Medical question

[timpercarpio]

A friend of mine was diagnosed with polycythemia vera which is a rare type of blood cancer where one’s bone marrow produces too much   blood. Too many red blood cells and platelets. This causes the blood to thicken and flow slower, and can lead to clots. It can be treated with low dosage aspirin and phlebotomy, blood letting, as well as some other medications. 
Does anyone know if this will cause a failure of a Class 3 medical exam?

[Andy95W]

https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/exam_tech/item48/amd/blood/

 

So the answer is it depends on severity, and must be approved by the FAA medical office on a case-by-case basis.

[timpercarpio]

Thanks Andy, I’ll pass it on. 

[WaynePierce]

If he already has a Class 3 Medical Certificate, be sure he researches as much as possible before going in to see his AME. If he has his medical now and it gets denied upon renewal he will not be eligible for BasicMed.

If he doesn't have his Cert. now it would still be good to know what his AME is likely to do. Maybe a discussion with Dr. Bruce Chien before he goes forward?

[timpercarpio]

Insurance requires Class 3 medical annually because of age as well as annual flight review. Who is Dr.Bruce Chien and how can he be contacted?

[Nick Pilotte]

http://www.aeromedicaldoc.com/

Dr Bruce is the real deal.  I’ve met him and he doesn’t BS anything.  He is one of the (likely THE BEST) AME for difficult cases. 
 

Had to fix the link. 

Edited September 30, 2020 by Nick Pilotte

[timpercarpio]

Thanks Nick. I’ll look into it. 

[Marauder]

Thanks Nick. I’ll look into it. 

Tim - a lot will depend if they have him on blood thinners and the cause for the clotting. If he is on or will be on Coumadin, they require a stable blood INR test for a period of time.

Most of the challenge with clotting is knowing the cause. Since they know the cause, it should be easier to approve.

If he has to go on a thinner, Xarelto is approved after 2 weeks of showing stability.






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[timpercarpio]

Thanks Chris. I’ll know more after Oct 23rd. That’s when he’ll learn the final diagnosis. The bone marrow biopsy is Oct 23rd. 

[carusoam]

If challenges arise with the Class III...

There are a few options that come after that...

-SI is for special issuance... where your AME works with you To find a viable work around...
 

SODA... where you can demonstrate your abilities... in the event you wash out using the standards... but still can handle the duties... (Statement of Demonstrated Abilities) 

Basic Med... A really convenient way to handle having an alternate route...

Read the AOPA page for acceptable meds... and Meds that are not so acceptable...

There can be good news hidden in these ideas...  
 

Many MSers are using one or more of these options to fly legally...
 

It all starts with a conversation with your AME... finding one with experience with the disease would be helpful...

PP thoughts only, but have some experience with the -SI and basic Med route...

Best regards,

-a-

[M20F-1968]

As a senior AME in the Boston area who works to support pilots through the Special Issuance process, I can state that he needs an AME (best to be local) who can interpret the FAA's requests and put assemble medical records that support his cause.  The decision will be made by the FAA regarding Special Issuance.  They likely will involve an outside specialist to weigh in.  An AME can not change that decision, but an AME can guide the pilot through the process and be an advocate to the pilot by guiding him in assembling a medical file with the necessary documents and/or medical opinions that may give the FAA what they need to approve an application.  The FAA has said many times that it is not their intention to deny airmen.  They look for the information they need to allow issuance.  Beware of AME's or consultants who charge high fees representing that an airman can not get through the process without them.

John Breda

[timpercarpio]

Thank you. I’ve received a lot of good information and will be able to make good decisions. 

[Nick Pilotte]

Tim, I also forgot to say this before and I’m sorry I didn’t. I hope that your friend gets the best treatment available for a good recovery.  Best wishes. 

[MikeOH]

16 hours ago, M20F-1968 said:

As a senior AME in the Boston area who works to support pilots through the Special Issuance process, I can state that he needs an AME (best to be local) who can interpret the FAA's requests and put assemble medical records that support his cause.  The decision will be made by the FAA regarding Special Issuance.  They likely will involve an outside specialist to weigh in.  An AME can not change that decision, but an AME can guide the pilot through the process and be an advocate to the pilot by guiding him in assembling a medical file with the necessary documents and/or medical opinions that may give the FAA what they need to approve an application.  The FAA has said many times that it is not their intention to deny airmen.  They look for the information they need to allow issuance.  Beware of AME's or consultants who charge high fees representing that an airman can not get through the process without them.

John Breda

Excellent post!

Especially, the last warning....I almost got sucked into Pilot Medical Solutions back in 2003 after my liver transplant.  Boy, I dodged a financial bullet NOT using them.  I ended up following AOPA's protocol for kidney transplant and wrote my own letter to OKC along with all the reports.  I gave them everything they needed, first time, and got my SI letter with no back and forth.

While I am NOT recommending this approach, I had a HORRIBLE time finding an AME that would work my case, so went the DIY route.

The OP needs to have his friend get a hold of Bruce Chien.

Finding a suitable AME is NOT an easy task, even in a populated area (I'm in southern California).  Many just want to take the fee for a standard, no trouble, exam

Edited October 3, 2020 by MikeOH

[timpercarpio]

Thank you , Nick and Mike. 

