Hoping to get my medical back. Fatigue and migraines gone. GUIDANCE NEEDED...

[TexasFlyer]

I'll keep this as short and factual as possible. For a decade I struggled with extreme fatigue and headaches which kept me from being reliable due to excessive sick calls. This led to depression and the ultimate denial of my medical about 6 years ago. The denial was specifically for:

1) Mild Sleep Apnea: bogus as retests showed none, but the initial test did show it early on and that stuck.
2) Depression: very true as at that time I knew my airline career was ending; now this is behind me as all stages of denial to anger to depression to acceptance run their course.
3) Idiopathic Hypersomnia or Narcolepsy Type II: this was based on a sleep study and determined this was the source of the fatigue, which at the time seemed to make sense since this was based on the results of a PSG/MSLT (sleep study).
4) Migraines: these are associated with lack of proper sleep and were extreme at the time.

For 6 years I been taking medications of all kind with zero success. So many I could not even begin to list them all. Nothing helped. So I stopped taking all meds for awhile and felt no better, but felt no worse. Earlier this year, I decided I needed to lose the 15 pounds of weight I put on over the last couple years. I went on a keto diet and cut carbs to around 20 grams a day, never more than 40 grams. THEN THIS HAPPENED!!!!

It's been several months and I noticed huge changes! I sleep great. I no longer have the excessive fatigue. The migraines subsided. I feel really good!!!

So now I am a but frustrated and confused. I simply had a carbohydrate issue? That it, really? The result of the diet change is that now I feel fit-to-fly and get my career back. But how do I explain a change in diet has somehow either cured me or made my conditions manageable? How does this even make sense?

Anyone else every experience this? Any AME have guidance here on what to do? I set up a doctor appointment for later this month to talk to the two doctors that diagnosed me years ago (a neurologist and a primary care doctor) about this development. And to see where to go from there. Problem is, they are doctors. They treat the sick, not the healthy! And now I need to show to the FAA I'm healthy and fit for duty. Help... where to begin?

 

[FlightSurgeon]

I'll keep this as short and factual as possible. For a decade I struggled with extreme fatigue and headaches which kept me from being reliable due to excessive sick calls. This led to depression and the ultimate denial of my medical about 6 years ago. The denial was specifically for:

1) Mild Sleep Apnea: bogus as retests showed none, but the initial test did show it early on and that stuck.
2) Depression: very true as at that time I knew my airline career was ending; now this is behind me as all stages of denial to anger to depression to acceptance run their course.
3) Idiopathic Hypersomnia or Narcolepsy Type II: this was based on a sleep study and determined this was the source of the fatigue, which at the time seemed to make sense since this was based on the results of a PSG/MSLT (sleep study).
4) Migraines: these are associated with lack of proper sleep and were extreme at the time.

For 6 years I been taking medications of all kind with zero success. So many I could not even begin to list them all. Nothing helped. So I stopped taking all meds for awhile and felt no better, but felt no worse. Earlier this year, I decided I needed to lose the 15 pounds of weight I put on over the last couple years. I went on a keto diet and cut carbs to around 20 grams a day, never more than 40 grams. THEN THIS HAPPENED!!!!

It's been several months and I noticed huge changes! I sleep great. I no longer have the excessive fatigue. The migraines subsided. I feel really good!!!

So now I am a but frustrated and confused. I simply had a carbohydrate issue? That it, really? The result of the diet change is that now I feel fit-to-fly and get my career back. But how do I explain a change in diet has somehow either cured me or made my conditions manageable? How does this even make sense?

Anyone else every experience this? Any AME have guidance here on what to do? I set up a doctor appointment for later this month to talk to the two doctors that diagnosed me years ago (a neurologist and a primary care doctor) about this development. And to see where to go from there. Problem is, they are doctors. They treat the sick, not the healthy! And now I need to show to the FAA I'm healthy and fit for duty. Help... where to begin?

Hi TexasFlyer,

It looks like the two issues you will need to resolve with the FAA are your sleep disorder (narcolepsy and sleep apnea) and depression. I would start by coordinating a new sleep study. If a sleep doctor can confidently say you no longer have OSA and narcolepsy that will be a good step.

Regarding the depression it really depends on the severity of your previous depression and your medication history. I'd start by collecting any professional evaluations and pharmacy records and I'd create a personal statement that summarizes your history of mood disorder. May consider seeing a psychiatrist and getting a positive progress report as well.

I think with that in hand you could engage with an AME. At that point they will decide whether to get a HIMS AME involved (special AME for depression) or to request more information.

