PILOT PROTECTION SERVICES AUGUST MEDICAL MAILBAG

QUESTION: I had knee replacement surgery 3 months ago and am wondering if there are any requirements from FAA prior to flying again.

ANSWER: Replacement of arthritic joints is performed frequently with hips and knees the most common operations, and there is a wide range of devices available. One should self-ground until fully recovered and provide your AME with the hospital discharge note, operative report and a letter from the orthopedic surgeon releasing you to normal activities. Of course, this assumes you have recovered the range of motion necessary to safely enter and exit an aircraft and manipulate all controls pain-free!

QUESTION: I was diagnosed with Right Bundle Branch Block many years ago and have been able to fly regardless with the Navy. Can you please explain?

ANSWER: Electrical impulses to initiate heartbeats start in the sino-atrial node, specialized cells on the right side of the heart. These signals travel through pathways within the muscle and ensure a coordinated and synchronized heartbeat. A variety of things can impede these signals or cause errant signals – everything from medications, dehydration, metabolic conditions and heart attacks being common. However, very often there is no identifiable cause and no health implications. That is especially true for signal blockage on the right side of the heart where heart muscular contraction may be totally normal. A number of other factors such as general health will play into what implications there are for flight. Of the two forms of Bundle Branch Block, Right has less implications than a Left because of the manner in which a Left Bundle Block manifests on an ECG.  The FAA and the military have much less heartburn (sorry, couldn’t resist) with a well-documented Right Bundle Block history.

QUESTION: I am an active GA and commercial airline pilot as well as commercial pilot, pushing 61 and getting ever closer to dealing with my cataracts and recent astigmatism. I am considering having intra-ocular lens implants and wonder if you can advise on which specific lens to choose? I would also like to know what sort of quality vision I might expect – I am sure you understand that close and distant as well as night vision are really important.

ANSWER: Cataracts are common with age and are the condition where the lens inside the eye becomes clouded. More common with diabetes, exposure to UV light also plays a role which is why we recommend that pilots wear good quality sunglasses. Astigmatism is a distortion in visual quality due to changes in spherical curvature of the lens.

One can merely remove the native lens and then correct vision with contact lenses and/or spectacles, or implant a manufactured lens. The quality of vision that results can be very good and can allow for continued life as a pilot. Although we cannot recommend specific lenses, there are a number that are approved for use by FDA. Talk to your surgeon and ask for his/her experience – also ask if you can speak to prior patients.  In order to get back in the cockpit, self-ground until your vision has stabilized and meets the vision standards for the class of medical privileges you are exercising, then provide a current FAA eye examination form to your AME at the time of your next FAA physical exam. (See “Fly Well: A Clear Picture,” May 2013 AOPA Pilot.)

QUESTION: I just read your article on heart problems ("Rhythm of My Heart," AOPA Pilot, August 2018, page 26). My heart specialist couldn't control my atrial fibrillation with drugs, and what a hassle with testing, monitors, and regular reporting back to the FAA.  I was surprised you didn't mention ablation.  That worked perfectly for me.  I've been fib-free and drug-free for 4 years now. 

ANSWER: Hello Barry. I did mention ablation (In those cases, a precise electrical shock, cardioversion, or minimally invasive techniques to stop the aberrant heart impulses may be offered.) The minimally invasive techniques in question usually involve the delivery of an energy source such as electricity or even cooling, to destroy the cells responsible for sending the Afib signal. I also mentioned the Watchman procedure where the left atrial appendage is isolated from the rest of the heart as it can be a common harbinger of troublesome clots in Afib. I have to cover the entire topic in less than 800 words. Pleased to know you are in good shape!