Pilot Protection Services Medical Mailbag- October Q&A

QUESTION: What do I need to do to get back up in air after heart bypass surgery? Thank you in advance of your answer. 

ANSWER: Cardiovascular disease is the biggest killer of pilots - and everyone else - and the most common manifestation is coronary artery disease, where the blood vessels that supply the heart muscle with oxygenated blood get blocked by "atheroma" which means "porridge tumor." These fatty deposits are a result of poor diet, lack of exercise, obesity, smoking and bad genes. Sometimes the problem presents with six inches of unwanted newspaper print and six feet of undesirable real estate - sudden cardiac death. Other times one will suffer a heart attack or "angina pectoris," chest pain caused by heart muscle literally crying out for oxygenated blood.  

If detected in time the narrowed or blocked artery can either be opened up by a stretching balloon and then held in that position by a stent,  a metal cage or tube basically. Other times surgeons have to go in and bypass the diseased artery. Thereafter the patient must change their lifestyle and take a number of drugs to minimize the chance of further problems. 

Of course, every pilot wants to keep flying and if one has survived a heart attack or headed one off at the pass with therapy as above, FAA has some pretty tight stipulations which you can learn about at one of AOPA's great online resources.  


Even better, change your lifestyle now before it is too late; check your blood pressure and lipid levels and keep your ticker ticking!

Staying with the heart theme...

QUESTION: Imagine my surprise learning I have mild, maybe severe, aortic value regurgitation!  Many of my pilot friends are saying "you are so done flying, forget about it!" 

Since I have a medical due soon, I've been researching this and found that in some instances, medicals are granted for mild aortic valve regurgitation. Since I have no symptoms at all, exercise a lot at age 67, feel great, some friends suggested I falsify the form and tell the FAA all is fine, since doctors think my heart sounds great, but I am determined to be honest and face the music and give full documentation of what they find. 

I have seen a top heart doctor and he is already doing the tests that the FAA will require.  Full blood workup, (looks perfect), two electrocardiograms which are normal, two echocardiograms, during one of which they measured pressures in the various parts of the heart and I could actually see the regurgitation on the screen, as well as a nuclear stress test.  My heart chambers are apparently normal in shape and I sit down with the doctor next week to go over it all. I know more about my heart's operation than any other part of my body now. We also did  echo tests of my carotid  arteries (some blockage on the right one, but not too bad yet). 

With the FAA so strict now, will any of this help or should I get ready to sell my airplane? I'd appreciate your opinion.  I'm also afraid to call my FAA flight doctor before my physical is due in case he ground me on the spot!

ANSWER:  As you now know there are four chambers in the heart and four valves which are intended to keep blood flowing in the right direction. The aortic valve guards blood being ejected from the left ventricle into the aorta, the main blood vessel in the body and then the blood travels to arms, legs, head and everywhere else. With a history of aortic regurgitation, the FAA will need to see all the test reports you mentioned.  If the echocardiogram shows mild to moderate regurgitation and you are otherwise symptom free, and there is no other cardiovascular history going on, I anticipate the FAA would be able to certify you with a request for an annual echocardiogram and status report from the cardiologist.  Obviously, we are shooting from the hip based only on what you mentioned in the email, but with that information to work with, it is our opinion that you would be OK.  As a Pilot Protection Services Plus member, we could review the medical records for you and probably be able to give you more specific information about the likelihood of certification, so you might consider joining PPS Plus. We are all members! And finally, always report honestly on the FAA forms - not only are there penalties for falsification but as in all aspects of life, the truth will set you free and the great thing about telling the truth? You never have to remember what you said! 

QUESTION: My Doctor just changed my Type 2 diabetes prescription from Januvia to Tradjenta. I also take Metformin. Will this affect my certificate?

ANSWER: The medication Tradjenta is in the same family of medications as Januvia but in oral form.  It is acceptable with Metformin but you need to report this to the FAA after the change is made. You should ground yourself for 14 days and after that obtain a letter from your treating physician regarding the change and a repeat hemoglobin A1C level and send this into the FAA.

