Getting back to flying...with diabetes...and kidney stone...strategy?

U

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Hi All -

Looking for some advice on getting my medical back after some time away. Here's the situation:

I started flying about 20 years ago. I was working at a non-flying aviation industry job at the time but, after a few years of that, I realized that what I really wanted was a career as a pilot. I started working down that path. Shortly after getting my instrument rating, I was diagnosed with type I (insulin dependent) diabetes. So, that put an end to my career aspirations.

After the diabetes diagnosis, I did work through the SI process smoothly and successfully, and got a third class medical. I flew for fun for a year or two with that. But, after a while, the frustration with not being able to progress to where I wanted, feeling like I was burning up a lot of money for no reason, and the hassle of the medical process led me to quit flying.

So, I've been away from flying for 14 years. Recently, I had a chance to fly again with a friend, and...well, you know how it goes. I'm looking at getting back in the air, and the medical is one of the hurdles.

I think I could probably handle renewing the special issuance with the diabetes. I had that down to a science (prewritten letters I wrote for the docs to sign, a cover letter from me, a checklist of documents, etc) and it worked well.

Unfortunately, there's a new complication. About a year ago, I had an ultrasound for some abdominal pain I was having. That was chalked up to bruised ribs, no big deal and it's all resolved itself. However, the ultrasound found a kidney stone (4mm upper pole). It's just sitting there doing nothing. I've had no other history of stones. I'm otherwise in fine health.

I've had (and continue to have) zero symptoms from the stone. But, my understanding is that the FAA isn't going to like it. I'm thinking that the stone needs to go away before I go back to flying or go for my medical. I also do some other hobbies that take me away from civilization (backpacking, boating, etc), so it seems smart to get rid of the stone before I proceed much further.

From my research, it seems that either ESWL (sonic smash) or a basket extraction might be candidates for treatment. I'd like to have an FAA-optimized game plan in mind before I have more detailed conversations with the urologist. I'm concerned that ESWL will leave fragments and create more of a mess than the current situation (lots of little retained stones causing random pain and FAA denial), while the extraction seems just generally unpleasant (post-op ureteral stent, etc) and complication-prone for something that's causing no symptoms.

So...

1) Any suggestions or personal experience on the best way to handle things...particularly the stone situation? I'm pretty sure that I need to aim for a "no retained stones" and "metabolism normal" labs and letter from the doc, but any advice on getting there would be welcome.

Other questions that come to mind:

2) Should I prepare the diabetes paperwork as a "renewal" of the old and expired diabetes special issuance, or just start fresh like a new applicant?

3) There's also a "maximal graded EKG" test that's required for the diabetes SI over age 40. I'm currently 39 1/2. Should I get that done now to avoid any surprises shortly down the road? I don't want to work on getting my medical back (and get current) only to lose it a year later.

Thanks...
 
The Doc wil be along shortly. Wait for Doc Bruce to guide you. Best would be to contact him directly, his web and contact are in other medical posts on this board, and remove the anonymous in your discussions with him.

You had a Class 3 SI that you let lapse. Have you considered flying as a Sport Pilot?
 
You had a Class 3 SI that you let lapse. Have you considered flying as a Sport Pilot?
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Thanks for the suggestion. For now though, I'm not so interested in the sport pilot route for a number of reasons. One reason is that I could continue with the commercial and CFI certificate, and that I could still (eventually, theoretically) instruct with the 3rd class medical. Not sure how realistic that is in real life (insurance, employability, etc), but it's an idea. Not exactly my original career plan from years ago but, at this point, I could be pretty content with minimum wage and 152's... :)

Aside from that, it would be nice to at least take my (4 person) family with me occasionally...so even there getting my (traditional) private certificate current again would be needed.
 
(3) If you get the SI before 40, you get one year (which is what you get anyway). Then you need the stress treadmill the upcoming year. Six of one half a dozen of the other. ...me personally, I'd run and know the outcome before I did everything else, as CAD is a make/break item on this list.

(2) They will see you were a holder of the SI formerly. You need two doc visits 90 days apart, the last one within 30 days prior. Two Decent HbA1c's 90 days apart, the last one within 90. Better if you can show quarterly doc visits.....which is the written requirement for continuation.

Many examiners will see you took a decade off, not hold you to the 4 quarterly visit requirement, PROVIDED your doc's comments are favorable and your control is good. If you started fresh, you'd need the documentation of DM education, the CFI letter that says you can finger prick and fly at the same time, etc etc etc. Those are already on file, and make the basis of asking for the reup with only two points in time.

In summary, "it depends" on how good your control has been and how negative your eyes are, no hypoglycemias, and no other organ system side effects.

(1)Retained stone SI- if you have two KUBs (Kidney-Upright-Bladder plain Xray) >90 days apart (if it's the kind of stone readily see on KUB) and the stone is completely unchanged, that'll just be added to your SI list- annual KUB to prove it hasn't changed, moved or multiplied. Or you can get it lithotripsy-ed. Stones become a disaster if you have a urinary tract infection, add to that IDDM, many elect to get the stone busted with External Shock Wave lithotripsy and be done with it. Most leave well enough alone.

