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Pilot Protection Services September Medical Mailbag

When operating under BasicMed, medication usage and the appropriateness of a change in medication would be determined by the pilot and their treating physician or medical care provider, who may also provide guidance on the impact the medication may have on flight safety. 

QUESTION: In the past I held a Special Issuance for my diagnosis of multiple sclerosis (MS). If my GP signed the BasicMed form and months later my neurologist wants to change medication, do I simply discuss the new medication with my GP? And find an agreeable downtime to monitor reaction, like two weeks?

ANSWER: Multiple sclerosis is a complex neurological disease that tends to be more common in temperate zones, has a variable presentation, and is thought to be autoimmune in nature. We have covered this in the pages of AOPA Pilot magazine (“Is your wiring firing?” September 2014, page 22).

Under BasicMed, pilots, in consultation with their treating physicians, are medically self-assessing to determine that any medical conditions, as currently treated, do not impact their ability to operate an aircraft in a safe manner. With that self-assessment comes the requirement that pilots will abide by FAR 61.53 and not exercise their privileges during times of medical deficiency. Additionally, FAR 91.17 refers generally to medication usage, and prohibits the use of any drug that “affects the pilot’s faculties in any way contrary to safety.” 

When operating under BasicMed, medication usage and the appropriateness of a change in medication would be determined by the pilot and their treating physician or medical care provider, who may also provide guidance on the impact the medication may have on flight safety. In your situation, if the medication doesn’t present any adverse side effects after the time period recommended by your physician and is effectively treating symptoms, you’ll be ready to make your self-assessment to continue operations under BasicMed.

 

 

QUESTION: I have very recently completed treatment for testicular cancer. Mine was metastatic when diagnosed. I had lesions on my liver, a large mass in my abdomen, and also one enlarged lymph node in my supra-clavicular area. I was treated with chemotherapy and surgery, and pathology reports showed mature teratoma.  I was elated to have come through treatment so well, but then I was dealt quite a shock when applying for my 1st class medical again so I could return to work flying Citations.

As I understand it, metastatic testicular cancer is a case where the AME must defer for Special Issuance consideration. No problem, I thought, they will see I am fully treated, healthy, and taking no medications, and issue an SI. But that was not the case.

I gathered all my records, reports, scans, and letters, and the AME submitted them to FAA, who said there is normally a waiting period of two years required for metastatic testicular cancer, but they would forward my file to the Federal Air Surgeon in Maryland for his consideration and ruling. To say the least, this was shocking news to me and the AME. Has something recently changed?

My caring physician has stated in a letter that I am fit to do any job or activity including that of a pilot and that a reoccurrence would be highly unlikely and not cause any physical problems even if it did return. However, I am still extremely concerned that the FAA may still require an observation period, which would be devastating having already been off work for nine months.

ANSWER: Malignant tumors of the testicle are of two common kinds, “seminoma” and “teratoma.” One salutary point for any other men reading this is that regular self-examination of the testicles and reporting any lumps to the doctor early might save a lot of fellas unnecessary grief; women are clued in to performing monthly breast self-exams, but getting men to follow suit has proven to be a real challenge.

Surgery is the mainstay of treatment, removing the diseased testicle and the lymph nodes closest to the area – those in the groin. Chemotherapy has a role to play and the good thing is that with treatment, the prognosis can be pretty good.

The word “metastasis” refers to the situation where cancer cells have migrated from the originally affected organ and have taken up residence in another location, getting there either by direct spread in a body cavity or via the blood or lymphatic systems. Such distant spread of any cancer usually demands chemotherapy be delivered systemically.

As for the regulatory component here, I am sorry to say that metastatic spread to a distant site such as the liver demands a mandatory two-year disqualification. I fully understand that this is not the news you wanted to hear, but please focus on getting better and beating the cancer.

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
AOPA NACC (FDK)
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.
Topics: Pilot Health and Medical Certification

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