Where Do I Begin?! Special issuance

[Rushie]

Boomer...before doing any tests, which then become a part of your permanent record, I strongly urge you to retain Dr. Chien or Dr. Fowler to guide you through the process. A wrong test, or even a stray comment by a doc in your records, could derail you. You need to listen to the good advice that you're getting here. Don't go rogue. Hire an expert before doing anything else, and follow their advice to the letter.

Great point, you don't want to do tests that aren't required. OP said in the first post he already messaged Dr. Bruce, but in the next post says he got "mixed" responses about what tests are needed.

Is "mixed" two different answers from Bruce? A different list from Bruce vs Dr. Fowler? Or a different list from Bruce and some AME unknown to us?

I would go with either Dr. Bruce or Dr. Fowler. If they are giving you two different lists of tests, understand they have slightly different approaches. Dr. Bruce is of the mind to get ALL tests and information the FAA could possible want assembled before ever submitting the first application. Dr. Fowler is okay with making a submission, then hearing from the FAA what more they might want. Please correct me if I am wrong, either of you! I am going from memory from some posts you made long ago.

Either doctor will get you there. Perhaps if you are very time constrained, it might be faster to go the Dr. Bruce way. On the other hand, if money is an issue and Dr. Fowler only recommends the minimum conservative number of tests initially, you might want to go with him. Possibly the FAA won't require more. But with Dr. Bruce almost certainly they won't, but more trouble and expense up front.

Again, Doctors, correct me if I'm misunderstanding either or both of you.

 

[SoCal 182 Driver]

But for everybody who needs a medical exam, the more you know about the medical pitfalls the more control you have over your own doctor in recording them in a way that's not damaging. This is particularly true now with coding pitfalls, which are very complex and often not performed by the doctor but by a coding specialist using the doctor's notes, and usually in a way to maximize reimbursement without actually being fraudulent.

 

[dbahn]

That has no bearing on the topic. I'm addressing all this scare advice from guys I'm betting never have gone through the process. This young man is concerned and asked for guidance. I'm trying to provide some from the been there-done that perspective.

OK, I'm doing that as well. Here's my personal "been-there" list:

1. Three separate Special Issuances, including one for a false cardiology finding, two for cancer requiring radical excisions
2. Several letters from OKC that start something like "we are unable to establish your eligibility for Class 2 medical".
3. Retired orthopedic surgeon very familiar with coding pitfalls, married to a coding specialist
4. Adjunct professor in the Professional Pilot Program at Vermont Technical College - course in "Aviation Physiology and Psychology" includes a lecture on Medical Certification and medical pitfalls, which has been highly appreciated by career minded students who "had no idea" about the pitfalls.

Your post that I quoted did not include the point about "odds are" that the cardiologist docs are experienced in pilot stuff, but I can tell you that most doctors are not experienced in pilot stuff and many simply don't care. I'm not sure why you think my post has "no bearing" on the topic. Please clarify.

 

[bflynn]

At some point you have to pick your Senior AME, consult with him ... and apply!

listen to this man too. He is another AME with a great big collection of BTDT t-shirts.

Is it still true that tests have to be current, within the last 90 days?

 

[AggieMike88]

Is "mixed" two different answers from Bruce? A different list from Bruce vs Dr. Fowler? Or a different list from Bruce and some AME unknown to us?

The way I read it is he got mixed up by communicating with Bruce and obtaining the proper list of what to do/obtain, then went to someone else(s) and got their list(s), and found the new one(s) was different from Bruce's.

 

[AggieMike88]

@dbahn ... please please please someday video that lecture and make it available to the rest of us for the purpose of education and sharing.

 

[dbahn]

@dbahn ... please please please someday video that lecture and make it available to the rest of us for the purpose of education and sharing.

I'm happy to send anyone the PowerPoint lecture, although it's never the same as giving the actual talk, but maybe I can get it it videotaped.

 

[flyingron]

I've had a friend that went through the Afib/RF ablation SI. It's pretty straightforward if you don't have other problems that show up, but again, it isn't going to be fast in processing.

 

[Clip4]

Thanks for your sarcastic, unneeded comment.

