Doctor recommends stress test during annual visit

M

Mike Lowe

Guest
Had an annual visit with my doctor and mentioned I get winded quicker than usual lately. I’ve gained about 20lbs in the last year and don’t exercise that much. I’ve had Covid twice.

She suggested a stress test or echo to rule out any cardiac issues. She said since I’m not having pain she would simply put that it is secondary to shortness of breath upon exertion.

Obviously if I have issues then that is a whole different problem to deal with but how will getting a stress test done affect my class 2 if there are no findings and it turns out I’m just out of shape and fat?

I fly for a living.
 
There are a couple AME's here that will actually give you good advice. I am NOT them.

IMO I would just report the annual visit with your doctor. The stress test is just testing related to that.

Of course if they find something then that needs to be reported or otherwise addressed (Sport pilot, Basic med, not likely an option for OP).
Reporting issues you have just proved you don't have seems like going a bit overboard on the reporting to me. Maybe the FAA thinks otherwise.


Brian
 
I think Supervised Exercise Therapy might be a better suggestion. Rather than just check, it gives you the opportunity to get active while monitoring you. If you've heard of the cardiac patient recovery programs, it's similar. You work out several times a week with medical staff to monitor you. Because it's exercise, I don't believe - but don't know - that it would not be reportable on a medical. If you have a problem, it will show up.

Bonus, you'll lose some weight, get active, feel better.
 
I would not do any such thing unless the test were done to FAA specs such that a negative test would be ABLE to @FAA, exclude the diagnosis of CAD.

If you do a lesser test, FAA will demand the result and then require an ADEQUATE test.

If you are the sort of person that needs a positive test to get you to modify your risk factors, stay active, eat right, don't get fat etc etc etc, then do the test. But if you are capable of modifying your risk factors, WHAT ARE YOU GOING TO DO DIFFERENTLY if you have a negative test?

Lastly do no go near the coronary calcium scan. If your agatson score is 400 (second and First class) or more you will be demanded to have a heart cath NOW!. Tell me which is more potentially damaging - heart cath or Stress treadmill! The underlying risk diagram for Agatson score >=400 to significant CAD "r" is about .67. I have no idea which external consultant sold this to the FAA.
 
Mike Lowe said:
Had an annual visit with my doctor and mentioned I get winded quicker than usual lately. I’ve gained about 20lbs in the last year and don’t exercise that much. I’ve had Covid twice.

She suggested a stress test or echo to rule out any cardiac issues. She said since I’m not having pain she would simply put that it is secondary to shortness of breath upon exertion.

Obviously if I have issues then that is a whole different problem to deal with but how will getting a stress test done affect my class 2 if there are no findings and it turns out I’m just out of shape and fat?

I fly for a living.
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If you go to a doctor, they will make a record, and probably prescribe you some medications.

I’m not a doctor, but in my opinion, just make different life choices with it comes to sleep, eat and exercise. It’s really simple to address the issue. Getting winded does happen from gaining weight and not exercising.

Consider core body fitness training. If you do this 5x per week for 3-4 weeks, guarantee these issues will reduce significantly. Now of course don’t over push yourself but know yourself and your body.

Cut out sugar from your diet, limit your food intake, it’s really a mental struggle more than anything else. If you feel hungry when you wake up and all the time then you are at the right level. If you’re eating too much then you will feel full when you wake up or throughout the day.

I also gained quite a bit of weight during Covid but I’ve been working on losing it (lost almost 60lbs so far) and trying to lose another 20lbs. So if I can do it, you can too.
 
bbchien said:
I would not do any such thing unless the test were done to FAA specs such that a negative test would be ABLE to @FAA, exclude the diagnosis of CAD.

If you do a lesser test, FAA will demand the result and then require an ADEQUATE test.
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If I understand this correctly, if you go to your doctor with a medical concern and your doctor orders tests which rule it out from your doctor's (and probably a specialist's) perspective, the FAA will force you to do it the way the FAA wants.

Gee, I can't imagine why pilots hide medical problems and avoid treatment.

So, would it be safe to go to a nutritionist or exercise expert, or will that also lead to an FAA "prove you're not sick" inquiry?
 
