FAA Medicals: Promise vs Reality

(Cross posted from http://blog.mytransponder.com/?p=308 )
Anyone who has known me for any length of time has likely heard that I’ve struggled over the last ten years with my medical and I have all but stopped flying.

What started with “your snoring is loud” became “you have mild sleep Apnea” which turned into “I can’t give you a medical” and finally a two year process to get my paperwork. I’m not advocating that a diagnosis of Apnea is unfairly classified as a “Disqualifying Condition” nor am I arguing that extra medical precaution is warranted. I firmly believe that sleep conditions need extra hurdles. But two years for mild Apnea? As my grandmother would say: “Something ‘aint right, there.” I’m now to the point that I’m ready to hang up 23 years of flying experience including 17 as a flight instructor.

How did I get here? I should have guessed that I’d have years of trouble ahead when my initial two-year process stalled rather than face the catch 22 of a denial…. and then included the following advise from AOPA’s medical staff :

“withdraw your application. Wait six or seven months. Then apply again with a different AME. Can you travel to another state?”

I kid you not. A six-month hiatus was part of the process. I know that was ten years ago and I did end up getting my paperwork after repeated sleep studies and Maintenance of Wakefulness tests (more on that ridiculous test later). In the end, I got both the medical and “the letter.” Letter? Yup, I got the golden ticket in the form of a Special Issuance with it’s big, bold title: “Six Year Authorization.” It meant I could both fly AND expect less hassle at my next medical…. or so I thought.

The Special Issuance document outlines what I have to do to renew my medical without having to go through all the tests every time. In theory, this letter lets me go an annual meeting with my personal doctor who reviews my situation and writes a letter to the FAA saying I’m ok and am following my treatment. I should be able to take that letter to any AME along with the Special Issuance letter and expect them to fill out the paperwork and hand me a medical certificate at the same time. While I have to do this annually, I don’t need the full FAA medical exam every time. A golden ticket to be sure.

If the process worked that easily, I wouldn’t be writing this blog post. Nor would I be considering hanging up my wings.

At this point, I’m frustrated by the practical process I’ve experienced for ten years and how it differs from what I thought was a documented, easy to follow procedure. I guess I’m frustrated by the large gap between expected procedure and observed practice. That golden ticket promises a medical exam on the schedule we all know. When I was under 40, I need only get a medical exam once every five years as long as I update the FAA annually per the authorization. Now, I should only need a medical exam every other year for my third class medical. How do they enforce an annual update? My medical is marked with a “not valid after…” and a date equating to one year post exam. Yup. It turns a third class medical into an annual requirement.

Annual? Fine. All I need is an update letter from a doctor, right? Wohhhh….. Slow down there. That sounds too easy.

Anyone out there tried to get a “simple” letter from a doctor certifying continued treatment? Doctors don’t like that unless there is data to back it up. How does the average general practitioner know if I’m using my c-pap machine every night? Unless they have special equipment to read the data card in my machine, they refer you out to a specialist. Ever tried to have a specialist sign off on a letter certifying effective treatment? Specialists ask for specialized tests. What are the tests for Apnea? Well, first you do a couple of overnight sleep studies so they can observe your apnea and titrate (adjust) the c-pap machine. In other words, they crank the knob to the right until you have enough pressure to keep you breathing without obstruction. I’ve done this test twice and I should do it again to see if I still need the same strength. Do I need it for the FAA? Not any more.

Now that I have an apnea diagnosis, specialists and the FAA want to see an occasional Maintenance of Wakefulness test (or MWT). What is an MWT and why don’t I just get one every year? The idea of the test is to see if you can stay awake all day, even when you lack sensory stimulation. My last MWT went like this… could you pass it?

