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Articles written by James D. Lakin

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  • Alcohol and Aviation: They Don't Mix

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Aug 1, 2022

    It’s challenging enough flying a high performance aircraft stone sober. Lord help the pilot that’s even slightly impaired. The FAA strongly agrees with that sentiment. That’s why the Eight Hours Bottle to Throttle rule was instituted (FAR 91.17). Likewise, if a pilot gets even one Driving While Impaired (DWI) conviction, all hell breaks loose. The FAA assumes that if you are dumb enough to drink while driving you just might be dumb enough to drink while flying. In other words, they are trying to keep you from killing you and your passe...

  • Signaling for Survival

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Jul 1, 2022

    Stuff happens. You never think it could happen to you, but sometimes it does. Engines quit, sometimes even when you have avgas. Wings ice up and suddenly you're in a stall. Trees or powerlines get in the way of a takeoff or landing in a remote strip. There are all kinds of ways to be out in the middle of nowhere with a banged up airplane and increasingly limited chances of survival. Obviously, filing a flight plan is a good way to increase your chances of being found when you don't show up...

  • Glaucoma: Early Detection Keeps You in the Cockpit

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Jun 1, 2022

    Glaucoma is the second leading cause of blindness in the world. In the U.S. it's estimated that some three million people have it but only half of them know it. The tragedy is that if left untreated blindness can result. As a matter of fact, some 10% of all blindness is caused by this disease. Obviously, this is a common problem. If you get it, it can have a big effect on your career as a pilot. So, what is glaucoma, how can you tell if you have it, how is it treated and what does the FAA have...

  • Deep Vein Thrombosis: A Cockpit Concern

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|May 1, 2022

    It’s warming up out there and I bet you’re thinking about some cross-country flying! There’s nothing greater than watching the landscape change from checkerboard farmland to rolling plains to majestic mountains as the hours roll by. With that throttle leaned back, you can easily spend four or five hours in the cockpit, enjoying the ride. Problem is you can’t very well get up and walk around in most GA aircraft, and prolonged immobility can pose some serious health problems. The biggest worry is developing deep vein thrombosis or DVT, which o...

  • Vertigo: Dizzy Pilots Make Distraught Passengers

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Apr 1, 2022

    Vertigo is a common experience. It's not just a feeling of light headedness but a sensation that the world is spinning around. When you were a kid and spun around you intentionally set off a form of positional vertigo. Something like that can happen in flight. For example, when you're in the clag and abruptly bend down, let's say to pick up a pencil; suddenly it seems as if either you or the plane is in a spin. Hold still. Don't do anything funny with the stick and it goes away. Accelerate...

  • Stayin' Alive with Pulse Oximeters

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Mar 1, 2022

    Last month we talked about the dangers of hypoxia and some procedures to avoid the potentially fatal effects of low blood oxygen levels. Symptoms of hypoxia vary from airman to airman so it is a good idea to take a ride in a hyperbaric chamber to personally experience the real thing. Learn more at The problem is not everyone can fly down to the FAA's chamber in Oklahoma City. As an alternative you can take a trip in a so-called "portable reduced oxygen training...

  • Up Where the Air is Thin: Hypoxia

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Feb 1, 2022

    Oxygen is the elixir of life. Our body’s cells need it to metabolize. Without enough of it we die. It just so happens that as we ascend in the atmosphere that’s exactly what happens—we get less and less of this vital gas and we suffer from low blood oxygen or hypoxia. Initially judgment is impaired and eventually consciousness is lost. How fast and how badly this happens is a function of altitude. Up at 22,000 feet in an unpressurized cabin, you’re toast in as little as five minutes! So how do you avoid this life-threatening situation infligh...

  • Flying With Contact Lenses

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Jan 1, 2022

    Every time you fill out your MedXpress form for a flight physical, you’ll find Question 17b. “Do You Ever Use Near Vision Contact Lenses While Flying?” Most folks get the question wrong. It’s not surprising since if you are not an eye doctor, you probably have no idea what they are asking. Contact lenses are great, especially for those of us that would be wearing “Coke bottle” lenses if we were sporting eyeglasses. They free you from fogged up lenses and restriction of peripheral vision. Assuming you tolerate them, they are a definite improveme...

  • You Can Fly With Insulin-Dependent Diabetes

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Dec 1, 2021

    There was a time when the diagnosis of diabetes was the prelude to a short life. Then insulin came along in 1922, which gave diabetic patients a reprieve from the immediate effects of a deficiency of that vital hormone. However, as time passed it become apparent that longstanding diabetes, if not well controlled, caused degeneration of the eyes, kidneys, heart and blood vessels. Also, not all diabetics could control their blood sugars well. Episodes of low blood sugar (hypoglycemia) would cause unconsciousness and brain damage if prolonged....