No sarcasm. You want to work in a profession regulated by bureaucracy. If you find this very unappealing you will not likely be happy.

 

[Boomer7200]

I've had a friend that went through the Afib/RF ablation SI. It's pretty straightforward if you don't have other problems that show up, but again, it isn't going to be fast in processing.

If I may ask, how long did the whole process take? From the start of getting tests to having an SI in hand? Thank you in advance!

 

[Boomer7200]

Great point, you don't want to do tests that aren't required. OP said in the first post he already messaged Dr. Bruce, but in the next post says he got "mixed" responses about what tests are needed.

Is "mixed" two different answers from Bruce? A different list from Bruce vs Dr. Fowler? Or a different list from Bruce and some AME unknown to us?

I would go with either Dr. Bruce or Dr. Fowler. If they are giving you two different lists of tests, understand they have slightly different approaches. Dr. Bruce is of the mind to get ALL tests and information the FAA could possible want assembled before ever submitting the first application. Dr. Fowler is okay with making a submission, then hearing from the FAA what more they might want. Please correct me if I am wrong, either of you! I am going from memory from some posts you made long ago.

Either doctor will get you there. Perhaps if you are very time constrained, it might be faster to go the Dr. Bruce way. On the other hand, if money is an issue and Dr. Fowler only recommends the minimum conservative number of tests initially, you might want to go with him. Possibly the FAA won't require more. But with Dr. Bruce almost certainly they won't, but more trouble and expense up front.

Again, Doctors, correct me if I'm misunderstanding either or both of you.

This is correct. I have been told that I will need a 7 day zio patch monitor and a complete echocardiogram and I have also been told from an AOPA medical specialist that I will need an EKG and just a 24 hour Holter Monitor.

 

[Texan Pilot]

I CAN concur with everything above and especially getting current tests (within last 90 days) and consulting the AME before you actually apply for the AME exam with them.

I personally made the mistake of visiting the AME exam with a 6 mos old EKG and was immediately deferred. That exam was in June, and 2 separate FAA letters requesting multiple tests and scores of doctors records and 5 long months later, I received my medical and SI in Nov.

I wish I had been properly advised to seek consultation beforehand.

Do not convince yourself that you can do this without being utterly prepared and advised by experienced professionals. I only wish I knew about this forum when I started the process... but fortunately now I’m happily moving forward with my training and would never wish these kind of delays on any aspiring pilot!

 

[Rushie]

This is correct. I have been told that I will need a 7 day zio patch monitor and a complete echocardiogram and I have also been told from an AOPA medical specialist that I will need an EKG and just a 24 hour Holter Monitor.

Ah I see. I myself got advice from the AOPA medical specialist, as I did not know of Drs. Chien and Fowler back in the day. I went to a local AME and applied, the FAA requested additional information, I ended up getting certified and all was fine. But if I had to do it again, I'd go through one of the doctors here. Especially now since my medical situation has gotten even more complicated.

 

[Half Fast]

That has no bearing on the topic. I'm addressing all this scare advice from guys I'm betting never have gone through the process. This young man is concerned and asked for guidance. I'm trying to provide some from the been there-done that perspective.

I have been through the SI process. I used Dr Bruce. Had I started talking with docs and getting letters and reports prior to getting his advice, and his boilerplate language to be used, my medical would have tanked.

 

[Half Fast]

... but there are many senior AME's not on forums that can handle complicated certifications.

I thought the others had all died by now.

 

[murphey]

That has no bearing on the topic. I'm addressing all this scare advice from guys I'm betting never have gone through the process. This young man is concerned and asked for guidance. I'm trying to provide some from the been there-done that perspective.

Or gone into cosmetic surgery.

It’s been that kind of day. Perfect flying weather and I’ve been home waiting for the new stove and patching drywall. Got a call truck in an accident, can’t deliver until Friday, another great day to fly,

Bah humbug.

 

[azure]

This is correct. I have been told that I will need a 7 day zio patch monitor and a complete echocardiogram and I have also been told from an AOPA medical specialist that I will need an EKG and just a 24 hour Holter Monitor.

If the "I have been told" part was advice from Dr. Bruce, then I would take that over what an AOPA medical specialist told you. That's all other things being equal, i.e. that both Bruce and the AOPA specialist had ALL the details of your case.

