This will be a monthly
contribution to the newsletter on issues of Medical and Aviation concerns.
A young, to me, pilot came to see me recently. He had had his physical a few months ago, and now his family doctor wanted him to start medicines for his hypertension (high blood pressure). He wanted to know what was the deal with FAA. Hypertension is a condition where our blood pressure runs too high. This does not lead to an acute problem, but over time can cause some real life threatening conditions, such as heart attacks, strokes, kidney failure, and even visual problems, if severe enough. The FAA will not accept blood pressure readings above 155 for the upper number (systolic) or 95 (diastolic) for the lower number. In the medical world, the suggested standards are now 135 over 85. So, many people who are called hypertensives by their physician are not, under FAA rules. But, the other part of the equation is that once someone is diagnosed hypertensive by their physician, they generally require medication. Fortunately, blood pressure medicines are usually waiverable, with a few hoop jumps. Only some of the very old medicines are not readily accepted by the FAA. So, what is needed to get the medical certificate back? (Remember, if you start any chronic medication, your medical must be self suspended until the FAA clears you to take that medication.) Well, a note from your doctor listing your coronary risk factors and response to the medication, some simple lab work, and an initial EKG. If your risk factors are high enough the FAA, and probably your Family Doctor, will suggest a Stress Test also. They also want three readings showing normal Blood Pressures after starting the medication. These are actually very simple steps to accomplish, and if all the data is gathered before you see your AME, the FAA will generally allow an immediate issuance of the medical certificate at the time of the physical, or as the case with my patient, they did not require a new physical and verified that he was acceptable to fly with the medicines. Remember, before you start new medicines, contact your AME. And don't avoid treatment, it could help extend your flying life. FLY SAFE!
In the past few months contributors to the Short Wing Piper Club (SWPC) mail list have been discussing the large number of general aviation (GA) accidents. We all agreed that it is entirely possible for something to break, the engine to roll over and die, or other events can occur that contribute. But, the overwhelming majority of the problems can fall under the heading "pilot error". Man, that is an alarming statement! This category can even cover events like running out of fuel or hitting bad weather. Why? Because the pilot may not have done a proper preflight, done proper planning or just did not have his "mind in the game". In the Air Force, we used to talk about the perfect pilot. He was the one who had different boxes for different parts of his life. When he was flying the only box open was flying! The family, bills, upcoming promotion list etc. were all in closed boxes. There should be no difference with GA pilots. When we fly, we must concentrate 100% on flying. If we are concerned about the sick kid, the upcoming new job, the bills, the need to get home, etc, we are not concentrating on flying. Flying is a fantastic pastime, but it can not be done without our total concentration. We must be attuned to all nuances of the plane and the flying environment. Anything less and we can become a NTSB statistic. I have advocated in the past here that the Pilot should be number one on your preflight checklist. IF YOU ARE NOT AT 100%, DO NOT FLY! The CAP has an excellent preflight checklist dealing with the pilot, the environment and the aircraft, resulting in a quantification of the risks. It is too big to reproduce here, but check with your local CAP for a copy, or email me for one. It will help. It will decrease your risk, and increase your enjoyment of flying. FLY SAFE!
This
past week, I met a very nice gentlemen who had been flying for
a lot of years. He had over 450 hours with 50 in the last 6
months. While going over his history, it was discovered that he
had been diagnosed with hypertension (high blood pressure) about 6
months ago. He had been started on medications, but had never
thought about telling his AME (Aviation Medical Examiner). As
all of you know, 14 CFR 61.53 says: "No person may act as a
pilot in command&ldots;while he has a known medical deficiency, or
increase of a known medical deficiency, that would make him unable to
meet the requirements for his current medical certificate".
He was jeopardizing his license, but worse, if he had some type of
incident that required an insurance payment, that would have been
denied him.
I was recently asked to comment in this column about a specific question, and initially was going to defer it because I thought it might be too personal and limiting for this space. But then I looked around at the recent Chapter 21 meeting and realized that many of us are more mature, and thus more prone to develop some form of the Big C, i.e. cancer. So, I will jump in and comment on the question that asked me to address chemotherapy and flying. Ok, first the bad news - a diagnosis of cancer is an automatic loss of your medical clearance. Not forever, just while being treated, cured, staged, whatever. The FAA's biggest concern is metastases (spread) to the nervous system. If you are staged and have mets then it will take at least 3 years to get recertified. If you have certain types of cancer, especially breast, lung or melanoma then you will have to be tested to prove you do not have brain metastases. In general, your cancer specialist will have to prove you do not have metastases. Other types of cancers have other protocols to follow. Now the good news, with some forms of oral chemotherapy, the FAA is willing to consider special issuance earlier than completion of the treatment. The smartest thing to do is get in touch with your AME, and find out what documentation you need before you even try to get recertified. Also check the AOPA and EAA websites for specific help. I want to wish all of you a very Happy and Peaceful Holiday season. FLY SAFE.
