CASA Are Asking For Alcohol Bloods

[I_Con]

Below is a direct cut and paste from a thread I started in the Australian GA section but I'm not having much luck there so I was hoping someone here might be able to help.
Hi all
Just after a bit of advice. I recently sat my medical exam and the DAME was happy with everything and re-validated my medical cert for 2 months stating there were no issues to be concerned about.

However I received a letter from casa stating they want Alcohol bloods, I inquired with them as to why and they told me that during the questionnaire regarding alcohol use they use a scoring system, and anyone who scores above 3 automatically gets sent for alcohol bloods. I have scored a 4. I don't really know why this is. I answered all the questions honestly and didn't think I was one to be classed as having a drinking problem. I answered no to all "the ever had a DUI, ever had a drink at work, do I ever consume more than 6 drinks in one sitting, e.t.c". The only thing I did state is that I have 2-3 drinks 2-4 times a week (again just being honest). I don't know if that was enough to score me a 4 or if my DAME ticked the wrong box somewhere.

It is a class 2 for a PPL(A). I received the letter on Monday and had blood taken that evening, however I was at a childs birthday the Sunday before where the alcohol was flowing freely and I had a couple (3 beers so around 4 std drinks over 4 hrs). I haven't had a drink since receiving the letter. 2 of the 3 blood test have come back, the full bloods came back normal, the liver function tests came back with some slightly elevated numbers (I can provide details if anyone knows what they mean) which from what I have read are very sensitive and can be not only be from recent alcohol consumption (not alcohol abuse) but can also be from some meds and even smoking, as well as early signs of liver problems. I'm still waiting on my carbohydrate-deficient transferrin test results, and from what I understand that is the real alcohol abuse test but again can be elevated from recent consumption (again, not abuse). Now when I went for my medical I had a talk to the DAME about my smoking and she prescribed Zyban which is a stop smoking drug which I was on and had not smoked for around 2 weeks when I did my blood tests, however I was using nicotine patches on the DAMES advice to increase my chance of success.

The other problem I have is it takes about 2 weeks to get into see my DAME, and my medical runs out on 22/9. Anyone ever had any experience with a similar situation? I'm just trying to figure out weather to give them my current blood test results with them being slightly elevated and get back inthe air ASAP or wait a week or 2 without drinking and have more blood taken and give them clean test results. And do you think this is the sort of thing that CASA are going to give me a hard time about for months/years to come (i.e am I stuffed?).

Any help/advice appreciated.

The only thing I will add is my GGT is 56 which the report says is above normal, should be 0-35. Total bili, alt, alk phos are also slightly high but not by much.

[gingernut]

Blood alcohol level gives a "snapshot." Even the most hardened drinker would score low if abstinent for a reasonable time before. By the same rule, an occasional drinker would score high if he or she had been on the pop a short time before.

"LFT'S" (Alk Phos/ Bilirubin etc), can be raised for a variety of reasons, alcohol, disease, infection, drugs, fatty liver etc. The gastroenterologists enjoy teasing out whether the disease in obstructive or non obstructive disease from the readings. Unfortunately, the test isn't specific or sensitive to alcohol. Interestingly, I think the DVLA use the test if a drunk driver gets caught twice in 10 years.

Gamma GT is more sensitive and specific test for (long term) alcohol use, but not always.

The reality is, if I performed these tests on a cohort of 100 pilots, there will be an abnormality in a substantial proportion of them. Teasing out what to do with the results can be problematic.

On the basis of what you've posted, I'm left wondering if the DAME's could be opening a can of worms.

Golden rule of performing a medical test- only do it if you know what to do with the result :-)

[I_Con]

Thanks for the reply gingernut, it's sounds like you know what you are talking about so I assume you have some sort of medical background.

Is my GGT of 56 high for a 37 yo male, and if so how high is it?? In your opinion does it paint a picture of alcohol abuse, or just alcohol consumption? I can't seem to get a straight answer online other that it can be sensitive to other environmental factors I.e coffee, which I do have one of each day. Smoking, which I was doing up until about 2 weeks before the blood test. Some meds, my dame perscribed Zyban to help me stop smoking.

From what I have read the carbohydrate-deficient transferrin test is a much better snapshot of ones drinking habits, and only responds to heavy alcohol consumption, and apparently is pretty reliable. I am confident the CDT results will come back favorable as leading up to all this I would class myself as a light drinker (1 per day, maybe 2 on weekends when would go out for dinner). I am a little concerned about the excessive consumption the day before the test.

So if you saw a GGT of 56 and a CDT of <1.7% what would your opinion be??

[gingernut]

I'm a nurse.

I'd suggest total abstinence and retesting ggt in 6w.

