AircraftOwner Online

When should you use over the counter cold medicines when flying or otherwise? Almost never!  Since this is cold and flu season, their use goes up and many pilots are faced with a choice.

Over the counter cold medications are just plain horrible.  Although their advertisements may imply they shorten the course of a cold, they do not.  In fact, most of the over counter cold medications have never been proven safe or effective for anything.  Their ingredients were grandfathered in prior to having to prove so and even now, new drugs only have to show they are better than nothing.

The implications for flying are significant.  Many of these cold medications are stimulating like pseudoephedrine which may induce symptoms ranging from being jittery to having tremors—not a good thing in the cockpit.  Plus, altitude may increase ones sensitivity to such medications. 

Other cold medications may cause such symptoms as sedation, dry eyes, dry mouth, and nose bleeds.  Also side effects that are troublesome in an aircraft.

It is important to remember that an antihistamine is for symptoms induced by allergy.  They may dry up a runny nose caused by a cold but that is not how they are supposed to be used. In fact, the dryness caused by antihistamines and other specific cold medications may actually prolong illness since it prevents your body from getting rid of the offensive material.

Although the FAA has accepted a large number of these medications (and even a longer list with a doctor’s note), I would not recommend them for flying unless you have really tried them on the ground and know they will not adversely affect you.  But first, ask yourself the question “Is it really doing anything for me?”

Let me give you an example.  One of the most painful situations we see with colds is related to sinus pressure.  The sinuses are like caves—big on the inside with small drainage openings.  They are lined with mucous membranes just like you nose and produce significant amounts of mucous during a cold.  The over the counter cold medications may dry you up but they thicken the mucous which blocks the small opening of the sinuses.  Then the pressure and pain begins.

What is safe over the counter?  Aspirin, ibuprofen, acetaminophen, and naproxen are the only ones I recommend.  Be sure not to be fooled into by something like “Tylenol Sinus” which is just expensive acetaminophen plus phenylephrine and guaifenesin.  Phenylephrine is similar to the stimulant pseudoephedrine and I have never seen guaifenesin do anything.  From my viewpoint, if you think “expectorants” and “decongestants” do anything, I would like to speak to you about ghosts and goblins.

Aspirin, Ibuprofen, and naproxen are anti inflammatory medications (called NSAIDs—non steroidal anti inflammatory drug) which also reduce fever and pain.  Acetaminophen reduces fever and pain but does not have any anti inflammatory effect.  Always buy the generics unless you like wasting money supporting drug companies!

The bottom line is that everyone gets common colds and nothing will shorten the course.  Lots of fluids (both oral and vapor), rest, and controlling fever are the only things that will help but nothing shortens the course.

The FAA may be improving your health and extending your life without either of you knowing it!

    John Abramson MD, in his book Overdosed America, makes compelling and referenced arguments about how the pharmaceutical industry is pushing as many drugs as possible on the American public—whether they do nothing, hurt, or even kill people. Fortunately, the FAA does not allow many of these medications for use by pilots so we may be inadvertently helping ourselves by avoiding medications.

    Antidepressant medications are an example. Many studies show that for mild depression, common antidepressant drugs do not do anything more than placebo. In addition, many of these medications have serious side effects.

    Unfortunately, the FAA does not prevent all medications which have potential harmful effects. Cholesterol lowering medications are a classic. In spite of all the pharmaceutical company advertising, both direct to consumers and physicians, the studies of cholesterol lowering medications effect on heart disease in people without documented coronary artery disease already is absent. Thus, we are poisoning a lot of people’s livers without helping their hearts.

    Claritin, the antihistamine drug approved by the FAA because it is not sedating, is an example of a drug which does not work because it is under dosed. The effective dose of Claritin is four times the standard tablet dose but the manufacturer did not want to test that dose because it is sedating at the higher, actual working level. Thus, they made a fortune on a drug (now non prescription with generics available) that was non-sedating and did not work very well. You might as well be taking M&Ms every morning.

    A place where a lot of people (and many pilots) get into trouble is with prescription pain medications. Many of the new medications such as Oxycotin do not work any better than generic narcotics, but because of their formulation, are much more addicting. It really breaks my heart when a professional pilot loses his medical due to narcotic abuse that was precipitated by a physician prescribing these new, expensive, and highly addictive narcotics. A truly despicable example is Tramadol which is a semi synthetic narcotic which was promoted as non addiction by its manufacturer. Unfortunately, after the drug was introduced, independent studies showed Tramadol was more addicting than non synthetic narcotics!

