AME inside or outside of current Med System for 3rd Class?

A

AspiringPilot2B

Guest
Aspiring GA pilot here, in my mid-50's with a couple of questions about obtaining a third class.

There are two AME's I'm considering. One is a cardiologist by day and a MD within the same medical system I currently use. The other is a DO and is outside my med system. The first would have a lot more access to my medical records. Here are the other factors:

I had a vasovagal syncope episode and lost conciousness about 12 years ago. I was a little scared by it and had a cardiology work-up. Results came back fine and support the vasovagal syncope diagnosis. I'd want to report the LOC. I think the inside AME would be able to read the reports and have reduced concern. They would also be able to see that my overall fitness has improved a good deal in the past few years.

I reported occasional marijuana use to my doctors in the same timeframe. I haven't used any in over two years, but the inside Dr. would be able to see this. Would this cause follow-up hassles? This information shows up in the medical records of the LOC issue above, so any medical history pull for the same timeframe would be visible to any AME, regardless of inside or outside.

In addition to the above complications, are there any general reasons to avoid an AME in the same med system as one's GP?

One more question while I'm posting this:

14 years ago, I thought that an ADHD drug might help my work performance. I got a Vyvance prescription from a mental health doctor (outside of my system). It didn't do anything for me (if anything, it made me worse) and I dropped it within a few months. The Dr. has since retired and he said the records were purged. Before he retired, he told me that there was never a formal ADHD diagnosis. (He said that the protocol was to try the med and if it helped, then it's likely a positive diagnosis.) He said that he wouldn't disclose any of this to the AME but if needed, he may still be able to write a letter on my behalf. I may have Vyvance listed somewhere deep in my current med system's records, so it might prompt the question.

Would this affect the inside/outside AME choice? Also, would you agree that I shouldn't disclose this?

Thanks for any advice you can share!!
 
AspiringPilot2B said:
Aspiring GA pilot here, in my mid-50's with a couple of questions about obtaining a third class.

There are two AME's I'm considering. One is a cardiologist by day and a MD within the same medical system I currently use. The other is a DO and is outside my med system. The first would have a lot more access to my medical records. Here are the other factors:

I had a vasovagal syncope episode and lost conciousness about 12 years ago. I was a little scared by it and had a cardiology work-up. Results came back fine and support the vasovagal syncope diagnosis. I'd want to report the LOC. I think the inside AME would be able to read the reports and have reduced concern. They would also be able to see that my overall fitness has improved a good deal in the past few years.

I reported occasional marijuana use to my doctors in the same timeframe. I haven't used any in over two years, but the inside Dr. would be able to see this. Would this cause follow-up hassles? This information shows up in the medical records of the LOC issue above, so any medical history pull for the same timeframe would be visible to any AME, regardless of inside or outside.

In addition to the above complications, are there any general reasons to avoid an AME in the same med system as one's GP?

One more question while I'm posting this:

14 years ago, I thought that an ADHD drug might help my work performance. I got a Vyvance prescription from a mental health doctor (outside of my system). It didn't do anything for me (if anything, it made me worse) and I dropped it within a few months. The Dr. has since retired and he said the records were purged. Before he retired, he told me that there was never a formal ADHD diagnosis. (He said that the protocol was to try the med and if it helped, then it's likely a positive diagnosis.) He said that he wouldn't disclose any of this to the AME but if needed, he may still be able to write a letter on my behalf. I may have Vyvance listed somewhere deep in my current med system's records, so it might prompt the question.

Would this affect the inside/outside AME choice? Also, would you agree that I shouldn't disclose this?

Thanks for any advice you can share!!
Click to expand...
I don't think the syncope should be an issue, sauce it's explained. The pot use is not reportable. Neither is the Vyvanse, but as you know, a diagnosis would be.

Not knowing anything about these two doctors and whether the first would actually access your old records, I'd probably choose the second. But why not go to him for a consult first and see what he says?
 
Please take a look at the medical form Question #18 (it's lengthy). The key words are "have you ever...?"

Why is the pot use not reportable?

To the FAA, nothing is expunged.

it's not a good idea to mix your GP and AME. Others will chime in with more details.
 
murphey said:
Please take a look at the medical form Question #18 (it's lengthy). The key words are "have you ever...?"

Why is the pot use not reportable?

To the FAA, nothing is expunged.

it's not a good idea to mix your GP and AME. Others will chime in with more details.
Click to expand...
Is "Have you ever used pot?" one of the questions?
 
The question is “have you ever?”…not “is there an easily discovered record of…”

ANYTHING for which insurance was used is findable.

And if the original doc disclosed, by means of self reversal, as to how he diagnoses ADD, he is not only in a world of licensure hurt, but he also self discredits in the eyes of the FAA.

So there are issues here…..

So is POT in you medical record.
How will the get that? Fill record disclosure in the ADD evaluation …and there it is.

AND remember, misleading an agency of the Federal Admin is a class 4 felony should you be thought to be not forthcoming. Then it’s tough to get any sort of job!

You are asking the wrong questions here.
 
murphey said:
Read the medical form.
Click to expand...

