Motrin

I met a flight doc (not one of the authors) who was telling me about the UCD; sounds downright awful. An article about it: http://docserver.ing...3EFE33158A1F99B If link doesn't work, the abstract links to the full article: http://www.ingentaco...000002/art00007

Looks like a 'clamshell' thoracotomy, a last ditch effort to revive a dead patient by evacuating blood and get more effective squeezing of the heart. Usually looks a little cleaner than that, maybe there were other wounds in the path of incision, or they probably let the med student try. Primum non nocere, first do no harm...

"The Military Judicial Reform Act of 2013 comes a day after Secretary of Defense Chuck Hagel wrote in a letter to two senators that he has ordered a review of the Aviano case and whether it is “necessary or appropriate” to continue to allow commanders to single-handedly toss aside judge and jury findings. The process has been a part of U.S. military justice since 1775. Commanders’ decisions are final." I meant clemency and military commander executive power specifically. http://www.armytimes...anders-031213w/ Edit: jet lag makes it hard to think

As of 2010 ATT cellular did the same

Yeah, those idiots in the video put their college government subsidized financial aid to good use.

Glad to hear that congress is hard at work redesigning the military justice system which has been this way for 200+ years. Ironically, due to sequestration, the independent judicial review panel they want will be immediately furloughed, if hired at all. Thus, no more military justice system! 'The saga continues... Wu-tang... Wu-Tang...'

No, you should not feel badly. He had a disqualifying condition for entry into a special duty; perhaps more time and workup woud yield a better diagnosis, but it's actually not our job to do that for initial entry physicals -- you make the call right then and there with what information you have, not always what information you could obtain. We do not make policy, nor do we enforce it; we abide by it. You did your best and you should be able to sleep at night. Flight medicine is occupational medicine and sometimes you have to be the bad guy. I'm all for advocating and fighting for trained assets, however. as far as sleep apnea and UP3, YMMV. Sure, CPAP is a one-size fits all way to beat it and works for most people. I was speaking more to Aeromedical disposition. In any medical case, you would be well served by ignoring its implications on continued flying and undergoing the best available medical treatment, allowing the aeromedical aspect to fall into place. Most aviators dislike that path, though, since it inevitably involves temporary grounding.

http://www.enttoday.org/details/article/496989/Eustachian_Tuboplasty_A_Potential_New_Option_for_Chronic_Tube_Dysfunction_and_Pa.html Again we don't give out medical advice publicly, but the above article has more info on the procedure. Aero medically if you had this condition and you were going IFC 1 they would take a long hard look at you, probably ACS eval, and they would wait probably years after the surgery since the restenosis rates are high, meaning it may come back. You're also looking at long term anti inflammatories like steroid inhalers which is not ok for class 1 but waiver able For trained asset you are looking at prolonged DNIF but i could see acs clearing someone for low performance acft. This is one of those special times when you get to be a trailblazer. I always thought it was cool when I brought an aviator back to flying (something) by challenging the reg. EDIT disclaimer, things might not work out. Good luck

Same deal. Dead debate probably has the new color blindness waiver guide? The cases I saw for cct fail all went like the above. You'll get a waiver unless something else is also wrong, or if it turns out you were blind while flying and only used the force to guide you.

Did he get a sleep study and not follow up? Or not get the sleep study. And what job is he going for. Kind of depends on why he was sent in the first place. Is he an obese hypertensive smoker sick call surfer. Or a fit guy with a big neck or some other anatomical consideration. If the latter, have his PCM work up, get a UPPPlasty or use Positioning techniques and voila waiver possible. I haven't read the new OSA waiver guide but I know it's gotten easier to waive recently. I didn't think you needed to code OSA unless they are on cpap, the standards changed. And the board is a fast track now. Any way my advice is try try try. It's easy to throw cases like these away because the sgp is in a hurry to go pull gs or play golf or somethingr, but put yourself in their shoes. Everybody deserves a fair shot. Remember that you can always scrutinize previous diagnoses if you think it's incorrect.

