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Flight Physician - January, 2012

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VOL 15, NO. 1 JANUARY 2012

President's Report The Aging Brain, Cognition, and Time Waits for No One Aeromedical Concerns BY HUGH J. O'NEILL, M.D., M.H.Sc., D.Av. Aeromedical Concerns Related to Age and MED., F.EO.M.I Cognition BY RICHARD RONAN MURPHY, MBCnB In This Issue IME MARCHES ON and another year starts. Have "Si jeunesse savoit; si vieillesse pouvoit" (tr.) "Ifonly youth Tyou ever noticed how quickly time goes as had the knowledge; if old age had the ability" FROM THE EDITOR 2 you get older? —Henri Estienne (1528-1598) What happened to all that time you prom- EXECUTIVE VICE PRESIDENT'S ised yourself when you stopped "normal" work? HE YEAR 2010 ended with more than 650,000 REPORT 3 Where are you Albert, when we need you most? TU.S.-certified pilots, nearly 10% of whom Plans and the Future were over the age of 65. More than 4,700 are over ANNUAL MEETING PHOTOS .4 the age of 80. Nearly two-thirds of the pilots over The beginning of a year is a good time to take age 65 held commercial, CFI, or ATP certificates, CAMA BOARD MEETING stock of the past and plan for the future. This is and nearly a quarter of those over age 80 were NOTES 7 what your Board and executive committee will flight instructors (1). Older pilots represent a sig- be doing in Dallas this February. There is a man- nificant proportion of certified pilots and bring How TO LIVE TO 100 10 datory requirement to review Bylaws at a regular a valuable wealth of knowledge and experience to interval. We will take this opportunity to review the cockpit, and to the aviation industry. NEW MEMBERS 11 everything from our Mission Statement, the aims, Normal aging and flight performance Slight cognitive decline is not unusual with MEMBER 'GONE WEST' ... 12 goals and objectives of our organization and its advancing age (2), though knowledge and expe- governance. This may seem a tall order but change rience accumulate over time. Older age does not SUSTAINING, CORPORATE, AND for its own sake is not the point of the exercise. The inevitably lead to cognitive decline, and signifi- LIFE MEMBERS 13 Board may decide that only small corrections are cant cognitive decline should not be considered needed for the future. One is mindful of the saying "normal aging." THE FIRST AIRCRAFT CARRIER not to fix something that is not broken. However, The effect of aging on flight performance LANDING 14 and safety has been the subject of considerable there have been many good ideas, which have scientific study. It has been shown that certain ON THE HORIZON 16 Continued on page 2 Continued on page 8 FLIGHT PHYSICIAN January 2012

President's Report from page 1 member of the latter society, Dr. Amescua, was a former President of not come to fruition but are still a CAMA. Perhaps this will be the year From the Editor matter of record. In particular, there when some of our Chinese colleagues exists an excellent and thoughtful will attend. The annual meeting is I would like to introduce long-term report from Robin Dodge just across the water, in California! myself as the new editor of and Jack Hastings that deserves re- the Flight Physician. Being visiting. Medical Teaching Opportunities Offered the editor is an honor (?) be- Visiting Success At our meeting in Tucson, Ari- stowed on the new president- CAMA has enjoyed success over zona, the Board was asked to take elect of CAMA, and because the past three years, particularly in part in developing a medical teach- there is no instruction manu- the past two during the presidency ing program for pilots. We declined al with the position, you will of James Heins. This is seen in our this opportunity put forward by the understand the reason for record attendances at the annual sci- Aircraft Owners and Pilots Associa- the changes in publication entific meeting and CAMA Sundays. tion and the Experimental Aircraft deadlines. Keeping up this high standard Association. The proposal was to I am an AME in solo will be the thrust of our efforts in extend the exemption that permits private family practice and a the immediate future. Thank good- sports pilots to use a driver's medical private pilot living in Weath- ness that we have a committed and instead of the evaluation by a trained erford, Texas. My business talented group of volunteers to guide medical examiner. Their stated inten- is called Dr. Mark-Private us forward. In part, our success is tion is to progress to all class 3 pilots, the result of working with the FAA if this is accepted by the FAA. The MD and is an insurance- in the field of AME education. We part played by AMEs will be replaced free, direct-pay practice. My owe Dr. Fred Tilton and his staff a by a "do-it-yourself" medical training father, also in Weatherford, debt of gratitude, and we will make package for pilots. There are a large had a family practice for every cooperative effort to continue number of contentious issues in this 50 years, and to keep from this work. proposal, which I will not review getting us confused (and here. However, it is my suggestion to because no one could spell or Welcome International Members all members of CAMA that they fa- pronounce our last name cor- While the majority of our mem- miliarize themselves thoroughly with rectly), we went by Dr. Jack bers are practicing as aeromedical this move. We are in the business of and Dr. Mark, thus the "Dr. examiners for the FAA, we seek to in- aeromedical education and would be Mark." crease our international membership. pleased to extend this to pilots in a co- It is always delightful to welcome our operative relationship. The Board will Happy Landings, Nigerian colleagues who attend the discuss the issue again, in a few weeks. Dr. Mark (Eidson) annual scientific meeting faithfully each year. Also, Dr. Gebremariam The Future P.S. For any suggestions, from Ethopia and Dr. Barlev from The coming year will be interest- articles, or comments, please Israel, are members of the Board who ing for CAMA and the United States! let me know. travel far to be with us. On a personal Let us hope, not too interesting; more Dr.MarkPrivateMD@gmail. level, I hope to increase our asso- of that later. In the meantime, my com ciation with the European Society of wife Ann, and I wish you and your Aviation Medicine and the Mexican families a happy, healthy, and pros- Aeromedical Society. A distinguished perous New Year. FP FLIGHT PHYSICIAN January 2012

