentioned previously, having a pulmonary embolism was a complete surprise to me, because I am a freak of preventive medicine and was told I was in such good health.  Even with the benefit of hindsight, I find few of the risk factors associated with PE on my personal check list.  Because I don’t plan to become another statistic, I am committed to doing everything I can, however, to reduce the chance of suffering another and potential more damaging pulmonary embolism and also to educate as many people as possible about PE.  And so I have developed my own prevention plan, of sorts:

• Continue to follow healthy diet and exercise program. Now that I’m clear to resume all normal activities, I’m going to pick up the pace again at the gym (OK, I’m pushing myself already – perhaps more than I should – but I’m determined).
• Exercise increased travel precautions.  Airline travel is the linchpin of my business endeavors, so discontinuing extended travel is not an option.  However, I can make my travel safer by doing more in-seat stretching exercises and walk-around breaks.  I’m also going to break down and start wearing compression socks (CONFIDENTIAL) to decrease the potential for blood pooling in my legs (please don’t try and get a peak as they’re really quite nasty).  I’m going to drink even more fluids in-flight (and do my best to stay away from Diet Coke and no it’s not an opportunity for Pepsi to step in)). -
• Obtain comprehensive health assessment.  After having made inaccurate assumptions about my health risks before, I am averse to future surprises.  I’m currently undergoing a complete battery of all kinds of medical tests.  I find myself wondering if what happened was a possible warning sign for something else that is awry with my health.  Just knowing other potential health vulnerabilities will allow me to expand my own health promotion program to address any other relevant risk factors.
• Practice (a little more) moderation in my schedule.  An 18-hour work day sounds extreme to someone who doesn’t have my particular personality, metabolism, and joy in what I do.  But even cutting back a few hours per day will create less wear and tear on all my body’s resources.  Learning the fine art of relaxation may be a challenge, but I’m willing to give it a try!

So that’s my own plan.  Lesson learned:  be prepared.  What do the experts tell us that you can apply to your own health promotion and disease prevention plan?

Reducing Risks of Prolonged Inactivity

You can reduce the overall risk of pulmonary embolism to practicing habits that will reduce the likelihood of having blood clots form in your legs.  The single most common cause of deep vein thrombosis is prolonged inactivity – often associated with surgery, bedrest, or travel.  Follow these guidelines to lower your own risk:

• Avoid long periods of inactivityat work– If your job involves sitting at a desk, get up at least every hour or so and take a stretch break.  Flex your feet and legs, using the following exercise:  Point your toes up toward your head.  Feel your calves stretch.  Hold, then relax.  Repeat this frequently.
• Taking reasonable travel precautions – If you’re on an extended car trip, take at least hourly stretch breaks.  On plane rides, get up at least hourly to stretch or walk the aisle.  Practice your leg stretching exercises, as described above, as you sit.  If you are at high risk for PEs, use compression stockings or socks when you travel.  Always drink plenty of fluids to avoid dehydration, but stay away from alcohol or caffeine.  Wear loose-fitting clothes that don’t constrict your waist or legs.
• Taking reasonable post-surgical or bedrest precautions – Try to get up out of bed and begin moving as soon as allowed after surgery or an illness.  If you’re confined to bed, do the above leg exercises to keep your blood circulating.

Reducing Lifestyle Risks

Smoking, overeating, and leading a sedentary life are manageable risk factors associated with increased incidence of pulmonary embolism.  All three factors are also associated with a variety of other health risks, including heart disease.  For the best cardio-pulmonary health promotion, try to follow as many of these guidelines as possible:

• Eat a reasonable, low-fat diet;
• Avoid any use of tobacco;
• Drink moderately, if at all;
• Get 30 minutes to one hour of exercise at least 3-4 times per week;
• Avoid use of hormones found in birth control pills or hormone replacement therapy, unless they are prescribed to reduce other health risks.

Following Physician Advice

If there’s ever a time to listen to your doctor, this is it.  After a PE, you’re likely to be on a regimen of blood thinners for several months.  In order to get maximum benefit, it’s critical to take them as prescribed and follow up with blood work and physician appointments.

