170 Self-imposed medical stresses
Hypoglycemia
Hypoglycemia is mentioned elsewhere, but it is also explained here, since it is a self-imposed stress (as a result of poor or inadequate nutrition). Often the situation is the inability to find or take the time to ingest adequate nutrition, limited many times to calories from a vending machine. Restaurants, coffee shops, and fast-food places aren’t always open when you need them, you’re in a hurry and don’t have time in the morning, or the expected meal is not available on board the airplane.
Missed meals is a problem, and you might not be able to control the unex- pected lack of food; however, there are creative ways of “bagging” food that you can keep in your flight bag or suitcase. This can range from a roll of candies to bags of peanuts or “trail mix” (peanuts, raisins, and candy). This is not as nutritious as a regular meal but does resolve the symptoms of hypo- glycemia for the short term, a necessary trade-off to prevent impairment. You might consider keeping packaged or canned microwavable soups, stews, and the like in your suitcase that can be at least partially heated in hot water if you end up at your hotel without a meal.
By recognizing symptoms of hypoglycemia, such as headache, stomachache, nervousness, light-headedness, or shakiness, you can take appropriate cor- rective action. This includes some form of instant energy: calories, such as candy. Prevention is still the best therapy, respecting the need the body has for adequate calories that will last several hours: fats and proteins. Even if you miss a meal, you can prevent hypoglycemia by planning ahead and keep- ing an emergency source of packaged calories always available.
At the crew base with just vending machines, the combination of peanuts, whole milk, a candy bar, and an apple can suffice for an “emergency” meal.
Avoid using “empty-calorie” food (sweet rolls and colas) to take the place of any meal. The trade-off of not being nutritious is minor compared to the chance of becoming hypoglycemic. The cola and candy bar, especially for breakfast, can lead to sugar rebound effect (a sugar-high in the blood fol- lowed in a few hours by a sugar-low). Try to find foods high in protein for snacking. These provide energy over a longer period of time. There are now many good-tasting Energy bars, Trail Mix bars, and Breakfast bars available for supplementing a poor meal or for a more nutritious snack.
Smoking
Aside from the risks to your health, smoking also puts carbon monoxide into your blood system and cells. Recall that carbon monoxide interferes with the absorption of oxygen, leading to even higher levels of hypoxia. Smoking one cigarette prior to flight increases your body’s hypoxic symptoms as if you were 2,000–3,000 feet higher. This becomes a significant factor with night vision, which is dramatically affected by mild hypoxia. Visual acuity impair- ment is more pronounced.
In addition, smoke can be very irritating, especially to your nonsmoking crew.
Symptoms of congestion, eye irritation, and general discomfort are common.
Fortunately, there has been a decrease of or even a ban on smoking on the
Miscellaneous abuses 171 flight deck with most companies. Practically all airliners are smoke-free now.
Secondhand smoke is another issue. Few will disagree that there is a prob- lem, but there are still mixed feelings about cabin air quality, and not just from smoking. This is a changing situation as more information from studies becomes available. Smoking doesn’t fit with aviation whether the flying is commercial or recreational (Fig. 9-3).
”Smokeless tobacco” (chewing tobacco, snuff, etc.) is another source of nico- tine. It, too, is highly risky for medical problems. It puts more nicotine into your body than smoking. A wad of tobacco in the mouth generates a lot of saliva, which must either be swallowed or spit out.
Prescribed medications
Although prescribed medications are not self-imposed, because your doctor feels you need to be on this therapy, it’s important to know that there are situations when one can fly and be on these medications. Many medications are certifiable if the FAA is given a complete medical report. (This is covered briefly in Chapter 17 regarding FAA medical certification.) Essentially, when determining if you are safe, it is a combination of why you need the medica- tion along with any side effects that would be present.
Remember that at altitude your symptoms might be different than at ground level. It is wise, therefore, to ground yourself for several days, determine if the medication is doing its job, and determine whether or not there are side effects. Some effects will disappear after several days on the medication. If the illness is under control and there are no side effects, then returning to flight status might be okay. In any case, this must be coordinated with your treating physician and your AME or flight surgeon before you can go back to flying.
Another problem is your schedule interfering with your timeliness in taking the medication or just plain forgetting to bring your medications along on a trip. If you are supposed to take a pill four times a day, that doesn’t mean
Figure 9-3
Figure 9-3 Self-imposed stress can spell DEATH for pilots.
172 Self-imposed medical stresses
one pill every hour for three hours in the morning before a trip that will last for the rest of the day. It is essential that you follow the required dosage and frequency and fully understand the potential side effects so that you know what to expect. Pilots on antibiotics will frequently quit taking them when the symptoms are gone. This is unhealthy because the infection still might be present; the lack of symptoms is not diagnostic of a cure. Always finish the medication if so directed. Seek necessary information and advice from your personal physician, and let him or her know that you are a pilot.