After the stents

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After having 4 stents, I feel great and after 1 month, I completed the Bruce Protocol with no negative rhythms etc. I am 168 lbs and 5'9". No weight problems. I am taking the usual blood thinners + asperin that follow the stent procedure.

1. Can I use that Bruce Protocol for the stress test for my 3rd class medical? I was never turned down, I just let the old 3rd class lapse.
2. Do I still have to wait the six months to present all the paperwork to my AME?
3. My Dr. suggested I take an exercise program. It is a 15 week 3xs a week monitered regiment. I think that is too much as it mostly has bypass patients etc. I would rather just start going back to the regular gym and using the treadmill 30 minutes brisk walking, and light weights for the rest of my body.
I have no more symtoms or chest discomfort ( that is what led me to the stent procedure and I am lucky ) and the only thing that I feel after climbing lots of stairs etc., is that my legs are out of shape :)

Your response is eagerly appreciated.
 
1&2. The Bruce Protocol stress test is the required test, but it needs to be done nearer the 6 month mark. Technical failures of the stents are most common in the first 6 months. That is why you have to wait 6 months to apply. A stress test at one month isn't helpful if a stent fails at say 4 months out. (Make sure you reach 100% of the targeted heart rate with the stress test)
3. Any exercise is better than nothing but the monitored regiment is set up as a heart specific regime.
What blood thinner are you on? Plavix--not so much of a problem. Coumadin--you have to have some documentation of stability of the regime.
Glad you feel better, and good luck on getting your medical. Talk to your AME before you actually go for the Medical and get all your ducks in a row. It does help.

Barb (AME)
 
Unregistered said:
After having 4 stents, I feel great and after 1 month, I completed the Bruce Protocol with no negative rhythms etc. I am 168 lbs and 5'9". No weight problems. I am taking the usual blood thinners + asperin that follow the stent procedure.

1. Can I use that Bruce Protocol for the stress test for my 3rd class medical? I was never turned down, I just let the old 3rd class lapse.
2. Do I still have to wait the six months to present all the paperwork to my AME?
3. My Dr. suggested I take an exercise program. It is a 15 week 3xs a week monitered regiment. I think that is too much as it mostly has bypass patients etc. I would rather just start going back to the regular gym and using the treadmill 30 minutes brisk walking, and light weights for the rest of my body.
I have no more symtoms or chest discomfort ( that is what led me to the stent procedure and I am lucky ) and the only thing that I feel after climbing lots of stairs etc., is that my legs are out of shape :)

Your response is eagerly appreciated.
Click to expand...
Hard to not chime in.

>90 days from your stenting do the treadmill run to 100% of your age determined Vmax. If you don't have ischemia on the tracings and you have a normal BP response, obtain a letter from you cardiologist stating your risk factors, what you are doing to modify them, your meds, and that you are having no side effects. Obtain fasting HDL/LDL.Triglycerides, Creatinine, K+. For Coumadin, you need to be able to show 4 of five consequtive INR values between 2 and 3.

If you have all this, submit them (all the tracings included) to FAA Appeals Section, AAM 313, 6700 MacArthur B-13, Oklahoma City, OK certified return receipt. Keep original copies. About three weeks later start bugging them at 405-954-4821 and be nice, but be repetitive and friendly and take names. Call twice per week. About ten days before the 90 days are out, you will get a letter that says pending an 8500-8 exam, you are eligible for six one year special issuances, contingent on a similar letter each year (90 days prior to the year end) and a similar treadmill result.

Do NOT take the thallium scan. There are enough false positives that I have had to work many hours to get airmen qualified when the cardiologist wants this unnecessary study. If you want Second class then this is a required study. Discuss that with the cardiologist BEFORE you get on the treadmill.
 
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Bruce,

Welcome back and I hope it is always hard for you not to chime in.:D I always learn from your posts.:yes:

I do have a question for you. If the medical is lapsed, can you still send the info to the FAA appeals section? I have an airman in this situation and Joan at the Regional office said they can't take action on a special issuance without a current medical. Am I being lead astray?

Barb
 
One Short said:
I do have a question for you. If the medical is lapsed, can you still send the info to the FAA appeals section? I have an airman in this situation and Joan at the Regional office said they can't take action on a special issuance without a current medical. Am I being lead astray?
Barb
Click to expand...
You are. It is Joan's job (and Cliff's) to minimize work for the RFS who is overtaxed. What I do:

Gather the information. Make certain it is going to pass per the Disease protocols section(s) and AASI sections, which give us clues as to what CAMI likes. If you are not certain, discuss with the airman/airwoman that this poses some risk to his/her sport pilot eligibility if they don't like what you send. Let him/her decide. After the first couple of ten of these you get pretty good at this.

FAX them into the appeals fax number. I'm NOT going to post that here, Dr. Carpenter will have my head. Airman/woman calls the 4821 number twice weekly for the next three weeks.

CAMI issues an "authorization letter" which states that pending completion of an 8500-8 exam, the aiman/woman is eligible for a one year SI. Airman/worman takes that to the AME (the AME of record gets one) and after passing the other elements of the exam is issued a one year ("Not valid for any class after XX/YY/2007) certificate. Three months later OKC mails the airman/woman a superceeding certificate signed by Dr. Silberman, with the instruction for maintenance of the SI.
 
Thank you Bruce and Barb. I thought that you just went to the AME with the Bruce test results and the letter from the Cardiologist. Now, I am understanding that you should first write to OKC as you stated.

Unless I read you wrong, now ( 30 days) is the time to get started.
What's an 8500-8 exam?
Thanks.
 
