Wednesday, January 02, 2013

Grounded

"What would you do if you couldn't be a pilot?"

The question was first posed in one of my aviation classes at UND, and has stuck with me since. It was always rhetorical, based on various imagined hazards ranging from a family history of diabetes to an industry meltdown rather than any specific, imminent threat. Early in my career any outcome seemed entirely possible, as did my imagined alternatives: Become an air traffic controller. Go back to school. Go into architecture or law. As I aged and my career became more established, both the prospect of not being able to fly and the chances of pursing an alternative course seemed increasingly remote, and the doomsday scenarios faded from my mind.

Yet here I am, in a sterile medical office, staring blankly at an anatomical poster on the wall and trying to understand what the doctor is telling me while the red master warning bell in my brain is blaring deafeningly. I wasn't expecting life-changing news today. I had a sharp pain on the right side of my abdomen last night, and grudgingly made a rare visit to the clinic on the off chance it was appendicitis. I dutifully drank some foul-smelling liquid and lay down for a CT scan, and figured worst-case scenario I'd be getting my appendix taken out laparoscopically before the day was done. And now this doctor is telling me that I have an inflamed ileum, he thinks it's likely Crohn's Disease, and I need to see a specialist to find out for sure.

I didn't know anything about Crohn's except that Dawn and I have two acquaintances with the disease, and their lives have been a living hell of torturous pain, ineffective medicine, failed surgeries, withered bodies, stunted careers, and strained marriages. I knew it was incurable. If I have Crohn's, I thought, it must mean the end of my flying career. The doctor was telling me that many Crohn's cases are mild and controllable with medication and diet, but I scarcely heard him. What am I going to do now? I thought. I looked across the room at Dawn. Despite her forcibly calm demeanor, I could tell she was thinking the same thing.

That was five weeks ago. Since then, I've gone to a gastroenterologist, consulted with several Aviation Medical Examiners, undergone a MRI, and had a colonoscopy. Crohn's is a tough disease to diagnose with certainty, and on the advice of ALPA Aeromedical, I continued to fly while the diagnosis was uncertain but I remained asymptomatic. I flew my trips in December knowing they would probably be my last in a while. And then, just before Christmas, came the final word: I do indeed have Crohn's, albeit a currently mild case. Based on past symptoms, I have probably been living and flying with it untreated for around ten years. Now that it's official, though, I'm grounded - for the time being.

The good news is that my diagnosis isn't nearly the death knell for my career that I initially imagined. Nearly 2,000 pilots currently hold a first class medical despite having Crohn's or ulcerative colitis. Most of the medicines used to treat Crohn's, including the one my gastroenterologist is putting me on (Remicade), are approved by the FAA and require only a short test period to make sure there are no severe side effects. Assuming that I don't have any, and the FAA has no objections to my case and their case load isn't more backed up than usual, I should be able to get a waiver by April or May.

Nevertheless, Crohn's is a somewhat mysterious and unpredictable malady, and despite my relatively mild symptoms thus far, it could take a turn for the worse at some point and end my flying career. I have a few things to occupy my time during my months out of work, but inevitably I'll return to the question: what will I do if at some point I can't be a pilot? I really don't know, right now. Aviation is my first love and has become such a large part of my identity that it would be very, very hard to give it up, even if I had to continue in a non-flying role. I guess I can consider the next few months a sort of trial run for an earth-bound existence. Fortunately, I have a few tailwheel-rated friends who can tag along in the C170 or the Cub when that old flying bug gets restless and starts biting again.

29 comments:

S Re said...

I have been reading your blog for awhile now and have always enjoyed it... I have no doubt that I will continue to enjoy it... I sometimes wondered if when I was fueling the NewCo and Horizon planes in Great Falls, MT if you might have been one of the Captains/First Officer on the plane on any given day?? After I found your blog...I am sorry to hear about your diagnosis... I cant even begin to imagine what you are feeling or going through... So I wont pretend that I do.. I will simply say that, this is just a bump in the road that we call life... You and Dawn can and will rise above this... Thank you for sharing this with us, it takes a lot of credit to tell the world how you were feeling and what is going on in your private/personal life... Keep your head up and your wings level(my attempt at pilot lingo)!

