Disappointed

[freenrgy2]

Posts removed as Dr. B is allowed write whatever he wants, the community will defend him but I am not allowed to refute anything he says with facts.

Sucks being the new guy.

 

[mscard88]

It's an area that people don't think about. Why would they if no one advised them beforehand? So they undergo a flight physical and something is found. I wouldn't lose hope. What did Dr Chien say? You're certainly better asking and/or listening to him as he is the expert and very knowledgeable. You'll get replies here, some ridiculous, some good, and maybe a few from folks who have the same or similar condition as yourself.

Work with Dr Bruce, he is your best resource. I hope you get through this and fulfill your dream of finally becoming a pilot. Good luck.

 

[Lachlan]

You were within the 10 year window since your last 3rd class cert was issued. You could have gone with Basic Med, right?

 

[Rushie]

Hindsight is 20/20. We've all learned through this forum (and personal first hand experience) the things that Bruce told you. A really good AME like him would not have submitted the application until you had obtained those things that the FAA is now going to ask for. That would have avoided the delay. I think you're going to end up getting issued but you will just have to navigate some hoops.

 

[SkyHog]

Yeah, I think so too, but at what cost. As Bruce said....it's MY stone(s). LOL. I just want someone to tell me, YES, the ultrasound (much cheaper) would be acceptable proof vs. the much more expensive CT scan, even though the CT was used as the initial diagnosis modality.

It wasn’t for me, but it appears that everything for me was different than most people’s experience.

But if the FAA asks for the KUB, get the results. If they ask for a CT, get that instead.

Then never play the game again and do BasicMed in the future.

 

[injb]

Background:

...

Bruce's comment made me feel that I should have had this knowledge before I walked into the AME's office last night. Maybe I should have?

...

Yes, but you didn't really have any way of knowing that. Lots of people make it sound like it's no big deal, because it wasn't for them. I was given the impression by my instructor and others that it's "easy" to get a medical certificate, "practically anyone" can get one etc. etc. Yes, it's super easy if you don't have anything in your history that the FAA cares about! If you do it can be a pain. It ended up taking me months and I was never completely sure that it was even going to happen until I got it. All over stuff that happened years ago. Luckily for me I tend to research things on the internet all the time anyway so I was prepared, but I feel sorry for anyone who trusts what they hear from people who were lucky and had no issues.

Good luck - you're in good hands with Dr. Chien anyway and I would take his advice over anything you read elsewhere.

 

[bflynn]

You know the deal - one time kidney stone and nothing now, you'll get approved. If you have a stone now, then you'll have to do more future testing to show the stone is stable. If so, you'll pass. If not, you'll be denied.

If you are making stones and denied now, I'm pretty sure you can still reapply later. You'd work with your urologist to figure out what is causing them and eliminate them. If your'e stone free with the cause of stones identified and eliminated then you should be able to still get back.

A lot of expensive testing in the future.

 

[murphey]

I have the advantage of a current 3rd class. Had 1 stone, removed surgically in 2014. Emailed Dr Bruce, got the shopping list. Got the letter from the urologist. Got another letter from the nephrologist. Had all the doctors involved fax releases and reports to Dr Bruce. Flew to Peoria to see Dr Bruce. Left 90 min later with a new Class 3. Worth every penny. Going local this year because everything is previously reported and I have current tests to back up any questions.

[updated 12/3/17]

I brought my checkbook with me to Peoria. I had cash, but Dr Bruce was happy with a check. I have no qualms or reservations about paying for any type of service or product. Dr Bruce is in business and deserves a fair remuneration for his expertise and services. I don't work for free, why should he?

[We now return you to our regularly scheduled programming]

Regardless of the snottiness and just plain hostlity that erupts around here at rare times, POA really is an invaluable resource. Two or more expert AMEs, many A&Ps, the owner/retired owner of one of the best engine shops anywhere, a few controllers...not too shabby.

 

[jordane93]

Hopefully it all works out for you. My dad’s been out on medical leave at Delta for 8 months now due to high blood pressure. He’s just waiting on the FAA to clear him. Of course they’re working at snail pace.

