Questions & Answers or FAQs
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Q 1. I can't do without coffee in the morning, can I have coffee before my medical examination ?
Ans : If you have been asked to come fasting or If you know you are required to do any blood tests like Blood Sugar or Cholesterol, you should not have coffee. You can have any amount of water you desire.
Q 2. I was asked to come fasting for my medical examination. How long do I need to fast ?
Ans : If you have been asked to come fasting, chances are that you might need to get a Lipid Profile or Cholesterol test done. For this it is advisable to fast for at least 12 hours. For a Blood Sugar test you need to fasting for at least 08 hours - if you are not sure what tests would be required it is safer to fast for 12 hours. So if your appointment is at 0800h, you should have your dinner by 2000h. And remember don't eat a heavy / fatty meal. Foodstuff like cheese, rich gravies, large amounts of red meat and alcohol can affect your cholesterol levels for upto 48 hours. Also, most commercially prepared food is quite rich to make it tasty. if you are travelling and have a medical exam planned - eat less, have a salad or take a packed meal from home. Please remember water intake is not restricted.
Q 3. I will be landing after a flight early morning, is it okay if I go straight to the clinic for my medical examination ?
Ans: Your circadian rhythm or biological clock controls the levels of almost everything in your body - Cholesterol, blood pressure, etc. If you have been up all night flying, your cholesterol may be elevated. Also, in some people the sleep deprivation causes the pulse rate and blood pressure to be a little higher. It is advisable to take an appointment on a day when you will be able to go after a good night sleep. The same also applies to partying late before a medical examination. While younger individuals may be able to get away with it, as you get older the body just cannot handle the abuse that well.
Q 4. I have been told my Blood Pressure is high but I feel fine. I am still young! Do I really need to take these pills ?
Ans: Blood pressure is also known as a "Silent Killer", as most people do not realise that they have high blood pressure till it is very late. Some people claim that they come to know when their BP is high but the only way to be reliably sure is measure it with a Blood pressure monitor at home or at a clinic.
An increasing number of people are getting high blood pressure these days and at a younger age than earlier due several factors. These include your genes (family history of hypertension), a sedentary lifestyle, increased pressures at work (off late poor financial & job security after the COVID pandemic has also contributed to the stress). People staying away from families have other pressures like eating commercially prepared food more frequently, staying up late due to time zone differences to keep in touch with loved ones, worrying about people back home.
Also, lot of individuals continue to maintain the same lifestyle (read partying !!) as they did when they were young, but as we age most individual's bodies are not able to keep up the same way as it could at a younger age.
High blood pressure may not cause any immediate problems, unless it is very high. But has a lot of long term side effects such as:
1. Myocardial hypertrophy / Left ventricular Hypertrophy or increased muscle mass of the heart (the higher the pressure the more the load on the heart (this acts almost like bulking up your biceps by going to the gym) - this also increases the oxygen demand of the heart which can lead to early Ischaemic Heart Disease and other complications.
2. High blood pressure also causes damage to the kidneys leading to kidney failure (Hypertensive Nephropathy) later in life
3. It also affects the eyes - causing something called Hypertensive Retinopathy
4. Most importantly, uncontrolled high blood pressure can precipitate a stroke or leak of blood into the brain which can cause paralysis and can be life threatening - this can cause serious incapacitation during critical phases of flight. And more importantly it may leave you crippled and dependant on others for the rest of your life. That will seriously affect your quality of life.
You may not realise it now but taking the pills for your hypertension is an investment in your long term well being - so that you can fly / work for longer and have a better quality of life in your old age.
Once you are diagnosed with Hypertension, you will most probably have to take blood pressure lowering medicine for the rest of your life (unless you reduce your weight and make serious changes in your lifestyle) but think of it this way - you eat food thrice a day - if taking a pill or two increases your life span by 10 years or improves your quality of life once you are older, it is definitely worth it.
Q 5. Aren't these blood pressure pills addicting ?
Ans: Addiction has a negative connotation. But chances are that once you are started on blood pressure medication you will have to take them for the rest of your life unless you make serious lifestyle modifications like reduce your weight, stop smoking, reduce salt intake, reduce alcohol intake, exercise regularly and sleep adequately. Also, if you have family history of early onset of high blood pressure - that predisposes you to developing hypertension earlier in life than the average person.
