NAMI INTERNAL MEDICINE Jan 2009 CDR Daniel R Juba
Recent Special Boards/Revisions <ul><li>Crohn’s disease </li></ul><ul><li>HIV/AIDS (class III flight duties) </li></ul><ul...
SBFS 2008 <ul><li>Crohn’s disease </li></ul><ul><ul><li>Colonic Crohn’s disease treated as ulcerative colitis </li></ul></...
SBFS - HIV/AIDS <ul><li>Aviation duties – CD WNR </li></ul><ul><li>Case by case basis for other aviation classes (?) </li>...
WPW/pre-excitation <ul><li>AMWG updated </li></ul><ul><ul><li>Non-inducible after procedure </li></ul></ul><ul><ul><li>6 m...
<ul><li>Class I : Applicants or Designated </li></ul><ul><li>1. Asymptomatic WPW pattern requires a cardiology evaluation...
Ablation – unintended consequences <ul><li>Ablation procedure was performed on a SG1 aviator with a-fib </li></ul><ul><ul>...
Asthma <ul><li>Still strictly enforced for applicants (any hx of use of inhaler in past generally requires objective evide...
GERD <ul><li>Updated in 2007-2008 in AMWG </li></ul><ul><li>Routine/daily use of ppI’s allowed (and prn use allowed as wel...
Kidney stones <ul><li>CT scan evaluation for stones is preferred modality </li></ul><ul><ul><li>Is CT too sensitive? </li>...
Diabetes <ul><li>Waived more commonly for all classes as long as under good control/guidelines with diet control </li></ul...
CAD <ul><li>Can be waived for all classes (designated), WNR for applicants </li></ul><ul><li>Class I aviators almost alway...
Upcoming/Wish list <ul><li>Ulcerative colitis to be updated in AMWG </li></ul><ul><ul><li>Medications and doses expanded <...
<ul><li>QUESTIONS? </li></ul>
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NAMI Internal Medicine

Published on: Mar 3, 2016
Source: www.slideshare.net


Transcripts - NAMI Internal Medicine

  • 1. NAMI INTERNAL MEDICINE Jan 2009 CDR Daniel R Juba
  • 2. Recent Special Boards/Revisions <ul><li>Crohn’s disease </li></ul><ul><li>HIV/AIDS (class III flight duties) </li></ul><ul><li>WPW/pre-excitation </li></ul><ul><ul><li>Ablation guidelines </li></ul></ul><ul><li>Asthma </li></ul><ul><li>GERD </li></ul>
  • 3. SBFS 2008 <ul><li>Crohn’s disease </li></ul><ul><ul><li>Colonic Crohn’s disease treated as ulcerative colitis </li></ul></ul><ul><ul><li>AAC to change waiver guide in near future </li></ul></ul><ul><ul><li>Case by case/class restrictions </li></ul></ul><ul><ul><li>More in-line with USAF policy </li></ul></ul>
  • 4. SBFS - HIV/AIDS <ul><li>Aviation duties – CD WNR </li></ul><ul><li>Case by case basis for other aviation classes (?) </li></ul><ul><li>Medication side effects and follow-up still problematic </li></ul><ul><li>SBFS 2008 – HIV positive on no meds and appears to be non-progressor, class III </li></ul>
  • 5. WPW/pre-excitation <ul><li>AMWG updated </li></ul><ul><ul><li>Non-inducible after procedure </li></ul></ul><ul><ul><li>6 month observation period with SG3 waiver after successful ablation </li></ul></ul><ul><ul><li>Applicants and designated treated the same, but different classes handled somewhat differently but with similar requirements </li></ul></ul>
  • 6. <ul><li>Class I : Applicants or Designated </li></ul><ul><li>1. Asymptomatic WPW pattern requires a cardiology evaluation, echocardiogram and EPS. </li></ul><ul><li>a. WPW pattern alone with a normal echocardiogram and non-inducible EPS is considered disqualifying (CD), but a waiver is recommended (WR). </li></ul><ul><li>b. If a dysrhythmia is induced by EPS and ablated, the patient must be retested with EPS immediately after the ablation during that same procedure to ensure dysrhythmias are no longer inducible. </li></ul><ul><li>(1) Designated members are CD/WR and waiverable to SG3 during the six-month post-ablation period. Waiver requests to SG 1 or SG 2 may be submitted six months post-ablation with documentation indicating they had no recurrence of dysrhythmias or symptoms. </li></ul><ul><li>(2) Applicants are CD/WR. Waivers are considered six months post-ablation, with documentation indicating no recurrence of dysrhythmias or symptoms. </li></ul><ul><ul><li>WPW syndrome (WPW pattern with symptoms) or LGL (short PR with palpitations) are CD, and require a cardiology evaluation and echocardiogram. Ablation is required for waiver </li></ul></ul>
  • 7. Ablation – unintended consequences <ul><li>Ablation procedure was performed on a SG1 aviator with a-fib </li></ul><ul><ul><li>Not commonly done/less successful </li></ul></ul><ul><ul><li>Tendency for recurrence </li></ul></ul><ul><ul><li>‘Unique’ patient population </li></ul></ul><ul><ul><li>‘extrapolated’ from the pre-excitation section of the AMWG to cover a different entity </li></ul></ul>
  • 8. Asthma <ul><li>Still strictly enforced for applicants (any hx of use of inhaler in past generally requires objective evidence of no active asthma) </li></ul><ul><li>PFTs AND MCCT needed for evaluation </li></ul><ul><li>Pulmonology consult does not take place of objective test results (PFT, MCCT) </li></ul><ul><li>Use of meds (including daily steroids) for designated aviation personnel allowed and typically waived </li></ul>
  • 9. GERD <ul><li>Updated in 2007-2008 in AMWG </li></ul><ul><li>Routine/daily use of ppI’s allowed (and prn use allowed as well) </li></ul><ul><li>Still NPQ but routinely waivered (CD WR) </li></ul><ul><li>Common problem but still requires waiver for condition and med use (routinely waived) </li></ul>
  • 10. Kidney stones <ul><li>CT scan evaluation for stones is preferred modality </li></ul><ul><ul><li>Is CT too sensitive? </li></ul></ul><ul><ul><li>Retained stones in calyces/collecting system must be removed </li></ul></ul><ul><ul><li>Any metabolic abnormality must be corrected </li></ul></ul><ul><ul><li>Urology tends to look at stones differently from aviation realm (not clinically significant.) </li></ul></ul>
  • 11. Diabetes <ul><li>Waived more commonly for all classes as long as under good control/guidelines with diet control </li></ul><ul><li>However, any med use for class I aviator will restrict to SG3 status (at best) </li></ul><ul><li>Type I DM not waivered </li></ul><ul><li>IGT, IFG, gestational DM are NCD but yearly HgA1c and weight required </li></ul>
  • 12. CAD <ul><li>Can be waived for all classes (designated), WNR for applicants </li></ul><ul><li>Class I aviators almost always restricted to SG3 (especially if any intervention done) </li></ul><ul><li>Yearly follow-up and testing required </li></ul>
  • 13. Upcoming/Wish list <ul><li>Ulcerative colitis to be updated in AMWG </li></ul><ul><ul><li>Medications and doses expanded </li></ul></ul><ul><li>Medications to be updated (plavix) </li></ul><ul><li>Hematology expanded (?) </li></ul><ul><ul><li>P vera SBFS done 2007, hope to incorporate findings in to AMWG </li></ul></ul><ul><li>Flight Surgeon consultants board (current or past FS subspecialties) </li></ul>
  • 14. <ul><li>QUESTIONS? </li></ul>

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