Pilot Protection Services Medical Mailbag- September Q&A

QUESTION:  I want to obtain my third class medical and have three issues I would value some help with.   I last flew about 3 years ago when I was diagnosed with duodenal plasmacytoma which was treated with surgery and chemotherapy. The following year I was diagnosed with papillary thyroid cancer, apparently unrelated to the plasmacytoma, treated by surgery and low dose radiation.   I have been told I must be in remission in both cases for over a year.  I also take Xarelto because of a history with blood clots.  I was on Warfarin before and have had special issuance medicals in the past. What documentation should I gather and what if any tests the AME or FAA will require to grant the special issuance.  I would love to get back up in the air this year if at all possible

ANSWER:  You have a complicated case. Let's take the easy one first: "the use of Xarelto for blood clots.” You should have reported the change from "warfarin" to "Xarelto" to the FAA.  If you notice in your special issuance letter, the FAA wants to know if there are changes in your condition or treatment.  The medication Xarelto is not acceptable by the FAA for "every" condition that warfarin was.  We would need to see your special issuance letter! 

For the plasmacytoma, the FAA will want to know how the tumor was discovered, be provided with the Admission and Discharge summaries from the surgery to remove the tumor, the Pathology specimen report, and any pertinent radiology reports and tests the physicians performed to determine the extent of the disease.  You will need a letter that states what chemotherapy medications were used, the dates they were started and the dates you completed therapy, and if you have had any complications. The FAA will also want to have copies of any scans and labs that your physicians are doing to follow the tumor. Lastly, you will need a current status of your condition.  I also suggest you provide the results of a current complete blood count to include platelet count.   

For the Papillary cancer of the thyroid, the FAA will want to know when and how the cancer was discovered, the results of any biopsies, the operative report from the surgery, the Pathology report from the surgical removal, when the radiation was started, the dose that you received and when the treatment was completed. They will also want a current status report that explains how things are now, the results of thyroid function studies and TSH level, and if you are taking thyroid replacement, the type and dose.   

You clearly have a very complicated case and if you belong to the AOPA PPS Plus program this would be perfect to work with AOPA’s medical certification folks who would review all the documents when you are ready to see how you will fare with the FAA.    

QUESTION:  Have you had any experience with anyone with an artificial cornea, in particular the K-Pro from Mass Eye and Ear Institute?  What does the FAA say about flying with this device?  If vision is better than 20/40 in the affected eye after the operation, is any further testing necessary?  Is a flight test required?  Special Issuance? 

ANSWER:  Clearly a novel question so we sought some feedback from several people including an FAA doctor who is a Regional Flight Surgeon and Ophthalmologist. 

The cornea plays a key role in vision helping to focus images. The Boston keratoprosthesis has gotten better over time, but the eyes that get them are end stage surface disease, and typically on the brink of one failure or another.  I would think the visual field would be constricted from this prosthesis, since the effective cornea is much reduced. Some patients receiving this device also have glaucoma so require field monitoring also. 

Our friendly FAA doctor said  “if faced with this in an airman--and I have not yet been challenged with an airman with this keratoprosthesis in my 14 years at the FAA-- I would look at the particulars of the case, and probably default to treating it like a monocular (single functional eye) pilot.  I would certainly make sure the other eye is normal.” 

My take on this is that it has not been approved and in the end may not be acceptable.  You see above that this doctor said that an airman who has  the corneal prosthesis eye would be considered "nonfunctional" and he would be placed in a monocular category and would definitely be on a special issuance. As such, providing the operative report, FAA Eye exam form, and Humphrey visual fields is required.  We shall keep tabs on this if further information becomes available and shall let folks know and in the interim, wish you well. 

QUESTION: I am a very fit pilot and have all the medical papers from my neurologist.  I was diagnosed with multiple sclerosis (MS) a year ago.  The medicine I use is approved by the FAA and I have my paperwork evaluation from the neurologist.  If I live in SC but get my medical in Georgia and the FAA requires a check ride , can it be done at the FSDO in SC? 

ANSWER:  Yes, you can request the FAA to send the authorization for the flight test to the FSDO of your choice.  Usually, the FAA special issuance doesn’t require a medical flight test if the MS is well controlled on medication.

QUESTION:  I'm a CFI and I have a general medical related question regarding idiopathic thrombocytopenia purpura & the FAA.  If an ATP were to be diagnosed with this condition, would there be any limitations imposed by the FAA on that pilot's 1st class medical / flying privileges? I assume it may depend on symptoms, platelet counts, and/or treatments; or maybe not at all?

ANSWER: “Idiopathic” is fancy medical speak for “we don’t know what causes it” the second word, “thrombocytopenia” means one has lower numbers of platelets in the blood, small particles that are critical to forming blood clots in the event of bleeding and “purpura” refers to the rash that one gets with “ITP.”

The condition can be managed with medication but sometimes removal of the spleen (and any so-called “accessory spleens” or “splenunculi”) is required. The FAA has granted medical certification for all classes to airmen who have the diagnosis of ITP and it will depend on what your average platelet count is and the treatment you are under. You will likely be issued a special issuance (waiver).  If you belonged to the PPS PLUS Program, the AOPA medical certification people can review your case file and give you a good idea concerning the likelihood of gaining medical certification.  

QUESTION:  I lost my medical due to fainting episodes and was diagnosed with right carotid sinus hypersensitivity and recently had a pacemaker implanted as a result. Please advise likelihood of restoring second class medical. Do I need to wait several months to submit normal function data?