blood pressure problems

[flyinhi777]

I am a student pilot and a about a week before my solo my dog chewed up my wallet and medical. I have high blood pressure, which is not a big deal in its self and i had to send a request to the faa to get another. I did that and they had me do a ecg, blood work, and I had to have a letter from my treating doctor. I a while back about 3weeks before I had this weird thing happen where I started sweating and got flushed. Nothing else happend no chest pain an i did not get dizzy or anything in that era. My doctor included these 2 isolated problems in the letter and stated that they where probably do to being overlymedicated becuase I have white coat syndrom and my body in response to the blood pressure meds lowering it to much shot it up and caused these spells(both times happend after my meds got increased). Sense than I have been put on a diet and started running and I am coming off most if not all the meds, mean while my blood pressure has been aroun 115/60 and have not had another one of these episodes. Keep in mind im only 16 and in other wise good health. My question is will they give me my medical back or if they do will it be an SI? thanks again. I have the first class medical also.

[homonculus]

I can't advise on the FAA but

If you are 16 and your blood pressure is normal and you are coming off drugs I would put my medical license on the line and say you have never had hypertension

You don't get high blood pressure at your age unless you have one of a number of serious conditions that don't simply go away. In fact most get worse and fast

Go buy yourself a blood pressure machine at Walmart and take your blood pressure a couple of times a day when you are resting. My guess is you don't need drugs, there is nothing wrong with you and the FAA will love you

Having said all that I can't advise you to stop medication unless your current doctor or a second opinion so advises

Good luck

[flyinhi777]

Yes, i agree so I am seeing a blood pressure doc. and she ran all the test on me, all coming back normal. Even had a mri to rule out some of the odd stuff, which also came back normal. She is taking me off all the meds that my family doc. put me on because i have white coat syndrom so the doctor said it was high and kept increasing it. She is taking me off it and my home bp stays below 120/75 and I have not had another attak. Because of this and being that both times happend when my meds increase she thinks I was being overly medicated. She does in fact think I may have a little bit of hypertention (runs in the family) but is not big enough of a problem for the meds, yet anyway. She is taking me off these slowly and my bp at home has been staying normal, sometimes even lower then normal. IM hoping becuase of these to little episodes that they will not deny me. Any replies on these episodes i had being a problem?

[obgraham]

FlyinHi:
Once you've been under treatment for hypertension, you'll have to jump through some hoops to prove you really don't have it. You need to be very careful not to dig yourself into a deeper hole.
If you are in the US, and a member of AOPA, they have a chat forum similar to this one, and a very knowledgeable AME there, Bruce, has been extremely helpful guiding folks through their FAA medical certification.

[flyinhi777]

Well, I really would hate to spend the 100$ on somthing that is not going to be a big deal, thats why im asking for your opinions. I will look into the forum though. I already have the basic account i just do not have the medical portion.

[homonculus]

Let's get the facts clear

1 you do not have any hypertension. Even if your family doctor took your readings a dozen times over a month the fact that you get off and your blood pressure is normal proves this. There is no blood pressure illness that comes and goes. A raised reading due to white coat or running up the stairs is not hypertension. NASA regularly got over 300/180 on crews at launch

2. A family history is irrelevant. There is no such thing as a little blood pressure. Your readings are normal.

3. There is no reason for the regulator to deny a medical as you have had no illness. A doctor Inappropriately gave you a drug you didn't need and you became hypotension. That is good as it shows you have a normal response

4. Your problem is you can't say you have never been on the drugs. You must get your current doctor to stop this 'bit of blood presure' nonsense and give you a letter saying you do not have hypertension, did not need medication, and the other doctor was wrong. I regret this will not be easy and you may need help from your forum BUT it will be easier to get your doctor on your side as opposed to another doctor fighting them

[flyinhi777]

Basicly, you are correct. She said that I may be hpertensive, but not like they thought. There is no way of knowing as of right now, and thats because im still on some medication. You cannot just stop taking it at all unfortunitly you have to slowly come off it, which we are doing. But my concern is the 2 episodes I had. Will they say no medical because I could have another, or will they say ok because she THINKS that it was caused by becoming hypotesnive and is not for sure we cannot give you your medical back. I got the letter in my hand and she basically said I cannot guarantee you that he even has hypertenstion as I seen him when he was already on the meds.

[gingernut]

some good stuff here.... http://www.nice.org.uk/nicemedia/live/13561/56015/56015.pdf

[White Knight]

On drugs at 16??????????????????????



