Pilot Protection Services Medical Mailbag- March Q&A

QUESTION: My second class medical is coming up in a couple of months and I need some advice with two issues. I am a 56 year male, a little bit on the heavy side but have never smoked. I have hypertension (high blood pressure, "BP") known to FAA for over ten years and am treated with exercise and some medications. Last year my blood sugar was mildly elevated but my AME provided an on-the-spot waiver and I had given him a form AOPA supplied detailing my hypertension history, signed by my primary care physician that said I was fine and I was thrilled to walk out with my medical intact. I have been using home monitoring equipment to measure my BP which seems okay and blood sugar, which has been borderline high and I seem to be edging closer to the diabetic stage.

ANSWER: First it is really important to note that the single biggest thing you can do to improve your health - and your chance of retaining your medical is to get some weight off, increase your exercise tolerance and watch your diet; these steps will impact hypertension and blood sugar issues. That aside, FAA policy dictates that one BP in the AME's office cannot be 155/95 or greater. However, one can deal with by repeating the measurement after a few minutes to dispel "white coat hypertension" or undergoing a 3 day BP morning and evening check and taking an average of those numbers. 

QUESTION: I am a private pilot working toward my Instrument rating. I spent 1.5 years corresponding with the FAA to get my Special Issuance Medical so I was very happy to hear about the CACI.

My primary care physician has been monitoring my liver enzymes for over 10 years which have remained stable since completing interferon treatment for Hepatitis C.  I feel great, but my primary wanted me to talk with a specialist about the a new multi-drug therapy as there was some concern the initial infection may not have been obliterated. A liver biopsy was performed which showed some inflammation (9/16) and scarring (5/6), leading to a recommendation I have the treatment, but if I do, I can't fly so I am putting it off. But I will need to have documentation for my next medical due in about 18 months and do not want to have another biopsy nor do I want to risk the lengthy treatment that doesn't offer a cure, just a 60-80 % chance of the virus becoming undetectable.

So, my question is this: Do I have to have a biopsy ever 2 years to get my medical? Isn't my blood work sufficient? If not, then what is the criteria that says I am too sick to fly? I feel great...I eat a healthy diet, exercise regularly, work and play like anyone else and I am (as far as I know) not going to 'fall apart' instantaneously. If my results were 6 out of 6 scarring, does that disqualify me from flying? I haven't been able to find a good resource for this information and my pilot buddy suggested I contact AOPA.

In closing, do you know of other pilots having Hepatitis C and how they are dealing with this. Please help me. I have waited 35 years to continue my flying and now it seems as though I have to give it up again. 

ANSWER: Chronic Hepatitis C infection is a very widely prevalent in our society and is a scoundrel of a disease in that it does not declare itself until very far advanced and is usually detected either as a result of screening or when it causes liver failure or liver cancer, both life-threatening conditions. Hepatitis C is now one of the "CACIs" - Conditions AMEs Can Issue.

Traditionally the condition has been treated with Interferon Alpha and as soon as an airman is placed on this medication, they are disqualified from flight until treatment has been completed and any side effects have resolved. 

As long as the airman is "stable" they can continue to fly and be "cleared" by their AME. This means that they must not have evidence of cirrhosis of the liver, esophageal varices (swollen veins in the esophagus which can burst and bleed very heavily) or other indications of serious problems. If the cirrhosis is stable, certification may be granted, probably as a special issuance, but once complications arise, denial will follow.  

Such airmen are required to have yearly follow up status reports and liver function tests from their treating physician to provide to the AME but there is no requirement for "regular" biopsies. That is left entirely to the treating physician. 

The infection can come from a variety of sources; contaminated blood transfusion, injected illicit drug use, tattooing, various sexual practices and so on. Getting screened makes eminent sense if you may be at risk. 

QUESTION: I have a second class medical that expires in a couple of months. I have a umbilical hernia that I need to get repaired. Should I wait until I get a new medical or does it matter? 

ANSWER: A hernia is where an organ or part of an organ protrudes beyond a tissue barrier that should constrain it. Umbilical hernias are common and can cause some discomfort and in rare circumstances, a knuckle of bowel can get stuck in the opening which can require an emergency operation. If you think you have a hernia due to an odd or new bulge, always get it checked out. It really makes no difference when you have the procedure. You must obtain the operative report and a note when the physician releases you back to full activities.  Provide these reports and the AME will be able to issue an unrestricted medical certificate providing you have had no complications. 

QUESTION: I have problems with two of my heart valves; moderately severe mitral regurgitation some of which is directed into the left atrial appendage and the aortic valve is showing moderate insufficiency and there is mild left atrial enlargement. My cardiologist recommended stop flying until I get this repaired/replaced. He feels the aorta will deteriorate to the point I need surgery in the next 6-12 months. Another doctor thought I might be able to continue flying for a short period by submitting my test results to the FAA.

I opted to self ground until after surgery in order to not lose my LSA option. What are the differences between Class I,II,III for recertification after surgery and what is the wait time for a valve replacement vs. repair or two valves repaired?

ANSWER: The heart has four chambers, the right atrium receives blood from around the body, pumps if across a valve into the right ventricle and thence towards the lungs across the pulmonary valve and through the pulmonary artery. Oxygenated blood returns to the left atrium via the pulmonary veins, crosses the mitral valve into the left ventricle which then pumps the blood across the aortic valve into the aorta and around the body. The valves serve to ensure blood goes in the correct direction and valves fail in one of two ways; they may become "stenotic" or narrowed and thereby limit flow, or "incompetent" or insufficient meaning blood regurgitates into the other chamber which diminishes the efficacy of the cardiovascular system. Additionally, the turbulent flow across diseased valves can increase the likelihood of a stroke. So it should be apparent that this is serious stuff.  

The good news is that modern therapies either at open surgery or by placing valves through minimally invasive techniques are very successful at returning people to great health. The initial certification for valve replacement requires a 6 month observation period. All first and second-class airmen must have their cases reviewed by the Federal Air Surgeon's Cardiology Consultant Panel.  Double valve replacement is also reviewed by the Panel but, in addition, is also reviewed at the Federal Air Surgeon's office in Washington, DC.  Valve repair requires a 3 month period of grounding and can be reviewed by the local FAA physicians.   

QUESTION: I have owned and flown aircraft for about 40 years, am 68 and have endured  some difficult times recently. My doctor has  suggested I use an anti depressant to prevent anxiety attacks, which have happened 3 times over a 15 year period. In the pass few months I was treated for prostatitis with 3  types of antibiotics and was possibly having anxiety attacks after this treatment. I have to go on something to relieve uncomfortable physical feelings. 

ANSWER: Depending on the particular medication used by your physician if you go on an "anti-anxiety" medication you cannot fly with any class of medical.  You would need to be off the medication for 90 days and having no problems to be reconsidered for medical certification.  I am sure you have heard of the new FAA Policy on Depression and the use of SSRI medications;  there are now 4 of these SSRI medications that the FAA will consider granting special issuance for. Currently you must be on the same dose of one of these medications for a full 12 months to be considered.  Please check the AOPA webite for the protocol (

QUESTION: What is the FAA's view on implants? Can a female, with breast implants, qualify for a 1st, 2nd, or 3rd class pilot medical? Likewise, can a male, with a testicular implant, qualify for the same?

ANSWER: Breast and testicular implants are acceptable to the FAA.  The airman would need to provide the operative report from the procedure and a note as to how they have done post operatively.

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