Class 1 Medical Certificate on Review Healthy Young Adult

T

Thomas L

Guest
Hey Pilots!

I’ve been aspiring to be a pilot for as long as I can remember. 2 years ago I started taking the steps to make that happen and I have ran into a wall in the home stretch.

I’m 23 years old, fit and healthy, with no known medical issues. Vision, BP, etc all checked out with the AME. Minor surgeries that are pretty standard: appendix removal, tonsils, and adenoids.

Whenever I was hospitalized for a procedure in 2017 I received a one time dose of Gabapentin with the intent to help alleviate stress and anxiety that comes post surgery from a hospitalization.
Whenever I took my medical this week and it was sent to special considerations because of this occurrence that happened when I was 17 years old.

Has anyone had a similar circumstance? How long does the process take typically for an approval/denial? I’m in no rush as I have my entire life to fly- but I want to seek out my peers experiences so I can plan accordingly.

What can I do on my end to be ahead of the FAA?

*The MedXPress website says 30 days but most reports I’ve read conclude at 6 months or longer.*
 
How do you know you were anxious for a procedure? And a one time dose? Interesting how clear your memory is about that. But I’m sure there’s a pathway and someone else will be contributing to this thread soon.
 
Thomas L said:
Hey Pilots!

I’ve been aspiring to be a pilot for as long as I can remember. 2 years ago I started taking the steps to make that happen and I have ran into a wall in the home stretch.

I’m 23 years old, fit and healthy, with no known medical issues. Vision, BP, etc all checked out with the AME. Minor surgeries that are pretty standard: appendix removal, tonsils, and adenoids.

Whenever I was hospitalized for a procedure in 2017 I received a one time dose of Gabapentin with the intent to help alleviate stress and anxiety that comes post surgery from a hospitalization.
Whenever I took my medical this week and it was sent to special considerations because of this occurrence that happened when I was 17 years old.

Has anyone had a similar circumstance? How long does the process take typically for an approval/denial? I’m in no rush as I have my entire life to fly- but I want to seek out my peers experiences so I can plan accordingly.

What can I do on my end to be ahead of the FAA?

*The MedXPress website says 30 days but most reports I’ve read conclude at 6 months or longer.*
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What do you mean it was sent to special consideration? Did the AME defer the application? How did her become aware that you had one dose of this medicine six years ago?
 
Lindberg said:
What do you mean it was sent to special consideration? Did the AME defer the application? How did her become aware that you had one dose of this medicine six years ago?
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They specifically asked what medications I was given during that period and I gave the appropriate answers. I was told by the nurse it was being deferred and when I asked if that’s standard she said it pertains to a special consideration due to the medication I *allegedly* took one time and was observed by health professionals during that period.
 
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I am aware of Gabapentin from people close to me. I am surprised to hear of it being used to relieve anxiety. I would question if something else is going on based on the use of this particular drug. It would not surprise me if the AME / FAA could have a similar thought?
—
On the other hand, I am not a Doc. So what do I know. Lol.
 
Gabapentin is a seizure medication. Even off label usage is mandatory FAA review.


Gather all medical documents related to the procedure and medication, you’ll likely be getting a letter in the mail asking for those records; you’ll be given a very short response time.
 
TommyAdventurous said:
They specifically asked what medications I was given during that period and I gave the appropriate answers. I was told by the nurse it was being deferred and when I asked if that’s standard she said it pertains to a special consideration due to the medication I *allegedly* took one time and was observed by health professionals during that period.
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What was the reason for the hospitalization? I've been hospitalized, had ER visits, surgeries, etc. I've never been asked to list all meds given during a hospitalization or procedure. I'm wondering if there's not some concern based on your diagnosis.
 
I
Lindberg said:
What was the reason for the hospitalization? I've been hospitalized, had ER visits, surgeries, etc. I've never been asked to list all meds given during a hospitalization or procedure. I'm wondering if there's not some concern based on your diagnosis.
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it was to have my appendix removed, not a crazy procedure.
 
