Gastro Issues

Discussion in 'Medical Topics' started by ChrisCC, Nov 30, 2018.

  1. ChrisCC

    ChrisCC Filing Flight Plan

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    hi. I’m 29 and am seriously considering a career in aviation and have begun the process of reviewing flight schools.
    I consider myself in good health and have had no issues except bouts of gastro complaints off and on through most of my life. Last spring (prior) to thinking about flight school I went to see a gastro doc to see if I have IBS. I went through routine tests including blood and a colonoscopy. My report came back clean. I still have occasions stomach issues and have considered going back to the gastro doctor to get on meds that will help me manage the problem. However, I’m wondering if doing so will create a red flag for my medical certification.
    Can u guys give me some insight. Thanks
     
  2. DaleB

    DaleB En-Route

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    Have you tried one of the OTC meds like Prevacid, Prilosec, etc.? I was on Prevacid daily for a while (when it was still prescription only), until I figured out which foods were causing me problems and started avoiding them.
     
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  3. ChrisCC

    ChrisCC Filing Flight Plan

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    Yeah DaleB I’m trying a route of ibgard and probiotics. I’m not confident in the success of of OTC meds. I haven’t made any good connections to my issues.
     
  4. Tantalum

    Tantalum En-Route

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    THIS.
    Growing up I tended to have a "sensitive" stomach as well. Nothing actually wrong with me.. as it sounds like there's nothing wrong with the OP.. I just realized that certain foods just didn't agree with me. Bread and salty foods in general aren't that great for you. Got to the point in my mid twenties where I kept a daily spreadsheet food and time log and how I felt.. helped nail down which foods to enjoy, or eat sparingly. For example I LOVE gelato.. but that's got to be an occasional small size delicacy for me!

    There is some truth to "whole" foods.. grilled chicken, walnuts, almonds, peanuts, etc.

    Anyway, good luck!
     
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  5. JonH

    JonH Pre-takeoff checklist

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    Any nicotine use? After 10 years of smoking I quit and switched to nicotine gum. I started having all kinds of GI issues from the increased nicotine. It took months of being 100% nicotine free before things started to go back to normal.
     
  6. Kenny Phillips

    Kenny Phillips Cleared for Takeoff

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    Same here. Of course, I was over 50 before I figured it out! A pretty serious bout of heartburn got me on Prilosec, plus a restricted diet. Now I still have the restricted diet (by choice) and no drugs, and no issues! (And, unfortunately, no caffeine and limited chocolate.)
     
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  7. wilkersk

    wilkersk Cleared for Takeoff

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  8. Tantalum

    Tantalum En-Route

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    ..English was my parent's second language.. this was a very long time ago, but we were at a get together somewhere and it was discovered that both my dad and a family friend shared a September birthday, which made them both Virgos. My dad got excited and said "you are a virgin! I am virgin too!" and the man replied "that's very impressive, considering you have 4 kids" .. I grew up with many of these types of interactions.. another one was someone (highschool teacher maybe?) telling my mom at some parent teacher event, orientation, something, that she looked very well rested and refreshed and my mom, in a very thick accent, responds back that she just had the most wonderful (insert French term for shower)... teacher cracked up and told her that the english word for shower was "shower" .. and not that other word.
     
  9. Van Johnston

    Van Johnston Line Up and Wait

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    "bouts of gastro complaints off and on" could also be gall bladder. I know you said you had routine blood tests, but think there is a special blood panel to check for that.

    I know that's how my diagnosis went: blood test #1 => blood test #2 => MRI => you've got gall stones; go see a surgeon to yank that puppy out.
     
  10. ChrisCC

    ChrisCC Filing Flight Plan

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    No nicotine. My issues are lower GI. sorry to be graphic but more diarrhea and cramping. I have long stretches with no problems but occasionally it really knocks me out. My concern and question really is will seeking further medical help and possible medication reduce my chance of getting my medical certificate. I have no actual diagnosis but assume I’d be treated with antispasm/diarrhea medication. How much is disclosed on my medical exam? Does the AME have access to all my prior medical history including rx’s And doc visits?
     