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The problem is, he has a symptom consistent with bad coronary disease and his doctor recommended a test to rule it in or out. Sure, maybe he's short of breath because he's overweight and out of shape. Or maybe he's short of breath because he's overweight and out of shape, with resulting coronary disease. Right now is the time he's at greatest risk because the extent of his disease (if any) is completely unknown. He could have what's called a left main lesion, follow the advice in this thread to "just go get some exercise," clutch his chest, and fall over, dead.

If you have coronary disease, you want to know. Whatever test the FAA wants will also satisfy your doctor and you.

And, while I generally agree that the coronary calcium score is a bad test, I do have two anecdotes of lives saved by it, one of which is my wife.
 
You’ll know your heart is healthy to the extent of what that test can indicate. They don’t ground you for that. I’d guess your doctor is ruling out the weight gain is a symptom before he blows it off as the cause.

In a couple of months I’ll voluntarily take a stress echo test. My cardiologist thinks it’s a good idea and I’d rather know than not. Ignorance is not bliss. Ignorance is ignorance, and FAA Aeromedical cultivates it.
 
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Clearly the FAA doesn't believe in health first.

When an occupational medicine doctor who has never seen you will overrule a cardiologist who does a thorough examination, no further proof of an out of control medical bureaucracy is required.
 
jbarrass said:
Clearly the FAA doesn't believe in health first.

When an occupational medicine doctor who has never seen you will overrule a cardiologist who does a thorough examination, no further proof of an out of control medical bureaucracy is required.
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That's not what's happening here. The OP's doctor, who presumably did an exam and clearly took a history, thinks he needs further examination.
 
Doctors are “generally” happy to order procedures and prescribe medications, as life is too busy to take care of yourself, so take a pill for that. With each pill you gain something and lose something else. More holistic approach and of course there are exceptions to the norm but that’s where knowing your body and family medical history can help.
 
All these problems seem to begin with the 1980's or so food pyramid. OP, hope it turns out to be nothing.
 
Better to know now than after a heart condition. A friend had a stress test and found they needed triple bypass. With no heart damage, they had their special issuance in 9 months post op. If you are in worse shape or have a heart attack, everything is worse for you and your family.
 
So you fly for a living. What good will that do if you let a simple problem ground you or kill you.??

Health first.

When I was flying for a paycheck I had a few symptoms that at the time was thought to be heart related. I did everything the docs asked for and did everything the FAA wanted and got to fly again. If I had refused, no more flying. Doing a stress test will do nothing to your medical if no problems are found. Otherwise might have to jump through a few hoops to appease the FAA and maybe a Special Issuance for a year or so. I was fortunate that I had a especially excellent AME who has since passed away and he was able to get me through everything in a very short time.

Then had heart problems and now have a stint installed. Now thinking about coming out of retirement and flying again.

Health first. Start walking. Cut out sugar, carbs, caffeine, alcohol and salt. I did this and lost 45 pounds and holding steady weight.

YMMV though.

Disclaimer: Not a doctor, just a been there done that person.
 
bbchien said:
jbarrass said:
Yes, and he's been advised in post #4 to be wary.
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No, he’s been advised to do an adequate, fair test.
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True. Unfortunately, the ultimate message from CAMI is "be wary."

Here's the attitude we're dealing with: Someone innocently reports they was genetically tested and found to have a genetic marker for a disease. No symptoms. FAA forced testing to prove he didn't have the disease. Medical school professor writes into the AME journal to complain about it. Editorial response came down to, "once he reported it, what else do you expect us to do?"

Bruce, can you tell us how CAMI has incorporated the FAA's Compliance Program?
 
Mike Lowe said:
Had an annual visit with my doctor and mentioned I get winded quicker than usual lately. I’ve gained about 20lbs in the last year and don’t exercise that much.
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I have a hunch I know what your problem is. I have a hunch you know too. Eat better, start exercising, and lose the weight. Then see how you feel.
Mike Lowe said:
Obviously if I have issues then that is a whole different problem to deal with but how will getting a stress test done affect my class 2 if there are no findings and it turns out I’m just out of shape and fat?
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Have a conversation with her. Explain your situation, explain how the FAA works. When I did this, my doctor suggested I NOT get a certain test that often has "incidental" findings that could lead to additional testing because I was low risk for any real problems. I'm not that kind of doctor, but your symptoms have a very obvious possible cause that you can address before doing any testing that will raise the FAA's antenna. Of course if your doctor thinks you NEED a stress test to diagnose a current serious condition, that's a different story.
 
midlifeflyer said:
If I understand this correctly, if you go to your doctor with a medical concern and your doctor orders tests which rule it out from your doctor's (and probably a specialist's) perspective, the FAA will force you to do it the way the FAA wants.

