AircraftOwner Online

    How many experienced pilots say “I’m sorry, can you repeat that—I don’t hear very well?” Then they get the sophomoric response from the young pilots “Say what?”

    Hearing loss in pilots is almost universal and especially in pilots who learned to fly without headsets.

    When I first started instruction, the instructor had to shout over the engine noise and I still blame all my current bad habits on those miscommunications!

    Hearing loss, in the far majority of people, is due primarily to exposure to loud noise and to some extent, heredity. Loud concerts, noise from drilling, hammering, riveting, wind noises, engine noises, and supersonic prop tips all contribute to hearing loss.

    What is important for everyone to understand is that noise exposure is cumulative. So even when someone already has hearing loss, they need to be aggressive about protecting what they have left because they will continue to lose more hearing with additional exposure.

    Sound intensity is measured in decibels and the scale is logarithmic so a deference of 3 dB is approximately twice the level of sound. In additions, there is “frequency weighting” because some frequencies, particular the 2,000 to 6,000 Hertz range, cause more hearing loss than other frequencies. (For you audio techies out there, I know this is not as simple as this explanation states but this is not a treatise on sound measurements.) General conversation occurs between 500-3000 Hertz.

    To understand the decibel ratings (know as dB level), OHSA (Occupation Health & Safety Administration) standards state the 85 dB over eight hours is safe but only two hours at 91 dB. However, the EPA (Environmental Protection Agency) has identified the level of 70 dB for 24 hour exposure to protect the public from hearing loss which is significantly lower than OHSA.

    Putting this in perspective, a jet taking off has a 180 dB rating. Riveting creates a 120 db level while a car horn at about 20 feet is a 100db. Pain usually begins at about 125 dB but hearing loss can occur with as little as one minute exposure to 100 dB which is about the sound level of a cement mixer.

    It really is impossible to give a dB level of noise in an aircraft unless measured (a reasonable portable dB meter is available from Radio Shack). Piston aircraft create noise from the engine through the exhaust and vibration, propeller blades beating the air, and airflow around the fuselage. Each aircraft has so many variables with these factors that no average level really is valid but the FAA states the range is between 70 and 90 dB. (Obviously, the FAA has never measured a Stearman!) What is valid is that all most all aircraft in the piston fleet will cause hearing loss over time.

    There are no regulatory criteria for aircraft occupants in general aviation which is good by keeping government out of our lives. Unfortunately, the other side of that coin is there are neither standards nor testing for ear protection in aircraft so buyers beware.

    Everyone should wear hearing protection and the type breaks down into passive and active protection. Passive ear protection includes the classic foam plugs and standard but relatively inexpensive headsets. The foam or wax plugs work very well but must be placed in the ear properly. For the foam plugs, this means that the plug must be rolled small enough to fit into the ear so that it completely seals the canal when it expands. The molded wax or custom plastic plugs work very well and are easier to place properly albeit more expensive.

    Passive headsets do not require any fitting and my recommendation is to buy the highest dB reduction set available. It is important to buy a reputable brand since there are no government standards or testing required when bought in the civilian world.

    Active noise reduction headsets (ANR) are more problematic. Most of the audible noise in an aircraft is lower frequency which is handled very well by the electronic portion of the ANR headset. However, higher frequency, less audible noise, which causes hearing damage, is generally not reduced very well by the ANR headset’s passive attenuation. This leads to a false sense of security with ANR headsets.

    My recommendation is to use foam/wax/molded ear plugs under ANR headsets in the aircraft. This will give you the best of both worlds. When working in the hangar, use the highest passive attenuation passive ear muffs available. I recommend ear muffs in the hangar because they are easy to put on and take off which increases use even for short exposures.

            The most important point is the use of some type of ear protection anytime there is exposure to loud noise. It will help avoid those dumb jokes in the future.  < B.B.

The Federal Aviation Administration’s Civil Aerospace Medical Institute in Oklahoma City offers a dynamic  course to help pilots understand physiological and psychological stresses of flight. The one day course is a must for anyone who flies higher than 10,000 feet but is valuable for all pilots.