MarkeyMarkBeaty said...

I agree with the comment above completely. I wish you the best and hope all stays well!

Jerry Sterner said...

Sam, keep your head up. I have had Crohn's for going on 12 years and it is under control with medication (asacol)and hopefully you will have the same result. Wish you the best.

Eric Bohn said...

I'm a few years from transitioning to a flying career, and many years from being where you are today; nonetheless, the thought of losing my medical and not being able to continue flying is staggering to say the least. Sounds like you have a pretty solid chance of continuing on, and I wish you luck.

Mark said...

I'm not a pilot but I love reading your blog and maybe one day i'll get into GA when I can afford it. I'll be rooting and praying for you, keep your head up and everything will be fine!

Chris Burgess said...

Hi Sam - have followed your very interesting blog for a couple of years now. I have had Crohn's for over twenty years and in the last eight have not had one flare up as it is well controlled by medication. I know the severity of the disease varies hugely and it can be very serious but I hope you are one of the lucky ones and keep flying (and writing about it!)

John Ewing said...

Sam,

Very sorry to hear about your diagnosis, but glad to hear you are doing well.

Being grounded sucks. No pilot can fully understand the situation until it happens to them personally.

If there is anything good about being grounded, it's having to slow down, put our lives in perspective, and reconsider our priorities.

While you're grounded, I think it's important to know you have the support of your friends. If you find yourself in the Bay Area with a hankering to go flying, or just visit, let me know. I mean it.

Michael Kelly said...

I'm sorry to hear that, I can imagine it would be heartbreaking to have to leave the amazing aviation world!
Hope you get well soon!

Tom B. said...

Sam,
I have a friend I went to college with who has been living with Crohn's for about 20 years now. She is a physical fitness instructor/personal trainer and she has had a rough time with it but manages somehow. This is a tough break but I sincerely believe you'll keep flying and keep your airline career when the dust settles. Good luck with everything and take care - I'll still be coming by this blog to look for your posts even if you aren't flying.

Ben Read said...

So sorry to read this, but I am certainly hoping this turns out to be a mild and manageable case and your medical certificate comes back quickly. Good luck, take care and be healthy! -- Ben Read

Anonymous said...

I have always enjoyed your blog and often wonder if you are at the controls when I see Newco aircraft here in Calgary. Please know my thoughts are with you and your wife through this difficult time and I look forward to your future postings as you overcome this bump in the road. Take care and best wishes!

YYC Dispatcher said...

Hi Sam,

I've read your blog for several years now and have always enjoyed reading about your progression, first with Horizon and now with NewCo. I wish you the very best in your treatment and look forward to reading more about your career.

YYC Dispatcher

Christopher said...

All the very best for the future Sam. I know this can't be beaten but it can be mitigated hopefully so that you can carry on flying.

Andrew said...

Hi Sam, I've been an avid reader of your blog for a long time and have followed your career with interest. I'm a 145 captain based in Europe. My Mum had Chron's and she was advised to go for surgery by many people, however one old doctor advised against it as the disease quite often returns. She did eventually have to go under the knife one time only as an emergency case but by the time she did, the disease had burnt itself out and she's no longer suffering from it. I sincerely wish you all the best and I hope you get back to work soon.

Matt Dearden said...

Sorry to read this Sam. From one pilot to another, I hope you can get your wings back real soon. In my experience, aviation doctors are normally very keen to do everything possible to help you get flying again.

whereintheworldiskate said...

Holy crap, crazy news. I recall that (probably same!) lecture hall at UND being asked the same thing... except it involved being stabbed in the eye with a hot-dog roasting stick at a graduation BBQ. Most of us chose to make jokes about it more than anything, but as I get older in the industry, I know more friends and colleagues that have had scares and/or lost their medicals completely and has made me really start to think.

I wish you all the best and hope that you get your waiver soon( and don't go too crazy in the meantime!)

Terry Schooler said...

