Going for 3rd Class / PP - History of vasovagal syncope

[YC698]

Just wondering what the process for this is going to be. I haven't started anything medical yet. Passed out once in high school during a JROTC emergency medicine class where they were showing gruesome injury pics and tourniquets. Happened again 8 years later in the Army during a combat lifesaver course, same exact scenario, gruesome injury and tourniquet pictures. It's now been 12 years since that second incident. I haven't subjected myself to those kinds of pictures to that extent or the time that was spent on them back then, but have done some medical stuff including give/get IV's, etc., viewed some light gore pics in training, no issues. I think just got better at keeping my mind on the task at hand instead of letting my brain dwell on the unpleasant stimuli. Anyway, would appreciate any input on just how much of a pain this will be. I probably could obtain the medical history where they checked me out the second time and stated it was vasovagal. The first incident when I was a kid, there is just no way. Was living in a different state/city temporarily at the time, and only got checked out by a random urgent care place my mom took me, where they just asked what happened and said it was the blood/gore pics.

 

[bbchien]

So, the FAA will require:

Cardiologist's consultation with
Stress treadmill to 90% of your Vmax (age related) heart rate and 9 minutes' duration.
24 hour Holter
Echocardiogram

May be overkill but "that's how it is".

I would not go to an AME first. He would be inclined to issue you, and then get teh 60 day demand letter, and you have no idea what'll show on these tests. IF they are not favorable you get a denial and that locks you out of even Light Sport flying.

 

[MacFly]

Just wondering what the process for this is going to be. I haven't started anything medical yet. Passed out once in high school during a JROTC emergency medicine class where they were showing gruesome injury pics and tourniquets. Happened again 8 years later in the Army during a combat lifesaver course, same exact scenario, gruesome battlefield injury and tourniquet pictures. It's now been 12 years since that second incident. I haven't subjected myself to those kinds of pictures to that extent or the time that was spent on them back then, but have done some medical stuff including give/get IV's, etc., viewed some light gore pics in training, no issues. I think just got better at keeping my mind on the task at hand instead of letting my brain dwell on the unpleasant stimuli. Anyway, would appreciate any input on just how much of a pain this will be. I probably could obtain the medical history where they checked me out the second time and stated it was vasovagal. The first incident when I was a kid, there is just no way. Was living in a different state/city temporarily at the time, and only got checked out by a random urgent care place my mom took me, where they just asked what happened and said it was the blood/gore pics.

If FAINTING (vasovagal syncope) twice in your life, most recently more than 12 years ago is something that is cause for special concern by the FAA then "overkill" doesn't begin to describe it. I would say "absurd" bordering on "ridiculous" and it's a great example of how crazy the FAA medical branch has become. I never would have even considered putting "fainting" into my MedXpress form or even mentioning it to my AME.

 

[YC698]

So, the FAA will require:

Cardiologist's consultation with
Stress treadmill to 90% of your Vmax (age related) heart rate and 9 minutes' duration.
24 hour Holter
Echocardiogram

May be overkill but "that's how it is".

I would not go to an AME first. He would be inclined to issue you, and then get teh 60 day demand letter, and you have no idea what'll show on these tests. IF they are not favorable you get a denial and that locks you out of even Light Sport flying.

So, I did for another job years ago (25 yr/o,) require an ECG as part of a physical (just part of the normal screening for them, not based on med. history) where they found nonspecific intraventricular conduction delay, had me do an echo, found everything completely normal on that, so they stated it was a normal variant and sent me on my way. Would this complicate or help matters? From what I've read the asymptomatic NIVD is an FAA normal variant finding and is typically fine.

 

[PeterNSteinmetz]

So, I did for another job years ago (25 yr/o,) require an ECG as part of a physical (just part of the normal screening for them, not based on med. history) where they found nonspecific intraventricular conduction delay, had me do an echo, found everything completely normal on that, so they stated it was a normal variant and sent me on my way. Would this complicate or help matters? From what I've read the asymptomatic NIVD is an FAA normal variant finding and is typically fine.

I think it will slightly complicate it as it will need to be explained. But you will need current testing as specified by Dr. Chien.