+1 FC I unlikely without refractive surgery, you improve your chances with PRK but definitely no guarantee. As an anecdote, I have seen people do it successfully. Good luck.

+1

Table 1 – Waiver criteria for renal stones Flying Class Category Waiver Potential Waiver Authority I, IA Single episode Recurrent, bilateral, or retained No waiver required, but full workup required on FC I/IA physical. No AETC II Recurrent or bilateral# Retained*# Yes MAJCOM Yes MAJCOM IIU Recurrent or bilateral Retained* Yes AFMSA Yes AFMSA III Recurrent or bilateral Retained* Yes MAJCOM Maybe MAJCOM ATC/GBC Recurrent or bilateral Retained* Yes MAJCOM Maybe MAJCOM SMOD Any evidence of stone disease Yes AFSPC * Stone in renal parenchyma or cyst, with no possibility of movement into collecting system, waiver likely for trained asset. # If flyer is a pilot, and there are any retained stones, then FC IIC and AFMSA is waiver authority. AIMWTS review through January 2010 and revealed 532 submitted cases for stone disease. There were 13 FC I/IA cases, 294 FC II cases, 2 FC IIU cases, and 223 FC III cases. Within the total were 51 disqualification dispositions: 8 were FC I/IA, 7 were FC II, and 36 were FC III. Of the 51 disqualification cases, 21 were disqualified primarily for diagnoses other than the stone disease and 30 were primarily for the stone disorders. Included in this total were cases of recurrent stone formation, retained stones, and multiple symptomatic episodes. I'll echo what deaddebate said. The table I posted is right from the USAF waiver guide. Waivers for trained assets with recurrent episodes or retained stones are possible, but reviewed very carefully. I would be more concerned about the underlying disease process; why is this individual getting recurrent stones? Sometimes there is a problem we can fix, but most of the time there is not. If you can read the table above, FC II (trained aviator) waivers are more common than disqualification. I won't ask you to divulge specifics about your case in a public setting, but in general, if you are disqualified outright from flying status, it is hard to get back on. Again, sometimes individual cases have particular stipulations made by the governing authority; your best bet is to discuss it with your new flight doc. You would need to re-accomplish an initial flying class physical, but if you are lucky they will hold you to FC II standards. It never hurts to try. Best of luck to you.

In case you've made it to this board, you find a growing number of military docs frustrated by interruptions in training, long deployments, in between dealing with the machine and all its paperwork/PME/AAD (this is not a typo, BTZ LT Col requires an AAD not your MD) and nurse commanders who scream and yell and throw clip boards. I invite you to peruse: http://forums.studentdoctor.net/forumdisplay.php?f=72

