C
Cogscreamer
Guest
I wanted to share my story of a difficult SI in the hopes that it will give others some insight and perhaps courage to not take 'no' for an answer.
I had been diagnosed with mild depression during my senior year of high school 25 years ago. The psychiatrist I had been sent to put me on Zoloft (Sertraline), which I guess helped. I stayed on it via my family doctor for the years afterwards, not really giving it much thought, and never realized the difficulty it would cause in working towards a PPL someday.
When I decided to pursue flying a few years ago, I first earned my sport pilot license instead of going for private, knowing that the SSRI could be an issue. However, a used Cessna 150 is a lot cheaper than pretty much any LSA that doesn't look like an overgrown ultralight.
So, it was time to reach out to the legendary Dr. Bruce. I had done my research and knew what I was in for: Dr. Bruce does not suffer fools gladly. His workload is immense - there are hundreds (thousands?) of airmen he is currently working with, so you have better have your stuff squared away so as not to burden his time. He will deliver results, but only if you do your part and follow his instructions.
With that in mind, I filled out the contact form on aeromedicaldoc.com with a brief summary of my quandary and soon got a response, indicating that he'd be willing to take me on and pursue my case further. He requested a pittance of a check paid to him to start a file (this kills me - I think I have paid less to Dr. Bruce in all of this than to any of the other medical professionals during this process).
He noted immediately that there were two paths available - on-medication or off-medication, and certainly off-medication was the far easier path. I was already on the very lowest dosage available, so in Dec. 2015 and Feb. 2016 I visited my general practitioner to have it noted in my records that I was discontinuing the SSRI and was then off of it for over 60 days. 2 months later, I visited a HIMS psychiatrist for evaluation. I then visited Dr. Bruce in May of 2016 for an exam and submission for the third class medical.
Dr. Bruce had warned that the only possible kicker that the FAA could come back with might be a diagnosis of 'dysthymia', which I had never even heard of at that point. However, in October of 2016 I received a letter via certified mail informing me that "...you do not meet the medical standard as prescribed in Title 14 of the Code of Federal Regulations (CFR), Section 67. Blah blah blah..."
I was devastated, as the denial meant I couldn't fly as a sport pilot, much less advance to private. I contacted Dr. Bruce right away, and he requested my "FAA Blue Ribbon Medical Record" to determine the cause of the denial. Because I had in the past tried discontinuing the medication on my own on a few occasions, but then would start taking it again a few months later when feeling slightly anxious, the FAA determined that this constituted dysthymia, and would not allow me to certify off-medication. This is hopefully the single biggest contribution I can make to those considering the SSRI certification path - do not do on-again, off-again with the medication, as the FAA will then determine that you need the SSRI, and not the much more likely (IMHO) conclusion that after 20 years on the stuff, you forget that having a little anxiety from time to time is just part of existing as a human being. Very hard lesson learned.
Dr. Bruce told me that my options were to (a) go back on Sertraline and endure the much more onerous 'on-medication' SSRI path, or (b) discontinue seeking a third class medical. Dr. Bruce was not going to coach me into one direction or the other, which impressed me - the decision on which path I wanted to pursue was truly my own. But I had "tasted flight" as the quote goes, and was willing to meet any requirement needed of me to continue flying. I told him that I would like to pursue the third class medical "on-medication" - I had absolutely nothing to lose, since it had already been taken away from me.
Step 1 was to get back onto the SSRI. However, this needed to be done under the guidance of a "board certified psychiatrist" (BCP). So I visited my general practitioner once more for a referral. This was an aggravating process, as everyone wants to shuttle you to a "therapist", and getting a proper BCP is a daunting task when you're not actually depressive. I finally got an appointment on Nov. 2016 with just such a BCP, with whom I outlined the entire situation, and my need to go back onto the SSRI. "25mg? That's usually for kids." "Maybe you shouldn't be flying at all." Gee, thanks for the support, doc! Fortunately, I didn't require much of them - just to be a "board certified psychiatrist" who could issue prescriptions and offer a "reasonable level of care".
Step 2 was to continue taking the pills for 6 months. Easy enough - after all, this dosage was "usually for kids".
