Question for Bruce and others thyroid/glucose/heart

[cujet]

Hello Bruce, I am a difficult case, now 50 years old.

At 33, Adult Mono nearly killed me. I was "shutting down" in the hospital. Shortly thereafter, I end up with Hashimoto's which induced AFIB, due to very low thyroid levels. Synthroid/Armour combo works for me and I've had no return of the AFIB. However, since then I've had reactive hypoglycemia. Often dropping to 55 after carbs.

However, heart function is diminished, EF is not ideal, and my heart is often enlarged. I've had Bruce treadmill results as short as 6 minutes. Kidney function is less than ideal too. Has been for years. I occasionally take a diuretic (less than 20/yr) for water retention (very salt sensitive) .

I'm an avid bicyclist and appear fit and feel pretty good. For the last 10 years I've learned to eat a near zero carb, calorie deficient diet to control how I feel (one salad/fish, no dressing, per day.nothing else) . I'm 10 pounds heavier than I'd like and really DRIVEN to be as active as my energy level will permit, which is not as good as I'd like, I get tired easily.

Problem: Blood glucose is climbing this year. I'm not quite in the diabetic range, but it is trending that way. I am at my exercise fatigue limit, and the low calorie limit. Those 10 pounds won't budge, likely due to inflammation around the gut area. Note: eating more and I gain weight rapidly around the belly, so I don't.

I'm midpoint in my medical, and my doc suggested metformin may be in my future.

Here is my fear: A diabetes diagnosis in the near future coupled with thyroid problems, heart AFIB history and less than ideal heart function, kidneys on the margin will add up to a "no-go" for a 3rd class SI medical.

I would appreciate your thoughts!

That's me on the left.

 

[bbchien]

Well- so you already have the SI for Afib (or maybe have been off all meds and no annual holter recurrence so you've been ruled eligible?). Are they continuing to demand stress tests (or are you ruled eligible for viral cardiomyopathy)? Are they demanding holters, still?

Metformin isn't the end, here...your goal should be next medical with metformin (and none other), HbA1c <6.6 and FBG <126 because the AME can declare you eligible (under the June 8 CACI program).

But I need to know what the deal is with the ejection fraction and where you are in the Federal scheme on that. If you had no CAD way back at the start of Afib, it might be good news as far as the performance of the left ventricle and FAA.

However, we also need knowledge of whether they are following you still for afib- as the EF goes down, the Holter will get worse and worse until you aren't certifiable.....

TOO MANY variables /not enough detail, to give you a good answer!

 

[cujet]

Thanks Bruce!

I generally do a nuke stress test every 2 years and submit the data. However, the FAA has not required it since they issued me the 6 year waiver. No demand for Holter monitors lately. Did that in the past 2 years with good results.

No history of CAD that the docs or I am aware of. However, at my age I think it's possible. Cardiologist noted that since I can bicycle at maximal heart rate without any discomfort, I probably don't have any restricted arteries. Still, I'm right to be concerned due to family history and so on.

I am sorry, but I don't know my most recent EF. Other than the cardioligist mentioning that it was less than ideal. I'll try to review my past results and post them. I've submitted 100% of the data to my AME (Dr. Greer) and there has been no mention of EF related issues.

This I know, my EF numbers vary wildly from year to year.

Current meds:
Synthroid 75mcg
Armour 90MG
Crestor 10mg
Androgel 5g
And, only if I consume salty food, Torsemide 5mg

 

[bbchien]

Actually, don't post them. Remember this is a public board. Send me an email through the board, and I'll email you back....our use aeromedicaldoc @ comcast.net

To really know the score I need a copy of your last FAA authorization letter.

 

[cujet]

OK,

If he wants me on Metformin in 3 months from now, how do I deal with the FAA on that one? Inform right away and then re-apply for another SI with good labs?

I am Director of Maintenance in a high end corporate flight department. I can't be messing around with medical issues and trying to skate through. I really do need to be on the level with everything. Hence my willingness to post all the info in the public forum.

My personal flying (I own a 177RG) is for my enjoyment. It has no bearing on my job. However, it does add risk to my airman certifications. I'm not willing to lose my job over a medical issue. I'd rather sell the plane and surrender the medical than try to BS my way through it. However, I'd much prefer to be eligible for a 3rd class medical.

 

[bbchien]

OK,

If he wants me on Metformin in 3 months from now, how do I deal with the FAA on that one? Inform right away and then re-apply for another SI with good labs?

I am Director of Maintenance in a high end corporate flight department. I can't be messing around with medical issues and trying to skate through. I really do need to be on the level with everything. Hence my willingness to post all the info in the public forum.

My personal flying (I own a 177RG) is for my enjoyment. It has no bearing on my job. However, it does add risk to my airman certifications. I'm not willing to lose my job over a medical issue. I'd rather sell the plane and surrender the medical than try to BS my way through it. However, I'd much prefer to be eligible for a 3rd class medical.

See PMs.

 

[cujet]

Bruce has been quite helpful.

However, I'd like to hear from others here who have had SI medicals and your suggestions. My ultimate goal is to retain my medical after my next doc visit. As last visit, he suggested that next time I may be on metformin.

Also, if you guys have any suggestions as to how to get FBG's lower naturally. I really want to avoid hypoglycemic meds if possible. As it's my understanding that they consider the use of those meds the same as a diabetes diagnosis.

