Pilot Protection Services Medical Mailbag- December Q&A

QUESTION: I am a private pilot, currently exercising privileges under Sport Pilot regulations, but want to return to flying “real" airplanes.  The third class reform additional roadblock of medical baselining will have me stopped as my last medical was back in the 80's.  In the intervening years, I've picked up a number if diagnoses that could potentially affect issuance.  In Section 67.312D there is catchall language about no other organic, functional, or structural disease.  Is there a succinct list of items the Federal Air Surgeon would find disqualifying?  I'm clear on the sleep/wakefulness study required for obstructive sleep apnea; I have the dry form of macular degeneration, but still have near and distance vision correctable to 20/15 with glasses, and know about the FAA vision form, but I'd like to figure out what other hoops I'm going to have to jump through if I'm going to get back into flying something that will carry the wife, me, and a weekend's worth of luggage.  I would like to be able to perform a reasonably comprehensive self-assessment before looking for an AME. 

ANSWER: You need to obtain a good summary of all your medical problems and if you are a member of the AOPA Pilot Protection Services Plus program, discuss this with AOPA’s medical certification people. They can review your conditions and best advise you what things are required for each of your medical issues. Just for an example, you will not only will need the FAA Eye exam form for macular degeneration, but also what are known as "Humphrey Visual Fields". 

QUESTION: I have found little to no reference made to flying GA with an implanted pacemaker and whether the type of device inserted matters. Is it possible to fly as PIC after this kind of operation?

ANSWER: We get a fair number of these questions and the good news is that FAA accepts all types of pacemakers. These are devices that provide the heart with a regular electrical rhythm when heart attack or other disease has caused abnormal heartbeats. The only issue would be if you had an implantable defibrillator, a device which restarts the heart if it is likely to stop beating and this is not acceptable to the FAA. 

Here are the requirements for providing your pacemaker case to our friends in Oklahoma City: 

A 2-month recovery period must elapse after the pacemaker implantation to allow for recovery and stabilization. Submit the following: 

   1.   Copies of hospital/medical records pertaining to why the pacemaker was required, make of the generator and leads, model and serial number, admission/discharge summaries, operative report, and all ECG tracings.

   2.   Evaluation of pacemaker function to include description and documentation of underlying rate and rhythm with the pacer turned "off" or at its lowest setting (pacemaker dependency), programmed pacemaker parameters, surveillance record, and exclusion of myopotential inhibition and pacemaker induced hypotension (pacemaker syndrome), Powerpack data including beginning of life (BOL) and elective replacement indicator/end of life (ERI/EOL).

   3.   Readable samples of all electronic pacemaker surveillance records post surgery or over the past 6 months, or whichever is longer. It must include a sample strip with pacemaker in free running mode and unless contraindicated, a sample strip with the pacemaker in magnetic mode.

   4.   An assessment and statement from a physician regarding general physical and cardiac examination to include symptoms or treatment referable to the cardiovascular system; the airman's interim and current cardiac condition, functional capacity, medical history, and medications.

   5.   A report of current fasting blood sugar and a current blood lipid profile to include: total cholesterol, HDL, LDL, and triglycerides.

   6.   A current Holter monitor evaluation for at least 24-consecutive hours, to include select representative tracings.

   7.   A current M-mode, 2-dimensional echocardiogram with Doppler.

   8.   A current Maximal Graded Exercise Stress Test Requirements

   9.   It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification. A medical release form may help in obtaining the necessary information. 

You can see that this is pretty extensive and might seem onerous, but FAA wants to know that you are not likely to have an issue aloft that could spell trouble for you.

QUESTION: I am a Type One Diabetic and was the 2nd in the country to receive my 3rd class medical certification in 1989. I am under very good control with no side effects but also have high blood pressure. I am taking four different medications to treat the high blood pressure, the fourth was started recently to allow my doctor to reduce the amount of one of the other medications. The four drugs are: Hydrochlorothiazide, Lisinopril, Metoprolol and Amlodipine.  My blood pressure is under good control with these meds. However, I listened to a recent AOPA webinar about Staying Fit to Fly and I heard that 3 blood pressure meds maybe okay but 4 would be a problem for a 3rd class medical certification. If I need to reduce to 3 meds or change something else please let me know what you think as I will pass that information along to my doctor.

ANSWER: Since you are already under a special issuance for diabetes, the addition of another BP medication will not change things from an administrative standpoint.  The FAA would put you under a special issuance for hypertension if you need four meds, but if you are otherwise doing well, the extra BP drug shouldn’t be a real problem for you.  

During the webinar you referenced, the comment was that when an airman is taking only 3 medications that makes them "eligible" to be included in the CACI program, meaning that they do not require a special issuance. 

QUESTION: I just received a letter from the FAA medical office.  It stated that I do not have a current problem but at my next physical I must download a form, have it filled out by my regular physician and then give it to the doctor doing the flight physical.  The items were related to high blood pressure, my blood pressure is 130/80 and has been for the last five years and do take medication for hypertension.  My cardiologist  reviewed the letter and the issues noted are not relevant to me.  Is this a new procedure by the FAA?  I am 76 years old and in otherwise good health – are there any addition steps I should take?

ANSWER: This is a topic we have covered extensively and there is a lot of information AOPA has disseminated and due to the wonders of the internet it is all available online! Certification for blood pressure has always required basic documentation, but now the FAA needs less information than before.  The hypertension worksheet can be completed by your treating doctor and given to the AME at your next flight physical.  If you are otherwise qualified, the AME can issue your medical in the office. This is called the CACI program (Conditions AME's Can Issue).  This is an instance where you could have the people at AOPA medical certification review the letter you received from the FAA.  You need to be a member of the AOPA Pilot Protection Services Program.

Jonathan Sackier

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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