Q 6. I have been told my blood pressure is high. My blood pressure is fine when I measure it at home. I don't think I have high blood pressure. Can't I just take these pills for a few days before my medical so that the blood pressure comes down in time for the medical ?
Ans: All clinical studies and data linked to problems/complications due to high blood pressure are based on blood pressure readings in the clinic / doctor's office. Hence, doctor's office readings are important. In case you feel that your blood pressure increases when you go to the doctor's office, you can request for a test called a 24-hour Ambulatory Blood Pressure Recording, which can detected how much of the time your blood pressure stays high.
Taking medicine just before the medical exam to get a normal reading is not a good idea as you are only fooling yourself - in the long run if your blood pressure stays high the rest of the time it will damage your body systems and it is your own health that will get affected.
If you have high blood pressure I recommend that visit a qualified doctor and take appropriate medicines and undergo periodic tests as advised to prevent long term damage to your health and career. Do not self medicate.
Diabetes, Hypertension and Heart Disease are the commonest medical causes for people becoming unfit to work later in life. These days almost all regulators allow you to continue to fly / work as long you keep these under control with appropriate medicines. It not just about working today, it is also about working till retirement age and most importantly your quality of life after you retire.
Q 7. My blood sugar stays a little high, but I am really fine, I don't feel anything. Why should I bother to take medicines. I can just take medicines to beat the medical exam. Isn't this all just made up stuff to make money ?
Ans: High blood sugar or diabetes if not controlled, is like a termite infection that will damage all your body systems - eyes, heart, kidneys, nerves, etc, etc - just like high blood pressure mentioned above. High blood sugar also impairs the ability of your body to fight infections. Extremely high blood sugar can cause loss of a limb (diabetic foot) or coma and death.
There are a number of factors that contribute to high blood sugar:
- Genetics - It depends upon your genes that you inherit from your parents - if your parents or brother and sisters have diabetes - you are at a higher risk of getting diabetes
- Exercise - A sedentary lifestyle makes you more likely to get high blood sugar - even a walk for 40-45 minutes a day for 4-5 times a week will delay the onset of diabetes
- Food - Foods with more sugar or high glycaemic index will cause your sugar to spike. Even fruits with a lot of sugar can increase your blood sugar. Do not believe the myth that fruit sugar does not cause diabetes.
- Stress - sometimes the stress hormone can push up your sugar if you are pre-diabetic.
- Infections - infections can cause the blood sugar to increase in a poorly controlled diabetic but not in a non-diabetic.
Q 8. Why is high cholesterol such an issue ? Do I really need to take medicine to lower my cholesterol ? Aren't statins supposed to be bad for you ?
Ans: High cholesterol is a risk factor for Ischaemic Heart Disease (IHD) - basically high cholesterol leads to build up of plaques in blood vessels much like scale build up in old water pipes. High cholesterol will usually not cause serious damage overnight but the problem will manifest in your late 40s and 50s when your quality of life gets affected due to the arteries getting blocked in the heart and elsewhere.
There is a good cholesterol (HDL) which increases with exercise and a healthy diet. The bad cholesterol (LDL) and Triglycerides need to be kept under control. Statins is one of the class of medicines used to keep the cholesterol especially LDL and Triglycerides under control.
There are lots of unfounded stories about statins being harmful and conspiracy theories about big pharma, etc but there has been no proof / study that have proved that these medicines are harmful.
But there are enough studies that have proved that high cholesterol is a risk factor for heart disease. Various medical organisations like American Heart Association and European Cardiology Society still consider keeping cholesterol under control an important way to reduce the risk of IHD.
You are a very important part of the man-machine interface in aviation safety. Keeping you well is important. Also, we need to ensure a long productive career. Not taking care of your health now can have long term implications later in life.
Q 9. Is Sleep Apnoea (Obstructive Sleep Apnoea or OSA) a real thing ? Or is just a made up thing ?