This week, I experienced a phenomenon that I know many of you would not expect. I did a physical on a gentleman that in the past would have taken 3 months to obtain final FAA approval. With the help of the EAA, through its AME Pilot Advocate group and a kinder gentler FAA medical certification Branch, I was able to perform the Physical on Tuesday, and have him certified on Friday. WOW! Of course he had to do some fast footwork, and I had to have everything in place before we could even attempt to call, but it is working as advertised. The FAA is really trying to apply more realistic medical policies. As I have stated many times in the past AME's get no delight in flunking or deferring a pilot. But, as we all know, the FAR's occasionally make the process difficult. Make life easier on yourself. If you have a known medical problem, contact your AME earlier, or the EAA AME Pilot Advocate program, or there are people out there now, such as Pilot Medical Solutions, at www.leftseat.com who will work with you to ensure you have all necessary documentation to get your medical ticket on your first visit to your AME. That web site will help you for a cost, but with serious medical problems, it is worth checking out. Be pro-active; plan your physical like a good cross-country trip. FLY SAFE! PS. I PASSED MY private pilot Checkride on the 30th of August and have now begun training in my "new" Pacer taildragger. Also I would like to welcome The New Braunfels Texas EAA Chapter 958, with its president, also an AME, Bill Tarver. Along with our Chapter 21 and Ayers Fling Club in Owensboro, this is now going out to very many people.
I am getting close to taking my FAA check ride for my license. I know for most of you that is a long ago time, but for me, despite all my Air Force hours, many at the controls, it is exciting for me. But it also causes a little of what is known in racing as the "red mist". This condition initially occurred at a race track (Road Atlanta) near Atlanta, where the local dirt is red clay. When the national championships for Sports Car Club of America were contested every year, we in the medical field saw some incredibly bad decision making and chance taking. We felt it was because the minds were getting clouded by the "red mist" of the local clay. Ergo, the expression, that is now part of professional racing announcers lexicon. Well, this all leads to the fact that yesterday, I suffered from Red Mist and tried to beat a storm out of Evansville. I had a feeling it was coming, but the weather forecast did not accurately predict. My instructor trusts me enough now to let me make the takeoff decisions, and he was along for some "hood time". Good thing, since after we took off, the weather changed by the second, and I had to ask him to land when we got recalled back. Why this confession? It is just a reminder that no matter how smart we are, we can not let ourselves be pressed, and must always make smart, conservative decisions. We cannot let our "red mist" cloud our decision making process. I learned, I am safe, and will fly another day, in fact thrice more this weekend, but not under pressure to finish, again. FLY SAFE! PS hope to see you at the Skylane Poker run on 4 Jun, or the EAA picnic on the 17th.
Finally everything is blooming, and it appears we have finally seen an end to the cold weather that has destroyed the plants. Of course that means that the pollen levels are now reaching maximum levels and many of us are suffering from Seasonal Allergic Rhinitis, more commonly known as "Hay Fever". There are very annoying symptoms including runny nose, sneezing, itchy watery eyes, etc. There are also many treatments, including many that are over the counter, and don't require a prescription. But, be careful of them, especially with flying. One of the more common over the counter anti-histamines is Benadryl, generically called diphenhydramine. It is very good for most of the nasal symptoms, but it has some significant side effects, especially drowsiness. That would definitely preclude you from flying safely. Of more recent concern is a study that showed users of Benadryl are as impaired as if they had been drinking, and similar to alcohol, the people do not realize they are impaired. That is very scary. Most of the other over the counter antihistamines have similar side effects, but haven't been study as specifically as Benadryl. FAA recommends no flying for at least 24 hours after taking these medications. I would also suggest that the nasal congestion itself would be a good reason to stay on the ground for a period until the symptoms resolve. There are many excellent prescription anti-histamines and nasal steroids available that can control your problems and allow you to fly safely. Don't hesitate to talk with your family doctor or local AME for help. FLY SAFE!
