Maintaining Your Personal Airworthiness

 

I earned my private pilot license when I was 17 years old, at a time when I had no health issues or worries. At age 55 I am fortunate that I am still healthy and take no medications, but I have become more aware of how issues such as diabetes and heart disease can be limiting factors for mature pilots and can interrupt or end a flying career. The purpose of this article is to explore the impact of more common medical issues on one's medical certificate and present a plan to help maximize the quantity and quality of a pilot's flying years. Pilots are subjected to periodic medical examinations to ensure they are healthy enough to safely perform pilot duties. The frequency and depth of these examinations depends on the type of certification. For 1st class, 2nd class and 3rd class medical certificates, pilots initiate the medical certification process by completing the first section of FAA Form 8500-9. This form requires the disclosure to the FAA of any current medications (prescription and nonprescription), use of near vision contact lenses, comprehensive medical history, history of arrest and/or conviction for DUI, history of revocation or suspension of driver's license, history of nontraffic convictions (misdemeanors or felonies), and any visits to health professionals in the past 3 years. Applicants must also make arrangements to see in person an FAA Aviation Medical Examiner (AME) to review the self-reported information, and for physical examination. FAA Aviation Medical Examiners are physicians (i.e. MD or DO only) who in addition to their medical and residency training have undergone specific instruction in performing aviation medical examinations from the FAA. The multisystem physical examination includes detailed vision assessment.

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Several medical issues are of interest to the FAA and AME and may potentially disqualify or limit an applicant. Reviewing FAA Form 8500-9 specifically lists several medical conditions, or signs/symptoms that warrant a detailed explanation and consideration. Most of these are at least somewhat self-explanatory, while some are rather vague. A positive response to some is probably a hard-stop for medical certification, while most are areas to be further explored before a decision is made.

Frequent or severe headaches. Headaches are a common symptom probably each of us has experienced at some time, and most people wouldn’t consider occasional headaches disabling. Tension-type and migraines are the types of headaches most people are familiar with but there are over 200 specific headache types according to the current International Headache Society classification (ICHD-3), and some may interfere with safe operation of aircraft. Headaches can be independent syndromes (i.e. primary headaches) or be symptoms of other serious problems. Such headaches are known as secondary and can serve as indicators of increased intracranial pressure, vasculitis, and tumors to name but a few.

Migraine headaches may be of particular concern because they may be associated with a variety of transient neurologic symptoms that may be unsafe. Visual auras are one such common migraine symptom that can obscure or distort vision. One less common syndrome is hemiplegic migraine which causes weakness on one side of the body (much like an acute stroke in severe cases). A person's migraine syndrome is often stable for years, but it’s not rare for new patterns to develop, making migraines somewhat unpredictable.


Dizziness or fainting spell. Most people have at one time experienced dizziness, or perhaps fainted. These symptoms can commonly be precipitated by getting up too quickly from a sitting or recumbent position. In these situations, the dizziness or fainting reflects inadequate cerebral perfusion due to a rapid change in position. When lying down, with your heart and head at essentially the same level, it takes very little pressure to keep blood flowing to the brain. Heart rate and blood pressure reflexively increase when we stand up, but this reflex might be briefly inadequate after rising quickly, leading to inadequate cerebral perfusion and symptoms of dizziness or fainting. While often random, factors that can contribute to this phenomenon include dehydration and blood pressure medications.

One interesting omission from the listed medical history section of FAA Form 8500-9 is vertigo. Vertigo is a sense of motion while stationary, or sense of motion contrary to actual motion, and reflects dysfunction of the vestibular organs in the temporal bones of the skull. Historically some effort has been made to differentiate dizziness and vertigo based on symptoms (i.e. a lightheadedness or “woozy” feeling versus spinning) but for a variety of reasons this doesn't always work. Symptoms self-identified as vertigo should be reported along with dizziness; the omission of vertigo explicitly should not be interpreted to mean it’s not a concern for the AME; in fact, vertigo could put a pilot and their passengers in a dire situation.

 

To be continued...