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7-2008

Flight Physician - July, 2008

Civil Aviation Medical Association

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Repository Citation Civil Aviation Medical Association (2008). Flight Physician - July, 2008. .

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VOL. 11, NO. 2 JULY 2008

President's Achieving and Maintaining Pilot Health Vector Check 2008 We pour anything we want into our bodies We want to remain relevant as an without a second thought. We'd never treat organization and valuable to our members. our airplanes like that. In This Issue BY SUSAN NORTHRUP, M.D. BY DAVID BRYMAN, D.O., FCAMA Senior International Aviation Medical Examiner EXEC. V.P.'S REPORT 3 s we enter the summer, it is always good FAA, Transport Canada, JAA, Australia, New Zealand to pause and evaluate where we were, TAMISIEA AWARD PRESENTED where we are, and where we want to go. A ILOTS ARE GENERALLY fit to fly and can meet TO GERMAN PROFESSOR ....5 The Executive Committee held a strategy meeting the minimal health standards set forth by in Dallas/Ft. Worth 31 Jan to 1 Feb 08 and met the Federal Aviation Administration. It's SUSTAINING, CORPORATE, AND again in Boston 1 1 May 08 to discuss just that! As P very rare that they will fail an FAA medical with a result, we are planning some important changes, LIFE MEMBERS 6 some unknown disqualifying medical condition which are listed below. discovered at the time of their flight physical. ANGINA PECTORIS: CAN I It is well known that simply passing an FAA NEWSLETTERS CONTROL IT? 10 medical doesn't mean the pilot is healthy. I always The first major change you will see is four-page encourage my pilots to be thoroughly evaluated newsletters between published FlightPhysician is- NEW MEMBERS 11 by their physician with a good wellness exam, sues. We will publish the FlightPhysician quarterly which includes lab work and cancer screening and intersperse newsletters with calendars and SONIC BOOM EFFECTS 12 tests screenings that are not usually done at the items of interest. We are still looking for articles, AME's office. pictures, and editorials for both! FRIENDS 'GONE WEST' .... 13 THE BASICS RECRUIT NEW MEMBERS AND SPONSORS Occasionally, I'm asked questions regarding ANNUAL MEETING AGENDA 14 CAMA Currently has 686 members, represent- health maintenance and fitness during an FAA ing 45 countries. Our members include federal, ON THE HORIZON 16 Continued on page 2 Continued on page 4 FLIGHT PHYSICIAN July 2008

President's Column from page 1 military, aviation industry, Sunday at the Aerospace added a number of exams required to private aviation medicine Medical Association's An- demonstrate proficiency — namely ten practitioners, pilot advo- nual Scientific Meeting will exams per year. There are many AMEs cates, and scientists. We have continue! Every year our who do not meet this requirement. If eight corporate sponsors. attendance has gone up, and you are an AME, it would be worth BUT, we'd like to have more the speakers continue to be your time to review this document. members and sponsors! So, Dr. Northrup outstanding. Next year, we It is available at www.faa.gov/about/ please, encourage your peers will work with the Airline office_org/headquarters_offices/avs/ to join. If you know of any corpora- Medical Directors Association—they offices/aam/ame/guide/ tions that might be interested in hold their annual meeting on the becoming a sponsor, pass their details Saturday prior to AsMA—to pro- SURVEY COMING to the CAMA office. vide a weekend dedicated to clinical Finally, CAMA claims to be a voice of medicine. Both the AMDA Scien- civilian aerospace medicine. We regu- MEMBER INVOLVEMENT tific Meeting and CAMA Sunday larly interact with aviation authorities We set another goal of increased are FREE! In addition, the AsMA and regulators. My committee and I member participation. We continue Scientific Program has developed a want to be sure we are accurately re- to look for articles for our journal strong clinical track this year, thanks flecting YOUR concerns, wishes, and and our page in Aviation, Space, and to Jack Hastings, who was the AsMA desires. We are finalizing a survey you Environmental Medicine. We would President last year. We would love will see in the near future. Please take also like volunteers for committees. to see you in Los Angeles next year. a few minutes, fill it out, and return These would operate predominately Details for the AsMA meetings are it. I plan to report on the results in via E-mail. Also, if you are interested available at www.asma.org. a future article. We want to remain in serving on the Board (which meets relevant as an organization and valu- three times per year) please let me, AWARENESS able to our members! I thank you in David Millett, or Jim Heins know, Aviation certification issues con- advance for your participation. and we will pass your request to the tinue to be an area of interest. Imple- Please note my E-mail address has Nominations Committee. mentation of the Age 65 law will changed to [email protected] prove interesting, but welcome. There H> MEETINGS WITH OTHERS is a new FAA Order [Order 8520.2F] In addition to our outstanding for Aviation Medical Examiners October Scientific meeting, CAMA available. One significant change

HONORS NIGHT (May 15, 2008). CAMA participation at the Aerospace Medical Association's Annual Scientific Meeting is growing each year and will continue! FLIGHT PHYSICIAN July 2008

