Ulcerative Colitis

[Guest footie]

Hi. A few months back I was originally diagnosed with Crohn's disease (so I figured there was no way I would be flying), but after some tests they decided it was only Ulcerative Colitis. My question is, is this a waiverable condition? My hope is someone on here knows someone with the problem or has had the problem and knows how the AF typically handles it. The waiver guide is kind of vague. Any info would be great. Thanks.

[Guest awfltdoc]

Hi. A few months back I was originally diagnosed with Crohn's disease (so I figured there was no way I would be flying), but after some tests they decided it was only Ulcerative Colitis. My question is, is this a waiverable condition? My hope is someone on here knows someone with the problem or has had the problem and knows how the AF typically handles it. The waiver guide is kind of vague. Any info would be great. Thanks.

The only folks I know who have gotten a waiver for Ulcerative Colitis are those that are already flying and are treated to the point that they do not have symptoms or evidence (by testing) of the condition with currently approved treatments. I seriously doubt a waiver would be approved for an individual before becoming flight trained.

[Guest footie]

The only folks I know who have gotten a waiver for Ulcerative Colitis are those that are already flying and are treated to the point that they do not have symptoms or evidence (by testing) of the condition with currently approved treatments. I seriously doubt a waiver would be approved for an individual before becoming flight trained.

I appreciate the response. Obviously not something I wanted to hear, but there is no harm in attempting a waiver I suppose. My symptoms are pretty much non existent, I have only had one flair up my entire life. You wouldn't happen to know if Pentasa is an approved medication would you? It seems to work wonders with no side effects. Also would you happen to know why they actually do not offer a waiver? It seems that really it is a fairly mild disease and can be in remission up to 20 yrs, and even when it does come out is so easily treated with a few days of steroids. It'd seem someone would have a better chance of coming down with the flu which could last weeks as appose to a flair up because of Colitis. Anyways, just a little venting because it seems this disease which is generally just a small pain in the @$$ may end up ruining what will all ready a very difficult dream to fulfill. Thanks again though, it's the first real response I've been able to get (recruiter knew nothing and other boards didn't seem to know much either).

[Guest ski2]

Hi. A few months back I was originally diagnosed with Crohn's disease (so I figured there was no way I would be flying), but after some tests they decided it was only Ulcerative Colitis. My question is, is this a waiverable condition? My hope is someone on here knows someone with the problem or has had the problem and knows how the AF typically handles it. The waiver guide is kind of vague. Any info would be great. Thanks.

I got a waiver for Ulcerative proctitis. I had one flareup that lasted a little over one month. It was brought into remission with medicine and I have been symptom free for two years (only took the medicine for a month). The symptoms were minor and otherwise didn't affect me. I am not sure what class of flight physical you are looking at, but I was able to get a waiver for a FCIII (I am enlisted and retraining into an Airborne comm job.). It did take a bit of legwork on my part to gather all of the tests and paperwork from my civilian doctors, but my unit was supportive and that went a long way. Below is a waiver guide I found referencing Ulcerative Colitis, and it is this that I used to help get the waiver. I can't seem to find it on the web now, but believe I found it on Brooks website. Best of luck to you!

AFPAM-48-132

Updated-11/03

By Lt Col. Van Camp

CONDITION: ULCERATIVE COLITIS

I. Overview. Ulcerative colitis (UC) is a chronic disease resulting in recurrent inflammation limited to the mucosa and submucosa of the colon. The disease usually presents in the third decade of life. UC results from inappropriate continuous activation of the colonic mucosal immune system responding to normal luminal flora. Diagnosis is made by history, endoscopic appearance and histology. Common symptoms include: fever, abdominal pain, diarrhea, rectal blood or mucus and weight loss. The colonic mucosal appearance progresses from hyperemic and edematous to hemorrhagic with severe punctate ulcers. The disease tends to be continuous and worse distally, however disease of the cecum can be seen even when the right colon is disease free. Infectious colitis must be excluded by stool culture in a lab capable of detecting Salmonella species, Shigella, pathogenic E. coli species, Campylobacter species, Clostridium difficile, and Yersinia species and parasitic diseases.

II. Aeromedical Concerns: The natural history of UC is variable, but is usually is dependent on the location disease at the time of the initial episode. Patients with proctitis or proctosigmoiditis usually have a benign course, normal cancer risk, and can be treated with rectal mesalamine. Careful monitoring is still necessary since the disease extends proximally or progresses in severity in up to 30%. Patients with left-sided or pancolitis usually have more severe symptoms and frequent complications and require oral sulfasalazine or mesalamine. Surgical intervention with colectomy is indicated in up to 30% within the first year, but after that year do not have increased risk. Ten percent of patients initially diagnosed with UC will later develop definitive signs of Crohn's disease. More common extra-intestinal manifestations include acute large joint asymmetric arthropathy, which develops in 15% of patients and iritis which develops in 5% of patients. It is estimated that 5% of patients develop primary sclerosing cholangitis, which is associated with an elevated risk of colon cancer. Oral and rectal steroids are often recommended for acute exacerbations, but should be tapered and discontinued when control is achieved. Factors that are associated with progression to more severe disease include onset at a young age, presence of joint symptoms, and significant bleeding and toxicity when first diagnosed. There may be long periods of remission. The majority of patients suffer a relapse within one year of onset, however 20% do not have a relapse for over ten years after the initial attack. Approximately 85% of patients with UC have mild disease and do not require hospitalization. The other 15% with fulminant disease are at risk of developing toxic dilation and perforation of the colon. Up to 25% of patents require colectomy in 10 years. The risk of colon cancer in UC that extends beyond proctitis is 5% over the first 10 years of disease and 1% per year after 10 years. Colonoscopy with biopsy of any lesion and biopsy every 10cm should be performed after 10 years of disease and every 1-2 years afterward to find dysplasia, an indication for colectomy. Maintenance therapy with mesalamine may reduce the risk of colon cancer. Life expectancy for patients with UC is normal.

