Pilot Protection Services Medical Mailbag- August Q&A

QUESTION: Shortly before my application for a medical/student pilot certificate, I had been diagnosed with a slightly dilated aortic root, a biscupid aortic valve and atrial fibrillation.  With the help of AOPA at that time, I received a special issuance subject to a lot of testing and reporting to the FAA.  Since then, my cardiac health has been stable and my a-fib well controlled with medication.  FAA has been gradually making it easier for me to obtain a 3rd class medical.  My most recent renewal came with an authorization for an AME assisted renewal.  In the "off-years" when I would not be otherwise required to undergo an FAA medical exam with an AME, I can submit the required medical reports to the FAA including a 24 hour Holter monitor test and a comprehensive echocardiogram and wait or I can go to an AME, pay some undefined fee and receive an AME issued medical certificate if there has not been any adverse change.  Bizarrely, FAA does not seem as interested in my aortic root or valve problem, especially as an unmonitored change could kill me, yet their requirement for the Holter test seems excessive as my rhythm issue is well controlled and the chance of "catching" an a-fib episode in one out of every 365 days is remote. At some point, my insurer is not going to pay for it any more as medically un-necessary.  Having to pay full price out of pocket will then be the end of my flying. 

ANSWER: Atrial fibrillation, or "a-fib" is the most common rhythm disorder afflicting the heart; basically, the right atrial chamber where heartbeats originate puts out some aberrant beats that can cause anywhere from no symptoms, to mild anxiety all the way to breathlessness and heart failure. It is often controlled with medication but there are some out-patient surgical procedures to zap the errant areas of the heart.  As long as you have A-fib treated with a medication, you will be required to provide a current status report and 24 hour Holter monitor.  That is it, pure and simple even though your comments ring true to me.   

The other issues you mention are a dilated aortic root, where the base of the main blood vessel leaving the heart is wider than normal and a valve that has a slightly different shape are more complex. These can be incidental findings but can also be a harbinger of future problems, for instance, the aorta can actually swell into an "aneurysm" and even burst so monitoring it makes eminent sense. I am rather surprised that FAA are only requiring an echo every other year because a dilated aortic root and bicuspid valve does also generally require yearly echos, depending on a number of factors.   

QUESTION: About 3 months ago (2 days before my 74th birthday), I experienced a cardiac event, which was diagnosed as coronary artery disease (one location at 98% blockage, one location at 75%).

Two stents were inserted, and I was put on Effient (10 mg / day), Lisinopril (2.5 mg / day), and Metropolol (12.5 mg b.i.d), plus 81 mg aspirin daily. My cardiologist specialist has reduced my exercising from 2.6 miles running, to 32 minutes walking (5.5° incline), retaining my 1 hour of floor exercising after cardio.  I work out every three days. He has also put me on a no-fat, no-animal protein diet, on which I will remain for another 3 months.  My weight has dropped from 152 to 138 (I am 5'6", and it's not easy for involuntary vegetarians to overeat), and my BMI seems to range between 22 and 23.  I wish to be pro-active and submit all paperwork necessary for the FAA to confirm I am medically fit to fly, 2nd class if possible, but at least full 3rd class.

What do I need to do please? 

ANSWER: There is lots of information about this topic that we have covered in the pages of AOPA Pilot magazine, web articles, webinars and at live events around the country but it is always worth revisiting as coronary artery disease kills more pilots - and earthbound mortals - than any other illness. For full second class privileges you will have to submit another Cardiac Catheterization at the 90 day point from the date your heart stents were inserted as well as a Maximal Bruce Protocol Nuclear stress test. You also need to know to request the medical class that you "need", not the one you want! 

For third-class you will require: areport from the treating physician that states how he/she discovered the coronary disease, a report from the Cardiac Catheterization and Stent insertion procedures. Assuming that it was NOT the Left Main Stem artery that they stented in 90 days you will need to provide a current status report from your treating physician that informs the FAA how you have been doing from a cardia perspective since the procedures and provide a current list of all your medications. For the Maximal Bruce Protocol stress test you should provide all the computer print outs and all the 12 Lead Electrocardiogram tracings from the test. Finally, you need to provide the results of a current Lipid panel and Fasting Blood sugar. Good luck with your continued recovery! 

