No good deed goes unpunished

[nightsta1ker]

On the 21st of December, in the early hours of the morning, I experienced severe abdominal pain and was hospitalized. The diagnosis: kidney stone. My CT scan revealed multiple retained stones. All of them smaller than 2mm (the one I was passing was 2.5mm). So, I did some research, talked to a few people I know have had this issue, and made the decision to ground myself. I got all the required tests done, a letter from a urologist, and went over it all with my AME, who then submitted it to FAA northwest region. He spoke with the FAA over the phone and they said I was very likely to get my medical back under a special issuance. My AME told me to expect a phone call within the next few days. I waited a week and called the FSDO. I was told that I was looking at a 6 week MINIMUM. My heart caught in my throat. I told her I was job dependent on this. She said it didn't matter, they're buried. I called AOPA. They told me the same thing. Between the sequester and the government shutdown, the FAA is 90 to 120 days behind on medical decisions. They ALSO told me I shouldn't have grounded myself, and that kidney stones are not on the list of conditions a pilot must immediately report. So now I just feel foolish. I tried to do the right thing and shot myself in the foot. Of course I would only have been kicking the can down the road... Come time to renew my medical, I would be right back where I am now.

 

But what about this 90-120 day wait? Ok, I get it. The FAA is buried and it's not their fault. But what about all this sleep apnea crap I keep hearing about? And how the FAA plans to drop the BMI until ALL pilots get tested for it. If they are really that buried, why the heck are they digging for more reasons to put pilots on hold? In the meantime, a growing number of aviators who did the right thing and reported their condition are out of work while they wait for the FAA to get around to their file. No good deed goes unpunished. I am sharing this experience so you all can learn something. Don't call your AME. Don't call the FAA. Call AOPA first. It didn't even occur to me to call then until after it was too late. Don't make my mistake. I am not encouraging anyone not to do the right thing, but talk to someone who wants to help you before you bring the issue up with those who don't want to be liable for your condition.

[palmfish]

I would hope that they are prioritizing the reviews based on need as well as date of submission. It would be a shame that someone who relies on their medical for putting food on the table has to wait in line behind all the doctors and lawyers who recreationally fly their Bonanzas and Mooneys 4X per year.

 

Have you thought about calling your Congressman?

[rodrop]

Sorry that you are going thru this... hang in there.

[ctimrun]

Makes a guy not want to do the right thing. Sorry your going through this. Have you looked into any of the medical solution places that are run by previous FAA directors? I haven't personally but have friends who have had great experiences, faster than AOPA. Might be worth a look. Leftseat dot com is one example. Hope you get it resolved sooner than later!

Edited January 26, 2014 by ctimrun

[avbug]

The FSDO is nearly always the wrong one to call. The FSDO doesn't have the authority to interpret regulation, and the FSDO will know nothing about medical issues. Don't call the FSDO about medical issues.

 

Your best bet when you have a questionable medical issue is to get with an AME who specializes in medical issues, and who helps people get waivers. These AME's have a lot of experience dealing with problems that come up, in helping people through them, and in helping determine what constitutes a grounding issue.

 

I went through the same thing, and had no idea the event would be grounding. I was scheduled to depart for an overseas assignment in Nigeria in the morning. I got hospitalized that night, surgery, and called the Chief Pilot from my hospital bed. His immediate response was to put me on the list of grounded airmen until I produced a statement from an AME returning me to service. Remember, holding a medical certificate is no guarantee of airworthiness; unless one meets all the requirements, one is not considered medically fit, regardless of the expiration date on the medical. At the time, two calls were placed; one to the union aviation medical examiner, and another to my own, both of whom confirmed that the first case of kidney stones wasn't a huge hurdle, but that yes, I was grounded until the FAA received verification that I was stone free (requiring statements from a urologist, and my AME, as well as X-rays and additional testing). Two more surgeries later and three months total, the paperwork was done, and I was back flying.

 

Try myflightsurgeon.com.

 

Don't ground yourself until the AME tells you so. Don't go flying until you've heard that you're good to do so, either.

 

This summer while I preflighted for a fire one morning, another company pilot looked like he was in pain. I helped him sit down, took his pulse, asked him a few questions, watched him vomit several times, and made arrangements to get him to a hospital right away. From his description, I surmised kidney stones, but it's no time to guess, and yes ,the hospital determined he had a blocked ureter with a large kidney stone. He was back flying a week later. In my opinion, I think he took a very big risk doing that (anyone that has experienced a blockage with a kidney stone knows how debilitating the pain can be…not something you want to experience in flight), and could have placed himself in legal jeopardy. It's not my place to tell him what to do, however, and I wasn't about to do so. He's an adult, and should seek the proper counseling and medical support.