    The course covers the common physiologic problems of flight as well as some of the uncommon ones like decompression sickness. Probably the most important part of the course is the experience in the altitude (hypobaric) chamber which cannot be easily duplicated in an aircraft.

    Pilots understand that training and recurrent training is important. Understanding physiologic issues is difficult without experiencing them and then periodically, revisiting the subject for new developments and reminders about how serious these problems may be.

    Spatial disorientation is one area that many pilots last felt on a spinning ride at a playground many years in the past. Adults tend to think that it takes that kind of force and velocity to create spatial disorientation because they have not felt the sensation in an aircraft.

    The FAA demonstrates that the initiators of do not require major forces using equipment like a Barany chair, a Vertigon, a GYRO, or a Virtual Reality Spatial Disorientation Demonstrator. This is the type of training that might have saved the life of John Kennedy Jr. and many other pilots­both high and low time.

    The use and abuse of oxygen and oxygen equipment is covered in the course as well as how to use a pulse oximeter. Understanding why the FAA recommends oxygen as low as 5,000 feet at night is covered as well as high altitude hypoxia in the chamber.

    The chamber experience is certainly dramatic. Pilots are taken to as high as 25,000 feet in the chamber and asked to remove their oxygen. They are then asked to do some simple math problems or other simple tasks. Watching the video of pilots going really stupid is entertaining and educational. The video is used to show this behavior because the hypoxic victim cannot recall how dumb they were.

    Rapid decompression from 8,000 to 18,000 feet is another demonstration that cannot be duplicated in an aircraft. Just knowing what that feels like and knowing what to expect is a real eye opener.

    Every pilot should go through a personal physiologic and psychological check list prior to each flight. The FAA uses the acronym “I M SAFE”. The acronym stands for Illness, Medication, Stress, Alcohol, Fatigue, and Emotion. Let’s go through this simple check list.

    Illness may seem straight forward but there are many pilots who took off with their stuffy noise from the spring hay fever season who suffered incapacitation pain when they could not clear their ears on decent. The stuffy nose did not appear to be important on the ground but aviation presents many unique factors to illness.

    Medications can definitely be a problem. No pilot should fly when starting new medications since every drug can cause side effects regardless of the labeling. Of particular concern are psychoactive medications. A psychoactive medication ranges from psychological drugs like anti anxiety agents to simple antihistamines over the counter. Any drug that can affect the brain, whether it is sedating or alerting, can pose problems in the cockpit. Altitude may also increase side effects of medications.

    Stress can have significant impact flight safety. Regional airline pilots has claimed, rightly so, that they jobs are harder than the big iron pilots due to all the takeoffs and landings in a day at uncontrolled airports with marginal weather reporting equipment. This is the kind of stress that leads to mistakes­most not so serious but some are tragically fatal. This same kind of stress can affect general aviation pilots. Getting up early for business trips with returns late on the same day is a classic example of stress for a GA pilot.

    Alcohol is generally an obvious problem for piloting an aircraft. What also has to be considered is the effect of residual alcohol from the night before and/or a hangover on pilot performance. Also, a hangover will increase the risk of motion sickness, spatial disorientation, and cognitive mistakes.

    Fatigue goes hand in hand with stress. It can be a real problem on long flights as well as cause real impairment as the work load increases.

    Emotion is a factor that frequently gets overlooked. Going out and doing touch and goes may not be the best way to shake off the anger generated by your teenage kids. The effect of emotions on the thought process and the ability to perform complex task is significant.

            More information on the CAMI course can be found at http://www.faa.gov/pilots/training/airman_education/aerospace_physiology/index.cfm. Courses are also given as several military facilities around the country.

   Never shying away from controversy, taking on the issue of helicopter aeromedical transport may be one of the most difficult. How do you argue against getting someone to the hospital faster? The answer is relatively easy if you look at the outcome results.