To Lasik or not To Lasik, that is
the question. (Sorry for the very poor para-phrasing of
the Avon Bard). If you, like myself, have had your glasses or
contacts for eons, and don't care, then you can skip this. I
realize that a world without glasses must be really neat. I would
love to see the clock when I wake up or see the bottom when I swim,
but I am also a fatalist in the belief that if one complication in a
million can occur, then it will be me; and I don't care for a glass
eye. Having said that, let's talk about Lasik. What is
it? A method of surgically correcting vision, where less than
20% of patients require glasses after the surgery. It works
better on less nearsighted people than those of us with coke bottle
glasses. On people who require both reading glasses and distant
correction, you will still need the reading glasses. It
generally takes up to 3 months for the vision to stabilize post
operatively, so flying in that time may require glasses, taking other
pilots along, or just not flying in that period. And remember,
there are complications, as there are with any medical
procedure. Those could jeopardize your flying status, but
usually do not. If you are interested, talk with your own
doctor, or a LASIK specialist. Weigh the benefits and possible
risks before embarking on what could be a life changing event. No
answers this month, just my opinion, comment, for what it is
worth. FLY SAFE.
Spring is here! Or at least it's coming soon. Among all the changes of spring, is the congestion that develops in the air. Birds heading north must compete with the greater number of fliers taking advantage of the longer days and nicer weather to fly. It starts looking like the Lloyd Expressway on the ATC radar screens. Those of you who keep up with the news of aircraft accidents realize that we are having a spate of mid-air collisions among general aviation aircraft. People are landing on top of each other, side-swiping each other and just hitting head-on. These have generally been occurring in the pattern, but some are also happening in clear skies. The lesson here is that we have to be more vigilant about what is in our environment. In addition to the instrument scan all of us develop, we have to develop a good scanning process outside the cockpit. It is very difficult to see a Cessna 152 at your altitude 2 to 3 miles away, but it can be done, and needs to be practiced. Any thing practiced often enough becomes a part of your normal behavior. Practice scanning, keep the eyes open for others, and help ensure that your flight ends as you planned it. Fly safe. PS In April I will be talking at the meeting about the FAA medical rules and you. I will be happy to address any questions, but would appreciate any questions now so that I can be better prepared, and also have a better idea of what people want to know about.
Those of you who read the monthly EAA magazine and read the medical article found a very good article on eye problems and issues. I have recently run into a problem that will adversely affect flying and felt I should bring it up. Many in my age group and older require at a minimum reading vision correction. Also many of those same people are also nearsighted. Many eye doctors suggest the use of mono-vision contacts for these two problems. That is, one contact corrects for reading and one for distant vision. Sounds good, but destroys your depth perception. Our brains adjust in early childhood to binocular vision and use it to help determine our position in relation to other objects in space. If we change that binocular view of the world, our brains can't adapt. For a test, close one eye and try to touch something around you. This lack of depth perception can be deadly in the cockpit. It has been blamed for at least one accident of a commercial airliner in the recent past. It is also illegal to fly that way, per FAA rules. Don't waste your money and jeopardize yourself or others. Also, for those presbyopic (we need reading glasses) fliers out there. You can have your reading glass prescriptions made for the cockpit environment. When you are getting a prescription tell the eye doctor how far away you sit from your instruments, and he can arrange your prescription to be optimal at that distance. I guarantee that it is very effective. Good vision, or vision correction makes our cockpit time just that much more fun. Fly safe.
Last week the AVWEB, (http://www.avweb.com/), an internet site devoted to aviation news, etc. asked its readers what they thought about medical self-certification for private and recreational pilots. That generated an amazing amount of emotion, with over 500 comments, diatribes and opinions. I am not going to give my opinion here, but must comment on many of the submitted statements. A large number of the readers noted that we as pilots must preflight our aircraft every time we fly, and that we also, in reality, preflight ourselves before we fly. I thought about that and realized that for many of us that may be true, but not truly for all of us. We, as a group are checklist oriented, with most of us having the checklist memorized by the time we have flown many hours. Well, maybe we should add Pilot as part of the preflight checklist. We should truly ask ourselves do we feel good about this flight. Do we have clear sinus and nasal passages, no stomach problems, no other untoward aches and pains?. Do we have any land-based problems that will disturb our thinking while in the air? Are we under any excess pressure to do this flight? Any of these problems could interfere with the act of flying and the FUN of flying. We as pilots must look as critically at ourselves as we do the rest of the aircraft systems. The greatest cause of aviation incidents still is human factors, the interface between man and machine. Add yourself to the checklist, and cancel the flight if you are not in good shape. Think safe, Fly safe!
