Undiagnosed problems and medical certification

[Unregistered]

So, about two weeks ago my legs started to hurt, specifically my knees and ankles. Thinking it was related to recent physical activity (car repair) I paid it no real mind. During the past two weeks I've experienced varying levels of pain and stiffness - sometimes I'll just hurt for the sake of hurting, other times I'll feel mostly normal and my ankles will only hurt if I do something "extreme."

A few days ago my ankles started to swell and I realized this wasn't just an injury that was taking a long time to heal, and went to see a doctor about it.

The doctor was fairly puzzled, saying she wasn't sure what was wrong with me, that I was two young for this (I'm 27) and she wasn't positive but thought I may have had an infection. She gave me prescriptions for antibiotics and a NSAID - Indomethacin. She sent off lab tests for gout and arthritis.

I'm a bit worried, as I'm positive this is going to be a long, drawn out process of diagnosis, and there's a chance I'll never get one.

Has anyone been through similar, and if so, how did you deal with it medical certification wise? Can I just report on my next medical "sometimes my legs hurt, sometimes they don't, for unknown reasons despite the amount of money I have thrown at this problem"

On a related note, I'm curious how much I want to chase the issue. I have high deductible insurance, so until I meet my deductible everything is out of pocket. $2,500 is a LOT of money to spend to NOT find an answer, not to mention the amount of time it will take.

Thanks in advance...

 

[ClimbnSink]

Lie and deny.

 

[murphey]

You are required to report going to the physician and if you taking the medications at the time of the FAA exam, you must report the meds.

The AOPA Medical website lists Indomethacin as permitted with a status report of no adverse side effects. Next, end the public, online discussion in this and any other forums, even if anonymous. Contact Dr Bruce Chien at [FONT=arial,helvetica,sans-serif]aeromedicaldoc@comcast.net[/FONT] for further information how to proceed.

 

[frfly172]

You are required to report going to the physician and if you taking the medications at the time of the FAA exam, you must report the meds.

The AOPA Medical website lists Indomethacin as permitted with a status report of no adverse side effects. Next, end the public, online discussion in this and any other forums, even if anonymous. Contact Dr Bruce Chien at [FONT=arial,helvetica,sans-serif]aeromedicaldoc@comcast.net[/FONT] for further information how to proceed.

+1 seek the advice of an expert

 

[Jim Logajan]

So, about two weeks ago my legs started to hurt, specifically my knees and ankles. Thinking it was related to recent physical activity (car repair) I paid it no real mind. During the past two weeks I've experienced varying levels of pain and stiffness - sometimes I'll just hurt for the sake of hurting, other times I'll feel mostly normal and my ankles will only hurt if I do something "extreme."

A few days ago my ankles started to swell and I realized this wasn't just an injury that was taking a long time to heal, and went to see a doctor about it.

There are many possibilities of course, but the ones mentioned by your doctor seem the most likely things to check for first.

The doctor was fairly puzzled, saying she wasn't sure what was wrong with me, that I was two young for this (I'm 27) and she wasn't positive but thought I may have had an infection. She gave me prescriptions for antibiotics and a NSAID - Indomethacin. She sent off lab tests for gout and arthritis.

With regard to an arthritis diagnosis: Rheumatoid Arthritis (RA) can and does occur regardless of age. Your doctor doesn't seem properly informed on that aspect, though she is at least is testing for it. Antibiotics and NSAIDs might both reduce the symptoms of RA, though, because they both can reduce its inflammation. Also, unfortunately there is no single or simple test for RA. Ideally she should refer you to a competent rheumatologist - but getting scheduled in may take a few weeks.

I'm a bit worried, as I'm positive this is going to be a long, drawn out process of diagnosis, and there's a chance I'll never get one.

Has anyone been through similar, and if so, how did you deal with it medical certification wise? Can I just report on my next medical "sometimes my legs hurt, sometimes they don't, for unknown reasons despite the amount of money I have thrown at this problem"

Absent a diagnosis, do what you think is prudent. Do you even want to go flying with those ailments? Think you would be able to fly safely for extended periods with those aches? Are you employed as a pilot or can you safely sit things out because you mostly just fly for pleasure?