Executive Vice President's Report FIJGHrPHYSICIAN BY DAVID P. MILLETT, M.D., MPH

A Publication of the Civil Aviation Medical HE BIG EVENT since Illig in recognition of her safety and Association (CAMA) Tour last publica- preventative medicine programs tion was the Annual provided to the aviators of Alaska. Scientific Meeting in • The final award was the Forrest and President Hugh I. O'Neill, M.D. Tucson, Arizona. The Pamela Bird Recognition awarded October 6-8, 2011, to physician and astronaut Dr. Dr. Millett President-Elect convention was out- Story Musgrave. Dr. Musgrave is MarkC.Eidson,M.D. standing in all aspects. a life member of CAMA and was Dr. Jack Hastings formulated a recognized for his contributions Secretary-Treasurer world-class program on cognitive to the development of space travel Gordon L. Hitter, D.O. function in aviation. The atten- life-support systems, including the dance was terrific! There were 155 design of new generation space Executive Vice-President David P. Milktt, M.D., MPH participants, 44 guests, 12 visiting suits. During his multiple mis- presenters, and 3 VIPs for a grand sions into space, he was noted for Executive Editor total of 214 persons. According to his advancement and research on Mark C. Eidson, M.D. the Federal Aviation Administration, extra-vehicular activities. 97 participants completed the FAA- The keynote speaker for Honors .Associate Editors AME refresher training. Night was our own member and Petra A. Illig, M.D. A large group of 136 attended the award-winner, Dr. Story Musgrave. Stephen Leonard, M.D. Honors Night Dinner. Five members His presentation covered many top- Alex M.Wolbrink, M.D. were introduced as new Fellows for ics — from how he obtains dirt for his Ingrid Zimmer-Galler, M.D. 2011: Doctors Avinoam Barlev, Petra farm in to his experiences in Historian, By-Laws/Constitution Illig, David Salisbury, Per-Johan space as an astronaut. A. Duane Catterson, M.D. Cappelen, and Story Musgrave. Since In his presentation were beauti- the Honors Program began six years ful photos of the objects of interest The editors of F%hfPhysician wel- ago, there have been 53 members in his life. One of our members was come submission of articles, letters elected, about 10% of the CAMA overheard to say, "That wasn't just to the editor, news bits, interesting membership. a keynote speech, it was a philoso- aeromedical cases, and photos for Four individual awards were phy of life." It was an outstanding publication. Please E-mail text on a presented: evening! • Dr. Jack Hastings received the We now turn our attention to computer file (MS Word preferred) President's Commendation in CAMA Sunday in Atlanta on May recognition of his organization of 13, 2012. It will be another excel- Mark C. Eidson, M.D. [email protected] the CAMA Sunday at the Aero- lent program. Our Annual Scientific David P. Millett, M.D., MPH space Medical Association and the Meeting for 2012 will be October CAMA Headquarters outstanding scientific program at 4-6, 2012, at the San Diego-La Jolla, P.O. Box 2382 Tucson. California, Marriott Hotel. I am Peachtree City, GA 30269-2382 •The Jim and Sammie Harris looking forward to another outstand- Phone: (770) 487-0100 Award went to Dr. Earl Beard in ing program and meeting organized Fax: (770) 487-0080 recognition of his years of service by Dr. Clay Cowl and his Education E-mail: [email protected] to the CAMA Trustees and his Committee. organization of the CAMA Fellows In closing, thank you all for your Program. support of CAMA. I wish you a • The Audie and Bernice Davis happy and successful 2012. Award was presented to Dr. Petra FLIGHT PHYSICIAN January 2012

Annual Meeting Photos Each year in October, the Civil Aviation Medical Association holds its scientific meet- ing to discuss topics of interest to physicians who specialize in the medical certification of plots. Members elected to positions of leader- ship meet at regular intervals during the year and at the annual meeting site to discuss how best to serve the membership in coming years. The goals of planning are achieved by several active committees that work dilligently to ensure that the Association's members are served.

CAMA'S Board of Directors and committee members meet prior to the 2011 Scientific Meeting.

Early arrivals are greeted by long-time member and former Executive Vice President, Jim Harris (right).

More than 150 attended this year's meeting in Tuscan, Arizona.

Photography by E. M.V. FLIGHT PHYSICIAN January 20 K

Members who distinguish themselves during the year are nominated for and re- ceive various awards for their achievements of ad- vancing aerospace medi- cine. Fellows of the Associa- tion are officially inducted into their fellowships dur- ing the annual meeting.

Dr. John Hastings (r) receives the President's Commendation from Jim Dr. Petra Illig (r) receives the He ins Audie and Bernice Davis Award from President Jim Heins

Or. Earl Beard receives the Jim and Sammie Harris Award. From left, Dr. Beard, Dr. Heins, Sammie Harris, and Jim Harris

Dr. Story Musgrave (center) receives the Bird Recognition Award from Doctors Forrest and Pamela Bird FLIGHT PHYSICIAN January 2012

Federal Air Surgeon Fred Tilton, M.D., speaks during the meeting

New Fellows present. From left, Doctors Story Musgrave, Per-Johan Cappelen, Petra Illig, Avinoam Barlev, and Graeme Maclarn (2010)

Dr. Story Musgrave (I) and CAMA Executive Vice President Dr. David Millett A group of presenters exchange notes exchange fraternity secrets

Dr. Story Musgrave (center) visits with President-elect Mark Eidson and Sarah Eidson

