FAA adds another hoop for medicals

That, is exactly correct. I had that conversation with the correct folks. I would feel al lot better about this at the $200-$250 total cost level.....but now that it's paid for by O-care, by me, that objection was thought to be immaterial. :(

Nick said:
******mit.
Guess what, Nick. Your policy (whether you bear the cost directly or not) is going to pay for the referral. But you're not in the BMI 40 group by a long shot. It'll never get down to BMI = 30. CAMI can't handle the 35,000 SIs as it is- the lag is 105 days currently and every lay document examiner has >1,000 items in his/her inbox currently. Adding 50,000 to the workflow will break the system.

Look, the way we make policy in this country is about how it looks. Trainmen fall asleep and have been screened for several years. This was inevitable and many of you know I have been warning about it for about 2 years......
 
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read the page that I cut n pasted from the FASMB in post #4. Also my edited post #35.

Well, I went back and read it again. The operative phrase appears to be:

Airman applicants with a BMI of 40 or more
will have to be evaluated by a physician who is a board certified
sleep specialist, and anyone who is diagnosed with OSA will
have to be treated before they can be medically certificated.

"Evaluated" could mean many things...

You "fail also to get (it)" the integration of national "policy". Under Obamacare, the elective Sleep Study has to be paid for under legally allowable insurance policies.

Based on the prevailing deductibles in individual policies, that's not much help.

Another reason my personal policy went up $300 per month. And I can now safely get pregnant. Whoopers.

Lucky you, eh? :D
 
Well, I went back and read it again. The operative phrase appears to be:
Based on the prevailing deductibles in individual policies, that's not much help.
Lucky you, eh? :D
No, it should fall under the "preventative care" provision. It won't be subject to my new, improved up from $3,000 to now $6,000 deductible. I actually READ the policy.

I think what's going to happen is the sleep specialist learns to just use the overnight saturimety as his basis for testimony- the FAA won't have to worry about whose finger it was on; the doc will have to worry.

And so it goes in America.
 
This was inevitable and many of you know I have been warning about it for about 2 years......
You certainly have.

This is the part that gets me:

Once we have appropriately dealt with every airman examinee
who has a BMI of 40 or greater, we will gradually expand the
testing pool by going to lower BMI measurements until we
have identified and assured treatment for every airman with
OSA
.

Like I stated in another thread on this subject, a co-worker and good friend was recently diagnosed with OSA. He knew that I have a CPAP and came to me for some advice. He's a marathon runner. Not a bit of excess fat on his body.
 
You certainly have.

This is the part that gets me:



Like I stated in another thread on this subject, a co-worker and good friend was recently diagnosed with OSA. He knew that I have a CPAP and came to me for some advice. He's a marathon runner. Not a bit of excess fat on his body.
I assure you that last bit was written for the Congressman, Mr. Mica. Agency does that all the time.
That would be like the agency saying they will detect every case of critical CAD. Ain't gonna happen. But, very unpublicized, under the Clinton Adm, FAS Jon Jordan said something very much like that to Mr. Oberstar. Remember Secretary Pena? "We will tolerate no more accidents!"

The Washington atmosphere for rational "posting" is very very toxic right now (and has been since Bill), you say what you can get away with.

With the resources CAMI now has, Testing below BMI 30 is never gonna happen. I doubt they can even sustain BMI 40, but the they might). Remember, CAMI is 105 days behind as it is.
 
Can they do a pulse oximeter home screen instead of a sleep study....
It strikes me that a market for some kind of glove that has the PO probe in it that can't be removed would be a lot cheaper than a full sleep study...
 
The Washington atmosphere for rational "posting" is very very toxic right now, you say what you can get away with.

Considering that the D.C. Insurance Commission was just sacked after criticizing the President's "fix" announced last week....
 
Can they do a pulse oximeter home screen instead of a sleep study....
It strikes me that a market for some kind of glove that has the PO probe in it that can't be removed would be a lot cheaper than a full sleep study...

