How painful will this process be - palpitations, offhand anxiety mention and third class medical

P

Philip L

Guest
Hi there,

I've been reading through a number of similar posts, wanted throw out my scenario and see if anyone else has had a similar story.

Last July, I woke up in the middle of the night with what I believed to be heart palpitations. I didn't quite know what was going on, but I know it didn't feel right, and at the time I had great insurance, so I went to the ER to get checked out. They checked my blood pressure, ran an EKG, took a chest x-ray - all looked great. They sent me home.

Followed up with my PCP, who blamed the pre-workout I had been taking. He also took another EKG. It was borderline abnormal, which is pretty much where my typical EKG lies, due to my narrow chest. He ordered an echocardiogram and referred me to a cardiologist. I told him I was nervous about all this, given I'm a 25 y/o male experiencing something uncertain in my chest (wasn't pain, although of course that's what my diagnosis said). He asked if I wanted him to give me something to help me calm down, I said sure. He prescribed me 6 doses of Alprazolam - I filled the script, but never took any - I just found the bottle with all 6 pills still in it. Of course, as I found the other day when looking back in my records, that means there's an "Anxiety" diagnosis on my chart, although I'm not sure of the exact code. I don't have an Anxiety diag on any other visit, nor is it on my "Active Problems" list.

I get the Echo done, see the cardiologist. All good. He says due to my chest, I feel more of the things in my chest than most people do - often, people experience what I did but never actually feel it. Go back to my PCP for another follow-up, things are feeling good by now, not taking pre-workout anymore, all good, everything is resolved here. I had a physical in November, everything came back clean.

At the time, I had no intentions of becoming a pilot, so I didn't think twice about any of this. However, my dad finished his PPL not long after, took me flying, and now I very much want to get my PPL as well.

My question is what do I have to report if/when I apply for my 3rd class medical, and how many hoops/how much $$ is it going to cost for me to get where I need to go? My long-term goal is to fly my wife/kids around, so while sport could work temporarily (no kids yet), I'm concerned about my long-term "plan."

I've read around a little, and so my current thoughts are to call the AOPA and ask for their advice, as well as schedule a consult with a local AME, but I wanted to see what other experiences are out there. And, of course, see if @bbchien might potentially weigh in. Thanks!
 
"... who blamed the pre-workout I had been taking." What is this? Report these event to your AME. I would likely issue a you certificate realizing the FAA may want the medical records surrounding
this event. I do not think you will have a bunch of 'hoops' nor the excessive expenditure of $.
 
Thanks for responding, doc! See below for an Amazon link to what I had been taking. Effectively, a chemical concoction to get you “amped” to work out. Lots of caffeine and other chemicals. Not a good decision by me.

Reassuring to hear! Should I be concerned about the off-hand anxiety “diagnosis?” Do I even need to report it since I never received any real treatment or evaluation? I’m just concerned about red flags from checking yes on heart issues and anxiety issues. I don’t want to check em off if I don’t need to but obviously don’t want to lie.

preworkout: Evlution Nutrition ENGN Pre-Workout, Pikatropin-Free, 30 Servings, Intense Pre-Workout Powder for Increased Energy, Power, and Focus (Cherry Limeade) https://www.amazon.com/dp/B01E0ZU8L...abc_H51QVESTYV26F6C3BQ8Z?_encoding=UTF8&psc=1
 
"... who blamed the pre-workout I had been taking." What is this? Report these event to your AME. I would likely issue a you certificate realizing the FAA may want the medical records surrounding
this event. I do not think you will have a bunch of 'hoops' nor the excessive expenditure of $.
"Pre-workout" is one of the fad adjectives that have been turned into nouns by leaving off the noun, as in "pre-workout dietary supplement."
 
I would likely issue a you certificate realizing the FAA may want the medical records surrounding this event. I do not think you will have a bunch of 'hoops' nor the excessive expenditure of $.

OP, you might consider traveling to Florida and having Dr. Fowler do your physical and issue your medical. If the FAA wanted further info, he would be in a good position to guide you through that process. I don't know where you're located, but traveling to Florida for your flight physical might be a lot less expensive than having to jump through FAA hoops if another AME were to defer you.

Alternatively, before you do anything formal, you should schedule a CONSULTATION with a local AME to discuss your situation and see if they would issue you a certificate, or defer you. If it were me, given the horror stories I've read in this forum and others and I had your history, I'd spend the money to have Dr. Fowler (or Dr. Bruce Chien) do your exam and issue a medical.
 
Seems to me a person having palpitations or their heart racing could feel anxious or have an anxious feeling. I think this is different from general anxiety about life. Not a doctor.
 