 

[murphey]

First, let me say that Dr. Chien has been great helping me navigate the waters of a first-timer having issues with a medical. He's been very responsive and I appreciate his advice and guidance immensely.

Basically, I was told that if a urologist looked at the CACI worksheet (prior to my attempt at getting the 3rd class), he would have more than likely checked the boxes, signed and I would have submitted this to the AME at the time of the exam.

Now I have to wait on the FAA to TELL ME WHAT TO DO, what documents or exams they will need. Funny thing is, I was planning to go see a urologist for these stones anyway. I've never been to one and figured I needed to start seeing one at my age.

I'm completely aware at how an acute kidney stone attack could make for a very bad day at altitude, and I'm more than willing to take care of it. It's just feeling like the AME screwed me over by going ahead with the exam and deferring to the FAA. I mean, did he really need my $80 that bad?

Regarding this wacky CACI form, Dr. Chien says that the urologist will check the boxes and sign the form. I'm a little confused on this. There is no signature line on this "worksheet." Would they just check the boxes in the ACCEPTABLE CERTIFICATION CRITERIA column? See attached worksheet.

What you see is one of many pages in the FAA medical guidebook. The AME has an electronic version that he/she works on, not what you see. Think of it as a huge PDF form. When everything that relates to your application is reviewed and checked off, the AME signs the whole thing electronically. Dr Bruce gave you a copy of the page so you could see the criteria to work with when you see your doctor to make sure you have all the tests and paperwork when you walk back into the AMEs office.

Trust Dr Bruce.

 

[EppyGA]

Did the AME sign into your MedExpress or was he just looking at the summary that you printed out and gave him first?

 

[Bill]

Hopefully it all works out for you. My dad’s been out on medical leave at Delta for 8 months now due to high blood pressure. He’s just waiting on the FAA to clear him. Of course they’re working at snail pace.

OP, follow Dr Bruce, he's one of your best bets at getting to the finish line. I'm another person who is trying to get my one time SI 3rd class so I can do BM going forward. Regarding snails pace, I'm at nearly 14wks from submission and I'm "still in the review process" per my call to AMCD today. Snails pace indeed.

 

[Walboy]

Hopefully it all works out for you. My dad’s been out on medical leave at Delta for 8 months now due to high blood pressure. He’s just waiting on the FAA to clear him. Of course they’re working at snail pace.

Not to derail the OP's thread, but I thought controllable HP is no big deal. Maybe it's due to being a 1ST class medical?

 

[AggieMike88]

I guess once he starts his part, he can't stop?

Kinda sorta....

When you fill out your side, a confirmation number is generated when you submit the information. And you're provided the opportunity to print the page (major hint: print this to a PDF file and keep that. Makes things much simpler when you submit in future).

By handing over the printed page with the number, you allowed the doc or his staff to open up the file and make the exam go live. Once the exam is live, the only options are issue in office, defer to OKC, or deny.

If you had trimmed that number off of the page and withheld it during the exam, the doctor or staff cannot open up the file to go live. The doctor can conduct a consultative exam doing all activities that are part of a live exam. If he says that all is okay, then he can issue your certificate in office once your surrender the confirmation code.

But in a case such as yours, when a showstopper is found, the exam remains consultative. The doctor can then advise you on how to proceed so office issuance is assured once you return with all the required tests, status letters, and lab documentation. And the exam remains "off the record" as far as the FAA is concerned.


Unfortunately, the tip of withholding the confirmation code is not well known amongst the masses, and prospective and existing pilots get stung like you did.

 

[genna]

Ultrasound will probably not be enough. It's not even enough for urologists,. Usually they just use it to see if they need to look into it further. Simple X-ray(KUB), however, should be sufficient for FAA. This and a letter from your urologist that you have no stones now or whatever stones you still have are small, not growing, and in a low risk location to pass. Do not do CT unless FAA asks you to do so. It basically depends on what FAA will request of you. You will get a special issue(SI) 3rd class and the next time can do Basic Med. This is my story basically(just a lot more SIs before BasicMed). If you have medical insurance, all of this is covered typically.

 

[AggieMike88]

No disagreement there....

