Medical Stuff for Geezers :)

Separate doctors

With all due respect to MD's out there, they can and do make errors. How often does anyone go through all the training, taking all the tests and score 100?!?

I use separate doc's for the biannual, yup, over 50 and the home town doc. I've had blood tests regularly and recently had an elevated sugar level, the home doc wants to start prescribing meds, I say hold the phone, let me do some home tests charting the numbers and really see if there is a problem. Labs can screw up. End of story, no problem, not even close. If this was an FAA examiner, I wonder if my medical would have been affected.

Q. What do they call the guy/gal who graduates at the bottom of the med school class?

A. Doctor!

let me do some home tests charting the numbers and REALLY SEE if there is a problem.

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So let me get this straight.

You went to a Doctor (who may or may not have finished in the top or bottom of his class) he did a blood test in a certified lab which revealed high blood sugar and recommended a medical regimen.

Instead you did some "home tests" which I suspect were not processed on a calibrated certified or regulated equipment. Then with your medical knowledge obtained from ? you determined there was REALLY no problem?



Most new onset diabetes manifests as intermittent blood sugar elevations that may or may not show up on home monitoring kits. There is no such thing as light or near diabetes. You either have it or you don't and if you have 1 blood sugar measurement over 126 you have it, end of story.

Diabetes does it's damage over long periods of time and once the damage is done it cannot be fixed. Untreated diabetes is the major cause of blindness, stroke, heart attack and disability in the United States.

The most effective treatment is early intervention before your blood sugar gets out of control on a regular basis.

Could your lab test have been in error? Sure it could?

Should you question an abnormal lab if you doubt it? Certainly you should.

If you think the lab or Dr. Made a mistake should you go home and diagnose/treat yourself? Even if you were a physician this would be foolish.

I would suggest you return to your Doc and question him about his results vs yours. At the very least he owes you an explanation as to why this is so and he has an obligation to educate you about what he is doing and why.


I think for a Dr. to make a diagnosis and a patient to do his own testing to REALLY SEE if there is a problem is a recipe for disaster.


That is just an opinion from a physician who finished in the middle of his class.

The reason we call those who finish at the bottom of their class Doctor is because we weed out 99.9% of the un qualified before they start med school and another .05% before they finish. That leaves 0.05% for you the consumer to find.

100 Hourlys.

So far my body has passed all it's 100 hourlys and Annual Inspections with only minor ailments.
However, my son's birthday card for my 60th last weekend was a reminder of things to come.
Be sure to read the text below the last photo.
Pete.
PS. Milt's comments, I value and appreciate. He's qualified. I am sceptical about any sources of medical (Or aeronautical) information that aren't from qualified authorities. ESPECIALLY those on the Net.
P.



I said to Paul after I read it, "Stop your laughing! You're going to be the one changing them."

Drs and aeroplane building....

Knife, Milt, other RV flyers/MDs...

where on earth do you guys get the time to be both doctors AND build RVs?

BTW, I appreciate your comments.

JCB

I said to Paul after I read it, "Stop your laughing! You're going to be the one changing them."

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Absolutely the most marvelous comeback I have heard in my entire life!!!

Medical Passed - RV12 Not in my future

Three months ago, I was about to give up on my medical and start flying LSA. I had some bad lab results, primarily sugar level and cholesterol. I was told by my doctor to start a couple of medicines that were verboten as far as the FAA is concerned. (Or at least a postponement until 3 months of verification). I even posted that I wanted to sell my Grumman Traveler. The Horror?.The Horror?

But thanks to encouragement, I decided to work on getting my weight down, no carbohydrates, mega-vitamins, anti-oxidants, fish-oil, etc. As a result (last weeks lab results), everything was down across the board. (-25lbs, -10 Cholesterol, -25% Triglycerides, -25% Glucose, normal A1C).

Yesterday I passed my medical with flying colors?WoooHooo!

Now I need to make the most important decision of my life...an RV-9A or a RV-7A?

John Edwards

Pre-Diabetes is Real

N395V said:

So let me get this straight.

There is no such thing as light or near diabetes. You either have it or you don't and if you have 1 blood sugar measurement over 126 you have it, end of story.