Gee, I can't imagine why pilots hide medical problems and avoid treatment.

So, would it be safe to go to a nutritionist or exercise expert, or will that also lead to an FAA "prove you're not sick" inquiry?
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In 30 years of FAA medicals, I've never disclosed testing that didn't result in a diagnosis. I don't know why anyone would. I disclose doctor's visits and diagnoses.
 
Lindberg said:
In 30 years of FAA medicals, I've never disclosed testing that didn't result in a diagnosis. I don't know why anyone would. I disclose doctor's visits and diagnoses.
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I agree. And don't answer questions that haven't been asked.

But isn't that exactly what "be wary" and the OP's question are about?
Mike Lowe said:
how will getting a stress test done affect my class 2 if there are no findings and it turns out I’m just out of shape and fat?
Click to expand...
 
midlifeflyer said:
I agree. And don't answer questions that haven't been asked.

But isn't that exactly what "be wary" and the OP's question are about?
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Yes. And if there are no findings, there's nothing to report but a doctor visit. But it was stated that if nothing was found, the FAA would demand more testing. Which can only happen if it's reported to the FAA.
 
OneCharlieTango said:
The problem is, he has a symptom consistent with bad coronary disease and his doctor recommended a test to rule it in or out. Sure, maybe he's short of breath because he's overweight and out of shape. Or maybe he's short of breath because he's overweight and out of shape, with resulting coronary disease. Right now is the time he's at greatest risk because the extent of his disease (if any) is completely unknown. He could have what's called a left main lesion, follow the advice in this thread to "just go get some exercise," clutch his chest, and fall over, dead.

If you have coronary disease, you want to know. Whatever test the FAA wants will also satisfy your doctor and you.

And, while I generally agree that the coronary calcium score is a bad test, I do have two anecdotes of lives saved by it, one of which is my wife.
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What was your wifes CAC score from what I have heard they won't do anything unless it's 300 or 400. Mine was 15 they said nothing to worry about at this point. I have a friend who got a CAC score test of 0 he had chest pain went to the ER found 99% blocked soft plaque buildup. ER said CAC CT scan only sees hard plaques the test shouldn't be used to rule out heart attacks too many primary care doctors were doing that.
 
kell490 said:
What was your wifes CAC score from what I have heard they won't do anything unless it's 300 or 400. Mine was 15 they said nothing to worry about at this point. I have a friend who got a CAC score test of 0 he had chest pain went to the ER found 99% blocked soft plaque buildup. ER said CAC CT scan only sees hard plaques the test shouldn't be used to rule out heart attacks too many primary care doctors were doing that.
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Her coronaries were completely normal. She had an incidental finding of an aneurysm of her ascending aorta.
 
Just a bit of an update on this...

I've now had COVID three times... I also joined a gym 7 weeks ago and started exercising regularly for the first time in about 9 years. I'm doing a mix of cardio and weights.

When I started, I was managing 1.5 miles on the treadmill at a 15 minute/ mile pace . Yesterday I did 1.5 miles with a pace of 10:42/ mile. I have also incorporated a bike ride at the end of my workouts and ride 4 miles at a 18-20mph pace. For fun, I started to do the Bruce protocol treadmill test and can manage to get to stage 3 and occasionally 4. Strength training has brought my bench press up from repping 110lbs to 190lbs (I have an old torn rotator cuff too.)


Today I had my appointment with the Cardiologist and it was an interesting discussion. They did a 12 lead EKG and the EKG was normal. During our discussion, the Cardiologist said he would not have me do a stress test because it was obvious to him, based upon my exercised improvements, that I would not have an issue passing the stress test. He said he wanted to do a echocardiogram and a cardiac calcium scan which reminded me of what was said on this thread!

I actually pulled up the thread for him to read. He was very surprised to see that the FAA would require if I was above 400. He said his treatment would be with medication and exercise not the invasiveness that the FAA has so he is not going to do the scan.

