I also learned this the hard way after a 14 hour session of Diablo 3. I went to the doctor a couple of times because my leg felt swolen and it was hurting but they didn't think much of it for some reason - only after I developed extreme difficulty breathing did I end up in the ER. The DVT had migrated from my leg into my lungs and gave me a pulmonary embolism.

What a terrible game to almost die for. I'm so sorry.

Also, 14 consecutive hours? Did you literally not get up at all in that period? Did you have enough fluids and snacks nearby that you didn't have to?

It was consecutive but I did get up from time to time for bathroom breaks, but clearly not often enough. As for fluids I'm fairly sure I was pretty dehydrated at the time. This occurred in 2015. Since this occurred and after I learned from a nurse about the leg muscles being critical to get the blood moving out of your legs I have developed a habit of constantly moving my legs around any time they have not moved in a bit. When this episode happened I remember that I would keep my legs very still during the gaming session.

You're lucky to be alive. Pulmonary embolisms are often fatal.

That’s a common misconception.

Most are clinically silent. The ones that land you in an emergency room are dangerous.

Yeah, I suppose.

A few years back, I was blinded in one eye by a retinal vein occlusion (basically a stroke in the retina). They're actually pretty common, affecting 5-10% of the population, but unless it crosses your macula, you'll probably never know it happened.

I recently suffered an occular migraine. My first and only (so far). Scariest moment of the decade for me. Thought I was going blind, thought I'd have to adjust to this new normal. Got myself to the ER just in time for it to clear out.

Eye issues terrify me and I'm not sure mental state could handle a retinal stroke. That sounds truly horrible.

I've had ocular migraines my whole life, as long as I can remember (I clearly remember them happening before kindergarten, and was seeing doctors when I was six). Luckily, they've gotten far less common and intense as I've gotten older... they were completely debilitating during my early teens.

Is it curable? Has your eyesight been restored?

It's treatable, not curable. Treatment lasted about a year, consisting of monthly injections into my eyeball (yeah), and a laser surgery that cauterized about 50 tiny veins. I have a blind spot and some unevenness, but it's usable. My bad eye is better than many people's good eye. It's about 20/40-20/80 now, depending (my good eye is 20/20).

Hooray for modern medicine! It saved my eye. When the occlusion first happened, my vision went from 20/20 to 20/500 in moments.

If "Clinically silent" is jargon for "no symptoms at all", sure.

But if it gets the point of even minor persistent chest pain or one is aware that something is not right, it's time for the emergency room.

Chest pain is not to be trifled with. One clot may be followed by others which might be serious or fatal in a very short time.

PE is common enough among people that sit for a living (most of HN), that I think it's important for folks to be aware of them and that they're dangerous.

I've had mild chest pain for years. I'm not going to live in the ER.

Do you know if the chair you sat on was impinging the back of your upper thigh? Do you have any health risks associated with DVT e.g. Smoker, use birth control, overweight, etc.

Any family history? Crazy how this happened from one 14 hour session or were you regularly doing this?

Thanks.

When it happens, it will result from one session. Whether it happens in any given session is a statistical question.

"Deep Vein Thrombosis" is the term if anyone is looking for more info. https://www.cdc.gov/ncbddd/dvt/travel.html

Yep, flew from Phoenix to Atlanta, fell asleep until the end of the flight, woke to get off the flight, and immediately became blind in one eye as an embolism blew up inside the vitreous fluid.

Not a great way to start a new job. Boss was meeting me at the airport thankfully and he drove me to the hospital to get checked out. A few weeks of an eye patch was the short term outcome and a bunch of new 'floaters' that my mind has mostly learned to filter out.

Just very grateful that it detonated in my eye instead of my brain...

The link I posted mentions it's not just air travel, but car, train, bus, etc, also.

But I have to wonder if the shrinking coach seat pitch/size isn't a big factor. I'm fairly average size, but flying is miserable these days.

Perhaps also the relative awkwardness of getting up while flying...the visible sighs from your row mates that have to move around a lot to let you pass.

That's a fluke. PHX to ATL is only 3.5 hours. If sitting still for that long easily led to blood clots, people would be dying in droves.

I imagine sleeping is part of it though, when you're asleep your heart beats even slower than when awake.

Woah, I will fly from Atlanta to Germany soon.

Now I'm scared..

Wear compression stockings from ankle to thigh and pop an aspirin to thin your blood an hour before flight. These helped me as I'm at high risk.

Just get up and walk around every hour or two...

"just" is not the word to associate with "get up and walk around" on an airplane. Unless you have an aisle seat it's a notable hassle.

No, it's not. You say "pardon me" to your seat mate and they let you out or you climb over them.

That is the description of the hassle (skipping the parts where they are asleep, have drinks/food/laptops, etc). But if you feel better for denying any social anxiety or physical discomfort I or others feel while "climbing over" strangers periodically, don't let me stop you.

Aisle seats make up at least a third of all seats and don’t cost extra.

