Frustrated

Kenny Lee

Kenny Lee

Pre-takeoff checklist
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Kenny Lee
Reluctant to toss all this out here in a forum, but, here goes.

I'm 61 y/o and am 10 hours into getting my PPL. I consider myself relatively healthy although I am Type 2 diabetic, I smoke, & my exercise consists of walking to the truck from the office or house. I did have a Melanoma removed off my left thigh about a year ago. I take cholesterol meds to keep it in check. I control diabetes with meds, and I'm not on insulin. I take Blood Pressure medication for preventive reasons. My blood pressure has always been great.

Today is 12-5-18. I submitted an application to MedXpress on 10-8-18. I made an appointment soon after with my AME. 2 weeks later I think. The AME seemed really knowledgeable, cordial, helpful and things went as I expected. He told me mine would have to be a special issuance through FAA but he felt I would get my medical. Just that it would take time. He gave me some forms to have filled out by my Oncologist (Vanderbilt hospital in Nashvville), by my Primary Care Clinic, and my eye doctor. I've never had a problem with my eyes, but evidently Melanoma can move into the eyes, and my oncologist recommended I get annual eye exams. So I head home and start trying to get these forms filled out. I knew Doctors don't get paid for filling out forms, so I knew it would be a pain. Took a month. After getting the required forms, I called to set up an appointment with my AME. Took 2 weeks to get in.11-7-18. It's a 2 hour drive by the way. (one way). Visit was short and sweet and he started the process and told me not to expect to hear anything back until after the first of the year. He did warn me he expected them to require a MRI brain scan because of the Melanoma. They want to make sure I don't have cancer in the brain. Below is what my Oncologist explained to me at the time of the surgery:

The Melanoma was on my left thigh. Right before the surgery they inject some sort of die or fluid to "map" my lymphoid system. They chose two lymphoids in the groin area to remove during the surgery. If the lymphoids were clear it was a 99.9% chance the cancer hasn't migrated to other parts of my body. If they weren't clear, they'd need to do more tests. They came back 100% clear and she assured me I'm cancer free.

I received a letter from FAA yesterday 12-4 that was dated 11-27. They give me 60 days to reply or they will either refer my case for legal enforcement action or deny my application. Well 7 days has gone by since they wrote the letter. So, I suppose I need to hurry.

They are insisting on a brain scan. My oncologist didn't see the need for one, why would they? Do I argue or give them what they ask for?

They are also insisting on a stress test due to my coronary artery disease. HUH? Not sure how they decide I have coronary artery disease?

I'm not even sure if the FAA has had a chance to review the papers and reports my AME sent them 11-7. I think my first step is to contact my AME again, as they copied him on this letter. If they are trying to get me to give up on this medical, they don't know me very well. I won't quit. But, it sure is frustrating.
 
Sounds like you didn't know this when you applied for your medical, but you are a classic case of someone who should go in for a consult before submitting to the actual FAA medical exam. This would have allowed you to get all this stuff done before the exam and possibly have your medical sooner. You are dealing with a big bureaucracy, it's nothing personal, don't get paranoid, just give them what they need to approve you. We have a couple great AMEs on the forum who hopefully will comment, but you should contact your AME immediately, sounds like the guy knows what he is doing.
 
You can't argue with the FAA, no sense trying. I'm your age, never smoked, walk a bit, no issues other than typical aches and pains, no meds, and I consider myself relatively healthy. I guess it depends on what you relate it to.
 
You are actually in a good position! Provide that which the FAA is requesting. You are not wasting time trying to divine the machinations of the FAA. I am a fan of pre exam consults with the AME usually only for drug, alcohol and mental health cases. Sounds to me you have a good AME!
 
lbfjrmd said:
You are actually in a good position! Provide that which the FAA is requesting. You are not wasting time trying to divine the machinations of the FAA. I am a fan of pre exam consults with the AME usually only for drug, alcohol and mental health cases. Sounds to me you have a good AME!
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This is one of the great AMEs to whom I was referring.
 
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thanks for the feedback guys!. I think/thought I'd work through this. It sure can be frustrating though.
 