Seriously???????????????????????


And you want a medical???????????


:ugh::ugh::ugh::ugh::ugh::ugh::ugh::ugh::ugh:



Stay out of my airspace is all I can say!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Bealzebub]

He is referring to blood pressure (hypertension) drugs.
He is serious.
He does want a medical, and has come here for some advice.
He is probably happy to stay out of "your airspace" for fear of colliding with some 56 question marks and 40 exclamation marks.

Do you read all questions as well as this? Perhaps you have some helpful advice for the poster?

[obgraham]

Boy, Knighty, if you are going to eliminate everyone who might or might not have had or done something odd at age 16, who are you going to get to fly you around when you're too old to do it yourself?

We don't know here if the young man does or does not have a medical problem -- let's just give him the opportunity to get a fair evaluation.

[gingernut]

Flyinhi, it seems like we are all at odds here.

It may be useful to ditinguish your use of "drugs" (ie illicit substances) or "medication" (ie prescribed.) White night, I'm wondering if you've got the wrong end of the stick?

Also, the terms "raised blood pressure" and "hypertension" are slightly different concepts. Homon seems to tease things out in this respect.

We shouldn't (quite rightly) advise you on specific medication-only your prescriber should do that, but could you give us a few clues as to what you were prescribed, and why ?

[DX Wombat]

Do calm down White Knight and try to behave like an adult. There are plenty of children out there who need various drugs to help them maintain a healthy life. There are also those for whom drugs are given as prophylaxis. There is a condition called IgA Nephropathy (http://www.patient.co.uk/doctor/IgA-Nephropathy-(Berger's-Disease).htm) where children may be given anti-hypertensives for just this reason. Do read that article and if you don't understand it then I'm sure someone on here will be able to help you.

[AIRWAY]

white coat syndrome

We learn something new everyday.

I always wondered why when I get my blood pressure measured at the GP it always shoots up the first time the measurement is taken!!!

[flyinhi777]

OK I am so sorry for the confusion here. I am not taking drugs just to get high. I am taking prescribed medication by my doctor for high blood pressure. My Family doctor prescribed this to me on my very first visit, checked it a couple times and told me I had high blood pressure. I disagree with his decision because You can take my bp a 100times at a doc. office and its going to be high. That is just me. Because every time I went in for checkups with my family doctor My blood pressure showed high readings so he put me on more bp meds and so of course I did what I was told. I stoped messing around with the docs around here and went to Indianapolis and I now see a Hypertension/kidney specialist for children at Riley's children hospital(I'm not over 18). They ran all the test on me from heart test to kidney test and every thing is clean. She did not like me on all of the medication (Mg of amlodipine and Mg of lasporine**spelling?). I purchased a home blood pressure machine, which showed my blood pressure at home being low(obviously do to the medication I was on). She took me off the amlodipine totally and its still low so they lasporine is going next, Probably in the next week. She is now thinking I may have never had ***hypertension*** and because my blood pressure was dipping to low my body in response would shoot my blood pressure up, thus causing the 2 episodes of me getting sweaty/flushed and my bp would go way up. She also told me she cannot tell me for sure her theory is true as I was already on the medication when I went to see her, so either way I'm coming off the meds, which I think is a good thing so I can prove that I do not have high blood pressure(i think I'm fairly healthy). Although hypertension runs in the family I dont think i have it, yet anyway. My question is, and al ask again to clarify( i think you guys are confused as I made it confusing sorry) Are those 2 episodes going to effect me getting my medical back. Thanks and I'm sorry for the confusion. And AL be sure to stay out of your airspace because I can tell you dont like to share...I almost thought you had a heart attack why pressing the ? key.......Mabe you should worry about your health 2. sorry for spelling mistakes in advance, I have time to review it.

[flyinhi777]

I will give you guys the info needed to help me..i dont think i left anything major out accept that i DO NOT have any organ damage, and i was diagnosed with hypertension after 1 doctor visit with no home bp readings.

[flyinhi777]

White Knight, I am also sorry you feel this way about a medical condition I do not have much control over, if I even have it. One thing I do know is an arrogant pilot make the worst pilots....That said you do not have to worry about me coming around your airspace.

[tom775257]

I have always showed raised BP at medicals since I was 16 (diving then flying). Eventually my aeromedical examiner wanted me to go to my doctor to check if I actually have hypertension. The upshot was I was grounded after being diagnosed and put on medication by my local doc.

