Kidney Stones

jason said:
So the stone is still in there? What were the scans for? Were you looking for stones? If the stone has been passed (and you're confirmed stone free) you can fly all you want.
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Sounds like he's waiting for his student medical to get issued so he can solo. For some reason it was deferred to FAA. Maybe there is a retained stone?
 
I passed a kidney stone 2 years ago and when my AME seen my history with ks he sent me for scans and blood work. To my understanding the scan picked up a very small stone and he said it would have to be sent for FAA approval. I asked if there was anything I needed to do as far as have the stone removed or what ever process nessasary and he said I didn't need to do anything and that he would send all the appropriate paper work and I should receive a letter in the mail within a few weeks
 
N6958H said:
Thank you, I will call everyday if I have to... It's very frustrating but after finding this forum I see I'm not alone with this kidney stone issue
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Ask you AME TO CALL. He can cut through the c_ap if he is willing to help you out.
 
N6958H said:
I passed a kidney stone 2 years ago and when my AME seen my history with ks he sent me for scans and blood work. To my understanding the scan picked up a very small stone and he said it would have to be sent for FAA approval. I asked if there was anything I needed to do as far as have the stone removed or what ever process nessasary and he said I didn't need to do anything and that he would send all the appropriate paper work and I should receive a letter in the mail within a few weeks
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Hmm. I'd really question my AME if he went searching for things like this. Maybe I'm wrong, but I want my AME getting me through the process. Not complicating things by searching out reasons to generate paperwork to the FAA.
 
I called my AME today to ask for help with my FAA dilema. I was disappointed when he seemed to not have time to make a simple phone call or anything for me. He said I should be notified by mail soon which I already know and was only asking him to help speed up the process. I really don't know what else I can do. I'll just keep flying every chance I get with my CFI until I am cleared or atleast findout what the next step is. Thanks guys for the info, I have pretty much been in the dark on everything until I found this forum.
 
bbchien said:
Well that seals it. WRONG AME.
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Yeah, it's REALLY sad that it's so variable! Bruce, I wish they were all like you! (And I bet your wife does too, because then you wouldn't always be so busy!)

[BTW, say "Hi!" to her from Leslie and me! I saw her a couple of weeks ago, but Leslie didn't!]
 
Jeff Oslick said:
Out of curiosity, I searched the FAA incident database for "kidney". In 28 years of records, it came up with only 8 incidents of kidney stones, and all of them were air carrier incidents. All, of course, ended fine with the other pilot landing. I think this shows evidence that sudden, truly incapcitating pain from kidney stones is very rare, and is a non-factor in general aviation incidents/accidents. Much like how the FAA medical folks hamstring people who have undergone chemo (I know someone in this situation) - they are setting standards that have little to do with legitimate, statistical probabilities of in-flight medical problems endangering the outcome of a flight.

Has anyone ever heard of a GA pilot having a major kidney stone incident in-flight?

I'm certainly not advocating that it's a good idea to go flying with known unstable stones, but I'm looking ahead at what I'm going to need to go through to get flying again and how much it's going to cost me on an on-going basis, and I'm not at all happy about it.

Jeff
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Pilot no, but my uncle started passing one while a passenger, that was a great Christmas!
 
SkyHog said:
yep...just passed one, two more to go, hopefully this weekend. most painful thing I have experienced to date.

what effect will this have on my class 3 medical?
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Get a spiral CT scan and send the results to oklahoma
 
Actually, you need to wait 90 days to show stability. If it has not moved you are certifiable on a Special. Of course it may be gone.

The key then is to move to KUBs (Much cheaper) so get a KUB at the time of the 90 day CT.
 
Bruce, can I request the KUB? My AME sent me for a spiral scan and made no mention of any other scan. A very small stone was spotted on the ct. I had a CFI (not mine) tell me I shouldn't have disclosed that I ever had stones. I'm thinking that wouldve cost me in the long run. Also since my medical is already up for review with the FAA can I go to an alternate AME for a second opinion and possibly be cleared or am I now at the mercy of the FAA? Thank you for your time
 
ONE MORE THING: read the CT report carefully. If the remaining stone is less than 0.2mm in size (NOT 2 millimeters, but 0.2 mms) you are certifiable as is.

BUT IT NOT:

This AME got you in the pickle. NO application should have been filed until he had had the reassessment, and he failed to get a KUB with the old study. Sigh.

Only go for the second spiral CT at 90 days. Otherwise you won't qualify for the "retained stone SI", should a stone still be there. ONLY IF YOU HAVE MONEY to flush, should you go again immediately.

