Gall Stones
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AJC Look on CAA website!
From memory: Single Gall Stone and no symptoms no problem.
Multiple Gall Stones then Medical is suspended (even if no symptoms)
Keyhole Gall Bladder removal is a commonplace, relatively minor operation.
Your medical will be suspended because you have to tell CAA if you undergo any operation. They will
probably advise you that the medical will be reinstated (with no limitations) once your surgeon writes
to advise them that you have fully recovered - probably 3 to 5 weeks post-op, with getting the surgeon's
letter taking longer than your actual physical recovery.
One point: Your surgeon will probably advise you to refrain from any
flying (inc Pax) for 48 hours to ensure any residual CO2 in your abdomen
has time to resorb and won't cause pain due to expansion as the pressure decreases with increasing altitude.
I am writing above only to suggest that if your problem is as "simple" as you indicate then you shouldn't be too concerned about regaining your Class 1.
However you should check with CAA, your AME and your surgeon (I am just an anonymous Poster)
From memory: Single Gall Stone and no symptoms no problem.
Multiple Gall Stones then Medical is suspended (even if no symptoms)
Keyhole Gall Bladder removal is a commonplace, relatively minor operation.
Your medical will be suspended because you have to tell CAA if you undergo any operation. They will
probably advise you that the medical will be reinstated (with no limitations) once your surgeon writes
to advise them that you have fully recovered - probably 3 to 5 weeks post-op, with getting the surgeon's
letter taking longer than your actual physical recovery.
One point: Your surgeon will probably advise you to refrain from any
flying (inc Pax) for 48 hours to ensure any residual CO2 in your abdomen
has time to resorb and won't cause pain due to expansion as the pressure decreases with increasing altitude.
I am writing above only to suggest that if your problem is as "simple" as you indicate then you shouldn't be too concerned about regaining your Class 1.
However you should check with CAA, your AME and your surgeon (I am just an anonymous Poster)
Thank you for this
But how would anyone know they had multiple gallstones if they were asymptomatic? I suppose the ultrasound probe could slip on a pregnant woman, but I don't go round Tesco waving my ultrasound at fit and healthy people
True it isn't the most major operation known, but I wouldn't call it minor, and complications can be significant.
Sorry to be a killjoy, but I worry about any pressure to take a risk....
And finally please don't fly 48 hours later or you may well be in agony as you depressurise - unpressurised aircraft are fine but commercial flights need at least 5 days and many airlines insist on 7 to 14
But how would anyone know they had multiple gallstones if they were asymptomatic? I suppose the ultrasound probe could slip on a pregnant woman, but I don't go round Tesco waving my ultrasound at fit and healthy people
True it isn't the most major operation known, but I wouldn't call it minor, and complications can be significant.
Sorry to be a killjoy, but I worry about any pressure to take a risk....
And finally please don't fly 48 hours later or you may well be in agony as you depressurise - unpressurised aircraft are fine but commercial flights need at least 5 days and many airlines insist on 7 to 14
Psychophysiological entity
AJC Look on CAA website!
From memory: Single Gall Stone and no symptoms no problem.
Multiple Gall Stones then Medical is suspended (even if no symptoms)
From memory: Single Gall Stone and no symptoms no problem.
Multiple Gall Stones then Medical is suspended (even if no symptoms)
Do you think I'd get into trouble if I found the person that made that decision, and stuck a spear in their belly until it came out between their shoulder blades?
The gall bag is pliable, and can form around a large stone totally blocking the outlet. The sheer quantity of bile I dumped onto the hospital gurney evidenced just how much was squirted into the large intestine when the stone moved. Given that much of it probably went the other way, the bladder must have been a colossal size to have back-flowed so much.
I say again. One stone or a million stones, get the damn thing removed before you fly.
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From CAA website (just type in "gallstones")
Loose rivets, from what you have said, surely the above would not have applied in your case with your first sympton being as you describe.
MED.B.020 Digestive System
Class 1
Class 1
(c) Gallstones
(1) Applicants with a single asymptomatic large gallstone discovered incidentally may be assessed as fit if not likely to cause incapacitation in flight.
(2) An applicant with asymptomatic multiple gallstones may be assessed as fit with a multi-pilot limitation.
(1) Applicants with a single asymptomatic large gallstone discovered incidentally may be assessed as fit if not likely to cause incapacitation in flight.
(2) An applicant with asymptomatic multiple gallstones may be assessed as fit with a multi-pilot limitation.
