Pilot Protection Services Medical Mailbag- August Q&A

QUESTION: I am currently flying as a sport pilot without a medical. I have a commercial license and am considering getting my medical back in order to become a CFI.

I am 60, have undergone heart surgery and a few years back obtained a 2nd class medical. Recurrent bouts with kidney stones also brought me into close contact with FAA but I kept going and most recently was diagnosed with Type 2 diabetes, controlled with medication (Metformin) and diet. What do I need to gather from my doctors to get my medical back and, assuming all tests are good, what is the chance the FAA would deny my medical?

ANSWER: In general if a person has a special issuance and decides to go sport pilot, I tell them to provide a very good status report , in your case from your cardiologist or internist that explains how you have performed since you let your medical certification lapse. This letter should include all your current medications and the testing that your special issuance letter had requested back then. There is a good likelihood that once the FAA reviews the information they may request more tests I am afraid.

As far as the kidney stones, you will need to obtain a status report from the urologist who treated you and will need to demonstrate to the FAA that you do not currently have any retained stones. Type 2 Diabetes mellitus on the medication Metformin requires a special issuance. You need to have been on the drug for 60 days before you can apply for consideration. The letter from your treating physician needs to state how they came to make the diagnosis, the date the metformin was started, whether you have any evidence of cardiovascular, renal, peripheral vascular, or neurological effects of the diabetes (what we physicians call "end organ" complications.) You will also need to provide a hemoglobin A1C level at the end of the 60 days.

If you are a member of the PPS PLUS program you can make a copy of all these evaluations and tests and send them to AOPA medical certification. They will review the paperwork and let you know what your chances are for regaining a special issuance.

QUESTION: My medical expired earlier this year and I was diagnosed with Multiple Sclerosis (MS) about a year ago. Since then, I have been on two different medications for MS and 4-5 months ago I went on Tysabri, as the other two did not work. I have done extremely well on this medication which requires an infusion every 28 days. I have not suffered from optic neuritis, my vision is 20/20 with good color vision and I walk well with all body parts functioning. I am on several different pills but am pretty knowledgeable about which the FAA won't allow. I have either eliminated them or am weaning myself off of them. I am a 69 year old pilot and other than MS I am in pretty good shape. I play tennis and swim. My last MRI showed no new lesions in my brain or spinal cord and all was stable. What are you thoughts about the likelihood of getting a special issuance so I can continue to fly?

ANSWER: MS is a neurological disease with a widely varying presentation and in fact was the subject of an article in AOPA Pilot magazine (“Is your wiring firing correctly?” September 2014, page 22).

Tysabri, a comparatively new drug, is an acceptable medication for multiple sclerosis. You must have had received 3 IV infusions prior to applying for consideration for special issuance. All of these cases will go to an FAA physicians for review. You need to have a favorable status report on the MS. The evaluation you provide must include a complete neurological examination with comments on any visual symptoms or signs and strength in your arms and legs. The Tysabri should be prescribed and comply according to FDA requirements. First and second-class airmen will require every 6 month follow-up reports from their treating physician. You can have the reports from your treating physician reviewed by the AOPA medical certification folks if you belong to the PPS Plus program.

QUESTION: A year ago during a physical checkup I was told that I had develop atrial fibrillation (AF) so I was referred to a cardiologist who prescribed Tikosyn and a cardioversion was done with success. This year I had my aviation physical and was grounded by the FAA. I have no symptoms and my cardiologist is trying to get me off the medicine since I am in normal cardiac rhythm and have had no further problems. Any advice to recover my third class certificate?

ANSWER: AF is the most common heart rhythm problem and is most commonly due to some faulty electrical cells in the heart that cause the upper chamber to “fibrillate” or squirm around like a bag of worms. This can be totally asymptomatic or can cause serious medical issues. Often controlled with medication, it can also be handled by “zapping” the errant cells with a dose of electricity, or “cardioversion.” You have not provided us with enough information to determine what you need to do in order to regain your medical certification. If you were still on the Tikosyn, that medication is unacceptable to the FAA for treatment of any irregularity of the heart rhythm. There are many medications that are acceptable for treatment of AF. We would need to review the FAA denial letter to best advise you. If you are a member of AOPA's PPS program you may phone AOPA's Medical Certification section and they can advise you on the best approach to regain you certificate.

QUESTION: As a child and young adult I suffered from symptoms of attention deficit disorder and at that time there were no drugs or treatments so I learned to cope. I made it through college and graduate school and 30 years in my chosen profession.

Earlier this year I read an article about potential benefits for adults from the common drugs used to treat this disorder. I talked with my family Doctor and decided to try Ritalin. After a month on the medication I could tell very little difference. I was only taking the medication occasionally because of its limited results. I listed it on my medical application and went in to renew my 3rd class medical. It never even crossed my mind that a drug designed to help me concentrate would be banned by the FAA. The Doctor told me that I now will have to be grounded for 90 days and jump through various other hoops to get back in the air. Is this true? Is there any way to move the process along faster?

ANSWER: There is a moral to your story and one that we have stated and restated: before initiating a treatment for a condition, you should check with AOPA's drug list to see the FAA's requirements for a medication. You will have to demonstrate to the FAA that you do not have ADD. This is their policy guideline. I am afraid your AME is correct.

QUESTION: I had prostate cancer, have had surgery, chemotherapy and radiation. My PSA is less than 0.01. What are my chances of passing a medical? Should I just limit my flying to sport pilot, wait and see if they pass the driver’s license requirement or take the chance of being denied a medical and then have to hang up my goggles and scarf ?

ANSWER: Prostate cancer is common and problematic and was addressed in the pages of AOPA Pilot (“Pythons, figs, donuts and broccoli” August, 2010). Unfortunately you have provided too little information concerning your history but it sounds like you initially had surgical removal of the prostate and may have had one or more recurrences with elevation of your PSA? However, broadly speaking for FAA special issuance consideration, you will need to demonstrate that the cancer is in remission. The FAA will need to see the scans that your physicians performed to determine the extent of the disease. If you are still receiving radiation therapy, then you should not reapply as yet as they do not permit someone who is actively receiving radiation to fly until the treatment has concluded and the individual is without side-effects. If you are a PPS PLUS member, you may want to gather up the medical records and show them to the folks at AOPA's medical certification section.

QUESTION: I am a 52 years old Part 135 pilot. I need your help as I did not pass my 1st class medical because my right eye visual acuity dropped down to 20/40. I had an eye exam but my right eye was 20/25 with glasses and the ophthalmologist diagnosed macular degeneration. After two treatments my vision returned to 20/20 with glasses. My doctor sent all the relevant information to my AME and then this doctor talked to FAA. My vision meets the requirements but FAA have my medical certificate on hold.

ANSWER: FAA review can be slow – like many government departments staffing is not where it could be. Your case illustrates another principle we have preached: prior to one’s AME visit have an eye exam and resolve any issues first. Macular degeneration is a serious issue as I am sure you are aware and merits close and detailed attention. FAA will likely want to see visual field studies that can demonstrate if you have any areas of loss of vision. It is also likely that your treating Ophthalmologist will follow you closely. The FAA will need to know what medication they used to treat your eye. As long as you meet all the vision standards for first-class and do not have any significant visual loss, they will likely provide you a special issuance.

If you belong to AOPA's Pilot Protection services, the folks would be able to follow your case along at medical certification in Oklahoma City.

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