Thank you Dr. Bruce and Dr. Barb. I thought that you just went to the AME with the Bruce Protocol test results and the letter from the Cardiologist. Now, I am understanding that you should first write to OKC as you stated.

Unless I read you wrong, now ( 30 days) is the time to get started.
What's an 8500-8 exam?
Thanks.
 
One Short said:
Joan at the Regional office said they can't take action on a special issuance without a current medical. Am I being lead astray?
Barb
Click to expand...
Barb, this is FAA new official position. I think it is because there has been a flood of document review without application for certification. There is no filing system for reviews unless there is a current exam...e.g a current file. They're getting tired of sticky notes.

The result: My airman from RFD who had a not quite negative thallium (not required for certification) was issued, after a long time, a "you are not eligible at this time" letter. His medical was lapsed. He had not applied, so he could not be denied and the word denial was not therein.

I have a mid life pharmacist who has been lapsed for 19 years, has a bunch of troubles. In Feb I got approval on his file of 3 SIs; OKC called to complain that they hadn't gotten the exam- I replied I would post it on the 16th, the date he's coming in. I think Dr. C___enter's sticky note is getting old.

One of the FAA docs last week said that sophisticated AMEs who are very comfortable with documentation and FAA's position were now simply issuing one year certificates and sending the whole kaboodle in at time of issuance- w/o getting the telephonic record of approval. But for sure, this is the end of sending documents in PRIOR to the airman's coming in, and then being able to issue on the spot. I had been gathering the info, getting them reviewed in OKC, getting the authority, then issuing. The process has changed.

There are a few that I am willing to do "on my designation" based on this conversation....but not all.
 
Now I am getting confused Dr. Bruce. My 3rd class ( valid for 1 year due to Type II diabetes, expired on 2/28/06. There was no point in trying to renew it due to the stent procedures in 12/05, so where am I ?
I did 11 minutes on the Bruce protocol after 30 days, and am registered ( awaiting insurance) in a monitered cardiac rehab exercise program to learn best routines etc.
Please point me in the right direction and thanks.

I didn't think it was good to go to my usual AME and get turned down last month, with the delays that follow, (he has been pretty cooperative and helpful in the past).

We spoke a few years ago on another Board about Single Pilot IFR and headsets etc. Thanks as always.
 
Unregistered said:
Now I am getting confused Dr. Bruce. My 3rd class ( valid for 1 year due to Type II diabetes, expired on 2/28/06. There was no point in trying to renew it due to the stent procedures in 12/05, so where am I ?
I did 11 minutes on the Bruce protocol after 30 days, and am registered ( awaiting insurance) in a monitered cardiac rehab exercise program to learn best routines etc.
Please point me in the right direction and thanks.

I didn't think it was good to go to my usual AME and get turned down last month, with the delays that follow, (he has been pretty cooperative and helpful in the past).

We spoke a few years ago on another Board about Single Pilot IFR and headsets etc. Thanks as always.
Click to expand...
On or after 3/30/06:

(1) Obtain another "through the end of Stage 3" treadmill run, and don't be on any beta blockers (-olols). FAA does NOT like diabetics (not just type 1s) on beta blockade.
(2) Obtain a "cardiovascular evaluation" letter from your Cardiologist stating your general condition, all medications, lack of side effects, what you are doing with your risk factors, with a current (After 4/30) HbA1c, LDL/HDL/Chol, Creatinine, and K+.
(3) Obtain a letter from you Internist saying no ocular disease, no neurologic disease, no renal disease....-can't possibly say no cardiac disease, now can he?
Find a really good AME. The way I'd handle this one now, is I'd engage FAA on the phone (OKC, not the RFS) on the morning of an afternoon apppointment, and fax them into AAM331 while talking to the doc. I'd swear on my first born to have the exam entered by the end of the day.
If the AME gets the approval, you'd be certifiable 6/31/06 (if all the tracings and numbers look right).
 
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Thank you so much. I am unclear about:

"Find a really good AME. The way I'd handle this one now, is I'd engage FAA on the phone (OKC, not the RFS) on the morning of an afternoon apppointment, and fax them into AAM331 while talking to the doc. I'd swear on my first born to have the exam entered by the end of the day."

I'm probably slow, but what do you mean?
Also, so far my AME seems to have gone to bat by calling for me etc. Is that considered OK?? I am in Nassau County NY.

thanks.
 
And... the Beta Blocker... Toprol XL, should I suggest to my cardiologist to consider that I might not need this anymore? Also on Plavix.
 
Bruce,

I'd like to ask a favor. I don't have a voice to voice relationship with OKC. If you can, could you give me names and phone numbers and fax numbers. My email address is-- rudder@ejourney.com. If you have the time and it is Ok to pass on the info, I would appreciate it. I always had good luck with RFS but it is getting harder.

Barb
 
Dr. Bruce,
My cardiologist suggests that Toprol XL is now preferred when cardiac problems existed ( even w. Diabetes II). He feels that OKC will not object to it's control of safer heart rhythms, especially if hypoglycemia is not an issue.
Do you think I need to examine this more with him?
THANKS!!!!
 
Unregistered said:
Dr. Bruce,
My cardiologist suggests that Toprol XL is now preferred when cardiac problems existed ( even w. Diabetes II). He feels that OKC will not object to it's control of safer heart rhythms, especially if hypoglycemia is not an issue.
Do you think I need to examine this more with him?
THANKS!!!!
Click to expand...
A lot of cardiologists feel this way. I think you'll be OK, but with type I it's definitely No-Kay.
 
I thought I was the only one who said No-Kay, thereby confusing everyone except me :)
PS Thanks !!!
 
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