The CAA asked me to go to an approved cardiologist, he ran tests and stated in his report to the CAA that in his opinion I do not have hypertension and just get nervous. I now record my BP at home for say a month before the medical and bring it in to show my aeromedical examiner. My medical is based mainly on these home readings now. I am a commercial pilot btw.

I have found there is a strong link between my heart rate and blood pressure. Resting I have a pulse 50-60 bpm; almost every time the docs record around 120 bpm for me.

[air pig]

Thom 775257, same problem with me, resting rate 50-60, in GPs rate better than a 100, BP elevated so like you self check at home, and am on minimal medication. Sometimes keeping a record yourself may influence serious decisions.

[andrew_wallis]

Transient raised BP fits with transient raised pulse rate as both are mediated by the release of adrenaline when you see the doc.
As an AME, my pilots often have raised BP with me, yet if my nurse checks it's normal.
What is interesting is how often this happens, and im sure it's related to the personality type of pilots.
We like being in control, and having all the cards, when we go to the AME ( even when I go for my class 2) we are not in control anymore, and that's stressful, which causes release of which chemical?

[gingernut]

It sounds like you have a robust plan there Flyinhi.

Hypertension doesn't seem to twitch the authorities too much, which is a good job, as people like me make a good living bombarding healthy people with chemicals in an attempt to keep them healthy.

What's different about your case is your age, and the threshold for looking for sinister causes, for example, pheochromcytoma, should be lower in someone your age. This is probably more important than looking for end organ damage in your case.

It does look like, in your case, there may have been a rush into nudging you into a protocol designed for managing this long term condition, and I'm wondering if your doc has been a little enthusiastic into placing you on this journey.

It sounds like you are seeking "undiagnosis" and the plan seems to be going well. Have a look at my earlier NICE link which explains the use of 24 hour ambulatory bp measurement in reaching a diagnosis. (Or undiagnosis.)

It sounds like the "flushing" incidents can be easilly unravelled by a listening clinician.

Let us know how you get on:)

[homonculus]

Feel free to ping me

You need to get off all medication

Then measure your blood pressure several times a day

Get confirmatory readings from a nurse or doctor or paramedic - you do NOT need a specialist

Go talk to an ame as any sensible doctor will know you have been mistreated and have no pathology

If the FAA are not happy I think you need to consider contacting your state licensing body as you may find they agree that nobody at 16 should be given medication at an initial consultation. If your treatment is subject to censure any restriction on your medical would have to be reviewed

[flyinhi777]

Well we ruled pheochromacytoma**(sp?) out with a urine collection, and blood work which showed a small elevation in one of the chemicals that this kind of tumor produces. She then had me do an MRI to see if she could find a tumor, using one of the best MRI machines in the world and could not find a thing. She did say it may take 2 or 3 scans to find it but because my blood pressure stays LOW at home( I just checked my blood pressure it was 100/50) she did not suspect it as she said no meds would really help my bp if I had this. I am thinking after I send my week of bp readings to her she will say that I have been mis diagnosed because my blood pressure is just simply to low. I thank you guys for all the help, and I sent in all my paper work they wanted and I should hear back from the faa in say oo about a month the way they move, I will however keep you guys updated, for the help of others if they come down the same road I am right now. At this point I dont think its not going to help do anything right now because they have not made there final decision.

[andrew_wallis]

Homonculus

Are you really suggesting he contact the equivalent of the UK GMC to report the practitioner?
If I've misunderstood your comment, then apologies, if I havn't, I don't think it matters what I say.

[flyinhi777]

Well guys, I got my medical back. Unfortunately, its a SI. They also said the next one I get by my Ame is also going to be a SI, and I'm not sure why. They are saying That because of episodes of dizziness and a cardiac condition is why. So now I'm stuck with a SI and I had dizziness because I had a sinus problem when I went to the doctor(he noted that) and the cardiac is because I have a benign heart mummer. Is it possible for me to get a regular 1st class back next visit? They are still thinking I have dizziness and I do not. I am also on no bp medication any more and my pressure is staying in normal ranges. Thus I think its safe to say I was misdiagnosed.

[homonculus]

sorry but where did the sinus problem and the heart murmer come from???

In medicine we have to deal with the entire pathology. You can't just add another diagnosis and assume it isn't relevant.