Executive Vice President's Report FL/GHTPHYSICIAN BY DAVID P. MILLETT, M.D. MPH

T is AN HONOR and a pleasure 2011. For 2012, we are looking for a A Publication of the Civil Aviation Medical Ifor me to be CAMA's Executive possible trip back to Canada. Association (CAMA) Vice President. The past Following the Board meeting, two months I have been the CAMA luncheon, as usual, was working closely with Jim a sellout with a large, enthusiastic, President Susan Northrup, M.D. Harris, and his guid- crowd. Board member Warren Silber- ance and assistance have Millett man gave an excellent update on FAA President-Elect been awesome. I owe certification issues. I was impressed James N. Heins, M.D. Jim a big thanks. The good news is by the number of current and past Secretary-Treasurer that he will continue to assist me at presidents of CAMA and AsMA in Gordon L. Ritter, D.O. least through the annual meeting in attendance. Executive Vice-President October. He and Sammie also plan to CAMA had a table at the AsMA David P. Millett, M.D., MPH attend future annual meetings. Honors' Night dinner. Several promi- CAMA's participation at the nent people were at our table, in- F//gMPhysician Editor AsMA meeting in Boston last May cluding member and frequent Flight James N. Heins, M.D. was outstanding. The CAMA Sun- Physician contributor, Bob Dille, Associate Editors day was the best ever with a program who was the recipient of the Marie MarkC. Eidson, M.D. arranged by our Vice Presidents for Marvingt Award. Petra A. Illig, M.D. Stephen Leonard, M.D. Education, David Bryman and Alex Finally, it is my impression that Alex M. Wolbrink, M.D. Wolbrink. The speakers were world- CAMA is alive and well. I look Ingrid Zimmer-Galier, M.D. class and the topic, "Current Issues forward to moving CAMA forward in Aviation Medicine," was well- and I appreciate your encouragement CAMA Photo Historian M. Young Stokes III, M.D. received. The audience numbered and support. about 80, and the participation was FP Historian, By-Laws/Constitution stimulating. A big CAMA thanks to A. Duane Catterson, M.D. David and Alex. The editors of F//g/?fPhysician The next day, the welcome submission of articles, CAMA Governing Board letters to the editor, news bits, met just before the CAMA interesting aeromedical cases, and photos for publication. Please luncheon. The attendance mail text in typewritten form or on numbered an impressive floppy disk (MS Word preferred) 15. Some members had to: James N. Heins, M.D. traveled all the way to Bos- [email protected] ton just for this meeting. Many important issues were David P. Millett, M.D., MPH addressed, and you will be CAMA Headquarters P.O. Box 2382 hearing more about this in Peachtree City, GA 30269-2382 the future. The locations of Phone:(770)487-0100 future meetings were deter- Fax: (770) 487-0080 mined: Rochester, Minn., E-mail: [email protected] in 2009; Pensacola, Fla., in MARIE MARVINeT AWARD. Dr. Bobl^ille" 2010; and Tucson, Ariz., in proudly displays his new trophy as friend looks on. FLIGHT PHYSICIAN July 2008

from page 1 FOOD QUALITY debt and will need to sleep longer The quality of food is also as im- to pay that debt. Lack of good sleep medical evaluation. In discussing portant as the amount consumed. will cause daytime fatigue, irritability, healthy lifestyles I think that there are High protein food is much better overeating, obesity, difficulty in con- a few basics that lead to good health. than high fat or high carbohydrate centrating, and more errors. A tired In my opinion, the most important foods. For example, baked chicken, pilot is potentially dangerous because of these are healthy eating, exercising, fish and lean meat rather than pasta, most times they are unaware of their sleep, and controlling stress. potatoes, and French fries. Try to fatigue and make the flight anyway. avoid a lot of red meat, fried, or fatty I rarely every hear a pilot admit that OVERWEIGHT foods. Very few pilots that I know of they are too tired to fly. It's obvious in our country that can eat a cheeseburger for lunch and overweight and obesity are of epi- not gain weight during that day. STRESS DOWN demic proportions. Unfortunately, Managing stress is perhaps the most this problem is as prevalent in our ALCOHOL difficult task for the healthy pilot to pilot population as in the general Also, remember that alcohol has accomplish. It is difficult to not allow population. Male pilots 40-60 years no nutrition value at all. It is the ulti- stress to keep us up at night worrying. old with a 3rd-class medical are mate empty calorie, and consumption Stress can lead to depression, anxiety, 50% overweight and 25% obese should be in reasonable moderation. and unhappiness if we allow it to rule (females 40-60 years-old are 27% our lives. Stress can be better managed overweight, 14% obese). I think EXERCISE! by increasing exercise and following a much of the problem with over- Exercise is very important for healthy diet. It's easy to advise pilots weight and obesity stems from poor overall fitness and endurance. A pilot not to worry about things out of their food choices, too many calories should exercise at least three times per control, but I know we all do it. Once consumed, sedentary life style, and week with varied exercises and weight in a while it is good to evaluate your genetic predisposition. lifting, if possible, to maintain lean stress level to see if you're allowing it body mass. Cardiovascular fitness is to get out of control. LOSE IT improved if the heart rate is increase It is absolutely essential for health to 80% of maximum heart rate (220— SUMMARY maintenance and wellbeing to de- age = maximum heart rate). Maintain Flying our aircraft is a complicated crease your weight if overweight. Even this heart rate for at least 15 minutes task that requires us to be as fit as a 10% weight loss will add years of (longer time is better if possible). A possible. Our bodies are machines life and decrease health risks. One brisk walk is an excellent exercise just like our airplanes and must be simple solution is to decrease the and can easily be done three to four maintained, fueled properly, and amount of calories consumed. I'll bet times per week. There is no need for have rest between flights to function most pilots can decrease their portion expensive gym memberships. well. It's odd that we pour anything of food by 50% and not even notice we want into our bodies without a an increase in appetite. We really do REST UP second thought. We would never treat "supersize" meals to ridiculous levels Pilots are notorious for working our airplanes in that way. I think it's when going out to eat at a restaurant. schedules that are not conducive to obvious that if we use the wrong fuel In my observation, a normal potion getting a good night's sleep. Early or fail to maintain them they will get for one person at a Mexican or Italian departures, jet lag, and working more sick and wind up out of service. restaurant can generally feed a family than one job all add to the problem. of four. Good restorative sleep is unaided by The views and opinions in this article are Dr Bryman's and do not represent alcohol or sleeping pills and lasts ap- the FAA, Transport Canada, Australia proximately 7-8 hrs per night. If you CASA, or the New Zealand CAA. sleep less, you will develop a sleep FP FLIGHT PHYSICIAN July 2008