    The Center for Medical Consumers ( http://medicalconsumers.org/ ) and Evidence
Based Drug Therapy ( http://www.ti.ubc.ca/ ) are good sites for unbiased information about drugs. Unfortunately, the FDA ( fda.gov), is hard to navigate and the most important data is very, very hard (or impossible) to find. That important information is the results of 18 months and/or 10,000 patient uses of drugs and the summary of adverse drug events reported by consumers and physicians (which is under reported).

    What about “ask your doctor” which is promoted by the direct to consumer (DTC) advertisements that you are bombarded with on TV, magazines, and newspapers? (I enjoy seeing these advertisements and thinking “I am doctor and I do not have a clue what that medicine is indicated for or what its’ side effects are!” Do not ask me, I do not know!) The first problem is the DTC advertisements have miss information and omissions that the FDA has monitored at levels as high 65% of the time. The second problem is that most physicians get their new drug information from drug representatives (actually, they are salesman) which drop sample off at their office. These folks are there to sell drugs, not to provide totally impartial information.

    The next source of information for your doctor is from continuing medical education (CME) courses. Unfortunately, CME courses have been hijacked by the pharmaceutical industry by providing physician speakers who are paid handsomely for their promotion of the industry’s drugs. (If you want to see if your physician is a pharma hired gun, check them out at ProPublica
( http://projects.propublica.org/docdollars/ ).

    I frequently tell patients “Stay away from doctors, they just make you sick.” There is truth in jest, especially when drugs and profit are involved. Maybe the FAA is smarter than we thought!

I never thought that my founding www.throughthefence.org would land me in front of a Congressional committee but that is exactly what happened on September 22, 2010.  I had the honor and privilege to testify before the House Transportation and Infrastructure Committee about the FAA’s newly released and updated FAA-2010-0831 (http://edocket.access.gpo.gov/2010/pdf/2010-22095.pdf) policy on residential through-the-fence access.  (Hearing can be seen at: http://transportation.edgeboss.net/wmedia/transportation/20100922fc.wvx)

The FAA’s “revised” policy essentially allows for all current and “shovel ready” residential through-the-fence (rTTF) properties but codifies a ban on all future rTTF.  This is an important distinction since the current policy (FAA 5190.6B) (http://www.faa.gov/airports/resources/publications/orders/compliance_5190_6/) had only been an interpretation by FAA personnel that rTTF was “incompatible airport adjacent land use.”

The Democrats lined up the FAA and three supporting witnesses while the Republicans selected me and Mitch Swecker who is the States Airport Manager for the State of Oregon which is very support of rTTF access. 

Catherine Lang (http://www.faa.gov/about/key_officials/lang/), who is the Acting Assistant Administrator for Airports at the FAA in Washington, was the first witness after Congressman Kurt Schrader from Oregon spoke favorably as a panel member himself.  Ms. Lang did not go into her background as a member of Chicago Mayor Richard Daley’s Aeronautical staff.  We certainly know how much Daley’s organization loves general aviation with its undying support of Meigs Field!

Ms. Lang sported the FAA’s previous points, all of which have been proven to be non factual, not supported by data, and/or not on point, except for a new one—some hangar homes enter the runway in the middle and require aircraft to back taxi.  It seems that the FAA has to keep coming up with new rTTF problems at every turn just to stay ahead of the truth.  The FAA office of Airport Compliance and Field Operations has be the model of “don’t let the facts get in the way of our policy!”

Ms. Lang was followed by Carol Comer (http://tomcat2.dot.state.ga.us/Aviation/Contact_Us/staff.cfm), Aviation Programs Manager of the Georgia DOT, who proudly announced she was a pilot who lived on a private airpark but supported the fact that no federally funded Georgia airport had rTTF access.  Ms. Comer may have neglected to mention that her property was made more valuable by her prohibition of rTTF access at public airports!

Mr. Swecker (http://www.aviation.state.or.us/Aviation/staff.shtml) was next and discussed how rTTF helped Oregon airports stay economically viable and active.  He was followed by Ann Crook (http://www.ecairport.com/AboutELM/airport_manager.asp), Manager of the Elmira Regional Airport, who stated her airport, did not have rTTF access nor did it want it.  Crook was followed by James Coyne who heads the National Air Transportation Association, the trade organization of FBOs, which is mostly concerned about off airport competition to on airport FBOs.

