Dizziness & Class 3 Medical

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Airmaster23

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Hi,

About 6 weeks ago, I bumped my head getting out a C172. I didn't blackout or lose consciousness. I got a headache and took an Advil.

Two days later, I experienced my first migraine headache while playing soccer - my blood sugar was low at the time.

Because of my symptoms - numbness in right hand and face, slurring of words and difficulty even thinking clearly, I went to the hospital the next day.

I've had a cat scan and MRI and both were negative. The neurologist thinks I was experiencing all of the classic symptoms of a migraine. He ordered the tests just because it was my first migraine.

However, about 4 or 5 days after the migraine episode, I started experiencing a mild dizziness - not vertigo. I have it almost every day since.

My dizziness is mild - I can still drive and work (I'm an engineer) and I'm experiencing no other symptoms at all. If I keep my head still (like working on a computer or watching tv), then it "goes away". However, if I turn my head quickly, look up/down/left/right then I feel dizzy.

I am due to renew my Class 3 medical (actually, it's a Category 3 - I live in Canada).

Should I post pone renewing until I get this dizziness sorted out?

The neurologist didn't think it was a problem and even wrote a letter for the aviation doctor saying that it wouldn't affect my flying.

However, I'm not sure if I want to fly if I don't feel 100% healthy.

I'm only 27 years old, non-smoker and I don't even drink.

What do you think?

Thanks.
 
Airmaster23 said:
Should I post pone renewing until I get this dizziness sorted out?

The neurologist didn't think it was a problem and even wrote a letter for the aviation doctor saying that it wouldn't affect my flying.

However, I'm not sure if I want to fly if I don't feel 100% healthy.
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Wow. Ask the neurologist if you can take his child on a 300 mile cross country. :hairraise:

I'm no Doc, but I would certainly advise getting to the root cause of this problem before flying. So if the Canadian version of our dear FAA Medical Certification folk are anything similar, I would follow your instincts and postpone the medical exam.

I respect your instincts here. "IM SAFE" is the test you are not passing at the moment. Get it fixed. I certainly hope the fix is easy and sudden, but it may take time. Sometimes a knock on the noggin just needs the passage of time... Other times the fix won't come without professional help.

Thanks for being safe about this!

-Skip
 
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who's your neurologist? Dr. Vinnie Boombatz?

Something doesn't sound quite right with this scenario. I would not only ground myself upon further investigation, but I would seek a new neurologist.
 
Mike Boehler said:
who's your neurologist? Dr. Vinnie Boombatz?

Something doesn't sound quite right with this scenario. I would not only ground myself upon further investigation, but I would seek a new neurologist.
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He's in Canada... I think they put leeches in your ears for these kinds of problems there...:lol:

As to trying for a Medical at this point, perhaps you should involve an AME at this point just so when there is an option in treatments available, you end up choosing the one that allows you a medical rather than the one that disqualifies you.

I think you've got a few weeks left to live, so you better get to enjoying. :yes:
 
Have you checked your blood pressure while having one of these light headed moments?
 
Airmaster23 said:
I'm only 27 years old, non-smoker and I don't even drink.

What do you think?

Thanks.
Click to expand...

I think you need a drink.

That is the problem with not smoking or drinking. If anything happens, you don't have anything to give up. If this were happening to me, I would quit drinking and be all better.

(Sorry about making light of a serious situation). I agree with the others that you should get this taken care of before your flight physical. Maybe if you come down here (to the USA) and use our rotten, corrupt, money grubbing, capitalist health care system you can get proper help.
 
Airmaster23 said:
The neurologist didn't think it was a problem and even wrote a letter for the aviation doctor saying that it wouldn't affect my flying.
Click to expand...


You need a second opinion. You might have more than one issue. How often does you blood sugar get "low", for example?
 
I am not a Transport Canada DME. Are we talking an United States of A 3rd class here?
 
Doggtyred said:
If you were in the US, a prudent ER physician would have done a CT of the head now to rule out any pathology..
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He did have a CT and MRI.

If he never had dizziness before the head bump hopefully it will resolve. The symptoms are consistent with a migraine which is a relatively benign diagnosis for the symptoms reported, at least compared to a TIA or brain tumor which have apparently been ruled out.

Low blood sugar is rarely a problem if not taking a medication that can lower it.
 
Hi guys,

Thanks for all the responses. I particularly liked the one about drinking and then I'd have something to give up!

Anyway, I have postponed renewing the medical for the time being.

I'm still dizzy, but not as much as I have been.