John A. Tamisiea Award Presented to German Professor, Dr. Ewe Steuben BY DAVID MILLETT, M.D.

N HONORS NIGHT at the an- Onual scientific meeting of the Aerospace Medical Association, in Boston, Professor Dr. Ewe Steuben of Germany was awarded the John A. Tamisiea Award. This award is sponsored by CAMA and is "awarded annually to an Aviation Medical Examiner or other individual who has made an "outstanding contribution to the art and science of aviation medicine in its application to the general aviation field." The award is named for Dr. John A. Tamisiea of Omaha, NE, At the May 16, 2008, ceremonies, the Tamisiea Award was presented who had a distinguished career as a to Dr. Ewe Steuben by AsMA President and former CAMA president, physician in both world wars and as Dr. John D. Hastings (right) and by current CAMA president, Dr. Susan E. Northrup. one of the original Aviation Medical Examiners appointed in 1927. He Medical Examiner for both the Unit- Academy of Aviation and Travel also provided medical support for ed States and The European Joint Medicine. Dr. Steuben has authored Boeing Air Transport in Omaha. Aviation Authorities. He is the head numerous scientific publications and Professor Dr. Steuben has had of Lufthansa's Department of Avia- is considered to be a world expert in a distinguished career in aviation tion Medicine and Tropical Disease aviation medicine. medicine. He is a pilot and Aviation and is the Director of the German FP

CAMA members enjoying food and fellowship: It was an excellent luncheon turnout at the AsMA annual scientific meeting in Boston. FLIGHT PHYSICIAN July 2008

Civil Aviation Medical Association SUSTAINING, CORPORATE, AND LIFE MEMBERS The financial resources of individual member dues alone cannot sustain the Association's pursuit of its broad goals and objectives. Its fifty-plus-year history is documented by innumerable contributions toward aviation health and safety that have become a daily expectation by airline passengers worldwide. Support from private and commercial sources is essential for CAMA to provide one of its most important functions: that of educa- tion. The following support CAMA through corporate and sustaining memberships:

Sustaining Members

James R. Almand Jr., M.D. Forrest M. Bird, M.D., Ph.D. Jeffrey M. Bishop, M.D. Stephen V. A. Blizzard, M.D. John R. Capurro, M.D. A. Duane Catterson, M.D. Frank J. Ceravolo, M.D. George H. Coupe, D.O. Gary E. Crump, P.A.Daniel M. Dietrich, M.D. R Robert Glatz, M.D. James N. Heins, M.D. Hugh O'Neill, M.D. Gordon L. Ritter, D.O. Robert A. Stein, M.D. Jan Stepanek, M.D. James L. Tucker Jr., M.D. H. Stacy Vereen, M.D. Rodney E.L. Williams, M.D. Ingrid Zimmer-Galler, M.D.

Corporate Members

Banyan International Corporation Continental Airlines Data Transformation Corp. P.O. Box 1779 9900 Richmond Ave. 108-D Greentree Road Abilene, TX 70604-1779 Houston, TX 77210-4807 Turnersville, NJ08012 Medaire, Inc. Sanofi Aventis Stereo Optical Company 80 East Rio Salado Parkway Kathleen B. Briggs 3539 North Ken ton Avenue Suite 610 300 Dogleg Drive , IL 60641-3819 Tempe, AZ 85281-9107 Williamsburg, VA 23188-7409 Phone: 800-344-9500 Percussion Aire Corp. Rurnmel Eye Care, PC. Titmus Optical P.O. Box 817 1022 Willow Creek Rd. 3311 Corporate Drive Forrest M. Bird, M.D., Pres. Prescott,AZ 86301-1642 Petersburg, VA 23805-9288 Sandpoint, ID 83864-0817 Harvey Watt & Company, Inc. P.O. Box 20787 Atlanta, GA 30320

Life Members Frank H. Austin, M.D. Rodney D. Steward, M.D. Halford R. Conwell, M.D. Thomas Nguyen, M.D. M. Young Stokes III, M.D. Donna Ewy, M.D. Michael G. Nosko, M.D., Ph.D. Salil C. Tiwari, M.D. Ernst J. Hollman, M.D. Michael A. Pimentel, D.O. Lars Tjensvoll, M.D. Stephen M. Kirkland, M.D. Robert M. Roeshman, M.D. Dottie Hildbrand Trembly, R.N. Andrew H. Miller, M.D. Mark S. Rubin, M.D. Harold N. Walgren, M.D. David P. Millett, M.D. Sergio B. Seoane, M.D. Alex M. Wolbrink, M.D. Story Musgrave, M.D. Kazuhito Shimada, M.D.