 

[MacFly]

So, I did for another job years ago (25 yr/o,) require an ECG as part of a physical (just part of the normal screening for them, not based on med. history) where they found nonspecific intraventricular conduction delay, had me do an echo, found everything completely normal on that, so they stated it was a normal variant and sent me on my way. Would this complicate or help matters? From what I've read the asymptomatic NIVD is an FAA normal variant finding and is typically fine.

Your workup was normal right? What are you going to report? Why would you even mention it?

 

[bbchien]

Mac fly- the Dxcode databases began in 1995-96. He can’t non report withou some reasonable fear of being contradicted by his codes......

The OP already has heart disease and may well by now have Left. Bundle Branch Block.....

My original commentary stands....

 

[YC698]

Mac fly- the Dxcode databases began in 1995-96. He can’t non report withou some reasonable fear of being contradicted by his codes......

The OP already has heart disease and may well by now have Left. Bundle Branch Block.....

My original commentary stands....

Dr. Chien, so then just to clarify, you would recommend that I get those tests done before seeing the AME, or it is a lost cause altogether? I guess I also never heard of NSIVCD being called "heart disease" in and of itself, but sometimes a symptom thereof. I was told it was a normal variant after the follow-up normal echo.

 

[Paul Allen]

This happened to me about 12 years ago. I followed Dr. Chien's advice and I never had a problem with the FAA. I gave the AME the test results and that was the last I heard of it!

 

[MacFly]

Mac fly- the Dxcode databases began in 1995-96. He can’t non report withou some reasonable fear of being contradicted by his codes......

The OP already has heart disease and may well by now have Left. Bundle Branch Block.....

My original commentary stands....

The OP was apparently worked up for that and was diagnosed as "normal variant". Sounds like it was determined NOT to be "heart disease".

I'm curious about this "diagnosis code database" that you mention, the mechanics of it. Are you saying that there's a central registry of diagnoses available to "The Government" where the FAA can go in and search an applicant for a history of their diagnoses recorded since 1995-96? Whether their medical record has been amended or corrected, or not? I've been a physician since well before 1995 and I'm not aware of anything like that. Furthermore, if such a database does exist...Americans should be extremely worried about the existence of such a database in the hands of a political entity like the FAA and which would also then be subject to the sloppy and careless record-keeping that most government agencies, like the FAA, are well-known for.

As a doctor, the existence of such a database would make me infinitely more careful about how I label a given diagnosis on a given patient if I knew that some day that patient might have to explain that diagnosis to some government agency based on their misinterpretation of my coding that's been sitting in some "central database". ICD-10 now gives me 70,000 codes to choose from. What is really worrisome is that, for the most part, diagnosis coding these days isn't even done by physicians...it's done by overworked non-physician coders in the basement picking a diagnosis code that seems like it would fit best with the physician's dictation. Of course...if the physician discovers a diagnosis coding error later and corrects the record...now we have to rely on that correction information getting into the secret database too.

Scary scary scary. If the OP is tripped up because of this...it's a perfect example of why we should all be worried.

 

[bbchien]

The OP was apparently worked up for that and was diagnosed as "normal variant". Sounds like it was determined NOT to be "heart disease".

I'm curious about this "diagnosis code database" that you mention, the mechanics of it. Are you saying that there's a central registry of diagnoses available to "The Government" where the FAA can go in and search an applicant for a history of their diagnoses recorded since 1995-96? Whether their medical record has been amended or corrected, or not? I've been a physician since well before 1995 and I'm not aware of anything like that. Furthermore, if such a database does exist...Americans should be extremely worried about the existence of such a database in the hands of a political entity like the FAA and which would also then be subject to the sloppy and careless record-keeping that most government agencies, like the FAA, are well-known for.