Listen to your physician’s advice about when to return to work, as well as other precautions you may need to follow, depending upon your own particular situation.

Conclusion

Over the past six weeks many of you have endured my writings about MY LIFE WITH PE.  In doing this writing I’ve had only one goal – TO TRY AND PREVENT JUST ONE PERSON FROM ENCOUNTERING A PE.  For those that have passed on any or all of the writingsIthank you and trust that the one person will be saved without any of us ever knowing and in doing so making thousands aware of this deadly killer.

As I stated at the beginning of this article series, the end of my story has not yet been written.  And neither has yours.  While no one knows for sure what the future holds for any of us, we can take the saying that “knowledge is power” and apply it to our personal healthcare.

It’s never too early to take an inventory of your own health and the lifestyle practices that inform it.  Waiting until a health crisis to take action is the least effective way of promoting your physical health and well-being.

I hope you’ll take some of my own lessons learned to heart (and to health):

• Pulmonary embolism (or insert your own choice of “disease of the day” here) can happen to anybody.  None of us are immune.
• Knowing the signs and symptoms of PE or any health problem for which you may be at risk, is critical, as timing is everything.
• Knowing your own degree of risk is crucial.  Feeling healthy does not give you immunity.
• Listen to what your body is telling you.  With medical providers, become a vocal health advocate for yourself, as you’re the expert, too.
• Healing takes time, and recovery is a process, not just an outcome.
• Be pro-active with your health. Choose the ounce of prevention any time.

And if you have travel insurance – Israeli or otherwise, don’t wait until you’re in the ER to determine whether it’s comprehensive.

Most people are not diagnosed with Pulmonary Embolism until autopsied.  I cannot tell you how many times I heard the word “lucky” when I was hospitalized.   Starting with the attending EER Physician who’s words I continue to hear – “You beat this one by 3 hours” and the assortment of doctors and nurses would come into my room and see me, sitting up reading, or perhaps blogging, all with a smile (often a painful one) on my face and some energy I had pre-PE and ask, “are you the patient?” as if someone else would willingly impersonate me at a time like that.  I was well aware of the severity of what I went through, but I WENT through it…time to move on.  I am literally a survivor and am trying to appreciate life differently now.  Whether you are a survivor, as well, have questions, or are a caregiver or support someone who has experienced a PE, feel free to comment.  There are times I will also need reassurance.  After all, recovery is a process and of course some days will be better than others.  I will surely look forward to your comments, especially then.

Those of you that know me — whether for 48 years or for 48 minutes – were probably shocked with the openness of my first article and that I continued to tell the story in the subsequent five.  As a very private individual I can say it wasn’t easy but I felt that it must be done

Finally, enjoy each second that life has to offer – whether it’s working, traveling, family time, or embellishing and furthering your faith.   Each second is truly precious.

Good luck on your own health journey, and wish me the best in mine, as my (NOT SO patient) recovery continues.Now, back to the private life.

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Part V: Recovery

Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering.  Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid.  Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences.

My Story

Approximately six weeks after my hospital stay, I am clearly still healing and not fully recovered (thank G-d it’s not the way feel –  it’s just what I’ve been told).  For someone who has always enjoyed excellent health, this is a new and somewhat disconcerting place in which to find myself.  I continue to experience some difficulty minor breathing as well as pain in my leg (particularly at the gym which I’m not stopping and when sitting still for long periods of time –  like 15 minutes).  It’s anticipated that I’ll remain on Coumadin for at least six months – likely a year.

My lifestyle has always been enjoyable to me, but very fast-paced.  I have been accustomed to often working 18-hour days, flying all over the globe, multi-tasking and relishing every minute of it.  And yes, I must admit that I continued to try and work from my hospital bed (NOTE TO SELF – If needing to go to a hospital again check for WIFI availability) . Now I must await my doctor’s permission for me to resume a “completely normal lifestyle,” although I know that will mean taking scrupulous travel precautions and reducing my work schedule by a few hours per day.

