Physicals, medicals, & diagnosis to avoid

J

John Doe

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I haven't flown in a few years due to other financial concerns and I'm about to pick it up again Q1 or Q2. I'm 30 something overweight male (obese by BMI, currently dieting & down >10 lbs so far) in generally good health (no conditions, no meds). My past medicals have been nonevents and I've had no reason to see a doc in over 3 or 4 years besides my mom badgering me one time over really bad exercise induced soreness.

Based on family history nearly all of us on my mom's side become diabetic by age 30 but so far I've managed to avoid it. I have glucose monitor and so far learned that I'm just past the high end of "normal" when I'm lazy, but ok with exercise 3+ times a week. However, when I'm stressed for too long I can wildly go from high to particularly low after exercise.

Next month I'm visiting the doc and will inquire about checking for early warning signs of all conditions that have hit other family members before or near my age. I expect get an a1c test among other blood work. I'm concerned that the spikes from earlier and a few stress induced spikes this week will yield a higher a1c. Moreover I fear the doc my call me "pre-diabetic".

Questions
1. If the doc says I'm "pre-diabetic" do I have to report that on the next medical?
2. If so, will it require a SI and the long list of test I've seen in other threads?
3. Can I or should I steer the doc away from any particular diagnosis or test?

Thanks,
John Doe
 
My advice/opinions (and I welcome correction from AME's):

Tell your doc about your family history with diabetes. Tell him that because you fly - you need to have him declare that you have it or you don't - wishiwashiness doesn't work, because you don't want there to be any question raised later that you were trying to avoid the diagnosis or that you were less than truthful on your medical application - THAT will ground you and KEEP you grounded.

There is a specific protocol for a diagnosis of DM - it can change over time but the last time I had this conversation with my doctor it required elevated fasting glucose on two separate tests.

It's perfectly normal given your family history to be screened for diabetes as part of your normal physical, so unless you are given the diagnosis, you don't have to report anything other than the visit for a routine physical exam.

With all of that said, IF your doctor says you are a diabetic, then you have to go through the reporting process and do the tests, but with a good AME like Dr. Bruce to guide you it really isn't a horrible thing - you can get the disease under control, you can get (and keep) a medical, and you can continue to enjoy flying. The FAA really does want to keep you in the air.

Best wishes,
 
Since you're in no hurry to achieve the license, continue your efforts for improved health, especially the weight loss. Continue to educate yourself on the foods and eating & excercise habits that keep your blood sugar levels high. Make and stick to the appropriate changes.

Remember that you're changing a very ingrained habit, so small corrections work best. Like, "this week I'll excercise 4 times instead of 3" and don't care if it's 15 minutes or 3 hours. Just that you increased your frequency is a move in the right direction. Another can be, "this week, no hamburgers, and at least one meal of fish and a healthy salad."

Something I'm about to try. Leave my debit card at home and only leave the house with $4.00 in my pocket. This makes it very hard to go raid the local fast food joint and hyperaware of finding myself at the soda fountain of the local RaceTrac or QuickTrip. Convenience food is both killing my health and my budget. Having easily available funds just enables that bad habit.


As far as possibility to Diabetes, start with education on the pre-diabetes symptoms and be mindful of when those are occuring.

Get one of the fingertip testing meters and start checking yourself on a regular schedule. Target number is a consistent 110-115 or less (this will eventually result in an A1c value below 7.0) Also, Bayer makes a home A1c test kit for about $30.00 (two tests). These are pretty accurate and allow you to monitor your progress before you go official with your primary doctor and the FAA.


I very much agree with Tim that your doctor needs to clearly understand that your DX needs to be "black or white" either you have Diabetes or you don't. If he says you don't, but are showing early signs that are correctable, then make sure he states clearly in your chart that you don't.

If he does say you got it, then it does need to be reported and you will be applying for a Special Issuance. As Tim said, the FAA will permit you to fly with diabetes as long as you exhibit it's being properly controlled. This SI is one of the simpler to obtain and comply with. To obtain the SI, a few things are needed from your doctor, and they can be found in this post in another thread.

And the "long list of tests" really isn't. The labs are all done with the same blood sample as your A1c, and your primary doc and easily determine the rest during a normal office exam.

Finally, as far as steering the doctor away from any tests, I can appreciate what you are considering. But as Dr. Bruce Chien wisely told me, "Personal Health first, flying second. You can't enjoy #2 unless you have #1."

This means allow your doctor to do what he believes is best for you to become healthier person. What you can do is to continue to be more involved in what he is looking for and how he's going about it. Then as needed, apply the "What does the FAA need to know about this?" thought. Continue to make sure you know what the doctor is recording in your chart and make sure it isn't some errant memory jogger thought that can turn out to be a landmine with the FAA.

Lastly, Own Your Medical. As you work with your doctor, ask for and obtain copies of everything generated. Start keeping your own chart so you can compare your progress with the FAA requirements (see the FAA website and look for the AME guide). As you progress, you'll learn what the AME and the AMCD (AeroMedical Certification Division) will want to see about you. Bringing them exactly what they are asking for definitely helps speed the process along. Continually Owning Your Medical will mean that once you have the Medical Certificate, you will never have any hiccups or surprises when it comes time for renewal.


