Special Tests
Certain tests are required at varying intervals under
the regulations. These are:-
The urine test, (at each medical).
The
ECG at initial medical, then for Class 1, 5 yearly till 30, 2 yearly
between 30 and 40, and yearly from 40. For Class 2 medicals, the ECG is
required at initial, then not until age 40. From 40 to 50 it is required 2
yearly, and yearly from 50.
The
haemoglobin blood test is required at each class 1 medical and at the
initial class 2.
The
cholesterol blood test is required at the initial Class 1 and at the first
class 1 over 40. For Class 2 medicals it is required at the initial and
first over 40 only if 2 relevant risk factors are present.
The audiogram
is not usually required for private pilots unless they are fully
instrument rated (Not required for IMC rated pilots). Class 1 and PPL/IR
medicals require an audiogram at initial, 5 yearly till 40 then 2
yearly thereafter.
From time to time I get asked why some of these tests
are performed
in the JAR pilot's medical examination. This is an attempt to explain some of
them. It only represents my personal views. So far I've only covered
the urine test and the ECG.
Special
Tests in the JAR Pilot's medical
No.1 in an occasional series
The Urine dipstick test (or Taking the
p***)
© Dr Andy Tobias 2003
At
each JAR pilot's medical, the urine is tested with a reagent strip. Have
you ever wondered why?
The
first thing is to explain what it is not for. It's not for drug or alcohol
testing. The urine is tested for 3 specific abnormalities. These are
Glucose (sometimes referred to as sugar), Blood and Protein. I will deal
with each in turn.
The
sugar test is to look for diabetes. Sugar in urine doesn’t necessarily
mean you do have diabetes, but it means that diabetes has to be ruled out
(usually by blood tests).
Invisible
traces of blood in the urine may indicate disease in the kidneys or
bladder. Again, a positive test for blood in the urine doesn’t mean that
there necessarily is a problem; it just means that one needs to be
excluded. I must stress that actually seeing visible blood in your urine
is a much more significant matter and should always prompt a visit to your
GP. Incidentally, female pilots with detectable blood in the urine during
menstruation are asked to produce a further sample after their period has
finished.
The
final test is for protein. Usually, in health, there is little or no
detectable protein in the urine. Results of more than "A Trace" of protein
should prompt investigation of kidney function, to exclude significant
kidney disease.
So,
since your intention in going for a medical is to pass it, how can you
make it as likely as possible that your urine sample will be free of the
Sugar, Blood and Protein for which it will be tested?
The
commonest cause of a falsely abnormal urine result seems to be providing
too concentrated a sample, so simply be prepared. AME's are not meant to
accept a sample you bring with you, (as it might be the cat's ), so make
certain you attend with a full bladder. Drink a pint or so of water an
hour or more before the medical, and certainly don't turn up "Hung-over".
(If desperate to produce your sample as soon as you arrive, say so rather
than risk embarrassing consequences). Make certain you do provide a
"mid-stream" sample; (Not the first few drops, not the last few drops but
some from the middle of the stream.)
Don't
exercise heavily just before your medical, as this can lead to small
amounts of blood and protein showing up in the urine. If you have been
warned that your blood sugar is higher than average, but not high enough
to be labelled as "Diabetes" and want the best chance of producing a sugar
free sample, don't have a meal or sugary drink or snack in the 2-3 hours
before producing your sample.
I
hope this helps.
Andy
Tobias © Andy Tobias 2003
Special
Tests in the JAR Pilot's medical
No.2 in an occasional series
The
ECG
© Dr Andy Tobias 10/10/2007
The
ECG (EKG in American) or electrocardiogram is the term used to describe
the process of making a recording of the electrical activity of the heart.
Like all muscle, the heart produces an electrical signal when it contracts
and when it repolarises (resets ready to contract again).
The
JAR regulations require an ECG at initial medical for a Private Pilots
licence, then 2 yearly from the first medical over the age of 40, and
yearly from the first after the age of 50. Commercial Pilots have to have
an ECG recording more frequently.
The
ECG is recorded by having 10 electrical leads connected to your body. 6
are placed across the chest in predetermined anatomical positions and 1
placed on each limb. Oddly enough this is called a “12 lead ECG.” There
are various methods of connection in use, but sticky electrodes for the
chest and spring loaded clamps for the limbs are probably the most common.