When you get the KUB, get it WITH the second spiral CT. Yes you can ask for it.

The only way that from afar I can cover you is to TELL YOU TO WAIT 90 DAYS. That way if the stone is still there, you can be special-issued. The KUB, having been gotten ~75 days from now, will be the tool of comparison for the next year when you need to show continued stone stability or stone-free status.

If you get denied in the interim, No Big Deal. Just Re-apply when you have the repeat Spiral CT+ KUB. The KUB lays the groundwork for a year from now and is cheap cheap cheap. We KNOW your stone is radio-opaque (or the CT wouldn't show it). AND FOR GOD's SAKE WHEN YOU reapply don't go to the same AME.

The problem with waiting 90 days and just getting the KUB is that there is no KUB from 15 days ago to compare with.

Your CFI is dead wrong. The problem is, you are using a non-knowledgeable AME. You are welcome in Peoria, but you are closer to Dr. Gerald Bock in Memphis (8573 Cordes Circle, Germantown TN...on the East side). He'll tell you the same thing. And he is a charter member of the "league of extraordinary AMEs" (with apologies to Sean Connery).
 
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Do everything that Bruce says...or everything that anybody that he recommends says. They'll get you through the process.

FYI, a KUB is an X-Ray (or multiple x-rays) of the kidneys, ureters, and bladder...hence the name KUB. The reason that they're recommended over a scan is that 1) they're cheap and 2) they don't show as much detail. A stone that could be seen in a scan may not be picked up on a KUB. BUT, you can be certified stone free from a KUB. That's why Bruce is recommending that you get a KUB done at the same time as your second scan. It's the "before" in the before and after that you'll need to start getting your medicals without special issuance. As he said, if you can show a stable stone, you'll be issued an SI. If you show stone free, then you can get a regular medical.

I understand why you trusted this AME. Why wouldn't you? That said, you're starting a new life now. Every medical professional that I encounter gets the same introduction from me. "I'm a pilot, so I have some extra things that I need to worry about. Depending on the direction of our conversation, I may need to stop our discussion. If I do, it's because I plan to seek council as it relates to my FAA medical certificate. Once I'm educated we can pick up our conversation and we'll choose the proper course of action. One that takes care of any medical issues that I may have, but also has the least impact on my standing with the FAA." That's a paraphrased version of it, but you get the gist.
 
gismo said:
My kidney stone experience was as painful as advertized but I think I could still have managed to fly to an airport and make a safe landing at the worst of it.
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Well yea, there was a guy who landed Cessna [sic] Mustang while paralized with stroke and basically dead. He died within an hour of landing. Depends how far airport is, I guess.
 
Add me to the club. The pain started this morning, wouldn't go away and I had my son haul me to the ER this afternoon. CT showed a stone. I'd rate the pain (prior to the pain killer they gave me) a 5 or so. Need to call the urologist in the morning to make an appointment. Thanks for the suggestion about using a coffee filter to catch the stone. The ER didn't give me anything, nor did they mention it, other than in the paperwork they gave me as they kicked me out the door. Why do I have the feeling we'll be driving across the state in a few weeks for a football game, rather than fly. Drat!​
 
Update - The report on the CT scan said 1 3mm stone and "Multiple tiny bilateral renal calculi". I got this from my urologist's office when I saw them on Monday. They gave me a strainer which I've used religiously since. I just passed what should have been the 3mm stone and captured it for the doctor.

So, let's take the next step and see where I am (assuming I don't suffer more pain between now and Monday morning). I'll call the urologist's office on Monday and make an appointment to bring in the stone. What do I do next to get back in the air? Possible scenarios are:

1. The CT scan said 1 3mm stone and I've passed that. Urologist and I agree I am good to go.

2. Same as 1 above and urologist orders KUB (the one last Sunday was labeled a CT KUB). KUB comes up clean and I'm good to go.

3. Something else?

I'm guessing #2 will be closer to the mark.

What should I have the urologist write in a letter for the FAA when I renew my medical next April? My AME is a Senior AME and one of Bruce's HIMS collegues (not that I ever expect to need that capability) and he doesn't seem to hesitate to pick up the phone and call the FAA when there's a question when I'm in his office.

Looking forward to getting this behind me.
 
Ghery. The key is to getting your urologist, in a letter, to call "the multiple tiny flecks that remain behind suggest nephrocalcinosis". This is NOT the same as stone disease, these guys do not pass, they get embedded in the lining of the tubes and can't move. Ask him to write that verbatim.