The form reads:

HAVE YOU EVER IN YOUR LIFE BEEN DIAGNOSED WITH, HAD, OR DO YOU PRESENTLY HAVE ANY OF THE FOLLOWING?
…
Substance dependence or failed a drug test ever; or substance abuse or use of illegal substance in the last 2 years

I can honestly answer this with a “no.”
 
bbchien said:
The question is “have you ever?”…not “is there an easily discovered record of…”

ANYTHING for which insurance was used is findable.

And if the original doc disclosed, by means of self reversal, as to how he diagnoses ADD, he is not only in a world of licensure hurt, but he also self discredits in the eyes of the FAA.

So there are issues here…..

So is POT in you medical record.
How will the get that? Fill record disclosure in the ADD evaluation …and there it is.

AND remember, misleading an agency of the Federal Admin is a class 4 felony should you be thought to be not forthcoming. Then it’s tough to get any sort of job!

You are asking the wrong questions here.
Click to expand...

I’m definitely not looking to mislead anyone, especially the feds!! This is why I’m asking about things here. I want to fully disclose within the bounds of the law and safe medical/aviation practice. I don’t want to over-disclose and hurt my case by revealing things that aren’t relevant or necessary. As a newbie, it’s hard to understand the line between the two.

My inside/outside question is more about whether this can help or hurt with the syncope issue and the 10+ year old note about marijuana.

The note about marijuana was in the syncope records but again, never any dependence or failed drug test and no use in previous 2 years. I can honestly say “no” to the question in 18 but will any record of previous use cause further review?

The Dr. that prescribed the Vyvance is retired but when I contacted him (about a year ago) to discuss this, he very specifically said that he didn’t formally diagnose me with ADHD. He prescribed the medication to see if it had any work-related benefits. If there were, then a diagnosis was more likely. It didn’t and I stopped taking it.

I agree that the answer he gave was vague. Regardless of the availability of records, I’m trying to figure out if this situation requires a “yes” answer to, “Mental disorders of any sort;
depression, anxiety, etc.”

I think my best course of action is to schedule a consultation with the AME in my system and bounce all of this off them. They’ll be able to see everything in my records and advise from there.
 
AspiringPilot2B said:
I’m definitely not looking to mislead anyone, especially the feds!! This is why I’m asking about things here. I want to fully disclose within the bounds of the law and safe medical/aviation practice. I don’t want to over-disclose and hurt my case by revealing things that aren’t relevant or necessary. As a newbie, it’s hard to understand the line between the two.

My inside/outside question is more about whether this can help or hurt with the syncope issue and the 10+ year old note about marijuana.

The note about marijuana was in the syncope records but again, never any dependence or failed drug test and no use in previous 2 years. I can honestly say “no” to the question in 18 but will any record of previous use cause further review?

The Dr. that prescribed the Vyvance is retired but when I contacted him (about a year ago) to discuss this, he very specifically said that he didn’t formally diagnose me with ADHD. He prescribed the medication to see if it had any work-related benefits. If there were, then a diagnosis was more likely. It didn’t and I stopped taking it.

I agree that the answer he gave was vague. Regardless of the availability of records, I’m trying to figure out if this situation requires a “yes” answer to, “Mental disorders of any sort;
depression, anxiety, etc.”

I think my best course of action is to schedule a consultation with the AME in my system and bounce all of this off them. They’ll be able to see everything in my records and advise from there.
Click to expand...
Medxpress is not the place to vomit up your entire medical history, despite what some might tell you. We all have things that might "be discovered" if one were to examine or entire record that aren't asked about on the form.

The form expressly limits the illegal drug use question to two years. Just like it limits doctor visits to three years and medications to current.

It wouldn't be illegal to disclose a doctor visit from four years ago or a drug you're no longer taking, but it's not illegal to not disclose it either. Even if for some reason the FAA winds up asking you about it later. So you get to choose which you think is wiser.

There are plenty of posts here by airmen whose Medical applications when sideways when they disclosed more than asked for.

You should consider filling out the medxpress accurately to the best of your knowledge, and go in for a consult based on that.
 
AspiringPilot2B said:
I had a vasovagal syncope episode and lost conciousness about 12 years ago.
Click to expand...
I disclose loss of consciousness (LOC) on my MedXPress form. I provide no reports nor any medical documentation around this. AME Doc reads my entry on the MedXPress form but never asks anything further about it. Initially I obtained Class 3 then at next renewal, bumped it up to a Class 1. Still list the LOC but now, I add (on that line) "as previously reported with no change". I do not get into a diagnosis or any long winded explanation. afaik, there is a big difference between LOC with reason vs LOC for unexplained cause. So, I list a specific cause - not a diagnosis (because I have none) but the cause. As there is no medical documentation to state anything contrary, what I believe to be the cause ... "is the cause".

Per Mayo Clinic:
The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to your brain, causing you to briefly lose consciousness.
Click to expand...
So what was the trigger? One assumes not a blow to the head - lol. What was your trigger? Did you faint during a blood draw? Then in my [very specifically non-doctor reply] reply on the form, I would put something like:
Single episode LOC in 2011 during routine blood draw. Follow-up with Doc showed no underlying issues.
Or whatever. And then on each subsequent MedXPress, say exactly the same thing and just append to that brief explanation, "as previously reported with no change".