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It's not that simple. There is a difference between people like me (with pre-diabetes) and those with full diabetes.

I passed my medical on Monday with a normal blood sugar. It took me 3 months to get my A1C within normal limits with diet and exercise.

The next stage is to take medicine to allow the sugar to be processed by the cells more effectively. FAA has a 3 month period of stability that is required.

The next stage is to take insulin producing medicine. Grounded!
There is a special issuance however with proper documentation.

The last stage is direct insulin injections. The documentation on the special issuance applies here as well.

I consider myself a pre-diabetic. I will become worse as my beta cells decrease, but I can still fly as FAA medicals allow.

There is a middle ground...I'm there

John Edwards

whats the diff

Q- whats the difference between a doctor and a mechanic?
A- doctors bury their mistakes

its a joke

It's not that simple. There is a difference between people like me (with pre-diabetes) and those with full diabetes

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Not to mince words but it is that simple.

The definition of Diabetes is simply "one single measurement of blood glucose greater than 126.

Below 126 you may have "impaired glucose tolerance" but you do not have diabetes. The American diabetic association likes to call impaired glucose tolerance "pre diabetes" because it is useful in teaching and an easier term than impaired glucose tolerance to understand. It is also useful in scaring people into understanding that they are about to have a disease that is deadly. Pre diabetes is not an accepted medical diagnosis. The chart below is from the ADA website. The area they call "prediabetes" is associated with an elevation above normal during a glucose tolerance test and should be a warning to change your lifestyle as you appear to have done.



You will note the area above 126 is clearly labelled "Diabetes"

It took me 3 months to get my A1C within normal limits with diet and exercise.

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I am a bit confused as Hemoglobin A1C to my knowledge does not rise above what is accepted as normal until you have been"diabetic" for at least 3 months.
Also it would be unusual for a physician to treat elevated blood sugar with any kind of medication before a diagnosis of diabetes is made.

From what you wrote above it appears to me that you are at significant risk of having "Type II" (adult onset) diabetes or already have it.

The good is that you took your Drs. warning seriously and did something about it that will prevent the ravages and devastation of longterm untreated diabetes. Unlike the poster above who disbelieved his test and in all liklihood is doing nothing in the belief that there is no problem.

Herein lies my and most physicians problem and dislike for terms like near diabetes, pre-diabetes, lite diabetes, almost diabetes, mild diabetes. They all connote a less than serious problem and often result in no treatment. It is my and most physicians practice to inform any patient witha glucose of greater than 126 that they have diabetes and treat it. Those with glucose in the range that the ADA calls pre diabetes we inform the patients that if they do not drastically change their ways they will become diabetics.

To write the word pre diabetes on a patient record, while not an acceptable medical diagnosis, will absolutely destroy their chances of getting medical insurance should they ever change employers.


Now I will grant you that "diabetes is not that simple" There are 2 forms of diabetes the cause of which and treatment for are grossly different as is the course of the disease. The end result however is the same if it is not treated promptly and aggressively especially if lack of treatment is caused by using trivializing terms such as pre or near diabetes.

You are a diabetic or you are not and if you are the possibility of not flying is a trivial problem compared to what lies ahead if you do not take it seriously.

Below is a link to the ADA website. In it they explain why "they" (the American Diabetic Association) coined the term pre diabetes.

This website is an excellent source of info about diabetes and if you are aman, sedentary and significantly over weight you would do well to read it.

American Diabetic Association

glucose tests

When you have a lab test it takes a snapshot of your condition at one time. Most diabetics use a tester to check their levels, and there are calibration tests with known levels to check the instrument.

It was quite interesting to find out how your body responds to diet and exercize before a problem does occur. I would suggest to anyone that has a test and finds that the their level is over 100 to obtain a kit and get some biofeedback, if that doesn't motivate you into good choices, chances are you'll be flying 80 HP Jubiru's before you're ready.

As far as doctors go, I wish more of them had an engineering background before Med school.

no doubt

Jalanci said:

As far as doctors go, I wish more of them had an engineering background before Med school.

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yes this is true, but then they would be 50 when they were finished with school.

N395V said:

Not to mince words but it is that simple.

......You are a diabetic or you are not and if you are the possibility of not flying is a trivial problem compared to what lies ahead if you do not take it seriously.

