Stress Test for New Medical

E

ElecTape

Filing Flight Plan
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DFW
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Display name:
Anthony
I recently decided to go back to school to finish my degree. I wound up being able to pursue my BS in Aviation Science. I followed all the steps to get thru the process and did my medical several weeks past. School has started for me and I’m currently on a flight hold since my medical has yet to be finished. Buried in debt now…lol

Friday I received a letter from the FAA concerning my medical and am now being asked to take a stress test. I have looked on the internet for information on this and will of course speak to my AME on Monday to see what this will take to do but I’m somewhat scared and confused as to why I’m being asked for this additional step.

Let me give some background information on me:

I am 40 years old and this is my first attempt for a medical certificate. I had to apply for a 1st class for school since I will be pursing an ATP certificate and they want to make sure I can achieve a 1st class.

Approximately 5 years ago I was over 350lbs in weight and became very sick, I made several life changing decisions and got my weight under control. During this time I was tagged with the Diabetes and High Blood pressure on my permanent medical information. My family doctor is also my AME. Since getting my health under control I have stop taking any medicine for Diabetes or High Blood Pressure per my doctor there is no longer a need since I have corrected these with diet and exercise. 2 years ago my grandmother went in for surgery and had a triple bypass and in the process has become disabled. So I left the lifestyle I adopted and have since taken the roll of her care giver and found local work. I have unfortunately strayed from some of the better and healthier choices I was making but have kept myself on a good track other than adding some additional weight back on.

When I went in for the medical everything went fine, My Doctor was happy and excited because he to is a pilot and has been advocating to me to get off my butt and move forward in my life. Well a couple of days after I was in I received a call to go back in since the EKG they took was bad due to the machine error. I retook the EKG and was informed that everything looked fantastic A1C was 3 and blood pressure was good.

I spoke to the FAA a week ago and was told that my medical was in process and that I could have my AME call in and speak to the physical on staff and possibly speed up the process. So I called my AME and he was more than happy to help. I spoke again to the FAA on Friday the previous week and was told that my AME had called and that they were examining my medical and to call back in a day or so to find out. Well I did Wednesday and was told it was again in the process for examination. I explained what had transpired to the rep on the phone and she couldn’t provide any information for me. Now Friday I receive the letter for Stress Test.

My questions are:

How hard is it to pass the stress test?

Is there anything one can do to help get through this?

Does one have to run; I have bad knees and can’t run really for any length of time.
What kind of cost is associated with this?

Since I have never held a pilots license or medical certificate do I have any grounds to stand on to question the need for this test?

I’m just scared, and hoping to find some good information here.

Thank you.

Anthony
 
There are several different types of stress tests. I believe that they want you to do a standard treadmill or graded exercise stress test which should be no big deal. The treadmill starts slow at a 10% grade and increases in both speed and treadmill every three minutes until one of several endpoints occurs. Hopefully you will be able to at least complete 9 minutes of exercise (stage 3) without developing chest pain or ECG (EKG for the traditionalists) changes before reaching target heart rate which for the FAA is 100% maximum predicted heart rate. Maximum predicted heart rate id 220-your age. The FAA has specific requirements for doing the test like recording an ECG every minute instead of every three minutes as is commonly done. Make sure your doctor has the FAA protocol or better yet get Dr. Bruce to set it up for you.

The test is terminated when one of several endpoints occurs:
1. The person can't continue to walk any more due to fatigue, leg pain or chest pain or whatever.
2. A bad heart rhythm occurs.
3. A drop in blood pressure as exercise progresses since BP should increase with exercise.
4. Scary looking ECG changes.

http://www.nlm.nih.gov/medlineplus/ency/article/003878.htm
http://en.wikipedia.org/wiki/Bruce_protocol
http://www.faa.gov/about/office_org.../guide/dec_cons/disease_prot/graded_exercise/
 
Waiting for Dr. Bruce to check in, but my guess is that you'll need to do a Bruce Protocol (no relation to "our" Dr. Bruce Chien). Here's some info on it: http://www.leftseat.com/tmst.htm
I understand that it is typically fairly inexpensive (as far as medical tests go). I will add that you should not go any further on the test than required to meet the FAA's conditions! Once you reach your target heart rate, STOP!

Typically it's performed with a treadmill, but I believe that it's possible to substitute stairs or an exercise bike.
 
gprellwitz said:
Waiting for Dr. Bruce to check in, but my guess is that you'll need to do a Bruce Protocol (no relation to "our" Dr. Bruce Chien). Here's some info on it: http://www.leftseat.com/tmst.htm
I understand that it is typically fairly inexpensive (as far as medical tests go). I will add that you should not go any further on the test than required to meet the FAA's conditions! Once you reach your target heart rate, STOP!

