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Old 07-09-2018, 11:28 AM   #1
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Default 1st class medical and heart surgery

Hey all,

Soooo, a couple of questions regarding the title of this post. I am a regional pilot and recently had to have emergency heart surgery. My aorta had to be replaced. This came out of the blue and there were no warning signs before this happened. In any case, I am currently recovering- this happened about 2 months ago. My most recent medical was in March. Does my medical automatically become invalid? I mean, I think I would have to go to an AME to get a physical and disclose my surgery which at that point would make me ineligible to hold a medical, but what about right now? Not that I would be flying again any time soon anyways, but just curious, because I have talked about this with some friends and we had different opinions about the answer...

I know that getting a medical back after heart surgery is going to be a big deal, but not really sure about my situation. I did not have a heart attack or bypass surgery etc... this was a straight up artery replacement, not to mention that I am now on blood pressure medication. So, getting back a first class, is that an impossibility or something that is feasible? My flight instructor developed a heart issue and still does not have a medical so.... Just trying to get a feel for what I might be up against.

Thanks in advance for your thoughts.
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Old 07-09-2018, 02:50 PM   #2
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Talk to your AME, or call AMAS:

https://www.aviationmedicine.com/

Many airlines pay for AMAS. Might be cheaper than an appointment with your AME. You can also contact your Regional FAA Flight Surgeon and see what has to be done.

Here's a good article on Heart Issues:

https://www.aviationmedicine.com/art...heart-disease/

Less than 1% of heart issues lead to permanent grounding:

In 1997, the FAA granted nearly 6,500 Special Issuance Authorizations/SIA (waivers) for pilots with coronary artery disease. Of these, most were for coronary artery disease or heart attacks (myocardial infarctions) treated with bypass grafting, angioplasty and/or intracoronary artery stents. With respect to class of medical certificate, 509 were for First Class, 512 were for Second Class and 5,555 were for Third Class. Pilots with heart valve replacements, rhythm disturbances, pacemakers and heart failure also were granted SIAs. Only 0.1% of medical applications to the FAA receive a final denial.
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Old 07-09-2018, 04:19 PM   #3
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What he said ^

For serious conditions between medicals, the FAA is going to expect you to consult your AME before un-grounding yourself. The AME may be able to give you a verbal OK, or you may have to provide more info to the FAA, depending.

In this case my guess is the FAA is definitely going to want more info, and they would not be happy if you went flying without asking anyone. Just my guess.
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Old 07-09-2018, 05:13 PM   #4
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You haven't given a specific enough description to be exact. By having your aorta "replaced" do you mean your thoracic (inside the chest) or abdominal (inside the abdomen) aorta, it runs through both spaces.

Generally the reason for replacing either of them is the development of an aneurysm. The concerns with replacement are several but the main ones are:

1. Why did you develop an aneurysm to begin with?
2. Were important arteries that branch off the aorta damaged?
3. How satisfactory was the repair?
4. How frequently do you need to be followed if a special issuance is granted?

1. Is important because there are some genetic conditions, Marfans disease and similar, that predispose to aneurysms. While it is likely you would still be granted a special issuance, this would affect item 4, how closely they would require you to be watched as a condition of the special issuance. Similarly, high blood pressure is a risk factor. They will want to see that your blood pressure is indeed well controlled on your current meds.

2. Arteries coming off the aorta include the coronary arteries that feed the heart, the carotids that feed the brain, and down in the abdomen the renal arteries that feed the kidneys. If you have had a synthetic graft splice near any of these, the FAA would want to guarantee themselves of the adequacy of the repair and subsequent the flow to these vessels.

3. While uncomplicated aortic grafts are generally easily waiverable, the FAA needs to do due diligence that there was a satisfactory repair. They are gonna need to see the records and the post graft imaging and/or flow studies.

Just the fact that you have been put on blood pressure medication technically means you don't meet standards, although even just a local AME (senior AMEs can do class 1s, other AMEs are restricted to 2s and 3s) can issue pending review. I SUPPOSE you could just go back to work until your next physical was due and CLAIM you thought that would be OK, but you ought to know better, and they are going to KNOW you should have known better. They won't REFUSE to waiver you if you do that, but they damn sure won't go out of their way to do you any favors if you pi$$ them off either, and that WILL pi$$ them off. And this may well be a lengthier process if they get irritated at you. Besides, the longer you wait before getting the required stuff, the harder it will become to collect it all.

So MY RECOMMENDATION is get a copy of your hospital discharge summary and call up your regional flight surgeon and fax it to him/her after talking to them personally. Depending on just what was done, the regional flight surgeon can talk to OKC and find out precisely what medical info/imaging studies/proof of adequacy of blood pressure control/etc., that you are going to need to satisfy the Federal Air Surgeon. They might even be able to tell you if they think that your senior flight surgeon is up to the job of doing this expeditiously, or if you ought to go to a specialized aeromedical clinic that has done a few of these and knows the requirements and the personalities of the reviewers.

I think your chances of getting a waiver are actually pretty good, but if it's not done right it can take months and months longer than it needs to.