Post #6
 
Beware the theocracy of the The Experts. They know better than we the Hoi Polloi ever would.

And the Founders are performing 360s in their graves.
 
Can they do a pulse oximeter home screen instead of a sleep study....
It strikes me that a market for some kind of glove that has the PO probe in it that can't be removed would be a lot cheaper than a full sleep study...
I think the way it's going to shake out is you go to the sleep credentialed doc, and he gets to decide whether or not an overnight home sleep study is good enough. That takes the "who's finger was it on" question out of the hand of the FAA and into his lap.

Lots to see ahead.
 
Attachments in posts # 4 and #6. I'm don't for the night. Early office in AM.

Thanks doc.


Edit (copied from the first attachment):
>>
The purpose of this editorial is to alert you to a policy that we will be releasing shortly on obstructive sleep apnea (OSA).
<<
 
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That, is exactly correct. I had that conversation with the correct folks. I would feel al lot better about this at the $200-$250 total cost level.....but now that it's paid for by O-care, by me, that objection was thought to be immaterial. :(

Guess what, Nick. Your policy (whether you bear the cost directly or not) is going to pay for the referral. But you're not in the BMI 40 group by a long shot. It'll never get down to BMI = 30. CAMI can't handle the 35,000 SIs as it is- the lag is 105 days currently and every lay document examiner has >1,000 items in his/her inbox currently. Adding 50,000 to the workflow will break the system.

Look, the way we make policy in this country is about how it looks. Trainmen fall asleep and have been screened for several years. This was inevitable and many of you know I have been warning about it for about 2 years......

I'm going to have to go calculate my BMI - at my heaviest, I was at 44. I presume I'm below 40 now - might have been an instinctual response.
 
I assure you that last bit was written for the Congressman, Mr. Mica. Agency does that all the time.
That would be like the agency saying they will detect every case of critical CAD. Ain't gonna happen. But, very unpublicized, under the Clinton Adm, FAS Jon Jordan said something very much like that to Mr. Oberstar. Remember Secretary Pena? "We will tolerate no more accidents!"

The Washington atmosphere for rational "posting" is very very toxic right now (and has been since Bill), you say what you can get away with.

With the resources CAMI now has, Testing below BMI 30 is never gonna happen. I doubt they can even sustain BMI 40, but the they might). Remember, CAMI is 105 days behind as it is.

You're making the assumption they care about how fast they provide services. The pilot population isn't enough of a political speck of dust for them to care. Bring it to the Press' attention? Oh poor rich pilots have to wait six months for thief medicals. No help there.

Judging by most other bureaucracies, they'll let CAMI get at least 360 days behind or more, before anyone large enough to get their attention will scream. Then it'll just be an excuse for demands for a bigger budget and larger empire.
 
P.S. I'll be hit by this. I can probably avoid it with workouts daily and/or one meal a day. LOL. :)

I've got photographs back four generations on the German/Dutch side and every male looks like a damn linebacker past age 22 or so. Most before. I was relatively "skinny" for my family and was pushing the underside of 200 at high school graduation at 5' 11" and a 16" neck. Wasn't an ounce of fat on me back then.

Today I can push the BMI number down into the top of the overweight range but it turns to muscle and my neck just might hit 17" then. To get out of the overweight range I'd have to be put in a prison camp with dysentery for a year, eating soup, from what I've read. I wasn't at or below 177 past freshman year of high school.

We got the "wide" genes. Nice folks say "broad". Some folks might say "redneck". LOL !

I'm also in the oddball 10% or whatever that usually ends up sleeping on my stomach in a face plant. I've always dreaded a diagnosis that requires a CPAP because I'd just end up sleeping on top of the hose with the mask smashed into or completely off of my face. I can fall asleep on my side, but once I'm "out", I could probably roll face down and break a mask or fitting or whatever and never wake up doing it. Every night.

