Fly Well: Who pays the Piper?

As Piper, that famous and storied aviation brand, celebrates its seventy-fifth birthday, perhaps it is a good time to ask yourself, will I reach that milestone? Statistically, the most likely reason to fail to age into your seventies is vascular disease; arteries in the heart or elsewhere develop blockages, tissue downstream becomes starved of nutrients and oxygen, arterial walls eventually harden (atherosclerosis)—and, like an arrow to the chest or tomahawk blow to the head, pain may be followed by two column inches in your local newspaper.

The most common reason for interrupted blood flow is excess circulating fats (lipids) called hypercholesterolemia. Although lipids such as cholesterol help normal bodily function, as in all things, balance and weight are important. Some are born with familial hyperlipidemia, and are predisposed to high fat levels. Certain races, including African Americans and Hispanics, have increased likelihood of cardiovascular disease.

High density lipoprotein (HDL) is “good” because it eradicates low density lipoprotein (LDL) or “bad” cholesterol. The sum of these equals total cholesterol. Excess calories, alcohol, and sugar are converted into triglycerides, another unhealthy fat, which is then stored in fat cells.

Just as you know your aircraft V numbers—stall speed in landing configuration, for instance—you should know your fat numbers. A family history of heart attack, stroke, or high lipid levels begs baseline screening beginning in youth, but everyone should start at 20, checking levels at least every five years, increasing in frequency with age. Guidelines are: LDL 70 to 130 (low is good), HDL 40 to 60 (high is good), total less than 200 (the lower the better) and triglycerides 10 to 150 (low is ideal). Although high fat levels might cause subtle visible signs during an eye examination, such as detecting a glistening plaque inside retinal blood vessels, the blood tests are much more reliable. For the detectives among you, keep alert for a gray ring in the eye (arcus cornealis); while common and benign in the elderly, if present in younger folk it merits a blood test. Xanthelasma, a yellow bump near the eye, may also imply raised cholesterol.

For those not born with a lipid disorder, preventing heart attack, strokes, or other circulatory problems is totally under your control. First, reduce fatty foods, especially saturated fats such as those found in eggs, dairy products, and red meat. Certain foods actually help reduce bad fat levels; oatmeal is one and makes a fabulous breakfast, as long as you skip the cream. Bran, oily fish, almonds and walnuts, fruits, vegetables, and other grains also are good; weight control is critical and exercise helps. Although garlic, lecithin, and even vinegar have been proposed as home remedies, I am not convinced by the evidence. Take a cue from the Piper Skycycle and rather than just lie on the beach at Malibu, try a bicycle ride. A puff of smoke from a Cheyenne exhaust on engine start is fine; any puff of smoke into your lungs is disastrous—quit now. Although smoking does not elevate cholesterol, it renders you more likely to problems by reducing “good” HDL levels.

If diagnosed with elevated cholesterol levels, follow medical advice closely—these numbers are as vital to your survival as knowing VNE. Your doctor may look for related conditions—diabetes, kidney problems, underactive thyroid, and in women, pregnancy and a type of ovary disease. A number of medicines can raise cholesterol levels including certain antidepressants, oral contraceptives, and some blood pressure pills. In addition to lifestyle changes, your doctor may recommend medication. Most often prescribed are statins (e.g., Lipitor, Crestor), which reduce heart-attack risk. Keep alert to side effects and report to your doctor promptly; sometimes surveillance blood tests are recommended. Other medications absorb fat or interfere with its manufacture. Once on therapy, it is important to comply, which can be tough when there are no symptoms: remember, the only indication you have elevated cholesterol may be a trip to the ER. If prescribed medications, you must report this to your AME, although test results and a waiver are not required. Currently all lipid-lowering medications are acceptable to the FAA.

AOPA Pilot Protection Services (PPS) provides information and resources to keep medical and legal problems at bay that might otherwise impede our freedom to fly. PPS helps you be a Warrior in tackling your adversary. You started life as a Cub, so be a Chieftain—and if you keep your pipes clean you will not have to pay the Piper—just fly one.

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through the AOPA Pilot Protection Services plan. Email [email protected].