I was the last speaker and I had to mention that even though I was a Republican witness, I was the Democratic candidate for coroner in Teton County Wyoming.  I continued that just like the coroner’s office, the rTTF policy should be a non partisan issue.

You may see the full text of my prepared comments at www.throughthefence.org but to summarize, I pointed out the lack of data and supporting information for the FAA’s position.  The FAA policy represents lots of “what if’s” and “maybe’s” that are not realistic.

I also could not let Ms. Lang get away with her written testimony comment where she characterized rTTF home owner’s input at a public airport board meeting as “influence” that was an “inappropriate process.”  Apparently Ms. Lang forgot the FAA is a part of the administrative branch of the United States, a representative democracy based on public meetings and individual input to government representatives.

My most important point is local airport authorities know who their best neighbors are and these local agencies should be allowed to make those decisions, not the FAA.

It is important for all pilots and those with an interest in aviation to contact their Congressman and Senators to support Representative Sam Graves’ house bill HR 4815 (http://www.govtrack.us/congress/bill.xpd?bill=h111-4815).

MedXPress is the FAA’s new system that allows pilots and student pilots to input their normal flight physical into an electronic database.  In the past, pilots would have to hand fill out the 8500-8 medical certificate form and then, the AME would have to type it into the system.  MedXPress now allows for the pilot to input this data directly saving time and insuring accuracy.  There are some “got ya’s” so read on!

A pilot starts the process by finding the site which is not necessarily an easy task. The easiest way to find MedXPress is to Google it or by remembering https://medxpress.faa.gov (don’t forget the https://). All the common browsers will work with the system except Chrome which I am sure will in the future.

During the first site visit, an account will need to be set up and a password established. The FAA will send you a temporary password which you will need to use to log immediately back in the system to change to a self chosen password explained below.

The account name is your Email address but the password has to be between eight and twelve characters containing three of the four character groups (upper case, lower case, numerals, and non alphabetic characters). Since most of us do not have a regular password that meets these criteria, I use my month and year of birth (e.g. August2010). There is a mechanism for recovery of a lost password but you will have to answer three security questions correctly to do it! You will also be locked out of the system for 15 minutes if you enter the wrong password three times.

Fill out the 8500 form as you normally would. Just remember, if it does not allow you to input some data, you have not checked something above it correctly. For instance, if you do not check “yes” for “Do you currently take any medicine…,” you will not be allowed to enter any drugs.

If you are not sure of what you should put down, you can call an AME or save you work and complete it later. You have 30 days to finish an application or it will disappear from the system. If you do put something down that is incorrect for whatever reason, your AME can correct the mistake but he must explain why the change was made. Thus, if you put down that you use heroin and then tell the AME is was a mistake, his explanation might appear “interesting.”

When you finish the form, the system will give you a number. Print out or write this number down. DO NOT LOSE THIS NUMBER. Take the number with you to your AME exam. Without the number, the AME will not be able to import
your data.

You have 60 days from the time your form is submitted to see your AME. During that time period, your form is in electronic “never, never land” and will evaporate in 60 days. If you do not see your AME in 60 days, you will have to re-enter all the data.

What if you have put something in the 8500 that you decide you did not want to put down on paper? Before giving your AME the MedXPress confirmation number, you can discuss the issue with him. If you decide that you do not want the data to become part of your record, do not give the AME the confirmation number. Your data will disappear in 60 days and you can do it all over again. However, it the AME is given the number, the data will be in your file forever.

Technical help with the MedXPress site can be obtained via Email at 9-NATL-AVS-IT-ServiceDesk@faa.gov (got to love those easy government addresses) or by calling 877-287-6731. 

Many pilots ask what the different criterions are for First, Second, and Third Class Pilot Medical Certificates. Interestingly, there are not very many. In fact, for healthy individuals, there are basically three—vision standards, the electrocardiogram (EKG) requirement, and the frequency of the exams.

The main purpose of the pilot medical exam is to predict sudden medical incapacitation. Since the world wide medical community has never been successful predicting incapacitation or death, the FAA does not have a chance. Thus, the medical exam is really a method of screening out pilots who have already had medical issues.

First Class Medicals are required for the pilot in command of a scheduled airline or in other words, a pilot exercising the privileges of an airline transport rating. A Second Class Medical is required for pilots who fly aircraft for hire including passenger transport but not on a scheduled basis, thus exercising commercial pilot privileges. This also includes freight dogs and sprayers. Third Class is for pilots who are not being paid for any
pilot services.

