3rd Class Medical Renewal Question

Discussion in 'Medical Topics' started by Cleared for Approach, Dec 14, 2018.

  1. Hello,

    I’ve been a long-time lurker on POA. I’ve enjoy, and have learned a lot from the forum. I have a question regarding renewing my 3rdclass medical.


    Background:

    I’m 36 years old and got my (first) 3rdclass medical 4 years ago from this coming January, followed shortly by my PPL Certificate. I fly as much as I can with 3 young kids and a pretty demanding job. I’m working on my instrument rating now, and hope to wrap it up early 2019. I hope to some day do instruction, but probably not within the next 10-15 years.


    Question:

    My question is regarding medical history within the past 3 years when I go to renew my medical. About a year and half ago, I was having very mild chest pain over the course of few days. The pain felt more like an ache, with no real signs of a heart issue. I had a relative that had recently had a stroke, convince me to go to the ER to have it checked out. The EKG, chest X-ray, and other tests came back great. No signs of a heart issue. With a “follow-up with you Dr.”. I believe the cause was due to a strained a muscle while lifting wieghts. The ache got better within a few days, and I never talked to my Dr. about it. I’ve also never had symptoms before or since. I run 4-6 miles a day, 5-6 days a week (have consitantly for more than 10 years), and lift weights a few times a week, and eat well. I consider myself in excellent shape physically, and mentally.


    I know I’ll have to report this when my medical comes due. My question is around how to report it honestly and correctly. I know certain words can trigger the FAA to look deeper. Do I need to go find out who saw me and get some sort of report? I don’t feel like this is a big deal, and don’t want something big coming out of it.


    I know I can go basic med, but would rather get my 3rdclass if possible. Thanks in advance.
     
  2. Stewartb

    Stewartb Final Approach

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    Dr visit for strained muscle sounds pretty accurate. precautionary tests ruled out a cardiac problem.
     
    Last edited: Dec 14, 2018
  3. Ryanb

    Ryanb Final Approach PoA Supporter

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    Honesty is always best. Just state exactly what you did here and then if the AME has any questions during your exam, than you can explain the rest to him or her.
     
  4. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    Yes. And which reports, how they are formatted, and what the doctor/hospital writes into those reports can make a difference.

    My suggestion is to do a consultation with your AME to find out you need to obtain so you can truthfully say to the FAA "I did go to the ER thinking cardiac issue, but it wasn't, and here is the information that proves it wasn't".

    Done properly, the first level reviewer at AMCD, or worst, the second level doctor at AMCD, will be able to agree with you, notate your file appropriately, and issue your certificate.

    Done wrong, you will be getting letters from OKC asking for additional documentation, testing, etc. that will likely be difficult to do in the deadline they set. And attempting to change their mind from "The airman likely does have a cardiac issue", to "airman does not have a cardiac issue" will be very challenging.


    So go find out from your AME how to get this done right and go do that.

    If needed, reach out to Dr. Bruce Chien, @bbchien, http://www.aeromedicaldoc.com/how-to-start.html


    PS. A reminder to plan for your next renewal before you turn 40 years old. This way you once again can go 5 years before renewal if you are staying with a 3rd class.
     
  5. Clip4

    Clip4 En-Route

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    I had this same issue about 11 years ago. I did a consultation with an AME immediately after the hospital visit, got a stress test done, took all the results to him and it was no issue. Basically everything was documented as observation and diagnostic testing.
     
  6. Ravioli

    Ravioli Final Approach

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    Two words: Basic Medical

    You can do basic med without the hysteria until such time that you may need another medical, at which time you'll have years of evidence that the incident was isolated.

    Some here espouse the idea that EVERY medical should involve a consult and/or a sr AME. That just can't be the case, but it is the mantra on PoA.
     
  7. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    posts #2 and #3 are the routes I would suggest.
     
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  8. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    Damn... missed by one
     
  9. bbchien

    bbchien Touchdown! Greaser!