[cavortingcheetah]

What follows is pure amateur conjecture and some of it may be derived from reading Marvel Comics.
If you submit a blood sample with elevated gammas to a CAA medical section they are unlikely to attribute the raised level as anything other than alcohol excess, abuse, fun, whatever word you want to use.
They might well construe that you have an alcohol problem, even if you don't.
They cannot afford to have you flying with such a perceived problem.
There would be likely to be problems with medical certification requiring extra blood tests and/or psychiatric counselling depending on the authority's protocols and the type of medical required. If that's the case, these will be tedious and expensive and you might have to put a tick on any box for anything involving 'treatment for substance abuse' on any form anywhere in the future.
That was all the downside of reasoning and it may all be completely wrong or inaccurate or even rotten to say.
The upside is that gingernut is correct. Go off the sauce, however small a dollop you normally take, for a period of six weeks. Then do a blood retest. The results after six weeks will almost certainly be within normal ranges. Once you've satisfied that medical requirement do yourself a favour, continue to avoid the stuff altogether. From the sound of things, that would be a wise course of action, then you don't have to worry any more as to whether you're an alcohol abuser or an over alcoholic consumer. If you're worried about your consumption then the fiery finger is already writing on the wall.
Smoking causes bladder cancer. Not that long ago bladder cancer was very much a male disease and this had medical science slightly confused. It's only now, when more or less as many women smoke as men that the sex orientated bladder cancer graphs rise pretty much in tandem.
Just a few of my own personal thoughts with no claim to medical knowledge at all. I don't even have a degree from the University of Calcutta.

[Radgirl]

For once cc we agree BUT this isn't a case of blood tests done for something else showing up a problem. The regulator is actively doing bloods on drinkers. I would be interested to know exactly what bloods they asked for as most doctors would just do liver function tests. If the poster's GP was over enthusiastic and did second line bloods then that is a warning to others.

The reality is perhaps 15% of the population have some abnormalities and we can't simply ground 15% of the profession. They really are digging a massive hole for themselves......and our wallets. The reality is I suspect most pilots can recall celebrating something the day before the test and are emphatic they normally drink wisely. In other words the regulator is making you jump through hoops, stop drinking for a few weeks, and alienating the profession.

That isn't to condone heavy drinking nor drinking and flying, but surely we can identify those at risk without this

[cavortingcheetah]

Surely in this case the authority in question is requiring a blood test as a follow on based on the response to a personal alcohol usage questionnaire? Mightn't that conceivably be a measured response to a perceived or suspected abuse of alcohol amongst, in this particluar case, Australian pilots. It could be a policy put into place as a result of confidential feedback such as CHIRP which exists in the UK? It is not the same as requiring a blood test as an overall condition for medical issue is it now?
Personally, I'd like to see hair follicle testing done on a regular basis for public transport drivers of trucks, planes, trains etc and so on. Strangely enough though in Britain you cannot use a hair follicle test as proof that someone is 'off' a substance, only that they are 'on' one. It's a test typically used by social services in child relocation scenarios and that's a sad story in both cases. There's always a conundrum for a responsible medical department of a CAA in that it is difficult to balance a humane attitude towards the individual foibles and fatuity of pilots and the overall interests of public safety combined with an intrusive press much given to exaggeration.
Pilots are gods of course but we sometimes have to adopt human guise to move more easily amongst mortals. You should agree with me on that.

[gingernut]

The bottom line is, test's aren't always that valid.

Take a look at reliability vs repeatability and sensitivity vs specificity.

Let's hope enthusiastic examiners don't get too.........enthusiastic :-)

[cavortingcheetah]

True enough but this is one specific test being undertaken in response to a very personal question and answer schedule. It only remains for all who fill in the form to be a trifle unenthusiastic in their alcoholic score card.
Here's a quite extensive policy paper which discusses, among other things, random testing in the Australian aviation sector.
From a medical point of view I'm sure that elevated GGTs or ALTs would lead to a suggestion for further investigation. From a pilot perspective I'd be concerned that excess alcohol might be a very likely cause of such results and from a personal point of view, if I were a non imbiber, I'd like to find out why my liver results were out of the normal range. I regard this particular example as a win win all round, even for the loser.

Workplace drug testing - November 2012 - Australian Drug Foundation (http://www.adf.org.au/policy-advocacy/policy-talk-november-2012)

[I_Con]

Since it has been asked, the blood tests that have been required by CASA (The GP has nothing to do with it other that ordering said tests and sending results to CASA):

Liver Function Test: Mine was pretty normal except for an elevated GGT. From what I have GGT is very sensitive to environmental factors, such as smoking, coffee, junk food/preservatives, and finally alcohol. I think It is unfair to base someones drinking habits on GGT levels alone as a false positive is a very real possibility (I am happy to be corrected by someone in the know)

Full Bloods: I dont know what this means or what they are looking for but mine where all normal and withing range for my sex/age.

