Frustrated

Discussion in 'Medical Topics' started by Kenny Lee, Dec 5, 2018.

  1. Kenny Lee

    Kenny Lee Pre-Flight

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    Reluctant to toss all this out here in a forum, but, here goes.

    I'm 61 y/o and am 10 hours into getting my PPL. I consider myself relatively healthy although I am Type 2 diabetic, I smoke, & my exercise consists of walking to the truck from the office or house. I did have a Melanoma removed off my left thigh about a year ago. I take cholesterol meds to keep it in check. I control diabetes with meds, and I'm not on insulin. I take Blood Pressure medication for preventive reasons. My blood pressure has always been great.

    Today is 12-5-18. I submitted an application to MedXpress on 10-8-18. I made an appointment soon after with my AME. 2 weeks later I think. The AME seemed really knowledgeable, cordial, helpful and things went as I expected. He told me mine would have to be a special issuance through FAA but he felt I would get my medical. Just that it would take time. He gave me some forms to have filled out by my Oncologist (Vanderbilt hospital in Nashvville), by my Primary Care Clinic, and my eye doctor. I've never had a problem with my eyes, but evidently Melanoma can move into the eyes, and my oncologist recommended I get annual eye exams. So I head home and start trying to get these forms filled out. I knew Doctors don't get paid for filling out forms, so I knew it would be a pain. Took a month. After getting the required forms, I called to set up an appointment with my AME. Took 2 weeks to get in.11-7-18. It's a 2 hour drive by the way. (one way). Visit was short and sweet and he started the process and told me not to expect to hear anything back until after the first of the year. He did warn me he expected them to require a MRI brain scan because of the Melanoma. They want to make sure I don't have cancer in the brain. Below is what my Oncologist explained to me at the time of the surgery:

    The Melanoma was on my left thigh. Right before the surgery they inject some sort of die or fluid to "map" my lymphoid system. They chose two lymphoids in the groin area to remove during the surgery. If the lymphoids were clear it was a 99.9% chance the cancer hasn't migrated to other parts of my body. If they weren't clear, they'd need to do more tests. They came back 100% clear and she assured me I'm cancer free.

    I received a letter from FAA yesterday 12-4 that was dated 11-27. They give me 60 days to reply or they will either refer my case for legal enforcement action or deny my application. Well 7 days has gone by since they wrote the letter. So, I suppose I need to hurry.

    They are insisting on a brain scan. My oncologist didn't see the need for one, why would they? Do I argue or give them what they ask for?

    They are also insisting on a stress test due to my coronary artery disease. HUH? Not sure how they decide I have coronary artery disease?

    I'm not even sure if the FAA has had a chance to review the papers and reports my AME sent them 11-7. I think my first step is to contact my AME again, as they copied him on this letter. If they are trying to get me to give up on this medical, they don't know me very well. I won't quit. But, it sure is frustrating.
     
  2. PaulS

    PaulS Final Approach

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    Sounds like you didn't know this when you applied for your medical, but you are a classic case of someone who should go in for a consult before submitting to the actual FAA medical exam. This would have allowed you to get all this stuff done before the exam and possibly have your medical sooner. You are dealing with a big bureaucracy, it's nothing personal, don't get paranoid, just give them what they need to approve you. We have a couple great AMEs on the forum who hopefully will comment, but you should contact your AME immediately, sounds like the guy knows what he is doing.
     
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  3. Kenny Phillips

    Kenny Phillips Pattern Altitude

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    You can't argue with the FAA, no sense trying. I'm your age, never smoked, walk a bit, no issues other than typical aches and pains, no meds, and I consider myself relatively healthy. I guess it depends on what you relate it to.
     
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  4. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    You are actually in a good position! Provide that which the FAA is requesting. You are not wasting time trying to divine the machinations of the FAA. I am a fan of pre exam consults with the AME usually only for drug, alcohol and mental health cases. Sounds to me you have a good AME!
     
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  5. PaulS

    PaulS Final Approach

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    This is one of the great AMEs to whom I was referring.
     
    Last edited: Dec 6, 2018
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  6. Kenny Lee

    Kenny Lee Pre-Flight

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    thanks for the feedback guys!. I think/thought I'd work through this. It sure can be frustrating though.
     
