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Stroke case-based scenario
Flying days end at a stroke
Jim’s dramatic collapse at home from a stroke one evening at the age 76 spelled the end of a long and happy flying career. Jim accepted his fate graciously, realising he had lasted longer than many, and consoled to know he would still be able to fly with a qualified flying instructor.
"I always knew that - if I lived that long - I would be forced to stop flying one day," Jim says. "Even so, it was a painful reality to have to accept when the time came. Still, I constantly told my students that in the air, safety first is safety always. I would be a hypocrite of the first order if I thought myself exempt from those rules - not to mention a danger to the public."
Jim held a Commercial Pilot's Licence (CPL) for almost 50 years, with a Class 1 medical certificate.
He learnt to fly with the RAAF then worked for a major airline for many years. His appetite for flight undimmed, Jim went on to spend another 15 years as a flying instructor with a regional flying school, with a bit of single pilot charter work thrown in for good measure.
Never happier than when he was up in the air, Jim loved the buzz he got from passing on his expertise to young pilots and seeing them take to the skies.
He also owns a Tiger Moth and would regularly take part in air shows performing formation flying displays.
For the six years before he suffered his stroke, Jim's medical certificate was the subject of audit requirements because he had been diagnosed with diabetes. He had also been treated for high cholesterol and high blood pressure. Jim visited his Townsville-based designated aviation medical examiner (DAME) every year to renew his medical certificate.
As part of his annual reviews Jim was required to see a number of specialists to monitor the progress of his diabetes.
Since diabetes can damage blood vessels and nerves, potentially causing disease of the heart, eye, kidney and brain, Jim thanked his lucky stars every day that his diabetes hadn't yet stopped him flying.
One weekend when Jim was relaxing at home with his wife Rhonda, his good luck finally came to an end. Jim collapsed for no apparent reason on the way to the bathroom. Deeply concerned, Rhonda tried to help him get back onto the couch but was too frail to lift him. Rhonda's alarm grew as she realised Jim was mumbling his words and that his face appeared to be drooping. She immediately called the ambulance service and Jim was rushed to the base hospital in Townsville.
The doctors in the emergency department grasped the seriousness of Jim's condition immediately and admitted him to the hospital. An emergency CT scan showed Jim had suffered a spontaneous bleed into the brain, commonly known as a stroke.
"The doctors told me there was nothing they could do that would reverse the immediate effects of the bleed," Jim says. "The best they could do would be to prevent further complications of the event. That really wasn't news I wanted to hear."
Jim spent four weeks in the hospital and improved relatively quickly with rehabilitation from the in-house physiotherapist, speech therapist and occupational therapist. Happy with his progress at last, the hospital discharged him back home to the care of his wife.
Jim's specialists advised him not to drive for a month after his discharge from hospital. Then his occupational therapist gave him a driving assessment and provided a report to Jim's GP, who cleared him back to driving. On the urgings of his GP, Jim notified the state roads authority of his new diagnosis.
Visit to DAME
Determined to do the right thing, Jim booked an appointment for a review with his Designated Aviation Medical Examiner (DAME). He drove himself to that appointment, where they discussed this new diagnosis.
Since Jim had fully recovered from his symptoms by then, and had been cleared for driving, he was optimistic his DAME would clear him back to flying, if not immediately, then at least in due course.
"I must admit, I was really surprised when my DAME warned me there was a good chance that CASA might suspend my medical certificates," he says. "I had assumed that if I could safely drive, I could just as safely fly.
"Of course, as soon as the DAME explained I could potentially suffer another stoke at any time, and reminded me how helpless I was that dreadful night on the living room floor, I could see the sense of the stance."
The DAME notified CASA's Aviation Medicine (AvMed) branch of a change in medical condition in accordance with their obligations under the Civil Aviation Safety Regulations. The DAME also advised Jim not to fly until he received a clearance from CASA or from the DAME himself.
The DAME forwarded copies of the hospital and specialist reports to AvMed with the notification email. AvMed reviewed the supplied information.
As the DAME expected, CASA then wrote to Jim confirming his certificate had been suspended, advised him that he should not fly for at least 12 months and asked him to seek an updated report from his neurologist.
Since Jim and his DAME had already accessed the clinical practice guidelines published on the CASA website by then, Jim knew that the neurologist's report would be important to CASA's deliberations.
Sadly Jim's neurologist confirmed that Jim had a high risk of future strokes. He also advised Jim that the combination of diabetes, high blood pressure and cholesterol made a heart attack a strong likelihood. He referred Jim for an exercise stress test and further management of his condition.
In due course AvMed received the reports and Jim's certificate was cancelled. Jim was very disappointed with the decision but continues to fly on occasions with a qualified flying instructor.
"I still miss flying all the time," Jim says. "But given the risks I would pose in the air, it is a decision I accept. And after all - I did have an excellent innings, so you won't hear a word of complaint from me."