Step 3 was meeting with the HIMS psychiatrist again. Fortunately, this person was supportive, understanding, and very pleasant to work with. Dr. Bruce informed me later that this individual was former military, like himself. I'm not sure if that's what made the difference, but when it comes to aeromedical issues, I would happily chose a retired military practitioner - they really have their stuff together.
Step 4 was the biggie, just 3 weeks later - the full neurological evaluation/screening, including the dreaded Cogscreen-AE. I was in fear of this day, and had been doing a few months of Lumosity beforehand just to try to prepare myself. The morning started out with all sorts of exams and tests - puzzles, memory challenges, response inhibition testing... I couldn't help but think of "The Right Stuff" the entire time. Finally the Cogscreen-AE machine was ready, which I detailed here: https://www.pilotsofamerica.com/community/threads/cogscreen.108790/#post-2495798
After that harrowing ordeal, we broke for lunch. Upon return, the staff were all smiles, and said that my Cogscreen-AE results were excellent, that I didn't have to endure any more testing, and the results of the morning tests weren't even needed. Oh, and since I had written out a check to cover the full gamut of testing, the total cost is much less, so here's your old check back and just write us a new one for about 60% of that. What a relief!
Step 5 (Jul. 2017) was optional, but Dr. Bruce suggested that I make one last visit with the HIMS psychiatrist in order to bolster my application. Hey, I was willing to put any cherry on top that I could. And as mentioned, the HIMS psychiatrist was someone I liked and respected, and I knew that they had my best interests in mind. Done.
Step 6 was to meet with Dr. Bruce once again (Aug. 2017) for another exam, just with much more paperwork behind it this time (I also had to compose a personal statement to submit, and I managed to get a note from my employer stating that I was a good, stable employee). There was a sizable stack of papers sent to the FAA afterwards. After that, the hardest part began - waiting. Call OKC after a certain day to see if they have the file in the system and 'express interest', then call again on non-consecutive business days until you get the magic words "we'll flag your file".
Step 7 was to continue meeting with the BCP every 3 months in the meantime (FAA only requires 6 month intervals, but this particular BCP works on a 3-month cycle), while calling OKC semi-regularly for status. By November 2017 I was informed that my case had been forwarded to the Federal Air Surgeon's office in Washington. By February of 2018 it was still in Washington, and I was given a contact there. Many messages and inquiries were left in the months afterwards, but finally in May 2018, the airman inquiry site for my name had changed status, and a week or so later I received a call from the Washington contact informing me that "there was something in the mail that I was looking forward to". Sure enough, a few days later, there it was - my third class SI!
Of course, Dr. Bruce had already sent me a scan of my SI by the time I got the letter! The only pressing issue that needed to be addressed right away was for the BCP to write a letter stating that he would inform the FAA immediately upon any change in my condition. Beyond that, though, there was nothing more needed, and Dr. Bruce instucted me to "enjoy the air!" I hardly needed any encouragement on that.
Now that the SI was issued, there were still requirements that had to be met. I still had to meet with the BCP every 3 months, meet with Dr. Bruce every 6 months, and undergo another Cogscreen-AE every 24 months as the major requirements of keeping my SI. While I did in fact visit the BCP right after Oshkosh, and then Dr. Bruce the very next day, Dr. Bruce cautioned against such a close scheduling, as the BCP needed to issue him a clinical report first. I managed to pull it off, yet Dr. Bruce voiced his displeasure - he knows the lead times that are standard in his profession, and rightfully chastised me for running things so close to the wire. Dr. Bruce knows his field, and I do not - even though it worked out, I knew I probably should have held off for a week. LISTEN TO DR. BRUCE.
That was early August, and Dr. Bruce was able to issue an extension of my SI for 6 months. He had strongly suggested to me last year that I take advantage of BasicMed, which I will most certainly do. I'll still need to see my "board certified psychiatrist" regularly for BasicMed, but it's only a minor inconvenience. So in a few months I'll contact my general practitioner and provide them with the BasicMed checklist, to continue on that path for the rest of my aviation life (unless something better comes along).
