Summer Flying

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Now that summer flying weather is here, long cross country trips might be on your horizon—even if it is on an airline.  DVTs or deep venous thrombosis are one of the unfortunate risk factors for long air travel and should be taken seriously.

DVTs are promoted by sitting for long periods of time, dehydration, injury to the legs (even small bruises), varicose veins and inactivity.  They can be prevented by keeping hydrated (and not drinking alcohol if on an airliner), doing isometric exercises in your airplane (or walking around the cabin on big iron), wearing support socks and exercise before flights (like walking or elliptical machines).

Although the jury is still out on aspirin, I think it is a good preventive medication and I personally take it for long trips.

When using your own aircraft for a long cross country flight, remember that an extra stop or two can make all the difference in DVT prevention.  Walking around during refueling or even from the airplane to the restroom will not only reduce your DVT risk, but make everyone on board more comfortable.

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Dr. Brent Blue on AOPA Live – April 24, 2014

See Dr. Brent Blue on AOPA live discussing third class medical certificates.

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Hypoxia

The 2014 flying season is starting up with the opening of Sun ‘n Fun which means it is time to think about what makes our flying safer.

Hypoxia (low oxygen levels) continues to be a problem for pilots even at altitudes below the 12,500 foot MSL FAA requirement.  Many pilots, especially those with any underlying heart or pulmonary disease, who are obese, and even those who have had LASIK surgery, need oxygen below FAA mandated altitudes and there are simple ways to prove this to yourself.

My favorite example is to fly at night at 8,000 feet MSL or so for 30 minutes.  Look at the lights around you.  Then turn on some oxygen.  Two liters per minutes should do.  You will see the lights become brighter just like they were on a rheostat!

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The same is true for our brains. After a long flight, even in a pressurized aircraft, our brains do not function as well be subjected to “relative hypoxia.”  That is hypoxia that would not be clinically significant in a hospital setting but might make our thinking process or our reflexes not as good as they could be.  Unfortunately, increased age tends to make this effect more pronounced.

Have you had LASIK surgery?  Have you ever noticed that after a long flight, your vision does not seem to be quite 20/20?  This is due to the hypoxic effect directly on the cornea.  Unfortunately, this will not be improved with oxygen unless the mask covers your eyes as well.

Those big stomachs also get in the way of our breathing, especially when we are in a sitting position.  Thus, hypoventilation or not taking a deep breath can increase our susceptibility to hypoxia at lower altitudes.  Obviously, anyone with a history of heart or lung disease will have a lower tolerance to low ambient oxygen levels as well.

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Oxygen is cheap and usually readily obtainable.  Portable tanks can be filled at most gas or medical supply houses.  (I will provide a free prescription if some yahoo requires it to fill a tank.  Just email me at Aeromedix.com.)  Unfortunately, only an A&P is supposed to fill a built in aircraft oxygen system but many choose to ignore this.

Also, oxygen is oxygen.  It all comes from liquid sources now and there is absolutely no difference between medical oxygen and aviator’s oxygen.  Without getting into a long explanation of why, just believe me on this.  Oxygen is oxygen and it is all the same from an inhalation point of view so buy where ever you can find it.

The best way to know for sure what your oxygen level is by using a pulse oximeter.  These inexpensive fingertip devices show the percentage of oxygen in your blood stream.  The normal range for people who live at or near sea level is 95-100%.  For people who live at 6,000’ MSL, it is 90 to 95%.  My general recommendation for oxygen use is a person “should” use oxygen when their saturation drops by 5% from their home airport saturation and they “must” use oxygen if it drops by 10 percentage points.  When starting the oxygen, the pilot should titrate the flow of oxygen to raise their saturation back to their home airport baseline saturation.

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Remember that there is one thing that will “fool” a pulse oximeter and artificially raise your oxygen saturation reading—carbon monoxide.  Carbon monoxide can leak into the cabin through cracks in the firewall, wheel wells, door seals, and even the tail cone.  I recommend everyone carry a low level digital carbon monoxide detector.

Dr. Brent Blue is a Senior Aviation Medical Examiner based in Jackson Hole, Wyoming.  He can be reached at brent.blue@aeromedix.com.

 

 

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The ReliefBand® is back!

Motion Sickness 3 Image CollageThe ReliefBand® is back!  Available to consumers without the need for a prescription and at a new low price, the ReliefBand® Voyager is an FDA cleared nerve stimulation medical device that treats and relieves motion-sickness. It is safe, drug-free, highly effective and clinically proven solution without side effects associated with medication. Voyager PackageThe ReliefBand® Voyager does not cause drowsiness, interact with medications, interfere with alcoholic beverages or cause drug-like side effects.

Because it produces no side effects, the ReliefBand® Voyager is fully FAA-legal for pilot use, and is ideal for student pilots and aerobatic pilots who need relief from motion sickness as well as passengers.