Carbohydrate Deficient Transferrin (CDT): What I have learned so far. Transferrin comes from the liver and is responsible for carrying iron around the body. Transferrin normally has a type of sugar attached also (Carbohydrate). When someone has been drinking heavily for a period of time (most stats say 4-6 a day for 2 weeks or more) the liver produces abnormal trasferrin which does not have the carb attached. This test is to count how many abnormal transferrin there is floating around in the blood stream, which indicates if the subject has been drinking heavily. This is the most reliable test for alcohol abuse to date and only shows a positive for sustained heavy drinking. My results have STILL not come back yet but I am confident they will come back favorable (i.e <1.7%) as I am not a heavy drinker.

The reason I am a little worried about this is because I have been led to believe that CASA have a history of taking minor medical ailments and turning them into major issues with lots of ongoing testing required despite multiple doctors and specialists clearing the pilot to fly. I don't know how true this is but I want to play it safe as I dont know how CASA will interpret the results.

I don't know if CASA are looking for liver disease, alcohol abuse problem or regular alcohol consumption. If its liver disease then I think I am safe if I can get my GGT levels down. If its an alcohol abuse problem then again I think I am safe as I have been abstinent for around a week and a half now and will keep it going for as long as it takes for me to get my results down to normal (which is really only my GGT) which pretty much proves I don't have a drinking problem. If they don't want pilots consuming alcohol well they are living in a dream world, and it will look like I will be up for a psychiatric evaluation.

The thing that sucks is because I was honest I am going to be grounded for a couple of months.

[cavortingcheetah]

No idea about the CASA but the SA CAA can be diabolical in their intransigent attempts to make life as difficult as possible. This is primarily due to the fact that the head of the medical department there is an Alabama trained doctor of extremely indifferent capability. That is a specialist assessment. The UK CAA, on the other hand, while making you jump through hoops, try to help you get back into the sky.
But on the whole though it doesn't seem as though it's ever a good idea to volunteer information to any government department unless there is to be a specific benefit to the person providing the information.

[I_Con]

No idea about the CASA but the SA CAA can be diabolical in their intransigent attempts to make life as difficult as possible.
Apparently CASA are the same, and for the same reason, the head of the medical dept. Or so I'm told atleast, I'll be finding out in the coming weeks. I'm hoping everyone is wrong, or my situation is not one of "those".

[BayBong]

Why not try to tapper it down then stop it then retest. Ask for an gastro-entero opinion too. If you have a gallblader stone that blocks your duct intermittently, other enzymes may go up then down. Keep us informed please. Good luck.

[I_Con]

A quick note on my results for those following, (and those that might search this thread in the future)


My full bloods were all normal.



The CDT was low (i.e it was good), the reference was 2.7% with 95% of the social drinking population being below that. Mine 1.3%



My liver function test had some slightly elevated numbers but nothing too alarming apparently. I have been to see my GP about the results, she said it looks like a fatty liver from smoking (and too much cheese apparently) but has sent me for more thorough tests and a liver ultrasound just to be sure its nothing more sinister.

Because of the good test results I am not going to bother abstaining and retesting. All the results have been forwarded to CASA and now I am just waiting for their interpretation.

[Radgirl]

Glad that everything is - hopefully - OK I Con, but I cant help reflecting that this is all BAD medicine.

You are no fitter as a result of this worry, disruption, cost etc nor are your passengers safer. And whilst cynics might comment that it doesnt matter if pilots are charged and b*******ed around for their living, you have now involved your GP, taking resources from others.

Your GP doesnt like to say there is nothing wrong, so he has given you a diagnosis of fatty liver without any real evidence. If you in time need other medical treatment this may increase investigations, cost, cause delay etc etc.

And now you, a fit person we assume, are having other tests which all have an incidence of false positives.

Some screening is of value - blood pressure, looking at the retina, checking the urine, female breast examination, virtual colonography - but much isnt. In the UK, mammography is being questioned as causing more harm than good, and every year we see patients on ITU as a result of false positives

It is not for me or others to say dont have the tests based on a posting, but in general CASA is not helping!

[Dirtyredbandana]

In response to this thread, you might be interested to hear of my experience.

An ex and I split a few years ago, and during the end stages I'd occasionally (maybe once every two weeks) go to the pub and drink too much (the break up was crazy, but perhaps not the best coping mechanism, however it is what I did)

Subsequently somebody (the ex perhaps?) rang CASA and my employer, or should I say harassed them with emails and phone calls so that I was pressured into going into "self-referral" by the company.

Although I probably should have said no to them I had cut down on my drinking so thought I'd just satisfy them by jumping through the hoops.

I had never been to work drunk, or done anything else to allow them to compel me to go into any sort of alcohol assessment, but after claims by someone about a pilot's drinking they are keen to get the pilot to be assessed (it's called arse covering).