Seems to me a person having palpitations or their heart racing could feel anxious or have an anxious feeling. I think this is different from general anxiety about life. Not a doctor.
If it were my doctor, simply hearing the word anxious or nervous, you're slapped with an anxiety issue.
 
Hey there, me again. I'm finally filling out the 8500-8, and I'm trying to figure out the best thing to put for "Reason" for my visits. Would putting "palpitations" be a bad idea? In advance of my ER visit in July 2020, I had seen my PCP and a cardiologist for weird feelings in my chest. I saw my PCP, he referred me, and by the time my cardiologist visit came, I wasn't feeling anything anymore. I went through with it anyways, but I'm just trying to think about how to report it without it being a red flag.

Any thoughts?
 
Hey there, me again. I'm finally filling out the 8500-8, and I'm trying to figure out the best thing to put for "Reason" for my visits. Would putting "palpitations" be a bad idea? In advance of my ER visit in July 2020, I had seen my PCP and a cardiologist for weird feelings in my chest. I saw my PCP, he referred me, and by the time my cardiologist visit came, I wasn't feeling anything anymore. I went through with it anyways, but I'm just trying to think about how to report it without it being a red flag.

Any thoughts?
Yes.

Did you complete the suggested consultation visit?

If that is a no or not yet, do not fill out the FAA 8500-8 form (via MedXpress) and take it to a formal “live exam”.

Unless you really want to land in deferral hell or roll the dice and get denied.
 
Hey AggieMike - I haven't yet. I'm planning to see Dr. Kozarsky next week (http://atlantaame.com/). He offers to go over the form with you prior to your visit to attack any red flags, so I was hoping to get his advice as well, before doing anything official. He seems to be exactly the kind of doc I'll need.

I just wanted to get things ready to go before I met with him. I was going to fill out the form and then send it over to him before officially submitting it, although I realize now there's no easy way to download it without having submitted it. Was just curious to see if you had any thoughts on what I should input for Reason for these visits - would you just see what the good doc has to say?

Big reason I went for these visits was I had awesome insurance and was like hey, why not...now I'm wishing I could go back and tell myself to not...ha
 
Realized I left off some info in my first post tonight - first visit was in 1/2020, then ER/follow-ups in 7/2020. Everything has looked good and comes from non-heart factors. Just trying to navigate the bureaucracy! Thanks for the help.
 
I just wanted to get things ready to go before I met with him. I was going to fill out the form and then send it over to him before officially submitting it, although I realize now there's no easy way to download it without having submitted it.

Once you complete the input of the form, you are provided the opportunity to print it. If you print to a PDF form, that version can be saved to your hard drive.

However, doing this as you are thinking runs the risk of the doctor or office staff taking the form and it’s confirmation code (see bottom of the form when finished), entering it into the FAA system to “open” it, and causing the exam to change from consultation to a live exam that has just three results: issue, deferral, or denial.

In my experience, unless the AME asks for the form in advance of your visit, there is no advantage to supplying it in advance of your visit.

But if you want to have him review a “mock up”, search for a “paper copy” of FAA Form 8500-8, print that off, and fill it in. This can be your “safe” version because there won’t be a confirmation code.

Was just curious to see if you had any thoughts on what I should input for Reason for these visits - would you just see what the good doc has to say?

Big reason I went for these visits was I had awesome insurance and was like hey, why not...now I'm wishing I could go back and tell myself to not...ha

I have nothing to offer for this. I will defer to Dr. Lou, Bruce, and the AME you will be seeing in Atlanta.
 
If you print the form out after a medexpress entry be sure to cut the codes off the bottom of the form. If anyone on the staff opens that application you are no longer getting a consultation.
 
Thanks for the replies! I'll print off the paper form and use that as my "safe" form for now. I will say, his website specifically says:

"Happy to discuss medical issues or arrange special appointments. Just text or email."
"Feel free to email me a "preview" copy of your MedXpress FAA 8500-8 application (or AOPA Turbo Medical) especially if your medical situation is "complex". Once I download your Medxpress application, the 14 day clock starts signaling when I must submit and defer issuance to FAA. Let's resolve all questions BEFORE opening the application."

He has more pilot certifications than I ever hope to acquire, so I feel like if nothing else, I've found a guy who truly wants to help folks like me. I'll follow up with what happens.
 
Can someone explain the concept of seeking medical treatment because one has "awesome insurance"?
 
