Pilot Protection Services Medical Mailbag- July Q&A

QUESTION: I had a stroke 20 months ago which only effected my speech and this was treated just with speech therapy. I have complete hospital records from my general practitioner and neurologist and they have no reservations. Do I wait 24 months? What details do I need to give to the AME? 

ANSWER: A "stroke" is where blood supply to a part of the brain is interrupted, either by a blockage in an artery or by an artery bursting – some people call it a’brain attack‘ because of the similarity to a heart attack. It is a serious medical condition and this is why FAA takes a lot of care setting guidelines on how to evaluate pilots who have suffered a stroke. No matter how mild a stroke may be, it is considered by the FAA as a specifically disqualifying medical condition - you should consider yourself grounded and should notify the FAA medical folks now.  Look to one of the articles from the AOPA e-Newlsletters in the upcoming months for a complete explanation of the requirements for a stroke.This has also been covered in the pages of AOPA Pilot (Practice Good Strokes – September 2012, page 26)  

QUESTION: If one has undergone cataract surgery, I believe the pilot has to take a completed form 8500-7 to the next AME medical. For implanted unifocal lenses, would this be the next medical after the current medical expires? In other words, after the operation the pilot may start flying again based on his or her usual "am I fit to fly" question before every flight? Put another way, does an 8500-7 form signed by the ophthalmic surgeon give the official go-ahead?  

I will need my right eye operated on for lazy eye (strabismus) and I've always been only just 20/40 for 3rd Class. I'd be happy to get back to that afterwards but it seems that people do not always do as well as popularly claimed after cataract surgery.   

ANSWER: A cataract describes a clouded lens in the eyes (A Clear Picture; AOPA Pilot May 2013, page 26).After surgery for cataract yes, one must have completed FAA Eye exam form  8500-7 which you can download from the FAA website or from AOPA medical certification. The results of cataract surgery are on the whole very good which is why it is so popular and I had no hesitation in recommending it to my father, however, always discuss your case, fears and concerns with your doctor. Additionally, intraocular lenses are acceptable which have been a big advance in this procedure. Post -operatively one must meet standards for medical class requested and once one is sure there are no complications one can resume flying and provide your AME with the eye exam form at the time of the next exam. If a multifocal lens is implanted then the airman is grounded for 90 days and must meet standards as above. 

"Strabismus" or lazy eye, the issue is diplopia. If you have this you are grounded until it is corrected.  If there is amblyopia you will need medical flight test for SODA.   

The question is, however, if you meet the standards for the class requested, then why have it done??   

QUESTION: I have been flying since 1967 and for many years I held a class I medical, as a commercial pilot. Most of that time, I was under a special issuance for an eye issue. Last year, the FAA finally removed the special issuance requirements and I thought I was home free. Not so fast! Within months, I had a cardiac event which led to the installation of a defibrillator. I know I am supposed to report all grounding type incidents to the FAA, but I have not yet done so. My current class three expires in May. Is there a provision for flying with a defibrillator? I have had no "events" - the unit is monitored remotely. If I choose to fly again, it would most likely be under the LSA provision, unless there is a potential to maintain a class three. 

ANSWER: A cardiac event could refer to a multitude of problems but the fact that the doctors recommended inserting a device that in can pace your heartbeat in the event that it starts fibrillating – a fancy way of seeing not working properly – suggests this was quite serious and maybe even life-threatening. The FAA does NOT accept the use of Internal cardiac defibrillators unless they are made not functional by being either turned off or removed.  Nevertheless, even if the condition was ultimately favorably considered, having a "live" defibrillator would preclude any medical certification.  For a defibrillator to be considered you would have to demonstrate that it did not discharge for a minimum period of two years and it would have to be disabled at that time.   

QUESTION: I have recently passed a kidney stone, the whole episode lasted about 4 hours from the time I first felt the pain until the stone was out of my body. I had a CT scan which showed no other stones present and I am going for a follow up with my family doctor later this week. My question is how will this affect my medical and what should I do when reapplying for my medical. My 2nd class privileges expire in a few months, my 3rd class privileges next year. As of now I am not utilizing my 2nd class and am only flying for personal reasons and to give some dual instruction to members of my local flying club. If you could advise me of the hoops I may need to jump through when it comes time for renewal I would be grateful and also need to know what I should do about reporting this event.  

ANSWER: Well if this is your first ever stone passage, you need to obtain the medical records from the hospital and physicians event and the report of the CT scan. If it is as you mentioned, that you have no stones remaining in your urinary system; this will not result in your being placed on a special issuance (waiver).  You should also obtain the stone analysis, if you or the hospital staff were able to catch the stone and it was sent for analysis.  The FAA will also wish to see the lab results that would have been drawn at the time as your treating physicians will have evaluated your kidney function and to ascertain whether you are prone to forming more stones. If this was your first ever kidney stone, you can save all these records and bring them to your AME when you next go for an exam.  You will note this on your exam form and your AME will send the records in to the FAA to place in your file.    