I've followed your blog for several years now and have enjoyed your stories. I'm currently on active duty going through my mid-career professional military education, but I'm a regional pilot on military leave in my civilian career.

You've talked to ALPA medical. That's a great first step. Make sure to continue your dialog with them as they are extremely knowledgable about navigating the process. I'm assuming that this process will lead you to a special issuance. The best thing I can tell you is to find an AME you trust and who is willing to take the time to work through the process, if you don't have one already. I went through the process about 4 years ago and, after the initial pain, and getting accustomed to the process, things get easier.

Best of luck in your treatment and getting back in the air.

Jim said...

Sam, Do not give up hope!

My wife has Crohn's and has it completely under control through diet alone. No medicine or side effects, and no symptoms, no surgeries, 10+ years. She has, in effect, exchanged a dreaded disease for an inconvenient diet. If she deviates from the diet even a little, the symptoms come back, so she has learned to stay on it 100%.
Please check out the book "Breaking the Vicious Cycle" by Elaine Gottschall.
Also a great website is nomorecrohns.com. Here you can learn about the SCD - Specific Carbohydrate Diet, get recipes, success stories and lots of encouragement.

You CAN beat this and keep flying, and you don't have to have the medicine, side effects, surgeries, and complications that our doctors resort to *by default*.

If you'll forgive a Matrix reference, this is a Red Pill moment in your life.
Your health is more important to you, personally, than to your doctor (who goes home everyday without your problems). You have to live with your body every minute. You have the option to to take control of your Crohn's disease for yourself and go beyond your doctor. You need to be aware that 99% of doctors don't really understand Crohn's disease, and only treat the symptoms and progressive problems.

The fundamental issue with Crohn's is that it is an immune response to certain intestinal flora. These specific fora feed on complex carbohydrates - starches and complex sugars - in your diet. The SCD eliminates those from your diet, so the bad intestinal flora do not thrive. With a much reduced (nearly eliminated) population of bad flora, your immune response is similarly reduced or eliminated. Think of the SCD as short-circuiting the disease process. That's how you can exchange this dreaded disease for an inconvenient diet.

Sorry for the long post, but I saw you were just diagnosed and my wife was in a similar position 10+ years ago. It was the kindness of a church friend who heard about her diagnosis and a copy of the book that saved her from the doctors. We laugh now, because those doctors and dieticians told her to eat white, bland food. Rice, white bread, potatoes, sugar... Basically the opposite of the SCD diet that saved her from Crohn's!

Good Luck and God Bless!

- Jim

Jackson said...

Every time I read these kinds of things it makes me really consider quitting flight training. I spent a LOT of money and effort so far on it in hopes of changing from my IT office job to my dream of flying for a living. I already spent years battling the FAA about my color vision deficiency, and finally got that taken care of (and will have to take the same test every year, hopefully my AME doesn't retire), and here I am at age 28, really wondering if it is worth it since it can be ripped out from under you in 1 minute. I know another pilot who just got grounded due to a failed drug test based on the type of tea he drinks. (literally, 1 nanogram over the arbitrary threshold, which was JUST changed this year, and he would have had no issue had he been tested last year) Now he has a court date and this isn't even with a judge and jury... It's with the feds. If that doesn't go against the US constitution I don't know what does. To me, the pilot is a powerless pawn against this machine of bureaucrats, lawyers, news media and pencil pushers, and it started weighing me down before I even finished my IFR ticket. I really am wondering if I should cut my losses and stop training right now. I don't know how I'm gonna get to 1500 hours anyway.

Sam said...

Thanks all for the kind words of support. I've begun Remicade treatment, am responding well, have been using ALPA Aeromedical, and am on track for a response from the feds by March or so. Jim, in my own research I've seen the link between diet and Crohn's, and am adjusting my diet accordingly. I can't forgo medicine entirely; there's some internal damage that needs to heal, and Remicade has been shown to do that. The feds would be unlikely to approve a special issuance without a treatment program that includes it or a similar drug. In time, I hope to be able to go off of it and control the crohns with diet alone, for several reasons not the least of which is that Remicade is bloody expensive!