Below is a link to the ADA website. In it they explain why "they" (the American Diabetic Association) coined the term pre diabetes.

This website is an excellent source of info about diabetes and if you are aman, sedentary and significantly over weight you would do well to read it.

American Diabetic Association

Click to expand...

Dr. Milt,

Thank you for taking the time to write this stuff. Now I can read a lab report and know what the glucose number means. I'm sure my Dr would have told me if it had rung a bell, but this is much better, knowing what the limits mean. The report says 65-99 is nomal.

My last report came in at 93. At my age, it is time to get serious about not letting it go higher.

Again, thank you for the very lucid comments on what many of us pay little attention to unitl it is too late.

dd

Apologies

My Apologies Dr. Milt,

I was only pointing out that there is a middle ground between non-diabetics and full blown diabetes requiring daily insulin. I didn?t know you were a doctor, so you already knew all this, my apologies.

I know from my own family what diabetes can do. My aunt went blind, lost her lower legs, and eventually died from the complications of diabetes. As someone wrote me on this topic, ?Nothing tastes as good as flying feels?. I can live without the carbs and still enjoy life.

Do I consider myself a diabetic? Yes! However, I?ve had three doctors in the last 4 years who have said some interesting things. (I?ve been moved a few times by my company). The first said I was pre-diabetic, the next said I wasn?t a diabetic, the next said I was a full blown diabetic (requiring meds), and this week, my AME said I wasn?t a diabetic. I actually got kicked out of a work sponsored diabetic study group because I had it under control so well.

I know I?m a diabetic so I do daily testing and I?m keeping it under control with diet and exercise. But I do have a question for you. When does one go on medications such as Glucophage? Is there any advantage to postponing the medication, other than the FAA ramifications? Or does the inevitability of the disease warrant an early start to the use of medications like Glucophage? I don?t want to accelerate the onset or force my body into a dependency when I can still control my glucose with diet alone.

Thanks,

John

yes this is true, but then they would be 50 when they were finished with school

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Actually I was 38 when I finished med school after several years of work as a mechanical engineer.

The similarities between these two professions would amaze you.

I just hope that some bright young engineer develops more comfortable "knappies" (depends here in the US) in time for when I again need them.

My Apologies Dr. Milt,

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Absolutely no apologies are necessary and please do not think I am indulging in criticism.

Medical problems, their diagnosis and treatment are complex subjects prone to misunderstanding and misinterpretation. Medical problems are often solved in different ways by different physicians and all of those ways are acceptable.

Un fortunately knowledge can be a detriment.

The most intelligent patients are the most difficult to treat because they bring a good bit of technical knowledge to the table. From this knowledge base they draw innappropriate conclusions that are difficult to counter.

The most important thing we do is not perform surgery or dispense medicine. The most important service we provide is education and understanding so that patients may participate effectively in their care.

As noted above a lab result is only a snapshot and not a tend. An elevated single lab of 126 is interpretad by me as Diabetes. n the face of several home monitoring tests below that number it can be interpreted by a nuclear physicist as a lab error. The physicist may be brilliant but he does not under stand the disease and whathas happened inside his body. He can only interpret his findings and mine on the basis of raw data which leads to an incorrect conclusion on his part.

As a Mechanical Engineer this pragmatic type of thinking actually caused me much difficulty in the early days of med school.

In any event no apologies necessary and no insults or criticisms intended. Just a thread about medical conditions and positing of information.

Fascinating

Fascinating?how did you know I was a Physicist?

John Edwards
(Also a Rocket Scientist ? Trident II missile program)

skyfrog said:

Fascinating?how did you know I was a Physicist?

John Edwards
(Also a Rocket Scientist ? Trident II missile program)

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By the depth of your insite, method of analysis, word and sentence construction and grammer .

Female Advice

Morning all.
Sun just came up here.

Milt,
Following some rather unpleasant surgery on my exhaust pipe, my darling wife put me on to 'Super Thin Maxi Shields'.
They make excellent 'Nappies'.
Pete.
PS. Remember, you have to write these things down BEFORE you loose your marbles.
P

'Twas Night Before Christmas (Aviation Style)

'Twas the night before Christmas all over the place,
When we were confronted by an old flying ace.

