Pilot Protection Services Medical Mailbag- May Q&A

QUESTION: About a year ago I was diagnosed with atrial flutter, which was corrected by ablation.  I contacted AOPA and asked for their suggestions as to how to deal with this from an aeromedical perspective and religiously followed what I was told.  On this basis, I talked to my AME and he stated that if things were as I stated, he could issue a Class III in his office when I brought in the requisite test results.  This I did, including the diagnosing and treating cardiologist reports, a statement of my current status from my personal physician, a T4, and other reports.  Done originally on January 22nd, the AME forwarded a complete file to the FAA Okla. City, who in turn requested originals of the stress and Holter monitor tracings, along with a complete analysis of my current condition from my personal physician. Mailed overnight to them on March 9th, and though I've called religiously every week, they still can't advise me where I stand.  They will not allow me to talk to anyone in authority relative to my case, and the AME patently refuses to call on my behalf even after being advised that he could do so.  I have been forced to jump through every medical hoop; meanwhile, I can't log air time since my medical expired at the end of January.  I suspect they are "sitting" on my application, or else have no sense of responsibility for their failure to act.  This is, without a doubt, the worst case of customer attention that I've experienced in many a year, and my question is this: Why can't they trust the people I form all the tests and furnish these reports to and get on with issuing a Class III license?

ANSWER: Atrial flutter is a type of heart rhythm disturbance not unlike atrial fibrillation (AF) that we have written and talked about extensively in the magazine, online and in webinars and live events. It is often asymptomatic but can cause breathlessness, fatigue and more serious issues. Often controlled with medication, one can also “ablate” or destroy those areas of the hear that are putting out defective heartbeat signals. The tests you reference include reports from the cardiologist who diagnosed the problem and, most likely, an interventional cardiologist skilled in treating this problem without major surgery. The “T4” is a way of referring to the measurement of thyroid hormones in the blood as too much (hyperthyroidism) can cause the heart to beat fast and erratically.

You indicated that your AME told you he could issue the medical certificate to you in the office, but you later stated that the AME forwarded the records to the FAA.  It sounds like the AME did not issue your certificate, but if he did, you can fly now! The FAA Aerospace Medical Certification Division (AMCD) is a very busy bureaucracy, and the FAA overall has never been as efficient as we would wish in processing airman medical certification reviews.  In the FAA’s pecking order of resource allocation, medical certification isn’t high on the list for acquiring the resources the division needs to do the job they are charged with doing.  Current processing times run about 90 days from the time the FAA receives all the information needed to make a certification decision. 

The inefficiency of this area of the FAA is one of the main reasons AOPA has fought so hard for third class medical reform.  It is our position that the delays in processing deferred medical applications actually creates a more serious safety issue than the medical condition the FAA is reviewing because the time the pilot is grounded while waiting for a decision is eroding pilot proficiency and competency!  If your information went into the FAA in early March 2016, it could be a while yet before you hear anything.  Rather than call the AMCD, you might try your regional FAA medical office as they are often able to pull your case from the queue and work it locally if it isn’t too complicated.  Here is a link to locate the contact information for your region.

QUESTION: I have amblyopia in one eye and it getting close to not being 20/20 corrected.  Is it possible to get a waiver for a 2nd class medical if one eye is not 20/20 corrected?

ANSWER: Amblyopia is the medical hundred dollar word that means “lazy eye” and it causes visual disturbances. Yes, it is possible to get a SODA (Statement of Demonstrated Ability) waiver for uncorrected distant vision, but it depends on what your best corrected visual acuity is in the affected eye.  The process is a bit more complicated than it was years ago, and may require a medical flight test (MFT) with an FAA Aviation Safety Inspector at your local FSDO (Flight Standards District Office). 

You will need your eye care specialist to complete the FAAEye Evaluation Form 8500 (, provide it to your AME at your next flight physical and it will be sent to the FAA.  The AME cannot issue a 2nd class medical to you in the office, but if your visual acuity meets 3rd class standards (20/40 visual acuity for near and distance in each eye separately), you can be issued a 3rd class medical by the AME.  The FAA will then contact you with instructions for obtaining the needed testing to be issued the 2nd class with the appropriate waiver.

QUESTION: I just had double bypass surgery what do I need to do to keep my medical?

ANSWER: When blood vessels become clogged by atheroma, a thick sludgy mess caused by genetics, poor diet, obesity, high blood pressure and a sedentary life style, the tissue downstream becomes starved for oxygen and nutrients. The coronary arteries supply blood to the hear muscle and if they become blocked one develops angina, a heart attack or even sudden death. Various treatment options exist but when too far gone, bypass is an option and in this technique a new conduit is fashioned to take blood around and past the blockage.