  • Say Again, Please: Flying and Hearing

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Nov 1, 2021

    If you don’t think hearing is important, try flying IFR into Chicago Bravo Airspace some afternoon. We were slated to land at Midway taking the OHHMY transition on the ENDEE SIX ARRIVAL. I dutifully plugged in all that info into my trusty Garmin 430, and felt I might be on top of things. No sooner had the buttons cooled than TRACON proceeded to reroute me not one but two times. More button pushing and a few steep turns. Finally I was instructed to “follow the Airbus on final.” Not high tech, but it worked. Bottom line, flying in our compl...

  • Opioid Epidemic An Aviation Concern

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Sep 1, 2021

    COVID-19 is storming back with the Delta variant. Yet another deadly epidemic lurks in the background, claiming many lives—opioid abuse. According to government estimates almost one-third of the population suffers from chronic pain of one source or another. About 25 million people have moderate to severe pain to the point where activity and performance are severely limited. So it’s not surprising that there is a large demand for the pain relief provided by opioids. In addition to illegally manufactured fentanyl and heroine, misuse of pre...

  • Deydration And Heat Stroke: No Fun In The Sun

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Aug 1, 2021

    Over the past few years, we’ve been setting record temperatures and dealing with the health hazards that go with them. Very few of our general aviation fleet has the luxury of air conditioning. Even if you do, summer flying without adequate fluid intake can mean trouble. A METAR temperature of some 90 degree usually means your cockpit will be boiling at over 100 degree. Add to that the time you spend pulling out your aircraft, pre-flighting, loading luggage and passengers and you’ve worked up a heck of a sweat. Unless you’re filed for up high,...

  • Oh Say Can You See: Flying with Color Blindness

    James D. Lakin PhD MD FACP CFI, FAA Senior Aviation Medical Examiner|Jul 1, 2021

    If you have ever landed at a Class Bravo airport, you know that the runway looks like the Las Vegas Strip. The strobing glide path, PAPI, illuminated runway centerline, side and center line taxi way markers all combine to make a colorful and critically important display. Likewise, if you’ve ever had to navigate into or out of an airport by tower signal gun, you realize how important it is to correctly interpret the controller’s signals. The FAA also thinks it’s darn important to be able to tell red from green and routinely has us test for c...

  • Medical Certification - Pilots with Leg Amputations

    James D. Lakin PhD MD FACP CFI|Jun 1, 2021

    More than 1.2 million Americans live with the loss or absence of a limb. Each year over 1,000 children are born with limb deficiencies. Over 130,000 amputations are performed annually as a result of trauma or disease, with 86 % of these amputations involving the legs. Of these, 93% are related to peripheral vascular disease — lousy circulation mostly due to diabetes, hardening of the arteries or cigarette-smoking. Modern prosthetic limbs allow many motivated amputees to achieve very active and productive lives. This sometimes involves f...

  • Death by Diphenhydramine: The Benadryl Bane

    James D. Lakin PhD MD FACP CFI|May 1, 2021

    If you look at the autopsy data of pilots killed in aviation accidents the No. 1 drug found in their bloodstreams is diphenhydramine. It is marketed as Benadryl® and a host of other brand names. You would think the most common killer would be something like marijuana, cocaine or other drugs of abuse, not that they didn’t pop up. But no, it’s common, old, you-can-buy-it-at-any-drugstore Benadryl®. Its generic name is diphenhydramine and it’s been around since 1946. It is one of a number of medications known as antihistamines. They work, as you... Full story

  • Breast Cancer and Medical Certification

    James D. Lakin PhD MD FACP CFI|Apr 1, 2021

    Breast cancer is common. Currently, the average risk for a woman in the United States to develop breast cancer sometime in her life is about 13%. That’s about a 1 in 8 chance. Fortunately, if it is detected early the outlook is good. That’s the reason screening mammograms are so important. When to start yearly mammograms is controversial. The Mayo Clinic recommends starting at age 40. The American Cancer society opts for age 45 and the U.S. Preventive Services Task Force, age 50. Obviously, if you have a family history of breast cancer, you...

  • Aviation Fluids: Put Them in the Plane Not You

    James D. Lakin PhD MD FACP CFI|Mar 1, 2021

    To get an airplane off the runway you’ve got to pump a lot of unusual fluids into her…avgas, oil, hydraulic fluid, deicing solvent. And let’s not forget the coffee and pop to pump into the pilot! There are many liquids involved in flying and contact with some of them is not completely benign. We usually don’t think much of it if we slosh a bit of Jet A on ourselves, but every one of the fluids I mentioned can cause trouble if they get in the wrong place in the wrong amount. A lot of aircraft, especially the larger ones run some of their s...

  • COVID-19 Vaccines: Get 'em Before They're Hot!

