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Discussion in 'Medical Topics' started by Unregistered, Apr 9, 2013.
I dont think I have heard the self-diagnosis and home-remedies for pulmonary embolus before .
A little knowledge is a dangerous thing. This post is proof of it right here. Glad you didn't die from your embolus, or the DVT's that precipitated it. And glad you didn't have a hemorrhagic stroke from over-treating yourself either.
In the past year I have lost two friends. The first self diagnosed her acute gallbladder and decided to finally get scanned at work one night. Stage 4 ovarian cancer. She had been an ER physician for about 20 years, and one of the smartest people I have known.
The second made several comments to his staff one morning about being short of breath after a minor fall at home over the weekend. His office stuff jokingly told him it was a PE. He had a full clinic that morning and did not feel it was worth getting checked. He was found dead in his office by his nurse after lunch. He had been a trauma surgeon (and faculty at a local medical school) for almost 30 years. It was, in fact, a PE.
"We are practitioners of medicine, not consumers."
PE is really weird and we really dont know much about which ones are insignificant and which ones are going to kill you. Last night, the ERs I cover had two patients with small pulmonary emboli of about the same (very small) size. One had severe chest pain variable with body position, the other had no symptoms relating to the chest or lungs at all (patient was being scanned for something else). Also, with large pulmonary emboli, some patients have a large clot load in the lungs and only need a bit of oxygen to keep them comfortable, others have severe symptoms and die.
But as this thread demonstrates, the only way you are going to know what has to be done is to go to the ER and get a proper chest-pain workup.
And I'm guessing neither of your late friends would have blindly self medicated without a diagnostic imaging study to rule in or rule out that concern.
Theres a smart way to go about being smart.. and a not so smart way.
OP here: Yeah - that's the reg I found before, when I referenced that there's gray areas. How is an amateur to know what the Fed air surgeon reasonably considers grounding? Of course, with my specific history, and knowing what I know from that episode, it would be a grounding event. It's still interpretive, but the tea leaves to seem to indicate that the clot is an organic defect that MAY(hate those kind) make it unable to perform those duties....
OTOH, I MAY be able to perform those duties just find for the duration. Who's to say?
I don't know anyone in the med branch. I have an appt with my internist this week, and my PT-inr is being taken on Mon.
At this point, I'm leaning toward LSA because if I do send it in, and the data isn't to their liking, that as they say, is the end of that(except for UL).
I've defended my decision to handle things the way I did. Knowing that it would stir some resentment, and frustration and/or anger. None of you were there. You don't have the history with the medical profession that I have. You know about me, and my situation only what I've told you, nothing more. There are MDs here who never make mistakes, never misdiagnose, and never mis-treat symptoms. They are the most perfect MDs ever, and I'm certain that any negative outcomes, are the result or fault of the patient. Now, all facetiousness aside, I have both a healthy respect, and a healthy mistrust working about some aspects of the profession.
We've heard a few homilies, about this or that person dying because they didn't seek or get treatment right away. Stubbornness is the common denominator, but I'd like you to consider that maybe, in some cases, that's not the only thing going on. Who knows, the patient is now dead. Why do somewhat rational people stay away from being treated? Why would a person with pain or some indication of a problem not seek out the diagnosis right away? You all know what a hypochondriac is, what do you call a person who is the opposite?
MDs are afforded and in most cases deserve the respect that we give. However, none of them are perfect, for if they were, there wouldn't be a need for any M&M conferences.
None of this is in any way an excuse for not seeking medical treatment. MDs are skilled at the kind of stuff I'm an amateur at in their field. I wouldn't expect them to be an expert in my fief, and I'm pretty good at what I do. I've made mistakes though, and those mistakes lead to unpredictable outcomes that can have negative consequences. Apparently, this 'concern' I have is shared by some within the MD community. In fact, I know a OB/GYN, who would do the same as I did, and he's been in the 'biz' for 30 years. When I called him, his advice was the same, and I had already decided to go once he called me back. In fact, I was already on the way to the ER when we spoke.
To the MDs who've provided mostly non-judgmental advice, thank you, I've found it useful, and I'm following it. This will be my last post EVER in this sub-forum.
Look up 67.313 and post again.
I believe I have posted the current standard. 4/5 consequitive, regularly spaced INRs between 2.0 and 3.0, the diagostic data to the diagnosis, and, a summary letter from your doc. If you are not confident, hire someone who know how to do this, to review your stuff.
Just like and attorney and court, NEVER send anything to the agency for which you are NOT CERTAIN of the answer. Coverting doubt to certainty is what a lot of us do.
The person who should know is the representative of the F.A.S. That would be an AME.
