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 Zipper Pilot A Left Seated “Zipper” Pilot
by Richard A. Hansen, M.D., AME
It used to be that the only zipper was in the jump suit pilots wore. Now we see more and more pilots with that tell-tale “zipper” on their chest, a scar straight down the breastbone, telling the story of their recent heart surgery. More risky than an off-field landing, the coronary artery bypass graft (called CABG, and pronounced like ‘cabbage’) is not the end of flying, that is if you are willing to pass the required tests.
Jim came for a physical, with a history of double bypass surgery six months before. He had been a member of an active flying club, and had logged more than 1000 hours of flight time, mostly in Cessna 172s, with endorsements also for retractable and high performance aircraft. He had sadly assumed that with the discovery of serious coronary heart disease his flying days were over. His RV (a recreational vehicle, actually a 5th wheel, not a hot experimental tail-dragger) along with his set of golf clubs, and his somewhat ailing wife were the companions of his retirement planning.
As a fellow aviator and his medical examiner, I was happy to inform Jim that he might be able to get his ‘medical’ back by the FAA provision for ‘special issuance,’ IF he could meet certain well-published conditions. First, he would have to secure his medical records, all the surgical reports, medical tests, and doctor’s notes that would document his past and current status, with the efforts made for rehabilitation. The treadmill stress test is particularly important, and the FAA medical consultants require that his exercise heart rate reach the maximal predicted for his age. He would need to go without his beta blocking medication, a tablet called Toprol, since it slows the heart rate and modifies its exercising power output, kind of like taking off in a Cessna 172 with the carburetor heat pulled out.
Further, Jim would need his cholesterol levels tested, and show signs of favorable modification of the heart risk factors. The HDL-C (which we call the good cholesterol) should be as high as possible, best achieved with a daily aerobic exercise regimen. Walking several miles is a good step toward this goal, with stretching and weight training also recommended. The total cholesterol and the LDL-C (the bad cholesterol) should be lowered as much as possible. Omega-3 fatty acids, found in nuts and flax seeds and green leafy vegetables, would assist this beneficial change. We gave Jim the needed formulas and recipes, which his wife readily agreed to prepare.
Now, with the goal in sight of again occupying that coveted left seat, Jim began in earnest to prepare himself to fulfill those many dreams which only a healthy retired pilot can understand. There would be a brief waiting interval, since each AME is required to ‘defer’ the decision of granting that medical certificate. Then, experienced FAA approved cardiologists review the data, prior to consideration of a ‘special issuance’ decision. Pilots who have CABG procedures are required to wait at least six months for healing time to be complete. While first or second class certificates are less likely, there are a few pilots who have been granted them, after proving that they are completely recovered, physically fit, and following a heart-healthy dietary with preventive exercise to keep the heart status that way. The exercise test which demonstrates this athletic heart function is called a SPECT myocardial perfusion test, and uses technetium agents and/or thallium. The goal, naturally, is to minimize any risk of angina, arrhythmia or a sudden heart attack, which could prove lethal when flying aloft, in any size of plane.
Similar testing procedures are required for other cardiac ailments, such as rhythm disturbances, heart failure, valvular surgery, or stenting of coronary vessels. In spite of the hassles of these protocols, it is exciting to know that this rehab regimen has succeeded in helping an aviator again enjoy the satisfaction of getting from here to there ‘as the crow flies.’ While some pilots can make their needed lifestyle changes at home, with some medical advice or a book or video of vital instruction, others will need personalized hands-on training in a Wellness Center. Our Oregon-based Live-for-Health program does this in 10 days. Other centers offer longer sessions. In flight training as we well remember, each pilot has a different learning curve. And, recovering heart health status may respond faster in some people than others. Generally, people get out of a wellness program what they put into it. For a grounded pilot who really wants to fly again, neither the cost nor the time are major stumbling blocks.
In Jim’s recovery, the lifestyle changes went well, aided by his wife’s enthusiastic support. He trimmed back the cholesterol-rich foods in his diet, began drinking more water and less coffee, and incorporated vigorous aerobic exercises into his daily routine. Shortly, Jim’s heart risk factors showed great improvement, and the treadmill stress test was passed with flying colors. Now Jim meets the standards, awaits his FAA letter, eager for another opportunity to check the mags, set the flaps, run up the engine, and cruise in the friendly skies.
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