On a related note, I'm curious how much I want to chase the issue. I have high deductible insurance, so until I meet my deductible everything is out of pocket. $2,500 is a LOT of money to spend to NOT find an answer, not to mention the amount of time it will take.

Thanks in advance...

It depends on whether it is transitory problem or not - if it a chronic disease you should consider spending the money now and find out what it is. Compared to the amount of money you can spend on aviating, $2500 is spare change. And you are spending that money on the only thing you have to hold your mind in for the rest of your life. Don't be afraid to spend the money up front when your body indicates it needs maintenance.

 

[Jim Logajan]

Next, end the public, online discussion in this and any other forums, even if anonymous.

Why should he do that? The feds can't do anything with what was posted.

Contact Dr Bruce Chien at [FONT=arial,helvetica,sans-serif]aeromedicaldoc@comcast.net[/FONT] for further information how to proceed.

Sigh. You'd think Chien is the only AME on the planet who knows how to handle a simple situation like this. The OP should first try contacting the nearest AME who also happens to be pilot (because it is nice if the AME can relate) and request a consultation (not an exam.) I did that with my local AME when I ran into a similar situation. If, and only if, it looks like the local consulting AME may be operating out of their depth should they consider a long-distance consultation with an AME in a distant state.

 

[Unregistered]

I do not fly professionally.

As far as trying to fly when it hurts, to be honest with you I don't see a problem. I've driven quite a bit without problems, walked a lot without problems, etc. It's not debilitating in the least. Weather or not I would want to fly would be a matter of how I "felt" at the time. FWIW I've not flown since it started for other reasons, like not having time.

I was hoping to apply for an ATC position next month, so that's the only "professional" implication this may or may not have.

I'm not trying to "hide" anything or lie. I want to feel better, number one. So if that means I need to do research and ask questions, so be it.

This is not my first go round with elusive problems. I had mono several months ago and it seems like every doctor I saw may as well have been throwing darts... it's your teeth. It's allergies. Who knows. Finally a mono test came back positive, and not long after that I was fine. Looking back, it was a non issue. At the time, it was rather scary. In addition, at the time I also had no financial interest in aviation. Taking a hiatus did not bother me one bit.

Now, I have financial interest in a club airplane. That is costing me money, weather or not I use it. I can't just "walk away" for a while with no harm no foul. Granted, it's not a terrible amount of money when not in use, but I'm also not a huge believer in throwing money away for no return.

 

[asgcpa]

You are required to report going to the physician and if you taking the medications at the time of the FAA exam, you must report the meds.

The AOPA Medical website lists Indomethacin as permitted with a status report of no adverse side effects. Next, end the public, online discussion in this and any other forums, even if anonymous. Contact Dr Bruce Chien at [FONT=arial,helvetica,sans-serif]aeromedicaldoc@comcast.net[/FONT] for further information how to proceed.

This is good advice. Do not "lie and deny".

 

[Vaflier]

You should consider testing for Lyme disease as well, since joint pain can be one of the symptoms and it can be really bad left untreated.

 

[Unregistered]

If you start having all kinds of strange symptoms that don't really make sense, I usually start thinking cancer screenings.

 

[timwinters]

OP...

Are you taking statins?

I used to and they caused me to have very similar symptoms, plus memory loss. I quit taking them and within 2 weeks all was back to normal.

Note: I know next to nothing about medical stuff...just relaying a personal experience.

 

[F01LA]

Sigh. You'd think Chien is the only AME on the planet who knows how to handle a simple situation like this. The OP should first try contacting the nearest AME who also happens to be pilot (because it is nice if the AME can relate) and request a consultation (not an exam.) I did that with my local AME when I ran into a similar situation.

You would think; But the fact is that deferrals are all too common even for things that should be simple. I recall multiple threads where pilots get deferred and Dr. Bruce says "Your AME should have done X".