He wants my cholesterol lower so he put me on a statin (first time I have ever been on any medication) and told me to keep doing what I am doing exercise wise. I have an echo scheduled for the first week of January, as he says, "to just get a picture of where you are at right now given your family history."
 
I've been on a deep dive into metabolic health for the last year. I heard a doc lecturing on the CAC score, and statins a while back. At one point not long ago I even listened to one lengthy interview with Dr Agatson himself.

Apparently statins will tend to drive up the CAC score numbers, because they tend to drive the soft plaque into calcification....so your CAC score will be higher if you've taken stain for any length of time. Not that this is bad, just that it throws the numbers off. My Primary care doc didn't know anything about this when she ordered a CAC test for me, in fact argued against the concept.

I was a bit worried to take the test given that I've been on a statin a long time. Probably 10-15 years, all the while in a very high insulin state, horrible diet, horrible everything.... so the docs were in a way managing me through the worse on both sides of the coin.

I quit the statin about a year ago. Had I known then what I know now, I would have been more aggressive about my insulin resistance and not taken the statin for all those years, because it's such a more significant threat to heart attack and stroke then is cholesterol.

Thankfully in my case, my recent CAC score was 0,0,0,4...so I must not have even had any soft plaque all those years for the statin to help calcify!...so now I'm really thinking that I had no business taking it and risking all the side effects!
 
Question re: stress testing.

I had a Bruce protocol stress test done as part of a general physical unrelated to FAA.

I ended up going to just shy of 10 minutes, but significantly exceeded the target BPM in the final stage of the process (not sure why the tech allowed this). Otherwise, no problem at all.

All of the basic readings were fine, and the doc told me everything looked great, and I was above standard for my age.

A week later, I got a note saying that there was an indication on the ECG of "possible ischemia" at the very end of the test, when my heart rate was well above target. No diagnosis of anything. but a recommendation to talk to a cardiologist.

My father had something similar 20 years ago. He went through many many tests and procedures, including a heart cath that nearly killed him from an internal infection caused by the process. There never was any actual heart problem found, and the tests did a lot more damage than was warranted.

Since there is no actual diagnosis and no symptoms, am I safe to ignore this from a FAA perspective?
 
I'm so glad to be on Basic Med.

About 15 years ago I volunteered for a cardiac CAT scan that my hospital was evaluating. One radiologist read it as normal and other one read it as abnormal, which led to an unnecessary cardiac cath and a Special Issuance for a few years. A few non-cardiac SIs later (for prostate cancer and malignant melanoma) I went on to Basic Med so I wouldn't have to fork out $5,000 out of pocket every year for a useless head and neck MRI that the FAA demands for the SI. Basic Med allows me to visit my cardiologist, get EKGs (normal), undergo echocardiograms, stress tests, etc. (all of which I've had) and not risk losing the class 2 medical that I had at the time. Now, if the cardiologist finds something concerning to him my grounding won't be determined in cubicle in OKC, and I'll have no argument with the decision.
 
midlifeflyer said:
If I understand this correctly, if you go to your doctor with a medical concern and your doctor orders tests which rule it out from your doctor's (and probably a specialist's) perspective, the FAA will force you to do it the way the FAA wants.

Gee, I can't imagine why pilots hide medical problems and avoid treatment.

So, would it be safe to go to a nutritionist or exercise expert, or will that also lead to an FAA "prove you're not sick" inquiry?
Click to expand...
The only treatment short of a cath or stent is:

Eat right
don't get fat
Don't get sedentary
Control your hypertension- well controlled, and not just "barely passable".
Control your cholesterol.
If it doesn't look like food it isn't food

If you are the person who needs a kick in the butt to do that, do the test. If not, do the 6 items above and bypass the test. The above is "Preventative TREATMENT".

dbahn said:
I'm so glad to be on Basic Med.