Heavy sleeper is an understatement for me. I'd be one of those people who'd sleep through a plane hitting the house. I go from awake to "gone" and have been known to hold what others thought were full conversations in my sleep when someone thought they woke me up. The only way they can tell is that I make no sense whatsoever. Karen knows this and knows she's only halfway to waking me up if I've sat up in bed and am talking to her but making zero sense. I'd love to see a video of this. I've had it described to me by mom, dad, Karen, and anyone who's woken me up out of deep sleep around the three or four hour mark. Apparently I carry full sentences that almost sound right but can't logically be right. I can answer simple questions too. I never remember these conversations other than a fleeting feeling that I talked to the person. Eyes open and everything.

To work my on-call career the only sound I've trained myself to wake up for is an old fashioned bell ringing telephone. If I have to use an alarm clock in anger (less than five hours of sleep) it has to be a windup bell type.

Otherwise, if I hit 5-6 hours asleep, you can wake me right up. No problem. I won't like you, but I'll wake.

A few other electronic alarm types work too but they're well above the jet engine dB threshold and anyone who's experienced them who sleeps lighter usually reports mild heart palpitations when they go off. Heh.

My home security system is painful on purpose, and integrated with my smoke, CO, water leak, and freezing temperature detectors. Those who've set any of those off by accident, are usually next seen holding their fingers in their ears in shock and awe.

I recommend not burning the toast if you visit. ;)

I usually sleep through the first few waves of radial engines departing for dawn patrol at OSH in a tent. Especially if I stayed up until.3 AM wandering around with Kent. ;)

I do snore intermittently and sometimes it's "freight train" quality. However it seems to be more dependent upon how my face plant worked out than consistent. I've joked that I'd probably sleep perfectly silently with a circular face pillow or on one if those massage tables you stick your face in. But they suck if you're on your side for a bit. Good way to end up with a week long neck ache. A face sized hole in the mattress would be nice. LOL! Sometimes I'll find the pillow gone and I'm in a real face plant. Other popular positions are sleeping with my head on one arm and waking up to it being so asleep I can barely move it. Ha.

Love those massage table face holder things whenever I've gotten a professional massage. Heh. A "daytime wakefulness" test on one of those would be hard but mostly because being on my stomach and warm would trigger my "this is how I fall asleep" thoughts than from being sleep-deprived. Especially the fancy heated variety. Ooh. It's nap time?! ;) Nice. Oh, ouch... WTF ? Oh yeah I did ask for a deep tissue massage didn't I ? Holy crap! That's a pressure point! Ahhh... There it released. Muuuuuch better.

And back when I had long hair and didn't buzz cut it, I had some incredible "bed head". I still can get either the left side or right side to look like I have a bald patch and hair standing straight up on one side with the face plant.

My face plant sleep style would be incredibly difficult or impossible with a mask on.
 
I'm also in the oddball 10% or whatever that usually ends up sleeping on my stomach in a face plant.

This was for me at least part of the reason along with some really bad posture while sitting that I ended up at the doctor with neck pain=.

When I stopped slouching all the time and sat up straight, stopped sleeping as much on my stomach. My neck pain and any associated other side effects have almost all but gone away.
 
Oh I agree on overweight being common, but a BMI of 40 is absolutely MASSIVE!
By definition with a BMI of 40 or higher is morbidly obese. Those of us who practice medicine understand the correlation between this level of obesity and medical problems. The cut-off is not as arbitrary as it appears.
 
By definition with a BMI of 40 or higher is morbidly obese. Those of us who practice medicine understand the correlation between this level of obesity and medical problems. The cut-off is not as arbitrary as it appears.
I believe you....I am just surprised that using 40 as the cutoff would affect that many pilots.

I guess being in the military, I live in a sheltered world - I'd get booted long before I got close to 40.
 
I don't think the issue is the 40. It's the bureaucrats stated goal of lowering the cutoff untill they get "all" the OSA. At that point a lot of healthy people will have $1500 physicals....
 
I believe you....I am just surprised that using 40 as the cutoff would affect that many pilots.

