Student Failed Medical Now What?

T

taters

Pattern Altitude
Joined
Jun 29, 2007
Messages
1,712
Display Name
Display name:
Taters
So I got a call from a student pilot (5 hrs) of mine that his medical was rejected to to blood pressure just over the limit. He was 155/100 and the limit is 150/95. He is a fit p90x type of guy, but told me today that he has always had "hot" blood pressure and his doctor has always assured him he was fine. The AME is pretty new "green" and the student was left very confused at the explanation of what is to come next. Basically told him to wait for a letter .

As an instructor I understand there are 2 options in this situation,

-Special Issuance
-Provide Evidence that condition is not disqualifying.

So

Can he begin the special issuance process now?
What is best course of action to get this over with?


This same AME created a nightmare for one of my other students at his first med renewal long long story but this dude is getting on my nerves.


Thanks All!

BTW. I'm gonna keep him flying for now.
 
Last edited:
Suggest this get moved to the medical issues forum, where several GOOD AMEs (and a bunch of other helpful folks) can weigh in.
 
taters said:
So I got a call from a student pilot (5 hrs) of mine that his medical was rejected to to blood pressure just over the limit. He was 155/100 and the limit is 150/95. He is a fit p90x type of guy, but told me today that he has always had "hot" blood pressure and his doctor has always assured him he was fine. The AME is pretty new "green" and the student was left very confused at the explanation of what is to come next. Basically told him to wait for a letter .

As an instructor I understand there are 2 options in this situation,

-Special Issuance
-Provide Evidence that condition is not disqualifying.

So

Can he begin the special issuance process now?
What is best course of action to get this over with?


This same AME created a nightmare for one of my other students at his first med renewal long long story but this dude is getting on my nerves.


Thanks All!

BTW. I'm gonna keep him flying for now.
Click to expand...

Keep flying with him, he'll be able to get a medical with no problem. I'll let Dr. Bruce some in with the low down on the procedure, but I'd encourage him to work with his primary care physician to lower the blood pressure. If he's already fit, exercise won't be the answer, but diet may be, and many BP medications are acceptable too. No matter how the procedure works, the FAA will want to see evidence of a lowered BP, and it'll be better for him on top of it.
 
If his NORMAL systolic reading is 155, then he should work on lowering it - for his own good as well as for the medical. If this is a case of "fear-of-physician induced hypertension", then a regular record of readings taken by a professional to document that the normal blood pressure is actually within tolerance may be sufficient.

But I'm one of those amateurs who tries to be helpful - let's see what the AMEs say.
 
Not to distract, but what is a "fit p90x" kind of guy?
 
TMetzinger said:
If his NORMAL systolic reading is 155, then he should work on lowering it - for his own good as well as for the medical. If this is a case of "fear-of-physician induced hypertension", then a regular record of readings taken by a professional to document that the normal blood pressure is actually within tolerance may be sufficient.
Click to expand...
Like Tim, I also wonder if his BP is usually this high or only in certain stressful situations (like maybe a FAA medical). Mine used to be comically high when I was at a doctor's office (got 167/something once), but then I realized that this was because I was holding my breath. Breathe = problem solved for me and BP down to 115.
 
taters said:
So I got a call from a student pilot (5 hrs) of mine that his medical was rejected to to blood pressure just over the limit. He was 155/100 and the limit is 150/95. He is a fit p90x type of guy, but told me today that he has always had "hot" blood pressure and his doctor has always assured him he was fine. The AME is pretty new "green" and the student was left very confused at the explanation of what is to come next. Basically told him to wait for a letter .

This same AME created a nightmare for one of my other students at his first med renewal long long story but this dude is getting on my nerves.
Click to expand...

So why keep using this AME for your students? At this point it will look like the student is "AME Shopping" so they are stuck with it.
 
