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Almost Failed Medical Exam


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So I went to a new doctor today for my 2nd class medical. Here are the results:

 

An extremely full bladder, plus white coat syndrome, plus a slightly larger arm than average from weight lifting (no brag), plus being rushed around to do the various tests, plus a dusty generic blood pressure machine, led my blood pressure to be 159/82. (/end excuses).

 

Now let me now say, I consistently watch my sodium and sugar intake, don't drink, don't smoke, not overweight, run 3 miles at least 4 times a week and generally am a big proponent of health and nutrition.

 

The doctor walks in and tells me if it's not under 140/xx then he can't approve my medical. I could've sworn 155/95 was the cut off limit, even though I was over that as well, but I didn't question it. I told him that my bladder was on the verge of rupturing (urine test) when the pressure was taken, and that I've done consistent readings over multiple weeks, all of which yielded a systolic of 115-135. He didn't seem to care.

 

Anyway, a nurse came in and retook it and it read in the low 130s, thus allowing him to approve it.

 

Based on this story, did the doctor follow the right protocol? Any ways that some of you have reduced the white coat syndrome and widely fluctuating blood pressure? Should I seek out a new AME? I don't want to feel like my medicals will be a gamble in the future based off a inaccurate reading or temporary high pressure.

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Depending on how the blood pressure was taken, remember that it's subjective. When using a stethoscope, both systolic and diastolic are determined based on when one begins hearing the beat, and when it ends. I guarantee that with my current state of hearing, what I get from taking a blood pressure reading is different than what a younger person with better hearing gets.

 

Did you get plenty of rest prior to your medical visit? Did you drink plenty of fluid prior? Your arm shouldn't have any bearing on the level of the blood pressure reading, regardless of your musculature. Your bladder shouldn't have a lot of bearing, either. Stress raises blood pressure somewhat, but a BP reading is a measure of two things; how hard your heart is working to push blood through your system, and it's status at rest.

 

You didn't indicate your diastolic on the second reading, but only indicated that your systolic had dropped to 115 or so. Was your diastolic still pushing 95?

 

Have you had an EKG lately and a workkup, and stress test (outside of the AME environment)? You might consider that, and discussing it with your doctor.

 

My AME specializes in assisting aviators with waivers and issues, and he will work with people. Not all AME's will do that. If your AME isn't working to help you, you might consider finding another AME. That said, high blood pressure isnn't a laughing matter, and everyone tries to find some other reason for their blood pressure, angina, etc, other than facing facts. It's very easy to say "I'm young, I eat right, I'm healthy..." but the truth is that young healthy people have heart attacks, too. You're not having a heart attack, but don't discount your medical indications simply because you feel you're too young or in too good of shape for them.

 

A second opinion is ALWAYS warranted; seek one on the side, away from the aviation medical system. Then you have more to go on, approach a different AME whom you, or your friends or associates trust.

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Depending on how the blood pressure was taken, remember that it's subjective. When using a stethoscope, both systolic and diastolic are determined based on when one begins hearing the beat, and when it ends. I guarantee that with my current state of hearing, what I get from taking a blood pressure reading is different than what a younger person with better hearing gets.

 

Did you get plenty of rest prior to your medical visit? Did you drink plenty of fluid prior? Your arm shouldn't have any bearing on the level of the blood pressure reading, regardless of your musculature. Your bladder shouldn't have a lot of bearing, either. Stress raises blood pressure somewhat, but a BP reading is a measure of two things; how hard your heart is working to push blood through your system, and it's status at rest.

 

You didn't indicate your diastolic on the second reading, but only indicated that your systolic had dropped to 115 or so. Was your diastolic still pushing 95?

 

Have you had an EKG lately and a workkup, and stress test (outside of the AME environment)? You might consider that, and discussing it with your doctor.