First Class Medicals are good for one year for pilots under age 40 and six months for pilots over 40. Second Class Medicals are good for one year regardless of age. Third Class Medicals are good for five years for those under 40 and two years for those above 40.

The distant vision required for First and Second Class is 20/20 in each eye with or without correction but Third Class only requires 20/40 in each eye with or without correction. Near vision is the same for all classes—20/40 corrected or uncorrected. However, for First Class Medicals, pilots over 50 have to have 20/40 corrected or uncorrected vision at the intermediate range o f 32 inches while there are no intermediate requirements for the other class medicals.

The only other difference between medicals is the requirement for resting electrocardiograms for First Class Medical Certificates for pilots once at 35 years of age and annually starting at 40. This rule dates from an age when EKGs were the only objective way to evaluate the heart and the requirement persists only because no one has the guts to stop it. Resting EKGs have no predictive value for sudden incapacitation. Stress (otherwise known as treadmill) electrocardiograms are far better. However, stress tests are more expensive and require more time. The FAA has yet to move to require stress testing and probably never will due to all the flak it gets for requiring anything that costs more money and time.

An interesting fact is although First Class Medical certificates are the most stringent, sudden incapacitation has not been an issue given almost all circumstances where a First Class Certificate is required also requires a second crew member. The most risky area for medicals may actually be a Second Class pilot who may be flying single pilot charters without the benefit of crew time limits and other organized labor efforts.

The number of medical related accidents is so small that there have been proposals to drop the medical requirement for Third Class similar to the Sport Pilot situation which does not require medicals. My prediction is that once Sport Pilot has ten or so years under its belt, the medical related accident rate will be similar to the third class private pilot experience and may spur the FAA to drop requirement for Third Class Medicals completely.

We now have a more “enlighten” aeromedical certification group in Oklahoma City, so only a minute portion of pilot applicants with medical problems that are turned down permanently. There are various hoops to jump through and more stringent testing requirements for pilots with health for First and Second Class Medicals than Third, but in the end, most pilots get their medical back.

One brief note about drug testing-- The FAA only looks at urine glucose and protein during a FAA physical. However, for Second and First Class, the DOT requires drug testing on a random basis. The logistics of this testing can be nightmarish so many single pilot and other small operations use third parties to administer their drug test “program.” I do not see this changing anytime soon so if you are flying for hire, avoid those trips to Amsterdam!

    I was shocked to hear that I was only one of two physicians in the small community of Jackson Hole that admit their own patients to the hospital. The other doctors admit to the “hospitalist” which means the patient is taken care of by someone they probably have never met and that person changes every day.

    Now why is that important in an aviation medicine article? The biggest problem is these dedicated “in hospital” physicians have no vested interest in your privileges to fly. Plus, once you are discharged, you are no longer their problem.

    Since the hospitalist never knows your detailed history, they also order more testing and imaging studies than you probably need. The problem with more tests is the risk of false positives which are frequent.

    So let’s say you have pneumonia with some chest pain—not an uncommon associated symptom. The hospitalist, in the name of being complete (and liability, and easy, and produces money for their hospital employer), orders an echocardiogram. They echo comes back with a “hypodynamic wall motion” abnormality which is not an uncommon finding in normal folks but “could” mean a cardiac problem.

    When you go for your next FAA medical and report the echo results, regardless of whether you are a competitive 30 year athletic or a 70 year old smoker, you are going to have to show the FAA you do not have a heart problem which will involve more testing. And the cycle goes on. Trying to unravel false positive results can be an expensive and time consuming proposition.

    Although physicians will imply that you do not, you do have a choice. You can refuse testing. You can ask for a second opinion. You can call your primary care doctor. You can call your Aviation Medical Examiner (AME).

    Over diagnosis and over prescribing is rampant in profit driven medicine. Aside from the inherent problems with this medical culture, it can wreck havoc with your medical certificate. It is not unusual to have pilots come in on high blood pressure medications only to find that their blood pressure was high normal and the doctor “just wanted to make sure it did not go higher.” There is no data to show this is appropriate medical care and will force you to provide information to the FAA to show you are OK!