There was icing reported and turbulent air,
He said, "File me a flight plan, I gotta get there."

Outside sat his aircraft all ready to run,
And the old man walked out to that P-51.

"Bad weather's no problem," he silently mumbled,
The prop came to life; that big Allison rumbled.

He eased in the throttle, the roar shook the ground,
He taxied on out and he turned it around.

He went through the run-up and seemed satisfied,
Then he said to himself, "I'm in for a ride."

So he lined it up straight as he poured on the coal,
The tailwheel came up as he started to roll.

Up off the runway, he sucked up the gear,
And that mighty V-12 was all you could hear.

He screamed overhead with a deafening crack,
The blue flames were flying from each shiny stack.

He pulled up the nose and started to climb,
No ice on that airframe, it didn't have time.

On top of the weather with the levers all set,
He looked up above him and saw a Lear jet.

With jet fuel and turbines there just ain't no class,
Gimmee pistons, and props and lots of avgas!

Now he was approaching where he wanted to go,
But weather had covered the runway with snow.

How will he land it? We just have to guess,
Because the only way in was a full I-L-S.

Then over the marker, he started his run,
The ceiling was zero, visibility. . . none.

Still going three hundred and he felt the need,
For an overhead break to diminish his speed.

Over the numbers he zoomed, along like a flash,
Pulled into his break, he just knew he would crash.

Oh, why do they do it on these kind of nights?
Then over the threshold, he saw landing lights.

"I'm on a short final with three in the green,
And I see enough runway to land this machine."

Then he tied down that Mustang, and they all hear him say. . .
"Next year, I'm stickin' with my reindeer and sleigh."

Milt the renasance man

Mechanical Engineer, Doctor, and now Poet.

And considering your choice in aircraft----Rocket scientist.

Mike

Professional opinions and AME's

First, I really appreciate the information I glean from this site, which is posted by truly knowledgable and/or professional people in the subject matter field. It makes wading thru all the other "stuff" worth it.

Second, I have been taking military and civilian flight physicals and medical exams, respectively, since 1979. I am yet to meet an examiner that I thought was unfair or out to "bust" me. Frankly, if I could not pass an FAA medical exam, I'd be more concerned with correction/stabilization of the disqualifying condition, than with taking some time off from flying, shopping for another AME, etc.. You can easily outsmart yourself in such a pursuit, if such condition decides to rear its head at the wrong time, i.e. in flight.

Another Flight Surgeon

I have been following this thread for some time - and have not replied.
I am a Board Certified Aerospace Medicine specialist (also Occupational Medicine) and an active duty senior USAF flight surgeon. I work at the USAF Surgeon General's office and give advice to flight surgeons and pilots every day. About 1000 hours in fighter aircraft, mostly in F-15Es doing the WSO job.
I am also an RV-8 builder with a whopping 79.2 hours on my new bird - I have every bit as much investment and risk as each of you to maintain my medical - both USAF and FAA.
I would offer a few short words of advice:
1. The only way to effectively manage your risk is to know about it. This means you are far better off discussing medical issues with your AME and taking early steps to manage your problems rather than allowing them to progress beyond any hope of a waiver, SODA or special issuance.
2. Someone mentioned Virtual Flight Surgeons in this thread. They are not AMEs specifically because that allows them to discuss any issue with you and they have no duty to report to the FAA. They offer sound clinical advice about your FAA medical with no strings attached. Use them if you fear your AME, or find another AME.
3. The LSA program accepts more risk medically and mitigates that risk by limiting the effects of flying (no high performance, low atitude, no IFR, etc) and limiting the damage caused by a bad outcome - meaning small, slow, low and fewer passengers if something goes wrong. More responsibility is placed on the pilot to monitor his/her health in order to remove some traditional barriers to flying. You as the pilot make a determination if the aircraft, crew and environment are all airworthy every time you fly. Warren Silberman was right - discuss it with your doctor if unsure, and for LSA they dont need to be an AME.
4. There is really no money in FAA physicals for the vast majority of Docs - so $ are never an issue in these matters. We love to fly and want to help you keep flying.