And, yeah, you didn't do anything wrong to cause yourself to have an aneurysm. You having an aneurysm isn't going to pi$$ them off. If they think you aren't taking your condition seriously - like pretending you didn't know they don't want you flying until this is OK'd by them, that won't be the case.

Last edited by Excargodog; 07-09-2018 at 05:31 PM. Reason: Because ****ing off the FAA Aeromedical people is ALWAYS a bad idea.
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Old 07-09-2018, 05:24 PM   #5
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Quote:
Originally Posted by AirBear View Post
Talk to your AME, or call AMAS:

https://www.aviationmedicine.com/

Many airlines pay for AMAS. Might be cheaper than an appointment with your AME. You can also contact your Regional FAA Flight Surgeon and see what has to be done.

Here's a good article on Heart Issues:

https://www.aviationmedicine.com/art...heart-disease/

Less than 1% of heart issues lead to permanent grounding:

In 1997, the FAA granted nearly 6,500 Special Issuance Authorizations/SIA (waivers) for pilots with coronary artery disease. Of these, most were for coronary artery disease or heart attacks (myocardial infarctions) treated with bypass grafting, angioplasty and/or intracoronary artery stents. With respect to class of medical certificate, 509 were for First Class, 512 were for Second Class and 5,555 were for Third Class. Pilots with heart valve replacements, rhythm disturbances, pacemakers and heart failure also were granted SIAs. Only 0.1% of medical applications to the FAA receive a final denial.

This actually falls under vascular rather than cardiac, but yeah, the odds on a waiver are pretty good.

Decision Considerations - Aerospace Medical Dispositions
Item 37. Vascular System

The following lists the most common conditions of aeromedical significance, and course of action that should be taken by the examiner as defined by the protocol and disposition in the table. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.
Common Conditions and Course of Action

Disease/Condition Class Evaluation Data Disposition
Aneurysm

(Abdominal or Thoracic) All Submit all available medical documentation Requires FAA Decision
Aneurysm (Status Post Repair) All Submit all documentation in accordance with CVE Protocol, and include a GXT

Last edited by Excargodog; 07-09-2018 at 05:51 PM.
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Old 07-09-2018, 07:12 PM   #6
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Thank you all for your responses. Quite a bit of info there that I appreciate. In any case, I had not intended to try to go flying without letting anybody know what happened; I don't like pi$$ing off the FAA either and know that it is always better to be up front about medical issues, etc... It was more a curiosity as to whether my medical is automatically rendered invalid due to the surgery or the BP meds or what...

Quote:
Originally Posted by Excargodog View Post
You haven't given a specific enough description to be exact. By having your aorta "replaced" do you mean your thoracic (inside the chest) or abdominal (inside the abdomen) aorta, it runs through both spaces.
It was definitely thoracic. Descending aortic dissection, if that means anything to you, which I imagine it might. If not, definitely an emergency situation and I am not one to go seeking help very easily, so for me to call 911 that morning, considering the pressure in my chest that was not dissipating was quite an unusual event for me, not to mention my first helicopter ride as I had to be airlifted to a different hospital and immediately went into surgery. Some poor guy had to have his bypass delayed because the doc that was doing it had to fix me instead.

Quote:
Originally Posted by Excargodog View Post
Generally the reason for replacing either of them is the development of an aneurysm. The concerns with replacement are several but the main ones are:

1. Why did you develop an aneurysm to begin with?
Good question. Doc did not say anything like Marfans or mention aneurysm, but was probably genetic I guess, but most likely just a weak aorta or, at least weakened over time. My BP was slightly elevated prior to this happening, but I even saw a former USAF flight surgeon(apart from my normal AME mind you) that did not feel that it was enough of an issue to prescribe BP meds, just advised changing habits a bit and being a little bit healthier in my life. Controlling stress in my life was a big factor, however one particular stress-causing factor was very difficult to manage and more than likely contributed to my aorta failing that morning.

Quote:
Originally Posted by Excargodog View Post
2. Were important arteries that branch off the aorta damaged?
Don't believe so, was not advised by the doc as such so, just assuming at this point, but I'm sure if I asked the doc, he would be able to tell me. It's questions like this that I don't know to ask naturally.

Quote:
Originally Posted by Excargodog View Post
3. How satisfactory was the repair?
Pretty good i think, but of course I am no expert.... Dacron was grafted into place and currently makes up the majority of my aorta. I recently had a CT scan which involved an IV that allowed Iodine to be injected into my bloodstream at pressure to show the integrity of the graft, etc... Aside from the discomfort of an IV and needing 3 nurses and 3 holes in 2 arms to get it right, it went swell.

Quote:
Originally Posted by Excargodog View Post
4. How frequently do you need to be followed if a special issuance is granted?


Just the fact that you have been put on blood pressure medication technically means you don't meet standards, although even just a local AME (senior AMEs can do class 1s, other AMEs are restricted to 2s and 3s) can issue pending review. I SUPPOSE you could just go back to work until your next physical was due and CLAIM you thought that would be OK, but you ought to know better, and they are going to KNOW you should have known better. They won't REFUSE to waiver you if you do that, but they damn sure won't go out of their way to do you any favors if you pi$$ them off either, and that WILL pi$$ them off. And this may well be a lengthier process if they get irritated at you. Besides, the longer you wait before getting the required stuff, the harder it will become to collect it all.