Thank you for supporting the Civil Aviation Medical Association FI/G//TPHYSICIAN July 2008 STEREO OPTICAL, A TRUI VISION SCREENING FOR OVER 50 YEARS.

OPTE

Forehead Rest Pressure Bar Ensures proper patient position. (Includes disposable forehead tissues.)

Controlled Lighting Lightweight, Portable For the most accurate Built in handle for easy color vision testing transport. available. Access Doors For easy patient/instructor interaction. Peripheral Test Test vision on a horizontal r Near/Far Point Indicators plane. Stimuli at 85, 70, .; Illuminates at proper position and 55 degrees temporal ]| to verify test selection. and nasal.

Distance/Near Lens Systems Two separate testing ports for accurate distance and near testing. Test at 32 inches for intermediate testing.* Tilt Activator Height adjustable to accommodate all patients. TEST PACKAGE SLIDE # 1 Peripheral Test Slide SLIDE # 2** Distance Letter Acuity Monocular/Binocular (20/200-20/20) SLIDE # 3** Pseudoisochromatic Color Perception SLIDE # 4** Near Letter Acuity Monocular/Binocular (20/100-20/20) SLIDE # 5** Lateral Phoria (1 Diopter Increments) SLIDE # 6** Vertical Phoria (1/2 Diopter Increments) SLIDE # 7 Stereo Depth Perception (400-20 Seconds of Arc) SLIDE # 8 Fusion SLIDE # 9 Distance Tumbling "E" Acuity Monocular/Binocular (20/200-20/20) SLIDE #10 Tumbling "E" Color Perception SLIDE #11 Muscle Balance (Combination Lateral & Vertical Phoria) SLIDE #12 Distance Allen Test (20/100-20/30) * This is a requirement for alt airmen over the age of 50. ** These tests are required for F.A.A. vision exam. » Includesi i-i :

Ampules Airway Equipment Benadryl 1ml 50mg/ml (2) Airway, Pediatric (1) pinephrine 1ml 1:1,000 Img/ml (2) Airway, Small Adult (1) Airway, Large Adult (1) Inhalant Albuterol Inhaler 17gr (1) Manual Resuscitation AmbuBag(l) Needles & Syringes Oral Medications Mask, Pediatric (1) 3cc, 22 gauge x 1" (2) Acetaminophen 325gr (4) Mask, Small Adult (1) 3cc, 25 gauge x 5/8" (2) Aspirin 325gr (4) Mask, Large Adult (1) 18 gauge xl 1/2 "(1) Diphenhydramine 25mg (4) CPR Mask Adapter (1) 20 gauge x 1 1/2" (1) Nitroglycerin l/150gr(25) 22 gauge xl 1/2" (1) Miscellaneous Equipment Prefilled Syringes Alcohol Sponges (2) Reference Materials Atropine Sulfete 5ml (2) Gloves (1 pr.) AHA Algorithm Book (1) Dextrose 50% 50ml (1) Scissors (1) EMK Contents Placard (2) Epinephrine 10ml 1:10,000 (2) Tapc(l) Seals: Red, Yellow, Green (1 ea) Lidocaine 2% 5ml (2) Tourniquet (1) Monitoring Equipment l.\f. Equipment Blood Pressure Curf(l) ].V. Catheter 20 gauge x 1" (2) Stethoscope (1) I.V. Set w/Y-sitc and clave (1) Sodium Chloride, 500ml bag (1)

BILLING INFORMATION: SHIPPING INFORMATION: OF DIFFERENT FROM BILLING.)

Name:, Name: -

E-Mail Address:_ E-Mail Address:

Company/Organization:. Company/Organization:

Street Address: Street Address:

P.O. Box Number:. P.O. Box Number:,

City:. City:.

State/Province: , ZIP/Postal Code:. State/Province:. . ZIP/Postal Code:

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Credit Card: D American Express O Discover u MasterCard u VISA Quantity:

Credit Card Number: ___ Exp. Date: Requested Delivery Date: I For Airlines

Dimensions: 13.5" xl 0.75" x 6.25" Weight: 8lbs. FLIGHT PHYSICIAN 10 July 2008

Angina Pectoris: Can I Control It exertion or emotional stress, either. and Continue Flying? Attacks can be very painful and The second in a series of articles describing in greater detail the 15 usually occur between midnight medical conditions that are automatically disqualifying and 8 a.m. according to the FAA Variant angina is due to transient BY THE NATIONAL PILOT ASSOCIATION coronary artery spasm. About two- thirds of people with it have severe NGINA PECTORIS is chest pain People with unstable angina have coronary atherosclerosis in at least or discomfort that is the re- unexpected episodes of discomfort one major vessel. The spasm usually Asult of myocardial ischemia, or pain that most commonly occurs occurs very close to the blockage. which is caused by an imbalance when they are at rest. The resulting Angina pectoris is treated with between myocardial (heart muscle) discomfort or pain can possibly be drugs that affect the blood supply blood supply and oxygen demand. more severe or prolonged than typical to the heart muscle or the heart's de- Angina is a common presenting angina, particularly if is the first time mand for oxygen, or a combination symptom (typically, chest pain) experiencing the problem. As stated of both types. Drugs that affect the among patients with coronary artery earlier, the most common cause blood supply are coronary vasodila- disease. There are several causes for is reduced blood flow to the heart tors; they cause blood vessels to relax. this, but the most common is that muscles due to atherosclerosis (nar- When this happens, the opening one or more of the heart's arteries has rowing of the coronary arteries). An inside the vessels (the lumen) gets either narrowed or is blocked. The artery may be narrowed or partially bigger. Then blood flow improves, resulting insufficient blood supply is obstructed by a blood clot or plaque letting more oxygen and nutrients referred to as ischemia. buildup. Occasionally, however, reach the heart muscle. The heart's Typically, angina is an uncomfort- inflammation or infection can also demand for oxygen can be assisted able pressure, squeezing or fullness, or cause angina. with drugs that reduce blood pres- even pain in the middle of the chest Unstable angina is an acute sure, which reduces the workload on area. However, the discomfort may coronary syndrome and should be the coronary system (and the heart) be felt in the shoulder, back, arm, treated as an emergency. and reduces the need for oxygen. and even the neck and jaw area. The People with new, worsening, or Drugs that affect the heart rate have discomfort or pain that results from persistent chest discomfort should a similar effect, the most common angina pectoris can be quite debilitat- be evaluated in a hospital emergency being beta-blockers and calcium ing. There are many types of chest department or "chest pain unit" antagonists. pain that can be totally unrelated to and monitored carefully. They're at Since there are several types of oral angina such as heartburn and a severe increased risk for medications, we will take a quick look lung inflammation. • Acute myocardial infarction at each type of oral medication. Angina most often occurs when (heart attack) Aspirin. Aspirin is an antiplatelet the heart needs more blood than is • Severe cardiac arrhythmias. agent that prevents platelet aggrega- being supplied. People with stable These may include ventricular tion by irreversible cyclooxygenase angina have episodes of discomfort tachycardia and fibrillation. inhibition with subsequent sup- or pain that are generally predict- • Cardiac arrest leading to sud- pression of thromboxane A2. The able. Running between flights may den death antiplatelet effect can last as long as possibly trigger an attack, while seven days. simply walking might not. Angina Variant angina pectoris is also Nitroglycerine. Nitroglycerine can happen during physical exercise, called Prinzmetal's angina. It gener- relaxes the veins and the coronary severe temperature fluctuations, and ally occurs spontaneously and nearly arteries. By relaxing the veins, it while enduring a period of intense always occurs when a person is at reduces the amount of blood that emotions. rest. It usually doesn't follow physical Continued—>• FLIGHT PHYSICIAN 11 July 2008 returns to the heart and eases the Atherectomy. A catheter with a NEW MEMBERS heart's workload. By relaxing the rotating blade on the end is used to Phillip W. Buys, M.D. coronary arteries, it increases the cut away the blockage. If necessary, a P.O. Box 29248 Moreletapark heart's blood supply. stent is placed at the site of the block- Pretoria, South Africa Phone: 27-12-9985428 The heart's demand for oxygen age to keep the artery open. Aviation Medicine AME can be assisted with drugs that Coronary artery bypass graft Kathy Fedack, M.D. reduce blood pressure, reduces the surgery. A blood vessel is grafted P.O. Box 1932 Evergreen, CO 80437-1932 workload on the coronary system and used to route blood around the Phone: 303-324-1254 (and the heart), and reduces the need blocked part of the artery, allowing Anesthesiology AME for oxygen. the blood to travel around or bypass Robert Hamilton III, M.D., Drugs that affect the heart rate the blockage. 1328 Wertz Ave., NW, Suite A Canton, OH 44708-4196 have a similar result, the most Before performing any of these Phone: 330-453-7339 common being beta blockers and procedures, the location(s) of any OB/GYN Pilot AME calcium antagonists. blockage(s) must be found. This David Henry, M.D. P.O. Box92663 Beta blockers. These also work requires coronary arteriography, dur- Anchorage, AK 99509-2663 by reducing myocardial oxygen de- ing which a doctor guides a catheter Phone: 907-248-9363 Internal Medicine Pilot AME mand and by decreasing the heart through an artery into the coronary rate and myocardial contractility. arteries. Then the doctor injects a Vimal Scott Kapoor, M.D. Suite 2312-99 Harbour Sq. Calcium antagonists. Causes liquid dye through the catheter and Toronto, Canada M5J 2H2 smooth muscle relaxation, resulting high-speed X-rays record the course of Family Practice AME in peripheral arterial dilation and the dye as it flows through the arteries. Ernest Lee, M.D. afterload reduction. The blockage(s) can then be identified 9855 East Redfield Road Scottsdale, AZ 85260-3837 Angina pectoris, if severe enough, by tracing the flow. Phone: 480-661-9709 may need a medical procedure to These are just a few examples of Family Practice AME correct. Since there are several types different medications and treatments Julian C. Levin, M.D., MPH 213 King George Street of procedures, we will take a quick that are used to treat angina pectoris. Daniel Island, SC 29492 look at each of the procedures. This is not a complete listing of medi- Phone: 843-856-1233 Family Practice Pilot AME Percutaneous transluminal cations or treatments that are available coronary angioplasty. PCTA, to use for this condition. You should William E. Mayher, III, M.D. P.O. Box71325 angioplasty, balloon dilation, or consult your physician for more de- Albany, GA 31708-1325 balloon angioplasty. A catheter (a tailed information on the treatment Phone:229-869-1071 Neurosurgery Pilot AME thin plastic tube) with a balloon at of angina pectoris. Neal Secrist, D.O. the end is inserted into an artery Remember, there are some individual 2435 Timbercreek Court and moved to where the blockage is medications for, as well as certain com- Wichita, KS 67204-2559 Phone: 316-831-9222 located. The balloon is then inflated, binations of medications that the FAA Family Practice Pilot AME and the resultant pressure opens the does not permit to be taken while on Ray Steinhauser, M.D. fatty plaque deposit. The catheter is flight duty. 1070 Township Road, f 713 withdrawn and, if necessary, a stent The FAA does not issue a list of Ashland, OH 44805-9773 Phone: 419-496-9773 is placed at the site of the blockage approved medications; therefore, you Anesthesology Pilot AME to keep the artery open. must check with your Aviation Medi- AbeTimmons, M.D. Laser angioplasty. A catheter cal Examiner to see if the FAA permits 135 Woodland Hill Road Greenfield, NH 03047-2486 with a laser on the end is used to the medication that your treating Phone: 603-547-2456 open the blockage and, if necessary, physician wants you to use. Occupational Medicine AME a stent is placed at the site of the FP The Civil Aviation Medical Associa- blockage to keep the artery open. tion, Welcomes Our New Members to the Growing Body of Aviation Medical Advocates! FLIGHT PHYSICIAN 12 July 2008

