I am hoping to start a serious conversation about the risks and issues around renewal of Pilot Medical Certificates, which is perhaps especially pertinent for us (slightly) older pilots.
In recent articles in the AOPA magazine in the US there have been several references to pilots who have been reluctant to seek or obtain treatment for some medications for fear of how their AME and regulator might (over)react. For example in certain cases I understand that questions about cardiac health can require the pilot to 1) be grounded, 2) undergo a series of gruelling examinations by specialists, 3) assemble a substantial medical dossier, 4) submit this to the FAA for review. This process can leave the pilot on the ground for many months, worsened by the current 120 day processing time at the FAA.
In my case – I am a 65 yo male, have both FAA and CAA (UK) PPL with IR licenses and second class medicals. I have passed all my medicals over the years without any concerns, but usually with the admonition to “make sure I don’t put on weight and maybe lose a few pounds”. My blood pressure is acceptable, but is at the upper end of the acceptable range, and my cholesterol and lipid numbers are at the upper end of the acceptable range, but not beyond. I suspect this lumps me with the majority of male pilots of my age.
During and following the whole covid pandemic my wife and I have been very diligent about fitness and eating habits. Moderate and or vigorous sustained exercise 5 to 7 times a week, lean protein only, only salad for dinner, cut way back on alcohol etc. This has led to a bit of weight loss for me and improved fitness. The BP and lipid levels are down a bit, but still towards the upper limits.
My wife, who is incredibly fit and lean, has suffered from bouts of very high BP this last 9 months and our doctor and now her cardio believe this is a common after effect of the covid we had last year combined with some stressful stuff in her family. Our doctor has succeeded in getting her to start a mild blood pressure medication.
Our regular doctor also has been telling me for years that in her opinion EVERY male in the UK over the age of 60 should take statins and blood pressure medication, and she wants me to do this as well obviously, as a preventative measure.
SO – QUESTION: If I tell my AME that my doctor wants me to take statins etc is this going to lead to him requiring me to do a full “cardiac evaluation”? Does anyone know what symptoms trigger such a process? Is there a formal FAA/CAA/NAA definition of cardiac disease? Or will my AME take a reasonable approach and simply say, sure, it’s a good preventative measure, go ahead.
Buckerfan wrote:
Our regular doctor also has been telling me for years that in her opinion EVERY male in the UK over the age of 60 should take statins and blood pressure medication, and she wants me to do this as well obviously, as a preventative measure.
Only tangential to your question, but if my doc told me something like that despite me having no risk factors, that would be the last conversation with said doc, on my way out the door.
More to the point, I think in general it’s a good idea to have a solid firewall between your regular doctor(s) and your AME. This does not mean you shouldn’t be truthful in your disclosures about medical visits and conditions, but IMHO the AME sees you in the rather narrowly defined context of whatever the relevant authority has defined and one should keep that in mind.
To phrase it perhaps more succinctly: never answer a question you haven’t been asked.
When I retired and moved house, my new doctor recommended statins as I was older then 45. I had no health problems and declined. Almost 17 years later, I’ve still never taken a statin, and am very satisfied with the medical practice.
I’m now on a UK PMD, as my HbA1c was too high for a Class2 13 months ago, and take Metformin. Approaching 82 age.
(If I see that doctor, he still occasionally suggests statins. I decline.)
Buckerfan wrote:
Is there a formal FAA/CAA/NAA definition of cardiac disease
I don’t know about FAA, but EASA defines that extensively. See for example here. On page 56 you’ll find that a BP >160 mmHg treated or untreated would qualify as unfit for class 1. For class 2 it doesn’t say – I guess up to the AME to decide. I’m not aware of specific cholesterol targets that would disqualify someone but high cholesterol would certainly be considered a risk factor leading to perhaps more scrutiny or additional exams.
172driver wrote:
To phrase it perhaps more succinctly: never answer a question you haven’t been asked.
100% agree. But normal cholesterol with pills is better than high cholesterol without pills. For your health and your chances of renewing your medical.
To phrase it perhaps more succinctly: never answer a question you haven’t been asked.
Exactly right.
