October 2005 - American Bonanza Society

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AEROMEDICALQuestion 18c on the medical history parr of Form 8500(the airman medical) asks if the applicant has ever hadany "unconsciousness for any reason." Funher along,question 181 asks about "ep ilepsy, seizures."A recent exam with a new applicant demonstrated that theaverage pilot or pilot-to-be might not really understand thereasoning behind these questions. For instance, I was reviewingthe history pan of Fonn 8500 with a new applicant whohad marked "yes" to the question about hospitalizations. Hehad been hospitalized for about six days 15 years before for afall from his garage roof.Further questioning revealed that he had suffered a headinjury, a skull fracture. He said that his spouse and doctorsrelated that he was talking with them in the hospital. However,he remembered nothing about the fall or hi s subsequent existenceuntil he was aware that someone was washing his faceabout 48 hours after the accident.This man had suffered a serious head trauma and subsequentamnesia of greater than 24 hours. In his case, the accidentwas 15 years distant and he fonunately had suffered nosequalae, i.e. no headaches or seizures.Because this airman 's neurological deficit (amnesia) hadbeen of significant duration, he was required to get an evaluationby a neurologist. He did well on this examination and wewere eventually able to go ahead with an issuance of a thirdclasscenificate.Question 18c asks about loss of consciousness for anyreason. This could include fainting, some kinds of seizure,hean arrhythntia, stroke, medication overdose and many morecauses.In the case illustrated, the applicant was not being purposelydishonest, but he did not consider his loss of memoryas being unconscious, and indeed, his medical records showthat he was talking 10 those at the hospital. But he was notfunctioning properly, as the brain injury he sustained caused aloss of shon-term memory. Definitely, this history was significantand only the other questions about being in the hospitalbrought it to the attention of the AME.So what constitutes being unconscious?According to Taber's Cyclopedia Medical DiCTionary,unconsciousness is, "The state of being insensible or withoutconscious experiences. Unconsciousness physiologicallyoccurs in sleep; pathologically, it may occur temporarily as insyncope (fainting) or be prolonged and vary in depth from stupor(senti-consciousness) to coma (profound unconsciousness).The patient whose unconsciousness is due to a pathologicalprocess is unable 10 swallow, the eyes do not react andhe or she is unaware of surroundings."When the records were reviewed about this ainnan's accident15 years previous, it was apparent that he was unconsciousfor a period after his head trauma. But later he wasreacting to his surroundings; he just did not recall his actions.I had a very good friend who was a well-known aviator.He had suffered a head injury in WWII and 30 years later hestarted having seizures. Most persons think of a seizure as a"fit" where the sufferer thrashes about on the floor, but thisman's seizure manifested itself only by staring into the distancein a trance-like state.He suffered one of these episodes in my presence oneevening after an aviation banquet. We were in a hotel roomand I noted he was just stari ng past me. His eyes were openand he seemed fine other lhan he stopped talking and juststared. I asked him if he was OK and he answered "yes."The episode lasted abo ut three ntinutes and he came backto us. It occurred about II p.m. after a long and busy day. Wewere still talking at I a.m. and my wife was getting prettysleepy. I mentioned to my friend that it was about our bedtime.He asked the time and I told him. He was shocked to find outhow late it was. He said he knew that he had the seizure but hehad no idea that it had lasted so long, and after such "spells"he would experience a son of time warp.At the time this episode occurred, he was taking medicationfor seizures and was no longer flying. He admitted that hethought he probably had suffered the spells for some time,even when he had been fl ying! He thought he was only "gone"for a few seconds. It does not take a lot of imagination to considerthe outcome of one of these spe lls occurring while handflyingan instrument approach.This airman was having a type of seizure or epilepsy.Seizures can involve total loss of consciousness or, as occurredin the hotel room event, a parrial awareness of surroundings(he was aware of my questions, but was not fully alen).A more common cause of temporary loss of consciousnessis fainting. Many persons suffer a "fainting" episodesometime in their lives. Taber's defines faint as "loss of consciousnessdue 10 cerebral anemia or insufficient blood 10 thebrain." Some in the medical profession refer to the faint as a"vagal" episode, referring to over-stimulation from the vagalnerve. The faint often is related to an emotional or visualstimulation.As a medical student, I was watChing a doctor remove aningrown toenail in the emergency room. The patient's toe wasnumb after some injections, but she was still being quite vocalabout the procedure.I was intently watch ing the removal when something hit
