September 1, 2012
By Jonathan Sackier
Stroking a cat soothes him and you, stroking egos beguiles, and doing the breast stroke in the pool exhilarates. And that’s about it for good strokes. Bad strokes are nasty, and pilots should know about them—and stick to the good kind.
The brain receives nutrients and oxygen via neck arteries and is highly sensitive to any interruption of service from defective heartbeats, narrowed arteries, or leaking brain blood vessels. Regardless of cause, brain segments deprived of continuous supply die, causing functional loss of whatever that part serves—muscles, speech, memory, or emotion. Or everything. Because stroke can invoke images of fuzzy kittens, I prefer the more dramatic term “brain attack.” Just like a heart attack, it’s another medical emergency.
Other than trauma or inherited problems, the right angle of attack prevents brain attacks; sedentary lifestyle, poor diet, and bad habits all dramatically increase risk. Maintaining healthy weight, eating a varied diet low in salt and fat, engaging in regular exercise, avoiding smoking like the plague it is, and consuming adult beverages in moderation all reduce stroke incidence. Additionally, regular monitoring of your blood pressure, cholesterol, and lipids is wise. Remember, these are not just numbers; they define your chances for a healthy, active lifespan. Another tangible benefit of an annual physical includes your physician listening to noises made by your neck arteries; obstructions cause turbulent flow heard as a “bruit,” a whirring noise indicating further studies are probably necessary.
Brain attacks fall into two broad categories: ischemic and hemorrhagic. The former is where the volume of blood supplied to a chunk of your grey matter is reduced, often because of an arterial blockage by “atheroma,” thick, porridge-like deposits that gum up arteries. Alternatively, obstruction can be because of embolism, where a blood clot travels from one part of the body to another, often caused by irregular heartbeats called atrial fibrillation. A typical modern American lifestyle—fast food, too much time watching TV, increasing incidence of diabetes, and failure to monitor blood pressure—can cause atheroma and blood clots.
We all know the term “big head”—someone with an overinflated opinion of themselves. Unfortunately, our heads cannot enlarge, and if bleeding occurs in the brain as in hemorrhagic stroke, pressure is exerted on nerve cells—compounding the damage caused by lack of blood flow. Such bleeding either occurs within the brain substance, from a ruptured “berry” aneurysm (an out-pouching in the vessel wall), or below the arachnoid brain covering. The same medical advice applies, and if there is a family history of aneurysm tell your doctor.
Sometimes one gets warnings of brewing problems. Transient ischemic attacks (TIAs) are where the brain is episodically and temporarily compromised, presenting with symptoms like Amaurosis fugax (a real $100 phrase) or fleeting blindness. Never ignore indicators of potential doom such as TIA, or FAST: Face drooping on one side; Arm weakness; Speech difficulty, and do not waste Time—get ye to a nunnery. I mean a hospital, FAST, because if you do, a brain attack team can bust a gut to bust your clot, saving your brain in the process.
If your regular medical exam, AME, or attendance at a vascular screening event detects obstructed flow in your neck arteries, medical intervention can head brain attack off at the pass. Although it may take a while to get back in the air, requiring a complete evaluation of your ticker and vessels, it beats the alternative hands down.
As you might imagine, the FAA gets twitchy about pilots puttering about the skies with less than a full deck. As a result any loss of nervous system function makes the FAA nervous and is one of its specifically disqualifying conditions. Under no circumstances can an AME issue a certificate to a pilot reporting TIA or stroke; this requires a mandatory two-year grounding. However, if there is a defined and properly treated cause, special issuance after one year is feasible.
Phil Englishman, a director of the Canadian Owners and Pilots Association, told me that at age 63 in 2004, with no obvious risk factors, he suffered a major stroke that left him paralyzed and unable to talk. Yet with therapy and persistence he is now flying again with a Canadian Class 3 certificate. “Having a stroke was the beginning, not the end, of my life and I love flying,” he said. His persistence is an inspiration—never give up but believe that it can happen to you.
Currently 308 pilots are flying with first, 247 with second, and 919 with third class medicals after brain attack. One can recover significantly from stroke, but like recovery from an unwanted spin, avoidance is preferable. Count your strokes on the golf course and avoid them in the course of your life.
Dr. Jonathan M. Sackier will provide information on AOPA Pilot Protection Services at AOPA Aviation Summit in Palm Springs, Calif., Oct. 11 through 13. Email the author at firstname.lastname@example.org.
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