    James D. Lakin PhD MD FACP CFI|Feb 1, 2021

    t is my sincere hope that the day is near when I will not be devoting this column exclusively to Corona Virus Disease 2019 (COVID-19). However, more Americans are dead from COVID-19 than died in the entirety of World War II. Pilots are in a unique exposure position. So it’s critical that we understand our options in dealing with this pandemic. As I write we are seeing a surge from the post-Thanksgiving, Christmas and New Year’s gatherings. A new, more highly infectious strain of the virus is spreading across the country. It’s going to get w...

  • Seat Belts and Shoulder Harnesses: Use 'em!

    James D. Lakin PhD MD FACP CFI, CFII MEI Airline Transport Pilot FAA Senior Medical Examiner|Oct 1, 2020

    The NHTSA isn't the only federal agency that has fun crashing things! Our own FAA's Civil Aerospace Medical Institute (CAMI) in Oklahoma City has blasted a number of perfectly good airplanes to smithereens in the interest of aviation safety. One thing they have found is that both seatbelts and shoulder harnesses are pretty darn good things to have around-around you the pilot! None of us plan on having an accident or an incident. Yet we all know that in spite of our best planning and precautions...

  • Aeromedical Forum

    James D. Lakin PhD MD FACP, CFI CFII MEI Airline Transport Pilot FAA Senior Medical Examiner|Jul 1, 2020

    This spring I received a note from an airman wondering about his odds of getting off a Special Issuance. Five years previously he had a heart artery calcium scan which showed heavy calcification in one of his coronaries-arteries that supply the heart muscle with blood. He reported this to the FAA. They promptly requested additional studies including a stress test and imaging studies. These looked OK, according to the airman. However, they placed him on a Special Issuance requiring these tests... Full story

  • Aeromedical Forum

    James D. Lakin PhD MD FACP, CFI,CFII,MEI, Airline Transport Pilot, FAA Senior Medical Examiner|May 1, 2020

    A couple of months ago we talked about the then looming pandemic. Well here it is and it looks like it's going to be around for a while. The good news is that Minnesota has done an effective job of slowing the rate of viral transmission of SARS Cov 2 (Serious Acute Respiratory Syndrome Coronavirus 2) and reducing the rate of development of clinical Covid 19 (Coronavirus 2019) illness. The bad news is that the duration of the epidemic may be prolonged, albeit at a lower intensity. So assuming that you're not going to spend the next two years... Full story

  • Aeromedical Forum

    James D. Lakin PhD MD FACP, CFI,CFII,MEI,Airline Transport Pilot, FAA Senior Aviation Medical Examiner|May 1, 2020

    As I sit in my office at Airlake, a King Air is revving up its engines. Good Lord it's loud and I have the benefit of 30 yards separation and a wall between me and it. Pity the lineman that's out there waving his batons. Ever since Wilbur and Orrville ran their Flyer down the sand at Kitty Hawk the business of powered flight has posed a threat to the hearing of pilots. So how to retain what hearing you have after an adolescence of rock concerts? First of all, let's talk about sound. You may... Full story

  • Aeromedical Forum

    James D. Lakin PhD MD FACP, CFI,CFII,MEI, Airline Transport Pilot, FAA Sen. Medical Examiner|Apr 1, 2020

    How many months are we into winter? How many pounds have we put on? Since you can only get so much exercise from throwing around snow, it's hard to avoid the "Late Winter Couch Potato Syndrome"! Lack of physical fitness and overweight are bad enough for the Average Joe. It sets you up for anything from lower back pain to hypertension to heart attacks. For a pilot, deconditioning can lead to problems in stamina, alertness and the ability to respond to the emotional and physical stressors... Full story

  • Aeromedical Forum

    James D. Lakin PhD MD FACP, CFI,CFII,MEI,Airline Trans Pilot,FAA Sen. Aviation Medical Examiner|Mar 1, 2020

    One thing about the aviation community, we get around. We are exposed to many different terrains, population, cultures and, unfortunately infections. If you’re flying under Part 121 or 135 you often cover a lot of territory and come into contact with a lot of people and a lot of viruses. Many General Aviation operations also fall into that category. Given all that, a lot of pilots have been wondering about the Coronavirus epidemic that started in China in January. It is spreading. The possibility of coming in contact with it is not as remote a... Full story

  • Aeromedical Forum

    James D. Lakin PhD MD FACP, CFI, CFII, MEI, Airline Transport Pilot, FAA Sen. aviation Medical Examiner|Feb 1, 2020

    What better flying weather than a crisp clear February day in Minnesota. You’d think you were flying a helicopter with the short takeoff runs. The air is smooth and the visibility unlimited in bright sunshine. The reflection from the snow is dazzling. I sure hope you didn’t forget those sunglasses! Sunglasses are a very important and often underappreciated piece of a pilot’s equipment. They are critical to optimize visual performance in the cockpit. If you have a good pair, they will reduce eye fatigue, reduce the negative effects of harsh... Full story

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