As a doctor, the existence of such a database would make me infinitely more careful about how I label a given diagnosis on a given patient if I knew that some day that patient might have to explain that diagnosis to some government agency based on their misinterpretation of my coding that's been sitting in some "central database". ICD-10 now gives me 70,000 codes to choose from. What is really worrisome is that, for the most part, diagnosis coding these days isn't even done by physicians...it's done by overworked non-physician coders in the basement picking a diagnosis code that seems like it would fit best with the physician's dictation. Of course...if the physician discovers a diagnosis coding error later and corrects the record...now we have to rely on that correction information getting into the secret database too.

Scary scary scary. If the OP is tripped up because of this...it's a perfect example of why we should all be worried.

The Medical Insurance Bureau went into business in about 1992. Their business is keeping the codes. I don't recall what your position was in 2010 but I screamed about the sentence in the Affordable Care act: "No part of this act shall be construed to contain the diagnosis, procedure, nor pharmacy codes" which effectively denies confidentiality protection to these codes. It was sold to Rep. Rangel on the late night of the debate as "don't you need access to this information to run a national healthcare system"? and the representative was apparently promised (forever without fee) access to the information if the sentence was inserted, for as long as we have this data".

I worry about this all the time.
As as you are probably aware, an IVCD before the age of 40 is likely NOT a normal variant. After 40, from the Framingham study, the survivorship was not statistically different. The OP didn't say his age, at the time.

I agree in this situation it's overkill, but it is federally what it is.
Since I like airmen to have success, and THIS YEAR, not after a two year battle.....I would obtain all B4 even applying. And then get success.

To omit as you suggest is pretty naieve. Since they can get the codes, at the first incident, "ATC DEAL", or hotline call in, they obtain all the information and then we have to deal with "falsification of the record" a class 4 felony. As as you might be aware there are "27 pilots indicted" and "4 delta pilots indicted" (google those phrases) and you'll get the environment in which we are operating.

Ohhhhhh......my head hurts....

What I have described is described by the FAA as the "basic Cardiovascular evaluation battery".

 

[jbarrass]

FWIW, you can call the MIB at (866) 692-6901 and get a copy of everything they have on you. And you can appeal anything in there that is wrong.

There is a lot less in there than many people fear. Mine has no "codes" at all.

 

[MacFly]

The Medical Insurance Bureau went into business in about 1992. Their business is keeping the codes. I don't recall what your position was in 2010 but I screamed about the sentence in the Affordable Care act: "No part of this act shall be construed to contain the diagnosis, procedure, nor pharmacy codes" which effectively denies confidentiality protection to these codes. It was sold to Rep. Rangel on the late night of the debate as "don't you need access to this information to run a national healthcare system"? and the representative was apparently promised (forever without fee) access to the information if the sentence was inserted, for as long as we have this data".

I worry about this all the time.
As as you are probably aware, an IVCD before the age of 40 is likely NOT a normal variant. After 40, from the Framingham study, the survivorship was not statistically different. The OP didn't say his age, at the time.

I agree in this situation it's overkill, but it is federally what it is.
Since I like airmen to have success, and THIS YEAR, not after a two year battle.....I would obtain all B4 even applying. And then get success.

To omit as you suggest is pretty naieve. Since they can get the codes, at the first incident, "ATC DEAL", or hotline call in, they obtain all the information and then we have to deal with "falsification of the record" a class 4 felony. As as you might be aware there are "27 pilots indicted" and "4 delta pilots indicted" (google those phrases) and you'll get the environment in which we are operating.

Ohhhhhh......my head hurts....

What I have described is described by the FAA as the "basic Cardiovascular evaluation battery".

I agree. One more reason to hate the ACA, as if another reason was needed. But, "we had to pass it to find out what was in it".

As to increased mortality in IVCD, my recollection is that that's only true if it is a LBBB. Presumably, the OP didn't have a LBBB when previously tested.

I acknowledge that it's not my specialty area...I'm a surgeon.

 

[YC698]

This happened to me about 12 years ago. I followed Dr. Chien's advice and I never had a problem with the FAA. I gave the AME the test results and that was the last I heard of it![/QUOT

I agree. One more reason to hate the ACA, as if another reason was needed. But, "we had to pass it to find out what was in it".

As to increased mortality in IVCD, my recollection is that that's only true if it is a LBBB. Presumably, the OP didn't have a LBBB when previously tested.