Bruce "FM" Edwards MD, MPH
RV-8 391FM - flying 79.2 hrs
200 hp IO-360
Dual GRT EFIS, Digiflight II
Flying naked (no paint yet)

Doc FM

Come on get some clothes on that bird!!!

I have a problem with the present system of saying, it is ok to kill yourself in a small 100 hp aircraft, but not in 180 hp aircraft, with two people in it.

I know many pilots right now who are really going naked and just flying with out a medical but far worse not doing any training or submitting to a BFR.

For me in my aged but healthy condition I would much prefer the FAA to adopte the orginal proposal.....Drivers Lic. for 3rd class type flying with my proposal of an added requirement to have an annual flight review. I would suspect that most accidents are caused by poor training, lack of practice, bad decision making, in frequent fight reviews, and not from some medical problem. Just think how much time and money this would free up at the FAA. They could then concentrate on those pilots involved in aviation as a commercial venture and probably have enough money left over to keep ATC funded with no user fees.

I know that my proposal still won't change those pilots going naked, they would probably not submit to any requirements that might stop them from flying. But the vast majority of pilots I know continually exercise excellent judgement in maintaining their aircraft and their mind/body.

A very good friend of mine got up one saturday morning about two years ago and suggested that he and his wife go for a day trip in their RV 4. Just before leaving he got a call from his work (Real Estate sales) and was summoned to show some clients around his project. So he kissed his wife goodbye, met his clients, and while showing them the property he dropped dead from a massive heart attack. GO figure!!! Great shape (exercised regularly), just had his family doc's medical, a very recent AME medical, 43 years old, in short a picture of health. I shudder to think if fate hadn't of step in that beautiful saturday morning. He and his lovely wife maybe would both be lost.

Maybe he is the exception and not the rule. Well I believe that medical caused accidents are the exception and not the rule.

Thanks for your valuable insight into this important aviation issue. Also thanks for being available to pilots in your area to stay current medically!.....

Frank @ sgu and slc... building a RV 7A

I have to say that I am amazed at how long this thread has gone on. This thread has been interesting to say the least. Great discussion.

fstringham7a said:

For me in my aged but healthy condition I would much prefer the FAA to adopte the orginal proposal.....Drivers Lic. for 3rd class type flying with my proposal of an added requirement to have an annual flight review. I would suspect that most accidents are caused by poor training, lack of practice, bad decision making, in frequent fight reviews, and not from some medical problem.

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I agree. If you have and can demonstrate the skills to pilot the aircraft, who cares if you have condition ubantuchmoditis or whatever from the perspective of a third-class medical? Yes, excluding people who have such conditions reduces risk, but there are lots of other ways that we could reduce risk in GA, and we don't. We (VAFers) accept the risk of flying (and riding in) experimental airplanes, something that other people may not want to accept.

wv4i said:

Frankly, if I could not pass an FAA medical exam, I'd be more concerned with correction/stabilization of the disqualifying condition, than with taking some time off from flying, shopping for another AME, etc.. You can easily outsmart yourself in such a pursuit, if such condition decides to rear its head at the wrong time, i.e. in flight.

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Stabilization and correction of conditions are very different. One can be stable for many years and still be denied or risk denial of a medical. One only needs to say "Bob Hoover" to be reminded of how things can go with the FAA.

So, from the SP perspective, if you know you're marginal why bother trying? If you get denied, you're done flying, at least legally. Who wants to spend months of being grounded while you're going around and around with the FAA and AME to get approved or not.

In my opinion, a much better policy would be to allow you to fly as a SP if you have been denied a medical but have a DL, i.e., eliminate the double standard that currently exists. Realistically, I don't see the FAA doing this, as it means giving up control over those denied a medical.

Get yer 3rd class medicals here!

FMF15E said:

4. There is really no money in FAA physicals for the vast majority of Docs - so $ are never an issue in these matters

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As you all may recall, I had to go across state to get a 3rd class done because of my weird little heart problem. As I was setting out for the 120 mile trip, I passed the local doctor's office just outside of town. There on the sign was "FLU SHOTS NO WAITING" and "FAA 3RD and 2ND CLASS PHYSICALS DONE HERE". If I hadn't already started with the guy in Saginaw, I might have started with this guy - and then used him as my family physician. It would have been new business for him...

--JCB