BillTIZ is correct, if LSAs serve your needs, that's also a very good choice.
 
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In summary, "it depends" on how good your control has been and how negative your eyes are, no hypoglycemias, and no other organ system side effects.
Thank you so much for the input.

To add to the information:

-No eye issues.
-No hypos, no assistance needed ever in 15+ years of taking insulin
-No other complications
-Good labs...low cholesterol, no proteinuria, etc.

On the other hand, my A1C's have not been what I'd like lately. Years ago (the last the FAA saw...), they were always between 5.0-6.0. More recently, they've been more like 8.6, 8.8, 8.8, 8.5. (i.e. always under 9.0, but definitely not under 7.0). I've been trying to use the possibility of flying again as a way to stay motivated to get the A1C's lower, but for now, that is the recent history. Not sure if those are acceptable as-is or if I should buckle down for 6-12 months and get some better A1C's logged before applying.
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I was a diabetic with an A1C 8.1 and above on metfirmin and insulin. You can PM me if you like.
 
asgcpa said:
I was a diabetic with an A1C 8.1 and above on metfirmin and insulin. You can PM me if you like.
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Art, they're tougher on the insulin dependent guys.

8.8 will not cut it. 9.0 is statutory denial territory.
Buckle down for two more quarters and let's see some 7.6's. It is really hard to say to a medical officer that someone who has high 8s has "good control".

PS. FAA LOVES the pump. Talk to your doc about that!
 
I've been on a pump and a CGM (continuous glucose monitor) for years. I had the pump when I did the initial SI ages ago. I didn't have the CGM back then, but I've had it for several years now - I was hoping that would be a big plus too. I do understand how the high A1C's are not good (in many ways).

Unfortunately, the high A1C's are more due to general diabetes burnout rather than a lack of technology or knowledge. The other factor (but less so...it is not an excuse) is that I tend to spend a lot of time alone with my kids and/or doing other activities where avoiding lows is important. So, there is a large portion of time where I tend to run things on the higher side (it's a bit like doing the FAA in-flight protocol...but all the time...and too much).

I am hoping that the goal of getting the medical will provide the motivation I need to get refocused on getting some better numbers.
 
Unregistered said:
I've been on a pump and a CGM (continuous glucose monitor) for years. I had the pump when I did the initial SI ages ago. I didn't have the CGM back then, but I've had it for several years now - I was hoping that would be a big plus too. I do understand how the high A1C's are not good (in many ways).

Unfortunately, the high A1C's are more due to general diabetes burnout rather than a lack of technology or knowledge. The other factor (but less so...it is not an excuse) is that I tend to spend a lot of time alone with my kids and/or doing other activities where avoiding lows is important. So, there is a large portion of time where I tend to run things on the higher side (it's a bit like doing the FAA in-flight protocol...but all the time...and too much).

I am hoping that the goal of getting the medical will provide the motivation I need to get refocused on getting some better numbers.
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Then I'd suggest: be more aggressive with the pump, and do the FAA's "bailout protocol" with 20 gm carbo snacks. It's pretty easy, and you'll be doing that as PIC anyway....!
 
Doc Bruce....I told you my latest A1C right? Just had the blood work done for my 1 year WLS follow up on August 1 and it was 5.5. Prior to the WLS, I was at 8.1. It's now over a year with no pills and no insulin. I could not be happier. All the numbers are good, including all the vitamin levels. Now I just have to lose the last 60 pounds.
 
Hi All -

I'm the one that created this thread a few months ago. Since this board was so helpful in getting me started, I just wanted to take a moment and finish up the story, for those who may come across this down the road and find it helpful....so, here is the outcome:

Success!

I am happy to report that I was able to get my medical back, and am going to start flying again ASAP.

There was a stack of paperwork to compile - somewhat of a chore but not too terrible:

-Got my A1C down to 7.0.
-Two more regular quarterly visits to the endocrinologist that showed the improved A1C. Visit reports from the past 4 visits.
-Letter from the endocrinologist
-Eye exam from an ophthalmologist showing no issues.
-Followup ultrasound showing that the kidney stone was completely unchanged from when it was first found.
-Yet another ultrasound to update the first one because 90 days had passed before all of the other stuff was done
-An EKG from a treadmill run, just for good measure :)

I worked with Dr. Bruce (www.aeromedicaldoc.com) to get all of this sorted out.

Could I have done it by myself or with another random AME? Possibly. But, I probably wouldn't have gotten the right stuff done the first time around, might have made some disastrous misstep, and I certainly would have been waiting on the FAA for an eternity each time around.

For anyone with a similar situation, I'd highly recommend Dr. Bruce. He is honest, knowledgeable, fair, responsive, and generous with his time and expertise.

So, thanks to this board and to Dr. Bruce!
 
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