me from behind, throwing me across the room into the wall. Iturned to see the patient's boyfriend, a lad of about 220pounds, lying on the floor by the exam table. He had"swooned" and toppled like a big sequoia! He awakenedshortly and was OK after we removed him from the scene ofhis loved one's minor surgery procedure.Pain can cause vagal stimulation and emotional upset(someone fainting at a funeral). If you have suffered any faint ornear-faint, you should discuss it with your AME. Usually, a distantsingle episode that occurred in a situation that would bringon vagal stimulation would not be disqualifying, but the AMEmay need to consult with the Regional Flight Surgeon or AMCD.It should be obvious that conditions that alter olle's abilityto be alert and aware could be a safety factor ill flyillg.Hypoxia and carbon monoxide poisoning are two potentialcauses of unconsciousness that can occur in flying. We havehad exce llent articles about both of these problems in recentABS Magazines.Be cautious of medications that could sedate, such asover-the-counter antihistamines, and always relate to yourdoctor that you are a pilot when he/she is prescribing medicationfor you.Charles S. Davidson, M.O" holds board certification in famity medicine and emergencymediCine. He has been an aviation medical examiner since 1978 andserves as a senior AME. He holds 0 private pilot license with multi.engine andinstrument rating. He is an active pi/of using general aviation for business ondpleasure for 23 years and is a/so an ABS board member. He flies an A36 and is amember of AOPA and EAA.IF YOU HAVE A MEDICAL QUESTION. SEND ITTO:American Bonanza SocietyAttn: Aeromedical NewsPO Box 12888. Wichita. KS 67277Fox: 316-945- 1710 or e-mail to QUESTIONS OF THE MONTHTreadmill testQ. I am coming up on my fifth month since I had a stentput in my heart arrery. When do I get my treadmill test?A. You should wait until a date six months after the insertionof the stent. I have heard of pilots getting the treadmill testbefore that and having to repeat it because the AMCD wants asix-month waiting period after the procedure.Also, you are required to get a routine stress test. It doesnot have to be a thallium test unless your physician requests itor feels it is necessary. Check with your AME if any questions.Colon polypsQ. I recently had a colon scope exam. This was routinebecause of my age. They found two polyps and said they werenot cancerous. How do I report this?A. On Form 8500 you would report it under item l8x. In thespace provided for explanations, you can write down that youhad the colon polyps removed and that they were not cancerous.Also under Section 19 you should answer "yes" and put the dateof the colonoscopy, the doctor's name, address and specialtyand that you saw himlher for a colonoscopy.Asthma concernsQ. I have mild asthma, mainly when I'm around cats andsome houses with mold. I just take an occasional puff on aninhaler before I go to houses that have pets or might be old andhave that musty smell. It asks about asthma on the form.Should I be reporting this?A. Si nce you have what sounds like a mild form of asthma,you should mark item 18f "yes." Explain the symptoms toyour AME and note them in the explanation section. The FAAmay want to see some breathing tests that check the function ofyour lungs, or a report from your doctor that prescribes theinhaler.U you only have to take it preventively and have never hada serious asthma attack, my experience is that your AME wiUprobably be able to certify you. Your AME may want to consultwith the Regional Flight Surgeon or with AMCD. If you getyour certificate, I suggest not flying with cats or in Bonanzasthat have been stored in a barn for several years.Antibiotic usageQ. My doctor is treating me for chronic prostatitis withBactrim, an antibiotic. He says I may have to take this for severalmonths. Is this medication a problem for flying? Is chronicprostatitis disqualifying?A. You should be able to act as PIC while taking theBactrim. As wi th any medication, you should take it for a trialperiod to be sure you do not have any side effects that wouldaffect your piloting skills.Bactrim can sun-sensitize some persons, so be wary oflong sun exposure as you might get a skin reaction. Otherwise,it should not be a problem.You should report the chronic prostatitis at your nextAME exam under item 18 (Medical History) and 19 (Visits toHealth Professional). Chronic prostatitis controUed with justan occasional use of the antibiotic should not be disqualifying.
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October 2005 - American Bonanza Society

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