Lesson (being) learned:  You don’t just “bounce back” from a major pulmonary embolism.  Now is the time for me to practice patience.  And gratitude (and more gratitude)!

Hospital Convalescence

Before you’re discharged from the hospital, your recovery plan is already beginning.  The medical staff will establish targets that must be reached before discharge can be considered.  They include:

• Having at least 72 hours of warfarin and/or heparin treatment;
• Having a therapeutic or close to therapeutic level of warfarin blood thinner;
• Having no signs of internal bleeding;
• Having no worsening of symptoms;
• Having strong vital signs and good pulse and blood pressure;
• Having no residual clots that pose a danger;
• Having sufficient heart health;
• Having good oxygen saturation in the bloodstream.

A follow-up appointment should be scheduled with either your primary care physician or a hematologist.  While you are on blood thinners, you will need to be seen regularly by your physician and receive frequent blood tests (non stop pricking and black and blue arms – so much for the summer tan lines – I have blood lines)  to check your levels.

Be assertive in your discussions with your physician.  Get clear instructions about what you can and cannot do once you are discharged, what preventive practices you should follow to reduce future risk, and what symptoms you should expect vs. those that may indicate a problem.

After Discharge: What to Expect

The single most important point you can remember is that everyone’s recovery is unique (and although I try – it’s not easy).  The speed and ease of a person’s recovery depends upon the degree of lung damage that was experienced, the presence or absence of other underlying medical conditions, the individual’s overall health, and the severity of the PE attack itself.  That’s why it’s so important to have frank discussion with your medical provider, so that you have realistic expectations about your recovery.

Some individuals are back at work within a week after hospital discharge, while others report significant residual problems a year or more after the pulmonary embolism episode.  By listening to what both your physician and your body tell you, you’ll be able to heal at the pace that is right for you.

Another important point that must be made: about half of all people who have one pulmonary embolism episode will experience future episodes.  This is not pointed out for the purpose of being pessimistic, but to stress the importance of having a good convalescence, followed by future preventive actions (which we’ll discuss later).

There are common residual symptoms which post-PE patients tend to experience.  They are often milder versions of the symptoms of a pulmonary embolism itself, which can be frightening if you don’t know what to expect.  Some of these symptoms include:

• Fatigue
• Breathing difficulties; e.g., shortness of breath
• Anxiety and/or depression
• Increased heart rate
• Chest pains

In the weeks and months after a pulmonary embolism, your body is using a lot of energy to heal both your lungs and your heart.  It’s understandable (to those who didn’t experience the PE) that you’ll feel more fatigued.  You’ll also probably find that you get sick more easily, as your resistance is down.  And experiencing milder versions of your initial symptoms is not uncommon.  You may also experience symptoms associated with your use of blood thinners.  The illness will also take a toll on your emotions.  You may feel like a ticking time bomb, waiting for the next clot to appear.  Or you may experience depression related to loss of control of your life and the self-perception of being an invalid.

Keep recovery symptoms in perspective, but discuss each of them with your doctor.  If any of them are severe or increase in intensity, it’s worth a trip to the emergency room.  Staff can check to see if any new clots have formed.

This may sound simplistic, but it’s important to take care of yourself.  While you need more rest, you also want to have enough physical activity to keep from being too inactive (a risk factor!).  Talk with your doctor about a gradual exercise program.  Make sure you get plenty of sleep, eat healthily, and try to keep as stress-free as possible (easier said than done).  Some individuals have found that a mild anti-anxiety medication helps.  For others, taking walks, listening to music, or learning meditation exercises may do the trick.  As a person accustomed to working up to 18 hours per day, I find this next recommendation difficult – but allow yourself extended sick leave from your work if that is what is needed to speed your recovery.

The good news is I’m told(and counting on) that after weeks or months of gradual recovery, most residual symptoms do subside or go away altogether.

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Part IV: Diagnosis and Treatment

Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering.  Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid.  Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences.