Can someone explain the concept of seeking medical treatment because one has "awesome insurance"?
In our broken healthcare system, many people defer non-essential treatments or consults because their insurance is crap and they can't afford to pay out of pocket. If they get somewhat decent insurance with their next job they have a laundry list of items to address, hopefully none of them having gotten worse due to the delay in preventative care. Conversely, if someone has decent insurance, they may be more likely to seek treatment or a consult while they still can knowing that that insurance can disappear or change quickly and be replaced with crap insurance, if any at all.
 
Haha yeah, my company was almost exclusively healthy, young people, so our benefits were fantastic. Changed jobs since then and that’s no longer the case
 
Haha yeah, my company was almost exclusively healthy, young people, so our benefits were fantastic. Changed jobs since then and that’s no longer the case

Yup.

I will refrain from saying more lest I stray into prohibited territory and violate the TOS.
 
Can someone explain the concept of seeking medical treatment because one has "awesome insurance"?
When you subsidize something, you get more of it. Subsidize healthcare consumption, and there will be more consumption.
 
I guess my question is more geared towards how going to the Emergency Department because he had awesome insurance is relevant to the discussion. Is the OP suggesting that he didn’t think it was particularly serious, but went anyway because it didn’t cost him anything?

I’m asking the question honestly because I’ve never seen anyone mention the quality of their insurance plan as a factor in a medical certification question. I think it’s safer to say that neither the AME nor the FAA would take that into consideration when determining whether you meet part 67 requirements or not for certification.

And yes, I’ve been minimally insured in the past and understand the cost/benefit analysis. Back when I was a broke independent flight instructor, I may or may not have consulted with my veterinarian instrument student on the care and treatment of an infection on “my 225 pound dog”.
 
Yes, the fact that I knew the ER visit was only going to cost $100 was a part of my decision to get checked out. Since it was the middle of the night and I was feeling something I was unsure about, I decided better safe than sorry since I knew the bill wouldn't be outrageous. Same for most of my doc visits...it's easy to decide to get checked out when it's only going to cost $20...if I had the insurance then that I have now, I probably would've taken more of a wait-and-see approach, on everything. It was a huge blessing, and it gave me peace of mind to know everything was good to go. But yeah like you said, I don't think the FAA will see it that way, haha. So I'm just trying to figure out the best way to approach it all.
 
Back when I was a broke independent flight instructor, I may or may not have consulted with my veterinarian instrument student on the care and treatment of an infection on “my 225 pound dog”
Being in that situation now, I empathize about the ruff times.
 
Hi everyone,

Phillip here again. I just wanted to come back around and give an update/conclusion to this scenario!

In the end, I emailed back and forth with Dr. Kozarsky a few times before I even went in to see him. I sent him my situation and was forthcoming with my full history. He advised I go back to my previous doctors and get letters of recommendation, effectively saying I have good health, from my doctors who had seen me for my previous issues.

So, I went back to my PCP and got a letter stating I have no true anxiety issues; rather, it was situational. I also had a 24-holter monitoring completed, as well as an echocardiogram.

Once I had all of this documentation, I went in for my official medical with Dr. Kozarsky. He was able to issue my medical without having to go through a deferral! I waited a long time to post this follow-up in case I ever got a request from OKC for additional docs or anything that might ground me. I DID eventually get a letter from OKC, but it basically just said my medical certificate is valid and if I ever experience situational anxiety again, I need to ground myself (obviously).

So, wanted to post this in case in might give encouragement to someone in a similar scenario! Also, don't freak out if one person says that an anxiety "diagnosis" like I received means you'll have to go through HIMS; I called AOPA med services once and once they heard anxiety, they immediately told me to prepare to see a HIMS. Rather, it's best to get in contact with your AME in advance (and I'd recommend seeing a first-class AME, too) and see exactly how they need to proceed in order to help get you to your end goal! My AME is also a pilot, and I think that helped, too!

I've since acquired my PPL and am enjoying life as a low-time pilot, learning more every flight.

Thanks, everyone!
 
Welcome to the skies. Glad to hear it worked out.

never be afraid to go get a medical condition checked - health first, flying second. Things can happen at any age.
 
Glad it worked out, sounds like it was a potential minefield to get through. I sometimes get fits(anxiety?) over the diagnosis of an anxiety condition. I’m not in the medical field but decades ago one could be a touch nervous about an upcoming situation. Now days we call it ‘anxiety’, and OBTW, here are some meds to help you.
 
I think that offhand anxiety comment is exactly the problem with the FAA medical process. Makes a pilot absolutely scared to tell or ask his regular doc anything.

One time I made some off hand comment about some little minor result of taking some codeine based pain killers one time in the past (dental work or some such thing).... just didn't like the way it made me feel.....now I'm apparently allergic to codeine ...in ink...forever!
I really don't think I'm allergic, just don't like it.....
 
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