Which is why Dr. Bruce's way of doing the exam is the better one: First 5 to 10 minutes of the exam, Run through the medical history questions, digging a little deeper if needed. If the way is clear, THEN make the exam live and proceed. If not, don't make it live, and proceed as consultative exam.

Unfortunately too many AME's of the land don't or won't do this.

 

[AggieMike88]

Look, just trying to same some money by only having the necessary tests done.

A resource that is not yet mentioned is your Regional Flight Surgeon. Most have a someone in the office that might help answer the question of "what tests are needed for my case so I can get approved".

Several others here have used the RFS's for various needs and can share their stories and results.

 

[flyingron]

Yeah, some AMEs are turds. I got grounded for about 12 weeks back in 2002 or so because not only was my AME an idiot, but also a liar (AOPA medical told me to have him call the RFS which he said he did but the RFS has no record of it and it would have ended there if he did), and also based on subsequent conversations with Dr. B over the years did other things that probably should result in the designation being pulled. Fortunately, the RFS was very helpful in helping me get this resolved. She was able to read the little letters at the bottom of my letter from Joklahoma City and get me directly to the guy handling my case and got an SI issued (it took a couple of years and prodding by a NEW AME to get the SI rescinded as I never actually had the condition it was issued for in the first place).

 

[jordane93]

Not to derail the OP's thread, but I thought controllable HP is no big deal. Maybe it's due to being a 1ST class medical?

Not sure. I think it was really bad. AME told him to get off the meds for a little and report back and it worked. He got the union involved and they basically haven’t done anything. I’d say it will still be at least another few months before he’s cleared.

 

[EppyGA]

I was told I had to use MedExpress so, yes, that is what the AME was using. I guess once he starts his part, he can't stop?

Unfortunately, correct. It's good to have a AME that will read over the summery before starting anything and let you know up front there will be problems. Sorry that you have to go through this now.

 

[genna]

I probably burned my bridge with Dr. Bruce. He's been great and maybe I'm thick-skulled, but I wanted exact, specific things I am going to need to do. I realize that the FAA is going to have to tell me. I just wanted to know if I was going to need to ask for a $500 test or a $5000 test. His response to me was that he's told me the same thing 6 times and I'm not getting it and he has paying airmen to attend to.

Really I get it. But, when he comes back with "if a KUB was done BEFORE the CT and it found something, then it can be used...blah blah blah" and I tell him several times that I never had an ultrasound prior to the CT, then where is the disconnect???? It sounds like he wasn't reading the details of my specific case and applying some general criteria.

I've read other posts here that say if only a CT was done, then that's what will be required. Look, just trying to same some money by only having the necessary tests done.

I'm not entirely clear if you think ultrasound is the same as KUB. KUB is Xray. A lot cheaper than CT. And, as i mentioned, should be nearly completely covered by pretty much any insurance as a preventative exam. I don't remember if FAA asked me for CT when i was first diagnosed and differed. I found out about it at my 3rd class exam. It was many years ago. I had to do surgery to remove stones twice. But once I got SI conditions from them, it was all just XRay and letters. And yes, i still had some small stones.

The reason you don't want CT is not the money(again, insurance should cover it) but a lot more details. These details can cause you to not get SI at all or do a surgery.

 

[James331]

You were within the 10 year window since your last 3rd class cert was issued. You could have gone with Basic Med, right?

Exactly what I was thinking.

 

[genna]

The big answer he is you have to wait. Nobody can tell you what exactly you will need other than FAA. It can be different every time based on who-knows-what

o.k. thanks. I've seen KUB referred to as both an imaging and ultrasound exam. Assumed it was the latter.

Ultrasound is pretty pointless at this point for you. It doesn't show anything to FAA and it really doesn't show anything to you either. Negative ultrasound means nothing. Positive one tells you where to look. That's about it. You can pretty much skip it unless insurance wants it done first.

Kidney Ureters Bladder(KUB) is just the area they are examining, but, unless CT is mentioned, it's typically a short hand for KUB X-Ray.

 

[wilkersk]

...Bruce suggested that I would need an urologist letter/sign-off that addresses the items CACI form and an ultrasound to back this up.

