3rd recurrence of kidney stones.

[yogifly]

I had my 3rd bout ( the first two, were when I was on AD with the military & reported on my initial medical) with Kidney stones in Sept. and am on long term sick leave from my job as an EMS Helicopter pilot. I was just cleared by my urologist, had the metabolic work up done (High Uric Acid count), have a clear MRI from Oct (except for some retained calculi that wont move), and am waiting for her letter stating my history, prognosis, and low likelihood of recurrence. Here are a few questions:

• I was told I can submit directly to OKC for the SI, is that correct?
• I called OKC and they told me the Film, metabolic work up and letter from the doc is all I need to submit, is that also correct?
• Do you see any immediate red flags or think there is a possibility I may not get my medical back?
• What is the rough timeline once my package reaches OKC till a decision?

Thanks in advance for the help and answers, they are appreciated.

 

[murphey]

Wait. Do not rush into anything.

Do you have an AME locally that you can discuss the issues along with the documentation prior to going for an official Class X exam?

If not, contact Dr Bruce Chien at

aeromedicaldoc.com

 

[AggieMike88]

I agree to wait and talk to a well qualified AME who specializes in "difficult" cases. Being third time with stones, this is something you want to do correct the first time and with the assistance of the AME, especially since you rely on flying for long term income.

Doing it yourself opens the risk of something being incomplete or missing and a big round of back and forth with OKC and your doctors, prolonging your grounded time. With the right AME, you can get it done in minimal time.

Where are you located? In addition to Bruce Chien in Peoria, we may have an AME recommendation in your area.

 

[yogifly]

The problem is, I really do not have a relationship with the AME's I have used here in Vegas. I just use them to get my medicals and that is it. I am willing to listen to alternatives. the send everything to OKC was the advice of the AOPA medical people.

 

[AggieMike88]

Bad advice of the guys a AOPA. Gary Crump who runs the department is a good guy and really knows the system, but it's unlikely you'll get him on the phone. But the regular phone crew are not AME's.

If it were me, and my career was in the mix of this, I would seek out Dr. Chien to be the AME or ask him for a referral in the Las Vegas area.

 

[Whiskey Romeo]

Take it from a guy that used to send my SI info directly to OKC. Go through someone like Dr. Bruce Chien. The advise and guidance is a time saver, very important to someone that flies for a living.

 

[lbfjrmd]

I had my 3rd bout ( the first two, were when I was on AD with the military & reported on my initial medical) with Kidney stones in Sept.

• I was told I can submit directly to OKC for the SI, is that correct?
• I called OKC and they told me the Film, metabolic work up and letter from the doc is all I need to submit, is that also correct?
• Do you see any immediate red flags or think there is a possibility I may not get my medical back?
• What is the rough timeline once my package reaches OKC till a decision?

Thanks in advance for the help and answers, they are appreciated.

SI's cannot be requested. When you are ready to return to flying present all facts to your AME at exam time and submit - decision deferred to FAA. Upon their letter in response send them only that they request in one mailing. You can be collecting data but letters tests need to be within 1 month of mailing.

First letter from FAA in response to your application: 3 to 5 weeks
Issuance: 3 to 5 weeks after info they request and only info they request has been received by them.

I see no red flags and anticipate you getting your medical back. You are obviously a 'stone former' and may likely run into this situation in the future and for this i would follow with your Urologist closely.

while you wait dream of a new plane, new girlfriend, winning $$$ or just study approach plates!

 

[Jeff Oslick]

Make sure you have a very supportive letter from the urologist, that movement isn't likely (supported by KUB x-rays at least 90 days apart - DON'T get a CT scan if you don't have a CT already - if you do have a CT, you may need another). The letter from the urologist should also indicate you've been counseled on how to prevent recurrence. Even better if you have blood chemistry and/or 24-hr urine collection that shows low risk, or that you've gone on meds to reduce the risk. *If* you do it right and it is very well documented that the recurrence risk is very low, you may be able to get a non-SI issuance.

Do this through an experienced AME, not on your own, and make sure they have recent experience with getting a kidney stone issuance.

This was supposed to have become an "AME can issue" condition, but the powers that be decided to keep this more complicated than needed.

Just saw that you're in Vegas. Consider going to John Phillipp in Glendora, CA. Would be worth the trip.
http://flightphysical.com/dr-phillipp

 

[WrightStuff]

I just went through this, with Dr. Chien's guidance (highly recommended). As of 9/30/2015, kidney stones can be issued by the AME in some situations even with a history of recurring stones. If you search for "CACI kidney stone" you should find the worksheet that the AME is to use. An SI is not required if the criteria are met.

As others have already suggested, do not send anything to the FAA until you've been advised by an AME who has recent experience dealing with kidney stone cases. Again, I highly recommend Dr. Chien.

 

[AggieMike88]

I just went through this, with Dr. Chien's guidance (highly recommended). As of 9/30/2015, kidney stones can be issued by the AME in some situations even with a history of recurring stones. If you search for "CACI kidney stone" you should find the worksheet that the AME is to use. An SI is not required if the criteria are met.

