Anxiety Vs Class 1 medical
 

Hello all,
I'm looking to receive some guidance after my recent visit with an AME, while attempting to renew my 1st class medical. Quick backstory is that I am a chimerical pilot but i'm not currently working as one, i'm actually an engineer. However, I just went for my first class anyway as I always have done in the past. So i am also a veteran and have been deployed and like many who came home, had come home with some PTSD. I did the right thing and was seen by the VA and was diagnosed with PTSD and anxiety (PTSD is a form of anxiety). I was on some anxiety meds and in therapy for a year or so, but I haven't been on meds in 4 months or so. In fact my doctor gave me a clean bill of health and haven't been in treatment either. After a years worth of counseling i'm feeling great and back to what some may call NORMAL. 3 weeks ago I went to see my AME to get my medical renewed and I had answered YES to having a mental health problem in the past and explained to him my situation. However he needed to see my VA medical records (which he hasn't yet) in order for the FAA to do an evaluation on my medical treatments. The VA knows i'm a pilot and they also have no concerns with me flying. I know this because I had to ask my therapist of there was any concerns for me flying, and I was told that "as long as I feel good and continue to feel good" there shouldn't be any issues. So is there any steps I should be taking in the meantime. The FAA has not yet sent me anything in the mail regarding a release of medical records from the VA? Thanks.

I would start by reviewing the info on the FAA.GOV website.

You can google "FAA guide to Aviation Medical Examiners", and it will be one of the first results. Here is a link for item 47, psychiatric conditions.

You aren't wrong to start gathering all of the info you have, sometimes that requires a lot of lead time in and of itself (particularly if you are dealing with VA records and such).

I would be hesitant, however, about turning over anything that the FAA hasn't asked for.

Once your request for a medical certificate gets deferred, you will receive a letter from the FAA explaining (in detail) what they need from you and what the next steps are.

Good luck!

Thanks,
I'll keep doing more research. Basically I don't want to get blind sided by anything that might be coming up. So far what I've read is people who do have anxiety and fly need to be off meds for "X" number of months (i believe it's 2) and have their physician state that in their record. Mostly this is for mild cases of anxiety (correctable and not severe) However what worries me is that I was getting seen for a year by the VA. Like I said though it's been 4 months since i've been off meds and feel great. Funny thing is flying is more therapeutic than stressful for me. But i'll keep doing some reading and research. Thanks for the help.

You should be fine. Anxiety is common enough and the FAA is pretty tolerant of "situational" anxiety and depression, which are almost a fact of life at some point for many people. You're removed from the "situation", had treatment and are fine. They'll just need to see the documentation. They might also ask you to sit for a second evaluation, but I'm guessing not in your case.

If it were me, I probably wouldn't describe flying as being therapeutic. Fun, yes. But therapeutic implies a need for therapy...

What the VA thinks about you flying really doesn't matter; what the FAA determines is everything. While the FAA aeromedical will use and rely on data from your physicians, they'll also determine what they want to see, and they'll ultimately interpret what's collected.

If on psychotropic chemicals, you may need to show at least a year's separation from the drugs, as well as a diagnosis showing clear, before you can be considered for issuance.

One more thing regarding the VA...

I'm guessing you do NOT want a VA disability rating for any mental health issue (might get away with a zero % placeholder for past history). That would tend to indicate that there is an active disorder if the VA is paying you for it.

The people who advise folks about VA disability claims tend to encourage you to claim anything and everything, and throw in the kitchen sink to boot, to maximize your benefit. This can backfire big-time for pilots, who then have to try to "undo" a federal government diagnosis for a condition they don't really have anymore.

Consult with Dr. Chien
 

I would highly recommend consulting with Dr. Bruce Chien over in Illinois. You can consult with him easily. I wish I had known about him when I had a very similar issue previously. For me, the FAA paperwork became a problem as the FAA kept asking for more and the psychologist was clearing me to fly but we couldnt figure out what the FAA really needed to approve it. Chien knew exactly what they needed as the psychologist had no experience with the FAA. I am almost through this now and should soon be cleared to fly.

Anyway, Chien knows the ins and outs of the FAA and will be able to give you some good insight as to what they might need to see. Even at an early stage I would recommend a consultation. 2 heads are better than one and he really knows what he's doing. I think you could save yourself SIGNIFICANT cost, difficulty, and delay by just calling him. He will give you the best counsel as to what to expect.