About 15 years ago I volunteered for a cardiac CAT scan that my hospital was evaluating. One radiologist read it as normal and other one read it as abnormal, which led to an unnecessary cardiac cath and a Special Issuance for a few years. A few non-cardiac SIs later (for prostate cancer and malignant melanoma) I went on to Basic Med so I wouldn't have to fork out $5,000 out of pocket every year for a useless head and neck MRI that the FAA demands for the SI. Basic Med allows me to visit my cardiologist, get EKGs (normal), undergo echocardiograms, stress tests, etc. (all of which I've had) and not risk losing the class 2 medical that I had at the time. Now, if the cardiologist finds something concerning to him my grounding won't be determined in cubicle in OKC, and I'll have no argument with the decision.
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Doesn't work for a guy who flies for his living.....

Foolwithmoney said:
Question re: stress testing.

I had a Bruce protocol stress test done as part of a general physical unrelated to FAA.

I ended up going to just shy of 10 minutes, but significantly exceeded the target BPM in the final stage of the process (not sure why the tech allowed this). Otherwise, no problem at all.

All of the basic readings were fine, and the doc told me everything looked great, and I was above standard for my age.

A week later, I got a note saying that there was an indication on the ECG of "possible ischemia" at the very end of the test, when my heart rate was well above target. No diagnosis of anything. but a recommendation to talk to a cardiologist.

My father had something similar 20 years ago. He went through many many tests and procedures, including a heart cath that nearly killed him from an internal infection caused by the process. There never was any actual heart problem found, and the tests did a lot more damage than was warranted.

Since there is no actual diagnosis and no symptoms, am I safe to ignore this from a FAA perspective?
Click to expand...
see other string. No bueno.
www.pilotsofamerica.com

Another stress test question:

I had a Bruce protocol stress test done recently as part of a general physical unrelated to FAA. I ended up going to just shy of 10 minutes, but significantly exceeded the target BPM in the final stage of the process (not sure why the tech allowed this). Otherwise, no problem at all. All of...
www.pilotsofamerica.com www.pilotsofamerica.com
 
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Obviously, Dr Bruce is your go to for keeping your class 2 encumbered with a minimum of unnecessary hassle.

With respect to your health-
You’re getting a wake up call. Answer it.

Don’t worry too much about caloric restriction. Do modify your diet if it’s unhealthy, but exercise is what matters. Don’t starve yourself. Study after study shows losing and keeping off weight long term is very unlikely without drugs or surgery.

But if you convert 15 pounds of fat, into 15 pounds of muscle? You’re way better off than before.

Even a bit of regular exercise helps. Do what you enjoy doing. If you hate an Exercycle or treadmill, you will probably slack off. Swim. Hike vigorously. Lift weights, or bike. Paddle. Any work- but set goals, keep track, and do it!
Good luck. Know I’m giving tangential unsolicited advice. Happy to talk by DM


Happy holidays!
 
bbchien said:
Doesn't work for a guy who flies for his living.....
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No question that Basic Med isn't for everybody, but it's a good compromise for those of us that don't really fly for a living.
 
Stewartb said:
My cardiologist thinks it’s a good idea and I’d rather know than not. Ignorance is not bliss. Ignorance is ignorance, and FAA Aeromedical cultivates it.
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This.

Decide which is more important: Alive and not flying or fly for a few years more and then get told you can't get a medical anymore.

Health first. For you the stress test may be nothing, or it may be something.

Just FYI, I quit flying for a living to take care of my health. I almost waited too late.
 
OP here... One month since the last post.

Just some more follow up for anybody who might be reading -

At my previous visit with the cardiologist, I noted he prescribed a statin for me and set me up for an echocardiogram. This was based on my 216 total cholesterol and none of the other levels being within normal limits. My A1C was also 6.0.

Knowing that I had been working out and had lost some weight I decided to wait until my normal follow up visit this past week to actually start the prescription. I figured I would at least have a benchmark for starting the statin versus the statin and the exercise.

I had my visit with my PCP and she pulled my labs. My weight is now down 15 lbs. from when I started working out. My total cholesterol is 180 (with no real diet change) and all other values are within normal limits. My report from the echocardiogram came back completely normal with an ejection fraction of 65% and no stenosis. Given this, my PCP told me not to take the statin that was previously prescribed. A1C is now 5.6. Again, no real diet change.

At the gym, I am now running a constant 1.5 miles at a pace slightly better than a 10 min. mile. Today, I knocked out a mile in 9:24 and probably could have done 1.5 miles. Still biking 4 miles after running.

It seems exercise really does make a difference!
 
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