    Helicopter aeromedical transport began in Vietnam and was transitioned to the public section in the late 1970’s. The services quickly became flying billboards for competitive hospitals in urban areas even though the most important location for their use is in rural areas where transport times can be significantly reduced.

    However, accident experience over the past couple of decades has not been good with even a higher rate the past few years. The number of accidents has stimulated congressional investigations and numerous lawsuits. In addition, helicopter transport is more expensive than fix wing and astronomically more expensive than ground transport.

    But do they shorten the time of transport and improve the outcomes of patients? The studies do not support significantly decreased transport times except in rural areas where they are rarely located. Even more important: studies do not show that patient outcomes are improved with helicopter transports.

    When the University of Texas-Galveston discontinued it helicopter service, they found there was no difference in transport time and no increase in mortality for trauma patients. In Los Angeles, a study showed that 85% of pediatric trauma patients transported by helicopter were considered to have minor injuries and of the 189 patients transported, 33% were discharged from the emergency room without even being admitted to the hospital. In Pennsylvania in a very large study of over 160,000 patients, researchers did not find helicopter transport affected the odds of survival.

    Layer these statistics on top of the cost of aeromedical helicopter transport and one has to ponder the costs vs. benefits of many of the flights being taken. And all this is before we get to accident issues.

    Weather, darkness, pilot experience, crew fatigue, lack of knowledge of the landing sites, and varying terrain makes medical helicopter transport a risk taking operation. Add the emotion of a potentially critically ill or injured patient into the mix and chances appear to be taken that should not be. Unfortunately, this mix has been proven to be hazardous by the accident statistics on file.

    I worked with a physician assistant who ran an air ambulance operation and he insisted on calling the pilots “ambulance drivers.” He would tell his “drivers” the location of a patient, when the run was to occur and ask “Is it safe?” without telling them the severity of the situation. In this way, the pilots could truly judge the safety of the mission without the emotional overlay of the patient’s condition.

    This procedure maintained safety. Nothing can be worse than losing an aeromedical transport crew because of an unsafe operational decision. Isolation of the mission safety from the patient situation is critical for preventing accidents.

    Another issue is to avoid flying to produce numbers to justify an aeromedical transport systems existence. Many helicopter transfers between medical centers have no justification except for producing usage numbers. When the door to door time difference between an elective transfer by ground ambulance and a helicopter is measured in minutes, it is extremely hard to justify—especially when weather or darkness may be factors.

    The University of Pittsburgh Medical Center (UPMC) may have the medical transport system down the best. During a visit of their command center recently, I observed an integrated dispatch system which controlled both ground and air ambulances. This way, expertly trained personnel made rational decisions on the proper transport vehicles for patients for most of western Pennsylvania.

    UPMC’s safety record is superb and their billboards are bolted to the ground--which is the way helicopter aeromedical transport sytems should be.

Carbon monoxide (CO) is a silent killer. We all know that and we have all heard that. Do pilots really understand the frequency and significance of CO in the cockpit?

    We introduced low level digital carbon monoxide detectors to general aviation in the late 1990s because of a rash of CO accidents in GA aircraft. This was in part due to the availability of new detector technology and concern over the lack of CO awareness in aviation. After the introduction of our detectors, we were engulfed by stories from our customers with near miss carbon monoxide problems.

    First, consider a bit of human physiology. Carbon monoxide is a tasteless, odorless gas emitted from the incomplete combustion of carbon fuels—particularly gasoline. The CO molecule binds the normally oxygen carrying hemoglobin molecule in red blood cells eight times stronger than oxygen so it displaces the oxygen. In simple terms, a person who has CO poisoning is suffocating on a cellular level in spite of breathing normally.

    Probably the most common first sign of carbon monoxide poisoning is headache and nausea. Cognitive disability is next followed by coma and death. Unfortunately, the aircraft environment makes this worse because the relative hypoxia (or low oxygen) associated with altitude has a synergistic ill effect on the occupants of the cabin.