At the Awards Dinner, International members gather together FLIGHT PHYSICIAN January 2012

CAMA Board Meeting Notes The CAMA Board of Directors met in Tucson, Ari- resentatives occurred earlier to discuss their proposal to zona October 5, 2011. President James Heins, M.D., gave expand the self-certification of pilots by use of a driver's a welcome to all board members and presented his annual license, thus relaxing the need for a third-class FAA Medi- report noting his action plans. cal. The CAMA Board passed a motion, by a large margin, Executive Vice President David Millett, MD, then gave not to support the expansion of self-certification of pilots. his report on the positive growth and activities of CAMA. The Membership and Nominating Committee, con- Future meetings are being arranged for Dallas, Texas, sisting of Drs. Susan Northrop, Dave Millett, Duane February 10-11, 2012; San Diego, California, on October Catterson, and Denise Baisden made their recommenda- 4-6, 2012; and Orlando, Florida on October 10-12,2013. tions, which were approved, on a new slate of officers and All Vice Presidents gave their respective reports on trustees and are listed. scientific programs, CME credits, "Flight Physician" New CAMA Fellows elected are: Drs. Avi Barlev, Per- publications, and the CAMA website progress. Joahn Cappelen, Petra Illig, Story Musgrave, and David A safety meeting with the Aircraft Owners and Pilots Salisbury. Association and Experimental Aircraft Association rep-

2012 CAMA Board Members Roster

President Trustees, Term Expires 2012 Hugh O'Neill, M.D. Earl F. Beard, M.D. DeWayne Caviness, M.D. President-Elect Robin Dodge, M.D. Mark C. Eidson, M.D. Howard Eliason, D.O. Aynalem Gebremariam, M.D. Immediate Past President James L. Harris, M.Ed. James R. Heins, M.D. W. David Rummel, M.D. Ingrid Zimmer-Galler, M.D. Secretary-Treasurer Gordon Ritter, D.O. Trustees, Term Expires 2013 James Almand, M.D. Executive Vice President Michael F. Boyer, M.D. David P. Millett, M.D., MPH Robert Gordon, D.O. Edward Luchansky, M.D. Vice-President for Education John S. Raniolo, D.O. Clayton T. Cowl, M.D. Gerald W. Saboe, D.O. Sergio B. Seoane, M.D. Vice-President Communications & Rodney Williams, M.D. Representation James L. Carpenter, M.D. Trustees, Term Expires 2014 Denise Baisden, M.D. Vice-President for Management Avinoam Barlev, M.D. Randall Caviness, M.D. Estol R. Belflower, M.D. David Bryman, D.O. Ex-Officio John D. Hastings, M.D. A. Duane Catterson, M.D. Katherine Helleur, M.D. Alex Wolbrink, M.D. FLIGHT PHYSICIAN January 2012

Aging from page 1 (FTD). In a very old population, only addition of new equipment, or soft- about a third of dementia autopsies ware upgrade of a GPS device. Prob- tasks, such as radio communication demonstrated pure Alzheimer's lems with frequently missing points on and performance on approach show pathology. Combined pathology in checklists may indicate difficulty with decline with age in normal pilots (3), this group is more the rule than the attention and concentration. Any cog- but it has also been shown that more exception (9). nitive difficulties would be expected advanced pilot proficiency ratings Mild cognitive impairment to be most evident and problematic in predict better piloting performance Mild cognitive impairment, or the setting of an in flight emergency overall (4). There is a modest in- "MCI" is a term used to describe a or unplanned event. crease in accident rates amongst clinical syndrome with a measurable Cognitive screening - role of the older pilots, and cognitive perfor- reduction in cognitive performance, AME mance may play a role (5, 6). It is which does not reach the threshold of The AME often has more frequent also important to keep in mind that dementia, and does not interfere with contact with the older pilot than visual, cardiovascular, respiratory and the majority of normal daily activities any other aviation professional. The musculoskeletal problems frequently (10). MCI may affect between 10- AME can provide a valuable service arise in old age, and may impact an 20% of individuals age 65 or older to the airman by identifying cognitive older pilot's flight performance. Pilot (8), and nearly 30% in those over age problems that may affect flight safety, experience is important. Higher pilot 85. It may be expected that pilots over or that may need further evaluation proficiency rating is associated with 65 applying for an FAA medical exam and treatment. less performance decline with age (7). would represent a select population A physician's evaluation of cogni- Alzheimer's disease and other de- with a lower prevalence of cognitive tion usually begins with the history, mentias problems, but the prevalence in this but occasionally, unusual behavior and One in eight people over the age of group is unknown. MCI is not neces- disheveled appearance may indicate a 65 have dementia. This risk increases sarily benign. Nearly half of MCI pa- difficulty. More commonly, cognitive with advancing age, for example: the tients will progress within a few years problems have an insidious onset and risk is less than one in twenty at age to probable Alzheimer's disease (11). may not be apparent at all in superfi- 65 but affects nearly half of those over Cognitive deficits and flight cial conversation. Asking about flight age 80 (8). Dementia is characterized Due to the nature of piloting re- performance as part of the history clinically by cognitive and behavioral quiring significant skill and cognitive may allow a pilot the opportunity to problems, severe enough to impair performance, symptoms may present voice and discuss a concern that they normal function. The pathological in the aviation domain before affecting may not have mentioned otherwise. changes and some of the cognitive other activities. It is not certain that a Perhaps other pilots, instructors, or changes seen in dementia may pre- pilot will always be aware of problems passengers have reported concerns to cede the clinical expression of the with their flying. The American Acad- the pilot. disease by decades. emy of Neurology published driving A question that I frequently en- The most common cause of de- guidelines in 2010 to address concerns counter is, what to do if the pilot has mentia over age 65 is Alzheimer's about driving and dementia (12). This problems with the electronic 8500-8 disease and most often presents with publication notes that persons with form, or Med Xpress. In my experi- memory difficulties. Other diseases cognitive impairment frequently rated ence, it is not unusual for patients in also commonly cause dementia. their driving as being much better their 70s or older to have difficulty Vascular dementia is the probably the than it actually was, while spouses' completing this. These patients usu- second most common type, followed reports of functioning were much ally perform normally with pen and by Lewy body dementia, a disease better correlated with actual driving paper. The examining physician's process which may show similar function. A pilot's peers, instructor, overall clinical impression, based on features to other dementias, but with or evaluator on a biennial flight review a thorough history and exam, is most some clinical features that differ from may be the first to notice problems. On important. Alzheimer's, such as more Parkin- the other hand, flight review tasks may In addition, the Alzheimer's As- sonism, visual hallucinations, more be practiced extensively and may not sociation has published a checklist of pronounced problems with attention identify an airman with mild cognitive symptoms that may warn of onset of and planning, and less memory dis- decline. Common early difficulties Alzheimer's: turbance. Bizarre behavior, personal- may include problems with read-back • Memory changes that disrupt daily ity change, poor executive function, or comprehension of ATC commu- life poor judgment, and onset in mid-life nications, difficulty learning how to • Challenges in planning or solving suggest Frontotemporal dementia operate equipment after changes, e.g., problems FLIGHT PHYSICIAN January 2012