Class 2
(c) Gallstones
(1) Applicants with a single asymptomatic large gallstone or asymptomatic multiple gallstones may be assessed as fit.
(2) Applicants with symptomatic single or multiple gallstones should be assessed as unfit. A fit assessment may be considered following gallstone removal.
(c) Gallstones
(1) Applicants with a single asymptomatic large gallstone or asymptomatic multiple gallstones may be assessed as fit.
(2) Applicants with symptomatic single or multiple gallstones should be assessed as unfit. A fit assessment may be considered following gallstone removal.
Last edited by Level Attitude; 9th Dec 2012 at 01:45.
Psychophysiological entity
Certainly, it wouldn't have applied. but there had to be a first time, and the stone was already very large - based on the fact it took years to reach that size.
I recall two occasions of getting up in the night with a miserable pain in my upper back. Just a feeling of being ill. I leaned over the sofa with my back to the fire and let it cook for a while. In hindsight, it was probably the position and pressure that brought the relief.
Years went by before the big one.
So, if someone knows they have a stone, but carries on based on a legal/medical interpretation, then they stand the risk of finding themselves in hell in the middle of an ocean. Sure, a multi-crew would take care of the passengers, but the thought of being in that pain for hours is horrific. Remember, I'd swallowed about 4-5 days worth of Pethidine in one night and it was still beyond my endurance.
(My wife was in America, and it was my daughter that called the night service.)
However, I'm quite convinced that if the worst should happen, it is possible to manipulate or jar a large stone out of the way of the bladder's outlet - because it is not stuck in the duct. The position on the sofa and later, the position on the gurney may have done the trick, and indeed the reeling, drugged, about the bedroom might have done the same where the Pethidine failed. But people have to be aware before they'd make an attempt.
Now, here's a thing I hadn't intended sharing. I was about 8 years old, and my mother, a hefty woman who loved her fried food, became ill after a day at our beach hut. She'd been swimming many times, and when the neighbors finally called the doctor in the night, it was because her screams could be heard down the road. I have an enduring memory of her kneeling on the bed with her aunt offering a sheet end for her to bite on.
The doctor knocked her out with an injection. He diagnosed a chill round the heart. It satisfied everyone for a while.
For years, she described minor occurrences as 'My pain' and would beat herself on the back with her stick. Astonishingly, it often did the trick - or perhaps it was the raised arms, who knows. As medicine became more refined, they finally decided she'd got a gallstone, but was too aged to risk the anesthetic. She lived with it until she died of something else at 93.
It occurs to me on this night, that it may be just another reason I'm kind of passionate about getting that useless organ out of the way.
I recall two occasions of getting up in the night with a miserable pain in my upper back. Just a feeling of being ill. I leaned over the sofa with my back to the fire and let it cook for a while. In hindsight, it was probably the position and pressure that brought the relief.
Years went by before the big one.
So, if someone knows they have a stone, but carries on based on a legal/medical interpretation, then they stand the risk of finding themselves in hell in the middle of an ocean. Sure, a multi-crew would take care of the passengers, but the thought of being in that pain for hours is horrific. Remember, I'd swallowed about 4-5 days worth of Pethidine in one night and it was still beyond my endurance.
(My wife was in America, and it was my daughter that called the night service.)
However, I'm quite convinced that if the worst should happen, it is possible to manipulate or jar a large stone out of the way of the bladder's outlet - because it is not stuck in the duct. The position on the sofa and later, the position on the gurney may have done the trick, and indeed the reeling, drugged, about the bedroom might have done the same where the Pethidine failed. But people have to be aware before they'd make an attempt.
Now, here's a thing I hadn't intended sharing. I was about 8 years old, and my mother, a hefty woman who loved her fried food, became ill after a day at our beach hut. She'd been swimming many times, and when the neighbors finally called the doctor in the night, it was because her screams could be heard down the road. I have an enduring memory of her kneeling on the bed with her aunt offering a sheet end for her to bite on.
The doctor knocked her out with an injection. He diagnosed a chill round the heart. It satisfied everyone for a while.
For years, she described minor occurrences as 'My pain' and would beat herself on the back with her stick. Astonishingly, it often did the trick - or perhaps it was the raised arms, who knows. As medicine became more refined, they finally decided she'd got a gallstone, but was too aged to risk the anesthetic. She lived with it until she died of something else at 93.
It occurs to me on this night, that it may be just another reason I'm kind of passionate about getting that useless organ out of the way.