After doing some more research and talking to my dad, a family doctor, it's possible that I have post concussive syndrome or PCS. But, my dad lives on the other side of the country, and I've only discussed my symptoms on the phone, so it's not really a diagnosis.

However, my dad knows some other docs in his building who are authorized by Transport Canada (our "FAA") to do aviation medicals. He will ask them about my situation.

Unfortunately, the only treatment for PCS is rest and time.

I have an appointment with a family doctor this week. Maybe he can confirm PCS or send me to an ear/nose/throat ENT specialist to rule out any sort of ear problem.

I was just wondering if any of you have had a concussion before and how that went when you disclosed it during your aviation medical.

Thanks.
 
I'm not sure about the ICP. How do they check that?

I had both a MRI and a catscan. Both were negative.

They said there was no bleeding anywhere internally and I certainly didn't bleed externally on the top of my head or ears/nose, etc. (not when I bumped my head or any other time).


Henning said:
Did anybody check your ICP? Did you get a bleed out of it?
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Airmaster23 said:
I'm not sure about the ICP. How do they check that?

I had both a MRI and a catscan. Both were negative.

They said there was no bleeding anywhere internally and I certainly didn't bleed externally on the top of my head or ears/nose, etc. (not when I bumped my head or any other time).
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Lumbar puncture also known as a spinal tap is the only way I know of to measure it directly, not as bad as it sounds but hopefully you will not need to have one.
 
I went to a walk-in clinic on Easter weekend to complain about my dizziness. The doctor tried a modified version of the epley maneuver.

In comparison to http://en.wikipedia.org/wiki/Epley_maneuver,

he didn't have me stay in any position for 5 minutes and he didn't have me do step 6, where you roll onto your side.

However, it is worth a shot. I'll try it tonight according to wikipedia (3 repetitions in total).

InotDizzy said:
Have you looked into the epley maneuver? Might be worth a shot...
Click to expand...
 
Gary F said:
Lumbar puncture also known as a spinal tap is the only way I know of to measure it directly, not as bad as it sounds but hopefully you will not need to have one.
Click to expand...

Lumbar Puncture gives a somewhat direct measure. And tapping it while you really have elevated ICP can be catastrophic in every sense of the word (think - herniation of brainstem). I have used lumbar drains (a catheter placed where an LP would be done) while managing post op Thoracic Aortic Aneurysm patients to trend pressures and try and prevent spinal ischemia and paralysis (I think you can still count the number of hospitals that do that surgery with both hands)

In the neuro ICU they drill a hole in your head and stick a catheter into the lateral ventricles of the brain (a "ventric") or put a transducer in the hole (a "bolt"). Neither is done routinely without a strong suspicion of elevated ICP from clinical presentation, abnormal vital signs, neurological exam and imaging studies.

A CT or MRI (coupled with a good exam) can give enough indications if intra-cranial pressure is elevated and causing a problem.
 
Henning said:
Did anybody check your ICP? Did you get a bleed out of it?
Click to expand...

I've always been told a concussion by definition was a traumatic neurological disruption that did not have any identifiable abnormalities on any imaging (such as a bleed).. So.. you got your bell rung but all the tests look normal.. except for the fact you got your bell rung..
 
Doggtyred said:
I've always been told a concussion by definition was a traumatic neurological disruption that did not have any identifiable abnormalities on any imaging (such as a bleed).. So.. you got your bell rung but all the tests look normal.. except for the fact you got your bell rung..
Click to expand...


True, and speaking as someone who has had his bell rung more times than Notre Dame, I never had any lasting effects like this which is why I was curious. Plus there is the issue that he's in Canada where they may cut back on the imaging to save money....:rolleyes:
 
Haha - I'm not sure if we cut back that much on medical expenses. 200 years ago, the British government encouraged its citizens to immigrate to Canada with the promise of free land and no taxes. Now we have some very expensive real estate and lots of taxes. The taxes pay for our medical system. However, our socialist medical system has cost me $0 so far.

Anyway, yeah, I'm confused about the lasting effects (dizziness) of my concussion too. I didn't black out, not even for a split second when I hit my head. And, I didn't have the dizziness until 6 days later. So, it's weird.

I have been under a lot of stress lately with moving across country, starting a new job, and being very busy at work on a demanding project. But, I've never responded to stress or fatigue before with dizziness.

I'm curious about disclosing the concussion to an aviation doc.

Have you reported your concussions during aviation medicals? What did the doc say?


Henning said:
True, and speaking as someone who has had his bell rung more times than Notre Dame, I never had any lasting effects like this which is why I was curious. Plus there is the issue that he's in Canada where they may cut back on the imaging to save money....:rolleyes:
Click to expand...
 