Typically it's performed with a treadmill, but I believe that it's possible to substitute stairs or an exercise bike.
Click to expand...
The FAA also requires a minimum time of exercise or you flunk this test:

The applicant is unable to make at least 85% of maximal heart rate on stress testing or less than 9 minutes (6 minutes if age 70 or greater)

If you have certain ECG abnormalities an imaging stress test will be required.

I have never seen bicycle exercise done other than as stress for real time echo or nuclear (MUGA) imaging. It is probably harder to get adequate exercise on a bike compared to a treadmill. The treadmill test is relatively inexpensive, probably only a couple of hundred bucks, add imaging and it gets a lot more costly. I think some hospitals bill as much as $7,000 for a rubidium PET cardiac stress perfusion study and technetium SPECT imaging is not much cheaper.
 
Gary F said:
I have never seen bicycle exercise done other than as stress for real time echo or nuclear (MUGA) imaging. It is probably harder to get adequate exercise on a bike compared to a treadmill. The treadmill test is relatively inexpensive, probably only a couple of hundred bucks, add imaging and it gets a lot more costly. I think some hospitals bill as much as $7,000 for a rubidium PET cardiac stress perfusion study and technetium SPECT imaging is not much cheaper.
Click to expand...
But the OP said he has bad knees and would have a lot of difficulty doing a treadmill test. I wonder if the FAA would accept a dipyridamole test in place of the treadmill in his case?

As far as a bicycle test, why do you say it would be harder to get adequate exercise that way? I think plenty of cyclists might disagree with you there. ;) (Which is not to say, of course, that the FAA in their infinite wisdom would accept a bicycle test, but just for discussion.)
 
azure said:
But the OP said he has bad knees and would have a lot of difficulty doing a treadmill test. I wonder if the FAA would accept a dipyridamole test in place of the treadmill in his case?

As far as a bicycle test, why do you say it would be harder to get adequate exercise that way? I think plenty of cyclists might disagree with you there. ;) (Which is not to say, of course, that the FAA in their infinite wisdom would accept a bicycle test, but just for discussion.)
Click to expand...
Bad knees might prevent adequate exercise but many people overestimate the difficulty in a standard (Bruce) protocol and can still accomplish the test in spite of an orthopedic issue. The OP can go to the gym with a copy of Bruce protocol and try it out first but should stop if he/she becomes breathless or develops chest discomfort. Bicycle exercise is not always easier on the knees. I am not sure why the bike protocol does not seem to work as well. In my neck of the woods only a single physician (primary care doc) does these and his patients do not achieve as high a workload (METS) as our treadmill patients do.
Pharmacologic stress tests have another big issue other than cost. In theory there should only be a 15% false positive rate but at many institutions it is closer to 30% due to over-reading. This would most likely lead to a heart cath which is not only costly but has some risks.
 
azure said:
But the OP said he has bad knees and would have a lot of difficulty doing a treadmill test. I wonder if the FAA would accept a dipyridamole test in place of the treadmill in his case?
Click to expand...
They require imaging stress tests under certain circumstances but these are really expensive and insurance might not cover it if it is only used to satisfy the FAA requirements. Dipyridamole has largely been replaced by adenosine or regadenoson. Although dipyridamole is cheap as dirt (and looks like Mountain Dew) it has annoying and fairly long lasting side effects such as headache that might take the fun out of your test.
 
Bad ankle and out of shape. I took one of these earlier this year and got to the target heart rate without running. Just walked really fast. And I'm glad it was only 9 minutes, my legs were burning when it finished.
 
Well I feel a little betteI feel a little better now that I have a better understanding of the test. Thank you.

As far as treadmill goes I can walk for hours even at the steepest incline I can make it do at the gym. Although it’s been a couple of months since I’ve been able to go with any regularity. Heck a year ago I was rowing for 30 minutes to an hour.

It’s just in the last year I have not had the ability or time to go. Work is demanding so much more time of me and each day and I have to prep everything for my grandmother so she will be ok while I’m gone for the day (she is partially disable and incapable of certain tasks). It just eats ups so much time.

I really miss going to the gym.

On another note I do love to bike ride. I do get to ride from time to time. I wonder if that might be a better option.

I just immediately figured I’d have to run. I have the ability to run it’s just that my knees begin to hurt because of the constant impact and sometimes I guess I land just right and pinch a nerve because at that point I stumble and fall over kind of like those funny treadmill films where the guy gets thrown off.