Glad you survived to be able to make your goodbye post. Many pulmonary embolisms are diagnosed post mortem. You were lucky. So was my dad when he had his (and this was 25 years ago when there wasn't such a concerted effort in medicine to prevent them).
Hopefully there will be no long lasting effects to your health or airman status.
Good luck, and blue skies.
ok.. reading this because i googled "what does embolism feel like".
I suffer from horrible anxiety for 4 yrs now. Im 41, female. Ive been to ER so many times, and just a few months ago had all bloodwork done (do that once a yr) and cardio checked out fine too (do that once a yr also).
But Ive recently, or experienced both legs cramping while laying down for sleep, which Ive experienced before a few yrs ago and had ultra sounds done on legs with negative results. It feels as if having charlie horse in legs, or tingling. I feel like they need to be elevated. They dont hurt much when I lift my toes to test the calves for pain.. but they already give me pain. Anyway, ive been having spurts of "anxiety' symptoms all day today with mild but uncomfortable pain in left shoulder n chest. Much like anxiety. my chest wheezes sometimes when i lay down for more than 5 min on my back, and thats been doing that for yrs and doc doesnt worry about it. I can breath, but when these spurts come back my breathing gets weird (its not like I "cant breath", but more like anxiety breathing), and i get dizzy, but also another sign of anxiety.
Im tired of going to the ER every single time I have a scare. and I havent done so in a while bc I just convince myself its just anxiety (which it usually turns out to be just that). I take aspirin just to ease my mind.
Im rambling. But it helps me to discuss things.
I also have strange tingles in my upper left arm, but again, have that w anxiety too.
Since Ive had blood work done months ago, would clotting have been seen in that blood work if I may be dealing w something other than anxiety?
Nothing gray about it. You need his blessing before you fly again. You only wish it to be gray.
The Federal Air surgeon. the mere existence of 67.313 tells you that 61.53 is superceeded.
Is the real problem that you are too cheap to hire someone who can accurately tell you if your stuff will win approval? I mean, its just barely into 3 figures! I suppose to each his own. But after a homily like that I'd sure be reluctant to be that person.....
To the OP: I don't have a dog in this hunt so I will just be blunt. Dr. Bruce has tried several times to tell you what to do. He does not "hold out" on this site. But, if you are interested in getting your medical back you need to contact Dr. Bruce directly by email. He will ask you to set up an account. His costs are very reasonable. I will not price his service but I doubt you will be able to spend $150.
When you contact him do EXACTLY what he says to do. He will be very specific on the information needed and what form it needs to be in. You can then send him all the information and he can determine what the outcome will be before you actually submit it. He has the knowledge and connections to know the answer before the question is asked.
If you don't want to do this, then just go LSA and be done with it. Oh, and I speak from personal experience.
I know that this is an old thread but I'm new to the PE world and need some guidance.
I had surgery to my left knee (subchondroplasty) at the end of May this year. Three or four weeks later I had been back to exercising and had some pain in my left calf but thought that it was overexertion. I was flying back from a trip to the in-laws at 12,000 and a couple of days later started having pains in my ribs like I was being stabbed with a knife. After a few days of this I woke up to a persistent stabbing in my ribs on my back.
On advice of my doctor I went to the ER and a CT scan revealed multiple blood clots in my lungs. They started a Heparin drip and transported me to the hospital. While I was there they also found a blood clot in my left calf. I'm assuming that was what I was feeling earlier and it spread to the lungs at high altitude. I spent 3 days there on Heparin before being released with Xeralto. The next day I was back in the ER with chest pains again. It turns out that Xeralto does not work for me and I was changed to Lovenox. I spent four months on Lovenox and then transitioned to Warfarin. My dosage got too high and my INR shot to 7.9 and all anti-coagulants were stopped until my INR came down. I have had steady INRs between 2 and 3 for the last 5 weeks.
Now I'm trying to determine how to proceed from here to allow me to fly again. I read one FAA document that tells me that I need to submit 3 months of INRs, with 80% of them between 2 and 3. Then I saw another document that says that I need 6 weeks of INRs. I have never had any PE or DVT issues before and none in my family. I was also started on blood pressure and cholesterol medication after leaving the hospital.
Can anyone shed some light on this before I talk to the AME? My medical runs out in May and the medical reform is supposed to kick in by July 15th. Does this factor in also?
Email Dr Bruce Chien through this site, or google him for his web page and contact him directly. He can counsel you on the process for keeping your medical certification, or if you go without, at least how to be smart about it.
Randy, the spec. is officialy worded: 4/5 REGULARLY SPACED INRs between 2.0 and 3.0. So if you are testing weekly, you can get this done pretty quick. A word to the wise, however, you have to have dietary discipline and eat the same amount of greens day by day over time, or it becomes impossible to do.