    Probably the most interesting finding we have made from all the field reports from pilots who bought our CO detectors was the muffler cuff, which we suspected would be the most frequent source of CO, was the least likely culprit. Our guess is that this is because the mufflers are inspected once a year and cracks are found early. Other places on the firewall which might have cracks may not be checked as carefully.

   

Here are some examples of sources of CO reported to Aeromedix:

    Before his death, Scotty Crossfield reported that his 210 had high CO levels. He took another pilot up with him one day to try to find the source. The other pilot flew while Scotty crawled all over the aircraft with our detector to locate where the CO was coming from.

To his surprise, the levels were higher in the back seat than the front. Crossfield determined that the CO was being sucked into the cabin from the tail cone through the rear bulkhead. Part of this is due to the Venturi effect that creates a relative negative pressure in the cabin. He cured the problem by sealing the bulkhead.

    Normally, twin engine aircraft do not have much of a CO risk but listen to this story. A Beech 18 driver had one of our detectors on the floor of his aircraft in front of the co pilot’s seat. While he was waiting in line to take off, he heard the alarm. When he read the detector, it showed over a 100 ppm which can have debilitating effects in minutes. The source was determined to be exhaust which was being funneled into the fresh air source of the cabin due to the aircraft’s relationship to the wind while waiting in line to leave.

    In another situation, a friend who owned a Maule who had never had a CO problem was given a replacement detector for one that was lost. On his first flight with the detector, he started getting very high readings. After landing, he found that one of the inspection covers on the bottom of the fuselage had come off and the cabin was being filled with CO through the three inch hole.

    Two questions about CO detectors come up all the time. One is whether the chemical spot detectors sold by many pilot shops are any good. The short answer is no. These spots turn color so late in the exposure that by the time they change, the occupants are either incapacitated or dead.

       The problem with the hardware store type detectors is due to Underwriters Laboratory restrictions, these detectors cannot read below 35 ppm and cannot alarm below 50 ppm. This is due to too many false alarms complaints from fire departments. There is no such thing as a false alarm in an aircraft at 10,000 feet so that is why I recommend a low level detector. You do not want to just know when the levels are high. You want to know when they are low before they get high!

       Flying lean of peak also reduces the production of CO to almost zero so there is another reason to join the church of LOP. You can read an in depth article by Mike Bush about CO and CO detectors at Aeromedix.com.

Based on the number of questions I get on the subject, there is a lot of confusion among pilots concerning the flow rates for oxygen.

    The FAA rules are simple—1 lpm (liter per minute) of oxygen for every 10,000 feet MSL. Most certified aircraft with built in systems have their flow rate set for the service ceiling of the aircraft. For instance, if your aircraft has a service ceiling of 25,000 feet, when you plug in your oxygen connector, you will receive 2.5 lpm even if you are at 15,000 feet. This empties your oxygen tank quickly!

    Some aircraft with built in systems (mainly Beechcraft) have an altitude compensation valve which uses barometric pressure to mechanically adjust the oxygen flow rate. These systems work with variable success and are found inconsistently even within the same model line.

    Why save oxygen? The main reasons are cost and hassles. Officially, built in oxygen systems are “supposed” to be filled or signed off by A&Ps. This makes dirt cheap oxygen absurdly expensive. Portable systems are easier to fill at most compressed gas stores (albeit some erroneously require prescriptions—if they do, write me an Email—I will send you a RX for those bozos) and usually the charge is minimal but it still takes your time.

    Many aircraft owners have started filling their own aircraft renting a couple of H cylinders and keeping them in the hangar. The fill procedure is relatively simple and requires a onetime purchase of hoses so the system can be filled sequentially. The first H cylinder is used to fill the system and the second to “top it off.” The sequential filling is similar to the technique used by scuba shops. It is not a difficult process but “officially” is supposed to be signed off.

    Can you use too much oxygen? No--except if you have a running out problem. Can you use too little? Absolutely! That is where people can get into trouble especially when no oxygen is used at all.

    Although pilots consider themselves “above average,” they still tend to underestimate the need for oxygen especially since the pilot population tends to be of a more “mature” age. In informal studies, we have seen that some pilots will need oxygen much lower than the 12,500/14,000 feet MSL FAA requirements while others do not drop their oxygen saturations till higher levels. Factors which contribute to needing oxygen at lower altitudes include underlying lung disease, upper respiratory infections (e.g. colds), allergies, obesity (a big gut tends to keep the pilot from taking deep breaths particularly in a sitting position), heart problems, anemia, and of course, smoking.

    About 25 years or so ago, Nelson started marketing an adjustable oxygen valve which could be placed in line with the oxygen tubing for both build in and portable systems. The Nelson valves were marked by altitude (e.g. 1,000s of feet MSL) which eliminated the simple 1 lpm/10,000 feet math and saved a considerable amount of oxygen. Now there are several flow meters on the market which are “in line” or part of the regulator at the tank.

    One of the neatest devices to come out for saving oxygen is the Oxymizer cannula. This is a patented product made by Chad and sold by several aviation oxygen shops as well as medical stores. The basic principal is the Oxymizer saves oxygen that is flowing during the exhalation and pause portions of the respiratory cycle. This savings allows for a 50 to 70% in the oxygen flow depending on the users oxygen needs and their respiratory rate. Oxymizers are cheap—about $27—and although disposable, they can be reused for years if protected from high heat (like the cockpit in open sun).

    There are also mechanical conserving devices which essentially open up the flow of oxygen sensing the negative pressure generated by the inspiration of the user. The amount of oxygen delivered when the valve opens is adjustable. There are also electronic versions. Personally, I think these devices are ridiculously expensive ($400 to $700 per user) since the amount you may save over the Oxymizer is minimal.

    The most important point to remember from this column is the only way to know how much oxygen to use is by using a device call a pulse oximeter. The best is made by Nonin which is a finger tip device, the size of a cigarette pack cut in half, which shows how much oxygen is in the blood in real time. Using anything less than an oximeter means you are purely guessing whether you need oxygen and how much oxygen to use if you do. It is 21st century technology and anyone who flies above 12,500 feet needs one.

I frequently get calls from pilots who want to know if a new drug that has been recommended is OK with the FAA. The problem is that there really is not an approved drug “list” by the FAA. There are many good reasons for this which I will attempt
to explain.

    First, the FAA Civil Aviation Medical Institute (CAMI) in Oklahoma City is concerned about a pilot’s ability to fly and the risk of sudden incapacitation. All medications have side effects. Many are predictable and many are not. Since there are thousands of medications and they are changing frequently, there is no way the FAA can monitor and maintain a list of “approved” medications which have “acceptable” side effects and do not cause incapacitation.

    The FAA is also concerned about what condition the medication is being taken for. Some medications, like bupropion are OK for smoking cessation as long as it is not taken in proximity to flying where bupropion taken for depression is not OK. The logic from the FAA is they are concerned about depressed pilots and not about people trying to quit tobacco products. (I do not agree with this logic since I would much rather be flying with a pilot whose depression is being treated versus one whose depression is not being treated.)

    The FAA does have some general rules about medications which do not necessarily prohibit or allow their use in toto. In general, the FAA prohibits sedating, psychoactive medications such as narcotics, sleeping or other sedating medications. They do not allow seizure medications because they do not allow anyone with seizures to fly. The FAA does not allow any antidepressants or stimulants like amphetamines. They do not allow motion sickness medication since they do not want pilots flying who get motion sick plus these medications cause sedation and blurred vision. Just for kickers, they do not allow Viagra to be taken in proximity to flying because it can affect color vision so guys with ED who want to join the Mile High Club just cannot get lucky!

    So how does an organization like the AOPA have a list of “approved” medications? What the AOPA has done is to collect information on pilots who have been approved on various medications and added medications which the FAA has specifically said were OK (not a list, mind you, but a few standard OKs). What is actually frustrating as an Aviation Medical Examiner is some drugs which were always denied by CAMI are suddenly OK and the only way AMEs hear about it is through the grapevine. Believe it or not, the FAA does not send blast Emails to AMEs due to some type of government regulation.

    Even medications that are always forbidden can be given
special OKs for use. I have had a patient on Beclofen, a sedating drug, receive a Special Issuance for use via an indwelling spinal catheter. In rare cases, some pilots have been approved for Ritalin (a stimulant) use for ADD but they had to prove they could operate an aircraft by taking lots of expensive medical tests.

    The issue of antidepressant medication has been a thorn in the FAA side for some time. They have always denied these medications and have been concerned about the underlying condition for which they are taken. The Aerospace Medical Association has encouraged the FAA to license pilots on third class medicals on antidepressant medications as a test group since AsMA did not feel these medications would adversely affect piloting skills. Even in a recent AME satisfaction survey for the FAA, AMEs urged reconsideration of the government’s position on antidepressant medication.

    The bottom line is the FAA moves slowly but they do move. When I first became an AME, very few blood pressure medications were approved for use by pilots. Now, too many years to count later, very few medications for blood pressure are not approved. The same goes for many cardiac medications.

    My sense of the FAA at this point is under Dr. Fred Tilton, who has been Federal Air Surgeon for about two years, and Dr. Warren Silberman, who is head of CAMI, major advances in approval of medications are forthcoming due to their progressive thinking. They have reduced the backlog of Special Issuance cases from over 100,000 to less than 1,000 during the past few years, so who know what is in store for medication approval in the next few!

People call or email me questions all the time but once in a while, just the question raises irritation levels.

    Recently, I received a question from a pilot about advancing age and the ability to fly. He had been chided by a “younger” pilot that he was too old to fly. Then last week, I fielded a complaint from an older pilot which stated that his insurance company was making him get a first class medical every year to keep his insurance.

    Age and flying is not a new subject. The FAA has looked at this many times debating the “age 60 rule” for airline pilots finally raising the age limit to 65 a year and half ago. During the “investigation,” the FAA commission a study by an Ivy League medical school for several million dollars to see what the effects of age had on the ability to fly. The only answer from the study was that as pilots get older, they generally get more medical problems. I could have told them that for a couple of beers at Oshkosh !

    Just last month, the AeroSpace Medical Association published an article that showed no difference in accident rates in commuter aircraft related to the age of the pilot. If nothing else, think about experience. Sullenberger landed in the Hudson at age 57 and Al Haynes was forced by the age 60 rule (at that time) to retire six months after he saved 184 people in a Sioux City corn field.

    Yes, pilots do have more medical problems as they get older. They also may not have the same quick reflexes they did as a newly minted private pilot. But they have something that those young pilots do not have—experience and maturity—qualities which are much more valuable in the cockpit.

    When it comes down to accident statistics, pilot error is far and away the most common cause of accidents and most of these tend to be “mental” errors. How much more needs to be said about judgment when the two most common causes of accidents are running out of gas and flying into IMC without qualifications?

    It is as hard to assess a pilot’s ability to make sound judgments as it is to assess their medical status. The main purpose of the medical certification exam is to “predict” the possibility of sudden incapacitation while flying. Physicians cannot do that well under any circumstances and especially with flight medicals. For instance, the medical form does not have any mention of smoking, family history, or cholesterol levels. The only issue for obesity is whether the abdomen is so big it gets in the way of the yoke. In fact, the word obesity is not even in the Guide for Aviation Medical Examiners.

    “A brief description of any comment-worthy personal characteristics as well as

height, weight… and other findings of consequence must be provided” is the only mention in the Guide of weight and there are no criteria or limitations beyond this mention. So what does the insurance company required first class medical standard do? Well, for the most part, it creates expense and hassles and does little else. The most significant safety factors for airlines pilots are the duplication of personnel in the cockpit, not the medical. The only different criteria in an otherwise non special issuance third and first class medical is vision criteria (20/20 required for 1st) and the annual resting EKG over 40.

    A resting EKG is not predictive of sudden incapacitation. I once had a conversation with Dr. Jon Jordan, the previous Federal Air Surgeon, who agreed that the resting EKG did nothing but stated “no one has the guts to stop it.” What is predictive of heart disease is a stress EKG (treadmill) or even better, a nuclear stress test. Since both these tests are expensive and time consuming, the chances of their being used for medical criteria are nil.

    So what is the bottom line? There are pilots out there who are 50 who should not be flying and there are those who are 75 who can grease a tail dragger on the runway effortlessly. Mature and experienced pilots generally choose to alter their flying as they see their ability wane such as discontinuing hard IFR or changing to lower performance aircraft. I wish younger pilots judged their capabilities as honestly.

    What may be more important evaluation criteria if used properly is the biannual review. How many instructors say to a pilot after a review, “Joe Pilot, you really need to work with an instructor to sharpen you skills or quit flying” regardless of their age. Not many. I just had an instructor tell me after what was supposed to be a ten minute check out that I needed a few more hours of touch and go’s in a conventional gear aircraft I was unfamiliar with before setting off on a 13 leg cross country stopping at unfamiliar airports. What made me do those extra couple of hours was not my self deceived mental age of 25 but the maturity of 30 plus years of flying.

~ BB ~

Flying gives us many privileges like seeing the world from above a cloud deck and incredible freedom to leave on a moment’s notice to head almost wherever we want. Being a physician and an Aviation Medical Examiner (AME) adds another dimension to aviation. Not only do I meet pilots through the normal airport channels, I also meet many though their application for their medical certificate. Because I help with problem medicals, I also meet many pilots who are pursuing special issuances from outside our local airport community.

Pilots are truly an extraordinary lot. They come from all walks of life--from those who scrape together money for rental aircraft to those whose only scrapping comes with the sticker on a new credit card. What pilots have in common is the love of flight, the smell of gas and oil, and for most, the turn of a wrench. 

What other group can you find in the same room liberals, conservatives, Republicans, Democrats, environmentalist, oil executives, heterosexuals, homosexuals, men and women, and all of them mad at the same organization (the TSA of course)?

The pilot community is a unique group. Helpful and generous to a fault but argumentative like you would not believe: “What do you mean, you have never flown lean of peak!” But the thing that scares the airline pilot and student pilot alike is the fear of losing their medical certificate.

There are four major factors that affect longevity and they happened to be the same as the ones which affect your medical status. The most important is the one you cannot change--heredity. The classic answer to patients who ask what they can do to live longer is still the same—“keep your parents alive!”
The three remaining factors are ones we can modify. If you use tobacco in any form, ceasing its use is the number one thing you can do to extend your life and you flying privileges. The next two factors we all can work on—keeping our weight down and regular daily exercise. These are tough tasks for pilots who are normally seated during their vocation, avocation, and/or the most pleasant times of their days.

Do not talk to me about your stinking cholesterol.  It is a minor league player in the longevity scheme of things but made much more visible by the opportunistic pharmaceutical industry. If you could take a pill called exercise, the pharmaceutical companies would have you remembering cholesterol like you remember smallpox. Exercise is the most important thing a person can do to keep their medical and to stay alive.

Exercise is defined from a medical perspective as keeping your heart rate in the target zone for 30 minutes every day. The target zone is calculated by taking 220 minus your age and multiplying by .7. Thus for a 50 year old, that number would be 119 (220-50 x .7=119). The important point is the target heart rate is sustained heart rate so activities like tennis will not count since you stop for serves and your heart rate drops. This does not mean tennis is not good exercise. It just is not as good from a cardiovascular point of view as sustained heart rate.

Heart rate is the end point and it does not make any difference how you get there so you can walk up a hill one day, bike the next, swim the next, use a stair climber the next, or whatever, as long as your heart rate is at or above the target continuously for 30 minutes, you will be in much better health for much longer which equates to more renewals of you medical certificate.
The same goes for your weight. In fact, if you do not increase your eating when you start the exercise above, you will lose a half to one pound a week. Add that to some caloric restriction and you will lose even more.