• Difficulty completing familiar tasks thorough history and physical exam 7. Taylor, J.L., et al. Influences of APOE • Confusion with time or place will cover most of this. epsilon4 and expertise on perfor- • Trouble understanding visual im- Specialist evaluation must be mance of older pilots. Psychology ages and spatial relationships obtained when there is not a clear and Aging, 2011. 26(2): p. 480-7. 1 New problems with words in writ- explanation, when there is a rapid or 8. Alzheimer's Association. 2011 Al- ing or speaking stuttering onset, or when there is any zheimer's Disease Facts and Figures. • Misplacing things and losing the concern for safety. 2011; Available from: www.alz.org/ ability to retrace steps Summary downloads/Facts_Figures_2011. pdf. 1 Decreased or poor judgment Older pilots have a wealth of 9. Lim, A., et al. Clinico-neuropatho- 1 Withdrawal from work or social experience that is of value to the logical correlation of Alzheimer's aviation industry. The AME should activities disease in a community-based • Changes in mood or personality consider the prevalence of cognitive case series. Journal of the American While the presence of one or two disease with age, symptoms that may Geriatrics Society, 1999. 47(5): p. of these symptoms does not make a indicate cognitive problems and their 564-9. diagnosis, presence of any of these potential impact on safety of flight. 10. Albert, M.S., etal. The diagnosis of symptoms warrants further evaluation. Not all cognitive problems are due mild cognitive impairment due to A full cognitive and behavioral to neurodegenerative disease. Early Alzheimer's disease: Recommenda- evaluation is beyond the scope of detection of cognitive problems not tions from the National Institute most AME exams, but the AME only improves pilot safety, but also on Aging-Alzheimer's Association may wish to take advantage of simple provides an opportunity to screen workgroups on diagnostic guide- tools that can help screen for sus- for treatable causes of cognitive lines for Alzheimer's disease. Al- pected cognitive problems. The Mini problems. zheimer's & Dementia: The Journal Mental State Examination (MMSE) References of the Alzheimer's Association, 2011. 7(3): p. 270-9. is a well-known tool used to screen 1. Federal Aviation Administration. U.S. for dementia, but a more sensitive civil airmen statistics, 2010, Table 11. Visser, P.J., et al. Ten-year risk of screen may be undertaken in the of- 12. Available from: www.faa.gov/ dementia in subjects with mild cogni- tive impairment. Neurology, 2006. fice with a 10-minute pen and paper data_research/aviation_data_sta- 67(7): p. 1201-7. examination called Montreal Cogni- tistics/civil_airmen_statistics/ 12. Iverson, D.J., et al. Practice pa- tive Assessment test, or MoCA. The 2. Schonknecht, P., et al. Prevalence and rameter update: Evaluation and test is very helpful when referring to natural course of aging-associated cognitive decline in a population- management of driving risk in a specialist for further evaluation, and dementia: Report of the Quality is available for download at no charge based sample of young-old subjects. The American Journal of Psychiatry, Standards Subcommittee of the at www.mocatest.org. 2005. 162(11): p. 2071-7. American Academy of Neurology. If clinical suspicion of cognitive Neurology, 2010. 74(16): p. 1316- 3. Taylor, J.L., et al., Pilot age and 24. or behavioral problems arise, it is expertise predict flight simulator essential that this be confirmed performance: A 3-year longitudinal Note: All Web links referenced here were accessed on 12/12/2011. with an informant, such as a spouse, study. Neurology, 2007. 68(9): p. colleague, close friend, or someone 648-54. FP who has detailed knowledge of the 4. Taylor, J.L., et al. Cognitive ability, patients day-to-day functioning. The expertise, and age differences in This article first appeared in the Federal AME may be in the best position to following air-traffic control instruc- Air Surgeon's Medical Bulletin. do this and should do so with the tions. Psychology and Aging, 2005. pilot's permission. 20(1): p. 117-33. About the author It is important to be aware that 5. Schroeder, D.J., et al. Pilot age and Dr Murphy is an AME, a board-certified neurologist, and is a fellow in mental health not all cognitive problems are due performance: An annotated bibliogra- O J to degenerative disease. Problems to phy, 1990-1999. Washington, DC: research with the Veteran's Administration consider include medical and meta- Federal Aviation Administration Mental Illness Research, Education, and bolic factors such as hypothyroidism Office of Aviation Medicine. Clinical Center, with clinical faculty ap- or Vitamin B12 deficiency, infection, 6. Causse, M.L., et al., Cognitive aging pointment to the University ofWashington Neurology department. Address Correspon- sleep deprivation, sleep apnea, alco- and flight performances in general aviation pilots. Neuropsychology, dence to: Dr Richard Ronan Murphy, VA hol or drug problems, medications, Puget Sound Healthcare System, 1660 anxiety, depression, and psychoso- Development, and Cognition. Sec- tion B, Aging, neuropsychology and South Columbian Way, MIRECCS-116-6 cial stress. Simple blood tests and a cognition, 2011. 18(5): p. 544-61. East, Seattle, WA 98108. Phone:206-764- 2069; ronan@u. washington.edu. FLIGHT PHYSICIAN 10 January 2012