    Sometimes, even explaining why a person had a specific test can be problematic. A classic scenario is the person who has stomach problems that gets a cardiac cauterization to “prove” it is not a heart problem. Then you get into explaining to the FAA the abdominal pain which was stated as “chest” pain in the medical record to justify the cauterization to the insurance company.

    Modern medicine can be a valuable tool in preserving health and prolonging life. It also can cause side effects and premature death with unnecessary treatments. Being a discerning user of the health care system is extremely important. Asking the question “why?” and “what are the options” and “what if I do nothing?” will produce valuable information. If a doctor ever refuses to answer those questions, change doctors.

    The more informed you are, the better but beware of where you get your information. The Internet has lots of information and much of it is tainted by the pharmaceutical industry and other vested interest. Just because it is on line, do not trust it as fact.

    To pilots, our medical certificates are very close to our heart and soul. Obviously our health is primary but there is no reason not to consider both when making health care decisions.

Mike Goulian invited my son and me to come up to the Red Bull Air Races in New York June 19^th and 20^th. Mike and I have been friends since I was the team doctor and he was a member of the US Aerobactic Team at the World Competition in Hungary in 1994. Goulian is seventh in the Red Bull standings so far this year. Since these opportunities do not come around every day, we flew to NYC for the event.

Red Bull does not do routine advertising but instead, concentrates on extreme sports. What they have done with their air races is to turn aerobatic competition into a spectator sport appreciated by the pilot and non pilot alike. They have done this by combining speed through a course which requires aerobatic maneuvers to compete.

Watching amateur aerobatic competition gets boring after the first couple of flights. Red Bull has an entirely different feel and experience. Of course, the technology involved is spectacular with real time cameras in all the cockpits, on the tails, and from ground and helicopter cameras over the entire course. Red Bull also has jumbo TV screens all over so the spectators can watch the race with the naked eye or from the various camera locations on the screens with “entertaining” play by play. Of course the replays of the flights are ubiquitous.

Competition is based on time through a course delineated by inflatable pylons. These pylons are usually set up on lakes and rivers but some course have been set on hard ground. Blue pylons have to be passed wings level between the solid color marks and the red pylons are passed wings vertical. The aircraft will pull as many as nine positive Gs during the race and times can be separated by hundredths of seconds. There are time penalties for going too high, too low, wings not level or knife edge when passing a pylon, and of course, the ultimate six second penalty for hitting a pylon. There is even a one second penalty for “insufficient smoke” which shows how important the spectator portion of the competition is.

The rules are strict and aircraft engines and weight are set to be exact as possible. In fact, there are close to 200 pages of rules and regulations that define locations, personnel, weather, and just about every other criterion imaginable to make sure the races are fair and in particular, safe. Rescue divers are fully geared up during the race and were on the pilot in less than 60 seconds during a dunking in Perth, Australia.

My photos on Aircraft Owner show various aspects of the race in New York (actually on the Hudson River, just off New Jersey’s Liberty Park next to Ellis Island) ranging from aircraft passing the pylons to the short skirted Red Bull hosts. In addition to the race, there is a fair amount of party atmosphere at night which adds to the event.

Red Bull’s commitment to the race is enormous. They transport 360 tons of equipment to each race which include two control towers (one for the departure airport and one at the race site), hangars for all the aircraft (plus the aircraft), bleachers, VIP tents, the pylons, and much more. Everyone I spoke with associated with the race from the pilots to contract Getty photographers said that Red Bull treats them in a first class manner whether it was hotel selection or routine amenities. Reliable sources said that every race costs between $6 and $8 million to produce although the exact amounts are not public.

Needless to say, there was lots of Red Bull at the race. In fact, the choice was Red Bull, Red Bull Cola, or water. In the New York heat and humidity, I was hoping for a Red Bull beer!

In a surprise announcement, the FAA announced April  2nd, that for the first time, it will allow pilots to fly on anti- depressant medications. There are multiple caveats and “gotchas” but it is a remarkable forward step for the normally conservative bureaucracy in understanding this disease.

I am one physician and AME that is glad to see this change. I have always said that I would rather be flying with a pilot with depression controlled on medication than a pilot who is depressed and needs medication.

Mild to moderate endogenous depression is very responsive to antidepressant medications mainly because it is a medical disease with psychological symptoms. Endogenous depression is due to an inadequate level of serotonin in the brain. When this chemical is below normal levels, a person will be depressed regardless of the life events around him. Unfortunately, serotonin does not cross the “blood-brain” barrier so it is not measurable in the blood. If it were, the diagnosis and treatment of depression would be immeasurably easier.