Ans: Obstructive Sleep Apnoea has gained a lot of attention off late as it has been implicated in a number of cases of road accidents due to drivers falling asleep while driving / micro-sleeps (National Highway Traffic Safety Administration - Drowsy Driving) . It has been found to be an important contributor to Aircrew Fatigue (ICAO - Air Crew Fatigue Risk Management) and by the same coin to ATCO fatigue.
Untreated OSA has been linked to impaired sustained attention, poorer vigilance task performance, increased response time, increased irritability and poorer health related quality of life.
Q 10. I sleep just fine - I don't think I have Sleep Apnoea (Obstructive Sleep Apnoea or OSA) ?
Ans: The right person to ask is your spouse / partner - if you snore a lot and have been noticed to stop breathing/snoring in your sleep and then wake up with a start - chances are that you have sleep apnoea. Other symptoms of sleep apnoea include - perpetually feeling sleepy or feeling tired when you wake up despite having slept for an adequate time (7-8 hours), dozing off while driving (at a traffic light or otherwise), difficulty in concentrating, feeling tired all the time.
Sometimes the fatigue also makes you overeat in bid to get some energy to beat the fatigue. That can lead to weight gain.
In some people, an apnoeic episode while sleeping would be associated with a nightmare and dream of being choked / drowning/ not being able to breathe and then you wake up with your heart pounding and gasping for a breath. Some people experience the need to pass urine repeatedly at night and feeling very thirsty with a dry mouth when they wake up (must exclude diabetes which has similar symptoms).
Q 11. Is Sleep Apnoea (Obstructive Sleep Apnoea or OSA) only a problem in obese people?
Ans: OSA is pretty common amongst non-obese people too - in fact in one study 90% people with OSA were not obese.
Q 12. Why is Sleep Apnoea (Obstructive Sleep Apnoea or OSA) important ?
Ans: Sleep Apnoea is associated with a number of health problems
Short Term:
Frequent awakening / Sleep disruption
Poor sleep quality
The hypoxia triggers a surge of adrenaline - causing you to wake up with your heart pounding due to an increased heart rate and blood pressure, this also makes it difficult to sleep immediately - causing further disturbance in sleep.
Long Term Effects
Excessive daytime sleepiness
Poor vigilance at task - skipping steps in the check list, poor scan pattern, etc!
Increased response time - Emergency Response !
3-4 times increased risk of auto accidents - micro-sleeps / poor concentration / irritability
Increased risk of cardiovascular diseases and sudden cardiac death
Increased incidence of hypertension - And one reason for poor control of blood pressure is OSA
Increased risk of heart failure
Increased risk of stroke
Q 13. What is an AeroMedical Examiner / Aviation Medical Examiner / AME / Designated Aviation Medical Examiner (DAME)?
Ans: An AME or DAME is a doctor with specialised training in Aviation Medicine and he or she is authorised and licensed by the civil aviation authority of the region / country to conduct medical examinations on their behalf. The training includes an understanding of how the human body behaves at altitude, during low oxygen, low temperatures, disruptions in circadian rhythm, medication and other such stresses of aviation. In addition, they are trained to evaluate how an illness could get worse during a flight or have implications on flight safety.
They also get a practical exposure to an aviation environment including flying in the cockpit in a simulator of a commercial aircraft and air traffic control towers / area control.
Most civil aviation authorities like GCAA, FAA, CASA, etc maintain an updated list of AMEs on their website. Some authorities also authorise certain specialists like Ophthalmologists, Cardiologists, etc to conduct evaluations for them. These specialists too need to undergo training to understand the requirements of an aviation environment like AMEs.
Q 14. Can I renew my GCAA Medical Certificate earlier ? Will the expiry date change ?
Ans: GCAA allows you to renew your medical certificate 44 days in advance - The expiry date will remain the same. This gives you peace of mind that you will not have to renew it at the last minute and also gives you leeway to cater for your flight schedule and personal commitments. Also, some companies might penalise you if you cannot fly due to an expired medical certificate - it is better to renew on time.
In case you need to renew it more than 45 days in advance - you need to take clearance from GCAA by email with reasons for the same. Ask your AME for the email ID to contact.