If you have that, the earliest you can apply after a DVT is 60 days. I would take the weekly values and run with it (e.g, reapply) before you get one out of "the slot"....if you have it.
You will need a current office visit from your doc saying completely resolved without sequelae, no swelling nor tenderness in the calf, etc. As you had chest symptoms the signoff needs come from a pulmonologist. You will need the doctors' hospital Discharge Summary AND the VQ scan, d-dimer-that's all in the hospital record. For the first episode, they will not insist that you remain on an anticoagulant (after the 6th month). For the second episode, you need Protein C, Protein A Leiden factor V workup and a hematologist's commentary.
So, since we are reviving this thread, if a pilot experiences chest pain and needs to go to the ER, obviously life is more important than flying, but is there anything the pilot should ask for/request to avoid in order to prevent OKC from becoming a royal pain in the arse?
I'm thinking of Nick's issue WRT testing involved with Kidney Stone diagnosis. Are there any well-meaning doctor gotcha's involved with chest pain/heart problems?
Numbness or weakness in your left arm accompanied by pain in chest means goto emergency room now. They have a test to see if you had a heart attack or not.
Thanks, I will check him out. This transition to the 3rd class medical reform throws a monkey wrench into an already complicated issue.
After the 7.9 INR scare, and the fact that I was out of the country and/or traveling for 2 weeks of it, I was testing twice a week. Now that I've had 5 week of good INRs I'm testing once a week. The diet is not so hard to do. I don't eat kale, chard, or brussel sprouts. I do miss cranberries, spinach, and greens though. I eat a salad with meals once or twice a week, mostly iceberg.
I had the PE in July so time is with me there. Being on Warfarin is a cakewalk compared to the Lovenox. Something I forgot to mention, when I was admitted to the ER, my blood pressure was 190/110, not normal for me at all. I'm guessing it was because I thought I was going to die or lose my medical. Hard to determine which was more traumatic to me. When I left the hospital I was prescribed blood pressure medication from my family physician. He had the results of some recent blood work and also prescribed cholesterol medication too, although a very small dose. He said that it was likely that I would be able to stop the blood pressure meds at some point.
I am hoping I can get hands on the discharge info and the other info there. I might have seen a pulmonologist in the hospital, not sure, but I have only seen a hematologist and my family doctor since discharge, except for the Orthopedic surgeon that started this mess.
I had a conversation with AOPA medical protection yesterday. She said that the FAA would be making an announcement in January about how 3rd class medical is to be handled and that there was a chance that I may not have to jump through the paperwork jungle at all. Since my current medical expires in May of this year, with the passage of the reform, I may be able to either self certify or go through me family doctor to accomplish the same. In addition, my medical would get an additional 2 year extension. She advised me to wait until the announcement in January before jumping into the fray. Opinions?
I have thought about this too in the event I ever need it (and welcome informed answers, unlike mine) but I concluded that there is only so much reasonable "patient direction" to your own health care that will be tolerated (without there being other consequences).
I am sorry that I left this part out earlier, but thank you for all of your help. There is so much contradictory information out there that it is refreshing to get a straight answer. In talking to my hematologist, he told me that he wouldn't be getting another CT scan. Is that normal? I know there is a certain amount of radiation exposure there and I have had two of them back to back but that was in July. Now that I've started exercising again, walking on the treadmill, i do have a little feeling in my left calf where the original clot was detected in July by ultrasound while I was in the hospital. I'm not saying that it is pain so much as an occasional twinge. I would think that getting back to exercise after 6 or 7 months might cause that but I don't feel it in my right calf, but of course that is not the one that sustained the damage. Also I am super sensitive (readaranoid) to any feelings in my chest or leg. Would an ultrasound of my calf be prudent at this point, nearly 5 months since the event? Thanks again for any information.
It's hard sitting here not flying. I have been a pilot for a long time but due to work, family, and other things that get in the way, I hardly flew during those years. I was an air traffic controller in a fairly busy approach control for the last 25 years and as soon as I retired, I bought a C172. In my usual anal retentive style, I researched all of the new equipment over a few month period and then designed the new panel. After leaving the plane with an installer for 6 weeks I had an awesome single pilot IFR platform, only no IFR ticket. I found a great instructor that does accelerated training and 6 days and 40 hours later I had my instrument ticket. I have flown over 120 hours in the last 12 months until the PE and am looking forward to getting back up there.
No CT in followup is common. That's an insurance cost $saving measure; but as for FAA (you know as a former ATO person) that there is the "FAA Way". The need for a pulmonologist to sign you off after PE is not waived. Get 'er done.
And, we know that after a DVT, the calf veins will Never BE THE SAME again. No repeat study is necessary unless you don't resolve.