TCABM said:
Gabapentin is a seizure medication. Even off label usage is mandatory FAA review.


Gather all medical documents related to the procedure and medication, you’ll likely be getting a letter in the mail asking for those records; you’ll be given a very short response time.
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Give that this was almost 8 years ago and was from when I was a minor, I do not have those records readily available or even remember the hospital the procedure was done at (I was rushed there from a urgent care center). The only reason I remembered this medication when asked if because read up a ton on it before taking it. I refuse to take something that can make me “high” and the hospital wanted to give me Xanax, gabapentin was their alternative.
 
TommyAdventurous said:
I

it was to have my appendix removed, not a crazy procedure.
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Ok then, that's just weird. I had a class 2 exam literally a month after an appendectomy, and all the AME wanted to know about it is that I was healed and had no limitations. Zero questions about what medications I was given. Obviously I was given drugs on the "no fly" list before, during, and after the operation, but wasn't taking any by that time. How would you even be expected to remember after 8 years? This seems like one of those situations where you could have benefited from a consultation (and possibly using a different AME) even though you're "healthy."

It sucks you're dealing with this, but as reported, you should ultimately be ok. Gabapentin is on the no fly list, but the fact that you took it 8 years ago shouldn't be an issue. You might have to jump through some hoops to clear up what exactly the "anxiety" was.
 
TommyAdventurous said:
Give that this was almost 8 years ago and was from when I was a minor, I do not have those records readily available or even remember the hospital the procedure was done at (I was rushed there from a urgent care center). The only reason I remembered this medication when asked if because read up a ton on it before taking it. I refuse to take something that can make me “high” and the hospital wanted to give me Xanax, gabapentin was their alternative.
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Ask mom/dad if they know. Did you have any follow ups with your regular doctor? There may be information there, as well.

Remember, all the FAA knows about you is what’s on the application in black and white and what, if any, information you provide them if they ask about it. That’s all they have to go on when determining if they can certify your medical history as fit for aviation.
 
Lindberg said:
Ok then, that's just weird. I had a class 2 exam literally a month after an appendectomy, and all the AME wanted to know about it is that I was healed and had no limitations. Zero questions about what medications I was given.
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Similar for me. Different surgery and Class 1.
AME did not ask anything remotely about what drugs I took prior to, during or after the surgery. My response would have been along the lines of “How would I have any idea?”. Maybe it is a cognitive failing on my part but I have no recollection of anything that is not documented. And I do not provide any documentation save for that which is explicitly requested.
 
Mongoose Aviator said:
I am aware of Gabapentin from people close to me. I am surprised to hear of it being used to relieve anxiety. I would question if something else is going on based on the use of this particular drug. It would not surprise me if the AME / FAA could have a similar thought?
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Gabapentin does many things, including control nerve pain, which is why it is used for (diabetic and other) neuropathy. It has a slight sedative effect in high / acute doses, so it's not routinely used as an anxiolytic, but it's not out of the ballpark.

All that said, my best guess as to what happened is, over the past decade or so, in the context of the opioid epidemic, there has been a big push in operating rooms to try to minimize the amount of opioid used for surgery, by throwing as many "adjunct analgesics" (other **** that decreases pain) at the patient in addition to a (hopefully reduced) normal dose of opioids. For a good portion of that effort, gabapentin was seen as low-hanging fruit in the "adjunct analgesics" realm -- it reduced pain scores, seemed to decrease the amount of opioids required, hopefully reduced the instance of chronic post-surgical pain, and was believed to have few side effects. Lots and lots of patients got a dose around surgery hoping to achieve those goals. [1, 2]

Further experience wound up showing that gabapentin did reduce acute post surgical pain a little bit, but not enough to matter clinically, and with no effect on chronic post surgical pain. It also did, rarely but significantly, cause respiratory "events" and ICU admission, probably by over-sedating patients, and fell out of favor. [1, 2, 3]

All that to say, it's not super odd that they gave you a dose of gabapentin while you were admitted for an appendectomy. It's a little odd that it was communicated (or miscommunicated) that it was for anxiety. It's quickly falling out of favor as "the done thing," but it was briefly quite popular for operative pain depending on where you were.
 