The FAA’s policy allows for the use of four medications for depression. They are
fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). These are very common, non-sedating medications, which have a long history of use with minimal side effects. In order to gain approval, the pilot must be stable on one (and only one) of these medications for 12 months. That means if a pilot was on non-accepted medication, he would have to change and then be stable for 12 additional months before he could apply for the certificate.

The initial consideration of a special issuance for depression also requires a consultation with a psychiatrist that describes the patient’s condition and full details of the treatment. As I interpret the written criteria, this evaluation could not be a primary care physician (PCP) who has been treating the patient but must be a psychiatrist. Since 90% of patients with depression are treated by PCPs, this is going to be a hurtle. I can assure you that a psychiatrist is not going to be excited about doing a consult on a well control, mild to moderately depressed pilot, in order to write a letter.

In addition to the consultation, the pilot will be required to take several psychological tests including COGSCREEN AE, Trails A/B, Stroop Test, CCPT, PASSAT, and Wisconsin Card Sorting Test. A psychologist usually administers these tests so a second consult will be required and the cost is attention getting.

The pilot will also be required to write a statement describing his history of medication use and mental health status.

Once everything above is all completed, a specially trained AME (HIMS trained) must review all the material and make a recommendation for a SI certificate to Oklahoma City. HIMS trained AMEs are part of a program to get pilots who have had drug or alcohol problems back in the cockpit. Unfortunately, there are not many of these specially trained AMEs. (I guess another FAA course is in my future.)

In an unusual twist to all this, pilots who have been taking antidepressants have six months of amnesty to admit their transgressions. Of course, they will be immediately grounded but will not be prosecuted. If pilot are on one of the accepted medications for a year or more, been stable and controlled, then they can apply for an SI by following the above criteria. In that situation and all goes well, the pilot would only be grounded for one to three months. However, if on a non-approved medication, the pilot would have to be switched to an approve one and the twelve month clock would start ticking.

What is the bottom line? Although there are many pilots out there who are taking antidepressant medication, my bet is there will not be many who are forthcoming since no one wants to be grounded for a minimum of three months and possibly permanently if they do not meet all the specifications.

The people who it will help most are pilots to be who have not started the training process because there has been a heretofore locked door prior. With time and experience with pilots flying under this new directive, the FAA may relax some of these requirements especially with regards to renewal of medical certificates.

As one AME wrote to the Federal Air Surgeon six weeks prior to this ruling, maybe the guy who flew into the IRS in Austin might not have if he had been on an antidepressant!

 I was diagnosed with rheumatic fever when I was five years old. When I was in medical school studying rheumatic fever, I just did not remember having all the signs and symptoms described in the text books. I searched my hospital records on microfilm and realized I never had rheumatic fever and confirmed that with my pediatrician who was fortunately still in practice. However, it was an incredible chore to get this mis-diagnosis off my medical record but absolutely hell to get off my medical and life insurance records.

    Now think what would have happened with the FAA! I would have probably been required to have a cardiology consultation, an echocardiogram, and other expensive testing to prove a negative. In addition to money, it would take a lot of time and paperwork collection.

    I have pilots come into my office on a regular basis carrying diagnoses on their record for conditions they have never experienced. Seizures are a classic example.

    Many people pass out when they see blood and many times, will jerk their arms and legs for a short period during the brief unconscious period. Non medical observers may report this as a seizure and unfortunately, this may become part of a medical record. However, it is incumbent on any treating physician to ask the appropriate questions to insure that it was a seizure as opposed to a “vasovagal” reaction that many do experience when they see blood. Those questions may be simple ones like “was the person confused when they came to” (in medical terms, was there a post ictal period). If there was no post event confusion, it is unlikely to have been a seizure. However, if it goes into the record as even a possible seizure, driving ability may be in jeopardy and flying is out.

    Physicians may or may not understand the importance of certain diagnosis on pilots. There is, for instance, a big difference between a “bad headache” and a true “migraine headache.” A true migraine syndrome is usually disqualifying for flight. Once “migraine” is in the pilots’ medical record, he may have to spend lots of time and money to prove that he does not have migraines.

    Depression is another common diagnosis that is thrown around by physicians without attention to the collateral damage it may cause. When your family doctor says to take this Prozac because “it will make you feel better during your divorce,” look out because you will feel worse because you are grounded.