QUESTION: I have a question about vision and my 1st class medical:   I know that checking the 17b "near vision contacts" box is 100% of the time a wrong choice if one ever wishes to receive their medical!  Doesn't matter if you have bottle bottom lenses my understanding is there is NO upside and 100% downside to checking this box. Am I basically correct? This went from a trivial non-issue to me (I do wear -3.75/-4.75 distance contacts) and have been forced to carry/wear +1.75 reading specs for close vision.  Last year however my eye doc had me try some soft contacts with same specs by adding +1.75 close vision area to my left eye only.  Wow, I can see perfect distance with same (in my opinion) depth perception and stereo vision as before, but now I have really good close vision.   It took me less than 15 minutes for my brain to adapt and I have not taken them off since.... except to wear old contacts with glasses to pass my Class I medical. Any advice? 

ANSWER: You are now considered to be wearing what is called "monovision contact lenses". This is exactly what the FAA is referring to in question 17b.  This is prohibited and will result in a denial if the FAA finds out about it. As we have said before, tell the truth or deal with the consequences.

QUESTION: Why does the FAA consider that my Type 2 Diabetes is not under control if I am successfully keeping hemoglobin A(1)(c) below 7.0 with more than three medications? The other choice is to become insulin dependent which, to me, is worse medically and certainly a lot harder to maintain flying status. Why should it matter how many medications it requires?

ANSWER: The FAA Diabetes consultants felt that if an airman requires more than 3 medications to control their diabetes that they are NOT under adequate control. I know, it is tough but this is where aviation medicine differs from clinical medicine, we are dealing with a bureaucracy.

QUESTION: At this point I have a third class medical under special issuance. I have non Hodgkin’s, Large B cell lymphoma that is in remission. Last cancer check up revealed a secondary diagnosis of therapy-related acute myeloid leukemia (AML). This is presently being treated with chemo with intent of  reversing the cells action and producing good cells from the bone marrow. Outside of a stem cell transplant (not practical at 82 says the insurance company) there is no cure only maintenance for a reasonable quality of life. As chemo clears my body, will my third class medical be valid? I would love to fly again.

ANSWER: We are very sorry to hear about your current medical condition and wish you a speedy recovery. Both Non Hodgkin's Lymphoma and Acute Myeloid Leukemia (AML) are disqualifying medical conditions and you should not exercise your third-class medical privileges.  Also, the FAA does not allow an airman to fly when they are receiving chemotherapy.  In general, an airman who has a Non-Hodgkin's Lymphoma may reapply for a special issuance when they complete their therapy and the side effects of that therapy have resolved. However, unfortunately, in your case, you now have the AML. The FAA does not grant a special issuance to airmen with this condition until they have been in remission for at least two full years.

QUESTION: The Fly Well article in the September 2014 issue of AOPA Pilot magazine triggered my synapses to fire off this question. I was a US Naval Aviator and instrument flight instructor in the late 1970’s through early 1990’s, and then a private pilot including ownership of Bonanza’s and an Aztec. In 1999 I had a right cerebral aneurysm that leaked, was treated by clipping and did okay afterwards. In the last couple of years I was experiencing some strange sensations after eating. Initial investigations with standard upper GI studies and so on I was sent to a neurologist and after being studied was diagnosed with epilepsy. This was treated with Gabapentin, an anti-seizure medication and for 9 months I have been symptom-free. Will this diagnosis preclude me from ever obtain a medical certificate again? 

ANSWER: Thanks for writing and we are sorry to hear of your woes and kudos to you for serving your country and thank you for your kind words about the articles. The policy guidelines for seizure disorder state: 

A single seizure, no definite etiology -> 4 years seizure free and the most recent two-years off any medications; 

If a seizure(s) can be DIRECTLY related to some treatable condition such as for example hyponatremia (low sodium levels in the blood) or a benign tumor that is surgically removed, then the medical condition will prevail and one can recover the medical certification; 

An immediate post-traumatic seizure after a head injury, the time of loss of consciousness and post traumatic amnesia, and/or blood in the brain will determine the length of grounding;  

More than one seizure = Epilepsy = TEN years being seizure-free and the most recent three years off medications; 

NO anti-epileptic medications are acceptable for flight. 

Sorry to be the bearer of tough news.

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