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Dave came into my office, red-faced, overweight, and obviously stressed. He was due for his biennial exam, and very anxious for his re-certification. To lose his "medical" would impact his job, thus his income, his health insurance, and his peace.
Predictably, it was Dave's blood pressure that gave greatest concern. He was shocked when I told him. It was 180/105, quite a ways above the limit allowed by regulations. I prescribed a medication that was compatible with his licensure, but also gave a short lecture on lifestyle. For one of Dave's habits, one he had struggled with for years was smoking. He had cut down to one pack a day, but he was still hooked. And tobacco always affects the blood pressure.
Second, Dave heavily salted his food. Sure, he carried some extra pounds, and drank a beer occasionally. However, now there was strong motivation to do something about these habits. His lifestyle was impacting his job!
Hypertension, better known as high blood pressure, affects over 50 million Americans, nearly one in every four adults, causing 180,000 deaths each year. The majority are unaware they have this so-called "silent killer," although a major risk factor for heart disease, stroke and kidney failure. Only 21% of Americans with high blood pressure are being monitored or properly treated.
While physicians normally use a reading of 140/90 as the cutoff point between normal and a diagnosis of hypertension, in reality a pressure of 120/80 or even 110/70 is much safer. The FAA allows a blood pressure of 155/95, consistent with its position of trying to certify any pilot who is not at immediate risk, even though the pressure should ideally be lower. Furthermore, the FAA will allow most medications commonly prescribed for hypertension B such as diuretics, beta-blockers, ACE inhibitors, and calcium channel blocking drugs. They exclude only five prescription medications which act centrally on the brain. In fact, more than 24,000 class three aviator pilots have been certified to fly, with known but controlled high blood pressure.
For my patient Dave, it turned out better than that. One week later his wife phoned, reporting that Dave had quit smoking! He had been drinking more water, eating more fruit, getting more rest, and exercising, just the simple lifestyle changes needed to lower blood pressure. His taste buds were coming back to life so he used less salt. And, without taking the medication prescribed, his blood pressure was back to normal!
The good news for pilot physicals is that generally such problems can be resolved without waivers, drugs or expensive testing. We all know that most drugs don=t belong in the cockpit; neither does tobacco or alcohol. From this AME "doc" -- get a pre-flight health checkup, and avoid the re-certification blues.
[Doctor Hansen serves as medical director of the Emerald Valley Wellness Clinic, and the Live For Health 10-Day Wellness Program in Creswell, Oregon. www.emeraldwellness.com.]
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