Pilot Protection Services Medical Mailbag- March Q&A

QUESTION: My father had a heart attack last year at age 67; I am almost 46.  Because of this, I had a precautionary heart scan, which showed very slight build up in one artery.  Given my family history, age, and the scan finding, my physician advised me to start taking a low dose statin, despite my cholesterol level being low.   Before I agree to taking the statin, I would like to understand what the implications are for my Aviation Physical.  I presently am a private pilot but am considering adding a commercial rating.  Would taking this low dose stain have any impact?  If so, what are the impacts and what are the best ways of handling th  

ANSWER: Good for you in being proactive – although your cholesterol level might be low (and one must take into account some more data on specific lipid levels) your family history is a concern. Heart scans are high speed CT investigations that reveal calcium blockages of the coronary arteries even before they are symptomatic. Like any medical test there are false positives and negatives and it should be used after consultation with your doctor. A statin is, as you probably know, a drug that reduces fatty levels in the blood and may even protect against heart attack in people with perfectly normal cholesterol levels by reducing inflammation. You must inform the FAA at the time of your next examination of any health care visits in Block #19 of the form. Since you reportedly had a "positive" heart scan for some calcium, the policy for 3rd-class airman is that you must have a Maximal Bruce Protocol stress test, which is where you run on a treadmill while your heart performance is measured. Yes, this is a bit of a pain, but not as much as having a fatal heart attack. As far as the low dose statin, you must report it on your next FAA examination in Block #17.a., but need do nothing else. This does not require a special issuance or any other reporting requirements.  

QUESTION: Seven weeks ago I finished radiation treatment for oropharyngeal cancer.  I shall soon wean myself off pain-killers that have caused me to ground myself and I’m anxious to get back in the air.  The folks at AOPA Pilot Protection Services have been very helpful and I understand that cancer is not a notifiable disease but advised I keep the FAA informed.   I believe I should send copies of reports of the PET scans.  Should I also send reports before and after treatment, and should I also send CD copies of the images?    

ANSWER: Cancer may not be one of the fifteen specifically disqualifying medical conditions but it is disqualifying and you should NOT fly until you receive a special issuance for the condition.  Here is what the FAA will need: 1. A letter from the treating physician that states how and when the tumor was discovered. If you were admitted for surgery then the history and physical examinations, discharge summary, operative report and pathology reports. You should also provide the results of all testing that was performed to determine any metastasis.  (scan reports, x-rays, etc.) 2. You need to provide the results of all treatment programs if it was radiation when it began and when it concluded as well as the total dose of radiation. You also need a current status report from the Radiation Oncologist. He/she should state all side effects of the radiation treatments. If you received any chemotherapeutic medications: what they were, the dates of treatment [esp. when they were discontinued]. 3.  You obviously need to be off all analgesic medications prior to initiating the recertification process.   4. Just before you are ready to present your case to the FAA, you need to provide a current status report from the Treating physician. This should list all current medications and plans for follow-up and if possible her prognosis. You should also provide the results of all scans and laboratory results that have been performed since treatment was discontinued.  I hope this helps and wish you the very best for a speedy and full recovery – and for anyone reading this who does not have oropharyngeal cancer you can reduce your chances of becoming like our brave reader by avoiding all forms of tobacco and avoiding excessive alcohol intake.

QUESTION: I have now had a third episode of kidney stones within the last 12 years, with the previous episodes reported to the FAA.  I just had laser therapy by minimally invasive means to break up one new stone and passed it successfully, but apparently still have one stone in each kidney with no movement recorded.  Can my local AME approve my Third Class medical with the appropriate paperwork, lab reports, c-scan, etc., provided?  

ANSWER:  It appears that you may be a "stone former". Your AME may NOT issue you a medical certificate!  First of all you need to have the urologist perform metabolic testing to evaluate why you are having these stone episodes.  Second, you now have retained kidney stones and that requires a special issuance.  You need to provide the FAA with the operative report from the Lithotripsy (fancy word for stone-breaking procedure), and some x-ray films (usually the CT scan of the kidneys) that demonstrate the exact location and size of the stones.  

QUESTION:  I had a posterior vitreous detachment right before my last medical a couple of years back.  I had a form 8500-7 filled out and submitted that at the time of my AME visit and he issued me the certificate.  Since then, I developed an epiretinal membrane/macular pucker with eyesight going to 20/70 or worse.  I then had vitrectomy/excision of the epiretinal membrane operation by a vitreoretinal surgeon.  Then I developed a cataract, and had that removed and an intraocular lens implanted October 7, 2014.  I now have 20/20 left eye, 20/25 to 20/20 right eye with correction.  This requires a contact in the left eye plus glasses due to anisometropia.   Of course I expect to fill out a form 8500-7, but is any of this disqualifying?  I am flying with an instructor and my landings are better than they have ever been.