Just my opinion as a non-professional but what I have found works for my particular situation.

And if you know your trigger, takes steps to avoid the trigger or to modify your response in that situation if it is a situation that you know will happen again. Still sticking with the hypothetical blood draw issue, if that is your trigger than every time you get a blood draw, insist that you lie down for the blood draw. When the phlebotomist insists you will be fine and that it is not necessary, than you politely but insistently refuse the blood draw until you are lying down. Not impossible to faint while lying down (I have seen somebody else do that - it was very strange) but it really is very much harder to faint lying down. No more LOC than you do not get more complicated MedXPress forms to fill out in the future with now multiple LOC. Again just my opinion using a hypothetical trigger as I have no idea what the OP has as their trigger.
 
Mongoose Aviator said:
I disclose loss of consciousness (LOC) on my MedXPress form. I provide no reports nor any medical documentation around this. AME Doc reads my entry on the MedXPress form but never asks anything further about it. Initially I obtained Class 3 then at next renewal, bumped it up to a Class 1. Still list the LOC but now, I add (on that line) "as previously reported with no change". I do not get into a diagnosis or any long winded explanation. afaik, there is a big difference between LOC with reason vs LOC for unexplained cause. So, I list a specific cause - not a diagnosis (because I have none) but the cause. As there is no medical documentation to state anything contrary, what I believe to be the cause ... "is the cause".

Per Mayo Clinic:

So what was the trigger? One assumes not a blow to the head - lol. What was your trigger? Did you faint during a blood draw? Then in my [very specifically non-doctor reply] reply on the form, I would put something like:
Single episode LOC in 2011 during routine blood draw. Follow-up with Doc showed no underlying issues.
Or whatever. And then on each subsequent MedXPress, say exactly the same thing and just append to that brief explanation, "as previously reported with no change".

Just my opinion as a non-professional but what I have found works for my particular situation.

And if you know your trigger, takes steps to avoid the trigger or to modify your response in that situation if it is a situation that you know will happen again. Still sticking with the hypothetical blood draw issue, if that is your trigger than every time you get a blood draw, insist that you lie down for the blood draw. When the phlebotomist insists you will be fine and that it is not necessary, than you politely but insistently refuse the blood draw until you are lying down. Not impossible to faint while lying down (I have seen somebody else do that - it was very strange) but it really is very much harder to faint lying down. No more LOC than you do not get more complicated MedXPress forms to fill out in the future with now multiple LOC. Again just my opinion using a hypothetical trigger as I have no idea what the OP has as their trigger.
Click to expand...

If I do a consultation visit with the AME in my system, will they be able to help me with the best way to word this kind of stuff?

A LOC actually happened twice. Once when I sliced open my thumb with a pocket knife. The other was after getting a cramp in my chest and just thinking, “would this be what a heat attack would feel like?” to the point that it caused the response. (Hence the cardio work-up and getting cleared for any heart-related conditions.)

Since then, I know how to interrupt the response and it hasn’t happened in years.

Also, I assume this would be a “yes” for both fainting spells and LOC.
 
AspiringPilot2B said:
If I do a consultation visit with the AME in my system, will they be able to help me with the best way to word this kind of stuff?

A LOC actually happened twice. Once when I sliced open my thumb with a pocket knife. The other was after getting a cramp in my chest and just thinking, “would this be what a heat attack would feel like?” to the point that it caused the response. (Hence the cardio work-up and getting cleared for any heart-related conditions.)

Since then, I know how to interrupt the response and it hasn’t happened in years.

Also, I assume this would be a “yes” for both fainting spells and LOC.
Click to expand...
The consult will advise you on whatever additional tests/paperwork you'll need as well as "terminology".
 
98% of LOC is vasovagal. Humans react this way. You get green under the gills, get nausea, flush and then your heart rate gets really slow (20s) and down you go.

FAA is interested in knowing that it isn't a:
Dysrhymia
Cardiac chamber obstruction
Anginal equivalent.

How appropriate is that? Not for me to say. But to deal with all that you need all the stuff in their workup:
Stress treadmill
Echocardiogram
24 hour rhythm monitor.

One of the worst things that ever happened to our system is that it got inbred and removed. The Federal docs son't see patients. The Federal Aviation safety officers don't fly anymore (it's been the mind 90's when that budget vanished). The Federal DME supervisors don't work aircraft any longer. I am reminded last spring of an exemplar "application for re-designation of the IA"...in which EVERY box was filled in incorrectly by an acting head.

I'm not saying that the FAA approach is reasonable or not. It is what it is. If you want to succeed, you fill their squares.

For ADD meds, their view is "someone with a license thnkthis man is cognitively abnormal. That leads to the Neurospcyhological profile and total record disclosure for psychology and psychiatry. From there Pot "this man confesses to using marijuana" results in an evaluation for that. And on it goes.

So (right or wrong) you have some work ahead of you....
 
Back
Top