  7. WannFly

    WannFly En-Route

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    Do what FAA says and save your frustration for important things in life like... how do I stop ballooning and such
     
  8. Aviator305

    Aviator305 Pre-Flight

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    I am going to say this even though I am afraid that it will come off as abrasive or mean or unsolicited advice, and I will go ahead and do so because it drives me a bit up the wall when patients’ self-assessment of their health is way out of alignment with reality. Diabetes by itself puts you in the same risk category as someone that has already had a heart attack right off the bat (reference Framingham risk score). On top of that, you choose to smoke. You have high cholesterol. Your blood pressure situation as you describe it is not clear, but prescribing blood pressure medications for preventive reasons is not common practice, so I suspect that you have hypertension that is under control with medication (if you need medications to keep you blood pressure normal, you still have hypertension). At any rate, you are the classic case of a person who should be scrutinized more carefully as you have every single risk factor for a heart attack. You may feel good, but you are not what I would describe as a healthy 61 year old. I have seen 61 year-olds that have great looking coronaries, and I have seen 45 year olds that are a hot mess full of plaques - usually diabetics. A lot of what you describe can be managed to some degree with meds, but there is no substitute for lifestyle changes, and for the love of everything please stop smoking. -a flying doctor that cares

    PS Getting a stress test is not a crazy thing to do at all given your risk factors. You seem to be taken care of by people that care.
     
    Last edited: Dec 5, 2018
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  9. bbchien

    bbchien Touchdown! Greaser!

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    You cannot argue with the crown.

    You melanoma was either Clarke level 6 or had penetrated you beyond 0.75 mm below the “basement “ membrane. FAA has their own experts who disagree with yours. So you can have a fit or jyst comply.

    Your choice: there is no other. Dr. Lou an I differ in how we “operate” insofar as responses from the agency are taking soo very long that my approach has been to get all of which we know to be necessaty BEFORE the flight physical. Then it’s only ONE round of waiting.

    CAD and stress: There must have been a comment in the notes to give you the dx of probable CAD. You sure have the risk factors ( and need to STOP Smokimg). You should have ithe treadmill done anyway! Know that for a 61 year old they expect you to go 9 minutes and get your heart rate up to 144 at the peak (“but i found THIS on the internet...”). Any other number you may cite from the internet is the “mandatory denial” cutoff and you don’t want to be there....(!)

    Oh well what’s done is done. Get the MRI. Do the treadmill. Fly.
     
    Last edited: Dec 5, 2018
  10. vman

    vman Pre-takeoff checklist

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    i took that treadmill test recently for the first time, haven't done much cardio in ages & 59, it was ugly,

    wife did it awhile ago & couldn't finish,

    i'd sort out the medical before continuing lessons
     
  11. Kenny Lee

    Kenny Lee Pre-Flight

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    You’re wrong about that part. I can do both. I threw a fit, but it only lasted a few hours. Now I am in the process of complying. Really no other choice, if I intend to fly.
     
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  12. Rushie

    Rushie Pattern Altitude

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    Many of us, including myself, threw fits at first when discovering that the FAA has no interest in the preponderance of one's own trusted doctors' conclusions, and instead exists in totalitarian rectitude, unilaterally holding anyone who wants to fly hostage to its whims. It goes against our understanding of this country's unique concept of unfettered liberty. Then we remember that it is only a concept after all, and not perfectly realized, only partly so, but still, in the U.S. better than ever before in the history of man. ("You think this is bad, just try to fly in Europe, or China, blah blah blah"). At least now we have BasicMed, a rare step back indeed, toward a nostalgic time when anyone could climb into a machine and kill themselves.
     
  13. gdwindowpane

    gdwindowpane Pre-takeoff checklist PoA Supporter

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    Any OSA issues? That will add some reports/time to the equation.
     
  14. Kenny Lee

    Kenny Lee Pre-Flight

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    Nope. I am in good shape there
     
  15. murphey

    murphey Final Approach PoA Supporter

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    My doctor asked if I'd ever taken the stress test. I reminded him I teach college computer science - every day is a stress test.
     
  16. Kenny Lee

    Kenny Lee Pre-Flight

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    You're right. I didn't like what you had to say, but, I know you're right. I need to quit smoking and work on lifestyle changes. I've known that for a long time. Maybe this flying bug that hit me is the excuse I needed to make those lifestyle changes. I'm in the process of scheduling both the stress test and the MRI. I'm confidant the MRI will have good results. I'm not 100% sure on the stress test. I am 100% sure I'll be sweating, huffing and puffing.
     
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  17. Kenny Lee

    Kenny Lee Pre-Flight

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    Little bit of a timeline on my medical.

    October 8th I applied for medical through Med Express (I know I should have researched a bit more first)

    A day or two later I made an appointment with my AME. He looked over the information on my Med Express and recommended I gather some more information to send to the FAA saying my application would have to be special issuance. It took a couple of weeks and I sent in the information he suggested.