Aeromedicaldoc

-Fellow pilot

And along the same lines, watch out what diagnoses are given to your kids. A lot of school districts play the 'special needs' game, getting more government aid by having as many kids as possible declared as requiring special needs, the commonest scam being to assert the kid is ADD and telling parents their kid needs to be evaluated - sometimes recommending a list of "knowledgable" pediatricians who they know throw this diagnosis (and the Ritalin and other drugs that go with it - around pretty loosely. There are middle schools in my town where 50% of the male students have been diagnosed as ADD, most for no more than being boys. And everyone benefits. The school gets more money, the pediatricians get more money, the parent is relieved of responsibility for their kids acting out, and the kid himself is given more slack when he does act out because he isn't misbehaving, just manifesting the symptoms of his illness.

Until 15 years later when he wants to get a Flight physical and finds he must somehow put together historical evidence and recommendations enough to convince the FAA that he had been misdiagnosed and had never had the condition to begin with despite years of taking a controlled medication for that condition. Not impossible, but long, tedious, and expensive.

Because nobody in the aeromedical community can reasonably expect their career to survive the hit if they issue a waiver for someone for ATTENTION DEFICIT DISORDER and that person is at the controls at the time of an aviation mishap.

I'm not saying the syndrome doesn't exist, but it damn sure doesn't affect 50% of the randomly selected male students at any public middle school. Don't sell your kids future for a scam.

I know this is an older thread, but the important thing is whether or not you were actually diagnosed AND given a rating by the VA for PTSD. If so, it matters what percentage and then the fun begins.

That is the reason why some people should take a medicine before flying. It will be better for them, crew and surrounding passengers. For example, there is a medicine called kratom. 100% natural and helps to overcome anxiety. So why would you have this headache with medicine certifications etc, when you can just temporary overcome this issue?

The Mayo Clinic calls this stuff unsafe and ineffective. Check with your doctor.

https://www.mayoclinic.org/healthy-l...m/art-20402171

Strychnine is a natural product too. So is morphine. “Natural product” means nothing and provides no assurance of either safety or efficacy.

Last year I became aware of that stuff, when a resolution came to the floor of our state political convention concerning it, from a lady I’ve know for decades, in our church. She suffers from severe hip and back pain as well as fibromyalgia. She had been on oxy...something for years and was trying to get weaned off. According to her, she’s been off the pain meds now for 6months has no issues with the fibromyalgia or anxiety. She takes that stuff 3 times a day, at a cost of about 3 dollars/day.

Needless to say she is a huge advocate. The more studies I read,the more I am convinced it is the next “aspirin”.

I’ve always been skeptical of the influence of big pharma on the FDA. Reading the actual science on it has made me an advocate.

However, I don’t think it would be a good idea to fly with it. You can read the studies for yourself here: American Kratom Association - Science

And I think you are a naive fool:

Aggarwal, Geeta et al. “Death from Kratom toxicity and the possible role of intralipid.” Journal of the Intensive Care Society vol. 19,1 (2017): 61-63. doi:10.1177/1751143717712652

Death from Kratom toxicity and the possible role of intralipid

Geeta Aggarwal, Edward Robertson, [...], and Edward Walter

Additional article information

Abstract

We present the case of a 26-year-old man who was brought into our emergency department in cardiorespiratory arrest, having taken Kratom 24 h previously. Despite multi-organ support, he deteriorated and died from cardiorespiratory failure and hypoxic brain damage 12 h later. Lipid emulsion was given, with significant temporary improvement in the cardiorespiratory failure. Kratom is derived from Mitragyna speciosa, a tropical deciduous and evergreen tree in the coffee family, and is native to Southeast Asia, and its leaves are used as a legal high in some parts of the world. Here, we review the pharmacochemistry of the drug, and wish to highlight that the effects of Kratom may not be as benign as are commonly reported, and the possible role of intralipid in managing the Kratom toxicity in this case.

......


