Sick of It: Milestones and kidney stones: Flying with a medical condition.

Sick of It: Milestones and kidney stones: Flying with a medical condition.

Sick of It: Milestones and kidney stones: Flying with a medical condition.

What major milestones mark the month of March? The 70th anniversary of Silly Putty and the 75th anniversary of the rubber band, of course. After all, what would childhood be without Silly Putty, and would we have pursued aviation if our balsa airplane had no rubber band? The annual celebration of Women’s Day was on March 8 as was the beginning of Daylight Saving Time. St. Patrick’s Day the 17 and the first day of Spring the 19. And certainly, we’re planning on attending the Sun ‘n Fun fly-in on the 31. These events all reside in the final third of cold-and-flu season and since words like contagion, pandemic, coronavirus and quarantine have been in our vocabulary as of late, let’s talk about flying airplanes while sick. There are a plethora of ailments that disqualify us from acting as a required crewmember, including the kidney stone reference in the subtitle above. We’ll get to that, and other painful tales, in a bit.

The official cold-and-flu season started in late fall (October-ish) and runs about 13 weeks, typically ending by April. This year I was blessed with having no flu, but during a January layover in PVR (Puerto Vallarta), I was infected by a rare international ailment: the painful, virulent and often deadly, Acute Mexican Rhinovirus (AMR). Actually, there’s no such thing; it’s not rare and it’s certainly not deadly. It was just a normal cold, but you know how us guys think we’re dying anytime our nose stuffs up or pain reaches level six. But thanks to oversized eustachian tubes and a slow-to-develop fever, it advanced slowly enough for me to finish the trip and return to the good old U.S.A. If you travel enough, you too will encounter sickness while away from home. For those yet to endure being sick-in-a-hotel with the flu, a cold or food poisoning, here is a list of some travel-related cooties we pilots may encounter:

  • African Tick-Bite Fever (not related to a fellow Michigander’s, Cat Scratch Fever)
  • African Trypanosomiasis (Sleeping Sickness)
  • Avian Flu (Bird Flu)
  • Chagas Disease (American Trypanosomiasis)
  • Chikungunya (from the bite of an infected mosquito)
  • Cholera (from food or water contaminated with bacterium Vibrio cholerae)
  • Dengue (a mosquito-borne viral infection)
  • Diphtheria (a thick covering in the back of the throat)
  • Food Poisoning (enterotoxigenic Escherichia coli: “Montezuma’s revenge” or “Delhi belly”)

Dangerous, Often Disqualifying Diagnosis

I’m not a physician, and I don’t play one on TV, but here is another list – this one of the well-known, and typically disqualifying, medical conditions for intrepid aviators:

Angina pectoris – severe pain in the chest

Bipolar disease – extreme mood swings 

Cardiac valve replacement – transcatheter aortic valve replacement (TAVR) 

Coronary heart disease – that has been symptomatic or clinically significant

Diabetes mellitus – diseases that affect how your body uses blood sugar 

Disturbance of consciousness – i.e., blackout or fainting without explanation

Epilepsy – chronic recurrent, unprovoked seizures 

Heart replacement

Myocardial infarction – a heart attack 

Permanent cardiac pacemaker

Personality disorder – that repeatedly manifested itself by overt acts

Psychosis – thoughts and emotions so impaired that reality is lost

Substance abuse – typically drugs or alcohol

Substance dependence – compulsive drug-seeking (why isn’t nicotine included?)

Mega-Corporation Mentality

Other medical conditions may be temporarily disqualifying, such as acute infections, anemia (lack of healthy red blood cells), kidney stones and peptic ulcer (sores in the lining of the stomach, lower esophagus or small intestine). If you’ve ever wondered if you could fly with a kidney stone, wonder no further. Once in the ureter, the pain will decide for you (see “Kidney Punch,” T &T, November 2012). As a DC-10 Flight Engineer, I awoke on the floor of the pilot restroom in L.A. operations having passed out from the pain of what turned out to be a traveling kidney stone. Imagine if the passengers had seen an in-uniform airline pilot being wheeled-out under critical care. Instead of following the EMT protocol of sporting an O2 ensemble and an IV bag while riding in a wheelchair, I walked through the passenger filled terminal to an ambulance. The stone soon completed its trek, and after the requisite tests the next day to confirm the event was over and there would be none to follow, I flew my next trip the day after the tests. 

