I Nose This Much Is True: Drugs, Blockages, and Bleeds

A well-functioning nose will allow you to detect aromas both beautiful and dangerous – leaking fuel, burning rubber, burning anything. So wake up and smell the roses and if you cannot, don’t go flying.

Spandau Ballet’s 1983 song, “True,” was, in part, a tribute to the beautiful music of Marvin Gaye, the iconic soul singer who was to die tragically by his own father’s hand a year later. At the heart of the murder was the conflict between the purportedly stern and abusive Gay Senior, who was a pastor, and Gaye the singer (he added the “e” to his stage name), who was plagued by many demons, one of them cocaine, a drug that is making further inroads into our society.

Cocaine is a white powder extracted from coca leaves. A stimulant that is used as a “recreational” drug, it is administered either by snorting, rubbing into the gums, breathed as smoke, or, in solution, injected into a vein. It causes intense feelings of elation or agitation and is addictive and dangerous. Apart from the irrational acts users might do during use, it can cause cardiac death, dangerous elevations of body temperature, and acute or chronic paranoia or disturbances of mood that lead to suicide. Additionally, the constriction of blood vessels caused by the drug can lead the nasal septum, the dividing structure between the two nostrils, to perforate. Once this happens it will never heal spontaneously, causing changes in the appearance and function of the nose, which can effectively collapse in on itself.

Cocaine is used medically to stop bleeding in the nose and was the genesis of local anesthetics – when you next visit the dentist and have a numbing injection, spare a thought for Dr. William Halsted, a giant of American surgery. He had heard of the new solution of cocaine and, in 1885, he and his colleague, Dr. Hall, perfected the technique of blocking nerves so that a diseased tooth could be removed painlessly. In true scientific tradition, Dr. Halsted carried out experiments before using the drug on patients; the problem was he experimented on himself and in the process became addicted for life.

Why mention this topic here, in an audience for pilots? First and foremost, as became obvious by the number of responses I received to the article about suicide in AOPA Pilot (“Close to Home,” October 2018, page 30), drug use does not respect pilots’ families. Given that cocaine is the third most abused substance after alcohol and cannabis, being alert to the signs – and dangers – is a service I owe you. If you have a family member or loved one who you think might be using it, please get them help. And if you think a fellow pilot is using it, please ensure they don’t climb into the cockpit as they are a danger to themselves and others.

As we enter the winter months, colds and flu become more common – people spend more time in close proximity in warm and humid environments, a veritable cauldron for viral spread. I have made these pleas many times but while the following issues recur they must be said again:

  1. If unwell, do not fly – when not functioning at 100% your judgment is impaired and this is not a good time to be in the captain’s seat. Plain and simple.
  2. Your ability to equalize ear pressure by pinching your nose and forcibly exhaling will not work as well and the resultant pain may be crippling and permanent damage might be done. Also, you may inadvertently expel some rather unpleasant nasal secretions and nobody will like that!
  3. Do not, under any circumstances, try to resolve a blocked nose by taking over-the-counter medications. Even if you do not ascribe to my first point above, consider that many OTC meds contain compounds (such as diphenhydramine) that are sedating and are forbidden by FAA. Check it out – this action kills pilots with horrible regularity. Please take this seriously.

Nosebleeds, or epistaxis as we call it, has many causes. Often emanating from an area at the front, lower part of the septum where four arteries come together (Kiesselbach’s plexus or Little’s area), it can be a symptom of many conditions such as a cold, local infection, allergies, breathing warm, dry air, or from cocaine use. In young adults, repeated bleeds should be taken very seriously as they may indicate drug use or one of the leukemias.

A well-functioning nose will allow you to detect aromas both beautiful and dangerous – leaking fuel, burning rubber, burning anything. So wake up and smell the roses and if you cannot, don’t go flying.

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

Related Articles