Aeromedix only offers products that have been tested and approved by Dr. Brent Blue, a FAA Senior Aviation Medical Examiner and Board Certified physician.  If Aeromedix sells it, it works!

Features and Components 4The Reletex was released in 2011, replacing the original ReliefBand®. Many customers have asked what the difference is between the Reletex and the ReliefBand® Voyager.  The Reletex is a prescription only. The ReliefBand® is an over the counter (OTC) version of the Reletex. The ReliefBand’s® maximum output of 35mA is slightly less than the 40ma of the Reletex. The ReliefBand® will last up to 60 days (based on usage of the device for 2 hours at power level 3 or below). As with the Reletex, the battery life depends on the individual usage of the device. Unfortunately, The ReliefBand Voyager® does not have replaceable batteries, a popular feature of the first generation of ReliefBand® devices.

Horizontal How to Use Voyager

If you want to know more about the ReliefBand® Voyager or place an order for one, visit the ReliefBand® Voyager product page. As always you can call us as well at 1-888-362-7123.

 

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The FAA’s New Big Brother Approach to Your Health

The FAA’s New Big Brother Approach to Your Health
By Brent Blue MD
Senior AME

The Federal Air Surgeon recently announced that Aviation Medical Examiners would soon be required to screen for obstructive sleep apnea (OSA) on all pilots by measuring neck circumference and calculating body mass index. Anyone who meets the criteria, neck size of 17 inches or over and a BMI of 40 or over, will not be granted a medical until they have been tested by a “sleep specialist” and either do not have OSA or have it adequately treated.

(Federal Air Surgeon’s Medical Bulletin)

Since the FAA does not show any significant number of accidents caused by OSA, what are they thinking? Are they now responsible for the overall health of pilots? If that is true, let us consider some other issues.

Aviation Medical Examiners do not ask, nor does the 8500 application form ask, if the pilot uses tobacco products—the greatest cause of preventable medical disease in the world. In addition, AMEs cannot require cholesterol history, family history, or exercise frequency. When it comes down to longevity, family history is the number one predictor. Number two is tobacco use. Exercise and weight control are tied for three and four.

So a pilot can come into my office for an AME exam, be 50 pounds overweight, be a two pack a day smoker, have parents who died from heart disease in their 40s, have a cholesterol of 300, and never exercises and all I will know about is his weight. And there is no weight limit for pilot medical qualifications!

So let us say this pilot has a neck size over 17 inches and a body mass index (BMI) over 40. (BMI was developed and only supposed to be valid for use with populations of people, not individuals. Use with individuals has been shown not to be valid. Tom Cruise’s BMI is 26 putting him in the “fat” category. LeBron James is 27.5—fat as well!) Now the FAA says that I must delay his medical until he sees a “sleep specialist” and either does not have OSA or is treated successfully. Now in either of these situations, we may have solved his sleep problems and that does lower his risk of high blood pressure and heart disease but he is still a flying time bomb. Other than the OSA, as his AME, I do not know it nor can do much about these other serious risk factor since I have no authority to force an answer and even do anything with just a risk factor.

A “sleep specialist”, usually a pulmonologist or neurologist who are into the high profit sleep centers, will require a full sleep study in their center—usually starting at $2,000 a pop. The frustrating part is most sleep apnea can be screened with a $200 nocturnal pulse oximetry study ordered or administered by your primary care physician. If your oxygen level does not drop when you sleep, it is highly unlikely you have OSA. If the oxygen level does drop, it may indicate a full sleep study in the sleep center.

So now the FAA is taking on sleep apnea as a risk factor even though it is low down the totem pole of risks which pose a hazard to aviation. Where does the FAA decide to stop? General aviation is already in a crisis with the slow economic recovery and the cost of fuel. Are potential pilots now going to have to go through more testing due to risk factors than life insurance companies require? (By the way, I have never had to measure someone’s neck for any life insurance physical in over 30 years. However, some life insurances do rate applicants on the basis of their BMI.) The FAA may be just trying to bury general aviation.

I am liberal Democrat who supports the Affordable Care Act. However, the Civil Aerospace Medical Institute’s (CAMI) Office of Aerospace Medicine job is to make sure that pilots are “safe” and they will not become “suddenly incapacitated” while piloting an aircraft. They are not mandated to make sure pilots are healthy specimens across the board. This is clearly an overreach of the FAA’s purpose utilizing the excuse of promoting aviation safety.

Keeping patients healthy is my job as their primary care physician and I am as aggressive as any doctor. Keeping people healthy is not the FAA’s job.

What is even more disturbing is CAMI cannot keep up with the paperwork for all the current special issuances and other non-routine medicals. With new rules like this, this back log will only increase in an agency whose budget is tight and getting tighter.

Just make sure you are wearing a 16 ½ inch shirt next time you see your AME!

*Dr. Brent Blue is a Senior AME based in Jackson Hole, Wyoming. He introduced pulse oximetry and digital carbon monoxide to general aviation through his company, Aeromedix.com.

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