A
modern ECG machine is a computerised, self calibrating device that
accurately records the electrical activity that your heart generates. It
then prints out a graph of electrical activity against time. There are
certain patterns that are recognised as normal and certain patterns that
are recognised as not normal and may indicate potential problems with the
heart's rhythm, its dimensions or its own blood supply. The ECG printout
produced by most modern machines usually has a computerised interpretation
printed on it. This doesn’t count as the ECG being “Read” until a doctor
has given his or her opinion.
This next sentence is very important. A "Normal
ECG" does not necessarily indicate a normal heart, and an ECG that is "not
normal" does not necessarily mean that there is a problem with the health
of the heart.
However,
the CAA work on the premise that if your ECG is not “Read” as “A Normal or
Acceptable ECG” then further investigations (usually an ECG performed to a
standard exercise protocol, an ultrasound scan of the heart called an
echocardiogram, a prolonged 24 Hour ECG recorded on a small portable
machine and a consultation with a heart specialist (a Cardiologist) are
required, at your expense, to prove that your heart is normal. Sometimes
even more complicated scans and x-rays on the heart’s own circulation
(called the coronary arteries) may be required. The vast majority of
pilots who have to have some or all these investigations do, in fact, have
normal hearts and gain certification.
So,
who is the doctor who “Reads” your ECG? Several modern ECG machines have
been approved by the CAA for a “Computer reading” scheme. If your AME uses
one of these machines and the machine reports your ECG as “Normal” or as
showing one of a list of minor anomalies which have been listed and
pre-defined as acceptable by the CAA, then your AME himself is allowed to
“Read” the ECG. So long as he agrees with the computerised interpretation,
your ECG is indeed “Normal/Acceptable” for JAR Certification.
If
the Computerised interpretation of the ECG is not “Normal/Acceptable” or
if your AME has concerns, then it has to be read by a doctor with
specialist knowledge of ECGs.
Here follows another very important sentence. The
vast majority of ECGs which are not read as “Normal/Acceptable” by the
computerised ECG machine are considered perfectly acceptable when read by
a specialist doctor.
This
doesn’t mean that the ECG machine is faulty, simply that the software has
been designed to err on the side of caution in deciding whether to pass an
ECG as normal.
I
have said that if the Computerised interpretation of the ECG is not
“Normal/Acceptable” than it has to be read by a doctor with specialist
knowledge of ECGs, so who are these specialist doctors?
For
JAR 1 medicals this means a Cardiology consultant at the CAA. The ECG is
sent to the CAA for reading, but usually you can have your certificate
issued in the meantime.
For
JAR 2 medicals this means a doctor who holds a qualification of MRCP
(Member of the Royal College of Physicians) or higher and who is in
current ECG reading practice. If this doctor is happy, your ECG is then
considered “Acceptable for certification.” If he or she is not able to
pass the ECG, then it is sent to a Cardiology Consultant at the CAA like
the commercial pilots’ ECGs mentioned in the paragraph above.
For
Initial JAR 2 medicals, you may not have your certificate issued until
your ECG has been passed as acceptable, either by your AME following the
approved computer reading protocol, or by a specialist with the
appropriate qualifications, or by a CAA Cardiologist. So it can take
anything between 30 seconds and six weeks to get the definitive reading.
Unlike initial certification, renewal and revalidation JAR 2 medical
certificates may be issued, at the AME’s discretion, pending formal
reporting.
If
you are going to have an ECG here are a few pointers which may help
prevent minor abnormalities which might otherwise trigger further
investigations.
Don’t
drink a lot of coffee or cola before your ECG as it can give you “Extra
Beats.” Don’t drink a lot of alcohol the night before as it can also give
you “Extra Beats.” (I’m not even going to bother to tell you not to drink
any alcohol on the day of your medical. Turning up smelling of alcohol is
not wise). Don’t turn up exhausted or jet-lagged and don’t eat a big or
spicy meal as large meals and spicy food seem to give some people minor
ECG changes. Some healthy people have minor ECG abnormalities that
disappear after an overnight fast. If you know that you are one of these
people, then book a morning appointment and don’t have breakfast.
Finally,
here is a digression. A “Heart Murmur” is not something seen on an ECG. A
“Heart Murmur” is a noise that a doctor hears through a stethoscope when
listening to your heart. (It is the noise of turbulent blood flow and may
mean something or nothing, but that would require another article).
Andy Tobias © Andy Tobias
10/10/2007