It also depends on what your status is right now. Are you already enlisted? Are you already a cadet somewhere? Or are you trying to enlist/commission/obtain flying status/etc. Two different regulations at work then. AFI 48-123 governs standards for continued service. DoDI 6130.4 governs appointnment, induction or enlistment, which includes commissioning if you were not commissioned within the last 6 months. Oh, and for flying, I can't comment on your individual case here, nor should you post details about your medical conditions on an 'anonymous' forum. I will say that in general, case waivers are approved if the condition relapsed after the age of 10m is not on visible parts of the skin, is less than 10%, you don't get frequent exacerbations which could hinder you in the field, and has not required frequent topical or systemic glucocorticoids, UV phototherapy, or Topical immunomodulators like pimecrolimus (currently a great area for flying, but i digress)... My man deaddebate probably has the answer you are looking for! For flying (from USAF waiver guide) Table 2: Waiver potential for dermatitis Flying Class (FC) Disqualifying Condition/Treatment Waiver Potential Waiver Authority I/IA, Initial FC II/III Any chronic skin disorder, which is severe enough to cause recurrent grounding from flying duties, or is aggravated by, or interferes with, the wearing of military equipment. Atopic dermatitis/eczema controlled with topical steroids, topical pimecrolimus, and/or oral nonsedating antihistamines (Fexofenadine or loratadine). Atopic dermatitis/eczema controlled with topical tacrolimus, oral steroids, oral cyclosporine, or PUVA. Eczema, chronic and resistant to treatment Verified history of atopic dermatitis or eczema after age 8 No AETC No AETC No AETC No AETC No AETC You can see there, that all of the NO responses imply that they will not take a waiver for anybody with significant involvement of eczema, so they say that any skin condition with is recurrent and has the ability to ground the member frequently is usually denied., All eczema cases sit in a spectrum, so once you figure where you are on that spectrum, you can see where you can go and how to get there,. My last piece of advice, when something is disqualifying dont act like its the final word. You just need a waiver. Waivers are given out for enlistment/comissioning for things like this all the time, otherwise we wouldn't any non rated officers, Just bring your paperwork and make sure its legit before going for the entrance physical. Get your civilian doc to write the note as conservatively as he can (without breaking the law). Many things get waived but you'll get in. The uphill battle will be to become a rated aviator. Your physical physical is much more strict than your enlistment and commissioning physical. Harrumph!

Required items in the aeromedical summary for initial waiver for applicants for AASD: A. History: 1. Address whether all clinical criteria prior to RS were met. If not, describe exceptions in detail. 2. Pre-op cycloplegic refraction. 3. Surgical procedure, date and location. Must be 12 months post-RS, at minimum, for waiver consideration. 4. Assessment (negative and positive) of post-op symptoms of glare, halos, reduced night vision and diplopia. 5. Eye medications usage, past and current. 6. Presence of other surgical or post-operative complications (e.g. corneal haze, flap striae, ocular hypertension, etc.) B. Physical (Current): 1. Uncorrected visual acuity high contrast (OVT) and Precision Vision 5% low contrast. 2. Best corrected visual acuity high contrast (OVT) and Precision Vision 5% low contrast. 3. Cycloplegic refraction and dilated fundus exam. 4. Two post-op refractions at least 2 weeks apart that shows stability (no more than 0.50 diopter shift in manifest sphere or cylinder power). 5. Slit lamp exam which must include grading of haze. 6. Intraocular pressures (IOPs). 7. Depth perception (OVT-DP). C. Attach copy of surgical documentation, post-RS evaluations and any RS-related incidents (this will meet the requirement to send this info to the APM. The following is a link to the post-RS evaluation form which should be used to report any RS related incidents: http://airforcemedicine.afms.mil/idc/groups/public/documents/webcontent/knowledgejunction.hcst? functionalarea=RS_USAF&doctype=subpage&docname=CTB_070886. 4. Initial follow up in conjunction with FC I application could be greater than one year after surgery (e.g. history of PRK or LASIK greater than one-year ago). ACS evaluation required for all LASIK and >-5.50 diopters. Table 2 Waiverable Examination Results Examination Waiverable Results Best corrected visual acuity (OVT) 20/20 or better each eye* Precision Vision 5% low contrast chart 20/50 or better each eye* Slit lamp exam LASIK – no striae or flap complications* PRK – no more than trace corneal haze* Refractive error Stable, no more than 0.50 diopter shift in manifest sphere or cylinder refractive power between two readings at least 2 weeks apart* Intraocular pressure (IOP) Normal – 21 mmHg* Fundus exam No new or previously unrecognized retinal pathology† Depth perception (OVT-DP) Line D, E or F. If fails and previously waived for depth perception using AO Vectograph then waived limits of that test. See defective depth perception/stereopsis waiver guide. * If outside these limits, refer to local eye care provider and/or treating refractive surgery center. If condition is unable to be resolved refer case to ACS. † Work-up and submit waiver request for new diagnosis.

I'll PM you tomorrow... sorry I am caught up with something right now.

