Monday, July 10, 2023

My Prostate Cancer Journey: Getting Back in the Air

I’m a pilot by profession. When I got my prostate cancer diagnosis, one of my first worries was, “What will I do if I can never fly again?” One of the downsides to professional flying is the possibility that an unexpected medical condition can prematurely end your career. You don’t have to be an old pilot for this to happen, but the odds of it definitely increase as one [ahem] amasses significant amounts of life experience. 

I couldn’t find statistics on what percentage of professional or airline pilots have to hang up their spurs before they are ready to retire (there is a mandatory retirement at age 65 for airline pilots but there is no maximum age limit for corporate and charter pilots), but I’m sure that a significant number of professional pilots are forced out early due to grounding medical conditions. There is a lot of anxiety around that possibility because, for many of us, flying may be our only marketable skill. Even if it isn’t, the income that we generate from our flying jobs can be hard to replace with a secondary career. 

Photo by David Thornton 

Luckily, for me, my condition was not career-ending. It did, however, require a long wait and jumping through a number of hoops to get back in the cockpit. 

When I got my diagnosis, one of the first calls that I made was to the Aircraft Owners and Pilots Association. A lot of professional pilots don’t keep their AOPA memberships once they pass the piston-engine phase of their careers, but I’ve found AOPA to be useful several times throughout the years. As a corporate pilot, I do my own flight planning, including international trips, and advice from AOPA has occasionally been invaluable in keeping my operations safe and legal. 

Part of the AOPA’s appeal is access to their staff of legal and medical experts. It was the medical team that I called after I learned that I had cancer. Pilots who are not AOPA members may belong to unions such as the Air Line Pilots Association, which also assist with medical certification questions. 

For those who aren’t familiar with the aviation world, here is a little background on FAA medical requirements. Professional pilots are required to maintain a medical certificate that must be periodically renewed. Pilots who fly for pleasure and meet certain requirements can self-certify their medical condition under Basic Med, but those who fly for hire must see an FAA-approved doctor, an Aviation Medical Examiner (AME), once or twice a year depending on what grade of medical certificate they hold. In my case, my first-class medical requires renewal every six months. 

AOPA told me what I hoped to hear, namely that I could keep flying until I started treatment. This was good from both a mental health and a financial perspective. I really didn’t want to sit home and do nothing but worry until I could be treated. 

They also told me that there was a good chance that I could regain my medical after treatment and referred me to the FAA’s guidelines for AMEs, which were posted online. Sure enough, when I started talking to my AME about my situation, he pulled out the exact information that I had been looking at on the internet. Forewarned, as they say, is forearmed. 

AOPA was also able to give me some information on how the FAA viewed various treatment options and when I would be eligible to apply for a new medical after treatment. This information entered into my decision on which course of treatment to pursue. An additional bit of advice from AOPA was to keep all of the documentation that I received from my various doctors and health professionals. I would also have to get a new medical before I could fly again after treatment. 

In my case, I chose surgery. The AME guidelines, confirmed my AME, told me that my PSA level had to be essentially undetectable (0.2 or less) to get a new medical. 

My surgeon told me that his rule of thumb was that PSA levels had a half-life of about three days. What this means is that, after surgery, the PSA level should decline by about half every three days. For example, if a PSA level was at 10 before surgery, it would take about 18 days to drop to FAA-approved levels. (Ten is halved six times to drop to get below 0.2. Multiply those six halvings by three to get 18 days). 

In practical terms, he wanted to wait even longer to be sure, especially since I would need time to recover from surgery anyway. We set up my first post-op PSA test for about two months after surgery. I had my blood drawn on April 19 and got my results back a few days later. My PSA was not detectable. Thank God! I breathed a huge sigh of relief. 

I immediately made an appointment with my AME and went for a physical. All went well at the appointment. We spent more time talking about the situation and examining paperwork (and printing out additional documentation from MyChart) than with the actual poking and prodding that make up the physical exam. 

As we went through the documentation, we found that we needed one more item from my cancer doctor. I ended up driving two hours to his office to sit with a nurse practitioner and make sure that every item listed in the AME guidelines was addressed. Driving to the office turned out to be a lot easier and quicker than communicating by MyChart or voicemail and I didn’t have a lot to do at that point anyway. 

As I’ve described before, when my pathology report came back after surgery, it showed traces of cancer cells in one of the 10 lymph nodes that were removed. That meant that my cancer was metastatic. That complicated my recertification. 

If it weren’t for that one lymph node, the AME could have issued my medical certificate in the office and I could have gone to work the next day. Instead, the guidelines required him to submit my application to the FAA’s airman certification branch in Oklahoma City for a special issue. 