My Story

After a week of ignoring my gradually worsening symptoms, Ilan(my son) took me (in reality forced me and in doing so saved my life) to the ER at the hospital (South Nassau Community Hospital – Oceanside, NY) I somehow had the presence of mind to recommend (from the choices which popped up on the GPS).  When I arrived at the ER, I was thinking peripherally about my health insurance.  I have Israeli insurance and I found myself wondering if this was the smartest choice – would I enter the ER door and have it cost me my life savings? But if I didn’t enter, would this mistake cost me my life?

After a few minutes of this cost-benefit analysis (isn’t the bottom line what it’s all about?), the doors to the ER swung open, and I was taken into the inner sanctum of probes, pricks, scans, and the always enjoyable peeing in a cup (the competitive soul I am I was hoping to get an “A”).  After a round of X-rays, I was told that they couldn’t find anything, and they debated about sending me home (actually the “A” was not wanted – I wanted to Fail at this point so I would understand the pain)

Thank G-d my instincts kicked in:  I told the attending PA that, while I didn’t normally frequent emergency rooms, nor was I a medical genius, I knew that something was wrong.  And now that I was here (and had worked through my financial misgivings!), they had better find what was wrong and fix it.   So they ordered a CT scan.  Lo and behold, they found three blood clots by my lung.  At 2:30 in the morning of June 27^th, 2011, I was admitted to the hospital – exactly 48 years and one week since the last time I was a hospital patient.

As for treatment, I was placed on a regimen ofHeparin to thin my blood and dissolve the clots.  They also tried to keep me comfortable with pain killers, but I’m usually a stickler about not taking medication.  The pain was so unbearable that I did succumb to taking the medication on two occasions.  I remained in the hospital for eight days, and didn’t require additional treatment other than the blood thinners (ultimately was weaned off Heparin to Coumadin which I can continue to take).

Lesson learned:  It’s important to listen to what your body is trying to tell you and get medical help.  The fact that I was insistent about the need for thorough testing led to the critical finding that ultimately saved my life (although Ilan who took me and Carol who encouraged him to do so are the ones who really save my life).

Obtaining a Diagnosis

Because many of the symptoms of a pulmonary embolism may resemble those of a heart attack, panic attack, or respiratory problem such as pneumonia, making an initial diagnosis can be a process of ruling out other problems.  A preliminary physical exam and medical history can help identify if you are at high risk for pulmonary embolism.  If your risk factors are high, the next step is to have testing done to look for blood clots or to rule out other possible disorders.

Some of the most common procedures to detect a PE include blood tests to check electrolytes and blood counts, electrocardiograms, spiral CT scans, MRIs, ultrasound, pulmonary angiograms, and venous Doppler checks on legs (where clots usually first form).

Treatment Methods

In the great majority of cases, the primary treatment regimen is a course of anticoagulant drugs, often referred to as blood thinners.  While they don’t actually thin the blood, they do help reduce the formation of new clots and stop existing clots from growing.  The treatment program often begins with an initial injection of heparin, a fast-acting blood thinner.  This medication is often followed by a type of warfarin, such as Coumadin, that is taken orally.  Once an individual is placed on warfarin, the course of treatment usually lasts several months.

When you’re on a schedule of blood thinners, it’s important to exercise precautions to prevent bleeding problems.  During a course of warfarin treatment, you’ll also be advised to obtain regular blood tests.

Luckily, most existing clots will usually dissolve on their own. For severe and life-threatening clots, other methods may be used, however.  A thrombolytic or clot-dissolving drug can quickly break up large clots, but the risk of serious bleeding is increased.

Another option for breaking up a large clot in the lung is through the use of a flexible tube or catheter threaded through the blood vessels. It can break up the clot with a few artful maneuvers.

For individuals who can’t take blood thinners or don’t respond to them sufficiently, a vein filter can be surgically placed in the inferior vena cava – the large vein that leads from the legs up to the right side of the heart.  Because deep vein thrombosis is the single greatest cause of pulmonary embolisms, having a filter in place to block moving clots can protect the cardio-pulmonary system and significantly reduce the incidence of PE reoccurrence.

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