    How do you avoid miss and over diagnosis? Always ask your doctor if they are sure of the diagnosis enough to testify at your NTSB appeal hearing. That usually gets them thinking about the potential consequences.

    Pilots may also call their AME and ask if the medication that has been recommended is copasetic with the FAA. I recently had a pilot ask me about a medication that was recommended for a non hearing affecting ringing in his ears. The medication was a tri-cyclic antidepressant and is used in this case to “calm” the auditory nerve. If he had consented to the medication, he would be grounded. When he stopped the medication, he would have to prove it was not for depression by providing medical records and a letter from the treating physician at a minimum.

    From a medical record point of view, George Orwell is alive and well. Unless you pay cash for every visit at any individual medical office or facility and never tell any insurance company about those visits, those encounters will all show up at some point in a national data bank when you buy medical or life insurance. (Not giving the correct Social Security number and birth date helps as well.) Once in the data bank, every insurance company you apply to will have opportunity to see the records.

    Are there people out there who do this? Absolutely. If they get caught by an insurance company, their claims could be denied. Do they get caught if they do it right? Not very often.

    What about those folks who do not report medical issues to the FAA?  Since that is a federal offense, it is more than a denial of an insurance claim. It is a potential fine and jail time. Do people omit items on their FAA medical? All the time. Do they get caught? Rarely. Is it worth the risk? You will have to answer that question for yourself.

The FAA is now considering new rules for regional airline pilots in regards to training as well as duty time. Duty time is something we do not think about very often in our bug smashers but we should.

I flew an IFR flight the other day which only lasted three hours. However, I was at the hangar preparing the flight plan, doing some minor maintenance, and cleaning things up for about six hours before takeoff. The result was doing a hard, night, IFR approach to an unfamiliar airport after being “on duty” for about nine hours.

No one was watching my “duty time” nor had I paid much attention but I was sure glad there was someone else with me to drive the three hours from the airport to our final destination.

There are multiple studies which show that fatigue affects performance and increases accident rates. Fatigue is difficult to measure and there are multiple variables which add to its effects such as hunger, thirst, stress, pain (e.g. that low back ache), or distractions. Unfortunately, the National Transportation Safety Board does not worry too much about small plane accidents and takes the easy way out attributing fatal accidents to the generalized “pilot error” cache. But how many of those accidents might be related to fatigue. We will never know without cockpit and data recorders.

We need to be self vigilant and monitor our own “duty time.” Are we fit to fly and by extension, will we be fit to land at the end of our flight?

The problem is accentuated by the demographics of the pilot population. We all are getting older. One of the most common problems brought to the attention of physicians by “older” patients is sleep disturbances. Sleep disturbances create fatigue and somnolence which is accentuated by advancing age.

Naps are good—just not while you are flying by yourself. In fact, sharing flying duties is a great way to reduce the effects of fatigue. Also, being more cognizant of scheduling is important. Do you really need to fly home after an exhausting all day meeting? Waiting till the next morning might may all the difference in the world.

What about drugs to help with getting to sleep, staying asleep, or to adjust sleep cycles to times zones? In a word, very simply, NO!

There are many problems with sleep medications whether they are over the counter (OTC) or prescription. First and foremost, they all are addicting. If you use any sleep medication for three days in a row whether it is Benadryl® OTC or prescription Ambien®, you will not sleep the next night. (Many pharmaceutical companies are allowed to say their medication is not “addicting” by FAA standards, however, that is only because insomnia is not a “withdrawal” symptom.)

More importantly, the metabolic breakdown products of these medications will affect daytime performance and wakefulness. Chemical metabolites also accumulate with chronic use and can cause other symptoms such as irritability and depression.

High carbohydrate meals will also accentuate fatigue. Generally, the carbohydrate load will increase wakefulness as blood sugar rises but this is short lived as fatigue returns with the rapid decrease in blood sugar that is associated with the insulin response. This rapid fall in blood sugar can be mitigated by making sure the preflight meal has significant protein content.

Dehydration increases fatigue as well as other problems. Drinking fluids on long flights, particularly at higher altitudes and pressurized environments, is very important for a variety of reasons. If you are worried about having to urinate in the aircraft, grab some “TravelJohns”. They are inexpensive, single use urinals which turn the urine into gel preventing spills and ensuring order.

The bottom line is that we all should be acting as our own dispatchers. We need to take into account all our physiologic factors when preparing for and making flight decisions.