  1. wake up at 5:45, have breakfast, get ready, and drive to the hospital affiliated with the sleep lab. Oh, and no caffeine in the morning. Water only.
  2. Arrive at the hospital before 7am to give blood and urine samples to test for caffeine or about ten other stimulants. The hospital lab affiliated with the sleep lab didn’t even have a way to test for some of what the sleep lab asked for. So, it became a $300 blood draw for a special analysis.
  3. Arrive around the corner at the sleep lab by 7am and fill out paperwork without the aid of coffee
  4. Wait 40 min. (why am I here this early?)
  5. Get wired up… get 20+ electrodes attached to your body, mostly your head and face. Oh, expect difficulty if you have a beard and/or thick hair.
  6. Go to and sit in your room and wait. At this point you can watch tv, email, whatever. Still no coffee
  7. At some point, the staff will come in and sit you in a chair and calibrate their night vision cameras to track eye movement. Then they will turn out the lights, close the shade, turn off the TV, etc. so that it’s dark and quiet. It’s now your job to sit in that chair and stay awake. No talking, singing, slapping, shaking your head, etc. Just sit there and not sleep for the 45 min test.
  8. This process happens three times through the day. That is two hours and 15 min of quiet darkness through the day.
  9. go home and have coffee

Mike with many electrodes

Could you pass this test? Really?

My specialist wanted annual MWTs but the FAA didn’t define a timeframe after the initial issuance. Since the FAA doesn’t care, I haven’t done an MWT in at least six years. Why six? Because I haven’t gone to a specialist in at least six years. I refuse to go unless someone tells me I HAVE to go. These days, I write the letter I need my general practitioner to sign and just go talk to him. Mine does a basic, annual physical, puts the letter on his letterhead, and signs it. He doesn’t seem to like the process but it’s what I’ll do until the AME asks for something different. If I do more than that, if I have more tests, it I “try to help” with more information, then I’m offering more data to the AME who could find even more wrong with me. I risk stepping into another invisible pile of poo that could lead to yet another hassle with getting my medical issued.

As you can tell, I understand the process well and all was working routinely until my AME went missing. I went in last fall and started the process by getting the FAA exam completed. I paid. The AME wanted a letter from my doctor with certain verbiage so, as expected, I left without the medical while I visited my GP which, unfortunately, took several weeks to schedule. When I had the letter and reached back out to my AME, he wasn’t answering his phone nor was he returning calls. No information from his office. Then I noticed he wasn’t listed in the FAA’s database. Uh oh. My AME is gone. By the way, if anyone knows Dr. Tesmond, please say hi and wish him well. I just hope he is alive and playing golf somewhere warmer than here in Chicago. In my mind, he decided to stop playing the FAA’s games. I just hope he isn’t dead.

So, I went looking for a new AME. Based on much feedback, I settled on Dr. Ostrom in Elgin IL. I liked that he answered his phone personally and that he only does only FAA exams. “If you go in an office and it isn’t full of airplane pictures, you are in the wrong place.” Great start, but it didn’t last. When I visited, he spend the entire exam bashing my employer who makes “worthless stuff.” This from a man who had World of Warcraft (or something like it) running on his computer on the desk in the exam room. Fine. He is certainly not the first to offer a less than professional opinion of my employer. Besides, his exam was up to the standards and was quick. To each his own. I paid my $100 and again left with no medical. Why? He wanted a change to the verbiage of the letter I brought in. So, I went back to my GP with the change and faxed the results to the AME within 48 hrs. Dr. Ostrom has everything he needs, but now won’t sign it and won’t call me back. Its been almost a month since my visit and I’ve called several times to follow up. Each time I’m met with the realization that the office manager doesn’t have my file and the doctor may well have lost it on his desk. Perhaps it’s under that WoW computer.

So here I am. I have a golden ticket but can’t get a medical. I’m again shopping for an AME… my third in six months. I’ve flown a couple of times as a non-PIC CFI, but I can’t get in the plane myself and I’m on my second hiatus in ten years. I have lots of credit with my club banked up and I’d sure like to use it before it expires and I loose it. I’ll find that new AME and get this done because I’m an optimist and “third time’s the charm.”

If it doesn’t work out this time, I’m hanging up the spurs. Done. No more flying. I’ve had enough of this crap and it’s just not worth it! The mere thought of going through this again makes me wonder why I do it at all. It fills me with frustration and a bit of anger. I’m finally in a place in life I can afford to fly and I can’t even go around the pattern. I’m in a club that I helped found and that I’ve help keep afloat, but I can’t get a simple bit of paper to let me turn the propeller.

I understand that my last round of medical interactions might just be bad luck, but when I look at this as part of the 10 year saga, I just can’t help but think the process is broken. Any process that doesn’t allow the system to work 15% of the time needs review. I’m on my second hiatus… and the FAA’s medical process may make it permanent.

-Mike

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