[1980Mooney]

On 10/2/2020 at 4:19 AM, M20F-1968 said:

As a senior AME in the Boston area who works to support pilots through the Special Issuance process, I can state that he needs an AME (best to be local) who can interpret the FAA's requests and put assemble medical records that support his cause.  The decision will be made by the FAA regarding Special Issuance.  They likely will involve an outside specialist to weigh in.  An AME can not change that decision, but an AME can guide the pilot through the process and be an advocate to the pilot by guiding him in assembling a medical file with the necessary documents and/or medical opinions that may give the FAA what they need to approve an application.  The FAA has said many times that it is not their intention to deny airmen.  They look for the information they need to allow issuance.  Beware of AME's or consultants who charge high fees representing that an airman can not get through the process without them.

John Breda

If he winds up going the Special Issuance route, I recommend that he contact the office of the Regional Flight Surgeon.  The FAA Medical Branch has panels and committees of AME's that regularly meet by specialty to discuss conditions, thresholds and potential rehabilitation related to disqualification and recertification.  Ask the Regional Flight Surgeon if there is an AME on a panel specializing in blood cancers that might be nearby who would be willing to work him either directly or with his local AME on his case. 

Special Issuances take a lot of work which many local AME's either are not knowledgeable or not willing to make the effort.  The Regional Flight Surgeon or an AME on one of the FAA Medical committees can help make your local AME knowledgeable on what it will exactly take for approval thereby streamlining the process for all involved.

https://www.faa.gov/licenses_certificates/medical_certification/rfs/aea/

Thirteen years ago I suffered a neurological condition requiring brain surgery.   It automatically disqualified my medical.  I worked with the Southwest Regional Flight Surgeon and a local Neurosurgeon AME that sits on a FAA Medical Branch committee specializing in my condition.  I was able to get a Special Issuance after considerable work.  I continue to see my AME annually and have to provide some paperwork to the FAA annually but it is not a burden.  I remain Instrument Rated in a high performance and complex single and it has not affected the cost or my ability to obtain insurance (I am now age 65).

[carusoam]

Great details shared, 1980!

One recurring challenge I had with my SI...

The amount of time and cost to get new data each year... collect the data and ship to the FAA...

Months of the 12mo cycle literally got lost...

Were you able streamline this better over time..?

Best regards,

-a-

[1980Mooney]

1 hour ago, carusoam said:

Great details shared, 1980!

One recurring challenge I had with my SI...

The amount of time and cost to get new data each year... collect the data and ship to the FAA...

Months of the 12mo cycle literally got lost...

Were you able streamline this better over time..?

Best regards,

-a-

Well one thing I learned is NEVER give them more information than they request.  Read the letters from the FAA very carefully.  Answer strictly to the letter.  For instance if they ask for:

"A current history and clinical examination from your treating physcian... The report should address history and symptoms, diagnosis, treatment plan, etc... Include the results and any current testing deemed appropriate"

That means the treating physician can comment on the results of any current testing that he deemed appropriate.  That does not mean that you should send the results of those tests.  For instance if you had an MRI or CT that does not mean you should send it and it does not mean you should send the radiologists report who read the images.

Don't think you will be helpful if you provide more information than requested.  If you send them then it will lead to more and more questions and time.  If the FAA wants them they will specifically request them or direct your AME to request and review them.

 

[jaylw314]

Assuming polycythemia vera is not caused by something else, the definitive treatment is often--get this--recurring bloodletting.  Doing so should not result in any other required treatment or change in lifestyle (other than stopping smoking, which is a common cause from chronic hypoxia).

Too bad you can't donate the blood, it's against the blood bank rules.

Unfortunately, there are a bunch of other causes of polycythemia, so it's tough to know ahead of time how serious this could be

[M20F-1968]

11 hours ago, 1980Mooney said:

If he winds up going the Special Issuance route, I recommend that he contact the office of the Regional Flight Surgeon.  The FAA Medical Branch has panels and committees of AME's that regularly meet by specialty to discuss conditions, thresholds and potential rehabilitation related to disqualification and recertification.  Ask the Regional Flight Surgeon if there is an AME on a panel specializing in blood cancers that might be nearby who would be willing to work him either directly or with his local AME on his case. 

Special Issuances take a lot of work which many local AME's either are not knowledgeable or not willing to make the effort.  The Regional Flight Surgeon or an AME on one of the FAA Medical committees can help make your local AME knowledgeable on what it will exactly take for approval thereby streamlining the process for all involved.

https://www.faa.gov/licenses_certificates/medical_certification/rfs/aea/

Thirteen years ago I suffered a neurological condition requiring brain surgery.   It automatically disqualified my medical.  I worked with the Southwest Regional Flight Surgeon and a local Neurosurgeon AME that sits on a FAA Medical Branch committee specializing in my condition.  I was able to get a Special Issuance after considerable work.  I continue to see my AME annually and have to provide some paperwork to the FAA annually but it is not a burden.  I remain Instrument Rated in a high performance and complex single and it has not affected the cost or my ability to obtain insurance (I am now age 65).

I am well aware of the process, in fact I was offered a position with the FAA in 2018 to become one of the certification physicians in Oklahoma City, but I was not able to relocate at that time.  I enjoy cases that require some research and work.  Feel free to reach out to me is necessary.

John Breda