May 01, 2010

AOPA Australia’s current president, Phillip Reiss, is going through a crisis. Even though he successfully passed his medical at Christmas, his ticker has since decided to give him trouble. This is the first of a planned series of articles, where Phillip will explain what it means to a pilot to lose then regain the right to fly and just how CASA helps or hinders that process.

Stunned disbelief

“How can it be? I have always had low blood pressure and every ECG has come up OK?" These were my initial reactions to receiving the news I had a narrowing of the left anterior descending artery – 90 to 95% stenosis (blockage), I was to be admitted to hospital next day Friday and on Monday would undergo angioplasty where a stent would be inserted.

First let me backtrack to the events the week before which led up to this not so good piece of news. My wife and I had been in Hong Kong, a welcome break after a busy few months. This was to be a shopping trip for my wife, a chance to attend the February sales, and for her to buy an outfit to wear at our daughter’s planned wedding and for me to relax. Relax – not normally how I would describe a shopping trip with any woman. We tramped our way around every shopping mall, designer store and outlet in Hong Kong. And as much as I tried, I could not avoid all of these expeditions. Did she manage to find a suitable outfit? No, but she bought gifts for our daughter and son. Whereas

I, who had no intention of buying anything ended up with a pair of shoes, two tailor made suits and three shirts. During the week, we travelled on the underground rail system with a lot of walking and climbing stairs out of the subway. On the last day while walking up a particularly long flight of steps, I experienced extreme breathlessness and my wife said my face went a deathly white. I told her it was only my reaction to so much shopping.

Later, on our return to Sydney, I experienced the same feeling walking down the concourse from our arrival gate to immigration and this time I could not blame the shopping. That was Sunday. The next morning my wife handed me my phone and insisted I ring our GP. My doctor saw me the same day, checked my blood pressure and gave me an ECG. Both were normal, but he arranged for a cardiologist to check me next day. This involved a stress ECG, and he did not push me beyond my fitness level. He said the ECG was OK, but said he would like me to have a CT scan as well because he had not pushed the stress ECG as far as he would have liked. Three days later, I had the CT scan and received a phone call from the cardiologist asking me to come in and see him the following morning – and that’s when I received the news.

The stent was installed via the femoral artery in my right groin the following Monday. My cardiologist said I had been very lucky I had not had a heart attack. Had I done so, he said, it would likely have been fatal. The good news was there had been no damage to the heart and the prognosis is a full recovery.

The chain of events that led to detecting the problem could have been broken at any time. First was my wife’s insistence that I consulted my GP, then his insistence I consult a cardiologist and finally the cardiologists request that I take the CT scan in spite of the OK stress ECG. Breaking that chain could have had disastrous results for myself, therefore I am grateful for the concern that these three people had for me.

The aftermath

For a pilot whose entire life has revolved around flying both professionally and for pleasure, the realisation that my medical was now invalid became the focus of my attention. Discharged from hospital on the day after my operation, I took a little time to consider my options and to plan a recovery and rehab program.

Basically it involved losing weight, getting plenty of exercise to get fit, and not eating anything that tastes good. I told the dietician that because of the diet I may not actually live any longer but it will certainly seem longer. At least my cardiologist said I am allowed a glass or two of red wine and the occasional scotch. Those are doctors orders, so now I have an excuse.

I had planned to take my aircraft up to Archerfield for it’s annual checkup and several weeks later had planned to fly the Twin Comanche to New Zealand to attend Warbirds over Wanaka and to meet with AOPA NZ colleagues. Getting my aircraft to Archerfield from Sydney was now a problem, but my friends in the International Comanche Society Australian group, came to the rescue.

Roy Sneasby received my initial call for help; Roy has been a good friend over the years, helping to sort out maintenance problems. Roy contacted Ken Holdsworth who re-arranged his timetable at considerable inconvenience to himself, to fly my aircraft to Archerfield and fly it back after the annual. Ken in turn suggested I talk to Dr. Tony Van Der Spek, a DAME who could handle my medical obligations with CASA. Tony is also a Comanche Society member and an AOPA member who I met at Deniliquin attending the Comanche Pilot Proficiency Program.

The New Zealand trip was cancelled. Jeff Muller (fellow AOPA director) and I had planned to fly the Comanche to New Zealand via Lord Howe and Norfolk Islands. But that plan is no longer an option.

Dealing with the Department

Well meaning individuals advised me not to tell CASA what had happened to me. The general view was that because it won’t show up on my medical, CASA would never know. I rejected that advice for several reasons. Primarily, because it is not the professional thing to do. We pilots should always consider and mitigate the risks we pose to other people – a clear medical is the first step in mitigating risk.

Secondly, it is a criminal offence to lie on a pilot medical.

Thirdly, in the event of an accident caused by an undisclosed medical condition my insurance would be voided including third party insurance. Potential claims against my estate could leave my dependants destitute. At my request, Dr. Tony Van Der Spek notified CASA and I have since received a letter from them.

The requirements

CASA requires the results of the standard 6-month post coronary intervention workup including:

• New aviation medical
• Results of stress Nucleotide scan or stress echocardiogram, completed no earlier than 6 months post operatively
• Assessment of ejection fraction
• Progress report from your cardiologist including the above
• Information, current clinical status and details of risk factor modification

Two months on

Two months after my operation, I am well on the way to achieving my goal of regaining my medical. I have lost 6 kgs, I am exercising every day including attending rehab gym twice weekly and I am following a strict diet regime. My motivation in explaining my medical condition in Australian Pilot magazine is to use the experience as a measure of the CASA medical process.

I intend inviting CASA to contribute. I want their input and I hope that in detailing my experience, I may be able to help others facing a similar problem. For a pilot, losing your medical can be a traumatic experience. One day you’re a pilot with all the privileges that entails, the next day you can no longer fly.

We all like to think we will decide when we will quit flying and some pilots make that decision happily – taking retirement after a long airline career. But it is their decision and freely made. For a younger man or woman who is suddenly faced with the prospect that his or her career is over prematurely, the event can be life changing. In many cases though, with medical intervention, prescription medication and lifestyle changes, pilots can resume their careers.

I am fitter and healthier now than I was back in December when I renewed my pilot medical. And I am safer too. I expect to have to undergo more stringent and expensive medicals to gain and retain my pilot medical. So be it, the cost is worth it to be able to continue to enjoy the privilege of flight.

I am taking a positive approach to regaining my medical. I have booked my stress echocardiogram for late August. In the next edition, I will include CASA aviation medicine’s contribution and I will detail my progress. This whole thing turned out to be a very loud wake up call to me.