Gapapentin is a poor anticonvulsant and is rarely used for seizure control. It however is frequently used for pain control. Initially this was for chronic pain issues but recently, over the last five or so years, it is being used for acute pain control, typically being prescribed in low doses but primary care docs. Likewise, it is commonly used preoperative as part of a cocktail for perioperative and immediate post operative pain control. This is being done as a standard protocol order at many hospitals and surgery centers.

This should be a non issue for the original poster, but I am not an AME, and I have had some interesting issues with helping some of my patients jump through the hoops presented by the FAA, but on the other hand have seen the opposite where I thought we would have problems and it was 3asy. A letter from the surgeon or anesthesiologist stating why it was used may help.

I would also take this as a warning for anyone having a procedure under anesthesia to make sure it does not affect your medical adversely.
 
douglas393 said:
Gapapentin is a poor anticonvulsant and is rarely used for seizure control. It however is frequently used for pain control. Initially this was for chronic pain issues but recently, over the last five or so years, it is being used for acute pain control, typically being prescribed in low doses but primary care docs. Likewise, it is commonly used preoperative as part of a cocktail for perioperative and immediate post operative pain control. This is being done as a standard protocol order at many hospitals and surgery centers.

This should be a non issue for the original poster, but I am not an AME, and I have had some interesting issues with helping some of my patients jump through the hoops presented by the FAA, but on the other hand have seen the opposite where I thought we would have problems and it was 3asy. A letter from the surgeon or anesthesiologist stating why it was used may help.

I would also take this as a warning for anyone having a procedure under anesthesia to make sure it does not affect your medical adversely.
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Lesson learned for future medications.. I have requested a note from my Doctor the prescribed it. Is there a certain way it should be structured to be most appealing to the FAA? Should I send it in before they even review my initial application? What information should this note include?
 
I would suggest to wait and hear what the FAA has to say.

I understand that forums are ripe for misunderstandings and many people have various languages as their primary. That being said, reading the specific posts from the OP and how they are worded leaves a great deal of questions.

I would STRONGLY suggest a CONSULT with an AME to discuss this further and come up with a real solid game plan.

Alternatively, it is faster and cheaper to listen to sgoti. At the end of the day you get to decide how you want to approach this.
 
TommyAdventurous said:
Lesson learned for future medications.. I have requested a note from my Doctor the prescribed it. Is there a certain way it should be structured to be most appealing to the FAA? Should I send it in before they even review my initial application? What information should this note include?
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Based on what you've told us, there was no apparent reason for the AME to inquire about this drug and no reason for him to defer your application. So either there's information we lack or your AME many have goofed. Without knowing more, you might just be well suited to wait and see what you hear from the FAA. You might also ask your AME for a copy of what he put in his notes to the FAA or at least to discuss it with him, since it seems you've only discussed this with his nurse.
 
Mongoose Aviator said:
I would STRONGLY suggest a CONSULT with an AME to discuss this further and come up with a real solid game plan.
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It might be worthwhile to discuss with the AME who did the exam, but at this point any other AME would have to defer him because of the earlier application.
 
SixPapaCharlie said:
My oldest dog takes gabapentin regularly but it's not for anxiety. He has really bad hip dysplasia.

How are your hips?
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One of my running partners had to go to the doctor for hip dysplasia. She didn't know she was going to end up with the same condition as her German Shepherd.
 
#15 is exactly right. There’s pressure to use something, anything, instead of narcotics. They didn’t want to give you Gabapentin in place of Xanax; they hoped it would decrease or eliminate your need for narcotics. It didn’t, because it never does.

And I have to chuckle a little that you expressly refused anything that would “make [you] high.” I’m going to pull your chain a little and say it’s because you were 17 and didn’t want to take anything that might make you say things in front of your mom!
 
