AircraftOwner Online

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. 

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.

    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 future is now and you can see it in Lindy’s aircraft tugs. To remain competitive going into the future, experts predict that the aviation industry and its attendant ground support operations will have to work harder, smarter and leaner. Marketed for FBO, corporate or individual ground operations, Lindy’s versatile aircraft tugs and tow tractors are designed to be the only aircraft tug you’ll ever need.

The ergonomic design of Lindy’s powered aircraft tugs allows a single operator to easily and safely maneuver airplanes up to 4K, 15K, even 35K. Ergonomics is the science of engineering equipment to fit the physical attributes and abilities of the worker. Ergonomics reduces worker discomfort and fatigue and prevents repetitive strain injuries that can lead to long-term disability. Lindy’s ergonomically-designed, battery-operated aircraft tugs allow workers of any size, age or sex to easily maneuver aircraft in and out of crowded hangers and around service areas. Because Lindy’s versatile aircraft tugs are safe and easy enough to be operated by any worker, FBO and ground service/support managers can exercise maximum flexibility in assigning staff. More effective staff utilization helps managers cut costs.

Lindy’s aircraft tugs feature an easy-on cradle that accommodates both tricycle drive and tail dragger aircraft with ease. A lever handle and cable system designed into our airport tows locks and releases the easy-on cradle for safe loading and unloading of the aircraft. When loaded, the cradle functions as a 5th wheel, allowing tugs to pivot a full 180 degrees underneath the wheel of the aircraft without engaging the plane’s wheel or steering mechanism. All of Lindy’s aircraft tow tractors are capable of handling airplanes with and without wheel pants. Versatile design makes Lindy’s aircraft tugs the only tug you’ll need to handle any airplane in your fleet.

For more information about Lindy’s aircraft tugs, visit our website.

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!