Jackson-- If you want a "sure thing" career with little that can go wrong, you're looking at the wrong business. There are a lot of things that can end or stunt an aviation career prematurely - medical, accident, a firing (justified or not), a furlough when nobody is hiring, etc. This is a chaotic business, pretty much the polar opposite of IT, which I suppose is why I've flown with a number of ex-IT guys.

The *only* reason to go into aviation as a career these days is because you enjoy it so much you can't imagine doing anything else - and if you don't enjoy it now, I promise you that you won't enjoy it when you're commuting across the country to make poverty-level wages as a regional FO.

So far as how you'll get to 1500 hours... you'll do it exactly like the vast majority of airline pilots did it before 2006-2008 when airlines were hiring with a wet-ink commercial and suddenly new pilots got it in their brain that they were owed an airline job at 250 hours. You work your ass off for shit pay flight instructing, banner towing, diver driving, freight dogging, etc. It comes with the territory, this isn't new stuff that has suddenly popped up because of the new law. Yeah, there are fewer jobs out there than there used to be...but there are also fewer new pilots to compete with. It wasn't exactly easy to get those jobs after 9/11 when nobody was going anywhere and the flight schools were still pumping out thousands each year. Good, motivated pilots still managed to get their time in.

It's gut check time, my friend. Before you spend much more money on flight training, you need to ask yourself if you really, truly want this...including all the hardship and uncertainty. If not, there is no shame in being an IT guy who flies for enjoyment on the weekends. I fly a Cub in my spare time and it's far more fun than the flying I do for work.

Unknown said...

so, do we get to get to keep hearing from you at blogging at FL 0.0840 (the elevation at MSP)? ok, that's supposed to be funny.

Good luck Sam and hope things work out.

Jim said...

Sam,

I'm really glad to hear you're looking into your diet's affect on your Crohn's. As far as medication goes, my wife was put on heavy doses of Asacol (drug of choice at the time) when she was first diagnosed, and gradually weaned herself off of it as her body healed and she didn't have any more symptoms. (This was all while she was also eating the SCD diet.) She hasn't needed the Asacol since, and we still have a pound or two of the pills in a ziplock bag somewhere. (Good grief, they gave her a gallon-sized ziplock bag full of pills when she was first diagnosed!) All this to simply say that I think you are wise to continue the Remicade while healing and learning how to do the diet. Once you are feeling normal, you can wean yourself off of the medications.

I mentioned this post to my wife, and she said that if you do the diet and it doesn't seem to work completely, it may be that you are inadvertently consuming a hidden ingredient that feeds the bad intestinal flora. The ingredient lists on prepared foods often don't list things below 2%. "Natural Flavor" can mean Sucrose. Starch is often added to shredded cheese to keep it from clumping... Canned foods can be slightly contaminated with whatever was canned previously... Makes us wish for 100% disclosure of ingredients. In the end, she makes most of her food, and adds in selected prepared products like certain flavors of Lara bars or fruit leather to fill in the gaps. The nomorecrohns.com website has a list of some of the prepared products that work for the SCD.

Most people who start the SCD show improvement in their symptoms in a few weeks to a few months, so I look forward to hearing how you progress as time goes on!

God Bless,

- Jim



Anonymous said...

Hi Sam,

Very sorry to hear your news.

I hope all turns out well for you, and that you're back in the air very shortly.

Regards

Nick Hopkins

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Rick said...

Hi Sam,

I've been reading your blog for quite a while and find it really interesting even though I have no connection to aviation.

I'm very sorry to hear about your Crohn's diagnosis. My sister has been living with Crohn's for the last 10 years. She's had some times where it's under control and other times when it rages. Currently she's dealing with its rage. As has been said, Crohn's is different for everyone, some can control it with diet, some can't. Some have very little complications, some have a lot. If you ever want a second opinion, the Mayo Clinic has some of the best gastroenterologists, and my sister is being treated there now after being led down some wrong paths by her hometown doctor.

I wish you the best and hope you'll be back in the skies soon. Maybe someday I'll see you on one of your flights.

Rick

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