Pilot Protection Services Medical Mailbag- June Q&A

QUESTION: I am a 68 year old male and had major surgery craniotomy for a brain tumor called "GBM" in March of 2012. I have quarterly MRIs and neurological exams and they have all been clear and normal, most recently was this February (2014). I have no neurological symptoms such as seizure, stroke or visual impairment and am otherwise in excellent health and work out regularly. I self-grounded and let my medical lapse and would like to know my options. Thank you. 

ANSWER: The majority of brain tumors are secondary deposits or metastases where fragments of a cancer arising in the lung, breast or colon for instance travels around the body and sets up shop inside the head. However, GBM or "glioblastoma multiforme" is a primary tumor, arising in the brain tissue itself. These tumors present with a range of issues such as headache, morning nausea, or neurological symptoms such as you mentioned. Treatment usually consists of surgery to remove as much of the malignancy as possible, radiotherapy and a range of drugs to either directly attack the cancer or address symptoms. As for getting back into the cockpit, this is a circumstance where Pilot Protection Services can be hugely helpful. Certfification will depend on cell type and tumor location which might require neuropsychological testing. You would need to provide the records and report from the treating physician to detail how the tumor presented and include the operative report. The pathology report must be included as must a detailed description of all treatments with any side effects. You will then need a current neurological examination and status report together with an MRI with and without contrast and provide copies of these films and the original one showing the tumor. Additionally, you must list current medications and side effects.  

QUESTION: I am two months into a six month regime of chemotherapy for colon cancer and things are going well so far.  My class III medical is due next month.  I am, of course, not flying now but hope to once I get back to normal.  Is there anything I should do at this point or just wait until I am back to normal to reschedule?

ANSWER: Colon cancer is where cells inside the lining of the large bowel start dividing in a disorganized and accelerated manner. Initially the tumor takes the form of a polyp, rather like a small cauliflower stalk and it may cause few symptoms other than some blood in the stool - always a reason to see your doctor. About 150,000 new cases arise every year in America and this disease kills tens of thousands of people annually - almost totally avoidable if one has a screening colonoscopy starting at 50 years of age. If a colon cancer appears, it is treated with a blend of surgery, radiotherapy and chemotherapy to kill any aberrant cells that might be lurking elsewhere.

In order to get back to flying you need to obtain a statement from the treating physician as to how the colon cancer was discovered, the pathology report from any biopsies that were taken and if you were admitted to the hospital for surgery: the hospital admission and discharge summaries, Pperative report from the surgery, and the Pathology report from the tumor that was removed. Additionally you will need reports from any scans that were done to evaluate whether the tumor had spread beyond the bowel.

You will also need a report from the oncologist who is treating you as to when the chemo was begun, what drugs they used, the date that they were stopped, and, if you had any side-effects, what those were.

If the physicians were monitoring a tumor marker, "Carcinoembryonic Antigen" (CEA) you will also need to provide a current result. You are grounded now and cannot fly until you receive written permission from the FAA.

If the cancer spread to the lymph nodes outside of the bowel, you will require a MRI of the Brain - as you will note from the prior letter above, there is a small chance that these cancers can spread there. When you have completed the chemo, you can apply for a special issuance (waiver)

QUESTION: I'm planning on having a left full knee replacement this year and understand that I will need to bring files/paperwork for my AME to review post surgery in preparation for renewal of my 3rd class medical certification.  Can you please help with "what" I need to have prepared and by whom? 

ANSWER: Osteoarthritis or "wear and tear" of the knee joint is the most common reason why hundreds of thousands of Americans have their knee joints replaced every year. The surgery is very succesful and the most frequent complaint voiced by patients is that they wished they had done it sooner.

It is a very good idea to prepare prior to your FAA examination and I commend you for that!  You need to bring the operative report from the knee surgery and what the FAA calls a "current status report".  This is preferably a typewritten letter from the treating surgeon that states how you have done since the surgery, notes how strong the leg is, evaluates the range of motion in the affected knee and lists any medications you are taking.  This particular condition does not usually require a special issuance (waiver).

Please note, you cannot be taking any narcotic pain medications and pass your medical. These would include drugs like Tylenol #3, Vicodin, Percocet, or Ultram. 

QUESTION: I recently passed my third class medical on 01/02/2014.  In the limitations it states “Not valid for any class after 1/2/2015.  Should this date read 1/31/2015 and what do I need to do about this?  Thanks! 

ANSWER: You are likely correct about the date! We cannot really tell you for sure without reviewing the actual Special Issuance Authorization letter. In general an expiration date is the end of the month.  You can phone the Customer Service people in Oklahoma City or even your Regional Medical Office and ask them. The OKC phone number is 405-954-4821. It is an automated system. Wait till you hear the option to speak to "customer service" or depending on the type of special issuance, if it is cardiac, you can dial the Medical Appeals section.  Make sure you have the letter in front of you.  Alternatively, you can write them a letter and explain the situation. 

You may already know this but use the PI number at the top right hand side of the letter. This is the "best" search mechanism for them to locate your case in the electronic system.

QUESTION: Must I report a doctor visit for minor back pain? What about an ER visit for a kidney stone that passed easily? Seems unnecessary to me!

ANSWER: The comment on Block 19 of the medical form asks the airman to provide "EVERY" visit to a health care provider within the prior 3 years of obtaining the FAA examination, so yes you must report both. If, however, one sees a physician multiple times for the same condition you can write in the "reason" section of that block that they were "seen multiple times for kidney stones."

Additionally, a kidney stone is disqualifying, but if it was your first stone you need to gather the medical records on the event, such as the Emergency room records if you went there or the Urologist's notes if you went there. You need to also provide proof that there are no stones remaining in the kidneys as that is a situation that will result in a special issuance.  If the doctor requested any laboratory tests, those should be provided as well and from a medical perspective you should want  to know why you had this in the first place and if it might return.  If you were able to retrieve the actual stone and the doctor sent it for a "Stone analysis" , that should be provided as well; it is not unusual to be asked to pass urine through a sieve so that one may capture the errant stone. If this was your first stone passage and if there are no retained stones in the kidney, your AME will be able to issue you a medical certificate.  One last important thing, if this was your first kidney stone and there is no evidence of retained stones, you can fly and provide all these records at the time of your next FAA examination.  

QUESTION: I lost my medical certificate due to being diagnosed with glaucoma and a substantial loss of peripheral vision even though I still have 20/20 vision. I have two friends that have only one eye, yet are able to retain their medical certificates. Is there anything that I can do to regain my medical certificate ? FYI I am commercially rated land and sea MEII. 

ANSWER: This would have been perfect case for the Pilot Protection Services medical certification folks at AOPA. I suspect you had significant visual loss in both eyes.  We would have had to see your Visual Field results to understand why the FAA denied your medical.  Classically, glaucoma initially affects one's peripheral vision. Take note that one's best vision is in the portion of the retina known as the "fovea centralis".  This is why a person could be 20/20 and yet have visual loss in a significant portion of the remainder of the visual field. 

 A person who has one eye (Monocular vision) must have "normal" vision in the "good" eye and have no disease that could result in a diminishing of that vision.   

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