Management never thanked me for avoiding national news by avoiding the wheelchair while writhing in agony, nor for my returning to flying duties quickly. Instead, the chief pilot chastised me for waiting until so late to call in sick. This corporate mentality was demonstrated again after my aforementioned Puerto Vallarta, Acute Mexican Rhinovirus event. When talking to crew scheduling after the trip with ears blocked and a fever over 100, I was told to “enjoy my time off.” If you have a supervisor to whom you report when medically disqualifying yourself for flying duties, there may be friction. Make the right decision as PIC about your condition regardless of external pressures from employers, passengers and perceived time commitments. Here are some guidelines to help make that tough call. 

IMSAFE

Illness

o Illness can produce fever impairing judgment, memory, alertness and the ability to make calculations. The safest rule is not to fly while suffering from any illness. 

Medication

o Performance can be degraded by both prescribed and over-the-counter medications. Any medication that depresses the nervous system, such as a sedative, tranquilizer, or antihistamine, can make us more susceptible to hypoxia. The safest rule is not to fly as a crewmember while taking any medication unless approved by the Feds.

Stress

o Stress and fatigue are a hazardous combination. When more than usual issues are encountered, we should consider delaying our flight until these difficulties are resolved. 

Alcohol

o As little as one ounce of liquor, one bottle of beer, or four ounces of wine can impair flying skills. Alcohol also renders us more susceptible to disorientation and hypoxia. We may still be under the influence eight hours after drinking a moderate amount of alcohol. A guideline is to allow at least 12 hours between “bottle
and throttle.”

Fatigue

o Acute fatigue is the tiredness felt after long periods of physical and mental strain, including strenuous muscular effort, immobility, heavy mental workload, strong emotional pressure, monotony and lack of sleep. Acute fatigue is prevented by adequate rest and sleep, as well as regular exercise and proper nutrition.

o Obstructive Sleep Apnea. OSA interrupts normal sleep and is associated with chronic illnesses such as hypertension, heart attack, stroke, obesity and diabetes. If you have a neck size over 17 inches in men or 16 inches in women, or a body mass index greater than 30, you should be evaluated for sleep apnea. A rough estimate of BMI is weight divided by height in inches – then move the decimal point one to the right. Otherwise, a precise calculator can be found online (www.cdc.gov).

Emotion

o The emotions of anger, depression and anxiety not only decrease alertness but also may lead to taking risks. Any pilot who experiences an emotionally upsetting event should not fly until recovered.

Personal Checklist

o We should be conducting preflight checklists on ourselves as well as the airplane. A personal checklist that can be committed to memory, which includes all of the categories of impairment discussed above, is available on the FAA website, www.faa.gov (search “Single-Pilot Crew Resource Management”).

14CFR 61.53

Federal Aviation Regulations prohibit a pilot who possesses a current medical certificate from performing crewmember duties while the pilot has a known medical condition or increase of a known medical condition that would make the pilot unable to meet the standards for the medical certificate.

If you were to have your flight physical today, with a cold, the flu, a broken bone, blurry vision, fatigue, fever, anger or whatever is ailing you, would you pass the physical? This is the question that we’re supposed to ask ourselves before each flight. If the answer is maybe or no, then until we believe that we would pass a physical, we are required to “ground” ourselves by temporarily self-invalidating our medical certificate. My AMR was nothing like a coronavirus (SARS-CoV or MERS-CoV), bird flu, hantavirus, or adenovirus and a kidney stone or broken bone are an easy go-no-go decision. A partially blocked ear, low-grade fever, grumpy tummy, anger, frustration or a sleep deficit are more subjective. Remember the adage that it’s better to be on the ground wishing you were in the air than in the air wishing you were on the ground. It’s not only mechanical issues and the weather that can bring this adage into focus – so can exposure to cooties like the Acute Mexican Rhinovirus.

Listen to an infectious disease podcast at:
https://threatjournal.com/podcast/DrSteveHatfillInterview.mp3

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