OneCharlieTango said:
#15 is exactly right. There’s pressure to use something, anything, instead of narcotics. They didn’t want to give you Gabapentin in place of Xanax; they hoped it would decrease or eliminate your need for narcotics. It didn’t, because it never does.

And I have to chuckle a little that you expressly refused anything that would “make [you] high.” I’m going to pull your chain a little and say it’s because you were 17 and didn’t want to take anything that might make you say things in front of your mom!
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Reading into my records it appears this is exactly what was written by the doc. For your side note: I don’t consume any type of alcohol or narcotics that may alter brain chemistry because I am not comfortable with that cognitive dissociation. My parents didn’t care much as long as you were honest, that doesn’t mean I exploited that.
 
flyingron said:
One of my running partners had to go to the doctor for hip dysplasia. She didn't know she was going to end up with the same condition as her German Shepherd.
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A few years ago the previous dog was prescribed something that I was taking over the counter. I asked the vet if I could share my cheaper OTC with the dog.
 
The onetime rx is considered to be a part of the surgical encounter. The rub is if you had ANYTHING “anxiety” prior in yot record. That then becomes recurrent disease…..a totally different beast.
 
murphey said:
A few years ago the previous dog was prescribed something that I was taking over the counter. I asked the vet if I could share my cheaper OTC with the dog.
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I got a call from the vet that one of my cats (not one I liked, it was abandoned by a former roommate) had diabetes and needed to be given insulin. They wanted me to come in and learn how to do it. I asked if it was any different than giving it to a child. They had no idea. I told them I'd a diabetic child so we were quite adept at giving the shots. They still made me come down. It was even easier on the cat. The fat thing didn't even notice (other than wondering why I was grabbing at it). Of course, one day I gave the cat some of my stepson's fast acting insulin that had been left in our fridge. I called him and asked what he thought. He said make sure it eats. Sure enough the thing was chowing down like crazy.
 
Thomas L said:
Gabapentin with the intent to help alleviate stress and anxiety that comes post surgery from a hospitalization
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I'm still trying to understand how we get from "I needed some medication to help w/ my Anxiety post surgery" to "It was probably just a misguided attempt to help w/ pain".

After various surgeries, I have never doubted the after medication they gave me was for pain. I never confused them for anti-anxiety meds. Nor have I been offered post op anxiety meds. Seems weird to me.

My guess is that the OP is a normal example of his generation where feelings of anxiety are a common thing (especially w/ the help of covid) and he made the mistake of being chatty with the AME which lead to the rabbit hole which led to here. I find it hard to believe that the AME went down the rabbit hole completely unprompted.

Regardless of how you landed here, I wish you the best of luck and hope this is able to clear up as easily as possible.
 
Guest User said:
My guess is that the OP is a normal example of his generation where feelings of anxiety are a common thing (especially w/ the help of covid) and he made the mistake of being chatty with the AME which lead to the rabbit hole which led to here. I find it hard to believe that the AME went down the rabbit hole completely unprompted.
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There are many apparently generational things that are unacceptable for aviators- or that just need evlauation.

Here's a comment from a recent captain:

"At my airline, a new hire, not even through IOE was jump seating out of ORD. He was talking on his cell in the jumpseat while the crew (the jumpseater is actualy part of the crew, "officially".....STERILE CABIN @ < 10K, right?) so the captain asked him to terminate tht call. He did not. New hire was fired."

Same airline, different captain: "FO was texting during a captian sim ride. Sim Captain asked him to stop. FO replied, "this is how we communicate, Boomer". FO no longer works in the industry".

I'm always wondering how the "what do I have to do to get this right" thinking went out the window....So I too think it hard to believe that an AME went down the rabbit hole without prompting.
 
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I'm amazed to hear that there are airline-crew trainees who think it's OK to disobey the captain in a situation like that!
 
