Educate Your Doctors

By Guy D. Baldwin, D.O.

Sport Aviation, April 1999

As an Aviation Medical Examiner I see frequent instances of mistakes made on medical conditions and medications in the aviation community. The most prevalent would be in the Third Class airman and the least in the First Class. First Class airmen mostly fly for a living and are getting more frequent aviation medicals. They are more likely to be thinking about their ability to continue on their flying jobs than a Third Class airman that may only fly occasionally on CAVU days. The most frequent mistake I see is during allergy seasons. Airmen go to their family doctors with the complaints of a runny nose, productive coughs and watery eyes. Most doctors will prescribe antihistamines/decongestants and/or cough suppressors.

Most all the cough preparations and a good number of the antihistamine/decongestants are disqualified due to their side effects of sedation or stimulation. It depends on the amount of Sudafed included in regards to the stimulation. The exceptions are the fairly new non sedating antihistamines like Claritin, Allegra, Hismanal and Zyrtec. Of that group, which are all good, I prescribe Claritin 10 mg or Claritin-D 24 the most. In most severe allergy conditions we use some steroids, not the "Arnold Swartzenegger," i.e. "muscle beach-type," but steroids like Medrol, Kenalog and Decadron. They can be disqualified based on the dose, especially those above 20 mg daily. They cause euphoria. Over the counter nose sprays like 4-Way, Duration and Afrin are not disqualifying, but due to the abuse and their rebound problems should be avoided. The prescription steroid nose sprays like Flonase, Nasonex and others are okay and very useful.

Hypertension or high blood pressure medications are also a common mistake made. The good news is that most of the blood pressure medications used now are okay to fly. However, you are to notify the FAA through the family doctor or "AME" because tests and reports are required. I have more often than not had a repeat airman apply and on Item 17 of the FAA Form list the new blood pressure medication he/she has been on for many months or years, but not on the last application. What we do is to hold the application in my office, accumulate the reports from doctors and lab, including the EKG from the family doctor, and forward all to the FAA. It has been my experience that no enforcement action is done even though it is not per the rules.

Another mistake is when a patient sees his or her doctor about family problems, possibly a failed marriage, sickness or death of a loved one. If faced with that patient myself I would probably want to do some counseling and may prescribe one of the new antidepressant medications in the SSRI group. They include Prozac, Paxil, Effexor, Zoloft, Serzone and others. If it is an airman, we have to weigh the benefit of the medications knowing that you cannot take the above medications and fly. Also, you must be off the medications for ninety days without any problems to regain your medical. There are some instances in that the ninety day wait can be shortened. I also see a group of airmen apply that list medications prescribed by doctors for weight loss. As a rule you cannot fly while on appetite suppressants. The meds in that group also cause euphoria or stimulation.

In the aging population, of which I am in since I'm over 50, my eyesight is less than perfect. When younger I thought I had the eyes of an eagle. What you have here now is one old eagle with bifocals. A common mistake is having the ophthalmologist or optometrist correct one eye for distant vision and the other eye for near vision. In doing that you have now become monocular . . . that is one-eyed. Even though there are one-eyed pilots, to be suddenly monocular can be dangerous on your first landing. Your doctor has caused you to lose your depth perception. It will not bother you in your car, but it will bother you flying.

The answer to the problem is to tell your doctor that you are a pilot and that some medications or conditions may effect your flying. If he is unsure about that, have him call your Aviation Medical Examiner. If that is not possible, the EAA, ALPA and other groups have the information you need.

(Dr. Guy Baldwin, EAA 117693, is a member of the EAA Aeromedical Council. He is a Senior Aviation Medical Examiner with an ATP CFII-MET ratings and regularly flies a Scout on floats and a Bonanza.)