September 2007 | Back to Table of Contents
Pulse
Fit to Fly
In order to keep their jobs, pilots need frequent medical checks and the help of physicians who “speak airplane.”
Charlie Dillard grew up dazzled by the planes zooming over rural Andrews, Texas, and he never doubted he would do anything but become a pilot. But 13 years ago, only four years into his career as a jet captain for Upjohn Company in Kalamazoo, Michigan, his life plan was shaken to its core. The occasional heart palpitations he’d attributed to “too much coffee and iced tea” turned out to be the result of abnormal electrical conduction in his right ventricle. He needed a pacemaker to ensure his pulse stayed on track. The diagnosis was mind-boggling for the 34-year-old father of three—all the more because it seemed to spell the end of his career.
For pilots, good health is a job requirement, according to Clayton Cowl, M.D., chief of the section of aerospace medicine at Mayo Clinic. Various medical conditions such as arrhythmias or neurological or psychiatric problems and their treatments can be cause for “grounding” a pilot, either for a period of time or for good. To keep tabs on pilots’ health, the Federal Aviation Administration (FAA) requires frequent medical exams conducted by certified aviation medical examiners (AMEs), physicians who are FAA-trained to perform flight physicals. Airline captains who fly scheduled public passenger flights must get checked every six months; corporate pilots or those who fly for pay once a year, and even recreational pilots need a clean bill of health every three years (or every two, if they’re older than 40 years).
During these exams, pilots legally are required to disclose every symptom, medication, doctor’s visit, and diagnosis since their last AME exam. Some are understandably jittery about the frequent check-ups. But the unique doctor-patient relationship that develops over the years can save the career of a pilot who has been diagnosed with a condition that could affect his or her ability to fly. “A lot of [community] physicians see pilots for general medical care,” Cowl says, “but they don’t speak airplane.”
A Healthy Profession
As a group, pilots tend to be a healthy lot, attests David Zanick, M.D., a Park Nicollet physician and medical director for Northwest Airlines. Zanick, who is an AME, has worked with pilots as patients for nearly 30 years. “Most people getting into aviation these days are conscious of their weight, diet, and cholesterol,” he says. They tend not to smoke. Most try to exercise, even with complicated schedules. Drug abuse is rare (the airlines conduct frequent drug tests). And they have an extra incentive to take care of themselves: “Their livelihoods are on the line,” Zanick says.
The most frequent health complaints, especially among pilots who cross time zones, include fatigue and disruption of circadian rhythms. Because of the sedentary nature of the job and because of the availability of fast food in airports, obesity has become a bigger concern among pilots, as have its downstream effects—diabetes, sleep apnea, and heart disease. Studies have investigated whether pilots are at increased risk for deep-venous thrombosis because they spend so much time sitting (the risk appears to be less than that for passengers) or cataracts from exposure to cosmic radiation (“I don’t think we’re seeing more than in the general population,” Zanick says). The chances of contracting an infectious disease such as Avian flu is increasingly under review, although Zanick points out that air flows up and down in a plane and not from the cabin to the cockpit, making transmission during flight less of an issue. Stress is a common complaint, and since 9/11, longer security lines, more back-to-back flights, and more frustrated passengers have ramped up the strain of the job.
But the frequency of medical exams and the pilots’ interest in their own health also makes them receptive to preventive health messages, says Tom Jetzer, M.D., an AME with Family Practice and Occupational Medicine in Minneapolis. “I’ve picked up a number of cancers early because I’ve had the chance to remind them to go for colon screenings or get their PSA checked,” he says.
Through the Land Mines
When health problems do arise, the AMEs can be most helpful in proving to the FAA that pilots have recovered and are medically fit to fly. In the past, a pilot who suffered a heart attack—or who turned up with an arrhythmia, like Charlie Dillard—would be permanently grounded. These days, a recovering pilot can pass a series of FAA-required tests, be reviewed by a cardiologist, and qualify for a “special issuance,” a time-limited certificate that can return him or her to the cockpit. Nearly 5,000 AMEs around the country evaluate pilots, making sure they have undergone the tests needed to return to work.
“We’re not certifying pilots who shouldn’t be flying,” Cowl says, “but we’re spending extra time, looking at all the options … helping to package the presentation and expediting their case [before the FAA] if they’re eligible for special issuance.”
AMEs also keep an eye out for treatments that might ground a pilot. Over-the-counter antihistamines, cough medicines, and certain nutritional supplements can preclude a pilot from being able to fly. One pilot who’d been to his primary care physician had been prescribed buproprion to help him quit smoking; but neither the doctor nor the pilot was aware that the medication, an antidepressant, immediately disqualified him (no neurologically altering drugs are admissible). “There’s no official book or website to check the meds,” notes Cowl, who recommends that primary care physicians consult a local AME or the FAA (www.faa.gov) if they think a medication may be in question. “An experienced flight examiner walks the pilot through the land mines.”
In fact, it was a flight examiner at Mayo who queried the FAA, consulting the most up-to-date medical journals and recommending the appropriate tests, so that Dillard could be re-evaluated six months after receiving his pacemaker. More than a decade later, he is continually monitored, healthy, and doing what he loves for a living with the same company (now Pfizer Pharmaceuticals). “[The flight physicians at] Mayo helped me work it out,” Dillard says. “They wanted to see me back in the cockpit.”—Kate Ledger