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Chemo's affect on flight status?

petenice
Posts: 1
Joined: Dec 2003

Hello there everyone. I'm a Navigator in the Air Force and I was recently diagnosed with testicular cancer. I just stumbled across this site while looking for any info I could find related to the military policy on returning members to flight status after undergoing chemotherapy. Apparently one of the chemo drugs, bleomycin, causes some damage to the lungs and this damage can be accelerated when the lungs are exposed to pure oxygen. I'm wondering how serious of a concern this is since I use pure oxygen routinely, and if this is something that will keep me from ever flying again. I was also wondering, if I do get permanantly grounded, what is the policy as far as getting a medical discharge. Is this likely, or would I most likely just be reassigned to a non-flying job? Thanks so much for any help you can give me regarding this. I truly appreciate it.

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spongebob
Posts: 2600
Joined: Apr 2003

Hi, petenice -

Thanks for the e-mail and I am so glad to see that someone is actually using the discussion site the way I envisioned!

As for your Q, I will ask around for you about the effects of the drug you mentioned. Will you be receiving that particular drug or is there an alternative that would not have the same effects?

I am active duty CG. A shipdriver. I was in a desk job when I was diagnosed with colon cancer. Since I don't have an appliance and I am heading into my second year of remission post-op/post-chemo, I am considered FFD and will be returning to a ship this summer. Were I unfit for sea duty, they could have initiated a medical board on me. You ask a very good question and I will float it past my attorney friend, Kat.

Here's one for you - I have heard and I cannot confirm the validity of this, that people who use radar a lot, especially naval types like me and pilots/navigators like you have an inordinately high incidence of testicular cx. Could it be a service-related disability? Something to consider.

I will ask Kat and Mike about the determination of status and drug side-effects respectively and get back to you.

Thanks again for posting!

- Bob

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spongebob
Posts: 2600
Joined: Apr 2003

Deployment Quarterly

Med Boards Not Always Career Enders

by 1st lt. brandon lingle
air force personnel center public affairs

--------------------------------------------------------------------------------

Airmen may think that being "medically boarded" means an end to a military career, but that is not always the case, according to medical officials at the Air Force Personnel Center.

While the goal of the medical review system is to maintain a fit and vital force, officials say the Air Force does not take the prospect of separating people for medical conditions lightly. A multi-step evaluation process helps ensure that the needs of both the Air Force and the member are served.

Master Sgt. Dan Derlein is still working more than a year after being diagnosed with Parkinson's disease and facing a medical-evaluation board. He is a computer programmer at the Air Force Personnel Center at Randolph Air Force Base, Texas.

"Being medically boarded isn’t the same as being kicked out of the Air Force," said Lt. Col. (Dr.) Leonard Trout, of the medical standards branch at the center. "The reality is that someone who faces a medical evaluation board has a good chance of remaining on active duty."

When an airman is diagnosed with any of several hundred medical conditions outlined in Air Force guidance, he or she may face a medical evaluation board. This is the first step in the Air Force’s disability-evaluation system. The airman’s medical record is reviewed by a panel of three base-level physicians. They forward their recommendation to senior reviewers at the personnel center who have to answer two questions: is the individual fit to stay in the military and, if approved, can the individual serve overseas?

An airman found unfit for military service may appeal the decision. Appeals go to medical officials at Randolph Air Force Base, Texas, and sometimes reach the secretary of the Air Force level. There is no appeal process for those found still fit for duty.

"We process an average of 4,000 medical boards each year," said Air Force Col. (Dr.) Ed Taxin, chief of the medical standards branch.

One airman whose future rested in the board’s hands is Air Force Master Sgt. Dan Derlein, a computer programmer at the Air Force Personnel Center at Randolph Air Force Base, Texas. Derlein was diagnosed with Parkinson’s disease, a debilitating and incurable disease of the nervous system that afflicts more than 1.5 million people, according to the Parkinson’s Disease Foundation.

"It’s difficult going through the diagnosis of a chronic, degenerative disease," said Derlein, a 37-year-old father of three. "To be honest, I was more afraid of that board than the disease. I still have two years before I can retire, and I want to be able to finish my career."

Before his medical board, Derlein visited a Web site run by Tom Berdine, a former technical sergeant who also suffers from Parkinson’s disease and also faced a medical board.

"Tom understood what I was going through," Derlein said. "He really helped me through the diagnosis and my medical evaluation board."