Thanks, Dr. Bruce - one more over the fence.
I had been diagnosed with mild depression during my senior year of high school 25 years ago. The psychiatrist I had been sent to put me on Zoloft (Sertraline), which I guess helped. I stayed on it via my family doctor for the years afterwards, not really giving it much thought, and never realized the difficulty it would cause in working towards a PPL someday.
When I decided to pursue flying a few years ago, I first earned my sport pilot license instead of going for private, knowing that the SSRI could be an issue. However, a used Cessna 150 is a lot cheaper than pretty much any LSA that doesn't look like an overgrown ultralight.
So, it was time to reach out to the legendary Dr. Bruce. I had done my research and knew what I was in for: Dr. Bruce does not suffer fools gladly. His workload is immense - there are hundreds (thousands?) of airmen he is currently working with, so you have better have your stuff squared away so as not to burden his time. He will deliver results, but only if you do your part and follow his instructions.
With that in mind, I filled out the contact form on aeromedicaldoc.com with a brief summary of my quandary and soon got a response, indicating that he'd be willing to take me on and pursue my case further. He requested a pittance of a check paid to him to start a file (this kills me - I think I have paid less to Dr. Bruce in all of this than to any of the other medical professionals during this process).
He noted immediately that there were two paths available - on-medication or off-medication, and certainly off-medication was the far easier path. I was already on the very lowest dosage available, so in Dec. 2015 and Feb. 2016 I visited my general practitioner to have it noted in my records that I was discontinuing the SSRI and was then off of it for over 60 days. 2 months later, I visited a HIMS psychiatrist for evaluation. I then visited Dr. Bruce in May of 2016 for an exam and submission for the third class medical.
Dr. Bruce had warned that the only possible kicker that the FAA could come back with might be a diagnosis of 'dysthymia', which I had never even heard of at that point. However, in October of 2016 I received a letter via certified mail informing me that "...you do not meet the medical standard as prescribed in Title 14 of the Code of Federal Regulations (CFR), Section 67. Blah blah blah..."
I was devastated, as the denial meant I couldn't fly as a sport pilot, much less advance to private. I contacted Dr. Bruce right away, and he requested my "FAA Blue Ribbon Medical Record" to determine the cause of the denial. Because I had in the past tried discontinuing the medication on my own on a few occasions, but then would start taking it again a few months later when feeling slightly anxious, the FAA determined that this constituted dysthymia, and would not allow me to certify off-medication. This is hopefully the single biggest contribution I can make to those considering the SSRI certification path - do not do on-again, off-again with the medication, as the FAA will then determine that you need the SSRI, and not the much more likely (IMHO) conclusion that after 20 years on the stuff, you forget that having a little anxiety from time to time is just part of existing as a human being. Very hard lesson learned.
Dr. Bruce told me that my options were to (a) go back on Sertraline and endure the much more onerous 'on-medication' SSRI path, or (b) discontinue seeking a third class medical. Dr. Bruce was not going to coach me into one direction or the other, which impressed me - the decision on which path I wanted to pursue was truly my own. But I had "tasted flight" as the quote goes, and was willing to meet any requirement needed of me to continue flying. I told him that I would like to pursue the third class medical "on-medication" - I had absolutely nothing to lose, since it had already been taken away from me.
Step 1 was to get back onto the SSRI. However, this needed to be done under the guidance of a "board certified psychiatrist" (BCP). So I visited my general practitioner once more for a referral. This was an aggravating process, as everyone wants to shuttle you to a "therapist", and getting a proper BCP is a daunting task when you're not actually depressive. I finally got an appointment on Nov. 2016 with just such a BCP, with whom I outlined the entire situation, and my need to go back onto the SSRI. "25mg? That's usually for kids." "Maybe you shouldn't be flying at all." Gee, thanks for the support, doc! Fortunately, I didn't require much of them - just to be a "board certified psychiatrist" who could issue prescriptions and offer a "reasonable level of care".
Step 2 was to continue taking the pills for 6 months. Easy enough - after all, this dosage was "usually for kids".