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There's two trains of though here......re a symptomatic multiple gallstones....go to one surgeon, he'll whip them out....the next guy says if they are not bothering you leave them.
Glad previous poster can posted CAA /JAA dictate......you can fly easily with assymptomatic with a multi crew endorse ment class 1....it ok on class 2.
If you thinking of heading off to the sand or Asia.....you'll have to get them out. This is my predicament. For the sake of a week of hassle and 4 weeks off .....it might be worth it.
Gallbladder disease
Glad previous poster can posted CAA /JAA dictate......you can fly easily with assymptomatic with a multi crew endorse ment class 1....it ok on class 2.
If you thinking of heading off to the sand or Asia.....you'll have to get them out. This is my predicament. For the sake of a week of hassle and 4 weeks off .....it might be worth it.
Gallbladder disease
Last edited by Bearcat; 9th Dec 2012 at 14:52.
But Loose Rivets you DIDN'T have asymptomatic gallstones - you had had two episodes of pain. And to tell everyone to pop off and have them whipped out when in the next breath you say the operation is so dangerous it can't be undertaken on the basis of age........just keep taking apple juice and hanging up by your feet.
Back to my unanswered question
How would anyone know they had asymptomatic gallstones??????
Back to my unanswered question
How would anyone know they had asymptomatic gallstones??????
How would anyone know they had asymptomatic gallstones??????
discovered incidentally
OK let me rephrase my question
How would they be discovered incidentally
I am only a simple doctor, but I am struggling to think of a way anyone who does not already have medical issues that in effect make the holding of a license questionable could ever have an incidental discovery. You can only find the gallstones by ultrasound, MRI or XRays. I suppose virtual colonography is the only possibility but VC screening in the UK is almost unknown
How would they be discovered incidentally
I am only a simple doctor, but I am struggling to think of a way anyone who does not already have medical issues that in effect make the holding of a license questionable could ever have an incidental discovery. You can only find the gallstones by ultrasound, MRI or XRays. I suppose virtual colonography is the only possibility but VC screening in the UK is almost unknown
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OK let me rephrase my question
How would they be discovered incidentally
How would they be discovered incidentally
GP wishes to exclude more sinister causes (kidney disease) and refers you
for a blood test and ultrasound of kidneys
Or, because you have private health insurance GP sends you for MRI of spine
Plus original poster gives a real life example?
Last edited by Level Attitude; 10th Dec 2012 at 20:56.
Psychophysiological entity
when in the next breath you say the operation is so dangerous it can't be undertaken on the basis of age........just keep taking apple juice and hanging up by your feet.
It's the trouble with speaking emotionally. I'm putting in too much passion and not enough accuracy, but, I did say my mother was of a great age, and that it was miss-diagnosed when she - probably - had the 'big one' many years before, evidenced by the fact I was 8 or so.
It was the anesthetic that was deemed the risk.
By the time she had the stone spotted - while another problem was being investigated - it was too late for a safe general anesthetic.
Mind you, I've often wondered how the Queen Mother had a general at 90 odd.
Psychophysiological entity
Quite so. My mother was heavily built and physically strong, but she wrecked her lungs with years of smoking. I suppose that's why they deemed it such a risk. Such a shame.
.
.
Last edited by Loose rivets; 11th Dec 2012 at 03:15.
I have to declare that I am .......
an anaesthetist
We do lots of 90 year olds under GA, and no the Queen mother had a GA not a spinal - my mentor anaesthetiassed her. Both are dead so this can be discussed.
The idea that it is the anaesthetic as opposed to the surgery that is the risk really hits the nail on the head, and is why I am so concerned at people being herded to major surgery for no good reason. Regulators need to be challenged on this
Oh, and a spinal MRI wont pick up gallstones in most cases.Ultrasound of the kidneys will often not look at the gall bladder. I agree some imaging of say the renal tract will pick up gallstones, but in this case the individual clearly has a medical problem - indeed it may be they have cholecystitis and the kidney issue is a misdiagnosis.
I accept people may have symptoms or other pathology leading to imaging that detects gallstones, but my question is how a fit asymptomatic pilot could end up being diagnosed. It is perhaps fortuitous that it is really very rare as otherwise 1 in 4 pilots might be sent for major surgery and be put at risk when there is scant evidence it is justified
an anaesthetist
We do lots of 90 year olds under GA, and no the Queen mother had a GA not a spinal - my mentor anaesthetiassed her. Both are dead so this can be discussed.
