Pilot Protection Services Medical Mailbag- February Q&A

QUESTION: I had a heart attack in December 2013 and they installed a stent.  Please guide me through what I need to do to get my third class medical back.  I am scheduled for a stress test and have a follow up appointment with my heart doctor thereafter. 

ANSWER: Heart disease is the leading killer of men and women in the USA so this is germane to EVERY reader! The best piece of advice? Avoid this like the plague it is – and if dodging an early death is not enough of an incentive, maybe avoiding the hoops you will have to jump through with FAA is! So, exercise, lose weight, stop smoking and eat a healthy diet.

Heart attacks occur when one or more arteries, tubes that supply oxygen and nutrient-rich blood to the heart muscle, are occluded and the area of muscle supplied dies. One treatment is to open up the narrowed vessel with a balloon and pop a metal stent in to the artery to keep it open. Some of these stents are coated with drugs to try and limit stenosis, or constriction, from happening again, others are “bare metal” stents.

The requirements to prepare for FAA are very well covered on the AOPA website and as a general rule, this is a good place to look first. So, here is the link and stay heart healthy!

QUESTION: I have read the articles Drs. Silberman and Sackier wrote about atrial fibrillation (Afib) with great interest, since I have contracted this condition. 

After 32 years of private flying without an incident, I had the misfortune of going to an AME who elected to defer my certification to the FAA for my irregular heartbeat while assuring me that the FAA was very easy on 3rd class applicants and my certificate would be issued with no problem. 

The actual result was that he opened up Pandora's Box and nailed me into it! Ironically, he mentioned that plenty of people live their entire lives with no problems from this kind of irregularity. My Afib is nothing like what is described in your articles; it is merely a late heartbeat from time to time, This has been the case all the way back before I began flying 34 years ago. Thus, I had passed 15 or 16 examinations with various AMEs, each of which had noted the irregularity in passing. 

I do not experience rapid heartbeats, have never passed out, fainted, or experienced any trouble in my many and varied athletic activities during the entire time I've been a pilot. I receive no treatment and have never sought urgent care for this. The cardiologist prescribed a mini-aspirin each day as a precaution. Actually, I cannot tell it is happening. I believe this is described as being asymptomatic. 

Now, I am trapped in a new world of unseeming and repetitive medical expense each year to satisfy the requirements for Special Issuance. To make matters worse, my cardiologist has retired, requiring me to start all over again with someone new. 

From my perspective, the FAA has taken a one-size-fits-all approach by lumping together under Afib, people who are without symptoms with people who are mortally ill with heart disease.  

Most unfortunately, this turn of events is driving me to the verge of a premature surrender and termination of my life as an aviator.

ANSWER: Atrial fibrillation is the most common heart rhythm disorder and while often symptomatic, it can become very problematic. Thankfully there are many treatment options that FAA finds acceptable. While we share your frustration that there are many airmen who have no symptoms with their Afib, the issue is that the complications are the  same.  The FAA looks at airmen with Afib the same. Even though you have no symptoms, you could still develop a clot that could break loose and lead to a stroke, or you could develop a chronic Afib condition.  People who have Afib eventually develop enlargement of their atria, one of the heart chambers and the Afib could become more difficult to control.  Hope you do continue to fly and can confound the obstacles with patience and understanding, as irritating as it may be.

QUESTION: I recently read Dr. Sackier’s article entitled "Is your wiring firing correctly" in the AOPA magazine. I can't believe I'm actually one of very few pilots with Multiple Sclerosis (MS) with third class medicals! 

Your article reminded me to ask if the FAA has made any decision on Tecfidera yet. It's a recent oral medication for treating MS. I'd like to get off the injection based treatment I'm currently using as I am getting awfully tired of giving my self shots on a regular basis. However, the last time I checked, the FAA hadn't issued any ruling on Tecfidera for pilots. 

Do you know anything about the FAA's process/status on making a decision about Tecfidera?

ANSWER: The process by which FAA approves drugs is long and bureaucratic and comes on the tails of FDA approval. Simply put, they want to see a drug in clinical use for a while before even considering approval for use by aviators. 

However, TECFIDERA (Dimethyly fumarate) for Multiple Sclerosis is acceptable for FAA. You would require a 30 day period of grounding after the medication is started and then a statement from the treating physician that includes why this med was chosen, any side effects and how the MS is responding.   

Medical Certification at FAA has also recently approved the medication AUBAGIO (=Teriflunomide) a "tetraeptide epoxyketone proteasome inhibitor" (now you know why they come up with fancy names!)

QUESTION: Someone was the first bypass, stent, diabetic, cancer, stroke patient to receive an FAA medical. I would like to be the first Gliobastoma survivor. Are you interested in the challenge? 