Best Regards,

Aaron Florkowski, MD
FAA designated Senior FAA Medical Examiner
www.kansascityame.com

 

[TexasFlyer]

Hi TexasFlyer,

It looks like the two issues you will need to resolve with the FAA are your sleep disorder (narcolepsy and sleep apnea) and depression. I would start by coordinating a new sleep study. If a sleep doctor can confidently say you no longer have OSA and narcolepsy that will be a good step.

Regarding the depression it really depends on the severity of your previous depression and your medication history. I'd start by collecting any professional evaluations and pharmacy records and I'd create a personal statement that summarizes your history of mood disorder. May consider seeing a psychiatrist and getting a positive progress report as well.

I think with that in hand you could engage with an AME. At that point they will decide whether to get a HIMS AME involved (special AME for depression) or to request more information.

Best Regards,

Aaron Florkowski, MD
FAA designated Senior FAA Medical Examiner
www.kansascityame.com

It will be easy to go back to see the psychologist I seen in 2018 to around 2020-ish for a clean sign off that I no longer have ongoing depression or anxiety issues, as those were brought on from traumatic sudden career loss. So advice will be taken there so I can turn that in to the AME.

Narcolepsy was an early diagnosis. It was changed to Idiopathic Hypersomnia after a second PSG/MSLT. The FAA only seen the first one which a new neurologist did not like the interpretation of after my original doctor passed away. The updated PSG/MSLT showed no narcolepsy, making the results inconclusive. So he said I have Idiopathic Hypersomnia, meaning he has no clue why I was so darn tired all the time!

We will be doing another PSG/MSLT in 2024 so he can interpret again for submission to the FAA. That gives me about another 6 months on this diet to be sure I still have no EDS (excessive daytime sleepiness). If then things look the same, I been told the doctor will conclude my diet has now resolved all Excessive Daytime Sleepiness. And that he actually has no reason to see me further other than for regular checkups to monitor me for any changes.

Here is the only issue he said we may have. It's the Mild Obstructive Sleep Apnea diagnosis. The last PSG/MSLT showed Apnea-Hypopnea Index of 9.9 for Mild OSA. We did try a CPAP and that made things worse! The CPAP completely disrupted my sleep after trying two different machines and 3 different masks. So CPAP was taken off the table. But now it seems diet has resolved this since EDS is no longer an issue.

Last week we did a home finger OSA test before doing the in-patient PSG/MSLT next year to see what we are working with right now. My Apnea-Hypopnea Index came back at 6.8. So still very Mild OSA.

Maybe since EDS is no longer a problem due to diet change and with the OSA being so mild and not having any other issues, we are hopeful the FAA approves the medical since we will have a good history at that point with a solid year of monitoring that EDS is no longer a concern. This assumes I do the medical in May 2024 and my health remains as it is today.

Advice on the OSA part of this?

Thank you.

 

[TexasFlyer]

Update. Took an overnight hospital based PSG for sleep apnea. Says NO SIGNIFICANT SLEEP APNEA. It came back Apnea-Hypopnea Index under 3 for the overnight hospital stay. So that solves that issue. Also, what could have helped, I been on a much better diet. I'm 6'1'' and my weight was 220lbs. I worked hard and now my weight is right at 200lbs. My target is 195lbs which is now easily in sight.

I'll be submitting to the FAA since now it seems with diet (low glycemic index diet) and the side effect from that diet of weight loss, I now have no sleep apnea and my excessive daytime sleepiness has been resolved. And since I am not fighting through fatigue all day, my headaches have also resolved themself. 5 years to figure this out!

Oh, and a test for celiac disease came back negative. That would have offered an explanation of my cutting carbs and glucose solved a long time issue. But the end result is what matters. I have more energy and been feeling great for months now. Time to reconnect with an AME that can present the updated PSG showing no sleep apnea and to show that all my meds have stopped and to show through the most recent doctor visits my excessive daytime sleepiness from what they thought was narcolepsy has resolved itself along with the migraines. That's a lot to go through, but I'm looking forward to getting back into the cockpit once I jump through any hoops the FAA tosses my way.

Any advice since I see this update as very good news? First good news in a long time.

 

[FlightSurgeon]

It sounds like you have a good base to approach an AME to get the application process started. Is it possible your daytime somnolence was due to OSA and now that you have lost some weight and the OSA has resolved your sleep problem has also resolved? You will probably need one of your doctors to attest that the daytime somnolence is no longer an issue.

 

[TexasFlyer]

It sounds like you have a good base to approach an AME to get the application process started. Is it possible your daytime somnolence was due to OSA and now that you have lost some weight and the OSA has resolved your sleep problem has also resolved? You will probably need one of your doctors to attest that the daytime somnolence is no longer an issue.