And they are my preference. But they aren't always available - per this topic, you're saying 2/3 of people have a harder time (despite the dismissive commentary from others) performing a routine task for their health.

It’s not a solution for the masses, but it works well for the individual.

Nah, screw your seatmates. If they didn't want to have to wake up every two hours they should have taken a window seat.

Even with that approach, I’m not sure there’s enough room for everyone to take the recommended stand breaks.

Thank you for your comment. I hadn't paid any attention to why sitting was bad for your health, I thought that my daily routine of exercise was sufficient to take care of this issue. Now that your comment has explained this really clearly - that it's the prolonged hours of the inactivity of the legs that's the issue, I will definitely make it a point to get up and move around more frequently. I can and have just sat at my desk for stretches as long as 4-5 hours just concentrating on code routinely. Your comment may have saved me from my work habits contributing to an early demise :-)

Does furiously bobbing one’s knee prevent this at all?

Been wondering the same thing: What manners of muscle movement work for circulating the blood?

According to (1) blood flow maximizes around 30% of max effort. So light contractions seem best.

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591373/

I'm certainly not a medical professional, but my impression is that it's not so much movement as muscle tension that helps. If the muscle just moves without encountering any resistance, it doesn't create nearly as much pressure as it does when e.g. walking. So you really need to have weight or some other sort of resistance against the motion. I try to wedge my feet against something and use my calves to lift myself off the seat.

Maybe someone who actually knows can tell me whether I'm totally off-base here?

From the article, it says that contraction of the muscles pushes against the veins. Given that, the less resistance the better. You don't need the muscles to work harder, you just need them to be maximally shortened.

In other words, what you should really do is flail around wildly. As a bonus, this also slightly increases the heartrate of nearby coworkers.

You have to flex your calves to pump the veins deep in your legs, you can do seated calf raises. Standing up and walking around is ideal.

Article said movement helps, but the victim usually gets tired of it.

Or someone else does and insists they stop fidgeting and keep their legs still.

There is a theory that pregnant women sleeping on their backs can have serious complications due to a venous return being obstructed. Some get supine hypotension, and others get restless or sore legs. There appears to be an an atomic variation in venous anatomy, where some women can get return via the azygus vein if the inferior vena cava is compressed.

This is very relevant for HN. Most devs need to be aware of how dangerous sitting down for too long really is.

That's just the tip. Even casual reading through Wikipedia shows that like a half of health functions are tied to muscle work. E.g. anti-inflammatory function, because muscles act as endocrinal organs.

The interdependencies in this bag of organs are an unbelievable mess.

Refactoring is not an option, we don't have root access to production. We can either exploit bugs or deploy new versions.

Those new versions are creating by randomly selecting between files from two other installations.

>The interdependencies in this bag of organs are an unbelievable mess.

I choose to look at it as incredible optimization instead.

Smoking is a high risk associated with DVT as well, quitting smoking is also ideal to reduce risk

So true. Be aware that you may have no symptoms in your legs at all, and still develop pulmonary embolisms.

As an otherwise healthy and fit adult male, my first symptom of my PE was a sharp stabbing pain in my chest when inhaling. Thinking I was having a heart attack, I self-admitted to the ER. I had 12 PEs in my lungs, and with ultrasound they found a 3" long deep vein thrombosis under my left knee. My left leg had absolutely no symptoms or pain. My PEs and DVT resolved with a 6-mo course of blood thinners, but I was lucky. PE mortality rate is around 15-20%.

Set your "stand up" timer for every 90 minutes and actually pay attention to it! And it wouldn't hurt to take a daily baby aspirin (probably should ask your doc first).

> And it wouldn't hurt to take a daily baby aspirin (probably should ask your doc first).

This is a really interesting point.

Most people have probably seen the debate around daily aspirin, which largely simplifies to "does the decreased clot risk outweigh the increased bleeding event risk?" The math tends to come out very close, but that's largely because the people at high risk of heart attack and stroke are also at elevated risk of bleeding events.

Programmers, heavy gamers, and other people who sit all day seem like they might break that parity; the raised clot risk is circumstantial, not biological, so they're not necessarily at elevated bleeding risk. Changing that circumstance is definitely the winning move, but I'd also love to see a study on how aspirin performs in those populations.

The American Heart Association now recommends against daily aspirin use for most people.

https://www.heart.org/en/news/2019/03/18/avoid-daily-aspirin...

I am haunted by DVT that took the life of a best friend who had a pulmonary embolism in her sleep and never woke up. I now take asprin regularly when I have to sit for prolonged hours. Stay safe everyone.

My former team lead had one of those standing desks. After he left, I toyed with the idea of using it. When the office moved, I decided to take it. It's pretty useful to keep me awake in the afternoons.

I've found there's another afternoon benefit. If I'm standing in the afternoons and struggling to stay awake, that's a really good push to take a short nap.

