Pilot Protection Services Medical Mailbag- July Q&A

QUESTION:  I’m 62 years old and completed another FAA flight physical. In the course of my flying career I have held every class of FAA physical and am curious as to why we get checked for color blindness every year? If my recollection of the section on genetics from my high school biology class is accurate (traits, recessive genes), color blindness is an inherited genetic defect. So once screened, why does the FAA require a retesting for color blindness? Is there an article in JAMA or Lancet that points to someone going color blind later in life?

ANSWER: Thanks for your email. Although your recollection is correct, color blindness is usually inherited and hence does not change with time. However, other eye disease such as glaucoma, age-related macular degeneration and diabetic retinopathy can cause color blindness, hence the FAA's insistence on a regular check up.

QUESTION: I'm curious about platelet donation over whole blood donation and any known affects other than the obvious increased risk of hypoxia associated with a whole blood donation.

ANSWER: Platelet transfusions are used to help patients with a bleeding problem. Generally, a platelet donation should not result in increased chances for hypoxia, however we recommend a period of 24 hours after donation and as always, as PIC you are responsible to ensure you are fit to fly.

QUESTION: What are the new CPAP use requirements? I have a special issuance with yearly review and have had 2 reviews already. I submit my saved graph for review. Usage averages 94% with an average of 4 to 5 hours sleep, which is my regular sleep requirements. Has FAA increased the nightly sleep requirements? 

ANSWER: Sleep apnea is widespread, increasing and dangerous. Often a function of being overweight, smoking or other problems, basically one’s airway is obstructed during sleep and with snoring, the patient suddenly stops breathing until the brain notices climbing carbon dioxide levels and forces one to make a deep inspiration. The bed partner of a person with sleep apnea also has disturbed rest and is often frightened by the experience of seeing their loved on stop breathing, then gasping for breath. First and foremost, one should address anything that might be contributing to this problem and certainly obtain therapy, like Continuous Positive Airway Pressure (CPAP) machines that keep the airway open during sleep.

FAA is aware of the long term health risks associated with sleep apnea and requires documentation that sufferers are being treated, either with a surgical procedure, with post-operative proof the problem has been solved, or by regular use of recording CPAP. The sleep requirements have not changed, the FAA wants the compliance report to show an average of 75% use of the days used in a period of time and an average nightly use of 6 hours. The FAA is aware that some machines will measure in 4 hour increments.  You need to see if you can get that measurement adjusted upwards.  Interestingly, the Medicare requirement is also an average of 6 hours use each night.

QUESTION: I would like to know how the FAA treats pilots that are being treated for Atrial Fibrillation ? 

ANSWER: Atrial Fibrillation (AF) is the most common cardiac rhythm disorder where the upper chamber of the heart, the atrium, “fibrillates” or wiggles like a bag of worms leading to ineffectual pumping action. You need to keep an eye on the medical sections in the AOPA e-Newsletters, magazine and Fly Well videos as this subject has been discussed many times!

The FAA treats AF as a special issuance condition.  It accepts treatment with “cardioversion,” which is where the heart is shocked back into a good rhythm and radio-frequency ablation, where the errant cells causing bad contractions are destroyed, but this results in a 90 day period of grounding post treatment. Chemical conversion with medication results in a 30 day period of observation.  If this is the first time you are presenting your case for review, you will need to provide a letter from your treating physician that describes how you presented, what was done to treat the AF, how you responded to the treatment and what medications you are currently taking. You will have to have a maximal Bruce Protocol stress test, thyroid function studies, a lipid panel and fasting blood sugar, and a 24 hour Holter monitor test, performed at the end of the 30 days if you were converted with medication and 90 days, if treated with cardioversion or ablation.  

FAA is cautious with good reason, although common and often benign, AF can lead to serious problems and merits careful review.

QUESTION: I recently had a partial left knee replacement followed a couple of months later by the same surgery on my right knee. I have not flown since and was just released by my doctor. My third class medical is due in two months and I asked the medical staff to send me all the relevant information. Can you please advise me on what I need to submit to my AME?