How to Live to 100—and Beyond am bent over forward, due to not Johnny Miller, Aviation Pioneer and Centenarian, Tells the Story only 35,000 hours (four solid years) bent over the controls of aircraft, This letter to the editor of the Eastern Airlines Retired Pilots Association and the but to that much more time driving REPArtee Magazine should be of interest to our members, especially since many of cars and again still much more just us are interested in healthy lifestyles and enhanced longevity. Though we published sitting, reading, and studying, plus this article six years ago in the Flight Physician, it bears repeating because of the thousands of hours making hunting sound health practices it states. Captain Johnny Miller, retired rifles and other machine shop work. captain and aviation icon, was the featured speaker at the 2003 CAMA Honors I've been very busy and I'm confi- Night Dinner. We will never forget his stories, humor, and pleasant manner as dent that keeping busy prolongs life. he was approaching his 98* birthday. Two years later, be wrote this article to All right, now about my diet? It is chronicle his 100th birthday. Capt. Miller passed away in 2008 at the age of 102. (Reproduced with permission of REPArtee Magazine) —Editor radically different from that of most people. In the first place, I avoided fats, all my life. That includes but- MADE IT to centenar- How did I get this way? ter, which I never touch. (It is good ian, on December 15, Well, I have never had a for lubricating wagon wheels!) I2005, in fine shape. drop of alcohol, or even a The only trouble with complete My father made it to al- drop of coffee, and never elimination of fats is that my gall most 99, my grandfather puff of tobacco smoke. bladder was rarely called upon to to 93, (after an injury), but My mother was a trained squeeze its contents of bile into the before that I just don't know. nurse before I was born, intestine for fat digestion. There- I'm not in a wheelchair or and she told me that she fore, the stagnant bile crystallized even a candidate for one, but had noticed that fat peo- in perfect health and fully opera- ple, drinkers, and smokers died Overweight tional. I have no aches or pains, no early, and even athletes did so. So, I arthritis, my joints are fully oper- decided that I would avoid all of the shortens Cife. you able, and my heart passes all tests above. We all now know why smok- never see an oCd with stress test included. My weight ers die early, but how come athletes ? fat person. So, get and blood pressure are the same as Maybe they just wear themselves when I was 18 on my first solo in down. As for overweight, when I lie rid of that fat! 1923. That was in a WW-I, JN-4 down on my back, my belly looks "Jenny," and I'll bet I'm the only like a saddle. About 95% of men early pilot still living who made a are overweight and their bellies into gallstones, and I had to have first solo in that type. protrude out forward of their belt the bladder removed. On the other I have some deficiency in hearing buckles. Overweight shortens life. hand, there is an advantage to that. and eyesight, but am still flying my You never see an old fat person. So, Without the large supply of bile it Bonanza. The hearing loss was due get rid of that fat! is not available to properly digest to years of flying in the old open There is only one positive and fat, when it is eaten. So, I'm happy. cockpit airplanes, both civilian quick way to absorb and get rid of My cholesterol level has always been and military, and rifle, pistol, and excess fat, and that is to be hungry low, and therefore my arteries are machine gun practice (USMCR), for a few hours per day, and then not clogged and my blood pressure before hearing protection was avail- avoid extra eating. One time my is normal. I have read that women able. I now use a hearing protection weight got too high, and I took off have about three times as many headset even when mowing my 50 pounds in 60 days. Willpower! gall bladder excisions as men. They lawn with a power mower. I have During most of my life my height avoid fats more than men do, and a SODA, or Statement of Dem- was 6 ft. 2Vi inches. However, it is live longer. onstrated Ability, for my partial now down to 5 ft. 11 inches. All that I do eat plenty of green, orange, deficiency of hearing. loss of height has taken place in my and red vegetables, plus meat and spine. Yet, no spine trouble. Yes, I fish. For breakfast I eat an orange FLIGHT PHYSICIAN 11 January 2012

