First time Medical - lots of questions

[BobLaPierre]

Hi all, I've historically been a lurker, and I never suspected that my first post would be about the Medical certification (nor a wall of text), but here we go:

I'm going through the paperwork on the MedXPress site before going to my AME appointment for the Medical requirement for my PPL and I've got several questions.

First, I've had LASIK but it was a long time ago (1997'ish). I'll obviously report it, but I've found documentation stating that if the surgery was over 2 years ago it wouldn't be a problem, but I also found other paperwork which seems like I'd need an eye doctor to fill out? Unfortunately since this is my first post I can't provide links to the above docs, though I have them.

Should I go to an eye doctor and pay to have that documentation filled out before I visit the AME, or is 20 years long enough ago that the AME can just examine me? No side effects to the surgery btw, though I now wear glasses because my vision slowly got a little worse over the last couple decades (1.25 and 1.5 prescriptions, so not bad), and because "old age eyes" finally caught up to me last year (getting old sucks).

Second, kidney stones. I've had kidney stones twice in my life, but the last time was probably 15 years ago. Once again I found documentation stating that if there were no symptoms in the last 5 years that it wasn't a problem, but that documentation was part of a form that apparently I'm supposed to have my regular physician fill out. Due to how long ago it was, is this something the AME can do, or do i need to bring (and thus pay for) supporting documentation from my primary doctor with me to the AME? Since they were so long ago I have no idea who treated me, so I'd basically be asking my primary doctor to examine me and say there's no evidence of kidney stones, as best as I can tell.

Third is the part where I'm "required to enter ALL visits to any health professionals" in the last 3 years. So we're talking things like my annual physical for the last 3 years? A year or two ago I was sick and went to a doc-in-the-box in a pharmacy. I'm supposed to list that? Heck, I might have even been sick more than once in the last 3 years, I can't hardly remember what I had for dinner last night, let alone a sniffle years ago. I don't have the faintest idea how i'd even come up with documentation for something like that. What about flu shots provided by "health professionals" onsite where I work? Am I overthinking this?

Finally, the last question in the medical history section says to list "Other illness, disability, or surgery", though the help text says "List any illness/illnesses or disability/disabilities not provided for in 18a-y.", which only mentions illness & disability but not surgeries. I ask because I've had other surgeries in my life (none in the last ~15 years), though I don't think any would have any bearing on a PPL - things like surgery for a deviated septum, getting fixed after our 3rd kid, etc. Also, like the thing with the kidney stones, I don't have any idea at this point in my life who did some of those surgeries. What am I supposed to do about these? Do I list them?

I scheduled the exam with an AME for later this month, but now I'm thinking about cancelling or rescheduling. Any thoughts on what I should do? I've seen a post or two suggesting people schedule a consultation with the AME instead - is that the route I should go? Cancel the exam and schedule a consult?

Sorry for the wall of text - I divested myself of much of another hobby to come up with the money to get my PPL (wife said expensive hobby limit is 1), and I'd hate for all of that to have been in vain.

Thanks in advance for any input you might have,

-bob

 

[bflynn]

Your first medical or your first medical coming back after an extended absence is a really PITA to fill out.

My advice is to consult with an AME prior to your physical. You have situations that are complicated enough and run right up next to the rules that you want to understand them before you give your confirmation number to the AME. In most cases, the FAA is looking for specific wording in statements from doctors, not just a general reassurance that everything is ok. The purpose of the consult is to understand the FAA's requirements so that you can make sure you are qualified. That may involve testing prior to your physical. You should never go into a physical guessing about whether or not you are going to pass.

Lasik and your other surgeries - list them, it's better to over report than find out later that you should have reported for years. For your lasik, you'll have to have a statement from your doctor that checks off the list of possible side effects and the absence of them. Your AME will know. Your other surgeries should be noted, but AFAIK are not an issue - AME can confirm.

Kidney stones have a specific protocol associated with them too. When you have had two, you move into another category of having to prove that you're really "cured", even after 17 years. Again, your AME can confirm what is needed. I'm writing from memory so I could be wrong, but I don't recall a time frame on the second instance. There will be specific requirements depending on how the stones were confirmed the first time - for example, you may need an xray showing the absence of stones. If an xray shows a stone, then you need a second one 90 days later to show that it's not moving. Don't quote me that those are the correct situations for you.

