Pilot Protection Services October Medical Mailbag

QUESTION: I just attended a “rusty pilot” seminar and this inspired me to become very interested in flying again. However, I will need to get a special issuance for insulin dependency and am getting all the tests and paperwork together. I would like to know what, exactly, the cardiac stress test involves. All I'm able to find is general references to generic stress tests. But what does the FAA test look like? 

ANSWER: First, we are delighted that the seminar re-ignited the passion to fly once more! Diabetes, for those not familiar with the condition, is common and becoming more so. In some, it starts in youth and in others, later in life and we know that obesity is often a factor so for those reading this who could shed a few pounds, heed these words! This is a topic we have covered in AOPA Pilot (“It's all Greek to me” December 2010, page 34) and in our online newsletters and videos. 

The condition is due to the body either not producing enough or becoming insensitive to insulin, a hormone produced by the pancreas that controls blood sugar levels. Untreated, it can lead to all sorts of unpleasant sequelae such as heart and kidney disease, stroke, nervous system issues, and blindness. Sometimes treated with diet, exercise, and oral medications, in many, replacement of insulin demands injections once, or several times a day. 

It is for the above reasons that anyone with diabetes merits a careful look by FAA before granting medical certification and because of the potential for the blood vessels that supply the heart to become blocked, a cardiac “stress” test is required as this will expose any lurking dangers. You can learn more about it at this weblink  


QUESTION: After a couple of biopsies and an MRI, the doctors have found the reason for my elevated PSA (6.4). It is a small area of cancer contained in the capsule of my prostate. I have considered all the options and am going to opt for radical robot prostatectomy. I know after the surgery I will be grounded until my doctor releases me. However, do I need to stop flying as I just passed a physical a few days before the diagnosis?

ANSWER: Prostate cancer is a topic we have covered quite extensively in the past and with new diagnostic and therapeutic approaches surfacing regularly, we will doubtless do so again (“Prostate cancer” AOPA Pilot magazine, March 2015, page 22). Self-grounding is required under FAR 61.53 until released by the treating doctor to resume normal activities. After that, you would qualify for a CACI (Conditions AME Can Issue) and would report with the worksheet at the next regular physical exam. We hope your treatment proceeds well. 


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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