I acknowledge that it's not my specialty area...I'm a surgeon.

I guess that's what I assumed when they told me it wasn't a big deal. I was 25 at the time of that ECG with Echo during an extensive employment physical. They never really went into any depth with the results when I had that vasovagal syncope at 21, just said my ECG was abnormal so they did an echo then as well and said it was fine, so I don't have any terminology from that round of workups. They didn't seem to think the syncope was connected to anything other than the gory pics in the class. Never had any issues doing Army PT or anything. I mean, I guess it might be worth another workup now that I'm in my early 30's?

 

[bbchien]

I guess that's what I assumed when they told me it wasn't a big deal. I was 25 at the time of that ECG with Echo during an extensive employment physical. They never really went into any depth with the results when I had that vasovagal syncope at 21, just said my ECG was abnormal so they did an echo then as well and said it was fine, so I don't have any terminology from that round of workups. They didn't seem to think the syncope was connected to anything other than the gory pics in the class. Never had any issues doing Army PT or anything. I mean, I guess it might be worth another workup now that I'm in my early 30's?

I've already expressed what I actually think about the requriements for the FAA CVE, in this situation. The Issue here isn't so much the IVCD at a young age. it's about two episodes of "falling out". One medical office said to me, "If he doesn't have the maturity to avoid dietary abuse and has a second event, how successful do you expect him to be, in becoming a responsible pilot?" It's how it is.

But it is also clear to me that if you don't do it, it will be a loooooonnnngggg time until you solo. "Show us that he is not going to "fall out" again!"

 

[Brad Z]

Another thread to perpetuate the professional pilot philosophy of seeking medical treatment only when death seems imminent.

 

[bbchien]

Another thread to perpetuate the professional pilot philosophy of seeking medical treatment only when death seems imminent.

It's "what it is". sigh. i have been there done that so many times.....what Medical officer wants to stick out his neck and get it hit? You can't hardly blame those guys!

And an IVCD at such a young age.....isn't the norm.

 

[YC698]

It's "what it is". sigh. i have been there done that so many times.....what Medical officer wants to stick out his neck and get it hit? You can't hardly blame those guys!

And an IVCD at such a young age.....isn't the norm.

I guess I am getting a bit turned around in these threads. I fully intend to report accurately, was just trying to get a good idea of what to expect and how to best go about it. I appreciate your advice and will follow that to get this all tested before I start with the AME. If there are hoops, I will go through them, if the ultimate answer grounds me, I accept that. I respect the process and just want the best shot at it. My questions about the nature of the other condition were really just a curiosity. I usually don't have much interaction with doctors, so was just using this thread as way to ask general questions about it (pilot or not), as I won't be able to get this checked out anytime soon as I am working overseas at the moment. As you point out, it's not normal at such a young age, and with the normal echo results, just makes it even more strange to me (everything I've read seems to point to individuals much older, likely with other factors found on a workup). Not sure what the "dietary abuse" thing has to do with either the fainting or the IVCD, unless that was some other particular case. I am in shape with a 25 BMI and clean diet.

 

[manac]

I’m confused. I know there is a lot of medical issues being discussed.
In the beginning of the thread it’s stated that the FAA requires a type of cardiac work up for vasovagal symptoms? I ask because my daughter can faint very easily. She has been diagnosed as vasovagal. The neurologist we took her to triggered the response with a pen that looked like a syringe and by pressing on her eyelids. The Dr said the only worry was falling when she passed out, and there was nothing to do about it but to avoid the triggers.
Why would the FAA be worried about the op’s heart when he passed out at the sight of gore?

 

[YC698]

I’m confused. I know there is a lot of medical issues being discussed.
In the beginning of the thread it’s stated that the FAA requires a type of cardiac work up for vasovagal symptoms? I ask because my daughter can faint very easily. She has been diagnosed as vasovagal. The neurologist we took her to triggered the response with a pen that looked like a syringe and by pressing on her eyelids. The Dr said the only worry was falling when she passed out, and there was nothing to do about it but to avoid the triggers.
Why would the FAA be worried about the op’s heart when he passed out at the sight of gore?