  11. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    In a sense, the AME and FAA will have a full history of recent doc visits and your medications because you are required to disclose it.

    This is something I frequently post to help answer questions such as yours.

    One of the first "milestones" for the Private Pilots License is obtaining your medical certification and should be something you do before spending large sums of money on airplane and instructor rental.

    It can also be one of the major "shoot yourself in the head" roadblocks if done wrong.

    So here is one of my cut and pastes about obtaining the medical certification that hopefully explains what to expect and what could turn out to be a fatal head wound if done wrong or your have a particular item in your medical history.....

    -----------------------------------------------------------

    To gain confidence, and more importantly, knowledge, of what is involved with obtaining your first medical certificate, start by reviewing the instruction manual for MedXpress, the FAA's online form for applying for a medical. You can find that here: https://medxpress.faa.gov/medxpress/Content/Docs/MedXPressUsersGuide.pdf

    Scroll down to page 24 of 36. This is where they ask about any medications you are currently taking (Question 17). If there are none, move to the next section. But if there are some, you will be asked to list the names, dosage, and frequency. Most medications are permitted. Some are not and will be a show stopper. Others may be an indicator of a medical item that the FAA will want to know more about. In many cases, the FAA will need a letter from your treating doctor that mention the medications, why they were prescribed, and how well they are helping you. During the examination, the Aviation Medical Examiner will ask questions about the medications and the doctors letter, fill in some blanks, and make notations on his side of the application form.

    Now scroll down to page 26 of 36. This is the medical history section (Question 18). An important phrase here is "Have you ever in your life..." Review these items and see if any should be answered yes. If one or more is answered yes, then definitely do not go to an AME to obtain a medical certificate until you thoroughly know what the FAA is going to want to know about the item you checked as yes.

    Some of these are minor and the documentation required is also minor. Others are big, BIG things, and while they might not be show stoppers, you will have to obtain more things that are the right things and in the right format and order in order to satisfy the FAA.

    Again, do not go to an AME for a live exam until you know every bit of what information and documentation the FAA wants for the item(s) you marked "yes"

    How do you find out what the FAA wants? The best way is to have a consultation visit with an AME. This visit does not get reported to the FAA. All it is is a information gather visit with the medical examiner to find out what you need to obtain. If you are unable to find an AME in your area to do this, then reach out to Dr. Bruce Chien in Bolingbrook, IL, www.aeromedicaldoc.com Dr. Bruce is a member here and can answer your questions online. But direct emails are often more efficient and allow him to discuss things in a way he cannot on a public form.


    Another important area of Question 18 is Question 18v. Alcohol and drug related motor vehicle actions. Question 18v asks about a history of “arrests or convictions involving driving while intoxicated by, while impaired by, or while under the influence of alcohol or a drug.” This would include arrests or convictions for offenses that were reduced to a lower offense, such as careless driving. This also includes offenses that were expunged by the courts after a certain time period. Pilots who have been ticketed for operating under the influence while driving a golf cart or a boat have also been required to report these offenses. Remember, your signature on the Form authorizes the FAA to search the National Drivers Register.

    Do not try to lie or fib or skirt the issue here.... if you are found out... it is major bad voodoo.

    If you do have an alcohol offense in your past, it is not a showstopper. But there will be some added steps to demonstrate to the FAA that you are worthy of the certificate in spite of alcohol being a part of your past life.

    Moving on, look at page 28 of 36 and Question 19, which asks questions about medical professionals. If all of your past doctor visits have been routine things with no major medical issues. Then the FAA will say all is good, thanks for telling us about the visits. But if there were visits for particular medical things, then additional explanations about the reason for the visit, and the doctor's findings will be needed.
    _______________________________________

    I hope this helps. Do continue to ask questions as you think of them.​
     
  12. wilkersk

    wilkersk Cleared for Takeoff

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    I'd just assume that any Dr. visit for which a claim was filed with your health insurance will be available for the FAA and aviation insurers to see.
     