Unpublished Experience With Sonic Boom Effects There was concern about public acceptance of sonic booms because of possible structural damage; unknown effects... and their being primarily for the benefit of relatively few passengers in a big hurry. BY J. ROBERT DiLIE, M.D.

HUCK YEAGER flew supersonic in a Bell X-l at Muroc Air CBase, California, on Oct. 14, 1947. Within ten years Britain, France, the USSR and the U.S. had supersonic military aircraft; ours in- cluded at least eight models of fighters and a supersonic bomber, the B-58 Hustler. Sonic booms followed along their flight paths, resulting in claims for structural damage, broken win- dows, damaged items that fell from walls and shelves, chickens not laying Original cartoon that appeared in The Daily Oklahoman Nov. eggs, mink on farms not breeding and 12,1964 (reprinted with permission). fish in commercial ponds being killed. Most of those affected would forgive Regular supersonic flights were final or official data). On the lighter annoyance for national defense, but made over Oklahoma City in 1964 side, some who relied on the 7 AM they wanted compensated for their to determine more about structural and 7:20 AM regular booms for losses. However, there was skepticism damage and human tolerance. It was awakening for work, were sometimes for many claims. recognized that OKC, started from late when weather or mechanical During the next ten years there scratch after the Land Run of 1889, problems prevented that flight. They were developmental efforts for su- had fewer houses with plastered walls. complained, too. personic passenger aircraft. In 1967, Two of the largest employers were Later that year, between Nov. 17 the Boeing Company received a aviation-related (Tinker AFB and the and Dec. 15, 1964, the effects of contract to build two prototype su- FAA Aeronautical Center). There was 600 booms up to 16 psf on a variety personic transports after winning an no medical involvement in the study. of instrumented structures built at FAA-sponsored design competition Dr. [Stanley] Mohler's Executive Of- White Sands Missile Range, N.M., over Lockheed and North American ficer had a splinter penetrate 3/4-inch were determined. This time there was Aviation entries. On Dec. 31, 1968, under a thumbnail when he was medical involvement - by me. The the [Russian-built] TU-144 made its startled by a boom. His chained dog original of the political cartoon for first flight and, about two months jumped over a fence after a boom and the event (shown above) was given to later, the British/French Concorde was hanging halfway down the other me by the artist. It is being reprinted completed its maiden flight. In the side; it was rescued only because of with permission of The Daily Oklaho- U.S., there was concern about public immediate awareness of this situation. man, copyright Nov. 12, 1964. acceptance of sonic booms because of Neither of these events was reported! Observers from the USAF, Eng- possible structural damage; unknown There were 8,000 complaints, 1,443 land, and France were present and effects on humans, animals, and the damage claims, 1,191 rejections, and expected the opportunity to study environment; and their being primar- 130 awards for damages that averaged animals in situations where claims ily for the benefit of relatively few $54. Forty percent of claims were had been made and even paid. Their passengers in a big hurry. for breakage of glass. (These are not studies were not approved. Continued—» FLIGHT PHYSICIAN 13 July 2008

said to be America's oldest pilot. He captain for . Under Friends 'Gone West' learned to fly as a teenager. He liked the old "age 60" rule, he had to retire to tell people that he never met his as an airline captain in 1965. flight instructor. That statement was He continued to fly for himself, true because he taught himself to fly particularly in his Beech Bonanza. only with the aid of a flight manual. In reviewing his career, he is probably After a few flights, he began his best known for his flying the 80-year aviation career as a barn- from the roof of the Philadelphia post stormer, primarily giving people a office to the airport in Camden, NJ. JOHN M. MILLER, AVIATION PIONEER ride in his plane for a dollar a flight. During 1939, he made five round- Many times he was able to cram two trip mail runs a day with his autogyro. ON JUNE 23, 2008, the aviation customers at once in the front seat In typical Miller fashion, he got in the world and CAMA lost a friend and of his biplane. During the 1920s, he autogyro and took off the first time icon when John M. "Johnny" Miller made a good living as a barnstormer, he saw this unusual airplane. passed away in this native Pough- clearing $60,000 a year. While in In 2003, CAMA was blessed to keepsie, NY, after a short illness. He engineering school, Johnny skipped have Johnny visit with us for two days was 102 years old. He was born in class so that he could go out to Long at our annual meeting in Seattle. He New York state almost two years to Island and watch was the speaker at the Honors Night the day after the Wright Brothers' take off for Paris. dinner, and we will never forget his historic flight at Kitty Hawk. He moved on to become an airmail stories, humor, and pleasant manner. Johnny flew his last flight about pilot, autogyro pioneer, Marine avia- He will be greatly missed by all of us two years ago. At one time, he was tor, racing and test pilot, and airline who love aviation and aviators. —David Millett, M.D.