My concern is whether the ultrasound will be good enough, since the diagnosis of kidney stones was made with a CT exam. Am I now forced to obtain another CT exam? HUGE difference in what I pay between a CT and an ultrasound....

I've been down this road.

You're getting ahead of yourself here. And, you''re reading to much into this. There is no cookie-cutter form with an "X" at the bottom for someone to sign.

You will receive a letter from the FAA stating exactly what they want in order to grant the 3rd class medical. But, I'm betting it will be just as Dr. Chein said: you will "need an urologist letter/sign-off that addresses the items CACI form and an ultrasound to back this up." The "sign-off" Dr. Chien was talking about is simply that the Dr. concurs with the blocks in the right column of the CACI form; as in, "I'll sign off on that" (meaning the doctor agrees that that is the case).

Comply with the instructions in the FAA letter that you will receive; no more, no less. I had a weak-a$$ AME that deferred when he could've easily made the determination and signed-off the 3rd class medical. It took me about 6 months to get it taken care of. I ended up writing the letter myself, taking it to the specialist, who then said something like, "oh, I understand what you need now. I'll sign this, no problem".

Hope this helps.

 

[SkyDog58]

Not sure why you are dumping on the AME. Sounds like he followed the regulations / guidance. If you just wanted a consult, you should have only scheduled that and not provided your MedExpress info to him. By scheduling a medical and providing your MedExpress info, you gave your consent for him to do the exam.

If you have any medical condition that might be questionable, you should always reach out to an expert AME ahead of your actual exam. While your situation does suck and I do feel bad for you, the fault is yours not the AME’s.

 

[mryan75]

First medical I had, the AME explained the MedExpress process and said, “If the mood hits you to answer ‘yes’ to any of those questions, don’t do so without discussing with me first.” Fortunately I’m healthy, but it shocks me that AMEs just let people fill this stuff out without a thorough discussion first.

 

[wilkersk]

Not sure why you are dumping on the AME. Sounds like he followed the regulations / guidance. If you just wanted a consult, you should have only scheduled that and not provided your MedExpress info to him. By scheduling a medical and providing your MedExpress info, you gave your consent for him to do the exam.

If you have any medical condition that might be questionable, you should always reach out to an expert AME ahead of your actual exam. While your situation does suck and I do feel bad for you, the fault is yours not the AME’s.

It does say on the CACI worksheet that the examiner (AME) can issue. It sounds like the OP's AME didn't even try. Don't know that thats the case. Perhaps the AME did try and the OP didn't meet the criteria on the CACI worksheet. But, since I've had a bad experience with a weak-a$$ AME, I'm a little prejudiced.

 

[SkyDog58]

It does say on the CACI worksheet that the examiner (AME) can issue. It sounds like the OP's AME didn't even try. Don't know that thats the case. Perhaps the AME did try and the OP didn't meet the criteria on the CACI worksheet. But, since I've had a bad experience with a weak-a$$ AME, I'm a little prejudiced.

And I’ve had bad experiences with a few pilots and owners in my time but I don’t hold that against all pilots or owners.

 

[AggieMike88]

Page from AME Guide on Kidney Stones, CACI Worksheet, and then something I found from the Federal Air Surgeon's newsletter

 

[AggieMike88]

Yes, Dr. Bruce sent me the CACI worksheet and told me how to proceed with this. I did attach this to one of my replies previously.

Acknowledged. Was sharing the info for the benefit of others who would find this thread.

 

[exncsurfer]

First, let me say that Dr. Chien has been great helping me navigate the waters of a first-timer having issues with a medical. He's been very responsive and I appreciate his advice and guidance immensely.

Basically, I was told that if a urologist looked at the CACI worksheet (prior to my attempt at getting the 3rd class), he would have more than likely checked the boxes, signed and I would have submitted this to the AME at the time of the exam.

Now I have to wait on the FAA to TELL ME WHAT TO DO, what documents or exams they will need. Funny thing is, I was planning to go see a urologist for these stones anyway. I've never been to one and figured I needed to start seeing one at my age.