  13. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    An additional resource that may explain what the AME's and the FAA will want to know about your gastro afflictions is the Guide for Aviation Medical Examiners (click this link)
     
  14. wrbix

    wrbix Pattern Altitude

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    Jeez, “gastro issues” sure covers a wide possible spectrum of symptoms....can you be more specific?
     
  15. AggieMike88

    AggieMike88 Touchdown! Greaser!

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  16. ChrisCC

    ChrisCC Filing Flight Plan

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    Gastro issues; what I thought was IBS- with diarrhea; flare-ups then fine for months. Tests show nothing so no diagnosis. But sure as hell don’t wanna be in the air during a flare up so have been considering getting back to my GI doc for something to prevent/manage episodes.
     
  17. Rushie

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    I echo what the others said about look at what you are eating, log your food and your symptoms. The typical American diet is atrocious, virtually poisonous in fact. Long stretches with no problems then sudden bouts is highly suspicious that it has something to do with what you're eating and/or stress. The doctor ruled out any readily identifiable cause. He probably tested for celiac via the blood test, although if you don't have weight loss that's not likely it, but it could be gluten intolerance, not overt celiac.

    If the bouts are related to high fat meals, it can be intermittent bile tract blockage, especially if accompanied by upper abdominal pain. The stools would be floaty and odorous.

    If related to eating a lot of fruit, it should become obvious from your food diary. Watermelon does this to me every time.

    It can be related to stress, log that in your diary too. You should eventually see a pattern. In the meantime, before going back to the doctor for a prescription, just try over the counter loperamide hydrochloride, 2 mg. (Generic anti-diarrheal, or Imodium) Follow the directions on the bottle. Upon the first loose stool take 2, then an additional one after each subsequent loose stool, not to exceed 4 in a day.

    If your issue is not daily, but only occasionally, and the OTC med fixes it quickly, I see absolutely no reason to involve the doctor while you log your food and try to nail down what might be causing it.

    Proceed with your medical application, and list your visit to the gastroenterologist. You might want to get your records and look for what diagnosis code the doctor gave you. I know the reports were "clean" but that just means clean for whatever they were looking for. The doctor had to code you for something for the insurance to pay for the tests, and IBS is kind of a wastebasket diagnosis, so it might be in there. I'm not an AME so can't tell you what that means for certification, but in any case that ship has already sailed, you must report that visit and those tests.

    Read carefully what AggieMike said about getting a CONSULT with an AME BEFORE letting the application go "live".
     
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  18. Rushie

    Rushie Pattern Altitude

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  19. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    @ChrisCC .... Rushie makes a good point here.

    The FAA can see the diagnosis codes used to bill insurance, and the similar codes that a pharmacy uses.

    Knowing what these actually are in advance should help during the consult with the AME.

    It isn't unheard of for the applicant to think all is well because their doc said so in the exam room. But the diagnosis code rings a different bell that causes the FAA to want more detail because that code is amongst their list of "possibly disqualifying" codes.
     
  20. tspear

    tspear Pattern Altitude PoA Supporter

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    Two coworkers have been fighting the same general symptoms for decades. Both recently got it figured out. One was a fructose allergy, the other was an oat allergy. Until this year, I had never heard of such allergies.

    Tim

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  21. wrbix

    wrbix Pattern Altitude

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    An often overlooked, but quite prevalent, cause of lower GI sxs (diarrhea/bloating/gas) is lactose intolerance which not infrequently arises in early adulthood.
    Lactose (milk sugar) is found, of course, in dairy products (milk, cream, cheese, etc) but finds its way into foods other places as well. Pay strict attention to ingredients and try to draw a correlation w your sxs....or you can give yourself a stress test of sorts with a glass of milk -> sxs as described within a few hours.
    Easily managed once diagnosed with Lactase supplement with meals.
     