QUESTION: How recent do medical tests have to be? My third class medical lapsed several years ago. Not having flown for several years, kids college tuition soaked up my flying funds, I now want to start scraping the rust off my skills. Since my last aviation medical I have been diagnosed with moderate sleep apnea and borderline diabetes. My Hemoglobin A1c tests have been good lately as a result of losing some weight and controlling carbohydrate intake, and I use an auto CPAP machine for the sleep apnea. I am also treated for hypothyroidism which was reported the last time I had a medical certification. It has been over a year since my last sleep study. Can I use that study or do I need to have another one done to reapply for my third class medical? 

ANSWER: You are certainly putting us to work, but your questions are good and interesting. As you know, you have 3 medical problems, but two of them, "borderline diabetes" and hypothyroidism, no longer require a special issuance. However, you must provide the AME with documentation when you go in for your exam. He or she will not be able to issue you a medical certificate without these evaluations and tests. 

For the sleep apnea, yes a test from a year ago is too old.  If you can, obtain the compliance card data printout from your machine for at least a two week period prior to your AME visit. If by some chance you do not have one of these compliance cards, then you will need to provide the FAA with a good letter from a Board Certified Sleep specialist that informs them of any current symptoms and how compliant you have been with the device. 

For the borderline diabetes, you will need a typed letter from your treating physician that states how they came to make this diagnosis and what you are doing to treat the condition. They will also need a current hemoglobin A1C level – as you know this is a sensitive test of how your glucose levels have been doing for a period of time. 

For the low thyroid, you will also need a typed letter from your treating physician that lists your current medication and what, if any, symptoms you are experiencing (none should be the response if you are taking the proper dose of thyroid replacement) and a current TSH level.

None of these evaluations or lab tests should be older than 90 days prior to obtaining your exam. 

QUESTION: I really enjoy reading all the medical content in AOPA and hope you can help me. In 2009, I had a DVT in the right lower leg, and a subsequent PE.  I went through a number of tests and spent one night in the hospital for observation. I had no problems, no symptoms whatsoever, and was released the next day. I received enoxaparin for a very short time, then was advised to take Coumadin which I did for 3 months then stopped of my own accord as I am an active person and felt great with no symptoms.  

Imagine my surprise when I was denied my Private Pilot License, as I told the AME I had this issue several years back. The AME had me take Pulmonary, and Hematology Tests and then re-apply to the FAA.  I did all of that, sending everything to the FAA in Oklahoma City. Bottom line, is I have Homozygtous Leidens Factor, and everyone at FAA wanted me to take the blood thinner and keep my INR at a certain level. Well, I declined to continue to apply as I don't want this medicine in my system. 

I have taken two very recent physicals, blood tests and all, I have two letters from my Private Physician attesting to my health in a most positive way. So now, I am going to the AME here in Everett, Wa., to re-apply. I also am in contact with AOPA Legal Advisers and hope this can be resolved and I can get my license back.  I have zero medical issues, I take no medicines at all., other than occasional Aleve, and 4 vitamins daily. 

This means a lot to me, as being a pilot is  the very best skill I  have ever accomplished, and I just feel its ripped away from me. I was honest, forthright but my license was yanked.  I am just a local pilot, love to fly on nice days, know my limitations, and so respect aviation. 

I would like your opinion, do you think I am spinning my wheels, and should abandon my efforts. If I thought I was a danger to anyone, aviation etc, I would so give up, but I feel I am in the very  best of health and so able to pilot small aircraft. 

ANSWER: Thank you for writing and am pleased you enjoyed the article. As I am sure you know, a DVT is when a thrombus, or clot, forms in a deep vein, often in the leg. A part of this can break off, travel in the blood stream and block an artery in the lung, a so-called pulmonary embolus or PE.  This condition of DVT and PE can be fatal so firstly, thank goodness you had a full recovery! Certain medical conditions are coded by our genes and broadly speaking, we have two sets of each gene (with the exception of those that code for sex, the "X" and "Y" genes) one from each parent. If the gene coding for a medical problem is only one of the pair of genes the person is heterozygous, if present on both, "homozygous" which is the case for you.  

Factor V Leiden deficiency is one such inherited blood clotting condition and you are prone to further DVT's and possible pulmonary emboli so for medical reasons alone, you should be on this medication or your life could be at risk.No joke.  Although many people with this condition never have a problem, you have already shown that you may have a tendency to abnormal clotting. That is it, pure and simple. 

From an aeromedical perspective, if you go back on the anti-coagulant and demonstrate control as reported by your physician you can get back in the cockpit. What FAA looks for is that 80% of the monthly INR blood levels are between 2.0 and 3.0. If well-controlled by a physician coumadin is a safe and widely used medication.

Perhaps you might want to consider joining Pilot Protection Services (I am a fully paid-up member) as they can help you navigate these waters. 

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