How tough will this be?

Discussion in 'Medical Topics' started by Silly Aggie, Jan 18, 2019.

  1. Silly Aggie

    Silly Aggie Guest

    So a few questions, given this general history:

    50 year old male, 6'2, 320lbs. (I won't be a friend of any weight and ballance sheet)

    Wellbutrin for approx 6 months in the early 90s.
    A sebaceous cyst removed around 2001, that the biopsy came back as "abnormal" and a larger margin was taken in a second surgery. Not even sure if this counts as a cancer finding. (Margins were clean)
    About 2003, a lipoma popped up suddenly, possibly released from between muscle bundles. Given above, it was removed surgically. Nothing of note in the biopsy.

    I'm not even sure I have a place to start if I need to find records on the items above.

    October 2014, laparoscopic gall bladder removal

    Allergic to most everything outdoors, but moderately well managed between Claritin, Flonase, and sometimes Astelin. But my ballance is always good enough to kneel on top of an exercise ball, usually long enough to get bored.

    My blood pressure is high enough that my primary physician insists on treatment, but untreated is lower than what I recall being permitted on 3rd class anyway. Between Losartan and a diuretic that I can't remember at the moment, it is usually in the 120/70 range.

    I occasionally use Advil, and step up to Lodine a few times a year. Maybe every other year I get a back spasm that I choose to use Skelaxin to unlock overnight, rather than fight through waiting it out with just the anti inflamitories.

    I currently switch back and forth between contacts or glasses with a -3.75 prescription with roughly 1/4 diopter astig correction per the prescription, but usually am happier with straight spherical correction. I have made it to the point that if wearing contacts, I keep reading glasses at hand.

    So, how complex is this history? How much documentation will I need, and on what?

    Who are some of the AME that you would recommend starting with in the North Dallas area? Frisco, Lewisville area, but driving farther for the right AME is no problem.

    I'm presuming this starts off as a consult. :)
     
  2. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    Howdy Ag!!!!

    For your situation with all that is going on, please, please, PLEASE do not proceed to a flight medical without first doing a consultation with a flight surgeon. Your medical history listed here includes several items that the FAA will a large amount of more detail on. So education on what those details are is going to be important. Also very important will be the form and format and organization of those details. Getting all of this done right is going to make the lives of you, the AME, and the reviewer at the FAA muuuuuch better. And improve your chances of approval.

    And since there are only two AME's that regularly contribute to this forum (@lbfjrmd and @bbchien), the rest of us are just SGOTI and can only render guesses, stories, and opinions. Only the AME's can provide you with gospel guidance. So while the opinions, stories, and guesses might have some use, apply appropriate sized grains of salt until you can consult with an AME.

    The AME you should talk to to get started (remember, talk as in a consultation, not a for real exam) is Dr. Gabriel Fried (pronounced freed as in freedom). He is located on Midway Road near Sigma, netween Beltline and Loop 635. He is an old navy doc (as in his late 70's) and very well known in this area for assisting with difficult cases. His office staff is good. But be on the watch for his blonde nurse who is not the most friendly of personalities.
     
    Last edited: Jan 18, 2019
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  3. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    Now, you shared info about your medical history including hypertension and much more. For completeness, I want to make sure you become knowledgeable about the other medical history things the FAA is going to ask.

    Below is one of my copy/paste items about the FAA application for a medical certificate.



    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 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.
     
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  4. SillyAggie

    SillyAggie Guest

    The one item that slipped my mind is something that I don't believe was ever formally diagnosed, but I don't think I've ever had any issues getting a prescription for:

    Exercise induced bronchial spasm. Essentially, if I work out above about 90% capability (racketball was the most reliable trigger, though I haven't played in years) there is a fair chance that when I cool off after, my airways will constrict. Management for this has always been to use an albuterol inhaler before planned heavy exertion like a session at the gym, working some types of construction projects on my parents acerage, etc. In the very rare cases where it is triggered without anticipating it, I'm pretty good at recognizing it before it is serious, and it responds well to albuterol at that point.
     
  5. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    Wellbutrin for approx 6 months in the early 90s - the only issue that will need 'splaining!
     
  6. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    What about his doctor following him for Hypertension? Would it be proactive to get the hypertension worksheet completed and bring with him to the consultation and live exam?
     
  7. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    @Silly Aggie.... A few other things to become aware of....

    From your height and weight... one has to inquire about Obstructive Sleep Apnea and Diabetes. The AME is going to see your stats, compute the BMI, and definitely going to ask.

    Is the 320 lbs a fit 320 like a linebacker or weight lifter? or an out of shape and fat 320? Your statement touching on hypertension has me concerned it is the latter.
     
  8. Silly Aggie

    Silly Aggie Guest

    My primary care physician does remind me that I might want to be more thoughtful with my diet, primarily for weight, but also that while my A1C is good, fasting blood sugar is towards the high end of the normal range. But she does not at this time call it even pre diabetic.

    As for build, one of my biggest mistakes was dropping recreational ice hockey from my life without replacing it with something else 10 years ago, and not adequately trimming my calorie intake. I added strength training to my routine a couple of years ago, and while my weight is not currently down, my body fat percentage should be down, and I am much better positioned to work towards weight loss without worrying about loosing muscle mass.

    At this point, I am not aware of any indicators towards sleep apnea other than snoring, which varies with what allergens have blown in this week. (Though I'll admit to being hesitant to step forward for a sleep study)
     
  9. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    @Silly Aggie .... Is this thread helping you?
     
  10. Silly Aggie

    Silly Aggie Guest

    Yes, the recommendation for who to consult with is a good find.

    And I think I will have a few specific questions as I work through the form.
     
  11. SkyDog58

    SkyDog58 Touchdown! Greaser! PoA Supporter

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    Isn't the name "Silly Aggie" just a bit redundant?






    I kid!

    Good luck!
     
  12. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    Works good for me.... along with "Crazy t-sip". (looking at you, Mr. Cutler)
     
  13. Dave Theisen

    Dave Theisen En-Route PoA Supporter

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    Worst mistake was giving up hockey. :) I’m still playing at 53. One of my teams is 63. I just bought new skates, so I’ve got to keep going for a long time. :)

    Good luck with the medical.
     
  14. bbchien

    bbchien Touchdown! Greaser!

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    ...and if your AME is sharp, provided you can verify it was <6 mos and it was your only lifetime episode, a good AME can defend such an issuance... though, he has to “have the goods”.
     
  15. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    The original "I don't know it all" of aviation.
    Here is another sticky that might help....

    D962DD67-30A0-42AF-8E34-2853CA047EBE.jpeg
     
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  16. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    I usually just rely on a good history from the airman, not the meds and a normal BP, and append a CACI to the application.
     
  17. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    An AME may label you at risk for OSA, and screw the "OSA later" pooch for you!