They need to make sure that it is indeed a vasovagal trigger and not something more serious that could cause it to happen randomly or even in the case of propensity to vasovagal reactions, something that isn't frequent or possible to happen in-flight. While I have a pretty solid notion of what made me faint (same trigger/situation both times), the workup will give them objective information to make this decision based on more than anecdotal remarks. My initial question and concern was to get advice on the order of operations for going about this to have things go a smoothly as possible, and Dr. Chien's recommendation was to get this testing done ahead of the AME appointment, which is now my course of action as opposed to just showing up and starting the process. Proactive vs reactive. Makes sense.

 

[ThatOtherGuy]

Dr. Chien's recommendation was to get this testing done ahead of the AME appointment, which is now my course of action as opposed to just showing up and starting the process. Proactive vs reactive. Makes sense.

It would be wise to have an AME review the planned tests before you take them. If Dr. Chien, or someone he recommends, is willing to help in that capacity even better. Ideally walk in the door to your cardiologist appointment with an exact written listen of what you'll need to satisfy the FAA for whatever class medical you seek. Your doc's vs the FAA's vs your medical insurance's opinion of medically necessary are going to vary significantly. If your docs don't have a lot of pilots or aren't used to dealing with FAA requests they may question the need for the tests/documentation.

Your insurance will most likely not cover them as they wont be considered medically necessary. It would be a shame to spend a lot of money out of pocket on tests that don't match the protocol. Then there's the time factor that'll happen when you get in the FAA medical hamster wheel of repeated requests for more information.

I'm sure your personal physicians would advise you about abnormal results. It would still be a good idea to have an AME review the results on a consultative basis before you put in the application and start an actual FAA medical exam. Remember, once the AME enters the confirmation code from the application there's no going back and you're committed. As others have pointed out, failing a medical can close doors to things like Sport Pilot or BasicMed.

The guide for AMEs is a good reference that's written in doctor speak. I didn't see a link specifically for Vasovagal Syncope, but here's the link for Syncope:
https://www.faa.gov/about/office_or...ide/app_process/exam_tech/item36/amd/syncope/

 

[SoCal 182 Driver]

It would be wise to have an AME review the planned tests before you take them. If Dr. Chien, or someone he recommends, is willing to help in that capacity even better.

And then, BEFORE applying for a medical, take the tests and have Dr. Chien review the results. You want to be ahead of the game, rather than trying to play catch-up should you be denied.

 

[MacFly]

I guess that's what I assumed when they told me it wasn't a big deal. I was 25 at the time of that ECG with Echo during an extensive employment physical. They never really went into any depth with the results when I had that vasovagal syncope at 21, just said my ECG was abnormal so they did an echo then as well and said it was fine, so I don't have any terminology from that round of workups. They didn't seem to think the syncope was connected to anything other than the gory pics in the class. Never had any issues doing Army PT or anything. I mean, I guess it might be worth another workup now that I'm in my early 30's?

According to Dr. Chien, that workup is likely to be a shorter and more likely path to an FAA 3rd class medical. Health implications aside (or lack thereof), his expertise in the arcane ways of the FAA medical branch is well known. If you're going to play their game (flying), you'll have to do so by their rules.

 

[bbchien]

FWIW, you can call the MIB at (866) 692-6901 and get a copy of everything they have on you. And you can appeal anything in there that is wrong.

There is a lot less in there than many people fear. Mine has no "codes" at all.

MIB is now held by epic....

 

[wsuffa]

FWIW, you can call the MIB at (866) 692-6901 and get a copy of everything they have on you. And you can appeal anything in there that is wrong.

There is a lot less in there than many people fear. Mine has no "codes" at all.

With the push to electronic medical records much more data is there and MIB is either entering or trying to enter partnerships to get that data, too. There may now be a lot more than you think.

 

[jbarrass]

Maybe, it's easy to check.

Every year when I file my taxes I make a point to get an update from the 3 credit bureaus, MIB, CLUE and the DMV. Takes a few minutes max.

Sometimes there is a surprise, usually not.