If you have had sinus issue they will need investigating or confirmation they have resolved. Until then the symptoms you put down to unnecessary drugs might be sinus symptoms which might cause dizziness when flying

There has been a recent thread on murmers but that may well need investigating too

It can be difficult posting if you don't know the relevance of various problems but if something is missed out the advice you receive may be incorrect

Best to discuss with your AME who should be able to advise on getting an unrestricted medical in the future

Good luck

[obgraham]

FlyinHi: There should never be any surprises at an AME medical visit. In the future, since there are at least some questions in your case, rightly or wrongly, my advice is to make a medical appointment with an AME, for only the purpose of reviewing your case to find out if you would pass.

You'd pay that visit yourself, in cash. And do NOT fill in the 8500 form. Present your stuff, discuss how you "would" complete the application.

Then make a regular AME appointment, with either that same AME or a different one.

Sure, you spend a few dollars more: but it's you're flying future you are dealing with here.

[homonculus]

iMHO a complete waste of time

He has sinus issues and a murmer and has to declare them

Period

[ciderman]

I can relate to all of this. I got caught with a high BP reading in 1987 when in all honesty it WAS high. I was burning the candle ay both ends, fast jet military flying by day and studying for ATPL at night, with associated money worries. Doc laid me in the sick bay for 30 minutes (they could do that in those days!) and it recovered. However, since then the sight of a BP machine sends shivers up my spine and I get serious white coat syndrome. I've been on treadmills and had 24hr ambulatories, seen cardiologists and never once given the same reading in the surgery as at home. I am eternally grateful to the CAA (the late AVM John Cook in particular) for their understanding but I always felt inadequate not being able to deliver the readings I could at home in their presence. Bit like always crashing the sim on landing.I don't do it for real, promise! Even the docs had to admit that if I was running their readings 24/7 there would be other signs and there were none, eyes, sugar,ECG's all normal. I am retired now and still can't get it out of my system and am on mild medication. My GP has seen to be doing something I think. My sympathies with my many colleagues who still suffer this problem

[gingernut]

Read today that death from heart disease has halved in the last 10 years. Maybe Vinnie Jones and complicated hospital procedures have helped somewhat, but I can't help thinking that the unsung heroes are in primary care, nagging on about high blood pressure, convincing people to take chemicals when they don't actually feel ill, sending people for blood tests etc:)

Long live the hypertensives.

[Matt101]

I renewed my class 1 today (only for the 4th time in my life!) and suffer from the same white coat syndrome. The trouble is I start to worry about the BP thing about a week out (I don't know where the initial worry came from to be honest!) and the anxiety builds up.

They bring out the machine and I can feel my heart trying to escape from my chest in utter defeat. It feels very much like an adrenaline rush to me (Fight or flight type stuff). This gives me an initial reading of something like 145/89 today. The next reading after me concentrating on a my book for a bit and generally trying not to think about it is down to 127/79 (still with a 102 heart rate) and then it keeps on coming down toward the optimal reading and a normal heart rate.

It's completely illogical but I have never been hugely keen on tests and am early in my career so everything seems like a fairly big deal. Our AME is lovely and sees the panic. As has been mentioned previously, for me it's suddenly a sense of having no control over the outcome of something quite important that does it I think.

I regularly self monitor for my own peace of mind (as important as my career is to me if something is wrong with me I'd rather know about it) and am always within the "optimal to normal" range.

I think a good AME know's when they're looking at a case of hypertension and when they're looking at a prize prat like me who is scared of an arm cuff with a pump attached.

[Nick Lee]

As there seem to be some conflicting viewpoints here, can I try to simplify things?
1. The first essential is to find out whether you actually have high blood pressure or not. A good way of doing so is to select one doctor and ask him/her to put you through the CAA's algorithm for the investigation of Hypertension (available on the CAA website), part of which is to do a 24 hour BP monitoring. If your BP drops while you are asleep, then your BP is probably anxiety-related (aka white coat syndrome). If it stays raised, then you need further tests to find out if there is an underlying cause.
2. One feature of your story that I do not like is the shaky, sweaty attack that you had. It's a rare, small print cause of high BP, but is caused by the adrenal gland letting adrenaline (epinephrine) into the circulation, and tends to cause bouts of raised BP rather than constantly raised BP. It is caused by a small, treatable benign tumour on the adrenal gland which goes under the jaw-breaking name of a phaeochromocytoma. I'm not saying that's what it is, but it should be considered given your history.
Good Luck!