Any experience with aeromedicals? I need your advice please!

[kashmiripilot1]

Hi guys, first post so I do apologise for lacking structure
1 (23F) have been wanting to apply for an initial class 1
medical for some time, but have had to wait for a
surgical treatment for three years (NHS waiting list is
long, but free so I won't complain too much), only to
find out the "things" (more info posted on links, I can't
articulate what I have well) are so tiny not even a micro
catheter could safely treat them. Symptomatically, I
have one nosebleed a year and my doctors see me as
low risk. If anything, I'm more at risk to being exposed
to radiation during X rays during scans of my lungs, so
they decided to call me once a year to figure out if my
symptoms have increased or stayed at bay.


The rare genetic condition I have (HHT) is quite rare (so
rare that most doctors haven't heard of it and there are
only three surgeons in the UK who can perform on me)
so UK CAA, FAA and EASA have no guidelines on it yet.
Statistically, if I'm untreated my chance of stroke
increases 1% every year, and I read somewhere the
EASA regard this as unfit. Technically, I'm left
untreated, but I was hoping because my "things" are so
tiny, the UK CAA may consider my case and leave me
with an OML


I saw some aeromedical centres allow consultations
before booking the initial, but don't know if that's just
the centre's way of squeezing every pound I have.
What is your opinion on this, and how do you suggest I
move forward?Do you think I have a chance at working
in commercial aviation as a pilot? Every insight is much
appreciated, thanks a lot guys!


Links cannot be posted because I haven’t made 8 posts, but here are the titles and website names if anyone is interested in looking into it, I would appreciate this very much!!



Hereditary hemorrhagic telangiectasia - Mayo Clinic

UK CAA Aeromedical conditions - haemotology

CAA Aeromedical conditions- deep vein thrombosis pulmonary embolism and use of Warfain

NHS - Hereditary hemorrhagic telangiectasia

CDC- Hereditary hemorrhagic telangiectasia

[sconnors]

Your condition sounds so rare that any advice you are going to get on here is likely to be speculative, even the AME (which are typically of a GP background) is unlikely to know about your condition. Even if they did, expecting them know where you are on its spectrum or quantify is impact on your ability to be a pilot is an unrealistic ask, what I would do were I in your shoes (and this isn't advice) is bring the CAA criteria to one of the experts and ask them if they feel how your condition affects you and your potential to be a pilot, in the form of a letter, and bring that to your AME.

[Radgirl]

Hi. I am afraid your condition affects all blood vessels and as you know it makes them fragile and at risk of bleeding. This includes the blood vessels in the brain making a stroke possible. The CAA's biggest concern is what is called 'sudden incapacitation' where a pilot suddenly and unexpectedly goes from being able to fly a plane to being incapacitated. As such I am afraid you will appear to be at risk. The CAA does not list every condition but it does discuss strokes. Even though the risk might be assessed as low by your doctors, it will be greater than for the rest of the population leading you to need to prove the risk is below a certain level. You would be well advised to sit down with your doctors and discuss the risk of bleeding including strokes and also bleeding inside the chest or abdomen. A doctor might say the risk is low but the level of safety you will need to demonstrate will be considerably higher ie a negligable risk or a risk only a few percent more than someone without HHT

I am sorry not to be more positive and do by all means follow up this consultation by asking the doctor to write a letter - no consultant should object in the NHS if an occupation is concerned. An AME will then need to forward the letter to the CAA for advice but I regret for most people with HHT a Class 1 is not achievable.

[+TSRA]

I'd agree with sconnors and Radgirl above as to what you should do - take the CAA criteria to your specialist and go from there. Your condition sounds and reads as rare enough that advice here will be speculative at best. I have a few concerns reading through the literature you provided, but I don't have the medical knowledge or training to assess whether the sudden incapacitation concern raised by Radgirl is of sufficient concern to deny a medical, although I would agree with her that the risk level, especially as you age, appears quite real with what I understood from the NIH et al. With that said, I do know a few pilots who have what would otherwise be considered nullifying medical conditions (albeit, here in Canada) who continue to hold a CAT 1 medical with restrictions, the most common is the "two crew operations only". I don't mean to suggest that as an avenue for you to pursue, but rather to let you know that there may be restrictive categories that you could query the CAA as a potential compromise if it is looking as though things will not go your way with an unrestricted Class 1.