Although he temporarily lost his mobility status, Derlein passed the medical board and is still able to do his job. Medications currently keep Derlein’s disease in check, but since there is no cure, the medicine only treats the symptoms, and his nervous system continues to degrade; however, he is still productive at work.

"Dan feels like he’s really gone downhill, but his work doesn’t show it," said his supervisor, Cherri Hummel. "He’s top notch, an amazing person. People are always coming to him for help because he’s so good with computers."

Derlein plans to continue serving his country as long as he can and looks forward to a computer programming job after his Air Force retirement.

"Things may take me a little longer, and I might complain a little louder, but I’ll get them done," he said.

For others facing a medical board, officials said there are some things people can do to help ensure the board has the most accurate information so the best decision is made.

It is important to keep a dialogue going with both the physician and the physical-evaluation board liaison officer. The liaison officer provides counseling and monitors specific cases. They know the process and can provide advice. Ignoring or delaying doctor’s appointments and paperwork deadlines only drags things out and could result in administrative problems.

spongebob's picture
spongebob
Posts: 2600
Joined: Apr 2003

petenice -

I spoke with the onc nurse and the military attorney; here's what they had to say;

First a bit about bleomycin. It causes pulmonary fibrosis - abnormal formation of fibrelike scar tissue in the lungs. The alveoli (the tiny grape-like air sacs that take oxygen into the lungs
and expel carbon dioxide), are affected. Fibrosis twists them out of shape.
Lung capillaries (small blood vessels) also can be distorted by pulmonary
fibrosis. In addition, the tissues between and surrounding the alveoli are
changed by fibrosis, thus completely deranging the basic architecture of the
inner lung. These "in-between" spaces are called the "interstitium".

This condition has a number of causes and is known by many different names. "Interstitial pulmonary fibrosis" is perhaps the most common name, but other terms frequently used include: "fibrosing alveolitis", "intersititial
pneumonitis" and "Hamman-Rich syndrome".

It can be mild or severe. The damage is related to the amount of drug given. You'll need to pass a new flight physical - including a pulmonarty function test after chemo.

If they do ground you - although that is NOT a foregone conclusion here - you will probably have a medical board to make an initial determination of your suitability to continue in the service. According to Kat (the military lawyer), there is every likelihood that the Air Force will retain you, albeit in a non-flight job. She pointed out "JAG" as an example (F-15 pilot, developed an eye issue, cross trained to be a TV star... er... lawyer). The AF, of course has their own regs that she's not privvy to so her assessment isn't gospel but her wealth of experience would seem to indicate that's the most likely outcome.

These are both issues you should discuss with your Onc and your command Admin Weenie. If maintaining flight status is of prime importance, maybe you and your Onc can look into a treatment regime that does not include bleomycin or other drugs that might effect your pulomnary function. Conversely, discuss with your admin weenie what procedures that AF has for grounded pilots - I am quite certain there is a well-established policy in place since the physical rigors of flight have grounded many good men (and women).

Most importantly - DON'T BE AFRAID OF THE OUTCOME OF A MEDBOARD! Secondly, and this is personal experience talking here, remember that nothing as to your personal health should ever make it into a FitRep. You will no doubt be on convo after your surgery, I suggest getting back into the saddle by tele-commuting and working on your collaterals from home. Don't overdo it, but, at the same time, make your presence felt at the command. You may be able to negotiate down some of the "unobserved" days with your boss. The fewer unobserved days you have the less suspect your situation will be with a promotion board. You will demonstrate you are still able to carry out your out-of-cockpit duties.

Lemme know if you have any other Qs.

- SpongeBob

molsen15e
Posts: 1
Joined: Mar 2004

Hey. I am an F-15E pilot and Non-Hodgkin's Lymphoma survivor. I had chemo back in summer of 2001. I was DNIF for about 15 months. It was a tough uphill battle getting off DNIF.

I know nothing of bleomycin. I had adriamycin, vincristine, cyclophosphamide and prednisone. The flight docs were most concerned with adriamycin and vincristine. Adriamycin can damage the heart and vincristine can damage the nervous system. Although the chances of any heart or nerve damage were extremely remote, I still had to do countless tests to prove I was still functional and not going to just keel over. But I eventually found some docs willing to take a chance on me.

