Playing doctor

May 1, 1998

On this late March Monday morning, the sun shines brightly through a widely scattered layer of stratocumulus clouds. Mother Nature has finally checked the calendar and realized that it's spring — temperatures are warming up after a couple of weeks of unseasonably cool weather here on the East Coast. Light winds out of the southwest keep the clouds moving along at a leisurely pace. It's a fine day for flying.

It's certainly not the weather that's keeping me ground-bound this time. Nor is it a maintenance problem with the airplane. This time I am the problem. For the first time in many years, I have postponed a business trip because of illness, but only after a weekend of agonizing over the decision. Over the years I've delayed or canceled lots of trips because of weather and always felt quite comfortable with the decision afterward. This time, though, I'm still second-guessing myself. Maybe I could have made it. It seems silly to cancel a trip because of a simple head cold. But is it that simple?

As I write this, I should have been touching down somewhere in Indiana or Illinois for fuel while en route to Independence, Kansas. The plan was to interview a number of Cessna employees about the status of the company's piston single-engine program. Instead of enjoying the long cross-country, I'm sitting in front of a keyboard, staring at a blue screen while the blue sky outside taunts me.

A scratchy throat last week turned into a full-blown cold and sinus infection over the weekend, jeopardizing a couple of weeks of planning that went into arranging the Independence trip. Postponing the trip means losing access to the Beech Bonanza that we typically use for trips like this; it's due in for an annual inspection. The beauty of flying a general aviation aircraft to a location like Independence is that I can take off from right outside my office door and land at the Cessna factory door. Otherwise, it's an hour's drive to a hub airport, an airline flight to Tulsa or Wichita, and then either a 1.5- or 2.5-hour drive to Independence in a rental car, only to reverse the whole procedure on the way back home. Instead of a few cherished solitary hours in the Bonanza, I'm in for airport hassles at each end and four hours of shoulder-to-shoulder, knees-to-seatback aggravation aboard a crowd killer — an impetus to get better real fast.

Most of the time, I don't hesitate about flying with a minor cold. An oral decongestant or a squirt or two of nasal spray decongestant before takeoff and again before the descent opens the sinuses enough to allow a reasonably comfortable ride. This time, though, the symptoms seemed more pronounced. The week-long prelude to the full onset of the cold told me that something big was in the works. I started popping decongestants early in the weekend, but to no avail. By Sunday afternoon, I was feeling groggy and a bit spaced out. I've discovered that a good way to judge my alertness is to play a couple of computer games. If I'm tired, I find myself making mistakes, my 30-something-model brain not keeping up with the Pentium-model processor in front of me. The electronic brain won big Sunday afternoon, convincing me that I was in no condition to be plying the skies solo across half a continent in a ton and a half of aluminum and steel.

And even though an airliner's cabin pressure would not likely climb any higher than the Bonanza's cruise altitude, I did not relish the idea of hacking my way across the country in a sealed tube with a bunch of strangers who might not take kindly to me screaming in agony if my ears didn't clear on the way back down. It was time to call it quits. I reluctantly made a few telephone calls and postponed the trip by a week.

The fact that the over-the-counter (OTC) antihistamine and decongestant combination might have dulled my alertness concerned me. I've been using the same brand, a generic version of Tavist-D, for a number of years because I felt it didn't cause any side effects, at least in me. As I discovered after a bit of research, every medication has side effects, and some affect us differently at different times. Dr. H. Stacy Vereen, a senior aviation medical examiner, made that point in the May 1993 issue of AOPA Pilot in an article titled " Over-the-Counter Medications in the Cockpit." There, he suggests not flying immediately after taking any medication that you have not taken before. If you are going to fly, wait about an hour after taking medication to make sure that you will not have a reaction to it. If you decide not to fly after taking a particular medication, how long should you wait? About twice the usual dosing frequency, he suggests. In other words, if a medication is to be taken every four hours, wait eight hours after taking it before you fly. With many pain relievers and antihistamine/decongestants now good for 12 hours at a time, you may find yourself waiting quite literally all day and night.

For the most part, OTC meds relieve symptoms; they do not cure illnesses. So if you need an OTC med, you might wonder what else it could be masking. Is the symptom you are relieving related to a common cold, or do you have the beginnings of a bronchial or sinus infection? If the latter is so, you'll probably need an antibiotic to clear it up. An upset stomach or heartburn might be just that. Perhaps it will be quelled by a couple of Tums or a swig of Mylanta. However, those meds might be masking the onset of a more serious condition. If those couple of Tums don't clear up your heartburn, you might well find yourself having an ulcer attack — or, worse, a heart attack — while tooling along in your airplane.

If you are suffering from symptoms that are unusual for you, put the headsets away and fly another day.

In my case, the onset of the head cold was different from the usual routine. I usually have a sore throat for just one day and then — boom — the sinuses fill up and my family has to listen to me moan and groan for a week. This one started out as a chest cold and sore throat. Because I was aware of my usual symptoms, I could be suspicious when this one didn't fit the norm.

When it comes to flying with nasal or sinus congestion, the big concern is with the ears. The nasal and sinus passages are connected to the middle ear through the Eustachian tube. A blocked Eustachian tube does not allow air pressure inside the ear to equalize with ambient pressure. It's not much of a problem during a climb. Then, the pressure inside the tube will be slightly higher than ambient as the airplane climbs. You'll feel your ears pop, which is really the air pressure inside the tube equalizing with ambient.

The bigger concern occurs on the way back down. Pressure is placed on the outside of the eardrum as the airplane descends into greater ambient pressure. If the blockage is complete, there is no way for the pressures to equalize, which causes increasing discomfort — sometimes to the point of near incapacitation. Here, flight in a pressurized airplane can help because the rate of cabin descent can be controlled. Even though the aircraft may be descending at a couple of thousand feet per minute, the cabin pressure might be increasing at a rate equivalent to only a 500-fpm descent. The slower descent may allow the pressures within the ear to stabilize.

If the pressure differential becomes great enough, the eardrum can rupture inward. That relieves the pressure instantly but can lead to hearing loss, particularly in adults. Depending on the extent of the damage, the eardrum may eventually heal itself, but in some cases surgery may be required to repair it.

Yawning or otherwise opening the mouth widely may partially relieve the pressure, thus the old adage about chewing gum when in airplanes. Another technique is the Valsalva maneuver. Close your mouth, pinch your nose shut, and gently force air into your ears, thus clearing the tubes. While effective, this in itself can be painful.

When flying with blocked ears, remember to start your descent early and make it a slow one. If the situation is serious enough, you may need to alert air traffic control that you will not be able to sustain the minimum descent rate of at least 500 fpm. Once informed of the problem, the controllers are generally quite accommodating.

And as I finish writing this, the spring sky has turned from a golden yellow sunset to gray, and now black. Instead of gearing up for a day of interviewing in Independence, I'm still in Maryland, staring at a blue screen next to a trash can overflowing with wadded-up tissues. Better here, I suppose, than reeling in pain over the Great Plains and wishing that I were on the ground.