[avbug]

But what about this 90-120 day wait? Ok, I get it. The FAA is buried and it's not their fault. But what about all this sleep apnea crap I keep hearing about? And how the FAA plans to drop the BMI until ALL pilots get tested for it. If they are really that buried, why the heck are they digging for more reasons to put pilots on hold?

 

The FAA isn't looking for reasons to put pilots on hold. The "BMI" issue has already been dropped. Old news. There is no sleep apnea crap…that went away, too. It was the same issue as the body mass question, which was related to sleep apnea. The entire issue blossomed, and was gone just as fast, a flash in the pan.

 

If you have sleep apnea, however, it's still a condition which must be addressed for certification.

[Nearly Retired]

I really hate to disagree with my dear friend, Avbug, but in this case he is sorely mistaken - or merely misinformed. The BMI and sleep apnea issues have not "gone away." It's only been shelved temporarily...at least, according to information we get from AOPA.

 

Read this: http://www.aopa.org/News-and-Video/All-News/2013/December/20/FAA-puts-sleep-apnea-policy-on-hold.aspx

 

 

This announcement, however, does not mean the FAA is dropping the issue altogether: The agency reiterated to AOPA that it still has significant concerns about pilots flying with undiagnosed sleep apnea.

 

 

Read between the lines, guys. "Significant concerns?" You can be sure that your next flight physical will include measuring and noting both your BMI and neck size. Neither of these things will be an immediate disqualifier...but it's coming. You can bet FAA Administrator Huerta will find a way to institute the changes "legally" (instead of the way Federal Air Surgeon Tilton tried to sneak it into our flight physicals).

[nightsta1ker]

The FSDO is nearly always the wrong one to call. The FSDO doesn't have the authority to interpret regulation, and the FSDO will know nothing about medical issues. Don't call the FSDO about medical issues.

 

Your best bet when you have a questionable medical issue is to get with an AME who specializes in medical issues, and who helps people get waivers. These AME's have a lot of experience dealing with problems that come up, in helping people through them, and in helping determine what constitutes a grounding issue.

 

I went through the same thing, and had no idea the event would be grounding. I was scheduled to depart for an overseas assignment in Nigeria in the morning. I got hospitalized that night, surgery, and called the Chief Pilot from my hospital bed. His immediate response was to put me on the list of grounded airmen until I produced a statement from an AME returning me to service. Remember, holding a medical certificate is no guarantee of airworthiness; unless one meets all the requirements, one is not considered medically fit, regardless of the expiration date on the medical. At the time, two calls were placed; one to the union aviation medical examiner, and another to my own, both of whom confirmed that the first case of kidney stones wasn't a huge hurdle, but that yes, I was grounded until the FAA received verification that I was stone free (requiring statements from a urologist, and my AME, as well as X-rays and additional testing). Two more surgeries later and three months total, the paperwork was done, and I was back flying.

 

Try myflightsurgeon.com.

 

Don't ground yourself until the AME tells you so.

Good advice all of it. Just to clarify though, I did NOT contact the FAA first. They were the absolute last people to know. I contacted my AME, who's judgment, experience, and professionalism are unquestionably top notch. He told me I was grounded, and what I needed to do to get a decision from the FAA. Unfortunately, if I knew then what I know now, my actions would have been a little different. Hindsight is 20/20. It's definitely going to be a lifestyle change, because I have to take steps to keep these stones from growing. They are small enough that I could pass them and not even know, but if they get bigger... That's why I need the special issuance. Every year I need to get an x-Ray to make sure they are not becoming a problem. However, kidney stones don't form over night. It takes months/years for them to get to a size that can cause blockage. My AME said I am a phone call away from being back in the air. Unfortunately in order for that to happen, they have to get to my file, which is somewhere near the bottom of the pile of second class medicals awaiting a decision.

 

I can certainly understand why it's a big deal to the FAA. What I don't get is why they don't leave the decision to the AME? If they don't trust their AME's to make good decisions about people's airworthiness, they shouldn't have them giving medicals out in the first place. Meanwhile, they are buried in paperwork, much of which could easily be deflected back to AME's that would LOVE to get their patients back in the air, but can't because of all the red tape.

 

Palmfish, I will definitely be writing my representatives in congress about this.

 

Everyone else, thanks for the support.

Edited January 27, 2014 by nightsta1ker

[avbug]

Certain things are within the discretion of the AME to issue a waiver, some things are not.

 

I'm not sure I understand the time line, but it appears that your AME told you that you were grounded, and that it was a call to the FSDO that told you that you shouldn't have been grounded. If that's the case, disregard the FSDO; one might as well be calling Warner Brothers or The Weekly Gazette for answers about medical certification. Go with the AME.

 

It may be that the reason you're needing a special issuance is because you're not free of kidney stones. I spent three months off flight status, doing maintenance inside C-130 wings, until I was able to show free of kidney stones (and get a stent removed from one ureter). I don't have any special issuance now, and no need for further x-rays or exams.