That is the plan if I can stay medication free and have no sleep issues and no fatigue and no headaches for a few more months. My long time Neurologist, since 2019, and my long time PCP, since 2018, both said they will write a note stating all symptoms have cleared with diet and lifestyle changes.

That'll be taken care of in January 2024 when I see both of them. They need to see a greater than 6 month documented track record of me being on no medications and me remaining productive with no fatigue, sleep, or headache issues. So far, so good on my health.

Once those very specific doctor notes are in hand, I'll make the appointment with an AME. Then will see where things go.

 

[tlove482]

I'll keep this as short and factual as possible. For a decade I struggled with extreme fatigue and headaches which kept me from being reliable due to excessive sick calls. This led to depression and the ultimate denial of my medical about 6 years ago. The denial was specifically for:

1) Mild Sleep Apnea: bogus as retests showed none, but the initial test did show it early on and that stuck.
2) Depression: very true as at that time I knew my airline career was ending; now this is behind me as all stages of denial to anger to depression to acceptance run their course.
3) Idiopathic Hypersomnia or Narcolepsy Type II: this was based on a sleep study and determined this was the source of the fatigue, which at the time seemed to make sense since this was based on the results of a PSG/MSLT (sleep study).
4) Migraines: these are associated with lack of proper sleep and were extreme at the time.

For 6 years I been taking medications of all kind with zero success. So many I could not even begin to list them all. Nothing helped. So I stopped taking all meds for awhile and felt no better, but felt no worse. Earlier this year, I decided I needed to lose the 15 pounds of weight I put on over the last couple years. I went on a keto diet and cut carbs to around 20 grams a day, never more than 40 grams. THEN THIS HAPPENED!!!!

It's been several months and I noticed huge changes! I sleep great. I no longer have the excessive fatigue. The migraines subsided. I feel really good!!!

So now I am a but frustrated and confused. I simply had a carbohydrate issue? That it, really? The result of the diet change is that now I feel fit-to-fly and get my career back. But how do I explain a change in diet has somehow either cured me or made my conditions manageable? How does this even make sense?

Anyone else every experience this? Any AME have guidance here on what to do? I set up a doctor appointment for later this month to talk to the two doctors that diagnosed me years ago (a neurologist and a primary care doctor) about this development. And to see where to go from there. Problem is, they are doctors. They treat the sick, not the healthy! And now I need to show to the FAA I'm healthy and fit for duty. Help... where to begin?

That's great! I'd be interested in seeing if you were diabetic. Have you had an A1C test? 20 grams of carbs is next to nothing. I know that wasn't easy.

 

[TexasFlyer]

That's great! I'd be interested in seeing if you were diabetic. Have you had an A1C test? 20 grams of carbs is next to nothing. I know that wasn't easy.

Not diabetic and no pre-diabetes. No Celiac Disease either. No one seems sure why the carbs lead me to severe headaches and fatigue. But the result of the low carb diet has been life changing. So I quit questioning it and enjoy living again! Now it's just waiting for doctor notes and then the AME and then the FAA/NTSB (or what ever that process shall be to get cleared for a medical again).

 

[TexasFlyer]

1st Class Medical approved. About a 60 day process.

To overcome anxiety and depression from 2018 = went to same PsyD for 4 sessions in 2023/2024 and had him turn in his medical notes stating none of that is no longer an issue and the anxiety and depression was adjustment disorder from illness and career loss in 2018. All solved.

To overcome a diagnosis of Sleep Apnea and Narcolepsy in 2018 = turned in doctor notes stating CPAP was not tolerated so never used after 2019 and tuned in the hospital overnight sleep study result from 2021 stating No Sleep Apnea and No Narcolepsy and turned in a second sleep study from 2024 stating No Sleep Apnea and No Narcolepsy. The tests were the PSG and MSLT.

To overcome prior meds of all kinds and excessive daytime sleepiness (fatigue) and migraines = turned in my Primary Care Doctor Notes from 2023 and 2024 showing no meds of any kind since June 2023 and that his latest doctor note re-iterating I have no health concerns and I been released from his care other than an advised annual wellness check-up. And his conclusion that the fatigue and migraines were caused by diet and my diet change to keto (low-glycemic index) has resolved all health issues.

I did not wait for the FAA to request this info. I did the 1st Class Medical with the AME which he had to deny due to my 2018 Medical DENIAL from Depression, Anxiety, Narcolepsy, Sleep Apnea, and use of unapproved meds at that time when doctors were trying to figure out why I was so tired with headaches. I front loaded the process by mailing to the FAA all those medical records up front along with a 2 page letter I wrote explaining my last 6 years of progress and how "here is substantial medical evidence that I no longer have a disqualifying condition."