The idea that it is the anaesthetic as opposed to the surgery that is the risk really hits the nail on the head, and is why I am so concerned at people being herded to major surgery for no good reason. Regulators need to be challenged on this
Oh, and a spinal MRI wont pick up gallstones in most cases.Ultrasound of the kidneys will often not look at the gall bladder. I agree some imaging of say the renal tract will pick up gallstones, but in this case the individual clearly has a medical problem - indeed it may be they have cholecystitis and the kidney issue is a misdiagnosis.
I accept people may have symptoms or other pathology leading to imaging that detects gallstones, but my question is how a fit asymptomatic pilot could end up being diagnosed. It is perhaps fortuitous that it is really very rare as otherwise 1 in 4 pilots might be sent for major surgery and be put at risk when there is scant evidence it is justified
Psychophysiological entity
Indeed, the horns of a dilemma. But not for me. I'd have to come out on the side of using a chainsaw to get the damn thing out, so perhaps it's a good thing I'm not a doctor.
The two sessions of pain I had much earlier were odd. Doctor, a young locum, was all set to send me off for an x-ray, but I was so well and fit following that, it kind of got forgotten. My fault entirely, but the symptoms were like a bad chill, so anyone could go through that mild experience and not have a clue about the cause. I cost myself a lot of grief, but I suppose having got one of the first keyhole ops, I saved having open surgery, but . . .
The two sessions of pain I had much earlier were odd. Doctor, a young locum, was all set to send me off for an x-ray, but I was so well and fit following that, it kind of got forgotten. My fault entirely, but the symptoms were like a bad chill, so anyone could go through that mild experience and not have a clue about the cause. I cost myself a lot of grief, but I suppose having got one of the first keyhole ops, I saved having open surgery, but . . .
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Homonculus:
I, of course, defer to your knowledge of the case regarding anesthetics. Certainly hereabouts, we use a lot of regional anesthesia.
However, as I many times advised, when asked "what should I have, general or spinal or epidural?", my standard answer was "speak to the anesthesiologist and go with what he/she thinks is best". Perhaps you agree, the worst thing is trying to tell the anesthetist what he/she should do!
I, of course, defer to your knowledge of the case regarding anesthetics. Certainly hereabouts, we use a lot of regional anesthesia.
However, as I many times advised, when asked "what should I have, general or spinal or epidural?", my standard answer was "speak to the anesthesiologist and go with what he/she thinks is best". Perhaps you agree, the worst thing is trying to tell the anesthetist what he/she should do!
There's two trains of though here......re a symptomatic multiple gallstones....go to one surgeon, he'll whip them out....the next guy says if they are not bothering you leave them.
We tend not to get these problems with nurses, 'cos they just do as they're told. (Although there are exceptions to the rule.)
The trouble with these bloo+y tests, is that often, the findings don't often correlate with the symptoms, and sometimes, even less so with the cure.
How may cancers have we sparked off from ordering lumbar spine x-ray's ? And did it ever affect the management ? (Although we have moved on with the like's of MRI's.)
We're almost into the realms of screening here, and if the process doesn't satisfy Wilson's Criteria (Wilson's criteria for screening tests - General Practice Notebook) then we shouldn't be using it.
PS homo, is it true that the job of anaesthetist is similar to that of pilot. Hour's and hours of tedium, punctuated by minutes of pure terror ?
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I accept people may have symptoms or other pathology leading to imaging that detects gallstones
but my question is how a fit asymptomatic pilot could end up being diagnosed.
It is perhaps fortuitous that it is really very rare as otherwise 1 in 4 pilots might be sent for major surgery and be put at risk when there is scant evidence it is justified
Risk of first sympton occuring whilst piloting an aircraft = Low
Risk of first ever sympton being incapacitating = Low
Consequences of incapacitation:
- Passenger Jet = Nil (That's what 2nd Pilot is for)
- Small GA = Person(s) on board only (Even a crash is highly unlikely to hit anything except open countryside)
Obgraham you are an unusual doctor to say go with the anaesthetist. Actually more and more now we use epidurals as treatment as well as a method of eliminating pain. It would be 'suboptimal' (doctor speak for c***) to do for example removal of large bowel (colon) witout both an epidural and general. so more and more it is good practice not my preference
Gingernut - no there is a big difference between my two jobs. As an anaesthetist I always walk away from my accidents........
Gingernut - no there is a big difference between my two jobs. As an anaesthetist I always walk away from my accidents........
Psychophysiological entity