Admittedly I’m not exactly sure what the issue with my knees are, I’ve never really had the money to have them fully examined and it really only bothers me if I try to run for any period of time. I didn’t think it would have been a factor in flying.

Now I just hope I can cover the costs.

I’m fearful I’m going to be out all this money for school. I’m past the drop out point so I’m stuck for the semester and flight time. I think it would truly stink if I can’t get the medical at this point.

Anyway thinks for the help.

I did speak to my AME’s rep this morning and they don’t do the test but are trying to find someone for me that will be reasonable on costs.
r understanding what involvded in thhte
 
Unregistered said:
Now I just hope I can cover the costs.

I’m fearful I’m going to be out all this money for school. I’m past the drop out point so I’m stuck for the semester and flight time. I think it would truly stink if I can’t get the medical at this point.
Click to expand...

Ugggh!! Are you saying you went into major debt for an uncertainty?? :mad2: :mad2: :no:
 
Unregistered said:
Well I feel a little betteI feel a little better now that I have a better understanding of the test. Thank you.

As far as treadmill goes I can walk for hours even at the steepest incline I can make it do at the gym. Although it’s been a couple of months since I’ve been able to go with any regularity. Heck a year ago I was rowing for 30 minutes to an hour.

It’s just in the last year I have not had the ability or time to go. Work is demanding so much more time of me and each day and I have to prep everything for my grandmother so she will be ok while I’m gone for the day (she is partially disable and incapable of certain tasks). It just eats ups so much time.

I really miss going to the gym.

On another note I do love to bike ride. I do get to ride from time to time. I wonder if that might be a better option.

I just immediately figured I’d have to run. I have the ability to run it’s just that my knees begin to hurt because of the constant impact and sometimes I guess I land just right and pinch a nerve because at that point I stumble and fall over kind of like those funny treadmill films where the guy gets thrown off.

Admittedly I’m not exactly sure what the issue with my knees are, I’ve never really had the money to have them fully examined and it really only bothers me if I try to run for any period of time. I didn’t think it would have been a factor in flying.

Now I just hope I can cover the costs.

I’m fearful I’m going to be out all this money for school. I’m past the drop out point so I’m stuck for the semester and flight time. I think it would truly stink if I can’t get the medical at this point.

Anyway thinks for the help.

I did speak to my AME’s rep this morning and they don’t do the test but are trying to find someone for me that will be reasonable on costs.
r understanding what involvded in thhte
Click to expand...
If you can walk on the treadmill this is what you should do as you can reproduce the speed and grade on many good treadmills before you actually take the test. I doubt that you would be able to find an exercise bike ergometer to try before the test. I think the FAA would prefer the treadmill as it is by far the most common form of graded exercise stress test.

http://en.wikipedia.org/wiki/Bruce_protocol

Note: Each stage is 3 minutes. The table is a little confusing as it lists the total time of exercise and not time in each stage. The FAA wants at least 9 minutes and 100% maximum predicted heart rate. If you are having trouble attaining target heart rate let go of the crossbar and let your legs work harder.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123032/
 
Well I tried to make sure all my bases were covered. I have been trying to get this medical taken care of; it’s taken over 8 weeks so far. When I first talked to my AME about it he figured maybe 4 or 5 at the longest and that I should have no issues whatsoever. The instructor at my school didn’t think it would take that long.

I figured I had enough time to back out of school if it went south. Well as of 2 weeks ago talking to the FAA it seemed everything was fine it was processed and I would be getting it in the mail. Well that changed and honestly I don’t understand why. I also don’t understand why they couldn’t tell me over the phone when I called several times that I needed to get this other part for them. Who knows when I could have started on it?

When school started I was under the impression thru the FAA that I was good to go, would just have to wait while they finish the process and for mail time. That was right at the beginning of school so I still had a 2 week drop out point. Now it’s at week 3 and I can no longer drop.

I truly had no intentions on getting in this deep if I wasn’t going to get a medical certificate. Now I’m buried. Argh!

Live and learn!
 
Well I'm setup for tomorrow morning! Let's hope I can get threw this! I really want the prise at the end of the tunnel!
 
Elec, remember that you have to run to NINE minutes and achieve a heart rate of 90% of (220-YourAge)= 162, in order for the test to be acceptable to the FAA.

Also, find an excuse to not run beyond the point where you have both NINE minutes, AND the 162 heart rate. Anything revealed beyond that might be uncomplimentary and there is no reason to expose yourself to that.

Have AT. I'm sorry I have difficulty keeping up with this board as my primary duties are at the red board.

