Syncopal Episode

[rogersinmayfield]

Hello Doctor,

About 6 years ago I had been in a lot of pain from a shoulder injury. I hurt so much I decided to go to the ER to make sure the injury wasn't more severe than I thought it was. While I was there I explained to the ER doctor what had been happening. I explained that I had injured my shoulder playing with my daughter and that I had been sick with some sort of cold virus over the past few weeks. The doctor decided to give me a shot with a muscle relaxer. As I was waiting for the nurse to give me the shot I felt myself get light headed and I felt like I was going to pass out. As I did I lurched backwards to keep me from falling off the bed that I was sitting on. The ER doctor thought that I was posturing as if with a seizure. I was out only seconds. I was aware of everything going on around me as soon as I regained consciousness, in fact I heard my wife crying and insisted on the medical staff seeing to her before me. I spent the night in the hospital with no further symptoms beside the original pain I was in from the shoulder injury. I was released the next morning to go home with an appointment to see a neurologist. The neurologist ordered an MRI of my brain. The MRI was normal with no cause for concern. The neurologist stated that he saw nothing concerning and that I was normal. Since then I have had two EKG's at my cardiologist and an aortic ultrasound as my routine check up. My question is I am applying for a 3rd class medical for my Private Pilots License. Before I risk never being able to fly again will I be denied or do you think this is a sufficient explanation and could be passed by the AME. I really don't want to be deferred to the FAA if I can keep from it. Thanks in advance.

Dr. Josh Rogers D.D. Ph.D (ABD)

 

[gotWXdagain]

Unfortunately the good doctor retired a couple of years ago or so. AOPA is going to be your best bet to answer your question.

 

[DE727UPS]

I think you could do a consult with an AME and get an opinion/answer without committing yourself to a pass/fail exam. I had something similar happen years ago and my AME was very proactive helping me get past the syncopal episode issue. Then, while have more tests done, I was a tad out on my thyroid numbers and lost my medical for six months waiting for a waiver on the medication I took for that. Later, they changed the acceptable range for thyroid numbers and I didn't need the waiver anymore. I passed out and went through the necessary hoops to retain my medical but was a tad out of the thyroid limit (totally unrelated) and lost my medical...

 

[FlightSurgeon]

Dr. Rogers,

Your history sounds consistent with a vasovagal episode. If you were in my office I would consider your explanation sufficient and run it by the regional flight surgeon with the expectation that I would issue a certificate. It is possible that the FAA could request a more detailed report of the episode and subsequent evaluation, and possibly request Holter monitor testing. See the AME guidance below:

Guide for Aviation Medical Examiners

Aaron Florkowski, MD
AME
www.kansascityame.com

 

[rogersinmayfield]

Dr. Rogers,

Your history sounds consistent with a vasovagal episode. If you were in my office I would consider your explanation sufficient and run it by the regional flight surgeon with the expectation that I would issue a certificate. It is possible that the FAA could request a more detailed report of the episode and subsequent evaluation, and possibly request Holter monitor testing. See the AME guidance below:

Guide for Aviation Medical Examiners

Aaron Florkowski, MD
AME
www.kansascityame.com

Thanks Doctor. Do you think it would be necessary to obtain the records of the event or just explain it to the AME. I’m not sure if the Neurologist I went to is even in practice anymore. All my other medical issues are hypertension but I’m under the care of a cardiologist for that and is under control and I have no issues whatsoever. Secondly I wish we could do an online visit for you to sign off on my medical. I’m not sure the AME’s in this area are a versed as you since I live in a very rural area.

 

[FlightSurgeon]

When you go for your FAA Medical Exam the Examiner has a 2 week window in which to ask for and receive more information prior to submitting it to the FAA for review. Some will use this as a time to gather more data, others will defer to the FAA and let them request documents. I would have your records available (those you can find) so you can produce them if asked within the 2 week window, but if you are not asked don't supply paperwork that wasn't requested. If you were to be deferred I would immediately get in touch with the FAA regional flight surgeon (the Examiner can give you a phone number) and ask them if they would be willing to take a look at the app, they will typically tell you what documents they need.

Don't forget to review the CACI for Hypertension:

https://www.faa.gov/about/office_or...es/aam/ame/guide/media/C-CACIHypertension.pdf

In particular note the first box:

"Treating physician or the AME finds the condition stable on current regimen for at least 7 days and no changes recommended"

You may want to call the Examiner in advance and find out how he/she wants that requirement fulfilled. Having your PCP jot a quick note saying exactly the phrase above with a recent BP reading in the note is best. Another option is to bring in 3 recent BP readings lower than 155/95 that are at least a week old.

Aaron Florkowski, MD
FAA Designated AME
www.kansascityame.com