Appeal Kidney Stone CACI Requirement?

Discussion in 'Medical Topics' started by frostyeric, Sep 13, 2020.

  1. frostyeric

    frostyeric Filing Flight Plan

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    When I got my 3rd class medical certificate in 2017 as a student, it took a long time because of a single kidney stone in my medical history. I did not have have any retained stones and provided supporting documentation from my urologist. I eventually got it, but with the CACI program requirements for a retained stone. I was excited to be done with the process and have my medical, so put that aside. My current medical expires in Feb 2022, but I'd like to get ahead of the process. How do I appeal the requirement to be in the CACI program and has anyone had luck with this? I had one stone that passed on its own without complications. I provided scans that I was not retaining any stones. So it's a waste of time and money for me to be in a program for people that have retained stones. Can I get out of this?
     
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  2. Jeff Oslick

    Jeff Oslick En-Route

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    If you can live with the limitations of Basic-Med, a history of kidney stones is a great reason to not deal with the FAA bureaucracy.
     
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  3. apilotb

    apilotb Pre-Flight

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    Everyone has kidney stones, but don't know it.
     
  4. WDD

    WDD Line Up and Wait

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    Why are kidney stones disqualifying? Does one have surprise, instant onsets of debilitating pain?
     
  5. Charlie Golf

    Charlie Golf Pre-Flight

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    I can sympathize with the OP here. About 8 or 10 years ago a CT scan for an unrelated purpose showed a small, nonobstructing kidney stone. I was 100% asymptomatic before and after the scan.

    I made the "mistake" :mad: of noting that at my next medical, not realizing the can of worms I was opening. Every subsequent imaging study shows that I am stone-free, but it still has to be addressed at every renewal.

    Just to clarify one thing: the "mistake" I refer to is not doing my homework in order to be prepared for the aftermath of the disclosure, not simply the kidney stone disclosure itself.
     
    Last edited: Sep 13, 2020
  6. Utah-Jay

    Utah-Jay Pre-takeoff checklist

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    yes
     
  7. Matthew

    Matthew Touchdown! Greaser!

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    The phrase that scares FAA is “sudden incapacitation”.

    It’s common for a stone to work its way to a tight passage and get stuck. In some cases (mine, for example), you go from feeling like nothing is wrong to being doubled up on the floor, puking from the pain in the time it takes to get from the bed to the bathroom. I got to the ER and the nurse asked about the pain on a 1-10 scale. I was fighting it so hard I couldn’t say anything. She said. “I’ll take that as a 10.”

    My scans and x-rays showed there was a single stone. I was able to catch it for the lab. FAA was satisfied it was routine stone and I was stone free. No special issuance, no limitations. And no stone since.
     
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  8. WDD

    WDD Line Up and Wait

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    Yikes. Hope to not run into that
     
  9. Matthew

    Matthew Touchdown! Greaser!

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    I hope - never again.

    From that day I carry a 1 liter water bottle. Fill it up in the morning and sip on it all day. At the end of the day I know that I have had at least 1 liter go through me. Probably more when I figure that I have water for lunch and dinner, too (I'm not that into iced tea or soft drinks). Keep your system flushed and dilute, and you'll probably able to prevent KS.

    Mine happened the day after my PP checkride.
     
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  10. bbchien

    bbchien Touchdown! Greaser!

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    Answer:

    You "evidence of Stone Free" cannot be a KUB. It fails to detect lotsa stones.
    I has either to be an ultrasound or, a CT.
     
  11. Jeff Oslick

    Jeff Oslick En-Route

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    And other folks, like me who has had 3 stone "incidents" (but none in the past 8 years), get hours of discomfort as a warning. Not only do I get hours of warning, there have been particular dietary changes the I can attribute both of the last 2 episode to (I was only 16 for the first one, so I just don't remember if there was a particular trigger).

    All that aside, if you have a clean CT showing no retained stones, you should not be in a "retained stones" program. Even with retained stones, I was able, with 2 scans >90 days apart, to show with (with a letter from my urologist) that those stones were not going to go anywhere. The FAA accepted that with no additional action needed. At least in my case, the urologist thought the FAA requirements were far more than medically necessary, because they could tell from the first scan that the retained stones were in positions that were highly unlikely to mobilize. Not to mention that the additional scans were not covered by insurance.
     
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  12. FastEddieB

    FastEddieB Final Approach

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    I’ve been described as a “stone factory”, going back to the 1980’s. Apparently hot climates don’t help, with dehydration being a major contributor. Diet seems to matter less than originally thought, and I now take Potassium Citrate 3x a day. I also wear a CamelBak hydration system on bike rides and longer motorcycle rides. Those things, plus having moved to slightly cooler climes seems to have slowed thing down a bit.

    But like you, I’ve been fortunate that my episodes are always preceded by a dull cramping in the groin area. Almost certainly a stone passing from the kidney to the bladder. Then, after rattling around in my bladder for a few days the stone makes its way out. None of it is pleasant, but usually handled with an occasional Percocet or equivalent “to take the edge off”.

    Recurring kidney stones were the main reason I let my medical expire and went with Light Sport. The annual hassle of getting the Special Issuance led to over treatment of what were small and often benign stones. The recent option of BasicMed has just expanded the planes I have access to. I see my urologist annually and we decide together if treatment is needed without the FAA’s involvement.

    That said, considering all the possible ailments that afflict pilots of all ages - heart disease, stroke, cancer and what have you - I feel fortunate to only be occasionally confronted with what is basically a “plumbing problem”, and one easily treated at that.
     
  13. frostyeric

    frostyeric Filing Flight Plan

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    I provided evidence with a CT scan as requested by the FAA back in 2017, but they still put me in the retained stone CACI program. How can I appeal?
     
  14. NHWannabe

    NHWannabe Line Up and Wait

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    Yes. I had an attack 25 years ago. Woke up on a Saturday morning and had some discomfort in my side thought I either slept wrong or wrong tweaked something at work the previous day, within 30 minutes I was on the floor in the bathroom in the fetal position.
     
  15. NHWannabe

    NHWannabe Line Up and Wait

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    Same here I totally changed my habits after that, dropped soda and always have water with me.
     
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  16. Jeff Oslick

    Jeff Oslick En-Route

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    That is a question for the AME who issued your medical. You may need a letter from your urologist confirming that there were no retained stones.