Pilot Protection Services Medical Mailbag- September Q&A

QUESTION: I would like to acquire medical oxygen for my occasional flights to altitude in my GA airplane.  A local medical oxygen supplier will happily provide the service if I bring them a prescription and my general practitioner is happy to write this to read: “Oxygen at 2 liters per minute via cannula for flight or as needed. Diagnosis: Altitude sickness or hypoxia. Length of need: Lifetime” 

Some fellow pilots are concerned that this might be a red flag when the FAA sees this reported, or that it might eventually get shared electronically when databases begin to merge, and consequentially affect flight privileges.

Consequently, I presented this question to my FAA medical examiner and he said “this does not need to be reported.” 

ANSWER: This is a topic dear to our hearts and one we have raised often. At live presentations I like to ask the audience “who uses oxygen when flying at altitude?” I am always intrigued when not every hand goes up because, of course, we all breathe oxygen – the question is “how much?” Liberal use of supplemental oxygen is almost totally without risk and has the likelihood of improving performance, preventing unpleasant sequelae and the great news is that as a pilot you do not need a doctor’s prescription to buy aviation oxygen.  Merely purchase the kit - bottle, regulator, nasal cannulae/masks and a pulse oxymeter - and you are good to go. I use the O2D2 regulators, masks and cannula sold by Mountain High of Oregon and a pony bottle from one of the aviation catalogues. I bought my pulse oximeter online  - it measures pulse rate and oxygen saturation by clipping on a finger. Advise passengers not to wear nail varnish if they are flying with you. I use oxygen on every flight during the day over 5,000 feet and don it on the ground prior to take off at night, way more conservative than the FAR AIM. 

If you have a medical issue that might compromise your ability to safely conduct a flight, take care of that first and then worry about your flight privileges - I am sure you would not want to put yourself or others at risk!

QUESTION: If one achieves the 11 minute mark on the Bruce Protocol Stress Test and exceed 100% of maximum predicted heart rate one year then, the next year only reach the 10 minute, 30 second mark and still exceed maximum predicted heart rate, will the FAA believe that your health is deteriorating and hold that against the applicant?             

ANSWER: A very good question, indeed!  Pardon this long-winded response, but you raise an important point.  A stress test is a way of evaluating the heart’s ability to respond to the demands of exercise as a way of ascertaining if there is any significant cardiovascular disease lurking in the background. 

In the FAA’s world, it is always best to give them information that doesn’t change much from year to year.  Thirty seconds less on the treadmill doesn’t sound like much, but a change in exercise duration can be a signal of something “aeromedically significant,” and it could result in questions from the FAA regarding your cardiac status.  Since a special issuance condition such as coronary artery disease is a “permanent” special issuance, over the course of many years of review, the FAA notices trend information in your annual cardiovascular evaluation and treadmill test.  Depending upon your age, a thirty second decrease in exercise duration each year may be an indication of progression of coronary disease, even if the stress ECG doesn’t show any noticeable change.  The FAA has been following pilots with coronary artery disease for decades, and the doctors that review these cases often find changes so subtle that your own cardiologist may not notice, or consider the change “clinically significant.”  In the world of aeromedical regulatory medicine that FAA lives in, a subtle change may mean something that is “aeromedically significant.”  In short, do your best to maintain a consistent pattern of testing performance in all your reporting to the FAA. 

QUESTION: If in doubt about something, is it wise to visit the AME prior to the exam to discuss it?

ANSWER: It certainly is, if your AME is willing to do a “pre-medical exam” consultation.  If your AME isn’t comfortable doing that, you can always call AOPA and speak with the medical certification specialists who can probably provide you the information you need to make an informed decision prior to your flight physical. Review the resources we have provided on preparing for your AME appointment.

QUESTION: What is the current certification standard for migraines? 

ANSWER: The FAA now has in place a CACI (Conditions AMEs Can Issue) that allows for an office issuance for migraine or other headache types. Even if you don’t meet the criteria for an office issuance, special issuance is still an option if your headaches are well controlled and not severe. You may want to read the article on this topic in AOPA Pilot magazine (“Oh my aching head” AOPA Pilot, October 2013).

QUESTION: What is the current issues regarding a person having experienced kidney stones?

ANSWER: Kidney stones are now covered under a CACI (Conditions AMEs Can Issue) and can result in the office issuance of a medical certificate if the pilot meets the criteria according to the worksheet of this CACI and here is a link: CACI worksheet . The policy applies to kidney stones that have passed and also to retained kidney stones.

QUESTION: My doctor says I have gallstones, if I have the simple surgery, how long do I wait to fly. Do I have to report this to FAA? 

ANSWER: Gallstones that are not causing you any problems do not require any special documentation for the FAA.  However, if you have surgery during the time your medical is current, just self-ground after your surgery until you are cleared by your doctor to resume normal activities and you feel well enough to resume flying.  You can then continue to fly until your medical expires.  You may well be a candidate for laparoscopic surgical removal, a topic dear to my heart and you may want to read the article I penned on this topic (“A rolling stone” AOPA Pilot magazine, January 2011, page 34. 

You can report the surgery on your next FAA medical application, and include a brief statement from your treating doctor that you are fully recovered and having no problems following the surgery. 

QUESTION: Can you get and keep a 3rd class medical if you are on dialysis for kidney failure?

ANSWER: Generally, the answer is no.  Hemodialysis is disqualifying for all classes of medical certification.  Peritoneal dialysis is reviewed on a case by case basis, although AOPA is not aware of any pilots flying even while undergoing peritoneal dialysis. In truth, people often do not feel up to the demands of safely piloting an aircraft at this time.

Have a question for Dr. Jonathan Sackier or Gary Crump? You may submit your question here.

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA
Gary Crump
Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.

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