every morning. Not orange juice, of the good 100% grape juice, with New Members but the pulp insides of the orange, some dry milk powder mixed in it. John J. Beck, M.D. dug out with a spoon into a blender. As a result of frequently eating milk 5267 Forest Road Sturgeon Bay, WI 54235 The pulp of the orange has prob- powder, I have very strong bones, Family Medicine ably 5 or 10 times the vitamins as according to a test by my M.D., AME the juice. So the orange growers who said that they are like granite. Joseph A. McClure, M.D. For dinner, broccoli flowers, MIMA, 1130 S. Hickory St. green peas or beans, spinach, and Melbourne, PL 32901 lleadze that to Internal Medicine, Hematology, Oncology meat, all cooked together in one pot Cose fat, you must in the microwave, and sometimes Kevin R. Green, M.D. 5282 Primrose be hungry a few sweet potatoes or yams. No fancy Oshkosh, WI 54904 hours per day, stuff. Sometimes I eat a few nuts. Family Practice & Integrative Medicine I avoid high-calorie carbohydrates Pilot AME "without making bread, white potatoes, etc., most of Cheryl Lowry, M.D. the time. Sweet potatoes and yams 9000 Allison Lane up for it fry eating Oklahoma City, OK 73151 have more vitamins. Not perform- Family Practice, Aerospace Medicine extra food Cater. ing strenuous work, I don't need a AME high-calorie diet. Peter Blum, M.D. sell the juice at fancy prices and For the last 20 years, I have never Lindeveien 42 4025 Stavanger, Norway use the rest of the orange for cattle used the cook stove. It kills the vi- Occupational Medicine feed, and the cows get a far better tamins in the food, due to the high AME diet than the people. The grow- temperatures used to force the heat Tarah Castleberry, M.D. ers make more money. I cover it into the food. I cook exclusively in a 4300 Bay Area Blvd., #1635 with dry milk powder, add a ripe microwave oven, which created the Houston, TX 77058 Aerospace Medicine/Family Practice banana (well freckled skin); one or heat within the food itself. two big green leaves of romaine let- Realize the fact that in order to Steven Eugene Catlett, M.D. 44520 Santa Margarita Ave. tuce, and then fill the blender half lose fat, you must be hungry a few Palm Desert, CA 92260 full of 100% grape juice. I blend hours per day, without making up Family Medicine and drink it slowly and swallow a for it by eating extra food later. AME one-a-day vitamin tablet. Then I When you are hungry is the only James D. Decker, M.D. 6412 Bolton Road eat two or three pieces of Herring time your body absorbs fat. That Alpena, MI 49707 Snacks (Nathan's) for their low-fat is nature's way. So be hungry and Family Medicine protein. I do not eat eggs or bacon, slimmer! Remember, you do not AME especially the latter. I would not see old overweight people! I love my Pen Hou, M.D. feed bacon to a pig. Eggs are OK, healthy living. When slim, you do 8195 166th Ave, N.E., Suite 203 Redmond, WA 98052 with protein whites and their high not get tired and have more energy. Family Medicine calorie yolks, rich in vitamins, if When I sit in a friend's Oshkosh AME you consume enough energy in display, watching the people walk Daniel S. Lann, M.D. your work, and you can eat them by, I record the number of men and 3950 Camai Circle Anchorage, AK 99507 without gaining weight. stomachs protruding out above their Emergency Medicine/Urgent Care I keep myself as slim as when belt buckles, over 95% of them! Pilot AME I was 18, at the same weight and Extra weight shortens their lives. Steven A.R. Murphy, M.D. blood pressure. If you owned a Only half as many women. 23 Maple Avenue prize-winning dog you would not I'm afraid that all of my old Greenwich, CT 06830 Internal Medicine overfeed it. friends on EAL are long gone, but AME I eat a very light lunch, usually a if any are still living, perhaps some Joseph Ryan Smolarz, M.D. thin slice of Rubschlager All Grain who were my co-pilots, I'd love to Paragon Medical Bldg., Bread with some natural peanut hear from them. 9149 Estate Thomas, Suite 308 John M. Miller St. Thomas, VI 00802 butter and some orange marma- Ear, Nose, and Throat lade, and a fig or date. Then a drink FP Pilot AME FLIGHT PHYSICIAN 12 January 2012

Member 'Gone West'

Audie Davis, M.D., MPH CAMA Friend and Medical Certification Icon DR. AUDIE DAVIS, a Civil Avia- rackets with a well-known celebrity tion Medical Association Fellow on the courts. "Funny," the pastor and former manager of the Federal mused, "he sat in that pew Sunday Aviation Administration's medi- after Sunday, and I never knew that cal certification division until his about him." retirement in 1996, passed away in I vividly recalled a time years ago October 2011 at the age of 80. when I was shocked to learn a truth Dr. Davis presented the first about Audie I had never suspected. Audie and Bernice Davis Award in With great courage, he acknowl- 2004 at the Association's annual f edged in a lecture for employees scientific meeting. The award rec- at the Aeronautical Center that he ognizes a CAMA member for pro- was a recovering alcoholic. Audie moting healthy lifestyles through records, bringing a computerized thought nothing of the potential aerospace medicine. operation together, and streamlining disgrace, embarrassment, and loss A native of Alabama, Dr. Davis certification procedures. He authored of trust by his staff. He was more earned his medical degree at the or co-authored many scientific publi- interested in sharing his personal Medical College of Alabama in cations and was a frequent lecturer at perspectives about the life-ruining 1957 and a Masters in Public Health medical schools and aviation industry aspects of substance abuse than he at the Harvard School of Public meetings. was in preserving his own reputa- Health in 1965. He served as a Med- He was a member of the Phi Beta tion, but his courage only enhanced ical Officer in the U.S. Air Force at Pi Medical Fraternity, as well as many our perception of Audie as one who Lackland AFB, Texas; Eglin AFB, medical and pilot organizations, and deeply cared for others. Florida; and at Space Systems Divi- he distinguished himself by earning There is no telling how many sion, Inglewood, California. many awards during his career. He lives he touched that day, lives that Following his Air Force service, also served on the board of directors may have been spared from deterio- Dr. Davis joined the FAA in 1962, of the Referral Center and Norman rating health, family destruction, eventually becoming the Chief (Okla.) Alcohol Information Center. and premature death.. .just by being of Medical Certification at the Dr. Davis was a genuine gentle- a caring human being who only Civil Aerospace Medical Institute in man who treated his work associates wished the best for others and for Oklahoma City, Oklahoma. with respect, fairness, and dignity. them to enjoy living free of a self- Dr. Davis and his staff were With unfailing kindness, he was con- induced handicap. responsible for processing more cerned about them and their families. He also worked closely with the than 500,000 medical applica- If an employee was ill or had a death Air Line Pilots Association develop- tions each year. His management in the family, he was the first to call, ing a treatment program for alco- of the system, development and send a card, offer assistance. holic pilots, enabling their return implementation of the medical ap- As fully as you may think you to flying with no adverse effects on praisal techniques needed to make know someone, there is always aviation safety. informed decisions on pilot applica- something of the unknown in each I am proud to say that Audie tions, won him the Aerospace Medi- of us. His pastor of many years, Davis was my friend, as well as the cal Association's Boothby-Edwards in delivering the prepared eulogy, friend and benefactor of many oth- Award. AsMA also recognized him was surprised to learn that Audie ers. His good works on Earth have with the Tamisiea Award for his was once a talented singer and a concluded. May he rest in peace. accomplishments in digitizing pilot gifted tennis player who often swung —Michael E. Wavda FLIGHT PHYSICIAN 13 January 2012