 

I can very well understand why the FAA insists on being free of kidney stones, having been through the process. I've experienced some real pain in my life, but nothing like the kidney stones. I'd hate to have been in Lagos or Abuja when that happened, and I'd especially have hated to seek treatment in those places. I'm glad it happened when it did; it may have saved my life. Happening in a third world rathole or in the cockpit might have cost me my life, as well as others. It's very serious stuff.

 

There is a lot that can be done to prevent kidney stones, mostly notably drinking a lot of water, and cutting down on certain foods known to contribute to a buildup of kidney stones (dark green vegetables, dark soft drinks (colas, etc), nuts, and other contributing foods. There are also treatments for the stones (surgery, ultrasonic lithotripsy, etc). If you can be shown to be stone free, it should eliminate recurring exams, x-rays, etc.

Edited January 27, 2014 by avbug

[Wally]

The kidney stone thing must be a common issue. I know lots of pilots who've hit that speed bump.

Sleep apnea? Somebody got a gold star/smiley face for putting some numbers down to "address" that issue. Meanwhile there is absolutely no oversight in day/night shift scheduling...

[nightsta1ker]

Timeline: passed stone. Did some research online. Called AME. AME confirmed what I had found online. Went to urologist. Got several tests done. Got letter from urologist on my condition and chances of incapacitation from retained stones. Brought packet to my AME. AME called FSDO, who told him that I should be good to go under a special issuance. Packet was faxed to FSDO. I was told to wait a week and then call to check if I hadn't heard anything. I waited a week and called. I was told by FSDO I would be waiting at LEAST 6 weeks and probably more. I called AOPA, who told me I did not have to ground myself, and could have avoided this whole mess, but that it's too late to fix it and I will have to wait. I post my experience on here. Hope that clears things up.

[pilot#476398]

I called AOPA, who told me I did not have to ground myself, and could have avoided this whole mess, but that it's too late to fix it and I will have to wait.

 

So, if I may ask, what should you have done?

[nightsta1ker]

Avbug is absolutely right that the RIGHTEST thing to do was to contact my AME, which I did. However, there are other paths I could have taken that would have kept me in the air and still been legal and safe. I certainly wasn't going to fly until I knew that my retained stones were not going to be an issue. Once I found that out, I started regretting taking the path I had taken. I should have waited to contact my AME. A pilot can ground themselves under 61.23, and they can also start flying again when they feel their condition is improved, unless the condition requires immediate reporting to the FAA, which apparently kidney stones do not. Once I told my AME, he was then on the hook for anything he said to me, so of course he was going to tell me I couldn't fly. Legally, though, I could have kept flying and reported it on my next flight physical. Here is the list of items that the FAA considers disqualifying:

(1) Coronary heart disease (2) Angina (3) Myocardial infarction (4) Heart replacement (5) Cardiac valve replacement (6) Permanent cardiac pacemakers
(7) Diabetes (8) Psychosis (9) Bipolar disorder
(10) Severe personality disorder (11) Substance dependence or abuse
(12) Epilepsy (13) Disturbance of consciousness (without satisfactory explanation)
(14) Transient loss of nervous system function

As you can see, kidney stones are not on the list. However, once you report your condition, you must either be stone free, or receive a special issuance in order to get your medical back.

Edited January 27, 2014 by nightsta1ker

[pilot#476398]

So then for anything not on that list you just basically call in sick to work until you feel better, then report it next time you renew your medical (at which time you may have to start the process of getting a special issuance)?

Edited January 27, 2014 by pilot#476398

[aeroscout]

nightsta1ker, I am glad you are still a forum member, and are active on the forum. You are a valuable asset here. I sure hope this event in your flying life gets resolved for the best in the shortest time.

It sucks when your livelihood is put in jeopardy. I know for me, it's not only my livelihood, it's a major source of satisfaction and enjoyment in my life, and I sense the same is true for yours.

Get well soon !

[nightsta1ker]

So then for anything not on that list you just basically call in sick to work until you feel better, then report it next time you renew your medical (at which time you may have to start the process of getting a special issuance)?

Legally, yes, is that the smart thing to do with every situation, probably not. My advice? Tread carefully, and talk to people who actually want to help you before you go and report yourself to your AME and or the FAA. I didn't know what all my options were until it was too late.

Edited January 27, 2014 by nightsta1ker

[avbug]

AME called FSDO, who told him that I should be good to go under a special issuance. Packet was faxed to FSDO. I was told to wait a week and then call to check if I hadn't heard anything. I waited a week and called. I was told by FSDO I would be waiting at LEAST 6 weeks and probably more.