Morbidity and Mortality Weekly Report (MMWR)
CDC
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Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected — 27 States, July 2016–December 2017
Weekly / April 12, 2019 / 68(14);326–327

Emily O’Malley Olsen, PhD1; Julie O’Donnell, PhD1; Christine L. Mattson, PhD1; Joshua G. Schier, MD1; Nana Wilson, PhD1 (View author affiliations)

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Kratom (Mitragyna speciosa), a plant native to Southeast Asia, contains the alkaloid mitragynine, which can produce stimulant effects in low doses and some opioid-like effects at higher doses when consumed (1). Use of kratom has recently increased in popularity in the United States, where it is usually marketed as a dietary or herbal supplement (1). Some studies suggest kratom has potential for dependence and abuse (1,2). As of April 2019, kratom was not scheduled as a controlled substance. However, since 2012, the Food and Drug Administration has taken a number of actions related to kratom, and in November 2017 issued a public health advisory*; in addition, the Drug Enforcement Administration has identified kratom as a drug of concern. During 2011–2017, the national poison center reporting database documented 1,807 calls concerning reported exposure to kratom (3). To assess the impact of kratom, CDC analyzed data from the State Unintentional Drug Overdose Reporting System (SUDORS)

....
Among the known side effects of this “herbal supplement” is seizures. You can play “bet your wings” all you want, but the risk of kidney or liver damage is high, and even one seizure and it is unlikely you will ever again fly legally as a commercial pilot.

https://www.consumerreports.org/diet...r-with-kratom/

Update: On April 3, the Food and Drug Administration released the final results of heavy metals testing on 30 kratom products, following up on an initial announcement made in November. "The analysis found significant levels of lead and nickel at concentrations that exceed safe exposure for oral daily drug intake," the agency said in a statement. "Based on these test results, the typical long-term kratom user could potentially develop heavy metal poisoning, which could include nervous system or kidney damage, anemia, high blood pressure, and/or increased risk of certain cancers." (The full list of tested products and results is available online.)

Scientists from the Food and Drug Administration (FDA) found dangerously high levels of heavy metals, including lead, in kratom products, the agency announced on November 27.

Kratom is an herbal substance that some consumers use to treat pain, mood disorders such as anxiety and depression, and addiction, as well as to ease opioid withdrawal.

Previously, the FDA warned that components of kratom act like opioids and that certain kratom products were highly contaminated with salmonella, prompting a mandatory recall. Now, the FDA is warning consumers that regular use of some of these products could lead to heavy-metal poisoning, which can cause a variety of serious health problems.

MORE ON KRATOM
Salmonella Outbreak in Kratom Products
The Dangers of Taking Kratom
“The findings identifying heavy metals in kratom only strengthen our public health warnings around this substance, and concern for the health and safety of Americans using it,” FDA Commissioner Scott Gottlieb said in a statement.

Kratom’s legal status is currently in limbo, with bans and restrictions in place in some states. Federally, the FDA says, the substance can’t currently be legally marketed as a drug or a supplement. The Drug Enforcement Agency (DEA) previously announced plans to list the active ingredients in the plant as Schedule I substances, like cannabis or LSD, which would make all forms of kratom illegal nationwide. But the agency temporarily reversed that decision and has not yet made a final announcement. (The DEA now lists kratom as a “drug of concern.”)

Sounds like you are a google expert now on it, and carrying the FDA water for them..

To be fair when I first heard of it, I was equally taken in by the FDA and other more anecdotal stories about it. Until I actually started reading the science on it from actual studies done by scientists and universities. One thing I found was that it does not affect the receptor (either kappa or delta) that affects repspiratory system, like opiates...which is why there never has been a death reported that was attributable to UNADULTERATED Kratom, taken by itself. When you actually drill down on every death, you find there were opioids in the system of the victim as well as other drugs. Usually stoners experimenting mixing drugs with Kratom for greater high effects. You’ll have to read all thes stuff in the link I posted. (Daunting task), but good for rainy day layovers.
That’s why opioids kill, it suppresses respiratory nerves, person just stops breathing.

What Kratom really needs is regulation, like other supplements, including gmp and testing, so those occasional instances of bacteria or heavy metals don’t find their way into the products as has happened a few times. Three state have recently enacted laws to protect Kratom and require gmp and testing. More will follow as the science wins out over hysteria and the DEA looking to replace the Marijuana bogey man, and keep their funding.