The risk of sudden incapacitation with UC is very low. There is a minimal risk for subtle performance decrement due to gradual onset of anemia if occult blood loss occurred. Most patients will relapse and should be maintained on an aminosalicylates drug. The most frequently cited side effects of sulfasalizine therapy include nausea, headache, and dyspepsia. These effects are secondary to the sulfa moiety and can be minimized with gradual titration of dose and use of an enteric-coated preparation. Allergic or toxic effects of the sulfapyridine moiety include generalized hypersensitivity reactions, hemolytic anemia, bone marrow suppression, hepatitis, and reversible oligospermia. Only 10% of patients will have significant work loss each year. Relapse and progression of disease is heralded by diarrhea, and accompanied by fever, rectal bleeding and malaise in severe cases. Stable disease requires annual colonoscopy after 10 years of disease, but still is compatible with flying operations in austere environments.

III. Information Recommended for Waiver Submission: The individual should have a recent evaluation to include; a complete physical exam, liver function tests, electrolytes, CBC, ESR or C-reactive protein, iron and iron binding capacity. The initial evaluation must include a small bowel contrast radiologic evaluation. Colonoscopy with biopsies of areas of active disease, any lesions and random biopsies every 10cm throughout the colon and cecum is recommended initially and annually starting at ten years of disease. A second pathology lab should review histology specimens. A gastroenterology consult is recommended.

IV. Waiver Considerations: FC1 waiver is usually not considered. FCII /FCIII waivers have been recommended for mild cases in remission at least one month. One year of remission should precede a FCII/FCIII waiver of for extensive disease or following colectomy. Medical regimens that may be waiverable include oral and topical aminosalicylates and topical steroids.

In the last ten years, ACS has evaluated 7 individuals with Ulcerative Colitis and recommended a class II waiver for 6 of them. The Air Force Medical Waiver File indicates that 81 individuals received waivers, 14 were disqualified permanently, 3 were disqualified and later received a waiver, and 9 received a waiver, but were later disqualified after a number of years of flying.

V. References:

Podolsky DK. Inflammatory Bowel Disease. New England Journal of Medicine 2002; 346(6): 417-429

Jewel DP. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 6th ed., 1998 W. B. Saunders Company. 1735-61

Sharan R, Schoen RE. Cancer in inflammatory bowel disease: An evidence-based analysis and guide for physicians and patients. Gastroenterol Clin North Am 2002; 31(1): 237-59.

Loftus EV, Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin North Am 2002; 31(1): 1-23.

Raj V, Lichtenstein DR. Hepatobiliary Manifestations of Inflammatory Bowel Disease. Gastroenterol Clin North Am 1999; 28(2): 491-412.

[Guest footie]

Thank you very much this information. This does give me at least a little hope. Mine has been in remission for about a year now, so hopefully I will be able to keep it there.

Again, Thanks.

[Guest ytz750]

I have a similar problem with UC and I would be really interested to know if anybody with this condition had been able to get a pilot slot. Does it depend on wich recruiter you get or is there a general policy against UC ? Lastly is there any set of circumstances which some one with UC could pass ?

[Guest footie]

According to the waiver guide, it seems as though it wouldn't be too hard to get a FCII or FCIII. If you look at the stats, they are also pretty good. What I am putting my emphasis on is the little piece that says USUALLY not considered. It appears to be that if you can keep it under control with approved medications, it may be possible. Anyways, it can't hurt to try. BTW, anyone know if Lialda is an approved medication?

Edited October 10, 2007 by footie

[Guest ytz750]

According to the waiver guide, it seems as though it wouldn't be too hard to get a FCII or FCIII. If you look at the stats, they are also pretty good. What I am putting my emphasis on is the little piece that says USUALLY not considered. It appears to be that if you can keep it under control with approved medications, it may be possible. Anyways, it can't hurt to try. BTW, anyone know if Lialda is an approved medication?

Yea, so its a maybe. So would you have this information printed out ready to hand into a recruiter ? or how would this work ? You'll have to tell me if you have any luck.

[Guest jload]

According to the waiver guide, it seems as though it wouldn't be too hard to get a FCII or FCIII. If you look at the stats, they are also pretty good. What I am putting my emphasis on is the little piece that says USUALLY not considered. It appears to be that if you can keep it under control with approved medications, it may be possible. Anyways, it can't hurt to try. BTW, anyone know if Lialda is an approved medication?

I too would like to know what approved medications might be. Thanks!