Paul Rice

I am seeking advice. I had a subsegmental PE in January 2016 and remain on DOAC anti coagulation since then resulting in the imposition of a permanent OML limitation on my Class One medical certificate.

Am a right in thinking that a subsegmental PE may in reality be nothing other than a curiosity with no real medical significance or risk whatsoever. Reading Dr Google articles it seems that advances in imaging is picking up more and more perfectly harmless PE s at the subsegmental level and that these very tiny clots are a natural physiological function of the filtration function of the lungs and nothing whatsoever to do with larger life threatening PE s. A filter doing its job as opposed to a blocked filter.

Would I be right in suspecting that calling a subsegmental PE a PE is a bit of an over diagnosis, being on permanent anti-coagulation for a subsegmental PE is a bit of over medication and being having an permanent OML imposed is a bit of severe over regulation. The OML is severly limiting my career and I desperately want shot of it.

Radgirl

I am afraid any pulmonary embolus is pathological and there is a need to assess risk. Whether to anticoagulate or permanently anticoagulate is debatable and I suspect if you ask several doctors you will not get the same response from any two. The best advice would be to sit down with your consultant - does he or she know your occupation? Does he or she know you need a 'medical' and the affect his decisions can have on your career? Only after that explanation from you can your consultant discuss the options. At that stage you might want to ask for a second opinion. No proper doctor will ever complain so if yours does, change him,

Armed with the facts you can then discuss with the CAA. I am sorry I havent answered your question more succinctly but it would be impossible without having all your notes and images

Paul Rice

With respect to subsegmental PE (I am assuming very small clots) Dr Google is suggesting that a positive diagnosis is incorrect on something like 59.4% of occasions. That when a positive diagnosis is made and a second opinion from another Radiologist is taken that 60% of these second opinions differ from the first. Diagnosis is wrong more often than it is right. Additionally with improvements in scanning smaller and smaller PE s are believed to being found (they may just be artifacts) leading to more and more diagnosis of PE being made but with the increasing diagnosis has come no consequent increase in mortality from PE strongly suggesting that that these newly observable subsegmental PE are clinically insignificant. Autopsies show subsegmental PE in 63 % of cases yet the subsegmental PE played no part in the death. With such an unreliable diagnostic tool and no evidence of any harm being done in fact some think that part of the lungs function is to filter small clots finding filtration occurring is quite normal. If you genuinely can not determine if there is a clot or not and if you genuinely do not do know if that clot is causing any harm or not it seems disproportionate to treat with long term anticoagulation despite the risk of bleeding is much lower with DOACs. I find the logic of the medical profession utterly confusing and would hate to have two Doctors one in the left hand seat and one in the right hand seat on a flight deck. OMLs are imposed for using anticoagulation to decrease risk for something that probably does not exist and if it did is probably doing no harm . While i have no idea of the process involved I think I smell flawed judgement in the logic somewhere.

Radgirl

Whilst I appreciate how frustrating this must be, Dr Google can no more turn you into a consultant physician than Microsoft flight simulator qualifies you for an ATPL. I too would hate to have 2 doctors flying me because medicine and flying are different. We are talking about a living organism not a man made machine. I find flying more difficult than medicine, but opinions in medicine will differ and our knowledge is evolving whereas the correct response on the flight deck is not a matter for lengthy debate. That is why I often say the best advice is to choose the best and most appropriate doctor. Your condition is one where there is no clear cut right or wrong but do please listen to your consultant rather than Dr Google. I cannot help you further because i simply dont know your history, and nor can anyone else on this thread.

Best of luck