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    Bring a note from your doc saying you “do not have any diagnosis of CAD”.
     
  10. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    post #4 is good too ... one can never go wrong with a consultation.
     
  11. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    <<evil chuckle>> If I ever find myself in your backyard, we're definitely gonna do an old fashioned hangar flying session.
     
  12. Thanks all for the time and advice. I certainly want to do this right and honest.

    Dr. Chien, are you saying if I go to my family dr and have him write me a note as you decribed (and of course comply with any tests he might advise), that should remove any potential red flags? Should I still consider a consult with an AME if I get that note, or do you think I’m good to proceed live?

    Aggie mike, thanks for the reminder on the additional medical before I turn 40.
     
  13. bbchien

    bbchien Touchdown! Greaser!

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    of course the $64k question is do you want to find out.if you do, then run a stress treadmill, to 9 min and 90% of (220-YourAge) for heart rate.
    Or
    Bring the ER doc’s dictation (not what you download) to the pcp and ask him to write those words... :)
     
    Last edited: Dec 16, 2018
  14. azure

    azure Final Approach

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    Is it 230 - Age now? I thought it was 220... or perhaps that was a typo?

    Anyway, OP, as one who has been through this exact scenario (but after age 40, indeed after age 50), I can vouch for the peace of mind a negative stress test will give you. If you run 4-6 miles per day as you say, it should be a piece of cake for you, and you will probably have to go well over 9 minutes, perhaps over 12, to get to your target heart rate.

    One question for Bruce: why have the pcp "transcribe" the ER doc's words? Why not just take the dictation straight to the AME? :confused:

    (Unless by "those words" you mean "no CAD diagnosis".)
     
  15. bbchien

    bbchien Touchdown! Greaser!

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    Typo corrected.
    Both are required- the ER and the PCP...
    tough typing on an iphone late in the evening....Much better on a keyboard!
     
  16. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    You and and many airmen including me should be glad that "fat thumb syndrome" isn't reportable on your medicals :) :)
     
  17. Lantraxco

    Lantraxco Pre-takeoff checklist

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    "Bill Clinton needed quadruple bypass surgery soon after leaving office, despite having had several normal stress tests as President."

    If you're in doubt, a coronary artery calcium scan is the gold standard. Non invasive and inexpensive relative to a cardiac catheterization.

    just sayin'.
     
  18. bbchien

    bbchien Touchdown! Greaser!

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    Completely incorrect, Doctor. The ultraslice CT can only give you the diagnosis and cannot acquit you as it does not have enough slices to resolve the situation.

    I just got a guy out of the weeds who had it called on his scan "70% lesion of the left main" and on cath he had nothing.

    The commercial interests forwarding ultraslice CT will have you believe they are the second coming. Don't believe it for a moment.

    Live right
    Exercise
    don't get fat
    Watch your cholesterol and HbAc.
    .....the Ultraslice won't do that for you.

    Exercise, do your annual treadmill run and watch your C-reactive protein.
     
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  19. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    @bbchien and @lbfjrmd .... question about the Bruce treadmill test...

    I know the FAA specs say things about 9 minutes and Heart rate of 220-age.... but if you start peaking above that heart rate before 9 minutes, do they stop the test? If that occurs, what needs gathering for the AME and AMCD?

    (Asking for my education because I don't recall this being asked or discussed for medical certification purposes)
     
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  20. Lantraxco

    Lantraxco Pre-takeoff checklist

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    I'm no doctor, and apologies for speaking out of turn. Good advice for all of us.
     
  21. bbchien

    bbchien Touchdown! Greaser!

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    no no no, the number isn't right It's to heart rate 0.9*(220-YourAge). for example, a 60 year old goes to Heart Rate 154.
     
  22. tceq24443

    tceq24443 Pre-Flight

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    yes
     
    Last edited: Jan 31, 2019
  23. bbchien

    bbchien Touchdown! Greaser!

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    And I just got it wrong.
    (220-60)*0.9 is 144 not 154. sigh.