Great questions! Keep us apprised of your progress and ask more if you think of them!
 
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Also, make sure you can pass BEFORE you go in. And don't fill out the form without at least talking to the AME FIRST.

If you can't pass and don't apply, Light Sport MAY still be an option (assuming you can still safely act as PIC). But once you fill out the form you are committed and if you fail (and can't get the SI) you are locked out of LSA.
 
AggieMike88 said:
Finally, as far as steering the doctor away from any tests, I can appreciate what you are considering. But as Dr. Bruce Chien wisely told me, "Personal Health first, flying second. You can't enjoy #2 unless you have #1."
Click to expand...

Based on recent improvements I've decided to make no attempts at steering the doc in any direction. I'm pretty much expecting to hear "everything looks good. Just lose more weight."

Great questions! Keep us apprised of your progress and ask more if you think of them!
Click to expand...

My appointment is near the end of next month. On a side note I'm steadily losing weight (slower then I'd like, but that's another topic probably out of scope for this site) and seeing my glucose readings slide down to ~100 mg/dl avg in about 3 months by losing just 6% (~20 lbs) of my previous weight. I wasn't expecting any meaningful health benefits from diet and exercise until next year and 35 lbs down.

Thanks for all of your input. I pretty sure I'm not diabetic yet, but I've heard other non-diabetic people claiming the doc said they're "pre-diabetic". My main concern was whether or not the becoming "pre-diabetic" would complicate my medical. At the rate things are going I was probably worried for no reason.

If I understand the posts above it seems "pre-diabetic" is not really a diagnosis but something docs says as a warning?
 
John Doe said:
Based on recent improvements I've decided to make no attempts at steering the doc in any direction. I'm pretty much expecting to hear "everything looks good. Just lose more weight."



My appointment is near the end of next month. On a side note I'm steadily losing weight (slower then I'd like, but that's another topic probably out of scope for this site) and seeing my glucose readings slide down to ~100 mg/dl avg in about 3 months by losing just 6% (~20 lbs) of my previous weight. I wasn't expecting any meaningful health benefits from diet and exercise until next year and 35 lbs down.

Thanks for all of your input. I pretty sure I'm not diabetic yet, but I've heard other non-diabetic people claiming the doc said they're "pre-diabetic". My main concern was whether or not the becoming "pre-diabetic" would complicate my medical. At the rate things are going I was probably worried for no reason.

If I understand the posts above it seems "pre-diabetic" is not really a diagnosis but something docs says as a warning?
Click to expand...

Great job!!! Keep up the good work. It is amazing how things change by just getting the weight down. :thumbsup:
 
Family/community medicine isn't something I have a lot of exposure to, but if your glucose on a normal chemistry is normal, and you dont have glucose or ketones in your urine, I'm not sure I'd expect them to do an A1c on you.

If you can eat right, exercise regularly and do the right things for the 6 weeks leading up to your medical, you should be scot free. That being said, if there is ANY suspicion of diabetes or pre-diabetes, jump on it now while you are healthy. Its a slow, silent, insidious disease that leaves you unaware of damage until its already done.

Its possible to be a "diabetic" and be diet/exercise controlled... and I believe that is acceptable to the FAA. Its unlikely to be suddenly incapacitated by high sugar, and if you aren't on meds that drop it (insulin or oral agents) its unlikely to be incapacitated by low sugar..
 
From the FAA's point of view, Diabetes controlled by diet and exercise is not a special issuance condition.

Don't steer this one. Do what the docs wants.
 
OP here. I didn't attempt to steer anything or even mention the FAA. I was open and honest with my doctor and treated this are more of a consultation wrt my present and future health. I showed up with a short list of small questions and made sure to mention a few trivial occurrences in case they connect the dots to something big. Other than personifying and yelling at the scale for reporting 6 pounds higher then my scale this physical was a non-event.

Other then being "diagnosed" as obese on my HMO's medical records I've got a clean bill of health. Doc gave me a fasting glucose test that showed incredibly normal numbers. Speaking of numbers I've got one last question. Immediately after my yelling and arguing with the scale the nurse measured my bp and it was in the prehypertensive range, obviously. I asked for a minute to calm down and a retest. I used a technique I've come up that I believe reduces my pulse and bp on demand through sheer willpower. The retest 2 minutes later was in the normal range, a reduction of about 25/15.

Is it cheating to lower your bp through concentration during a doctor visit?
 
Unregistered said:
Is it cheating to lower your bp through concentration during a doctor visit?
Click to expand...

I always ask the AME (and he always complies) to take my BP at the end of the exam. Much closer to my normal 115/70 (or thereabouts) than when I walk in.

Had a procedure last week and was immediately put on the continuous BP machine. As the IV was being inserted (very painfully as I have small veins that roll) the BP registered 180/85...duuuuhhhh!

Walking out? 120/75.
 
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