A Pilot’s Experience—Survival and Success

November 2015 - One of the really good reasons to work/diet your weight down by age 60 to what you weighed at 21 is the cardio stress test (CST). Even after a number of complete successes, it’s no fun. Note: Typically, heavy men show abnormally high blood glucose at age 62.

In the medical section of the Personnel Licensing Handbook, the criteria are stated for which Transport Canada (TC) requires a stress test. Type 2 diabetes is near the top of the list. Once you have it, it’s hard to say what it would take TC to drop it, but it might take an act of God.

TC has hired someone in Ottawa to administer all the medical requirements. I’d guess one person serves the whole country. When she gets your medical exam report, she sees whether additional tests are required. I have had some years where those tests approached $1,000. See the first sentence of this article for the way to avoid those expenses.

I hasten to add that the tests in the fields of endocrinology, renal function, ophthalmology, and cardiology essentially do nothing to help you manage or deal with the implications of diabetes. You are just paying for tests and the reports that go to Transport Canada: Civil Aviation Medicine. Nothing more!

One year you go for your medical and within a month, the letter arrives that reads “further information is required.” That information will cost you plenty.

Now TC is not unreasonable, and provided that you show willingness (read results) for some tests such as glaucoma, they may well grant you an extension(s) for the tests that cost much, say five times as much, such as a cardiacstress test. It is advantageous to schedule this test for midsummer or fall. It is to your advantage to exercise a lot and to do that exercise in a way that mimics the actual treadmill test.

In my case I have a specially made city bike that does not aggravate various skeleton conditions. You can be suited for a wheelchair but with planning/conditioning you can still qualify for a Class 1 medical. My bike has a magnetic attachment that allows the bike to be ridden indoors in winter. You place a TV in front, install travel logs or flight tapes, and ride away. Turn the volume off!

If you must have sound, use an MP3 or tape player with bright but easy music such as Vivaldi, Pachelbel, possibly Handel. You need music that will allow your stress level to minimize. Allowing your veins, arteries, and blood vessels to relax and stretch, while you increase your exercise rate matters greatly. Even if your heart is fantastic, that’s only half the risk; a stroke is the other half. In my case we work initially for a heart rate up from 65 to say 90 and maintain that for maybe 10 minutes, then gradually increase it to, say, 120 beats per minute (bpm), all the while relaxing but being aware of head pain. If your head hurts, slow back to the last rate where your head did not hurt, empty your mind, and relax everything except your legs, which are pedalling. It’s not as hard as it sounds if you have some bright baroque music to ease the pain.

At the third level you’d increase your pedaling to, say, 140 or more bpm. If over 65, it might be 135 bpm. You need those sorts of numbers for the cardio stress test, which you want to pass without cardiac episode. If you are pain-free, try to maintain it for five minutes. With practice you can get there.

A bicycle path is better suited to this sort of exercise than say Highway 401. After your allotted time, you reduce the gearing and back off the speed for, say, two minutes at each level to give your heart a chance to gradually slow down. Now you know why bicyclists don’t stop for stop signs. They can’t.

You’ll certainly need weeks, and maybe months, to get ready for a stress test. That’s why you probably need an extension or two for your cardio stress test results. This is real, and TC realizes it.

In the same way that you’ve carefully managed your preparation, training, diet for the test, you have no interest in getting on a treadmill and having a cardiac event, stroke, or pass out from exhaustion…agreed?

That brings us to the day of the stress test. The clinic will give you a time; ask for a time that is in the best possible time of the day for you. Accept a later date to get that. That might also be a valid reason to get a further extension for your stress test! You should stop drinking coffee a full day before your test. A light breakfast or lunch is in order. Something very easy to digest three or more hours before your test. Do not max out on sugar. We find that energy drinks are a very bad idea. Caffeine can and does cause anomalies in cardiograms. Think organic in your pretest diet, not chemical.

I’ve found that clinics operate in a warm but slow environment. Both are to your advantage. You want to be relaxed but your legs need to be warm. Stretching is a good idea. So is draining your bladder right before the test. Empty your mind; bring some very light reading while you wait. Relax your mind and, just as important, your heart. If you know a poem or a psalm, this would be a good time to go over it. The knight, he went for to doone his pilgrimage, the holy blessed blissful martyr for to seken. (Apologies to Chaucer.)

What do we want or, more importantly, what exactly will Transport Canada accept? Now, what TC will accept and what the technicians are trying to get you to do are two different things. Read that sentence again and remember it. Both the young men I have had as technicians are the walk-until-you-drop type. The young lady I had in between the two guys was not. Now she quit before my third test, but not before she taught me (in French) the difference between what TC writes in the manual and what they will accept. Vive la différence!

The letter they send asking for more information, requesting a report reads: a treadmill exercise stress cardiogram (EST) to a minimum effort of 8.5 METS (end of stage 3) using the Bruce protocol.

However when they evaluate the test report, what they need is this:

You need to meet three requirements:

1. A heart rate at or above the required heart rate for your age, basically 220 minus your age and possibly less 15 percent. Mine is around 135.
2. A blood oxygen level of 8.5 METS.

3. A blood pressure (BP) level below their maximum, which is 180/110. At rest ideally your BP might be 125/65. The goal of the examination is to ensure that the pilot has a BP at rest that is below 140/90.

There is no reason to walk until you drop in the third level of the Bruce protocol. It is ill advised. During the first test the technician stated that unless we went to nine minutes and three full minutes at the third level of the Bruce protocol, then Transport Canada would reject the test result and cancel all my pilot’s certificates. Mark Twain said there are three types of lies: lies, damned lies, and statistics. The technician’s statement involved both a damned lie and statistics.

Now I can complain folks, and complain I did to my medical examiner. Before the next test the clinic terminated his employment.

To get to my point for this article, you need to make it exceedingly clear during the preparation for the test that the technician’s job is to inform you the second you get to the required heart rate for your age (e.g. 135) and the minimum METS, which is say 8.5. In my experience that occurs around seven minutes and 33 seconds. That brilliant young lady I was tested by, for the second test, taught me this stuff.

If you allow the test to continue, sometime after seven minutes, 33 seconds, the treadmill elevates to its highest level, your respiration and heart rate and blood pressure are maxed out, and guess what? You are at great risk of passing out or experiencing a heart attack and/or stroke. You have no reason to do this. None!

In any event, you have done all this training/preparation to avoid all these events, haven’t you?

Whatever you do, at any sign of chest pain, tightening of the chest wall, more than a mild headache, or difficulty breathing, tell the technician to stop the test. Wait at the clinic until all symptoms have disappeared. Possibly a drink of water/aspirin would be a good idea. Ask the clinic to reschedule you for a later date, by which time you will have re-evaluated your choices and retrained for the test. Contact TC for an extension, but don’t be too specific as to why. You might say you didn’t feel well, got sick, tripped…but only if asked. Pilots never have panic attacks. Never!

You, of course, might avoid all of the above and more, if you diet/exercise back to your age 21 weight. Nuff said.

As I reviewed this article, the phone rang and the screen said GOC, so it was answered. Turns out it was TC medical division saying they had my CST report, that it looked great, and I am good to fly until the next time. So it ends well.

God bless the young women at the clinic.