Meds Changed - Still OK?

U

Unregistered 66

Guest
New team has changed meds, and just wanna be sure I am still legal.

New stuff: Propanol, Spironolactone, Lasix, Coumadin (reduced). Off of Procardia XL. PT/INR numbers remain stable and within limits. Everything cardiovascular is OK. Other things are poo poo. Feel mostly OK. Still gonna die, but flying is therapy and life. I self grounded for about 45 days to make sure things were unchanged.

Will report all at next med; trick will be to find an AME in the area. Not just a good one, but any one. Not many in this neck of the woods. But I have a few months.

Thoughts from the Doc?
 
If you're taking propanol (a form of alcohol), 14 CFR 91.17 says you're grounded for at least 8 hours after consumption, but I suspect you're really taking propranolol, about which Drugs.com says, "Propranolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert." To this medical layman, that doesn't sound compatible with flying.
 
Ron Levy said:
If you're taking propanol (a form of alcohol), 14 CFR 91.17 says you're grounded for at least 8 hours after consumption, but I suspect you're really taking propranolol, about which Drugs.com says, "Propranolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert." To this medical layman, that doesn't sound compatible with flying.
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UR right Mr. Levy. It's a BP med, not alcohol.

Impair my thinking? Even more than usual? Now I am worried. Good thing I no longer live in a concealed carry state.

Seriously though, I weigh each and every action every time. I apply the I'M SAFE philosophy as well as STAR (depending on your perspective: Stop Think Act Review or Shux, That Ain't Right). So far all is well. And I used to take propranolol (1995 & 1999 medical), but a Dr. said I needed a calcium blocker and a beta blocker in 2000. New Dr. says propanolol is better for my needs.

Thanks for the input.
 
Ron Levy said:
If you're taking propanol (a form of alcohol), 14 CFR 91.17 says you're grounded for at least 8 hours after consumption, but I suspect you're really taking propranolol, about which Drugs.com says, "Propranolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert." To this medical layman, that doesn't sound compatible with flying.
Click to expand...

UR right Mr. Levy. It's a BP med, not alcohol.

Impair my thinking? Even more than usual? Now I am worried. Good thing I no longer live in a concealed carry state.

Seriously though, I weigh each and every action every time. I apply the I'M SAFE philosophy as well as STAR (depending on your perspective: Stop Think Act Review or Shux, That Ain't Right). So far all is well. And I used to take propranolol (1995 & 1999 medical), but a Dr. said I needed a calcium blocker and a beta blocker in 2000. New Dr. says propanolol is better for my needs.

Thanks for the input. PS - BP is about 100/55, pulse 58 -62 at rest. Life is good.
 
Unregistered 66 said:
New team has changed meds, and just wanna be sure I am still legal.

New stuff: Propanol, Spironolactone, Lasix, Coumadin (reduced). Off of Procardia XL. PT/INR numbers remain stable and within limits. Everything cardiovascular is OK. Other things are poo poo. Feel mostly OK. Still gonna die, but flying is therapy and life. I self grounded for about 45 days to make sure things were unchanged.

Will report all at next med; trick will be to find an AME in the area. Not just a good one, but any one. Not many in this neck of the woods. But I have a few months.

Thoughts from the Doc?
Click to expand...
You're on a Coumadin Special Issuance and have hypertension. I am guessing you're in Atrial Fibrillation. This one is OK. But look at your SI letter. ...you CAN find the letter, can't you?
My last dozen or so SI airmen got the certificate, stuffed the letter in a drawer and can't remember where it is.....

If it says anything about your control regimen changing and needing to self ground, then you can't change w/o grounding. I'll bet your letter doesn't say that.
 
bbchien said:
If it says anything about your control regimen changing and needing to self ground, then you can't change w/o grounding. I'll bet your letter doesn't say that.
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Bruce:

Your post implies that unless there's a clause in the SI letter requiring self-grounding for a change in meds, the pilot may continue to fly after a change in meds -- am I reading it right? If so, is not the pilot responsible for determining that the new meds are safe for flight? In further research on propranolol via the AOPA web site drugs list, I find that it is FAA-approved for flight deck use (a surprise to me given the side effects listed on the Drugs.com site, but it is what it is), but if it were not, would not the pilot have to self-ground or change to an approved med?

Ron
 
The one exception that I have pointed out to FAA is when a diabetic airman on an SI (oral control) gets propranolol added to control his hypertension. The SI letters going out for hypertension combined wtih T1 Diabetes do not contain the "if the regimen changes, you are to self ground and send the information to FAA" sentence. They want the airman's doc to be able to change the pill control regimen for the best, and do not want to mess with the doc's ability to change the hypertension stuff either. But this is the ONE condition where the SI letter does not state fully what is required. Propran... or other "olols" and diabetes together are a problem. Ask me how I know that!

The heart of your question deals with how much the airman is supposed to know. If the drug is disqualifying (OKC still maintains there is no such list, but promises to publish one in the future, sigh) the airman has "reason to know of a deficiency". But how many can really be held to that standard... maybe an AME who is also a CFI and ATP?

There are some SIs in which ANY change in meds is grounding, but the letter says so. We're working on one right now, see the many many (sigh) depression strings on the red board. Right now the challenge is to get the airmen to read the letter, and then to not lose the letter.