There is likely no diagnostic information in a follow-up CT for a pulmonary embolus that would help to guide your further treatment.
Okay. I'll tell you what it feels like.
That's the problem. You don't feel it. I mean, having a pulmonary embolism is preferable to having a stroke or a heart attack (the two other places where clots can end up from DVT) but it sneaks up on you, slowly.
What happens is you start to lose your cardiovascular strength. You get winded a little easier than before. This can happen over weeks, or months. As it progresses, you will find that after a moderate level of activity, you will go in to a breathing spasm, and then you'll rest, and then you will feel fine. The doctor might even attribute the spasm to a muscular reaction and not recognize it for what it is.
Then finally, you have one from just walking, then you go in to the ER, and you have such an elevated heartbeat and blood pressure level they put you on immediate meds to lower them, and then the do a few blood tests, and suspect that you might be susceptible to a pulmonary embolism. Then it's all about hoping to live through the night before you have a stroke from elevated blood pressure.
It will take a few days of Lovenox injections to get your INR up. That stuff is nasty. Then it's Warferin. The clots themselves will clear out in a few days to a couple weeks. Gradually, your cardiovascular conditioning will return. I was back to normal physical activity within about two weeks. And I mean heavy cardiovascular conditioning.
You don't have to be in bad shape for this to happen either. I was in great shape. Never saw it coming. Not sure what caused it. So far it hasn't returned. AME said don't even bother to apply until you can have a diagnosis that states the cause and the fact that it is a one time event not likely to reoccur. Then again they are no Dr. Bruce either.
Right now I'm in a holding pattern, hoping that the PBOR2 will kick in and that I will be able to fly under those rules. So far it doesn't look like a PE history is a disqualifying condition if I'm reading it correctly.
Get also with a hematologist and get a protein C, Protein A and Leiden factor V done. These will determine if you need to be on something so that you don't get this close to the headstone again.....never mind the FAA. Get the straight dope.
Insist on the referrals. O-care will never let you go there unless you INSIST.
You should let Dr. Bruce assist you. "Or you you could let someone who knows if it's going to go well at the agency look at it before sending anything to the agency, tell you whether to just step down to LSA and say the heck with it, rather than risk a denial. 'Lotta variables here." Hint, Hint.
Okay I'm going to revisit this since the Basic Med process is now a thing.
Current situation: after several months of being off of Warfarin treatment, I've had another episode of PE's. They did not originate from DVT's. I caught it early enough that it wasn't a major crisis like the first time. Now....
I'm on blood thinners for life. After another initial Lovenox treatment, they put me on Pradaxa (INR's are now irrelevant.) I have consulted with a local AME, and informed that a) the local AME would neither perform Basic Med exams, nor did the AME have a definitive answer on whether I could do Basic Med in lieu of a SI third class, and b) that the door was not closed on the possibility of receiving an SI. That is a route for which I could pursue but it would take a lot of work.
So, given that, is Basic Med currently an option for me, in lieu of a third class SI?
Does a PE fall under any of these categories (I don't think it does but I'm not sure):
If it does then you need a one-time SI before flying under BasicMed. If not then you need to have held a medical since at least July 15, 2006, your last medical cannot have have been been revoked, withdrawn, or suspended, and your last application for a medical cannot have been completed and denied.
Of course you will also need to find a doctor willing to sign the form after disclosing the details of your condition.
After my PE it was a waiting game and trying to decide the best course. Since I knew that BasicMed was coming, I was reluctant to get into a SI situation with a possible denial. That would be a lengthy and expensive proposition at best, and at worst, the end of flying. Since I still had an active 3rd class medical and hadn't been denied, I waited until May 1 and got a BasicMed physical. My family doctor wouldn't do it because he said he wouldn't accept the liability this close to retirement so I had to go elsewhere. Some of the AMEs in the area will not do them either. I could have waited until July when I will come off Warfarin completely but I wanted to get back into the air now.
The big thing here about BasicMed is that you have to have had a good medical, SI or otherwise in the last 10 years and not been denied since in order to go the BasicMed route.
I know it's possible to get an SI for DVT and PE because I sent someone I know to Dr. Bruce. The guy is also on meds for life. I think everyone was surprised how quickly he was able to get an SI, for a first class, no less. It only took 3-4 months, as I remember.
Yes, I think it's pretty obvious that PE is not one of the conditions requiring a one-time SI under BasicMed. The closest match would be cardiac but it isn't strictly cardiac and it certainly isn't coronary artery disease. Good luck to the OP, it sounds like you've found a way to keep flying as long as you're healthy.
Did they give you any idea why this happened to you again? Genetic susceptibility? Diet? Lifestyle? Apparently you're not sedentary so that's not it.