ANSWER: This kind of surgery is common and very successful for many people. All you will need for your FAA exam is a copy of the office note from your surgeon confirming what you had done, when , and that you have no restrictions to activities. Your AME can reissue your medical if you are otherwise qualified.

QUESTION: I just was diagnosed with MS. What are the next steps I need to do to keep flying?

ANSWER: MS or Multiple  Sclerosis afflicts the nervous system and potentially causes a wide array of symptoms.  This is a disqualifying medical condition and should ground yourself until you are stable on treatment. As we have said many times, you need to listen to your treating physician and take care of yourself first and foremost!  This condition does require you to have a special issuance where you must provide documentation to demonstrate that the condition is stable and you are taking acceptable medications.  When the time comes for you to present your case for consideration of a special issuance, you will need to provide the FAA with a complete neurological examination. The letter from the Neurologist should provide them with the history of how the condition presented (the symptoms you had), what neurological findings you had on exam, and typed reports of all scans you had to determine where the MS lesions were located.  You should also provide copies of all laboratory studies they performed on you as well. This normally will include the results of a spinal tap where the neurologist places a needle in your lower spine to draw off fluid for analysis.  

There are a limited number of medications that the FAA will accept for treatment.  You need to check with AOPA's data base or contact the medical certification people at AOPA headquarters.  If you are a member of the PPS PLUS program, you can send the medical certification folks a copy of the evaluation that the treating physician provides and they can advise you if it is sufficient and what chances you have of gaining a special issuance.  

QUESTION: I would like to educate the AOPA medical team about the use of neuropathy drugs for more than diabetes and epilepsy--there are more people using these drugs for the after effects of chemotherapy than other reasons.  I am a cancer survivor and had the experience of such medications and now am down to using them once in a while, but because the drug is not accepted by FAA I will not be able to get my medical back. Peripheral neuropathy is NOT a reason for denial!!    

Who do I contact for an explanation to the "powers that be"?

ANSWER: Neuropathy  literally means “sick nerve” and often manifests itself either as pain or strange or altered sensations. Many disease states can cause a neuropathy, diabetes being most common, but multiple sclerosis and many others can also be a culprit and some anti-cancer drugs do this also. Some of the medications used to address these symptoms are widely used for epilepsy and similar disorders, and while I understand your frustration, being aggressive to “the powers that be” is not constructive and I assure you that those of us endeavoring to serve our fellow pilots with medical guidance are well informed.

FAA is interested in the reason patients are taking medications as this may merit a regulatory medical action. Additionally, neuropathy affecting peripheral nerves if not severe and disabling could be granted medical certification, as long as the airman can manipulate the rudder pedals and is not having such discomfort to interfere with flight duties.  However, the drugs used for these conditions (gabapentin, Lyrica, etc.) are anti-seizure medications and are unacceptable to FAA for any condition.  They have side effects such as ataxia (loss of control of bodily motion), dizziness, drowsiness, fatigue, and sleepiness.  They can also cause double vision, depression, and tremors. All of these side effects are incompatible with flying. I certainly hope you make a full recovery from your illness and chemotherapy treatment and can be free of these medications. I also hope you can return to flying but please understand, the regulations exist for safety reasons and are not arbitrary.

QUESTION: In November of 2004 I was feeling some chest discomfort and at the urging of a doctor friend went to the hospital for some tests and was found to have some coronary artery blockages. It was decided the best approach would be open heart surgery and they did 5 vessel bypasses. I made a great recovery and was back at work in 2 weeks.

Now my question, the FAA requires me to have a treadmill test every year. For the last 10 years they have all been perfectly normal which has inspired my non-AME doctor to ask me “why are you doing this?” My out of pocket expense is $3,000 - $5,000 each time.  Is there any way to appeal this? 

ANSWER: Coronary artery occlusion is a progressive disease. The FAA follow-up requirements are fixed and they will not change them.  Everyone who has the same condition as yourself is required to provide the yearly stress testing. I know, it is expensive and frustrating but this is where regulatory medicine differs from clinical medicine. The good news, though, is that you are well and still able to fly!

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

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