Airmaster23 said:
Haha - I'm not sure if we cut back that much on medical expenses. 200 years ago, the British government encouraged its citizens to immigrate to Canada with the promise of free land and no taxes. Now we have some very expensive real estate and lots of taxes. The taxes pay for our medical system. However, our socialist medical system has cost me $0 so far.

Anyway, yeah, I'm confused about the lasting effects (dizziness) of my concussion too. I didn't black out, not even for a split second when I hit my head. And, I didn't have the dizziness until 6 days later. So, it's weird.

I have been under a lot of stress lately with moving across country, starting a new job, and being very busy at work on a demanding project. But, I've never responded to stress or fatigue before with dizziness.

I'm curious about disclosing the concussion to an aviation doc.

Have you reported your concussions during aviation medicals? What did the doc say?
Click to expand...


Never been asked. BTW, you sure you don't have an inner ear infection? Getting dizzy 6 days later... the hit bonk may be unrelated. Stress often breaks down the immune system leaving you susceptible to low grade infections. Go drink 2 liters of grapefruit juice and see how you feel tomorrow...
 
I've definitely wondered if it's an ear infection - bacteria or viral. However, I've had no other noticeable symptoms - no pain, no ringing, or anything like that. And, I started feeling dizzy on Saturday, March 17th and have felt dizzy almost every single day since. I find it hard to believe that even without treatment, it would take my body 2 months to heal from an ear infection. Maybe I have mono. But, then I don't have any of those symptoms.

I have had some fairly persistent headaches the past couple weeks, but I went for massage therapy and the headaches have subsided. The massage therapist said that I had a lot of trigger points in my shoulders and neck that were responsible for my headaches.

However, the dizziness has not gone away. It's definitely not vertigo - nothing is spinning. If I keep my head & body still, like sitting at a computer or watching TV or even driving, there's almost no dizziness. It's only things like turning my head, looking down and back that aggravate it. However, I can do active things like play soccer or go for a bike ride in traffic and not have my dizziness noticeably affect me.

The neurologist didn't think that the dizziness is related to the concussion - he actually didn't even think it was a concussion based on my description of the incident and the lack of symptoms (headache only).

What will grapefruit juice do? (I'll try that idea - I just not aware of the medicinal properties of the drink).

Thanks.
 
Grapefruit juice is great stuff, if you can get Indian River brand it even tastes good. Just lots of vitamins and general good stuff. As for a concussion, I always though that by definition you have to have a loss of consciousness to have a concussion.

Maybe you need to come down to the US and see a doctor like all your MPs do...;)
 
Doggtyred said:
Lumbar Puncture gives a somewhat direct measure. And tapping it while you really have elevated ICP can be catastrophic in every sense of the word (think - herniation of brainstem). I have used lumbar drains (a catheter placed where an LP would be done) while managing post op Thoracic Aortic Aneurysm patients to trend pressures and try and prevent spinal ischemia and paralysis (I think you can still count the number of hospitals that do that surgery with both hands)

In the neuro ICU they drill a hole in your head and stick a catheter into the lateral ventricles of the brain (a "ventric") or put a transducer in the hole (a "bolt"). Neither is done routinely without a strong suspicion of elevated ICP from clinical presentation, abnormal vital signs, neurological exam and imaging studies.

A CT or MRI (coupled with a good exam) can give enough indications if intra-cranial pressure is elevated and causing a problem.
Click to expand...
A ventricular drain would not be used as a diagnostic procedure. I was just pointing out that measuring ICP is not an easy thing to do. He already had a CT so really high ICP is unlikely.
 
Henning said:
Grapefruit juice is great stuff, if you can get Indian River brand it even tastes good. Just lots of vitamins and general good stuff.
Click to expand...
Just don't do that it you're on one of the cholesterol drugs, e.g. Lipitor, Zocor (simvastatin), etc.

http://cholesterol.about.com/od/statindrugs/a/grapefruitstat.htm
Grapefruit juice and certain statins (used to treat high cholesterol) such as Lipitor (atorvastatin), Mevacor (lovastatin), and Zocor (simvastatin) do not mix.
Click to expand...
 
Henning said:
True, and speaking as someone who has had his bell rung more times than Notre Dame, I never had any lasting effects like this which is why I was curious. Plus there is the issue that he's in Canada where they may cut back on the imaging to save money....:rolleyes:
Click to expand...

I'm not sure that Canada's medical system is as bad as some say. Today, Michael Douglas was on The View and they discussed his current cancer treatment -- stage 4 but in remission after treatments and cautiously optimistic for the future. An interesting item was that various tests done in the U. S. did not find the cancer -- the docs prescribed antibiotics for his symptoms. Douglas went to Canada where they found the cancer, at stage 4.
 
