Pilot Protection Services Medical Mailbag- January Q&A

January 3, 2017

 


Gary Crump

  • Director, AOPA Pilot Information Center Medical Certification Section
  • 28 years assisting AOPA members
  • Former Operating Room Technician, Professional Firefighter/Emergency Medical Technician
  • Pilot since 1973

Jonathan Sackier
Jonathan Sackier

  • Surgeon, Clinical Professor 
  • 30 years of healthcare experience 
  • Author of the “Fly Well” column in AOPA PILOT 
  • Flying since 15 years old, owns a Columbia 400 

QUESTION: My doctor wants to put me on Adipex and Victoza for weight loss, are any of these medications approved by the FAA for weight loss?  

ANSWER: Let’s be clear, obesity is a major problem in the USA and other developed countries and is even now affecting people in lesser developed countries. It reduces lifespan and negatively impacts healthspan, damaging sleep, mobility, intimate relationships, ability to work and play and, of course, can limit one’s time in the most important seat in the world, the left hand seat. The foundation of all approaches to treating obesity is to eat less and get out of one’s seat and exercise. Not the left seat, of course! While medications and surgical interventions can have benefit, please ensure that your commitment to weight loss includes these lifestyle modifications.  

You would be OK with Victoza, which is a diabetes medication that can produce some weight loss, but Adipex is a stimulant type medication that FAA does not allow for medical certification. 

Good luck in your efforts to become healthier.

QUESTION: Just over two years ago I had a mild stroke.  I would like to get a 3rd class medical again.  What is required?

ANSWER:
A stroke is where the brain is damaged by an acute lack of blood supply and there are two types; ischemic, where a blood vessel is blocked or hemorrhagic, where a blood vessel ruptures, often from an aneurysm, a berry-like outpouching from the vessel wall. Depending on which part of the brain is impacted a range of symptoms can ensue such as loss of ability to move body parts, damaged sensation, loss of speech or comprehension.  

Stroke is often a sequel of raised blood pressure so make sure this is checked up regularly and, if elevated, properly treated. 

The FAA will need to see your medical records from the time of the stroke, plus a current neurological evaluation and neurocognitive testing to identify possible residual cognitive deficits.  Here is a link to our website information with more details. https://www.aopa.org/go-fly/medical-resources/health-conditions/neurological/cerebrovascular-conditions 

QUESTION: Can you get and keep a 3rd class medical if you are on dialysis for kidney failure? 

ANSWER: The kidneys primarily serve to “clean” the blood and moderated fluids and certain electrolytes in the blood ensuring the body stays in balance. This can be damaged by raised blood pressure (see above), infections and a number of diseases. As they fail, this causes one to become tired and lethargic, retain fluid, have diminished appetite and many other symptoms.

A mainstay of treatment is to direct blood from the body via a special tube into a kidney dialysis machine that serves to replace the role of the malfunctioning kidneys and, of course, kidney transplant either from a living or deceased donor can free the patient from having to regularly undergo this therapy.Unfortunately, the FAA has historically not granted medical certification to anyone undergoing dialysis for renal failure.  If your condition improves or you have a kidney transplant and no longer require dialysis, the FAA would be able to consider you for a special issuance medical certificate. 

QUESTION: Is it possible to get a 2nd class medical after cataract surgery?

ANSWER: Cataracts is the condition where the lens inside your eye becomes foggy thereby interfering with clear vision. A condition that is associated with aging, but certain diseases make it more common and that is why having regular eye check-ups can actually spot other, more general problems brewing. We also know that UV light is a factor which is why you should wear those snazzy sunglasses at every opportunity outside.

Cataracts are normally treated by removing the errant lens and sometimes replacing it with an artificial lens, a technology that is pretty advanced these days. 

Obtaining any class of medical after cataract surgery with lens implants is a straightforward process.  Once your visual acuity is stable and meets the vision standards for the class of medical you hold or are applying for, have your eye care doctor complete an FAA eye evaluation form and provide it the aviation medical examiner at the time your next flight physical. If you meet the vision standards and there are no complications from the procedure, the AME can issue your medical to you in the office. 

QUESTION: Has Oklahoma City made any headway in decreasing special issuance wait times? The current 3 - 4 months seems long.

ANSWER: Unfortunately, no, not much progress there.  Processing times are still running about 90-110 days on average so plan accordingly if you are providing information to the FAA in support of a special issuance.

QUESTION: What is the general opinion of the FAA when it comes to atrial fibrillation and treatment? 

ANSWER: Atrial fibrillation – “afib” - is where one of the chambers of the heart wriggles around instead of pumping efficiently. This can be a sequel to a heart attack or develop for many other reasons including problems with the thyroid gland in the neck so it needs to be properly evaluated. Symptoms vary from none at all to profound breathlessness, feeling tired and even episodes of passing out. Treatment consists of merely keeping an eye on things, taking various medications or zapping the area of the heart causing aberrant heartbeats with an energy source to calm things down. 

The FAA will need to see a cardiovascular evaluation that includes a maximum exercise stress test, a 24 hour Holter monitor, and an M Mode 2D echocardiogram, along with a narrative summary from your cardiologist.  If the afib is well controlled and there are no other underlying cardiac issues, you would probably qualify for a special issuance.  https://www.aopa.org/go-fly/medical-resources/health-conditions/heart-and-circulatory-system/arrhythmia    

QUESTION: My special issue medical has expired, can I fly as a sport pilot until I get it renewed?

ANSWER: Yes you can.  Light Sport requires a valid state driver’s license and knowledge that there is no medical condition that would make you unable to safely exercise the privileges of a Sport Pilot. 

Have a question for Dr. Jonathan Sackier or Gary Crump? You may submit your question here.

Gary Crump