I'm completely aware at how an acute kidney stone attack could make for a very bad day at altitude, and I'm more than willing to take care of it. It's just feeling like the AME screwed me over by going ahead with the exam and deferring to the FAA. I mean, did he really need my $80 that bad?

Regarding this wacky CACI form, Dr. Chien says that the urologist will check the boxes and sign the form. I'm a little confused on this. There is no signature line on this "worksheet." Would they just check the boxes in the ACCEPTABLE CERTIFICATION CRITERIA column? See attached worksheet.

Its possible that he didn't have a choice by the time he reviewed your form. Luckily I came on this forum before I went for my 3rd class and saw the many warnings to not submit the form until you know you can pass it. When you fill out the form online you get a code, if you give that to the receptionist and they enter it into the computer, the exam is on and there is no turning back. I withheld my medexpress code until I spoke with the AME and reviewed my answers. He told me he would have to defer based on my form so I actually ended up canceling and gathering more info for him before returning a month or so later to be issued. I guess the info I gathered was convincing. Basically if you have any item in the 'have you ever' list, you need to review that with someone knowledgeable and be prepared. I went Basic Med for my renewal. Hopefully you can get issued and you'll have that option next time.

Whenever I see a new student on POA bring up a Medical appointment, I try to throw in a warning for them to do their homework BEFORE submitting it, that its not so much based on how healthy you are, its more like a trap. The whole process probably caused a 6 month delay in the middle of my training and a lot of worrying, and I didn't even get deferred.

 

[Dave Theisen]

I see that your location is central Illinois. You are fortunate to be so close to the best resource available in Dr. Bruce. Use him and do what he says, he is well worth every penny. I am literally sitting at Midway waiting to fly home to Atlanta having seen him today with Medical in hand. It's for a different issue, so I have no advice on the stones. As a working pilot, I can't express enough how invaluable he his.

Bruce, If you are reading this, thanks again and I'll see you in May!

 

[Rushie]

You got it. Newbie here didn't know about these forums, nor that the kidney stone was an issue, so I gave the code away without having AME review my answers first. That's why this is a "Lesson learned" post.

Some people on these forums have been here 20 years or more (well this forum isn't 20 years old but there was an old defunct one several of the members here, including Dr. Bruce, were on.) You see these stories over and over and you learn so well the traps to avoid with the medical that people forget that pilots who haven't been online and who never had a medical issue before can have no clue that they're stepping in it.

 

[mscard88]

people forget that pilots who haven't been online and who never had a medical issue before can have no clue that they're stepping in it.

Exactly Rushie! But it's so easy to do as they have no idea, especially if CFIs tell them they need to get a medical and don't warn them of the drawback. That's the bad thing about MEDEX or whatever it's called. It almost seems like a trap for unsuspecting innocent users. Old way was better, fill the form out at the office and talk to the AME before they turn it in.

 

[Rushie]

Exactly Rushie! But it's so easy to do as they have no idea, especially if CFIs tell them they need to get a medical and don't warn them of the drawback. That's the bad thing about MEDEX or whatever it's called. It almost seems like a trap for unsuspecting innocent users. Old way was better, fill the form out at the office and talk to the AME before they turn it in.

Yep there is something dangerous about pushing a button and having things go irreversibly into cyberspace. In the old days when you put paper into an envelope, put a stamp on it and took it to the post office, you didn't inadvertently send stuff off before you knew you were good and ready to.

 

[Vf6cruiser]

A few years ago I thought Popeye had the right idea and would down some spinach on occasion.....BAD idea, turns out worst thing you can eat for stones. Google being our friend here's the stuff to avoid.......

What foods to avoid with kidney stones?
Foods high (>10mg per serving) in oxalates include:

• spinach, okra, beets (root and leaves), Swiss chard.
• star fruit, rhubarb, dried figs.
• peanuts, tree nuts (pecans, almonds, hazelnuts)
• soybeans (including tofu and meat substitutes made with soy)
• black tea.
• wheat bran.
• buckwheat.
• dark chocolate.

 

[bbchien]

Yes, he can. But, according to Dr. Bruce, it would be prudent to have an urologist initial below each check box on the CACI worksheet, along with a letter addressing those points + ultrasound at the least. Then, the AME should feel comfortable signing off on this. But, he punted to the FAA, so now I wait on them.