The good news here is that assuming that you were not given a diagnosis at any time of organic heart disease of some kind, and assuming your SVT never recurs, you will almost certainly get a "letter of eligibility" from the FAA in a few short years and be off of the SI treadmill. You will need to jump through the hoops once, maybe twice, and then you'll be done assuming no red flags show up during that time. I was not so lucky. I was long ago given a "wastebasket" diagnosis that, if it were real, could pose an actual danger of sudden incapacitation. It's almost certainly a bogus diagnosis and has never shown up on imaging since the original dx, but there is no noninvasive test in the world that can rule it out 100%. So as far as FAA is concerned, I have it. Insurance will no longer pay for the annual tests I would need to maintain a 3rd class medical, and I can't afford to pay for them out of pocket. So I've gone over to Basic Med since I'm not interested in flying professionally or internationally.

Under our system, healthy people can easily have to pay thousands of dollars annually for as long as they continue to fly, if they want to keep an FAA medical certificate. Your only defense against that happening is to own your own medical from the get-go, as @AggieMike advises. It's something you have to learn to do and actively practice every time you visit the doctor for anything more serious than the common cold. It sounds like you're on the right road, so kudos to you for that.

 

[flyingron]

Yep, it took my AME to write a letter proclaiming the FAA original misinterpretation of the data that lead to my SI as a "********" diagnosis to get them to grudgingly admit that I did not and never did have the issue (the original paperwork plain as day said that the initial test indicated a condition that much subsequent testing and analysis showed I didn't have).

 

[lbfjrmd]

I would go with either Dr. Bruce or Dr. Fowler. If they are giving you two different lists of tests, understand they have slightly different approaches. Dr. Bruce is of the mind to get ALL tests and information the FAA could possible want assembled before ever submitting the first application. Dr. Fowler is okay with making a submission, then hearing from the FAA what more they might want. Please correct me if I am wrong, either of you! I am going from memory from some posts you made long ago.

Either doctor will get you there. Perhaps if you are very time constrained, it might be faster to go the Dr. Bruce way. On the other hand, if money is an issue and Dr. Fowler only recommends the minimum conservative number of tests initially, you might want to go with him. Possibly the FAA won't require more. But with Dr. Bruce almost certainly they won't, but more trouble and expense up front.

Again, Doctors, correct me if I'm misunderstanding either or both of you.

Basically, yes this is my typical approach. I 'curate' the 1st submission and afterward, the Airman and I get our ducks in a row. Half the time if necessary I make a phone call or two to the FAA or a FAA designated specialist to clear the fog!

 

[bbchien]

Either approach is valid. One simply takes more “rounds around FAA” than the other, with SVT, You prolly have had the echo done already.

But, bear in mind you can’t really get good use of your aviation $$s until you have a cert (also CFI)......time vs $$ is hard to assess.

 

[Boomer7200]

For anyone wondering, I have put together a list of tests recommended from Dr. Bruce and an AOPA medical specialists which consists of an

EKG, 24 Holter, echocardiogram, stress test, and an evaluation from a cardiologist. A 7 day Zio Patch is required in special cases, so I will wait until I know I need that one.

I am looking to complete all these tests in the next month, follow up with a consultation from a senior AME, then if able, complete an actual exam and submitting my tests. I am hopeful that I will have an SI in hand by July or August. I have gathered that I should only need an SI for 2 or 3 years, as that will bring me to the 5 and 6 year mark since my last procedure. I have also determined that flying is 100% worth the cost and time as I can't see myself doing anything else.

 

[Crashnburn]

Thinking a little outside of the box here. I agree the OP should get a medical consult before going to an AME for a medical. However, that doesn't keep him from training before he gets the SI.

As long as he has passed a medical for a Driver's License, and hasn't been rejected for a medical, he qualifies for Light Sport Pilot, and can fly LSAs. Of course, there are limitations - Day VFR, max of one passenger, altitude limits, etc., but he can train to PPL standards in the LSA, as long as he stays within the Light Sport Pilot limitations, some of which I listed above. (A solo is a solo, a long day XC is a long day XC, etc.) Just a thought.

