Pilot Protection Services Medical Mailbag- April Q&A

QUESTION: Do you have any information on airmen maintaining a Second or Third class medical certificate who have been diagnosed with Mild Seropositive Myasthenia Gravis? Neurological examination by a doctor specializing in this area revealed no ptosis, weakness in extremities or EOM limitations. The only abnormal finding was mild weakness when trying to puff out the cheek.  Symptoms are  under control with medication consisting of Prednisone 10mg once daily and CellCept 250mg once daily. The doctor stated that the prognosis is good, perhaps with a chance of complete regression.

ANSWER: The name “Myasthenia Gravis” literally means “grave weak muscles” and is caused by the body attacking interfaces between nerves and muscles, the “neuromuscular junction” thereby interfering with normal muscle function. The weakness tends to come on after periods of activity and improve with rest and often hits those muscles controlling the eyelids (giving sufferers droopy-looking eyes), the mouth, making it hard to puff out one’s cheeks, swallowing muscles and a variety of others. The thymus gland, located in the chest, normally shrinks as one passes puberty, but in patients with Myasthenia it may remain large and sometimes develops tumors. The disease strikes all people, but women are more susceptible as with all the autoimmune disorders. Diagnosis is made by taking a good history, performing a physical exam, looking for the anti-MuSK antibody in the blood, checking nerve and muscle function with an EMG machine (like ECG, only looking at muscles) and administering edrophonium, a drug that temporarily helps the blocked neuromuscular junction.

Medications today are quite successful at controlling Myasthenia and treat the disease either suppress the immune response or help prevent disturbance at the neuromuscular junction. Additionally, one can periodically “clean” the blood of the troublesome antibodies with “plasmapharesis” or, on occasion, remove the thymus gland.

The FAA has granted medical certification to airmen with Myasthenia Gravis.  You will need to provide a detailed report from the treating Neurologist that includes what your symptoms were when you first presented, all the treatments you have been tried on, and comments on the current medications and any side effects associated with their use. This condition will result in your being placed on a special issuance (waiver).

QUESTION: I will be having my 3rd class medical next month and have had high blood pressure for many years with no trouble passing exams in past years.  I do take medication and have no side effects or problems with the medication.  The CACI-Hypertension Worksheet says the "Treating physician or the AME finds the condition stable on current regimen for at least 7 days and no changes recommended."  What documentation would be needed from the treating physician to be given to the AME to show that this condition is stable?  Do I have to go back to the treating physician every day for seven days and have him check my blood pressure or will some other action do? 

ANSWER: No sir, you do not have to see the physician every day for the 7 days. You need a letter from the treating Doctor that states that he/she has started treatment for high blood pressure, list the medication(s) that you are taking, mention if you have any other cardiovascular diseases, and lists some of your more recent blood pressure results.

QUESTION: Are there any limitations on how pregnant one can be and continue to fly?

ANSWER: There are some aspects to the English language that always delight me; one is either 100% pregnant or 100% not pregnant! I presume you are referring to how far along in the pregnancy one can fly and if flying with the great unwashed, the airlines hold sway and it is highly variable as to what is “allowed.” The FAA recommends no flying after the 3rd trimester commences until after the baby delivers. One should also take into account comfort in the cockpit which might be impacted earlier in pregnancy and please consider that the relative hypoxia incurred by flying without oxygen may potentially be harmful to the developing baby.

QUESTION: I was recently diagnosed with prostate cancer. What are the chances of passing my medical? Thanks for your response.

ANSWER: Sorry to hear this, but prostate cancer is prevalent and is most often not the reason someone dies – my father lived with prostate cancer for many years and succumbed to his chronic lung disease. Once diagnosed you should ground yourself pending the onset of treatment.  The FAA accepts all of the treatments for prostate cancer. Prostate cancer is now under the Category of a Condition that AMEs Can Issue (CACI). In order to participate, you must have completed treatment.  Then you will need to provide the biopsy report, the operative and pathology reports if surgery is performed to remove the gland.  No airman may fly until any chemotherapy and/or radiation therapy has been completed and there are no complications.  The airman must also provide a current PSA level at the time of presenting the paper work to the AME.  

We have written articles on this topic in the magazine (“Pythons, figs, donuts and broccoli” AOPA Pilot, August 2010, page 44 and “Prostate cancer: fighting it and the healthcare industry” AOPA Pilot, March 2015, page 22), online newsletters and Fly Well videos.

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