That was enough to end up with a 1st Class Medical. Maybe this thread will help someone in the future that was ill and upon being healthy again, needs to know the amount of evidence it may take to show you now qualify.

 

[ppragman]

1st Class Medical approved. About a 60 day process.

To overcome anxiety and depression from 2018 = went to same PsyD for 4 sessions in 2023/2024 and had him turn in his medical notes stating none of that is no longer an issue and the anxiety and depression was adjustment disorder from illness and career loss in 2018. All solved.

To overcome a diagnosis of Sleep Apnea and Narcolepsy in 2018 = turned in doctor notes stating CPAP was not tolerated so never used after 2019 and tuned in the hospital overnight sleep study result from 2021 stating No Sleep Apnea and No Narcolepsy and turned in a second sleep study from 2024 stating No Sleep Apnea and No Narcolepsy. The tests were the PSG and MSLT.

To overcome prior meds of all kinds and excessive daytime sleepiness (fatigue) and migraines = turned in my Primary Care Doctor Notes from 2023 and 2024 showing no meds of any kind since June 2023 and that his latest doctor note re-iterating I have no health concerns and I been released from his care other than an advised annual wellness check-up. And his conclusion that the fatigue and migraines were caused by diet and my diet change to keto (low-glycemic index) has resolved all health issues.

I did not wait for the FAA to request this info. I did the 1st Class Medical with the AME which he had to deny due to my 2018 Medical DENIAL from Depression, Anxiety, Narcolepsy, Sleep Apnea, and use of unapproved meds at that time when doctors were trying to figure out why I was so tired with headaches. I front loaded the process by mailing to the FAA all those medical records up front along with a 2 page letter I wrote explaining my last 6 years of progress and how "here is substantial medical evidence that I no longer have a disqualifying condition."

That was enough to end up with a 1st Class Medical. Maybe this thread will help someone in the future that was ill and upon being healthy again, needs to know the amount of evidence it may take to show you now qualify.

Hey, I just want to say I'm proud of you. I don't know you (or maybe we've met but I doubt it) - but losing my medical from illness was objectively the hardest thing I've ever dealt with, mentally, emotionally, philosophically (crisis of meaning), everything - the works. I got my first class back for about 2 years just before I got sick again and am still down (but recovering). While it is likely that I'll never fly again, I just want to commend you for your persistence and mention how brave it is to talk about here. I hope you make all the money, have all the success, and enjoy your well earned career.

o7

 

[Screaming_Emu]

1st Class Medical approved. About a 60 day process.

To overcome anxiety and depression from 2018 = went to same PsyD for 4 sessions in 2023/2024 and had him turn in his medical notes stating none of that is no longer an issue and the anxiety and depression was adjustment disorder from illness and career loss in 2018. All solved.

To overcome a diagnosis of Sleep Apnea and Narcolepsy in 2018 = turned in doctor notes stating CPAP was not tolerated so never used after 2019 and tuned in the hospital overnight sleep study result from 2021 stating No Sleep Apnea and No Narcolepsy and turned in a second sleep study from 2024 stating No Sleep Apnea and No Narcolepsy. The tests were the PSG and MSLT.

To overcome prior meds of all kinds and excessive daytime sleepiness (fatigue) and migraines = turned in my Primary Care Doctor Notes from 2023 and 2024 showing no meds of any kind since June 2023 and that his latest doctor note re-iterating I have no health concerns and I been released from his care other than an advised annual wellness check-up. And his conclusion that the fatigue and migraines were caused by diet and my diet change to keto (low-glycemic index) has resolved all health issues.

I did not wait for the FAA to request this info. I did the 1st Class Medical with the AME which he had to deny due to my 2018 Medical DENIAL from Depression, Anxiety, Narcolepsy, Sleep Apnea, and use of unapproved meds at that time when doctors were trying to figure out why I was so tired with headaches. I front loaded the process by mailing to the FAA all those medical records up front along with a 2 page letter I wrote explaining my last 6 years of progress and how "here is substantial medical evidence that I no longer have a disqualifying condition."

That was enough to end up with a 1st Class Medical. Maybe this thread will help someone in the future that was ill and upon being healthy again, needs to know the amount of evidence it may take to show you now qualify.

Congrats! Got to be a huge relief.

 

[F9DXER]

Congrats as well. Also to thank you for how you came over it and the steps that were involved. I'm sure it will help someone in the future. Best of luck with the "new" you!