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 CAM A to provide one of its most important functions: that of education. The following support CAMA through corporate and sustaining memberships: Sustaining Members James R. Almand Jr., M.D. Richard Cooper, M.D. Renee Roy, M.D. Estol R. Belflower, M.D. Gary E. Crump, P.A. John H. Rummel, M.D. Forrest M. Bird, M.D., Ph.D. Daniel H. Dietrich, M.D. David A. Salisbury, M.D. Jeffrey M. Bishop, M.D. F. Robert Glatz, M.D. Christian Steindl, M.D. Per-Johan Cappelen, M.D. James N. Heins, M.D. Jan Stepanek, M.D. Richard Carlson, M.D. Paul Lilly, M.D. James L. Tucker Jr., M.D. A. Duane Catterson, M.D. Hugh O'Neill, M.D. H. Stacy Vereen, M.D. DeWayne E. Caviness, M.D. Robert Rigg, M.D. Rodney E.L. Williams, M.D. Frank J. Ceravolo, M.D. Gordon L. Ritter, D.O. Ingrid Zimmer-Galler, M.D. Liu Yu-Ching, M.D. Corporate Members

Continental Airlines Rummel Eye Care, P.C. 1600 Smith St. 1022 Willow Creek Rd. Houston, TX 77002 Percussion Aire Corp. Prescott, AZ 86301-1642 Forrest M. Bird, M.D., President Medaire, Inc. P.O. Box 817 Harvey Watt & Company, Inc. 80 East Rio Salado Parkway Sandpoint, ID 83864-0817 P.O. Box 20787 Suite 610 Atlanta, GA 30320 Tempe,AZ 85281-9107

Life Members

Michael Boyer, M.D. Andrew H. Miller, M.D. Sergio B. Seoane, M.D. John R. Capurro, M.D. David P. Millett, M.D. Kazuhito Shimada, M.D. Halford R. Conwell, M.D. Story Musgrave, M.D. Brian Smalley, D.O. George H. Coupe, D.O. Thomas Nguyen, M.D. Ruth Steward, R.N. Mark C. Eidson, M.D. Michael G. Nosko, M.D., Ph.D. Shepard B. Stone, M.P.S., PA. Donna Ewy, M.D. Hugh O'Neill, M.D. Salil C. Tiwari, M.D. Edmond Peeks, M.D., MPH Michael A. Pimentel, D.O. Lars Tjensvoll, M.D. Robert Gordon, D.O. Jeffrey P. Powell, M.D., D.D.S. Dottie Hildbrand Trembly, R.N. Ernst J. Hollman, M.D. Robert M. Roeshman, M.D. Harold N. Walgren, M.D. Atsuo Kikuchi, M.D. Mark S. Rubin, M.D. Alex M. Wolbrink, M.D. Stephen M. Kirkland, M.D. Gerald W. Saboe, D.O.

Thank you for supporting the Civil Aviation Medical Association FLIGHT PHYSICIAN 14 January 2012

U.S. Naval History: The First Aircraft Carrier Landing

n January 18, 1911, U.S. Naval aviation was invented Owhen a 24-year-old barnstormer pilot named Eugene B. Ely completed the world's first successful landing on a ship.

It happened in San Francisco Bay aboard the cruiser USS In an era of innovation, Ely's Curtis Pusher had been fitted Pennsylvania, which had a temporary 133-foot wooden land- with a new invention called a tail hook. The idea was to quickly ing strip built above her afterdeck and gun turret as part of halt the aircraft after landing by catching one or two of 22 rope the experiment. lines, each propped up a foot above the deck and weighted by It was only eight years after the Wright Brothers made their 50-pound sandbags tied to each end and strung three feet apart historic first flight at Kitty Hawk that Ely accomplished his feat. along the Pennsylvania's temporary flight deck. His aircraft was a rudimentary a "Pusher" Mark J. Denger, of the California Center for Military His- biplane, equipped with a 60 h.p. V-8 engine that gave the air- tory, has written a biography of Eugene Ely that narrates the craft a 50 mph airspeed. historic day:

A contemporary replica of Ely's 1911 Curtiss Pusher was "On the morning of January 18, 1911, Eugene Ely, in a built to celebrate the 100th anniversary and shows its simplicity. Curtiss pusher biplane specially equipped with arresting hooks on its axle, took off from Selfridge Field (Tanforan Racetrack, in San Bruno, Calif.) and headed for the San Francisco Bay. After about 10 minutes flying North toward Goat Island (now Yerba Buena), Eugene spotted his target through the gray haze. "Ely's plane was first sighted one-half mile from the Penn- sylvania's bridge at an altitude of 1,500 feet, cruising at a speed of approximately 60 mph. Now 10 miles out from Tanforan, he circled the several vessels of the Pacific Fleet at anchor in San Francisco Bay. The aero plane dipped to 400 feet as it passed directly over the and, still dropping, flew over the West 's bow at a height of only 100 feet. With a crosswind of almost 15 knots, he flew past the cruiser and then banked some 400 yards from the Pennsylvania's starboard quarter to set up his landing approach. Ely now headed straight for the ship, cutting his engine when he was only 75 feet from the fantail, and allowed the wind to glide the aircraft onto the landing FLIGHT PHYSICIAN 15 January 2012

and from surrounding vessels. "Ely was imme- diately greeted by his wife, Mabel, who greeted him with an enthusiastic 'I knew you could do it,' and then by Captain Pond, Commanding Officer of the Pennsylvania. Then it was time fot interviews and a few photographs for the reporters. "Everything had gone exactly as planned; Pond called it 'the most important landing of a bird since the dove flew back to Noah's ark.' Pond would later report, 'nothing damaged, and not a bolt or brace startled, and Ely the coolest man on board.'

"After completing several interviews, Ely was escorted to the Captain's cabin where he and his wife were the honored guests at an officer's lunch. "While they dined, the landing platform was cleared and the plane turned around in preparation for takeoff. Then the Elys, Pond, and the others posed for photographs.

"57 minutes later, he made a perfect take-off from the plat- form, returning to Selfridge Field at the Tanforan Racetrack where another tremendous ovation awaited him. "Both the landing and take-off were witnessed by several deck. At a speed of 40 mph, Ely landed on the centerline of distinguished members of both U.S. Army and Navy, as well the Pennsylvania's deck at 11:01 a.m. as state military officials. Ely had successfully demonstrated "The forward momentum of his plane was quickly retarded the possibility of the aircraft carrier. by the ropes stretched between the large movable bags of sand "Indeed. The U.S. Navy's first aircraft carrier, the USSLang- that had been placed along the entire length of the runway. ley, was commissioned in 1922, eleven years later. But Ely didn't As the plane landed, the hooks on the undercarriage caught live to witness the milestone; he died just a few months after the ropes exactly as planned, which brought the plane to a his historic flight, on October 11, 1911, when he was thrown complete stop. from his aircraft during a crash at an air show. But 100 years "Once on board the Pennsylvania, sheer pandemonium ago, he merged the power of naval warships and aviation in broke loose as Ely was greeted with a bombardment of cheers, ways that remain cutting edge, even today." boat horns, and whistles, both from aboard the Pennsylvania Happy Landings, Dr. Mark (Eidson) On The Horizon

2012 CAM A Annual Board Meeting President Hugh O'Neill is requesting that all CAMA Officers and Trustees attend the Annual Board Meeting in Dallas, Texas, on February 10 — 11, 2012. The meeting FAA Aviation Medical Examiner will be held at the Embassy Suites DFW South, 4650 West Seminar Schedule 2012 Airport Freeway, Irving, Texas. All will convene at 1:30 p.m. until 5:00 p.m. on Friday, Feb. 10. On Saturday, Feb. 11, all February 3—5 Charlotte, N.C. OOE will reconvene at 9:00 a.m. until adjournment at 5:00 p.m. Note: further agenda items should be sent to the President March 5-9 Oklahoma City, Okla. Basic ([email protected]) not later than February 6. March 30-Apr. 1 Albuquerque, N.M. CAR AGENDA May 14-17 Atlanta, Ga. AsMA Welcome and Introductions — President June 18-22 Oklahoma City, Okla. Basic Review and Approval of October 2011 Minutes August 10-12 Washington, D.C. NEU President's Report October 4-6 La Jolla, Calif. CAMA t Executive Vice President's Report Secretary-Treasurer's Report including presentation of the October 29-Nov. 2 Oklahoma City, Okla. Basic financial statement for 2011 November 16-18 Denver, Colo. OOE Report from Vice President for Management CODES Report from Vice President for Education CAR Cardiology Theme Report on CAMA Website Report from Vice President for Communication and NEU Neurology Theme Representation OOE Ophthalmology-Otolaryngology- Speaker expenses at Annual Scientific meeting Endocrinology Theme CAMA Sunday 13 MAY 12 - Atlanta Hilton tThis seminar is being sponsored by the Civil Aviation CAMA luncheon 14 MAY 12 - Atlanta Hilton Medical Association and is sanctioned by the FAA as AOPA/EAA petition. fulfilling the FAA recertification training requirement. Review of CAMA Mission, Constitution, and Bylaws Registration will be through the CAMA Web site: Liaison with Airline Medical Directors Association www.civilavmed.com. International outreach, Board Function, Membership Next Board meeting Any other business Adjournment

RELAXING IN THE SUN. Completing our annual meeting highlights at Tucson is a tour of the BioSphere 2 exhibit. Shown enjoying the scenery are attendee spouses Sarah Eidson, Joan Heins, Lovie Beard, and Josie Herbert.