QUESTION: I hold a 3rd class medical certificate by special issuance.  At the last required medical examination (April 2013) I submitted the required information for the special issuance (treadmill stress test).  I also submitted a completed FAA Form 8500-8 so that my AME could get the information and certificate he was to sign and give to me. This year I was required to forward to Dr. Courtney Scott in Oklahoma the results of this year’s treadmill test but I was not required to see the AME.  I have forwarded the results of the treadmill test to Dr. Scott.  My question is since I do not see my AME this year am I still required to file the 8500-8 form this year? Thank you for your assistance. 

ANSWER: The short of it is, if you hold a 3rd class and last year you had an FAA flight exam, you will not need a new examination this year.  The regulations that govern the duration of medical certificates (61.23) is different from the one that allows the FAA to issue a special issuance for a disqualifying medical condition  (67.401).  Trust this helps! 

QUESTION: I've recently had a total ceramic hip replacement - what information will I be required to supply my AME when I apply to renew my Pilots Medical Certificate. I am presently able to drive an automatic transmission car but I've not yet tried to get into an aircraft , I'm probably going to try this in 4 weeks from today after I next see my surgeon. 

ANSWER: Most airmen who have had a total joint replacement do not notify the FAA until their next FAA exam (this is not "really" kosher, but what is generally done.). The condition will not require a waiver or SODA unless you are having persistent pain that requires regular medication and/or has some limitation in range of motion that makes it difficult for you to fly. You should provide the operative report and a letter from the treating doctor at the time that you are going to be released that notes your status, range of motion, any pain, healing and so on and that you are being released to your own care. 

QUESTION: I read with much interest the Fly Well article in the June 2014 edition of  AOPA Pilot -  I have been flying since 1998 when I started at the age of 55.   I am addicted to flying. I even wrote a navigation app! In the the article you mentioned some possible changes at the FAA including efforts by AOPA and others to remove the 3rd class medical. This interests me because I have been an insulin dependent type 1 diabetic for 40 years.  My AME passed me for 2nd class as an experiment and the FAA shot me down. They said "sorry, if you take insulin your can't get a 2nd class."  I wanted it because in my unintentional semi retirement, I would like to do some revenue generating work to feed my habit. 

So, my question is: if they do away with 3rd class medical does that mean:

a) I can't get a certificate at all or

b) can I get a commercial endorsement?

My flight instructor says I could easily pass the tests. Thanks for your time and please keep up the informative pieces.

ANSWER: I am glad you have the flying bug and enjoy the magazine but am sorry you have had issues. I covered this topic in the magazine a couple of years back and we also address this in webinars at live events and in electronic articles. 

The ONLY medical certificate an individual with Diabetes mellitus on Insulin can obtain is a 3rd class and limited to flight within the borders of the USA.  If the third class medical initiative is approved by FAA, they will hold these individuals who fly the heavier aircraft to "sport pilot" rules. So, to get into this category, you might reapply for third-class with your insulin dependent diabetes and gain a special issuance that way.  Then, you would be eligible, as you would no longer be denied.   

Confusing, I know. It might be worth joining the AOPA Pilot Protections Services plan as they can be helpful with such situations - I am a member. 

Best of luck! 

QUESTION: What are the regulations concerning cataract surgery and flying with a private pilot license? 

ANSWER: A cataract is where the lens inside the eye becomes cloudy, or opaque - one is seeing the world in IMC! Most commonly this is a function of aging, diabetes, exposure to radiation (so wear sunglasses always!) or various other diseases. This is treated by removing the diseased lens and nowadays, most often replacing it with an implantable lens although some people choose just to wear glasses or contact lenses after surgery. If a cataract obscures vision and does not allow the airman to meet vision standards for the class requested, the airman is denied. After surgical removal and insertion of an intraocular lens, the airman needs to have the treating Ophthalmologist complete an 8500-7 (FAA Eye Exam form).

If they meet standards for the class of medical they have or require, then they can resume flying (once they meet standards) and give the AME the report at the time of their next FAA exam. 

If the airman has cataracts and they do not affect vision, they should also have the physician complete the FAA Eye exam form and they can fly providing they meet vision standards. Hope that works out for you!

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