A noted FAA audiologist planned any movement, the amount, and to use physiological instrumentation. to determine if hearing loss could be the duration after each boom. One Consideration will be given to more demonstrated in parrots following to three were awakened each night scientific investigation with appropriate sonic booms. He was intercepted at with no adaptation noted after five physiological instruments. Carrizozo, N.M., and sent back to nights. (I was 33 and healthy.) CARI [the Civil Aviation Research I joined the subjects and recorded a More tests did follow at Stanford Institute]. Lead II EKG with each boom. Some University and at the new Civil Audiograms were performed on increases in heart rates from the low Aeromedical Institute with simulated the technicians and a few volunteers 70s to as high as 100 and some flat- booms, and by the Swedish on Got- from nearby ranches. No changes tening of t-waves were noted (a startle land Island using actual sonic booms. were found after this four-week pro- response confirmed by a cardiology Results have been published. There gram. The local residents reported consultant). I also collected urine were startle effects on hand steadi- adaptation to new nocturnal train samples for 17-OH-CS determina- ness (less in the ages 50-65 group) noises and predicted that adaptation tions, which were little changed from and some adaptation to low- and and acceptance would eventually oc- home or office. medium-intensity booms, but not cur to sonic booms as well. However, The Program Manager on site to intense ones. I know of no further technicians reported tension, fatigue, called someone in Washington Head- tests of effects on EKGs nor of any of and "I think I will scream if I hear one quarters about my EKG findings. I boom effects on parrots' hearing. more 10-16 psf boom" at the end of soon received a telegram, which said By 1979, British Airways and Air the study. in part: France were providing Concorde The effects of nighttime booms Initial sleep disturbance tests are service between DFW and London on four male technicians, ages 27-37, to obtain gross psycho-physiological and Paris — but they flew subsonic on who volunteered because they "could information only on sleep patterns the Dulles - DFW legs of the flights. sleep anywhere," were determined by of average young healthy personnel. There are no civilian supersonic trans- morning questionnaires and infrared Remain as medical observer and cease port flights now. motion picture photography to detect FP FLIGHT PHYSICIAN 14 July 2008

THE CIVIL AVIATION MEDICAL ASSOCIATION ANNUAL MEETING PROGRAM October 7-11,2008

Crowne Plaza Hotel 2947 N.W. Expressway Oklahoma City, OK 73112 Phone:(405)848-4811

AGENDA THEME: MOVING FORWARD IN AVIATION MEDICINE WEDNESDAY, OCTOBER 8 10:00 a.m.- REGISTRATION 12:15 p.m. LUNCH 5:15 p.m. Lobby Oklahoma Ballroom 8:30- ^BOARD OF TRUSTEES MEETING 1:15 P.M. GENERAL SESSION 11:30 a.m. Wildcat Room State Room 12:00 noon GENERAL SESSION Moderator: Ridge Smith, M.Ed. State Room 1:15 p.m. Certification Issues Welcome: Susan Northrup, M.D. Warren Silberman, D.O. CAMA President 2:15 p.m. Human Factors Research ATC 12:05 p.m. Invocation: DeWayne Caviness, M.D. Carol Manning, Ph.D. 12:10 p.m. Administrative Announcements 3:00 p.m. Medical Certification After MI David Millett, M.D. MPH Stephen Carpenter, M.D. CAMA Executive Vice President 3:45 p.m. Certification Trends in Neurological Disorders 12:15 p.m. Course Documentation John Hastings, M.D. Ridge Smith, M.Ed. 4:30 p.m. AME Performance Reporting 12:30 p.m. FAA, Medical Programs, Policies and Standards Richard Jones, M.D. Frederick Tilton, M.D. 5:45 p.m. ADJOURNMENT 1:30 p.m. AME Program Overview 6:15 p.m. Buses depart for Dinner Richard Jones, M.D. Cattleman's Steak House 2:30 p.m. BREAK Fine Wire Band 2:45 p.m. Aeromedical Research Tour of National Bombing Museum Melchor Antunano, M.D. 9:15 p.m. Buses return to hotel 3:30 p.m. AMCS Jana Weems FRIDAY, OCTOBER 10 4:15p Medical/Legal 6:45- BREAKFAST BUFFET 5:00 p.m. ADJOURNMENT 7:45 a.m. Oklahoma Ballroom 8:00 a.m. GENERAL SESSION THURSDAY, OCTOBER 9 State Room 6:45- BREAKFAST BUFFET Moderator: Alex Wolbrink, M.D. 7:45 a.m. Oklahoma Ballroom 8:00 a.m. Preventive Health During Airmen Medical 7:00 a.m.- REGISTRATION Examinations 4:30 p.m. Lobby Bill Mills, M.D. 8:00 a.m. GENERAL SESSION 8:45 a.m. Medical Findings From Aircraft Accident State Room Investigations Moderator: Denise Baisden, M.D. Charles Dejohn, D.O. 8:00 a.m. Medical Certification Update 9:30 a.m. Infectious Disease Dissemination on Aircraft Warren Silberman, D.O., MPH Nicholas Webster, M.D., MPH 8:45a: Otorhinolaryngology 10:15 a.m. BREAK Anthony]. Yonkers, M.D. 10:30 a.m. CDC Travel Response to Pandemic Influenza 10:30 a.m. BREAK Petra Illig, M.D. 10:45 a.m. Hypoxia Pilot/Passenger 11:15 a.m. Ophthalmology Clayton T. Cowl, M.D., MS Ingrid Zimmer Galler, M.D. 11:30 a.m. Advances in Cardiology as They Apply to the Pilot Earl Beard, M.D. FLIGHT PHYSICIAN 15 July 2008