 

My AME specializes in assisting aviators with waivers and issues, and he will work with people. Not all AME's will do that. If your AME isn't working to help you, you might consider finding another AME. That said, high blood pressure isnn't a laughing matter, and everyone tries to find some other reason for their blood pressure, angina, etc, other than facing facts. It's very easy to say "I'm young, I eat right, I'm healthy..." but the truth is that young healthy people have heart attacks, too. You're not having a heart attack, but don't discount your medical indications simply because you feel you're too young or in too good of shape for them.

 

A second opinion is ALWAYS warranted; seek one on the side, away from the aviation medical system. Then you have more to go on, approach a different AME whom you, or your friends or associates trust.

 

I got my normal 8 hours without any interruption and always drink at least 8 large glasses of water a day.

 

I forget what the second measuring was of the diastolic. I know I heard 80s, but not sure what the second digit was.

 

I’ve actually been to a cardiologist before (friend of a friend), as my pressure read high in one of the grocery store pressure monitors and thought I would get it officially checked out. He did an EKG, and all the normal tests, and said I was perfectly fine. He explained to me that blood pressures are recorded on a bell curve, in that the average is 120/80, but there are healthy outliers that are not a cause for concern. He is the one that planted the cuff size being important in my head, and when I googled it, sure enough, using the wrong cuff size can cause inaccurate readings (to what degree, I’m not sure). Anything over a 13” arm requires a “large” cuff size, and the norm is obviously “medium”.

 

I’m right there with you with blood pressure being the silent killer, however the specialists say I’m fine, but I know the AME is just looking for that cut and dry number.

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One of the most important things you can do is to get an AME you trust. Changing to a new one can be traumatic, and I've had to to that a few times. I've had 3 of the die without warning, and the first I knew of it was when I called for an appointment. Every issue I've ever had on a physical has been with a new AME, and I immediately look for a new one if there is any issue. The one I have now is much older than I am, and he left the Army the same year I entered it. I just hope he lasts a few more years. One of the more common topics of conversation among older pilots is about finding an AME. Talk to pilots and find out who they use, and if they're happy with theirs. Your AME should not be your family physician, (s)he should be just for physicals. I look for one who has done it for a long time, knows the ropes, and is just checking to see if you meet the minimum requirements. If I want a complete physical to see if there could possibly anything wrong with me, I'll go to another doctor for that, not my AME. I might get the AME involved if there are issues that need to be cleared up with the FAA, but not otherwise.

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I used to repair medical equipment so I can chime in. Maybe someone in the future armed with this info can save their career.

 

The cuff size matters if the pressure is being taken with a machine since the machine is getting feedback through the pressure in the cuff. It senses the small pressure fluctuations due to the artery pushing in and out on it. A new machine comes with a range of sizes from children to obese people and the reading will be off if the wrong size is used. Nurses then loose the cuffs or patients poop on them and when it comes time to order new ones, not every size gets ordered. So, your doc might not have the right size for you but also might not admit that.

 

The accuracy of the machine is tested to be within 10%. There is also a tiny amount of error allowed in the testing device. Hoses and cuffs leak. Hopefully it is tested once a year.

 

With this in mind, doctors average out several readings over time to get a good idea of what the pressure is. It is well known that digital BP machines are not very accurate. If your doc was relying on one reading from his obsolete device, then scares the hell out of you, and expects a better result next reading with the same machine...then you need a new doctor.

 

The tried and true analog way, called the auscultation method, is much more accurate and consistent. I am talking about when they listen with a stethoscope. If the room is quiet and the pressure in the cuff is let out slowly it is a very good reading. It is the best non-invasive method and the cuff size doesn't matter. Never accept a failure based on anything other than this method and still being averaged out from several readings.

 

Most advances in digital technology actually improve something but in this case the BP readings are worse. The improvement comes from the workload decrease and not paying a nurse to the work. Hospitals use the digital type because they have better things to do and the reading can get fed and recorded onto a central monitor. If someone is really sick they get the pressure directly from the blood.

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