This is a topic we have talked about quite a bit in the past.  Coronary artery bypass surgery and stents are common medical procedures reviewed by the FAA and special issuance authorizations are required for these conditions.  Bypass surgery requires a six month recovery and observation period after the surgery before one can reapply for a special issuance.  Following the recovery period, the FAA will need to see your hospital treatment records including the admission history and physical, the surgical report, and discharge summary.  You will also need a maximum exercise treadmill stress test, current lab work including cholesterol, triglycerides, and fasting glucose, and a detailed narrative summary from your cardiologist about your general medical history, a cardiac exam summary, and the results of your treadmill test.  Here is a that provides the specifics of the process:

QUESTION: I have a question regarding the 6 month wait after Aortic Valve Replacement before applying for a new Special Issuance: I have printed the list of requirements to be submitted to the FAA in applying for a new special issuance. My question is do I have to wait the entire six months. before I have the required tests done, or can I have them done in time to mail the results on the 6 month anniversary of my surgery say, within 30 days of submission? The surgery was performed before any symptoms showed, so I am told my recovery was shorter than the average This could make 4-8 weeks difference in me getting back in the air!

ANSWER: The aortic valve is pretty critical in that it controls the flow of blood from the main chamber of the heart, the left ventricle, into the aorta, the main conduit of blood around the body. Aortic valves can either become “stenotic” or tight and thereby limit blood flow out of the heart or they can become flabby or “incompetent” whereby blood washes back and forth and each individual heartbeat becomes less productive. Hopefully this might lead you the conclusion that aortic valves  issues, and the surgery to correct them is pretty serious stuff.

As to your question, the short answer is “yes,” you have to wait six months after a cardiac valve replacement before doing the required follow up testing.   

QUESTION: Is there some easily understandable source where I can get a list of common over-the-counter drugs that are approved or not approved by the FAA?  I have not been flying for a couple of years but plan to become active again soon.  Before that, I need to get some regulations straight.  I am trying to find something that I can take at night to alleviate sinus congestion that wakes me up with a headache by early in the morning.  I have been taking Coricidin (Acetaminophen 325 mg) which works well; however, my AME told me that if I continue to take Coricidin, that I will have to wait a week for it to clear my system before flying as PIC.  I've tried over-the-counter drugs such as Benadryl (Diphenhydramine HCL 25 mg), Rhinocort (Glucocorticoid 32 mcg)  and Nasacort (Glucocorticoid 55 mcg) but all have a limited short-term effect.  I previously had a prescription from my family physician for Nasonex (Mometasone furoate monohydrate 50 mcg) and it worked reasonably well but now I am unsure what I can use that is approved by the FAA.

ANSWER: Have you checked AOPA’s Medications Database ( It is a very good online source for medications, both allowed and non-allowed.  Many of the sinus decongestants, including some of the ones you mentioned, can produce sedating side effects.  When you check the meds database, you will see that some drugs have longer wait times than others, and that’s because of the active ingredients of the remedies that produce the tendency for sedation. For instance, diphenhydramine is not allowable – and for a significant period of time after a dose depending on your age and general health. It might be worth considering seeing an ENT surgeon skilled in the art of Functional Endoscopic Sinus Surgery which can be a game-changer for many people.

QUESTION: Concerning FAA "Non-Allowed" medications.  How long after I stop taking the medication need it not be reported on a medical application?

ANSWER: The FAA’s rule of thumb for these medications is to wait five times the dosing interval after the last dose before flying.  For example, if the dosing interval is every 8 hours, wait five times that 8 hour dosing interval, or 40 hours after the last dose.  Some meds have a longer half life than others so the active ingredients stay in your system longer.  If you have taken a medication since your last AME visit, declare it on the form including reason and date started and stopped. Bear in mind that some conditions, regardless of therapy, might be disqualifying, so ensure your Pilot Protection Services membership is up to date and check with the good folks at AOPA!

QUESTION: Can you have provide some information on “floaters” that typically occur around 60 years old and are very annoying?   What are the treatments?  Laser surgery or vitrectomy.  I saw a physician who thought that current Laser options were risky and were more inclined to recommend a vitrectomy after about a year wait.   

ANSWER: We addressed this topic in AOPA Pilot magazine (“Eyes on the prize” July 2015, page 22). Floaters are fairly common in people age 50 and older and are generally benign, but sometimes one of the indications of a floater, a bright flash of light in the peripheral vision that appears rather suddenly, is definitely a wake-up call to see an eye care specialist.  Sometimes that flash of light can be indicative of a more serious condition that includes a retinal tear or detachment.  These are ophthalmological emergencies that need to be treated as soon as possible.

Floaters are tiny structures of protein or other cellular debris that reside in the vitreous humor, the thick fluid or gel that fills the inner eye.  The condition is sometimes referred to as a posterior vitreous detachment, not to be confused with a “retinal detachment.”  

In most cases, no treatment is required as the floaters usually migrate, or “float” around in the vitreous humor and don’t remain directly in the sight line.  For more severe cases, vitrectomy is an option, but for most people who notice floaters, over time they will disappear as the brain just learns to ignore the distraction.  If you visit an ophthalmologist for evaluation of a floater, the visit is reportable on the FAA medical application, so you should ask your eye care specialist to complete an FAA eye evaluation form that you will present to your aviation medical examiner at your next flight physical.  The AME can issue a medical based on the history provided you are otherwise qualified.

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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