From what you've posted here, you sound certifiable and in the FAA speak, that's a good thing.

BTW, I'm not an AME and I don't even play one on the internet. Like a lot of others here, I had a brush with the FAA medical system and I learned way, way too much about how they operate.

 

[azure]

I had some similar issues, but I'm not sure if my situation was similar enough that my experience will be applicable to your situation.

I had RK surgery about 9 years before my first FAA physical, and I needed my ophthalmologist to fill out an 8500-7. But that was 9 years, not 21.

I was dx'd with kidney stones and had lithotripsy for them about 7 years into my flying "career". But it was an incidental diagnosis, and the stones turned out to be embedded in the parenchyma and the doc could testify to their being immobile. This was a special issuance.

Yes, you need to list all previous surgeries, whether or not you can provide documentation. I had a couple of surgeries as a child, done at hospitals that no longer exist, by doctors long dead. They were a yawn.

I don't think flu shots or routine physicals need to be reported, but yes you should try to report all office visits for illness. No one is going to come after you or revoke your pilot's license if you miss a visit for the sniffles, it's the serious stuff that can get you into trouble if you lie about it. But do the best you can. If you keep your insurance EOBs, they can help you remember those odd visits to the doctor.

The best advice anyone can give you, given your history, is to NOT schedule an exam with the AME but a consultation. You will likely pay the doc the same fee as if you had gone in for a regular FAA physical, but without the jeopardy attached. The AME can guide you through the process and tell you whether any of your issues will cause a problem with the FAA.

And make sure your AME is a "pilot advocate", one who goes the extra mile to help pilots get and keep their medicals. If your AME refuses to do a consultation, that's a good hint that he is not someone you want to do business with.

If you post your location here (even just state or region), someone might be able to recommend a good AME.

 

[murphey]

Calling Dr. Mike for the medical sticky.....
(no, he's not really a doctor but he's got the most complete posting for process and documentation)

 

[BobLaPierre]

And make sure your AME is a "pilot advocate", one who goes the extra mile to help pilots get and keep their medicals. If your AME refuses to do a consultation, that's a good hint that he is not someone you want to do business with.

If you post your location here (even just state or region), someone might be able to recommend a good AME.

I live in the Northwest Atlanta area. I dunno if it's appropriate to give specific names on this forum or not, but I was planning on using the AME off Windy Hill Road in Marietta since the database says he's also a private pilot. Does anyone have a better suggestion?

Thanks

 

[Matthew]

Other than the LASIK, I've had all the other things you mentioned, and then some.

Medical professional visits in the last 3 years - yeah, you need to list all doc visits. If you see a doc about something, then go to a follow-up, you only need to list it once. Somewhere there's a comment that dental and eye exams don't count (or something to that effect). You might be able to get online with your medical insurance and find out where and when you saw a doc. Annual routine physicals and the doc in the box visit for a sinus infection (or whatever) need to be reported.

As far as the old surgeries go - tonsillectomy at 5 yrs old, sure that counts, but there's no way to find records of when and where - just report it. Once it's reported, on following medicals you put down "PRNC", previously reported no change.

That first medical is always a pain, but we've all been through it.

 

[EppyGA]

I live in the Northwest Atlanta area. I dunno if it's appropriate to give specific names on this forum or not, but I was planning on using the AME off Windy Hill Road in Marietta since the database says he's also a private pilot. Does anyone have a better suggestion?

Thanks

Usually, one that is a pilot is a good choice. You should talk with him before hand. Many will allow you to bring in the the printed summary of your MedXpress and go over it and if they see something they can give you guidance without opening your file. Protect that conf. number with your life and do not let it go without knowing the outcome will be positive.

 

[AggieMike88]

Calling Mike for the medical sticky.....

Which one?

For the eyes and stones, conducting a search would find the info he doesn't already have. And doing a search in the Guide for Aviation Medical Examiners for eyes and Kidney Stones would be of big help.