He also has tos ay that your stone have been sent for analysis and you "will be advised as to the proper metabolic maneuvers to curtail stone production". Ask him to write that verbatim.

I don't want to hold out here, but you might want direct communication about this- though I think you can handle it.
 
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Bruce,

Thanks. I'll take care of the letter with the urologist when I see him (assuming, of course, that he agrees with the statements). My medical isn't due until next April (3rd class), so there's time for this. Should have the analysis of the stone and recommended future actions provided and in progress by then. I'm assuming (dangerous word) that once he and I agree I'm good to go that I can get back in the air.

The big relief right now is that I don't have to worry about this getting in the way of a business trip I have scheduled in a few weeks. I did not want to hop on a flight to Rome without having gotten that stone out of my system. Especially with a non-refundable ticket that would have come out of my pocket if I had to cancel. I'm starting to get to the point where I can see the benefit of trip insurance.
 
Saw the urologist this afternoon after having a KUB. "Stone free" was his statement. So, I'm back in the air. I'll have a letter from him and the imaging study report for my medical next April. The only down side is that he now wants me to have a KUB every 6 months to ensure I don't start developing stones again. We'll get together after the lab results are back so he can tell me what dietary changes to make to prevent another stone. I'm all in favor of that. :D
 
Ghery said:
The only down side is that he now wants me to have a KUB every 6 months to ensure I don't start developing stones again.
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I'll leave this to you and your doctor, especially since I have no clue what I'm talking about, but going "looking" for something that can be grounding isn't always the best idea since you can do little to absolutely nothing about real small stones.
 
jesse said:
I'll leave this to you and your doctor, especially since I have no clue what I'm talking about, but going "looking" for something that can be grounding isn't always the best idea since you can do little to absolutely nothing about real small stones.
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That is EXACTLY what I was thinking when I read his post.
 
It sounds like the doc is launching on a stone prevention campaign, with the simple Xrays as the measure of "how're we doing?" instead of "darn, passing another one- we failed".

With alkalinization of the urine, it's sometimes hard to tel if you're doing enough of it.

With Hydrochlorothiazide to reduce calcuria, it hard to tell if you're doint tha hard enough.
 
bbchien said:
It sounds like the doc is launching on a stone prevention campaign, with the simple Xrays as the measure of "how're we doing?" instead of "darn, passing another one- we failed".

With alkalinization of the urine, it's sometimes hard to tel if you're doing enough of it.

With Hydrochlorothiazide to reduce calcuria, it hard to tell if you're doint tha hard enough.
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It is my understanding that if the doctor does suddenly find some small stones during his quest then you're grounded until you prove that the stones aren't going to be moving and won't be an issue and that takes 90 days. Is my understanding incorrect?
 
jesse said:
It is my understanding that if the doctor does suddenly find some small stones during his quest then you're grounded until you prove that the stones aren't going to be moving and won't be an issue and that takes 90 days. Is my understanding incorrect?
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Jesse,

IF you have an SI for stone,
then you are correct.

IF you do not have an SI for stones, and
IF you are NOT certificated at the level of CFI (....have reason to know about part 67.313)
Then you are in the murky gray zone of self certification 61.53.

If you have an SI for stone, and no KUB since last certified and no symptoms, you keep flying even though you are making them. But then you end up down at the end of the year, doing your 90 days.

Better to get the stone factory shut down....
 
My understanding is the KUB is the least sensitive of the imaging methods - what is the resolution on the KUB? Just how big does the stone need to be for it to be seen on the KUB?
 
That has to do with the concentration of ca++ and Mg++ in the stone. It can be seen dowe to ~<0.1mm or so IF DENSE enough.
 
Quick update and question:

I caught 2 of the 3 stones, and have not had another issue where I felt stones coming at all. I am going to get another scan done to make sure I am stone free, because I suspect I may have passed the 3rd without knowing. Unfortunately, I only caught the first stone, and did not catch #2 or #3. I have paperwork from the Urologist that gives me diet tips that I have followed to a tee since I got them.

If I go in, and confirm no more stones, does that mean I can submit this stupid medical form and get my medical back (neglecting all of the other crap I'm trying to work out?), or does the fact that I never cause the second or third stones put me into SI land?
 
IF you can get a radiologc study that shows you are stone free, or a pair of them 90 days apart showing no change in the 90 days, you can be certified. The FIRST is a regular issuance, the second case is a special issuance.

Nick do you know what type of stones they are, from the report? It affects whcih studies are admissible for the re-eval and/or the 90 day pair of re-evals if present.
 
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