This will be a monthly contribution to the newsletter on issues of Medical and Aviation concerns. I am willing to cover any topic you want. Just email me at DrJWButler@FlightMD.com or call 812-499-4725 Last month we talked about allergic rhinitis (hay fever) and I alluded to sinus and ear blocks. Well, it is time to discuss those nemeses of fliers. We must cover a small bit of anatomy, physiology, and physics. First, our ears are comprised of two chambers: inner and middle. The inner does not connect with the outside world, usually, and the middle has a "vent tube" to the back of our throat. The sinuses, which I always think of as the system that helps keep our head on balance, are connected by small openings into the outside world inside our nose. Both the middle ear and sinuses are surrounded by bone. Second, the physics of the situation is such that air at ground level takes up a specified volume. In my mind I always think of air as a single bubble, it will make the rest of this make sense. When we ascend the bubble gets bigger because the pressure is less, and if we descend the bubble gets smaller because the pressure increases. Ok so far? Now the physiology. The vent tube for the ears (called eustachian tube) and the openings for the sinuses are lined by a type of skin that can swell or shrink as needed. When we have a cold or hay fever the skin swells. Now, we put it together. If we are fine and take off, we can occasionally feel a light pressure in our ears or sinuses due to the air bubble increasing in size, until the pressure of the enlarging bubble is such that it escapes via the vents. When we descend, the air bubble decreases in size and more air must come in or a vacuum is created. Thus, we may have to clear our ears with yawning, chewing gum, etc, but it occurs easily and we have no problem. Now if we have a cold, or some other cause for the lining to swell, then we have a problem. As we ascend, we can occasionally hear squeaking as air escaping from the ears and sinuses has to work harder to get out. When we descend, and the air bubble is getting smaller and creating a vacuum, the lining is first drawn into the opening, and the air can not get in to equalize the pressure. The continuing vacuum causes the lining of the middle ear or sinus to be sucked away from the bony surface, and the empty spot fills with blood. That is an ear or sinus block. For those of you lucky enough to not have one it feels like an ice pick has been shoved in your face or side of your head. You can't concentrate on flying, and it hurts. If this develops in the air, the immediate treatment is to level off, or climb until pain is relieved, spray Afrin in the nose, wait a few minutes and slowly descend, clearing your ears constantly. When you land you should see your physician. If there are any questions on how to treat the problem have either them or you call me. I'll be happy to give telephone help. The best way is to avoid the issue and don't fly with a cold, or stuffy nose or ear infection. Prevention hurts a lot less, and you can survive to fly another day. FLY SAFE.
As we head into
fall, some of us will suffer from fall allergies (hay fever, seasonal
allergic rhinitis). There are
PS A shameful plug
to say that the FAA bureaucracy finally gave in and awarded me an AME
ticket for class 2 and 3 physicals. I also enjoy helping pilots get
special issuances, so if you want a PE or help on special
Before this big heat wave, I had planned to cover heat issues. Now it is just some very specific issues as they relate to flying. We all know that at ground level, IT IS HOT, and we should take measures to prevent heat injuries. How about at altitude? Anywhere in the space of 3,000 to 14,000 ft is where the majority of us fly. Well, in addition to the ambient temperature, we now also have the sun beating on the glass in the cockpit (of course the open cockpit aviators have less of a problem, but we'll cover them in the winter), and the increased ability to become dehydrated at altitude. I once had a young flight surgeon weigh himself pre and post a 1 hour flight on a beautiful sunny day with outside temp of 89F. He lost 5 lbs.! (No, not a new diet technique) More importantly, on a psychomotor test he lost 20% in speed and mental ability. That to me is the real issue!!! Many major studies show that heat and water loss produce very similar results. We aren't as sharp as we should be, especially in the critical phase of landing. How to prevent it: Fluids, fluids, fluids. I personally prefer water, but any of the sport drinks, etc. are acceptable. Don't drink caffeinated beverages before flight! And my final suggestion is to urinate before flight, and if it is not clear, you need more fluids. My only rule to young pilots in training in the Air Force was to P Clear. That way you know you are hydrated enough. Fly safe.
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