Gmaper said:
I'm not sure that Canada's medical system is as bad as some say. Today, Michael Douglas was on The View and they discussed his current cancer treatment -- stage 4 but in remission after treatments and cautiously optimistic for the future. An interesting item was that various tests done in the U. S. did not find the cancer -- the docs prescribed antibiotics for his symptoms. Douglas went to Canada where they found the cancer, at stage 4.
Click to expand...


I'm actually just yankin his chain a bit...:wink2:
 
gprellwitz said:
It's amazing how many people are on those drugs, totally unaware of potential interactions. My pharmacy used to actually have a sticker that they put on the bottles, but it isn't there anymore. :dunno:
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How about a generic, Pravastatin?
 
AggieMike88 said:
How about a generic, Pravastatin?
Click to expand...
Found a reference on Google that answered my own question. Emphasis added at the end is mine.

http://www.powernetdesign.com/grapefruit/interactions/cholesterol.html

pravastatin (Pravachol®)
newarticle.gif
Pravastatin, a HMG-CoA reductase inhibitor and cholesterol-lowering drug, was studied for a grapefruit juice interaction. Eleven healthy volunteers received either 200 mL water or DOUBLE-STRENGTH grapefruit juice three times daily for two days before receiving a single 40mg dose of pravastatin with either 200 mL water or grapefruit juice in a randomized crossover fashion. GJ had no significant effects on the pharmacokinetics of pravastatin, other than the Tmax of active HMG-CoA reductase inhibitors was significantly prolonged from 1 hour to 2 hours.52 Pravastatin is a hydrophilic HMG-CoA reductase inhibitor with an oral bioavailability of approximately 20%, and is excreted to a significant extent unchanged in the urine. CYP3A4 plays only a minor role in the metabolism of pravastatin, which explains why pravastatin is not susceptible to interaction with GJ and other CYP3A4 inhibitors.

newarticle.gif
In a randomized, crossover study, 20 healthy Japanese males, aged 20-33 years, received 10 mg pravastatin (a lower dose compared to what is commonly used in North America) following either water or 250 mL SSGJ given three times daily for 2 days prior to drug administration, and on the day of drug administration. The washout between study periods was 3 weeks.

Compared to the water group, the pravastatin group showed no statistically significant changes in total drug availability (AUC, unchanged with GJ), peak concentration (Cmax, 13% decrease with GJ), time to peak concentration (Tmax, increased 17% with GJ) or half-life (unchanged with GJ).

Total exposure (AUC) of pravastatin lactone (the major metabolite of pravastatin) was increased 29% with grapefruit, and peak level (Cmax) was increased 20%, but this was not statistically significant.The authors concluded that repeated GJ intake does not appear to affect the pharmacokinetics of pravastatin
 
Grapefruit juice can interfere with the enzyme that metabolizes (breaks down) certain drugs. If you drink enough grapefruit juice the blood levels of some medications can increase above safe levels. As far as I know pravastatin, rousvastatin (Crestor) and pitavastin (Livalo) are not affected by grapefruit juice.

http://www.mayoclinic.com/health/food-and-nutrition/AN00413
 
Yesterday I bought some grapefruit juice - President's Choice brand. It tasted awful. My wife knocked back half a glass and almost spit it out. For fun, I gave some to the cats. They made a sour face after tepidly only drinking 1 sip. The dog however lapped it up. I only let him have a little though. He'll eat anything (including his own vomit - I've seen him do it).

A couple weeks ago, after the neurologist cleared me, I went to a walk-in clinic to see what they thought about the dizziness. The doc sent me for bloodwork. I went to the clinic last night to get the results.

My vitamin D is low - but that's not a big surprise for anyone who lives in Canada. Everything else is fine.

The doctor also does aviation medicals, so I asked her about my flight status. She said that I wouldn't be grounded and that I'd pass the medical even with a bit of non-specific lightheadness. She most likely thought it was post-concussive syndrome and that it would go away on its own in time. She asked if there's anything I can't do because of the dizziness (which there isn't) and she said it would be fine for me to fly and that she'd renew my medical.

My wife thought that I should get it renewed, but hold off on flying until my dizziness is better or gone. That way I won't be distracted by anything and I won't be second guessing myself on account of the dizziness.

Interesting though that both a neurologist and an aviation doctor think I'm fine to fly, but I'm not so sure myself.

I guess I'll wait to see what my dad's aviation colleagues/doc think.
 
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