When I'm sitting in the afternoons it's easier to push myself and skip the nap, which actually results in worse productivity and me feeling worse the rest of the day. It's harder to skip a nap with a standing desk because it's harder to tolerate being sleepy when standing.

YMMV based on if afternoon power naps work for you or not.

Does your workplace have accommodations for taking a nap?

Right now I work from home most days so yes :)

In the past I've napped in my car. At one job they had a "multicultural room" that was basically an interior room with a comfortable chair. At another job (a startup that was collapsing) there was a couch in a vacant office on the same floor.

Note that I've many places did not provide standing desks.

I bet restless feet help a lot in preventing this, too.

I'm not sure why that's being dismissed. Standard advice for travelers to avoid thrombosis recommends leg exercises during extended sitting, including both toe and heel raises. "Shaking your legs" while sitting generally consists of either tapping your toes or bouncing your heels; heel raises in particular really are the same motion as fidgeting.

I wonder if standing desks can be just as dangerous as sitting if you are standing motionless for more than an hour or so.

I'd say it's much harder to stay perfectly motionless while standing than while sitting. Subtle shifts of weight from one leg to the other are enough to stave off DVT.

If you don't want to buy a FitBit, Workrave[0] is great computer software for this. Runs on Windows and GNU/Linux.

I know I should take breaks, but never end up doing so - the desire to just keep sitting and working is too great. The reminders from Workrave have been effective at actually getting me to stand up and move around.

The only issue is that if you are sitting at your desk but not using the computer, it will detect you as taking a break.

[0]: http://www.workrave.org/

Second the fitbit tip! Aside from not dying prematurely, you'll also enjoy increased energy and focus (assuming you actually do get up and walk around every hour) and, at least in my experience, you'll feel better at the end of the day. Just the few minutes of walking every hour makes the difference between a sore and achy back and comfort. Sleeping is easier, too.

I have privacy concerns with fitness trackers, so I did a search and found this: https://github.com/Freeyourgadget/Gadgetbridge

Seems very interesting, if this project is any good (certainly looks like it is) I may just get one of the supported devices.

Back in 2013 or so, I had privacy concerns, so I got a device that was popular for folks that wanted to put free software on it. Hacking on it (both for fun, as well as frequent buggy behavior) served to keep me at the desk instead of working out :(

You should stop using HN. I can tell that 4 hours ago you were awake, using your computer, not taking steps. Are you really comfortable with this loss of privacy?

The best thing I ever did for myself recently was getting a Swiss ball as a seating implement. It fixed my posture and every so often I can just bounce "locally" to unwind and get blood going. Good thing nobody can see me acting weird at home.

Plus as the ability to slouch is gone, I've got no incentive to stay seated and get up more often.

My manager sits on one at work. He also rolls it around the office as he goes to meetings, etc. Nobody thinks he's acting weird, and recently I saw that someone else had brought one in.

When I got an Apple Watch I quickly learned that for me the hardest ring to close was to stand up at least once in the hour for 12 hours in the day. Now it has become habit, but it's something I never really noticed since I went to the gym every day and am generally healthy.

Could standing for too long also result in blood clots? Gravity is going to keep more blood in your feet. Am I gonna have to start doing regular squats at work?

The people that I know who have to scrub into a long surgery in the OR typically wear compression socks as they may need to stand for 9+ hours straight.

If you want to do squats go for it, but compression socks are passive & much harder to forget doing.

If you are sitting down for lunch & meetings during your work day it's probably not as much of a big deal.

So you sacrifice your privacy to buy a device that tells you to get away from another device?

I don't understand this way of solving problems.

What's not to understand? Op uses a Fitbit to keep track of how much time they spend sitting to help avoid injury.

Not sure how devices or privacy have anything to do with the problem.

That's what I don't understand. Devices are the problem. You're solving one problem and creating several more.

When you could just set an alarm on your computer to get up and walk around in and hour or two.

I'm a #FitbitEmployee but don't speak for Fitbit.

The advantage of the device is that it doesn't interrupt you if you've already taken 250 steps that hour.

I take it you own a smartphone based on this previous comment: https://news.ycombinator.com/item?id=19688327

Even if you don't own a smartphone, the loss of privacy to Fitbit is minimal, in my personal opinion. If you do own a smartphone, adding a Fitbit to the picture means an infinitesimal loss of privacy, too small to even be worth talking about. Fitbit has a financial incentive to keep your data private. Can you say that about every app on your phone?

When this phone dies I probably won't get another one. Someone gave me their old cracked phone. It would otherwise be garbage and I won't buy a new phone because the whole system is killing the planet and human beings in places we can't name.

It's so gross, I don't want to be part of it anymore.

So I think you're not going to change my mind about this.

Until we start saying no this can't happen anymore. It will keep on.

We are all culpable.

Sitting for too long is the problem not devices. I agree a timer would probably work just as well, but the number of devices has nothing to do with fixing the problem of sitting too much (especially a device intended to help increase physical activity).