QUESTION: I was having some episodes of breathlessness and chest pain with physical exercise and this led to me seeing a cardiologist. He did an angiogram, which showed two narrowed blood vessels, and he put in two stents. He told me I had not had a heart attack and this was a preventative measure. I feel ten years younger and am back to full exercise and want to get back to flying – can you tell me what I need to do with my AME and so on?
ANSWER: Cardiovascular disease is the biggest killer in the USA and good for you, seeing your doctor before the narrowed vessels could do major harm. It is likely you are also taking some medications and it is important that these are all permitted by FAA – always check the AOPA medication database.
An angiogram involves injecting a chemical that shows up on X-rays that we call “contrast” and it will reveal narrowed areas. The doctor skilled in addressing this problem, an interventional cardiologist, will then stretch the area with an inflatable balloon and insert a metal cage that may be coated with various drugs – we call that a stent and its purpose is to hold the area widely open. This should help the blood supply to heart muscle.
There is a recovery time from an aeromedical perspective – for First and Second Class special issuances, a 3- or 6-month period is required. For Third Class you will need a list of documents/tests that you can find on the AOPA website.
QUESTION: My wife has been on at me about my snoring and I must admit to waking up not fully rested and with a bit of a sore throat. Is there anything I can about this that will not impact my Third Class medical?
ANSWER: Snoring is very often associated with obstructive sleep apnea (OSA); basically, the passage of the air you need to breathe is impeded. The term is self-explanatory other than that word “apnea,” which means “to not breathe” – during snoring there is often a silent pause followed by a deep intake of breath as your brain triggers breathing to restart. It is a serious condition and merits attention as the long-term consequences for your health are concerning and, of course, for your wife who has to endure sleepless nights!
It is not unusual for OSA to be associated with being overweight, so the first step is to address that issue. Additionally, consumption of alcohol and tobacco play their part, so cut down on the former and stop the latter! You should plan on seeing a doctor who can examine you for any precipitating conditions and check your heart. He or she may then order a “sleep study” where a machine will capture episodes of snoring, chest movements, heart rate, and oxygen levels while you snooze. If abnormal, and weight loss does not solve the problem, one can either have a surgical procedure to “tighten up” floppy tissue in your throat (uvulopalatopharyngeouplasty or “UP3,” perhaps using a laser) or use a machine called a “CPAP” (continuous positive airway pressure) device that utilizes a mask and pump to keep the airway open. The current generation of machines produces a report that you will need to share with your AME proving you are using the device.
There are FAA implications for all this as OSA is associated with daytime sleepiness (not a good thing to happen when piloting an aircraft) and cardiovascular problems. The good news is that well-controlled sleep apnea usually results in a special issuance authorization. As with any special issuance, there is some work the pilot needs to do on the front end, but once you can demonstrate consistent use of the CPAP and evidence of a decent night’s sleep, a special issuance will probably be coming your way!
QUESTION: I have been told by my doctor that I need to have my cataracts done. What are cataracts exactly? I am a bit nervous about the surgery and wonder about my flying once everything is done.
ANSWER: Cataracts refer to the lens in the eye becoming cloudy. This happens with advancing age, a number of medical conditions, and is precipitated by exposure to ultraviolet light – one of the reasons we encourage pilots to wear sunglasses.
The treatment involves making an incision in the eye usually under local anesthetic with some sedation and popping out the defective lens. One can either then insert an artificial lens or correct vision with spectacles.
Obtaining any class of medical after cataract surgery with lens implants is a straightforward process. Once your visual acuity is stable and meets the vision standards for the class of medical you hold or are applying for, have your eye care doctor complete an FAA eye evaluation form and provide it to the aviation medical examiner at the time of your next flight physical. If you meet the vision standards and there are no complications from the procedure, the AME can issue your medical to you in the office and you can then get back to flying, although your medical certificate may bear an endorsement that you need to wear glasses. Always use the “IM SAFE” mnemonic before every flight as a good way to touch base with your own health.
QUESTION: I was recently at an air show and was feeling generally unwell, developed a fever, and noticed that when I used the bathroom to pass urine, it was stinging and I saw some blood in the water. Furthermore, I had the urge to pee every hour or so. I am a 62-year-old, otherwise healthy man and have never experienced this before. I saw a local doctor who started me on antibiotics and I feel better but wonder if there is anything else I should do about this.
ANSWER: You are describing classic symptoms of a urinary tract infection, or “UTI.” These are much more common in women as they have a much shorter urethra, the tube that takes urine from the bladder to the outside world. In women, a UTI can follow sexual intercourse and demonstrates the need for cleanliness around the pelvic area.
Other things can predispose to getting a UTI, with diabetes being the most common, so your regular doctor should certainly follow up to ensure your blood sugars are normal. People whose immune system is suppressed due to taking chemotherapy, for instance, may also be more susceptible. Otherwise, one should check for stones within the urinary tract (kidney, bladder, or the tube joining them together, the ureter). While stones often present with severe episodes of colicky pain, they can be silent and merely sit there quietly making a nice home for some bacteria.
Clearly don’t fly if feeling unwell and you should have a proper checkup to exclude any factor that might put you at risk of another episode – you certainly would not want a repeat of this under any circumstances, but worse yet while focused on flying an airplane!