From the AME's guidebook:
The average blood pressure while sitting should not exceed 155 mm mercury systolic and 95 mm mercury diastolic maximum pressure for all classes.
Click to expand...
If your trainee tested at 155/100 as you said, it's hard to argue that the "condition is not disqualifying," since 100 is greater than 95. Bruce can tell you for sure, but I think what your trainee will have to do is either go the SI route or somehow show that either the reading was erroneous or due to a temporary condition which has been resolved. Unless this physician is a total hamburger who cannot accuratly assess BP, I don't see the AME's "greenness" being at issue -- the standard is clear, and your trainee didn't meet it. If any physician involved is to be avoided, it's the one who told him that 155/100 was "fine," because the National Institutes of Health says that 155 systolic is Stage 1 High Blood Pressure, and 100 diastolic is Stage 2, and that "All levels above 120/80 mmHg raise your risk." (http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html) That suggests that he is in need of help on his general medical condition, not just FAA certification.

All that said, I suggest doing nothing on the FAA medical certification front until you get advice from Bruce.
 
Last edited:
From a general health standpoint (as opposed to Dr Bruce's AME standpoint), have him buy a bp cuff (auto/semi auto is fine, they arent that expensive) and monitor his BP every day.. in the morning before he gets out of bed. Log it.

If its over 140/90 it meets the OLD, DATED definition of high blood pressure (note this is a little less than the DOT limit)..

BUT.. the Cardiology guys revised their position statement quite a few years ago and consider 120/80 to be a better sign of BP control, with less risk of complications.

If he's living a healthy lifestyle and his resting BP is higher than these guideposts, he should consider getting on BP meds. He wouldn't pass a DOT truck drivers physical with his current numbers either. The green-ness of the AME has nothing to do with this.. its pass/fail. But its easily controllable in most people. He should get starting (and one month followup) blood chemistry to ensure that his kidneys (and their blood flow) are not the cause of the elevated BP. Any doc with half a clue will understand what I am referring to.

Once his BP is in control, plus any other minimums required by the FAA, he should be a shoo-in. Expect a chest Xray and EKG to make sure that there aren't any detectable problems as a result of long term untreated high blood pressure.

If he wants to get a head start on clearing his medical, he should go see his regular doc (or select a new one if the current one doesn't think BP control is a big issue at the moment) or at least get the appointment made, and get a full physical, Labwork including at least a chem7/basic metabolic panel, Chest Xray and 12 lead EKG. If blood pressure remains high, consider starting meds for it. Even if this is overkill for the AME, this is a good baseline exam for future health concerns.
 
Last edited:
To follow up, the trainee is a dentists himself-halfway germane to this conversation,

the "greeness" of the AME is an issue because this guy has no idea what to do next when someone fails. Just gives some loquacious answer that leads no where. I have been through this twice now. I give my students a sheet with 3 options on AME's. My favorite guy recently retired.
 
Last edited:
Get BP controlled. Two weeks later, get a letter from the Rxing doc saying BP under good control, no side effects. Needs EKG, fasting glucose, fasting lipid profile and serum creatinine. If the AME has sent the papers in, go to another AME get re-examined and issued.
 
bbchien said:
Get BP controlled. Two weeks later, get a letter from the Rxing doc saying BP under good control, no side effects. Needs EKG, fasting glucose, fasting lipid profile and serum creatinine. If the AME has sent the papers in, go to another AME get re-examined and issued.
Click to expand...

Dr. Bruce
Papers have been sent in,
To be clear
So should he take this letter from the Rxing doc to the "new" AME and have it sent in with his assumed successful 3rd class medical results?
Thanks,-Clay
 
Yes, or if he can stand it he can go back to the old AME and do it all over again. The guy's a horses' rear, he shoulda held the papers for 14 days and told your student what to do.
 
bbchien said:
Yes, or if he can stand it he can go back to the old AME and do it all over again. The guy's a horses' rear, he shoulda held the papers for 14 days and told your student what to do.
Click to expand...

Or gave him a Viagra sample and retested a 45 min later....
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top