There was good news and bad news, the AME said. The good news is that the turnaround time for special issuance certification was down from the three months that it had taken last year. The bad news was that the FAA was still taking around two months to approve applications. (This is a long time, but it isn’t horrible. An older pilot told me that his special-issue medical had taken years to get approval in the pre-internet days.)

So we sent my medical certificate off to the FAA on May 3. About a week later, I got a letter from the FAA. 

Wow, I thought. This is quicker than I expected. 

Of course, the FAA seldom works quicker than expected, at least not when it is to the pilot’s benefit. This letter did not contain my medical. Instead, it said that we didn’t include everything that the FAA wanted in the application package. This was despite following the AME guidelines to the letter.

After a few days of trying to figure out what he missed, my AME told me that he had contacted the FAA and determined that they had everything that they needed. He explained that the FAA’s medical branch employed a lot of people who had no medical background. His best guess was that someone had sent out the letter because they didn’t fully understand what they were looking at. 

But if I thought that the quick attention to my application meant that I would get a quick approval, I was wrong. After the AME confirmed that the FAA had everything that they needed, the waiting game began. I waited. And waited. And waited some more. 

After about a month, with my disability payments running out, I contacted my congressman on the advice of some friends. My Republican congressman’s website contained a form to fill out if you were requesting help with a federal agency. I filled it out, got the acknowledgment, and waited some more. I never heard anything else. 

After a week with no word, I decided to move down the list. I looked up one of my senators. His website also contained a similar form. I filled it out and waited. 

Unlike the congressman, the office of Senator Raphael Warnock emailed me back. On Monday, June 19, one of his aides said that they would work on my situation. Be patient, they said. 

Around this time, I started wondering if there was a way to follow the approval process online (there was) and maybe to print out the medical certificate when it was issued (there was not). I learned that the FAA’s Med Xpress website, the same site where I go to fill out the medical application, shows the status of the medical issuance process. I started checking every day for updates, but unfortunately, requesting a replacement medical is still a lengthy process. Once it was issued, I would have to wait on the mail. 

It was only a few days later, on Thursday, June 22, that I logged into Med Xpress and saw that the status of my medical had changed from “in review” to issued. I couldn’t believe it. Another huge weight was lifted. 

It took about another week to get the hard copy of the medical certificate. It showed up on Friday, June 30. But even without the paper in hand, I didn’t wait to start the paperwork to return to work. 

All told it took 58 days (eight weeks and 2 days) from the time we sent in the application package until I got my medical. It was almost exactly the predicted two months, even with congressional intervention. 

Let me just say here that if you are a professional pilot, you should look into the details of your company’s disability insurance. In my case, the company did not buy loss of license coverage. This meant that I was getting paid (at partial pay) while I was medically unfit to work, but there was no coverage while I was administratively (not medically) grounded as I waited on the FAA to get off its collective posterior. 

I kept the disability payments coming for as long as I could, but I went six weeks without pay while I waited for the FAA to issue my certificate and for the insurance company to decide whether they were going to keep paying me. They ultimately decided that no, they were not going to pay me anymore and what’s more, that I owed them money because they overpaid me. They made this decision shortly after my medical was issued. 

If you’re a pilot or work in some other job that requires medical certification, take my advice and build an emergency fund that will carry you through at least several months of interrupted pay. This is especially true for those of us in the corporate world where flight departments and jobs can sometimes disappear without warning. If your company doesn’t have Loss of License insurance, you might want to consider an individual policy

Shortly after my medical was in hand and HR paperwork was completed, I went back out to the airport. With a wait for my recurrent simulator training, we decided to get me back on the schedule with a flight in the airport traffic pattern to make three “bounces.” 

Even though I hadn’t flown in more than four months, it came back quickly. As they said, it’s like riding a bicycle… only a lot more fun. 

It was a long and somewhat difficult road back to the cockpit, but it could have been a lot worse. I’m thankful for my return to good health and my return to the cockpit. 

Thank you for reading My Prostate Cancer Journey. This post is public so feel free to share it.


Please keep in mind that I am not a medical professional and this blog does not provide individualized medical advice. If you think you are sick, you should seek treatment from a real doctor.

My Prostate Cancer Journey is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

My Prostate Cancer Journey is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

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Previous Installments:

1 - The Diagnosis

2 - What Is Prostate Cancer?

3- Easter Special - An Apology to Apostle Thomas

4- My Treatment

5-Post-op and Recovery

6-Night is the Darkest Time - The Mental Battle of Cancer

7-How To Be Prepared For A Health Crisis


Aircraft Owners and Pilots Association

AOPA Prostate Cancer Information

ALPA Cancer Article

Basic Med

AME Guidelines for Prostate Cancer

FAA MedXpress

Harvey Wyatt Loss of License insurance


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