Exercise stress test

O

onwards

Pattern Altitude
Joined
Jul 6, 2011
Messages
1,998
Location
CA
Display Name
Display name:
onwards
The FAA sent me a letter asking me to do one - apparently I should have done one as part of my renewal this year.

I've never done one of these before. Do I have to go to an AME to do it? or can it be done anywhere?
 
I think your going to need a referral ,to a hospital,or cardiac screening unit. It's more than just walking on a tread mill.
 
onwards said:
The FAA sent me a letter asking me to do one - apparently I should have done one as part of my renewal this year.

I've never done one of these before. Do I have to go to an AME to do it? or can it be done anywhere?
Click to expand...
It does not need to be done by an AME but the lab performing the test needs to know that the FAA requires a non-standard protocol. I think they want an ECG every minute of exercise where most places get one every three minutes at the end of each stage. They have other requirements so it's possible to pass by usual standards and not meet FAA requirements. Get a copy of the rules and have the stress test person read them if they are not already familiar with the FAA protocol.
 
If you are under the care of a cardiologist, they can administer it or refer you to the lab to get it done.

Before you do it, get with Bruce Chien to find out what the FAA wants. The FAA wants it done a certain way and some cardiologists might not do it that completely.

Looking for some posts on the Red Board about the stress test, I found this common theme

Dr. Bruce Chien on AOPA Forums said:
Stress treadmill to 90% of (220-YourAge) for a heart rate and nine minutes on the Bruce Protocol. If your too heavy you may not be able to make it, remember you are running progressively uphill on steeper and steeper grades, faster and faster. It has got to make both rate and 9 minutes or its' a fail
Click to expand...

But contact Dr. Bruce directly for a better insight into what they are looking for and how to get them what they need.
 
It's not a "non-standard" protocol, it's just a different one than the hospital may be using. It's the "Bruce protocol" (no relation to Dr. Chien). Doc Bruce (Chien) does recommend avoiding thallium as well.
 
flyingron said:
It's not a "non-standard" protocol, it's just a different one than the hospital may be using. It's the "Bruce protocol" (no relation to Dr. Chien). Doc Bruce (Chien) does recommend avoiding thallium as well.
Click to expand...
The Bruce protocol refers to the rate and incline of the treadmill and is standard for everybody. The protocol does not specify the recording interval and other requirements of the test. The FAA has rules that are different than most stress labs. I know as I do this for a living.
 
Last edited:
AggieMike88 said:
If you are under the care of a cardiologist, they can administer it or refer you to the lab to get it done.
Click to expand...

I'm not, but I'm diabetic, so I think they want this because diabetics can develop heart disease more easily.

They did send the full instructions with the slightly modified protocol, so I'll get a referral and get it done. Doesn't seem too complicated or particularly hard.
 
onwards said:
I'm not, but I'm diabetic, so I think they want this because diabetics can develop heart disease more easily.

They did send the full instructions with the slightly modified protocol, so I'll get a referral and get it done. Doesn't seem too complicated or particularly hard.
Click to expand...

I too am a diabetic, type 2, since 2010, and I'm on a low dosage of Lisonipril to aid in keeping BP will within the desired range. But none of my PCP's have expressed concerns with cardiac issues beyond "You're in the green arc, stay there and don't get out of it".

I don't think your "because diabetics can develop heart disease more easily" is the full reason. While that statement is true, something else may have been reported to them from your PCP or AME to cause them to think the stress test is warranted. You might check what the AME sent up to for any clues.

I was "newly" diabetic when I did my first medical certificate application, and have renewed 2 years ago, and am due for renewal next month. Never have I gotten a letter from the FAA asking for the stress test. To my knowledge, being diabetic with no related complications isn't enough to trip the need for the stress test.

Besides diabetes, any other obvious cardiac related issues that are not yet in evidence?

For the benefit of anyone reading the thread, good management of diabetes through smart food choices, increasing exercise levels, and dropping weight goes a long way toward quality of life and keeping the FAA AMCD happy.

Since mid summer, I made a choice to walk 5 days a week instead of 2 or 3, and go 3-4 miles instead of 1.5 to 2, and kept my total carb intake per meal to 35 grams or less. Results have been very positive with a 13 lb weight reduction, average fasting and pre-meal finger stick numbers down to 108-115 from 145-160, and BP reading at the doc's office well within the green arc.
 
AggieMike88 said:
I too am a diabetic, type 2, since 2010, and I'm on a low dosage of Lisonipril to aid in keeping BP will within the desired range. But none of my PCP's have expressed concerns with cardiac issues beyond "You're in the green arc, stay there and don't get out of it".

I don't think your "because diabetics can develop heart disease more easily" is the full reason. While that statement is true, something else may have been reported to them from your PCP or AME to cause them to think the stress test is warranted. You might check what the AME sent up to for any clues.

I was "newly" diabetic when I did my first medical certificate application, and have renewed 2 years ago, and am due for renewal next month. Never have I gotten a letter from the FAA asking for the stress test. To my knowledge, being diabetic with no related complications isn't enough to trip the need for the stress test.

Besides diabetes, any other obvious cardiac related issues that are not yet in evidence?

For the benefit of anyone reading the thread, good management of diabetes through smart food choices, increasing exercise levels, and dropping weight goes a long way toward quality of life and keeping the FAA AMCD happy.

Since mid summer, I made a choice to walk 5 days a week instead of 2 or 3, and go 3-4 miles instead of 1.5 to 2, and kept my total carb intake per meal to 35 grams or less. Results have been very positive with a 13 lb weight reduction, average fasting and pre-meal finger stick numbers down to 108-115 from 145-160, and BP reading at the doc's office well within the green arc.
Click to expand...

No, nothing at all. No heart disease, history of such, or history in the family of the same.

Do note however that I am type 1, not 2. I think it IS related.
 
onwards said:
No, nothing at all. No heart disease, history of such, or history in the family of the same.

Do note however that I am type 1, not 2. I think it IS related.
Click to expand...

Very much not the expert and my "aviation medical background" comes from paying attention to what Dr. Bruce has posted on the various forums. But I consider the request a bit out of the ordinary from what Bruce has shared in the past. I bring it up from a can of worms standpoint. If the test is truly needed, sure, get er done. But while you have a bit of time, eliminate that it's a fishing expedition that could develop into an SI documentation nightmare.

AKA, call Bruce tomorrow and gain his counsel.
 
AggieMike88 said:
Very much not the expert and my "aviation medical background" comes from paying attention to what Dr. Bruce has posted on the various forums. But I consider the request a bit out of the ordinary from what Bruce has shared in the past. I bring it up from a can of worms standpoint. If the test is truly needed, sure, get er done. But while you have a bit of time, eliminate that it's a fishing expedition that could develop into an SI documentation nightmare.

AKA, call Bruce tomorrow and gain his counsel.
Click to expand...

I am in communications with Dr Bruce after the last scare already, although had not brought this up yet.

But this really is related to diabetes. Here is the exact quote from the letter:

Due to your history of diabetes melitus controlled with insulin protocol, which state "at the first examination after age 40 and at 5-year intervals, the report, with ECG tracings, of a maximal graded exercise test must be included in consideration of continued medical certification," therefore you must provide...

They are right, they did say that on my original SI issuance letter back in 2010, I just assumed it would be in 2015, not 2014. However, because of the other issue I had recently (look up the "Gah!" thread) I ended up having to go to an AME this year instead of next one, which counts as an examination, which triggers this, which I totally missed.
 
I also know that they are tightening some of these things. I got a letter after my last issuance which said: due to blood pressure and having gall bladder removed we want a letter from your primary care physician on BP control. Or words to that effect. My AME is also my PCP (I understand the risks. It's worked well for me so far.) He commented that they are tightening all this stuff up and asking for (in his words) unprecedented levels of documentation for 3rd class medicals. He also had to right something up for the thyroid medication I'm on. Part of the irony is that I really got off my butt and have dropped 60 lbs. I've dropped all but 1 of my BP meds and may be able to drop that one. But I need this letter now and didn't for the prior 5 medicals with higher weight and higher levels of BP meds.

Go figure.

John
 
I'm glad you are working with Dr Chien!

I can tell you about my treadmill experience.

I had a 'get off' on my motorcycle that resulted in a brief ER visit. I was lucky enough to have scheduled Dr. Chien for my physical just prior to this incident.

I send the ER report to him. Dr. Chien told me that the FAA would probably want a stress test (and some other tests) to verify that I had not had a minor heart attack.

My family doctor referred me to a Cardiologist who gives these tests. The Cardiologist told me that there are a number of treadmill profiles that are required for different purposes, and that the ones for truck drivers and pilots are the most demanding.

In any case, what it involves is getting all wired up and walking briskly on a treadmill, for, IIRC, nine minutes while the EKG machine records whatever it is that an EKG records. During the test the treadmill speeds up, slows down, and I think it also changed slopes.

The Cardiologist looks the EKG output over, says 'looks OK to me' and then sends a report back to my family doctor and to Dr Chien. That's all there was to it.

Bottom line: Even though I had OSA and this accident, because Dr Chien took the time to coordinate with the FAA in advance I was able to walk out with my Class III in my wallet that day!
 
Last edited:
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top