In the mean time, it would be ill-advised for a pilot to take it, as it might show up as an opiate in the pee test (maybe..I dunno). But I do want to see my friend Pam be able to continue to have access to it. It has saved her life, and others from what I hear.

She buys only from a known source who does insure purity and test every shipment.


Read the available studies and docs on the links I provided. Hopefully no one you care about will ever have a need to get off pain meds, while relying on the FDA (FAA of medicine world).

Oh, if you don want to bother with all the reading, try watching “Leaf of Faith”.,I think it is on Amazon.

Sounds like you are a conspiracy theorist as well as a naive fool. Don’t let them chemtrails get you.
:rolleyes:

Pharmacognosy - the science of drug products from plants and other natural sources is not rocket science.

Plants don’t create these substances - generally alkaloids - because they wish to help mankind. They generally evolve these substances as a protective mechanism to poison or otherwise discourage animals that would otherwise eat them in much the same way that fugu (pufferfish) evolved the ability to concentrate tetrodotoxin to poison anything eating it. In the case of Kratom, Mitragynine is only one of approximately 40 varying stereoisomers of alkaloids found in it, and these alkaloids are variable in concentration and proportion from plant to plant. No actual standardization is possible because nobody knows which (if any) of these alkaloids is the (most) active ingredient. And every batch is different. AND NOBODY CAN STANDARDIZE A MIXTURE OF 40 COMPOUNDS.

Now you can keep citing cases like the “lady you have known for decades,” which any biostatistician would tell you constitutes an essentially meaningless “n of one” experiment, but all you demonstrate by such claims is your own ignorance. And I don't really mind you wasting your money or imperiling your own health buying worthless (or in this case potentially harmful) supplements but you are promulgating this idiocy on a board for airline pilots where encouraging others to follow the idiocy (or doing it yourself while flying) places the public at risk. That’s my gripe.

So go ahead and use. But when you have your seizures or your liver rots or your kidneys give out, don’t come whining about it. You made your choice, and wow, you sure will show those evil FDA scientists.

Come to think of it, if you go international, don’t bother with that yellow fever immunization either, that’s just an evil plot of theirs too no doubt. And the case-mortality rate for yellow fever actually isn’t much more than 20%.

I don’t use it, but someday may need it. I hope the right to use alternative therapies for personal health remains, as it has for a couple hundred years....

Just like your right to be an anonymous jerk in public.

I’m glad the food and drug nazi’s have people like you being a public advocate.

The shrinks call this “cognitive dissonance” when they are being polite. “Irrationality” when they are being less polite.

It’s also a textbook example of Godwin’s Law. :D

Sledding like that, in pajamas and bare feet, can be dangerous.

Especially on rainbows. A lady I have known for decades says they can be sharp.




I visited the American Kratom Association web site, linked above. I was curious about the orgnization: was it a scientific body composed of researchers who were promoting a product based on their efforts, and who were willing to hang their reputations on the line, or was it an organization made up of a bunch of wuffos who had nothing to do with anything but promoting their flavor of the day?

Turns out it's the latter. Visit the link "Leadership," and you find that Chairman of the Board Herman was a hotel and investment banker. The treasurer and secretary was in marketing. Board member Graham is an accountant. Board member Bake is a venture capitalist with a background in marketing. Executive Director Candland has an "extensive business background." A running clock at the bottom of the page advises that it's been 274 days since the FDA refused to meet with them.

A little more reading will reveal that the AKA established itself for branding, to require all kratom manufacturers and sellers to come to it to get a branded AKA Seal, as one who holds the AKA approval for their "Good Manufacturing Process."

"It is only through the generosity of individual donors and volunteers that we have been able to fight anti-kratom legislation throughout the united states."

A nonprofit organized by marketers, agenda driven and selling a brand. That's the source one should look to for a whole picture and better understanding, before ingesting a potentially lethal herbal drug.

You’ll find the same with most any lobbyist. Maybe you should look at the bio of the actual researchers and scientists whose studies are cited. I know the research is not easy reading and dry, and maybe hard to understand if you don’t have much education in chemistry or physiology, but don’t shoot the messenger.

But you’re right, nazi references are over used. If I could edit it, I’d say “Stalin-esque”...or pick a fascist.