I guess being in the military, I live in a sheltered world - I'd get booted long before I got close to 40.
I hate to be a jerk but I believe that a BMI over 40 in itself should be disqualifying at least 1st and 2nd class medicals.
 
Wait until they start testing everyone for ADD. Pilots all be wishing we only had fat guy discrimination.
 
I don't think the issue is the 40. It's the bureaucrats stated goal of lowering the cutoff untill they get "all" the OSA. At that point a lot of healthy people will have $1500 physicals....
True, but that is the downstream effect. Like Doc Bruce said, they are backed up already. It is going to take a while (if they even get there) before they are even in a position to go after the lower ones.

It will be interesting to see how the airlines and pilot unions will respond. Think about all the guys doing 1st class medicals every 6 months and having to deal with this.
 
I hate to be a jerk but I believe that a BMI over 40 in itself should be disqualifying at least 1st and 2nd class medicals.
How many guys flying 121 do you think are pushing 40 on the BMI scale? IOW, how big of a problem is this going to be for the airlines?
 
I hate to be a jerk but I believe that a BMI over 40 in itself should be disqualifying at least 1st and 2nd class medicals.

"At least for 1st and 2nd class" means your preference would be that it applies to 3rd class as well.
For private, non-commercial ops, why is that your business?
 
By definition with a BMI of 40 or higher is morbidly obese.
Do you not recognize that BMI tables are based on body types within x number of standard deviations from the mean, and that there is a population which lies outside the range defined by the table?

Again, address the young man with a 54 inch chest and 30 inch waist, who (according to the tables) is significantly obese.

Am I overweight? Yes. But I currently have a 56 inch chest and 42 in waist, not the "beachball" by numerical BMI might suggest.
BMI assumes that everything over a certain "ideal" weight is fat. That is true in many, but not all, cases. That's why the military and some insurers will do an immersion buoyancy test to determine what's muscle and what's fat.
 
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......Why not just require it for everyone? Where's the limiting principle?
This is an extremely dangerous precedent.

Agreed....they say they believe "..up to 30% of individuals with a BMI less than 30 have OSA."

and

"Once we have appropriately dealt with every airman examinee who has a BMI of 40 or greater, we will gradually expand the testing pool by going to lower BMI measurements until we have identified and assured treatment for every airman with OSA."

Clearly we all will have to do this if the bureaucrats continue unchecked. I'm in the 20's so I guess I have a while but it's coming for all of us it seems.

The worst part is they appear to be doing this by bureaucratic fiat rather then following the rules and amending the regs. If they tried to do it right there would be a comment period so the more stupid parts of this would get cleaned up. I agree 40 is a risk factor and could be reasonable for a class 1 but they are not demonstrating any boundaries here.....
 
I've scanned through all three pages of messages on this ...........
Please point me to the one that describes the AVIATION related issue.
Check the NTSB, can't find a "17" neck cause the plane to crash"
What is ACTUALLY going on here???????
 
How many guys flying 121 do you think are pushing 40 on the BMI scale? IOW, how big of a problem is this going to be for the airlines?


I fly about 150 segments a year and my wild assed guess is that it will hit about 1 in 30.
 
Quote:
Originally Posted by bbchien View Post
Loss of alertness is a political hot button- NWA at MSP and ATC falling asleep at Reagan National Airport.

This.

And I asked this.....
So how is restriction on third class medicals for GA pilots suppose to improve the alertness of commercial airline pilots on insane schedules or union issues for bored controllers?

Were these pilots and controllers over 40 BMI with neck size greater then 17"?????
 
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That BMI chart is a joke. I think I know one guy... out of everyone I know who might actually fit into the normal category. He's been underweight his whole life and continually advised by doctors to increase his calorie intake.

Agreed,

.6 from "overweight"
45970_1550788859394_7046505_n.jpg


I do have a 50lb cushion to a BMI of 30 but...
 
Wondering do heavy muscular guys also have sleep apnea at a higher rate? Might not be the fat but the mass. Dunno the answer and am certainly not defending the latest war on pilots fun hoop.
 
