Welcome to the Civil Aviation Medicine Frequently Asked Questions (FAQ). This document contains typical questions and their appropriate responses to help to educate the aviation community regarding issues of concern for the regulators (Transport Canada) and the end-user. For your convenience, the FAQ has been organized under specific topic headings. We will continue to update this document and add to it, so please visit this site regularly.
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Renal Stone
I am a Category 3 private pilot and have recently experienced some right sided flank pain which has been diagnosed as a kidney stone. What effect does this have on my flying and what information will Transport Canada require from me or my doctor prior to getting back in the air?
The attack of flank pain that you have endured is termed renal colic and the diagnosis is either renal or ureteral calculus, depending on where the stone is located in the renal system. These do have an implication on flight safety so we require some documentation to ensure firstly, that this is in fact the correct diagnosis, and secondly, that the risk of recurrence is controlled.
The medical requirements for the genito-urinary system are spelled out in the Canadian Aviation Regulations, 424.17(3) and stipulate that "any sequelae of disease of the kidney and urinary tract that is liable to cause incapacitation, in particular, any obstruction due to a stone shall be assessed as unfit unless accredited medical opinion can conclude otherwise".
An attack of renal colic can be quite severe and incapacitating. At Civil Aviation Medicine Branch, we would like to know that the stone has passed and the risk of forming new stones is low. In order to establish this, we usually will request a letter from your attending physician or urologist attesting to this fact. A supporting document would usually include a report of investigation such as an IVP (Intravenous Pyelogram) or US (ultrasound) to show no residual stone or obstruction. Renal CT scanning is now replacing the other two tests in the investigation of stone disease, because of it's superior accuracy, however such a test might only be requested in a small number of specific cases.
Once it is determined that the stone has passed, your medical certification maybe reinstated It is recommended that you have the stone analyzed in order to determine if any dietary restrictions may aid in preventing recurrences.
SSRI
I’ve been under a lot of stress recently and my family physician has started me on “Zoloft™” to help me get through this difficult time. I’m actually feeling better and I’m ready to fly but I understand that these medications (called SSRI’s) are not compatible with flying. Why is this?
Zoloft™ is a Selective Seratonin Reuptake Inhibitor (SSRI) and is considered a mood altering medication. There are a number of SSRI’s and related medications presently on the market. These go under such trade names as Prozac, Paxil, Zoloft, Luvox, Serzone, and Effexor to name a few. Similar classes of mood alternating medications, which are equally important, are listed in the table below. In some ways these medications have revolutionized the treatment of mental health problems. The indications for use of these medications are expanding almost daily and more and more aviation personnel are candidates for or should be candidates for their use. These medications may be acceptable for aviation activities in selected circumstances.
At the present time, all new applicants, current aviators and air traffic controllers using mood-altering medications, will initially be refused certification or have their medical certification suspended until the circumstances of the case are reviewed.
Transport Canada’s medical advisors must determine if the medical situation requiring treatment represents a threat to flight safety. We are concerned with both the underlying medical condition for which the medication has been prescribed and the side effects arising from the medication. Every case is considered individually and assessed according to diagnosis, severity of symptoms pretreatment, medication dosage and type, response to treatment, side effects of medications and prognosis for recovery or need for prolonged therapy. Other factors related to fitness to fly will also be factored in to the decision-making process including: the category of license or permit desired or held –airline, commercial, private, recreational; operational duties – single pilot, multi crew, fixed wing, helicopter, etc.; flying experience – ab initio or experienced.
As far as the side effect profile is concerned, anyone taking these medications should be aware of the wide array of potential side effects. While most of the effects are of little significance, a small number of pilots may experience some serious alterations in thinking, mood, judgment and personality. Of even greater concern is that often these effects may go unrecognized by the pilot or air traffic controller.
Transport Canada Civil Aviation Medicine continues to review the literature and conduct studies to determine whether certain medical conditions and medications may be considered safe for aviation related activities. Our current approach to return to flying decisions can be viewed on our website under the Other Guidelines section of the Handbook for Civil Aviation Medical Examiners.
In the meantime, you would be best advised to discuss your particular situation with your physician. Discontinuing any medication should only be done under the supervision of your physician and only when the clinical situation has stabilized.
| Serotonin uptake inhibitors | |
|---|---|
| Selective serotonin reuptake inhibitors (SSRIs) | |
| citalopram | (Celexa, Cipramil, Emocal, Sepram, Seropram etc) |
| escitalopram | (Cipralex, Lexapro, Cipralex, Esertia) |
| fluoxetine | (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin etc.) |
| fluvoxamine | (Luvox, Faverin etc.) |
| paroxetine | (Paxil, Seroxat, Aropax, Deroxat, Rexetin, Xetanor, Paroxat etc.) |
| sertraline | (Zoloft, Lustral, Serlain etc.) |
| Serotonin-norepinephrine reuptake inhibitors (SNRIs) | |
| venlafaxine | (Effexor) |
| desvenlafaxine | (Pristiq) |
| sibutramine | (Meridia, Reductil) |
| Others | |
| aminoketones | |
| bupropion | (Wellbutrin, Zyban, Budeprion, Buproban Elontril, Odranal, Quomen, Voxra, Zetron, Zylexx etc.) |
Note: This list is merely representative. It is not intended to be complete nor an endorsement by Transport Canada Civil Aviation Medicine.
HIV Applicants and Document holders
The medical certification of persons with HIV seropositivity will be considered in the same manner as any other acute or chronic disease process. The medical assessment will be based on a risk assessment for subtle or sudden incapacitation occurring during the validity period of the aviation license or permit held by the document holder or applicant.
In the case of HIV/AIDS, much is known about the natural course of the disease, the influence of treatment protocols, the side effect profiles of those medications, and the potential for significant physical and psychological dysfunction arising from the disease and the treatment. The potential for prolonged periods of medical stability is also recognized.
Transport Canada Civil Aviation Medicine will consider applicants for all classes of civil aviation medical certificates. Issues such as severity of disease, treatment protocols, side effects of treatment, potential for cognitive impairment and general prognosis will influence the aeromedical decision making for each individual applicant with respect to licensing fitness and/or limitations, and follow-up requirements.