Here's what you need to do. First get your MEB done. Once you're returned to nonflying duty by the MEB, start working on your local flight docs to get off DNIF. Save everything related to your treatments, etc... Try and get a specialist to recommend you be returned to flight duty. Make sure he emphasizes that the chance of relapse is low and that the effects of the treatments will be minimal. You'll need a Flying Class II waiver of course. Your flight doc should do the waiver package. Your MAJCOM decides the case. Testicular cancer is more common for aviators to recover from. I've known several who've returned to flying in less han a year. I don't know if they had chemo though. Because you had chemo, you may need to go to the Aeromedical Consult Service at Brooks AFB. The MAJCOM will ask for a consult with ACS if they can't make a decision on the waiver. I got most of the crazy (and pointless) tests at ACS. I had to go there 3 times over a period of 14 months before they recommended a waiver. Once they recommended the waiver, my MAJCOM approved the waiver a couple of weeks later.

I'd be happy to chat with you on the phone or over e-mail. I am currently in the 492nd Fighter Squadron at RAF Lakenheath. My e-mail is molsen15e@onetel.net.uk

Take care!

nickga
Posts: 1
Joined: Apr 2004

Hi all, I'm 23 and another Air Force Navigator. Seems to be a couple of us on here. I was first told I had Hodgkin's Disease about a year ago and started chemo right away. I did the standard ABVD. I have had bleomycin also. I was told the same thing about pure O2. ABVD didn't work out so well and I had to go to Wilford Hall last Nov for a blood stem cell transplant. I really could have done without that TDY. Well on to the point, afterwords my doc there wrote a deal for my MEB stating that I should be returned to flight status in June 04. I just got my MEB back last week and was cleared to return to duty with a code C. Tomorrow I do my flight physical and will be cleared to fly, but still need the waiver from ACC. So I'm told 3 more weeks till i'm back in the air. That will put me DNIF for 13 months. Petenice I won't worry about not getting back on flight status. Now that I think about it I had an instructor in JSUNT that had testicular cancer and he's flying now. Anyone please let me know if I can help out in anyway, this was a battle and i know it helps to have others who know what's going on. my name is Nick Edwards and I'm on global or nickcap21@hotmail.com

gorget
Posts: 23
Joined: Feb 2004

Hi Pete,
I'm not military (unless you count being an AF brat!), but I can relate to your plight. I had ovarian cancer in 1985 (a type that is usually found in men - testicular cancer - called endodermalcynis) and I received 3 courses of bleomyacin, along with vinblastin and cysplatin. While I only had 3 courses, in 2004 terms that is probably more like 6+. They performed pulmonary functions on me each time prior to a treatment to assure that I had no lung damage. I'm happy to say that my lungs were not affected in any way. So, depending on how many courses you receive, and the condition of your lungs prior to treatment (I used to ride my bicycle ~10 months out of the year in NH! - to work every day, so was in pretty good lung capacity health prior to being ill) you should be fine.
I'm afraid I don't know the effects of pure O2 - but it sounds like others have a better idea.
I know I'm really late in adding my two cents to this string, but only just noticed the military survivor listing. (I'm at the OVCA boards as a different type come back at me - what fun!)
I wish you all the best with your treatments - I hope by this time they are all over for you and that you are fast on the road to recovery and flying again soon!
Best of luck.
Be well,
Georgette

kcolkitt
Posts: 1
Joined: Jun 2010

Hi Sir,
My daughter died 1 year ago from bleomycin toxicity while receiving treament for hodgkins. She did not complete her treatment before this took her life. It is very fatal and if you can do treatment without using the bleomycin I would. we were not educated in the area of the drugs she was taking. Toxicity can happen much later down the line as I am learning as well. I would research all the drugs you are receiving and see the side efffects and then make a decision for your treatment. Bleomycin has a 20% toxicity rate. I am sorry I have no information regarding the military or flying but I wanted you to know the severity of the treatment. Our daughter was 26 years young. Blessings and good luck in your treatment. Kathy

Kelvin_K
Posts: 6
Joined: Jan 2011

Probably too late to respond and still be helpful, but I am (was) an ANG KC-135 pilot and had a VERY rare cancer in my right leg diagnosed in 1999. I had a somewhat radical surgery and 35 radiation treatments to my leg (no chemo). Was DNIF for 18 months but eventually got back on flying status. Early in the MEB board process they wanted to know my desires and said they would TRY to accomodate my desire (I wanted to stay in Air Force and return to flight status if possible). I eventually returned to flying status, completed my career and retired with a normal military retirement.

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