October 14, 2013
Going back to that Statistical Manual published by the Civil Aerospace Medical Institute in January 2013, I pulled the top five medical diagnoses and will give you those and let you know what you need to do to gain medical certification should you have one of these conditions.
The No. 1 medical condition (and it had been for as long as I was at the FAA) is hypertension (high blood pressure) on medications. This condition makes up 11.08 percent of the entire medically certificated airmen population. If you recall from a previous e-newsletter, I told you that this condition is now one of the CACIs (Conditions that AMEs Can Issue). Your aviation medical examiner (AME) has always been able to issue your certificate the first time you reported blood pressure medications, but under the CACI program, the required information is less than before. As long as you bring in a note from your treating physician that tells the FAA how long you have had the blood pressure problem, lists the current medications you are taking, gives a little about your immediate family history, and discusses whether you have developed any of the long-term side-effects of having high blood pressure, the AME may continue to issue you a medical certificate for any class. However, some AMEs still do not get it, so you may need to educate your examiner if he or she tries to defer your application. Your blood pressure in the AME's office cannot be higher than 155/95; if you have a tendency to have “nervous” high blood pressure, ask your treating physician to comment on the blood pressure values he/she has been obtaining in the office, in case your pressure is elevated when you are the AME’s office.
The second most prominent condition is miscellaneous allergic conditions (excluding hay fever and asthma). This makes up 6.55 percent of the total medically certificated pilots. These conditions do not generally require a special issuance, unless the symptoms are more severe. It is always advisable to hand-carry a typewritten letter from your treating physician to the AME's office at the time of examination, explaining the current condition and what treatments, if any, you are receiving. Remember to check the AOPA medication list prior to seeing your AME to make sure the medication is an acceptable one.
Number three is hernias of all types. A hernia does not require a special issuance unless it has not been repaired. The FAA will then likely request routine updates as some hernias can become “strangulated,” meaning the protrusion of tissue or bowel gets stuck in the hernia and could potentially result in gangrene. These conditions make up 5.25 percent of the airmen population.
Fourth is kidney stones, which make up 4.03 percent of the airmen population. As I have mentioned in numerous articles and talks, a solitary kidney stone does not require a special issuance and your AME may issue you a medical certificate. However, you need to bring in a letter from the physician, emergency room, or urologist who treated you. This letter needs to state what your symptoms were, where the stone was felt to be, what was done to assist with the stone passage, whether there is any evidence of stones that have not passed, and the results of what is called a “metabolic profile,” a series of lab and urine tests that can tell physicians if you may be “prone” to producing stones.
The fifth and last for today is a group of urological conditions that includes benign enlargement of the prostate gland and prostate cancer. These make up 3.79 percent of the airmen population. Even though the prevention folks have been preaching lately that physicians should not rely on the PSA level, most urologists today still rely on the PSA level! Other than your treating physician performing what is called a DRE (digital rectal examination), the only other way to diagnose one of these conditions is using the PSA level. Generally, when the level is elevated, the urologist will recommend a biopsy of the prostate gland. Benign prostate enlargement means there is no current evidence of cancer and it is usually treated with medications. I have discussed the treatment and management of prostate cancer and how the FAA manages it in recent newsletters.
Dr. Warren Silberman is the former manager of FAA Aerospace Medical Certification and a doctor of osteopathic medicine. A pilot since 1986, he is recognized nationally as an expert in aerospace/preventative medicine, and is a regular writer for AOPA’s Pilot Protection Services.
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