The FAA is making my chest glow

[Steve Ashby]

Almost 5 years ago I had some shortness of breath and a few weeks later, I had the joy of experiencing a couple of cardiac cath operatons, an angioplasty and the installation of two stents in my left anterior descending artery (this is a popular spot for stents: they call it the widdow maker). I never had a heart attack and have been symptom free since then. However, to regain my FAA medical, I have to undergo a thalium stress test every January and forward the results to the flight surgeons in Oklahoma. Although this is an expensive proposition each year, I figured that it was the price I had to pay to aviate.

Today, I saw my cardiologist for a followup visit after my annual thalium stress test. He told me that my results were fine and that I should not need another test for about 4 or 5 years unless I have more symptoms. I reminded him that I needed the test every year for the FAA and he was visibly upset. He said that such an invasive test was not medically indicated and that each time I took it, they injected enough radioactive stuff in me to equal about 100 chest x-rays. Cripes-Amighty!

Has anyone else had this experience with the FAA? My case might be a little different because I acquired an abnormal EKG after my stents (about 13% of post stent patients get this lucky trait). Is there any way I can avoid this costly and glowing requirement each year?

[Low Pass]

Too bad Jury Nullification can't be applied to the rulings of the FAA medical division...

The actions of the FAA medical division, and most federal agencies for that matter, are not based on logic or prudence. They're based on covering their jobs. Either protecting themselves from adverse actions resulting from their decision, or just making work for themselves.

I've been doing the aviating thing for a long time now, and I can think of *maybe* 1-2 incidents where someone was injured by a medically impaired pilot. And ZERO cases where someone on the ground was injured. This is just the Feds making work for themselves.

Best wishes to you in your dealings with the FAA medical division, Steve.

[rv7boy]

Steve,

I know a lot of people will tell you to contact AOPA and that's what I'd do. They have a new Medical Services program they just started less than a month ago. It's much better than what they used to do, but it comes at a cost. It's offered at two levels.

I had mitral valve replacement surgery in April and am now going through the process of re-applying for a Special Issuance Class III medical. After I assemble all my reports from my tests, lab work, surgeon's reports, etc. I'll forward them to the AOPA medical office for their review BEFORE I go see my AME.

I've talked to several folks that work in that office, and they seem to have their act together. A lot of the routine testing that has been required in the past seems to have been streamlined by the FAA in recent years. I'm not saying that would apply to your case. I'd recommend you at least give AOPA a call to see what they think about your annual tests that seem unnecessary.

Good luck,

[DGlaeser]

If you have a Special Issuance (SI) medical for heart related issues, then a stress test will be a yearly thing. However carefully read your letter from the FAA. They may just require a stress test - no Thalium required. If not, they may drop the Thalium later, if your results are favorable and consistent. No guarantees, but that's what happened to me.
This year, I had my doctor write in his evaluation that a yearly stress test was not required in his opinion, that every other year would be sufficient. However the letter came back that I need to do it again next year. I spoke to a senior AME recently and he said one year is all you get for heart related stuff, and doesn't expect that to change.
Good luck!

[terrykohler]

Steve:
Dennis sounds pretty much spot on. Here's another opinion from an active Naval Flight Surgeon - I believe she's also qualified for civilian physicals, but I won't let her do mine ...
Coronary artery disease (CAD) is the number one cause of death in the United States, and encompasses not only myocardial infarction ("heart attack"), but also coronary insufficiency and thrombosis. It doesn't matter that this gentleman "didn't have a heart attack." If there was enough blockage in his coronary artery to necessitate the placement of not one...but TWO stents, he has, by every possible sense of the definition, CAD. The major aeromedical concern for a pilot with CAD is the risk of sudden death or incapacitation in flight. Coronary disease is unpredictable, and often catastrophic. Thirty years ago, your aviation career would have been over (if you were even lucky enough to leave the hospital). Today, medicine has advanced to the point that it is possible to control the condition and minimize risk of recurrence so you can return to flight safely. This being said, strict criteria must be met:
1. Annual cardiology consultation
2. Annual exercise stress testing with imaging (this enables us to see not only the electrical function of your heart but also the anatomy and movement of your heart muscle under stress).
3. Cholesterol and glucose levels in acceptable ranges.
4. Blood pressure consistently under 140/90.
5. Absolutely NO SMOKING.
6. Absolute compliance with all prescribed medications.
7. BMI (body mass index) under 27.
Note how numbers 5, 6, and 7 are YOUR responsibility...not your doctor's. If you smoke, if you don't take your meds regularly, or if you're overweight you are welcoming increased risk for a recurrence or progression of your heart condition.
The FAA is not "out to get you." Remember, you are not a typical cardiac patient. You are an aviator, and under your control is a machine that could potentially cause catastrophic damage to you, your passengers, and those walking below you should your heart decide to infarct while flying. Any stressful flight condition (weather, instrument malfunction, lack of fuel) is a mini-stress test for your heart. If there is going to be any issues, you want to know this on the ground, not in the air. This is the reason for the annual stress test with imaging.
Flying is an incredible privilege, not a right. We as a flight community have a responsibility to ourselves, everyone else in the sky, and those on the ground looking up to enjoy our hobby SAFELY.
Best regards and wishes for a happy and healthy future.