Step 3 was meeting with the HIMS psychiatrist again. Fortunately, this person was supportive, understanding, and very pleasant to work with. Dr. Bruce informed me later that this individual was former military, like himself. I'm not sure if that's what made the difference, but when it comes to aeromedical issues, I would happily chose a retired military practitioner - they really have their stuff together.
Step 4 was the biggie, just 3 weeks later - the full neurological evaluation/screening, including the dreaded Cogscreen-AE. I was in fear of this day, and had been doing a few months of Lumosity beforehand just to try to prepare myself. The morning started out with all sorts of exams and tests - puzzles, memory challenges, response inhibition testing... I couldn't help but think of "The Right Stuff" the entire time. Finally the Cogscreen-AE machine was ready, which I detailed here: https://www.pilotsofamerica.com/community/threads/cogscreen.108790/#post-2495798
After that harrowing ordeal, we broke for lunch. Upon return, the staff were all smiles, and said that my Cogscreen-AE results were excellent, that I didn't have to endure any more testing, and the results of the morning tests weren't even needed. Oh, and since I had written out a check to cover the full gamut of testing, the total cost is much less, so here's your old check back and just write us a new one for about 60% of that. What a relief!
Step 5 (Jul. 2017) was optional, but Dr. Bruce suggested that I make one last visit with the HIMS psychiatrist in order to bolster my application. Hey, I was willing to put any cherry on top that I could. And as mentioned, the HIMS psychiatrist was someone I liked and respected, and I knew that they had my best interests in mind. Done.
Step 6 was to meet with Dr. Bruce once again (Aug. 2017) for another exam, just with much more paperwork behind it this time (I also had to compose a personal statement to submit, and I managed to get a note from my employer stating that I was a good, stable employee). There was a sizable stack of papers sent to the FAA afterwards. After that, the hardest part began - waiting. Call OKC after a certain day to see if they have the file in the system and 'express interest', then call again on non-consecutive business days until you get the magic words "we'll flag your file".
Step 7 was to continue meeting with the BCP every 3 months in the meantime (FAA only requires 6 month intervals, but this particular BCP works on a 3-month cycle), while calling OKC semi-regularly for status. By November 2017 I was informed that my case had been forwarded to the Federal Air Surgeon's office in Washington. By February of 2018 it was still in Washington, and I was given a contact there. Many messages and inquiries were left in the months afterwards, but finally in May 2018, the airman inquiry site for my name had changed status, and a week or so later I received a call from the Washington contact informing me that "there was something in the mail that I was looking forward to". Sure enough, a few days later, there it was - my third class SI!
Of course, Dr. Bruce had already sent me a scan of my SI by the time I got the letter! The only pressing issue that needed to be addressed right away was for the BCP to write a letter stating that he would inform the FAA immediately upon any change in my condition. Beyond that, though, there was nothing more needed, and Dr. Bruce instucted me to "enjoy the air!" I hardly needed any encouragement on that.
Now that the SI was issued, there were still requirements that had to be met. I still had to meet with the BCP every 3 months, meet with Dr. Bruce every 6 months, and undergo another Cogscreen-AE every 24 months as the major requirements of keeping my SI. While I did in fact visit the BCP right after Oshkosh, and then Dr. Bruce the very next day, Dr. Bruce cautioned against such a close scheduling, as the BCP needed to issue him a clinical report first. I managed to pull it off, yet Dr. Bruce voiced his displeasure - he knows the lead times that are standard in his profession, and rightfully chastised me for running things so close to the wire. Dr. Bruce knows his field, and I do not - even though it worked out, I knew I probably should have held off for a week. LISTEN TO DR. BRUCE.
That was early August, and Dr. Bruce was able to issue an extension of my SI for 6 months. He had strongly suggested to me last year that I take advantage of BasicMed, which I will most certainly do. I'll still need to see my "board certified psychiatrist" regularly for BasicMed, but it's only a minor inconvenience. So in a few months I'll contact my general practitioner and provide them with the BasicMed checklist, to continue on that path for the rest of my aviation life (unless something better comes along).
Thanks, Dr. Bruce - one more over the fence.