One thing I don't currently do is lift weights, musclebuilder style. I'm going to start that at a local gym. I've read that improves insulin resistance and may help reduce fasting blood glucose. I've been an avid cyclist for 30 years and generally remain fit through that, other outdoor activities and dirt bike riding. But never weightlifting.

Just a cool pic from a Florida flight in my 177RG:

 

[AggieMike88]

Type 2 Diabetic taking metformin on an SI.

This SI is not a difficult one to maintain if you eat sensible and maintain a moderate exercise routine.

One of the best bits of advice is to maintain a food and exercise diary (there are several good smartphone apps for this) and cross reference your finger tip readings with what you eat. The goal is to learn what foods (especially carbs) cause a major spike in the mg/dl number and what doesn't.

And routine (3-4 times a day) fingertip testing will also help show how daily activities, exercise, and stress affects your blood sugar levels.

For me, my goal is to keep a daily average of 120 mg/dl or less and no more than a 40-50 point spike 1.5 hrs after start of a meal. And over time, I've learned what foods I need to avoid and what I can eat plenty of to attain this goal. Lately I've been running about the low 130's and my last A1C was 6.6%. (insert Maxwell Smart voice: "Missed CACI by that much!")

And it's important to state that taking the medication is an important part of this routine too.

That's the daily part of complying. Reporting to the FAA is a simple task of having my primary care physician (PCP) do his normal annual exam with blood labs and then write a simply worded status letter that includes the required items from my Special Issuance specifications. I provide this to the AME and I'm good for another year.

Does that help answer some of your questions?

 

[cujet]

That's the daily part of complying. Reporting to the FAA is a simple task of having my primary care physician (PCP) do his normal annual exam with blood labs and then write a simply worded status letter that includes the required items from my Special Issuance specifications. I provide this to the AME and I'm good for another year.

Does that help answer some of your questions?

Yes, very much, thank you. Bruce also wanted a copy of the SI letter, and, of course, I re-read it. The "inform" instructions are clear.

I've moved up my next doc visit to tomorrow (wed) . Labs to follow.

I've called my AME, and informed him about my declining condition. He's got the form to fill out, with all the required information. As you know, my lab results must be good. I do have some apprehension on that score. He will get them as soon as they are available.

I am quite disciplined and driven especially with diet and exercise. I'll make every attempt at medical retention. However, I can certainly see the future uncertainties.

 

[bbchien]

cujet, that is one great photo

 

[cujet]

cujet, that is one great photo

Thanks! We do have a lot of fun, and some really nice flights in our flight department.

Update: Doc did labs today and 2PM FBG was 67! That's the first time I've seen it that low in 2 months. Don't know why it was low today, and not other days while fasting.

Doc wants me to lose 15 pounds and exercise more. Ugh. I'm already at my fatigue limit. However, I am looking forward to being properly thin.

 

[cujet]

Lab results in: A1c 5.1. That's due to incredibly strict, no carb" diet and exercise. However, my AM fasting glucose has been elevated and post "no carb" meal very elevated. Without posting numbers, let's just say the glucose numbers are not in the proper range. GTT test next week, (Wed) to determine the extent of the problem.

Doc did talk about metformin again, but would rather I do HIT, high intensity training (weight lifting + strength training) in addition to my cycling, and lose weight. Might keep me off drugs and improve my recently worsening blood sugar issues.

 

[bbchien]

The problem is, it appears that gluconeogenesis from your liver overnight is an issue, and that you might actually be better with metformin.

But, if you can get a fasting at 125 or below, you're okay even on metformin!

 

[cujet]

I wanted to post an update. As I'm heading to the doc tomorrow.

I've been on a low cal, low fat Atkins diet for nearly 5 months. I am very near my ideal weight, and I've been lifting weights/working out at the gym religiously and with serious determination. I look good (for a 50 year old) !!

Every day this week, my AM fasting glucose has been 90 or below! No problems with post meal BG's either. One thing is clear, the gym was much more effective than the long distance cycling I had been doing. And, I'm no longer having any issues with wildly fluctuating BG's.

We shall see what the doc says and how my labs look. But I've got to admit that I feel worlds better, stronger and "fit to fly".

I really expect to have a favorable outcome and then go for my BFR! I'm quite excited!

 

[Plainman3]

First time user so bear with me- Any one out there tried the oral chelation pills being hawked on aviation sites? From what I can find out on med sites it's pretty scary stuff. Like the idea of scrubbing out the old arteries but don't want to experiment with snake oil. Somebody in the aviation world is buying this stuff or they would not be paying high $ for the ads. They make it sound like greatest fountain of youth since Ponce Deleon found naked girls in the hot springs-so whats the truth?

 

[Gary F]

First time user so bear with me- Any one out there tried the oral chelation pills being hawked on aviation sites? From what I can find out on med sites it's pretty scary stuff. Like the idea of scrubbing out the old arteries but don't want to experiment with snake oil. Somebody in the aviation world is buying this stuff or they would not be paying high $ for the ads. They make it sound like greatest fountain of youth since Ponce Deleon found naked girls in the hot springs-so whats the truth?

If you want to try something that has been discredited as a legitimate form of medical therapy consider crystal therapy instead.