REMEMBER: GET the EKG tracings. All 20 of them, and copy them twice, take one set of COPIES to the AME, and keep a set. Mail the first one to the FAA according to their requirements letter, and put your name and DOB on EACH AND EVERY PAGE. Send it CERTIFIED RETURN RECEIPT. Do not trust an AME office to deliver these.

Best, Hard Case AME.
 
Well I think I passed!

They had the Bruce Protocol listed on the wall but it looked different than what I read earlier. Anyway I gave the test giver a copy of my FAA letter and he kind of shrugged it off and said they would do the same test that the do for the Lockheed Martin pilots. I didn’t want to argue and figured it was best to not **** off my test giver.

I went over 17 minutes before he finally had the machine slow to a stop and measure my return to normal heart rate.

I did question him at the end of stage 3 I was asking him are you sure I need to keep going. He said I had to get to maximum heart rate of 185. This is when I started doing the math 220-40 is 180 not 185, what the heck is this guy thinking. I kept fairly quiet about it but began to start asking questions about the test. By level 4 I explained to the guy that if this goes much faster we may have an issue with my bad knees. He said he would change the incline only on the next level but we needed to get my heart rate to 185. Well it got there finally; it felt like I was climbing the side of a building.

I’m kind of worried that his version of the test is not what the FAA asked for and is going to cause another issue for me.

I’m just about ready to just give up. Argh… Frustrated!
 
ElecTape said:
Well I think I passed!

They had the Bruce Protocol listed on the wall but it looked different than what I read earlier. Anyway I gave the test giver a copy of my FAA letter and he kind of shrugged it off and said they would do the same test that the do for the Lockheed Martin pilots. I didn’t want to argue and figured it was best to not **** off my test giver.

I went over 17 minutes before he finally had the machine slow to a stop and measure my return to normal heart rate.

I did question him at the end of stage 3 I was asking him are you sure I need to keep going. He said I had to get to maximum heart rate of 185. This is when I started doing the math 220-40 is 180 not 185, what the heck is this guy thinking. I kept fairly quiet about it but began to start asking questions about the test. By level 4 I explained to the guy that if this goes much faster we may have an issue with my bad knees. He said he would change the incline only on the next level but we needed to get my heart rate to 185. Well it got there finally; it felt like I was climbing the side of a building.

I’m kind of worried that his version of the test is not what the FAA asked for and is going to cause another issue for me.

I’m just about ready to just give up. Argh… Frustrated!
Click to expand...
Seventeen minutes on a Bruce is damn good exercise tolerance.
 
But I hope the extra EIGHT minutes did not needlessly reveal something unflattering.

Many moons ago, running one of these as a Lt. to nineteen minutes..... Completely exhausted, and had diffuse ST Segment depressions- 0.6 mm. If you run hard enough, ANYBODY will become ischemic, even a 21 year old 5'8 and 135 pounds in o/w tip top shape who ran with the Marines....

Stage FIVE is for escaping the kill zone because at that level of oxygen consumption you are soon going to be dead.
 
Very, very unlikely. And that has been studied.

Global myocardial ischemia is not good for any situation.....
 
Mtns2Skies said:
Couldn't that "unflattering" issue to be revealed be potentially life saving?
Click to expand...

Nope. But it would be costly and time consuming to prove it's not a factor in your medical.

Likewise. You can work yourself hard enough that your heart's workload is outpacing it's oxygen supply. "Very bad things" happen when you sustain that.

The older and less healthy you become, the easier it is to exceed that threshold. In the winter months, lots if those old folks who die with flu and pneumonia are actually dying of heart attacks brought on by the stress of the respiratory illness.
 
Duration of exercise on the treadmill correlates inversely with all cause mortality. If you have a crummy heart you will probably not be able to exercise well. Conversely, the better the exercise tolerance the lower probability of cardiac events or death.

Remarkably, the longer the patient can keep going on the treadmill, the less likely he or she is to die soon of coronary artery disease—or of any cause. In fact, of the prognostic variables measured during exercise treadmill testing, exercise duration is the strongest.1,2 Its prognostic value has been demonstrated in healthy subjects being screened for coronary artery disease (FIGURE 1)3–6 and in patients being evaluated for suspected or known coronary artery disease (FIGURE 2).7–10 The independent prognostic value of exercise duration has been demonstrated in men,3,4,7,8 women,4–7,9 and the elderly.11 Although functional capacity decreases with age and generally is lower in women than men, exercise duration retains its prognostic value after adjusting for age and sex. http://www.ccjm.org/content/75/6/424.full
 
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