ANSWER: We get a lot of fascinating enquiries like this but people neglect to state what class of medical they need! You will definitely need to provide another FAA eye exam form.  The physician needs to note the surgeries performed and on which dates.  In general, the FAA will allow someone whose diplopia (double vision)is corrected with some minor prism correction to fly, but there can be no diplopia in any of your fields of vision.  If the intraocular lens that was inserted is a mulitifocal lens, you are grounded for 3 months for all classes.  You will also need to clarify whether the visual acuity you quoted is for distant or near vision. Our advice is to have the eye exam form completed making sure you provide what is noted and ensure the eye doctor notes all the visual acuities to include the intermediate one.  If you have the Pilot Protection Program Plus program the folks in medical certification will review the form and see whether you meet standards and require a special issuance before submission.

QUESTION:  I recently had a sleep study because I was having trouble sleeping which I thought might have been stress related but I was diagnosed with mild sleep apnea. The study included the following language: “AHI was 7 and RDI was 10.4 per hour.  Disordered breathing events were positional in nature.  Minimum saturation of 87% and only 1% of the time spent with saturation less than 90%.  Occasional PVCs were noted.  No significant PLMs were seen.   I don’t have any complications such as heart failure or hypertension.  I am being treated with a dental appliance and am sleeping much better and do not have any significant daytime sleepiness.   In reading AOPA guidance, it looks like I need a “Maintenance of wakefulness test,” a $2,000-plus study!  Other places say I would need a repeat sleep study for about the same amount.  What would you recommend?  

ANSWER: Sleep apnea simply means one is having disordered breathing while in the land of dreams – never a good thing. This may be a function of excess weight, alcohol consumption, smoking, lung disease or other issues that could be dealt with. The terminology noted above include: AHI – apnea-hypopnea index, a measure of how often one stops breathing or breathes poorly during sleep; RDI – respiratory disturbance index, a measure of how breathing is impacted and in your case seem to be related to how you were positioned which may (or may not) imply some lax tissue in your airway from being overweight). The percentages refer to how much oxygen your blood is carrying – although your numbers are not terrible, the higher they are, the better.So, if there are things you can do to improve your general health, that would be a good thing. The Sleep apnea will result in a special issuance and FAA will need the original sleep study. Additionally, FAA does accept an oral appliance as therapy to help hold the jaw forward away from the airway, but you will need a good letter from the sleep specialist that notes whether you are having any daytime sleepiness. If you are having daytime sleepiness, the FAA will deny your medical!  If the letter is "good enough" you will not likely require another sleep study. This is another case where support from Pilot Protection Services “Plus” could be helpful to review everything prior to submission. 

QUESTION:  Last summer I developed stomach ache and was operated on for a mesenteric cyst discovered during a CT scan. According to the surgeon the cyst was removed, did not involve any other internal organs and was non-cancerous. Later in the year I had robotic surgery to remove a one inch diameter cancer on my right kidney. The procedure went well and the doctor said I was “cured” of that malady.  Am I legal to fly if both doctors have sent post op letters citing my compete recovery?? If not, what steps to I have to take, and what documentation do I need to present to the FAA Aeromedical branch??

ANSWER: You had a tough year and I do hope 2015 is less punctuated by time spent with doctors! The mesentery is the supporting membrane that carries blood to and from the bowel and a cyst is a fluid-filled sac that can develop for a number of reasons throughout the body – some are developmental, some infectious and so on. For the mestenteric cyst, you will need to provide the admission and discharge summaries, operative note and pathology report from the cyst removal. You will also need a current status report that relates to the cyst, how you have done since the surgery and is there anything planned for follow-up.  This problem is not grounding per se, but your AME should not issue you without this information. I am glad the kidney cancer was caught early but it is disqualifying and will require a special issuance. Even though you may be cured, the FAA will follow you for the next 5 years for this. They may allow your AME to clear you in the future but you will need to provide a status report each year. You need to provide the admission and discharge summaries from the hospitalization, the operative report from the surgery and the pathology report from the tumor specimen.  You will also need to provide the results of the CT scan or MRI that was performed to determine the extent of the tumor.  You will need a current status report that details how you have done since the surgery and what are the plansyou’re your follow up.  You cannot fly until you receive the special issuance letter from the FAA.   Sorry about the hoops you have to jump through, but thank goodness you sound like you are okay. My medical 3rd class is coming in a few months and last week I surgical removal of my gallbladder which was found to be infected but the surgeon said I should expect a full recovery. I did take pain medication post-operatively and needless to say, I self grounded during this period. Should I expect any "hurdles" when I go for my exam?   You need to obtain the medical records including the date of the surgery, operative and pathology reports, and, if possible a letter from your surgeon that releases you back to regular care.  You can take all of these items to your AME at the time of your next 3rd-class examination.  The condition as noted above is only grounding during the surgical period and while you are physically unable to fly his plane.  Obviously, one cannot take any analgesic pain medications for at least 24 hours prior to a flight.

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

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