Getting the consultation is sound advice.

 

[Unregistered]

OP...

Are you taking statins?

I used to and they caused me to have very similar symptoms, plus memory loss. I quit taking them and within 2 weeks all was back to normal.

Note: I know next to nothing about medical stuff...just relaying a personal experience.

Negative. Only things I take regularly are Zantac, tums and vitamins.

 

[AggieMike88]

Negative. Only things I take regularly are Zantac, tums and vitamins.

From the highlighted, looks like Acid Reflux going on, which can be an indicator of additional things worth some concern.

For me, bad reflex (for a long time) accompanied my weight gain, higher BP, being dx'd with type 2 diabetes.... I was buying enough Pepcid AC and tums to make the regional sales manager a healthy bonus.

Then once I lost pounds, got my Diabetes under control, and lost weight, improved diet, the occurrences reflex is 99% gone.

So there may be additional items to the story beyond what you initially reported that might be worth discussing with your primary doc.

 

[asgcpa]

From the highlighted, looks like Acid Reflux going on, which can be an indicator of additional things worth some concern.

For me, bad reflex (for a long time) accompanied my weight gain, higher BP, being dx'd with type 2 diabetes.... I was buying enough Pepcid AC and tums to make the regional sales manager a healthy bonus.

Then once I lost pounds, got my Diabetes under control, and lost weight, improved diet, the occurrences reflex is 99% gone.

So there may be additional items to the story beyond what you initially reported that might be worth discussing with your primary doc.

That is good advice as well.

 

[AggieMike88]

And the other night time aggravator of my acid reflux was the long time suffering from Obstructive Sleep Apnea....

Come to think of it, it might have been "stirring the daytime pot" as well, since I now recall that soon after I started CPAP therapy (2008), the recurrences of reflux began dropping off.

So OSA might be in the mix as well.

 

[asgcpa]

And the other night time aggravator of my acid reflux was the long time suffering from Obstructive Sleep Apnea....

Come to think of it, it might have been "stirring the daytime pot" as well, since I now recall that soon after I started CPAP therapy (2008), the recurrences of reflux began dropping off.

So OSA might be in the mix as well.

I had severe reflux, weight issues, type II and OSA. When I had my WLS, type II went away immediately, and although I still use a CPAP (have it and it doesn't bother me) I have not had a bought of reflux since before my surgery.

 

[ClimbnSink]

Nevermind the FAA and BMI note the health maladies cured by weight loss. Being normal weight is a miracle cure.

 

[Palmpilot]

When I had pain and swelling in my ankles, the official diagnosis ended up being inflammation. It had no effect when I reported it on my medical application. It went away when I found and fixed a bad mold infestation in my home.

 

[Jimmy cooper]

Seems strange your primary care didn't order an in depth blood test before giving you antibiotics or proceeding further. I'd put money in a good physical before continuing further, or depending on an Internet answer. . Am I missing something?

 

[Unregistered]

OP here.

Heard back from the doc, my tests for gout and arthritis were "normal."

I'm feeling a bit better, and I'm going to be honest here I do not have the time to chase down doctors for a possible answer. Getting a day off? LOL.


Given that it is not bothering me a lot, and it does not appear to impede medical certification I'm going to let it do its thing, if it gets worse I'll look into it, otherwise I'm done messing with it.

Maybe I should just change the way I work on cars. (hobby, btw) Think a two post lift and the "required" garage would be considered "durable medical equipment?"

Regarding my weight, acid reflux, sleep apnea, etc - I am 6' and weigh 175 lbs. This is down from about 200 pounds. My current weight puts me at the higher end of the "normal" category on the BMI chart, but everyone I know tells me I shouldn't lose any more as I won't look right... I tend to agree with them.

Sleep apnea? If I can sleep for 7 hours a night, get up and work 12, 13, 14, 15 hours (several hours of that on the road) for 5, 6, or 7 days a week without really feeling tired, and I'm still alive? I must be some sort of walking miracle.

Acid reflux? Never had it up until I started this job.