  22. JonH

    JonH Pre-takeoff checklist

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    That's great you can rule nicotine out. Imodium sounds like the way to go. I wish I knew about that stuff back when I was chewing nicotine gum. The only thing that worked for me was eating very small portions, with nothing between meals except for a couple of tic tacs.
     
  23. wrbix

    wrbix Pattern Altitude

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    Loperamide acts on opioid receptors in the gut with potential with chronic use to down regulate them. Would urge caution with more than occasional use.

    Also treating symptoms without a diagnosis is not to be encouraged, again IMHO.
     
  24. Stingray Don

    Stingray Don Pattern Altitude

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    I have severe Crohn’s disease. My symptoms were far worse than what you described. I have had one bowel resection. Humira brought the disease under control. Once establishing long-term control, I was able to get a class 3 medical without any problem. I think if you can get your symptoms under control without meds or only FAA approved meds, you should be able to get a medical. Make sure you have an AME review everything as a consultation and be certain you will be approved before applying for your medical. You do not want to get a denial. First and foremost, you need to get your symptoms under control.
     
  25. PaulS

    PaulS Final Approach

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    Screw the drugs, you need to figure out what's bugging you. Keep track of what you are eating on paper or in your phone and refer back to that when you have issues. My issue is milk. For some it's eggs, or bread or what ever. Work through it either on your own or with a gastro doctor (probably a better idea) who will probably tell you to do what I just told you. Drugs should be a last resort only for a condition that needs it. Don't go in asking for pills, tell them you want to figure it out and would prefer not to have to take pills for the rest of your life.

    There are tests they can do for things like lactose intolerance and celiac disease, some of which are done during a colonoscopy when done for issues like you had it done for, so you've probably already been tested.

    The key for you is you say occasionally, to me that means something isn't agreeing with you, figure out what it is and stop eating it.
     
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  26. RJM62

    RJM62 Touchdown! Greaser!

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  27. wrbix

    wrbix Pattern Altitude

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  28. RJM62

    RJM62 Touchdown! Greaser!

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    Cat's claw has been used to treat IBD-like issues for generations by the traditional healers in South America. But some people don't believe anything about medicine until it's published on PubMed. So there you have it.

    Rich
     
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  29. murphey

    murphey Final Approach PoA Supporter

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    There are allergies to,almost everything. Food, environmental, medical. I speak from experience. I've learned to avoid or limit certain foods.
     
  30. ChrisCC

    ChrisCC Filing Flight Plan

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    I’ve investigated food triggers. I think I found a trigger but it’s inconsistent in that it only will affect me 2 out of 10 times.
    I’ve read online about cats claw but don’t know a single person who has used it therefore I’m apprehensive.
     
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  31. Rushie

    Rushie Pattern Altitude

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    That's true, (about daily use causing rebound symptoms) OP what do you mean you're not confident in the success of OTC meds? Do you mean you tried them and they don't work or you haven't tried them and don't think they will work?

    You've said you have long stretches with no problems then a flare so you should have no issues with "down regulating" your receptors. That's a problem with many, many drugs both prescription and OTC. Loperamide like most drugs should only be taken occasionally when you have a flare.

    I disagree about not treating because there's no diagnosis. First, there might be a diagnosis, just not one the doctor made clear verbally. That's why he needs to get his encounter report. If the gastroenterologist sent him on his way with clean test reports and no recommendation for additional testing, then he's been cut loose and expected to carry on; is he supposed to continue to suffer the symptoms without doing anything about it?

    Very likely he has either IBS or what the doctor will call "physiological" which means, normal function but you might be a hypochondriac making a bigger deal of it than most people would. If that's the case it's very likely back to something he's eating. Either way he needs to address the bouts when they occur or it's very annoying.