Leah Kohler, D.O.
LT, MC/FS, USNG

Good luck Steve. Hope it all works out for you.
Terry, CFI
RV-9A N323TP

[N395V]

Steve,

The amount of radiation is really insignificant no matter what its relativity to a number of chest x rays. It is also not what we consider an invasive test. Your cardiologist is correct in that if yours looked good last time you really do not need another (from a medical standpoint) for several years or unless you have symptoms. Statistically every 5 years should be sufficient.

You however belong to a group where having one undiagnosed problem in a thousand is unacceptable which is why the FAA requires a yearly test.

Clearly your cardiologist does not understand the FAA (actually probably no one understands the FAA)

Whenever you fly above 10,000 ft msl you are absorbing about .7mrem (millirem) per hour. Or 700mrem/year for a 100hr period.
Annually you absorb 36mrem from cosmic and ground radiation and 240 mrem from breathing air and eating food. You probably pick up another 25mrem form phone, TV and computer usage per year and another 100-200 mrem from other sources.

I am guessing being a pilot you are sucking up about 1000 mrem a year from eating breathing existing and flying.

The average thallium stress test for a man is about 750 mrem.

Numerous medical studies have shown no statistical increase in radiation related cancers or illnesses when doses of less than 5000 mrem per year are used. Medical workers who administer nuclear and xray tests are closely monitored. They year in and out absorb far more radiation than any patient and there is no significant radiation related epidemic among their ranks.


In any event the radiation from a stress test yearly will not hurt you.

If it did we would be seeing lots of tv commercials that ended with
call 1-800-BAD-XRAY. If your Cardiologist won't do the test find another Cardiologist, or come on down to Mississippi and I'll do it.

To put it in perspective.........

"from the top ten myths about nuclear power...

Top 10 Myths about Nuclear Energy


Myth # 1: Americans get most of their yearly radiation dose from nuclear power plants.

Truth: We are surrounded by naturally occurring radiation. Only 0.005% of the average American's yearly radiation dose comes from nuclear power; 100 times less than we get from coal [1], 200 times less than a cross-country flight, and about the same as eating 1 banana per year [2].

As you can see eating a banana expose you to radiation.

I have several pilot patients with stents and I THINK after 5 years post stent you only need the stress test without the Thallium. Till then it's yearly thallium or you don't fly.

If you are over 65 the tests just got cheaper , as of Jan 1st medicare cut reimbursement by 30% so your copay should decrease.


For those interested below is a website you can visit to calculate your own annual radiation exposure.

http://www.ans.org/pi/resources/dosechart/

[Brantel]

Originally Posted by N395V

I have several pilot patients with stents and I THINK after 5 years post stent you only need the stress test without the Thallium. Till then it's yearly thallium or you don't fly.

I do not think that stents automatically equals Thallium Stress tests. It seems to be more on a case by case basis.

I happen to know a pilot that had two stents in late 2008 and all the FAA wants is a regular Maximal Stress Test on the Bruce Protocol. If that comes back abnormal all bets are off.

[N395V]

It seems to be more on a case by case basis.

I am sure Bryan is correct in that It seems the only requests I get for the nuclear stress tests are thos who have Stents in the left anterior descending artery.