@BobLaPierre .... doing a consult first would be a very good idea. Finding out during consult you would have passed if you had brought the right documentation is much better than going in for the real exam and finding out you should have brought the right documentation. The latter is a problem because now you are on a tight deadline to produce the documentation, and have opened up the risk for denial (a very bad thing).

Some Google results and links

• Lasik
• Kidney Stones
  • Federal Air Surgeon Medical Bulletin (Page 8)
  • AME Guide Evaluation/Disposition for Kidney Stone(s) (Nephrolithiasis, Renal Calculi) or Renal Colic
    • Note: a KUB imaging study will be required as documentation if there was only a single stone passed to demonstrate there are no additional stones being formed or retained
  • CACI – Retained Kidney Stone(s) Worksheet. AME must review
    • A current status report from the treating physician that notes the airman’s condition is:
      • Asymptomatic;
      • Stable (no increase in number or size of stones);
      • Unlikely to cause a sudden incapacitating event;
      • If surgery has been performed, the airman:
        • Is off pain medication(s);
        • Has made a full recovery; and
        • Has a full release from the surgeon;
      • No history of complications (including chronic hydronephrosis; metabolic/underlying condition; procedures (3 or more in the last 5 years); renal failure or obstruction; sepsis; or recurrent UTIs due to stones.)

 

[AggieMike88]

Finally, the last question in the medical history section says to list "Other illness, disability, or surgery", though the help text says "List any illness/illnesses or disability/disabilities not provided for in 18a-y.", which only mentions illness & disability but not surgeries. I ask because I've had other surgeries in my life (none in the last ~15 years), though I don't think any would have any bearing on a PPL - things like surgery for a deviated septum, getting fixed after our 3rd kid, etc. Also, like the thing with the kidney stones, I don't have any idea at this point in my life who did some of those surgeries. What am I supposed to do about these? Do I list them?

Regarding "They were more than 10 years ago, do I report?" The answer is yes. Remember, the preamble to question 18 is "HAVE YOU EVER IN YOUR LIFE...."

Question 18u asks "Admission to Hospital". And I would think your surgeries make this a yes in addition to 18x.

So check yes to these two, then in the explanations area, just have entries that say something like

18u and 18x. (Month)/(Year): Admission to hospital for surgery to increase the size of my funny bone
18u and 18x. (Month)/(Year): Admission to hospital for a particular enhancement surgery so I can be known as "Mr. Tripod"
18u and 18x. (Month)/(Year): Admission to hospital for surgery to __________​

For each hospitalization and surgery, the AME will ask you for more detail and make notes on his side of the form. He will also determine if they have any impact on your application. If no impact, he notes that and moves on to the next topic. If there is impact, the he should discuss why and what additional information the FAA is going to want.

 

[murphey]

How many think Mike should forget about being a pro pilot and go to medical school to become a SuperAME? Perhaps he could apprentice with Dr Bruce...

 

[BobLaPierre]

Thanks for the advice all. My appointment with the AME has been cancelled and I've scheduled a consult with him instead. Regarding the LASIK documentation, I called my eye doc and it turns out I'm due for my annual eye exam anyway, plus they had an available appointment at 3 this afternoon. So, I'll take the 8500-7 with me and hopefully get that taken care of today. I'll wait for my consult before I look for documentation about the kidney stones, since anything I tried to gather right now would be a stab in the dark and there's no point spending money if I'm not sure it'll help.

Now I just have to figure out the list of "every visit to a medical professional" I've made the past 3 years. I get the feeling that a medical logbook would be a good idea going forward.

-bob

 

[Matthew]

Now I just have to figure out the list of "every visit to a medical professional" I've made the past 3 years. I get the feeling that a medical logbook would be a good idea going forward.

-bob

It's simple to make a note somewhere every time you see a doc. Or just drop a copy of your check-out paperwork in a file folder with your other FAA medical docs.

 

[AggieMike88]

I get the feeling that a medical logbook would be a good idea going forward.

Create a DropBox folder called "Medical Visits"

Create a Google Spreadsheet saved to that DropBox folder. Each row is a visit. Columns are for Dr. Name, Addr, Phone#, Reason for visit, and any findings discussed.

Folder is also good for storing copies of any status letters and worksheets that the FAA wants.

 

[AggieMike88]

and I've scheduled a consult with him instead.

If you are asked by the office staff to surrender the MedXpress confirmation number, DO NOT surrender the number. Remind them that you are here for a consultation and there is no obligation to surrender the number for such a visit. If the staff start getting bent out of shape on that, ask to speak directly to the doctor.

If the doctor insists on surrendering the confirmation number, try one more time to remind him/her this is a consultation. If he/she still insists, thank them for their time and leave. This isn't the AME for you.

Some additional items that Murphey was hinting at.

If you have questions about your medical history or the process of the FAA approving your application,

• call the AME to setup a consultative office visit.
• You will be asked to pay his fee, but that's okay since you are taking up his time
• You may be asked to fill out the online MedXpress in advance.
  • This is okay, however, after printing out the paper copy, grab scissors and remove the confirmation number that appears at the bottom of the form.
  • While in consultative mode, under no circumstance will you surrender this confirmation number
  • The confirmation number is needed to make the exam go "live". But going live means the AME can only issue, deny or defer. You are here to avoid denial and deferral.
• If after completing the consultative visit, the AME says he can issue you right then and there, now you can surrender the confirmation number.
• If after completing the consultative visit, the AME says your application would be deferred due to X, Y, and/or Z, discuss with him what it is you need to go obtain and bring back that will satisfy the FAA and allow the AME to issue your certificate.

 

[lbfjrmd]

your issues are straightforward ... only ? is do you have kidney stone(s) now. Your family doctor could address this with a urine test and an x-ray.

 

[bbchien]

Even if there is a stone remaining with 15 years and no events, if a stone remains, all that needs is a review of the history for hydronephrosis. I'm not sure I'd ask for a KUB as that may be opening a can of worms.

There are three ways to certify a retained stone but the one you want to know about requires two identical studies 90 days apart that are unchanged. And that is a special issuance. But if your PCP is wiling to write that he warrants there are no complications, you've been asymptomatic, the 15 years speaks to the unlikely-ness of any remains to cause sudden incapacity.

Lasik- if you had a good outcome, if more than 2 years ago the FAA can certify you based on what the AME describes as to your outcome.

I agree with Dr. Lou-you should walk out with a certificate provided you make standards, can see and have nothing in your pee.

 

[BobLaPierre]

... provided you make standards, can see and have nothing in your pee.

LOL I like that line.

Thanks for that PDF Bruce. Question - the document you provided says "A current status report from the treating physician...". Is the treating physician my regular primary doctor? If so, based on what the document says (and what you mentioned), it looks like I should be able to just get an "ok letter" from my regular doctor (containing verbiage that the CACI worksheet is looking for) and that might be all I need to handle the kidney stone history.

My eye doc filled out the 8500-7 at my annual exam today, so that piece of documentation is behind me.

My consultation with the AME is in two weeks - it shouldn't be a problem to get my medical history completed by then.

If I get the above three items taken care of before the consult, maybe that means there's a chance the AME could issue the certificate that day..... boy wouldn't that be nice!

Thanks a bunch guys - I'll let everyone know how it turns out.

-bob

 

[BobLaPierre]

Thanks a bunch guys - I'll let everyone know how it turns out.

Well, I had to push back my consult a few times because of work scheduling issues, but I finally got in today. I spoke with the doctor at length and he addressed all of my concerns in a straightforward manner. At the end he said that none of these issues would be a problem based on my documentation and that if I wanted to do the exam right then we could. A little while later I walked out of the office with a 3rd class medical in my hand and a smile on my face.

Thanks all!!!

-bob

 

[AggieMike88]

Well, I had to push back my consult a few times because of work scheduling issues, but I finally got in today. I spoke with the doctor at length and he addressed all of my concerns in a straightforward manner. At the end he said that none of these issues would be a problem based on my documentation and that if I wanted to do the exam right then we could. A little while later I walked out of the office with a 3rd class medical in my hand and a smile on my face.

Thanks all!!!

-bob

Awesome!

 

[Hank S]

How many think Mike should forget about being a pro pilot and go to medical school to become a SuperAME? Perhaps he could apprentice with Dr Bruce...

Nah, he can still do both. He's a great resource to have around here.