To your last question, Ron, the answer is YES. Anytime a doc changes the regimen, before the scrip is filled, the airman rings my phone. We don't want deferral h_ll.

Sigih.
 
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bbchien said:
You're on a Coumadin Special Issuance and have hypertension. I am guessing you're in Atrial Fibrillation. This one is OK. But look at your SI letter. ...you CAN find the letter, can't you?
My last dozen or so SI airmen got the certificate, stuffed the letter in a drawer and can't remember where it is.....

If it says anything about your control regimen changing and needing to self ground, then you can't change w/o grounding. I'll bet your letter doesn't say that.
Click to expand...

I know where the letter is (in a pouch on my flying bag), but can't quote verbatim. Basically I am taking the coumadin because I am hypercoagulative, and as the gist of it was to remain stable on coumadin (2 to 3 range). No Atrial Fibs, no hypertension on meds (as shown by almost abnormally low BP IMHO). I have cardiac echo annually with pressure, and cardiologist says my heart is in great shape. Unfortunately, other parts aren't, but they don't affect flying or decision making.

Maybe I will just let the medical lapse and go SP to forego the hassle.

Thank you for the information.
 
Unregistered 66 said:
Maybe I will just let the medical lapse and go SP to forego the hassle.
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Bruce can correct me if I'm wrong, but I believe that if your last medical was a SI, it isn't that simple.
 
Ron Levy said:
Bruce can correct me if I'm wrong, but I believe that if your last medical was a SI, it isn't that simple.
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I believe that as long as that SI hasn't been withdrawn, and your
medical simply expired with the SI still in effect.. you would
be cool for SP as long as you don't have reason to believe that you
have a disqualifying medical condition. The requirement to self
certify will still be there.
 
RogerT said:
I believe that as long as that SI hasn't been withdrawn, and your
medical simply expired with the SI still in effect.. you would
be cool for SP as long as you don't have reason to believe that you
have a disqualifying medical condition. The requirement to self
certify will still be there.
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Actually it is. A lot of airmen after maintaining their SI for a cycle or two, just let it expire. Although the third class components have nto expired after one year, the certificat is never good for longer than a year and just out-dates.
 
So if I go to my non AME doc and ask him to take me off coumadin- go the natural route, there is nothing to report. I have reported everything else that I take as well. If I have to, I will just use large doses of aspirin, which has the about same effect.

The system almost encourages you to find a way around it when you have a non impairing condition. I can drive cars and boats, work hazmat, etc. If coumadin is the problem, I will find a legal way or I will just hang it up because I do not think that hypercoagulativity is a defined disqualifying condition, is it?

I will do some personal research. Again, thank you all for your input.
 
I guess this why I am confused. I don't have any of the conditions listed. There is no official list of banned drugs (so the story goes). So where is my deficiency? I have thick blood?

The following medical conditions are specifically disqualifying under 14 CFR part 67. However, the FAA may exercise discretionary authority under the provisions of Authorization of Special Issuance, to issue an airman medical certificate. See the Special Issuances section for additional guidance where applicable.

Angina pectoris; (NO)
Bipolar disorder; (NO)
Cardiac valve replacement; (NO)
Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant; (NO)
Diabetes mellitus requiring insulin or other hypoglycemic medication;(NO)
Disturbance of consciousness without satisfactory medical explanation of the cause;(NO)
Epilepsy; (NO)
Heart replacement; (NO)
Myocardial infarction; (NO)
Permanent cardiac pacemaker; (NO)
Personality disorder that is severe enough to have repeatedly manifested itself by overt acts; (NO)
Psychosis; (NO)
Substance abuse and dependence; (NO)
Transient loss of control of nervous system function(s) without satisfactory medical explanation of cause. (NO)

Or is there an FAA catch all too that allows them to say "That guy is too fat. Deny Him." "That girl is too ugly. Deny Her"?

If the rules are fluid and flexible, then we must be as well to stay inside the guidelines.
 
The coumadin SI is really easy. Just show up with four of your last 5 INRs (withing 90 days prior) between 2 and 3, and a letter saying you have Leiden IV or whichever other hypercoagulable....and that'll do. You are compliant enough with the rat poison to keep it in that range- that's just HEALTH, so one you have that, there is nothing else to do.
 
One more quick one Doc. How do you think someone with Protein S deficiency would be handled?
 
bbchien said:
Actually it is. A lot of airmen after maintaining their SI for a cycle or two, just let it expire. Although the third class components have nto expired after one year, the certificat is never good for longer than a year and just out-dates.
Click to expand...

Bruce .. I'm not sure what you're saying. If someone has a SI and
it expires then they're not eligible for SP?
 
RogerT said:
Bruce .. I'm not sure what you're saying. If someone has a SI and
it expires then they're not eligible for SP?
Click to expand...
No, if they let any valid certificate expire, they have avoided the scourge of being denied. A third class (or any denial) if left to stand, is what grounds you.
 
Unregistered 66 said:
One more quick one Doc. How do you think someone with Protein S deficiency would be handled?
Click to expand...
With the Coumadin SI....clearly you're going to walk around with a bag of fresh frozen plasma..... But depending on your hsitory you may not even require Coumadin....so it's not like a automat.
 
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