Do what FAA says and save your frustration for important things in life like... how do I stop ballooning and such
 
I am going to say this even though I am afraid that it will come off as abrasive or mean or unsolicited advice, and I will go ahead and do so because it drives me a bit up the wall when patients’ self-assessment of their health is way out of alignment with reality. Diabetes by itself puts you in the same risk category as someone that has already had a heart attack right off the bat (reference Framingham risk score). On top of that, you choose to smoke. You have high cholesterol. Your blood pressure situation as you describe it is not clear, but prescribing blood pressure medications for preventive reasons is not common practice, so I suspect that you have hypertension that is under control with medication (if you need medications to keep you blood pressure normal, you still have hypertension). At any rate, you are the classic case of a person who should be scrutinized more carefully as you have every single risk factor for a heart attack. You may feel good, but you are not what I would describe as a healthy 61 year old. I have seen 61 year-olds that have great looking coronaries, and I have seen 45 year olds that are a hot mess full of plaques - usually diabetics. A lot of what you describe can be managed to some degree with meds, but there is no substitute for lifestyle changes, and for the love of everything please stop smoking. -a flying doctor that cares

PS Getting a stress test is not a crazy thing to do at all given your risk factors. You seem to be taken care of by people that care.
 
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You cannot argue with the crown.

You melanoma was either Clarke level 6 or had penetrated you beyond 0.75 mm below the “basement “ membrane. FAA has their own experts who disagree with yours. So you can have a fit or jyst comply.

Your choice: there is no other. Dr. Lou an I differ in how we “operate” insofar as responses from the agency are taking soo very long that my approach has been to get all of which we know to be necessaty BEFORE the flight physical. Then it’s only ONE round of waiting.

CAD and stress: There must have been a comment in the notes to give you the dx of probable CAD. You sure have the risk factors ( and need to STOP Smokimg). You should have ithe treadmill done anyway! Know that for a 61 year old they expect you to go 9 minutes and get your heart rate up to 144 at the peak (“but i found THIS on the internet...”). Any other number you may cite from the internet is the “mandatory denial” cutoff and you don’t want to be there....(!)

Oh well what’s done is done. Get the MRI. Do the treadmill. Fly.
 
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i took that treadmill test recently for the first time, haven't done much cardio in ages & 59, it was ugly,

wife did it awhile ago & couldn't finish,

i'd sort out the medical before continuing lessons
 
Kenny Lee said:
You’re wrong about that part. I can do both. I threw a fit, but it only lasted a few hours. Now I am in the process of complying. Really no other choice, if I intend to fly.
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Many of us, including myself, threw fits at first when discovering that the FAA has no interest in the preponderance of one's own trusted doctors' conclusions, and instead exists in totalitarian rectitude, unilaterally holding anyone who wants to fly hostage to its whims. It goes against our understanding of this country's unique concept of unfettered liberty. Then we remember that it is only a concept after all, and not perfectly realized, only partly so, but still, in the U.S. better than ever before in the history of man. ("You think this is bad, just try to fly in Europe, or China, blah blah blah"). At least now we have BasicMed, a rare step back indeed, toward a nostalgic time when anyone could climb into a machine and kill themselves.
 
vman said:
i took that treadmill test recently for the first time, haven't done much cardio in ages & 59, it was ugly,

wife did it awhile ago & couldn't finish,

i'd sort out the medical before continuing lessons
Click to expand...
My doctor asked if I'd ever taken the stress test. I reminded him I teach college computer science - every day is a stress test.
 
Aviator305 said:
I am going to say this even though I am afraid that it will come off as abrasive or mean or unsolicited advice, and I will go ahead and do so because it drives me a bit up the wall when patients’ self-assessment of their health is way out of alignment with reality. Diabetes by itself puts you in the same risk category as someone that has already had a heart attack right off the bat (reference Framingham risk score). On top of that, you choose to smoke. You have high cholesterol. Your blood pressure situation as you describe it is not clear, but prescribing blood pressure medications for preventive reasons is not common practice, so I suspect that you have hypertension that is under control with medication (if you need medications to keep you blood pressure normal, you still have hypertension). At any rate, you are the classic case of a person who should be scrutinized more carefully as you have every single risk factor for a heart attack. You may feel good, but you are not what I would describe as a healthy 61 year old. I have seen 61 year-olds that have great looking coronaries, and I have seen 45 year olds that are a hot mess full of plaques - usually diabetics. A lot of what you describe can be managed to some degree with meds, but there is no substitute for lifestyle changes, and for the love of everything please stop smoking. -a flying doctor that cares

PS Getting a stress test is not a crazy thing to do at all given your risk factors. You seem to be taken care of by people that care.
Click to expand...


You're right. I didn't like what you had to say, but, I know you're right. I need to quit smoking and work on lifestyle changes. I've known that for a long time. Maybe this flying bug that hit me is the excuse I needed to make those lifestyle changes. I'm in the process of scheduling both the stress test and the MRI. I'm confidant the MRI will have good results. I'm not 100% sure on the stress test. I am 100% sure I'll be sweating, huffing and puffing.
 
Little bit of a timeline on my medical.

October 8th I applied for medical through Med Express (I know I should have researched a bit more first)

A day or two later I made an appointment with my AME. He looked over the information on my Med Express and recommended I gather some more information to send to the FAA saying my application would have to be special issuance. It took a couple of weeks and I sent in the information he suggested.

November 27.
I received a letter from FAA saying I needed a brain scan (because of a previous melanoma), more information about a possible fatty liver condition, and a stress test. As I've stated earlier I have the first two items completed and it all looks good. The stress test didn't go as well. I can't remember the exact date but I only completed 6 minutes of the required 9 minute stress test. The letter from FAA gave me 60 days to complete the requested items and send it to them.

January 22nd.
I sent FAA a letter requesting a 60 day extension.

January 28
Got a letter from FAA saying they didn't receive my information and gave me 30 days to get it. I'm confident my January 22nd letter to them and their letter dated January 28th either crossed in the mail or they ignored it.

Since not completing the original stress test, I've bought a tread mill and I've been using it. they require 3 minutes at 1.7 MPH, 3 minutes at 2.5 MPH and 3 minutes at 3.4 MPH. 3.4 is tough! I am doing a lot better now than I did at the time of the original stress test, but, it is going to be tough for me to complete. I've not completely quit smoking but, I've cut way back. I'm trying to completely quit. That also is tough. according to their January 28th letter I need to have another stress test by February 28th. that's 3 weeks from today.

Somewhere in my readings on this forum, I've read Dr Bruce has a thread about how to prepare for and pass the stress test. I've not been able to locate it. Can anyone point me in the right direction?
 
Kenny Lee said:
Little bit of a timeline on my medical.

October 8th I applied for medical through Med Express (I know I should have researched a bit more first)

A day or two later I made an appointment with my AME. He looked over the information on my Med Express and recommended I gather some more information to send to the FAA saying my application would have to be special issuance. It took a couple of weeks and I sent in the information he suggested.

November 27.
I received a letter from FAA saying I needed a brain scan (because of a previous melanoma), more information about a possible fatty liver condition, and a stress test. As I've stated earlier I have the first two items completed and it all looks good. The stress test didn't go as well. I can't remember the exact date but I only completed 6 minutes of the required 9 minute stress test. The letter from FAA gave me 60 days to complete the requested items and send it to them.

January 22nd.
I sent FAA a letter requesting a 60 day extension.

January 28
Got a letter from FAA saying they didn't receive my information and gave me 30 days to get it. I'm confident my January 22nd letter to them and their letter dated January 28th either crossed in the mail or they ignored it.

Since not completing the original stress test, I've bought a tread mill and I've been using it. they require 3 minutes at 1.7 MPH, 3 minutes at 2.5 MPH and 3 minutes at 3.4 MPH. 3.4 is tough! I am doing a lot better now than I did at the time of the original stress test, but, it is going to be tough for me to complete. I've not completely quit smoking but, I've cut way back. I'm trying to completely quit. That also is tough. according to their January 28th letter I need to have another stress test by February 28th. that's 3 weeks from today.

Somewhere in my readings on this forum, I've read Dr Bruce has a thread about how to prepare for and pass the stress test. I've not been able to locate it. Can anyone point me in the right direction?
Click to expand...

Hmmm, usually a not so good stress test results in more cardio tests. How did those go?
 
PaulS said:
Hmmm, usually a not so good stress test results in more cardio tests. How did those go?
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Cardio Doc (2 of them) Both said results aren't showing any problems and see no need for more tests. They do both agree that if I don't change my lifestyle, quit smoking etc, it's just a matter of time.
 
Kenny Lee said:
Cardio Doc (2 of them) Both said results aren't showing any problems and see no need for more tests. They do both agree that if I don't change my lifestyle, quit smoking etc, it's just a matter of time.
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Which qualifies you for the bumper sticker

Screen Shot 2019-02-07 at 2.00.38 PM.png
 
While I understand the frustration of the faa docs wanting more and more, I chose to look at it from a positive point of view. Either their required tests were going to find something (which i would be grateful to know about) or I was going to get a very clean bill of health. Fortunately for me it was the latter.

A brief list of items I had to give them: brain MRI, visual fields test, stress test, labs requiring 15 vials of blood (no, I am not joking), completely nerocog exam including the nerocog-ae, event monitor, plus more that I am not remembering exactly.
 
Kenny Lee said:
I take Blood Pressure medication for preventive reasons. My blood pressure has always been great.


They are also insisting on a stress test due to my coronary artery disease. HUH? Not sure how they decide I have coronary artery disease?
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I'm guessing from the meds you take.

Kenny Lee said:
Since not completing the original stress test, I've bought a tread mill and I've been using it. they require 3 minutes at 1.7 MPH, 3 minutes at 2.5 MPH and 3 minutes at 3.4 MPH. 3.4 is tough! I am doing a lot better now than I did at the time of the original stress test, but, it is going to be tough for me to complete.
...
Somewhere in my readings on this forum, I've read Dr Bruce has a thread about how to prepare for and pass the stress test. I've not been able to locate it. Can anyone point me in the right direction?
Click to expand...
I don't know where that is, but from personal experience I can tell you to practice, practice, practice. Don't forget, they raise the incline every three minutes. I would start at whatever pace you can walk for 20 minutes. Gradually increase the pace and incline as necessary to maintain a heart rate about 2/3 of the way between resting and maximum theoretical (220-age). When you can do that at least once or twice per day and can do it on a 15% grade, then you can practice the Bruce Protocol--carefully. Pay attention to any chest pain (angina) and your heart rate. Approach the maximum at your own risk. Quit if you have symptoms and talk to your doc. Don't do this Protocol every day either. You need to rebuild damaged cells for a day or two or three before repeating.

That's what I'd do and more or less have done, but I'm no doctor nor an athlete, so take it for what it's worth.

I'm coming off triple bypass surgery in August and can do 4 MPH on an 11% grade for 45 minutes, but I've been at this for over seven years now. That smoking has to stop, NOW, buddy. :) Throw 'em away.
 
dtuuri said:
I'm guessing from the meds you take.


I don't know where that is, but from personal experience I can tell you to practice, practice, practice. Don't forget, they raise the incline every three minutes. I would start at whatever pace you can walk for 20 minutes. Gradually increase the pace and incline as necessary to maintain a heart rate about 2/3 of the way between resting and maximum theoretical (220-age). When you can do that at least once or twice per day and can do it on a 15% grade, then you can practice the Bruce Protocol--carefully. Pay attention to any chest pain (angina) and your heart rate. Approach the maximum at your own risk. Quit if you have symptoms and talk to your doc. Don't do this Protocol every day either. You need to rebuild damaged cells for a day or two or three before repeating.

That's what I'd do and more or less have done, but I'm no doctor nor an athlete, so take it for what it's worth.

I'm coming off triple bypass surgery in August and can do 4 MPH on an 11% grade for 45 minutes, but I've been at this for over seven years now. That smoking has to stop, NOW, buddy. :) Throw 'em away.
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This man know about what he speaks.
 
Kenny Lee said:
I just finished taking the stress test again. I made it through the full 9 minutes this time. Now to send it all in to the FAA
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Before sending it in, let "the right" AME take a look at what you are about to send. One more double check that it's 100%+ complete and in proper format/sequence/etc can save you from more delays and stress.
 
Quick question related to stress tests.... What happens if one can’t get the heart rate up to the desired numbers despite maxing out the incline and speed?
 
I've not posted updates to this thread in a long time. But here goes. I just received my third class airman medical certificate. I suppose I should be excited but I'm still confused. Below I'll type word for word what I feel is pertinent in this 2 page letter.

You are ineligible for medical certification under Title 14 of the code of Federal Regulations (CFRs) revised part 67,; specifically under paragraph or sections 67.113, 67.213, and 67.313.

I have determined, however, that you may be granted Authorization for special issuance of the enclosed third class airman medical certificate under Title 1 of the CFRs Section 67.401.

First thing that is disheartening is it expires November 30, 2019. I suppose it is based on my original examination which was November 8, 2018. They require further documentation & tests 60 days before my next examination 11-30-19. Another brain scan & more reports on the melanoma treatment. I really don't feel I will have any problems with the past melanoma. Just the fact I have to go for another brain scan. Will this be typical every year? I'm unclear. I'm guessing just this next time.

It drops down another paragraph and starts:
You meet the CACI program criteria for diabetes and hypertension: Your conditions will be monitored by your AME under the CACI program. Prior to your November 2020 FAA medical examination, and every 24 months thereafter, you should follow these steps:

Consult your AME or the online CACI criteria at: www.faa.gov/go/caci to identify the reports and/or testing required by the FAA.

Using the CACI worksheet as a reference, ask your healthcare provider for a current medical summary that addresses the items on the worksheet and include any required testing.

Give the required documentation to your AME, or if you are not otherwise qualified, the AMER is instructed NOT to issue a certificate. If you continue to meet CACI criteria, your AME will continue to follow this condition.

A couple more paragraphs I'll not bother to type, then this.
You will still be required to have a FAA medical examination at the frequency prescribed under the provisions of Title 14 of the CFRs, section 61.23

My plan was to buy an airplane after obtaining my medical certificate. This being a special issuance, and the wording of it, makes it unclear to me whether I'll be able to keep the medical, or if I'll be able to keep a medical without a Large amount of testing and documentation etc. Makes me question is it worth it. Thing is, I haven't given up yet, why now after receiving my medical? Hence my confusion.
 
As long as your A1C is below 6.4, your diabetes is considered under control.
Download the appropriate sections of CACI for everything mentioned so you know what your goals are.
 
Are you eligible for Basic Med?

I have my own question: What's the difference between a "new diagnosis" and "continued treatment"? In my case, I had a special issuance due to CAD, then further treatment (CABG) of the same thing (CAD) after I went to Basic Med. I'm told it's a new diagnosis, so I have to go through the special issuance process again. With your melanoma, what if it progresses and requires more treatment after you go Basic Med (if eligible)? Same thing as me? Or do I have bad advice (it came from an FAA inquiry)?
 
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This is where your AME gets another opportunity to prove he is the right guy/gal for you.

His office will get a copy of this letter for their files. So they will see the same wording. Call the office and ask to speak with the doc to ask your questions and gain clarification.


Regarding the special issuance letter... DO NOT LOSE IT. That letter has the instructions on how you go about maintaining the SI. If you misplace it, you can get a copy but it isn't a quick thing. Probably also a good idea that you scan it as a PDF and keep it in a few electronic cubbyholes.


Finally, regarding the renewal at the 12 month mark, this is not uncommon for many SI's. While the usual Third Class renews at 5 or 2 years depending on age, many SI's are a shorter time because the FAA wants a more frequent update on your condition.

Drs. Lou and Bruce will likely be along later for additional comment and clarification.
 
Two words: Basic Med.

I commend you. When I read your first post I thought, "No chance". I igve you all the credit in the world for the effort it took todo all of this, including the physical work to get up to speed for the stress test.

Whichever way forward you choose I wish you the best.
 
I think a byproduct of all these documentations can save a life.

Your SI is pretty simple now annual letter from the oncologist; you're going to go see him anyway; see him in September and send in the exam record. you wont need to repeat the fasting glucose and HbAc until 11/2020....but you should consider CACI prediabetes an incentive to lose the weight and get physical...RUN!

I've no problem with Basic med but if you use basic med as a way to let your diabetes go out of control...well that's not a good thing.
 
Hmmm, seems like a win to me, don't snatch defeat from the jaws of victory. Do what they ask you to do and fly.
 
sometimes it's cheaper to fly without any medical at all...
 
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