Weight is related to two things—calories “in” and calories “out.” Calories “in” are what your eat and calories “out” are what you expend with exercise and other activity. You cannot gain weight unless you eat more than you expend no matter how many times you say “I don’t eat anything!” Remember, everything you eat counts. From a weight perspective, it does not mean a thing that the caloric content is organic or low fat. In fact, many of the sugar free or fat free stuff on the highly marketed grocery shelves have more calories than the same food with sugar or fat. Read the labels. Just remember, soft drinks (including sports drinks) are liquid candy bars and protein bars are just expensive candy bars!

I value the pilot population and I have lost too many aviation friends to health issues. I can help you with your medical but more importantly, I want you to work on these three risk factors to stay alive. Getting your medical renewed is one thing. Being alive to keep the appointment is another!

Tears are an integral part of vision. When eyes get dry, vision worsens. This is an obviously important concept for pilots especially making an approach after a long flight.
 
Dry eyes have many causes but the one most common in aviation is altitude. As we ascend, the relative humidity decreases and our eyes tend to dry out. This occurs in unpressurized aircraft and even more in pressurized aircraft since pressurization removes water vapor. As our tears dry out, their coating over the cornea of the eye changes which affects our vision. This coating is an integral part of our eye’s focusing system.
 
Tears are composed of three substances­oil, water, and mucous. The outer layer is an oily one that is secreted by meibomian glands which are located on the edge of your eyelids. These are the glands that cause styes when they get plugged up. The water layer is from the lacrimal glands and is the middle, thicker layer of the tear. The bottom layer which spreads the tear evenly across the eye is the mucus layer.
 
Decreased humidity will cause evaporation of the water and mucous layer which then will affect vision. Certain medications will increase the dryness such as birth control pills, diuretics and ACE inhibitors used to treat blood pressure, and antihistamines/decongestants. Underlying conditions can also increase dryness such as being over 40 (Is that a condition!?), menopause, arthritis, diabetes, and Vitamin A deficiency. Previous Lasik eye surgery can also cause dryness.
 
There are ways to help prevent dry eyes and the visual changes associated with dry eyes. Staying hydrated is very important not only for dry eyes but a multitude of reasons. Also, avoid rubbing the eyes as this can irritate the lacrimal glands and decrease their output of the watery portion of the tear.
 
Flax seed oil, in capsules or liquid, when taken on a regular basis, can also increase eye lubrication. Omega 3 oils in supplements and fish like salmon will also help increase production of the oil component of the tear but it must be an ongoing part of ones diet.
 
Regardless of prevention, on long flights eyes will get dry. I keep a supply of artificial tears in the plane and will put them in my eyes about 15 minutes before descent to make sure my vision is the best it can be (although it does take away one of my excuses for hard landings). I prefer the unit dose artificial tears because they do not have preservatives and avoid the contamination that can occur with multidose bottles.
 
Do not use Visine or other constricting eye drops (e.g. get the red out). These are bad for your eyes in general and actual make the eye drier by causing constriction of blood vessels.
 
While we are on the subject of eyes, sun protection should be mandatory for all pilots and passengers. There are multiple brands and lots of personal choices but the major importance is protection from ultraviolet radiation. This is not just a comfort issue but can protect the eye from developing cataracts which can be promoted by bright sunlight. Sunglasses should be marked as filtering 99% of ultraviolet radiation.
 
Polarizing sunglasses are not particularly good for pilots because they cause difficulty with certain types of displays. If you are looking for a cheap but good quality lenses (and there are lots of bad quality lenses out there), American made safety work glasses sold in hardware stores are the best value out there. Make sure to look for American made because the foreign made lenses are not reliable.
 
You can judge the quality of a lens by looking at something square like a ceiling tile. Close one eye and hold the lens out from the open eye. Move the lens slowly up and down and side to side. Good lenses will keep the square’s borders straight. If the line moves or gets wavy during the motion, look for another pair.