 

 

I've never heard of an AME working under a FSDO or reporting to one. AME's are under the Aeromedical program in Oklahoma City, and their communications go directly there. The FSDO has nothing to do with medical certification. Something isn't right in that process; there's either some misinformation, or someone directed you to the wrong place, or there's some misunderstanding.

 

An AME isn't obligated to ground you or to counsel you that you're grounded, but if you have something reportable to an AME that causes you to be grounded, you do need to understand that you're medically grounded whether you report it or not.

 

Also be aware that the items on the list you provided are a fraction of what can ground you. That is by no means a comprehensive list of what's grounding. An over the counter medication can ground you, as can numerous physiological or psychological conditions.

[nightsta1ker]

Renton FSDO is also headquarters for the Northwest Region. They also process medical certification.

[pilot#476398]

Is it safe to say that dealing with real life medical issues (who and when to contact with what) is something that we need to spend a little more time on in school?

 

All we ever went over was the differences between the classes of medical certs and the symtoms of hypoxia/hyperventilation! I know not to fly when I feel like sh*t, or while on certain types of meds, but I really have no idea what to do with sh*t like kidney stones and such!?

 

...or maybe its just me?

Edited January 28, 2014 by pilot#476398

[nightsta1ker]

I highly recommend you read 14 CFR 61.53

[iChris]

There are five (5) medical conditions that an aviation medical examiner may issue an airman a medical certificate at the time of the examination:

 

1. Hypertension

 

2. Diabetes mellitus (controlled by diet)

 

3. Kidney stone (formation of calculi known as lithiasis)

 

4. Duodenal ulcer

 

5. Asthma

 

If the airman provides the AME with the proper medical reports (submit current metabolic evaluation and status report) and this is a single episode and no residual or retained calculi (Kidney stone) the medical certificate can be issued at the AME level.

 

Before you rush out and ground yourself over §61.53 (prohibition on operations during medical deficiency) take a look at §67.213 (general medical condition). Those are the general medical standards for a second-class airman medical certificate that you must maintain.

 

 

Question - A 30-y/o first-class airman is a flight instructor for a company that specializes in upset recovery training. He had passed a kidney stone three months ago after being seen in a local emergency room. He had a complete workup at the time. He had never passed a kidney stone before, but when he was admitted to the ER, he was writhing in pain, necessitating an intravenous injection of morphine sulfate.

 

He was given a urine strainer and hydrocodone for analgesia; that evening, he passed a small stone. An X-ray performed in the ER revealed a stone in the distal LT ureter with some hydronephrosis. There were no other stones observed, and his serum calcium and uric acid studies were negative. The stone analysis was calcium oxalate.

 

The airman took the emergency room paperwork and laboratory results to his AME when he went for his FAA examination. The AME told him that he could not issue for this situation, but the airman, being a detail person, had gone into the Aircraft Owners and Pilots Association’s Web site, where he learned that if he provided a medical history showing that there were no other “retained kidney stones” and confirming that this was his first such event, he could be issued by his AME.

 

When he showed the AME information that he had printed from the Web site, the AME issued him an unrestricted medical certificate. Was this a correct decision?

 

Answer. This AME was also correct; a solitary kidney stone that has passed, and with proof that there are no retained stones, can be issued by the AME—as long as the airman provides the proper documentation.

 

REF: Certification Update, The Federal Air Surgeon's Medical Bulletin Vol. 46, No. 3

 

Edited January 28, 2014 by iChris

[nightsta1ker]

Yes, I am aware of all of that iChris, but thanks for posting. My issue is that I have retained stones. The FAA policy on retained stones is that they cannot be larger than 4mm. Mine are 1.6mm and 1.4mm respectively, so I should be good to go... as soon as they get around to processing my special issuance.

 

In the meantime, my medical is still technically good on the FAA website. But because I grounded myself under 61.53, and because I still have a disqualifying condition that requires a special issuance, I can't fly until I get the go ahead from the FAA. After reading some more and talking with my AME again today, I feel like I am doing the right thing. It just sucks that it is going to take so long to get my special issuance. And there is always the off chance that after 90 days, they get to my file, and decide that they want more tests done, etc. Then I would need to get back in line.... So there is a lingering possibility I may be out for as long as 6 months before I can cut through all this red tape.

[pilot#476398]

Any chance they'd still let you fly under a 3rd class while you wait?

[avbug]

Nightstalker,

 

You may be able to present your situation to the employer along with a letter from your AME, to show that your availability isn't in question, and that all you have is a temporary delay on the part of the FAA. It may be that you can fill other duties pending a return to medical airworthiness; it's worth pursuing if it means not losing the job.

[nightsta1ker]

Avbug,

 

Fortunately my employer has been very understanding, and I wear multiple hats within the company enabling me to keep relatively busy. 3-4 months is a long time though. A lot can happen in 3-4 months. All I can do is make myself useful and tough it out.