Now all I can say is if you ever get offered this do not do it.

Firstly it was sold to me on the basis of it being an extra assistance to me in my desire to drink sensibly (or not at all), but the truth is that the "addiction specialist" I saw was not a personal mentor, but much more of a CASA spy in that once in the self-referral program you are automatically assumed to have a problem and he is bound to fill in a comprehensive report and assessment that goes to CASA.

If you ever drink quantities of alcohol that are high, or you drink regularly, then you will be labelled as "substance dependant". Although it may only say low level substance dependence (as in my case), CASA nevertheless have you on the radar and will demand regular CDT testing, addiction specialist reports on a regular basis, and possibly abstinence.

For my first two medicals after this occurrence (a 3 month cancellation of my medical was the first thing that occurred before I returned to work), nothing was really stipulated by CASA about whether I could drink or not so I occasionally had little one night sessions (not extreme - no vomiting, passing out, or blank memories, but certainly more than 3 or 4 drinks), but tried to leave it at least 2 weeks before a CDT test was due.

Now in all these tests they showed low CDTs but after the second year of this when I sat for my medical, CASA didn't send it out to me.

I called them after a month or two (I was on holiday so wasn't too hurried about it) and they said they'd not received one of my blood test results, nor had they received a copy of my attendance records at recovery meetings (I was going to them but CASA hadn't previously stipulated that I keep such a record) - assumption by them being that I must be drinking.



Now as it turned out the "missing" blood test result was simply lost somewhere between lab, specialist, DAME and CASA, and it turned up later.

Too late however because CASA had already now decided I could not have my medical back for another month and in that time I had to get a record of attendance at recovery meetings plus get another CDT test and reports from the addiction specialist and DAME.

Bear in mind that nobody at CASA had bothered to inform me of the lost blood test prior to me calling them, which I think is pretty useless of them.

So I complied with the requirements and they received all they wanted but apparently one of the tests had a CDT of 1.6% - this is low and would not flag a misuse of alcohol but in my case since it was higher than earlier readings it did show that I had not been completely abstinent (remember, I had not been mandated to remain abstinent, though perhaps CASA assumed this was what I was expected to achieve).


Anyway, dither, dither, procrastinate, etc, CASA didn't know what to do - probably because they assumed I was a raging alcoholic (not true) and had not been abstinent, therefore I was likely to perhaps go off the deep end, start flying with a hip flask of vodka and constantly searching for the nearest bars in slip ports (like many pilots)

Yet they had no hard evidence, apart from a low range CDT result that was pretty inconclusive.

So basically they did nothing for 3 weeks but finally just before they shut down for XMAS they sent me a request for written approval for them to consult my company DAME to arrange a return to work plan.

Considering I'd only been off work because of a missing blood test result and an inability to retrospectively provide a recovery meeting attendance record, this seemed odd, but I sent them this approval, and finally after CASA came back to work in January the work doctor told them what to do regarding further testing and monitoring - 4 random CDT tests (much better than previously where I knew when they were coming), total abstinence (only took them two and a half years to actually specify that this is what they wanted), and 4 addiction specialist reports and DAME reports prior to next medical, plus monthly random breath tests (I would never have failed those anyway).

So if you think you might drink too much and want to cut back, do it clandestinely, do it yourself and never admit anything to CASA, otherwise you will be subject to the same sort of rigorous and officious monitoring and assessment that probably will make life harder generally.

And once you are on the CASA radar any sort of indication that you had a drink will be seen as a disaster resulting in them cancelling your medical while they think about what to do.

I actually asked the DAME why they don't do CDTs for all pilots if they are so damned focused on my CDTs and he actually said that if they did then more than fifty percent wouldn't be flying!

It's easier for them to closely monitor and control a perceived problem than to open up a Pandorah's box by actually monitoring the alcohol use of most pilots (who's actually had RBTs? I've never had one in over twenty years of flying professionally, so even that simple procedure seems to be not used much, and I've never seen one conducted at a non- Australian port).

I wouldn't be surprised however if they do eventually start blood testing for alcohol use markers at medicals - might cause some dramas if they ever do that!

Hope this information helps some of you, and my mistakes in "self-referring" allow you to not do the same (unless you think it would be helpful).

If you do want to cut down on your alcohol use I recommend "SMART recovery" (Self Management And Recovery Training). Quite helpful and just hanging out with others who are choosing to cut down or stop drinking is a good tool, as well as a way of reflecting on one's own alcohol use in a confidential, non-judgemental environment.

Cheers (not the best sign off word considering the topic)

[Angle of Attack]

Interesting post red banana , pretty much your experience Sums up CASA in every medical related area, they are over the top beurocratic nightmare. Wow no Damp tests in 20 years? I've had about 9 in the last 5 years! I feel targeted now! :eek: