Aeromedical Report: Frequently Asked Questions

Air Line Pilot, April 2001, p. 5
By Dr. Tom Yasuhara, ALPA Associate Aeromedical Advisor

I just had oral surgery under intravenous (IV) sedation, and I was given a prescription for a pain reliever to take as needed after I was released. When can I plan to return to flying?

The grounding period following such surgeries can vary from case to case depending on several factors. As a general rule, the medications used for IV sedation would require a 24-hour "washout" period before the drug is sufficiently out of your body (unless a narcotic IV medication was used, in which case you should observe a 72-hour period). If nitrous oxide gas was used, you should observe a 24-hour washout period. If only a local anesthetic was needed, you should be sure your speech is normal again, but no observation period for the medication per se is defined.

In addition, a pilot who takes narcotic pain medications (codeine, oxycodone, etc.) after the surgery should not return to work until 72 hours following the last dose. Certain other non-narcotic pain relievers may be used while flying as long as they prove to have no side effects (e.g., Motrin, Tylenol, etc.).

Keep in mind that the primary factor dictating when returning to work is appropriate for you is when the site of the operation has adequately healed. The attending dental surgeon and the pilot jointly decide when no further dental problems will recur (including exposure to cabin altitudes) and when the symptoms have subsided enough for the pilot to safely perform all his or her crew duties. Because the foregoing considerations can occasionally be complicated, checking with one of the aerospace medicine specialists at our office for a recommendation tailored to your particular situation is probably a good idea.

My doctor just biopsied a suspicious lesion on my skin, and I’m worried about the possibility that I might have skin cancer. What effect would a diagnosis of skin cancer have on my medical certificate?

Several forms of skin cancer exist, the most common of which are squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma. With the more superficial skin cancers (i.e., SCC and BCC) that have not spread beyond the initial site of occurrence, a pilot can often return to work under his or her current medical certificate, once the cancer is documented as having been completely removed. In such cases, the diagnostic procedure itself often serves as sufficient treatment, and no additional surgery is needed. If your case falls into this category, you can return to flying after your attending physician clears you back to normal activities. You would then report your treatment at your next scheduled FAA medical examination. At the time of your FAA exam, having on hand copies of operative and pathology reports that document your diagnosis and adequacy of treatment will be very important.

The process is very different for more aggressive types of skin cancers like melanoma, because of their potential for relatively rapid spread (metastasis) to critical sites like the brain. If a melanoma is diagnosed, you must stop flying and wait for all treatment to be completed before submitting a request to return to flying. The FAA’s special issuance of a new certificate and any ongoing surveillance testing will depend on the stage of the melanoma and other case specifics. Our office stands ready to help guide you and your physician through this process.

Ultraviolet radiation from excessive sun exposure is a known risk factor for skin cancers, especially in lighter-skinned ethnic groups. You should limit your outdoor exposures (especially at midday) and wear sunscreen, hats, and sunglasses for protection whenever possible.

I just found out that I’m pregnant—when will the FAA require me to stop flying?

The FAA does not consider a normal, uncomplicated pregnancy disqualifying for medical certification and therefore has not issued specific medical standards that state exactly when flight duties must be restricted during pregnancy. The agency does recommend that the pilot describe all her current aviation activities to her obstetrician, who can then properly advise the pilot about continuing to work from an obstetric standpoint.

In addition, the FAA also states in the Guide to Aviation Medical Examiners (AMEs) that the AME "may wish to counsel applicants concerning piloting aircraft during the third trimester, and the proper use of lap belt and shoulder harness warrants discussion." Obviously, late in pregnancy, the appropriate use of safety restraints, reach to controls and instruments, emergency egress procedures, etc., could be impeded in individual cases.

Some companies may restrict flying after a certain point in pregnancy, and these specific restrictions may be stated in your particular contract or operations manual. We recommend that you check any applicable contract provisions with your LEC or MEC representatives.

I’m being treated for a sports injury that my doctor says won’t be completely healed until several weeks after my current medical is due to expire. What are the consequences of having my medical certificate lapse?

Having your certificate expire should not result in administrative complications or "red flags," as long as you do not try to fly before you are issued a new certificate. You should not fly until after your injury heals and your doctor has cleared you back to unrestricted activity. Then, to regain your expired medical certificate, you simply schedule a new FAA medical exam with your aeromedical examiner (AME), during which you will report the injury and your treatment. You will take the same physical and fill out the same paperwork as you would have done had you been ready to have your exam on time. Assuming you pass all the elements of the exam, you will then be ready to report back for flight duties.

I was recently cautioned that even non-alcoholic beer could place me in violation of the 8-hour alcohol restriction before flying. How can this be true?

Many of the "non-alcoholic" beers on the market actually contain some alcohol (e.g., 0.5 percent) and are not truly free of alcohol. As a result, having consumed an alcoholic beverage within 8 hours of flight duty, you could indeed be considered in violation of the FARs. Our recommendation is to read the labels of such products very carefully. (This is also important when you may be taking medications that can cause serious reactions when taken with alcohol, or themselves contain additional alcohol).

Dr. Tom Yasuhara, MD, MSPH, is an associate aeromedical advisor with ALPA’s Aeromedical Office, which is located in Aurora, Colo.