Negative ghostrider. If the “CACI” sheet is completely and clearly initialled in all boxes by a board certified urologist, it’s a good bet an agency analyst will issue you Very quickly.

What you have going against you is that (1) you don’t get that KUB is in fact a plain xray which is not an ultrasound and is not equivalent (2) That ultrasound is acceptable to FAA and i told you that, by way of recommending that, and (3) and the essential item which is that if the stone was not seen on a pre CT xray, a negative KUB cannot be used to show ANYTHING as to stone free in the left side. KUBs are not “sensitive”, and FAA is not dimb.

I understand you want the cheapest way out but substituting “KUB” for ultrasound as you did in our conversation...I remind you that I never proposed a KUB for followup proof. You did. It won’t work and I have no idea where you got it from, but it certainly is cheap. And it won’t work.

So now you need the urologist to opine. If you want surety you have someone that knows what’s what write your urologist b4 you go so you get maximum “punch”. But as you were from the get-go complaining about cost, I sent you the CACI sheet and if fully initialed by the urologist, signed by him at the bottom, and you send it in, it should work. Not guaranteed, but should. But I see that you are not going to act in that advice, either. Cheap, can’t hurt and might work...pretty good combo. And that pretty mich exhausts what I can do on your budget of ZERO. Well, I tried, gave it the good go.

You cannot have all three: Cheap, Free, and Easy. The readers here have all done the work...be it reading carefully here constantly or engaging the AME for a consult B4 you go to a live flight physical. Like I say, you can get two of three but not all three.

So after five rounds of email in a busy day “pri bono”, (i got home at 10:00 PM) excuse me, I gave up. You kind of reminded me of an E-2, that long ago in a distant place in a far away time, I could not help.

I wish you the best, however. How can I not?

And to Dave Theisen, today was a pleasure.

 

[PaulS]

I'm confused here, sounds like you did a pre consult with the AME per your original post where he asked you about meds and any other conditions before you went for the exam. Retained kidney stones is a condition, you forgot to tell him, that's on you, not the AME.

My advice, stop, take a breath, and LISTEN to Dr. B. Do what he says. Go to a urologist, tell him what's up, specifically about the FAA medical and what you need, since it sounds like it is an initial consult for you with a urologist he will probably be able to get the tests you need and have insurance pay for it, if you have insurance. Time to quit whining about cost and get it done. If you can't afford this stuff you probably can't afford to fly.

 

[PaulS]

Look, no one is dumping on you, but it's your exam and medical, no one else's. You need to own it. If you answer yes to any of the questions then you need to have a good explanation to get a medical. It's water under the bridge now, but that was your indication to ask more questions before the exam. Live and learn, now you know.

You passed a stone, you have retained stones, you should be seeing a specialist. Get the tests they recommend, if you want a slam dunk, then get the test and the sign offs Dr B recommends. You have everything you need to get it done, get it done.

I can vouch for Dr B, I got my medical a month ago after consulting with him a couple years ago (I'm a little slow too sometimes, lol.) Although I didn't make the trip to see Dr. B, I followed his instructions to a T, I also found an AME locally who I consulted with ahead of the exam, I told him all my "conditions" , he told me the same thing as Dr B as far as tests the FAA would want, I got the tests done, took the exam, was deferred and issued . Dr B was spot on as to what the FAA would be looking for.

It sounds like you are on a similar road except you missed a condition in the initial consult, so it's going to take a little longer IF everything checks out. At the end of the day figuring that out is on you, deal with it, move forward and get it done. I hope you are successful.

 

[Rushie]

I don't think you are doing anything wrong other than trying to predict which test the FAA will require which seems to be blowing up in your face. Bruce might be assuming that you're cheap but I sense you are just an exacting personality who likes to know ahead of time what's going to happen so you can plan, but in this situation the answer is not going to come to you. Just have to wait til the FAA responds. Best not to overthink it right now. There may have been some misunderstanding between you and Bruce (I'm not privy to the emails) but right now I'd let it slide.