Do you not recognize that BMI tables are based on body types within x number of standard deviations from the mean, and that there is a population which lies outside the range defined by the table?

Again, address the young man with a 54 inch chest and 30 inch waist, who (according to the tables) is significantly obese.

Am I overweight? Yes. But I currently have a 56 inch chest and 42 in waist, not the "beachball" by numerical BMI might suggest.
BMI assumes that everything over a certain "ideal" weight is fat. That is true in many, but not all, cases. That's why the military and some insurers will do an immersion buoyancy test to determine what's muscle and what's fat.

Show me somebody who has a BMI of 40 and is not severly overweight. They should undergo a formal body fat analysis to prove otherwise. Morbid obesity for all practical purposes is a disease and those who wish to obtain a medical certificate should undergo additional evaluation just as those with diabetes, hypertension, coronary artery disease or any of a number of other chronic illnesses.

Gary F
 
The average male height in the US is 5'9" a person of that height would need to weigh 272 pounds to have a BMI that exceeds 40. I am 6' 1.5" and as of this morning 279 on a big frame and although I happy with the weight I am losing I am still plenty fat. Someone 5'9" and 272 is very overweight no matter how you slice it.

The real question should be what is the real risk? What is the real likelihood of incapacitation on any given flight?
 
Men who lift weights in excess of body weight (bench press primarily) and who lift regularly may also have a neck circumference in excess of 17". These folks are definitely not either obese or in poor medical condition.

Bmi between 25 and 27.5 are commonly seen in healthy males who lift weights. Because of my type II I am required to participate in this stupid program from my wife's employer where they call me up to chat about my 'health' and they give me grief about having a BMI of 26.7. Then I ask them about resting pulse of 60, BP of 118/75, cholesterol of 144' and a A1c under 6.0. Am I cardiovascular shape? How about asking relevant questions? Not these asinine screening questions that are fine for the diabetic eating candy and ice cream daily . . . Am I controlling my DM? The numbers don't lie. You have access to the numbers. Use the f'ing data. Then they ask you if you 'feel down,' or if you are cooking your food completely . . . This is insane.
 
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Show me somebody who has a BMI of 40 and is not severly overweight.
My BMI is 39%.
Here's what the BMI chart says I look like:
utf-8Qwebmd5Frf5Fphoto5Fof5Fbody5Fmass5Findex.jpg


Here's what I actually look like.
utf-8Q201311185F102219.jpg

One of these is not like the other.

So Doc, am I overweight? Yes. Am I SEVERELY overweight?
Right now I weigh 260#. Can I stand to lose 30#? Yes. Can I EVER get to the 155 pounds the BMI chart says is normal for my height? No. Not ever. At zero percent body fat, I would still be obese according to the BMI chart.

Will you at least admit that there are some people who fall outside the statistical range of the BMI chart?
If I gain 4 pounds should my medical be revoked?
They should undergo a formal body fat analysis to prove otherwise.
That's not what you said. You said
I believe that a BMI over 40 in itself should be disqualifying at least 1st and 2nd class medicals.
So are you now stating that a body fat analysis is the gold standard, and BMI charts an approximation?

I did go through a body fat analysis when I had knee surgery. The BMI chart said my body fat was 24%, which put me in the very high risk category. My orthopod immediately recognized I was outside the range of the BMI chart, and did a body fat analysis which found I was at 14% (higher than I want, but not "morbidly obese").
EDIT: For clarity, I was 14% at that time. I've added some pounds, and am at about 19% now.
 
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The real question should be what is the real risk? What is the real likelihood of incapacitation on any given flight?
That's a good question....personally I'd feel safer if they changed the rest rules for 121 box carriers....but apparently that is too hard to accomplish.
 
When I was in the Army they used the "tape test" to differentiate who was muscular verses who was fat. The took your height, weight, neck and waist measurements and plugged it inta a formula to see if you met the standard. Not perfect but probably better than using the one size fits all BMI calculation.

Gary F
 
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