As others have already suggested, do not send anything to the FAA until you've been advised by an AME who has recent experience dealing with kidney stone cases. Again, I highly recommend Dr. Chien.

CACI = Conditions an AME Can Issue. These are items that were previously always deferred as a Special Issuance. Now the items on this list can be handled in the AME's office if specific criteria is met.

Attached is the worksheet for Kidney Stones.

 

[lbfjrmd]

CACI-Kidney Stone(s) unlikely to apply:

1 there are retained stones
2 it is possible a high uric acid is a metabolic cause of stone (urate stones?)
3 3rd stone

But your AME will make the decision and can call during the exam and speak with the FAA doctor of the day in OKC (what i would do).

 

[Jeff Oslick]

CACI-Kidney Stone(s) unlikely to apply:

1 there are retained stones
2 it is possible a high uric acid is a metabolic cause of stone (urate stones?)
3 3rd stone

But your AME will make the decision and can call during the exam and speak with the FAA doctor of the day in OKC (what i would do).

Does the 2nd box at the bottom of the form (not-CACI, AASI) mean the AME can fax-in the supporting info and get a phone consult to get an approval without going the full "deferred" route?

I'll also note the "no underlying cause" is technically impossible to check "no" ... there is always an underlying cause, the question is can it be reasonably controlled through diet/medication.

 

[lbfjrmd]

1 ASSI is for re-issue of a previous disqual condition that has been approved before ... but a phone call to them is helpful.

2 for the CACI to be successful the AME has to be able to check all three boxes ... the form is never sent in. It is just a checklist. True most stones are calcium types but are the common ones and thus not (in medicine) felt to be from a possible underlying cause. You can have calcium stones with normal calcium level and no metabolic conditions. An elevated uric acid though needs to be addressed.

 

[bflynn]

Repeated kidney stones without a known cause and correction is a grounding condition. It means that you're a time bomb, waiting for the next one to reoccur and drop while you're in the middle of a Cat 2 approach.

It sounds like you know the cause. What is your doctor's recommendation for fixing it? Hoping that it won't happen again is not a fix.

My recommendation is not to submit your medical until you're ready for it, you could wind up with an outright denial.

 

[Jeff Oslick]

Repeated kidney stones without a known cause and correction is a grounding condition. It means that you're a time bomb, waiting for the next one to reoccur and drop while you're in the middle of a Cat 2 approach.

It is very rare for a kidney stone to cause sudden incapacitation without warning. It is even more rare for sudden incapacitation to happen in a recurring stone, because the subtle warning signs are more easily recognized.

If the risk of sudden incapacitation from kidney stones was real, the FAA wouldn't be able to just rely on a pilot with a history of stones and/or retained stone SI to properly manage their condition through diet/medication.

 

[NHWannabe]

I plan on starting my training in the spring, I had a kidney stone in 1998. Should I seek out a consult with an AME? What is the "statute of limitations" if any for a single incident of kidney stones.

 

[AggieMike88]

A consult (no paperwork, no "live" exam) is always a good idea when ever you have questions and don't want to cause yourself a world of grief by not owning your medical.

But since the medical history questions are phrased, "Have you ever in your life..." you will be required to answer YES to anything to do with the kidneys and kidney stones.

Take a look at the attached worksheet. If your urologist can write a status letter on his letterhead that covers those required items, you will be ahead of the game and might not need anything else. So have that letter before you see the AME.

In addition to talking to the urologist, consider a general physical exam with your family doc. It's a good preventative practice anyhow, and might save the embarrassment of the AME finding any health speed bumps. If the family doc stamps "grade A" on you're forehead, proceed to GO and collect your student medical. But if he discovers something of concern, get that squared up before going to the AME.

 

[NHWannabe]

A consult (no paperwork, no "live" exam) is always a good idea when ever you have questions and don't want to cause yourself a world of grief by not owning your medical.

But since the medical history questions are phrased, "Have you ever in your life..." you will be required to answer YES to anything to do with the kidneys and kidney stones.

Take a look at the attached worksheet. If your urologist can write a status letter on his letterhead that covers those required items, you will be ahead of the game and might not need anything else. So have that letter before you see the AME.

In addition to talking to the urologist, consider a general physical exam with your family doc. It's a good preventative practice anyhow, and might save the embarrassment of the AME finding any health speed bumps. If the family doc stamps "grade A" on you're forehead, proceed to GO and collect your student medical. But if he discovers something of concern, get that squared up before going to the AME.

Thanks for the info, appreciate the tips and guidance!

 

[Henning]

From the sounds of it, you are maintaining an SI, not obtaining it, is that correct? If so, follow the FAA's instructions. A chat with Bruce Chien to make sure that you have the paperwork state what they are looking for before you send it in, and getting that wording for your treating physician if they are not familiar would be a good thing. If this is the same urologist that has been supporting your SI up to now, just send in what they want, they should know the drill.