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  • The Blues in the Wild Blue: Minor Depression

    James D Lakin|Nov 1, 2022

    Everybody gets “down in the dumps” now and then. Marital or financial problems, a death in the family, job stress, change of location…you name it. Life can be darn hard and get the best of you for a while. Fortunately, the FAA realizes this. They recently gave guidance to us Aviation Medical Examiners (AMEs) as to how to handle an airman who honestly reports depression arising from a challenging situation--- minor or situational depression ( com/watch?v=FebHBtwezwE). Mi...

  • 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...

  • 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,...

  • 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...

  • 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 defini... Full story

  • 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...

  • 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...

  • 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...

  • 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...

  • 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...

  • 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,...

  • 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,...

  • 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...

  • 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...

  • Alcohol and Aviation: They Don't Mix

    James D Lakin PhD MD FACP CFI CFII MEI|Dec 1, 2020

    OK, "tis the season to be jolly." Don't get me wrong. I'm really big on jolly. Problem is I'm also really big on making it through the holiday season alive and with my pilot's license intact. An important part of achieving that noble goal is knowing where, when and how much of Christmas cheer to consume. You know as well as I do that the successful outcome of any flight depends upon the ability of the pilot to make myriad decisions rapidly and correctly, to see and avoid, to communicate...

  • Aeromedical Forum

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

    Headaches and aviation are frequent companions. Anyone who has made a long cross country flight knows why. Hours of engine noise and vibration, traffic, buildups, headwinds that make your fuel consumption jump…any and all are headache generators. That’s just part of flying. So why would the FAA care about something that’s pretty much built in to aeronautical endeavors? Well, there are headaches and there are headaches. What I’ve been talking about is what are referred to as tension headaches, that achy feeling in your temples, sometimes...

  • 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...

  • On to College for Aviation: What You'll Need to Get off the Ground

    James D. Latkin PhD MD FACP CFI CFII MEI|Sep 1, 2020

    Summer's days are passing by and COVID-19 willing, it will be off to college for a number of aspiring pilots. As Minnesotans we are blessed with a couple of first rate aviation programs at Minnesota State and up at the University of North Dakota. Thus, I've been talking with a number of soon to be college students and their parents about preparing to pack off for education in the wild blue. I've been impressed with the intelligence and motivation of so many of these students, two critical... Full story

  • Aeromedical Forum

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

    I was planning a spine-tingling discussion on the use of seatbelts in aviation for this month, but it seems like the questions at the FBO are overwhelmingly about something else, COVID-19. Rightly so. As we try to inch back to a semblance of normalcy in the aviation community, we increasingly risk infection, hospitalization or even death. The rate of infection is skyrocketing nationally. Fortunately, here in Minnesota we have not seen exponential increases but, at this writing infection rates are beginning to creep up again. As pilots, we are...

  • 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

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