    If it were me at this point, having been failed by my second round of mainstream medicine (assuming OP complained to his primary first) I would either embark on a quest to figure it out on my own (diary and food elimination testing) or turn to a good functional medicine practitioner.

    Of course having said that, one always goes back to the "real" doctor if any alarming new symptoms develop such as blood in stool, weight loss, etc etc.
     
  32. gkainz

    gkainz Final Approach

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    My wife had debilitating GI distress for years, her whole life actually, that would on occasion put her in the ER. We figured IBS is a diagnosis for "we have no idea what's wrong". She lived on Levsin, Loperamide (immodium when it was prescription) and some other anti-spasmodal drugs.

    She found a doc who did some kind of IgA blood test for food allergies, determined 20 some foods that had a response from 1 (severe) to 3 (mild). She avoided all those foods for a number of years and is now able have some of the 3 or 2 rated foods without a gastric attack.

    Some of these foods she never would have found by elimination or food diary. Eggs, clams, (all bi-valves actually, and turns out that nearly all seafood dishes are prepared with clam juice, and steamed in the same water, so crab - her favorite - in a restaurant is probably contaminated with clam), yeast, black pepper, white pepper, citrus, are the biggies that I recall.
     
    Last edited: Dec 1, 2018
  33. tspear

    tspear Pattern Altitude PoA Supporter

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    I am way outside my knowledge base. But a friend has a long list of food allergies. Lactose, celiac, artificial flavors and colors, shell fish (iodine)... those are the big ones, I forget the rest.
    But she can tolerate many items on the list in small quantities, but have just a little to much and she is miserable for days. For example, 10 oz. of Coke (her favorite drink) at most every other day she is fine. Drink the whole can, or have it two days in a row, she gets migraines, stomach cramps, and diarrhea.
    So in your food diary, which is a major pain in the a** if no obvious triggers you go to step 2 which includes tracking quantity.

    Tim

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  34. Rushie

    Rushie Pattern Altitude

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    There is a huge universe of alternative medicine much of which is highly effective and much of which is total quackery. When failed by mainstream medicine one can often find relief there but one must take responsibility for self education and for separating the real deal from the scam artists.

    Could be coincidence or could be the "stacked boxes" theory. There may be more than one thing contributing to your events and you don't suffer a bout unless two or more are "stacked" together. You may need a lot more data points. Be sure to include your activities. Also if you're on well water have it tested. I'm going to assume you're not drinking from streams and maybe one of your docs thought to test you for giardiasis already.

    It's good to be apprehensive about unregulated supplements. The biggest challenge is finding a reputable source. I haven't tried Cats Claw but I have tried another supplement from this company and found it to be what it says it is. I'm very pleased with their product.

    https://www.allergyresearchgroup.com/cats-claw-60-vegetarian-capsules

    Be sure to click on and read the Monograph under the picture of the bottle. I don't recommend trying this until you've done a lot more logging keeping the stacked boxes theory in mind.

    The other caution I have is this should be effective if your problem is inflammatory and might not be otherwise. It is likely not good for immediately stopping an attack like loperamide would and if it works may need to be taken continuously which I don't think is a good thing. You'd have to judge for yourself.

    There are tons of great medicines used by indigenous people all over the world and many can help other humans but keep in mind these people co-evolved with their medicines. They might not effect others whose ancestors lived in different ecological niches, the same way. Always use with caution.


    DISCLAIMER: I am not a doctor and don't pretend to be. I am not currently residing at a Holiday Inn express. I am SGOTI with zero credibility. You should disbelieve everything I say and go learn it for yourself. Take any advice I give with a metric ton of salt. Ask your doctor if you are healthy enough for sexual activity. Do not operate heavy machinery while under the influence of this forum. Do not follow any advise given on any forum unless you have verified it for yourself except Drs. Lou and Bruce and even then make sure they are responding to your post and not some other OP in a necro'ed thread. Side effects include uncontrollable affect, leg falling asleep, rash, headache, joint pain and anal leakage. YMMV.
     
