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A Squawk List for Your Next Annual Inspection

Whether you have your own airplane or fly a rental, there’s always a way of letting your mechanics know when something’s not right. It’s affectionately called a “squawk list.” 

You likely have a pretty good relationship with your mechanics and give them a verbal or formal written list of items you want them to check into and fix at the plane’s annual inspection. The back-and-forth between mechanics and pilots has generated some of the best aviation humor out there. Supposedly, a pilot once complained to his mechanic, “Test flight OK, except auto-land very rough.” The mechanic had a bit of a harsh reply: “Auto-land not installed on this aircraft.” Ouch. Sometimes the back-and-forth is actually instructional. One pilot complained that the “friction locks cause throttle levers to stick,” to which the mechanic came back, “That’s what they’re for.” The FAA requires specific training to service airplanes and get an Aviation Maintenance Technicians (AMT) certification and their work is critical to your safety. It’s no exaggeration to say that your life may depend on their skills.

A good pilot would no sooner bring his plane to his AMT for an annual inspection without a squawk list than anyone should show up to their local doctor for an annual physical exam without a similar list of problems and questions. On an airplane, the list of rough-running engines, strange noises and warning alarms might produce a long list of specific items to address during the annual inspection. The same is true for alarms that your body sends to you with aches, pains, and symptoms. Someone once said “pain is your body’s way of telling you something is wrong,” but signs and symptoms are not always as obvious as the alarm bells and lights on your plane. As subtle as they may be, these alerts are not just an annoyance, you need to pay attention to all of them and discuss them with your doc at your yearly exam. Just like in your plane, it helps to keep a log of things that you have questions about all during the year, not just the day before your appointment. When you work on your medical squawk list keep in mind that the actual time you have with your doctor for a physical exam is going to be much shorter than the time a mechanic has with an airplane, so make use of every minute. Write your list down and stick to it item by item. But don’t be shy; there’s no such thing as “just a little thing.” If it’s bugging you and concerns you it’s a big thing. Be specific. A vague mention like “something loose in the cockpit” will only get you a glib response like “something tightened in the cockpit,” and it’s no different at your annual health exam. For your mechanic to identify and solve airplane problems he needs details; the same is true with your family doc who is charged with figuring and out solving your yearly health squawks.

Organize your medical squawk list like you would with your airplane, front to back and top to bottom, from the prop spinner working back to the empennage. Start at the top of your head and go down to the bottom of your feet. Besides the usual age-related trauma, we men have with hair loss. If your hair is thin or falling out when it had not before that could be the tip of a more serious problem. Hair loss in women or sudden loss in men can be from a dietary deficiency, anemia, and exposure to some types of toxins, fad diets, overuse of some vitamins (vitamin A is very common), side effects of some medications or thyroid abnormalities. Headaches, earaches, dizziness, and sinus problems are all important things to note, especially for pilots spending time at altitude. Visual or hearing changes can also be age related but might be a tip-off to other, treatable conditions. Taste has been a big deal lately with COVID, but it can be a harbinger of lots of other issues. It can be related to medications like ACE inhibitors and beta-blockers used for blood pressure and also some meds like antidepressants, decongestive and antihistamines. It can also be related to cigarette smoking, sinus disease, nerve injuries, and nasal polyps.

Write down if you haven’t been sleeping well or your appetite is changing or you’re having mood swings. It’s not a whole lot healthier to be losing weight when you’re not trying to than gaining weight when you’re trying not to. Mention if your speech patterns have changed or if you have had even a momentary episode of slurred speech that can indicate subtle atherosclerotic changes in the blood supply to your brain, something we call “transient ischemic attack (TIA).” This is particularly more worrisome if it is associated with brief visual changes knows as “Amaurosis Fugax.” Another really important thing to report is any changes in swallowing that can portend esophageal diseases like cancer or neurological damage due to local nerves in the neck or a central nerve injury.

Report on any chest issues, obviously chest pain but also irregular heartbeats, changes in exercise capacity, palpitations, wheezing, or shortness of breath. Pay special attention to when you get these symptoms, if they awaken you from sleep or come on during exertion or at rest. All these bits of information are important clues for your physician to nail down the source of your “squawks.” Something you might think is a little silly to report like prolonged hiccupping can be a clue that you have something directly irritating your diaphragm like an infection, tumor, nerve injury or any source of irritation along the course of the phrenic nerve that runs through your neck and chest all the way to the diaphragm.

Abdominal complaints are among the most common symptoms that people bring to medical attention. Pay particular attention to any changes in your appetite or stomach aches and pains. Don’t forget about any changes in bowel habits or blood in your stool that can be important information and may point to early diagnosis of a major problem when it is still very treatable. The same is true for any urinary symptoms such as burning, pain, frequency, hesitancy, or difficulty emptying your bladder that would help your doc decide to do some extra checking. In men the concern is for prostate disease or cancer and women for infection or pelvic malignancy. With all of these issues, early diagnosis and treatment are not just essential, they are lifesavers.

Changes or complaints about your arms and legs need to be mentioned, especially if you are experiencing new onset of tremulousness, twitches or joint pains. Pain down your arms with exertion is a common symptom of cardiac disease. While you’re at it, make sure you get all the way down to the bottom of your toes. Specifically mention cramps in your calves that are a tip-off to peripheral vascular disease or any ankle swelling that can indicate many types of systemic problems.

I’m not trying to make anyone into a hypochondriac, but don’t be shy about your squawk list for your annual physical exam. Be honest, not apologetic, and never think you’re just “whining” or complaining. Don’t worry about that pilot who wrote on his post-flight squawk list, ”Whining sound heard during the shutdown of the engine.” The mechanic’s reply was kind of harsh: ”Pilot removed from aircraft. Whining stopped.” Let your doc decide what’s important and what needs to be checked out further. It’s not whining, it’s helping. The more complete your list, the more it helps you and your doc reach your goal of maintaining good health. Get your doc all the information about your own power plant and frame just like you give your mechanic all the things he needs to diagnose and treat what’s wrong with your airplane. That way you and your airplane will always be “fit to fly.”

Kenneth Stahl, MD, FACS

Kenneth Stahl, MD, FACS is an expert in adapting principles of aviation safety to the healthcare industry for patient safety. He also writes and teaches pilot safety principles and error avoidance. He is triple board-certified in cardiac surgery, trauma surgery, surgical critical care and general surgery and holds an active ATP certification and a 20-year member of the AOPA. Dr. Stahl practices surgery full-time and is Healthcare Division President for Convergent Performance, an industry leader in teamwork, checklist and accountability training and consulting. He can be reached at [email protected]

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