    November 27.
    I received a letter from FAA saying I needed a brain scan (because of a previous melanoma), more information about a possible fatty liver condition, and a stress test. As I've stated earlier I have the first two items completed and it all looks good. The stress test didn't go as well. I can't remember the exact date but I only completed 6 minutes of the required 9 minute stress test. The letter from FAA gave me 60 days to complete the requested items and send it to them.

    January 22nd.
    I sent FAA a letter requesting a 60 day extension.

    January 28
    Got a letter from FAA saying they didn't receive my information and gave me 30 days to get it. I'm confident my January 22nd letter to them and their letter dated January 28th either crossed in the mail or they ignored it.

    Since not completing the original stress test, I've bought a tread mill and I've been using it. they require 3 minutes at 1.7 MPH, 3 minutes at 2.5 MPH and 3 minutes at 3.4 MPH. 3.4 is tough! I am doing a lot better now than I did at the time of the original stress test, but, it is going to be tough for me to complete. I've not completely quit smoking but, I've cut way back. I'm trying to completely quit. That also is tough. according to their January 28th letter I need to have another stress test by February 28th. that's 3 weeks from today.

    Somewhere in my readings on this forum, I've read Dr Bruce has a thread about how to prepare for and pass the stress test. I've not been able to locate it. Can anyone point me in the right direction?
     
  18. PaulS

    PaulS Final Approach

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    Hmmm, usually a not so good stress test results in more cardio tests. How did those go?
     
  19. Kenny Lee

    Kenny Lee Pre-Flight

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    Cardio Doc (2 of them) Both said results aren't showing any problems and see no need for more tests. They do both agree that if I don't change my lifestyle, quit smoking etc, it's just a matter of time.
     
  20. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    Which qualifies you for the bumper sticker

    Screen Shot 2019-02-07 at 2.00.38 PM.png
     
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  21. Topper

    Topper Pre-takeoff checklist

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    While I understand the frustration of the faa docs wanting more and more, I chose to look at it from a positive point of view. Either their required tests were going to find something (which i would be grateful to know about) or I was going to get a very clean bill of health. Fortunately for me it was the latter.

    A brief list of items I had to give them: brain MRI, visual fields test, stress test, labs requiring 15 vials of blood (no, I am not joking), completely nerocog exam including the nerocog-ae, event monitor, plus more that I am not remembering exactly.
     
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  22. dtuuri

    dtuuri En-Route

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    I'm guessing from the meds you take.

    I don't know where that is, but from personal experience I can tell you to practice, practice, practice. Don't forget, they raise the incline every three minutes. I would start at whatever pace you can walk for 20 minutes. Gradually increase the pace and incline as necessary to maintain a heart rate about 2/3 of the way between resting and maximum theoretical (220-age). When you can do that at least once or twice per day and can do it on a 15% grade, then you can practice the Bruce Protocol--carefully. Pay attention to any chest pain (angina) and your heart rate. Approach the maximum at your own risk. Quit if you have symptoms and talk to your doc. Don't do this Protocol every day either. You need to rebuild damaged cells for a day or two or three before repeating.

    That's what I'd do and more or less have done, but I'm no doctor nor an athlete, so take it for what it's worth.

    I'm coming off triple bypass surgery in August and can do 4 MPH on an 11% grade for 45 minutes, but I've been at this for over seven years now. That smoking has to stop, NOW, buddy. :) Throw 'em away.
     
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  23. bbchien

    bbchien Touchdown! Greaser!

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    This man know about what he speaks.
     
  24. bbchien

    bbchien Touchdown! Greaser!

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    So does this man.
     
  25. Kenny Lee

    Kenny Lee Pre-Flight

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    I just finished taking the stress test again. I made it through the full 9 minutes this time. Now to send it all in to the FAA
     
  26. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    Before sending it in, let "the right" AME take a look at what you are about to send. One more double check that it's 100%+ complete and in proper format/sequence/etc can save you from more delays and stress.
     
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  27. PaulS

    PaulS Final Approach

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    Nice work Kenny!
     
  28. bbchien

    bbchien Touchdown! Greaser!

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    remember the definition of a stress test is ALL the tracings, the report AND the tech’s worksheet. Don’t send them any less.....
     
  29. Craig

    Craig Line Up and Wait

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    Quick question related to stress tests.... What happens if one can’t get the heart rate up to the desired numbers despite maxing out the incline and speed?
     
  30. Stingray Don

    Stingray Don En-Route

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    They threaten to tell your wife the actual cost of flying. Works every time.
     
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  31. Craig

    Craig Line Up and Wait

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    My wife would laugh and then ask them how could I be pushed into buying another airplane.....