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  35. PaulS

    PaulS Final Approach

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    Rushie makes good points. You should be an avid hand washer, and a meticulous house keeper, wash dishes immediately, keep counters clean, etc. Bad habits can lead to bad things.

    I had an uncle who had IBS, he swore blackberry brandy kept his issues under control. He'd have 3 or 4 half gallon bottles of it on his table and sometimes be sloshed by 12 noon. I'm not sure if his method really worked or he just didn't give a crap after he took his "medicine".

    I'm not a doctor either.
     
  36. azure

    azure Final Approach

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    FWIW... not only IBD, but IBS is a diagnosis you do NOT want from an FAA standpoint if you need a 3rd class medical, since it requires a SI (not sure if this is published anywhere, but it is true even for IBS-C - I know this from experience - so I assume it is true also for IBS-D).

    This might be a good time to go BasicMed, if it will meet your flying needs.
     
  37. ChrisCC

    ChrisCC Filing Flight Plan

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    Yeah. No diagnosis. But can you explain what you mean by being a good time to go BasicMed?
    Maybe I’m not understanding the process. Thanks
     
  38. RJM62

    RJM62 Touchdown! Greaser!

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    I've used it for years, albeit not for anything bowel-related. It works better for my bursitis and arthritis than anything I've ever taken. It's also being investigated for many other uses, including as a cancer drug. Apparently smokers who take cat's claw have a 40 percent lower rate of lung cancer.

    The one caution is that cat's claw is a possible teratogen.

    Rich

    EDIT: I've found cat's claw made by NOW or sold by Vitamin Shoppe (which I believe is the same product) to be the genuine article. The part with the therapeutic alkaloids is the inner bark of the plant.

    DISCLAIMER: I'm not a doctor. But I did date one years ago (DO). She's presently traipsing through the jungles looking for cures. Cat's claw was high on her list of herbs with actual therapeutic benefits.
     
  39. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    BasicMed is an FAA approved medical certification that is slightly less restrictive to apply for and comply with than Third, Second, or First Class medical certifications. But the trade off is that there are a few restrictions on what equipment you can operate and where you are permitted to fly.

    One of the "less restrictive" aspects of applying for is that as long as you don't have any of the four disqualifying items in your medical history, but do have something that would require additional documentation or a Special Issuance, you can still apply and fly without having to jump through all of the SI hoops.

    If you already possessed at least a third class medical certificate that was valid during any period starting from July 15, 2006, then you can take advantage of BasicMed.

    If you’ve never held a FAA medical certificate, you'll need to obtain one from an aviation medical examiner (AME), but you will just have to do that one time. If your regular or special issuance medical certificate lapsed before July 15, 2006, you will also need to get a medical certificate from an AME one time only.

    More information can be found at these AOPA webpages
     
  40. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    What @azure is hinting at is that possessing a BasicMed certificate could be simpler for you in the long run should your symptoms be chronic.

    Special Issuances for Third, Second, and First class medicals come with instructions on how frequently you must submit an updated status from your treating physician. For some SI's, this isn't too difficult or expensive. But for others, the testing required is expensive, and your health insurance may not cover the cost of the frequent testing.

    For your Gastro Troubles, if a Special Issuance is required, you may be told to provide an update as frequently as every 12 months. Which means a doctors visit and having him write a status letter on your current state.

    Under BasicMed, you are responsible for self certifying that your condition is under control and won't affect your performance as Pilot in Command. aka, you don't need to frequently submit items to the FAA.

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    However, as I mentioned in the post just above, "If you’ve never held a FAA medical certificate, you'll need to obtain one from an aviation medical examiner (AME)". This includes obtaining a Special Issuance if your health condition requires one.