Are you active duty? On active flying status? If so, then you need to contact your flight medicine clinic and apply for permission to proceed, at which time they will 'vet' your eye center and tell if you if you can proceed or not. If you are anything but an FC I pilot, they will probably say yes. If you proceed on your own dime for whatever reason without USAFSAM permission to proceed, they will not be happy. I don't see why anybody would do that though, since it is essentially free (small ADSC) to get it done. If you are a civilian and thinking about pilot training, I highly suggest using a US based center. During your physical, they will go over all of your documentation thoroughly. Although they are competent physicians over there in Taiwan, often times the language barrier and sheer distance from the homeland causes documentation problems, which will turn into a problem with your physical. Also see below: The PRK vs LASIX debate for AF flying duty is too in depth to go into here. The AF still prefers PRK for pilots in most cases for a variety of reasons. I recommend that all flyers and flying applicants obtain a personal consultation with a service specific flight surgeon to obtain the latest recommendation on which one to obtain, how to proceed, etc.

Yeah, um, hmm... pine nut 'allergy'... parental issues... SA Low light flashing... if that is a good summary of what happened here, then I guess i'll comment. Actually, no, no I won't. You are on your own, brother. Anecdotes about food allergies: I have actually treated folks down range with serious allergic reactions to foods. Most of the time, they knew about the allergy but I guess its hard to figure out what is in the DFAC menu sometimes. Common allergies like peanut and soy are usually listed as ingredients so you can avoid them. One time this gal who had a serious coconut allergy knew there was coconut on that cake but 'it looked so good'. Don't know how to help there. Also knew a guy who had an allergy to Beer. The horror..........

I am male. Thanks for the motivation, i'll check back in as much as I can.

I will check in frequently then! For legal purposes I won't post direct medical advice, but aeromedical considerations are fair game. Thanks, yes I always forget about the PHA time rule since most of my patients are aircrew and are required a (flight) PHA every 12-15 months. Luckily I have great techs which remind me! Also, I have done too many involuntary separation physicals (non continuation, PT failures, RIF, personality disorders, and even for confinement) in my career. Just plain sad.

This

As an AD flight doc, I am friends with lots of pilots, and not for the purpose of ruining careers once trust is built. I'm going to stay anonymous, but if you knew me you would know that I fight tooth and nail to keep you flying provided that you are not a risk to yourself or others. Grounding a trained asset is never anything we want to do. Ideally the problem can be fixed (such as with myopia --> glasses or PRK) and a waiver is possible. If your local flight surgeon fights to get you back in the air, and basically puts their reputation on the line and takes responsibility for your medical safety, the higher ups at MAJCOM will listen. Regulations are pretty strict though and there's only so much the peon local FS can do, but the current trend is more aeromedical waivers. Recent decade of operations and pilot shortages may have something to do with it. Of course, if you are an applicant, none of this applies. You are right, the docs really aren't your friend in this case. The AF is risk averse and isn't going to spend alot of money training someone who will have major issues down the road. Don't lie, choose your words carefully, and be respectful. There is no back door to flying. I hope this helps! Flight docs are not jerks, we do not get paid more based on how many careers we ruin. I was a flight doc for a period of time so I could obtain a specialty, and it worked out for me. I enjoyed working with aircrew and hope I saved many more careers than destroyed. We do care about your safety though and take that seriously.

deaddebate is right, yet again. Your chances of obtaining a waiver for FC I or Ia (nav, wso, etc..) are very low. You may not even make it to the physical exam portion if your record is screened out as having a dq condition that is not waiverable. However, it never hurts to try, so I suggest you start the progress. I have seen a few FC I exams with herniated discs, history of fusion, spondylolisthesis which is symptomatic, which were rejected despite my begging and pleading with AETC. On the bright side, I have seen plenty of FC IIU (RPA), initial FC II (flight surgeon), FC II (trained asset rated aviator), and FC III (most other flying jobs like ABM, FE, aerial gunner). Good luck to you!