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Pilot Protection Services Medical Mailbag - November Q&APilot Protection Services Medical Mailbag - November Q&A

Warren Silberman

Warren Silberman

  • Former Manager, FAA Aerospace Medical Certification 
  • Doctor of Osteopathic Medicine 
  • Expert in Aerospace/Preventive Medicine 
  • Pilot since 1986

Jonathan Sackier
Jonathan Sackier

  • Surgeon, Clinical Professor 
  • 30 years of healthcare experience 
  • Author of the “Fly Well” column in AOPA PILOT 
  • Flying since 15 years old, owns a Columbia 400 

QUESTION: I was diagnosed with two leaky heart valves disease last year, FAA received the medical chart and I was granted my Class 1, without a special issuance. However, a recent echocardiogram showed "moderate to severe regurgitation". I have voluntarily stopped flying pending further examination. I have a TAA scheduled in two weeks. The cardiologist does not think the gradient is beyond a 3. Am I going to need a special issuance? I fly professionally and maintain a class 1 but retiring and flying my personal airplane is an option I have at this point, requiring a class 3. Would the FAA's requirement to maintain a 3rd class medical be less than a class 1 with this condition? Would It be easier just to go with a class 3?

ANSWER: It is always difficult to address complex medical issues with limited information, another good reason to join Pilot Protection Services so that when medical problems do arise you have someone in your corner to guide you through the bureaucratic maze that is FAA! There are four valves in the heart that ensure blood flows in the right direction; broadly speaking the diseases that afflict the valves either cause limitation of flow from stenosis or reversed flow or regurgitation or incompetence. Treatable by surgery, valve replacement is one of the FAA's 15 Specifically Disqualifying Medical Conditions. In general Mitral valve prolapse will require a special issuance if there is regurgitation If valve disease occurs in the presence of atrial fibrillation, the most common heart rhythm disturbance, that may lead to a denial. If valve disease can be "related" to cause AFIB, that may lead to a denial, but special cardiology consultation will be required to stand any chance - this would be needed for good medicine anyway! Aortic Stenosis will result in a denial and ultimate requirement for valve replacement (in order to obtain potentially obtain recertification) when the mean pressure gradient across the valve is 40 mmHg or greater and/or the valve area is less than one square centimeter. Aortic Incompetence will likely result in the requirement for yearly 2 dimensional echocardiograms. Valve repair results in yearly follow up requirements and it falls under the AME Assisted Authorization for Special Issuance which means after the "initial" certification by the Medical Certification folks, the AME is granted written permission to issue the airman providing they meet certain set criteria.

QUESTION: I’ve tried to check into issues with temazepam, a benzodiazepine sleep drug. The AOPA site mentions “non-benzodiazepine” drugs but don’t say that a “…benzodiazepine drug is not allowed.” What is FAA's stand on benzodiazepine drugs?

ANSWER: We all need to get a good night's sleep - taking the left seat when tired is never a good idea. If one is having issues with sleep it is important to exclude other things going on - sleep apnea or stress imposing on one's rest. As for the use of sleep medications such as the Benzodiazepine class of drugs (e.g. valium) the FAA stand is simple; they are NEVER ACCEPTABLE. If an airman should happen to take one, they must wait 5 dosing intervals before they can fly.

QUESTION: Due to recent thyroid surgery I now have hyperparathyroidism. In the presence of hyperparathyroidism is it difficult to get a special issuance if I have no history of low calcium symptoms and good status report from my physician? Additionally, I also have acquired hypothyroidism, hyperlipidemia, and non-insulin treated type II diabetes. All conditions are under control with a good status report from my treating physicians. Would the shear number of conditions make getting the special issuance more difficult?

ANSWER: The thyroid is an organ located in the neck and it produces hormones that are rather like the throttle in our aircraft, they set the speed our metabolism runs at. On occasion the gland needs to be removed either due to cancer, over activity or other reasons and patients then receive replacement thyroid hormone therapy. Embedded within the thyroid are four parathyroids that produce hormones to control calcium metabolism, important to bone and kidney health among other things. Firstly you will be relieved to know that hyperparathyroidism (low levels of parathyroid hormone) is not an issue. FAA will need to know how the doctors discovered the problem and will require the operative and pathology reports as well as a current status report including serum calcium and phosphorous levels. For the hypothyroidism, (low thyroid hormone levels) FAA will need to know medication type and dose as well as blood levels of thyroid stimulating hormone (TSH) level. Diabetes is unfortunately a common and growing problem and one we have addressed many times. I commend aviators with questions on this topic to peruse the AOPA website where there is plenty of information. Finally, the number of problems is not an issue, just ensure each one is properly treated, carefully documented and submitted to FAA. Again, Pilot Protection Services exists to support airmen (and women!) in this regard.

Fly Well! Jonathan & Warren

Fly Well!  Jonathan & Warren

Jonathan Sackier

Jonathan Sackier

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

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