Conversations and so on between you and your real physician are irrelevant to your AME exam unless they directly relate to a question asked on the application, i.e. have you had any heart trouble ever in your life. That means a written diagnosis of a cardiovascular illness by a medical doctor. Or for example if you are actually, now, on some medication that is listed as relevant for flight physical status.
The blood pressure limits for a medical BTW are obviously very high at 160 mmHg, much too high for good health… because they aren’t concerned with your overall health, they are concerned with your likelihood of incapacitation while flying in the validity period of the medical certification.
How would your AME know your cholesterol levels?
Buckerfan wrote:
My blood pressure is acceptable, but is at the upper end of the acceptable range
Acceptable for flying or acceptable in general? High cholesterol and high BP is indication of a rather unhealthy life style. Way too little exercise, way too much unhealthy food and drinks. My neighbor almost died (literally) due to such a “condition”. Walking the stairs gradually became harder and harder, until one day he simply collapsed. He was sent to the hospital, and almost died on the way there. It leads to some kind of diabetes condition after some years (according to him). With a (prescribed) diet and some regular exercise (just walks) he was a new man in no time.
Buckerfan wrote:
Our regular doctor also has been telling me for years that in her opinion EVERY male in the UK over the age of 60 should take statins and blood pressure medication, and she wants me to do this as well obviously, as a preventative measure.
You would have a very hard time finding a doctor in Norway saying such things about ordinary life style conditions. (As this usually is. It may not be that in your case though).
There seems to be a lot of controversy about both statins and cholesterol. Also, about what you should eat to help with “high” cholesterol. Seems there are two different types of “bad” cholesterol, and if you don’t test properly, you might start solving a problem that’s not there. I find it amazing in one of the most information-rich societies that has ever existed we still struggle to find clear answers to fundamental health questions. There are known things we should avoid, like sugar, and highly processed foods. Much beyond that, lots of confusing information.
Buckerfan wrote:
Our regular doctor also has been telling me for years that in her opinion EVERY male in the UK over the age of 60 should take statins and blood pressure medication, and she wants me to do this as well obviously, as a preventative measure.
And that is why the world is in the state it is in. 3 questions you must ask your doctor. Please, my advice is do not medicate until it is a last resort.
This video by Sanjay Gupta will explain the BP.
Life style changes, subtle changes will assist you on cholesterol. Keep away from processed foods, 20 minute walk each day, sleep, hydrate.
Remember there is a difference between the US and Europe.
In the US, the AME is working for you. He can legally advise you on disclosure requirements. Accordingly, many US AMEs are working as consultants.
In Europe he is working for the CAA and is an agent of the CAA and is required to disclose every word to them. There is no “off the record” conversation option. Of course there might be in reality but he is then acting illegally. I have this from an EASA AME. This is why no European AME, of the many on EuroGA, participates here – he’s required to report everything to his CAA. And of course the CAAs read EuroGA anyway, every day 
The UK NHS is currently on a campaign to dish out statins to everybody over some age and there is talk of doing this to everyone over 16! That is crazy, but like many other countries we have an obesity epidemic which directly drives diabetes which together with vascular dementia, obesity related cancers (most are), etc, is accountable, directly or indirectly, for about half the NHS workload, and the NHS costs around 5k per taxpayer annually. So we get these “public policy” drives – about as smart as the UK CAA “bust-them-all” infringements policy It is politically impossible to tackle obesity directly.
The most common statin, Atorvastatin, is dirt cheap – almost as cheap as the packaging. But all statins do muscle damage and most people get pains, especially upper legs. That’s on the dose which a GP is likely to chuck you on to start with. If you complain about the pain, he will reduce the dose. Rosuvastatin is generally much better but used to be too expensive to get on the NHS, and most people, having been fed the “free NHS” story since 1947, won’t pay even if they can Now it is free. The dose is about 1/4 for the same LDL etc result.
Best thing is to eat healthy, cut out as much meat and dairy as you can, lose weight, and then you don’t need to eat chemicals Also get your T4 and TSH checked; there is an epidemic of hypothyroidism (possibly environmental exposure to something) and that drives cholesterol way up. It is easy and safe to fix with thyroxine.
Thank you everyone for the very insightful responses. I am doing sone more research and will come back with my thoughts.