I had a 100% resection at the Cleveland Clinic with no seizures. I have no symptoms; headaches, dizzy, blurred vision, loss of reaction/motor skills, memory, language/speech, calculative skills. In fact I work out everyday, ride 24-30 miles continually. I'm probably in bettor health than ever.

I take no  medications at the moment and could easily pass a class 1 Medical and have been assessed from stem to stern and may well be demonstrably healthier than the bulk of airline and professional pilots out there.  

ANSWER: For those of the readers who are not familiar with the term, Glioblastoma is a primary brain tumor, meaning it originates in the glial cells inside the head. Left untreated it is fatal as I am sure our correspondent knows.

I need to be very straight here, you have a huge uphill battle.  I do not believe that FAA have ever granted a special issuance for this condition.  The only class medical you would potentially be able to obtain will be a third-class.  If you are totally committed  on trying this, here is what you will need to obtain and, if you are an AOPA Pilot Protection Services Plus member, Dr. Warren Silberman, with his vast experience, and the team at AOPA will endeavor to support you to the best of their ability.

1. How the tumor was discovered.

2. The initial MRI or CT scan of the brain. You will need to obtain copies of the actual films to provide to the FAA.

3. The operative report from the surgery

4. The Pathology report from the tumor taken at surgery

5. A note from the oncologist, if you have seen one.

6. A current, complete Neurological examination performed within 90-days of sending the case into the FAA.

7. A current Electroencephalogram with copies of the tracings provided.

8.  Whomever is following the tumor needs to prognosticate on what the chances are for recurrence.  This will be a very large issue and needs to be well worded.

You may need to obtain more information, once we review what you provide. No promises, but it would be a privilege to support one so brave. Regardless, we wish you well.

QUESTION: I inherited this gene from my French ancestors who populated the Québec Province. It’s called Dupuytren’s Contracture as you probably know. About 3 years ago I had the surgery and since I am right handed, it’s a hell of an inconvenience. Now it’s back and this time it’s not only one finger but spreading to my whole hand. It’s so bad I can’t wear gloves. Is there any way or treatment available to avoid surgery?

Thank you in advance for your kind answer. 

ANSWER: Dupuytrens Contracture can be inherited as in your case, or acquired as part of other disease processes and afflicts maybe 10 million Americans. Effectively it is a healing process in tissue that was not damaged and the scarring causes the tendons that flex the fingers to become thickened and contracted, drawing the afflicted finger to bend towards the palm in a permanent bend.  

There have been many attempts to address this from drugs taken orally or injected including steroids, allopurinol, colchicine, tamoxifen and 5-Fluorouracil, the latter two being known primarily as cancer medications. 

Non-surgical therapies have included massage (which does not seem effective), splinting, radiotherapy and other energy sources beamed into the affected area.  

Surgery consists of minimally invasive needle-born approaches all the way to excising the damaged tissue. While none are perfect, it is clearly to your benefit to see a good and experienced hand surgeon and discuss all the options. I am sure that the alternative medicine/homeopathic folks have some ideas but I am not at all clued in to that space. 

I do wish you the very best of luck and a happy and healthy 2105!

QUESTION: I am a public servant and have flown for a living, and for the past few years debated whether or not to take the SSRI anti-depressant, Lexapro. Having decided to take the medicine and duly report it, I have experienced a major hassle, and I want to share my frustration with the pilot population, to hopefully let others know the trap they could find themselves in, which in my case means loss of employment. 

The short story is I took a Cognitive Screen test, and my score is 0.9082.   The range is: 0 - 1.0 which the way I read it means I am within the limit.  Also, the test is for those under the age of 45, and I turned 48. 

My AME stated they he does not feel comfortable signing me off for a special issuance due to the score, and may request additional tests, and sent it off to a private firm to aid in making the decision. I am concerned that this is headed towards a denial, and I will have to spend even more money to defend this.  

This saddens me more than anything, especially since I did it the honest way, unlike so many others who just take the meds and do not say anything to the AME.  Perhaps they are the smart ones?

ANSWER: Firstly, I am so sorry you are going through this issue but let me state categorically, doing it the honest way is the ONLY way to go; making a fraudulent statement opens one up to all sorts of problems.  

Once a case goes to Washington it is out of "our" or anyone's hands.  An LRPV score of a CogScreen above 0.67 is abnormal, so your score of 0.9 + is not “good" and generally when one has an abnormal score such as that, the clinical psychologist will perform more specific neuropsychological testing on the areas of abnormality.  These cases are reviewed in Washington by a clinical psychologist and a Psychiatrist.  Washington is a "black hole" and it is taking many months to review things. If it is any consolation, let me restate that telling the truth will set you free so I cannot excuse aviators who lie. But I do feel for you and my fingers and toes are crossed.

Topics: Pilot Protection Services, AOPA Products and Services, People

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