Affair of the heart

Getting back in the left seat after narrowly avoiding the ‘widow maker’

July 1, 2011

My dog Sophie helped save my medical certificate, if not my life. It wasn’t as dramatic as her running home barking out a message that I had fallen down a well. It was far more subtle and gradual than that, and with coronary artery disease, that’s often part of the problem.

Since rescuing Sophie from an animal shelter more than a year earlier, I had begun to walk more—a lot more. And, for a while, it was doing both of us some good. Short daily walks became longer and at a faster pace, and both of us began to drop pounds. I had even started to congratulate myself. That is, until the denial began.

It was a denial of the obvious—a denial that would lead to an almost complete blockage of an artery doctors call the “widow maker.” And it would lead to a just-in-time heart procedure and an education on how to get an airman medical certificate back in the shortest time possible. Here’s my story, a very typical one that every pilot who faces the loss of a medical because of coronary artery disease should find encouraging.

Doubt

When spring turned into summer I had to start shortening our walks, blaming it on the effects of increasing North Carolina heat and humidity. A two-mile walk soon became a one-and-a-half mile walk, and then a mile with a stop halfway to catch my breath. But soon doubt began to replace denial, and then fear started to creep in.

HeartI wasn’t afraid of dying (although I should have been); I was afraid of the FAA. More specifically, FAA doctors who could deny my medical if it turned out I had a serious medical problem. I was right to be afraid, but I was wrong about what to fear. That fear led to a doctor coming out to speak to my wife after my heart procedure and telling her that I’d had a 90- to 95-percent blockage, and becoming the first of several doctors to use the widow-maker terminology she didn’t want to hear.

The issue came to a head in Wisconsin as we were visiting my in-laws in the week before EAA AirVenture. Over a matter of just a few days my walks with Sophie became shorter, until finally I could barely manage 15 minutes as I was experiencing an obvious shortness of breath and a vague feeling of a band of pressure crossing my chest. But since I had duties in Oshkosh for the nonprofit organization I run, I wanted to wait until I returned home to see a doctor.

Then there was one last walk with Sophie looking up at me, wondering why we had halted less than two blocks from the house. It was time to ask my father-in-law to drive me to a clinic. That led to medication for symptoms and a very strong admonition to see a doctor. Even then I resisted, as I had responsibilities at the airshow. But my father-in-law convinced me—in the strongest terms possible—that I needed to go directly to the emergency room at the nearby Wisconsin Heart Hospital. My wife drove me there, and the response was immediate. In just a few hours I was in the heart catheterization room waiting for the surgeon to arrive on his Harley (it was Milwaukee, after all). I watched a monitor over my head as he performed angioplasty and put in a stent, and the effect on the blocked artery was stunning, with blood now feeding a starved area of my heart. Still on my back and watching a now normally functioning heart, I began to plan how to get my medical back.

A new medical?

I spent just 36 hours in the hospital and the next hours resting at my in-laws’ home and searching both the AOPA and FAA Aerospace Medical Certification databases on protocols for recertification after a stent procedure. I found out I was lucky because it had been caught prior to a heart attack, or in doctor speak, “an event.” That would shorten the time before I could reapply to six months, a fact confirmed a few days later at AirVenture when I visited the FAA Aerospace Medical booth and spoke to Dr. Warren Silberman, the federal air surgeon who could have ultimate responsibility for an approval.

After explaining what had happened and what my research of the FAA’s medical database had revealed, I asked the big question: If I followed the testing and documentation procedures exactly, could I leave my AME’s office on the day of the exam with a new medical in hand?

His answer was an unqualified yes. To get a waiver or authorization in the most expeditious manner, the best thing is to find an AME who would be willing to phone the medical certification division or the regional flight surgeon to get a verbal authorization. This would only apply to third class airmen medicals, as first and second class must be reviewed by the FAA’s cardiology panel. The airman must bring all the required reports and testing for the AME to report to the FAA. The airman could potentially walk out of the AME’s office with a medical certificate. The AME will then need to send the data and testing in to the FAA, Silberman told me.

"If you want to be successful in getting a medical back, it boils down to properly submitting complete reports to document your case."

I then asked if it would be better if both Silberman’s office and the regional flight surgeon had the same information the AME needed, but before the exam, so when the AME placed the call they would have everything they required to support their decision. He agreed.

Now I had a plan that I could share with my new cardiologist back home in North Carolina, and over the next six months I made sure I did my part with lifestyle changes that led to weight loss—as well as excellent results on endurance and cholesterol tests. A month prior to the exam I contacted my AME to let him know what I would need from him, and then scheduled the necessary blood work and treadmill stress tests with the cardiologist.

Following the FAA protocol, I assembled a thick stack of documents that included detailed doctor’s notes, blood test results, and printouts of EKGs from both the original procedure in Milwaukee and the testing done to prepare for the AME’s exam. The new tests included a treadmill stress test, blood testing for cholesterol and blood sugar, and a copy of my family medical history. Those reports and results were then summarized in a cover letter from my cardiologist. I sent copies of the whole package to the regional flight surgeon and Silberman’s office, kept one for my records, and took one to my AME on the day of the exam.

Bottom line

If you want to be successful in getting a medical back, it boils down to properly submitting complete reports to document your case. Silberman puts it very plainly, “The airman needs to go to the AOPA medical website and review the FAA’s requirements for the medical condition and then provide the FAA with all of the medical records and testing just as the FAA requests them. Do not let your treating physician talk you into performing another test unless you check.”

He also comments on a pitfall some pilots run into when advised by a personal physician instead of an AME. “If your treating physician is not a pilot or aviation medical examiner, do not take for gospel when they tell you that you are good to go for flying. Many times you are not! Please provide the FAA with all of the medical records and testing results at one time. Do not send it in bits and pieces.”

Of the 22,594 applicants with a history of coronary heart disease in 2010, a very encouraging 84 percent were approved. According to the FAA’s records, just fewer than 19,000 pilots who had coronary heart disease were issued third, second, and first class medicals in 2010, and that included pilots who had heart attacks, stents, and bypass surgery. By comparison, 3,606 were denied, and some of those were denied because they didn’t support their request with the right—or complete—documentation.

On the day of my exam I did indeed walk out of my AME’s office with a new medical certificate. It is good for a year, and annual test reports will be required to keep it. That’s a requirement I can live with, because the alternative is too difficult to contemplate.

So, how did I celebrate? I dropped by the house and picked up my dog Sophie, and took her flying.

Heart

Charles H. Stites, of Chapel Hill, North Carolina, owns a restored 1949 Ryan Navion.