12:00 p.m. LUNCH 11:30 a.m. OB/GYN Conditions Affecting Flight Crew Oklahoma Ballroom and Passengers 1:00 p.m. GENERAL SESSION Lauranne Harris, M.D. State Room 12:15 p.m. LUNCH Moderator: David Bryman, D.O. Oklahoma Ballroom 1:00 p.m. Drug/Alcohol Addiction Speaker: Paul Rock Charles Chesnow, D.O. Medical Problems Cabin Altitude 1:45 p.m. ADJOURN 1:45 p.m. GENERAL SESSION 2:00 p.m. Buses depart for tour State Room National Cowboy & Western Heritage Museum Moderator: Gordon Ritter, D.O. DINNER 1:45 p.m. Fit to Fly? Helping Pilots Understand Health 8:00 p.m. Buses depart for hotel Influences on Flight Safety John and Martha King SATURDAY, OCTOBER 11 2:45 p.m. Handling an In-Flight Medical Emergency 6:45- BREAKFAST BUFFET Joan Sullivan Garrett 7:45 a.m. Oklahoma Ballroom 3:30 p.m. New Treatment for Ischemic Heart Disease 8:00 a.m. GENERAL SESSION Andrew Miller, M.D State Room 4:15 p.m. PANEL: Would You Fly With This Pilot? Moderator: Farhad Sahiar , M.D. Moderator: Frederick Tilton, M.D. 8:00 a.m. Aviation Psychiatry Jack Hastings, M.D. Charles Chesnow, D.O. Earl Beard, M.D. 8:45 a.m. Art of Aviation Medical History-Taking James Heins, M.D. Mark Eidson, M.D. Anthony Yonkers, M.D. 9:30 a.m. Medical and Safety Aspects of Commercial Ingrid Zimmer-Galler, M.D. Space Flights 5:45 p.m. ADJOURNMENT Melchor Antunano, M.D. 6:45 p.m. SOCIAL HOUR 10:30 a.m. BREAK 7:30 p.m. HONOR'S NIGHT DINNER 10:45 a.m. Endocrinology—Thyroid Speaker: TBA James Heins, M.D. AWARDS

PROGRAM OBJECTIVES To understand and apply the changes in aviation medicine to the individual's private practice To assess specific clinical conditions/disciplines with respect to aviation medicine to correctly utilize the Federal Aviation medical standards with the specific conditions discussed To comprehend the FAA medical program initiatives To understand and be able to work with the aeromedical certification system To comprehend the legal aspects of being an AME

This program is approved for FAA - AME training. Reviewed and acceptable for up to 25 prescribed credits by the American Academy of Family Physicians.

BRING THE FAMILY Tours are planned, so be sure to take your family members with you. Anyone interested in aviation medicine and safety—member or non-member—may attend. Make your reservations soon! Call or E-mail David Millett: (770) 487-0100; [email protected] On The Horizon

FAA Aviation Medical Examiner Seminar Schedule 2008 August 1-3 Washington, D.C. Cardiology August 21-24 Weisbaden, Germany Scheduled by the German Society of Aviation and Travel Medicine; sanctioned by the FAA and fulfills the FAA recertification training requirement. October 7-11 Oklahoma City, Okla. Annual Scientific Meeting Sponsored by CAMA and ap- proved by the FAA for AME periodic training. Register through the CAMA Web site, www.civilavmed.com or call (770) 487-0100 November 3-7 Oklahoma City, Okla. Basic November 14—16 Reno, Nev. Neuro-Psycol/Psych 2009 (Incomplete) January 23 — 25 Orlando, Fla. (tentative) Opth/Otolaryn/Endocrin March 2-6 Oklahoma City, Okla. Basic July 20 - 24 Oklahoma City, Okla. Basic

For information, call your Regional Flight Surgeon. To sign up for a seminar, call the FAA Civil Aerospace Medi- cal Institute's AME Programs Office: (405) 954-4830

Civil Aviation Medical Association Annual Meeting Schedule

October 7-11, 2008 Oklahoma City, Oklahoma Crowne Plaza Hotel 2947 N.W. Expressway October 14-17, 2009 Rochester, Minnesota Mayo Clinic October 2010 Pensacola, October 2011 Tucson, Arizona