Palmpilot said:
I'm amazed to hear that there are airline-crew trainees who think it's OK to disobey the captain in a situation like that!
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I have trouble imagining how they made it that far given the underlying personality issue required to tell the Captain to **** off.
 
I work with a whole lot of people who are a whole lot younger than me.
Palmpilot said:
I'm amazed to hear that there are airline-crew trainees who think it's OK to disobey the captain in a situation like that!
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I'm not. Not at all.
Mongoose Aviator said:
I have trouble imagining how they made it that far given the underlying personality issue required to tell the Captain to **** off.
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I don't.
 
I’ve got a student who spends the class period while I’m lecturing or in a group activity playing computer games, doesn’t even try to hide it. Wednesday he gets a private email offering to let him withdraw with no penalty since his game time is more important than working on his degree.
 
bbchien said:
There are many apparently generational things that are unacceptable for aviators- or that just need evlauation.

Here's a comment from a recent captain:

"At my airline, a new hire, not even through IOE was jump seating out of ORD. He was talking on his cell in the jumpseat while the crew (the jumpseater is actauly part of the crew, "officially".....STERILE CABIN @ < 10K, right?) so the captain asked him to terminate tht call. He did not. New hire was fired."

Same airline, different captain: "FO was texting during a captian sim ride. Sim Captain asked him to stop. FO replied, "this is how we communicate, Boomer". FO no longer works in the industry".

I'm always wondering how the "what do I have to do to get this right" thinking went out the window....So I too think if hard to believe that an AME wend toown the rabbit hole without prompting.
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This occurs in many places and it is not generational. It is cultural and the new norm. In the operating room nurse anesthetists and physician anesthesiogists spend more time on their cell phones than administering to their patients, same with floor nurses, icu nurses, er nurses and docs. Driving. How often do you see drivers on their cell phone, I have seen the occasional motor cyclist and bicycle rider on their phone. Go to a restaurant and look at the tables next to, most of the patrons are on their phones. I went to a meeting a year ago in the same city I went to college in. Went to some of old haunts. At everyone of them there would be tables of students from my old school, the difference was when I went to these places we were drinking and talking, now they were drinking and texting or surfing the web. The only good thing about it was I could hear my girlfriend talk!
 
murphey said:
I’ve got a student who spends the class period while I’m lecturing or in a group activity playing computer games, doesn’t even try to hide it. Wednesday he gets a private email offering to let him withdraw with no penalty since his game time is more important than working on his degree.
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I always announced in the first class of the semester that if I saw someone on their cell phone during the lecture I would call on them to further explain what I had just said.
 
Palmpilot said:
Technology addiction is real. :(
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I'll bet those of us in the high-tech industry avoid tech unless necessary when we're away from work. I was at PT this morning, 5 sitting in the lobby waiting, I was the only one NOT on the cell phone.
 
OneCharlieTango said:
#15 is exactly right. There’s pressure to use something, anything, instead of narcotics. They didn’t want to give you Gabapentin in place of Xanax; they hoped it would decrease or eliminate your need for narcotics. It didn’t, because it never does.

And I have to chuckle a little that you expressly refused anything that would “make [you] high.” I’m going to pull your chain a little and say it’s because you were 17 and didn’t want to take anything that might make you say things in front of your mom!
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I had wrist surgery when I was 17. The nurse asked where to send the rx. I asked what it was for. One was anti-inflammatory, the other was oxycontin for pain. I refused the oxy. Nurse was stunned. Then adamant I take them just in case. Told her I had a similar surgery on the other wrist and I won't need them.
 
It doesn't take long in a surgical practice to devise methods to keep patients from calling in the middle of the night because of pain once a local anesthetic wears off. So most docs instruct the nursing staff to encourage patients to fill the prescription just in case. (Don't get me started on how the Sacklers instituted a program of "educating" nurses that pain was not being managed correctly). I tried to get our hospital to dispense pain meds for one or two nights and have the patient call during the daytime if their pain wasn't controlled. Hospital administration wouldn't do it. ("We're not a pharmacy!")
 
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