So MY RECOMMENDATION is get a copy of your hospital discharge summary and call up your regional flight surgeon and fax it to him/her after talking to them personally. Depending on just what was done, the regional flight surgeon can talk to OKC and find out precisely what medical info/imaging studies/proof of adequacy of blood pressure control/etc., that you are going to need to satisfy the Federal Air Surgeon. They might even be able to tell you if they think that your senior flight surgeon is up to the job of doing this expeditiously, or if you ought to go to a specialized aeromedical clinic that has done a few of these and knows the requirements and the personalities of the reviewers.

I think your chances of getting a waiver are actually pretty good, but if it's not done right it can take months and months longer than it needs to.

And, yeah, you didn't do anything wrong to cause yourself to have an aneurysm. You having an aneurysm isn't going to pi$$ them off. If they think you aren't taking your condition seriously - like pretending you didn't know they don't want you flying until this is OK'd by them, that won't be the case.
Well, like I said already, not trying to subvert any procedure or process, it would never occur to me to try, because it is not worth it of course. I already have an AME in mind that deals a lot with heart issues for one of the majors and plan on going to him. My doc has not given me the go-ahead yet anyways as far as trying to fly again, but I do understand that I need to get the wheels set in motion here soon. Mostly, I just wanted to get a bit of an idea as to what I might be up against and if my unique condition is more of a hurdle than most.
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Old 07-09-2018, 08:40 PM   #7
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Yea, you do NOT want to fly after a major medical procedure. In 2004 I had a malignant melanoma on top of my head. Luckily it hadn't metastasized. Was cut out in a minor outpatient procedure. Lab said I was good, no more cancer. This happened a month after my Medical. So I went back to flying not thinking anything about it.

Next medical my AME's nurse said I should call AMAS about how to document the cancer. The Doc there called me back and said I had been flying illegally Any cancer is grounding until the FAA looks at everything. I had to stop flying even thou I was healthy, get a bunch of paperwork done, and after about 2 months I got cleared to fly and also got a nastygram from the FAA about following regs in the future.

So they do get a tad sensitive about that stuff.
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Old 07-10-2018, 08:47 AM   #8
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Quote:
Originally Posted by AirBear View Post
Yea, you do NOT want to fly after a major medical procedure. In 2004 I had a malignant melanoma on top of my head. Luckily it hadn't metastasized. Was cut out in a minor outpatient procedure. Lab said I was good, no more cancer. This happened a month after my Medical. So I went back to flying not thinking anything about it.

Next medical my AME's nurse said I should call AMAS about how to document the cancer. The Doc there called me back and said I had been flying illegally Any cancer is grounding until the FAA looks at everything. I had to stop flying even thou I was healthy, get a bunch of paperwork done, and after about 2 months I got cleared to fly and also got a nastygram from the FAA about following regs in the future.

So they do get a tad sensitive about that stuff.
Well, glad to hear that your cancer was so easily removed, that had to be a relief... Yes, I am sure the FAA was less than pleased, but again, how would one know that having had a malignant tumor would be grounding? Maybe that is common knowledge or just plain logical, I don't know... as the answer to my question probably is.

I will say again though, I had no plans of flying. It was just a question to satisfy a curiosity as far as the validity of my medical. (Anyways, my company is aware of what happened; at least my base chief pilot is so, I'm sure he, or somebody at the company, would have questioned any attempt to get back in the cockpit without a new medical, etc...) And to be clear, the question was not can I go fly after open-heart surgery, it was, is my medical still valid....?
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Old 07-10-2018, 06:48 PM   #9
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FAA Home ▸ Licenses & Certificates ▸ Medical Certification
Pilot Medical Certification Questions and Answers
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Am I prohibited from exercising the privileges of my pilot certificate during medical deficiency?
Yes. You are prohibited from acting as pilot-in-command or as a required pilot flight crewmember during any medical deficiency that would be disqualifying or may interfere with the safe operation of an aircraft.
For more information, see 14 CFR �61.53
A simple problem such as a cold, a broken arm, or an abscessed tooth may require nothing more than the appropriate treatment and a little time before you can safely return to the skies. A more complicated problem or the development or change of a chronic illness may necessitate consultation with an AME or the FAA before resuming flying. New medical conditions do not need to be reported to the FAA until you wish to return to flying.
Page last modified: April 16, 2013 7:12:10 AM EDT
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Old 07-10-2018, 08:31 PM   #10
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(Anyways, my company is aware of what happened; at least my base chief pilot is so, I'm sure he, or somebody at the company, would have questioned any attempt to get back in the cockpit without a new medical, etc...) And to be clear, the question was not can I go fly after open-heart surgery, it was, is my medical still valid....?
At least some airline GOMs specify that you need to consult an AME before returning to flying after treatment for cancer or cardiovascular issues.
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