 

[Bill]

F stress test,

Be sure to clarify with Bruce whether you need a regular stress test or a nuclear stress test. Sometimes AMCD requires the nuclear.

 

[AggieMike88]

@Boomer7200 -- Bill makes a good point about which stress test.

Saves the trouble cost of repeating if you guess wrong. Or the FAA witch hunting if you did the nuke when the non-nuke was acceptable.

Also, make sure Dr. Bruce provides you with the guidance of how the stress test is to be done. On this board, we have heard of a few examples where the test was not done the way the FAA wanted it (mainly stopping too early). This caused more delays and bad feelings than if the Doctor conducting the test had known/done it the way the FAA was expecting.

 

[Boomer7200]

@Boomer7200 -- Bill makes a good point about which stress test.

Saves the trouble cost of repeating if you guess wrong. Or the FAA witch hunting if you did the nuke when the non-nuke was acceptable.

Also, make sure Dr. Bruce provides you with the guidance of how the stress test is to be done. On this board, we have heard of a few examples where the test was not done the way the FAA wanted it (mainly stopping too early). This caused more delays and bad feelings than if the Doctor conducting the test had known/done it the way the FAA was expecting.

I was planning on just getting the maximum stress test. But I will look into finding out about the nuclear. I hope not, seems unnecessary and not too good for you.

 

[Boomer7200]

Thinking a little outside of the box here. I agree the OP should get a medical consult before going to an AME for a medical. However, that doesn't keep him from training before he gets the SI.

As long as he has passed a medical for a Driver's License, and hasn't been rejected for a medical, he qualifies for Light Sport Pilot, and can fly LSAs. Of course, there are limitations - Day VFR, max of one passenger, altitude limits, etc., but he can train to PPL standards in the LSA, as long as he stays within the Light Sport Pilot limitations, some of which I listed above. (A solo is a solo, a long day XC is a long day XC, etc.) Just a thought.

I appreciate the thought, but I will be starting an aviation program within a university that requires me to hold a medical before starting. Looking to receive ATP certificate in a few years.

 

[AggieMike88]

I was planning on just getting the maximum stress test. But I will look into finding out about the nuclear. I hope not, seems unnecessary and not too good for you.

My point was to find out exactly what is needed for the stress test and do that and just that.

The nuclear version is where they inject you with a a radionuclide dye and get images of your heart in action as you run on the treadmill.

If this version is not needed for your case, then don’t do that. Whatever is needed, get the full information, including how the test is to be conducted, from Dr Bruce and your supervising AME.

 

[Boomer7200]

My point was to find out exactly what is needed for the stress test and do that and just that.

The nuclear version is where they inject you with a a radionuclide dye and get images of your heart in action as you run on the treadmill.

If this version is not needed for your case, then don’t do that. Whatever is needed, get the full information, including how the test is to be conducted, from Dr Bruce and your supervising AME.

I knew what you were saying, I just found out that a Stress Echo would be sufficient.

 

[azure]

I knew what you were saying, I just found out that a Stress Echo would be sufficient.

That's good news. As I understand it, the stress echo is nearly as sensitive as a nuclear stress test, has less chance of a false positive, and best of all, gives you zero exposure to radiation.

The stress echo is one of the tests the FAA required because of my supposed condition.

 

[TCABM]

I knew what you were saying, I just found out that a Stress Echo would be sufficient.

Couple of things to consider for the stress echo; they may need to inject a dye to get good image. They do this in the before images, then let you know to give them a 30-second warning before you stop on the treadmill to inject the dye again to give it time to circulate before the second imaging.

Almost as soon as you finish the treadmill portion, the tech will want you to hold your breath on demand during the second imaging. This also can help produce a better set of images, but it can be difficult as you may be out of breath.

Before leaving, make sure you have a copy of the entire tracing, and not just the summary. Also, it can be useful to get a copy of the images on disk...you never know when the FAA might ask for that additional data.

My biggest lesson learned from my stress echo earlier this year was that my cardiology team wasn’t used to dealing with what the FAA wants, both in duration/performance and documentation, so We has a good conversation about what was needed to satisfy the FAAs request.